Mid Sweden University

A steep increase of small papillary thyroid cancers (sPTCs) has been observed globally. A major risk factor for developing PTC is ionizing radiation. The aim of this study is to investigate the spatial distribution of sPTC in Sweden and the extent to which prevalence is correlated to gamma radiation levels (Caesium-137 (Cs-137), Thorium-232 (Th-232), Uranium-238 (U-238) and Potassium-40 (K-40)) using multiple geospatial and geostatistical methods. The prevalence of metastatic sPTC was associated with significantly higher levels of Gamma radiation from Th-232, U-238 and K-40. The association is, however, inconsistent and the prevalence is higher in densely populated areas. The results clearly indicate that sPTC has causative factors that are neither evenly distributed among the population, nor geographically, calling for further studies with bigger cohorts. Environmental factors are believed to play a major role in the pathogenesis of the disease.

Bakgrund: I flera kommuner har socialtjänsten under lång tid haft hög personalomsättning bland socialsekreterare och tillika stora svårigheter att rekrytera dessa. Mot den bakgrunden strävar alltfler kommuner efter att bli attraktiva arbetsgivare genom att erbjuda goda arbetsvillkor. Några kommuner har prövat olika arbetstidsmodeller där den arbetsplatsförlagda arbetstiden förkortas. Som en del av kompetensförsörjningsstrategin beslutade Örnsköldsviks kommun att under åren 2019 och 2020 pröva att förkorta den arbetsplatsförlagda arbetstiden med 45 minuter per dag i ”Projekt arbetstid” bland myndighetsutövande personal inom avdelningen för social utredning.

Metod: I utvärderingen besvarade all personal som ingick i projektet en enkät kring arbetsmiljö och hälsa. Enkäten skickades ut inför projektstart (2019) och ett år in i projektet (2020). Däremellan genomfördes individuella intervjuer med enhetschefer och fokusgruppsintervjuer med personalen. Intervjuerna med personalen skedde enhetsvis.

Resultat: Projektets huvudmål var att främja möjligheter till återhämtning och det upplever majoriteten av personalen att de har fått. En faktor som särskilt lyfts fram är flexibilitet, att personalen kan ta ut tid för återhämtning vid behov under veckan. Resultatet visar också positiva förändringar rörande personalens hälsa. Det skedde en generell effektivisering av mötesrutiner och teknikanvändning, samt utveckling av mer kollektiva arbetssätt på vissa enheter och en förändrad syn och hantering av arbetstiden hos enskilda medarbetare. När det gäller arbetsmiljön framkom en generellt positiv bild med goda utvecklingsmöjligheter och en stark social gemenskap, men även förekomst av potentiella riskfaktorer som högt arbetstempo och lågt inflytande. Projektet bidrog till att en större andel av personalen började arbeta heltid. Faktisk bemanning och förekomsten av organisatoriska förändringar i övrigt påverkade personalens möjligheter att förändra arbetssätt, arbetsmiljö och ta ut återhämtningstid. Avslutningsvis vill vi påminna om att utvärderingen genomfördes innan verksamhetens organisering anpassades till pandemins utbrott.

Objective Health effects of different physical activity domains (ie, during leisure time, work and transport) are generally considered positive. Using Active Worker consortium data, we assessed independent associations of occupational and leisure-time physical activity (OPA and LTPA) with all-cause mortality.Design Two-stage individual participant data meta-analysis.Data source Published and unpublished cohort study data.Eligibility criteria Working participants aged 18-65 years.Methods After data harmonisation, we assessed associations of OPA and LTPA with all-cause mortality. In stage 1, we analysed data from each study separately using Cox survival regression, and in stage 2, we pooled individual study findings with random-effects modelling.Results In 22 studies with up to 590 497 participants from 11 countries, during a mean follow-up of 23.1 (SD: 6.8) years, 99 743 (16%) participants died. Adjusted for LTPA, body mass index, age, smoking and education level, summary (ie, stage 2) hazard ration (HRs) and 95% confidence interval (95% CI) for low, moderate and high OPA among men (n=2 96 134) were 1.01 (0.99 to 1.03), 1.05 (1.01 to 1.10) and 1.12 (1.03 to 1.23), respectively. For women (n=2 94 364), HRs (95% CI) were 0.98 (0.92 to 1.04), 0.96 (0.92 to 1.00) and 0.97 (0.86 to 1.10), respectively. In contrast, higher levels of LTPA were inversely associated with mortality for both genders. For example, for women HR for low, moderate and high compared with sedentary LTPA were 0.85 (0.81 to 0.89), 0.78 (0.74 to 0.81) and 0.75 (0.65 to 0.88), respectively. Effects were attenuated when adjusting for income (although data on income were available from only 9 and 6 studies, for men and women, respectively).Conclusion Our findings indicate that OPA may not result in the same beneficial health effects as LTPA.

