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  • 1. 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 University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Omenaas, E.
    Real, F.
    Schlunssen, V
    Sigsgaard, T.
    Skorge, T.
    Timm, S.
    Wieslander, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Dharmage, S.
    Early life parental exposure to cats and dogs reduces the risk of allergic disease in their children: possible intergenerational effect2014In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 69, p. 577-578Article in journal (Other academic)
  • 2.
    Ahlroth Pind, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Gunnbjörnsdottír, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. 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 University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Middelveld, R
    Karolinska Inst, Stockholm, Sweden.
    Nilsson Sommar, J
    Umeå Univ, Umeå, Sweden.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Patient-reported signs of dampness at home may be a risk factor for chronic rhinosinusitis: A cross-sectional study2017In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 47, no 11, p. 1383-1389Article in journal (Refereed)
    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.

  • 3.
    Ahlroth Pind, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Sundh, Josefin
    Kisiel, Marta A
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Sandelowsky, Hanna
    Nager, Anna
    Hasselgren, Mikael
    Montgomery, Scott
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Pharmacological treatment of asthma in Sweden from 2005 to 2015.2023In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, p. 1-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Despite access to effective therapies many asthma patients still do not have well-controlled disease. This is possibly related to underuse of inhaled corticosteroids (ICS) and overuse of short-acting β2-agonists (SABA). Our aim was to investigate longitudinal trends and associated factors in asthma treatment.

    METHODS: Two separate cohorts of adults with physician-diagnosed asthma were randomly selected from 14 hospitals and 56 primary health centers in Sweden in 2005 (n = 1182) and 2015 (n = 1225). Information about symptoms, maintenance treatment, and use of rescue medication was collected by questionnaires. Associations between treatment and sex, age, smoking, education, body mass index (BMI), physical activity, allergic asthma, and symptom control were analyzed using Pearson's chi2-test. Odds ratios (ORs) were calculated using logistic regression.

    RESULTS: Maintenance treatment with ICS together with long-acting β2-agonists (LABA) and/or montelukast increased from 39.2% to 44.2% (p = 0.012). The use of ICS + LABA as-needed increased (11.1-18.9%, p < 0.001), while SABA use decreased (46.4- 41.8%, p = 0.023). Regular treatment with ICS did not change notably (54.2-57.2%, p = 0.14). Older age, former smoking, and poor symptom control were related to treatment with ICS + LABA/montelukast. In 2015, 22.7% reported daily use of SABA. A higher step of maintenance treatment, older age, obesity, shorter education, current smoking, allergic asthma, low or very high physical activity, and a history of exacerbations were associated with daily SABA use.

    CONCLUSIONS: The use of ICS + LABA both for maintenance treatment and symptom relief has increased over time. Despite this, the problem of low use of ICS and high use of SABA remains.

  • 4. Aili, K
    et al.
    Nyman, T
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Hillert, L
    Sleep as a predictive factor for the onset and resolution of multi-site pain: A 5-year prospective study2015In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 19, no 3, p. 341-349Article in journal (Refereed)
    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.

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  • 5.
    Aili, Katarina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Department of Health and Sport, School of Health and Welfare, Halmstad University.
    Hellman, Therese
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Danielsson, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Psychiatry.
    Including a Three-Party Meeting Using the Demand and Ability Protocol in an Interdisciplinary Pain Rehabilitation Programme for a Successful Return to Work Process2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 24, article id 16614Article in journal (Refereed)
    Abstract [en]

    The Demand and Ability Protocol (DAP) is used in three-party meetings involving an employee, an employer, and a representative from the rehabilitation team. The aim of this study is to investigate the inclusion of an intervention using the DAP in an interdisciplinary pain rehabilitation programme (IPRP) compared to usual care. This non-randomised controlled trial included patients assigned to an IPRP in Sweden. The intervention group received a DAP intervention targeting their work situation in addition to the usual care provided by the IPRP. The control group received IPRP only. Outcome measures were collected from the Swedish Quality Registry for Pain Rehabilitation. Results demonstrated improvements in both groups regarding self-reported anxiety, depression and EQ5D. Sleep was improved in the intervention group but not in the control group. No statistical differences in outcomes were observed between the groups. In conclusion, adding the DAP intervention to IPRP seemed to have the potential to improve sleep among the patients, which may indicate an overall improvement regarding health outcomes from a longer perspective. The results were less clear, however, regarding the work-related outcomes of sickness absence and workability.

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  • 6. Aili, Katarina
    et al.
    Nyman, Teresia
    Hillert, Lena
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Sleep disturbances predict future sickness absence among individuals with lower back or neck-shoulder pain: A 5-year prospective study2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 3, p. 315-323Article in journal (Refereed)
    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.

  • 7.
    Aili, Katarina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Department of Health and Sport, School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Danielsson, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Psychiatry.
    Johansson, Elin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Central Hospital in Karlstad, Karlstad, Sweden.
    Hellman, Therese
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Active engagement of managers in employee RTW and manager-employee relationship: managers’ experiences of participating in a dialogue using the Demand and Ability Protocol2023In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 45, no 26, p. 4394-4403Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe how managers of employees on sick-leave, due to chronic pain conditions, experience participating in a three-party meeting using the Demand and Ability Protocol (DAP) in the return-to-work process.

    Materials and methods: This study is based on individual semi-structured interviews with 17 managers of employees with chronic pain. Interviews were conducted after participating in a three-party meeting including the employee, manager, and a representative from the rehabilitation team. The data were analyzed using thematic analysis with an inductive approach.

    Results: Two main themes were identified - "to converse with a clear structure and setup" and "to be involved in the employee's rehabilitation." The first theme describe experiences from the conversation, and the second theme reflected the managers' insights when being involved in the employee's rehabilitation. The themes comprise 11 sub-themes describing how the DAP conversation and the manager ' s involvement in the rehabilitation may influence the manager, the manager-employee relationship, and the organization.

    Conclusions: This study show, from a manager's perspective, how having a dialogue with a clear structure and an active involvement in the employee's rehabilitation may be beneficial for the manager-employee relationship. Insights from participating in the DAP may also be beneficial for the organization.

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  • 8.
    Aili, Katarina
    et al.
    Karolinska Inst, Inst Environm Med, Unit Occupat Med, Stockholm, Sweden..
    Åström-Paulsson, Sofia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Stoetzer, Ulrich
    Karolinska Inst, Inst Environm Med, Unit Intervent & Implementat Res, Stockholm, Sweden..
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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 Assessments2017In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 13, no 1, p. 39-47Article in journal (Refereed)
    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.

  • 9. Akerstedt, T.
    et al.
    Alfredsson, L.
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Fischer, H.
    Nilsson, L. -G
    Nordin, M.
    Fatigue/sleepiness and important aspects of sleep restoration improve across aging2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, p. 241-241Article in journal (Other academic)
  • 10.
    Alavian-Ghavanini, Ali
    et al.
    Karolinska Inst, Unit Toxicol Sci, Swetox, Forskargatan 20, S-15136 Sodertalje, Sweden;Karolinska Inst, Dept Clin Neurosci, CMM, S-17164 Solna, Sweden.
    Lin, Ping-I
    Karlstad Univ, Dept Hlth Sci, S-65188 Karlstad, Sweden.
    Lind, P. Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Rimfors, Sabina Risen
    Karolinska Inst, Unit Toxicol Sci, Swetox, Forskargatan 20, S-15136 Sodertalje, Sweden.
    Lejonklou, Margareta Halin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Dunder, Linda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Tang, Mandy
    Karolinska Inst, Unit Toxicol Sci, Swetox, Forskargatan 20, S-15136 Sodertalje, Sweden.
    Lindh, Christian
    Lund Univ, Div Occupat & Environm Med, S-22185 Lund, Sweden.
    Bornehag, Carl-Gustaf
    Icahn Sch Med Mt Sinai, New York, NY 10029 USA;Karlstad Univ, Dept Hlth Sci, S-65188 Karlstad, Sweden.
    Rueegg, Joelle
    Karolinska Inst, Unit Toxicol Sci, Swetox, Forskargatan 20, S-15136 Sodertalje, Sweden;Karolinska Inst, Dept Clin Neurosci, CMM, S-17164 Solna, Sweden.
    Prenatal Bisphenol A Exposure is Linked to Epigenetic Changes in Glutamate Receptor Subunit Gene Grin2b in Female Rats and Humans2018In: Scientific Reports, E-ISSN 2045-2322, Vol. 8, article id 11315Article in journal (Refereed)
    Abstract [en]

    Bisphenol A (BPA) exposure has been linked to neurodevelopmental disorders and to effects on epigenetic regulation, such as DNA methylation, at genes involved in brain function. High doses of BPA have been shown to change expression and regulation of one such gene, Grin2b, in mice. Yet, if such changes occur at relevant doses in animals and humans has not been addressed. We investigated if low-dose developmental BPA exposure affects DNA methylation and expression of Grin2b in brains of adult rats. Furthermore, we assessed associations between prenatal BPA exposure and Grin2b methylation in 7-year old children. We found that Grin2b mRNA expression was increased and DNA methylation decreased in female, but not in male rats. In humans, prenatal BPA exposure was associated with increased methylation levels in girls. Additionally, Iow APGAR scores, a predictor for increased risk for neurodevelopmental diseases, were associated with higher Grin2b methylation levels in girls. Thus, we could link developmental BPA exposure and Iow APGAR scores to changes in the epigenetic regulation of Grin2b, a gene important for neuronal function, in a sexual dimorphic fashion. Discrepancies in exact locations and directions of the DNA methylation change might reflect differences between species, analysed tissues, exposure level and/or timing.

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  • 11.
    Alinaghizadeh, Hassan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Radioactive fall-out from the Chernobyl nuclear power plant accident in 1986 and cancer rates in Sweden, a 25-year follow up2019Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The current research aimed to study the association between exposure to low-dose radiation fallout after the Chernobyl accident in 1986 and the incidence of cancer in Sweden.

    Methods: A nationwide study population, selecting information from nine counties out of 21 in Sweden for the period from 1980 – 2010.

