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  • 1.
    Barboza, Madelene
    et al.
    Karolinska institutet.
    Marttila, Anneli
    University of Gävle, Faculty of Health and Occupational Studies, Department of Public Health and Sport Science, Public Health Science. Karolinska institutet.
    Burström, Bo
    Karolinska institutet.
    Kulane, Asli
    Karolinska institutet.
    Towards health equity: core components of an extended home visiting intervention in disadvantaged areas of Sweden2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 1091Article in journal (Refereed)
    Abstract [en]

    Background: Understanding the mechanisms of implementation of public health interventions in community settings is a key aspect of programme assessments. To determine core components and establish a programme theory are important tools to improve functioning and support dissemination of programme models to new locations. An extended early childhood home visiting intervention has been developed on-site in a socioeconomically disadvantaged area of Sweden since 2013 with the aim of reducing persisting health inequities in the population. This study aimed at investigating the core programme components and how the intervention was perceived to contribute towards health equity from early childhood.

    Methods: Qualitative framework method was applied in a document analysis and subsequent semi-structured interviews with 15 key actors involved in the programme.

    Results: The intervention was found to be constituted of five core components centred around the situation-based, parental strengthening work method delivered by a qualified team of child health care nurse and social worker. The programme theory foresaw positive effects on child and parental health, responsive parenting practices, families' use of welfare services according to need and increased integration and participation in society. The principles of Proportionate Universalism were recognised in the programme theory and the intervention was perceived as an important contribution to creating conditions for improved health equity for the families. Still, barriers to health equity were identified on the structural level which limit the potential impact of the programme.

    Conclusions: The core components of the Extended home visiting programme in Rinkeby correspond well to those of similar evidence-based home visiting interventions. Combining focus on early childhood development and responsive parenting with promoting access to the universal welfare services and integration into society are considered important steppingstones towards health equity. However, a favourable macro-political environment is required in the endeavour to balance the structural determinants' influence on health inequities. Improved availability and accessibility to welfare services that respond to the needs of the families regarding housing, education and employment are priorities.

    Trial registration: The study was retrospectively registered on 11/08/2016 in the ISRCTN registry ( ISRCTN11832097 ).

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  • 2.
    Berglund, Erik
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Anderzén, Ingrid
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Andersén, Åsa
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Lindberg, Per
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Work-life balance predicted work ability two years later: A cohort study of employees in the Swedish energy and water sector2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 1212Article in journal (Refereed)
    Abstract [en]

    Background Work-life balance (WLB) is the extent to which individual’s multiple life roles and demands carry over between each role. WLB can be divided into work interference with personal life (WIPL) and personal life interference with work (PLIW). This study aimed to investigate longitudinal associations between WIPL, PLIW and work ability outcomes.

    Methods In this cohort study, 224 employees in the energy and water sector in Sweden were followed-up over 2 years. Three questions derived from the Work Ability Index were used for measuring work ability outcome: current work ability compared with lifetime best; work ability regarding physical; and mental demands. Logistic regression models were used to analyse longitudinal associations between work ability and WIPL and WIPL respectively, controlling for workplace (company), position at work, experience of leadership quality, demographics, and work ability.

    Results Work ability compared to lifetime best were associated with WIPL in the adjusted logistic regression models (odds ratio (OR) 1.77, 95% confidence interval (CI) 1.15–2.73), and PLIW (OR 3.34, 95% CI 1.66–6.74). Work ability regarding physical demands was associated with WIPL (OR 1.60, 95% CI 1.07–2.40). Work ability regarding mental demands was associated with WIPL (OR 1.59, 95% CI 1.03–2.44) and PLIW (OR 2.88, 95% CI 1.31–6.32).

    Conclusion In this two-year longitudinal study, lower WIPL predicted good/excellent overall work ability compared with lifetime best, higher work ability regarding physical and mental demands, and lower PLIW predicted good/excellent overall work ability compared with lifetime best and higher work ability regarding and mental demands.

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  • 3.
    Björk Brämberg, E
    et al.
    Karolinska institutet.
    Arapovic-Johansson, B
    Karolinska institutet.
    Bültmann, U
    University of Groningen, The Netherlands.
    Svedberg, P
    Karolinska institutet.
    Bergström, Gunnar
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska institutet.
    Prevention of sick leave at the workplace: design of a cluster-randomized controlled trial of a problem-solving intervention among employees with common mental disorders2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, article id 1756Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Common mental disorders are highly prevalent in the working population, affecting about 1 in 5 persons in the Organisation for Economic Co-operation and Development countries. About 30% of those affected have a first period of sick leave. Despite several attempts to reduce the risk of sick leave among employees with common mental disorders, there is a lack of knowledge about effective, preventive interventions which aim to reduce such risks. This protocol describes the design of a study to evaluate the effectiveness of a problem-solving intervention delivered by first-line managers to employees with common mental disorders on the prevention of sick leave during the 12-month follow-up.

    METHODS/DESIGN: The study applies a two-armed cluster-randomized trial design of a problem-solving intervention conducted in private-sector companies. First-line managers are randomized into intervention- or control groups by computer-generated random numbers, allocation ratio 1:1. Employees are eligible if at risk for future sick leave due to common mental disorders. These are identified by self-reported psychological health measured by the General Health Questionnaire 12-item, cut-off ≥3, or a positive answer to risk of sick leave. The intervention is based on problem-solving principles. It involves the training of the first-line managers who then deliver the intervention to employees identified at risk of sick leave. First-line managers in the control group receives a lecture. Primary outcome is number of registered days of sick leave due to common mental disorders during the 12-month follow-up. Secondary outcomes are general health, psychological symptoms, work performance, work ability and psychosocial work environment. A process evaluation will examine the intervention's reach, fidelity, dose delivered, dose received, satisfaction and context. Research assistants managing the screening procedure, outcome assessors and employees are blinded to randomization and allocation.

    DISCUSSION: The study includes analyses of the intervention's effectiveness and an alongside process evaluation. Methodological strengths and limitations, for example the risk of selection bias, attrition and risk of contamination are discussed.

    TRIAL REGISTRATION: Clinicaltrials.gov NCT04975750 Date of registration: 08/16/2021.

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  • 4.
    Björk Brämberg, Elisabeth
    et al.
    Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Närhälsan, Region of Västra Götaland, Hisings-Backa, Sweden .
    Holmgren, Kristina
    Närhälsan, Region of Västra Götaland, Hisings-Backa, Sweden; Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden .
    Bültmann, Ute
    Department of Health Sciences, University Medical Center Groningen, Community and Occupational Medicine, Groningen, Netherlands.
    Gyllensten, Hanna
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden .
    Hagberg, Jan
    Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Sandman, Lars
    National Centre for Priorities in Health, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Bergström, Gunnar
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Increasing return-to-work among people on sick leave due to common mental disorders: Design of a cluster-randomized controlled trial of a problem-solving intervention versus care-as-usual conducted in the Swedish primary health care system (PROSA)2018In: BMC Public Health, E-ISSN 1471-2458, Vol. 18, no 1, article id 889Article in journal (Refereed)
    Abstract [en]

    Background: Common mental disorders affect about one-third of the European working-age population and are one of the leading causes of sick leave in Sweden and other OECD countries. Besides the individual suffering, the costs for society are high. This paper describes the design of a study to evaluate a work-related, problem-solving intervention provided at primary health care centers for employees on sick leave due to common mental disorders. Methods: The study has a two-armed cluster randomized design in which the participating rehabilitation coordinators are randomized into delivering the intervention or providing care-as-usual. Employees on sick leave due to common mental disorders will be recruited by an independent research assistant. The intervention aims to improve the employee's return-to-work process by identifying problems perceived as hindering return-to-work and finding solutions. The rehabilitation coordinator facilitates a participatory approach, in which the employee and the employer together identify obstacles and solutions in relation to the work situation. The primary outcome is total number of sick leave days during the 18-month follow-up after inclusion. A long-term follow-up at 36 months is planned. Secondary outcomes are short-term sick leave (min. 2 weeks and max. 12 weeks), psychological symptoms, work ability, presenteeism and health related quality of life assessed at baseline, 6 and 12-month follow-up. Intervention fidelity, reach, dose delivered and dose received will be examined in a process evaluation. An economic evaluation will put health-related quality of life and sick leave in relation to costs from the perspectives of society and health care services. A parallel ethical evaluation will focus on the interventions consequences for patient autonomy, privacy, equality, fairness and professional ethos and integrity. Discussion: The study is a pragmatic trial which will include analyses of the intervention's effectiveness, and a process evaluation in primary health care settings. Methodological strengths and challenges are discussed, such as the risk of selection bias, contamination and detection bias. If the intervention shows promising results for return-to-work, the prospects are good for implementing the intervention in routine primary health care. Trial registration: ClinicalTrials.gov Identifier: NCT03346395 Registered January, 12 2018. © 2018 The Author(s).

