Background. Utilization of professional care during childbirth by women in low-income countries i... more Background. Utilization of professional care during childbirth by women in low-income countries is important for the progress towards MDG 5. In Yemen, home births have decreased minimally during the past decades. Objective. The study investigates the influence of socio-demographic, birth outcome and demand factors on women's future preference of a home or institutional childbirth. Method. We interviewed 220 women with childbirth experience in urban/rural Yemen. We performed bivariate chisquare tests and multiple logistic regression analysis. A multistage sampling process was used. Results. The issues of own choice, birth support and birth complications were the most important for women's preference of future location of childbirth. Women who had previously been able to follow their own individual choice regarding birth attendance and/or location of childbirth were six times more likely to plan a future childbirth in the same location and women who received birth support four times more likely. Birth complications were associated with a 2.5-fold decrease in likelihood. Conclusions. To offer women with institutional childbirth access to birth support is crucial in attracting women to professional care during childbirth. Yemeni women's low utilization of modern delivery care should be seen in the context of women's low autonomy and status.
Objectives: In the effort to increase utilization of professional care during childbirth in low-i... more Objectives: In the effort to increase utilization of professional care during childbirth in low-income countries, few studies have taken a holistic approach to investigating women's perspective of safety and the link to perceived own authority at birth. The aim of the study was to examine women's authority at birth with reference to the intrapartum factors, the level of training of staff and the social and demographic background of women. Study design: A multistage (stratified-purposive-random) sampling process was used. Main outcome measures: We interviewed 220 women with childbirth experience in urban/rural Yemen. We performed bivariate chi-square tests and multiple logistic regression analysis. Results: Women who had their questions answered and requests met during childbirth had 83% higher probability (95% CI 1.66-2.02) to perceive own authority. Women who reported skin-to-skin contact/ newborn in arms had 28% higher (95% CI 1.03-1.59) and those who had more distant contact 15% lower (95% CI 0.75-0.95) probability. A graded negative association was found between the perceived authority of the woman in childbirth and the level of biomedical training of staff (p < .0001). Women's social and demographic background played no role for their perceived own authority at birth. Conclusions: This paper argues that supporting Yemeni women to exercise their own authority during childbirth would significantly facilitate their ability to give birth successfully and with personal satisfaction. In a country where women are routinely disempowered, their personal empowerment at birth is very important to them. Skilled birth assistants often, in women's perceptions, work against their personal power and authority, most especially MDs but also midwives. This failure results in women failing to seek medical care when needed. Supporting women to experience their own authority at birth would facilitate the accomplishment of both the Millennium Development Goals and those of the Safe Motherhood Initiative. We call for increased cooperation between modern and traditional methods of care.
Background. Few studies from low-income countries have addressed women's fear of childbirth (FOC)... more Background. Few studies from low-income countries have addressed women's fear of childbirth (FOC) although likely to affect women during both pregnancy and childbirth. The aim of this study was to explore FOC in a high maternal mortality setting on the Arabian Peninsula, Yemen. Methods. A multi-stage (stratified–purposive–random) sampling process was used. We interviewed 220 women with childbirth experience in urban/rural Yemen. Answers to the question "Were you afraid of giving birth?" were analyzed using qualitative content analysis. Results. Women perceived childbirth as a place of danger. Fear of death and childbirth complications stemming from previous traumatic childbirth and traumatic experience in the community was rampant. Husbands' and in-laws' disappointment in a girl infant constituted a strong socio-cultural component of FOC. Women's perception of living in tension between worlds of tradition and modernity reinforced fear of institutional childbirth. Women without FOC gave reasons of faith, social belonging and trust in either traditional or modern childbirth practice, past positive experience of childbirth and the desire for social status associated with children. Conclusions. The numerous maternal and infant deaths have a strong impact on women's FOC. Antenatal care has an important role in reducing fear including that of institutional childbirth and in strengthening a couple in welcoming a female infant. Staff should be sensitized to the fears of both husband and wife and women be allowed support during childbirth. Within the scope of the Millennium Development Goals and strengthening of reproductive mental health programs , FOC urgently needs to be addressed.
Background: Practitioners and decision makers in the medical and insurance systems need knowledge... more Background: Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies – original as well as reviews-restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms. Methods: A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990–2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1–5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used.
