This study was designed to examine the relationships between problem-solving skills, hardiness, and perceived stress and to test the moderating role of hardiness in the relationship between problem-solving skills and perceived stress among 500 undergraduates from Malaysian public universities. The analyses showed that undergraduates with poor problem-solving confidence, external personal control of emotion, and approach-avoidance style were more likely to report perceived stress. Hardiness moderated the relationships between problem-solving skills and perceived stress. These findings reinforce the importance of moderating role of hardiness as an influencing factor that explains how problem-solving skills affect perceived stress among undergraduates.

Recent evidence suggests that test anxiety is increasing among students; however, relatively little is known regarding the related factors of test anxiety. The purpose of this study was to (1) examine the relationships between two forms of perfectionism, academic hardiness, and test anxiety, and (2) examine the moderating role of academic hardiness on the association between two types of perfectionism and test anxiety. This study included 520 students ranging from 15 to 21 years of age from eight high schools in Tehran, Iran completed the self-administered questionnaires. The results of Structural Equation Modelling (SEM) revealed that students with high levels of personal standards perfectionism and high levels of academic hardiness were less likely to experience test anxiety, while students with high levels of evaluative concerns perfectionism were more likely to experience test anxiety. A multi-group analysis revealed that academic hardiness moderated the relationship between evaluative concerns perfectionism and test anxiety. These findings enhance existing literature by revealing moderating processes that explain how perfectionism effects test anxiety.

Recent evidence indicates an elevated risk of suicidal ideation for undergraduate nursing students. This research was designed to enhance the understanding of suicidal ideation in nursing students by investigating the relationships between problem-solving skills, perceived stress, hardiness, and suicidal ideation, with the possibility of hardiness acting as a moderator in the relationships between problem-solving skills appraisal and perceived stress with suicidal ideation. A multi-stage cluster random sample of Malaysian nursing undergraduate students (N = 204) completed self-report questionnaires. The results of structural equation modeling revealed that poor problem-solving skills, greater levels of perceived stress, and low levels of hardiness predicted greater levels of suicidal ideation. Also, hardiness emerged as a moderator in the links between problem-solving skills appraisal and perceived stress with suicidal ideation. The findings incrementally improve our understanding about the importance of hardiness as a moderator in explaining how problem-solving skills and perceived stress affect suicidal ideation. The results of this study are obtained from Malaysian nursing students and possible generalization to other populations should be verified by further studies.

Introduction Integrating diabetes self-management into daily life involves a range of complex challenges for affected individuals. Environmental, social, behavioural and emotional psychological factors influence the lives of those with diabetes. The aim of this study is to evaluate the impact of a stress management group intervention based on acceptance and commitment therapy (ACT) among adults living with poorly controlled type 1 diabetes.

Methods and analysis This study will use a randomised controlled trial design evaluating treatment as usual (TAU) and ACT versus TAU. The stress management group intervention will be based on ACT and comprises a programme divided into seven 2-hour sessions conducted over 14 weeks. A total of 70 patients who meet inclusion criteria will be recruited over a 2-year period with follow-up after 1, 2 and 5 years. The primary outcome measure will be HbA1c. The secondary outcome measures will be the Depression Anxiety Stress Scales, the Swedish version of the Hypoglycemia Fear Survey, the Swedish version of the Problem Areas in Diabetes Scale, The Summary of Self-Care Activities, Acceptance Action Diabetes Questionnaire, Swedish Acceptance and Action Questionnaire and the Manchester Short Assessment of Quality of Life. The questionnaires will be administered via the internet at baseline, after sessions 4 (study week 7) and 7 (study week 14), and 6, 12 and 24 months later, then finally after 5 years. HbA1c will be measured at the same time points. Assessment of intervention effect will be performed through the analysis of covariance. An intention-to-treat approach will be used. Mixed-model repeated measures will be applied to explore effect of intervention across all time points.

Ethics and dissemination The study has received ethical approval (Dnr: 2016/14-31/1). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders.

Trial registration number NCT02914496; Pre-results.

