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  • 801.
    Virtanen, Pekka
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Lipiainen, Liudmila
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Saloniemi, Antti
    Nummi, Tapio
    Tracks of labour market attachment in early middle age: A trajectory analysis over 12 years2011Ingår i: ADVANCES IN LIFE COURSE RESEARCH, ISSN 1040-2608, Vol. 16, nr 2, s. 55-64Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The predominant aim of this study was to contribute to the methodology in research on work trajectories as essential element of the life course in adulthood. Data on the labour market attachment of a population cohort (n = 1005) from age 30 to age 42 were collected with a questionnaire. We applied trajectory analysis in order to define different attachment tracks. According to the information criteria, six tracks were discerned: in addition to those who are in permanent employment (high-level attachment), in temporary employment (medium-level attachment) and out of work (poor-level attachment) throughout early middle age, we were able to define subgroups that move from temporary to permanent employment (strengthening attachment) or vice versa (weakening attachment), and also some who enter working life and attain permanent employment at a relatively high age (delayed attachment). On average, attachment was high and strengthened with time, indicating that no major de-standardization of employment occurred during the follow-up years (1995-2007) in the studied labour market and age cohort. Given longitudinal data with at least ordinal scale variables, the applied trajectory analysis may be recommended as a "method of choice" in clustering the diverse and non-standard work-life courses into a meaningful set of tracks. (C) 2011 Elsevier Ltd. All rights reserved.

  • 802.
    Virtanen, Pekka
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Institute for Advanced Social Research and School of Health Sciences, University of Tampere, Tampere, Finland.
    Nummi, Tapio
    Lintonen, Tomi
    Westerlund, Hugo
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Mental health in adolescence as determinant of alcohol consumption trajectories in the Northern Swedish Cohort2015Ingår i: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 63, nr 3, s. 335-342Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The study aimed to analyze whether poor mental health in adolescence predicts heavy alcohol consumption over the long term. Alcohol consumption in the population cohort (n = 1010) was surveyed at the ages of 16, 18, 21, 30 and 42. Utilizing latent class growth analysis, six consumption trajectories ranging from 'Late Onset Low' to 'Early Onset High' were defined and analyzed with respect to internalization (depressiveness and anxiousness) and externalization (truancy and vandalism) at age 16. Poor mental health predicted the Early Onset High trajectory (risk ratios in relation to the compliant trajectory 3.59 for anxiousness, 2.85 for depressiveness, 5.69 for truancy and 7.75 for externalized vandalism). Moreover, significant associations were found for the Early Onset Moderate and Early Onset Low trajectories. This is the first study to show an association between internalized mental health problems in adolescence and lifelong heavy drinking. The study also confirmed a strong association between externalized behavior and heavy drinking, indicating a need of preventive measures in this group. Nevertheless, the analyses demonstrated that most teenagers with mental health problems continue along a reasonable drinking trajectory.

  • 803. Vogt, Hartmut
    et al.
    Bråbäck, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Kling, Anna-Maria
    Grünewald, Maria
    Nilsson, Lennart
    Pertussis immunization in infancy and adolescent asthma medication.2014Ingår i: Pediatrics, ISSN 1098-4275, Vol. 134, nr 4, s. 721-728Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Childhood immunization may influence the development of asthma, possibly due to lack of infections or a shift in the T-helper cell type 1/T-helper cell type 2/regulatory T cells balance. We therefore investigated whether pertussis immunization in infancy is associated with asthma medication in adolescence.

    METHODS: After 14 years of no general pertussis vaccination, almost 82 000 Swedish children were immunized for pertussis in a vaccination trial between June 1, 1993, and June 30, 1994. In a follow-up analysis of almost 80 000 children, their data were compared with those of ∼100 000 nonvaccinated children, born during a 5-month period before and a 7-month period after the vaccination trial. Data for the main outcome variable (ie, dispensed prescribed asthma medication for each individual in the cohort during 2008-2010) were obtained from the national prescription database. Multivariate regression models were used to calculate the effect size of vaccination on dispensed asthma medication (odds ratios [OR], 95% confidence intervals [CI]). Approaches similar to intention-to-treat and per-protocol methods were used.

    RESULTS: The prevalence rates of various asthma medications for study patients at 15 years of age differed between 4.6% and 7.0%. The crude ORs for any asthma medication and antiinflammatory treatment in pertussis-vaccinated children after intention-to-treat analysis were 0.97 (95% CI: 0.93-1.00) and 0.94 (95% CI: 0.90-0.98), respectively. Corresponding adjusted ORs were 0.99 (95% CI: 0.95-1.03) and 0.97 (95% CI: 0.92-1.01). Similar ORs were found after per-protocol analysis.

    CONCLUSIONS: Pertussis immunization in infancy does not increase the risk of asthma medication use in adolescents. Our study presents evidence that pertussis immunization in early childhood can be considered safe with respect to long-term development of asthma.

  • 804. von Thiele Schwarz, Ulrica
    et al.
    Hasson, Henna
    Tafvelin, Susanne
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Leadership training as an occupational health intervention: improved safety and sustained productivity2016Ingår i: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 81, s. 35-45Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The safety climate in an organization is determined by how managers balance the relative importance of safety and productivity. This gives leaders a central role in safety in an organization, and from this follows that leadership training may improve safety. Transformational leadership may be one important component but may need to be combined with positive control leadership behaviors. Leadership training that combines transformational leadership and applied behavior analysis may be a way to achieve this. Purpose: The study evaluates changes in safety climate and productivity among employees whose leaders (n = 76) took part in a leadership training program combining transformational leadership and applied behavior analysis. Changes in managers' ratings of transformational leadership, contingent rewards, Management-by-Exceptions Active (MBEA) and safety self-efficacy were evaluated. Moreover, we compare whether the training has differentiated effects on safety depending on managers' specific focus on improvements in: (1) safety, (2) productivity or (3) general leadership. Result: Safety climate improved over time, while self-rated productivity remained unchanged. As hypothesized, transformational leadership, contingent rewards and safety self-efficacy as proxies for positive control behaviors increased while MBEA, a negative control behavior, decreased. Managers focusing on general leadership skills showed greater improvement in safety climate expectations. Conclusions: Training leaders in both transformational leadership and applied behavior analysis is related to improvements in leadership and safety. There is no added benefit of focusing specifically on safety or productivity.

  • 805. von Thiele Schwarz, Ulrica
    et al.
    Sjoberg, Anders
    Hasson, Henna
    Tafvelin, Susanne
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Measuring Self-Rated Productivity Factor Structure and Variance Component Analysis of the Health and Work Questionnaire2014Ingår i: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 56, nr 12, s. 1302-1307Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To test the factor structure and variance components of the productivity subscales of the Health and Work Questionnaire (HWQ). Methods: A total of 272 individuals from one company answered the HWQ scale, including three dimensions (efficiency, quality, and quantity) that the respondent rated from three perspectives: their own, their supervisor's, and their coworkers'. A confirmatory factor analysis was performed, and common and unique variance components evaluated. Results: A common factor explained 81% of the variance (reliability 0.95). All dimensions and rater perspectives contributed with unique variance. The final model provided a perfect fit to the data. Conclusions: Efficiency, quality, and quantity and three rater perspectives are valid parts of the self-rated productivity measurement model, but with a large common factor. Thus, the HWQ can be analyzed either as one factor or by extracting the unique variance for each subdimension.

  • 806. Wagman, Petra
    et al.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Alfredsson, Lars
    Westerholm, Peter J. M.
    Fransson, Eleonor I.
    Domestic work division and satisfaction in cohabiting adults: associations with life satisfaction and self-rated health2017Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 24, nr 1, s. 24-31Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The amount and perception of domestic work may affect satisfaction with everyday life, but further knowledge is needed about the relationship between domestic work division and health and well-being. Aim: To describe the division of, and satisfaction with, domestic work and responsibility for home/family in adults living with a partner. A further aim was to investigate the associations between these aspects and self-rated life satisfaction and health. Method: Data from the Work, Lipids and Fibrinogen survey collected 2009 were used, comprising 4924 participants living with a partner. Data were analyzed using logistic regression. Results: The majority shared domestic work and responsibility for home/family equally with their partner. However, more women conducted the majority of the domestic work and were less satisfied with its division. When both division and satisfaction with division was included in the analysis, solely satisfaction with the division and the responsibility were associated with higher odds for good life satisfaction. Regarding health, higher odds for good self-rated health were seen in those who were satisfied with their division of responsibility. Conclusion and significance: The results highlight the importance of taking into account not solely the actual division of domestic work but also the satisfaction with it.

  • 807.
    Wahlström, Jens
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bergsten, Eva
    Trask, Catherine
    Mathiassen, Svend Erik
    Jackson, Jennie
    Forsman, Mikael
    Full-Shift Trunk and Upper Arm Postures and Movements Among Aircraft Baggage Handlers2016Ingår i: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 60, nr 8, s. 977-90Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The present study assessed full-shift trunk and upper arm postural exposure amplitudes, frequencies, and durations among Swedish airport baggage handlers and aimed to determine whether exposures differ between workers at the ramp (loading and unloading aircraft) and baggage sorting areas.

    METHODS: Trunk and upper arm postures were measured using inclinometers during three full work shifts on each of 27 male baggage handlers working at a large Swedish airport. Sixteen of the baggage handlers worked on the ramp and 11 in the sorting area. Variables summarizing postures and movements were calculated, and mean values and variance components between subjects and within subject (between days) were estimated using restricted maximum likelihood algorithms in a one-way random effect model.