Aim: Many individuals play an instrument or sing during childhood, but they often stop later in l... more Aim: Many individuals play an instrument or sing during childhood, but they often stop later in life. This study surveyed adults representative of the Swedish population about musical activities during childhood.
Although the health risk of socioeconomic disadvantage over the life-course is fairly established... more Although the health risk of socioeconomic disadvantage over the life-course is fairly established, the mechanisms are less studied. One candidate pathway is long-term dysregulation of cortisol. This study assesses whether socioeconomic trajectories from adolescence to adulthood influences the regulation of cortisol in mid-adulthood, and further investigates the importance of adolescence as a critical period and of accumulation of socioeconomic disadvantage. Participants were drawn from a 27-year prospective cohort study (n=732, 68% of the original cohort). Information on socioeconomic status (SES) was collected at the ages of 16 (based on parental occupation), 21, 30 and 43 (based on own occupation) years, and at 43 years participants collected one-day salivary cortisol samples at awakening, after 15min, before lunch and at bedtime. We found that the cortisol awakening response (CAR) differed with respect to SES trajectory; those with stable low or early low/upwardly mobile SES tended to display higher CAR than those with early high/downwardly mobile, highly mobile or stable high trajectories. Further analyses revealed that early low SES was related to higher CAR, and in women low SES was related to lower bedtime cortisol, independently of later SES and potential confounders. We found no support for a linear effect of accumulation of socioeconomic disadvantage. In conclusion, our study gives support for an independent effect of low socioeconomic status early in life, on the regulation of cortisol in adulthood.
Three patients with documented peptic ulcer and four patients with depressive disorder were follo... more Three patients with documented peptic ulcer and four patients with depressive disorder were followed every month for 10 to 14 months. A life events inventory, clinical ratings of depressive mood and ulcer symptoms, and analysis of the urinary excretion of cortisol and melatonin were used on every occasion. Although the number of patients was small a few tentative findings were made. First of all, associations between life events and depressive mood seemed to be "delayed" more often in the ulcer patients than in the depression patients. Secondly, there were individual associations between cortisol excretion and life events or between cortisol excretion and ulcer symptoms, but these associations seemed to form individual patterns. Two of the ulcer patients who had correlations in the expected directions showed a personality profile close to the one expected from classical literature, whereas the third patient who showed no correlations showed alexithymic traits.
Background: The purpose was to compare the levels and patterns of plasma cortisol and prolactin i... more Background: The purpose was to compare the levels and patterns of plasma cortisol and prolactin in patients with functional dyspepsia (FD) during a controlled laboratory experiment. Method: 25 patients (12 men, 13 women), aged 24–50, with recurrent FD, and 25 pair-wise gender- and age-matched community control subjects were studied at a gastroenterological laboratory in a Swedish university hospital. In an experiment, after a rest period, subjects were studied during a neutral interview and a stress interview. Before and during interventions, blood samples were drawn for later peptide analyses. The main outcome measures were the Gastrointestinal Symptom Rating Scale, heart rate, blood pressure, plas- ma cortisol and prolactin. Results: Mean plasma corti- sol concentration correlated negatively with diarrhoea symptoms (partial correlation; p ! 0.01). The level of plasma proclatin (Ìg/l) was significantly lower (paired t test; p ! 0.01) in the patient group (mean = 3.34, CI: 2.75– 3.93) compared to the control group (mean = 4.70, CI: 3.63–5.78). During the stress interview, prolactin in- creased significantly in both groups. When the whole sample was divided according to degree of reflux symp-
toms, those with high reflux symptomatology had lower prolactin (ANCOVA with covariates for group, gender, age, body mass index and smoking; p ! 0.05). Conclu- sion: Plasma prolactin concentration was significantly lower in FD patients compared to a matched control group. A high degree of reflux symptoms was signifi- cantly associated with inhibition of the prolactin increase during a stress interview.