Aims: To investigate fear of hypoglycaemia (FoH) longitudinally in a cross‐sectional study of adult patients with type 1 diabetes. Specifically, we investigated two subgroups of patients who over 4 years either showed a substantial increase or decrease in level of FoH to identify factors associated with changes in FoH.

Methods: The Swedish version of the Hypoglycaemia Fear Survey (HFS) along with a questionnaire to assess hypoglycaemia history was sent by mail to 764 patients in 2010. The responders in 2010 (n = 469) received another set of the same two questionnaires in 2014. HbA1c, insulin regimen, weight and creatinine from 2010 and 2014 were obtained from medical records. Those with an absolute difference in HFS scores ≥ 75th percentile were included in the subgroup analyses. Statistical analyses included one‐sample t tests, chi‐square and McNemar's test.

Results: The absolute difference in the HFS total score (n = 347) between 2010 and 2014 was m = ±7.6, SD ± 6. In the increased FoH group, more patients reported a high level of moderate hypoglycaemic episodes as well as impaired awareness of hypoglycaemia in 2014 compared with the decreased FoH group. There were more subjects in the increased FoH group with insulin pumps in 2014 and in 2010. In the decreased FoH group, more patients had a high frequency of daily self‐monitoring of blood glucose (SMBG) in 2010 and in 2014.

Conclusions: Fear of hypoglycaemia is stable across time for most patients. Changes in fear level are associated with changes in hypoglycaemia frequency. Thus, asking patients about changes in hypoglycaemia experiences is of great importance.

Among persons living with type 1-diabetes hypoglycemia and fear of hypoglycemia remain limiting barriers for achieving optimal glucose control and a good quality of life. Fear of hypoglycemia has been found stable over time if not treated. Uncooked cornstarch has been found to reduce the risk of hypoglycemia but has not been studied in relation to fear of hypoglycemia. The aims of this study were to through clinical data, self-reported measures and clinical interviews explore subjects’ experience of using uncooked cornstarch before bedtime and their beliefs and experiences of fear of hypoglycemia. Methods: Mixed methods with both quantitative and qualitative data were used. Self-reported measures of hypoglycemia and fear of hypoglycemia were compared to subjects’ responses during a clinical interview. The interviews were analyzed with a functional behavior analytical approach. Results: A total of five subjects took part in the study. One subject perceived the uncooked cornstarch helpful in reducing hypoglycemia. Several subjects could recall frightening hypoglycemic episodes triggering their fear. Three out of the five subjects reported avoidance behaviors such as excessive self-monitoring of blood glucose or overeating related to fear of hypoglycemia. Conclusions: The uncooked cornstarch was found appetizing but was not perceived as having an effect on BG or hypoglycemia frequency. The clinical interviews confirmed previous research regarding experience of hypoglycemia and fear of hypoglycemia.

Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer.This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8–15 weeks). The pre-to follow-up effect size was Hedge’s g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects.While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.

Introduction: Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer.

Areas covered: This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8–15 weeks). The pre-to follow-up effect size was Hedge’s g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects.

Expert commentary: While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.

A widely held view is that top-down modulation of sensory information relies on an amodal control network that acts through the thalamus to regulate incoming signals. Olfaction lacks a direct thalamic projection, which suggests that it may differ from other modalities in this regard. We investigated the late positive complex (LPC) amplitudes of event-related potentials (ERP) from 28 participants, elicited by intensity-matched olfactory, auditory and visual stimuli, during a condition of focused attention, a neutral condition, and a condition in which stimuli were to be actively ignored. Amplitudes were largest during the attend condition, lowest during the ignore condition, with the neutral condition in between. A Bayesian analysis resulted in strong evidence for similar effects of task across sensory modalities. We conclude that olfaction, despite its unique neural projections, does not differ from audition and vision in terms of task-dependent neural modulation of the LPC.

Selection research has typically focused on how to identify suitable candidates, while less is known regarding the long-term effects of various selection factors once the suitable candidates have start-ed working. The overall aim of this study was to examine the relative importance of selection fac-tors (measured during recruitment), and psychosocial working conditions (once candidates started working) for four outcomes, namely (1) job satisfaction, (2) organizational citizenship behavior, (3) occupational retention, and (4) health. Data came from a longitudinal study of newly hired police officers in Sweden (N = 508), including recruitment data and a follow-up after 3.5 years. Results of hierarchical multiple regression analyses showed that psychosocial working conditions were more important than selection factors in predicting the four outcomes. The findings suggest that employers, to ensure sustainability, need to focus on activities that facilitate newcomers’ enter-ing in the organization and their professions by providing a sound work climate.

