Chemotherapy-induced Emesis: Experienced Burden in Life, and Significance of Treatment Expectations and Communication in Chemotherapy Care.

OBJECTIVE: Because antiemetics have become more effective and integrative therapies such as acupuncture are used in combination with antiemetics, people receiving chemotherapy for cancer today might expect less emesis than in the past. It is not previously described if and how people receiving modern antiemetics during chemotherapy experience emesis. The objective of this study was to describe experiences regarding emesis among persons undergoing emetogenic chemotherapy, and how it affects their quality of life, daily life and work. A further aim was to describe views on the significance of treatment expectations and communication with healthcare personnel while undergoing chemotherapy for cancer. METHOD: Fifteen participants (median age 62 years, n = 1 man and n = 14 women, with breast (n = 13) or colorectal (n = 2) cancer) undergoing adjuvant or neo-adjuvant highly or moderately emetogenic chemotherapy were interviewed individually. The data were then analyzed using inductive thematic analysis. RESULTS: Three themes described the participants' experiences: "Your whole life is affected, or continues as usual," covering descriptions of emesis limiting some participants' everyday lives, while others experienced no emesis at all or had found ways to manage it. Overall, participants described satisfaction with their antiemetic treatment. "Experiences and expectations more important than information", that is, the participants reported wanting all the information they could get about possible adverse effects of treatment, although they believed previous experiences were more important than information in creating expectations about treatment outcomes. The participants reported that being seen as a unique person was of utmost importance: "Meet me as I am." This creates trust in healthcare personnel and a feeling of safety and security in the situation. CONCLUSIONS: These findings underline the importance of person-centered care and support in creating positive treatment expectations. Future research is called for regarding the potential antiemetic effects of positive communication regarding strengthening positive treatment expectations during emetogenic chemotherapy.

Establishment and Utility of SwedAD: A Nationwide Swedish Registry for Patients with Atopic Dermatitis Receiving Systemic Pharmacotherapy.

SwedAD, a Swedish nationwide registry for patients with atopic dermatitis receiving systemic pharmacotherapy, was launched on 1 September 2019. We describe here the establishment of a user-friendly registry to the benefit of patients with atopic dermatitis. By 5 November 2022, 38 clinics had recorded 931 treatment episodes in 850 patients with an approximate national coverage rate of 40%. Characteristics at enrolment included median Eczema Area and Severity Index (EASI) 10.2 (interquartile range 4.0, 19.4), Patient-Oriented Eczema Measure (POEM) 18.0 (10.0, 24.0), Dermatology Life Quality Index (DLQI) 11.0 (5.0, 19.0) and Peak Itch Numerical Rating Scale-11 (NRS-11) 6.0 (3.0, 8.0). At 3 months, median EASI was 3.2 (1.0, 7.3) and POEM, DLQI, and NRS-11 were improved. Regional coverage varied, reflecting the distribution of dermatologists, the ratio of public to private healthcare, and difficulties in recruiting certain clinics. This study highlights the importance of a nationwide registry when managing systemic pharmacotherapy of atopic dermatitis.

Haemodialysis nurses' occupational health and work-related musculoskeletal hand pain after work: A cluster analysis.

AIM: To identify clusters based on haemodialysis nurses' self-rated work ability, work engagement and self-reported work hours and to compare the identified clusters regarding hand pain after work. DESIGN: Cross-sectional survey. METHODS: Data based on the Work Ability Index, Utrecht Work Engagement Scale and hand pain severity after work were collected through a web-based survey among 503 haemodialysis nurses working in Sweden and Denmark. A two-step cluster analysis was used to identify homogenous groups of cases within the dataset, followed by comparative analyses of the clusters. RESULTS: Four distinct clusters were identified, illustrating differing profiles of haemodialysis nurses' work ability, work engagement and working hours. Nurses who worked part-time and reported moderate work ability and average work engagement had significantly higher ratings of hand pain after work. CONCLUSIONS: Haemodialysis nurses are a heterogeneous group as regards work ability, work engagement and self-reported work hours. The four distinct clusters of nurses indicate a need for customized interventions for retaining each subgroup at work.

