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Forsberg, Bertil, professorORCID iD iconorcid.org/0000-0002-0159-6657
Alternative names
Biography [swe]

Bertil Forsberg är professor i miljömedicin vid Umeå universitet, med forskning inriktad på miljöfaktorers effekter på hälsan. Han disputerade 1997 i epidemiologi och folkhälsovetenskap vid Umeå universitet med en avhandling om luftföroreningar och astma. År 2000 började han bygga upp epidemiologisk forskning om luftföroreningars hälsoeffekter, inledningsvis främst kring sjukdomar i andningsorganen. Senare har denna forskning breddats till att omfatta även hjärtkärlsjukdom, födelseutfall, demens och dödlighet. Forskningen om sjukdomar i andningsorganen, särskilt astma, har även undersökt faktorer kopplade till arbetsmiljö och kemisk exponering, boendemiljö och levnadsvanor. 2007 startade han forskning om hälsoeffekter av klimatförändringar och extremväder, särskilt om dödligheten under värmeböljor. Som en vidareutveckling av denna forskning har följt scenariobaserade hälsokonsekvensanalyser, t ex om miljöåtgärder och klimatförändringar. Under senare år studierna även avsett vinster med överföring från bilresor till aktiv transport.         

Publications (10 of 372) Show all publications
Wen, B., Wu, Y., Guo, Y., Gasparrini, A., Tong, S., Overcenco, A., . . . Li, S. (2024). Comparison for the effects of different components of temperature variability on mortality: A multi-country time-series study. Environment International, 187, Article ID 108712.
Open this publication in new window or tab >>Comparison for the effects of different components of temperature variability on mortality: A multi-country time-series study
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2024 (English)In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 187, article id 108712Article in journal (Refereed) Published
Abstract [en]

Background: Temperature variability (TV) is associated with increased mortality risk. However, it is still unknown whether intra-day or inter-day TV has different effects. Objectives: We aimed to assess the association of intra-day TV and inter-day TV with all-cause, cardiovascular, and respiratory mortality.

Methods: We collected data on total, cardiovascular, and respiratory mortality and meteorology from 758 locations in 47 countries or regions from 1972 to 2020. We defined inter-day TV as the standard deviation (SD) of daily mean temperatures across the lag interval, and intra-day TV as the average SD of minimum and maximum temperatures on each day. In the first stage, inter-day and intra-day TVs were modelled simultaneously in the quasi-Poisson time-series model for each location. In the second stage, a multi-level analysis was used to pool the location-specific estimates.

Results: Overall, the mortality risk due to each interquartile range [IQR] increase was higher for intra-day TV than for inter-day TV. The risk increased by 0.59% (95% confidence interval [CI]: 0.53, 0.65) for all-cause mortality, 0.64% (95% CI: 0.56, 0.73) for cardiovascular mortality, and 0.65% (95% CI: 0.49, 0.80) for respiratory mortality per IQR increase in intra-day TV0–7 (0.9 °C). An IQR increase in inter-day TV0–7 (1.6 °C) was associated with 0.22% (95% CI: 0.18, 0.26) increase in all-cause mortality, 0.44% (95% CI: 0.37, 0.50) increase in cardiovascular mortality, and 0.31% (95% CI: 0.21, 0.41) increase in respiratory mortality. The proportion of all-cause deaths attributable to intra-day TV0–7 and inter-day TV0–7 was 1.45% and 0.35%, respectively. The mortality risks varied by lag interval, climate area, season, and climate type.

Conclusions: Our results indicated that intra-day TV may explain the main part of the mortality risk related to TV and suggested that comprehensive evaluations should be proposed in more countries to help protect human health.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Inter-day, Intra-day, Mortality, Temperature variability
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-224246 (URN)10.1016/j.envint.2024.108712 (DOI)2-s2.0-85192145675 (Scopus ID)
Funder
EU, Horizon 2020, 820655
Available from: 2024-05-15 Created: 2024-05-15 Last updated: 2024-05-15Bibliographically approved
Gao, Y., Huang, W., Zhao, Q., Ryti, N., Armstrong, B., Gasparrini, A., . . . Li, S. (2024). Global, regional, and national burden of mortality associated with cold spells during 2000-19: a three-stage modelling study. The Lancet Planetary Health, 8(2), e108-e116
Open this publication in new window or tab >>Global, regional, and national burden of mortality associated with cold spells during 2000-19: a three-stage modelling study
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2024 (English)In: The Lancet Planetary Health, E-ISSN 2542-5196, Vol. 8, no 2, p. e108-e116Article in journal (Refereed) Published
Abstract [en]

Background: Exposure to cold spells is associated with mortality. However, little is known about the global mortality burden of cold spells.