I denna skrift har vi försökt ringa in en aspekt – gränslöst arbete – i det mångdimensionella och komplexa fenomen som nu allt oftare benämns digitalisering. En del människor associerar ordet snarast med gränslösa möjligheter, och för andra är upplevelsen snarare gränslösa krav. Vi har i skriften mer betonat möjligheterna än farhågorna genom att lägga stor vikt vid forskning och erfarenheter som kan vägleda och stärka de gränslöst arbetandes kontroll över sitt arbetsliv och sin livssituation. I detta avslutande kapitel sammanfattas vissa tendenser och vi tar på nytt upp en del farhågor som blivit knapphändigt behandlade i kapitlen samt försöker urskilja riskgrupper.

Den informationstekniska utvecklingen har möjliggjort helt nya sätt att organisera arbete. I rum och på platser som tidigare var reserverade för privatliv har nu det avlönade arbetet tagit sig in, och på den uppkopplade arbetsplatsen finns möjligheter för anställda att via nätet sköta privatlivsärenden. Både på arbetsplatsen, på andra platser och i det uppkopplade hemmet går det att snabbt växla fram och tillbaka mellan arbete och personliga angelägenheter. Denna typ av arbetsvillkor kallas för gränslöst arbete, och det kan också ställas i kontrast till fabriksarbete med höggradig maskinstyrning där arbetaren måste finnas vid sin maskin och genomföra specificerade arbetsuppgifter i tidsintervall som bestäms av maskinernas hastighet. Sådant arbete var vanligt i Sverige för bara några decennier sedan men har nu kraftigt minskat genom teknikutveckling. Höggradigt styrt arbete är dock fortfarande utbrett runt om i världen. De två exemplen är poler i en skala och däremellan finns en stor variation i villkor vad gäller arbetets reglering och tidsmässigt och rumsligt oberoende.

Delar av arbetslivet har under de senaste decennierna gått mot mer flexibilitet, inte minst i fråga om när och var man kan utföra sitt arbete. Denna flexibilitet kan innebära fördelar men det gränslösa arbetslivet medför också utmaningar för både arbetsgivare och arbetstagare. 

I regeringens arbetsmiljöstrategi 2016–2020 fick Arbetsmiljöverket ett uppdrag att i samråd med arbetsmarknadens parter ta fram en vägledning om arbetsmiljöutmaningar i anknytning till ett gränslöst arbetsliv. Den här forskarantologin har tagits fram inom ramen för det uppdraget. Texterna har skrivits av ledande forskare inom området och utgör ett av underlagen till vägledningen. Professor Gunnar Aronsson har varit redaktör för antologin. Både antologin och vägledningen finns att ladda ner från Arbetsmiljöverkets webbplats.

Projektledare för denna antologi vid Arbetsmiljöverket har varit Tommy Fahlander. Vi vill även tacka övriga kollegor vid Arbetsmiljöverket som varit behjälpliga i arbetet med antologin. 

De åsikter som uttrycks i denna antologi är författarnas egna och speglar inte nödvändigtvis Arbetsmiljöverkets uppfattning. 

Christina Jonsson

Chef för enheten för människa och omgivning, Arbetsmiljöverket, Stockholm i januari 2018

In mammals respiratory-locked hippocampal rhythms are implicated in the scaffolding and transfer of information between sensory and memory networks. These oscillations are entrained by nasal respiration and driven by the olfactory bulb. They then travel to the piriform cortex where they propagate further downstream to the hippocampus and modulate neural processes critical for memory formation. In humans, bypassing nasal airflow through mouth-breathing abolishes these rhythms and impacts encoding as well as recognition processes thereby reducing memory performance. It has been hypothesized that similar behavior should be observed for the consolidation process, the stage between encoding and recognition, were memory is reactivated and strengthened. However, direct evidence for such an effect is lacking in human and nonhuman animals. Here we tested this hypothesis by examining the effect of respiration on consolidation of episodic odor memory. In two separate sessions, female and male participants encoded odors followed by a 1 h awake resting consolidation phase where they either breathed solely through their nose or mouth. Immediately after the consolidation phase, memory for odors was tested. Recognition memory significantly increased during nasal respiration compared with mouth respiration during consolidation. These results provide the first evidence that respiration directly impacts consolidation of episodic events, and lends further support to the notion that core cognitive functions are modulated by the respiratory cycle.

