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  • 1.
    Abeid, Muzdalifat
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Muganyizi, Projestine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Olsson, Pia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Darj, Elisabeth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Axemo, Pia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Community perceptions of rape and child sexual abuse: a qualitative study in rural Tanzania2014Inngår i: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 14, s. 23-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Rape of women and children is recognized as a health and human rights issue in Tanzania and internationally. Exploration of the prevailing perceptions in rural areas is needed in order to expand the understanding of sexual violence in the diversity of Tanzania's contexts. The aim of this study therefore was to explore and understand perceptions of rape of women and children at the community level in a rural district in Tanzania with the added objective of exploring those perceptions that may contribute to perpetuating and/or hindering the disclosure of rape incidences. Methods: A qualitative design was employed using focus group discussions with male and female community members including religious leaders, professionals, and other community members. The discussions centered on causes of rape, survivors of rape, help-seeking and reporting, and gathered suggestions on measures for improvement. Six focus group discussions (four of single gender and two of mixed gender) were conducted. The focus group discussions were recorded, transcribed verbatim, and analyzed using manifest qualitative content analysis. Results: The participants perceived rape of women and children to be a frequent and hidden phenomenon. A number of factors were singled out as contributing to rape, such as erosion of social norms, globalization, poverty, vulnerability of children, alcohol/drug abuse and poor parental care. Participants perceived the need for educating the community to raise their knowledge of sexual violence and its consequences, and their roles as preventive agents. Conclusions: In this rural context, social norms reinforce sexual violence against women and children, and hinder them from seeking help from support services. Addressing the identified challenges may promote help-seeking behavior and improve care of survivors of sexual violence, while changes in social and cultural norms are needed for the prevention of sexual violence.

  • 2. Adrian, L.
    et al.
    Svanes, C.
    Johannessen, A.
    Lodge, C.
    Bertelsen, R.
    Dratva, J.
    Forsberg, B.
    Gislason, T.
    Benedikstdottir, B.
    Holm, M.
    Jogi, R.
    Modig, L.
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Omenaas, E.
    Real, F.
    Schlunssen, V
    Sigsgaard, T.
    Skorge, T.
    Timm, S.
    Wieslander, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Dharmage, S.
    Early life parental exposure to cats and dogs reduces the risk of allergic disease in their children: possible intergenerational effect2014Inngår i: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 69, s. 577-578Artikkel i tidsskrift (Annet vitenskapelig)
  • 3.
    Ahlroth Pind, Caroline
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Gunnbjörnsdottír, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning. National University Hospital of Iceland, Reykjavik, Iceland.
    Bjerg, A
    Karolinska Inst, Stockholm, Sweden.
    Järvholm, B
    Umeå Univ, Umeå, Sweden.
    Lundbäck, B
    Univ Gothenburg, Gothenburg, Sweden.
    Malinovschi, Andrei
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Middelveld, R
    Karolinska Inst, Stockholm, Sweden.
    Nilsson Sommar, J
    Umeå Univ, Umeå, Sweden.
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Patient-reported signs of dampness at home may be a risk factor for chronic rhinosinusitis: A cross-sectional study2017Inngår i: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 47, nr 11, s. 1383-1389Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

    METHODS: The Swedish GA2 LEN questionnaire was answered by 26 577 adults (16-75 years) and included questions on respiratory symptoms, smoking, education and environmental exposure. CRS was defined according to the EP3 OS criteria. Dampness was defined as reporting water damage, floor dampness or visible moulds in the home during the last 12 months. The dampness score was ranked from 0 to 3, counting the number of signs of dampness reported.

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

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

  • 4. Aili, K
    et al.
    Nyman, T
    Svartengren, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Hillert, L
    Sleep as a predictive factor for the onset and resolution of multi-site pain: A 5-year prospective study2015Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 19, nr 3, s. 341-349Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Disturbed sleep and pain often co-exist and the relationship between the two conditions is complex and likely reciprocal. This 5-year prospective study examines whether disturbed sleep can predict the onset of multi-site pain, and whether non-disturbed sleep can predict the resolution of multi-site pain.

    METHODS: The cohort (n = 1599) was stratified by the number of self-reported pain sites: no pain, pain from 1-2 sites and multi-site pain (≥3 pain sites). Sleep was categorized by self-reported sleep disturbance: sleep A (best sleep), sleep B and sleep C (worst sleep). In the no-pain and pain-from-1-2 sites strata, the association between sleep (A, B and C) and multi-site pain 5 years later was analysed. Further, the prognostic value of sleep for the resolution of multi-site pain at follow-up was calculated for the stratum with multi-site pain at baseline. In the analyses, gender, age, body mass index, smoking, physical activity and work-related exposures were treated as potential confounders.

    RESULTS: For individuals with no pain at baseline, a significantly higher odds ratio for multi-site pain 5 years later was seen for the tertile reporting worst sleep [odds ratio (OR) 4.55; 95% confidence interval (CI) 1.28-16.12]. Non-disturbed (or less disturbed) sleep had a significant effect when predicting the resolution of multi-site pain (to no pain) (OR 3.96; 95% CI 1.69-9.31).

    CONCLUSION: In conclusion, sleep could be relevant for predicting both the onset and the resolution of multi-site pain. It seems to be a significant factor to include in research on multi-site pain and when conducting or evaluating intervention programmes for pain.

  • 5. Aili, Katarina
    et al.
    Nyman, Teresia
    Hillert, Lena
    Svartengren, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Sleep disturbances predict future sickness absence among individuals with lower back or neck-shoulder pain: A 5-year prospective study2015Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, nr 3, s. 315-323Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Musculoskeletal pain is one of the most common causes of sickness absence. Sleep disturbances are often co-occurring with pain, but the relationship between sleep and pain is complex. Little is known about the importance of self-reported sleep, when predicting sickness absence among persons with musculoskeletal pain. This study aims to study the association between self-reported sleep quality and sickness absence 5 years later, among individuals stratified by presence of lower back pain (LBP) and neck and shoulder pain (NSP). Methods: The cohort (n = 2286) in this 5-year prospective study (using data from the MUSIC-Norrtalje study) was stratified by self-reported pain into three groups: no LBP or NSP, solely LBP or NSP, and oncurrent LBP and NSP. Odds ratios (ORs) for the effect of self-reported sleep disturbances at baseline on sickness absence (> 14 consecutive days), 5 years later, were calculated. Results: Within all three pain strata, individuals reporting the most sleep problems showed a significantly higher OR for all-cause sickness absence, 5 years later. The group with the most pronounced sleep problems within the concurrent LBP and NSP stratum had a significantly higher OR (OR 2.00; CI 1.09-3.67) also for long-term sickness absence (> 90days) 5 years later, compared to the group with the best sleep. Conclusions: Sleep disturbances predict sickness absence among individuals regardless of co-existing features of LBP and/or NSP. The clinical evaluation of patients should take possible sleep disturbances into account in the planning of treatments.

  • 6.
    Aili, Katarina
    et al.
    Karolinska Inst, Inst Environm Med, Unit Occupat Med, Stockholm, Sweden..
    Åström-Paulsson, Sofia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Stoetzer, Ulrich
    Karolinska Inst, Inst Environm Med, Unit Intervent & Implementat Res, Stockholm, Sweden..
    Svartengren, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Hillert, Lena
    Karolinska Inst, Inst Environm Med, Unit Occupat Med, Stockholm, Sweden..
    Reliability of Actigraphy and Subjective Sleep Measurements in Adults: the Design of Sleep Assessments2017Inngår i: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 13, nr 1, s. 39-47Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY OBJECTIVES: The aim of the study was to investigate how many nights of measurement are needed for a reliable measure of sleep in a working population including adult women and men.

    METHODS: In all, 54 individuals participated in the study. Sleep was assessed for 7 consecutive nights using actigraphy as an objective measure, and the Karolinska sleep diary for a subjective measure of quality. Using intra-class correlation and the Spearman-Brown formula, calculations of how many nights of measurements were required for a reliable measure were performed. Differences in reliability according to whether or not weekend measurements were included were investigated. Further, the correlation between objectively (actigraphy) measured sleep and subjectively measured sleep quality was studied over the different days of the week.

    RESULTS/CONCLUSIONS: The results concerning actigraphy sleep measures suggest that data from at least 2 nights are to be recommended when assessing sleep percent and at least 5 nights when assessing sleep efficiency. For actigraphy-measured total sleep time, more than 7 nights are needed. At least 6 nights of measurements are required for a reliable measure of self-reported sleep. Fewer nights (days) are required if measurements include only week nights. Overall, there was a low correlation between the investigated actigraphy sleep parameters and subjective sleep quality, suggesting that the two methods of measurement capture different dimensions of sleep.

  • 7. Airaksinen, Jaakko
    et al.
    Ervasti, Jenni
    Pentti, Jaana
    Oksanen, Tuula
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Folkhälsovetenskap.
    Kivimäki, Mika
    The effect of smoking cessation on work disability risk: a longitudinal study analysing observational data as non-randomized nested pseudo-trials2019Inngår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685Artikkel i tidsskrift (Fagfellevurdert)
  • 8. Ali, Imran
    et al.
    Damdimopoulou, Pauliina
    Stenius, Ulla
    Adamsson, Annika
    Mäkelä, Sari I
    Åkesson, Agneta
    Berglund, Marika
    Håkansson, Helen
    Halldin, Krister
    Cadmium-induced effects on cellular signaling pathways in the liver of transgenic estrogen reporter mice.2012Inngår i: Toxicological Sciences, ISSN 1096-6080, E-ISSN 1096-0929, Vol. 127, nr 1, s. 66-75Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Estrogen-like effects of cadmium (Cd) have been reported in several animal studies, and recent epidemiological findings suggest increased risk of hormone-dependent cancers after Cd exposure. The mechanisms underlying these effects are still under investigation. Our aim was to study the effects of Cd on cellular signaling pathways in vivo with special focus on estrogen signaling and to perform benchmark dose analysis on the effects. Transgenic adult ERE-luciferase male mice were exposed subcutaneously to 0.5-500 μg CdCl(2) per kg body weight (bw) or 17α-ethinylestradiol (EE2) for 3 days. These doses had no effects on organ and bw or testicular histology, indicating subtoxic exposure levels. The transgene luciferase, reporting genomic estrogen response, was significantly increased by EE2 but not by Cd. However, Cd significantly affected kinase phosphorylation and endogenous gene expression. Interestingly, gene expression changes displayed a traditional dose-response relationship, with benchmark dose levels for the expression of Mt1, Mt2, p53, c-fos, and Mdm2 being 92.9, 19.9, 7.6, 259, and 25.9 μg/kg bw, respectively, but changes in kinase phosphorylation were only detected at low exposure levels. Phosphorylation of Erk1/2 was significantly increased even in the lowest dose group, 0.5 μg/kg bw, rendering pErk1/2 a more sensitive sensor of exposure than changes in gene expression. Collectively, our data suggest that the effects triggered by Cd in vivo are markedly concentration dependent. Furthermore, we conclude that the estrogen-like effects of Cd are likely to result from a mechanism different from steroidal estrogens.

