umu.sePublikationer
Ändra sökning
Avgränsa sökresultatet
1234567 151 - 200 av 847
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Träffar per sida
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sortering
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
Markera
Maxantalet träffar du kan exportera från sökgränssnittet är 250. Vid större uttag använd dig av utsökningar.
  • 151. Delcloo, Andy
    et al.
    Andersson, Camilla
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nawrot, Tim
    Valari, Myrto
    ACCEPTED: An Assessment of Changing Conditions, Environmental Policies, Time-Activities, Exposure and Disease2014Ingår i: Air Pollution Modeling and its Application XXIII / [ed] Douw Steyn, Rohit Mathur, SPRINGER-VERLAG BERLIN , 2014, s. 55-59Konferensbidrag (Refereegranskat)
    Abstract [en]

    Changes in urban design and traffic policy, demography, climate and associated adaptation, mitigation measures and environmental policies are likely to modify both outdoor and indoor air quality and therefore public health. The project aims to improve our understanding of future exposure situations and their impact on health, from an interdisciplinary approach. This will be achieved by using various state-of-the-art atmospheric models, measurements, epidemiological studies and reviews. To assess population full exposure, an integrated view accounting both for indoor and outdoor air pollution as well as for population time activity data will be developed. New dose-response functions will be estimated between health outcome, air pollution and temperature in order to better estimate the effects on the foetus and young children. Ultimately, scenarios of future urban climate and air quality will be simulated, combining future exposure scenarios, population scenarios and exposure-response functions to describe the effects of different trends and relevant policies on relative risk and burden of illness attributed to urban pollutants and their interactions with extreme temperatures. Also the mitigation strategies that can be used to reduce urbanization and climate change effects on the local urban meteorology and air quality will be assessed. With applications in several large European cities, the project will study the impact of several alternative adaptation scenarios on urban air quality and human health to a mid-century horizon (2030-2060) accounting for the effects of a changing urban climate. Scenario-based health impact assessments will combine exposure information from climate models, emission scenarios, policy evaluation studies and concentration calculations with exposure-response functions from epidemiological studies of vulnerable groups within the project and previously published functions for mortality and hospital admissions. The effects of socioeconomic and demographic trends will be discussed, the predicted health impacts and benefits associated with different interventions and policies and other urban changes will be described.

  • 152.
    Desvars-Larrive, Amélie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk bakteriologi. Umeå universitet, Medicinska fakulteten, Molekylär Infektionsmedicin, Sverige (MIMS).
    Liu, X.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk bakteriologi. Umeå universitet, Medicinska fakulteten, Molekylär Infektionsmedicin, Sverige (MIMS).
    Hjertqvist, M.
    Sjöstedt, A.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk bakteriologi. Umeå universitet, Medicinska fakulteten, Molekylär Infektionsmedicin, Sverige (MIMS).
    Johansson, A.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk bakteriologi. Umeå universitet, Medicinska fakulteten, Molekylär Infektionsmedicin, Sverige (MIMS).
    Ryden, Patrik
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för matematik och matematisk statistik.
    High-risk regions and outbreak modelling of tularemia in humans2017Ingår i: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 145, nr 3, s. 482-490Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Sweden reports large and variable numbers of human tularemia cases, but the high-risk regions are anecdotally defined and factors explaining annual variations are poorly understood. Here, high-risk regions were identified by spatial cluster analysis on disease surveillance data for 1984-2012. Negative binomial regression with five previously validated predictors (including predicted mosquito abundance and predictors based on local weather data) was used to model the annual number of tularemia cases within the high-risk regions. Seven high-risk regions were identified with annual incidences of 3.8-44 cases/100 000 inhabitants, accounting for 56.4% of the tularemia cases but only 9.3% of Sweden's population. For all high-risk regions, most cases occurred between July and September. The regression models explained the annual variation of tularemia cases within most high-risk regions and discriminated between years with and without outbreaks. In conclusion, tularemia in Sweden is concentrated in a few high-risk regions and shows high annual and seasonal variations. We present reproducible methods for identifying tularemia high-risk regions and modelling tularemia cases within these regions. The results may help health authorities to target populations at risk and lay the foundation for developing an early warning system for outbreaks.

  • 153. Dimakopoulou, Konstantina
    et al.
    Samoli, Evangelia
    Beelen, Rob
    Stafoggia, Massimo
    Jovanovic Andersen, Zorana
    Hoffmann, Barbara
    Fischer, Paul
    Nieuwenhuijsen, Mark
    Vineis, Paolo
    Xun, Wei
    Hoek, Gerard
    Raaschou-Nielsen, Ole
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Jousilahti, Pekka
    Lanki, Timo
    Turunen, Anu
    Oftedal, Bente
    Nafstad, Per
    Schwarze, Per E
    Penell, Johanna
    Fratiglioni, Laura
    Andersson, Niklas
    Pedersen, Nancy
    Korek, Michal
    De Faire, Ulf
    Thorup Eriksen, Kirsten
    Tjønneland, Anne
    Becker, Thomas
    Wang, Meng
    Bueno-de-Mesquita, Bas
    Tsai, Ming-Yi
    Eeftens, Marloes
    Peeters, Petra H
    Meliefste, Kees
    Marcon, Alessandro
    Krämer, Ursula
    Kuhlbusch, Thomas Aj
    Vossoughi, Mohammad
    Key, Timothy
    de Hoogh, Kees
    Hampel, Regina
    Peters, Annette
    Heinrich, Joachim
    Weinmayr, Gudrun
    Concin, Hans
    Nagel, Gabriele
    Ineichen, Alex
    Jacquemin, Bénédicte
    Stempfelet, Morgane
    Vilier, Alice
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Pedeli, Xanthi
    Katsoulis, Michalis
    Trichopoulou, Antonia
    Brunekreef, Bert
    Katsouyanni, Klea
    Air Pollution and Non-Malignant Respiratory Mortality in 16 Cohorts within the ESCAPE Project2014Ingår i: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 189, nr 6, s. 684-696Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale: Prospective cohort studies have shown that chronic exposure to particulate matter and traffic related air pollution is associated with reduced survival. However, the effects on non-malignant respiratory mortality are less studied and those reported are less consistent.

    Objectives: We have investigated the relationship of long-term exposure to air pollution and non-malignant respiratory mortality in 16 cohorts with individual level data within the multi center European Study of Cohorts for Air Pollution Effects (ESCAPE).

    Methods: Data from 16 ongoing cohort studies from Europe were used. The total number of subjects was 307,553. There were 1,559 respiratory deaths during follow-up.

    Measurements: Air pollution exposure was estimated by land use regression models at the baseline residential addresses of study participants and traffic-proximity variables were derived from geographical databases, following a standardized procedure within ESCAPE study. Cohort-specific hazard ratios obtained by Cox proportional hazard models from standardized individual cohort analyses were combined using meta-analyses. Main Results: We found no significant associations between air pollution exposure and non-malignant respiratory mortality. Most hazard ratios were slightly below unity, with the exception of the traffic-proximity indicators.

    Conclusions: In this study of 16 cohorts there was no association between air pollution exposure and non malignant respiratory mortality.

  • 154.
    Domellöf, Erik
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Kolbäcken Child Rehabilitation Centre, Umeå, Sweden .
    Hedlund, Ludmilla
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Ödman, Pia
    Avd för sjukgymnastik, Institutionen för medicin och hälsa, Linköpings universitet.
    Health-related quality of life of children and adolescents with functional disabilities in a northern Swedish county2014Ingår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 23, nr 6, s. 1877-1882Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Health-related quality of life (HRQoL) studies in children and adolescents with disabilities tend to report lower self-reported health than in the typical population. However, reports are not always consistent and HRQoL appears to vary depending on diagnosis, cultural setting and clinical context. The aim of this study was to explore HRQoL in children and adolescents with various disabilities in Västerbotten County, Sweden.

    METHODS: A total of 175 children and adolescents [57 girls, 118 boys; mean age 11.7 years (range 7-17 years)] divided into four different diagnostic groups (intellectual disabilities, autism spectrum disorders, movement disorders and hearing disabilities) participated in the study. The EuroQol Five Dimensions Health Questionnaire, Youth version (EQ-5D-Y) was used as HRQoL measure.

    RESULTS: Significant differences in various EQ-5D-Y dimensions between the different diagnostic groups were found, but no differences in overall health status. HRQoL in children and adolescents with hearing disabilities was found similar to the typical child population in Sweden whereas children and adolescents with other diagnoses reported evidently more problems.

    CONCLUSIONS: Findings suggest that there is an increased risk for children with functional disabilities other than hearing disabilities in northern Sweden to experience difficulties in various health domains and lowered general health.

  • 155. Donat-Vargas, Carolina
    et al.
    Bergdahl, Ingvar A.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Tornevi, Andreas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Wennberg, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Sommar, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Koponen, Jani
    Kiviranta, Hannu
    Åkesson, Agneta
    Associations between repeated measure of plasma perfluoroalkyl substances and cardiometabolic risk factors2019Ingår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 124, s. 58-65Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 156. Donat-Vargas, Carolina
    et al.
    Åkesson, Agneta
    Tornevi, Andreas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Wennberg, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Sommar, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Kiviranta, Hannu
    Rantakokko, Panu
    Bergdahl, Ingvar A.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Persistent Organochlorine Pollutants in Plasma, Blood Pressure, and Hypertension in a Longitudinal Study2018Ingår i: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 71, nr 6, s. 1258-1268Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 157. Dratva, Julia
    et al.
    Bertelsen, Randi
    Janson, Christer
    Johannessen, Ane
    Benediktsdóttir, Bryndis
    Bråbäck, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Dharmage, Shyamali C
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Gislason, Thorarinn
    Jarvis, Debbie
    Jogi, Rain
    Lindberg, Eva
    Norback, Dan
    Omenaas, Ernst
    Skorge, Trude D
    Sigsgaard, Torben
    Toren, Kjell
    Waatevik, Marie
    Wieslander, Gundula
    Schlünssen, Vivi
    Svanes, Cecilie
    Real, Francisco Gomez
    Validation of self-reported figural drawing scales against anthropometric measurements in adults2016Ingår i: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 19, nr 11, s. 1944-1951Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim of the present study was to validate figural drawing scales depicting extremely lean to extremely obese subjects to obtain proxies for BMI and waist circumference in postal surveys.

    DESIGN: Reported figural scales and anthropometric data from a large population-based postal survey were validated with measured anthropometric data from the same individuals by means of receiver-operating characteristic curves and a BMI prediction model.

    SETTING: Adult participants in a Scandinavian cohort study first recruited in 1990 and followed up twice since.

