Bjarne Jansson

Work load and work hours in relation to disturbed sleep and fatigue in a large representative sample.

OBJECTIVE To study the relation between work and background factors on the one hand and disturbed sleep and fatigue on the other. METHOD A representative national sample of 58,115 individuals was selected at regular intervals over a period of 20 years and interviewed on issues related to work and health. The data were subjected to a multiple logistic regression analysis. RESULTS The number of cases was 18,828 (32.8%) for fatigue and 7347 (12.8%) for disturbed sleep. For disturbed sleep, the significant predictors became: female gender, age above 49 years, present illness, hectic work, physically strenuous work, and shift work. For fatigue, the significant predictors became female gender, age below 49 years, high socioeconomic status, present illness, hectic work, overtime work, and physically strenuous work. CONCLUSION Work stress, shift work, and physical workload interfere with sleep and are related to fatigue.

A prospective study of fatal occupational accidents--relationship to sleeping difficulties and occupational factors.

Very little is known about the association between sleep and (fatal) occupational accidents. This study investigated this relationship using register data of self‐rated sleep difficulties, together with occupational and demographic characteristics. The variables were related to subsequent occupational fatal accidents. A national sample of 47 860 individuals was selected at regular intervals over a period of 20 years, and interviewed over the phone on issues related to work and health. The responses were linked to the cause of death register (suicides excluded) and the data set was subjected to a (multivariate) Cox regression survival analysis. One hundred and sixty six fatal occupational accidents occurred, and the significant predictors were: male vs. female: relative risk (RR)=2.30 with a 95% confidence interval (CI) of 1.56–3.38; difficulties in sleeping (past 2 weeks): RR=1.89 with CI=1.22–2.94; and non‐day work: RR=1.63 with CI=1.09–2.45. No significant effect was seen for age, socio‐economic group, hectic work, overtime (>50 h per week), or physically strenuous work. It was concluded that self‐reported disturbed sleep is a predictor of accidental death at work, in addition to non‐day work and male gender.

Tanning habits and sunburn in a Swedish population age 13–50 years

As part of a skin cancer control programme, we studied the occurrence of self-reported outdoor tanning, sunbed use and ultraviolet (UV)-induced erythema in an urban area. A cross-sectional questionnaire study of 6000 adolescents aged 13-19 years, and 4000 adults aged 20-50 years was applied. Non-response was analysed for outdoor tanning and sunbed use. Results, in general, did not differ between responders and non-responders. Females aged 17-29 years tanned outdoors most frequently. Sunbed use and related erythema was twice as common in young females. In males, outdoor tanning was not age-related. In the past 12 months, 55% reported sunburn and/or burn from sunbed use, one-third were burned in Sweden, one-quarter on sunny resorts abroad. Sunburn occurs frequently. Compliance with recommendations for sunbed use is poor, especially among adolescents and young adults. To reduce the occurrence of erythema, the influence of risk settings upon behaviours is a critical issue for exploration.

Sunbed use in relation to phenotype, erythema, sunscreen use and skin diseases. A questionnaire survey among Swedish adolescents

Summary Sunbed use was studied in relation to phenotype, erythema, sunscreen use and skin disease. The study population comprised 14–19 year‐old Stockholm adolescents in 60 randomly selected classes, with 1252 students providing information. More than half (57%) reported sunbed use ± 4 times during the previous year. Skin type III dominated (64%). Excessive exposure (± 10 times/year) was not correlated to skin type. Sunscreens were most commonly used by sunbed users. Of all sunbed users, 44% reported erythema. Adolescents with acne/seborrhoea, eczema or psoriasis used sunbeds more than others without skin diseases. The proportion with sunbed erythema (44%) indicates an unrecognized susceptibility to artificial ultraviolet radiation (UVR) among adolescents. The association between high exposure to UVR and sunscreen use stresses the importance of sunscreens being used as supplementary protection, not as a tool for tanning.

Association between use of sedatives or hypnotics, alcohol consumption, or other risk factors and a single injurious fall or multiple injurious falls: a longitudinal general population study

In this study, we investigated the association between risk factors, including use of sedatives or hypnotics or alcohol consumption, and injurious falls leading to hospitalization or death among 4023 subjects (1828 men and 2195 women) aged 20-89 years in Stockholm County, Sweden. Questionnaire data obtained from the 1984-1985 Stockholm Health of the Population Study (SHPS) were linked to official data registers on hospitalization and mortality. Of the 4023 subjects, 330 (121 men and 209 women) had been treated for or died of injurious falls during the 12-year follow-up period. High age was significantly associated with injurious falls among both men and women. Multivariate analyses showed that women who had used sedatives or hypnotics during the 2 weeks before an injurious fall were at increased risk [relative risk of 1.83 (95% confidence interval, 1.10-3.06)] for two or more injurious falls, but not for a single fall accident. High alcohol consumption and earlier self-reported injurious falls were significantly associated with injurious falls for women younger than 60 years of age and with earlier self-reported falls and living alone for men in the same age category. Among older women (>60 years of age), high alcohol consumption and use of sedatives or hypnotics were significantly associated with injurious falls, whereas living alone and earlier self-reported accidents were significant predictors for men in the same age category. These results support a cautious prescribing policy for sedatives and hypnotics, as well as an awareness of high alcohol consumption and its association with injurious falls.