  • 9. Ali, Imran
    et al.
    Damdimopoulou, Pauliina
    Stenius, Ulla
    Halldin, Krister
    Cadmium at nanomolar concentrations activates Raf-MEK-ERK1/2 MAPKs signaling via EGFR in human cancer cell lines.2015Inngår i: Chemico-Biological Interactions, ISSN 0009-2797, E-ISSN 1872-7786, Vol. 231Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cadmium (Cd) is an environmental contaminant classified as carcinogenic to humans by the International Agency for Research on Cancer, supported by data from occupational exposure. Environmentally relevant dietary exposure to Cd has recently been associated with osteoporosis and cancers of the prostate, endometrium, and breast in the general population. The low exposure effects have been proposed to result from endocrine modulative properties of Cd, which mimic the physiological actions of estrogen and androgen. However, the mechanism of action of Cd is an unanswered question. We have shown previously, using mouse models, that canonical estrogen receptor signaling is not involved in estrogen mimicry effects of Cd. Instead, low-level Cd exposure stimulated the mitogen-activated protein kinases (MAPKs) ERK1/2 in these mice. Here we investigate further the ERK1/2 MAPK signaling activation by Cd in vitro by using nanomolar concentrations of cadmium chloride (CdCl2) in three different human carcinoma cell lines: HepG2, MCF-7, and ECC-1. The findings also were confirmed in previously collected mouse tissue samples. We show that 10(-8)M levels of CdCl2 activate ERK1/2 (Tyr 204) and the p53 specific ubiquitin ligase Mdm2 (Ser 166) via Raf and MEK by acting through the epidermal growth factor receptor (EGFR). Furthermore, our results suggest that the CdCl2-induced activation of ERK1/2 and Mdm2 may interfere with the p53 response to genotoxic compounds in cancer cell lines. Our data collectively suggest that nanomolar levels of CdCl2 activate Raf-MEK-ERK1/2 via EGFR. We hypothesize that this signaling cascade may be involved in observed low exposure effects of Cd in certain human populations.

  • 10. Ali, Imran
    et al.
    Engström, Annette
    Vahter, Marie
    Skerfving, Staffan
    Lundh, Thomas
    Lidfeldt, Jonas
    Samsioe, Göran
    Halldin, Krister
    Akesson, Agneta
    Associations between cadmium exposure and circulating levels of sex hormones in postmenopausal women2014Inngår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 134, s. 265-269Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recent epidemiological as well as in vivo and in vitro studies collectively suggest that the metalloestrogen cadmium (Cd) could be a potential risk factor for hormone-related cancers in particularly breast cancer. Assessment of the association between Cd exposure and levels of endogenous sex hormones is of pivotal importance, as increased levels of such have been associated with a higher risk of breast cancer in postmenopausal women. The present study investigated the perceived relationship (multivariable-adjusted linear regression analyses) between Cd exposure [blood Cd (B-Cd) and urinary Cd (U-Cd)], and serum levels of androstenedione, testosterone, estradiol, and sex-hormone binding globulin (SHBG), in 438 postmenopausal Swedish women without hormone replacement therapy (HRT). A significant positive association between B-Cd (median 3.4nmol/L) and serum testosterone levels, as well as a significant inverse association between B-Cd and serum estradiol levels and with the estradiol/testosterone ratio were encountered. However, U-Cd (median 0.69nmol/mmol creatinine) was inversely associated with serum estradiol levels only. Our data may suggest that Cd interferes with the levels of testosterone and estradiol in postmenopausal women, which might have implications for breast cancer risk.

  • 11. Ali, Imran
    et al.
    Hurmerinta, Teija
    Nurmi, Tarja
    Berglund, Marika
    Rüegg, Joelle
    Poutanen, Matti
    Halldin, Krister
    Mäkelä, Sari
    Damdimopoulou, Pauliina
    From pure compounds to complex exposure: Effects of dietary cadmium and lignans on estrogen, epidermal growth factor receptor, and mitogen activated protein kinase signaling in vivo.2016Inngår i: Toxicology Letters, ISSN 0378-4274, E-ISSN 1879-3169, Vol. 253Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Exposure to environmental endocrine active compounds correlates with altered susceptibility to disease in human populations. Chemical risk assessment is single compound based, although exposure often takes place as heterogeneous mixtures of man-made and natural substances within complex matrices like diet. Here we studied whether the effects of cadmium and enterolactone on endocrine endpoints in dietary exposure can be predicted based on pure compound effects. Ovariectomized estrogen reporter ERE-luciferase (ERE-luc) mice were maintained on diets that intrinsically contain increasing concentrations of cadmium and enterolactone precursors for three and 21 days. The activation of the ERE-luc, epidermal growth factor receptor (EGFR), mitogen activated protein kinase (MAPK)-ERK1/2, and classical estrogen responses were measured. Interactions between the diets and endogenous hormone were evaluated by challenging the animals with 17β-estradiol. Compared to animals on basal purified diet, mice consuming experimental diets were exposed to significantly higher levels of cadmium and enterolactone, yet the exposure remained comparable to typical human dietary intake. Surprisingly, we could not detect effects on endpoints regulated by pure enterolactone, such as ERE-luc activation. However, cadmium accumulation in the liver was accompanied with activation of EGFR and MAPK-ERK1/2 in line with our earlier CdCl2 studies. Further, attenuation of 17β-estradiol-induced ERE-luc response in liver by experimental diets was observed. Our findings indicate that the exposure context can have substantial effects on the activity of endocrine active compounds in vivo. Thus, whenever possible, a context that mimics human exposure should be tested along with pure compounds.

  • 12.
    Alinaghizadeh, Hassan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Tondel, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Wålinder, Robert
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Cancer incidence in northern Sweden before and after the Chernobyl nuclear power plant accident2014Inngår i: Radiation and Environmental Biophysics, ISSN 0301-634X, E-ISSN 1432-2099, Vol. 53, nr 3, s. 495-504Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Sweden received about 5 % of the total release of Cs-137 from the Chernobyl nuclear power plant accident in 1986. The distribution of the fallout mainly affected northern Sweden, where some parts of the population could have received an estimated annual effective dose of 1-2 mSv per year. It is disputed whether an increased incidence of cancer can be detected in epidemiological studies after the Chernobyl nuclear power plant accident outside the former Union of Soviet Socialist Republics. In the present paper, a possible exposure-response pattern between deposition of Cs-137 and cancer incidence after the Chernobyl nuclear power plant accident was investigated in the nine northernmost counties of Sweden (2.2 million inhabitants in 1986). The activity of Cs-137 from the fallout maps at 1986 was used as a proxy for the received dose of ionizing radiation. Diagnoses of cancer (ICD-7 code 140-209) from 1980 to 2009 were received from the Swedish Cancer Registry (273,222 cases). Age-adjusted incidence rate ratios, stratified by gender, were calculated with Poisson regression in two closed cohorts of the population in the nine counties 1980 and 1986, respectively. The follow-up periods were 1980-1985 and 1986-2009, respectively. The average surface-weighted deposition of Cs-137 at three geographical levels; county (n = 9), municipality (n = 95) and parish level (n = 612) was applied for the two cohorts to study the pre- and the post-Chernobyl periods separately. To analyze time trends, the age-standardized total cancer incidence was calculated for the general Swedish population and the population in the nine counties. Joinpoint regression was used to compare the average annual percent change in the general population and the study population within each gender. No obvious exposure-response pattern was seen in the age-adjusted total cancer incidence rate ratios. A spurious association between fallout and cancer incidence was present, where areas with the lowest incidence of cancer before the accident coincidentally had the lowest fallout of Cs-137. Increasing the geographical resolution of exposure from nine county averages to 612 parish averages resulted in a two to three times higher value of variance in the regression model. There was a secular trend with an increase in age-standardized incidence of cancer in both genders from 1980 to 2009, but significant only in females. This trend was stronger and statistically significant for both genders in the general Swedish population compared to the nine counties. In conclusion, using both high quality cancer registry data and high resolution exposure maps of Cs-137 deposition, it was not possible to distinguish an effect of Cs-137 on cancer incidence after the Chernobyl nuclear power plant accident in Sweden.

  • 13.
    Alinaghizadeh, Hassan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Wålinder, Robert
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Vingård, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Tondel, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Total cancer incidence in relation to 137Cs fallout in the most contaminated counties in Sweden after the Chernobyl nuclear power plant accident: a register-based study2016Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 12, artikkel-id e011924Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To determine the total cancer incidence in relation to a 5-year exposure to caesium-137 ((137)Cs) from the 1986 Chernobyl nuclear power plant accident.

    METHODS: A closed cohort was defined as all individuals living in the three most contaminated counties in mid-Sweden in 1986. Fallout of (137)Cs was retrieved as a digital map from the Geological Survey of Sweden, demographic data from Statistics Sweden, and cancer diagnosis from the National Board of Health and Welfare. Individuals were assigned an annual (137)Cs exposure based on their place of residence (1986-1990), from which 5-year cumulative (137)Cs exposures were calculated, accounting for the physical decay of (137)Cs and changing residencies. HRs were adjusted for age, sex, rural/non-rural residence and pre-Chernobyl total cancer incidence.

    RESULTS: The 734 537 people identified were categorised by exposure: the first quartile was low exposure (0.0-45.4 kBq/m(2)), the second and third quartiles were intermediate exposure (45.41-118.8 kBq/m(2)), and the fourth quartile was the highest exposure (118.81-564.71 kBq/m(2)). Between 1991 and 2010, 82 495 cancer cases were registered in the 3 counties. Adjusted HRs (95% CI) were 1.03 (1.01 to 1.05) for intermediate exposure and 1.05 (1.03 to 1.07) for the highest exposure compared to the reference exposure.

    CONCLUSIONS: We found a small overall exposure-response pattern of the total cancer incidence related to (137)Cs after adjustment for age, sex, rural residence and pre-Chernobyl cancer incidence.

  • 14.
    Andersson, Helén
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Increased expression of genes encoding proangiogenic and vasoconstriction factors in the cardiac tissues of rats following long‑term exposure to bisphenol AManuskript (preprint) (Annet vitenskapelig)
  • 15.
    Andersson, Helén
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Brittebo, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Proangiogenic Effects of Environmentally Relevant Levels of Bisphenol A in Human Primary Endothelial Cells2012Inngår i: Archives of Toxicology, ISSN 0340-5761, E-ISSN 1432-0738, Vol. 86, nr 3, s. 465-474Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Bisphenol A (BPA) is widely used in the manufacturing of consumer products such as plastic food containers and food cans. Experimental studies suggest a relationship between exposure to BPA and changes in metabolic processes and reproductive organs. Also, epidemiological studies report an association between elevated exposure to BPA and cardiovascular disease and diabetes. Although alterations in the vascular endothelium are implicated in pathological conditions associated with BPA, little is known about the effects of BPA in the human endothelium. This study aimed to investigate the effects of 0.1 nM-1 μM of BPA on selected biomarkers of endothelial dysfunction, inflammation, and angiogenesis in human umbilical vein endothelial cells (HUVEC). The mRNA expression of biomarkers was assayed using qRT-PCR, and the production of nitric oxide and reactive oxygen species was measured using the H(2)DCFDA and the DAF-FM assays. The effect of BPA on phosphorylated eNOS was examined using Western blot and immunofluorescence, and the endothelial tube formation assay was used to investigate in vitro angiogenesis. BPA (≤1 μM) increased the mRNA expression of the proangiogenic genes VEGFR-2, VEGF-A, eNOS, and Cx43 and increased the production of nitric oxide in HUVEC. Furthermore, BPA increased the expression of phosphorylated eNOS and endothelial tube formation in HUVEC. These studies demonstrate that environmentally relevant levels of BPA have direct proangiogenic effects on human primary endothelial cells in vitro suggesting that the human endothelium may be an important target for BPA.

