Population Study Of Women Research Articles

Exploring the impact of mental and work-related stress on sick leave among middle-aged women: observations from the population study of women in Gothenburg, Sweden

Objective To investigate whether mental and work-related stress predicts a one-year incidence of sick leave in a cohort of middle-aged working women. Design The 2016/17 survey was part of the Population Study of Women in Gothenburg, Sweden, with registry data information on sick leave during one year pre- and post-baseline. Subjects A cohort of women aged 38 and 50 in 2016/17 (n = 573; 68% participation), of which 504 women were gainfully employed and not on sick leave ± 2 weeks around baseline examination; 493 women had complete data on stress exposure. Methods We studied associations between self-assessed mental and work-related stress and incident sick leave of >14 days during the year following the baseline examination. We used multiple logistic regression, adjusting for age and previous sick leave, and additionally for sleep quality, well-being, and physical activity. Results Overall, 75 women (16%) experienced at least one period of sick leave after baseline. Permanent stress during the last five years almost tripled the risk for incident sick leave, OR = 2.8 (95% CI 1.2–6.3), independent of previous sick leave, OR = 2.3 (95% CI 1.3–4.2). Among 21 specific work-related problems, conflicts at work, OR = 2.2 (95% CI 1.3–3.6), and low decision latitude, OR = 1.7 (95% CI 1.0–2.9), were associated with incident sick leave. The association with conflicts at work remained upon further covariate adjustment. Conclusion Low decision latitude and conflicts at work are risk factors for incident sick leave among working women. The impact of conflicts at work, irrespective of own involvement, may indicate a specific vulnerability among women of interest for future interventions.

Eating Behaviors and Adiposity Indicators - Observations from the 2016/17 Examination of the Population Study of Women in Gothenburg.

To determine the cross-sectional association between eating behavior in terms of the three-factor eating questionnaire (TFEQ) and adiposity measures. The TFEQ-R21 was administered to 573 women aged 38 and 50 who participated in the population study of women in Gothenburg 2016/17. Three domains, emotional eating (EE), uncontrolled eating (UE), and cognitive restraint (CR) were examined as outcomes as well as predictors of adiposity outcomes. Multiple linear and logistic regression models were adjusted for age, education, lifestyle factors, and dieting behavior. All TFEQ domains were positively associated with dieting. EE and UE were associated with higher consumption of sweets and CR with lower consumption of sweets. Wellbeing was negatively associated with EE and UE. In mutually adjusted models, EE and CR but not UE were positively associated with BMI, waist circumference (WC), waist-to-hip ratio, waist-to-height ratio, and skinfold. One standard deviation higher EE was associated with obesity, BMI ≥ 30 kg/m2, OR = 1.62 (1.26, 2.10), and abdominal fatness, WC > 88 cm, OR = 1.57 (1.26, 1.95). Former and current dieting were positively associated with these outcomes, too, but UE and CR were not associated in mutually adjusted models. This study shows that emotional eating behavior is associated with adiposity in a population of middle-aged women, over a large range of values for body fatness, and independent of dieting behavior. The results imply that treatment of obesity should include psychological support to restrict the risk for emotional eating in response to states of negative mood.

Increased use of analgesics in midlife women but no association with mental stress: observations from the Prospective Population Study of Women in Gothenburg

