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  • 1. Araujo, Pedro
    et al.
    Tilahun, Ephrem
    Zeng, Yingxu
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    A novel strategy for discriminating marine oils by using the positional distribution (sn-1, sn-2, sn-3) of omega-3 polyunsaturated fatty acids in triacylglycerols2018In: Talanta: The International Journal of Pure and Applied Analytical Chemistry, ISSN 0039-9140, E-ISSN 1873-3573, Vol. 182, p. 32-37Article in journal (Refereed)
    Abstract [en]

    A novel strategy for discriminating genuine and adulterated marine oils is proposed. The strategy consists of i) determining the stereospecific distribution (sn-1, sn-2 and sn-3) of omega 3 polyunsaturated fatty acids (omega-3 PUFA) on the backbone of triacylglycerols by using liquid chromatography tandem mass spectrometry; ii) transforming the qualitative stereospecific information into quantitative data by means of a novel strategy; iii) analyzing the transformed data by principal component analysis. The proposed strategy was tested on pure oils (seal, salmon, cod liver, sandeel, blue whiting, herring), a mixture of blue whiting, herring, sandeel and Norway pout and some intentionally adulterated oils. In addition, some published krill oil data were analyzed to confirm the reliability of the new approach.

  • 2.
    Backman, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Jansson, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Stridsman, Caroline
    Eriksson, Berne
    Hedman, Linnea
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Eklund, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Sandström, Thomas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lundbäck, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Severe asthma: A population study perspective2019In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 6, p. 819-828Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Severe asthma is a considerable challenge for patients, health care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study.

    OBJECTIVE: To describe characteristics and estimate the prevalence of severe asthma in a large adult population-based asthma cohort followed for 10-28 years.

    METHODS: N=1006 subjects with asthma participated in a follow-up during 2012-14, when 830 (mean age 59y, 56% women) still had current asthma. Severe asthma was defined according to three internationally well-known criteria: the ATS workshop definition from 2000 used in the US Severe Asthma Research Program (SARP), the 2014 ATS/ERS Task force definition and the GINA 2017. All subjects with severe asthma according to any of these criteria were undergoing respiratory specialist care, and were also contacted by telephone to verify treatment adherence.

    RESULTS: The prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS Taskforce), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >40% had uncontrolled asthma according to the asthma control test. Severe asthma was related to age >50 years, nasal polyposis, impaired lung function, sensitization to aspergillus, and tended to be more common in women. Further, neutrophils in blood significantly discriminated severe asthma from other asthma.

    CONCLUSIONS AND CLINICAL RELEVANCE: Severe asthma differed significantly from other asthma in terms of demographic, clinical and inflammatory characteristics, results suggesting possibilities for improved treatment regimens of severe asthma. The prevalence of severe asthma in this asthma cohort was 4-6%, corresponding to approximately 0.5% of the general population. This article is protected by copyright. All rights reserved.

  • 3.
    Berginström, Nils
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. School of Sport Sciences, The Arctic University of Norway, Tromsø, Norway Medicine.
    Ekman, Urban
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Johan
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. School of Sport Sciences, The Arctic University of Norway, Tromsø, Norway.
    Pharmaco-fMRI in Patients With Traumatic Brain Injury: A Randomized Controlled Trial With the Monoaminergic Stabilizer (-)-OSU61622019In: The journal of head trauma rehabilitation, ISSN 0885-9701, E-ISSN 1550-509X, Vol. 34, no 3, p. 189-198Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine the effects of monoaminergic stabilizer (-)-OSU6162 on brain activity, as measured by blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI), in patients in the chronic phase of traumatic brain injury suffering from fatigue.

    SETTING: Neurorehabilitation clinic.

    PARTICIPANTS: Patients with traumatic brain injury received either placebo (n = 24) or active treatment (n = 28). Healthy controls (n = 27) went through fMRI examination at one point and were used in sensitivity analysis on normalization of BOLD response.

    DESIGN: Randomized, double-blinded, placebo-controlled design.

    MAIN MEASURES: Effects on BOLD signal changes from before to after treatment during performance of a fatiguing attention task.

    RESULTS: The fMRI results revealed treatment effects within the right occipitotemporal cortex and the right orbitofrontal cortex. In these regions, the BOLD response was normalized relative to healthy controls at the postintervention fMRI session. No effects were seen in regions in which we previously observed activity differences between patients and healthy controls while performing this fMRI task, such as the striatum.

    CONCLUSION: (-)-OSU6162 treatment had influences on functional brain activity, although the normalized regional BOLD response was observed in regions that were not a priori hypothesized to be sensitive to this particular treatment, and was not accompanied by any effects on in-scanner test performance or on fatigue.

  • 4.
    Bergman, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wahlström, Viktoria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Stomby, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Otten, Julia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lanthén, Ellen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Renklint, Rebecka
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Waling, Maria
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Sörlin, Ann
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Danish Research Center for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Levine, James A.
    Department of Endocrinology, The Mayo Clinic, Rochester, MN, USA; Fondation IPSEN, Paris, France.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Treadmill workstations in office workers who are overweight or obese: a randomised controlled trial2018In: The Lancet Public Health, ISSN 2468-2667, Vol. 3, no 11, article id e523-e535Article in journal (Refereed)
    Abstract [en]

    Background: Treadmill workstations that enable office workers to walk on a treadmill while working at their computers might increase physical activity in offices, but long-term effects are unknown. We therefore investigated whether treadmill workstations in offices increased daily walking time.

    Methods: We did a randomised controlled trial of healthy office workers who were either overweight or obese. We recruited participants from 13 different companies, which comprised 17 offices, in Umeå, Sweden. We included people who were aged 40-67 years, had sedentary work tasks, and had a body-mass index (BMI) between 25 kg/m2 and 40 kg/m2. After the baseline measurement, we stratified participants by their BMI (25-30 kg/m2 and >30 to 40 kg/m2); subsequently, an external statistician randomly assigned these participants (1:1) to either the intervention group (who received treadmill workstations for optional use) or the control group (who continued to work at their sit-stand desks as usual). Participants in the intervention group received reminders in boosting emails sent out to them at four occasions during the study period. Researchers were masked to group assignment until after analysis of the primary outcome. After the baseline measurement, participants were not masked to group belongings. The primary outcome was total daily walking time at weekdays and weekends, measured at baseline, 2 months, 6 months, 10 months, and 13 months with the accelerometer activPAL (PAL Technologies, Glasgow, UK), which was worn on the thigh of participants for 24 h a day for 7 consecutive days. We used an intention-to-treat approach for our analyses. This trial is registered with ClinicalTrials.gov, number NCT01997970, and is closed to new participants.

    Findings: Between Nov 1, 2013, and June 30, 2014, a total of 80 participants were recruited and enrolled (n=40 in both the intervention and control groups). Daily walking time during total time awake at weekdays increased between baseline and 13 months by 18 min (95% CI 9 to 26) in the intervention group and 1 min (-7 to 9) in the control group (difference 22 min [95% CI 7 to 37], pinteraction=0·00045); for weekend walking, the change from baseline to 13 months was 5 min (-8 to 18) in the intervention group and 8 min (-5 to 21) in the control group (difference -1 min [-19 to 17]; pinteraction=0·00045). Neither measure met our predetermined primary outcome of 30 min difference in total walking time between the intervention and control group, so the primary outcome of the trial was not met. One adverse event was reported in a participant who accidently stepped on their Achilles tendon.

