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Tornevi, Andreas
Publications (10 of 19) Show all publications
Olstrup, H., Johansson, C., Forsberg, B., Tornevi, A., Ekebom, A. & Meister, K. (2019). A Multi-Pollutant Air Quality Health Index (AQHI) Based on Short-Term Respiratory Effects in Stockholm, Sweden. International Journal of Environmental Research and Public Health, 16(1), Article ID 105.
Open this publication in new window or tab >>A Multi-Pollutant Air Quality Health Index (AQHI) Based on Short-Term Respiratory Effects in Stockholm, Sweden
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2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 1, article id 105Article in journal (Refereed) Published
Abstract [en]

In this study, an Air Quality Health Index (AQHI) for Stockholm is introduced as a tool to capture the combined effects associated with multi-pollutant exposure. Public information regarding the expected health risks associated with current or forecasted concentrations of pollutants and pollen can be very useful for sensitive persons when planning their outdoor activities. For interventions, it can also be important to know the contribution from pollen and the specific air pollutants, judged to cause the risk. The AQHI is based on an epidemiological analysis of asthma emergency department visits (AEDV) and urban background concentrations of NOx, O₃, PM10 and birch pollen in Stockholm during 2001⁻2005. This analysis showed per 10 µg·m⁻3 increase in the mean of same day and yesterday an increase in AEDV of 0.5% (95% CI: -1.2⁻2.2), 0.3% (95% CI: -1.4⁻2.0) and 2.5% (95% CI: 0.3⁻4.8) for NOx, O₃ and PM10, respectively. For birch pollen, the AEDV increased with 0.26% (95% CI: 0.18⁻0.34) for 10 pollen grains·m⁻3. In comparison with the coefficients in a meta-analysis, the mean values of the coefficients obtained in Stockholm are smaller. The mean value of the risk increase associated with PM10 is somewhat smaller than the mean value of the meta-coefficient, while for O₃, it is less than one fifth of the meta-coefficient. We have not found any meta-coefficient using NOx as an indicator of AEDV, but compared to the mean value associated with NO₂, our value of NOx is less than half as large. The AQHI is expressed as the predicted percentage increase in AEDV without any threshold level. When comparing the relative contribution of each pollutant to the total AQHI, based on monthly averages concentrations during the period 2015⁻2017, there is a tangible pattern. The AQHI increase associated with NOx exhibits a relatively even distribution throughout the year, but with a clear decrease during the summer months due to less traffic. O₃ contributes to an increase in AQHI during the spring. For PM10, there is a significant increase during early spring associated with increased suspension of road dust. For birch pollen, there is a remarkable peak during the late spring and early summer during the flowering period. Based on monthly averages, the total AQHI during 2015⁻2017 varies between 4 and 9%, but with a peak value of almost 16% during the birch pollen season in the spring 2016. Based on daily mean values, the most important risk contribution during the study period is from PM10 with 3.1%, followed by O₃ with 2.0%.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
AQHI, NOx, PM10, asthma, birch pollen, ozone, risk coefficients
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-154982 (URN)10.3390/ijerph16010105 (DOI)000459111400105 ()30609753 (PubMedID)
Funder
EU, Horizon 2020
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-04-15Bibliographically approved
Donat-Vargas, C., Bergdahl, I. A., Tornevi, A., Wennberg, M., Sommar, J., Koponen, J., . . . Åkesson, A. (2019). Associations between repeated measure of plasma perfluoroalkyl substances and cardiometabolic risk factors. Environment International, 124, 58-65
Open this publication in new window or tab >>Associations between repeated measure of plasma perfluoroalkyl substances and cardiometabolic risk factors
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2019 (English)In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 124, p. 58-65Article in journal (Refereed) Published
Abstract [en]

Background: Perfluoroalkyl substances (PFAS) are persistent synthetic chemicals that may affect components of metabolic risk through the peroxisome proliferator-activated receptor but epidemiological data remain scarce and inconsistent.

Objective: To estimate associations between repeated measurements of the main PFAS in plasma and total cholesterol, triglycerides and hypertension among the control subjects from a population-based nested case-control study on diabetes type 2 in middle-aged women and men.

