Synergistic interaction effect between job control and social support at work on general psychological distress.

PURPOSE: Little is known about the interaction between job control and social support at work on common mental disorders. To examine whether there is a synergistic interaction effect between job control and social support at work on general psychological distress and whether it differs by the level of job demands. METHODS: About 1,940 male and female workers from the Malmö Shoulder and Neck Study were chosen for this cross-sectional study. Job control, social support at work, and job demands were measured by the Swedish version of the Job Content Questionnaire, and general psychological distress was assessed by the General Health Questionnaire. RESULTS: A significant excessive risk increase for general psychological distress was observed when workers had both low job control and low social support at work in both men and women. The synergistic effect was stronger in women, when job demands were low (Rothman's synergy index was 2.16 vs. 1.51 when job demands were high). However, in male workers, while a strong synergistic effect between job control and social support at work was found when job demands were low (synergy index was 9.25), there was an antagonistic effect when job demands were high (synergy index was 0.52). CONCLUSIONS: There was a synergistic interaction effect between job control and social support at work on general psychological distress, but the synergistic effect or its effect size differed by the level of job demands and gender. An atomic, additive approach to the risk assessment of the psychosocial work characteristics on common mental disorders could be misleading or lead to a risk underestimation.

Psychosocial working conditions and exhaustion in a working population sample of Swedish middle-aged men and women.

BACKGROUND: Exhaustion is a concept of interest for both occupational health research and stress-disease theory research. The aim of the present study was to explore associations between chronic stressors, in terms of psychosocial working conditions, and exhaustion in a Swedish middle-aged population sample. METHODS: A vocationally active population sample of the Malmö Shoulder and Neck Study cohort, comprising 2555 men and 2466 women between 45 and 64 years of age, was used. Psychosocial working conditions, assessed by means of the demand-control-support model, were measured longitudinally with a 1-year interval. Exhaustion was assessed by the SF-36 vitality scale and measured at follow-up, yielding a cross-sectional study design. RESULTS: Exhaustion was twice as common in women as in men. High psychological job demands, low job control and low job support were independently associated with exhaustion in both men and women. These associations remained after controlling for a variety of potential confounders and mediators, including socio-demographic factors, lifestyle factors, musculoskeletal pain, disease, other work-related factors (including physical workload) and non-work-related factors. High demands in combination with low control (job strain), and job strain combined with low job support (iso-strain), increased the risk for exhaustion. CONCLUSION: Psychosocial working conditions seem to contribute to exhaustion in middle-aged men and women. Future research should include exploration of exhaustion as a possible mediator between work stress and disease, as well as exploration of other chronic stressors, including non-work-related stressors, regarding their effects on exhaustion in men and women.

Sleeping problems as a risk factor for subsequent musculoskeletal pain and the role of job strain: results from a one-year follow-up of the Malmö Shoulder Neck Study Cohort.

BACKGROUND: The role of sleeping problems in the causal pathway between job strain and musculoskeletal pain is not clear. PURPOSE: To investigate the impact of sleeping problems and job strain on the one-year risk for neck, shoulder, and lumbar pain. METHOD: A prospective study, using self-administered questionnaires, of a healthy cohort of 4,140 vocationally active persons ages 45-64, residing in the city of Malmo. RESULTS: At follow-up, 11.8% of the men and 14.8% of the women had developed pain. The odds ratios (OR) for pain at follow-up and sleeping problems at baseline were 1.72 (95% CI: 1.13-2.61) in men and 1.91 (1.35-2.70) in women. Regarding exposure to job strain, ORs were 1.39 (0.94-2.05) for men and 1.63 (1.18-2.23) for women. These statistically significant risks remained so when controlled for possible confounding. A modest synergistic effect was noted in women with concurrent sleeping problems and job strain, but not in men. CONCLUSION: One in 15-20 of all new cases of chronic pain in the population could be attributed to sleeping problems. No evidence was found for a causal chain with job strain leading to musculoskeletal pain by the pathway of sleeping problems.