    SUBJECTS: Individuals aged 38-66 years with complete data for BMI (n 1580) and waist circumference (n 1017).

    RESULTS: Median BMI and waist circumference increased exponentially with increasing figural scales. Receiver-operating characteristic curve analyses showed a high predictive ability to identify individuals with BMI > 25·0 kg/m2 in both sexes. The optimal figural scales for identifying overweight or obese individuals with a correct detection rate were 4 and 5 in women, and 5 and 6 in men, respectively. The prediction model explained 74 % of the variance among women and 62 % among men. Predicted BMI differed only marginally from objectively measured BMI.

    CONCLUSIONS: Figural drawing scales explained a large part of the anthropometric variance in this population and showed a high predictive ability for identifying overweight/obese subjects. These figural scales can be used with confidence as proxies of BMI and waist circumference in settings where objective measures are not feasible.

  • 158.
    Ebi, Kristie L.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Kram, Tom
    van Vuuren, Detlef P.
    O'Neill, Brian C.
    Kriegler, Elmar
    A New Toolkit for Developing Scenarios for Climate Change Research and Policy Analysis2014Ingår i: Environment, ISSN 0013-9157, E-ISSN 1939-9154, Vol. 56, nr 2, s. 6-16Artikel i tidskrift (Refereegranskat)
  • 159.
    Edlinger, M.
    et al.
    Medical University Innsbruck, Innsbruck, Austria.
    Bjorge, T.
    University of Bergen, Bergen, Norway; Norwegian Institute of Public Health, Oslo, Norway.
    Manjer, J.
    Skåne University Hospital Malmö and Lund University, Malmö, Sweden.
    Stattin, Pär
    Ulmer, H.
    Umeå universitet.
    Metabolic syndrome and risk of brain tumour in a large population-based cohort study2011Ingår i: IEA World Congress of Epidemiology, 7–11 August 2011, Edinburgh International Conference Centre, Edinburgh, Scotland: Programme and abstracts, 2011, Vol. 65Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: There are few established determinants of brain tumour. We assessed among adults the risk of brain tumour in relation to metabolic syndrome factors.

    Methods: 580 000 subjects from Sweden, Austria, and Norway were followed for a median of 10 years (Me-Can). Brain tumour information was obtained from national cancer registries. The factors of metabolic syndrome, body mass index, blood pressure, and blood levels of glucose, cholesterol, and triglycerides, were analysed in quintiles and for transformed z-scores (mean of 0 and SD of 1). Cox proportional hazards regression models were applied, stratified by cohort and corrected for measurement error.

    Results: In total 1312 primary brain tumours were diagnosed during follow-up, predominantly high-grade glioma (n=436) and meningioma (n=348). For meningioma, the HR was increased for systolic blood pressure (HR=1.27 per unit SD, 95% CI 1.03 to 1.57), for diastolic blood pressure (HR=1.29, 95% CI 1.04 to 1.58), and for the combined metabolic syndrome score (HR=1.31, 95% CI 1.11 to 1.54). For high-grade glioma the risk was increased for diastolic blood pressure (HR=1.23, 95% CI 1.01 to 1.50) and triglycerides (HR=1.35, 95% CI 1.05 to 1.72). For both meningioma and high-grade glioma, the risk was more than doubled in the fifth quintiles of diastolic blood pressure compared to the first quintile. For systolic blood pressure the meningioma risk was even larger.

    Conclusion: Increased blood pressure was related to risk of brain tumour, particularly of meningiomas.

  • 160. Edlund, Maria
    et al.
    Burström, Lage
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Gerhardsson, Lars
    Lundström, Ronnie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nilsson, Tohr
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Sandén, Helena
    Hagberg, Mats
    A prospective cohort study investigating an exposure-response relationship among vibration-exposed male workers with numbness of the hands2014Ingår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 40, nr 2, s. 203-209Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate the exposure-response relationship of hand-arm vibration exposure to neurological symptoms (numbness) of the hand in a cohort of vibration-exposed workers.

    METHODS: The baseline cohort comprised 241 office and manual workers with or without exposure to hand-arm vibration. Numbness (the symptom or event) in the hand was assessed for all subjects at baseline and follow-ups after 5, 10, and 16 years. The workers were stratified into quartiles with no exposure in the first quartile and increasing intensity of exposure in quartiles 2-4 (groups 1-3). Data analysis was performed using survival analysis (time to event). Information on cumulative exposure and years of exposure to event was collected via questionnaires. Measurements were performed in accordance with the International Organization for Standardization (ISO) 5349-1.

    RESULTS: The hazard ratio (HR) of risk of event (numbness) differed statistically significantly between the non-exposed group (group 0) and the two higher exposure groups (groups 2 and 3). There was also a significant ratio difference between the lowest exposure group (group 1) and the two higher groups. The ratio for group 1 was 1.77 [95% confidence interval (95% CI) 0.96-3.26] compared with 3.78 (95% CI 2.15-6.62) and 5.31 (95% CI 3.06-9.20) for groups 2 and 3, respectively.

    CONCLUSION: The results suggest a dose-response relationship between vibration exposure and numbness of the hands. This underlines the importance of keeping vibration levels low to prevent neurological injury to the hands.

  • 161. Edlund, Maria
    et al.
    Burström, Lage
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hagberg, Mats
    Lundström, Ronnie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nilsson, Tohr
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Sanden, Helena
    Wastensson, Gunilla
    Quantitatively measured tremor in hand-arm vibration-exposed workers2015Ingår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 88, nr 3, s. 305-310Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the present study was to investigate the possible increase in hand tremor in relation to hand-arm vibration (HAV) exposure in a cohort of exposed and unexposed workers. Participants were 178 male workers with or without exposure to HAV. The study is cross-sectional regarding the outcome of tremor and has a longitudinal design with respect to exposure. The dose of HAV exposure was collected via questionnaires and measurements at several follow-ups. The CATSYS Tremor Pen(A (R)) was used for measuring postural tremor. Multiple linear regression methods were used to analyze associations between different tremor variables and HAV exposure, along with predictor variables with biological relevance. There were no statistically significant associations between the different tremor variables and cumulative HAV or current exposure. Age was a statistically significant predictor of variation in tremor outcomes for three of the four tremor variables, whereas nicotine use was a statistically significant predictor of either left or right hand or both hands for all four tremor variables. In the present study, there was no evidence of an exposure-response association between HAV exposure and measured postural tremor. Increase in age and nicotine use appeared to be the strongest predictors of tremor.

  • 162.
    Edvardsson, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Dermatologi och venereologi.
    "Det är inte mig det är fel på, det är huset": en studie av prognosfaktorer och bemötande med fokus på sjuka hus-syndromet2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Bakgrund: Sick Building Syndrome, SBS, är fortfarande 2015 ett tillstånd som vållar mycket diskussion. Symtomen kan grupperas i slemhinnesymtom, hudsymtom och allmänna symtom. I definitionen ingår att personen/ personerna som fått symtom har exponerats för dålig inomhusluft i en speciell byggnad. När personen inte är i byggnaden så förbättras eller försvinner symtomen. Många olika faktorer kan orsaka eller medverka till uppkomst eller försämringar av SBS-symtom, som t.ex. luftens innehåll av olika ämnen, luftflöden, temperatur, buller, fukt och mögel. Utbredd enighet finns om att fukt och mögel i byggnaderna påverkar eller ger upphov till symtom hos vissa personer som exponeras där. Psykosociala faktorer som arbetets organisation och krav och individuella faktorer som kön och personlighet påverkar också.

    Syfte: Hypotesen är att faktorer som tidigare hälsa, åtgärder på arbetet, tid, behandling, personlighet och copingresurser alla kan påverka prognosen för SBS-patienterna. Syftet med avhandlingen är att undersöka hur symtomen påverkar arbetsförmågan och om patienterna återhämtar sig från SBS-symtomen. Ett annat syfte är att undersöka bemötande och de erfarenheter som SBS-symtomen gett en grupp av informanter med SBS. För att förstå om personlighet mätt med självbild och coping hade någon betydelse för progressionen av SBS-symtom och arbetsförmåga gjordes jämförelser av personlighet mellan en patientgrupp med SBS, en patientgrupp med handeksem, en patientgrupp med elkänslighet och en normalpopulation.

    Metod:  En uppföljningsenkät skickades till 239 patienter med SBS-symtom som under åren 1986–1998 blivit undersökta och bedömda på Universitets-sjukhuset i Umeå, Sverige. Frågorna innehöll social och medicinsk status, nuvarande symtom, behandlingar, åtgärder på arbetsplatsen, coping och självbild och svarsfrekvensen var 79,1%. Prognos och riskfaktorer för prognos beräknades för SBS-patienterna. Mätningar av personlighetsfaktorer gjordes med instrumentet Structural analysis of Social Behaviour, SASB, och coping mättes med Coping Resources Inventory, CRI. Likadana uppföljningsenkäter skickades till en grupp patienter med handeksem och patienter med upplevd elkänslighet. Svarsfrekvensen var 68% respektive 73% och enkätsvaren har sedan analyserats och jämförts genom beräknngar av prognos med fokus på självbild och coping för SBS-patienterna och handeksempatienterna. Jämförelser gjordes också mellan de tre olika grupperna och en kontrollgrupp vad gäller självbild och coping. För att undersöka erfarenheterna av SBS-symtomen och bemötandet genomfördes kvalitativa intervjuer med 10 informanter som hade eller hade haft SBS-symtom. Fem av dem hade diagnostiserats en längre tid tillbaka medan de andra fem hade haft SBS-symtomen en kortare period. Semi-strukturerade intervjuformulär användes vid intervjuerna och anlyserades med kvalitativ innehållsanalys.

    Resultat: Graden och svårigheten av SBS-symtomen minskade över tid trots att nästan hälften av SBS-patienterna beskrev att symtomen var mer eller mindre oförändrade efter 7 år eller mer. Risken att ha symtom vid uppföljningen var större för de patienter som remitterats sent efter symtomdebut men även för de som hade kort uppföljningstid. Risken att inte ha någon arbetsförmåga vid uppföljningen var signifikant ökad om det var mer än ett års skillnad mellan symtomdebut och första läkarbesöket p.g.a. SBS-symtomen eller om patienten vid första undersökningen hade fler än 5 SBS-symtom. Dagliga aktiviteter som t.ex. bussåkning förvärrade också symtomen för patienterna. Informanternas upplevelser av SBS-symtomen från början visar en influensaliknande bild med rinnande näsa och ögon, heshet, hosta och huvudvärk. Informanterna agerar för att klara av situationen när symtomen förvärras. Genom hela processen upplever de en brist på bekräftelse och stöd från arbetsgivare, primärvård, företagshälsovård och fastighetsförvaltare.