Methods: A three-stage meta-analytical method was used to estimate the global mortality burden associated with cold spells by means of a time series dataset of 1960 locations across 59 countries (or regions). First, we fitted the location-specific, cold spell-related mortality associations using a quasi-Poisson regression with a distributed lag non-linear model with a lag period of up to 21 days. Second, we built a multivariate meta-regression model between location-specific associations and seven predictors. Finally, we predicted the global grid-specific cold spell-related mortality associations during 2000-19 using the fitted meta-regression model and the yearly grid-specific meta-predictors. We calculated the annual excess deaths, excess death ratio (excess deaths per 1000 deaths), and excess death rate (excess deaths per 100 000 population) due to cold spells for each grid across the world.

Findings: Globally, 205 932 (95% empirical CI [eCI] 162 692-250 337) excess deaths, representing 3·81 (95% eCI 2·93-4·71) excess deaths per 1000 deaths (excess death ratio), and 3·03 (2·33-3·75) excess deaths per 100 000 population (excess death rate) were associated with cold spells per year between 2000 and 2019. The annual average global excess death ratio in 2016-19 increased by 0·12 percentage points and the excess death rate in 2016-19 increased by 0·18 percentage points, compared with those in 2000-03. The mortality burden varied geographically. The excess death ratio and rate were highest in Europe, whereas these indicators were lowest in Africa. Temperate climates had higher excess death ratio and rate associated with cold spells than other climate zones.

Interpretation: Cold spells are associated with substantial mortality burden around the world with geographically varying patterns. Although the number of cold spells has on average been decreasing since year 2000, the public health threat of cold spells remains substantial. The findings indicate an urgency of taking local and regional measures to protect the public from the mortality burdens of cold spells.

Place, publisher, year, edition, pages
Elsevier, 2024
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-222446 (URN)10.1016/S2542-5196(23)00277-2 (DOI)38331527 (PubMedID)2-s2.0-85184714850 (Scopus ID)
Funder
EU, Horizon 2020, 820655
Available from: 2024-03-18 Created: 2024-03-18 Last updated: 2024-03-18Bibliographically approved
Kriit, H. K., Forsberg, B. & Nilsson Sommar, J. (2024). Increase in sick leave episodes from short-term fine particulate matter exposure: a case-crossover study in Stockholm, Sweden. Environmental Research, 244, Article ID 117950.
Open this publication in new window or tab >>Increase in sick leave episodes from short-term fine particulate matter exposure: a case-crossover study in Stockholm, Sweden
2024 (English)In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 244, article id 117950Article in journal (Refereed) Published
Abstract [en]

Air pollution's short-term effects on a wide range of health outcomes have been studied extensively, primarily focused on vulnerable groups (e.g., children and the elderly). However, the air pollution effects on the adult working population through sick leave have received little attention. This study aims to 1) estimate the associations between particulate matter ≤2.5 μm3 (PM2.5) and sick leave episodes and 2) calculate the attributable number of sick leave days and the consequential productivity loss in the City of Stockholm, Sweden. Individual level daily sick leave data was obtained from Statistics Sweden for the years 2011–2019. Daily average concentrations of PM2.5 were obtained from the main urban background monitoring station in Stockholm. A case-crossover study design was applied to estimate the association between short-term PM2.5 and onset of sick leave episodes. Conditional logistic regression was used to estimate the relative increase in odds of onset per 10 μg/m3 of PM2.5, adjusting for temperature, season, and pollen. A human capital method was applied to estimate the PM2.5 attributable productivity loss. In total, 1.5 million (M) individual sick leave occurrences were studied. The measured daily mean PM2.5 concentration was 4.2 μg/m3 (IQR 3.7 μg/m3). The odds of a sick leave episode was estimated to increase by 8.5% (95% CI: 7.8–9.3) per 10 μg/m3 average exposure 2–4 days before. Sub-group analysis showed that private sector and individuals 15–24 years old had a lower increase in odds of sick leave episodes in relation to PM2.5 exposure. In Stockholm, 4% of the sick leave episodes were attributable to PM2.5 exposure, corresponding to €17 M per year in productivity loss. Our study suggests a positive association between PM2.5 and sick leave episodes in a low exposure area.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Air pollution, Case-crossover, Economic evaluation, Health impact assessment, PM2.5, Sick leave episode
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-220459 (URN)10.1016/j.envres.2023.117950 (DOI)38104916 (PubMedID)2-s2.0-85183348531 (Scopus ID)
Available from: 2024-02-14 Created: 2024-02-14 Last updated: 2024-02-15Bibliographically approved
Domingo, N. G. .., Fiore, A. M., Lamarque, J.-F., Kinney, P. L., Jiang, L., Gasparrini, A., . . . Chen, K. (2024). Ozone-related acute excess mortality projected to increase in the absence of climate and air quality controls consistent with the Paris Agreement. One Earth, 7(2), 325-335
Open this publication in new window or tab >>Ozone-related acute excess mortality projected to increase in the absence of climate and air quality controls consistent with the Paris Agreement
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2024 (English)In: One Earth, ISSN 2590-3330, E-ISSN 2590-3322, Vol. 7, no 2, p. 325-335Article in journal (Refereed) Published
Abstract [en]