  • 5.
    Brusaca, Luiz Augusto
    et al.
    Department of Physical Therapy, Federal University of São Carlos.
    Januario, Leticia
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Barbieri, Dechristian
    Department of Physical Therapy, Federal University of São Carlos.
    Oliveira, Rafael
    Department of Physical Therapy, Federal University of São Carlos.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Oliveira, Ana Beatriz
    Department of Physical Therapy, Federal University of São Carlos.
    Hallman, David
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Sedentary behaviour, physical activity, and sleep among office workers during the COVID-19 pandemic: a comparison of Brazil and Sweden2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, article id 2196Article in journal (Refereed)
    Abstract [en]

    Background: The COVID-19 pandemic has affected the physical behaviours of office workers worldwide, but studies comparing physical behaviours between countries with similar restrictions policies are rare. This study aimed to document and compare the 24-hour time-use compositions of physical behaviours among Brazilian and Swedish office workers on working and non-working days during the pandemic.

    Methods: Physical behaviours were monitored over 7 days using thigh-worn accelerometers in 73 Brazilian and 202 Swedish workers. Daily time-use compositions were exhaustively described in terms of sedentary behaviour (SED) in short (<30 min) and long (≥30 min) bouts, light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and time-in-bed. We examined differences between countries using MANOVA on data processed according to compositional data analysis. As Swedish workers had the possibility to do hybrid work, we conducted a set of sensitivity analyses including only data from days when Swedish workers worked from home.

    Results: During working days, Brazilian office workers spent more time SED in short (294 min) and long (478 min) bouts and less time in LPA (156 min) and MVPA (50 min) than Swedish workers (274, 367, 256 and 85 min, respectively). Time spent in bed was similar in both groups. Similar differences between Brazilians and Swedes were observed on non-working days, while workers were, in general, less sedentary, more active and spent more time-in-bed than during working days. The MANOVA showed that Brazilians and Swedes differed significantly in behaviours during working (p < 0.001, ηp2 = 0.36) and non-working days (p < 0.001, ηp2 = 0.20). Brazilian workers spent significantly more time in SED relative to being active, less time in short relative to long bouts in SED, and more time in LPA relative to MVPA, both during workdays and non-workdays. Sensitivity analyses only on data from days when participants worked from home showed similar results.

    Conclusions: During the COVID-19 pandemic Brazilian office workers were more sedentary and less active than Swedish workers, both during working and non-working days. Whether this relates to the perception or interpretation of restrictions being different or to differences present even before the pandemic is not clear, and we encourage further research to resolve this important issue.

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  • 6.
    Eriksson, Elisabet
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Wejåker, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Danhard, Anna
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Living with a spouse with chronic illness – the challenge of balancing demands and resources2019In: BMC Public Health, E-ISSN 1471-2458, Vol. 19, no 1, article id 422Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To describe the partners’ experiences of living with a person with chronic illness and how they manage everyday life.

    Background. The number of partners providing informal care for their chronically ill spouse is rising, and they describe their daily life as demanding.

    Design. A descriptive design with a qualitative approach was used.   

    Methods. A purposive sample of 16 partners with a chronically ill spouse were interviewed. The interviews were recorded, transcribed, and analyzed using qualitative content analysis.

    Results Four main themes were identified: ‘Living with challenges caused by the spouse's disease,’ ‘Seeking support for living with the spouse’s illness,’ ‘Appreciating the good parts of life’ and ‘Adapting to constant changes and an uncertain future.’ The participants rated their health as rather good and had great confidence in their own ability to cope with daily life. Their experiences of support from formal care providers varied; they expressed the need for more assistance from the health care sector.

    Conclusions. The partners experienced many challenges in everyday life when providing informal care for their chronically ill spouse. This affected both their physical and psychological health, as they had limited time for themselves. The partners seemed to receive more support from their informal network than from formal care providers. In handling daily life, the partners balanced demands and resources to identify possibilities to move forward and find meaning in life.

    Relevance to clinical practice. Formal care providers must acknowledge partners' needs, develop evidence-based assessment guidelines, and provide efficient support to partners with a chronically ill spouse. 

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  • 7.
    Gupta, Nidhi
    et al.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Hallman, David
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Aadahl, Mette
    Research Centre for Prevention and Health, Glostrup Hospital, Denmark; Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Denmark.
    Jørgensen, Marie Birk
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Are Temporal Patterns of Sitting Associated with Obesity among Blue-Collar Workers?: A Cross Sectional Study Using Accelerometers2016In: BMC Public Health, E-ISSN 1471-2458, Vol. 16, no 1, article id 148Article in journal (Refereed)
    Abstract [en]

    Background

    Little is known about the association of objectively measured temporal patterns of sitting (i.e., how sitting is distributed across time) with obesity indicators. We aimed to investigate the extent to which temporal patterns of sitting (time spent in long, moderate and brief uninterrupted sitting periods) are associated with obesity indicators (body mass index (BMI), waist circumference and fat percentage), independently from moderate-vigorous physical activity (MVPA) and total sitting time among blue-collar workers.

    Methods

    Workers (n=205) wore Actigraph GT3X+ accelerometers on the thigh and trunk for 1-4 working days. The time-line of sitting on working days was computed using the validated Acti4 software. Total sitting time and time spent sitting in brief (≤5 mins), moderate (>5 and ≤30 mins), and long (>30mins) periods were determined for the whole day, and for leisure and work separately. Obesity indicators, i.e. BMI (kg/m2), waist circumference (cm) and fat percentage were objectively measured. Associations between duration of sitting periods and each obesity indicator were determined using linear regression analysis adjusted for several potential confounders including objectively measured MVPA and total sitting time.

    Results

    Sitting time in brief periods was negatively associated with obesity indicators for the whole day (BMI, P<0.01; fat percentage, P<0.01; waist circumference, P<0.01) and work (BMI, P<0.01; fat percentage, P<0.01; waist circumference, P<0.01), but not for leisure time. Sitting time in long periods was positively associated with obesity indicators for the whole day (waist circumference, P=0.05) and work (waist circumference, P=0.01; BMI, P=0.04), but not for leisure time. Sitting in moderate periods was not associated with obesity indicators for any domain.

    Conclusion

    Time spent in brief and long periods of sitting during the whole day and at work were inversely associated with obesity indicators when adjusting for MVPA and total sitting time, while sitting during leisure time did not show these associations. Thus, the temporal distribution of sitting seems to influence the relationship between sitting and obesity.

  • 8.
    Hallman, David
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Januario, Leticia
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Svensson, Sven
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Bergström, Gunnar
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska institutet.
    Working from home during the COVID-19 outbreak in Sweden: effects on 24-h time-use in office workers2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, article id 528Article in journal (Refereed)
    Abstract [en]

    Background: The COVID-19 pandemic has triggered national recommendations encouraging people to work from home (WFH), but the possible impact of WFH on physical behaviors is unknown. This study aimed to determine the extent to which the 24-h allocation of time to different physical behaviors changes between days working at the office (WAO) and days WFH in office workers during the pandemic.

    Methods: Data were collected on 27 office workers with full-time employment at a Swedish municipal division during the COVID-19 outbreak in May–July 2020. A thigh-worn accelerometer (Axivity) was used to assess physical behavior (sedentary, stand, move) during seven consecutive days. A diary was used to identify periods of work, leisure and sleep. 24-h compositions of sedentary, standing and moving behaviors during work and non-work time were examined using Compositional data analysis (CoDA), and differences between days WAO and days WFH were determined using repeated measures ANOVA.

