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  • 201. Jarvholm, Bengt
    et al.
    From, Carin
    Lewold, Stefan
    Malchau, Henrik
    Vingård, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Incidence of surgically treated osteoarthritis in the hip and knee in male construction workers2008Ingår i: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 65, nr 4, s. 275-278Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Occupational workload has been associated with an increased risk of osteoarthritis. The objective was to further examine the association between workload and occurrence of osteoarthritis and in particular to study whether heavy workload has similar importance as a causative factor for osteoarthritis of the hip and knee. Methods: In a cohort study, the authors investigated the incidence of surgically treated osteoarthritis in the hip and knee among men employed in the Swedish construction industry (n = 204 741). Incident cases were found by linkage with the Swedish hospital discharge register between 1987 and 1998. Incidence rates adjusted for age and BMI were compared between different occupational groups. Results: The incidence rates for osteoarthritis in hip and knee were positively correlated (r = 0.62; p = 0.01). There was a significantly increased risk of surgically treated osteoarthritis in the knee among floor layers, asphalt workers, sheet-metal workers, rock workers, plumbers, brick layers, wood workers and concrete workers. Even if there was a trend towards increased relative risks for osteoarthritis in the hip in floor layers, asphalt workers, wood workers and concrete workers they were not statistically significant. The relative risk for surgically treated osteoarthritis of the knee was 4.7 (95% CI 1.8 to 12.3) among floor layers, indicating an attributable fraction for work factors of 79%. Conclusions: This study shows that some work-related factors seem to be risk factors for osteoarthritis both in the knee and hip. However, the risk factors seem to be of greater importance for osteoarthritis in the knee compared with the hip. This study indicates that at least 50% of the cases of severe osteoarthritis of the knee can be prevented through decreasing occupational risk factors in some occupational groups.

  • 202. Jarvis, Deborah
    et al.
    Zock, Jan-Paul
    Heinrich, Joachim
    Svanes, Cecilie
    Verlato, Giuseppe
    Olivieri, Mario
    Villani, Simona
    Ponzio, Michela
    Leynaert, Benedicte
    Sunyer, Jordi
    Dahlman-Höglund, Anna
    Chinn, Susan
    Luczynska, Christina
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Burney, Peter
    Cat and dust mite allergen levels, specific IgG and IgG4, and respiratory symptoms in adults2007Ingår i: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 119, nr 3, s. 697-704Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Exposure to allergen may induce a modified TH2 response characterized by high IgG4 levels, absence of IgE sensitization, and a decreased risk of allergic respiratory symptoms. Objective: To assess the association of IgG4 level with allergic respiratory symptoms in a community-based sample of adults. Methods: Information on exposure to cats, respiratory symptoms, and mattress allergen levels was obtained from 2780 adults. Levels of cat and house dust mite (HDM) specific IgE, IgG, and IgG4 were measured. The association of exposure to allergen with IgG4 and of IgG4 with symptoms was assessed. Results: Geometric mean (GM) cat specific IgG and IgG4 was higher in subjects who had a cat that was allowed in the bedroom than in subjects without a cat (adjusted ratio of GM IgG4, 1.41; 95% CI, 1.25-1.57). Levels of HDM specific IgG and IgG4 were similar in subjects with undetectable and high (>20.22 μg/g) mattress Der 1 levels (adjusted ratio of GM IgG4, 1.02; 95% CI, 0.89-1.17). There was no evidence that high cat or HDM specific IgG4 levels were associated with less IgE sensitization or with fewer symptoms. Conclusion: In this community-based sample of adults, high IgG4 levels to cat or HDM were not associated with a lower risk of allergic respiratory symptoms. Clinical implications: In adults, high cat allergen exposure does not protect against respiratory symptoms.

  • 203. Jayasinghe, Saroj
    et al.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Salihovic, Samira
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi. Uppsala universitet, Science for Life Laboratory, SciLifeLab. MTM Research Centre, School of Science and Technology, Örebro University, Örebro, Sweden.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    DDT and its metabolites could contribute to the aetiology of chronic kidney disease of unknown aetiology (CKDu) and more studies are a priority2019Ingår i: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 649, s. 1638-1639Artikel i tidskrift (Refereegranskat)
  • 204. Jayasinghe, Saroj
    et al.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Salihovic, Samira
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi. Uppsala universitet, Science for Life Laboratory, SciLifeLab.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    High serum levels of p,p'-DDE are associated with an accelerated decline in GFR during 10 years follow-up.2018Ingår i: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 644, s. 371-374Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Over the past 20 years, the global incidence of chronic kidney disease (CKD) has been increasing and organochlorine pesticides (such as DDT) is a suspected etiological factor. The present study examines the associations between low level background exposure to p,p'-DDE (1-dichloro-2,2-bis (p-chlorophenyl) ethylene), the main DDT metabolite, and kidney function during a 10-year follow-up. Data was analysed from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study (n = 1016, 50% women, all aged 70 years). Serum levels of p,p'-DDE was measured by gas chromatography coupled to high-resolution mass spectrometry (GC/HRMS) at baseline (i.e. age of 70 years). Glomerular filtration rate (GFR) was estimated using serum creatinine and cystatin C at 70, 75 and 80 years of age. A significant decline in GFR was seen during the 10-year follow-up (-24 ml/min/1.73 m2, p < 0.0001). A significant negative interaction was seen between baseline p,p'-DDE levels and change in GFR over time (p < 0.0001) following adjustment for sex, systolic blood pressure, diabetes, BMI, smoking and education level at age 70. Subjects with the lowest levels of p,p'-DDE levels at age 70 showed the lowest decline in GFR over 10 years, while subjects with the highest p,p'-DDE levels showed the greatest decline. Baseline levels of p,p'-DDE were related to an accelerated reduction in GFR over 10 years suggesting a nephrotoxic effect of DDT/p,p'-DDE. These findings support a potential role for DDT in the epidemic of CKD of unknown etiology (CKDu) in agricultural communities of Sri Lanka and Central America where DDT was previously used.

  • 205.
    Johansson, Bo
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Helgesson, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lundberg, Ingvar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Nordquist, Tobias
    Leijon, Ola
    Lindberg, Per
    Vingård, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Work and health among immigrants and native Swedes 1990-2008: a register-based study on hospitalization for common potentially work-related disorders, disability pension and mortality2012Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, s. 845-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration.

    Methods

    This study included migrants to Sweden since 1960 who were 28--47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately.

    Results

    Nordic immigrants had increased risks for all investigated disorders and mortality, while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results.

    Conclusions

    Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers.

  • 206. Johansson, Gun
    et al.
    Lundberg, Ingvar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Components of the illness flexibility model as explanations of socioeconomic differences in sickness absence2009Ingår i: International Journal of Health Services, ISSN 0020-7314, E-ISSN 1541-4469, Vol. 39, nr 1, s. 123-138Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The authors studied the social gradient in sickness absence in relation to components of the illness flexibility model, which highlights conditions affecting whether people attend work when they are ill. The conditions studied were: adjustment latitude, attendance requirements at work, stimulating work, and health. The population sample was part of a panel originating in 1994 when 15,154 inhabitants of Stockholm County were randomly selected to receive a questionnaire covering, among other things, health and psychosocial conditions. New questionnaires were sent to the respondents in 1998 and 2002. This article analyzes the 2002 data, for 1,634 women and 1,063 men. These respondents had reported being employed or on leave of absence. In this sample, a social difference was found in sickness absence of 31 days or more per year. For manual workers, women had an odds ratio (OR) of 2.8 and men an OR of 3.4 for such absence compared with nonmanual workers of both sexes in high socioeconomic positions. All single potential confounders decreased these ORs. Adding all characteristics decreased the OR by 78 percent for women and 67 percent for men. The results indicate that the social gradient in sickness absence is due to differences in health and in working conditions when one is ill.

  • 207.
    Johnsen, Anna M.
    et al.
    Jonkoping Univ, Dept Nat Sci & Biomed, Sch Hlth & Welf, Jonkoping, Sweden..
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden..
    Westerholm, Peter J. M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Fransson, Eleonor I.
    Jonkoping Univ, Dept Nat Sci & Biomed, Sch Hlth & Welf, Jonkoping, Sweden.;Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Association between occupational physical activity and myocardial infarction: a prospective cohort study2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 10, artikel-id e012692Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Recommendations regarding physical activity typically include both leisure time and occupational physical activity. However, the results from previous studies on occupational physical activity and the association with myocardial infarction have been inconsistent. The aim of this study was to investigate if occupational physical activity is associated with the risk of myocardial infarction. Design: Prospective cohort study. Participants: Data from the Swedish Work, Lipids and Fibrinogen (WOLF) study was used, comprising 9961 employees (6849 men, 3112 women, mean age 42.7 years) having no history of myocardial infarction. The participants were categorised into 3 groups according to their level of occupational physical activity. Outcome: Data regarding incident myocardial infarction were obtained from the Swedish National Patient Register and the Cause of Death Register. Cox proportional hazard regression was used for estimation of HRs for different levels of occupational physical activity in relation to the risk of myocardial infarction. Results: During a mean follow-up of 13.1 years, 249 cases of incident myocardial infarction were identified. In analyses adjusted for age, sex and socioeconomic status, participants standing and walking more than 50% of their working day had an HR of 1.13 (95% CI 0.83 to 1.54), compared with participants seated more than 50% of their working day. The corresponding HR for participants whose work included lifting or carrying was 0.86 (95% CI 0.59 to 1.24). Further adjustment did not alter the results. Stratified analyses resulted in a significantly decreased risk for young people whose work included lifting or carrying, HR 0.37 (95% CI 0.17 to 0.84), compared with younger persons who sat most of their working day. Conclusions: No significant association between occupational physical activity and the risk of myocardial infarction was observed in the total group of employees in this study. Based on the results from this study, occupational physical activity in general does not seem to be enough for reducing the risk of myocardial infarction.

  • 208.
    Johnson, Ann-Christin
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Unit Audiol, S-14183 Stockholm, Sweden..
    Bogo, Renata
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Unit Audiol, S-14183 Stockholm, Sweden.; Karolinska Univ Hosp, Dept Audiol & Neurotol, Huddinge, Sweden..
    Farah, Ahmed
    Publ Hlth Agcy Sweden, Dept Monitoring & Evaluat, Stockholm, Sweden..
    Karlsson, Kjell K.
    Karolinska Univ Hosp, Dept Audiol & Neurotol, Huddinge, Sweden..
    Muhr, Per
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Unit Audiol, S-14183 Stockholm, Sweden..
    Sjöström, Mattias
    Karolinska Inst, Dept Occupat Med, Stockholm, Sweden..
    Svensson, Eva B.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Unit Audiol, S-14183 Stockholm, Sweden..
    Skjönsberg, Åsa
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Unit Audiol, S-14183 Stockholm, Sweden.; Karolinska Univ Hosp, Dept Audiol & Neurotol, Huddinge, Sweden..
    Svartengren, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Influence of well-known risk factors for hearing loss in a longitudinal twin study2017Ingår i: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 56, s. 63-73Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim was to investigate the influence of environmental exposures on hearing loss in a twin cohort.

    STUDY SAMPLE: Male twins born 1914-1958, representing an unscreened population, were tested for hearing loss at two occasions, 18 years apart.

    DESIGN: Clinical audiometry and a questionnaire were performed at both time points in this longitudinal study. Noise and solvent exposure were assessed using occupational work codes and a job exposure matrix. Hearing impairment was investigated using two different pure tone averages: PTA4 (0.5, 1, 2, and 4 kHz) and HPTA4 (3, 4, 6, and 8 kHz).

    RESULTS: Age affected all outcome measures. Noise exposure between time point one and two affected the threshold shifts of PTA4 and HPTA4 more in participants with a pre-existing hearing loss at time point one. Lifetime occupational noise exposure was a risk factor especially for the low-frequency hearing threshold PTA4. Firearm use was a statistically significant risk factor for all outcome measures.

    CONCLUSIONS: Pre-existing hearing loss can increase the risk of hearing impairment due to occupational noise exposure. An increased risk for NIHL was also seen in the group with exposures below 85 dB(A), a result that indicates awareness of NIHL should be raised even for those working in environments where sound levels are below 85 dB(A).

  • 209.
    Jonsson, E.
    et al.
    Swedish Social Insurance Agcy, Stockholm, Sweden..
    Ornstein, P.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Statistiska institutionen. Swedish Social Insurance Agcy, Stockholm, Sweden.
    Goine, H.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Swedish Social Insurance Agcy, Stockholm, Sweden.
    Hedenbro, J. L.
    Lund Univ, Dept Surg, Clin Sci, Nicolovius 7, SE-22465 Lund, Sweden..
    Diabetes Resolution and Work Absenteeism After Gastric Bypass: a 6-Year Study2017Ingår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, nr 9, s. 2246-2252Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Obesity-related diseases cause costs to society. We studied the cost of work absenteeism before and after gastric bypass and the effects of postoperative diabetes resolution.