    RESULTS: In total, data from 79 full shifts (651h) were collected with a mean recording time of 495min per shift (range 319-632). On average, baggage handlers worked with the right and left arm elevated >60° for 6.4% and 6.3% of the total workday, respectively. The 90th percentile trunk forward projection (FP) was 34.1°, and the 50th percentile trunk movement velocity was 8° s(-1). For most trunk (FP) and upper arm exposure variables, between-subject variability was considerable, suggesting that the flight baggage handlers were not a homogeneously exposed group. A notable between-days variability pointed to the contents of the job differing on different days. Peak exposures (>90°) were higher for ramp workers than for sorting area workers (trunk 0.6% ramp versus 0.3% sorting; right arm 1.3% ramp versus 0.7% sorting).

    CONCLUSIONS: Trunk and upper arm postures and movements among flight baggage handlers measured by inclinometry were similar to those found in other jobs comprising manual material handling, known to be associated with increased risks for musculoskeletal disorders. The results showed that full-shift trunk (FP) and, to some extent, peak arm exposures were higher for ramp workers compared with sorting workers.

  • 808.
    Wahlström, Jens
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Burström, Lage
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Johnson, Peter W
    Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
    Nilsson, Tohr
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Järvholm, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Exposure to whole-body vibration and hospitalization due to lumbar disc herniation2018Ingår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 91, nr 6, s. 689-694Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim was to examine if exposure to whole-body vibration (WBV) increases the risk for hospitalization due to lumbar disc herniation.

    Methods: The study basis is a cohort of 288,926 Swedish construction workers who participated in a national occupational health surveillance programme from 1971 until 1992. Job title, smoking habits, body weight, height and age were registered at the examinations. Assessment of WBV were made for each of the constituent occupations by constructing a job-exposure matrix (JEM). Exposure to WBV was graded on a scale from 0 to 5. In addition, the occurrence of hospitalization due to lumbar disc herniation from January 1st 1987 until December 31st 2010 was collected from a linkage with the Swedish Hospital Discharge Register. Poisson regressions were used to estimate relative risk with 95 percent confidence intervals (95% CI), adjusting for age, height, weight and smoking, using white-collar workers and foremen as a reference group.

    Results: There was an increased risk for hospitalization due to lumbar disc herniation for workers in the construction industry exposed to medium to high WBV compared to white-collar workers and foremen 1.35 (1.12-1.63). When restricting the analyses to include workers 30-49 years of age at the time of the hospital admission the risk was 1.69 (95% CI 1.29-2.21).

    Conclusion: This study further supports that occupational exposure to whole-body vibration increases the risk for hospitalization due to lumbar disc herniation.

  • 809.
    Wahlström, Jens
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Burström, Lage
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nilsson, Tohr
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Järvholm, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Risk factors for hospitalization due to lumbar disc disease2012Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 37, nr 15, s. 1334-1339Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Design. Prospective cohort study

    Objective. To study biomechanical factors in relation to symptomatic lumbar disc disease

    Summary of Background Data. The importance of biomechanical factors in lumbar disc disease have been questioned the past decade and knowledge from large prospective studies is lacking.

    Methods. The study basis is a cohort of 263 529 Swedish construction workers who participated in a national occupational health surveillance programme from 1971 until 1992. The workers' job title, smoking habits, body weight, height and age were registered at the examinations. The occurrence of hospitalization due to lumbar disc disease from January 1 1987 until December 31 2003 was collected from a linkage with the Swedish Hospital Discharge Register.

    Results. There was an increased risk for hospitalization due to lumbar disc disease for several occupational groups compared to white-collar workers and foremen. Occupational groups with high biomechanical loads had the highest risks, e.g the relative risk for concrete workers was 1.55 (95% CI 1.29-1.87). A taller stature was consistently associated with an increased risk. The relative risk for a man of 190-199 cm height was 1.55 (95% CI 1.30-1.86) compared to a man being 170-179 cm. Body weight and smoking were also risk factors, but weaker than height. Workers in the age span of 30-39 had the highest relative risk (RR = 1.87; 95% CI 1.58-2.23) compared to those 20-29, while men 60-65 years old had a lower risk (RR = 0.86; 95%CI 0.68-1.09).

    Conclusions. This study indicates that factors increasing the load on the lumbar spine are associated with hospitalization for lumbar disc disease. Occupational biomechanical factors seem to be important, and a taller stature was consistently associated with an increased risk.

  • 810.
    Wahlström, Jens
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Liv, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Jackson, Jennie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Occupational risk factors for surgically treated carpal tunnel syndrome: a prospective cohort study of 220,610 Swedish construction workers2019Ingår i: PREMUS 2019: 10th International Scientific Conference on the Prevention of Work-Related Musculoskeletal Disorders: From research to evidence based sustainable interventions and practices, 2019, s. 141-141Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Background: Carpal tunnel syndrome (CTS) is the most common upper extremity nerve entrapment syndrome . The aim of this study was to determine the association between occupational biomechanical exposures and occurrence of surgically treated CTS in construction workers over a 16-year follow-up.

    Methods: A cohort of 220 610 male construction workers who participated in a national occupational health surveillance program (1971–1992) were examined prospectively (2001–2016) for surgically treated CTS. Cases were determined via a linkage with the Swedish Hospital Outpatient Register. Job title (construction trade), smoking status, height, weight and age were recorded on examination. Job titles were merged into occupational groups of workers performing similar work tasks and having similar training. Occupational biomechanical exposure estimates were assigned to each occupational group using a job exposure matrix (JEM) developed for the study. Poisson regression models were used to assess the relative risks for each biomechanical exposure. Relative risks were adjusted for age, surgical time period, BMI, and smoking status at first examination.

    Results: There were 4048 cases of surgically treated CTS within the cohort which represented an incidence rate of 134 cases per 100 000 person years. Workers exposed to medium and high forceful handgrip factors had relative risks of 1.3 (95% CI 1.16-1.38) and 1.6 (95% CI 1.50-1.77), respectively, of undergoing surgical treatment for CTS compared to low exposed workers. Workers exposed to medium and high exposure to hand-arm vibration had relative risks of 1.3 (95% CI 1.19-1.34) and 1.2 (95% CI 1.07-1.28), respectively, of undergoing surgical treatment for CTS compared to low exposed workers.

    Conclusions: In conclusion, forceful hand-grip work and exposure to hand-arm vibration increased the risk for surgically treated carpal tunnel syndrome.

  • 811.
    Wahlström, Jens
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Mathiassen, Svend Erik
    Liv, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hedlund, Pernilla
    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.
    Forsman, Mikael
    Upper arm postures and movements in female hairdressers across four full working days2010Ingår i: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 54, nr 5, s. 584-594Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe upper arm postures and movements among female hairdressers, including the variability between hairdressers, between days within hairdresser, and between tasks, as a basis for understanding the characteristics of exposures in the job, considering possible sources of variation and recovery, and discussing appropriate exposure assessment strategies.

    METHODS: Data on upper arm postures were collected using inclinometers during four working days the same week from 28 female hairdressers working in 13 salons. Twenty of the hairdressers noted customer on and off times in a diary, to allow separate analyses of customer tasks (CT) and auxiliary non-customer tasks (AT), including breaks. For a number of posture and movement variables, mean values and variance components between subjects (BS) and within subjects between days (BD) were estimated using restricted maximum likelihood algorithms in one-way random effect models.

    RESULTS: For the 20 hairdressers with diaries, CT accounted for 279 min (58%) (SD(BS) = 39 min and SD(BD) = 85 min) of the working day and AT and breaks for 207 min (42%) (SD(BS) = 46 min and SD(BD) = 88 min). The hairdressers worked with the right arm elevated >60 degrees for 6.8% of the whole job (SD(BS) = 2.8% and SD(BD) = 2.0%). On average, the hairdressers worked with the right arm elevated >60 degrees for 9.0% of the time during CT, compared to 3.7% during AT, resulting in a contrast between tasks of 0.35.

    CONCLUSIONS: Hairdressers may be at risk for developing musculoskeletal disorders in the neck and shoulders due to a considerable occurrence of highly elevated arms, especially during CT. On the other hand, we do not find reasons to classify hairdressing as a job with too little variation. Posture variability between days within hairdressers was in the same order of magnitude as that between hairdressers, suggesting that 'typical' workdays do not exist. The exposure contrast between CT and AT for variables describing elevated arm postures indicates that for these variables a simple task-based approach for estimating job exposure could be successful.

  • 812.
    Wahlström, Jens
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Östman, Christina
    Leijon, Ola
    The effect of flooring on musculoskeletal symptoms in the lower extremities and low back among female nursing assistants2012Ingår i: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 55, nr 2, s. 248-255Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study examines the effect of changing the floor from a 2-mm homogenous vinyl floor to a 4-mm heterogeneous vinyl floor (1.5-mm wear layer and 2.5-mm foam layer) on musculoskeletal symptoms in the lower extremities and low back among nursing assistants in a geriatric care centre. A pre-post design with a reference group consisting of nursing assistants from a similar geriatric care centre was used. Follow-up measurements were carried out 12 and 24 months after the intervention by means of questionnaires. At the 1-year follow-up, the pain intensity score in the feet of the intervention group had decreased compared with the baseline value and remained statistically significant at the 2-year follow-up. The decrease in pain intensity score of the feet in the intervention group was statistically significantly different from the reference group, both after 1 and 2 years. Statement of Relevance: The results show the importance of flooring in the workplace with regard to reducing musculoskeletal symptoms. Appropriate flooring is especially important in the female-dominated health care sector, where workers must stand or walk for long periods.

  • 813.
    Wahlström, Viktoria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Interventions for increased physical activity among office workers2019Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The positive association between physical activity (PA) and health is well established. Technical developments in modern life have created major changes in our societies and working life, and a growing body of research has identified sedentary behavior (SB) as an independent risk factor for type 2 diabetes, cardiovascular disease, and cancer as well as for premature mortality. To promote health, it is important to find ways to decrease SB and incorporate PA in office settings, for example, by using new office designs and behavioral interventions.

