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  • 1. Andersen, Zorana J.
    et al.
    Stafoggia, Massimo
    Weinmayr, Gudrun
    Pedersen, Marie
    Galassi, Claudia
    Jørgensen, Jeanette T.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Olsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oftedal, Bente
    Aasvang, Gunn Marit
    Aamodt, Geir
    Pyko, Andrei
    Pershagen, Göran
    Korek, Michal
    De Faire, Ulf
    Pedersen, Nancy L.
    Östenson, Claes-Göran
    Fratiglioni, Laura
    Eriksen, Kirsten T.
    Tjønneland, Anne
    Peeters, Petra H.
    Bueno-de-Mesquita, Bas
    Plusquin, Michelle
    Key, Timothy J.
    Jaensch, Andrea
    Nagel, Gabriele
    Lang, Alois
    Wang, Meng
    Tsai, Ming-Yi
    Fournier, Agnes
    Boutron-Ruault, Marie-Christine
    Baglietto, Laura
    Grioni, Sara
    Marcon, Alessandro
    Krogh, Vittorio
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Migliore, Enrica
    Tamayo-Uria, Ibon
    Amiano, Pilar
    Dorronsoro, Miren
    Vermeulen, Roel
    Sokhi, Ranjeet
    Keuken, Menno
    de Hoogh, Kees
    Beelen, Rob
    Vineis, Paolo
    Cesaroni, Giulia
    Brunekreef, Bert
    Hoek, Gerard
    Raaschou-Nielsen, Ole
    Long-term exposure to ambient air pollution and incidence of postmenopausal breast cancer in 15 European cohorts within the ESCAPE project2017Ingår i: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 125, nr 10, artikel-id 107005Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Epidemiological evidence on the association between ambient air pollution and breast cancer risk is inconsistent.

    OBJECTIVE: We examined the association between long-term exposure to ambient air pollution and incidence of postmenopausal breast cancer in European women.

    METHODS: In 15 cohorts from nine European countries, individual estimates of air pollution levels at the residence were estimated by standardized land-use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE) and Transport related Air Pollution and Health impacts – Integrated Methodologies for Assessing Particulate Matter (TRANSPHORM) projects: particulate matter (PM) ≤2.5μm, ≤10μm, and 2.5–10μm in diameter (PM2.5, PM10, and PMcoarse, respectively); PM2.5 absorbance; nitrogen oxides (NO2 and NOx); traffic intensity; and elemental composition of PM. We estimated cohort-specific associations between breast cancer and air pollutants using Cox regression models, adjusting for major lifestyle risk factors, and pooled cohort-specific estimates using random-effects meta-analyses.

    RESULTS: Of 74,750 postmenopausal women included in the study, 3,612 developed breast cancer during 991,353 person-years of follow-up. We found positive and statistically insignificant associations between breast cancer and PM2.5 {hazard ratio (HR)=1.08 [95% confidence interval (CI): 0.77, 1.51] per 5 μg/m(3)}, PM10 [1.07 (95% CI: 0.89, 1.30) per 10 μg/m(3)], PMcoarse[1.20 (95% CI: 0.96, 1.49 per 5 μg/m(3)], and NO(2) [1.02 (95% CI: 0.98, 1.07 per 10 μg/m(3)], and a statistically significant association with NOx [1.04 (95% CI: 1.00, 1.08) per 20 μg/m(3), p=0.04].

    CONCLUSIONS: We found suggestive evidence of an association between ambient air pollution and incidence of postmenopausal breast cancer in European women.

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  • 2.
    Andersson, John
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Nordin, Steven
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    PM2.5 exposure and olfactory functions2022Ingår i: International Journal of Environmental Health Research, ISSN 0960-3123, E-ISSN 1369-1619, Vol. 32, nr 11, s. 2484-2495Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Growing evidence indicates that air pollution can negatively impact cognitive functions. The olfactory system is interesting in this context as it is directly exposed to pollutants and also associated with cognitive functions. The aim of this study was to investigate long- and short-term PM2.5 exposure in association with olfactory functions. Scores from odor tests were obtained from the Betula project - a longitudinal cohort study. Estimates of annual mean PM2.5 concentrations at the participants' residential address were obtained from a dispersion-model. Daily mean PM2.5 concentrations were obtained from a measuring station close to the test location. We found a positive association between long-term PM2.5 exposure and odor identification, i.e. exposure was associated with a better ability to identify odors. We also found an interaction effect between PM2.5 and age on odor identification. We found no associations between any PM2.5 exposure and odor detection or between short-term PM2.5 exposure and olfactory functions.

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  • 3.
    Andersson, John
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Road traffic noise, air pollution, and risk of dementia: results from the Betula project2018Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 166, s. 334-339Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is growing evidence for a negative impact of traffic-related air pollution on risk of dementia. However, the contribution of noise exposure to this association has been rarely examined.

    Objective: We aimed to investigate the individual and combined effect of noise and air pollution on risk of dementia.

    Methods: Data on dementia incidence over a 15 year period was obtained from the Betula project, a longitudinal study on health and ageing. Estimates of annual mean levels of nitrogen oxides (NOx) at the participants’ residential address were obtained using a land-use regression model. Modelled data provided road traffic noise levels (Leq. 24 h) at the participants’ residential address at baseline. Cox proportional hazard regression was used to calculate hazard ratios (HR).

    Results: Of 1721 participants at baseline, 302 developed dementia during the follow up period. Exposure to noise levels (Leq. 24 h) > 55 dB had no significant effect on dementia risk (HR 0.95; CI: 0.57, 1.57). Residing in the two highest quartiles of NOx exposure was associated with an increased risk of dementia. The risk associated with NOx was not modified by adjusting for noise. Moreover, we found no significant interaction effects between NOx and road traffic noise on dementia risk.

    Conclusion: We found no evidence that exposure to road traffic noise, either independently or in combination with traffic air pollution, was associated with risk of dementia in our study area. Our results suggest that pollution should be considered the main component in the association between traffic related exposures and dementia.

  • 4.
    Andersson, John
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Department of Research and Development, Sundsvall Hospital, Sundsvall, Sweden.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Segersson, David
    Swedish Meteorological and Hydrological Institute (SMHI), Norrköping, Sweden.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Pm2.5 and dementia in a low exposure setting: the influence of odor identification ability and APOE2023Ingår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 92, nr 2, s. 679-689Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Growing evidence show that long term exposure to air pollution increases the risk of dementia.

    Objective: The aim of this study was to investigate associations between PM2.5 exposure and dementia in a low exposure area, and to investigate the role of olfaction and the APOE ε4 allele in these associations.

    Methods: Data were drawn from the Betula project, a longitudinal study on aging, memory, and dementia in Sweden. Odor identification ability was assessed using the Scandinavian Odor Identification Test (SOIT). Annual mean PM2.5 concentrations were obtained from a dispersion-model and matched at the participants’ residential address. Proportional hazard regression was used to calculate hazard ratios.

    Results: Of 1,846 participants, 348 developed dementia during the 21-year follow-up period. The average annual mean PM2.5 exposure at baseline was 6.77 µg/m3, which is 1.77 µg/m3 above the WHO definition of clean air. In a fully adjusted model (adjusted for age, sex, APOE, SOIT, cardiovascular diseases and risk factors, and education) each 1 µg/m3 difference in annual mean PM2.5-concentration was associated with a hazard ratio of 1.23 for dementia (95% CI: 1.01–1.50). Analyses stratified by APOE status (ε4 carriers versus non-carriers), and odor identification ability (high versus low), showed associations only for ε4 carriers, and for low performance on odor identification ability.

    Conclusion: PM2.5 was associated with an increased risk of dementia in this low pollution setting. The associations between PM2.5 and dementia seemed stronger in APOE carriers and those with below average odor identification ability.

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  • 5.
    Arvidsson, Inger
    et al.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Leo, Ulf
    Umeå universitet, Samhällsvetenskapliga fakulteten, Statsvetenskapliga institutionen. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för skolledarutveckling.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Nilsson, Kerstin
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Department of Public Health, Kristianstad University, Kristianstad, Sweden.
    Håkansson, Carita
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Österberg, Kai
    Department of Psychology, Lund University, Lund, Sweden.
    Persson, Roger
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Department of Psychology, Lund University, Lund, Sweden.
    Should i stay or should i go? Associations between occupational factors, signs of exhaustion and the intention to change workplace among swedish principals2021Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, nr 10, artikel-id 5376Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A high turnover among principals may disrupt the continuity of leadership and negatively affect teachers and, by extension, the students. The aim was to investigate to what extent various work environment factors and signs of exhaustion were associated with reported intentions to change workplace among principals working in compulsory schools. A web-based questionnaire was administered twice, in 2018 and in 2019. Part I of the study involved cross-sectional analyses of the associations 2018 (n = 984) and 2019 (n = 884) between occupational factors, signs of exhaustion, and the intention to change workplace, using Generalized Estimating Equations models. Part II involved 631 principals who participated in both surveys. The patterns of intended and actual changes of workplace across two years were described, together with associated changes of occupational factors and signs of exhaustion. Supportive management was associated with an intention to stay, while demanding role conflicts and the feeling of being squeezed between management and co-workers (buffer-function) were associated with the intention to change workplace. The principals who intended to change their workplace reported more signs of exhaustion. To increase retention among principals, systematic efforts are probably needed at the national, municipal, and local level, in order to improve their working conditions.

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  • 6.
    Azzouz, Mehjar
    et al.
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Xu, Yiyi
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Barregard, Lars
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Fagerberg, Björn
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Zöller, Bengt
    Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
    Molnár, Peter
    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.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Lund, Sweden.
    Spanne, Mårten
    Environment Department, Malmö, Sweden.
    Engström, Gunnar
    Department of Clinical Sciences in Malmö, CRC, Lund University, Lund, Sweden.
    Stockfelt, Leo
    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.
    Air pollution and biomarkers of cardiovascular disease and inflammation in the Malmö Diet and Cancer cohort2022Ingår i: Environmental Health, E-ISSN 1476-069X, Vol. 21, nr 1, artikel-id 39Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Air pollution is associated with increased risk of cardiovascular disease, possibly through chronic systemic inflammation that promotes the progression of atherosclerosis and the risk of cardiovascular events. This study aimed to investigate the associations between air pollution and established biomarkers of inflammation and cardiovascular disease.

    METHODS: The Cardiovascular Subcohort of the Malmö Diet and Cancer cohort includes 6103 participants from the general population of Malmö, Sweden. The participants were recruited 1991-1994. Annual mean residential exposure to particulate matter < 2.5 and < 10 μm (PM2.5 and PM10), and nitrogen oxides (NOx) at year of recruitment were assigned from dispersion models. Blood samples collected at recruitment, including blood cell counts, and biomarkers (lymphocyte- and neutrophil counts, C-reactive protein (CRP), soluble urokinase-type plasminogen activator receptor (suPAR), lipoprotein-associated phospholipase A2 (Lp-PLA2), ceruloplasmin, orosomucoid, haptoglobin, complement-C3, and alpha-1-antitrypsin) were analyzed. Multiple linear regression models were used to investigate the cross-sectional associations between air pollutants and biomarkers.

    RESULTS: The mean annual exposure levels in the cohort were only slightly or moderately above the new WHO guidelines of 5 μg/m3 PM2.5 (10.5 μg/m3 PM2.5). Residential PM2.5 exposure was associated with increased levels of ceruloplasmin, orosomucoid, C3, alpha-1-antitrypsin, haptoglobin, Lp-PLA2 and the neutrophil-lymphocyte ratio. Ceruloplasmin, orosomucoid, C3 and alpha-1-antitrypsin were also positively associated with PM10. There were no associations between air pollutants and suPAR, leukocyte counts or CRP. The associations between particles and biomarkers were still significant after removing outliers and adjustment for CRP levels. The associations were more prominent in smokers.

    CONCLUSION: Long-term residential exposure to moderate levels of particulate air pollution was associated with several biomarkers of inflammation and cardiovascular disease. This supports inflammation as a mechanism behind the association between air pollution and cardiovascular disease.