    In the first study, an ecological design was defined for two closed cohorts from 1980 and 1986. A possible exposure response pattern between the exposure to 137Cs on the ground and the cancer incidence after the Chernobyl nuclear power plant accident was investigated in the nine northernmost counties of Sweden (n=2.2 million). The activity of 137Cs at the county, municipality and parish level in 1986 was retrieved from the Swedish Radiation Safety Authority (SSI) and used as a proxy for received dose of ionizing radiation. Information about diagnoses of cancer (ICD-7 code 140-209) from 1958 – 2009 were received from the Swedish Cancer Registry, National Board of Health and Welfare (368,244 cases were reported for the period 1958 to 2009). The incidence rate ratios were calculated by using Poisson Regression for pre-Chernobyl (1980 – 1986) and post-Chernobyl (1986 – 2009) using average deposition of 137Cs at three geographical levels: county (n=9), municipality (n=95), and parish level (n=612). Also, a time trend analysis with age standardized cancer incidence in the study population and in the general Swedish population was drawn from 1980 – 2009.

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

    Results: No obvious exposure-response pattern in the age-standardized total cancer incidence rate ratios could be seen in the first study. However, a spurious association between the fallout and cancer incidence was present, where areas with the lowest incidence of cancer before the accident coincidentally had the lowest fallout of cesium-137. Increasing the geographical resolution of exposure from the average values of nine counties to the average values of 612 parishes resulted in two to three times higher degree of variance explanation by regression model. There was a secular trend, with an increase in age standardized incidence of cancer from 1980 – 2009. This trend was stronger in the general Swedish population compared to the nine counties of the present study.

    In the second study, 734,537 people identified were divided into three exposure categories: the first quartile was low exposure (0.0 to 45.4 kBq/m2), the second and third quartiles were intermediate exposure (45.41 to 118.8 kBq/m2), and the fourth quartile was highest exposure (118.81 to 564.71 kBq/m2). Between 1991 and 2010, 82,495 cancer cases were registered in the three 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, when comparing to the reference exposure.

    Conclusion: Using the ecological data, there was no exposure response trend; however, after refining the data to the individual level of exposure, there was an overall exposure response pattern. Nonetheless, due to the time dependency, these results were restricted to the age group of 25 – 49 among males. Using register-based data only, for determining the association between low-dose exposure to radiation and the risk of developing cancer, is difficult since we cannot control for other significant factors that are associated with cancer.

    List of papers
    1. Cancer incidence in northern Sweden before and after the Chernobyl nuclear power plant accident
    Open this publication in new window or tab >>Cancer incidence in northern Sweden before and after the Chernobyl nuclear power plant accident
    2014 (English)In: Radiation and Environmental Biophysics, ISSN 0301-634X, E-ISSN 1432-2099, Vol. 53, no 3, p. 495-504Article in journal (Refereed) Published
    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.

    Keywords
    Cancer, Cesium-137, Chernobyl, Ecological study, Environment, Epidemiology, Ionizing radiation, Nuclear accident, Radiation, Sweden
    National Category
    Occupational Health and Environmental Health
    Identifiers
    urn:nbn:se:uu:diva-231289 (URN)10.1007/s00411-014-0545-6 (DOI)000339898300003 ()24811728 (PubMedID)
    Available from: 2014-09-08 Created: 2014-09-07 Last updated: 2019-03-28Bibliographically approved
    2. 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 study
    Open this publication in new window or tab >>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 study
    2016 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 6, no 12, article id e011924Article in journal (Refereed) Published
    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.

    National Category
    Occupational Health and Environmental Health
    Identifiers
    urn:nbn:se:uu:diva-311895 (URN)10.1136/bmjopen-2016-011924 (DOI)000391303600003 ()27998898 (PubMedID)
    Available from: 2017-01-03 Created: 2017-01-03 Last updated: 2023-08-28Bibliographically approved
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  • 12.
    Alinaghizadeh, Hassan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Tondel, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Wålinder, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Cancer incidence in northern Sweden before and after the Chernobyl nuclear power plant accident2014In: Radiation and Environmental Biophysics, ISSN 0301-634X, E-ISSN 1432-2099, Vol. 53, no 3, p. 495-504Article in journal (Refereed)
    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.

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  • 13.
    Alinaghizadeh, Hassan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Wålinder, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Vingård, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Tondel, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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 study2016In: BMJ Open, E-ISSN 2044-6055, Vol. 6, no 12, article id e011924Article in journal (Refereed)
    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.

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  • 14.
    Alipour, Akbar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Bodin, Lennart
    Bergstrom, Gunnar
    Jensen, Irene
    The transitional pattern of pain and disability, from perceived pain to sick leave: Experience from a longitudinal study2013In: Journal of Back and Musculoskeletal Rehabilitation, ISSN 1053-8127, E-ISSN 1878-6324, Vol. 26, no 4, p. 411-419Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the prospective value of the transitional and dynamic patterns of pain disability over time on sick leave in chronic recurrent back/neck pain cases. METHODS: The material used was based on a longitudinal study with three repeated measurements. The graded Chronic Pain Scale was used to assess levels of pain disability. The relationship between the transitional patterns of the pain disability score ( ten defined states of decrease, increase or no change, between two time points) and sick leave was analyzed for 909 chronic/recurrent cases in three different models using logistic regression. RESULTS: Those with high level of pain disability have a more transitional pattern and their pain level changed during the time period studied. When adjusting for age, gender, education and previous sick leave, the final model indicated that the current level of pain disability was a risk factor in taking sick leave. The likelihood of sick leave was highest in the transition of pain into the highest levels of disability, independent of past disability level of pain. Earlier sick leave remained as an important predictor of sick leave. CONCLUSIONS: From a clinical and prognostic perspective the probability of sick leave will be different and can be predicted based on previous sick leave but not from former history of pain disability level or its transitional pattern.

  • 15.
    Alipour, Akbar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Ghaffari, Mostafa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Shariati, Batoul
    Jensen, Irene
    Vingård, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Four-year incidence of sick leave because of neck and shoulder pain and its association with work and lifestyle2009In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 34, no 4, p. 413-418Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Four-year prospective cohort study. OBJECTIVE: To find the incidence of sick leave because of neck and shoulder pain (NSP) in industrial workers, and its association with work and lifestyle risk factors. SUMMARY OF BACKGROUND DATA: Longitudinal studies to investigate NSP incidence and risk factors are rare, and even fewer have been conducted in middle- and low-income countries. METHODS: After inviting all full-time employees of an Iranian car manufacturing company with 18,031 employees to participate in a baseline study, they were followed for 4 years. New episodes of sick leave because of NSP have been calculated based on sickness absence registration between the years 2003 and 2007. The incidence was compared for participants and nonparticipants. The association between sick leave, physical, and psychosocial risk factors at work, and previous self-reported NSP, was calculated for the remaining population of baseline participants (12,184 employees) during a 4-year follow-up. RESULTS: During a 4-year follow-up of study subjects for the remaining participants of the baseline study, the incidence of sick leave was 0.8% (98 sick leave cases in 12,184 employees). For nonparticipants this incidence was 4.2% (130 cases in 3127 employees). In the final regression model for sick leave cases, the remaining factors for potential physical risk factors were repetitive work and sitting positions at work; for psychosocial factors unattractive work was the only significant remaining factor. CONCLUSION: The incidence of NSP based on sick leave is definitely very low compared with previous studies in high-income countries. This incidence varies between participants and nonparticipants. Risk factors for sick leave differ from risk factors for self-reported pain. A young population, job security, the insurance system, different health behaviors, and healthy worker bias, are all factors that may affect the results, and sick-leave as an outcome must be interpreted with more caution in middle- and low-income countries.

  • 16.
    Alipour, Akbar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Ghaffari, Mostafa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Shariati, Batoul
    Jensen, Irene
    Vingård, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Occupational neck and shoulder pain among automobile manufacturing workers in Iran2008In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 51, no 5, p. 372-379Article in journal (Refereed)
    Abstract [en]

    Background Work-related musculoskeletal disorders (MSDs) of the upper extremities are a major problem globally, though most relevant studies have been reported from high income countries. Aims and Methods The prevalence of neck and shoulder pain and its association with work-related physical and psychosocial factors and life style was determined by a cross-sectional survey using the Nordic Musculoskeletal Questionnaire (NMQ) in the largest Iranian car manufacturing company, with more than 18,000 employees. Results A total of 14,384 (79.8%) of all employees completed the questionnaire. Depending on the questions used to measure neck and shoulder symptoms, the prevalence varied widely (from 20.5% to 3.9%). In the multiple logistic regression model, limited to employees with at least I year of work experience, risk indicators for disabling pain of the neck and/or shoulder that remained for male were: duration of employment, high visual demands, repetitive work, sitting position at work, awkward working position, no regular exercise, monotonous work, lack of encouraging organizational culture, and anxiety concerning change. For female repetitive work, sitting position at work and no support if there is trouble at work were the only remaining factors. Conclusions The study confirms the effects of physical and psychosocial factors on neck and shoulder symptoms among automobile manufacturing workers in a low to middle income country in spite of the relative youth and job insecurity of the population.

  • 17. Alvarez-Lloret, Pedro
    et al.
    Lind, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Nyberg, Ingrid
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Physiology and Developmental Biology, Environmental Toxicology.
    Örberg, Jan
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Physiology and Developmental Biology, Environmental Toxicology.
    Rodríguez-Navarro, Alejandro B
    Effects of 3,3',4,4',5-pentachlorobiphenyl (PCB126) on vertebral bone mineralization and on thyroxin and vitamin D levels in Sprague-Dawley rats2009In: Toxicology Letters, ISSN 0378-4274, E-ISSN 1879-3169, Vol. 187, no 2, p. 63-68Article in journal (Refereed)
    Abstract [en]

    The aim of the present study is to use Fourier transform infrared spectrometry (FTIR), and transmission electron microscopy (TEM) techniques, to make a more detailed description of toxic effects of 3,3',4,4',5-pentachlorobiphenyl (PCB126) on bone tissue at the microstructural and at the molecular level as a result of an altered bone metabolism. We have analysed potential changes on vitamin D and thyroxin serum levels since these hormones represent endocrine endpoints that are critical for bone growth and development. For this purpose Sprague-Dawley rats were exposed (n=10) to PCB126 (i.p.) for 3 months (total dose, 384microg/kg bodyweight), while control rats (n=10) were injected with corn oil (vehicle). Results from FTIR showed that vertebrae from the exposed rats had an overall lower degree of mineralization (-8.5%; p<0.05) compared with the controls. In addition, results from peripheral quantitative computed tomography (pQCT) analyses showed significant increases in the trabecular bone mineral density (+12%; p<0.05) in the exposed group compared with the controls. The TEM analyses also showed an alteration in the crystallinity properties of vertebral bone mineral with a significant decrease in the size and crystallinity of apatite crystal forming the bone tissue in the exposed vs. non-exposed rats. Serum analysis revealed lower levels of thyroid hormones, FT4 (-42%; p<0.005), TT4 (-26%; p<0.005), and vitamin D (-21%; p<0.005) in exposed group compared to control animals. The complementary techniques (TEM and FTIR) used in this study have revealed insights into possible bone mineralization alteration due to PCB126 exposure. The lowering of both the thyroxin and vitamin D serum levels might be an underlying explanation for the observed effects on bone mineralization.