Short-term exposure to ground-level ozone in cities is associated with increased mortality and is expected to worsen with climate and emission changes. However, no study has yet comprehensively assessed future ozone-related acute mortality across diverse geographic areas, various climate scenarios, and using CMIP6 multi-model ensembles, limiting our knowledge on future changes in global ozone-related acute mortality and our ability to design targeted health policies. Here, we combine CMIP6 simulations and epidemiological data from 406 cities in 20 countries or regions. We find that ozone-related deaths in 406 cities will increase by 45 to 6,200 deaths/year between 2010 and 2014 and between 2050 and 2054, with attributable fractions increasing in all climate scenarios (from 0.17% to 0.22% total deaths), except the single scenario consistent with the Paris Climate Agreement (declines from 0.17% to 0.15% total deaths). These findings stress the need for more stringent air quality regulations, as current standards in many countries are inadequate.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
acute excess mortality, bias correction, climate change, CMIP6, Ozone, Paris Agreement, projection, shared socioeconomic pathways, short-term exposure
National Category
Climate Research
Identifiers
urn:nbn:se:umu:diva-220318 (URN)10.1016/j.oneear.2024.01.001 (DOI)001188239700001 ()38420618 (PubMedID)2-s2.0-85183166139 (Scopus ID)
Available from: 2024-02-13 Created: 2024-02-13 Last updated: 2024-05-07Bibliographically approved
Carsin, A.-E., Garcia-Aymerich, J., Accordini, S., Dharmage, S., Leynaert, B., De Las Heras, M., . . . Guerra, S. (2024). Spirometric patterns in young and middle-aged adults: a 20-year European study. Thorax, 79(2), 153-162
Open this publication in new window or tab >>Spirometric patterns in young and middle-aged adults: a 20-year European study
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2024 (English)In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 79, no 2, p. 153-162Article in journal (Refereed) Published
Abstract [en]

Background: Understanding the natural history of abnormal spirometric patterns at different stages of life is critical to identify and optimise preventive strategies. We aimed to describe characteristics and risk factors of restrictive and obstructive spirometric patterns occurring before 40 years (young onset) and between 40 and 61 years (mid-adult onset).

Methods: We used data from the population-based cohort of the European Community Respiratory Health Survey (ECRHS). Prebronchodilator forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were assessed longitudinally at baseline (ECRHS1, 1993-1994) and again 20 years later (ECRHS3, 2010-2013). Spirometry patterns were defined as: restrictive if FEV1/FVC≥LLN and FVC<10th percentile, obstructive if FEV1/FVC<LLN or normal otherwise. Five spirometry patterns were derived depending on whether participants never developed restrictive/obstructive (normal), developed restrictive/obstructive at baseline (young onset) or at last follow-up (mid-adult onset). The characteristics and risk factors associated with these patterns were described and assessed using multilevel multinomial logistic regression analysis adjusting for age, sex, sample (random or symptomatic) and centre.

Results: Among 3502 participants (mean age=30.4 (SD 5.4) at ECRHS1, 50.4 (SD 5.4) at ECRHS3), 2293 (65%) had a normal, 371 (11%) a young restrictive, 301 (9%) a young obstructive, 187 (5%) a mid-adult onset restrictive and 350 (10%) a mid-adult onset obstructive spirometric pattern. Being lean/underweight in childhood and young adult life was associated with the occurrence of the young spirometric restrictive pattern (relative risk ratio (RRR)=1.61 95% CI=1.21 to 2.14, and RRR=2.43 95% CI=1.80 to 3.29; respectively), so were respiratory infections before 5 years (RRR=1.48, 95% CI=1.05 to 2.08). The main determinants for young obstructive, mid-adult restrictive and mid-adult obstructive patterns were asthma, obesity and smoking, respectively.

