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  • 1. Ahlroth Pind, C.
    et al.
    Gunnbjörnsdottír, M.
    Bjerg, A.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundbäck, B.
    Malinovschi, A.
    Middelveld, R.
    Nilsson Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Norbäck, D.
    Janson, C.
    Patient-reported signs of dampness at home may be a risk factor for chronic rhinosinusitis: a cross-sectional study2017In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 47, no 11, p. 1383-1389Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: An association between dampness at home and respiratory conditions has been convincingly demonstrated in children. Fewer studies have been performed in adults, and data are lacking for chronic rhinosinusitis (CRS). With a prevalence of 10.9% in Europe, CRS imposes a significant burden on quality of life, as well as economy.

    OBJECTIVE: Our aim was to study CRS and other respiratory conditions in relation to dampness at home in a representative sample of adults.

    METHODS: The Swedish GA(2) LEN questionnaire was answered by 26 577 adults (16-75 years) and included questions on respiratory symptoms, smoking, education and environmental exposure. CRS was defined according to the EP(3) OS criteria. Dampness was defined as reporting water damage, floor dampness or visible moulds in the home during the last 12 months. The dampness score was ranked from 0 to 3, counting the number of signs of dampness reported.

    RESULTS: Dampness at home was reported by 11.3% and was independently related to respiratory conditions after adjustment for demographic and socio-economic factors and smoking: CRS odds ratio (OR) 1.71; allergic rhinitis OR 1.24; current asthma OR 1.21; wheeze OR 1.37; nocturnal dyspnoea OR 1.80; nocturnal coughing OR 1.34; and chronic bronchitis OR 1.64. The risk of CRS and most of the other respiratory conditions was further elevated in subjects reporting multiple signs of dampness.

    CONCLUSIONS AND CLINICAL RELEVANCE: This study demonstrated an independent association between dampness at home and CRS in adults. The high burden of this and the other respiratory conditions studied is a strong argument in favour of countering indoor dampness by improving building standards.

  • 2. Airoldi, Luisa
    et al.
    Vineis, Paolo
    Colombi, Alessandro
    Olgiati, Luca
    Dell'Osta, Carlo
    Fanelli, Roberto
    Manzi, Luca
    Veglia, Fabrizio
    Autrup, Herman
    Dunning, Alison
    Garte, Seymour
    Hainaut, Pierre
    Hoek, Gerard
    Krzyzanowski, Michal
    Malaveille, Christian
    Matullo, Giuseppe
    Overvad, Kim
    Tjonneland, Anne
    Clavel-Chapelon, Francoise
    Linseisen, Jakob
    Boeing, Heiner
    Trichopoulou, Antonia
    Palli, Domenico
    Peluso, Marco
    Krogh, Vittorio
    Tumino, Rosario
    Panico, Salvatore
    Bueno-De-Mesquita, Hendrik B
    Peeters, Petra H
    Lund, Eiliv
    Agudo, Antonio
    Martinez, Carmen
    Dorronsoro, Miren
    Barricarte, Aurelio
    Chirlaque, M Dolores
    Quiros, Josè R
    Berglund, Goran
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Day, Nicholas E
    Allen, Naomi
    Saracci, Rodolfo
    Kaaks, Rudolf
    Riboli, Elio
    4-Aminobiphenyl-hemoglobin adducts and risk of smoking-related disease in never smokers and former smokers in the European Prospective Investigation into Cancer and Nutrition prospective study.2005In: Cancer Epidemiology Biomarkers & Prevention, ISSN 1055-9965, Vol. 14, no 9, p. 2118-24Article in journal (Refereed)
  • 3.
    Andersson, E.M.
    et al.
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Barregard, L.
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Akerstrom, M.
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden.
    Sallsten, G.
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Nilsson, R.I.
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Cancer incidence in Swedish oil refinery workers exposed to benzene2024In: International journal of hygiene and environmental health, ISSN 1438-4639, E-ISSN 1618-131X, Vol. 261, article id 114420Article in journal (Refereed)
    Abstract [en]

    Background: Oil refinery workers are exposed to benzene, which is a well-known cause of leukaemia, but results on leukaemia in oil refinery workers have been mixed, and the data on workers’ exposure is limited. Oil refinery workers are also exposed to asbestos and several studies have shown increased risk of mesothelioma.

    Aim: The objective was to investigate cancer incidence, especially leukaemia, at low to moderate exposure to benzene in an update of a previous study of employees at three Swedish oil refineries.

    Methods: Cancer incidence was followed up in 2264 men (1548 refinery operators) employed at three oil refineries in Sweden for at least one year. Job types and employment times were collected from complete company files. A retrospective assessment of the benzene exposure was performed by occupational hygienists in collaboration with the refineries using historic measurements as well as detailed information on changes in the industrial hygiene and technological developments. Cases of cancer were retrieved by a linkage with the Swedish Cancer Register through 35–47 years of follow-up and standardized incidence ratios (SIR) with 95% confidence intervals (CI) were calculated.

    Results: In total, 258 tumors had occurred versus 240 expected (SIR 1.07; 95% CI 0.95–1.21). There were 10 cases of leukaemia, all in refinery operators (SIR 2.4; 95% CI 1.18–4.51). There were three cases of pleural mesothelioma, two of which in refinery operators. The mean estimated cumulative benzene exposure for the cases of leukaemia was 7.9 ppm-years (median 4.9, range 0.1–31.1). Discussion: The study suggests that low to moderate average cumulative benzene exposure increases the risk of leukaemia. Limitations include the modest number of cases and potential misclassification of exposure.

    Conclusion: The present study indicated an increased risk of leukaemia in male oil refinery workers with low to moderate exposure to benzene.

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  • 4.
    Andersson, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Blanc, Paul D.
    Department of Medicine, Division of Occupational and Environmental Medicine, University of California San Francisco, CA, San Francisco, United States.
    Torén, Kjell
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Smoking, occupational exposures, and idiopathic pulmonary fibrosis among Swedish construction workers2021In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 64, no 4, p. 251-257Article in journal (Refereed)
    Abstract [en]

    Background: Cigarette smoking and occupational exposures each have been reported to increase the risk of idiopathic pulmonary fibrosis (IPF), a disease previously considered of unknown origin. We investigated the risk of IPF mortality associated with combined smoking and occupational exposures.

