Prospective study of job stress and risk of infections in Swedish adults

ObjectivesPsychological stress may influence both susceptibility and severity of infections. Although work-related stress is a widespread concern among many employees, few studies have been conducted with the focus on work stressors and infections. We therefore aimed to investigate this association in a prospective cohort study.MethodsOur study included 25 029 employed individuals who filled-out a questionnaire in September 1997 and were followed through record linkages until retirement or December 2016. Work stress was assessed at baseline using a Swedish version of the Demand-Control Questionnaire, whereas hospital contacts related to infections were identified from the National Patient Register. We fitted extensions of the standard Cox model to account for recurrent infections.ResultsIn total, we observed 8257 infections. Individuals in the third tertile of job demand had a 13% higher hazard of infections (HR=1.13; 95% CI=1.03 to 1.24) compared with individuals in the first tertile, specifically an increased incidence of upper respiratory tract infections (HR=1.15; 95% CI=1.00 to 1.33) and urinary tract infections (HR=1.31; 95% CI=1.09 to 1.57) was found. Employees with the highest job control (third tertile) had no lower risk of infections than individuals in the lowest tertile (HR=1.02; 95% CI=0.92 to 1.13). When combining the demand and control dimensions into job strain scale, no association between high job strain and infections was observed (HR=1.08; 95% CI=0.97 to 1.21).ConclusionHigh job demand, but not low job control, is associated with an increased occurrence of infections. No difference was observed in workers with high strain jobs compared with those with low strain jobs

The relationship between nightmares, depression and suicide

Abstract Objective Previous studies investigating the association between nightmares and suicide have yielded different results. We aimed to investigate whether nightmares, directly or indirectly, influence the incidence of suicide. Methods We used a prospective cohort study, based on 40,902 participants with a mean follow-up duration of 19.0 years. Cox proportional hazards models with attained age as time-scale were fitted to estimate hazard ratios (HR) of suicide with 95% confidence intervals (CI) as a function of the presence or absence of depression and nightmares. Mediation analysis was used to asses to what extent the relationship between nightmares and the incidence rate of suicide could be mediated by depression. Results No association was observed between nightmares and the incidence of suicide among participants without depression. Compared with non-depressed participants without nightmares, the incidence of suicide among participants with a diagnosis of depression was similar among those with and without nightmares (HR 12.3, 95% CI 5.55–27.2 versus HR 13.2, 95% CI 7.25–24.1). The mediation analysis revealed no significant effects of nightmares on suicide incidence. However, the incidence of depression during follow-up was higher among those who suffered from nightmares than among those who did not (p Conclusions Our findings indicate that nightmares have no influence on the incidence rate of suicide, but may reflect pre-existing depression. This is supported by a recent discovery of a strong genetic correlation of nightmares with depressive disorders, with no evidence that nightmares would predispose to psychiatric illness or psychological problems. Interventions targeting both depression and nightmares, when these conditions co-occur, may provide additional therapeutic benefit

Sleep duration and mortality, influence of age, retirement, and occupational group

SummaryPrevious work has shown that both long and short sleep duration is associated with increased mortality, with lowest risk around 7 hr. This has had widespread impact on views on the optimal sleep duration. However, age, being employed/retired, and blue‐/white‐collar status, may influence the time available for sleep and thus, confound the association. We investigated the role of these factors on the association between sleep duration and mortality. We used employed and retired participants (N = 25,430) from the Swedish National March Cohort and Cox proportional hazards regression to model the shape of the association. We found a significant U‐shaped association in a multivariable model with a hazard ratio (HR) of 1.24 (95% confidence interval [CI] 1.10, 1.39) for 60.3 years at baseline. The shape of the association did not differ between blue‐/white‐collar workers, nor between employed and retired groups. We conclude that the U‐shaped association between sleep duration and mortality is present only in older individuals

Association of Phosphodiesterase-5 Inhibitors Versus Alprostadil With Survival in Men With Coronary Artery Disease

Abstract Background Phosphodiesterase 5 inhibitor (PDE5i) treatment is associated with reduced mortality compared with no treatment for erectile dysfunction after myocardial infarction (MI). Objectives This study sought to investigate the association between treatment with PDE5i or alprostadil and outcomes in men with stable coronary artery disease. Methods All Swedish men with a prior MI or revascularization who received PDE5i or alprostadil during 2006 through 2013 at >6 months after the event were included, using the Swedish Patient Register and the Swedish Prescribed Drug Register. Cox regression was used to estimate adjusted hazard ratios with 95% confidence intervals for all-cause mortality, MI, heart failure, cardiovascular mortality, noncardiovascular mortality, cardiac revascularization, peripheral arterial disease, and stroke in men treated with PDE5i versus alprostadil. Results This study included 16,548 men treated with PDE5i and 1,994 treated with alprostadil. The mean follow-up was 5.8 years, with 2,261 deaths (14%) in the PDE5i group and 521 (26%) in the alprostadil group. PDE5i compared with alprostadil treatment was associated with lower mortality (hazard ratio: 0.88; 95% confidence interval: 0.79 to 0.98) and with similar associations for MI, heart failure, cardiovascular mortality, and revascularization. When quintiles (q) of filled PDE5i prescriptions were compared using q1 as reference, patients in q3, q4, and q5 had lower all-cause mortality. Among alprostadil users, those in q5 had a lower all-cause mortality compared to q1. Conclusions In men with stable coronary artery disease, treatment with PDE5i is associated with lower risks of death, MI, heart failure, and revascularization compared with alprostadil treatment. Although the decrease in all-cause mortality was PDE5i dose dependent, the data do not permit the inference of causality or any clinical benefits of PDE5i because of the observational study design

