Aims: To investigate the course of fear, pain and stress hormones during labor, and the associations between fear, pain, stress hormones and duration of labor in nulliparous women with and without epidural analgesia (EDA).

Method: One day during gestation weeks 37-39, urinary and salivary samples were collected to measure catecholamines and cortisol. Hourly during labor, the participants answered the Delivery Fear Scale and a pain intensity scale, and urinary and salivary samples were collected to measure stress hormones.

Results: The course of fear, pain and stress hormones differed throughout labor in women with and without EDA. Pain and cortisol increased throughout labor in women without EDA. Women who received EDA had more fear, but not more pain, before the administration of the EDA than women who did not receive EDA. Pain, fear and catecholamines decreased when women received EDA, but fear and pain increased again later in labor. Fear and pain correlated, as well as levels of fear in the different phases of labor. During phase one of labor epinephrine and duration of the phase were negatively correlated.

Conclusion: The course of fear, pain and concentrations of stress hormones differed, highly influenced by the administration of EDA. Fear and pain correlated more pronounced than stress hormones and fear, pain and duration of labor.

Sedan 1970-talet har villkoren i arbetslivet förändrats till den grad att det finns fog för att tala om ”en industriell revolution”. Det svenska näringslivet har blivit alltmer internationaliserat och beroende av en global marknad. Som en följd av det har kraven på organisationer, fackföreningar, myndigheter och välfärdsstaten att anpassa sig ökat. Därmed förändras också förutsättningarna på arbetsmarknaden och i arbetslivet. Det nya arbetsliv som växer fram är betydligt mer oförutsägbart, skiftat och tävlingsinriktat än tidigare. Denna bok handlar om detta nya arbetsliv och de psykiska och sociala konsekvenserna det för med sig. Boken redogör för och diskuterar nya och flexibla organisationsformer och deras styrinstrument, de förändrade kraven på kunskaper och lärande i arbetslivet, den förändrade relationen mellan arbete och övrigt liv samt de nya förutsättningarna för stress och hälsa. Boken går inte bara igenom aktuella företeelser i samhället och arbetslivet, den redogör även för relevanta kunskaper, begrepp och teorier inom samhällsteori, organisation, socialisation, kognition och stress. Trots den breda utblicken ges en samlad bild av det nya arbetslivet som alltmer oreglerat, heterogent och individualiserat.

Författarna är alla forskare inom området och boken bygger delvis på erfarenheterna från ett omfattande forskningsprogram om nya arbetsvillkor. Gränslöst arbete är tänkt att använda som kurslitteratur på universitet och högskolor inom såväl psykologi, pedagogik och sociologi som företagsekonomi. Boken kan även läsas av alla som är intresserade, och kanske drabbade, av villkoren i det nya arbetslivet.

Translated and adapted from a Swedish original, Work without Boundaries: Psychological Perspectives on the New Working Life tackles the human impact of the changing nature of work. It brings together strands of research from a variety of disciplines including work psychology, occupational health psychology, social psychology, and psychobiology. Written by two leading international researchers and writers in this field, Work without Boundaries delivers new levels of understanding in the field and charts the way forward for future research.

Under covid-19-pandemins första våg, tidigt våren 2020, valde de flesta länder, inklusive Sverige, att rekommendera eller kräva att de anställda som kunde skulle arbeta på distans från bostaden för att minska smittspridningen på arbetsplatser och under resor till och från dessa arbetsplatser. Att arbeta på distans skiljer sig i många avseenden från att arbeta i arbetsgivarens lokaler.

Det övergripande syftet med denna översikt, som består av tre delar, har varit att sammanställa och öka den forskningsbaserade kunskapen om distansarbete i hemmet.

Översikten omfattar forskningslitteratur inom tre områden:

• arbetsmiljö och hälsa
• balans mellan arbetsliv och privatliv
• produktivitet.

I analyserna har vi därtill särskilt fokuserat på likheter och skillnader i mäns och kvinnors villkor vid lönearbete i hemmet. Ytterligare syften har varit att undersöka och dra slutsatser om distansarbete i hemmet under tiden före respektive under pandemin.

Rehabilitering och samordning, Rehsam, var ett forskningsprogram som initierades av regeringen år 2009. Målet var att öka den evidensbaserade kunskapsmassan kring rehabilitering av personer som är sjukskrivna, eller riskerar att bli sjukskrivna, på grund av psykiska eller muskuloskeletala problem. Denna rapport är en sammanfattande utvärdering av Rehsamprogrammet.

Som en uppföljning av Rehsam-satsningen fick Forte 2014 bland annat i uppdrag att göra en vetenskaplig kvalitetsbedömning av den forskning som genomförts inom Rehsam-satsningen. Detta uppdrag har genomförts i olika etapper, med två delrapporter under 2015. Den här utvärderingen omfattar 21 projekt och är en slutrapport av uppdraget.

