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  • 1.
    Abdalla Omer, Hemn
    et al.
    University of Sulaimani.
    Amin, Kawa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    TGFβ1, SMAD2, CTNNβ1, and Wnt3a gene mutational status and serum concentrations in individuals with non-small cell lung cancer2023In: Cellular and Molecular Biology, ISSN 0145-5680, E-ISSN 1165-158X, Vol. 69, no 11, p. 81-91Article in journal (Refereed)
    Abstract [en]

    The objective of the current investigation was to investigate the diagnostic utility of the serum concentrations and mutational status of TGFβ1, SMAD2, CTNNβ1, and Wnt3a. and the expression levels of human-rela-ted genes in patients with non-small cell lung cancer (NSCLC). The serum concentrations were determined using the ELISA technique, and PCR for genotype variations of TGFβ1, SMAD2, CTNNβ1, and Wnt3a were examined using Sanger sequencing in tissue samples obtained from 93 patients with NSCLC and 84 healthy individuals for blood, and 20 Formalin Fixed Paraffin Embedded (FFPE) from normal samples dissected adja-cent to the tumour. The findings of the current investigation indicate that individuals diagnosed with NSCLC exhibited significant elevation in the serum levels of CEA and CYFRA21-1, as well as TGFβ1, SMAD2, CTNNβ1, and Wnt3a. In total, 325 mutations in four trialled genes (243 mutations in TGFβ1, 24 mutations in SMAD2,47 mutation Wnt3a and 11 mutations in CTNNβ1) were identified in patients with NSCLC. Fur-thermore, all mutations were recorded in adenocarcinoma, not squamous and normal adjacent tumour cells. CYFRA21-1 and CEA are more significant between NSCLC and HC, gender, and NSCLC types (p<0.001). In detail, TGFβ1 exhibited the highest rate of mutations among other genes and three types of genomic mutations. Elevated levels and genetic polymorphisms of TGFβ1, SMAD2, CTNNβ1, and Wnt3a may play crucial func-tions in the pathogenesis and angiogenesis of non-small cell lung cancer (NSCLC). These biomarkers might play a role in future immunologic response and pharmacologically targeted NSCLC therapy.

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  • 2.
    Abdalla Omer, Hemn
    et al.
    Department of Microbiology/Immunology, College of Medicine, University of Suleimani, Sulaymaniyah, Iraq.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Amin, Kawa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Department of Microbiology/Immunology, College of Medicine, University of Suleimani, Sulaymaniyah, Iraq.
    The role of inflammatory and remodelling biomarkers in patients with non-small cell lung cancer2023In: Central European Journal of Immunology, ISSN 1426-3912, E-ISSN 1644-4124, Vol. 48, no 4, p. 330-337Article in journal (Refereed)
    Abstract [en]

    Introduction:

    Biomarkers play a crucial role in evaluating the prognosis, diagnosis, and monitoringof non-small cell lung cancer (NSCLC). The aim of this study was to compare the levels of inflammatoryand remodelling biomarkers among patients with NSCLC and healthy controls (HCs) and to investigatethe correlation between these biomarkers.

    Material and methods:

    Blood samples were taken from 93 NSCLC and 84 HCs. Each sample wasanalysed for the inflammatory biomarkers transforming growth factor β1 (TGF-β1), mothers againstdecapentaplegic homolog 2 (SMAD2) and the remodelling biomarkers Wingless-related integration site(Wnt3a) and β-catenin (CTNN-β1).

    Results:

    The patients with NSCLC had significantly higher levels of all the measured biomarkers.In the NSCLC patients, TGF-β1 correlated significantly with SMAD2 (r = 0.34, p = 0.0008), Wnt3a(r = 0.328, p = 0.0013), and CTNN-β1 levels (r = 0.30, p = 0.004). SMAD2 correlated significantlywith CTNN-β1 (r = 0.546, p = 0.0001) and Wnt3a (r = 0.598, p = 0.0001). CTNN-β1 level also correlated with the level of Wnt3a (r = 0.61, p = 0.0001). No correlation was found between biomarkersand symptom scores.

    Discussion:

    In this study, patients with NSCLC had higher inflammatory and remodelling biomarker levels than HCs. In the NSCLC, there were significant associations between inflammatory andremodelling biomarkers. This indicates that measuring biomarkers could be valuable in the workupof NSCLC patients.

    Conclusions:

    Our investigation showed that inflammatory and remodelling biomarkers might playa role in future immunologic response and pharmacologically targeted NSCLC therapy.

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    Lung Cancer
  • 3.
    Abozid, Hazim
    et al.
    Vienna Healthcare Grp, Clin Penzing, Dept Resp & Pulm Dis, Vienna, Austria.;Ludwig Boltzmann Inst Lung Hlth, Sanat Str 2, A-1140 Vienna, Austria..
    Patel, Jaymini
    Imperial Coll London, Natl Heart & Lung Inst, London, England..
    Burney, Peter
    Imperial Coll London, Natl Heart & Lung Inst, London, England..
    Hartl, Sylvia
    Ludwig Boltzmann Inst Lung Hlth, Sanat Str 2, A-1140 Vienna, Austria.;Sigmund Freud Univ, Fac Med, Vienna, Austria..
    Breyer-Kohansal, Robab
    Ludwig Boltzmann Inst Lung Hlth, Sanat Str 2, A-1140 Vienna, Austria.;Vienna Healthcare Grp, Clin Hietzing, Dept Resp & Pulm Dis, Vienna, Austria..
    Mortimer, Kevin
    Univ Cambridge, Cambridge, England.;Liverpool Univ Hosp NHS Fdn Trust, Liverpool, Merseyside, England..
    Nafees, Asaad A.
    Aga Khan Univ, Dept Community Hlth Sci, Karachi, Pakistan..
    Al Ghobain, Mohammed
    King Saud Bin Abdulaziz Univ Hlth Sci, Riyadh, Saudi Arabia.;King Abdullah Int Med Res Ctr, Riyadh, Saudi Arabia..
    Welte, Tobias
    German Ctr Lung Res, Hannover Sch Med, Dept Resp Med Infect Dis, Hannover, Germany..
    Harrabi, Imed
    Univ Sousse, Ibn El Jazzar Fac Med Sousse, Sousse, Tunisia..
    Denguezli, Meriam
    Univ Badji Mokhtar Annaba, Fac Med Annaba, Dept Pneumol, Annaba, Algeria..
    Loh, Li Cher
    Royal Coll Surgeons Ireland, Dublin, Ireland.;Univ Coll Dublin, Malaysia Campus, George Town, Malaysia..
    Rashid, Abdul
    Royal Coll Surgeons Ireland, Dublin, Ireland.;Univ Coll Dublin, Malaysia Campus, George Town, Malaysia..
    Gislason, Thorarinn
    Univ Iceland, Fac Med, Reykjavik, Iceland.;Natl Univ Hosp Iceland, Dept Neurol, Landspitali, Reykjavik, Iceland..
    Barbara, Cristina
    Univ Lisbon, Fac Med, Inst Saude Ambiental, Lisbon, Portugal.;Ctr Hosp Univ Lisboa Norte, Serv Pneumol, Lisbon, Portugal..
    Cardoso, Joao
    Ctr Hosp Univ Lisboa Cent, Pulmunol Dept, Lisbon, Portugal.;Nova Univ Lisbon, NOVA Med Sch, Lisbon, Portugal..
    Rodrigues, Fatima
    Ctr Hosp Univ Lisboa Norte, Serv Pneumol, Lisbon, Portugal.;Lisbon Univ, Inst Environm Hlth, Lisbon Med Sch, Associate Lab TERRA, Lisbon, Portugal..
    Seemungal, Terence
    Univ West Indies St Augustine, Fac Med Sci, St Augustine, Trinidad Tobago..
    Obaseki, Daniel
    Obafemi Awolowo Univ, Dept Med, Ife, Nigeria.;Univ British Columbia, Fac Med, Vancouver, BC, Canada..
    Juvekar, Sanjay
    KEM Hosp Res Ctr, Vadu Rural Hlth Program, Pune, Maharashtra, India..
    Paraguas, Stefanni Nonna
    Philippine Coll Chest Phys, Manila, Philippines..
    Tan, Wan C.
    Univ British Columbia, Ctr Heart Lung Innovat, St Pauls Hosp, Vancouver, BC, Canada..
    Franssen, Frits M. E.
    Maastricht Univ, Med Ctr, Maastricht, Netherlands..
    Mejza, Filip
    Jagiellonian Univ, Ctr Evidence Based Med, Dept Internal Med 2, Med Coll, Krakow, Poland..
    Mannino, David
    Univ Kentucky, Lexington, KY USA.;COPD Fdn, Miami, FL USA..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Cherkaski, Hamid Hacene
    Univ Badji Mokhtar Annaba, Fac Med Annaba, Dept Pneumol, Annaba, Algeria..
    Anand, Mahesh Padukudru
    JSSAHER, JSS Med Coll, Dept Resp Med, Mysuru 570015, India..
    Hafizi, Hasan
    Tirana Univ Hosp Shefqet Ndroqi, Fac Med, Tirana, Albania..
    Buist, Sonia
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA..
    Koul, Parvaiz A.
    Sheri Kashmir Inst Med Sci, Dept Pulm Med, Srinagar, India..
    Sony, Asmael
    NIHR Imperial Biomed Res Ctr, London, England..
    Breyer, Marie-Kathrin
    Vienna Healthcare Grp, Clin Penzing, Dept Resp & Pulm Dis, Vienna, Austria.;Ludwig Boltzmann Inst Lung Hlth, Sanat Str 2, A-1140 Vienna, Austria..
    Burghuber, Otto C.
    Ludwig Boltzmann Inst Lung Hlth, Sanat Str 2, A-1140 Vienna, Austria.;Sigmund Freud Univ, Fac Med, Vienna, Austria..
    Wouters, Emiel F. M.
    Ludwig Boltzmann Inst Lung Hlth, Sanat Str 2, A-1140 Vienna, Austria.;NIHR Imperial Biomed Res Ctr, London, England..
    Amaral, Andre F. S.
    Imperial Coll London, Natl Heart & Lung Inst, London, England.;Epi Lab, Khartoum, Sudan.;NIHR Imperial Biomed Res Ctr, London, England..
    Prevalence of chronic cough, its risk factors and population attributable risk in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study2024In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 68, article id 102423Article in journal (Refereed)
    Abstract [en]

    Background Chronic cough is a common respiratory symptom with an impact on daily activities and quality of life. Global prevalence data are scarce and derive mainly from European and Asian countries and studies with outcomes other than chronic cough. In this study, we aimed to estimate the prevalence of chronic cough across a large number of study sites as well as to identify its main risk factors using a standardised protocol and definition. Methods We analysed cross-sectional data from 33,983 adults (>= 40 years), recruited between Jan 2, 2003 and Dec 26, 2016, in 41 sites (34 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We estimated the prevalence of chronic cough for each site accounting for sampling design. To identify risk factors, we conducted multivariable logistic regression analysis within each site and then pooled estimates using random -effects metaanalysis. We also calculated the population attributable risk (PAR) associated with each of the identifed risk factors. Findings The prevalence of chronic cough varied from 3% in India (rural Pune) to 24% in the United States of America (Lexington,KY). Chronic cough was more common among females, both current and passive smokers, those working in a dusty job, those with a history of tuberculosis, those who were obese, those with a low level of education and those with hypertension or airflow limitation. The most influential risk factors were current smoking and working in a dusty job. Interpretation Our findings suggested that the prevalence of chronic cough varies widely across sites in different world regions. Cigarette smoking and exposure to dust in the workplace are its major risk factors.

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  • 4.
    Accordini, Simone
    et al.
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy..
    Calciano, Lucia
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy..
    Johannessen, Ane
    Univ Bergen, Ctr Int Hlth, Dept Global Publ Hlth & Primary Care, Bergen, Norway..
    Benediktsdottir, Bryndis
    Univ Iceland, Fac Med, Reykjavik, Iceland..
    Bertelsen, Randi Jacobsen
    Univ Bergen, Dept Clin Sci, Bergen, Norway.;Oral Hlth Ctr Expertise Western Norway Vestland, Bergen, Norway..
    Braback, Lennart
    Umeå Univ, Dept Publ Hlth & Clin Med, Sect Sustainable Hlth, Umeå, Sweden..
    Dharmage, Shyamali C.
    Univ Melbourne, Sch Populat & Global Hlth, Allergy & Lung Hlth Unit, Melbourne, Vic, Australia..
    Forsberg, Bertil
    Umeå Univ, Dept Publ Hlth & Clin Med, Sect Sustainable Hlth, Umeå, Sweden..
    Real, Francisco Gomez
    Univ Bergen, Dept Clin Sci, Bergen, Norway.;Haukeland Hosp, Dept Obstet & Gynecol, Bergen, Norway..
    Holloway, John W.
    Univ Southampton, Fac Med, Human Dev & Hlth, Southampton, Hants, England..
    Holm, Mathias
    Univ Gothenburg, Sahlgrenska Acad, Sch Publ Hlth & Community Med, Occupat & Environm Med, Gothenburg, Sweden..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jogi, Nils O.
    Univ Bergen, Dept Clin Sci, Bergen, Norway.;Tartu Univ Hosp, Lung Clin, Tartu, Estonia..
    Jogi, Rain
    Tartu Univ Hosp, Lung Clin, Tartu, Estonia..
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Marcon, Alessandro
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy..
    Rovira, Jesus Martinez-Moratalla
    Complejo Hosp Univ Albacete CHUA, Serv Neurol, Serv Salud Castilla La Mancha SESCAM, Albacete, Spain..
    Sanchez-Ramos, Jose Luis
    Univ Huelva, Dept Nursing, Huelva, Spain..
    Schlunssen, Vivi
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark..
    Toren, Kjell
    Univ Gothenburg, Sahlgrenska Acad, Sch Publ Hlth & Community Med, Occupat & Environm Med, Gothenburg, Sweden..
    Jarvis, Deborah
    Imperial Coll London, Fac Med, Natl Heart & Lung Inst, London, England.;Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England..
    Svanes, Cecilie
    Univ Bergen, Ctr Int Hlth, Dept Global Publ Hlth & Primary Care, Bergen, Norway..
    Prenatal and prepubertal exposures to tobacco smoke in men may cause lower lung function in future offspring: a three-generation study using a causal modelling approach2021In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 58, no 4, article id 2002791Article in journal (Refereed)
    Abstract [en]

    Mechanistic research suggests that lifestyle and environmental factors impact respiratory health across generations by epigenetic changes transmitted through male germ cells. Evidence from studies on humans is very limited. We investigated multigeneration causal associations to estimate the causal effects of tobacco smoking on lung function within the paternal line. We analysed data from 383 adult offspring (age 18-47 years; 52.0% female) and their 274 fathers, who had participated in the European Community Respiratory Health Survey (ECRHS)/Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study and had provided valid measures of pre-bronchodilator lung function. Two counterfactual-based, multilevel mediation models were developed with: paternal grandmothers' smoking in pregnancy and fathers' smoking initiation in prepuberty as exposures; fathers' forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), or FEV1/FVC z-scores as potential mediators (proxies of unobserved biological mechanisms that are true mediators); and offspring's FEV1 and FVC, or FEV1/FVC z-scores as outcomes. All effects were summarised as differences (Delta) in expected z-scores related to fathers' and grandmothers' smoking history. Fathers' smoking initiation in prepuberty had a negative direct effect on both offspring's FEV1 (Delta z-score -0.36, 95% CI -0.63--0.10) and FVC (-0.50, 95% CI -0.80--0.20) compared with fathers' never smoking. Paternal grandmothers' smoking in pregnancy had a negative direct effect on fathers' FEV1/FVC -0.57, 95% CI -1.09--0.05) and a negative indirect effect on offspring's FEV1/FVC (-0.12, 95% CI -0.21--0.03) compared with grandmothers' not smoking before fathers' birth nor during fathers' childhood. Fathers' smoking in prepuberty and paternal grandmothers' smoking in pregnancy may cause lower lung function in offspring. Our results support the concept that lifestyle-related exposures during these susceptibility periods influence the health of future generations.