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  • 7.
    Azzouz, Mehjar
    et al.
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Xu, Yiyi
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Barregard, Lars
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Zöller, Bengt
    Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
    Molnar, Peter
    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.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Sweden.
    Spanne, Mårten
    Environment Department, City of Malmö, Malmö, Sweden.
    Engström, Gunnar
    Department of Clinical Sciences in Malmö, CRC, Lund University and Skåne University Hospital, Malmö, Sweden.
    Stockfelt, Leo
    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.
    Long-term ambient air pollution and venous thromboembolism in a population-based Swedish cohort2023Ingår i: Environmental Pollution, ISSN 0269-7491, E-ISSN 1873-6424, Vol. 331, artikel-id 121841Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Air pollution is a major contributor to the global burden of disease and has been linked to several diseases and conditions, including cardiovascular disease. The biological mechanisms are related to inflammation and increased coagulability, factors that play an important role in the pathogenesis of venous thromboembolism (VTE, i.e., deep vein thrombosis or pulmonary embolism). This study investigates if long-term exposure to air pollution is associated with increased VTE incidence. The study followed 29 408 participants from the Malmö Diet and Cancer (MDC) cohort, which consists of adults aged 44–74 recruited in Malmö, Sweden between 1991 and 1996. For each participant, annual mean residential exposures to particulate matter <2.5 μg (PM2.5) and <10 μg (PM10), nitrogen oxides (NOx) and black carbon (BC) from 1990 up to 2016 were calculated. Associations with VTE were analysed using Cox proportional hazard models for air pollution in the year of the VTE event (lag0) and the mean of the prior 1–10 years (lag1-10). Annual air pollution exposures for the full follow-up period had the following means: 10.8 μg/m3 for PM2.5, 15.8 μg/m3 for PM10, 27.7 μg/m3 for NOx, and 0.96 μg/m3 for BC. The mean follow-up period was 19.5 years, with 1418 incident VTE events recorded during this period. Exposure to lag1-10 PM2.5 was associated with an increased risk of VTE (HR 1.17 (95%CI 1.01–1.37)) per interquartile range (IQR) of 1.2 μg/m3 increase in PM2.5 exposure. No significant associations were found between other pollutants or lag0 PM2.5 and incident VTE. When VTE was divided into specific diagnoses, associations with lag1-10 PM2.5 exposure were similarly positive for deep vein thrombosis but not for pulmonary embolism. Results persisted in sensitivity analyses and in multi-pollutant models. Long-term exposure to moderate concentrations of ambient PM2.5 was associated with increased risks of VTE in the general population in Sweden.

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  • 8.
    Balidemaj, Festina
    et al.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Flanagan, Erin
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Malmqvist, Ebba
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Rittner, Ralf
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Källén, Karin
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Prenatal Exposure to Locally Emitted Air Pollutants Is Associated with Birth Weight: An Administrative Cohort Study from Southern Sweden2022Ingår i: Toxics, E-ISSN 2305-6304, Vol. 10, nr 7, artikel-id 366Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    While prenatal exposure to ambient air pollution has been shown to be associated with reduced birth weight, there is substantial heterogeneity across studies, and few epidemiological studies have utilized source-specific exposure data. The aim of the present study was, therefore, to investigate the associations between local, source-specific exposure to fine particulate matter (PM2.5) during pregnancy and birth weight. An administrative cohort comprising 40,245 singleton births from 2000 to 2009 in Scania, Sweden, was combined with data on relevant covariates. Investigated sources of PM2.5 included all local sources together as well as tailpipe exhaust, vehicle wear-and-tear, and small-scale residential heating separately. The relationships between these exposures, rep-resented as interquartile range (IQR) increases, and birth weight (continuous) and low birth weight (LBW; <2500 g) were analyzed in crude and adjusted models. Each local PM2.5 source investigated was associated with reduced birth weight; average decreases varied by source (12–34 g). Only small-scale residential heating was clearly associated with LBW (adjusted odds ratio: 1.14 (95% confidence interval: 1.04–1.26) per IQR increase). These results add to existing evidence that prenatal exposure to ambient air pollution disrupts fetal growth and suggest that PM2.5 from both vehicles and small-scale residential heating may reduce birth weight.

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  • 9. Beelen, Rob
    et al.
    Raaschou-Nielsen, Ole
    Stafoggia, Massimo
    Andersen, Zorana Jovanovic
    Weinmayr, Gudrun
    Hoffmann, Barbara
    Wolf, Kathrin
    Samoli, Evangelia
    Fischer, Paul
    Nieuwenhuijsen, Mark
    Vineis, Paolo
    Xun, Wei W
    Katsouyanni, Klea
    Dimakopoulou, Konstantina
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Havulinna, Aki S
    Lanki, Timo
    Turunen, Anu
    Oftedal, Bente
    Nystad, Wenche
    Nafstad, Per
    De Faire, Ulf
    Pedersen, Nancy L
    Ostenson, Claes-Göran
    Fratiglioni, Laura
    Penell, Johanna
    Korek, Michal
    Pershagen, Göran
    Eriksen, Kirsten Thorup
    Overvad, Kim
    Ellermann, Thomas
    Eeftens, Marloes
    Peeters, Petra H
    Meliefste, Kees
    Wang, Meng
    Bueno-de-Mesquita, Bas
    Sugiri, Dorothea
    Krämer, Ursula
    Heinrich, Joachim
    de Hoogh, Kees
    Key, Timothy
    Peters, Annette
    Hampel, Regina
    Concin, Hans
    Nagel, Gabriele
    Ineichen, Alex
    Schaffner, Emmanuel
    Probst-Hensch, Nicole
    Künzli, Nino
    Schindler, Christian
    Schikowski, Tamara
    Adam, Martin
    Phuleria, Harish
    Vilier, Alice
    Clavel-Chapelon, Françoise
    Declercq, Christophe
    Grioni, Sara
    Krogh, Vittorio
    Tsai, Ming-Yi
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Galassi, Claudia
    Migliore, Enrica
    Ranzi, Andrea
    Cesaroni, Giulia
    Badaloni, Chiara
    Forastiere, Francesco
    Tamayo, Ibon
    Amiano, Pilar
    Dorronsoro, Miren
    Katsoulis, Michail
    Trichopoulou, Antonia
    Brunekreef, Bert
    Hoek, Gerard
    Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project2014Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 383, nr 9919, s. 785-795Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants.

    METHODS: We used data from 22 European cohort studies, which created a total study population of 367 251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2·5 μm (PM2·5), less than 10 μm (PM10), and between 10 μm and 2·5 μm (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx), with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buffer. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects meta-analysis.

    FINDINGS: The total study population consisted of 367 251 participants who contributed 5 118 039 person-years at risk (average follow-up 13·9 years), of whom 29 076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2·5 of 1·07 (95% CI 1·02-1·13) per 5 μg/m(3) was recorded. No heterogeneity was noted between individual cohort effect estimates (I(2) p value=0·95). HRs for PM2·5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 μg/m(3) (HR 1·06, 95% CI 1·00-1·12) or below 20 μg/m(3) (1·07, 1·01-1·13).

    INTERPRETATION: Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value.

    FUNDING: European Community's Seventh Framework Program (FP7/2007-2011).

  • 10. Beelen, Rob
    et al.
    Stafoggia, Massimo
    Raaschou-Nielsen, Ole
    Andersen, Zorana Jovanovic
    Xun, Wei W
    Katsouyanni, Klea
    Dimakopoulou, Konstantina
    Brunekreef, Bert
    Weinmayr, Gudrun
    Hoffmann, Barbara
    Wolf, Kathrin
    Samoli, Evangelia
    Houthuijs, Danny
    Nieuwenhuijsen, Mark
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Olsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Salomaa, Veikko
    Lanki, Timo
    Yli-Tuomi, Tarja
    Oftedal, Bente
    Aamodt, Geir
    Nafstad, Per
    De Faire, Ulf
    Pedersen, Nancy L
    Östenson, Claes-Göran
    Fratiglioni, Laura
    Penell, Johanna
    Korek, Michal
    Pyko, Andrei
    Eriksen, Kirsten Thorup
    Tjønneland, Anne
    Becker, Thomas
    Eeftens, Marloes
    Bots, Michiel
    Meliefste, Kees
    Wang, Meng
    Bueno-de-Mesquita, Bas
    Sugiri, Dorothea
    Krämer, Ursula
    Heinrich, Joachim
    de Hoogh, Kees
    Key, Timothy
    Peters, Annette
    Cyrys, Josef
    Concin, Hans
    Nagel, Gabriele
    Ineichen, Alex
    Schaffner, Emmanuel
    Probst-Hensch, Nicole
    Dratva, Julia
    Ducret-Stich, Regina
    Vilier, Alice
    Clavel-Chapelon, Françoise
    Stempfelet, Morgane
    Grioni, Sara
    Krogh, Vittorio
    Tsai, Ming-Yi
    Marcon, Alessandro
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Galassi, Claudia
    Migliore, Enrica
    Ranzi, Andrea
    Cesaroni, Giulia
    Badaloni, Chiara
    Forastiere, Francesco
    Tamayo, Ibon
    Amiano, Pilar
    Dorronsoro, Miren
    Katsoulis, Michail
    Trichopoulou, Antonia
    Vineis, Paolo
    Hoek, Gerard
    Long-term exposure to air pollution and cardiovascular mortality: an analysis of 22 European cohorts2014Ingår i: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 25, nr 3, s. 368-378Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Air pollution has been associated with cardiovascular mortality, but it remains unclear as to whether specific pollutants are related to specific cardiovascular causes of death. Within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE), we investigated the associations of long-term exposure to several air pollutants with all cardiovascular disease (CVD) mortality, as well as with specific cardiovascular causes of death.

    METHODS: Data from 22 European cohort studies were used. Using a standardized protocol, study area-specific air pollution exposure at the residential address was characterized as annual average concentrations of the following: nitrogen oxides (NO2 and NOx); particles with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and 10 μm to 2.5 μm (PMcoarse); PM2.5 absorbance estimated by land-use regression models; and traffic indicators. We applied cohort-specific Cox proportional hazards models using a standardized protocol. Random-effects meta-analysis was used to obtain pooled effect estimates.

    RESULTS: The total study population consisted of 367,383 participants, with 9994 deaths from CVD (including 4,992 from ischemic heart disease, 2264 from myocardial infarction, and 2484 from cerebrovascular disease). All hazard ratios were approximately 1.0, except for particle mass and cerebrovascular disease mortality; for PM2.5, the hazard ratio was 1.21 (95% confidence interval = 0.87-1.69) per 5 μg/m and for PM10, 1.22 (0.91-1.63) per 10 μg/m.

    CONCLUSION: In a joint analysis of data from 22 European cohorts, most hazard ratios for the association of air pollutants with mortality from overall CVD and with specific CVDs were approximately 1.0, with the exception of particulate mass and cerebrovascular disease mortality for which there was suggestive evidence for an association.

  • 11. Biggar, Robert J
    et al.
    Wohlfahrt, Jan
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hjuler, Thomas
    Melbye, Mads
    Digoxin use and the risk of breast cancer in women2011Ingår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 29, nr 16, s. 2165-2170Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE Digoxin resembles estrogen chemically and may have estrogenic effect. We hypothesized that digoxin use might increase breast cancer incidence and examined if use might be associated with risk of breast cancer, categorized by estrogen receptor (ER) status. To determine if being under care for heart disease biased the findings, rate ratios in users of angina drugs were similarly evaluated as a control exposure group.

    PATIENTS AND METHODS Women using digoxin and angina drugs were identified in the nationwide Danish Prescription Database, available between 1995 and 2008. Incident breast cancers were identified in the Danish Cancer Registry and further classifying by ER status. Relative risks (RR) were compared to nonusers using age- and period-adjusted incidence rate ratios.

    RESULTS Two thousand one hundred forty-four of 104,648 women using digoxin developed breast cancer. Current digoxin users were at increased risk of breast cancer (RR, 1.39; 95% CI, 1.32 to 1.46), but risk was not increased in former users (RR, 0.91; 95% CI, 0.83 to 1.00). The increased risks in digoxin users were marginally higher for ER-positive breast cancers (RR, 1.35; 95% CI, 1.26 to 1.45) and ER unknown breast cancers (RR, 1.51; 95% CI, 1.38 to 1.64) than for ER-negative breast cancers (RR, 1.20; 95% CI, 1.03 to 1.40). Among 137,493 women exposed to angina drugs only (a comparison group with cardiovascular disease; n = 2,658 breast cancers), incidence was not increased in current or former users.

    CONCLUSION Women currently using digoxin had a significantly increased risk of breast cancer. Risk normalized when digoxin was stopped. No risk increases were observed in women using angina drugs only. The higher risk of developing ER-positive breast cancers supports an estrogen-mimicking mechanism.

