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  • 251.
    Hagenbjörk, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Malmqvist, E
    Mattisson, K
    Sommar, Nilsson J.
    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.
    The spatial variation of O3, NO, NO2 and NOx and the relation between them in two Swedish cities2017Ingår i: Environmental Monitoring & Assessment, ISSN 0167-6369, E-ISSN 1573-2959, Vol. 189, nr 4, artikel-id UNSP 161Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Ozone and nitrogen oxides (NO x ) are air pollutants with known associations to adverse health effects on humans. Few studies have simultaneously measured ozone and nitrogen oxides with high spatial resolution. The main aim of this paper was to assess the levels and variation of ground-level ozone, NO2 and NO x in two Swedish cities. An additional aim was to describe the levels of these pollutants within and between three different types of measurement sites (regional background, urban background and traffic sites) and within and between different measurement periods of the year. Three weekly sampling campaigns of NO x and ozone were conducted simultaneously at 20 sites in two Swedish regions using Ogawa badges. Ozone was measured at 20 additional sites in each area. The median ozone concentration for all measurements was statistically significantly higher in Malmö (67 μg/m(3)) compared to Umeå (56 μg/m(3)), and in both cities, ozone levels were highest in April. Measurement period was a more important factor for describing the variation in ozone concentrations than the type of measurement site. The levels of NO2 and NO x were statistically significantly higher in the Malmö area (8.1 and 12 μg/m(3)) compared to the Umeå area (4.5 and 8.9 μg/m(3)). The levels were generally highest at the sites categorized as traffic, while the variability between different seasons was sparse.

  • 252.
    Hagenbjörk Gustafsson, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Jämförande mätning av ozon utomhus med Ogawa diffusionsprovtagare och referensmetoden UV-fotometri2012Rapport (Övrigt vetenskapligt)
  • 253.
    Hagenbjörk Gustafsson, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Utvärdering av Ogawa diffusionsprovtagare för mätning av NO2 och NOx i inomhusmiljö, samt jämförelse mellan två diffusionsprovtagare för mätning av NO22012Rapport (Övrigt vetenskapligt)
  • 254.
    Hagenbjörk-Gustafsson, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Validation of diffusive samplers for nitrogen oxides and applications in various environments2014Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The overall aim of this thesis was to validate diffusive samplers for measurements of nitrogen dioxide (NO2) and nitrogen oxides (NOx). The Willems badge was validated for NO2 measurements both in laboratory tests and in field tests (Paper I-II). The sampling rate was 40.0 mL/min for ambient air concentrations and 46.0 mL/min for higher concentrations. No effects of different factors on sampling rate were found except for a reduced sampling rate at low wind velocity. The results of the laboratory validation were confirmed in field tests in ambient air and with personal sampling. The correlation between diffusive samplers and the reference monitor was good for ambient measurements. In conclusion, the Willems badge performs well at wind velocities down to 0.3 m/s, and this makes it suitable for personal sampling but less suitable for measurements in indoor air where the wind velocity is lower. Paper III reports about the field validation of the Ogawa diffusive samplers. Absolute humidity and temperature were found to have the strongest effect on sampling rate with lower uptake rates at low absolute humidity or temperature. The sampling rates above 0 °C were 8.6 mL/min for NO2 and 9.9 mL/min for NOx. NO2 and NOx concentrations that were determined using the manufacturer’s protocol were either underestimated or overestimated. The agreement between concentrations measured by the Ogawa sampler and the reference monitor was improved when field-determined sampling rates were used to calculate concentrations. Paper IV is based on a study with the aim of assessing the exposure of the Swedish general population to NO2 and some carcinogenic substances. The surveys were performed in one of five Swedish cities every year. In each survey, personal measurements of NO2 and some carcinogenic substances were conducted on 40 randomly selected individuals. In the study presented in this thesis, the NO2 part of the study is in focus and results were available for eight surveys conducted across the five cities. The estimated arithmetic mean concentration for the general Swedish population was 14.1 μg/m3. The exposure level for NO2 was higher for smokers compared with non-smokers, and the NO2 exposure levels were higher for people who had gas stoves at home or who were exposed at their workplace. The exposure was lower for those who had oil heating in their houses.

  • 255.
    Hagenbjörk-Gustafsson, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindahl, Roger
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Levin, Jan-Olof
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Karlsson, Doris
    Validation of a diffusive sampler for NO21999Ingår i: Journal of Environmental Monitoring, ISSN 1464-0325, E-ISSN 1464-0333, Vol. 1, s. 349-352Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A diffusive sampler for NO2, Willems badge, was validated in laboratory experiments and field tests. The collecting reagent for NO2 in the sampler is triethanolamine, and the analysis is based on a modified colorimetric method, the

    Saltzman method. The analysis was performed by a flow injection analysis (FIA) technique. The sampling rate for the sampler was determined to be 40.0 ml min−1. There was no effect of NO2 concentration or relative humidity on sampling rate, and the influence of sampling time was found to be small. The detection limit was 4 mg m−3 for a 24 h

    sample. The capacity is high enough to allow sampling of 150 mg m−3 for 7 days, which is twice the recommended Swedish short-term (24 h) guideline value as a 98-percentile over 6 months. In field tests, the sampler performedwell, even at wind speeds higher than 2 m s−1, and at low temperatures. The overall uncertainty of the method was 24%. The sensitivity and capacity of the method also make it suitable for personal sampling for 2–8 h in working environments.

  • 256.
    Hagenbjörk-Gustafsson, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. National Institute for Working Life, Programme for Chemical Exposure Assessment, Umeå.
    Lindahl, Roger
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen. National Institute for Working Life, Programme for Chemical Exposure Assessment, Umeå.
    Levin, Jan-Olof
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen. National Institute for Working Life, Programme for Chemical Exposure Assessment, Umeå.
    Karlsson, Doris
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Validation of the Willems badge diffusive sampler for nitrogen dioxide determinations in occupational environments2002Ingår i: The Analyst, ISSN 0003-2654, E-ISSN 1364-5528, Vol. 127, nr 1, s. 163-168Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Willems badge, a diffusive sampler for nitrogen dioxide, has previously been validated for ambient air measurements. This paper describes the laboratory and field validation of the Willems badge for personal sampling under working environment conditions. The mean sampling rate in the laboratory tests was 46 ml min(-1), with an RSD of 12%. No statistically significant effects on sampling rate of the sampling time, concentration of NO2 or relative humidity were found. A slightly decreased sampling rate was observed at low wind velocity. This was also confirmed during static sampling, which makes the sampler less appropriate for static sampling indoors. No back diffusion was observed. Storage of the samplers for two weeks before or after exposure did not affect the sampling rate. Our analysis is based on a modified colorimetric method, performed by FIA (flow injection analysis). This technique was compared to ion chromatography analysis. The use of ion chromatography lowered the detection limit from 11 to 2 microg m(-3) for an 8 h sample, and furthermore enabled the detection of other anions. In conclusion, the diffusive sampler was found to perform well for personal measurements in industrial environments.

  • 257.
    Hagenbjörk-Gustafsson, Annika
    et al.
    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.
    Andersson, Eva M
    Johannesson, Sandra
    Bellander, Tom
    Merritt, Anne-Sophie
    Tinnerberg, Håkan
    Westberg, Håkan
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Sallsten, Gerd
    Determinants of personal exposure to some carcinogenic substances and nitrogen dioxide among the general population in five Swedish cities2014Ingår i: Journal of Exposure Science and Environmental Epidemiology, ISSN 1559-0631, E-ISSN 1559-064X, Vol. 24, nr 4, s. 437-443Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Environmental levels of airborne carcinogenic and related substances are comparatively better known than individual exposure and its determinants. We report on a personal monitoring program involving five Swedish urban populations. The aim of the program was to investigate personal exposure to benzene, 1,3-butadiene, formaldehyde, and nitrogen dioxide (NO2). The measurements were performed among 40 inhabitants during seven consecutive days, in one urban area each year, during 2000-2008. The estimated population exposure levels were 1.95 μg/m(3) for benzene, 0.56 μg/m(3) for 1,3-butadiene, 19.4 μg/m(3) for formaldehyde, and 14.1 μg/m(3) for NO2. Statistical analysis using a mixed-effects model revealed that time spent in traffic and time outdoors contributed to benzene and 1,3- butadiene exposure. For benzene, refueling a car was an additional determinant influencing the exposure level. Smoking or environmental tobacco smoke were significant determinants of exposure to NO2, benzene, and 1,3-butadiene. Those with a gas stove had higher NO2 exposure. Living in a single-family house increased the exposure to formaldehyde significantly. In a variance component model, the between-subject variance dominated for 1,3-butadiene and formaldehyde, whereas the between-city variance dominated for NO2. For benzene, the between-subject and between-cities variances were similar.

