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OBJECTIVES: While suicidal behaviour has become less prevalent in non-manual workers in recent decades, rates have increased in manual workers. We aimed to identify occupations within the construction industry with excess risk of suicide and non-fatal self-harm. METHODS: This cohort of Swedish construction workers comprises 389 132 individuals examined 1971-1993 and followed 1987-2018 using national hospital and cause of death registers. More than 200 job titles were merged into 22 occupational groups. For 296 891 men alive in 1987 and active in the construction sector, survival was calculated from baseline to first event of non-fatal self-harm or suicide and censored for emigration, long-term unemployment, disability pension, retirement, death from other causes or end of follow-up. HRs with 95% CIs were obtained from multiple Cox proportional hazard regression. RESULTS: Overall, 1618 cases of suicide and 4774 events of non-fatal self-harm were registered. Self-harm before baseline was the single largest risk factor for suicide, HR 9.3 (95% CI 7.5 to 11.6). Compared with the overall mean, labourers and rock workers had excess risk for suicide, HR 1.4 (95% CI 1.1 to 1.7) and 1.5 (95% CI 1.0 to 2.3), respectively, while electricians, clerks and foremen had reduced risk. Labourers, concrete workers, sheet metal workers, painters, glaziers and the group 'other construction workers' were at increased risk for non-fatal self-harm. Almost all categories of manual workers were at increased risk for suicidal behaviour relative to clerks and foremen. CONCLUSIONS: Specific occupations within the construction sector were associated with excess risk for suicidal behaviour. Future studies should identify underlying risk factors to inform tailored interventions.
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Industria de la Construcción , Conducta Autodestructiva , Suicidio , Humanos , Masculino , Suecia/epidemiología , Conducta Autodestructiva/epidemiología , Ocupaciones , Factores de RiesgoRESUMEN
Previously published analyses of suicide case investigations suggest that work or working conditions contribute to 10%-13% of suicide deaths. Yet, the way in which work may increase suicide risk is an underdeveloped area of epidemiologic research. In this Commentary, we propose a definition of work-related suicide from an occupational health and safety perspective, and review the case investigation-based and epidemiologic evidence on work-related causes of suicide. We identified six broad categories of potential work-related causes of suicide, which are: (1) workplace chemical, physical, and psychosocial exposures; (2) exposure to trauma on the job; (3) access to means of suicide through work; (4) exposure to high-stigma work environments; (5) exposure to normative environments promoting extreme orientation to work; and (6) adverse experiences arising from work-related injury or illness. We summarise current evidence in a schema of potential work-related causes that can also be applied in workplace risk assessment and suicide case investigations. There are numerous implications of these findings for policy and practice. Various principle- and evidence-based workplace intervention strategies for suicide prevention exist, some of which have been shown to improve suicide-prevention literacy, reduce stigma, enhance helping behaviours, and in some instances maybe even reduce suicide rates. Prevailing practice in workplace suicide prevention, however, overly emphasises individual- and illness-directed interventions, with little attention directed to addressing the working conditions that may increase suicide risk. We conclude that a stronger emphasis on improving working conditions will be required for workplace suicide prevention to reach its full preventive potential.
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Suicidio , Lugar de Trabajo , Humanos , Lugar de Trabajo/psicología , Suicidio/estadística & datos numéricos , Suicidio/psicología , Salud Laboral , Prevención del Suicidio , Factores de Riesgo , Exposición Profesional/efectos adversos , Estigma Social , Medición de RiesgoRESUMEN
OBJECTIVES: We investigated whether crowded workplaces, sharing surfaces and exposure to infections were factors associated with a positive test for influenza virus. METHODS: We studied 11 300 cases with a positive test for influenza A and 3671 cases of influenza B from Swedish registry of communicable diseases. Six controls for each case were selected from the population registry, with each control being assigned the index date of their corresponding case. We linked job histories to job-exposure matrices (JEMs), to assess different transmission dimensions of influenza and risks for different occupations compared with occupations that the JEM classifies as low exposed. We used adjusted conditional logistic analyses to estimate the ORs for influenza with 95% CI. RESULTS: The highest odds were for influenza were: regular contact with infected patients (OR 1.64, 95% CI 1.54 to 1.73); never maintained social distance (OR 1.51, 95% CI 1.43 to 1.59); frequently sharing materials/surfaces with the general public (OR 1.41, 95% CI 1.34 to 1.48); close physical proximity (OR 1.54, 95% CI 1.45 to 1.62) and high exposure to diseases or infections (OR 1.54, 95% CI 1.44 to 1.64). There were small differences between influenza A and influenza B. The five occupations with the highest odds as compared with low exposed occupations were: primary care physicians, protective service workers, elementary workers, medical and laboratory technicians, and taxi drivers. CONCLUSIONS: Contact with infected patients, low social distance and sharing surfaces are dimensions that increase risk for influenza A and B. Further safety measures are needed to diminish viral transmission in these contexts.