Conclusion: Spirometric patterns with onset in young and mid-adult life were associated with distinct characteristics and risk factors.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
Keywords
Clinical Epidemiology, COPD epidemiology
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-215238 (URN)10.1136/thorax-2022-219696 (DOI)001076902900001 ()37758456 (PubMedID)2-s2.0-85173063186 (Scopus ID)
Available from: 2023-10-16 Created: 2023-10-16 Last updated: 2024-05-08Bibliographically approved
Malmqvist, E., Andersen, Z. J., Spadaro, J., Nieuwenhuijsen, M., Katsouyanni, K., Forsberg, B., . . . Hoffmann, B. (2024). Urgent call to ensure clean air for all in Europe, fight health inequalities and oppose delays in action. International Journal of Public Health, 69, Article ID 1606958.
Open this publication in new window or tab >>Urgent call to ensure clean air for all in Europe, fight health inequalities and oppose delays in action
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2024 (English)In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 69, article id 1606958Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Frontiers Media S.A., 2024
Keywords
air pollution, air quality, European Commission, health, legislation
National Category
Public Health, Global Health, Social Medicine and Epidemiology Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-221563 (URN)10.3389/ijph.2024.1606958 (DOI)001162409200001 ()38362306 (PubMedID)2-s2.0-85185147240 (Scopus ID)
Available from: 2024-03-05 Created: 2024-03-05 Last updated: 2024-03-05Bibliographically approved
Boogaard, H., Andersen, Z. J., Brunekreef, B., Forastiere, F., Forsberg, B., Hoek, G., . . . Hoffmann, B. (2023). Aria pulita in Europa per tutti. Un invito ad agire in modo più incisivo: [Clean air in Europe for all. A call for more ambitious action]. Epidemiologia & Prevenzione, 47(3), 118-121
Open this publication in new window or tab >>Aria pulita in Europa per tutti. Un invito ad agire in modo più incisivo: [Clean air in Europe for all. A call for more ambitious action]
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2023 (Italian)In: Epidemiologia & Prevenzione, ISSN 1120-9763, E-ISSN 2385-1937, Vol. 47, no 3, p. 118-121Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Inferenze Scarl, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-212244 (URN)10.19191/EP23.3.041 (DOI)2-s2.0-85164103025 (Scopus ID)
Available from: 2023-07-20 Created: 2023-07-20 Last updated: 2023-07-20Bibliographically approved
Boogaard, H., Andersen, Z. J., Brunekreef, B., Forastiere, F., Forsberg, B., Hoek, G., . . . Hoffmann, B. (2023). Clean air in Europe for all: a call for more ambitious action. Environmental Epidemiology, 7(2), Article ID E245.
Open this publication in new window or tab >>Clean air in Europe for all: a call for more ambitious action
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2023 (English)In: Environmental Epidemiology, E-ISSN 2474-7882, Vol. 7, no 2, article id E245Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Occupational Health and Environmental Health Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-205921 (URN)10.1097/EE9.0000000000000245 (DOI)2-s2.0-85149844095 (Scopus ID)
Available from: 2023-03-24 Created: 2023-03-24 Last updated: 2023-03-24Bibliographically approved
Rai, M., Stafoggia, M., de'Donato, F., Scortichini, M., Zafeiratou, S., Vazquez Fernandez, L., . . . Breitner, S. (2023). Heat-related cardiorespiratory mortality: effect modification by air pollution across 482 cities from 24 countries. Environment International, 174, Article ID 107825.
Open this publication in new window or tab >>Heat-related cardiorespiratory mortality: effect modification by air pollution across 482 cities from 24 countries
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2023 (English)In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 174, article id 107825Article in journal (Refereed) Published
Abstract [en]

Background: Evidence on the potential interactive effects of heat and ambient air pollution on cause-specific mortality is inconclusive and limited to selected locations. Objectives: We investigated the effects of heat on cardiovascular and respiratory mortality and its modification by air pollution during summer months (six consecutive hottest months) in 482 locations across 24 countries.

Methods: Location-specific daily death counts and exposure data (e.g., particulate matter with diameters ≤ 2.5 µm [PM2.5]) were obtained from 2000 to 2018. We used location-specific confounder-adjusted Quasi-Poisson regression with a tensor product between air temperature and the air pollutant. We extracted heat effects at low, medium, and high levels of pollutants, defined as the 5th, 50th, and 95th percentile of the location-specific pollutant concentrations. Country-specific and overall estimates were derived using a random-effects multilevel meta-analytical model.