Development and Validation of the Infection Prevention Appraisal Scale.

It has been emphasized that future studies aimed at improving adherence to infection prevention guidelines should focus on beliefs in, e.g., self-efficacy. Reliable situation specific measures are needed to measure the phenomenon of self-efficacy, but there seems to be few valid scales available that are suitable for measuring one's belief in self-efficacy regarding infection prevention measures. The purpose of the study was to develop a unidimensional appraisal scale to capture nurses' beliefs in their abilities to practice medical asepsis in care situations. When creating the items, evidence-based guidelines for preventing healthcare-associated infections were used together with Bandura's guide for constructing self-efficacy scales. Face validity, content validity, and concurrent validity were tested in various samples of the target population. Furthermore, dimensionality was evaluated on data collected from 525 registered nurses and licensed practical nurses recruited from the medical, surgical, and orthopaedic wards of 22 Swedish hospitals. The Infection Prevention Appraisal Scale (IPAS) consists of 14 items. Face and content validity were endorsed by target population representatives. The exploratory factor analysis suggested unidimensionality, and the internal consistency was good (Cronbach's alpha 0.83). The total scale score correlated with the General Self-Efficacy Scale, as expected, and supported concurrent validity. The Infection Prevention Appraisal Scale demonstrates sound psychometric properties supporting a unidimensional measure of self-efficacy to medical asepsis in care situations.

Nurses' assessed self-efficacy levels to medical asepsis and their relation to structural empowerment, work engagement and work-related stress.

BACKGROUND: Nurses' working conditions are important for their well-being at work and for their ability to provide patients with safe care. Self-efficacy can influence employees' behaviour at work. Therefore, it is valuable to study self-efficacy levels to medical asepsis in relation to working conditions. OBJECTIVE: To investigate the relationship between nurses' assessed self-efficacy levels to medical asepsis in care situations and structural empowerment, work engagement and work-related stress. METHODS: A cross-sectional study with a correlational design was conducted. A total of 417 registered nurses and licensed practical nurses at surgical and orthopaedic units responded to a questionnaire containing: the Infection Prevention Appraisal Scale, the Conditions of Work Effectiveness Questionnaire-II, the Utrecht Work Engagement Scale-9 and the Health & Safety Executive Management Standards Indicator Tool. Correlational analyses and group comparisons were performed. RESULTS: The nurses rated high levels of self-efficacy to medical asepsis in care situations. The correlational analyses revealed that correlation coefficients between structural empowerment, work engagement, work-related stress and self-efficacy to medical asepsis were 0.254-0.268. Significant differences in self-efficacy were found in the grouped working conditions. CONCLUSIONS: This study revealed that nurses rated high self-efficacy levels to medical asepsis and, to some extent, this seemed related to structural empowerment, work engagement and work-related stress. This valuable knowledge could enable improvements at the managerial and organisational levels, benefiting both nurses and patients in the long run.

Incentives behind and Experiences of Being Active in Working Life after Age 65 in Sweden.

Since individual and societal expectations regarding the possibility of an extended working life after the expected retirement age are increasing, research on sustainable working life combined with healthy ageing is needed. This study explores the incentives behind and experiences of an extended working life after the expected retirement age of 65 among Swedish people. The inductive qualitative content analyses are based on 18 individual semi-structured interviews among persons 67-90 years old with varying characteristics and varying experiences of extended working lives. The analyses revealed that working contributed to (1) sustained internal resources, i.e., cognitive function, physical ability and increased vigor; (2) sustained external resources, i.e., social enrichment, better daily routines and economic benefits; (3) added meaningfulness to life, i.e., being needed, capability and satisfaction with working tasks. Meanwhile, having flexible working conditions enabled a satisfying balance between work and leisure. Altogether, these different aspects of overall health and working life were interpreted as contributing to increased feelings of vitality, the innermost dimension of health. Conclusions: regardless of biological age, our results indicate that being able to remain active in working life can be beneficial to vitality and could make these results valuable for both health-care personnel and employers.