    Methods: A registry study of Swedish construction workers (N = 389,132), linked baseline smoking and occupational data with registry data on cause of death and hospital care diagnoses. Occupation was classified by the likelihood of exposure to vapors, gases, dusts, or fumes using a job-exposure matrix. Those likely exposed to asbestos or silica were excluded from the analysis. Age-adjusted relative risks [RRs] were calculated using Poisson regression. Follow-up observation began at age 40 and ended at age 89.

    Results: Heavy smokers at baseline who were exposed to inorganic dusts during their working life had an increased risk of IPF mortality (RR 1.70; 95% confidence interval [CI] 1.11–2.60), while there was no statistically increased risk in the other exposure groups. There were dose–response relationships between smoking at baseline and IPF mortality among both unexposed and dust exposed workers, with similar risk for dust exposed and unexposed, except among baseline heavy smokers, where workers exposed to inorganic dust manifested the highest risk (RR 4.22; 95% CI 2.69–6.60). Excluding workers with chronic obstructive pulmonary disease or emphysema did not affect the results substantively.

    Conclusion: A clear dose–response relationship was seen between smoking at baseline and IPF, supporting a causal relationship. Occupational exposure to inorganic dusts, excluding silica and asbestos, was associated with increased risk of IPF in baseline heavy current smokers.

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  • 5.
    Andersson, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Selin, F
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Asbestos exposure and the risk of sinonasal cancer2016In: Occupational Medicine, ISSN 0962-7480, E-ISSN 1471-8405, Vol. 66, no 4, p. 326-331Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While the increased risk of lung cancer and mesothelioma is well established, the relationship between exposure to asbestos dust and sinonasal cancer is less clear.

    AIMS: To study the risk of sinonasal cancer in relation to asbestos dust exposure.

    METHODS: A retrospective cohort study of construction workers, linked to the Swedish Cancer Registry. Participants were classified into four exposure groups; heavy, medium, low or very low exposure to asbestos, according to the incidence of pleural mesothelioma in their occupational group. Standardized incidence ratios (SIRs) and relative risks (RRs) were analysed, adjusted for age and smoking habits. The risks of adenocarcinoma and squamous cell carcinoma were investigated separately.

    RESULTS: Among the 280222 subjects, there was no increased risk of sinonasal cancer compared to the general population [SIR 0.85, 95% confidence interval (CI) 0.68-1.03], or any dose-response relationship with exposure to asbestos. The highest RR was found in the low exposure group (RR 1.25, 95% CI 0.69-2.28) and the lowest RR was found in the group with the highest exposure to asbestos (RR 0.71, 95% CI 0.33-1.53). No significantly increased risk or dose-response association could be found for adenocarcinoma or squamous cell carcinoma when analysed separately.

    CONCLUSIONS: This study did not find an increased risk of developing sinonasal cancer after asbestos exposure.

  • 6. Anveden Berglind, I
    et al.
    Alderling, M
    Järvholm, B
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Lidén, C
    Meding, B
    Occupational skin exposure to water: a population-based study.2008In: The British journal of dermatology, ISSN 1365-2133Article in journal (Refereed)
    Abstract [en]

    Background Occupational exposure to skin irritants, in particular to water, is an important risk factor for hand eczema. Objectives To assess occupational skin exposure to water in the general population. Methods As part of a public health survey in Stockholm, Sweden, 18 267 gainfully employed individuals aged 18-64 years completed a questionnaire with previously validated questions regarding occupational skin exposure to water. Results Altogether 16% reported exposure to water for (1/2) h or more a day, and 13% reported exposure to water more than 10 times a day. Furthermore, 7% reported water exposure of more than 2 h and 6% of more than 20 times a day. Women reported more water exposure than men and many female-dominated occupations were seen to comprise water exposure. Women were also more exposed than men within the same jobs. Young adults were more exposed than older. A total of 18% were employed in high-risk occupations for hand eczema. Fifty-nine per cent of individuals employed in high-risk occupations reported water exposure at work, compared with 11% in low-risk occupations. Conclusions A total of 20% of the population of working age acknowledged occupational skin exposure to water, which was found to be more common in young adults and women. Using job title as a proxy for water exposure gives an underestimation due to misclassification. In assessing occupational skin exposure to water, both exposure time and frequency should be considered.

  • 7. Anveden, Ingegärd
    et al.
    Wrangsjö, Karin
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Meding, Birgitta
    Self-reported skin exposure: a population-based study2006In: Contact Dermatitis, ISSN 0105-1873, Vol. 54, no 5, p. 272-7Article in journal (Refereed)
  • 8.
    Bergdahl, I A
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Torén, K
    Eriksson, K
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Hedlund, U
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Nilsson, T
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Flodin, R
    Järvholm, B
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Increased mortality in COPD among construction workers exposed to inorganic dust.2004In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 23, no 3, p. 402-406Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to find out if occupational exposure to dust, fumes or gases, especially among never-smokers, increased the mortality from chronic obstructive pulmonary disease (COPD). A cohort of 317,629 Swedish male construction workers was followed from 1971 to 1999. Exposure to inorganic dust (asbestos, man-made mineral fibres, dust from cement, concrete and quartz), gases and irritants (epoxy resins, isocyanates and organic solvents), fumes (asphalt fumes, diesel exhaust and metal fumes), and wood dust was based on a job-exposure matrix. An internal control group with "unexposed" construction workers was used, and the analyses were adjusted for age and smoking. When all subjects were analysed, there was an increased mortality from COPD among those with any airborne exposure (relative risk 1.12 (95% confidence interval (CI) 1.03-1.22)). In a Poisson regression model, including smoking, age and the major exposure groups, exposure to inorganic dust was associated with an increased risk (hazard ratio (HR) 1.10 (95% CI 1.06-1.14)), especially among never-smokers (HR 2.30 (95% CI 1.07-4.96)). The fraction of COPD among the exposed attributable to any airborne exposure was estimated as 10.7% overall and 52.6% among never-smokers. In conclusion, occupational exposure among construction workers increases mortality due to chronic obstructive pulmonary disease, even among never-smokers.