Research in the field of occupational health often uses a risk factor approach which has been criticized by feminist researchers for not considering the combination of many different variables that are at play simultaneously. To overcome this shortcoming this study aims to identify patterns of gender equality at workplaces and to investigate how these patterns are associated with psychological distress. Questionnaire data from the Northern Swedish Cohort (n = 715) have been analysed and supplemented with register data about the participants' workplaces. The register data were used to create gender equality indicators of women/men ratios of number of employees, educational level, salary and parental leave. Cluster analysis was used to identify patterns of gender equality at the workplaces. Differences in psychological distress between the clusters were analysed by chi-square test and logistic regression analyses, adjusting for individual socio-demographics and previous psychological distress. The cluster analysis resulted in six distinctive clusters with different patterns of gender equality at the workplaces that were associated to psychological distress for women but not for men. For women the highest odds of psychological distress was found on traditionally gender unequal workplaces. The lowest overall occurrence of psychological distress as well as same occurrence for women and men was found on the most gender equal workplaces. The results from this study support the convergence hypothesis as gender equality at the workplace does not only relate to better mental health for women, but also more similar occurrence of mental ill-health between women and men. This study highlights the importance of utilizing a multidimensional view of gender equality to understand its association to health outcomes. Health policies need to consider gender equality at the workplace level as a social determinant of health that is of importance for reducing differences in health outcomes for women and men. © 2013 Elwér et al.

While a significant number of employees want a hybrid workplace solution that combines onsite and remote work, many employers require their employees back to the conventional office. This discrepancy can partly depend on the prevailing knowledge gap regarding success factors for performance and work-life balance (WLB) in the hybrid work context. To fill this knowledge gap, we used a reflexive thematic analysis to explore the suggestions of success factors for collaboration, work-related health, and WLB in 33 hybrid workers. The success factors suggested by our participants were formed into four themes: (i) Combining onsite and remote work environments supports work effectiveness, (ii) Socialization and collaboration onsite and remotely promotes work engagement, (iii) Suitable ICT-solutions, digital maturity, and structured communication promote work engagement and effectiveness, and (iv) Workplace flexibility, empowerment, and personalized strategies promote work-related health and WLB. Overall, our results indicate that employees find that the hybrid work model can be optimal since it overcomes the shortcomings of onsite and remote work environments, respectively. Our results also suggest that a sustainable hybrid work-life can be achieved through a combination of common strategies at the organizational level and individual strategies at the personal level. 

The research was carried out into the changes within psychic and immune domains ofthe Russian Nenets people migrating from the traditional northern habitat (tundra) to urbanenvironment. It is noted that in the process of significantly changing lifestyle supposedlysingle ethnic group can be clearly sub-divided according to the differences in adaptationdynamics. This division reflects sociological differences and is connected to the psychoimmunologicalaspects. Thus, with the adaptation of forest Nenets to the new conditions ofexistence (from the tundra to the urban centers), we found a division of a whole ethnic groupinto two groups according to a social attribute, which is fixed at the psychophysiologicallevel. First, psychic and immune domains are not only sharing a number of commonfeatures but also can have deep evolutionary connections and can be governed by similarlaws. Second, the psyche and the immune system show the most important functions andproperties that ensure an effective existence, generalizing the values of adaptation, protectionand vitality into a single structure. Such a concept is closed to “wholeness” and “integrity” showing that the distribution of vital forces or body resources can adjust the condition orcope with the pre-illness or even disease.

Background: Job strain (i.e., high job demands combined with low job control) is a frequently used indicator of harmful work stress, but studies have often used partial versions of the complete multi-item job demands and control scales. Understanding whether the different instruments assess the same underlying concepts has crucial implications for the interpretation of findings across studies, harmonisation of multi-cohort data for pooled analyses, and design of future studies. As part of the ’IPD-Work’ (Individual-participant-data meta-analysis in working populations) consortium, we compared different versions of the demands and control scales available in 17 European cohort studies. Methods. Six of the 17 studies had information on the complete scales and 11 on partial scales. Here, we analyse individual level data from 70 751 participants of the studies which had complete scales (5 demand items, 6 job control items). Results. We found high Pearson correlation coefficients between complete scales of job demands and control relative to scales with at least three items (r > 0.90) and for partial scales with two items only (r = 0.76-0.88). In comparison with scores from the complete scales, the agreement between job strain definitions was very good when only one item was missing in either the demands or the control scale (kappa > 0.80); good for job strain assessed with three demand items and all six control items (kappa > 0.68) and moderate to good when items were missing from both scales (kappa = 0.54-0.76). The sensitivity was > 0.80 when only one item was missing from either scale, decreasing when several items were missing in one or both job strain subscales. Conclusions. Partial job demand and job control scales with at least half of the items of the complete scales, and job strain indices based on one complete and one partial scale, seemed to assess the same underlying concepts as the complete survey instruments. 

