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  • 201.
    Karlsson, Veronika
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Bergbom, Ingegerd
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ringdal, Mona
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jonsson, Annikki
    School of Health Science, Borås University College, Borås, Sweden.
    After discharge home: a qualitative analysis of older ICU patients' experiences and care needs2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 4, p. 749-756Article in journal (Refereed)
  • 202.
    Kazemi, Ali
    University of Skövde, School of Technology and Society. University of Skövde, Health and Education.
    Avslutande reflektioner kring socialpsykologiska aspekter på välbefinnande2009In: Välbefinnande i arbetslivet: socialpsykologiska perspektiv / [ed] Ali Kazemi, Lund: Studentlitteratur, 2009, 1, p. 195-200Chapter in book (Refereed)
  • 203.
    Kazemi, Ali
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Conceptualizing and measuring occupational social well-being: a validation study2017In: International Journal of Organizational Analysis, ISSN 1934-8835, E-ISSN 1758-8561, Vol. 25, no 1, p. 45-61Article in journal (Refereed)
    Abstract [en]

    Purpose: The current conceptualizations and measurements of well-being are inadequate in the context of work. Specifically, well-being research has neglected the social aspects of well-being. Therefore, the present study aims to investigate the validity of a multi-dimensional view of occupational social well-being. Design/methodology/approach: Data were collected in an educational setting, i.e. six different schools in a Swedish municipality. A total of 314 teachers and other categories of school staff (239 females and 75 males) participated in a survey study. Findings: Results provided empirical support for a multi-dimensional view of occupational social well-being. The dimensions were integration, acceptance, contribution, actualization and coherence, and they were differentially correlated with previous measures of well-being. Furthermore, occupational social well-being accounted for additional variance in work tension, overall job satisfaction and organizational commitment over and above the variance accounted for by positive and negative affect and satisfaction with life, indicating the value of taking domain-specific social indicators of well-being into account in explaining various employee outcomes. Practical implications: Occupational social well-being is an umbrella term for describing the well-lived social life in the context of work. As such, this is a crucial part of a holistic view of well-being at work. Thus, effective employee well-being enhancement programs should not only focus on physical and mental health promotion or competence development but must also include measures of relational experience and functioning as discussed in the present study. Originality/value: This is the first study to measure and validate occupational social well-being as an attempt to complement existing measures of subjective and psychological well-being. Measures of social aspects of well-being are crucial to assess as it has been argued in previous research that context-free measures of well-being might render misleading results.

  • 204.
    Kazemi, Ali
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Examining the Interplay of Justice Perceptions, Motivation, and School Achievement among Secondary School Students2016In: Social Justice Research, ISSN 0885-7466, E-ISSN 1573-6725, Vol. 29, no 1, p. 103-118Article in journal (Refereed)
    Abstract [en]

    There is a paucity of empirical research on the social psychology of justice in educational settings. A few previous studies have predominantly focused on distributive and procedural justice concerns, and knowledge about the role of what have been called informational and interpersonal justice for school outcomes is very scarce. In the present study, data from 227 eighth- and ninth-grade students who participated in a survey study were analyzed to examine the interplay between relational justice concerns (decomposed into procedural, interpersonal, and informational justice), motivation to study, and school achievement. A comprehensive theoretically grounded multi-item measure of informational justice was developed and validated. The results showed that informational justice significantly predicts school grades, and that motivation to study fully mediates this effect. Neither procedural nor interpersonal justice was associated with school grades. The implications of these results for research and practice are discussed in detail.

  • 205.
    Kazemi, Ali
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Overtime2015In: The SAGE Encyclopedia of Economics and Society / [ed] Frederick F. Wherry & Juliet B. Schor, Thousand Oaks: Sage Publications, 2015, p. 1235-1236Chapter in book (Refereed)
  • 206.
    Kazemi, Ali
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Promotion2015In: The SAGE Encyclopedia of Economics and Society / [ed] Frederick F. Wherry & Juliet B. Schor, Thousand Oaks: Sage Publications, 2015, p. 1336-1337Chapter in book (Refereed)
  • 207.
    Kazemi, Ali
    University of Skövde, School of Technology and Society. University of Skövde, Health and Education.
    Välbefinnande2009In: Välbefinnande i arbetslivet: socialpsykologiska perspektiv / [ed] Ali Kazemi, Lund: Studentlitteratur, 2009, 1, p. 23-33Chapter in book (Refereed)
  • 208.
    Kazemi, Ali
    University of Skövde, School of Technology and Society. University of Skövde, Health and Education.
    Välbefinnande i arbetslivet: socialpsykologiska perspektiv2009Collection (editor) (Other academic)
  • 209.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Eek, Daniel
    Department of Psychology, Göteborg University, Sweden.
    Gärling, Tommy
    Department of Psychology, Göteborg University, Sweden.
    Allocation of Public Goods: The Interplay of Self-Interest, Fairness, and Group Goal2016In: Social Psychology, ISSN 1864-9335, E-ISSN 2151-2590, Vol. 47, no 4, p. 214-222Article in journal (Refereed)
    Abstract [en]

    Seventy-two undergraduates participating in a step-level asymmetric public good dilemma were requested to distribute the provided public good among the group members to achieve different group goals. In Line with the hypotheses, economic productivity resulted in equitable allocations, harmony in equal allocations, and social concern in need-based allocations. The results also supported the hypotheses that salience of group goal minimizes influences of self-interest on allocations and that perceived fairness accounts for why people pursuing different group goals differ in their preferences for allocation of public goods.