  • 18. Amaral, Andre F. S.
    et al.
    Ramasamy, Adaikalavan
    Castro-Giner, Francesc
    Minelli, Cosetta
    Accordini, Simone
    Sorheim, Inga-Cecilie
    Pin, Isabelle
    Kogevinas, Manolis
    Jõgi, Rain
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Balding, David J.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Verlato, Giuseppe
    Olivieri, Mario
    Probst-Hensch, Nicole
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Zock, Jan-Paul
    Heinrich, Joachim
    Jarvis, Deborah L.
    Interaction between gas cooking and GSTM1 null genotype in bronchial responsiveness: results from the European Community Respiratory Health Survey2014In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 69, no 6, p. 558-564Article in journal (Refereed)
    Abstract [en]

    Background Increased bronchial responsiveness is characteristic of asthma. Gas cooking, which is a major indoor source of the highly oxidant nitrogen dioxide, has been associated with respiratory symptoms and reduced lung function. However, little is known about the effect of gas cooking on bronchial responsiveness and on how this relationship may be modified by variants in the genes GSTM1, GSTT1 and GSTP1, which influence antioxidant defences. Methods The study was performed in subjects with forced expiratory volume in one second at least 70% of predicted who took part in the multicentre European Community Respiratory Health Survey, had bronchial responsiveness assessed by methacholine challenge and had been genotyped for GSTM1, GSTT1 and GSTP1-rs1695. Information on the use of gas for cooking was obtained from interviewer-led questionnaires. Effect modification by genotype on the association between the use of gas for cooking and bronchial responsiveness was assessed within each participating country, and estimates combined using meta-analysis. Results Overall, gas cooking, as compared with cooking with electricity, was not associated with bronchial responsiveness (beta=-0.08, 95% CI -0.40 to 0.25, p=0.648). However, GSTM1 significantly modified this effect (beta for interaction=-0.75, 95% CI - 1.16 to -0.33, p=4x10(-4)), with GSTM1 null subjects showing more responsiveness if they cooked with gas. No effect modification by GSTT1 or GSTP1-rs1695 genotypes was observed. Conclusions Increased bronchial responsiveness was associated with gas cooking among subjects with the GSTM1 null genotype. This may reflect the oxidant effects on the bronchi of exposure to nitrogen dioxide.

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  • 19.
    Amid Hägg, Shadi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Elena, Ilieva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Ljunggren, Mirjam
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Franklin, Karl A
    Department of Surgical and perioperative sciences, surgery, Umeå University, Umeå.
    Middelveld, Roelinde
    Center for Allergy research, Karolinska Institute, Stockholm.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    The negative health effects of having a combination of snoring and insomnia2022In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 18, no 4Article in journal (Refereed)
    Abstract [en]

    Study objectives: Insomnia and snoring are common sleep disorders. The aim was to investigate the association of a combination of insomnia symptoms and snoring with comorbidity and daytime sleepiness. 

    Methods: The study population consisted of 25,901 subjects (16-75 years, 54.4% women) from four Swedish cities, who answered a postal questionnaire that contained questions on snoring, insomnia symptoms (difficulties initiating and/or maintaining sleep and/or early morning awakening), smoking, educational level and respiratory and non-respiratory disorders. 

    Results: Snoring was reported by 4,221 (16.2%), while 9,872 (38.1%) reported ≥ 1 insomnia symptom. A combination of insomnia symptoms and snoring was reported by 2,150 (8.3%). The association with hypertension (OR 1.4, 95% CI: 1.2-1.6), chronic obstructive pulmonary disease (COPD) (OR 1.8, 95% CI: 1.3-2.4), asthma (OR 1.9; 95% CI: 1.6-2.3), daytime sleepiness (OR 7.9, 95% CI 7.1-8.8) and the use of hypnotics (OR 7.5, 95% CI: 6.1-9.1) was highest for the group with both insomnia symptoms and snoring.

    Conclusions: Subjects with snoring and insomnia combined run an increased risk of hypertension, COPD, asthma, daytime sleepiness and the use of hypnotics. It is important to consider snoring in patients seeking medical assistance for insomnia and, vice versa, in patients with snoring enquire about insomnia. 

    Keywords:  Snoring, insomnia, daytime sleepiness, hypertension, COPD, asthma

  • 20.
    Amin, Hesham
    et al.
    Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway..
    Santl-Temkiv, Tina
    Aarhus Univ, Dept Biol, Sect Microbiol, DK-8000 Aarhus, Denmark..
    Cramer, Christine
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth Environm Work & Hlth, DK-8000 Aarhus, Denmark.;Aarhus Univ Hosp, Danish Ramazzini Ctr, Dept Occupat Med, DK-8200 Aarhus, Denmark..
    Finster, Kai
    Aarhus Univ, Dept Biol, Sect Microbiol, DK-8000 Aarhus, Denmark..
    Real, Francisco Gomez
    Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway..
    Gislason, Thorarinn
    Univ Iceland, Fac Med, IS-102 Reykjavik, Iceland..
    Holm, Mathias
    Univ Gothenburg, Dept Occupat & Environm Med, S-40530 Gothenburg, Sweden..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Jögi, Nils Oskar
    Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway..
    Jögi, Rain
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Tartu Univ Hosp, Lung Clin, EE-50406 Tartu, Estonia..
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Marshall, Ian P. G.
    Aarhus Univ, Dept Biol, Sect Microbiol, DK-8000 Aarhus, Denmark..
    Modig, Lars
    Umeå Univ, Dept Publ Hlth & Clin Med, Div Occupat & Environm Med, S-90187 Umeå, Sweden..
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Shigdel, Rajesh
    Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway..
    Sigsgaard, Torben
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth Environm Work & Hlth, DK-8000 Aarhus, Denmark..
    Svanes, Cecilie
    Haukeland Hosp, Dept Occupat Med, N-5053 Bergen, Norway.;Univ Bergen, Ctr Int Hlth, Dept Global Publ Hlth & Primary Care, N-5009 Bergen, Norway..
    Thorarinsdottir, Hulda
    Landspitali Univ Hosp, Dept Anesthesia & Intens Care, IS-101 Reykjavik, Iceland..
    Wouters, Inge M.
    Univ Utrecht, Inst Risk Assessment Sci, Fac Vet Med, NL-3584 CS Utrecht, Netherlands..
    Schlünssen, Vivi
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth Environm Work & Hlth, DK-8000 Aarhus, Denmark..
    Bertelsen, Randi J.
    Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway..
    Indoor Airborne Microbiome and Endotoxin: Meteorological Events and Occupant Characteristics Are Important Determinants2023In: Environmental Science and Technology, ISSN 0013-936X, E-ISSN 1520-5851, Vol. 57, no 32, p. 11750-11766Article in journal (Refereed)
    Abstract [en]

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

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  • 21.
    Amin, Ridwanul
    et al.
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden.
    Mittendorfer-Rutz, Ellenor
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden.
    Björkenstam, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Psychiatry. Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden.
    Virtanen, Marianna
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden.;Univ Eastern Finland, Sch Educ Sci & Psychol, Joensuu, Finland.
    Helgesson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health equity and working life. Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden.
    Gustafsson, Niklas
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden.
    Rahman, Syed
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden.
    Time period effects in work disability due to common mental disorders among young employees in Sweden-a register-based cohort study across occupational classes and employment sectors2023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 2, p. 272-278Article in journal (Refereed)
    Abstract [en]

    Background We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to employment sector (private/public) and occupational class (non-manual/manual).

    Methods Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19-29 years and resident in Sweden on 31 December 2004, 2009 and 2014 (n = 573 516, 665 138 and 600 889, respectively) were followed for 4 years. Multivariate-adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated to examine the risk of LTSA and DP due to CMDs using Cox regression analyses.

    Results In all cohorts, public sector employees had higher aHRs for LTSA due to CMDs than private sector employees, irrespective of occupational class, e.g. aHR, 95% CI: 1.24, 1.16-1.33 and 1.15, 1.08-1.23 among non-manual and manual workers in cohort 2004. The rates of DP due to CMDs were much lower in cohorts 2009 and 2014 than 2004 leading to uncertain risk estimates in the later cohorts. Still, public sector manual workers had a higher risk for DP due to CMDs than manual workers in the private sector in cohort 2014 than in 2004 (aHR, 95% CI: 1.54, 1.34-1.76 and 3.64, 2.14-6.18, respectively).

    Conclusions Manual workers in the public sector seem to have a higher risk of work disability due to CMDs than their counterparts in the private sector calling for the need for early intervention strategies to prevent long-term work disability.

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  • 22.
    Andersson, Helén
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Lind, P. Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Rönn, Monika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Eva, Brittebo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Experimental studies of bisphenol A in cardiovascular cells and tissues: effects on genes that regulate angiogenesis and vascular tone2012In:  , 2012Conference paper (Refereed)
  • 23.
    Andersson, Ing-Marie
    et al.
    Dalarna University, School of Technology and Business Studies.
    Gunnarsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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 School2017In: Nordic Journal of Working Life Studies, E-ISSN 2245-0157, Vol. 7, no 1, p. 55-68Article in journal (Refereed)
    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. 

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  • 24.
    Andersson, Ing-Marie
    et al.
    Högskolan Dalarna, Falun, Sweden.
    Gunnarsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Rosén, Gunnar
    Högskolan Dalarna, Falun, Sweden.
    Role of Headmasters, Teachers, and Supervisors in Knowledge Transfer about Occupational Health and Safety to Pupils in Vocational Education2015In: Safety and Health at Work, ISSN 2093-7911, Vol. 6, no 4, p. 317-323Article in journal (Refereed)
    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.

