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  • 301.
    Lind, P. Monica
    et al.
    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 Center, School of Science and Technology, Örebro University, Örebro, Sweden.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    High plasma organochlorine pesticide levels are related to increased biological age as calculated by DNA methylation analysis2018Ingår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 113, s. 109-113Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Organochlorine pesticides (OCPs) have been shown in the experimental setting to alter DNA methylation. Since DNA methylation changes during the life-span, formulas have been presented to calculate "DNA methylation age" as a measure of biological age.

    OBJECTIVES: We aimed to investigate if circulating levels of three OCPs were related to increased DNA methylation age METHODS: 71CpG DNA methylation age (Hannum formula) was calculated based on data from the Illumina 450 k Bead Methylation chip in 1000 subjects in the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study (50% women, all aged 70 years at the examination). The difference between DNA methylation age and chronological age was calculated (DiffAge). 2,2-bis (4-chlorophenyl)-1,1-dichloroethene (p,p'-DDE), hexachlorobenzene (HCB), and transnonachlor (TNC) levels were measured in plasma by high-resolution gas chromatography coupled mass spectrometry (HRGC-HRMS).

    RESULTS: Increased p,p'-DDE and TNC, but not HCB, levels were related to increased DiffAge both in sex and BMI-adjusted models, as well as in multiple adjusted models (sex, education level, exercise habits, smoking, energy and alcohol consumption and BMI) (p = 0.0051 and p = 0.011, respectively). No significant interactions between the OCPs and sex or BMI regarding DiffAge were found.

    CONCLUSION: In this cross-sectional study, increased levels of two out of three OCPs were related to increased DNA methylation age, further suggesting negative health effects in humans of these widespread environmental contaminants.

  • 302.
    Lind, P. Monica
    et al.
    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. Orebro Univ, Sch Sci & Technol, MTM Res Ctr, Orebro, Sweden.
    Stubleski, Jordan
    Orebro Univ, Sch Sci & Technol, MTM Res Ctr, Orebro, Sweden.
    Kärrman, Anna
    Orebro Univ, Sch Sci & Technol, MTM Res Ctr, Orebro, Sweden.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Changes in plasma levels of perfluoroalkyl substances (PFASs) are related to increase in carotid intima-media thickness over 10 years - a longitudinal study2018Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 17, artikel-id 59Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: It has previously been reported that the environmental contaminants perfluoroalkyl substances (PFASs) are linked to atherosclerosis in cross-sectional studies. Since cross-sectional studies could be subject to reverse causation, the purpose of this study was to analyze if the longitudinal changes in PFASs during a 10-year follow-up were related to the change in carotid artery intima-media thickness (IMT, ultrasound) during the same period.

    Methods: In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, 1016 individuals were investigated at age 70; 826 of them were reinvestigated at age 75 and 602 at age 80 years. Eight different PFASs were measured in plasma by ultra-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), and IMT was measured at all three time points. Random-effects mixed regression models were used to examine the associations over time.

    Results: IMT increased 0.058 mm during the 10-year period (p <0.0001). Following adjustment for baseline values of PFASs (age 70) and sex, the changes in plasma levels of 6 of the 8 measured PFASs were significantly related to the change in IMT over the 10-year follow-up period in a positive fashion (p <0.0062 using Bonferroni correction for 8 tests). Further adjustment for traditional cardiovascular (CV) risk factors (HDL and LDL cholesterol, smoking, systolic blood pressure, statin use, fasting glucose and serum triglycerides) affected these relationships only marginally.

    Conclusion: The change in plasma levels of several PFASs during 10 years was positively related to increase in IMT seen during the same period, giving prospective evidence that PFASs might interfere with the atherosclerotic process.

  • 303.
    Lind, P. Monica
    et al.
    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.
    van Bavel, Bert
    MTM Research Centre, School of Science and Technology, Örebro University, Örebro, Sweden.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Circulating levels of perfluoroalkyl substances (PFASs) and carotid artery atherosclerosis2017Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 152, s. 157-164Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: During recent years, some persistent organic pollutants (POPs) have been linked to atherosclerosis. One group of POPs, the poly- and perfluoroalkyl substances (PFASs) have not been investigated with regard to atherosclerotic plaques.

    METHODS: Carotid artery atherosclerosis was assessed by ultrasound in 1016 subjects aged 70 years in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Eight PFASs were detected in >75% of participants' plasma by ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS).

    RESULTS: No significant linear associations were observed between the PFASs and intima-media thickness (IMT), or the echogenicity in the intima-media complex (IM-GSM, a marker of lipid infiltration in the artery) when men and women were analyzed together. Neither was occurrence of carotid plaques related to PFASs levels. However, highly significant interactions were observed between some PFASs and sex regarding both IM-GSM and plaque prevalence. Perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA), were all related to IM-GSM in a positive fashion in women (p=0.002-0.003), while these relationships were negative in men. The levels of PFUnDA were significantly related to carotid plaque in women (OR 1.59, 95%CI 1.03-2.43, p=0.03), but not in men (OR 0.93, 95%CI 0.62-1.42, p=0.75).

    CONCLUSIONS: In this cross-sectional study, a pronounced gender difference was observed regarding associations between some PFASs, especially the long-chain PFUnDA, and markers of atherosclerosis, with more pronounced relationships found in women. These findings suggest a sex-specific role for PFASs in atherosclerosis.

  • 304.
    Lind, P. Monica
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Zethelius, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Circulating Levels of Phthalate Metabolites Are Associated With Prevalent Diabetes in the Elderly2012Ingår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 35, nr 7, s. 1519-1524Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE-Phthalates are ubiquitous industrial high-volume chemicals known as ligands to peroxisome proliferator activated receptors (PPARs). Because PPAR-gamma agonists modulate insulin sensitivity and are used to treat type 2 diabetes, we investigated whether circulating levels of phthalate metabolites are related to prevalent type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 1,016 subjects, aged 70 years, were investigated in the Prospective Investigation of the Vasculature in Uppsala Seniors Study. Four phthalate metabolites were detected in almost all participant sera by an API 4000 liquid chromatograph/tandem mass spectrometer. Type 2 diabetes was defined as the use of pharmacological hypoglycemic agents or a fasting plasma glucose >7.0 mmol/L. RESULTS-A total of 114 subjects were shown to have diabetes. Following adjustment for sex, BMI, serum cholesterol and triglycerides, educational level, and smoking and exercise habits, high levels of the phthalate metabolites monomethyl phthalate (MMP) (P < 0.01), monoisobutyl phthalate (MiBP) (P < 0.05), and monoethyl phthalate (MEP) (P < 0.05), but not mono(2-ethylhexyl) phthalate, were associated with an increased prevalence of diabetes. Using the fasting proinsulin to insulin ratio as a marker of insulin secretion and the homeostasis model assessment-insulin resistance index as a marker of insulin resistance, MiBP was mainly related to poor insulin secretion, whereas MEP and MMP mainly were related to insulin resistance. CONCLUSIONS-The findings in this cross-sectional study showed that several phthalate metabolites are related to diabetes prevalence, as well as to markers of insulin secretion and resistance. These findings support the view that these commonly used chemicals might influence major factors that are regulating glucose metabolism in humans at the level of exposure of phthalate metabolites seen in the general elderly population.

  • 305.
    Lind, Thomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Hu, Lijuan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Lind, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Sugars, Rachael
    Andersson, Göran
    Jacobson, Annica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Melhus, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Microarray Profiling of Diaphyseal Bone of Rats Suffering from Hypervitaminosis A2012Ingår i: Calcified Tissue International, ISSN 0171-967X, E-ISSN 1432-0827, Vol. 90, nr 3, s. 219-229Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Vitamin A is the only known compound that produces spontaneous fractures in rats. In an effort to resolve the molecular mechanism behind this effect, we fed young male rats high doses of vitamin A and performed microarray analysis of diaphyseal bone with and without marrow after 1 week, i.e., just before the first fractures appeared. Of the differentially expressed genes in cortical bone, including marrow, 98% were upregulated. In contrast, hypervitaminotic cortical bone without marrow showed reduced expression of 37% of differentially expressed genes. Gene ontology (GO) analysis revealed that only samples containing bone marrow were associated with a GO term, which principally represented extracellular matrix. This is consistent with the histological findings of increased endosteal/marrow osteoblast number. Fourteen genes, including Cyp26b1, which is known to be upregulated by vitamin A, were selected and verified by real-time PCR. In addition, immunohistochemical staining of bone sections confirmed that the bone-specific molecule osteoadherin was upregulated. Further analysis of the major gene-expression changes revealed apparent augmented Wnt signaling in the sample containing bone marrow but reduced Wnt signaling in cortical bone. Moreover, induced expression of hypoxia-associated genes was found only in samples containing bone marrow. Together, these results highlight the importance of compartment-specific analysis of bone and corroborate previous observations of compartment-specific effects of vitamin A, with reduced activity in cortical bone but increased activity in the endosteal/marrow compartment. We specifically identify potential key osteoblast-, Wnt signaling-, and hypoxia-associated genes in the processes leading to spontaneous fractures.

  • 306.
    Lind, Thomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Lejonklou, Margareta Halin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Dunder, Linda
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Rasmusson, Annica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Melhus, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Low-dose developmental exposure to bisphenol A induces sex-specific effects in bone of Fischer 344 rat offspring2017Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 159, s. 61-68, artikel-id S0013-9351(17)30727-2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Bisphenol A (BPA) is a component of polycarbonate plastics to which humans are regularly exposed at low levels, and an endocrine disruptor with effects on several hormonal systems. Bone is a sensitive hormone target tissue, and we have recently shown that in utero and lactational exposure to 25µg BPA/kg BW/day alters femoral geometry in rat offspring.

    OBJECTIVE: To investigate bone effects in rat offspring after developmental exposure to a BPA dose in the range of human daily exposure (0.1-1.5µg/kg BW/day) as well as a dose to corroborate previous findings.

    METHODS: Pregnant Fischer 344 rats were exposed to BPA via drinking water corresponding to 0.5µg/kg BW/day: [0.5], (n=21) or 50µg/kg BW/day: [50], (n = 16) from gestational day 3.5 until postnatal day 22, while controls were given only vehicle (n = 25). The offspring was sacrificed at 5 weeks of age. Bone effects were analyzed using peripheral quantitative computed tomography (pQCT), the 3-point bending test, plasma markers of bone turnover, and gene expression in cortical bone and bone marrow.

    RESULTS: Compared to controls, male offspring developmentally exposed to BPA had shorter femurs. pQCT analysis revealed effects in the [0.5] group, but not in the [50] group; BPA reduced both trabecular area (-3.9%, p < 0.01) and total cross sectional area (-4.1%, p < 0.01) of femurs in the [0.5] group, whereas no effects were seen on bone density. Conversely, bone length and size were not affected in female offspring. However, the procollagen type I N-terminal propeptide (P1NP), a peptide formed during type 1 collagen synthesis, was increased in plasma (42%: p < 0.01) in female offspring exposed to [0.5] of BPA, although collagen gene expression was not increased in bone. The biomechanical properties of the bones were not altered in either sex. Bone marrow mRNA expression was only affected in male offspring.

    CONCLUSIONS: Developmental low-dose exposure to BPA resulted in sex-specific bone effects in rat offspring. A dose approximately eight times lower than the current temporary EFSA human tolerable daily intake of 4µg/kg BW/day, reduced bone length and size in male rat offspring. Long-term studies are needed to clarify whether the increased plasma levels of P1NP in female offspring reflect development of fibrosis.