A complex challenge with unclear improvement: the need for involvement, contextualization and facilitation when managers implement a leadership model.

PURPOSE: Management and leadership in health care are described as complex and challenging, and the span of control is known to be a key component in the manager's job demands. The implementation of change can be a challenge in health care, and managers often have roles as implementation leaders. Little attention has been given to how managers perceive the process of implementation. Thus, this study aims to explore second-line managers' perceptions of, prerequisites for and experiences from the implementation of changes in their manager's work conditions. DESIGN/METHODOLOGY/APPROACH: A grounded theory-based qualitative design was used. Data were collected from a purposive sample of nine second-line managers by individual semi-structured interviews. The three stages of initial coding, focus codes and axial coding were used in data analysis. FINDINGS: Three thematic areas were identified: engagement, facilitation and achievement. The second-line managers' descriptions suggest that the change work entails a complex challenge with an unclear result. Involvement, consideration for the context and facilitation are needed to be able to conduct a cohesive implementation process. ORIGINALITY/VALUE: This study findings outline that to succeed when implementing change in complex organizations, it is crucial that managers at different levels are involved in the entire process, and that there are prerequisites established for the facilitation and achievement of goals during the planning, implementation and follow-up.

Work-related musculoskeletal complaints among haemodialysis nurses: An exploratory study of the work situation from an ergonomic perspective.

BACKGROUND: Haemodialysis nurses have a high prevalence of musculoskeletal complaints, but the reason for this is yet unknown. OBJECTIVE: The aim of this study was to carry out an exploratory analysis of the work situation of haemodialysis nurses from an ergonomic perspective. METHODS: Non-participant observations and reflective discussions to assess the work environment and explore possible potential hazards contributing to musculoskeletal complaints were conducted among nineteen nurses at five haemodialysis centres. Additional reflective notes from the observer's experiences and progress in the field were made. Analytic integration was applied to merge the collected data. RESULTS: Eight haemodialysis work tasks believed to increase the risk of developing work-related musculoskeletal complaints were identified. Different types of musculoskeletal complaints, mainly in the upper extremity, were mentioned. The design of the dialysis machine used and the physical demands of repetitive work procedures were implicated. CONCLUSIONS: Our findings add to the understanding of the work-related factors that contribute to musculoskeletal complaints among haemodialysis nurses. The findings support the hypothesis that there might be an association between materials used and the development of work-related complaints involving the fingers, hands and wrists of this population. Repetitive work tasks that have an impact on the development of musculoskeletal problems need to be further investigated.

Incidence Rate of Hand Eczema in Different Occupations: A Systematic Review and Meta-analysis.

Hand eczema is a chronic disease that results in economic and psychosocial burdens. The aim of this study was to systematically review and assess the magnitude of the association between exposure related to occupations and the incidence rate of hand eczema. A systematic search in PubMed, EMBASE, CINAHL and Cochrane databases, from inception to September 2017, of full-text observational studies reporting incident cases of hand eczema during employment, and a supplementary search in PubMed to September 2020, were conducted. Among 2,417 screened abstracts, 15 studies fulfilled the inclusion criteria. Incidence rates were reported per 100 person-years. Based on the Newcastle-Ottawa Scale, 9 studies were good quality, 2 fair quality, and 4 poor quality. Hairdressers had a high incidence of hand eczema of 21.4 (95% confidence interval [CI] 15.3-27.4), as did nurses, 16.9 (95% CI 11.2-22.7), and metal workers, 12.4 (95% CI 3.5-21.3). Hairdressers were predominantly women, and metal worker were predominantly men. Office occupations had an incidence rate of hand eczema of 4.9 (95% CI 1.2-9.6). The high risk of hand eczema for hairdressers, nurses, and metal workers, should be considered by healthcare policymakers. Even occupations with low irritant profile, such as office workers, were at risk of developing hand eczema, and more occupations should be investigated regarding the related risk of developing hand eczema.