    Alla tre patientgrupperna hade högre värden i spontan och positiv självbild i jämförelse med en kontrollgrupp. De hade också alla lägre värden i kontroll medan patienterna med handeksem och de med elkänslighet hade högre värden i sin negativa självbild. När det gäller coping skilde sig inte patientgrupperna från kontrollgruppen utom i CRI kognitiv där SBS-patienterna hade hög poäng i motsats till handeksempatienterna som hade låg poäng i samma domän. De elkänsliga patienterna hade i stället höga poäng i domänen andlig/filosofisk. Självbild eller copingförmåga var inte associerade med SBS-symtom eller symtom av handeksem vid uppföljningen och deras personlighet påverkade inte arbetsförmågan. Tidigare atopisk dermatit var en signifikant risk för kvarvarande symtom men inte för arbetsförmågan hos handeksempatienterna.

    Slutsats: En grupp av patienter som tidigare diagnostiserats för symtom från inomhusmiljön har kroniska symtom och påverkan på sitt sociala liv. Över tid minskar symtomen. Resultaten pekar på att ett tidigt omhändertagande är av vikt. SBS-symtomen är från början svåra att upptäcka för alla inblandade och kunskap om hur symtomen kan uppstå i dagligt liv kan bidra till bredare förståelse. Erfarenheterna från personer med SBS visar på avsaknad av bekräftelse och stöd från vården, företagshälsan, arbetsgivare och fastighetsförvaltare. Sambandet mellan symtom och inomhusmiljö får inte glömmas bort. Stöd och bekräftelse innebär också kunskap om skyldigheter för arbetsgivare och fastighetsförvaltare.

    Skillnad i självbild i jämförelse med en kontrollgrupp ses hos patientgrupperna med symtom som är delvis oförklarade men också hos handeksempatienter med ett väletablerat tillstånd. Det kan innebära att patienter med kroniska tillstånd överlag kan avvika från den allmänna populationen. Patienterna visar som grupp en hög positiv och hög spontan självbild som kan leda till svårigheter att sätta gränser. Detta kan leda till en mental stress och i förlängningen också ge en ökad känslighet/sårbarhet för miljöfaktorer.

     

  • 163.
    Edvardsson, Berit
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Stenberg, Berndt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Dermatologi och venereologi.
    Bergdahl, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Eriksson, Nils
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Linden, G
    Widman, L
    The medical and social prognosis of Sick Building Syndrome: a follow-up study focusing on female patients2005Ingår i: Indoor air 2005: proceedings of the 10th international conference on indoor air quality and climate, vols 1-5 / [ed] Yang, X; Zhao, B; Zhao, R, Beijing: Tsinghua university press , 2005, s. 3706-3710Konferensbidrag (Refereegranskat)
    Abstract [en]

    A follow-up questionnaire focusing medical and social status, actions taken and personality traits was sent to 239 patients with Sick Building Syndrome (SBS) registered at the University Hospital in Umea, Sweden. The response rate was 79 percent. As females constituted 92 percent of the respondents all statistical analyses were restricted to women. Almost half of the respondents had been exposed to environments with visible water damages. Fatigue, irritated eyes and facial erythema were the most common symptoms. Nearly half of the patients claimed that the symptoms were more or less unchanged after 7 years or more. Twenty-five percent of the patients were on the sick-list and twenty percent drew disability pension due to SBS-symptoms at follow-up. Symptoms were often aggravated in different situations in everyday life. No important deviations concerning personality factors were found. The results support that early and comprehensive measures for rehabilitation are essential for these patients.

  • 164. Egondi, Thaddaeus
    et al.
    Ettarh, Remare
    Kyobutungi, Catherine
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Exposure to Outdoor Particles (PM2.5) and Associated Child Morbidity and Mortality in Socially Deprived Neighborhoods of Nairobi, Kenya2018Ingår i: Atmosphere, ISSN 2073-4433, E-ISSN 2073-4433, Vol. 9, nr 9, artikel-id 351Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Exposure to air pollution is associated with adverse health outcomes. However, the health burden related to ambient outdoor air pollution in sub-Saharan Africa remains unclear. This study examined the relationship between exposure to outdoor air pollution and child health in urban slums of Nairobi, Kenya. We conducted a semi-ecological study among children under 5 years of age from two slum areas and exposure measurements of particulate matter (PM2.5) at the village level were aligned to data from a retrospective cohort study design. We used logistic and Poisson regression models to ascertain the associations between PM2.5 exposure level and child morbidity and mortality. Compared to those in low-pollution areas (PM2.5 < 25 µg/m3), children in high-pollution areas (PM2.5 ≥ 25 µg/m3) were at significantly higher risk for morbidity in general (odds ratio (OR) = 1.25, 95% confidence interval (CI): 1.11–1.41) and, specifically, cough (OR = 1.38, 95% CI: 1.20–1.48). Exposure to high levels of pollution was associated with a high child mortality rate from all causes (IRR = 1.22, 95% CI: 1.08–1.39) and respiratory causes (IRR = 1.12, 95% CI: 0.88–1.42). The findings indicate that there are associated adverse health outcomes with air pollution in urban slums. Further research on air pollution health impact assessments in similar urban areas is required.

  • 165.
    Egondi, Thaddaeus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kyobutungi, Catherine
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Muindi, Kanyiva
    Oti, Samuel
    van de Vijver, Steven
    Ettarh, Remare
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Community perceptions of air pollution and related health risks in Nairobi slums2013Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 10, nr 10, s. 4851-4868Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Air pollution is among the leading global risks for mortality and responsible for increasing risk for chronic diseases. Community perceptions on exposure are critical in determining people's response and acceptance of related policies. Therefore, understanding people' perception is critical in informing the design of appropriate intervention measures. The aim of this paper was to establish levels and associations between perceived pollution and health risk perception among slum residents. A cross-sectional study of 5,317 individuals aged 35+ years was conducted in two slums of Nairobi. Association of perceived score and individual characteristics was assessed using linear regression. Spatial variation in the perceived levels was determined through hot spot analysis using ArcGIS. The average perceived air pollution level was higher among residents in Viwandani compared to those in Korogocho. Perceived air pollution level was positively associated with perceived health risks. The majority of respondents were exposed to air pollution in their place of work with 66% exposed to at least two sources of air pollution. Less than 20% of the respondents in both areas mentioned sources related to indoor pollution. The perceived air pollution level and related health risks in the study community were low among the residents indicating the need for promoting awareness on air pollution sources and related health risks.

  • 166. Ekblom, Örjan
    et al.
    Ekblom-Bak, Elin
    Bolam, Kate A.
    Ekblom, Björn
    Schmidt, Caroline
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bergström, Göran
    Börjesson, Mats
    Concurrent and predictive validity of physical activity measurement items commonly used in clinical settings– data from SCAPIS pilot study2015Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, artikel-id 978Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: As the understanding of how different aspects of the physical activity (PA) pattern relate to health and disease, proper assessment is increasingly important. In clinical care, self-reports are the most commonly used assessment technique. However, systematic comparisons between questions regarding concurrent or criterion validity are rare, as are measures of predictive validity. The aim of the study was to examine the concurrent (using accelerometry as reference) and predictive validity (for metabolic syndrome) of five PA questions.

    Methods: A sample of 948 middle-aged Swedish men and women reported their PA patterns via five different questions and wore an accelerometer (Actigraph GT3X) for a minimum of 4 days. Concurrent validity was assessed as correlations and ROC-analyses. Predictive validity was assessed using logistic regression, controlling for potential confounders.

    Results: Concurrent validity was low-to-moderate (r <0.35 and ROC AUC <0.7) with large misclassifications regarding time spent sitting/sedentary and in moderate-to vigorous PA. The predictive validity of the questions was good, and one question (PHAS) showed an 80 % decreased odds-ratio of having metabolic syndrome, after taking potential confounders into consideration.

    Discussion: In this mixed sample of adults, both concurrent and predictive validity vaired between items and between measures of the physical activity pattern. The PHAS and WALK items are proposed for assessment of adherence to PA recommendations.

    Conclusion: Assessing PA patterns using self-report measures results in methodological problems when trying to predict individual risk for the metabolic syndrome, as the concurrent validity generally was low. However, several of the investigated questions may be useful for assessing risk at a group level, showing better predictive validity.

  • 167.
    Ekerljung, Linda
    et al.
    Krefting Research Centre, Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bossios, Apostolos
    Krefting Research Centre, Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lötvall, Jan
    Krefting Research Centre, Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Olin, Anna-Carin
    Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Obstructive Lung Disease in Northern Sweden (OLIN), Dept of Medicine, Sunderby Central Hospital of Norrbotten, Luleå, Sweden.
    Wennergren, Göran
    Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Torén, Kjell
    Department of Environmental & Occupational Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lundbäck, Bo
    Obstructive Lung Disease In Northern Sweden (OLIN) studies, Department of Medicine, Sunderby Central Hospital of Norrbotten, Luleå, Sweden.
    Multi-symptom asthma as an indication of disease severity in epidemiology2011Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 38, nr 4, s. 825-832Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Epidemiological questionnaires have failed to identify individuals with severe asthma. The extent of symptoms of asthma can, however, be easily established in epidemiology, by identification of multiple symptoms. We hypothesise that reporting of multiple symptoms of asthma reflects uncontrolled disease and is a sign of more severe asthma. The aims of the current study were, therefore, to determine the prevalence and determinants of multi-symptom asthma.

    A postal questionnaire was sent to 30,000 randomly selected individuals aged 16–75 yrs. A subgroup underwent clinical examinations. Multi-symptom asthma was defined as reported physician-diagnosed asthma, use of asthma medication, recurrent wheeze, attacks of shortness of breath and at least one additional respiratory symptom.

    The prevalence of multi-symptom asthma was 2.0%, and it was more common among females (2.4 versus 1.5%; p<0.001) and those with a body mass index >30 kg·m-2. Multi-symptom asthmatics had lower forced expiratory volume in 1 s, higher exhaled nitric oxide fraction and more pronounced hyperresponsiveness. Family history of both asthma and allergy (OR 7.3), and occupational exposure to gas dust or fumes (OR 2.0) were also significant risk factors.

    Multi-symptom asthmatics comprise 2% of the general population; multi-symptom asthma is related to signs of more severe disease and could be used as an epidemiological marker of disease severity.