  • 9.
    Bergdahl, Ingvar A
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Eriksson, Kåre
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Damber, Lena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lung cancer and exposure to quartz and diesel exhaust in Swedish iron ore miners with concurrent exposure to radon2010In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 67, no 8, p. 513-518Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Studies of underground miners have documented an increased risk of lung cancer mainly linked to radon exposure but possibly influenced by other concurrent exposures. METHODS: A cohort study was carried out in 8321 iron ore miners with low exposure to radon, employed in 1923-1998 and followed up for lung cancer in 1958-2000. Historical exposures to radon, crystalline silica and diesel exhaust were assessed. Data including exposure to radon, quartz and diesel exhaust from another mine with higher exposure to radon were reanalysed. RESULTS: Miners had increased risk for lung cancer (SIR 1.48 (95% CI 1.22 to 1.78), based on 112 cases during 227,000 person-years). The increased risk could not be explained by exposure to radon or diesel exhaust but was associated with exposure to crystalline silica: SIR 0.96 (0.53 to 1.62), 1.45 (1.10 to 1.87), 1.99 (1.31 to 2.90) and 1.77 (0.92 to 3.10) in groups with exposure to 0, 0-2, 2-5 and >5 mg years/m3, respectively. Reanalysis of data from the other mine indicated that quartz was a possible confounder in the analysis of relationship between radon and lung cancer. In the highest radon exposed group, the point estimate for the RR decreased from 5.65 to 3.90 when adjusting for concurrent exposure to quartz. CONCLUSIONS: Crystalline silica, a known carcinogen, probably affects lung cancer risk in iron ore miners. The main implication of the results is for interpretation of the dose-response curve for radon and lung cancer in underground iron ore miners. Since exposure to radon and quartz is often correlated, quartz exposure can be an important confounder.

  • 10.
    Bergdahl, Ingvar
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Torén, K
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Eriksson, Kåre
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hedlund, U
    Flodin, R
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Increased mortality in COPD among construction workers exposed to inorganic dust: from the authors2004In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 24, no 3, p. 512-512Article in journal (Refereed)
  • 11.
    Björnstig, Johanna
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dödsolyckor i arbetslivet: Delrapport 12016Report (Other academic)
    Abstract [sv]

    Nio av tio arbetsrelaterade dödsolyckor drabbar män. Utifrån vår analys verkar det som att kvinnor och män har liknande risk att drabbas av en dödsolycka om förhållandena i arbetsmiljön är likartade.

    Dödsolyckor drabbar också i högre grad äldre personer än yngre, och mer än hälften av männen som omkom var över 50 år. En viktig delförklaring är att äldre får svårare skador och har högre risk för dödlig utgång än yngre om de utsätts för samma skadevåld.

    Fordonsrelaterade olyckor utgör ca hälften av alla dödsolyckor, och hälften av dem sker i vägtrafikområden. Det finns dock redan många aktörer som arbetar för att förebygga olyckor i trafiken, så aktörer inom arbetsmiljöområdet bör prioritera förebyggande åtgärder i andra miljöer. Olyckor i sådana andra miljöer utgör ca en fjärdedel av alla dödsolyckor.

    Fallolyckor är en viktig orsak till dödsolyckor och då främst fall från höjd. Många sådana olyckor inträffar inom byggverksamhet, och vår analys tyder på att tekniska brister i byggställningar kan vara ett område för förbättringar. Dessutom bör åtgärder riktas mot gruppen äldre elinstallatörer eftersom de förhållandevis ofta drabbas av dödliga elolyckor.

    Trädfällning är en annan betydande orsak till dödsolyckor, framför allt inom jord- och skogsbruk.

    En jämförelse mellan data ur registren för dödliga och svåra men icke-dödliga arbetsolyckor visar på stora skillnader ibland annat vem som drabbas och var skadan inträffar. Det innebär att register om svåra men icke-dödliga skador ger begränsad information om vilka förebyggande åtgärder som är lämpliga mot dödsolyckor och var de ska sättas in.

    Sammantaget visar vår analys att statistik över allvarliga arbetsrelaterade olyckor, baserat på sjukskrivningstid, har begränsat värde när det gäller att prioritera åtgärder för att förebygga arbetsrelaterade dödsolyckor. I registren finns fritextsvar som beskriver händelseförloppet för varje anmäld olycka. En textanalys av dessa beskrivningar kan ge värdefull kunskap, men det är något som behöver studeras ytterligare.

  • 12.
    Björnstig, Johanna
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dödsolyckor i arbetslivet: Delrapport 22017Report (Other academic)
    Abstract [en]

    Fatal and serious occupational accidents have decreased in Sweden since the 1950s. Today, there is on average, about 1 fatal outcome of occupational accidents per 100 000 persons, and 1 serious accident per 500 persons.2 Nine of ten occupational accidents with fatal outcome 2010-2014 happened to men. Fatal accidents are more common among elderly people and more than half of the male victims were over the age of 50. Older people often suffer more severe injuries than younger people for the same trauma, which may have contributed to the observed higher death rate among mature and elderly persons.

    Accidents related to vehicles represented about half of all fatalities. Half of these happened on public roads in ordinary road traffic, and the other half happened in other places and under other circumstances than vehicle crashes. Falls, especially from higher level, were another significant cause of fatal accidents. Many such accidents occurred in the construction industry, and our analysis indicates that e.g. improvement of scaffolding could decrease the risk. Half of fatally injured electricians were older than 58 years with long occupational experience. This indicates that persons with long experience may also need repeated training and education. Cutting down trees was another important cause of fatalities, especially among older persons working within forestry and agriculture.

    Comparative data from registers of fatal and serious occupational accidents indicates differences in who had the accident and where the accident occurred. This means that a register of non-fatal accidents gives limited information about possible strategies for the prevention of accidents with fatal outcome.

    2 A serious accident is an accident with at least 14 days sick absenteeism.12

    Important conclusions are

    • Fatal and serious occupational accidents are rare events with different causes. It is therefore difficult for organizations and working groups to learn from incidents in their own organization. Personal experience and general information about risks have thus limited potential to prevent fatal and serious accidents within a single organization if not compiled or aggregated in e.g. a wider national perspective. We think that injury mitigation work should focus on technical measures and support strict organizational procedures, e.g. for the use of protective equipment especially where there is risk for fatal accidents. Today that is routine procedure in organizations with high awareness of risks, such as the aviation industry.
    • The strategy for prevention of fatal and serious occupational injuries may partly have different focus as their epidemiology is different.
    • Two of three fatal accidents are related to vehicles, or to falls from higher level, which are the two most important areas to address in the injury reducing work of fatalities.
    • Many of the most risky activities above happened at temporary workplaces, which often require that the worker themselves prevent risks. This requires special training and education.
    • Fatal accidents due to electricity or cutting of trees often happened to mature and elderly persons. It may indicate that continuous training and education could be of value also in experienced persons as well as in small enterprises and among the self-employed.
    • Investigation of fatal and serious occupational accidents could be developed to have an even stronger focus on injury mitigation and prevention.
  • 13.
    Blanc, Paul D.
    et al.
    University of California, San Francisco, USA.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Torén, Kjell
    Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Prospective risk of rheumatologic disease associated with occupational exposure in a cohort of male construction workers2015In: American Journal of Medicine, ISSN 0002-9343, E-ISSN 1555-7162, Vol. 128, no 10, p. 1094-1101Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The association between occupational exposure and autoimmune disease is well recognized for silica, and suspected for other inhalants. We used a large cohort to estimate the risks of rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and dermatomyositis associated with silica and other occupational exposures.