  • 12.
    Bjursten, Henrik
    et al.
    Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Nozohoor, Shahab
    Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
    Ahmad, Khalil
    Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark.
    Tang, Mariann
    Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark.
    Bjurbom, Markus
    Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Hansson, Emma C.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jeppsson, Anders
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Joost Holdflod Møller, Christian
    Department of Cardiothoracic Surgery, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
    Jormalainen, Miko
    Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
    Juvonen, Tatu
    Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; Research Unit of Surgery, Anesthesia, Critical Care, University of Oulu, Oulu, Finland.
    Mennander, Ari
    Heart Centre, Tampere University Hospital and University of Tampere, Tampere, Finland.
    Olsen, Peter S.
    Department of Cardiothoracic Surgery, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.
    Olsson, Christian
    Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Ahlsson, Anders
    Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Pan, Emily
    Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland; Turku University Hospital, Turku, Finland.
    Raivio, Peter
    Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
    Wickbom, Anders
    Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital and Faculty of Medicine and Health, Orebro University, Sweden.
    Sjögren, Johan
    Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
    Geirsson, Arnar
    Section of Cardiac Surgery, Yale University School of Medicine, CT, New Haven, United States; Department of Cardiothoracic Surgery, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Gudbjartsson, Tomas
    Department of Cardiothoracic Surgery, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Zindovic, Igor
    Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
    Once after a full moon: acute type A aortic dissection and lunar phases2022Ingår i: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 34, nr 1, s. 105-110Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Acute type A aortic dissection (ATAAD) is a rare but severe condition, routinely treated with emergent cardiac surgery. Many surgeons have the notion that patients with ATAAD tend to come in clusters, but no studies have examined these observations. This investigation was undertaken to study the potential association between the lunar cycle and the incidence of ATAAD.

    METHODS: We collected information on 2995 patients who underwent ATAAD surgery at centres from the Nordic Consortium for Acute Type A Aortic Dissection collaboration. We cross-referenced the time of surgery with lunar phase using a case-crossover design with 2 different definitions of full moon (>99% illumination and the 7-day full moon period).

    RESULTS: The period when the moon was illuminated the most (99% definition) did not show any significant increase in incidence for ATAAD surgery. However, when the full moon period was compared with all other moon phases, it yielded a relative risk of 1.08 [95% confidence interval (CI) 1.00-1.17, P = 0.057] and, compared to waxing moon, only the relative risk was 1.11 (95% CI 1.01-1.23, P = 0.027). The peak incidence came 4-6 days after the moon was fully illuminated.

    CONCLUSIONS: This study found an overrepresentation of surgery for ATAAD during the full moon phase. The explanation for this is not known, but we speculate that sleep deprivation during full moon leads to a temporary increase in blood pressure, which in turn could trigger rupture of the aortic wall. While this finding is interesting, it needs to be corroborated and the clinical implications are debateable.

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  • 13.
    Carlsen, Hanne Krage
    et al.
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden..
    Andersson, Eva M
    Molnár, Peter
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Xu, Yiyi
    Wichmann, Janine
    Spanne, Mårten
    Stroh, Emilie
    Engström, Gunnar
    Stockfelt, Leo
    Incident cardiovascular disease and long-term exposure to source-specific air pollutants in a Swedish cohort2022Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 209, artikel-id 112698Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Air pollution is associated with cardiovascular morbidity and mortality, but its role in the development of congestive heart failure (CHF) and the role of different pollution sources in cardiovascular disease remain uncertain.

    METHODS: Participants were enrolled in the Malmö Diet and Cancer cohort in 1991-1996 with information on lifestyle and clinical indicators of cardiovascular disease. The cohort participants were followed through registers until 2016. Annual total and local source-specific concentrations of particulate matter less than 10 μm and 2.5 μm (PM10 and PM2.5), black carbon (BC), and nitrogen oxides (NOx) from traffic, residential heating, and industry were assigned to each participant's address throughout the study period. Cox proportional hazards models adjusted for possible confounders was used to estimate associations between air pollution 1-5 years prior to outcomes of incident CHF, fatal myocardial infarction (MI), major adverse coronary events (MACE), and ischemic stroke.

    RESULTS: Air pollution exposure levels (mean annual exposures to PM2.5 of 11 μg/m3 and NOx of 26 μg/m3) within the cohort were moderate in terms of environmental standards. After adjusting for confounders, we observed statistically significant associations between NOx and CHF (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.01-1.22) and NOx and fatal MI (HR 1.10, 95%CI 1.01-1.20) per interquartile range (IQR) of 9.6 μg/m3. In fully adjusted models, the estimates were similar, but the precision worse. In stratified analyses, the associations were stronger in males, ever-smokers, older participants, and those with baseline carotid artery plaques. Locally emitted and traffic-related air pollutants generally showed positive associations with CHF and fatal MI. There were no associations between air pollution and MACE or stroke.

    DISCUSSION/CONCLUSION: In an area with low to moderate air pollution exposure, we observed significant associations of long-term residential NOx with increased risk of incident CHF and fatal MI, but not with coronary events and stroke.

  • 14.
    Carlsen, Hanne Krage
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Meister, Kadri
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Gíslason, Thorarinn
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ozone is associated with cardiopulmonary and stroke emergency hospital visits in Reykjavik, Iceland 2003--20092013Ingår i: Environmental Health, E-ISSN 1476-069X, Vol. 12, nr 1, s. 28-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Air pollution exposure is associated with hospital admissions and emergency room visits for cardiopulmonary disease and stroke. Iceland's capital area, Reykjavik, has generally low air pollution levels, but traffic and natural sources contribute to pollution levels. The objective of this study was to investigate temporal associations between emergency hospital visits and air pollutants ozone (O3), nitrogen dioxide (NO2), and particulate matter (PM10) in the Icelandic capital area.

    METHODS: We constructed a time series of the daily number of adults who visited the emergency room, or were acutely admitted for stroke or cardiorespiratory causes to Landspitali University Hospital 1 January 2003 -- 31 December 2009 from the hospital in-patient register. We used generalized additive models assuming Poisson distribution, to analyze the daily emergency hospital visits as a function of the pollutant levels, and adjusted for meteorological variables, day of week, and time trend with splines.

    RESULTS: Daily emergency hospital visits increased 3.9% (95% confidence interval (CI) 1.7-6.1%) per interquartile (IQR) change in average O3 the same and two previous days. For females, the increase was 7.8% (95% CI 3.6-12.1) for elderly (70+), the increase was 3.9% (95% CI 0.6-7.3%) per IQR increase of NO2. There were no associations with PM10.

    CONCLUSIONS: We found an increase in daily emergency hospital visits associated with O3, indicating that low-level exposure may trigger cardiopulmonary events or stroke.

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  • 15.
    Carlsen, Hanne Krage
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Gislason, T
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Meister, Kadri
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Thorsteinsson, T
    Jóhannsson, T
    Finnbjornsdottir, R
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Emergency Hospital Visits in Association with Volcanic Ash, Dust Storms and Other Sources of Ambient Particles: A Time-Series Study in Reykjavik, Iceland2015Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, nr 4, s. 4047-4059Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Volcanic ash contributed significantly to particulate matter (PM) in Iceland following the eruptions in Eyjafjallajökull 2010 and Grímsvötn 2011. This study aimed to investigate the association between different PM sources and emergency hospital visits for cardiorespiratory causes from 2007 to 2012. Indicators of PM10 sources; “volcanic ash”, “dust storms”, or “other sources” (traffic, fireworks, and re-suspension) on days when PM10 exceeded the daily air quality guideline value of 50 µg/m3 were entered into generalized additive models, adjusted for weather, time trend and co-pollutants. The average number of daily emergency hospital visits was 10.5. PM10 exceeded the air quality guideline value 115 out of 2191 days; 20 days due to volcanic ash, 14 due to dust storms (two days had both dust storm and ash contribution) and 83 due to other sources. High PM10 levels from volcanic ash tended to be significantly associated with the emergency hospital visits; estimates ranged from 4.8% (95% Confidence Interval (CI): 0.6, 9.2%) per day of exposure in unadjusted models to 7.3% (95% CI: −0.4, 15.5%) in adjusted models. Dust storms were not consistently associated with daily emergency hospital visits and other sources tended to show a negative association. We found some evidence indicating that volcanic ash particles were more harmful than particles from other sources, but the results were inconclusive and should be interpreted with caution.

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  • 16.
    Carlsen, Hanne Krage
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Centre of Public Health, University of Iceland.
    Gislason, Thorarinn
    Faculty of Medicine, University of Iceland.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Meister, Kadri
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Thorsteinsson, Throstur
    Department of Environment and Natural resources, University of Iceland.
    Johansson, Thorsteinn
    Environmental Agency of Iceland.
    Finnbjornsdottir, Ragnhildur
    Centre of Public Health, University of Iceland.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Effects of PM10 from volcanic ash, natural dust, and other sources on emergency hospital visits in Reykjavík, IcelandManuskript (preprint) (Övrigt vetenskapligt)
  • 17.
    Carlsen, Hanne Krage
    et al.
    Psykiatri Affektiva, Sahlgrenska University Hospital, 416 50 Gothenburg, Sweden. Occupational and Environmental Medicine, Gothenburg University, 40530 Gothenburg, Sweden..
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Occupational and Environmental Medicine, Lund University, 223 63 Lund, Sweden..
    Steingrimsson, Steinn
    Psykiatri Affektiva, Sahlgrenska University Hospital, 416 50 Gothenburg, Sweden. Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden..
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ambient Temperature and Associations with Daily Visits to a Psychiatric Emergency Unit in Sweden2019Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, nr 2, artikel-id E286Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    High or low ambient temperatures pose a risk factor for the worsening or onset of psychiatric disorders. The aim of this study was to investigate the association between ambient temperature and psychiatric emergency visits in an urban region in a temperate climate. The daily number of visits to a psychiatric emergency room (PEVs) at Sahlgrenska University Hospital, Gothenburg, Sweden and the daily mean temperature were extracted for the study period 1 July 2012 to 31 December 2017. Case-crossover analysis with distributed lag non-linear models was used to analyse the data by season. The warm season was defined as May to August and the cold season as November to February. Shorter lags periods were used for the warm season than the cold season. In the analysis, temperatures at the 95th percentile was associated with 14% (95% confidence interval (CI): 2%, 28%) increase in PEVs at lag 0⁻3 and 22% (95%CI: 6%, 40%) for lags 0⁻14 during the warm season, relative to the seasonal minimum effect temperature (MET). During the cold season temperatures at the 5th percentile were associated with 25% (95% CI: -8%, 13%) and 18% (95% CI: -30%, 98%) increase in PEVs at lags 0⁻14 and 0⁻21 respectively. We observed an increased number of PEVs at high and low temperatures; however, not to a statistically significant extent for low temperatures. Our findings are similar to what has been found for somatic diseases and in studies of other mental health outcomes in regions with more extreme climates. This merits the inclusion of individuals with psychiatric disorders in awareness planning for climate warning systems.

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  • 18.
    Chandra, Mina
    et al.
    Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
    Rai, Chandra Bhushan
    Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
    Kumari, Neelam
    Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
    Sandhu, Vipindeep Kaur
    Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
    Chandra, Kalpana
    Delhi Jal Board, Government of National Capital Territory of Delhi, New Delhi, India.
    Krishna, Murali
    JSS Academy of Higher Education & Research, Karnataka, Mysore, India.
    Kota, Sri Harsha
    Department of Civil Engineering, Indian Institute of Technology Delhi, New Delhi, India.
    Anand, Kuljeet Singh
    Department of Neurology, Atal Bihari Vajpayee Institute of Medical Sciences (Formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Air Pollution and Cognitive Impairment across the Life Course in Humans: A Systematic Review with Specific Focus on Income Level of Study Area2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 3, artikel-id 1405Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Cognitive function is a crucial determinant of human capital. The Lancet Commission (2020) has recognized air pollution as a risk factor for dementia. However, the scientific evidence on the impact of air pollution on cognitive outcomes across the life course and across different income settings, with varying levels of air pollution, needs further exploration. A systematic review was conducted, using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Guidelines to assess the association between air pollution and cognitive outcomes across the life course with a plan to analyze findings as per the income status of the study population. The PubMed search included keywords related to cognition and to pollution (in their titles) to identify studies on human participants published in English until 10 July 2020. The search yielded 84 relevant studies that described associations between exposure to air pollutants and an increased risk of lower cognitive function among children and adolescents, cognitive impairment and decline among adults, and dementia among older adults with supportive evidence of neuroimaging and inflammatory biomarkers. No study from low-and middle-income countries (LMICs)was identified despite high levels of air pollutants and high rates of dementia. To conclude, air pollution may impair cognitive function across the life-course, but a paucity of studies from reLMICs is a major lacuna in research.

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  • 19.
    de Crom, Tosca O E
    et al.
    Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
    Ginos, Bigina N R
    Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Ikram, M Kamran
    Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
    Voortman, Trudy
    Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands.
    Ikram, M Arfan
    Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
    Air pollution and the risk of dementia: the Rotterdam study2023Ingår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 91, nr 2, s. 603-613Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Exposure to air pollution has been suggested to increase the risk of dementia, but studies on this link often lack a detailed screening for dementia and data on important confounders.

    OBJECTIVE: To determine the association of exposure to air pollution with the risk of dementia and cognitive decline in the population-based Rotterdam Study.