     

    The aim of this thesis was to evaluate two workplace interventions among office workers to determine if these led to increased PA and reduced SB, and to describe underlying factors behind these results.

     

    The thesis is based on two workplace interventions. The first intervention was the Inphact treadmill study, a 13-month randomized controlled trial where treadmill workstations were installed and participants were instructed to use the treadmill for at least one hour per workday. The second intervention was the Active Office Design (AOD) study. This study included a multicomponent PA promoting program, implemented in parallel with an office relocation to either traditional cell offices or to a flex office with activity-based work (ABW). The two groups in the AOD study were followed from 6 months before relocation to 18 months after. 

     

    Objectively measured data for SB, PA, and body measurements were collected in both studies. In the Inphact treadmill study, body composition, metabolic outcomes, self-reported energy and stress, and depression and anxiety scores were also measured. In the AOD study, measurements of health and lifestyle, musculoskeletal disorders, workload, work tasks, utilization of possibilities to be active at work, and perceptions of the performed PA promoting program were assessed via questionnaires. In addition, interview data were collected via focus groups and individual interviews. Linear mixed models were used for the main statistical analyses of the quantitative data. To explore the factors that influence SB and PA at work we combined factor analysis of mixed data with multiple linear regression.Interview data were analyzed using qualitative content analysis and a deductive approach to a process evaluation model. 

     

    In both study populations, sitting time was low and stand­ing time was high already at baseline, compared to other studies on office workers. In the Inphact treadmill study, the intervention group showed increased walking time during workdays compared to the control group for all follow-up measurements. At the same time, a decrease in moderate-to-vigorous PA (MVPA) was observed in both the intervention and control groups during leisure time. No intervention effects were seen on body measurements, body composition, metabolic outcomes, stress, or anxiety during the treadmill intervention. 

     

    In the AOD study, employees relocated to flex offices increased their walking time and MVPA during work hours to a greater extent than those relocated to cell offices, but neither group changed the amount of time spent sitting at work. Contrary to the Inphact treadmill study, no compensatory effects were seen during leisure time. The exploratory analysis resulted in six employee character-types, where the “harmonic and healthy” and “engaged with high workload” tended to sit more and to stand less, while the character type with “high BMI, creative and collaborative work” tended to sit less and stand more. The process evaluation of the intervention revealed a strong culture to encourage PA within the organization and that the intervention was supported by management. The timing of the program was questioned, and activities to support the relocation to the flex office with ABW were requested. Social acceptance for standing and walking at work increased, although the need for the intervention was debated due to the strong culture of facilitating PA at work already in place prior to the study.

     

    In conclusion, we showed long-term increases in PA were achieved in office workers, but the changes did not lead to improvements in body measurements and metabolic balance during the follow-up period. The two studies showed conflicting results regarding compensatory effects during leisure. Participants in the Inphact treadmill study decreased their MVPA during leisure, while no compensatory effects were seen in the AOD-study. Our results suggest a possible ceiling effect for the amount sitting time can be reducedin office workers, and that SB and PA in offices is influenced by many factors, such as organizational culture, physical environment, work tasks, work load and physical comfort. Together, the studies in this thesis confirm the importance of carefully tailored worksite interventions for decreasing SB and increasing PA at work.

     

  • 814.
    Wahlström, Viktoria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Bergman, Frida
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Öhberg, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Eskilsson, Therese
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Slunga-Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Effects of a multicomponent physical activity promoting program on sedentary behavior, physical activity and body measures: a longitudinal study in different office types2019Ingår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 45, nr 5, s. 493-504Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The aim of this study was to investigate effects of a multicomponent program promoting physical activity on sedentary behavior, physical activity, and body measures, when relocating from cell offices to either a flex or cell office.

    Methods: The Active Office Design (AOD) study is a longitudinal non-randomized controlled study performed in a municipality in northern Sweden. A subsample of 86 participants were randomly recruited from the AOD study to objectively measure sedentary behavior and physical activity, using ActivPAL and ActiGraph, before and after relocation to the two different office types. The multicomponent program promoting physical activity was performed in both offices. Data were analyzed using linear mixed models.

    Results: Eighteen months after relocation, the total number of steps per work day increased by 21% in the flex office and 3% in the cell office group, compared to baseline. Moderate and vigorous physical activity (MVPA) during work hours increased by 42% in the flex office group and 19% in the cell office group. No changes were seen regarding sitting time at work. Small additive effects for walking and MVPA were seen for both groups during non-work time. Weight increased in the flex office group.

    Conclusions: This long-term study shows that a multicomponent workplace intervention can lead to increased walking time, steps, and MVPA in a flex compared to a cell office. Small additive increases of physical activity were seen during non-work time in both groups. More long-term controlled studies are needed to confirm these results.

  • 815.
    Wahlström, Viktoria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Harder, Mette
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Arkitekthögskolan vid Umeå universitet.
    Slunga-Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Stenlund, Therese
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Implementing a Physical Activity promoting program in a flex-office - a process evaluation with a mixed methods designManuskript (preprint) (Övrigt vetenskapligt)
  • 816.
    Wahlström, Viktoria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Olsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Öhberg, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Slunga-Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Underlying factors explaining sedentary behavior and physical activity among office workers - an exploratory analysisManuskript (preprint) (Övrigt vetenskapligt)
  • 817.
    Wallin, Stina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Vaasa, Finland.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Act with respect: Views of supportive actions for older workers after completion of comprehensive vocational rehabilitation services2019Ingår i: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 62, nr 4, s. 585-598Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The number of older workers will expand during the next decades. Older workers have more long-term health problems and related limitations.

    OBJECTIVE: This study examined supportive actions provided in occupational healthcare services to older workers after vocational rehabilitation. An additional purpose was to explore occupational healthcare professionals' views on how to realize and improve adequate support activities.

    METHODS: Qualitative and quantitative methods were used, including a postal questionnaire and focus group discussions. Sixty-seven occupational healthcare service units participated in the postal questionnaire. Eight occupational healthcare professionals participated in two focus group discussions. The qualitative data was analyzed using qualitative content analysis.

    RESULTS: The qualitative analysis resulted in one theme (Act with respect), and four categories (Need for cooperation, Collaborative resources of involved stakeholders, Individual needs for support, and Gender as homogenous and separate groups). Quantitative results revealed that the workers' initiative strongly influenced the support carried out. Recommendations from the rehabilitation clinic were almost always considered when deciding on supportive actions. Focus group discussions brought up gender differences especially highlighted in the category Gender as homogenous and separate groups.

    CONCLUSIONS: Appropriate support of older workers requires cooperation between involved stakeholders, including occupational healthcare services. Provided support should be based on individual needs, but a mutual practice of determining needed support is requested.

  • 818. Wang, Meng
    et al.
    Beelen, Rob
    Bellander, Tom
    Birk, Matthias
    Cesaroni, Giulia
    Cirach, Marta
    Cyrys, Josef
    de Hoogh, Kees
    Declercq, Christophe
    Dimakopoulou, Konstantina
    Eeftens, Marloes
    Eriksen, Kirsten T.
    Forastiere, Francesco
    Galassi, Claudia
    Grivas, Georgios
    Heinrich, Joachim
    Hoffmann, Barbara
    Ineichen, Alex
    Korek, Michal
    Lanki, Timo
    Lindley, Sarah
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Mölter, Anna
    Nafstad, Per
    Nieuwenhuijsen, Mark J.
    Nystad, Wenche
    Olsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Raaschou-Nielsen, Ole
    Ragettli, Martina
    Ranzi, Andrea
    Stempfelet, Morgane
    Sugiri, Dorothea
    Tsai, Ming-Yi
    Udvardy, Orsolya
    Varró, Mihaly J.
    Vienneau, Danielle
    Weinmayr, Gudrun
    Wolf, Kathrin
    Yli-Tuomi, Tarja
    Hoek, Gerard
    Brunekreef, Bert
    Performance of multi-city land use regression models for nitrogen dioxide and fine particles2014Ingår i: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 122, nr 8, s. 843-849Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Land use regression (LUR) models have been developed mostly to explain intraurban variations in air pollution based on often small local monitoring campaigns. Transferability of LUR models from city to city has been investigated, but little is known about the performance of models based on large numbers of monitoring sites covering a large area.

    OBJECTIVES: We aimed to develop European and regional LUR models and to examine their transferability to areas not used for model development.

    METHODS: We evaluated LUR models for nitrogen dioxide (NO2) and particulate matter (PM; PM2.5, PM2.5 absorbance) by combining standardized measurement data from 17 (PM) and 23 (NO2) ESCAPE (European Study of Cohorts for Air Pollution Effects) study areas across 14 European countries for PM and NO2. Models were evaluated with cross-validation (CV) and hold-out validation (HV). We investigated the transferability of the models by successively excluding each study area from model building.

    RESULTS: The European model explained 56% of the concentration variability across all sites for NO2, 86% for PM2.5, and 70% for PM2.5 absorbance. The HV R2s were only slightly lower than the model R2 (NO2, 54%; PM2.5, 80%; PM2.5 absorbance, 70%). The European NO2, PM2.5, and PM2.5 absorbance models explained a median of 59%, 48%, and 70% of within-area variability in individual areas. The transferred models predicted a modest-to-large fraction of variability in areas that were excluded from model building (median R2: NO2, 59%; PM2.5, 42%; PM2.5 absorbance, 67%).

    CONCLUSIONS: Using a large data set from 23 European study areas, we were able to develop LUR models for NO2 and PM metrics that predicted measurements made at independent sites and areas reasonably well. This finding is useful for assessing exposure in health studies conducted in areas where no measurements were conducted.