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    FULLTEXT01
  • 5.
    Accordini, Simone
    et al.
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Calciano, Lucia
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Johannessen, Ane
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Ctr Int Hlth, Bergen, Norway.
    Portas, Laura
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Benediktsdottir, Bryndis
    Univ Iceland, Fac Med, Reykjavik, Iceland.
    Bertelsen, Randi Jacobsen
    Univ Bergen, Dept Clin Sci, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Braback, Lennart
    Umea Univ, Dept Publ Hlth & Clin Med, Div Occupat & Environm Med, Umea, Sweden.
    Carsin, Anne-Elie
    Ctr Res Environm Epidemiol CREAL, ISGlobal, Barcelona, Spain;UPF, Barcelona, Spain;CIBER Epidemiol & Salud PUbl CIBERESP, Barcelona, Spain.
    Dharmage, Shyamali C.
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy;Univ Melbourne, Sch Populat & Global Hlth, Melbourne, Vic, Australia.
    Dratva, Julia
    ZHAW Sch Hlth Profess, Inst Hlth Sci, Winterthur, Switzerland;Basel Univ, Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland.
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Div Occupat & Environm Med, Umea, Sweden.
    Real, Francisco Gomez
    Univ Bergen, Dept Clin Sci, Bergen, Norway.
    Heinrich, Joachim
    Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Inner City Clin, Inst & Outpatient Clin Occupat,Social & Environm, Munich, Germany.
    Holloway, John W.
    Univ Southampton, Fac Med, Human Dev & Hlth, Southampton, Hants, England.
    Holm, Mathias
    Univ Gothenburg, Sahlgrenska Acad, Dept Occupat & Environm Med, Gothenburg, Sweden.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jogi, 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, Tartu, Estonia.
    Leynaert, Benedicte
    INSERM, Pathophysiol & Epidemiol Resp Dis, UMR 1152, Paris, France.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Marcon, Alessandro
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Martinez-Moratalla Rovira, Jesus
    CHUA, Hlth Serv Castilla La Mancha SESCAM, Pneumol Serv, Albacete, Spain;Univ Castilla La Mancha, Sch Med, Albacete, Spain.
    Raherison, Chantal
    Bordeaux Univ, INSERM, U1219, Bordeaux, France.
    Luis Sanchez-Ramos, Jose
    Univ Huelva, Dept Nursing, Huelva, Spain.
    Schlunssen, Vivi
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark;Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Bono, Roberto
    Univ Turin, Dept Publ Hlth & Pediat, Turin, Italy.
    Corsico, Angelo G.
    Univ Pavia, IRCCS San Matteo Hosp Fdn, Div Resp Dis, Pavia, Italy.
    Demoly, Pascal
    Univ Montpellier, Hop Arnaud Villeneuve, Dept Pneumol & Addictol, Montpellier, France;Sorbonne Univ, INSERM, IPLESP, Paris, France.
    Dorado Arenas, Sandra
    Galdakao Usansolo Hosp, Pulmonol Dept, Biscay, Spain.
    Nowak, Dennis
    Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Inner City Clin, Inst & Outpatient Clin Occupat,Social & Environm, Munich, Germany;Comprehens Pneumol Ctr Munich, German Ctr Lung Res, Munich, Germany.
    Pin, Isabelle
    CHU Grenoble Alpes, Pediat, Grenoble, France;Inst Adv Biosci, INSERM 1209, Grenoble, France;Univ Grenoble Alpes, Grenoble, France.
    Weyler, Joost
    Univ Antwerp, Dept Epidemiol & Social Med, Antwerp, Belgium;Univ Antwerp, StatUA Stat Ctr, Antwerp, Belgium.
    Jarvis, Deborah
    Imperial Coll, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England;Imperial Coll, MRC PHE Ctr Environm & Hlth, London, England.
    Svanes, Cecilie
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Ctr Int Hlth, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Ageing, Lungs European Cohorts A. L. E. C. Study
    A three-generation study on the association of tobacco smoking with asthma2018In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 4, p. 1106-1117Article in journal (Refereed)
    Abstract [en]

    Background: Mothers' smoking during pregnancy increases asthma risk in their offspring. There is some evidence that grandmothers' smoking may have a similar effect, and biological plausibility that fathers' smoking during adolescence may influence offspring's health through transmittable epigenetic changes in sperm precursor cells. We evaluated the three-generation associations of tobacco smoking with asthma. Methods: Between 2010 and 2013, at the European Community Respiratory Health Survey III clinical interview, 2233 mothers and 1964 fathers from 26 centres reported whether their offspring (aged <= 51 years) had ever had asthma and whether it had coexisted with nasal allergies or not. Mothers and fathers also provided information on their parents' (grandparents) and their own asthma, education and smoking history. Multilevel mediation models within a multicentre three-generation framework were fitted separately within the maternal (4666 offspring) and paternal (4192 offspring) lines. Results: Fathers' smoking before they were 15 [relative risk ratio (RRR) = 1.43, 95% confidence interval (CI): 1.01-2.01] and mothers' smoking during pregnancy (RRR = 1.27, 95% CI: 1.01-1.59) were associated with asthma without nasal allergies in their offspring. Grandmothers' smoking during pregnancy was associated with asthma in their daughters [odds ratio (OR) = 1.55, 95% CI: 1.17-2.06] and with asthma with nasal allergies in their grandchildren within the maternal line (RRR = 1.25, 95% CI: 1.02-1.55). Conclusions: Fathers' smoking during early adolescence and grandmothers' and mothers' smoking during pregnancy may independently increase asthma risk in offspring. Thus, risk factors for asthma should be sought in both parents and before conception.

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    fulltext
  • 6.
    Accordini, Simone
    et al.
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy..
    Calciano, Lucia
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy..
    Marcon, Alessandro
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy..
    Pesce, Giancarlo
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.;Sorbonne Univ, INSERM, UMR S 1136, IPLESP,Team EPAR, F-75012 Paris, France..
    Ant, Josep M.
    Ctr Res Environm Epidemiol CREAL, ISGlobal, Barcelona, Spain.;Hosp del Mar Med Res Inst IMIM, Barcelona, Spain.;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain.;Univ Pompeu Fabra UPF, Barcelona, Spain..
    Beckmeyer-Borowko, Anna B.
    Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland.;Univ Basel, Basel, Switzerland..
    Carsin, Anne-Elie
    Ctr Res Environm Epidemiol CREAL, ISGlobal, Barcelona, Spain.;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain.;Univ Pompeu Fabra UPF, Barcelona, Spain..
    Corsico, Angelo G.
    Univ Pavia, San Matteo Hosp Fdn, IRCCS, Div Resp Dis, Pavia, Italy..
    Imboden, Medea
    Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland.;Univ Basel, Basel, Switzerland..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Keidel, Dirk
    Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland.;Univ Basel, Basel, Switzerland..
    Locatelli, Francesca
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy..
    Svanes, Cecilie
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Ctr Int Hlth, Bergen, Norway.;Haukeland Hosp, Dept Occupat Med, Bergen, Norway..
    Burney, Peter G. J.
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England.;Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England..
    Jarvis, Deborah
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England.;Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England..
    Probst-Hensch, Nicole M.
    Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland.;Univ Basel, Basel, Switzerland..
    Minelli, Cosetta
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England..
    Incidence trends of airflow obstruction among European adults without asthma: a 20-year cohort study2020In: Scientific Reports, E-ISSN 2045-2322, Vol. 10, no 1, article id 3452Article in journal (Refereed)
    Abstract [en]

    Investigating COPD trends may help healthcare providers to forecast future disease burden. We estimated sex- and smoking-specific incidence trends of pre-bronchodilator airflow obstruction (AO) among adults without asthma from 11 European countries within a 20-year follow-up (ECRHS and SAPALDIA cohorts). We also quantified the extent of misclassification in the definition based on pre-bronchodilator spirometry (using post-bronchodilator measurements from a subsample of subjects) and we used this information to estimate the incidence of post-bronchodilator AO (AO(post-BD)), which is the primary characteristic of COPD. AO incidence was 4.4 (95% CI: 3.5-5.3) male and 3.8 (3.1-4.6) female cases/1,000/year. Among ever smokers (median pack-years: 20, males; 12, females), AO incidence significantly increased with ageing in men only [incidence rate ratio (IRR), 1-year increase: 1.05 (1.03-1.07)]. A strong exposure-response relationship with smoking was found both in males [IRR, 1-pack-year increase: 1.03 (1.02-1.04)] and females [1.03 (1.02-1.05)]. The positive predictive value of AO for AO(post-BD) was 59.1% (52.0-66.2%) in men and 42.6% (35.1-50.1%) in women. AO(post-BD) incidence was 2.6 (1.7-3.4) male and 1.6 (1.0-2.2) female cases/1,000/year. AO incidence was considerable in Europe and the sex-specific ageing-related increase among ever smokers was strongly related to cumulative tobacco exposure. AO(post-BD) incidence is expected to be half of AO incidence.

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  • 7.
    Accordini, Simone
    et al.
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Calciano, Lucia
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Marcon, Alessandro
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Pesce, Giancarlo
    INSERM, UMR 1152, Pathophysiol & Epidemiol Resp Dis, Paris, France.
    Anto, Josep
    Inst Global Hlth, Barcelona, Spain.
    Beckmeyer-Borowko, Anna
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland.
    Corsico, Angelo
    Univ Pavia, IRCCS San Matteo Hosp Fdn, Div Resp Dis, Pavia, Italy.
    Imboden, Medea
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Keidel, Dirk
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland.
    Locatelli, Francesca
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Svanes, Cecilie
    Univ Bergen, Ctr Int Hlth, Bergen, Norway.
    Jarvis, Deborah
    Imperial Coll, Natl Heart & Lung Inst, Fac Med, London, England.
    Probst-Hensch, Nicole
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland.
    Minelli, Cosetta
    Imperial Coll, Natl Heart & Lung Inst, Fac Med, London, England.
    Incidence of airflow obstruction over 20 years in Europe2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal (Other academic)
  • 8.
    Accordini, Simone
    et al.
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Cazzoletti, Lucia
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Anto, Josep
    Inst Global Hlth, Barcelona, Spain.
    Cerveri, Isa
    Univ Pavia, IRCCS San Matteo Hosp Fdn, Div Resp Dis, Pavia, Italy.
    Corsico, Angelo
    Univ Pavia, IRCCS San Matteo Hosp Fdn, Div Resp Dis, Pavia, Italy.
    Garcia-Aymerich, Judith
    Inst Global Hlth, Barcelona, Spain.
    Heinrich, Joachim
    Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Inner City Clin, Inst & Outpatient Clin Occupat Social & Environm, Munich, Germany.
    Gislason, David
    Landspitali Univ Hosp, Dept Allergy Resp Med & Sleep, Reykjavik, Iceland.
    Jogi, Rain
    Tartu Univ Hosp, Lung Clin, Tartu, Estonia.
    Johannessen, Ane
    Univ Bergen, Ctr Int Hlth, Bergen, Norway.
    Leynaert, Benedicte
    INSERM, UMR 1152, Pathophysiol & Epidemiol Resp Dis, Paris, France.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Pin, Isabelle
    CHU Grenoble Alpes, Pediat, Grenoble, France.
    Portas, Laura
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Weyler, Joost
    Univ Antwerp, Epidemiol & Social Med, Antwerp, France;Univ Antwerp, StatUA Stat Ctr, Antwerp, France.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Marcon, Alessandro
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Jarvis, Deborah
    Imperial Coll, Natl Heart & Lung Inst, Fac Med, London, England.
    Asthma control and decline in FEV1/FVC ratio over 10 years in adults2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal (Other academic)
  • 9.
    Adhikari, Tara Ballav
    et al.
    Nepal Dev Soc, COBIN Project, Bharatpur, Chitwan, Nepal.;Aarhus Univ, Ctr Global Hlth, Dept Publ Hlth, DK-8000 Aarhus, Denmark..
    Acharya, Pawan
    Nepal Dev Soc, COBIN Project, Bharatpur, Chitwan, Nepal.;Univ Oklahoma, Hlth Sci Ctr, Hudson Coll Publ Hlth, Oklahoma City, OK USA..
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Neupane, Dinesh
    Nepal Dev Soc, COBIN Project, Bharatpur, Chitwan, Nepal.;Johns Hopkins Univ, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD USA..
    Karki, Arjun
    HAMS Hosp, Dept Pulm Crit Care & Sleep Med, Kathmandu, Nepal..
    Drews, Arne
    Nepalmed, Leipzig, Germany..
    Cooper, Brendan G.
    Univ Hosp Birmingham, Lung Funct & Sleep, Birmingham, W Midlands, England..
    Sigsgaard, Torben
    Aarhus Univ, Sect Environm Occupat & Hlth, Dept Publ Hlth, Aarhus, Denmark..
    Kallestrup, Per
    Aarhus Univ, Ctr Global Hlth, Dept Publ Hlth, DK-8000 Aarhus, Denmark..
    Prevalence of Chronic Obstructive Pulmonary Disease and its Associated Factors in Nepal: Findings from a Community-based Household Survey2020In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 15, p. 2319-2331Article in journal (Refereed)
    Abstract [en]

    Background: Despite chronic obstructive pulmonary disease (COPD) being the commonest non-communicable disease in Nepal, there is limited research evidence estimating the spirometry-based burden of COPD. This study aims to estimate the prevalence of COPD and its correlates through a community-based survey in Pokhara Metropolitan City, a semiurban area of Western Nepal. Methods: A cross-sectional household survey was conducted among 1459 adults >= 40 years. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as a post-bronchodilator ratio of forced expiratory volume in 1st second (FEV1) to forced vital capacity (FVC) <0.70 with the presence of symptoms. COPD was also defined by the lower limit of normal (LLN) threshold - FEV1/FVC < LLN cut-off values with the presence of symptoms. Study participants were interviewed about sociodemographic and behavioural characteristics and respiratory symptoms. Descriptive statistics and logistic regression analysis were applied. Results: Spirometry reports were acceptable in 1438 participants. The mean age of the participants was 55 (+/- 10) years, and, 54% were female. The prevalence of GOLD-defined COPD was 8.5% (95% CI: 7.1-10.0) and based on the LLN threshold of 5.4% (95% CI: 4.2-6.6). The multivariate logistic regression showed that increasing age, low body mass index, illiterate, current or former smoker, and biomass fuel smoke increased the odds of COPD in both the definitions. Conclusion: COPD is highly prevalent at community level and often underdiagnosed. Strategies aiming at early diagnosis and treatment of COPD, especially for the elderly, illiterate, and reducing exposure to smoking and biomass fuel smoke and childhood lung infection could be effective.

