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  • 151. Malm, Annika
    et al.
    Axelsson, Gösta
    Barregard, Lars
    Ljungqvist, Jakob
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bergstedt, Olof
    Pettersson, Thomas JR
    The association of drinking water treatment and distribution network disturbances with Health Call Centre contacts for gastrointestinal illness symptoms2013In: Water Research, ISSN 0043-1354, E-ISSN 1879-2448, Vol. 47, no 13, p. 4474-4484Article in journal (Refereed)
    Abstract [en]

    There are relatively few studies on the association between disturbances in drinking water services and symptoms of gastrointestinal (GI) illness. Health Call Centres data concerning GI illness may be a useful source of information. This study investigates if there is an increased frequency of contacts with the Health Call Centre (HCC) concerning gastrointestinal symptoms at times when there is a risk of impaired water quality due to disturbances at water works or the distribution network. The study was conducted in Gothenburg, a Swedish city with 0.5 million inhabitants with a surface water source of drinking water and two water works. All HCC contacts due to GI symptoms (diarrhoea, vomiting or abdominal pain) were recorded for a three-year period, including also sex, age, and geocoded location of residence. The number of contacts with the HCC in the affected geographical areas were recorded during eight periods of disturbances in the water works (e.g. short stops of chlorine dosing), six periods of large disturbances in the distribution network (e.g. pumping station failure or pipe breaks with major consequences), and 818 pipe break and leak repairs over a three-year period. For each period of disturbance the observed number of calls was compared with the number of calls during a control period without disturbances in the same geographical area. In total about 55, 000 calls to the HCC due to GI symptoms were recorded over the three-year period, 35 per 1000 inhabitants and year, but much higher (>200) for children <3 yrs of age. There was no statistically significant increase in calls due to GI illness during or after disturbances at the water works or in the distribution network. Our results indicate that GI symptoms due to disturbances in water works or the distribution network are rare. The number of serious failures was, however limited, and further studies are needed to be able to assess the risk of GI illness in such cases. The technique of using geocoded HCC data together with geocoded records of disturbances in the drinking water network was feasible.

  • 152.
    Malmqvist, E.
    et al.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagenbjörk-Gustafsson, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Mattisson, K.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Stroh, E.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Strömgren, Magnus
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Swietlicki, E.
    Division of Nuclear Physics, Department of Physics, Lund University, Sweden.
    Rylander, L.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Hoek, G.
    Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.
    Tinnerberg, H.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Modig, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Assessing ozone exposure for epidemiological studies in Malmö and Umeå, Sweden2014In: Atmospheric Environment, ISSN 1352-2310, E-ISSN 1873-2844, Vol. 94, p. 241-248Article in journal (Refereed)
    Abstract [en]

    Ground level ozone [ozone] is considered a harmful air pollutant but there is a knowledge gap regarding its long term health effects. The main aim of this study is to develop local Land Use Regression [LUR] models that can be used to study long term health effects of ozone. The specific aim is to develop spatial LUR models for two Swedish cities, Umea and Malmo, as well as a temporal model for Malmo in order to assess ozone exposure for long term epidemiological studies. For the spatial model we measured ozone, using Ogawa passive samplers, as weekly averages at 40 sites in each study area, during three seasons. This data was then inserted in the LUR-model with data on traffic, land use, population density and altitude to develop explanatory models of ozone variation. To develop the temporal model for Malmo, hourly ozone data was aggregated into daily means for two measurement stations in Malmo and one in a rural area outside Malmo. Using regression analyses we inserted meteorological variables into different temporal models and the one that performed best for all three stations was chosen. For Malmo the LUR-model had an adjusted model R-2 of 0.40 and cross validation R-2 of 0.17. For Umea the model had an adjusted model R-2 of 0.67 and cross validation adjusted R-2 of 0.48. When restricting the model to only including measuring sites from urban areas, the Malmo model had adjusted model R-2 of 0.51 (cross validation adjusted R-2 0.33) and the Umea model had adjusted model R-2 of 0.81 (validation adjusted R-2 of 0.73). The temporal model had adjusted model R-2 0.54 and 0.61 for the two Malmo sites, the cross validation adjusted R-2 was 0.42. In conclusion, we can with moderate accuracy, at least for Umea, predict the spatial variability, and in Malmo the temporal variability in ozone variation. 

  • 153. Markevych, Iana
    et al.
    Fuertes, Elaine
    Marcon, Alessandro
    Dadvand, Payam
    Nowak, Dennis
    Aymerich, Judith Garcia
    Vienneau, Danielle
    De Hoogh, Kees
    Jarvis, Deborah
    Abramson, Michael J.
    Accordini, Simone
    Amaral, Andre
    Bentouhami, Hayat
    Bertelsen, Randi Jacobsen
    Boudier, Anne
    Bono, Roberto
    Bowatte, Gayan
    Carsin, Anne-Elie
    Dharmage, Shyamali Chandrika
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Gislason, Thorarinn
    Gnesi, Marco
    Holm, Mathias
    Jacquemin, Benedicte
    Janson, Christer
    Jogi, Rain
    Johannessen, Ane
    Keidel, Dirk
    Leynaert, Benedicte
    Perez, Jose Antonio Maldonado
    Marchetti, Piepaolo
    Migliore, Enrica
    Martinez Moratalla, Jesus
    Olsson, David
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Pin, Isabelle
    Potts, James
    Probst-Hensch, Nicole
    Ranzi, Andrea
    Luis Sanchez-Ramos, Jose
    Siroux, Valerie
    Schindler, Christian
    Soussan, David
    Sunyer, Jordi
    Svanes, Cecilie
    Urrutia Landa, Isabel
    Villani, Simona
    Weyler, Joost
    Heinrich, Joachim
    Residential greenness and lung function in a prospective cohort of European adults: The ECRHS study2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54Article in journal (Other academic)
  • 154. Martens, Dries S
    et al.
    Gouveia, Sandra
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Madhloum, Narjes
    Janssen, Bram G
    Plusquin, Michelle
    Vanpoucke, Charlotte
    Lefebvre, Wouter
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nording, Malin
    Nawrot, Tim S
    Neonatal Cord Blood Oxylipins and Exposure to Particulate Matter in the Early-Life Environment: an ENVIRONAGE Birth Cohort Study2017In: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 125, no 4, p. 691-698Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As part of the lipidome, oxylipins are bioactive lipid compounds originating from oxidation of different fatty acids. Oxylipins could provide a new target in the developmental origins model or the ability of early life exposure to change biology.

    OBJECTIVES: We studied the association between in utero PM2.5 (particulate matter with aerodynamic diameter <2.5µm) exposure and oxylipin profiles in newborns.

    METHODS: Thirty-seven oxylipins reflecting the cyclooxygenase (COX), lipoxygenase (5-LOX and 12/15-LOX) and cytochrome P450 (CYP) pathways were assayed in 197 cord blood plasma samples from the ENVIRONAGE birth cohort. Principal component (PC) analysis and multiple regression models were used to estimate associations of in utero PM2.5 exposure with oxylipin pathways and individual metabolites.

    RESULTS: A principal component representing the 5-LOX pathway (6 metabolites) was significantly positively associated with PM2.5 exposure during the entire (multiple testing-adjusted q-value = 0.05) and second trimester of pregnancy (q = 0.05). A principal component representing the 12/15-LOX pathway (11 metabolites) was positively associated with PM2.5 exposure during the second trimester of pregnancy (q = 0.05). PM2.5 was not significantly associated with the COX pathway during any time period. There was a positive but non-significant association between second trimester PM2.5 and the CYP pathway (q = 0.16).

    CONCLUSION: In utero exposure to particulate matter, particularly during the second trimester, was associated with differences in the cord blood levels of metabolites derived from the lipoxygenase pathways. These differences may indicate an effect of air pollution during in utero life on the inflammatory state of the newborn at birth. Oxylipins may be important mediators between early life exposures and health outcomes later in life.

  • 155.
    Meister, Kadri
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Luftföroreningshalter och akutbesök för astma och andra luftvägssjukdomar i Stockholm, Göteborg och Malmö 2001-2008: projektrapport till Naturvårdsverket, hälsorelaterad miljöövervakning avtal 21509012012Report (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 och alla sjukdomar i andningsorganen, vilka ofta medför 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 direkta samband 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 under åren 2001 till och med 2008 för andningsorganens sjukdomar inklusive astma vid akutsjukhusen i StorStockholm (9 sjukhus), Göteborg och Mölndal respektive Malmö 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, Göteborgs miljöförvaltning respektive Malmö miljöförvaltning. Vi har studerat partikelhalten som PM10, avgashalten indikerad med kväveoxider (NOx) samt ozon. Vi har för första gången studerat effekterna för olika åldergrupper: barn (tom 18 år), vuxna (19-64 år) och äldre (from 65 år).

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

    Sambanden skiljer sig i några fall signifikant mellan studieområdena. För akutbesök för andningsorganen totalt och för astma alla åldrar fann vi kraftigare effekter av PM10 i Malmö. För kväveoxider (NOx) och akutbesök för andningsorganen totalt liksom för astma alla åldrar var den skattade effekten högre i Stockholm. Effekten av ozon på astma alla åldrar var lägre i Malmö.

    När resultaten vägdes ihop för de tre studieområdena beräknas att antalet akutbesök för andningsorganen totalt ökar med 1.4% (95% KI =0.0-2.9%) per 10 μg/m3 PM10, akutbesök för astma med 2.1% (95% KI= -0.1-4.3%) per 10 μg/m3, medan akutbesök för astma bland barn med 2.9% (95% KI=0.9- 4.8%) per 10 μg/m3.

    Motsvarande sammanvägda resultat för NOx visar en ökning av totala antalet akutbesök för andningsorganen med 0.7% (95% KI=-0.1-1.5 %) per 10 μg/m3, akutbesök för astma med 1.6% (95% KI=0.5-2.7%) samt akutbesök för astma bland barn med 1.7% (95% KI=0.4-3.1%) per 10 μg/m3. 2

    För ozon visar de sammanvägda resultat en ökning av totala antalet akutbesök för andningsorganen med 1.3% (95% KI=0.5-2.1%) per 10 μg/m3, akutbesök för astma med 1.7% (95% KI=0.0-3.4% ) samt akutbesök för astma bland barn med 1.8% (95% KI=0.2- 3.3%) per 10 μg/m3.

    Eftersom föroreningssituationen som indikatorerna representerar kan förändras med tiden, bör analyserna upprepas med viss periodicitet. Vi ser för Malmö att vissa effekter är säkerställt högre under den senare delen av studien. I framtiden kommer trendanalyser att kunna genomföras lämpligtvis genom att resultat för 3-5-årsintervall jämförs.

  • 156.
    Meister, Kadri
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Johansson, Christer
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Estimated short-term effects of coarse particles on daily mortality in Stockholm, Sweden2012In: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 120, p. 431-436Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Whereas serious health effects associated with particles with an aerodynamic diameter ≤ 10 µm (PM10) and ≤ 2.5 µm (fine fraction; PM2.5) are documented in many studies, the effects of coarse particles with aerodynamic diameter between 2.5 and 10 µm (PM2.5-10) are still under debate. In this study we estimate the effects of short-term exposure of coarse particles on daily mortality in Stockholm.