    METHODS: Between 2009 and 2010, we determined air pollutant concentrations at participants residential addresses using land use regression models. Determined air pollutants include particulate matter <10μm (PM10) and <2.5μm (PM2.5), a proxy of elemental carbon (PM2.5 absorbance), nitrogen oxide (NOx), and nitrogen dioxide (NO2). As the individual air pollutant levels were highly correlated (r = 0.71-0.98), we computed a general marker covering all air pollutants based on a principal component analysis. We followed participants up for dementia until 2018 and determined cognitive performance during two subsequent examination rounds. Using Cox and linear mixed models, we related air pollution to dementia and cognitive decline.

    RESULTS: Of the 7,511 non-demented participants at baseline, 545 developed dementia during a median follow-up of 7 years. The general marker of all air pollutants was not associated with the risk of dementia (hazard ratio [95% confidence interval]: 1.04 [0.95-1.15]), neither were the individual air pollutants. Also, the general marker of all air pollutants or the individual air pollutant levels were not associated with cognitive decline.

    CONCLUSION: In this study, we found no clear evidence for an association between exposure to air pollution and the risk of dementia or cognitive decline.

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

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

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

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

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

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

  • 21.
    Ekström, Magnus
    et al.
    Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden.
    Johannessen, Ane
    Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
    Abramson, Michael J.
    School of Public Health and Preventive Medicine, Monash University, Victoria, VIC, Melbourne, Australia.
    Benediktsdottir, Bryndis
    Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Franklin, Karl
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gislason, Thorarinn
    Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Gómez Real, Francisco
    Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
    Holm, Mathias
    Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden.
    Janson, Christer
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Jogi, Rain
    The Lung Clinic, Tartu University Hospital, Tartu, Estonia.
    Lowe, Adrian
    Melbourne School of Population and Global Health, University of Melbourne, Victoria, VIC, Melbourne, Australia.
    Malinovschi, Andrei
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Martínez-Moratalla, Jesús
    Servicio de Pneumologla Del Complejo Hospitalario Universitario de Albacete (CHUA), Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Sánchez-Ramos, José Luis
    Nursing Department, University of Huelva, Huelva, Spain.
    Schlünssen, Vivi
    Department of Public Health Environment, Work and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark; Department of Public Health, Department of Public Health, Environment, Work and Health, Danish Ramazzini Center, Copenhagen, Denmark.
    Svanes, Cecilie
    Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    Breathlessness across generations: results from the RHINESSA generation study2022Ingår i: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 77, nr 2, s. 172-177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Breathlessness is a major cause of suffering and disability globally. The symptom relates to multiple factors including asthma and lung function, which are influenced by hereditary factors. No study has evaluated potential inheritance of breathlessness itself across generations.

    Methods: We analysed the association between breathlessness in parents and their offspring in the Respiratory Health in Northern Europe, Spain and Australia generation study. Data on parents and offspring aged ≥18 years across 10 study centres in seven countries included demographics, self-reported breathlessness, asthma, depression, smoking, physical activity level, measured Body Mass Index and spirometry. Data were analysed using multivariable logistic regression accounting for clustering within centres and between siblings.

    Results: A total of 1720 parents (mean age at assessment 36 years, 55% mothers) and 2476 offspring (mean 30 years, 55% daughters) were included. Breathlessness was reported by 809 (32.7%) parents and 363 (14.7%) offspring. Factors independently associated with breathlessness in parents and offspring included obesity, current smoking, asthma, depression, lower lung function and female sex. After adjusting for potential confounders, parents with breathlessness were more likely to have offspring with breathlessness, adjusted OR 1.8 (95% CI 1.1 to 2.9). The association was not modified by sex of the parent or offspring.

    Conclusion: Parents with breathlessness were more likely to have children who developed breathlessness, after adjusting for asthma, lung function, obesity, smoking, depression and female sex in both generations. The hereditary components of breathlessness need to be further explored.

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

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

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

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

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

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

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

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

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

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

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

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

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

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  • 24.
    Flanagan, Erin
    et al.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Skåne, Sweden.
    Malmqvist, Ebba
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Skåne, Sweden.
    Gustafsson, Susanna
    Environmental Department of the City of Malmö, Malmö, Skåne, Sweden.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Skåne, Sweden.
    Estimated public health benefits of a low-emission zone in Malmö, Sweden2022Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 214, nr Part 4, artikel-id 114124Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Air pollution is one of the leading causes of morbidity and mortality worldwide. Low-emission zones (LEZ) have been increasingly implemented in cities throughout Europe as a measure to reduce the adverse health effects and premature deaths associated with traffic-related air pollution. In the present study, a health impact analysis was conducted to estimate the effect of a hypothetical LEZ on mortality and morbidity in Malmö, Sweden. Baseline health statistics were gathered from health registers and applied to each resident according to individual-level data on age and/or sex. Concentration-response parameters were derived from current epidemiological literature, specifically meta-analyses. A Gaussian dispersion model (AERMOD) combined with a detailed emission database was used to calculate NO2 emissions from traffic, which could be applied on an individual-level using data on each person's residential coordinates. The adjusted exposure scenario replaced all vehicles on municipal roads having Euro 5 or lower emission standards with Euro 6 equivalents. This LEZ would, on average, decrease NO2 concentrations by 13.4%, preventing an estimated 9-26 deaths in Malmö each year. Additionally, 12 respiratory disease hospitalizations, 8 childhood asthma cases, and 9 cases of hypertensive disorders of pregnancy were estimated to be avoided annually. These results suggest that LEZs can effectively improve air quality, reduce greenhouse gas emissions, and safeguard public health.

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  • 25.
    Flanagan, Erin
    et al.
    Division of Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University.
    Stroh, Emilie
    Division of Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Lund, Skåne, Sweden.
    Malmqvist, Ebba
    Division of Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University.
    Connecting Air Pollution Exposure to Socioeconomic Status: A Cross-Sectional Study on Environmental Injustice among Pregnant Women in Scania, Sweden2019Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, nr 24, artikel-id 5116Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Environmental injustice, characterized by lower socioeconomic status (SES) persons being subjected to higher air pollution concentrations, was explored among pregnant women in Scania, Sweden. Understanding if the general reduction of air pollution recorded is enjoyed by all SES groups could illuminate existing inequalities and inform policy development. "Maternal Air Pollution in Southern Sweden", an epidemiological database, contains data for 48,777 pregnancies in Scanian hospital catchment areas and includes births from 1999-2009. SES predictors considered included education level, household disposable income, and birth country. A Gaussian dispersion model was used to model women's average NOX and PM2.5 exposure at home residence over the pregnancy period. Total concentrations were dichotomized into emission levels below/above respective Swedish Environmental Protection Agency (EPA) Clean Air objectives. The data were analyzed using binary logistic regression. A sensitivity analysis facilitated the investigation of associations' variation over time. Lower-SES women born outside Sweden were disproportionately exposed to higher pollutant concentrations. Odds of exposure to NOX above Swedish EPA objectives reduced over time, especially for low-SES persons. Environmental injustice exists in Scania, but it lessened with declining overall air pollution levels, implying that continued air quality improvement could help protect vulnerable populations and further reduce environmental inequalities.

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  • 26. Fuks, Kateryna B.
    et al.
    Weinmayr, Gudrun
    Foraster, Maria
    Dratva, Julia
    Hampel, Regina
    Houthuijs, Danny
    Oftedal, Bente
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Panasevich, Sviatlana
    Penell, Johanna
    Nilsson Sommar, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Sørensen, Mette
    Tiittanen, Pekka
    Wolf, Kathrin
    Xun, Wei W.
    Aguilera, Inmaculada
    Basagaña, Xavier
    Beelen, Rob
    Bots, Michiel L.
    Brunekreef, Bert
    Bueno-de-Mesquita, H. Bas
    Caracciolo, Barbara
    Cirach, Marta
    de Faire, Ulf
    de Nazelle, Audrey
    Eeftens, Marloes
    Elosua, Roberto
    Erbel, Raimund
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Fratiglioni, Laura
    Gaspoz, Jean-Michel
    Hilding, Agneta
    Jula, Antti
    Korek, Michal
    Krämer, Ursula
    Künzli, Nino
    Lanki, Timo
    Leander, Karin
    Magnusson, Patrik K.
    Marrugat, Jaume
    Nieuwenhuijsen, Mark J.
    Östenson, Claes-Göran
    Pedersen, Nancy L.
    Pershagen, Göran
    Phuleria, Harish C.
    Probst-Hensch, Nicole M.
    Raaschou-Nielsen, Ole
    Schaffner, Emmanuel
    Schikowski, Tamara
    Schindler, Christian
    Schwarze, Per E.
    Søgaard, Annee J.
    Sugiri, Dorothea
    Swart, Wim J.
    Tsai, Ming-Yi
    Turunen, Anu W.
    Vineis, Paolo
    Peters, Annette
    Hoffmann, Barbara
    Arterial blood pressure and long-term exposure to traffic-related air pollution: an analysis in the European Study of Cohorts for Air Pollution Effects (ESCAPE)2014Ingår i: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 122, nr 9, s. 896-905Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    BACKGROUND: Long-term exposure to air pollution is hypothesized to elevate arterial blood pressure (BP). The existing evidence is scarce and country-specific. OBJECTIVES: We investigated the cross-sectional association of long-term traffic-related air pollution with BP and prevalent hypertension in European populations. METHODS: Fifteen population-based cohorts, participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE), were analysed. Residential exposure to particulate matter and nitrogen oxides was modelled with land use regression using a uniform protocol. Traffic exposure was assessed with traffic indicator variables. We analysed systolic and diastolic BP in participants medicated and non-medicated with BP lowering medication (BPLM) separately, adjusting for personal and area-level risk factors and environmental noise. Prevalent hypertension was defined as ≥ 140 mmHg systolic, or ≥ 90 mmHg diastolic BP, or intake of BPLM. We combined cohort-specific results using random-effects meta-analysis. RESULTS: In the main meta-analysis of 113,926 participants, traffic load on major roads within 100 m of the residence was associated with increased systolic and diastolic BP in non-medicated participants (0.35 mmHg [95% CI: 0.02-0.68] and 0.22 mmHg [95% CI: 0.04-0.40] per 4,000,000 vehicles × m/day, respectively). The estimated odds ratio for prevalent hypertension was 1.05 [95% CI: 0.99-1.11] per 4,000,000 vehicles × m/day. Modelled air pollutants and BP were not clearly associated. CONCLUSIONS: In this first comprehensive meta-analysis of European population-based cohorts we observed a weak positive association of high residential traffic exposure with BP in non-medicated participants, and an elevated OR for prevalent hypertension. The relationship of modelled air pollutants with BP was inconsistent.

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  • 27.
    Haargaard, Birgitte
    et al.
    Department of Epidemiology Research, Statens Serum Institut, Denmark & Department of Ophthalmology, Glostrup University Hospital, Copenhagen, Denmark.
    Andersen, Elisabeth W
    Department of Epidemiology Research, Statens Serum Institut, Denmark.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Epidemiology Research, Statens Serum Institut, Denmark.
    Poulsen, Gry
    Department of Epidemiology Research, Statens Serum Institut, Denmark.
    Wohlfahrt, Jan
    Department of Epidemiology Research, Statens Serum Institut, Denmark.
    la Cour, Morten
    Department of Ophthalmology, Glostrup University Hospital, Copenhagen, Denmark .
    Melbye, Mads
    Department of Epidemiology Research, Statens Serum Institut, Denmark.
    Risk of retinal detachment after pediatric cataract surgery2014Ingår i: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 55, nr 5, s. 2947-2951Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To determine the long-term risk of retinal detachment following pediatric cataract surgery and to identify risk factors for retinal detachment.

    METHODS: We included all children (aged 0 to 17 years) who during the time period of 1977 to 2005 underwent pediatric cataract surgery in Denmark, excluding cataract cases caused by trauma, or acquired systemic or acquired ocular pathology, and cases with ocular anomalies associated with the development of retinal detachment. Cases of cataract were ascertained from the mandatory Danish National Patient Register, and information on retinal detachment was based on medical chart review.

    RESULTS: Among 1043 eyes of 656 children undergoing surgery for pediatric cataract, 25 eyes (23 children) developed retinal detachment at a median time of 9.1 years after surgery. The overall 20-year risk of retinal detachment was 7% (95% confidence interval [CI]: 3%-11%) among cataract patients. In otherwise normal children having isolated cataract, the risk was 3% (95% CI: 0%-7%). A significantly higher risk of developing retinal detachment was found in children with mental retardation (23% [95% CI: 9%-35%]) or in cataract cases with other ocular or systemic anomalies (16% [95% CI: 6%-24%]).