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  • 25.
    Andersson, Ing-Marie
    et al.
    Högskolan Dalarna, Arbetsvetenskap.
    Gunnarsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Rosén, Gunnar
    Högskolan Dalarna, Arbetsvetenskap.
    Moström Åberg, Marie
    Högskolan Dalarna, Arbetsvetenskap.
    Knowledge and Experiences of Risks among Pupils in Vocational Education2014In: SH@W Safety and Health at Work, ISSN 2093-7911, E-ISSN 2093-7997, Vol. 5, no 3, p. 140-146Article in journal (Refereed)
  • 26. Annesi-Maesano, Isabella
    et al.
    Norback, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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.2013In: Multidisciplinary Respiratory Medicine, ISSN 1828-695X, E-ISSN 2049-6958, Vol. 8, no 1, p. 71-Article in journal (Refereed)
    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.

  • 27.
    Anundi, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Langworth, S
    Johanson, G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lind, M-L
    Akesson, B
    Friis, L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Itkes, N
    Soderman, E
    Jonsson, BAG
    Edling, C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Air and biological monitoring of solvent exposure during grafitti removal2000In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 73, no 8, p. 561-569Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The principal aim of the study was to estimate the level of exposure to organic solvents of graffiti removers, and to identify the chemicals used in different cleaning agents. A secondary objective was to inform about the toxicity of various products and to optimise working procedures.

    METHODS: Exposure to organic solvents was determined by active air sampling and biological monitoring among 38 graffiti removers during an 8-h work shift in the Stockholm underground system. The air samples and biological samples were analysed by gas chromatography. Exposure to organic solvents was also assessed by a questionnaire and interviews.

    RESULTS: Solvents identified were N-methylpyrrolidone (NMP), dipropylene glycol monomethyl ether (DPGME), propylene glycol monomethyl ether (PGME), diethylene glycol monoethyl ether (DEGEE), toluene, xylene, pseudocumene, hemimellitine, mesitylene, ethylbenzene, limonene, nonane, decane, undecane, hexandecane and gamma-butyrolactone. The 8-h average exposures [time-weighted average (TWA)] were below 20% of the Swedish permissible exposure limit value (PEL) for all solvents identified. In poorly ventilated spaces, e.g. in elevators etc., the short-term exposures exceeded occasionally the Swedish short-term exposure limit values (STEL). The blood and urine concentrations of NMP and its metabolites were low. Glycol ethers and their metabolites (2-methoxypropionic acid (MPA), ethoxy acetic acid (EAA), butoxy acetic acid (BAA), and 2-(2-methoxyethoxy) acetic acid (MEAA)) were found in low concentrations in urine. There were significant correlation between the concentrations of NMP in air and levels of NMP and its metabolites in blood and urine. The use of personal protective equipment, i.e. gloves and respirators, was generally high.

    CONCLUSIONS: Many different cleaning agents were used. The average exposure to solvents was low, but some working tasks included relatively high short-term exposure. To prevent adverse health effects, it is important to inform workers about the health risks and to restrict the use of the most toxic chemicals. Furthermore, it is important to develop good working procedures and to encourage the use of personal protection equipment.

  • 28.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Hellman, Therese
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Experiences of the Initial Phase Implementation of the STAMINA-Model in Perioperative Context Addressing Environmental Issues Systematically: A Qualitative Study2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 9, article id 3037Article in journal (Refereed)
    Abstract [en]

    (1) Background: Challenges in perioperative settings put demands on staff working with systematic work environment management. A support model, STAMINA (Structured and Time-effective Approach through Methods for an Inclusive and Active working life), was implemented in a hospital in Sweden, to help staff address environmental issues systematically. The aim was to describe the experiences of the initial phase of implementation of the adapted STAMINA model in perioperative context. (2) Methods: Qualitative individual interviews were held with 14 managers and employees (three men and 11 women). Data were analysed by systematic text condensation. (3) Results: Five themes were identified: Limited knowledge of the model and the implementation process; scepticism, lack of confidence in the model and a passive attitude; the model offered increased participation; the culture in the organization-to understand one's role as employees and managers; and endurance and feedback are key factors for success in the implementation process. (4) Conclusions: Scepticism turned to positive attitude by recognising that the STAMINA model offered increased participation. In order to have successful implementation, the organisational culture must be taken into consideration by giving the employees increased responsibilities and timely feedbacks. Role description, goal definition, feedback, and sticking to one model are key factors for success.

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  • 29.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Molin, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. IPF The Institute for Organizational and Leadership Development at Uppsala University, Uppsala Sweden.
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Success factors when implementing a structured support model for systematic work environment management in operating departments: A case study from Sweden2022In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 30, no 7, p. 3618-3627Article in journal (Refereed)
    Abstract [en]

    Aim The study aimed to investigate how departments in a Swedish hospital worked with a structured support model between the sessions and what they identified as success factors. Background To improve the work environment in a Swedish hospital, a structured support model for systematic work environment management was implemented in operating departments. The structured work starts with sending a web-based, open-ended, anonymous questionnaire to all employees. In response, employees describe how they perceive their work environment 'right now'. Next, a session is held where employees' viewpoints are discussed, and areas of improvement are agreed upon. Action plans are created between the sessions, and the employees start working with their plans with support from their managers. Implementing new models takes time and requires efforts from employees and managers. Method A case study was conducted, including three operating departments within a perioperative organization in a university hospital in Sweden. The participating departments had used the model without interruption during the Covid-19 pandemic 2 years after implementation, and they had created a customized working method. Three first-line managers were interviewed, and 22 action plans, 21 workplace meeting notes and two presentations were analysed using thematic analysis. Results The results are sorted under three main thematic headings: Experience of results and benefits, Marketing and cheering on and Making adjustments and making the model one's own. The results from the action plans and workplace meetings indicated that the employees had discussed problems with cooperation, work organization and how to treat each other. Conclusion Human factors, such as support, encouragement, seeing the benefits, allowing for time and respecting each other can facilitate and contribute to the implementation and success of a new model. Implications for Nursing Management The main finding of the study indicates that with a structured way of working, and with the participation of the employees in the systematic work environment work, the employees contributed with constructive suggestions for improvement. This, in turn, contributed to reducing the workload for first-line managers. In addition, when working with a structured model, deficiencies in the workplace were identified, which triggered an improvement process in the participating hospital departments.

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  • 30.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Paulsson, Sofia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Molin, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. The Institute for Organizational and Leadership Development (IPF).
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    How Human Resources Index, Relational Justice, and Perceived Productivity Change after Reorganization at a Hospital in Sweden That Uses a Structured Support Model for Systematic Work Environment Management2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 21, article id 11611Article in journal (Refereed)
    Abstract [en]

    To facilitate systematic work environment management, which should be a natural part of business development, a structured support model was developed. The Stamina model has previously been used in Swedish municipalities, showing positive results. The aim was to study how the Human Resources Index (HRI), relational justice, short-term recovery and perceived productivity changed in a recently reorganised perioperative setting in a hospital in Sweden that uses a structured support model for systematic work environment management. A longitudinal design that took measurements at four time points was used in a sample of 500 employees in a perioperative hospital department. The results for the overall sample indicated a positive trend in the HRI (Mt1 = 48.5, SDt1 = 22.5; Mt3 = 56.7, SDt1 = 21.2; p < 0.001). Perceived health-related production loss (Mdt1 = 2, IQR = 3; Mdt3 = 0, IQR = 3; p < 0.001) and perceived work environment-related production loss (Mdt1 = 2, IQR = 3; Mdt3 = 0, IQR = 4; p < 0.001) showed major improvements. Short-term recovery showed a minor improvement (Mt1 = 2.61, SDt1 = 1.33; Mt3 = 2.65, SDt3 = 1.22; p = 0.872). In conclusion, the implementation of the Stamina model, of which the HRI constitutes an important part, seems to be a helpful tool to follow-up on work environment processes, and minimise production losses due to health and work environment-related issues.

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  • 31.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Rudolfsson, Gudrun
    Univ West, Dept Hlth Sci, Div Nursing, Trollhattan, Sweden; Nord Univ, Fac Nursing & Hlth Sci, Bodo, Norway.
    Rask-Andersen, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Runeson, Roma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Wålinder, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    I Stay: Swedish Specialist Nurses in the Perioperative Context and Their Reasons to Stay at Their Workplace2019In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 34, no 3, p. 633-644Article in journal (Refereed)
    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.

  • 32.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Wålinder, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Rask-Andersen, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Rudolfsson, Gudrun
    Nurse managers in perioperative settings and their reasons for remaining in their jobs: A qualitative study.2020In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 28, no 6, p. 1191-1198Article in journal (Refereed)
    Abstract [en]

    AIM: The study describes what helps nurse managers maintain the strength to keep going as leaders.

    BACKGROUND: Good leadership is important for the quality of patient care, patient satisfaction in care and efficiency. Many nurse managers stay on despite challenges at work.

    METHODS: Twelve nurse managers were interviewed. Data were analysed by systematic text condensation according to Malterud.

    RESULTS: The results were as follows: A-Walking side by side with my employees; B-Knowing that I mean something to my employees; C-Talking to myself-asking myself tough questions; D-Having someone to talk to, to decrease the feeling of being alone; E-Leading and managing in my own way-the fear of not succeeding is my motivation.

    CONCLUSION: The nurse managers built their own strategies to get through and get on when difficult situations arose. In order to succeed in leading their employees, the nurse managers gathered their inner strength through moving caritatively back and forth between the 'secret room' and the 'staff room' in the house of leadership.

    IMPLICATIONS IN NURSING MANAGEMENT: The manuscript gives insights into where nurse managers found sources of strengths in their everyday work. To realize their employees' strengths and motivation made a difference for nurse managers as a driving force. By having someone to talk to and by asking themselves tough questions, they were prepared for the challenges that came.

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  • 33. Arsalani, N.
    et al.
    Fallahi-Khoshknab, M.
    Josephson, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lagerstrom, M.
    Iranian nursing staff's self-reported general and mental health related to working conditions and family situation2012In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 59, no 3, p. 416-423Article in journal (Refereed)
    Abstract [en]

    Background: There is increasing global evidence that today's work environment results in higher risk of adverse health among nursing staff than among other professions.

    Aim: To investigate self-reported general and mental health among Iranian nursing staff, and associations with organizational, physical and psychosocial working conditions and family situation.

    Methods: 520 nursing personnel from 10 university hospitals in Tehran participated in this cross-sectional study. Data were collected using a validated questionnaire in the Persian language, containing the Copenhagen Psychosocial Questionnaire, physical items from the Nurse Early eXit Study and two scales relating to general health and mental health from the Short Form-36. The Chi-square test with P < 0.05 and logistic regression were used to analyse data.