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  • 10.
    Adhikari, Tara Ballav
    et al.
    Aarhus Univ, Sect Global Hlth, Dept Publ Hlth, Aarhus, Denmark.;Nepal Dev Soc, COBIN Project, Bharatpur, Chitwan, Nepal..
    Neupane, Dinesh
    Nepal Dev Soc, COBIN Project, Bharatpur, Chitwan, Nepal.;Johns Hopkins Univ, Dept Epidemiol, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD USA..
    Karki, Arjun
    HAMS Hosp, Dept Pulm Crit Care & Sleep Med, Kathmandu, Nepal..
    Drews, Arne
    Nepalmed, Leipzig, Germany..
    Cooper, Brendan
    Univ Hosp Birmingham, Lung Funct & Sleep, Birmingham, W Midlands, England..
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Sigsgaard, Torben
    Aarhus Univ, Sect Environm Occupat & Hlth, Dept Publ Hlth, Aarhus, Denmark..
    Kallestrup, Per
    Aarhus Univ, Sect Global Hlth, Dept Publ Hlth, Aarhus, Denmark..
    Community-based intervention for prevention and management of chronic obstructive pulmonary disease in Nepal (COBIN-P trial): study protocol for a cluster-randomized controlled trial2021In: Trials, E-ISSN 1745-6215, Vol. 22, article id 474Article in journal (Refereed)
    Abstract [en]

    Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide and the commonest of non-communicable diseases (NCDs) in Nepal. Risk factors like indoor and outdoor air pollution, a high prevalence of smoking, and the lack of awareness of COPD make it a serious public health concern. However, no attempt has been made in Nepal to estimate its burden and address the disease at the community level.

    Method: This study aims to evaluate the effect of a community-based health educational intervention administered by Female Community Health Volunteers (FCHVs) on the prevention and management of COPD. An open-label, two-group, community-based, cluster-randomized controlled trial will be implemented in the semi-urban area of Pokhara Metropolitan city (former Lekhnath Municipality) located in the Kaski district of Nepal. The estimated sample size of the intervention will be 1143. The unit of randomization is the ward (administrative unit) of the study area. The follow-up survey will be conducted immediately after 12months of FCHVs-led interventions. The difference in the rate of decline of forced expiratory volume in 1s (FEV1) and FEV1/FVC (forced vital capacity) ratio are the primary outcomes and the change in the proportion of modifiable risk factors of COPD, health-related quality of life scores, and change in knowledge of COPD will be secondary outcomes.

    Discussion: This study will estimate the burden of COPD, the magnitude of risk factors and generate evidence to mobilize community health workers for COPD prevention and management at the community level in Nepal.Trial registrationClinicalTrials.gov NCT03797768. Registered on January 9, 2019.

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  • 11.
    Adhikari, Tara Ballav
    et al.
    Nepal Hlth Frontiers, Tokha 5, Kathmandu 44600, Nepal.;Nepal Dev Soc, COBIN Project, Chitwan, Nepal.;Aarhus Univ, Dept Publ Hlth, Sect Environm Occupat & Hlth, Aarhus, Denmark..
    Paudel, Kiran
    Nepal Hlth Frontiers, Tokha 5, Kathmandu 44600, Nepal..
    Paudel, Rajan
    Nepal Hlth Frontiers, Tokha 5, Kathmandu 44600, Nepal..
    Bhusal, Sandesh
    Nepal Hlth Frontiers, Tokha 5, Kathmandu 44600, Nepal..
    Rijal, Anupa
    Nepal Hlth Frontiers, Tokha 5, Kathmandu 44600, Nepal.;Nepal Dev Soc, COBIN Project, Chitwan, Nepal.;Univ Southern Denmark, Fac Hlth Sci, Dept Reg Hlth Res, Odense, Denmark..
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Neupane, Dinesh
    Nepal Dev Soc, COBIN Project, Chitwan, Nepal.;Johns Hopkins Univ, Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA..
    Sigsgaard, Torben
    Aarhus Univ, Dept Publ Hlth, Sect Environm Occupat & Hlth, Aarhus, Denmark..
    Kallestrup, Per
    Aarhus Univ, Dept Publ Hlth, Sect Global Hlth, Aarhus, Denmark..
    Burden and risk factors of chronic respiratory diseases in Nepal, 1990-2019: An analysis of the global burden of diseases study2023In: Health Science Reports, E-ISSN 2398-8835, Vol. 6, no 2, article id e1091Article in journal (Refereed)
    Abstract [en]

    Background and Aims: Chronic respiratory diseases (CRDs) substantially contribute to morbidity and mortality globally and in Nepal. However, there is a paucity of evidence on the trend and the burden of CRDs in Nepal. This study reports the trend of the burden and contribution of major risk factors to CRDs in Nepal from 1990 to 2019.

    Methods: This study is an observational study using publicly available data from Global Burden of Disease 2019 estimations for Nepal. The age-standardized and age-specific prevalence, incidence, mortality, disability-adjusted life years (DALYs), and risk factors for CRDs in Nepal were extracted to measure the burden and its trend. The data are presented as percentages or as rates per 100,000 population.

    Results: The age-standardized incidence rate of CRDs in Nepal in 2019 was 913.6 per 100,000 (95% uncertainty interval [UI]: 828.7-1000.1), which was an increase of 7.7% from 848.6 per 100,000 (95% UI: 780.2-918.2) in 1990. However, the age-standardized prevalence rate [4453/100,000 (4234.2-4671.8) in 1990; 4457.1/100,000 (4255.2-4666.8) in 2019] was almost stagnant. Most CRDs attributed to deaths and DALYs were due to chronic obstructive pulmonary disease.

    Conclusions: Air pollution and smoking are the main risk factors for DALYs due to CRDs in Nepal. This surging burden of the incidence rate of CRDs in Nepal calls for more effective actions to curb the risk factors and diseases.

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  • 12.
    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.

  • 13.
    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.

  • 14.
    Ahmadi, Zainab
    et al.
    Lund Univ, Fac Med, Dept Clin Sci Lund, Resp Med & Allergol, Lund, Sweden..
    Igelström, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Sandberg, Jacob
    Lund Univ, Fac Med, Dept Clin Sci Lund, Resp Med & Allergol, Lund, Sweden..
    Sundh, Josefin
    Örebro Univ, Sch Med Sci, Dept Resp Med, Örebro, Sweden..
    Sköld, Magnus
    Karolinska Inst, Dept Med Solna, Resp Med Unit, Stockholm, Sweden.;Karolinska Inst, Ctr Mol Med, Stockholm, Sweden.;Karolinska Univ Hosp Solna, Dept Resp Med & Allergy, Stockholm, Sweden..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Blomberg, Anders
    Umeå Univ, Dept Publ Hlth & Clin Med, Sect Med, Umeå, Sweden..
    Bornefalk, Hans
    Hans Bornefalk AB, Vallentuna, Sweden..
    Bornefalk Hermansson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR).
    Ekström, Magnus
    Lund Univ, Fac Med, Dept Clin Sci Lund, Resp Med & Allergol, Lund, Sweden..
    Agreement of the modified Medical Research Council and New York Heart Association scales for assessing the impact of self-rated breathlessness in cardiopulmonary disease2022In: ERJ Open Research, E-ISSN 2312-0541, Vol. 8, no 1, article id 00460-2021Article in journal (Refereed)
    Abstract [en]

    Background The functional impact of breathlessness is assessed using the modified Medical Research Council (mMRC) scale for chronic respiratory disease and with the New York Heart Association Functional Classification (NYHA) scale for heart failure. We evaluated agreement between the scales and their concurrent validity with other clinically relevant patient-reported outcomes in cardiorespiratory disease. Methods Outpatients with stable chronic respiratory disease or heart failure were recruited. Agreement between the mMRC and NYHA scales was analysed using Cramer's V and Kendall's tau B tests. Concurrent validity was evaluated using correlations with clinically relevant measures of breathlessness, anxiety, depression, and health-related quality of life. Analyses were conducted for all participants and separately in chronic obstructive pulmonary disease (COPD) and heart failure. Results In a total of 182 participants with cardiorespiratory disease, the agreement between the mMRC and NYHA scales was moderate (Cramer's V: 0.46; Kendall's tau B: 0.57) with similar results for COPD (Cramer's V: 0.46; Kendall's tau B: 0.66) and heart failure (Cramer's V: 0.46; Kendall's tau B: 0.67). In the total population, the scales correlated in similar ways to other patient-reported outcomes. Conclusion In outpatients with cardiorespiratory disease, the mMRC and NYHA scales show moderate to strong correlations and similar associations with other patient-reported outcomes. This supports that the scales are comparable when assessing the impact of breathlessness on function and patient-reported outcomes.

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  • 15.
    Akerstedt, T.
    et al.
    Karolinska Inst, Stockholm, Sweden.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Schwaz, J.
    Stockholm Univ, Stocholm, Sweden.
    What Characterizes the Combination of Seeking Medical Help for Insomnia and Snoring in Terms of PSG and Metabolic Parameters?2017In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 40, p. A34-A34Article in journal (Other academic)
  • 16.
    Akerstedt, T.
    et al.
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Schwarz, J.
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    The change in sleepiness across 10 years of aging and its relation to changes in polysomnographic variables2017In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Supplement 1, p. E8-E8Article in journal (Other academic)
  • 17.
    Akerstedt, Torbjorn
    et al.
    Karolinska Inst, Dept Clin Neurosci, S-17177 Stockholm, Sweden;Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Schwarz, Johanna
    Karolinska Inst, Dept Clin Neurosci, S-17177 Stockholm, Sweden;Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Gruber, Georg
    Siesta Grp, Vienna, Austria.
    Theorell-Haglöw, Jenny
    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.
    Women with both sleep problems and snoring show objective impairment of sleep2018In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 51, p. 80-84Article in journal (Refereed)
    Abstract [en]

    Objective: Combined insomnia and obstructive sleep apnea has been the focus of considerable research with respect to its health effects. A related issue is whether sleep disturbances in combination with snoring might exert effects on objective sleep variables in the non-clinical general population. The purpose of the present study was to investigate the polysomnographical characteristics of individuals who had sought medical help for both disturbed sleep and for snoring. No previous work of this type has been carried out. Method: For this study we used a representative set of data of 384 women with one night of in-home PSG. We identified those individuals who had sought medical help for sleep problems (SL), individuals that had sought help for snoring (SN), as well as those that had sought help for either both (Combined), or for neither (Control). Results: Our results yielded an N of 46, 16, 21, and 301 individuals, respectively. A one-factor analysis of variance showed significant main effects on N1% (F = 10.2, p < 0.001), N3% (F = 2.7, p < 0.05), AHI/h (F = 5.5, p < 0.001), and a delta power measure (F = 3.8, p < 0.05). The combined group showed significantly higher levels than the other groups for N1% (29% vs < 21%), AHI/h (19/h vs < 10/h) and lower levels for N3%, and a measure of delta power. Reported sleep quality measures did not show the same pattern, since the highest/lowest value were found for either the group presenting snoring alone or sleep problems alone. Conclusion: We concluded that individuals who had sought help for both insomnia and snoring showed impaired sleep in terms of PSG and that this was not reflected in ratings of sleep or health. This suggests that simultaneous sleep disturbances and snoring may potentiate each other to cause impaired sleep, yet the mechanism still needs to be elucidated.

  • 18.
    Akerstedt, Torbjorn
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Univ, Stress Res Inst, Dept Psychol, Stockholm, Sweden.;Karolinska Inst, Clin Neurosci, S-17177 Stockholm, Sweden..
    Schwarz, Johanna
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Univ, Stress Res Inst, Dept Psychol, Stockholm, Sweden..
    Theorell-Haglöw, Jenny
    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.
    What do women mean by poor sleep?: A large population-based sample with polysomnographical indicators, inflammation, fatigue, depression, and anxiety2023In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 109, p. 219-225Article in journal (Refereed)
    Abstract [en]

    Survey studies indicate that reports of disturbed sleep are prevalent and may be prospectively linked to several major diseases. However, it is not clear what self-reported disturbed sleep represents, since the link with objective sleep measures (polysomnography; PSG) seems very weak. The purpose of the present study was to try to investigate what combination of variables (PSG, inflammation, fatigue, anxiety, depression) that would characterize those who complain of disturbed sleep. This has never been done before. Participants were 319 women in a population-based sample, who gave ratings of sleep quality, fatigue, depression, and anxiety, then had their sleep recorded at home, and had blood drawn the following morning for analysis of immune parameters. Correlations and hierarchical multivariable regression analyses were applied to the data. For ratings of difficulties initiating sleep, the associations in the final step were beta =.22, (p <.001) for fatigue, beta = 0.22 (p <.001) for anxiety, and beta = 0.17 (p <.01) for sleep latency, with R-2 = 0.14. The rating of repeated awakenings was associated with fatigue (beta = 0.35, p <.001) and C-reactive protein (CRP) (beta = 0.12, p <.05), with R-2 = 0.19. The rating of early morning awakenings was associated with fatigue (beta = 0.31, p <.001), total sleep time (TST) (beta = -0.20, p <.01), and CRP (beta = 0.15, p <.05), with R-2 = 0.17. Interleukin-6 and Tumour Necrosis Factor were not associated with ratings of sleep problems. The results indicate that subjective fatigue, rather than objective sleep variables, is central in the perception of poor sleep, together with CRP.

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  • 19.
    Alaie, Iman
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry.
    Philipson, Anna
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Copeland, William E.
    Department of Psychiatry, Vermont Center for Children, Youth, and Families, University of Vermont, Burlington, USA.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry. Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Adolescent depression and adult labor market marginalization: a longitudinal cohort study2022In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 31, no 11, p. 1799-1813Article in journal (Refereed)
    Abstract [en]

    Adolescent depression is linked to adult ill-health and functional impairment, but recent research suggests that individual/contextual factors might account for this association. This study aimed to test whether the clinical heterogeneity of adolescent depression is related to marginalization from the labor market across early to middle adulthood. Data were drawn from the Uppsala Longitudinal Adolescent Depression Study, a community-based cohort initially assessed with structured clinical interviews at age 16-17. The cohort (n = 321 depressed; n = 218 nondepressed) was followed up after 2+ decades through linkage to nationwide population-based registries. Outcomes included consecutive annual data on unemployment, work disability, social welfare recipiency, and a composite marginalization measure, spanning from age 21 to 40. Longitudinal associations were examined using logistic regression analysis in a generalized estimating equations modeling framework. Subsequent depressive episodes and educational attainment in early adulthood were explored as potential pathways. The results showed that adolescent depression was associated with adult marginalization outcomes, but the strength of association varied across depressed subgroups. Adolescents with persistent depressive disorder had higher odds of all outcomes, including the composite marginalization measure (adjusted OR = 2.0, 95% CI = 1.4-2.7, p < 0.001), and this was partially (31%) mediated by subsequent depressive episodes in early adulthood. Exploratory moderation analysis revealed that entry into tertiary education mitigated the association with later marginalization, but only for adolescents with episodic major depression. In conclusion, the risk for future labor market marginalization is elevated among depressed adolescents, particularly those presenting with persistent depressive disorder. Targeted interventions seem crucial to mitigate the long-lasting impact of early-onset depression.

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  • 20.
    Ali, Azheen
    et al.
    Department of Orthodontics, College of Dentistry, University of Sulaimani, Sulaimanyah, Iraq.
    Ismail, Hadi
    Department of Orthodontics, College of Dentistry, University of Sulaimani, Sulaimanyah, Iraq.
    Amin, Kawa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Department of Microbiology/Immunology, College of Medicine, University of Sulaimani, Sulaimanyah, Iraq.
    Effect of nanosilver mouthwash on prevention of white spot lesions in patients undergoing fixed orthodontic treatment: a randomized double-blind clinical trial2022In: Journal of Dental Sciences, ISSN 1991-7902, Vol. 17, no 1, p. 249-255Article in journal (Refereed)
    Abstract [en]

    Background/purpose The formation of white spot lesions (WSLs) around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, marking the result of a successfully completed treatment. This double-blind, randomized clinical trial study aims to investigate the varying effects of nano-silver, chlorhexidine (CHX) or fluoride mouthwashes on WSLs.