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Gripe Humana , Exposición Profesional , Humanos , Gripe Humana/epidemiología , Estudios de Casos y Controles , Exposición Profesional/efectos adversos , Ocupaciones , Lugar de TrabajoRESUMEN
BACKGROUND: Estimating excess mortality and years of life lost (YLL) attributed to coronavirus disease 19 (COVID-19) infection provides a comprehensive picture of the mortality burden on society. We aimed to estimate the impact of the COVID-19 pandemic on age- and sex-specific excess mortality and YLL in Sweden during the first 17 months of the pandemic. METHODS: In this population-based observational study, we calculated age- and sex-specific excess all-cause mortality and excess YLL during 2020 and the first 5 months of 2021 and cause-specific death [deaths from cardiovascular disease (CVD), cancer, other causes and deaths excluding COVID-19] in 2020 compared with an average baseline for 2017-19 in the whole Swedish population. RESULTS: COVID-19 deaths contributed 9.9% of total deaths (98â441 deaths, 960â305 YLL) in 2020, accounting for 75â151 YLL (7.7 YLL/death). There were 2672 (5.7%) and 1408 (3.0%) excess deaths, and 19â141 (3.8%) and 3596 (0.8%) excess YLL in men and women, respectively. Men aged 65-110 years and women aged 75-110 years were the greatest contributors. Fewer deaths and YLL from CVD, cancer and other causes were observed in 2020 compared with the baseline adjusted to the population size in 2020. CONCLUSIONS: Compared with the baseline, excess mortality and YLL from all causes were experienced in Sweden during 2020, with a higher excess observed in men than in women, indicating that more men died at a younger age while more women died at older ages than expected. A notable reduction in deaths and YLL due to CVD suggests a displacement effect from CVD to COVID-19.
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BACKGROUND: Working in close contacts with coworkers or the general public may be associated with transmission of invasive pneumococcal disease (IPD). We investigated whether crowded workplaces, sharing surfaces, and exposure to infections were factors associated with IPD. METHODS: We studied 3,968 cases of IPD, and selected six controls for each case from the Swedish population registry with each control being assigned the index date of their corresponding case. We linked job histories to job-exposure matrices to assess different transmission dimensions of pneumococci, as well as occupational exposure to fumes. We used adjusted conditional logistic analyses to estimate the odds ratios (ORs) for IPD with 95% confidence intervals (95% CI). RESULTS: ORs for IPD for the different transmission dimensions were increased moderately but were statistically significant. Compared to home-working or working alone, the highest odds was for Working mostly outside, or partly inside (OR 1.19, 95% CI 1.04-1.38). Estimates were higher in men for all dimensions, compared to women. The odds for IPD for Working mostly outside, or partly inside were 1.33 (95% CI 1.13-1.56) and 0.79 (95% CI 0.55-1.14) for men and women, respectively. Higher odds were seen for all transmission dimensions among those exposed to fumes, although CIs included unity. Contact with ill or infected patients did not increase the odds for IPD. CONCLUSION: IPD was associated with working in close contact with coworkers or the general public, and with outside work, especially for men. Contact with infected patients or persons was not associated with IPD.
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Exposición Profesional , Infecciones Neumocócicas , Masculino , Humanos , Femenino , Estudios de Casos y Controles , Factores de Riesgo , Infecciones Neumocócicas/epidemiología , Exposición Profesional/efectos adversos , Oportunidad Relativa , GasesRESUMEN
OBJECTIVES: To assess the associations between cardiorespiratory fitness (CRF) in young men and the incidence of site-specific cancer. METHODS: A Swedish population-based cohort study with register linkage of men who underwent military conscription in 1968-2005 was undertaken. CRF was assessed by maximal aerobic workload cycle test at conscription. Cox regression models assessed linear associations and included CRF, age, year and site of conscription, body mass index and parental level of education. CRF was also categorised into low, moderate and high for facilitated interpretation and results comparing high and low CRF are reported. RESULTS: Primary analyses were performed in 1 078 000 men, of whom 84 117 subsequently developed cancer in at least one site during a mean follow-up of 33 years. Higher CRF was linearly associated with a lower hazard ratio (HR) of developing cancer in the head and neck (n=2738, HR 0.81, 95% CI 0.74 to 0.90), oesophagus (n=689, HR 0.61, 95% CI 0.50 to 0.74), stomach (n=902, HR 0.79, 95% CI 0.67 to 0.94), pancreas (n=1280, HR 0.88, 95% CI 0.76 to 1.01), liver (n=1111, HR 0.60, 95% CI 0.51 to 0.71), colon (n=3222, HR 0.82, 95% CI 0.75 to 0.90), rectum (n=2337, HR 0.95, 95% CI 0.85 to 1.05), kidney (n=1753, HR 0.80, 95% CI 0.70 to 0.90) and lung (n=1635, HR 0.58, 95% CI 0.51 to 0.66). However, higher CRF predicted a higher hazard of being diagnosed with prostate cancer (n=14 232, HR 1.07, 95% CI 1.03 to 1.12) and malignant skin cancer (n=23 064, HR 1.31, 95% CI 1.27 to 1.36). CONCLUSION: We report a number of protective associations between higher CRF in healthy young men and the subsequent hazard of site-specific cancers. These results have implications for public health policymaking, strengthening the incentive to promote health through improving CRF in youth.