    Results: Three out of four nursing staff reported overtime work. The self-reported general and mental health rates of participants were poor/fair (38%, 41%), good (44%, 39%) and very good/excellent (18%, 20%), respectively. Family demands were associated with general health but were not associated with mental health. Adverse physical and psychosocial work conditions gave an elevated odds ratio for poor health.

    Conclusion: Poor general and mental health was associated with adverse working conditions and family demands. Physical and psychosocial working conditions of nursing personnel should be improved. Social facilities such as daycare for children and care for the elderly should be available during work shifts to help Iranian nurses play their family roles.

  • 34. Arsalani, Narges
    et al.
    Fallahi-Khoshknab, Masoud
    Ghaffari, Mostafa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Josephson, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lagerstrom, Monica
    Adaptation of Questionnaire Measuring Working Conditions and Health Problems Among Iranian Nursing Personnel2011In: Asian Nursing Research, ISSN 1976-1317, Vol. 5, no 3, p. 177-182Article in journal (Refereed)
    Abstract [en]

    Purpose: To adapt a questionnaire in the Persian language measuring working conditions and health problems among nursing personnel. A further aim was to test the validity and reliability of the questionnaire. Methods: The adapted questionnaire was based on three well-established questionnaires. Physical working conditions items were from Nurse Early Exit Study. Psychosocial working conditions scales were included from Copenhagen Psychosocial Questionnaire which contains two scales on general and mental health as well. The Nordic Musculoskeletal Questionnaire was the origin of the musculoskeletal disorders questions. During the culture adaptation process, an expert panel method was used. To achieve equivalence between the sources and target version, some changes were made by the expert panel. Then the questionnaire was examined in the field for face validity and construct validity (n = 92) among Iranian nursing personnel from two hospitals. Construct validity was assessed using a priori hypothesized correlations of the outcomes with exposures. Finally the adaptation process was completed by reliability assessment using Cronbach's alpha and Intra-class Correlation Coefficient (ICC). Results: The construct validity result was the correlation of the health outcome with the work-related exposure (physical r(s) = .71 and psychosocial r(s) = .66). In the reliability assessment, Cronbach's alpha and ICC were .60 and .70 respectively. Conclusion: The findings show that the adapted questionnaire has an acceptable conceptual structure and provides reliable information from the nursing profession. Consequently, the questionnaire is applicable to work situation studies among nurses and other health care workers.

  • 35. Arsalani, Narges
    et al.
    Fallahi-Khoshknab, Masoud
    Josephson, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lagerstrom, Monica
    Musculoskeletal Disorders and Working Conditions Among Iranian Nursing Personnel2014In: International Journal of Occupational Safety and Ergonomics, ISSN 1080-3548, E-ISSN 2376-9130, Vol. 20, no 4, p. 671-680Article in journal (Refereed)
    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.

  • 36.
    Athlin, Asa
    et al.
    Örebro Univ, Fac Med & Hlth, Sch Med Sci, Örebro, Sweden..
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hasselgren, Mikael
    Örebro Univ, Fac Med & Hlth, Sch Med Sci, Örebro, Sweden.;Reg Varmland, Ctr Clin Res & Educ, Karlstad, Sweden..
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Montgomery, Scott
    Örebro Univ, Sch Med Sci, Clin Epidemiol & Biostat, Örebro, Sweden.;Karolinska Inst, Dept Med, Clin Epidemiol Div, Stockholm, Sweden.;UCL, Dept Epidemiol & Publ Hlth, London, England..
    Giezeman, Maaike
    Örebro Univ, Fac Med & Hlth, Sch Med Sci, Örebro, Sweden.;Reg Varmland, Ctr Clin Res & Educ, Karlstad, Sweden..
    Kisiel, Marta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Nager, Anna
    Karolinska Inst, Inst NVS, Div Family Med & Primary Care, Stockholm, Sweden..
    Sandelowsky, Hanna
    Karolinska Inst, Dept Med, Clin Epidemiol Div, Stockholm, Sweden.;Karolinska Inst, Inst NVS, Div Family Med & Primary Care, Stockholm, Sweden.;Reg Stockholm, Acad Primary Hlth Care Ctr, Stockholm, Sweden..
    Arne, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Reg Varmland, Ctr Clin Res & Educ, Karlstad, Sweden..
    Sundh, Josefin
    Örebro Univ, Fac Med & Hlth, Sch Med Sci, Dept Resp Med, Örebro, Sweden..
    Diagnostic spirometry in COPD is increasing, a comparison of two Swedish cohorts2023In: npj Primary Care Respiratory Medicine, E-ISSN 2055-1010, Vol. 33, no 1, article id 23Article in journal (Refereed)
    Abstract [en]

    Spirometry should be used to confirm a diagnosis of chronic obstructive pulmonary disease (COPD). This test is not always performed, leading to possible misdiagnosis. We investigated whether the proportion of patients with diagnostic spirometry has increased over time as well as factors associated with omitted or incorrectly interpreted spirometry. Data from medical reviews and a questionnaire from primary and secondary care patients with a doctors' diagnosis of COPD between 2004 and 2010 were collected. Data were compared with a COPD cohort diagnosed between 2000 and 2003. Among 703 patients with a first diagnosis of COPD between 2004 and 2010, 88% had a diagnostic spirometry, compared with 59% (p < 0.001) in the previous cohort. Factors associated with not having diagnostic spirometry were current smoking (OR 2.21; 95% CI 1.36-3.60), low educational level (OR 1.81; 1.09-3.02) and management in primary care (OR 2.28; 1.02-5.14). The correct interpretation of spirometry results increased (75% vs 82%; p = 0.010). Among patients with a repeated spirometry, 94% had a persistent FEV1/FVC or FEV1/VC ratio <0.70.

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  • 37.
    Ax, Erika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Lampa, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Salihovic, Samira
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    van Bavel, Bert
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Sjögren, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Lind, P Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Circulating levels of environmental contaminants are associated with dietary patterns in older adults2015In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 75, p. 93-102Article in journal (Refereed)
    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.

  • 38. Axelsson, Par
    et al.
    Johansson, Magnus S.K.
    Lindgren, Torsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Hearing status among commercial pilots2006In: INTER-NOISE 2006, Washington, D.C: Institute of Noise Control Engineering of the USA , 2006, p. 4231-4234Conference paper (Refereed)
    Abstract [en]

    This study evaluates the hearing status of commercial pilots. Studies show that noise-induced hearing loss initially appears as a threshold shift in a specific frequency region. Deterioration in pure-tone average of the frequencies 3, 4 and 6 kHz is used as an indicator for noise-induced hearing loss and to evaluate hearing loss due to occupational noise exposure. The present study provides a comparison of the hearing status of commercial pilots and a reference group. The study looks at the high frequency pure-tone average for 3, 4 and 6 kHz of 658 commercial pilots. The pure-tone average was calculated from the regular health examinations of the pilots. The reference group was from a general adult population, aged 20 to 79 years, not exposed to hazardous occupational noise. The results indicate no influence from occupational noise exposure on the hearing status of commercial pilots.

  • 39. Bakke, J V
    et al.
    Norbäck, D
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Wieslander, G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Hollund, B-E
    Florvaag, E
    Haugen, E N
    Moen, B E
    Symptoms, complaints, ocular and nasal physiological signs in university staff in relation to indoor environment: temperature and gender interactions2008In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 18, no 2, p. 131-143Article in journal (Refereed)
    Abstract [en]

    Symptoms, signs, perceptions, and objective measures were studied in university buildings. Two problem buildings with a history of dampness and complaints were compared with two control buildings. Health investigations among university staff were performed at the workplace (n = 173) including tear film stability [non-invasive break-up time (NIBUT) and self-reported break-up time (SBUT)], nasal patency (acoustic rhinometry), nasal lavage fluid analysis [NAL: eosinophil cationic protein (ECP), myeloperoxidase (MPO), lysozyme and albumin] and atopy by total serum IgE and IgE antibodies (Phadiatop (R)). Exposure assessment included inspections, thermal and atmospheric climate at 56 points modelled for all work sites. Multiple regressions were applied, controlling for age and gender. Exposure differences between problem buildings and controls were small, and variations between rooms were greater. Workers in the problem buildings had more general and dermal symptoms, but not more objective signs than the others. Adjusted day NIBUT and SBUT increased at higher night air temperatures, with B (95% CI) 0.6 (0.04-1.2) and 1.3 (-0.02 to 2.5), respectively. Higher relative humidity at mean day air temperature < 22.1 degrees C was associated with adjusted NIBUT and SBUT, with B (95% CI) 0.16 (0.03-0.29) and 0.37 (-0.01 to 0.75), respectively. Air velocity below recommended winter values and reduced relative humidity in the range of 15-30% were associated with dry air and too low temperature.

  • 40. Bakke, Jan Vilhelm
    et al.
    Moen, Bente E
    Wieslander, Gunilla
    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.
    Gender and the physical and psychosocial work environments are related to indoor air symptoms2007In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 49, no 6, p. 641-650Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess gender differences in self-reported symptoms, psychosocial, subjective, and objective physical environments. Methods: Staff (N = 173) in four university buildings were investigated by questionnaires, blood samples, and objective assessment of indoor environment (temperature, air velocity, relative humidity, CO2, and dust [PM10]). Analyses were performed by linear and logistic regressions. Results: Women reported health symptoms more often than did men and complained more about physical but not psychosocial factors. Men's symptoms and complaints were more specifically associated to air velocity and humidity. For both genders, symptoms were related to both strain (P = 0.02) and perceived physical environments (P = 0.01). Lower relative humidity in the range of 15% to 35% was associated with perception of too low temperature and dry air. Conclusion: Gender, psychosocial, and physical environment factors were related to symptoms and perceived indoor climate.