Results: Heat was associated with increased cardiorespiratory mortality. Moreover, the heat effects were modified by elevated levels of all air pollutants in most locations, with stronger effects for respiratory than cardiovascular mortality. For example, the percent increase in respiratory mortality per increase in the 2-day average summer temperature from the 75th to the 99th percentile was 7.7% (95% Confidence Interval [CI] 7.6–7.7), 11.3% (95%CI 11.2–11.3), and 14.3% (95% CI 14.1–14.5) at low, medium, and high levels of PM2.5, respectively. Similarly, cardiovascular mortality increased by 1.6 (95%CI 1.5–1.6), 5.1 (95%CI 5.1–5.2), and 8.7 (95%CI 8.7–8.8) at low, medium, and high levels of O3, respectively.

Discussion: We observed considerable modification of the heat effects on cardiovascular and respiratory mortality by elevated levels of air pollutants. Therefore, mitigation measures following the new WHO Air Quality Guidelines are crucial to enhance better health and promote sustainable development.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Air pollution, Air temperature, Cardiovascular mortality, Effect modification, Heat, Respiratory mortality
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-206020 (URN)10.1016/j.envint.2023.107825 (DOI)000981629200001 ()2-s2.0-85150267738 (Scopus ID)
Funder
EU, Horizon 2020, 820655
Available from: 2023-03-28 Created: 2023-03-28 Last updated: 2023-09-05Bibliographically approved
Zhao, T., Markevych, I., Fuertes, E., de Hoogh, K., Accordini, S., Boudier, A., . . . Heinrich, J. (2023). Impact of long-term exposure to ambient ozone on lung function over a course of 20 years (The ECRHS study): a prospective cohort study in adults. The Lancet Regional Health: Europe, 34, Article ID 100729.
Open this publication in new window or tab >>Impact of long-term exposure to ambient ozone on lung function over a course of 20 years (The ECRHS study): a prospective cohort study in adults
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2023 (English)In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 34, article id 100729Article in journal (Refereed) Published
Abstract [en]

Background: While the adverse effects of short-term ambient ozone exposure on lung function are well-documented, the impact of long-term exposure remains poorly understood, especially in adults.

Methods: We aimed to investigate the association between long-term ozone exposure and lung function decline. The 3014 participants were drawn from 17 centers across eight countries, all of which were from the European Community Respiratory Health Survey (ECRHS). Spirometry was conducted to measure pre-bronchodilation forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) at approximately 35, 44, and 55 years of age. We assigned annual mean values of daily maximum running 8-h average ozone concentrations to individual residential addresses. Adjustments were made for PM2.5, NO2, and greenness. To capture the ozone-related change in spirometric parameters, our linear mixed effects regression models included an interaction term between long-term ozone exposure and age.

Findings: Mean ambient ozone concentrations were approximately 65 μg/m³. A one interquartile range increase of 7 μg/m³ in ozone was associated with a faster decline in FEV1 of −2.08 mL/year (95% confidence interval: −2.79, −1.36) and in FVC of −2.86 mL/year (−3.73, −1.99) mL/year over the study period. Associations were robust after adjusting for PM2.5, NO2, and greenness. The associations were more pronounced in residents of northern Europe and individuals who were older at baseline. No consistent associations were detected with the FEV1/FVC ratio.

Interpretation: Long-term exposure to elevated ambient ozone concentrations was associated with a faster decline of spirometric lung function among middle-aged European adults over a 20-year period. Funding: German Research Foundation.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Air pollution, Forced expiratory volume, Middle aged, NDVI, Spirometry, Vital capacity
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-214280 (URN)10.1016/j.lanepe.2023.100729 (DOI)2-s2.0-85169614645 (Scopus ID)
Available from: 2023-09-11 Created: 2023-09-11 Last updated: 2023-09-11Bibliographically approved
Projects
The potential for prevention of heat related deaths when heat waves become more extreme [2009-00454_Forte]; Umeå UniversityClimate change, source water quality, treatment and distribution ? assessment of microbial risks from health studies [2010-134_Formas]; Umeå UniversityDoes traffic related air pollution accelerate brain aging and dementia? A prospective cohort study with individual exposure data [2011-01218_Forte]; Umeå UniversityShifting from car to active transport ? an integrated environment and health impact assessment [2012-01296_Forte]; Umeå UniversityTrichloramine (NCl3) in air of indoor swimming pools and its relationship to health effects in exposed children. [2013-431_Formas]; Umeå UniversityIs exercise in an air polluted place good or bad for health [2014-01908_Forte]; Umeå UniversityThe effects of noise, socioeconomic status and genetics in the relationship between air pollution and dementia [2015-1099_Formas]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0159-6657

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