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Liljelind, Ingrid
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Publications (10 of 37) Show all publications
Forsell, K., Liljelind, I., Ljungkvist, G., Nordlinder, R., Andersson, E. & Nilsson, R. (2019). Benzene Exposure and Biomarkers in Alveolar Air and Urine Among Deck Crews on Tankers Transporting Gasoline. Annals of work exposures and health, Article ID wxz055.
Open this publication in new window or tab >>Benzene Exposure and Biomarkers in Alveolar Air and Urine Among Deck Crews on Tankers Transporting Gasoline
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2019 (English)In: Annals of work exposures and health, ISSN 2398-7316, article id wxz055Article in journal (Refereed) Epub ahead of print
Abstract [en]

INTRODUCTION: Increased rates of leukaemia have been found among tanker crews. Occupational exposures to the leukomogen benzene during loading, unloading, and tank cleaning are possible causes. Studies on older types of tankers carrying gasoline with most handling being done manually have revealed important exposures to benzene. Our study explores benzene exposures on tankers with both automatic and manual systems. Correlations between benzene exposure and benzene in alveolar air (AlvBe), benzene in urine (UBe), and trans,trans-muconic acid (ttMA) in urine were investigated.

METHODS: Forty-three male seafarers (22 deck crewmembers and 21 not on deck) on five Swedish different product and chemical tankers transporting 95- or 98-octane gasoline were investigated between 1995 and 1998. The tankers used closed systems for the loading and unloading of gasoline but stripping and tank cleaning were done manually. Benzene in respiratory air was measured using personal passive dosimeters during a 4-h work shift. Samples for biomarker analyses were collected pre- and post-shift. Smoking did occur and crewmembers did not use any respiratory protection during work.

RESULTS: The average 4-h benzene exposure level for exposed was 0.45 mg m-3 and for non-exposed 0.02 mg m-3. Benzene exposure varied with type of work (range 0.02-143 mg m-3). AlvBe, UBe, and ttMA were significantly higher in post-shift samples among exposed and correlated with exposure level (r = 0.89, 0.74, and 0.57, respectively). Smoking did not change the level of significance among exposed.

DISCUSSION: Benzene in alveolar air, unmetabolized benzene, and ttMA in urine are potential biomarkers for occupational benzene exposure. Biomarkers were detectable in non-exposed, suggesting benzene exposure even for other work categories on board tankers. Work on tankers carrying gasoline with more or less closed handling of the cargo may still lead to significant benzene exposure for deck crewmembers, and even exceed the Swedish Occupational Exposure Limit (OEL; 8-h time-weighted average [TWA]) of 1.5 mg m-3.

Place, publisher, year, edition, pages
Oxford University Press, 2019
Keywords
t, t-muconic acid, biological monitoring, chemical/product tanker, gasoline, seafarer
National Category
Public Health, Global Health, Social Medicine and Epidemiology Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-162432 (URN)10.1093/annweh/wxz055 (DOI)31382272 (PubMedID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-27
Söderholm, A., Liljelind, I., Edvardsson, B. & Nordin, S. (2019). Development and evaluation of a questionnaire instrument for chemical intolerance, based on the International Classification of Functioning, Disability and Health.. Disability and Rehabilitation, 1-8
Open this publication in new window or tab >>Development and evaluation of a questionnaire instrument for chemical intolerance, based on the International Classification of Functioning, Disability and Health.
2019 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, p. 1-8Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose: The purpose was to develop a questionnaire instrument to measure difficulties in activities and participation, and impact of environmental factors in chemical intolerance, based on the International Classification of Functioning, Disability and Health, and to assess its validity and reliability. Method: Development in three steps: (1) choosing items of relevance for chemical intolerance with an expert group, (2) conducting interviews with persons with chemical intolerance, using sampling to redundancy, (3) conducting a survey with 112 respondents at a first assessment and 91 at a second assessment for test-retest. Results: The final version of the instrument consists of 57 items divided in three parts, which showed good internal consistency in each part, Cronbach alpha: 0.73-0.87. It had good content validity, readability and face validity. Test-retest showed good to very good (≥0.61) Kappa agreement for 37 items, and moderate (0.41-0.60) for 17 items. Three items had poor or fair (<0.41) Kappa agreement. Conclusion: The instrument was found to be valid and reliable. It can be used as a clinical tool to help persons with chemical intolerance to receive the best suited help and support for each individual, identify key points in rehabilitation, measure rehabilitation outcome and establish priority for treatment. IMPLICATIONS FOR REHABILITATION The questionnaire instrument based on the International Classification of Functioning, Disability and Health which was developed and evaluated in this study, can be used to measure difficulties in activities and participation, and impact of environmental factors in chemical intolerance. Persons with chemical intolerance report lack of support from healthcare and society. Using this questionnaire instrument can help forming the best suited help and support for each individual based on his/her preconditions. This questionnaire instrument can be used to identify key points in rehabilitation and measure rehabilitation outcome.