    Patients and Methods

    Data were obtained from the Scandinavian Obesity Surgery Registry (SOReg) (national coverage >98%) and cross-matched with data from the Social insurance Agency (coverage 100%) for the period ± 3 years from operation. In 2010, a total of 7454 bariatric surgeries were performed; the study group is 4971 unique individuals with an annual income of >10,750 Euros and complete data sets. A sex-, age-, and income-matched reference population was identified for comparison.

    Results

    Patients with obesity had preoperatively a 3.5-fold higher absenteeism. During follow-up (FU), the ratio relative to the reference population remained constant. An increase of 12-14 net absenteeism days was observed in the first 3 months after surgery. Female sex (OR 1.5, CI 1.13-1.8), preoperative anti-depressant use (OR 1.5, CI 1.3-1.9), low income (OR 1.4, CI 1.2-1.8), and a history of sick leave (OR 1.004, CI 1.003-1.004) were associated with increased absenteeism during FU. Diabetes resolution did not decrease absenteeism from preoperative values.

    Conclusions

    Patients with obesity have higher preoperative absenteeism than the reference population. Operation caused an increase the first 90 days after surgery of 12-13 days. There were no relative increases in absenteeism in the next 3 years; patients did not deviate from preoperative patterns but followed the trend of the reference population. Preoperative diabetes did not elevate that level during FU; diabetes resolution did not lower absenteeism.

  • 210.
    Josephson, Malin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lindberg, Per
    Voss, Margaretha
    Alfredsson, Lars
    Vingård, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    The same factors influence job turnover and long spells of sick leave: a 3-year follow-up of Swedish nurses2008Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, nr 4, s. 380-385Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In many countries, a general shortage of nurses is a public health problem, and retention of nurses in active work is a challenge. The aim of this study was to ascertain whether the same individual factors, working conditions and health problems had led to increased probability of both leaving jobs and prolonged sickness absence in a cohort of Swedish nurses over a period of 3 years. METHODS: A baseline questionnaire was answered by 2293 nurses, representing a response rate of 86%. Exposed and unexposed nurses were compared with regard to two outcomes. During the 3-year follow-up, exposed and unexposed nurses were compared with regard to two outcomes: resigning and having at least one sick leave spell that lasted 28 days or longer. RESULTS: We found that 18% of the nurses left their employment, and 16% had sick leave spells > or =28 days. Work in geriatric care, being socially excluded by superiors and/or workmates, negative effects of organizational changes and poor self-rated general health were factors that increased the likelihood of both leaving jobs and long-term sick leave. CONCLUSIONS: The present results underline the importance of improving working conditions and supporting sustainable health in order to prevent high turnover and prolonged sick leave among nurses. Resigning and moving to another institution can be interpreted as a way to actively cope with an unhealthy work environment.

  • 211.
    Juan, Wang
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    BaiZhan, Li
    Qin, Yang
    Han, Wang
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Sundell, Jan
    Sick building syndrome among parents of preschool children in relation to home environment in Chongqing, China2013Ingår i: Chinese Science Bulletin, ISSN 1001-6538, E-ISSN 1861-9541, Vol. 58, nr 34, s. 4267-4276Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The prevalence and risk factors of sick building syndrome (SBS) symptoms in domestic environments were studied by a questionnaire survey on the home environment. Parents of 5299 3-6 years old children from randomly selected kindergartens in Chongqing, China returned completed questionnaires between December 2010 and April 2011. The prevalence of parents' SBS symptoms (often (every week) compared with never) were: 11.4% for general symptoms, 7.1% for mucosal symptoms and 4.4% for skin symptoms. Multiple logistic regressions were applied controlling for gender and asthma/allergic rhinitis/eczema. Living near a main road or highway was a strong risk factor for general symptoms (adjusted odds ratio, aOR=2.16, P<0.001), skin symptoms (aOR=2.69, P<0.001), and mucosal symptoms (aOR=1.63, P<0.01). Redecoration was a risk factor for general symptoms (aOR=2.00, P<0.001), skin symptoms (aOR=1.66, P<0.01), and mucosal symptoms (aOR=1.66, P<0.05). New furniture was a risk factor for general symptoms (aOR=2.16, P<0.001) and skin symptoms (aOR=1.67, P<0.01). Dampness related problems (mould spot, damp stain, water damage and condensation) were all risk factors for SBS symptoms, as was the presence of cockroaches, rats, and mosquitoes/flies and use of incense. Protective factors include cleaning the child's bedroom every day and frequently exposing bedding to sunshine. In conclusion, adults' SBS symptoms were related to factors of the home environment.

  • 212. Järvholm, Bengt
    et al.
    Vingård, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Englyst, Vagn
    Elgstrand, Kaj
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Burström, Lage
    Sverige bör vara förebild för säkerhet och miljö i gruvindustrin: [Sweden should be a model for safety and environment in the mining industry].2014Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, nr 18-19, s. 812-Artikel i tidskrift (Övrigt vetenskapligt)
  • 213.
    Jönsson, Mattias
    et al.
    Medical Radiation Physics, Department of Translational Medicine, Malmö, Lund University, Malmö, Sweden.
    Tondel, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Isaksson, Mats
    Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Finck, Robert
    Medical Radiation Physics, Department of Translational Medicine, Malmö, Lund University, Malmö, Sweden.
    Wålinder, Robert
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Mamour, Afrah
    Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Rääf, Christopher
    Medical Radiation Physics, Department of Translational Medicine, Malmö, Lund University, Malmö, Sweden.
    Modelling the external radiation exposure from the Chernobyl fallout using data from the Swedish municipality measurement system2017Ingår i: Journal of Environmental Radioactivity, ISSN 0265-931X, E-ISSN 1879-1700, Vol. 178-179, s. 16-27Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In connection with the Chernobyl fallout and the subsequent deposition of radionuclides in Sweden, Swedish municipalities launched a measurement program to monitor the external radiation exposure. This program encompasses measurements of the ambient dose equivalent rate 1 m above ground at selected locations, and repeats those measurements at the same locations at 7-month intervals. Measurement data compiled from the seven locations with the highest deposition were combined with data from aerial surveys since May 1986 of ground deposition of 137Cs, high-resolution gamma spectrometry performed at four locations in May 1986, and measurements from fixed continuous air gamma rate monitoring stations from 28 April to 15 May 1986. Based on these datasets, a model of the time pattern of the external dose rate in terms of ambient dose equivalent rate from the Chernobyl fallout was developed. The decrease in the ambient dose equivalent rate could, on average, be described by a four-component exponential decay function with effective half-times of 6.8 ± 0.3 d, 104 ± 26 d, 1.0 ± 0.02 y and 5.5 ± 0.09 y, respectively. The predominant contributions to the external dose rate in the first month were from short-lived fission products superseded by 134Cs and then 137Cs. Integrated over 70 y and using extrapolation of the curve fits, our model predicts that 137Cs contributes about 60% and 134Cs contributes about 30% of the external effective dose at these seven locations. The projected time-integrated 70 y external effective dose to an unshielded person from all nuclides per unit total activity deposition of 137Cs is estimated to be 0.29 ± 0.0.08 mSv/(kBq m-2). These results are in agreement with those found in Chernobyl contaminated Russian forest areas, and emphasize the usefulness of maintaining a long-term and regular measurement program in contaminated areas.

  • 214.
    Kim, Jeong-Lim
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Elfman, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Mi, Yahong
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Wieslander, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Smedje, Greta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Indoor molds, bacteria, microbial volatile organic compounds and plasticizers in schools: associations with asthma and respiratory symptoms in pupils2007Ingår i: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 17, nr 2, s. 153-163Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We investigated asthma and atopy in relation to microbial and plasticizer exposure. Pupils in eight primary schools in Uppsala (Sweden) answered a questionnaire, 1014 (68%) participated. Totally, 7.7% reported doctor-diagnosed asthma, 5.9% current asthma, and 12.2% allergy to pollen/pets. Wheeze was reported by 7.8%, 4.5% reported daytime breathlessness, and 2.0% nocturnal breathlessness. Measurements were performed in 23 classrooms (May–June), 74% had <1000 ppm CO2 indoors. None had visible mold growth or dampness. Mean total microbial volatile organic compound (MVOC) concentration was 423 ng/m3 indoors and 123 ng/m3 outdoors. Indoor concentration of TMPD-MIB (2,2,4-trimethyl-1,3-pentanediol monoisobutyrate, Texanol) and TMPD-DIB (2,2,4-trimethyl-1,3-pentanediol diisobutyrate, TXIB), two common plasticizers, were 0.89 and 1.64 μg/m3, respectively. MVOC and plasticizer concentration were correlated (r = 0.5; P < 0.01). Mold concentration was 360 cfu/m3 indoors and 980 cfu/m3 outdoors. At higher indoor concentrations of total MVOC, nocturnal breathlessness (P < 0.01) and doctor-diagnosed asthma (P < 0.05) were more common. Moreover, there were positive associations between nocturnal breathlessness and 3-methylfuran (P < 0.01), 3-methyl-1-butanol (P < 0.05), dimethyldisulfide (P < 0.01), 2-heptanone (P < 0.01), 1-octen-3-ol (P < 0.05), 3-octanone (P < 0.05), TMPD-MIB (P < 0.05), and TMPD-DIB (P < 0.01). TMPD-DIB was positively associated with wheeze (P < 0.05), daytime breathlessness (P < 0.05), doctor-diagnosed asthma (P < 0.05), and current asthma (P < 0.05). In conclusion, exposure to MVOC and plasticizers at school may be a risk factor for asthmatic symptoms in children.

  • 215.
    Kim, Jeong-Lim
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Elfman, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Respiratory symptoms, asthma and allergen levels in schools: comparison between Korea and Sweden2007Ingår i: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 17, nr 2, s. 122-129Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We studied reports on respiratory symptoms, asthma and atopic sensitisation in relation to allergen contamination in Korean schools and compared with data from a previous Swedish study performed in eight primary schools. Korean pupils (n = 2365) in 12 primary schools first completed a questionnaire. Then airborne and settled dust were collected from 34 classrooms and analyzed for allergens by ELISA. In both countries, boys reported more symptoms. The prevalence of wheeze was similar, while daytime [odds ratio (OR) = 14.0, 95% confidence interval (CI) = 9.0–21.9] and nocturnal breathlessness (OR = 3.1, 95% CI = 1.5–6.4) were much higher among Korean students. In Korean schools, dog allergen (Can f 1) was the most common followed by mite allergen (Der f 1), while cat (Fel d 1), dog, and horse allergen (Equ cx) were abundant in Sweden. Moreover, CO2 levels were high in most Korean schools (range 907–4113 ppm). There was an association between allergen levels in dust and air samples, and number of pet-keepers in the classrooms. In conclusion, allergen contamination in Korean schools may be an important public issue.

  • 216. Kim, Jeong-Lim
    et al.
    Elfman, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Wieslander, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Ferm, Martin
    Torén, Kjell
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Respiratory Health among Korean Pupils in Relation to Home, School and Outdoor Environment2011Ingår i: Journal of Korean medical science, ISSN 1011-8934, E-ISSN 1598-6357, Vol. 26, nr 2, s. 166-173Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There are few studies about school-environment in relation to pupils' respiratory health, and Korean school-environment has not been characterized. All pupils in 4th grade in 12 selected schools in three urban cities in Korea received a questionnaire (n = 2,453), 96% participated. Gaseous pollutants and ultrafine particles (UFPs) were measured indoors (n = 34) and outdoors (n = 12) during winter, 2004. Indoor dampness at home was investigated by the questionnaire. To evaluate associations between respiratory health and environment, multiple logistic- and multi-level regression models were applied adjusting for potential confounders. The mean age of pupils was 10 yr and 49% were boys. No school had mechanical ventilation and CO2-levels exceeded 1,000 ppm in all except one of the classrooms. The indoor mean concentrations of SO2, NO2, O-3 and formaldehyde were 0.6 mu g/m(3), 19 mu g/m(3), 8 mu g/m(3) and 28 mu g/m(3), respectively. The average level of UFPs was 18,230 pt/cm(3) in the classrooms and 16,480 pt/cm(3) outdoors. There were positive associations between wheeze and outdoor NO2, and between current asthma and outdoor UFPs. With dampness at home, pupils had more wheeze. In conclusion, outdoor UFPs and even low levels of NO2 may adversely contribute to respiratory health in children. High CO2-levels in classrooms and indoor dampness/mold at home should be reduced.

  • 217. Kivimaeki, Mika
    et al.
    Nyberg, Solja T.
    Batty, G. David
    Fransson, Eleonor I.
    Heikkila, Katriina
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Casini, Annalisa
    Clays, Els
    De Bacquer, Dirk
    Dragano, Nico
    Ferrie, Jane E.
    Geuskens, Goedele A.
    Goldberg, Marcel
    Hamer, Mark
    Hooftman, Wendela E.
    Houtman, Irene L.
    Joensuu, Matti
    Jokela, Markus
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Kumari, Meena
    Madsen, Ida E. H.
    Marmot, Michael G.
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Singh-Manoux, Archana
    Suominen, Sakari B.
    Vaananen, Ari
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter J. M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerlund, Hugo
    Zins, Marie
    Steptoe, Andrew
    Theorell, Tores
    Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data2012Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 380, nr 9852, s. 1491-1497Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies. Methods We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death. Findings 30 214 (15%) of 197 473 participants reported job strain. In 1.49 million person-years at risk (mean follow-up 7.5 years [SD 1.7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1.23 (95% CI 1.10-1.37). This effect estimate was higher in published (1.43, 1.15-1.77) than unpublished (1.16, 1.02-1.32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1.31, 1.15-1.48) and 5 years (1.30, 1.13-1.50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3.4%. Interpretation Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking.

