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Biomedical subjects

T Theorell

Publications and source records attributed to T Theorell.

At least 37 records · Page 2Linked to original sources

Association between job stress and depression among Japanese employees threatened by job loss in a comparison between two complementary job-stress models.

OBJECTIVES: This study compared the separate effects produced by two complementary stress models--the job demand-control model and the effort-reward imbalance model--on depression among employees threatened by job loss. METHODS: A cross-sectional analysis was conducted to examine these associations among 190 male and female employees who responded to a self-administered questionnaire in a small Japanese plant with economic hardship. The employees were engaged in 2 job types--direct assembly line and indirect supportive tasks--and the latter was threatened by job loss because of downsizing. Independent variables were measured by the Japanese versions of Karasek's demand-control questionnaire and Siegrist's effort-reward imbalance questionnaire. Depression was assessed by the Center for Epidemiologic Studies Depression Scale. RESULTS: The employees with indirect supportive tasks (target for downsizing) were more likely to have depressive symptoms than direct assembly-line workers. Job strain, a combination of high demand and low control at work, was more frequent among the latter, while the combination of high effort and low reward was more frequent among the former. After adjustment for work environment factors, low control [odds ratio (OR) 4.7], effort reward imbalance (OR 4.1), and overcommitment (the person characteristic included in the effort-reward imbalance model) (OR 2.6) were independently related to depression. There is some indication that these effects were particularly strong in the subgroup suffering from potential job loss. CONCLUSIONS: This study confirms that the 2 job stress models identify different aspects of stressful job conditions. Moreover, effort-reward imbalance and low control at work are both associated with symptoms of depression.

Adult↗

Changes in quality of life after hormonal treatment of endometriosis.

BACKGROUND: To assess whether hormonal treatment of endometriosis improves quality of life for women with endometriosis. METHODS: In a prospective, randomized, double-blind, double-dummy study on 48 women with verified endometriosis, the pain pattern and quality of life were registered before, during and after treatment with nafarelin or medroxyprogesterone acetate. The distribution of the studied parameters were tested by means of a Skewness test. ANOVA analysis was used for normally distributed variables and Friedman's analysis and Mann-Whitney U-test for non normally distributed variables. RESULTS: There was a difference between the 30 women who participated all through the study and the 18 who dropped out. It was noticeable that anxiety-depression and sleep disturbances were significantly more common among the drop outs. There was a significant reduction in symptom score during the study, without any significant difference between the treatment groups. The sleep disturbances and anxiety-depression score improved significantly from before treatment to the end of the follow-up, but the anxiety-depression score increased during the nafarelin treatment period. There was a statistically significant improvement of paid working life in the nafarelin treated group. All the other psycho-social parameters as well as emotional balance improved during the study period without difference between groups. CONCLUSION: When hormonal treatment is planned it is very important to take into consideration previous psychosocial experiences of the patient. Factors of importance for quality of life such as sleep disturbances and anxiety-depression improved significantly after treatment with nafarelin or medroxyprogesterone acetate.

Adolescent↗

To what extent do current and past physical and psychosocial occupational factors explain care-seeking for low back pain in a working population? Results from the Musculoskeletal Intervention Center-Norrtälje Study.

STUDY DESIGN: A population-based case referent study. OBJECTIVES: To determine whether current and past physical and psychosocial occupational factors are associated with care-seeking for low back pain in working men and women. SUMMARY OF BACKGROUND DATA: The importance of physical and psychosocial workloads as causal factors of low back pain has mostly been investigated in special occupational groups and with a cross-sectional design, which makes generalizability and interpretations more difficult. METHODS: The study comprised 2118 working men and women 20 to 59 years old (695 cases, and 1423 referents). Cases were defined as persons seeking care by any caregiver for low back pain. The exposure assessments were made through questionnaires and interviews about current and past physical and psychosocial loads during work and leisure time. RESULTS: In a logistic regression analysis, physical load from forward bending in men (RR = 1.8) and high physical load, in general, in women (RR = 2.0) showed increased relative risks. Psychosocial factors alone seemed to be of less importance in women, but "poor job satisfaction" and "mostly routine work without possibilities of learning" increased the risk in men. Combined current and past exposures further increased the risks. A combination of high physical and psychosocial loads increased the risk substantially, but few were exposed to such loads. Adjustment for lifestyle and other loads outside work did not change the results. CONCLUSION: Current and past physical and psychosocial occupational factors, both separately and combined, seem to be gender-specific, and to have a moderate impact on care-seeking for low back pain in a general working population.