Keywords
Chemical intolerance, International Classification of Functioning, Disability and Health, multiple chemical sensitivity, reliability, sensory hypereactivity, validity
Identifiers
urn:nbn:se:umu:diva-165800 (URN)10.1080/09638288.2019.1672812 (DOI)31591906 (PubMedID)
Available from: 2019-12-04 Created: 2019-12-04 Last updated: 2019-12-04
Shirdel, M., Bergdahl A., I., Andersson, B. M., Wingfors, H., Sommar, J. N. & Liljelind, I. E. (2019). Passive personal air sampling of dust in a working environment: A pilot study. Journal of Occupational and Environmental Hygiene, 16(10), 675-684
Open this publication in new window or tab >>Passive personal air sampling of dust in a working environment: A pilot study
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2019 (English)In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 16, no 10, p. 675-684Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to make a preliminary evaluation of the University of North Carolina passive aerosol sampler (UNC sampler) for personal air sampling of particles. Nine personal air samplings of respirable fraction were conducted in an open-pit mine, with pairwise UNC samplers and a respirable cyclone mounted on the chest of workers. UNC samples were analyzed with scanning electron microscopy (SEM) and to some extent energy dispersive X-ray spectroscopy (EDS). Respirable cyclone filter samples were weighed. Correlations and particle elemental compositions were described. Microscopic imaging of the collection surface showed that the particles were heterogeneously deposited across the surface of the UNC sampler. Collected particles were shaped as gravel particles and the resulting particle size distribution in air showed a peak at ca. 3 µm aerodynamic diameter, similarly to what has previously been reported from the same mine. The elemental composition indicated mineral origin. All correlations between the airborne mass concentrations from UNC samplers and respirable cyclones (Pearson = 0.54 and Spearman = 0.43) and between pairs of parallel UNC samplers (Pearson = 0.55 and Spearman = 0.67) were weak. The UNC sampler mass concentrations were approximately 30 times higher than those measured with the respirable cyclone. In conclusion, the UNC sampler, when used for personal sampling in a mine, provides a reasonable particle size distribution and the deposited particles appeared to be of mineral origin and not from textile or skin but the approximately 30-fold overestimation of mass concentrations when comparing with respirable cyclone sampling indicates that further improvements are necessary. Positioning of the sampler may be critical and moving the UNC sampler from the chest to e.g. the top of a helmet might be an improvement. Grounding of the sampler in order to avoid static electricity might also be useful. The UNC sampler should continue to be researched for personal sampling, as passive sampling might become a useful alternative to more laborious sampling techniques.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Area factor, UNC passive aerosol sampler, mesh factor, mineral, occupational exposure, respirable cyclone
National Category
Public Health, Global Health, Social Medicine and Epidemiology Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-162647 (URN)10.1080/15459624.2019.1648814 (DOI)000490322700001 ()31442106 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-0478
Available from: 2019-08-26 Created: 2019-08-26 Last updated: 2019-11-05Bibliographically approved
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
Hamada, H., Liljelind, I., Bruze, M., Engfeldt, M., Isaksson, M., Jönsson, B., . . . Zimerson, E. (2018). Assessment of dermal uptake of diphenylmethane-4,4'-diisocyanate using tape stripping and biological monitoring. EJD. European journal of dermatology, 28(2), 143-148
Open this publication in new window or tab >>Assessment of dermal uptake of diphenylmethane-4,4'-diisocyanate using tape stripping and biological monitoring
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2018 (English)In: EJD. European journal of dermatology, ISSN 1167-1122, E-ISSN 1952-4013, Vol. 28, no 2, p. 143-148Article in journal (Refereed) Published
Abstract [en]

