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  • 1.
    Berg, Vivian
    et al.
    Department of Medical Biology, Faculty of Health Sciences, UIT-The Arctic University of Norway, Tromsø, Norway; Department of Laboratory Medicine, Division of Diagnostic Services, University Hospital of North-Norway, Tromsø, Norway.
    Charles, Dolley
    Department of Community Medicine, Faculty of Health Sciences, UIT-The Arctic University of Norway, Tromsø, Norway.
    Bergdahl, Ingvar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Nøst, Therese H.
    Department of Community Medicine, Faculty of Health Sciences, UIT-The Arctic University of Norway, Tromsø, Norway.
    Sandanger, Torkjel M.
    Department of Community Medicine, Faculty of Health Sciences, UIT-The Arctic University of Norway, Tromsø, Norway.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Huber, Sandra
    Department of Laboratory Medicine, Division of Diagnostic Services, University Hospital of North-Norway, Tromsø, Norway.
    Fuskevåg, Ole-Martin
    Department of Laboratory Medicine, Division of Diagnostic Services, University Hospital of North-Norway, Tromsø, Norway.
    Rylander, Charlotta
    Department of Community Medicine, Faculty of Health Sciences, UIT-The Arctic University of Norway, Tromsø, Norway.
    Pre- and post-diagnostic blood profiles of chlorinated persistent organic pollutants and metabolic markers in type 2 diabetes mellitus cases and controls: a pilot study2021In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 195, article id 110846Article in journal (Refereed)
    Abstract [en]

    Objective: Several risk factors for type 2 diabetes mellitus (T2DM) are also associated with blood concentrations of persistent organic pollutants (POPs), and factors related to the disease may affect POP concentrations, and subsequent associations between POPs and T2DM. The purpose of this pilot study was to investigate the change in concentrations of lipids, hormones and POPs pre- and post-diagnosis in T2DM cases compared to healthy controls and their associations with T2DM.

    Methods: We measured POPs, lipids, and thyroid and steroid hormones in plasma from 44 female cases collected prior to (pre-diagnostic) and following (post-diagnostic) T2DM diagnosis, and in 44 healthy female age-matched controls. We compared cross-sectional differences and longitudinal changes within and between matched cases and controls with t-tests and multivariable linear regression models. Associations between POP concentrations and T2DM were investigated using conditional logistic regression.

    Results: Between the pre- and post-diagnostic measurement, cases developed more favorable lipid profiles and the longitudinal changes in lipid-normalized concentrations of non-dioxin-like polychlorinated biphenyls (PCBs), dioxin-like PCBs, beta-hexachlorocyclohexane (HCH), HCB, and 1,1,1-trichloro-2,2-bis(4-chlorophenyl) ethane (p,p'-DDE) differed significantly between cases and controls. The longitudinal changes in POPs were mainly driven by changes in bodyweight, total lipids and T2DM status. Cases had significantly higher pre-diagnostic concentrations of POPs and triglycerides, and lower concentrations of high-density lipoprotein cholesterol and free thyroxin than controls. Pre-diagnostic POP concentrations were not significantly associated with incident T2DM, whereas several post-diagnostic POP concentrations were significantly positively associated with prevalent T2DM.

    Conclusions: This pilot study suggests that factors related to T2DM affect blood concentrations of POPs and may partly explain the positive associations between POPs and T2DM.

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  • 2.
    Bäcklund, Nils
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lundstedt, Staffan
    Umeå University, Faculty of Science and Technology, Department of Chemistry. Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Wihlbäck, Anna-Carin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Dahlqvist, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Brattsand, Göran
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Comparison of plasma cortisol-, salivary cortisol- and salivary cortisone-response to the short Synacthen test in women using oral contraceptivesManuscript (preprint) (Other academic)
  • 3.
    Bäcklund, Nils
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lundstedt, Staffan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wihlbäck, Anna-Carin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Dahlqvist, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Brattsand, Göran
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Salivary cortisol and cortisone can circumvent confounding effects of oral contraceptives in the short synacthen test2024In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 109, no 7, p. 1899-1906Article in journal (Refereed)
    Abstract [en]

    Context: Adrenal insufficiency (AI) is usually diagnosed by low plasma cortisol levels following a short Synacthen test (SST). Most plasma cortisol is bound to corticosteroid-binding globulin, which is increased by estrogen in combined estrogen-progestin oral contraceptives (COCs). Women with AI using COCs are therefore at risk of having an apparently normal plasma cortisol level during SST, which would not adequately reflect AI.

    Objective: To test whether salivary cortisol or cortisone during SST is more robust against the COC effect and to calculate the lower reference limits (LRLs) for these to be used as tentative diagnostic cutoffs to exclude AI.

    Methods: Forty-one healthy women on COCs and 46 healthy women without exogenous estrogens performed an SST with collection of plasma and salivary samples at 0, 30, and 60 min after Synacthen injection. The groups were compared using regression analysis with age as covariate and the LRLs were calculated parametrically.

    Results: SST-stimulated plasma cortisol levels were significantly higher in the COC group versus controls, while mean salivary cortisol and cortisone levels were slightly lower in the COC group. Importantly, COC use did not significantly alter LRLs for salivary cortisol or cortisone. The smallest LRL difference between groups was seen for salivary cortisone.

    Conclusion: Salivary cortisol and especially salivary cortisone are considerably less affected by COC use than plasma cortisol during SST. Due to similar LRLs, a common cutoff for salivary cortisol and cortisone during SST can be used to exclude AI in premenopausal women irrespective of COC use.

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  • 4. Donat-Vargas, Carolina
    et al.
    Bergdahl, Ingvar A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Koponen, Jani
    Kiviranta, Hannu
    Åkesson, Agneta
    Associations between repeated measure of plasma perfluoroalkyl substances and cardiometabolic risk factors2019In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 124, p. 58-65Article in journal (Refereed)
    Abstract [en]

    Background: Perfluoroalkyl substances (PFAS) are persistent synthetic chemicals that may affect components of metabolic risk through the peroxisome proliferator-activated receptor but epidemiological data remain scarce and inconsistent.

    Objective: To estimate associations between repeated measurements of the main PFAS in plasma and total cholesterol, triglycerides and hypertension among the control subjects from a population-based nested case-control study on diabetes type 2 in middle-aged women and men.

    Methods: Participants (n = 187) were free of diabetes at both baseline and follow-up visits to the Västerbotten Intervention Programme, 10 years apart: during 1990 to 2003 (baseline) and 2001 to 2013 (follow-up). Participants left blood samples, completed questionnaires on diet and lifestyle factors, and underwent medical examinations, including measurement of blood pressure. PFAS and lipids were later determined in stored plasma samples. Associations for the repeated measurements were assessed using generalized estimating equations.

    Results: Six PFAS exceeded the limit of quantitation. Repeated measures of PFAS in plasma, cardiometabolic risk factors and confounders, showed an average decrease of triglycerides from −0.16 mmol/l (95% confidence interval [CI]: −0.33, 0.02 for PFOA) to −0.26 mmol/l (95% CI: −0.50, −0.08 for PFOS), when comparing the highest tertile of PFAS plasma levels with the lowest. Associations based on average PFAS measurements and follow-up triglycerides revealed similar inverse associations, although attenuated. The estimates for cholesterol and hypertension were inconsistent and with few exception non-significant.

    Conclusions: This study found inverse associations between PFAS and triglycerides, but did not support any clear link with either cholesterol or hypertension.

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  • 5. Donat-Vargas, Carolina
    et al.
    Bergdahl, Ingvar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Kiviranta, Hannu
    Koponen, Jani
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Akesson, Agneta
    Perfluoroalkyl substances and risk of type II diabetes: A prospective nested case-control study2019In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 123, p. 390-398Article in journal (Refereed)
    Abstract [en]

    Background: Perfluoroalkyl substances (PFAS) have drawn much attention due to bioaccumulation potential and their current omnipresence in human blood. We assessed whether plasma PFAS, suspected to induce endocrine-disrupting effects, were prospectively associated with clinical type 2 diabetes (T2D) risk.