  • 210.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Eek, Daniel
    Department of Psychology, University of Gothenburg, Göteborg, Sweden.
    Gärling, Tommy
    Department of Psychology, University of Gothenburg, Göteborg, Sweden.
    Equity, Equal Shares or Equal Final Outcomes?: Group Goal Guides Allocations of Public Goods2017In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 8, p. 1-7, article id 36Article in journal (Refereed)
    Abstract [en]

    In an experiment we investigate preferences for allocation of a public good among group members who contributed unequally in providing the public good. Inducing the group goal of productivity resulted in preferences for equitable allocations, whereas inducing the group goals of harmony and social concern resulted in preferences for equal final outcomes. The study makes a contribution by simultaneously treating provision and allocation of a public good, thus viewing these as related processes. Another contribution is that a new paradigm is introduced that bears closer resemblance to real life public good dilemmas than previous research paradigms do.

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  • 211.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kajonius, Petri
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Psychology, Göteborg University, Sweden.
    Predictors of Satisfaction with Elderly Care Services2015Conference paper (Refereed)
  • 212.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kajonius, Petri
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    Variations in user-oriented elderly care: a multilevel approach2017In: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703, Vol. 9, no 2, p. 138-147Article in journal (Refereed)
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  • 213.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kajonius, Petri J.
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    Cost and satisfaction trends in Swedish elderly home care2016In: Home Health Care Management & Practice, ISSN 1084-8223, E-ISSN 1552-6739, Vol. 28, no 4, p. 250-255Article in journal (Refereed)
  • 214.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kajonius, Petri J.
    Division of Gerontology, Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    User-oriented elderly care: A validation study in two different settings using observational data2015In: Quality in Ageing and Older Adults, ISSN 1471-7794, Vol. 16, no 3, p. 140-152Article in journal (Refereed)
    Abstract [en]

    Purpose - User-oriented care, defined as individualized assisting behaviors, is the dominant approach within elderly care today. Yet, there is little known about its conceptual structure. This paper proposes that user-oriented care has a bi-partite structure which may be decomposed into the two dimensions of task and relation. Design/methodology/approach - Care workers were "shadowed" (i.e. observed) at their work (n=391 rated interactions). User-oriented care was assessed along ten process quality indicators targeting the acts of caregiving (i.e. task focus, relation focus, involvement, time-use, body language, autonomy, respect, warmth, encouragement, and information) in two elderly care settings, i.e. home care and nursing home. Observations added up to 45 hours. Findings - Principal component analyses confirmed the proposed two-factor structure of user-oriented care. Specifically, the user-oriented care indicators loaded on two distinct factors, i.e. task and relation. The underlying structure of user-oriented care revealed to be invariant across the two settings. However, the results revealed interesting structural differences in terms of explained variance and the magnitude of factor loadings in the home care and nursing home settings. Differences also emerged specifically pertaining to the indicators of autonomy and time-use. These findings suggest that user-oriented behavior may to some extent denote different acts of caregiving and what may be called task- and relation-orientation may be loaded with different meanings in these two care settings. Originality/value - This is the first study investigating user-oriented behavior in the context of elderly care using a quantitative observational approach. The authors propose that the observed differences between the two care settings are primarily not due to better elderly care work in home care, but due to some inherent differences between these two contexts of care (e.g. better health and living at home). © Ali Kazemi and Petri J. Kajonius. Published by Emerald Group Publishing Limited.