    CONCLUSIONS: The estimated overall risk of retinal detachment 20 years after pediatric cataract surgery was 7%, but only 3% for isolated cataract. Particularly high risks of retinal detachment after cataract surgery were associated with mental retardation and having other ocular or systemic diseases.

  • 28. Hansson, Erik
    et al.
    Cuadra, Steven
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    de Jong, Kim
    Stroh, Emilie
    Torén, Kjell
    Albin, Maria
    Mapping snakebite epidemiology in Nicaragua: pitfalls and possible solutions2010Ingår i: PLoS neglected tropical diseases, ISSN 1935-2735, Vol. 4, nr 11, s. e896-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Using publicly available data, we identified areas likely to be underreporting snakebites and highlighted these areas instead of leaving them "white" on the incidence map. The effects of the case detection bias on the distribution of resources against snakebites could decrease. Although not yet verified empirically, our study provides an example of how snake bite epidemiology may be investigated in similar settings worldwide at a low cost.

  • 29.
    Holmström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    de Luna, Xavier
    Umeå universitet, Samhällsvetenskapliga fakulteten, Statistiska institutionen.
    Nilsson, Karina
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Lindgren, Urban
    Umeå universitet, Samhällsvetenskapliga fakulteten, Kulturgeografiska institutionen.
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    SIMSAM-nätverket i Umeå strävar mot att bli ett framstående center för registerforskning som knyter samman barndomen med livslång hälsa och välfärd2011Ingår i: SVEPET - Medlemstidning för Svensk Epidemiologisk Förening (SVEP), ISSN 1101-4385, Vol. 29, nr 3, s. 8-9Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [sv]

    Vetenskapsrådets SIMSAM initiativ syftar till att stärka multidisciplinär registerforskning i Sverige. Inom SIMSAM-nätverket i Umeå arbetar vi tvärvetenskapligt med sikte på att utvecklas till ett center med excellens kring mikrodataforskning som knyter samman barndomen med livslång hälsa och välfärd. Just nu fokuserar vi på att få tillgång till sammanlänkade data från ett flertal nationella och regionala register för att komma vidare med vår planerade forskning. Dessutom har Umeå-nätverket nyligen fått i uppdrag att leda den nationella samordningen av SIMSAM initiativet.

  • 30.
    Kennedy, Beatrice
    et al.
    Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Fitipaldi, Hugo
    Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Lund, Sweden.
    Hammar, Ulf
    Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Maziarz, Marlena
    Diabetic Complications Unit, Department of Clinical Sciences in Malmö, Lund University Diabetes Centre, Lund, Sweden.
    Tsereteli, Neli
    Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Lund, Sweden.
    Oskolkov, Nikolay
    Department of Biology, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Lund University, Lund, Sweden.
    Varotsis, Georgios
    Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Franks, Camilla A.
    Diabetic Complications Unit, Department of Clinical Sciences in Malmö, Lund University Diabetes Centre, Lund, Sweden.
    Nguyen, Diem
    Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Spiliopoulos, Lampros
    Diabetic Complications Unit, Department of Clinical Sciences in Malmö, Lund University Diabetes Centre, Lund, Sweden; Skåne University Hospital, Malmö, Sweden.
    Adami, Hans-Olov
    Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Harvard T.H. Chan School of Public Health, MA, Boston, United States.
    Björk, Jonas
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden.
    Engblom, Stefan
    Division of Scientific Computing, Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Fall, Katja
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Grimby-Ekman, Anna
    Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Litton, Jan-Eric
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Martinell, Mats
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Primary Care and Health, Region Uppsala, Uppsala, Sweden.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Sjöström, Torbjörn
    Novus Group International AB, Stockholm, Sweden.
    Timpka, Toomas
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Sudre, Carole H.
    MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom; Centre for Medical Image Computing, University College London, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom.
    Graham, Mark S.
    School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom.
    du Cadet, Julien Lavigne
    ZOE Limited, 164 Westminster Bridge Road, London, United Kingdom.
    Chan, Andrew T.
    Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, MA, Boston, United States.
    Davies, Richard
    ZOE Limited, 164 Westminster Bridge Road, London, United Kingdom.
    Ganesh, Sajaysurya
    ZOE Limited, 164 Westminster Bridge Road, London, United Kingdom.
    May, Anna
    ZOE Limited, 164 Westminster Bridge Road, London, United Kingdom.
    Ourselin, Sébastien
    School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom.
    Pujol, Joan Capdevila
    ZOE Limited, 164 Westminster Bridge Road, London, United Kingdom.
    Selvachandran, Somesh
    ZOE Limited, 164 Westminster Bridge Road, London, United Kingdom.
    Wolf, Jonathan
    ZOE Limited, 164 Westminster Bridge Road, London, United Kingdom.
    Spector, Tim D.
    Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom.
    Steves, Claire J.
    Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom.
    Gomez, Maria F.
    Diabetic Complications Unit, Department of Clinical Sciences in Malmö, Lund University Diabetes Centre, Lund, Sweden.
    Franks, Paul W.
    Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Lund, Sweden.
    Fall, Tove
    Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    App-based COVID-19 syndromic surveillance and prediction of hospital admissions in COVID Symptom Study Sweden2022Ingår i: Nature Communications, E-ISSN 2041-1723, Vol. 13, nr 1, artikel-id 2110Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The app-based COVID Symptom Study was launched in Sweden in April 2020 to contribute to real-time COVID-19 surveillance. We enrolled 143,531 study participants (≥18 years) who contributed 10.6 million daily symptom reports between April 29, 2020 and February 10, 2021. Here, we include data from 19,161 self-reported PCR tests to create a symptom-based model to estimate the individual probability of symptomatic COVID-19, with an AUC of 0.78 (95% CI 0.74–0.83) in an external dataset. These individual probabilities are employed to estimate daily regional COVID-19 prevalence, which are in turn used together with current hospital data to predict next week COVID-19 hospital admissions. We show that this hospital prediction model demonstrates a lower median absolute percentage error (MdAPE: 25.9%) across the five most populated regions in Sweden during the first pandemic wave than a model based on case notifications (MdAPE: 30.3%). During the second wave, the error rates are similar. When we apply the same model to an English dataset, not including local COVID-19 test data, we observe MdAPEs of 22.3% and 19.0% during the first and second pandemic waves, respectively, highlighting the transferability of the prediction model.

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  • 31.
    Kitaba, Negusse Tadesse
    et al.
    Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
    Knudsen, Gerd Toril Mørkve
    Department of Clinical Sciences, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    Johannessen, Ane
    Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
    Rezwan, Faisal I.
    Department of Computer Science, Aberystwyth University, Aberystwyth, United Kingdom.
    Malinovschi, Andrei
    Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Benediktsdottir, Bryndis
    Department of Allergy, Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Martino, David
    Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia.
    González, Francisco Javier Callejas
    Department of Pulmonology, Albacete University Hospital Complex, Albacete, Spain.
    Gómez, Leopoldo Palacios
    El Torrejón Health Centre, Andalusian Health Service, Huelva, Spain.
    Holm, Mathias
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Jõgi, Nils Oskar
    Department of Clinical Sciences, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    Dharmage, Shyamali C.
    Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
    Skulstad, Svein Magne
    Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    Watkins, Sarah H.
    University of Bristol, MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, Bristol, United Kingdom.
    Suderman, Matthew
    University of Bristol, MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, Bristol, United Kingdom.
    Gómez-Real, Francisco
    Department of Clinical Sciences, University of Bergen, Bergen, Norway; Department of Gynaecology and Obstetrics, Haukeland University Hospital, Bergen, Norway.
    Schlünssen, Vivi
    Department of Public Health, Work, Environment and Health, Danish Ramazzini Centre, Aarhus University Denmark, Aarhus, Denmark; National Research Center for the Working Environment, Copenhagen, Denmark.
    Svanes, Cecilie
    Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
    Holloway, John W.
    Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Center, University Hospitals Southampton, Southampton, United Kingdom.
    Fathers’ preconception smoking and offspring DNA methylation2023Ingår i: Clinical Epigenetics, E-ISSN 1868-7083, Vol. 15, nr 1, artikel-id 131Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Experimental studies suggest that exposures may impact respiratory health across generations via epigenetic changes transmitted specifically through male germ cells. Studies in humans are, however, limited. We aim to identify epigenetic marks in offspring associated with father’s preconception smoking.

    Methods: We conducted epigenome-wide association studies (EWAS) in the RHINESSA cohort (7–50 years) on father’s any preconception smoking (n = 875 offspring) and father’s pubertal onset smoking < 15 years (n = 304), using Infinium MethylationEPIC Beadchip arrays, adjusting for offspring age, own smoking and maternal smoking. EWAS of maternal and offspring personal smoking were performed for comparison. Father’s smoking-associated dmCpGs were checked in subpopulations of offspring who reported no personal smoking and no maternal smoking exposure.

    Results: Father’s smoking commencing preconception was associated with methylation of blood DNA in offspring at two cytosine-phosphate-guanine sites (CpGs) (false discovery rate (FDR) < 0.05) in PRR5 and CENPP. Father’s pubertal onset smoking was associated with 19 CpGs (FDR < 0.05) mapped to 14 genes (TLR9, DNTT, FAM53B, NCAPG2, PSTPIP2, MBIP, C2orf39, NTRK2, DNAJC14, CDO1, PRAP1, TPCN1, IRS1 and CSF1R). These differentially methylated sites were hypermethylated and associated with promoter regions capable of gene silencing. Some of these sites were associated with offspring outcomes in this cohort including ever-asthma (NTRK2), ever-wheezing (DNAJC14, TPCN1), weight (FAM53B, NTRK2) and BMI (FAM53B, NTRK2) (p < 0.05). Pathway analysis showed enrichment for gene ontology pathways including regulation of gene expression, inflammation and innate immune responses. Father’s smoking-associated sites did not overlap with dmCpGs identified in EWAS of personal and maternal smoking (FDR < 0.05), and all sites remained significant (p < 0.05) in analyses of offspring with no personal smoking and no maternal smoking exposure. Conclusion: Father’s preconception smoking, particularly in puberty, is associated with offspring DNA methylation, providing evidence that epigenetic mechanisms may underlie epidemiological observations that pubertal paternal smoking increases risk of offspring asthma, low lung function and obesity.

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  • 32.
    Kriit, Hedi Katre
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Tornblad Institute, Biskopsgatan 7, 223v62, Lund, Sweden..
    Annual dementia incidence and monetary burden attributable to fine particulate matter (PM2.5) exposure in Sweden2021Ingår i: Environmental Health, E-ISSN 1476-069X, Vol. 20, nr 1, artikel-id 65Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Alzheimer's disease (AD) and other dementias currently represent the fifth most common cause of death in the world, according to the World Health Organization, with a projected future increase as the proportion of the elderly in the population is growing. Air pollution has emerged as a plausible risk factor for AD, but studies estimating dementia cases attributable to exposure to fine particulate matter (PM2.5) air pollution and resulting monetary estimates are lacking.

    METHODS: We used data on average population-weighted exposure to ambient PM2.5 for the entire population of Sweden above 30 years of age. To estimate the annual number of dementia cases attributable to air pollution in the Swedish population above 60 years of age, we used the latest concentration response functions (CRF) between PM2.5 exposure and dementia incidence, based on ten longitudinal cohort studies, for the population above 60 years of age. To estimate the monetary burden of attributable cases, we calculated total costs related to dementia, including direct and indirect lifetime costs and intangible costs by including quality-adjusted life years (QALYs) lost. Two different monetary valuations of QALYs in Sweden were used to estimate the monetary value of reduced quality-of-life from two different payer perspectives.

    RESULTS: The annual number of dementia cases attributable to PM2.5 exposure was estimated to be 820, which represents 5% of the annual dementia cases in Sweden. Direct and indirect lifetime average cost per dementia case was estimated to correspond € 213,000. A reduction of PM2.5 by 1 μg/m3 was estimated to yield 101 fewer cases of dementia incidences annually, resulting in an estimated monetary benefit ranging up to 0.01% of the Swedish GDP in 2019.

    CONCLUSION: This study estimated that 5% of annual dementia cases could be attributed to PM2.5 exposure, and that the resulting monetary burden is substantial. These findings suggest the need to consider airborne toxic pollutants associated with dementia incidence in public health policy decisions.

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  • 33. Kuiper, Ingrid Nordeide
    et al.
    Svanes, Cecilie
    Abramson, Michael J.
    Benediktsdottir, Bryndis
    Bertelsen, Randi J.
    Dennekamp, Martine
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Gislason, Thorarinn
    Halvorsen, Thomas
    Heinrich, Joachim
    Holm, Mathias
    Janson, Christer
    Jögi, Rain
    Malinovschi, Andrei
    Marcon, Alessandro
    Markevych, Iana
    Moratalla, Jesús M.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Division of Occupational and Environmental Medicine, Lund University, Sweden.
    Pearce, John L.
    Schlünssen, Vivi
    Vega, Antonio P.
    Johannessen, Ane
    Lung health in adulthood after childhood exposure to air pollution and greenness2018Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: Little is known on childhood exposure to air pollution and adult chronic respiratory outcomes.