    Methods: We established a nested case-control study within the Swedish prospective population-based Västerbotten Intervention Programme cohort. Several PFAS were measured in plasma from a subset of 124 case-control pairs at baseline (during 1990–2003) and at 10-year follow-up. T2D cases were matched (1:1) according to gender, age and sample date with participants without T2D (controls).

    Conditional logistic regressions were used to prospectively assess risk of T2D by baseline PFAS plasma concentrations. Associations between long-term PFAS plasma levels (mean of baseline and follow-up) and insulin resistance (HOMA2-IR) and beta-cell function (HOMA2-B%) at follow-up were prospectively explored among 178 and 181 controls, respectively, by multivariable linear regressions.

    Results: After adjusting for gender, age, sample year, diet and body mass index, the odds ratio of T2D for the sum of PFAS (Σ z-score PFAS) was 0.52 (95% confidence interval, CI: 0.20, 1.36), comparing third with first tertile; and 0.92 (95% CI: 0.84, 1.00) per one standard deviation increment of sum of log-transformed PFAS. Among the controls, the adjusted β of HOMA2-IR and HOMA-B% for the sum of PFAS were −0.26 (95% CI: −0.52, −0.01) and −9.61 (95% CI: −22.60, 3.39) respectively comparing third with first tertile.

    Conclusions: This prospective nested case-control study yielded overall inverse associations between individual PFAS and risk of T2D, although mostly non-significant. Among participants without T2D, long-term PFAS exposure was prospectively associated with lower insulin resistance.

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  • 6. Donat-Vargas, Carolina
    et al.
    Åkesson, Agneta
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Kiviranta, Hannu
    Rantakokko, Panu
    Bergdahl, Ingvar A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Persistent Organochlorine Pollutants in Plasma, Blood Pressure, and Hypertension in a Longitudinal Study2018In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 71, no 6, p. 1258-1268Article in journal (Refereed)
    Abstract [en]

    Persistent organochlorine pollutants (POPs) have shown to be involved in the atherosclerotic process and to cause endothelial cell dysfunction. To assess longitudinally whether plasma concentrations of different POPs were associated with blood pressure and risk of hypertension in middle-aged women and men. Study subjects were 850 participants in the VIP (Västerbotten Intervention Programme) with 2 blood samples and blood pressure measurements, 10 years apart, during 1990 to 2003 (baseline) and during 2000 to 2013 (follow-up). Dioxin-like and nondioxin-like polychlorinated biphenyls (DL-PCBs, NDL-PCBs) and p,p'-dichlorodiphenyldichloroethylene (DDE) were measured. Associations were assessed using generalized estimating equations. At baseline sampling 49% and at follow-up 64% had hypertension. DL-PCBs and DDE, but not NDL-PCBs or hexachlorobenzene, were associated with hypertension. Only the association for DL-PCBs remained statistically significant after lipid-standardization and adjustment for body mass index and total serum lipids. The multivariable-adjusted odds ratio of hypertension based on repeated measurements were 1.52 (95% confidence interval, 1.08-2.13) for DL-PCBs (third versus first tertile of lipid-standardized POPs). In stratified adjusted analyses, odds ratio for those born after 1950 increased to 3.99 (95% confidence interval, 2.15-7.43), whereas no association was observed among those born earlier. Based on repeated measurements, the accumulated exposure to DL-PCBs and DDE, although less clear for the latter, may disrupt the normal blood pressure levels and increase the odds of hypertension. Moreover, individuals experiencing early-life POP exposure may be at elevated risk of vascular POP effects.

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  • 7.
    Forsberg, Bertil
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Silvergren, Sanna
    Stockholms miljöförvaltning, SLB-analys.
    Johansson, Christer
    Stockholms miljöförvaltning, SLB-analys; Stockholms universitet, Institutionen för miljövetenskap, Avd för atmosfärvetenskap.
    Coronanedstängningens betydelse för luftföroreningshalter, beräknade hälsokonsekvenser och registrerade uttag av astmaläkemedel i Stockholmsområdet2022Report (Other academic)
    Abstract [sv]

    Nedstängningen av samhällen på grund av pandemin våren 2020 skedde tämligen globalt, varför åtföljande förändringar av utsläpp både lokalt och på långt avstånd kan ha påverkat luftkvaliteten i Stockholm. Denna rapport redovisar tre delstudier: en analys av hur föroreningshalterna i Stockholmsområdet påverkades av den inledande nedstängningen av samhället, en hälsokonsekvensberäkning av vilka hälsoeffekter en sådan förändring av halterna antas medföra, samt en epidemiologisk tidsseriestudie av sambanden mellan registrerat dagligt antal utköp av astmamediciner och halter av luftföroreningar under den inledande nedstängningen och före/efter denna period.

    Vi har i detta projekt använt två metoder, spridningsmodellering med emissionsdata respektive regressionsanalys med mätdata, för att beräkna hur främst kväveoxidhalterna påverkades av minskade emissioner lokalt, samt hur bl.a halterna av kvävedioxid och ozon i staden avvek ifrån förväntade värden efter hänsyn till meteorologins inverkan på halterna.

    Spridningsberäkningarna visade att halterna av kvävedioxid minskade med 0,7 μg/m3 under mars-juli till följd av minskad lokal trafik. Utifrån sammanvägningar av publicerade epidemiologiska samband skulle detta leda till cirka 2 dödsfall färre i 9 kommuner med totalt drygt 1,5 miljoner invånare, medan besök och inläggningar på sjukhus för andningsorganen förväntas minska med drygt 24 fall genom minskade lokala utsläpp.

    Den väderjusterade minskningen av totala NO2 halterna var 2,8 μg/m3, vilket skulle förväntas leda till ungefär 97 färre besök och inläggningar på sjukhus för andningsorganen under samma 5 månader. Men eftersom minskade utsläpp av kväveoxider även följdes av en oväntat stor väderjusterad ökning av marknära ozon förväntas för vissa hälsoutfall en nettoökning av antalet fall, exempelvis av patienter med problem i andningsorganen.

    Eftersom utköp av förskrivna läkemedel inte kräver att man besöker sjukvården, inte ens att man besöker ett apotek, studerades dagligt antal utköp av astmaläkemedel i relation till variationer i luftföroreningshalterna. Trots en inledande hamstringsvåg med efterföljande svacka i utköp under maj och lägre uppmätta halter av kväveoxider (NOx) och partiklar <10 mikrometer (PM10) än normalt, fanns sammantaget även under april-juli 2020 en statistiskt säkerställd effekt av PM10 och NOx på dagligt antal utköp. När relativa riskökningen per 10 μg/m3 jämförs mellan denna nedstängningsperiod och övrig studieperiod kan konstateras att ökningen av utköp per haltökning var högre under april-juli 2020. För hela perioden 2018 - 2021 visade en meta-skattning över 21 kommuner i Stockholms län på 2,6 procent ökning i uttag av lång- och korttidsverkande astmaläkemedel per 10 μg/m3 ökning av PM10 (medelvärde för samma dygn och det föregående).