  • 307.
    Lind, Thomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakologi.
    Lind, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Jacobson, Annica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakologi.
    Hu, Lijuan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakologi.
    Sundqvist, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakologi.
    Risteli, Juha
    Yebra-Rodriguez, Africa
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Rodriguez-Navarro, Alejandro
    Andersson, Göran
    Melhus, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakologi.
    High dietary intake of retinol leads to bone marrow hypoxia and diaphyseal endosteal mineralization in rats2011Ingår i: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 48, nr 3, s. 496-506Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Vitamin A (retinol) is the only molecule known to induce spontaneous fractures in laboratory animals and we have identified retinol as a risk factor for fracture in humans. Since subsequent observational studies in humans and old animal data both show that high retinol intake appears to only have small effects on bone mineral density (BMD) we undertook a mechanistic study of how excess retinol reduces bone diameter while leaving BMD essentially unaffected. We fed growing rats high doses of retinol for only 1week. Bone analysis involved antibody-based methods, histology, pQCT, biomechanics and bone compartment-specific PCR together with Fourier Transform Infrared Spectroscopy of bone mineral. Excess dietary retinol induced weakening of bones with little apparent effect on BMD. Periosteal osteoclasts increased but unexpectedly endosteal osteoclasts disappeared and there was a reduction of osteoclastic serum markers. There was also a lack of capillary erythrocytes, endothelial cells and serum retinol transport protein in the endosteal/marrow compartment. A further indication of reduced endosteal/marrow blood flow was the increased expression of hypoxia-associated genes. Also, in contrast to the inhibitory effects in vitro, the marrow of retinol-treated rats showed increased expression of osteogenic genes. Finally, we show that hypervitaminotic bones have a higher degree of mineralization, which is in line with biomechanical data of preserved stiffness in spite of thinner bones. Together these novel findings suggest that a rapid primary effect of excess retinol on bone tissue is the impairment of endosteal/marrow blood flow leading to hypoxia and pathological endosteal mineralization.

  • 308.
    Lind, Thomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Hu, Lijuan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Melhus, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Studies of indirect and direct effects of hypervitaminosis A on rat bone by comparing free access to food and pair-feeding.2018Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, nr 2, s. 82-85Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The most prominent features of hypervitaminosis A in rats are spontaneous fractures and anorexia. Since caloric restriction induces alterations in bone, some effects could be secondary to loss of appetite. To clarify the mechanisms behind vitamin A-induced bone fragility it is necessary to distinguish between direct and indirect effects.

    MATERIALS AND METHODS: In this study we compared rats fed high doses of vitamin A both with pair-fed controls, which were fed the same amount of chow as that consumed by the vitamin A group to keep food intake the same, and to controls with free access to food.

    RESULTS: In contrast to the pair-fed animals, rats in the free access group fed high doses of vitamin A for 7 days had 13% lower food intake, 15% lower body weight, and 2.7% shorter femurs compared with controls. In addition, serum biomarkers of bone turnover were reduced. Peripheral quantitative computed tomography of the femurs showed that the bone mineral content, cross sectional area, and periosteal circumference were similarly reduced in the pair-fed and free access groups. However, bone mineral density (BMD) and cortical parameters were only significantly decreased in the free access group.

    CONCLUSIONS: Our data indicate that the major direct short-term effect of high doses of vitamin A on rat bone is a reduced bone diameter, whereas the effects on bone length, serum biomarkers of bone turnover, BMD, and bone cortex appear to be mainly indirect, caused by a systemic toxicity with loss of appetite, reduced food intake, and general effects on growth.

  • 309. Lind, Ylva Sjoberg
    et al.
    Lind, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Salihovic, Samira
    van Bavel, Bert
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Circulating levels of persistent organic pollutants (POPs) are associated with left ventricular systolic and diastolic dysfunction in the elderly2013Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 123, s. 39-45Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and objective: Major risk factors for congestive heart failure (CHF) are myocardial infarction, hypertension, diabetes, atrial fibrillation, smoking, left ventricular hypertrophy (LVH) and obesity. However, since these risk factors only explain part of the risk of CHF, we investigated whether persistent organic pollutants (POPs) might also play a role. Methods: In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, left ventricular ejection fraction, (EF), E/A-ratio and isovolumic relaxation time (IVRT), were determined by echocardiography and serum samples of 21 POPs were analyzed in serum measured by high-resolution chromatography coupled to high-resolution mass spectrometry (HRGC/HRMS) in 998 subjects all aged 70 years. Results: In this cross-sectional analysis, high levels of several of the polychlorinated biphenyls (PCB congeners 99, 118, 105, 138, 153, and 180) and octachlorodibenzo-p-dioxin (OCDD) were significantly related to a decreased EF. Some POPs were also related to a decreased E/A-ratio (PCBs 206 and 209). All the results were adjusted for gender, hypertension, diabetes, smoking, LVH and BMI, and subjects with myocardial infarction or atrial fibrillation were excluded from the analysis. Conclusions: Circulating levels of POPs were related to impairments in both left ventricular systolic and diastolic function independently of major congestive heart failure risk factors, suggesting a possible role of POPs in heart failure.

  • 310. Lind, Ylva Sjoeberg
    et al.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Salihovic, Samira
    van Bavel, Bert
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Persistent organic pollutants and abnormal geometry of the left ventricle in the elderly2013Ingår i: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 31, nr 8, s. 1547-1553Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:

    Established risk factors for left ventricular hypertrophy (LVH) are hypertension, diabetes, and obesity. However, as these risk factors explain only part of the variation in left ventricular mass, we investigated whether persistent organic pollutants (POPs) might also play a role in LVH, because exposure to polychlorinated biphenyl 126 induced cardiac growth in rats.

    Methods:

    In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS), left ventricular mass index (LVMI), relative wall thickness (RWT), and geometric groups of LVH, were determined by echocardiography and 21 POPs were measured by high-resolution chromatography coupled to high-resolution mass spectrometry (HRGC/HRMS) in 1016 individuals aged 70 years. All individuals with a history of myocardial infarction were excluded from analysis (n=72).

    Results:

    Several of the POPs were related to abnormal left ventricular geometry before adjustment for established risk factors, but lost in significance following adjustment. However, the pesticide hexachlorobenzene (HCB) levels were significantly related to RWT, and concentric left ventricular remodeling, also following adjustment for sex, blood pressure, antihypertensive treatment, diabetes, and BMI (P<0.0001).

    Conclusion:

    In this cross-sectional study, circulating levels of HCB were related to increased wall thickness of the left ventricle and concentric left ventricular remodeling, independently of LVH risk factors, suggesting a role of this environmental contaminant in abnormal growth of the left ventricle.

  • 311.
    Lindberg, Per
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Vingård, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Indicators of healthy work environments: a systematic review2012Ingår i: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 41, s. 3032-3038Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The purpose of this study was to systematically review the scientific literature and search for indicators of healthy work environments. A number of major national and international databases for scientific publication were searched for research addressing indicators of healthy work environments. Altogether 19 768 publications were found. After excluding duplicates, non-relevant publications, or publications that did not comply with the inclusion criteria 24 peer-reviewed publications remained to be included in this systematic review. Only one study explicitly addressing indicators of healthy work environments was found. That study suggested that the presence of stress management programs in an organization might serve as indicator of a 'good place to work', as these organizations were more likely to offer programs that encouraged employee well-being, safety and skill development than those without stress management programs. The other 23 studies either investigated employee's views of what constitute a healthy workplace or were guidelines for how to create such a workplace. Summarizing, the nine most pronounced factors considered as important for a healthy workplace that emerged from these studies were, in descending order: collaboration/teamwork: growth and development of the individual; recognition; employee involvement; positive, accessible and fair leader; autonomy and empowerment; appropriate staffing; skilled communication; and safe physical work.

  • 312.
    Lindgren, Torsten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    A case of indoor air pollution of ammonia emitted from concrete in a newly built office in Beijing2009Ingår i: Building and Environment, ISSN 0360-1323, E-ISSN 1873-684X, Vol. 45, nr 3, s. 596-600Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A case of suspected indoor ammonia contamination from concrete was   investigated in an airline company office in Beijing. A standardized   questionnaire on indoor environment perceptions, medical symptoms and   psychosocial work environment was distributed to all staff and compared   with a reference group of office workers from the same company in   Stockholm. Temperature, relative humidity, formaldehyde, volatile   organic compounds (VOC), ammonia, and carbon dioxide were measured both   in Beijing and Stockholm. In Beijing mould and bacteria were also   measured. Totally 95% (N = 14) participated. The Beijing staff reported   a higher rate of complaints regarding poor work satisfaction, and work   stress as compared to the Stockholm reference group. In the total   material (N = 203) the psychosocial environment was related to general   symptoms (headache and tiredness) but not odour perception or mucous   membrane symptoms. Controlling for age, smoking habits, and   psychosocial work environment the Beijing staff had more complaints on   unpleasant odour and mucous membrane symptoms. An increased indoor   concentration of ammonia (3-6 ppm) and benzene (26.8 mu g/m(3)) was   measured in the indoor air in the Beijing office, as compared to the   office in Stockholm (<0.1 ppm ammonia and 0.4 mu g/m(3) benzene). The   ammonia contamination in the Beijing office was confirmed, the probable   source being additives in the concrete. The ammonia level was well   below the Swedish threshold limit values (TLV) (25 ppm). In addition   the exposure to benzene, an indicator of traffic exhaust pollution was   high both indoors and outdoors in Beijing, possible related to   increased levels of odour complaints and mucous membrane irritation.

  • 313.
    Lindgren, Torsten
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Andersson, Kjell
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Perception of cockpit environment among pilots on commercial aircraft2006Ingår i: Aviation, Space and Environmental Medicine, ISSN 0095-6562, E-ISSN 1943-4448, Vol. 77, nr 8, s. 832-837Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Impaired cockpit environment may influence both well-being and performance of pilots. Objective: To study the perception of cockpit environment among pilots, in relation to demographic factors, and type of air craft (B767-300, B737-600, DC9/21-41, MD 81/90 series). Methods: A standardized questionnaire was mailed to all pilots in one airline company; 81% participated (n = 622). All flights were non-smoking flights and the B767 was the only aircraft operated on intercontinental flights. The DC9 was the only aircraft without air recirculation. Multiple logistic regression analysis was applied, controlling for age, gender, smoking, perceived psychosocial work environment, and type of aircraft. Results: Younger age and a history of atopy and stress due to excess work were the main predictors of symptom and environmental perceptions. The most common symptoms were fatigue (14%), facial dermal (10%), and nasal symptoms (9%). Common complaints on cockpit environment were dry air (53%), dust and dirt (48%), noise (46%), and inadequate illumination (34%). Using the DC9 as a reference category, Boeing 767 pilots had more fatigue (OR 19.5; p < 0.001), throat symptoms (OR = 4.40; p < 0.05), complaints on dry air (OR = 2.93; p < 0.01), stuffy air (OR = 4.60; p < 0.01), static electricity (OR = 6.39; < 0.05), and dust (OR = 2.01; p < 0.05). Boeing 737 pilots had more complaints on noise (OR = 4.01; p < 0.001) and dust (OR = 1.81; p < 0.05). MD 81/90 pilots had more complaints on dry air (OR = 1.76; p < 0.05), dust (OR = 1.92; p < 0.05), and inadequate illumination (OR = 2.08; p < 0.05). Conclusion: Complaints on the cockpit environment were common and differed between different types of aircraft. This indicates a need to optimize the cockpit environment, e.g., increase the cleaning and relative air humidity.

  • 314.
    Lindgren, Torsten
    et al.
    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.
    Wieslander, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Perception of cabin air quality in airline crew related to air humidification, on intercontinental flights2007Ingår i: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 17, nr 3, s. 204-210Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The influence of air humidification in aircraft, on perception of cabin air quality among airline crew (N = 71) was investigated. In-flight investigations were performed in the forward part and in the aft part on eight intercontinental flights with one Boeing 767 individually, equipped with an evaporation humidifier combined with a dehumidifying unit, to reduce accumulation of condensed water in the wall construction. Four flights had the air humidification active when going out, and turned off on the return flight. The four others had the inverse humidification sequence. The sequences were randomized, and double blind. Air humidification increased relative air humidity (RH) by 10% in forward part, and by 3% in aft part of the cabin and in the cockpit. When the humidification device was active, the cabin air was perceived as being less dry (P = 0.008), and fresher (P = 0.002). The mean concentration of viable bacteria (77–108 cfu/m3), viable molds (74–84 cfu/m3), and respirable particles (1–8 μg/m3) was low, both during humidified and non-humidified flights. On flights with air humidification, there were less particles in the forward part of the aircraft (P = 0.01). In conclusion, RH can be slightly increased by using ceramic evaporation humidifier, without any measurable increase of microorganisms in cabin air. The cabin air quality was perceived as being better with air humidification.