    Results: Days WFH were associated with more time spent sleeping relative to awake, and the effect size was large (F = 7.4; p = 0.01; ηp2 = 0.22). The increase (34 min) in sleep time during WFH occurred at the expense of a reduction in work and leisure time by 26 min and 7 min, respectively. Sedentary, standing and moving behaviors did not change markedly during days WFH compared to days WAO.

    Conclusion: Days working from home during the COVID-19 pandemic in Sweden were associated with longer duration of sleep than days working at the office. This behavioral change may be beneficial to health.

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  • 9.
    Hallman, David
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Gupta, Nidhi
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Korshøj, Mette
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Differences between work and leisure in temporal patterns of objectively measured physical activity among blue-collar workers2015In: BMC Public Health, E-ISSN 1471-2458, Vol. 15, no 1, article id 976Article in journal (Refereed)
    Abstract [en]

    Background

    Leisure time physical activity (LTPA) is generally associated with favorable cardiovascular health outcomes, while occupational physical activity (OPA) shows less clear, or even opposite, cardiovascular effects. This apparent paradox is not sufficiently understood, but differences in temporal patterns of OPA and LTPA have been suggested as one explanation. Our aim was to investigate the extent to which work and leisure (non-occupational time) differ in temporal activity patterns among blue-collar workers, and to assess the modification of these patterns by age and gender.

    Methods

    This study was conducted on a cross-sectional sample of male (n = 108) and female (n = 83) blue-collar workers, aged between 21 and 65 years. Physical activity and sedentary behavior were assessed using accelerometers (Actigraph GT3X+) worn on the thigh and trunk for four consecutive days. Temporal patterns of OPA and LTPA were retrieved using Exposure Variation Analysis (EVA), and expressed in terms of percentage of work and leisure time spent in uninterrupted periods of different durations (<1 min, 1–5 min, 5–10 min, 10–30 min, 30–60 min and > 60 min) of sitting, standing, and walking. Repeated measures ANOVA and linear regression analyses were used to test a) possible differences between OPA and LTPA in selected EVA derivatives, and b) the modification of these differences by age and gender.

    Results

    OPA showed a larger percentage time walking in brief (<5 min) periods [mean (SD): 33.4 % (12.2)], and less time in prolonged (>30 min) sitting [7.0 % (9.3)] than LTPA [walking 15.4 % (5.0); sitting 31.9 % (15.3)], even after adjustment for the difference between work and leisure in total time spent in each activity type. These marked differences in the temporal pattern of OPA and LTPA were modified by gender, but not age.

    Conclusion

    We found that the temporal patterns of OPA and LTPA among blue-collar workers were markedly different even after adjustment for total physical activity time, and that this difference was modified by gender. We recommend using EVA derivatives in future studies striving to disentangle the apparent paradoxical cardiovascular effect of physical activity at work and during leisure.

  • 10.
    Hedlund, Åsa
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Boman, Eva
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Psychology.
    Nieuwenhuijsen, Karen
    Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Women’s health and psychological well-being in the return-to-work process after long-term sick leave for common mental disorders: Women’s and first-line managers' perspectives2023In: BMC Public Health, E-ISSN 1471-2458Article in journal (Refereed)
  • 11.
    Hedlund, Åsa
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Boman, Eva
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Psychology.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Are return to work beliefs, psychological well-being and perceived health related to return-to-work intentions among women on long-term sick leave for common mental disorders? A cross-sectional study based on the Theory of Planned Behaviour2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 535Article in journal (Refereed)
    Abstract [en]

    Background: Long-term sick leave due to common mental disorders (CMDs) is a great burden in several countries. Women are more likely to be affected by CMDs. A strong intention to return to work (RTW) as well as symptom relief may facilitate RTW in this group. However, there is a lack of knowledge regarding what constitutes a strong intention. The Theory of Planned Behaviour is well-suited to identifying underlying beliefs about intentions to perform a behaviour. By including psychological well-being and perceived health, a more comprehensive picture of determinants of RTW intention might be achieved. Thus, the aim of the present study was to identify associations between RTW beliefs, psychological well-being, perceived health and RTW intentions among women on long-term sick leave due to CMDs, and to do so based on the Theory of Planned Behaviour.

    Methods: The study was cross-sectional. Between October 2019 and January 2020, 282 women on long-term sick leave (>2 months) due to CMDs were included in the study. The questionnaires for data collection were: “RTW Beliefs Among Women-Questionnaire”, the “General Health Questionnaire -12” and the “EuroQol Visual Analogue Scale”. Standard multiple regression analysis was performed both with and without adjustment for potential confounders.

    Results: The results showed that more positive attitude towards RTW, stronger social pressure to RTW, higher perceived control over RTW and higher psychological well-being were associated with stronger RTW intention. The adjusted analysis eliminated the importance of psychological well-being for RTW intention, but showed that women who reported that their employer had taken actions to facilitate their RTW had stronger RTW intention. 

    Conclusion: The RTW beliefs, derived from the Theory of Planned Behaviour, were all important for a strong RTW intention, while psychological well-being and perceived health showed weaker associations. Furthermore, having an employer that take actions for facilitating RTW was associated with stronger RTW intentions. Though some caution is warranted regarding the representativeness of the sample, the results do improve our understanding of some important determinants of RTW intention among women on long-term sick leave for CMDs. 

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  • 12.
    Heiden, Marina
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Hallman, David
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Svensson, Malin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Svensson, Sven
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Bergström, Gunnar
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska institutet.
    Mismatch between actual and preferred extent of telework: cross-sectional and prospective associations with well-being and burnout2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, article id 1736Article in journal (Refereed)
    Abstract [en]

    Background: This study aimed to determine whether telework mismatch, i.e., lack of fit between actual and preferred extent of telework, is cross-sectionally and prospectively associated with well-being and burnout.

    Methods: A questionnaire was sent to employees in a Swedish manufacturing company in November 2020 (baseline) and September 2021 (follow-up). It contained questions about well-being (WHO-5 Well-Being Index) and burnout (Copenhagen Psychosocial Questionnaire III), as well as the preferred extent of telework and extent of telework performed. Telework mismatch was calculated as the difference between the actual and preferred extent of telework. Change in mismatch over time was categorized as 1) less mismatch at follow-up than at baseline, 2) more mismatch at follow-up, and 3) identical levels of mismatch at baseline and follow-up. Multivariate and univariate analyses of variance were used to determine the effects of mismatch and change in mismatch over time on baseline ratings and changes in ratings of well-being and burnout. All analyses were performed with and without adjustment for age, sex, marital status, children, type of employment, commuting time and extent of telework performed.

    Results: The response rate was 39% at baseline (n=928, 67% men, mean(SD) age: 45(11) years) and 60% at follow-up (n=556, 64% men, mean(SD) age: 46(11) years). A cross-sectional association was found between telework mismatch and well-being, showing that employees who teleworked more than they would like reported worse well-being than those who teleworked less than they would like. No statistically significant association was found between telework mismatch and burnout. The ability of telework mismatch at baseline to predict changes in well-being or burnout over 10 months was small and non-significant. No association was found between change in telework mismatch over the 10-month period and corresponding changes in well-being or burnout.

    Conclusion: Our results suggest that telework should be thoughtfully practiced in companies/organizations to avoid negative consequences for employees who already telework more than they prefer. Studies are needed to determine how long-term changes in match between preferred and actual extent of telework is associated with employee well-being, including how the association is modified by the nature of the job and the work environment.

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  • 13.
    Ida, Karlsson
    et al.
    Karolinska institutet.
    Lydia, Kwak
    Karolinska institutet.
    Iben, Axén
    Karolinska institutet.
    Bergström, Gunnar
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska institutet.
    Ute, Bültmann
    University of Groningen, The Netherlands.
    Kristina, Holmgren
    Göteborgs universitet.
    Elisabeth, Björk Brämberg
    Karolinska institutet.
    Experiences of participating in a problem-solving intervention with workplace involvement in Swedish primary health care: a qualitative study from rehabilitation coordinator's, employee's, and manager's perspectives2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 940Article in journal (Refereed)
    Abstract [en]

    Background

    Work-directed interventions that include problem-solving can reduce the number of sickness absence days. The effect of combining a problem-solving intervention with involvement of the employer is currently being tested in primary care in Sweden for employees on sickness absence due to common mental disorders (PROSA trial). The current study is part of the PROSA trial and has a two-fold aim: 1) to explore the experiences of participating in a problem-solving intervention with workplace involvement aimed at reducing sickness absence in employees with common mental disorders, delivered in Swedish primary health care, and 2) to identify facilitators of and barriers to participate in the intervention. Both aims targeted rehabilitation coordinators, employees on sickness absence, and first-line managers.

