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  • 3701.
    Ternhag, Anders
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Törner, Anna
    Swedish Institute for Infectious Disease Control, Solna, Sweden.
    Svensson, Åke
    Stockholm University, Faculty of Science, Department of Mathematics.
    Ekdahl, Karl
    Karolinska Institute, Stockholm, Sweden.
    Giesecke, Johan
    Karolinska Institute, Stockholm, Sweden.
    Short- and long-term effects of bacterial gastrointestinal infections.2008In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 14, no 1, p. 143-8Article in journal (Refereed)
    Abstract [en]

    During 1997–2004, microbiologically confirmed gastrointestinal infections were reported for 101,855 patients in Sweden. Among patients who had Salmonella infection (n = 34,664), we found an increased risk for aortic aneurysm (standardized incidence ratio [SIR] 6.4, 95% confidence interval [CI] 3.1–11.8) within 3 months after infection and an elevated risk for ulcerative colitis (SIR 3.2, 95% CI 2.2–4.6) within 1 year after infection. We also found this elevated risk for ulcerative colitis among Campylobacter infections (n = 57,425; SIR 2.8, 95% CI 2.0–3.8). Within 1 year, we found an increased risk for reactive arthritis among patients with Yersinia enteritis (n = 5,133; SIR 47.0, 95% CI 21.5–89.2), Salmonella infection (SIR 18.2, 95% CI 12.0–26.5), and Campylobacter infection (SIR 6.3, 95% CI 3.5–10.4). Acute gastroenteritis is sometimes associated with disease manifestations from several organ systems that may require hospitalization of patients.

  • 3702. Terzoudi, Georgia I.
    et al.
    Pantelias, Gabriel
    Darroudi, Firouz
    Barszczewska, Katarzyna
    Buraczewska, Iwona
    Depuydt, Julie
    Georgieva, Dimka
    Hadjidekova, Valeria
    Hatzi, Vasiliki I.
    Karachristou, Ioanna
    Karakosta, Maria
    Meschini, Roberta
    M'Kacher, Radhia
    Montoro, Alegria
    Palitti, Fabrizio
    Pantelias, Antonio
    Pepe, Gaetano
    Ricoul, Michelle
    Sabatier, Laure
    Sebastia, Natividad
    Sommer, Sylwester
    Vral, Anne
    Zafiropoulos, Demetre
    Wojcik, Andrzej
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute. Jan Kochanowski University, Poland.
    Dose assessment intercomparisons within the RENEB network using G(0)-lymphocyte prematurely condensed chromosomes (PCC assay)2017In: International Journal of Radiation Biology, ISSN 0955-3002, E-ISSN 1362-3095, Vol. 93, no 1, p. 48-57Article in journal (Refereed)
    Abstract [en]

    Purpose: Dose assessment intercomparisons within the RENEB network were performed for triage biodosimetry analyzing G(0)-lymphocyte PCC for harmonization, standardization and optimization of the PCC assay. Materials and methods: Comparative analysis among different partners for dose assessment included shipment of PCC-slides and captured images to construct dose-response curves for up to 6 Gy gamma-rays. Accident simulation exercises were performed to assess the suitability of the PCC assay by detecting speed of analysis and minimum number of cells required for categorization of potentially exposed individuals. Results: Calibration data based on Giemsa-stained fragments in excess of 46 PCC were obtained by different partners using galleries of PCC images for each dose-point. Mean values derived from all scores yielded a linear dose-response with approximately 4 excess-fragments/cell/Gy. To unify scoring criteria, exercises were carried out using coded PCC-slides and/or coded irradiated blood samples. Analysis of samples received 24h post-exposure was successfully performed using Giemsa staining (1 excess-fragment/cell/Gy) or centromere/telomere FISH-staining for dicentrics. Conclusions: Dose assessments by RENEB partners using appropriate calibration curves were mostly in good agreement. The PCC assay is quick and reliable for whole- or partial-body triage biodosimetry by scoring excess-fragments or dicentrics in G(0)-lymphocytes. Particularly, analysis of Giemsa-stained excess PCC-fragments is simple, inexpensive and its automation could increase throughput and scoring objectivity of the PCC assay.

  • 3703. Teär Fahnehjelm, Kristina
    et al.
    Törnquist, Alba Lucia
    Olsson, Monica
    Winiarski, Jacek
    Ek, Ulla
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Visual perceptual skills and visual motor integration in children and adolescents after allogeneic hematopoietic stem cell transplantation2018In: Pediatric Transplantation, ISSN 1397-3142, E-ISSN 1399-3046, Vol. 22, no 2, article id e13117Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to study visual acuity, visual perceptual, and VMI skills in patients after HSCT in childhood. Tests of visual perceptual skills, VMI, and visual acuity were performed in 102 children/adolescents (age range 4.3-20.9years). Mean time from HSCT to testing was 6.0years (0.9-17.5years). Visual acuity was median 1.0 decimal (range 0.16-1.6). Visual perceptual skills (memory, form constancy, visual sequential memory) and VMI were low compared to age-equivalent normative data with, respectively, 36%, 45%, 60%, and 46% of all patients performing below the 25 percentile. All patients performed significantly lower than the 50 percentile in the reference material in visual sequential memory, P<.001 (boys P<.001 and girls P<.05). All patients also performed significantly lower than the 50 percentile in VMI (P<.01) (boys P<.05). Pretransplant conditioning regimen did not affect outcome if the results were corrected for age at HSCT. Visual perceptual skill problems and VMI problems frequently occur in patients after HSCT in childhood. Age at HSCT and original diagnosis influence the outcome. Neuropsychological assessment including visual perception is recommended in children after HSCT.