    Interpretation: In a sedentary work environment, treadmill workstations result in a statistically significant but smaller-than-expected increase in daily walking time. Future studies need to investigate how increasing physical activity at work might have potentially compensatory effects on non-work activity.

  • 5.
    Bergman, Jonathan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. School of Sport Sciences, UiT Arctic University of Norway, Postboks 1621, 9509, Alta, Norway.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Epidemiology of osteonecrosis among older adults in Sweden2019In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 30, no 5, p. 965-973Article in journal (Refereed)
    Abstract [en]

    Summary: This study estimated the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults. Osteonecrosis was approximately 10 times more common than in previous studies. The strongest risk factors were dialysis, hip fracture, osteomyelitis, and organ transplantation, but only hip fractures could have contributed substantially to the disease burden.

    Introduction: The aim of this study was to estimate the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults and in a large number of risk groups in that cohort.

    Methods: In this retrospective cohort study, we included everyone who was aged 50 years or older and who was living in Sweden on 31 December 2005. We used Swedish national databases to collect data about prescription medication use, diagnosed medical conditions, and performed medical and surgical procedures. The study outcome was diagnosis of primary or secondary osteonecrosis at any skeletal site. The strength of risk factors was assessed using age- and sex-standardized incidence ratios (SIRs).

    Results: The study cohort comprised 3,338,463 adults. The 10-year risk of osteonecrosis was 0.4% (n = 13,425), and the incidence rate was 4.7 cases/10000 person-years (95% confidence interval [CI], 4.6 to 4.7 cases). The strongest risk factors for osteonecrosis were hip fracture (SIR, 7.98; 95% CI, 7.69–8.27), solid organ transplantation (SIR, 7.14; 95% CI, 5.59–8.99), dialysis (SIR, 6.65; 95% CI, 5.62–7.81), and osteomyelitis (SIR, 6.43; 95% CI, 5.70–7.23). A history of hip fracture was present in 21.7% of cases of osteonecrosis, but osteomyelitis, dialysis, and solid organ transplantation were present in only 0.5 to 2% of cases.

    Conclusions: Osteonecrosis was approximately 10 times more common than a small number of previous population-based studies have suggested. The strongest risk factors for osteonecrosis were dialysis, hip fracture, osteomyelitis, and solid organ transplantation, but only hip fractures could have contributed substantially to the disease burden.

  • 6.
    Bergman, Jonathan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. School of Sport Sciences, Arctic University of Norway, Tromsø, Norway.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Overestimation of the Limitations of Randomized Controlled Trials2019In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681Article in journal (Refereed)
  • 7.
    Bodén, Stina
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Myte, Robin
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Harlid, Sophia
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Shivappa, Nitin
    Hébert, James R
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    The inflammatory potential of diet in determining cancer risk: a prospective investigation of two dietary pattern scores2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 4, article id e0214551Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Inflammation-related mechanisms may contribute to the link between diet and cancer. We sought to investigate the inflammatory impact of diet on cancer risk using the Dietary inflammatory index (DII) and an adapted Mediterranean diet score (MDS).

    METHODS: This population-based, prospective cohort study used self-reported dietary data from the Västerbotten Intervention Programme, including 100,881 participants, of whom 35,393 had repeated measures. Associations between dietary patterns and cancer risk were evaluated using Cox proportional hazards regression. We also used restricted cubic splines to test for potential non-linear associations.

    RESULTS: A total of 9,250 incident cancer cases were diagnosed during a median follow-up of 15 years. The two dietary patterns were moderately correlated to each other and had similar associations with cancer risk, predominantly lung cancer in men (DII per tertile decrease: Hazard ratio (HR) 0.81 (0.66-0.99), MDS per tertile increase: HR 0.86 (0.72-1.03)), and gastric cancer in men (DII: 0.73 (0.53-0.99), MDS: 0.73 (0.56-0.96)). Associations were, in general, found to be linear. We found no longitudinal association between 10-year change in diet and cancer risk.

    CONCLUSION: We confirm small, but consistent and statistically significant associations between a more anti-inflammatory or healthier diet and reduced risk of cancer, including a lower risk of lung and gastric cancer in men. The dietary indexes produced similar associations with respect to the risk of cancer.

  • 8.
    Bråbäck, Lennart
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Grandmaternal smoking during pregnancy and asthma in grandchildren.2019In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 144, no 2, article id 624Article in journal (Refereed)
  • 9.
    Forsell, Karl
    et al.
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden..
    Liljelind, Ingrid
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ljungkvist, Göran
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden..
    Nordlinder, Rolf
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden..
    Andersson, Eva
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden..
    Nilsson, Ralph
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden..
    Benzene Exposure and Biomarkers in Alveolar Air and Urine Among Deck Crews on Tankers Transporting Gasoline.2019In: Annals of work exposures and health, ISSN 2398-7316, article id wxz055Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 10. Huseinovic, Ena
    et al.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Esberg, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Sweden.
    Changes in food intake patterns during 2000–2007 and 2008–2016 in the population-based Northern Sweden Diet Database2019In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 18, article id 36Article in journal (Refereed)
    Abstract [en]

    Background: Food intake patterns provide a summary of dietary intake. Few studies have examined trends in food intake patterns over time in large, population-based studies. We examined food intake patterns and related sociodemographic and individual characteristics in the large Northern Sweden Diet Database during the two time windows 2000–2007 and 2008–2016.

    Methods: In total, 100 507 participants (51% women) who had filled in a 64-item food frequency questionnaire and provided background and sociodemographic data between 2000 and 2016 were included. Food intake patterns were evaluated for women and men separately for the two time windows 2000–2007 and 2008–2016, respectively. Latent class analysis was used to identify distinct, latent clusters based on 40 food groups.

    Results: Among both women and men, a greater proportion of participants were classified into food intake patterns characterized by high-fat spread and high-fat dairy during 2008–2016 compared to 2000–2007. In the earlier time window, these high-fat clusters were related to lower educational level and smoking. Simultaneously, the proportion of women and men classified into a cluster characterized by high intake of fruit, vegetables, and fibre decreased from the earlier to the later time window.

    Conclusion: From a public health perspective, the increase in clusters with a high conditional mean for high-fat spread and high-fat dairy and decrease in clusters with a high conditional mean for fruit and vegetables, during the time period 2008–2016 compared to 2000–2007, is worrisome as it indicates a shift away from the recommended food habits. Subgroups of women and men with less healthy dietary patterns in the time window 2008–2016 with lower education, lower age, higher body mass index, lower levels of physical activity and more smoking were identified and future interventions may be targeted towards these groups.

  • 11. Höök, Kristina
    et al.
    Caramiaux, Baptiste
    Erkut, Cumhur
    Forlizzi, Jodi
    Hajinejad, Nassrin
    Haller, Michael
    Hummels, Caroline C. M.
    Isbister, Katherine
    Jonsson, Martin
    Khut, George
    Loke, Lian
    Lottridge, Danielle
    Marti, Patrizia
    Melcer, Edward
    Müller, Florian Floyd
    Petersen, Marianne Graves
    Schiphorst, Thecla
    Segura, Elena Márquez
    Ståhl, Anna
    Svanæs, Dag
    Tholander, Jakob
    Tobiasson, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Embracing First-Person Perspectives in Soma-Based Design2018In: INFORMATICS-BASEL, ISSN 2227-9709, Vol. 5, no 1, article id 8Article in journal (Refereed)
    Abstract [en]

    A set of prominent designers embarked on a research journey to explore aesthetics in movement-based design. Here we unpack one of the design sensitivities unique to our practice: a strong first person perspective—where the movements, somatics and aesthetic sensibilities of the designer, design researcher and user are at the forefront. We present an annotated portfolio of design exemplars and a brief introduction to some of the design methods and theory we use, together substantiating and explaining the first-person perspective. At the same time, we show how this felt dimension, despite its subjective nature, is what provides rigor and structure to our design research. Our aim is to assist researchers in soma-based design and designers wanting to consider the multiple facets when designing for the aesthetics of movement. The applications span a large field of designs, including slow introspective, contemplative interactions, arts, dance, health applications, games, work applications and many others.