    Methods

    Data were collected from semi-structured interviews with participants from the PROSA intervention group; rehabilitation coordinators (n = 8), employees (n = 13), and first-line managers (n = 8). Content analysis was used to analyse the data and the Consolidated Framework for Implementation Research was used to group the data according to four contextual domains. One theme describing the participation experiences was established for each domain. Facilitators and barriers for each domain and stakeholder group were identified.

    Results

    The stakeholders experienced the intervention as supportive in identifying problems and solutions and enabling a dialogue between them. However, the intervention was considered demanding and good relationships between the stakeholders were needed. Facilitating factors were the manual and work sheets which the coordinators were provided with, and the manager being involved early in the return-to-work process. Barriers were the number of on-site meetings, disagreements and conflicts between employees and first-line managers, and symptom severity.

    Conclusions

    Seeing the workplace as an integral part of the intervention by always conducting a three-part meeting enabled a dialogue that can be used to identify and address disagreements, to explain CMD symptoms, and how these can be handled at the workplace. We suggest allocating time towards developing good relationships, provide RCs with training in handling disagreements, and additional knowledge about factors in the employee’s psychosocial work environment that can impair or promote health to increase the RCs ability to support the employee and manager.

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  • 14.
    Johansson, Bo
    et al.
    Uppsala University Hospital, Occupational and Environmental Medicine.
    Helgesson, Magnus
    Uppsala University, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lundberg, Ingvar
    Uppsala University, Department of Medical Sciences, Occupational and Environmental Medicine.
    Nordquist, Tobias
    Uppsala University Hospital, Occupational and Environmental Medicine.
    Leijon, Ola
    Karolinska Institutet, Department of Public Health Sciences, Division of Occupational and Environmental Medicine.
    Lindberg, Per
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Vingård, Eva
    Uppsala University, Department of Medical Sciences, Occupational and Environmental Medicine.
    Work and health among native and foreign-born residents in Sweden 1990-2008: a register-based study on hospitalization for common potentially work-related disorders, disability pension and mortality2012In: BMC Public Health, E-ISSN 1471-2458, Vol. 12, no 1, p. 845-854Article in journal (Refereed)
    Abstract [en]

    Background: There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration.

    Methods: This study included migrants to Sweden since 1960 who were 28-47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately.

    Results: Nordic immigrants had increased risks for all investigated outcomes while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results.

    Conclusions: Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers.

  • 15.
    Johansson, Elin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Lund Rasmussen, Charlotte
    National Research Centre for the Working Environment, Copenhagen.
    Hallman, David
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Sitting, standing and moving during work and leisure among male and female office workers of different age: A compositional data analysis2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, article id 826Article in journal (Refereed)
    Abstract [en]

    Background Gendered patterns of physical activity behaviours may help explaining health inequalities between men and women. However, evidence on such patterns in the working population is sparse. This study aimed at documenting and comparing compositions of sitting, standing and moving at work and during leisure among male and female office workers of different age.

    Methods Sitting (including lying), standing and moving were measured using accelerometry for, on average, four working days in 55 male and 57 female Swedish office workers. Behaviours were described in terms of time spent in four exhaustive categories: sitting in short (<30 min) and long (≥30 min) bouts, standing, and moving. In a compositional data analysis approach, isometric log-ratios (ilr) were calculated for time sitting relative to non-sitting, time in short relative to long sitting bouts, and time in standing relative to moving. Differences between genders (men vs. women), domains (work vs. leisure), and according to age were examined for each ilr using ANOVA.

    Results At work, time spent sitting in short bouts, sitting in long bouts, standing, and moving was, on average, 29%, 43%, 21% and 7% among men, and 28%, 38%, 26% and 7% among women. Corresponding proportions during leisure were 34%, 27%, 27% and 13% among men and 28%, 27%, 32% and 13% among women. Men spent more time sitting relative to non-sitting (partial eta-squared=0.04, p=0.03) than women, and less time standing relative to moving (pes=0.07, p=0.01). At work compared to during leisure, both genders spent more time sitting relative to non-sitting (pes=0.47, p<0.01); within sitting more time was spent in long relative to short sitting bouts (pes=0.26, p<0.01), and within non-sitting, more time was spent standing than moving (pes=0.12, p<0.01). Older workers spent less of their non-sitting time moving than younger workers (pes=0.07, p=0.01).

    Conclusion Male office workers spent more time sitting relative to non-sitting than female workers, and more time moving relative to standing. Both genders were sitting more at work than during leisure. Older workers moved less than younger. These workers could likely benefit from interventions to reduce or break up prolonged sitting time, preferably by moving more.

  • 16.
    Johansson, Nina
    et al.
    Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Sarkadi, Anna
    Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Feldman, Inna
    Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Price, Anna M. H.
    Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.
    Goldfeld, Sharon
    Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.
    Salonen, Tapio
    Department of Social Work, Malmö University, Malmö, Sweden.
    Wijk, Katarina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Uppsala University, Gävle, Region Gävleborg, Sweden.
    Isaksson, David
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    Kolic, Emir
    Konsument Gästrikland Budget and Debt Counselling Service, Gävle, Sweden.
    Stenquist, Sara
    Konsument Gästrikland Budget and Debt Counselling Service, Gävle, Sweden.
    Elg, Maria
    Sandviken Municipality, Sandviken, Sweden.
    Lönn, Ewa
    Sandviken Municipality, Sandviken, Sweden.
    Wennelin, Josefine
    Gävle Municipality, Gävle, Sweden.
    Lindström, Linda
    Helsingborg Municipality, Helsingborg, Sweden.
    Medina, Mirelle
    Public Contributor, Sandviken, Sweden.
    Åberg, Sofie
    Public Contributor, Sandviken, Sweden.
    Viklund, Jessica
    Public Contributor, Sandviken, Sweden.
    Warner, Georgina
    Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Ameliorating Child poverty through Connecting Economic Services with child health Services (ACCESS): study protocol for a randomised controlled trial of the healthier wealthier families model in Sweden2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 2181Article in journal (Refereed)
    Abstract [en]

    Background: Sweden is often held up as an example of a country with low child deprivation; yet, rates of relative deprivation are rising. Every municipality in Sweden is required to provide free, timely and accessible budget and debt counselling under the Social Services Act. The services have been encouraged to perform preventative practice with families; however, this has not been realised. The Healthier Wealthier Families (HWF) model embeds universal screening for economic hardship into child health services and creates a referral pathway to economic support services. Given the universal child health system in Sweden, which is freely available and has excellent coverage of the child population, implementation of the HWF model has potential to support families to access the freely available municipal budget and debt counselling and ultimately improve rates of child deprivation in Sweden.

    Methods/design: We will conduct a two-arm randomised waitlist-control superiority trial to examine the effectiveness and cost-effectiveness of the HWF model in the Sweden. A longitudinal follow-up with the cohort will explore whether any effects are maintained in the longer-term.

    Discussion: HWF is a collaborative and sustainable model that could maximise the effectiveness of current services to address child deprivation in Sweden. The study outlined in this protocol is the first effectiveness evaluation of the HWF model in Sweden and is a crucial step before HWF can be recommended for national implementation within the child health services.

    Trial registration: Clinicaltrials.gov; NCT05511961. Prospectively registered on 23 August 2022. https://clinicaltrials.gov/ct2/show/NCT05511961.

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  • 17.
    Kjeldgård, Linnea
    et al.
    Karolinska institutet.
    Stigson, Helena
    Karolinska institutet; Chalmers University of Technology; Folksam Research.
    Bergsten, Eva L.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska institutet.
    Farrants, Kristin
    Karolinska institutet.
    Friberg, Emilie
    Karolinska institutet.
    Diagnosis-specific sickness absence among injured working-aged pedestrians: a sequence analysis2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 367Article in journal (Refereed)
    Abstract [en]

    Background

    The knowledge about the long-term consequences in terms of sickness absence (SA) among pedestrians injured in a traffic-related accident, including falls, is scarce. Therefore, the aim was to explore diagnosis-specific patterns of SA during a four-year period and their association with different sociodemographic and occupational factors among all individuals of working ages who were injured as a pedestrian.

