Ingemar Åkerlind

Loneliness and alcohol abuse: A review of evidences of an interplay

This report contains a review of the literature about the interplay between loneliness and the abuse of alcohol. A theoretical discussion based on clinical observations can be dated back to the 1950s. Systematic empirical studies, however, appear sparsely and have mainly been performed during the last decade. Thus, knowledge is still incomplete, but the review indicates that loneliness may be significant at all stages in the course of alcoholism: as a contributing and maintaining factor in the growth of abuse and as an encumbrance in attempts to give it up. Concordant reports demonstrate that alcoholics do feel more lonely than members of most other groups do. In advanced abusers, loneliness is obviously connected with a number of negative characteristics and, together with several of those, directly linked to a poor prognosis. There are, however, no obvious relations to the external social situation (i.e. network) or amount of drinking. Instead, the feeling of loneliness appears to be more connected with a general negative perception about oneself and ones relations to other people and also with a general dissatisfaction with most things in life. The lonely abuser seems likewise resigned and unable to bring himself to change his/her situation. There are also associations with a broad array of psychopathology. In comparison to people with other health problems, the supportive value of the social network of alcoholics appears to be more wavering.

Epidemiology of Sickness Absence in a Swedish County in 1985, 1986 and 1987 A Three Year Longitudinal Study with Focus on Gender, Age and Occupation

In order to get a better epidemiological base for preventive intervention in the county of Östergötland, Sweden, a comprehensive study of sickness absence was done. During the years 1985, 1986 and 1987, all new periods of sick-leave exceeding seven days were registered with demographic variables. This information was related to data about the total population of Östergötland. Each year approx. 45,000 persons had approx. 61,000 sickness spells. These figures were stable over the years while the number of sick-leave days increased. Blue-collar occupations had the highest sick-leave rates and the female sick-leave rate was higher in general and much higher in most male-dominated occupations. The male rate was lower within female-dominated areas, except among secretaries and textile workers. Females in extremely male-dominated groups had the highest rates, while both male and female sick-leave rates were lower in more gender-integrated occupations.

Sick-leave due to minor psychiatric morbidity: role of sex integration

During the years 1985–1987 all sick-leave spells exceeding 7 days, together with a number of demographic variables, were registered in a Swedish county. Using this register, the 3,100 employed persons with at least one sick-leave per year due to minor psychiatric morbidity were analysed with regard to age, occupation and sex. The annual cumulative incidence was 1.7% of the employed population. In 1985 the female incidence was 2.1% and the male incidence was 1.3%. Incidence was highest in the middle-aged. The mean number of absence days per sick-listed person was 73 in 1985. For women, the corresponding figure was 63 and for men, 82. Industrial occupations had the highest incidence and with few exceptions, women had a higher incidence than men in each occupation. Occupations were categorized into five groups according to the number of women and men employed. Women in extremely male-dominated occupations had the highest incidence of all groups, 4.6%. Men in extremely female-dominated occupations had the highest incidence of all men, 2.9%. Occupations with an equal sex distribution had the lowest sick-leave incidence, 1.2%. Further studies on the influence of sex integration on sickness absence need to be done.

Sex differences in sickness absence in relation to parental status.

The aim of this study was to analyse sex differences in medically certified sickness absence with special regard to parental status and age. All new sick-leave spells exceeding seven days and certified by a physician in a county of Sweden were registered in 1985-1987. The data-base was related to the population at risk by using data from the Swedish Official Population and Housing Census 1985. The analysis concerned the employed population in the age group from 16 to 54 with and without custody of children younger than ten years. In all ages, women with children had more sickness absence than men with children. Corresponding sex differences did not appear for persons without children, except for the oldest age-groups. Men with children had the lowest sickness absence of all groups. Young women with children had the highest. These findings remained the same when pregnancy-related sickness absence was excluded. The common finding of sex differences in sickness absence is here highly interrelated to custody of small children. The results suggest that the often reported positive health effects of multiple roles in women may be counteracted by inequality between the sexes in the responsibility as parents.

Presence of hyperventilation in patients with asthma-like symptoms but negative asthma test responses: Provocation with voluntary hyperventilation and mental stress

BACKGROUND A group of patients reporting asthma-like symptoms but with negative asthma tests has been identified. OBJECTIVE The objective of this study was to determine whether hyperventilation might explain these symptoms and whether the tests could be used as diagnostic tools. METHODS A hyperventilation provocation test (HVPT), a mental stress test, and the Word Color Conflict Test (WCCT) were performed on 10 patients with asthma-like symptoms, 10 patients with asthma, and 10 healthy subjects. End-tidal PCO 2 (PETCO2) was recorded 10 minutes after the HVPT and during the WCCT. Blood pressure, heart rate, and respiratory rate were also studied. The Nijmegen symptom questionnaire was used in the assessment of symptoms. RESULTS After the HVPT, the PETCO2 values recovered most slowly in the study group, the difference being significant compared with the healthy group (P <.01). During the WCCT, the study group had the lowest PETCO2 values at the 10- and 15-minute measurements, the difference again being significant compared with the healthy group (P <.05). The study group more often experienced symptoms before the test than the group with asthma (P <.05) and the healthy group (P <.001). The study group recognized significantly more symptoms previously experienced during the HVPT than the group with asthma (P <.05) and the healthy group (P <.01) and during the WCCT than the healthy group (P <.05). The study group showed a negative correlation between the PETCO2 level and the number of symptoms after the HVPT at 8 (r = -0-72; P <.05) and 10 minutes (r = -0.76; P <.05) and after the WCCT (r = -0.59; P <.05). Blood pressure, heart rate, and respiratory rate showed small differences between the groups. CONCLUSION Patients with asthma-like symptoms may experience hyperventilation when provoked. Mental stress might be 1 trigger factor. The HVPT and WCCT can be used as diagnostic instruments.