Sammanfattningsvis visar Rehsam-projektens resultat att projekt som omfattar insatser på arbetsplatsen är mer effektiva än de projekt som inte genomfört arbetsplats-interventioner. Tendensen är även att projekt med högre vetenskaplig kvalitet oftare har signifikanta utfall.

Cognitive bias, such as selective memory for pain-related information, is frequently observed in chronic pain patients and is assessed mostly using verbal material. Beside word lists, the current study used photographs of people presenting pain behaviours to assess memory bias in chronic pain patients. Chronic pain patients were hypothesized to show better recall of pain-related words and pictures as compared to pain-free controls. Twenty-eight female chronic neck patients and 28 pain-free female controls completed two computerized pictorial memory games and two word recall tasks. Patients and controls performed equally well in the neutral memory game. In the pain-related game, patients performed significantly worse than did controls. No significant differences were found in the word recall task. The result is discussed in terms of cognitive avoidance.

Purpose: To investigate the effects of total workload and other work-related factors on postpartum depression in the first 6 months after childbirth, utilizing a hybrid model of health and workforce participation. Methods: We utilized data from the Maternal Postpartum Health Study collected in 2001 from a prospective cohort of 817 employed women who delivered in three commu- nity hospitals in Minnesota. Interviewers collected data at enrollment and 5 weeks, 11 weeks, and 6 months after childbirth. The Edinburgh Postnatal Depression Scale measured postpartum depression. Independent variables included total workload (paid and unpaid work), job flex- ibility, supervisor and coworker support, available social support, job satisfaction, infant sleep problems, infant irritable temperament, and breastfeeding. Results: Total average daily workload increased from 14.4 h (6.8 h of paid work; 7.1% working at 5 weeks postpartum) to 15.0 h (7.9 h of paid work; 87% working at 6 months postpartum) over the 6 months. Fixed effects regression analyses showed worse depression scores were associated with higher total workload, lower job flexibility, lower social support, an infant with sleep problems, and breastfeeding. Conclusions: Working mothers of reproductive years may find the study results valuable as they consider merging their work and parenting roles after childbirth. Future studies should examine the specific mechanisms through which total workload affects postpartum depressive symptoms.

Stress can be defined as an imbalance between demands placed on us and our ability to manage them. The body’s stress system is adapted to confront sudden physical threats. Today, however, we are increasingly exposed to prolonged mental and psychosocial stress. Prolonged stress can give rise to a range of problems: poor performance, chronic fatigue, disinterest, dejection, memory disturbances, sleep problems, numbness and diffuse muscle pains. These symptoms may eventually be followed by depression, post-traumatic stress disorder and chronic fatigue syndrome, and ultimately chronic pain conditions, cardiovascular disease and diabetes. Sleep is a vital counterbalance to stress as it enables the body to recover properly. Good sleep is thus essential to our ability to cope with stress and stay healthy.

The decline in the mental wellbeing of the population since the 1980s has been accompanied by a rise in the number of pain complaints. A similar development in respect of symptoms such as anxiousness, nervousness and anxiety, constant fatigue and neck and shoulder pain and sleeping problems has been observed in the population. This increase, which continued throughout the 1990s and culminated in 2001, was followed by a slight fall. However, there was no decline among young people in the early 2000s. Rather, the number of complaints continued to increase.

Since the mid-1990s, the proportion of people suffering from stress symptoms has risen and fallen in step with employment levels. Since the beginning of the 1980s, growing numbers of people in gainful employment have experienced their work as hectic and mentally taxing. This may indicate that the balance between healthy and unhealthy factors impacting the actively employed has tilted towards less favourable conditions. Mental stress at work has increased among women and men, particularly among county council employees. Repeated organisational restructuring may explain why hectic and mentally taxing work has become more commonplace. Mental ill-health along with musculoskeletal disorders are the most frequent diagnoses in connection with newly granted disability pensions. Sickness absence trends largely reflect the trend in stress symptoms.

Several studies have shown positive results for group treatments of a wide range of physical and psychological diseases. In a randomised study the effect of two stress management methods were evaluated. A treatment with cognitive behavioural approach called Strategical Resource use (SRA) was compared with Kundalini yoga. 33 subjects from a large Swedish company were divided into four groups. One all female and one mixed group were introduced to each method. After the treatment, the subjects of both methods had improved their values on both subjectively rated and physiologically measured variables significantly, e.g. perceived stress, stress behaviour, anger, exhaustion, quality of life, blood pressure and pulse. The yoga group had significantly decreased norepinephrine values. The SRA group’s decrease on epinephrine was approaching significancy. No significant difference was found between the two methods. The conclusion is that both methods have an effect on physiological as well as psychological aspects of stress.

To describe the associations between physiology and recovery, reliable methods to measure rest and recovery are needed. One of the most common methods to gain information on rest and recovery is to ask people to provide self-ratings in questionnaires. To determine whether the answers to such questions are associated with health, self-ratings can be evaluated with respect to established biomarkers of physiological functioning, such as cortisol. The findings show that self-ratings of rest and recovery are related to cortisol, particularly to morning cortisol, and that self-ratings provide important information on physiological recovery in terms of cortisol output.

