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  • 1.
    Accordini, Simone
    et al.
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Calciano, Lucia
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Johannessen, Ane
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Ctr Int Hlth, Bergen, Norway.
    Portas, Laura
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Benediktsdottir, Bryndis
    Univ Iceland, Fac Med, Reykjavik, Iceland.
    Bertelsen, Randi Jacobsen
    Univ Bergen, Dept Clin Sci, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Braback, Lennart
    Umea Univ, Dept Publ Hlth & Clin Med, Div Occupat & Environm Med, Umea, Sweden.
    Carsin, Anne-Elie
    Ctr Res Environm Epidemiol CREAL, ISGlobal, Barcelona, Spain;UPF, Barcelona, Spain;CIBER Epidemiol & Salud PUbl CIBERESP, Barcelona, Spain.
    Dharmage, Shyamali C.
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy;Univ Melbourne, Sch Populat & Global Hlth, Melbourne, Vic, Australia.
    Dratva, Julia
    ZHAW Sch Hlth Profess, Inst Hlth Sci, Winterthur, Switzerland;Basel Univ, Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland.
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Div Occupat & Environm Med, Umea, Sweden.
    Real, Francisco Gomez
    Univ Bergen, Dept Clin Sci, Bergen, Norway.
    Heinrich, Joachim
    Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Inner City Clin, Inst & Outpatient Clin Occupat,Social & Environm, Munich, Germany.
    Holloway, John W.
    Univ Southampton, Fac Med, Human Dev & Hlth, Southampton, Hants, England.
    Holm, Mathias
    Univ Gothenburg, Sahlgrenska Acad, Dept Occupat & Environm Med, Gothenburg, Sweden.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jogi, Rain
    Tartu Univ Hosp, Lung Clin, Tartu, Estonia.
    Leynaert, Benedicte
    INSERM, Pathophysiol & Epidemiol Resp Dis, UMR 1152, Paris, France.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Marcon, Alessandro
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy.
    Martinez-Moratalla Rovira, Jesus
    CHUA, Hlth Serv Castilla La Mancha SESCAM, Pneumol Serv, Albacete, Spain;Univ Castilla La Mancha, Sch Med, Albacete, Spain.
    Raherison, Chantal
    Bordeaux Univ, INSERM, U1219, Bordeaux, France.
    Luis Sanchez-Ramos, Jose
    Univ Huelva, Dept Nursing, Huelva, Spain.
    Schlunssen, Vivi
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark;Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Bono, Roberto
    Univ Turin, Dept Publ Hlth & Pediat, Turin, Italy.
    Corsico, Angelo G.
    Univ Pavia, IRCCS San Matteo Hosp Fdn, Div Resp Dis, Pavia, Italy.
    Demoly, Pascal
    Univ Montpellier, Hop Arnaud Villeneuve, Dept Pneumol & Addictol, Montpellier, France;Sorbonne Univ, INSERM, IPLESP, Paris, France.
    Dorado Arenas, Sandra
    Galdakao Usansolo Hosp, Pulmonol Dept, Biscay, Spain.
    Nowak, Dennis
    Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Inner City Clin, Inst & Outpatient Clin Occupat,Social & Environm, Munich, Germany;Comprehens Pneumol Ctr Munich, German Ctr Lung Res, Munich, Germany.
    Pin, Isabelle
    CHU Grenoble Alpes, Pediat, Grenoble, France;Inst Adv Biosci, INSERM 1209, Grenoble, France;Univ Grenoble Alpes, Grenoble, France.
    Weyler, Joost
    Univ Antwerp, Dept Epidemiol & Social Med, Antwerp, Belgium;Univ Antwerp, StatUA Stat Ctr, Antwerp, Belgium.
    Jarvis, Deborah
    Imperial Coll, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England;Imperial Coll, MRC PHE Ctr Environm & Hlth, London, England.
    Svanes, Cecilie
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Ctr Int Hlth, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Ageing, Lungs European Cohorts A. L. E. C. Study
    A three-generation study on the association of tobacco smoking with asthma2018In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 4, p. 1106-1117Article in journal (Refereed)
    Abstract [en]

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

  • 2.
    Ahlroth Pind, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Gunnbjörnsdottír, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. National University Hospital of Iceland, Reykjavik, Iceland.
    Bjerg, A
    Karolinska Inst, Stockholm, Sweden.
    Järvholm, B
    Umeå Univ, Umeå, Sweden.
    Lundbäck, B
    Univ Gothenburg, Gothenburg, Sweden.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Middelveld, R
    Karolinska Inst, Stockholm, Sweden.
    Nilsson Sommar, J
    Umeå Univ, Umeå, Sweden.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Patient-reported signs of dampness at home may be a risk factor for chronic rhinosinusitis: A cross-sectional study2017In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 47, no 11, p. 1383-1389Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: An association between dampness at home and respiratory conditions has been convincingly demonstrated in children. Fewer studies have been performed in adults, and data are lacking for chronic rhinosinusitis (CRS). With a prevalence of 10.9% in Europe, CRS imposes a significant burden on quality of life, as well as economy.

    OBJECTIVE: Our aim was to study CRS and other respiratory conditions in relation to dampness at home in a representative sample of adults.

    METHODS: The Swedish GA2 LEN questionnaire was answered by 26 577 adults (16-75 years) and included questions on respiratory symptoms, smoking, education and environmental exposure. CRS was defined according to the EP3 OS criteria. Dampness was defined as reporting water damage, floor dampness or visible moulds in the home during the last 12 months. The dampness score was ranked from 0 to 3, counting the number of signs of dampness reported.

    RESULTS: Dampness at home was reported by 11.3% and was independently related to respiratory conditions after adjustment for demographic and socio-economic factors and smoking: CRS odds ratio (OR) 1.71; allergic rhinitis OR 1.24; current asthma OR 1.21; wheeze OR 1.37; nocturnal dyspnoea OR 1.80; nocturnal coughing OR 1.34; and chronic bronchitis OR 1.64. The risk of CRS and most of the other respiratory conditions was further elevated in subjects reporting multiple signs of dampness.

    CONCLUSIONS AND CLINICAL RELEVANCE: This study demonstrated an independent association between dampness at home and CRS in adults. The high burden of this and the other respiratory conditions studied is a strong argument in favour of countering indoor dampness by improving building standards.

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

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

  • 4.
    Amaral, Rita
    et al.
    Univ Porto, Fac Med, CINTESIS Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2,Rua Dr Placido Costa S-N, P-4200450 Porto, Portugal;Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal.
    Fonseca, Joao A.
    Univ Porto, Fac Med, CINTESIS Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2,Rua Dr Placido Costa S-N, P-4200450 Porto, Portugal;Univ Porto, Fac Med, MEDCIDS Dept Community Med Informat & Hlth Sci, Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal.
    Jacinto, Tiago
    Univ Porto, Fac Med, CINTESIS Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2,Rua Dr Placido Costa S-N, P-4200450 Porto, Portugal;Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal.
    Pereira, Ana M.
    Univ Porto, Fac Med, CINTESIS Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2,Rua Dr Placido Costa S-N, P-4200450 Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Having concomitant asthma phenotypes is common and independently relates to poor lung function in NHANES 2007-20122018In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 8, article id 13Article in journal (Refereed)
    Abstract [en]

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

  • 5.
    Amin, Kawa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Univ Sulaimani, Dept Microbiol Immunol, Sch Med, Fac Med Sci, Sulaimani, Iraq.
    Allergic Respiratory Inflammation and Remodeling2015In: Turkish Thoracic Journal, ISSN 1302-7808, Vol. 16, no 3, p. 133-140Article, review/survey (Refereed)
    Abstract [en]

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

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

  • 6.
    Amin, Kawa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Hepatic immune response to environmental carcinogens: Hepatic immune response to environmental carcinogens2018In: Pharmacognosy Magazine, ISSN 0973-1296, 0976-4062, Vol. 14:3, p. 548-553Article in journal (Refereed)
    Abstract [en]

    Aim: Environmental carcinogenic substances contribute to increasing incidence of hepatocellular carcinoma (HCC). We employed a sensitive method for the detection of DNA damage combined with analysis of the immune response to gain better knowledge how environmental carcinogens mediate pathology. Materials and Methods: Rat hepatocytes were isolated and stimulated with carcinogenic substances for the assessment of DNA damage. The mycotoxin aflatoxin B1(AFB1), two heterocyclic amines from the cooking of meat amino-3-methylimidazo[4,5-f] quinoline (IQ) and 3-amino-1-methyl-5H-pyrido-(4,3-b)-indole (TRP-P-2), and protein extract from the fungus Lactarius necator were assayed. Unscheduled DNA synthesis in hepatocytes was measured by the incorporation of radioactive thymidine during DNA repair. Stimulation of hepatocyte/immune cell preparation with the substances and measurement of IFNγ release at different time points determined their ability to induce an inflammatory response. Results: DNA repair in the hepatocytes was induced in response to 10−7 M AFB1 and 10−9 M IQ. TRP-P-2 did not induce DNA repair; however, at 10−4 M, the fungus extract did this. Furthermore, liver-resident immune cells responded with differential production of IFNγ over time in response to stimulation by all the carcinogens, with AFB1 being the most potent. TRP-P-2 showed the most significant reduction in IFNγ response over time. Conclusion: DNA damage in hepatocytes induced by environmental substances was detected at low molecular concentrations. The system did provide novel evidence for hepatic carcinogenicity by the fungus L. necator. Analysis of the response by liver-resident immune cells to the substances suggested that highly mutagenic substances induce prolonged inflammatory response.