    METHOD: We collected data on daily mortality for the years 2000-2008. Concentrations of PM10, PM2.5, O3 and CO were measured simultaneously in central Stockholm. We used additive Poisson regression models to examine the association between daily mortality and the coarse fraction at day of death and day before. Effect estimates were adjusted for other pollutants (two-pollutant models) during different seasons.

    RESULTS: We estimated a 1.68% increase [95% confidence interval (CI) 0.20, 3.15%] in daily mortality per 10 µg m-3 increase in PM2.5-10 (single-pollutant model). The association with PM2.5-10 was stronger for November - May when road dust is most important (1.69% increase, CI 0.21, 3.17%) compared to the rest of the year (1.31% increase, CI -2.08, 4.70%), although the difference was not statistically significant. When adjusted for other pollutants, particularly PM2.5, the effect estimates per 10 µg m-3 for coarse particles decreased slightly, but were still higher than corresponding effect estimates for PM2.5.

    CONCLUSIONS: Our analysis shows an increase in daily mortality associated with elevated urban background levels of coarse particles. Regulation of the coarse particle fraction should be considered, along with actions to specifically reduce coarse particle emissions, especially road dust suspension, in cities.

  • 157.
    Meister, Kadri
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sambandet mellan luftföroreningshalter och akuta vårdkontakter för luftvägssjukdomar som hälsoindikator för luftkvalitet2016Report (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.

  • 158. Melén, Erik
    et al.
    Barouki, Robert
    Barry, Maeve
    Boezen, H. Marike
    Hoffmann, Barbara
    Krauss-Etschmann, Susanne
    Koppelman, Gerard H.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Promoting respiratory public health through epigenetics research: an ERS Environment Health Committee workshop report2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 51, no 4, article id 1702410Article in journal (Refereed)
  • 159. Michelozzi, Paola
    et al.
    Accetta, Gabriele
    De Sario, Manuela
    D'Ippoliti, Daniela
    Marino, Claudia
    Baccini, Michela
    Biggeri, Annibale
    Anderson, H Ross
    Katsouyanni, Klea
    Ballester, Ferran
    Bisanti, Luigi
    Cadum, Ennio
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Forastiere, Francesco
    Goodman, Patrick G
    Hojs, Ana
    Kirchmayer, Ursula
    Medina, Sylvia
    Paldy, Anna
    Schindler, Christian
    Sunyer, Jordi
    Perucci, Carlo A
    High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities.2009In: American journal of respiratory and critical care medicine, ISSN 1535-4970, Vol. 179, no 5, p. 383-9Article in journal (Refereed)
    Abstract [en]

    RATIONALE: Episode analyses of heat waves have documented a comparatively higher impact on mortality than on morbidity (hospital admissions) in European cities. The evidence from daily time series studies is scarce and inconsistent. OBJECTIVES: To evaluate the impact of high environmental temperatures on hospital admissions during April to September in 12 European cities participating in the Assessment and Prevention of Acute Health Effects of Weather Conditions in Europe (PHEWE) project. METHODS: For each city, time series analysis was used to model the relationship between maximum apparent temperature (lag 0-3 days) and daily hospital admissions for cardiovascular, cerebrovascular, and respiratory causes by age (all ages, 65-74 age group, and 75+ age group), and the city-specific estimates were pooled for two geographical groupings of cities. MEASUREMENTS AND MAIN RESULTS: For respiratory admissions, there was a positive association that was heterogeneous between cities. For a 1 degrees C increase in maximum apparent temperature above a threshold, respiratory admissions increased by +4.5% (95% confidence interval, 1.9-7.3) and +3.1% (95% confidence interval, 0.8-5.5) in the 75+ age group in Mediterranean and North-Continental cities, respectively. In contrast, the association between temperature and cardiovascular and cerebrovascular admissions tended to be negative and did not reach statistical significance. CONCLUSIONS: High temperatures have a specific impact on respiratory admissions, particularly in the elderly population, but the underlying mechanisms are poorly understood. Why high temperature increases cardiovascular mortality but not cardiovascular admissions is also unclear. The impact of extreme heat events on respiratory admissions is expected to increase in European cities as a result of global warming and progressive population aging.

  • 160. Mindus, Stephanie
    et al.
    Malinovschi, Andrei
    Ekerljung, Linda
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gíslason, Thórarinn
    Jõgi, Rain
    Franklin, Karl A.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Holm, Mathias
    Johannessen, Ane
    Middelveld, Roelinde
    Schlünssen, Vivi
    Svanes, Cecilie
    Torén, Kjell
    Lindberg, Eva
    Janson, Christer
    Asthma and COPD overlap (ACO) is related to a high burden of sleep disturbance and respiratory symptoms: results from the RHINE and Swedish GA2LEN surveys2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 4, article id e0195055Article in journal (Refereed)
    Abstract [en]

    Background: The term Asthma and COPD Overlap (ACO) describes a condition where asthma and COPD overlap. We aimed to investigate associations between ACO and insomnia and respiratory symptoms, and to investigate the prevalence of ACO and the characteristics of subjects with ACO in two Northern European population studies.

    Methods: The study comprised 25 429 subjects aged ≥ 40 years who participated in one of two Northern European general population surveys. Both surveys included questions on asthma, COPD, respiratory and sleep-related symptoms, including difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and excessive daytime sleepiness. ACO was defined as having both self-reported asthma and COPD.

    Results: The prevalence of ACO was 1.0%. The group with ACO had a higher prevalence of both insomnia and respiratory symptoms than subjects with only asthma or COPD. Having ACO was independently associated with a 2-3 times higher probability of having sleep-related symptoms as compared with the group without asthma or COPD, after adjustment for age, sex, BMI, smoking history and educational level (adjusted odds ratio 2.14-3.36, 95% CI).

    Conclusion: Subjects with ACO have a high prevalence of insomnia and respiratory symptoms. To our knowledge, this is the first study to assess the association between sleep-related symptoms and ACO.

  • 161.
    Modig, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dahgam, Santosh
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nyberg, Fredrik
    Wass, Kristina
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Olin, Anna-Carin
    Short-Term Exposure to Ozone and Levels of Exhaled Nitric Oxide2014In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 25, no 1, p. 79-87Article in journal (Refereed)
    Abstract [en]

    Background: Adverse effects of air pollution include respiratory inflammation. A few epidemiologic studies have shown elevations in the fraction of exhaled nitric oxide, a marker of airway inflammation, after exposure to traffic-related pollutants. Methods: We examined whether short-term exposures to ozone (O-3), oxides of nitrogen (NOx), or particulate matter <10 m (PM10) were associated with proximal and distal airway inflammation. The study included 5841 randomly selected Swedish adults from 25 to 75 years of age. Fraction of exhaled nitrogen was measured at two flow rates: 50 ml/s representing the proximal airways and 270 ml/s representing the distal airways. Air pollution data were obtained from an urban monitoring site. We applied linear regression to estimate short-term associations of O-3, NOx, and PM10 with fractions of exhaled NO at 50 and 270 ml/s. Results: An interquartile range increase in 120-hour average O-3 levels was associated with a 5.1% (95% confidence interval = 1.7% to 8.5%) higher level of fraction of exhaled NO at 270 ml/s and 3.6% (-0.4% to 3.4%) higher level of the fraction of exhaled NO at 50 ml/s. For NOx, a small effect was seen for the 24-hour average on the fraction of exhaled NO at 270 ml/s, while for PM10 no clear effects were seen. There was a tendency for a weaker effect of ozone and a stronger effect of NOx in subjects with asthma. Conclusions: Exposure to O-3 was associated with a marker of distal airway inflammation, while the association was less obvious for inflammation of the proximal airways.

  • 162.
    Modig, Lars
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Perceived annoyance and asthmatic symptoms in relation to vehicle exhaust levels outside home: a cross-sectional study2007In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 6, p. 29-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exhaust emissions from vehicles is a well known problem with both epidemiological and experimental studies showing increasing adverse health effects with elevating levels. Many of the studies concerning vehicle exhausts and health are focused on health outcomes where the proportion attributed to exhaust is low, while there is less information on early and more frequent subjective indicators of adverse effects.

    METHODS: The primary aim of this study was to study perceived annoyance in relation to vehicle exhaust concentrations using modelled levels of nitrogen dioxide outside the home as an indicator with high spatial resolution. Almost 2800 persons in a random sample from three Swedish cities (Umea, Uppsala and Gothenburg) responded to our questionnaire. Questions were asked to determine the degree of annoyance related to vehicle exhausts and also the prevalence of irritating and asthmatic symptoms. Exposure was described for each participants home address by meteorological dispersion models with a 50 meter resolution.

    RESULTS: We found a significant increase of peoples' self-assessed annoyance with rising levels of NO2. The odds of being very annoyed by vehicle exhausts increased by 14% per 1 microg/m3 increase of the NO2 level (odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.11-1.18), and the odds of reporting the air as daily or almost daily irritating increased by 9% (OR = 1.09, 95% CI = 1.05-1.13). Also the odds of reporting asthmatic symptoms increased significantly with elevated NO2 levels (OR = 1.04, 95% CI = 1.01-1.07).

    CONCLUSION: This study found the degree of annoyance related to vehicle exhaust and irritating and asthmatic symptoms to be significantly dependent on the levels of traffic related pollutants outside the home. The detailed exposure assessment lowers the degree of misclassification as compared to between-city analyses, which makes the results more accurate and applicable on the local scale.

  • 163. Modig, Lars
    et al.
    Forsberg, Bertil
    Hagenbjörk-Gustafsson, Annika
    Järvholm, Bengt
    Levin, Jan-Olof
    Lindahl, Roger
    Rhén, Margaret
    Segerstedt, Bo
    Sundgren, Margit
    Sunesson, Anna-Lena
    Brorström-Lunden, Eva
    Cancerframkallande ämnen i tätortsluft Exponering och halter i Umeå 20012002Report (Other academic)
    Abstract [en]