  • 16.
    Andersson, Ing-Marie
    et al.
    Dalarna University, School of Technology and Business Studies.
    Gunnarsson, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Hedlund, Ann
    Dalarna University, School of Technology and Business Studies.
    Rosén, Gunnar
    Dalarna University, School of Technology and Business Studies.
    Young People’s Attitudes to Attractive Work, During and After Upper Secondary School2017Inngår i: Nordic Journal of Working Life Studies, ISSN 2245-0157, E-ISSN 2245-0157, Vol. 7, nr 1, s. 55-68Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Attractive work has been defined as a job position which an individual wants, where the employee experiences job stability and where employee identification and dedication are fostered. The present study is aimed at increasing knowledge about attitude changes to work during young people’s transition from school to work-life. A closed cohort, consisting of 225 pupils from graduating classes in 10 upper secondary schools in Sweden, was studied. The most significant result was found in the pupils’ expectations regarding work attractiveness while they were still attending school and in the subsequent year, after they had finished school. During school attendance, there were no differences between the groups, while those who did not find employment after school greatly reduced their demands regarding attractive work.Those who managed to get a job maintained the same level of expectation as during their school years, in terms of requirements for an attractive job. 

  • 17.
    Andersson, Ing-Marie
    et al.
    Högskolan Dalarna.
    Gunnarsson, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Rosén, Gunnar
    Högskolan Dalarna.
    Role of Headmasters, Teachers, and Supervisors in Knowledge Transfer about Occupational Health and Safety to Pupils in Vocational Education2015Inngår i: Safety and health at work, ISSN 2093-7997, Vol. 6, nr 4, s. 317-323Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Young people are at an increased risk for illness in working life. The authorities stipulate certain goals for training in occupational health and safety (OHS) in vocational schools. A previous study concluded that pupils in vocational education had limited knowledge in the prevention of health risks at work. The aim of the current study, therefore, was to study how OHS training is organized in school and in workplace-based learning (WPL).

    Methods

    The study design featured a qualitative approach, which included interviews with 12 headmasters, 20 teachers, and 20 supervisors at companies in which the pupils had their WPL. The study was conducted at 10 upper secondary schools, located in Central Sweden, that were graduating pupils in four vocational programs.

    Results

    The interviews with headmasters, teachers, and supervisors indicate a staggered picture of how pupils are prepared for safe work. The headmasters generally give teachers the responsibility for how goals should be reached. Teaching is very much based on risk factors that are present in the workshops and on teachers' own experiences and knowledge. The teaching during WPL also lacks the systematic training in OHS as well as in the traditional classroom environment.

    Conclusion

    Teachers and supervisors did not plan the training in OHS in accordance with the provisions of systematic work environment management. Instead, the teachers based the training on their own experiences. Most of the supervisors did not receive information from the schools as to what should be included when introducing OHS issues in WPL.

  • 18.
    Andersson, Ing-Marie
    et al.
    Högskolan Dalarna, Arbetsvetenskap.
    Gunnarsson, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Rosén, Gunnar
    Högskolan Dalarna, Arbetsvetenskap.
    Moström Åberg, Marie
    Högskolan Dalarna, Arbetsvetenskap.
    Knowledge and Experiences of Risks among Pupils in Vocational Education2014Inngår i: SH@W Safety and Health at Work, ISSN 2093-7911, E-ISSN 2093-7997, Vol. 5, nr 3, s. 140-146Artikkel i tidsskrift (Fagfellevurdert)
  • 19.
    Annerbäck, Eva-Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Sahlqvist, Lotta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Wingren, Gun
    A cross-sectional study of victimisation of bullying among schoolchildren in Sweden: background factors and self-reported health complaints2014Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, nr 3, s. 270-277Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To examine background factors for bullying and associations between bullying victimisation and health problems. Methods: A cross-sectional study on all pupils in grades 7 and 9 in a Swedish county was conducted in 2011 (n=5248). Data have been analysed with bi- and multivariate models. Results: 14% of the children reported that they had been bullied during the past 2 months. Background factors for bullying were: gender (girls more often); age (younger students more often); disability/disease; high body mass index, and having parents born abroad. There were strong associations between being bullied and poor health and self-harm. Associations with poor general health for boys and girls and mental health problems for girls showed stronger associations with higher frequency of bullying than with lower. For boys, physical bullying had stronger correlations with poor general health than written-verbal bullying. Conclusions: Bullying is a serious public health problem among young people and healthcare professionals have an important task in identifying exposed children. Children who are "different" are more exposed to bullying, which implies that school personnel, parents, and other adults in these children's social networks can play an important role in paying attention to and preventing the risk of bullying.

  • 20. Annesi-Maesano, Isabella
    et al.
    Norback, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Zielinski, Jan
    Bernard, Alfred
    Gratziou, Cristina
    Sigsgaard, Torben
    Sestini, Piersante
    Viegi, Giovanni
    Geriatric study in Europe on health effects of air quality in nursing homes (GERIE study) profile: objectives, study protocol and descriptive data.2013Inngår i: Multidisciplinary Respiratory Medicine, ISSN 1828-695X, E-ISSN 2049-6958, Vol. 8, nr 1, s. 71-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Indoor air pollution (IAP) constitutes a major global public health problem requiring increasing efforts in research and policymaking that may have special significance for elderly that are likely to spend most of their day indoors and appear to be particularly susceptible to adverse effects of chemical pollutants and bio-contaminants. Yet, evidence existing on the effects of IAP in elderly is scanty. The Geriatric study in Europe on health effects of air quality in nursing homes (GERIE) study aimed to assess health effects of major indoor air pollutants and thermal conditions in elderly (> 70 years) living stably in nursing homes (NH) across Europe. Respiratory effects were particularly considered as airways and lung constitute the first target of air pollutants.

    OBJECTIVES: We describe here the rationale and the methods of the GERIE Study.

    METHODS: 8 nursing homes were randomly selected in 7 European countries. Twenty individuals were randomly selected in each nursing home. Major indoor and outdoor air chemical pollutants (PM10, PM2.5, PM0.1, formaldehyde, NO2; O3, VOC, CO2) and bio-contaminants (moulds, allergens) were assessed objectively with standardized procedures. Major health status indicators were assessed through a standardized questionnaire, non-invasive clinical tests and blood and urine biomarkers as well as saliva for ADN.

    RESULTS: The GERIE study has given the opportunity to publish two reviews on respiratory health effects of indoor and outdoor air pollution in elderly. In addition it has provided the inventory of air quality and thermal conditions in 50 nursing homes across Europe and data on respiratory health status in 600 elderly aged 82 years in mean. Major future results will include the relationships between NH environment and health in elderly.

    CONCLUSIONS: The main long-term purpose of the GERIE study is to improve the health of elderly who permanently reside in nursing homes or of those who are exposed to indoor air pollution because of reduced mobility.

  • 21.
    Arakelian, Erebouni
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Rudolfsson, Gudrun
    Univ West, Dept Hlth Sci, Div Nursing, Trollhattan, Sweden; Nord Univ, Fac Nursing & Hlth Sci, Bodo, Norway.
    Rask-Andersen, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Runeson, Roma
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Wålinder, Robert
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    I Stay: Swedish Specialist Nurses in the Perioperative Context and Their Reasons to Stay at Their Workplace2019Inngår i: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 34, nr 3, s. 633-644Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To investigate why nurse anesthetists and operating room nurses choose to stay in the same workplace.

    DESIGN: Qualitative design.

    METHODS: Individual interviews were conducted with 15 nurse specialists from four hospitals in Sweden. Two men and 13 women aged between 43 and 63 participated. Data were analyzed with systematic text condensation according to Malterud.

    FINDINGS: Three themes were identified. (1) Organizational stability contributed to low staff turnover, with good spirits between colleagues, representing everyone's equal value and resulting in a feeling of homelikeness. (2) Sustained development in one's own profession. (3) A humane head nurse who was at hand, who was a facilitator, who knew staff members, and eliminated obstacles for them.

    CONCLUSIONS: In a nonhierarchical and stable organization with a head nurse with caritative leadership skills, a welcoming working environment with opportunities for professional development is created. Thus, nurse specialists choose to stay, contributing to organizational development.

  • 22.
    Arnetz, Bengt B.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Michigan State Univ, E Lansing, USA; Umea Univ, Umea, Sweden.
    Lewalski, Philip
    Wayne State Univ, Sch Med, Dept Emergency Med, Detroit, MI USA..
    Arnetz, Judy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Michigan State Univ, E Lansing, USA; Umea Univ, Umea, Sweden.
    Breejen, Karen
    Michigan State Univ, Coll Human Med, Dept Family Med, E Lansing, MI 48824 USA..
    Przyklenk, Karin
    Wayne State Univ, Sch Med, Dept Emergency Med, Detroit, MI USA.;Wayne State Univ, Sch Med, Cardiovasc Res Inst, Detroit, MI USA.;Wayne State Univ, Sch Med, Dept Physiol, Detroit, MI 48201 USA..
    Examining self-reported and biological stress and near misses among Emergency Medicine residents: a single-centre cross-sectional assessment in the USA2017Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 8, artikkel-id e016479Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives To examine the relationship between perceived and biological stress and near misses among Emergency Medicine residents. Design Self-rated stress and stress biomarkers were assessed in residents in Emergency Medicine before and after a day shift. The supervising physicians and residents reported numbers of near misses. Setting The study took place in the Emergency Department of a large trauma 1 centre, located in Detroit, USA. Participants Residents in Emergency Medicine volunteered to participate. The sample consisted of 32 residents, with complete data on 28 subjects. Residents' supervising physicians assessed the clinical performance of each resident. Primary and secondary outcome measures Participants' preshift and postshift stress, biological stress (salivary cortisol, plasma interleukin-6, tumour necrosis factor-alpha (TNF-alpha) and high-sensitivity C-reactive protein), residents' and supervisors' reports of near misses, number of critically ill and patients with trauma seen during the shift. Results Residents' self-reported stress increased from an average preshift level of 2.79 of 10 (SD 1.81) to a postshift level of 5.82 (2.13) (p<0.001). Residents cared for an average of 2.32 (1.52) critically ill patients and 0.68 (1.06) patients with trauma. Residents reported a total of 7 near misses, compared with 11 reported by the supervising physicians. After controlling for baseline work-related exhaustion, residents that cared for more patients with trauma and had higher levels of TNF-a reported a higher frequency of near misses (R-2=0.72; p=0.001). Residents' preshift ratings of how stressful they expected the shift to be were related to the supervising physicians' ratings of residents' near misses during the shift. Conclusion Residents' own ratings of near misses were associated with residents' TNF-alpha, a biomarker of systemic inflammation and the number of patients with trauma seen during the shift. In contrast, supervisor reports on residents' near misses were related only to the residents' preshift expectations of how stressful the shift would be.