  • 315.
    Lindgren, Torsten
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Runeson, Roma
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Wahlstedt, K
    Wieslander, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Dammström, B-G
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Digestive Functional Symptoms Among Commercial Pilots in Relation to Diet, Insomnia, and Lifestyle Factors2012Ingår i: Aviation, Space and Environmental Medicine, ISSN 0095-6562, E-ISSN 1943-4448, Vol. 83, nr 9, s. 872-878Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The aim of our study was to identify associations between digestive symptoms among pilots and diet, insomnia, and lifestyle factors.

    Methods: A standardized questionnaire was mailed to all Stockholm pilots on duty in a Swedish airline company: 354 pilots and 564 office workers from the same company participated. Associations were analyzed by multiple logistic regressions with mutual adjustment.

    Results: Of the pilots, 9.9% reported poor appetite, 15.2% heartburn, 12.4% diarrhea, 62.1% bloating, 9.3% constipation, and 14.4% epigastralgia. Pilots reported more bloating and poor appetite compared with office workers. The prevalence of insomnia was 70.6% among pilots and 63.1% among office workers. Among pilots, insomnia was related to poor appetite, heartburn, diarrhea, bloating, constipation, and epigastralgia. There were no associations between insomnia and digestive symptoms among office workers. Among pilots, higher body mass index (BMI) was related to heartburn and smokers more often suffered from constipation. Frequent milk consumption was associated with heartburn and less constipation; female pilots suffered from more constipation. The number of years as an active pilot was negatively associated with epigastralgia and bloating.

    Conclusion: Insomnia and some digestive symptoms were more common among pilots than office workers. In addition to insomnia, BMI, smoking, female gender, and milk consumption were associated with some digestive symptoms. The strong association between insomnia and digestive symptoms among pilots, but not among office workers, suggests a stress component related to this occupation.

  • 316.
    Lindgren, Torsten
    et al.
    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.
    Dammström, Bo-Göran
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Tinnitus among airline pilots: prevalence and effects of age, flight experience, and other noise2009Ingår i: Aviation, Space and Environmental Medicine, ISSN 0095-6562, E-ISSN 1943-4448, Vol. 80, nr 2, s. 112-116Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Frequent or constant tinnitus can be a problem for pilots because it can be distracting and/or interfere with communications in the cockpit. We studied tinnitus in a population of airline pilots to determine its prevalence and identify predictors. METHODS: A total of 418 male and 42 female pilots on duty in a Swedish airline returned a completed tinnitus questionnaire (response rate 79%). Multiple logistic regression analysis was performed; variables retained in the model included age, smoking, exposure to loud impulse noise during leisure time, previous work as a military pilot, years of employment as a commercial pilot, and type of aircraft. When available, the pilots' most recent routine audiometric test (N = 388) was used to study the association between hearing impairment and tinnitus. RESULTS: A total of 40% of respondents had experienced tinnitus for more than 5 min during the past year, 18% reported constant or severe tinnitus, and 12% had at some time visited a doctor for problems related to tinnitus. There were associations between tinnitus and age, impulse noise, and hearing impairment at 3, 4, and 6 kHz. There was no association with aircraft type or work as a military pilot. Pilots with tinnitus were more likely to report themselves disturbed by noise in the cockpit. CONCLUSION: These results show that tinnitus is relatively common among pilots and can create problems with sensitivity to noise. The frequency of tinnitus is most closely related to age, gender, exposure to high impulse noise during leisure time, and hearing impairment.

  • 317.
    Lindström, Linda
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Ahlsson, Fredrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Perinatal, neonatal och barnkardiologisk forskning.
    Lundgren, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Bergman, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Lampa, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Born small for gestational age and moderate preterm; implications on postnatal growthIngår i: Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Today we lack knowledge if size at birth and gestational age interacts regarding postnatal growth pattern in children born at 32 gestational weeks or later.

    This population-based cohort study comprised 41,669 children born in gestational weeks 32-40 in Uppsala County, Sweden, between 2000 and 2015. We applied a generalized least squares model including anthropometric measurements at 1.5, 3, 4 and 5 years. We calculated estimated mean height, weight and BMI for children born in week 32+0, 35+0 or 40+0 with birthweight 50th percentile (standardized appropriate for gestational age, sAGA) or 3rd percentile (standardized small for gestational age, sSGA).

    Compared with children born sAGA at gestational week 40+0, those born sAGA week 32+0 or 35+0 had comparable estimated mean height, weight and BMI after 3 years of age. Making the same comparison, those born sSGA week 32+0 or 35+0 were shorter and lighter with lower estimated mean BMI throughout the whole follow-up period.

    Our findings suggest that being born SGA and moderate preterm is associated with short stature and low BMI during the first five years of life. The association seemed stronger the shorter gestational age at birth.

  • 318.
    Lisspers, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Larsson, K.
    Karolinska Inst, Solna, Sweden..
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Gutzwiller, F. S.
    Novartis Pharma AG, Basel, Switzerland..
    Mezzi, K.
    Novartis Pharma AG, Basel, Switzerland..
    Uhde, M.
    QuintilesIMS, Stockholm, Sweden..
    Jorgensen, L.
    QuintilesIMS, Copenhagen, Denmark..
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Extent And Impact Of Late Versus Early COPD Diagnosis In Women In The Swedish Arctic Study2017Ingår i: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 195, artikel-id A4705Artikel i tidskrift (Övrigt vetenskapligt)
  • 319. Liu, Bojing
    et al.
    Lavebratt, Catharina
    Nordqvist, Tobias
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Fandino-Losada, Andres
    Theorell, Tores
    Forsell, Yvonne
    Lundberg, Ingvar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Working conditions, serotonin transporter gene polymorphism (5-HTTLPR) and anxiety disorders: A prospective cohort study2013Ingår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 151, nr 2, s. 652-659Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The etiology and pathology of anxiety disorders involve both genetic and environmental influences. Adverse working conditions may contribute to the development of anxiety. The serotonin transporter-linked polymorphic region (5-HTTLPR) has been implicated in stress sensitivity. Therefore, we investigated the potential interplay between 5-HTTLPR and job-related risk factors in the prediction of the occurrence of anxiety. Methods: We conducted a prospective study using the first two waves of a Swedish population-based cohort. At Wave l, 1585 individuals without anxiety, depression or dysthymia who were active in the labor market during both waves were included. Information on job demands, skill discretion, decision authority and social climate was collected at Wave I. After a three year interval, the presence of anxiety disorders was determined at Wave II, All 1585 participants were genotyped for 5-HTTLPR. Both additive and multiplicative models were considered in examining the potential interaction between 5-HTTLPR and adverse working conditions on the development of anxiety. Results: Anxiety was associated with high job demands but not with 5-HTTLPR. An interaction was observed between 5-HTTLPR and high job demands among females. Individuals with 5-HTTLPR high expression genotype (LL) developed anxiety disorders more frequently when exposed to high job demands compared to 'LS/SS' carriers. Limitations: A limited number of participants developed anxiety. Conclusions: High job demands predict the development of anxiety. The 5-HTT polymorphism has a moderating effect on the relationship between high job demands and anxiety among females.

  • 320.
    Liu, Wei
    et al.
    Tsinghua Univ, Dept Bldg Sci, Beijing, Peoples R China;Tsinghua Univ, Beijing Key Lab Indoor Air Qual Evaluat & Control, Beijing, Peoples R China.
    Huang, Chen
    Univ Shanghai Sci & Technol, Sch Environm & Architecture, Shanghai, Peoples R China.
    Li, Baizhan
    Chongqing Univ, Joint Int Res Lab Green Bldg & Built Environm, Minist Educ, Chongqing, Peoples R China.
    Zhao, Zhuohui
    Fudan Univ, Sch Publ Hlth, Dept Environm Hlth, Shanghai, Peoples R China.
    Yang, Xu
    Cent China Normal Univ, Coll Life Sci, Wuhan, Hubei, Peoples R China.
    Deng, Qihong
    Cent S Univ, Sch Energy Sci & Engn, Changsha, Hunan, Peoples R China.
    Zhang, Xin
    Shanxi Univ, Res Ctr Environm Sci & Engn, Taiyuan, Shanxi, Peoples R China.
    Qian, Hua
    Southeast Univ, Sch Energy & Environm, Nanjing, Jiangsu, Peoples R China.
    Sun, Yuexia
    Tianjin Univ, Sch Environm Sci & Technol, Tianjin, Peoples R China.
    Qu, Fang
    China Meteorol Adm, China Meteorol Adm Training Ctr, Beijing, Peoples R China.
    Wang, Lifang
    Inner Mongolia Univ Sci & Technol, Sch Energy & Environm, Baotou, Peoples R China.
    Lin, Zhijing
    Fudan Univ, Sch Publ Hlth, Dept Environm Hlth, Shanghai, Peoples R China.
    Lu, Chan
    Cent S Univ, Sch Energy Sci & Engn, Changsha, Hunan, Peoples R China.
    Wang, Han
    Chongqing Univ, Joint Int Res Lab Green Bldg & Built Environm, Minist Educ, Chongqing, Peoples R China.
    Wang, Juan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Cai, Jiao
    Chongqing Univ, Joint Int Res Lab Green Bldg & Built Environm, Minist Educ, Chongqing, Peoples R China.
    Zhang, Jialing
    Univ Shanghai Sci & Technol, Sch Environm & Architecture, Shanghai, Peoples R China.
    Sun, Chanjuan
    Univ Shanghai Sci & Technol, Sch Environm & Architecture, Shanghai, Peoples R China.
    Mo, Jinhan
    Tsinghua Univ, Dept Bldg Sci, Beijing, Peoples R China;Tsinghua Univ, Beijing Key Lab Indoor Air Qual Evaluat & Control, Beijing, Peoples R China.
    Weschler, Louise B.
    Tsinghua Univ, Dept Bldg Sci, Beijing, Peoples R China.
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Sundell, Jan
    Tsinghua Univ, Dept Bldg Sci, Beijing, Peoples R China;Tsinghua Univ, Beijing Key Lab Indoor Air Qual Evaluat & Control, Beijing, Peoples R China;Tianjin Univ, Sch Environm Sci & Technol, Tianjin, Peoples R China.
    Zhang, Yinping
    Tsinghua Univ, Dept Bldg Sci, Beijing, Peoples R China;Tsinghua Univ, Beijing Key Lab Indoor Air Qual Evaluat & Control, Beijing, Peoples R China.
    Household renovation before and during pregnancy in relation to preterm birth and low birthweight in China2019Ingår i: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 29, nr 2, s. 202-214Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    From October 2010 to April 2012, we conducted a cross-sectional study of associations between household environments and childhood health among preschool children in eight Chinese cities. Here, we analyze associations of early household renovation with preterm birth (PTB), low birthweight (LBW), term low birthweight (Term-LBW), and small for gestational age (SGA). Parents responded to questions about household renovation and their children's gestational age and birthweight. In the multivariate logistic regression analyses, household renovation in the year before pregnancy was significantly associated with LBW (sample size: N = 25 813; adjusted odds ratio (OR) with 95% confidence intervals (CIs): 1.23, 1.01-1.50) and Term-LBW (N = 24 823; 1.29, 1.01-1.67). Household renovation during pregnancy was significantly associated with PTB (N = 25 202; 1.28, 1.01-1.69). These significant associations were also found in the two-level (city-child) logistic regression analyses and in the sensitivity analyses among 21 009 children with complete data in all studied variates. Stronger associations were found in certain subgroups. Our findings indicate that household renovation within one year before pregnancy might be a risk factor for LBW and Term-LBW, while household renovation during pregnancy could be a risk factor for PTB.