  • 12.
    Jackson, Jennie A
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Burdorf, Alex
    Department of Public Health, Erasmus MC, Rotterdam, The Netherlands..
    Punnett, Laura
    Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, USA..
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Occupational biomechanical risk factors for radial nerve entrapment in a 13-year prospective study among male construction workers2019In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 76, no 5, p. 326-331Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim was to assess the association between occupational biomechanical exposure and the occurrence of radial nerve entrapment (RNE) in construction workers over a 13-year follow-up period.

    METHODS: A cohort of 229 707 male construction workers who participated in a national occupational health surveillance programme (1971-1993) was examined prospectively (2001-2013) for RNE. Height, weight, age, smoking status and job title (construction trade) were obtained on health examination. RNE case status was defined by surgical release of RNE, with data from the Swedish national registry for out-patient surgery records. A job exposure matrix was developed, and biomechanical exposure estimates were assigned according to job title. Highly correlated exposures were summed into biomechanical exposure scores. Negative binomial models were used to estimate the relative risks (RR) (incidence rate ratios) of RNE surgical release for the biomechanical factors and exposure sum scores. Predicted incidence was assessed for each exposure score modelled as a continuous variable to assess exposure-response relationships.

    RESULTS: The total incidence rate of surgically treated RNE over the 13-year observation period was 3.53 cases per 100 000 person-years. There were 92 cases with occupational information. Increased risk for RNE was seen in workers with elevated hand-grip forces (RR=1.79, 95% CI 0.97 to 3.28) and exposure to hand-arm vibration (RR=1.47, 95% CI 1.08 to 2.00).

    CONCLUSIONS: Occupational exposure to forceful handgrip work and vibration increased the risk for surgical treatment of RNE.

  • 13.
    Johansson, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Jarocka, Ewa
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Westling, Göran
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Predicting incident falls: Relationship between postural sway and limits of stability in older adults2019In: Human Movement Science, ISSN 0167-9457, E-ISSN 1872-7646, Vol. 66, p. 117-123Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We have previously shown that objective measurements of postural sway predicts fall risk, although it is currently unknown how limits of stability (LOS) might influence these results.

    RESEARCH QUESTION: How integrated postural sway and LOS measurements predict the risk of incident falls in a population-based sample of older adults.

    METHODS: The sample for this prospective observational study was drawn from the Healthy Ageing Initiative cohort and included data collected between June 2012 and December 2016 for 2396 men and women, all 70 years of age. LOS was compared to postural sway with measurements during eyes-open (EO) and eyes-closed (EC) trials, using the previously validated Wii Force Plate. Fall history was assessed during baseline examination and incident falls were collected during follow-up at 6 and 12 months. Independent predictors of incident falls and additional covariates were investigated using multiple logistic regression models.

    RESULTS: During follow-up, 337 out of 2396 participants (14%) had experienced a fall. Unadjusted regression models from the EO trial revealed increased fall risk by 6% (OR 1.06, 95% CI 1.02-1.11) per each centimeter squared increase in sway area and by 16% (OR 1.16, 95% CI 1.07-1.25) per 1-unit increase in Sway-Area-to-LOS ratio. Odds ratios were generally lower when analyzing EC trials and only slightly attenuated in fully adjusted models.

    SIGNIFICANCE: Integrating postural sway and LOS parameters provides valid fall risk prediction and a holistic analysis of postural stability. Future work should establish normative values and evaluate clinical utility of these measures.

  • 14. Lee, Jae Young
    et al.
    Kim, Ho
    Gasparrini, Antonio
    Armstrong, Ben
    Bell, Michelle L
    Sera, Francesco
    Lavigne, Eric
    Abrutzky, Rosana
    Tong, Shilu
    Coelho, Micheline de Sousa Zanotti Stagliorio
    Saldiva, Paulo Hilario Nascimento
    Correa, Patricia Matus
    Ortega, Nicolas Valdes
    Kan, Haidong
    Garcia, Samuel Osorio
    Kyselý, Jan
    Urban, Aleš
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Indermitte, Ene
    Jaakkola, Jouni J K
    Ryti, Niilo R I
    Pascal, Mathilde
    Goodman, Patrick G
    Zeka, Ariana
    Michelozzi, Paola
    Scortichini, Matteo
    Hashizume, Masahiro
    Honda, Yasushi
    Hurtado, Magali
    Cruz, Julio
    Seposo, Xerxes
    Nunes, Baltazar
    Teixeira, João Paulo
    Tobias, Aurelio
    Íñiguez, Carmen
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Vicedo-Cabrera, Ana Maria
    Ragettli, Martina S
    Guo, Yue-Liang Leon
    Chen, Bing-Yu
    Zanobetti, Antonella
    Schwartz, Joel
    Dang, Tran Ngoc
    Do Van, Dung
    Mayvaneh, Fetemeh
    Overcenco, Ala
    Li, Shanshan
    Guo, Yuming
    Predicted temperature-increase-induced global health burden and its regional variability2019In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 131, article id 105027Article in journal (Refereed)
    Abstract [en]

    An increase in the global health burden of temperature was projected for 459 locations in 28 countries worldwide under four representative concentration pathway scenarios until 2099. We determined that the amount of temperature increase for each 100 ppm increase in global CO2 concentrations is nearly constant, regardless of climate scenarios. The overall average temperature increase during 2010-2099 is largest in Canada (1.16 °C/100 ppm) and Finland (1.14 °C/100 ppm), while it is smallest in Ireland (0.62 °C/100 ppm) and Argentina (0.63 °C/100 ppm). In addition, for each 1 °C temperature increase, the amount of excess mortality is increased largely in tropical countries such as Vietnam (10.34%p/°C) and the Philippines (8.18%p/°C), while it is decreased in Ireland (-0.92%p/°C) and Australia (-0.32%p/°C). To understand the regional variability in temperature increase and mortality, we performed a regression-based modeling. We observed that the projected temperature increase is highly correlated with daily temperature range at the location and vulnerability to temperature increase is affected by health expenditure, and proportions of obese and elderly population.

  • 15. Lillepold, Kate
    et al.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Liu-Helmersson, Jing
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sewe, Maquins
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Semenza, Jan C.
    More arboviral disease outbreaks in continental Europe due to the warming climate?2019In: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305Article in journal (Refereed)
  • 16.
    Liu-Helmersson, Jing
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Brännström, Åke
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics. Evolution and Ecology Program, International Institute for Applied Systems Analysis, Laxenburg, Austria.
    Sewe, Maquins
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Estimating past, present and future trends in the global distribution and abundance of the arbovirus vector Aedes aegypti2019In: Frontiers In Public Health, ISSN 2296-2565, Vol. 7, article id 148Article in journal (Other academic)
    Abstract [en]

    Background: Aedes aegypti is the principal vector for several important arbovirus diseases, including dengue, chikungunya, yellow fever, and Zika. While recent empirical research has attempted to identify the current global distribution of the vector, the seasonal, and longer-term dynamics of the mosquito in response to trends in climate, population, and economic development over the twentieth and the twenty-first century remains to be elucidated.