  • 23. Arnetz, Judith E.
    et al.
    Hamblin, Lydia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Ager, Joel
    Aranyos, Deanna
    Essenmacher, Lynnette
    Upfal, Mark J.
    Luborsky, Mark
    Using database reports to reduce workplace violence: Perceptions of hospital stakeholders2015Inngår i: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 51, nr 1, s. 51-59Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Documented incidents of violence provide the foundation for any workplace violence prevention program. However, no published research to date has examined stakeholders' preferences for workplace violence data reports in healthcare settings. If relevant data are not readily available and effectively summarized and presented, the likelihood is low that they will be utilized by stakeholders in targeted efforts to reduce violence. OBJECTIVE: To discover and describe hospital system stakeholders' perceptions of database-generated workplace violence data reports. PARTICIPANTS: Eight hospital system stakeholders representing Human Resources, Security, Occupational Health Services, Quality and Safety, and Labor in a large, metropolitan hospital system. METHODS: The hospital system utilizes a central database for reporting adverse workplace events, including incidents of violence. A focus group was conducted to identify stakeholders' preferences and specifications for standardized, computerized reports of workplace violence data to be generated by the central database. The discussion was audio-taped, transcribed verbatim, processed as text, and analyzed using stepwise content analysis. RESULTS: Five distinct themes emerged from participant responses: Concerns, Etiology, Customization, Use, and Outcomes. In general, stakeholders wanted data reports to provide "the big picture," i.e., rates of occurrence; reasons for and details regarding incident occurrence; consequences for the individual employee and/or the workplace; and organizational efforts that were employed to deal with the incident. CONCLUSIONS: Exploring stakeholder views regarding workplace violence summary reports provided concrete information on the preferred content, format, and use of workplace violence data. Participants desired both epidemiological and incident-specific data in order to better understand and work to prevent the workplace violence occurring in their hospital system.

  • 24. Arsalani, Narges
    et al.
    Fallahi-Khoshknab, Masoud
    Josephson, Malin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lagerstrom, Monica
    Musculoskeletal Disorders and Working Conditions Among Iranian Nursing Personnel2014Inngår i: International Journal of Occupational Safety and Ergonomics, ISSN 1080-3548, E-ISSN 2376-9130, Vol. 20, nr 4, s. 671-680Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study investigated the prevalence of musculoskeletal disorders (MSDs) and associations with organizational, physical and psychosocial working conditions among 520 nursing personnel in Tehran, Iran. The results of the cross-sectional study on aids and different educational levels of nurses showed that the participants experienced 88% of MSDs in at least one body region during the past 12 months. The 3 most prevalent body regions were the low back (65.3%), knee (56.2%) and neck (49.8%). The participants reported inflexible work schedule, poor quality of devices for transferring patients, overexertion and job dissatisfaction. Physical and psychosocial exposure revealed an elevated odds ratio (95% confidence interval) of MSDs. The results showed a combination of high physical and psychosocial work demands along with low control over the work which increased work-related stress and enhanced the risk of MSDs. This study findings could help to understand work-related MSDs among nursing personnel in a developing country where the work situation and sociocultural context differ from other countries.

  • 25. Astell-Burt, Thomas
    et al.
    Mitchell, Richard
    Hartig, Terry
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutet för bostads- och urbanforskning (IBF).
    The association between green space and mental health varies across the lifecourse. A longitudinal study2014Inngår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, nr 6, s. 578-583Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Epidemiological studies on green space and health have relied almost exclusively on cross-sectional designs, restricting understanding on how this relationship could vary across the lifecourse. Methods We used multilevel linear regression to analyse variation in minor psychiatric morbidity over nine annual waves of the British Household Panel Survey (1996-2004). The sample was restricted to residents of urban areas who remained within their neighbourhoods for at least 12 months. The 12-item General Health Questionnaire and confounders were reported for 29 626 male and 35 781 female observations (person-years). This individual-level dataset was linked to a measure of green space availability within each ward of residence. Regression models included age, gender, employment status, household tenure, marital status, education, smoking status and household income. Results When not considering age, green space was associated with better mental health among men, but not women. Interaction terms fitted between age and green space revealed variation in the association between green space and mental health across the lifecourse and by gender. For men, the benefit of more green space emerged in early to mid-adulthood. Among older women, a curvilinear association materialised wherein those with a moderate availability of green space had better mental health. Conclusions These findings illustrate how the relationship between urban green space and health can vary across the lifecourse, and they highlight the need for longitudinal studies to answer why green space may be better for health at some points in the lifecourse than others.

  • 26.
    August, Furaha
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Pembe, Andrea B.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Kayombo, Edmund
    Mbekenga, Columba
    Axemo, Pia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Darj, Elisabeth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Birth preparedness and complication readiness - a qualitative study among community members in rural Tanzania2015Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, s. 1-U12, artikkel-id 26922Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. Design: A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. Results: The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. Conclusions: This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers.

  • 27.
    Ax, Erika
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Lampa, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Salihovic, Samira
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    van Bavel, Bert
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Sjögren, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Lind, P Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Circulating levels of environmental contaminants are associated with dietary patterns in older adults2015Inngår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 75, s. 93-102Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Food intake contributes substantially to our exposure to environmental contaminants. Still, little is known about our dietary habits' contribution to exposure variability.

    OBJECTIVE: The aim of this study was to assess circulating levels of environmental contaminants in relation to predefined dietary patterns in an elderly Swedish population.

    METHODS: Dietary data and serum concentrations of environmental contaminants were obtained from 844 70-year-old Swedish subjects (50% women) in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Dietary data from 7-day food records was used to assess adherence to a Mediterranean-like diet, a low carbohydrate-high protein diet and the WHO dietary recommendations. Circulating levels of 6 polychlorinated biphenyl markers, 3 organochlorine pesticides, 1 dioxin and 1 polybrominated diphenyl ether, the metals cadmium, lead, mercury and aluminum and serum levels of bisphenol A and 4 phthalate metabolites were investigated in relation to dietary patterns in multivariate linear regression models.

    RESULTS: A Mediterranean-like diet was positively associated with levels of several polychlorinated biphenyls (118, 126, 153, and 209), trans-nonachlor and mercury. A low carbohydrate-high protein diet was positively associated with polychlorinated biphenyls 118 and 153, trans-nonachlor, hexachlorobenzene and p, p'-dichlorodiphenyldichloroethylene, mercury and lead. The WHO recommended diet was negatively related to levels of dioxin and lead, and borderline positively to polychlorinated biphenyl 118 and trans-nonachlor.

    CONCLUSION: Dietary patterns were associated in diverse manners with circulating levels of environmental contaminants in this elderly Swedish population. Following the WHO dietary recommendations seems to be associated with a lower burden of environmental contaminants.

  • 28. Baker, Ulrika
    et al.
    Peterson, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Marchant, Tanya
    Mbaruku, Godfrey
    Temu, Silas
    Manzi, Fatuma
    Hanson, Claudia
    Identifying implementation bottlenecks for maternal and newborn health interventions in rural districts of the United Republic of Tanzania2015Inngår i: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 93, nr 6, s. 380-389Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective To estimate effective coverage of maternal and newborn health interventions and to identify bottlenecks in their implementation in rural districts of the United Republic of Tanzania. Methods Cross-sectional data from households and health facilities in Tandahimba and Newala districts were used in the analysis. We adapted Tanahashi's model to estimate intervention coverage in conditional stages and to identify implementation bottlenecks in access, health facility readiness and clinical practice. The interventions studied were syphilis and pre-eclampsia screening, partograph use, active management of the third stage of labour and postpartum care. Findings Effective coverage was low in both districts, ranging from only 3% for postpartum care in Tandahimba to 49% for active management of the third stage of labour in Newala. In Tandahimba, health facility readiness was the largest bottleneck for most interventions, whereas in Newala, it was access. Clinical practice was another large bottleneck for syphilis screening in both districts. Conclusion The poor effective coverage of maternal and newborn health interventions in rural districts of the United Republic of Tanzania reinforces the need to prioritize health service quality. Access to high-quality local data by decision-makers would assist planning and prioritization. The approach of estimating effective coverage and identifying bottlenecks described here could facilitate progress towards universal health coverage for any area of care and in any context.

  • 29. Bakolis, I
    et al.
    Heinrich, J
    Zock, J P
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Svanes, C
    Chen, C M
    Accordini, S
    Verlato, G
    Olivieri, M
    Jarvis, D
    House dust-mite allergen exposure is associated with serum specific IgE but not with respiratory outcomes2015Inngår i: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 25, nr 3, s. 235-244Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Exposure to house dust has been associated with asthma in adults, and this is commonly interpreted as a direct immunologic response to dust-mite allergens in those who are IgE sensitized to house dust-mite. Mattress house dust-mite concentrations were measured in a population-based sample of 2890 adults aged between 27 and 56 years living in 22 centers in 10 countries. Generalized linear mixed models were employed to explore the association of respiratory symptoms with house dust-mite concentrations, adjusting for individual and household confounders. There was no overall association of respiratory outcomes with measured house dust-mite concentrations, even in those who reported they had symptoms on exposure to dust and those who had physician-diagnosed asthma. However, there was a positive association of high serum specific IgE levels to HDM (>3.5 kUA /l) with mattress house dust-mite concentrations and a negative association of sensitization to cat with increasing house dust-mite concentrations. In conclusion, there was no evidence that respiratory symptoms in adults were associated with exposure to house dust-mite allergen in the mattress, but an association of house mite with strong sensitization was observed.

  • 30.
    Bellini, Diego
    et al.
    Univ Verona, Assessment Ctr, Via S Francesco 22, I-37129 Verona, VR, Italy.
    Hartig, Terry
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutet för bostads- och urbanforskning (IBF).
    Bonaiuto, Marino
    Sapienza Univ Roma, Dept Psychol Dev & Socializat Proc, Interuniv Res Ctr Environm Psychol CIRPA, Rome, Italy.
    Social support in the company canteen: A restorative resource buffering the relationship between job demands and fatigue2019Inngår i: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 63, nr 3, s. 375-387Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The quality of the places where workers take their breaks may affect the completeness of recovery in the time available. Little is known about how characteristics of a company canteen buffer the relationship between job demands and fatigue. OBJECTIVE: We addressed the possibility that the company canteen buffers the relationship between job demands and fatigue to the extent that workers perceive it to hold restorative quality. Further, we considered how the restorative quality of the canteen signals the provision of organizational support, another job resource thought to buffer the demands-fatigue relationship. METHODS: A questionnaire was completed by 141 male blue collars workers during their lunch break in the factory canteen of an Italian industrial organization. RESULTS: Canteen restorative quality correlated positively with organizational support. In multivariate regression analyses, the demands-fatigue association was weaker among workers who saw greater restorative quality in the canteen. This buffering effect was accounted for by a buffering effect of organizational support. CONCLUSIONS: When settings for rest in the workplace have higher restorative quality, they may better function as job resources in two respects: serving the immediate needs of workers for recovery from job demands, and signaling the interest of the organization in their well-being.