  • 321.
    Ljunggren, S. A.
    et al.
    Linkoping Univ, Occupat & Environm Med Ctr, Linkoping, Sweden.;Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Iggland, M.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    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.
    Karlsson, H.
    Linkoping Univ, Occupat & Environm Med Ctr, Linkoping, Sweden.;Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Altered heart proteome in fructose-fed Fisher 344 rats exposed to bisphenol A2016Ingår i: Toxicology, ISSN 0300-483X, E-ISSN 1879-3185, Vol. 347-349, s. 6-16Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Bisphenol A (BPA), is an artificial estrogen initially produced for medical purposes but is today widely used in polycarbonate plastics and epoxy resins. Exposure-related reproductive disorders have been found, but recently it has also been suggested that BPA may be involved in obesity, diabetes, myocardial hypertrophy and myocardial infarction in humans. To mimic a modern lifestyle, female rats were fed with fructose or fructose plus BPA (0.25 mg/L drinking water). The myocardial left ventricle proteome of water controls, fructose-fed and fructose-fed plus BPA supplemented rats was explored. The proteome was investigated using nano-liquid chromatography tandem mass spectrometry and two-dimensional gel electrophoresis followed by matrix assisted laser desorption/ionization mass spectrometry identification. In total, 41 proteins were significantly altered by BPA exposure compared to water or fructose controls. Principal component analysis and cellular process enrichment analysis of altered proteins suggested increased fatty acid transport and oxidation, increased ROS generation and altered structural integrity of the myocardial left ventricle in the fructose-fed BPA-exposed rats, indicating unfavorable effects on the myocardium. In conclusion, BPA exposure in the rats induces major alterations in the myocardial proteome.

  • 322. London, Leslie
    et al.
    Coggon, David
    Moretto, Angelo
    Westerholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Wilks, Martin F.
    Colosio, Claudio
    The ethics of human volunteer studies involving experimental exposure to pesticides: unanswered dilemmas2010Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 9, s. 50-Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The controversy about the use of data from human volunteer studies involving experimental exposure to pesticides as part of regulatory risk assessment has been widely discussed, but the complex and interrelated scientific and ethical issues remain largely unresolved. This discussion paper, generated by authors who comprised a workgroup of the ICOH Scientific Committee on Rural Health, reviews the use of human experimental studies in regulatory risk assessment for pesticides with a view to advancing the debate as to when, if ever, such studies might be ethically justifiable. The discussion is based on three elements: (a) a review of discussion papers on the topic of human testing of pesticides and the positions adopted by regulatory agencies in developed countries; (b) an analysis of published and unpublished studies involving human testing with pesticides, both in the peer-reviewed literature and in the JMPR database; and (c) application of an ethical analysis to the problem. The paper identifies areas of agreement which include general principles that may provide a starting point on which to base criteria for judgements as to the ethical acceptability of such studies. However, the paper also highlights ongoing unresolved differences of opinion inherent in ethical analysis of contentious issues, which we propose should form a starting point for further debate and the development of guidelines to achieve better resolution of this matter.

  • 323. London, Leslie
    et al.
    Tangwa, Godfrey
    Matchaba-Hove, Reginald
    Mkhize, Nhlanhla
    Nwabueze, Remi
    Nyika, Aceme
    Westerholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Ethics in occupational health: deliberations of an international workgroup addressing challenges in an African context2014Ingår i: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 15, s. 48-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process. Discussion: Firstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address workplace hazards demand that actions for occupational health extend beyond just the workplace. Summary: A stronger articulation of occupational health practice with advocacy for prevention should be an ethical norm. Ethical codes should ideally harmonize and balance individual and community needs so as to provide stronger moral authority guidelines. There is a need to consider an African Charter on Bioethics as complementary and strengthening of existing codes for the region.

  • 324.
    Lu, Chan
    et al.
    Cent S Univ, Sch Energy Sci & Engn, Changsha 410083, Hunan, Peoples R China..
    Deng, Qihong
    Cent S Univ, Sch Energy Sci & Engn, Changsha 410083, Hunan, Peoples R China.;Cent S Univ, Sch Publ Hlth, Changsha 410083, Hunan, Peoples R China..
    Li, Yuguo
    Univ Hong Kong, Dept Mech Engn, Hong Kong, Hong Kong, Peoples R China..
    Sundell, Jan
    Cent S Univ, Sch Energy Sci & Engn, Changsha 410083, Hunan, Peoples R China.;Tsinghua Univ, Sch Architecture, Beijing 100084, Peoples R China..
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Outdoor air pollution, meteorological conditions and indoor factors in dwellings in relation to sick building syndrome (SBS) among adults in China2016Ingår i: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 560-561, s. 186-196Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Indoor environment is associated with the sick building syndrome (SBS), but little is known about the contribution of outdoor air pollution and meteorological conditions to SBS. We studied associations between outdoor air pollution, meteorological parameters and selected indoor exposure and building characteristics at home and weekly SBS symptoms in a standardized questionnaire study among 3485 randomly selected adults in China. Outdoor factors included particulate matters with diameter <10 mu m (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), outdoor temperature (T), relative air humidity (RH), and wind speed (WS) during last three months. Multiple logistic regression was applied calculating odds ratios (OR) with 95% confidence interval (95% CI). Asthma or allergic rhinitis (atopy) was associated with all types of SBS symptoms except fatigue. Indoor factors played a major role in SBS symptoms. Mold/dampness on the floor/ceiling was associated with fatigue OR = 1.60 (1.11-2.30) and headache OR = 1.80 (1.07-3.04). Moldy odor was associated with fatigue OR = 1.59 (1.07-2.37) and dermal symptoms OR = 1.91 (1.21-3.02). Window pane condensation in winter was associated with fatigue OR = 1.73 (1.30-2.31) and throat symptoms OR = 1.53 (1.01-2.31). Damp bed clothing was related with throat symptom OR = 1.62 (1.09-2.40). Home redecoration was associated with fatigue OR = 1.49 (1.07-2.06). Frequent window opening was associated with less nose symptoms OR = 0.54 (0.36-0.82) and mechanical ventilation in the bathroom reduced dermal symptoms OR = 0.66 (0.44-0.99). Females were more susceptible to redecoration and window pane condensation than men. No associations with SBS were observed for outdoor air pollutants or meteorological parameters in the final models combining indoor and outdoor factors, although SO2, T, and RH were associated with some SBS symptoms (fatigue, eyes and nose symptoms) in the separate outdoor models. In conclusion, indoor mold/dampness, air pollution from redecoration and poorer ventilation conditions in dwellings can be risk factors for SBS symptoms in an adult Chinese population, especially among females.

  • 325. Lund, Thomas
    et al.
    Christensen, Karl Bang
    Vaez, Marjan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Labriola, Merete
    Josephson, Malin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Villadsen, Ebbe
    Voss, Margaretha
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Differences in sickness absence in Sweden and Denmark: the cross national HAKNAK study2009Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 19, nr 3, s. 343-349Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To investigate potential differences in sickness absence among public sector employees in Sweden and Denmark, and to what extent a difference was associated with age, gender, physical and psychosocial work environment exposures, lifestyle factors, self-rated health or work ability. METHODS: In 2000, two cross-sectional samples of 8562 public sector employees in Sweden and Denmark were surveyed. The study outcome, self-reported number of sick-leave days the year preceding interview, was dichotomized into 7 days or less, and more than 7 days. Chi square test was used to analyse distribution of dependent and independent variables in the two sub-cohorts. Stratified logistic regression analysis was performed to identify causes for absence within the two sub-cohorts, and logistic regression analysis was performed to study differences in sickness absence levels between the two sub-cohorts. RESULTS: More subjects from the Swedish study population reported more than 7 days of sickness absence. Factors associated with sickness absence were largely similar in the two countries. The difference in absence level between Sweden and Denmark was not associated with differences in age, gender, skill level, lifestyle, psychosocial or physical work environment, musculoskeletal symptoms or self-rated health, whereas work ability score decreased the difference in sickness absence level. CONCLUSION: The results could indicate an increased retention of employees with health problems in the Swedish labour market compared with the Danish labour market. A possible explanation for the differences in sickness absence ascertained in this study could be due to differences in the sickness insurance legislation.

  • 326.
    Lundberg, Ingvar
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Allebeck, P
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Ågren, P
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Depressions- och ångesttillstånd som arbetsskada: En systematisk översikt över den vetenskapliga litteraturen med relevans för bedömningen2008Ingår i: Psykisk arbetsskada, Göteborg: Arbets- och miljömedicin vid Göteborgs universitet , 2008, Vol. 42, nr 1, s. 24-75Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 327.
    Lundin, A.
    et al.
    Stockholm Cty Council, Ctr Epidemiol & Community Med, Stockholm, Sweden.;Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden..
    Hallgren, M.
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden..
    Theobald, H.
    Stockholm Cty Council, Acad Primary Hlth Care Ctr, Stockholm, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Hellgren, C.
    Swedish Council Higher Educ, Stockholm, Sweden..
    Torgén, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Validity of the 12-item version of the General Health Questionnaire in detecting depression in the general population2016Ingår i: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 136, s. 66-74Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The 12-item version of the General Health Questionnaire (GHQ-12) is frequently used to measure common mental disorder in public health surveys, but few population-based validations have been made. We validated the GHQ-12 against structured psychiatric interviews of depression using a population-based cohort in Stockholm, Sweden. Methods: We used a population-based cohort of 484 individuals in Stockholm, Sweden (participation rate 62%). All completed the GHQ-12 and a semi-structured psychiatric interview. Last month DSM-III-R symptoms were used to classify major and minor depression. Three scoring methods for GHQ-12 were assessed, the Standard, Likert and Corrected method. Discriminatory ability was assessed with area under the receiver operating characteristic (ROC) curve. Results: A total of 9.5% had a major or minor depression. The area under the ROC curve was for the Standard method 0.73 (0.65-0.82), the Likert method 0.80 (0.72-0.87) and the Corrected method 0.80 (0.73-0.87) when using major or minor depression as standard criterion. Adequate sensitivity and specificity for separating those with or without a depressive disorder was reached at >12 Likert scored points (80.4 and 69.6%) or >6 Corrected GHQ points (78.3 and 73.7%). Sensitivity and specificity was at >= 2 Standard scored points 67.4% and 74.2%. Conclusion: When scored using the Likert and Corrected methods, the GHQ-12 performed excellently. When scored using the Standard method, performance was acceptable in detecting depressive disorder in the general population. The GHQ-12 appears to be a good proxy for depressive disorder when used in public health surveys.

  • 328. Lundin, A.
    et al.
    Lundberg, Ingvar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Allebeck, P.
    Hemmingsson, T.
    Psychiatric diagnosis in late adolescence and long-term risk of suicide and suicide attempt2011Ingår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 124, nr 6, s. 454-461Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate the associations between psychiatric diagnosis in late adolescence in an unselected population and subsequent suicide attempt and suicide during 36-year follow-up.

    Method: A total of 49 321 Swedish men conscripted for compulsory military training in 1969/1970, born 1949-1951, were screened for psychiatric disorder and, if detected, diagnosed by a psychiatrist according to ICD-8. Data on suicides and suicide attempts 1971-2006 were collected in national registers.

    Results: At conscription examination, 11.7% of the cohort received a psychiatric diagnosis. Among those, increased risks of suicide 19712006 [HR = 2.7 (2.2-3.2), 624 cases] and suicide attempt 1973-2006 [HR = 3.5 (3.1-4.0), 1170 cases] were found. The increased relative risks persisted during the follow-up period 19-36 years after examination [1989-2006 suicide HR = 2.1 (1.6-2.7), 308 cases, and 1989-2006 suicide attempt HR = 2.6 (2.1-3.1), 484 cases]. The dominant diagnostic groups, neurosis and personality disorder, were significantly associated with suicide and suicide attempt in the early as well as the late follow-up period.

    Conclusion: Psychiatric diagnoses made in late adolescence predicted subsequent suicide and suicide attempt over a 36-year follow-up period. The increased relative risks were not limited to young adulthood but were also evident 18-36 years after conscription examination.

  • 329. Lundin, A.
    et al.
    Lundberg, Ingvar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Allebeck, P.
    Hemmingsson, T.
    Unemployment and suicide in the Stockholm population: A register-based study on 771,068 men and women2012Ingår i: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 126, nr 5, s. 371-377Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Several studies have reported a higher risk of suicide among the unemployed. Some individuals may be more prone to both unemployment and suicide due to an underlying health-related factor. In that case, suicide among the unemployed might be a consequence of health-related selection. This study aimed to investigate the relationship between unemployment and suicide, and the importance of previous sickness absence to this relationship.