  • 168. Ekerljung, Linda
    et al.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Internal Medicine, Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Obstructive Lung Disease In Northern Sweden (OLIN) studies, Department of Medicine, Sunderby Central Hospital of Norrbotten, Luleå, Sweden.
    Lötvall, Jan
    Wennergren, Göran
    Torén, Kjell
    Lundbäck, Bo
    Questionnaire layout and wording influence prevalence and risk estimates of respiratory symptoms in a population cohort2013Ingår i: Clinical Respiratory Journal, ISSN 1752-6981, E-ISSN 1752-699X, Vol. 7, nr 1, s. 53-63Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Results of epidemiological studies are greatly influenced by the chosen methodology. The study aims to investigate how two frequently used questionnaires (Qs), with partly different layout, influence the prevalence of respiratory symptoms.

    Study Design and Setting: A booklet containing two Qs, the Global Allergy and Asthma European Network Q and the Obstructive Lung Disease in Northern Sweden Q, was mailed to 30 000 subjects aged 16-75 years in West Sweden; 62% responded. Sixteen questions were included in the analysis: seven identical between the Qs, four different in set-up and five with the same layout but different wording. Comparisons were made using differences in proportions, observed agreement and Kappa statistics.

    Results: Identical questions yielded similar prevalences with high observed agreement and kappa values. Questions with different set-up or differences in wording resulted in significantly different prevalences with lower observed agreement and kappa values. In general, the use of follow-up questions, excluding subjects answering no to the initial question, resulted in 2.9-6.7% units lower prevalence.

    Conclusion: The question set-up has great influences on epidemiological results, and specifically questions that are set up to be excluded based on a previous no answer leads to lower prevalence compared with detached questions. Therefore, Q layout and exact wording of questions has to be carefully considered when comparing studies.

  • 169. Ekström, Magnus
    et al.
    Schiöler, Linus
    Grønseth, Rune
    Johannessen, Ane
    Svanes, Cecilie
    Leynaert, Benedicte
    Jarvis, Deborah
    Gislason, Thorarinn
    Demoly, Pascal
    Probst-Hensch, Nicole
    Pin, Isabelle
    Corsico, Angelo G
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Heinrich, Joachim
    Nowak, Dennis
    Raherison-Semjen, Chantal
    Dharmage, Shyamali C
    Trucco, Giulia
    Urrutia, Isabel
    Martinez-Moratalla Rovira, Jesús
    Sánchez-Ramos, José Luis
    Janson, Christer
    Torén, Kjell
    Absolute values of lung function explain the sex difference in breathlessness in the general population2017Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 49, nr 5, artikel-id 1602047Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Activity-related breathlessness is twice as common among females as males in the general population and is associated with adverse health outcomes. We tested whether this sex difference is explained by the lower absolute forced expiratory volume in 1 s (FEV1) or forced vital capacity (FVC) in females.This was a cross-sectional analysis of 3250 subjects (51% female) aged 38-67 years across 13 countries in the population-based third European Community Respiratory Health Survey. Activity-related breathlessness was measured using the modified Medical Research Council (mMRC) scale. Associations with mMRC were analysed using ordered logistic regression clustering on centre, adjusting for post-bronchodilator spirometry, body mass index, pack-years smoking, cardiopulmonary diseases, depression and level of exercise.Activity-related breathlessness (mMRC ≥1) was twice as common in females (27%) as in males (14%) (odds ratio (OR) 2.21, 95% CI 1.79-2.72). The sex difference was not reduced when controlling for FEV1 % predicted (OR 2.33), but disappeared when controlling for absolute FEV1 (OR 0.89, 95% CI 0.69-1.14). Absolute FEV1 explained 98-100% of the sex difference adjusting for confounders. The effect was similar within males and females, when using FVC instead of FEV1 and in healthy never-smokers.The markedly more severe activity-related breathlessness among females in the general population is explained by their smaller spirometric lung volumes.

  • 170. Elder, Alison
    et al.
    Nordberg, Gunnar F
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Kleinman, Michael
    Routes of exposure, dose, and toxicokinetics of metals2015Ingår i: Handbook on the toxicology of metals: Volume I: General considerations / [ed] Gunnar F. Nordberg, Bruce A. Fowler, Monica Nordberg, Academic Press, 2015, 4, s. 45-74Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    The chapter first describes the main sources of metal exposure through air, food, and water, but also points to unusual sources such as medical implants. Special attention is given to the processes of lung deposition and clearance of inhaled gases, vapors, and particulates, including ultrafine particles. In contrast to the extensive studies on the lung, the absorption of metal in the gastrointestinal tract is less well understood. A summary diagram shows the contribution of all the absorption processes to the total body burden. Since the publication of the third edition, new information has become available on the mechanisms of transport and distribution of metals in the body. In particular, it has been shown that several metals can cross cell membranes via specific carriers and ion channels intended for endogenous substrates. One well-documented example is the chromate oxyanion that is structurally similar to the sulfate anion and thereby gains entrance into the cell via the sulfate carrier. Attention is also given to the transport of ultrafine particles and nanoparticles across barrier epithelia. The fecal excretion of several metals occurs as the end result of extensive enterohepatic recirculation. In the case of certain organometallic species, gut microflora may play a critical role in converting the metal to an inorganic form, which is excreted in the feces. Renal accumulation and excretion of metals has also received considerable attention. Renal accumulation of cadmium in the form of its complex with the small molecular weight protein, metallothionein, remains one of the best-documented mechanisms. Toxicokinetic models continue to be useful in providing a quantitative description of the overall body turnover of metals. They can be useful in establishing dose-response relationships where, for example, the range of half-times of elimination of a metal can contribute to the overall variance in the dose-response relationship. In addition to the observation-based models, pharmacokinetic models can be developed based on a priori physiological and mechanistic considerations. The chapter concludes with a consideration of indicator media that best reflect the dose to the critical organ.

  • 171. Eneroth, Hanna
    et al.
    Wallin, Stina
    Leander, Karin
    Nilsson Sommar, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Åkesson, Agneta
    Risks and Benefits of Increased Nut Consumption: Cardiovascular Health Benefits Outweigh the Burden of Carcinogenic Effects Attributed to Aflatoxin B1 Exposure2017Ingår i: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 9, nr 12, artikel-id 1355Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Nuts are rich in nutrients and mounting evidence shows that consumption reduces cardiovascular disease (CVD) incidence. Nuts may also be a major source of aflatoxin B₁, a potent liver carcinogen and the risk/benefit balance is unknown. Based on national statistics and data from the PREDIMED intervention trial, we estimated the potential CVD-reduction if Swedes aged 55-79 consumed 30 g nuts/day, instead of the current national average of five grams per day. We also assessed the reduction in disability-adjusted life years (DALYs) due to myocardial infarction (MI) and stroke. We estimated the aflatoxin B₁ exposure from nuts and calculated the margin of exposure. The approximation that one nanogram aflatoxin B₁/kg body weight/day results in one additional liver cancer case/10 million person-years was used to estimate the number of liver cancer cases. The increased nut consumption scenario prevented more than 7000 CVDs in 2013 (306/100,000 person-years) and contributed to about 55,000 saved DALYs for stroke and 22,000 for MI. The concomitant increase in aflatoxin B₁ exposure caused an estimated zero to three additional cases of liver cancer, corresponding to 159 DALYs spent, emphasizing the associated risks. Increased nut consumption, as part of a varied healthy diet, is warranted even when aflatoxin B₁ exposure is taken into account. However, efforts to reduce aflatoxin exposure from food are essential.

  • 172. Engeset, Dagrun
    et al.
    Braaten, Tonje
    Teucher, Birgit
    Kühn, Tilman
    Bueno-de-Mesquita, H B
    Leenders, Max
    Agudo, Antonio
    Bergmann, Manuela M
    Valanou, Elisavet
    Naska, Androniki
    Trichopoulou, Antonia
    Key, Timothy J
    Crowe, Francesca L
    Overvad, Kim
    Sonestedt, Emily
    Mattiello, Amalia
    Peeters, Petra H
    Wennberg, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Jansson, Jan Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Boutron-Ruault, Marie-Christine
    Dossus, Laure
    Dartois, Laureen
    Li, Kuanrong
    Barricarte, Aurelio
    Ward, Heather
    Riboli, Elio
    Agnoli, Claudia
    Huerta, José María
    Sánchez, María-José
    Tumino, Rosario
    Altzibar, Jone M
    Vineis, Paolo
    Masala, Giovanna
    Ferrari, Pietro
    Muller, David C
    Johansson, Mattias
    Luisa Redondo, M
    Tjønneland, Anne
    Olsen, Anja
    Olsen, Karina Standahl
    Brustad, Magritt
    Skeie, Guri
    Lund, Eiliv
    Fish consumption and mortality in the European Prospective Investigation into Cancer and Nutrition cohort2015Ingår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 30, nr 1, s. 57-70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Fish is a source of important nutrients and may play a role in preventing heart diseases and other health outcomes. However, studies of overall mortality and cause-specific mortality related to fish consumption are inconclusive. We examined the rate of overall mortality, as well as mortality from ischaemic heart disease and cancer in relation to the intake of total fish, lean fish, and fatty fish in a large prospective cohort including ten European countries. More than 500,000 men and women completed a dietary questionnaire in 1992-1999 and were followed up for mortality until the end of 2010. 32,587 persons were reported dead since enrolment. Hazard ratios and their 99 % confidence interval were estimated using Cox proportional hazard regression models. Fish consumption was examined using quintiles based on reported consumption, using moderate fish consumption (third quintile) as reference, and as continuous variables, using increments of 10 g/day. All analyses were adjusted for possible confounders. No association was seen for fish consumption and overall or cause-specific mortality for both the categorical and the continuous analyses, but there seemed to be a U-shaped trend (p < 0.000) with fatty fish consumption and total mortality and with total fish consumption and cancer mortality (p = 0.046).

  • 173. Engeset, Dagrun
    et al.
    Hofoss, Dag
    Nilsson, Lena Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Olsen, Anja
    Tjønneland, Anne
    Skeie, Guri
    Dietary patterns and whole grain cereals in the Scandinavian countries: differences and similarities. The HELGA project2015Ingår i: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, nr 5, s. 905-915Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To identify dietary patterns with whole grains as a main focus to see if there is a similar whole grain pattern in the three Scandinavian countries; Denmark, Sweden and Norway. Another objective is to see if items suggested for a Nordic Food Index will form a typical Nordic pattern when using factor analysis. Setting: The HELGA study population is based on samples of existing cohorts: the Norwegian Women and Cancer Study, the Swedish Vasterbotten cohort and the Danish Diet, Cancer and Health study. The HELGA study aims to generate knowledge about the health effects of whole grain foods. Subjects: The study included a total of 119 913 participants. Design: The associations among food variables from FFQ were investigated by principal component analysis. Only food groups common for all three cohorts were included. High factor loading of a food item shows high correlation of the item to the specific diet pattern. Results: The main whole grain for Denmark and Sweden was rye, while Norway had highest consumption of wheat. Three similar patterns were found: a cereal pattern, a meat pattern and a bread pattern. However, even if the patterns look similar, the food items belonging to the patterns differ between countries. Conclusions: High loadings on breakfast cereals and whole grain oat were common in the cereal patterns for all three countries. Thus, the cereal pattern may be considered a common Scandinavian whole grain pattern. Food items belonging to a Nordic Food Index were distributed between different patterns.

