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  • 1. Adrian, L.
    et al.
    Svanes, C.
    Johannessen, A.
    Lodge, C.
    Bertelsen, R.
    Dratva, J.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Gislason, T.
    Benedikstdottir, B.
    Holm, M.
    Jogi, R.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Norback, D.
    Omenaas, E.
    Real, F.
    Schlunssen, V
    Sigsgaard, T.
    Skorge, T.
    Timm, S.
    Wieslander, G.
    Janson, C.
    Dharmage, S.
    Early life parental exposure to cats and dogs reduces the risk of allergic disease in their children: possible intergenerational effect2014Ingår i: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 69, nr Supplement: 99, s. 577-578Artikel i tidskrift (Refereegranskat)
  • 2.
    Amin, Hesham
    et al.
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Šantl-Temkiv, Tina
    Section for Microbiology, Department of Biology, Aarhus University, Aarhus, Denmark.
    Cramer, Christine
    Department of Public Health, Environment, Work and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark; Department of Occupational Medicine, Danish Ramazzini Center, Aarhus University Hospital, Aarhus, Denmark.
    Finster, Kai
    Section for Microbiology, Department of Biology, Aarhus University, Aarhus, Denmark.
    Real, Francisco Gomez
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Gislason, Thorarinn
    Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
    Holm, Mathias
    Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden.
    Janson, Christer
    Department of Medical Sciences: Respiratory, Allergy, Sleep Research, Uppsala University, Uppsala, Sweden; Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Jögi, Nils Oskar
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Jogi, Rain
    Tartu University Hospital, Lung Clinic, Tartu, Estonia.
    Malinovschi, Andrei
    Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Marshall, Ian P. G.
    Section for Microbiology, Department of Biology, Aarhus University, Aarhus, Denmark.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Norbäck, Dan
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Shigdel, Rajesh
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Sigsgaard, Torben
    Department of Public Health, Environment, Work and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark.
    Svanes, Cecilie
    Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Centre for International Health, University of Bergen Department of Global Public Health and Primary Care, Bergen, Norway.
    Thorarinsdottir, Hulda
    Department of Anesthesia and Intensive Care, Landspitali University Hospital, Reykjavik, Iceland.
    Wouters, Inge M.
    Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands.
    Schlünssen, Vivi
    Department of Public Health, Environment, Work and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark.
    Bertelsen, Randi J.
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Indoor airborne microbiome and endotoxin: meteorological events and occupant characteristics are important determinants2023Ingår i: Environmental Science and Technology, ISSN 0013-936X, E-ISSN 1520-5851, Vol. 57, nr 32, s. 11750-11766Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Airborne bacteria and endotoxin may affect asthma and allergies. However, there is limited understanding of the environmental determinants that influence them. This study investigated the airborne microbiomes in the homes of 1038 participants from five cities in Northern Europe: Aarhus, Bergen, Reykjavik, Tartu, and Uppsala. Airborne dust particles were sampled with electrostatic dust fall collectors (EDCs) from the participants' bedrooms. The dust washed from the EDCs' clothes was used to extract DNA and endotoxin. The DNA extracts were used for quantitative polymerase chain (qPCR) measurement and 16S rRNA gene sequencing, while endotoxin was measured using the kinetic chromogenic limulus amoebocyte lysate (LAL) assay. The results showed that households in Tartu and Aarhus had a higher bacterial load and diversity than those in Bergen and Reykjavik, possibly due to elevated concentrations of outdoor bacterial taxa associated with low precipitation and high wind speeds. Bergen-Tartu had the highest difference (ANOSIM R = 0.203) in β diversity. Multivariate regression models showed that α diversity indices and bacterial and endotoxin loads were positively associated with the occupants' age, number of occupants, cleaning frequency, presence of dogs, and age of the house. Further studies are needed to understand how meteorological factors influence the indoor bacterial community in light of climate change.

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  • 3.
    Andersson, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Heavy vehicle traffic is related to wheeze among schoolchildren: a population-based study in an area with low traffic flows2011Ingår i: Environmental Health, E-ISSN 1476-069X, Vol. 10, nr 91Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: An association between traffic air pollution and respiratory symptoms among children has been reported. However, the effects of traffic air pollution on asthma and wheeze have been very sparsely studied in areas with low traffic intensity in cold climate with poor dispersion. We evaluated the impact of vehicle traffic on childhood asthma and wheeze by objective exposure assessment.

    Methods: As a part of the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a questionnaire was sent to the families of all children attending first or second grade in Luleå (72,000 inhabitants) in Northern Sweden in 2006. The age of the children was 7-8 years and the participation rate was 98% (n = 1357). Skin prick tests were performed in 1224 (89%) children. The home addresses were given geographical coordinates and traffic counts were obtained from the local traffic authorities. A proximity model of average daily traffic and average daily heavy vehicle traffic within 200 meters from each participant's home address was used. The associations between traffic exposure and asthma and wheeze, respectively, were analysed in an adjusted multiple logistic regression model.

    Results: Exposure to high traffic flows was uncommon in the study area; only 15% of the children lived within 200 meters from a road with a traffic flow of ≥8000 vehicles per day. Living closer than 200 meters from a road with ≥500 heavy vehicles daily was associated with current wheeze, odds ratio 1.7 (confidence interval 1.0-2.7). A dose-response relation was indicated. An increased risk of asthma was also seen, however not significant, odds ratio 1.5 (confidence interval 0.8-2.9). Stratified analyses revealed that the effect of traffic exposure was restricted to the non-sensitized phenotype of asthma and wheeze. The agreement between self-reported traffic exposure and objective measurements of exposure was moderate.

    Conclusions: This study showed that already at low levels of exposure, vehicle traffic is related to an increased risk of wheeze among children. Thus, the global burden of traffic air pollution may be underestimated.

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

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

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

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

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

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

  • 5.
    Carlsen, Hanne Krage
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Univ Iceland, Engn & Nat Sci, Reykjavik, Iceland; Univ Gothenburg, Inst Med, Sect Occupat & Environm Med, Dept Publ Hlth & Community Med,Sahlgrenska Acad, Gothenburg, Sweden.
    Bäck, E.
    Eneroth, K.
    Gislason, T.
    Holm, M.
    Janson, C.
    Jensen, S. S.
    Johannessen, A.
    Kaasik, M.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Segersson, D.
    Sigsgaard, T.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Olsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Orru, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Univ Tartu, Dept Family Med & Publ Hlth, Tartu, Estonia.
    Indicators of residential traffic exposure: Modelled NOX, traffic proximity, and self-reported exposure in RHINE III2017Ingår i: Atmospheric Environment, ISSN 1352-2310, Vol. 167, s. 416-425Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Few studies have investigated associations between self-reported and modelled exposure to traffic pollution. The objective of this study was to examine correlations between self-reported traffic exposure and modelled (a) NOx and (b) traffic proximity in seven different northern European cities; Aarhus (Denmark), Bergen (Norway), Gothenburg, Ulna and Uppsala (Sweden), Reykjavik (Iceland), and Tartu (Estonia). We analysed data from the RHINE III (Respiratory Health in Northern Europe, www.rhine.nu) cohorts of the seven study cities. Traffic proximity (distance to the nearest road with >10,000 vehicles per day) was calculated and vehicle exhaust (NOx) was modelled using dispersion models and land-use regression (LUR) data from 2011. Participants were asked a question about self-reported traffic intensity near bedroom window and another about traffic noise exposure at the residence. The data were analysed using rank correlation (Kendall's tau) and inter-rater agreement (Cohen's Kappa) between tertiles of modelled NOx and traffic proximity tertile and traffic proximity categories (0-150 metres (m), 150 -200 m, >300 m) in each centre. Data on variables of interest were available for 50-99% of study participants per each cohort. Mean modelled NOx levels were between 6.5 and 16.0 mu g/m(3); median traffic intensity was between 303 and 10,750 m in each centre. In each centre, 7.7-18.7% of respondents reported exposure to high traffic intensity and 3.6-16.3% of respondents reported high exposure to traffic noise. Self-reported residential traffic exposure had low or no correlation with modelled exposure and traffic proximity in all centres, although results were statistically significant (tau = 0.057-0.305). Self reported residential traffic noise correlated weakly (tau = 0.090-0.255), with modelled exposure in all centres except Reykjavik. Modelled NOx\] had the highest correlations between self-reported and modelled traffic exposure in five of seven centres, traffic noise exposure had the highest correlation with traffic proximity in tertiles in three centres. Self-reported exposure to high traffic intensity and traffic noise at each participant's residence had low or weak although statistically significant correlations with modelled vehicle exhaust pollution levels and traffic proximity.