    Methods: In this study, we use a process-based mathematical model to estimate global vector distribution and abundance. The model is based on the lifecycle of the vector and its dependence on climate, and the model sensitivity to socio-economic development is tested. Model parameters were generally empirically based, and the model was calibrated to global databases and time series of occurrence and abundance records. Climate data on temperature and rainfall were taken from CRU TS3.25 (1901–2015) and five global circulation models (CMIP5; 2006–2099) forced by a high-end (RCP8.5) and a low-end (RCP2.6) emission scenario. Socio-economic data on global GDP and human population density were from ISIMIP (1950–2099).

    Findings: The change in the potential of global abundance in A. aegypti over the last century up to today is estimated to be an increase of 9.5% globally and a further increase of 20 or 30% by the end of this century under a low compared to a high carbon emission future, respectively. The largest increase has occurred in the last two decades, indicating a tipping point in climate-driven global abundance which will be stabilized at the earliest in the mid-twenty-first century. The realized abundance is estimated to be sensitive to socioeconomic development.

    Interpretation: Our data indicate that climate change mitigation, i.e., following the Paris Agreement, could considerably help in suppressing risks of increased abundance and emergence of A. aegypti globally in the second half of the twenty-first century.

  • 17.
    Liu-Helmersson, Jing
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Heidelberg University Medical School, Institute of Public Health, Heidelberg, Germany.
    Sewe, Maquins
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Brännström, Åke
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics. Evolution and Ecology Program, International Institute for Applied Systems Analysis, Laxenburg, Austria.
    Climate change may enable Aedes aegypti infestation in major European cities by 21002019In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 172, p. 693-699Article in journal (Refereed)
    Abstract [en]

    Background: Climate change allows Aedes aegyptito infest new areas. Consequently, it enables the arboviruses the mosquito transmits - e.g., dengue, chikungunya, Zika and yellow fever – to emerge in previously uninfected areas. An example is the Portuguese island of Madeira during 2012–13.

    Objective: We aim to understand how climate change will affect the future spread of this potent vector, as an aidin assessing the risk of disease outbreaks and effectively allocating resources for vector control.

    Methods: We used an empirically-informed, process-based mathematical model to study the feasibility of Aedes aegypti infestation into continental Europe. Based on established global climate-change scenario data, we assess the potential of Aedes aegypti to establish in Europe over the 21st century by estimating the vector population growth rate for five climate models (GCM5).

    Results: In a low carbon emission future (RCP2.6), we find minimal change to the current situation throughout the whole of the 21st century. In a high carbon future (RCP8.5), a large parts of southern Europe risks being invaded by Aedes aegypti.

    Conclusion: Our results show that successfully enforcing the Paris Agreement by limiting global warming to below 2 °C significantly lowers the risk for infestation of Aedes aegypti and consequently of potential large-scale arboviral disease outbreaks in Europe within the 21st century.

  • 18.
    Olstrup, Henrik
    et al.
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, 11418 Stockholm, Sweden..
    Johansson, Christer
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, 11418 Stockholm, Sweden. Environment and Health Administration, SLB, Box 8136, 104 20 Stockholm, Sweden..
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Association between Mortality and Short-Term Exposure to Particles, Ozone and Nitrogen Dioxide in Stockholm, Sweden2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 6, article id E1028Article in journal (Refereed)
    Abstract [en]

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

  • 19.
    Otten, Julia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Ryberg, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Mellberg, Caroline
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Andersson, Tomas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Chorell, Elin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Larsson, Christel
    Department of Food and Nutrition, and Sport Science, Goteborgs Universitet, Goteborg, Sweden.
    Holst, Jens Juul
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Postprandial levels of GLP-1, GIP, and glucagon after two years of weight loss with a Paleolithic diet: a randomized controlled trial in healthy obese women2019In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 180, no 6, p. 417-427Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate how weight loss by different diets impacts on postprandial levels of glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon.

    METHODS: In this single-centre, parallel group 2-year trial, 70 healthy postmenopausal obese women were randomized to the Paleolithic diet or a healthy control diet based on Nordic Nutrition Recommendations. Both diets were without calorie restriction. The primary outcome was the change in fat mass. Here, secondary analyses on GLP-1, GIP, and glucagon measured during an OGTT are described.

    RESULTS: In the Paleolithic diet group, mean weight loss compared to baseline was 11% at 6 months, and 10% at 24 months. In the control diet group, mean weight loss was 6% after 6 and 24 months (P = 0.0001 and P = 0.049 for the comparison between groups at 6 and 24 months respectively). Compared to baseline, the mean incremental area under the curve (iAUC) for GLP-1 increased by 34% and 45% after 6 and 24 months in the Paleolithic diet group, and increased by 59% after 24 months in the control diet group. The mean iAUC for GIP increased only in the Paleolithic diet group. The AUC for glucagon increased during the first 6 months in both groups. The fasting glucagon increase correlated with the β-hydroxybutyrate increase.

    CONCLUSIONS: Weight loss caused an increase in postprandial GLP-1 levels and a further rise occurred during weight maintenance. Postprandial GIP levels increased only after the Paleolithic diet. Reduced postprandial glucagon suppression may be caused by a catabolic state.

  • 20.
    Oudin Åström, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Veber, Triin
    Martinsone, Žanna
    Kaļužnaja, Darja
    Indermitte, Ene
    Oudin, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia.
    Mortality Related to Cold Temperatures in Two Capitals of the Baltics: Tallinn and Riga2019In: Medicina (Kaunas), ISSN 1010-660X, E-ISSN 1648-9144, Vol. 55, no 8, article id 429Article in journal (Refereed)
    Abstract [en]

    Background and objectives: Despite global warming, the climate in Northern Europe is generally cold, and the large number of deaths due to non-optimal temperatures is likely due to cold temperatures. The aim of the current study is to investigate the association between cold temperatures and all-cause mortality, as well as cause-specific mortality, in Tallinn and Riga in North-Eastern Europe.

    Materials and Methods: We used daily information on deaths from state death registries and minimum temperatures from November to March over the period 1997-2015 in Tallinn and 2009-2015 in Riga. The relationship between the daily minimum temperature and mortality was investigated using the Poisson regression, combined with a distributed lag non-linear model considering lag times of up to 21 days.

    Results: We found significantly higher all-cause mortality owing to cold temperatures both in Tallinn (Relative Risk (RR) = 1.28, 95% Confidence Interval (CI) 1.01-1.62) and in Riga (RR = 1.41, 95% CI 1.11-1.79). In addition, significantly increased mortality due to cold temperatures was observed in the 75+ age group (RR = 1.64, 95% CI 1.17-2.31) and in cardiovascular mortality (RR = 1.83, 95% CI 1.31-2.55) in Tallinn and in the under 75 age group in Riga (RR = 1.58, 95% CI 1.12-2.22). In this study, we found no statistically significant relationship between mortality due to respiratory or external causes and cold days. The cold-related attributable fraction (AF) was 7.4% (95% CI -3.7-17.5) in Tallinn and 8.3% (95% CI -0.5-16.3) in Riga. This indicates that a relatively large proportion of deaths in cold periods can be related to cold in North-Eastern Europe, where winters are relatively harsh.