  • 819. Weiss, Jana M.
    et al.
    Gustafsson, Åsa
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen. Swetox, Karolinska Institute, Unit of Toxicology Sciences, Forskargatan 20, 151 36, Södertälje, Sweden.
    Gerde, Per
    Bergman, Åke
    Lindh, Christian H.
    Krais, Annette M.
    Daily intake of phthalates, MEHP, and DINCH by ingestion and inhalation2018Ingår i: Chemosphere, ISSN 0045-6535, E-ISSN 1879-1298, Vol. 208, s. 40-49Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Phthalate esters, suspected endocrine disrupting chemicals, are used in a wide range of applications. Because phthalate esters are not covalently bound, they can easily leach into the indoor environment and associate to dust particles. Thus, exposure may occur through inhalation, ingestion, or contact with the skin. However, it is unclear to what degree indoor dust contributes to the daily intake of phthalate esters.

    This study investigates household dust as an exposure pathway for seven phthalate esters, the monoester MEHP, and the plasticizer DINCH. Household dust collected from children's sleeping rooms and from living rooms were analysed using gas and liquid chromatography tandem mass spectrometry. To compare two exposure pathways, different dust particle sizes were generated: a respirable fraction (<5 mu m) and an ingested particle fraction in the anticipated size range of skin adherence (<75 mu m). Modelling of dust inhalation and ingestion showed that the daily intake of dust-bound phthalate esters was likely to be 2 times (inhalation) to 12 times (ingestion) higher for 21-month-old children than for adults. These children's daily uptake of phthalate esters was 40-140 times higher through ingestion than inhalation. Furthermore, dust may be an exposure pathway for phthalate esters as well as for MEHP. Therefore, phthalate monoesters could be environmental contaminants of their own and need to be considered in health risk assessments. (C) 2018 Elsevier Ltd. All rights reserved.

  • 820.
    Wennberg, Anna Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Midwives' strategies in challenging dietary and weight counselling situations2014Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, nr 3, s. 107-112Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: By enhancing maternal nutritional status, midwives can help women lower the risks of pregnancy complications and adverse birth outcomes as well as improve maternal health during pregnancy and in the long run. Dietary counselling is, on the other hand, not reported to be effective. Poor communication and conflicting messages are identified as possible barriers to adherence with recommendations. Midwives' experiences of providing dietary advice and counselling during pregnancy are sparsely reported. The aim of this study was therefore to explore midwives' strategies when faced with challenging dietary counselling situations. Methods: Seventeen midwives from different parts of Sweden and working within antenatal health care were interviewed by telephone. The interviews were analysed using qualitative content analysis. Results: Challenges were commonly experienced when counselling women who were overweight, obese, had eating disorders or were from different cultures. The midwives talked in terms of "the problematic women" when addressing counselling problems. Strategies used in challenging counselling situations were Getting acquainted; Trying to support and motivate; Pressure to choose "correttly"; Controlling and mastering; and Resigning responsibility. Conclusions: The results indicate that Swedish midwives' counselling strategies are quite ambiguous and need to be questioned and that counselling of vulnerable groups of women should be highlighted. We could identify a need for education of practicing midwives to develop person-centred counselling skills.

  • 821.
    Wennberg, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Biomarkers of fish consumption and risk of stroke or myocardial infarction2010Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The effect of fish consumption on the risk of cardiovascular disease has been extensively studied. Omega-3 fatty acids present in fish, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been found to have beneficial effects through several mechanisms. In addition, selenium, an antioxidant, may be protective. Fish also represents the main human exposure source to the pollutant methylmercury (MeHg), which is associated with elevated cardiovascular risk in previous studies. The aim of this thesis was to evaluate whether MeHg is associated with the risk of myocardial infarction (MI) or stroke, whether EPA+DHA or selenium (Se) have protective associations, and if the overall association between fish consumption and risk of stroke or MI is detrimental or protective.

    A prospective incident case-control study design was used to study effects on stroke or MI. Three hundred and sixty-nine cases with twice as many matched controls were included in the study on stroke, while 431 cases with 499 controls participated in the MI study, all from the Northern Sweden Health and Disease Study. The data was collected from health examinations of the population from 1986 until 1999. Also, time trends in burdens of mercury (Hg), lead (Pb) and cadmium (Cd) in erythrocytes (Ery) from 1990 to 1999 were examined. The food frequency questionnaire (FFQ) used in the case-control studies was correlated with measurements of fatty acids in erythrocyte membranes as biomarkers of intake.

    In this northern Swedish population, levels of Ery-Hg and Ery-Pb decreased during the 1990´s, but Ery-Cd decreased only in smoking men. No significant associations were found between Ery-Hg or levels of EPA+DHA and the risk of stroke. Men reporting fish consumption >3 meals/week had an elevated risk of stroke. In the MI study, higher levels of Ery-Hg were associated with lower risk of MI. No clear associations were found for reported fish consumption, levels of EPA+DHA or Ery-Se. The validated FFQ has a fair reliability in estimating intake of fatty acids EPA and DHA. However, the low variation in fish consumption in the general population in combination with different versions of the FFQ (with pre-defined, multiple choice alternatives) decreased the reliability of self-reported fish consumption in the case-control studies on risk of stroke or MI.

    In conclusion, MeHg has no harmful association regarding the risk of stroke or MI in this population with generally low exposure levels. The protective association regarding risk of MI is probably due to Ery-Hg being a biomarker for consumption of fish, a source of other beneficial nutrients. Thus, in this population the benefits of the nutrients in fish appear to overcome the potential harm of MeHg.

    The finding of elevated stroke risk related to high fish consumption in men will be investigated further.

  • 822.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Högre exponering för miljöföroreningar hos högkonsumeter av viltkött?2012Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    I norra Sverige är en högre konsumtion av viltkött vanligare än i södra delarna av landet. Syftet med detta projekt var att genom en kunskapssammanställning undersöka om det finns anledning att mäta nivåer av miljöföroreningar hos högkonsumenter av viltkött.

    Sammanställningen ger inte belägg för att högkonsumenter av viltkött skulle vara i riskzonen för höga intag av miljöföroreningar, i någon större utsträckning än högkonsumenter av nötkött eller fisk. En reservation finns: Renkött innehåller mer HCB än annat kött och fisk. Nivåerna av HCB i renkött är dock betydligt lägre än gränsvärdet för kött. Långt ifrån alla organiska miljöföroreningar finns uppmätta i livsmedel, men de data vi har funnit visar på att hög konsumtion av förorenad fet fisk (från Vänern, Vättern och Östersjön) utgör den största risken för höga intag av flera organiska miljöföroreningar. P.g.a. tidstrender blir det lättare att jämföra framtida mätningar i olika köttslag om jämförelser görs på kött slaktat vid ungefär samma tidpunkt samt att omräkningar görs till halt i kött, i de fall mätningarna har gjorts i fett. Vid eventuella mätningar av organiska miljöföroreningar eller kvicksilver hos människor med hög konsumtion av viltkött är det viktigt att ha kunskap om deltagarnas fiskkonsumtion.

  • 823.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Utvärdering av resultat som underlag till AMAP-arbetet – finns det skillnader mellan norra och södra Sverige i människors exponering för organiska miljöföroreningar och metaller?2012Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Sverige deltar i det arktiska samarbetet AMAP, som följer exponering av miljöföroreningar i arktiska områden. Det är av intresse att känna till om det finns regionala skillnader i Sverige när det gäller människors exponering för miljöföroreningar. Om skillnaderna är små kan data från norra Sverige både användas inom AMAP och för att skaffa kunskap om resten av landet, och vice versa. Syftet med detta projekt var att utvärdera de data som finns avseende skillnader i exponering mellan norra och södra Sverige.

    Det finns bara ett fåtal studier som kan användas för att klarlägga skillnader mellan norra och södra Sverige i människors exponering för organiska miljöföroreningar och metaller. De studier som gjorts visar små eller inga skillnader mellan norra och södra Sverige.

    Om Sverige inom det arktiska samarbetet karaktäriserar miljöföroreningsexponering hos populationer i norra Sverige, så kommer dessa data snarare att avspegla tillståndet i Sverige än en särskild arktisk exponeringssituation. Data från sådana studier, t.ex. om nivåer och tidstrender, skulle alltså ge information som kan förväntas relativt väl avspegla tillståndet även i övriga Sverige. Omvänt så kan data från andra delar av Sverige förväntas avspegla även tillståndet hos populationen i den arktiska delen av Sverige. Eftersom bara några ämnen är undersökta kan det inte uteslutas att det finns miljöföroreningar med betydande regional variation.

  • 824.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bergdahl, Ingvar A
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lundh, Thomas
    Skerfving, Staffan
    Strömberg, Ulf
    Wessby, Bengt
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Fish consumption and myocardial infarction: a second prospective biomarker study from northern Sweden2011Ingår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 93, nr 1, s. 27-36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A beneficial role of fish consumption on the risk of myocardial infarction (MI) has been reported, mostly ascribed to n-3 fatty acids. However, fish also contains methylmercury, which may increase the risk of MI.

    Objective: Describe how fish consumption and erythrocyte concentrations of mercury (Ery-Hg) and selenium (Ery-Se) are related to the risk of MI, and whether n-3 fatty acids (eicosapentaenoic and docosahexaenoic acid) in plasma phospholipids (P-EPA+DHA) are protective.

    Design: This is a case-control study nested within the northern Sweden cohort with prospectively collected data and samples. It comprises 431 cases with an MI after data and sample collection, including 81 sudden cardiac deaths (SCD), and 499 matched controls. Another 69 female cases with controls from a breast cancer screening registry were included in sex-specific analyses.