    Aim: To investigate associations between air pollution and greenness in childhood and adult lung health.

    Methods: In selected centres of the RHINESSA study (age 18-52) we analysed the outcomes respiratory symptoms (≥3 symptoms), severe wheeze (wheeze last year with breathlessness, no cold) and late onset asthma (>10 years). We calculated mean annual exposures of PM2.5, PM10, NO2 (µg/m³) and greenness (Normalized Difference Vegetation Index, 100m buffer) from offspring's birth till age 18, categorised into mean exposure <10 years and 11-18 years. We performed multilevel logistic regression clustered by family, stratified by centre and adjusted for childhood passive smoke and parental asthma.

    Results: 12% had ≥3 respiratory symptoms, 7.7% severe wheeze, and 9.4% late onset asthma. Overall estimates: greenness was associated with less respiratory symptoms, PM2.5 and NO2 with more late onset asthma. Exposure <10 years: Greenness was associated with less wheeze in Tartu (OR 0.29, 95%CI 0.11-0.73). PM2.5 (OR 1.22, 95%CI 1.00-1.48) and NO2 (OR 1.06, 95%CI 1.01-1.11) were risk factors for late onset asthma in Bergen. PM10 was a risk factor for respiratory symptoms (OR 1.21, 95%CI 1.04-1.41) in Uppsala and late onset asthma (OR 1.23, 95%CI 1.02-1.45) in Bergen. Exposure 11-18 years: Greenness was protective for respiratory symptoms (OR 0.29, 95%CI 0.10-0.86) and wheeze (OR 0.39, 95%CI 0.19-0.80) in Tartu.

    Conclusions: Childhood exposure to greenness was associated with less respiratory symptoms, while air pollutants were associated with more respiratory symptoms (some centres) and late onset asthma.

  • 34.
    Leander, Mai
    et al.
    Uppsala Univ, Dept Med Sci Occupat & Environm Med, SE-75185 Uppsala, Sweden.
    Lampa, Erik
    Uppsala Univ, Dept Med Sci Occupat & Environm Med, SE-75185 Uppsala, Sweden.
    Rask-Andersen, Anna
    Uppsala Univ, Dept Med Sci Occupat & Environm Med, SE-75185 Uppsala, Sweden.
    Franklin, Karl
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gislason, Thorarinn
    Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Svanes, Cecilie
    Univ Bergen, Inst Med, Bergen Resp Res Grp, Bergen, Norway.
    Toren, Kjell
    Med Univ Gothenburg, Sect Occupat & Environm Med, S-40530 Gothenburg, Sweden.
    Janson, Christer
    Uppsala Univ, Dept Med Sci Resp Med & Allergol, SE-75185 Uppsala, Sweden.
    Impact of anxiety and depression on respiratory symptoms2014Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 108, nr 11, s. 1594-1600Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Psychological factors such as anxiety and depression are prevalent in patients with asthma. The purpose of this study was to investigate the relationship between respiratory symptoms and psychological status and to estimate the importance of psychological status in comparison with other factors that are known to be associated with respiratory symptoms. This study included 2270 subjects aged 20-44 (52% female) from Sweden, Iceland, and Norway. Each participant underwent a clinical interview including questions on respiratory symptoms. Spirometry and methacholine challenge were performed. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Eighty-two percent of the subjects reported no anxiety or depression whatsoever, 11% reported anxiety, 2.5% depression and 4% reported both anxiety and depression. All respiratory symptoms, such as wheezing, breathlessness and nightly symptoms, were more common, at a statistically significant level, in participants who had depression and anxiety, even after adjusting for confounders (ORs 1.33-1.94). The HADS score was the most important determinant for nightly symptoms and attacks of breathlessness when at rest whereas bronchial responsiveness was the most important determinant for wheezing, and breathlessness when wheezing. The probability of respiratory symptoms related to HADS score increased with increasing HADS score for all respiratory symptoms. In conclusion, there is a strong association between respiratory symptoms and psychological status. There is therefore a need for interventional studies designed to improve depression and anxiety in patients with respiratory symptoms.

  • 35.
    Lepistö, Teemu
    et al.
    Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, Finland.
    Lintusaari, Henna
    Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, Finland.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Barreira, Luis M.F.
    Atmospheric Composition Research, Finnish Meteorological Institute, Helsinki, Finland.
    Niemi, Jarkko V.
    Helsinki Region Environmental Services Authority HSY, Helsinki, Finland.
    Karjalainen, Panu
    Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, Finland.
    Salo, Laura
    Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, Finland.
    Silvonen, Ville
    Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, Finland.
    Markkula, Lassi
    Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, Finland.
    Hoivala, Jussi
    Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, Finland.
    Marjanen, Petteri
    Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, Finland.
    Martikainen, Sampsa
    Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, Finland.
    Aurela, Minna
    Atmospheric Composition Research, Finnish Meteorological Institute, Helsinki, Finland.
    Reyes, Felipe Reyes
    Centro Mario Molina Chile, Santiago, Chile.
    Oyola, Pedro
    Centro Mario Molina Chile, Santiago, Chile.
    Kuuluvainen, Heino
    Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, Finland.
    Manninen, Hanna E.
    Helsinki Region Environmental Services Authority HSY, Helsinki, Finland.
    Schins, Roel P.F.
    IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
    Vojtisek-Lom, Michal
    Centre of Vehicles for Sustainable Mobility, Faculty of Mechanical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
    Ondracek, Jakub
    Laboratory of Aerosol Chemistry and Physics, ICPF CAS, Prague, Czech Republic.
    Topinka, Jan
    Department of Genetic Toxicology and Epigenetics, Institute of Experimental Medicine AS CR, Prague, Czech Republic.
    Timonen, Hilkka
    Atmospheric Composition Research, Finnish Meteorological Institute, Helsinki, Finland.
    Jalava, Pasi
    Inhalation Toxicology Laboratory, Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland.
    Saarikoski, Sanna
    Atmospheric Composition Research, Finnish Meteorological Institute, Helsinki, Finland.
    Rönkkö, Topi
    Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, Finland.
    Particle lung deposited surface area (LDSAal) size distributions in different urban environments and geographical regions: Towards understanding of the PM2.5 dose–response2023Ingår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 180, artikel-id 108224Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Recent studies indicate that monitoring only fine particulate matter (PM2.5) may not be enough to understand and tackle the health risk caused by particulate pollution. Health effects per unit PM2.5 seem to increase in countries with low PM2.5, but also near local pollution sources (e.g., traffic) within cities. The aim of this study is to understand the differences in the characteristics of lung-depositing particles in different geographical regions and urban environments. Particle lung deposited surface area (LDSAal) concentrations and size distributions, along with PM2.5, were compared with ambient measurement data from Finland, Germany, Czechia, Chile, and India, covering traffic sites, residential areas, airports, shipping, and industrial sites. In Finland (low PM2.5), LDSAal size distributions depended significantly on the urban environment and were mainly attributable to ultrafine particles (<100 nm). In Central Europe (moderate PM2.5), LDSAal was also dependent on the urban environment, but furthermore heavily influenced by the regional aerosol. In Chile and India (high PM2.5), LDSAal was mostly contributed by the regional aerosol despite that the measurements were done at busy traffic sites. The results indicate that the characteristics of lung-depositing particles vary significantly both within cities and between geographical regions. In addition, ratio between LDSAal and PM2.5 depended notably on the environment and the country, suggesting that LDSAal exposure per unit PM2.5 may be multiple times higher in areas having low PM2.5 compared to areas with continuously high PM2.5. These findings may partly explain why PM2.5 seems more toxic near local pollution sources and in areas with low PM2.5. Furthermore, performance of a typical sensor based LDSAal measurement is discussed and a new LDSAal2.5 notation indicating deposition region and particle size range is introduced. Overall, the study emphasizes the need for country-specific emission mitigation strategies, and the potential of LDSAal concentration as a health-relevant pollution metric.

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  • 36. Lisberg Jensen, Ebba
    et al.
    Westerberg, Karin
    Malmqvist, Ebba
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Tornblad Institute, Lund, Sweden.
    Through Internet and Friends: Translation of Air Pollution Research in Malmö Municipality, Sweden2020Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, nr 12, artikel-id 4214Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Air pollution is estimated to cause more than 7000 deaths annually in Sweden alone. To reduce the impact of air pollution and to plan and build sustainable cities, it is vital that research is translated into efficient decisions and practice. However, how do civil servants in a municipality access research results? How do they normally find relevant information, and what obstacles are there to accessing and applying research results? As part of the collaborative and transdisciplinary research project Air Pollution Research in Local Environmental Planning (ARIEL), these questions were explored through interviews and seminars with civil servants within the Malmö Municipality Environmental Office. We found that the civil servants generally have proficiency in processing research results, but often do not use such results as part of their everyday decision making and practices. Instead, the data and measurements used are mostly produced case-by-case within the municipal sector itself. Information about best practices is also collected via a number of knowledge access practices, involving the Internet or social networks within other municipalities. Lack of time, paywalls, and the insufficient applicability of research hinder the dissemination of up-to-date results. This slows down the process whereby research, funded by tax-money, can be put to best practice in the effort to create healthy and sustainable cities.

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  • 37. Madsen, Marie Kjær
    et al.
    Schlünssen, Vivi
    Svanes, Cecilie
    Johannessen, Ane
    Jõgi, Nils Oskar
    Holm, Mathias
    Janson, Christer
    Pereira-Vega, Antonio
    Lowe, Adrian J.
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Malinovschi, Andrei
    Sigsgaard, Torben
    Abramson, Michael J.
    Bertelsen, Randi
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Gislason, Thorarinn
    Timm, Signe
    The effect of farming environment on asthma: time dependent or universal?2022Ingår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 37, s. 779-788Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The increasing prevalence of asthma is linked to westernization and urbanization. Farm environments have been associated with a lower risk of asthma development. However, this may not be universal, as the association differs across birth cohorts and farming methods. The aim of this study was to investigate the associations of farm upbringing with asthma in different generations and at different times in history. The study population consisted of three generations: 13,868 subjects participating in the ECRHS in 2010, their 9,638 parents, and their 8,885 offspring participating in RHINESSA in 2013. Information on place of upbringing and self-reported ever asthma was provided via questionnaires. Logistic regression was performed including subgroup analysis stratified by generation and birthyear into ten-year-intervals. The prevalence of asthma increased from 8% among grandparents to 13% among parents and to 18% among offspring. An overall analysis showed an inverse association of farm upbringing on the risk of asthma (OR = 0.64; 95%CI 0.55-0.74). Subgroup analysis stratified into ten-year-intervals showed a tendency towards a more pronounced inverse association between growing up on a farm and asthma among subjects born in the 1940s (0.74; 0.48-1.12), 1950s (0.70; 0.54-0.90) and 1960s (0.70; 0.52-0.93). For subjects born in 1970 and thereafter this association appeared less consistent. While growing up on a farm was associated with a reduced risk of developing asthma in participants born between 1945-1999, this was mainly driven by generations born from 1945 to 1973.

  • 38.
    Malmqvist, Ebba
    et al.
    Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Sweden..
    Lisberg Jensen, Ebba
    Dept. of urban studies, Malmö University, Sweden..
    Westerberg, Karin
    Dept. of urban studies, Malmö University, Sweden..
    Stroh, Emilie
    Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Sweden..
    Rittner, Ralf
    Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Sweden..
    Gustafsson, Susanna
    Environmental Department of the City of Malmö, Sweden..
    Spanne, Mårten
    Environmental Department of the City of Malmö, Sweden..
    Nilsson, Henric
    Environmental Department of the City of Malmö, Sweden..
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Sweden..
    Estimated health benefits of exhaust free transport in the city of Malmö, Southern Sweden2018Ingår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 118, s. 78-85Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Air pollution is responsible for one in eight premature deaths worldwide, and thereby a major threat to human health. Health impact assessments of hypothetic changes in air pollution concentrations can be used as a mean of assessing the health impacts of policy, plans and projects, and support decision-makers in choices to prevent disease.

    The aim of this study was to estimate health impacts attributable to a hypothetical decrease in air pollution concentrations in the city of Malmö in Southern Sweden corresponding to a policy on-road transportations without tail-pipe emissions in the municipality. We used air pollution data modelled for each of the 326,092 inhabitants in Malmö by a Gaussian dispersion model combined with an emission database with >40,000 sources. The dispersion model calculates Nitrogen Oxides (NOx) (later transformed into Nitrogen Dioxide (NO2)) and particulate matter with an aerodynamic diameter < 2.5 μg/m3 (PM2.5) with high spatial and temporal resolution (85 m and 1 h, respectively).