Methods: Participants (n = 187) were free of diabetes at both baseline and follow-up visits to the Västerbotten Intervention Programme, 10 years apart: during 1990 to 2003 (baseline) and 2001 to 2013 (follow-up). Participants left blood samples, completed questionnaires on diet and lifestyle factors, and underwent medical examinations, including measurement of blood pressure. PFAS and lipids were later determined in stored plasma samples. Associations for the repeated measurements were assessed using generalized estimating equations.

Results: Six PFAS exceeded the limit of quantitation. Repeated measures of PFAS in plasma, cardiometabolic risk factors and confounders, showed an average decrease of triglycerides from −0.16 mmol/l (95% confidence interval [CI]: −0.33, 0.02 for PFOA) to −0.26 mmol/l (95% CI: −0.50, −0.08 for PFOS), when comparing the highest tertile of PFAS plasma levels with the lowest. Associations based on average PFAS measurements and follow-up triglycerides revealed similar inverse associations, although attenuated. The estimates for cholesterol and hypertension were inconsistent and with few exception non-significant.

Conclusions: This study found inverse associations between PFAS and triglycerides, but did not support any clear link with either cholesterol or hypertension.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Cardiometabolic risk factors, Environmental epidemiology, Hypertension, Lipids, Plasma perfluoroalkyl substances, Prospective assessment, Repeated measurements
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-156228 (URN)10.1016/j.envint.2019.01.007 (DOI)000457122700007 ()30639908 (PubMedID)2-s2.0-85059696116 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-0758Västerbotten County CouncilSwedish Research Council, 2017-00822
Available from: 2019-02-08 Created: 2019-02-08 Last updated: 2019-02-22Bibliographically approved
Tornevi, A., Sommar, J., Rantakokko, P., Åkesson, A., Donat-Vargas, C., Kiviranta, H., . . . Bergdahl, I. A. (2019). Chlorinated persistent organic pollutants and type 2 diabetes - A population-based study with pre- and post- diagnostic plasma samples. Environmental Research, 174, 35-45
Open this publication in new window or tab >>Chlorinated persistent organic pollutants and type 2 diabetes - A population-based study with pre- and post- diagnostic plasma samples
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2019 (English)In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 174, p. 35-45Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Persistent organic pollutants (POPs) have been associated with type 2 diabetes (T2D), but causality is uncertain.

OBJECTIVE: Within longitudinal population-based data from northern Sweden, we assessed how POPs associated with T2D prospectively and cross-sectionally, and further investigated factors related to individual changes in POP concentrations.

METHODS: For 129 case-controls pairs matched by age, sex and date of sampling, plasma concentrations of hexachlorobenzene (HCB), dichlorodiphenyl-dichloroethylene (p,p'-DDE), dioxin-like (DL) polychlorinated biphenyl congeners (PCB-118 and PCB-156), and non-dioxin like (NDL-PCB: PCB-74, -99, -138 -153, -170, -180, -183 and PCB-187) were analyzed twice (baseline and follow-up, 9-20 years apart). The cases received their T2D diagnose between baseline and follow-up. Prospective (using baseline data) and cross-sectional (using follow-up data) odds ratios (ORs) for T2D on lipid standardized POPs (HCB, p,p'-DDE, ∑DL-PCBs, ∑NDL-PCBs) were estimated using conditional logistic regression, adjusting for body mass index (BMI) and plasma lipids. The influence of BMI, weight-change, and plasma lipids on longitudinal changes in POP concentrations were evaluated among non-diabetic individuals (n = 306).

RESULTS: POPs were associated with T2D in both the prospective and cross-sectional assessments. Of a standard deviation increase in POPs, prospective ORs ranged 1.42 (95% CI: 0.99, 2.06) for ∑NDL-PCBs to 1.55 (95% CI: 1.01, 2.38) for HCB (p < 0.05 only for HCB), and cross-sectional ORs ranged 1.62 (95% CI: 1.13; 2.32) for p,p'-DDE to 2.06 (95% CI: 1.29, 3.28) for ∑DL-PCBs (p < 0.05 for all POPs). In analyses of non-diabetic individuals, higher baseline BMI, decreased weight and decreased plasma lipid concentrations were associated with a slower decrease of POPs. Cases had, besides a higher BMI, reduced cholesterol and weight gain at follow-up compared to controls, which can explain the higher ORs in the cross-sectional assessments.