BackgroundThe study is part of the ongoing Prospective Population Study of Women in Gothenburg, Sweden, initiated in 1968–1969 with the aim of characterising a total population of women who were representative of middle-aged females. The aim of the present study was to investigate the prevalence of actual analgesic use (prescribed and self-medication) and the possible association with perceived mental stress among women aged 38 and 50 years, respectively, in the Population Study of Women.MethodsTwo different cohorts of population-based samples of 38- and 50-year-old women examined in 2004–2005 and 2016–2017, respectively, were eligible participants. The women were representative for their age cohort at the time of the examinations. Use of medicines and especially analgesics, as well as perceived mental stress, was registered. Changes in medicine use among 38- and 50-year-old women between 2004 and 2005 and 38- and 50-year-old women in 2016–2017 were studied. Data were analysed using logistic regression. Use of analgesics and mental stress were analysed controlling for lifestyle factors, use of other medicines and pain.ResultsThe overall sample size across the time periods was 1,073 individuals. The frequency of analgesic use in 38- and 50-year-old women was about 26% in 2004–2005 and 58% in 2016–2017. 28% of women who reported high mental stress in 2004–2005 used analgesics, compared to 60% in 2016–2017. There were no associations between self-perceived mental stress and the use of analgesics.ConclusionThe higher use of analgesics among midlife women in 2016–2017 is in line with global findings and could be due to increased availability in Sweden of over the counter medicines. The impact of mental stress on analgesic use found previously by other researchers was not confirmed. However, medicine use as a potential coping strategy is an important public health issue that needs to be further explored.

Forty-four-year longitudinal study of stroke incidence and risk factors – the Prospective Population Study of Women in Gothenburg

Objective To assess stroke incidence over 44 years and association with risk factors. To study total stroke incidence at 60–82 years of age and risk factors. Design Prospective population study. Setting Gothenburg, Sweden, with ∼450,000 inhabitants. Subjects A representative sample of a general population of women (1462 in total) in 5 age strata aged 38–60 years in 1968–1969 (the Population Study of Women in Gothenburg, PSWG) were followed up to the ages of 82–104 years in 2012. Further, analysis was also performed for the age interval 60–82 years. Main outcome measures Incidence of total stroke (TS), ischaemic (IS), haemorrhagic (HS), non-specified (NS) and fatal (FS) strokes and association with baseline classic risk factors (such as hypertension, atrial fibrillation, low physical activity, diabetes, high waist-hip-ratio, hyperlipidaemia, smoking), low education, mental stress, pre-eclampsia and oral health as expressed by loss of teeth and bone score. Blood pressure in levels 1–3 according to modern guidelines. Associations with atrial fibrillation, diabetes and myocardial infarction shown in survival analyses. The five cohorts contributed to risk time data concerning associations with TS in the 60–82 age interval from the examination performed when they were 60. Results Three hundred and thirty-seven (23%) women had a first-ever stroke, 64 (19%) fatal. TS was associated with physical inactivity, high triglycerides and low education in multivariable analysis. The main sub-type IS was associated with systolic blood pressure, physical inactivity and low education. Pre-eclampsia showed association with IS only in the univariable analysis. FS was associated with systolic blood pressure and smoking. During 60–82 years of age, having <20 teeth (HR 1.74, CI 1.25–2.42), diabetes (HR 2.28 CI 1.09–4.76), WHR (HR 1.29 per 0.1 units CI 1.01–1.63), systolic blood pressure (HR 1.11 per 10 units CI 1.04–1.18) and smoking (HR 1.57, CI 1.14–2.16), were associated with TS in the combined five cohorts. Conclusions Several classic risk factors showed independent associations with stroke. Vulnerability factors as low education and oral health, reflected by loss of teeth, also showed association with stroke. All these factors are possible to target in primary care preventive interventions. Key Points Stroke is a common disease and the risk of stroke is a key issue demanding preventive strategies in primary health care. The present prospective population study of women shows Out of 1460 women, almost a quarter got a stroke. The stroke incidence 60–82 years of age was rather stable between the first four age cohorts but somewhat lower in the latest cohort, born 1930. Hypertension, low physical activity, low education and high triglyceride levels but not cholesterol were associated with stroke in women. Low education and loss of teeth are vulnerability factors that should need particular attention.

Intra-Individual Variability in Self-Reported Use of Non-Steroidal Anti-Inflammatory and Analgesic Medicines Depending on Mode of Data Collection - Observations from the Population Study of Women in Gothenburg, Sweden.