Income change at retirement, neighbourhood-based social support, and ischaemic heart disease: results from the prospective cohort study "Men born in 1914".

Retirement from active life often leads to decreased finances and reduced social contact, which may increase ischaemic heart disease (IHD) risk in individuals. We examined whether income evolution during the decade before retirement has an impact on subsequent IHD, and explored the mediating effect of common risk factors and social support from different sources (marriage/cohabitation, support from friends/relatives, and neighbourhood-based social support). We analyzed data from the 1982-1983 prospective cohort study, "Men born in 1914" (n=498, follow-up period=10 years) conducted in Malmö, Sweden, merged with yearly income data for 14 years preceding baseline. Low income 10 years before retirement predicted both higher prevalence of IHD risk factors at retirement, and weaker neighbourhood-based social support. Income 10 years before retirement was a strong predictor of IHD incidence and mortality after retirement, but a significant downward income mobility at retirement did not increase IHD risk. After adjustment, low neighbourhood-based social support increased the risk of IHD incidence and mortality, and mediated 7-8% of the income effect. In conclusion, income 10 years before retirement, but not the subsequent income evolution, was a strong predictor of IHD post-retirement. This socioeconomic gradient was partly mediated by the protective effect of neighbourhood-based social support, which may be particularly important among the elderly in compensating for social disruptions related to retirement.

Socioeconomic differences in the progression of carotid atherosclerosis in middle-aged men and women with subclinical atherosclerosis in Sweden.

While the persistence of socioeconomic differences in cardiovascular disease (CVD) has been recognized for many years, less is known about whether socioeconomic factors are of importance to CVD before symptoms of the disease appear. In this study the associations among educational level, occupational status and progression of atherosclerosis were investigated in 1016 Swedish middle-aged men and women with signs of subclinical atherosclerosis, i.e., carotid plaque (defined as focal intima-media thickness (IMT) > 1.2 mm). IMT in the common carotid artery (CCA) and in the carotid bifurcation area, as well as carotid plaque score, was determined by B-mode ultrasound. Results showed only weak associations between educational level, occupational status and age-, sex- and baseline IMT-adjusted progression of IMT in the CCA. However, in the age, sex- and baseline IMT-adjusted analyses, those in unskilled manual occupations showed a significantly higher yearly progression of carotid IMT in the bifurcation area compared to those in high- or medium-level non-manual occupations. Those with primary education tended to show a higher yearly progression of carotid IMT in the bifurcation area compared to those with completed secondary education. After adjustment for risk factors, the magnitude of these associations were somewhat attenuated. Similar patterns of associations were seen for the change of carotid plaque score. We conclude that low socioeconomic status (SES) is associated with progression of atherosclerosis in a middle-aged population with signs of subclinical atherosclerosis. Even though socioeconomic differences in cardiovascular risk factor levels could explain part of the found differences in progression rate in women, the mechanisms involved remain to be further established.

The transition of reported pain in different body regions--a one-year follow-up study.

BACKGROUND: The course of pain at a specific region such as the lower back has previously been shown as well as for generalized pain. However we have not found any report on the course of pain from various different specific regions. The aim of this investigation was to study the one-year transition of reported pain in different body locations. METHODS: From a general population 14,555 men and women, 46-68 years, responded to an extensive health questionnaire including the standardized Nordic questionnaire. The population represented 27% of the total population within the age group in Malmö, Sweden. At the one year follow-up 12,607 responded to the questionnaire, yielding a response rate of 87%. The one year prevalence of long-lasting pain and the pattern of pain reporting from different regions were studied for men and women. RESULTS: The one-year prevalence of long-lasting neck pain was 14% (95% CI 13-15) among men and 25% (95% CI 24-26) among women at baseline and 15% (95% CI 14-16) for the men and 23% (95% CI 22-24) for the women at follow-up. Of those reporting neck pain "all the time" at baseline, 48% of the men and 54% of the women also reported neck pain "all the time" at the one-year follow-up. At the follow-up neck pain was reported as present "often" by 43% of the men and 47% of the women who reported neck pain "often" at baseline. Similar transition pattern were found for neck, shoulders, elbow/wrist/hand and lower back symptoms, as well as consistent prevalence rates. CONCLUSION: The one-year transition pattern of reported pain was similar in different body regions and among men and women. Furthermore the prevalence rates of long-lasting pain in the population were consistent at baseline and the follow-up. The findings of similar transition patterns support the interpretation of long-lasting pain as a generalized phenomenon rather than attributed to specific exposure. This may have implications for future pain research.