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  • 8.
    Hagenbjörk-Gustafsson, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Andersson, Eva M
    Johannesson, Sandra
    Bellander, Tom
    Merritt, Anne-Sophie
    Tinnerberg, Håkan
    Westberg, Håkan
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sallsten, Gerd
    Determinants of personal exposure to some carcinogenic substances and nitrogen dioxide among the general population in five Swedish cities2014In: Journal of Exposure Science and Environmental Epidemiology, ISSN 1559-0631, E-ISSN 1559-064X, Vol. 24, no 4, p. 437-443Article in journal (Refereed)
    Abstract [en]

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

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  • 9.
    Hagenbjörk-Gustafsson, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Eriksson, Kåre
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Field validation of the Ogawa diffusive sampler for NO(2) and NO(x) in a cold climate2010In: Journal of Environmental Monitoring, ISSN 1464-0325, E-ISSN 1464-0333, Vol. 12, no 6, p. 1315-24Article in journal (Refereed)
    Abstract [en]

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

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  • 10.
    Meister, Kadri
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sambandet mellan luftföroreningshalter och akuta vårdkontakter för luftvägssjukdomar som hälsoindikator för luftkvalitet2016Report (Other academic)
    Abstract [sv]

    Denna studie inom den hälsorelaterade miljöövervakningen har genomförts på uppdrag av Naturvårdsverket för att belysa eventuella korttidseffekter av luftföroreningar på akutbesök för astma samt för alla sjukdomar i andningsorganen. Dessa sjukdomar medför ofta ökad känslighet för luftföroreningar. Halternas samband med akutbesök för andningsorganens sjukdomar har tidigare studerats inom miljöövervakningen. För att underlätta jämförelser har metodiken anpassats till tidigare studier där betydelsen av halterna de två senaste dygnen beräknas. Övervakning av denna typ av korttidssamband med halter i miljön är mindre känslig för trender och förändringar i diagnostik och vårdresurser än enklare epidemiologisk bevakning av antalet fall per år etc., eftersom totala antalet fall i sig kan påverkas av en rad olika typer av faktorer utan koppling till luftföroreningssituationen.

    Uppgifter om den skrivna befolkningens akutbesök (vid akutmottagning samt akuta (inte planerade) inläggningar) under åren 2005 till och med 2013 för andningsorganens sjukdomar inklusive astma vid akutsjukhusen i StorStockholm, Göteborg/Mölndal respektive Malmö/Burlöv har inhämtats från Socialstyrelsens Patientregister. Uppgifterna från registret avser avidentifierade akutbesök med diagnoser dygn för dygn under perioden.

    Luftföroreningsdata i form av urbana bakgrundshalter har hämtats från Stockholm luft- och bulleranalys (SLB) vid miljöförvaltningen i Stockholm och från IVL Svenska miljöinstitutet data för Göteborg respektive Malmö. Vi har studerat effekterna av partikelhalten (PM10 ~ partiklar mindre än 10 mikrometer i diameter), avgashalten indikerad med kväveoxider (NOx) samt ozon. Analyser har gjorts av akutbesök totalt för alla åldrar samt i olika åldergrupper: barn, vuxna och äldre.

    Tidsserieanalyserna har utförts med Poisson-regression. I dessa analyser tas hänsyn till tidstrender, årstidsmönster, influensaperioder, väderförhållanden, pollenhalt, veckodag, helgperioder mm. Deinkluderade luftföroreningarna är ozon, kvävedioxid och partiklar (PM10). Alla luftföroreningsvariabler kan ses som indikatorer på olika typer av luftföroreningar, och har simultant beaktats i de slutliga analyserna.

    I alla tre städer hade ozon effekten på akutbesök för andningsorganens sjukdomar totalt och för astma totalt. Effekten av ozon på akutbesök för andningsorganen samt på astma finns även för barn respektive vuxna separat i Stockholm och Göteborg.

    Effekter av ozon kan ses som inte skiljande sig mellan de tre olika studieområdena och därför har även ensammanvägd skattning för ozon beräknats gällande antalet akutbesök för andningsorganen totalt, akutbesök för astma totalt samt akutbesök för astma bland barn. När resultaten vägdes ihop för de tre studieområdena beräknas att antalet akutbesök för andningsorganen totalt ökar med 1,6% (95% KI=1,1-2%) per 10 µg/m3 haltökning av ozon, akutbesök för astma totalt med 2,5% (95% KI=1,5-3,6% ) per 10 µg/m3 haltökning, medan akutbesök för astma bland barn med 3,9% (95% KI=1,7- 4%) per 10 µg/m3 haltökning av ozon.

    Eftersom föroreningssituationen som indikatorerna representerar kan förändras med tiden har analyserna gjorts även för två olika tidsperioder: 2005-2008 samt 2009-2013. Analysen för Malmö visade på vissa statistiskt säkerställda skillnader. Effekten av ozon på akutbesök för andningsorganen totalt var högre under den senare tidsperioden, 2009-2013. Denna trend finns även för barn respektive vuxna separat.

    Att analysera variationen i telefonsamtal till 1177-Vårdguiden har tidigare visat sig vara en fördelaktig metod vid studier gällande magsjuka och den mest lämpliga metoden för att tidigt detektera utbrott av magsjuka. Till följd av detta var det angeläget att undersöka om denna relativt nya databas innehållande 1177-samtal även kan vara lämplig att använda i studier som avser akuta hälsoproblem av sjukdomar i andningsorganen som kan påverkas av luftföroreningshalterna.

    Som tillägg har en pilotstudie gjorts i Göteborg, där uppgifter om dygnsvisa antal samtal med kontaktorsakerna andningsproblem respektive hosta från 1177-Vårdguiden under perioden 2007-11-30 – 2013-12-01 har använts för att jämföra sambanden till luftföroreningshalter. Även här är antalsuppgifteruppdelade i olika åldersgrupper. I likhet med besöksdata påvisades effekter av luftföroreningar där ökning av PM10-halten ökade antalet samtal gällande andningsbesvär och hosta bland barn. Samtal gällande andningsbesvär hos vuxna ökade med ökande halter av ozon. Studien visar att denna typ av data kan användas för att övervaka luftföroreningsexponeringens effekter.

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  • 11.
    Olstrup, Henrik
    et al.
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, 11418 Stockholm, Sweden. .
    Johansson, Christer
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, 11418 Stockholm, Sweden. Environment and Health Administration, SLB, Box 8136, 104 20 Stockholm, Sweden..
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ekebom, Agneta
    Swedish Museum of Natural History, 114 18 Stockholm, Sweden..
    Meister, Kadri
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    A Multi-Pollutant Air Quality Health Index (AQHI) Based on Short-Term Respiratory Effects in Stockholm, Sweden2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 1, article id 105Article in journal (Refereed)
    Abstract [en]

    In this study, an Air Quality Health Index (AQHI) for Stockholm is introduced as a tool to capture the combined effects associated with multi-pollutant exposure. Public information regarding the expected health risks associated with current or forecasted concentrations of pollutants and pollen can be very useful for sensitive persons when planning their outdoor activities. For interventions, it can also be important to know the contribution from pollen and the specific air pollutants, judged to cause the risk. The AQHI is based on an epidemiological analysis of asthma emergency department visits (AEDV) and urban background concentrations of NOx, O₃, PM10 and birch pollen in Stockholm during 2001⁻2005. This analysis showed per 10 µg·m⁻3 increase in the mean of same day and yesterday an increase in AEDV of 0.5% (95% CI: -1.2⁻2.2), 0.3% (95% CI: -1.4⁻2.0) and 2.5% (95% CI: 0.3⁻4.8) for NOx, O₃ and PM10, respectively. For birch pollen, the AEDV increased with 0.26% (95% CI: 0.18⁻0.34) for 10 pollen grains·m⁻3. In comparison with the coefficients in a meta-analysis, the mean values of the coefficients obtained in Stockholm are smaller. The mean value of the risk increase associated with PM10 is somewhat smaller than the mean value of the meta-coefficient, while for O₃, it is less than one fifth of the meta-coefficient. We have not found any meta-coefficient using NOx as an indicator of AEDV, but compared to the mean value associated with NO₂, our value of NOx is less than half as large. The AQHI is expressed as the predicted percentage increase in AEDV without any threshold level. When comparing the relative contribution of each pollutant to the total AQHI, based on monthly averages concentrations during the period 2015⁻2017, there is a tangible pattern. The AQHI increase associated with NOx exhibits a relatively even distribution throughout the year, but with a clear decrease during the summer months due to less traffic. O₃ contributes to an increase in AQHI during the spring. For PM10, there is a significant increase during early spring associated with increased suspension of road dust. For birch pollen, there is a remarkable peak during the late spring and early summer during the flowering period. Based on monthly averages, the total AQHI during 2015⁻2017 varies between 4 and 9%, but with a peak value of almost 16% during the birch pollen season in the spring 2016. Based on daily mean values, the most important risk contribution during the study period is from PM10 with 3.1%, followed by O₃ with 2.0%.