  • 174. Engström, Karin S
    et al.
    Wennberg, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Medicine, Skellefteå Hospital, Skellefteå, Sweden.
    Strömberg, Ulf
    Bergdahl, Ingvar A.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lundh, Thomas
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Rentschler, Gerda
    Vessby, Bengt
    Skerfving, Staffan
    Broberg, Karin
    Evaluation of the impact of genetic polymorphisms in glutathione-related genes on the association between methylmercury or n-3 polyunsaturated long chain fatty acids and risk of myocardial infarction: a case-control study2011Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 10, s. Article nr 33-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The n-3 polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid, which are present in fish, are protective against myocardial infarction. However, fish also contains methylmercury, which influences the risk of myocardial infarction, possibly by generating oxidative stress. Methylmercury is metabolized by conjugation to glutathione, which facilitates elimination. Glutathione is also an antioxidant. Individuals with certain polymorphisms in glutathione-related genes may tolerate higher exposures to methylmercury, due to faster metabolism and elimination and/or better glutathione-associated antioxidative capacity. They would thus benefit more from the protective agents in fish, such as eicosapentaenoic+docosahexaenoic acid and selenium. The objective for this study was to elucidate whether genetic polymorphisms in glutathione-related genes modify the association between eicosapentaenoic+docosahexaenoic acid or methylmercury and risk of first ever myocardial infarction.

    METHODS: Polymorphisms in glutathione-synthesizing (glutamyl-cysteine ligase catalytic subunit, GCLC and glutamyl-cysteine ligase modifier subunit, GCLM) or glutathione-conjugating (glutathione S-transferase P, GSTP1) genes were genotyped in 1027 individuals from northern Sweden (458 cases of first-ever myocardial infarction and 569 matched controls). The impact of these polymorphisms on the association between erythrocyte-mercury (proxy for methylmercury) and risk of myocardial infarction, as well as between plasma eicosapentaenoic+docosahexaenoic acid and risk of myocardial infarction, was evaluated by conditional logistic regression. The effect of erythrocyte-selenium on risk of myocardial infarction was also taken into consideration.

    RESULTS: There were no strong genetic modifying effects on the association between plasma eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury and risk of myocardial infarction risk. When eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury were divided into tertiles, individuals with GCLM-588 TT genotype displayed a lower risk relative to the CC genotype in all but one tertile; in most tertiles the odds ratio was around 0.5 for TT. However, there were few TT carriers and the results were not statistically significant. The results were similar when taking plasma eicosapentaenoic+docosahexaenoic acid, erythrocyte-selenium and erythrocyte-mercury into account simultaneously.

    CONCLUSIONS: No statistically significant genetic modifying effects were seen for the association between plasma eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury and risk of myocardial infarction. Still, our results indicate that the relatively rare GCLM-588 TT genotype may have an impact, but a larger study is necessary for confirmation.

  • 175. Eriksson, Berne
    et al.
    Backman, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bossios, Apostolos
    Bjerg, Anders
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundbäck, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Only severe COPD is associated with being underweight: results from a population survey.2016Ingår i: ERJ open research, E-ISSN 2312-0541, Vol. 2, nr 3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Low body mass index (BMI) and malnutrition in chronic obstructive pulmonary disease (COPD) are associated with a poor prognosis. The prevalence of underweight, as well as overweight, in severity grades of COPD is sparsely investigated in studies of the general population and the associated patterns of risk factors are not well established. The aim of the present study was to determine the association between severity grades of airflow limitation in COPD, and both underweight and obesity when corrected for possible confounding factors. The study is based on pooled data from the OLIN (Obstructive Lung Disease in Northern Sweden) studies. Complete records with lung function, BMI and structured interview data were available from 3942 subjects (50.7% women and 49.3% men). COPD and severity grading were defined using the Global Initiative for Chronic Obstructive Lung Disease criteria. In sensitivity analyses, the lower limit of normal was used. The prevalence of underweight was 7.3% in severe COPD (grades 3 and 4) versus 2.0% in those with normal spirometry. The prevalence of obesity increased from 9.7% in grade 1, to 16.3% in grade 2 and 20.0% in severe COPD, versus 17.7% in those with normal spirometry. In adjusted analysis, of the COPD severity grades, only severe COPD was associated with underweight (OR 3.24, 95% CI 1.0004-10.5), while the COPD severity grades tended to be inversely associated with overweight.

  • 176.
    Eriksson, Berne
    et al.
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Internal Medicine, Central County Hospital of Halmstad, Halmstad, Sweden.
    Backman, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ekerljung, Linda
    Krefting Research Centre, Institute of Medicine, University of Gothenburg , Gothenburg, Sweden.
    Axelsson, Malin
    Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundbäck, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Pattern of Cardiovascular Comorbidity in COPD in a Country with Low-smoking Prevalence: Results from Two-population-based Cohorts from Sweden2018Ingår i: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 15, nr 5, s. 454-463Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Cardiovascular diseases are the most common comorbidities in COPD, due to common risk factors such as smoking. The prevalence of current smokers in Sweden has decreased over four decades to around 10%. The aim of the present study was to investigate the prevalence, distribution and associations of cardiovascular comorbidities in COPD by disease severity in two large areas of Sweden, both with low-smoking prevalence. Data from clinical examinations in 2009-2012, including spirometry and structured interview, from two large-scale population studies, the West Sweden Asthma Study (WSAS) and the OLIN Studies in Northern Sweden, were pooled. COPD was defined using post-bronchodilator spirometry according to the fixed ratio FEV1/FVC <0.70 and the lower limit of normal (LLN5th percentile) of the ratio of FEV1/FVC. Of the 1839 subjects included, 8.7% and 5.7% had COPD according to the fixed ratio and the LLN criterion. Medication for heart disease or hypertension among those with moderate-to-severe COPD was more common than among those without COPD (fixed ratio definition of COPD: 51% vs. 23%, p < 0.001; LLN definition: 42% vs. 24%, p = 0.002). After adjusting for known risk factors for COPD, including smoking, age, socio-economic status, and occupational exposure for gas, dust and fumes, only heart failure remained significantly, and independently, associated with COPD, irrespective of the definitions of COPD. Though a major decrease in smoking prevalence, the pattern of cardiovascular comorbidities in COPD still remains similar with previously performed studies in Sweden and in other Westernized countries as well.

  • 177.
    Eriksson, Jeanette
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Wahlström, Jens
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Hofverberg, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Pettersson-Strömbäck, Anita
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Längre arbetsliv: om samverkan mellan företagshälsovård och personalavdelningar inom norrländska kommuner och landsting2014Rapport (Övrigt vetenskapligt)
  • 178. Eriksson, Jonas
    et al.
    Ekerljung, Linda
    Bossios, Apostolos
    Bjerg, Anders
    Wennergren, Göran
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Studies, Department of Medicine, Sunderby Central Hospital of Norrbotten, Luleå.
    Torén, Kjell
    Lötvall, Jan
    Lundbäck, Bo
    Aspirin-intolerant asthma in the population: prevalence and important determinants2015Ingår i: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 45, nr 1, s. 211-219Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Population-based studies on aspirin-intolerant asthma are very few and no previous population study has investigated risk factors for the condition.

    OBJECTIVE: To investigate the prevalence and risk factors of aspirin-intolerant asthma in the general population.

    METHODS: A questionnaire on respiratory health was mailed to 30 000 randomly selected subjects aged 16-75 years in West Sweden, 29 218 could be traced and 18 087 (62%) responded. The questionnaire included questions on asthma, respiratory symptoms, aspirin-induced dyspnea and possible determinants.

    RESULTS: The prevalence of aspirin-intolerant asthma was 0.5%, 0.3% in men and 0.6% in women (p=0.014). Sick leave, emergency visits due to asthma and all investigated lower respiratory symptoms were more common in aspirin-intolerant asthma than in aspirin-tolerant asthma. Obesity was a strong risk factor for aspirin-intolerant asthma (BMI>35: OR 12.1; 95% CI 2.49-58.5) and there was a dose-response relationship between increasing body mass index and risk of aspirin-intolerant asthma. Obesity, airborne occupational exposure and visible mold at home were considerably stronger risk factors for aspirin-intolerant asthma than for aspirin-tolerant asthma. Current smoking was a risk factor for aspirin-intolerant asthma (OR 2.55; 95% CI 1.47-4.42), but not aspirin-tolerant asthma.

    CONCLUSION: Aspirin-intolerant asthma identified in the general population was associated with a high burden of symptoms, uncontrolled disease and a high morbidity. Increasing body mass index increased the risk of aspirin-intolerant asthma in a dose-response manner. A number of risk factors, including obesity and current smoking, were considerably stronger for aspirin-intolerant asthma than for aspirin-tolerant asthma.

  • 179.
    Eriksson, Kåre
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bryngelsson, Ing-Liss
    Hagström, Katja
    Temporal Trend in Wood Dust Exposure During the Production of Wood Pellets2017Ingår i: Annals of work exposures and health, ISSN 2398-7316, Vol. 61, nr 4, s. 429-439Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Wood dust data collected in the production of wood pellets during 2001 to 2013 were evaluated to study a temporal trend in inhalation exposure.

    Methods: A linear mixed effects model of natural ln-transformed data was used to express the relative annual difference in inhalation wood dust exposure.

    Results: There was an annual decrease of -20.5% of the geometric mean wood dust exposure during 2001 until 2013. The results were based on 617 inhalable dust samples collected at 14 different production units. The exposure to wood dust at the industrial premises investigated has decreased from a relatively high level of 6.4 mg m-3 in 2001 to 1.0 mg-3 in 2013. The Swedish Occupational Exposure Limit (SOEL) of 2 mg m-3 may still be exceeded.