BackgroundSelf-report by questionnaire is one of the main methods to collect data on drug utilization. There are several modes of data collection by questionnaire, differing in the way of delivering the questionnaire to respondents and in the administration of the questions, both influencing the recall and participation rates. The aim of this study was to compare different modes of data collection for self-reported use of non-steroidal anti-inflammatory (NSAIDs) and analgesic medicines.MethodsData on 573 women (38 or 50 years) were retrieved from the Population Study of Women in Gothenburg. Data on medicine use were collected using two different modes: (1) a self-administered questionnaire with closed-ended medicine-specific questions; and (2) an interviewer-administered questionnaire with open-ended questions. Cohen’s kappa statistics were applied to assess the agreement of the two modes.ResultsThe proportion of participants that reported use of NSAIDs and analgesics was higher with the self-administered questionnaire compared with the interviewer-administered questionnaire (69.3% vs 58.5%, p <0.001). The overall agreement between the two modes of data collection was fair (Ⱪ=0.27), ranging from none for antimigraine preparations to fair (Ⱪ=0.36) for NSAIDs. A higher proportion of the participants aged 38 years reported use of NSAIDs and analgesics compared with the 50-year olds. In the regression model using data from the self-administered questionnaire, all four categories of bodily pain were significant predictors for use of NSAIDs and analgesics. The most severe reported bodily pain was the only significant predictor in the model using data from the interviewer-administered questionnaire.ConclusionThis study showed that use of a self-administered questionnaire with closed-ended medicine-specific questions identified more users of NSAIDs and analgesic medicines compared with an interviewer-administered questionnaire with open-ended questions. Reported use according to the self-administered questionnaire was also more strongly associated with experienced pain.

Well-being and mental stress in the population study of women in Gothenburg, Sweden: cohort comparisons from 1980 to 2016 of 36-year trends and socioeconomic disparities in 38-and 50-year old women

BackgroundWomen’s lives have dramatically changed in recent decades as evidenced by trends in educational attainment, employment outside the home, income, and other socioeconomic factors. Self-reported health in 18–70 year old women has been reported to be significantly lower than in men. In Sweden, the 2005 National Public Health Report showed that stressful work environments have become more common, especially for women. The purpose of the study was to monitor trends in well-being and perceived mental stress in the populations of 38- and 50-year-old women and to examine associations with socioeconomic position (SEP).SubjectsIn 1980, 2004, and 2017, population-based samples of 38- and 50-year old women were recruited into the Prospective Population Study of Women in Gothenburg (PPSWG), Sweden. This population-based study included participants from selected birth cohorts to participate in health examinations, at similar ages and with similar protocols on each occasion.MethodsBirth cohort comparisons between three representative samples of 38- and 50-year-old women. Well-being (scale 1–7) and perceived mental stress (scale 1–6) based on questionnaires were the main outcomes studied in relation to time. Socioeconomic position (SEP) based on socio-occupational group, i.e. occupational and educational level combined, were examined as correlates of well-being and mental stress at different points in time.ResultsPerception of good well-being increased in generations of 50-year-old women between 1980 to 2016, but no significant time trends were seen in 38-year-old women. Perception of high mental stress increased between 1980 and 2016, for both 38-and 50-year-old women. Belonging to a low socio-occupational group was associated with lower perceived well-being in 1980 but not in 2016. Belonging to a low socio-occupational group was not associated with perceived mental stress at any examination.ConclusionsContemporary women of today have generally higher perceptions of well-being but also higher mental stress regardless of belonging to low or high socio-occupational group. Associations between poor well-being and belonging to a low socio-occupational group that were observed in 1980 and 2004 were not observed in 2016.The Prospective Population Study of Women in Gothenburg, Sweden was approved by the ethics committee of University of Gothenburg (Dnr 65–80; Ö564–03; 258–16). The studies comply with the Declaration of Helsinki and informed consent has been obtained from the subjects.

Characteristics of male triple negative breast cancer: A population-based study.