During adolescence, risk behaviors (e.g., running away from home, truancy, alcohol/drug use, and delinquency) increase, and most individuals who at some point commit crimes do so during their teenage years. Since the crime rate is so high during adolescence, juvenile delinquency can be regarded as a normal rather than a deviant behavior. Delinquent females have historically been under-researched. However, the little research that is available indicates that low-risk female offenders (females with limited delinquency receiving community-based measures), may be at risk of suboptimal development. The objective of the present study was to provide a basic description of this group of offenders by using their self-reports on delinquency, drug and alcohol use, school, peers, family and mental health. The self-reports of 138 females between 15 and 20 years of age sentenced to youth service in Stockholm, Sweden, were compared to young females in residential care and to a reference group of adolescent females without known adjustment problems. The results showed that the youth service females did not have a higher number of accumulated problems than the reference group with regard to criminal acts, drug and alcohol use, peers, mental health, and in some regards also for family. However, the youth service group reported various school-related problems and failures, more in line with the residential group. This suggests that interventions aimed at helping the young females develop strategies for becoming more academically successful are important.

Delinquent peers have a strong influence on adolescent delinquent behavior. However, few studies have investigated adolescents’, and in particular young females’, own perspectives of the role of peers on their delinquent behavior. The purpose of the present study was to explore how young female offenders described their delinquent behavior and more specifically the role they assign to peer relations in committing or avoiding delinquent acts. Nine female adolescents, sentenced to youth service, were interviewed, and the data was analyzed using the Consensual Qualitative Research (CQR) method. The results showed that committing crimes and taking drugs with peers were portrayed as a way for the female delinquents to socialize. Delinquent and pro-social activities with peers appear to serve similar developmental functions in the sense that it is described to fulfill the same developmental needs. The young offenders also described collectively created pressures and norms in the peer group as the main contributing factor to their norm-breaking behavior, where they described being both recipients and producers of influence in the group. Another important finding was that the female offenders showed an awareness of the importance of pro-social peers and the need to eliminate delinquent friends from their peer network in order to help them refrain from deviant behavior. Implications for prevention and intervention are discussed.

The aims of this study were to investigate the type and extent to which women with substance abuse problems have been exposed to male violence during their lifetime, and to examine possible differences between women with a residence (WR) and homeless women (HW). The total sample included 79 women (WR, n = 35; HW, n = 44; M age = 47.8 years). Of the total sample, 72 women (91%) had experienced different kinds of male violence, 88% from former partners, and 26% from male friends or acquaintances. Of the 72 women, 71% further reported “Countless occasions of violent events,” and 36% had been forced to commit criminal acts. Abused women who had been forced to commit criminal acts were significantly more frequently found to be homeless, have reported parental alcohol and/or drug problems, have witnessed domestic violence in childhood, have been victims of sexual violence, have used illicit drugs as a dominant preparation, and have injected illicit drugs. Almost half of the abused women (46%) met criteria for posttraumatic stress disorder (PTSD), where HW showed an almost 4-time higher risk (RR 3.78) than WR. In conclusion there is a particular vulnerability in women with substance abuse to male violence, which has an important impact on their health status. Thus, from a public health perspective, it is suggested that for those women who have experienced male violence, treatment protocols need to include both assessing and addressing the impact of such experience in relation to substance abuse as well as concomitant health concerns.