    Results: Odds ratio (OR) for the third tertile versus the first were for Ery-Hg: 0.65 (95% CI: 0.46, 0.91); Ery-Se: 0.75 (95% CI: 0.53, 1.06) and P-EPA+DHA: 0.78 (95% CI: 0.54, 1.11). No association was seen for reported fish consumption. Multivariate modelling did not change these associations significantly. Sex-specific analyses revealed no differences in risk associations for Ery-Hg, but a tendency to a higher protective association with P-EPA+DHA for women. High levels of Ery-Se were associated with increased risk of SCD.

    Conclusions: Ery-Hg, a stable biomarker for fish consumption, is associated with a decreased risk of MI. The result indicates a protective effect of fish consumption against MI, even though data on self-reported fish consumption do not reveal any clear protective association.

  • 825.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Jönsson, Bo AG.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Lindh, Christian H
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Organic pollutants in urine 2014 and levels of bisphenol A 2009 and 2014 in the adult population of Northern Sweden2015Rapport (Övrigt vetenskapligt)
  • 826.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Lindh, Christian
    Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Organiska miljöföroreningar i urin hos unga i norra och södra Sverige2018Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Det är viktigt att följa halter av miljöföroreningar hos människor, för riskvärdering och för att få kunskap om hur exponeringen kan minskas.

    Organiska miljöföroreningar (ftalat-metaboliter, bisfenol A, bisfenol F, triklosan, pesticiderna 3-PBA och TCP samt PAH-metaboliten 1-HP) analyserades i urin hos 204 unga i Skåne (gymnasieelever, år 2013) och hos 143 unga i MONICA-studien i norra Sverige (25-35 år, år 2014). Koncentrationer jämfördes statistiskt mellan studierna och kopplingar till levnadsvanor som efterfrågades i båda studierna undersöktes (rökning, fiskintag, intag av mat från konserver och typ av golv i sovrum). En kompletterande enkätstudie gjordes på deltagarna i MONICA-studien som uppgav att de hade plastgolv i sovrummet (n=65), för att utröna om golvvärme under plastgolv i sovrummet kan öka exponering av "plast-ftalaten" MBzP.

    De statistiskt säkerställda skillnader som uppdagades var att de unga i norr hade högre koncentration av de flesta ftalat-metaboliter och av pesticiden 3-PBA medan de unga i söder hade högre koncentration av triklosan.

    Ftalat-metaboliten MBzP kunde kopplas till att ha plastgolv i sovrummet i båda studiepopulationerna. Då endast fyra personer i MONICA-studien uppgav golvvärme under plastgolv och den gruppen inte hade anmärkningsvärt hög MBzP-koncentration i urin kan inte högre användning av golvvärme i norr vara förklaringen till högre koncentration av MBzP i norra Sverige.

    Skillnader i levnadsförhållanden av betydelse för exponering av miljöföroreningarna som beror på den åldersskillnad som fanns mellan studiepopulationerna i norr och söder, och inte undersöktes i den här studien, kan inte uteslutas. Framtida geografiska jämförelser av miljöföroreningar hos människor bör om möjligt göras på människor i samma åldersintervall.

  • 827.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Lundh, Thomas
    Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden.
    Nilsson Sommar, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Time trends of lead and cadmium in the adult population of Northern Sweden 1990-20142015Rapport (Övrigt vetenskapligt)
  • 828.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Lundh, Thomas
    Nilsson Sommar, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bergdahl, Ingvar A.
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Time trends and exposure determinants of lead and cadmium in the adult population of northern Sweden 1990-20142017Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 159, s. 111-117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: This study follows cadmium and lead concentrations in blood in the adult population in northern Sweden over 24 years.

    MATERIAL AND METHODS: Concentrations of lead and cadmium were measured in single whole blood samples (B-Pb and B-Cd) from 619 men and 926 women participating in the Northern Sweden WHO MONICA Study on one occasion 1990-2014. Associations with smoking and dietary factors were investigated. Consumption of moose meat was asked for in 2014.

    RESULTS: In the adult population in northern Sweden, the median B-Pb in 2014 was 11.0µg/L in young (25-35 years) men and 9.69µg/L in young women. In an older age-group (50-60 years), the median B-Pb was 15.1µg/L in men and 13.1µg/L in women. B-Pb decreased from 1990 to 2009, after which time no further decrease was observed. B-Pb was higher in smokers than in non-smokers. In never-smokers, positive associations were found between B-Pb and consumption of wine and brewed coffee (women only) in 2004-2014. Higher B-Pb with consumption of moose meat was demonstrated in men, but not in women. B-Cd was essentially stable over the whole period, but an increase in B-Cd, of 3% per year, was detected in never-smoking women between 2009 and 2014. In 2014, median B-Cd in never-smokers in the four groups was; 0.11µg/L in younger men, 0.15µg/L in younger women, 0.14µg/L in older men, and 0.21µg/L in older women. B-Cd was higher in smokers than in non-smokers. The only positive association between B-Cd and food items in 2004-2014 was with consumption of brewed coffee (men only).

    CONCLUSIONS: The lack of a decrease in B-Cd from 1990 to 2014 and the absence of a further decrease in B-Pb after 2009 are unsatisfactory considering the health risks these metals pose in the general population at current concentrations.

  • 829.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Ruuth, Anders
    Department of Obstetrics and Gynaecology, Sunderby Hospital, Luleå, Sweden.
    Andersson, Liselott
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Department of Obstetrics and Gynaecology, Sunderby Hospital, Luleå, Sweden.
    Bergdahl, Ingvar A.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Mercury concentrations in pregnant women in circumpolar Sweden (Kiruna)2018Rapport (Övrigt vetenskapligt)
    Abstract [en]

    High exposure to mercury have been found in populations living in circumpolar areas, due to high consumption of sea food and accumulation of mercury closer to the north pole. The developing fetus is especially sensitive to effects of mercury. Exposure to mercury has previously been examined in pregnant women in Sweden, but not in pregnant women residing in Sweden north of the polar circle.

    In the years 2015-2016, mercury was measured in whole blood from 51 pregnant women living in the city of Kiruna in circumpolar Sweden, taking part in an international comparison between eight circumpolar countries. This report presents the Swedish results on mercury concentrations and associations with some exposure determinants. Also, compliance to dietary advice on fish consumption, appointed to fertile women, was examined.

    The median concentration of total-Hg in whole blood was 0.40 μg/L (min, max; <0.40, 1.88) among the 51 pregnant women in Kiruna. This is similar or lower compared to concentrations of mercury in pregnant women in other parts of Sweden. None of the women in the study had concentrations of mercury that are considered as dangerous.

    Mercury concentrations were associated with total fish consumption but not to consumption of predatory fish, known to be higher in mercury. All of the women in the study had knowledge about dietary advice on fish consumption. One woman exceeded the recommended consumption of predatory fish, limited due to risk of high mercury content, but this woman did not have high concentrations of mercury. While the vast majority of women thus followed the recommendations of not eating too much polluted fish, only 15 % of the women reported sufficient fish consumption to comply with the dietary advice (2-3 times/week).

    In conclusion, pregnant women in circumpolar Sweden have low exposure to mercury, and do not deviant from pregnant women in other parts of Sweden. Knowledge about dietary advice on fish consumption appointed to fertile women is very good. The public health concern though, is that pregnant women in circumpolar Sweden do not eat enough fish.

  • 830.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Strömberg, Ulf
    Bergdahl, Ingvar A
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Kauhanen, Jussi
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Salonen, Jukka T
    Skerfving, Staffan
    Tuomainen, Tomi-Pekka
    Vessby, Bengt
    Virtanen, Jyrki K
    Myocardial infarction in relation to mercury and fatty acids from fish: a risk-benefit analysis based on pooled Finnish and Swedish data in men2012Ingår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 96, nr 4, s. 706-713Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Exposure to methylmercury from fish has been associated with increased risk of myocardial infarction (MI) in some studies. At the same time, marine n-3 (omega-3) PUFAs are an inherent constituent of fish and are regarded as beneficial. To our knowledge, no risk-benefit model on the basis of data on methylmercury, PUFA, and MI risk has yet been presented.

    Objective: The objective of this study was to describe how exposure to both marine n-3 PUFAs and methylmercury relates to MI risk by using data from Finland and Sweden.

    Design: We used matched case-control sets from Sweden and Finland that were nested in population-based, prospective cohort studies. We included 361 men with MI from Sweden and 211 men with MI from Finland. MI risk was estimated in a logistic regression model with the amount of mercury in hair (hair-Hg) and concentrations of n-3 PUFAs (EPA and DHA) in serum (S-PUFA) as independent variables.

    Results: The median hair-Hg was 0.57 mu g/g in Swedish and 1.32 mu g/g in Finnish control subjects, whereas the percentage of S-PUFA was 4.21% and 3.83%, respectively. In combined analysis, hair-Hg was associated with higher (P = 0.005) and S-PUFA with lower (P = 0.011) MI risk. Our model indicated that even a small change in fish consumption (ie, by increasing S-PUFA by 1%) would prevent 7% of MIs, despite a small increase in mercury exposure. However, at a high hair-Hg, the modeled beneficial effect of PUFA on MI risk was counteracted by methylmercury.

    Conclusions: Exposure to methylmercury was associated with increased risk of MI, and higher S-PUFA concentrations were associated with decreased risk of MI. Thus, MI risk may be reduced by the consumption of fish high in PUFAs and low in methylmercury.

    Am J Clin Nutr 2012;96:706-13.

  • 831.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Tornevi, Andreas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Kariologi.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Bergdahl, Ingvar A
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Diet and lifestyle factors associated with fish consumption in men and women: a study of whether gender differences can result in gender-specific confounding2012Ingår i: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 11, s. 101-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Fish consumption and intake of omega-3 fatty acids from fish are associated with a lower risk of cardiovascular disease. However, a prospective study from northern Sweden showed that high consumption of fish is associated with an increased risk of stroke in men, but not in women. The current study aimed to determine if fish consumption is differently related to lifestyle in men compared with women in northern Sweden.