  • 31.
    Berglund, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicinsk epidemiologi.
    Anderzén, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicinsk epidemiologi.
    Andersén, Åsa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicinsk epidemiologi.
    Carlsson, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna.
    Gustavsson, Catharina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna.
    Wallman, Thorne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lytsy, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicinsk epidemiologi. Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, SE-17177 Stockholm, Sweden.
    Multidisciplinary Intervention and Acceptance and Commitment Therapy for Return-to-Work and Increased Employability among Patients with Mental Illness and/or Chronic Pain: A Randomized Controlled Trial2018Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, nr 11, artikkel-id 2424Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: People on long-term sick leave often have a long-lasting process back to work, where the individuals may be in multiple and recurrent states; i.e., receiving different social security benefits or working, and over time they may shift between these states. The purpose of this study was to evaluate the effects of two vocational rehabilitation programs, compared to a control, on return-to-work (RTW) or increased employability in patients on long-term sick leave due to mental illness and/or chronic pain. Methods: In this randomized controlled study, 427 women and men were allocated to either (1) multidisciplinary team management, i.e., multidisciplinary assessments and individual rehabilitation management, (2) acceptance and commitment therapy (ACT), or (3) control. A positive outcome was defined as RTW or increased employability. The outcome was considered negative if the (part-time) wage was reduced or ceased, or if there was an indication of decreased employability. The outcome was measured one year after entry in the project and analyzed using binary and multinomial logistic regressions. Results: Participants in the multidisciplinary team group reported having RTW odds ratio (OR) 3.31 (95% CI 1.39-7.87) compared to the control group in adjusted models. Participants in the ACT group reported having increased employability OR 3.22 (95% CI 1.13-9.15) compared to the control group in adjusted models. Conclusions: This study of vocational rehabilitation in mainly female patients on long-term sick leave due to mental illness and/or chronic pain suggests that multidisciplinary team assessments and individually adapted rehabilitation interventions increased RTW and employability. Solely receiving the ACT intervention also increased employability.

  • 32.
    Bergsten, Eva L.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, SE-801 76 Gävle, Sweden.
    Mathiassen, Svend Erik
    Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, SE-801 76 Gävle, Sweden.
    Kwak, Lydia
    Unit of Intervention and Implementation Research for worker health, Institute of Environmental Medicine, Karolinska Institutet, SE- 171 77 Stockholm, Sweden.
    Vingård, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Daily shoulder pain among flight baggage handlers and its association with work tasks and upper arm postures on the same day2017Inngår i: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 61, nr 9, s. 1145-1153Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives

    This study of flight baggage handlers aimed at examining the extent to which shoulder pain developed during single work shifts, and whether a possible development was associated with biomechanical exposures and psychosocial factors during the same shift.

    Methods

    Data were collected during, in total, 82 work shifts in 44 workers. Right and left shoulder pain intensity was rated just before and just after the shift (VAS scale 0–100 mm). Objective data on ‘time in extreme’ and ‘time in neutral’ upper arm postures were obtained for the full shift using accelerometers, and the baggage handlers registered the number of ‘aircrafts handled’ in a diary. During half of the shift, workers were recorded on video for subsequent task analysis of baggage handling. ‘Influence’ at work and ‘support’ from colleagues were measured by use of Copenhagen Psychosocial Questionnaire (COPSOQ). Associations between exposures and the increase in pain intensity during the shift (‘daily pain’) were analysed for the right and left shoulder separately using Generalized Estimating Equations (GEE).

    Results

    ‘Daily pain’ was observed in approximately one third of all shifts. It was significantly associated with the number of ‘aircrafts handled’ for both the right and left shoulder. In multivariate models including both biomechanical exposures and the psychosocial factors ‘influence’ at work and ‘support’ from colleagues, ‘aircrafts handled’ was still significantly associated with ‘daily pain’ in both shoulders, and so was ‘influence’ and ‘support’, however in opposite directions.

    Conclusions

    ‘Daily pain’ was, in general, associated with biomechanical exposures during the same shift and with general ‘influence’ and ‘support’ in the job. In an effort to reduce pain among flight baggage handlers, it may therefore be justified to consider a reduction of biomechanical exposures during handling of aircrafts, combined with due attention to psychosocial factors at work.

  • 33.
    Bergsten, Eva L.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, SE-801 76 Gävle, Sweden.
    Mathiassen, Svend Erik
    Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, SE-801 76 Gävle, Sweden.
    Larsson, Johan
    Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, SE-801 76 Gävle, Sweden.
    Kwak, Lydia
    Unit of Intervention and Implementation Research for worker health, Institute of Environmental Medicine, Karolinska Institutet, SE- 171 77 Stockholm, Sweden.
    Implementation of an ergonomics intervention in a Swedish flight baggage handling company: a process evaluation2018Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, nr 3, artikkel-id e0191760Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    To conduct a process evaluation of the implementation of an ergonomics training program aimed at increasing the use of loading assist devices in flight baggage handling.

    Methods

    Feasibility related to the process items recruitment, reach, context, dose delivered (training time and content); dose received (participants’ engagement); satisfaction with training; intermediate outcomes (skills, confidence and behaviors); and barriers and facilitators of the training intervention were assessed by qualitative and quantitative methods.

    Results

    Implementation proved successful regarding dose delivered, dose received and satisfaction. Confidence among participants in the training program in using and talking about devices, observed use of devices among colleagues, and internal feedback on work behavior increased significantly (p<0.01). Main facilitators were self-efficacy, motivation, and perceived utility of training among the trainees. Barriers included lack of peer support, opportunities to observe and practice behaviors, and follow-up activities; as well as staff reduction and job insecurity.

    Conclusions

    In identifying important barriers and facilitators for a successful outcome, this study can help supporting the effectiveness of future interventions. Our results suggest that barriers caused by organizational changes may likely be alleviated by recruiting motivated trainees and securing strong organizational support for the implementation.

  • 34.
    Bergström, Aileen L.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin.
    Eriksson, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Forskning om funktionshinder och habilitering.
    Asaba, Eric
    Erikson, Anette
    Tham, Kerstin
    Complex negotiations: The lived experience of enacting agency after a stroke2015Inngår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 22, nr 1, s. 43-53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: This qualitative, longitudinal, descriptive study aimed to understand the lived experience of enacting agency, and to describe the phenomenon of agency and the meaning structure of the phenomenon during the year after a stroke. Agency is defined as making things happen in everyday life through one's actions. Methods: This study followed six persons (three men and three women, ages 63 to 89), interviewed on four separate occasions. Interview data were analysed using the Empirical Phenomenological Psychological method. Results: The main findings showed that the participants experienced enacting agency in their everyday lives after stroke as negotiating different characteristics over a span of time, a range of difficulty, and in a number of activities, making these negotiations complex. The four characteristics described how the participants made things happen in their everyday lives through managing their disrupted bodies, taking into account their past and envisioning their futures, dealing with the world outside themselves, and negotiating through internal dialogues. Conclusions: This empirical evidence regarding negotiations challenges traditional definitions of agency and a new definition of agency is proposed. Understanding clients' complex negotiations and offering innovative solutions to train in real-life situations may help in the process of enabling occupations after a stroke.

  • 35.
    Bergström, Aileen L.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin.
    Eriksson, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Forskning om funktionshinder och habilitering.
    Asaba, Eric
    Erikson, Anette
    Tham, Kerstin
    Complex negotiations: The lived experience of enacting agency after a stroke2015Inngår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 22, nr 1, s. 43-53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: This qualitative, longitudinal, descriptive study aimed to understand the lived experience of enacting agency, and to describe the phenomenon of agency and the meaning structure of the phenomenon during the year after a stroke. Agency is defined as making things happen in everyday life through one's actions. Methods: This study followed six persons (three men and three women, ages 63 to 89), interviewed on four separate occasions. Interview data were analysed using the Empirical Phenomenological Psychological method. Results: The main findings showed that the participants experienced enacting agency in their everyday lives after stroke as negotiating different characteristics over a span of time, a range of difficulty, and in a number of activities, making these negotiations complex. The four characteristics described how the participants made things happen in their everyday lives through managing their disrupted bodies, taking into account their past and envisioning their futures, dealing with the world outside themselves, and negotiating through internal dialogues. Conclusions: This empirical evidence regarding negotiations challenges traditional definitions of agency and a new definition of agency is proposed. Understanding clients' complex negotiations and offering innovative solutions to train in real-life situations may help in the process of enabling occupations after a stroke.

  • 36.
    Bich, Tran Huu
    et al.
    Hanoi School of Public Health, Ba Dinh, Vietnam.
    Hoa, Dinh Thi Phuong
    Hanoi School of Public Health, Ba Dinh, Vietnam.
    Målqvist, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Fathers as Supporters for Improved Exclusive Breastfeeding in Viet Nam2014Inngår i: Maternal and Child Health Journal, ISSN 1092-7875, E-ISSN 1573-6628, Vol. 18, nr 6, s. 1444-1453Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To determine the extent of exclusive breastfeeding practices among mothers of 4 and 6 month old infants whose fathers received breastfeeding education materials and counseling services. A quasi-experimental design was used. At the baseline, 251 and 241 couples were recruited into the intervention and control sites respectively. Fathers in the intervention area received breastfeeding education materials, counseling services at commune health centers and household visits. In the control site, where mothers routinely receive services on antenatal and postpartum care, fathers did not receive any intervention services on promoting breastfeeding. Primary indicators were exclusive breastfeeding at 4 and 6 months. At 6 months of age, based on 24-hour recall, 16.0 % (38/238) of mothers in the intervention group were exclusively breastfeeding their children, compared to 3.9 % (10/230) of those mothers in the control group (p < 0.001). Significant differences were found based on last-week recall (8.8 % in the intervention group vs. 1.3 % in the control group, p < 0.001) and since-birth recall (6.7 % in the intervention group vs. 0.9 % in the control group, p < 0.01). At 4 months of age, based on since birth recall, the breastfeeding proportion was significantly higher in the intervention group than in control group (20.6 % in the intervention group vs. 11.3 % in the control group, p < 0.01). An intervention targeting fathers might be effective in increasing exclusive breastfeeding practices at 4 and 6 months. To improve exclusive breastfeeding, health care staff working in maternal and child health units, should consider integrating fathers with services delivered to mothers and children.

  • 37.
    Binder-Finnema, Pauline
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Lien, Pham T. L.
    Hoa, Dinh T. P.
    Målqvist, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Determinants of marginalization and inequitable maternal health care in North-Central Vietnam: a framework analysis2015Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, artikkel-id 27554Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Vietnam has achieved great improvements in maternal healthcare outcomes, but there is evidence of increasing inequity. Disadvantaged groups, predominantly ethnic minorities and people living in remote mountainous areas, do not gain access to maternal health improvements despite targeted efforts from policymakers. Objective: This study identifies underlying structural barriers to equitable maternal health care in Nghe An province, Vietnam. Experiences of social inequity and limited access among child-bearing ethnic and minority women are explored in relation to barriers of care provision experienced by maternal health professionals to gain deeper understanding on health outcomes. Design: In 2012, 11 focus group discussions with women and medical care professionals at local community health centers and district hospitals were conducted using a hermeneutic-dialectic method and analyzed for interpretation using framework analysis. Results: The social determinants 'limited negotiation power' and 'limited autonomy' orchestrate cyclical effects of shared marginalization for both women and care professionals within the provincial health system's infrastructure. Under-staffed and poorly equipped community health facilities referwomen and create overload at receiving health centers. Limited resources appear diverted away from local community centers as compensation to the district for overloaded facilities. Poor reputation for low care quality exists, and professionals are held in low repute for causing overload and resulting adverse outcomes. Country-wide reforms force women to bear responsibility for limited treatment adherence and health insight, but overlook providers' limited professional development. Ethnic minority women are hindered by relatives from accessing care choices and costs, despite having advanced insight about government reforms to alleviate poverty. Communication challenges are worsened by non-existent interpretation systems. Conclusions: For maternal health policy outcomes to become effective, it is important to understand that limited negotiation power and limited autonomy simultaneously confront childbearing women and health professionals. These two determinants underlie the inequitable economic, social, and political forces in Vietnam's disadvantaged communities, and result in marginalized status shared by both in the poorest sectors.