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  • 12.
    Oudin Åström, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ebi, Kristie L
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Evolution of Minimum Mortality Temperature in Stockholm, Sweden, 1901-20092016In: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 124, no 6, p. 740-744Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The mortality impacts of hot and cold temperatures have been thoroughly documented, with most locations reporting a U-shaped relationship with a minimum mortality temperature (MMT) at which mortality is lowest. How MMT may have evolved over past decades as global mean surface temperature increased has not been thoroughly explored.

    OBJECTIVE: We used observations of daily mean temperatures to investigate whether MMT changed in Stockholm, Sweden, from the beginning of the 20th century until 2009.

    METHODS: Daily mortality and temperature data for the period 1901-2009 in Stockholm, Sweden were used to model the temperature-mortality relationship. We estimated MMT using distributed lag non-linear Poisson regression models considering lags up to 21 days of daily mean temperature as the exposure variable. To avoid large influences on the MMT from intra and inter annual climatic variability, we estimated MMT based on 30-year periods. Further, we investigated whether there were trends in the absolute value of the MMT and the relative value of the MMT (the corresponding percentile of the same day temperature distribution) over the study period.

    RESULTS: Our findings suggest that both the absolute MMT and the relative MMT increased in Stockholm, Sweden over the course of the last century.

    CONCLUSIONS: The increase in MMT over the course of the last century suggests autonomous adaptation within the context of the large epidemiological, demographical and societal changes that occurred. Whether the rate of increase will be sustained with climate change is an open question.

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  • 13.
    Rolandsson, Olov
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Steneberg, Pär
    Umeå University, Faculty of Medicine, Department of Medical and Translational Biology.
    Edlund, Helena
    Umeå University, Faculty of Medicine, Department of Medical and Translational Biology.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Andreasson, Ulf
    Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
    Zetterberg, Henrik
    Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, Ucl Institute of Neurology, London, United Kingdom; Dementia Research Institute at Ucl, London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, Hong Kong; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, WI, Madison, United States.
    Blennow, Kaj
    Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Paris Brain Institute, Icm, Pitié-Salpetriere Hospital, Sorbonne University, Paris, France; Department of Neurology, Neurodegenerative Disorder Research Center, Division of Life Sciences and Medicine, Institute on Aging and Brain Disorders, University of Science and Technology of China and First Affiliated Hospital of Ustc, Hefei, China.
    Acute hyperglycemia induced by hyperglycemic clamp affects plasma Amyloid-β in type 2 diabetes2024In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 99, no 3, p. 1033-1046Article in journal (Refereed)
    Abstract [en]

    Background: Individuals with type 2 diabetes (T2D) have an increased risk of cognitive symptoms and Alzheimer's disease (AD). Mis-metabolism with aggregation of amyloid-β peptides (Aβ) play a key role in AD pathophysiology. Therefore, human studies on Aβ metabolism and T2D are warranted.

    Objective: The objective of this study was to examine whether acute hyperglycemia affects plasma Aβ1-40 and Aβ1-42 concentrations in individuals with T2D and matched controls.

    Methods: Ten participants with T2D and 11 controls (median age, 69 years; range, 66-72 years) underwent hyperglycemic clamp and placebo clamp (saline infusion) in a randomized order, each lasting 4 hours. Aβ1-40, Aβ1-42, and insulin-degrading enzyme (IDE) plasma concentrations were measured in blood samples taken at 0 and 4 hours of each clamp. Linear mixed-effect regression models were used to evaluate the 4-hour changes in Aβ1-40 and Aβ1-42 concentrations, adjusting for body mass index, estimated glomerular filtration rate, and 4-hour change in insulin concentration.

    Results: At baseline, Aβ1-40 and Aβ1-42 concentrations did not differ between the two groups. During the hyperglycemic clamp, Aβ decreased in the control group, compared to the placebo clamp (Aβ1-40: p = 0.034, Aβ1-42: p = 0.020), IDE increased (p = 0.016) during the hyperglycemic clamp, whereas no significant changes in either Aβ or IDE was noted in the T2D group.

    Conclusions: Clamp-induced hyperglycemia was associated with increased IDE levels and enhanced Aβ40 and Aβ42 clearance in controls, but not in individuals with T2D. We hypothesize that insulin-degrading enzyme was inhibited during hyperglycemic conditions in people with T2D.

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  • 14. Schillemans, Tessa
    et al.
    Shi, Lin
    Donat-Vargas, Carolina
    Hanhineva, Kati
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Koponen, Jani
    Kiviranta, Hannu
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Bergdahl, Ingvar A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Landberg, Rikard
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden.
    Åkesson, Agneta
    Brunius, Carl
    Plasma metabolites associated with exposure to perfluoroalkyl substances and risk of type 2 diabetes: A nested case-control study2021In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 146, article id 106180Article in journal (Refereed)
    Abstract [en]

    Perfluoroalkyl substances (PFAS) are widespread persistent environmental pollutants. There is evidence that PFAS induce metabolic perturbations in humans, but underlying mechanisms are still unknown. In this exploratory study, we investigated PFAS-related plasma metabolites for their associations with type 2 diabetes (T2D) to gain potential mechanistic insight in these perturbations. We used untargeted LC-MS metabolomics to find metabolites related to PFAS exposures in a case-control study on T2D (n = 187 matched pairs) nested within the Västerbotten Intervention Programme cohort. Following principal component analysis (PCA), six PFAS measured in plasma appeared in two groups: 1) perfluorononanoic acid, perfluorodecanoic acid and perfluoroundecanoic acid and 2) perfluorohexane sulfonic acid, perfluorooctane sulfonic acid and perfluorooctanoic acid. Using a random forest algorithm, we discovered metabolite features associated with individual PFAS and PFAS exposure groups which were subsequently investigated for associations with risk of T2D. PFAS levels correlated with 171 metabolite features (0.16 ≤ |r| ≤ 0.37, false discovery rate (FDR) adjusted p < 0.05). Out of these, 35 associated with T2D (p < 0.05), with 7 remaining after multiple testing adjustment (FDR < 0.05). PCA of the 35 PFAS- and T2D-related metabolite features revealed two patterns, dominated by glycerophospholipids and diacylglycerols, with opposite T2D associations. The glycerophospholipids correlated positively with PFAS and associated inversely with risk for T2D (Odds Ratio (OR) per 1 standard deviation (1-SD) increase in metabolite PCA pattern score = 0.2; 95% Confidence Interval (CI) = 0.1-0.4). The diacylglycerols also correlated positively with PFAS, but they associated with increased risk for T2D (OR per 1-SD = 1.9; 95% CI = 1.3-2.7). These results suggest that PFAS associate with two groups of lipid species with opposite relations to T2D risk.

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  • 15.
    Stoltz Sjöström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Intake and macronutrient content in human milk given to extremely preterm infantsManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Human milk (HM) is the preferred basis of nutrition for infants, including those born prematurely. Information on macronutrient content in HM is necessary to optimize nutritional support of preterm infants.

    Objectives: To describe the types and amounts of enteral feeds given to Swedish extremely preterm infants during hospitalization and to investigate the energy and macronutrient content in HM given to these infants.

    ­Methods: A population-based study of Swedish extremely preterm infants (n=586) born before 27 gestational weeks. Data on ingested volumes of different milks during hospitalization and analyses of macronutrient content in HM samples were obtained from hospital records. Nutritional content of HM was determined by mid-infrared spectrophotometry analysis.