  • 21.
    Ramadona, Aditya Lia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Center for Environmental Studies, Universitas Gadjah Mada, Yogyakarta, Indonesia.
    Tozan, Yesim
    Lazuardi, Lutfan
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    A combination of incidence data and mobility proxies from social media predicts the intra-urban spread of dengue in Yogyakarta, Indonesia2019In: PLoS Neglected Tropical Diseases, ISSN 1935-2727, E-ISSN 1935-2735, Vol. 13, no 4, article id e0007298Article in journal (Refereed)
    Abstract [en]

    Only a few studies have investigated the potential of using geotagged social media data for predicting the patterns of spatio-temporal spread of vector-borne diseases. We herein demonstrated the role of human mobility in the intra-urban spread of dengue by weighting local incidence data with geo-tagged Twitter data as a proxy for human mobility across 45 neighborhoods in Yogyakarta city, Indonesia. To estimate the dengue virus importation pressure in each study neighborhood monthly, we developed an algorithm to estimate a dynamic mobility-weighted incidence index (MI), which quantifies the level of exposure to virus importation in any given neighborhood. Using a Bayesian spatio-temporal regression model, we estimated the coefficients and predictiveness of the MI index for lags up to 6 months. Specifically, we used a Poisson regression model with an unstructured spatial covariance matrix. We compared the predictability of the MI index to that of the dengue incidence rate over the preceding months in the same neighborhood (autocorrelation) and that of the mobility information alone. We based our estimates on a volume of 1·302·405 geotagged tweets (from 118·114 unique users) and monthly dengue incidence data for the 45 study neighborhoods in Yogyakarta city over the period from August 2016 to June 2018. The MI index, as a standalone variable, had the highest explanatory power for predicting dengue transmission risk in the study neighborhoods, with the greatest predictive ability at a 3-months lead time. The MI index was a better predictor of the dengue risk in a neighborhood than the recent transmission patterns in the same neighborhood, or just the mobility patterns between neighborhoods. Our results suggest that human mobility is an important driver of the spread of dengue within cities when combined with information on local circulation of the dengue virus. The geotagged Twitter data can provide important information on human mobility patterns to improve our understanding of the direction and the risk of spread of diseases, such as dengue. The proposed MI index together with traditional data sources can provide useful information for the development of more accurate and efficient early warning and response systems.

  • 22.
    Rocklöv, Joacim
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ebi, K
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Contrast in mortality related to temperature and persistent temperature extremes: a study of cause-specific and age stratified mortalityIn: Article in journal (Other academic)
  • 23. Santucci-Pereira, Julia
    et al.
    Zeleniuch-Jacquotte, Anne
    Afanasyeva, Yelena
    Zhong, Hua
    Slifker, Michael
    Peri, Suraj
    Ross, Eric A
    López de Cicco, Ricardo
    Zhai, Yubo
    Nguyen, Theresa
    Sheriff, Fathima
    Russo, Irma H
    Su, Yanrong
    Arslan, Alan A
    Bordas, Pal
    Lenner, Per
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Åhman, Janet
    Landström Eriksson, Anna Stina
    Johansson, Robert
    Umeå University, Faculty of Medicine, Department of Biobank Research.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Toniolo, Paolo
    Russo, Jose
    Genomic signature of parity in the breast of premenopausal women2019In: Breast Cancer Research, ISSN 1465-5411, E-ISSN 1465-542X, Vol. 21, no 1, article id 46Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Full-term pregnancy (FTP) at an early age confers long-term protection against breast cancer. Previously, we reported that a FTP imprints a specific gene expression profile in the breast of postmenopausal women. Herein, we evaluated gene expression changes induced by parity in the breast of premenopausal women.

    METHODS: Gene expression profiling of normal breast tissue from 30 nulliparous (NP) and 79 parous (P) premenopausal volunteers was performed using Affymetrix microarrays. In addition to a discovery/validation analysis, we conducted an analysis of gene expression differences in P vs. NP women as a function of time since last FTP. Finally, a laser capture microdissection substudy was performed to compare the gene expression profile in the whole breast biopsy with that in the epithelial and stromal tissues.

    RESULTS: Discovery/validation analysis identified 43 differentially expressed genes in P vs. NP breast. Analysis of expression as a function of time since FTP revealed 286 differentially expressed genes (238 up- and 48 downregulated) comparing all P vs. all NP, and/or P women whose last FTP was less than 5 years before biopsy vs. all NP women. The upregulated genes showed three expression patterns: (1) transient: genes upregulated after FTP but whose expression levels returned to NP levels. These genes were mainly related to immune response, specifically activation of T cells. (2) Long-term changing: genes upregulated following FTP, whose expression levels decreased with increasing time since FTP but did not return to NP levels. These were related to immune response and development. (3) Long-term constant: genes that remained upregulated in parous compared to nulliparous breast, independently of time since FTP. These were mainly involved in development/cell differentiation processes, and also chromatin remodeling. Lastly, we found that the gene expression in whole tissue was a weighted average of the expression in epithelial and stromal tissues.

    CONCLUSIONS: Genes transiently activated by FTP may have a role in protecting the mammary gland against neoplastically transformed cells through activation of T cells. Furthermore, chromatin remodeling and cell differentiation, represented by the genes that are maintained upregulated long after the FTP, may be responsible for the lasting preventive effect against breast cancer.

  • 24.
    Sawalha, Sami
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Hedman, Linnea
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Stenfors, Nikolai
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Lundback, Bo
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study2019In: THERAPEUTIC ADVANCES IN RESPIRATORY DISEASE, ISSN 1753-4658, Vol. 13, article id 1753466619860058Article in journal (Refereed)
    Abstract [en]

    Background: Comorbidities probably contribute to the increased mortality observed among subjects with chronic obstructive pulmonary disease (COPD), but sex differences in the prognostic impact of comorbidities have rarely been evaluated in population-based studies. The aim of this study was to evaluate the impact of common comorbidities, cardiovascular disease (CVD), diabetes mellitus (DM), and anxiety/depression (A/D), on mortality among men and women with and without airway obstruction in a population-based study. Methods: All subjects with airway obstruction [forced expiratory volume in 1 second (FEV1)/(forced) vital capacity ((F)VC) <0.70, n = 993] were, together with age- and sex-matched referents, identified after examinations of population-based cohorts in 2002-2004. Spirometric groups: normal lung function (NLF) and COPD (post-bronchodilator FEV1/(F)VC <0.70) and additionally, LLN-COPD (FEV1/(F)VC <lower limit of normal). Mortality data was collected until December 2015. Results: In COPD, the prevalence of CVD and DM was higher in men, whereas the prevalence of A/D was higher in women. The cumulative mortality was significantly higher in COPD than NLF, and higher in men than women in both groups. Among women with COPD, CVD and A/D but not DM increased the risk of death independent of age, body mass index, smoking habits, and disease severity, whereas among men DM and A/D but not CVD increased the risk for death. When the LLN criterion was applied, the pattern was similar. Conclusion: There were sex-dependent differences regarding the impact of comorbidities on prognosis in COPD. Even though the prevalence of CVD was higher in men, the impact of CVD on mortality was higher in women, and despite higher prevalence of A/D in women, the impact on mortality was similar in both sexes. The reviews of this paper are available via the supplemental material section.