Dapagliflozin and new-onset type 2 diabetes in patients with chronic kidney disease or heart failure: pooled analysis of the DAPA-CKD and DAPA-HF trials.

BACKGROUND: Chronic kidney disease and heart failure are insulin resistant states associated with a high incidence of diabetes. We assessed the effect of dapagliflozin on new-onset type 2 diabetes in a pooled analysis of patient-level data from the DAPA-CKD and DAPA-HF trials. METHODS: This study is a pooled analysis of individual participant data from two phase 3, randomised, double-blind, placebo-controlled, multicentre, clinical trials. Participants with no history of diabetes and HbA1c less than 6·5% (48 mmol/mol) at baseline were included in this pooled analysis. New-onset type 2 diabetes was a prespecified exploratory endpoint in both DAPA-CKD and DAPA-HF trials and is the focus of this analysis. New-onset type 2 diabetes was identified by serial trial measurements of HbA1c (two consecutive values ≥6·5% [≥48 mmol/mol]) or following a clinical diagnosis of diabetes between trial visits. Time to new-onset type 2 diabetes was analysed in a Cox proportional Hazards model from random assignment to end of treatment. FINDINGS: 4003 participants (1398 [34·9%] from the DADA-CKD trial and 2605 [65·1%] from the DAPA-HF trial) were included in our analysis: 1995 (49·8%) had received dapagliflozin and 2008 (50·2%) had received placebo. Over a median follow-up of 21·2 months (IQR 16·0 to 25·4), 126 (6·3%) of 2008 patients in the placebo group (event rate 3·9 per 100 patient-years) and 85 (4·3%) of 1995 patients in the dapagliflozin group (event rate 2·6 per 100 patient-years) developed type 2 diabetes (hazard ratio 0·67 [95% CI 0·51 to 0·88]; p=0·0040). There was no heterogeneity between studies (p interaction 0·77) and there was no clear evidence that the effect of dapagliflozin varied in prespecified subgroups including sex, age, glycaemic status, BMI, glomerular filtration rate, systolic blood pressure, and baseline cardiovascular medication use. More than 90% of the participants who developed type 2 diabetes had prediabetes at baseline (HbA1c 5·7% to 6·4% [39 to 46 mmol/mol]). Mean HbA1c remained unchanged (placebo-adjusted change in the dapagliflozin group of -0·01% [95% CI -0·03 to 0·01], -0·1 mmol/mol [95% CI -0·3 to 0·1] at 12 months). INTERPRETATION: Treatment with dapagliflozin reduced the incidence of new-onset type 2 diabetes in participants with chronic kidney disease and HF without a reduction in HbA1c. FUNDING: AstraZeneca.

Contact allergy to haptens in the Swedish baseline series: Results from the Swedish Patch Test Register (2010 to 2017).

BACKGROUND: Allergic contact dermatitis has considerable public health impact and causative haptens vary over time. OBJECTIVES: To report the prevalence of contact allergy to allergens in the Swedish baseline series 2010 to 2017, as registered in the Swedish Patch Test Register. METHODS: Results and demographic information for patients tested with the Swedish baseline series in 2010 to 2017 were analysed. RESULTS: Data for 21 663 individuals (females 69%) were included. Females had significantly more positive patch tests (54% vs 40%). The reaction prevalence rates were highest for nickel sulfate (20.7%), fragrance mix I (7.1%), Myroxylon pereirae (6.9%), potassium dichromate (6.9%), cobalt chloride (6.8%), methylchloroisothiazolinone/methylisothiazolinone (MCI/MI; 6.4%), MI (3.7%), colophonium (3.5%), fragrance mix II (3.2%), and formaldehyde (3.2%). Myroxylon pereirae reaction prevalence increased from 5% in 2010 to 9% in 2017 and that for methyldibromo glutaronitrile from 3.1% to 4.6%. MCI/MI and MI reactions decreased in prevalence after 2014. Nickel reaction prevalence decreased among females aged 10 to 19 years. CONCLUSIONS: Nickel remains the most common sensitizing agent, with reaction prevalence decreasing among females younger than 20 years. The changes in MCI/MI and MI reaction prevalence mirrored those in Europe. The register can reveal changes in contact allergy prevalence over time among patients patch tested in Sweden.