  • 3704. Thelin, Eric
    et al.
    Johannesson, Louise
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    Bellander, Bo-Michael
    THE SENSITIVITY AND ROLE OF PROTEIN S100B IN DETECTING SECONDARY INJURIES AFTER TRAUMATIC BRAIN INJURY IN HUMANS2011In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 28, no 6, p. a55-A55Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients suffering from traumatic brain injury (TBI) are often treated in specialized neuro-intensive care units (NICU) using multi-modal monitoring to detect harmful secondary insults such as increased intra cranial pressure. In addition to different monitoring devices. serum biomarkers have been shown to provide additional important information regarding the patient. Elevated serum levels of S100B have been detected following TBI. cerebral ischemia. spontaneous intra-cerebral hematomas and edema formation. S100B is known to correlate to outcome. Severe secondary cerebral injuries have been shown to correlate to secondary peaks in serum levels of S100B. Increases of more than 0.1mug/L are considered pathological. METHOD: 267 patients treated in the NICU for TBI with S100B samples obtained every 12 hours during a minimum of a 96-hour time period were included. Secondary increases of S100B after 48 hours following trauma were noted. All patients had at least 2 CT-scans and/or MRI scans performed. RESULTS: 67 secondary injuries during the NICU stay were detected using MRI or CT-scans. The most common lesions were diffuse is- chemic injuries (29). edema (13). cerebral infarctions (11) and intracerebral hematoma (5). Looking at secondary peaks of S100B in detecting radiological verifiable cerebral lesions during the NICU stay. a cut-off level of more than 0.5mug/L the specificity was 100% and sensitivity 8.9%. Decreasing the cut-off level to 0.1mug/L a specificity of 95.9% and sensitivity of 64.2% was obtained. while a cut-off level of 0.05mug/L presented a specificity of 92.7% and sensitivity of 92.5%. CONCLUSIONS: S100B is a sensitive marker for secondary cerebral injuries occurring in the NICU after TBI. A low cut-off point for the secondary peak of S100B (0.05 mug/L) increases sensitivity without any major deficit of specificity in detecting secondary injuries during the NICU stay.

  • 3705.
    Thelin, Eric Peter
    et al.
    Karolinska Inst, Dept Clin Neurosci, Neurosurg Sect, Stockholm, Sweden.
    Johannesson, Louise
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    Nelson, David
    Karolinska Inst, Dept Physiol & Pharmacol, Sect Anesthesiol & Intens Care, Stockholm, Swede.
    Bellander, Bo-Michael
    Karolinska Inst, Dept Clin Neurosci, Neurosurg Sect, Stockholm, Sweden.
    S100B Is an Important Outcome Predictor in Traumatic Brain Injury2013In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 30, no 7, p. 519-528Article in journal (Refereed)
    Abstract [en]

    The objective of the study was to examine how S100B, a biomarker of traumatic brain injury (TBI), contributes to outcome prediction after adjusting for known parameters, including age, Glasgow Coma Scale (GCS), pupil reaction, and computed tomography (CT) variables; to examine which parameters have the best correlation to elevated serum levels of S100B; and to investigate when to sample S100B to achieve the strongest association to outcome. This retrospective study included 265 patients with TBI admitted to the neurointensive care unit, Karolinska University Hospital Solna, Stockholm, Sweden. Univariate and multivariate proportional odds regressions were performed to determine parameters most closely related to outcome, and how S100B adds to prediction accuracy. Age (p < 0.0001), pupil reaction (p < 0.0001), and levels of S100B (p < 0.0001) had the strongest statistical correlation to outcome. The area under curve of S100B, the first 48 h after trauma, yielded an additional explained variance of 6.6% in excess of known outcome parameters, including age, GCS, pupil reaction, and CT variables, themselves exhibiting an explained variance of 29.3%. S100B adds substantial information regarding patient outcome, in excess of that provided by known parameters. Only CT variables were found to be significant predictors of increased levels of S100B in uni- and multivariate analysis. Early samples of S100B, within 12 h after trauma, appear to have little prognostic value, and S100B should likely be sampled 12-36 h following trauma to best enhance TBI outcome prediction.

  • 3706.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    A long-term perspective on cardiovascular job stress research2019In: Journal of Occupational Health, ISSN 1341-9145, E-ISSN 1348-9585, Vol. 61, no 1, p. 3-9Article, review/survey (Refereed)
    Abstract [en]

    This review provides perspectives on cardiovascular occupational stress research since the 1960s until now. The author argues for closer links between basic science and clinical follow-up examinations of patients. In an excellent way urinary excretion of adrenaline and noradrenaline during wake hours mirrors day to day or week to week variations in sympathomedullary activity which could be related to variations in the patient's and cardiovascular and psychosocial situation. Modern methods for following variations over time in heart contractility should also be related to the patients' psychosocial situation. In addition the author argues for more extensive use of the increasing knowledge regarding regeneration and vagal activity in relation to variations in job conditions and development or prevention of cardiovascular disease.