    Results: During the first four weeks of life, 99% of the infants were exclusively fed HM and at four weeks of life, 70% of the infants received only mother’s own milk (MOM). Nutritional content in 821 MOM samples were analyzed. Protein content in MOM decreased significantly from 2.2g to 1.2g/100 mL during the first 112 postpartum days, while fat and energy content were highly variable within and between MOM samples. Additionally, 354 samples of donor milk were analyzed. Content of protein, fat and energy in pooled donor milk (n=129) were lower compared to single donor milk.

    Conclusions: Swedish extremely preterm infants receive MOM to a large extent during hospitalization. Protein, carbohydrates and energy in MOM changed significantly with time. Weekly analyses of MOM during the first month of lactation would allow a more individualized nutritional support to these vulnerable infants.

  • 16.
    Stoltz Sjöström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Intake and macronutrient content of human milk given to extremely preterm infants2014In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 30, no 4, p. 442-449Article in journal (Refereed)
    Abstract [en]

    Background: Human milk (HM) is the preferred basis of nutrition for infants, including those born prematurely. Information on HM macronutrient content is necessary to optimize nutritional support of preterm infants. Objectives: This study aimed to describe the types and amounts of enteral feeds given to Swedish extremely preterm infants during hospitalization and to investigate the energy and macronutrient contents in HM given to these infants. Methods: A population-based study of Swedish extremely preterm infants (n = 586) born before 27 gestational weeks was conducted. Data on ingested volumes of different milk during hospitalization and analyses of macronutrient content in HM samples were obtained from hospital records. Nutritional content of HM was determined by mid-infrared spectrophotometry analysis. Results: During the first 4 weeks of life, 99% of the infants were exclusively fed HM, and at 4 weeks of life, 70% of the infants received only mother’s own milk (MOM). Nutritional content in 821 MOM samples was analyzed. Protein content in MOM decreased significantly from 2.2 to 1.2 g/100 mL during the first 112 postpartum days, whereas fat and energy content were highly variable within and between MOM samples. In addition, 354 samples of donor milk were analyzed. Content of protein, fat, and energy in pooled donor milk (n = 129) was lower compared to single donor milk. Conclusion: Swedish extremely preterm infants receive MOM to a large extent during hospitalization. Protein, carbohydrates, and energy in MOM changed significantly with time. Weekly analyses of MOM during the first month of lactation would allow more individualized nutritional support for these vulnerable infants.

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  • 17.
    Strandell, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Videholm, Samuel
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Björmsjö, Maria
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Increased risk of bacterial pneumonia before and after respiratory syncytial virus infection in young children2024In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed)
    Abstract [en]

    Aim: The burden of respiratory disease is great among children. This study aimed to examine the temporal relationship between hospitalisation for respiratory syncytial virus (RSV) and bacterial pneumonia.

    Methods: A Swedish population-based cohort was created by combining data from the Swedish Medical Birth Register, the National Inpatient Register, the Cause of Death Register, the Total Population Register, and the Longitudinal Integration Database for Health Insurance and Labour Market Studies. Children born between 1998 and 2015 were included and followed for 2 years. We examined the temporal relationship between RSV hospitalisation and bacterial pneumonia using piecewise exponential models.

    Results: The final cohort comprised 1 641 747 children, 48.5% were females. There were 23 632 RSV and 4722 bacterial pneumonia hospitalisations, with mean age of 137.8 and 424.2 days, respectively. RSV hospitalisation was associated with bacterial pneumonia with an adjusted incidence rate ratio (aIRR) of 3.18. The risk was highest in the first month after RSV hospitalisation, aIRR 11.19. The risk of bacterial pneumonia was elevated for 4 months after RSV hospitalisation and before RSV hospitalisation.

    Conclusion: We found an increased risk for bacterial pneumonia hospitalisation in children hospitalised for RSV both before and after RSV hospitalisation, indicating a bidirectional relationship.

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  • 18.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Precipitation, Raw Water Quality, Drinking Water Treatment and Gastrointestinal Illness2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    On numerous occasions, outbreaks of acute gastrointestinal illnesses (AGI) have been linked to municipal drinking water in the industrialised world. Many of the reported outbreaks were observed after heavy rainfall events, which suggests that such events could result in a deterioration in the quality of drinking water. The observed drinking water-related outbreaks are, however, probably just the tip of the iceberg, and the extent to which public drinking water also influences the endemic level of gastroenteritis during non-outbreak periods is largely unknown. With climate change projected to increase the frequency of extreme weather events, data for preventive actions are needed now, to ensure safe drinking water today and in the future. The primary aim of this thesis is to increase the knowledge of the extent to which rainfall can still be a risk for insufficient drinking water quality, even with modern drinking water production methods. We aim to study if the incidence of gastroenteritis during normal endemic levels can be associated with water quality and the efficacy of pathogen elimination in different treatment processes. The thesis focuses first on AGI in the Gothenburg population and how precipitation affects its main fresh water supply (papers I-III); this is followed by a broader comparison of AGI in 20 cities across Sweden (Paper IV).

    Methods

    Observational time series data was used for all papers to construct generalized additive regression models, using smooth functions to adjust for long-term trends. Delayed effects on the outcome were evaluated using distributed lag non-linear models. In Paper I, the raw water-quality data for the river Göta älv were analysed – this water is used to produce drinking water for the population living in the north part of City of Gothenburg. The short-term variation of daily mean turbidity measurements and samples of three different types of indicator bacteria were modelled with daily precipitation using seven years of data. In papers II and III, the analyses aimed to determine whether the daily incidence of AGI in the population which households received drinking water produced from the river water could be associated with precipitation. As a measure of AGI, we used four years of data on the daily number of phone calls to the nurse advice line about vomiting, diarrhoea or abdominal pain (Paper II), and six years of data of the daily number of visits to health care clinics, when individuals were diagnosed with gastrointestinal infections (Paper III). Paper III also evaluates the similarities and differences between the frequency of nurse advice calls and primary health care visits. Paper IV analyses and compares the occurrence and seasonal patterns of nurse advice calls in twenty cities in Sweden, using seven years of data. The water treatment technique used by the public drinking water plants was obtained, and the processes theoretical efficacy of pathogen elimination was determined. The extent of AGI calls in relation to the pathogen elimination efficacy was analysed using a binomial regression design, adjusting for population size, age distribution and geographical area.

    Results

    We observed a strong relation between precipitation and the water quality in the Göta älv. A heavy rainfall event was related to increased concentrations of E. coli bacteria for several days, with the peak increase two days after the event. Precipitation was found to affect raw water quality parameters across all seasons. Heavy precipitation was also associated with a significant increase in the daily number of nurse advice calls due to AGI symptoms, with the number of calls peaking five days later. Consecutive wet weather periods were associated with both an increased number of AGI calls, as well as visits to clinics that led to diagnoses of AGI. Finally, we observed in Paper IV that cities with a higher pathogen elimination efficacy in their drinking water utility had a lower amount of AGI calls. The relations applied both to surface water and groundwater utilities, although the protective effect of a more advanced drinking water treatment on AGI was observed to be most significant in cities with surface water plants during the winter season.

    Conclusions

    The results suggest it is possible to reduce the occurrence of endemic gastroenteritis with a more advanced treatment process for drinking water. The delay between a heavy rainfall event (and the resulting decrease in raw water quality) and the increased number of nurse advice calls suggests viruses are the main cause, as the timing is consistent with viral incubation times. A viral transmission was also proposed when comparing different cities, as a more advanced water treatment process seems to be most beneficial during seasons where viruses are acknowledged as the main cause of AGI. Our research suggests that upgrades to drinking water treatment techniques, especially those aiming to better eliminate viruses, are warranted

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  • 19.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Andersson, Camilla
    SMHI.
    Carvalho, Ana Christina
    SMHI.
    Langer, Joakim
    SMHI.
    Robertsson, Lennart
    SMHI.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Arbets- och miljömedicin, AB-centrum, Norrlands universitetssjukhus.
    Effekter på luft och hälsa i områden utsatta för rök från skogsbränder: med fokus på Jämtland Härjedalen 20182021Report (Other academic)
    Abstract [sv]

    Denna studie syftar till att följa upp episoden med skogsbrandrök som drabbade Östersund och Jämtland Härjedalen sommaren 2018, samt att belysa vilka erfarenheter man har från andra länder om nivåer för exponering och risker.