    METHODS: We analyzed data for male Swedish construction industry employees. Exposure was defined by a job-exposure matrix for silica and for other inorganic dusts; those with other job-exposure matrix exposures but not to either of the 2 inorganic dust categories were excluded. National hospital treatment data were linked for International Classification of Diseases, 10(th) Revision-coded diagnoses of rheumatoid arthritis (seronegative and positive), systemic lupus erythematosus, systemic sclerosis, and dermatomyositis. The 2 occupational exposures were tested as independent predictors of prospective hospital-based treatment for these diagnoses using age-adjusted Poisson multivariable regression analyses to calculate relative risk (RR).

    RESULTS: We analyzed hospital-based treatment data (1997 through 2010) for 240,983 men aged 30 to 84 years. There were 713 incident cases of rheumatoid arthritis (467 seropositive, 195 seronegative, 51 not classified) and 128 cases combined for systemic lupus erythematosus, systemic sclerosis, and dermatomyositis. Adjusted for smoking and age, the 2 occupational exposures (silica and other inorganic dusts) were each associated with increased risk of rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and dermatomyositis combined: RR 1.39 (95% confidence interval [CI], 1.17-1.64) and RR 1.31 (95% CI, 1.11-1.53), respectively. Among ever smokers, both silica and other inorganic dust exposure were associated with increased risk of rheumatoid arthritis (RRs 1.36; 95% CI, 1.11-1.68 and 1.42; 95% CI, 1.17-1.73, respectively), while among never smokers, neither exposure was associated with statistically significant increased risk of rheumatoid arthritis.

    CONCLUSION: This analysis reaffirms the link between occupational silica and a range of autoimmune diseases, while also suggesting that other inorganic dusts may also impart excess risk of such disease.

  • 14. Burdorf, Alex
    et al.
    Jarvholm, Bengt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Siesling, Sabine
    Asbestos exposure and differences in occurrence of peritoneal mesothelioma in the Netherlands and Sweden.2007In: Occupational and environmental medicine, ISSN 1470-7926, no 64, p. 839-42Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In several countries the incidence of peritoneal mesotheliomas among women closely mirrors the pattern among men. The aim was to investigate the role of asbestos exposure in the aetiology of peritoneal mesotheliomas in women and men. METHODS: All cases of peritoneal mesothelioma were selected from the Swedish and Netherlands Cancer Registers for the period 1989-2003. For both countries incidence rates were calculated, stratified by sex. A linear regression analysis was used to analyse the existence of a trend over time. RESULTS: Among men the incidence rate of peritoneal mesothelioma in The Netherlands (0.60 per 100,000 persons) was consistently higher than in Sweden with an average ratio of 1.8 (range 1.4-2.8). In both countries no trend over time was observed. During the 15 year period in The Netherlands the incidence rate among men was about 3.3-fold higher than among women. In Sweden the incidence rate among women was slightly higher than in men up to 1999, and thereafter about 3-fold higher among men. This sudden shift was statistically significant and seemed mainly caused by changes in classification of peritoneal tumours. CONCLUSION: The absence of a time trend in the incidence rate of peritoneal mesothelioma in the Netherlands and Sweden in the past 15 years may point at a more limited role of occupational exposure to asbestos in the etiology of peritoneal mesothelioma than for pleural mesothelioma, especially among women. The observed drop around 2000 in annual incidence of peritoneal mesothelioma among Swedish women indicates the presence in the past of a substantial misclassification with other tumours in the peritoneum.

  • 15. Burdorf, Alex
    et al.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Englund, Anders
    Explaining differences in incidence rates of pleural mesothelioma between Sweden and the Netherlands.2005In: Int J Cancer, ISSN 0020-7136, Vol. 113, no 2, p. 298-301Article in journal (Refereed)
  • 16. Burdorf, Alex
    et al.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Harma, Mikko
    The importance of preventing work-related disability2014In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 40, no 4, p. 331-333Article in journal (Refereed)
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  • 17.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Back and neck pain due to working in a cold environment: a cross-sectional study of male construction workers2013In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 86, no 7, p. 809-813Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study whether work in a cold environment increased the risk of musculoskeletal symptoms in the neck and low back among construction workers. METHODS: This cross-sectional study is based on a cohort of male workers in the Swedish construction industry that participated in regular health examinations through a nationwide occupational health service. The analysis is based on workers examined from 1971 to 1974, who answered a questionnaire including questions about neck and back pain. The cohort consists of 134,754 male workers, including 16,496 office workers and foremen. The health examinations of the workers were conducted in provinces covering Sweden from the south to the north, and temperature data were collected for the provinces. In the analyses, the results were adjusted for age, BMI and use of nicotine. RESULTS: The prevalence's of neck and low back pain were higher among manual construction workers than among foremen and office workers (24.3 vs. 8.6 % and 16.5 vs. 6.2 %, respectively); the corresponding adjusted ORs for low back and neck pain were 1.59 (95 % CI 1.52-1.66) and 1.39 (95 % CI 1.30-1.49), respectively. Workers in the northern and central provinces had higher ORs for low back and neck pain compared to workers in the southern province. The test for trends showed an increased risk of developing low back and neck pain with decreased outdoor temperature. CONCLUSIONS: Outdoor work in a cold environment may increase the risk of low back and neck pain.

