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Stjernbrandt, A., Pettersson, H., Liljelind, I., Nilsson, T. & Wahlström, J. (2019). Raynaud's phenomenon in Northern Sweden: a population-based nested case-control study. Rheumatology International, 39(2), 265-275
Open this publication in new window or tab >>Raynaud's phenomenon in Northern Sweden: a population-based nested case-control study
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2019 (English)In: Rheumatology International, ISSN 0172-8172, E-ISSN 1437-160X, Vol. 39, no 2, p. 265-275Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to determine the association between individual and external exposure factors, and the reporting of Raynaud’s phenomenon, with or without concomitant cold sensitivity. In a population-based nested case–control study, cases with Raynaud’s phenomenon (N = 578), and matched controls (N = 1156), were asked to respond to a questionnaire focusing on different risk factors. Univariate and multiple conditional logistic regression were performed. Analyses were stratified according to whether the cases reported cold sensitivity or not. In total, 1400 out of 1734 study subjects answered the questionnaire (response rate 80.7%). In the final multiple model, the factor with the strongest association to Raynaud’s phenomenon, with and without cold sensitivity, was previous frostbite affecting the hands (OR 12.44; 95% CI 5.84–26.52 and OR 4.01; 95% CI 1.78–9.01, respectively). Upper extremity nerve injury was associated to reporting Raynaud’s phenomenon and cold sensitivity (OR 2.23; 95% CI 1.29–3.85), but not Raynaud’s phenomenon alone. Reporting any exposure to hand-arm vibration or cumulative cold exposure was significant in univariate analyses for cases with both Raynaud’s phenomenon and cold sensitivity, but not in the multiple model. Raynaud’s phenomenon is strongly associated to previous cold injury, with a larger effect size among those who also report cold sensitivity. The fact that only upper extremity nerve injury differed significantly between case groups in our multiple model offers additional support to the neural basis for cold sensitivity.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Cold exposure, Epidemiology, Frostbite, Hand, Occupational exposure, Risk factors
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-152083 (URN)10.1007/s00296-018-4133-y (DOI)000457425100009 ()30128730 (PubMedID)
Funder
Västerbotten County Council, VLL-646641
Available from: 2018-09-26 Created: 2018-09-26 Last updated: 2019-02-20Bibliographically approved
Stjernbrandt, A., Carlsson, D., Pettersson, H., Liljelind, I., Nilsson, T. & Wahlström, J. (2018). Cold sensitivity and associated factors: a nested case–control study performed in Northern Sweden. International Archives of Occupational and Environmental Health, 91(7), 785-797
Open this publication in new window or tab >>Cold sensitivity and associated factors: a nested case–control study performed in Northern Sweden
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2018 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 91, no 7, p. 785-797Article in journal (Refereed) Published
Abstract [en]

Aim To identify possible risk factors for cold sensitivity, by comparing cases to controls with regard to demographic and anthropometric characteristics, previous illnesses and injuries as well as ambient exposures.

Methods Through a questionnaire responded to by the general population (n=12,627) cold sensitivity cases (n=502) and matched controls (n=1,004) were identified and asked to respond to a second questionnaire with focus on different aspects of cold sensitivity, hereditary factors, previous diseases, medication, tobacco use as well as exposure to ambient cold climate and hand-arm vibration (HAV).

Results In total, 997 out of 1506 study subjects answered the second questionnaire, 374 cases and 623 match controls. Identified risk factors among the cases were frostbite of the hands Odds Ratio (OR) 10.3 (95% confidence interval (CI) 5.5-19.3), rheumatic disease OR 3.1 (95% CI 1.7-5.7), upper extremity nerve injury OR 2.0 (95% CI 1.3-3.0), and vascular disease OR 1.9 (95% CI 1.2-2.9). Sex differences in risk factors were HAV exposure for men and cold exposure for women increased the risk of cold sensitivity. Rheumatic diseases and migraine increased the risk of cold sensitivity among women but not among men.

Conclusions The present study shows that cold sensitivity is associated with both inherent factors, acquired conditions and external exposures. Among acquired conditions, frostbite, vascular disease, nerve injury, joint disorders and migraine are significantly related to the reporting of cold sensitivity. Among external exposures, both cold climate and HAV exposure are significantly associated to cold sensitivity, and thus suitable targets for primary preventive measures. There was a difference in risk factors related to sex. HAV exposure for men and cold exposure for women increased the risk of cold sensitivity.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2018
Keywords
Cold exposure, Cold sensitivity, Frostbite, Hand, Raynaud’s phenomenon, Sweden
National Category
Occupational Health and Environmental Health
Research subject
Occupational and Environmental Medicine
Identifiers
urn:nbn:se:umu:diva-141016 (URN)10.1007/s00420-018-1327-2 (DOI)000443357600002 ()29808434 (PubMedID)2-s2.0-85047665099 (Scopus ID)
Projects
CHINS
Note

Originally included in thesis in manuscript form with title [Cold sensitivity and associated factors: a case-control study performed in northern Sweden]