  • 6.
    Carlsen, Hanne Krage
    et al.
    Section of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 16A, Gothenburg, Sweden.
    Haga, Susanna Lohman
    Section of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 16A, Gothenburg, Sweden.
    Olsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Behndig, Annelie F.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Meister, Kadri
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Olin, Anna-Carin
    Section of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 16A, Gothenburg, Sweden.
    Birch pollen, air pollution and their interactive effects on airway symptoms and peak expiratory flow in allergic asthma during pollen season: a panel study in Northern and Southern Sweden2022Ingår i: Environmental Health, E-ISSN 1476-069X, Vol. 21, nr 1, artikel-id 63Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Evidence of the role of interactions between air pollution and pollen exposure in subjects with allergic asthma is limited and need further exploration to promote adequate preventive measures. The objective of this study was to assess effects of exposure to ambient air pollution and birch pollen on exacerbation of respiratory symptoms in subjects with asthma and allergy to birch.

    Methods: Thirty-seven subjects from two Swedish cities (Gothenburg and Umeå) with large variation in exposure to both birch-pollen and air pollutants, participated in the study. All subjects had confirmed allergy to birch and self-reported physician-diagnosed asthma. The subjects recorded respiratory symptoms such as rhinitis or eye irritation, dry cough, dyspnoea, the use of any asthma or allergy medication and peak respiratory flow (PEF), daily for five consecutive weeks during two separate pollen seasons and a control season without pollen. Nitrogen oxides (NOx), ozone (O3), particulate matter (PM2.5), birch pollen counts, and meteorological data were obtained from an urban background monitoring stations in the study city centres. The data were analysed using linear mixed effects models.

    Results: During pollen seasons all symptoms and medication use were higher, and PEF was reduced in the subjects. In regression analysis, exposure to pollen at lags 0 to 2 days, and lags 0 to 6 days was associated with increased ORs of symptoms and decreased RRs for PEF. Pollen and air pollution interacted in some cases; during low pollen exposure, there were no associations between air pollution and symptoms, but during high pollen exposure, O3 concentrations were associated with increased OR of rhinitis or eye irritation, and PM2.5 concentrations were associated with increased ORs of rhinitis or eye irritation, dyspnea and increased use of allergy medication. Conclusions: Pollen and air pollutants interacted to increase the effect of air pollution on respiratory symptoms in allergic asthma. Implementing the results from this study, advisories for individuals with allergic asthma could be improved, minimizing the morbidities associated with the condition.

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  • 7. Carlsen, Hanne Krage
    et al.
    Koca, Hatice
    Lohman-Haga, Susanna
    Behndig, Annelie F.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Occupational and environmental medicine, School of Public Health and Community Medicine Sahlgrenska Academy, Sweden.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Olin, Anna-Carin
    In allergic individuals, FENO50 is associated with O3 and PM10 during pollen season2020Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56Artikel i tidskrift (Övrigt vetenskapligt)
  • 8.
    Carlsen, Hanne Krage
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Levinsson, Anna
    Kim, Jeong-Lim
    Toren, Kjell
    Nyberg, Fredrik
    Olin, Anna-Carin
    Exposure to traffic and lung function in adults: a general population cohort study2015Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 5, nr 6, artikel-id e007624Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate the association between living near dense traffic and lung function in a cohort of adults from a single urban region. Design: Cross-sectional results from a cohort study. Setting: The adult-onset asthma and exhaled nitric oxide (ADONIX) cohort, sampled during 2001-2008 in Gothenburg, Sweden. Exposure was expressed as the distance from participants' residential address to the nearest road with dense traffic (>10 000 vehicles per day) or very dense traffic (>30 000 vehicles per day). The exposure categories were: low (>500 m; reference), medium (75-500 m) or high (<75 m). Participants: The source population was a population-based cohort of adults (n=6153). The study population included 5441 participants of European descent with good quality spirometry and information about all outcomes and covariates. Outcome measures: Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured at a clinical examination. The association with exposure was examined using linear regression adjusting for age, gender, body mass index, smoking status and education in all participants and stratified by sex, smoking status and respiratory health status. Results: We identified a significant dose-response trend between exposure category and FEV1 (p=0.03) and borderline significant trend for FVC (p=0.06) after adjusting for covariates. High exposure was associated with lower FEV1 (-1.0%, 95% CI -2.5% to 0.5%) and lower FVC (-0.9%, 95% CI -2.2% to 0.4%). The effect appeared to be stronger in women. In highly exposed individuals with current asthma or chronic obstructive pulmonary disease, FVC was lower (-4.5%, 95% CI -8.8% to -0.1%). Conclusions: High traffic exposure at the residential address was associated with lower than predicted FEV1 and FVC lung function compared with living further away in a large general population cohort. There were particular effects on women and individuals with obstructive disease.

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  • 9. Chen, Chih-Mei
    et al.
    Thiering, Elisabeth
    Zock, Jan-Paul
    Villani, Simona
    Olivieri, Mario
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Jarvis, Deborah
    Norbaeck, Dan
    Verlato, Giuseppe
    Heinrich, Joachim
    Is There a Threshold Concentration of Cat Allergen Exposure on Respiratory Symptoms in Adults?2015Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 10, nr 6, artikel-id e0127457Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and Objective Cat allergen concentrations higher than 8 mu g/g in settled house dust, have been suggested to provoke exacerbation of allergic respiratory symptoms. However, whether the 8 mu g/g of indoor cat allergen concentration is indeed the minimal exposure required for triggering the asthma related respiratory symptoms or the development of sensitization has not yet been confirmed. We studied the associations between domestic cat allergen concentrations and allergic symptoms in the European Community Respiratory Health Survey II, with the aim of confirming this suggested threshold. Methods Cat allergen concentrations were measured in the mattress dust of 3003 participants from 22 study centres. Levels of specific immunoglobulin E to cat allergens were measured in serum samples using an immunoassay. Information on allergic symptoms, medication use, home environment and smoking was obtained from a face-to-face interview. Results Domestic cat allergen concentrations were not associated with allergic/asthmatic symptoms in the entire study population, nor in the subset sensitized to cat allergen. We also found no association among individuals exposed to concentrations higher than 8 mu g/g. However, exposure to medium cat allergen concentrations (0.24-0.63 mu g/g) was positively associated with reported asthmatic respiratory symptoms in subjects who have experienced allergic symptoms when near animals. Conclusions The proposed 8 mu g/g threshold of cat allergen concentrations for the exacerbation of allergic/respiratory symptoms was not confirmed in a general European adult population. Potential biases attributable to avoidance behaviours and an imprecise exposure assessment cannot be excluded.