    Materials and methods Double-blind prospective randomized clinical trial, comprised of forty-two patients with mild to moderate crowding, were recruited for this study. Randomization and allocation to trial group were carried out by computer system in college of dentistry, university of Sulaimani from January 2020 to September 2020. The patients were divided into three groups (14 per group) according to the type of mouthwash used during the treatment (nano-silver, CHX or fluoride), using block randomization. The clinical examination for the presence of WSLs was recorded through visual examination of the upper and lower anterior teeth using the International Caries Detection and Assessment System (ICDAS II) score before bonding and at 30, 90 and 180 days after bonding of the upper and lower arches.

    Results The total number of patients was 42 (16 males and 26 females) with a mean age of 23.02 ± 3.841 (18–37) years old, distributed into three groups of 14 patients. There is significant difference in white spot lesions formation between the three groups; the mean of WSLs in nanosilver group is lower than CHX and fluoride group in 90 and 180 days of follow-up (P < 0.05).

    Conclusion Nano-silver mouthwash is more effective than CHX and fluoride mouthwash in reducing WSLs during orthodontic treatment.

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  • 21.
    Alvarado-Vazquez, Perla Abigail
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Mendez-Enriquez, Erika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Salomonsson, Maya
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Waern, Ida
    Department of Anatomy, Physiology and Biochemistry, Swedish University of Agriculture.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Wernersson, Sara
    Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Hallgren, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    ­­Circulating mast cell progenitors increase in frequency during natural birch pollen exposure in allergic asthma patients2023In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 78, no 11, p. 2959-2968Article in journal (Refereed)
    Abstract [en]

    Background: Mast cells (MCs) develop from a rare population of peripheral blood circulating MC progenitors (MCps). Here, we investigated whether the frequency of circulating MCps is altered in asthma patients sensitized to birch pollen during pollen season, compared to out of season.

    Methods: Asthma patients were examined during birch pollen season in late April to early June (May), and out of season in November–January. Spirometry measurements, asthma and allergy-related symptoms, asthma control questionnaire (ACQ), and asthma control test (ACT) scores were assessed at both time points. The MCp frequency was determined by flow cytometry in ficoll-separated blood samples from patients with positive birch pollen-specific IgE, and analyzed in relation to basic and disease parameters.

    Results: The frequency of MCps per liter of blood was higher in May than in November (p = .004), particularly in women (p = .009). Patients that reported moderate to severe asthma symptoms (<.0001), nose or eye symptoms (p = .02; p = .01), or reduced asthma control (higher ACQ, p = .01) had higher MCp frequency in May than those that did not report this. These associations remained significant after adjusting for sex and BMI. The change in asthma control to a lower ACT score in May correlated with an increase in MCp frequency in May (p = .006, rho = 0.46).

    Conclusions: The data suggest that the frequency of MCps increases in symptomatic patients with allergic asthma. Our results unravel a link between asthma symptoms and circulating MCps, and bring new insight into the impact of natural allergen exposure on the expansion of MCs.

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  • 22.
    Amaral, Andre F. S.
    et al.
    Imperial Coll London, Natl Heart & Lung Inst, London SW3 6LR, England..
    Burney, Peter G. J.
    Imperial Coll London, Natl Heart & Lung Inst, London SW3 6LR, England..
    Patel, Jaymini
    Imperial Coll London, Natl Heart & Lung Inst, London SW3 6LR, England..
    Minelli, Cosetta
    Imperial Coll London, Natl Heart & Lung Inst, London SW3 6LR, England..
    Mejza, Filip
    Jagiellonian Univ Med Coll, Ctr Evidence Based Med, Dept Internal Med 2, Krakow, Poland..
    Mannino, David M.
    Univ Kentucky, Prevent Med & Environm Hlth, Lexington, KY USA..
    Seemungal, Terence A. R.
    Univ West Indies St Augustine, Clin Med Sci, St Augustine, Trinidad Tobago..
    Mahesh, Padukudru Anand
    JSS Med Coll & Hosp, Resp Med, Mysore, Karnataka, India..
    Lo, Li Cher
    RCSI & UCD Malaysia Campus, Dept Med, Georgetown, Pulau Pinang, Malaysia..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Juvekar, Sanjay
    King Edward Mem Hosp Pune, Vadu Rural Hlth Program, Pune, Maharashtra, India..
    Denguezli, Meriam
    Univ Sousse, Lab Physiol Explorat Fonct, Fac Med Sousse, Sousse, Tunisia..
    Harrabi, Imed
    Univ Sousse, Lab Physiol Explorat Fonct, Fac Med Sousse, Sousse, Tunisia..
    Wouters, Emiel F. M.
    Maastricht Univ, Dept Resp Med, Maastricht, Netherlands..
    Cherkaski, Hamid
    Univ Badji Mokhtar Annaba, Serv Epidemiol Med Prevent, Fac Med, Annaba, Algeria..
    Mortimer, Kevin
    Univ Liverpool Liverpool Sch Trop Med, Clin Sci, Liverpool, England.;Aintree Univ Hosp NHS Fdn Trust, Resp Med, Liverpool, England..
    Jogi, Rain
    Tartu Univ Hosp, Lung Clin, Tartu, Estonia..
    Bateman, Eric D.
    Univ Cape Town, Div Resp Med, Rondebosch, South Africa..
    Fuertes, Elaine
    Imperial Coll London, Natl Heart & Lung Inst, London SW3 6LR, England..
    Al Ghobain, Mohammed
    King Saud Bin Abdulaziz Univ Hlth Sci, Dept Med, Riyadh, Saudi Arabia.;King Saud Bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Riyadh, Saudi Arabia..
    Tan, Wan
    Univ British Columbia, iCAPTURE Ctr, Vancouver, ON, Canada..
    Obaseki, Daniel O.
    Obafemi Awolowo Univ, Med, Ife, Nigeria..
    El Sony, Asma
    Epi Lab, Khartoum, North Sudan..
    Studnicka, Michael
    Paracelsus Med Univ Salzburg, Dept Pulm Med, Salzburg, Austria..
    Aquart-Stewart, Althea
    Univ West Indies Mona, Dept Internal Med, Mona, Jamaica..
    Koul, Parvaiz
    SKIMS, Pulm Med, Srinagar, Jammu & Kashmir, India..
    Lawin, Herve
    Univ Abomey Calavi, Occupat & Environm Hlth, Cotonou, Benin..
    Nafees, Asaad Ahmed
    Aga Khan Univ, Commun Hlth Sci, Karachi, Pakistan..
    Awopeju, Olayemi
    Obafemi Awolowo Univ, Med, Ife, Nigeria..
    Erhabor, Gregory E.
    Obafemi Awolowo Univ, Med, Ife, Nigeria..
    Gislason, Thorarinn
    Landspitali Univ Hosp, Dept Sleep, Reykjavik, England.;Univ Iceland, Med, Reykjavik, Iceland..
    Welte, Tobias
    Hannover Med Sch, Resp Med, Hannover, Germany..
    Gulsvik, Amund
    Haukeland Hosp, Dept Thorac Med, Bergen, Norway..
    Nielsen, Rune
    Haukeland Hosp, Dept Thorac Med, Bergen, Norway.;Univ Bergen, Dept Clin Sci, Bergen, Norway..
    Gnatiuc, Louisa
    Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England..
    Kocabas, Ali
    Cukurova Univ, Sch Med, Dept Chest Dis, Adana, Turkey..
    Marks, Guy B.
    Woolcock Inst Med Res, Resp & Environm Epidmiol, Glebe, NSW, Australia.;Univ New South Wales, South Western Sydney Clin Sch, Sydney, NSW, Australia..
    Sooronbaev, Talant
    Natl Ctr Cardiol & Internal Med, Dept Resp Med, Bishkek, Kyrgyzstan..
    Mbatchou Ngahane, Bertrand Hugo
    Douala Gen Hosp, Internal Med, Douala, Cameroon..
    Barbara, Cristina
    Lisbon Univ, Inst Environm Hlth, Lisbon Med Sch, Lisbon, Portugal..
    Buist, A. Sonia
    Oregon Hlth & Sci Univ, Pulm & Crit Care Med, Portland, OR USA..
    Chronic airflow obstruction and ambient particulate air pollution2021In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 76, no 12, p. 1236-1241Article in journal (Refereed)
    Abstract [en]

    Smoking is the most well-established cause of chronic airflow obstruction (CAO) but particulate air pollution and poverty have also been implicated. We regressed sex-specific prevalence of CAO from 41 Burden of Obstructive Lung Disease study sites against smoking prevalence from the same study, the gross national income per capita and the local annual mean level of ambient particulate matter (PM2.5) using negative binomial regression. The prevalence of CAO was not independently associated with PM2.5 but was strongly associated with smoking and was also associated with poverty. Strengthening tobacco control and improved understanding of the link between CAO and poverty should be prioritised.

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  • 23.
    Amaral, Andre F. S.
    et al.
    Univ London Imperial Coll Sci Technol & Med, Resp Epidemiol Occupat Med & Publ Hlth, Natl Heart & Lung Inst, Emmanuel Kaye Bldg,1B Manresa Rd, London SW3 6LR, England..
    Newson, Roger B.
    Univ London Imperial Coll Sci Technol & Med, Resp Epidemiol Occupat Med & Publ Hlth, Natl Heart & Lung Inst, Emmanuel Kaye Bldg,1B Manresa Rd, London SW3 6LR, England.;Univ London Imperial Coll Sci Technol & Med, Dept Primary Care & Publ Hlth, Sch Publ Hlth, London, England..
    Abramson, Michael J.
    Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic 3004, Australia..
    Anto, Josep M.
    Ctr Res Environm Epidemiol CREAL, Barcelona, Spain.;IMIM Hosp del Mar, Med Res Inst, Barcelona, Spain.;UPF, Barcelona, Spain.;CIBERESP, Madrid, Spain..
    Bono, Roberto
    Univ Turin, Dept Publ Hlth & Pediat, Turin, Italy..
    Corsico, Angelo G.
    Univ Pavia, Div Resp Dis, IRCCS Policlin San Matteo Fdn, Via Palestro 3, I-27100 Pavia, Italy..
    de Marco, Roberto
    Univ Verona, Unit Epidemiol & Med Stat, Dept Publ Hlth & Community Med, I-37100 Verona, Italy..
    Demoly, Pascal
    CHU Montpellier, Dept Pulmonol, Div Allergy, Arnaud de Villeneuve Hosp, Paris, France.;INSERM, EPAR Team, UMR S 1136, Paris, France..
    Forsberg, Bertil
    Umea Univ, Div Occupat & Environm Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Gislason, Thorarinn
    Univ Iceland, Fac Med, Reykjavik, Iceland.;Natl Univ Hosp Iceland, Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland..
    Heinrich, Joachim
    Helmholtz Zentrum, Inst Epidemiol 1, Munich, Germany.;Univ Munich, Inst & Outpatient Clin Occupat Social & Environm, Inner City Clin, Univ Hosp Munich, Munich, Germany..
    Huerta, Ismael
    Dept Hlth Asturias, Directorate Gen Publ Hlth, Epidemiol Surveillance Sect, Oviedo, Spain..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Jogi, 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, Tartu, Estonia..
    Kim, Jeong-Lim
    Univ Gothenburg, Dept Publich Hlth & Community Med, Sahlgrenska Acad, Gothenburg, Sweden..
    Maldonado, Jose
    Univ Hosp Huelva, Unit Clin Management Pneumol & Allergy, Huelva, Spain..
    Rovira, Jesus Martinez-Moratalla
    Univ Hosp Albacete, Unit Pneumol, Albacete, Spain..
    Neukirch, Catherine
    INSERM, UMR1152, Paris, France.;Univ Paris 07, UMR1152, Paris, France..
    Nowak, Dennis
    Univ Munich, Inst & Outpatient Clin Occupat Social & Environm, Inner City Clin, Univ Hosp Munich, Munich, Germany.;German Ctr Lung Res, Munich, Germany..
    Pin, Isabelle
    CHU Grenoble, Pole Couple Enfants, Pediat, F-38043 Grenoble, France.;Inst Albert Bonniot, INSERM, U823, Grenoble, France.;Univ Grenoble 1, Grenoble, France..
    Probst-Hensch, Nicole
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland.;Univ Basel, Basel, Switzerland..
    Raherison-Semjen, Chantal
    Bordeaux Univ, Inst Publ Hlth & Epidemiol, INSERM, U897, Bordeaux, France..
    Svanes, Cecilie
    Univ Bergen, Ctr Int Hlth, Bergen, Norway.;Haukeland Hosp, Dept Occupat Med, N-5021 Bergen, Norway..
    Landa, Isabel Urrutia
    Galdakao Hosp, Dept Pneumol, Bizkaia, Spain..
    van Ree, Ronald
    Univ Amsterdam, Acad Med Ctr, Dept Expt Immunol, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands.;Univ Amsterdam, Acad Med Ctr, Dept Otorhinolaryngol, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands..
    Versteeg, Serge A.
    Univ Amsterdam, Acad Med Ctr, Dept Expt Immunol, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands..
    Weyler, Joost
    Univ Antwerp, Epidemiol & Social Med, B-2020 Antwerp, Belgium.;Univ Antwerp, StatUA Stat Ctr, B-2020 Antwerp, Belgium..
    Zock, Jan-Paul
    Ctr Res Environm Epidemiol CREAL, Barcelona, Spain.;UPF, Barcelona, Spain.;CIBERESP, Madrid, Spain..
    Burney, Peter G. J.
    Univ London Imperial Coll Sci Technol & Med, Resp Epidemiol Occupat Med & Publ Hlth, Natl Heart & Lung Inst, Emmanuel Kaye Bldg,1B Manresa Rd, London SW3 6LR, England..
    Jarvis, Deborah L.
    Univ London Imperial Coll Sci Technol & Med, Resp Epidemiol Occupat Med & Publ Hlth, Natl Heart & Lung Inst, Emmanuel Kaye Bldg,1B Manresa Rd, London SW3 6LR, England..
    Changes in IgE sensitization and total IgE levels over 20 years of follow-up2016In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 137, no 6, p. 1788-1795Article in journal (Refereed)
    Abstract [en]

    Background: Cross-sectional studies have reported a lower prevalence of sensitization in older adults, but few longitudinal studies have examined whether this is an aging or a year-of-birth cohort effect. Objective: We sought to assess changes in sensitization and total IgE levels in a cohort of European adults as they aged over a 20-year period. Methods: Levels of serum specific IgE to common aeroallergens (house dust mite, cat, and grass) and total IgE levels were measured in 3206 adults from 25 centers in the European Community Respiratory Health Survey on 3 occasions over 20 years. Changes in sensitization and total IgE levels were analyzed by using regression analysis corrected for potential differences in laboratory equipment and by using inverse sampling probability weights to account for nonresponse. Results: Over the 20-year follow-up, the prevalence of sensitization to at least 1 of the 3 allergens decreased from 29.4% to 24.8% (-4.6%; 95% CI, -7.0% to -2.1%). The prevalence of sensitization to house dust mite (-4.3%; 95% CI, -6.0% to -2.6%) and cat (-2.1%; 95% CI, -3.6% to -0.7%) decreased more than sensitization to grass (-0.6%; 95% CI, -2.5% to 1.3%). Age-specific prevalence of sensitization to house dust mite and cat did not differ between year-of-birth cohorts, but sensitization to grass was most prevalent in the most recent ones. Overall, total IgE levels decreased significantly (geometric mean ratio, 0.63; 95% CI, 0.58-0.68) at all ages in all year-of-birth cohorts. Conclusion: Aging was associated with lower levels of sensitization, especially to house dust mite and cat, after the age of 20 years.