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Capacidad Cardiovascular , Neoplasias , Masculino , Humanos , Adolescente , Estudios de Cohortes , Incidencia , Promoción de la Salud , Factores de Riesgo , Neoplasias/epidemiología , Prueba de Esfuerzo/métodos , Aptitud FísicaRESUMEN
OBJECTIVES: Non-fatal self-harm (SH) is a major risk factor for late-life suicide. A better knowledge of the clinical management of older adults who self-harm is needed to establish where improvements could be made for the implementation of effective suicide prevention interventions. We therefore assessed contacts with primary and specialised care for mental disorders and psychotropic drug use during the year before and after a late-life non-fatal SH episode. METHOD: Longitudinal population-based study in adults aged ≥75 years with SH episode between 2007 and 2015 retrieved from the regional database VEGA. Healthcare contacts for mental disorders and psychotropic use were assessed during the year before and after the index SH episode. RESULTS: There were 659 older adults who self-harmed. During the year before SH, 33.7% had primary care contacts with a mental disorder, 27.8% had such contacts in specialised care. Use of specialised care increased sharply after the SH, reaching a maximum of 68.9%, but this figure dropped to 19.5% by the end of the year. Use of antidepressants increased from 41% before to 60% after the SH episode. Use of hypnotics was extensive before and after SH (60%). Psychotherapy was rare in both primary and specialised care. CONCLUSION: The use of specialised care for mental disorders and antidepressant prescribing increased after SH. The drop in long-term healthcare visits should be further explored to align primary and specialised healthcare to the needs of older adults who self-harmed. The psychosocial support of older adults with common mental disorders needs to be strengthened.
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Trastornos Mentales , Conducta Autodestructiva , Suicidio , Humanos , Anciano , Conducta Autodestructiva/tratamiento farmacológico , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/psicología , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Psicotrópicos/uso terapéutico , Antidepresivos/uso terapéutico , Atención a la SaludRESUMEN
BACKGROUND: Exposure to many contacts is the main risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while risk of serious disease and death is chiefly determined by old age and comorbidities. Relative and population-attributable fractions (PAFs) of multiple medical and social exposures for COVID-19 outcomes have not been evaluated among older adults. OBJECTIVES: We describe the effect of multiple exposures on the odds of testing positive for the virus and of severe disease (hospital care or death) and PAFs in Swedish citizens aged 55 years and above. METHODS: We used national registers to follow all citizens aged 55 years and above with respect to (1) testing positive, (2) hospitalization, and (3) death between 31 January 2020 and 1 February 2021. RESULTS: Of 3,410,241 persons, 156,017 (4.6%, mean age 68.3 years) tested positive for SARS-CoV-2, while 35,999 (1.1%, mean age 76.7 years) were hospitalized or died (12,384 deaths, 0.4%, mean age 84.0 years). Among the total cohort, the proportion living without home care or long-term care was 98.8% among persons aged 55-64 and 22.1% of those aged 95 and above. After multiple adjustment, home care and long-term care were associated with odds ratios of 7.9 (95% confidence interval [CI] 6.8-9.1) and 22.5 (95% CI 19.6-25.7) for mortality, with PAFs of 21.9% (95% CI 20.9-22.9) and 33.3% (95% CI 32.4-34.3), respectively. CONCLUSION: Among Swedish residents aged 55 years and above, those with home care or long-term care had markedly increased risk for COVID-19 death during the first year of the pandemic, with over 50% of deaths attributable to these factors.
