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In the self-worth model, burnout is considered to be a syndrome of performance-based self-esteem (PBSE) and experiences of exhaustion. Studies have shown that PBSE and burnout indices such as Pines' Burnout Measure (BM) are associated. Whether these variables have overlapping etiologies has however not been studied before. Genetic and environmental components of covariation between PBSE and exhaustion measured with Pines' BM were examined in a bivariate Cholesky model using data from 14,875 monozygotic and dizygotic Swedish twins. Fifty-two per cent of the phenotypic correlation (r = 0.41) between PBSE and Pines' BM was explained by genetics and 48% by environmental factors. The findings of the present study strengthen the assumption that PBSE should be considered in the burnout process as proposed by the self-worth conception of burnout. The present results extend our understanding of the link between this contingent self-esteem construct and exhaustion and provide additional information about the underlying mechanisms in terms of genetics and environment. This finding corroborates the assumed syndrome view on burnout, while it also suggests an altered view of how the syndrome emerges and how it can be alleviated., (© 2016 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Within occupational health research, one of the most influential models is the Job Demands-Control-Support model. Numerous studies have applied the model to different domains, with both physical and psychological health outcomes, such as burnout. The twin design provides a unique and powerful research methodology for examining the effects of environmental risk factors on burnout while taking familial factors (genetic and shared environment) into account. The aim of the present study was to investigate the impact of familial factors on the associations of burnout with job demands, control and support. A total of 14,516 individuals from the Swedish Twin Registry, who were born between 1959 and 1986, and who participated in the Study of Twin Adults: Genes and Environment (STAGE) by responding to a web-based questionnaire in 2005, were included in the analyses. Of these, there were 5108 individuals in complete same-sex twin pairs. Co-twin control analyses were performed using linear mixed modeling, comparing between-pairs effects and within-pair effects, stratified also by zygosity and sex. The results indicate that familial factors are of importance in the association between support and burnout in both women and men, but not between job demands and burnout. There are also tendencies towards familial factors being involved in the association between control and burnout in men. These results offer increased understanding of the mechanisms involved in the associations between work stress and burnout.

Most previous studies of burnout have focused on work environmental stressors, while familial factors so far mainly have been overlooked. The aim of the study was to estimate the relative importance of genetic influences on burnout (measured with Pines Burnout Measure) in a sample of monozygotic (MZ) and dizygotic (DZ) Swedish twins. The study sample consisted of 20,286 individuals, born 1959-1986 from the Swedish twin registry who participated in the cross-sectional study of twin adults: genes and environment. Probandwise concordance rates (the risk for one twin to be affected given that his/her twin partner is affected by burnout) and within pair correlations were calculated for MZ and DZ same--and opposite sexed twin pairs. Heritability coefficients i.e. the proportion of the total variance attributable to genetic factors were calculated using standard biometrical model fitting procedures. The results showed that genetic factors explained 33% of the individual differences in burnout symptoms in women and men. Environmental factors explained a substantial part of the variation as well and are thus important to address in rehabilitation and prevention efforts to combat burnout.

Objective: The Job Demand Control model presents combinations of working conditions that may facilitate learning, the active learning hypothesis, or have detrimental effects on health, the strain hypothesis. To test the active learning hypothesis, this study analysed the effects of job demands and job control on general problem-solving strategies., Participants: A population-based sample of 4,636 individuals (55% women, 45% men) with the same job characteristics measured at two times with a three year time lag was used., Methods: Main effects of demands, skill discretion, task authority and control, and the combined effects of demands and control were analysed in logistic regressions, on four outcomes representing general problem-solving strategies., Results: Those reporting high on skill discretion, task authority and control, as well as those reporting high demand/high control and low demand/high control job characteristics were more likely to state using problem solving strategies., Conclusions: Results suggest that working conditions including high levels of control may affect how individuals cope with problems and that workplace characteristics may affect behaviour in the non-work domain.

