Associations Between Being ‘Locked-In’ and Health – An Epidemiological Study

Objective. The aim of this study was to investigate associations between an individual’s level of perceived control over labor market position (locked-in and not locked-in) and self-rated health and psychological well-being.Methods. A representative sample (n = 11,675) of the working population in southern Sweden responded to a questionnaire.Results. Sixty-seven percent of the respondents worked in their preferred workplace and occupation. Nineteen percent reported being in a nonpreferred workplace and nonpreferred occupation (double locked-in). Twenty-three percent reported suboptimal health compared with 31% among the double locked-in. The risk of suboptimal health was elevated in all locked-in groups also after adjustment for background variables and job strain. In the double locked-in group, the fully adjusted odds ratio for suboptimal health was 1.72 (95% confidence interval 1.49–1.99) and for suboptimal psychological well-being 2.17 (95% confidence inter val 1.84–2.56). Odds ratio for the other locked-in groups was lower but still statistically significant.Conclusions. Being at a nonpreferred work-place or occupation was associated with impaired health

Можливості розвитку інноваційної діяльності малого та середнього бізнесу в Україні та за кордоном

Objectives The unemployed are assumed to adopt unhealthy behaviours, including harmful use of alcohol. This study sought to elucidate the relations between unemployment before age 21years and consumption of alcohol from 21 to 42years. The design was based on the conception of youth as a sensitive period for obtaining drinking scars' that are visible up to middle age. Setting The Northern Swedish Cohort Study has followed up a population sample from 1981 to 2007 with five surveys. Participants All pupils (n=1083) attending the last year of compulsory school in Lulea participated in the baseline survey in classrooms, and 1010 of them (522 men and 488 women) participated in the last follow-up survey that was conducted at classmate reunions or by post or by phone. Outcome measure The trajectory of alcohol consumption from 21 to 43years, obtained with latent class growth analyses, was scaled. Results Men were assigned to five and women to three consumption trajectories. The trajectory membership was regressed on accumulation of unemployment from 16 to 21years, with multinomial logistic regression analyses. The trajectory of moderate consumption was preceded by lowest exposure to unemployment in men and in women. With reference to this, the relative risk ratios for high-level trajectory groups were 3.49 (1.25 to 9.79) in men and 1.41 (0.74 to 2.72) in women, but also the trajectories of low-level consumption were more probable (relative risk ratio 3.18 (1.12 to 9.02) in men and 2.41 (1.24 to 4.67) in women). Conclusions High-level alcohol consumption throughout adulthood is, particularly among men, partly due to scars' from youth unemployment, particularly in men, but there are also groups of men and women where unemployment in the teens predicts a trajectory of low consumption

Diagnosis-specific sickness absence as a predictor of mortality: the Whitehall II prospective cohort study

Objective To investigate whether knowing the diagnosis for sickness absence improves prediction of mortality

Expectancies, Socioeconomic Status, and Self-Rated Health: Use of the Simplified TOMCATS Questionnaire

Background: Coping has traditionally been measured with inventories containing many items meant to identify specific coping strategies. An alternative is to develop a shorter inventory that focusses on coping expectancies which may determine the extent to which an individual attempts to cope actively. Purpose: This paper explores the usefulness and validity of a simplified seven-item questionnaire (Theoretically Originated Measure of the Cognitive Activation Theory of Stress, TOMCATS) for response outcome expectancies defined either as positive (“coping”), negative (“hopelessness”), or none (“helplessness”). The definitions are based on the Cognitive Activation Theory of Stress (CATS; Ursin and Eriksen, Psychoneuroendocrinology, 29(5):567–92, 2004). The questionnaire was tested in two different samples. First, the questionnaire was compared with a traditional test of coping and then tested for validity in relation to socioeconomic differences in self-reported health. Methods: The first study was a comparison of the brief TOMCATS with a short version of the Utrecht Coping List (UCL; Eriksen et al., Scand J Psychol, 38(3):175–82, 1997). Both questionnaires were tested in a population of 1,704 Norwegian municipality workers. The second study was a cross-sectional analysis of TOMCATS, subjective and objective socioeconomic status, and health in a representative sample of the Swedish working population in 2003– 2005 (N011,441). Results: In the first study, the coping item in the TOMCATS questionnaire showed an expected significant positive correlation with the UCL factors of instrumental masteryoriented coping and negative correlations with passive and depressive scores. There were also the expected correlations for the helplessness and hopelessness scores, but there was no clear distinction between helplessness and hopelessness in the way they correlated with the UCL. In the second study, the coping item in TOMCATS and the three-item helplessness scores showed clear and monotonous gradients over a subjective socioeconomic status (SES) ladder. Positive response outcome expectancy (“coping”) was related to high subjective SES and no expectancy (“helplessness”) to low subjective SES. In a model including age and sex, TOMCATS scores explained more variance (r200.16) in self-reported health than both subjective (r200.08) and objective SES (r200.02). Conclusion: The brief TOMCATS questionnaire showed acceptable and significant correlations with a traditional coping questionnaire and is sensitive enough to register systematic differences in response outcome expectancies across the socioeconomic ladder. The results furthermore confirm that psychological and learning factors contribute to the socioeconomic gradient in health.publishedVersio

It's giving me the blues: A fixed-effects and g-formula approach to understanding job insecurity, sleep disturbances, and major depression

Research suggests that work-related factors like job insecurity increases the risk of major depression (MD), although it is unclear whether the association is causal. Research further suggests that job insecurity increases sleep disturbances, which is also a risk factor for MD. Based on current knowledge, it is possible that job insecurity operates through sleep disturbances to affect MD, but this pathway has not been examined in the literature. The current study extends the literature by using two complementary, counterfactual approaches (i.e., random- and fixed-effects regression and a mediational g-formula) to examine whether job insecurity causes MD and whether sleep disturbances mediate the relationship. A methodological triangulation approach allowed us to adjust for unobserved and intermediate confounding, which has not been addressed in prior research. Findings suggest that the relationship between job insecurity and MD is primarily direct, that hypothetically intervening on job insecurity (in our g-formula) would reduce MD by approximately 10% at the population level, and this relationship operates via sleep disturbances to some degree. However, the indirect pathway had a high degree of uncertainty

Validade transcultural da escala demanda-controle: trabalhadores suecos e brasileiros

OBJECTIVE To evaluate the cross-cultural validity of the Demand-Control Questionnaire, comparing the original Swedish questionnaire with the Brazilian version. METHODS We compared data from 362 Swedish and 399 Brazilian health workers. Confirmatory and exploratory factor analyses were performed to test structural validity, using the robust weighted least squares mean and variance-adjusted (WLSMV) estimator. Construct validity, using hypotheses testing, was evaluated through the inspection of the mean score distribution of the scale dimensions according to sociodemographic and social support at work variables. RESULTS The confirmatory and exploratory factor analyses supported the instrument in three dimensions (for Swedish and Brazilians): psychological demands, skill discretion and decision authority. The best-fit model was achieved by including an error correlation between work fast and work intensely (psychological demands) and removing the item repetitive work (skill discretion). Hypotheses testing showed that workers with university degree had higher scores on skill discretion and decision authority and those with high levels of Social Support at Work had lower scores on psychological demands and higher scores on decision authority. CONCLUSIONS The results supported the equivalent dimensional structures across the two culturally different work contexts. Skill discretion and decision authority formed two distinct dimensions and the item repetitive work should be removed.OBJETIVO Avaliar a validade transcultural da escala demanda-controle, comparando o questionário original sueco com a versão brasileira. MÉTODOS Foram comparados os dados de trabalhadores de saúde, 362 suecos e 399 brasileiros. Foram utilizadas análise fatorial confirmatória e exploratória para avaliar a validade estrutural, usando o estimador robusto de mínimos quadrados ponderados ajustados para média e variância (WLSMV). A validade de construto via teste de hipóteses foi avaliada pela inspeção da distribuição dos escores médios das dimensões da escala segundo as características sociodemográficas e níveis de apoio social no trabalho. RESULTADOS A análise fatorial confirmatória e exploratória corroborou o instrumento em três dimensões (suecos e brasileiros): demandas psicológicas, uso de habilidades e autonomia para decisão. O modelo de melhor ajuste foi obtido após incluir uma correlação de resíduos entre os itens trabalho rápido e trabalho intenso (demandas psicológicas) e remover o item trabalho repetitivo (uso de habilidades). O teste de hipóteses mostrou que trabalhadores com nível universitário apresentaram maiores escores em uso de habilidades e autonomia para decisão e aqueles com grau elevado de apoio social no trabalho obtiveram escores menores em demandas psicológicas e maiores em autonomia para decisão. CONCLUSÕES Os resultados confirmaram a equivalência da estrutura dimensional em dois contextos laborais culturalmente diferentes. Uso de habilidades e autonomia para decisão formaram duas dimensões distintas e o item trabalho repetitivo deveria ser removido da escala

Job insecurity and risk of coronary heart disease : Mediation analyses of health behaviors, sleep problems, physiological and psychological factors

Job insecurity has been linked to increased risk of coronary heart disease (CHD), but underlying mechanisms remain uncertain. Our aim was to assess the extent to which this association is mediated through life style, physiological, or psychological factors. A total of 3917 men and women free from CHD provided data on job insecurity in the Whitehall II cohort study in 1997-1999. The association between job insecurity and CHD was decomposed into a direct and indirect effect mediated through unhealthy behaviors (smoking, high alcohol consumption, physical inactivity), sleep disturbances, 'allostatic load', or psychological distress. The counterfactual analyses on psychological distress indicated a marginally significant association between job insecurity and incident CHD (hazard ratio (HR) 1.32; 95 % confidence interval (CI) 1.00-1.75). This association was decomposed into a direct (HR 1.22, 95 %CI 0.92-1.63) and indirect association (1.08, 95 %CI 1.01-1.15), suggesting that about 30 % of the total relationship was mediated by psychological distress. No mediation was indicated via health behaviors, sleep disturbances, or allostatic load, although job insecurity was related to disturbed sleep and C-reactive protein, which, in turn were associated with CHD. In conclusion, our results suggest that psychological distress may play a role in the relation between job insecurity and CHD.Peer reviewe

Work stress, anthropometry, lung function, blood pressure, and blood-based biomarkers : a cross-sectional study of 43,593 French men and women

Work stress is a risk factor for cardio-metabolic diseases, but few large-scale studies have examined the clinical profile of individuals with work stress. To address this limitation, we conducted a cross-sectional study including 43,593 working adults from a French population-based sample aged 18-72 years (the CONSTANCES cohort). According to the Effort-Reward Imbalance model, work stress was defined as an imbalance between perceived high efforts and low rewards at work. A standardized health examination included measures of anthropometry, lung function, blood pressure and standard blood-based biomarkers. Linear regression analyses before and after multivariable adjustment for age, socioeconomic status, depressive symptoms, health-related behaviours, and chronic conditions showed that work stress was associated with higher BMI, waist circumference, waist-hip ratio, alanine transaminase, white blood cell count and lower high-density lipoprotein cholesterol in men, and with higher BMI and white blood cell count in women (differences 0.03-0.06 standard deviations, P <0.05 between individuals with and without work stress). No robust associations were observed with lung function, haemoglobin, creatinine, glucose levels or resting blood pressure measures. This indicates that work stress is associated altered metabolic profile, increased systemic inflammation, and, in men, poorer liver function, which is a marker of high alcohol consumption.Peer reviewe

Smoking, physical inactivity and obesity as predictors of healthy and disease-free life expectancy between ages 50 and 75 : a multicohort study

Background: Smoking, physical inactivity and obesity are modifiable risk factors for morbidity and mortality. The aim of this study was to examine the extent to which the co-occurrence of these behaviour-related risk factors predict healthy life expectancy and chronic disease-free life expectancy in four European cohort studies. Methods: Data were drawn from repeated waves of four cohort studies in England, Finland, France and Sweden. Smoking status, physical inactivity and obesity (body mass index >= 30 kg/m(2)) were examined separately and in combination. Health expectancy was estimated by using two health indicators: suboptimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years. Results: Compared with men and women with at least two behaviour-related risk factors, those with no behaviour-related risk factors could expect to live on average8 years longer in good health and 6 years longer free of chronic diseases between ages 50 and 75.Having any single risk factor was also associated with reduction in healthy years. No consistent differences between cohorts were observed. Conclusions: Data from four European countries show that persons with individual and co-occurring behaviour-related risk factors have shorter healthy life expectancy and shorter chronic disease-free life expectancy. Population level reductions in smoking, physical inactivity and obesity could increase life-years lived in good health.Peer reviewe