  • 215.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kylberg, Elisabeth
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Pilotstudie om psykisk ohälsa och utanförskap bland unga vuxna: Personliga berättelser och reflektioner kring vägar som bär till förändring2014Report (Other academic)
  • 216.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Stark Ekman, Diana
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kylberg, Elisabeth
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Differing attitudes toward health and sickness2014In: Encyclopedia of human services and diversity / [ed] Linwood H. Cousins, Sage Publications, 2014, p. 616-618Chapter in book (Refereed)
  • 217.
    Kazemi, Ali
    et al.
    University of Skövde, School of Technology and Society. University of Skövde, Health and Education.
    Törnblom, Kjell
    University of Skövde, School of Technology and Society. University of Skövde, Health and Education.
    Rättvist ledarskap2009In: Välbefinnande i arbetslivet: socialpsykologiska perspektiv / [ed] Ali Kazemi, Lund: Studentlitteratur, 2009, 1, p. 37-63Chapter in book (Refereed)
  • 218.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zurich, Switzerland.
    Social Justice Research2016Collection (editor) (Other academic)
  • 219.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zurich, Switzerland.
    Social Justice Research2016Collection (editor) (Other academic)
  • 220.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zurich, Switzerland.
    Social Justice Research2016Collection (editor) (Other academic)
  • 221.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zurich, Switzerland.
    Social Justice Research2016Collection (editor) (Other academic)
  • 222.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellUniversity of Skövde, School of Health and Education.
    Social Justice Research2015Collection (editor) (Other academic)
  • 223.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zürich, Switzerland.
    Social Justice Research2015Collection (editor) (Other academic)
  • 224.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zürich, Switzerland.
    Social Justice Research2015Collection (editor) (Other academic)
  • 225.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zürich, Switzerland.
    Social Justice Research2017Collection (editor) (Other academic)
  • 226.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zürich, Switzerland.
    Social Justice Research2017Collection (editor) (Other academic)
  • 227.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zürich, Switzerland.
    Social Justice Research2017Collection (editor) (Other academic)
  • 228.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zürich, Switzerland.
    Social Justice Research2017Collection (editor) (Other academic)
  • 229.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zürich, Switzerland.
    Social Justice Research2018Collection (editor) (Other academic)
  • 230.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zürich, Switzerland.
    Social Justice Research2018Collection (editor) (Other academic)
  • 231.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zürich, Switzerland.
    Social Justice Research2018Collection (editor) (Other academic)
  • 232.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellDepartment of Environmental Systems Science, ETH Zürich, Switzerland.
    Social Justice Research2018Collection (editor) (Other academic)
  • 233.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellUniversity of Skövde, School of Health and Education.
    Social Justice Research2015Collection (editor) (Other academic)
  • 234.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellUniversity of Skövde, School of Health and Education.
    Social Justice Research2014Collection (editor) (Other academic)
  • 235.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellUniversity of Skövde, School of Health and Education.
    Social Justice Research2014Collection (editor) (Other academic)
  • 236.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellUniversity of Skövde, School of Health and Education.
    Social Justice Research2014Collection (editor) (Other academic)
  • 237.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, KjellUniversity of Skövde, School of Health and Education.
    Social Justice Research2014Collection (editor) (Other academic)
  • 238.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, Kjell
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Third-Party Allocation of Rewards: The Effects of Categorization and Request for Justice2014In: Small Group Research, ISSN 1046-4964, E-ISSN 1552-8278, Vol. 45, no 4, p. 435-450Article in journal (Refereed)
    Abstract [en]

    The present study shows that categorization of reward recipients into different entities affects distributive preferences by third-party non-recipient allocators. Rewards were allocated more equally to members of one group than to members of two dyads or to independent recipients. Moreover, allocators who were explicitly requested to allocate rewards justly were more egalitarian than those who were not requested to do so. More interestingly, rewards were allocated more equally between members in each of two dyads and between independent recipients, when a just allocation request was made, than when such a request was not made. This implies that a request for just allocation modifies the effects of recipient entity categorization toward more equal reward allocations. © The Author(s) 2014.

  • 239.
    Kazemi, Ali
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Törnblom, Kjell
    ETH Zürich, Zürich, Switzerland.
    Mikula, Gerold
    University of Graz, Graz, Austria.
    Justice: Social Psychological Perspectives2015In: International Encyclopedia of the Social & Behavioral Sciences / [ed] James D. Wright, Oxford: Elsevier, 2015, 2, p. 949-955Chapter in book (Refereed)
    Abstract [en]

    This article discusses the concept of justice from a social psychological perspective. The authors begin by briefly outlining some theoretical precursors of current social psychological research on justice. Another part is devoted to an overview of theories and empirical research in the areas of distributive and procedural justice. The article furthermore addresses interactional justice, why people care about justice, and reactions to injustice in the context of which individual differences in conceptions of justice are briefly discussed. The article ends by discussing some current trends, social applications, and some future challenges in social psychological inquiries of social justice.

  • 240.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Johns Hopkins University, Baltimore, Maryland, USA / Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Johns Hopkins University, Baltimore, Maryland, USA / Institute of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden / Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA / Institute of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
    Gaston-Johansson, Fannie
    Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA.
    Symptom Burden Clusters: A Challenge for Targeted Symptom Management. A Longitudinal Study Examining Symptom Burden Clusters in Breast Cancer2014In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 47, no 4, p. 731-741Article in journal (Refereed)
    Abstract [en]

    Context: Although there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters. Objectives: To explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer. Methods: In this longitudinal study, a sample of 206 patients completed the Memorial Symptom Assessment Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Sense of Coherence scale, at diagnosis of primary or recurrent breast cancer, and at one-, three-, and six-month follow-ups. Results: Three clusters of burdensome symptoms were identified: emotional symptom burden, gastrointestinal symptom burden, and unwellness symptom burden. Most burdensome were emotional symptoms, with worrying, feeling sad, and feeling nervous as the core or defining symptoms. Over time, additional symptoms escalated the emotional symptom burden. The gastrointestinal symptom burden, with "change in the way food tastes" as a core symptom, was more often associated with chemotherapy. Less stable over time, the unwellness symptom burden could be interpreted as short- and long-term side effects of hormonal therapy. Of these clusters, only the emotional symptom burden cluster significantly diminished health status and quality of life. Patients reporting lower coping capacity experienced higher levels of symptom burden. Conclusion: This study provides insights into symptom burden clusters over time. A challenging approach toward symptom management in clinical oncology is to target the burden of a symptom cluster and to recognize the need for individually designed interventions to ameliorate symptom burden in cancer patients. © 2013 U.S. Cancer Pain Relief Committee.