    Exponeringen för ett antal cancerframkallande ämnen undersöktes i ett slumpmässigt urval av allmänbefolkningen i Umeå, 2001. Den huvudsakliga studien genomfördes från slutet av september till mitten av oktober som personburna 7-dygns mätningar på totalt 60 personer, medan några av mätningarna genomfördes i januari 2002. Parallellt med de personburna mätningarna genomfördes även mätningar vid två stationära platser i Umeå, bibliotekstaket och E4:an. Mätningarna omfattade bensen, 1,3-butadien, formaldehyd, acetaldehyd, PAH (polyaromatiska kolväten) samt kvävedioxid (NO2). Mätningarna genomfördes med passiva provtagare med undantag för PAH där provtagningen genomfördes med hjälp av en pump. Resultatet från de personburna provtagningarna av bensen gav medianvärdet 1,5 ?g/m3, vilket kan jämföras med resultatet från fjolårets studie i Göteborg (1?g/m3) och den av Institutet för miljömedicin (IMM) föreslagna lågrisknivån 1,3?g/m3. Exponeringen för bensen var signifikant associerad till tiden som deltagarna vistats inomhus, utomhus på arbetsplatsen, i rum med rökning samt om de var rökare. Det var marginell skillnad mellan medianhalten uppmätt vid E4:an och den personburna halten (1,6 ?g/m3 och 1,5 ?g/m3) medan halten på bibliotekstaket låg lägre (1,0 ?g/m3). Medianvärdet för butadien var 0,4 ?g/m3, vilket är samma som halten uppmätt vid E4:an men högre jämfört med halten på bibliotekstaket (0,12 ?g/m3). Det var signifikant skillnad mellan rökare och icke-rökare (p=0,007), och tid som tillbringats i rum med rökning var signifikant förknippat med ökad exponering för butadien. Mätningar genomfördes för både formaldehyd och acetaldehyd, dock redovisas enbart resultaten för formaldehyd på grund av problem med provtagningen av acetaldehyd. Bland mätningarna som genomfördes personburet var medianhalten formaldehyd 15 ?g/m3 vilket kan jämföras med resultaten från samma studie i Göteborg förra året (19 ?g/m3). Resultatet ligger inom det intervall som angivit som lågrisknivå (IMM, 12-60 ?g/m3). Halterna som uppmättes vid E4:an och Biblioteket var nästintill lika (3,5 ?g/m3 och 3,0 ?g/m3), dock var de betydligt lägre jämfört med den halt som uppmättes personburet. Bostadstyp (villa alt lägenhet), framstod som den enda variabeln som var signifikant associerad till den personburna halten formaldehyd. PAH-mätningarna genomfördes stationärt hemma hos 10 deltagare ur befolkningsurvalet, samt personburet och stationärt på 10 personer i anknytning till forskargruppen. Mediankoncentrationen av bens(a)pyren, mätt personburet, var 0,08 ng/m3 vilket är i nivå med resultaten från Göteborg. Halterna hemma hos personerna från befolkningsurvalet samt de med anknytning till kliniken var 0,17 respektive 0,07 ng/m3. De stationära utomhusmätningarna visade att halten vid E4:an var betydligt högre jämfört med halten på Bibliotekstaket (0,3 respektive 0,1 ng/m3). Kvävedioxid (NO2) mättes som ett lokalt tillägg i syfte att undersöka samband mellan NO2, som trafikindikator, och övriga ämnen. Median halten för mätningarna som gjordes personburet var 8 ?g/m3 medan resultaten från de stationära mätningarna var betydligt högre. NO2 uppvisade ingen signifikant korrelation till övriga ämnen mätta personburet. Vidare sågs inga samband till vistelse i specifika miljöer.

  • 164. Modig, Lars
    et al.
    Forsberg, Bertil
    Hagenbjörk-Gustafsson, Annika
    Järvholm, Bengt
    Levin, Jan-Olof
    Lindahl, Roger
    Rhén, Margaret
    Segerstedt, Bo
    Sundgren, Margit
    Sunesson, Anna-Lena
    Brorström-Lunden, Eva
    Cancerframkallande ämnentätortsluft - Umeå 20012002Report (Other academic)
    Abstract [en]

    Exponeringen för ett antal cancerframkallande ämnen undersöktes i ett slumpmässigturval av allmänbefolkningen i Umeå, 2001. Den huvudsakliga studien genomfördesfrån slutet av september till mitten av oktober som personburna 7-dygns mätningar påtotalt 60 personer, medan några av mätningarna genomfördes i januari 2002. Parallelltmed de personburna mätningarna genomfördes även mätningar vid två stationäraplatser i Umeå, bibliotekstaket och E4:an. Mätningarna omfattade bensen, 1,3-butadien, formaldehyd, acetaldehyd, PAH (polyaromatiska kolväten) samtkvävedioxid (NO2). Mätningarna genomfördes med passiva provtagare med undantagför PAH där provtagningen genomfördes med hjälp av en pump.Resultatet från de personburna provtagningarna av bensen gav medianvärdet1,5 ?g/m3, vilket kan jämföras med resultatet från fjolårets studie i Göteborg (1?g/m3)och den av Institutet för miljömedicin (IMM) föreslagna lågrisknivån 1,3?g/m3.Exponeringen för bensen var signifikant associerad till tiden som deltagarna vistatsinomhus, utomhus på arbetsplatsen, i rum med rökning samt om de var rökare. Detvar marginell skillnad mellan medianhalten uppmätt vid E4:an och den personburnahalten (1,6 ?g/m3 och 1,5 ?g/m3) medan halten på bibliotekstaket låg lägre (1,0?g/m3).Medianvärdet för butadien var 0,4 ?g/m3, vilket är samma som halten uppmätt vidE4:an men högre jämfört med halten på bibliotekstaket (0,12 ?g/m3). Det varsignifikant skillnad mellan rökare och icke-rökare (p=0,007), och tid som tillbringats irum med rökning var signifikant förknippat med ökad exponering för butadien.Mätningar genomfördes för både formaldehyd och acetaldehyd, dock redovisas enbartresultaten för formaldehyd på grund av problem med provtagningen av acetaldehyd.Bland mätningarna som genomfördes personburet var medianhalten formaldehyd15 ?g/m3 vilket kan jämföras med resultaten från samma studie i Göteborg förra året(19 ?g/m3). Resultatet ligger inom det intervall som angivit som lågrisknivå (IMM,12-60 ?g/m3). Halterna som uppmättes vid E4:an och Biblioteket var nästintill lika(3,5 ?g/m3 och 3,0 ?g/m3), dock var de betydligt lägre jämfört med den halt somuppmättes personburet. Bostadstyp (villa alt lägenhet), framstod som den endavariabeln som var signifikant associerad till den personburna halten formaldehyd.PAH-mätningarna genomfördes stationärt hemma hos 10 deltagare urbefolkningsurvalet, samt personburet och stationärt på 10 personer i anknytning tillforskargruppen. Mediankoncentrationen av bens(a)pyren, mätt personburet, var 0,08ng/m3 vilket är i nivå med resultaten från Göteborg. Halterna hemma hos personernafrån befolkningsurvalet samt de med anknytning till kliniken var 0,17 respektive 0,07ng/m3. De stationära utomhusmätningarna visade att halten vid E4:an var betydligthögre jämfört med halten på Bibliotekstaket (0,3 respektive 0,1 ng/m3).Kvävedioxid (NO2) mättes som ett lokalt tillägg i syfte att undersöka samband mellanNO2, som trafikindikator, och övriga ämnen. Median halten för mätningarna somgjordes personburet var 8 ?g/m3 medan resultaten från de stationära mätningarna varbetydligt högre. NO2 uppvisade ingen signifikant korrelation till övriga ämnen mättapersonburet. Vidare sågs inga samband till vistelse i specifika miljöer.

  • 165.
    Modig, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagenbjörk-Gustafsson, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jonsson, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Strömgren, Magnus
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Modell för beräkning av bensen- och 1,3-butadienhalter i omgivningsluft utifrån geografisk information om bland annat biobränsleeldning och trafik2012Report (Other academic)
    Abstract [sv]

    Luftföroreningar är ett känt folkhälsoproblem i tätorter där trafiken oftast är den största enskilda emissionskällan. Det finns dock andra källor som lokalt kan ge upphov till höga luftföroreningshalter och en sådan är småskalig biobränsleeldning. För att begränsa hälsoeffekterna av luftföroreningar finns normvärden reglerade i lagstiftning, och övervakningen av dessa kan ske via mätningar eller olika typer av beräkningar.

    Syftet med projekt har varit att tillämpa en typ av statistisk beräkningsmodell, ”Land Use Regression (LUR)”, för att predicera halterna av luftföroreningarna bensen och 1,3-butadien i ett antal tätorter med hög andel småskalig biobränsleeldning i och omkring Umeå.

    Principen för en LUR-modell är att först förklara variationen i luftföroreningshalter mellan ett begränsat antal mätpunkter med skillnader i geografiska variabler, som t.ex. populationsdensitet och trafikflöde inom olika radier runt respektive mätplats. Sedan kan modellen användas för att beräkna halten i många fler punkter. I denna studie har bensen och 1,3-butadien mätts vid tre tillfällen på 39 olika mätpunkter. Geografisk information har samlats in för respektive mätpunkt, och innefattar bland annat trafikvariabler men även uppgifter om biobränsleeldning baserat på uppgifter från sotarregister. LUR-modellen har byggts upp i enlighet med den procedur som finns beskrivet inom ett stort europeiskt forskningsprojekt, ESCAPE.

    Rapporten visar att det är möjligt utifrån geografiska variabler att predicera halten bensen och 1,3-butadien i en given punkt med acceptabel precision. Resultaten visar också att befolkningstäthet tillsammans med småskalig biobränsleeldning och trafik är de variabler som gemensamt är viktigast för årsmedelhalten bensen och 1,3-butadien.

    Denna typ av modell är således tillämpbar för att kartlägga och predicera halter av bensen och 1,3-butadien i områden med småskalig biobränsleeldning. Modellen kan även användas för att studera betydelsen av nyetablering av småskalig biobränsleeldning för halten bensen och 1,3-butadien inom t.ex. ett bostadsområde.

  • 166.
    Modig, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Rönnmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nyström, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lundbäck, B
    Andersson, C
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Vehicle exhaust exposure in an incident case-control study of adult asthma2006In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 28, no 1, p. 75-81Article in journal (Refereed)
    Abstract [en]

    The objective of this case–control study was to evaluate whether traffic-related air pollution exposure at home increases the risk of asthma in adults and to compare two commonly used exposure variables and differences between urban and rural living. Incident cases of asthma and matched controls of subjects aged 20–60 yrs were recruited in Luleå, Sweden. In total 203 cases and 203 controls were enrolled in the study. Exposure was estimated by traffic flow and measured levels of outdoor nitrogen dioxide (NO2) in the surrounding environment of each home, respectively. The relationship between measured levels of NO2 and traffic flow was studied using linear regression. The results indicated a nonsignificant tendency between living in a home close to a high traffic flow and an increased risk of asthma. The association between asthma and measured NO2 was weak and not significant, but the skin-prick test result acted as an effect modifier with a borderline significant association among positives. The correlation between traffic flow and outdoor NO2 was low. The results suggest that living close to high traffic flows might increase the asthma incidence in adults, while the tendency for nitrogen dioxide was only seen among atopics. Traffic flow and nitrogen dioxide had a lower than expected correlation.