  • 24. Amaral, Andre F S
    et al.
    Potts, James
    Knox-Brown, Ben
    Bagkeris, Emmanouil
    Harrabi, Imed
    Cherkaski, Hamid Hacene
    Agarwal, Dhiraj
    Juvekar, Sanjay
    Anand, Mahesh Padukudru
    Gislason, Thorarinn
    Nafees, Asaad Ahmed
    Mortimer, Kevin
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Loh, Li Cher
    Paraguas, Stefanni Nonna
    Denguezli, Meriam
    Al Ghobain, Mohammed
    Mannino, David
    Njoroge, Martin W
    Devereux, Graham
    Seemungal, Terence
    Barbara, Cristina
    Kocabaş, Ali
    Ahmed, Rana
    Aquart-Stewart, Althea
    Studnicka, Michael
    Welte, Tobias
    Tan, Wan C
    van Zyl-Smit, Richard N
    Koul, Parvaiz
    Garcia-Larsen, Vanessa
    Minelli, Cosetta
    Buist, A Sonia
    Burney, Peter
    Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study2023In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 52, no 6, p. e364-e373Article in journal (Refereed)
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  • 25.
    Amaral, Rita
    et al.
    Univ Porto, Fac Med, CINTESIS Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2,Rua Dr Placido Costa S-N, P-4200450 Porto, Portugal;Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal.
    Fonseca, Joao A.
    Univ Porto, Fac Med, CINTESIS Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2,Rua Dr Placido Costa S-N, P-4200450 Porto, Portugal;Univ Porto, Fac Med, MEDCIDS Dept Community Med Informat & Hlth Sci, Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal.
    Jacinto, Tiago
    Univ Porto, Fac Med, CINTESIS Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2,Rua Dr Placido Costa S-N, P-4200450 Porto, Portugal;Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal.
    Pereira, Ana M.
    Univ Porto, Fac Med, CINTESIS Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2,Rua Dr Placido Costa S-N, P-4200450 Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Having concomitant asthma phenotypes is common and independently relates to poor lung function in NHANES 2007-20122018In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 8, article id 13Article in journal (Refereed)
    Abstract [en]

    Background: Evidence for distinct asthma phenotypes and their overlap is becoming increasingly relevant to identify personalized and targeted therapeutic strategies. In this study, we aimed to describe the overlap of five commonly reported asthma phenotypes in US adults with current asthma and assess its association with asthma outcomes. Methods: Data from the National Health and Nutrition Examination Surveys (NHANES) 2007-2012 were used (n =30,442). Adults with current asthma were selected. Asthma phenotypes were: B-Eos-high [if blood eosinophils (B-Eos) >= 300/mm(3)]; FeNO-high (FeNO >= 35 ppb); B-Eos&FeNO-low (B-Eos < 150/mm(3) and FeNO < 20 ppb); asthma with obesity (AwObesity) (BMI >= 30 kg/m(2)); and asthma with concurrent COPD. Data were weighted for the US population and analyses were stratified by age (< 40 and >= 40 years old). Results: Of the 18,619 adults included, 1059 (5.6% [95% CI 5.1-5.9]) had current asthma. A substantial overlap was observed both in subjects aged < 40 years (44%) and >= 40 years (54%). The more prevalent specific overlaps in both age groups were AwObesity associated with either B-Eos-high (15 and 12%, respectively) or B-Eos&FeNO-low asthma (13 and 11%, respectively). About 14% of the current asthma patients were"non-classified". Regardless of phenotype classification, having concomitant phenotypes was significantly associated with (adjusted OR, 95% CI) >= 2 controller medications (2.03, 1.16-3.57), and FEV1 < LLN (3.21, 1.74-5.94), adjusted for confounding variables. Conclusions: A prevalent overlap of commonly reported asthma phenotypes was observed among asthma patients from the general population, with implications for objective asthma outcomes. A broader approach may be required to better characterize asthma patients and prevent poor asthma outcomes.

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  • 26.
    Amaral, Rita
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research. Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente,Piso 2, P-4200450 Porto, Portugal; Polytech Inst Porto, Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal; Univ Porto, MEDCIDS Dept Community Med Informat & Hlth Sci, Fac Med, Porto, Portugal.
    Jacinto, Tiago
    Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente, Piso 2, P-4200450 Porto, Portugal; Polytech Inst Porto, Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Price, David
    Observat & Pragmat Res Inst, Singapore, Singapore; Univ Aberdeen, Div Appl Hlth Sci, Ctr Acad Primary Care, Aberdeen, Scotland.
    Fonseca, Joao A.
    Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente, Piso 2, P-4200450 Porto, Portugal; Univ Porto, MEDCIDS Dept Community Med Informat & Hlth Sci, Fac Med, Porto, Portugal.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research.
    The influence of individual characteristics and non-respiratory diseases on blood eosinophil count2021In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 11, no 4, article id e12036Article in journal (Refereed)
    Abstract [en]

    Background

    Blood eosinophil (B-Eos) count is an emerging biomarker in the management of respiratory disease but determinants of B-Eos count besides respiratory disease are poorly described. Therefore, we aimed to evaluate the influence of non-respiratory diseases on B-Eos count, in comparison to the effect on two other biomarkers: fraction of exhaled nitric oxide (FeNO) and C-reactive protein (CRP), and to identify individual characteristics associated with B-Eos count in healthy controls.

    Methods

    Children/adolescents (<18 years) and adults with complete B-Eos data from the US National Health and Nutritional Examination Surveys 2005–2016 were included, and they were divided into having respiratory diseases (n = 3333 and n = 7,894, respectively) or not having respiratory disease (n = 8944 and n = 15,010, respectively). After excluding any respiratory disease, the association between B-Eos count, FeNO or CRP, and non-respiratory diseases was analyzed in multivariate models and multicollinearity was tested. After excluding also non-respiratory diseases independently associated with B-Eos count (giving healthy controls; 8944 children/adolescents and 5667 adults), the independent association between individual characteristics and B-Eos count was analyzed.

    Results

    In adults, metabolic syndrome, heart disease or stroke was independently associated with higher B-Eos count (12%, 13%, and 15%, respectively), whereas no associations were found with FeNO or CRP. In healthy controls, male sex or being obese was associated with higher B-Eos counts, both in children/adolescents (15% and 3% higher, respectively) and adults (14% and 19% higher, respectively) (p < 0.01 all). A significant influence of race/ethnicity was also noted, and current smokers had 17% higher B-Eos count than never smokers (p < 0.001).

    Conclusions

    Non-respiratory diseases influence B-Eos count but not FeNO or CRP. Male sex, obesity, certain races/ethnicities, and current smoking are individual characteristics or exposures that are associated with higher B-Eos counts. All these factors should be considered when using B-Eos count in the management of respiratory disease.

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    fulltext
  • 27.
    Amaral, Rita
    et al.
    Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente,Piso 2, P-4200450 Porto, Portugal;Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal.
    Pereira, Ana M.
    Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente,Piso 2, P-4200450 Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal.
    Jacinto, Tiago
    Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente,Piso 2, P-4200450 Porto, Portugal;Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Fonseca, Joao A.
    Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente,Piso 2, P-4200450 Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal;Univ Porto, MEDCIDS Dept Community Med Informat & Hlth Sci, Fac Med, Porto, Portugal.
    Comparison of hypothesis- and data-driven asthma phenotypes in NHANES 2007-2012: the importance of comprehensive data availability2019In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 9, article id 17Article in journal (Refereed)
    Abstract [en]

    Background

    Half of the adults with current asthma among the US National Health and Nutrition Examination Survey (NHANES) participants could be classified in more than one hypothesis-driven phenotype. A data-driven approach applied to the same subjects may allow a more useful classification compared to the hypothesis-driven one.

    Aim

    To compare previously defined hypothesis-driven with newly derived data-driven asthma phenotypes, identified by latent class analysis (LCA), in adults with current asthma from NHANES 2007-2012.

    Methods

    Adults (18years) with current asthma from the NHANES were included (n=1059). LCA included variables commonly used to subdivide asthma. LCA models were derived independently according to age groups: <40 and 40years old.

    Results

    Two data-driven phenotypes were identified among adults with current asthma, for both age groups. The proportions of the hypothesis-driven phenotypes were similar among the two data-driven phenotypes (p>0.05). Class A <40years (n=285; 75%) and Class A 40years (n=462; 73%), respectively, were characterized by a predominance of highly symptomatic asthma subjects with poor lung function, compared to Class B <40years (n=94; 25%) and Class B 40years (n=170; 27%). Inflammatory biomarkers, smoking status, presence of obesity and hay fever did not markedly differ between the phenotypes.

    Conclusion

    Both data- and hypothesis-driven approaches using clinical and physiological variables commonly used to characterize asthma are suboptimal to identify asthma phenotypes among adults from the general population. Further studies based on more comprehensive disease features are required to identify asthma phenotypes in population-based studies.

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  • 28.
    Amid Hägg, Shadi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Sleep disturbances: Consequences and comorbidities2021Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Sleep disorders are common in the general population, with insomnia and sleep-related breathing disorders being the most common disorders. Since sleep has many important functions, such as a role in consolidation of memories and learning, energy conservation, cardiovascular and immune system regulation, it is not surprising that the disruption of normal sleep may lead to negative health effects and various comorbidities.  

    Aim: The overall aim of this thesis was to investigate the impact of disturbed sleep on various consequences and comorbidities. 

    Methods and results: Papers I and II were based on the Sleep and Health in Women (SHE), a population-based prospective study of women, where a questionnaire was sent to women in 2000 and 2010. 

    In paper I, the study cohort comprised 4,320 women <67 years of age who answered both questionnaires and had worked during the follow-up period. In women, having a long history of insomnia symptoms was associated with an increased risk of self-reported occupational accidents.

    In paper II, the 4,882 participants who answered the questions regarding nocturnal gastroesophageal reflux and snoring in both questionnaires were included in the study cohort. Women with nocturnal gastroesophageal reflux and snoring were at an increased risk of developing daytime sleepiness and to involuntarily fall asleep during the day. 

    Paper III was based on the RHINE-cohort with participants from seven Northern European centers. The study cohort in paper III comprised the 2,568 smokers in the baseline study that also reported being smokers or former smokers in the follow-up study. It was found that having insomnia symptoms or excessive daytime sleepiness decreases the chance of long-term smoking cessation, and that smoking increases the risk of incident difficulties inducing sleep. 

    Paper IV was the population-based, cross-sectional GA2LEN-survey which was conducted in four major Swedish cities. Paper IV included the 25,901 participants who answered questions regarding both snoring and insomnia symptoms. The combination of snoring and insomnia symptoms was associated with an increased risk of hypertension, asthma, chronic obstructive pulmonary disease, and daytime sleepiness. 

    Conclusions: Disturbed sleep, due to varying causes, influences the risk of occupational accidents, on the chance of successful smoking cessation, on the risk of daytime sleepiness, hypertension, and obstructive lung disease. In clinical consultation, it is important to always inquire about disturbed sleep as it can have an impact on many aspects of health.  

    List of papers
    1. Role of sleep disturbances in occupational accidents among women
    Open this publication in new window or tab >>Role of sleep disturbances in occupational accidents among women
    2015 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 41, no 4, p. 368-376Article in journal (Refereed) Published
    Abstract [en]

    Objectives This population-based cohort study was performed to assess the association between sleep disturbances and the risk of occupational accidents among women. Methods Data were collected by questionnaires on two different occasions (2000 and 2010) and data on work injuries were also collected from Swedish government records (ISA). Insomnia symptoms were defined as having severe or very severe problems with (i) difficulty initiating sleep, (ii) difficulty maintaining sleep, or (iii) early morning awakening. Symptom of obstructive sleep apnea syndrome (OSAS) was defined as reporting both snoring and daytime sleepiness. Working-age respondents (20-67 years of age) who responded to both baseline and follow-up questionnaires and had worked for part or all of the 10-year follow-up period (N=4320) were included in the study. Results Of the subjects responding to the questionnaire, 12.2% reported >= 1 accident and 6.3% reported an accident requiring sick leave in the government register. Blue-collar workers and night and shift work were more common in the group with occupational accidents. Subjects with insomnia symptoms both at baseline and follow-up (persistent insomnia symptoms) ran a higher risk of being involved in an self-reported occupational accident [adjusted OR (ORadj) 1.5, 95% confidence interval (95% CI) 1.2-2.0] after adjusting for age, body mass index, smoking, alcohol dependency, white- or blue-collar worker, years at work, night work, and physical activity. Persistent insomnia symptoms did not reach statistical significance as an independent predictor of register-reported occupational accident with sick leave (ORadj 1.4, 95% CI 0.99-2.1). No significant association was found between symptoms of OSAS and self-reported or register-based occupational accidents. Conclusions Persistent insomnia symptoms were associated with an increased risk of self-reported occupational accidents, while no significant association was found with occupational accidents with sick leave reported to government register.

    Keywords
    difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, insomnia, population-based study, work injury
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Respiratory Medicine and Allergy
    Identifiers
    urn:nbn:se:uu:diva-259678 (URN)10.5271/sjweh.3495 (DOI)000357361600006 ()25830787 (PubMedID)
    Available from: 2015-08-10 Created: 2015-08-10 Last updated: 2021-06-17
    2. Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women
    Open this publication in new window or tab >>Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women
    Show others...
    2019 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 53, p. 94-100Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: Daytime sleepiness is common in women and has negative health effects. Nocturnal gastroesophageal reflux (nGER) and snoring are risk factors for daytime sleepiness, but the effect of their interaction remains unknown. The aim of this study was to examine how nGER and snoring combined affected daytime sleepiness and involuntary falling asleep in women.

    METHODS: A questionnaire was sent to randomly selected women in 2000 and 2010. Participants who answered questions regarding both nGER and snoring in both questionnaires were included (N = 4882). Daytime sleepiness was defined as severe or very severe problems with daytime sleepiness. Involuntary falling asleep was defined as sometimes, often or very often falling asleep involuntarily during the day. Respondents snoring loudly and disturbingly sometimes, often or very often were defined as snorers. Having nocturnal heartburn or acid reflux sometimes, often or very often was defined as having nGER.

    RESULTS: Daytime sleepiness was reported by 14% of the participants, involuntary falling asleep by 11%. After adjustment for age, smoking, physical activity, caffeine intake and alcohol dependency, increased odd ratios (ORs) for both daytime sleepiness (adjusted OR 4.2, 95% confidence interval (CI): 1.9-9.2) and involuntary falling asleep (adjusted OR 3.1, 95% CI: 1.5-6.4) were seen in women with the combination of nGER and snoring at both baseline and follow-up. The association with daytime sleepiness was also strong for those with only persistent nGER but not for those with only persistent snoring.

    CONCLUSION: Women with nGER were at increased risk of developing daytime sleepiness and snoring augmented this association. In addition, women with both nGER and snoring were also at increased risk of developing involuntary falling asleep.

    Keywords
    Daytime sleepiness, Involuntary falling asleep, Nocturnal gastroesophageal reflux, Snoring
    National Category
    Gastroenterology and Hepatology Respiratory Medicine and Allergy
    Research subject
    Lung Medicine
    Identifiers
    urn:nbn:se:uu:diva-375498 (URN)10.1016/j.sleep.2018.08.036 (DOI)000457169500016 ()30504084 (PubMedID)
    Funder
    Swedish Heart Lung Foundation
    Available from: 2019-01-30 Created: 2019-01-30 Last updated: 2021-06-17Bibliographically approved
    3. Smokers with insomnia symptoms are less likely to stop smoking
    Open this publication in new window or tab >>Smokers with insomnia symptoms are less likely to stop smoking
    Show others...
    2020 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 170, article id 106069Article in journal (Refereed) Published
    Abstract [en]

    Objectives

    Smoking is associated with sleep disturbances. The aim of this study was to analyze whether sleep disturbances are predictors of smoking cessation and whether continued smoking is associated with the development of sleep disturbances.