  • 241.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Andersson, Bengt A.
    Department of Clinical immunology and transfusion medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Karlsson, Per
    Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital,Sweden University of Gothenburg, Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Mindfulness and its efficacy for psychological and biological responses in women with breast cancer2017In: Cancer Medicine, E-ISSN 2045-7634, Vol. 6, no 5, p. 1108-1122Article in journal (Refereed)
    Abstract [en]

    Many breast cancer survivors have to deal with a variety of psychological andphysiological sequelae including impaired immune responses. The primary purposeof this randomized controlled trial was to determine the efficacy of amindfulness-basedstress reduction (MBSR) intervention for mood disorders inwomen with breast cancer. Secondary outcomes were symptom experience, healthstatus, coping capacity, mindfulness, posttraumatic growth, and immune status.This RTC assigned 166 women with breast cancer to one of three groups: MBSR(8 weekly group sessions of MBSR), active controls (self-instructingMBSR) andnon-MBSR.The primary outcome measure was the Hospital Anxiety and DepressionScale. Secondary outcome measures were: Memorial Symptom AssessmentScale, SF-36,Sense of Coherence, Five Facets of Mindfulness Questionnaire,and Posttraumatic Growth Index. Blood samples were analyzed using flow cytometryfor NK-cellactivity (FANKIA) and lymphocyte phenotyping; concentrationsof cytokines were determined in sera using commercial high sensitivityIL-6and IL-8ELISA (enzyme-linkedimmunosorbent assay) kits. Results provideevidence for beneficial effects of MBSR on psychological and biological responses.Women in the MBSR group experienced significant improvements in depressionscores, with a mean pre-MBSRHAD-scoreof 4.3 and post-MBSRscore of 3.3(P = 0.001), and compared to non-MBSR(P = 0.015). Significant improvementson scores for distress, symptom burden, and mental health were also observed.Furthermore, MBSR facilitated coping capacity as well as mindfulness and posttraumaticgrowth. Significant benefits in immune response within the MBSRgroup and between groups were observed. MBSR have potential for alleviatingdepression, symptom experience, and for enhancing coping capacity, mindfulnessand posttraumatic growth, which may improve breast cancer survivorship.MBSR also led to beneficial effect on immune function; the clinical implicationsof this finding merit further research.

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  • 242.
    Kharkova, Olga A.
    et al.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway,Tromsø, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Grjibovski, Andrej M.
    International School of Public Health, Northern State Medical University, Arkhangelsk, Russia / Department of Public Health, North-Eastern Federal University, Yakutsk, Russia / Department of Preventive Medicine, International Kazakh-Turkish University, Turkestan, Kazakhstan.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Nieboer, Evert
    Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada.
    Odland, Jon Ø.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
    Effect of Smoking Behavior before and during Pregnancy on Selected Birth Outcomes among Singleton Full-Term Pregnancy: A Murmansk County Birth Registry Study2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 8, p. 1-11, article id E867Article in journal (Refereed)
    Abstract [en]

    The aim of our study was to assess associations between smoking behavior before and during pregnancy and selected adverse birth outcomes. This study is based on the Murmansk County Birth Registry (MCBR). Our study includes women who delivered a singleton pregnancy after 37 weeks of gestation (N = 44,486). Smoking information was self-reported and assessed at the first antenatal visit during pregnancy. We adjusted for potential confounders using logistic regression. The highest proportion of infants with low values of birth weight, birth length, head circumference, ponderal index and of the Apgar score at 5 min was observed for women who smoked both before and during pregnancy. We observed a dose-response relationship between the number of cigarettes smoked per day during pregnancy and the odds of the aforementioned adverse birth outcomes; neither were there significant differences in their occurrences among non-smokers and those who smoked before but not during pregnancy. Moreover, smoking reduction during pregnancy relative to its pre-gestation level did not influence the odds of the adverse birth outcomes. Our findings emphasize a continued need for action against tobacco smoking during pregnancy.

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  • 243.
    Kharkova, Olga A.
    et al.
    UiT The Arctic University of Norway, Tromsø, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Grjibovski, Andrej M.
    International School of Public Health, Northern State Medical University, Arkhangelsk, Russia / Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway / Department of Preventive Medicine, International Kazakh-Turkish University, Kazakhstan / Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway / Department of Preventive Medicine, International Kazakh-Turkish University, Turkestan, Kazakhstan.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Nieboer, Evert
    Department of Biochemistry and Biomedical Sciences, Hamilton, ON, Canada.
    Odland, Jon Ø.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
    First-trimester smoking cessation in pregnancy did not increase the risk of preeclampsia/eclampsia: A Murmansk County Birth Registry study2017In: PLOS ONE, E-ISSN 1932-6203, Vol. 12, no 8, article id e0179354Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although prior studies have shown that smoking reduces preeclampsia/eclampsia risk, the consequence of giving up this habit during pregnancy should be assessed. The aims of the current study were threefold: (i) describe maternal characteristics of women with preeclampsia/eclampsia; (ii) examine a possible association between the number of cigarettes smoked daily during pregnancy and the development of this affliction; and (iii) determine if first-trimester discontinuation of smoking during pregnancy influences the risk.

    METHODS: A registry-based study was conducted using data from the Murmansk County Birth Registry (MCBR). It included women without pre-existing hypertension, who delivered a singleton infant during 2006-2011 and had attended the first antenatal visit before 12 week of gestation. We adjusted for potential confounders using logistic regression.