  • 3707.
    Theorell, Töres
    Stockholm University.
    Anabolism and catabolism: antagonistic partners i stress and strain2008In: SJWEH Suppl 2008;(6):136-143, ISSN 1795-9926Article, review/survey (Other (popular science, discussion, etc.))
  • 3708.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Anabolism and catabolism at work2009In: Research in Occupational Stress and Well Being, ISSN 1479-3555, Vol. 07, p. 249-276Article, review/survey (Other academic)
    Abstract [en]

    The importance of anabolism and regeneration is related to lack or loss of control. This chapter discusses the pshychophysiological basis for such relationship.

  • 3709.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Arbetsmiljöfrågan i 2010-talets Sverige2012In: Psykisk hälsa, ISSN 0033-3212, Vol. 53, no 3, p. 16-23Article in journal (Other (popular science, discussion, etc.))
  • 3710.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Commentary triggered by the individual participant datameta-analysis consortium study of job strain and myocardial infarction risk2014In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 40, no 1, p. 89-95Article in journal (Refereed)
  • 3711.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Evaluating life events and chronic stressors in relation to health: Stressors and health in clinical work2012In: Psychosomatic assessment: Strategies to improve clinical practice / [ed] G.A. Fava, N. Sonino, T.N. Wise, Karger , 2012, p. 58-71Chapter in book (Refereed)
    Abstract [en]

    Despite the fact that there is an extensive scientific literature regarding the importance of exposure to psychosocial stressors, the assessment of such stressors is often neglected in clinical work. The present review summarizes the scientific literature on critical life changes and work-related stressors. Particular emphasis has been on somatic outcomes and physiological processes that have been shown to be affected by exposure to stressors. Although the relationships are highly complex, it could be concluded that exposure to stressors may often determine the onset of many illnesses. Standardized well-functioning assessment instruments that could be used in clinical practice exist and should be used.

  • 3712.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Flexibility at Work in Relation to Employee Health2010In: International Handbook of Work and Health Psychology, 3rd Edition / [ed] Cooper L C, Campbell Quick J, Schabracq J M, Wiley-Blackwell , 2010, 3, p. 251-267Chapter in book (Other academic)
  • 3713.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Growing evidence supports the positive impact of music on child health2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 10, p. 1119-1120Article in journal (Other academic)
  • 3714.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    How Does Music Translate Itself Biologically in a Public Health Context?2018In: Music and Public Health: A Nordic Perspective / [ed] Lars Ole Bonde, Töres Theorell, Cham, Schweiz: Springer, 2018, p. 71-84Chapter in book (Refereed)
    Abstract [en]

    This chapter illustrates how researchers reflect on links between music and public health. Music enters the brain in a different way than do conversations based on words, and since the brain tends to react more directly and rapidly to music, this may sometimes create a basis for surprise and unexpected reorientation in life.

    Specific emotions induced by different types of music experiences correspond to various combinations of psychophysiological states (dilated or constricted arteries, increased or decreased variation in heart rate, accelerated or decelerated pulse, elevated or lowered blood pressure, increased or decreased sweating, etc.). In addition, the body adapts its hormones and its immune system to the musical experiences.

    Experiments with school children have shown that musical collective experiences (having fun with music together and making pupils collaborate with one another) can contribute to an improved calmer social environment possibly favouring, for instance, learning at school.

    Modern recording techniques have made it possible to record immediate online physiology during musical experiences, for instance, in the gastrointestinal system, in breathing patterns and in the arteries as well as physiological states during intense experiences such as flow and goose skin.

    Music in the gym, during choir singing and in clinical applications such as choir singing for patients with chronic respiratory disease is discussed in the chapter. One conclusion is that there is extensive knowledge about immediate reactions during music experiences but that long-term biological consequences of repeated musical experiences (such as choir singing or instrument playing in groups once a week for years) have been understudied although such research is beginning to emerge.

  • 3715.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Introducation: After 30 years with the demand-control-support model – hos is it used today?2008In: SJWEH Suppl 2008;(6):3-5Article in journal (Other academic)
  • 3716.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kulturella aktiviteter, social förhållanden och folkhälsa2012In: Den orättvisa hälsan: om socioekonomiska skillnader i hälsa och livslängd / [ed] Mikael Rostila och Susanna Toivanen, Stockholm: Liber, 2012, 1, p. 221-239Chapter in book (Other academic)
  • 3717.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    [Many physicians feel distressed after committing medical errors.: Two thirds worried about committing new errors, according to a North American survey]2008In: Lakartidningen, ISSN 0023-7205, Vol. 105, no 9, p. 610-1Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Sömnproblem, depression, rädsla att begå nya fel och känslan av att ha dragit skam över läkaryrket är vanliga efter medicinska felhandlingar.

    Över hälften av en representativ grupp av kururger, medicinare och barnmedicinare i USA och Kanada säger att de upplevt konsekvenserna av att begå en allvarlig medicinsk felhandling,

    Hur är det i Sverige? En del undersökninngar har gjorts, men vi skulle behöva veta ännu mera.