DISCUSSION: The association between POPs and T2D was confirmed, but an indication that individuals body fat history might influence POP-T2D associations weakens the epidemiological support for a causal association. It also warrants studies based on other exposure metrics than biomonitoring. In addition, we note that a cross-sectional design overestimates the ORs if T2D cases have successfully intervened on weight and/or blood lipids, as changes in these factors cause changes in POPs.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Biomonitoring, Longitudinal data, POPs, Polychlorinated biphenyl congeners, Type 2 diabetes
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-158688 (URN)10.1016/j.envres.2019.04.017 (DOI)000470801100005 ()31029940 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-0758Swedish Research Council, VR 2017-00650
Available from: 2019-05-07 Created: 2019-05-07 Last updated: 2019-07-10Bibliographically approved
Donat-Vargas, C., Bergdahl, I., Tornevi, A., Wennberg, M., Sommar, J., Kiviranta, H., . . . Akesson, A. (2019). Perfluoroalkyl substances and risk of type II diabetes: A prospective nested case-control study. Environment International, 123, 390-398
Open this publication in new window or tab >>Perfluoroalkyl substances and risk of type II diabetes: A prospective nested case-control study
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2019 (English)In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 123, p. 390-398Article in journal (Refereed) Published
Abstract [en]

Background: Perfluoroalkyl substances (PFAS) have drawn much attention due to bioaccumulation potential and their current omnipresence in human blood. We assessed whether plasma PFAS, suspected to induce endocrine-disrupting effects, were prospectively associated with clinical type 2 diabetes (T2D) risk.

Methods: We established a nested case-control study within the Swedish prospective population-based Västerbotten Intervention Programme cohort. Several PFAS were measured in plasma from a subset of 124 case-control pairs at baseline (during 1990–2003) and at 10-year follow-up. T2D cases were matched (1:1) according to gender, age and sample date with participants without T2D (controls).

Conditional logistic regressions were used to prospectively assess risk of T2D by baseline PFAS plasma concentrations. Associations between long-term PFAS plasma levels (mean of baseline and follow-up) and insulin resistance (HOMA2-IR) and beta-cell function (HOMA2-B%) at follow-up were prospectively explored among 178 and 181 controls, respectively, by multivariable linear regressions.

Results: After adjusting for gender, age, sample year, diet and body mass index, the odds ratio of T2D for the sum of PFAS (Σ z-score PFAS) was 0.52 (95% confidence interval, CI: 0.20, 1.36), comparing third with first tertile; and 0.92 (95% CI: 0.84, 1.00) per one standard deviation increment of sum of log-transformed PFAS. Among the controls, the adjusted β of HOMA2-IR and HOMA-B% for the sum of PFAS were −0.26 (95% CI: −0.52, −0.01) and −9.61 (95% CI: −22.60, 3.39) respectively comparing third with first tertile.

Conclusions: This prospective nested case-control study yielded overall inverse associations between individual PFAS and risk of T2D, although mostly non-significant. Among participants without T2D, long-term PFAS exposure was prospectively associated with lower insulin resistance.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Environmental contaminants, Plasma perfluoroalkyl substances, Environmental risk factors, Diabetes, Insulin resistance, Endocrine disruption, Environmental epidemiology, Nested case-control study, Prospective assessment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-155947 (URN)10.1016/j.envint.2018.12.026 (DOI)000455532500044 ()30622063 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-0758Västerbotten County Council, 2017-00822Swedish Research Council
Available from: 2019-02-08 Created: 2019-02-08 Last updated: 2019-02-08Bibliographically approved
Zamir, I., Tornevi, A., Abrahamsson, T., Ahlsson, F., Engström, E., Hallberg, B., . . . Domellöf, M. (2018). Hyperglycemia in extremely preterm infants: insulin treatment, mortality and nutrient intakes. Journal of Pediatrics, 200, 104-110
Open this publication in new window or tab >>Hyperglycemia in extremely preterm infants: insulin treatment, mortality and nutrient intakes
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2018 (English)In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 200, p. 104-110Article in journal (Refereed) Published
Abstract [en]

Objective: To explore the prevalence of hyperglycemia and the associations between nutritional intakes, hyperglycemia, insulin treatment, and mortality in extremely preterm infants.