    Study design: The study was based on 771,068 adults aged 25-58 years in Stockholm County in 1990-1991. Data on sickness absence in 1990-1991 and unemployment in 1991-1993 were collected from registers for each individual. Time and cause of death in 1994-1995 were obtained from Sweden's Cause of Death Register.

    Methods: The association between sickness absence in 1990-1991 and unemployment in 1992-1993, and the association between unemployment in 1992-1993 and suicide in 1994-1995 was investigated using logistic regression.

    Results: Unemployment lasting for >90 days in 1992-1993 was associated with suicide in men in 1994-1995 [odds ratio (OR) 2.16, 95% confidence interval (CI) 1.38-3.38], while unemployment lasting for <= 90 days in 1992-1993 was associated with suicide in women in 1994-1995 (OR 2.68, 95% CI 1.23-5.85). Higher levels of sickness absence were related to an increased risk of subsequent unemployment in both sexes. The higher prevalence of sickness absence among the unemployed attenuated the association between unemployment and suicide in both men and women.

    Conclusions: Unemployment is related to suicide. Individuals in poor health are at increased risk of unemployment and also suicide. The higher relative risk of suicide among the unemployed seems to be, in part, a consequence of exclusion of less healthy individuals from the labour market.

  • 330.
    Lundin, Andreas
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, SE-17177 Stockholm, Sweden..
    Danielsson, Anna-Karin
    Karolinska Inst, Dept Publ Hlth Sci, SE-17177 Stockholm, Sweden..
    Hallgren, Mats
    Karolinska Inst, Dept Publ Hlth Sci, SE-17177 Stockholm, Sweden..
    Torgén, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Effect of Screening and Advising on Alcohol Habits in Sweden: A Repeated Population Survey Following Nationwide Implementation of Screening and Brief Intervention2017Ingår i: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 52, nr 2, s. 190-196Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: To examine: (a) to what extent individuals in contact with heath care had been asked and advised on their alcohol habits; (b) how self-reports of alcohol consumption and patient characteristics affected the probability of being asked and advised on alcohol consumption; (c) the potential effect of alcohol advice on readiness and ability to change, across levels of high alcohol consumption.

    METHODS: A repeated cross-sectional public health postal questionnaire in Uppsala County among 18-84 year old, covering a period of a national programme encouraging alcohol screening, brief interventions and motivational interviewing (2004-2012). Response rates were 65.5-52.2%. Respondent who stated that they had visited health-care services had a further question on whether the staff asked questions about habits including alcohol, and whether the staff had given them advice concerning the same habits. AUDIT-C was the measure of alcohol consumption, and there was a question on wanting to cut down on drinking and/or needing support to do so.

    RESULTS: Screening for and advising patients on alcohol consumption increased during the period, but there were no decreases in population-level consumption. Screening occurred independent of self-reports of AUDIT-C and varied with other individual characteristics. Advice was associated with AUDIT-C score. Being advised increased the likelihood of wanting to reduce drinking, both among those scoring above the national hazardous consumption levels and at higher scores.

    CONCLUSIONS: Screening and advising on alcohol habits in health care impacted individual readiness and ability to change. Population-level effects have yet to be proven.

    SHORT SUMMARY: Screening for and advising patients on alcohol consumption increased following a national programme encouraging alcohol screening, brief interventions and motivational interviewing. Overall consumption levels remained unchanged. Screening was largely systematic. The positive effect of advice on wanting to cut back drinking was similar in moderate and high drinkers.

  • 331.
    Lundin, Andreas
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, SE-17177 Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Leijon, Ola
    Swedish Social Insurance Inspectorate, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Vaez, Marjan
    Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, Stockholm, Sweden..
    Hallgren, Mats
    Karolinska Inst, Dept Publ Hlth Sci, SE-17177 Stockholm, Sweden..
    Torgén, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Predictive validity of the Work Ability Index and its individual items in the general population2017Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, nr 4, s. 350-356Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: This study assesses the predictive ability of the full Work Ability Index (WAI) as well as its individual items in the general population.

    Methods: The Work, Health and Retirement Study (WHRS) is a stratified random national sample of 25-75-year-olds living in Sweden in 2000 that received a postal questionnaire (n = 6637, response rate = 53%). Current and subsequent sickness absence was obtained from registers. The ability of the WAI to predict long-term sickness absence (LTSA; 90 consecutive days) during a period of four years was analysed by logistic regression, from which the Area Under the Receiver Operating Characteristic curve (AUC) was computed.

    Results: There were 313 incident LTSA cases among 1786 employed individuals. The full WAI had acceptable ability to predict LTSA during the 4-year follow-up (AUC = 0.79; 95% CI 0.76 to 0.82). Individual items were less stable in their predictive ability. However, three of the individual items: current work ability compared with lifetime best, estimated work impairment due to diseases, and number of diagnosed current diseases, exceeded AUC > 0.70. Excluding the WAI item on number of days on sickness absence did not result in an inferior predictive ability of the WAI.

    Conclusions: The full WAI has acceptable predictive validity, and is superior to its individual items. For public health surveys, three items may be suitable proxies of the full WAI; current work ability compared with lifetime best, estimated work impairment due to diseases, and number of current diseases diagnosed by a physician.

  • 332. Lundin, Andreas
    et al.
    Lundberg, Ingvar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Hallsten, Lennart
    Ottosson, Jan
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Ekonomisk-historiska institutionen.
    Hemmingsson, Tomas
    Unemployment and mortality: a longitudinal prospective study on selection and causation in 49 321 Swedish middle-aged men2010Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 64, nr 1, s. 22-28Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Unemployment is associated with increased risk of mortality. It is, however, not clear to what extent this is causal, or whether other risk factors remain uncontrolled for. The aim of this study was to investigate the association between unemployment and all cause and cause specific mortality, adjusting for indicators of mental disorder, behavioural risk factors, and social factors over the life course. METHODS: This study was based on a cohort of 49 321 Swedish males born 1949/51, tested for compulsory military conscription in 1969/70. Data on employment/unemployment 1990-1994 was based on information from the Longitudinal Register of Education and Labour Market Statistics. Information on childhood circumstances was drawn from National Population and Housing Census 1960. Information on psychiatric diagnosis and behavioral risk factors was collected at conscription testing in 1969/70. Data on mortality and hospitalisation 1973-2004 was collected in national registers. RESULTS: An increased risk of mortality 1995-2003 was found among individuals who experienced 90 days or more of unemployment during 1992-1994, compared with those still employed (all cause mortality HR = 1.91, 95 % CI: 1.58-2.31. Adjustment for risk factors measured along the life-course considerably lowered the relative risk (all cause mortality HR = 1.30, 95 % CI: 1.06-1.58). Statistically significant increased relative risk was found during the first four years of follow up (all cause mortality, adjusted HR = 1.57, 95 % CI: 1.13-2.18, but not the following four (all cause mortality, adjusted HR = 1.17, 95 % CI: 0.91-1.50). CONCLUSION: Our results suggest that a substantial part of the increased relative risk of mortality associated with unemployment may be attributable to confounding by individual risk factors.

  • 333.
    Lytras, Theodore
    et al.
    Barcelona Inst Global Hlth ISGlobal, Barcelona 08003, Spain;UPF, Barcelona, Spain.
    Kogevinas, Manolis
    Barcelona Inst Global Hlth ISGlobal, Barcelona 08003, Spain;UPF, Barcelona, Spain;CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain;Hosp del Mar, Med Res Inst IMIM, Barcelona, Spain.
    Kromhout, Hans
    Univ Utrecht, IRAS, Utrecht, Netherlands.
    Carsin, Anne-Elie
    Barcelona Inst Global Hlth ISGlobal, Barcelona 08003, Spain;UPF, Barcelona, Spain.
    Anto, Josep M.
    Barcelona Inst Global Hlth ISGlobal, Barcelona 08003, Spain;UPF, Barcelona, Spain;CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain;Hosp del Mar, Med Res Inst IMIM, Barcelona, Spain.
    Bentouhami, Hayat
    Univ Antwerp, Dept Epidemiol & Social Med ESOC, Fac Med & Hlth Sci, Antwerp, Belgium.
    Weyler, Joost
    Univ Antwerp, Dept Epidemiol & Social Med ESOC, Fac Med & Hlth Sci, Antwerp, Belgium;Univ Antwerp, StatUA Stat Ctr, Antwerp, Belgium.
    Heinrich, Joachim
    Nowak, Dennis
    Ludwig Maximilians Univ Munchen, Inst & Outpatient Clin Occupat Social & Environm, Comprehens Pneumol Ctr Munich, Univ Hosp,German Ctr Lung Res, Munich, Germany.
    Urrutia, Isabel
    Galdakao Hosp, Pulmonol Dept, Bizkaia, Spain.
    Martinez-Moratalla, Jesus
    Complejo Hosp Univ, Serv Neumol, Albacete, Spain;Univ Castilla La Mancha, Fac Med Albacete, Ciudad Real, Spain.
    Antonio Gullon, Jose
    Hosp Univ San Agustin, Resp Dept, Aviles, Spain.
    Pereira-Vega, Antonio
    Univ Hospitalary Complex, Resp & Allergy Clin Unit, Huelva, Spain.
    Raherison-Semjen, Chantal
    Univ Bordeaux, Inserm, Bordeaux Populat Hlth Res Ctr, Team EPICENE,UMR 1219, Bordeaux, France.
    Pin, Isabelle
    CHU Grenoble Alpes, Dept Pediat, Grenoble, France;Inserm, U1209, IAB, Team Environm Epidemiol Appl Reprod & Resp Hlth, Grenoble, France;Univ Grenoble Alpes, Grenoble, France.
    Demoly, Pascal
    Univ Hosp Montpellier, Montpellier, France;Sorbonne Univ, Paris, France.
    Leynaert, Benedicte
    Univ Paris Diderot, Inserm UMR Equipe Epidemiol 1152, Paris, France.
    Villani, Simona
    Univ Pavia, Unit Biostat & Clin Epidemiol, Dept Hlth Sci Expt & Forens Med, Pavia, Italy.
    Gislason, Thorarinn
    Landspitali Univ Hosp, Dept Resp Med & Sleep, Reykjavik, Iceland;Univ Iceland, Fac Med, Reykjavik, Iceland.
    Svanes, Cecilie
    Haukeland Hosp, Dept Occupat Med, Bergen, Norway;Univ Bergen, Ctr Int Hlth, Bergen, Norway.
    Holm, Mathias
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, Gothenburg, Sweden.
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden.
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Mehta, Amar J.
    Boston Publ Hlth Commiss, Res & Evaluat Off, Boston, MA USA.
    Probst-Hensch, Nicole
    Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    Benke, Geza
    Monash Univ, Sch Publ Hlth & Prevent Med, Monash Ctr Occupat & Environm Hlth, Melbourne, Vic, Australia.
    Jogi, Rain
    Tartu Univ Hosp, Lung Clin, Tartu, Estonia.
    Toren, Kjell
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Sect Occupat & Environm Med, Gothenburg, Sweden.
    Sigsgaard, Torben
    Aarhus Univ, Sect Environm, Danish Ramazzini Ctr, Dept Publ Hlth, Aarhus, Denmark.
    Schlunssen, Vivi
    Aarhus Univ, Sect Environm, Danish Ramazzini Ctr, Dept Publ Hlth, Aarhus, Denmark;Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Olivieri, Mario
    Univ Hosp Verona, Unit Occupat Med, Verona, Italy.
    Blanc, Paul D.
    Univ Calif San Francisco, San Francisco Vet Affairs Med Ctr, San Francisco, CA 94143 USA.
    Vermeulen, Roel
    Univ Utrecht, IRAS, Utrecht, Netherlands.
    Garcia-Aymerich, Judith
    Barcelona Inst Global Hlth ISGlobal, Barcelona 08003, Spain;UPF, Barcelona, Spain;CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain;Hosp del Mar, Med Res Inst IMIM, Barcelona, Spain.
    Jarvis, Deborah
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England;Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England.
    Zock, Jan-Paul
    Barcelona Inst Global Hlth ISGlobal, Barcelona 08003, Spain;UPF, Barcelona, Spain;CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain.
    Occupational exposures and 20-year incidence of COPD: the European Community Respiratory Health Survey2018Ingår i: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 73, nr 11, s. 1008-1015Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Occupational exposures have been associated with an increased risk of COPD. However, few studies have related objectively assessed occupational exposures to prospectively assessed incidence of COPD, using postbronchodilator lung function tests. Our objective was to examine the effect of occupational exposures on COPD incidence in the European Community Respiratory Health Survey.