Background: Strenuous exercise in sub-zero environments may cause airway injury and exerciseinduced bronchoconstriction (EIB) (1). Atopic disposition is a risk factor for EIB development (2). However, it is currently unknown whether atopic disposition influences the acute respiratory responses to exercise in a sub-zero climate. Aim: To examine whether the respiratory responses to short- and long-duration exercise at -15⁰C differ between atopic and non-atopic subjects. Methods: Eighteen non-asthmatic, endurance-trained volunteers (males/females: 14/4, age: 29.4 ± 5.9 years old, maximal oxygen consumption (V̇O2max): 61.3 ± 8.7 ml/kg/min) were screened for atopy via the Allergy Questionnaire for Athletes (3) and completed two moderate-intensity (60% V̇O2max) environmental chamber running trials at -15⁰C lasting for 30 and 90 min in a randomized cross-over design. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Swedish Ethical Review Authority. Dynamic spirometry (4) was performed at baseline and 15 and 55 min post-exercise to measure forced expiratory volume in 1 sec (FEV1). Venous blood samples collected pre-exercise and 10 and 65 min post-exercise were analysed for serum Clara cell secretory protein (CC16) using an enzyme-linked immunosorbent assay. A respiratory questionnaire (5) was administered before, immediately after and 20 min after exercise to examine the proportion of affirmative responses (‘YES’) to the occurrence of four symptoms (cough, wheezing, chest tightness and hypersecretion of mucus) associated with lower airways. To examine 2- and 3-way interaction effects on the relative change in FEV1 from baseline as well as the CC16 concentration, a 3-factor repeated measures ANOVA and a linear mixed-effects model were employed, respectively. A twoproportion z-test was performed to compare the symptom frequency between the two groups. Analyses entailing multiple comparisons were adjusted with the Benjamini-Hochberg method. Results: Atopy was identified in 10 subjects (56%, 7/3: men/women). There were no significant interaction effects for FEV1 or CC16 concentration (group x trial, FEV1: p = 0.35, CC16: p = 0.50; group x time, FEV1: p = 0.10, CC16: 0.10; group x trial x time, FEV1: p = 0.39, CC16: p = 0.51). Nevertheless, immediately after the 90-min trial, the onset of airway symptoms was significantly more frequent in atopic volunteers than their non-atopic peers (22.5% vs 0%, p < 0.01) with no intergroup differences observed 20 min post-trial. Atopic status did not affect the occurrence of the lower airway symptoms immediately after (10% in atopic vs 0% in non-atopic, p = 0.08) or 20 min after (5% in atopic vs 0% in non-atopic, p = 0.19) the 30-min trial. Conclusion: Atopy is not a major risk for bronchoconstriction when moderate-intensity exercise of either short or long duration is performed in a sub-zero climate by non-asthmatic subjects. Although the extent of bronchial epithelial damage did not differ between the two groups, atopic disposition may transiently elicit more lower airway symptoms after prolonged exercise. Reference 1 :- Hanstock, H.G.; Ainegren, M.; Stenfors, N. "Exercise in Sub-zero Temperatures and Airway Health: Implications for Athletes With Special Focus on Heat-and-Moisture-Exchanging Breathing Devices." Frontiers in Sports and Active Living. 2020, 2: 34. Reference 2 :- Bauza, D.; Silveyra, P. ‘’Asthma, atopy, and exercise: Sex differences in exerciseinduced bronchoconstriction.’’ Experimental Biology and Medicine. 2021, 246, 1400-1409 Reference 3 :- Bonini, M.; Braido, F.; Rasi, G.; Bonini, S.; Baiardini, I.; Del Giacco, S.; Gramiccioni, C.; Manara, M.; Tagliapietra, G.; Scardigno, A.; Sargentini, V.; Brozzi, M. "AQUA : Allergy Questionnaire 67 for Athletes. Development and Validation." Medicine and Science in Sports and Exercise. 2009, 41, 1034-1041 Reference 4 :- Graham, B. L., Steenbruggen, I., Miller, M. R., Barjaktarevic, I. Z., Cooper, B. G., Hall, G. L., Hallstrand, T. S., Kaminsky, D. A., McCarthy, K., McCormack, M. C., Oropez, C. E., Rosenfeld, M., Stanojevic, S., & Swanney, M. P. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2019; 200: E70–88 Reference 5 :- Kennedy, M.D.; Faulhaber, M. "Respiratory Function and Symptoms Post Cold Air Exercise in Female High and Low Ventilation Sport Athletes." Allergy, Asthma & Immunology Research. 2018, 10, 43-51. PC21 Influence of aerobic training on exercise capacity and mitoch

Background: The relationship between work-related stress and alcohol intake is uncertain. In order to add to the thus far inconsistent evidence from relatively small studies, we conducted individual-participant meta-analyses of the association between work-related stress (operationalised as self-reported job strain) and alcohol intake. Methodology and Principal Findings: We analysed cross-sectional data from 12 European studies (n = 142 140) and longitudinal data from four studies (n = 48 646). Job strain and alcohol intake were self-reported. Job strain was analysed as a binary variable (strain vs. no strain). Alcohol intake was harmonised into the following categories: none, moderate (women: 1-14, men: 1-21 drinks/week), intermediate (women: 15-20, men: 22-27 drinks/week) and heavy (women: > 20, men: > 27 drinks/week). Cross-sectional associations were modelled using logistic regression and the results pooled in random effects meta-analyses. Longitudinal associations were examined using mixed effects logistic and modified Poisson regression. Compared to moderate drinkers, non-drinkers and (random effects odds ratio (OR): 1.10, 95% CI: 1.05, 1.14) and heavy drinkers (OR: 1.12, 95% CI: 1.00, 1.26) had higher odds of job strain. Intermediate drinkers, on the other hand, had lower odds of job strain (OR: 0.92, 95% CI: 0.86, 0.99). We found no clear evidence for longitudinal associations between job strain and alcohol intake. Conclusions: Our findings suggest that compared to moderate drinkers, non-drinkers and heavy drinkers are more likely and intermediate drinkers less likely to report work-related stress.