    Methods

    A nationwide register-based study, including all individuals aged 20–59 and living in Sweden, who in 2014–2016 had in- or specialized outpatient healthcare after a new traffic-related accident as a pedestrian. Diagnosis-specific SA (> 14 days) was assessed weekly from one year before the accident up until three years after the accident. Sequence analysis was used to identify patterns (sequences) of SA, and cluster analysis to form clusters of individuals with similar sequences. Odds ratios (ORs) with 95% confidence intervals (CIs) for association of the different factors and cluster memberships were estimated by multinomial logistic regression.

    Results

    In total, 11,432 pedestrians received healthcare due to a traffic-related accident. Eight clusters of SA patterns were identified. The largest cluster was characterized by no SA, three clusters had different SA patterns due to injury diagnoses (immediate, episodic, and later). One cluster had SA both due to injury and other diagnoses. Two clusters had SA due to other diagnoses (short-term and long-term) and one cluster mainly consisted of individuals with disability pension (DP). Compared to the cluster “No SA”, all other clusters were associated with older age, no university education, having been hospitalized, and working in health and social care. The clusters “Immediate SA”, “Episodic SA” and “Both SA due to injury and other diagnoses” were also associated with higher odds of pedestrians who sustained a fracture.

    Conclusions

    This nationwide study of the working-aged pedestrians observed diverging patterns of SA after their accident. The largest cluster of pedestrians had no SA, and the other seven clusters had different patterns of SA in terms of diagnosis (injury and other diagnoses) and timing of SA. Differences were found between all clusters regarding sociodemographic and occupational factors. This information can contribute to the understanding of long-term consequences of road traffic accidents.

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  • 18.
    Kwak, Lydia
    et al.
    Karolinska institutet.
    Lornudd, Caroline
    Karolinska institutet.
    Björklund, Christina
    Karolinska institutet.
    Bergström, Gunnar
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska institutet.
    Nybergh, Lotta
    Karolinska institutet.
    Schäfer Elinder, Liselotte
    Karolinska institutet.
    Stigmar, Kjerstin
    Lunds universitet.
    Wåhlin, Charlotte
    Linköpings universitet.
    Jensen, Irene
    Karolinska institutet.
    Implementation of the Swedish Guideline for Prevention of Mental ill-health at the workplace: study protocol of a cluster randomized controlled trial, using multifaceted implementation strategies in schools2019In: BMC Public Health, E-ISSN 1471-2458, Vol. 19, article id 1668Article in journal (Other academic)
    Abstract [en]

    Given today’s high prevalence of common mental disorders and related sick leave among teachers, an urgent need exists for a more systematic approach to the management of social and organizational risk factors within schools. In 2015, we launched the first Swedish occupational health guideline to support a structured prevention of these risks at the workplace. The existence of guidelines does however not guarantee their usage, as studies show that guidelines are often underused. Knowledge is therefore needed on effective implementation strategies that can facilitate the translation of guidelines into practice. The primary aim of the randomized waiting list-controlled trial described in this study protocol is to compare the effectiveness of a multifaceted implementation strategy versus a single implementation strategy for implementing the Guideline for the prevention of mental ill-health at the workplace within schools. The effectiveness will be compared regarding the extent to which the recommendations are implemented (implementation effectiveness) and with regard to social and organisational risk factors for mental ill-health, absenteeism and presenteeism (intervention effectiveness).

  • 19.
    Lerche, Anders Fritz
    et al.
    National Research Centre for the Working Environment, Copenhagen.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Lund Rasmussen, Charlotte
    Norwegian University of Science and Technology, Department of Public Health and Nursing, Trondheim.
    Straker, Leon
    School of Allied Health, Curtin University, Perth.
    Søgaard, Karen
    Department of Clinical Research, University of Southern Denmark.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen.
    Designing industrial work to be ‘just right’ to promote health – A study protocol for a goldilocks work intervention2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, article id 381Article in journal (Refereed)
    Abstract [en]

    Background: The Goldilocks Work Principle expresses that productive work should be designed to promote workers’ health. We recently showed that it is feasible to develop and implement modifications to productive work that change physical behaviors (i.e. sitting, standing and being active) in a direction that may promote health among industrial workers. Therefore, the aim of the present study is to conduct a cluster randomised controlled trial investigating health effects of implementing the Goldilocks Work intervention among industrial workers. 

    Methods: Our implementation plan consists of educating work teams, organizing implementation meetings, and providing feedback to workers. Three meetings with a preselected local workplace group will be scheduled. The first meeting educates the group to use a planning tool by which work can be planned to have ‘just right’ physical behaviors. The second and third meetings will focus on supporting implementation of the tool in daily work. An expected 28 clusters of work teams across two participating production sites will be randomized to either intervention or control group. Data collection will consist of 1) questionnaires regarding work and musculoskeletal health, 2) wearable sensor measurements of the physical behavior, and 3) assessment of general health indicators, including BMI, blood pressure, and fat percentage. The primary outcome is musculoskeletal health, measured by low back pain intensity, and secondary outcomes are 1) physical behaviors at work, 2) accumulated time in long bouts of sitting, standing, and being active and 3) perceived fatigue and energy during work. Furthermore, implementation and cost of the intervention will be evaluated based on questionnaires and data from the planning tool completed by the workers.

    Discussion: This study will evaluate the effectiveness and implementation of a 12- weeks Goldilocks Work intervention with the aim of improving musculoskeletal health among industrial workers. The cluster randomized controlled study design and the evaluation of the implementation, results and costs of the intervention will make it capable of contributing with valuable evidence of how productive work may be designed to promote industrial workers’ health.

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  • 20.
    Lidegaard, Mark
    et al.
    National Research Centre for the Working Environment, Copenhagen.
    Fritz Lerche, Anders
    National Research Centre for the Working Environment, Copenhagen.
    Kold Munch, Pernille
    National Research Centre for the Working Environment, Copenhagen.
    Greby Schmidt, Kathrine
    National Research Centre for the Working Environment, Copenhagen.
    Lund Rasmussen, Charlotte
    National Research Centre for the Working Environment, Copenhagen.
    Nørregaard Rasmussen, Charlotte Diana
    National Research Centre for the Working Environment, Copenhagen.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Straker, Leon
    School of Physiotherapy and Exercise Science, Curtin University, Perth.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen.
    Can childcare work be designed to promote moderate and vigorous physical activity, cardiorespiratory fitness and health? Study protocol for the Goldilocks-childcare randomised controlled trial2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 237Article in journal (Refereed)
    Abstract [en]

    Background: Despite extensive efforts, issues like obesity and poor physical capacity remain challenges for a healthy work life in several occupations. The Goldilocks work principle offers a new approach, encouraging design of productive work to promote physical capacity and health. This paper presents the protocol for the Goldilocks-childcare study, a randomised controlled intervention trial aiming to evaluate the effectiveness of implementing the Goldilocks work principle in childcare. The primary aim of the intervention is to increase time in moderate to vigorous physical activity (MVPA) by having the childcare workers act as active role models for children in daily playful physical activities, and thereby improve cardiorespiratory fitness and health of the workers.

    Methods/ design: The study is a cluster-randomised trial with a usual-practice wait-list control group. The 10-week intervention consists of two phases. In the first, the childcare workers will participate in two participatory workshops aiming, a) to develop playful physical activities (‘Goldilocks-games’) for children in which childcare workers participate as active role models at MVPA intensity, and b) to develop action plans for implementation of the Goldilocks-games in daily work routines. In the second phase, childcare institutions will implement the Goldilocks-games. The primary outcome is working time spent in MVPA, and secondary outcomes are cardiorespiratory fitness, sleeping heart rate, perceived need for recovery, and productivity. Primary outcome and process evaluation will be based on direct measurements of physical activity and heart rate, determination of cardiorespiratory fitness, and questionnaires.

    Discussion: If proven effective, the Goldilocks work principle has a large potential for promoting sustainable health and working lives of childcare workers.