  • 7.
    Andersson Kallin, Sandra
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Sommar, Johan Nilsson
    Umeå Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umeå, Sweden.
    Bossios, Apostolos
    Univ Gothenburg, Sahlgrenska Acad, Krefting Res Ctr, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Ekerljung, Linda
    Univ Gothenburg, Sahlgrenska Acad, Krefting Res Ctr, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Middelveld, Roelinde
    Karolinska Inst, Ctr Allergy Res, Stockholm, Sweden; Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Excessive daytime sleepiness in asthma: what are the risk factors?2018In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 55, no 8, p. 844-850Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 8.
    Bartley, K.
    et al.
    Genentech Inc, San Francisco, CA 94080 USA..
    Levine, A.
    IMS Hlth, Solna, Sweden..
    Arnheim-Dahlstrom, L.
    IMS Hlth, Solna, Sweden..
    Ferrara, G.
    Karolinska Univ Hosp, Stockholm, Sweden..
    Kirchgaessler, K.
    F Hoffmann Roche Ltd, Basel, Switzerland..
    Linder, R.
    IMS Hlth, Solna, Sweden..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Skold, C. M.
    Karolinska Inst, Stockholm, Sweden..
    Description Of A National Pulmonary Fibrosis Cohort In Sweden2017In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 72, p. A164-A165Article in journal (Other academic)
  • 9.
    Bertelsen, R. J.
    et al.
    Univ Bergen, Dept Clin Sci, POB 7804, N-5020 Bergen, Norway.;Haukeland Hosp, Dept Occupat Med, Bergen, Norway..
    Rava, M.
    INSERM U1168, VIMA Aging & Chron Dis Epidemiol & Publ Hlth Appr, Villejuif, France.;Univ Versailles St Quentin En Yvelines, UMR S 1168, Montigny Le Bretonneux, France.;Spanish Natl Canc Res Ctr CNIO, Genet & Mol Epidemiol Grp, Madrid, Spain..
    Carsin, A. E.
    Ctr Res Environm Epidemiol CREAL, ISGlobal, Barcelona, Spain.;Univ Pompeu Fabra, Barcelona, Spain.;CIBERESP, Barcelona, Spain..
    Accordini, S.
    Univ Verona, Unit Epidemiol & Med Stat, Dept Diagnost & Publ Hlth, Verona, Italy..
    Benediktsdottir, B.
    Univ Iceland, Fac Med, Reykjavik, Iceland..
    Dratva, J.
    Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland..
    Franklin, K. A.
    Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden..
    Heinrich, J.
    Helmholtz Zentrum Munchen, Inst Epidemiol 1, German Res Ctr Environm Hlth, Neuherberg, Germany.;Ludwig Maximilians Univ Munchen, Inst & Outpatient Clin Occupat Social & Environm, Munich, Germany..
    Holm, M.
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, Gothenburg, Sweden..
    Janson, C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Johannessen, A.
    Univ Bergen, Ctr Int Hlth, Dept Global Publ Hlth & Primary Care, Bergen, Norway.;Haukeland Hosp, Clin Res Ctr, Bergen, Norway..
    Jarvis, D. L.
    Imperial Coll, Natl Heart & Lung Inst, Resp Epidemiol Occupat Med & Publ Hlth, London, England..
    Jogi, R.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Tartu Univ Hosp, Lung Clin, Tartu, Estonia..
    Leynaert, B.
    INSERM, UMR 1152, Pathophysiol & Epidemiol Resp Dis, Epidemiol Team, Paris, France.;Univ Paris Diderot Paris 7, UMR 1152, Paris, France..
    Norback, D.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Omenaas, E. R.
    Univ Bergen, Dept Clin Sci, POB 7804, N-5020 Bergen, Norway.;Haukeland Hosp, Clin Res Ctr, Bergen, Norway..
    Raherison, C.
    Bordeaux Univ, INSERM U897, Bordeaux, France..
    Sanchez-Ramos, J. L.
    Univ Huelva, Dept Nursing, Huelva, Spain..
    Schlunssen, V.
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark.;Natl Res Ctr Working Environm, Copenhagen, Denmark..
    Sigsgaard, T.
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark..
    Dharmage, S. C.
    Univ Melbourne, Melbourne Sch Populat Hlth, Allergy & Lung Hlth Unit, Melbourne, Vic, Australia..
    Svanes, C.
    Haukeland Hosp, Dept Occupat Med, Bergen, Norway.;Univ Bergen, Ctr Int Hlth, Dept Global Publ Hlth & Primary Care, Bergen, Norway..
    Clinical markers of asthma and IgE assessed in parents before conception predict asthma and hayfever in the offspring2017In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 47, no 5, p. 627-638Article in journal (Refereed)
    Abstract [en]

    Background Mice models suggest epigenetic inheritance induced by parental allergic disease activity. However, we know little of how parental disease activity before conception influences offspring's asthma and allergy in humans. Objective We aimed to assess the associations of parental asthma severity, bronchial hyperresponsiveness (BHR), and total and specific IgEs, measured before conception vs. after birth, with offspring asthma and hayfever. Methods The study included 4293 participants (mean age 34, 47% men) from the European Community Respiratory Health Survey (ECRHS) with information on asthma symptom severity, BHR, total and specific IgEs from 1991 to 1993, and data on 9100 offspring born 1972-2012. Adjusted relative risk ratios (aRRR) for associations of parental clinical outcome with offspring allergic disease were estimated with multinomial logistic regressions. Results Offspring asthma with hayfever was more strongly associated with parental BHR and specific IgE measured before conception than after birth [BHR: aRRR = 2.96 (95% CI: 1.92, 4.57) and 1.40 (1.03, 1.91), respectively; specific IgEs: 3.08 (2.13, 4.45) and 1.83 (1.45, 2.31), respectively]. This was confirmed in a sensitivity analysis of a subgroup of offspring aged 11-22 years with information on parental disease activity both before and after birth. Conclusion & Clinical Relevance Parental BHR and specific IgE were associated with offspring asthma and hayfever, with the strongest associations observed with clinical assessment before conception as compared to after birth of the child. If the hypothesis is confirmed in other studies, parental disease activity assessed before conception may prove useful for identifying children at risk for developing asthma with hayfever.

  • 10.
    Bjornsdottir, Erla
    et al.
    Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Arnardottir, Erna Sif
    Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Benediktsdottir, Bryndis
    Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Garcia-Aymerich, Judith
    ISGlobal, Ctr Res Environm Epidemiol CREAL, Barcelona, Spain.;UPF, Barcelona, Spain.;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain..
    Elie Carsin, Anne
    ISGlobal, Ctr Res Environm Epidemiol CREAL, Barcelona, Spain.;UPF, Barcelona, Spain.;CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain..
    Gomez Real, Francisco
    Univ Bergen, Dept Clin Sci, Bergen, Norway..
    Toren, Kjell
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Occupat & Environm Med, Gothenburg, Sweden..
    Heinrich, Joachim
    Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Inst & Outpatient Clin Occupat Social & Environm, Munich, Germany.;Helmholtz Zentrum Munchen, German Res Ctr Environm Hlth, Inst Epidemiol 1, Neuherberg, Germany..
    Nowak, Dennis
    Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Inst & Outpatient Clin Occupat Social & Environm, Munich, Germany..
    Luis Sanchez-Ramos, Jose
    Univ Huelva, Dept Nursing, Huelva, Spain..
    Demoly, Pascal
    Univ Hosp Montpellier, Dept Pneumol, Montpellier, France..
    Dorado Arenas, Sandra
    Galdakao Usansolo Hosp, Dept Pulmonol, Biscay, Spain..
    Coloma Navarro, Ramon
    Hosp Gen Univ, Serv Neumol, Unidad Sueno, Albacete, Spain..
    Schlunssen, Vivi
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark.;Natl Res Ctr Working Environm, Copenhagen, Denmark..
    Raherison, Chantal
    Bordeaux Populat Hlth Res Ctr, U1219, Bordeaux, France..
    Jarvis, Debbie L.
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England.;Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England..
    Gislason, Thorarinn
    Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Respiratory symptoms are more common among short sleepers independent of obesity2017In: BMJ OPEN RESPIRATORY RESEARCH, ISSN 2052-4439, Vol. 4, no 1, article id e000206Article in journal (Refereed)
    Abstract [en]

    Introduction Sleep length has been associated with obesity and various adverse health outcomes. The possible association of sleep length and respiratory symptoms has not been previously described. The aim of this study was to investigate the association between sleep length and respiratory symptoms and whether such an association existed independent of obesity. Methods This is a multicentre, cross-sectional, population-based study performed in 23 centres in 10 different countries. Participants (n=5079, 52.3% males) were adults in the third follow-up of the European Community Respiratory Health Survey III. The mean +/- SD age was 54.2 +/- 7.1 (age range 39-67 years). Information was collected on general and respiratory health and sleep characteristics. Results The mean reported nighttime sleep duration was 6.9 +/- 1.0 hours. Short sleepers (<6 hours per night) were n=387 (7.6%) and long sleepers (>= 9 hours per night) were n=271 (4.3%). Short sleepers were significantly more likely to report all respiratory symptoms (wheezing, waking up with chest tightness, shortness of breath, coughing, phlegm and bronchitis) except asthma after adjusting for age, gender, body mass index (BMI), centre, marital status, exercise and smoking. Excluding BMI from the model covariates did not affect the results. Short sleep was related to 11 out of 16 respiratory and nasal symptoms among subjects with BMI >= 30 and 9 out of 16 symptoms among subjects with BMI <30. Much fewer symptoms were related to long sleep, both for subjects with BMI <30 and >= 30. Conclusions Our results show that short sleep duration is associated with many common respiratory symptoms, and this relationship is independent of obesity.

  • 11.
    Broström, Erika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jogi, Rain
    Tartu Univ Hosp, Lung Clin, Tartu, Estonia.
    Gislason, Thorarinn
    Landspitali Univ Hosp, Dept Sleep, Reykjavik, Iceland;Univ Iceland, Fac Med, Reykjavik, Iceland.
    Benediktsdottir, Bryndis
    Univ Iceland, Fac Med, Reykjavik, Iceland.
    Burney, Peter G. J.
    Imperial Coll, Natl Heart & Lung Inst, London, England.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Imperial Coll, Natl Heart & Lung Inst, London, England.
    The prevalence of chronic airflow obstruction in three cities in the Nordic-Baltic region2018In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 143, p. 8-13Article in journal (Refereed)
    Abstract [en]

    Back ground: Chronic airflow obstruction (CAO) is the primary characteristic of Chronic obstructive pulmonary disease (COPD) but is also seen in chronic asthma. Objective: To compare the prevalence of CAO and possible risk factors between Tartu in Estonia, Reykjavik in Iceland and Uppsala in Sweden. Methods: All participants underwent spirometry testing of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) before and after bronchodilation. CAO was defined as post-bronchodilator FEV1/FVC below lower limit of normal. Information on respiratory diseases and smoking status, was obtained through questionnaires administered by trained interviewers. Results: 1037 men and 956 women participated in the study. The prevalence of CAO was lower in women in Tartu compared to the other centres (4.9% vs. 13.4 and 8.7% in Reykjavik and Uppsala, respectively, p = 0.002) while no difference was found for men. A similar picture was seen for the proportion of participants that had smoked 10 pack years or more which was much lower in Tartu for women than in Reykjavik and Uppsala, respectively (13.2% vs. 33.7 and 29.2%, p < 0.001). (Fig. 1). Of the participants with CAO the majority (57-67%) did not have a previous diagnosis of asthma or COPD. Conclusion: The prevalence of CAO was lower in Estonian women than in women from Iceland and Sweden. The reason for this was probably that the Estonian women had smoked less than the female participants from Iceland and Sweden. The majority of those with CAO do not have a diagnosed lung disease.

  • 12.
    Cai, Gui-Hong
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Benedict, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Elmståhl, Sölve
    Lund Univ, Skane Univ Hosp, Sweden CRC, Dept Hlth Sci,Div Geriatr Med, Malmo, Sweden..
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Both Weight at Age 20 and Weight Gain Have an Impact on Sleep Disturbances Later in Life: Results of the EpiHealth Study2018In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 41, no 1, article id zsx176Article in journal (Refereed)
    Abstract [en]

    Study Objectives: Obesity is often associated with impaired sleep, whereas the impact of body mass index (BMI) at younger age and previous weight gain on sleep problems remains unknown.

    Methods: The present study utilized data from the Swedish EpiHealth cohort study. A total of 15 845 participants (45-75 years) filled out an internet-based questionnaire. BMI was calculated from both measured data at study time and self-reported data at age 20 from the questionnaire.

    Results: Sleep-related symptoms were most common among obese individuals (BMI >30 kg/m(2)). An association between weight gain and sleep problems was found and those with a low BMI at age 20 were most vulnerable to weight gain when it came to risk of sleep problems. Among those who were underweight (BMI <18.5 kg/m(2)) at age 20, weight gain (kg/year) was associated with difficulties initiating sleep with an adjusted OR of 2.64 (95% CI: 1.51-4.62) after adjusting for age, sex, smoking, alcohol consumption, physical activity, education, and civil status. The corresponding adjusted OR's among those who had been normal weight (BMI 18.5-24.99) and overweight (BMI 25-29.99 kg/m(2)) at age 20 were 1.89 (1.47-2.45) and 1.02 (0.48-2.13), respectively. Also difficulties maintaining sleep and snoring were most strongly related to weight gain among those who were underweight at age 20 with decreasing odds with increasing BMI at that age.

    Conclusions: Sleep problems are related to weight gain and obesity. The impact of weight is most pronounced among those who had a low BMI when young.