    Tyvärr hade ingen av regionens tätorter kontinuerliga partikelmätningar sommaren 2018. En spridningsmodell vid SMHI användes för att beskriva spridning av rök från skogsbränderna 2018, samt en jämförbar period 2017 (då antalet bränder var färre), med fokus på fina partiklar (PM2.5) och sot-partiklar. Utifrån halt- och befolkningsskikt användes befolkningsviktade dygnsmedelhalter som mått på exponeringen i respektive kommun. Statistik över dagligt antal akuta besök för problem från andnings-organen vid sjukhuset i Östersund och regionens olika vårdcentraler och mottagningar, samt över antalet samtal till sjukvårdsupplysningen 1177 om andningsproblem, användes för att studera eventuella akuta hälsoeffekter inom respektive kommuns befolkning.

    Enligt beräkningarna förekom befolkningsviktade dygnsmedelhalter på upp till 97 μg/m3. I verkligheten förekom sannolikt, under kortare tid och avgränsade platser, betydligt högre halter. När brand-röksepisoder definierades som dygn med PM2.5>20 μg/m3 beräknades den sammanviktade relativa ökningen av akuta besök gällande astma till 68% (RR=1.68, 95% KI:1.09-2.57). För diagnoser gällande nedre luftvägar totalt observerades en ökning med 40% (RR=1.4, 95% KI:1.01-1.92). I genomsnitt innebar brandröksepisoder en ökning av halten PM2.5 med 28 μg/m3 i jämförelse med referensdygnen.

    Analyserna av förhöjda partikelhalter i Jämtland-Härjedalen under brandröksperioden sommaren 2018 tyder på att en ökning av akuta problem gällande de nedre luftvägarna kan förväntas från dygns-medelhalter på 20-40 μg/m3 av PM2.5 med ursprung i huvudsak från bränder. För information och varningar under pågående exponering för PM2.5 i skogsbrandrök torde de kriterier för korttidshalter som finns i USA och Kanada vara tillämpliga även för Sverige. Om haltbidraget från branden förväntas bli omkring 60-90 μg/m3 av PM2.5 under 1 timme eller längre bör känsliga grupper uppmanas att begränsa sin exponering.

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  • 20.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Andersson, Camilla
    Swedish Meteorological and Hydrological Institute (SMHI), Folkborgsvägen 17, Norrköping, Sweden.
    Carvalho, Ana Cristina
    Swedish Meteorological and Hydrological Institute (SMHI), Folkborgsvägen 17, Norrköping, Sweden.
    Langner, Joakim
    Swedish Meteorological and Hydrological Institute (SMHI), Folkborgsvägen 17, Norrköping, Sweden.
    Stenfors, Nikolai
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Respiratory Health Effects of Wildfire Smoke during Summer of 2018 in the Jämtland Härjedalen Region, Sweden2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 13, article id 6987Article in journal (Refereed)
    Abstract [en]

    During the summer of 2018 Sweden experienced a high occurrence of wildfires, most intense in the low-densely populated Jämtland Härjedalen region. The aim of this study was to investigate any short-term respiratory health effects due to deteriorated air quality generated by the smoke from wildfires. For each municipality in the region Jämtland Härjedalen, daily population-weighted concentrations of fine particulate matter (PM2.5) were calculated through the application of the MATCH chemistry transport model. Modelled levels of PM2.5 were obtained for two summer periods (2017, 2018). Potential health effects of wildfire related levels of PM2.5 were examined by studying daily health care contacts concerning respiratory problems in each municipality in a quasi-Poisson regression model, adjusting for long-term trends, weekday patterns and weather conditions. In the municipality most exposed to wildfire smoke, having 9 days with daily maximum 1-h mean of PM2.5 > 20 μg/m3, smoke days resulted in a significant increase in daily asthma visits the same and two following days (relative risk (RR) = 2.64, 95% confidence interval (CI): 1.28–5.47). Meta-estimates for all eight municipalities revealed statistically significant increase in asthma visits (RR = 1.68, 95% CI: 1.09–2.57) and also when grouping all disorders of the lower airways (RR = 1.40, 95% CI: 1.01–1.92).

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  • 21.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Andersson, Camilla
    Swedish Meteorological and Hydrological Institute (SMHI), Norrköping, Sweden.
    Carvalho, Ana
    Swedish Meteorological and Hydrological Institute (SMHI), Norrköping, Sweden.
    Langner, Joakim
    Swedish Meteorological and Hydrological Institute (SMHI), Norrköping, Sweden.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Potential health impacts from a wildfire smoke plume over Region Jämtland Härjedalen, Sweden2023In: Atmosphere, E-ISSN 2073-4433, Vol. 14, no 10, article id 1491Article in journal (Refereed)
    Abstract [en]

    In the summer of 2018, Sweden experienced widespread wildfires, particularly in the region of Jämtland Härjedalen during the final weeks of July. We previously conducted an epidemiological study and investigated acute respiratory health effects in eight municipalities relation to the wildfire air pollution. In this study, we aimed to estimate the potential health impacts under less favorable conditions with different locations of the major fires. Our scenarios focused on the most intense plume from the 2018 wildfire episode affecting the largest municipality, which is the region’s only city. Combining modeled PM2.5 concentrations, gridded population data, and exposure–response functions, we assessed the relative increase in acute health effects. The cumulative population-weighted 24 h PM2.5 exposure during the nine highest-level days reached 207 μg/m3 days for 63,227 inhabitants. We observed a small number of excess cases, particularly in emergency unit visits for asthma, with 13 additional cases compared to the normal 12. Overall, our scenario-based health impact assessment indicates minor effects on the studied endpoints due to factors such as the relatively small population, limited exposure period, and moderate increase in exposure compared to similar assessments. Nonetheless, considering the expected rise in fire potential due to global warming and the long-range transport of wildfire smoke, raising awareness of the potential health risks in this region is important.

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  • 22.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Axelsson, Gösta
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Association between precipitation upstream of a drinking water utility and nurse advice calls relating to acute gastrointestinal illnesses2013In: PLOS ONE, E-ISSN 1932-6203, Vol. 8, no 7, article id e69918Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The River Göta Älv is a source of fresh-water for the City of Gothenburg (Sweden). We recently identified a clear association between upstream precipitation and indicator bacteria concentrations in the river water outside the intake to the drinking water utility. This study aimed to determine if variation in the incidence of acute gastrointestinal illnesses is associated with upstream precipitation.

    METHODS: We acquired data, covering 1494 days, on the daily number of telephone calls to the nurse advice line from citizens in Gothenburg living in areas with Göta Älv as a fresh-water supply. We separated calls relating to gastrointestinal illnesses from other medical concerns, and analyzed their association with precipitation using a distributed lag non-linear Poisson regression model, adjusting for seasonal patterns and covariates. We used a 0-21-day lag period for precipitation to account for drinking water delivery times and incubation periods of waterborne pathogens.

    RESULTS: The study period contained 25,659 nurse advice calls relating to gastrointestinal illnesses. Heavy rainfall was associated with increased calls the same day and around 5-6 days later. Consecutive days of wet weather were also found to be associated with an increase in the daily number of gastrointestinal concerns. No associations were identified between precipitation and nurse advice calls relating to other medical concerns.