Study design: Prospectively collected data from the Extremely Preterm Infants in Sweden Study (EXPRESS) was used in this study and included 580 infants born <27 gestational weeks during 2004-2007. Available glucose measurements (n = 9850) as well as insulin treatment and nutritional data were obtained retrospectively from hospital records for the first 28 postnatal days as well as 28- and 70-day mortality data.

Results: Daily prevalence of hyperglycemia >180 mg/dL (10 mmol/L) of up to 30% was observed during the first 2 postnatal weeks, followed by a slow decrease in its occurrence thereafter. Generalized additive model analysis showed that increasing parenteral carbohydrate supply with 1 g/kg/day was associated with a 1.6% increase in glucose concentration (P < .001). Hyperglycemia was associated with more than double the 28-day mortality risk (P < .01). In a logistic regression model, insulin treatment was associated with lower 28- and 70-day mortality when given to infants with hyperglycemia irrespective of the duration of the hyperglycemic episode (P < .05).

Conclusions: Hyperglycemia is common in extremely preterm infants throughout the first postnatal month. Glucose infusions seem to have only a minimal impact on glucose concentrations. In the EXPRESS cohort, insulin treatment was associated with lower mortality in infants with hyperglycemia. Current practices of hyperglycemia treatment in extremely preterm infants should be reevaluated and assessed in randomized controlled clinical trials.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
neonatology, nutrition
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-146880 (URN)10.1016/j.jpeds.2018.03.049 (DOI)000442390400020 ()2-s2.0-85046719751 (Scopus ID)
Funder
Swedish Research Council, 2016-02095Västerbotten County Council, VLL-640871
Available from: 2018-04-20 Created: 2018-04-20 Last updated: 2019-10-01Bibliographically approved
Donat-Vargas, C., Åkesson, A., Tornevi, A., Wennberg, M., Sommar, J., Kiviranta, H., . . . Bergdahl, I. A. (2018). Persistent Organochlorine Pollutants in Plasma, Blood Pressure, and Hypertension in a Longitudinal Study. Hypertension, 71(6), 1258-1268
Open this publication in new window or tab >>Persistent Organochlorine Pollutants in Plasma, Blood Pressure, and Hypertension in a Longitudinal Study
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2018 (English)In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 71, no 6, p. 1258-1268Article in journal (Refereed) Published
Abstract [en]

Persistent organochlorine pollutants (POPs) have shown to be involved in the atherosclerotic process and to cause endothelial cell dysfunction. To assess longitudinally whether plasma concentrations of different POPs were associated with blood pressure and risk of hypertension in middle-aged women and men. Study subjects were 850 participants in the VIP (Västerbotten Intervention Programme) with 2 blood samples and blood pressure measurements, 10 years apart, during 1990 to 2003 (baseline) and during 2000 to 2013 (follow-up). Dioxin-like and nondioxin-like polychlorinated biphenyls (DL-PCBs, NDL-PCBs) and p,p'-dichlorodiphenyldichloroethylene (DDE) were measured. Associations were assessed using generalized estimating equations. At baseline sampling 49% and at follow-up 64% had hypertension. DL-PCBs and DDE, but not NDL-PCBs or hexachlorobenzene, were associated with hypertension. Only the association for DL-PCBs remained statistically significant after lipid-standardization and adjustment for body mass index and total serum lipids. The multivariable-adjusted odds ratio of hypertension based on repeated measurements were 1.52 (95% confidence interval, 1.08-2.13) for DL-PCBs (third versus first tertile of lipid-standardized POPs). In stratified adjusted analyses, odds ratio for those born after 1950 increased to 3.99 (95% confidence interval, 2.15-7.43), whereas no association was observed among those born earlier. Based on repeated measurements, the accumulated exposure to DL-PCBs and DDE, although less clear for the latter, may disrupt the normal blood pressure levels and increase the odds of hypertension. Moreover, individuals experiencing early-life POP exposure may be at elevated risk of vascular POP effects.