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  • 10. Cyrys, Josef
    et al.
    Eeftens, Marloes
    Heinrich, Joachim
    Ampe, Christophe
    Armengaud, Alexandre
    Beelen, Rob
    Bellander, Tom
    Beregszaszi, Timea
    Birk, Matthias
    Cesaroni, Giulia
    Cirach, Marta
    de Hoogh, Kees
    De Nazelle, Audrey
    de Vocht, Frank
    Declercq, Christophe
    Dėdelė, Audrius
    Dimakopoulou, Konstantina
    Eriksen, Kirsten
    Galassi, Claudia
    Gra˛ulevičienėo, Regina
    Grivas, Georgios
    Gruzieva, Olena
    Hagenbjörk Gustafsson, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hoffmann, Barbara
    Iakovides, Minas
    Ineichen, Alex
    Krämer, Ursula
    Lanki, Timo
    Lozano, Patricia
    Madsena, Christian
    Meliefste, Kees
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Mölter, Anna
    Mosler, Gioia
    Nieuwenhuijsen, Mark
    Nonnemachera, Michael
    Oldenwening, Marieke
    Peters, Annette
    Ponteta, Sabrina
    Probst-Hensch, Nicole
    Quassa, Ulrich
    Raaschou-Nielsen, Ole
    Ranzia, Andrea
    Sugiri, Dorothee
    Stephanou, Euripides G.
    Taimisto, Pekka
    Tsai, Ming-Yi
    Vaskövi, Éva
    Villania, Simona
    Wang, Meng
    Brunekreef, Bert
    Hoek, Gerard
    Variation of NO2 and NOx concentrations between and within 36 European study areas: Results from the ESCAPE study2012Ingår i: Atmospheric Environment, ISSN 1352-2310, E-ISSN 1873-2844, Vol. 62, s. 374-390Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The ESCAPE study (European Study of Cohorts for Air Pollution Effects) investigates long-term effects of exposure to air pollution on human health in Europe. This paper documents the spatial variation of measured NO2 and NOx concentrations between and within 36 ESCAPE study areas across Europe.

    In all study areas NO2 and NOx were measured using standardized methods between October 2008 and April 2011. On average, 41 sites were selected per study area, including regional and urban background as well as street sites. The measurements were conducted in three different seasons, using Ogawa badges. Average concentrations for each site were calculated after adjustment for temporal variation using data obtained from a routine monitor background site.

    Substantial spatial variability was found in NO2 and NOx concentrations between and within study areas; 40% of the overall NO2 variance was attributable to the variability between study areas and 60% to variability within study areas. The corresponding values for NOx were 30% and 70%. The within-area spatial variability was mostly determined by differences between street and urban background concentrations. The street/urban background concentration ratio for NO2 varied between 1.09 and 3.16 across areas. The highest median concentrations were observed in Southern Europe, the lowest in Northern Europe.

    In conclusion, we found significant contrasts in annual average NO2 and NOx concentrations between and especially within 36 study areas across Europe. Epidemiological long-term studies should therefore consider different approaches for better characterization of the intra-urban contrasts, either by increasing of the number of monitors or by modelling.

  • 11. Dahgam, Santosh
    et al.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Naluai, Asa Torinsson
    Olin, Anna-Carin
    Nyberg, Fredrik
    Haplotypes of the inducible nitric oxide synthase gene are strongly associated with exhaled nitric oxide levels in adults: a population-based study2014Ingår i: Journal of Medical Genetics, ISSN 0022-2593, E-ISSN 1468-6244, Vol. 51, nr 7, s. 449-454Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Previous genetic association studies have reported evidence for association of single-nucleotide polymorphisms (SNPs) in the NOS2 gene, encoding inducible nitric oxide synthase (iNOS), to variation in levels of fractional exhaled nitric oxide (FENO) in children and adults. In this study, we evaluated 10 SNPs in the region of chromosome 17 from 26.07Mb to 26.13Mb to further understand the contribution of NOS2 to variation in levels of FENO. Methods In a cohort of 5912 adults 25-75years of age, we investigated the relationship between NOS2 haplotypes and FENO, and effect modification by asthma. Results Seven common (frequency 5%) haplotypes (H1-H7) were inferred from all possible haplotype combinations. One haplotype (H3) was significantly associated with lower levels of FENO: -5.8% (95% CI -9.8 to -1.7; p=0.006) compared with the most common baseline haplotype H1. Two haplotypes (H5 and H6) were significantly associated with higher levels of FENO: +10.7% (95% CI 5.0 to 16.7; p=0.0002) and +14.9% (95% CI 10.6 to 19.3; p=7.8x10(-13)), respectively. The effect of haplotype H3 was mainly seen in subjects with asthma (-21.6% (95% CI -33.5 to -5.9)) and was not significant in subjects without asthma (-4.2% (95% CI -8.4 to 0.2)). The p value for interaction between H3 and asthma status was 0.004. Conclusions Our findings suggest that several common haplotypes in the NOS2 gene contribute to variation in FENO in adults. We also saw some evidence of effect modification by asthma status on haplotype H3.

  • 12. Dahgam, Santosh
    et al.
    Nyberg, Fredrik
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Naluai, Åsa Torinsson
    Olin, Anna-Carin
    Single nucleotide polymorphisms in the NOS2 and NOS3 genes are associated with exhaled nitric oxide2012Ingår i: Journal of Medical Genetics, ISSN 0022-2593, E-ISSN 1468-6244, Vol. 49, nr 3, s. 200-205Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Polymorphisms in nitric oxide synthase genes (NOS1, NOS2, and NOS3) have been suggested to have a major impact on fraction of exhaled nitric oxide (FENO), a biomarker of airway inflammation. However, the genetic contribution of NOS polymorphisms to FENO is not fully understood. The aim of this study was to investigate comprehensively the association between single nucleotide polymorphisms (SNPs) in all three NOS genes and FENO in an adult population, and to assess whether such associations are modified by asthma or atopy.

    Method In 1737 adults from a Swedish general population sample, FENO was measured and genetic variation in the NOS genes was assessed using 49 SNPs. The genetic effect of NOS polymorphisms on FENO, asthma, and atopy was estimated using multiple regression methods.

    Results In a multi-SNP model based on stepwise regression analysis, two SNPs in NOS2 and one in NOS3 showed independent associations with levels of FENO. For NOS2 SNP rs9901734, subjects had 5.3% (95% CI 1.0% to 9.7%) higher levels of FENO per G allele, and for rs3729508, subjects with CC or CT genotypes had 9.4% (95% CI 3.1% to 15.2%) higher levels compared with TT. For NOS3 SNP rs7830, subjects with GT or TT had 5.6% (95% CI 0.4% to 11.1%) higher levels than GG; the genetic effect of this SNP was stronger in asthmatics (21.9%, 95% CI 4.6% to 42.0%).

    Conclusion These results suggest that NOS2 is the major NOS gene determining variability in exhaled nitric oxide in the healthy adult population, while NOS3 may play a more important role in asthmatic adults.

  • 13. de Hoogh, Kees
    et al.
    Korek, Michal
    Vienneau, Danielle
    Keuken, Menno
    Kukkonen, Jaakko
    Nieuwenhuijsen, Mark J
    Badaloni, Chiara
    Beelen, Rob
    Bolignano, Andrea
    Cesaroni, Giulia
    Pradas, Marta Cirach
    Cyrys, Josef
    Douros, John
    Eeftens, Marloes
    Forastiere, Francesco
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Fuks, Kateryna
    Gehring, Ulrike
    Gryparis, Alexandros
    Gulliver, John
    Hansell, Anna L
    Hoffmann, Barbara
    Johansson, Christer
    Jonkers, Sander
    Kangas, Leena
    Katsouyanni, Klea
    Künzli, Nino
    Lanki, Timo
    Memmesheimer, Michael
    Moussiopoulos, Nicolas
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Pershagen, Göran
    Probst-Hensch, Nicole
    Schindler, Christian
    Schikowski, Tamara
    Sugiri, Dorothee
    Teixidó, Oriol
    Tsai, Ming-Yi
    Yli-Tuomi, Tarja
    Brunekreef, Bert
    Hoek, Gerard
    Bellander, Tom
    Comparing land use regression and dispersion modelling to assess residential exposure to ambient air pollution for epidemiological studies2014Ingår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 73, s. 382-392Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Land-use regression (LUR) and dispersion models (DM) are commonly used for estimating individual air pollution exposure in population studies. Few comparisons have however been made of the performance of these methods.