  • 13.
    Cai, Gui-Hong
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Elmstahl, Solve
    Lund Univ, Div Geriatr Med, Dept Hlth Sci, Sweden CRC,Skane Univ Hosp, Malmo, Sweden.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Insomnia symptoms and sleep duration and their combined effects in relation to associations with obesity and central obesity2018In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 46, p. 81-87Article in journal (Refereed)
    Abstract [en]

    Objective: Previous studies have shown that both sleep duration and insomnia have an impact on obesity and central obesity. However, studies of the joint effects of these sleep disorders are still sparse. Methods: The present study utilized data from the Swedish EpiHealth cohort study. Participants (45 - 78 y) were asked to fill out an internet-based questionnaire. Body mass index (BMI) and central obesity (calculated from waist circumference) were based on measured data. Results: A total of 18,823 participants (mean age = 60 ys) were included in this study. The reported prevalence of short (<6 h/night) and long (>9 h/night) sleep duration was 8% and 4% respectively, and insomnia symptoms was 19%. Of the study population, 16% were obese (BMI >= 30 kg/m(2)) and 40% had central obesity. There was a U-shaped association between sleep duration and obesity and central obesity, and significant associations between insomnia symptoms and obesity. When stratifying sleep duration by concurrent insomnia symptoms, there were associations (odds ratios, (95% confidence intervals)) between the combination of both short (1.48, (1.22-1.80)) and long sleep duration (1.77 (1.00 - 3.16)) with insomnia symptoms and obesity and central obesity (1.36 (1.16-1.61) and 2.44 (1.41-3.24) respectively). However, there was no significant association between insomnia symptoms and obesity or central obesity in participants with normal sleep duration. For central obesity there was an association with long sleep duration regardless of insomnia symptoms, while the association with short sleep duration was significant only if insomnia symptoms were present. Conclusions: Both short and long sleep duration, as well as insomnia symptoms, are associated with obesity and central obesity. There is an important joint effect of sleep duration and insomnia symptoms and there is no association between insomnia symptoms and obesity, as long as a normal sleeping time can be attained. This indicates that sleep duration rather than insomnia symptoms per se is of importance for the relationship between sleep and obesity.

  • 14.
    Carlsen, Hanne Krage
    et al.
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden.;Univ Iceland, Engn & Nat Sci, Reykjavik, Iceland.;Univ Gothenburg, Inst Med, Sect Occupat & Environm Med, Dept Publ Hlth & Community Med,Sahlgrenska Acad, Gothenburg, Sweden..
    Bäck, Erik
    Environm Adm, Gothenburg, Sweden..
    Eneroth, Kristina
    Environm & Hlth Adm, Stockholm, Sweden..
    Gislason, Thorarinn
    Univ Iceland, Fac Med, Reykjavik, Iceland.;Landspitali Natl Univ Hosp Iceland, Dept Resp Med & Sleep, Reykjavik, Iceland..
    Holm, Mathias
    Univ Gothenburg, Inst Med, Sect Occupat & Environm Med, Dept Publ Hlth & Community Med,Sahlgrenska Acad, Gothenburg, Sweden..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jensen, Steen Solvang
    Aarhus Univ, Dept Environm Sci, Roskilde, Denmark..
    Johannessen, Ane
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway..
    Kaasik, Marko
    Univ Tartu, Inst Phys, Tartu, Estonia..
    Modig, Lars
    Umea Univ, Div Occupat & Environm Med, Dept Publ Hlth & Clin Med, Umed, Sweden..
    Segersson, David
    Swedish Meteorol & Hydrol Inst, Norrkoping, Sweden..
    Sigsgaard, Torben
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark..
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden..
    Olsson, David
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden..
    Orru, Hans
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden.;Univ Tartu, Dept Family Med & Publ Hlth, Tartu, Estonia..
    Indicators of residential traffic exposure: Modelled NOX, traffic proximity, and self-reported exposure in RHINE III2017In: Atmospheric Environment, ISSN 1352-2310, E-ISSN 1873-2844, Vol. 167, p. 416-425Article in journal (Refereed)
    Abstract [en]

    Few studies have investigated associations between self-reported and modelled exposure to traffic pollution. The objective of this study was to examine correlations between self-reported traffic exposure and modelled (a) NOx and (b) traffic proximity in seven different northern European cities; Aarhus (Denmark), Bergen (Norway), Gothenburg, Ulna and Uppsala (Sweden), Reykjavik (Iceland), and Tartu (Estonia). We analysed data from the RHINE III (Respiratory Health in Northern Europe, www.rhine.nu) cohorts of the seven study cities. Traffic proximity (distance to the nearest road with >10,000 vehicles per day) was calculated and vehicle exhaust (NOx) was modelled using dispersion models and land-use regression (LUR) data from 2011. Participants were asked a question about self-reported traffic intensity near bedroom window and another about traffic noise exposure at the residence. The data were analysed using rank correlation (Kendall's tau) and inter-rater agreement (Cohen's Kappa) between tertiles of modelled NOx and traffic proximity tertile and traffic proximity categories (0-150 metres (m), 150 -200 m, >300 m) in each centre. Data on variables of interest were available for 50-99% of study participants per each cohort. Mean modelled NOx levels were between 6.5 and 16.0 mu g/m(3); median traffic intensity was between 303 and 10,750 m in each centre. In each centre, 7.7-18.7% of respondents reported exposure to high traffic intensity and 3.6-16.3% of respondents reported high exposure to traffic noise. Self-reported residential traffic exposure had low or no correlation with modelled exposure and traffic proximity in all centres, although results were statistically significant (tau = 0.057-0.305). Self reported residential traffic noise correlated weakly (tau = 0.090-0.255), with modelled exposure in all centres except Reykjavik. Modelled NOx\] had the highest correlations between self-reported and modelled traffic exposure in five of seven centres, traffic noise exposure had the highest correlation with traffic proximity in tertiles in three centres. Self-reported exposure to high traffic intensity and traffic noise at each participant's residence had low or weak although statistically significant correlations with modelled vehicle exhaust pollution levels and traffic proximity.

  • 15. Christensson, Eva
    et al.
    Franklin, Karl A
    Sahlin, Carin
    Palm, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Ulfberg, Jan
    Eriksson, Lars I
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Hagel, Eva
    Jonsson Fagerlund, Malin
    Can STOP-Bang and Pulse Oximetry Detect and Exclude Obstructive Sleep Apnea?2018In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 127, no 3, p. 736-743Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Obstructive sleep apnea (OSA) is related to postoperative complications and is a common disorder. Most patients with sleep apnea are, however, undiagnosed, and there is a need for simple screening tools. We aimed to investigate whether STOP-Bang and oxygen desaturation index can identify subjects with OSA.

    METHODS: In this prospective, observational multicenter trial, 449 adult patients referred to a sleep clinic for evaluation of OSA were investigated with ambulatory polygraphy, including pulse oximetry and the STOP-Bang questionnaire in 4 Swedish centers. The STOP-Bang score is the sum of 8 positive answers to Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index >35 kg/m, Age >50 years, Neck circumference >40 cm, and male Gender.

    RESULTS: The optimal STOP-Bang cutoff score was 6 for moderate and severe sleep apnea, defined as apnea-hypopnea index (AHI) ≥15, and the sensitivity and specificity for this score were 63% (95% CI, 0.55-0.70) and 69% (95% CI, 0.64-0.75), respectively. A STOP-Bang score of <2 had a probability of 95% (95% CI, 0.92-0.98) to exclude an AHI >15 and a STOP-Bang score of ≥6 had a specificity of 91% (95% CI, 0.87-0.94) for an AHI >15. The items contributing most to the STOP-Bang were the Bang items. There was a positive correlation between AHI versus STOP-Bang and between AHI versus oxygen desaturation index, Spearman ρ 0.50 (95% CI, 0.43-0.58) and 0.96 (95% CI, 0.94-0.97), respectively.

    CONCLUSIONS: STOP-Bang and pulse oximetry can be used to screen for sleep apnea. A STOP-Bang score of <2 almost excludes moderate and severe OSA, whereas nearly all the patients with a STOP-Bang score ≥6 have OSA. We suggest the addition of nightly pulse oximetry in patients with a STOP-Bang score of 2-5 when there is a need for screening for sleep apnea (ie, before surgery).

  • 16.
    Coton, Sonia
    et al.
    UCL, Res Dept Primary Care & Populat Hlth, London, England..
    Vollmer, William M.
    Kaiser Permanente Ctr Hlth Res, Portland, OR USA..
    Bateman, Eric
    Univ Cape Town, Dept Med, Div Pulmonol, Cape Town, South Africa..
    Marks, Guy B.
    UNSW, Woolcock Inst Med Res, Sydney, NSW, Australia.;UNSW, South Western Sydney Clin Sch, Sydney, NSW, Australia..
    Tan, Wan
    Univ British Columbia, iCapture Ctr Cardiovasc & Pulm Res, Vancouver, BC, Canada..
    Mejza, Filip
    Jagiellonian Univ, Coll Med, Dept Internal Med 2, Krakow, Poland..
    Juvekar, Sanjay
    KEM Hosp Res Ctr, Vadu HDSS, Pune, Maharashtra, India..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Mortimer, Kevin
    Univ Liverpool Liverpool Sch Trop Med, Dept Clin Sci, Liverpool, Merseyside, England..
    Mahesh, P. A.
    JSS Med Coll, Dept Pulm Med, Mysore, Karnataka, India..
    Buist, A. Sonia
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA..
    Burney, Peter G. J.
    Imperial Coll, Natl Heart & Lung Inst, London, England..
    Severity of Airflow Obstruction in Chronic Obstructive Pulmonary Disease (COPD): Proposal for a New Classification2017In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 14, no 5, p. 469-475Article in journal (Refereed)
    Abstract [en]

    Current classifications of Chronic Obstructive Pulmonary Disease (COPD) severity are complex and do not grade levels of obstruction. Obstruction is a simpler construct and independent of ethnicity. We constructed an index of obstruction severity based on the FEV1/FVC ratio, with cut-points dividing the Burden of Obstructive Lung Disease (BOLD) study population into four similarly sized strata to those created by the GOLD criteria that uses FEV1. Wemeasured the agreement between classifications and the validity of the FEV1-based classification in identifying the level of obstruction as defined by the new groupings. We compared the strengths of association of each classification with quality of life (QoL), MRC dyspnoea score and the self-reported exacerbation rate. Agreement between classifications was only fair. FEV1-based criteria for moderate COPD identified only 79% of those with moderate obstruction and misclassified half of the participants with mild obstruction as having more severe COPD. Both scales were equally strongly associated with QoL, exertional dyspnoea and respiratory exacerbations. Severity assessed using the FEV1/FVC ratio is only in moderate agreement with the severity assessed using FEV1 but is equally strongly associated with other outcomes. Severity assessed using the FEV1/FVC ratio is likely to be independent of ethnicity.

  • 17.
    Danielsson, Katarina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Jansson-Fröjmark, Markus
    Institutionen för Psykologi, Stockholms Universitet.
    Jan-Erik, Broman
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Markström, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Light therapy with scheduled rise times in young adults with delayed sleep phase disorder: Therapeutic outcomes and possible predictors2018In: Behavioural Sleep Medicine, ISSN 1540-2002, E-ISSN 1540-2010, Vol. 16, no 4, p. 325-336Article in journal (Refereed)
    Abstract [en]

    Clinical trials with light therapy (LT) for delayed sleep phase disorder (DSPD) are sparse and little is known about factors that are favorable for improvements. In this study, LT with scheduled rise times was conducted at home for 14 days by 44 participants with DSPD aged 16–26 years. Primary outcomes were sleep onset and sleep offset. Potential predictors were demographic characteristics, chronotype, dim light melatonin onset, the number of days the LT lamp was used, the daily duration of LT, daytime sleepiness, anxiety, depression, worry, and rumination. Significant advances were observed in sleep onset and sleep offset from baseline to the end of treatment. The number of days of LT predicted earlier sleep onset and sleep offset.