To date, the understanding of how recovery from work relates to cortisol output is poor. Considering this, the present study set out to investigate the associations between self-ratings of 15 items of rest and recovery and salivary cortisol sampled every second hour across two working days. Data came from 12 female and 13 male white-collar workers and were analyzed by linear regression analyses and repeated measures ANOVA. Poor rest and recovery was associated with high levels of morning cortisol, with the strongest relationships emerging for "rested in the morning", "rested after a weekend", "feel energetic during the working day", "tired during the working day", "sufficient sleep" and "worry about something". Moreover, significant interaction effects emerged between sex and "rested after a weekend" and "worry about something". To conclude, the findings show that self-ratings of rest and recovery are related to cortisol, particularly to morning cortisol, and that self-ratings provide important information on physiological recovery in terms of cortisol output.

Positive psychology investigates the positive aspects of human life. Positive psychologists contend that it is difficult to understand the factors that create health, balance and meaningful lives through studying sickness, dissatisfaction and suffering. Accordingly, positive psychology represents a turn for a more positive approach to psychology.

The ideas of positive psychology are also applicable within the sphere of work and organisational psychology. It is a central contention of this report that positive psychology may provide interesting answers to some of the challenges that are confronting the Nordic welfare states in the years ahead.

The aim of this report is to give a theoretical and methodological overview of existing Nordic research about positive factors at work. The report contains a series of operationalised concepts that measure positive factors at work. These measures of positive factors at work are brought together in a theoretical model that the authors of this report will use as a starting point for further research into positive psychology at work in a Nordic context.

The aim of this study was to validate subjective ratings of questions on unwinding and recuperation and to investigate the relationships with cortisol output. Participants were 25 white-collar workers employed at a Swedish government authority. Linear regressions and repeated measures of ANOVA were used to calculate mean levels of salivary cortisol as related to recovery/recuperation. The results show significant main effects of cortisol as related to subjective ratings (p < 0.01) and a significant interaction effect (p < 0.05) between cortisol and sex. The study indicates that high levels of morning cortisol are significantly related to failure to recuperate. Results are discussed in terms of validity, prediction, sex differences, selection and generalization.

This chapter systematically reviews how different measures of salivary cortisol are related to different measures of psychosocial work stress. Divergent findings were scrutinized with respect to study quality and the methods used. Measures of work stress included concepts reflecting those included in the demand–control–support model or the effort–reward–imbalance model. General bibliographic databases (PsychINFO and PubMed) were searched up to September 30, 2009. Two reviewers extracted data on study characteristics and study quality. In total 27 articles fulfilled the inclusion criteria. Cortisol measures were grouped into single time points at different times during the day, deviations at different time periods during the day, reactivity and recovery after a standardized laboratory test, area under the curve from deviations and reactivity measures. A large proportion of the analyses of the associations between cortisol and psychosocial work stressors showed nonsignificant findings. However, of the significant findings, most results showed that a high work stress was associated with high cortisol levels. Significant relationships were evenly distributed across different measures of psychosocial work stress. As regards salivary sampling or statistical analysis, no strategy seemed superior but some strategies have only been used in the past few years. Typically, older studies were of lower quality. Low quality studies tended to have a higher proportion of significant findings which is a reason for concern. The relatively few significant findings may be because many psychosocial work stressors were of mild or moderate intensity and the study groups were rather small and fairly homogeneous, thus variability was too small to reveal any effects. The results indicate a normal, healthy response to work stress in most workers, according to CATS and the Allostatic Load Models.

It had been suggested that programming of the hypothalamo-pituitary-adrenal axis may underlie the associations of reduced size at birth with raised blood pressure in later life. We investigated whether morning salivary cortisol mediates the inverse association of birthweight with systolic blood pressure in children.Subjects and measurements– a historical cohort study involving 1152 Swedish children aged 5–14 years, who took part in a family study comprised of mother, father, and two full-sibs delivered in 1987–1995 after 38–41 weeks gestation within 36 months of each other. Birthweight and gestational age were available from obstetric records. Blood pressure, weight, height and puberty stage were measured at a clinic. Cortisol was measured by radioimmunoassay in morning salivary samples taken at home, within 30 min of waking.Morning cortisol showed a weak negative association with length of gestation in siblings, was not related to birthweight or to systolic or diastolic blood pressure. There was no change in the strength of the negative association between birthweight and systolic blood pressure on adjustment for cortisol (−1·4 mmHg/kg, 95% CI−2·7,−0·2; adjusted for age, sex, puberty stage, weight and height, and cortisol).Morning cortisol was not associated with size at birth, and did not mediate the birthweight–blood pressure association in children born from full-term pregnancies. It is possible that basal cortisol levels are of more importance in explaining associations of size at birth with later blood pressure in older subjects, or in populations with more varied length of gestation. Alternatively, our results may be caused by misclassification of the hypothalamo–pituitary-adrenal activity.