Adult↗

The impact of life events in female patients with fibromyalgia and in female healthy controls.

The aim was to investigate if female fibromyalgia patients (FMS) had experienced more negative life events than healthy women. Furthermore, the life events experienced in relation to onset of the FMS were evaluated. Another important area was to investigate the impact of the events experienced in the patients compared to healthy women. A new inventory was constructed to assess life events during childhood, adolescence and in adulthood as well as life events experienced in relation to the onset of the disorder. Forty female FMS patients and 38 healthy age-matched women participated in the study. During childhood or adolescence 51% of the patients had experienced very negative life events as compared to 28% of the controls. Conflict with parents was the most common life event. Before onset, 65% of the patients experienced some negative life event. Economic problems and conflicts with husband/partner were common. During the last year, 51% of the patients had life events which they experienced as very negative, compared to 24.5% of the controls (P < 0.01). Stressful life events in childhood/adolescence and in adulthood seem to be very common in FMS. Furthermore, the life events were experienced as more negative than the life events experienced by healthy controls.

Adult↗

Coping with anger-provoking situations, psychosocial working conditions, and ECG-detected signs of coronary heart disease.

This study explored the association among coping, psychosocial work factors, and signs of coronary heart disease (CHD) among prison staff (777 men, 345 women). Electrocardiogram (ECG) recordings at rest, health examinations, and a questionnaire were used. A high level of covert coping in men and a low level of open coping in women showed the strongest association with signs of CHD. Among several traditional biological and lifestyle risk factors, only age and systolic blood pressure in men and none in the case of women were significantly associated with CHD signs in the final multivariate regression analyses. A coping style of repressed emotions and actions in anger-provoking situations, independent of traditional risk factors, seems to be associated with a prevalence of ECG signs in male and female prison staff.

Adaptation, Psychological↗

Effect of change in the psychosocial work environment on sickness absence: a seven year follow up of initially healthy employees.

STUDY OBJECTIVE: To investigate the impact of changes in psychosocial work environment on subsequent sickness absence. DESIGN: Analysis of questionnaire and sickness absence data collected in three time periods: 1990-1991, before the recession; 1993, worst slump during the recession; and 1993-1997, a period after changes. SETTING: Raisio, a town in south western Finland, during and after a period of economic decline. PARTICIPANTS: 530 municipal employees (138 men, 392 women) working during 1990-1997 who had no medically certified sick leaves in 1991. Mean length of follow up was 6.7 years. MAIN RESULTS: After adjustment for the pre-recession levels, the changes in the job characteristics of the workers during the recession predicted their subsequent sick leaves. Lowered job control caused a 1.30 (95% CI = 1.19, 1.41) times higher risk of sick leave than an increase in job control. The corresponding figures in relation to decreased social support and increased job demands were 1.30 (95% CI = 1.20, 1.41) and 1.10 (95% CI = 1.03, 1.17), respectively. In some cases there was an interaction with socioeconomic status, changes in the job characteristics being stronger predictors of sick leaves for employees with a high income than for the others. The highest risks of sick leave (ranging from 1.40 to 1.90) were associated with combined effects related to poor levels of and negative changes in job control, job demands and social support. CONCLUSION: Negative changes in psychosocial work environment have adverse effects on the health of employees. Those working in an unfavourable psychosocial environment before changes are at greatest risk.

Adolescent↗

Higher relative, but lower absolute risks of myocardial infarction in women than in men: analysis of some major risk factors in the SHEEP study. The SHEEP Study Group.