  • 18.
    Demenais, Florence
    et al.
    INSERM, UMR 946, Genet Variat & Human Dis Unit, Paris, France.;Univ Paris Diderot, Univ Sorbonne Paris Cite, Inst Univ Hematol, Paris, France..
    Margaritte-Jeannin, Patricia
    INSERM, UMR 946, Genet Variat & Human Dis Unit, Paris, France.;Univ Paris Diderot, Univ Sorbonne Paris Cite, Inst Univ Hematol, Paris, France..
    Barnes, Kathleen C.
    Univ Colorado, Colorado Ctr Personalized Med, Div Biomed Informat & Personalized Med, Denver, CO 80202 USA..
    Cookson, William O. C.
    Natl Heart & Lung Inst, Sect Genom Med, London, England..
    Altmueller, Janine
    Univ Cologne, Cologne Ctr Genom, Cologne, Germany.;Univ Cologne, CMMC, Cologne, Germany..
    Ang, Wei
    Univ Western Australia, Sch Womens & Infants Hlth, Perth, WA, Australia..
    Barr, R. Graham
    Columbia Univ, Dept Med, New York, NY USA.;Columbia Univ, Div Epidemiol, New York, NY USA..
    Beaty, Terri H.
    Johns Hopkins Univ, Div Genet Epidemiol, Dept Epidemiol, Bloomberg Sch Publ Hlth, Baltimore, MD USA..
    Becker, Allan B.
    Univ Manitoba, Dept Pediat & Child Hlth, Winnipeg, MB, Canada..
    Beilby, John
    Queen Elizabeth II Med Ctr, Dept Diagnost Genom Lab, PathWest Lab Med, Nedlands, WA, Australia..
    Bisgaard, Hans
    Univ Copenhagen, Herlev & Gentofte Hosp, Copenhagen Prospect Studies Asthma Childhood, Copenhagen, Denmark..
    Bjornsdottir, Unnur Steina
    Natl Univ Hosp Iceland, Landspitali, Dept Med, Reykjavik, Iceland..
    Bleecker, Eugene
    Wake Forest Univ, Sch Med, Ctr Gen, Winston Salem, NC 27109 USA..
    Bonnelykke, Klaus
    Univ Copenhagen, Herlev & Gentofte Hosp, Copenhagen Prospect Studies Asthma Childhood, Copenhagen, Denmark..
    Boomsma, Dorret I.
    Vrjie Univ, Amsterdam Publ Hlth Res Inst, Dept Biol Psychol, Amsterdam, Netherlands..
    Bouzigon, Emmanuelle
    INSERM, UMR 946, Genet Variat & Human Dis Unit, Paris, France.;Univ Paris Diderot, Univ Sorbonne Paris Cite, Inst Univ Hematol, Paris, France..
    Brightling, Christopher E.
    Univ Leicester, Glenfield Hosp, Inst Lung Hlth, Leicester, Leics, England..
    Brossard, Myriam
    INSERM, UMR 946, Genet Variat & Human Dis Unit, Paris, France.;Univ Paris Diderot, Univ Sorbonne Paris Cite, Inst Univ Hematol, Paris, France..
    Brusselle, Guy G.
    Ghent Univ Hosp, Dept Resp Med, Ghent, Belgium.;Univ Med Ctr Rotterdam, Erasmus MC, Dept Epidemiol, Rotterdam, Netherlands.;Univ Med Ctr Rotterdam, Erasmus MC, Dept Resp Med, Rotterdam, Netherlands..
    Burchard, Esteban
    Univ Calif San Francisco, Dept Bioengn & Therapeut Sci & Med, San Francisco, CA 94143 USA..
    Burkart, Kristin M.
    Columbia Univ, Coll Phys & Surg, Div Pulm Allergy & Crit Care, New York, NY USA..
    Bush, Andrew
    Imperial Coll London, Natl Heart & Lung Inst, London, England.;Royal Brompton Harefield Natl Hlth Serv NHS Fdn T, London, England..
    Chan-Yeung, Moira
    Univ British Columbia, Dept Med, Vancouver, BC, Canada..
    Chung, Kian Fan
    Imperial Coll London, Natl Heart & Lung Inst, London, England.;Royal Brompton & Harefield Natl Hlth Serv NHS Tru, Biomed Res Unit, London, England..
    Alves, Alexessander Couto
    Imperial Coll London, Dept Epidemiol & Biostat, London, England..
    Curtin, John A.
    Univ Manchester, Div Infect Immun & Resp Med, Sch Biol Sci, Fac Biol Med & Hlth,Manchester Acad Hlth Sci Ctr, Manchester, Lancs, England..
    Custovic, Adnan
    Imperial Coll London, Dept Pediat, London, England..
    Daley, Denise
    Univ British Columbia, Dept Med, Vancouver, BC, Canada.;Univ British Columbia, Ctr Heart & Lung Innovat, Vancouver, BC, Canada..
    de Jongste, Johan C.
    Univ Med Ctr Rotterdam, Erasmus MC, Div Resp Med, Dept Pediat, Rotterdam, Netherlands..
    Del-Rio-Navarro, Blanca E.
    Hosp Infantil Mexico Dr Federico Gomez, Mexico City, DF, Mexico..
    Donohue, Kathleen M.
    Columbia Univ, Dept Med, New York, NY USA.;Columbia Univ, Div Epidemiol, New York, NY USA..
    Duijts, Liesbeth
    Univ Med Ctr Rotterdam, Erasmus MC, Div Resp Med, Dept Pediat, Rotterdam, Netherlands.;Univ Med Ctr Rotterdam, Erasmus MC, Dept Pediat, Div Neonatol, Rotterdam, Netherlands..
    Eng, Celeste
    Univ Calif San Francisco, Dept Med, San Francisco, CA USA..
    Eriksson, Johan G.
    Univ Helsinki, Dept Gen Practice & Primary Hlth Care, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland..
    Farrall, Martin
    Univ Oxford, Radcliffe Dept Med, Div Cardiovasc Med, Oxford, England.;Univ Oxford, Wellcome Trust Ctr Human Genet, Oxford, England..
    Fedorova, Yuliya
    Russian Acad Sci, Inst Biochem & Genet, Ufa Sci Ctr, Ufa, Russia..
    Feenstra, Bjarke
    Statens Serum Inst, Dept Epidemiol Res, Copenhagen, Denmark..
    Ferreira, Manuel A.
    QIMR Berghofer Med Res Inst, Genet & Computat Biol, Brisbane, Qld, Australia..
    Freidin, Maxim B.
    Tomsk NRMC, Res Inst Med Genet, Populat Genet Lab, Tomsk, Russia..
    Gajdos, Zofia
    Childrens Hosp, Div Genet & Endocrinol, 300 Longwood Ave, Boston, MA 02115 USA.;Broad Inst, Cambridge, MA USA..
    Gauderman, Jim
    Univ Southern Calif, Keck Sch Med, Dept Prevent Med, Los Angeles, CA USA..
    Gehring, Ulrike
    Univ Utrecht, Inst Risk Assessment Sci, Div Environm Epidemiol, Utrecht, Netherlands..
    Geller, Frank
    Statens Serum Inst, Dept Epidemiol Res, Copenhagen, Denmark..
    Genuneit, Jon
    Ulm Univ, Inst Epidemiol & Med Biometry, Ulm, Germany..
    Gharib, Sina A.
    Univ Washington, Dept Med, Seattle, WA USA..
    Gilliland, Frank
    Univ Southern Calif, Keck Sch Med, Dept Prevent Med, Los Angeles, CA USA..
    Granell, Raquel
    Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England.;Univ Bristol, MRC Integrat Epidemiol Unit, Bristol, Avon, England..
    Graves, Penelope E.
    Univ Arizona, Asthma & Airway Dis Res Ctr, Tucson, AZ USA.;Univ Arizona, Inst BIO5, Tucson, AZ USA..
    Gudbjartsson, Daniel F.
    Amgen Inc, deCODE Genet, Reykjavik, Iceland.;Univ Iceland, Sch Engn & Nat Sci, Reykjavik, Iceland..
    Haahtela, Tari
    Univ Helsinki, Skin & Allergy Hosp, Helsinki, Finland..
    Heckbert, Susan R.
    Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA..
    Heederik, Dick
    Univ Utrecht, Inst Risk Assessment Sci, Div Environm Epidemiol, Utrecht, Netherlands..
    Heinrich, Joachim
    Univ Hosp Munich, Inst & Outpatient Clin Occupat Social & En, Munich, Germany.;Helmholtz Zentrum Munchen, German Res Ctr Environm Hlth, Inst Epidemiol 1, Neuherberg, Germany..
    Heliovaara, Markku
    Natl Inst Hlth & Welf THL, Helsinki, Finland..
    Henderson, John
    Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England.;Univ Bristol, MRC Integrat Epidemiol Unit, Bristol, Avon, England..
    Himes, Blanca E.
    Univ Penn, Dept Biostat Epidemiol & Informat, Philadelphia, PA 19104 USA..
    Hirose, Hiroshi
    Keio Univ, Dept Internal Med, Hlth Ctr, Tokyo, Japan..
    Hirschhorn, Joel N.
    Broad Inst, Cambridge, MA USA.;Boston Childrens Hosp, Div Endocrinol, Boston, MA USA.;Boston Childrens Hosp, Ctr Basic & Translat Obes Res, Boston, MA USA.;Harvard Med Sch, Dept Pediat, Boston, MA USA.;Harvard Med Sch, Dept Genet, Boston, MA USA..
    Hofman, Albert
    Univ Med Ctr Rotterdam, Erasmus MC, Dept Epidemiol, Rotterdam, Netherlands.;Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA..
    Holt, Patrick
    Univ Western Australia, Cell Biol Telethon Kids Inst, Subiaco, WA, Australia..
    Hottenga, Jouke
    Vrjie Univ, Amsterdam Publ Hlth Res Inst, Dept Biol Psychol, Amsterdam, Netherlands..
    Hudson, Thomas J.
    Ontario Inst Canc Res, Toronto, ON, Canada.;AbbVie Inc, Redwood City, CA USA..
    Hui, Jennie
    Queen Elizabeth II Med Ctr, Dept Diagnost Genom Lab, PathWest Lab Med, Nedlands, WA, Australia.;Busselton Populat Med Res Inst, Perth, WA, Australia.;Univ Western Australia, Sch Populat & Global Hlth, Nedlands, WA, Australia..
    Imboden, Medea
    Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland.;Univ Basel, Basel, Switzerland..
    Ivanov, Vladimir
    Kursk State Med Univ, Dept Biol Med Genet & Ecol, Kursk, Russia..
    Jaddoe, Vincent W. V.
    Univ Med Ctr Rotterdam, Erasmus MC, Generat R Study Grp, Dept Pediat, Rotterdam, Netherlands.;Univ Med Ctr Rotterdam, Erasmus MC, Dept Epidemiol, Rotterdam, Netherlands..
    James, Alan
    Sir Charles Gairdner Hosp, Dept Pulm Physiol & Sleep Med, Busselton Populat Med Res Inst, Nedlands, WA, Australia.;Univ Western Australia, Sch Med & Pharmacol, Crawley, WA, Australia..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jarvelin, Marjo-Riitta
    Imperial Coll London, Dept Epidemiol & Biostat, MRC PHE Ctr Environm & Hlth, Sch Publ Hlth, London, England.;Univ Oulu, Fac Med, Ctr Life Course Hlth Res, Oulu, Finland.;Univ Oulu, Bioctr Oulu, Oulu, Finland.;Oulu Univ Hosp, Unit Primary Care, Oulu, Finland..
    Jarvis, Deborah
    Imperial Coll London, Natl Heart & Lung Inst, London, England.;Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England..
    Jones, Graham
    Western Sydney Univ, Sch Sci & Hlth, Sydney, NSW, Australia..
    Jonsdottir, Ingileif
    Amgen Inc, deCODE Genet, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Jousilahti, Pekka
    Natl Inst Hlth & Welf THL, Helsinki, Finland..
    Kabesch, Michael
    Univ Childrens Hosp Regensburg KUNO, Dept Pediat Pneumol & Allergy, Regensburg, Germany..
    Kahonen, Mika
    Univ Tampere, Dept Clin Physiol, Tampere, Finland.;Tampere Univ Hosp, Tampere, Finland..
    Kantor, David B.
    Boston Childrens Hosp, Div Crit Care Med, Dept Anesthesiol Perioperat & Pain Med, Boston, MA USA.;Harvard Med Sch, Dept Anaesthesia, Boston, MA USA..
    Karunas, Alexandra S.
    Russian Acad Sci, Inst Biochem & Genet, Ufa Sci Ctr, Ufa, Russia.;Bashkir State Univ, Dept Genet & Fundamental Med, Ufa, Russia..
    Khusnutdinova, Elza
    Russian Acad Sci, Inst Biochem & Genet, Ufa Sci Ctr, Ufa, Russia.;Bashkir State Univ, Dept Genet & Fundamental Med, Ufa, Russia..
    Koppelman, Gerard H.
    Univ Groningen, Beatrix Childrens Hosp, Univ Med Ctr Groningen, Dept Pediat Pulmonol & Pediat Allergol, Groningen, Netherlands.;Groningen Res Inst Asthma & COPD GRIAC, Groningen, Netherlands..
    Kozyrskyj, Anita L.
    Univ Alberta, Dept Pediat, Edmonton, AB, Canada..
    Kreiner, Eskil
    Univ Copenhagen, Herlev & Gentofte Hosp, Copenhagen Prospect Studies Asthma Childhood, Copenhagen, Denmark..
    Kubo, Michiaki
    RIKEN Ctr Integrat Med Sci, Yokohama, Kanagawa, Japan..
    Kumar, Rajesh
    Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL 60611 USA.;Northwestern Univ, Dept Pediat, Div Allergy & Clin Immunol, Feinberg Sch Med, Chicago, IL 60611 USA..
    Kumar, Ashish
    Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland.;Univ Basel, Basel, Switzerland.;Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Kuokkanen, Mikko
    Natl Inst Hlth & Welf THL, Helsinki, Finland.;Univ Helsinki, Inst Mol Med Finland FIMM, Helsinki, Finland..
    Lahousse, Lies
    Univ Med Ctr Rotterdam, Erasmus MC, Dept Epidemiol, Rotterdam, Netherlands.;Univ Ghent, Fac Pharmaceut Sci, Pharmaceut Care Unit, Ghent, Belgium..
    Laitinen, Tarja
    Univ Turku, Dept Pulm Med, Turku, Finland.;Turku Univ Hosp, Turku, Finland..
    Laprise, Catherine
    Univ Quebec Chicoutimi, Dept Sci Fondament, Chicoutimi, PQ, Canada.;Ctr Sante & Serv Sociaux Saguenay Lac St Jean, Saguenay, PQ, Canada..