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COVID-19 , Pandemias , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , Comorbilidad , Hospitalización , Humanos , Factores de Riesgo , SARS-CoV-2 , Suecia/epidemiologíaRESUMEN
BACKGROUND: Incidence rates of cardiomyopathies, which are a common cause of heart failure in young people, have increased during the last decades. An association between body weight in adolescence and future cardiomyopathy among men was recently identified. Whether or not this holds true also for women is unknown. The aim was therefore to determine whether for young women being overweight or obese is associated with a higher risk of developing cardiomyopathy. METHODS: This was a registry-based national prospective cohort study with data collected from the Swedish Medical Birth Register, 1982 to 2014, with up to 33 years of follow-up. Included women were of childbearing age (18-45 years) during the initial antenatal visit in their first or second pregnancy (n=1 393 346). We obtained baseline data on body mass index (BMI), smoking, education, and previous disorders. After exclusions, mainly because of previous disorders, the final sample was composed of 1 388 571 women. Cardiomyopathy cases were identified by linking the Medical Birth Register to the National Patient and Cause of Death registers. RESULTS: In total, we identified 1699 cases of cardiomyopathy (mean age at diagnosis, 46.2 [SD 9.1] years) during the follow-up with an incidence rate of 5.9 per 100 000 observation years. Of these, 481 were diagnosed with dilated cardiomyopathy, 246 had hypertrophic cardiomyopathy, 61 had alcohol/drug-induced cardiomyopathy, and 509 had other forms. The lowest risk for being diagnosed with a cardiomyopathy was detected at a BMI of 21 kg/m2, with a gradual increase in risk with higher BMI, particularly for dilated cardiomyopathy, where a hazard ratio of 4.71 (95% CI, 2.81-7.89) was found for severely obese subjects (BMI ≥35 kg/m2), as compared with BMI 20 to <22.5. CONCLUSIONS: Elevated BMI among young women was associated with an increased risk of being diagnosed with a subsequent cardiomyopathy, especially dilated cardiomyopathy, starting already at mildly elevated body weight, whereas severe obesity entailed an almost 5-fold increase in risk. With the increasing numbers of persons who are overweight or obese, higher rates of cardiomyopathy can be expected in the future, along with an altered disease burden related to adiposity.
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Adiposidad , Índice de Masa Corporal , Cardiomiopatía Dilatada , Complicaciones Cardiovasculares del Embarazo , Adolescente , Adulto , Factores de Edad , Cardiomiopatía Dilatada/epidemiología , Cardiomiopatía Dilatada/patología , Cardiomiopatía Dilatada/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Embarazo , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/patología , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Factores de Riesgo , Suecia/epidemiologíaRESUMEN
BACKGROUND: Deficits in cognitive performance are reported in patients with anxiety disorders, but research is limited and inconsistent. We aimed to investigate cross-sectional associations between cognitive function, with focus on executive function, and anxiety severity in primary care patients diagnosed with anxiety disorders. METHODS: 189 Swedish patients aged 18-65 years (31% men) with anxiety disorders diagnosed according to Mini International Neuropsychiatric Interview were included. Severity of anxiety was assessed using Beck Anxiety Inventory self-assessment scale. Digit span, block design and matrix reasoning tests from the Wechsler Adult Intelligence Scale IV, and the design fluency test from the Delis-Kaplan Executive Function System were used. Multivariable linear regression models were applied to investigate the relationship of anxiety severity and cognitive functioning. Comparisons were also performed to a normed non-clinical population, using the Wilcoxon signed rank test. RESULTS: More severe anxiety was associated with lower digit span test scores (R2 = 0.109, B = -0.040, p = 0.018), but not with block design, matrix reasoning or design fluency tests scores, after adjustment for comorbid major depression in a multivariable model. When compared to a normed population, patients with anxiety performed significantly lower on the block design, digit span forward, digit span sequencing and matrix reasoning tests. CONCLUSIONS: Severity of anxiety among patients with anxiety disorder was associated with executive functions related to working memory, independently of comorbid major depression, but not with lower fluid intelligence. A further understanding of the executive behavioral control in patients with anxiety could allow for more tailored treatment strategies including medication, therapy and interventions targeted to improve specific cognitive domains.