  • 258.
    Hagenbjörk-Gustafsson, Annika
    et al.
    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.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Eriksson, Kåre
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Field validation of the Ogawa diffusive sampler for NO(2) and NO(x) in a cold climate2010Ingår i: Journal of Environmental Monitoring, ISSN 1464-0325, E-ISSN 1464-0333, Vol. 12, nr 6, s. 1315-24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A small-scale field trial in Umeå, Sweden with Ogawa samplers and a chemiluminescence instrument indicated that the NO(2) concentration was underestimated with respect to the reference monitor, if calculated according to the manufacturer's Ogawa sampling protocol. By co-locating Ogawa samplers and reference monitors at six sites in two Swedish cities, uptake rates were determined for NO(2) and NO(x) better applicable to the Swedish conditions and climate. The concentrations of NO(2) and NO(x) calculated according to the instruction manual of the sampler and using the field-determined uptake rates were compared with values derived from chemiluminescence monitors for each week over which samples were taken. When calculated according to the manufacturer's suggested protocol, the Ogawa sampler underestimated the NO(2) concentrations by 9.1% on average for all samples (N = 53), with respect to the reference monitor. In contrast, NO(x) concentrations were overestimated by a mean value of 15% for all samples (N = 45). By using the field determined uptake rates for the calculation of NO(2) and NO(x) a better estimation of the concentrations was obtained. The ratio between concentrations determined with the Ogawa samplers and chemiluminescence monitors was then 1.02 for all measurements of NO(2) and 1.00 for NO(x). Precision, expressed as the mean coefficient of variation, was 6.4% for six, 6-replicate measurements of NO(2) and 3.7% for five, 6-replicate measurements of NO(x).

  • 259.
    Hagenbjörk-Gustavsson, Annika
    et al.
    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.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hälsorelaterad miljöövervakning. Cancerframkallande ämnen i tätortsluft: personlig exponering och bakgrundsmätningar i Umeå 20132014Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Undersökningen kartlägger allmänbefolkningens exponering via luften för vissa cancerframkallande ämnen (bensen, 1,3-butadien, formaldehyd) och kvävedioxid. Undersökningen genomfördes i centrala Umeå under hösten 2013, och inkluderade totalt 40 slumpvis utvalda personer i åldrarna 20-50 år.

    Mätningarna upprepades på 20 personer. Utöver de personburna mätningarna genomfördes även stationära mätningar på två platser utomhus, samt för partiklar även inomhus hos 20 deltagare. Deltagarfrekvensen var 66% och medelåldern var 35 år. Den personliga medianhalten för bensen och 1,3-butadien var 1,4 μg/m3 respektive 0,2 μg/m3 vilket är något lägre än halterna år 2001. Bensenhalten överskrider lågrisknivån (1,3 μg/m3), medan halten 1,3-butadien ligger i nedre kanten av lågriskintervallet. Det fanns en signifikant korrelation mellan den personliga exponeringen för bensen och 1,3-butadien (rs=0.50, p=<0.01). Medianhalten för formaldehyd var 12 μg/m3, och halterna var högre bland de som bodde i villa jämfört med lägenhet. Medianhalten kvävedioxid var 12 μg/m3. PM2.5 mättes utomhus i urban bakgrund samt hemma hos deltagare under två dygn. Medianvärdet för inomhusmätningarna av PM2.5 var högre än motsvarande halt vid mätningarna 2007 (1,9 μg/m3). PM2,5 filtren analyserades även på sitt innehåll av polycykliska kolväten och halterna inomhus var lägre jämfört med halterna utomhus, och var klart lägre än den fastställda lågrisknivån.

  • 260.
    Hagström, Katja
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Schlünssen, Vivi
    National Reserach Centre for the Working Environment, Copenhagen, Denmark; Aarhus University, Aarhus, Denmark.
    Eriksson, Kåre
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Exposure to softwood dust in the wood industry2016Ingår i: The quality of air / [ed] Series Editor D. Barcelo; Volume Editors Miguel de la Guardia, Sergio Armenta, Amsterdam: Elsevier, 2016, 30, s. 801-823Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 261. Hallman, David M.
    et al.
    Holtermann, Andreas
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden.
    Gupta, Nidhi
    Norregaard Rasmussen, Charlotte D.
    Sick leave due to musculoskeletal pain: determinants of distinct trajectories over 1 year2019Ingår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 92, nr 8, s. 1099-1108Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: This study aimed to identify sub-groups of workers with different trajectories of sick leave due to musculoskeletal pain over 1 year, and to investigate the extent to which the identified trajectories are associated with personal, occupational, lifestyle, and pain-related factors at baseline.

    Methods: Data on 981 blue- and white-collar workers were analyzed in the DPHACTO cohort (2012-2014). The number of days on sick leave due to pain was reported using text messages at 4-week intervals across 1 year. Latent class growth analysis was used to distinguish sub-groups with different trajectories of sick leave. A web-based questionnaire at baseline was used to assess personal, occupational (physical and psychosocial), lifestyle, and pain-related factors. Multinomial regression models were constructed to determine associations between baseline factors and trajectories of sick leave (referencing no sick leave), with adjustment for potential confounders.

    Results: Four distinct sub-groups were identified, with trajectories of sick leave due to pain ranging from no sick leave (prevalence 76%; average 0.5 days/year) to some days and increasing sick leave due to pain over 1 year (2%; 89 days/year). The increasing trajectory of sick leave was associated with higher perceived physical exertion, more time in manual work, less social community and influence at work, less leisure-time physical activity, smoking, and more severe symptoms (e.g., multisite pain, low back pain intensity, and pain interference).

    Conclusions: We identified four distinct trajectories of sick leave due to musculoskeletal pain. The sub-group with increasing sick leave due to pain was associated with several modifiable physical and psychosocial factors at work and outside work, which may have implications for prevention.

  • 262. Hamada, Haneen
    et al.
    Isaksson, Marléene
    Bruze, Magnus
    Engfeldt, Malin
    Liljelind, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Axelsson, Sara
    Jönsson, Bo
    Tinnerberg, Håkan
    Zimerson, Erik
    Dermal uptake study with 4,4'-diphenylmethane diisocyanate led to active sensitization2012Ingår i: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 66, nr 2, s. 101-105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. To investigate the dermal uptake of 4,4'-diphenylmethane diisocyanate (4,4'-MDI), a study was performed in which 2 female volunteers were exposed to 10 and 25 mg, respectively, of 4,4'-MDI by applying 2.0% 4,4'-MDI in petrolatum over areas where the surface concentration corresponded to 800 µg/cm(2) . Ten days later, they developed eczematous dermatitis at the area of application.

    Objectives. To investigate whether the dermal application caused active sensitization to 4,4'-MDI.

    Methods. Chemical analysis of the 4,4'-MDI preparation used in the application and the amount of 4,4'-MDI not absorbed by the skin was performed with liquid chromatography-mass spectrometry. The volunteers were tested with serial dilutions of 4,4'-MDI and the potentially cross-reacting substances 4,4'-diaminodiphenylmethane (4,4'-MDA), p-phenylenediamine (PPD), and dicyclohexylmethane-4,4'-diisocyanate (DMDI).

    Results. Patch test results suggested that the volunteers were actively sensitized to 4,4'-MDI following the dermal uptake study, as they reacted positively to 4,4'-MDA, a marker for 4,4'-MDI allergy. No positive reactions were seen to PPD or DMDI. Chemical investigation confirmed that the correct concentration had been used for the dermal uptake study, and showed that about 70% of the applied 4,4'-MDI was not absorbed.

    Conclusions. A dermal uptake study with 4,4'-MDI in 2.0% pet. with an occlusion time of 8 hr induced active sensitization to 4,4'-MDI and subsequently to 4,4'-MDA.

  • 263. Hamblin, Lydia E.
    et al.
    Essenmacher, Lynnette
    Luborsky, Mark
    Russell, Jim
    Janisse, James
    Upfal, Mark
    Arnetz, Judith
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Michigan State Univ, Dept Family Med, E Lansing, MI 48824 USA; Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.
    Worksite Walkthrough Intervention Data-driven Prevention of Workplace Violence on Hospital Units2017Ingår i: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, nr 9, s. 875-884Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of this study was to describe the implementation of a data-driven, unit-based walkthrough intervention shown to be effective in reducing the risk of workplace violence in hospitals. Methods: A structured worksite walkthrough was conducted on 21 hospital units. Unit-level workplace violence data were reviewed and a checklist of possible prevention strategies and an Action Plan form guided development of unit-specific intervention. Unit supervisor perceptions of the walkthrough and implemented prevention strategies were reported via questionnaires. Prevention strategies were categorized as environmental, behavioral, or administrative. Results: A majority of units implemented strategies within 12 months' postintervention. Participants found the walkthrough useful, practical, and worthy of continued use. Conclusions: Structured worksite walkthroughs provide a feasible method for workplace violence reduction in hospitals. Core elements are standardized yet flexible, promoting fidelity and transferability of this intervention.

  • 264.
    Hammarström, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS). Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Larsson, Christel
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Department of Food and Nutrition, and Sport Science, University of Gothenburg, Sweden.
    Ahlgren, Christina
    Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS). Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Experiences of barriers and facilitators to weight-loss in a diet intervention: a qualitative study of women in Northern Sweden2014Ingår i: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 14, s. 59-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is a lack of research about the experiences of participating in weight-reducing interventions. The aim of this study was to explore barriers and facilitators to weight-loss experienced by participants in a diet intervention for middle-aged to older women in the general population in Northern Sweden.

    METHOD: In the intervention the women were randomised to eat either a Palaeolithic-type diet or a diet according to Nordic Nutrition recommendations for 24 months. A strategic selection was made of women from the two intervention groups as well as from the drop-outs in relation to social class, civil status and age. Thematic structured interviews were performed with twelve women and analysed with qualitative content analyses.

    RESULTS: The results showed that the women in the dietary intervention experienced two main barriers - struggling with self (related to difficulties in changing food habits, health problems, lack of self-control and insecurity) and struggling with implementing the diet (related to social relations and project-related difficulties) - and two main facilitators- striving for self-determination (related to having clear goals) and receiving support (from family/friends as well as from the project) - for weight-loss. There was a greater emphasis on barriers than on facilitators.