  • 41. Bakke, Jan Vilhelm
    et al.
    Wieslander, Gunilla
    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.
    Moen, Bente E
    Atopy, symptoms and indoor environmental perceptions, tear film stability, nasal patency and lavage biomarkers in university staff2008In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 81, no 7, p. 861-872Article in journal (Refereed)
    Abstract [en]

    Objective Study associations between airway symptoms, complaints on environmental perceptions, atopy definitions and biomarkers including tear film stability (BUT), nasal patency and nasal lavage (NAL). Personal predictors (gender, age, smoking, infections) for the biomarkers as well as associations between the biomarkers were also assessed. Methods A cross-sectional study of 173 employees in four university buildings, response rate 86%. Tear film break up time (BUT) was measured by a non-invasive method (NIBUT) and self-reported (SBUT). NAL-analysis included eosinophilic cationic protein (ECP), myeloperoxidase (MPO), lysozyme and albumin. Total serum IgE, and specific IgE using Phadiatop(R) was measured. Data on subjective symptoms, environmental perceptions and background data were collected by use of a questionnaire. Multiple regression analyses were applied. Results Mean age was 43 years, 21% had weekly ocular, 21% nasal, and 17% laryngeal symptoms. Women had more complaints on environmental perceptions, shorter BUT and less nasal patency. Neither atopy (Phadiatop) nor Total IgE or allergy in the family, but asthma and hay fever was associated with mucosal symptoms or perceptions. Subjects with positive Phadiatop had higher levels of all NAL-biomarkers. Those with ocular symptoms had shorter BUT. Nasal symptoms were related to respiratory infections and laryngeal symptoms to NAL-lysozyme. Perceiving dry air was associated with lower BUT and reduced nasal volume difference before and after decongestion. Older subjects had greater nasal patency, and less atopy. All NAL-biomarkers were positively correlated. Higher lysozyme level was associated with less nasal patency and greater nasal decongestion. Conclusions BUT and NAL-lysozyme was associated with ocular, nasal, laryngeal symptoms and indoor environmental perceptions. Ever having had asthma and ever having had hay fever were predictors for symptoms and perceived air quality, respectively. Phadiatop, Total IgE, familiar allergy and ever eczema were not associated to symptoms or perceived environments. Age, gender and Phadiatop were main predictors for ocular and nasal biomarkers.

  • 42. Bakke, Jan Vilhelm
    et al.
    Wieslander, Gunilla
    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.
    Moen, Bente E.
    Eczema Increases Susceptibility to PM10 in Office Indoor Environments2012In: Archives of Environmental & Occupational Health, ISSN 1933-8244, E-ISSN 2154-4700, Vol. 67, no 1, p. 15-21Article in journal (Refereed)
    Abstract [en]

    The objective was to compare impact of indoor office environment on employees with eczema with those without eczema. Exposure was measured at 56 sites and modelled for 173 work places. Tear film stability, lysozyme in nasal lavage, immunoglobulin E (IgE), and Phadiatop were assessed, and symptoms and perceptions collected by questionnaires. Multiple regression analyses were applied, adjusted for age, gender, strain, current smoking, and respiratory infections. Those with eczema perceived temperature too high but not associated with measured temperature. They had increased lysozyme in nasal lavage associated with increased air temperature difference between 6 and 10 AM, more general and mucosal symptoms, and "dry or flushed facial skin" associated with airborne particulate matter less than 10 microns in diameter (PM10). Impact of PM10 was most pronounced among those with eczema previous 30 days. Having eczema might be an important predictor for subjective and objective responses to indoor environment.

  • 43. Bakke, JV
    et al.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Wieslander, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Hollund, B.E
    Moen, B.E
    Pet keeping and dampness in the dwelling: associations with airway infections, symptoms, and physiological signs from the ocular and nasal mucosa2007In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 17, no 1, p. 60-69Article in journal (Refereed)
    Abstract [en]

    The aim was to utilize data from a study of occupational indoor environments to analyze symptoms and physiological signs in relation to the home environment. A medical investigation was performed at the workplace among university staff (n = 173) from four university buildings in Bergen, in March 2004. Tear film break up time (BUT) was measured by two methods. Nasal patency was measured by acoustic rhinometry. Nasal lavage fluid analysis (NAL) included eosinophilic cationic protein (ECP); myeloperoxidase (MPO), lysozyme and albumin. Atopy was assessed by total serum IgE and specific IgE (Phadiatop®). Totally 21%, 21%, 18%, 11%, and 27% had weekly ocular, nasal, facial dermal symptoms, headache and tiredness, respectively, 15% had a damp dwelling, and 20% had a cat or dog. Multiple linear or logistic regressions were applied, controlling for age gender, smoking, and environmental factors. Building dampness was associated with increased NAL-lysozyme (P = 0.02) and an increase of airway infections [odd ratio (OR) = 3.14, P = 0.04]. Pet keeping was associated with difficulties to concentrate (OR = 5.10, P = 0.001), heavy headedness (OR = 4.35, P = 0.004), four more days with tiredness per month (P = 0.04), and less airway infections (OR = 0.32; P = 0.02). In conclusion, pet keeping was associated with more central nervous system (CNS)-symptoms but less airway infections. Dampness in the dwelling may have inflammatory effects on the airway mucosa, possibly mediated via increased infection proneness.

  • 44. Bakolis, I
    et al.
    Doekes, G
    Heinrich, J
    Zock, J P
    Heederik, D
    Kogevinas, M
    Guerra, S
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Ramasamy, A
    Nevalainen, A
    Svanes, C
    Chen, C M
    Verlato, G
    Olivieri, M
    Castro-Giner, F
    Jarvis, D
    Respiratory health and endotoxin: associations and modification by CD14/-260 genotype2012In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 39, no 3, p. 573-581Article in journal (Refereed)
    Abstract [en]

    Exposure to endotoxin has been associated with increased respiratory symptoms and decrements in lung function in occupational settings but little is known about health effects of domestic exposure in adults. We describe the association of respiratory disease, IgE sensitisation, bronchial reactivity and lung function with mattress endotoxin levels in adults and determine whether these associations are modified by polymorphisms in CD14.Endotoxin levels in mattress dust from a population based sample of 972 adults were measured. Associations were examined using generalized linear mixed models, adjusting for individual and household confounders. Effect modification of these associations by CD14/-260 (rs2569190) was assessed.Mattress endotoxin levels varied from 0.1 to 402.6&emsp14;EU·mg(-1). Although there was no overall association of lung function with endotoxin exposure, there was evidence that the association of FEV1 and FVC with endotoxin was modified by CD14/-260 genotype (p for interaction 0.005 and 0.013 respectively). There was no evidence that symptoms, IgE sensitisation or bronchial reactivity was associated with mattress endotoxin levels.In this large epidemiological study of adults there was no evidence that mattress endotoxin level was associated with respiratory symptoms or IgE sensitisation but the association of lung function with endotoxin levels may be modified by CD14-genotype.

  • 45. Bakolis, I
    et al.
    Heinrich, J
    Zock, J P
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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 outcomes2015In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 25, no 3, p. 235-244Article in journal (Refereed)
    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.

  • 46.
    Baldanzi, Gabriel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Sayols-Baixeras, Sergi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Ekblom-Bak, Elin
    Ekblom, Örjan
    Dekkers, Koen F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Hammar, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Nguyen, Diem
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Ahmad, Shafqat
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Preventive Medicine Division, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, United States.
    Ericson, Ulrika
    Arvidsson, Daniel
    Börjesson, Mats
    Johansson, Peter J.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Smith, J. Gustav
    Bergström, Göran
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Engström, Gunnar
    Ärnlöv, Johan
    Kennedy, Beatrice
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Orho-Melander, Marju
    Fall, Tove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Accelerometer-based physical activity is associated with the gut microbiota in 8416 individuals in SCAPIS2024In: EBioMedicine, E-ISSN 2352-3964, Vol. 100, article id 104989Article in journal (Refereed)
    Abstract [en]

    Background

    Previous population-based studies investigating the relationship between physical activity and the gut microbiota have relied on self-reported activity, prone to reporting bias. Here, we investigated the associations of accelerometer-based sedentary (SED), moderate-intensity (MPA), and vigorous-intensity (VPA) physical activity with the gut microbiota using cross-sectional data from the Swedish CArdioPulmonary bioImage Study.

    Methods

    In 8416 participants aged 50–65, time in SED, MPA, and VPA were estimated with hip-worn accelerometer. Gut microbiota was profiled using shotgun metagenomics of faecal samples. We applied multivariable regression models, adjusting for sociodemographic, lifestyle, and technical covariates, and accounted for multiple testing.

    Findings

    Overall, associations between time in SED and microbiota species abundance were in opposite direction to those for MPA or VPA. For example, MPA was associated with lower, while SED with higher abundance of Escherichia coli. MPA and VPA were associated with higher abundance of the butyrate-producers Faecalibacterium prausnitzii and Roseburia spp. We observed discrepancies between specific VPA and MPA associations, such as a positive association between MPA and Prevotella copri, while no association was detected for VPA. Additionally, SED, MPA and VPA were associated with the functional potential of the microbiome. For instance, MPA was associated with higher capacity for acetate synthesis and SED with lower carbohydrate degradation capacity.

    Interpretation

    Our findings suggest that sedentary and physical activity are associated with a similar set of gut microbiota species but in opposite directions. Furthermore, the intensity of physical activity may have specific effects on certain gut microbiota species.