  • 167.
    Modig, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Meister, Kadri
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE).
    Strömgren, Magnus
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Jonsson, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Betydelsen av förändring i befolkningens geografiska utbredning över tid för resultaten i en hälsokonsekvensbedömning för ett större vägprojekt: Slutrapport2015Report (Other academic)
  • 168.
    Modig, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sunesson, Anna-Lena
    Levin, Jan-Olof
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Sundgren, Margit
    Hagenbjörk-Gustafsson, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Can NO(2) be used to indicate ambient and personal levels of benzene and 1,3-butadiene in air?2004In: J Environ Monit, ISSN 1464-0325, Vol. 6, no 12, p. 957-62Article in journal (Refereed)
  • 169.
    Modig, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Torén, K
    Janson, C
    Jarvholm, B
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, B
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Vehicle exhaust outside the home and onset of asthma among adults2009In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 33, no 6, p. 1261-7Article in journal (Refereed)
    Abstract [en]

    Few studies have investigated the relationship between vehicle exhaust and new onset of asthma among adults. The aim of this prospective cohort study was to investigate the relationship between the cumulative incidence of asthma and onset asthma among adults and vehicle exhaust concentrations at home.Participants from three Swedish cities included in the RHINE (Respiratory Health in Northern Europe) Cohort constituted the study population. Exposure at each participant's home was calculated using dispersion models. We also used less than 50 meter distance to nearest major road as a more simple indicator of exposure. The adjusted model included 3609 participants of which 107 were classified as onset cases and 55 as true incident cases of asthma.There was a positive association between asthma onset (Odds Ratio, OR per 10 microg.m(-3) = 1.46, 95% Confidence Interval (CI) 1.07-1.99) and incident asthma (OR per 10 microg.m(-3) = 1.54, 95% CI 1.00-2.36) and the levels of NO2 which remained statistically significant after adjusting for potential confounders. The relationship between asthma and NO2 was not significantly modified by sex, hay fever or wheeze.This study suggests that elevated levels of vehicle exhaust outside the home increase the risk of onset and incident asthma among adults.

  • 170. Mogensen, I
    et al.
    Alving, K.
    James, A.
    Ono, J.
    Ohta, S.
    Izuhara, K.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dahlen, S.
    Janson, C.
    Malinovschi, A.
    Decreased lung function relates to increased type-2 inflammation in asthma subjects from the Swedish ga2len study2017In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 72, p. 8-8Article in journal (Other academic)
  • 171. Mogensen, Ida
    et al.
    Alving, Kjell
    Dahlen, Sven-Erik
    James, Anna
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ono, Junya
    Ohta, Shoichiro
    Venge, Per
    Borres, Magnus
    Izuhara, Kenji
    Janson, Christer
    Malinovschi, Andrei
    Fixed airflow obstruction relates to eosinophil activation in asthmatics.2019In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 2, p. 155-162Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Some asthmatics develop irreversible chronic airflow obstruction, e.g., fixed airflow obstruction (fixed-AO). This is probably a consequence of airway remodeling, but neither its relation to inflammation, nor which asthma biomarkers can be clinically useful are elucidated. We hypothesized that the presence of type-2 inflammation relates to fixed-AO.

    OBJECTIVES: Evaluate the presence of four markers for type-2 inflammation in fixed airflow obstruction among asthmatics.

    METHODS: This was a cross-sectional study of 403 participants with asthma, aged 17-75 years, from three Swedish centers. Fixed airflow obstruction was defined as forced expiratory volume during the first second (FEV1 ) over forced vital capacity (FVC) being below the lower limit of normal (LLN). The following type-2 inflammation markers were assessed: exhaled nitric oxide (FeNO), serum periostin, serum eosinophil cationic protein (S-ECP) and urinary eosinophil-derived neurotoxin (U-EDN).

    RESULTS: Elevated U-EDN (values in the highest tertile, ≥ 65.95 mg/mol creatinine) was more common in subjects with fixed-AO vs. subjects without fixed-AO: 55% vs. 29%, p<0.001. Elevated U-EDN related to increased likelihood of having fixed-AO in both all subjects and never-smoking subjects, with adjusted (adjusted for sex, age group, use of inhaled corticosteroids last week, atopy, early onset asthma, smoking history and packyears) odds ratios (aOR) of 2.38 (1.28-4.41) and 2.51 (1.04-6.07), respectively. In a separate analysis, having both elevated S-ECP (>20 μg/L) and U-EDN was related to having the highest likelihood of fixed-AO (aOR (95% CI) 6.06 (2.32-15.75)). Elevated serum periostin or FeNO did not relate to fixed-AO.

    CONCLUSIONS AND CLINICAL RELEVANCE: These findings support that type-2 inflammation, and in particular eosinophil inflammation, is found in asthma with fixed-AO. This could indicate a benefit from eosinophil-directed therapies. Further longitudinal studies are warranted to investigate causality and relation to lung function decline. This article is protected by copyright. All rights reserved.

  • 172. Moitra, Subhabrata
    et al.
    Carsin, Anne-Elie
    Abramson, Michael
    Amaral, André
    Anto, Josep Maria
    Chatzi, Vaia Lida
    Forsberg, Bertil
    Umeå University.
    Gilliland, Frank
    Real, Francisco Gomez
    Jarvis, Deborah
    Kim, Jeong-Lim
    Leynaert, Benedicte
    Piccioni, Pavilio
    Probst-Hensch, Nicole
    Siroux, Valerie
    Guerra, Stefano
    Garcia-Aymerich, Judith
    Kogevinas, Manolis
    Effect of asthma on the development of obesity among adults: Results of the European Community Respiratory Health Survey (ECRHS)2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal (Other academic)
    Abstract [en]

    Introduction: Obesity has been associated with asthma, however the reverse relation has recently been observed among children.

    Objective: To investigate whether asthma contributes to obesity incidence in adults.

    Methods: The ECRHS is a cohort study with two follow-ups around, 10-years (ECRHS-II) and 20-years (ECRHS-III) after enrolment. Participants with obesity (BMI>30kg/m2) at baseline were excluded (n=957), leaving 8618 non-obese subjects who participated in at least one follow-up. Asthmatics were described if the subjects reported ever having asthma and had an asthma attack or woke up by an attack of shortness of breath in last 12 months or on current asthma medication. We evaluated the association between: (1) asthma at baseline (ECRHS-I) and obesity at ECRHS-II; and (2) newly reported asthma at ECRHS-II and obesity at ECRHS-III.

    Results: 10.2% of asthmatics at baseline developed obesity after 10 years compared to 7.7% of non-asthmatics (Age, sex & country-adjusted relative risk: 1.26; 95% confidence interval: 1.03-1.55). Further adjustment for BMI at baseline slightly reduced this risk (RR:1.2; 95%CI: 1.0-1.4). Obesity risk was highest for those developing asthma in adulthood (RR:1.37; 95%CI: 1.01-1.86) compared to those with childhood onset asthma (RR: 1.13; 95%CI: 0.83-1.53). Asthmatics who were non-atopic at baseline had a higher risk of developing obesity at 1st follow up (RR: 1.47; 95%CI: 1.15-1.86). Similar trend was observed in newly reported asthmatics in ECRHS-II and increased obesity risk at the final follow up ECRHS-III (RR: 1.22; 95%CI: 0.86-1.73).

    Conclusion: These results suggest that asthmatics are at a higher risk of developing obesity.

  • 173. Morelli, Xavier
    et al.
    Rieux, Camille
    Cyrys, Josef
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Slama, Rémy
    Corrigendum to "Air pollution, health and social deprivation: A fine-scale risk assessment" [Environ. Res. 147 (2016) 59-70]2016In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 150, p. 664-664Article in journal (Refereed)
  • 174. Morelli, Xavier
    et al.
    Rieux, Camille
    Cyrys, Josef
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Slama, Rémy
    Air pollution, health and social deprivation: a fine-scale risk assessment2016In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 147, p. 59-70Article in journal (Refereed)
    Abstract [en]

    Risk assessment studies often ignore within-city variations of air pollutants. Our objective was to quantify the risk associated with fine particulate matter (PM2.5) exposure in 2 urban areas using fine-scale air pollution modeling and to characterize how this risk varied according to social deprivation. In Grenoble and Lyon areas (0.4 and 1.2 million inhabitants, respectively) in 2012, PM2.5 exposure was estimated on a 10×10m grid by coupling a dispersion model to population density. Outcomes were mortality, lung cancer and term low birth weight incidences. Cases attributable to air pollution were estimated overall and stratifying areas according to the European Deprivation Index (EDI), taking 10µg/m(3) yearly average as reference (counterfactual) level. Estimations were repeated assuming spatial homogeneity of air pollutants within urban area. Median PM2.5 levels were 18.1 and 19.6μg/m(3) in Grenoble and Lyon urban areas, respectively, corresponding to 114 (5.1% of total, 95% confidence interval, CI, 3.2-7.0%) and 491 non-accidental deaths (6.0% of total, 95% CI 3.7-8.3%) attributable to long-term exposure to PM2.5, respectively. Attributable term low birth weight cases represented 23.6% of total cases (9.0-37.1%) in Grenoble and 27.6% of cases (10.7-42.6%) in Lyon. In Grenoble, 6.8% of incident lung cancer cases were attributable to air pollution (95% CI 3.1-10.1%). Risk was lower by 8 to 20% when estimating exposure through background stations. Risk was highest in neighborhoods with intermediate to higher social deprivation. Risk assessment studies relying on background stations to estimate air pollution levels may underestimate the attributable risk.

  • 175. Nagel, Gabriele
    et al.
    Stafoggia, Massimo
    Pedersen, Marie
    Andersen, Zorana J
    Galassi, Claudia
    Munkenast, Jule
    Jaensch, Andrea
    Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Oftedal, Bente
    Krog, Norun H
    Aamodt, Geir
    Pyko, Andrei
    Pershagen, Göran
    Korek, Michal
    De Faire, Ulf
    Pedersen, Nancy L
    Östenson, Claes-Göran
    Fratiglioni, Laura
    Sørensen, Mette
    Tjønneland, Anne
    Peeters, Petra H
    Bueno-de-Mesquita, Bas
    Vermeulen, Roel
    Eeftens, Marloes
    Plusquin, Michelle
    Key, Timothy J
    Concin, Hans
    Lang, Alois
    Wang, Meng
    Tsai, Ming-Yi
    Grioni, Sara
    Marcon, Alessandro
    Krogh, Vittorio
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Ranzi, Andrea
    Cesaroni, Giulia
    Forastiere, Francesco
    Tamayo-Uria, Ibon
    Amiano, Pilar
    Dorronsoro, Miren
    de Hoogh, Kees
    Beelen, Rob
    Vineis, Paolo
    Brunekreef, Bert
    Hoek, Gerard
    Raaschou-Nielsen, Ole
    Weinmayr, Gudrun
    Air pollution and incidence of cancers of the stomach and the upper aerodigestive tract in the European Study of Cohorts for Air Pollution Effects (ESCAPE)2018In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 143, no 7, p. 1632-1643Article in journal (Refereed)
    Abstract [en]

    Air pollution has been classified as carcinogenic to humans. However, to date little is known about the relevance for cancersof the stomach and upper aerodigestive tract (UADT). We investigated the association of long-term exposure to ambient airpollution with incidence of gastric and UADT cancer in 11 European cohorts. Air pollution exposure was assigned by land-useregression models for particulate matter (PM) below 10mm (PM10), below 2.5mm (PM2.5), between 2.5 and 10mm (PMcoarse),PM2.5absorbance and nitrogen oxides (NO2and NOX) as well as approximated by traffic indicators. Cox regression modelswith adjustment for potential confounders were used for cohort-specific analyses. Combined estimates were determined withrandom effects meta-analyses. During average follow-up of 14.1 years of 305,551 individuals, 744 incident cases of gastriccancer and 933 of UADT cancer occurred. The hazard ratio for an increase of 5mg/m3of PM2.5was 1.38 (95% CI 0.99; 1.92)for gastric and 1.05 (95% CI 0.62; 1.77) for UADT cancers. No associations were found for any of the other exposures consid-ered. Adjustment for additional confounders and restriction to study participants with stable addresses did not influencemarkedly the effect estimate for PM2.5and gastric cancer. Higher estimated risks of gastric cancer associated with PM2.5wasfound in men (HR 1.98 [1.30; 3.01]) as compared to women (HR 0.85 [0.5; 1.45]). This large multicentre cohort study showsan association between long-term exposure to PM2.5and gastric cancer, but not UADT cancers, suggesting that air pollutionmay contribute to gastric cancer risk.