    Methods: General population samples aged 20-44 were randomly selected in 1991-1993 and followed up 20 years later (2010-2012). Spirometry was performed at baseline and at follow-up, with incident COPD defined using a lower limit of normal criterion for postbronchodilator FEV1/FVC. Only participants without COPD and without current asthma at baseline were included. Coded job histories during follow-up were linked to a Job-Exposure Matrix, generating occupational exposure estimates to 12 categories of agents. Their association with COPD incidence was examined in log-binomial models fitted in a Bayesian framework.

    Findings: 3343 participants fulfilled the inclusion criteria; 89 of them had COPD at follow-up (1.4 cases/1000 person-years). Participants exposed to biological dust had a higher incidence of COPD compared with those unexposed (relative risk (RR) 1.6, 95% CI 1.1 to 2.3), as did those exposed to gases and fumes (RR 1.5, 95% CI 1.0 to 2.2) and pesticides (RR 2.2, 95% CI 1.1 to 3.8). The combined population attributable fraction for these exposures was 21.0%.

    Interpretation: These results substantially strengthen the evidence base for occupational exposures as an important risk factor for COPD.

  • 334.
    Lytras, Theodore
    et al.
    Barcelona Inst Global Hlth ISGlobal, Barcelona 08003, Spain;UPF, Barcelona, Spain.
    Kogevinas, Manolis
    Barcelona Inst Global Hlth ISGlobal, Barcelona 08003, Spain;UPF, Barcelona, Spain;CIBERESP, Madrid, Spain;Hosp Mar, Med Res Inst, Barcelona, Spain.
    Kromhout, Hans
    Univ Utrecht, IRAS, Utrecht, Netherlands.
    Carsin, Anne-Elie
    Barcelona Inst Global Hlth ISGlobal, Barcelona 08003, Spain;UPF, Barcelona, Spain;CIBERESP, Madrid, Spain.
    Maria Anto, Josep
    Barcelona Inst Global Hlth ISGlobal, Barcelona 08003, Spain;UPF, Barcelona, Spain;CIBERESP, Madrid, Spain;Hosp Mar, Med Res Inst, Barcelona, Spain.
    Bentouhami, Hayat
    Univ Antwerp, StatUA Stat Ctr, Fac Med & Hlth Sci, Dept Epidemiol & Social Med ESOC, Antwerp, Belgium.
    Weyler, Joost
    Univ Antwerp, StatUA Stat Ctr, Fac Med & Hlth Sci, Dept Epidemiol & Social Med ESOC, Antwerp, Belgium.
    Heinrich, Joachim
    Ludwig Maximilians Univ Munchen, Inst & Outpatient Clin Occupat Social & Environm, Comprehens Pneumol Ctr, German Ctr Lung Res,Univ Hosp, Munich, Germany.
    Nowak, Dennis
    Ludwig Maximilians Univ Munchen, Inst & Outpatient Clin Occupat Social & Environm, Comprehens Pneumol Ctr, German Ctr Lung Res,Univ Hosp, Munich, Germany.
    Urrutia, Isabel
    Galdakao Hosp, Dept Pulmonol, Galdakao, Spain.
    Martinez-Moratalla, Jesus
    Complejo Hosp Univ, Serv Neumol, Albacete, Spain;Univ Castilla La Mancha, Fac Med Albacete, Ciudad Real, Spain.
    Antonio Gullon, Jose
    Hosp Univ San Agustin, Resp Dept, Aviles, Spain.
    Pereira Vega, Antonio
    Univ Hosp Juan Ramon Jimenez, Pulmonol & Allergy Clin Unit, Huelva, Spain.
    Semjen, Chantal Raherison
    Univ Bordeaux, Bordeaux Populat Hlth Res Ctr, INSERM, Team EPICENE,UMR 1219, Bordeaux, France.
    Pin, Isabelle
    CHU Grenoble Alpes, Dept Pediat, Grenoble, France;INSERM, U1209, Team Environm Epidemiol Appl Reprod & Resp Hlth, IAB, Grenoble, France;Univ Grenoble Alpes, Grenoble, France.
    Demoly, Pascal
    Univ Hosp Montpellier, Montpellier, France;Sorbonne Univ, Paris, France.
    Leynaert, Benedicte
    Univ Paris Diderot, INSERM, UMR 1152, Equipe Epidemiol, Paris, France.
    Villani, Simona
    Univ Pavia, Dept Hlth Sci, Sect Epidemiol & Med Stat, Pavia, Italy.
    Gislason, Thorarinn
    Landspitali Univ Hosp, Dept Resp Med & Sleep, Reykjavik, Iceland;Univ Iceland, Fac Med, Reykjavik, Iceland.
    Svanes, Oistein
    Haukeland Hosp, Dept Occupat Med, Bergen, Norway;Univ Bergen, Dept Clin Sci, Bergen, Norway.
    Holm, Mathias
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, Gothenburg, Sweden.
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden.
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Mehta, Amar J.
    Boston Publ Hlth Commiss, Off Res & Evaluat, Boston, MA USA.
    Probst-Hensch, Nicole
    Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland.
    Benke, Geza
    Monash Univ, Sch Publ Hlth & Prevent Med, Monash Ctr Occupat & Environm Hlth, Melbourne, Vic, Australia.
    Jogi, Rain
    Tartu Univ Hosp, Lung Clin, Tartu, Estonia.
    Toren, Kjell
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Sect Occupat & Environm Med, Gothenburg, Sweden.
    Sigsgaard, Torben
    Aarhus Univ, Dept Publ Hlth, Danish Ramazzini Ctr, Sect Environm Occupat & Hlth, Aarhus, Denmark.
    Schlunssen, Vivi
    Aarhus Univ, Dept Publ Hlth, Danish Ramazzini Ctr, Sect Environm Occupat & Hlth, Aarhus, Denmark;Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Olivieri, Mario
    Univ Hosp Verona, Unit Occupat Med, Verona, Italy.
    Blanc, Paul D.
    Univ Calif San Francisco, San Francisco Vet Affairs Med Ctr, San Francisco, CA 94143 USA.
    Watkins, John
    Cardiff Univ, Sch Med, Cardiff, S Glam, Wales;Publ Hlth Wales, Cardiff, S Glam, Wales.
    Bono, Roberto
    Univ Turin, Dept Publ Hlth & Pediat, Turin, Italy.
    Buist, A. Sonia
    Oregon Hlth & Sci Univ, Pulm & Crit Care Med, Portland, OR 97201 USA.
    Vermeulen, Roel
    Univ Utrecht, IRAS, Utrecht, Netherlands.
    Jarvis, Deborah
    Cardiff Univ, Sch Med, Cardiff, S Glam, Wales;Publ Hlth Wales, Cardiff, S Glam, Wales;Univ Turin, Dept Publ Hlth & Pediat, Turin, Italy;Imperial Coll London, Populat Hlth & Occupat Dis, Natl Heart & Lung Inst, MRC PHE Ctr Environm & Hlth, London, England;Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England.
    Zock, Jan-Paul
    Barcelona Inst Global Hlth ISGlobal, Barcelona 08003, Spain;UPF, Barcelona, Spain;CIBERESP, Madrid, Spain.
    Occupational exposures and incidence of chronic bronchitis and related symptoms over two decades: the European Community Respiratory Health Survey2019Ingår i: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 76, nr 4, s. 222-229Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives Chronic bronchitis (CB) is an important chronic obstructive pulmonary disease (COPD)-related phenotype, with distinct clinical features and prognostic implications. Occupational exposures have been previously associated with increased risk of CB but few studies have examined this association prospectively using objective exposure assessment. We examined the effect of occupational exposures on CB incidence in the European Community Respiratory Health Survey. Methods Population samples aged 20-44 were randomly selected in 1991-1993, and followed up twice over 20 years. Participants without chronic cough or phlegm at baseline were analysed. Coded job histories during follow-up were linked to the ALOHA Job Exposure Matrix, generating occupational exposure estimates to 12 categories of chemical agents. Their association with CB incidence over both follow-ups was examined with Poisson models using generalised estimating equations. Results 8794 participants fulfilled the inclusion criteria, contributing 13 185 observations. Only participants exposed to metals had a higher incidence of CB (relative risk (RR) 1.70, 95% CI 1.16 to 2.50) compared with non-exposed to metals. Mineral dust exposure increased the incidence of chronic phlegm (RR 1.72, 95% CI 1.43 to 2.06). Incidence of chronic phlegm was increased in men exposed to gases/fumes and to solvents and in women exposed to pesticides. Conclusions Occupational exposures are associated with chronic phlegm and CB, and the evidence is strongest for metals and mineral dust exposure. The observed differences between men and women warrant further investigation.

  • 335.
    Lytsy, Per
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Andersen, Åsa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Liljestam Hurtigh, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Kams, Piret
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Anderzén, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Vitalis: A randomized intervention and coordination program aimed at Return to Work for women with long term sick leave2014Rapport (Övrigt vetenskapligt)
  • 336.
    Lytsy, Per
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Larsson, Kjerstin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Forskning om funktionshinder och habilitering.
    Anderzén, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Health in women on long-term sick leave because of pain or mental illness2015Ingår i: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 38, nr 1, s. 27-33Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Mental illness and pain are common causes of long-term sick absence and major difficulties in vocational rehabilitation. The aim of this study was to investigate health in a group of women with pain or mental illness who had exhausted their days of sickness benefit. This cross-sectional study uses baseline data from 355 women on long-term sick leave participating in controlled intervention studies aiming at returning to work. The study population filled in a written questionnaire with questions of self-rated health and sleep quality and validated indexes of mental health, satisfaction with life and general self-efficacy. Clinical psychiatric screening was performed on 230 individuals. The study population had a mean age of 48.8 years (SD 8.4), with an average time on sick leave of 7.8 years (SD 3.2). Self-rated health and sleep quality was poor compared with other populations. In all, 80.1% had at least one psychiatric diagnosis according to the psychiatric screening, and the average numbers of psychiatric diagnoses were 2.2 (SD 1.9). Foreign-born women showed significantly higher levels of mental illness, poorer self-rated health and sleep quality and lower self-efficacy and life satisfaction than native Swedish women. Women with long sick leave because of mental illness and/or pain have poor self-rated health and sleep quality, high prevalence of mental illness and low self-efficacy and life satisfaction. Psychiatric screening suggests more extensive mental illness than what was stated on the sick leave certificates. The health of foreign-born women seems to be worse than that of native Swedish women.

  • 337.
    Löfstedt, Håkan
    et al.
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health Örebro University , Örebro.
    Hagström, Katja
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health Örebro University , Örebro.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health Örebro University , Örebro.
    Holmström, Mats
    Division of Ear, Nose and Throat Diseases, Department of Clinical Science , Intervention and Technology, Karolinska Institutet .
    Rask-Andersen, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Respiratory symptoms and lung function in relation to wood dust and monoterpene exposure in the wood pellet industry2017Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, nr 2, s. 78-84Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Wood pellets are used as a source of renewable energy for heating purposes. Common exposures are wood dust and monoterpenes, which are known to be hazardous for the airways. The purpose of this study was to study the effect of occupational exposure on respiratory health in wood pellet workers.

    Materials and methods: Thirty-nine men working with wood pellet production at six plants were investigated with a questionnaire, medical examination, allergy screening, spirometry, and nasal peak expiratory flow (nasal PEF). Exposure to wood dust and monoterpenes was measured.