Type II diabetes and quality of life : a review of the literature.

SummaryIn this review, an attempt was made to describe how non-insulin-dependent diabetes mellitus (NIDDM, type II diabetes) affects the life of the ill person. Patients are affected by and cope with this complex disease in different ways, depending on its severity and complications. Influences on well-being therefore also vary — from none to major deterioration. A substantial proportion of patients are primarily affected with fatigue, anxiety, and depression. Deteriorations in cognitive function have also been documented, although diverging evidence exists. Some negative social circumstances have also been noted. Social support, particularly specific support, appears to be helpful, although self-efficacy and health practices seem to be as important. Resistance to compliance with diabetes regimens together with reactions to the demands for increased levels of physical activity are often seen.Systematic focused studies examining how patients and significant others perceive the impact of the disease in retrospect are still awaited. There is a great need for more research on type II diabetes; broad prospective longitudinal follow-up studies monitoring natural disease progression, as well as examining the predictive significance of quality of life, would be welcome.

Unfavourable working conditions for female GPs A comparison between Swedish general practitioners and district nurses

Objective - The aim was to analyse gender and occupational differences in the psychosocial working conditions of general practitioners (GPs) and district nurses (DNs) in Sweden. Design - A stratified random sample of GPs (n = 566) and DNs (n =554) from four county councils in Sweden. The overall participation rate was 83%. Setting - Primary health care. Main outcome measures - A mailed questionnaire comprising 10 items providing demographic data and 36 items on psychosocial working conditions was used. The questionnaire had been tested for validity and reliability. A factor analysis included five items: strains and symptoms, professional content, social support at work, workload and job control. Results - Professional content was the most positively rated aspect, whereas workload was the most negatively rated. GPs perceived a higher workload and lower social support than did the DNs. Female GPs scored significantly more negatively than both male GPs and female DNs did in four out of the five factors. Female GPs reported a high workload, low job control and low social support at work. Female DNs, too, reported a high workload, relatively low job control but fairly strong social support. Conclusion - Female GPs perceived more unfavourable psychosocial working conditions than both male GPs and female DNs did in the same organisational setting.

Workplace health promotion and working conditions as determinants of employee health

Purpose - The purpose of this paper is to investigate general psychosocial work conditions and specific workplace health promotion (WHP) measures in relation to employee health and sickness absence in Swedish municipal social care organizations. Design/methodology/approach - In a random sample of 60 out of the 290 municipalities in Sweden, 15,871 municipal social care employees working with elderly and disabled clients were sent a questionnaire concerning psychosocial work environment, WHP, and self-rated health. The responses (response rate 58.4 per cent) were complemented by register data on sickness absence (agt;14 days). All data were aggregated to employer level. Findings - A structural equation modelling analysis using employer-level data demonstrated that employers with more favourable employee ratings of the psychosocial work conditions, as well as of specific health-promoting measures, had better self-rated health and lower sickness absence level among employees. Practical implications - The results from this representative nationwide sample of employers within one sector indicate that employers can promote employee health both by offering various health-specific programmes and activities, such as work environment education, fitness activities, and lifestyle guidance, as well as by forming a high-quality work environment in general including developmental and supportive leadership styles, prevention of role conflicts, and a supportive and comfortable social climate. Originality/value - This study with a representative nationwide sample demonstrates: results in line with earlier studies and explanations to the challenges in comparing effects from specific and general WHP interventions on health.

Assessment of quality of life in rheumatoid arthritis: methods and implications.

SummaryDuring the last decade, self-report of health status and quality of life has gained increasing credibility and acceptance in studies of individuals with rheumatoid arthritis (RA). According to a number of reports. the new self-assessment instruments offer an excellent complement to the more traditional clinical outcome measurements.In the absence of a cure for RA and the use of potentially toxic drugs, quality-of-life assessment seems to have an important place in clinical drug trials. The most commonly used quality of life or health Status instruments in studies of RA seem 10 perform well and give reliable and valid information. A common concern. however, with these instruments is that there appears to be a lack of questionnaires which allow satisfaction with various aspects of quality o f life to be expressed. Many instruments focus on negative aspects of quality of life, although quality of life for most individuals is related to something positive.There is no perfect instrument applicable for all situations, but the selection of an instrument depends on the specific purpose of a particular study. Psychological interventions are more likely to affect people’s emotions and well-being, whereas a drug intervention might more dramatically affect physical function. It appears, however, reasonable to assume that effects of drug intervention on quality of life should be measured with a longer perspective, such as after at least 6 months’ observation. The field is still in a phase of methodological and theoretical development which is also reflected in the few numbers of published studies concerning the effect of drug interventions on quality of life of patients with RA.

Self-reported health and physical activity among community mental healthcare users.

The aim of the study was to survey the self-reported health and physical activity in a sample of community mental healthcare users in a city of Sweden. The study was conducted through a cross-sectional design with participants requested to fill out a self-report questionnaire. Participants (n = 103) were persons with psychiatric disabilities living in residential psychiatric settings and/or participating in daily activities provided by community mental healthcare services. The results showed that the group is affected with serious risk factors, such as high body mass index, low rated extent and frequency of physical activity and low self-estimated general state of health. Even though some difficulties associated with the answering process of this questionnaire emerged, these self-reported results clearly confirm the fact that persons with psychiatric disabilities constitute a vulnerable group in need for health-promoting caring activities and interventions.