    OBJECTIVES: Within the European Study of Cohorts for Air Pollution Effects (ESCAPE) we explored the differences between LUR and DM estimates for NO2, PM10 and PM2.5.

    METHODS: The ESCAPE study developed LUR models for outdoor air pollution levels based on a harmonised monitoring campaign. In thirteen ESCAPE study areas we further applied dispersion models. We compared LUR and DM estimates at the residential addresses of participants in 13 cohorts for NO2; 7 for PM10 and 4 for PM2.5. Additionally, we compared the DM estimates with measured concentrations at the 20-40 ESCAPE monitoring sites in each area.

    RESULTS: The median Pearson R (range) correlation coefficients between LUR and DM estimates for the annual average concentrations of NO2, PM10 and PM2.5 were 0.75 (0.19-0.89), 0.39 (0.23-0.66) and 0.29 (0.22-0.81) for 112,971 (13 study areas), 69,591 (7) and 28,519 (4) addresses respectively. The median Pearson R correlation coefficients (range) between DM estimates and ESCAPE measurements were of 0.74 (0.09-0.86) for NO2; 0.58 (0.36-0.88) for PM10 and 0.58 (0.39-0.66) for PM2.5.

    CONCLUSIONS: LUR and dispersion model estimates correlated on average well for NO2 but only moderately for PM10 and PM2.5, with large variability across areas. DM predicted a moderate to large proportion of the measured variation for NO2 but less for PM10 and PM2.5.

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

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

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

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

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

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

  • 15. Forsberg, Bertil
    et al.
    Modig, Lars
    Segerstedt, Bo
    Hälsokonsekvenser av partikulära luftföroreningar i 26 europeiska städer Svenska resultat från APHEIS 32004Rapport (Övrigt vetenskapligt)
    Abstract [en]

    Stockholm och Göteborg ingår som svenska städer bland de 26 europeiska städer som ingår i APHEIS. Beräkningarna inom APHEIS 3 visar att en sänkning av den urbana bakgrundshalten av partiklar med 5 mikrogram per kubikmeter mätt som PM10 (eller 3,5 ?g/m3 av dess finare fraktion PM2.5) på sikt bedöms minska antalet dödsfall med ungefär 2 %. Detta innebär per år cirka 80 dödsfall färre i Göteborg och cirka 220 i Stockholm. Mer än ¾ av dessa för tidiga dödsfall sker i hjärt-och lungsjukdomar, medan lungcancer svarar för en liten andel. Drygt ¼ av de tidigarelagda dödsfallen bedöms vara relaterade till partikelhalten under de senaste 40 dygnen, och skulle därför kunna påverkas tämligen omgående om partikelhalten minskades. Ungefär vart 7:e av dessa dödsfall beror av halten samma dag eller dagen innan. Tre fjärdedelar av dödsfallen som är tidigarelagda på grund av luften, tycks dock sammanhänga med längre tids exponering och kan huvudsakligen påverkas först på många års sikt. Luftföroreningarna får naturligtvis olika personers hälsa och livslängd att påverkas mer eller mindre, men de förtida dödsfall i Stockholm och Göteborg som skulle undvikas med 5 ?g/m3 lägre långtidshalt av PM10 (eller 3,5 ?g/m3 av PM2.5) beräknas motsvara en livslängdsförlust med i genomsnitt cirka 2,5 månader för städernas invånare. En haltminskning av diskuterad storlek kan åstadkommas såväl genom minskade utsläpp i vår omvärld, som genom lokala åtgärder mot främst trafikens avgaser, slitagepartiklar och damm. Storleken på de förväntade hälsovinsterna beror troligtvis även på hur partikelhalten minskas. Det är sannolikt så att en sänkt halt av avgaspartiklar har större betydelse räknat per ?g/m3 än en sänkt halt på grund av andra källor. Det finns även andra luftföroreningar i städerna som är av betydelse bl.a. för dödligheten och som inte täcks av dessa beräkningar baserade på den urbana bakgrundshalten av PM10 och PM2.5. Inom APHEIS har även beräknats hur antalet akuta inläggningar på sjukhus skulle minska med sänkta partikelhalter. Dessa beräkningar har klara begränsningar. Här finns kunskap bara om hur antalet vårdfall beror av halterna de senaste två dagarna, vilket troligen leder till en stor underskattning av hur luftföroreningarna totalt påverkar antalet fall. Dessutom har de faktiska analyserna inom APHEIS 3 visat att den genomsnittliga effekt som partikelhalten i konsekvensberäkningarna för alla 26 städer antas ha på inläggningar för andningsorganens sjukdomar är mycket lägre än den verkliga effekt vi nu funnit i Stockholm och Göteborg. Detta är sannolikt inte ett slumpbetingat resultat, utan kan motivera att vi antar starkare effekter per haltökning vid beräkningar för svenska städer. Förklaringen kan finnas i såväl befolkningens känslighet och möjlighet att få vård, som i partiklarnas sammansättning och toxiska egenskaper.

  • 16.
    Gyawali, Sanjay
    et al.
    Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    López-Cervantes, Juan Pablo
    Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    Johannessen, Ane
    Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
    Gislason, Thorarinn
    Faculty of Medical, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland.
    Holm, Mathias
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Jögi, Rain
    Lung Clinic, Tartu University Hospital, Tartu, Estonia.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Schlünssen, Vivi
    Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark.
    Mustafa, Tehmina
    Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
    Svanes, Cecilie
    Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    Maternal and paternal tuberculosis is associated with increased asthma and respiratory symptoms in their offspring: a study from Northern Europe2023Ingår i: Frontiers in Allergy, E-ISSN 2673-6101, Vol. 4, artikel-id 1193141Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Given the profound impact of tuberculosis (TB) on immunity and given murine studies suggesting that infections may influence immunity across generations, we hypothesize that parental TB might impact health and disease in future offspring.

    Objective: This study investigated the impact of maternal and paternal TB on offspring asthma and respiratory symptoms.

    Methods: We included data from the third follow-up of the Respiratory Health in Northern Europe study (RHINE). Information on own asthma status, asthma-like symptoms and other respiratory symptoms, as well as information about parental TB and asthma, were collected using standardized questionnaires. The associations between parental TB and RHINE participants' asthma and respiratory symptoms were analyzed using multiple logistic regression, with adjustment for parental education, smoking habits and asthma.

    Results: Of 8,323 study participants, 227 (2.7%) reported only paternal TB, 282 (3.4%) only maternal TB, and 33 (0.4%) reported that both parents had TB. We found a higher risk of asthma (aOR: 1.29, 95% CI: 1.05–1.57) in offspring with a history of parental TB as compared to offspring without parental TB., Parental TB was significantly associated with allergic asthma in offspring (aOR: 1.58, 95% CI: 1.29–2.05), while no significant association between parental TB and asthma without allergy (aOR: 1.00, 95% CI: 0.76–1.32) in offspring was observed.

    Conclusion: Results from this study indicate that parental TB might be a risk factor for offspring's asthma and respiratory symptoms. We raise the hypothesis that the immunological impact of infections might be transmitted to influence offspring phenotype in humans.

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  • 17.
    Gyawali, Sanjay
    et al.
    Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    López-Cervantes, Juan Pablo
    Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    Jõgi, Nils Oskar
    Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    Mustafa, Tehmina
    Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
    Janson, Christer
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Holm, Mathias
    Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Cramer, Christine
    Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark; Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.
    Gislason, Thorarinn
    Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland; University of Iceland, Medical faculty, Reykjavik, Iceland.
    Svanes, Cecilie
    Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
    Previous tuberculosis infection associated with increased frequency of asthma and respiratory symptoms in a nordic–baltic multicentre population study2023Ingår i: ERJ Open Research, E-ISSN 2312-0541, Vol. 9, nr 3, artikel-id 00011-2023Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Tuberculosis (TB) infection induces profound local and systemic, immunological and inflammatory changes that could influence the development of other respiratory diseases; however, the association between TB and asthma is only partly understood. Our objective was to study the association of TB with asthma and respiratory symptoms in a Nordic–Baltic population-based study.