  • 25.
    Schyllert, Christian
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Social Determinants in Asthma: Population-based studies on asthma and respiratory symptoms in relation to occupation, occupational exposure and socioeconomic status2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Asthma is one of the most common chronic obstructive airway diseases among children and adults, with a prevalence between 6-11% in European countries. It is also the most common work-related occupational respiratory disease. There are different methods to classify occupational exposure and, even though there is no clear consensus on which method is the most accurate, the single-item question on exposure to the composite measure vapour, gas, dust or fumes (VGDF) is commonly used in epidemiological research. Low socioeconomic status is associated with asthma and also behavioural factors such as smoking and over-weight, which by themselves are risk factors for asthma. Socioeconomic status is, however, truly a multifaceted concept and using only one measure does not encompass its entire effect on health-related outcomes. Asthma does also have a negative impact on the quality of life among adolescents: they report less physical fitness compared to their peers and more school absenteeism due to respiratory symptoms. Still, research on whether childhood asthma has any impact on socioeconomic status in young adulthood is scarce.

    Aim: The overall aim is to study social determinants of health such as socioeconomic status, occupation and occupational exposure and their relationship with asthma and respiratory symptoms among adults and further, to evaluate if asthma during childhood or adolescence is associated with social determinants in young adulthood.

    Method: This thesis includes four papers based on data from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. Papers I-III are cross-sectional studies among adults; a structured interview from clinical examinations between 2002-04 (paper I, n=4036) and postal questionnaire surveys from 2006 (paper II, n=9992) and 2016 (paper III, n=6854) with the addition of register-based data in paper III. Paper IV is a longitudinal prospective cohort study; the first OLIN paediatric cohort followed from 7 to 19 years of age and a postal questionnaire follow-up at ages 27-28 in 2015 (n=2017). Asthma was defined as physician diagnosis (paper I) together with respiratory symptoms (paper II-IV) or use of asthma medication (paper IV). In paper IV asthma was further categorized based on age of onset and p v and adolescence. Main or longest held occupation was used to categorize occupational and socioeconomic groups. In papers III and IV additional measures of socioeconomic status were included; educational level (papers III and IV) and income (paper III). In all papers, occupational exposure to vapour and/or gas, dust and fumes (VGDF or GDF) were taken into consideration and in paper I further divided into subgroups based on a detailed questionnaire on occupational exposure.

    Results: In paper I we found that the association between occupational exposure to VGDF and asthma and rhinitis was driven by the component of chemicals rather than dusts. In paper II, the ISCO-based manual Swedish Standard Classification of Occupations (SSYK) and the manual Socioeconomic classification (SEI), could both identify occupational and socioeconomic groups at risk for respiratory symptoms and asthma, while the older ISCO-based manual Nordic Classification of Occupations (NYK) was not as sensitive.

    In paper III, behavioural risk factors for respiratory symptoms and asthma such as smoking and obesity and, occupational exposure to GDF were associated with low educational level. Interaction analyses between income level and sex revealed different patterns among women and men. Among women, low income was associated with all respiratory symptoms as well as asthma, while among men only with productive cough.

    In paper IV, early onset asthma was associated with lower educational level in young adulthood, especially not continuing after compulsory school. Further, those with asthma during childhood or adolescence did not seem to refrain from smoking at age 19, nor did they as young adults seem to avoid occupations with known or expected exposure to GDF.

    Conclusions: Increased automation in industries have decreased the number of manual workers in industries with typically dirty tasks, meaning that the interrelationships between the subgroups included in VGDF may have changed. This may also affect the meaning of occupational exposure to VGDF, at least with regard to asthma and rhinitis, and according to our findings exposure to the component of chemicals may be the most important. We also found that the use of an ISCO-based manual (SSYK) as well as socioeconomic classification based on job-title (SEI) can be useful and easily applicable tools to identify occupational and socioeconomic groups at risk for respiratory symptoms and asthma. Further, low socioeconomic status is associated with respiratory vi symptoms and asthma. It seems as these associations relies more on low income than low educational level. Low educational level as well as low income are furthermore related to known behavioural risk factors for respiratory symptoms and asthma such as obesity, smoking and, also potentially modifiable risk factors as occupational exposure to gas dust or fumes. Having a persisting asthma since childhood is associated with lower educational level as a young adult. This may, in turn, be related with behavioural risk factors as discussed above and, there were no indications that those with child or adolescent asthma refrained from smoking at age 19. Neither did they in young adulthood avoid occupations with known or expected exposure to gas, dust or fumes, such as manufacturing, construction and transportation work. To conclude, our results indicate a vicious circle with regard to the relationship between the studied social determinants of health and asthma and respiratory symptoms.

  • 26.
    Schyllert, Christian
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Linnea, Hedman
    Caroline, Stridsman
    Pinja, Ilmarinen
    Päivi, Piirilä
    Krokstad, Steinar
    Lundbäck, Bo
    Rönmark, Eva
    Backman, Helena
    Low socioeconomic status is associated with asthma and respiratory symptoms in northern Sweden, especially among women: The OLIN and Nordic EpiLung studiesManuscript (preprint) (Other academic)
  • 27.
    Schyllert, Christian
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Rönmark, Eva
    Andersson, Martin
    Backman, Helena
    Lindberg, Anne
    Hedman, Linnea
    Childhood asthma affects educational level in young adults: a prospective cohort studyManuscript (preprint) (Other academic)
  • 28. Sera, Francesco
    et al.
    Armstrong, Ben
    Tobias, Aurelio
    Vicedo-Cabrera, Ana Maria
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bell, Michelle L
    Chen, Bing-Yu
    de Sousa Zanotti Stagliorio Coelho, Micheline
    Matus Correa, Patricia
    Cruz, Julio Cesar
    Dang, Tran Ngoc
    Hurtado-Diaz, Magali
    Do Van, Dung
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Guo, Yue Leon
    Guo, Yuming
    Hashizume, Masahiro
    Honda, Yasushi
    Iñiguez, Carmen
    Jaakkola, Jouni J K
    Kan, Haidong
    Kim, Ho
    Lavigne, Eric
    Michelozzi, Paola
    Ortega, Nicolas Valdes
    Osorio, Samuel
    Pascal, Mathilde
    Ragettli, Martina S
    Ryti, Niilo R I
    Saldiva, Paulo Hilario Nascimento
    Schwartz, Joel
    Scortichini, Matteo
    Seposo, Xerxes
    Tong, Shilu
    Zanobetti, Antonella
    Gasparrini, Antonio
    How urban characteristics affect vulnerability to heat and cold: a multi-country analysis2019In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, article id dyz008Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature-mortality relationships by a range of city-specific indicators.

    METHODS: We collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities.

    RESULTS: Heat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat.

    CONCLUSIONS: This represents the largest study to date assessing the effect modification of temperature-mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.

  • 29.
    Shi, Lin
    et al.
    Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden..
    Brunius, Carl
    Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden..
    Bergdahl, Ingvar
    Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Donat Vargas, Carolina
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden..
    Kiviranta, Hannu
    Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland..
    Hanhineva, Kati
    LC-MS Metabolomics Center, Kuopio, Finland. Department of Clinical Nutrition, University of Eastern Finland, Kuopio, Finland..
    Åkesson, Agneta
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden..
    Landberg, Rikard
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden..
    Joint Analysis of Metabolite Markers of Fish Intake and Persistent Organic Pollutants in Relation to Type 2 Diabetes Risk in Swedish Adults.2019In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 149, no 8, p. 1413-1423Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is conflicting evidence regarding the association between fish intake and type 2 diabetes (T2D) incidence, possibly owing to measurement errors in self-reported intake and coexposure to persistent organic pollutants (POPs) present in fish.