  • 218. Kivimaeki, Mika
    et al.
    Virtanen, Marianna
    Kawachi, Ichiro
    Nyberg, Solja T.
    Alfredsson, Lars
    Batty, G. David
    Bjorner, Jakob B.
    Borritz, Marianne
    Brunner, Eric J.
    Burr, Hermann
    Dragano, Nico
    Ferrie, Jane E.
    Fransson, Eleonor I.
    Hamer, Mark
    Heikkila, Katriina
    Knutsson, Anders
    Koskenvuo, Markku
    Madsen, Ida E. H.
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Steptoe, Andrew
    Suominen, Sakari
    Theorell, Tres
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerlund, Hugo
    Singh-Manoux, Archana
    Jokela, Markus
    Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals2015Ingår i: Lancet Diabetes & Endocrinology, ISSN 2213-8587, Vol. 3, nr 1, s. 27-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Working long hours might have adverse health effects, but whether this is true for all socioeconomic status groups is unclear. In this meta-analysis stratified by socioeconomic status, we investigated the role of long working hours as a risk factor for type 2 diabetes. Methods We identified four published studies through a systematic literature search of PubMed and Embase up to April 30, 2014. Study inclusion criteria were English-language publication; prospective design (cohort study); investigation of the effect of working hours or overtime work; incident diabetes as an outcome; and relative risks, odds ratios, or hazard ratios (HRs) with 95% CIs, or sufficient information to calculate these estimates. Additionally, we used unpublished individual-level data from 19 cohort studies from the Individual-Participant-Data Meta-analysis in Working-Populations Consortium and international open-access data archives. Effect estimates from published and unpublished data from 222 120 men and women from the USA, Europe, Japan, and Australia were pooled with random-effects meta-analysis. Findings During 1.7 million person-years at risk, 4963 individuals developed diabetes (incidence 29 per 10 000 person-years). The minimally adjusted summary risk ratio for long (>= 55 h per week) compared with standard working hours (35-40 h) was 1.07 (95% CI 0.89-1.27, difference in incidence three cases per 10 000 person-years) with significant heterogeneity in study-specific estimates (I-2 = 53%, p = 0.0016). In an analysis stratified by socioeconomic status, the association between long working hours and diabetes was evident in the low socioeconomic status group (risk ratio 1.29, 95% CI 1.06-1.57, difference in incidence 13 per 10 000 person-years, I-2 = 0%, p = 0.4662), but was null in the high socioeconomic status group (1. 00, 95% CI 0.80-1.25, incidence diff erence zero per 10 000 person-years, I-2 = 15%, p = 0.2464). The association in the low socioeconomic status group was robust to adjustment for age, sex, obesity, and physical activity, and remained after exclusion of shift workers. Interpretation In this meta-analysis, the link between longer working hours and type 2 diabetes was apparent only in individuals in the low socioeconomic status groups. Copyright (C) Kivimaki et al. Open Access article distributed under the terms of CC BY.

  • 219.
    Kivimaki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Helsinki, Fac Med, Helsinki, Finland..
    Jokela, Markus
    Univ Helsinki, Inst Behav Sci, Helsinki, Finland..
    Nyberg, Solja T.
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Ctr Res Epidemiol & Populat Hlth, INSERM, U1018, Villejuif, France..
    Fransson, Eleonor I.
    Karolinska Inst, Inst Environm Med, S-10401 Stockholm, Sweden.;Jonkoping Univ, Sch Hlth Sci, Jonkoping, Sweden.;Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden..
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, S-10401 Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Bjorner, Jakob B.
    Natl Res Ctr Working Environm, Copenhagen, Denmark..
    Borritz, Marianne
    Koege Hosp, Dept Occupat Med, Copenhagen, Denmark..
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth BAuA, Berlin, Germany..
    Casini, Annalisa
    Univ Libre Bruxelles, Sch Publ Hlth, Brussels, Belgium..
    Clays, Els
    Univ Ghent, Dept Publ Hlth, B-9000 Ghent, Belgium..
    De Bacquer, Dirk
    Univ Ghent, Dept Publ Hlth, B-9000 Ghent, Belgium..
    Dragano, Nico
    Univ Dusseldorf, Fac Med, Inst Med Sociol, Dusseldorf, Germany..
    Erbel, Raimund
    Univ Duisburg Essen, West German Heart Ctr Essen, Dept Cardiol, Essen, Germany..
    Geuskens, Goedele A.
    TNO, Hoofddorp, Netherlands..
    Hamer, Mark
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Hooftman, Wendela E.
    TNO, Hoofddorp, Netherlands..
    Houtman, Irene L.
    TNO, Hoofddorp, Netherlands..
    Jockel, Karl-Heinz
    Univ Duisburg Essen, Fac Med, Inst Med Informat Biometry & Epidemiol, Essen, Germany..
    Kittel, France
    Univ Libre Bruxelles, Sch Publ Hlth, Brussels, Belgium..
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden..
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland..
    Lunau, Thorsten
    Univ Dusseldorf, Fac Med, Inst Med Sociol, Dusseldorf, Germany..
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Copenhagen, Denmark..
    Nielsen, Martin L.
    Frederiksberg Univ Hosp, Unit Social Med, DK-2000 Copenhagen, Denmark..
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden.;Umea Univ, Dept Psychol, S-90187 Umea, Sweden..
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Copenhagen, Denmark..
    Pentti, Jaana
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark.;Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark.;Univ Copenhagen, Dept Psychol, Copenhagen, Denmark..
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland.;Univ Turku, Dept Psychol, Turku, Finland..
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Siegrist, Johannes
    Univ Dusseldorf, Fac Med, Inst Med Sociol, Dusseldorf, Germany..
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Suominen, Sakari B.
    Univ Turku, Dept Publ Hlth, Turku, Finland.;Folkhalsan Res Ctr, Helsinki, Finland.;Univ Skovde, Skovde, Sweden..
    Theorell, Tores
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden..
    Vahtera, Jussi
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland.;Univ Turku, Dept Publ Hlth, Turku, Finland.;Turku Univ Hosp, FIN-20520 Turku, Finland..
    Westerholm, Peter J. M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden..
    O'Reilly, Dermot
    Queens Univ Belfast, Ctr Publ Hlth, Belfast, Antrim, North Ireland..
    Kumari, Meena
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Essex, Inst Social & Econ Res, Colchester CO4 3SQ, Essex, England..
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Edinburgh, Ctr Cognit Ageing & Cognit Epidemiol, Edinburgh, Midlothian, Scotland.;Univ Edinburgh, Alzheimer Scotland Dementia Res Ctr, Edinburgh, Midlothian, Scotland..
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Bristol, Sch Community & Social Med, Bristol, Avon, England..
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals2015Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, nr 10005, s. 1739-1746Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. Methods We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. Findings We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5.1 million person-years (mean 8.5 years), in which 4768 events were recorded, and for stroke was 3.8 million person-years (mean 7.2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (>= 55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1.13, 95% CI 1.02-1.26; p=0.02) and incident stroke (1.33, 1.11-1.61; p=0.002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1.30-1.42). We recorded a dose-response association for stroke, with RR estimates of 1.10 (95% CI 0.94-1.28; p=0.24) for 41-48 working hours, 1.27 (1.03-1.56; p=0.03) for 49-54 working hours, and 1.33 (1.11-1.61; p=0.002) for 55 working hours or more per week compared with standard working hours (p(trend)<0.0001). Interpretation Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.

  • 220.
    Kivimaki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Helsinki, Fac Med, Clinicum, Tukholmankatu 8 B, FIN-00290 Helsinki, Finland.;Finnish Inst Occupat Hlth, Topeliuksenkatu 41 B, Helsinki 00250, Finland..
    Nyberg, Solja T.
    Univ Helsinki, Fac Med, Clinicum, Tukholmankatu 8 B, FIN-00290 Helsinki, Finland..
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Edinburgh, Ctr Cognit Ageing & Cognit Epidemiol, 7 George Sq, Edinburgh EH8 9JZ, Midlothian, Scotland..
    Kawachi, Ichiro
    Harvard TH Chan Sch Publ Hlth, Dept Social & Behav Sci, 677 Huntington Ave,Kresge Bldg,7th Floor, Boston, MA 02115 USA..
    Jokela, Markus
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Haartmaninkatu 3, FIN-00014 Helsinki, Finland..
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Solnavagen 4, S-11365 Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Nobels Vag 13, S-17177 Stockholm, Sweden..
    Bjorner, Jakob B.
    Natl Res Ctr Working Environm, Lerso Parkalle 105, DK-2100 Copenhagen O, Denmark..
    Borritz, Marianne
    Bispebjerg Univ Hosp Copenhagen, Dept Occupat & Environm Med, Bispebjerg Bakke 23_20F, DK-2400 Copenhagen NV, Denmark..
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth BAuA, Noldnerstr 40-42, D-10317 Berlin, Germany..
    Dragano, Nico
    Univ Dusseldorf, Inst Med Sociol, Fac Med, Univ Str 1, D-40225 Dusseldorf, Germany..
    Fransson, Eleonor I.
    Jonkoping Univ, Sch Hlth & Welf, Barnarpsgatan 39, S-55111 Jonkoping, Sweden.;Stockholm Univ, Stress Res Inst, Frescati Hagvag 16 A, S-11419 Stockholm, Sweden..
    Heikkila, Katriina
    London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, UK 15-17 Tavistock Pl, London WC1H 9SH, England.;Royal Coll Surgeons England, Clin Effectiveness Unit, 35-43 Lincolns Inn Fields, London WC2A 3PE, England..
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Holmgatan 10, S-85170 Sundsvall, Sweden..
    Koskenvuo, Markku
    Univ Helsinki, Fac Med, Clinicum, Tukholmankatu 8 B, FIN-00290 Helsinki, Finland..
    Kumari, Meena
    Univ Essex, Inst Social & Econ Res, Wivenhoe Pk, Colchester CO4 3SQ, Essex, England..
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Lerso Parkalle 105, DK-2100 Copenhagen O, Denmark..
    Nielsen, Martin L.
    AS3 Co, AS3 Employment, Hasselager Centervej 35, DK-8260 Viby J, Denmark..
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, Frescati Hagvag 16 A, S-11419 Stockholm, Sweden.;Umea Univ, Dept Psychol, SE-90187 Umea, Sweden..
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Topeliuksenkatu 41 B, Helsinki 00250, Finland..
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Herluf Trolles Gade 11, DK-1052 Copenhagen K, Denmark..
    Pentti, Jaana
    Univ Helsinki, Fac Med, Clinicum, Tukholmankatu 8 B, FIN-00290 Helsinki, Finland..
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Lerso Parkalle 105, DK-2100 Copenhagen O, Denmark.;Univ Copenhagen, Dept Publ Hlth, Norregade 10,POB 2177, DK-1017 Copenhagen K, Denmark.;Univ Copenhagen, Dept Psychol, Norregade 10,POB 2177, DK-1017 Copenhagen K, Denmark..
    Salo, Paula
    Finnish Inst Occupat Hlth, Topeliuksenkatu 41 B, Helsinki 00250, Finland.;Univ Turku, Dept Psychol, Assistentinkatu 7, Turku 20014, Finland..
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Suominen, Sakari
    Univ Skovde, Hgsk Vagen 28, S-54145 Skovde, Sweden.;Univ Turku, Dept Publ Hlth, Joukahaisenkatu 3-5 A, FIN-20520 Turku, Finland..
    Theorell, Tores
    Stockholm Univ, Stress Res Inst, Frescati Hagvag 16 A, S-11419 Stockholm, Sweden..
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Joukahaisenkatu 3-5 A, FIN-20520 Turku, Finland.;Turku Univ Hosp, Kiinamyllynkatu 4-8, Turku 20521, Finland..
    Westerholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Frescati Hagvag 16 A, S-11419 Stockholm, Sweden..
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Singh-Manoux, Archana
    Hop Paul Brousse, INSERM, U1018, Ctr Res Epidemiol & Populat Hlth, 16 Ave Paul Vaillant Couturier,Batiment 15-16, F-94807 Villejuif, France..
    Hamer, Mark
    Loughborough Univ Technol, Natl Ctr Sport & Exercise Med, Sch Sport Exercise & Hlth Sci, Epinal Way, Loughborough LE11 3TU, Leics, England..
    Ferrie, Jane E.
    Univ Bristol, Sch Social & Community Med, Oakfield House, Bristol BS8 2BN, Avon, England..
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Topeliuksenkatu 41 B, Helsinki 00250, Finland..
    Tabak, Adam G.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Semmelweis Univ, Fac Med, Dept Med 1, Ulloi Ut 26, H-1085 Budapest, Hungary..
    Long working hours as a risk factor for atrial fibrillation: a multi-cohort study2017Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, nr 34, s. 2621-2628Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (>= 55 per week) and those working standard 35-40 h/week.