  • 18.
    Burström, Lage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Occupational and Environmental Medicine, University Hospital of Northern Sweden, Umeå, Sweden.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, SE-851 86 Sweden.
    Wahlström, Jens
    Department of Occupational and Environmental Medicine, University Hospital of Northern Sweden, Umeå, Sweden.
    White fingers, cold environment, and vibration: exposure among Swedish construction workers2010In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, ISSN 1795-990X, Vol. 36, no 6, p. 509-513Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to examine the association between white fingers, cold environment, and exposure to hand–arm vibration (HAV). The hypothesis was that working in cold climate increases the risk of white fingers.

    Methods The occurrence of white fingers was investigated as a cross-sectional study in a cohort of Swedish male construction workers (N=134 757). Exposure to HAV was based on a job-exposure matrix. Living in the north or south of Sweden was, in a subgroup of the cohort, used as an indicator of the exposure to cold environment (ie, living in the north meant a higher exposure to cold climate). The analyses were adjusted for age and use of nicotine products (smoking and snuff).

    Results HAV-exposed workers living in a colder climate had a higher risk for white fingers than those living in a warmer climate [odds ratio (OR) 1.71, 95% confidence interval (95% CI) 1.42–2.06]. As expected, we found that HAV-exposed workers had an increased risk compared to controls (OR 2.02, 95% CI 1.75–2.34). The risk for white fingers increased with increased level of exposure to HAV and also age.

    Conclusions Cold environment increases the risk for white fingers in workers occupationally exposed to HAV. The results underscore the need to keep exposure to HAV at workplaces as low as possible especially in cold climate.

  • 19. Burstyn, I
    et al.
    Boffetta, P
    Järvholm, B
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Partanen, T
    Svane, O
    Langård, S
    Kauppinen, T
    Stücker, I
    Shaham, J
    Heederik, D
    Ahrens, W
    Bergdahl, I
    Cenée, S
    Hooiveld, M
    Randem, B G
    Johansen, C
    Ferro, G
    Kromhout, H
    Risk of fatal industrial accidents and death from other external causes among asphalt workers.2004In: Occup Environ Med, ISSN 1470-7926, Vol. 61, no 1, p. 86-8Article in journal (Refereed)
  • 20.
    Forsberg, Bertil
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Hansson, Hans-Christen
    Johansson, Christer
    Areskoug, Hans
    Persson, Karin
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Comparative health impact assessment of local and regional particulate air pollutants in Scandinavia.2005In: Ambio, ISSN 0044-7447, Vol. 34, no 1, p. 11-9Article in journal (Refereed)
  • 21.
    Forsell, Karl
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Björ, Ove
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Eriksson, Helena
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Nilsson, Ralph
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Andersson, Eva
    Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Cancer incidence in a cohort of Swedish merchant seafarers between 1985 and 20112022In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 95, no 5, p. 1103-1111Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Lung cancer, mesothelioma and several lifestyle-associated cancer forms have been reported more common in merchant seafarers. However, few studies reflect recent occupational settings and women seafarers are usually too scarce for meaningful analyses. We conducted a study on cancer incidence between 1985 and 2011 in a Swedish cohort consisting of male and female seafarers.

    METHODS: All seafarers in the Swedish Seafarers' Register with at least one sea service between 1985 and 2011 and a cumulated sea service time of ≥ 30 days (N = 75,745; 64% men, 36% women; 1,245,691 person-years) were linked to the Swedish Cancer Register and followed-up until 31 December 2011. Standardized incidence ratios (SIR) were calculated with the general population as reference.

    RESULTS: There were 4159 cancer cases in total, with 3221 among men and 938 among women. Male seafarers had an increased risk of total cancer (SIR 1.05; 95% CI 1.01-1.09), lung cancer (SIR 1.51; 95% CI 1.35-1.67) and urinary bladder cancer (SIR 1.17; 95% CI 1.02-1.33). Several lifestyle-associated cancer forms were more common in men. Previous work on tankers was associated with leukaemia (SIR 1.41; 95% CI 1.00-1.86). The risk of cancer decreased with a start as a male seafarer after 1985, with a significant trend for total cancer (P < 0.001), lung cancer (P = 0.001) and, for tanker seafarers, leukaemia (P = 0.045). Women seafarers had an increased risk of lung cancer (SIR 1.54; 95% CI 1.23-1.87) but the risk of total cancer was not increased (SIR 0.83; 95% CI 0.78-0.89).

    CONCLUSIONS: In this cohort of merchant Swedish seafarers 1985-2011, the risk of total cancer was increased in men but not in women compared to the general population. Lung cancer was increased in both genders. The risk of cancer seems to decrease over the last decades, but better exposure assessments to occupational carcinogens and longer observation times are needed.

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  • 22.
    Forsell, Karl
    et al.
    Department of Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg.
    Björ, Ove
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Nilsson, Ralph
    Department of Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg.
    Andersson, Eva
    Department of Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg.
    Hematologic malignancy in tanker crewmembers: a case‐referent study among male Swedish seafarers2020In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 63, no 8, p. 685-692Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Work on Swedish petroleum tankers before the late 1980s has been associated with an increased risk of hematologic malignancy (HM). Since then, ship modernizations have decreased occupational exposure to gases, including the carcinogen benzene. We explored the risk of HMs in Swedish seafarers who had worked on newer types of tankers.

    METHODS: A case-referent study in male seafarers from a cohort of all Swedish seafarers was set up by record linkage with the Swedish Cancer Registry using the subjects' personal identification number. For each case (N = 315), five referents were randomly chosen from within the cohort, matched by birth year and three different periods of first sea service (<1985, 1985-1991, and ≥1992). Information on the type of ship and dates of service was retrieved from the Swedish Seafarers' Registry. Odds ratios (OR) were calculated by conditional logistic regression together with 95% confidence intervals (CI).

    RESULTS: The OR of HM was 1.07 (95% CI, 0.80-1.42) for work on tankers. In seafarers that had started to work on tankers ≥1985, the OR was 0.85 (95% CI, 0.50-1.43). For those who started to work on tankers before 1985, the OR was 1.17 (95% CI, 0.84-1.21) and 1.32 (95% CI, 0.86-2.03) if the cumulative time on tankers exceeded 5 years of service. In this last group, the OR of multiple myeloma was 5.39 (95% CI, 1.11-26.1).

    CONCLUSION: Although limited by crude exposure contrast and a short follow-up, work on tankers after 1985 was not associated with an increased risk of HM among Swedish seafarers.