    The average individual reduction was 5.1 (ranging from 0.6 to 11.8) μg/m3 in NO2, which would prevent 55 (2% of all deaths) to 93 (4%) deaths annually, depending on dose-response function used. Furthermore, we estimate that the NO2 reduction would result in 21 (6%) fewer cases of incident asthma in children, 95 (10%) fewer children with bronchitis every year, 30 (1%) fewer hospital admissions for respiratory disease, 87(4%) fewer dementia cases, and 11(11%) fewer cases of preeclampsia every year. The average reduction in PM2.5 of 0.6 (ranging from 0.1 till 1.7) μg/m3 would mean that 2729 (0.3%) work days would not be lost due to sick-days and that there would be 16,472 fewer restricted activity days (0.3%) that year had all on-road transportations been without tail-pipe emissions.

    Even though the estimates are sensitive to the dose-response functions used and to exposure misclassification errors, even the most conservative estimate of the number of prevented deaths is 7 times larger than the annual traffic fatalities in Malmö, indicating a substantial possibility to reduce the health burden attributed to tail-pipe emissions in the study area.

  • 39.
    Malmqvist, Ebba
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Occupational and Environmental Medicine, Lund University, Lund, Sweden..
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Occupational and Environmental Medicine, Lund University, Lund, Sweden..
    Pascal, M
    Medina, S
    Choices behind numbers: a review of the major air pollution health impact assessments in Europe2018Ingår i: Current environmental health reports, ISSN 2196-5412, Vol. 5, nr 1, s. 34-43Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    PURPOSE OF REVIEW: The aim of this review is to identify the key contextual and methodological differences in health impact assessments (HIA) of ambient air pollution performed for Europe. We limited our review to multi-country reviews. An additional aim is to quantify some of these differences by applying them in a HIA template in three European cities.

    RECENT FINDINGS: Several HIAs of ambient air pollution have been performed for Europe, and their key results have been largely disseminated. Different studies have, however, come up with substantial differences in attributed health effects. It is of importance to review the background contributing to these differences and to quantify their importance for decision makers who will use them. We identified several methodological differences that could explain the discrepancy behind the number of attributable deaths or years of life lost. The main differences are due to the exposure-response functions chosen, the ways of assessing air pollution levels, the air pollution scenarios and the study population. In the quantification part, we found that using risk estimates from the European Study of Cohorts for Air Pollution Effects (ESCAPE) instead of the American Cancer Society (ACS) study could nearly double the attributable burden of ambient air pollution. This study provides some insights into the differential results in previously published HIAs on air pollution in Europe. These results are important for stakeholders in order to make informed decisions.

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  • 40.
    Mandakh, Yumjirmaa
    et al.
    Environment Society and Health, Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Environment Society and Health, Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Erlandsson, Lena
    Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Isaxon, Christina
    Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden.
    Hansson, Stefan R.
    Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Obstetrics & Gynaecology, Skåne University Hospital, Malmö, Sweden.
    Broberg, Karin
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Malmqvist, Ebba
    Environment Society and Health, Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Association of prenatal ambient air pollution exposure with placental mitochondrial DNA copy number, telomere length and preeclampsia2021Ingår i: Frontiers in Toxicology, E-ISSN 2673-3080, Vol. 3, artikel-id 659407Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Studies have shown that ambient air pollution is linked to preeclampsia (PE), possibly via generation of oxidative stress in the placenta. Telomere length and mitochondrial DNA copy number (mtDNAcn) are sensitive to oxidative stress damage. Objective: To study the association between prenatal exposure to ambient nitrogen oxides (NOx, a marker for traffic-related air pollution), and PE, as well as potential mediation effects by placental telomere length and mtDNAcn.

    Methods: This is a cross-sectional study of 42 preeclamptic and 95 arbitrarily selected normotensive pregnant women with gestational ambient NOx exposure assessment in southern Scania, Sweden. Hourly concentrations of NOx were estimated at the residential addresses by a Gaussian-plume dispersion model with 100 × 100 m spatial resolutions and aggregated into trimester-specific mean concentrations. Placental relative mtDNAcn and telomere length were measured using qPCR. Linear and logistic regression models were used to investigate associations, adjusted for perinatal and seasonal characteristics.

    Results: Exposure was categorized into low and high exposures by median cut-offs during first [11.9 μg/m3; interquartile range (IQR) 7.9, 17.9], second (11.6 μg/m3; IQR: 7.1, 21.1), third trimesters (11.9 μg/m3; IQR: 7.7, 19.5) and entire pregnancy (12.0 μg/m3; IQR: 7.6, 20.1). Increased risk of PE was found for high prenatal NOx exposure during the first trimester (OR 4.0; 95% CI: 1.4, 11.1; p = 0.008), and entire pregnancy (OR 3.7; 95% CI: 1.3, 10.4; p = 0.012). High exposed group during the first trimester had lower placental relative mtDNAcn compared with low exposed group (−0.20; 95% CI: −0.36, −0.04; p = 0.01). Changes in relative mtDNAcn did not mediate the association between prenatal NOx exposure and PE. No statistically significant association was found between placental relative telomere length, prenatal NOx exposure and PE.

    Conclusion: In this region with relatively low levels of air pollution, ambient NOx exposure during the first trimester was associated with reduced placental relative mtDNAcn and an increased risk of PE. However, we did not find any evidence that mtDNAcn or TL mediated the association between air pollution and PE. Future research should further investigate the role of mtDNAcn for pregnancy complications in relation to exposure to ambient air pollution during pregnancy.

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  • 41.
    Martikainen, Maria-Viola
    et al.
    Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland.
    Aakko-Saksa, Päivi
    VTT Technical Research Centre of Finland Ltd., Espoo, Finland.
    Broek, Lenie van den
    Mimetas BV, Oegstgeest, Netherlands.
    Cassee, Flemming R.
    Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands; Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands.
    Carare, Roxana O.
    Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
    Chew, Sweelin
    A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
    Dinnyes, Andras
    Biotalentum Ltd., Godollo, Hungary.
    Giugno, Rosalba
    Computer Science Department, University of Verona, Verona, Italy.
    Kanninen, Katja M.
    A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
    Malm, Tarja
    A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
    Muala, Ala
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Nedergaard, Maiken
    Center for Translational Neuromedicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Oyola, Pedro
    Centro Mario Molina Chile, Strategic Studies Department, Santiago, Chile.
    Pfeiffer, Tobias V.
    VSParticle B.V., Delft, Netherlands.
    Rönkkö, Topi
    Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, Finland.
    Saarikoski, Sanna
    Atmospheric Composition Research, Finnish Meteorological Institute, Helsinki, Finland.
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Schins, Roel P.F.
    IUF—Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
    Topinka, Jan
    Department of Genetic Toxicology and Epigenetics, Institute of Experimental Medicine of the CAS, Videnska 1083, Prague, Czech Republic.
    Yang, Mo
    Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland.
    Zeng, Xiaowen
    Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.
    Westerink, Remco H.S.
    Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands.
    Jalava, Pasi I.
    Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland.
    TUBE project: Transport-derived ultrafines and the brain effects2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 1, artikel-id 311Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The adverse effects of air pollutants on the respiratory and cardiovascular systems are unquestionable. However, in recent years, indications of effects beyond these organ systems have become more evident. Traffic-related air pollution has been linked with neurological diseases, exacerbated cognitive dysfunction, and Alzheimer’s disease. However, the exact air pollutant compositions and exposure scenarios leading to these adverse health effects are not known. Although several components of air pollution may be at play, recent experimental studies point to a key role of ultrafine particles (UFPs). While the importance of UFPs has been recognized, almost nothing is known about the smallest fraction of UFPs, and only >23 nm emissions are regulated in the EU. Moreover, the role of the semivolatile fraction of the emissions has been neglected. The Transport-Derived Ultrafines and the Brain Effects (TUBE) project will increase knowledge on harmful ultrafine air pollutants, as well as semivolatile compounds related to adverse health effects. By including all the major current combustion and emission control technologies, the TUBE project aims to provide new information on the adverse health effects of current traffic, as well as information for decision makers to develop more effective emission legislation. Most importantly, the TUBE project will include adverse health effects beyond the respiratory system; TUBE will assess how air pollution affects the brain and how air pollution particles might be removed from the brain. The purpose of this report is to describe the TUBE project, its background, and its goals.

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  • 42.
    Muhsin, Huda Ahmed
    et al.
    University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.
    Steingrimsson, Steinn
    University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden; Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Occupational and Environmental Medicine, Dept. for Laboratory Medicine, Lund University, Lund, Sweden.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Occupational and Environmental Medicine, Dept. for Laboratory Medicine, Lund University, Lund, Sweden.
    Carlsen, Hanne Krage
    Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Air pollution and increased number of psychiatric emergency room visits: A case-crossover study for identifying susceptible groups2022Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 204, artikel-id 112001Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Ambient particulate matter is a leading risk factor for disease globally. Particulate matter 10 (PM10) and particulate matter 2.5 (PM2.5) are derived from different sources, including operating motor vehicles as well as from industrial activities. In this study we investigate the association between increased concentrations of PM and total daily visits to the psychiatric emergency unit (PEV). Further, the aim is to identify specific risk groups who are more susceptible to the effects of air pollution exposure by studying sex, age, ongoing psychiatric follow-up and diagnoses of depression/anxiety or substance use.

    Material and methods: The sample was comprised of data from 2740 days to 81 548 PEVs at Sahlgrenska University Hospital in Gothenburg and daily mean concentrations of PM10 and PM2.5. A time-stratified case-crossover design was used to analyse associations between air pollution and PEVs.

    Results: Mean number of daily PEVs were 35 and sex distribution was even. PM exposure was associated with total PEV at lag 0 (the same day), by RR 1.016 (95% confidence interval [CI] 1.004–1.028) and RR 1.020 (95%CI 1.003–1.038) per 10 μg/m3 increase in PM10 and PM2.5, respectively. In females, PEV were increased at lag 0 and lag 1, and in males at lag 1 and lag 2. In the age-stratified analysis, PEVs significantly increased following PM exposure amongst individuals aged 35–65 years by lag 0–2 and in individuals who had contact with outpatient care at lag 0 to lag 1. There were no associations between air pollution and PEVs for any specific diagnostic group evaluated (amongst depression, anxiety and substance use disorder).

    Conclusions: The results indicate that acute exposure to PM10 and PM2.5 may trigger acute worsening in mental health in both males and females, especially among 35–65 year old individuals. However, in subgroups of the most common psychiatric diagnoses, we did not observe statistically significant associations with PM exposure.

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  • 43.
    Nilsson, Kerstin
    et al.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Department of Public Health, Kristianstad University, Kristianstad, Sweden.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Arvidsson, Inger
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Håkansson, Carita
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Österberg, Kai
    Department of Psychology, Lund University, Lund, Sweden.
    Leo, Ulf
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för skolledarutveckling.
    Persson, Roger
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Department of Psychology, Lund University, Lund, Sweden.
    School Principals' Work Participation in an Extended Working Life—Are They Able to, and Do They Want to?: A Quantitative Study of the Work Situation2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 7, artikel-id 3983Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The objective of this study is to increase the knowledge regarding school principals' work situations by examining the associations between various factors and the school principals' assessments of their ability or wish to work until 65 years of age or longer. The 1356 participating school principals in this study were aged between 50 and 64 years of age. Individual and work factors were evaluated in relation to two dichotomized outcomes: i.e., can work and want to work beyond 65 years of age, respectively. Generalized Estimating Equations (GEE) models were used to specify bivariate and multivariate cross-sectional logistic regression models that accounted for repeated measurements. The results showed that, both in 2018 and 2019, about 83% of the school principals stated that they could work and about 50% stated that they wanted to work until 65 years of age and beyond. School principals' exhaustion symptoms and experiences of an excessive burden were statistically significantly associated with whether they both could not and did not want to work beyond 65 years of age. Additionally, the school principals' experiences of support from the executive management in the performance of their managerial duties was of primary importance for whether the school principals wanted to work until 65 years of age and beyond. To conclude, it is important that school principals receive sufficient support from the management to cope with their often very stressful leadership tasks so that they have the opportunity to be able and willing to continue working their entire working life. The study strengthens the robustness of the theoretical SwAge model regarding the investigated factors related to determinant factors for a sustainable working life and as a basis for developing practical tools for increased employability for people of older ages.