    Methods and results: In this prospective multi-cohort study from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium, the study population was 85 494 working men and women (mean age 43.4 years) with no recorded atrial fibrillation. Working hours were assessed at study baseline (1991-2004). Mean follow-up for incident atrial fibrillation was 10 years and cases were defined using data on electrocardiograms, hospital records, drug reimbursement registers, and death certificates. We identified 1061 new cases of atrial fibrillation (10-year cumulative incidence 12.4 per 1000). After adjustment for age, sex and socioeconomic status, individuals working long hours had a 1.4-fold increased risk of atrial fibrillation compared with those working standard hours (hazard ratio = 1.42, 95% CI= 1.13-1.80, P= 0.003). There was no significant heterogeneity between the cohort-specific effect estimates (I-2= 0%, P = 0.66) and the finding remained after excluding participants with coronary heart disease or stroke at baseline or during the follow-up (N= 2006, hazard ratio= 1.36, 95% CI= 1.05-1.76, P = 0.0180). Adjustment for potential confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association.

    Conclusion: Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours.

  • 221. Kivimaki, Mika
    et al.
    Nyberg, Solja T.
    Fransson, Eleonor I.
    Heikkila, Katriina
    Alfredsson, Lars
    Casini, Annalisa
    Clays, Els
    De Bacquer, Dirk
    Dragano, Nico
    Ferrie, Jane E.
    Goldberg, Marcel
    Hamer, Mark
    Jokela, Markus
    Karasek, Robert
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Suominen, Sakari B.
    Theorell, Tores
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter J. M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerlund, Hugo
    Zins, Marie
    Steptoe, Andrew
    Singh-Manoux, Archana
    Batty, G. David
    Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data2013Ingår i: CMJA. Canadian Medical Association Journal. Onlineutg. Med tittel: ECMAJ. ISSN 1488-2329, ISSN 0820-3946, E-ISSN 1488-2329, Vol. 185, nr 9, s. 763-769Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: It is unclear whether a healthy lifestyle mitigates the adverse effects of job strain on coronary artery disease. We examined the associations of job strain and lifestyle risk factors with the risk of coronary artery disease. Methods: We pooled individual-level data from 7 cohort studies comprising 102 128 men and women who were free of existing coronary artery disease at baseline (1985-2000). Questionnaires were used to measure job strain (yes v. no) and 4 lifestyle risk factors: current smoking, physical inactivity, heavy drinking and obesity. We grouped participants into 3 lifestyle categories: healthy (no lifestyle risk factors), moderately unhealthy (1 risk factor) and unhealthy (2-4 risk factors). The primary outcome was incident coronary artery disease (defined as first nonfatal myocardial infarction or cardiac-related death). Results: There were 1086 incident events in 743 948 person-years at risk during a mean follow-up of 7.3 years. The risk of coronary artery disease among people who had an unhealthy lifestyle compared with those who had a healthy lifestyle (hazard ratio [HR] 2.55, 95% confidence interval [CI] 2.18-2.98; population attributable risk 26.4%) was higher than the risk among participants who had job strain compared with those who had no job strain (HR 1.25, 95% CI 1.06-1.47; population attributable risk 3.8%). The 10-year incidence of coronary artery disease among participants with job strain and a healthy lifestyle (14.7 per 1000) was 53% lower than the incidence among those with job strain and an unhealthy lifestyle (31.2 per 1000). Interpretation: The risk of coronary artery disease was highest among participants who reported job strain and an unhealthy lifestyle; those with job strain and a healthy lifestyle had half the rate of disease. A healthy life style may substantially reduce disease risk among people with job strain.

  • 222.
    Kivimaki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England;Univ Helsinki, Clinicum, Fac Med, FI-00014 Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland.
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England;INSERM, U1153, Epidemiol Ageing & Neurodegenerat Dis, Paris, France.
    Pentti, Jaana
    Univ Helsinki, Clinicum, Fac Med, FI-00014 Helsinki, Finland;Univ Turku, Dept Publ Hlth, Turku, Finland.
    Sabia, Severine
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England;INSERM, U1153, Epidemiol Ageing & Neurodegenerat Dis, Paris, France.
    Nyberg, Solja T.
    Univ Helsinki, Clinicum, Fac Med, FI-00014 Helsinki, Finland.
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Goldberg, Marcel
    INSERM, UMS 011, Populat Based Epidemiol Cohorts Unit, Villejuif, France.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Koskenvuo, Markku
    Univ Helsinki, Clinicum, Fac Med, FI-00014 Helsinki, Finland.
    Koskinen, Aki
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kouvonen, Anne
    Univ Helsinki, Fac Social Sci, Helsinki, Finland;SWPS Univ Social Sci & Humanities Wroclaw, Wroclaw, Poland;Queens Univ Belfast, Ctr Publ Hlth, Adm Data Res Ctr Northern Ireland, Belfast, Antrim, North Ireland.
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden;Umea Univ, Dept Psychol, Umea, Sweden.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Strandberg, Timo
    Univ Helsinki, Clinicum, Fac Med, FI-00014 Helsinki, Finland;Helsinki Univ Hosp, Helsinki, Finland;Univ Oulu, Ctr Life Course Hlth Res, Oulu, Finland.
    Suominen, Sakari B.
    Univ Turku, Dept Publ Hlth, Turku, Finland;Univ Skovde, Skovde, Sweden.
    Theorell, Tores
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Turku, Finland;Turku Univ Hosp, Turku, Finland.
    Vaananen, Ari
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Virtanen, Marianna
    Univ Eastern Finland, Sch Educ Sci & Psychol, Joensuu, Finland.
    Westerholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Zins, Marie
    INSERM, UMS 011, Populat Based Epidemiol Cohorts Unit, Villejuif, France.
    Seshadri, Sudha
    Univ Texas Hlth Sci Ctr San Antonio, Glenn Biggs Inst Alzheimers & Neurodegenerat Dis, San Antonio, TX 78229 USA;Framingham Heart Dis Epidemiol Study, Framingham, MA USA.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Sipila, Pyry N.
    Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England.
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Lindbohm, Joni V.
    Univ Helsinki, Clinicum, Fac Med, FI-00014 Helsinki, Finland.
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England;Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England.
    Jokela, Markus
    Univ Helsinki, Biomedicum, Fac Med, Helsinki, Finland.
    Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis2019Ingår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 365, artikel-id l1495Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE To examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia. DESIGN Meta-analysis of 19 prospective observational cohort studies. DATA SOURCES The Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies. REVIEW METHOD The search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer's disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis. RESULTS Study population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer's disease was 1602 in 5.2 million person-years. When measured < 10 years before dementia diagnosis (that is, the preclinical stage of dementia), physical inactivity was associated with increased incidence of all-cause dementia (hazard ratio 1.40, 95% confidence interval 1.23 to 1.71) and Alzheimer's disease (1.36, 1.12 to 1.65). When reverse causation was minimised by assessing physical activity >= 10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed > 10 before dementia onset 1.30, 0.79 to 2.14). CONCLUSIONS In analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer's disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.

  • 223.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London, England; Univ Helsinki, Dept Publ Hlth, Fac Med, Helsinki, Finland; Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kuosma, Eeva
    Univ Helsinki, Dept Publ Hlth, Fac Med, Helsinki, Finland.
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, London, England; Univ Bristol, Sch Social & Community Med, Bristol, Avon, England.
    Luukkonen, Ritva
    Univ Helsinki, Dept Publ Hlth, Fac Med, Helsinki, Finland.
    Nyberg, Solja T.
    Univ Helsinki, Dept Publ Hlth, Fac Med, Helsinki, Finland.
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden; Karolinska Inst, Inst Environm Med, Stockholm, Sweden .
    Batty, G David
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Brunner, Eric J.
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Fransson, Eleonor
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden; Stockholm Univ, Stress Res Inst, Stockholm, Sweden; Jönköping Univ, Sch Hlth Sci, Jönköping, Sweden.
    Goldberg, Marcel
    INSERM, UMS 011, Population Based Epidemiol Cohorts Unit, Villejuif, France.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden; Umeå Univ, Dept Psychol, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Pentti, Jaana
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Rugulies, Reiner
    Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark; Univ Copenhagen, Dept Psychol, Copenhagen, Denmark; Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Shipley, Martin J
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London, England; INSERM, U1018, Ctr Res Epidemiol & Populat Hlth, Villejuif, France.
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Suominen, Sakari B.
    Univ Turku, Dept Publ Hlth, Turku, Finland; Folkhälsan Res Ctr, Helsinki, Finland; Univ Skövde, Skövde, Sweden.
    Theorell, Töres
    INSERM, UMS 011, Population Based Epidemiol Cohorts Unit, Villejuif, France.
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Turku, Finland; Turku Univ Hosp, Turku, Finland.
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Westerholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Zins, Marie
    INSERM, UMS 011, Population Based Epidemiol Cohorts Unit, Villejuif, France.
    Hamer, Mark
    UCL, Dept Epidemiol & Publ Hlth, London, England; Loughborough Univ Technol, Natl Ctr Sport & Exercise Med, Loughborough, Leics, England.
    Bell, Joshua A
    UCL, Dept Epidemiol & Publ Hlth, London, England; Univ Bristol, MRC Integrat Epidemiol Unit, Bristol, Avon, England.
    Tabak, Adam G.
    UCL, Dept Epidemiol & Publ Hlth, London, England; Semmelweis Univ, Dept Med 1, Fac Med, Budapest, Hungary.
    Jokela, Markus
    Univ Helsinki, Inst Behav Sci, Helsinki, Finland.
    Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe.2017Ingår i: The Lancet. Public health, ISSN 2468-2667, Vol. 2, nr 6, s. e277-e285Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight.

    Methods: We pooled individual-participant data for BMI and incident cardiometabolic multimorbidity from 16 prospective cohort studies from the USA and Europe. Participants included in the analyses were 35 years or older and had data available for BMI at baseline and for type 2 diabetes, coronary heart disease, and stroke at baseline and follow-up. We excluded participants with a diagnosis of diabetes, coronary heart disease, or stroke at or before study baseline. According to WHO recommendations, we classified BMI into categories of healthy (20·0–24·9 kg/m2), overweight (25·0–29·9 kg/m2), class I (mild) obesity (30·0–34·9 kg/m2), and class II and III (severe) obesity (≥35·0 kg/m2). We used an inclusive definition of underweight (<20 kg/m2) to achieve sufficient case numbers for analysis. The main outcome was cardiometabolic multimorbidity (ie, developing at least two from: type 2 diabetes, coronary heart disease, and stroke). Incident cardiometabolic multimorbidity was ascertained via resurvey or linkage to electronic medical records (including hospital admissions and death). We analysed data from each cohort separately using logistic regression and then pooled cohort-specific estimates using random-effects meta-analysis.

    Findings: Participants were 120  813 adults (mean age 51·4 years, range 35–103; 71 445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973–2012). During a mean follow-up of 10·7 years (1995–2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2·0, 95% CI 1·7–2·4; p<0·0001), almost five times higher for individuals with class I obesity (4·5, 3·5–5·8; p<0·0001), and almost 15 times higher for individuals with classes II and III obesity combined (14·5, 10·1–21·0; p<0·0001). This association was noted in men and women, young and old, and white and non-white participants, and was not dependent on the method of exposure assessment or outcome ascertainment. In analyses of different combinations of cardiometabolic conditions, odds ratios associated with classes II and III obesity were 2·2 (95% CI 1·9–2·6) for vascular disease only (coronary heart disease or stroke), 12·0 (8·1–17·9) for vascular disease followed by diabetes, 18·6 (16·6–20·9) for diabetes only, and 29·8 (21·7–40·8) for diabetes followed by vascular disease.

    Interpretation: The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes.

    Funding: NordForsk, Medical Research Council, Cancer Research UK, Finnish Work Environment Fund, and Academy of Finland.

  • 224. Kivimäki, Mika
    et al.
    Luukkonen, Ritva
    Batty, G David
    Ferrie, Jane E
    Pentti, Jaana
    Nyberg, Solja T
    Shipley, Martin J
    Alfredsson, Lars
    Fransson, Eleonor I
    Goldberg, Marcel
    Knutsson, Anders
    Koskenvuo, Markku
    Kuosma, Eeva
    Nordin, Maria
    Suominen, Sakari B
    Theorell, Töres
    Vuoksimaa, Eero
    Westerholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerlund, Hugo
    Zins, Marie
    Kivipelto, Miia
    Vahtera, Jussi
    Kaprio, Jaakko
    Singh-Manoux, Archana
    Jokela, Markus
    Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals2018Ingår i: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 14, nr 5, s. 601-609Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects.

    METHODS: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis.

    RESULTS: Hazard ratios per 5-kg/m2 increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis.

    CONCLUSIONS: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short.