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Cognición , Trastorno Depresivo Mayor , Adulto , Ansiedad , Trastornos de Ansiedad/diagnóstico , Estudios Transversales , Función Ejecutiva , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Atención Primaria de SaludRESUMEN
BACKGROUND: Modifiable lifestyle factors in relation to risk for cardiomyopathy, a common and increasing cause of heart failure in the young, have not been widely studied. We sought to investigate a potential link between obesity, a recognized predictor of early heart failure, in adolescence and being diagnosed with cardiomyopathy in adulthood. METHODS: This was a nationwide register-based prospective cohort study of 1 668 893 adolescent men (mean age, 18.3 years; SD, 0.7 years) who enlisted for compulsory military service from 1969 to 2005. At baseline, body mass index (BMI), blood pressure, and medical disorders were registered, along with test results for fitness and muscle strength. Cardiomyopathy diagnoses were identified from the National Hospital Register and Cause of Death Register during an up to 46-year follow-up and divided into categories: dilated, hypertrophic, alcohol/drug-induced, and other. Hazard ratios were calculated with Cox proportional hazards models. RESULTS: During follow-up (median, 27 years; Q1-Q3, 19-35 years), 4477 cases of cardiomyopathy were identified, of which 2631 (59%) were dilated, 673 (15%) were hypertrophic, and 480 (11%) were alcohol/drug-induced. Increasing BMI was strongly associated with elevated risk of cardiomyopathy, especially dilated, starting at levels considered normal (BMI, 22.5-<25 kg/m2; hazard ratio, 1.38 [95% CI, 1.22-1.57]), adjusted for age, year, center, and baseline comorbidities, and with a >8-fold increased risk at BMI ≥35 kg/m2 compared with BMI of 18.5 to <20 kg/m2. For each 1-unit increase in BMI, similarly adjusted hazard ratios were 1.15 (95% CI, 1.14-1.17) for dilated cardiomyopathy, 1.09 (95% CI, 1.06-1.12) for hypertrophic cardiomyopathy, and 1.10 (1.06-1.13) for alcohol/drug-induced cardiomyopathy. CONCLUSIONS: Even mildly elevated body weight in late adolescence may contribute to being diagnosed with cardiomyopathy in adulthood. The already marked importance of weight control in youth is further strengthened by these findings, as well as greater evidence for obesity as a potential important cause of adverse cardiac remodeling that is independent of clinically evident ischemic heart disease.
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Índice de Masa Corporal , Peso Corporal/fisiología , Cardiomiopatías/epidemiología , Cardiomiopatías/fisiopatología , Obesidad/epidemiología , Obesidad/fisiopatología , Adolescente , Adulto , Cardiomiopatías/diagnóstico , Estudios de Cohortes , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Suecia/epidemiologíaRESUMEN
BACKGROUND: Recent reports show alarmingly high rates of suicide in middle-aged men, yet there are few long-term prospective studies that focus on suicidal behaviour in men in this age group. AIMS: To prospectively explore associations of potential risk factors at age 18 with suicide and self-harm in middle-aged men. METHOD: A population-based Swedish longitudinal cohort study of male conscripts with no history of self-harm at enlistment in 1968-1989 (n = 987 583). Conscription examinations included measures of cognitive performance, stress resilience, psychiatric diagnoses, body mass index (BMI), cardiovascular fitness and muscle strength. Suicides and self-harm at age 45-65 years were identified in the National Hospital Register and Swedish Cause of Death Register. Risks were calculated using Cox proportional hazards models. RESULTS: Low stress resilience (cause-specific hazard ratio CHR = 2.31, 95% CI 1.95-2.74), low cognitive ability (CHR = 2.01, 95% CI 1.71-2.37) as well as psychiatric disorders and low cardiovascular fitness in late adolescence were associated with increased risk for suicide in middle-aged men. Similar risk estimates were obtained for self-harm. In addition, high and low BMI as well as low muscle strength were associated with increased risk of self-harm. Associations also remained significant after exclusion of men with self-harm before age 45. CONCLUSIONS: This prospective study provides life-course perspective support that psychological and physical characteristics in late adolescence may have long-lasting consequences for suicidal behaviour in middle-aged men, a very large population at heightened risk of suicide.
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Conducta Autodestructiva , Suicidio , Adolescente , Adulto , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Conducta Autodestructiva/epidemiología , Suicidio/estadística & datos numéricos , Suecia/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Anxiety disorders are common and associated with reduced quality of life, impaired physical and mental health and an increased economic burden for society. While evidence exists for the effectiveness of exercise treatment for depression, there is a need for high-quality randomized clinical trials (RCT) with a focus on anxiety disorders. Further research is also warranted regarding outcomes of cognitive function, other health-related variables, dose-response effects, work ability and potential mechanisms. METHOD/DESIGN: Using a parallel, RCT design with three assessment points (baseline, post-intervention and one-year follow-up), we aim to assess the effect of a 12-week exercise intervention in primary care patients with anxiety disorders (n = 180), diagnosed using the Mini International Neuropsychiatric Interview (M.I.N.I; Swedish version 6.0.0d DSM-IV). Participants are randomly assigned to three physical exercise groups: one low-intensity training group, one moderate- to high intensity training group and one control non-exercise group. Assessments include measures of anxiety symptoms, cognitive function, physical health variables such as cardiovascular fitness, sick-leave and levels of hormones/cytokines in blood samples. DISCUSSION: Findings from this study will provide novel insights regarding the effects of exercise treatment on not only anxiety symptoms but also other outcomes including mental and physical health, cognitive function, dose-response effects, work ability/sick leave and on biomarkers that may help explain underlying mechanisms. TRIAL REGISTRATION: The trial was registered at ClinicalTrial.gov NCT03247270 August 8, 2017.