  • 3718.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Noter om musik och hälsa2009Book (Other (popular science, discussion, etc.))
    Abstract [en]

    Kan hälsan förbättras av att vi älskar musiken? Kan musiken påverka vår stresskänslighet, och är det rent av så att vi kan få kraft att ta tag i våra problem genom musikens hjälp?Töres Theorell undersöker biologiska och sociala effekter av musiken i vården, av att sjunga och av att sjunga i kör, av att musicera med barn liksom hur yrkesmusiker har det på jobbet. Vid sidan av sin långa och välkända gärning som stressforskare har Töres Theorell haft musiken som livsinnehåll, såväl i forskningsprojekt som privat. Han har frågat sig vilken betydelse musiken kan ha för människans hälsa och han har själv alltid sjungit och spelat fiol.

  • 3719. Theorell, Töres
    Om körsångens betydelse för hälsan – en biologisk betraktelse2011In: Bosse och hans flickkörsvärld: om Bo Johansson och Adolf Fredriks Flickkör : ett försök till förklaring av en legendarisk körledar- och musikfostrargärning / [ed] Byström Per-Åke, Adolf fredriks flickkör , 2011, p. 149-153Chapter in book (Other academic)
  • 3720.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    On Basic Physiological Stress Mechanisms in Men and Women: Gender Observations on Catecholamines, Cortisol and Blood Pressure Monitored in Daily Life2014In: Psychosocial Stress and Cardiovascular Disease in Women: Concepts, Findings, Future Perspectives / [ed] Kristina Orth-Gomér, Heidelberg: Springer, 2014, p. 89-105Chapter in book (Other academic)
  • 3721.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Physiological links between cultural activities and public health2015In: Oxford Textbook of Creative Arts, Health and Wellbeing: International perspectives on practice, policy and research / [ed] Stephen Clift, Paul M. Camic, Oxford: Oxford University Press, 2015, p. 65-72Chapter in book (Refereed)
  • 3722. Theorell, Töres
    Psychobiological factors in environmental health2011In: Encyclopedia of Environmental Health / [ed] Nriagu JO, Elsevier , 2011, p. 694-701Chapter in book (Refereed)
  • 3723.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Psychological health effects of musical experiences: theories, studies and reflections in music health science2014Book (Refereed)
  • 3724.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Psychosocial factors in research on work conditions and health in Sweden.2007In: Scand J Work Environ Health, ISSN 0355-3140, Vol. 33 Suppl 1, p. 20-6Article, review/survey (Other (popular science, discussion, etc.))
  • 3725.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Psykofysiologiska samband mellan kulturella aktiviteter och folkhälsa2015In: Kultur & folkhälsa: antologi om forskning och praktik / [ed] Eva Bojner Horwitz, Christer Hogstedt, Pelle Wistén, Töres Theorell, Stockholm: Tolvnitton förlag , 2015, p. 49-79Chapter in book (Other academic)
  • 3726.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Psykosociala faktorer – vad är det?2012In: Psykosocial miljö och stress / [ed] Töres Theorell, Lund: Studentlitteratur , 2012, 2, p. 15-75Chapter in book (Other academic)
  • 3727.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Reward, flow and control at work2016In: Work Stress and Health in a Globalized Economy: The model of effort-reward imbalance / [ed] Johannes Siegrist, Morten Wahrendorf, Springer Publishing Company, 2016, p. 315-332Chapter in book (Refereed)
  • 3728.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Stress reduction programmes for the workplace2012In: Handbook of occupational health and wellness / [ed] Robert J. Gatchel, Izabela Z. Schultz, Boston: Springer, 2012, p. 383-403Chapter in book (Other academic)
  • 3729.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Stressens endokrinologi2015In: Endokrinologi / [ed] Sigbritt Werner, Stockholm: Liber, 2015, 3, p. 389-394Chapter in book (Other academic)
  • 3730.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Andreeva, Elena
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hanson Magnusson, Linda
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Oxenstierna, Gabriel
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Restructuring and Employee Health2009In: Knowledge-Based Technologies and OR Methodologies for Strategic Decisions of Substainable Development, 2009, p. 331-336Conference paper (Refereed)
  • 3731.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Bernin, Peggy
    Nyberg, Anna
    Oxenstierna, Gabriel
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Romanowska, Julia
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Leadership and Employee Health: A Challenge in the Contemporary Workplace2010In: Contemporary Occupational Health Psychology: Global Perspectives on Research and Practice, Volume 1 / [ed] Jonathan Houdmont, Stavroula Leka, Wiley-blackwell , 2010, 1, p. 46-58Chapter in book (Other academic)
  • 3732.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden .
    De Manzano, Örjan
    Lennartsson, Anna-Karin
    Pedersen, Nancy L.
    Ullén, Fredrik
    Self-reported psychological demands, skill discretion and decision authority at work: A twin study2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 4, p. 354-360Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To examine the contribution of genetic factors to self-reported psychological demands (PD), skill discretion (SD) and decision authority (DA) and the possible importance of such influence on the association between these work variables and depressive symptoms.

    METHODS: 11,543 participants aged 27-54 in the Swedish Twin Registry participated in a web survey. First of all, in multiple regressions, phenotypic associations between each one of the three work environment variables and depressive symptoms were analysed. Secondly, by means of classical twin analysis, the genetic contribution to PD, SD and DA was assessed. After this, cross-twin cross-trait correlations were computed between PD, SD and DA, on the one hand, and depressive symptom score, on the other hand.