  • 225.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England;Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland.
    Pentti, Jaana
    Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland;Univ Turku, Dept Publ Hlth, Turku, Finland.
    Ferrie, Jane E.
    Univ Bristol, Sch Social & Community Med, Bristol, Avon, England;UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Nyberg, Solja T.
    Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland.
    Jokela, Markus
    Univ Helsinki, Inst Behav Sci, Helsinki, Finland.
    Virtanen, Marianna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Folkhälsovetenskap.
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden;Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Dragano, Nico
    Univ Dusseldorf, Med Fac, Inst Med Sociol, Dusseldorf, Germany.
    Fransson, Eleonor I.
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden;Jonkoping Univ, Sch Hlth & Welf, Jonkoping, Sweden;Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Goldberg, Marcel
    INSERM, Populat Based Epidemiol Cohorts Unit, UMS 011, Villejuif, France;Versailles St Quentin Univ, UMS 011, Villejuif, France.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Koskinen, Aki
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kouvonen, Anne
    Univ Helsinki, Fac Social Sci, Helsinki, Finland;Queens Univ Belfast, Ctr Publ Hlth, Adm Data Res Ctr Northern Ireland, Belfast, Antrim, North Ireland;SWPS Univ Social Sci & Humanities Wroclaw, Div Hlth Psychol, Wroclaw, Poland.
    Luukkonen, Ritva
    Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland.
    Oksanen, Tuula
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark;Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark;Univ Copenhagen, Dept Psychol, Copenhagen, Denmark.
    Siegrist, Johannes
    Univ Dusseldorf, Med Fac, Inst Med Sociol, Dusseldorf, Germany.
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England;Ctr Res Epidemiol & Populat Hlth, INSERM, UMR 1018, Villejuif, France.
    Suominen, Sakari
    Folkhalsan Res Ctr, Helsinki, Finland;Univ Skovde, Sch Hlth & Educ, Skovde, Sweden;Univ Kent, Sch Social Policy Sociol & Social Res, Canterbury, Kent, England;Univ Turku, Dept Publ Hlth, Turku, Finland.
    Theorell, Töres
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden;Finnish Inst Occupat Hlth, Helsinki, Finland.
    Väänänen, Ari
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Vahtera, Jussi
    Turku Univ Hosp, Turku, Finland;Univ Turku, Dept Publ Hlth, Turku, Finland.
    Westerholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Zins, Marie
    INSERM, Populat Based Epidemiol Cohorts Unit, UMS 011, Villejuif, France;Versailles St Quentin Univ, UMS 011, Villejuif, France.
    Strandberg, Timo
    Helsinki Univ Hosp, Dept Internal Med, Helsinki, Finland;Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland;Univ Oulu, Ctr Life Course Hlth Res, Oulu, Finland.
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Deanfield, John
    UCL, Natl Ctr Cardiovasc Prevent & Outcomes, London, England.
    Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study2018Ingår i: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 6, nr 9, s. 705-713Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease.

    Methods: In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort-reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease.

    Results: We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13.9 years [SD 3.9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149.8 per 10 000 person-years) than in those without (97.7 per 10 000 person-years; mortality difference 52.1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1.68, 95% CI 1.19-2.35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78.1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5.9-44.0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2.01, 95% CI 1.18-3.43) and those with normal blood pressure and no dyslipidaemia (6.17, 1.74-21.9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress-mortality association were not significant, apart from effort-reward imbalance in men without cardiometabolic disease (mortality difference 6.6 per 10 000 person-years; multivariable-adjusted HR 1.22, 1.06-1.41).

    Interpretation: In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.

  • 226. Kjellberg, Katarina
    et al.
    Palm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Josephson, Malin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Development of an instrument for assessing workstyle in checkout cashier work (BAsIK)2012Ingår i: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 41, nr Suppl 1, s. 663-668Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Checkout cashier work consists of handling a large number of items during a work shift, which implies repetitive movements of the shoulders, arms and hands/wrists, and a high work rate. The work is associated with a high prevalence of disorders in the neck and upper extremity. The concept of workstyle explains how ergonomic and psychosocial factors interact in the development of work-related upper extremity disorders. The aim of the project was to develop an instrument for the occupational health services to be used in the efforts to prevent upper extremity disorders in checkout cashier work. The instrument is based on the workstyle concept and is intended to be used as a tool to identify high-risk workstyle and needs for interventions, such as training and education. The instrument, BAsIK, consists of four parts; a questionnaire about workstyle, an observation protocol for work technique, a checklist about the design of the checkout and a questionnaire about work organization. The instrument was developed by selecting workstyle items developed for office work and adapting them to checkout cashier work, discussions with researchers and ergonomists, focus-group interviews with cashiers, observations of video recordings of cashiers, and studies of existing guidelines and checklists.

  • 227.
    Klint, Helén
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Lejonklou, Margareta H.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Karimullina, Elina
    University of California, Irvine, Department of Developmental and Cell Biology, Irvine, CA 92697, USA.
    Rönn, Monika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Brittebo, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Low-dose exposure to bisphenol A in combination with fructose increases expression of genes regulating angiogenesis and vascular tone in juvenile Fischer 344 rat cardiac tissue2017Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, nr 1, s. 20-27Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Epidemiological studies report associations between exposure to the high-volume chemical and endocrine disruptor bisphenol A (BPA) and cardiovascular disorders, but there is a lack of experimental studies addressing the mechanisms of action of BPA on the cardiovascular system. In the present study, effects on markers for cardiovascular function of exposure to BPA and fructose in vivo in rat cardiac tissues, and of BPA exposure in human cardiomyocytes in vitro, were investigated.

    MATERIALS: Juvenile female Fischer 344 rats were exposed to 5, 50, and 500 μg BPA/kg bodyweight/day in their drinking water from 5 to 15 weeks of age, in combination with 5% fructose. Further, cultured human cardiomyocytes were exposed to 10 nM BPA to 1 × 10(4) nM BPA for six hours. Expression of markers for cardiovascular function and BPA target receptors was investigated using qRT-PCR.

    RESULTS: Exposure to 5 μg BPA/kg bodyweight/day plus fructose increased mRNA expression of Vegf, Vegfr2, eNos, and Ace1 in rat heart. Exposure of human cardiomyocytes to 1 × 10(4) nM BPA increased mRNA expression of eNOS and ACE1, as well as IL-8 and NFκβ known to regulate inflammatory response.

    CONCLUSIONS: . Low-dose exposure of juvenile rats to BPA and fructose induced up-regulation of expression of genes controlling angiogenesis and vascular tone in cardiac tissues. The observed effects of BPA in rat heart were in line with our present and previous studies of BPA in human endothelial cells and cardiomyocytes. These findings may aid in understanding the mechanisms of the association between BPA exposure and cardiovascular disorders reported in epidemiological studies.

  • 228. Knutsson, Anders
    et al.
    Alfredsson, Lars
    Karlsson, Berndt
    Åkerstedt, Torbjörn
    Fransson, Eleonor I
    Westerholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerlund, Hugo
    Breast cancer among shift workers: results of the WOLF longitudinal cohort study2013Ingår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 39, nr 2, s. 170-177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate whether shift work (with or without night work) is associated with increased risk of breast cancer. METHODS: The population consisted of 4036 women. Data were obtained from WOLF (Work, Lipids, and Fibrinogen), a longitudinal cohort study. Information about baseline characteristics was based on questionnaire responses and medical examination. Cancer incidence from baseline to follow-up was obtained from the national cancer registry. Two exposure groups were identified: shift work with and without night work. The group with day work only was used as the reference group in the analysis. Cox regression analysis was used to calculate relative risk. RESULTS: In total, 94 women developed breast cancer during follow-up. The average follow-up time was 12.4 years. The hazard ratio for breast cancer was 1.23 [95% confidence interval (95% CI) 0.70-2.17] for shifts without night work and 2.02 (95% CI 1.03-3.95) for shifts with night work. When including only women <60 years of age, the risk estimates were 1.18 (95% CI 0.67-2.07) for shifts without night work, and 2.15 (95% CI 1.10-4.21) for shifts with night work. CONCLUSIONS: Our results indicate an increased risk for breast cancer among women who work shifts that includes night work.

  • 229. Kogevinas, Manolis
    et al.
    Zock, Jan-Paul
    Jarvis, Debbie
    Kromhout, Hans
    Lillienberg, Linnéa
    Plana, Estel
    Radon, Katja
    Torén, Kjell
    Alliksoo, Ada
    Benke, Geza
    Blanc, Paul D
    Dahlman-Hoglund, Anna
    D'Errico, Angelo
    Héry, Michel
    Kennedy, Susan
    Kunzli, Nino
    Leynaert, Bénédicte
    Mirabelli, Maria C
    Muniozguren, Nerea
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Olivieri, Mario
    Payo, Félix
    Villani, Simona
    van Sprundel, Marc
    Urrutia, Isabel
    Wieslander, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Sunyer, Jordi
    Antó, Josep M
    Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II)2007Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 370, nr 9584, s. 336-341Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents.

    Methods We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study Centre.

    Findings A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1.6, 95% CI 1.1-2.3, p=0.017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2.4,1.3-4.6, p=0.008). Of common occupations, a significant excess risk of asthma was seen for nursing (2.2,1.3-4.0, p=0.007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3.3, 95% CI 1.0-11.1, p=0.051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year.

    Interpretation Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.

  • 230.
    Kumar, Jitender
    et al.
    Uppsala universitet, Science for Life Laboratory, SciLifeLab. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Salihovic, Samira
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    van Bavel, Bert
    MTM Research Centre, School of Science and Technology, Örebro University, Örebro, Sweden.
    Ingelsson, Erik
    Uppsala universitet, Science for Life Laboratory, SciLifeLab. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi.
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample of men and women2014Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 134, nr SI, s. 251-256Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Persistent organic pollutants (POPs) are stable organic compounds generated through different industrial activities. Liver is involved in the metabolism of POPs, and hence exposure to POPs may interfere with liver function. Although a few studies have shown adverse effects of POPs on liver function, large-scale studies involving humans are lacking. We performed this large population-based cross-sectional study to assess the associations between different POPs and liver dysfunction biomarkers.

    METHODS: A total of 992 individuals (all aged 70 years, 50% males) were recruited as part of Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) cohort. The total toxic equivalency (TEQ) value was calculated for seven mono-ortho and two non-ortho substituted polychlorinated biphenyls (PCBs) and octachloro-p-dibenzodioxin (OCDD) to assess their toxicological effects. The association of TEQ values, summary measures of 16 PCBs (sum of PCBs) and three organochlorine pesticides (sum of OC pesticides) with liver dysfunction biomarkers (bilirubin; alkaline phosphatase, ALP; alanine aminotransferase, ALT; and gamma-glutamyltransferase, GGT) was analyzed utilizing linear regression analysis.

    RESULTS: The mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=0.71, P=0.008), while sum of OC pesticide concentrations was negatively associated with ALP (β=-0.02, P=0.002) after adjusting for various potential confounders. When analyzed individually, a number of different POPs were associated with ALP, ALT and bilirubin. No such association with GGT was observed.

    CONCLUSION: Various POPs including PCBs, OCDD and pesticides were associated with the liver dysfunction biomarkers bilirubin, ALT and ALP, suggesting adverse effects on liver function from these environmental pollutants.

  • 231.
    Kumar, Jitender
    et al.
    Uppsala universitet, Science for Life Laboratory, SciLifeLab. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi.
    Lind, Monica P.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Salihovic, Samira
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    van Bavel, Bert
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Ingelsson, Erik
    Uppsala universitet, Science for Life Laboratory, SciLifeLab. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi.
    Influence of persistent organic pollutants on oxidative stress in population-based samples2014Ingår i: Chemosphere, ISSN 0045-6535, E-ISSN 1879-1298, Vol. 114, s. 303-309Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Persistent organic pollutants (POPs) are a large group of chemicals widely used and produced in various industrial applications. Many cell culture/animal studies have shown that POPs can induce oxidative stress. Since such data is lacking in humans, we conducted a large population-based study to analyze associations between POPs and oxidative stress markers. We measured following POPs; 16 polychlorinated biphenyls (PCBs), 5 organochlorine (OC) pesticides, octachlorinated dibenzo-p-dioxin, and polybrominated diphenyl ether 47, and oxidative stress markers; homocysteine, reduced [GSH] and oxidized glutathione [GSSG], glutathione ratio [GSSG/GSH], total glutathione, oxidized low-density lipoprotein [ox-LDL], ox-LDL antibodies, conjugated dienes, baseline conjugated dienes of LDL, and total anti-oxidative capacity in plasma samples collected from 992 70-year old individuals (50% women) from the population-based Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) cohort. Linear regression analyses were performed to study the associations between oxidative stress markers and summary measures of POPs including the total toxic equivalence (TEQ), sums of PCBs and BC pesticides (main exposures) while adjusting for potential confounders. In multivariable-adjusted analyses, sum of PCBs showed strong associations with ox-LDL (beta = 0.94; P = 2.9 * 10(-6)). Further, sum of PCBs showed association with glutathione-related markers (GSSG: beta = 0.01; P = 6.0 *10(-7); GSSG/GSH: beta = 0.002; P = 9.7 * 10(-10)), although in reverse direction. Other summary measures did not show any significant association with these markers. In our study of elderly individuals from the general population, we show that plasma levels of POPs are associated with markers of increased oxidative stress thereby suggesting that even low dose background exposure to POPs may be involved in oxidative stress.