    OBJECTIVE: The aim of this study was to identify plasma metabolites associated with fish intake and to assess their association with T2D risk, independently of POPs, in Swedish adults.

    METHODS: In a case-control study nested in the Swedish Västerbotten Intervention Programme, fasting plasma samples from 421 matched T2D case-control pairs of men and women aged 30-60 y at baseline and 10-y follow-up samples from a subset of 149 pairs were analyzed using untargeted metabolomics. Moreover, 16 plasma POPs were analyzed for the 149 pairs who had repeated samples available. Fish-related plasma metabolites were identified using multivariate modelling and partial correlation analysis. Reproducibility of metabolites and metabolite patterns, derived via principal component analysis (PCA), was assessed by intraclass correlation. A unique component of metabolites unrelated to POPs was dissected by integrating metabolites and POPs using 2-way orthogonal partial least squares regression. ORs of T2D were estimated using conditional logistic regression.

    RESULTS: We identified 31 metabolites associated with fish intake that had poor to good reproducibility. A PCA-derived metabolite pattern strongly correlated with fish intake (ρ = 0.37, P < 0.001) but showed no association with T2D risk. Integrating fish-related metabolites and POPs led to a unique metabolite component independent of POPs, which tended to be inversely associated with T2D risk (OR: 0.75; 95% CI: 0.54, 1.02, P = 0.07). This component mainly consisted of metabolites reflecting fatty fish intake.

    CONCLUSIONS: Our results suggest that fatty fish intake may be beneficial for T2D prevention, after removing the counteractive effects of coexposure to POPs in Swedish adults. Integrating metabolite markers and POP exposures appears a promising approach to advance the understanding of associations between fish intake and T2D incidence.

  • 30.
    Sulistyawati, Sulistyawati
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health, Universitas Ahmad Dahlan, Yogyakarta 55164, Indonesia.
    Dwi Astuti, Fardhiasih
    Rahmah Umniyati, Sitti
    Tunggul Satoto, Tri Baskoro
    Lazuardi, Lutfan
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Andersson, Camilla
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Holmner, Åsa
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Dengue Vector Control through Community Empowerment: Lessons Learned from a Community-Based Study in Yogyakarta, Indonesia2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 6, article id E1013Article in journal (Refereed)
    Abstract [en]

    Effort to control dengue transmission requires community participation to ensure its sustainability. We carried out a knowledge attitude and practice (KAP) survey of dengue prevention to inform the design of a vector control intervention. A cross-sectional survey was conducted in June⁻August 2014 among 521 households in two villages of Yogyakarta, Indonesia. Demographic characteristics and KAP questions were asked using a self-managed questionnaire. Knowledge, attitudes and practice scores were summarized for the population according to sex, age, occupation and education. The average knowledge score was rather poor-3.7 out of 8-although both attitude and practice scores were good: 25.5 out of 32 and 9.2 out of 11 respectively. The best knowledge within the different groups were found among women, the age group 30⁻44 years, people with a university degree and government employees. Best practice scores were found among retired people and housewives. There were several significant gaps in knowledge with respect to basic dengue symptoms, preventive practices and biting and breeding habits of the Aedes mosquito. In contrast, people's practices were considered good, although many respondents failed to recognize outdoor containers as mosquito breeding sites. Accordingly, we developed a vector control card to support people's container cleaning practices. The card was assessed for eight consecutive weeks in 2015, with pre-post larvae positive houses and containers as primary outcome measures. The use of control cards reached a low engagement of the community. Despite ongoing campaigns aiming to engage the community in dengue prevention, knowledge levels were meagre and adherence to taught routines poor in many societal groups. To increase motivation levels, bottom-up strategies are needed to involve all community members in dengue control, not only those that already comply with best practices.

  • 31. Sundström, Johan
    et al.
    Söderholm, Martin
    Söderberg, Stefan
    Alfredsson, Lars
    Andersson, Martin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bellocco, Rino
    Björck, Martin
    Broberg, Per
    Eriksson, Maria
    Eriksson, Marie
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Fransson, Eleonor I
    Giedraitis, Vilmantas
    Theorell-Haglöw, Jenny
    Hallqvist, Johan
    Hansson, Per-Olof
    Heller, Susanne
    Håkansson, Niclas
    Ingelsson, Martin
    Janson, Christer
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Khalili, Payam
    Knutsson, Anders
    Lager, Anton
    Lagerros, Ylva Trolle
    Larsson, Susanna C
    Leander, Karin
    Leppert, Jerzy
    Lind, Lars
    Lindberg, Eva
    Magnusson, Cecilia
    Magnusson, Patrik K E
    Malfert, Mauricio
    Michaëlsson, Karl
    Nilsson, Peter
    Olsson, Håkan
    Pedersen, Nancy L
    Pennlert, Johanna
    Rosenblad, Andreas
    Rosengren, Annika
    Torén, Kjell
    Wanhainen, Anders
    Wolk, Alicja
    Engström, Gunnar
    Svennblad, Bodil
    Wiberg, Bernice
    Risk factors for subarachnoid haemorrhage: a nationwide cohort of 950 000 adults.2019In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, article id dyz163Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.

    METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.

    RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.

    CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.

  • 32. Svebrant, Sofia
    et al.
    Olsen, Therese
    Larsson, Jim
    Öhagen, Patrik
    Söderström, Hanna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Järhult, Josef D
    The enzyme toilet rim block 'pCure' does not efficiently remove drug residues in a hospital setting: exemplifying the importance of on-site implementation testing2018In: Infection Ecology & Epidemiology, ISSN 2000-8686, E-ISSN 2000-8686, Vol. 8, no 1, article id 1553463Article in journal (Refereed)
    Abstract [en]

    Introduction: Negative environmental effects of active pharmaceutical ingredients (APIs) are increasingly recognized, especially concerning antibiotics, and hospitals are important point sources. "pCure" is a toilet rim block containing API-degrading enzymes; the producing company claims positive in vitro results but no implementation studies have been performed.

    Materials and methods: In a university hospital setting, 16 weeks were randomized to installation or no installation of pCure in all 261 toilets connected to the same cesspit where sewage water was sampled daily. Ninety-six samples were analyzed for 102 APIs using liquid chromatography/tandem mass spectrometry.

    Results and Discussion: Fifty-one APIs were detected with a large variation in levels but no significant differences in the initial statistical analysis. More statistical testing of API level ratios (pCure installed/not installed) yielded some cases of significant decrease. Differences were small and not consistent when comparing means and medians. We cannot exclude a small pCure effect but clearly pCure has no effect of biological importance. Conclusion: pCure is not useful to reduce drug residue discharge in a hospital setting. In a bigger perspective, our study exemplifies that products claiming to reduce an environmental problem need to be tested in on-site implementation studies by independent researchers before reaching the market.

  • 33. Theorell, Tores
    et al.
    Jood, Katarina
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Vingard, Eva
    Perk, Joep
    Ostergren, Per Olov
    Hall, Charlotte
    A systematic review of studies in the contributions of the work environment to ischaemic heart disease development2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 3, p. 470-477Article, review/survey (Refereed)
    Abstract [en]

    Background: There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system.