Background: The aim of this study was to analyse how paid work, unpaid household tasks, child care, work-child care interactions and perceived work stress are associated with reported symptoms in male and female white-collar employees. Methods: A questionnaire was mailed to 1300 men and 1300 women belonging to the white-collar sector, with at least 35 hours of regular employment a week and a participant age of between 32 and 58 years. It contained items relating to total workload (hours spent on paid work, unpaid household tasks and childcare), subjective indices for work stress and symptoms. The response rate was 65% (743 women; 595 men). Gender difference in symptom prevalence was tested by analyses of variance. Odds ratios were used to estimate the bivariate associations between work-related variables and symptom prevalence. A multivariate analysis estimated the effect of paid and unpaid work interaction, work-childcare interplay and possible synergy. Results: The frequency and severity of symptoms was higher in women than in men (P < 0.0001). Employed women's health was determined by the interaction between conditions at work and household duties (OR 2.09; 1.06-4.14), whereas men responded more selectively to long working hours, i.e. >50h/week (OR 1.61; 1.02-2.54). However, childcare (<21 h/week) appeared to have a buffer effect on the risk of a high level of symptoms in men working long hours. Conclusion: Working life and private circumstances and the interplay between them need to be taken into account to curb stress-related ill health in both men and women.

Aims: This study aimed to analyse, in a homogeneous population of highly educated men and women, gender differences in self‐reported sickness absence as related to paid and unpaid work and combinations of these (double exposure), as well as to perceived work stress and work–home conflict, i.e. conflict between demands from the home and work environment. Methods: A total of 743 women and 596 men, full‐time working white‐collar employees randomly selected from the general Swedish population aged 32–58, were assessed by a Swedish total workload instrument. The influence of conditions in paid and unpaid work and combinations of these on self‐reported sickness absence was investigated by multivariate regression analyses. Analysis of variance (ANOVA) was used to assess differences between men and women. Results: Overtime was associated with lower sickness absence, not only for men but also for women, and a double‐exposure situation did not increase the risk of sick leave. Contrary to what is normally seen, conflict between demands did not emerge as a risk factor for sickness absence for women, but for men. Conclusions: Our assumption that sickness absence patterns would be more similar for white‐collar men and women than for the general population was not confirmed. However, the women working most hours were also the least sick‐listed and assumed less responsibility for household chores. These women were mainly in top‐level positions and therefore we conclude that men and women in these high‐level positions seem to share household burdens more evenly, but they can also afford to employ someone to assist in the household.

Aims: This study aimed to analyse, in a homogeneous population of highly educated men and women, gender differences in self‐reported sickness absence as related to paid and unpaid work and combinations of these (double exposure), as well as to perceived work stress and work–home conflict, i.e. conflict between demands from the home and work environment. Methods: A total of 743 women and 596 men, full‐time working white‐collar employees randomly selected from the general Swedish population aged 32–58, were assessed by a Swedish total workload instrument. The influence of conditions in paid and unpaid work and combinations of these on self‐reported sickness absence was investigated by multivariate regression analyses. Analysis of variance (ANOVA) was used to assess differences between men and women. Results: Overtime was associated with lower sickness absence, not only for men but also for women, and a double‐exposure situation did not increase the risk of sick leave. Contrary to what is normally seen, conflict between demands did not emerge as a risk factor for sickness absence for women, but for men. Conclusions: Our assumption that sickness absence patterns would be more similar for white‐collar men and women than for the general population was not confirmed. However, the women working most hours were also the least sick‐listed and assumed less responsibility for household chores. These women were mainly in top‐level positions and therefore we conclude that men and women in these high‐level positions seem to share household burdens more evenly, but they can also afford to employ someone to assist in the household.

This book is based on the wish to use saliva cortisol measurement because of its many advantages but frustrations over opposing results in the literature. Several discussions at different meetings led to the development of a network of researchers from Sweden, funded by the Swedish National Research Council. This network was soon expanded to also include colleagues from Norway and Denmark. The main aim of the group was to try to understand the results from different studies on saliva cortisol measurement and thereby better understand how and when saliva cortisol assessment best could be made. A hypothesis was that, seemingly, divergent findings could be effects of differences in the theoretic assumptions made and methods used. This led over to a decision to perform a literature review focusing on if the many different ways of evaluating the levels and dynamics of salivary cortisol especially with regard to time points of assessment and analyses of data affect the interpretation of cortisol measurement in various contexts.

In recent decades, the technique of using ambulatory saliva sampling for measuring cortisol levels has become increasingly popular in field research and clinical studies aimed at investigating bodily responses to psychosocial stress and other psychological and clinical conditions. This interest is paralleled with frustrations on opposing and ambiguous results. To get a deeper understanding of the seemingly contradictory results, the Scandinavian cortisol and stress network (Scancort) was formed, based on 20 researchers from the disciplines of public health, psychology, biology and medicine. This e-book is based on a critical review of the existing empirical literature on salivary cortisol, aiming to evaluate the usefulness of salivary cortisol as a biomarker in various settings. In particular, this e-book focuses on how the many different ways of evaluating the levels and dynamics of salivary cortisol (i.e., with regard to time points of assessment and different algorithms used to integrate data from multiple time points) affect the interpretation of cortisol measurements in various contexts. One main question is to find out if it is possible that different results of studies involving cortisol assessments are functions of differences in the theoretic assumptions made and the methods used.