    CONCLUSION: It is important to also include drop-outs from diet interventions in order to fully understand barriers to weight-loss. A gender-relational approach can bring new insights into understanding experiences of barriers to weight-loss.

  • 265. Hanna, Elizabeth G
    et al.
    Kjellström, Tord
    Bennett, Charmian
    Dear, Keith
    Climate change and rising heat: population health implications for working people in Australia2011Ingår i: Asia-Pacific journal of public health / Asia-Pacific Academic Consortium for Public Health, ISSN 1941-2479, Vol. 23, nr 2 Suppl, s. 14S-26SArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    The rapid rise in extreme heat events in Australia recently is already taking a health toll. Climate change scenarios predict increases in the frequency and intensity of extreme heat events in the future, and population health may be significantly compromised for people who cannot reduce their heat exposure. Exposure to extreme heat presents a health hazard to all who are physically active, particularly outdoor workers and indoor workers with minimal access to cooling systems while working. At air temperatures close to (or beyond) the core body temperature of 37°C, body cooling via sweating is essential, and this mechanism is hampered by high air humidity. Heat exposure among elite athletes and the military has been investigated, whereas the impacts on workers remain largely unexplored, particularly in relation to future climate change. Workers span all age groups and diverse levels of fitness and health status, including people with higher than "normal" sensitivity to heat. In a hotter world, workers are likely to experience more heat stress and find it increasingly difficult to maintain productivity. Modeling of future climate change in Australia shows a substantial increase in the number of very hot days (>35°C) across the country. In this article, the authors characterize the health risks associated with heat exposure on working people and discuss future exposure risks as temperatures rise. Progress toward developing occupational health and safety guidelines for heat in Australia are summarized.

  • 266.
    Hansson Mild, Kjell
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Hand, Jeff
    Hietanen, Maila
    Gowland, Penny
    Karpowicz, Jolanta
    Keevil, Stephen
    Lagroye, Isabelle
    van Rongen, Eric
    Scarfi, Maria Rosaria
    Wilén, Jonna
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Exposure classification of MRI workers in epidemiological studies2013Ingår i: Bioelectromagnetics, ISSN 0197-8462, E-ISSN 1521-186X, Vol. 34, nr 1, s. 81-84Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We estimate that there are about 100,000 workers from different disciplines, such as radiographers, nurses, anesthetists, technicians, engineers, etc., who can be exposed to substantial electromagnetic fields (compared to normal background levels) around magnetic resonance imaging (MRI) scanners. There is a need for well-designed epidemiological studies of MRI workers but since the exposure from MRI equipment is a very complex mixture of static magnetic fields, switched gradient magnetic fields, and radiofrequency electromagnetic fields (RF EMF), it is necessary to discuss how to assess the exposure in epidemiological studies. As an alternative to the use of job title as a proxy of exposure, we propose an exposure categorization for the different professions working with MRI equipment. Specifically, we propose defining exposure in three categories, depending on whether people are exposed to only the static field, to the static plus switched gradient fields or to the static plus switched gradient plus RF fields, as a basis for exposure assessment in epidemiological studies.

  • 267.
    Hansson Mild, Kjell
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Lundström, Ronnie
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Wilén, Jonna
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Non-Ionizing Radiation in Swedish Health CareExposure and Safety Aspects2019Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, nr 7, artikel-id 1186Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The main aim of the study was to identify and describe methods using non-ionizing radiation (NIR) such as electromagnetic fields (EMF) and optical radiation in Swedish health care. By examining anticipated exposure levels and by identifying possible health hazards we also aimed to recognize knowledge gaps in the field. NIR is mainly used in health care for diagnosis and therapy. Three applications were identified where acute effects cannot be ruled out: magnetic resonance imaging (MRI), transcranial magnetic stimulation (TMS) and electrosurgery. When using optical radiation, such as class 3 and 4 lasers for therapy or surgical procedures and ultra-violet light for therapy, acute effects such as unintentional burns, photo reactions, erythema and effects on the eyes need to be avoided. There is a need for more knowledge regarding long-term effects of MRI as well as on the combination of different NIR exposures. Based on literature and after consulting staff we conclude that the health care professionals' knowledge about the risks and safety measures should be improved and that there is a need for clear, evidence-based information from reliable sources, and it should be obvious to the user which source to address.

  • 268.
    Harlid, Sophia
    et al.
    Epigenetics and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA.
    Adgent, Margaret
    Jefferson, Wendy N.
    Panduri, Vijayalakshmi
    Umbach, David M.
    Xu, Zongli
    Stallings, Virginia A.
    Williams, Carmen J.
    Rogan, Walter J.
    Taylor, Jack A.
    Soy formula and epigenetic modifications: analysis of vaginal epithelial cells from infant girls in the IFED study2017Ingår i: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 125, nr 3, s. 447-452Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Early-life exposure to estrogenic compounds affects the development of the reproductive system in rodent models and humans. Soy products, which contain phytoestrogens such as genistein, are one source of exposure in infants fed soy formula, and they result in high serum concentrations.

    OBJECTIVES: Our goal was to determine whether soy exposure is associated with differential DNA methylation in vaginal cells from soy-fed infant girls.

    METHODS: Using the Illumina HumanMethylation450 BeadChip, we evaluated epigenome-wide DNA methylation in vaginal cells from four soy formula-fed and six cow formula-fed girls from the Infant Feeding and Early Development (IFED) study. Using pyrosequencing we followed up the two most differentially methylated sites in 214 vaginal cell samples serially collected between birth and 9 months of age from 50 girls (28 soy formula-fed and 22 cow formula-fed). With a mouse model, we examined the effect of neonatal exposure to genistein on gene specific mRNA levels in vaginal tissue.

    RESULTS: The epigenome-wide scan suggested differences in methylation between soy formula-fed and cow formula-fed infants at three CpGs in the gene proline rich 5 like (PRR5L) (p < 10(4)). Pyrosequencing of the two feeding groups found that methylation levels progressively diverged with age, with pointwise differences becoming statistically significant after 126 days. Genistein-exposed mice showed a 50% decrease in vaginal Prr5l mRNA levels compared to controls.

    CONCLUSIONS: Girls fed soy formula have altered DNA methylation in vaginal cell DNA which may be associated with decreased expression of an estrogen-responsive gene.

  • 269.
    Harryson, Lisa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Novo, Mehmet
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Is gender inequality in the domestic sphere associated with psychological distress among women and men? Results from the Northern Swedish Cohort2012Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, nr 3, s. 271-276Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim The aim of this study was to analyse whether gender inequality in the domestic sphere was associated with psychological distress among women and men.

    Methods In a cohort study, all pupils in the last year of compulsory school in a middle-sized industrial town in northern Sweden were followed until the age of 42. For this study a sample of cohabiting participants (n¼372 women, 352 men) was selected. Gender inequality was measured as perceptions of gender inequality in the couple relationship, time spent on household work, responsibility for domestic work and childcare, and was analysed in relation to psychological distress, after taking possible background variables as well as earlier health status into account.

    Results In the multivariate analyses, perception of gender inequality in the couple relationship was associated with psychological distress for both women (OR 2.23, CI 1.20 to 4.18) and men (OR 3.51, CI 1.69 to 7.31). For women only, taking whole responsibility for domestic work was associated with the outcome (OR 2.17, CI 1.05 to 4.48). For men, taking less than half of the responsibility for domestic work was associated with psychological distress (OR 2.25, CI 1.24 to 3.91).

    Conclusions Gender inequality in the domestic sphere seems to be an important determinant of psychological distress for both women and men.

  • 270. Hastan, D
    et al.
    Fokkens, W J
    Bachert, C
    Newson, R B
    Bislimovska, J
    Bockelbrink, A
    Bousquet, P J
    Brozek, G
    Bruno, A
    Dahlén, S E
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Gunnbjörnsdóttir, M
    Kasper, L
    Krämer, U
    Kowalski, M L
    Lange, B
    Lundbäck, B
    Salagean, E
    Todo-Bom, A
    Tomassen, P
    Toskala, E
    van Drunen, C M
    Bousquet, J
    Zuberbier, T
    Jarvis, D
    Burney, P
    Chronic rhinosinusitis in Europe: an underestimated disease. A GA²LEN study2011Ingår i: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 66, nr 9, s. 1216-1223Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:  Chronic rhinosinusitis (CRS) is a common health problem, with significant medical costs and impact on general health. Even so, prevalence figures for Europe are unavailable. In this study, conducted by the GA2LEN network of excellence, the European Position Paper on Rhinosinusitis and nasal Polyps (EP3OS) diagnostic criteria are applied to estimate variation in the prevalence of Chronic rhinosinusitis (CRS) for Europe.

    Method:  A postal questionnaire was sent to a random sample of adults aged 15–75 years in 19 centres in Europe. Participants reported symptoms of CRS, and doctor diagnosed CRS, allergic rhinitis, age, gender and smoking history. Definition of CRS was based on the EP3OS diagnostic criteria: the presence of more than two of the symptoms: (i) nasal blockage, (ii) nasal discharge, (iii) facial pain/pressure or (iv) reduction in sense of smell, for >12 weeks in the past year – with at least one symptom being nasal blockage or discharge.

    Results:  Information was obtained from 57 128 responders living in 19 centres in 12 countries. The overall prevalence of CRS by EP3OS criteria was 10.9% (range 6.9–27.1). CRS was more common in smokers than in nonsmokers (OR 1.7: 95% CI 1.6–1.9). The prevalence of self-reported physician-diagnosed CRS within centres was highly correlated with the prevalence of EP3OS-diagnosed CRS.