OBJECTIVES: Middle-aged men have often been the subjects of multifactorial studies of myocardial infarction (MI) risk factors. One major objective of the SHEEP study was to compare the effects of different MI risk factors in women and men. DESIGN: SHEEP (Stockholm Heart Epidemiology Program) is a population-based case-referent study of causes of MI (first event) in Swedish women and men aged 45-70 years. During the period 1992-94, 2246 cases of MI were identified; 34% of the cases were women and 27% of the cases were fatal. One referent per case was chosen randomly from the Stockholm County population after stratification for the case's sex and age. Logistic regression was used to estimate the relative risks associated with risk factors of primary interest (diabetes, hypercholesterolaemia, hypertriglyceridaemia, hypertension, overweight, physical inactivity, smoking and job strain). RESULTS: The relative risk estimates ranged from 1.5 to 4.4 in women and from 1.3 to 2.9 in men (results for nonfatal cases and their referents). None of the 95% confidence intervals included 1.0. The relative risks were higher in the women than in the men (101-180%). The absolute risks, however, were all lower in the women than in the men. Estimates of Rothman's synergy index for gender ranged from 1.0 (hypertension) to 1.8 (current smoking). CONCLUSIONS: The indications of some effect modification due to sex (stronger risks in men for certain exposures) invoke the question of possible mechanisms.

Aged↗

Association between job characteristics and plasma fibrinogen in a normal working population: a cross sectional analysis in referents of the SHEEP Study. Stockholm Heart Epidemiology Program.

STUDY OBJECTIVE: To explore the association between job characteristics and plasma fibrinogen concentrations. DESIGN: Cross sectional design. SETTING: The Greater Stockholm area. SUBJECTS: A total of 1018 men and 490 women aged 45-70 who were randomly selected from the general population during 1992-1994. They were all employed and had no history of myocardial infarction. MAIN RESULTS: The self reported job characteristics were measured by a Swedish version of the Karasek demand-control questionnaire. For inferred scoring of job characteristics, psychosocial exposure categories (job control and psychological demands) were assigned by linking each subject's occupational history with a work organisation exposure matrix. Job strain was defined as the ratio between demands and control. In univariate analyses, expected linear trends were found in three of four tests of association between high plasma fibrinogen and low control (the self reported score for women and the inferred score for both sexes), in one of four tests of association between high plasma fibrinogen and high demands (the inferred score for women) and in two of four tests of association between high plasma fibrinogen and job strain (the inferred score for both sexes). Multiple logistic regression analyses showed that men in the inferred job strain group have an increased risk of falling into the increased plasma fibrinogen concentration group (above median level of the distribution) (odds ratio (OR) 1.2; 95% CI 1.0, 1.5) after adjustment for the variables that were associated with plasma fibrinogen in the univariate analyses. In women, low self reported control, high inferred demand, and inferred job strain were significantly associated with increased plasma fibrinogen concentration (OR 1.3; 95% CI 1.0, 1.8, OR 1.5; 95% CI 1.0, 2.2, OR 1.5; 95% CI 1.1, 2.2, respectively). CONCLUSIONS: These results indicate that adverse job characteristics may be related to plasma fibrinogen concentrations and this relation is more relevant in female workers. The clearest evidence for psychosocial effects on plasma fibrinogen seems to be with job control and the associations are clearer for the objective than for the self report variables.

Aged↗

Shiftwork and myocardial infarction: a case-control study.

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 relation between shiftwork, job strain, and myocardial infarction. METHODS: 2006 cases with acute first time myocardial infarction were compared with 2642 controls without symptoms of myocardial infarction, and obtained from the same population that gave rise to the cases (population based case-control study). RESULTS: Myocardial infarction risk was associated with shiftwork both in men (odds ratio (OR) 1.3, 95% confidence interval (95% CI) 1.1 to 1.6) and women (OR 1.3, 95% CI 0.9 to 1.8). In the age group 45-55, the relative risk was 1.6 in men and 3.0 in women. The results cannot be explained by job strain, age, job education level, or smoking. No interaction was found between shiftwork and job strain. CONCLUSIONS: The findings indicate that shiftwork is associated with myocardial infarction in both men and women. The mechanism is unclear, but the relation cannot be explained by job strain, smoking, or job education level.