    Methods

    A questionnaire was sent to randomly selected men and women in Northern Europe in 1999–2001 (RHINE II) and was followed up by a questionnaire in 2010–2012 (RHINE III). The study population consisted of 2568 participants who were smokers at baseline and provided data on smoking at follow-up. Insomnia symptoms were defined as having difficulty initiating and/or maintaining sleep and/or early morning awakening ≥3 nights/week. Multiple logistic regression analyses were performed to calculate odds ratios (OR).

    Results

    Subjects with difficulty initiating sleep (adjusted odds ratio; 95% confidence interval: 0.6; 0.4–0.8), difficulty maintaining sleep (0.7; 0.5–0.9), early morning awakening (0.6; 0.4–0.8), any insomnia symptom (0.6; 0.5–0.8) or excessive daytime sleepiness (0.7; 0.5–0.8) were less likely to achieve long-term smoking cessation after adjustment for age, BMI, pack-years, hypertension, diabetes, chronic bronchitis, rhinitis, asthma, gender and BMI difference. There was no significant association between snoring and smoking cessation. In subjects without sleep disturbance at baseline, continued smoking increased the risk of developing difficulty initiating sleep during the follow-up period compared with those that had quit smoking (adj. OR 1.7, 95% CI 1.2–2.3).

    Conclusions

    Insomnia symptoms and excessive daytime sleepiness negatively predict smoking cessation. Smoking is a risk factor for the development of difficulty initiating sleep. Treatment for sleep disturbances should be included in smoking-cessation programs.

    Keywords
    Moking cessation, Insomnia, Difficulties inducing sleep, Daytime sleepiness
    National Category
    Respiratory Medicine and Allergy Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-423159 (URN)10.1016/j.rmed.2020.106069 (DOI)000571749800024 ()32843184 (PubMedID)
    Funder
    Swedish Heart Lung FoundationThe Research Council of Norway, 214123
    Available from: 2020-11-18 Created: 2020-11-18 Last updated: 2021-06-17
    4. The negative health effects of having a combination of snoring and insomnia
    Open this publication in new window or tab >>The negative health effects of having a combination of snoring and insomnia
    Show others...
    2022 (English)In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 18, no 4Article in journal (Refereed) Published
    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

    Place, publisher, year, edition, pages
    American Academy of Sleep Medicine (AASM), 2022
    Keywords
    Snoring, Insomnia, hypertension, asthma, COPD, daytime sleepiness
    National Category
    Clinical Medicine Respiratory Medicine and Allergy
    Research subject
    Lung Medicine
    Identifiers
    urn:nbn:se:uu:diva-442992 (URN)10.5664/jcsm.9764 (DOI)000783900000004 ()34753555 (PubMedID)
    Funder
    Swedish Heart Lung FoundationBror Hjerpstedts stiftelse
    Available from: 2021-05-22 Created: 2021-05-22 Last updated: 2023-01-09Bibliographically approved
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  • 29.
    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

  • 30.
    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.
    Emilsson, Össur Ingi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Franklin, Karl
    Janson, Christer
    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.
    Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women2019In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 53, p. 94-100Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Daytime sleepiness is common in women and has negative health effects. Nocturnal gastroesophageal reflux (nGER) and snoring are risk factors for daytime sleepiness, but the effect of their interaction remains unknown. The aim of this study was to examine how nGER and snoring combined affected daytime sleepiness and involuntary falling asleep in women.

    METHODS: A questionnaire was sent to randomly selected women in 2000 and 2010. Participants who answered questions regarding both nGER and snoring in both questionnaires were included (N = 4882). Daytime sleepiness was defined as severe or very severe problems with daytime sleepiness. Involuntary falling asleep was defined as sometimes, often or very often falling asleep involuntarily during the day. Respondents snoring loudly and disturbingly sometimes, often or very often were defined as snorers. Having nocturnal heartburn or acid reflux sometimes, often or very often was defined as having nGER.

    RESULTS: Daytime sleepiness was reported by 14% of the participants, involuntary falling asleep by 11%. After adjustment for age, smoking, physical activity, caffeine intake and alcohol dependency, increased odd ratios (ORs) for both daytime sleepiness (adjusted OR 4.2, 95% confidence interval (CI): 1.9-9.2) and involuntary falling asleep (adjusted OR 3.1, 95% CI: 1.5-6.4) were seen in women with the combination of nGER and snoring at both baseline and follow-up. The association with daytime sleepiness was also strong for those with only persistent nGER but not for those with only persistent snoring.

    CONCLUSION: Women with nGER were at increased risk of developing daytime sleepiness and snoring augmented this association. In addition, women with both nGER and snoring were also at increased risk of developing involuntary falling asleep.

  • 31.
    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.
    Ljunggren, Mirjam
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Holm, Mathias
    Univ Gothenburg, Dept Occupat & Environm Med, Gothenburg, Sweden.
    Franklin, Karl A.
    Umeå Univ, Dept Surg & Perioperat Sci, Umeå, Sweden.
    Gislason, Thorarinn
    Landspitali Univ Hosp, Dept Sleep, Reykjavik, Iceland; Univ Iceland, Fac Med, Reykjavik, Iceland.
    Johannessen, Ane
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway; Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Jõgi, Rain
    Tartu Univ Hosp, Lung Clin, Tartu, Estonia.
    Olin, Anna-Carin
    Univ Gothenburg, Dept Occupat & Environm Med, Gothenburg, Sweden.
    Schlünssen, Vivi
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth, Aarhus, Denmark; Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Smokers with insomnia symptoms are less likely to stop smoking2020In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 170, article id 106069Article in journal (Refereed)
    Abstract [en]

    Objectives

    Smoking is associated with sleep disturbances. The aim of this study was to analyze whether sleep disturbances are predictors of smoking cessation and whether continued smoking is associated with the development of sleep disturbances.

    Methods

    A questionnaire was sent to randomly selected men and women in Northern Europe in 1999–2001 (RHINE II) and was followed up by a questionnaire in 2010–2012 (RHINE III). The study population consisted of 2568 participants who were smokers at baseline and provided data on smoking at follow-up. Insomnia symptoms were defined as having difficulty initiating and/or maintaining sleep and/or early morning awakening ≥3 nights/week. Multiple logistic regression analyses were performed to calculate odds ratios (OR).

    Results

    Subjects with difficulty initiating sleep (adjusted odds ratio; 95% confidence interval: 0.6; 0.4–0.8), difficulty maintaining sleep (0.7; 0.5–0.9), early morning awakening (0.6; 0.4–0.8), any insomnia symptom (0.6; 0.5–0.8) or excessive daytime sleepiness (0.7; 0.5–0.8) were less likely to achieve long-term smoking cessation after adjustment for age, BMI, pack-years, hypertension, diabetes, chronic bronchitis, rhinitis, asthma, gender and BMI difference. There was no significant association between snoring and smoking cessation. In subjects without sleep disturbance at baseline, continued smoking increased the risk of developing difficulty initiating sleep during the follow-up period compared with those that had quit smoking (adj. OR 1.7, 95% CI 1.2–2.3).

    Conclusions

    Insomnia symptoms and excessive daytime sleepiness negatively predict smoking cessation. Smoking is a risk factor for the development of difficulty initiating sleep. Treatment for sleep disturbances should be included in smoking-cessation programs.

  • 32.
    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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  • 33.
    Amin, Kawa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Univ Sulaimani, Dept Microbiol Immunol, Sch Med, Fac Med Sci, Sulaimani, Iraq.
    Allergic Respiratory Inflammation and Remodeling2015In: Turkish Thoracic Journal, ISSN 1302-7808, Vol. 16, no 3, p. 133-140Article, review/survey (Refereed)
    Abstract [en]

    Asthma and rhinitis are inflammatory diseases of the respiratory tract. Respiratory inflammation of the adaptive and innate immune system is the focus of this review, and chronic inflammation is not limited to the respiratory tissue. The inflammatory response, which consists of phagocytes, eosinophils, mast cells, and lymphocytes, spreads along the respiratory tract, leading to tissue damage. Mast cells and eosinophils are commonly recognized for their detrimental role in allergic reactions on activation through the high- and low-affinity receptors for IgE FcεRI. These cells rapidly produce and secrete many of the mediators responsible for the typical symptoms of asthma and rhinitis. However, increasing amount of evidence demonstrate that mast cells and leukocytes have vital roles in host defense against pathogenesis. Histological methods are used to study leukocytes and receptor expression pattern in different respiratory tract compartments.

    The overall aim of this review was to understand the relationship between upper and lower respiratory tract inflammation and remodeling in patients with allergic and non-allergic asthma and rhinitis. In conclusion, this review discusses the relationship between the upper and lower airway in respiratory disease and focuses on the effect of respiratory processes on laryngeal inflammation, remodeling, function, and symptoms; however, they also have a central role in the initiation of the allergic immune response. Our findings suggest that there are differences that contribute to the development of immunopathological mechanisms of these clinically distinct forms of asthma, rhinitis, and chronic obstructive pulmonary disease.

  • 34.
    Amin, Kawa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Levels of cytokines and GADA in type I and II diabetic patients2020In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 14, no 1, p. 61-67Article in journal (Refereed)
    Abstract [en]

    AbstractBACKGROUND:

    Diabetes Mellitus is described as a group of metabolic diseases in which the patient has higher blood glucose levels due to many causes. These include a defect in insulin secretion and failure of the body's cells to respond to the hormone. Cytokines and autoantibodies have a critical role in the pathogenesis of diabetes, especially type I.

    AIM OF THE STUDY:

    The aim of this study was to measure the serum levels of interleukin-1 beta (IL-1 β), interleukin-3 (IL-3), interferon-gamma (INF- γ), and glutamic acid decarboxylase autoantibody (GADA) in patients with type I and type II diabetes mellitus.

    MATERIAL AND METHODS:

    In this cross-sectional study, serum samples were taken from 250 individuals, including 100 samples from patients with type II diabetes mellitus, 100 samples from healthy controls, and 50 samples from patients with type I diabetes mellitus. Five milliliters of venous blood were taken from each individual and the samples were analyzed for cytokines (IL-1 β, IL-3, and INF- γ) and GABA using ELISA.

    RESULTS:

    In the study, we found that the serum levels of IL-1 β were significantly higher in the healthy control group compared to the patients with type I and type II diabetes mellitus. The levels of IL-3 and INF- γ were significantly higher in type II diabetes mellitus, while GABA serum levels were higher in type I diabetes mellitus.

    CONCLUSION:

    Our data showed that GADA is an important autoantibody, not only in type I but also in type II diabetes mellitus and can probably be used in the future for diagnosis of this disease. There was also a close association of GADA with systemic immunoregulation in type I and II diabetes mellitus. The relation of cytokines (IL-1 β, IL-3, and INF- γ) and GADA in patients with diabetes will also increase our understanding for the immunology of diabetes mellitus and to propose specific treatment on the basis of our findings. Our data also include correlation between age and the level of cytokines and GADA with different conclusion for each parameter.

  • 35.
    Amin, Kawa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Univ Sulaimani, Dept Microbiol Immunol, Coll Med, Sulaimani, Iraq.
    Ali, Kosar Muhammad
    Univ Sulaimani, Dept Med, Coll Med, Sulaimani, Iraq.
    Saeed, Amanj
    Minist Higher Educ & Sci Res, Erbil, Iraq.
    Rahman, Heshu Sulaiman
    Univ Sulaimani, Coll Vet Med, Sulaimani, Iraq.
    Byström, Jonas
    Barts & London Queen Mary Univ London, William Harvey Res Inst, Ctr Expt Med & Rheumatol, Charterhouse Sq, London EC1M 6BQ, England.
    Hepatic Immune Response to Environmental Carcinogens2018In: Pharmacognosy Magazine, ISSN 0973-1296, E-ISSN 0976-4062, Vol. 14, no 58, p. 548-553Article in journal (Refereed)
    Abstract [en]

    Aim: Environmental carcinogenic substances contribute to increasing incidence of hepatocellular carcinoma (HCC). We employed a sensitive method for the detection of DNA damage combined with analysis of the immune response to gain better knowledge how environmental carcinogens mediate pathology.

    Materials and Methods: Rat hepatocytes were isolated and stimulated with carcinogenic substances for the assessment of DNA damage. The mycotoxin aflatoxin B-1 (AFB(1)), two heterocyclic amines from the cooking of meat amino-3-methylimidazo[4,5-f] quinoline (IQ) and 3-amino-1-methyl-5H-pyr ido-(4,3-b)-indole (TRP-P-2), and protein extract from the fungus Lactarius necator were assayed. Unscheduled DNA synthesis in hepatocytes was measured by the incorporation of radioactive thymidine during DNA repair. Stimulation of hepatocyte/immune cell preparation with the substances and measurement of IFN gamma release at different time points determined their ability to induce an inflammatory response.

    Results: DNA repair in the hepatocytes was induced in response to 10(-7) M AFB(1) and 10(-9) M IQ. TRP-P-2 did not induce DNA repair; however, at 10(-4) M, the fungus extract did this. Furthermore, liver-resident immune cells responded with differential production of IFN gamma over time in response to stimulation by all the carcinogens, with AFB(1) being the most potent. TRP-P-2 showed the most significant reduction in IFN gamma response over time.

    Conclusion: DNA damage in hepatocytes induced by environmental substances was detected at low molecular concentrations. The system did provide novel evidence for hepatic carcinogenicity by the fungus L. necator. Analysis of the response by liver-resident immune cells to the substances suggested that highly mutagenic substances induce prolonged inflammatory response.

  • 36.
    Amin, Kawa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Department of Medicine and Microbiology/Immunology, College of Medicine, University of Sulaimani, Sulaimanyah, Iraq.
    Issa, Sulaf Mosa
    Department of Medicine and Microbiology/Immunology, College of Medicine, University of Sulaimani, Sulaimanyah, Iraq.
    Ali, Kosar Mohammad
    Department of Medicine and Microbiology/Immunology, College of Medicine, University of Sulaimani, Sulaimanyah, Iraq.
    Aziz, Muaid Ismiel
    Department of Medicine and Microbiology/Immunology, College of Medicine, University of Sulaimani, Sulaimanyah, Iraq.
    Hama Amieen, Huner Mohamed
    Otolaryngology Center, Sulaimani Teaching Hospital, Sulaimanyah, Iraq.
    Byström, Jonas
    Expermiental Medicine and Rheumatology, William Harvey Research Institute, Barts & The London, Queen Mary, University of London, Charterhouse Square, London, EC1M 6BQ, UK.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Evidence for eosinophil and IL-17 mediated inflammation in allergic rhinitis2020In: Clinical and Molecular Allergy, E-ISSN 1476-7961, Vol. 18, article id 6Article in journal (Refereed)
    Abstract [en]

    Background: The aim was to determine the level of inflammatory cytokines, eosinophil cationic protein and IgE in allergic rhinitis (AR) patients.

    Subjects and methods: Blood samples were taken from 88 AR patients and 88 healthy controls (HC). Each sample was analysed for eosinophil counts by flow cytometry, IgE by ECLIA, ECP, IL-17, and IL-33 by using ELISA test.

    Results: There was no significant difference between AR patients and the control group in age and gender. Levels of eosinophils, IgE, ECP, IL-17, IL-33 and the total symptom scores were significantly higher in AR patients than the HC (P = 0.0001). Serum ECP correlated with IL-17 (P = 0.041, r = 0.42), IL-33 (P = 0.0001, r = 080), and IgE levels (P = 0.017, r = 0.45) in the R patients. There was no correlation between IL-17 and IL-33. There was a correlation between symptom scores and eosinophils (P = 0.026, r = 0.52), and IgE (P = 0.001, r = 0.60) in the patients. No correlation was observed between symptom scores and ECP, IL-17, and IL-33 in the AR patient.