Over the last decade, the technique of using ambulatory salivary sampling has become increasingly popular in field research and clinical studies. The non-invasive method is easy to administer and analyze and allows implmentation in large scale study designs. However, this large interest in the use of salivary cortisol measurement is paralleled with frustrations on opposing results. This presentation is based on a critical evaluation of the existing literature on salivary cortisol, aiming to evaluate the utility of salivary cortisol as a biomarker in various settings  and how we can understand cortisol reactivity using evidence of experiences from different study designs. The work is compiled by the Scandinavian Stress and Cortisol Network, a network financed by the Swedish Research Council, and one main question asked was: is it possible that different results of studies involving cortisol assessments are functions of differences in the theoretical assumptions made and methods used. In particular, the symposium will focus on how the many different ways of evaluating levels and dynamics of salivary cortisol (i. e. with regard to time points of assessment and different algorithms based on multiple time points) may have an impact on the interpretation of cortisol measurements in various contexts. Salivary cortisol has been studied in relation to the following topics: demographic variables, psychosocial work environment, psychosocial resources (e.g. mastery) and outcomes (e.g. burnout), sleep quality, biological markers (markers of cardivascular risk, inflammation and metabolism) and somatic outcome.

The present study aimed to investigate the structure of a Swedish translation of Ryff’s psychological wellbeing scales covering self-acceptance, positive relations, autonomy, environmental mastery, personal growth and purpose in life. Moreover, the consistency of previously reported age and gender profiles of psychological well-being was examined. Analyses were based on data from 1260 white-collar workers aged 32–58 years. The internal consistency coefficients of the translated scales were higher than that of the original Ryff scales. Further confirmatory factor analyses replicated previous findings showing that the proposed six-factor model with a single second-order super-factor had better fit than the single factor model. Besides confirming previously reported age and gender profiles, the study showed age differences in self-acceptance and gender differences in environmental mastery and purpose in life but not in personal growth. The present findings clearly demonstrate the adequacy of the Swedish version of the Ryff scales in female and male white-collar workers.

Most research on the combined effects of paid and unpaid workload has related these factors to stress, depression, and physical symptoms. Thus, comparative knowledge concerning positive aspects of human functioning, such as health and well-being and how they relate to total workload of employed women and men, is limited. Our aim in this study was to investigate how total workload including paid and unpaid work is related to psychological well-being and symptoms in full-time employed women and men. We obtained data on workload, general symptoms, and the Ryff scales covering self-acceptance, environmental mastery, positive relations, personal growth, purpose in life, and autonomy from questionnaires mailed to a stratified sample of highly educated white-collar workers aged between 32 and 58 years. Data from women (n = 430) and men (n = 400) living in partner relationships with at least one child showed that increasing hours of unpaid work was associated with decreasing levels of self-acceptance and environmental mastery in women, whereas paid work was associated with increasing levels of personal growth and decreasing levels of purpose in life. For men, paid work was associated with increasing levels of personal growth and more symptoms. We discuss factors underlying the gender-specific relationships between paid and unpaid work, psychological well-being, and symptoms.

Objective: To investigate how physiologic dysregulation, in terms of allostatic load and clinical risk, respectively, relates to sense of coherence (SOC) in women with no previously diagnosed pathology. Methods: At baseline, 200 43-year-old women took part in a standardized medical health examination and completed a 3-item measure of SOC, which they completed again 6 years later. According to data from the medical examination, two different measures of physiologic dysregulation were calculated: a) a measure of allostatic load based on empirically derived cut points and b) a measure of clinical risk based on clinically significant cut points. Results: In line with the initial hypotheses, allostatic load was found to predict future SOC, whereas clinical risk did not. In addition to baseline SOC and nicotine consumption, allostatic load was strongly associated with a weak SOC at the follow-up. Conclusions: The better predictive value of allostatic load to clinical risk indicates that focusing solely on clinical risk obscures patterns of physiologic dysregulation that influence future SOC.

The aim of this cross-sectional study was to investigate how sense of coherence (SOC) relates to biomarkers of health in 43-year-old nonsmoking premenopausal women. Before taking part in a standardized medical health examination including assessment of blood pressure, blood lipids, and physical symptoms, participants completed a three-item measure of SOC. On the basis of their SOC scores, the 244 women with complete datasets were categorized into 1 of 3 groups with a weak, intermediate, or strong SOC. Results showed that women with a strong SOC had significantly lower levels of systolic blood pressure (p < .05) and total cholesterol (p < .05) than did women with a weak SOC. It is suggested that the lower levels of systolic blood pressure and total cholesterol found in women with a strong SOC may constitute a biological buffer against ill health and disease.