Healthcare personnel's working conditions in relation to risk behaviours for organism transmission: A mixed-methods study.

AIMS AND OBJECTIVES: To investigate healthcare personnel's working conditions in relation to risk behaviours for organism transmission. BACKGROUND: Healthcare personnel's behaviour is often influenced by working conditions that in turn can impact the development of healthcare-associated infections. Observational studies are scarce, and further understanding of working conditions in relation to behaviour is essential for the benefit of the healthcare personnel and the safety of the patients. DESIGN: A mixed-methods convergent design. METHODS: Data were collected during 104 h of observation at eight hospital units. All 79 observed healthcare personnel were interviewed. Structured interviews covering aspects of working conditions were performed with the respective first-line manager. The qualitative and quantitative data were collected concurrently and given equal priority. Data were analysed separately and then merged. The study follows the GRAMMS guidelines for reporting mixed-methods research. RESULTS: Regardless of measurable and perceived working conditions, risk behaviours frequently occurred especially missed hand disinfection. Healthcare personnel described staffing levels, patient-level workload, physical factors and interruptions as important conditions that influence infection prevention behaviours. The statistical analyses confirmed that interruptions increase the frequency of risk behaviours. Significantly higher frequencies of risk behaviours also occurred in activities where healthcare personnel worked together, which in the interviews was described as a consequence of caring for high-need patients. CONCLUSIONS: These mixed-methods findings illustrate that healthcare personnel's perceptions do not always correspond to the observed results since risk behaviours frequently occurred regardless of the observed and perceived working conditions. Facilitating the possibility for healthcare personnel to work undisturbed when needed is essential for their benefit and for patient safety. RELEVANCE FOR CLINICAL PRACTICE: The results can be used to enlighten healthcare personnel and managers and when designing future infection prevention work.

Dermal exposure to cobalt studied in vitro in keratinocytes - effects of cobalt exposure on inflammasome activated cytokines, and mRNA response.

BACKGROUND: Cobalt is a dermal sensitizer, and keratinocytes respond to cobalt exposure by releasing proinflammatory mediators, regulating the immune response. OBJECTIVE: To determine the effect of cobalt on the inflammasome associated cytokine- and gene expression in cultured human keratinocytes (HaCaT). Cultivation in low- or high calcium conditions model separate differentiation states of keratinocytes in the skin. METHOD: HaCaT cells in two different states of differentiation were exposed to cobalt chloride and caspase-1 activity as well as the production of IL-1ß, IL-18 and gene expression of IL1B, IL18, NLRP3, CASP1, and PYCARD was quantified. RESULTS: High cobalt chloride exposure mediated significant increase in caspase-1 activity, cytokine levels, and IL1B and NLRP3 expression with a corresponding regulatory decrease for CASP1 and PYCARD expression. No difference between high- and low calcium culturing conditions modelling differentiation states was detected. CONCLUSIONS: Our data suggest that HaCaT cells respond with inflammmasome associated activity upon cobalt exposure in a concentration-dependent manner. These mechanisms could be of importance for the understanding of the pathophysiology behind allergic sensitization to dermal cobalt exposure.

An exploratory analysis of work engagement among women with and without disordered eating.