We examined if the accumulation of neighborhood disadvantages from adolescence to mid-adulthood w... more We examined if the accumulation of neighborhood disadvantages from adolescence to mid-adulthood were related to allostatic load, a measure of cumulative biological risk, in mid-adulthood, and explored whether this association was similar in women and men. Data were from the participants in the Northern Swedish Cohort (analytical n = 818) at ages 16, 21, 30, and 43 years in 1981, 1986, 1995, and 2008. Personal living conditions were self-reported at each wave. At age 43 years, 12 biological markers were measured to operationalize allostatic load. Registered data for all residents in the cohort participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; neighborhoods at each wave were used to construct a cumulative measure of neighborhood disadvantage. Associations were examined in ordinary least-squares regression models. We found that cumulative neighborhood disadvantage between ages 16 and 43 years was related to higher allostatic load at age 43 years after adjusting for personal living conditions in the total sample (B = 0.11; P = .004) and in men (B = 0.16; P = .004), but not in women (B = 0.07; P = .248). Our findings suggested that neighborhood disadvantage acted cumulatively over the life course on biological wear and tear, and exemplified the gains of integrating social determinants of health frameworks.
Background: Numerous cross-sectional studies have examined neighborhood effects on health. Reside... more Background: Numerous cross-sectional studies have examined neighborhood effects on health. Residential selection in adulthood has been stressed as an important cause of selection bias but has received little empirical attention, particularly its determinants from the earlier life course. The present study aims to examine whether neighborhood, family, school, health behaviors and health in adolescence are related to socioeconomic disadvantage of one's neighborhood of residence in adulthood.
Background and Purpose—A socioeconomic gradient in stroke has been demonstrated in a variety of s... more Background and Purpose—A socioeconomic gradient in stroke has been demonstrated in a variety of settings, but mostly in men. Our purpose was to establish whether a socioeconomic gradient in stroke existed in a group of Swedish women and whether this gradient could be explained by established stroke risk factors or psychosocial factors. Methods—The Women's Lifestyle and Health Cohort Study includes
OBJECTIVES: Previous studies have indicated an association between shiftwork and coronary heart d... more OBJECTIVES: Previous studies have indicated an association between shiftwork and coronary heart disease. The increased risk could be due to job strain, which could act as a mediator of disease. There is also a possibility that interaction between shiftwork and job strain could occur that may induce or modify the development of disease. We conducted this study to explore the
The objective of this study was to investigate the relationship between managerial leadership and... more The objective of this study was to investigate the relationship between managerial leadership and self-reported sickness absence/presenteeism among Swedish men and women. Five thousand one hundred and forty-one Swedish employees, 56% of the participants in a nationally representative sample of the Swedish working population, were included in this cross-sectional questionnaire study. The leadership dimensions measured were five subscales of a standardized leadership questionnaire (Global Leadership and Organizational Behaviour Effectiveness Programme): Integrity, Team integration, Inspirational leadership, Autocratic leadership, and Self-centred leadership. Multiple logistic regression analyses were conducted, adjusting for factors in private life, employment category, labour-market sector, working conditions, self-reported general health, and satisfaction with life in general. Inspirational leadership was associated with a lower rate of short spells of sickness absence (<1 week) ...
Journal of epidemiology and community health, 2005
Recent changes in labour market conditions and in the organisation of work in developed societies... more Recent changes in labour market conditions and in the organisation of work in developed societies have increased exposure to work related stress. The question is whether this also implies an increased risk of myocardial infarction, either through the triggering effect of acute stress, or through accumulation of stress over several months. A case-control and a case-crossover study design was applied. The Stockholm heart epidemiology programme (SHEEP), in Stockholm County during 1992 to 1994. Patients with a first episode of non-fatal acute myocardial infarction, a total of 1381 men and women, responded to questionnaires and participated in interviews and health examinations. The case-crossover analysis showed triggering effects of sudden, short term situations of increased work load or work competition. Having "had a high pressure deadline at work" entailed a sixfold increase in risk of myocardial infarction (OR = 6.0 95% CI (1.8 to 20.4)) during the next 24 hours. The impo...
The combination of population ageing and increasingly early labour market exit (LME) throughout E... more The combination of population ageing and increasingly early labour market exit (LME) throughout Europe has made older age a key issue in social policy and research. There is increasing awareness that older people are a heterogeneous group in which health inequalities persist. However, the effects of different types of LME on health have received relatively little attention. Existing studies reach different conclusions. This might be due to several reasons: different types of LME are rarely explored in conjuncture; studies often lack objective assessments of health and frequently rely on small populations. This paper aims to test the relative effects of different LME on the risk of hospitalization compared with those who remained in paid employment. Using Government register data on pooled cross-section samples of Swedish workers aged 55-63 years (n=7,024) the authors have compared the likelihood of hospitalization for three types of LME - disability pension (fortidpension), unemploy...