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  • 44.
    Nilsson Sommar, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Segersson, David
    Swedish Meteorological and Hydrological Institute, Norrköping, Sweden..
    Flanagan, Erin
    Division for Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Lund, Sweden..
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division for Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Lund, Sweden..
    Long-term residential exposure to source-specific particulate matter and incidence of diabetes mellitus: A cohort study in northern Sweden2023Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 217, artikel-id 114833Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Diabetes mellitus (DM) incidence have been assessed in connection with air pollution exposure in several studies; however, few have investigated associations with source-specific local emissions. This study aims to estimate the risk of DM incidence associated with source-specific air pollution in a Swedish cohort with relatively low exposure. Individuals in the Västerbotten intervention programme cohort were followed until either a DM diagnosis or initiation of treatment with glucose-lowering medication occurred. Dispersion models with high spatial resolution were used to estimate annual mean concentrations of particulate matter (PM) with aerodynamic diameter ≤10 μm (PM10) and ≤2.5 μm (PM2.5) at individual addresses. Hazard ratios were estimated using Cox regression models in relation to moving averages 1-5 years preceding the outcome. During the study period, 1479 incident cases of DM were observed during 261,703 person-years of follow-up. Increased incidence of DM was observed in association with PM10 (4% [95% CI: -54-137%] per 10 μg/m3), PM10-traffic (2% [95% CI: -6-11%] per 1 μg/m3) and PM2.5-exhaust (11% [95% CI: -39-103%] per 1 μg/m3). A negative association was found for both PM2.5 (-18% [95% CI: -99-66%] per 5 μg/m3), but only in the 2nd exposure tertile (-10% [95% CI: -25-9%] compared to the first tertile), and PM2.5-woodburning (-30% [95% CI: -49-4%] per 1 μg/m3). In two-pollutant models including PM2.5-woodburning, there was an 11% [95% CI: -11-38%], 6% [95% CI: -16-34%], 13% [95% CI: -7-36%] and 17% [95% CI: 4-41%] higher risk in the 3rd tertile of PM10, PM2.5, PM10-traffic and PM2.5-exhaust, respectively, compared to the 1st. Although the results lacked in precision they are generally in line with the current evidence detailing particulate matter air pollution from traffic as an environmental risk factor for DM.

  • 45.
    Nyberg, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi. Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Boraxbekk, Carl-Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark .
    Eriksson Sörman, Daniel
    Department of Human Work Science, Luleå University of Technology, Luleå, Sweden.
    Hansson, Patrik
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Herlitz, Agneta
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Kauppi, Karolina
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden .
    Ljungberg, Jessica K.
    Department of Human Work Science, Luleå University of Technology, Luleå, Sweden.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM).
    Lundquist, Anders
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Nordin Adolfsson, Annelie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Environment Society and Health, Occupational and Environmental Medicine, Lund University.
    Pudas, Sara
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Rönnlund, Michael
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Stiernstedt, Mikael
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Biological and environmental predictors of heterogeneity in neurocognitive ageing: Evidence from Betula and other longitudinal studies2020Ingår i: Ageing Research Reviews, ISSN 1568-1637, E-ISSN 1872-9649, Vol. 64, artikel-id 101184Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Individual differences in cognitive performance increase with advancing age, reflecting marked cognitive changes in some individuals along with little or no change in others. Genetic and lifestyle factors are assumed to influence cognitive performance in ageing by affecting the magnitude and extent of age-related brain changes (i.e., brain maintenance or atrophy), as well as the ability to recruit compensatory processes. The purpose of this review is to present findings from the Betula study and other longitudinal studies, with a focus on clarifying the role of key biological and environmental factors assumed to underlie individual differences in brain and cognitive ageing. We discuss the vital importance of sampling, analytic methods, consideration of non-ignorable dropout, and related issues for valid conclusions on factors that influence healthy neurocognitive ageing.

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  • 46.
    Olsson, David
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Bråbäck, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Geels, Camilla
    Brandt, Jørgen
    Christensen, Jesper H.
    Frohn, Lise M.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Early childhood exposure to ambient air pollution is associated with increased risk of paediatric asthma: An administrative cohort study from Stockholm, Sweden2021Ingår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 155, artikel-id 106667Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Asthma is a complex, heterogeneous disease and one of the most common chronic diseases among children. Exposure to ambient air pollution in early life and childhood may influence asthma aetiology, but it is uncertain which specific components of air pollution and exposure windows are of importance. The role of socioeconomic status (SES) is also unclear. The aims of the present study are, therefore, to investigate how various exposure windows of different pollutants affect risk-induced asthma in early life and to explore the possible effect SES has on that relationship.

    Methods: The study population was constructed using register data on all singleton births in the greater Stockholm area between 2006 and 2013. Exposure to ambient black carbon (BC), fine particulate matter (PM2.5), primary organic carbon (pOC) secondary organic aerosols (SOA), secondary inorganic aerosols, and oxidative potential at the residential address was modelled as mean values for the entire pregnancy period, the first year of life and the first three years of life. Swedish national registers were used to define the outcome: asthma diagnosis assessed at hospital during the first six years of life. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were modelled with Cox proportional hazards model with age as the underlying time-scale, adjusting for relevant potential confounding variables.

    Results: An increased risk for developing childhood asthma was observed in association with exposure to PM2.5, pOC and SOA during the first three years of life. With an interquartile range increase in exposure, the HRs were 1.06 (95% CI: 1.01-1.10), 1.05 (95% CI: 1.02-1.09) and 1.02 (95% CI: 1.00-1.04), for PM2.5, pOC and SOA, respectively, in the fully adjusted models. Exposure during foetal life or the first year of life was not associated with asthma risk, and the other pollutants were not statistically significantly associated with increased risk. Furthermore, the increase in risk associated with PM2.5 and the components BC, pOC and SOA were stronger in areas with lower SES.

    Conclusion: Our results suggest that exposure to air pollution during the first three years of life may increase the risk for asthma in early childhood. The findings further imply a possible increased vulnerability to air pollutionattributed asthma among low SES children.

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  • 47.
    Olstrup, Henrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Flanagan, Erin
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Persson, Jan-Olov
    Department of Mathematics, Stockholm University, Stockholm, Sweden.
    Rittner, Ralf
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Krage Carlsen, Hanne
    School of Public Health and Community Medicine, Institute of Medicine, Center of Registers, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Stockfelt, Leo
    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.
    Xu, Yiyi
    Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rylander, Lars
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Gustafsson, Susanna
    Environment Department, City of Malmö, Malmö, Sweden.
    Spanne, Mårten
    Environment Department, City of Malmö, Malmö, Sweden.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Engström, Gunnar
    Department of Clinical Sciences at Malmö, CRC, Lund University, Lund, Sweden.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    The long-term mortality effects associated with exposure to particles and nox in the Malmö diet and cancer cohort2023Ingår i: Toxics, E-ISSN 2305-6304, Vol. 11, nr 11, artikel-id 913Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this study, the long-term mortality effects associated with exposure to PM10 (particles with an aerodynamic diameter smaller than or equal to 10 µm), PM2.5 (particles with an aerodynamic diameter smaller than or equal to 2.5 µm), BC (black carbon), and NOx (nitrogen oxides) were analyzed in a cohort in southern Sweden during the period from 1991 to 2016. Participants (those residing in Malmö, Sweden, born between 1923 and 1950) were randomly recruited from 1991 to 1996. At enrollment, 30,438 participants underwent a health screening, which consisted of questionnaires about lifestyle and diet, a clinical examination, and blood sampling. Mortality data were retrieved from the Swedish National Cause of Death Register. The modeled concentrations of PM10, PM2.5, BC, and NOx at the cohort participants’ home addresses were used to assess air pollution exposure. Cox proportional hazard models were used to estimate the associations between long-term exposure to PM10, PM2.5, BC, and NOx and the time until death among the participants during the period from 1991 to 2016. The hazard ratios (HRs) associated with an interquartile range (IQR) increase in each air pollutant were calculated based on the exposure lag windows of the same year (lag0), 1–5 years (lag1–5), and 6–10 years (lag6–10). Three models were used with varying adjustments for possible confounders including both single-pollutant estimates and two-pollutant estimates. With adjustments for all covariates, the HRs for PM10, PM2.5, BC, and NOx in the single-pollutant models at lag1–5 were 1.06 (95% CI: 1.02–1.11), 1.01 (95% CI: 0.95–1.08), 1.07 (95% CI: 1.04–1.11), and 1.11 (95% CI: 1.07–1.16) per IQR increase, respectively. The HRs, in most cases, decreased with the inclusion of a larger number of covariates in the models. The most robust associations were shown for NOx, with statistically significant positive HRs in all the models. An overall conclusion is that road traffic-related pollutants had a significant association with mortality in the cohort.

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  • 48.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Occupational and Environmental Medicine, Lund University .
    Short review: Air pollution, noise and lack of greenness as risk factors for Alzheimer's disease- epidemiologic and experimental evidence2020Ingår i: Neurochemistry International, ISSN 0197-0186, E-ISSN 1872-9754, Vol. 134, artikel-id 104646Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The number of patients with Alzheimer's disease (AD) is likely to triple in a few decades as the world's population ages. Given the high personal and societal burden of this disease, it is imperative to identify its risk factors. The etiology of AD is still not fully understood, but environmental factors have emerged as plausible important risk factors on the population-level. In this short review, the author summarizes literature on air pollution, noise and (lack of) greenness as risk factors for AD. In conclusion, a link between air pollution and AD is supported by experimental studies as well as epidemiological studies, although a multi-exposure approach is lacking in most epidemiological studies. Although evidence is much more limited regarding noise and (lack of) greenness as risk factors for AD, future epidemiological studies should have a multi-exposure approach in order to separate potential effects of air pollution, noise and lack of greenness. Given the heavy toll of AD on individuals and society, as well as the ubiquitous nature of environmental factors, a link between environmental stressors and AD deserves special attention.

  • 49.
    Oudin, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Andersson, John
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Nordin Adolfsson, Annelie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Traffic-Related air pollution as a risk factor for dementia: no clear modifying effects of apoe ɛ4 in the betula cohort2021Ingår i: Alzheimer's disease and air pollution: the development and progression of a fatal disease from childhood and the opportunities for early prevention / [ed] Lilian Calderón-Garcidueñas, Amsterdam: IOS Press, 2021, s. 357-364Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    It is widely known that the apolipoprotein E (APOE) ε4 allele imposes a higher risk for Alzheimer's disease (AD). Recent evidence suggests that exposure to air pollution is also a risk factor for AD, and results from a few studies indicate that the effect of air pollution on cognitive function and dementia is stronger in APOE ε4 carriers than in non-carriers. Air pollution and interaction with APOE ε4 on AD risk thus merits further attention. We studied dementia incidence over a 15-year period from the longitudinal Betula study in Northern Sweden. As a marker for long-term exposure to traffic-related air pollution, we used modelled annual mean nitrogen oxide levels at the residential address of the participants at start of follow-up. Nitrogen oxide correlate well with fine particulate air pollution levels in the study area. We had full data on air pollution, incidence of AD and vascular dementia (VaD), APOE ε4 carrier status, and relevant confounding factors for 1,567 participants. As expected, air pollution was rather clearly associated with dementia incidence. However, there was no evidence for a modifying effect by APOE ε4 on the association (p-value for interaction > 0.30 for both total dementia (AD+VaD) and AD). The results from this study do not imply that adverse effects of air pollution on dementia incidence is limited to, or stronger in, APOE ε4 carriers than in the total population.

  • 50.
    Oudin, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Department of Laboratory Medicine, Lund University, Lund, Sweden..
    Andersson, John
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Nordin Adolfsson, Annelie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Traffic-Related Air Pollution as a Risk Factor for Dementia: No Clear Modifying Effects of APOEɛ4 in the Betula Cohort2019Ingår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 71, nr 3, s. 733-740Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It is widely known that the apolipoprotein E (APOE) ɛ4 allele imposes a higher risk for Alzheimer’s disease (AD). Recent evidence suggests that exposure to air pollution is also a risk factor for AD, and results from a few studies indicate that the effect of air pollution on cognitive function and dementia is stronger in APOE ɛ4 carriers than in non-carriers. Air pollution and interaction with APOE ɛ4 on AD risk thus merits further attention. We studied dementia incidence over a 15-year period from the longitudinal Betula study in Northern Sweden. As a marker for long-term exposure to traffic-related air pollution, we used modelled annual mean nitrogen oxide levels at the residential address of the participants at start of follow-up. Nitrogen oxide correlate well with fine particulate air pollution levels in the study area. We had full data on air pollution, incidence of AD and vascular dementia (VaD), APOE ɛ4 carrier status, and relevant confounding factors for 1,567 participants. As expected, air pollution was rather clearly associated with dementia incidence. However, there was no evidence for a modifying effect by APOE ɛ4 on the association (p-value for interaction > 0.30 for both total dementia (AD+VaD) and AD). The results from this study do not imply that adverse effects of air pollution on dementia incidence is limited to, or stronger in, APOE ɛ4 carriers than in the total population.

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