Male triple negative breast cancer (TNBC), which lacks expression of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), is a very rare entity, comprising only a very small percentage of all male breast cancer cases. Management strategies are typically based off research conducted in female TNBC patients; however, there is still much that remains unknown in the male cohort, such as risk factors for developing these malignancies, the optimal treatment approach, and both short-term and long-term outcome data. In this retrospective cohort study, we aimed to address these concerns by assessing both the characteristics of male patients who develop TNBC as well as their outcomes. We harnessed data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program and identified 66 male patients diagnosed with TNBC between 2010 and 2016. Patients were stratified by several variables including age, insurance status, time period of diagnosis, histology, nodal status, tumor grade, tumor stage at diagnosis, and treatment strategy employed for the assessment of overall survival (OS) differences. Our analysis demonstrated that stage remains the most important prognostic factor for OS, with higher stage corresponding to worse OS. A significant OS benefit was also identified in men undergoing a total mastectomy, compared to partial mastectomy or no surgery at all. We also identified that male patients are more likely to present with more advanced disease stages compared to their female counterparts and, therefore, have worse outcomes on average. This may be due to various factors, including the rarity of male TNBC cases and less clear screening guidelines for male breast cancer in general. Trends toward poorer OS with higher tumor grade, higher tumor T stage, advanced age, earlier time period of diagnosis, and ductal histology were also identified, but did not achieve statistical significance. The remaining variables did not appear to influence outcomes in a meaningful manner. In summary, our study suggests, similar to population studies of women with TNBC, that tumor stage is a major prognostic factor of OS in men with TNBC. The data also suggest that the surgical treatment strategy employed is also likely of significance, with improved OS being seen with total mastectomies over partial mastectomies. Other variables such as tumor grade and T stage also likely play a role, but did not achieve statistical significance owing to the small population size. Owing to the rarity of cases, further studies of male TNBC are needed to better understand this rare entity and guide future management strategies.

Regular versus episodic drinking in Swedish women: Reporting of regular drinking may be less biased by social desirability.

To describe the personality and social characteristics associated with regular and episodic alcohol consumption in a Swedish cohort of women. 406 women aged 38 and 50 who participated in the Population Study of Women in Gothenburg in 2004-2005 with complete data on the key variables are included. Regular alcohol use was based on frequencies of alcoholic beverage consumption, reported to examining physicians. Regular drinking was defined as those consuming wine, beer, or spirits at least twice weekly. Episodic drinking was defined as consumption of six drinks or more on a single occasion at least once during the last year. Personality traits were studied using the self-administered 57-item Eysenck Personality Inventory, which includes a 'lie scale' measuring the tendency toward social desirability, a 'neuroticism scale', and an 'extraversion scale'. Logistic regression was used to estimate odds ratios (OR) for regular and episodic drinking, respectively, in relation to standardized (SD) personality scores and selected social characteristics. 49% of the women reported episodic drinking, while 58% reported regular drinking, and 34% reported both. Women with a higher tendency toward socially desirable responses were less likely to report episodic drinking (odds ratio [OR]=0.67, 95% confidence interval [CI]=0.53-0.84) per standard deviation (SD), a trait that was not associated with regular drinking. The strong inverse association between the propensity to lie scale with episodic but not regular drinking suggests that episodic drinking is subject to greater social desirability and under-reporting biases than regular drinking. Our findings indicate that this type of problem drinking may be missed in medical examinations, which limits the ability of health professionals to intervene.

Organizational climate and work commitment as predictor of 10-year registered sickness absence