The objective is to present our recent research on the biological underpinnings of positive health. In the first study, the Ryff scales covering self-acceptance, environmental mastery, positive relations, personal growth, purpose in life, and autonomy were used to measure positive health in female and male white-collar workers (n = 23) at the same workplace. Biological indicators, including salivary cortisol, urinary catecholamines and blood pressure, were collected during two workdays. The results revealed that individuals with high scores on the Ryff scales had significantly lower levels of morning cortisol and a significantly lower total cortisol output than did the others, while no significant differences emerged for catecholamines or blood pressure. In a second study, sense of coherence (SOC) was used to measure positive health in 43 year-old women (n = 244) who took part in a standardized medical examination. As hypothesized, the results showed that women reporting a strong SOC had significantly lower systolic blood pressure and total cholesterol than did those with a weak SOC. A third study explored further the longitudinal associations between SOC and allostatic load in women (n = 200). The results showed that, at age 43, SOC, nicotine consumption and allostatic load were significantly associated with SOC at age 49. Taken together, our studies indicate possible mechanisms linking self-reports of positive health to health-related biological reactions. It is suggested that, in comparison to individuals with low positive health, individuals with high positive health have access to resources for dealing successfully with daily life stress, which reduces chronic stress and cumulative load on bodily systems and contributes to long-term health.

Contextual factors including neighborhood status have consistently been associated with health disparities. This may relate to a poorer neighborhood status involving an exposure to chronic stressors, which dysregulates cortisol secretion. This study investigated single and aggregate cortisol measures in 88 working women living in high and low status neighborhoods. Results showed significantly lower waking cortisol among women in low status neighborhoods. However, there were no group differences in aggregate cortisol measures. The lower morning cortisol among women in the low status neighborhoods follows previous research suggesting hypocortisolism as a pathway linking neighborhood status and health disparities, albeit a less consistent finding across cortisol measures in this sample. This may relate to the Swedish welfare state and its fostering of equality.

Many dental health workers suffer from musculoskeletal disorders in the upper extremities. In addition to ergonomic factors, psychosocial work characteristics have been linked to musculoskeletal disorders. The present cross-sectional study aimed at investigating how musculoskeletal disorders in the upper extremities (UED) and occupational position are related to work characteristics and general health problems in female dental health workers. Questionnaire data from dentists, dental hygienists and dental nurses (N=945) showed that 81% reported UED. Multivariate analysis of variance showed that dentists reported the highest levels of physical load and fatigue whereas dental nurses reported the lowest levels of influence at work. Irrespective of position, those with UED considered their physical and psychosocial work environment and their own health to be significantly poorer than did those without UED. A hierarchical multiple regression showed that the physical load of dentistry was most strongly related to UED. Despite improvements to the ergonomics and physical work environment of dentistry, it is concluded that female dental health workers are still at high risk of developing UED.

The Swedish Council on Health Technology Assessment (SBU) conducted a systematic literature review of research on the association between occupational exposures and back disorders. In this review, we use back disorders as an umbrella term to include the more specific terms back trouble (a subjective experience of pain, ache or discomfort in the back), symptoms of sciatica, intervertebral disc changes and diseases of the back. The report is focused on disorders of the thoracic and lumbar spine. A wide range of occupational exposures were investigated, including: physical work load, vibration, organizational and psychosocial factors, chemical and biological factors, noise, environmental factors and contagious substances.

Background: Since 2011 SBU has had a mandate from the Swedish government to systematically assess the evidence associating occupational exposures to health issues. The objective of this review was to assess the scientific basis describing the influence of occupational exposures on back disorders. Back disorders are common. Between 60 and 70 percent of the general population world-wide suffer from back pain at least once in their life. For affected individuals, back disorders are the source of both suffering and decreased functioning. The costs to society are also considerable in terms of direct health care costs, financial support to individuals with work disability, as well as costs due to loss of production.

Method: A systematic review was undertaken following the PRISMA statement and standard methods used by SBU adapted to an occupational context. A literature search covering years 1980 to January 2014 was conducted in international medical and occupational data bases. The review assessed almost 8 000 abstracts. Studies that fulfilled strict inclusion criteria were assessed for relevance and quality, using pre-set protocols. Relevance and quality assessments were conducted by two experts, working in an evaluation pair. After conducting independent assessments, the two experts had to agree on a mutual relevance and quality classification. Some articles required that all exporters participated in discussion and made a collective assessment. A total of 109 studies were classified as moderate or high quality, representing more than 150 000 study participants. The strength of the scientific evidence was assessed with the GRADE system.

Results: There is an association between occupational exposure and back disorders. This result is based on investigations of a large variety of work environments, mainly in Europe and North America. In most studies passing the quality criteria, researchers investigated occupational exposure and back disorders in populations consisting of both women and men with at least one year of follow up.