Background: Occupational health hazards and injuries are an alarming concern among traffic police. Occupational injuries affect the physical, social, and mental well-being of police personnel, which has various public health implications. The evaluation of occupational health and safety policies and regulations for the traffic police relies on their occupational exposure and health hazard statistics and assessments. Objective: The purpose of this scoping review is to systematically explore, analyze, and describe relevant findings from all studies conducted on occupational exposure and associated health hazards among traffic police in South Asia. Methods: The scoping review will include studies that assessed occupational exposure prevalence, types, knowledge, predisposing factors, and prevention strategies. Databases like PubMed, Springer Link, EBSCOhost, the Cochrane library, and Google Scholar will be used to obtain both published and unpublished works in the English language. Relevant gray literature, including governmental and international organization reports, will be examined. After removing duplicates and screening titles and abstracts, the full-text analysis will begin. Arksey and O'Malley's methodology framework for scoping reviews will be followed. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, the scoping review will be reported. Two qualified reviewers will independently conduct article screening and data extraction. The extracted data will then be tabulated and accompanied by an explanation to facilitate comprehension. We will extract relevant article results using NVivo (version 10; QSR International) and thematic content analysis. The included articles will be evaluated using the mixed methods appraisal tool (version 2018). Results: The scoping review will provide insight into how occupational health hazards affect traffic police physically and psychologically in South Asia. The theoretical conceptualization of different aspects of the occupational health of traffic police will emphasize future studies in this region, which will inform policy makers to revise their occupational health and safety policies and principles. It will have implications for taking necessary preventive measures in the future to reduce occupational injuries and fatalities resulting from different types of occupational hazards. Conclusions: This scoping review will describe the overview of occupational hazards among South Asian traffic police and will provide insights for policy makers to implement changes and to adapt new strategies. 

Background Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies. Methods We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death. Findings 30 214 (15%) of 197 473 participants reported job strain. In 1•49 million person-years at risk (mean follow-up 7•5 years [SD 1•7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1•23 (95% CI 1•10-1•37). This effect estimate was higher in published (1•43, 1•15-1•77) than unpublished (1•16, 1•02-1•32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1•31, 1•15-1•48) and 5 years (1•30, 1•13-1•50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3•4%. Interpretation Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking. Funding Finnish Work Environment Fund, the Academy of Finland, the Swedish Research Council for Working Life and Social Research, the German Social Accident Insurance, the Danish National Research Centre for the Working Environment, the BUPA Foundation, the Ministry of Social Affairs and Employment, the Medical Research Council, the Wellcome Trust, and the US National Institutes of Health.

Accurate measurement of exposure to noise in the workplace is important for employee health prevention as well as cost implications for employers. Standard ISO 9612 employs an engineering methodology for estimating noise exposure levels including levels of uncertainty. In this procedure some aspects are left to the discretion of the operator. Beginning with preliminary studies on the determination of the measurement intervals for evaluating workers' exposure to noise, this paper proposes an innovative approach to estimating work conditions for bus drivers. Measurement results are analysed and compared to the estimations based on both the ISO 9612 and the continuous acquisition analysis showing the feasibility of the proposal for accurately measuring the exposure to acoustic noise in a typical work situation. 

This study examines diferences in leadership behaviors and in the perceived work environment between older and younger managers in a large Swedish mining company. The leadership behaviors and work environment of young managers in the mining industry will become more important in the future due to the changes taking place in the industry. Such changes include the older generation of managers reaching retirement age, while the industry generally fnds it difcult to recruit a younger generation of employees. Moreover, rapid technology-centered transition, such as the green transition of the mining industry, is underway which may put young managers in particular under pressure. Meanwhile, research on young managers in the mining industry more broadly is sparse. Data for this study was mainly gathered via a questionnaire, complemented by data from interviews. The questionnaire included 48 validated self-rate questions on background variables, social and organizational working conditions, health, and leadership behavior. The survey was answered by 216 managers (response rate: 63%). Interviews were carried out with ten young managers (35 years or younger). The study found no statistically signifcant diferences between younger and older managers with regards to workload, working hours, health, and work satisfaction. We found that older managers rate themselves higher, at a statistically signifcant level, for change-oriented leadership behaviors. However, when age is analyzed together with other variables that are signifcantly diferent between the two groups, only managerial experience and managerial positions show statistically signifcant associations with change-oriented and healthy and efective leadership behaviors. The interviews indicate that the young managers encounter challenges that are related to their experience and training, but few are related to their age. Given the infuence of managerial experience on leadership behaviors, leadership training appears to be an important area of intervention, and conditions must be improved to enable change-oriented leadership among managers in the mining industry, with a greater focus on young managers

To be able to attract, retain and develop talented individuals to managerial positions is important for organizations. Recently, however, there are indications that young professionals are reluctant to accept a leadership role. There is a lack of research exploring the reasons for this reluctance and investigating the working conditions and health of young managers; especially within heavy industries such as mining. The aim of the study is to gain a deeper understanding of the factors affecting the health and sustainability of young managers in the mining industry. A qualitative case study is conducted based on in-depth interviews with 10 managers aged 35 years or younger at a large international mining company in Northern Europe. A content analysis indicated several straining and facilitating aspects of the work situation in terms of maintaining sustainability and good health. The resulting themes are analyzed and discussed through the lens of the Job-demand-control-support (JDCS) model. Perceived stimulation, growth, and development seems to have a facilitating role in promoting sustainability and health, and is one theme that stood out from complete adaptation to the model. The study contributes with insights into how this model can be applied to a specific professional group (young managers) and in a certain context (mining and similar heavy industry). The findings have practical implications for organizations regarding the ability to ensure good, healthy, attractive, and sustainable working conditions for young managers.   