  • 232.
    Kumar, Jitender
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi. Uppsala universitet, Science for Life Laboratory, SciLifeLab.
    Lind, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Salihovic, Samira
    van Bavel, Bert
    Ingelsson, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi. Uppsala universitet, Science for Life Laboratory, SciLifeLab.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Persistent Organic Pollutants and Inflammatory Markers in a Cross-Sectional Study of Elderly Swedish People: The PIVUS Cohort2014Ingår i: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 122, nr 9, s. 977-983Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Persistent organic pollutants (POPs) are compounds that are generated through various industrial activities and released in the surrounding environment. Different animal studies have shown effects of different POPs on various inflammatory markers. OBJECTIVE: Because very few studies have been conducted in humans, we assessed the associations between different POPs and inflammatory markers in a large population-based sample of elderly men and women (all 70 years of age) from Sweden. METHODS: This cross-sectional study investigated the concentrations of several polychlorinated biphenyls (PCBs), organochlorine pesticides, polychlorinated dibenzo-p-dioxin, and brominated diphenyl ether congeners and their association with a number of inflammatory markers [vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), E-selectin, C-reactive protein (CRP), total leucocyte count, tumor necrosis factor alpha (TNF-alpha), monocyte chemotactic protein 1 (MCP-1), and interleukin 6 (IL-6)] in 992 individuals. These individuals were recruited from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) cohort. We used a total toxic equivalency (TEQ) value that measures toxicological effects with the relative potencies of various POPs. RESULTS: Following adjustment for potential confounders, the TEQ value (driven mainly by PCB-126) was significantly associated with levels of ICAM-1 (p < 10(-5)). A similar trend was also observed between sum of PCBs and VCAM-1 (p < 0.001). No significant associations were observed between levels of POPs and other inflammatory markers. CONCLUSIONS: TEQ values were associated with levels of ICAM-1, to a lesser degree also with VCAM-1, but not with CRP and several other inflammatory markers. These findings suggest an activation of vascular adhesion molecules by POPs, and particularly by PCB-126.

  • 233.
    Kumar, Jitender
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi. Uppsala universitet, Science for Life Laboratory, SciLifeLab.
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Salihovic, Samira
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    van Bavel, Bert
    Ekdahl, Kristina Nilsson
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Klinisk immunologi.
    Nilsson, Bo
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Ingelsson, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi. Uppsala universitet, Science for Life Laboratory, SciLifeLab.
    Influence of persistent organic pollutants on the complement system in a population-based human sample2014Ingår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 71, s. 94-100Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Persistent organic pollutants (POPS) are toxic compounds generated through various industrial activities and have adverse effects on human health. Studies performed in cell cultures and animals have revealed that POPs can alter immune-system functioning. The complement system is part of innate immune system that helps to clear pathogens from the body. We performed a large-scale population-based study to find out associations between summary measures of different POPs and different complement system markers. Methods: In this cross-sectional study, 16 polychlorinated biphenyls (PCBs), 3 organochlorine (OC) pesticides, octachloro-p-dibenzodioxin, and 2,2',4,4'-tetrabromodiphenyl ether (BDE-47) were analyzed for their association with levels of protein complement 3 (C3), 3a (C3a), 4 (C4) and C3a/C3 ratio. A total of 992 individuals (all aged 70 years, 50% females) were recruited from the Prospective Investigation of the Vasculature in Uppsala Seniors cohort. Regression analysis adjusting for a variety of confounders was performed to study the associations of different POP exposures (total toxic equivalency value or TEQ and sum of 16 PCBs) with protein complements. Results: The TEQ values were found to be positively associated with C3a (beta = 0.07, 95% CI = 0.017-0.131, p = 0.01) and C3a/C3 ratio (beta = 0.07, 95% Cl = 0.015-0.126, p = 0.01) taking possible confounders into account. The association observed was mainly driven by PCB-126. Conclusion: In this study involving 992 elderly individuals from the general population, we showed that POPs, mainly PCB-126, were associated with levels of complement system markers indicating that the association of these toxic compounds with downstream disease could be mediated by activation of immune system.

  • 234.
    La Merrill, M A
    et al.
    Department of Environmental Toxicology, University of California, Davis, CA, USA.
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Salihovic, Samira
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi. Uppsala universitet, Science for Life Laboratory, SciLifeLab. MTM Research Centre, School of Science and Technology, Örebro University, Örebro, Sweden, and Norwegian Institute for Water Research, NIVA, Oslo, Norway.
    van Bavel, B
    MTM Research Centre, School of Science and Technology, Örebro University, Örebro, Sweden, and Norwegian Institute for Water Research, NIVA, Oslo, Norway.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    The association between p,p'-DDE levels and left ventricular mass is mainly mediated by obesity2018Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 160, s. 541-546, artikel-id S0013-9351(17)31176-3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: The pesticide metabolite p,p'-DDE has been associated with left ventricular (LV) mass and known risk factors for LV hypertrophy in humans and in experimental models. We hypothesized that the associations of p,p'-DDE with LV hypertrophy risk factors, namely elevated glucose, adiposity and hypertension, mediate the association of p,p'-DDE with LV mass.

    METHODS: p,p'-DDE was measured in plasma from 70-year-old subjects (n = 988) of the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS). When these subjects were 70-, 75- and 80- years old, LV characteristics were measured by echocardiography, while fasting glucose, body mass index (BMI) and blood pressure were assessed with standard clinical techniques.

    RESULTS: We found that p,p'-DDE levels were associated with increased fasting glucose, BMI, hypertension and LV mass in separate models adjusted for sex. Structural equation modeling revealed that the association between p,p'-DDE and LV mass was almost entirely mediated by BMI (70%), and also by hypertension (19%).

    CONCLUSION: The obesogenic effect of p,p'-DDE is a major determinant responsible for the association of p,p'-DDE with LV mass.

  • 235. Lagerström, Monica
    et al.
    Josephson, Malin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Arsalani, Narges
    Fallahi-Khoshknab, Masoud
    Striving for Balance Between Family and Work Demands Among Iranian Nurses2010Ingår i: Nursing Science Quarterly, ISSN 0894-3184, E-ISSN 1552-7409, Vol. 23, nr 2, s. 166-172Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The study reported here explored Iranian nurses' experience of managing work and family roles. Grounded theory method guided the data collection and data analysis from both individual and focus group interviews. Five categories emerged: family role, working conditions, seeking support, perceiving dissatisfaction, and perceiving threats to health. The core concept that emerged was striving for balance between family and work demands. In the work family role the Iranian nurses faced significant pressures, and they mostly relied on their own capabilities to create balance, often neglecting their own needs. This resulted in perceived dissatisfaction and health threats.

  • 236.
    Lampa, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Mixture Effects of Environmental Contaminants2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Chemical exposure in humans rarely consists of a single chemical. The everyday exposure is characterized by thousands of chemicals mainly present at low levels. Despite that fact, risk assessment of chemicals is carried out on a chemical-by-chemical basis although there is a consensus that this view is too simplistic.

    This thesis aims to validate a statistical method to study the impact of mixtures of contaminants and to use that method to investigate the associations between circulating levels of a large number of environmental contaminants and atherosclerosis and the metabolic syndrome in an elderly population. Contaminants measured in the circulation represented various classes, such as persistent organic pollutants, plastic-associated chemicals and metals.

    There was little co-variation among the contaminants and only two clusters of PCBs could be discerned. Gradient boosted CARTs were used to assess additive and multiplicative associations between atherosclerosis, as measured by the intima-media thickness (IMT) and the echogenicity of the intima-media complex (IM-GSM), and prevalent metabolic syndrome.

    Systolic blood pressure was the most important predictor of IMT while the influence of the contaminants was marginal. Three phthalate metabolites; MMP, MEHP and MIBP were strongly related to IM-GSM. A synergistic interaction was found for MMP and MIBP, and a small antagonistic interaction was found for MIBP and MEHP. Associations between the contaminants and prevalent metabolic syndrome were modest, but three pesticides; p,p’-DDE, hexachlorbenzene and trans-nonachlor along with PCBs 118 and 209 and mercury were the strongest predictors of prevalent metabolic syndrome.

    This thesis concludes that many contaminants need to be measured to get a clear picture of the exposure. Boosted CARTs are useful for uncovering interactions. Multiplicative and/or additive effects of certain contaminant mixtures were found for atherosclerosis or the metabolic syndrome.

    Delarbeten
    1. An investigation of the co-variation in circulating levels of a large number of environmental contaminants
    Öppna denna publikation i ny flik eller fönster >>An investigation of the co-variation in circulating levels of a large number of environmental contaminants
    Visa övriga...
    2012 (Engelska)Ingår i: Journal of Exposure Science and Environmental Epidemiology, ISSN 1559-0631, E-ISSN 1559-064X, Vol. 22, nr 5, s. 476-482Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    We are daily exposed to many different environmental contaminants. Mixtures of these contaminants could act together to induce more pronounced effects than the sum of the individual contaminants. To evaluate the effects of such mixtures, it is of importance to assess the co-variance amongst the contaminants. Thirty-seven environmental contaminants representing different classes were measured in blood samples from 1016 individuals aged 70 years. Hierarchical cluster analysis and principal component analysis were used to assess the co-variation among the contaminants. Within each identified cluster, possible marker contaminants were sought for. We validated our findings using data from the National Health and Nutrition Examination Survey (NHANES) 2003--2004 study. Two large clusters could be identified, one representing low/medium chlorinated polychlorinated biphenyls (PCBs) (<= 6 chlorine atoms), as well as two pesticides and one representing medium/high chlorinated PCBs (>= 6 chlorine atoms). PCBs 118 and 153 could be used as markers for the low/medium chlorinated cluster and PCBs 170 and 209 could be used as markers for the medium/high chlorinated cluster. This pattern was similar to data from the NHANES study. Apart from the PCBs, little co-variation was seen among the contaminants. Thus, a large number of chemicals have to be measured to adequately identify mixtures of environmental contaminants.

    Nyckelord
    mixtures, environmental contaminants, multivariate analysis
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-182769 (URN)10.1038/jes.2012.41 (DOI)000307934000007 ()
    Tillgänglig från: 2012-10-17 Skapad: 2012-10-15 Senast uppdaterad: 2017-12-07Bibliografiskt granskad
    2. The identification of complex interactions in epidemiology and toxicology: a simulation study of Boosted Regression Trees
    Öppna denna publikation i ny flik eller fönster >>The identification of complex interactions in epidemiology and toxicology: a simulation study of Boosted Regression Trees
    2014 (Engelska)Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 13, s. 57-Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: There is a need to evaluate complex interaction effects on human health, such as those induced by mixtures of environmental contaminants. The usual approach is to formulate an additive statistical model and check for departures using product terms between the variables of interest. In this paper, we present an approach to search for interaction effects among several variables using boosted regression trees. Methods: We simulate a continuous outcome from real data on 27 environmental contaminants, some of which are correlated, and test the method's ability to uncover the simulated interactions. The simulated outcome contains one four-way interaction, one non-linear effect and one interaction between a continuous variable and a binary variable. Four scenarios reflecting different strengths of association are simulated. We illustrate the method using real data. Results: The method succeeded in identifying the true interactions in all scenarios except where the association was weakest. Some spurious interactions were also found, however. The method was also capable to identify interactions in the real data set. Conclusions: We conclude that boosted regression trees can be used to uncover complex interaction effects in epidemiological studies.

    Nationell ämneskategori
    Sannolikhetsteori och statistik Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:uu:diva-228915 (URN)10.1186/1476-069X-13-57 (DOI)000340001300001 ()24993424 (PubMedID)
    Tillgänglig från: 2014-07-22 Skapad: 2014-07-22 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
    3. Atherosclerosis in Humans and the Association to Environmental Contaminant Mixtures
    Öppna denna publikation i ny flik eller fönster >>Atherosclerosis in Humans and the Association to Environmental Contaminant Mixtures
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:uu:diva-237688 (URN)
    Tillgänglig från: 2014-12-04 Skapad: 2014-12-04 Senast uppdaterad: 2015-03-09
    4. Mixture Effects of Multiple Environmental Contaminants on the Metabolic Syndrome in a Human Population-based Sample
    Öppna denna publikation i ny flik eller fönster >>Mixture Effects of Multiple Environmental Contaminants on the Metabolic Syndrome in a Human Population-based Sample
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:uu:diva-237689 (URN)
    Tillgänglig från: 2014-12-04 Skapad: 2014-12-04 Senast uppdaterad: 2015-03-09
  • 237.
    Lampa, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Bornefalk-Hermansson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Mixture Effects of Multiple Environmental Contaminants on the Metabolic Syndrome in a Human Population-based SampleManuskript (preprint) (Övrigt vetenskapligt)
  • 238.
    Lampa, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Bornefalk-Hermansson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Lind, P Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Mixture Effects of Multiple Environmental Contaminants on the Metabolic Syndrome in a Human Population-based SampleManuskript (preprint) (Övrigt vetenskapligt)
  • 239.
    Lampa, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Bornefalk-Hermansson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Atherosclerosis in Humans and the Association to Environmental Contaminant MixturesManuskript (preprint) (Övrigt vetenskapligt)
  • 240.
    Lampa, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Bornefalk-Hermansson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Lind, P Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Atherosclerosis in Humans and the Association to Environmental Contaminant MixturesManuskript (preprint) (Övrigt vetenskapligt)
  • 241.
    Lampa, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Bornefalk Hermansson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Salihovic, Samira
    van Bavel, Bert
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    An investigation of the co-variation in circulating levels of a large number of environmental contaminants2012Ingår i: Journal of Exposure Science and Environmental Epidemiology, ISSN 1559-0631, E-ISSN 1559-064X, Vol. 22, nr 5, s. 476-482Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We are daily exposed to many different environmental contaminants. Mixtures of these contaminants could act together to induce more pronounced effects than the sum of the individual contaminants. To evaluate the effects of such mixtures, it is of importance to assess the co-variance amongst the contaminants. Thirty-seven environmental contaminants representing different classes were measured in blood samples from 1016 individuals aged 70 years. Hierarchical cluster analysis and principal component analysis were used to assess the co-variation among the contaminants. Within each identified cluster, possible marker contaminants were sought for. We validated our findings using data from the National Health and Nutrition Examination Survey (NHANES) 2003--2004 study. Two large clusters could be identified, one representing low/medium chlorinated polychlorinated biphenyls (PCBs) (<= 6 chlorine atoms), as well as two pesticides and one representing medium/high chlorinated PCBs (>= 6 chlorine atoms). PCBs 118 and 153 could be used as markers for the low/medium chlorinated cluster and PCBs 170 and 209 could be used as markers for the medium/high chlorinated cluster. This pattern was similar to data from the NHANES study. Apart from the PCBs, little co-variation was seen among the contaminants. Thus, a large number of chemicals have to be measured to adequately identify mixtures of environmental contaminants.