    RESULTS: The genetic contribution to self-reported PD, DS and DA ranged from 18% for decision authority to 30% for skill discretion. Cross-twin cross-trait correlations were very weak (r values < .1) and non-significant for dizygotic twins, and we lacked power to analyse the genetic architecture of the phenotypic associations using bivariate twin modelling. However, substantial genetic contribution to these associations seems unlikely.

    CONCLUSIONS: Genetic contributions to the self-reported work environment scores were 18-30%.

  • 3733.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Hammarström, Anne
    Aronsson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Bendz, Lil Träskman
    Grape, Tom
    Hogstedt, Christer
    Marteinsdottir, Ina
    Skoog, Ingmar
    Hall, Charlotte
    A systematic review including meta-analysis of work environment and depressive symptoms2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 1, p. 738-Article, review/survey (Refereed)
    Abstract [en]

    Background: Depressive symptoms are potential outcomes of poorly functioning work environments. Such symptoms are frequent and cause considerable suffering for the employees as well as financial loss for the employers. Accordingly good prospective studies of psychosocial working conditions and depressive symptoms are valuable. Scientific reviews of such studies have pointed at methodological difficulties but still established a few job risk factors. Those reviews were published some years ago. There is need for an updated systematic review using the GRADE system. In addition, gender related questions have been insufficiently reviewed. Method: Inclusion criteria for the studies published 1990 to June 2013: 1. European and English speaking countries. 2. Quantified results describing the relationship between exposure (psychosocial or physical/chemical) and outcome (standardized questionnaire assessment of depressive symptoms or interview-based clinical depression). 3. Prospective or comparable case-control design with at least 100 participants. 4. Assessments of exposure (working conditions) and outcome at baseline and outcome (depressive symptoms) once again after follow-up 1-5 years later. 5. Adjustment for age and adjustment or stratification for gender. Studies filling inclusion criteria were subjected to assessment of 1.) relevance and 2.) quality using predefined criteria. Systematic review of the evidence was made using the GRADE system. When applicable, meta-analysis of the magnitude of associations was made. Consistency of findings was examined for a number of possible confounders and publication bias was discussed. Results: Fifty-nine articles of high or medium high scientific quality were included. Moderately strong evidence (grade three out of four) was found for job strain (high psychological demands and low decision latitude), low decision latitude and bullying having significant impact on development of depressive symptoms. Limited evidence (grade two) was shown for psychological demands, effort reward imbalance, low support, unfavorable social climate, lack of work justice, conflicts, limited skill discretion, job insecurity and long working hours. There was no differential gender effect of adverse job conditions on depressive symptoms Conclusion: There is substantial empirical evidence that employees, both men and women, who report lack of decision latitude, job strain and bullying, will experience increasing depressive symptoms over time. These conditions are amenable to organizational interventions.

  • 3734.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Harmat, László
    Eriksson, Helene
    Ullén, Fredrik
    Talking about childhood music: A twin study2018In: The Arts and The Brain: Psychology and Physiology Beyond Pleasure / [ed] Julia F. Christensen, Antoni Gomila, Amsterdam: Elsevier, 2018, Vol. 237, p. 279-289Chapter in book (Refereed)
    Abstract [en]

    To what extent do childhood experiences of music practice influence thinking about music later in life? In this contribution, 27-54-year-old monozygotic twins discordant with regard to piano playing in life were interviewed about music experiences during childhood and adult years. Recordings of heart rate variability were performed continuously during the interviews which were done separately with playing and nonplaying cotwins. Random factors had determined whether the twin chose to play or not. The rationale behind using monozygotic twins was that this offered a possibility to account totally for genetic influence. The physiological recordings in general showed small intrapair differences. However, during the initial discussion about how the difference arose in piano practice during childhood, the nonplaying twin used more time and showed evidence of a stronger sympathetic activation than the cotwin. These findings are discussed against the background of music's importance in childhood.

  • 3735.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hartzell, Margaretha
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Näslund, Stina
    Brief report: A note on designing evaluations of health effects of cultural activities at work2009In: Arts & Health, ISSN 1753-3023 (electronic) 1753-3015 (paper) , Vol. 1, no 1, p. 89-92Article in journal (Refereed)
    Abstract [en]

    The present pilot study was performed as part of the preparation for a larger controlled evaluation of health effects of a work site-based cultural programme. Forty participants, 10 in each of 4 work sites, were exposed to cultural events that took place once a week during a 3-month period. Standardised health questionnaires were distributed and blood samples collected before and after the three-month period. Visual analogue scales were distributed before and after the event, and from those average emotional effects for each individual were calculated. The individuals who had the highest average emotional effects were those who had the most pronounced deterioration in social support at work - a possible jealousy effect. The potentially most important effect to be evaluated is probably a collective beneficial “climate change” effect which cannot be studied if participants are sparsely distributed in the work site.

  • 3736.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Jood, Katarina
    Slunga Järvholm, Lisbeth
    Vingård, Eva
    Perk, Joep
    Östergren, Per Olov
    Hall, Charlotte
    A systematic review of studies in the contributions of the work environment to ischaemic heart disease development2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 3, p. 470-477Article in journal (Refereed)
    Abstract [en]

    Background: There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system. Methods: Inclusion criteria: (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed. Results: Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence. Conclusions: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD.