  • 176. Nawrot, Tim S
    et al.
    Kuenzli, Nino
    Sunyer, Jordi
    Shi, Tingming
    Moreno, Teresa
    Viana, Mar
    Heinrich, Joachim
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Kelly, Frank J
    Sughis, Muhammad
    Nemery, Benoit
    Borm, Paul
    Oxidative properties of ambient PM2.5 and elemental composition: heterogeneous associations in 19 European cities2009In: Atmospheric Environment, ISSN 1352-2310, E-ISSN 1873-2844, Vol. 43, no 30, p. 4595-4602Article in journal (Refereed)
    Abstract [en]

    We assessed the extent to which constituents of PM2.5 (transition metals, sodium, chloride) contribute to the ability to generate hydroxyl radicals (OH) in vitro in PM2.5 sampled at 20 locations in 19 European centres participating in the European Community Respiratory Health Survey. PM2.5 samples (n = 716) were collected on filters over one year and the oxidative activity of particle suspensions obtained from these filters was then assessed by measuring their ability to generate OH in the presence of hydrogen peroxide. Associations between OH formation and the studied PM constituents were heterogeneous. The total explained variance ranged from 85% in Norwich to only 6% in Albacete. Among the 20 centres, 15 showed positive correlations between one or more of the measured transition metals (copper, iron, manganese, lead, vanadium and titanium) and OH formation. In 9 of 20 centres OH formation was negatively associated with chloride, and in 3 centres with sodium. Across 19 European cities, elements which explained the largest variations in OH formation were chloride, iron and sodium.

  • 177. Nerpin, E.
    et al.
    Olivieri, M.
    Gislason, T.
    Olin, A. C.
    Nielsen, R.
    Johannessen, A.
    Ferreira, D. S.
    Marcon, A.
    Cazzoletti, L.
    Accordini, S.
    Pin, I.
    Corsico, A.
    Demoly, P.
    Weyler, J.
    Nowak, D.
    Jõgi, R.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Zock, J.P.
    Sigsgaard, T.
    Heinric, J.
    Bono, R.
    Leynaert, B.
    Jarvis, D.
    Janson, C.
    Malinovschi, A.
    Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III2019In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 7, p. 969-979Article in journal (Refereed)
    Abstract [en]

    Introduction: The fractional exhaled nitric oxide (FENO) is a marker for type 2 inflammation used in diagnostics and management of asthma. In order to use FENO as a reliable biomarker, it is important to investigate factors that influence FENO in healthy individuals. Men have higher levels of FENO than women, but it is unclear whether determinants of FENO differ by sex.

    Objective: To identify determinants of FENO in men and women without lung diseases.

    Method: FENO was validly measured in 3,881 healthy subjects that had answered the main questionnaire of the European Community Respiratory Health Survey III without airways or lung disease

    Results: Exhaled NO levels were 21.3% higher in men compared with women p<0.001. Being in the upper age quartile (60.3–67.6 years) men had 19.2 ppb (95% CI: 18.3, 20.2) higher FENO than subjects in the lowest age quartile (39.7–48.3 years) p=0.02. Women in the two highest age quartiles (54.6–60.2 and 60.3–67.6 years) had 15.4 ppb (14.7, 16.2), p=0.03 and 16.4 ppb (15.6, 17.1), p=<0.001 higher FENO, compared with the lowest age quartile.

    Height was related to 8% higher FENO level in men (p<0.001) and 5% higher FENO levels in women (p=0.008). Men who smoked had 37% lower FENO levels and women had 30% lower levels compared with never‐smokers (p<0.001 for both). Men and women sensitized to both grass and perennial allergens had higher FENO levels compared with non‐sensitized subjects 26% and 29%, p<0.001 for both.

    Conclusion & Clinical Relevance: FENO levels were higher in men than women. Similar effects of current smoking, height, and IgE sensitization were found in both sexes. FENO started increasing at lower age in women than in men, suggesting that interpretation of FENO levels in adults aged over 50 years should take into account age and sex.

  • 178. Newson, R. B.
    et al.
    Jones, M.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Janson, C.
    Bossios, A.
    Dahlen, S.-E.
    Toskala, E. M.
    Al-Kalemji, A.
    Kowalski, M. L.
    Rymarczyk, B.
    Salagean, E. M.
    van Drunen, C. M.
    Bachert, C.
    Wehrend, T.
    Krämer, U.
    Mota-Pinto, A.
    Burney, P.
    Leynaert, B.
    Jarvis, D.
    The association of asthma, nasal allergies, and positive skin prick tests with obesity, leptin, and adiponectin2014In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 44, no 2, p. 250-260Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cross-sectional and longitudinal reports show that obese adults have more asthma than non-obese adults. A proposed mechanism is via effects of adipokines (leptin and adiponectin) on the immune system.

    OBJECTIVE: We wished to measure the associations of asthma and other atopic diseases with serum adipokine levels and to find whether the associations with asthma were strong enough to rule out the possibility that they are secondary to the association of fatness measures with asthma.

    METHODS: The Global Asthma and Allergy Network of Excellence (GA(2) LEN) clinical follow-up survey is a clinical survey, embedded in a larger multi-centre cross-sectional postal survey, involving, with a case/control design, enrichment of the sample with subjects with asthma and chronic rhinosinusitis (CRS). We recorded serum leptin or adiponectin in 845 men and 1110 women in 15 centres and also anthropometric measures of fatness including body mass index and waist/hip ratio, current asthma, and specific skin prick and IgE sensitisation. We used inverse sampling-probability-weighted rank and regression statistics to measure population associations of disease outcomes with adipokines in males and females, adjusting for confounders (area, age, smoking history, and number of elder siblings) and also mutually adjusting associations with adipokines and fatness measures.

    RESULTS: One thousand nine hundred and fifty-five subjects aged 16-77 years had information on leptin or adiponectin levels. Leptin and leptin/adiponectin ratio were positively associated with the level of asthma, especially in females (Somers' D of leptin by asthma score, 0.20; 95% CI, 0.08-0.30; P = 0.00079). These associations were attenuated after adjusting for confounders and became non-significant after additionally adjusting for fatness measures and multiple comparisons.

    CONCLUSIONS AND CLINICAL RELEVANCE: Asthma levels are positively associated with serum leptin. However, we cannot rule out the possibility that this association is secondary to associations of both with fatness measures.

  • 179. Newson, R B
    et al.
    van Ree, R
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Janson, C
    Lötvall, J
    Dahlén, S-E
    Toskala, E M
    Baelum, J
    Brożek, G M
    Kasper, L
    Kowalski, M L
    Howarth, P H
    Fokkens, W J
    Bachert, C
    Keil, T
    Krämer, U
    Bislimovska, J
    Gjomarkaj, M
    Loureiro, C
    Burney, P G J
    Jarvis, D
    Geographical variation in the prevalence of sensitization to common aeroallergens in adults: the GA2LEN survey2014In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 69, no 5, p. 643-651Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Geographical variation in the prevalence of sensitization to aeroallergens may reflect differences in exposure to risk factors such as having older siblings, being raised on a farm or other unidentified exposures.

    OBJECTIVE: We wanted to measure geographical variation in skin prick test positivity and assess whether it was explained by differences in family size and/or farm exposure. We also compared prevalence in younger and older subjects.

    METHODS: Within the Global Allergy and Asthma European Network (GA(2) LEN) survey, we measured the prevalence of skin prick positivity to a panel of allergens, and geometric mean serum total immunoglobulin E (IgE), in 3451 participants aged 18-75 years in 13 areas of Europe. Estimated prevalence was standardized to account for study design. We compared prevalence estimates in younger and older subjects and further adjusted for age, gender, smoking history, farm exposure, number of older siblings and body mass index (BMI).

    RESULTS: Skin prick test positivity to any one of the measured allergens varied within Europe from 31.4% to 52.9%. Prevalence of sensitization to single allergens also varied. Variation in serum total IgE was less marked. Younger participants had higher skin prick sensitivity prevalence, but not total IgE, than older participants. Geographical variation remained even after adjustment for confounders.

    CONCLUSION: Geographical variation in the prevalence of skin prick test positivity in Europe is unlikely to be explained by geographical variation in gender, age, smoking history, farm exposure, family size and BMI. Higher prevalence in younger, compared to older, adults may reflect cohort-associated increases in sensitization or the influence of ageing on immune or tissue responses.

  • 180.
    Nordberg, Gunnar F
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundström, Nils-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagenbjörk-Gustafsson, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lagerkvist, Birgitta J-Son
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Svensson, Mona
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Blomberg, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
    Nilsson, Leif
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Bernard, Alfred
    Dumont, Xavier
    Bertilsson, Helen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Eriksson, Kåre
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lung function in volunteers before and after exposure to trichloramine in indoor pool environments and asthma in a cohort of pool workers2012In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 5, p. e000973-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Exposure to trichloramine (NCl(3)) in indoor swimming-pool environments is known to cause mucous membrane irritation, but if it gives rise to changes in lung function or asthma in adults is not known. (1) We determined lung function in volunteers before and after exposure to indoor pool environments. (2) We studied the occurrence of respiratory symptoms and asthma in a cohort of pool workers.

    DESIGN/METHODS/PARTICIPANTS: (1) We studied two groups of volunteers, 37 previously non-exposed healthy persons and 14 pool workers, who performed exercise for 2 h in an indoor pool environment. NCl(3) in air was measured during pool exposures and in 10 other pool environments. Filtered air exposures were used as controls. Lung function and biomarkers of pulmonary epithelial integrity were measured before and after exposure. (2) We mailed a questionnaire to 1741 persons who indicated in the Swedish census 1990 that they worked at indoor swimming-pools.

    RESULTS: (1) In previously non-exposed volunteers, statistically significant decreases in FEV(1) (forced expiratory volume) and FEV(%) (p=0.01 and 0.05, respectively) were found after exposure to pool air (0.23 mg/m(3) of NCl(3)). In pool workers, a statistically significant decrease in FEV(%) (p=0.003) was seen (but no significant change of FEV(1))(.) In the 10 other pool environments the median NCl(3) concentration was 0.18 mg/m(3). (2) Our nested case/control study in pool workers found an OR for asthma of 2.31 (95% CI 0.79 to 6.74) among those with the highest exposure. Exposure-related acute mucous membrane and respiratory symptoms were also found.

    CONCLUSIONS: This is the first study in adults showing statistically significant decreases in lung function after exposure to NCl(3). An increased OR for asthma among highly exposed pool workers did not reach statistical significance, but the combined evidence supports the notion that current workroom exposures may contribute to asthma development. Further research on sensitive groups is warranted.