Incidence of shoulder and neck pain in a working population: effect modification between mechanical and psychosocial exposures at work? Results from a one year follow up of the Malmö shoulder and neck study cohort.

STUDY OBJECTIVE: To assess the impact of mechanical exposure and work related psychosocial factors on shoulder and neck pain. DESIGN: A prospective cohort study. PARTICIPANTS: 4919 randomly chosen, vocationally active men and women ages 45-65 residing in a Swedish city. Neck and shoulder pain were determined by the standardised Nordic questionnaire. Mechanical exposure was assessed by an index based on 11 items designed and evaluated for shoulder and neck disorders. Work related psychosocial factors were measured by the Karasek and Theorell demand-control instrument. MAIN RESULTS: High mechanical exposure was associated with heightened risk for shoulder and neck pain among men and women during follow up. Age adjusted odds ratios (OR) were 2.17 (95% confidence intervals (CI): 1.65, 2.85) and 1.59 (95% CI: 1.22, 2.06), respectively. In women, job strain (high psychological job demands and low job decision latitude) correlated with heightened risk (OR = 1.73, 95% CI: 1.29, 2.31). These risk estimates remained statistically significant when controlled for high mechanical exposure regarding job strain (and vice versa), and for sociodemographic factors. Testing for effect modification between high mechanical exposure and job strain showed them acting synergistically only in women. CONCLUSION: Job related mechanical exposure in both sexes, and psychosocial factors in women, seem independently of each other to play a part for development of shoulder and neck pain in vocationally active people. The effect of psychosocial factors was more prominent in women, which could be the result of biological factors as well as gender issues. These results suggest that interventions aiming at reducing the occurrence of shoulder and neck pain should include both mechanical and psychosocial factors.

Life-course perspective on socioeconomic differences in carotid atherosclerosis.

OBJECTIVE: Socioeconomic status (SES) in adulthood is known to be related to carotid atherosclerosis. However, few studies have tried to assess its association with SES from a life-course perspective. METHODS AND RESULTS: We examined the relationship between SES in childhood and in adulthood and carotid atherosclerosis in a general population of Swedish men and women. Carotid stenosis was determined by B-mode ultrasound. Results showed that women whose fathers' occupations involved unskilled manual labor had higher odds of carotid stenosis than did women whose fathers' occupations involved high- or medium-level nonmanual labor, even after adjustment for adult occupational status and risk factors (odds ratio 1.8, 95% CI 1.1 to 2.8). No such association appeared in men. Furthermore, the impact of life-course SES on atherosclerosis was examined by using an additive measure of one's combined SES during childhood and adulthood. Among women, the odds of carotid stenosis increased with a rise in exposure to low SES during the life-course (P for trend <0.001). In men, no such trend was found. CONCLUSIONS: The results indicate that the total life-course exposure to low SES, with contributions from childhood and adulthood, seems to play a role in atherogenesis in women. Such a pattern of association could not be shown in men.

The experience of pain from the shoulder-neck area related to the total body pain, self-experienced health and mental distress. The Malmö Shoulder-Neck Study group.