BACKGROUND: Around 10% of the female population is estimated to have a subclinical eating disorder. Many of these women are of working age. Previous research has shown associations between unhealthy eating behaviors and occupational stress or burnout. However, no previous study has explored the association between disordered eating and work engagement, a positive, fulfilling, affective-cognitive state of mind which has been positioned as the conceptual opposite of burnout. Thus, that was the aim of the present study. METHODS: In this cross-sectional study, a sample of 701 Swedish women completed the 9-item Utrecht Work Engagement Scale (UWES-9) and the Eating Disorder Examination Questionnaire (EDE-Q). They were divided into a Healthy Eating (HE) and a Disordered Eating (DE) group based on their EDE-Q scores. The Mann-Whitney U test was used to test the association between disordered eating and work engagement. The Kruskal Wallis test was used to assess the associations between educational level, marital status and age group, and work engagement. RESULTS: Neither the UWES scores nor the EDE-Q scores were found to have a normal distribution. Non-parametric testing showed that the DE group reported significantly lower work engagement than the HE group (p = 0.016). There were no significant associations between education, marital status or age (independent variables) and work engagement (dependent variable) (p = 0.826, 0.309, and 0.349, respectively). CONCLUSION: These findings indicate that work engagement may play a role in disordered eating, and that there is a need for future research to consider the workplace environment as a potential source for altering disordered eating behaviors.

Dose- and time-dependent changes in viability and IL-6, CXCL8 and CCL2 production by HaCaT-cells exposed to cobalt. Effects of high and low calcium growth conditions.

BACKGROUND: Sensitization requires exposure to an allergen with subsequent production of a "danger "signal. In the skin, keratinocytes are the main producers of these signals. OBJECTIVE: To compare dose- and time-effects of cobalt on the viability of and cytokine release from HaCaT cells cultured at low or high calcium. METHOD: To model two separate states of differentiation of keratinocytes, HaCaT cells were cultured under low or high calcium conditions. HaCaT were exposed to different concentrations of cobalt chloride (10 µm to 5 mM) over time (30 minutes- 48 hours). Cell viability was measured with the Cell-Titer Blue Viability assay. Cytokine production was measured using a bead-based immunoassay and flow cytometry. Gene expression was quantified using qPCR. Data was analyzed by ANOVA and linear mixed model. RESULTS: Viability of the cells was dose- and time-dependent. A linear mixed statistical model showed that cobalt exposure induces increase in IL-6, CXCL8 and CCL2 production over time and whereas increase of IL-6 and a decrease of CCL2 was associated with increasing cobalt chloride concentrations. When comparing the cells incubated under high and low calcium conditions, the more differentiated cells in the high concentration were found to exert a stronger response in terms of IL-6 release. CONCLUSIONS: Our data suggest that cobalt chloride triggered an alarm system in HaCaT cells, and proinflammatory cytokines/chemokines were secreted in a dose- and time-dependent manner. When high and low calcium incubations were compared, the difference was seen only for IL-6. These findings indicate that the effect of cobalt chloride on cell toxicity occurs throughout the living epidermis.

Prevalence of musculoskeletal complaints among haemodialysis nurses - a comparison between Danish and Swedish samples.

Objective. The repetitiveness of priming and dismantling disposables for haemodialysis treatments might be an important contributor to musculoskeletal complaints. The objective was therefore to compare the prevalence of musculoskeletal complaints among haemodialysis nurses in Denmark and Sweden. Methods. For this cross-sectional study, nurses were recruited from haemodialysis centres in Denmark (n = 194) and Sweden (n = 351). Prevalence of musculoskeletal complaints was evaluated using the Nordic musculoskeletal questionnaire. Results. The percentage of nurses reporting musculoskeletal complaints from at least one part of their body was 90.2% in the Danish sample and 88.9% in the Swedish sample. The anatomical locations with the most complaints were the neck, lower back and hands. Except for the proportion of complaints concerning the neck, there were no differences between the countries. Absenteeism from work was mostly due to complaints regarding the hands. Conclusion. The prevalence of musculoskeletal complaints seems to be higher among haemodialysis nurses than among nurses in general. Because complaints concerning the hands are common, and also related to absenteeism from work, it is of particular importance that manufacturers of dialysis equipment and nurse managers acknowledge these occupational health and safety hazards in their efforts to create a good work environment.