    METHODS: Lifestyle information on 32,782 men and 34,866 women (aged 30--60 years) was collected between 1992 and 2006 within the Vasterbotten Intervention Programme (a health intervention in northern Sweden). Spearman correlation coefficients (Rs) were calculated for associations between self-reported consumption of fish and other food items or lifestyle variables.

    RESULTS: Fish consumption was positively associated with other foods considered healthy (e.g., root vegetables, lettuce/cabbage/spinach/broccoli, chicken, and berries; Rs = 0.21-0.30), as well as with other healthy lifestyle factors (e.g., exercise and not smoking) and a higher educational level, in both men and women. The only gender difference found, concerned the association between fish consumption and alcohol consumption. Men who were high consumers of fish had a higher intake of all types of alcohol compared with low to moderate fish consumers. For women, this was true only for wine.

    CONCLUSIONS: Except for alcohol, the association between fish consumption and healthy lifestyle did not differ between men and women in northern Sweden. It is important to adjust for other lifestyle variables and socioeconomic variables in studies concerning the effect of fish consumption on disease outcome.

  • 832.
    Wennberg, Patrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Messner, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Johansson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    The effects of commuting activity and occupational and leisure time physical activity on risk of myocardial infarction2006Ingår i: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 13, nr 6, s. 924-930Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AB Background: Risk reduction of myocardial infarction has been shown for leisure time physical activity. The results of studies on occupational physical activity and risk of myocardial infarction are incongruous and studies on commuting activity are scarce. The aim of this study was to investigate how commuting activity, occupational physical activity and leisure time physical activity were associated with risk of future first myocardial infarction.

    Design: We used a prospective incident case-referent study design nested in Vasterbotten Intervention Program and the Northern Sweden MONICA study.

    Methods: Commuting habits, occupational physical activity, leisure time physical activity and cardiovascular risk factors were assessed at baseline screening and compared in 583 cases (20% women) with a first myocardial infarction and 2098 matched referents.

    Results: Regular car commuting was associated with increased risk of myocardial infarction versus commuting by bus, cycling or walking [odds ratio (OR) 1.74; 95% confidence interval (CI), 1.20-2.52] after multivariate adjustment. High versus low leisure time physical activity was associated with reduced risk of myocardial infarction (OR 0.69; 95% CI, 0.50-0.95) after adjustment for occupational physical activity and commuting activity, but the association was not statistically significant after further multivariate adjustment. After multivariate adjustment we observed a reduced risk for myocardial infarction in men with moderate (OR 0.70; 95% CI, 0.50-0.98) or high (OR 0.67; 95% CI, 0.42-1.08) versus low occupational physical activity.

    Conclusions: We found a clear association between car commuting and a first myocardial infarction and a corresponding inverse association with leisure time physical activity, while the impact of occupational physical activity on the risk of myocardial infarction was weaker. (C) 2006 European Society of Cardiology

  • 833.
    Westerberg, Kristina
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Tafvelin, Susanne
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    The importance of leadership style and psychosocial work environment to staff-assessed quality of care: implications for home help services2014Ingår i: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 22, nr 5, s. 461-468Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Work in home help services is typically conducted by an assistant nurse or nursing aide in the home of an elderly person, and working conditions have been described as solitary with a high workload, little influence and lack of peer and leader support. Relations between leadership styles, psychosocial work environment and a number of positive and negative employee outcomes have been established in research, but the outcome in terms of quality of care has been addressed to a lesser extent. In the present study, we aimed to focus on working conditions in terms of leadership and the employee psychosocial work environment, and how these conditions are related to the quality of care. The hypothesis was that the relation between a transformational leadership style and quality of care is mediated through organisational and peer support, job control and workload. A cross-sectional survey design was used and a total of 469 questionnaires were distributed (March-April 2012) to assistant nurses in nine Swedish home help organisations, including six municipalities and one private organisation, representing both rural and urban areas (302 questionnaires were returned, yielding a 65% response rate). The results showed that our hypothesis was supported and, when indirect effects were also taken into consideration, there was no direct effect of leadership style on quality of care. The mediated model explained 51% of the variance in quality of care. These results indicate that leadership style is important not only to employee outcomes in home help services but is also indirectly related to quality of care as assessed by staff members.

  • 834.
    Westerlund, Jessica
    et al.
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Löfstedt, Håkan
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Eriksson, Kåre
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Westberg, Håkan
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Man-Technology-Environment Research Center (MTM), Department of Science, Örebro University, Örebro, Sweden.
    Graff, Pål
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway.
    Occupational exposure to trichloramine and trihalomethanes: adverse health effects among personnel in habilitation and rehabilitation swimming pools2019Ingår i: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 16, nr 1, s. 78-88Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Personnel in swimming pool facilities typically experience ocular, nasal, and respiratory symptoms due to water chlorination and consequent exposure to disinfection by-products in the air. The aim of the study was to investigate exposure to trichloramine and trihalomethanes (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) from the perspective of adverse health effects on the personnel at Swedish habilitation and rehabilitation swimming pools. The study included ten habilitation and rehabilitation swimming pool facilities in nine Swedish cities. The study population comprised 24 exposed swimming pool workers and 50 unexposed office workers. Personal and stationary measurements of trichloramine and trihalomethanes in air were performed at all the facilities. Questionnaires were distributed to exposed workers and referents. Spirometry, fraction of exhaled nitric oxide (FENO) and peak expiratory flow (PEF) were measured. Personal and stationary measurements yielded trichloramine levels of 1-76 µg/m3 (average: 19 µg/m3) and 1-140 µg/m3 (average: 23 µg/m3), respectively. A slightly higher, but not significant, prevalence of reported eye- and throat-related symptoms occurred among the exposed workers than among the referents. A significantly increased risk of at least one ocular symptom was attributed to trichloramine exposure above the median (20 µg/m3). Lung function (FVC and FEV1) was in the normal range according to the Swedish reference materials, and no significant change in lung function before and after shift could be established between the groups. Average FENO values were in the normal range in both groups, but the difference in the values between the exposed workers and referents showed a significant increase after shift. Hourly registered PEF values during the day of the investigation did not show any unusual individual variability. In conclusion, the increased risk of developing at least one ocular symptom at personal trichloramine concentrations over 20 µg/m3 combined with an increase in the difference in FENO during the work shift of the exposed workers should not be neglected as an increased risk of respiratory inflammation in the habilitation and rehabilitation swimming pool environment.

  • 835.
    Wilder-Smith, Annelies
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Renhorn, Karl-Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Tissera, Hasitha
    Abu Bakar, Sazaly
    Alphey, Luke
    Kittayapong, Pattamaporn
    Lindsay, Steve
    Logan, James
    Hatz, Christoph
    Reiter, Paul
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Louis, Valerie R.
    Tozan, Yesim
    Massad, Eduardo
    Tenorio, Antonio
    Lagneau, Christophe
    L'Ambert, Gregory
    Brooks, David
    Wegerdt, Johannah
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Gubler, Duane
    DengueTools: innovative tools and strategies for the surveillance and control of dengue2012Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, s. 17273-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Dengue fever is a mosquito-borne viral disease estimated to cause about 230 million infections worldwide every year, of which 25,000 are fatal. Global incidence has risen rapidly in recent decades with some 3.6 billion people, over half of the world's population, now at risk, mainly in urban centres of the tropics and subtropics. Demographic and societal changes, in particular urbanization, globalization, and increased international travel, are major contributors to the rise in incidence and geographic expansion of dengue infections. Major research gaps continue to hamper the control of dengue. The European Commission launched a call under the 7th Framework Programme with the title of 'Comprehensive control of Dengue fever under changing climatic conditions'. Fourteen partners from several countries in Europe, Asia, and South America formed a consortium named 'DengueTools' to respond to the call to achieve better diagnosis, surveillance, prevention, and predictive models and improve our understanding of the spread of dengue to previously uninfected regions (including Europe) in the context of globalization and climate change. The consortium comprises 12 work packages to address a set of research questions in three areas: Research area 1: Develop a comprehensive early warning and surveillance system that has predictive capability for epidemic dengue and benefits from novel tools for laboratory diagnosis and vector monitoring. Research area 2: Develop novel strategies to prevent dengue in children. Research area 3: Understand and predict the risk of global spread of dengue, in particular the risk of introduction and establishment in Europe, within the context of parameters of vectorial capacity, global mobility, and climate change. In this paper, we report on the rationale and specific study objectives of 'DengueTools'. DengueTools is funded under the Health theme of the Seventh Framework Programme of the European Community, Grant Agreement Number: 282589 Dengue Tools.

  • 836.
    Wilén, Jonna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Hansson Mild, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Lundström, Ronnie
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Non-Ionising Radiation in Swedish Health Care2018Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Bakgrund

    Inom sjukvården används alltmera teknik som exponerar patienter för icke-joniserande strålning vid diagnostik och terapi. Ofta används sådan teknik som ett alternativ till och ibland i kombination med metoder som exponerar för joniserande strålning.

    Huvudsyftet med studien var att identifiera och beskriva hur icke-joniserande strålning används inom hälso- och sjukvård, samt att undersöka förväntade exponeringsnivåer, identifiera eventuella hälsorisker och identifiera kunskapsluckor inom området. Icke-joniserande strålning refererar här till icke-joniserande elektromagnetisk strålning med frekvenser från 0 Hz upp till 3,0 PHz, inkluderande elektromagnetiska fält, optisk strålning och mekaniska vågor såsom ultraljud.

    SSM har saknat en samlad kunskap kring de metoder och exponeringsnivåer som använder icke-joniserande strålning inom sjukvården. Bland annat EU:s vetenskapliga råd SCENIHR (har numera bytt namn till SCHEER) har pekat på behovet av forskning om potentiella hälsoeffekter inom detta område. Studien var alltså viktig för att få ett underlag för att bedöma behovet av ytterligare säkerhetsåtgärder inom området, identifiera kunskapsluckor och också för att få ett bättre underlag för att besvara frågor angående säkerhet och eventuella risker.