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Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/terapia , Terapia por Ejercicio/métodos , Ejercicio Físico/psicología , Ausencia por Enfermedad/estadística & datos numéricos , Adulto , Cognición , Femenino , Humanos , Masculino , Atención Primaria de Salud , Escalas de Valoración Psiquiátrica , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Suecia , Resultado del TratamientoRESUMEN
AIMS: To study the relation between body mass index (BMI) in young men and risk of early hospitalization with heart failure. METHODS AND RESULTS: In a prospective cohort study, men from the Swedish Conscript Registry investigated 1968-2005 (n = 1 610 437; mean age, 18.6 years were followed 5-42 years (median, 23.0 years; interquartile range, 15.0-32.0), 5492 first hospitalizations for heart failure occurred (mean age at diagnosis, 46.6 (SD 8.0) years). Compared with men with a body mass index (BMI) of 18.5-20.0 kg/m2, men with a BMI 20.0-22.5 kg/m2 had an hazard ratio (HR) of 1.22 (95% CI, 1.10-1.35), after adjustment for age, year of conscription, comorbidities at baseline, parental education, blood pressure, IQ, muscle strength, and fitness. The risk rose incrementally with increasing BMI such that men with a BMI of 30-35 kg/m2 had an adjusted HR of 6.47 (95% CI, 5.39-7.77) and those with a BMI of ≥35 kg/m2 had an HR of 9.21 (95% CI, 6.57-12.92). The multiple-adjusted risk of heart failure per 1 unit increase in BMI ranged from 1.06 (95% CI, 1.02-1.11) in heart failure associated with valvular disease to 1.20 (95% CI, 1.18-1.22) for cases associated with coronary heart disease, diabetes, or hypertension. CONCLUSION: We found a steeply rising risk of early heart failure detectable already at a normal body weight, increasing nearly 10-fold in the highest weight category. Given the current obesity epidemic, heart failure in the young may increase substantially in the future and physicians need to be aware of this.
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Insuficiencia Cardíaca/epidemiología , Adolescente , Adulto , Presión Sanguínea/fisiología , Índice de Masa Corporal , Peso Corporal , Escolaridad , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Fuerza Muscular/fisiología , Obesidad/epidemiología , Aptitud Física/fisiología , Estudios Prospectivos , Factores de Riesgo , Suecia/epidemiología , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: Although the incidence of stroke is on the decline worldwide, this is not the case for early stroke. We aimed to determine whether nonpsychotic mental disorder at the age of 18 years is a risk factor for early stroke, and if adolescent cardiovascular fitness and intelligence quotient might attenuate the risk. METHOD: Population-based Swedish cohort study of conscripts (n=1 163 845) who enlisted during 1968 to 2005. At conscription, 45 064 males were diagnosed with nonpsychotic mental disorder. Risk of stroke during follow-up (5-42 years) was calculated with Cox proportional hazards models. Objective baseline measures of fitness and cognition were included in the models in a second set of analyses. RESULTS: There were 7770 first-time stroke events. In adjusted models, increased risk for stroke was observed in men diagnosed with depressive/neurotic disorders (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.11-1.37), personality disorders (HR, 1.52; 95% CI, 1.29-1.78), and alcohol/substance use disorders (HR, 1.61; 95% CI, 1.41-1.83) at conscription. Corresponding figures for fatal stroke were HR, 1.38; 95% CI, 1.06 to 1.79; HR, 2.26; 95% CI, 1.60 to 3.19; and HR, 2.20; 95% CI, 1.63 to 2.96. HRs for stroke were attenuated when fitness level and intelligence quotient were introduced. Associations remained significant for personality disorders and alcohol/substance use in the fully adjusted models. The interaction term was statistically significant for fitness but not for intelligence quotient. CONCLUSIONS: Our findings suggest that fitness may modify associations between nonpsychotic disorders and stroke. It remains to be clarified whether interventions designed to improve fitness in mentally ill youth can influence future risk of early stroke.