The Fluid Intake Appraisal Inventory for low fluid intake among patients on haemodialysis: Translation and psychometric evaluation of the Danish version.

AIMS AND OBJECTIVES: To translate and evaluate the psychometric properties of a Danish version of the Fluid Intake Appraisal Inventory (Da-FIAI) regarding reliability and validity. BACKGROUND: Patients on haemodialysis are advised to restrict their fluid intake, which often requires patients to change their way of life and health behaviour. DESIGN: Cross-sectional study. METHODS: The FIAI was translated to Danish by two sets of target translations and two sets of back-translations (n = 4). One hundred and ninety-five patients on haemodialysis needing ultrafiltration completed the questionnaire for the evaluation study of the Da-FIAI, and psychometric properties were evaluated. RESULTS: Criterion validity was supported, and the Da-FIAI had an excellent internal consistency; known-groups validity and the factor structure could not be confirmed in the Danish sample. CONCLUSIONS: We have shown that the Da-FIAI is useful in a Danish haemodialysis population to score the patient's ability to avoid drinking in specific situations. RELEVANCE TO CLINICAL PRACTICE: Using the Da-FIAI in the continuing nurse-patient communication, nurses have a validated instrument to evaluate patients' self-efficacy in fluid intake management and systematically identify and advise patients who need additional support.

Associations of self-reported atopic dermatitis with comorbid conditions in adults: a population-based cross-sectional study.

BACKGROUND: The objective of this study was to investigate the relationships between atopic dermatitis (AD) and other common chronic health conditions in adults. METHODS: A cross-sectional survey was sent to a randomly selected population sample of 78,004 adults in Sweden. The questionnaires included measures of self-reported physical and mental health. Binary and multinomial logistic regression were used to examine the associations of AD with common chronic health conditions and psychological wellbeing. RESULTS: AD was self-reported by 4,175 respondents, representing almost 14% of the study population of 34,313 adults. Our results showed positive associations between AD and chronic health disorders, including conditions of the oral cavity: chronic obstructive pulmonary disease (adjusted odds ratio [aOR] = 1.58, 95% confidence interval [CI]: 1.30 to 1.92), asthma (aOR = 2.13, 95% CI: 1.91 to 2.38), mild recurrent gastrointestinal symptoms (adjusted relative risk ratio [aRRR] = 1.78, 95% CI: 1.64 to 1.92), high blood pressure (aOR = 1.16, 95% CI: 1.06 to 1.26), obesity (aOR = 1.34, 95% CI: 1.23 to 1.47), mild joint pain (aRRR = 1.47, 95% CI: 1.35 to 1.61), mild headache or migraine (aRRR = 1.50, 95% CI: 1.38 to 1.64), caries (aOR = 1.25, 95% CI: 1.04 to 1.49), bleeding gums (aOR = 1.69, 95% CI: 1.38 to 2.08), periodontitis (aOR = 1.42, 95% CI: 1.13 to 1.77), sensitive teeth (aOR = 1.57, 95% CI: 1.35 to 1.82), and dry mouth (aOR = 1.52, 95% CI: 1.33 to 1.74). Adjustment for asthma and depression attenuated the magnitude of the associations between AD and the study outcomes. AD was also associated with poorer general psychological wellbeing. CONCLUSIONS: Adults reporting AD may be at increased risk of chronic disorders and decreased psychological wellbeing. Physicians should recognize that individuals with severe AD and those with comorbid asthma or depression may be especially vulnerable.