To examine secular trends in work-related sleep disturbances and their association with sickness ... more To examine secular trends in work-related sleep disturbances and their association with sickness absence in the Swedish working population. Nationally representative cross-sectional samples of the Swedish working population aged 16-64 (the biennial Swedish Work Environment Survey) in 1993, 1995, and 1999 respectively. Questionnaire data on work-related sleep disturbances were linked to records of medically-certified sick-leave spells exceeding 14 days obtained from national registers. All Sweden. A total of 28,424 individuals aged 16-65 with complete data (5162/5173 women/men in 1993; 4635/4764 in 1995; and 4422/4268 in 1999). N/A. The age-adjusted proportion of women with work-related sleep disturbances at least once a week increased from 12.3% in 1993 to 21.7% in 1999 (P < 0.001). The corresponding figures for men were 12.5% to 18.6% (P < 0.001). There was a strong cross-sectional association between work-related sleep disturbances and sickness absence in both genders and in...
The aim of this study was to analyse experiences of moral concerns in intensive care nursing. The... more The aim of this study was to analyse experiences of moral concerns in intensive care nursing. The theoretical perspective of the study is based on relational ethics, also referred to as ethics of care. The participants were 36 intensive care nurses from 10 general, neonatal and thoracic intensive care units. The structural characteristics of the units were similar: a high working pace, advanced technology, budget restrictions, recent reorganization, and shortage of experienced nurses. The data consisted of the participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; examples of ethical situations they had experienced in their intensive care unit. A qualitative content analysis identified five themes: believing in a good death; knowing the course of events; feelings of distress; reasoning about physicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;doings&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and tensions in expressing moral awareness. A main theme was formulated as caring about--caring for: moral obligations and work responsibilities. Moral obligations and work responsibilities are assumed to be complementary dimensions in nursing, yet they were found not to be in balance for intensive care nurses. In conclusion there is a need to support nurses in difficult intensive care situations, for example, by mentoring, as a step towards developing moral action knowledge in the context of intensive care nursing.
Twenty-one participants in a mobilising labour market project offering temporary, alternative emp... more Twenty-one participants in a mobilising labour market project offering temporary, alternative employment in Sweden were followed longitudinally for one year, including a six month post-participation follow-up period. Earlier analyses of self-rated psychosocial data have indicated consistent improvements in mental health and quality of life. In the present study, however, a significant rise in serum prolactin, plus decreased dehydro-epiandro-sterone sulphate levels and tendencies towards increased alanine aminotransferase, g-glutamyl transferase and diastolic blood pressure, seem to disconfirm the hypothesis that biological markers of psychosocial health would improve in a similar fashion. It is speculated that this apparent inconsistency could be part of a protective adaptation to long-term unemployment similar to the cocooning tendencies in maternal behaviour. Specifically, we argue that this could protect against the stress of being in an uncontrollable and 'helpless' situation by facilitating a re-focusing on more private matters as opposed to 'hopeless' job seeking. While being potentially detrimental for people with fair chances on the labour market, it is possible that such an adaptation may be helpful for more vulnerable groups. #
Global Perspectives on Research and Practice, 2010
This chapter describes scientific discussions about leadership in Sweden during the past two deca... more This chapter describes scientific discussions about leadership in Sweden during the past two decades and sets them against the historical background. One of the main themes in this discussion has been participatory leadership. While this kind of managerial lead-ership seems to ...
Background. Utilization of professional care during childbirth by women in low-income countries i... more Background. Utilization of professional care during childbirth by women in low-income countries is important for the progress towards MDG 5. In Yemen, home births have decreased minimally during the past decades. Objective. The study investigates the influence of socio-demographic, birth outcome and demand factors on women's future preference of a home or institutional childbirth. Method. We interviewed 220 women with childbirth experience in urban/rural Yemen. We performed bivariate chisquare tests and multiple logistic regression analysis. A multistage sampling process was used. Results. The issues of own choice, birth support and birth complications were the most important for women's preference of future location of childbirth. Women who had previously been able to follow their own individual choice regarding birth attendance and/or location of childbirth were six times more likely to plan a future childbirth in the same location and women who received birth support four times more likely. Birth complications were associated with a 2.5-fold decrease in likelihood. Conclusions. To offer women with institutional childbirth access to birth support is crucial in attracting women to professional care during childbirth. Yemeni women's low utilization of modern delivery care should be seen in the context of women's low autonomy and status.