  • 3737.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kreutz, Gunther
    Epidemiological studies of the relationship between musical experiences and public health2012In: Music, Health & Wellbeing / [ed] MacDonald, R, Kreutz, G and Mitchell, L, Oxford: Oxford University Press, 2012, p. 424-435Chapter in book (Refereed)
  • 3738.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lennartsson, A. -K
    Madison, G.
    Mosing, M. A.
    Ullén, F.
    Predictors of continued playing or singing - from childhood and adolescence to adult years2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 3, p. 274-284Article in journal (Refereed)
    Abstract [en]

    Aim: Many individuals play an instrument or sing during childhood, but they often stop later in life. This study surveyed adults representative of the Swedish population about musical activities during childhood.

    Methods: We asked 3820 adults (65% women) aged from 27 to 54 from the Swedish Twin Registry, who took extra music lessons to those provided at school, to fill in a web-based questionnaire. Factors analysed were the age they started studying music, the instrument they played, kind of teaching, institution and educational content, number of lessons and perceived characteristics of the lessons, the music environment during their childhood years and their preferred music genre. All variables were dichotomised.

    Results: Factors strongly associated with continued playing or singing were male sex, young starting age, cultural family background, self-selected instrument, attending music classes and more than once a week, church-related or private education, pop, rock or classical music, playing by ear and improvisation.

    Conclusion: Several significant predictors determined whether a child continued to sing or play an instrument as an adult and many could be externally influenced, such as starting at a young age, taking music classes more than once a week, improvisation and the type of music they played.

  • 3739.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lingham, Joseph
    Self-selected "favourite" stimulativ and sedative music listening - hoe does familiar and preferred music listening affect the body?2009In: Nordic journal of Music Therapy, ISSN 0809-8131, Vol. 18, no 2, p. 150-166Article in journal (Refereed)
  • 3740.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Nyberg, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Romanowska, Julia
    Om ledarskap och de anställdas hälsa2013In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 90, no 6, p. 780-792Article in journal (Refereed)
    Abstract [sv]

    Författarna diskuterar med utgångspunkt från sin egen forskning på vilket sätt ledaren på en arbetsplats kan påverka de anställdas hälsa och vilka faktorer som enligt forskningen tycks har störst betydelse. Passiva och auktoritära ledarstilar visar sig i epidemiologiska studier ha samband med dålig psykisk hälsa hos de anställda, särskilt upplevelse av mobbning, depressiva symptom, känslomässig utmattning och ökad sjukskrivning. I en prospektiv studie har man även visat samband mellan vad den anställde upplever som gott ledarskap (bedömt med en standardiserad skala) och minskad hjärtinfarktrisk hos de anställda under en uppföljningstid. I ett par kontrollerade interventionsstudier har det visat sig möjligt att påverka chefsbeteende så att hälsoeffekter för de anställda kan påvisas. Det är dock viktigt att utveckla den typ av interventioner som används. Om man vill öka känsla av ansvar och engagemang (med minskad låt-gå-mentalitet, ”laissez-faire”) hos chefen i relation till de anställda räcker förmodligen inte de pedagogiska metoder som för närvarande används i chefsutvecklingsprogram. Vi föreslår att man utnyttjar den emotionella och etiska potential att öka engagemang som finns i konstnärliga upplevelser.

  • 3741.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Osika, Walter
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Bojner Horwitz, Eva
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Is cultural activity at work related to mental health in employees?2013In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 86, no 3, p. 281-288Article in journal (Refereed)
    Abstract [en]

    Objective: To examine relationships between work-based cultural activities and mental employee health in working Swedes.

    Hypothesis: A positive relationship between frequent cultural activity at work and good employee health was expected.

    Research design: Random sample of working Swedish men and women in three waves, 2006, 2008 and 2010, on average 60 % participation rate.

    Methods: A postal questionnaire with questions about cultural activities organised for employees and about emotional exhaustion (Maslach) and depressive symptoms (short form of SCL). Employee assessments of "non-listening manager" and work environment ("psychological demands" and "decision latitude") as well as socioeconomic variables were covariates. Cross-sectional analyses for each study year as well as prospective analyses for 2006-2008 and 2008-2010 were performed.

    Main outcome and results: Lower frequency of cultural activities at work during the period of high unemployment. The effects of relationships with emotional exhaustion were more significant than those with depressive symptoms. The associations were attenuated when adjustments were made for manager function (does your manager listen?) and demand/control. Associations were more pronounced during the period with low unemployment and high cultural activity at work (2008). In a prospective analysis, cultural activity at work in 2008 had an independent statistically significant "protective" effect on emotional exhaustion in 2010. No corresponding such association was found between 2006 and 2008.

    Conclusions: Cultural activities at work vary according to business cycle and have a statistical association with mental employee health, particularly with emotional exhaustion.

    Implications for future research: There are particularly pronounced statistical protective effects of frequent cultural activity at work on likelihood of emotional exhaustion among employees.