    Methods: We included data from the Respiratory Health in Northern Europe (RHINE) study, in which information on general characteristics, TB infection, asthma and asthma-like symptoms were collected using standardised postal questionnaires. Asthma was defined based on asthma medication usage and/or asthma attacks 12 months prior to the study, and/or by a report of ≥three out of five respiratory symptoms in the last 12 months. Allergic/nonallergic asthma were defined as asthma with/without nasal allergy. The associations of TB with asthma outcomes were analysed using logistic regressions with adjustments for age, sex, smoking, body mass index and parental education.

    Results: We included 8379 study participants aged 50–75 years, 61 of whom reported having had TB. In adjusted analyses, participants with a history of TB had higher odds of asthma (OR 1.99, 95% CI 1.13– 3.47). The associations were consistent for nonallergic asthma (OR 2.17, 95% CI 1.16–4.07), but not for allergic asthma (OR 1.20, 95% CI 0.53–2.71).

    Conclusion: We found that in a large Northern European population-based cohort, persons with a history of TB infection more frequently had asthma and asthma symptoms. We speculate that this may reflect longterm effects of TB, including direct damage to the airways and lungs, as well as inflammatory responses.

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  • 18.
    Haga, Susanna Lohman
    et al.
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy At University of Gothenburg, Gothenburg, Sweden.
    Hagenbjörk-Gustavsson, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Olin, Anna-Carin
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy At University of Gothenburg, Gothenburg, Sweden.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Liljelind, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Carlsen, Hanne Krage
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy At University of Gothenburg, Gothenburg, Sweden.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Personal exposure levels to O3, NO x and PM10 and the association to ambient levels in two Swedish cities2021Ingår i: Environmental Monitoring & Assessment, ISSN 0167-6369, E-ISSN 1573-2959, Vol. 193, nr 10, artikel-id 674Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Exposure to air pollution is of great concern for public health although studies on the associations between exposure estimates and personal exposure are limited and somewhat inconsistent. The aim of this study was to quantify the associations between personal nitrogen oxides (NOx), ozone (O3) and particulate matter (PM10) exposure levels and ambient levels, and the impact of climate and time spent outdoors in two cities in Sweden. Subjects (n = 65) from two Swedish cities participated in the study. The study protocol included personal exposure measurements at three occasions, or waves. Personal exposure measurements were performed for NOx and O3 for 24 h and PM10 for 24 h, and the participants kept an activity diary. Stationary monitoring stations provided hourly data of NOx, O3 and PM, as well as data on air temperature and relative humidity. Data were analysed using mixed linear models with the subject-id as a random effect and stationary exposure and covariates as fixed effects. Personal exposure levels of NOx, O3 and PM10 were significantly associated with levels measured at air pollution monitoring stations. The associations persisted after adjusting for temperature, relative humidity, city and wave, but the modelled estimates were slightly attenuated from 2.4% (95% CI 1.8–2.9) to 2.0% (0.97–2.94%) for NOx, from 3.7% (95% CI 3.1–4.4) to 2.1% (95% CI 1.1–2.9%) for O3 and from 2.6% (95% 0.9–4.2%) to 1.3% (95% CI − 1.5–4.0) for PM10. After adding covariates, the degree of explanation offered by the model (coefficient of determination, or R2) did not change for NOx (0.64 to 0.63) but increased from 0.46 to 0.63 for O3, and from 0.38 to 0.43 for PM10. Personal exposure to NOx, O3 and PM has moderate to good association with levels measured at urban background sites. The results indicate that stationary measurements are valid as measure of exposure in environmental health risk assessments, especially if they can be refined using activity diaries and meteorological data. Approximately 50–70% of the variation of the personal exposure was explained by the stationary measurement, implying occurrence of misclassification in studies using more crude exposure metrics, potentially leading to underestimates of the effects of exposure to ambient air pollution.

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  • 19.
    Hagenbjörk, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Malmqvist, E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Mattisson, K
    Sommar, Nilsson J.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    The spatial variation of O3, NO, NO2 and NOx and the relation between them in two Swedish cities2017Ingår i: Environmental Monitoring & Assessment, ISSN 0167-6369, E-ISSN 1573-2959, Vol. 189, nr 4, artikel-id 161Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Ozone and nitrogen oxides (NO x ) are air pollutants with known associations to adverse health effects on humans. Few studies have simultaneously measured ozone and nitrogen oxides with high spatial resolution. The main aim of this paper was to assess the levels and variation of ground-level ozone, NO2 and NO x in two Swedish cities. An additional aim was to describe the levels of these pollutants within and between three different types of measurement sites (regional background, urban background and traffic sites) and within and between different measurement periods of the year. Three weekly sampling campaigns of NO x and ozone were conducted simultaneously at 20 sites in two Swedish regions using Ogawa badges. Ozone was measured at 20 additional sites in each area. The median ozone concentration for all measurements was statistically significantly higher in Malmö (67 μg/m(3)) compared to Umeå (56 μg/m(3)), and in both cities, ozone levels were highest in April. Measurement period was a more important factor for describing the variation in ozone concentrations than the type of measurement site. The levels of NO2 and NO x were statistically significantly higher in the Malmö area (8.1 and 12 μg/m(3)) compared to the Umeå area (4.5 and 8.9 μg/m(3)). The levels were generally highest at the sites categorized as traffic, while the variability between different seasons was sparse.

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  • 20.
    Hagenbjörk-Gustavsson, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hälsorelaterad miljöövervakning. Cancerframkallande ämnen i tätortsluft: personlig exponering och bakgrundsmätningar i Umeå 20132014Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Undersökningen kartlägger allmänbefolkningens exponering via luften för vissa cancerframkallande ämnen (bensen, 1,3-butadien, formaldehyd) och kvävedioxid. Undersökningen genomfördes i centrala Umeå under hösten 2013, och inkluderade totalt 40 slumpvis utvalda personer i åldrarna 20-50 år.

    Mätningarna upprepades på 20 personer. Utöver de personburna mätningarna genomfördes även stationära mätningar på två platser utomhus, samt för partiklar även inomhus hos 20 deltagare. Deltagarfrekvensen var 66% och medelåldern var 35 år. Den personliga medianhalten för bensen och 1,3-butadien var 1,4 μg/m3 respektive 0,2 μg/m3 vilket är något lägre än halterna år 2001. Bensenhalten överskrider lågrisknivån (1,3 μg/m3), medan halten 1,3-butadien ligger i nedre kanten av lågriskintervallet. Det fanns en signifikant korrelation mellan den personliga exponeringen för bensen och 1,3-butadien (rs=0.50, p=<0.01). Medianhalten för formaldehyd var 12 μg/m3, och halterna var högre bland de som bodde i villa jämfört med lägenhet. Medianhalten kvävedioxid var 12 μg/m3. PM2.5 mättes utomhus i urban bakgrund samt hemma hos deltagare under två dygn. Medianvärdet för inomhusmätningarna av PM2.5 var högre än motsvarande halt vid mätningarna 2007 (1,9 μg/m3). PM2,5 filtren analyserades även på sitt innehåll av polycykliska kolväten och halterna inomhus var lägre jämfört med halterna utomhus, och var klart lägre än den fastställda lågrisknivån.