    Lathrop, Mark
    McGill Univ, Montreal, PQ, Canada.;Genome Quebec Innovat Ctr, Montreal, PQ, Canada..
    Lau, Susanne
    Charite, Pediat Pneumol & Immunol, Berlin, Germany..
    Lee, Young-Ae
    Max Delbruck Centrum MDC Mol Med, Berlin, Germany.;Charite, Pediat Allergol Expt & Clin Res Ctr, Berlin, Germany..
    Lehtimaki, Terho
    Univ Tampere, Fac Med & Life Sci, Dept Clin Chem, Fimlab Labs, Tampere, Finland..
    Letort, Sebastien
    INSERM, UMR 946, Genet Variat & Human Dis Unit, Paris, France.;Univ Paris Diderot, Univ Sorbonne Paris Cite, Inst Univ Hematol, Paris, France..
    Levin, Albert M.
    Henry Ford Hlth Syst, Dept Publ Hlth Sci, Detroit, MI USA..
    Li, Guo
    Univ Washington, Dept Med, Seattle, WA USA..
    Liang, Liming
    Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA.;Harvard TH Chan Sch Publ Hlth, Dept Biostat, Boston, MA USA..
    Loehr, Laura R.
    Univ North Carolina Chapel Hill, Div Gen Med, Chapel Hill, NC USA..
    London, Stephanie J.
    NIEHS, NIH, Dept Hlth & Human Serv, POB 12233, Res Triangle Pk, NC 27709 USA..
    Loth, Daan W.
    Univ Med Ctr Rotterdam, Erasmus MC, Dept Epidemiol, Rotterdam, Netherlands..
    Manichaikul, Ani
    Univ Virginia, Ctr Publ Hlth Gen, Charlottesville, VA USA..
    Marenholz, Ingo
    Max Delbruck Centrum MDC Mol Med, Berlin, Germany.;Charite, Pediat Allergol Expt & Clin Res Ctr, Berlin, Germany..
    Martinez, Fernando J.
    Univ Arizona, Asthma & Airway Dis Res Ctr, Tucson, AZ USA.;Univ Arizona, Inst BIO5, Tucson, AZ USA..
    Matheson, Melanie C.
    Univ Melbourne, Melbourne Sch Populat & Global Hlth, Melbourne, Vic, Australia..
    Mathias, Rasika A.
    Johns Hopkins Univ, Dept Med, Div Allergy & Clin Immunol, Baltimore, MD USA..
    Matsumoto, Kenji
    Natl Res Inst Child Hlth & Dev, Dept Allergy & Clin Immunol, Tokyo, Japan..
    Mbarek, Hamdi
    Vrjie Univ, Amsterdam Publ Hlth Res Inst, Dept Biol Psychol, Amsterdam, Netherlands..
    McArdle, Wendy L.
    Univ Bristol, Sch Social & Community Med, Bristol Bioresource Labs, Bristol, Avon, England..
    Melbye, Mads
    Statens Serum Inst, Dept Epidemiol Res, Copenhagen, Denmark.;Univ Copenhagen, Dept Clin Med, Copenhagen, Denmark.;Stanford Univ, Dept Med, Sch Med, Stanford, CA 94305 USA..
    Melen, Erik
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden.;Sachs Childrens Hosp, Stockholm, Sweden..
    Meyers, Deborah
    Wake Forest Univ, Sch Med, Ctr Gen, Winston Salem, NC 27109 USA..
    Michel, Sven
    Univ Childrens Hosp Regensburg KUNO, Dept Pediat Pneumol & Allergy, Regensburg, Germany..
    Mohamdi, Hamida
    INSERM, UMR 946, Genet Variat & Human Dis Unit, Paris, France.;Univ Paris Diderot, Univ Sorbonne Paris Cite, Inst Univ Hematol, Paris, France..
    Musk, Arthur W.
    Sir Charles Gairdner Hosp, Dept Resp Med, Nedlands, WA, Australia.;Univ Western Australia, Sch Populat Hlth, Perth, WA, Australia.;Univ Western Australia, Sch Med & Pharmacol, Perth, WA, Australia..
    Myers, Rachel A.
    Duke Univ, Sch Med, Ctr Appl Genom & Precis Med, Durham, NC USA..
    Nieuwenhuis, Maartje A. E.
    Groningen Res Inst Asthma & COPD GRIAC, Groningen, Netherlands.;Univ Groningen, Dept Pulmonol, Univ Med Ctr Groningen, Groningen, Netherlands..
    Noguchi, Emiko
    Univ Tsukuba, Fac Med, Dept Med Genet, Tsukuba, Ibaraki, Japan..
    O'Connor, George T.
    Boston Univ, Sch Med, Dept Med, Pulmonary Ctr, Boston, MA 02118 USA.;Natl Heart Lung & Blood Inst Framingham Heart Stu, Framingham, MA USA..
    Ogorodova, Ludmila M.
    Siberian State Med Univ, Dept Fac Pediat, Tomsk, Russia..
    Palmer, Cameron D.
    Broad Inst, Cambridge, MA USA.;Boston Childrens Hosp, Div Endocrinol, Boston, MA USA.;Boston Childrens Hosp, Ctr Basic & Translat Obes Res, Boston, MA USA..
    Palotie, Aarno
    Univ Helsinki, Inst Mol Med Finland FIMM, Helsinki, Finland.;Massachusetts Gen Hosp, Analyt & Translat Genet Unit, Dept Med, Boston, MA 02114 USA.;Massachusetts Gen Hosp, Analyt & Translat Genet Unit, Dept Neurol, Boston, MA 02114 USA.;Massachusetts Gen Hosp, Analyt & Translat Genet Unit, Dept Psychiat, Boston, MA 02114 USA.;Broad Inst, Stanley Ctr Psychiat Res & Program Med & Populat, Cambridge, MA USA..
    Park, Julie E.
    Univ British Columbia, Dept Med, Vancouver, BC, Canada..
    Pennell, Craig E.
    Univ Western Australia, Sch Womens & Infants Hlth, Perth, WA, Australia..
    Pershagen, Goran
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Polonikov, Alexey
    Kursk State Med Univ, Dept Biol Med Genet & Ecol, Kursk, Russia..
    Postma, Dirkje S.
    Groningen Res Inst Asthma & COPD GRIAC, Groningen, Netherlands.;Univ Groningen, Dept Pulmonol, Univ Med Ctr Groningen, Groningen, Netherlands..
    Probst-Hensch, Nicole
    Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland.;Univ Basel, Basel, Switzerland..
    Puzyrev, Valery P.
    Tomsk NRMC, Res Inst Med Genet, Populat Genet Lab, Tomsk, Russia..
    Raby, Benjamin A.
    Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA.;Harvard Med Sch, Boston, MA USA..
    Raitakari, Olli T.
    Univ Turku, Dept Clin Physiol & Nucl Med, Turku, Finland.;Turku Univ Hosp, Turku, Finland..
    Ramasamy, Adaikalavan
    Imperial Coll London, Dept Epidemiol & Biostat, London, England.;Kings Coll London, Dept Med & Mol Genet, London, England..
    Rich, Stephen S.
    Univ Virginia, Ctr Publ Hlth Gen, Charlottesville, VA USA..
    Robertson, Colin F.
    Murdoch Childrens Res Inst, Respiratory Med, Melbourne, Vic, Australia..
    Romieu, Isabelle
    Mory Univ, Hubert Dept Global Hlth, Atlanta, GA USA.;Natl Inst Publ Hlth, Ctr Populat Hlth Res, Cuernavaca, Morelos, Mexico..
    Salam, Muhammad T.
    Univ Southern Calif, Keck Sch Med, Dept Prevent Med, Los Angeles, CA USA.;Kern Med, Dept Psychiat, Bakersfield, CA USA..
    Salomaa, Veikko
    Natl Inst Hlth & Welf THL, Helsinki, Finland..
    Schlunssen, Vivi
    Aarhus Univ, Sect Environm Occupat & Hlth, Dept Publ Hlth, Aarhus, Denmark..
    Scott, Robert
    Univ Cambridge, Sch Clin Med, Inst Metab Sci, MRC Epidemiol Unit, Cambridge Biomed Campus, Cambridge, England..
    Selivanova, Polina A.
    Siberian State Med Univ, Dept Fac Therapy, Tomsk, Russia..
    Sigsgaard, Torben
    Aarhus Univ, Sect Environm Occupat & Hlth, Dept Publ Hlth, Aarhus, Denmark..
    Simpson, Angela
    Univ Manchester, Div Infect Immun & Resp Med, Sch Biol Sci, Fac Biol Med & Hlth,Manchester Acad Hlth Sci Ctr, Manchester, Lancs, England.;Natl Hlth Serv NHS Fdn Trust, Univ Hosp South Manchester, Manchester, Lancs, England..
    Siroux, Valerie
    INSERM, Inst Adv Biosci, Team Environm Epidemiol Appl Reprod & Resp Hlth, U1209, Grenoble, France.;Univ Grenoble Alpes, CNRS, UMR5309, Inst Adv Biosci,Team Environm Epidemiol Appl Repr, Grenoble, France..
    Smith, Lewis J.
    Northwestern Univ, Div Pulm & Crit Care Med, Feinberg Sch Med, Chicago, IL 60611 USA..
    Solodilova, Maria
    Kursk State Med Univ, Dept Biol Med Genet & Ecol, Kursk, Russia..
    Standl, Marie
    Helmholtz Zentrum Munchen, German Res Ctr Environm Hlth, Inst Epidemiol 1, Neuherberg, Germany..
    Stefansson, Kari
    Amgen Inc, deCODE Genet, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Strachan, David P.
    St Georges Univ London, Populat Hlth Res Inst, London, England..
    Stricker, Bruno H.
    Univ Med Ctr Rotterdam, Erasmus MC, Dept Epidemiol, Rotterdam, Netherlands.;Netherlands Healthcare Inspectorate, The Hague, Netherlands.;Univ Med Ctr Rotterdam, Erasmus MC, Dept Internal Med, Rotterdam, Netherlands..
    Takahashi, Atsushi
    RIKEN Ctr Integrat Med Sci, Yokohama, Kanagawa, Japan..
    Thompson, Philip J.
    Univ Western Australia, Inst Resp Hlth, Nedlands, WA, Australia.;Univ Western Australia, Harry Perkins Inst Med Res, Nedlands, WA, Australia.;Lung Hlth Clin, Nedlands, WA, Australia..
    Thorleifsson, Gudmar
    Amgen Inc, deCODE Genet, Reykjavik, Iceland..
    Thorsteinsdottir, Unnur
    Amgen Inc, deCODE Genet, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Tiesler, Carla M. T.
    Helmholtz Zentrum Munchen, German Res Ctr Environm Hlth, Inst Epidemiol 1, Neuherberg, Germany.;Ludwig Maximilians Univ Munchen, Dr von Hauner Childrens Hosp, Div Metab Dis & Nutrit Med, Munich, Germany..
    Torgerson, Dara G.
    Univ Calif San Francisco, Dept Med, San Francisco, CA USA..
    Tsunoda, Tatsuhiko
    RIKEN Ctr Integrat Med Sci, Yokohama, Kanagawa, Japan.;Tokyo Med & Dent Univ, Dept Med Sci Math, Med Res Inst, Tokyo, Japan..
    Uitterlinden, Andre G.
    Univ Med Ctr Rotterdam, Erasmus MC, Dept Internal Med, Rotterdam, Netherlands..
    van der Valk, Ralf J. P.
    Univ Med Ctr Rotterdam, Erasmus MC, Generat R Study Grp, Dept Pediat,Div Resp Med, Rotterdam, Netherlands.;Univ Med Ctr Rotterdam, Erasmus MC, Dept Epidemiol, Rotterdam, Netherlands..
    Vaysse, Amaury
    INSERM, UMR 946, Genet Variat & Human Dis Unit, Paris, France.;Univ Paris Diderot, Univ Sorbonne Paris Cite, Inst Univ Hematol, Paris, France..
    Vedantam, Sailaja
    Childrens Hosp, Div Genet & Endocrinol, 300 Longwood Ave, Boston, MA 02115 USA.;Broad Inst, Cambridge, MA USA..
    von Berg, Andrea
    Marien Hosp Wesel, Dept Pediat, Wesel, Germany..
    von Mutius, Erika
    Ludwig Maximilians Univ Munchen, Dr Von Hauner Childrens Hosp, Munich, Germany.;German Ctr Lung Res, Munich, Germany..
    Vonk, Judith M.
    Groningen Res Inst Asthma & COPD GRIAC, Groningen, Netherlands.;Univ Groningen, Univ Med Ctr Groningen, Dept Epidemiol, Groningen, Netherlands..
    Waage, Johannes
    Univ Copenhagen, Herlev & Gentofte Hosp, Copenhagen Prospect Studies Asthma Childhood, Copenhagen, Denmark..
    Wareham, Nick J.
    Univ Cambridge, Sch Clin Med, Inst Metab Sci, MRC Epidemiol Unit, Cambridge Biomed Campus, Cambridge, England..
    Weiss, Scott T.
    Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA.;Harvard Med Sch, Boston, MA USA..
    White, Wendy B.
    Tougaloo Coll, UTEC, Jackson Heart Study, Jackson, MI USA..
    Wickman, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Widen, Elisabeth
    Univ Helsinki, Inst Mol Med Finland FIMM, Helsinki, Finland..
    Willemsen, Gonneke
    Vrjie Univ, Amsterdam Publ Hlth Res Inst, Dept Biol Psychol, Amsterdam, Netherlands..
    Williams, L. Keoki
    Henry Ford Hlth Syst, Ctr Hlth Policy & Hlth Serv Res, Detroit, MI USA.;Henry Ford Hlth Syst, Dept Internal Med, Detroit, MI USA..
    Wouters, Inge M.
    Univ Utrecht, Inst Risk Assessment Sci, Div Environm Epidemiol, Utrecht, Netherlands..
    Yang, James J.
    Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA..
    Zhao, Jing Hua
    Univ Cambridge, Sch Clin Med, Inst Metab Sci, MRC Epidemiol Unit, Cambridge Biomed Campus, Cambridge, England..
    Moffatt, Miriam F.
    Natl Heart & Lung Inst, Sect Genom Med, London, England..
    Ober, Carole
    Univ Chicago, Dept Human Genet, Chicago, IL 60637 USA..
    Nicolae, Dan L.
    Univ Chicago, Dept Stat, Med Genet Sect, Chicago, IL 60637 USA.;Univ Chicago, Dept Human Genet, Med Genet Sect, Chicago, IL 60637 USA.;Univ Chicago, Dept Med, Med Genet Sect, Chicago, IL 60637 USA..
    Multiancestry association study identifies new asthma risk loci that colocalize with immune-cell enhancer marks2018In: Nature Genetics, ISSN 1061-4036, E-ISSN 1546-1718, Vol. 50, no 1, p. 42-+Article in journal (Refereed)
    Abstract [en]