  • 38. Björkenstam, Charlotte
    et al.
    Johansson, Lars Age
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Nordström, Peter
    Thiblin, Ingemar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Rättsmedicin.
    Fugelstad, Anna
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Ljung, Rickard
    Suicide or undetermined intent?: A register-based study of signs of misclassification2014Inngår i: Population Health Metrics, ISSN 1478-7954, E-ISSN 1478-7954, Vol. 12, artikkel-id 11Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Several studies have concluded that some deaths classified as undetermined intent are in fact suicides, and it is common in suicide research in Europe to include these deaths. Our aim was to investigate if information on background variables would be helpful in assessing if deaths classified as undetermined intent should be included in the analyses of suicides. Methods: We performed a register study of 31,883 deaths classified as suicides and 9,196 deaths classified as undetermined intent in Sweden from 1987 to 2011. We compared suicide deaths with deaths classified as undetermined intent with regard to different background variables such as sex, age, country of birth, marital status, prior inpatient care for self-inflicted harm, alcohol and drug abuse, psychiatric inpatient care, and use of psychotropics. We also performed a multivariate analysis with logistic regression. Results: Our results showed differences in most studied background factors. Higher education was more common in suicides; hospitalization for self-inflicted harm was more common among female suicides as was prior psychiatric inpatient care. Deaths in foreign-born men were classified as undetermined intent in a higher degree and hospitalization for substance abuse was more common in undetermined intents of both sexes. Roughly 50% of both suicide and deaths classified as undetermined intent had a filled prescription of psychotropics during their last six months. Our multivariate analysis showed male deaths to more likely be classified as suicide than female: OR: 1.13 (1.07-1.18). The probability of a death being classified as suicide was also increased for individuals aged 15-24, being born in Sweden, individuals who were married, and for deaths after 1987-1992. Conclusion: By analyzing Sweden's unique high-validity population-based register data, we found several differences in background variables between deaths classified as suicide and deaths classified as undetermined intent. However, we were not able to clearly distinguish these two death manners. For future research we suggest, separate analyses of the two different manners of death.

  • 39.
    Bogale, Tesfahun Yonas
    et al.
    Wolaita Sodo Univ, Hlth Sci & Med Coll, Wolaita Sodo, Ethiopia.
    Tadesse Balla, Elazar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH), Internationell barnhälsa och nutrition.
    Tadesse, Minyahil
    Wolaita Sodo Univ, Hlth Sci & Med Coll, Wolaita Sodo, Ethiopia.
    Asamoah, Benedict Oppong
    Lund Univ, Dept Clin Sci, Social Med & Global Hlth, Malmo, Sweden.
    Prevalence and associated factors for stunting among 6-12 years old school age children from rural community of Humbo district, Southern Ethiopia2018Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, artikkel-id 653Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Stunting is one of the most serious and challenging public health problems in Ethiopia, which constitute a significant obstacle to achieving better child health outcomes. This study aimed to assess the prevalence and factors associated with stunting among 6-12 years old children in Humbo district, Southern Ethiopia. Methods: This was a cross-sectional study conducted among 633 children 6-12 years old living in Humbo district, Southern Ethiopia, from March to April, 2015. A multistage cluster sampling technique was used to select participants from households in eight Villages in the study area. Height was measured using standard methods and height for age Z-score was computed to assess stunting. EPI info version 3.5.4 was used for data entry, whereas Anthroplus software and SPSS version 20.0 were used for computation of height for age Z-scores and statistical analyses respectively. Simple and multiple logistic regression analyses were used to examine factors associated with stunting in the study sample, using 95% confidence limits (statistical significance set at p < 0.050). Results: Prevalence of stunting was 57%, about, 3.5% were severely stunted, 27.3% moderately stunted and 26.4% mildly stunted, and the mean (SD) was -1.1 (+/- 1.2). About 7 (1.1%) boys and 15 (2.4%) girls were severely stunted. Age groups 10-12 years had significantly higher rate of stunting than others. Age (AOR = 1.7, 95% CI = 1.1-2.6), big family size (AOR = 4.6, 95% CI = 2.2-9.5) and field disposal of wastes (AOR = 2.7, 95% CI = 1.2-5.8) were factors significantly associated with stunting. Conclusion: This study exposed high rate of stunting among school age children. Stunting remains a noticeable attribute of rural school age children. Findings suggest the need to implement evidence-based school-aged rural children nutrition policy and strategies as well as need for intervention to improve domestic waste management system in the rural community.

  • 40. Bogdanska, Jasna
    et al.
    Borg, Daniel
    Sundström, Maria
    Bergström, Ulrika
    Halldin, Krister
    Abedi-Valugerdi, Manuchehr
    Bergman, Ake
    Nelson, Buck
    Depierre, Joseph
    Nobel, Stefan
    Tissue distribution of ³⁵S-labelled perfluorooctane sulfonate in adult mice after oral exposure to a low environmentally relevant dose or a high experimental dose.2011Inngår i: Toxicology, ISSN 0300-483X, E-ISSN 1879-3185, Vol. 284, nr 1-3, s. 54-62Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The widespread environmental pollutant perfluorooctane sulfonate (PFOS), detected in most animal species including the general human population, exerts several effects on experimental animals, e.g., hepatotoxicity, immunotoxicity and developmental toxicity. However, detailed information on the tissue distribution of PFOS in mammals is scarce and, in particular, the lack of available information regarding environmentally relevant exposure levels limits our understanding of how mammals (including humans) may be affected. Accordingly, we characterized the tissue distribution of this compound in mice, an important experimental animal for studying PFOS toxicity. Following dietary exposure of adult male C57/BL6 mice for 1-5 days to an environmentally relevant (0.031 mg/kg/day) or a 750-fold higher experimentally relevant dose (23 mg/kg/day) of ³⁵S-PFOS, most of the radioactivity administered was recovered in liver, bone (bone marrow), blood, skin and muscle, with the highest levels detected in liver, lung, blood, kidney and bone (bone marrow). Following high daily dose exposure, PFOS exhibited a different distribution profile than with low daily dose exposure, which indicated a shift in distribution from the blood to the tissues with increasing dose. Both scintillation counting (with correction for the blood present in the tissues) and whole-body autoradiography revealed the presence of PFOS in all 19 tissues examined, with identification of thymus as a novel site for localization for PFOS and bone (bone marrow), skin and muscle as significant body compartments for PFOS. These findings demonstrate that PFOS leaves the bloodstream and enters most tissues in a dose-dependent manner.

  • 41.
    Bogo, Renata
    et al.
    Karolinska Inst, Sect Audiol, Dept Clin Sci Intervent & Technol, Alfred Nobels Alle 10, SE-14183 Huddinge, Sweden; Karolinska Univ Hosp, Dept Audiol & Neurotol, Huddinge, Sweden.
    Farah, Ahmed
    Publ Hlth Agcy Sweden, Stockholm, Sweden.
    Karlsson, Kjell K
    Karolinska Univ Hosp, Dept Audiol & Neurotol, Huddinge, Sweden.
    Pedersen, Nancy L
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Svartengren, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Skjönsberg, Åsa
    Karolinska Inst, Sect Audiol, Dept Clin Sci Intervent & Technol, Alfred Nobels Alle 10, SE-14183 Huddinge, Sweden; Karolinska Univ Hosp, Dept Audiol & Neurotol, Huddinge, Sweden.
    Prevalence, Incidence Proportion, and Heritability for Tinnitus: A Longitudinal Twin Study2017Inngår i: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 38, nr 3, s. 292-300Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: The purpose of this longitudinal twin study was to explore the effect of tinnitus on hearing thresholds and threshold shifts over two decades and to investigate the genetic contribution to tinnitus in a male twin cohort (n = 1114 at baseline and 583 at follow-up). The hypothesis was that participants with faster hearing deterioration had a higher risk for developing tinnitus and there is an underlying role of genetic influences on tinnitus.

    DESIGN: Male mono- and dizygotic twin pairs, born between 1914 and 1958 were included. Mixed models were used for comparison of hearing threshold shifts, adjusted for age. A co-twin comparison was made within pairs discordant for tinnitus. The relative influence of genetic and environmental factors was estimated by genetic modeling.

    RESULTS: The overall prevalence of tinnitus was 13.5% at baseline (x age 50) and 34.4% at follow-up (x age 67). The overall incidence proportion was 27.8%. Participants who reported tinnitus at baseline or at both time points were older. At baseline, the hearing thresholds differed between tinnitus cases and controls at all frequencies. New tinnitus cases at follow-up had the greatest hearing threshold shift at the high-frequency area compared with the control group. Within pairs, the tinnitus twin had poorer hearing than his unaffected co-twin, more so for dizygotic than monozygotic twin pairs. The relative proportion of additive genetic factors was approximately 0.40 at both time points, and the influence of individual-specific environment was 0.56 to 0.61. The influence of genetic factors on tinnitus was largely independent of genetic factors for hearing thresholds.

    CONCLUSIONS: Our hypotheses were confirmed: The fastest hearing deterioration occurred for new tinnitus cases. A moderate genetic influence for tinnitus was confirmed.

  • 42. Bohman, Tony
    et al.
    Alfredsson, Lars
    Jensen, Irene
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Vingård, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Skillgate, Eva
    Does a healthy lifestyle behaviour influence the prognosis of low back pain among men and women in a general population? A population-based cohort study2014Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, nr 12, artikkel-id e005713Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES:

    To study the influence of healthy lifestyle behaviour on the prognosis of occasional low back pain among men and women in a general population.

    DESIGN:

    Cohort study with a 4-year follow-up.

    SETTINGS:

    General population in Stockholm County, Sweden.

    PARTICIPANTS:

    The study sample comprised 3938 men and 5056 women aged 18-84 from the Stockholm Public Health Cohort reporting occasional low back pain in the baseline questionnaire 2006.

    MEASURES:

    Lifestyle factors and potential confounders were assessed at baseline. The lifestyle factors smoking habits, alcohol consumption, leisure physical activity and consumption of fruit and vegetables were dichotomised using recommendations for a health-enhancing lifestyle and combined to form the exposure variable 'healthy lifestyle behaviour'. The exposure was categorised into five levels according to the number of healthy lifestyle factors met. The follow-up questionnaire in 2010 gave information about the outcome, long duration troublesome low back pain. Crude and adjusted binomial regression models were applied to estimate the association between the exposure and the outcome analysing men and women separately.

    RESULTS:

    The risk of developing long duration troublesome low back pain among women with occasional low back pain decreased with increasing healthy lifestyle behaviour (trend test: p=0.006). 21% (28/131) among women with no healthy lifestyle factor (reference) experienced the outcome compared to 9% (36/420) among women with all four factors. Compared to the reference group, the risk was reduced by 35% (RR 0.65, 95% CI 0.44 to 0.96) for women with one healthy lifestyle factor and 52% (RR 0.48, 95% CI 0.31 to 0.77) for women with all four healthy lifestyle factors. There were no clear associations found among men.