Background: This study aimed to investigate the accuracy and reliability of a free mobile heart rate variability (HRV) application in measuring HRV. Methods: Twelve females and 12 males underwent five-minute simultaneous HRV recording from electrocardiogram (ECG) and chest strap connected to a free mobile HRV application (HRVapp) in a supine position. HRV data from ECG and HRVapp were used to examine accuracy and reliability via relative error and intraclass correlation coefficient respectively. Results: The natural log of the square root of the mean of the sum of the squares of differences between adjacent normal to normal intervals (lnRMSSD) exhibited accuracy and high reliability in HRVapp. Conclusion: lnRMSSD in HRVapp can serve as an alternative, low-cost technology for measurement of autonomic activity.

This study had a twofold objective. First, we aimed to measure the levels of stress symptoms and burnout on the police officers who volunteered for the study. Second, we proposed to examine the effect of COVID-19 exposure and exposure to traumatic experiences in the context of the COVID-19 pandemic on the officers’ mental health.

The National Directorate of the Policia de Segurança Pública (Portuguese Public Security Police) approved this study and was responsible for distributing information about the study and the link to an online questionnaire among their officers. As expected, the levels of burnout, psychological distress, and posttraumatic stress (PTS) were higher than similar professional populations in non-pandemic conditions. Officers with fewer than 11 years of work experience showed fewer symptoms of PTS compared to those with longer work experience, but at the same time, they reported higher levels of burnout. Women revealed higher scores of burnout-disengagement, but no other differences compared to their male colleagues. Officers who were married or living in a partner relationship obtained lower levels of posttraumatic stress than officers who reported being single, divorced, or widowed. The responsibility of caring for an elderly relative increased psychological distress and PTS levels. In general, exposure to COVID-19 or being at risk of infection had less impact on the officers’ mental health than exposure to traumatic experiences.

In conclusion, as expected, the pandemic is having a stressful effect on police officers, but it is not homogeneous among different groups. Implications for intervention policies are discussed.

The aim of the study was to analyze the presence of stress-related health problems among preschool employees and the way in which these reactions are related to noise and other work parameters. The investigation included 101 employees at 17 preschools in Umea County, located in northern Sweden. Individual noise recordings and recordings in dining rooms and play halls were made at two departments from each preschool. The adverse effects on the employees were analyzed by use of different validated questionnaires and by saliva cortisol samples. Stress and energy output were pronounced among the employees, and about 30 of the staff experienced strong burnout syndromes. Mental recovery after work was low, indicated by remaining high levels of stress after work. The burnout symptoms were associated with reduced sleep quality and morning sleepiness. Cortisol levels supported the conclusion about pronounced daily stress levels of the preschool employees.

The aim of the study was to analyze the exposure effects of different types of noise measures carried out at preschools. The project was carried out as an intervention study. The investigation included 89 employees at 17 preschools in the northern part of Sweden. Individual noise recordings and recordings in dining rooms and play halls were made at two departments in each preschool. The adverse effects on the employees were analyzed with validated questionnaires and saliva cortisol samples. Evaluations were made before and 1 year after the first measurement. Between the two measurements, measures were taken to improve the sound environments at the preschools. The effects of the measures varied a lot, with respect to both the sound environments and health. Regarding acoustical measures, significant changes were seen for some of the variables analyzed. For most of the tested effects, the changes, however, were very small and non-significant. The effects of organizational measures on the objective and subjective noise values were in overall less pronounced. Acoustical measures improved the subjectively rated sound environment more than organizational measures. This may be due to the high work effort needed to implement organizational measures. Even though the sound level was not lower, the personnel experienced improvements of the sound environment.

Heat‐ and moisture exchanging breathing devices (HME) humidify and heat inhaled air and prevent exercise‐induced bronchoconstriction. HMEs have potential as primary preventers against airway damage and asthma induced by exercise in sub‐zero temperatures. HME usage among athletes has not been previously investigated.

This study surveyed the usage of and attitudes towards HMEs among elite skiers.

We invited all 347 students from Swedish National Elite Sports Schools in cross‐country skiing and biathlon to participate in a web‐survey. The response rate was 55%, 53% were women, 30% had asthma, and 87% were cross‐country skiers. Their mean (range) age was 17 (15‐19) years.

HMEs were used often or occasionally by 71% of respondents, while. 68% reported respiratory symptoms while training in sub‐zero temperatures. The most common temperature threshold for using HMEs was −15 °C. Almost all participants believed that HMEs prevent airway problems induced by training in cold. The participants were motivated, and confident in succeeding, to increase their HME usage during exercise in −10 °C or colder, if recommended.

Swedish adolescent skiers commonly use HMEs and have positive attitudes towards increased HME usage. HMEs may constitute a simple and effective prevention strategy against airway symptoms and asthma among winter endurance athletes.

Aim. The aim of this thesis was to deepen the knowledge concerning health care managers’ everyday work experiences and their handling of stress and balance.

Background. Health care managers’ work is characterized by daily hassles, conflicting perspectives, and unclear boundary setting. They could therefore use support in boundary and stress management.

Methods. A qualitatively driven mixed methods approach was used. Qualitative interviews, focus groups and workplace observations were used for data collection in Study I. Physiological stress indicators, stress self-assessments, workplace observations and interviewing were used in Study II. Analyses were mainly carried out on the interview data, using grounded theory methodology (Study I) and conventional content analysis (Study II).