  • 3742.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Skjei Knutsen, Margunn
    Bojner Horwitz, Eva
    Wikström, Britt-Maj
    Culture and public health activities in Sweden and Norway2015In: Oxford Textbook of Creative Arts, Health and Wellbeing: International perspectives on practice, policy and research / [ed] Stephen Clift, Paul M. Camic, Oxford: Oxford University Press, 2015, p. 171-177Chapter in book (Refereed)
  • 3743.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ullén, Fredrik
    Epidemiological studies of the relationship between cultural experiences and public health2015In: Oxford Textbook of Creative Arts, Health and Wellbeing: International perspectives on practice, policy and research / [ed] Stephen Clift, Paul M. Camic, Oxford: Oxford University Press, 2015, p. 55-63Chapter in book (Refereed)
  • 3744.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ullén, Fredrik
    Kultur och folkhälsa – vilka samband ser vi?2015In: Kultur & folkhälsa: antologi om forskning och praktik / [ed] Eva Bojner Horwitz, Christer Hogstedt, Pelle Wistén, Töres Theorell, Stockholm: Tolvnitton förlag , 2015, p. 15-40Chapter in book (Other academic)
  • 3745.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Ullén, Fredrik
    Music Practice and Emotion Handling2018In: Music and Public Health: A Nordic Perspective / [ed] Lars Ole Bonde, Töres Theorell, Cham, Schweiz: Springer, 2018, p. 55-67Chapter in book (Refereed)
    Abstract [en]

    Our main question is: is there any correlation between a life with music on one hand and ability to handle emotions on the other hand? In order to illuminate this question, we have performed a series of studies on the Swedish Twin Registry.

    Our studies confirmed the expectation that a high level of musical activities throughout life, particularly if there has been ensemble playing or singing, was associated with good ability to handle emotions. We also found that the association between music practice and emotional skill was strongly influenced by genetic factors.

    We found that there were statistically significant independent relationships between artistic achievement in general (writing, music, visual arts, theatre and dance) and the ability to handle emotions and those concomitant achievements in several forms of art added to one another from this point of view.

    In separated qualitative interviews with monozygotic twin pairs who had had lifelong discordance with regard to music activity (piano playing), we showed that the discordance had arisen because of randomly occurring life conditions but also that the musically inactive twin talked longer and showed more evidence of sympathetic arousal during talk about childhood music experiences (uneasiness?) than the musically active partner did. As expected, the musically active twin had more diverse and detailed descriptions of music experiences that were related to flow.

    The relationship was examined between the ability to handle emotions and objective measures of musicality (rhythm, melody and pitch) and likelihood of working in creative occupations. General intelligence was correlated with all three aspects of musicality. However, regardless of education, age and general intelligence, among men a high pitch score (good ability to differentiate high and low notes) was significantly associated with high likelihood of working in a creative occupation. Among women, the corresponding analysis showed that good ability to handle emotions (but not musicality) was associated with working in a creative occupation.

  • 3746.
    Theorell, Töres
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Ullén, Fredrik
    Om känslor och musik. Studier på tvillingar2018In: Musikens makt / [ed] Jenny Björkman, Arne Jarrick, Göteborg: Makadam Förlag, 2018, p. 33-49Chapter in book (Other academic)
    Abstract [sv]

    Kapitlet belyser de komplexa sambanden mellan förmåga att hantera känslor, musikalitet och uppväxtförhållanden. Vad är det som gör att ett barn som får extra musikundervisning fortsätter att utöva musik som vuxen? Hur mycket av sambandet mellan musikträning och förmåga att hantera känslor beror på arv? Finns det något samband mellan musikalitet och att hamna i ett kreativt (icke musikallist) jobb?

  • 3747. Theorell-Haglöw, Jenny
    et al.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Schwarz, Johanna F. A.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lindberg, Eva
    Predictors for Development of Excessive Daytime Sleepiness in Women: A Population-Based 10-Year Follow-Up2015In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 38, no 12, p. 1995-2002Article in journal (Refereed)
    Abstract [en]

    Study Objectives:

    To analyze predictors of excessive daytime sleepiness (EDS) and to analyze how changes within risk factors over time predict incident EDS in women.

    Design:

    Population-based prospective study.

    Setting:

    General population of the City of Uppsala, Sweden.

    Participants:

    From a random, general population sample of 7,051 women from the Sleep and HEalth in women (“SHE”) cohort, 4,322 women without EDS at baseline were followed up after 10 y.

    Interventions:

    N/A.

    Measurements and Results:

    At baseline and follow-up, women answered a questionnaire on sleeping habits, somatic disease, obesity, insomnia, anxiety and depression, lifestyle, and social factors. The risk of incident EDS was analyzed from changes over time in risk factors using logistic regression modeling. Of the women, EDS developed in 7.9%. Incident: insomnia (adjusted odds ratio = 5.01; 95% confidence interval 3.63–6.92), anxiety and/or depression (3.34; 2.22–5.02), somatic disease (1.73; 1.17–2.55), obesity (1.91; 1.14–2.57), snoring (1.91; 1.17–3.10) and smoking (4.31; 1.95–9.54) were all independent risk factors for the development of EDS. In addition, persistent: insomnia (4.44; 2.97–6.65) and anxiety and/or depression (4.91; 3.17–7.62) increased the risk of developing EDS. Apart from incident: snoring and obesity, similar results were obtained when only including women without somatic disease in the analyses.

    Conclusion:

    Insomnia, anxiety and/or depression, and smoking were the most important factors for predicting incident excessive daytime sleepiness (EDS) and, in addition, somatic disease, obesity, and snoring predicted EDS. It is important not only to treat these conditions but also to inform women of the importance of a healthy lifestyle in order to prevent and reduce EDS in women.