Keywords
DDE, dioxin-like polychlorinated biphenyls, early-life exposures, exposure via diet, hypertension
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-147706 (URN)10.1161/HYPERTENSIONAHA.117.10691 (DOI)000441020300049 ()29712742 (PubMedID)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-09-11Bibliographically approved
Tornevi, A., Simonsson, M., Forsberg, B., Säve-Söderbergh, M. & Toljander, J. (2016). Efficacy of water treatment processes and endemic gastrointestinal illness: A multi-city study in Sweden. Water Research, 102, 263-270
Open this publication in new window or tab >>Efficacy of water treatment processes and endemic gastrointestinal illness: A multi-city study in Sweden
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2016 (English)In: Water Research, ISSN 0043-1354, E-ISSN 1879-2448, Vol. 102, p. 263-270Article in journal (Refereed) Published
Abstract [en]

Outbreaks of acute gastrointestinal illnesses (AGI) have been linked to insufficient drinking water treatment on numerous occasions in the industrialized world, but it is largely unknown to what extent public drinking water influences the endemic level of AGI. This paper aimed to examine endemic AGI and the relationship with pathogen elimination efficacy in public drinking water treatment processes. For this reason, time series data of all telephone calls to the Swedish National Healthcare Guide between November 2007 and February 2014 from twenty Swedish cities were obtained. Calls concerning vomiting, diarrhea or abdominal pain (AGI calls) were separated from other concerns (non-AGI calls). Information on which type of microbial barriers each drinking water treatment plant in these cities have been used were obtained, together with the barriers' theoretical pathogen log reduction efficacy. The total log reduction in the drinking water plants varied between 0.0 and 6.1 units for viruses, 0.0-14.6 units for bacteria and 0.0-7.3 units regarding protozoans. To achieve one general efficacy parameter for each plant, a weighted mean value of the log reductions (WLR) was calculated, with the weights based on how commonly these pathogen groups cause AGI. The WLR in the plants varied between 0.0 and 6.4 units. The effect of different pathogen elimination efficacy on levels of AGI calls relative non-AGI calls was evaluated in regression models, controlling for long term trends, population size, age distribution, and climatological area. Populations receiving drinking water produced with higher total log reduction was associated with a lower relative number of AGI calls. In overall, AGI calls decreased by 4% (OR = 0.96, CI: 0.96-0.97) for each unit increase in the WLR. The findings apply to both groundwater and surface water study sites, but are particularly evident among surface water sites during seasons when viruses are the main cause of AGI. This study proposes that the endemic level of gastroenteritis can indeed be reduced with more advanced treatment processes at many municipal drinking water treatment plants.

Keywords
exhaled NO, respiratory inflammation, coarse particle matter, air pollution, children
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-125057 (URN)10.1016/j.watres.2016.06.018 (DOI)000381950400026 ()27362446 (PubMedID)
Available from: 2016-09-05 Created: 2016-09-05 Last updated: 2018-06-07Bibliographically approved
Oudin Åström, D., Tornevi, A., Ebi, K. L., Rocklöv, J. & Forsberg, B. (2016). Evolution of Minimum Mortality Temperature in Stockholm, Sweden, 1901-2009. Journal of Environmental Health Perspectives, 124(6), 740-744
Open this publication in new window or tab >>Evolution of Minimum Mortality Temperature in Stockholm, Sweden, 1901-2009
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2016 (English)In: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 124, no 6, p. 740-744Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The mortality impacts of hot and cold temperatures have been thoroughly documented, with most locations reporting a U-shaped relationship with a minimum mortality temperature (MMT) at which mortality is lowest. How MMT may have evolved over past decades as global mean surface temperature increased has not been thoroughly explored.

OBJECTIVE: We used observations of daily mean temperatures to investigate whether MMT changed in Stockholm, Sweden, from the beginning of the 20th century until 2009.

METHODS: Daily mortality and temperature data for the period 1901-2009 in Stockholm, Sweden were used to model the temperature-mortality relationship. We estimated MMT using distributed lag non-linear Poisson regression models considering lags up to 21 days of daily mean temperature as the exposure variable. To avoid large influences on the MMT from intra and inter annual climatic variability, we estimated MMT based on 30-year periods. Further, we investigated whether there were trends in the absolute value of the MMT and the relative value of the MMT (the corresponding percentile of the same day temperature distribution) over the study period.

RESULTS: Our findings suggest that both the absolute MMT and the relative MMT increased in Stockholm, Sweden over the course of the last century.