Results. Paper I shows that a first step in managers’ boundary setting is to recognize areas at work with conflicting expectations and inexhaustible needs. Strategies can then be formed through proactive, continuous negotiating of their time commitments. These strategies, termed ‘boundary approaches’, are more or less strict regarding the boundary setting at work. Paper II shows that nonnormative, interactive feedback sessions could encourage understanding and meaningfulness of previous stress experiences through a two-step appraisal process. In the first appraisal in the study, feedback was spontaneously reacted on, while in phase two it was made sensible and given meaning. However, during the sessions, some obstacles appeared to managers’ learning about their stress, preventing a second appraisal of the feedback.

Conclusions. Awareness and continuous negotiation regarding boundary dilemmas can be effective as a proactive stress management tool among managers. Further, non-normative feedback on stress indicators may initiate key 3 processes of sensemaking which can aid managers’ stress management by increasing awareness and supporting learning about their stress. Proactive boundary awareness is a concept leading to better understanding of lower-level managers’ management of their time commitments and stress, which can be supported by continuous reflection, feedback situations and a supportive context.

PURPOSE: Understanding of the capacity to work among employees with common mental disorders (CMDs) is important, but contemporary knowledge on this issue lacks the managers' perspective. The aim of this study was to explore and describe managers' experience-based understanding of capacity to work in employees with CMD.

METHODS: A qualitative focus group study was designed. Managers with experience in supporting employees with CMD were recruited via organizations and networks. Eight focus group interviews with 31 participants took place.

RESULTS: The analysis resulted in five categories. (1) Capacity to mentally focus on work tasks decreases or disappears, with negative consequences for work output. (2) Capacity to commit to continuous and coherent task changes, making tasks that span longer periods of time difficult. (3) Capacity to independently adapt to the needs of the situation decreases, and employees need more guidance and instructions than usual. (4) Capacity to keep up professional appearances is reduced, and the employees struggle with the professional role. (5) Ability to interact socially and professionally decreases, which potentially causes conflicts at the workplace.

CONCLUSIONS: This study adds managers' perspective to the increasing knowledge on how capacity to work is influenced by CMDs. Managers understand CMDs in employees as changed, reducing the capacities needed for occupational functioning. A deeper understanding of reduced capacity to work is needed to adapt workplaces, and our findings can facilitate work accommodations for employees with CMDs.

Under åren 2014-2016 har projektet ”Trygg i Åre - arbetsgivare mot droger” bedrivits med fokus mot att minska alkohol- och droganvändande bland säsongsanställda i kommunens företag. Projektet har drivits av kommunens drogsamordnare och en styrgrupp bestående av representanter från olika företag i regionen och Åre hälsocentral. De insatser som främst genomförts har varit: framtagande och implementering av en alkohol- och drogpolicy, fem utbildningstillfällen för arbetsgivare och chefer med personalansvar, ett utbildningstillfälle för projektets styrgrupp och kommunens personalavdelning avseende policyutveckling, kommunikationsinsatser via en utvecklad hemsida och sociala medier samt spridning av projektet genom en web-baserad värdskapsutbildning för personal hos stora arbetsgivare, krögarträffar, rekryteringsdagar etc. Projektets huvudmål har varit att minska användandet av alkohol- och droger på arbetsplatser med säsongsanställd personal i Åre kommun. Delmålen har handlat om ökad kunskapsnivå hos arbetsgivare, ökade förebyggande insatser, ökad förmåga till tidiga insatser och tydligt ställningstagande mot alkohol och droger. 

Projektets forskare har följt projektet interaktivt och kopplat tillbaka resultat vid ett flertal styrgruppsmöten. Projektets insatser har utvärderats via en enkät till medarbetare i företagen före och efter projektet omfattande 43 frågor om alkohol- och drogförebyggande arbete, arbetssituation, alkoholvanor, droger, hälsa och levnadsvanor. Kvalitativa analyser har bestått av intervjuer med ledare och deltagare i styrgruppen och noteringar från deltagande vid elva styrgruppsmöten. En enkätstudie med jämförelser av förhållanden i områdena Åre och Härjedalen har också genomförts. Enkäten besvarades 2014 av 611 personer (54 procent kvinnor, 46 procent män) i Åre-området, vilket utgjorde 47 procent av de som blev tillfrågade. Motsvarande siffror 2016 var att 423 personer (49 procent kvinnor, 51 procent män) besvarade enkäten med en svarsfrekvens på 34 procent. Enkäten besvarades 2016 av 125 personer i Härjedalen-området (svarsfrekvens 30 procent). 

Resultat från enkätstudien före projektets insatser visade att i gruppen 18-24 år fanns den högsta riskkonsumtionen av både alkohol (90 procent) och droger (6 procent). I åldersgruppen 18-24 år fanns inga signifikanta skillnader mellan könen när det gällde riskbruk av alkohol, till skillnad från droganvändning där fler män än kvinnor visade sig ha ett drogmissbruk. När det gäller det förebyggande arbetet svarade 87 procent att företaget hade en alkoholpolicy och 85 procent att det fanns en drogpolicy.  

 Resultat av de mulitivariata regressionsanalyserna av riskkonsumtion av alkohol visade att för kvinnor var detta associerat till faktorerna: bo med kollegor/vänner, ej vara fast boende i Åre, arbeta kväll/skift. För männens del var det att vänner ofta dricker sig berusade och om de upplevde ett gott arbetsklimat som visade sig ha en signifikant association. Resultatet av de multivariata regressionsanalyserna, där riskkonsumtion av droger studerades, visade att drogriskbruk för både kvinnors och mäns del var associerat med att ha vänner som ofta dricker sig berusade. För männen var dessutom säsongsanställning associerat till ett drogriskbruk. 