Abstract Background Early identification of persons at risk for sickness absence offers an opportunity to put in place preventive measures in the future. The Work Stress Questionnaire (WSQ) is specifically designed to identify people at risk for sickness absence due to work-related stress. In this study we examine prospective associations between work-related stress as measured by the WSQ and registered sickness absence up till 10 years later among employed and self-employed women in the general population in Gothenburg. Methods This is a survey-linkage study based on the 2004-05 wave of the Swedish “Population Study of Women in Gothenburg (PSWG)” and 10-year follow-up in the MiDAS sickness absence register. Participants registered as employed or self-employed were included (n = 396). Outcomes were number of sickness absence episodes during follow-up and sickness absence during each two-year time band of follow-up. Results High perceived stress due to poor organizational climate, compared to low stress, gave an adjusted Incidence Risk Rate (IRR) of 1.99 [95% CI 1.19-3.34] for sickness absence episodes. Combining high perceived stress due to poor organizational climate with high perceived stress due to work commitment gave an IRR of 2.32 [95% CI 1.26-4.26]. Examining separate time periods, similar associations were found during years 5-6 and 7-8. Perceived low influence at work also gave increased odds for sickness absence, at both in the shorter term (1st-2nd year) and longer term (7th-8th year). Conclusions The findings align with previous studies that WSQ may successfully identify women with elevated risk for future sickness absence, and adds that this is even true in a general population context and using a very long follow-up period. Nevertheless, the findings should preferably be confirmed using a larger sample to improve precision of the observed associations. Key messages The present study contribute with knowledge about screening instruments that may identify women in the general working population with elevated risk for sickness absence. The findings suggest that high perceived stress due to organizational climate, alone and in combination with high work commitment, as well as low influence at work, increase risk of sickness absence.

The association of birthweight with age at natural menopause: a population study of women in Norway.

BackgroundPrevious studies suggest that birthweight may influence age at natural menopause, but the evidence remains inconclusive. Thus, we aimed to estimate the association of birthweight with age at natural menopause.MethodsA retrospective population study of 164 608 women in Norway, aged 48–71 years. Data were obtained by two self-administered questionnaires among participants in BreastScreen Norway during 2006–2014. We used Cox proportional hazard models to estimate hazard ratios and logistic regression models to estimate odds ratios of menopause according to birthweight. Restricted cubic splines were applied to allow for possible non-linear associations, and adjustments were made for year and country of birth.ResultsWomen with birthweight <2500 g were median 51 years at menopause (interquartile range 49–54 years), whereas women with birthweight 3500–3999 g were median 52 years at menopause (interquartile range 49–54 years). The hazard ratio of menopause decreased with increasing birthweight up until 3500 g. At birthweights >3500 g, we estimated no further decrease (P for non-linearity = 0.007). Birthweight at 2500 g increased the odds ratios of menopause before the age of 45 [1.20; 95% confidence interval (CI): 1.14–1.25] and the age of 40 (1.26; 95% CI: 1.15–1.38) compared with birthweight at 3500 g. At birthweights 4000 g and 4500 g, the odds ratio estimates were very similar to the reference group and the CIs overlapped 1.00.ConclusionsWe found a non-linear dose-relationship of birthweight with age at natural menopause, and low birthweight was associated with early natural menopause. Our findings suggest that growth restriction during fetal life may influence the timing of natural menopause.

Reprint of: Women with polycystic ovary syndrome wedge resected in 1956 to 1965: a long-term follow-up focusing on natural history and circulating hormones

Objective To determine if the hormonal imbalance in women with polycystic ovary syndrome (PCOS) continues into and after menopause and to analyze factors constituting an increased risk for developing metabolic disorders. Design The study was a transectional retrospective cohort follow-up of patients with PCOS. Setting The women with PCOS were recruited from hospital clinics, and referents were randomized from a population study of women. Participants Thirty-three women ages 40 to 59 years with ovarian histopathology typical of PCOS at wedge resection 22 to 31 years previously; 132 age-matched referents were analyzed. Main Outcome Measures Clinical data were collected via a questionnaire supplemented with an interview in connection to a clinical examination that also included fasting venous sampling. Results Infertility, hirsutism, and oligomenorrhea were more common among the subjects with PCOS, but there was a considerable spontaneous restitution of cyclic regularity with time. Women with PCOS were more often hysterectomized and entered menopause later compared with referents. The hormone data show a typical profile for PCOS. Compared with referents women with PCOS showed marked increase in prevalence of central obesity, higher basal serum insulin concentrations, and a higher prevalence of diabetes mellitus and hypertension. Conclusion erimenopausal women with PCOS have an increased morbidity in hypertension and diabetes mellitus that adds to the classic symptoms, such as anovulation, hirsutism, and infertility.