    Conclusion:  This is the first European international multicentre prevalence study of CRS. In this multicentre survey of adults in Europe, about one in ten participants had CRS with marked geographical variation. Smoking was associated with having CRS in all parts of Europe.

  • 271. Hebels, Dennie G. A. J.
    et al.
    Georgiadis, Panagiotis
    Keun, Hector C.
    Athersuch, Toby J.
    Vineis, Paolo
    Vermeulen, Roel
    Portengen, Lützen
    Bergdahl, Ingvar A.
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Palli, Domenico
    Bendinelli, Benedetta
    Krogh, Vittorio
    Tumino, Rosario
    Sacerdote, Carlotta
    Panico, Salvatore
    Kleinjans, Jos C. S.
    de Kok, Theo M. C. M.
    Smith, Martyn T.
    Kyrtopoulos, Soterios A.
    Performance in omics analyses of blood samples in long-term storage: opportunities for the exploitation of existing biobanks in environmental health research2013Ingår i: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 121, nr 4, s. 480-487Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The suitability for omic analysis of biosamples collected in previous decades and currently stored in biobanks is unknown.

    Objectives: We evaluated the influence of handling and storage conditions of blood-derived biosamples on transcriptomic, epigenomic (CpG methylation), plasma metabolomic [UPLC-ToFMS (ultra performance liquid chromatography-time-of-flight mass spectrometry)], and wide-target proteomic profiles.

    Methods: We collected fresh blood samples without RNA preservative in heparin, EDTA, or citrate and held them at room temperature for ≤ 24 hr before fractionating them into buffy coat, erythrocytes, and plasma and freezing the fractions at -80oC or in liquid nitrogen. We developed methodology for isolating RNA from the buffy coats and conducted omic analyses. Finally, we analyzed analogous samples from the EPIC-Italy and Northern Sweden Health and Disease Study biobanks.

    Results: Microarray-quality RNA could be isolated from buffy coats (including most biobank samples) that had been frozen within 8 hr of blood collection by thawing the samples in RNA preservative. Different anticoagulants influenced the metabolomic, proteomic, and to a lesser extent transcriptomic profiles. Transcriptomic profiles were most affected by the delay (as little as 2 hr) before blood fractionation, whereas storage temperature had minimal impact. Effects on metabolomic and proteomic profiles were noted in samples processed ≥ 8 hr after collection, but no effects were due to storage temperature. None of the variables examined significantly influenced the epigenomic profiles. No systematic influence of time-in-storage was observed in samples stored over a period of 13-17 years.

    Conclusions: Most samples currently stored in biobanks are amenable to meaningful omics analysis, provided that they satisfy collection and storage criteria defined in this study.

  • 272.
    Hedlund, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Eriksson, Kåre
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Socio-economic status is related to incidence of asthma and respiratory symptoms in adults.2006Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 28, nr 2, s. 303-310Artikel i tidskrift (Refereegranskat)
  • 273.
    Hedman, Linnea
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Sunderby Cent Hosp Norrbotten, Dept Med, Obstruct Lung Dis No Sweden Studies, S-97189 Lulea, Sweden.
    Bjerg, Anders
    Perzanowski, Matthew
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Sunderby Cent Hosp Norrbotten, Dept Med, Obstruct Lung Dis No Sweden Studies, S-97189 Lulea, Sweden.
    Good agreement between parental and self-completed questionnaires about allergic diseases and environmental factors in teenagers2010Ingår i: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 63, nr 7, s. 783-789Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To study whether the methodological change from parent to index subject as questionnaire respondent affected the prevalence estimates and risk factor patterns for allergic diseases in a longitudinal study.

    STUDY DESIGN AND SETTING: A prospective study of asthma and allergic diseases among children was begun in 1996 within the Obstructive Lung Disease in Northern Sweden Study. In 2002, about 3,342 (95% of invited) teenagers (13 to 14 years) completed the annual questionnaire. A random sample of 294 (84% of invited) parents also completed the same extended International Study of Asthma and Allergies in Childhood questionnaire. Skin prick tests were performed in 1996 and 2000.

    RESULTS: There were no significant differences in the prevalence of rhinitis, eczema, or related environmental factors between parental and self-reports, except for the question of having a dog at home. The absolute agreement was high, whereas the kappa values were fair or moderate. Kappa values of questions regarding parental smoking were 0.8-0.9. Allergic sensitization was the major risk factor for both rhinitis and eczema, and the odds ratios were similar regardless of who reported the condition.

    CONCLUSION: The agreement between the parental and teenagers' reports was good, and the methodological change did not affect the study results.

  • 274.
    Hedman, Linnea
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindgren, Berit
    Perzanowski, Matthew
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Agreement between parental and self-completed questionnaires about asthma in teenagers2005Ingår i: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 16, s. 176-181Artikel i tidskrift (Refereegranskat)
  • 275.
    Hedman, Linnea
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden.
    Stridsman, Caroline
    Andersson, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Backman, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Jansson, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Population-based study shows that teenage girls with asthma had impaired health-related quality of life2017Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, nr 7, s. 1128-1135Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: This study examined the health-related quality of life (HRQoL) of teenagers with and without asthma, including the impact of their sex, allergic conditions, smoking, living conditions and physical activity.

    METHODS: The Obstructive Lung Disease in Northern Sweden (OLIN) studies recruited a cohort of schoolchildren in 2006. The parents of all children aged 7-8 years in three municipalities were invited to complete a questionnaire and 2,585 (96%) participated. The cohort was followed up at the ages of 11-12 years and 14-15 years with high participation rates. At 14-15 years, the HRQoL questionnaire KIDSCREEN-10 and Asthma Control Test were added.

    RESULTS: Girls with current asthma at 14-15 years had a lower mean HRQoL score than girls without asthma (46.4 versus 49.3, p<0.001), but this was not seen among boys (53.8 versus 52.8, p=0.373). Poor HRQoL was related to current asthma, uncontrolled asthma and teenage onset of asthma. It was also related to eczema, living in a single parent household, maternal smoking, daily smoking and inversely related to physical activity.

    CONCLUSION: Teenage girls with asthma had lower HRQoL than girls without asthma. Possible interventions to improve HRQoL among teenagers with asthma were identified: increasing asthma control, preventing smoking and promoting physical activity. 

  • 276.
    Hedman, Linnéa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Andersson, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bjerg, Anders
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundbäck, Bo
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Environmental risk factors related to the incidence of wheeze and asthma in adolescence2015Ingår i: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 45, nr 1, s. 184-191Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Asthma is common among adolescents, but there are few population-based studies on the risk factors for incident asthma and wheeze at this age group OBJECTIVE: To study risk factors for incident asthma and wheeze in adolescence.

    METHOD: Within the Obstructive Lung Disease In Northern Sweden (OLIN) studies, a cohort of 3430 school children (age 7-8y) was recruited in 1996. In the present study, this cohort was followed from age 12 to 19y. At baseline (age 12y), 3151 participated and skin prick tests (SPT) were performed. The cohort was resurveyed annually and risk factors for the cumulative incidence of asthma and wheeze from age 12 to19y were analysed using multivariate Cox regression.

    RESULTS: Female sex (wheeze: HR1.4 95%CI 1.2-1.6; asthma: HR1.8 95%CI1.2-2.5) and a positive SPT to cat, dog or horse at baseline (wheeze: HR 1.6 95%CI 1.2-2.1; asthma: HR2.3 95%CI 1.4-4.0) were significantly associated with the cumulative incidence of wheeze and asthma. Increasing numbers of siblings were inversely related to the incidence of wheeze (HR0.9 95%CI 0.8-0.97) and asthma (HR0.8 95%CI 0.7-0.97). Parental asthma was related to the incidence of asthma (HR 1.8 95%CI 1.2-2.6) while ever smoking (HR 2.0 95%CI 1.6-2.4) and house dampness (HR 1.3 95%CI 1.1-1.6) were risk factors for the incidence of wheeze. Maternal ETS exposure increased the risk of incident asthma in non-sensitized subjects (HR 1.9 95%CI 1.0-3.7).

    CONCLUSION AND CLINICAL RELEVANCE: Several environmental risk factors related to the incidence of asthma and wheeze in adolescence were identified and may be possible targets for intervention and prevention.

  • 277.
    Hedman, Linnéa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bjerg, Anders
    The OLIN-studies, Norrbotten County Council, S-971 89 Luleå, Sweden .
    Lundbäck, Bo
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Conventional epidemiology underestimates the incidence of asthma and wheeze: a longitudinal population-based study among teenagers2012Ingår i: Clinical and translational allergy, ISSN 2045-7022, Vol. 2, nr 1, s. 1-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Because of shifts in the gender ratio and incidence and remission rates of asthma during the teen ages, the methodology of incidence studies among teenagers is important, i.e. if the time intervals between surveys are too long, the incident cases might not be properly identified. The aim was to study the impact of study design on the incidence rates of asthma and wheeze during the teen ages.

    METHODS: In a study about asthma and allergic diseases within the OLIN studies (Obstructive Lung Disease in northern Sweden), a cohort of school children (n = 3,430) was followed annually by questionnaire from age 8 yrs. In the endpoint survey (age 18 yrs) 2,582 (75% of original responders) participated. Incident cases from age 12-18 yrs were identified by two methods: annual questionnaire reports (AR) and baseline-endpoint surveys only (BE).