  • 21.
    Lunde, Lars-Kristian
    et al.
    National Institute of Occupational Health, Oslo.
    Koch, Markus
    National Institute of Occupational Health, Oslo.
    Knardahl, Stein
    National Institute of Occupational Health, Oslo.
    Wærsted, Morten
    National Institute of Occupational Health, Oslo.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Forsman, Mikael
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen.
    Veiersted, Bo
    National Institute of Occupational Health, Oslo.
    Musculoskeletal health and work ability in physically demanding occupations: study protocol for a prospective field study on construction and health care workers2014In: BMC Public Health, E-ISSN 1471-2458, Vol. 14, article id 1075Article in journal (Refereed)
    Abstract [en]

    Background: Musculoskeletal disorders have a profound impact on individual health, sickness absence and early retirement, particularly in physically demanding occupations. Demographics are changing in the developed countries, towards increasing proportions of senior workers. These senior workers may have particular difficulties coping with physically demanding occupations while maintaining good health. Previous studies investigating the relationship between physical work demands and musculoskeletal disorders are mainly based on self-reported exposures and lack a prospective design. The aim of this paper is to describe the background and methods and discuss challenges for a field study examining physical demands in construction and health care work and their prospective associations with musculoskeletal disorders, work ability and sickness absence.

    Methods and design: This protocol describes a prospective cohort study on 1200 construction and health care workers. Participants will answer a baseline questionnaire concerning musculoskeletal complaints, general health, psychosocial and organizational factors at work, work demands, work ability and physical activity during leisure. A shorter questionnaire will be answered every 6 months for a total of two years, together with continuous sickness absence monitoring during this period. Analysis will prospectively consider associations between self-reported physical demands and musculoskeletal disorders, work ability and sickness absence. To obtain objective data on physical exposures, technical measurements will be collected from two subgroups of N = 300 (Group A) and N = 160 (Group B) during work and leisure. Both group A and B will be given a physical health examination, be tested for physical capacity and physical activity will be measured for four days. Additionally, muscle activity, ground reaction force, body positions and physical activity will be examined during one workday for Group B. Analysis of associations between objectively measured exposure data and the outcomes described above will be done separately for these subpopulations.

    Discussion: The field study will at baseline produce objectively measured data on physical demands in the construction and health care occupations. In combination with clinical measurements and questionnaire data during follow-up, this will provide a solid foundation to prospectively investigate relationships between physical demands at work and development of musculoskeletal disorders, work ability and sickness absence.

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  • 22.
    Marttila, Anneli
    et al.
    Karolinska institutet.
    Johansson, Eva
    Karolinska institutet.
    Whitehead, Margaret
    University of Liverpool.
    Burström, Bo
    Karolinska institutet.
    Dilemmas in providing resilience-enhancing social services to long-term social assistance clients. A qualitative study of Swedish social workers2012In: BMC Public Health, E-ISSN 1471-2458, Vol. 12, no 1, article id 517Article in journal (Refereed)
    Abstract [en]

    Background

    Long-term recipients of social assistance face barriers to social and economic inclusion, and have poorer health and more limited opportunities for improving their health than many other groups in the population. During recent decades there have been changes in Swedish social policy, with cutbacks in public benefits and a re-emphasis on means-tested policies. In this context, it is important to investigate the necessary conditions for social workers to offer social assistance and services, as well as the mediating role of social workers between public policies and their clients. Swedish social services aim to promote social inclusion by strengthening the individual´s own resources. We investigated the issues that arise when providing social services to long-term social assistance clients within the framework of resilience, which focuses on the processes leading to positive functioning in adverse conditions.

    Methods

    Interviews were conducted with 23 social workers in Stockholm and analysed by qualitative content analysis.

    Results

    The main theme to emerge from the interviews concerned the constraints that the social workers faced in providing social services to social assistance clients. The first subtheme focused on dilemmas in the interaction between social workers and clients resulting from the dual role of exercising authority and supporting and building trust with clients. Working conditions of social workers also played a crucial role. The second subtheme addressed the impact of the societal context, such as labour market opportunities and coordination between authorities.

    Conclusions

    Overall, we found that social workers to a great extent tried to find individual solutions to structural problems. To provide resilience-enhancing social services to long-term social assistance clients with varying obstacles and needs requires a constructive working environment, supportive societal structures and inter-sectoral cooperation between different authorities.

  • 23.
    Marttila, Anneli
    et al.
    Karolinska institutet.
    Johansson, Eva
    Karolinska institutet.
    Whitehead, Margaret
    University of Liverpool.
    Burström, Bo
    Karolinska institutet.
    Living on social assistance with chronic illness: Buffering and undermining features to well-being2010In: BMC Public Health, E-ISSN 1471-2458, Vol. 10, no 1, article id 754Article in journal (Refereed)
    Abstract [en]

    Background

    In Sweden, the social security and sickness insurance systems are comprehensive and aim to provide people whose illness prevents them from earning their own living, with either sickness benefits or disability pension. Some, however, are not entitled to these benefits or receive social insurance benefits at a level too low for subsistence, and are referred to social assistance. The purpose of this study was to explore in depth how social assistance recipients with chronic illness perceive and respond to the experience of living on social assistance.

    Methods

    Seventeen in-depth interviews were carried out with chronically ill people who had received social assistance for several years. Grounded theory informed the design of the study.

    Results

    The study showed that different strategies (living one day at a time, taking steps forwards and backwards and making attempts to find ways out of the situation) were employed by social assistance recipients to maintain or improve their well-being. Contextual features like the prevailing welfare system, public services and the local neighbourhood could buffer or undermine these strategies and their overall well-being. These features together influenced how interviewees perceived their situation, the possible ways out of the situation and the consequences for their well-being.

    Conclusion

    From this study it is evident that the way in which individuals on social assistance interact with services and how they are treated by professionals plays an important role in their well-being, in combination with what kind of help and support is available for recipients through the welfare system. In this respect, persons living on social assistance with chronic illness are particularly vulnerable. This study suggests that more effort should be made to find long term solutions concerning income support, rehabilitation and other services provided to this group.

  • 24.
    Mekhail, Kirsi Tiitinen
    et al.
    Karolinska institutet.
    Burström, Bo
    Karolinska institutet.
    Marttila, Anneli
    Karolinska institutet.
    Wångdahl, Josefin
    Uppsala universitet.
    Lindberg, Lene
    Karolinska institutet.
    Psychometric qualities of the HLS-EU-Q16 instrument for parental health literacy in Swedish multicultural settings2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 293Article in journal (Refereed)
    Abstract [en]

    Background

    Health literacy (HL) is important for individuals in terms of knowledge and competence to make decisions about healthcare, health promotion and disease prevention. Migrants generally demonstrate lower HL levels compared to the majority populations. HL interventions among migrants are rarely studied. Thus, there is a need to find useful HL measurements for multicultural settings. The importance of understanding parents’ HL is related to their key role in providing and promoting the health of their children. This study aimed to add knowledge about the psychometric properties of the HLS-EU-Q16 instrument (Swedish version) among parents in Swedish multicultural settings.

    Methods

    A cross sectional design was used. Totally 193 first-time parents (N = 193) were recruited through two child healthcare centres in Stockholm. Parents were interviewed when their infants were < 2 months old using structured questionnaires including HLS-EU-Q16. For psychometric evaluation of HLS-EU-Q16 instrument, exploratory factor analyses (EFA) were used to test internal consistency (N = 164). HL levels in sub-groups were explored with Kruskal-Wallis/Chi2 tests. Participants’ comments on HLS-EU-Q16 questionnaire were viewed to explore how the questions were perceived by the target population.

    Results

    One factor solution of EFA explained 37.3% of the total variance in HLS-EU-Q16. Statistically significant differences in HL levels were found in relation to migration including language difficulties and level of education of the study population and access to support in line with previous research. Challenges related to understanding HLS-EU-Q16 questionnaire were found among participants with migrant background.

    Conclusions

    The Swedish version of HLS-EU-Q16 could be used together with other instruments for measuring overall HL in multicultural settings. HLS-EU-Q16 appears to discriminate between different levels of HL in relation to migrant background and shorter education and limited access to support. However, other measures of HL which should be adapted to use in multicultural settings, need to be explored in further studies of parental HL and its relationship to child health in multicultural settings.

    Trial registration

    The study was retrospectively registered (18 February 2020) in the ISRCTN registry (ISRCTN10336603).