Very little is known about the dermal uptake of isocyanates, and dermal exposure to isocyanates has been discussed as a factor involved in the induction of respiratory diseases. To investigate the dermal uptake of diphenylmethane-4,4'-diisocyanate (4,4'-MDI). Four volunteers were dermally exposed to 10, 25, 49 and 50 mg 4,4'-MDI, respectively, for eight hours. The exposed areas were tape stripped. Urine and blood were biologically monitored for 48 hours. Tape strips, plasma, and urine were analysed by liquid chromatography-mass spectrometry. In total, 35-70% of the applied dose of 4,4'-MDI was absorbed by the skin. Very low fractions of applied dose were found in the tape strips. The 4,4'-MDA concentration in plasma and urine was low, but peaked in urine at 10-14 hours and plasma at 8-32 hours after exposure. 4,4'-MDI is readily absorbed by human skin. Only small fractions of 4,4'-MDI remain as such in the superficial skin layers. The amounts found in blood and urine were only small fractions of the total applied doses which indicates that very small amounts of 4,4'-MDI penetrate the skin and reach the blood stream. The dermal uptake and distribution of 4,4'-MDI is much slower compared to that associated with airway uptake. Our data strongly indicate that formation of 4,4'-MDA from 4,4'-MDI upon reacting with water in the skin can only occur to a very limited extent.

Place, publisher, year, edition, pages
John Libbey Publishing, 2018
Keywords
diphenylmethane-4, 4’-diisocyanate, 4, 4’-MDI, diphenylmethane-4, 4’-diamine, 4, 4’-MDA, contact dermatitis, dermal absorption, tape stripping
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-147922 (URN)10.1684/ejd.2018.3247 (DOI)000433044600001 ()29620002 (PubMedID)
Available from: 2018-05-22 Created: 2018-05-22 Last updated: 2018-06-19Bibliographically approved
Shirdel, M., Sommar, J. N., Andersson, B. M., Bergdahl, I. A., Wingfors, H. & Liljelind, I. E. (2018). Choosing the number of images and image position when analysing the UNC Passive Aerosol Sampler for occupational exposure assessment. Journal of Occupational and Environmental Hygiene, 15(11), 767-772
Open this publication in new window or tab >>Choosing the number of images and image position when analysing the UNC Passive Aerosol Sampler for occupational exposure assessment
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2018 (English)In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 15, no 11, p. 767-772Article in journal (Refereed) Published
Abstract [en]

The University of North Carolina passive aerosol sampler (UNC sampler) could be an alternative when measuring occupational dust exposure, but the time required for microscopic imaging of the sampler needs to be reduced to make it more attractive. The aims of this study were to 1) characterise the effect on precision when reducing imaging, in order to shorten analysis time and 2) assess if the position of the images makes a difference. Eighty-eight samplers were deployed in different locations of an open pit mine. Sixty images were captured for each UNC sampler, covering 51% of its collection surface, using scanning electron microscopy. Bootstrapped samples were generated with different image combinations, to assess the within-sampler coefficient of variation (CVws) for different numbers of images. In addition, the particle concentration relative to the distance from the centre of the sampler was studied. Reducing the number of images collected from the UNC sampler led to up to 8.3% CVws for ten images when calculating respirable fraction. As the overall CV has previously been assessed to 36%, the additional contribution becomes minimal, increasing the overall CV to 37%. The mean concentrations of the images were modestly related to distance from the centre of the sampler. The CVws changed from 8.26% to 8.13% for ten images when applying rules for the image collection based on distance. Thus, the benefit of these rules on the precision is small and the images can therefore be chosen at random. In conclusion, reducing the number of images analysed from 60 to 10, corresponding to a reduction of the imaged sampling area from 51% to 8.5%, results in a negligible loss in precision for respirable fraction dust measurements in occupational environments.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Dust particles, PM10, PM2.5, occupational hygienist, passive sampling, respirable fraction
National Category
Public Health, Global Health, Social Medicine and Epidemiology Environmental Sciences
Identifiers
urn:nbn:se:umu:diva-152114 (URN)10.1080/15459624.2018.1508875 (DOI)000451621900002 ()30111275 (PubMedID)
Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2018-12-19Bibliographically 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
Shirdel, M., Andersson, B. M., Bergdahl, I., Sommar, J. N., Wingfors, H. & Liljelind, I. E. (2018). Improving the UNC passive aerosol sampler model based on comparison with commonly used aerosol sampling methods. Annals of Work Exposures and Health, 62(3), 328-338
Open this publication in new window or tab >>Improving the UNC passive aerosol sampler model based on comparison with commonly used aerosol sampling methods
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2018 (English)In: Annals of Work Exposures and Health, ISSN 2398-7308, Vol. 62, no 3, p. 328-338Article in journal (Refereed) Published
Abstract [en]

Objectives: In an occupational environment, passive sampling could be an alternative to active sampling with pumps for sampling of dust. One passive sampler is the University of North Carolina passive aerosol sampler (UNC sampler). It is often analysed by microscopic imaging. Promising results have been shown for particles above 2.5 µm, but indicate large underestimations for PM2.5. The aim of this study was to evaluate, and possibly improve, the UNC sampler for stationary sampling in a working environment.