  • 242.
    Lampa, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Lind, Monica P.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Bornefalk-Hermansson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    The identification of complex interactions in epidemiology and toxicology: a simulation study of Boosted Regression Trees2014Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 13, s. 57-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is a need to evaluate complex interaction effects on human health, such as those induced by mixtures of environmental contaminants. The usual approach is to formulate an additive statistical model and check for departures using product terms between the variables of interest. In this paper, we present an approach to search for interaction effects among several variables using boosted regression trees. Methods: We simulate a continuous outcome from real data on 27 environmental contaminants, some of which are correlated, and test the method's ability to uncover the simulated interactions. The simulated outcome contains one four-way interaction, one non-linear effect and one interaction between a continuous variable and a binary variable. Four scenarios reflecting different strengths of association are simulated. We illustrate the method using real data. Results: The method succeeded in identifying the true interactions in all scenarios except where the association was weakest. Some spurious interactions were also found, however. The method was also capable to identify interactions in the real data set. Conclusions: We conclude that boosted regression trees can be used to uncover complex interaction effects in epidemiological studies.

  • 243. Lastovkova, Andrea
    et al.
    Carder, Melanie
    Rasmussen, Hans Martin
    Sjoberg, Lars
    de Groene, Gerda J
    Sauni, Riitta
    Vevoda, Jiri
    Vevodova, Sarka
    Lasfargues, Gerard
    Svartengren, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Varga, Marek
    Colosio, Claudio
    Pelclova, Daniela
    Burnout syndrome as an occupational disease in the European Union: an exploratory study.2018Ingår i: Industrial Health, ISSN 0019-8366, E-ISSN 1880-8026, Vol. 56, nr 2, s. 160-165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The risk of psychological disorders influencing the health of workers increases in accordance with growing requirements on employees across various professions. This study aimed to compare approaches to the burnout syndrome in European countries. A questionnaire focusing on stress-related occupational diseases was distributed to national experts of 28 European Union countries. A total of 23 countries responded. In 9 countries (Denmark, Estonia, France, Hungary, Latvia, Netherlands, Portugal, Slovakia and Sweden) burnout syndrome may be acknowledged as an occupational disease. Latvia has burnout syndrome explicitly included on the List of ODs. Compensation for burnout syndrome has been awarded in Denmark, France, Latvia, Portugal and Sweden.Only in 39% of the countries a possibility to acknowledge burnout syndrome as an occupational disease exists, with most of compensated cases only occurring in recent years. New systems to collect data on suspected cases have been developed reflecting the growing recognition of the impact of the psychosocial work environment. In agreement with the EU legislation, all EU countries in the study have an action plan to prevent stress at the workplace.

  • 244. Laux, Timothy S
    et al.
    Bert, Philip J
    Barreto Ruiz, Gerardo M
    González, Marvin
    Unruh, Mark
    Aragon, Aurora
    Torres Lacourt, Cecilia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Nicaragua revisited: evidence of lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village2012Ingår i: JN. Journal of Nephrology (Milano. 1992), ISSN 1121-8428, E-ISSN 1724-6059, Vol. 25, nr 4, s. 533-540Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Chronic kidney disease (CKD) is found at epidemic levels in certain populations of the Pacific Coast in northwestern Nicaragua especially in younger men. There are knowledge gaps concerning CKD's prevalence in regions at higher altitudes.

    METHODS: A cross-sectional study of adults between the ages of 20 and 60 years in 1 coffee-growing village in Nicaragua located at 1,000 m above sea level (MASL) altitude was performed. Predictors included participant sex, age, occupation, conventional CKD risk factors and other factors associated with CKD suggested by previous surveys in Central America. Outcomes included serum creatinine (SCr) values >1.2 mg/dL for men and >0.9 mg/dL for women, estimated glomerular filtration rate (GFR) <60 ml/min per 1.73 m2, dipstick proteinuria stratified as microalbuminuria (30-300 mg/dL) and macroalbuminuria (>300 mg/dL), hypertension and body mass index.

    RESULTS: Of 324 eligible participants, 293 were interviewed (90.4%), and 267 of those received the physical exam (82.4% overall). Of the sample, 45% were men. Prevalence rate of estimated GFR <60 ml/min per 1.73 m2 was 0 for men (0%) and 2 for women (1.4%). The prevalence of at least microalbuminuria was significantly higher among men compared with women (27.5% vs. 21.4%, respectively; p=0.02).

    CONCLUSIONS: The CKD prevalence in this village is comparable to a previously studied Nicaraguan coffee-farming region and much lower than previously screened portions of northwestern Nicaragua. There is heterogeneity in CKD prevalence across Nicaragua. At this time, screenings should target individuals living in previously identified, higher risk regions. More work is needed to understand determinants of CKD in this resource-poor nation.

  • 245. Laux, Timothy S.
    et al.
    Bert, Philip J.
    Gonzalez, Marvin
    Unruh, Mark
    Aragon, Aurora
    Lacourt, Cecilia Torres
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Revalence of hypertension and associated risk factors in six nicaraguan communities2012Ingår i: Ethnicity & Disease, ISSN 1049-510X, Vol. 22, nr 2, s. 129-135Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Describe the prevalence of hypertension. Design: Population based cross-sectional survey. Setting: Six Nicaraguan communities with varying economies. Participants: 1,355 adults aged 20-60 years who completed both self-reported and quantitative measures of health. Main Outcome Measures: Prevalence of hypertension (systolic >= 140 mm Hg, diastolic >= 90 mm Hg, or self-reported medical history with diagnosis by a health care professional), uncontrolled hypertension (systolic >= 140 mm Hg or diastolic >= 90 mm Hg), diabetes (urinary glucose excretion >= 100 mg/dL or self-reported medical history diagnosed by a health care professional), and uncontrolled diabetes (urinary glucose excretion >= 100 mg/dL only). Results: The prevalence of hypertension was 22.0% (19.2% in men, 24.2% in women). Blood pressure was controlled in 31.0% of male hypertensives and 55.1% of female hypertensives (odds ratio [OR] 2.86; 95% confidence interval [CI] 1.74-4.69). Older age and higher body mass index were strongly associated with hypertension. Women who completed primary school had a lower risk of hypertension (OR .40; 95% CI .19-.85) compared to those with no formal education. A history of living in both urban and rural settings was associated with lower prevalence of hypertension (OR .52; 95% CI .34-.79). Diabetes mellitus was found in 1.2% of men and 4.3% of women. Male sex was independently associated with decreased risk of diabetes (OR .31; 95% CI .11-.86). Conclusions: At least one cardiovascular risk factor was found in half of this Nicaraguan sample. Cardiovascular risk factors should be the target of educational efforts, screening, and treatment.

  • 246. Le Moual, Nicole
    et al.
    Carsin, Anne-Elie
    Siroux, Valerie
    Radon, Katja
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Toren, Kjell
    Olivieri, Mario
    Urrutia, Isabel
    Cazzoletti, Lucia
    Jacquemin, Benedicte
    Benke, Geza
    Kromhout, Hans
    Mirabelli, Maria C.
    Mehta, Amar J.
    Schluenssen, Vivi
    Sigsgaard, Torben
    Blanc, Paul D.
    Kogevinas, Manolis
    Anto, Josep M.
    Zock, Jan-Paul
    Occupational exposures and uncontrolled adult-onset asthma in the European Community Respiratory Health Survey II2014Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 43, nr 2, s. 374-386Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Occupational exposure is a well-recognised modifiable risk factor for asthma, but the relationship between occupational exposure and asthma control has not been studied. We aimed to study this association among working-age adults from the European Community Respiratory Health Survey (ECRHS). Data were available for 7077 participants (mean age 43 years, 45% never-smokers, 5867 without asthma and 1210 with current asthma). Associations between occupational exposure to specific asthmagens and asthma control status (33% with uncontrolled asthma, based on the Global Initiative for Asthma guidelines) were evaluated using logistic and multinomial regressions, adjusted for age, sex and smoking status, with study areas included as a random effect. Statistically significant positive associations were observed between uncontrolled adult-onset asthma and both past 12-month and 10-year exposure to any occupational asthmagens (OR (95% CI) 1.6 (1.0-2.40) and 1.7 (1.2-2.5), respectively); high (1.7 (1.0-2.8) and 1.9 (1.3-2.9), respectively) and low (1.6 (1.0-2.7) and 1.8 (1.2-2.7), respectively) molecular weight agents; and cleaning agents (2.0 (1.1-3.6) and 2.3 (1.4-3.6), respectively), with stronger associations for long-term exposures. These associations were mainly explained by the exacerbation domain of asthma control and no associations were observed between asthmagens and partly controlled asthma. These findings suggest that occupational exposure to asthmagens is associated with uncontrolled adult-onset asthma. Occupational risk factors should be quickly identified to prevent uncontrolled asthma.

  • 247.
    Leander, Mai
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Health-Related Quality of Life in Asthma2010Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Health-related quality of life (HRQL) has become an important outcome in asthma, since traditional outcomes, such as respiratory symptoms and pulmonary function, might not entirely express the patient’s perception of the limitations caused by the disease. The aim of this thesis was to study HRQL in asthma and to analyse if HRQL was related to asthma onset and prognosis. Other aims were to identify determinants of low HRQL in clinically-verified asthmatics, and to study whether low HRQL was a predictor of mortality.

    In 1990, a self-administered questionnaire was completed by 12,560 individuals from three age groups (16, 30-39, and 60-69 years) in two counties of Sweden. In a second phase, all subjects who reported a history of obstructive respiratory symptoms (n = 1,851) and 600 randomly-selected controls were invited to a clinical investigation including spirometry, allergy testing, and assessment of HRQL with the Gothenburg Quality of Life instrument. In 2003, the eligible subjects in the cohort (n=11,282) were sent a new questionnaire. Mortality data in the cohort was followed up during 1990–2008 using data from the National Board of Health and Welfare Mortality Database.

    The 616 subjects with clinically-verified asthma 1990 had significantly lower HRQL than subjects without asthma. In the 2003 follow-up, the 305 subjects with persistent asthma had a lower HRQL than the 155 subjects who showed improvement in asthma during the follow-up. Subjects who had developed asthma by the follow-up had a significantly lower HRQL at baseline than those who did not develop asthma. Significant determinants of quality of life in asthma were female sex, smoking habits, higher airway responsiveness to irritants, respiratory symptom severity, positive skin prick test, and absenteeism from work or school. Low HRQL was related to increased mortality, but this association was not found when analyzing the asthmatic group alone.

    In conclusion, measurements of HRQL are of value for evaluating both the impact and progression of asthma.