    Conclusion: Analysis of the temporal trend in soft wood production units revealed declines in exposure of 20.5% per annum. It is important that precautions are taken to protect workers from a hazardous exposure to wood dust at the premises as the SOEL of 2 mg m-3 at some occasions is still exceeded. Additional measurements of wood dust exposure should be carried out on a regular basis in wood pellet production units in Sweden as well in other countries.

  • 180. Espín-Pérez, Almudena
    et al.
    Hebels, Dennie G. A. J.
    Kiviranta, Hannu
    Rantakokko, Panu
    Georgiadis, Panagiotis
    Botsivali, Maria
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Palli, Domenico
    Späth, Florentin
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Johansson, Anders
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Chadeau-Hyam, Marc
    Kyrtopoulos, Soterios A
    Kleinjans, Jos C. S.
    de Kok, Theo M. C. M.
    Identification of Sex-Specific Transcriptome Responses to Polychlorinated Biphenyls (PCBs)2019Ingår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, artikel-id 746Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PCBs are classified as xenoestrogens and carcinogens and their health risks may be sex-specific. To identify potential sex-specific responses to PCB-exposure we established gene expression profiles in a population study subdivided into females and males. Gene expression profiles were determined in a study population consisting of 512 subjects from the EnviroGenomarkers project, 217 subjects who developed lymphoma and 295 controls were selected in later life. We ran linear mixed models in order to find associations between gene expression and exposure to PCBs, while correcting for confounders, in particular distribution of white blood cells (WBC), as well as random effects. The analysis was subdivided according to sex and development of lymphoma in later life. The changes in gene expression as a result of exposure to the six studied PCB congeners were sex- and WBC type specific. The relatively large number of genes that are significantly associated with PCB-exposure in the female subpopulation already indicates different biological response mechanisms to PCBs between the two sexes. The interaction analysis between different PCBs and WBCs provides only a small overlap between sexes. In males, cancer-related pathways and in females immune system-related pathways are identified in association with PCBs and WBCs. Future lymphoma cases and controls for both sexes show different responses to the interaction of PCBs with WBCs, suggesting a role of the immune system in PCB-related cancer development.

  • 181.
    Evengard, Birgitta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    McMichael, Anthony
    Australian Natl Univ, Canberra, ACT, Australia.
    Vulnerable populations in the Arctic2011Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, s. 11210-Artikel i tidskrift (Refereegranskat)
  • 182.
    Evengård, Birgitta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Berner, Jim
    Brubaker, Michael
    Mulvad, Gert
    Revich, Boris
    Climate change and water security with a focus on the Arctic2011Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, s. 8449-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Water is of fundamental importance for human life; access to water of good quality is of vital concern for mankind. Currently however, the situation is under severe pressure due to several stressors that have a clear impact on access to water. In the Arctic, climate change is having an impact on water availability by melting glaciers, decreasing seasonal rates of precipitation, increasing evapotranspiration, and drying lakes and rivers existing in permafrost grounds. Water quality is also being impacted as manmade pollutants stored in the environment are released, lowland areas are flooded with salty ocean water during storms, turbidity from permafrost-driven thaw and erosion is increased, and the growth or emergence of natural pollutants are increased. By 2030 it is estimated that the world will need to produce 50% more food and energy which means a continuous increase in demand for water. Decisionmakers will have to very clearly include life quality aspects of future generations in the work as impact of ongoing changes will be noticeable, in many cases, in the future. This article will focus on effects of climate-change on water security with an Arctic perspective giving some examples from different countries how arising problems are being addressed.

  • 183. Finnbjornsdottir, Ragnhildur Gudrun
    et al.
    Carlsen, Hanne Krage
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Centre of Public Health Sciences, University of Iceland, Stapi, v/Hringbraut, 101 Reykjavik, Iceland.
    Thorsteinsson, Throstur
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lund, Sigrun Helga
    Gislason, Thorarinn
    Rafnsson, Vilhjalmur
    Association between Daily Hydrogen Sulfide Exposure and Incidence of Emergency Hospital Visits: A Population-Based Study2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 5, artikel-id e0154946Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The adverse health effects of high concentrations of hydrogen sulfide (H2S) exposure are well known, though the possible effects of low concentrations have not been thoroughly studied. The aim was to study short-term associations between modelled ambient low-level concentrations of intermittent hydrogen sulfide (H2S) and emergency hospital visits with heart diseases (HD), respiratory diseases, and stroke as primary diagnosis.

    METHODS: The study is population-based, using data from patient-, and population-registers from the only acute care institution in the Reykjavik capital area, between 1 January, 2007 and 30 June, 2014. The study population was individuals (≥18yr) living in the Reykjavik capital area. The H2S emission originates from a geothermal power plant in the vicinity. A model was used to estimate H2S exposure in different sections of the area. A generalized linear model assuming Poisson distribution was used to investigate the association between emergency hospital visits and H2S exposure. Distributed lag models were adjusted for seasonality, gender, age, traffic zones, and other relevant factors. Lag days from 0 to 4 were considered.

    RESULTS: The total number of emergency hospital visits was 32961 with a mean age of 70 years. In fully adjusted un-stratified models, H2S concentrations exceeding 7.00μg/m3 were associated with increases in emergency hospital visits with HD as primary diagnosis at lag 0 risk ratio (RR): 1.067; 95% confidence interval (CI): 1.024-1.111, lag 2 RR: 1.049; 95%CI: 1.005-1.095, and lag 4 RR: 1.046; 95%CI: 1.004-1.089. Among males an association was found between H2S concentrations exceeding 7.00μg/m3, and HD at lag 0 RR: 1.087; 95%CI: 1.032-1.146 and lag 4 RR: 1080; 95%CI: 1.025-1.138; and among those 73 years and older at lag 0 RR: 1.075; 95%CI: 1.014-1.140 and lag 3 RR: 1.072; 95%CI: 1.009-1.139. No associations were found with other diseases.

    CONCLUSIONS: The study showed an association between emergency hospital visits with HD as primary diagnosis and same day H2S concentrations exceeding 7.00μg/m3, more pronounced among males and those 73 years and older than among females and younger individuals.

  • 184. Finnbjornsdottir, Ragnhildur Gudrun
    et al.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Elvarsson, Bjarki Thor
    Gislason, Thorarinn
    Rafnsson, Vilhjalmur
    Hydrogen sulfide and traffic-related air pollutants in association with increased mortality: a case-crossover study in Reykjavik, Iceland2015Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, nr 4, artikel-id e007272Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To study the association between daily mortality and short-term increases in air pollutants, both traffic-related and the geothermal source-specific hydrogen sulfide (H2S).

    DESIGN: Population-based, time stratified case-crossover. A lag time to 4 days was considered. Seasonal, gender and age stratification were calculated. Also, the best-fit lag when introducing H2S >7 µg/m(3) was selected by the Akaike Information Criterion (AIC).

    SETTING: The population of the greater Reykjavik area (n=181 558) during 2003-2009.

    PARTICIPANTS: Cases were defined as individuals living in the Reykjavik capital area, 18 years or older (N=138 657), who died due to all natural causes (ICD-10 codes A00-R99) other than injury, poisoning and certain other consequences of external causes, or cardiovascular disease (ICD-10 codes I00-I99) during the study period.

    MAIN OUTCOME MEASURE: Percentage increases in risk of death (IR%) following an interquartile range increase in pollutants.

    RESULTS: The total number of deaths due to all natural causes was 7679 and due to cardiovascular diseases was 3033. The interquartile range increased concentrations of H2S (2.6 µg/m(3)) were associated with daily all natural cause mortality in the Reykjavik capital area. The IR% was statistically significant during the summer season (lag 1: IR%=5.05, 95% CI 0.61 to 9.68; lag 2: IR%=5.09, 95% CI 0.44 to 9.97), among males (lag 0: IR%=2.26, 95% CI 0.23 to 4.44), and among the elderly (lag 0: IR%=1.94, 95% CI 0.12 to 1.04; lag 1: IR%=1.99, 95% CI 0.21 to 1.04), when adjusted for traffic-related pollutants and meteorological variables. The traffic-related pollutants were generally not associated with statistical significant IR%s.

    CONCLUSIONS: The results suggest that ambient H2S air pollution may increase mortality in Reykjavik, Iceland. To the best of our knowledge, ambient H2S exposure has not previously been associated with increased mortality in population-based studies and therefore the results should be interpreted with caution. Further studies are warranted to confirm or refute whether H2S exposure induces premature deaths.

  • 185.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Klimatförändring och hälsorelaterad miljöövervakning: - redovisning av utredningsuppdrag2009Rapport (Övrigt vetenskapligt)
  • 186.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Slutrapport från pilotstudie Uppskattning av exponering för ozon2014Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Syftet med denna pilotstudie var att genomföra en undersökning angående ozonexponering under ”ozonsäsongen” (dvs maj-september) 2013 inne i skolor och utanför på skolgården samt i sovrummet hos skolbarn och i utomhus bostadens närhet. Pilotstudien ska ge vägledning angående kriterier och uppläggning vid mätning av ozon, samt leda till ett förslag till mätprogram för ozonexponering med fokus på ozonsäsongen och barns miljöer.

    För skolmätningen valdes 10 representativa skolor ut. Ozonprovtagare placerades öppet i två klassrum per skola, oftast på ca 2 m höjd, t ex ovanför en hylla. En provtagare placerades på en öppen plats på skolgården. Mätningarna pågick under samma veckolånga period inomhus och utomhus, alla skolmätningarna startades 13-14 maj. Vi en sköterska inbjöds skolbarn med astma att ingå i bostadsmätningarna”, och 25 tackade efter att ha fått skriftlig information ja till att medverka i studien. Skolornas och bostädernas avgasbelastning har indikerats med en modellberäkning av lokalt trafikgenererad halt av NOx/NO2. På skolgårdarna var veckomedelhalten i genomsnitt 67,4 μg/m3. Det var stora skillnader i utomhushalten av ozon mellan mitten på maj då mätningarna på de 10 skolgårdarna utfördes, och i slutet av september då bostadsområdena studerades. I klassrummen varierade ozonhalten från 12,3 till 48,1 μg/m3, med ett medelvärde på 23.3 μg/m3. I barnens sovrum fanns nästan inget ozon alls. Medelvärdet var 2,1 μg/m3 och spridningen från 0,4 till 5,8 μg/m3. Det observerades inget samband mellan ozonhalten inomhus och utomhus, vilket torde bero på liten ventilation och att ozon är så reaktivt. Utifrån denna pilotstudie kan kostateras att mätningarna för att spegla den mest intressanta exponeringen för ozon bör ske under sommaren, vilket om skolbarn ska inkluderas förmodligen innebär att det vore lättast att göra studien under slutet av vårterminen.