Available from: 2017-10-20 Created: 2017-10-20 Last updated: 2018-12-04Bibliographically approved
Stjernbrandt, A., Björ, B., Andersson, M., Burström, L., Liljelind, I., Nilsson, T., . . . Wahlström, J. (2017). Neurovascular hand symptoms in relation to cold exposure in northern Sweden: a population-based study. International Archives of Occupational and Environmental Health, 90(7), 587-595
Open this publication in new window or tab >>Neurovascular hand symptoms in relation to cold exposure in northern Sweden: a population-based study
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2017 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 90, no 7, p. 587-595Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To describe the self-reported ambient cold exposure in northern Sweden and to relate the level of cumulative cold exposure to the occurrence of sensory and vascular hand symptoms. We hypothesize that cold exposure is positively related to reporting such symptoms.

METHODS: A questionnaire about cold exposure and related symptoms was sent out to 35,144 subjects aged 18-70 years and living in northern Sweden.

RESULTS: A total of 12,627 out of 35,144 subjects returned the questionnaire (response rate 35.9%). Subjects living in the rural alpine areas reported more extensive cold exposure both during work and leisure time compared to the urbanized coastal regions. Frostbite in the hands was present in 11.4% of men and 7.1% of women, cold sensitivity was present in 9.7 and 14.4%, and Raynaud's phenomenon was present in 11.0% of men and 14.0% of women. There was a positive association between cumulative cold exposure and neurovascular hand symptoms.

CONCLUSION: The present study demonstrates that the cold environment in northern Sweden might be an underestimated health risk. Our hypothesis that cold exposure is positively related to reporting of neurovascular hand symptoms was supported by our findings. In addition, such symptoms were common not only in conjunction with an overt cold injury. Our results warrant further study on pathophysiological mechanisms and suggest the need for confirmatory prevalence studies to support national public health planning.

Keywords
Cold exposure, Cold sensitivity, Frostbite, Hand, Raynaud’s phenomenon, Sweden
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-133879 (URN)10.1007/s00420-017-1221-3 (DOI)000409295700003 ()28401298 (PubMedID)
Available from: 2017-04-20 Created: 2017-04-20 Last updated: 2018-06-09Bibliographically approved
Stjernbrandt, A., Björ, B., Andersson, M. & Liljelind, I. (2015). Kyla och hälsa i Norrland: deskriptiva data från enkätundersökning februari - maj 2015. Umeå: Umeå universitet
Open this publication in new window or tab >>Kyla och hälsa i Norrland: deskriptiva data från enkätundersökning februari - maj 2015
2015 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2015. p. 33
Series
Yrkes- och miljömedicin i Umeå rapporterar, ISSN 1654-7314 ; 2/2015
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-111061 (URN)
Available from: 2015-11-03 Created: 2015-11-03 Last updated: 2018-06-07Bibliographically approved
Stjernbrandt, A., Öström, M., Eriksson, A. & Björnstig, U. (2008). Land Motor Vehicle-Related Drownings in Sweden. Traffic Injury Prevention, 9(6), 539-543
Open this publication in new window or tab >>Land Motor Vehicle-Related Drownings in Sweden
2008 (English)In: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 9, no 6, p. 539-543Article in journal (Refereed) Published
Abstract [en]

Objectives: Knowledge regarding drownings related to land motor vehicle events is limited although reports of these events occur globally. This study elucidates crash and injury mechanisms in motor vehicle-related drownings in a Swedish population during 1992 through 2006 in order to suggest preventive countermeasures. Methods: The cases were identified in the National Board of Forensic Medicine database and crosschecked against the official statistics. All available autopsy reports, hospital records, and police records were analyzed. In addition, corresponding in-depth analyses performed by the Swedish Road Administration were reviewed and analyzed. Results: In total, 83 drownings occurred in 64 vehicles. The great majority of victims had no serious injuries (92% MAIS ≤ 2) and would probably have survived if they had not drowned. Most events took place in waters directly adjacent to a roadway (36%) or bridge (34%). The vehicles were most often (72%) found upside down, and most drownings occurred in shallow water (65% depth <2 m). One third (32%) of the drivers tested positive for alcohol (mean BAC of 2.0 g/L; range 0.16-2.6). The majority (69%) of the fatalities could possibly have been prevented if effective guardrails had been in place. Conclusions: Drownings in motor vehicles are not negligible events and in many cases they are preventable. Sufficient design and placement of guardrails can minimize these events, but further experimental investigation should be conducted to better understand these events and how to optimize vehicle design, rescue operations, and self-rescue.

Place, publisher, year, edition, pages
Taylor & Francis, 2008
Keywords
Accident Prevention; Alcohol; Drowning; Immersion; Injuries; Motor Vehicles
National Category
Medical and Health Sciences
Research subject
Forensic Medicine
Identifiers
urn:nbn:se:umu:diva-123326 (URN)10.1080/15389580802339150 (DOI)
Available from: 2016-07-01 Created: 2016-07-01 Last updated: 2018-06-07
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6082-8465

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