Obesity and risk of infections: results from men and women in the Swedish National March Cohort.

Abstract Background Previous studies have shown an association between body mass index (BMI) and infections, but the literature on type-specific community acquired infections is still limited. Methods We included 39 163 Swedish adults who completed a questionnaire in September 1997 and were followed through record-linkages until December 2016. Information on BMI was self-reported and infections were identified from the Swedish National Patient Register using International Classification of Diseases (ICD), Tenth Revision (ICD-10) codes. We fitted multivariable Cox proportional hazards models for time-to-first-event analysis, and we used extensions of the standard Cox model when repeated events were included. Results During a 19-year follow-up 32% of the subjects had at least one infection requiring health care contact, leading to a total of 27 675 events. We found an increased incidence of any infection in obese women [hazard ratio (HR) = 1.22; 95% confidence interval (CI) = 1.12; 1.33] and obese men (HR = 1.25; 95% CI = 1.09; 1.43) compared with normal weight subjects. For specific infections, higher incidences were observed for skin infections in both genders (HR = 1.76; 95% CI = 1.47; 2.12 for obese females and HR = 1.74; 95% CI = 1.33; 2.28 for obese males) and gastrointestinal tract infections (HR = 1.44; 95% CI = 1.19; 1.75), urinary tract infections (HR = 1.30; 95% CI = 1.08; 1.55) and sepsis (HR = 2.09; 95% CI = 1.46; 2.99) in obese females. When accounting for repeated events, estimates similar to the aforementioned ones were found. Conclusions Obesity was associated with an increased risk of infections in both genders. Results from multiple-failure survival analysis were consistent with those from classic Cox models

A Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Protocol for a Randomized Controlled Trial

Background: Excessive gestational weight gain is common and associated with adverse outcomes both in the short and long term. Although traditional lifestyle-based interventions have shown to mitigate excess gestational weight gain, little is known about whether mobile Health (mHealth) apps can promote healthy weight gain, diet, and physical activity during pregnancy. Objective: The primary aim of the HealthyMoms trial is to determine the effectiveness of a smartphone app (HealthyMoms) for mitigating excess gestational weight gain during pregnancy. Secondary aims are to determine the effectiveness of the app on dietary habits, physical activity, body fatness, and glycemia during pregnancy. Methods: HealthyMoms is a two-arm randomized controlled trial. Women are being recruited at routine visits at the maternity clinics in Linköping, Norrköping and Motala, Sweden. Women are randomized to the control or intervention group (n=150 per group). All women will receive standard care, and women in the intervention group will also receive the HealthyMoms smartphone app. Results: Recruitment of participants to the trial was initiated in October 2017, and 190 women have so far completed the baseline measurement. The baseline measures are estimated to be finalized in December 2019, and the follow-up measures are estimated to be completed in June 2020. Conclusions: This project will evaluate a novel smartphone app intervention integrated with existing maternity health care. If successful, it has great potential to be implemented nationally in order to promote healthy weight gain and health behaviors during pregnancy

Rationale for a Swedish cohort consortium

We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants' data, better return of funders' investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.Peer reviewe

The Smart City Active Mobile Phone Intervention (SCAMPI) study to promote physical activity through active transportation in healthy adults: a study protocol for a randomised controlled trial

Abstract Background The global pandemic of physical inactivity represents a considerable public health challenge. Active transportation (i.e., walking or cycling for transport) can contribute to greater total physical activity levels. Mobile phone-based programs can promote behaviour change, but no study has evaluated whether such a program can promote active transportation in adults. This study protocol presents the design and methodology of The Smart City Active Mobile Phone Intervention (SCAMPI), a randomised controlled trial to promote active transportation via a smartphone application (app) with the aim to increase physical activity. Methods/design A two-arm parallel randomised controlled trial will be conducted in Stockholm County, Sweden. Two hundred fifty adults aged 20–65 years will be randomised to either monitoring of active transport via the TRavelVU app (control), or to a 3-month evidence-based behaviour change program to promote active transport and monitoring of active travel via the TRavelVU Plus app (intervention). The primary outcome is moderate-to-vigorous intensity physical activity (MVPA in minutes/day) (ActiGraph wGT3x-BT) measured post intervention. Secondary outcomes include: time spent in active transportation measured via the TRavelVU app, perceptions about active transportation (the Transport and Physical Activity Questionnaire (TPAQ)) and health related quality of life (RAND-36). Assessments are conducted at baseline, after the completed intervention (after 3 months) and 6 months post randomisation. Discussion SCAMPI will determine the effectiveness of a smartphone app to promote active transportation and physical activity in an adult population. If effective, the app has potential to be a low-cost intervention that can be delivered at scale. Trial registration ClinicalTrials.gov NCT03086837; 22 March, 2017