CONCLUSIONS: The increase in MMT over the course of the last century suggests autonomous adaptation within the context of the large epidemiological, demographical and societal changes that occurred. Whether the rate of increase will be sustained with climate change is an open question.

National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-111544 (URN)10.1289/ehp.1509692 (DOI)000377081300016 ()26566270 (PubMedID)
Available from: 2015-11-16 Created: 2015-11-16 Last updated: 2018-06-07Bibliographically approved
Meister, K., Tornevi, A. & Forsberg, B. (2016). Sambandet mellan luftföroreningshalter och akuta vårdkontakter för luftvägssjukdomar som hälsoindikator för luftkvalitet. Umeå
Open this publication in new window or tab >>Sambandet mellan luftföroreningshalter och akuta vårdkontakter för luftvägssjukdomar som hälsoindikator för luftkvalitet
2016 (Swedish)Report (Other academic)
Abstract [sv]

Denna studie inom den hälsorelaterade miljöövervakningen har genomförts på uppdrag av Naturvårdsverket för att belysa eventuella korttidseffekter av luftföroreningar på akutbesök för astma samt för alla sjukdomar i andningsorganen. Dessa sjukdomar medför ofta ökad känslighet för luftföroreningar. Halternas samband med akutbesök för andningsorganens sjukdomar har tidigare studerats inom miljöövervakningen. För att underlätta jämförelser har metodiken anpassats till tidigare studier där betydelsen av halterna de två senaste dygnen beräknas. Övervakning av denna typ av korttidssamband med halter i miljön är mindre känslig för trender och förändringar i diagnostik och vårdresurser än enklare epidemiologisk bevakning av antalet fall per år etc., eftersom totala antalet fall i sig kan påverkas av en rad olika typer av faktorer utan koppling till luftföroreningssituationen.

Uppgifter om den skrivna befolkningens akutbesök (vid akutmottagning samt akuta (inte planerade) inläggningar) under åren 2005 till och med 2013 för andningsorganens sjukdomar inklusive astma vid akutsjukhusen i StorStockholm, Göteborg/Mölndal respektive Malmö/Burlöv har inhämtats från Socialstyrelsens Patientregister. Uppgifterna från registret avser avidentifierade akutbesök med diagnoser dygn för dygn under perioden.

Luftföroreningsdata i form av urbana bakgrundshalter har hämtats från Stockholm luft- och bulleranalys (SLB) vid miljöförvaltningen i Stockholm och från IVL Svenska miljöinstitutet data för Göteborg respektive Malmö. Vi har studerat effekterna av partikelhalten (PM10 ~ partiklar mindre än 10 mikrometer i diameter), avgashalten indikerad med kväveoxider (NOx) samt ozon. Analyser har gjorts av akutbesök totalt för alla åldrar samt i olika åldergrupper: barn, vuxna och äldre.

Tidsserieanalyserna har utförts med Poisson-regression. I dessa analyser tas hänsyn till tidstrender, årstidsmönster, influensaperioder, väderförhållanden, pollenhalt, veckodag, helgperioder mm. Deinkluderade luftföroreningarna är ozon, kvävedioxid och partiklar (PM10). Alla luftföroreningsvariabler kan ses som indikatorer på olika typer av luftföroreningar, och har simultant beaktats i de slutliga analyserna.

I alla tre städer hade ozon effekten på akutbesök för andningsorganens sjukdomar totalt och för astma totalt. Effekten av ozon på akutbesök för andningsorganen samt på astma finns även för barn respektive vuxna separat i Stockholm och Göteborg.

Effekter av ozon kan ses som inte skiljande sig mellan de tre olika studieområdena och därför har även ensammanvägd skattning för ozon beräknats gällande antalet akutbesök för andningsorganen totalt, akutbesök för astma totalt samt akutbesök för astma bland barn. När resultaten vägdes ihop för de tre studieområdena beräknas att antalet akutbesök för andningsorganen totalt ökar med 1,6% (95% KI=1,1-2%) per 10 µg/m3 haltökning av ozon, akutbesök för astma totalt med 2,5% (95% KI=1,5-3,6% ) per 10 µg/m3 haltökning, medan akutbesök för astma bland barn med 3,9% (95% KI=1,7- 4%) per 10 µg/m3 haltökning av ozon.