Methods: Sampling was carried out at 8-h intervals during 24 h in four locations in an open pit mine with UNC samplers, respirable cyclones, PM10 and PM2.5 impactors, and an aerodynamic particle sizer (APS). The wind was minimal. For quantification, two modifications of the UNC sampler analysis model, UNC sampler with hybrid model and UNC sampler with area factor, were compared with the original one, UNC sampler with mesh factor derived from wind tunnel experiments. The effect of increased resolution for the microscopic imaging was examined.

Results: Use of the area factor and a higher resolution eliminated the underestimation for PM10 and PM2.5. The model with area factor had the overall lowest deviation versus the impactor and the cyclone. The intraclass correlation (ICC) showed that the UNC sampler had a higher precision and better ability to distinguish between different exposure levels compared to the cyclone (ICC: 0.51 versus 0.24), but lower precision compared to the impactor (PM10: 0.79 versus 0.99; PM2.5: 0.30 versus 0.45). The particle size distributions as calculated from the different UNC sampler analysis models were visually compared with the distributions determined by APS. The distributions were obviously different when the UNC sampler with mesh factor was used but came to a reasonable agreement when the area factor was used.

Conclusions: High resolution combined with a factor based on area only, results in no underestimation of small particles compared to impactors and cyclones and a better agreement with the APS’s particle size distributions. The UNC sampler had lower precision than the impactors, but higher than the respirable cyclone. The UNC sampler with area factor could be used for PM2.5, PM10 and respirable fraction measurements in this working environment without wind.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
inorganic dust, mesh factor, PM10, PM2.5, respirable fraction, UNC passive aerosol sampler, working environment
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-145698 (URN)10.1093/annweh/wxx110 (DOI)000432804600008 ()29300818 (PubMedID)
Available from: 2018-03-14 Created: 2018-03-14 Last updated: 2018-06-26Bibliographically approved
Shirdel, M., Wingfors, H., Andersson, B. M., Sommar, J. N., Bergdahl, I. A. & Liljelind, I. E. (2017). A pilot study: the UNC passive aerosol sampler in a working environment. Annals of Work Exposures and Health, 61(8), 1029-1034
Open this publication in new window or tab >>A pilot study: the UNC passive aerosol sampler in a working environment
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2017 (English)In: Annals of Work Exposures and Health, ISSN 2398-7308, Vol. 61, no 8, p. 1029-1034Article in journal (Refereed) Published
Abstract [en]

Objectives: Dust is generally sampled on a filter using air pumps, but passive sampling could be a cost-effective alternative. One promising passive sampler is the University of North Carolina passive aerosol sampler (UNC sampler). The aim of this study is to characterize and compare the UNC sampler’s performance with PM10 and PM2.5 impactors in a working environment.

Methods: Area sampling was carried out at different mining locations using UNC samplers in parallel with PM2.5 and PM10 impactors. Two different collection surfaces, polycarbonate (PC) and carbon tabs (CT), were employed for the UNC sampling. Sampling was carried out for 4–25 hours.

Results: The UNC samplers underestimated the concentrations compared to PM10 and PM2.5 impactor data. At the location with the highest aerosol concentration, the time-averaged mean of PC showed 24% and CT 35% of the impactor result for PM2.5. For PM10, it was 39% with PC and 58% with CT. Sample blank values differed between PC and CT. For PM2.5, PC blank values were ~7 times higher than those of CT, but only 1.8 times higher for PM10. The blank variations were larger for PC than for CT.

Conclusions: Particle mass concentrations appear to be underestimated by the UNC sampler compared to impactors, more so for PM2.5 than for PM10. CT may be preferred as a collection surface because the blank values were lower and less variable than for PC. Future validations in the working environment should include respirable dust sampling.

Place, publisher, year, edition, pages
Oxford University Press, 2017
Keywords
inorganic dust, PM2.5, PM10, scanning electron microscopy, UNC passive aerosol sampler, working environment
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-140539 (URN)10.1093/annweh/wxx067 (DOI)000417608500013 ()29028256 (PubMedID)
Available from: 2017-10-13 Created: 2017-10-13 Last updated: 2018-06-09Bibliographically 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
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