    CONCLUSIONS:

    Healthy lifestyle behaviour seems to decrease the risk of developing long duration troublesome low back pain among women with occasional low back pain and may be recommended to improve the prognosis.

  • 43.
    Bramberg, Elisabeth Björk
    et al.
    Karolinska Inst, Inst Environm Med, Unit Intervent & Implementat Res Worker Hlth, Nobels Vag 13, S-17177 Stockholm, Sweden..
    Nyman, Teresia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Karolinska Inst, Inst Environm Med, Unit Intervent & Implementat Res Worker Hlth, Nobels Vag 13, S-17177 Stockholm, Sweden.;KTH Royal Inst Technol, Sch Technol & Hlth, Ergon Unit, Stockholm, Sweden..
    Kwak, Lydia
    Karolinska Inst, Inst Environm Med, Unit Intervent & Implementat Res Worker Hlth, Nobels Vag 13, S-17177 Stockholm, Sweden..
    Alipour, Akbar
    Storvretens Primary Hlth Clin, Stockholm, Sweden..
    Bergstrom, Gunnar
    Karolinska Inst, Inst Environm Med, Unit Intervent & Implementat Res Worker Hlth, Nobels Vag 13, S-17177 Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Elinder, Liselotte Schafer
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden..
    Hermansson, Ulric
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Jensen, Irene
    Karolinska Inst, Inst Environm Med, Unit Intervent & Implementat Res Worker Hlth, Nobels Vag 13, S-17177 Stockholm, Sweden..
    Development of evidence-based practice in occupational health services in Sweden: a 3-year follow-up of attitudes, barriers and facilitators2017Inngår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 90, nr 4, s. 335-348Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Swedish government initiated an investigation of how to secure and develop the competence of the occupational health services. The primary aim of the present study was to investigate whether the development of evidence-based practice (EBP) in the Swedish occupational health services in relation to attitudes, knowledge and use improved during the first 3 years of the government's initiative. The study has a mixed methods design combining questionnaires and interviews with data collection at baseline and at 3-year follow-up. The response rate was 66% at baseline and 63% at follow-up. The results show that practitioners' knowledge of EBP was moderate at baseline and improved at follow-up (p = 0.002; 95% CI 0.01; 0.21). Practitioners experienced lower levels of organizational and managerial support for EBP at follow-up (p < 0.001; 95% CI 0.18; 0.38). The results revealed that managers viewed responsibility for implementing EBP as a matter for individual practitioners rather than as an organizational issue. Occupational health service managers and practitioners are generally positive to EBP. However, the findings emphasize the need to educate managers in how to support EBP at the organizational level by creating an infrastructure for EBP in the OHS.

  • 44.
    Brittebo, Eva
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Andersson, Helén
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Rönn, Monika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lind, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Brandt, Ingvar
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Biologiska sektionen, Institutionen för organismbiologi, Ekotoxikologi.
    Bioactivation and effects of environmental pollutants in human and rodent blood vessel endothelial cells2012Inngår i: Organohalogen compound database (http://www.dioxin20xx.org/ohc_database_search.htm), 2012Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction

    Recent epidemiological studies reveal associations between exposure to environmental pollutants and cardiovascular disorders in humans. Elevated serum concentrations of polychlorinated biphenyls (PCBs) have for instance been associated with cardiovascular risk factors such as hypertension (1-3). Exposure to the carbonate plastic monomer bisphenol A (BPA) has been associated with an increased incidence of cardiovascular disease and atherogenic changes in the vascular wall (4-6). The contention that the human cardiovascular system is a sensitive target for toxic chemicals gain support from our earlier and recent experimental studies in rodents, birds and fish, as well as in cultured human primary endothelial cells. It is also compatible with earlier observations that certain polycyclic aromatic hydrocarbons (PAHs) are environmental carcinogens that may also contribute to atherosclerosis in mice and birds (7,8).

    In this presentation we will briefly discuss effects of Ah receptor (AhR) agonists (e.g. the coplanar PCB126 or BNF, ß-naphthoflavone) on the expression of cytochrome P450 (CYP)1 enzymes in various endothelia in rodents in vivo or ex vivo, as well as in cultured human umbilical vein endothelial cells (HUVEC). The CYP1-dependent bioactivation and irreversible binding of prototype polyaromatic hydrocarbons (PAH) and heterocyclic amines such as benzo(a)pyrene (BaP), 7,12-dimethyl- benz(a)anthracene (DMBA) and 3-amino-1,4-dimethyl-5H-pyrido- [4,3-b]indole (Trp-P1) in these endothelia will be reviewed. We will also report how PCB126 affects vasoactive factors in HUVEC, and how these effects are modulated by physiological 17ß-oestradiol concentrations. Some effects of PCB126, 1-nitropyrene (1-NP) and bisphenol A (BPA) on biomarkers for endothelial dysfunction, cell stress and DNA damage in HUVEC will finally be presented.

    Material and methods

    Human umbilical vein endothelial cells (HUVEC) were purchased from Science Cell Research laboratories, Carlsbad, CA. C57Bl mice and Wistar or Sprague Dawley rats were purchased from various suppliers. All animal experiments were approved by the Local Ethical Committee for Research on Animals in Uppsala and the studies followed the guidelines laid down by the Swedish and European Union legislation on animal experimentation. Rodents, tissue-slices and cultured cells were treated with model chemicals as previously described. Tape section and light microscopy autoradiographic imaging using 3H-labelled BaP, DMBA and Trp-P-1 and immunohistochemistry was performed as previously described (9-19). Precision-cut tissue slices for in vitro autoradiography were prepared as described in (14) and the slices were incubated with various 3H-labelled chemicals. HUVEC were exposed to various compounds and the detection of biomarkers of endothelial dysfunction, DNA damage were performed as described (20-22). Finally, female Fischer rats were exposed to BPA (0.025, 0.25 and 2.5 mg/l) and fructose (50 g/l) in the drinking water from 5 to 15 weeks of age to mimic human exposure (unpublished data).

    Results and discussion

    Co-localization of CYP1A1 expression and BaP, DMBA and Trp-P-1 adduct formation in endothelial linings As demonstrated by immunohistochemistry, a high CYP1A immunoreactivity occurred in capillaries of the heart, skeletal muscle, uterus and in blood-brain interfaces such as the leptomeninges and plexus choroideus, whereas no expression was observed for instance in cerebral capillary endothelial cells of mice treated with AhR agonists (9-11). No, or very low constitutive immunoreactivities were observed in these endothelia in vehicle-treated animals. No basal or induced CYP1B1 expression was observed in endothelial cells, while a weak CYP1B1 immunostaining was detected in the muscle layer of small arteries. It should be noted that in subcellular preparations of whole organs, e.g. heart and brain, the CYP1A1 in endothelial cells is diluted due to cells that do not express high levels of CYP1A1, for examples myocytes or neurons, in excess. A cell-specific metabolism in endothelial cells may therefore remain undetected due to the presence of metabolically inactive cells. In order to detect minor sites of bioactivation such as endothelial linings we employed light microscopic autoradiographic imaging to examine the bioactivation and subsequent irreversible binding of the radiolabelled prototype toxicants in tissues of animals pretreated with AhR-agonists. As determined by light microscopic autoradiography of AhR-agonist-treated mice exposed to 3H-labelled BaP, DMBA or Trp-P-1 and birds exposed to 3H-Trp-P-1 a significant accumulation of non-extractable radioactivity occurred in endothelial linings (9-18). The bound radioactivity occurred in the nuclei and the perinuclear cytoplasm, suggesting that the autoradiograms depict both DNA- and protein-bound adducts. Since the binding sites of 3H-labelled BaP, DMBA or Trp-P-1 corresponded with the sites of CYP1A1 induction, we concluded that rodents express a constitutively low but highly inducible and functional CYP1A1 in endothelial cells. The binding of reactive metabolites in endothelial cells exceeded the binding in all other cell types in AhR-agonist treated mice and was abolished by pretreatment with the CYP1A1 inhibitor ellipticine, supporting a CYP1A1-catalysed metabolic activation in situ to a reactive species (9, 10,12). These findings imply that there is a preferential CYP1A1-catalysed formation of reactive metabolites from all three carcinogens in endothelial cells expressing high CYP1A1 levels. Interestingly, however, carcinogenesis in endothelial cells is a relative rare finding, suggesting that degenerative lesions and cell death may be more prevalent responses to metabolism-activated carcinogens/mutagens in these cells. Experiments with 3H-DMBA and 3H-Trp-P-1 in HUVEC confirmed that AhR-agonists induced an increased bioactivation, suggesting that also human endothelial cells should be targets for toxicity of reactive intermediates formed from CYP1A1- activated carcinogens/mutagens (17-18). This conclusion is supported by immunohistochemical studies on the heavily vascularized human endometrium demonstrating an expression of CYP1A1 and CYP1B1 protein in and around human endometrial blood vessels, although a large interindividual

    variation was observed (19). None of the endometrial biopsy samples displayed vascular expression of CYP2A6, CYP2B6, CYP2C8/2C9/2C19, CYP2D6, or CYP3A4/5 protein.

    Effects of PCB 126, 1-NP, and BPA on biomarkers of endothelial dysfunction and cell stress in endothelial cells In vitro studies demonstrated that PCB126 increased the levels of vasoconstriction factors and decreased the levels of vasodilating factors in cultured HUVEC in a fashion that is characteristic for endothelial dysfunction related to human hypertension. The study showed that the co-planar PCB126 induced expression of the endothelium-derived vasoconstriction factor COX-2 and stimulated formation of the vasoconstrictor prostaglandin PGF2 via the AhR in HUVEC (20). COX-2 is known to play a role in hypertension by catalysing the formation of vasoconstriction prostaglandins and by stimulating reactive oxygen species (ROS) production. Further studies demonstrated that PCB126 increased the production of the vasoconstriction prostaglandin PGF2 and ROS in HUVEC. The relationship between increased ROS production and human hypertension is well established, ROS promotes vasoconstriction by stimulating the production of vasoconstriction prostaglandins and by reducing bioavailability of the vasorelaxing factor NO. Indeed, exposure to PCB126 slightly reduced the production of NO in HUVEC. Furthermore, the PCB126-induced mRNA expressions of CYP1A1, CYP1B1 and COX-2 in HUVEC were enhanced in the presence of physiological levels of 17- estradiol. This suggests that increased levels of oestrogen stimulate AhR-dependent transcription of genes previously associated with endothelial dysfunction and hypertension.

    In another study we have examined the effects of a nitrated PAH, 1-nitropyrene, that is abundant in diesel exhausts (21). The results revealed that 1-NP induced DNA damage, increased levels of ROS and increased protein expression of the endoplasmic reticulum stress chaperone GRP78 in cultured HUVEC. Induction of CYP1A1 by PCB126 as well as inhibition of nitroreductive metabolism by dicoumarol attenuated the induction of DNA damage, intracellular ROS levels and GRP78 expression. This suggests that the effects of 1-NP on HUVEC were mediated by metabolites mainly formed at nitroreduction and not by CYP1-dependent bioactivation to reactive intermediates.