The present paper presents the relationship between the total body-pain (TBP) score, defined as the total number of areas shaded on a pain drawing, and the pain from one area, the Shoulder-Neck (SN), among subjects in or out of full-time gainful work respectively. Furthermore, relationships between pain-score, self-experienced health (SEH) and level of mental distress, measured with the General Health Questionnaire (GHQ) were investigated. The analyses is based on a general population sample of 8,116 men and women, 45-60 years of age, completing a questionnaire in the Malmö Shoulder Neck Study. The TBP-score was higher with increasing pain from the SN area, being out of full-time work and among women. Independently of working status, the SEH decreased with increasing pain in the SN area, which was enhanced, by increasing TBP-score. The proportion of women out of full-time gainful work was twice as high as for men. Women showed the same SEH levels with regard to their pain status, independently of their working status while men working full-time scored higher than women did. Oppositely, men out of full-time work had the lowest SEH in relation to their pain status. The GHQ scores of mental distress varied essentially in the same way as the SEH did. The results emphasize the need for an assessment of the number of pain locations and which one that first gave symptoms when studying possible causal relationships between low force musculoskeletal load and development of localized pain. If such data are not collected in epidemiological studies on causes for musculoskeletal pain it will at best lead to unnoticed effect modifications. At worst a potential confounding situation may occur. The relationship between the self-experienced health, mental distress and chronic pain identifies chronic pain as a major public-health problem and suggests a multidisciplinary approach in the treatment and rehabilitation already before work capacity is lost.

Smoking cessation among daily smokers, aged 45-69 years: a longitudinal study in Malmö, Sweden.

OBJECTIVE: To investigate differences in snuff consumption, socio-demographic and psychosocial characteristics between baseline daily smokers who had remained daily smokers, become intermittent smokers or stopped smoking at the 1-year follow-up. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: A population of 12 507 individuals aged 45-69 years, interviewed at baseline in 1992-94 and at a 1-year follow-up, was investigated in this longitudinal study. The three groups of baseline daily smokers were compared to the total population according to socio-demographic, psychosocial and snuff consumption characteristics. A multivariate logistic regression model was used to assess differences in psychosocial conditions, adjusting for age, sex, country of origin, marital status, education and snuff consumption. FINDINGS: Eighty-six per cent of all baseline daily smokers remained daily smokers, 6.5% had become intermittent smokers and 7.3% had stopped smoking at the 1-year follow-up. The daily smokers who remained daily smokers were more likely to be born in other countries than Sweden, not married, have a lower educational level and poorer psychosocial conditions than the total population, while the socio-demographic characteristics and psychosocial resources of those daily smokers who had become intermittent smokers or had stopped smoking were much more similar to the general population, with the exception of a higher snuff consumption, especially for intermittent smokers. CONCLUSIONS: Daily smokers who remained daily smokers at the 1-year follow-up had poorer psychosocial assets, especially social participation, than baseline daily smokers who had become intermittent smokers or had stopped smoking, and the general population. The results suggest that low levels of social participation are a potent barrier against smoking cessation. Snuff consumption may explain a part of the increase in smoking cessation among men as opposed to women in Sweden.

Behaviour-focused pain coping: consistency and convergence to work capability of the swedish version of the chronic pain coping inventory.

The aim was to study the psychometric properties of the Swedish version of the Chronic Pain Coping Inventory. The material consisted of a group of 100 subjects recruited from a large population study. Pain status and the absence of pain-related sick leave during the previous year conditioned inclusion. Another group comprised 160 patients on the long-term sick list and who had been referred to a multidisciplinary pain clinic for evaluation. The psychometric properties in terms of internal consistency of the scales were good or very good for all scales of behaviour-focused pain coping. Use of the strategies "Guarding", "Resting", "Asking for assistance", "Relaxation", "Task persistence", "Coping self-statements" and "Seeking social support" was significantly related to vocational capability. "Guarding". "Asking for assistance", "Relaxation", "Exercise and stretch" and "Coping self-statements" increased in parallel to increasing pain from localized to intermediate or widespread. No gender difference was found in cases reporting more pronounced pain.