    CONCLUSION: An increase in nurse advice calls relating to gastrointestinal illnesses around 5-6 days after heavy rainfall is consistent with a hypothesis that the cause could be related to drinking water due to insufficient barriers in the drinking water production, suggesting the need for improved drinking water treatment.

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  • 23.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Barregård, Lars
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Precipitation and primary health care visits for gastrointestinal illness in Gothenburg, Sweden2015In: PLOS ONE, E-ISSN 1932-6203, Vol. 10, no 5, article id e0128487Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The river Göta Älv is a source of freshwater for the City of Gothenburg, Sweden, and we recently identified a clear influence of upstream precipitation on concentrations of indicator bacteria in the river water, as well as an association with the daily number of phone calls to the nurse advice line related to acute gastrointestinal illnesses (AGI calls). This study aimed to examine visits to primary health-care centers owing to similar symptoms (AGI visits) in the same area, to explore associations with precipitation, and to compare variability in AGI visits and AGI calls.

    METHODS: We obtained data covering six years (2007-2012) of daily AGI visits and studied their association with prior precipitation (0-28 days) using a distributed lag nonlinear Poisson regression model, adjusting for seasonal patterns and covariates. In addition, we studied the effects of prolonged wet and dry weather on AGI visits. We analyzed lagged short-term relations between AGI visits and AGI calls, and we studied differences in their seasonal patterns using a binomial regression model.

    RESULTS: The study period saw a total of 17,030 AGI visits, and the number of daily visits decreased on days when precipitation occurred. However, prolonged wet weather was associated with an elevated number of AGI visits. Differences in seasonality patterns were observed between AGI visits and AGI calls, as visits were relatively less frequent during winter and relatively more frequent in August, and only weak short-term relations were found.

    CONCLUSION: AGI visits and AGI calls seems to partly reflect different types of AGI illnesses, and the patients' choice of medical contact (in-person visits versus phone calls) appears to depend on current weather conditions. An association between prolonged wet weather and increased AGI visits supports the hypothesis that the drinking water is related to an increased risk of AGI illnesses.

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  • 24.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bergstedt, Olof
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Precipitation Effects on Microbial Pollution in a River: Lag Structures and Seasonal Effect Modification2014In: PLOS ONE, E-ISSN 1932-6203, Vol. 9, no 5Article in journal (Refereed)
    Abstract [en]

    Background: The river Gota Alv is a source of freshwater for 0.7 million swedes. The river is subject to contamination from sewer systems discharge and runoff from agricultural lands. Climate models projects an increase in precipitation and heavy rainfall in this region. This study aimed to determine how daily rainfall causes variation in indicators of pathogen loads, to increase knowledge of variations in river water quality and discuss implications for risk management. Methods: Data covering 7 years of daily monitoring of river water turbidity and concentrations of E. coli, Clostridium and coliforms were obtained, and their short-term variations in relation with precipitation were analyzed with time series regression and non-linear distributed lag models. We studied how precipitation effects varied with season and compared different weather stations for predictive ability. Results: Generally, the lowest raw water quality occurs 2 days after rainfall, with poor raw water quality continuing for several more days. A rainfall event of >15 mm/24-h (local 95 percentile) was associated with a three-fold higher concentration of E. coli and 30% higher turbidity levels (lag 2). Rainfall was associated with exponential increases in concentrations of indicator bacteria while the effect on turbidity attenuated with very heavy rainfall. Clear associations were also observed between consecutive days of wet weather and decreased water quality. The precipitation effect on increased levels of indicator bacteria was significant in all seasons. Conclusions: Rainfall elevates microbial risks year-round in this river and freshwater source and acts as the main driver of varying water quality. Heavy rainfall appears to be a better predictor of fecal pollution than water turbidity. An increase of wet weather and extreme events with climate change will lower river water quality even more, indicating greater challenges for drinking water producers, and suggesting better control of sources of pollution.

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  • 25.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bergstedt, Olof
    Kretslopp och vatten, Göteborgs stad.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tidsmässiga samband mellan nederbörd, råvattenkvalitet och magsjuka2015Report (Other academic)
    Abstract [en]

    Relations described between heavy rainfall, poor raw water quality and an increased number of cases of gastroenteritis in which the temporal delay is consistent with the incubation times of viruses. The report suggests that better protection against pollution in the river Göta Älv and improved barriers in drinking water production are justified.

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  • 26.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ekebom, Agneta
    Molnar, Peter
    Olstrup, Henrik
    Spanne, Mårten
    Luftföroreningars effekt på akutbesök för andningsorganen och uttag av astmamedicin2019Report (Other academic)
    Abstract [sv]

    Denna rapport presenterar den femte studien för Naturvårdsverkets hälsorelaterade miljöövervakning inom detta område, och syftar till att analysera luftföroreningars korttidseffekter på antalet akutbesök för astma och övriga sjukdomar i andningsorganen under perioden 2013-2018 i tre storstadsområden: Stockholm, Göteborg och Malmö. Som ett tillägg i denna studie har också samband mellan luftföroreningar och läkemedelsuttag för astmabesvär utvärderats som en alternativ indikator på akuta effekter av luftföroreningar på astma. Luftföroreningsdata kommer från respektive miljöförvaltning och avser bakgrundshalter (taknivå) vid huvudmätstationen för respektive studieområde (Stockholm: Södermalm, Malmö: Rådhuset, Göteborg: Femmanhuset). Även pollenhalter, väder, veckodag, tid på året mm har beaktats i analyserna. Uppgifter om akutbesök och läkemedelsuttag kommer från Socialstyrelsens register.

    Analysen med alla tre områden och hela befolkningen (alla åldrar) visar att akutbesök för astma påverkas av de senaste två dygnens halt av alla tre föroreningstyperna: partiklar som PM10, ozon och kvävedioxid, medan det för övriga akutbesök för andningsorganen enbart är PM10 som visar ett statistisk säkerställt samband totalt sett (alla orter och alla åldrar).I jämförelse med tidigare analysers resultat angående sambanden mellan PM10 och akutbesök för astma så ses ingen säkerställd trend sedan 2001, men den senaste perioden ger störst ökning med omkring 4% fler akutbesök per 10 μg/m3 för PM10 (alla åldrar).

    Medan det främst finns samband mellan partikelkoncentrationen som PM10 och akutbesök, ses för uttag av astmaläkemedel främst ett samband med halten av kvävedioxid, och särskilt för barn 0-17 år. För alla tre studieområdena och båda typerna av astmaläkemedel uppvisades liknande samband mellan NO2 och uttag av medicin, vilket kan motivera fördjupade analyser kring avgaskomponenter och mildare uttryck för astmabesvär än akutbesök.

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  • 27.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Samband mellan partikelhalten i Visby och akuta kontakter för astma och sjukdomar i andningsorganen2020Report (Other academic)
    Abstract [sv]

    I Visby har under många år uppmätts med svenska mått ovanligt höga partikelhalter. Detta har inneburit att den gällande miljökvalitetsnormen för partikelmåttet PM10 överskridits under flera år, vilket i sin tur gjorde att ett åtgärdsprogram krävdes.

    De höga halterna har framförallt uppmätts under januari-april, med högst värden under mars. Årstidsmönstret bedöms främst bero på att kalksten från lokal gatubeläggning och halkbekämpning genom nötning, särskilt vid dubbdäcksanvändning, bildar ett damm som vid torr väderlek når höga halter. Under sommar och höst är partikelhalterna betydligt lägre, och partiklarna har i mindre utsträckning ett lokalt ursprung.

    Inom Naturvårdsverkets hälsorelaterade miljöövervakning har konstaterats att förhöjda partikelhalter mätt som PM10 i storstäderna ger akuta effekter som syns exempelvis i form av fler akutbesök för astma, och vägdamm är en orsak. Det speciella partikelproblemet i Visby har föranlett en liknande undersökning av eventuella samband mellan de senaste två dygnens halt av PM10 och dygnets antal akuta besök för astma och andra problem i andningsorganen. Statistik över dygnsvis antal akuta besök har erhållits från Region Gotland.