    Results: The wood pellet workers reported a higher frequency of nasal symptoms, dry cough, and asthma medication compared to controls from the general population. There were no differences in nasal PEF between work and leisure time. A lower lung function than expected (vital capacity [VC], 95%; forced vital capacity in 1 second [FEV1], 96% of predicted) was noted, but no changes were noted during shifts. There was no correlation between lung function and years working in pellet production. Personal measurements of wood dust at work showed high concentrations (0.16–19 mg/m3), and exposure peaks when performing certain work tasks. Levels of monoterpenes were low (0.64–28 mg/m3). There was no association between exposure and acute lung function effects.

    Conclusions: In this study of wood pellet workers, high levels of wood dust were observed, and that may have influenced the airways negatively as the study group reported upper airway symptoms and dry cough more frequently than expected. The wood pellet workers had both a lower VC and FEV1 than expected. No cross-shift changes were found.

  • 338.
    Lögde, Ann
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Rudolfsson, Gudrun
    Univ West, Div Nursing, Dept Hlth Sci, SE-46186 Trollhattan, Sweden;Nord Univ, Fac Nursing & Heath Sci, N-8049 Bodo, Norway.
    Runeson, Roma
    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.
    Wålinder, Robert
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Arakelian, Erebouni
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    I am quitting my job: Specialist nurses in perioperative context and their experiences of the process and reasons to quit their job2018Ingår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, nr 4, s. 313-320Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The lack of specialist nurses in operating theatres is a serious problem. The aim of this study was to describe reasons why specialist nurses in perioperative care chose to leave their workplaces and to describe the process from the thought to the decision. Twenty specialist nurses (i.e. anaesthesia, NA, and operating room nurses) from seven university-and county hospitals in Sweden participated in qualitative individual in-depth interviews. Data were analysed by systematic text condensation. We identified four themes of reasons why specialist nurses quitted their jobs: the head nurses' betrayal and dismissive attitude, and not feeling needed; inhumane working conditions leading to the negative health effects; not being free to decide about one's life and family life being more important than work; and, colleagues' diminishing behaviour. Leaving one's job was described as a process and specialist nurses had thought about it for some time. Two main reasons were described; the head nurse manager's dismissive attitude and treatment of their employees and colleagues' mistreatment and colleagues' diminishing behaviour. Increasing knowledge on the role of the head nurse managers in specialist nurses' decision making for leaving their workplace, and creating a friendly, non-violent workplace, may give the opportunity for them to take action before it is too late.

  • 339. Madsen, I. E. H.
    et al.
    Nyberg, S. T.
    Magnusson Hanson, L. L.
    Ferrie, J. E.
    Ahola, K.
    Alfredsson, L.
    Batty, G. D.
    Bjorner, J. B.
    Borritz, M.
    Burr, H.
    Chastang, J.-F.
    de Graaf, R.
    Dragano, N.
    Hamer, M.
    Jokela, M.
    Knutsson, A.
    Koskenvuo, M.
    Koskinen, A.
    Leineweber, C.
    Niedhammer, I.
    Nielsen, M. L.
    Nordin, M.
    Oksanen, T.
    Pejtersen, J. H.
    Pentti, J.
    Plaisier, I.
    Salo, P.
    Singh-Manoux, A.
    Suominen, S.
    ten Have, M.
    Theorell, T.
    Toppinen-Tanner, S.
    Vahtera, J.
    Väänänen, A.
    Westerholm, Peter J. M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerlund, H.
    Fransson, E. I.
    Heikkilä, K.
    Virtanen, M.
    Rugulies, R.
    Kivimäki, M.
    Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data2017Ingår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 47, nr 8, s. 1342-1356Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression.

    METHOD: We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol.

    RESULTS: We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47-2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81-1.32).

    CONCLUSIONS: Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.

  • 340. Madsen, Ida E H
    et al.
    Hannerz, Harald
    Nyberg, Solja T
    Magnusson Hanson, Linda L
    Ahola, Kirsi
    Alfredsson, Lars
    Batty, G David
    Bjorner, Jakob B
    Borritz, Marianne
    Burr, Hermann
    Dragano, Nico
    Ferrie, Jane E
    Hamer, Mark
    Jokela, Markus
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Leineweber, Constanze
    Nielsen, Martin L
    Nordin, Maria
    Oksanen, Tuula
    Pejtersen, Jan H
    Pentti, Jaana
    Salo, Paula
    Singh-Manoux, Archana
    Suominen, Sakari
    Theorell, Töres
    Toppinen-Tanner, Salla
    Vahtera, Jussi
    Väänänen, Ari
    Westerholm, Peter J M
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westerlund, Hugo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Fransson, Eleonor
    Heikkilä, Katriina
    Virtanen, Marianna
    Rugulies, Reiner
    Kivimäki, Mika
    Study protocol for examining job strain as a risk factor for severe unipolar depression in an individual participant meta-analysis of 14 European cohorts.2013Ingår i: F1000 Research, E-ISSN 2046-1402, Vol. 2, s. 233-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Previous studies have shown that gainfully employed individuals with high work demands and low control at work (denoted "job strain") are at increased risk of common mental disorders, including depression. Most existing studies have, however, measured depression using self-rated symptom scales that do not necessarily correspond to clinically diagnosed depression. In addition, a meta-analysis from 2008 indicated publication bias in the field.  

    METHODS: This study protocol describes the planned design and analyses of an individual participant data meta-analysis, to examine whether job strain is associated with an increased risk of clinically diagnosed unipolar depression based on hospital treatment registers.  The study will be based on data from approximately 120,000 individuals who participated in 14 studies on work environment and health in 4 European countries. The self-reported working conditions data will be merged with national registers on psychiatric hospital treatment, primarily hospital admissions. Study-specific risk estimates for the association between job strain and depression will be calculated using Cox regressions. The study-specific risk estimates will be pooled using random effects meta-analysis.  

    DISCUSSION: The planned analyses will help clarify whether job strain is associated with an increased risk of clinically diagnosed unipolar depression. As the analysis is based on pre-planned study protocols and an individual participant data meta-analysis, the pooled risk estimates will not be influenced by selective reporting and publication bias. However, the results of the planned study may only pertain to severe cases of unipolar depression, because of the outcome measure applied.

  • 341.
    Malinovschi, Andrei
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Holmkvist, Thomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi.
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Meriläinen, P.
    Högman, Marieann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Effect of smoking on exhaled nitric oxide and flow-independent nitric oxide exchange parameters2006Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 28, nr 2, s. 339-345Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It is a well-known fact that smoking is associated with a reduction in exhaled nitric oxide (NO) levels. There is, however, limited knowledge relating to the smoking-induced changes in production or exchange of NO in different compartments of the airways. This study comprised 221 adult subjects from the European Community Respiratory Health Survey 11, who were investigated in terms of their exhaled NO, lung function, immunoglobulin E sensitisation and smoking habits. The following parameters were determined using extended NO analysis: airway tissue nitric oxide concentration (Caw,NO), airway transfer factor (or diffusing capacity) for nitric oxide (Daw,NO), alveolar nitric oxide concentration (CA,No) and fractional exhaled nitric oxide concentration at a flow rate of 50 mL(.)s(-1) (FeNO,0.05). Maximum total airway nitric oxide flux (J'aw,NO) was calculated from Daw,NO(Caw,NO-CA,NO). Current smokers (n=35) exhibited lower (geometric mean) FeNO,0.05 (14.0 versus 22.8 ppb), Caw,NO (79.0 versus 126 ppb) and J'aw,NO (688 versus 1,153 pL(.)s(-1)) than never-smokers (n=111). Ex-smokers (n=75) were characterised by lower FeNO,0.05 (17.7 versus 22.8 ppb) and Jaw,NO (858 versus 1,153 pL-s(-1)) than never-smokers. These relationships were maintained after adjusting for potential confounders (sex, age, height, immunoglobulin E sensitisation and forced expiratory volume in one second), and, in this analysis, a negative association was found between current smoking and CA,NO. Snus (oral moist snuff) consumption (n=21) in ex-smokers was associated with an increase in Daw,NO and a reduction in Caw,No, after adjusting for potential confounders. Passive smoking was associated with a higher CA,NO. Using extended nitric oxide analysis, it was possible to attribute the reduction in exhaled nitric oxide levels seen in ex- and current smokers to 6 lower total airway nitric oxide flux in ex-smokers and reduced airway and alveolar nitric oxide concentrations in current smokers. The association between snus (oral tobacco) use and reduced nitric oxide concentrations in the airways and increased nitric oxide transfer from the airways warrants further studies.

  • 342.
    Malinovschi, Andrei
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Holmkvist, Thomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi.
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Meriläinen, Pekka
    Högman, Marieann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    IgE sensitisation in relation to flow-independent nitric oxide exchange parameters2006Ingår i: Respiratory research (Online), ISSN 1465-9921, E-ISSN 1465-993X, Vol. 7, s. 92-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A positive association between IgE sensitisation and exhaled NO levels has been found in several studies, but there are no reports on the compartment of the lung that is responsible for the increase in exhaled NO levels seen in IgE-sensitised subjects.

    Methods: The present study comprised 288 adult subjects from the European Community Respiratory Health Survey II who were investigated in terms of lung function, IgE sensitisation ( sum of specific IgE), smoking history and presence of rhinitis and asthma. Mean airway tissue concentration of NO (Caw(NO)), airway transfer factor for NO (Daw(NO)), mean alveolar concentration of NO (Calv(NO)) and fractional exhaled concentration of NO at a flow rate of 50 mL s(-1) ( FENO0.05) were determined using the extended NO analysis.

    Results: IgE-sensitised subjects had higher levels ( geometric mean) of FENO 0.05 (24.9 vs. 17.3 ppb) ( p < 0.001), Daw(NO) ( 10.5 vs. 8 mL s(-1)) ( p = 0.02) and Caw(NO) (124 vs. 107 ppb) ( p < 0.001) and positive correlations were found between the sum of specific IgE and FENO 0.05, Caw(NO) and Daw(NO) levels ( p < 0.001 for all correlations). Sensitisation to cat allergen was the major determinant of exhaled NO when adjusting for type of sensitisation. Rhinitis and asthma were not associated with the increase in exhaled NO variables after adjusting for the degree of IgE sensitisation.

    Conclusion: The presence of IgE sensitisation and the degree of allergic sensitisation were related to the increase in airway NO transfer factor and the increase in NO concentration in the airway wall. Sensitisation to cat allergen was related to the highest increases in exhaled NO parameters. Our data suggest that exhaled NO is more a specific marker of allergic inflammation than a marker of asthma or rhinitis.

  • 343.
    Malinovschi, Andrei
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Högman, M
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Rolla, G
    Torén, K
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Olin, A-C
    Both allergic and nonallergic asthma are associated with increased FENO levels, but only in never-smokers2009Ingår i: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 64, nr 1, s. 55-61Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Allergic asthma is consistently associated with increased FENO levels whereas divergence exists regarding the use of exhaled nitric oxide (NO) as marker of inflammation in nonallergic asthma and in asthmatic smokers. The aim of this study is to analyze the effect of having   allergic or nonallergic asthma on exhaled nitric oxide levels, with special regard to smoking history. Exhaled NO measurements were performed in 695 subjects from Turin (Italy), Gothenburg and Uppsala (both Sweden). Current asthma was defined as self-reported physician-diagnosed asthma with at least one asthma symptom or attack recorded during the last year. Allergic status was defined by using measurements of specific immunoglobulin E (IgE).   Smoking history was questionnaire-assessed. Allergic asthma was associated with 91 (60, 128) % [mean (95% CI)] increase of FENO while no significant association was found for nonallergic asthma [6 (-17, 35) %] in univariate analysis, when compared to nonatopic healthy subjects. In a multivariate analysis for never-smokers, subjects with allergic asthma had 77 (27, 145) % higher FENO levels than atopic healthy subjects while subjects with   nonallergic asthma had 97 (46, 166) % higher FENO levels than nonatopic healthy subjects. No significant asthma-related FENO increases were noted for ex- and current smokers in multivariate analysis. Both allergic and nonallergic asthma are related to increased FENO   levels, but only in never-smoking subjects. The limited value of FENO to detect subjects with asthma among ex- and current smokers suggests the predominance of a noneosinophilic inflammatory phenotype of asthma among ever-smokers.