Conflict between the work and family domains and exhaustion among vocationally active men and women.

Exhaustion is consistently found to be more prevalent in women than in men. Women suffer from job strain more often, which may constitute a partial explanation for this phenomenon, but experienced shortcomings in combining work and family demands may also contribute to ill health. The aim of this study was to investigate, and analyse by gender, how work-related and family-related factors, as well as the interface between them, i.e. work-to-family conflict (WFC) and family-to-work conflict (FWC), are related to exhaustion. The study was cross-sectional with self-administered questionnaires assessing exposures and outcome with previously well-validated instruments. The participants were 2726 men and 2735 women, aged 45-64, vocationally active, and residing in Malmö, Sweden. Sixteen percent of the women and 8% of the men considered themselves exhausted. WFC, FWC, job strain, and low job support were all strongly correlated to exhaustion in both genders. In the multivariate analyses, adjusting for other work and family risk factors, WFC and FWC remained statistically significant risk factors for exhaustion in both men and women. Job strain, low job support, and having a somatic disorder were also independently associated with exhaustion. While WFC was more prevalent among men, it was more strongly associated with exhaustion in women than in men. In women, WFC and FWC contributed to a larger part of the explanatory power of the model, which amounted to 22% of the variance in women and 14% in men. The results imply that the concept of 'work stress' should be regarded in a wider context in order to understand gender related issues of exhaustion among vocationally active individuals.

Job stress and major coronary events: results from the Job Stress, Absenteeism and Coronary Heart Disease in Europe study.

AIMS: The intention of this study is to investigate the relationship of the demands/control/strain model with hard coronary events in an epidemiological, prospective, multicenter, European study. METHODS AND RESULTS: Six cohorts (Brussels, Ghent, Lille, Barcelona, Göteborg and Malmö) from four European countries (Belgium, France, Spain and Sweden) consisting of 21 111 middle-aged male subjects participated between 1993 and 1996 in the baseline survey of the Job Stress, Absenteeism and Coronary Heart Disease in Europe (JACE) study. The Karasek strain model of psychological demands (five items)/control (nine items) was used. During a mean follow-up of 40 months 185 acute coronary events or coronary deaths were observed. Age-adjusted hazard ratios (HRs) for developing an acute coronary event were 1.46 [CI 95% confidence interval (1.08-1.97)] for high against low psychological demands and 1.53 (95% CI 1.0-2.35) for strained (high demands plus low control) against relaxed (low demands plus high control) groups. After adjustment for standard cardiovascular risk factors the HR for developing a coronary event for those above or equal to the median against those below the median of psychological demands was 1.46 (95% CI 1.08-1.97) whereas the HR for strained against relaxed groups is 1.46 (95% CI 0.96-2.25). Sensitivity analyses confirmed the robustness of the results. CONCLUSION: In this European, multicenter, prospective, epidemiological study the Karasek job strain model was an independent predictor of acute coronary events, with the psychological demands scale emerging as the important component.

Increasing prevalence of overweight, obesity and physical inactivity: two population-based studies 1986 and 1994.