    RESULTS: The prevalence of preeclampsia/eclampsia was 8.3% (95%CI: 8.0-8.6). Preeclampsia/eclampsia associated with maternal age, education, marital status, parity, excessive weight gain and body mass index at the first antenatal visit. There was a dose-response relationship between the number of smoked cigarettes per day during pregnancy and the risk of preeclampsia/eclampsia (adjusted OR1-5 cig/day = 0.69 with 95%CI: 0.56-0.87; OR6-10 cig/day = 0.65 with 95%CI: 0.51-0.82; and OR≥11 cig/day = 0.49 with 95%CI: 0.30-0.81). There was no difference in this risk among women who smoked before and during pregnancy and those who did so before but not during pregnancy (adjusted OR = 1.10 with 95%CI: 0.91-1.32).

    CONCLUSIONS: Preeclampsia/eclampsia was associated with maternal age, education, marital status, parity, excessive weight gain, and body mass index at the first antenatal visit. There was a negative dose-response relationship between the number of smoked cigarettes per day during pregnancy and the odds of preeclampsia/eclampsia. However, women who gave up smoking during the first trimester of gestation had the same risk of preeclampsia/eclampsia as those who smoked while pregnant. Consequently, antenatal clinic specialists are advised to take these various observations into account when counselling women on smoking cessation during pregnancy.

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  • 244.
    Kharkova, Olga A.
    et al.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Grjibovski, Andrej M.
    International School of Public Health, Northern State Medical University, Arkhangelsk, Russia / Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway / Department of Preventive Medicine, International Kazakh-Turkish University, Turkestan, Kazakhstan / North-Easten Federal University, Yakutsk, Russia.
    Nieboer, Evert
    Department of Biochemistry and Biomedical Sciences, Hamilton, ON, Canada.
    Odland, Jon Øyvind
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
    Prevalence of smoking before and during pregnancy and changes in this habit during pregnancy in Northwest Russia: a Murmansk county birth registry study2016In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 13, no 1, p. 1-9, article id 18Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Smoking during pregnancy leads to adverse maternal and birth outcomes. However, the prevalence of smoking among women in Russia has increased from < 5 % in the 1980s to > 20 % in the 2000s. We conducted a registry-based study in Murmansk County, Northwest Russia. Our aims were twofold: (i) assess the prevalence of smoking before and during pregnancy; and (ii) examine the socio-demographic factors associated with giving up smoking or reducing the number of cigarettes smoked once pregnancy was established.

    METHODS: This study employs data from the population-based Murmansk County Birth Registry (MCBR) collected during 2006-2011. We used logistic regression to investigate associations between women's socio-demographic characteristics and changes in smoking habit during pregnancy. To avoid departure from uniform risk within specific delivery departments, we employed clustered robust standard errors.

    RESULTS: Of all births registered in the MCBR, 25.2 % of the mothers were smokers before pregnancy and 18.9 % continued smoking during pregnancy. Cessation of smoking during pregnancy was associated with education, marital status and parity but not with maternal age, place of residence, and ethnicity. Women aged ≤ 20-24 years had higher odds of reducing the absolute numbers of cigarettes smoked per day during pregnancy than those aged ≥ 30-34 years. Moreover, smoking nulliparae and pregnant women who had one child were more likely to reduce the absolute numbers of cigarettes smoked per day compared to women having ≥ 2 children.

    CONCLUSIONS: About 25.0 % of smoking women in the Murmansk County in Northwest Russia quit smoking after awareness of the pregnancy, and one-third of them reduced the number cigarettes smoked during pregnancy. Our study demonstrates that women who have a higher education, husband, and are primiparous are more likely to quit smoking during pregnancy. Maternal age and number of children are indicators that influence reduction in smoking during pregnancy. Our findings are useful in identifying target groups for smoking intervention campaigns.

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  • 245.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Jokela, Markus
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
    Nyberg, Solja T.
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
    Fransson, Eleonor I.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / School of Health Sciences, Jönköping University, Jönköping, Sweden / Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Bjorner, Jakob B.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Borritz, Marianne
    Department of Occupational Medicine, Koege Hospital, Copenhagen, Denmark.
    Burr, Hermann
    Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
    Casini, Annalisa
    School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium.
    Clays, Els
    Department of Public Health, Ghent University, Ghent, Belgium.
    De Bacquer, Dirk
    Department of Public Health, Ghent University, Ghent, Belgium.
    Dragano, Nico
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Erbel, Raimund
    Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
    Geuskens, Goedele A.
    TNO, Hoofddorp, Netherlands.
    Hamer, Mark
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Hooftman, Wendela E.
    TNO, Hoofddorp, Netherlands.
    Houtman, Irene L.
    TNO, Hoofddorp, Netherlands.
    Jöckel, Karl-Heinz
    Institute for Medical Informatics, Biometry, and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.
    Kittel, France
    School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Lunau, Thorsten
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Madsen, Ida E. H.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Nielsen, Martin L.
    Unit of Social Medicine, Frederiksberg University Hospital, Copenhagen, Denmark.
    Nordin, Maria
    Stress Research Institute, Stockholm University, Stockholm, Sweden / Department of Psychology, Umeå University, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Pejtersen, Jan H.
    The Danish National Centre for Social Research, Copenhagen, Denmark.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Rugulies, Reiner
    National Research Centre for the Working Environment, Copenhagen, Denmark / Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
    Salo, Paula
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland / Department of Psychology, University of Turku, Turku, Finland.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Siegrist, Johannes
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Steptoe, Andrew
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Suominen, Sakari B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Turku, Finland / Folkhälsan Research Center, Helsinki, Finland.
    Theorell, Töres
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Vahtera, Jussi
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland / Department of Public Health, University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Westerholm, Peter J. M.
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    O'Reilly, Dermot
    Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
    Kumari, Meena
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Centre for Cognitive Ageing and Cognitive Epidemiology and Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / School of Community and Social Medicine, University of Bristol, Bristol, United Kingdom.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10005, p. 1739-1746Article in journal (Refereed)
    Abstract [en]