  • 181. Obaseki, D
    et al.
    Potts, J
    Joos, G
    Baelum, J
    Haahtela, T
    Ahlström, M
    Matricardi, P
    Kramer, U
    Gjomarkaj, M
    Fokkens, W
    Makowska, J
    Todo-Bom, A
    Toren, K
    Janson, C
    Dahlen, S-E
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jarvis, D
    Howarth, P
    Brozek, G
    Minov, J
    Bachert, C
    Burney, P
    The relation of airway obstruction to asthma, chronic rhinosinusitis and age: results from a population survey of adults2014In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 69, no 9, p. 1205-1214Article in journal (Refereed)
    Abstract [en]

    RATIONALE: There is conflicting evidence on whether patients with asthma experience an accelerated decline in lung function with age. We examined the association between postbronchodilator lung function, asthma, chronic rhinosinusitis (CRS), and atopy with age using a large European sample.

    METHODS: In 17 centers in 11 European countries, case-control studies were nested within representative cross-sectional surveys of adults aged less than 75 years. Representative samples of participants with asthma, CRS or both and controls were assessed for postbronchodilator ventilatory function, smoking history, atopy, and treatment. Multiple regression was used to assess the interactive effects of age and diagnostic group on decline in postbronchodilator ventilatory function.

    RESULTS: A total of 3337 participants provided adequate data (778 with asthma, 399 with CRS, 244 with both asthma and CRS and 1916 controls who had neither asthma nor CRS). Participants with asthma had lower FEV1 /FVC (-4.09% (95% CI: -5.02, -3.15, P < 0.001) and a steeper slope of FEV1 /FVC against age (-0.14%/annum [95%CI: -0.19, -0.08]) equivalent to smoking 1-2 packs of cigarettes per day. Those with atopy had a slope equivalent to controls.

    CONCLUSIONS: People with asthma have a steeper decline in postbronchodilator lung function with age, but neither CRS nor atopy alone were associated with such decline.

  • 182. Olivieri, Mario
    et al.
    Heinrich, Joachim
    Schlünssen, Vivi
    Antó, Josep M
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Janson, Christer
    Leynaert, Benedicte
    Norback, Dan
    Sigsgaard, Torben
    Svanes, Cecilie
    Tischer, Christina
    Villani, Simona
    Jarvis, Debbie
    Verlato, Giuseppe
    The risk of respiratory symptoms on allergen exposure increases with increasing specific IgE levels.2016In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 71, no 6, p. 859-868Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The relation between IgE sensitization and allergic respiratory symptoms has usually been evaluated by dichotomizing specific IgE levels. The aim of the present study was to evaluate the association between specific IgE levels and risk of symptoms on allergen-related exposure, with special reference to allergen-related asthma-rhinitis comorbidity.

    METHODS: We considered 6391 subjects enrolled within the European Community Respiratory Health Survey 2, having information on cat/grass/D. pteronissinus IgE levels and symptoms on exposure to animals/pollen/dust. The risk of oculonasal/asthmalike/both symptoms was evaluated by a multinomial logistic model.

    RESULTS: A clear positive association was observed between specific IgE levels to cat/grass/mite and the risk of symptoms on each allergen-related exposure (test for trend with p<0.001). This trend was particularly pronounced when considering the coexistence of asthma-like and oculonasal symptoms. Compared to not-sensitized subjects, subjects with specific IgE to cat >=3.5 kU/l presented Relative Risk Ratios of 11.4 (95% CI 6.7-19.2), 18.8 (8.2-42.8), and 55.3 (30.5-100.2) when considering respectively, only oculonasal symptoms, only asthmalike symptoms, or both. A similar pattern was observed when considering specific IgE to grass/mite and symptoms on exposure to pollen/dust. Also the proportion of people using inhaled medicines or visiting a general practitioner for breathing problems in the previous year increased with increasing sum of specific IgE to cat/grass/mite.

    CONCLUSION: Specific IgE levels are the most important predictor of allergen-related symptoms. The risk of both oculonasal/asthmalike symptoms increases with specific IgE levels, suggesting that specific IgE contribute to the "united airways disease".

  • 183. Olivieri, Mario
    et al.
    Murgia, Nicola
    Carsin, Anne-Elie
    Heinrich, Joachim
    Benke, Geza
    Bono, Roberto
    Corsico, Angelo Guido
    Demoly, Pascal
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gislason, Thorarinn
    Janson, Christer
    Jõgi, Rain
    Leynaert, Bénédicte
    Martínez-Moratalla Rovira, Jesús
    Norbäck, Dan
    Nowak, Dennis
    Pascual, Silvia
    Pin, Isabelle
    Probst-Hensch, Nicole
    Raherison, Chantal
    Sigsgaard, Torben
    Svanes, Cecilie
    Torén, Kjell
    Urrutia, Isabel
    Weyler, Joost
    Jarvis, Deborah
    Zock, Jan-Paul
    Verlato, Giuseppe
    Effects of Smoking Bans on Passive Smoking Exposure at Work and at Home. The European Community Respiratory Health Survey2019In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 29, no 4, p. 670-679Article in journal (Refereed)
    Abstract [en]

    This longitudinal study investigated whether smoking bans influence passive smoking at work and/or at home in the same subjects. Passive smoking at work and/or at home was investigated in random population samples (European Community Respiratory Health Survey) in 1990-95, with follow-up interviews in 1998-2003 and 2010-2014. National smoking bans were classified as partial (restricted to public workplaces) or global (extended to private workplaces). Multivariable analysis was accomplished by three-level logistic regression models, where level-1, level-2 and level-3 units were respectively questionnaire responses, subjects and centres. Passive smoking at work was reported by 31.9% in 1990-95, 17.5% in 1998-2003 and 2.5% in 2010-14. Concurrently passive smoking at home decreased from 28.9% to 18.2% and 8.8%. When controlling for sex, age, education, smoking status and ECHRS wave, the odds of passive smoking at work was markedly reduced after global smoking bans (OR=0.45, 95%CI 0.25-0.81), particularly among non-smokers, while the protective effect of global smoking bans on passive smoking at home was only detected in non-smokers. Smoking bans both in public and private workplaces were effective in reducing passive smoking at work in Europe. However, given the inefficacy of smoking bans in current smokers' dwellings, better strategies are needed to avoid smoking indoors. 

  • 184.
    Olsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bråbäck, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Traffic pollution exposure at home during pregnancy and infancy and childhood asthma medicationManuscript (preprint) (Other academic)
  • 185.
    Olsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ekström, Magnus
    Centre of Biostochastics, Swedish University of Agricultural Sciences, 901 83 Umeå, Sweden.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Temporal variation in air pollution concentrations and preterm birth: a population based epidemiological study2012In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 9, no 1, p. 272-285Article in journal (Refereed)
    Abstract [en]

    There is growing evidence of adverse birth outcomes due to exposure to air pollution during gestation. However, recent negative studies are also reported. The aim of this study was to assess the effect of ozone and vehicle exhaust exposure (NO2) on the length of the gestational period and risk of preterm delivery. We used data from the Swedish Medical Birth Registry on all vaginally delivered singleton births in the Greater Stockholm area who were conceived during 1987–1995 (n = 115,588). Daily average levels of NO2 (from three measuring stations) and ozone (two stations) were used to estimate trimester and last week of gestation average exposures. Linear regression models were used to assess the association between the two air pollutants and three exposure windows, while logistic regression models were used when analyzing associations with preterm delivery ( < 37 weeks gestation). Five percent were born preterm. The median gestational period was 40 weeks. Higher levels of ozone during the first trimester were associated with shorter gestation as well as with an elevated risk of preterm delivery, the odds ratio from the most complex model was 1.06 (95% CI: 1.00–1.13) per 10 μg/m3 increase in the mean daily 8-h maximum concentration. Higher levels of ozone during the second trimester were associated with shorter gestation but the elevated risk of preterm delivery was not statistically significant. Higher levels of ozone and NO2 during the last week of gestation were associated with a shorter duration of gestation and NO2 also with preterm delivery. There were no significant associations between first and second trimester NO2 exposure estimates and studied outcomes. The effect of first trimester ozone exposure, known to cause oxidative stress, was smallest among women who conceived during autumn when vitamin D status, important for fetal health, in Scandinavian women is the highest.Keywords: pregnancy; preterm birth; vehicle emissions; ozone; nitrogen dioxide

  • 186.
    Olsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Eneroth, Kristina
    Environment and Health Administration, Stockholm, Sweden.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Traffic pollution at home address and pregnancy outcomesManuscript (preprint) (Other academic)
  • 187.
    Olsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Eneroth, Kristina
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Traffic pollution at the home address and pregnancy outcomes in Stockholm, Sweden2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 8, article id e007034Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: For the past two decades, several studies have reported associations between elevated levels of ambient air pollution and adverse pregnancy outcomes, although with varying conclusions.

    OBJECTIVES: To examine possible associations between the traffic pollution situation at the home address, for women who did not change address during pregnancy, and three types of pregnancy outcomes: spontaneous preterm delivery, children born small for gestational age (SGA) and pregnancy-induced hypertensive disorders.

    METHODS: We used data for the Greater Stockholm Area from the Swedish Medical Birth Register to construct a cohort based on all pregnancies conceived between July 1997 and March 2006, n=100 190. The pregnancy average nitrogen oxide, NOx, levels and annual mean daily vehicles at the home address were used as exposure variables. Mixed-model logistic regression was performed to assess any associations between exposure and outcome.

    RESULTS: There was an association between elevated traffic pollution exposure during pregnancy and pregnancy-induced hypertensive disorders. A 10 µg/m(3) increase in the pregnancy average NOx level at the home address resulted in an OR of 1.17 (95% CI 1.10 to 1.26). The 2nd to 4th quartiles of NOx were all associated with an increased risk of SGA, but there was no difference in the risk estimate among the higher quartiles. There was a tendency of a higher risk of spontaneous preterm delivery in relation to higher levels of NOx. There was no evidence of an association between vehicle flow, the cruder indicator of traffic pollution, and the studied outcomes in this study.

    CONCLUSIONS: In this large cohort, there was a fairly strong association between vehicle exhaust levels at the home address and pregnancy-induced hypertensive disorders, after adjustment for important risk factors.

  • 188.
    Olsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Air pollution exposure in early pregnancy and adverse pregnancy outcomes: a register-based cohort study2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 2, p. e001955-Article in journal (Refereed)
    Abstract [en]

    Objectives: Our aim was to study the possible associations between exposure to elevated levels of air pollution, ozone (O-3) and vehicle exhaust (NOx), during early gestation, and adverse pregnancy outcomes such as pre-eclampsia, preterm birth and small for gestational age.

    Design: Prospective register-based cohort study. Setting: The Swedish Medical Birth Register includes data on all deliveries during 1998 to 2006 in Greater Stockholm, Sweden. The national Patient Register and the Prescribed Drug Register were used to collect information on maternal asthma.

    Participants: All singleton pregnancies, conceived at the earliest in August 1997 and at the latest in February 2006, were included, n=120 755.