Riksmarschkohorten

Three pages of this questionnaire were devoted to physical activity, the main focus of the project. Both previously validated and newly developed questions were used in order to estimate energy expenditure and to distinguish between constant low-level activity and short-term peak activity. We used a new rating scale for self-reports of time spent on different intensity levels of physical activity (and inactivity) during a typical day, allowing estimation of total energy expenditure on an interval scale level. This scale has been shown to be both valid and reliable. Seven pages contained questions about diet, using a 63-item validated semi-quantitative food frequency questionnaire that allows estimation of total energy intake and calorie adjustment. Supplementary questions were asked about intake of fried food, detailed pattern of alcohol intake, dietary supplements and use of health food preparations. Two pages had questions about anthropometrical measures, including height, weight (birth weight, current weight, and weight fluctuations), waist and hip measures (allowing calculations of BMI, lean body mass, waist-hip ratio). Further, three pages were allocated to questions about various background and possibly confounding factors such as country of birth, environment during childhood and adolescence, birthplace of parents, own education, type of employment. Two pages were about smoking (including passive smoking) and snuff dipping habits. One page was dedicated to vaccination history, two pages to medical history, two pages to pharmacological history. Two pages were about sun and UV exposure, possible use of sunbeds, and type of complexion. Five pages were spent on questions concerning the psychosocial history, including validated sets of questions about demands and autonomy at work, life events, self-perceived health, social support, as well as duration and quality of sleep. Sleep disturbances were assessed using a modified version of the Karolinska Sleep Questionnaire (KSQ), a widely used tool to assess quality and restorative function of sleep. One page was about the use of mobile telephones. Two pages were devoted to questions specific for women (age at menarche, parity, infertility, menstruation, menopause, use of oral contraceptives and hormone replacement therapy). Essentially complete follow-up has since been attained through multiple record linkages, using the individually unique national registration numbers (NRNs) to ensure exact linkages. We have linked the cohort to Statistics Sweden’s Register of the Total Population and Population Changes, and to the Patient Register, Cancer Register, Causes of Death Register, and Prescribed Drug Register from the National Board of Health and Welfare, permitting accurate tracking of vital and health status of all cohort members. Presently, we have complete follow-up through 2010. We are currently applying for new linkages, which will allow us to have information updated through 2012. Purpose: In September 1997, the Swedish Cancer Society organized a four-day national fund-raising event, the National March, in almost 3,600 cities and villages around the country. In conjunction with this event, we established the Swedish National March Cohort. The cohort consists of 43,880 well-motivated men and women who participated in the National March in support of the Swedish Cancer Society. With a 36-page questionnaire about lifestyle, exposure was assessed in much greater detail than in almost any other cohort. Essentially complete follow-up is attained through multiple linkages with high-quality Swedish registers.I samband med Cancerfondens Riksmarsch 1997 fyllde 43 880 svenskar i ett detaljerat 36-sidigt frågeformulär om livsstil och hälsa en sk prospektiv kohortstudie. Deltagarna gav samtidigt sitt samtycke till framtida uppföljning medelst samkörningar med de högkvalitativa svenska befolknings- och hälsoregistren. Kohorten, unik i sitt slag med tanke på detaljrikedomen för både exponering och utfall, har tillräckligt med fall för att ge den statistiska styrka som behövs för att kunna studera livsstilens betydelse och dess association för många av våra vanligaste sjukdomar. Målet är att kunna omsätta kunskapen vi får fram, till rekommendationer och förebyggande åtgärder. Syfte: I september 1997 organiserade den svenska Cancerfonden ett nationellt insamlingsevent, Riksmarschen, som pågick under fyra dagar i nästan 3 600 städer och byar runt om i landet. I samband med detta etablerades Riksmarschkohorten, the National March Cohort. Kohorten består av 43 880 män och kvinnor som deltog i Riksmarschen för att stödja för den svenska Cancerfonden. Med ett 36-sidigt frågeformulär om livsstil, kan exponering bedömas mycket mer detaljerat än i nästan alla andra kohorten. Uppföljning sker huvudsakligen genom kopplingar till flera svenska register av hög kvalitet