    Recent in vitro studies demonstrated that bisphenol A increased the mRNA expression of genes that regulate vasoconstriction and angiogenesis in HUVEC (eNOS, VEGF, VEGFR2, connexin 43 and ACE1) and in human cardiomyocytes (eNOS and ACE1) (22). The results also showed that BPA increased the expression of P-eNOS(ser1177) and the production of NO in HUVEC. NO is the main effector molecule in angiogenesis downstream of VEGF. Based on the findings that BPA increase the expression of proangiogenic factors we investigated whether BPA could stimulate in vitro angiogenesis in HUVEC using the endothelial tube formation assay. The results demonstrated that BPA increased HUVEC tube formation suggesting that BPA can act directly on the endothelium and stimulate angiogenesis. Long-term exposure in rats revealed that environmentally relevant levels of BPA, increased the cardiac mRNA expression of genes that regulate vasoconstriction and angiogenesis. Ten weeks exposure of rats from preadolescence to adulthood to BPA in the drinking water increased the

    expression of eNOS, VEGF, VEGFR2 and ACE1 in the heart. Taken together, the genes that were upregulated in rat cardiac tissues in vivo were also upregulated in human endothelial cells and cardiomyocytes in vitro. The heart is a heavily vascularized tissue that consists mainly of cardiac endothelial cells and cardiomyocytes and although cardiomyocytes dominate the volume of the myocardium the number of endothelial cells exceeds the number of cardiomyocytes by approximately three to one. Thus, the effects of BPA on eNOS VEGF, VEGFR2 and ACE1 mRNA expression in rat cardiac tissues are most likely to be related to an effect of BPA on endothelial cells but may also involve cardiomyocytes.

    We conclude that endothelial cells may be targets for bioactivation and toxicity of environmental pollutants. The immunohistochemical and autoradiographic data demonstrated a differential expression of CYP1 enzymes and metabolic activation of pollutants in various endothelial linings suggesting that some but not all endothelial linings may be targets for xenobiotics metabolised by AhR-regulated enzymes. Studies on the effects of PCB126, 1-nitropyrene and BPA in cultured human primary endothelial cells demonstrated up-regulation of various biomarkers for endothelial dysfunction and cell stress suggesting that the human endothelium may be a sensitive target for these pollutants. The bioactivation and effects of environmental pollutants in endothelial cells should be further studied in order to unravel the role of these chemicals in human cardiovascular disease.

  • 45.
    Brännlund, Annica
    et al.
    Umeå universitet, Sociologiska institutionen.
    Hammarström, Anne
    Umeå universitet, Allmänmedicin.
    Higher education and psychological distress: a 27-year prospective cohort study in Sweden2014Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, nr 2, s. 155-162Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: Research identifies a positive link between education and a reduction of psychological distress, but few studies have analysed the long-term impact of education on psychological distress. This study followed the same cohort for 27 years, investigating the association between education and adult psychological distress. Further, it discuss whether the link can be understood through the mediating mechanisms of social and labour-market resources, furthermore, if the mechanisms operate differently for men and women. Method: A 27-year prospective cohort study was performed at ages 16, 18, 21, 30 and 43. The cohort consisted of all students (n = 1083, of which 1001 are included in this study) in their final year of compulsory school in Sweden. Data were collected through comprehensive questionnaires (response rate 96.4%), and analysed with OLS regression, with psychological distress at age 21, 30 and 43 as dependent variable. Baseline psychological distress, measures of social and labour-market resources, and possible educational selection factors were used as independent variables. To compare the overall magnitude of educational differences, a kappa index was calculated. Results: A positive relation between higher education and less psychological distress was found. When becoming older this relation weakens and a link between social and labour-market resources and psychological distress is observed, indicating that education in a long-term perspective operates through the suggested mechanisms. Additionally, the mechanisms work somewhat differently for men than for women: labour-market resources were significant for men and social resources were important for women. Conclusions: Main findings: higher education is positively linked to less psychological distress, and the link can somewhat be understood through the mechanisms of social and labour-market resources.

  • 46.
    Cai, Gui-Hong
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Mälarstig, Björn
    Kumlin, Anders
    Johansson, Ingrid
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Fungal DNA and pet allergen levels in Swedish day care centers and associations with building characteristics2011Inngår i: Journal of Environmental Monitoring, ISSN 1464-0325, E-ISSN 1464-0333, Vol. 13, nr 7, s. 2018-2024Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Pet allergens and mold growth related to damp are common phenomena in day care centers in Sweden but exposure measurements of these factors are lacking. The aim of this study was to investigate the relationship between building construction and indoor environment quality in Swedish day care centers and the potential for exposure to fungi (analyzed by quantitative PCR) and animal allergens (analyzed by ELISA). Measurements were performed in 21 day care centers (103 rooms) from one municipality in Sweden, which were identified as constructions at risk of dampness (85% of the buildings) and with visible damage and mold growth (54% of the buildings). Dust samples were collected using cotton swab and Petri dishes. Total fungal DNA was detected in 99% and 100%, Aspergillus/Penicillium DNA in 54% and 68%, and Stachybotrys chartarum DNA in 4% and 9% of the investigated rooms in cotton swab and Petri dish samples, respectively. The total fungal DNA levels (Geometric Mean, GM) were 4.2 × 106 cell equivalents per m2 and 2.9 × 105 cell equivalents per m2 per day in the swab and Petri dish samples, respectively. The concentrations (GM) of cat (Fel d1), dog (Can f1), and horse (Equ cx) allergens were 9.4, 7.2 ng m−2 day−1, and 5.0 unit per m2 per day, respectively. Total fungal DNA levels were higher in risk construction buildings (p = 0.01), in rooms with linoleum flooring material (p = 0.003), and in buildings with rotating heat exchangers (p = 0.02). There were associations between total fungal DNA levels and cat (p = 0.02), dog (p < 0.001), and horse (p = 0.001) allergens. In conclusion, risk constructions, damp constructions, mould growth, fungal DNA, and animal allergens were common exposure factors in Swedish day care centers. Building constructions that represent a high risk for internal dampness should be avoided in the future, and measures to reduce allergen levels should be considered to protect pet-allergic children from asthmatic problems.

  • 47.
    Campbell, William
    et al.
    Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA 30322 USA..
    Ganna, Andrea
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi. Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Swedden..
    Ingelsson, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi.
    Janssens, A. Cecile J. W.
    Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA 30322 USA.;Vrije Univ Amsterdam Med Ctr, EMGO Inst Hlth & Care Res, Sect Community Genet, Dept Clin Genet, NL-1007 MB Amsterdam, Netherlands..
    Prediction impact curve is a new measure integrating intervention effects in the evaluation of risk models2016Inngår i: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 69, s. 89-95Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: We propose a new measure of assessing the performance of risk models, the area under the prediction impact curve (auPIC), which quantifies the performance of risk models in terms of their average health impact in the population. Study Design and Setting: Using simulated data, we explain how the prediction impact curve (PIC) estimates the percentage of events prevented when a risk model is used to assign high-risk individuals to an intervention. We apply the PIC to the Atherosclerosis Risk in Communities (ARIC) Study to illustrate its application toward prevention of coronary heart disease. Results: We estimated that if the ARIC cohort received statins at baseline, 5% of events would be prevented when the risk model was evaluated at a cutoff threshold of 20% predicted risk compared to 1% when individuals were assigned to the intervention without the use of a model. By calculating the auPIC, we estimated that an average of 15% of events would be prevented when considering performance across the entire interval. Conclusion: We conclude that the PIC is a clinically meaningful measure for quantifying the expected health impact of risk models that supplements existing measures of model performance.

  • 48. Catalano, Ralph
    et al.
    Karasek, Deborah
    Gemmill, Alison
    Falconi, April
    Goodman, Julia
    Magganas, Aristotle
    Hartig, Terry
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutet för bostads- och urbanforskning (IBF).
    Very low birthweight: Dysregulated gestation versus evolutionary adaptation2014Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 108, s. 237-242Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Much medical literature attributes persistently high rates of very low birthweight (VLBW) to "dysregulated" gestation. We offer the alternative view that natural selection conserved well-regulated, though nonconscious, decisional biology that protects the reproductive fitness of women by spontaneously aborting gestations that would otherwise yield frail infants, particularly small males. Modern obstetric practice, however, converts some fraction of these erstwhile spontaneous abortions into live births of very small infants. We further propose that the nonconscious decisional biology of gestation exhibits preferences also seen in consciously made decisions. We hypothesize that the incidence of VLBW among male infants should vary with the population's self-reported intentions to assume financial risk. We apply time-series modeling to monthly birth counts by sex and weight from the Swedish Medical Birth Registry between January 1993 and December 2010. We gauge risk aversion with monthly data from the Micro Index of the Swedish Consumer Tendency Survey (MISCT). Consistent with our argument that nonconscious decisional biology shares risk aversion with conscious decisions, we find that the incidence of VLBW among male infants in Sweden varies with the population's self-reported intentions to assume financial risk. We find increases above expected odds of a very low weight infant among males born 1 month after increases above expected levels of self-reported risk aversion in the Swedish population. We offer this finding as support for the argument that persistently high rates of VLBW arise, at least in part, from a combination of medical interventions and mechanisms conserved by natural selection to protect reproductive fitness. (C) 2014 Elsevier Ltd. All rights reserved.

  • 49. Cedervall, Therese
    et al.
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Savendahl, Lars
    Expression of the Aryl Hydrocarbon Receptor in Growth Plate Cartilage and the Impact of Its Local Modulation on Longitudinal Bone Growth2015Inngår i: International Journal of Molecular Sciences, ISSN 1422-0067, E-ISSN 1422-0067, Vol. 16, nr 4, s. 8059-8069Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Although dioxin has been reported to impair bone growth in both humans and animals, the underlying mechanisms have not been clarified. We conducted this study to rule out if dioxin may directly target the growth plate, via local modulation of the aryl hydrocarbon receptor (AhR). Initial studies in rare tissue samples of the human growth plate confirmed that the AhR protein is widely expressed in growth plate cartilage. To explore the local role of the AhR, mechanistic studies were performed in a well-established model of cultured fetal rat metatarsal bones. The longitudinal growth of these bones was monitored while being exposed to AhR modulators. The AhR agonist, 2,3,7,8-tetrachlorodibenzo-p-dioxin, did not affect bone growth at any concentrations tested (1 pM-10 nM). In contrast, the AhR antagonist, alpha-naphthoflavone, suppressed bone growth and increased chondrocyte apoptosis, although only at a high, potentially cytotoxic concentration (50 mu M). We conclude that although the AhR is widely expressed in the growth plate, bone growth is not modulated when locally activated, and therefore, dioxin-induced growth failure is likely mediated through systemic rather than local actions.

  • 50. Chen, Chih-Mei
    et al.
    Thiering, Elisabeth
    Zock, Jan-Paul
    Villani, Simona
    Olivieri, Mario
    Modig, Lars
    Jarvis, Deborah
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Verlato, Giuseppe
    Heinrich, Joachim
    Is There a Threshold Concentration of Cat Allergen Exposure on Respiratory Symptoms in Adults?2015Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 6, artikkel-id e0127457Artikkel i tidsskrift (Fagfellevurdert)
    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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