Objectives: In the effort to increase utilization of professional care during childbirth in low-i... more Objectives: In the effort to increase utilization of professional care during childbirth in low-income countries, few studies have taken a holistic approach to investigating women's perspective of safety and the link to perceived own authority at birth. The aim of the study was to examine women's authority at birth with reference to the intrapartum factors, the level of training of staff and the social and demographic background of women. Study design: A multistage (stratified-purposive-random) sampling process was used. Main outcome measures: We interviewed 220 women with childbirth experience in urban/rural Yemen. We performed bivariate chi-square tests and multiple logistic regression analysis. Results: Women who had their questions answered and requests met during childbirth had 83% higher probability (95% CI 1.66-2.02) to perceive own authority. Women who reported skin-to-skin contact/ newborn in arms had 28% higher (95% CI 1.03-1.59) and those who had more distant contact 15% lower (95% CI 0.75-0.95) probability. A graded negative association was found between the perceived authority of the woman in childbirth and the level of biomedical training of staff (p < .0001). Women's social and demographic background played no role for their perceived own authority at birth. Conclusions: This paper argues that supporting Yemeni women to exercise their own authority during childbirth would significantly facilitate their ability to give birth successfully and with personal satisfaction. In a country where women are routinely disempowered, their personal empowerment at birth is very important to them. Skilled birth assistants often, in women's perceptions, work against their personal power and authority, most especially MDs but also midwives. This failure results in women failing to seek medical care when needed. Supporting women to experience their own authority at birth would facilitate the accomplishment of both the Millennium Development Goals and those of the Safe Motherhood Initiative. We call for increased cooperation between modern and traditional methods of care.
Background. Few studies from low-income countries have addressed women's fear of childbirth (FOC)... more Background. Few studies from low-income countries have addressed women's fear of childbirth (FOC) although likely to affect women during both pregnancy and childbirth. The aim of this study was to explore FOC in a high maternal mortality setting on the Arabian Peninsula, Yemen. Methods. A multi-stage (stratified–purposive–random) sampling process was used. We interviewed 220 women with childbirth experience in urban/rural Yemen. Answers to the question "Were you afraid of giving birth?" were analyzed using qualitative content analysis. Results. Women perceived childbirth as a place of danger. Fear of death and childbirth complications stemming from previous traumatic childbirth and traumatic experience in the community was rampant. Husbands' and in-laws' disappointment in a girl infant constituted a strong socio-cultural component of FOC. Women's perception of living in tension between worlds of tradition and modernity reinforced fear of institutional childbirth. Women without FOC gave reasons of faith, social belonging and trust in either traditional or modern childbirth practice, past positive experience of childbirth and the desire for social status associated with children. Conclusions. The numerous maternal and infant deaths have a strong impact on women's FOC. Antenatal care has an important role in reducing fear including that of institutional childbirth and in strengthening a couple in welcoming a female infant. Staff should be sensitized to the fears of both husband and wife and women be allowed support during childbirth. Within the scope of the Millennium Development Goals and strengthening of reproductive mental health programs , FOC urgently needs to be addressed.
Background: Practitioners and decision makers in the medical and insurance systems need knowledge... more Background: Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies – original as well as reviews-restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms. Methods: A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990–2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1–5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used.
Aim: Many individuals play an instrument or sing during childhood, but they often stop later in l... more Aim: Many individuals play an instrument or sing during childhood, but they often stop later in life. This study surveyed adults representative of the Swedish population about musical activities during childhood.
Although the health risk of socioeconomic disadvantage over the life-course is fairly established... more Although the health risk of socioeconomic disadvantage over the life-course is fairly established, the mechanisms are less studied. One candidate pathway is long-term dysregulation of cortisol. This study assesses whether socioeconomic trajectories from adolescence to adulthood influences the regulation of cortisol in mid-adulthood, and further investigates the importance of adolescence as a critical period and of accumulation of socioeconomic disadvantage. Participants were drawn from a 27-year prospective cohort study (n=732, 68% of the original cohort). Information on socioeconomic status (SES) was collected at the ages of 16 (based on parental occupation), 21, 30 and 43 (based on own occupation) years, and at 43 years participants collected one-day salivary cortisol samples at awakening, after 15min, before lunch and at bedtime. We found that the cortisol awakening response (CAR) differed with respect to SES trajectory; those with stable low or early low/upwardly mobile SES tended to display higher CAR than those with early high/downwardly mobile, highly mobile or stable high trajectories. Further analyses revealed that early low SES was related to higher CAR, and in women low SES was related to lower bedtime cortisol, independently of later SES and potential confounders. We found no support for a linear effect of accumulation of socioeconomic disadvantage. In conclusion, our study gives support for an independent effect of low socioeconomic status early in life, on the regulation of cortisol in adulthood.