  • 344.
    Malinovschi, Andrei
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Högman, Marieann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Rolla, Giovanni
    Torén, Kjell
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Olin, Anna-Carin
    Bronchial Responsiveness Is Related to Increased Exhaled NO (FENO) in Non-Smokers and Decreased FENO in Smokers2012Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, nr 4, s. e35725-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale

    Both atopy and smoking are known to be associated with increased bronchial responsiveness. Fraction of nitric oxide (NO) in the exhaled air (FENO), a marker of airways inflammation, is decreased by smoking and increased by atopy. NO has also a physiological bronchodilating and bronchoprotective role.

    Objectives

    To investigate how the relation between FENO and bronchial responsiveness is modulated by atopy and smoking habits.

    Methods

    Exhaled NO measurements and methacholine challenge were performed in 468 subjects from the random sample of three European Community Respiratory Health Survey II centers: Turin (Italy), Gothenburg and Uppsala (both Sweden). Atopy status was defined by using specific IgE measurements while smoking status was questionnaire-assessed.

    Main Results

    Increased bronchial responsiveness was associated with increased FENO levels in non-smokers (p = 0.02) and decreased FENO levels in current smokers (p = 0.03). The negative association between bronchial responsiveness and FENO was seen only in the group smoking less <10 cigarettes/day (p = 0.008). Increased bronchial responsiveness was associated with increased FENO in atopic subjects (p = 0.04) while no significant association was found in non-atopic participants. The reported interaction between FENO and smoking and atopy, respectively were maintained after adjusting for possible confounders (p-values<0.05).

    Conclusions

    The present study highlights the interactions of the relationship between FENO and bronchial responsiveness with smoking and atopy, suggesting different mechanisms behind atopy- and smoking-related increases of bronchial responsiveness.

  • 345.
    Manukyan, Levon
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Dunder, Linda
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lind, P. Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Bergsten, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Pediatrisk inflammationsforskning.
    Lejonklou, Margareta Halin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Developmental exposure to a very low dose of bisphenol A induces persistent islet insulin hypersecretion in Fischer 344 rat offspring2019Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 172, s. 127-136Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In children with obesity, accentuated insulin secretion has been coupled with development of type 2 diabetes mellitus (T2DM). Bisphenol A (BPA) is a chemical with endocrine- and metabolism-disrupting properties which can be measured in a majority of the population. Exposure to BPA has been associated with the development of metabolic diseases including T2DM.

    Objective: The aim of this study was to investigate if exposure early in life to an environmentally relevant low dose of BPA causes insulin hypersecretion in rat offspring.

    Methods: Pregnant Fischer 344 rats were exposed to 0.5 (BPA0.5) or 50 (BPA50) jig BPA/kg BW/day via drinking water from gestational day 3.5 until postnatal day 22. Pancreata from dams and 5- and 52-week-old offspring were procured and islets were isolated by collagenase digestion. Glucose-stimulated insulin secretion and insulin content in the islets were determined by ELISA.

    Results: Basal (5.5 mM glucose) islet insulin secretion was not affected by BPA exposure. However, stimulated (11 mM glucose) insulin secretion was enhanced by about 50% in islets isolated from BPA0.5-exposed 5- and 52 week-old female and male offspring and by 80% in islets from dams, compared with control. In contrast, the higher dose, BPA50, reduced stimulated insulin secretion by 40% in both 5- and 52-week-old female and male offspring and dams, compared with control.

    Conclusion: A BPA intake 8 times lower than the European Food Safety Authority's (EFSA's) current tolerable daily intake (TDI) of 4 mu g/kg BW/day of BPA delivered via drinking water during gestation and early development causes islet insulin hypersecretion in rat offspring up to one year after exposure. The effects of BPA exposure on the endocrine pancreas may promote the development of metabolic disease including T2DM.

  • 346. Marsh, Gary M
    et al.
    Buchanich, Jeanine M
    Zimmerman, Sarah
    Liu, Yimeng
    Balmert, Lauren C
    Graves, Jessica
    Kennedy, Kathleen J
    Esmen, Nurtan A
    Moshammer, Hanns
    Morfeld, Peter
    Erren, Thomas
    Groß, Juliane Valérie
    Yong, Mei
    Svartengren, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Westberg, Hakan
    McElvenny, Damien
    Cherrie, John W
    Mortality Among Hardmetal Production Workers: Pooled Analysis of Cohort Data From an International Investigation.2017Ingår i: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, nr 12, s. e342-e364Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Based on a pooled analysis of data from an international study, evaluate total and cause-specific mortality among hardmetal production workers with emphasis on lung cancer.

    METHODS: Study members were 32,354 workers from three companies and 17 manufacturing sites in five countries. We computed standardized mortality ratios and evaluated exposure-response via relative risk regression analysis.

    RESULTS: Among long-term workers, we observed overall deficits or slight excesses in deaths for total mortality, all cancers, and lung cancer and found no evidence of any exposure-response relationships for lung cancer.

    CONCLUSIONS: We found no evidence that duration, average intensity, or cumulative exposure to tungsten, cobalt, or nickel, at levels experienced by the workers examined, increases lung cancer mortality risks. We also found no evidence that work in these facilities increased mortality risks from any other causes of death.

  • 347. Matheson, Melanie Claire
    et al.
    Dharmage, Shyamali Chandrika
    Abramson, Michael John
    Walters, Eugene Haydn
    Sunyer, Jordi
    de Marco, Roberto
    Leynaert, Benedicte
    Heinrich, Joachim
    Jarvis, Deborah
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Raherison, Chantal
    Wjst, Matthias
    Svanes, Cecilie
    Early-life risk factors and incidence of rhinitis: Results from the European Community Respiratory Health Study - an international population-based cohort study2011Ingår i: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 128, nr 4, s. 816-823.e5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Rhinitis is an increasingly common condition with a heavy health care burden, but relatively little is known about its risk factors.

    Objective: To examine the association between early-life factors and the development of rhinitis in the European Community Respiratory Health Study (ECRHS).

    Methods: In 1992-1994, community-based samples of 20-44-year-old people were recruited from 48 centers in 22 countries. On average, 8.9 years later, 28 centers reinvestigated their samples. Onset of rhinitis was reported by 8486 participants in interviewer-led questionnaires. Cox regression was used to assess independent predictors of rhinitis at ages <= 5, 6-10, 11-20, and >= 21 years.

    Results: The crude lifelong incidence of rhinitis was 7.00/1000/year (men) and 7.95/1000/year (women) (P = .002). Women developed less rhinitis in later childhood (hazard ratios [HR], 0.63; 95% CI, 0.47-0.85) and more rhinitis in adulthood (HR, 1.36; 95% CI, 1.11-1.66) than did men. In atopic subjects, siblings were associated with lower risk of rhinitis throughout life (pooled HR, 0.94; 95% CI, 0.91-0.98 per 1 sibling). Early contact with children in the family or day care was associated with less incidence of rhinitis, predominantly before age 5 years (HR, 0.84; 95% CI, 0.72-0.99). Early childhood pets or growing up on a farm was associated with less incidence of rhinitis in adolescence (HR, 0.50; 95% CI, 0.37-0.68). Combining these factors showed evidence of a dose-response relationship (trend P = .0001).

    Conclusions: Gender is a strong risk factor for rhinitis, with age patterns varying according to atopic status. Protective effects of early contact with children and animals were suggested for incident rhinitis, with risk patterns varying by age window and atopic status.

  • 348. Merritt, A-S
    et al.
    Emenius, G
    Elfman, Lena
    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.
    Measurement of horse allergen (Equ cx) in schools2011Ingår i: ISRN Allergy, ISSN 2090-553XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background.

    The presence of horse allergen in public places is not well-known, unlike for instance cat and dog allergens, which have been studied extensively. The aim was to investigate the presence of horse allergen in schools and to what extent the influence of number of children with regular horse contact have on indoor allergen levels.

    Methods.

    Petri dishes were used to collect airborne dust samples during one week in classrooms. In some cases, vacuumed dust samples were also collected. All samples were extracted, frozen and analysed for Equ cx content shortly after sampling, and some were re-analysed six years later with a more sensitive ELISA assay.

    Results.

    Horse allergen levels were significantly higher in classrooms, in which many children had horse contact, regardless of sampling method. Allergen levels in extracts from Petri dish samples, which had been kept frozen, dropped about 53% over a six-year period.

    Conclusion.

    Horse allergen was present in classrooms and levels were higher in classrooms where many children had regular horse contact in their leisure time. This suggests that transfer of allergens takes place via contaminated clothing. Measures should be taken to minimize possible transfer and deposition of allergens in pet-free environments, such as schools.

  • 349. Mirabelli, Maria C.
    et al.
    Olivieri, Mario
    Kromhout, Hans
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Radon, Katja
    Torén, Kjell
    van Sprundel, Marc
    Villani, Simona
    Zock, Jan-Paul
    Inhalation incidents and respiratory health: results from the European Community Respiratory Health Survey2009Ingår i: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 52, nr 1, s. 17-24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Inhalation incidents are an important cause of acute respiratory symptoms, but little is known about how these incidents affect chronic respiratory health. METHODS: We assessed reported inhalation incidents among 3,763 European Community Respiratory Health Survey (ECRHS) participants with and without cough, phlegm, asthma, wheezing or bronchial hyperresponsiveness. We then examined whether inhalation incidents during the 9-year ECRHS follow-up period were associated with a new onset of any of these respiratory outcomes among 2,809 participants who were free of all five outcomes at the time of the baseline ECRHS survey. RESULTS: Inhalation incidents were reported by 5% of participants, with higher percentages reported among individuals with asthma-related outcomes at the time of the baseline survey. Among participants without symptoms at baseline, our analyses generated non-statistically significant elevated estimates of the risk of cough, phlegm, asthma and wheezing and a non-statistically significant inverse estimate of the risk of bronchial hyperresponsiveness among participants who reported an inhalation incident compared to those without such an event reported. DISCUSSION: Our findings provide limited evidence of an association between inhalation incidents and asthma-related symptoms. These data could be affected by differences in the reporting of inhalation incidents according to symptom status at the time of the baseline survey; they should thus be interpreted with caution.

  • 350. Mirabelli, Maria C.
    et al.
    Zock, Jan-Paul
    Bircher, Andreas J.
    Jarvis, Debbie
    Keidel, Dirk
    Kromhout, Hans
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Olivieri, Mario
    Plana, Estel
    Radon, Katja
    Schindler, Christian
    Schmid-Grendelmeier, Peter
    Torén, Kjell
    Villani, Simona
    Kogevinas, Manolis
    Metalworking exposures and persistent skin symptoms in the ECRHS II and SAPALDIA 2 cohorts2009Ingår i: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 60, nr 5, s. 256-263Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Diseases of the skin are important and often preventable conditions occurring among workers with dermal exposures to irritant and sensitizing agents. OBJECTIVE: We conducted this analysis to assess the associations between metalworking exposures and current and persistent skin symptoms among male and female participants in two population-based epidemiologic studies. METHODS: We pooled data from the European Community Respiratory Health Survey II (ECRHS II) and the Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults 2 (SAPALDIA 2), two prospective cohort studies in Europe. Each participant completed interviewer-administered questionnaires to provide information about symptoms and exposures related to selected occupations, including metalworking, during the follow-up periods. We assessed associations between skin symptoms and the frequency of metalworking exposures among 676 ECRHS II/SAPALDIA 2 respondents. RESULTS: Current skin symptoms were reported by 10% of metalworkers and were associated with frequent use, defined as four or more days per week, of oil-based metalworking fluids [prevalence ratio (PR): 1.76, 95% confidence interval (CI): 1.25-2.49)] and organic solvent/degreasing agents (PR: 2.06, 95% CI: 1.21-3.50). CONCLUSIONS: Skin symptom prevalence is associated with increasing frequency of oil-based metalworking fluid and degreasing agent use. Our findings justify assessing strategies for reducing the frequency of metal-related exposures.

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