Eftersom föroreningssituationen som indikatorerna representerar kan förändras med tiden har analyserna gjorts även för två olika tidsperioder: 2005-2008 samt 2009-2013. Analysen för Malmö visade på vissa statistiskt säkerställda skillnader. Effekten av ozon på akutbesök för andningsorganen totalt var högre under den senare tidsperioden, 2009-2013. Denna trend finns även för barn respektive vuxna separat.

Att analysera variationen i telefonsamtal till 1177-Vårdguiden har tidigare visat sig vara en fördelaktig metod vid studier gällande magsjuka och den mest lämpliga metoden för att tidigt detektera utbrott av magsjuka. Till följd av detta var det angeläget att undersöka om denna relativt nya databas innehållande 1177-samtal även kan vara lämplig att använda i studier som avser akuta hälsoproblem av sjukdomar i andningsorganen som kan påverkas av luftföroreningshalterna.

Som tillägg har en pilotstudie gjorts i Göteborg, där uppgifter om dygnsvisa antal samtal med kontaktorsakerna andningsproblem respektive hosta från 1177-Vårdguiden under perioden 2007-11-30 – 2013-12-01 har använts för att jämföra sambanden till luftföroreningshalter. Även här är antalsuppgifteruppdelade i olika åldersgrupper. I likhet med besöksdata påvisades effekter av luftföroreningar där ökning av PM10-halten ökade antalet samtal gällande andningsbesvär och hosta bland barn. Samtal gällande andningsbesvär hos vuxna ökade med ökande halter av ozon. Studien visar att denna typ av data kan användas för att övervaka luftföroreningsexponeringens effekter.

Place, publisher, year, edition, pages
Umeå: , 2016. p. 33
Series
Yrkes- och miljömedicin i Umeå rapporterar, ISSN 1654-7314 ; 2016:2
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-130364 (URN)
Available from: 2017-01-18 Created: 2017-01-18 Last updated: 2018-06-09Bibliographically approved
Tornevi, A., Barregård, L. & Forsberg, B. (2015). Precipitation and primary health care visits for gastrointestinal illness in Gothenburg, Sweden. PLoS ONE, 10(5), Article ID e0128487.
Open this publication in new window or tab >>Precipitation and primary health care visits for gastrointestinal illness in Gothenburg, Sweden
2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0128487Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The river Göta Älv is a source of freshwater for the City of Gothenburg, Sweden, and we recently identified a clear influence of upstream precipitation on concentrations of indicator bacteria in the river water, as well as an association with the daily number of phone calls to the nurse advice line related to acute gastrointestinal illnesses (AGI calls). This study aimed to examine visits to primary health-care centers owing to similar symptoms (AGI visits) in the same area, to explore associations with precipitation, and to compare variability in AGI visits and AGI calls.

METHODS: We obtained data covering six years (2007-2012) of daily AGI visits and studied their association with prior precipitation (0-28 days) using a distributed lag nonlinear Poisson regression model, adjusting for seasonal patterns and covariates. In addition, we studied the effects of prolonged wet and dry weather on AGI visits. We analyzed lagged short-term relations between AGI visits and AGI calls, and we studied differences in their seasonal patterns using a binomial regression model.

RESULTS: The study period saw a total of 17,030 AGI visits, and the number of daily visits decreased on days when precipitation occurred. However, prolonged wet weather was associated with an elevated number of AGI visits. Differences in seasonality patterns were observed between AGI visits and AGI calls, as visits were relatively less frequent during winter and relatively more frequent in August, and only weak short-term relations were found.

CONCLUSION: AGI visits and AGI calls seems to partly reflect different types of AGI illnesses, and the patients' choice of medical contact (in-person visits versus phone calls) appears to depend on current weather conditions. An association between prolonged wet weather and increased AGI visits supports the hypothesis that the drinking water is related to an increased risk of AGI illnesses.

Place, publisher, year, edition, pages
Public Library Science, 2015
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-103837 (URN)10.1371/journal.pone.0128487 (DOI)000355187300116 ()26020929 (PubMedID)
Available from: 2015-06-02 Created: 2015-06-02 Last updated: 2018-06-07Bibliographically approved
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