    Resultat

    Inga hälsorisker eller allvarliga säkerhetsbrister har identifierats. Däremot är de exponeringsnivåer som används många gånger på en nivå där det finns en tydlig biologisk påverkan och ibland kan även akuta symtom upplevas, detta är dock ofta helt avsiktligt för att få önskad effekt och av övergående natur.

    Författarna har identifierat ett behov av att förbättra hälsovårdspersonalens kunskap om risker och säkerhet vid användning av icke-joniserande strålning samt pekar på vikten av tydlighet när det gäller vilken organisation/myndighet som ska tillhandahålla sådan information.

    Rapporten indikerar också att ett robust forskningsunderlag för närvarande saknas för att bedöma möjliga långsiktiga hälsorisker med användning av exempelvis MRI, TMS och ultraljud. Den kunskap och forskning som finns tillgänglig tyder dock inte på några betydande hälsorisker med nu aktuella exponeringsnivåer.

    Relevans

    Rapporten stöder Strålsäkerhetsmyndighetens tidigare uppfattning att de tillämpningar med icke-joniserande strålning som används i sjukvården inte utgör några kända hälsorisker. När metoder som bygger på icke-joniserande strålning ersätter metoder som bygger på joniserande strålning ökar patientsäkerheten, under förutsättning att syftet med undersökningen eller behandlingen uppnås.

  • 837.
    Winkvist, Anna
    et al.
    Department of Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Kariologi.
    More distinct food intake patterns among women than men in northern Sweden: a population-based survey2009Ingår i: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Nutrition journal, Vol. 8, nr 1, s. 1-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The need to promote a healthy diet to curb the current obesity epidemic has today been recognized by most countries. A prerequisite for planning and evaluating interventions on dietary intake is the existence of valid information on long-term average dietary intake in a population. Few large, population-based studies of dietary intake have been carried out in Sweden. The largest to date is the Vasterbotten Intervention Program (VIP), which was initiated in 1985, with data collection still ongoing. This paper reports on the first comprehensive analyses of the dietary data and presents dietary intake patterns among over 60,000 women and men in northern Sweden during 1992-2005. METHODS: Between 1992 and 2005, 71,367 inhabitants in Vasterbotten county aged 30, 40, 50, and 60 years visited their local health care center as part of the VIP. Participants of VIP filled in an 84- or 64-item food frequency questionnaire (FFQ) and provided sociodemographic information. Complete and realistic information on consumption frequency was provided by 62,531 individuals. Food intake patterns were analyzed using K-means cluster analyses. RESULTS: The mean daily energy intake was 6,83 (+/-1,77) MJ among women and 8,71 (+/- 2,26) MJ among men. More than half of both women and men were classified as Low Energy Reporters (defined as individuals reporting a food intake level below the lower 95% confidence interval limit of the physical activity level). Larger variation in frequency of daily intake was seen among women than among men for most food groups. Among women, four dietary clusters were identified, labeled "Fruit and vegetables", "High fat", "Coffee and sandwich", and "Tea and ice cream". Among men, three dietary clusters were identified, labeled "Fruit and vegetables", "High fat", and "Tea, soda and cookies". CONCLUSION: More distinct food intake patterns were seen among women than men in this study in northern Sweden. Due to large proportions of Low Energy Reporters, our results on dietary intake may not be suitable for comparisons with recommended intake levels. However, the results on food intake patterns should still be valid and useful as a basis for targeting interventions to groups most in need.

  • 838. Yamamoto, Shelby
    et al.
    Sie, Ali
    Sauerborn, Rainer
    Institute of Public Health, University of Heidelberg .
    Cooking fuels and the push for cleaner alternatives: a case study from Burkina Faso2009Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, s. 156-164Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: More than 95% of the population in Burkina Faso uses some form of solid biomass fuel. When these fuels are burned in traditional, inefficient stoves, pollutant levels within and outside the home can be very high. This can have important consequences for both health and climate change. Thus, the push to switch to cleaner burning fuels is advantageous. However, there are several considerations that need to be taken into account when considering the use and promotion of different fuel types.

    Objective: In the setting of the semi-urban area of Nouna, Burkina Faso, we examine the common fuel types used (wood, charcoal and liquid petroleum gas (LPG)) in terms of consumption, energy, availability, air pollution and climate change.

    Results and conclusion: Although biomass solid fuel does offer some advantages over LPG, the disadvantages make this option much less desirable. Lower energy efficiencies, higher pollutant emission levels, the associated health consequences and climate change effects favour the choice of LPG over solid biomass fuel use. Further studies specific to Burkina Faso, which are lacking in this region, should also be undertaken in this area to better inform policy decisions.

  • 839.
    Yang, Lei
    et al.
    School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, PR China.
    Zhang, Jianping
    School of Clinical Medicine, Hainan Medical University, Haikou, PR China.
    Zhao, Guanghui
    Hong Hui Hospital, Health Science Center, Xi'an Jiaotong University, Xi'an, PR China.
    Wu, Cuiyan
    School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, PR China.
    Ning, Yujie
    School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, PR China.
    Wang, Xi
    School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, PR China.
    Lammi, Mikko
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, PR China.
    Guo, Xiong
    School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, PR China.
    Gene expression profiles and molecular mechanism of cultured human chondrocytes' exposure to T-2 toxin and deoxynivalenol2017Ingår i: Toxicon, ISSN 0041-0101, E-ISSN 1879-3150, Vol. 140, s. 38-44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    T-2 toxin and deoxynivalenol (DON) are secondary metabolites produced by Fusarium fungi and are commonly found on food and feed. Although T-2 toxin and DON have been suggested as the etiology of Kashin-Beck disease (KBD), an endemic osteochondropathy, little is known about the mechanism when human chondrocytes are exposed to T-2 toxin and DON. The purpose of this study is to identify the gene expression differences and underlying molecular changes modulated by T-2 toxin and DON in vitro in human chondrocytes. After the experiments of cell viability, the gene expression profiles were analyzed in cells that were treated with 0.01 μg/ml T-2 toxin and 1.0 μg/ml DON for 72 h by Affymetrix Human Gene Chip. The array results showed that 882 and 2118 genes were differentially expressed for T-2 toxin and DON exposure, respectively. Enrichment analysis revealed that diverse cellular processes including DNA damage, cell cycle regulation and metabolism of extracellular matrix were affected when human chondrocytes were exposed to T-2 toxin and DON. These results demonstrate the gene expression differences and molecular mechanism of cultured human chondrocytes exposure to T-2 toxin and DON, and provide a new insight into future research in the etiology of KBD.

  • 840.
    Zafar, Hamayun
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
    Alghadir, A. H.
    Iqbal, Z. A.
    Effect of different head-neck-jaw postures on cervicocephalic kinesthetic sense2017Ingår i: Journal of Musculoskeletal and Neuronal Interactions - JMNI, ISSN 1108-7161, Vol. 17, nr 4, s. 341-346Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate the effect of different induced head-neck-jaw postures on head-neck relocation error among healthy subjects.

    Methods: 30 healthy adult male subjects participated in this study. Cervicocephalic kinesthetic sense was measured while standing, habitual sitting, habitual sitting with clenched jaw and habitual sitting with forward head posture during right rotation, left rotation, flexion and extension using kinesthetic sensibility test.

    Results: Head-neck relocation error was least while standing, followed by habitual sitting, habitual sitting with forward head posture and habitual sitting with jaw clenched. However, there was no significant difference in error between different tested postures during all the movements.

    Conclusions: To the best of our knowledge, this is the first study to see the effect of different induced head-neck-jaw postures on head-neck position sense among healthy subjects. Assuming a posture for a short duration of time doesn’t affect head-neck relocation error in normal healthy subjects.

  • 841. Zheng, Guang
    et al.
    Tian, Liting
    Liang, Yihuai
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Broberg, Karin
    Lei, Lijian
    Guo, Weijun
    Nilsson, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bergdahl, Ingvar A
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Skerfving, Staffan
    Jin, Taiyi
    δ-Aminolevulinic acid dehydratase genotype predicts toxic effects of lead on workers' peripheral nervous system2011Ingår i: Neurotoxicology, ISSN 0161-813X, E-ISSN 1872-9711, Vol. 32, nr 4, s. 374-382Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a wide variation in sensitivity to lead (Pb) exposure, which may be due to genetic susceptibility towards Pb. We investigated whether a polymorphism (rs1800435) in the δ-aminolevulinic acid dehydratase (ALAD) gene affected the toxicokinetics and toxicodynamics of Pb. Among 461 Chinese Pb-exposed storage battery and 175 unexposed workers, allele frequencies for the ALAD1 and ALAD2 alleles were 0.968 and 0.032, respectively. The Pb-exposed workers had a higher fraction of the ALAD1-2/2-2 genotype than unexposed workers (7.8% vs. 2.3%, p=0.01). The Pb levels in blood (B-Pb) and urine (U-Pb) were higher in Pb-exposed workers carrying the ALAD2 allele compared to homozygotes for ALAD1 (median B-Pb: 606 vs. 499 μg/L; U-Pb: 233 vs. 164 μg/g creatinine), while there was no statistically significant difference in the unexposed controls (median: 24 vs. 37 μg/L, and 3.9 vs. 6.4μg/g creatinine, respectively). High B-Pb and U-Pb were associated with statistically significantly lower sensory and motor conduction velocities in the median, ulnar and peroneal nerves. At the same B-Pb and U-Pb, ALAD1 homozygotes had lower conduction velocities than the ALAD2 carriers. There were similar trends for toxic effects on haem synthesis (zinc protoporphyrin and haemoglobin in blood) and renal function (albumin and N-acetyl-d-β-acetylglucosaminidase in urine), but without statistical significance. There was no difference in Pb toxicokinetics and toxicodynamics associated with VDR BsmI polymorphism. Our results show that the ALAD genotype modifies the relationship between Pb and its toxic effects on the peripheral nervous system. This must be considered in the assessment of risks at Pb exposure.