    We examined common variation in asthma risk by conducting a meta-analysis of worldwide asthma genome-wide association studies (23,948 asthma cases, 118,538 controls) of individuals from ethnically diverse populations. We identified five new asthma loci, found two new associations at two known asthma loci, established asthma associations at two loci previously implicated in the comorbidity of asthma plus hay fever, and confirmed nine known loci. Investigation of pleiotropy showed large overlaps in genetic variants with autoimmune and inflammatory diseases. The enrichment in enhancer marks at asthma risk loci, especially in immune cells, suggested a major role of these loci in the regulation of immunologically related mechanisms.

  • 19.
    Ekström, Magnus
    et al.
    Lund Univ, Inst Clin Sci, Dept Resp Med & Allergol, Lund, Sweden..
    Sundh, Josefin
    Orebro Univ, Sch Med Sci, Dept Resp Med, Orebro, Sweden..
    Schiöler, Linus
    Univ Gothenburg, Sahlgrenska Acad, Sect Occupat & Environm Med, Gothenburg, Sweden..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Rosengren, Annika
    Univ Gothenburg, Sahlgrenska Univ Hosp, Inst Med, Wallenberg Lab,Dept Mol & Clin Med, Gothenburg, Sweden..
    Bergström, Göran
    Univ Gothenburg, Sahlgrenska Univ Hosp, Inst Med, Wallenberg Lab,Dept Mol & Clin Med, Gothenburg, Sweden..
    Angerås, Oskar
    Univ Gothenburg, Sahlgrenska Univ Hosp, Inst Med, Wallenberg Lab,Dept Mol & Clin Med, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden..
    Hedner, Jan
    Univ Gothenburg, Inst Med, Dept Internal Med, Gothenburg, Sweden..
    Brandberg, John
    Univ Gothenburg, Inst Clin Sci, Dept Radiol, Gothenburg, Sweden..
    Bake, Björn
    Univ Gothenburg, Dept Resp Med & Allergol, Gothenburg, Sweden..
    Toren, Kjell
    Univ Gothenburg, Sahlgrenska Acad, Sect Occupat & Environm Med, Gothenburg, Sweden..
    Absolute lung size and the sex difference in breathlessness in the general population2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 1, article id e0190876Article in journal (Refereed)
    Abstract [en]

    Background: Breathlessness is associated with major adverse health outcomes and is twice as common in women as men in the general population. We evaluated whether this is related to their lower absolute lung volumes.

    Methods: Cross-sectional analysis of the population-based Swedish CardioPulmonarybioImage Study (SCAPIS) Pilot, including static spirometry and diffusing capacity (n = 1,013; 49% women). Breathlessness was measured using the modified Medical Research Council (mMRC) scale and analyzed using ordinal logistic regression adjusting for age, pack-years of smoking, body mass index, chronic airway limitation, asthma, chronic bronchitis, depression and anxiety in all models.

    Results: Breathlessness was twice as common in women as in men; adjusted odds ratio (OR) 2.20 (95% confidence interval, 1.32-3.66). Lower absolute lung volumes were associated with increased breathlessness prevalence in both men and women. The sex difference in breathlessness was unchanged when adjusting for lung function in %predicted, but disappeared when controlling for absolute values of total lung capacity (OR 1.12; 0.59-2.15), inspiratory capacity (OR 1.26; 0.68-2.35), forced vital capacity (OR 0.84; 0.42-1.66), forced expiratory volume in one second (OR 0.70; 0.36-1.35) or lung diffusing capacity (OR 1.07; 0.58-1.97).

    Conclusion: In the general population, the markedly higher prevalence of breathlessness in women is related to their smaller absolute lung volumes.