  • 25.
    Nybergh, Lotta
    et al.
    Karolinska institutet.
    Bergström, Gunnar
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska institutet.
    Hellman, Therese
    Karolinska institutet; Uppsala university.
    Do work- and home-related demands and resources differ between women and men during return-to-work?: A focus group study among employees with common mental disorders2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, article id 1914Article in journal (Refereed)
    Abstract [en]

    Common mental disorders present the main reason for registered sick leave in Sweden today, and women are at a higher risk of such sick leave than men. The aim of our study was to explore how the experiences of work- and home-related demands as well as resources influence return-to-work among employees sick-listed for common mental disorders in Sweden. Specifically, we aimed to explore similarities and differences in patterns of experiences among women and men.

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  • 26.
    Priebe, Stefan
    et al.
    Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK .
    Matanov, Alexandra
    Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK .
    Schor, Ruth
    Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK .
    Straßmayr, Christa
    Ludwig Boltzmann Institute for Social Psychiatry, Vienna, Austria.
    Barros, Henrique
    Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.
    Barry, Margareth M
    Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland .
    Díaz-Olalla, José Manuel
    Madrid Salud, Madrid, Spain .
    Gabor, Edina
    National Institute for Health Development, Budapest, Hungary.
    Greacen, Tim
    Laboratoire de recherche, Etablissement Public de Santé Maison Blanche, Paris, France.
    Holcnerová, Petra
    Department of Psychiatry, 1st Faculty of Medicine, Charles University, Prague, Czech Republic .
    Kluge, Ulrike
    Clinic for Psychiatry and Psychotherapy, Charité, University Medicine Berlin, Berlin, Germany.
    Lorant, Vincent
    Institute of Health and Society (IRSS), Université Catholique de Louvain, Bruxelles, Belgium.
    Moskalewicz, Jasec
    Institute of Psychiatry and Neurology, Warsaw, Poland.
    Schene, Aart H
    Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
    Macassa, Gloria
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Gaddini, Andrea
    Laziosanità ASP - Public Health Agency, Lazio Region, Rome, Italy.
    Good practice in mental health care for socially marginalised groups in Europe: a qualitative study of expert views in 14 countries2012In: BMC Public Health, E-ISSN 1471-2458, Vol. 12, p. -Article Number: 248Article in journal (Refereed)
    Abstract [en]

    Background: Socially marginalised groups tend to have higher rates of mental disorders than the general population and can be difficult to engage in health care. Providing mental health care for these groups represents a particular challenge, and evidence on good practice is required. This study explored the experiences and views of experts in 14 European countries regarding mental health care for six socially marginalised groups: long-term unemployed; street sex workers; homeless; refugees/asylum seekers; irregular migrants and members of the travelling communities.      

    Methods: Two highly deprived areas were selected in the capital cities of 14 countries, and experts were interviewed for each of the six marginalised groups. Semi-structured interviews with case vignettes were conducted to explore experiences of good practice and analysed using thematic analysis.      

    Results: In a total of 154 interviews, four components of good practice were identified across all six groups: a) establishing outreach programmes to identify and engage with individuals with mental disorders; b) facilitating access to services that provide different aspects of health care, including mental health care, and thus reducing the need for further referrals; c) strengthening the collaboration and co-ordination between different services; and d) disseminating information on services both to marginalised groups and to practitioners in the area.      

    Conclusions: Experts across Europe hold similar views on what constitutes good practice in mental health care for marginalised groups. Care may be improved through better service organisation, coordination and information.      

      

  • 27.
    Rashid, Mamunur
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Do work ability and life satisfaction matter for return to work? Predictive ability of the work ability index and life satisfaction questionnaire among women with long-term musculoskeletal pain2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 584Article in journal (Refereed)
    Abstract [en]

    Objectives: To determine whether work ability and well-being predict return to work (RTW) among women with long-term neck/shoulder and/or back pain at a 1-year follow-up, and to assess the ability of the Work Ability Index (WAI) and Life Satisfaction questionnaire (LiSat-11) to discriminate between those who did RTW and those who did not RTW. 

    Methods: A survey was sent to 600 women receiving time-loss benefits from the Swedish Social Insurance Agency. In total, 208 women responded at baseline, and 141 at a 1-year follow-up. To identify whether work ability and well-being predicted RTW, multiple logistic regression analyses were performed with and without adjustment for type of work and pain intensity. To assess the discriminative ability of the WAI and LiSat-11 for women who did RTW and those who did not RTW, Receiver Operating Characteristic curves were fitted.  

    Results: Work ability predicted RTW, and the results remained significant after adjusting for type of work and pain intensity (OR 1.12, 95% CI: 1.04-1.22). Well-being was not significant. The WAI at baseline adequately discriminated between RTW and no RTW after one year (AUC 0.78, 95% CI 0.70-0.86), but the LiSat-11 did not.

    Conclusions: Our results indicate that work ability is an important factor for RTW among women on SL for long-term neck/shoulder and/or back pain. The WAI has adequate discriminatory ability in this population, but the LiSat-11 has not.  

     

    Keywords: Life satisfaction, Musculoskeletal pain, Sickness absence, Work status

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  • 28.
    Rashid, Mamunur
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden.
    Factors related to work ability and well-being among women on sick leave due to long-term pain in the neck/shoulders and/or back: a cross-sectional study2018In: BMC Public Health, E-ISSN 1471-2458, Vol. 18, no 1, article id 672Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Musculoskeletal pain is one of the leading causes of sick leave, especially among women, in Western countries. The aim of the present study was to identify factors associated with work ability and well-being, respectively, among women on sick leave due to long-term pain in the neck/shoulders and/or back.

    METHODS:

    A cross-sectional study with a correlational design was conducted on women who were sick-listed due to long-term pain in the neck/shoulders and/or back. A total of 208 participants responded to a survey comprising eight instruments: Multidimensional Pain Inventory scale, General Self-Efficacy scale, Sense of Coherence scale, Coping Strategies Questionnaire, Demand-Control-Support Questionnaire, Hospital Anxiety and Depression Scale, Work Ability Index and Life Satisfaction questionnaire. Multiple linear regression analyses were performed to identify factors associated with work ability and well-being, respectively.

    RESULTS:

    Women who more strongly believed they would return to the same work had greater work ability (β = 0.39, p < 0.001), whereas women with higher pain intensity (β = - 0.30, p < 0.001) and higher job strain (β = - 0.12, p < 0.05) had lower work ability. Women with higher self-efficacy rated greater well-being (β = 0.14, p < 0.05). As the women's scores for depression increased, their well-being decreased by 48%, which was statistically significant (p < 0.001). The regression models for work ability and well-being were significant (p < 0.001), and their adjusted R- square values were 48% and 59%, respectively.

    CONCLUSIONS:

    The study suggests that the factors beliefs to be back at the same work, pain intensity and job strain are predictive of work ability. Moreover, the factors self-efficacy and depression seem to be predictive of well-being. The findings highlight factors that should be considered by health care professionals and policy-makers to guide attempts to reduce sick leave.

  • 29.
    Rising Holmström, Malin
    et al.
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Olofsson, Niclas
    Folkhälsocentrum, Landstinget Västernorrland, Härnösand, Sweden.
    Asplund, Kenneth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Kristiansen, Lisbeth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Transitions in the Swedish school system and the impact on student's positive self-reported-health2014In: BMC Public Health, E-ISSN 1471-2458, Vol. 14, article id 1045Article in journal (Refereed)
    Abstract [en]

    Background: To explore three school based transitions and their impact on positive self-reported-health (SRH), pre-school to elementary school (6-10 y), elementary school to junior high school (10-13y), and junior high school to upper secondary school/high school (13-16y), in a long-term longitudinal population based study. Methods: The study followed three cohorts through one school transition each. A longitudinal study with data from 6693 Health Dialogue questionnaires were used. Data were collected in the middle of Sweden during 2007-2012 with school children age 6-16 years old. Results: Several significant factors were identified with an impact for a positive self-reported-health among children age 6-16y; not feeling sad or depressed, afraid or worried, positive school environment (schoolyard and restrooms), not bullied, good sleep, daily physical activity and ability to concentrate. There was no single factor identified, the factors differed according to gender and age. Conclusion: The study have identified several gender and age specific factors for successful school transitions relevant for a positive SRH. This is valuable information for school staff, parents and school children and provides a possibility to provide support and assistance when needed.

