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  • 1. Bentayeb, M
    et al.
    Simoni, M
    Baiz, N
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Baldacci, S
    Maio, S
    Viegi, G
    Annesi-Maesano, I
    Adverse respiratory effects of outdoor air pollution in the elderly2012In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 16, no 9, 1149-1161 p.Article in journal (Refereed)
    Abstract [en]

    Compared to the rest of the population, the elderly are potentially highly susceptible to the effects of outdoor air pollution due to normal and pathological ageing. The purpose of the present review was to gather data on the effects on respiratory health of outdoor air pollution in the elderly, on whom data are scarce. These show statistically significant short-term and chronic adverse effects of various outdoor air pollutants on cardiopulmonary morbidity and mortality in the elderly. When exposed to air pollution, the elderly experience more hospital admissions for asthma and chronic obstructive pulmonary disease (COPD) and higher COPD mortality than others. Previous studies also indicate that research on the health effects of air pollution in the elderly has been affected by methodological problems in terms of exposure and health effect assessments. Few pollutants have been considered, and exposure assessment has been based mostly on background air pollution and more rarely on objective measurements and modelling. Significant progress needs to be made through the development of 'hybrid' models utilising the strengths of information on exposure in various environments to several air pollutants, coupled with daily activity exposure patterns. Investigations of chronic effects of air pollution and of multi-pollutant mixtures are needed to better understand the role of air pollution in the elderly. Lastly, smoking, occupation, comorbidities, treatment and the neighbourhood context should be considered as confounders or modifiers of such a role. In this context, the underlying biological, physiological and toxicological mechanisms need to be explored to better understand the phenomenon through a multidisciplinary approach.

  • 2. Fan, X-J
    et al.
    Yang, C
    Zhang, L
    Fan, Q
    Li, T
    Bai, X
    Zhao, Z-H
    Zhang, X
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Asthma symptoms among Chinese children: the role of ventilation and PM10 exposure at school and home.2017In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 21, no 11, 1187-1193 p.Article in journal (Refereed)
    Abstract [en]

    SETTING: Respiratory symptoms in relation to environment in Taiyuan, China.

    OBJECTIVE: To study associations between school/home exposure and prevalence of respiratory symptoms and self-reported respiratory infections (RIs) among students.

    DESIGN: A total of 2134 pupils from 10 schools answered a questionnaire; air pollution at school was measured.

    RESULTS: The prevalence of current wheeze, daytime attacks of breathlessness, nocturnal cough, nocturnal respiratory symptoms and RI was respectively 4.4%, 18.7%, 11.6%, 3.6% and 32.3%. Environmental tobacco smoke (ETS) at home was associated with daytime attacks of breathlessness (OR 1.41), nocturnal cough (OR 1.41) and RI (OR 1.26). Redecoration or indoor painting at home was associated with wheeze (OR 2.02), daytime attacks of breathlessness (OR 1.57) and nocturnal symptoms (OR 1.83). Dampness or mould at home was associated with daytime attacks of breathlessness (OR 1.68), nocturnal cough (OR 1.68) and RI (OR 1.69). Particulate matter of diameter  10 microns (PM10) in the classroom was associated with nocturnal cough (OR 1.20/10 μg/m3). PM10 outside school was associated with daytime attacks of breathlessness (OR 1.07/10 μg/m3) and nocturnal cough (OR 1.13/10 μg/m3). Indoor carbon dioxide, a marker of poor ventilation (OR 1.52/1000 parts per million), and relative humidity (RH) (OR 1.33/10%) were associated with nocturnal cough.

    CONCLUSION: Dampness, redecoration and ETS at home, as well as poor ventilation flow, and high RH and PM10 concentration at school may influence respiratory health.

  • 3. Gnatiuc, L.
    et al.
    Buist, A. S.
    Kato, B.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Ait-Khaled, N.
    Nielsen, R.
    Koul, P. A.
    Nizankowska-Mogilnicka, E.
    Obaseki, D.
    Idolor, L. F.
    Harrabi, I.
    Burney, P. G. J.
    Gaps in using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high-and low-income sites2015In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 19, no 1, 21-30 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Increasing access to essential respiratory medicines and influenza vaccination has been a priority for over three decades. Their use remains low in low-and middle-income countries (LMICs), where little is known about factors influencing use, or about the use of influenza vaccination for preventing respiratory exacerbations. METHODS: We estimated rates of regular use of bronchodilators, inhaled corticosteroids and influenza vaccine, and predictors for use among 19000 adults in 23 high-income countries (HICs) and LMIC sites. RESULTS: Bronchodilators, inhaled corticosteroids and influenza vaccine were used significantly more in HICs than in LMICs, after adjusting for similar clinical needs. Although they are used more commonly by people with symptomatic or severe respiratory disease, the gap between HICs and LMICs is not explained by the prevalence of chronic obstructive pulmonary disease or doctor-diagnosed asthma. Site-specific factors are likely to influence use differently. The gross national income per capita for the country is a strong predictor for use of these treatments, suggesting that economics influence under-treatment. CONCLUSION: We still need a better understanding of determinants for the low use of essential respiratory medicines and influenza vaccine in low-income settings. Identifying and addressing these more systematically could improve the access and use of effective treatments.