    RESULTS: The cumulative incidence of asthma and wheeze was significantly higher based on AR compared to BE. Compared to the incidence rates based on all the annual surveys, the calculated average annual rates based on BE were in general lower both among the boys and among the girls. There were no differences between boys and girls in incidence rates of asthma or wheeze during the early teen years. However, from the age of 15 years, the annual incidence rates were significantly or borderline significantly higher among girls than boys. At onset, the additional cases of current asthma identified by AR had significantly less severe asthma than those identified in BE (p < 0.02).

    CONCLUSION: the size of the incidence of asthma and wheeze during the teen ages was influenced by study design. By using the conventional prospective study design with longer follow-up time, the incidence was underestimated.

  • 278.
    Hedman, Linnéa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bjerg, Anders
    Sundberg, Sigrid
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Both environmental tobacco smoke and personal smoking is related to asthma and wheeze in teenagers2011Ingår i: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 66, nr 1, s. 20-25Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Environmental tobacco smoke (ETS) has been reported as a significant risk factor for childhood asthma. Among adults, personal smoking is a major cause of respiratory symptoms and diseases. The effects of these exposures on the prevalence of asthma and wheeze among teenagers are less well known.

    Objective: The aim was to study the independent and combined effects of ETS and personal smoking on the prevalence of asthma and wheeze in teenagers.

    Methods: A longitudinal study of asthma and allergic diseases in schoolchildren has been in progress in Northern Sweden since 1996. All children aged 7–8 years in three municipalities were invited and 3430 (97%) participants have been followed by annual questionnaires. At the age 16–17 years, 82% of the initial participants took part in the 2005 survey.

    Results: Prevalence of physician-diagnosed asthma, ever wheeze and current wheeze was significantly higher among those exposed to maternal ETS and among daily smokers. In multivariate analyses, maternal ETS was a significant risk factor for physician-diagnosed asthma and ever wheeze (OR 1.3–1.5) and personal daily smoking for current wheeze (OR 2.0). ORs for asthma and ever wheeze were highest among daily smokers who were also exposed to maternal ETS with ORs of 1.7 and 2.5, respectively. A significant dose–response association between number of cigarettes/day and the prevalence of wheeze was also found.

    Conclusions: Both ETS and personal smoking were significantly related to asthma and wheeze in teenagers. Maternal ETS exposure was associated with lifetime symptoms, but daily smoking among the teenagers was more strongly related to current symptoms.

  • 279. Heiden, Marina
    et al.
    Mathiassen, Svend Erik
    Garza, Jennifer
    Liv, Per
    Wahlström, Jens
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    A Comparison of Two Strategies for Building an Exposure Prediction Model.2016Ingår i: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 60, nr 1, s. 74-89Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Cost-efficient assessments of job exposures in large populations may be obtained from models in which 'true' exposures assessed by expensive measurement methods are estimated from easily accessible and cheap predictors. Typically, the models are built on the basis of a validation study comprising 'true' exposure data as well as an extensive collection of candidate predictors from questionnaires or company data, which cannot all be included in the models due to restrictions in the degrees of freedom available for modeling. In these situations, predictors need to be selected using procedures that can identify the best possible subset of predictors among the candidates. The present study compares two strategies for selecting a set of predictor variables. One strategy relies on stepwise hypothesis testing of associations between predictors and exposure, while the other uses cluster analysis to reduce the number of predictors without relying on empirical information about the measured exposure. Both strategies were applied to the same dataset on biomechanical exposure and candidate predictors among computer users, and they were compared in terms of identified predictors of exposure as well as the resulting model fit using bootstrapped resamples of the original data. The identified predictors were, to a large part, different between the two strategies, and the initial model fit was better for the stepwise testing strategy than for the clustering approach. Internal validation of the models using bootstrap resampling with fixed predictors revealed an equally reduced model fit in resampled datasets for both strategies. However, when predictor selection was incorporated in the validation procedure for the stepwise testing strategy, the model fit was reduced to the extent that both strategies showed similar model fit. Thus, the two strategies would both be expected to perform poorly with respect to predicting biomechanical exposure in other samples of computer users.

  • 280. Heikkila, K.
    et al.
    Madsen, I. E. H.
    Nyberg, S. T.
    Fransson, E. I.
    Westerlund, H.
    Westerholm, P. J. M.
    Virtanen, M.
    Vahtera, J.
    Vaananen, A.
    Theorell, T.
    Suominen, S. B.
    Shipley, M. J.
    Salo, P.
    Rugulies, R.
    Pentti, J.
    Pejtersen, J. H.
    Oksanen, T.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Nielsen, M. L.
    Kouvonen, A.
    Koskinen, A.
    Koskenvuo, M.
    Knutsson, A.
    Ferrie, J. E.
    Dragano, N.
    Burr, H.
    Borritz, M.
    Bjorner, J. B.
    Alfredsson, L.
    Batty, G. D.
    Singh-Manoux, A.
    Kivimaki, M.
    Job strain and the risk of severe asthma exacerbations: a meta-analysis of individual-participant data from 100 000 European men and women2014Ingår i: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 69, nr 6, s. 775-783Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women.

    Methods

    We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses.

    Results

    During a median follow-up of 10years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19).

    Conclusions

    Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.

  • 281. Heikkila, Katriina
    et al.
    Fransson, Eleonor I.
    Nyberg, Solja T.
    Zins, Marie
    Westerlund, Hugo
    Westerholm, Peter
    Virtanen, Marianna
    Vahtera, Jussi
    Suominen, Sakari
    Steptoe, Andrew
    Salo, Paula
    Pentti, Jaana
    Oksanen, Tuula
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Marmot, Michael G.
    Lunau, Thorsten
    Ladwig, Karl-Heinz
    Koskenvuo, Markku
    Knutsson, Anders
    Kittel, France
    Jockel, Karl-Heinz
    Goldberg, Marcel
    Erbel, Raimund
    Dragano, Nico
    DeBacquer, Dirk
    Clays, Els
    Casini, Annalisa
    Alfredsson, Lars
    Ferrie, Jane E.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimaki, Mika
    Job Strain and Health-Related Lifestyle: Findings From an Individual-Participant Meta-Analysis of 118 000 Working Adults2013Ingår i: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 103, nr 11, s. 2090-2097Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives. We examined the associations of job strain, an indicator of work-related stress, with overall unhealthy and healthy lifestyles. Methods. We conducted a meta-analysis of individual-level data from 11 European studies (cross-sectional data: n = 118 701; longitudinal data: n = 43 971). We analyzed job strain as a set of binary (job strain vs no job strain) and categorical (high job strain, active job, passive job, and low job strain) variables. Factors used to define healthy and unhealthy lifestyles were body mass index, smoking, alcohol intake, and leisure-time physical activity. Results. Individuals with job strain were more likely than those with no job strain to have 4 unhealthy lifestyle factors (odds ratio [OR] = 1.25; 95% confidence interval [CI] = 1.12, 1.39) and less likely to have 4 healthy lifestyle factors (OR = 0.89; 95% CI = 0.80, 0.99). The odds of adopting a healthy lifestyle during study follow-up were lower among individuals with high job strain than among those with low job strain (OR = 0.88; 95% CI = 0.81, 0.96). Conclusions. Work-related stress is associated with unhealthy lifestyles and the absence of stress is associated with healthy lifestyles, but longitudinal analyses suggest no straightforward cause-effect relationship between work-related stress and lifestyle.

  • 282. Heikkila, Katriina
    et al.
    Nyberg, Solja T.
    Theorell, Tores
    Fransson, Eleonor I.
    Alfredsson, Lars
    Bjorner, Jakob B.
    Bonenfant, Sebastien
    Borritz, Marianne
    Bouillon, Kim
    Burr, Herman
    Dragano, Nico
    Geuskens, Goedele A.
    Goldberg, Marcel
    Hamer, Mark
    Hooftman, Wendela E.
    Houtman, Irene L.
    Joensuu, Matti
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Madsen, Ida E. H.
    Magnusson, Linda L.
    Marmot, Michael G.
    Nielsen, Martin L.
    Nordin, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oksanen, Tuula
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Vaananen, Ari
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Ferrie, Jane E.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimaki, Mika
    Work stress and risk of cancer: meta-analysis of 5700 incident cancer events in 116 000 European men and women2013Ingår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 346, s. f165-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To investigate whether work related stress, measured and defined as job strain, is associated with the overall risk of cancer and the risk of colorectal, lung, breast, or prostate cancers.

    Design Meta-analysis of pooled prospective individual participant data from 12 European cohort studies including 116 056 men and women aged 17-70 who were free from cancer at study baseline and were followed-up for a median of 12 years. Work stress was measured and defined as job strain, which was self reported at baseline. Incident cancers (all n=5765, colorectal cancer n=522, lung cancer n=374, breast cancer n=1010, prostate cancer n=865) were ascertained from cancer, hospital admission, and death registers. Data were analysed in each study with Cox regression and the study specific estimates pooled in meta-analyses. Models were adjusted for age, sex, socioeconomic position, body mass index (BMI), smoking, and alcohol intake

    Results A harmonised measure of work stress, high job strain, was not associated with overall risk of cancer (hazard ratio 0.97, 95% confidence interval 0.90 to 1.04) in the multivariable adjusted analyses. Similarly, no association was observed between job strain and the risk of colorectal (1.16, 0.90 to 1.48), lung (1.17, 0.88 to 1.54), breast (0.97, 0.82 to 1.14), or prostate (0.86, 0.68 to 1.09) cancers. There was no clear evidence for an association between the categories of job strain and the risk of cancer.