    Background Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. Methods We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. Findings We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5.1 million person-years (mean 8.5 years), in which 4768 events were recorded, and for stroke was 3.8 million person-years (mean 7.2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (>= 55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1.13, 95% CI 1.02-1.26; p=0.02) and incident stroke (1.33, 1.11-1.61; p=0.002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1.30-1.42). We recorded a dose-response association for stroke, with RR estimates of 1.10 (95% CI 0.94-1.28; p=0.24) for 41-48 working hours, 1.27 (1.03-1.56; p=0.03) for 49-54 working hours, and 1.33 (1.11-1.61; p=0.002) for 55 working hours or more per week compared with standard working hours (p(trend)<0.0001). Interpretation Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours. 

  • 246.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki, Finland.
    Kuosma, Eeva
    Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
    Luukkonen, Ritva
    Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland .
    Nyberg, Solja T.
    Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland .
    Alfredsson, Lars
    Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden / Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Batty, G David.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Brunner, Eric J.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Fransson, Eleonor
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / Stress Research Institute, Stockholm University, Stockholm, Sweden / School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Goldberg, Marcel
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Nordin, Maria
    Stress Research Institute, Stockholm University, Stockholm, Sweden / Department of Psychology, Umeå University, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Finland .
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Finland .
    Rugulies, Reiner
    Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark / National Research Centre for the Working Environment, Copenhagen, Denmark.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
    Steptoe, Andrew
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Suominen, Sakari B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Turku, Finland / Folkhälsan Research Center, Helsinki, Finland.
    Theorell, Töres
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Westerholm, Peter
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Zins, Marie
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
    Hamer, Mark
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom.
    Bell, Joshua A.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom.
    Tabak, Adam G.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary.
    Jokela, Markus
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
    Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe2017In: The Lancet Public Health, ISSN 2468-2667, Vol. 2, no 6, p. e277-e285Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight.

    METHODS: ) to achieve sufficient case numbers for analysis. The main outcome was cardiometabolic multimorbidity (ie, developing at least two from: type 2 diabetes, coronary heart disease, and stroke). Incident cardiometabolic multimorbidity was ascertained via resurvey or linkage to electronic medical records (including hospital admissions and death). We analysed data from each cohort separately using logistic regression and then pooled cohort-specific estimates using random-effects meta-analysis.

    FINDINGS: Participants were 120  813 adults (mean age 51·4 years, range 35-103; 71 445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973-2012). During a mean follow-up of 10·7 years (1995-2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2·0, 95% CI 1·7-2·4; p<0·0001), almost five times higher for individuals with class I obesity (4·5, 3·5-5·8; p<0·0001), and almost 15 times higher for individuals with classes II and III obesity combined (14·5, 10·1-21·0; p<0·0001). This association was noted in men and women, young and old, and white and non-white participants, and was not dependent on the method of exposure assessment or outcome ascertainment. In analyses of different combinations of cardiometabolic conditions, odds ratios associated with classes II and III obesity were 2·2 (95% CI 1·9-2·6) for vascular disease only (coronary heart disease or stroke), 12·0 (8·1-17·9) for vascular disease followed by diabetes, 18·6 (16·6-20·9) for diabetes only, and 29·8 (21·7-40·8) for diabetes followed by vascular disease.

    INTERPRETATION: The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes.

    FUNDING: NordForsk, Medical Research Council, Cancer Research UK, Finnish Work Environment Fund, and Academy of Finland.

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  • 247.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Luukkonen, Ritva
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Centre for Cognitive Ageing and Cognitive Epidemiology, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom.
    Ferrie, Jane E.
    School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
    Pentti, Jaana
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Nyberg, Solja T.
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Fransson, Eleonor I.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / School of Health Sciences and Welfare, Jönköping University, Jönköping, Sweden / Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm.
    Goldberg, Marcel
    Population-based Epidemiologic Cohort Unit, Villejuif, France.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Kuosma, Eeva
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Nordin, Maria
    Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm, Sweden / Department of Psychology, Umeå University, Umeå, Sweden.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Folkhälsan Research Center, Folkhälsan, Helsinki, Finland / Turku University Hospital, Turku, Finland.
    Theorell, Töres
    Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Vuoksimaa, Eero
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland.
    Westerholm, Peter
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Zins, Marie
    Population-based Epidemiologic Cohort Unit, France.
    Kivipelto, Miia
    Department of Neurobiology, Karolinska Institute, Stockholm, Sweden / National Institute for Health and Welfare, Helsinki, Finland.
    Vahtera, Jussi
    Turku University Hospital, Turku, Finland / University of Turku, Turku, Finland.
    Kaprio, Jaakko
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Population-based Epidemiologic Cohort Unit, France / Department of Psychology, Umeå University, Umeå, Sweden.
    Jokela, Markus
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland / Department of Psychology, Umeå University, Umeå, Sweden.
    Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals2018In: Alzheimer's & Dementia: Journal of the Alzheimer's Association, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 14, no 5, p. 601-609Article in journal (Refereed)
    Abstract [en]

    Introduction: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. Methods: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Results: Hazard ratios per 5-kg/m(2) increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. Conclusions: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short. (C) 2017 The Authors. Published by Elsevier Inc. on behalf of the Alzheimer's Association.