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    Accelerometer-based physical activity is associated with the gut microbiota in 8416 individuals in SCAPIS
  • 47.
    Baloch, Ramen Munir
    et al.
    Sorbonne Univ, INSERM, Pierre Louis Inst Epidemiol & Publ Hlth IPLESP UM, Epidemiol Allerg & Resp Dis Dept EPAR,St Antoine, F-75012 Paris, France..
    Maesano, Cara Nichole
    Sorbonne Univ, INSERM, Pierre Louis Inst Epidemiol & Publ Hlth IPLESP UM, Epidemiol Allerg & Resp Dis Dept EPAR,St Antoine, F-75012 Paris, France..
    Christoffersen, Jens
    Velux AS, Adalsvej 99, DK-2970 Horsholm, Denmark..
    Banerjee, Soutrik
    Sorbonne Univ, INSERM, Pierre Louis Inst Epidemiol & Publ Hlth IPLESP UM, Epidemiol Allerg & Resp Dis Dept EPAR,St Antoine, F-75012 Paris, France..
    Gabriel, Marta
    Inst Sci & Innovat Mech Engn & Ind Management INE, Porto, Portugal..
    Csobod, Eva
    Reg Environm Ctr Cent & Eastern Europe, HQ, REC, Szentendre, Hungary.;Reg Environm Ctr Cent & Eastern Europe REC, 9-11 Ady Endre Ut, H-2000 Szentendre, Hungary..
    Fernandes, Eduardo de Oliveira
    Univ Porto, IDMEC FEUP, Inst Engn Mecan, Fac Engn, Porto, Portugal.;Inst Sci & Innovat Mech Engn & Ind Management INE, Porto, Portugal..
    Annesi-Maesano, Isabella
    Sorbonne Univ, Pierre Louis Inst Epidemiol & Publ Hlth IPLESP UM, Epidemiol Allerg & Resp Dis Dept EPAR, INSERM, Paris, France.;Sorbonne Univ, INSERM, Pierre Louis Inst Epidemiol & Publ Hlth IPLESP UM, Epidemiol Allerg & Resp Dis Dept EPAR,St Antoine, F-75012 Paris, France..
    Szuppinger, Peter
    Reg Environm Ctr Cent & Eastern Europe, HQ, REC, Szentendre, Hungary..
    Prokai, Reka
    Reg Environm Ctr Cent & Eastern Europe, HQ, REC, Szentendre, Hungary..
    Farkas, Petur
    Reg Environm Ctr Cent & Eastern Europe, HQ, REC, Szentendre, Hungary..
    Fuzi, Cecilia
    Reg Environm Ctr Cent & Eastern Europe, HQ, REC, Szentendre, Hungary..
    Cani, Eduart
    REC Albania, Tirana, Albania..
    Draganic, Jasna
    REC Bosnia & Herzegovina, Sarajevo, Bosnia & Herceg..
    Mogyorosy, Eszter Reka
    REC Serbia, Belgrade, Serbia..
    Korac, Zorica
    REC Serbia, Belgrade, Serbia..
    Ventura, Gabriela
    Univ Porto, IDMEC FEUP, Inst Engn Mecan, Fac Engn, Porto, Portugal..
    Madureira, Joana
    Univ Porto, IDMEC FEUP, Inst Engn Mecan, Fac Engn, Porto, Portugal..
    Paciencia, Ines
    Univ Porto, IDMEC FEUP, Inst Engn Mecan, Fac Engn, Porto, Portugal..
    Martins, Anabela
    Univ Porto, IDMEC FEUP, Inst Engn Mecan, Fac Engn, Porto, Portugal..
    Pereira, Ricardo
    Univ Porto, IDMEC FEUP, Inst Engn Mecan, Fac Engn, Porto, Portugal..
    Ramos, Elisabete
    Univ Porto, IDMEC FEUP, Inst Engn Mecan, Fac Engn, Porto, Portugal..
    Rudnai, Peter
    Natl Inst Environm Hlth, Budapest, Hungary..
    Paldy, Anna
    Natl Inst Environm Hlth, Budapest, Hungary..
    Dura, Gyula
    Natl Inst Environm Hlth, Budapest, Hungary..
    Beregszaszi, Timea
    Natl Inst Environm Hlth, Budapest, Hungary..
    Vaskovi, Eva
    Natl Inst Environm Hlth, Budapest, Hungary..
    Magyar, Donat
    Natl Inst Environm Hlth, Budapest, Hungary..
    Pandics, Tamas
    Natl Inst Environm Hlth, Budapest, Hungary..
    Remeny-Nagy, Zsuzsanna
    Natl Inst Environm Hlth, Budapest, Hungary..
    Szentmihalyi, Renata
    Natl Inst Environm Hlth, Budapest, Hungary..
    Udvardy, Orsolya
    Natl Inst Environm Hlth, Budapest, Hungary..
    Varro, Mihaly J.
    Natl Inst Environm Hlth, Budapest, Hungary..
    Kephalopoulos, Stylianos
    European Commiss, Joint Res Ctr Inst Hlth & Consumer Protect, JRC, Ispra, Italy..
    Kotzias, Dimitrios
    European Commiss, Joint Res Ctr Inst Hlth & Consumer Protect, JRC, Ispra, Italy..
    Barrero-Moreno, Josefa
    European Commiss, Joint Res Ctr Inst Hlth & Consumer Protect, JRC, Ispra, Italy..
    Mehmeti, Rahmije
    Inst Publ Hlth, IPH ALB, Tirana, Albania..
    Vilic, Aida
    Inst Publ Hlth, IPH BH, Sarajevo, Bosnia & Herceg..
    Maestro, Daniel
    Inst Publ Hlth, IPH BH, Sarajevo, Bosnia & Herceg..
    Moshammer, Hanns
    Med Univ, Inst Environm Hlth, Graz, Austria..
    Strasser, Gabriela
    Med Univ, Inst Environm Hlth, Graz, Austria..
    Brigitte, Piegler
    Med Univ, Inst Environm Hlth, Graz, Austria..
    Hohenblum, Philipp
    Umweltbundesamt GmbH, UBA A, Planning & Coordinat Subst & Anal, Vienna, Austria..
    Goelen, Eddy
    VITO, Flemish Inst Technol Res, Mol, Belgium..
    Stranger, Marianne
    VITO, Flemish Inst Technol Res, Mol, Belgium..
    Spruy, Maarten
    VITO, Flemish Inst Technol Res, Mol, Belgium..
    Sidjimov, Momchil
    Natl Ctr Publ Hlth & Anal, Sofia, Bulgaria..
    Hadjipanayis, Adamos
    Larnaca Gen Hosp, Larnax, Cyprus..
    Katsonouri-Sazeides, Andromachi
    State Gen Lab, CSGL, Nicosia, Cyprus..
    Demetriou, Eleni
    State Gen Lab, CSGL, Nicosia, Cyprus..
    Kubinova, Ruzana
    Natl Publ Hlth Inst, NPHI CZ, Prague, Czech Republic..
    Kazmarova, Helena
    Natl Publ Hlth Inst, NPHI CZ, Prague, Czech Republic..
    Dlouha, Beatricia
    Natl Publ Hlth Inst, NPHI CZ, Prague, Czech Republic..
    Kotlik, Bohumil
    Natl Publ Hlth Inst, NPHI CZ, Prague, Czech Republic..
    Vabar, Helen
    Hlth Board, HPI, Tallinn, Estonia..
    Ruut, Juri
    Hlth Board, HPI, Tallinn, Estonia..
    Metus, Meelis
    Hlth Board, HPI, Tallinn, Estonia..
    Rand, Kristiina
    Hlth Board, HPI, Tallinn, Estonia..
    Jarviste, Antonina
    Hlth Board, HPI, Tallinn, Estonia..
    Nevalainen, Aino
    Natl Inst Hlth & Welf, THL, Helsinki, Finland..
    Hyvarinen, Anne
    Natl Inst Hlth & Welf, THL, Helsinki, Finland..
    Taubel, Martin
    Natl Inst Hlth & Welf, THL, Helsinki, Finland..
    Jarvi, Kati
    Natl Inst Hlth & Welf, THL, Helsinki, Finland..
    Mandin, Corinne
    Ctr Sci & Tech Batiment, St Martin Dheres, France..
    Berthineau, Bruno
    Ctr Sci & Tech Batiment, St Martin Dheres, France..
    Moriske, Heinz-Joern
    Umweltbundesamt Fed Environm Agcy, UBA, Indoor Hyg Sect, Dessau Rosslau, Germany..
    Giacomini, Marcia
    Umweltbundesamt Fed Environm Agcy, UBA, Indoor Hyg Sect, Dessau Rosslau, Germany..
    Neumann, Anett
    Umweltbundesamt Fed Environm Agcy, UBA, Indoor Hyg Sect, Dessau Rosslau, Germany..
    Bartzis, John
    Univ Western Macedonia, UOWM, Kozani, Greece..
    Kalimeri, Krystallia
    Univ Western Macedonia, UOWM, Kozani, Greece..
    Saraga, Dikaia
    Univ Western Macedonia, UOWM, Kozani, Greece..
    Santamouris, Mattheos
    Natl Kapodistrian Univ Athens, NKUA, Athens, Greece..
    Assimakopoulos, Margarita Niki
    Natl Kapodistrian Univ Athens, NKUA, Athens, Greece..
    Asimakopoulos, Vasiliki
    Natl Kapodistrian Univ Athens, NKUA, Athens, Greece..
    Carrer, Paolo
    Univ Milan, UMIL, Milan, Italy..
    Cattaneo, Andrea
    Univ Milan, UMIL, Milan, Italy..
    Pulvirenti, Salvatore
    Univ Milan, UMIL, Milan, Italy..
    Vercelli, Franco
    Univ Milan, UMIL, Milan, Italy..
    Strangi, Fabio
    Univ Milan, UMIL, Milan, Italy..
    Omeri, Elida
    Univ Milan, UMIL, Milan, Italy..
    Piazza, Silvia
    Univ Milan, UMIL, Milan, Italy..
    D'Alcamo, Andrea
    Univ Milan, UMIL, Milan, Italy..
    Fanetti, Anna Clara
    Univ Milan, UMIL, Milan, Italy..
    Sestini, Piersante
    Univ Siena, USiena, Siena, Italy..
    Kouri, Magdalini
    Univ Siena, USiena, Siena, Italy..
    Viegi, Giovanni
    Natl Res Council CNR, CNR, Pisa, Italy.;Natl Res Council CNR, CNR, Palermo, Italy..
    Sarno, Giuseppe
    Natl Res Council CNR, CNR, Pisa, Italy.;Natl Res Council CNR, CNR, Palermo, Italy..
    Baldacci, Sandra
    Natl Res Council CNR, CNR, Pisa, Italy.;Natl Res Council CNR, CNR, Palermo, Italy..
    Maio, Sara
    Natl Res Council CNR, CNR, Pisa, Italy.;Natl Res Council CNR, CNR, Palermo, Italy..
    Cerrai, Sonia
    Natl Res Council CNR, CNR, Pisa, Italy.;Natl Res Council CNR, CNR, Palermo, Italy..
    Franzitta, Vincenzo
    Natl Res Council CNR, CNR, Pisa, Italy.;Natl Res Council CNR, CNR, Palermo, Italy..
    Bucchieri, Salvatore
    Natl Res Council CNR, CNR, Pisa, Italy.;Natl Res Council CNR, CNR, Palermo, Italy..
    Cibella, Fabio
    Natl Res Council CNR, CNR, Pisa, Italy.;Natl Res Council CNR, CNR, Palermo, Italy..
    Simoni, Marzia
    Natl Res Council CNR, CNR, Pisa, Italy.;Natl Res Council CNR, CNR, Palermo, Italy..
    Neri, Margherita
    Fdn Salvatore Maugeri, FSM, Pavia, Italy..
    Martuzevicius, Dainius
    Kaunas Univ Technol, KTU, Kaunas, Lithuania..
    Krugly, Edvinas
    Kaunas Univ Technol, KTU, Kaunas, Lithuania..
    Montefort, Stephen
    Univ Malta, Msida, Malta..
    Fsadni, Peter
    Univ Malta, Msida, Malta..
    Brewczynski, Piotr Z.
    Inst Occupat Med & Environm Hlth, Lodz, Poland..
    Krakowiak, Ewa
    Inst Occupat Med & Environm Hlth, Lodz, Poland..
    Kurek, Jolanta
    Inst Occupat Med & Environm Hlth, Lodz, Poland..
    Kubarek, Elibieta
    Inst Occupat Med & Environm Hlth, Lodz, Poland..
    Wlazlo, Agnieszka
    Inst Occupat Med & Environm Hlth, Lodz, Poland..
    Borrego, Carlos
    Univ Aveiro, UAVR CESAM, Ctr Environm & Marine Studies, Aveiro, Portugal..
    Alves, Celia
    Univ Aveiro, UAVR CESAM, Ctr Environm & Marine Studies, Aveiro, Portugal..
    Valente, Joana
    Univ Aveiro, UAVR CESAM, Ctr Environm & Marine Studies, Aveiro, Portugal..
    Gurzau, Eugen
    Babes Bolyai Univ, UBB, Cluj Napoca, Romania..
    Rosu, Cristina
    Babes Bolyai Univ, UBB, Cluj Napoca, Romania..
    Popita, Gabriela
    Babes Bolyai Univ, UBB, Cluj Napoca, Romania..
    Neamtiu, Iulia
    Babes Bolyai Univ, UBB, Cluj Napoca, Romania..
    Neagu, Cristina
    Babes Bolyai Univ, UBB, Cluj Napoca, Romania..
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Bluyssen, Phylomena
    TNO, Netherlands Org Appl Sci Res, The Hague, Netherlands..
    Bohms, Michel
    TNO, Netherlands Org Appl Sci Res, The Hague, Netherlands..
    Van den Hazel, Peter
    Publ Hlth Serv Gelderland Midden, HVDGM, Arnhem, Netherlands..
    Cassee, Flemming
    Natl Inst Publ Hlth & Environm, RIVM, Utrecht, Netherlands..
    de Bruin, Yuri Bruinen
    Natl Inst Publ Hlth & Environm, RIVM, Utrecht, Netherlands..
    Bartonova, Alena
    Norwegian Inst Air Res, NILU, Kjeller, Norway..
    Yang, Aileen
    Norwegian Inst Air Res, NILU, Kjeller, Norway..
    Halzlova, Katarina
    Publ Hlth Author, PHA SK, Bratislava, Slovakia..
    Jajcaj, Michal
    Publ Hlth Author, PHA SK, Bratislava, Slovakia..
    Kanikova, Milada
    Publ Hlth Author, PHA SK, Bratislava, Slovakia..
    Miklankova, Olga
    Publ Hlth Author, PHA SK, Bratislava, Slovakia..
    Vitkiva, Marianna
    Publ Hlth Author, PHA SK, Bratislava, Slovakia..
    Jovasevic-Stojanovic, Milena
    Inst Vinca, Vinca, Serbia..
    Zivkovic, Marija
    Inst Vinca, Vinca, Serbia..
    Stevanovic, Zarko
    Inst Vinca, Vinca, Serbia..
    Lazovic, Ivan
    Inst Vinca, Vinca, Serbia..
    Stevanovic, Zana
    Inst Vinca, Vinca, Serbia..
    Zivkovic, Zorica
    Dr Dragisa Misovic Med Ctr, MC, Belgrade, Serbia..
    Cerovic, Sofija
    Dr Dragisa Misovic Med Ctr, MC, Belgrade, Serbia..
    Jocic-Stojanovic, Jasmina
    Dr Dragisa Misovic Med Ctr, MC, Belgrade, Serbia..
    Mumovic, Dejan
    UCL, London, England..
    Tarttelin, Paula
    UCL, London, England..
    Chatzidiakou, Lia
    UCL, London, England..
    Chatzidiakou, Evangelia
    UCL, London, England..
    Dewolf, Marie-Christine
    Hainaut Publ Hlth Inst, Antwerp, Belgium..
    Indoor air pollution, physical and comfort parameters related to schoolchildren's health: Data from the European SINPHONIE study2020In: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 739, article id 139870Article in journal (Refereed)
    Abstract [en]