The present study explored the effects of match-to-sample training on emergent responses in the domains of receptive and expressive language among children with autism spectrum disorder (ASD) in an applied setting. A concurrent multiple probe design across six participants was applied, with a follow-up after 10 days. All six children participated in a match-to-sample training procedure. The participants were trained to match a picture card of an item with a word card corresponding to the name of the item, and a word card of an item with a picture card corresponding to the name of the item. After training, three participants developed the emergent responses of receptively identifying and expressively naming both picture cards and word cards. There was a correspondence between acquired matching skills and the development of emergent language responses. Follow-up measures showed that the acquired emergent responses remained somewhat stable over time. The results are discussed in relation to prior research and in terms of implications for teaching children with ASD language skills in applied settings such as preschools. The results are also discussed in relation to the participant’s prior verbal skills and to the retention of emergent language responses.

Background: With the continuous changing world of work towards more automatisation, and global competition that requires organisations to cut costs wherever possible, job insecurity is a concern of workers across many different occupations. Job insecurity is a stressful experience and its negative impact on wellbeing and health is well-documented. However, the exact mechanisms for the link between job insecurity and health need further study.

We argue that job insecurity is a breach of the psychological contract for permanent workers, leading to perceptions that the employer acts unfairly, which is related to immediate (synchronous) and long-term (two years delayed) negative health effects. Thus, we firstly hypothesise indirect effects between job insecurity on depressive symptoms and sleep difficulties via organisational injustice at the within person level. Furthermore, because employees who often experience job insecurity may no longer have security expectations in their psychological contract, we suggest that the strength of the job insecurity-injustice relationship differs between individuals, such that the relationship is weaker for individuals with higher average levels of job insecurity over time. Finally, we hypothesised that the relationship between organisational injustice and depressive symptoms and sleep difficulties is stronger for individuals who experience more over time-variation in organisational injustice. We expect this pattern because recent research shows that injustice has stronger effects for individuals whose justice experiences vary as opposed to relatively stable injustice perceptions.

Method: The study population consisted of participants in the Swedish Longitudinal Occupational Survey of Health (SLOSH) study, a nationally representative longitudinal cohort survey. We selected only permanent workers over four consecutive data waves (2010, 2012, 2014, 2016) and analyzed the data with multilevel analysis.

Results: At the within-person level, we found significant direct effects of job insecurity on organisational injustice. Job insecurity and organisational injustice displayed direct synchronous effects on both health outcomes, but few delayed effects were found. The indirect effects were significant for synchronous but not for delayed health outcomes. Significant cross-level interactions were found for between-individual differences in job insecurity, but not for between- individual differences in organisational justice. In particular, as hypothesised, the link between job insecurity and organisational injustice at each wave was weaker for individuals with higher average levels of job insecurity perceptions but stronger for those who rarely experienced job insecurity during the time of the study.

Discussion: This study is one of the few studies investigating within- and between-person mechanisms that link feelings of job insecurity to the experience of organisational injustice and health outcomes over time. It also adds to the debate whether job insecurity and organisational injustice associate with health via mediation or moderation mechanisms by showing that both mechanisms may operate simultaneously yet on different levels. Furthermore, this study highlights that permanent workers view their organisation as less fair when they experience job insecurity, the more so if their psychological contract is largely intact and builds on security expectations. Both job insecurity and injustice have rather direct effects for health.

The aim of this study was to conduct an in-depth exploration of therapists' experiences of patients who affect them more than others and occupy their inner world beyond the context of therapy sessions. A phenomenological analysis was performed on semi-structured interviews with five relational therapists. All the therapists had a strong experience of a particular patient getting "under their skin". In all these cases, the patient was a traumatized woman. The distinctive characteristic of the phenomenon was a sense of blurred or too permeable boundaries between the therapist and the patient. This was associated with fear and anxiety, but also with feelings of love. The therapists' reactions to having a patient "under their skin" varied from resistance to symbiotic relatedness. The therapists' ideas of their professional role influenced how the experience of carrying the patient's suffering was interpreted. The phenomenon of the patient's presence in the therapist's representational world might be interpreted as a distinct countertransference phenomenon when working in a more "thin boundary" manner with particular cases. The therapists' ability to effectively manage their vulnerabilities, activated in the countertransference, seems to be crucial for therapeutic progress. Implications for research, clinical practice, and training are discussed.