Comparison of Time to Pregnancy in Women With and Without Inflammatory Bowel Diseases

Patients are often diagnosed with inflammatory bowel diseases (IBD) during their peak reproductive years. We investigated how IBD affects fertility in a population study of women in Denmark. We collected data from the Danish National Birth Cohort, a nationwide study of 92,274 pregnant women recruited from 1996 through 2002. Women who had been actively trying to conceive reported their time to pregnancy through a computer-assisted telephone interview at approximately 16 weeks of gestation. Information regarding IBD was retrieved from the Danish National Patient Register. Using regression models and adjusting for important confounders, we compared time to pregnancy in women with and without IBD. We calculated time to pregnancy for 74,471 pregnancies in women without IBD, 340 pregnancies in women with ulcerative colitis (UC), and 206 pregnancies in women with Crohn's disease (CD). Compared to non-IBD pregnancies, the adjusted relative risk ratios for time to pregnancy of more than 12 months in women with IBD, UC, and CD were 1.28 (95% CI, 0.99-1.65), 1.10 (95% CI, 0.80-1.51), and 1.54 (95% CI, 1.03-2.30), respectively. The adjusted relative risk ratio was 2.54 (95% CI, 1.39-4.65) for a time to pregnancy of more than 12 months in women who had CD surgery prior to conception vs non-IBD pregnancies. There were too few patients with UC with surgery prior to conception to perform meaningful analyses of this group. In a study of women with IBD not confounded by voluntary childlessness, we found that women with CD, especially those who have undergone surgery, have a significant increase in time to pregnancy compared to women without IBD. This indicates reduced fertility in subgroups of women with IBD.

Editors' note: Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women

“Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women” investigated whether greater cardiovascular fitness in midlife is associated with a decreased risk of dementia in women. The authors found that women with high fitness had a lower adjusted hazard ratio for all-cause dementia and delayed age at onset of dementia compared with women with medium fitness. Commenting on the article, Kivimäki et al. believe that the results are overoptimistic. They explain that because of the small number of dementia cases, the results reported are unlikely to be robust. They support their argument by analyzing an alternative scenario with just 2 additional dementia cases in the high-fitness group, which would decrease the population attributable fraction to less than 60%. Hörder et al. agree that the results may be overoptimistic, but they justify the low number of dementia cases in the highest-fitness group as a consequence of the strong effect of high midlife fitness on dementia risk. They add that high fitness could be regarded as a sum of a number of beneficial factors related to dementia risk (e.g., genetics, exercise, diet, nonsmoking, and blood pressure). “Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women” investigated whether greater cardiovascular fitness in midlife is associated with a decreased risk of dementia in women. The authors found that women with high fitness had a lower adjusted hazard ratio for all-cause dementia and delayed age at onset of dementia compared with women with medium fitness.

Author response: Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women.

We are grateful for the comments by Kivimäki et al. on our article.1 We agree that the effect of dementia prevention in our study is probably overoptimistic. However, the results still suggest that there is a strong effect of midlife cardiovascular fitness on dementia risk in old age. Kivimäki et al. conclude that results based on 2 individuals with dementia are entirely based on chance. However, 44 individuals developed dementia during the 44-year follow-up period. Two of those were in the highest quintile of fitness. The low number of dementia cases in the highest-fitness group is thus the consequence of the strong effect of high midlife fitness on dementia risk. However, as Kivimäki et al. point out, this makes the exact estimation of the benefit of fitness less robust, but it still suggests a strong effect. Kivimäki et al. report that with 2 more cases, the population attributable fraction would decrease from 78% to approximately 60%. We would argue that this is also a strong effect. In addition, high fitness could be regarded as a sum of a number of beneficial factors related to dementia risk (e.g., genetics, exercise, diet, nonsmoking, and blood pressure).

Reader response: Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women.