  • 20.
    Emilsson, Össur Ingi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Univ Iceland, Fac Med, Reykjavik, Iceland.;Landspitali Univ Hosp, Dept Resp Med & Sleep, Reykjavik, Iceland..
    Benediktsdottir, Bryndis
    Univ Iceland, Fac Med, Reykjavik, Iceland.;Landspitali Univ Hosp, Dept Resp Med & Sleep, Reykjavik, Iceland..
    Olafsson, Isleifur
    Landspitali Univ Hosp, Dept Clin Biochem, Reykjavik, Iceland..
    Cook, Elizabeth
    Landspitali Univ Hosp, Dept Clin Biochem, Reykjavik, Iceland..
    Juliusson, Sigurdur
    Univ Iceland, Fac Med, Reykjavik, Iceland.;Landspitali Univ Hosp, Dept Ear Nose & Throat, Reykjavik, Iceland..
    Berg, Sören
    Lund Univ, Dept Otolaryngol & Head & Neck Surg, Lund, Sweden..
    Nordang, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Björnsson, Einar Stefan
    Univ Iceland, Fac Med, Reykjavik, Iceland.;Landspitali Univ Hosp, Dept Gastroenterol, Reykjavik, Iceland..
    Gudlaugsdottir, Sunna
    Landspitali Univ Hosp, Dept Gastroenterol, Reykjavik, Iceland..
    Gudmundsdottir, Anna Soffia
    Landspitali Univ Hosp, Dept Gastroenterol, Reykjavik, Iceland..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Gislason, Thorarinn
    Univ Iceland, Fac Med, Reykjavik, Iceland.;Landspitali Univ Hosp, Dept Resp Med & Sleep, Reykjavik, Iceland..
    Definition of nocturnal gastroesophageal reflux for studies on respiratory diseases2016In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, no 5, p. 524-530Article in journal (Refereed)
    Abstract [en]

    Objective Nocturnal gastroesophageal reflux (nGER) has been associated with respiratory diseases. Our aim was to study a questionnaire method to identify nGER subjects with respiratory involvement in a general population. Material and methods A subgroup of Icelandic participants in the European Community Respiratory Health Survey III (ECRHS III) reporting symptoms of nGER (n =48) as well as age and gender paired controls (n =42) were studied further by a structured interview, questionnaires, laryngeal fibrescopy, and exhaled breath condensate. A subgroup underwent 24-h oesophageal pH impedance (24-h MII-pH) measurements. Symptoms of nGER were assessed with a modified version of the reflux disease questionnaire (RDQ), where symptoms were divided into daytime and nocturnal. A report of nGER both at baseline and at follow-up was defined as persistent nGER. Results Participants reporting persistent nGER had significantly more signs of laryngopharyngeal reflux according to the reflux finding score than those without nGER (Mean +/- SD: 5.1 +/- 2.3 vs. 3.9 +/- 2.2, p =0.02). Of the 16 persistent nGER subjects that underwent 24-h MII-pH, 11 had abnormal gastroesophageal reflux, but none of three control subjects (69% vs. 0%). Pepsin was more commonly found in exhaled breath condensate in the nGER group (67% vs. 45%, p =0.04). Conclusions Participants with nGER symptoms at least once a month, reported on two occasions, had a high level of positive 24-h MII-pH measurements, laryngeal inflammation and pepsin in exhaled breath condensate. This nGER definition identified a representable group for studies on nGER and respiratory diseases in a general population.

  • 21.
    Emtner, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Wadell, Karin
    Personer med KOL behöver träna: Ökad fysisk aktivitet kan förbättra livskvalitet, dyspné, kondition och styrka och minska risken för förtida död2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, article id D6PCArticle in journal (Refereed)
    Abstract [en]

    Persons with COPD should be recommended training Persons with chronic obstructive pulmonary disease (COPD) should be recommended aerobic and resistance training to be able to improve quality of life and physical capacity, and to decrease dyspnoea, anxiety and depression (moderately strong scientific evidence - quality of evidence grade 3). Subjects with an exacerbation should be recommended training at a low intensity in direct connection with the exacerbation to improve quality of life and physical capacity (moderately strong scientific evidence - quality of evidence grade 3), and to lower the risk of mortality and hospitalization (limited scientific evidence - quality of evidence grade 2). Prescription of exercise should be based on assessment of physical capacity. Aerobic exercise can be performed as interval or continuous training. Special attention is needed regarding oxygen saturation, heart rate, blood pressure and subjective rating of dyspnea and leg fatigue.

  • 22.
    Erbas, Bircan
    et al.
    La Trobe Univ, Dept Publ Hlth, Melbourne, Vic, Australia.
    Knudsen, Toril Morkve
    Univ Bergen, Dept Clin Sci, Bergen, Norway.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Nilsen, Roy M.
    Haukeland Hosp, Ctr Clin Res, Bergen, Norway.
    Accordini, Simone
    Univ Verona, Dept Publ Hlth & Community Med, Unit Epidemiol & Med Stat, Verona, Italy.
    Benediktdottir, Bryndis
    Univ Iceland, Landspitali Univ Hosp, Fac Med, Dept Resp Med & Sleep, Reykjavik, Iceland.
    Dratva, Julia
    Swiss Trop & Publ Hlth Inst, Dept Publ Hlth & Epidemiol, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    Heinrich, Joachim
    Helmholtz Zentrum, Inst Epidemiol 1, Munich, Germany;Ludwig Maximilian Univ Munich, Univ Hosp Munich, Inst & Outpatient Clin Occupat Social & Environm, Inner City Clin, Munich, Germany.
    Jarvis, Debbie
    Imperial Coll, Natl Heart & Lung Inst, Dept Resp Epidemiol Occupat Med & Publ Hlth, London, England.
    Leynaert, Benedcite
    INSERM, UMR1152, Team Epidemiol, Paris, France.
    Matheson, Melanie C.
    Univ Melbourne, Allergy & Lung Hlth Unit, Sch Populat & Global Hlth, Ctr Epidemiol & Biostat, Melbourne, Vic, Australia.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Real, Francisco G.
    Univ Bergen, Dept Clin Sci, Bergen, Norway;Haukeland Hosp, Dept Gynecol & Obstet, Bergen, Norway.
    Raherison-Semjen, Chantal
    Bordeaux Univ, Inst Publ Hlth & Epidemiol, INSERM, U897, Bordeaux, France.
    Villani, Simona
    Univ Pavia, Dept Publ Hlth Expt & Forens Med, Unit Biostat & Clin Epidemiol, Pavia, Italy.
    Dharmage, S. C.
    Univ Melbourne, Allergy & Lung Hlth Unit, Sch Populat & Global Hlth, Ctr Epidemiol & Biostat, Melbourne, Vic, Australia.
    Svanes, C.
    Univ Bergen, Ctr Int Hlth, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Critical age windows in the impact of lifetime smoking exposure on respiratory symptoms and disease among ever smokers2018In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 164, p. 241-247Article in journal (Refereed)
    Abstract [en]

    Background: Despite extensive knowledge of smoking effects on respiratory disease, there is no study including all age windows of exposure among ever smokers. The objective of this study was to assess the effects from smoking exposure in utero, early childhood, adolescence and adulthood on respiratory health outcomes in adult male and female ever smokers. Methods: Respiratory health outcomes were assessed in 10,610 participants of the European Community Respiratory Health Survey (ECRHS) I who reported a history of ever smoking by questionnaire. The associations of maternal smoking in utero, maternal smoking during childhood, age of smoking debut and pack-years of smoking with respiratory symptoms, obstructive diseases and bronchial hyperreactivity were analysed using generalized linear regression, non-linearity between age of smoking debut and outcomes were assessed by Generalized additive mixed models. Results: Respiratory symptoms and asthma were more frequent in adults if their mother smoked during pregnancy, and, in men, also if mother smoked in childhood. Wheeze and >= 3 respiratory symptoms declined with later smoking debut among women [<= 10 years: OR = 3.51, 95% CI 1.26, 9.73; 11-12 years: 1.57[1.01-2.44]; 13-15 years: 1.11[0.94-1.32] and <= 10 years: 3.74[1.56-8.83]; 11-12 years: 1.76[1.19-2.56]; 13-15 years: 1.12[0.94-1.35], respectively]. Effects of increasing number of packyears were pronounced in women (Chronic Obstructive Pulmonary Disease (COPD): OR/10 packyears women: 1.33 [1.18, 1.50], men: 1.14 [1.04, 1.26] P-interaction = 0.01). Conclusions: Among ever smokers, smoking exposure in each stage of the lifespan show persistent harmful effects for adult respiratory health, while women appeared to be more vulnerable to an early age of smoking debut and amount of smoking in adulthood.

  • 23.
    Farkhooy, Amir
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Bodegård, Johan
    Erikssen, Jan-Erik
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Stavem, Knut
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Cross-sectional and longitudinal analyses of the association between lung function and exercise capacity in healthy Norwegian men2018In: BMC Pulmonary Medicine, ISSN 1471-2466, E-ISSN 1471-2466, Vol. 18, no 118Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    It is widely accepted that exercise capacity in healthy individuals is limited by the cardiac function, while the respiratory system is considered oversized. Although there is physiological, age-related decline in both lung function and physical capacity, the association between decline in lung function and decline in exercise capacity is little studied. Therefore, we examined the longitudinal association between lung function indices and exercise capacity, assessed by the total amount of work performed on a standardized incremental test, in a cohort of middle-aged men.

    METHODS:

    A total of 745 men between 40 and 59 years were examined using spirometry and standardized bicycle exercise ECG test within "The Oslo Ischemia Study," at two time points: once during 1972-1975, and again, approximately 16 years later, during 1989-1990. The subjects exercise capacity was assessed as physical fitness i.e. the total bicycle work (in Joules) at all workloads divided by bodyweight (in kg).

    RESULTS:

    Higher FEV1, FVC and PEF values related to higher physical fitness at both baseline and follow-up (all p values < 0.05). Higher explanatory values were found at follow-up than baseline for FEV1 (r2 = 0.16 vs. r2 = 0.03), FVC (r2 = 0.14 vs. r2 = 0.03) and PEF (r2 = 0.13 vs. r2 = 0.02). No significant correlations were found between decline in physical fitness and declines in FEV1, FVC or PEF.

    CONCLUSIONS:

    A weak association between lung function indices and exercise capacity, assessed through physical fitness, was found in middle-aged, healthy men. This association was strengthened with increasing age, suggesting a larger role for lung function in limiting exercise capacity among elderly subjects. However, decline in physical fitness over time was not related to decline in lung function.

  • 24. Ferrara, Giovanni
    et al.
    Carlson, Lisa
    Palm, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Einarsson, Jonas
    Olivesten, Cecilia
    Sköld, Magnus
    Idiopathic pulmonary fibrosis in Sweden: report from the first year of activity of the Swedish IPF-Registry.2016In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 3, article id 31090Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is an emerging problem in the western world, being related to increasing age and implying significant costs for the diagnosis and management of affected patients. The epidemiology of IPF is not well understood.

    METHODS: To allow estimates of the problem and eventually to evaluate quality of the care of IPF patients in Sweden, a national IPF Registry was started in the autumn of 2014. Data on criteria used to diagnose IPF, demographics, lung function, and quality of life (measured with the King's Brief Interstitial Lung Disease Questionnaire, K-BILD) were reported directly to the registry, based at the coordinating centre (Karolinska University Hospital, Stockholm, Sweden) via a web-based platform.

    RESULTS: During the first year, the registry was implemented in 11 (33%) of the 33 respiratory units in the country. Seventy-one patients were registered between October 2014 and October 2015, 50 (70.4%) males and 21 (29.6%) females. Median age was 70 (range 47-86). The mean K-BILD score at the first inclusion in the registry was 54.3+9.5.

    CONCLUSIONS: The main features of IPF patients in this first Swedish cohort were consistent with data published in the literature in main multinational randomized controlled trials. The K-BILD questionnaire showed that quality of life of patients with IPF and their perception of the disease are quite poor at the time of inclusion in the registry.