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  • 23.
    Forsell, Karl
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden..
    Eriksson, Helena
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundh, Monica
    Andersson, Eva
    Nilsson, Ralph
    Work environment and safety climate in the Swedish merchant fleet2017In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 90, no 2, p. 161-168Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 24.
    Hedlund, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Eriksson, Kåre
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Exposure-response of silicosis mortality in Swedish iron ore miners.2008In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 52, no 1, p. 3-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To assess the exposure-response relationship between exposure to quartz and fatal silicosis. METHODS: The mortality from silicosis in 7729 miners was analyzed and compared to their estimated exposure to respirable quartz. The miners had been working as a miner for at least 1 year between 1923 and 1996. Their mortality between 1952 and 2001 was studied by using information from the national cause of death register. Both underlying and contributing causes of death were considered in the analysis. The exposure to quartz was estimated from job titles and using 3239 measurements of personal exposure to respirable quartz from 1965 to 1999. The mortality rates were adjusted to attained age and years of birth using a Poisson regression. RESULTS: The median cumulative exposure among the 7729 miners was 0.9 mg x years m(-3). There were 58 deaths from silicosis. Their median cumulative exposure was 4.8 mg x years m(-3). The crude mortality rate was 53 cases per 100,000 person-years with an exposure-response relationship. CONCLUSION: There seems to be an increased risk of fatal silicosis at exposure levels around 3 mg x years m(-3) for respirable quartz.

  • 25.
    Hedlund, Ulf
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine. Yrkes- och miljömedicin.
    Järvholm, B
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine. Yrkes- och miljömedicin.
    Lundbäck, B
    Persistence of respiratory symptoms in ex-underground iron ore miners.2006In: Occup Med (Lond), ISSN 0962-7480, Vol. 56, no 6, p. 380-385Article in journal (Refereed)
  • 26.
    Hedlund, Ulf
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Lundbäck, Bo
    Respiratory symptoms and obstructive lung diseases in iron ore miners: report from the obstructive lung disease in northern Sweden studies.2004In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 19, no 10, p. 953-958Article in journal (Refereed)
    Abstract [en]

    This is a population-based study on the prevalence of respiratory symptoms assessed by a mail questionnaire. The objective was to examine if work in an iron mine increased the risk of airway symptoms or obstructive diseases. The exposed group consisted of 114 previous or current male miners. Referents, 2472 males from the province, had never been employed by the mining company or worked as miners. Age, smoking and a family history of asthma were considered as possible confounders. The miners had an increased risk for respiratory symptoms (OR=2.2, 95% CI=1.4-3.1) including recurrent wheeze (OR= 2.4, 95% CI= 1.5-3.9), longstanding cough (OR= 1.8, 95% CI = 1.0-3.2), and for physician-diagnosed chronic bronchitis (OR=2.2, 95% CI= 1.0-4.5). Attacks of shortness of breath and asthma manifestations were similar between miners and referents. Higher risks in miners were found particularly among the non-smokers for physician-diagnosed chronic bronchitis (OR=9.2, 95% CI= 3.0-28) and for symptoms as well. A family history of asthma was less common among miners (9.2% vs. 17%, p < 0.05). We conclude that miners in a modern underground iron mine had an increased risk of respiratory symptoms. In contrast to other studies, this increased risk was particularly found in nonsmokers. A family history of asthma may be an important confounder in occupational studies of respiratory diseases.

  • 27.
    Hedlund, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Eriksson, Kåre
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundbäck, Bo
    Department of Internal Medicine/Respiratory Medicine & Allergology, Sahlgrenska Academy, University of Göteborg, Göteborg.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Occupational exposure to dust, gases and fumes, a family history of asthma and impaired respiratory health2008In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 34, no 5, p. 381-386Article in journal (Refereed)
    Abstract [en]

    Objectives: This study assessed the impact of occupational exposure to dust, gases, and fumes on respiratory symptoms, obstructive lung diseases, or the use of asthma medication among persons with and without a family history of asthma.

    Methods: A population-based cohort was followed for 10 years. This study included all 1739 men and 1594 women occupationally active at the first survey. Exposure and respiratory health were assessed from questionnaires. Multiple logistic regression was used to estimate the effects in relation to occupational groups, with age, gender, and smoking habits as possible confounders, using both cross-sectional and longitudinal analyses. The susceptibility to impaired respiratory health was determined from a family history of asthma.

    Results: A family history of asthma was reported by 27% of the men and 34% of the women. Both occupational exposure and a family history of asthma were associated with impaired respiratory health. The etiologic fractions showed that up to about 70% of the symptoms could be explained by a family history of asthma among those exposed to low levels of air pollutants, as well as among those with high exposure. However, high exposure contributed up to 35% of the symptoms both among those with and among those without a family history of asthma. The study indicates that the relative risk of occupational exposure to pollutants is similar for both persons with and those without a family history of asthma.

    Conclusions: The relative risk for impaired respiratory health after exposure to occupational air pollutants seems to be similar for persons with and those without a susceptibility to impaired respiratory health.

  • 28.
    Hult, Carl
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Stattin, Mikael
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Comparing mortality rates and recognizing health selection bias: A response to Wallman and Svärdsudd2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 10, p. 1489-1491Article in journal (Other academic)
  • 29.
    Hult, Carl
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Stattin, Mikael
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Timing of retirement and mortality: A cohort study of Swedish construction workers2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 10, p. 1480-1486Article in journal (Refereed)
    Abstract [en]

    Recent studies indicate that early retirement per se may have a negative effect on health to such an extent that it increases mortality risk. One type of early retirement often referred to in these studies is retirement with disability pension/benefit. Given the overall objective of disability benefit programmes - to help the disabled live socially and economically satisfactory lives, freed from exposure to employment health hazards and thus avoid further declines in health - the finding is challenging. This paper examined the relationship between timing of retirement and mortality using a cohort of Swedish construction workers. The mortality risk of disability pensioners - excluding those with diagnoses normally connected to increased mortality - was compared with the risk of those continuing to work. Although initial indications were in line with earlier results, it became obvious that the increased mortality risk of disability pensioners did not depend on early retirement per se but on poor health before early retirement not explicitly recognized in the diagnosis on which the disability pension rested. The results indicate that there are no general differences in mortality depending on timing of retirement. Future studies of mortality differences arising from working or not working must sufficiently control for health selection effects into the studied retirement paths.