Three patients with documented peptic ulcer and four patients with depressive disorder were follo... more Three patients with documented peptic ulcer and four patients with depressive disorder were followed every month for 10 to 14 months. A life events inventory, clinical ratings of depressive mood and ulcer symptoms, and analysis of the urinary excretion of cortisol and melatonin were used on every occasion. Although the number of patients was small a few tentative findings were made. First of all, associations between life events and depressive mood seemed to be "delayed" more often in the ulcer patients than in the depression patients. Secondly, there were individual associations between cortisol excretion and life events or between cortisol excretion and ulcer symptoms, but these associations seemed to form individual patterns. Two of the ulcer patients who had correlations in the expected directions showed a personality profile close to the one expected from classical literature, whereas the third patient who showed no correlations showed alexithymic traits.
Background: The purpose was to compare the levels and patterns of plasma cortisol and prolactin i... more Background: The purpose was to compare the levels and patterns of plasma cortisol and prolactin in patients with functional dyspepsia (FD) during a controlled laboratory experiment. Method: 25 patients (12 men, 13 women), aged 24–50, with recurrent FD, and 25 pair-wise gender- and age-matched community control subjects were studied at a gastroenterological laboratory in a Swedish university hospital. In an experiment, after a rest period, subjects were studied during a neutral interview and a stress interview. Before and during interventions, blood samples were drawn for later peptide analyses. The main outcome measures were the Gastrointestinal Symptom Rating Scale, heart rate, blood pressure, plas- ma cortisol and prolactin. Results: Mean plasma corti- sol concentration correlated negatively with diarrhoea symptoms (partial correlation; p ! 0.01). The level of plasma proclatin (Ìg/l) was significantly lower (paired t test; p ! 0.01) in the patient group (mean = 3.34, CI: 2.75– 3.93) compared to the control group (mean = 4.70, CI: 3.63–5.78). During the stress interview, prolactin in- creased significantly in both groups. When the whole sample was divided according to degree of reflux symp-
toms, those with high reflux symptomatology had lower prolactin (ANCOVA with covariates for group, gender, age, body mass index and smoking; p ! 0.05). Conclu- sion: Plasma prolactin concentration was significantly lower in FD patients compared to a matched control group. A high degree of reflux symptoms was signifi- cantly associated with inhibition of the prolactin increase during a stress interview.
We examined if the accumulation of neighborhood disadvantages from adolescence to mid-adulthood w... more We examined if the accumulation of neighborhood disadvantages from adolescence to mid-adulthood were related to allostatic load, a measure of cumulative biological risk, in mid-adulthood, and explored whether this association was similar in women and men. Data were from the participants in the Northern Swedish Cohort (analytical n = 818) at ages 16, 21, 30, and 43 years in 1981, 1986, 1995, and 2008. Personal living conditions were self-reported at each wave. At age 43 years, 12 biological markers were measured to operationalize allostatic load. Registered data for all residents in the cohort participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; neighborhoods at each wave were used to construct a cumulative measure of neighborhood disadvantage. Associations were examined in ordinary least-squares regression models. We found that cumulative neighborhood disadvantage between ages 16 and 43 years was related to higher allostatic load at age 43 years after adjusting for personal living conditions in the total sample (B = 0.11; P = .004) and in men (B = 0.16; P = .004), but not in women (B = 0.07; P = .248). Our findings suggested that neighborhood disadvantage acted cumulatively over the life course on biological wear and tear, and exemplified the gains of integrating social determinants of health frameworks.
Background: Numerous cross-sectional studies have examined neighborhood effects on health. Reside... more Background: Numerous cross-sectional studies have examined neighborhood effects on health. Residential selection in adulthood has been stressed as an important cause of selection bias but has received little empirical attention, particularly its determinants from the earlier life course. The present study aims to examine whether neighborhood, family, school, health behaviors and health in adolescence are related to socioeconomic disadvantage of one's neighborhood of residence in adulthood.