    Conclusions These findings suggest that work related stress, measured and defined as job strain, at baseline is unlikely to be an important risk factor for colorectal, lung, breast, or prostate cancers.

  • 283. Heikkilä, HM
    et al.
    Schwab, U
    Krachler, Benno
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Männikkö, R
    Rauramaa, R
    Dietary associations with prediabetic states: the DR's EXTRA study (ISRCTN45977199)2012Ingår i: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 66, nr 7, s. 819-824Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background/objectives: Impaired fasting plasma glucose (IFG) and impaired glucose tolerance (IGT) predict development of type 2 diabetes (T2D), but display different pathophysiology for T2D. We studied the association of selected food items and nutrients with IFG, IGT and combined IFG and IGT (IFG+IGT), independent of cardiorespiratory fitness (VO(2max)).

    Subjects/methods: In a population-based sample of 1261 individuals, aged 58-78 years, we identified 126 subjects with IFG, 97 with IGT and 49 with simultaneous IFG and IGT by an oral glucose tolerance test. Dietary intake was assessed by 4-day food records. Cardiorespiratory fitness was assessed by defining maximal oxygen uptake (VO(2max)) from respiratory gas analysis during a maximal symptom-limited exercise stress test on a bicycle ergometer.

    Results: Increased intake of saturated fat was associated with higher odds for IFG (OR 1.07; 1.01-1.14) after adjustment for age, gender, VO(2max) and energy misreporting variable. Consumption of additional whole-grain bread (50 g/1000 kcal) and intake of dietary fiber (g/1000 kcal) were inversely associated with IGT (OR 0.61; 0.41-0.92, OR 0.91; CI 0.85-0.97, respectively).

    Conclusion: Dietary fiber and sources of cereal fiber are negatively associated with IGT, and saturated fat intake is positively associated with IFG, but not with IGT. The present data give practical dietary means at the population level for the elimination of prediabetic conditions. European Journal of Clinical Nutrition advance online publication, 14 March 2012; doi:10.1038/ejcn.2012.23.

  • 284. Heinälä, M
    et al.
    Gundert-Remy, U
    Wood, M
    Ruijten, M
    Bos, PMJ
    Bull, S
    Mahieu, K
    Russell, D
    Nielsen, E
    Cassel, G
    Leffler, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Zitting, A
    Tissot, S
    Vincent, J-M
    Santonen, T
    Survey on European methodologies in the risk assessment of chemical exposures in emergency response situations2013Rapport (Övrigt vetenskapligt)
    Abstract [en]

    Survey on European methodologies in the risk assessment of chemical exposures in emergency response situations. Prevention or mitigation of human health effects is often the major determinant underlying chemical incident prevention policy and emergency response decisions. The ability to perform a human health risk assessment is a prerequisite for effective chemical incident prevention, preparedness and response. To identify knowledge gaps, needs and concerns relating to health risks from chemical incidents, a web-based survey was sent to various groups of stakeholders. The release of acutely toxic substances and irritating/corrosive substances appeared to be the most important risk scenario. Almost 40% of the respondents also expected a future increase of chemical terrorism or sabotage. Developments in nanotechnology were perceived as potential future risk drivers although more information is needed on the health hazards of nanoparticles. A high number of respondents also expressed concern for the consequences of globalization, international trade and higher industry efficiency demands on health risks through chemical incidents. Acute Exposure Reference Values (AERVs) were considered important cornerstones but a need was expressed for recommendations on their use for the management of chemical emergencies. Based on this survey, it is advised to develop European consensus on an authoritative methodology to derive AERVs, to design a process for their implementation and to provide guidance and training on their practical application. Attention should be paid to the widely used acutely toxic and irritating/corrosive substances, to specific endpoints such as carcinogenicity and reproductive toxicity and new and emerging chemicals. Research should focus on developing plausible scenarios for emerging human health risks from chemical incidents to allow better prioritisation of future risk assessments.

  • 285. Heinälä, Milla
    et al.
    Gundert-Remy, Ursula
    Heraty Wood, Maureen
    Ruijten, Marc
    M.J. Bos, Peter
    Zitting, Antti
    Bull, Sarah
    Russell, David
    Nielsen, Elsa
    Cassel, Gudrun
    Swedish Defence Research Agency (FOI).
    Leffler, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Swedish Defence Research Agency (FOI).
    Tissot, Sylvie
    Vincent, Jean-Martin
    Santonen, Tiina
    Survey on methodologies in the risk assessment of chemical exposures in emergency response situations in Europe2013Ingår i: Journal of Hazardous Materials, ISSN 0304-3894, E-ISSN 1873-3336, Vol. 244, s. 545-554Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A scientifically sound assessment of the risk to human health resulting from acute chemical releases is the cornerstone for chemical incident prevention, preparedness and response. Although the general methodology to identify acute toxicity of chemicals has not substantially changed in the last decades, there is ongoing debate on the current approaches for human health risk assessment in scenarios involving acute chemical releases.

    A survey was conducted to identify 1) the most important present and potential future chemical incident scenarios and anticipated changes in chemical incidents or their management; 2) information, tools and guidance used in different countries to assess health risks from acute chemical releases; and 3) needs for new information, tools, guidance and expertise to enable the valid and rapid health risk assessment of acute chemical exposures.

    According to the results, there is an obvious variability in risk assessment practices within Europe. The multiplicity of acute exposure reference values appears to result in variable practices. There is a need for training especially on the practical application of acute exposure reference values. Although acutely toxic and irritating/corrosive chemicals will remain serious risks also in future the development of plausible scenarios for potential emerging risks is also needed. This includes risks from new mixtures and chemicals (e.g. nanoparticles).

  • 286. Henschel, Susann
    et al.
    Atkinson, Richard
    Zeka, Ariana
    Le Tertre, Alain
    Analitis, Antonis
    Katsouyanni, Klea
    Chanel, Olivier
    Pascal, Mathilde
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Medina, Sylvia
    Goodman, Patrick G
    Air pollution interventions and their impact on public health2012Ingår i: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 57, nr 5, s. 757-768Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Numerous epidemiological studies have found a link between air pollution and health. We are reviewing a collection of published intervention studies with particular focus on studies assessing both improvements in air quality and associated health effects. METHODS: Interventions, defined as events aimed at reducing air pollution or where reductions occurred as a side effect, e.g. strikes, German reunification, from the 1960s onwards were considered for inclusion. This review is not a complete record of all existing air pollution interventions. In total, 28 studies published in English were selected based on a systematic search of internet databases. RESULTS: Overall air pollution interventions have succeeded at improving air quality. Consistently published evidence suggests that most of these interventions have been associated with health benefits, mainly by the way of reduced cardiovascular and/or respiratory mortality and/or morbidity. The decrease in mortality from the majority of the reviewed interventions has been estimated to exceed the expected predicted figures based on the estimates from time-series studies. CONCLUSION: There is consistent evidence that decreased air pollution levels following an intervention resulted in health benefits for the assessed population.

  • 287. Hermann, Silke
    et al.
    Rohrmann, Sabine
    Linseisen, Jakob
    May, Anne M
    Kunst, Anton
    Besson, Herve
    Romaguera, Dora
    Travier, Noemie
    Tormo, Maria-Jose
    Molina, Esther
    Dorronsoro, Miren
    Barricarte, Aurelio
    Rodriguez, Laudina
    Crowe, Francesca L
    Khaw, Kay-Tee
    Wareham, Nicholas J
    van Boeckel, Petra Ga
    Bueno-de-Mesquita, H Bas
    Overvad, Kim
    Uhre Jakobsen, Marianne
    Tjonneland, Anne
    Halkjaer, Jytte
    Agnoli, Claudia
    Mattiello, Amalia
    Tumino, Rosario
    Masala, Giovanna
    Vineis, Paolo
    Naska, Androniki
    Orfanos, Philippos
    Trichopoulou, Antonia
    Kaaks, Rudolf
    Bergmann, Manuela M
    Steffen, Annika
    Van Guelpen, Bethany
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Kariologi.
    Borgquist, Signe
    Manjer, Jonas
    Braaten, Tonje
    Fagherazzi, Guy
    Clavel-Chapelon, Francoise
    Mouw, Traci
    Norat, Teresa
    Riboli, Elio
    Rinaldi, Sabina
    Slimani, Nadia
    Peeters, Petra Hm
    The association of education with body mass index and waist circumference in the EPIC-PANACEA study2011Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, nr 1, s. 169-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To examine the association of education with body mass index (BMI) and waist circumference (WC) in the European Prospective Investigation into Cancer and Nutrition (EPIC).

    METHOD: This study included 141,230 male and 336,637 female EPIC-participants, who were recruited between 1992 and 2000. Education, which was assessed by questionnaire, was classified into four categories; BMI and WC, measured by trained personnel in most participating centers, were modeled as continuous dependent variables. Associations were estimated using multilevel mixed effects linear regression models.

    RESULTS: Compared with the lowest education level, BMI and WC were significantly lower for all three higher education categories, which was consistent for all countries. Women with university degree had a 2.1 kg/m2 lower BMI compared with women with lowest education level. For men, a statistically significant, but less pronounced difference was observed (1.3 kg/m2). The association between WC and education level was also of greater magnitude for women: compared with the lowest education level, average WC of women was lower by 5.2 cm for women in the highest category. For men the difference was 2.9 cm.