  • 30. Humes, D. J.
    et al.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ludvigsson, J. F.
    Body mass index and the risk of symptomatic diverticular disease: A Swedish population based cohort study2015In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 64, p. A164-A164Article in journal (Other academic)
  • 31. Humes, D. J.
    et al.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ludvigsson, J. F.
    PTU-230 Smoking and the risk of symptomatic diverticular disease: a swedish population based cohort study2015In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 64, p. A164-A164Article in journal (Other academic)
  • 32. Humes, David J
    et al.
    Ludvigsson, Jonas F
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Smoking and the Risk of Hospitalization for Symptomatic Diverticular Disease: A Population-Based Cohort Study from Sweden.2016In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 59, no 2, p. 110-114Article in journal (Refereed)
    Abstract [en]

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

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

    DESIGN: This is a cohort study

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

    PATIENTS: Patients were selected from construction workers in Sweden.

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

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

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

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

  • 33. Högberg, J
    et al.
    Larsson, K
    Albin, M
    Järvholm, B
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Montelius, J
    Comments on "Respiratory effects of toluene diisocyanate in the workplace: a discussion of exposure-response relationships".2005In: Critical reviews in toxicology, ISSN 1040-8444, E-ISSN 1547-6898, Vol. 35, no 5, p. 459-60; author reply 461Article in journal (Refereed)
  • 34.
    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.

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  • 35.
    Jackson, Jennie A
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Punnett, Laura
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. College of Health Sciences, University of Massachusetts Lowell, Lowell, USA. .
    Burdorf, Alex
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Public Health, Erasmus MC, Rotterdam, The Netherlands..
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Occupational biomechanical risk factors for surgically treated ulnar nerve entrapment in a prospective study of male construction workers2019In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 45, no 1, p. 63-72Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to determine the association between occupational biomechanical exposures and occurrence of surgically treated ulnar nerve entrapment (UNE).

    Methods: A cohort of 229 689 male construction workers who participated in a national occupational health surveillance program (1971–1993) were examined prospectively over a 13-year case ascertainment period (2001–2013) for surgically treated UNE. Job title (construction trade), smoking status, height, weight and age were recorded on examination. Job titles were merged into occupational groups of workers performing similar work tasks and having similar training. Occupational biomechanical exposure estimates were assigned to each occupational group with a job exposure matrix (JEM) developed for the study. Negative binomial models were used to assess the relative risks for each biomechanical exposure and the sums of highly correlated biomechanical exposures. Surgical treatment of UNE was determined via a linkage with the Swedish Hospital Outpatient Surgery Register.

    Results: There were 555 cases of surgically treated UNE within the cohort. Workers exposed to forceful hand-grip factors had a 1.4-fold higher relative risk (95% CI 1.18–1.63) of undergoing surgical treatment for UNE compared to unexposed workers. Occupational groups comprising workers exposed to forceful hand-grip work showed the highest risks for UNE and included concrete workers, floor layers, ground preparatory workers, rock blasters, and sheet-metal workers.

    Conclusion: Forceful hand-grip work increases the risk for surgically treated ulnar nerve entrapment.

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  • 36.
    Jackson, Jennie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Punnett, Laura
    College of Health Sciences, University of Massachusetts Lowell, Lowell, USA. .
    Burdorf, Alex
    Department of Public Health, Erasmus MC, Rotterdam, The Netherlands..
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Biomechanical risk factors for surgically treated ulnar nerve entrapment in a cohort of Swedish male construction workers2018Conference paper (Other academic)
    Abstract [en]

    Background: The literature on occupational risk factors for ulnar nerve entrapment (UNE), also called cubital tunnel syndrome is sparse.

    Objectives: The aim was study the association between occupational biomechanical exposures and UNE.

    Methods: The occurrence of UNE was examined prospectively in a cohort of 229 689 Swedish male construction workers who participated in a nation-wide occupational health surveillance program between 1971 and 1996. UNE case status was defined on the basis of a surgical release of ulnar nerve entrapment; case data were obtained from a national outpatient database for a 13 year observation period (2001-2013). Individual risk factors considered were smoking status, BMI and age. Biomechanical exposure estimates were assigned at the occupational group level using a job exposure matrix developed specifically for the study and included 10 ergonomic (force/posture/repetition) and 2 hand-arm vibration exposure parameters determined a priori to be relevant to UNE. Relative risks (RR) for all biomechanical factors were modelled using negative binomial regression analyses and adjusted for age, smoking habits and BMI.

    Results: There were 555 cases of surgically treated UNE in the cohort and the average annual incidence was 19.2 cases per 100,000 person-years. Smoking status (ever vs. never smoker RR=1.28, 95% CI=1.07-1.54) and BMI (≥25 kg/m2 vs. < 25 kg/m2 RR=1.60 , 95% CI=1.34-1.91) were associated with increased risk of UNE. Increased grip force (RR=1.54, 95% CI =1.24-1.92), hand-Arm-vibration (RR=1.35, 95% CI=1.07-1.71) upper extremity load (RR=1.63, 95% CI=1.30-1.92), and increased frequency of hand tool use (RR =1.37, 95% CI=1.09-1.71), elbow flexion and extension (RR=1.36, 95% CI=1.10-1.68), and static work (RR=1.36, 95% CI=1.12-1.65) were also associated with increased risk of UNE.

    Discussion and Conclusions: Our findings demonstrate that multiple biomechanical factors were associated with increased risk of UNE. Many of the identified risk factors involved elevated hand grip force (grip force, upper extremity load, and frequency of hand tool use and hand-arm vibration) which may indicate it is a key etiological aspect of UNE.

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  • 37. Jacquemin, Bénédicte
    et al.
    Sunyer, Jordi
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Aguilera, Inmaculada
    Briggs, David
    García-Esteban, Raquel
    Götschi, Thomas
    Heinrich, Joachim
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jarvis, Debbie
    Vienneau, Danielle
    Künzli, Nino
    Home outdoor NO2 and new onset of self-reported asthma in adults2009In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 20, no 1, p. 119-126Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Few studies have investigated new onset of asthma in adults in relation to air pollution. The aim of this study is to investigate the association between modeled background levels of traffic-related air pollution at the subjects' home addresses and self-reported asthma incidence in a European adult population. METHODS: Adults from the European Respiratory Health Survey were included (n = 4185 from 17 cities). Subjects' home addresses were geocoded and linked to outdoor nitrogen dioxide (NO2) estimates, as a marker of local traffic-related pollution. We obtained this information from the 1-km background NO2 surface modeled in APMoSPHERE (Air Pollution Modelling for Support to Policy on Health and Environmental Risk in Europe). Asthma incidence was defined as reporting asthma in the follow-up (1999 to 2001) but not in the baseline (1991 to 1993). RESULTS: A positive association was found between NO2 and asthma incidence (odds ratio 1.43; 95% confidence interval = 1.02 to 2.01) per 10 microg/m. Results were homogeneous among centers (P value for heterogeneity = 0.59). CONCLUSIONS: We found an association between a marker of traffic-related air pollution and asthma incidence in European adults.