Conclusions: People in the following groups develop more back trouble over time than those who are not subjected to the specified exposure at work:

– Those who work with manual handling (e.g. lift) or in a posture where the back is bent or rotated

– Those who work in a kneeling or squatting posture, or have physically demanding work tasks

– Those exposed to whole body vibration

– Those who experience work as mentally stressful; or those who find their work demanding, but lack decision latitude (personal control of their own working situation); or those who have insufficient opportunities for personal development

– Those who work outside standard office hours.

In some work environments, people have less back trouble. Those who experience high influence over work-related decisions, those who get social support at work and those with high job satisfaction develop less back trouble than others.

Women and men with similar occupational exposures develop back troubles to the same extent.

Those who work in forward bent postures or are exposed to whole body vibration in their work develop more symptoms of sciatica than others, while those with high job satisfaction develop less such symptoms. Those whose work entails manual handling develop more intervertebral disc changes than others.

This systematic literature review has uncovered a substantial body of knowledge concerning occupational exposures and back disorders. Future research should include intervention studies, i.e. studies that scientifically test the effect of well defined interventions on back disorders over extended periods of time in authentic work situations.

Project group

Experts: Karin Harms-Ringdahl (Chair), Sven Ove Hanson (Ethics), Olle Hägg, Ulf Lundberg, Svend Erik Mathiasen, Gunnevi Sundelin, Magnus Svartengren, and Hans Tropp.

SBU: Charlotte Hall (Project Director), Karin Stenström (Assistant Project Director), Agneta Brolund (Information Specialist), Therese Kedebring (Project Administrator), Laura Lintamo (Investigator), Maria Skogholm (Project Administrator), Lena Wallgren (Scientific Writer)

Scientific reviewers: Eva Denison, Mats Hagberg, Gunnar Nemeth, Esa-Pekka Takala.

The catecholamines have been of central interest and importance in stress research since the first demonstrations of the role of sympathetic arousal in response to stress exposure early in the 20th century. Numerous animal experiments have illustrated the active defence reaction and the ”emergency function” of the adrenal medulla, which increases the organism’s chances of survival by ”fight-or-flight”. During the past decades, a considerable number of studies in humans, in laboratory as well as in natural settings, has confirmed and extended the conclusions from the animal studies. The aim of this article is to summarize research and conclusions relevant to the role of catecholamines in stress and health, including their assessment and methodological considerations, as well as gender differences in catecholamine responses to stress.

The aim of this review is to describe and discuss various aspects of measurements of catecholamines as biomarkers of environmental stress. The following aspects are treated: Catecholamines and health, Assessment, Methodological considerations, Gender differences and Relevance for allostasis.

Muscular pains, stress, fatigue, and headaches are the most common work-related health problems in the European Union, and psychosocial stress is assumed to play an important role in these disorders. This paper is describing some modern work conditions contributing to stress, major bodily responses to stress and potential health consequences in women and men. It is concluded that demands for constant activity, competition, and personal responsibilities are increasiing. The borders between work and other parts of life are becoming blurred and time for rest and recovery is deminishing, which contributes to allostatic load. In modern societies, the lack of recuperation seems to be more important for health problems than the intensity of stress and physical demands at work. Many women find the combined load from paid and unpaid work responsibilities to be too high. To encourage and help both women and men to find a reasonable work-life balance, economic and political societal measures seem necessary.

The aim of this review is to describe and discuss the role of mental stress in muscular activity and musculoskeletal disorders. The following aspects are treated: Psychobiological mechanisms, Measurements of acute and chronic effects, Surface and intramuscular recordings, Gender differences, Gaps of knowledge, Research needs and Psychological and psychosocial factors.

The role of psychological and psychosocial stress in the development of musculoskeletal disordes is reviewed.

This is a review of present knowledge regarding the association between psychological stress and physical health. The physiological responses to stress, involving the pituitary adrenocortical and the sympathetic adrenomedullary systems, can be health promoting as well as health damaging. According to the Allostatic Load Model, a healthy reaction to stress means a rapid activation of the allostatic systems followed by a rapid deactivation when the stress is over, whereas repeated and sustained activation may cause wear and tear of the body. Longterm stress exposure has been linked to cardiovascular disorders, metabolic syndroms, impaired immune function, memory impairment and musculoskeletal disorders. The psychobiological mechanisms linking stress to these disorders are rather wellknown today. It is concluded, that in modern society, sustained activation and lack of rest and recovery is a greater health problem that intense mental and physical stress exposure at work.