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  • 30.
    Samuelsson, Åsa
    et al.
    Karolinska institutet.
    Ropponen, Annina
    University of Eastern Finland; Finnish Institute of Occupational Health, Helsinki, Finland.
    Alexanderson, Kristina
    Karolinska institutet.
    Svedberg, Pia
    Karolinska institutet.
    A prospective cohort study of disability pension due to mental diagnoses: the importance of health factors and behaviors2013In: BMC Public Health, E-ISSN 1471-2458, Vol. 13, article id 621Article in journal (Refereed)
    Abstract [en]

    Background

    Previous studies have found associations between various health factors and behaviors and mental disorders. However, knowledge of such associations with disability pension (DP) due to mental diagnoses is scarce. Moreover, the influence of familial factors (genetics and family background) on the associations are mainly unknown. The aim of the study was to investigate associations between health factors and behaviors and future DP due to mental diagnoses in a twin cohort, accounting for familial confounding.

    Methods

    A prospective cohort study of Swedish twins (N=28 613), including survey data and national register data on DP and other background factors was conducted. Cox proportional hazards regression models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for the whole twin cohort, and for discordant twin pairs.

    Results

    During follow-up 1998–2008 (median 10 years), 2.2% of the cohort was granted a DP with a mental diagnosis. In the fully adjusted analyses of the whole cohort, the associations of poor or moderate self-rated health (SRH), under- or overweight, former or current tobacco use, or being an abstainer from alcohol were significantly associated with risk of DP due to mental diagnoses. Analyses of discordant twin pairs confirmed all these associations, except for current tobacco use, being independent from familial confounding. Exclusion of individuals with current or previous depression or anxiety at baseline did not influence the associations found.

    Conclusions

    Poor or moderate SRH, under- or overweight, former tobacco use or being an abstainer from alcohol seem to be strong direct predictors of DP due to mental diagnoses, independently of several confounders of this study, including familial factors.

  • 31.
    Tiitinen Mekhail, Kirsi
    et al.
    Karolinska institutet.
    Lindberg, Lene
    Karolinska institutet.
    Burström, Bo
    Karolinska institutet.
    Marttila, Anneli
    Karolinska institutet.
    Strengthening resilience through an extended postnatal home visiting program in a multicultural suburb in Sweden: fathers striving for stability2019In: BMC Public Health, E-ISSN 1471-2458, Vol. 19, no 1, article id 102Article in journal (Refereed)
    Abstract [en]

    Background

    To improve prerequisites for better health development among children growing up in multicultural suburbs in Stockholm County, where poorer health is displayed in several aspects including child health, early support was initiated for first-time parents in one of the suburbs. An extended postnatal home visiting program during the child’s first 15 months was offered to families with first-time mothers during 2013–2014 and consisted of six home visits by a child health care nurse and a parental advisor from social services. Almost all invited families (94%) participated in the program and the program evaluation. Fathers’ participation in two or more home visits within the program was 53%.

    The aim of this study was to explore the experiences of fathers participating in the program, with respect to their role as a first-time parent from a resilience perspective.

    Methods

    In-depth interviews were conducted with nine fathers. Constructivist grounded theory (GT) was applied in the analysis.

    Results

    The fathers’ experiences formed the core category of the study, ‘striving for stability in living conditions’, as well as three categories: ‘everyday life conditions’, ‘adjustment to fatherhood in Sweden’ and ‘channels of support’. The fathers perceived that the home visiting program strengthened their parental confidence and increased their knowledge of societal services and local resources for their family.

    Conclusions

    In terms of resilience, the extended postnatal home visiting program benefitted the interviewed migrant fathers on an individual level by meeting part of their need for support regarding knowledge and parental confidence; on a structural level the program helped fathers gain information about available societal services and resources in their local area.

    Trial registrationThe study was retrospectively registered (11 August 2016) in the ISRCTN registry (ISRCTN11832097 DOI: https://doi.org/10.1186/ISRCTN11832097).

  • 32.
    Toomingas, Allan
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Forsman, Mikael
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Nilsson, Tohr
    Department of Public Health and Clinical Medicine, Umeå university.
    Variation between seated and standing/walking postures among male and female call centre operators2012In: BMC Public Health, E-ISSN 1471-2458, Vol. 12, p. 154-Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the present study was to assess variation in gross body posture amongst male and female call centre operators using whole-day registrations of seated and standing/walking periods, analyzed and described by a number of novel variables.

    Methods: Body postures, identified as either seated or standing/walking, were recorded using inclinometers throughout an entire work shift for 43 male and 97 female call centre operators at 16 call centres. Data were analyzed using an extensive set of variables describing occurrence of postures, switches between postures, posture similarities across the day, and compliance with posture recommendations.

    Results: The majority of the operators, both male and female, spent more than 80% of the shift in a seated posture. The average number of switches between seated and standing/walking or vice versa was 10.4 per hour. Female operators spent, on average, 11% of the day in periods of sustained sitting longer than 1 hour; male operators only 4.6% of the day (p=0.013). Only 38% of the operators followed current standard recommendations of having an uninterrupted break from seated work, lasting a minimum of 5minutes within a one hour of work and only 11% of operators had a 10 minute (or longer) uninterrupted break. Substantial variation between operators was observed in many variables. Since work tasks were essentially similar across operators and were expected to be similar across days, this indicates individual differences in working technique.

    Conclusions: The dominance of seated work for extended periods indicates that efforts should be made at call centres to introduce more gross physical variation during the work day. Appropriate and effective initiatives for realizing this intervention need to be identified

  • 33.
    Trygged, Sven
    et al.
    Stockholms universitet, Institutionen för socialt arbete - Socialhögskolan.
    Ahacic, Kozma
    Kåreholt, Ingemar
    Stockholms universitet, Institutionen för socialt arbete - Socialhögskolan.
    Income and education as predictors of return to working life among younger stroke patients2011In: BMC Public Health, E-ISSN 1471-2458, Vol. 11, p. 742-Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic conditions are not only related to poor health outcomes, they also contribute to the chances of recovery from stroke. This study examines whether income and education were predictors of return to work after a first stroke among persons aged 40-59. Methods: All first-stroke survivors aged 40-59 who were discharged from a hospital in 1996-2000 and who had received income from work during the year prior to the stroke were sampled from the Swedish national register of in-patient care (n = 7,081). Income and education variables were included in hazard regressions, modelling the probability of returning to work from one to four years after discharge. Adjustments for age, sex, stroke subtype, and length of in-patient care were included in the models. Results: Both higher income and higher education were associated with higher probability of returning to work. While the association between education and return to work was attenuated by income, individuals with university education were 13 percent more likely to return than those who had completed only compulsory education, and individuals in the highest income quartile were about twice as likely to return as those in the lowest. The association between socioeconomic position and return to work was similar for different stroke subtypes. Income differences between men and women also accounted for women's lower probability of returning to work. Conclusions: The study demonstrates that education and income were independent predictors of returning to work among stroke patients during the first post-stroke years. Taking the relative risk of return to work among those in the higher socioeconomic positions as the benchmark, there may be considerable room for improvement among patients in lower socioeconomic strata.

  • 34.
    Wang, Mo
    et al.
    Karolinska institutet.
    Ropponen, Annina
    Karolinska institutet; Finnish Institute of Occupational Health, Helsinki, Finland.
    Narusyte, Jurgita
    Karolinska institutet.
    Helgadóttir, Björg
    Karolinska institutet, The Swedish School of Sport and Health Sciences.
    Bergström, Gunnar
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska institutet.
    Blom, Victoria
    Karolinska institutet, The Swedish School of Sport and Health Sciences.
    Svedberg, Pia
    Karolinska institutet.
    Adverse outcomes of chronic widespread pain and common mental disorders in individuals with sickness absence – a prospective study of Swedish twins2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, article id 1301Article in journal (Refereed)
    Abstract [en]

    Chronic widespread pain (CWP) and common mental disorders (CMDs) are common public health problems, but little is known about the role of CWP and CMDs on future adverse outcomes among work disabled individuals. The aims of the study were to investigate the associations between CWP and CMDs with subsequent disability pension (DP), long-term unemployment (> 90 days) and all-cause mortality in individuals with sickness absence (SA) and whether the associations were explained by familial factors.

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