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  • 248.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London, United Kingdom / Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland / Finnish Inst Occupat Hlth, Helsinki, Finland.
    Nyberg, Solja T.
    Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London, United Kingdom / Univ Edinburgh, Ctr Cognit Ageing & Cognit Epidemiol, Edinburgh, Scotland, United Kingdom.
    Kawachi, Ichiro
    Harvard TH Chan Sch Publ Hlth, Dept Social & Behav Sci, Boston, USA.
    Jokela, Markus
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Helsinki, Finland.
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden / Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Bjorner, Jakob B.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Borritz, Marianne
    Bispebjerg Univ Hosp Copenhagen, Dept Occupat & Environm Med, Copenhagen, Denmark.
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth BAuA, Berlin, Germany.
    Dragano, Nico
    Univ Düsseldorf, Inst Med Sociol, Fac Med, Düsseldorf, Germany.
    Fransson, Eleonor I.
    Jönköping Univ, Sch Hlth & Welf, Jönköping, Sweden / Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Heikkilä, Katriina
    London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, London, United Kingdom / Royal Coll Surgeons England, Clin Effectiveness Unit, London, United Kingdom.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Koskenvuo, Markku
    Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland.
    Kumari, Meena
    Univ Essex, Inst Social & Econ Res, Wivenhoe Pk, Colchester, Essex, England, United Kingdom.
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Nielsen, Martin L.
    AS3 Co, AS3 Employment, Viby, Denmark.
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden / Umeå Univ, Dept Psychol, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Copenhagen, Denmark.
    Pentti, Jaana
    Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland.
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark / Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark / Univ Copenhagen, Dept Psychol, Copenhagen, Denmark.
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, Finland / Univ Turku, Dept Psychol, Turku, Finland.
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London, England, United Kingdom.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Univ Turku, Dept Publ Hlth, Turku, Finland.
    Theorell, Töres
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Turku, Finland / Turku Univ Hosp, Turku, Finland.
    Westerholm, Peter
    Uppsala Univ, Dept Med Sci, Akad Sjukhuset, Uppsala, Sweden.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London, England, United Kingdom.
    Singh-Manoux, Archana
    Hop Paul Brousse, INSERM, U1018, Ctr Res Epidemiol & Populat Hlth, Villejuif, France.
    Hamer, Mark
    Loughborough Univ Technol, Natl Ctr Sport & Exercise Med, Sch Sport Exercise & Hlth Sci, Loughborough, Leics, England, United Kingdom.
    Ferrie, Jane E.
    Univ Bristol, Sch Social & Community Med, Bristol, Avon, England, United Kingdom.
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Tabak, Adam G.
    UCL, Dept Epidemiol & Publ Hlth, London, England, United Kingdom / Semmelweis Univ, Fac Med, Dept Med 1, Budapest, Hungary.
    Long working hours as a risk factor for atrial fibrillation: a multi-cohort study2017In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no 34, p. 2621-2628Article in journal (Refereed)
    Abstract [en]

    Aims Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (>= 55 per week) and those working standard 35-40 h/week. Methods and results In this prospective multi-cohort study from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium, the study population was 85 494 working men and women (mean age 43.4 years) with no recorded atrial fibrillation. Working hours were assessed at study baseline (1991-2004). Mean follow-up for incident atrial fibrillation was 10 years and cases were defined using data on electrocardiograms, hospital records, drug reimbursement registers, and death certificates. We identified 1061 new cases of atrial fibrillation (10-year cumulative incidence 12.4 per 1000). After adjustment for age, sex and socioeconomic status, individuals working long hours had a 1.4-fold increased risk of atrial fibrillation compared with those working standard hours (hazard ratio = 1.42, 95% CI= 1.13-1.80, P= 0.003). There was no significant heterogeneity between the cohort-specific effect estimates (I-2= 0%, P = 0.66) and the finding remained after excluding participants with coronary heart disease or stroke at baseline or during the follow-up (N= 2006, hazard ratio= 1.36, 95% CI= 1.05-1.76, P = 0.0180). Adjustment for potential confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association. Conclusion Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours.