Att ha lägre utbildning, lägre yrkesstatus och begränsade sociala och ekonomiska resurser, jämfört med andra människor, innebär att man inte har samma möjligheter att tillgodose sina egna och familjens behov som den som har större resurser. Detta leder inte bara till lägre materiell standard utan även till mindre kontroll och sämre möjligheter att hantera problem och motgångar liksom att påverka sitt eget liv och sin omgivning. I relation till dem man jämför sig med, till exempel mer gynnade arbetskamrater, bekanta och grannar, kan detta upplevas som orättvist och framkalla en kronisk stressbelastning (Wilkinson och Picket, 2010). Även en måttlig men långvarig stressbelastning kan leda till ohälsa. I studier av djur har man också funnit att social status i gruppen sammanhänger med vissa fysiologiska tillstånd (Sapolsky, 2005). Upplevelser av orättvisa och begränsade resurser kan således påverka biologiska system i kroppen som har betydelse för hälsa och välbefinnande. Med kunskap om dessa stressrelaterade processer kan man förklara hur sociala förhållanden kryper in i kroppen och avspeglas i hälsa och livslängd. I detta kapitel sammanfattas vad man i dag vet om dessa samband och om hur låg socioekonomisk position kan sammanhänga med stress.

Om boken på förlagets hemsida: Stora grupper av människor riskerar idag att drabbas av social jetlag - att leva i ett tomrum där de är fysiskt uppkopplade men inte socialt, emotionellt och intellektuellt upplever ett sammanhang. Nytt i denna upplaga är beskrivningen av strategier för att motverka detta och för att öka vår egen och arbetslivets motståndskraft mot stress. Här presenteras både beprövade och helt nya metoder för en effektiv stressbehandling på individ-, grupp-, organisations- och samhällsnivå.

In modern society, there are a number of factors contributing to stimulation, variation and development, but also to high workload and stress. In view of the high prevalence of stress-related disorders in the industrialized countries, it is important to understand the social, behavioral, psychological and biological mechanisms linking psychosocial stress to physical health problems. The aim of this chapter is to review the empirical knowledge and the theoretical models explaining these relationships. This knowledge is important in order to understand why people exposed to psychosocial stress develop physical, and often medically unexplained, health problems. One conclusion is that in the modern society, lack of time for rest and recovery may be a greater health problem than the absolute levels of stress and workload at work.

The article focuses on sleep disorders as a risk factor for musculoskeletal pain. It is reported that sleep disorders at baseline predict development of chronic musculoskeletal pain in initially healthy working female and male one year later. Job strain was also predictive of musculoskeletal pain in female. The hypothalamo-pituitary adrenal axis is activated by sleep disturbance which results in elevated cortisol levels.

The aim of this review is to describe and discuss the role of stress in health and disease. The following aspects are treated: The concept of stress, Models of Stress Responses, Health problems in modern society, Socioeconomic status and health, Bodily responses to stress, Stress as a health promoting or health damaging factor, Stress-related disorders, Gender differences in stress-related health, and Positive stress.

The paper summarizes reseach on the role of work-related stress in health and disease in a gender perspective.

Two neuroendocrine systmes are of specific interest in the study of stress and health; the sympathetic adrenomedullary system with the secretion of epinephrine and norepinephrine, and the hypothalamic pituitary adrenocortical (HPA) system with the secretion of cortisol. These hormones have often been used as objective indicators of stress in the individual. However, through their bodily effects, they are also a link between the psychosocial environment and various health outcomes. From a series of studies of women and men, it was concluded that gender roles and psychological factors are more important than biological factors for the sex differences in stress responses. The stress responses have been important for human and animal survival and for protection of the body. However, in modern society, some of these bodily responses may cause harm rather than protection. The catecholamines have been linked to cardiovascular disorders such as hypertension, myocardial infarction and stroke, cortisol to cardiovascular disease, Type 2 diabetes, reduced immune function and cognitive impairment. An adequate balance between catabolic (mobilization of energy) and anabolic processes (growth, healing) is considered necessary for long term health and survival. In modern society, which is characterized by a rapid pace of life, high demands, efficiency and competitiveness in a global econcomy, it is likely that lack of rest, recovery and restitution is a greater health problem than the absolute level of stress.

Stressrelaterad ohälsa svarar för en stor del av sjukfrånvaron i Sverige och medför således omfattande kostnader för samhället och stort lidande för dem som drabbas. I denna artikel beskrivs vilka faktorer i det moderna samhället som bidrar till ökad stressbelastning och vad som händer i kroppen som kan förklara olika stressrelaterade hälsoproblem, både psykiska och fysiska, hos kvinnor och män. Vidare beskrivs vanliga stressymtom och möjligheter att förebygga dessa.

The aim of this article is to describe the main physiological stress responses and to analyse under which conditions these responses are health-promoting versus health-damaging, and how subjective and objective health is related. The brain communicates with the rest of the body through nerves, hormones and the immune system. Thus, perceived stress affects various systems and organs in the body, such as the cardiovascular and the gastrointestinal systems, sleep and breathing patterns, healing processes, the effectiveness of the immune system and, by feedback mechanisms, the brain itself. These bodily responses to stress have developed during evolution and are necessary for survival and protection of the body. However, activation of the stress systems means energy mobilisation, and in modern society, where stress is often induced by mental and psychosocial conditions, the mobilisation of energy for fight or flight may have harmful consequences on various bodily systems. To maintain health, repeated or long-term activation of these systems, i.e. catabolic processes, has to be followed by periods of rest and restitution to allow growth, healing and buildup of new resources, i.e. anabolic processes.