Aged↗

Low plasma prolactin levels in patients with functional dyspepsia.

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, plasma cortisol and prolactin. RESULTS: Mean plasma cortisol concentration correlated negatively with diarrhoea symptoms (partial correlation; p < 0.01). The level of plasma proclatin ( microg/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 increased significantly in both groups. When the whole sample was divided according to degree of reflux symptoms, those with high reflux symptomatology had lower prolactin (ANCOVA with covariates for group, gender, age, body mass index and smoking; p < 0.05). CONCLUSION: Plasma prolactin concentration was significantly lower in FD patients compared to a matched control group. A high degree of reflux symptoms was significantly associated with inhibition of the prolactin increase during a stress interview.

Adult↗

How to deal with stress in organizations?--a health perspective on theory and practice.

This review is focused on organizational aspects of stress reduction. Theoretical models are presented. The association with a few health outcomes (cardiovascular disease, musculoskeletal disorders, and functional gastrointestinal illness) is examined. A few examples of evaluations of health consequences of improved work organization are introduced. Realistic expectations are discussed against the background of etiologic fractions. Concepts like psychological demands, decision latitude, social support, and effort-reward balance or imbalance are discussed and related to practical reorganizational efforts.

Humans↗

Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude? Results from Stockholm Heart Epidemiology Program (SHEEP).

The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material is a population-based case-referent study having incident first events of myocardial infarction as outcome (SHEEP: Stockholm Heart Epidemiology Program). The analysis is restricted to males 45-64 yr of age with a more detailed analysis confined to those still working at inclusion. In total, 1047 cases and 1450 referents were included in the analysis. Exposure categories of job strain were formed from self reported questionnaire information. The results show that high demands and low decision latitude interact with a synergy index of 7.5 (95% C.I.: 1.8-30.6) providing empirical support for the core mechanism of the job strain model. Manual workers are more susceptible when exposed to job strain and its components and this increased susceptibility explains about 25-50% of the relative excess risk among manual workers. Low decision latitude may also, as a causal link, explain about 30% of the socioeconomic difference in risk of myocardial infarction. The distinction between the interaction and the causal link mechanisms identifies new etiologic questions and intervention alternatives. The specific causes of the increased susceptibility among manual workers to job strain and its components seem to be an interesting and important research question.

Case-Control Studies↗

Psychophysiologic sensitization to headlight glare among professional drivers with and without cardiovascular disease.

Previous studies have shown that young, healthy professional drivers show heightened central nervous system arousal and cardiovascular hyperreactivity to simulated headlight glare. Electroencephalographic and cardiovascular response and recovery to simulated headlight glare (the glare pressor test) were examined in 4 groups of male professional drivers (age 25-52 years)--12 with ischemic heart disease (IHD), 12 with hypertension (HTN), 10 with borderline hypertension (BHTN), and 34 who were healthy--and in 23 non-professional driver controls--with the aim of assessing sensitization to this night driving stressor in relation to degree of cardiovascular disease severity. After glare exposure the IHD drivers showed the most pronounced alpha blockade, a rise in diastolic blood pressure (DBP; p < .05), and, unlike the other groups, a persistent fall in finger pulse volume (p < .02). The BHTN group reacted initially with DBP rise and finger pulse drop (ps < .05 and .02, respectively), mainly without central nervous system arousal. The DBP remained constant in normotensive professional drivers older than 40. The drivers' cardiovascular responses to glare were inversely related to reported stressors and subjective experience. Anxiety trait and long work hours were associated with heightened central arousal to glare in professional drivers. The results suggest that there may be progressive degrees of sensitization to glare exposure in these samples, with the least among normotensive professional drivers older than 40, moderate levels in borderline hypertensives, and the most severe in drivers with IHD.

Adaptation, Psychological↗