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Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Vigilancia de la Población , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Adolescente , Factores de Edad , Estudios de Cohortes , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Trastornos Mentales/psicología , Vigilancia de la Población/métodos , Factores de Riesgo , Accidente Cerebrovascular/psicología , Suecia/epidemiologíaRESUMEN
BACKGROUND AND PURPOSE: Low cardiovascular fitness (fitness) in mid- and late life is a risk factor for stroke. However, the respective effects on long-term stroke risk of fitness and muscle strength in early adulthood are unknown. Therefore, we analyzed these in a large cohort of young men. METHOD: We performed a population-based longitudinal cohort study of Swedish male conscripts registered in 1968 to 2005. Data on fitness (by the cycle ergometric test; n=1 166 035) and muscle strength (n=1,563,750) were trichotomized (low, medium, and high). During a 42-year follow-up, risk of stroke (subarachnoidal hemorrhage, intracerebral hemorrhage, and ischemic stroke) and fatality were calculated with Cox proportional hazards models. To identify cases, we used the International Classification of Diseases-Eighth to Tenth Revision in the Hospital Discharge Register and the Cause of Death Register. RESULTS: First-time stroke events were identified (subarachnoidal hemorrhage, n=895; intracerebral hemorrhage, n=2904; ischemic stroke, n=7767). For all stroke and fatality analysis any type of first-time stroke was recorded (n=10,917). There were inverse relationships in a dose-response fashion between fitness and muscle strength with any stroke (adjusted hazard ratios for the lowest, compared with the highest, tertile of each 1.70 [1.50-1.93] and 1.39 [1.27-1.53], respectively). There were stronger associations for fatal stroke. All 3 stroke types displayed similar associations. Associations between fitness and stroke remained when adjusted for muscle strength, whereas associations between muscle strength and stroke weakened/disappeared when adjusted for fitness. CONCLUSIONS: At the age of 18 years, low fitness and to a lesser degree low muscle strength were independently associated with an increased future stroke risk.
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Fuerza Muscular/fisiología , Aptitud Física/fisiología , Vigilancia de la Población , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Adolescente , Adulto , Estudios de Cohortes , Prueba de Esfuerzo/métodos , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores de Riesgo , Suecia/epidemiología , Factores de Tiempo , Adulto JovenRESUMEN
Patients with early-onset dementia are a significantly under-recognized subgroup of patients with an increasing prevalence. Epidemiological studies are limited and studies of modifiable risk factors, such as physical fitness, are lacking. We aimed to investigate the associations between cardiovascular fitness individually and in combination with cognitive performance at age 18 and risk of early-onset dementia and mild cognitive impairment later in life. We performed a population-based cohort study of over 1.1 million Swedish, 18-year-old, male conscripts, who underwent conscription exams between 1968 and 2005. These males were then followed for up to 42 years. Objective data on cardiovascular fitness and cognitive performance were collected during conscription exams and were subsequently linked with hospital registries to calculate later risk of early-onset dementia and mild cognitive impairment using Cox proportional hazards models controlling for several confounders. The scores from the exams were divided into tertiles (low, medium, high) for the analyses. The mean follow-up time for the analyses was 25.7 years (standard deviation: 9.3) and the median was 27 years. In total, 30 195 315 person-years of follow-up were included in the study. In fully adjusted models, both low cardiovascular fitness and cognitive performance (compared to high) at age 18 were associated with increased risk for future early-onset dementia (cardiovascular fitness, n = 662 events: hazard ratio 2.49, 95%, confidence interval 1.87-3.32; cognitive performance, n = 657 events: hazard ratio 4.11, 95%, confidence interval 3.19-5.29) and mild cognitive impairment (cardiovascular fitness, n = 213 events: hazard ratio 3.57, 95%, confidence interval 2.23-5.74; cognitive performance, n = 212 events: hazard ratio 3.23, 95%, confidence interval 2.12-4.95). Poor performance on both cardiovascular fitness and cognitive tests was associated with a >7-fold (hazard ratio 7.34, 95%, confidence interval 5.08-10.58) and a >8-fold (hazard ratio 8.44, 95%, confidence interval 4.64-15.37) increased risk of early-onset dementia and early-onset mild cognitive impairment, respectively. In conclusion, lower cardiovascular fitness and cognitive performance in early adulthood were associated with an increased risk of early-onset dementia and mild cognitive impairment later in life, and the greatest risks were observed for individuals with a combination of low cardiovascular fitness and low cognitive performance.