    Outcome measures: We studied preterm birth, small for gestational age and pre-eclampsia. Results: 4.4% of pregnancies resulted in a preterm birth. The prevalence of pre-eclampsia was 2.7%. We observed an association between first trimester O-3 and preterm birth (OR 1.04, 95% CI 1.01 to 1.08) as well as an association with pre-eclampsia (OR 1.04, 95% CI 1.01 to 1.08), per 10 mu g/m(3) increase in O-3. We observed no association between first trimester NOx and adverse pregnancy outcomes. No associations were observed between any of the air pollutants and small for gestational age.

    Conclusions: Increased levels of O-3 during the first trimester increased the risk of pre-eclampsia and preterm birth. Air pollutants did not exhibit any effects on fetal growth restriction. We estimated 1 in every 20 cases of pre-eclampsia to be associated with O-3 exposure.

  • 189.
    Olsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Air pollution exposure in early pregnancy and adverse pregnancy outcomes: a register-based cohort study2013In: BMJ open, ISSN 2044-6055, Vol. 3, no 2, p. e001955-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Our aim was to study the possible associations between exposure to elevated levels of air pollution, ozone (O(3)) and vehicle exhaust (NO(x)), during early gestation, and adverse pregnancy outcomes such as pre-eclampsia, preterm birth and small for gestational age. DESIGN: Prospective register-based cohort study. SETTING: The Swedish Medical Birth Register includes data on all deliveries during 1998 to 2006 in Greater Stockholm, Sweden. The national Patient Register and the Prescribed Drug Register were used to collect information on maternal asthma. PARTICIPANTS: All singleton pregnancies, conceived at the earliest in August 1997 and at the latest in February 2006, were included, n=120 755. OUTCOME MEASURES: We studied preterm birth, small for gestational age and pre-eclampsia. RESULTS: 4.4% of pregnancies resulted in a preterm birth. The prevalence of pre-eclampsia was 2.7%. We observed an association between first trimester O(3) and preterm birth (OR 1.04, 95% CI 1.01 to 1.08) as well as an association with pre-eclampsia (OR 1.04, 95% CI 1.01 to 1.08), per 10 µg/m(3) increase in O(3). We observed no association between first trimester NO(x) and adverse pregnancy outcomes. No associations were observed between any of the air pollutants and small for gestational age. CONCLUSIONS: Increased levels of O(3) during the first trimester increased the risk of pre-eclampsia and preterm birth. Air pollutants did not exhibit any effects on fetal growth restriction. We estimated 1 in every 20 cases of pre-eclampsia to be associated with O(3) exposure.

  • 190.
    Olstrup, Henrik
    et al.
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, 10691, Sweden.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Family Medicine and Public Health, University of Tartu, Tartu, 500 90, Estonia; Environment Department, City of Malmö, Malmö, 205 80, Sweden..
    Spanne, Mårten
    Environment Department, City of Malmö, 205 80 Malmö, Sweden.
    Nguyen, Hung
    Environmental Administration in Gothenburg, P.O. Box 7012, Gothenburg, 402 31, Sweden.
    Molnár, Peter
    Occupational and Environmental Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, 40530, Sweden..
    Johansson, Christer
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, 10691, Sweden; Environment and Health Administration, SLB, P.O. Box 8136, Stockholm, 104 20, Sweden..
    Trends in air pollutants and health impacts in three Swedish cities over the past three decades2018In: Atmospheric Chemistry And Physics, ISSN 1680-7316, E-ISSN 1680-7324, Vol. 18, no 21, p. 15705-15723Article in journal (Refereed)
    Abstract [en]

    Air pollution concentrations have been decreasing in many cities in the developed countries. We have estimated time trends and health effects associated with exposure to NOx, NO2, O3, and PM10 (particulate matter) in the Swedish cities Stockholm, Gothenburg, and Malmö from the 1990s to 2015. Trend analyses of concentrations have been performed by using the Mann–Kendall test and the Theil–Sen method. Measured concentrations are from central monitoring stations representing urban background levels, and they are assumed to indicate changes in long-term exposure to the population. However, corrections for population exposure have been performed for NOx, O3, and PM10 in Stockholm, and for NOx in Gothenburg. For NOx and PM10, the concentrations at the central monitoring stations are shown to overestimate exposure when compared to dispersion model calculations of spatially resolved, population-weighted exposure concentrations, while the reverse applies to O3. The trends are very different for the pollutants that are studied; NOx and NO2 have been decreasing in all cities, O3 exhibits an increasing trend in all cities, and for PM10, there is a slowly decreasing trend in Stockholm, a slowly increasing trend in Gothenburg, and no significant trend in Malmö. Trends associated with NOxand NO2 are mainly attributed to local emission reductions from traffic. Long-range transport and local emissions from road traffic (non-exhaust PM emissions) and residential wood combustion are the main sources of PM10. For O3, the trends are affected by long-range transport, and there is a net removal of O3 in the cities. The increasing trends are attributed to decreased net removal, as NOx emissions have been reduced.

    Health effects in terms of changes in life expectancy are calculated based on the trends in exposure to NOx, NO2, O3, and PM10 and the relative risks associated with exposure to these pollutants. The decreased levels of NOx are estimated to increase the life expectancy by up to 11 months for Stockholm and 12 months for Gothenburg. This corresponds to up to one-fifth of the total increase in life expectancy (54–70 months) in the cities during the period of 1990–2015. Since the increased concentrations in O3 have a relatively small impact on the changes in life expectancy, the overall net effect is increased life expectancies in the cities that have been studied.

  • 191. Olstrup, Henrik
    et al.
    Johansson, Christer
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    The Use of Carbonaceous Particle Exposure Metrics in Health Impact Calculations2016In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 13, no 3, article id 249Article in journal (Refereed)
    Abstract [en]

    Combustion-related carbonaceous particles seem to be a better indicator of adverse health effects compared to PM2.5 and PM10. Historical studies are based on black smoke (BS), but more recent studies use absorbance (Abs), black carbon (BC) or elemental carbon (EC) as exposure indicators. To estimate health risks based on BS, we review the literature regarding the relationship between Abs, BS, BC and EC. We also discuss the uncertainties associated with the comparison of relative risks (RRs) based on these conversions. EC is reported to represent a proportion between 5.2% and 27% of BS with a mean value of 12%. Correlations of different metrics at one particular site are higher than when different sites are compared. Comparing all traffic, urban and rural sites, there is no systematic site dependence, indicating that other properties of the particles or errors affect the measurements and obscure the results. It is shown that the estimated daily mortality associated with short-term levels of EC is in the same range as PM10, but this is highly dependent on the EC to BS relationship that is used. RRs for all-cause mortality associated with short-term exposure to PM10 seem to be higher at sites with higher EC concentrations, but more data are needed to verify this.

  • 192.
    Olstrup, Henrik
    et al.
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, 11418 Stockholm, Sweden. .
    Johansson, Christer
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, 11418 Stockholm, Sweden. Environment and Health Administration, SLB, Box 8136, 104 20 Stockholm, Sweden..
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ekebom, Agneta
    Swedish Museum of Natural History, 114 18 Stockholm, Sweden..
    Meister, Kadri
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    A Multi-Pollutant Air Quality Health Index (AQHI) Based on Short-Term Respiratory Effects in Stockholm, Sweden2019In: 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)
    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%.

  • 193.
    Olstrup, Henrik
    et al.
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, 11418 Stockholm, Sweden..
    Johansson, Christer
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, 11418 Stockholm, Sweden. Environment and Health Administration, SLB, Box 8136, 104 20 Stockholm, Sweden..
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Association between Mortality and Short-Term Exposure to Particles, Ozone and Nitrogen Dioxide in Stockholm, Sweden2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 6, article id E1028Article in journal (Refereed)
    Abstract [en]

    In this study, the effects on daily mortality in Stockholm associated with short-term exposure to ultrafine particles (measured as number of particles with a diameter larger than 4 nm, PNC₄), black carbon (BC) and coarse particles (PM2.5⁻10) have been compared with the effects from more common traffic-pollution indicators (PM10, PM2.5 and NO₂) and O₃ during the period 2000⁻2016. Air pollution exposure was estimated from measurements at a 20 m high building in central Stockholm. The associations between daily mortality lagged up to two days (lag 02) and the different air pollutants were modelled by using Poisson regression. The pollutants with the strongest indications of an independent effect on daily mortality were O₃, PM2.5⁻10 and PM10. In the single-pollutant model, an interquartile range (IQR) increase in O₃ was associated with an increase in daily mortality of 2.0% (95% CI: 1.1⁻3.0) for lag 01 and 1.9% (95% CI: 1.0⁻2.9) for lag 02. An IQR increase in PM2.5⁻10 was associated with an increase in daily mortality of 0.8% (95% CI: 0.1⁻1.5) for lag 01 and 1.1% (95% CI: 0.4⁻1.8) for lag 02. PM10 was associated with a significant increase only at lag 02, with 0.8% (95% CI: 0.08⁻1.4) increase in daily mortality associated with an IQR increase in the concentration. NO₂ exhibits negative associations with mortality. The significant excess risk associated with O₃ remained significant in two-pollutant models after adjustments for PM2.5⁻10, BC and NO₂. The significant excess risk associated with PM2.5⁻10 remained significant in a two-pollutant model after adjustment for NO₂. The significantly negative associations for NO₂ remained significant in two-pollutant models after adjustments for PM2.5⁻10, O₃ and BC. A potential reason for these findings, where statistically significant excess risks were found for O₃, PM2.5⁻10 and PM10, but not for NO₂, PM2.5, PNC₄ and BC, is behavioral factors that lead to misclassification in the exposure. The concentrations of O₃ and PM2.5⁻10 are in general highest during sunny and dry days during the spring, when exposure to outdoor air tend to increase, while the opposite applies to NO₂, PNC₄ and BC, with the highest concentrations during the short winter days with cold weather, when people are less exposed to outdoor air.

  • 194.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Andersson, Camilla
    Swedish Meteorological and Hydrological Institute, Norrköping, Sweden.
    Ebi, Kristie L
    ClimAdapt, Los Altos, California, USA.
    Langner, Joakim
    Swedish Meteorological and Hydrological Institute, Norrköping, Sweden.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Impact of climate change on ozone-related mortality and morbidity in Europe2013In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 41, no 2, p. 285-294Article in journal (Refereed)
    Abstract [en]

    Ozone is a highly oxidative pollutant formed from precursors in the presence of sunlight, associated with respiratory morbidity and mortality. All else being equal, concentrations of ground-level ozone are expected to increase due to climate change.Ozone-related health impacts under a changing climate are projected using emission scenarios, models and epidemiological data. European ozone concentrations are modelled with MATCH-RCA3 (50×50 km). Projections from two climate models, ECHAM4 and HadCM3, are applied, under greenhouse gas emission scenarios A2 and A1B respectively. We apply a European-wide exposure-response function to gridded population data and country-specific baseline mortality and morbidity.Comparing the current situation (1990-2009) with the baseline period (1961-1990), the largest increase in ozone-associated mortality and morbidity due to climate change (4-5%) have occurred in Belgium, Ireland, Netherlands and UK. Comparing the baseline period and the future periods (2021-2050 and 2041-2060), much larger increase in ozone-related mortality and morbidity are projected for Belgium, France, Spain and Portugal with the impact being stronger using the climate projection from ECHAM4 (A2). However, in Nordic and Baltic countries the same magnitude of decrease is projected.The current study suggests that projected effects of climate change on ozone concentrations could differentially influence mortality and morbidity across Europe.