  • 38.
    Jarvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Slutreplik: Vi är oense om tolkningen av fakta2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 9, p. 651-Article in journal (Other academic)
  • 39. Jerning, Camilla
    et al.
    Martinander, Emma
    Bjerg, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
    Ekerljung, Linda
    Franklin, Karl
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Larsson, Kjell
    Malinovschi, Andrei
    Middelveld, Roelinde
    Emtner, Margareta
    Janson, Christer
    Asthma and physical activity: a population based study results from the Swedish GA(2)LEN survey2013In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 107, no 11, p. 1651-1658Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Having asthma has in previous reports been related to a lower physical activity level. At the same time the prevalence of asthma among elite athletes is high. The aim of this study was to investigate the association between physical activity level and asthma.

    METHODS: A postal questionnaire was completed by 25,610 individuals in Sweden. Current asthma was defined as having had an asthma attack during the last 12 months or current use of asthma medication. The participants were asked how often and for how many hours a week they were physically active.

    RESULTS: In the population 1830 subjects (7.1%) had current asthma. There was no significant difference in the proportion of subjects that reported being inactive or slightly physically active between asthmatic and non-asthmatics (57 vs. 58%) while the proportion of subjects that were vigorously physically active (≥2 times a week and ≥7 h per week) was higher among the subjects with asthma (6.7 vs. 4.8%, p < 0.0001). Being vigorously physically active was independently related to current asthma (OR (95% CI)) 1.40 (1.11-1.77)), wheeze (1.39 (1.17-1.65)), wheeze and breathlessness (1.68 (1.38-2.04)), and wheezing without having a cold (1.39 (1.13-1.71)). The association between being vigorously physically active and wheeze was significantly stronger in women compared to men.

    CONCLUSIONS: There was no difference in the proportion of subjects with a reported low level of physical activity between asthmatics and non-asthmatics. Health care professionals should, however, be aware of the increased prevalence of asthma and asthma-related symptoms in vigorously physically active subjects.

  • 40.
    Jochems, Sylvia H. J.
    et al.
    Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Häggström, Christel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Stattin, Pär
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Stocks, Tanja
    Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Association of Blood Pressure with Prostate Cancer Risk by Disease Severity and Prostate Cancer Death2022In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 31, no 7, p. 1483-1491Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The association of blood pressure (BP) with prostate cancer risk after accounting for asymptomatic prostate-specific antigen (PSA) testing, and with prostate cancer death, is unclear.

    METHODS: We investigated BP, measured at a mean age of 38 years among 430,472 men from five Swedish cohorts, in association with incident prostate cancer (n = 32,720) and prostate cancer death (n = 6718). HRs were calculated from multivariable Cox regression models.

    RESULTS: Increasing systolic and diastolic BP levels combined were associated with a slightly lower prostate cancer risk, with a HR of 0.98 (95% CI, 0.97-0.99) per standard deviation (SD) of mid-BP (average of systolic and diastolic BP). The association was restricted to the PSA era (1997 onwards, HR, 0.96; 95% CI, 0.95-0.98), to diagnoses initiated by a PSA test in asymptomatic men (HR, 0.95; 95% CI, 0.93-0.97), and to low-risk prostate cancer (HR, 0.95; 95% CI, 0.92-0.97). There was no clear association with more advanced disease at diagnosis. In cases, a slightly higher risk of prostate cancer death was observed for higher BP levels (HR, 1.05; 95% CI, 1.01-1.08) per SD of mid-BP; however, the association was restricted to distant metastatic disease (Pheterogeneity between case groups = 0.01), and there was no association for BP measured less than 10 years prior to diagnosis.

    CONCLUSIONS: Prediagnostic BP is unlikely an important risk factor for prostate cancer development and death. Less asymptomatic PSA testing among men with higher BP levels may explain their lower risk of prostate cancer.

    IMPACT: Elevated BP is unlikely to be an important risk factor for prostate cancer.

  • 41. Jochems, Sylvia H. J.
    et al.
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Häggström, Christel
    Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden..
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Orho-Melander, Marju
    Wood, Angela M.
    Stocks, Tanja
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Height, body mass index, and prostate cancer risk and mortality by way of detection and cancer risk category2020In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 147, no 12, p. 3328-3338Article in journal (Refereed)
    Abstract [en]

    Obesity is a risk factor for advanced, but not localised, prostate cancer (PCa), and for poor prognosis. However, the detection of localised PCa through asymptomatic screening might influence these associations. We investigated height and body mass index (BMI) among 431 902 men in five Swedish cohorts in relation to PCa risk, according to cancer risk category and detection mode, and PCa-specific mortality using Cox regression. Statistical tests were two-sided. Height was positively associated with localised intermediate-risk PCa (HR per 5 cm, 1.03, 95% CI 1.01 to 1.05), while overweight and obesity were negatively associated with localised low- and intermediate-risk PCa (HRs per 5 kg/m2 , 0.86, 95% CI 0.81 to 0.90, and 0.92, 95% CI 0.88 to 0.97). However, these associations were partially driven by PCa's detected by asymptomatic screening and, for height, also by symptoms unrelated to PCa. The HR of localised PCa's, per 5 kg/m2 , was 0.88, 95% CI 0.83 to 0.92 for screen-detected PCa's, and 0.96, 95% CI 0.90 to 1.01 for PCa's detected through lower urinary tract symptoms. BMI was positively associated with PCa-specific mortality in the full population and in case-only analysis of each PCa risk category (HRs per 5 kg/m2 , 95% CI 1.11 to 1.22, P for heterogeneity = 0.14). More active health-seeking behaviour among tall and normal-weight men may partially explain their higher risk of localised PCa. The higher PCa-specific mortality among obese men accros all PCa risk categories in our s