Horder et al.1 advanced the hypothesis that midlife cardiovascular fitness protects against old-age dementia. However, the limitations of the data were not fully discussed. The estimated benefit of greater fitness in terms of dementia prevention is overoptimistic. Using data from tables 3 and 4 in the article,1 we calculated a population attributable fraction (PAF) of 78.3%, suggesting that 8 of 10 dementia cases would be avoided if all women had high cardiovascular fitness (table). This is more than 2 times greater than the collective PAF for all known modifiable risk factors in the most recent synopsis,2 which is itself an upper-bound estimate.3

Socioeconomic disparities in physical activity among Swedish women and trends over time – the population study of women in Gothenburg

Objective: To explore secular trends in physical activity in relation to socioeconomic position in middle-aged women, with focus on whether the social gaps have become wider, narrower, or remain unchanged.Design: Cohort comparisons between two representative samples of women, recruited in 1980–81 and 2004–05 as a part of the Population Study of Women in Gothenburg.Setting: Gothenburg, the second largest city of Sweden, with ≈ 450 000 inhabitants.Subjects: Population-based cohorts of 38- and 50-year-old women, invited in 1980–81 and 2004–05 to free health examinations. The study population in 1980 was n = 477, 38- and 50-year-old women born in 1930 (n = 355) and 1942 (n = 122), and in 2004 n = 500, 38- and 50-year- old women born in 1966 (n = 207) and 1954 (n = 293).Main outcome measure: Physical activity at work and leisure time. Socioeconomic position was defined based on socio-occupational group and level of education. Physical activity during work and leisure time was based on questionnaires.Results: On average 38- and 50-year-old women were more physically active at work and leisure time in 2004–05 compared to 1980–81; odds ratio (OR) for increase over time for physical activity at work for 38-year-olds: 2.59, (95% confidence interval (CI) 1.65–4.07), and for 50-year-olds: OR 2.09 (1.52–2.88); OR for increase physical activity leisure time in 38-year-olds: 1.93 (1.25–2.98), and in 50-year-olds 2.04 (1.49–2.79). There were no significant differences between socioeconomic groups in physical activity levels changes over time.Conclusion: Women in different socioeconomic groups improved their physical activity at work and leisure time to the same extent from 1980 to 2004, indicating that the socioeconomic gap in physical activity is neither increasing nor decreasing.Key Points The gap in physical activity levels between socioeconomic groups seems to have remained stable for middle-aged women the last 25 years. • However, women were more physically active in 2004 at work and during leisure time, independent of socioeconomic position, compared to 1980. • It remains a great challenge to create structures that enable these behaviours for all social groups.

Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women.

ObjectiveTo investigate whether greater cardiovascular fitness in midlife is associated with decreased dementia risk in women followed up for 44 years.MethodsA population-based sample of 1,462 women 38 to 60 years of age was examined in 1968. Of these, a systematic subsample comprising 191 women completed a stepwise-increased maximal ergometer cycling test to evaluate cardiovascular fitness. Subsequent examinations of dementia incidence were done in 1974, 1980, 1992, 2000, 2005, and 2009. Dementia was diagnosed according to DSM-III-R criteria on the basis of information from neuropsychiatric examinations, informant interviews, hospital records, and registry data up to 2012. Cox regressions were performed with adjustment for socioeconomic, lifestyle, and medical confounders.ResultsCompared with medium fitness, the adjusted hazard ratio for all-cause dementia during the 44-year follow-up was 0.12 (95% confidence interval [CI] 0.03–0.54) among those with high fitness and 1.41 (95% CI 0.72–2.79) among those with low fitness. High fitness delayed age at dementia onset by 9.5 years and time to dementia onset by 5 years compared to medium fitness.ConclusionsAmong Swedish women, a high cardiovascular fitness in midlife was associated with a decreased risk of subsequent dementia. Promotion of a high cardiovascular fitness may be included in strategies to mitigate or prevent dementia. Findings are not causal, and future research needs to focus on whether improved fitness could have positive effects on dementia risk and when during the life course a high cardiovascular fitness is most important.