Resultatet av intervjuer med ledare och av medarbetares öppna svar i enkäten visade att för att nå framgång i det alkohol- och drogförebyggande arbetet finns det flera utmaningar som framförallt handlar om normer och ledarskap. Tre teman utkristalliserades i analysen: reproducerande av alkoholnormer, en alkoholkontrollerande arbetsmiljö och omhändertagande ledare. Ledarna såg alkohol som en naturlig del på skidorten och medarbetarna lyfte fram problematik kring ett aktivt policyarbete parallellt med en liberal hållning till alkohol och ”partykultur”. 

Jämförelser av enkätresultat före och efter projektets insatser visade på flera positiva tendenser. När det gäller riskkonsumtion av alkohol, mätt med frågeformuläret AUDIT (Alcohol Use Disorders Identification Test), noterades en signifikant minskning av riskkonsumtionen: 75 procent av de säsongsanställda angav riskkonsumtion 2014 jämfört med 56 procent 2016. För riskkonsumtion av droger, mätt med frågeformuläret DUDIT (Drug Disorders Identification), var konsumtionen relativt likartad före och efter projektet. Enkätresultat om arbetsgivarnas förebyggande arbete visar att andelen medarbetare som uppger att arbetsplatsen har en alkoholpolicy respektive drogpolicy har ökat signifikant sedan 2014, signifikant fler uppger att arbetsgivaren genomför slumpmässiga nykterhetskontroller och drogtester samt en större andel har vid eftermätningen kännedom om att arbetsgivaren erbjuder rehabilitering om alkohol- eller drogproblem uppdagas. När det gäller arbetsvillkor och hälsa kan utläsas att andelen som arbetar 40 timmar eller mer och övertid ökat något, oförändrad hälsa mätt med en positiv hälsoskala (Positive Health Scale), en liten minskning av sjuknärvaro och att drygt 80 procent av de anställda angav att de ofta/alltid upplever en meningsfull fritid både före och efter projektet.  

 Intervjuer med deltagare i styrgruppen pekar på flera positiva resultat som en ökad samverkan mellan företagare i Åre, ett mer aktivt ställningstagande och agerande när det gäller alkohol och droger. De intervjuade styrgruppsdeltagarna nämnde även att ledare nu vågar prata om problem som uppstår kring alkohol och droger, att de fångar upp de unga tidigt men också att det finns en ökad förmåga att hitta dem som har haft problem länge. Projektledaren menar att hen lagt märke till att det är en förändring bland chefer i deras förhållningssätt till det drogförebyggande arbetet. De intervjuade menar att de utbildningar som genomförts har bidragit till en ökad kunskap inom alkohol- och drogområdet och hur de som chefer kan agera, främst bland företagare i Åre och i mindre utsträckning vid andra orter i området. Styrgruppens deltagare nämner även att framtagande och implementering av alkohol- och drogpolicyn varit en viktig del i projektet liksom förändrade rutiner vid rekryteringar inför kommande säsong och ökad förmåga att agera då alkohol- och drogproblem uppdagas, bland annat genom ökat samarbete med områdets hälsocentral. 

En jämförelse mellan enkätresultat för områdena Härjedalen och Åre visade på signifikant lägre riskkonsumtion av alkohol bland både kvinnor och män i Härjedalen. Däremot fanns inga signifikanta skillnader gällande riskkonsumtion av droger. När det gäller de svarandes bedömning av förekomst av alkohol- och drogpolicy och utandningstester var dessa mer förekommande i Åre-området. 

Säsongsanställning på en vinterturistort kan innebära särskilda utmaningar när det gäller levnads- och arbetsvillkor samt alkohol- och drogkonsumtion och därför är studier angelägna. Forskningsområdet är av betydelse eftersom kunskapen är ofullständig om alkoholrelaterade problem i arbetslivet särskilt när det gäller tillfälliga anställningar som säsongsanställning. Det finns också behov av att utveckla interventioner för att förebygga alkohol- och drogproblem i arbetslivet samt att följa sådana via kvantitativa och kvalitativa studier. Resultaten av genomförd utvärdering och forskning bör tolkas med viss försiktighet på grund av den relativt låga svarsfrekvensen i genomförda enkätstudier, att data utgörs av tvärsnitt och att det finns skillnader i åldersfördelning och boendeformer i Åre-området före och efter projektet.  

Med denna reservation i åtanke kan ändå följande slutsatser dras: 

 Riskkonsumtionen av alkohol och droger ligger på en hög nivå bland studerad säsongsanställd personal jämfört med nationella urval och fortsatta förebyggande och främjande insatser är därför angelägna. 

 Enkätresultat före och efter projektets insatser och genomförda intervjuer med ledare och deltagare i styrgruppen tyder på att projektet haft signifikanta effekter för att minska användandet av alkohol på en del företag med säsongsanställd personal i Åre-området. 

 Genomförda utbildningar och övrig kunskapsspridning förefaller ha bidragit till ökad kunskapsnivå hos ledare i företag avseende alkohol- och drogfrågor och handlingsförmåga att förebygga dessa problem. Projektet har i mindre utsträckning nått orter utanför Åre by och därför finns behov av fortsatta insatser. 