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  • 21. Hazenkamp-Von Arx, M.E.
    et al.
    Gotschi, T.
    Ackermann-Liebrich, U.
    Bono, R.
    Burney, P.
    Cyrys, J.
    Jarvis, D.
    Lillienberg, L.
    Luczynska, C.
    Maldonado, J.A.
    Jaen, A.
    De Marco, R.
    Mi, Y.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bayer-Oglesby, L.
    Payo, F
    Soon, A.
    Sunyer, J.
    Villani, S.
    Weyler, J.
    Kunzli, N.
    PM2.5 and NO2 assessment in 21 European study centres of ECRHS II: annual means and seasonal differences2004Ingår i: Atmospheric Environment, ISSN 1352-2310, E-ISSN 1873-2844, Vol. 38, nr 13, s. 1943-1953Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The follow-up of cohorts of adults from more than 20 European centres of the former ECRHS I (1989-1992) investigates long-term effects of exposure to ambient air pollution on respiratory health, in particular asthma and change of pulmonary function. Since PM2.5 is not routinely monitored in Europe, we measured PM2.5 concentrations in 21 participating centres to estimate 'background' exposure in these cities. Winter (November-February), summer (May-August) and annual mean (all months) values of PM2.5 were determined from measuring periods between June 2000 and November 2001. Sampling was conducted for 7 days per month for a year. Annual and winter mean concentrations of PM2.5 vary substantially being lowest in Iceland and highest in centres in Northern Italy. Annual mean concentrations ranged from 3.7 to 44.9 mug m(-3), winter mean concentrations from 4.8 to 69.2 mug m(-3), and summer mean concentrations from 3.3 to 23.1 mugm(-3). Seasonal variability occurred but did not follow the same pattern across all centres. Therefore, ranking of centres varied from summer to winter. Simultaneously, NO2 concentrations were measured using passive sampling tubes. Annual mean NO2 concentrations range from 4.9 to 72.1 mug m(-3) with similar seasonal variations across centres and constant ranking of centres between seasons. The correlation between annual NO2 and PM2.5 concentrations is fair (Spearman correlation coefficient r(s) = 0.75), but when considered as monthly means the correlation is far less consistent and varies substantially between centres. The range of PM2.5 mass concentrations obtained in ECRHS II is larger than in other current cohort studies on long-term effects of air pollution. This substantial variation in PM2.5 exposure will improve statistical power in future multilevel health analyses and to some degree may compensate for the lack of information on within-city variability. Seasonal means may be used to indicate potential differences in the toxicity across the year. Across ECRHS cities annual NO2 might serve as a surrogate for PM2.5, especially for past exposure assessment, when PM2.5 is not available.

  • 22. Jacquemin, Benedicte
    et al.
    Siroux, Valerie
    Sanchez, Margaux
    Carsin, Anne-Elie
    Schikowski, Tamara
    Adam, Martin
    Bellisario, Valeria
    Buschka, Anna
    Bono, Roberto
    Brunekreef, Bert
    Cai, Yutong
    Cirach, Marta
    Clavel-Chapelon, Francoise
    Declercq, Christophe
    de Marco, Roberto
    de Nazelle, Audrey
    Ducret-Stich, Regina E.
    Ferretti, Virginia Valeria
    Gerbase, Margaret W.
    Hardy, Rebecca
    Heinrich, Joachim
    Janson, Christer
    Jarvis, Deborah
    al Kanaani, Zaina
    Keidel, Dirk
    Kuh, Diana
    Le Moual, Nicole
    Nieuwenhuijsen, Mark J.
    Marcon, Alessandro
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Pin, Isabelle
    Rochat, Thierry
    Schindler, Christian
    Sugiri, Dorothea
    Stempfelet, Morgane
    Temam, Sofia
    Tsai, Ming-Yi
    Varraso, Raphaelle
    Vienneau, Danielle
    Vierkoetter, Andrea
    Hansell, Anna L.
    Kraemer, Ursula
    Probst-Hensch, Nicole M.
    Sunyer, Jordi
    Kuenzli, Nino
    Kauffmann, Francine
    Ambient Air Pollution and Adult Asthma Incidence in Six European horts ESCAPE)2015Ingår i: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 123, nr 6, s. 613-621Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Short-term exposure to air pollution has adverse effects among patients with asthma, but whether long-term exposure to air pollution is a cause of adult-onset asthma is unclear. Objective: We aimed to investigate the association between air pollution and adult onset asthma. Methods: Asthma incidence was prospectively assessed in six European cohorts. Exposures studied were annual average concentrations at home addresses for nitrogen oxides assessed for 23,704 participants (including 1,257 incident cases) and particulate matter (PM) assessed for 17,909 participants through ESCAPE land-use regression models and traffic exposure indicators. Meta-analyses of cohort-specific logistic regression on asthma incidence were performed. Models were adjusted for age, sex, overweight, education, and smoking and included city/area within each cohort as a random effect. Results: In this longitudinal analysis, asthma incidence was positively, but not significantly, associated with all exposure metrics, except for PMcoarse. Positive associations of borderline significance were observed for nitrogen dioxide [adjusted odds ratio (OR) = 1.10; 95% CI: 0.99, 1.21 per 10 μg/m3; p = 0.10] and nitrogen oxides (adjusted OR = 1.04; 95% CI: 0.99, 1.08 per 20 μg/m3; p = 0.08). Nonsignificant positive associations were estimated for PM10 (adjusted OR = 1.04; 95% CI: 0.88, 1.23 per 10 μg/m3), PM2.5 (adjusted OR = 1.04; 95% CI: 0.88, 1.23 per 5 μg/m3), PM2.5absorbance (adjusted OR = 1.06; 95% CI: 0.95, 1.19 per 10–5/m), traffic load (adjusted OR = 1.10; 95% CI: 0.93, 1.30 per 4 million vehicles × meters/day on major roads in a 100-m buffer), and traffic intensity (adjusted OR = 1.10; 95% CI: 0.93, 1.30 per 5,000 vehicles/day on the nearest road). A nonsignificant negative association was estimated for PMcoarse (adjusted OR = 0.98; 95% CI: 0.87, 1.14 per 5 μg/m3). Conclusions: Results suggest a deleterious effect of ambient air pollution on asthma incidence in adults. Further research with improved personal-level exposure assessment (vs. residential exposure assessment only) and phenotypic characterization is needed.

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  • 23.
    Jiang, Zheshun
    et al.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Schenk, Linda
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Assarsson, Eva
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Albin, Maria
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bertilsson, Helen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Dock, Eva
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden; Occupational and Environmental Medicine, Region Skåne, Lund, Sweden.
    Hagberg, Jessika
    Department of Occupational and Environmental Health, Faculty of Business, Science and Engineering, Örebro University, Örebro, Sweden.
    Karlsson, Lovisa E.
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Region Örebro County, Sweden.
    Kines, Pete
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Krais, Annette M.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Ljunggren, Stefan
    Occupational and Environmental Medicine Center in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Lundh, Thomas
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Möller, Rickie
    Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Pineda, Daniela
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Ricklund, Niklas
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Region Örebro County, Sweden.
    Saber, Anne T.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Storsjö, Tobias
    Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Amir, Evana Taher
    Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
    Tinnerberg, Håkan
    Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Tondel, Martin
    Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Vogel, Ulla
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Wiebert, Pernilla
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
    Broberg, Karin
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; National Research Centre for the Working Environment, Copenhagen, Denmark.
    Engfeldt, Malin
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden; Occupational and Environmental Medicine, Region Skåne, Lund, Sweden.
    Hexavalent chromium still a concern in Sweden: evidence from a cross-sectional study within the safechrom project2024Ingår i: International journal of hygiene and environmental health (Print), ISSN 1438-4639, E-ISSN 1618-131X, Vol. 256, artikel-id 114298Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Hexavalent chromium (Cr(VI)) is classified as a human carcinogen. Occupational Cr(VI) exposure can occur during different work processes, but the current exposure to Cr(VI) at Swedish workplaces is unknown.