    Substantial knowledge is available on the association of the indoor school environment and its effect among schoolchildren. In the same context, the SINPHONIE (School indoor pollution and health: Observatory network in Europe) conducted a study to collect data and determine the distribution of several indoor air pollutants (IAPs), physical and thermal parameters and their association with eye, skin, upper-, lower respiratory and systemic disorder symptoms during the previous three months. Finally, data from 115 schools in 54 European cities from 23 countries were collected and included 5175 schoolchildren using a harmonized and standardized protocol. The association between exposures and the health outcomes were examined using logistic regression models on the environmental stressors assessed in classroom while adjusting for several confounding factors; a VOC (volatile organic compound) score defined as the sum of the number of pollutants to which the children were highly exposed (concentration > median of the distribution) in classroom was also introduced to evaluate the mul tiexposu re - outcome association. Schoolchildren while adjusting for several confounding factors. Schoolchildren exposed to above or equal median concentration of PM2.5, benzene, limonene, ozone and radon were at significantly higher odds of suffering from upper, lower airways, eye and systemic disorders. Increased odds were also observed for any symptom (sick school syndrome) among schoolchildren exposed to concentrations of limonene and ozone above median values. Furthermore, the risks for upper and lower airways and systemic disorders significantly increased with the VOCs score. Results also showed that increased ventilation rate was significantly associated with decreased odds of suffering from eye and skin disorders whereas similar association was observed between temperature and upper airways symptoms. The present study provides evidence that exposure to IAPs in schools is associated with various health problems in children. Further investigations are needed to confirm our findings. (C) 2020 Elsevier B.V. All rights reserved.

  • 48.
    Barbu, Andreea
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Lejonklou, Margareta H
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrine Tumor Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Skogseid, Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrine Tumor Biology.
    Progranulin Stimulates Proliferation of Mouse Pancreatic Islet Cells and Is Overexpressed in the Endocrine Pancreatic Tissue of an MEN1 Mouse Model2016In: Pancreas, ISSN 0885-3177, E-ISSN 1536-4828, Vol. 45, no 4, p. 533-540Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Progranulin (PGRN) promotes cell growth and cell cycle progression in several cell types and contributes to tumorigenesis in diverse cancers. We have recently reported PGRN expression in islets and tumors developed in an MEN1 transgenic mouse. Here we sought to investigate PGRN expression and regulation after exposure to hypoxia as well as its effects on pancreatic islet cells and neuroendocrine tumors (NETs) in MEN1 mice.

    METHODS: Gene and protein expression were analyzed by quantitative polymerase chain reaction, immunohistochemistry, and Western blot. We also investigated PGRN expression in samples from patients carrying pancreatic NETs associated or not with the multiple endocrine neoplasia 1 syndrome, using enzyme-linked immunosorbent assay and immunohistochemistry analysis.

    RESULTS: Progranulin is upregulated in tumors and islets of the MEN1 mouse as well as in the serum of patients with pancreatic NETs associated with glucagonoma syndrome. In normal mice islets and pancreatic tumors, PGRN expression was strongly potentiated by hypoxia. Progranulin promotes cell proliferation in islet cells and βTC-6 cells, a process paralleled by activation of the mitogen-activated protein kinase signaling cascade.

    CONCLUSIONS: Our findings identify PGRN as an effective inducer of pancreatic islet cell proliferation and a possible important factor for pancreatic endocrine tumor development.

  • 49. 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, p. 1149-1161Article 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.

  • 50. Bentayeb, Malek
    et al.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Bednarek, Micha
    Bernard, Alfred
    Cai, Guihong
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Cerrai, Sonia
    Eleftheriou, Konstantinos Kostas
    Gratziou, Christina
    Holst, Gitte Juel
    Lavaud, Francois
    Nasilowski, Jacek
    Sestini, Piersante
    Sarno, Giuseppe
    Sigsgaard, Torben
    Wieslander, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Zielinski, Jan
    Viegi, Giovanni
    Annesi-Maesano, Isabella
    Indoor air quality, ventilation and respiratory health in elderly residents Living in nursing homes in Europe2015In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 45, no 5, p. 1228-1238Article in journal (Refereed)
    Abstract [en]

    Few data exist on respiratory effects of indoor air quality and comfort parameters in the elderly. In the context of the GERIE study, we investigated for the first time the relationships of these factors to respiratory morbidity among elderly people permanently living in nursing homes in seven European countries. 600 elderly people from 50 nursing homes underwent a medical examination and completed a standardised questionnaire. Air quality and comfort parameters were objectively assessed in situ in the nursing home. Mean concentrations of air pollutants did not exceed the existing standards. Forced expiratory volume in 1 s/forced vital capacity ratio was highly significantly related to elevated levels of particles with a 50% cut-off aerodynamic diameter of <0.1 mu m (PM0.1) (adjusted OR 8.16, 95% CI 2.24-29.3) and nitrogen dioxide (aOR 3.74, 95% CI 1.06-13.1). Excess risks for usual breathlessness and cough were found with elevated PM10 (aOR 1.53 (95% CI 1.15-2.07) and aOR 1.73 (95% CI 1.17-10.3), respectively) and nitrogen dioxide (aOR 1.58 (95% CI 1.15-2.20) and aOR 1.56 (95% CI 1.03-2.41), respectively). Excess risks for wheeze in the past year were found with PM0.1 (aOR 2.82, 95% CI 1.15-7.02) and for chronic obstructive pulmonary disease and exhaled carbon monoxide with formaldehyde (aOR 3.49 (95% CI 1.17-10.3) and aOR 1.25 (95% CI 1.02-1.55), respectively). Breathlessness and cough were associated with higher carbon dioxide. Relative humidity was inversely related to wheeze in the past year and usual cough. Elderly subjects aged >= 80 years were at higher risk. Pollutant effects were more pronounced in the case of poor ventilation. Even at low levels, indoor air quality affected respiratory health in elderly people permanently living in nursing homes, with frailty increasing with age. The effects were modulated by ventilation.

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