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  • 249.
    Kivimäki, Mika
    et al.
    Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland / Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Pentti, Jaana
    Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland / Department of Public Health, University of Turku, Turku, Finland.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
    Batty, G David.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Nyberg, Solja T.
    Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.
    Jokela, Markus
    Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
    Virtanen, Marianna
    Institute of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden.
    Alfredsson, Lars
    Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden / Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dragano, Nico
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Fransson, Eleonor I.
    Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden / School of Health and Welfare, Jönköping University, Jönköping, Sweden / Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Goldberg, Marcel
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France / Versailles St-Quentin University, UMS 011, Villejuif, France.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Koskinen, Aki
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Kouvonen, Anne
    Faculty of Social Sciences, University of Helsinki, Helsinki, Finland / Division of Health Psychology, SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland / Administrative Data Research Centre Northern Ireland, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
    Luukkonen, Ritva
    Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Rugulies, Reiner
    National Research Centre for the Working Environment, Copenhagen, Denmark / Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
    Siegrist, Johannes
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Inserm UMR 1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Turku, Finland / Folkhälsan Research Center, Helsinki, Finland / School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, United Kingdom.
    Theorell, Töres
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Väänänen, Ari
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Westerholm, Peter J. M.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Zins, Marie
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France / Versailles St-Quentin University, UMS 011, Villejuif, France.
    Strandberg, Timo
    Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland / Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland / Center for Life Course Health Research, University of Oulu, Oulu, Finland.
    Steptoe, Andrew
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Deanfield, John
    National Centre for Cardiovascular Prevention and Outcomes, University College London, London, United Kingdom.
    Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study2018In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 6, no 9, p. 705-713, article id S2213-8587(18)30140-2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease.

    METHODS: In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort-reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease.

    RESULTS: We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13·9 years [SD 3·9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149·8 per 10 000 person-years) than in those without (97·7 per 10 000 person-years; mortality difference 52·1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1·68, 95% CI 1·19-2·35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78·1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5·9-44·0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2·01, 95% CI 1·18-3·43) and those with normal blood pressure and no dyslipidaemia (6·17, 1·74-21·9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress-mortality association were not significant, apart from effort-reward imbalance in men without cardiometabolic disease (mortality difference 6·6 per 10 000 person-years; multivariable-adjusted HR 1·22, 1·06-1·41).

    INTERPRETATION: In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.

    FUNDING: NordForsk, UK Medical Research Council, and Academy of Finland.

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  • 250.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London, England / Univ Helsinki, Clinicum, Finland / Univ Helsinki, Helsinki Inst Life Sci, Finland.
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, England / INSERM, U1153, Epidemiol Ageing & Neurodegenerat Dis, Paris, France.
    Pentti, Jaana
    Univ Helsinki, Clinicum, Finland / Univ Turku, Dept Publ Hlth, Finland.
    Sabia, Séverine
    UCL, Dept Epidemiol & Publ Hlth, England / INSERM, U1153, Epidemiol Ageing & Neurodegenerat Dis, Paris, France.
    Nyberg, Solja T.
    Univ Helsinki, Clinicum, Finland.
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Goldberg, Marcel
    INSERM, UMS 011, Populat Based Epidemiol Cohorts Unit, Villejuif, France.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Koskenvuo, Markku
    Univ Helsinki, Clinicum, Finland.
    Koskinen, Aki
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kouvonen, Anne
    Univ Helsinki, Fac Social Sci, Finland / SWPS Univ Social Sci & Humanities Wroclaw, Poland / Queens Univ Belfast, Ctr Publ Hlth, Adm Data Res Ctr Northern Ireland, Belfast, Antrim, North Ireland.
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, Sweden / Umea Univ, Dept Psychol, Sweden.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Strandberg, Timo
    Univ Helsinki, Clinicum, Finland / Helsinki Univ Hosp, Finland / Univ Oulu, Ctr Life Course Hlth Res, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Univ Turku, Dept Publ Hlth, Finland.
    Theorell, Töres
    Stockholm Univ, Stress Res Inst, Sweden.
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Finland / Turku Univ Hosp, Finland.
    Väänanen, Ari
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Virtanen, Marianna
    Univ Eastern Finland, Sch Educ Sci & Psychol, Joensuu, Finland.
    Westerholm, Peter
    Uppsala Univ, Dept Med Sci, Sweden.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Sweden.
    Zins, Marie
    INSERM, UMS 011, Populat Based Epidemiol Cohorts Unit, Villejuif, France.
    Seshadri, Sudha
    Univ Texas Hlth Sci Ctr San Antonio, Glenn Biggs Inst Alzheimers & Neurodegenerat Dis, San Antonio, TX 78229 USA / Framingham Heart Dis Epidemiol Study, Framingham, MA USA.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Sipilä, Pyry N.
    Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England.
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Lindbohm, Joni V.
    Univ Helsinki, Clinicum, Finland.
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England / Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England.
    Jokela, Markus
    Univ Helsinki, Biomedicum, Fac Med, Finland.
    Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis2019In: The BMJ, E-ISSN 1756-1833, Vol. 365, article id l1495Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia. DESIGN Meta-analysis of 19 prospective observational cohort studies. DATA SOURCES The Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies. REVIEW METHOD The search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer's disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis. RESULTS Study population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer's disease was 1602 in 5.2 million person-years. When measured < 10 years before dementia diagnosis (that is, the preclinical stage of dementia), physical inactivity was associated with increased incidence of all-cause dementia (hazard ratio 1.40, 95% confidence interval 1.23 to 1.71) and Alzheimer's disease (1.36, 1.12 to 1.65). When reverse causation was minimised by assessing physical activity >= 10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed > 10 before dementia onset 1.30, 0.79 to 2.14). CONCLUSIONS In analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer's disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.

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