    CONCLUSION: In this European cohort, there is an inverse association between higher BMI as well as higher WC and lower education level. Public Health Programs that aim to reduce overweight and obesity should primarily focus on the lower educated population.

  • 288. Hermansson, J.
    et al.
    Hallqvist, J.
    Karlsson, B.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Knutsson, A.
    Gillander Gådin, K.
    Shift work, parental cardiovascular disease and myocardial infarction in males2018Ingår i: Occupational Medicine, ISSN 0962-7480, E-ISSN 1471-8405, Vol. 68, nr 2, s. 120-125Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Shift work has been associated with an increased risk of cardiovascular disease (CVD). However, there is a need for more studies to determine whether there is an interaction between shift work and other risk factors of CVD, thereby increasing the risk of CVD in shift workers. Aims: To discern whether shift work and parental mortality from myocardial infarction (MI) or sudden cardiac death (SCD) interact to increase the risk of MI in men. Methods: A case-control dataset was used to assess interaction between shift work and parental history of CVD, using death from MI or SCD, or death before age 65, on an additive scale. Results were reported as relative excess risk due to interaction, attributable proportion due to interaction (AP) and synergy index (SI). Results: There was an interaction between shift work and paternal mortality from MI or SCD, when both factors were present [SI = 2.39; 95% confidence interval (CI) 1.02. 5.6 and AP = 0.4; 95% CI 0.08. 0.73]. Conclusions: Paternal mortality from MI or SCD interacts with shift work to increase the risk of MI in men.

  • 289. Hermansson, Jonas
    et al.
    Bøggild, Henrik
    Hallqvist, Johan
    Karlsson, Berndt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Knutsson, Anders
    Nilsson, Tohr
    Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, Sweden..
    Reuterwall, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Gillander Gådin, Katja
    Interaction between Shift Work and Established Coronary Risk Factors2019Ingår i: International Journal of Occupational and Environmental Medicine, ISSN 2008-6520, E-ISSN 2008-6814, Vol. 10, nr 2, s. 57-65, artikel-id 1466Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Shift work is associated with increased risk of cardiovascular disease, but the causes have not yet been fully established. It has been proposed that the coronary risk factors are more hazardous for shift workers, resulting in a potential interaction effect with shift work.

    OBJECTIVE: To analyse interaction effects of work schedule and established risk factors for coronary artery disease on the risk of myocardial infarction.

    METHODS: This analysis was conducted in SHEEP/VHEEP, a case-control study conducted in two counties in Sweden, comprising all first-time cases of myocardial infarction among men and women 45-70 years of age with controls stratified by sex, age, and hospital catchment area, totalling to 4648 participants. Synergy index (SI) was used as the main outcome analysis method for interaction analysis.

    RESULTS: There was an interaction effect between shift work and physical inactivity on the risk of myocardial infarction with SI of 2.05 (95% CI 1.07 to 3.92) for male shift workers. For female shift workers, interaction effects were found with high waist-hip ratio (SI 4.0, 95% CI 1.12 to 14.28) and elevated triglycerides (SI 5.69, 95% CI 1.67 to 19.38).

    CONCLUSION: Shift work and some established coronary risk factors have significant interactions.

  • 290. Hermansson, Jonas
    et al.
    Gillander Gådin, Katja
    Karlsson, Berndt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stegmayr, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Knutsson, Anders
    Ischemic stroke and shift work.2007Ingår i: Scand J Work Environ Health, ISSN 0355-3140, Vol. 33, nr 6, s. 435-9Artikel i tidskrift (Refereegranskat)
  • 291.
    Hirve, Siddhivinayak
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Gomez-Olive, Xavier
    Oti, Samuel
    Debpuur, Cornelius
    Juvekar, Sanjay
    Tollman, Stephen
    Blomstedt, Yulia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Use of anchoring vignettes to evaluate health reporting behavior amongst adults aged 50 years and above in Africa and Asia: testing assumptions2013Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, s. 1-15Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Comparing self-rating health responses across individuals and cultures is misleading due to different reporting behaviors. Anchoring vignettes is a technique that allows identifying and adjusting self-rating responses for reporting heterogeneity (RH). Objective: This article aims to test two crucial assumptions of vignette equivalence (VE) and response consistency (RC) that are required to be met before vignettes can be used to adjust self-rating responses for RH. Design: We used self-ratings, vignettes, and objective measures covering domains of mobility and cognition from the WHO study on global AGEing and adult health, administered to older adults aged 50 years and above from eight low-and middle-income countries in Africa and Asia. For VE, we specified a hierarchical ordered probit (HOPIT) model to test for equality of perceived vignette locations. For RC, we tested for equality of thresholds that are used to rate vignettes with thresholds derived from objective measures and used to rate their own health function. Results: There was evidence of RH in self-rating responses for difficulty in mobility and cognition. Assumptions of VE and RC between countries were violated driven by age, sex, and education. However, within a country context, assumption of VE was met in some countries (mainly in Africa, except Tanzania) and violated in others (mainly in Asia, except India). Conclusion: We conclude that violation of assumptions of RC and VE precluded the use of anchoring vignettes to adjust self-rated responses for RH across countries in Asia and Africa.

  • 292. Holler, James S
    et al.
    Fowler, Bruce A
    Nordberg, Gunnar F
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Silver2015Ingår i: Handbook on the toxicology of metals: Volume II: Specific metals / [ed] Gunnar F. Nordberg, Bruce A. Fowler, Monica Nordberg, Academic Press, 2015, 4, s. 1209-1216Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    Silver compounds may be absorbed through inhalation, but there are no quantitative human data on the extent of this phenomenon. Silver salts may be absorbed by up to 10-20% after ingestion. After ingestion in humans, the highest concentrations of silver are usually found in the liver and spleen, but also to some extent in the muscles, skin, and brain. The biological half-time for silver ranges from a few days for animals up to approximately 50 days for the human liver; it is possible that skin deposits have an even longer half-time, but there are no quantitative data on this for humans. Silver binds to high molecular weight proteins and metallothionein in tissue cytosol fractions. Excretion of silver from the body is primarily biliary. Silver nanoparticles have been shown to be absorbed by both inhalation and oral routes, resulting in deposition in various organ systems. Water-soluble silver compounds such as the nitrate have a local corrosive effect and may cause fatal poisoning if swallowed accidentally. Chronic exposure of humans leads to argyria, a clinical entity characterized by gray-blue pigmentation of the skin and other body viscera. Repeated exposure of animals to silver may produce anemia, cardiac enlargement, growth retardation, and degenerative changes in the liver.

  • 293. Holm, M
    et al.
    Kim, J-L
    Lillienberg, L
    Storaas, T
    Jögi, R
    Svanes, C
    Schlünssen, V
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Gíslason, T
    Janson, C
    Torén, K
    Incidence and prevalence of chronic bronchitis: impact of smoking and welding. The RHINE study2012Ingår i: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 16, nr 4, s. 553-557Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate the prevalence and incidence rate of chronic bronchitis (CB) in relation to smoking habits and exposure to welding fumes in a general population sample.

    METHODS: Subjects from Northern Europe born between 1945 and 1971 who participated in Stage 1 (1989-1994) of the European Community Respiratory Health Survey were mailed a respiratory questionnaire in 1999-2001 (the RHINE study); 15 909 answered the questionnaire and gave complete data on smoking. CB was defined as chronic productive cough of at least 3 months a year for 2 consecutive years. The questionnaire comprised an item about age when CB started and items about exposure to welding fumes. The incidence of CB was retrospectively assessed for the observation period 1980-2001.

    RESULTS: CB had a prevalence of 5.4%, and was associated with current smoking and welding exposure. The incidence rate of CB was 1.9 per 1000 person-years, and was increased in relation to welding exposure (low exposure HR 1.4, 95%CI 1.1-1.8; high exposure HR 2.0, 95%CI 1.6-2.7) and in relation to smoking (HR 2.1, 95%CI 1.8-2.5).

    CONCLUSION: Smoking and occupational exposure to welding fumes are both associated with an increased risk of CB.

  • 294. Houle, Brian
    et al.
    Stein, Alan
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Madhavan, Sangeetha
    Collinson, Mark
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Tollman, Stephen M.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Clark, Samuel J.
    Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status2013Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 42, nr 5, s. 1444-1454Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Household characteristics are important influences on the risk of child death. However, little is known about this influence in HIV-endemic areas. We describe the effects of household characteristics on children's risk of dying in rural South Africa.

    Methods We use data describing the mortality of children younger than 5 years living in the Agincourt health and socio-demographic surveillance system study population in rural northeast South Africa during the period 1994-2008. Using discrete time event history analysis we estimate children's probability of dying by child characteristics and household composition (other children and adults other than parents) (N = 924 818 child-months), and household socio-economic status (N = 501 732 child-months).

    Results Children under 24 months of age whose subsequent sibling was born within 11 months experience increased odds of dying (OR 2.5; 95% CI 1.1-5.7). Children also experience increased odds of dying in the period 6 months (OR 2.1; 95% CI 1.2-3.6), 3-5 months (OR 3.0; 95% CI 1.5-5.9), and 2 months (OR 11.8; 95% CI 7.6-18.3) before another household child dies. The odds of dying remain high at the time of another child's death (OR 11.7; 95% CI 6.3-21.7) and for the 2 months following (OR 4.0; 95% CI 1.9-8.6). Having a related but non-parent adult aged 20-59 years in the household reduces the odds (OR 0.6; 95% CI 0.5-0.8). There is an inverse relationship between a child's odds of dying and household socio-economic status.