  • 195.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Family Medicine and Public Health, University of Tartu.
    Ebi, K. L.
    Center for Health and the Global Environment, University of Washington, Seattle, WA, USA.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    The interplay of climate change and air pollution on health2017In: Current environmental health reports, ISSN 2196-5412, Vol. 4, no 4, p. 504-513Article in journal (Refereed)
    Abstract [en]

    Purpose of review: Air pollution significantly affects health, causing up to 7 million premature deaths annually with an even larger number of hospitalizations and days of sick leave. Climate change could alter the dispersion of primary pollutants, particularly particulate matter, and intensify the formation of secondary pollutants, such as near-surface ozone. The purpose of the review is to evaluate the recent evidence on the impacts of climate change on air pollution and air pollution-related health impacts and identify knowledge gaps for future research.

    Recent findings: Several studies modelled future ozone and particulate matter concentrations and calculated the resulting health impacts under different climate scenarios. Due to climate change, ozone- and fine particle-related mortalities are expected to increase in most studies; however, results differ by region, assumed climate change scenario and other factors such as population and background emissions.

    Summary: This review explores the relationships between climate change, air pollution and air pollution-related health impacts. The results highly depend on the climate change scenario used and on projections of future air pollution emissions, with relatively high uncertainty. Studies primarily focused on mortality; projections on the effects on morbidity are needed.

  • 196.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Assessment of long-term health impacts of air quality with different guideline values for NOX in the planned by-pass tunnel Förbifart Stockholm2016Report (Other academic)
    Abstract [en]

    To meet increased needs of transports in the Stockholm region and reduce the problems with traffic congestion in central parts, a 21 km long by-pass (18 km in a tunnel) is planned. The bypass is expected to reduce traffic and emissions in central Stockholm, but at the same time tunnel users could be exposed to high concentrations of air pollutants from traffic. Thus to control the air quality in the tunnel system, air pollution guideline values have been proposed. The current study is initiated and funded by the Swedish Transport Administration (Trafikverket), and the aim is to assess the potential health impacts of applying different NOX guideline values (1000, 2000, 3000 and 4000 μg/m3 as hourly average max values all-over the tunnel system). The passengers’ exposure was estimated based on annual average NOX exposures, time spent in the tunnel and the number of tunnel users. Health impacts were assessed following health impact assessment principles using equations and WHO’s software AirQPlus.

    With minimal ventilation and maximal traffic amounts during rush hours the NOX hourly average concentrations could raise up to 3500 μg/m3 and even when the planned maximum ventilation would be in use, the maximum concentration would stay as high as 1789 μg/m3. Thus, it is in principle with planned the technology impossible to meet the lowest proposed guideline value of 1000 μg/m3 in the whole tunnel system. However, the effects would be with this guideline still the smallest, resulting annually in 22.2 (CI 95% 16.8–30.1) more premature deaths and 480.4 (95% CI 364.1–650.6) years of life lost (assuming travellers to come from the age group 30–74). If the guideline value would be 2000 μg/m3, the exposure would annually in the same age group cause 35.2 (CI 95% 26.7–47.6) premature deaths with 760.9 (480.4–650.6) years of life lost. With the lowest guideline level, passing the whole tunnel during rush hours on working days would increase mortality risk by 7.4% (95% CI 5.5-10.1), on average corresponding to a life expectancy decrease by 0.27 (95% CI 0.20-0.37) years for people aged 30–74 years.

    Among different tunnel links, the biggest exposure is expected in link 5N, where 28.6-37.2% (depending on limit value scenario) of the total health impact could be generated. The link 3N has high NOX concentration, large number of passengers and long exposure time (time spent in the tunnel link). Even the NOX concentrations are expected to be highest in links 411 and 314, the exposure time there would be shorter and the number of exposed passengers smaller. For the separate links the differences in exposure between limit value scenarios could also vary largely: while the difference was big for link 5N, it was rather small for link 7N.

    If we compare these results with the previously estimated beneficial effect on the health of the local population due to decrease of urban air pollution exposure (expecting annually 23.7 (95% CI 17.7–32.3) fewer premature deaths), only with most favourable assumptions as less older persons using tunnel and with highest ventilation the tunnel could have smaller negative health effects compared to the alternative current open road E4. In all other cases the health effects in the by-pass tunnel Förbifart Stockholm are expected to be higher. Also the exposure levels in the tunnel are expected to be somewhat higher compared to previous analysis due to more 5 enhanced dispersion modelling for the tunnel, including also ramps in the impact assessment and predicting higher numbers of cars than previously.

  • 197.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jõgi, Rain
    Lung Clinic, Tartu University Hospital.
    Kaasik, Marko
    Institute of Physics, University of Tartu.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Chronic traffic-induced PM exposure and self-reported respiratory and cardiovascular health in the RHINE Tartu cohort2009In: International journal of environmental research and public health, ISSN 1660-4601, Vol. 6, no 11, p. 68p. 2740-2751Article in journal (Refereed)
    Abstract [en]

    The relationship between exposure to traffic induced particles and respiratory health, and cardiac diseases was studied in the RHINE Tartu cohort. A postal questionnaire with commonly used questions regarding respiratory symptoms, cardiac disease, lifestyle as smoking habits, indoor environment, occupation, early life exposure and sleep disorders was sent to 2460 adults. The annual concentrations of local traffic induced particles were modelled with an atmospheric dispersion model with traffic flow data, and obtained PMexhaust concentrations in 40x40 m grids were linked with home addresses with GIS. The relationship between the level of exhaust particles outside home and self-reported health problems were analyzed using a multiple logistic regression model. We found a significant relation between fine exhaust particles and cardiac disease, OR = 1.64 (95% CI 1.12-2.43) for increase in PMexhaust corresponding to the fifth to the 95th percentile range. The associations also were positive but non-significant for hypertension OR = 1.42 (95% CI 0.94-2.13), shortness of breath OR = 1.27 (95% CI 0.84-1.94) and other respiratory symptoms.

  • 198.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Kaasik, M
    Antov, D
    Forsberg, B
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Evolution of traffic flows and traffic induced air pollution due to structural changes and development during 1993-2006 in Tartu (Estonia)2008In: Baltic journal of road and bridge engineering, ISSN 1822-427X, Vol. 3, no 4, p. 206-212Article in journal (Refereed)
    Abstract [en]

    Traffic is the main factor affecting air quality in most cities. After the Estonian re-independence in 1991, the increase of motorization has been fast and car usage has intensified. During the same period, the average age of cars has decreased and thanks to improvements in engine technology, the emissions per km have been reduced. The objective was to see how these factors have reflected in air quality. This paper also aim to present an analytical approach to estimate the air pollution levels in recent years, when air quality monitoring has not been conducted, and available traffic data are limited. Based on traffic counts in 25 points across the city the amounts of traffic were modelled for 680 street segments with CUBE software. As air quality is monitored irregularly in Tartu, dispersion modelling was used to estimate pollution levels. Annual concentrations of exhaust particles (PMexhaust), particulate matter (PM10) and nitrogen oxides (NOx) in 1993, 2000 and 2006 were calculated with AEROPOL software. The traffic increase in the city centre of Tartu was especially rapid in the 1990s. In recent years, it has slowed due to congestion. Overall, traffic levels have increased more than 3 times since 1993. In residential areas, the increase is still rapid – up to 6 times from 1993 to 2006. However, the changes in air quality are less dramatic. Increases from 1993 to 2000 were followed by stable or slightly increasing pollution levels in recent years, especially in case of PMexhaust. The study showed that 2 factors, namely, increase of traffic and improvement of vehicles, have been compensating each other in the dynamics of air pollution.

  • 199.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Kaasik, Marko
    Institute of Physics, University of Tartu.
    Merisalu, Eda
    Department of Public Health, University of Tartu.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Health impact assess­ment in case of peat: co-use of environmental scenarios and exposure-response functions2009In: Biomass and Bioenergy, ISSN 0961-9534, E-ISSN 1873-2909, Vol. 33, no 8, p. 1080-1086Article in journal (Refereed)
    Abstract [en]

    Peat will be used more widely for heating in Tartu (Estonia), therefore the potential health effects needed to be assessed. In transition from today's gas heating to burning of peat, the amount of exhaust gases emitted will increase and more than 100 000 people will be exposed to greater health risks. Based on the peat quality data, the emissions were calculated and their dispersion in Tartu was modelled using the air pollution dispersion and deposition model AEROPOL. The AirQ software, developed by the WHO, was used for calculating the health impacts. The number of years of life lost (YLL) due to the emissions from peat burning was estimated to be up to 55.5 in a year within the population of Tartu (101 000 citizens). However, in perspective, this would be about 28 times less than YLL calculated due to emissions from traffic, local heating etc.

  • 200.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Public Health, University of Tartu, Ravila 19, Tartu 50411, Estonia.
    Kimmel, Veljo
    Estonian University of Life Sciences.
    Kikas, Ülle
    University of Tartu.
    Soon, Argo
    Archimedes Foundation.
    Künzli, Nino
    CREAL.
    Schins, Roel
    University of Dusseldorf.
    Borm, Paul
    Centre of Expertise Life Sciences .
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Elemental composition and oxidative properties of PM2.5 in Estonia in relation to origin of air masses: results from the ECRHS II in Tartu2010In: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 408, no 7, p. 1515-1522Article in journal (Refereed)
    Abstract [en]

    Fine particulate matter (PM2.5) was sampled at an urban background site in Tartu, Estonia over one-year period during the ECRHS II study. The elemental composition of 71 PM2.5 samples was analyzed for different chemical elements using energy-dispersive X-ray fluorescence spectrometry (ED-XRF). The oxidative activity of 36 samples was assessed by measuring their ability to generate hydroxyl radicals in the presence of hydrogen peroxide.

    The origin of air masses was determined by computing 96-hour back trajectories of air masses with the HYSPLIT Model. The trajectories of air masses were divided into four sectors according to geographical patterns: “Russia,” “Eastern Europe,” “Western Europe,” and “Scandinavia.”

    During the study period, approximately 30% of air masses originated from “Scandinavia.”  The other three sectors had slightly lower values (between 18 and 22%). In spring, summer, and winter, higher total PM levels originated from air masses from continental areas, namely “Russia” and “Eastern Europe” (18.51±7.33 and 19.96±9.23 μgm-3, respectively). In autumn, the PM levels were highest in “Western Europe”. High levels of Fe, Ti, and AlCaSi (Al, Ca, Si) were also detected in air masses from the Eurasian continent. The oxidative properties were correlated to the origin of air masses. The ∙OH values were approximately 1.5 times higher when air masses originated from the direction of “Eastern Europe” or “Russia.”

    The origin of measured particles was evaluated using principal compo­nent factor analysis. When comparing the PM2.5 elemental composition with seasonal variation, factor scores, and other studies, the factors represent: (1) combustion of biomass; (2) crustal dust; (3) traffic; and (4) power plants and industrial processes associated with oil burning.

    The total PM2.5 is driven mainly by biomass and industrial combustion (63%) and other unidentified sources (23%). Other sources of PM, such as crustal dust and traffic, contribute a total of 13%.

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