    Trots att halterna av PM10 är högre under januari-april så konstateras betydligt tydligare samband under maj-december. Då ses bland annat effekter av partikelhalten på dagligt antal akuta besök för astma på cirka 4-5% per 10 μg/m3 ökning av PM10 som medelvärde över de två senaste dygnen, vilket stämmer väl med resultat som nyligen presenterats för de tre största svenska städerna. För alla diagnoser gällande de nedre luftvägarna är riskökningen också statistiskt signifikant totalt för alla åldrar liksom för barn.

    Det enda statistiskt säkerställda sambandet med PM10-halten under januari-april, ”vägdammsperioden”, gäller besöken för de övre luftvägarna bland vuxna. Dessa ökar med cirka 1% per 10 μg/m3. I övrigt visar analyserna för den perioden oftast på svaga och osäkra tendenser i båda riktningarna, vilket talar för att dessa partiklar med högt innehåll av kalksten kan utgöra ett mindre problem ur hälsosynpunkt än befarat utifrån de höga halterna.

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  • 28.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Olstrup, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Increase in daily asthma medication sales in association with air pollution levels in Greater Stockholm2023In: Environmental Epidemiology, E-ISSN 2474-7882, Vol. 7, no 4, article id E256Article in journal (Refereed)
    Abstract [en]

    Background: Daily air pollution levels are known to influence the number of patients with acute asthma. We investigated the short-term effects of air pollution exposure on the daily number of asthma medication purchases in the Greater Stockholm area, Sweden.

    Methods: We conducted a time-series study with data on asthma medication purchases and daily mean values of particulate matter ≤10 µm (PM10), nitrogen oxides (NOx), and ozone during 2018-2019. We used nonlinear distributed lag quasi-Poisson regression models to estimate the associations between air pollution levels and medication purchases, adjusting for meteorological variables, pollen levels, day of the week, and long-term trends. The models established linear relationships between air pollutants and the outcome, and potential delayed effects were smoothed with a spline across a lag period of 2 weeks. We applied separate models for each municipality (n = 21) in Greater Stockholm, and calculated pooled estimates to achieve combined results for the whole region.

    Results: We observed associations between daily levels of air pollution and purchases of asthma medications, most clearly for PM10. The pooled estimates of the relative risks for asthma medication purchases across all 21 municipalities associated with a 10 μg m-3increase in PM10the same day (lag 0) was 1.7% [95% confidence interval (CI): 1.2%, 2.1%], a cumulative increase of 4.6% (95% CI: 3.7%, 5.6%) over one week (lag 0-6), and a 6.5% (95% CI: 5%, 8%) increase over 2 weeks (lag 0-13). The corresponding pooled effect per 10 μg m-3increase in NOxand ozone were 2.8% (95% CI: 1.6%, 4.1%) and 0.7% (95% CI: 0%, 1.4%) over 2 weeks (lag 0-13), respectively.

    Conclusions: Our study revealed short-term associations between air pollution, especially PM10, and purchases of asthma medications.

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  • 29.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Olstrup, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Short-Term Associations between PM10 and Respiratory Health Effects in Visby, Sweden2022In: Toxics, E-ISSN 2305-6304, Vol. 10, no 6, article id 333Article in journal (Refereed)
    Abstract [en]

    The old Swedish city Visby, located on the island Gotland, has, for several years, reported higher PM10 concentrations than any other city in Sweden. In Visby, local limestone is used, both in road paving and as sand used for anti-slip measures, resulting in a clear annual pattern of PM10 with the highest concentrations during winter/spring when studded tires are allowed. This study analyzes the short-term associations between PM10 and daily number of patients with acute respiratory problems (ICD-10 diagnoses: J00-J99) seeking care at the hospital or primary healthcare units in Visby during the period of 2013-2019. The daily mean of PM10 was on average 45 µg m-3 during winter/spring and 18 µg m-3 during summer/autumn. Four outcome categories were analyzed using quasi-Poisson regression models, stratifying for period and adjusting for calendar variables and weather. An increase in respiratory visits was associated with increasing concentrations in PM10 during the summer/autumn period, most prominent among children, where asthma visits increased by 5% (95% CI: 2-9%) per 10 µg m-3 increase in PM10. For the winter/spring period, no significant effects were observed, except for the diagnose group 'upper airways' in adults, where respiratory visits increased by 1% (95% CI: 0.1-1.9%) per 10 µg m-3 increase. According to the results, limestone in particles seem to be relatively harmless at the exposure concentrations observed in Visby, and this is in line with the results from a few experimental and occupational studies.

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  • 30.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Simonsson, Magnus
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Säve-Söderbergh, Melle
    Toljander, Jonas
    Efficacy of water treatment processes and endemic gastrointestinal illness: A multi-city study in Sweden2016In: Water Research, ISSN 0043-1354, E-ISSN 1879-2448, Vol. 102, p. 263-270Article in journal (Refereed)
    Abstract [en]

    Outbreaks of acute gastrointestinal illnesses (AGI) have been linked to insufficient drinking water treatment on numerous occasions in the industrialized world, but it is largely unknown to what extent public drinking water influences the endemic level of AGI. This paper aimed to examine endemic AGI and the relationship with pathogen elimination efficacy in public drinking water treatment processes. For this reason, time series data of all telephone calls to the Swedish National Healthcare Guide between November 2007 and February 2014 from twenty Swedish cities were obtained. Calls concerning vomiting, diarrhea or abdominal pain (AGI calls) were separated from other concerns (non-AGI calls). Information on which type of microbial barriers each drinking water treatment plant in these cities have been used were obtained, together with the barriers' theoretical pathogen log reduction efficacy. The total log reduction in the drinking water plants varied between 0.0 and 6.1 units for viruses, 0.0-14.6 units for bacteria and 0.0-7.3 units regarding protozoans. To achieve one general efficacy parameter for each plant, a weighted mean value of the log reductions (WLR) was calculated, with the weights based on how commonly these pathogen groups cause AGI. The WLR in the plants varied between 0.0 and 6.4 units. The effect of different pathogen elimination efficacy on levels of AGI calls relative non-AGI calls was evaluated in regression models, controlling for long term trends, population size, age distribution, and climatological area. Populations receiving drinking water produced with higher total log reduction was associated with a lower relative number of AGI calls. In overall, AGI calls decreased by 4% (OR = 0.96, CI: 0.96-0.97) for each unit increase in the WLR. The findings apply to both groundwater and surface water study sites, but are particularly evident among surface water sites during seasons when viruses are the main cause of AGI. This study proposes that the endemic level of gastroenteritis can indeed be reduced with more advanced treatment processes at many municipal drinking water treatment plants.

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  • 31.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Rantakokko, Panu
    Åkesson, Agneta
    Donat-Vargas, Carolina
    Kiviranta, Hannu
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Rylander, Lars
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bergdahl, Ingvar A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Chlorinated persistent organic pollutants and type 2 diabetes - A population-based study with pre- and post- diagnostic plasma samples2019In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 174, p. 35-45Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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  • 32.
    Wennberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Bergdahl, Ingvar A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Diet and lifestyle factors associated with fish consumption in men and women: a study of whether gender differences can result in gender-specific confounding2012In: Nutrition Journal, E-ISSN 1475-2891, Vol. 11, p. 101-Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 33.
    Zamir, Itay
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Abrahamsson, Thomas
    Ahlsson, Fredrik
    Engström, Eva
    Hallberg, Boubou
    Hansen-Pupp, Ingrid
    Stoltz Sjöström, Elisabeth
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hyperglycemia in extremely preterm infants: insulin treatment, mortality and nutrient intakes2018In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 200, p. 104-110Article in journal (Refereed)
    Abstract [en]