  • 4. Holm, M
    et al.
    Kim, J-L
    Lillienberg, L
    Storaas, T
    Jögi, Rain
    Svanes, C
    Schlünssen, V
    Forsberg, B
    Gíslason, T
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Torén, K
    Incidence and prevalence of chronic bronchitis: impact of smoking and welding. The RHINE study2012In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 16, no 4, 553-557 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the prevalence and incidence rate of chronic bronchitis (CB) in relation to smoking habits and exposure to welding fumes in a general population sample.

    METHODS: Subjects from Northern Europe born between 1945 and 1971 who participated in Stage 1 (1989-1994) of the European Community Respiratory Health Survey were mailed a respiratory questionnaire in 1999-2001 (the RHINE study); 15 909 answered the questionnaire and gave complete data on smoking. CB was defined as chronic productive cough of at least 3 months a year for 2 consecutive years. The questionnaire comprised an item about age when CB started and items about exposure to welding fumes. The incidence of CB was retrospectively assessed for the observation period 1980-2001.

    RESULTS: CB had a prevalence of 5.4%, and was associated with current smoking and welding exposure. The incidence rate of CB was 1.9 per 1000 person-years, and was increased in relation to welding exposure (low exposure HR 1.4, 95%CI 1.1-1.8; high exposure HR 2.0, 95%CI 1.6-2.7) and in relation to smoking (HR 2.1, 95%CI 1.8-2.5).

    CONCLUSION: Smoking and occupational exposure to welding fumes are both associated with an increased risk of CB.

  • 5. Schön, T.
    et al.
    Juréen, P.
    Chryssanthou, E.
    Giske, C. G.
    Sturegård, E.
    Kahlmeter, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
    Hoffner, S.
    Ängeby, K. A.
    Wild-type distributions of seven oral second-line drugs against Mycobacterium tuberculosis2011In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 15, no 4, 502-509 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To determine wild-type minimum inhibitory concentration (MIC) distributions for Mycobacterium tuberculosis, as the background data for defining susceptibility breakpoints are limited. METHODS: We determined wild-type MIC distributions of M. tuberculosis using a 96-stick replicator in Middlebrook 7H10 (7H10) medium for ethionamide (ETH), prothionamide, thiacetazone, cycloserine, rifabutin (RFB), clofazimine and linezolid in consecutive susceptible clinical isolates (n = 78). RESULTS: Tentative epidemiological wild-type cut-offs (ECOFF) were determined for all investigated drugs where World Health Organization recommended critical concentrations for 7H10 are lacking, except for ETH. As the ECOFF was closely related to the non-wild-type strains for ETH and thiacetazone, the use of an intermediary (1) category in drug susceptibility testing could increase reproducibility. The cross-resistance between ETH and isoniazid was 21%. Applying 0.5 mg/l as a breakpoint for RFB classified two non-wild type and rpoB mutated isolates as susceptible for RFB and resistant against rifampicin. CONCLUSIONS: We propose that wild-type MIC distributions should be used as a tool to define clinical breakpoints against second-line drugs. This is increasingly important considering the rapid emergence of drug resistance.

  • 6.
    Wang, Juan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Engvall, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Smedje, Greta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Exacerbation of asthma among adults in relation to the home environment in multi-family buildings in Sweden2017In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 21, no 2, 223-229 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the association between the home environment and asthma medication and exacerbation of asthma among adults with physician-diagnosed asthma. METHODS: Adults aged >= 18 years in a stratified sample of multi-family buildings throughout Sweden were invited to respond to a postal questionnaire (the BETSI Study). A total of 639 adults (11.5%) with physician-diagnosed asthma were included. RESULTS: Of the 639 adults, 62.0% were females, 10.8% were current smokers, 62.6% had pollen or furry pet allergy, 61.7% were on current asthma medication and 48.6% had experienced an asthma exacerbation in the past year. Logistic regression models were applied to study the association between the home environment and asthma medication and asthma exacerbation, adjusting for sex, age and smoking status. Asthma medication was more commonly prescribed for those who kept dogs as pets (OR 2.66, 95 % CI 1.05-6.75) and in homes with mouldy odour (OR 5.72, 95%CI 1.29-25.4). Asthma exacerbation was more frequent among those living in buildings constructed in 1961-1975 (OR 2.56, 95%CI 1.22-5.34), in areas with a high population density (OR 4.69, 95%CI 1.42-15.5), in rented apartments (OR 1.77, 95 %CI 1.12-2.78) and in homes with a greater degree of window opening (OR 1.47, 95 % CI 1.12-1.94). CONCLUSIONS: Factors in the home environment were associated with exacerbation of asthma in adults. Certain construction periods (1961-1975), rented apartments, mould, having dogs as pets and living in urban areas were associated with asthma exacerbations.

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