    Conclusions: Patients with AR have significant higher serum levels of ECP, IL-17, and IL-33 than healthy controls. This indicates that these markers could be used to in order to diagnose AR and to monitor disease. Inhibitory molecules to IL-17 and IL-33 may be considered as novel treatment strategies.

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  • 37.
    Andersson, Emelie
    et al.
    Swedish Inst Hlth Econ IHE, Lund, Sweden.;Swedish Inst Hlth Econ, Rabygatan 2, S-22361 Lund, Sweden..
    Löfvendahl, Sofia
    Swedish Inst Hlth Econ IHE, Lund, Sweden..
    Olofsson, Sara
    Swedish Inst Hlth Econ IHE, Lund, Sweden..
    Wahlberg, Karin
    Swedish Inst Hlth Econ IHE, Lund, Sweden..
    Bjermer, Leif
    Lund Univ, Dept Resp Med & Allergol, Lund, Sweden..
    Tornling, Göran
    Karolinska Inst, Dept Med Solna, Resp Med Div, Stockholm, Sweden..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Hjelmgren, Jonas
    Swedish Inst Hlth Econ IHE, Lund, Sweden..
    Disease burden and unmet need for acute allergic reactions - A patient perspective2024In: World Allergy Organization Journal, E-ISSN 1939-4551, Vol. 17, no 4, article id 100896Article in journal (Refereed)
    Abstract [en]

    Background: Acute allergic reactions (AARs) occur shortly after exposure to an allergen, and the severity is on a continuum. Systemic corticosteroids (CS) are mainstay treatment of moderate to severe AARs, whereas those at risk of the most severe AARs (ie, anaphylaxis) are also recommended prescription of epinephrine autoinjectors. There is limited research on the impact of AARs not fulfilling the criteria for anaphylaxis. We have characterized a sample with a history of moderate to severe AARs and evaluated their self-reported disease burden (ie, daily life impact, anxiety, and treatment impediments).

    Methods: Survey study of adults with experience of AARs treated with CS. Participants recruited from a web-based panel and using social media were asked to complete a questionnaire related to their allergy and experience of AARs. The results were summarized for the whole sample and across subgroups with and without prescription of epinephrine.

    Results: The final study sample included 387 participants (80% women, mean age 41), of which 129 (33%) had at some point been prescribed epinephrine. The most common symptoms were respiratory (80%) and skin (78%) manifestations, and the mean (standard deviation, SD) self-rated severity score (scale from 0 [very mild] to 10 [very severe]) of the most recent AAR was 6.1 (2.0). More than 80% had experience of AARs interrupting daily activities and 50% of AARs that had limited work/studies or participation in leisure activities. Most of the respondents reported some degree of anxiety related to AARs and 43% had feared for their lives. Moreover, difficulties swallowing allergy medicine at an AAR was experienced by 26% and not having the medicine available when needed by 66%. Participants with prescription of epinephrine experienced more severe AARs than those without such prescription (mean [SD] severity 6.8 [2.1] vs 5.8 [1.8], p < 0.0001); however, also those without epinephrine prescription reported considerable anxiety and impact on daily life and to a similar degree as those with prescription.

    Conclusions: In this sample, subjects with experience of AARs treated with CS showed a considerable disease burden with anxiety and interruption on daily life, as well as problems related to access to, and swallowing of, medication. Although respondents with epinephrine prescription had more severe disease, a high disease burden was also evident among those without epinephrine. The study increases the knowledge of people with moderate to severe AARs, a patient population that has previously been underrepresented in the research literature.

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  • 38.
    Andersson Kallin, Sandra
    et al.
    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.
    Sommar, Johan Nilsson
    Umeå Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umeå, Sweden.
    Bossios, Apostolos
    Univ Gothenburg, Sahlgrenska Acad, Krefting Res Ctr, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Ekerljung, Linda
    Univ Gothenburg, Sahlgrenska Acad, Krefting Res Ctr, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Middelveld, Roelinde
    Karolinska Inst, Ctr Allergy Res, Stockholm, Sweden; Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Excessive daytime sleepiness in asthma: what are the risk factors?2018In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 55, no 8, p. 844-850Article in journal (Refereed)
    Abstract [en]

    Objective: Previous studies have found that excessive daytime sleepiness (EDS) is a more common problem in asthmatic subjects than in the general population. The aim of this study was to investigate whether the prevalence of EDS is increased in asthmatic subjects and, if so, to analyse the occurrence of potential risk factors for EDS in asthmatics.

    Methods: Cross-sectional epidemiological study. In 2008, a postal questionnaire was sent out to a random sample of 45,000 individuals aged 16–75 years in four Swedish cities.

    Results: Of the 25,160 persons who participated, 7.3% were defined as having asthma. The prevalence of EDS was significantly higher in asthmatic subjects (42.1% vs. 28.5%, p < 0.001) compared with non-asthmatic subjects. Asthma was an independent risk factor for EDS (adjusted OR 1.29) and the risk of having EDS increased with asthma severity. Risk factors for EDS in subjects with asthma included insomnia (OR, 3.87; 95% CI, 3.10–4.84); chronic rhinosinusitis (OR, 2.00; 95% CI, 1.53–2.62); current smoking (OR, 1.60; 95% CI, 1.15–2.22) and obesity (OR, 1.53; 95% CI, 1.09–2.13).

    Conclusions: EDS is a common problem among subjects with asthma. Asthma is an independent risk factor for having EDS. Furthermore, subjects with asthma often have other risk factors for EDS, many of them potentially modifiable.

  • 39.
    Andersson, Maria
    et al.
    AstraZeneca Nordic Baltic, Södertälje, Sweden..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Kristensen, Thomas
    AstraZeneca Nordic Baltic, Södertälje, Sweden..
    Szende, Agota
    Covance, Leeds, W Yorkshire, England..
    Golam, Sarowar
    AstraZeneca, BioPharmaceut R&D, Global Market Access & Pricing, Gothenburg, Sweden..
    Cost effectiveness of benralizumab for severe, uncontrolled oral corticosteroid-dependent asthma in Sweden2020In: Journal of Medical Economics, ISSN 1369-6998, E-ISSN 1941-837X, Vol. 23, no 8, p. 877-884Article in journal (Refereed)
    Abstract [en]

    Aim: We investigated cost effectiveness of benralizumab vs. standard of care (SOC) plus oral corticosteroids (OCS) for patients with severe, eosinophilic OCS-dependent asthma in Sweden. Materials and methods: A three-state, cohort-based Markov model of data from three Phase III benralizumab clinical trials (ZONDA [NCT02075255], SIROCCO [NCT01928771], and CALIMA [NCT01914757]) was used to assess the incremental cost-effectiveness ratio of benralizumab vs. SOC plus OCS. Health outcomes were estimated in terms of quality-adjusted life-years (QALYs). The model included costs and disutilities associated with extrapolated OCS-related adverse events. Patients with severe asthma were defined as those receiving OCS >= 5 mg/day. Results: Benralizumab demonstrated a cost-effectiveness ratio vs. SOC plus OCS of 2018 Swedish Kronor (SEK) 366,855 (euro34,127) per QALY gained, based on increases of 1.33 QALYs and SEK 488,742 (euro45,344) per patient. Benralizumab treatment costs contributed most to incremental costs. The probability of benralizumab's being cost-effective with willingness-to-pay (WTP) thresholds between SEK 429,972 (euro40,000) and SEK 752,452 (euro70,000) ranged from 75% to 99%. Limitations: Potential limitations of these analyses include the use of combined data from three different clinical trials, a one-way sensitivity analysis that did not include mortality and transition estimates, and Observational & Pragmatic Research Institute (OPRI) data from the UK as a proxy of the Swedish health care system. Conclusions: The results of these analyses demonstrate that benralizumab has a high probability of being cost-effective compared with SOC plus OCS for a subgroup of patients with severe, eosinophilic asthma receiving regular OCS treatment and may support clinicians, payers and patients in making treatment decisions.

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  • 40.
    Andersson, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Physical activity and physical capacity in subjects with chronic obstructive pulmonary disease2017In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 5, no sup1Article in journal (Other academic)
  • 41.
    Arnadottir, Solrun Dogg
    et al.
    Univ Akureyri, Sch Hlth Sci, Akureyri, Iceland.;Landspitali Univ Hosp, Vasc Surg Unit, Reykjavik, Iceland..
    Palsdottir, Gudbjorg
    Landspitali Univ Hosp, Wound Care Unit, Reykjavik, Iceland..
    Logason, Karl
    Landspitali Univ Hosp, Vasc Surg Unit, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Arnardottir, Harpa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Univ Akureyri, Sch Hlth Sci, Akureyri, Iceland.;Akureyri Hosp, Rehabil Unit, Akureyri, Iceland..
    Aflimanir ofan ökkla 2010-2019 vegna útæðasjúkdóms og/eða sykursýki: Aðdragandi og áhættuþættir2024In: Laeknabladid: The icelandic medical journal, ISSN 0023-7213, E-ISSN 1670-4959, Vol. 110, no 1, p. 20-27Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: No recent studies exist on lower extremity amputations (LLAs) in Iceland. The aim of this study was to investigate LLA incidence in Iceland 2010-2019 and preceding procedures in amputations induced by peripheral arterial disease (PAD) and diabetes mellitus (DM).

    MATERIAL AND METHODS: Retrospective study on clinical records of all patients (>18 years) who underwent LLA in Iceland's two main hospitals during 2010-2019. Patients were excluded if LLA was performed for reasons other than DM and/or PAD. Symptoms, medication and circulation assessment were recorded from first hospital visit due to symptoms, and prior to the last LLA, respectively. Previous arterial surgeries and amputations were also recorded.

    RESULTS: A total of 167 patients underwent LLA. Thereof, 134 (77 ± 11 years, 93 men and 41 woman) due to DM and/or PAD. The LLA-rate due to those diseases increased from 4.1/100,000 inhabitants in 2010-2013 to 6.7/100,000 in 2016-2019 (p=0,04). Risk factors were mainly hypertension, 84%, and smoking, 69%. Chronic limb -threatening ischemia induced 71% of first hospital visits. Revascularisations were performed (66% endovascular) in 101 patients. Non -diabetic patients were 52% and had statins less frequently prescribed than DM patients (26:45, p<0.001).

    CONCLUSION: DM and/or PAD are the leading causes of LLA in Iceland. Amputation rate increased during the period but is low in an international context. Amputation is most often preceded by arterial surgery. DM is present in almost half of cases, similar or less than in most other countries. Opportunities for improved prevention should aim on earlier diagnosis and preventive treatment of non -diabetic individuals with PAD.

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  • 42.
    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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  • 43.
    Athlin, Åsa
    et al.
    Örebro Univ, Fac Med & Hlth, Sch Med Sci, Örebro, Sweden..
    Giezeman, Maaike
    Örebro Univ, Fac Med & Hlth, Sch Med Sci, Örebro, Sweden.;Ctr Clin Res, Karlstad, Sweden..
    Hasselgren, Mikael
    Örebro Univ, Fac Med & Hlth, Sch Med Sci, Örebro, Sweden..
    Montgomery, Scott
    Örebro Univ, Sch Med Sci, Clin Epidemiol & Biostat, S-70182 Örebro, Sweden.;Karolinska Inst, Dept Med, Clin Epidemiol Div, Stockholm, Sweden.;UCL, Dept Epidemiol & Publ Hlth, London, England..
    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.
    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.
    Sundh, Josefin
    Örebro Univ, Fac Med & Hlth, Sch Med Sci, Dept Resp Med, Örebro, Sweden..
    Prediction of Mortality Using Different COPD Risk Assessments: A 12-Year Follow-Up2021In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 16, p. 665-675Article in journal (Refereed)
    Abstract [en]

    Purpose: A multidimensional approach in the risk assessment of chronic obstructive pulmonary disease (COPD) is preferable. The aim of this study is to compare the prognostic ability for mortality by different COPD assessment systems; spirometric staging, classification by GOLD 2011, GOLD 2017, the age, dyspnea, obstruction (ADO) and the dyspnea, obstruction, smoking, exacerbation (DOSE) indices.

    Patients and Methods: A total of 490 patients diagnosed with COPD were recruited from primary and secondary care in central Sweden in 2005. The cohort was followed until 2017. Data for categorization using the different assessment systems were obtained through questionnaire data from 2005 and medical record reviews between 2000 and 2003. Kaplan-Meier survival analyses and Cox proportional hazard models were used to assess mortality risk. Receiver operating characteristic curves estimated areas under the curve (AUC) to evaluate each assessment systems' ability to predict mortality.

    Results: By the end of follow-up, 49% of the patients were deceased. The mortality rate was higher for patients categorized as stage 3-4, GOLD D in both GOLD classifications and those with a DOSE score above 4 and ADO score above 8. The ADO index was most accurate for predicting mortality, AUC 0.79 (95% CI 0.75-0.83) for all-cause mortality and 0.80 (95% CI 0.75-0.85) for respiratory mortality. The AUC values for stages 1-4, GOLD 2011, GOLD 2017 and DOSE index were 0.73, 0.66, 0.63 and 0.69, respectively, for allcause mortality.

    Conclusion: All of the risk assessment systems predict mortality. The ADO index was in this study the best predictor and could be a helpful tool in COPD risk assessment.

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  • 44.
    Bakolis, Ioannis
    et al.
    Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Biostat & Hlth Informat, London, England;Kings Coll London, Inst Psychiat Psychol & Neurosci, Hlth Serv & Populat Res Dept, Ctr Implementat Sci, London, England.
    Hooper, Richard
    Barts & London Queen Marys Sch Med & Dent, Blizard Inst, Ctr Primary Care & Publ Hlth, London, England.
    Bachert, Claus
    Univ Ghent, Upper Airway Res Lab, Ghent, Belgium.
    Lange, Bibi
    Odense Univ Hosp, Dept Otorhinolaryngol, Odense, Denmark.
    Haahtela, Tari
    Helsinki Univ Hosp, Skin & Allergy Hosp, Helsinki, Finland.
    Keil, Thomas
    Charite Univ Med Berlin, Inst Social Med Epidemiol & Hlth Econ, Lodz, Germany;Wurzburg Univ, Inst Clin Epidemiol & Biometry, Wurzburg, Germany.
    Hofmaier, Stephanie
    Charite Univ Med Berlin, Dept Paediat Pneumol & Immunol, Berlin, Germany.
    Fokkens, Wytske
    Acad Med Ctr, Otorhinolaryngol Dept, Amsterdam, Netherlands.
    Rymarczyk, Barbara
    Med Univ Silesia, Clin Dept Internal Dis Allergol & Clin Immunol, Katowice, Poland.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Burney, Peter G. J.
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Med, London, England.
    Garcia-Larsen, Vanessa
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Med, London, England;Johns Hopkins Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA.
    Dietary patterns and respiratory health in adults from nine European countries-Evidence from the GA2LEN study2018In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 48, no 11, p. 1474-1482Article in journal (Refereed)
    Abstract [en]

    Background: Dietary patterns defined using principal component analysis (PCA) offer an alternative to the analysis of individual foods and nutrients and have been linked with asthma and allergic disease. However, results have not been reproducible in different settings.

    Objective: To identify dietary patterns common to different European countries and examine their associations with asthma and allergic symptoms. Methods: In sixteen study centers in nine European countries, 3206 individuals aged 15-77 years completed a common, internationally validated, food frequency questionnaire and a respiratory symptoms questionnaire. The outcomes of interest were current asthma, asthma symptoms score (derived based on responses to 5 asthma symptom-related questions), atopy (positive skin prick test). Spirometry was used to estimate forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), the FEV1/FVC, spirometric restriction (FVC below the lower limit of normal (<LLN)) and FEV1/FVC < LLN. A novel meta-analytic approach was used to identify dietary patterns using PCA and to examine associations with asthma and allergic symptoms.