Asunto(s)
Trastornos del Conocimiento/epidemiología , Demencia/epidemiología , Aptitud Física/fisiología , Medición de Riesgo/métodos , Adolescente , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/epidemiología , Trastornos del Conocimiento/complicaciones , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Estudios de Cohortes , Demencia/etiología , Progresión de la Enfermedad , Humanos , Masculino , Modelos de Riesgos Proporcionales , SueciaRESUMEN
UNLABELLED: While the detrimental effects of cranial radiotherapy on the developing brain are well known, the effects on cognitive performance of low doses of ionizing radiation is less studied. We performed a population-based cohort study to determine whether low doses of ionizing radiation to the brain in infancy affects cognitive function later in life. Further we hypothesized that the dose to the hippocampus predicts cognitive late side effects better than the anterior or the posterior brain doses. MATERIAL AND METHODS: During 1950-1960 3860 boys were treated with radiation in Sweden for cutaneous hemangiomas before the age of 18 months. Of these, 3030 were analyzed for military test scores at the age of 18 years and 2559 for the highest obtained educational level. RESULTS: Logical, spatial and technical test scores were not affected by increasing irradiation doses. The verbal test scores displayed a significant trend for decreasing scores with increasing doses to the hippocampus (p = 0.005). However, the absolute mean difference between the zero dose and the highest dose category (median 680 mGy) was very small, only 0.64 stanine points, and the significance was dependent on the highest dose category, containing few subjects. The educational level was not affected by brain irradiation. Overall, the hippocampal dose was a better predictor of late cognitive side effects than the doses to the anterior or the posterior brain. In conclusion, there was no decrease in logical, spatial and technical verbal or global test scores after ionizing radiation doses up to 250 mGy, but a subtle decrease in verbal test scores if the highest dose category was included (median 680 mGy). However, the clinical relevance of this decline in the highest dose group is questionable, since we could not find any effect on the highest obtained educational level.
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Encéfalo/efectos de la radiación , Trastornos del Conocimiento/etiología , Cognición/efectos de la radiación , Adolescente , Neoplasias Encefálicas/radioterapia , Estudios de Cohortes , Escolaridad , Hemangioma/radioterapia , Hipocampo/efectos de la radiación , Humanos , Lactante , Inteligencia/efectos de la radiación , Pruebas de Inteligencia/estadística & datos numéricos , Masculino , Dosis de Radiación , Análisis de Regresión , Neoplasias Cutáneas/radioterapia , Suecia , Conducta Verbal/efectos de la radiaciónRESUMEN
OBJECTIVE: The aim of the study was to explore perceptions of mental ill health, suicidal behaviour and working conditions among male construction workers, in order to gain an in-depth understanding of these phenomenon and to identify relevant avenues for workplace interventions. METHOD: Data were collected in individual and group interviews, and 43 individuals from the Swedish construction industry, workers, union representative and managers, participated in the study. Inductive thematic analysis was used to analyse the data. RESULTS: Five main themes were found: Difficult to talk about mental health, Demanding working environment affects mental health, Substance abuse among construction workers, Importance of management, and Need for routines and social support in the workplace. Many participants reported that there was a stigma related to mental health. Suicides that had occurred among colleagues were perceived to come out of the blue. The working environment in the construction industry was perceived to have a negative effect on mental health, and it was reported that the management played an important role in both the cause and prevention of mental health problems. CONCLUSIONS: The results from this Swedish study are in accordance with previous international research regarding a macho culture, stigma of mental health and a demanding working environment in the construction industry. The study adds to existing knowledge by highlighting that suicides were perceived to be very unexpected, that poor physical health affected mental health and that many participants did not know how to deal with mental health issues in the workplace.
Asunto(s)
Industria de la Construcción , Salud Mental , Investigación Cualitativa , Suicidio , Lugar de Trabajo , Humanos , Masculino , Adulto , Lugar de Trabajo/psicología , Suicidio/psicología , Suicidio/estadística & datos numéricos , Persona de Mediana Edad , Suecia/epidemiología , Estigma Social , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Adulto Joven , Percepción , Condiciones de TrabajoRESUMEN
INTRODUCTION: High cardiorespiratory fitness (CRF) has been associated with a lower risk of depression, anxiety, and cerebrovascular disease. The aim was to explore CRF changes over-time associated with these outcomes. METHODS: This large-scale prospective cohort study, using data from Swedish population-wide registries and databases (during 1972-2020), included men (n=131,431), with measures of estimated CRF (estCRF) in late adolescence (maximal cycle test) and adulthood (submaximal cycle test) (mean years between 24.6, SD 8.8). The study explored how change in estCRF was associated with incident depression, anxiety, and cerebrovascular disease using Cox proportional hazards models. Analyses were performed in 2023. RESULTS: Higher estCRF in late adolescence and adulthood were associated with a lower risk of incident depression, anxiety, and cerebrovascular disease later in life. For all three outcomes, an increase in estCRF (mL/min/kg and z-score) between the two-time points was associated with a lower risk. Further, decreasing from moderate or high estCRF in adolescence to low estCRF in adulthood, compared to staying at a moderate or high level, was associated with a higher risk of depression and anxiety (HR: 1.24 95% CI 1.07-1.45 and 1.25 95% CI 1.06-1.49, respectively). Conversely, increasing from moderate to high estCRF was associated with a lower risk of incident anxiety (HR: 0.84 95% CI 0.71-0.99). CONCLUSIONS: The findings indicate that there is a longitudinal association between negative change in estCRF and increased risk of depression, anxiety, and cerebrovascular disease later in life. Decreasing levels of estCRF could be a helpful indicator when identifying these disorders at a population level.