    Methods: This cross-sectional study (SafeChrom) recruited non-smoking men and women from 14 companies with potential Cr(VI) exposure (n = 113) and controls from 6 companies without Cr(VI) exposure (n = 72). Inhalable Cr(VI) was measured by personal air sampling (outside of respiratory protection) in exposed workers. Total Cr was measured in urine (pre- and post-shift, density-adjusted) and red blood cells (RBC) (reflecting Cr(VI)) in exposed workers and controls. The Bayesian tool Expostats was used to assess risk and evaluate occupational exposure limit (OEL) compliance.

    Results: The exposed workers performed processing of metal products, steel production, welding, plating, and various chemical processes. The geometric mean concentration of inhalable Cr(VI) in exposed workers was 0.15 μg/m3 (95% confidence interval: 0.11–0.21). Eight of the 113 exposed workers (7%) exceeded the Swedish OEL of 5 μg/m3, and the Bayesian analysis estimated the share of OEL exceedances up to 19.6% for stainless steel welders. Median post-shift urinary (0.60 μg/L, 5th-95th percentile 0.10–3.20) and RBC concentrations (0.73 μg/L, 0.51–2.33) of Cr were significantly higher in the exposed group compared with the controls (urinary 0.10 μg/L, 0.06–0.56 and RBC 0.53 μg/L, 0.42–0.72). Inhalable Cr(VI) correlated with urinary Cr (rS = 0.64) and RBC-Cr (rS = 0.53). Workers within steel production showed the highest concentrations of inhalable, urinary and RBC Cr. Workers with inferred non-acceptable local exhaustion ventilation showed significantly higher inhalable Cr(VI), urinary and RBC Cr concentrations compared with those with inferred acceptable ventilation. Furthermore, workers with inferred correct use of respiratory protection were exposed to significantly higher concentrations of Cr(VI) in air and had higher levels of Cr in urine and RBC than those assessed with incorrect or no use. Based on the Swedish job-exposure-matrix, approximately 17 900 workers were estimated to be occupationally exposed to Cr(VI) today.

    Conclusions: Our study demonstrates that some workers in Sweden are exposed to high levels of the non-threshold carcinogen Cr(VI). Employers and workers seem aware of Cr(VI) exposure, but more efficient exposure control strategies are required. National strategies aligned with the European strategies are needed in order to eliminate this cause of occupational cancer.

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  • 24.
    Järvholm, Bengt
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Pettersson, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Arbetsolyckor vid användning av rullställningar i byggbranschen2022Rapport (Övrigt vetenskapligt)
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  • 25.
    Kisiel, Marta A.
    et al.
    Department of Medical Sciences: Environmental and Occupational Medicine, Uppsala University, Uppsala, Sweden.
    Arnfelt, Oscar
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Lindberg, Eva
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Jogi, Oscar
    Lung Clinic, Tartu University Hospital, Tartu, Estonia.
    Malinovschi, Andrei
    Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Johannessen, Ane
    Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
    Benediktsdottir, Bryndis
    The Medical Faculty, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland.
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Holm, Mathias
    Section of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Real, Francisco Gomez
    Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
    Sigsgaard, Torben
    Department of Public Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark.
    Gislason, Thorarinn
    The Medical Faculty, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Janson, Christer
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Association between abdominal and general obesity and respiratory symptoms, asthma and COPD: Results from the RHINE study2023Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 211, artikel-id 107213Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Previous studies on the association between abdominal and general obesity and respiratory disease have provided conflicting results. Aims and objectives: We aimed to explore the associations of abdominal obesity with respiratory symptoms, asthma, and chronic obstructive pulmonary disease independently from general obesity in women and men.

    Methods: This cross-sectional study was based on the Respiratory Health in Northern Europe (RHINE) III questionnaire (n = 12 290) conducted in 2010–2012. Abdominal obesity was self-measured waist circumference using a sex-specific standard cut-off point: ≥102 cm in males and ≥88 cm in females. General obesity was defined as self-reported BMI ≥30.0 kg/m2.

    Results: There were 4261 subjects (63% women) with abdominal obesity and 1837 subjects (50% women) with general obesity. Both abdominal and general obesity was independent of each other and associated with respiratory symptoms (odds ratio (OR) from 1.25 to 2.00)). Asthma was significantly associated with abdominal and general obesity in women, OR (95% CI) 1.56 (1.30–1.87) and 1.95 (1.56–2.43), respectively, but not in men, OR 1.22 (0.97–3.17) and 1.28 (0.97–1.68) respectively. A similar sex difference was found for self-reported chronic obstructive pulmonary disease.

    Conclusions: General and abdominal obesity were independent factors associated with respiratory symptoms in adults. Asthma and chronic obstructive pulmonary disease were independently linked to abdominal and general obesity in women but not men.

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  • 26.
    Kisiel, Marta A.
    et al.
    Department of Medical Sciences: Environmental and Occupational Medicine, Uppsala University, Uppsala, Sweden.
    Sedvall, Martin
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Malinovschi, Andrei
    Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Gislason, Thorarinn
    The Medical Faculty, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland.
    Shlunssen, Vivi
    Dept of Public Health, Danish Ramazzini Centre, Aarhus University and the National Research Centre for the Working Environment, Copenhagen, Denmark.
    Johansson, Ane
    Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Jogi, Rain
    The Lung Clinic, Tartu University Hospital, Tartu, Estonia.
    Holm, Mathias
    Section of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Svanes, Cecilia
    Dept of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
    Lindholdt, Louise
    Dept of Public Health, Danish Ramazzini Centre, Aarhus University and the National Research Centre for the Working Environment, Copenhagen, Denmark.
    Carlson, Marie
    Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Inflammatory bowel disease and asthma: results from the RHINE study2023Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 216, artikel-id 107307Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Asthma and inflammatory bowel disease (IBD) are common inflammatory diseases. The aim of this study was to investigate the associations of IBD with asthma and respiratory symptoms.

    Methods: This study is based on 13,499 participants from seven northern European countries that filled in a postal questionnaire on asthma, respiratory symptoms, IBD including ulcerative colitis and Crohn's disease and various lifestyle variables.

    Results: There were 195 participants with IBD. The prevalence of asthma (14.5 vs 8.1%, p = 0.001), different respiratory symptoms (range 11.9–36.8% vs range 6.0–18.6%, p < 0.005), non-infectious rhinitis (52.1 vs. 41.6%, p = 0.004) and chronic rhinosinusitis (11.6 vs 6.0%, p = 0.001) were higher in subjects with IBD than in those without IBD. In multivariable regression analysis, the association between IBD and asthma was statistically significant (OR 1.95 (95% CI 1.28–2.96)) after adjusting for confounders such as sex, BMI, smoking history, educational level and physical activity. There was a significant association between asthma and ulcerative colitis (adjusted OR 2.02 (95% CI 1.27–2.19)), and asthma but not Crohn's disease (adjusted OR 1.66 (95% CI 0.69–3.95)). A significant gender interaction was found with a significant association between IBD and asthma in women but not in men ((OR 2.72 (95% CI 1.67–4.46) vs OR 0.87 (95% CI 0.35–2.19), p = 0.038).

    Conclusions: Patients with IBD, particularly those with ulcerative colitis and female, have a higher prevalence of asthma and respiratory symptoms. Our findings indicate that it is important to consider respiratory symptoms and disorders when examining patients with manifest or suspected IBD.

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  • 27. Levinsson, Anna
    et al.
    Olin, Anna-Carin
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Dahgam, Santosh
    Björck, Lena
    Rosengren, Annika
    Nyberg, Fredrik
    Interaction effects of long-term air pollution exposure and variants in the GSTP1, GSTT1 and GSTCD genes on risk of acute myocardial infarction and hypertension: a case-control study2014Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 9, nr 6, s. e99043-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Experimental and epidemiological studies have reported associations between air pollution exposure, in particular related to vehicle exhaust, and cardiovascular disease. A potential pathophysiological pathway is pollution-induced pulmonary oxidative stress, with secondary systemic inflammation. Genetic polymorphisms in genes implicated in oxidative stress, such as GSTP1, GSTT1 and GSTCD, may contribute to determining individual susceptibility to air pollution as a promoter of coronary vulnerability.