    Results: Two dietary patterns emerged, generally correlating with the same foods in different countries: one associated with intake of animal proteins and carbohydrates; the other with fruit and vegetables. There was evidence that the former pattern was associated with a higher asthma score (RR 1.63, 95% CI: 1.33-2.01), current asthma (RR 2.03, 95% CI: 1.52-2.71), wheeze (RR 1.84, 95% CI: 1.30-2.60), atopic status (RR 1.68, 95% CI: 1.16-2.44) and with decreased lung function, including an FVC <LLN (RR 4.57, 95% CI: 2.27-9.21).

    Conclusions and Clinical Relevance: Our findings suggest an increase in sensitisation to common allergens, an increase in asthma symptoms, and a reduction in lung function in those eating a diet rich in animal proteins and carbohydrates. We found little evidence of an association between these outcomes and eating a diet rich in fruits and vegetables.

  • 45.
    Baldanzi, Gabriel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Hammar, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Fall, Tove
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Elmståhl, Sölve
    Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Lund University, Sweden; CRC, Skåne University Hospital, Malmö, Sweden.
    Theorell-Haglöw, Jenny
    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, Molecular epidemiology.
    Evening chronotype is associated with elevated biomarkers of cardiometabolic risk in the EpiHealth cohort: a cross-sectional study2022In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 45, no 2, article id zsab226Article in journal (Refereed)
    Abstract [en]

    Study objectives: Individuals with evening chronotype have a higher risk of cardiovascular and metabolic disorders, although the underlying mechanisms are not well understood. In a population- based cohort, we aimed to investigate the association between chronotype and 242 circulating proteins from three panels of established or candidate biomarkers of cardiometabolic processes. 

    Methods: In 2,471 participants (49.7% men, mean age 61.2±8.4 SD years) from the EpiHealth cohort, circulating proteins were analyzed with a multiplex proximity extension technique. Participants self- reported their chronotype on a five-level scale from extreme morning to extreme evening chronotype. With the intermediate chronotype set as the reference, each protein was added as the dependent variable in a series of linear regression models adjusted for confounders. Next, the chronotype coefficients were jointly tested and the resulting p-values adjusted for multiple testing using false discovery rate (5%). For the associations identified, we then analyzed the marginal effect of each chronotype category. 

    Results: We identified 17 proteins associated with chronotype. Evening chronotype was positively associated with proteins previously linked to insulin resistance and cardiovascular risk, namely retinoic acid receptor protein 2, fatty acid-binding protein adipocyte, tissue-type plasminogen activator, and plasminogen activator inhibitor 1 (PAI-1). Additionally, PAI-1 was inversely associated with the extreme morning chronotype. 

    Conclusions: In this population-based study, proteins previously related with cardiometabolic risk were elevated in the evening chronotypes. These results may guide future research in the relation between chronotype and cardiometabolic disorders. 

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  • 46.
    Baldanzi, Gabriel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Sayols-Baixeras, Sergi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Dekkers, Koen F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Hammar, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Nguyen, Diem
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Lin, Yi-Ting
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institute, Huddinge, Sweden; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan.
    Ahmad, Shafqat
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Preventive Medicine Division, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA.
    Bak Holm, Jacob
    Nielsen, Henrik Bjørn
    Brunkwall, Louise
    Benedict, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Cedernaes, Jonathan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Transplantation and regenerative medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Koskiniemi, Sanna
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Microbiology and Immunology.
    Phillipson, Mia
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology. The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
    Bergström, Göran
    Engström, Gunnar
    Smith, J. Gustav
    Orho-Melander, Marju
    Ärnlöv, Johan
    Kennedy, Beatrice
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Fall, Tove
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    OSA Is Associated With the Human Gut Microbiota Composition and Functional Potential in the Population-Based Swedish CardioPulmonary bioImage Study2023In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 164, no 2, p. 503-516Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep-breathing disorder linked to increased risk of cardiovascular disease. Intermittent hypoxia and intermittent airway obstruction, hallmarks of OSA, have been shown in animal models to induce substantial changes to the gut microbiota composition and subsequent transplantation of fecal matter to other animals induced changes in blood pressure and glucose metabolism.

    RESEARCH QUESTION: Does obstructive sleep apnea in adults associate with the composition and metabolic potential of the human gut microbiota?

    STUDY DESIGN AND METHODS: We used respiratory polygraphy data from up to 3,570 individuals aged 50-64 from the population-based Swedish CardioPulmonary bioImage Study combined with deep shotgun metagenomics of fecal samples to identify cross-sectional associations between three OSA parameters covering apneas and hypopneas, cumulative sleep time in hypoxia and number of oxygen desaturation events with gut microbiota composition. Data collection about potential confounders was based on questionnaires, on-site anthropometric measurements, plasma metabolomics, and linkage with the Swedish Prescribed Drug Register.

    RESULTS: We found that all three OSA parameters were associated with lower diversity of species in the gut. Further, the OSA-related hypoxia parameters were in multivariable-adjusted analysis associated with the relative abundance of 128 gut bacterial species, including higher abundance of Blautia obeum and Collinsela aerofaciens. The latter species was also independently associated with increased systolic blood pressure. Further, the cumulative time in hypoxia during sleep was associated with the abundance of genes involved in nine gut microbiota metabolic pathways, including propionate production from lactate. Lastly, we observed two heterogeneous sets of plasma metabolites with opposite association with species positively and negatively associated with hypoxia parameters, respectively.

    INTERPRETATION: OSA-related hypoxia, but not the number of apneas/hypopneas, is associated with specific gut microbiota species and functions. Our findings lay the foundation for future research on the gut microbiota-mediated health effects of OSA.

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  • 47.
    Ballav Adhikari, Tara
    et al.
    Aarhus Univ, Dept Publ Hlth, Ctr Global Hlth, Aarhus, Denmark; Nepal Dev Soc, COBIN Project, Bharatpur, Chitwan, Nepal.
    Rijal, Anupa
    Nepal Dev Soc, COBIN Project, Bharatpur, Chitwan, Nepal; Univ Southern Denmark, Fac Hlth Sci, Dept Reg Hlth Res, Odense, Denmark.
    Acharya, Pawan
    Nepal Dev Soc, COBIN Project, Bharatpur, Chitwan, Nepal; Univ Oklahoma, Hlth Sci Ctr, Hudson Coll Publ Hlth, Oklahoma City, OK USA.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Karki, Arjun
    HAMS Hosp, Dept Pulm Crit Care & Sleep Med, Kathmandu, Nepal.
    Drews, Arne
    Nepalmed, Leipzig, Germany.
    Cooper, Brendan G.
    Univ Hosp Birmingham, Lung Funct & Sleep, Birmingham, W Midlands, England.
    Sigsgaard, Torben
    Aarhus Univ, Dept Publ Hlth, Sect Environm Occupat & Hlth, Aarhus, Denmark.
    Neupane, Dinesh
    Nepal Dev Soc, COBIN Project, Bharatpur, Chitwan, Nepal; Johns Hopkins Univ, Dept Epidemiol, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD USA.
    Kallestrup, Per
    Aarhus Univ, Dept Publ Hlth, Ctr Global Hlth, Aarhus, Denmark.
    Health-Related Quality of Life of People Living with COPD in a Semiurban Area of Western Nepal: A Community-Based Study2021In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 18, no 3, p. 349-356Article in journal (Refereed)
    Abstract [en]

    Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality in Nepal. It is a progressive lung disease and has a significant impact on the quality of life of patients. Health-related quality of life (HRQOL) reflects the health- and disease-related facets of quality of life. Limited studies have assessed the impact of COPD on HRQOL and associated factors in Nepal. This study is based on a cross-sectional household survey data from a semiurban area of Western Nepal. A validated Nepali version of St George's Respiratory Questionnaire (SGRQ) was used to measure the HRQOL. COPD was defined together with post-bronchodilator airflow obstruction and the presence of respiratory symptoms. Post-bronchodilator airflow obstruction was defined as Forced Expiratory Volume in 1st second (FEV1) to Forced Vital Capacity (FVC) ratio < 0.70. COPD was diagnosed in 122 participants, and their median (IQR) total score of HRQOL was 40 (26 - 69); the score of symptoms, activity, and impact area were 53 (37 - 74), 57 (36 - 86), and 26 (13 - 62), respectively. The overall HRQOL was significantly different in terms of age, occupational status, physical activity, and comorbidities. Disease severity and the presence of respiratory symptoms had a significant difference in HRQOL (p = 0.0001). Appropriate measures to improve conditions and addressing the associated factors like respiratory symptoms and enhancing physical activity are necessary and important.

  • 48.
    Bartley, K.
    et al.
    Genentech Inc, San Francisco, CA 94080 USA..
    Levine, A.
    IMS Hlth, Solna, Sweden..
    Arnheim-Dahlstrom, L.
    IMS Hlth, Solna, Sweden..
    Ferrara, G.
    Karolinska Univ Hosp, Stockholm, Sweden..
    Kirchgaessler, K.
    F Hoffmann Roche Ltd, Basel, Switzerland..
    Linder, R.
    IMS Hlth, Solna, Sweden..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Skold, C. M.
    Karolinska Inst, Stockholm, Sweden..
    Description Of A National Pulmonary Fibrosis Cohort In Sweden2017In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 72, p. A164-A165Article in journal (Other academic)
  • 49.
    Bech, Thea Wilhelmine
    et al.
    Lund Univ, Fac Med, Dept Clin Sci Lund, Resp Med & Allergol, Lund, Sweden..
    Eklund, Moa
    Lund Univ, Fac Med, Dept Clin Sci Lund, Resp Med & Allergol, Lund, Sweden..
    Spaak, Elisabeth
    Lund Univ, Fac Med, Dept Clin Sci Lund, Resp Med & Allergol, Lund, Sweden..
    Palm, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Ekström, Magnus
    Lund Univ, Fac Med, Dept Clin Sci Lund, Resp Med & Allergol, Lund, Sweden..
    Feasibility of completing Multidimensional Dyspnea Profile and Dyspnea-12 over the telephone in patients with oxygen-dependent disease2021In: BMJ OPEN RESPIRATORY RESEARCH, ISSN 2052-4439, Vol. 8, article id e001027Article in journal (Refereed)
    Abstract [en]

    Background: Breathlessness is prevalent in severe disease and consists of different dimensions that can be measured using the Multidimensional Dyspnea Profile (MOP) and Dyspnea-12 (D-12). We aimed to evaluate the feasibility of MDP and D-12 over telephone interviews in oxygen-dependent patients, compared with other patient-reported outcomes (modified Medical Research Council (mMRC) and Chronic Obstructive Pulmonary Disease Assessment Test (CAT)) and with completion by hand.

    Methods: Cross-sectional, telephone study of 50 patients with home oxygen therapy. Feasibility was assessed as completion time (self-reported by patients and measured), difficulty (self-reported) and help required to complete the instruments (staff). Completion time was compared with mMRC and CAT, and feasibility was compared with completion by hand in cardiopulmonary outpatients (n=182). Feasibility by age and gender was analysed using logistic regression.

    Results: Of 136 patients approached, 50 (37%) participated (mean age: 72 +/- 10 years, 66% women). Completion times (in minutes) were relatively short for MDP (self-reported 6 (IOR 5-10), measured 8 (IOR 6-10)) and D-12 (self-reported 5 (IOR 3-8), measured 3 (IOR 3-4)), and slightly longer than mMRC (median 1 (IOR 1-1)) and CAT (median 3 (IOR 2-5)). Even though the majority of patients required no help, more assistance was required by older patients. Compared with patients reporting by hand, completion over the telephone required somewhat longer time and more assistance.

    Conclusion: Many patients with severe oxygen-dependent disease were unable or unwilling to assess symptoms over the telephone. However, among those able to participate, MDP and D-12 are feasible to measure multiple dimensions of breathlessness over the telephone.

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  • 50.
    Bedard, Annabelle
    et al.
    ISGlobal, Barcelona, Spain.;Univ Pompeu Fabra UPF, Barcelona, Spain.;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain..
    Carsin, Anne-Elie
    ISGlobal, Barcelona, Spain.;Univ Pompeu Fabra UPF, Barcelona, Spain.;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain..
    Fuertes, Elaine
    ISGlobal, Barcelona, Spain.;Univ Pompeu Fabra UPF, Barcelona, Spain.;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain.;Imperial Coll London, Natl Heart & Lung Inst, London, England..
    Accordini, Simone
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy..
    Dharmage, Shyamali C.
    Univ Melbourne, Sch Populat & Global Hlth, Allergy & Lung Hlth Unit, Melbourne, Vic, Australia..
    Garcia-Larsen, Vanessa
    Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Program Human Nutr, Baltimore, MD USA..
    Heinrich, Joachim
    Univ Melbourne, Sch Populat & Global Hlth, Allergy & Lung Hlth Unit, Melbourne, Vic, Australia.;Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Inst & Outpatient Clin Occupat Social & Environm, Munich, Germany..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Johannessen, Ane
    Univ Bergen, Ctr Int Hlth, Dept Global Publ Hlth & Primary Care, Bergen, Norway.;Haukeland Hosp, Dept Occupat Med, Bergen, Norway..
    Leynaert, Benedicte
    INSERM, Pathophysiol & Epidemiol Resp Dis, UMR 1152, Paris, France.;Univ Paris Diderot, UMR 1152, Paris, France..
    Luis Sanchez-Ramos, Jose
    Juan Ramon Jimenez Hosp, Pneumol Serv, Huelva, Spain..
    Peralta, Gabriela P.
    ISGlobal, Barcelona, Spain.;Univ Pompeu Fabra UPF, Barcelona, Spain.;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain..
    Pin, Isabelle
    CHU Grenoble Alpes, Dept Pediat, Grenoble, France.;INSERM, Inst Adv Biosci, Grenoble, France.;Univ Grenoble Alpes, Grenoble, France..
    Squillacioti, Giulia
    Univ Turin, Dept Publ Hlth & Pediat, Turin, Italy..
    Weyler, Joost
    Univ Antwerp, Dept Epidemiol & Social Med, Antwerp, Belgium..
    Jarvis, Deborah
    Imperial Coll London, Natl Heart & Lung Inst, London, England.;Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England..
    Garcia-Aymerich, Judith
    ISGlobal, Barcelona, Spain.;Univ Pompeu Fabra UPF, Barcelona, Spain.;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain..
    Physical activity and lung function-Cause or consequence?2020In: PLOS ONE, E-ISSN 1932-6203, Vol. 15, no 8, article id e0237769Article in journal (Refereed)
    Abstract [en]

    Concerns exist that the positive association of physical activity with better lung function, which has been suggested in previous longitudinal studies in smokers, is due to reverse causation. To investigate this, we applied structural equation modeling (SEM), an exploratory approach, and marginal structural modeling (MSM), an approach from the causal inference framework that corrects for reverse causation and time-dependent confounding and estimates causal effects, on data from participants in the European Community Respiratory Health Survey (ECRHS, a multicentre European cohort study initiated in 1991-1993 with ECRHS I, and with two follow-ups: ECRHS II in 1999-2003, and ECRHS III in 2010-2014). 753 subjects who reported current smoking at ECRHS II, with repeated data on lung function at ECRHS I, II and III, physical activity at ECRHS II and III, and potential confounders at ECRHS I and II, were included in the analyses. SEM showed positive associations between physical activity and lung function in both directions. MSM suggested a protectivecausaleffect of physical activity on lung function (overall difference in mean beta (95% CI), comparing active versus non-active individuals: 58 mL (21-95) for forced expiratory volume in one second and 83 mL (36-130) for forced vital capacity). Our results suggest bi-directional causation and support a true protective effect of physical activity on lung function in smokers, after accounting for reverse causation and time-dependent confounding.

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