Childbirth or termination of pregnancy: does paid employment matter? A population study of women in reproductive age in Norway

IntroductionWe studied whether female paid employment is associated with pregnancy outcome; childbirth or pregnancy termination.Material and methodsAll women in Norway, 16–54 years of age, during the years 2007–10 were included. Data sources were; the Norwegian Central Person Registry, the Medical Birth Registry of Norway, and the Registry of Pregnancy Termination. We compared the proportion without paid employment among all women, women who gave birth, and among women who requested termination of pregnancy. Thereafter, and among pregnant women, we estimated the odds ratio for pregnancy termination request for women without paid employment by applying logistic regression analyses, using women with paid employment as reference.ResultsAmong all women 16–54 years of age, 23.5% were without paid employment. Among women who gave birth, 15.8% were without paid employment, whereas this proportion was 46.4% among women who requested pregnancy termination (p < 0.05). Among the 307 512 women who were pregnant, 60 734 (19.4%) requested pregnancy termination. The odds ratio for pregnancy termination request was 3.18 (95% CI 3.11–3.25) for women without paid employment. Adjustments were made for age, number of children, and region of residence in Norway.ConclusionBeing without paid employment was more common among women in the general population and among women requesting pregnancy termination than among women who gave birth. Hence, women seem to have children when they are in paid employment. The role of women's paid employment for reproductive choices should be further investigated.

Serum 25-hydroxy vitamin D levels in middle-aged women in relationship to adiposity and height trajectories over three decades.

The long-term chronology of the association between low serum concentrations of 25-hydroxy vitamin D (25(OH)D) and weight status is unclear. We examined whether lower 25(OH)D in middle-aged women drives upwards the weight, body mass index (BMI) and waist-hip ratio (WHR) over the next 32 years, and whether higher 25(OH)D might predict less decline in the mid- to late-life height trajectory. The Population Study of Women in Gothenburg started in 1968-1969 (the baseline) in 38-60-year-old women residing in Gothenburg, Sweden. Anthropometric measures were taken at baseline and 4 re-examinations until 2000-2003. Levels of 25(OH)D were analyzed in serum stored since baseline in 1227 (84%) women. Repeated measures analyses were used to model associations between 25(OH)D (dichotomized, cut point 51.45 nmol/l) at baseline and anthropometric trajectories, adjusting for fixed and time-dependent covariates. At baseline, mean BMI was 25.2 kg/m(2) in women with low 25(OH)D and 23.8 kg/m(2) in the remaining women (P<0.001), but this difference did not increase over 32 years and longitudinal differences were explained by the baseline BMI. Similar results were observed for weight and WHR. In contrast, no association was seen for height at baseline or longitudinally. No relationship was observed between 25(OH)D height trajectory, but lower 25(OH)D was associated with higher BMI, weight and WHR differences that were maintained over three decades. This provides no evidence for the direction of causality, but for a life-long difference in adiposity-related measures according to the 25D level in middle-aged women.

Quality Assessment of 25(OH)D, Insulin, Total Cholesterol, Triglycerides, and Potassium in 40-Year-Old Frozen Serum

Background.Many longitudinal epidemiological studies collect specimens into biobanks to investigate how biomarkers predict future disease. In 1968-1969, the Population Study of Women in Gothenburg (PSWG) established a biobank of serum samples.Objective.To examine the validity of 25-hydroxyvitamin D (25(OH)D), total cholesterol, triglycerides, insulin, and potassium after 40 years of storage at −20°C in terms of relative and absolute agreement. The quality of these markers under such condition has not been previously investigated.Methods.Baseline and remeasured levels were compared in selected samples through percentage change, correlation, and regression. 25(OH)D levels, not assessed at baseline, were compared by season, by BMI, and longitudinally over six years.Results.Despite some lack of absolute agreement, Spearman correlations were &gt;0.7 and statistically significant for all biomarkers. The 1968-1969 25(OH)D correlated with BMI(r=-0.45, P=0.05)and with levels six years later(r=0.85, P&lt;0.001). Summer 25(OH)D was higher than winter 25(OH)D(P=0.02).Conclusion.For all markers, baseline and remeasured levels exhibited high relative agreement. 25(OH)D was comparable with expected levels on fresh blood and varied with season. In future studies, PSWG individuals will be ranked according to these markers in order to predict incidence of disease.