    AIMS: We aimed to investigate effects of long-term traffic-related air pollution exposure, as well as variants in GSTP1, GSTT1 and GSTCD, on risk of acute myocardial infarction (AMI) and hypertension. In addition, we studied whether air pollution effects were modified by the investigated genetic variants.

    METHODS: Genotype data at 7 single nucleotide polymorphisms (SNPs) in the GSTP1 gene, and one in each of the GSTT1 and GSTCD genes, as well as air pollution exposure estimates, were available for 119 AMI cases and 1310 randomly selected population controls. Population control individuals with systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg or on daily antihypertensive medication were defined as hypertensive (n = 468). Individual air pollution exposure levels were modeled as annual means of NO₂ (marker of vehicle exhaust pollutants) using central monitoring data and dispersion models, linking to participants' home addresses.

    RESULTS: Air pollution was significantly associated with risk of AMI: OR 1.78 (95%CI 1.04-3.03) per 10 µg/m³ of long-term NO₂ exposure. Three GSTP1 SNPs were significantly associated with hypertension. The effect of air pollution on risk of AMI varied by genotype strata, although the suggested interaction was not significant. We saw no obvious interaction between genetic variants in the GST genes and air pollution exposure for hypertension.

    CONCLUSION: Air pollution exposure entails an increased risk of AMI, and this risk differed over genotype strata for variants in the GSTP1, GSTT1 and GSTCD genes, albeit not statistically-significantly.

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  • 28.
    Malmqvist, E.
    et al.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Olsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hagenbjörk-Gustafsson, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Mattisson, K.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Stroh, E.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Strömgren, Magnus
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för geografi och ekonomisk historia.
    Swietlicki, E.
    Division of Nuclear Physics, Department of Physics, Lund University, Sweden.
    Rylander, L.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Hoek, G.
    Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.
    Tinnerberg, H.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Assessing ozone exposure for epidemiological studies in Malmö and Umeå, Sweden2014Ingår i: Atmospheric Environment, ISSN 1352-2310, E-ISSN 1873-2844, Vol. 94, s. 241-248Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Ground level ozone [ozone] is considered a harmful air pollutant but there is a knowledge gap regarding its long term health effects. The main aim of this study is to develop local Land Use Regression [LUR] models that can be used to study long term health effects of ozone. The specific aim is to develop spatial LUR models for two Swedish cities, Umea and Malmo, as well as a temporal model for Malmo in order to assess ozone exposure for long term epidemiological studies. For the spatial model we measured ozone, using Ogawa passive samplers, as weekly averages at 40 sites in each study area, during three seasons. This data was then inserted in the LUR-model with data on traffic, land use, population density and altitude to develop explanatory models of ozone variation. To develop the temporal model for Malmo, hourly ozone data was aggregated into daily means for two measurement stations in Malmo and one in a rural area outside Malmo. Using regression analyses we inserted meteorological variables into different temporal models and the one that performed best for all three stations was chosen. For Malmo the LUR-model had an adjusted model R-2 of 0.40 and cross validation R-2 of 0.17. For Umea the model had an adjusted model R-2 of 0.67 and cross validation adjusted R-2 of 0.48. When restricting the model to only including measuring sites from urban areas, the Malmo model had adjusted model R-2 of 0.51 (cross validation adjusted R-2 0.33) and the Umea model had adjusted model R-2 of 0.81 (validation adjusted R-2 of 0.73). The temporal model had adjusted model R-2 0.54 and 0.61 for the two Malmo sites, the cross validation adjusted R-2 was 0.42. In conclusion, we can with moderate accuracy, at least for Umea, predict the spatial variability, and in Malmo the temporal variability in ozone variation. 

  • 29.
    Mir Fakhraei, Rima
    et al.
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Lindberg, Eva
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Benediktsdóttir, Bryndís
    Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Svanes, Cecilie
    Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    Johannessen, Ane
    Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
    Holm, Mathias
    Department of Occupational and Environmental Medicine, University of Gothenburg, Sweden.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Malinovschi, Andrei
    Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Gislason, Thorarinn
    Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali, University Hospital, Reykjavik, Iceland.
    Jõgi, Rain
    The Lung Clinic, Tartu University Hospital, Tartu, Estonia.
    Cramer, Christine
    Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Emilsson, Össur Ingi
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Gastroesophageal reflux and snoring are related to asthma and respiratory symptoms: Results from a Nordic longitudinal population survey2024Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 221, artikel-id 107495Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To study if individuals with nocturnal gastroesophageal reflux (nGER) and habitual snoring are more likely to develop asthma and respiratory symptoms (i.e. wheeze, cough, chest tightness, breathlessness) than those without these conditions, and if these associations are additive.

    Methods: We used data from the population-based prospective questionnaire study Respiratory Health in Northern Europe (RHINE) (11,024 participants), with data from 1999 and 2011. Participants with heartburn or belching after going to bed, at least 1 night/week, were considered to have nGER. Participants reporting loud snoring at least 3 nights/week were considered to have habitual snoring. Participants were grouped into four groups by their nGER and snoring status: “never”; “former”; “incident”; “persistent”. Incident respiratory symptoms were analyzed among participants without respective symptom at baseline.

    Results: Snoring and nGER were independently associated with incident asthma and respiratory symptoms. The risk of incident wheeze was increased in subjects with incident or persistent snoring (adjusted odds ratio (95 % CI): 1.44 (1.21–1.72)), nGER (2.18 (1.60–2.98)) and in those with both snoring and nGER (2.59 (1.83–3.65)). The risk of developing asthma was increased in subjects with incident or persistent snoring (1.44 (1.15–1.82)), nGER (1.99 (1.35–2.93)) and in those with both snoring and nGER (1.72 (1.06–2.77)). No significant interaction was found between snoring and nGER. A similar pattern was found for the incidence of all other respiratory symptoms studied, with the highest risk among those with both incident or persistent nGER and snoring.

    Conclusion: The risk of developing asthma and respiratory symptoms is increased among subjects with nGER and habitual snoring. These associations are independent of each other and confounding factors. Snoring and nGER together are additive on respiratory symptoms.

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  • 30.
    Modig, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Dahgam, Santosh
    Olsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nyberg, Fredrik
    Wass, Kristina
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Olin, Anna-Carin
    Short-Term Exposure to Ozone and Levels of Exhaled Nitric Oxide2014Ingår i: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 25, nr 1, s. 79-87Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Adverse effects of air pollution include respiratory inflammation. A few epidemiologic studies have shown elevations in the fraction of exhaled nitric oxide, a marker of airway inflammation, after exposure to traffic-related pollutants. Methods: We examined whether short-term exposures to ozone (O-3), oxides of nitrogen (NOx), or particulate matter <10 m (PM10) were associated with proximal and distal airway inflammation. The study included 5841 randomly selected Swedish adults from 25 to 75 years of age. Fraction of exhaled nitrogen was measured at two flow rates: 50 ml/s representing the proximal airways and 270 ml/s representing the distal airways. Air pollution data were obtained from an urban monitoring site. We applied linear regression to estimate short-term associations of O-3, NOx, and PM10 with fractions of exhaled NO at 50 and 270 ml/s. Results: An interquartile range increase in 120-hour average O-3 levels was associated with a 5.1% (95% confidence interval = 1.7% to 8.5%) higher level of fraction of exhaled NO at 270 ml/s and 3.6% (-0.4% to 3.4%) higher level of the fraction of exhaled NO at 50 ml/s. For NOx, a small effect was seen for the 24-hour average on the fraction of exhaled NO at 270 ml/s, while for PM10 no clear effects were seen. There was a tendency for a weaker effect of ozone and a stronger effect of NOx in subjects with asthma. Conclusions: Exposure to O-3 was associated with a marker of distal airway inflammation, while the association was less obvious for inflammation of the proximal airways.

  • 31.
    Modig, Lars