INTRODUCTION: The aim of this study was to investigate the 1986-1994 trend in obesity, overweight and sedentary leisure-time physical activity status, and the educational gradient in overweight and obesity in the city of Malmö, Sweden. MATERIAL/METHODS: The public health surveys in Malmö 1986 and 1994 are cross-sectional studies. A total of 4,800 and 5,600 individuals aged 20-80 years were randomly chosen to be interviewed by a postal questionnaire. The participation rates were 74% and 71%. Obesity was defined as BMI 30.0 or more and overweight as BMI 25.0-29.9. The prevalences of leisure-time physical inactivity, obesity and overweight were computed, and the differences between 1986 and 1994 as well as educational gradients in overweight and obesity were assessed. RESULTS: The prevalence of obesity increased from 4.6% to 11.4% (p<0.001) among men and from 6.1% to 9.8% (p<0.001) among women. The prevalence of overweight (BMI 25.0-29.9) increased from 33.9% to 45.2% (p<0.001) among men, and from 19.6% to 29.1% (p<0.001) among women. The prevalence of leisure time physical inactivity increased among men from 14.7% to 18.1% (p<0.001) among men and from 19.4% to 26.7% (p<0.001) among women. The increasing prevalences of obesity, overweight and physical inactivity were observed in all age, country of origin and educational status groups. The educational differences in BMI 25.0+ observed among both men and women in 1986 disappeared among men in 1994. In contrast, educational differences in obesity (BMI 30.0+), not seen in 1986, appeared in 1994 among men. CONCLUSION: The proportions of the population with obesity and overweight increased significantly between 1986 and 1994 for both men and women. The increasing prevalence of physical inactivity seems to be an important explanation.

Life expectancy in the province of Halland, Sweden, 1911-50: the progress of public health in a long-living population.

BACKGROUND: Life expectancy in Sweden is currently one of the longest in the world. The population of Halland has the longest life expectancy in Sweden. AIM: Life expectancy in the province of Halland and Sweden as a whole during 1911-50 was studied and the findings are discussed in the light of local historical data. METHOD: A trend analysis of risk ratio of death and life expectancy for Halland and Sweden was done for the period 1911-50 with regard to calendar year, age, and sex using a Poisson model. RESULTS: The risk ratio between Halland and Sweden was 0.83 for 1911 and 0.76 for 1950. The risk ratio of death for women was lower compared with men and this difference increased over time. At the start of the study period life expectancy for men and women was higher in Halland (58.5 and 60.1 years, respectively) compared with Sweden (54.7 and 56.4 years, respectively) with a difference of approximately 3.8 years. At the end of the study period this difference in life expectancy for men and women in Halland (71.3 and 72.3 years, respectively) and the nation (68.0 and 69.2 years, respectively) had decreased to approximately 3.3 years. CONCLUSION: The long life expectancy seen in Halland today can be traced back to the early twentieth century. The starting point for this development seems to be a lower infant mortality in Halland compared with Sweden as a nation during the 1880-90. The basis for this might have been a greater increase of food production during the whole nineteenth century as well as other socioeconomic characteristics of Halland compared with the rest of the country.

Causes of death between 1911-1950 in a Swedish province with a population characterized by longevity.

AIMS: Life expectancy in Sweden is among the highest in the world, and the province of Halland has the highest life expectancy in Sweden today. In an earlier paper the authors reported that life expectancy in the province of Halland in the south-west of the country was approx. 3.5 years above the national average between 1911 and 1950. The aim of this study was to explore the influence of different causes of death on life expectancy in Sweden and the distribution of these causes of death in Halland compared with Sweden as a whole during the same period of time. METHOD: Causes of death between 1911 and 1950 in the whole of Sweden and in Halland were obtained from the archives of Statistics Sweden. A trend analysis was performed on the impact of the various causes of death on life expectancy in Sweden. Calendar year, age, and sex were controlled for in a Poisson model. The distribution and incidence of the most frequent causes of death were compared between Halland and Sweden as a whole. RESULTS: The decreasing mortality risk due to infectious diseases and the simultaneous increase in the risk of mortality from tumours and circulatory diseases contributed most to the change in life expectancy in Sweden. In Halland there was a lower mortality risk in the seven most important causes of death, which accounted for approx 80% of all deaths during the study period. CONCLUSIONS: The lower mortality risk from infectious diseases mostly favoured the improvement in life expectancy in Halland up to the mid-1930s. Thereafter, a low mortality risk from tumours and particularly circulatory diseases gained increasing importance although there was always a difference in favour of Halland from the beginning of the study period. Thus, the positive trend in life expectancy that favours Halland today seems to have existed for a long period of time.