Introduction: Merkel cell carcinoma is a rare malignant cutaneous neoplasm that is locally invasive and frequently metastasizes to lymph nodes, liver, lungs, bone and brain. The incidence of Merkel cell carcinoma has increased in the past three decades., Case Presentation: A 65-year-old Caucasian man presented with a sudden onset of severe headache and a three-month history of balance disturbance. Magnetic resonance imaging revealed a large meningeal metastasis. The radiologic workup showed retroperitoneal and inguinal lymph node metastases. Biopsy of the inguinal lymph nodes showed metastases of Merkel cell carcinoma. Biopsy from three different suspected skin lesions revealed no Merkel cell carcinoma, and the primary site of Merkel cell carcinoma remained unknown. Leptomeningeal metastases, new axillary lymph node metastases, and intraspinal (epidural and intradural) metastases were detected within six, seven and eight months, respectively, from the start of symptoms despite treating the intracranial metastasis with gamma knife and the abdominal metastases with surgical dissection and external radiotherapy. This indicates the aggressive nature of the disease., Conclusion: To the best of our knowledge, this is the first report in the literature of an intracranial meningeal metastasis of Merkel cell carcinoma treated with gamma knife and of intraspinal intradural metastases of Merkel cell carcinoma. Despite good initial response to radiotherapy, recurrence and occurrence of new metastases are common in Merkel cell carcinoma.

Objective: Contingent self-esteem has been assumed to be a risk for burnout-related disorders, and a contingent self-worth notion of job burnout was applied to study the prospective relationship between job burnout and registered episodes of sickness absence of ≥ 60 consecutive days., Methods: Job burnout was defined as being in the high quartiles on the Maslach Burnout Inventory - General Survey (MBI-GS) scales of exhaustion and cynicism and, in addition, as being above the median on a scale for performance-based self-esteem. Another high exhaustion-cynicism group, a "job wornout" group, was defined as being high on the same MBI-GS scales but having performance-based self-esteem scores below the median. Data were analyzed by a multivariate, logistic regression approach., Participants: 4,109 public employees in Sweden., Results: The job burnout group showed an over-risk of long-term sickness absence incidence, both compared with a low exhaustion-cynicism reference group and with the job wornout group after adjustment for several potential confounders. No association with incidence of long-term sickness absence was found for the job wornout group., Conclusions: The differential vulnerability to long-term sickness absence among high exhaustion-cynicism groups suggests that a self-worth perspective of job burnout can be advantageous for prevention of the costly long-term sickness absences.

Background: Cherniss's pioneering research on burnout, based on grounded theory, focused specifically on competence crisis among new graduates, and identified negative attitude changes as the core phenomenon in the progression from competence crisis into early career burnout. In this model, the two main burnout dimensions of exhaustion and dysfunctional coping are ordered sequentially; i.e., initial exhaustion develops, due to dysfunctional coping (cynicism and disengagement), into burnout., Objective: To test the sequential-developmental model of burnout originally proposed by Cherniss, using a psychometric approach., Design: A sample of 933 early-career nursing professionals, recruited from a Swedish population-based cohort (response rate 81%), were assessed three years after graduation, using items from a burnout inventory. Data were analysed using the Rasch measurement model., Results: The psychometric tests showed that data adhere to a sequential-developmental model when examined using the one-parameter item response approach. When tested against external variables, the prevalence of low mood, low levels of job performance and health problems increased monotonically along this sequential-developmental model of early career burnout., Conclusion: Among early-career nursing professionals burnout may be operationalized as a one-dimensional sequential-developmental model. This model resembles the results found in the literature on transition and socialization, and the association between these psychometric results and studies on nursing students' transition and socialization into working life are discussed., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Background: Unemployment is associated with increased risk of mortality. It is, however, not clear to what extent this is causal, or whether other risk factors remain uncontrolled for. The aim of this study was to investigate the association between unemployment and all-cause and cause-specific mortality, adjusting for indicators of mental disorder, behavioural risk factors and social factors over the life course., Methods: This study was based on a cohort of 49321 Swedish males, born 1949/51, tested for compulsory military conscription in 1969/70. Data on employment/unemployment 1990-4 was based on information from the Longitudinal Register of Education and Labour Market Statistics. Information on childhood circumstances was drawn from National Population and Housing Census 1960. Information on psychiatric diagnosis and behavioral risk factors was collected at conscription testing in 1969/70. Data on mortality and hospitalisation 1973-2004 were collected in national registers., Results: An increased risk of mortality 1995-2003 was found among individuals who experienced 90 days or more of unemployment during 1992-4 compared with those still employed (all-cause mortality HR 1.91, 95% CI 1.58 to 2.31. Adjustment for risk factors measured along the life course considerably lowered the relative risk (all cause mortality HR 1.30, 95% CI 1.06 to 1.58). Statistically significant increased relative risk was found during the first 4 years of follow up (all-cause mortality, adjusted HR 1.57, 95% CI 1.13 to 2.18, but not the following 4 years (all cause mortality, adjusted HR 1.17, 95% CI 0.91 to 1.50)., Conclusion: The results suggest that a substantial part of the increased relative risk of mortality associated with unemployment may be attributable to confounding by individual risk factors.