  • 842.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Health effects of heatwaves: short and long term predictions2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Climate change is defined by the Intergovernmental Panel on Climate Change as changes in the state of the climate associated with changes in the mean and/or the variability of its properties. Climate change will affect temperatures both as an increase in mean temperature as well as changes in the frequency of temperature extremes. Health effects associated with extreme heat, both mortality and morbidity, have been observed all over the globe. Groups that are often found to be more vulnerable are the elderly and people diagnosed with certain diseases and/or on taking some specific types of medication. The health effects from climate change in the future depend on a number of underlying sociodemographic and other factors. It is difficult to predict how the underlying societal factors that are likely to alter the health effects from high temperatures will change. The aim of this thesis is to investigate the influence of the underlying assumptions and factors that are key components when predicting and projecting heat-related illness, both in the short and long term. This work aims to identify and to some extent quantify different sources of uncertainty that will have effects on the outcome of health impact assessments.

    Methods: We wanted to evaluate if different statistical models would alter the ability to identify days with elevated heat-related risk. We used observations of temperatures and daily mortality for Greater Stockholm to model different exposure-response relationships (Paper I). Along the observed data, we collected temperature forecasts for the Stockholm area. We defined what constitutes a risk day and compared the model’s ability to identify these days using both observed and forecasted temperatures to evaluate the predictive performance of models based on the different statistical approaches. To estimate how climate change will alter the heat-related health impacts we used climate change projections from a range of climate change scenarios to be able to get stable estimates as well as a measure of the uncertainty in the climate projections (Paper II-III). We estimated the change in respiratory hospital admissions (Paper II) and the future need for adaptation to keep heat-related mortality at current levels (Paper III) in Europe. We also estimated the change in heat-related mortality due to changes in climate, demographics and health status of the population in Stockholm (Paper IV).

    Results: The models using a highly complex exposure-response relationship showed lower predictive performance, especially when looking at a longer time-scale. The more complex models did also estimate a lower mortality increase compared to the less complex ones. There was however high agreement of which days to be considered risk days. The estimated increase in heat-related illness from the three health impact assessment studies showed impacts on a similar order of magnitude when looking at changes in climate only. Respiratory hospital admissions were estimated to more than double in Europe and heat-related mortality in Stockholm was estimated to increase to around 257% of current levels. Therefore, adaptation needs to lower the vulnerability to heat by around 50% in the European countries. In study III and IV we take changes in demographics into account and find that the future health burden from heat will increase due to the growing elderly population.

    Conclusion: To be able to make predictions of future health burdens from heat, both in the long and short term, we need to consider the properties of the epidemiological models and how the choice of model might limit its use within a health impact assessment. Climate change seems to be the main driver of the future health burden from extreme temperatures, but our results suggests that changing demographics will add to the burden considerably unless relevant adaptation measures are implemented. Adding this on top of the challenges posed by climate change, we find that need for adaptation will increase substantially in the future.

  • 843.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Bjelkmar, Pär
    Folkhälsomyndighe-ten, Stockholm.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Ovanligt många dödsfalli Sverige sommaren 2018: drygt 600 kan ha dött till följd av värmeböljan2019Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, artikel-id FLFHArtikel i tidskrift (Refereegranskat)
  • 844.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ebi, Kristie L
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Langner, Joakim
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Developing a heatwave early warning system for Sweden: evaluating sensitivity of different epidemiological modelling approaches to forecast temperatures2015Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, nr 1, s. 254-267Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Over the last two decades a number of heatwaves have brought the need for heatwave early warning systems (HEWS) to the attention of many European governments. The HEWS in Europe are operating under the assumption that there is a high correlation between observed and forecasted temperatures. We investigated the sensitivity of different temperature mortality relationships when using forecast temperatures. We modelled mortality in Stockholm using observed temperatures and made predictions using forecast temperatures from the European Centre for Medium-range Weather Forecasts to assess the sensitivity. We found that the forecast will alter the expected future risk differently for different temperature mortality relationships. The more complex models seemed more sensitive to inaccurate forecasts. Despite the difference between models, there was a high agreement between models when identifying risk-days. We find that considerations of the accuracy in temperature forecasts should be part of the design of a HEWS. Currently operating HEWS do evaluate their predictive performance; this information should also be part of the evaluation of the epidemiological models that are the foundation in the HEWS. The most accurate description of the relationship between high temperature and mortality might not be the most suitable or practical when incorporated into a HEWS.

  • 845.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Orru, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. orru@ut.ee.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Strandberg, Gustav
    Rossby Centre, SMHI, Norrköping, Sweden.
    Ebi, Kristie L
    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.
    Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 1, s. e001842-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives Respiratory diseases are ranked second in Europe in terms of mortality, prevalence and costs. Studies have shown that extreme heat has a large impact on mortality and morbidity, with a large relative increase for respiratory diseases. Expected increases in mean temperature and the number of extreme heat events over the coming decades due to climate change raise questions about the possible health impacts. We assess the number of heat-related respiratory hospital admissions in a future with a different climate.                                

    Design A Europe-wide health impact assessment.                                

    Setting An assessment for each of the EU27 countries.                                

    Methods Heat-related hospital admissions under a changing climate are projected using multicity epidemiological exposure–response relationships applied to gridded population data and country-specific baseline respiratory hospital admission rates. Times-series of temperatures are simulated with a regional climate model based on four global climate models, under two greenhouse gas emission scenarios.                                

    Results Between a reference period (1981–2010) and a future period (2021–2050), the total number of respiratory hospital admissions attributed to heat is projected to be larger in southern Europe, with three times more heat attributed respiratory hospital admissions in the future period. The smallest change was estimated in Eastern Europe with about a twofold increase. For all of Europe, the number of heat-related respiratory hospital admissions is projected to be 26 000 annually in the future period compared with 11 000 in the reference period.                                

    Conclusions The results suggest that the projected effects of climate change on temperature and the number of extreme heat events could substantially influence respiratory morbidity across Europe.                                

     

  • 846.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Lund Universitet.
    Andersson, Camilla
    SMHI.
    Ebi, Kristie L.
    University of Washington.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Future health impact of higher ambient temperatures in Stockholm, SwedenManuskript (preprint) (Övrigt vetenskapligt)
  • 847.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Lund Universitet.
    Andersson, Camilla
    SMHI.
    Ebi, Kristie L.
    University of Washington.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Vulnerability reduction needed to adapt to projected future heat exposure in Europe: Magnitude and determinantsManuskript (preprint) (Övrigt vetenskapligt)
  • 848.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Åström, Daniel Oudin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
    Andersson, Camilla
    Ebi, Kristie L
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Vulnerability Reduction Needed to Maintain Current Burdens of Heat-Related Mortality in a Changing Climate-Magnitude and Determinants2017Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, nr 7, artikel-id 741Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The health burden from heatwaves is expected to increase with rising global mean temperatures and more extreme heat events over the coming decades. Health-related effects from extreme heat are more common in elderly populations. The population of Europe is rapidly aging, which will increase the health effects of future temperatures. In this study, we estimate the magnitude of adaptation needed to lower vulnerability to heat in order to prevent an increase in heat-related deaths in the 2050s; this is the Adaptive Risk Reduction (ARR) needed. Temperature projections under Representative Concentration Pathway (RCP) 4.5 and RCP 8.5 from 18 climate models were coupled with gridded population data and exposure-response relationships from a European multi-city study on heat-related mortality. In the 2050s, the ARR for the general population is 53.5%, based on temperature projections under RCP 4.5. For the population above 65 years in Southern Europe, the ARR is projected to be 45.9% in a future with an unchanged climate and 74.7% with climate change under RCP 4.5. The ARRs were higher under RCP 8.5. Whichever emission scenario is followed or population projection assumed, Europe will need to adapt to a great degree to maintain heat-related mortality at present levels, which are themselves unacceptably high, posing an even greater challenge.

  • 849.
    Öman, Mikael
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Fredriksson, Rikard
    Bylund, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Analysis of the mechanism of injury in non-fatal vehicle-to-pedestrian and vehicle-to-bicyclist frontal crashes in Sweden2016Ingår i: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, E-ISSN 1745-7319, Vol. 23, nr 4, s. 405-412Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this paper is to analyse and compare injuries and injury sources in pedestrian and bicyclist non-fatal real-life frontal passengercar crashes, considering in what way pedestrian injury mitigation systems also might be adequate for bicyclists. Data from 203 non-fatal vehicle-to-pedestrian and vehicle-to-bicyclist crashes from 1997 through 2006 in a city in northern Sweden were analysed by use of the hospitals injury data base in addition to interviews with the injured. In vehicle-to-pedestrian crashes (n = 103) head and neck injuries were in general due to hitting the windscreen frame, while in vehicle-to-bicycle crashes (n = 100) head and neck injuries were typically sustained by ground impact. Abdominal, pelvic and thoracic injuries in pedestrians and thoracic injuries in bicyclists were in general caused by impacting the bonnet. In vehicle-to-pedestrian crashes, energy reducing airbags at critical impact points with low yielding ability on the car, as the bonnet and the windscreen frame, might reduce injuries. As vehicle-to-bicyclist crashes occurred mostly in good lighting conditions and visibility and the ground impact causing almost four times as many injuries as an impact to the different regions of the car, crash avoidance systems as well as separating bicyclists from motor traffic, may contribute to mitigate these injuries.

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