Wife abuse in rural bangladesh

Intimate partner violence (IPV) is a global public health and gender problem, especially in low-income countries. The study focused on verbal abuse, physical abuse and abuse by restricting food provision to wives by their husbands by victim and perpetrator characteristics, emphasizing the socioeconomic context of rural Bangladesh. Using a cross-sectional household survey of 4411 randomly selected married women of reproductive age, the study found that a majority of the respondents are exposed to verbal abuse (79%), while 41% are exposed to physical abuse. A small proportion (5%) of the women had suffered food-related abuse. Risk factors observed were age of the wife, illiteracy (of both victims and perpetrators), alcohol misuse, dowry management, husbands monetary greed involving parents-in-law, and wifes suspicions concerning husbands extramarital affairs. Well-established risk factors for wife abuse, along with dowry and husbands monetary greed, have a relatively high prevalence in rural Bangladesh.

Social inequalities in intimate partner violence: A study of women in Kenya

This study examines social inequalities in intimate partner violence (IPV) among women of reproductive age in Kenya. A sample comprising 3,696 women was retrieved from the Kenyan Demographic and Health Survey of 2003. The study design was cross-sectional. Chi-square tests and logistic regression were used to analyze the data. Results indicated that while high education among women reduced the risk of IPV exposure, both being employed and having a higher education/occupational status than her partner increased a woman’s vulnerability to IPV. Age differences between the partners, illiteracy, and lack of autonomy and access to information increased the likelihood of IPV. Finally, being in polygamous relationships was associated with IPV exposure. The findings indicate demographic, social, and structural differences in exposure to IPV with important implications for interventions.

Unintentional injury mortality in children: a priority for middle income countries in the advanced stage of epidemiological transition

Objectives—To examine the relationship between the magnitude, and the relative importance of unintentional child injury mortality with socioeconomic development, and to conceptualise the dynamic changes in injury mortality within the framework of epidemiological transition. Design—Ecological cross sectional study using data on 51 countries. Main outcome measures—The relationship between total mortality rates, unintentional injury mortality rates, and percentage in children 1–14 years of age with gross national product (GNP) per capita. Results—Unintentional injury mortality rates in children were negatively correlated with GNP per capita. However, by categorising the data, we found some areas of non-correlation: in children 5–14 years in low income versus lower middle income countries, and in all age and gender groups in lower high income versus higher high income countries. A high percentage of total deaths due to injuries was clearest in the lower middle income countries in all age and gender groups. Conclusions—The changes in child injury mortality in relation to socioeconomic development could be conceptualised as three stages: a stage of high magnitude; a stage of high priority; and a stage of improvement. Most middle income countries are in the high priority stage where both injury mortality rates and injury percentage of total deaths are high.

Sunbed use among Swedish adolescents in the 1990s: a decline with an unchanged relationship to health risk behaviors

Aims: Sunbed use is common among adolescents, and may give an increment to UV exposure and an overall skin cancer risk comparable to that of the sun. Sunbed use was studied among 15- to 19-year-old adolescents in Stockholm County. Methods: Data from two questionnaire surveys (1,252 respondents in 1993, and 2,950 respondents in 1999, survey tool partly revised) were analysed. By stepwise binary logistic regression the occurrence of sunbed use was assessed and analysed versus sunbed erythema, skin type, outdoor tanning, sunscreen use and smoking. Results: Sunbed use declined between the surveys. In 1993, 70% of females, and 44% of males used sunbeds; in 1999, these were 45% and 19% respectively. Sunbeds were used against user recommendations. Of the sunbed users in 1993, 45% and 43% reported sunbed erythema; in 1999, 29% and 19% did so. Sunbed erythema, though related to sun sensitivity, occurred in all skin types. In both surveys, sunbed use was positively related to moderately sensitive skin type (females), outdoor tanning, and smoking (females). Smoking was a strong predictor for sunbed use among females in both surveys. Conclusions: Even though different survey tools were used, and in spite of a decline in sunbed use, sunbed erythema was still common, and the relation to other health risk behaviour remained. Further research on sunbed use and its role in the aggregation of health risk behaviours in vulnerable ages is warranted, particularly its relation to outdoor tanning and smoking. A national and international harmonization of survey tools is also recommended for improved comparability.

Coxarthrosis and farm work: A case-referent study

The purpose of this case-referent study was to analyze the association between coxarthrosis and occupation. The study was performed in a Swedish agricultural county and comprised 269 cases of radiologically verified arthrosis of osteoarthritis (< 3 mm joint space) that were compared to 538 randomly selected controls in the same region, matched for age, sex, and place of residence. Farmers and agricultural workers showed an increased risk of coxarthrosis and the observed risk increased with increasing number of years of farming. Tractor driving and milking were associated with coxarthrosis, whereas no association with other types of machine work could be demonstrated. An association between coxarthrosis and heavy physical work before the age of 16 years was also observed. The results give only limited information on the external causes of coxarthrosis, however. More detailed studies of groups of individuals with coxarthrosis in order to obtain more information about contributing and underlying factors would therefore be valuable.