  • 3748. Thern, Emelie
    et al.
    de Munter, Jeroen
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Rasmussen, Finn
    Long-term effects of youth unemployment on mental health: does an economic crisis make a difference?2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 4, p. 344-349Article in journal (Refereed)
    Abstract [en]

    Background Ill health is a risk factor and a consequence of unemployment, which might vary depending on the national rate of unemployment. We investigated the long-term effect of youth unemployment on mental health and explored the possible interaction during periods of high (economic crisis) and low (non-crisis) unemployment rates. Methods A register-linked population-based cohort study was conducted including individuals aged 1724 years. The crisis cohort (n= 6410) took part in the Labour Force Survey during the economic crisis (1991-1994) in Sweden and the non-crisis cohort (n= 8162) took part in the same survey before the crisis (1983-1986). Follow-up was 19 years. Adjusted HRs and 95% CIs for an inpatient care discharge mental diagnosis with employed people as the reference group were calculated by Cox regressions models. Results In fully adjusted models, <3 months (HR: 1.69; 95% CI 1.14 to 2.49), 3-6 months (2.19; 1.43 to 3.37) and > 6 months (2.70; 1.71 to 4.28) of unemployment were associated with increased risks of getting a mental diagnosis in the crisis cohort. In the non-crisis cohort the risks were: 1.92; 1.40 to 2.63, 2.60; 1.72 to 3.94 and 3.33; 2.00 to 5.57, respectively. No interactions between labour force status and level of unemployment were found. Conclusions Youth unemployment is related to mental health problems, independent of the overall national rate of unemployment, which is important as the youth unemployment rates are currently at stable high level.

  • 3749. Thern, Emelie
    et al.
    de Munter, Jeroen
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Smith, George Davey
    Ramstedt, Mats
    Tynelius, Per
    Rasmussen, Finn
    Effects of increased alcohol availability during adolescence on the risk of all-cause and cause-specific disability pension: a natural experiment2017In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 112, no 6, p. 1004-1012Article in journal (Refereed)
    Abstract [en]

    Aim To test if being exposed to increased alcohol availability during adolescence is associated with an increased risk of receiving disability pension due to all-cause, alcohol use disorders and mental disorders. Design Register-based population-based study using a natural experiment setting, the alcohol policy change in Sweden (1967-68), with increased access to strong beer in a narrow time window and geographical area. The individuals exposed to the policy change were compared with non-exposed individuals living in the rest of Sweden, excluding a border area. Setting Sweden. Participants A total of 518810 individuals (70761 in the intervention group; 448049 in the control group) born 1948-1953, aged 14-20 years during the policy change. Measurements Date and diagnosis of the outcome variable of disability pension due to all-cause, alcohol use disorders and mental disorders were obtained from the Swedish National Social Insurance Agency database from 1971 to 2013. Individual and family level socio-demographic and health-related covariates, as well as a regional level covariate, were included. Findings Compared with the control group, adolescents exposed to the alcohol policy change were at an increased risk of receiving disability pension due to all-causes [hazard ratio (HR)=1.09, 95% confidence interval (CI)=1.07-1.11], alcohol use disorders (HR=1.17, 95% CI=1.05-1.30) and mental disorders (HR=1.19, 95% CI=1.15-1.23). Conclusion In Sweden, a natural experiment with a 43-year follow-up suggests that exposure to increased alcohol availability during adolescence is associated with an increased risk of receiving a disability pension due to all-cause, alcohol use disorder and mental disorder diagnoses.

  • 3750. Thern, Emelie
    et al.
    Jia, Ting
    Willmer, Mikaela
    de Munter, Jeroen
    Norström, Thor
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Ramstedt, Mats
    Smith, George Davey
    Tynelius, Per
    Rasmussen, Finn
    No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades: a natural experiment2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 11, p. 1072-1077Article in journal (Refereed)
    Abstract [en]

    Background A strict high legal age limit for alcohol purchases decreases adolescents' access to alcohol, but little is known about long-term health effects. The aim was to estimate the effect of increased alcohol availability during adolescence on alcohol-related morbidity and mortality. Methods A nationwide register-based study using data from a natural experiment setting. In two regions of Sweden, strong beer (4.5%-5.6% alcohol by volume) became temporarily available for purchase in grocery stores for individuals 16 years or older (instead of 21) in 1967/1968. The intervention group was defined as all individuals living in the intervention area when they were 14-20 years old (n=72 110). The remaining Swedish counties excluding bordering counties, without the policy change, were used as the control group (n=456 224). The outcomes of alcohol-related morbidity and mortality were collected from the Hospital Discharge Register and Cause of Death Register, in which average follow-up times were 38 years and 41 years, respectively. HRs with 95% CIs were obtained by Cox regression analysis. Results In the fully adjusted model, no clear evidence of an association between increased alcohol availability during adolescence and alcohol-related morbidity (HR: 0.99, 95% CI 0.96 to 1.02) or mortality (HR: 1.02, 95% CI 0.95 to 1.10) was found. Conclusion The initial elevated risk of alcohol-related morbidity and mortality later in life among adolescents exposed to increased access to strong beer in Sweden vanished when a regional measure population density of locality was included in the model, which is important to consider in future research.

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