Objectives: Studies have shown that interpersonal relations at work are important for several health related outcomes. The aim of the present study was to investigate whether low social support, serious conflict, exclusion by superiors or by co-workers at work may be determinants of depression., Methods: In a representative Swedish cohort study data were obtained in two waves three years apart. 4,040 women and men who did not change their jobs between the waves were chosen for the study. Exposure and confounders were obtained at Time 1 and outcome, depression according to Bech's MDI at Time 2. Previous depression was controlled for by adjusting for depression at Time 1. Data were analyzed using multiple logistic regression analyses., Results: Odds-ratios adjusted for possible confounders and depression at base-line showed significant effects for all four exposures on depression (adjusted OR, low social support 1.5 CI 95% 1.1-2.0, serious conflict 1.4 CI 95% 1.1-1.9, exclusion by superiors 1.6 CI 95% 1.2-2.1 and exclusion by co-workers 1.7 CI 95% 1.2-2.3)., Conclusions: The present results support the conclusion that problematic interpersonal relationships at work can be determinants of depression. These prospective findings may be of relevance for prevention and when rehabilitating depressed patients.

Objective: To give an overview of an economic crisis in Sweden and its health consequences for employed and unemployed groups together with some health-related data from participants in labour market programmes., Outcome and Conclusions: During the first half of the 1990's, Sweden was hit by a pervasive crises characterised by steeply increasing unemployment and growing job insecurity. Long-term survey data show that somatic well-being continued to improve in the population, while psychological well-being deteriorated, and this deterioration was of a similar magnitude among unemployed and employed groups. Two non-traditional labour market programmes for unemployed individuals are briefly described. Both programmes resulted in some positive effects on subjective health, which, however, were not corroborated by psychophysiological data. It is argued that the employment-unemployment dichotomy can be replaced by a dimensional view on labour market connection, as insecure jobs may have as detrimental health effects as open unemployment. Impediments to empowerment in the labour market programmes are discussed.

Short-term intra-arterial Mitomycin C treatment of hepatic metastases from various malignancies was performed in 24 evaluable patients. An objective regression was obtained in 12 patients. The median survival of responders was 11 months compared with 3 months in nonresponders. No complication of the technical procedure occurred and the treatment was well tolerated. The only side effect of clinical importance was thrombocytopenia, which occurred at a median dose of 45 mg of Mitomycin C.

In a Phase II study, 50 patients with advanced breast cancer were treated with a combination of 5-fluorouracil (1000 mg/m2 on days 1 and 2) and mitomycin C (6 mg/m2 on day 2) (FuMi regimen). The courses were repeated every third to sixth week. Although 35 patients had previously received combination chemotherapy and 40 patients had received endocrine treatment, objective responses were obtained in 29 patients (six complete, 23 partial). The survival was significantly correlated to the response (P less than 0.001, log rank test) complete versus partial response, partial response versus no change, no change versus progressive disease. The regimen was well tolerated (19 of 50 experienced nausea). Thirteen patients had hematopoietic toxicity at the day of starting a new course and in six cases, the FuMi regimen had to be discontinued because of longlasting thrombocytopenia. Otherwise, no side-effect of clinical importance was observed. The FuMi regimen is now compared with Adriamycin regimens and can be recommended for both first line chemotherapy and salvage chemotherapy.