    Conclusions This detailed household profile from a poor rural setting where HIV infection is endemic indicates that children are at high risk of dying when another child is very ill or has recently died. Short birth intervals and additional children in the household are further risk factors. Presence of a related adult is protective, as is higher socio-economic status. Such evidence can inform primary health care practice and facilitate targeting of community health worker efforts, especially when covering defined catchment areas.

  • 295. Hounton, Sennen
    et al.
    Sombié, Issiaka
    Meda, Nicolas
    Bassane, Brahima
    Byass, Peter
    Immpact, University of Aberdeen, Aberdeen, UK.
    Stanton, Cynthia
    De Brouwere, Vincent
    Methods for evaluating effectiveness and cost-effectiveness of a Skilled Care Initiative in rural Burkina Faso2008Ingår i: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 13, nr Suppl 1, s. 14-24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: This paper aims to describe the design, methods and approaches used to assess the effectiveness and cost-effectiveness of the Skilled Care Initiative in reducing pregnancy-related and perinatal mortality in Ouargaye district, Burkina Faso. Methods: The evaluation used a quasi-experimental design, mixed methods and a composite of tools to compare mortality and severe morbidity (near-miss) of women in reproductive age, perinatal mortality, facility functionality, perceived quality of care, utilisation of maternal health services, and costs borne by families and the health care system for maternal health care in Ouargaye and Diapaga districts. Structured questionnaires and interview guides were developed, pre-tested and piloted prior to the main survey. The evaluation was carried out from January to July 2006. A household census was used to retrospectively assess pregnancy-related and perinatal mortality over the previous 5 years, and causes of pregnancy-related death were identified using a newly developed and tested probabilistic model for interpreting verbal autopsy data. Data were directly entered into Personal Digital Assistant devices at the point of interview. Analyses included univariate and multivariate regressions and incremental cost-effectiveness ratios. Results: A population census covering over half a million people, three qualitative surveys and facility surveys in 47 health centres have been carried out. Conclusions: A partnership with key stakeholders and the use of mixed methods proved feasible for evaluating complex safe motherhood strategies, and the use of hand-held computers proved possible for direct data capture, even in this remote rural environment.

  • 296.
    Hult, Carl
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Stattin, Mikael
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Järvholm, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Comparing mortality rates and recognizing health selection bias: A response to Wallman and Svärdsudd2010Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, nr 10, s. 1489-1491Artikel i tidskrift (Övrigt vetenskapligt)
  • 297. Humes, David J
    et al.
    Ludvigsson, Jonas F
    Järvholm, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Smoking and the Risk of Hospitalization for Symptomatic Diverticular Disease: A Population-Based Cohort Study from Sweden.2016Ingår i: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 59, nr 2, s. 110-114Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Current studies reporting on the risk of smoking and development of symptomatic diverticular disease have reported conflicting results.

    OBJECTIVE: The aim of this study was to investigate the association between smoking and symptomatic diverticular disease.

    DESIGN: This is a cohort study

    SETTINGS: : Information was derived from the Swedish Construction Workers Cohort 1971-1993.

    PATIENTS: Patients were selected from construction workers in Sweden.

    MAIN OUTCOME MEASURES: The primary outcome measured was the development of symptomatic diverticular disease and complicated diverticular disease (abscess and perforation) as identified in the Swedish Hospital Discharge Register. Adjusted relative risks of symptomatic diverticular disease according to smoking status were estimated by using negative binomial regression analysis.

    RESULTS: In total, the study included 232,685 men and 14,592 women. During follow-up, 3891 men and 318 women had a diagnosis of later symptomatic diverticular disease. In men, heavy smokers (≥15 cigarettes a day) had a 1.6-fold increased risk of developing symptomatic diverticular disease compared with nonsmokers (adjusted relative risk, 1.56; 95% CI, 1.42-1.72). There was evidence of a dose-response relationship, because moderate and ex-smokers had a 1.4- and 1.2-fold increased risk compared with nonsmokers (adjusted relative risk, 1.39; 95% CI, 1.27-1.52 and adjusted relative risk, 1.14; 95% CI, 1.04-1.27). These relationships were similar in women, but the risk estimates were less precise owing to smaller numbers. Male ever-smokers had a 2.7-fold increased risk of developing complicated diverticular disease (perforation/abscess) compared with nonsmokers (adjusted relative risks, 2.73; 95% CI, 1.69-4.41).

    LIMITATIONS: We were unable to account for other confounding variables such as comorbidity, prescription medication, or lifestyle factors.

    CONCLUSIONS: Smoking is associated with symptomatic diverticular disease in both men and women and with an increased risk of developing complicated diverticular disease.

  • 298.
    Häggström, Christel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Stocks, Tanja
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Nagel, Gabriele
    Manjer, Jonas
    Bjørge, Tone
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Engeland, Anders
    Ulmer, Hanno
    Lindkvist, Bjorn
    Selmer, Randi
    Concin, Hans
    Tretli, Steinar
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Stattin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Prostate Cancer, Prostate Cancer Death, and Death from Other Causes, Among Men with Metabolic Aberrations2014Ingår i: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 25, nr 6, s. 823-828Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Few previous studies of metabolic aberrations and prostate cancer risk have taken into account the fact that men with metabolic aberrations have an increased risk of death from causes other than prostate cancer. The aim of this study was to calculate, in a real-life scenario, the risk of prostate cancer diagnosis, prostate cancer death, and death from other causes.

    Methods: In the Metabolic Syndrome and Cancer Project, prospective data on body mass index, blood pressure, glucose, cholesterol, and triglycerides were collected from 285,040 men. Risks of prostate cancer diagnosis, prostate cancer death, and death from other causes were calculated by use of competing risk analysis for men with normal (bottom 84%) and high (top 16%) levels of each factor, and a composite score.

    Results: During a mean follow-up period of 12 years, 5,893 men were diagnosed with prostate cancer, 1,013 died of prostate cancer, and 26,328 died of other causes. After 1996, when prostate-specific antigen testing was introduced, men up to age 80 years with normal metabolic levels had 13% risk of prostate cancer, 2% risk of prostate cancer death, and 30% risk of death from other causes, whereas men with metabolic aberrations had corresponding risks of 11%, 2%, and 44%.

    Conclusions: In contrast to recent studies using conventional survival analysis, in a real-world scenario taking risk of competing events into account, men with metabolic aberrations had lower risk of prostate cancer diagnosis, similar risk of prostate cancer death, and substantially higher risk of death from other causes compared with men who had normal metabolic levels.

  • 299.
    Högström, Gabriel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Aerobic fitness in late adolescence and the risk of early death: a prospective cohort study of 1.3 million Swedish men2016Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 45, nr 4, s. 1159-1168Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Fitness level and obesity have been associated with death in older populations. We investigated the relationship between aerobic fitness in late adolescence and early death, and whether a high fitness level can compensate the risk of being obese.

    METHODS: The cohort comprised 1 317 713 Swedish men (mean age, 18 years) that conscripted between 1969 and 1996. Aerobic fitness was assessed by an electrically braked cycle test. All-cause and specific causes of death were tracked using national registers. Multivariable adjusted associations were tested using Cox regression models.

    RESULTS: During a mean follow-up period of 29 years, 44 301 subjects died. Individuals in the highest fifth of aerobic fitness were at lower risk of death from any cause [hazard ratio (HR), 0.49; 95% confidence interval (CI), 0.47-0.51] in comparison with individuals in the lowest fifth, with the strongest association seen for death related to alcohol and narcotics abuse (HR, 0.20; 95% CI, 0.15-0.26). Similar risks were found for weight-adjusted aerobic fitness. Aerobic fitness was associated with a reduced risk of death from any cause in normal-weight and overweight individuals, whereas the benefits were reduced in obese individuals (P < 0.001 for interaction). Furthermore, unfit normal-weight individuals had 30% lower risk of death from any cause (HR, 0.70; 95% CI, 0.53-0.92) than did fit obese individuals.

    CONCLUSIONS: Low aerobic fitness in late adolescence is associated with an increased risk of early death. Furthermore, the risk of early death was higher in fit obese individuals than in unfit normal-weight individuals.

  • 300.
    Hörnqwist Bylund, Sonya
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ahlgren, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Experiences and consequences for women with hand-arm vibration2010Ingår i: Work: A Journal of Prevention, Assessment and Rehabilitation, ISSN 1051-9815 (Print) 1875-9270 (Online), Vol. 35, nr 4, s. 431-439Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Vibrating machines are used in a variety of occupations. Exposure to hand-arm vibration can cause vascular, neurological, and muscular symptoms in the hands and arms. This qualitative study provides a deeper understanding of the consequences of vibration injuries in women. In depth interviews were conducted with eight women with vibration injuries. The women were metal and wood product assemblers and dental personnel. The transcribed interviews were analyzed in accordance with the grounded theory method.

    The core category in the findings was "{another life}". This was constructed by the categories "consequences for everyday activities", "work performance", "household duties", "leisure", and "self perception" and shows that the injury had affected most parts of the women's lives and decreased their quality of life. The importance of well-functioning hands in all activities was highlighted. Reduced hand function due to numbness, muscle weakness, and pain caused restricted abilities to perform activities at work, at home, and during leisure time. The women described impact on their self-perception, as the injury had affected them in their roles as a worker, mother, and woman. The findings indicate that a vibration injury is a multidimensional problem that can affect every aspect of an individual's life. Health care providers should be aware of these complex consequences.

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