 Projektets utbildningar, kunskapsspridning och utveckling av policy för alkohol och droger har bidragit till ökade förebyggande insatser och ett mer tydligt ställningstagande mot alkohol och droger. Förädling av policyn och utvecklad hemsida har också bidragit med kunskap om hur arbetsgivare kan arbeta med förebyggande och främjande insatser och till strategier vid rekrytering av säsongsanställda. 

 Andra positiva effekter i projektet är ett mer utvecklat samarbete med hälsocentral gällande alkohol- och drogfrågor samt att samarbetet mellan representanter från Åre kommun, företrädare för näringslivet och forskare upplevts positivt av berörda personer. 

 Resultaten tyder på signifikanta skillnader mellan alkohol- och drogkonsumtion i Härjedalen jämfört med Åre området. Förklaringar bakom dessa skillnader bör analyseras inför fortsatta insatser. 

 Projektet har i liten omfattning fokuserat på frågor kring anställningsvillkor, arbetsvillkor och hälsa. Då forskning visar på samband mellan dessa faktorer och alkohol- och drogkonsumtion bör detta beaktas i fortsatta insatser. 

 Resultaten pekar på att sociala faktorer har stor betydelse för riskkonsumtion, framförallt gällande alkohol. Ett förebyggande arbete måste därför omfatta boendeformer, kultur och normer bland de säsongsanställda och arbetsgivarna. 

 Vår bedömning är att projektets huvudmål (att minska användandet av alkohol och narkotika på arbetsplatser med säsongsanställd personal i Åre kommun) har uppfyllts när det gäller alkohol, men inte narkotika. Avseende delmål 1 (ökad kunskapsnivå hos arbetsgivare om förekomst av alkohol och narkotika och dess skadliga effekter) är bedömningen att kunskapsnivån ökat genom de utbildnings- och informationsinsatser som genomförts. När det gäller delmål 2 (ökade förebyggande insatser mot alkohol och narkotika) visar resultaten att fler företag har en alkohol- och drogpolicy samt tillämpar slumpmässiga kontroller. När det gäller delmål 3 (ökad förmåga till tidiga insatser) är resultatet svårbedömt. Dock är vår tolkning att styrgruppens deltagare uppvisar en ökad förmåga vid misstanke om alkohol- och narkotikamissbruk. Delmål 4 (ett ökat ställningstagande mot alkohol och narkotika på arbetsplatser) bedöms ha uppfyllts via projektets sammantagna insatser. Flera av projektets resultatmål bedöms ha uppfyllts: framtagande och genomförande av utbildning samt framtagande av gemensam alkohol- och drogpolicy och hemsida. Då enkätstudien riktad mot ledare i företagen inte kunde genomföras kan inte mål om ökad kunskap och förmåga bland ledare att agera bedömas. 

När det gäller fortsatta insatser finns flera praktiska implikationer. I förebyggande syfte är det av stor betydelse att förändra normer och rådande kultur för att begränsa alkoholkonsumtionen bland unga säsongsanställda. Eftersom resultaten tyder på att drogkonsumtionen förhållit sig oförändrad och omfattar en låg andel av de anställda jämfört med alkoholkonsumtionen finns behov av fortsatta studier där fler vinterturistorter ingår. Det är också viktigt att det finns strategier på arbetsplatsen för stöd till personer med alkoholrelaterade problem, likväl som generella alkohol- och drogtester för de säsongsanställda. Det finns behov av att ytterligare utveckla samarbetet med hälsocentral och företagshälsor. Av betydelse är också insatser för att förändra den kultur och de normer som skapas i de kollektiva boendeformer som många säsongsanställda har. Här bör arbetsgivarna ha möjlighet att anvisa andra boendeformer för de som så önskar. Arbetsgivarna bör även aktivt arbeta för att förändra den kultur kring alkohol som är nuvarande norm bland anställda. Ett sådant förändringsarbete kan vara relaterat till den hälsotrend som finns i dagens samhälle. En praktisk applikation är också att arbeta för att integrera frågor som rör alkohol och droger i företagens arbetsmiljö- och jämställdhetsarbete i ökad omfattning.

Winter tourism hires thousands of young seasonal workers every year. Work, but mostly skiing and party attracts them to stay at the ski resort for four or five months.  Previous research shows that seasonal employment is associated with hazardous drinking and risk taking behaviors. Seasonal workers’ health and healthy working environment are important issues for the tourism sector. Between 2014 and 2016 the project “Safe in Åre – employer against drugs” is running with the purpose to reduce alcohol and drugs among seasonal employees.  

A qualitative method was used to understand critical factors for alcohol prevention among seasonal workers. Twelve HR managers in tourism companies were interviewed about alcohol prevention and the role of alcohol in seasonal workers’ daily lives. The interviews were analyzed with content analysis together with one open ended questions about seasonal workers view of the companies’ alcohol- and drug prevention. The question was answered by 611 of 1313 employees.  

The results shows that HR managers view on alcohol prevention was two-edged. They contribute to the preservation of existing alcohol norm but have policies to control soberness at work. Emerging themes were: Retention of existing alcohol norms and Alcohol-controlled working environment. But it was also a tendency of a preventive approach among some HR managers. 

The results are in progress but the preliminary conclusion is that the double message from the manager to the seasonal workers with restrictions and control of alcohol use at work but invitations to drink in the evening is problematic and contribute to the norm of “party culture”.