Background and Purpose—A socioeconomic gradient in stroke has been demonstrated in a variety of s... more Background and Purpose—A socioeconomic gradient in stroke has been demonstrated in a variety of settings, but mostly in men. Our purpose was to establish whether a socioeconomic gradient in stroke existed in a group of Swedish women and whether this gradient could be explained by established stroke risk factors or psychosocial factors. Methods—The Women's Lifestyle and Health Cohort Study includes
OBJECTIVES: Previous studies have indicated an association between shiftwork and coronary heart d... more OBJECTIVES: Previous studies have indicated an association between shiftwork and coronary heart disease. The increased risk could be due to job strain, which could act as a mediator of disease. There is also a possibility that interaction between shiftwork and job strain could occur that may induce or modify the development of disease. We conducted this study to explore the
The objective of this study was to investigate the relationship between managerial leadership and... more The objective of this study was to investigate the relationship between managerial leadership and self-reported sickness absence/presenteeism among Swedish men and women. Five thousand one hundred and forty-one Swedish employees, 56% of the participants in a nationally representative sample of the Swedish working population, were included in this cross-sectional questionnaire study. The leadership dimensions measured were five subscales of a standardized leadership questionnaire (Global Leadership and Organizational Behaviour Effectiveness Programme): Integrity, Team integration, Inspirational leadership, Autocratic leadership, and Self-centred leadership. Multiple logistic regression analyses were conducted, adjusting for factors in private life, employment category, labour-market sector, working conditions, self-reported general health, and satisfaction with life in general. Inspirational leadership was associated with a lower rate of short spells of sickness absence (<1 week) ...
Journal of epidemiology and community health, 2005
Recent changes in labour market conditions and in the organisation of work in developed societies... more Recent changes in labour market conditions and in the organisation of work in developed societies have increased exposure to work related stress. The question is whether this also implies an increased risk of myocardial infarction, either through the triggering effect of acute stress, or through accumulation of stress over several months. A case-control and a case-crossover study design was applied. The Stockholm heart epidemiology programme (SHEEP), in Stockholm County during 1992 to 1994. Patients with a first episode of non-fatal acute myocardial infarction, a total of 1381 men and women, responded to questionnaires and participated in interviews and health examinations. The case-crossover analysis showed triggering effects of sudden, short term situations of increased work load or work competition. Having "had a high pressure deadline at work" entailed a sixfold increase in risk of myocardial infarction (OR = 6.0 95% CI (1.8 to 20.4)) during the next 24 hours. The impo...
The combination of population ageing and increasingly early labour market exit (LME) throughout E... more The combination of population ageing and increasingly early labour market exit (LME) throughout Europe has made older age a key issue in social policy and research. There is increasing awareness that older people are a heterogeneous group in which health inequalities persist. However, the effects of different types of LME on health have received relatively little attention. Existing studies reach different conclusions. This might be due to several reasons: different types of LME are rarely explored in conjuncture; studies often lack objective assessments of health and frequently rely on small populations. This paper aims to test the relative effects of different LME on the risk of hospitalization compared with those who remained in paid employment. Using Government register data on pooled cross-section samples of Swedish workers aged 55-63 years (n=7,024) the authors have compared the likelihood of hospitalization for three types of LME - disability pension (fortidpension), unemploy...
To examine secular trends in work-related sleep disturbances and their association with sickness ... more To examine secular trends in work-related sleep disturbances and their association with sickness absence in the Swedish working population. Nationally representative cross-sectional samples of the Swedish working population aged 16-64 (the biennial Swedish Work Environment Survey) in 1993, 1995, and 1999 respectively. Questionnaire data on work-related sleep disturbances were linked to records of medically-certified sick-leave spells exceeding 14 days obtained from national registers. All Sweden. A total of 28,424 individuals aged 16-65 with complete data (5162/5173 women/men in 1993; 4635/4764 in 1995; and 4422/4268 in 1999). N/A. The age-adjusted proportion of women with work-related sleep disturbances at least once a week increased from 12.3% in 1993 to 21.7% in 1999 (P < 0.001). The corresponding figures for men were 12.5% to 18.6% (P < 0.001). There was a strong cross-sectional association between work-related sleep disturbances and sickness absence in both genders and in...