  • 187.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Traffic related PM and mortality: exposure-response functions and impact calculations for TESS2008Rapport (Övrigt vetenskapligt)
    Abstract [en]

    This is a report from the research project TESS – Traffic Emissions, Socio-economic valuation and Socio-economic measures, which is funded by EMFO. In 2002 an agreement about the EMFO program was reached between the partners from the Swedish Vehicle Research Council, PFF. EMFO is a sector-wide research competence to develop vehicles and vehicle components with emission levels that are sustainable in the long term. The aim of EMFO is to offer academia, industry and authorities access to necessary knowledge and pioneering solutions that are necessary if vehicle technology is to develop in the desired direction. One important task is to coordinate activities within the program with both national and international research in the field. EMFO comprises subsidiary programs and two of these were: “Socio-economic evaluation of the health and environmental impact of different emissions” and “Optimal range of socio-economic measures”. TESS undertakes research in these two areas but it is also related to the subsidiary program: “Health and Environmental Impact”. The application was approved in 2005 and the project runs during 2005-2008. The basis for the research in TESS is the valuation methods developed in the EU funded ExternE projects where the external cost of emissions is calculated by tracing the effects that the emissions have on human health and then valuing these effects. The aim is to calculate the external costs related to particles that local emissions (from traffic and other sources) generate on a local and regional scale using Stockholm as a case study. Based on this information an analysis will be made on what reductions measures are likely to be efficient from an economic point of view. The analysis undertaken in TESS requires collaboration between researchers from different research disciplines. There are four parties involved in this project; VTI, SLB analys (Environment and Health Administration, Stockholm), Umeå University and SMHI. This report is focused on the health impact assessment. The first aim is to overview and discuss the epidemiological basis for selection of an exposure-response function, ERF, (or several different) for traffic related particles and mortality. The second aim is to use the exposure calculations by SLB and SMHI presented in TESS to make impact calculations using the selected exposure-response assumptions for particles of three types; exhaust particles, road dust particles and secondary particles (especially nitrates).

  • 188.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Urban air quality and indicators of respiratory problems1997Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
  • 189.
    Forsberg, Bertil
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bråbäck, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Keune, Hans
    Kobernus, Mike
    Krayer von Krauss, Martin
    Yang, Aileen
    Bartonova, Alena
    An expert assessment on climate change and health: with a European focus on lungs and allergies2012Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 11, nr Supplement 1, s. S4-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    For almost 20 years, the Intergovernmental Panel on Climate Change has been assessing the potential health risks associated with climate change; with increasingly convincing evidence that climate change presents existing impacts on human health. In industrialized countries climate change may further affect public health and in particular respiratory health, through existing health stressors, including, anticipated increased number of deaths and acute morbidity due to heat waves; increased frequency of cardiopulmonary events due to higher concentrations of air pollutants; and altered spatial and temporal distribution of allergens and some infectious disease vectors. Additionally exposure to moulds and contaminants from water damaged buildings may increase.

    Methods

    We undertook an expert elicitation amongst European researchers engaged in environmental medicine or respiratory health. All experts were actively publishing researchers on lung disease and air pollution, climate and health or a closely related research. We conducted an online questionnaire on proposed causal diagrams and determined levels of confidence that climate change will have an impact on a series of stressors. In a workshop following the online questionnaire, half of the experts further discussed the results and reasons for differences in assessments of the state of knowledge on exposures and health effects.

    Results

    Out of 16 experts, 100% expressed high to very high confidence that climate change would increase the frequency of heat waves. At least half expressed high or very high confidence that climate change would increase levels of pollen (50%), particulate matter (PM2.5) (55%), and ozone (70%). While clarity is needed around the impacts of increased exposures to health impacts of some stressors, including ozone and particulate matter levels, it was noted that definitive knowledge is not a prerequisite for policy action. Information to the public, preventive measures, monitoring and warning systems were among the most commonly mentioned preventative actions.

    Conclusions

    This group of experts identifies clear health risks associated with climate change, and express opinions about these risks even while they do not necessarily regard themselves as covering all areas of expertise. Since some changes in exposure have already been observed, the consensus is that there is already a scientific basis for preventative action, and that the associated adaptation and mitigation policies should also be evidence based.

  • 190.
    Forsberg, Bertil
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Meister, Kadri
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Segerstedt, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Luftföroreningshalter och akutbesök för astma samt några andra luftvägssjukdomar i Stockholm, Göteborg och Malmö 2001-2005: projektrapport till Naturvårdsverket2008Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Denna studie inom den hälsorelaterade miljöövervakningen har genomförts på uppdrag avNaturvårdsverket för att belysa eventuella korttidseffekter av luftföroreningar på akutbesökför astma och andra sjukdomar i andningsorganen, vilka ofta medför ökad känslighet förluftföroreningar. Halternas samband med sjukhusinläggningar för andningsorganenssjukdomar har tidigare studerats inom miljöövervakningen. För att underlätta jämförelser harmetodiken anpassats till dessa tidigare studier av sjukhusinläggningar, där betydelsen avhalterna de två senaste dygnen beräknas. Övervakning av denna typ av ”akuta samband” medhalter i miljön bedöms mindre känslig än enklare epidemiologisk bevakning av antalet fall förtrender och förändringar i diagnostik och vårdresurser, eftersom totala antalet fall i sig kanpåverkas av en rad olika typer av faktorer utan koppling till luftföroreningssituationen.

    Uppgifter om den skrivna befolkningens akutbesök under åren 2001 till och med 2005 förandningsorganens sjukdomar inklusive astma vid akutsjukhusen i StorStockholm (8 sjukhus),Göteborg och Mölndal respektive Malmö har inhämtats från Socialstyrelsens Patientregister.Uppgifterna från registret avser avidentifierade akutbesök med diagnoser dygn för dygn underperioden.

    Luftföroreningsdata i form av urbana bakgrundshalter har hämtats från Stockholm luft- ochbulleranalys (SLB) vid miljöförvaltningen i Stockholm, Göteborgs miljöförvaltningrespektive Malmö miljöförvaltning. Vi har studerat partikelhalten som PM10, avgashaltenindikerad med kväveoxider (NOx) samt ozon.

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

    Vi fann att resultaten inte skiljer sig signifikant mellan studieområdena beträffande effekternaav partikelhalten som PM10 och NOx, medan vi för ozon fann kraftigare effekter i Göteborg.När resultaten vägdes ihop för de tre studieområdena beräknas att antalet akutbesök förandningsorganen ökar med 1,4% (95% KI= 0,4-2,4%) per 10 μg/m3 PM10 och akutbesök förastma med 2,8% (95% KI= 1,8-3,7%). Motsvarande sammanvägda resultat för NOx visar enökning av totala antalet akutbesök för andningsorganen med 0,5% (95% KI= 0,1-1,0%) per 10μg/m3 och akutbesök för astma med 1,2% (95% KI= 0,4-2,1%).

    Eftersom föroreningssituationen som indikatorerna representerar kan förändras med tiden, böranalyserna upprepas med viss periodicitet.

  • 191.
    Forsberg, Bertil
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Miljömedicin.
    Pekkanen, J
    Clench-Aas, J
    Mårtensson, MB
    Stjernberg, Nils
    Bartonova, A
    Timonen, KL
    Skerfving, S
    Childhood asthma in four regions in Scandinavia: risk factors and avoidance effects1997Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 26, nr 3, s. 610-619Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The high and increasing prevalence of childhood asthma is a major public health issue. Various risk factors have been proposed in local studies with different designs.

    METHODS: We have made a questionnaire study of the prevalence of childhood asthma, potential risk factors and their relations in four regions in Scandinavia (Umeå and Malmö in Sweden, Kuopio in eastern Finland and Oslo, Norway). One urban and one less urbanized area were selected in each region, and a study group of 15962 children aged 6-12 years was recruited.

    RESULTS: The prevalence of symptoms suggestive of asthma varied considerably between different areas (dry cough 8-19%, asthma attacks 4-8%, physician-diagnosed asthma 4-9%), as did the potential risk factors. Urban residency was generally not a risk factor. However, dry cough was common in the most traffic polluted area. Exposure to some of the risk factors. such as smoking indoors and moisture stains or moulds at home during the first 2 years of life, resulted in an increased risk. However, current exposure was associated with odds ratios less than one.

    CONCLUSIONS: Our findings were probably due to a combination of early impact and later avoidance of these risk factors. The effects of some risk factors were found to differ significantly between regions. No overall pattern between air pollution and asthma was seen, but air pollution differed less than expected between the areas.

  • 192.
    Forsberg, Bertil
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Stjernberg, Nils
    Falk, M
    Lundbäck, B
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Air pollution levels, meteorological conditions and asthma symptoms1993Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 6, nr 8, s. 1109-1115Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We wanted to assess relations between the daily occurrence of asthma symptoms and fluctuations of air pollution concentrations and meteorological conditions. In a panel of 31 asthmatic patients residing in the town of Piteå in northern Sweden, severe symptoms of shortness of breath, wheeze, cough and phlegm were recorded in an asthma diary together with suspected causes. Sulphur dioxide, nitrogen dioxide, black smoke, relative humidity and temperature were used to evaluate the relationship to the environment. By using multivariate analyses, we found that daily variations in the particulate pollution levels, indicated by black smoke levels below the criteria limits, had significant effects on the risk of developing severe symptoms of shortness of breath. This association was stronger among 10 subjects, who had at least five incident days with severe shortness of breath. Meteorological conditions were not significant in the multivariate models. Cough and phlegm did not show significant relationships to any environmental condition that was evaluated. Only one-third of the subjects reported, at least once during the study, symptoms believed to be related to air pollutants, although we found significant correlations between the pollution levels and the frequency of pollution-related symptoms. We conclude that an association has been established for black smoke as pollutant and shortness of breath as respiratory symptom, and that in certain asthmatics, effects were occurring at lower particulate levels than suggested previously.

  • 193.
    Forsberg, Bertil
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Stjernberg, Nils
    National Institute for Working Life, Umeå, Sweden.
    Linné, R
    Landskrona Hospital, Landskrona, Sweden.
    Segerstedt, Bo
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet (USBE).
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Daily air pollution levels and acute asthma in southern Sweden1998Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 12, nr 4, s. 900-905Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study aimed to investigate the association between daily air pollution levels and the occurrence of acute respiratory signs and symptoms among people with asthma or asthma-like problems.

    Thirty eight subjects in the southern Swedish city of Landskrona kept a daily diary for 10 weeks. The daily prevalence of symptoms, supplementary bronchodilator use and peak flow deviations were compared with measurements of environmental nitrogen dioxide (NO2), sulphur dioxide, temperature and humidity in the city.

