Healthy workplaces for women and men of all ages

The aim of this knowledge compilation is to contribute with know-ledge about the work environment in relation to the ever-older workforce. How do employee needs and possibilities change from a course of life perspective? What should the employer and other work environment actors think about in order for the workforce to be able to and want to work to a high age? The Swedish Work Environment Authority wishes to give an overar-ching knowledge profile of different aspects of the work environment and the ageing workforce, and we therefore asked seven researchers to summarise the research-based knowledge within each of their are-as, from a course of life and gender perspective. An eighth researcher acted as an editor for the anthology, and has also written the preface. In summary, the report shows that we are becoming even healthier, living ever longer and working to an ever higher age. Older people in the workforce are positive for the economy because productivity increases, and the business sector can make use of competent and experienced staff for a longer time. But for the older labour force to be healthy and want to work at higher ages, one needs to take into consideration how ageing influences health and the capacity to work. With age, all people are affected to different degrees by reduced vision, hearing and physical capacity, as well as longer reaction times. Even their cognitive capacity changes. Certain cognitive abilities are strengthened with rising age, while others deteriorate. With an ageing workforce, more employees have chronic illnesses, which, however, seldom affect the actual working ability. Changes in working life also affect health and wellbeing, for example deregulated work and the technical development. Age and previous experiences impact upon our ability to adapt to these changes. One factor that promotes adap-tation is partly resilience (that is to say, resistance and the ability to adapt to the new), partly compensation strategies when the mental and physical resources change. There are no great differences bet-ween gender when it comes to the consequences of ageing on health and wellbeing in the work. On the other hand, the public health trend shows increasing differences in health between the lower educated and the higher educated - a difference increasing more quickly among women than among men. The gender-segregated labour market also means that more women than men work in physical and mentally burdensome work. Attitudes at the workplace also affect wellbeing and the will to continue working at higher ages. Men tend to be more sensitive to age discrimination while women run the risk of double discrimination, that is to say based upon both gender and age. Work 10 environment and the attitude to an older workforce are central to the considerations that an employee makes in the choice between continuing to work and retiring. Other prerequisites that influence the decision are one’s own health, private finances and self-fulfilling activities. The employer can do a great deal to lengthen and improve their employees’ working life. Systematic work environment management benefits everyone, and it can contribute to everyone keeping their working ability and to older people wanting to and being able to work for longer. Occupational health services of good quality also play an important role. Technical aids and adaptation of the working pace and working tasks are other measures that improve the work environment for the older workforce. The employer can also contri-bute to stimulating work arrangements and organisational support for the employees in order to strengthen their resilience and promote the development of compensation strategies

Baseline characteristics of 547 new onset heart failure patients in the PREFERS heart failure study

Aim We present the baseline characteristics of the PREFERS Stockholm epidemiological study on the natural history and course of new onset heart failure (HF) aiming to improve phenotyping focusing on HF with preserved left ventricular ejection fraction (HFpEF) pathophysiology. Methods and results New onset HF patients diagnosed in hospital or at outpatient HF clinics were included at five Stockholm hospitals 2015-2018 and characterized by N-terminal pro brain natriuretic peptide (NT-proBNP), biomarkers, echocardiography, and cardiac magnetic resonance imaging (subset). HFpEF [left ventricular ejection fraction (LVEF) >= 50%) was compared with HF with mildly reduced LVEF (HFmrEF; LVEF 41-49%) and with HF with reduced LVEF (HFrEF; LVEF <= 40%). We included 547 patients whereof HFpEF (n = 137; 25%), HFmrEF (n = 61; 11%), and HFrEF (n = 349; 64%). HFpEF patients were older (76; 70-81 years; median; interquartile range) than HFrEF (67; 58-74; P < 0.001), more often women (49% vs. 30%; P < 0.001), and had significantly higher comorbidity burden. They more often had atrial fibrillation, hypertension, and renal dysfunction. NT-proBNP was lower in HFpEF (896; 462-1645 ng/L) than in HFrEF (1160; 563-2370; P = 0.005). In HFpEF, left ventricular (LV) diameters and volumes were smaller (P < 0.001) and septa! and posterior wall thickness and relative wall thickness higher (P < 0.001). E/e >= 14 was present in 26% of HFpEF vs. 32% of HFrEF (P = 0.017) and left atrial volume index > 34 mL/m(2) in 57% vs. 61% (P = 0.040). HFmrEF patients were intermediary between HFpEF and HFrEF for LV mass, LV volumes, and RV volumes but had the highest proportion of left ventricular hypertrophy and the lowest proportion of elevated E/e. Conclusions Phenotype data in new onset HF patients recruited in a broad clinical setting showed that 25% had HFpEF, were older, more often women, and had greater comorbidity burden. PREFERS is well suited to further explore biomarker and imaging components of HFpEF pathophysiology and may contribute to the emerging knowledge of HF epidemiology

Vital capacity and COPD: the Swedish CArdioPulmonary bioImage Study (SCAPIS)

Background: Spirometric diagnosis of chronic obstructive pulmonary disease (COPD) is based on the ratio of forced expiratory volume in 1 second (FEV1)/vital capacity (VC), either as a fixed value &amp;lt;0.7 or below the lower limit of normal (LLN). Forced vital capacity (FVC) is a proxy for VC. The first aim was to compare the use of FVC and VC, assessed as the highest value of FVC or slow vital capacity (SVC), when assessing the FEV1/VC ratio in a general population setting. The second aim was to evaluate the characteristics of subjects with COPD who obtained a higher SVC than FVC. Methods: Subjects (n=1,050) aged 50-64 years were investigated with FEV1, FVC, and SVC after bronchodilation. Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPDFVC was defined as FEV1/FVC &amp;lt;0.7, GOLDCOPD(VC) as FEV1/VC &amp;lt;0.7 using the maximum value of FVC or SVC, LLNCOPDFVC as FEV1/FVC below the LLN, and LLNCOPDVC as FEV1/VC below the LLN using the maximum value of FVC or SVC. Results: Prevalence of GOLDCOPD(FVC) was 10.0% (95% confidence interval [CI] 8.2-12.0) and the prevalence of LLNCOPDFVC was 9.5% (95% CI 7.8-11.4). When estimates were based on VC, the prevalence became higher; 16.4% (95% CI 14.3-18.9) and 15.6% (95% CI 13.5-17.9) for GOLDCOPD(VC) and LLNCOPDVC, respectively. The group of additional subjects classified as having COPD based on VC, had lower FEV1, more wheeze and higher residual volume compared to subjects without any COPD. Conclusion: The prevalence of COPD was significantly higher when the ratio FEV1/VC was calculated using the highest value of SVC or FVC compared with using FVC only. Subjects classified as having COPD when using the VC concept were more obstructive and with indications of air trapping. Hence, the use of only FVC when assessing airflow limitation may result in a considerable under diagnosis of subjects with mild COPD.Funding Agencies|Swedish Heart Lung Foundation; Knut and Alice Wallenberg Foundation; Swedish Research Council (VR); VINNOVA; Swedish Council for Working Life, Health, and Welfare (FORTE); Sahlgrenska Academy at the University of Gothenburg, Krefting Research Centre; ALF/LUA in western Sweden</p

The association of body mass index, weight gain and central obesity with activity-related breathlessness : The Swedish Cardiopulmonary Bioimage Study

Introduction: Breathlessness is common in the population, especially in women and associated with adverse health outcomes. Obesity (body mass index (BMI) >30 kg/m2) is rapidly increasing globally and its impact on breathlessness is unclear. Methods: This population-based study aimed primarily to evaluate the association of current BMI and self-reported change in BMI since age 20 with breathlessness (modified Research Council score ≥1) in the middle-aged population. Secondary aims were to evaluate factors that contribute to breathlessness in obesity, including the interaction with spirometric lung volume and sex. Results: We included 13 437 individuals; mean age 57.5 years; 52.5% women; mean BMI 26.8 (SD 4.3); mean BMI increase since age 20 was 5.0 kg/m2; and 1283 (9.6%) reported breathlessness. Obesity was strongly associated with increased breathlessness, OR 3.54 (95% CI, 3.03 to 4.13) independent of age, sex, smoking, airflow obstruction, exercise level and the presence of comorbidities. The association between BMI and breathlessness was modified by lung volume; the increase in breathlessness prevalence with higher BMI was steeper for individuals with lower forced vital capacity (FVC). The higher breathlessness prevalence in obese women than men (27.4% vs 12.5%; p<0.001) was related to their lower FVC. Irrespective of current BMI and confounders, individuals who had increased in BMI since age 20 had more breathlessness. Conclusion: Breathlessness is independently associated with obesity and with weight gain in adult life, and the association is stronger for individuals with lower lung volumes