The aim of this study was to analyse experiences of moral concerns in intensive care nursing. The... more The aim of this study was to analyse experiences of moral concerns in intensive care nursing. The theoretical perspective of the study is based on relational ethics, also referred to as ethics of care. The participants were 36 intensive care nurses from 10 general, neonatal and thoracic intensive care units. The structural characteristics of the units were similar: a high working pace, advanced technology, budget restrictions, recent reorganization, and shortage of experienced nurses. The data consisted of the participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; examples of ethical situations they had experienced in their intensive care unit. A qualitative content analysis identified five themes: believing in a good death; knowing the course of events; feelings of distress; reasoning about physicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;doings&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and tensions in expressing moral awareness. A main theme was formulated as caring about--caring for: moral obligations and work responsibilities. Moral obligations and work responsibilities are assumed to be complementary dimensions in nursing, yet they were found not to be in balance for intensive care nurses. In conclusion there is a need to support nurses in difficult intensive care situations, for example, by mentoring, as a step towards developing moral action knowledge in the context of intensive care nursing.
Twenty-one participants in a mobilising labour market project offering temporary, alternative emp... more Twenty-one participants in a mobilising labour market project offering temporary, alternative employment in Sweden were followed longitudinally for one year, including a six month post-participation follow-up period. Earlier analyses of self-rated psychosocial data have indicated consistent improvements in mental health and quality of life. In the present study, however, a significant rise in serum prolactin, plus decreased dehydro-epiandro-sterone sulphate levels and tendencies towards increased alanine aminotransferase, g-glutamyl transferase and diastolic blood pressure, seem to disconfirm the hypothesis that biological markers of psychosocial health would improve in a similar fashion. It is speculated that this apparent inconsistency could be part of a protective adaptation to long-term unemployment similar to the cocooning tendencies in maternal behaviour. Specifically, we argue that this could protect against the stress of being in an uncontrollable and 'helpless' situation by facilitating a re-focusing on more private matters as opposed to 'hopeless' job seeking. While being potentially detrimental for people with fair chances on the labour market, it is possible that such an adaptation may be helpful for more vulnerable groups. #
Global Perspectives on Research and Practice, 2010
This chapter describes scientific discussions about leadership in Sweden during the past two deca... more This chapter describes scientific discussions about leadership in Sweden during the past two decades and sets them against the historical background. One of the main themes in this discussion has been participatory leadership. While this kind of managerial lead-ership seems to ...
World Congress on Developmental Origins of Health and Disease (DOHaD), 2015
The 9th World Congress in Cape Town, South Africa, brought together scientists, clinical research... more The 9th World Congress in Cape Town, South Africa, brought together scientists, clinical researchers, obstetricians, pediatricians, public health professionals and policy leaders from around the world. More than 1 200 participants including 350 speakers addressed the many challenges that currently impact the health of mothers, babies in the womb, infants, children and adolescents, as well as explored solutions, interventions and policies to optimize health across the life of people. The 9th DOHaD World Congress was the first to be held in Africa. It presented an occasion for bringing to the forefront new solutions to persisting infant and child malnutrition, the burgeoning epidemic of obesity and non-communicable diseases.
My own participation concerned an aspect of women’s reproductive mental health in a low-income country setting with a high maternal mortality: fear of childbirth. While a well-known phenomenon in Western society where fear of childbirth affects 5-30 percent of women of reproductive age, the impact of women’s mental distress on pregnancy, childbirth and the postpartum period in low-income countries is much less known.
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toms, those with high reflux symptomatology had lower prolactin (ANCOVA with covariates for group, gender, age, body mass index and smoking; p ! 0.05). Conclu- sion: Plasma prolactin concentration was significantly lower in FD patients compared to a matched control group. A high degree of reflux symptoms was signifi- cantly associated with inhibition of the prolactin increase during a stress interview.
toms, those with high reflux symptomatology had lower prolactin (ANCOVA with covariates for group, gender, age, body mass index and smoking; p ! 0.05). Conclu- sion: Plasma prolactin concentration was significantly lower in FD patients compared to a matched control group. A high degree of reflux symptoms was signifi- cantly associated with inhibition of the prolactin increase during a stress interview.
My own participation concerned an aspect of women’s reproductive mental health in a low-income country setting with a high maternal mortality: fear of childbirth. While a well-known phenomenon in Western society where fear of childbirth affects 5-30 percent of women of reproductive age, the impact of women’s mental distress on pregnancy, childbirth and the postpartum period in low-income countries is much less known.