    The occurrence of severe asthma, both during the day and during the evening, was significantly positively associated with the concurrent 24 h average concentration of NO2, which never exceeded 72 microg x m(-3). A correlation of borderline significance was found between the use of on-demand medication and the NO2 level. However, peak flow deviations were not associated with air pollution or weather conditions, which may be explained by the beneficial effect of bronchodilators used by 28 of the subjects.

    The results of this study confirm those of some earlier studies and suggest that aggravation of asthma is related to daily variations in air quality, as indicated by relatively low ambient concentrations of nitrogen dioxide. These results also indicate that it may be appropriate to examine severe asthma symptoms separately.

  • 194.
    Forsberg, Bertil
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Stjernberg, Nils
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    People can detect poor air quality well below guideline concentrations: a prevalence study of annoyance reactions and air pollution from traffic1997Ingår i: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 54, nr 1, s. 44-48Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Motor vehicle exhaust fumes are the main source of atmospheric pollution in cities in industrialised countries. They cause respiratory disease and annoy people exposed to them. The relation between ambient exposure to air pollution mainly from motor vehicles and annoyance reactions in a general population was assessed. Also, the importance of factors such as age, sex, respiratory disease, access to the use of a car, and smoking habits on the reporting of these reactions was studied.

    METHODS: A postal questionnaire was sent out in 55 urban areas in Sweden that had nearly identical air quality monitoring stations of the urban air monitoring network. From each area, 150 people aged 16-70 were randomly selected. The questionnaire contained questions on perception of air quality as well as a question on how often exhaust fumes were annoying.

    RESULTS: Six-monthly nitrogen dioxide concentrations correlated consistently with the prevalence of reported annoyance related to air pollution and traffic exhaust fumes. Black smoke and sulphur dioxide had no significant effects. The frequency of reporting annoyance reactions was higher among people with asthma, women, and people with lack of access to a car.

    CONCLUSIONS: In this study town dwellers could detect poor air quality at concentrations well below current guidelines for outdoor air pollution. This suggests that questionnaire studies have a place in monitoring air quality.

  • 195.
    Forsberg, Bertil
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Miljömedicin.
    Stjernberg, Nils
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Prevalence of respiratory and hyperreactivity symptoms in relation to levels of criteria air pollutants in Sweden1997Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 7, nr 3, s. 291-296Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Our knowledge of the adverse health effects from exposure to low levels of air pollution is still insufficient. Early indicators, such as respiratory symptoms, need more attention. We made use of the fact that possible weak effects can be detected more easily when the relevant exposure and other determinants are well controlled. A postal questionnaire was sent to random samples of inhabitants registered as residing in the Vicinity of 55 centrally located air quality monitoring stations in Swedish towns. There were 6,109 questionnaires (76%) returned. Multivariate analyses with confounding control were used to examine the effects of different levels of criteria pollutants on the prevalence of symptoms. The ranges of the half year values were 9-32 and 2-16 mu g/m(3) for nitrogen dioxide and sulphur dioxide respectively. Logistic regression analyses showed higher risks for respiratory problems such as coughs, throat irritation and nose irritation among the persons most exposed, The associations were most obvious for nitrogen dioxide exposure among women. The suggested effects of air pollution exposure cannot be medically evaluated today but they are nevertheless interesting since they are found within common levels usually considered to be safe.

  • 196.
    Forsberg, Bertil
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Wahlgren, Chatrin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundström, Nils-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Jonsson, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Eldningsvanor inom några studieområden i Västerbotten2014Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    I syfte att få bättre underlag om vedeldningens omfattning och emissioner har en eldningsvaneundersökning genomförts i fyra områden inom Västerbotten. Undersökningen baseras på en besöksintervju genomförd av två personer vilka följt ett formulär med frågor och standardiserat sina klassificeringar av de intervjuades svar av mer öppen karaktär. Intervjuerna har genomförts i fyra områden med bebyggelse av olika ålder: Vännäs (kommuncentra), Vännäsby, Sävar och Tavleliden/Tomtebo (villaförort i Umeå). På dessa platser har partikelmätningar i en punkt genomförts inom ramen för ett annat projekt, och kortvariga sotmätningar genomförts på fler platser. Hushåll till intervjuerna utvaldes utifrån att de enligt sotarregistret har någon form av ved- , flis- eller pelletseldning. Totalt intervjuades 176 hushåll, endast ett två ytterligare var tillfrågade och avböjde. Studien visar anläggningarnas användningsgrad, bl.a. bränsleförbrukning per år, vilket kan användas för att beräkna utsläppsmängder. För pannor fanns dock inget samband mellan hög sotnings-frekvens enligt sotarregistren och hög vedförbrukning per år enligt intervjuerna. De som har fjärrvärme som huvudsakligt uppvärmningssätt använder sin kamin/lokaleldstad mindre än den som i huvudsak värmer bostaden med el. Utsläpps- och haltberäkningar kan ta hänsyn till denna kunskap.

  • 197.
    Forsell, Karl
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden..
    Eriksson, Helena
    Järvholm, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundh, Monica
    Andersson, Eva
    Nilsson, Ralph
    Work environment and safety climate in the Swedish merchant fleet2017Ingår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 90, nr 2, s. 161-168Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To get knowledge of the work environment for seafarers sailing under the Swedish flag, in terms of safety climate, ergonomical, chemical and psychosocial exposures, and the seafarers self-rated health and work ability.

    METHODS: A Web-based questionnaire was sent to all seafarers with a personal e-mail address in the Swedish Maritime Registry (N = 5608). Comparisons were made mainly within the study population, using Student's t test, prevalence odds ratios and logistic regressions with 95% confidence intervals.

    RESULTS: The response rate was 35% (N = 1972; 10% women, 90% men), with 61% of the respondents working on deck, 31% in the engine room and 7% in the catering/service department (1% not classifiable). Strain on neck, arm or back and heavy lifting were associated with female gender (p = 0.0001) and younger age (below or above 30 years of age, p < 0.0001). Exposures to exhausts, oils and dust were commonly reported. Major work problems were noise, risk of an accident and vibrations from the hull of the ship. The safety climate was high in comparison with that in land-based occupations. One-fourth had experienced personal harassment or bullying during last year of service.

    CONCLUSIONS: Noise, risk of accidents, hand/arm and whole-body vibrations and psychosocial factors such as harassment were commonly reported work environment problems among seafarers within the Swedish merchant fleet.

  • 198.
    Forsell, Karl
    et al.
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden..
    Liljelind, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Ljungkvist, Göran
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden..
    Nordlinder, Rolf
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden..
    Andersson, Eva
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden..
    Nilsson, Ralph
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden..
    Benzene Exposure and Biomarkers in Alveolar Air and Urine Among Deck Crews on Tankers Transporting Gasoline2019Ingår i: Annals of work exposures and health, ISSN 2398-7316, artikel-id wxz055Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 199.
    Fottrell, Edward
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Identifying humanitarian crises in population surveillance field sites: simple procedures and ethical imperatives.2009Ingår i: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 123, nr 2, s. 151-155Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Effective early warning systems of humanitarian crises may help to avert substantial increases in mortality and morbidity, and prevent major population movements. The Butajira Rural Health Programme (BRHP) in Ethiopia has maintained a programme of epidemiological surveillance since 1987. Inspection of the BRHP data revealed large peaks of mortality in 1998 and 1999, well in excess of the normally observed year-to-year variation. Further investigation and enquiry revealed that these peaks related to a measles epidemic, and a serious episode of drought and consequent food insecurity that went undetected by the BRHP. This paper applies international humanitarian crisis threshold definitions to the BRHP data in an attempt to identify suitable mortality thresholds that may be used for the prospective detection of humanitarian crises in population surveillance sites in developing countries.

    STUDY DESIGN: Empirical investigation using secondary analysis of longitudinal population-based cohort data.

    METHODS: The daily, weekly and monthly thresholds for crises in Butajira were applied to mortality data for the 5-year period incorporating the crisis periods of 1998-1999. Days, weeks and months in which mortality exceeded each threshold level were identified. Each threshold level was assessed in terms of prospectively identifying the true crisis periods in a timely manner whilst avoiding false alarms.

    RESULTS: The daily threshold definition is too sensitive to accurately detect impending or real crises in the population surveillance setting of the BRHP. However, the weekly threshold level is useful in identifying important increases in mortality in a timely manner without the excessive sensitivity of the daily threshold. The weekly threshold level detects the crisis periods approximately 2 weeks before the monthly threshold level.

    CONCLUSION: Mortality measures are highly specific indicators of the health status of populations, and simple procedures can be used to apply international crisis threshold definitions in population surveillance settings for the prospective detection of important changes in mortality rate. Standards for the timely use of surveillance data and ethical responsibilities of those responsible for the data should be made explicit to improve the public health functioning of current sentinel surveillance methodologies.

  • 200. Franceschi, Silvia
    et al.
    Lise, Mauro
    Trépo, Christian
    Berthillon, Pascale
    Chuang, Shu-Chun
    Nieters, Alexandra
    Travis, Ruth C
    Vermeulen, Roel
    Overvad, Kim
    Tjønneland, Anne
    Olsen, Anja
    Bergmann, Manuela M
    Boeing, Heiner
    Kaaks, Rudolf
    Becker, Nikolaus
    Trichopoulou, Antonia
    Lagiou, Pagona
    Bamia, Christina
    Palli, Domenico
    Sieri, Sabina
    Panico, Salvatore
    Tumino, Rosario
    Sacerdote, Carlotta
    Bueno-de-Mesquita, Bas
    Peeters, Petra HM
    Rodríguez, Laudina
    Barroso, Leila Luján
    Dorronsoro, Miren
    Sánchez, María-José
    Navarro, Carmen
    Barricarte, Aurelio
    Regnér, Sara
    Borgquist, Signe
    Melin, Beatrice
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Khaw, Kay-Tee
    Wareham, Nick
    Rinaldi, Sabina
    Hainaut, Pierre
    Riboli, Elio
    Vineis, Paolo
    Infection with hepatitis B and C viruses and risk of lymphoid malignancies in the European Prospective Investigation into Cancer and Nutrition (EPIC)2011Ingår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 20, nr 1, s. 208-214Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Chronic HBV infection may increase the risk of lymphoid malignancies among healthy European volunteers. Impact: Treatment directed at control of HBV infection should be evaluated in HBsAg-seropositive patients with lymphoid tissue malignancies. Cancer Epidemiol Biomarkers Prev; 20(1); 208-14. ©2011 AACR.

1234567 151 - 200 av 847
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf