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Biomedical subjects

T Theorell

Publications and source records attributed to T Theorell.

At least 19 recordsLinked to original sources
PubMed1998

Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude? Results from Stockholm Heart Epidemiology Program (SHEEP).

The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material is a population-based case-referent study having incident first events of myocardial infarction as outcome (SHEEP: Stockholm Heart Epidemiology Program). The analysis is restricted to males 45-64 yr of age with a more detailed analysis confined to those still working at inclusion. In total, 1047 cases and 1450 referents were included in the analysis. Exposure categories of job strain were formed from self reported questionnaire information. The results show that high demands and low decision latitude interact with a synergy index of 7.5 (95% C.I.: 1.8-30.6) providing empirical support for the core mechanism of the job strain model. Manual workers are more susceptible when exposed to job strain and its components and this increased susceptibility explains about 25-50% of the relative excess risk among manual workers. Low decision latitude may also, as a causal link, explain about 30% of the socioeconomic difference in risk of myocardial infarction. The distinction between the interaction and the causal link mechanisms identifies new etiologic questions and intervention alternatives. The specific causes of the increased susceptibility among manual workers to job strain and its components seem to be an interesting and important research question.

Case-Control Studies↗
PubMed1998

Psychophysiologic sensitization to headlight glare among professional drivers with and without cardiovascular disease.

Previous studies have shown that young, healthy professional drivers show heightened central nervous system arousal and cardiovascular hyperreactivity to simulated headlight glare. Electroencephalographic and cardiovascular response and recovery to simulated headlight glare (the glare pressor test) were examined in 4 groups of male professional drivers (age 25-52 years)--12 with ischemic heart disease (IHD), 12 with hypertension (HTN), 10 with borderline hypertension (BHTN), and 34 who were healthy--and in 23 non-professional driver controls--with the aim of assessing sensitization to this night driving stressor in relation to degree of cardiovascular disease severity. After glare exposure the IHD drivers showed the most pronounced alpha blockade, a rise in diastolic blood pressure (DBP; p < .05), and, unlike the other groups, a persistent fall in finger pulse volume (p < .02). The BHTN group reacted initially with DBP rise and finger pulse drop (ps < .05 and .02, respectively), mainly without central nervous system arousal. The DBP remained constant in normotensive professional drivers older than 40. The drivers' cardiovascular responses to glare were inversely related to reported stressors and subjective experience. Anxiety trait and long work hours were associated with heightened central arousal to glare in professional drivers. The results suggest that there may be progressive degrees of sensitization to glare exposure in these samples, with the least among normotensive professional drivers older than 40, moderate levels in borderline hypertensives, and the most severe in drivers with IHD.

Adaptation, Psychological↗
PubMed1998

Interview reliability for assessing mental work demands.

This study presented and evaluated an interview method for the analysis of tasks included in a work situation. What mental demands and possibilities do the work tasks give rise to? When was the work more or less automatic? When was use of active knowledge required? When were problem solving and planning needed? The study included an assessment of the interobserver reliability of the interviews with employees from 5 different careers: bus drivers (n = 10), home service workers (n = 32), carpenters (n = 11), farmers (n = 14), and teachers (n = 26). The extent to which this method can be reproduced in studies of different occupations is discussed. The interobserver reliability was good (.75-.82). There is support for the stability and usefulness of the interview for most types of work concerning the 3 categories of mental demands: routine, active knowledge, and problem solving/creativity.

Adult↗
PubMed1998

Treatment of patients with chronic somatic symptoms by means of art psychotherapy: a process description.

BACKGROUND: Inability to express emotions is common in patients with long-lasting somatic symptoms associated with incapacitation and impaired quality of life. One method for treating this inability is art psychotherapy. In this study the typical course in such treatments is described. Patients were followed longitudinally before therapy and every 4th to 6th month during the treatment. METHODS: Patients with long-lasting psychosomatic conditions resulting in partial or total loss of working capacity for at least 1 year have been treated in the programme. All of them had chronic pain. The majority of the patients that were referred to us were offered treatment. Three-fourths of those who started treatment stayed in treatment as long as the therapist considered it optimal. Twenty-four patients (22 women and 2 men) in the present study had their treatment started on average 2 years (range 13-42 months) before the end of the treatment period. In addition these 24 patients were contacted 6-48 months after the end of the therapy (average 23 months) and a short post-evaluation was made by telephone. RESULTS: The first year of treatment was characterized by emotional turmoil paralleled by increased energy level reflected in temporary elevation of serum uric acid. Significant improvement was observed with regard to anxiety-depression after one year of treatment. A tendency towards decreased levels of psychosomatic symptoms in general was observed after two years of treatment. One-fourth of the 20 non-working or part-time working patients increased their working activity. CONCLUSIONS: A slow partial recovery was observed. Art psychotherapy may have contributed to this.

Adult↗
PubMed1998

Decision latitude, job strain, and myocardial infarction: a study of working men in Stockholm. The SHEEP Study Group. Stockholm Heart epidemiology Program.

OBJECTIVES: This study examined the role of decision latitude and job strain in the etiology of a first myocardial infarction. METHODS: Eligible case patients were all full-time working men 45 to 64 years of age who suffered a first myocardial infarction during the period January 1992 to January 1993 in the greater Stockholm region. Referents were selected from the general population. Participation rates were 82% (case patients) and 75% (referents). RESULTS: Both inferred and self-reported low decision latitude were associated with increased risk of a first myocardial infarction, although this association was weakened after adjustment for social class. A decrease in inferred decision latitude during the 10 years preceding the myocardial infarction was associated with increased risk after all adjustments, including chest pain and social class. The combination of high self-reported demands and low self-reported decision latitude was an independent predictor of risk after all adjustments. CONCLUSIONS: Both negative change in inferred decision latitude and self-reported job strain are important risk indicators in men less than 55 years of age and in blue-collar workers.

Decision Making↗
PubMed1998

Occupational profile and cardiac risk: possible mechanisms and implications for professional drivers.

There has been at least forty empirical investigations concerning cardiovascular disease (CVD) among professional drivers (PDs). Standard cardiac risk factor status does not consistently distinguish PDs from other lower risk groups. PDs showed more than twice the overall exposure to stressful work factors compared to referents. They also showed lower maximum bicycle exercise level with a higher double product and higher diastolic blood pressure at the end of exercise compared to controls. Catecholamine excretion has been reported to be elevated during driving. Ambulatory measurements showed higher systolic and diastolic blood pressure in drivers before, during and after driving shifts. Using spectral analysis, the low to high frequency ratio was more than doubled towards the end of a 4-hour drive compared to the early one and a linear increase in 0.1 heart rate variability as a function of distance driven. Reactivity to headlight glare has been shown to roughly parallel the degree of CVD severity in PDs with IHD, essential and borderline hypertension. It was postulated that PDs with IHD form a powerful association between the exposure to glare and the stressfulness of driving and this association was resistant to extinction. The occupational medicine specialist "should have the authority to check the patient regularly in the workplace itself (to ascertain whether or not) the decision to return to work is still valid". An integrated diagnostic approach for PDs might entail using exercise stress testing, with evaluation of silent myocardial ischaemia and heart rate variability during work as well as laboratory tests which simulate aspects of their work environment, with catecholamines measured in relation to these procedures. Assessment of left ventricular mass and further evaluation of atherogenic biochemical abnormalities would be of value for further untangling the mechanisms of cardiac risk among PDs.

Adult↗
PubMed1998

Comparison of stress, job satisfaction, perception of control, and health among district nurses in Stockholm and prewar Zagreb.

The increasing number of studies of stress among nurses in the last two decades have mainly dealt with nurses in hospitals. A few studies have included community-based nurses. However, no comparative studies of district nurses in different countries have been published. We have conducted a study to identify sources of stress, job satisfaction, perceived demands, control and health among district nurses (DNs) in Zagreb (Croatia) and Stockholm (Sweden), working in a polyvalent health care organization. Data were obtained regarding altogether 305 district nurses by means of self-administered questionnaires using identical methods and items, with response rates between 88% and 95%. In general, district nurses reported high levels of job-related stress, satisfaction and control. Organizational sources of stress, such as ongoing changes in the primary care organization, and reorganization of tasks, were of importance for the district nurses in Stockholm. They reported also more job satisfaction and commitment than the district nurses in Zagreb. The district nurses in Zagreb had significantly higher level of "lack of resources". They displayed significantly higher scores of psychological demands but also a greater feeling of control than the district nurses in Stockholm. Significant differences were also found between the groups in ranking of self-reported stressors. Thus results show that differences in work organization and in essential resources have a substantial impact of perceived stress, job satisfaction, and on the generality both of single association and on the applications of models.

Adult↗
PubMed1997

Combined somatic and psychiatric care--effects on personnel treating drug addicts with infectious diseases.

Infectious disease care, psychiatric care of drug addicts, and social care were combined in a ward for drug addicts with infectious diseases. The aim of this study was to evaluate the effects on the personnel (n = 22). One ward with infectious disease care of HIV and AIDS patients (n = 24) and another with nonsomatic care of drug addicts (n = 18) were selected to make comparisons possible. The questionnaire concerned psychosocial work environment and health. The personnel at the new ward also participated in a semistructured interview. The personnel at the special ward experienced a significantly higher degree of emotional exhaustion and lack of ability to concentrate than the comparison groups. They also reported a higher degree of lack of clarity, more job strain, and more difficulties due to demands from patients. The combined care is probably associated with heavier psychological burdens than other forms of care. In spite of this, the personnel experienced their work as meaningful and mentally stimulating.

AIDS-Related Opportunistic Infections↗
PubMed1997

Fathers' experience of childbirth and its relation to crying in his infant.

As part of a research project exploring ways through which we can understand the crying infant and its family, this study focuses on the experiences of fathers during labour and delivery of their infant. In a previous part of the project it was shown that fathers' negative experiences during the childbirth were correlated with the amount of crying in the infant during the first months after birth. The aim of the present study was to explore and interpret the experiences that fathers reported in an interview when the infant was between six months and one year of age. A hundred and nine fathers were interviewed. The interviews, which took place in the families' homes and with both parents present, were carried out in dialogue form with open-ended questions. The results reveal that complications during the delivery were significantly correlated with the amount of crying in the infant. Feelings of helplessness, of guilt and that staff behaviour had been negative were more common in the group of fathers who experienced the delivery as a negative event. 'Locus of control' seems to be the most relevant concept.

Adult↗
PubMed1997

Coping style and social support in women suffering from cluster headache or migraine.

BACKGROUND: Many clinical neurologists have considered cluster headache patients to differ from migraine patients as to behavioral patterns. There is, however, little empirical validation of such a differentiation. METHODS: Coping profiles and social networks were studied in patients suffering from two kinds of recurrent headache. Twenty-four female patients with cluster headache, aged 23-72 years, and 24 age-matched migraine patients with and without aura participated in the study. All female cluster patients treated at the neurologic clinic of the hospital were included, and consecutive outpatients, who had been referred to the policlinics for diagnosis and treatment, whose symptoms agreed with the IHS criteria for migraine and who had ages matching the cluster headache patients, participated in the study. RESULTS: In the semiprojective coping tests the cluster headache patients were found to be statistically significant more 'positive' as to their anticipated activities in the future compared to the migraine patients (p < 0.04). No other statistical differences were found between the two groups. Compared to randomly selected and age-matched referents in the population. cluster headache patients reported significantly poorer social support (p < 0.01), while no other difference was found when the migraine patients were compared with controls. CONCLUSIONS: The findings indicate that there are differences in perception of anticipated activities and social support between patients with cluster headache and migraine.

Activities of Daily Living↗
PubMed1997

Working conditions and family situation in relation to functional gastrointestinal disorders. The Swedish Dyspepsia Project.

OBJECTIVE: To examine whether improvement and/or deterioration of functional gastrointestinal symptoms relate to psychosocial factors, and whether patients with such symptoms have special characteristics with regard to working environment in comparison to a referent population. DESIGN: Multicentre, prospective study of consecutive patients seeking medical advice at health centres for gastrointestinal symptoms. SETTING: Several municipalities in Sweden: Vänersborg, Trollhättan, Tibro, Alfta, Borensberg, Malmö, Kungälv, Hudiksvall, Vadstena, and Sandviken. PARTICIPANTS: 615 patients, aged 18-81 years, who after medical examination, upper endoscopy and laboratory test were defined as having functional gastrointestinal disorders. MAIN OUTCOME MEASURES: Initial characteristics and response to treatment according to a 5-graded symptom score as obtained from a psychosocial questionnaire collected during and at the end of a four-week treatment period. RESULTS: Patients with functional gastrointestinal disorders differed from a referent population of actively employed women and men in the county of Stockholm. They felt less possibility to influence their working conditions. Shift workers were also overrepresented. Psychosocial background factors had an effect on improvement of symptoms during four weeks of treatment. There were some differences between men and women. For women, working hours and home circumstances were important. After four weeks women who worked part-time felt better than those who worked full-time. Married women made a better recovery than single women. For men, working conditions had a greater effect on recovery. Those who felt that they received support from their colleagues at work improved to a greater extent than the other men.

Adult↗
PubMed1997

Associations between self-rated psychosocial work conditions and musculoskeletal symptoms and signs. Stockholm MUSIC I Study Group.

OBJECTIVES: The aim was to study the associations between self-rated psychosocial work conditions and the characteristics and location of musculoskeletal symptoms, signs, and syndromes. METHODS: Perceived psychosocial work conditions were recorded in a cross-sectional study with 358 men and women in various occupations. Symptoms were recorded from the musculoskeletal system with a questionnaire, and signs were detected in a medical examination of all body regions. The analyses of statistical associations between the psychosocial factors and musculoskeletal disorders were performed with control for age, gender, and physical load. RESULTS: The most consistent and pronounced associations were mainly seen between poor psychosocial work conditions and coexisting symptoms and signs of the neck and back regions. Poor psychosocial work conditions were more consistently and strongly associated with signs of muscular (soft tissue) tenderness than with signs of tenderness in the joints, tendons, or muscular insertions or signs in nerve compression tests. Mainly low social support at work, but also high psychological demands and high job strain, were associated with such symptoms and signs, whereas decision latitude at work showed few associations with musculoskeletal disorders. CONCLUSIONS: Perceived poor psychosocial work conditions are statistically associated mainly with symptoms and signs of muscular tenderness in the central body regions. Studies on associations between psychosocial work conditions and musculoskeletal disorders should separate effect measures of different clinical signs and different body regions in order to avoid attenuation of the risk estimates.

Adult↗
PubMed1997

Fighting for and losing or gaining control in life.

In JP Henry's work, fighting for and losing control were important concepts in the interpretation of energy mobilization in psychosocial conditions. Attachment and support were important protective and salutogenic factors. These concepts have been applied in a series of epidemiological and psychophysiological real life studies. Job conditions which force the worker to mobilize energy and concomitantly inhibit anabolism could be identified at least partly by means of the demand-control-support model originally proposed by Karasek. The most adverse conditions at work arise when psychological demands are high and at the same time the decision latitude is low. This combination is associated with changes in the regulation of endocrine parameters as well as with increased morbidity--heart disease, functional gastrointestinal symptoms and musculoskeletal disorders. Examples of studies of physiological correlates of psychosocial processes leading to fight for control are also described from outside work activities.

Animals↗
PubMed1996

Current issues relating to psychosocial job strain and cardiovascular disease research.

The authors comment on recent reviews of cardiovascular job strain research by P. L. Schnall and P. A. Landsbergis (1994), and by T. S. Kristensen (1995), which conclude that job strain as defined by the demand-control model (the combination of contributions of low job decision latitudes and high psychological job demands) is confirmed as a risk factor for cardiovascular mortality in a large majority of studies. Lack of social support at work appears to further increase risk. Several still-unresolved research questions are examined in light of recent studies: (a) methodological issues related to use of occupational aggregate estimations and occupational career aggregate assessments, use of standard scales for job analysis and recall bias issues in self-reporting; (b) confounding factors and differential strengths of association by subgroups in job strain-cardiovascular disease analyses with respect to social class, gender, and working hours; and (c) review of results of monitoring job strain-blood pressure associations and associated methodological issues.

Blood Coagulation Factors↗
PubMed1996

Intraindividual relationships between blood pressure level and emotional state.

BACKGROUND: Because of the increasing attention to the association between emotion and blood pressure (BP) during activity, there is a need to examine the subjects' own description of feelings in relation to different levels of BP during activity. METHODS: Fifty-eight Swedish subjects in six occupational groups were instructed to measure their own BP and subsequently record emotions at 1-hour intervals during waking hours. This was repeated during 4 different working days. Emotional states were recorded on a 4-point scale. Relationships between BP and each emotion were analyzed individually. RESULTS: One fourth of the subjects were unable to relate BP variations to emotional states whereas more than one tenth reported correlations between at least five different adjectives and BP. The number of adjectives correlated with systolic BP in an individual was linearly related to the individual's variation in systolic BP-the more significant the adjective the more systolic BP variation. Systolic BP increase with increasing job strain showed a curvilinear relationship with number of adjectives related to systolic BP-those with no significant adjectives and those with excessively many were those who showed the most increase in systolic BP with increasing job strain. CONCLUSIONS: Despite the fact that subjects recorded their emotions after the BP measurement, as many as 25% were unable to see any relationship between emotion and BP. This groups as well as those who described many emotion correlates had marked elevations in systolic BP with increasing job strain.

Adult↗