    Delarbeten
    1. Non-respiratory symptoms and well-being in asthmatics from a general population sample
    Öppna denna publikation i ny flik eller fönster >>Non-respiratory symptoms and well-being in asthmatics from a general population sample
    Visa övriga...
    2009 (Engelska)Ingår i: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 46, nr 6, s. 552-559Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND: Different instruments have been developed to assess health-related quality of life (HRQL) in asthma patients. However, relatively few studies have assessed HRQL in asthma patients from a general population, and it is still unclear which instrument is most suitable. The purpose of this study was to compare HRQL in clinically verified asthmatics with subjects with respiratory symptoms without asthma and with subjects with no respiratory symptoms from a general population. The generic instrument Gothenburg Quality of Life (GQL) was used. A secondary aim was to study if GQL had any prognostic value in asthma. METHODS: A cohort of three age groups in Sweden was investigated in 1990 using a respiratory questionnaire and GQL. The cohort consisted of 616 subjects with asthma, 488 subjects with respiratory symptoms but no asthma, and 347 subjects without respiratory symptoms. The participants were also investigated by spirometry and allergy testing. In a follow-up study, subjects were identified who had persistent and improved asthma. RESULTS: The prevalence of 28 of the 30 common symptoms in GQL was significantly increased (p < 0.001) in subjects with asthma as compared to non-asthmatics. All symptoms in the domains heart and lung, head, musculoskeletal, tension, and depression were significantly increased among the asthmatics. The asthmatics also rated their physical well-being lower (p < 0.001) than subjects with no respiratory symptoms. Subjects with persistent asthma had a significantly higher prevalence of 7 of the 30 symptoms and lower social well-being than subjects showing improvement in asthma during the follow-up. All differences remained significant after adjusting for age, sex, and smoking habits. CONCLUSION: Subjects with asthma had different symptom-profiles compared to those of non-asthmatics, with a higher prevalence of both respiratory and non-respiratory symptoms. Asthma is also a disease that is related to low well-being. The use of quality-of-life questionnaires such as the GQL may provide useful information for evaluating the non-respiratory aspects of asthma as well as for assessing the impact of disease on health status and well-being.

    Nyckelord
    asthma, GQL, quality of life, generic instrument, prognostic
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-108009 (URN)10.1080/02770900902866743 (DOI)000268707700005 ()19657894 (PubMedID)
    Tillgänglig från: 2009-09-03 Skapad: 2009-09-03 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    2. Health-related quality of life predicts onset of asthma in a longitudinal population study
    Öppna denna publikation i ny flik eller fönster >>Health-related quality of life predicts onset of asthma in a longitudinal population study
    Visa övriga...
    2009 (Engelska)Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 103, nr 2, s. 194-200Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND: Health-related quality of life (HRQL) has been increasingly used as an outcome measure in asthma, but less is known about the prognostic implication of low health-related quality of life. The purpose of this study was to investigate if a set of quality of life measures could predict onset of asthma. METHODS: In the baseline study 391 subjects without asthma answered a respiratory questionnaire and the Gothenburg Quality of Life (GQL) instrument in 1990. The GQL questionnaire included two parts: (1) the prevalence of HRQL-related symptoms and (2) well-being scores for physical, mental and social dimensions. The participants were also investigated with spirometry and allergy testing. In 2003, the same respiratory questionnaire that had been used in 1990 was sent. There were 290 responders, of whom 22 subjects had developed asthma. RESULTS: Participants who had developed asthma by the follow-up had a higher prevalence of sleep disturbances (30% vs. 10%), problems with chest pain (16% vs. 2%), depression (40% vs. 20%) difficulty relaxing (40% vs. 13%) and constipation (25% vs. 2%) at baseline than participants who did not develop asthma (p<0.05). Subjects who developed asthma also scored significantly lower on well-being variables as sleep, energy, mood, patience, memory, appetite, fitness and sense of appreciation outside home. These differences remained after adjusting for age, sex, smoking habits, asthma heredity, socioeconomic groups and building dampness. CONCLUSION: Participants with low health-related quality of life at baseline were more likely to report having developed asthma 12 years later.

    Nyckelord
    Quality of life, asthma
    Nationell ämneskategori
    Lungmedicin och allergi
    Forskningsämne
    Arbets- och miljömedicin
    Identifikatorer
    urn:nbn:se:uu:diva-102474 (URN)10.1016/j.rmed.2008.09.015 (DOI)000263187100006 ()19046862 (PubMedID)
    Tillgänglig från: 2009-05-07 Skapad: 2009-05-07 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    3. Associations Between Mortality, Asthma, and Health-Related Qualityof Life in an Elderly Cohort of Swedes
    Öppna denna publikation i ny flik eller fönster >>Associations Between Mortality, Asthma, and Health-Related Qualityof Life in an Elderly Cohort of Swedes
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    2010 (Engelska)Ingår i: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background. Asthma is a common chronic health condition among the elderly and an important cause of morbidity and mortality. Some studiesshow that subjective assessments of health-related quality of life (HRQL) are important predictors of mortality and survival. The primary aim ofthis study was to investigate whether low HRQL was a predictor of mortality in elderly subjects and whether such an association differed betweensubjects with and without asthma. Methods. In 1990, a cohort in middle Sweden was investigated using a respiratory questionnaire. To assess HRQL,the generic instrument Gothenburg Quality of Life (GQL) was used. The participants were also investigated by spirometry and allergy testing. Thepresent study was limited to the subjects in the oldest age group, aged 60–69 years in 1990, and included 222 subjects with clinically verified asthma,148 subjects with respiratory symptoms but no asthma or other lung diseases, and 102 subjects with no respiratory symptoms. Mortality in thecohort was followed during 1990–2008. Results. Altogether, 166 of the 472 subjects in the original cohort had died during the follow-up period of1990–2008. Mortality was significantly higher in men, in older subjects, in smokers, and subjects with a low forced expiratory volume in one second(FEV1). There was, however, no difference in mortality between the asthmatic and the nonasthmatic groups. A higher symptoms score for GQLwas significantly related to increased mortality. No association between HRQL and mortality was found when limiting the analysis to the asthmaticgroup, although the asthmatics had a lower symptom score for GQL compared to the other groups. Conclusion. A higher symptom score in the GQLinstrument was significantly related to increased mortality, but this association was not found when analyzing the asthmatic group alone. The negativeprognostic implications of a low HRQL in the whole group and the fact that the asthmatic group had a lower HRQL than the other group supports theuse of HRQL instruments in clinical health assessments.

    Nyckelord
    asthma, generic instrument, GQL, mortality, quality of life
    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Forskningsämne
    Arbets- och miljömedicin
    Identifikatorer
    urn:nbn:se:uu:diva-129463 (URN)
    Tillgänglig från: 2010-08-16 Skapad: 2010-08-16 Senast uppdaterad: 2017-12-12
    4. Determinants for a low health-related quality of life in asthmatics
    Öppna denna publikation i ny flik eller fönster >>Determinants for a low health-related quality of life in asthmatics
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    2012 (Engelska)Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, nr 1, s. 57-66Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    People with asthma suffer from impaired health-related quality of life (HRQL) but the determinants of HRQL among asthmatics are not completely understood. The aim of this study was to study determinants of low HRQL in asthmatics and to study whether the determinants of HRQL differ between sexes and age groups.

    A cohort of three age groups in Sweden was investigated in 1990 using a respiratory questionnaire. To study quality of life, the generic instrument Gothenburg Quality of Life was used. The participants were also investigated with interviews, spirometry and allergy testing. Asthma was diagnosed in 616 subjects.

    Fifty-eight percent (n=359) of the subjects were women. Twenty-four percent were smokers, 22% ex-smokers and 54% were non-smokers. Women were more likely than men to report poor health-related quality of life. Respiratory symptoms severity was another independent determinant of a lower quality of life as well as airway responsiveness to irritants. Current and former smokers also reported lower quality of life. Finally, absenteeism from school and work was associated with lower quality of life.

    Factors such as sex, smoking habits, airway responsiveness to irritants, respiratory symptom severity, allergy, and absenteeism from school and work were associated with low HRQL in asthmatics.

    Nyckelord
    asthma, GQL, quality of life, generic instrument, prognostic
    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Forskningsämne
    Arbets- och miljömedicin
    Identifikatorer
    urn:nbn:se:uu:diva-129457 (URN)10.3109/03009734.2011.638730 (DOI)000300304000010 ()
    Tillgänglig från: 2010-08-16 Skapad: 2010-08-16 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
  • 248.
    Leander, Mai
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Cronqvist, Agneta
    Institutionen för vårdvetenskap, Ersta Sköndal högskola.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Uddenfeldt, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Rask-Andersen, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Health-related quality of life predicts onset of asthma in a longitudinal population study2009Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 103, nr 2, s. 194-200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Health-related quality of life (HRQL) has been increasingly used as an outcome measure in asthma, but less is known about the prognostic implication of low health-related quality of life. The purpose of this study was to investigate if a set of quality of life measures could predict onset of asthma. METHODS: In the baseline study 391 subjects without asthma answered a respiratory questionnaire and the Gothenburg Quality of Life (GQL) instrument in 1990. The GQL questionnaire included two parts: (1) the prevalence of HRQL-related symptoms and (2) well-being scores for physical, mental and social dimensions. The participants were also investigated with spirometry and allergy testing. In 2003, the same respiratory questionnaire that had been used in 1990 was sent. There were 290 responders, of whom 22 subjects had developed asthma. RESULTS: Participants who had developed asthma by the follow-up had a higher prevalence of sleep disturbances (30% vs. 10%), problems with chest pain (16% vs. 2%), depression (40% vs. 20%) difficulty relaxing (40% vs. 13%) and constipation (25% vs. 2%) at baseline than participants who did not develop asthma (p<0.05). Subjects who developed asthma also scored significantly lower on well-being variables as sleep, energy, mood, patience, memory, appetite, fitness and sense of appreciation outside home. These differences remained after adjusting for age, sex, smoking habits, asthma heredity, socioeconomic groups and building dampness. CONCLUSION: Participants with low health-related quality of life at baseline were more likely to report having developed asthma 12 years later.

  • 249.
    Leander, Mai
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Cronqvist, Agneta
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Uddenfeldt, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Rask-Andersen, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Non-respiratory symptoms and well-being in asthmatics from a general population sample2009Ingår i: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 46, nr 6, s. 552-559Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Different instruments have been developed to assess health-related quality of life (HRQL) in asthma patients. However, relatively few studies have assessed HRQL in asthma patients from a general population, and it is still unclear which instrument is most suitable. The purpose of this study was to compare HRQL in clinically verified asthmatics with subjects with respiratory symptoms without asthma and with subjects with no respiratory symptoms from a general population. The generic instrument Gothenburg Quality of Life (GQL) was used. A secondary aim was to study if GQL had any prognostic value in asthma. METHODS: A cohort of three age groups in Sweden was investigated in 1990 using a respiratory questionnaire and GQL. The cohort consisted of 616 subjects with asthma, 488 subjects with respiratory symptoms but no asthma, and 347 subjects without respiratory symptoms. The participants were also investigated by spirometry and allergy testing. In a follow-up study, subjects were identified who had persistent and improved asthma. RESULTS: The prevalence of 28 of the 30 common symptoms in GQL was significantly increased (p < 0.001) in subjects with asthma as compared to non-asthmatics. All symptoms in the domains heart and lung, head, musculoskeletal, tension, and depression were significantly increased among the asthmatics. The asthmatics also rated their physical well-being lower (p < 0.001) than subjects with no respiratory symptoms. Subjects with persistent asthma had a significantly higher prevalence of 7 of the 30 symptoms and lower social well-being than subjects showing improvement in asthma during the follow-up. All differences remained significant after adjusting for age, sex, and smoking habits. CONCLUSION: Subjects with asthma had different symptom-profiles compared to those of non-asthmatics, with a higher prevalence of both respiratory and non-respiratory symptoms. Asthma is also a disease that is related to low well-being. The use of quality-of-life questionnaires such as the GQL may provide useful information for evaluating the non-respiratory aspects of asthma as well as for assessing the impact of disease on health status and well-being.

  • 250.
    Leander, Mai
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Uddenfeldt, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Cronqvist, Agneta
    Rask-Andersen, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Associations between mortality, asthma, and health-related quality of life in an elderly cohort of Swedes2010Ingår i: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 47, nr 6, s. 627-632Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Asthma is a common chronic health condition among the elderly and an important cause of morbidity and mortality. Some studies show that subjective assessments of health-related quality of life (HRQL) are important predictors of mortality and survival. The primary aim of this study was to investigate whether low HRQL was a predictor of mortality in elderly subjects and whether such an association differed between subjects with and without asthma. METHODS: In 1990, a cohort in middle Sweden was investigated using a respiratory questionnaire. To assess HRQL, the generic instrument Gothenburg Quality of Life (GQL) was used. The participants were also investigated by spirometry and allergy testing. The present study was limited to the subjects in the oldest age group, aged 60-69 years in 1990, and included 222 subjects with clinically verified asthma, 148 subjects with respiratory symptoms but no asthma or other lung diseases, and 102 subjects with no respiratory symptoms. Mortality in the cohort was followed during 1990-2008. RESULTS: Altogether, 166 of the 472 subjects in the original cohort had died during the follow-up period of 1990-2008. Mortality was significantly higher in men, in older subjects, in smokers, and subjects with a low forced expiratory volume in one second (FEV(1)). There was, however, no difference in mortality between the asthmatic and the nonasthmatic groups. A higher symptoms score for GQL was significantly related to increased mortality. No association between HRQL and mortality was found when limiting the analysis to the asthmatic group, although the asthmatics had a lower symptom score for GQL compared to the other groups. CONCLUSION: A higher symptom score in the GQL instrument was significantly related to increased mortality, but this association was not found when analyzing the asthmatic group alone. The negative prognostic implications of a low HRQL in the whole group and the fact that the asthmatic group had a lower HRQL than the other group supports the use of HRQL instruments in clinical health assessments.

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