    Methods: Inclusion criteria: (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed.

    Results: Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence.

    Conclusions: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD.

  • 34. Timm, Signe
    et al.
    Frydenberg, Morten
    Abramson, Michael J.
    Bertelsen, Randi J.
    Bråbäck, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Benediktsdottir, Bryndis
    Gislason, Thorarinn
    Holm, Mathias
    Janson, Christer
    Jogi, Rain
    Johannessen, Ane
    Kim, Jeong-Lim
    Malinovschi, Andrei
    Mishra, Gita
    Moratalla, Jesús
    Sigsgaard, Torben
    Svanes, Cecilie
    Schlünssen, Vivi
    Asthma and selective migration from farming environments in a three-generation cohort study2019In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 34, no 6, p. 601-609Article in journal (Refereed)
    Abstract [en]

    Individuals raised on a farm appear to have less asthma than individual raised elsewhere. However, selective migration might contribute to this as may also the suggested protection from farm environment. This study investigated if parents with asthma are less likely to raise their children on a farm. This study involved three generations: 6045 participants in ECRHS/RHINE cohorts (born 1945-1973, denoted G1), their 10,121 parents (denoted G0) and their 8260 offspring participating in RHINESSA (born 1963-1998, denoted G2). G2-offspring provided information on parents not participating in ECRHS/RHINE. Asthma status and place of upbringing for all three generations were reported in questionnaires by G1 in 2010-2012 and by G2 in 2013-2016. Binary regressions with farm upbringing as outcome were performed to explore associations between parental asthma and offspring farm upbringing in G0-G1 and G1-G2. Having at least one parent with asthma was not associated with offspring farm upbringing, either in G1-G2 (RR 1.11, 95% CI 0.81-1.52) or in G0-G1 (RR 0.99, 0.85-1.15). G1 parents with asthma born in a city tended to move and raise their G2 offspring on a farm (RR 2.00, 1.12-3.55), while G1 parents with asthma born on a farm were less likely to raise their G2 offspring on a farm (RR 0.34, 0.11-1.06). This pattern was not observed in analyses of G0-G1. This study suggests that the protective effect from farm upbringing on subsequent asthma development could not be explained by selective migration. Intriguingly, asthmatic parents appeared to change environment when having children.

  • 35.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Rantakokko, Panu
    Åkesson, Agneta
    Donat-Vargas, Carolina
    Kiviranta, Hannu
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Rylander, Lars
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bergdahl, Ingvar A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Chlorinated persistent organic pollutants and type 2 diabetes - A population-based study with pre- and post- diagnostic plasma samples2019In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 174, p. 35-45Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Persistent organic pollutants (POPs) have been associated with type 2 diabetes (T2D), but causality is uncertain.

    OBJECTIVE: Within longitudinal population-based data from northern Sweden, we assessed how POPs associated with T2D prospectively and cross-sectionally, and further investigated factors related to individual changes in POP concentrations.

    METHODS: For 129 case-controls pairs matched by age, sex and date of sampling, plasma concentrations of hexachlorobenzene (HCB), dichlorodiphenyl-dichloroethylene (p,p'-DDE), dioxin-like (DL) polychlorinated biphenyl congeners (PCB-118 and PCB-156), and non-dioxin like (NDL-PCB: PCB-74, -99, -138 -153, -170, -180, -183 and PCB-187) were analyzed twice (baseline and follow-up, 9-20 years apart). The cases received their T2D diagnose between baseline and follow-up. Prospective (using baseline data) and cross-sectional (using follow-up data) odds ratios (ORs) for T2D on lipid standardized POPs (HCB, p,p'-DDE, ∑DL-PCBs, ∑NDL-PCBs) were estimated using conditional logistic regression, adjusting for body mass index (BMI) and plasma lipids. The influence of BMI, weight-change, and plasma lipids on longitudinal changes in POP concentrations were evaluated among non-diabetic individuals (n = 306).

    RESULTS: POPs were associated with T2D in both the prospective and cross-sectional assessments. Of a standard deviation increase in POPs, prospective ORs ranged 1.42 (95% CI: 0.99, 2.06) for ∑NDL-PCBs to 1.55 (95% CI: 1.01, 2.38) for HCB (p < 0.05 only for HCB), and cross-sectional ORs ranged 1.62 (95% CI: 1.13; 2.32) for p,p'-DDE to 2.06 (95% CI: 1.29, 3.28) for ∑DL-PCBs (p < 0.05 for all POPs). In analyses of non-diabetic individuals, higher baseline BMI, decreased weight and decreased plasma lipid concentrations were associated with a slower decrease of POPs. Cases had, besides a higher BMI, reduced cholesterol and weight gain at follow-up compared to controls, which can explain the higher ORs in the cross-sectional assessments.

    DISCUSSION: The association between POPs and T2D was confirmed, but an indication that individuals body fat history might influence POP-T2D associations weakens the epidemiological support for a causal association. It also warrants studies based on other exposure metrics than biomonitoring. In addition, we note that a cross-sectional design overestimates the ORs if T2D cases have successfully intervened on weight and/or blood lipids, as changes in these factors cause changes in POPs.

  • 36.
    Wahlström, Viktoria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bergman, Frida
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Eskilsson, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Effects of a multicomponent physical activity promoting program on sedentary behavior, physical activity and body measures: a longitudinal study in different office types2019In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, article id 3808Article in journal (Refereed)
    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.

  • 37. Wang, Juan
    et al.
    Pindus, Mihkel
    Janson, Christer
    Sigsgaard, Torben
    Kim, Jeong-Lim
    Holm, Mathias
    Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Estonia.
    Gislason, Thorarinn
    Johannessen, Ane
    Bertelsen, Randi J
    Norbäck, Dan
    Dampness, mould, onset and remission of adult respiratory symptoms, asthma and rhinitis2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 53, no 5, article id 1801921Article in journal (Refereed)
    Abstract [en]

    THE QUESTION ADDRESSED BY THE STUDY: Is dampness and indoor mould associated with onset and remission of respiratory symptoms, asthma and rhinitis among adults?

    MATERIALS AND METHODS: Associations between dampness, mould and mould odour at home and at work and respiratory health were investigated in cohort of 11 506 adults from Iceland, Norway, Sweden, Denmark and Estonia. They answered a questionnaire at baseline and ten years later, with questions on respiratory health, home and work environment.

    RESULTS: Baseline water damage, floor dampness, mould and mould odour at home were associated with onset of respiratory symptoms and asthma (ORs from 1.23 to 2.24). Dampness at home during follow up was associated with onset of respiratory symptoms, asthma and rhinitis (ORs from 1.21 to 1.52). Dampness at work during follow up was associated with onset of respiratory symptoms, asthma and rhinitis (ORs from 1.31 to 1.50). Combined dampness at home and at work increased the risk of onset of respiratory symptoms and rhinitis. Dampness and mould at home and at work decreased remission of respiratory symptoms and rhinitis.

    THE ANSWER TO THE QUESTION: Dampness and mould at home and at work can increase onset of respiratory symptoms, asthma and rhinitis, and decrease remission.

  • 38.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bjelkmar, Pär
    Folkhälsomyndighe-ten, Stockholm.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ovanligt många dödsfalli Sverige sommaren 2018: drygt 600 kan ha dött till följd av värmeböljan2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, article id FLFHArticle in journal (Refereed)
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