  • 25.
    Fuertes, Elaine
    et al.
    IS Global, Ctr Res Environm Epidemiol CREAL, Barcelona 08003, Spain.;UPF, Barcelona, Spain.;CIBERESP, Barcelona, Spain..
    Carsin, Anne-Elie
    IS Global, Ctr Res Environm Epidemiol CREAL, Barcelona 08003, Spain.;UPF, Barcelona, Spain.;CIBERESP, Barcelona, Spain..
    Anto, Josep M.
    IS Global, Ctr Res Environm Epidemiol CREAL, Barcelona 08003, Spain.;UPF, Barcelona, Spain.;CIBERESP, Barcelona, Spain..
    Bono, Roberto
    Univ Turin, Dept Publ Hlth & Pediat, Turin, Italy..
    Corsico, Angelo Guido
    IRCS Policlin San Matteo Fdn, Div Resp Dis, Pavia, Italy.;Univ Pavia, Dept Internal Med & Therapeut, Pavia, Italy..
    Demoly, Pascal
    Univ Hosp Montpellier, Hop Arnaud de Villeneuve, Dept Pneumol & Addictol, Montpellier, France.;Sorbonne Univ, UPMC, IPLESP, INSERM,UMR S 1136, Paris, France..
    Gislason, Thorarinn
    Landspitali Univ Hosp Reykjavik, Dept Resp Med & Sleep, Reykjavik, Iceland..
    Gullon, Jose-Antonio
    Hosp San Agustin, Dept Pneumol, Aviles, Asturias, Spain..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jarvis, Deborah
    Imperial Coll London, MRC PHE Ctr Environm & Hlth, London, England.;Imperial Coll London, Natl Heart & Lung Inst, Dept Populat Hlth & Occupat Dis, London, England..
    Heinrich, Joachim
    Helmholtz Zentrum Munchen German Res Ctr Environ, Inst Epidemiol 1, Neuherberg, Germany.;Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Inst & Outpatient Clin Occupat Social & Ennvironm, Munich, Germany..
    Holm, Mathias
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, Gothenburg, Sweden..
    Leynaert, Benedicte
    INSERM, UMR 1152, Pathophysiol & Epidemiol Resp Dis, Paris, France.;Univ Paris Diderot Paris, UMR 1152, Paris, France..
    Marcon, Alessandro
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Verona, Italy..
    Martinez-Moratalla, Jesus
    Hosp Univ Albacete, Serv Neumol Complejo Serv Salud Castilla La Manch, Albacete, Spain.;Univ Castilla La Mancha, Fac Med Albacete, Albacete, Spain..
    Nowak, Dennis
    Univ Hosp Munich LMU, Inst & Outpatient Clin Occupat Social & Environm, Munich, Germany.;CPC M, Munich, Germany..
    Erquicia, Silvia Pascual
    Galdakao Hosp, OSI Barrualde Galdakao, Resp Dept, Biscay, Spain..
    Probst-Hensch, Nicole M.
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland.;Univ Basel, Dept Publ Hlth, Basel, Switzerland..
    Raherison, Chantal
    Bordeaux Univ, U1219, Bordeaux, France..
    Raza, Wasif
    Umea Univ, Dept Occupat & Environm Med, Umea, Sweden..
    Real, Francisco Gomez
    Univ Bergen, Dept Clin Sci, Bergen, Norway.;Haukeland Hosp, Dept Gynecol & Obstet, Bergen, Norway..
    Russell, Melissa
    Univ Melbourne, Sch Populat & Global Hlth, Ctr Epidemiol & Biostat, Allergy & Lung Hlth Unit, Melbourne, Vic, Australia..
    Sanchez-Ramos, Jose Luis
    Univ Huelva, Dept Nursing, Huelva, Spain..
    Weyler, Joost
    Univ Antwerp, Dept Epidemiol & Social Med, Antwerp, Belgium..
    Aymerich, Judith Garcia
    IS Global, Ctr Res Environm Epidemiol CREAL, Barcelona 08003, Spain.;UPF, Barcelona, Spain.;CIBERESP, Barcelona, Spain..
    Leisure-time vigorous physical activity is associated with better lung function: the prospective ECRHS study2018In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 73, no 4, p. 376-384Article in journal (Refereed)
    Abstract [en]

    Objective

    We assessed associations between physical activity and lung function, and its decline, in the prospective population-based European Community Respiratory Health Survey cohort.

    Methods

    FEV1 and FVC were measured in 3912 participants at 27-57 years and 39-67 years (mean time between examinations= 11.1 years). Physical activity frequency and duration were assessed using questionnaires and used to identify active individuals (physical activity >= 2 times and >= 1 hour per week) at each examination. Adjusted mixed linear regression models assessed associations of regular physical activity with FEV1 and FVC.

    Results

    Physical activity frequency and duration increased over the study period. In adjusted models, active individuals at the first examination had higher FEV1 (43.6 mL (95% CI 12.0 to 75.1)) and FVC (53.9 mL (95% CI 17.8 to 89.9)) at both examinations than their non-active counterparts. These associations appeared restricted to current smokers. In the whole population, FEV1 and FVC were higher among those who changed from inactive to active during the follow-up (38.0 mL (95% CI 15.8 to 60.3) and 54.2 mL (95% CI 25.1 to 83.3), respectively) and who were consistently active, compared with those consistently non-active. No associations were found for lung function decline.

    Conclusion

    Leisure-time vigorous physical activity was associated with higher FEV1 and FVC over a 10-year period among current smokers, but not with FEV1 and FVC decline.

  • 26.
    Garcia-Larsen, Vanessa
    et al.
    Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Program Human Nutr, Baltimore, MD 21205 USA..
    Thawer, Narjis
    Imperial Coll London, Natl Heart & Lung Inst, Resp Epidemiol & Publ Hlth Grp, London SW7 1BU, England..
    Charles, David
    Imperial Coll London, Natl Heart & Lung Inst, Resp Epidemiol & Publ Hlth Grp, London SW7 1BU, England.;Queen Mary Univ London, Barts & London Sch Med, London E1 1BZ, England..
    Cassidy, Aedin
    Univ East Anglia, Norwich Med Sch, Dept Nutr, Norwich NR4 7TJ, Norfolk, England..
    van Zele, Thibaut
    Univ Ghent, Upper Airway Res Lab, B-9000 Ghent, Belgium..
    Thilsing, Trine
    Univ Southern Denmark, Dept Publ Hlth, Res Unit Gen Practice, DK-5000 Odense C, Denmark..
    Ahlström, Matti
    Helsinki Univ Hosp, Skin & Allergy Hosp, Hus Helsinki 00029, Finland..
    Haahtela, Tari
    Helsinki Univ Hosp, Skin & Allergy Hosp, Hus Helsinki 00029, Finland..
    Keil, Thomas
    Charite, Dept Pediat, D-10117 Berlin, Germany.;Charite, Inst Social Med Epidemiol & Hlth Econ, D-10117 Berlin, Germany..
    Matricardi, Paolo M.
    Wurzburg Univ, Inst Clin Epidemiol & Biometry, D-97070 Wurzburg, Germany..
    Brozek, Grzegorz
    Med Univ Silesia, Coll Med, Dept Epidemiol, PL-40752 Katowice, Poland..
    Kowalski, Marek L.
    Med Univ Lodz, Dept Immunol Rheumatol & Allergy, PL-90647 Lodz, Poland..
    Makowska, Joanna
    Med Univ Lodz, Dept Immunol Rheumatol & Allergy, PL-90647 Lodz, Poland..
    Nizankowska-Mogilnicka, Ewa
    Jagiellonian Univ, Sch Med, PL-31008 Krakow, Poland..
    Rymarczyk, Barbara
    Med Univ Silesia, Clin Dept Internal Dis Allergol & Clin Immunol, PL-40055 Katowice, Poland..
    Loureiro, Carlos
    Coimbra Univ Hosp, Dept Immunoallergol, P-3000075 Coimbra, Portugal..
    Bom, Ana Todo
    Coimbra Univ Hosp, Dept Immunoallergol, P-3000075 Coimbra, Portugal..
    Bachert, Claus
    Karolinska Inst, Div ENT Dis, S-17177 Stockholm, Sweden..
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Div Occupat & Environm Med, S-90187 Umea, Sweden..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Toren, Kjell
    Univ Gothenburg, Sect Occupat & Environm Med, S-40530 Gothenburg, Sweden..
    Potts, James F.
    Imperial Coll London, Natl Heart & Lung Inst, Resp Epidemiol & Publ Hlth Grp, London SW7 1BU, England..
    Burney, Peter G. J.
    Imperial Coll London, Natl Heart & Lung Inst, Resp Epidemiol & Publ Hlth Grp, London SW7 1BU, England..
    Dietary Intake of Flavonoids and Ventilatory Function in European Adults: A GA(2)LEN Study2018In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 10, no 1, article id 95Article in journal (Refereed)
    Abstract [en]

    Background: Flavonoids exert anti-inflammatory properties and modulate oxidative stress in vitro, suggesting a protective effect on lung function, but epidemiological studies examining this association are scarce. Methods: A stratified random sample was drawn from the GA(2)LEN screening survey, in which 55,000 adults aged 15 to 75 answered a questionnaire on respiratory symptoms. Post-bronchodilator spirometry was obtained from 2850 subjects. Forced vital capacity (FVC), the ratio between the forced exhaled volume in 1 second (FEV1) and FVC (FEV1/FVC), FVC below lower limit of normal (FVC < LLN), and FEV1/FVC < LLN were calculated. Intake of the six main subclasses of flavonoids was estimated using the GA(2)LEN Food Frequency Questionnaire. Adjusted associations between outcomes and each subclass of flavonoids were examined with multivariate regressions. Simes' procedure was used to test for multiple comparisons. Results: A total of 2599 subjects had valid lung function and dietary data. A lower prevalence of FVC < LLN (airway restriction) was observed in those with higher total flavonoid (adjusted odds ratio (aOR), higher vs. lowest quintile intake 0.58; 95% Confidence Interval (CI) 0.36, 0.94), and pro-anthocyanidin intakes (aOR 0.47; 95% CI 0.27, 0.81). A higher FEV1/FVC was associated with higher intakes of total flavonoids and pro-anthocyanidins (adjusted correlation coefficient (a -coeff 0.33; 0.10, 0.57 and a -coeff 0.44; 95% CI 0.19, 0.69, respectively). After Simes' procedure, the statistical significance of each of these associations was attenuated but remained below 0.05, with the exception of total flavonoids and airway restriction. Conclusions: This population-based study in European adults provides cross-sectional evidence of a positive association of total flavonoid intake and pro-anthocyanidins and ventilatory function, and a negative association with spirometric restriction in European adults.

  • 27.
    Giezeman, Maaike
    et al.
    Örebro Univ, Örebro, Sweden; Cty Council Värmland, Karlstad, Sweden.
    Arne, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Cty Council Värmland, Karlstad, Sweden.
    Theander, Kersti
    Cty Council Värmland, Karlstad, Sweden; Karlstad Univ, Karlstad, Sweden.
    Adherence to guidelines in patients with chronic heart failure in primary health care2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 4, p. 336-343Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe adherence to international guidelines for chronic heart failure (CHF) management concerning diagnostics, pharmacological treatment and self-care behaviour in primary health care.

    DESIGN: A cross-sectional descriptive study of patients with CHF, using data obtained from medical records and a postal questionnaire.

    SETTING: Three primary health care centres in Sweden.

    SUBJECTS: Patients with a CHF diagnosis registered in their medical record.

    MAIN OUTCOME MEASURES: Adherence to recommended diagnostic tests and pharmacological treatment by the European Society of Cardiology guidelines and self-care behaviour, using the European Heart Failure Self-care Behaviour Scale (EHFScBS-9).

    RESULTS: The 155 participating patients had a mean age of 79 (SD9) years and 89 (57%) were male. An ECG was performed in all participants, 135 (87%) had their NT-proBNP measured, and 127 (82%) had transthoracic echocardiography performed. An inhibitor of the renin angiotensin system (RAS) was prescribed in 120 (78%) patients, however only 45 (29%) in target dose. More men than women were prescribed RAS-inhibition. Beta blockers (BBs) were prescribed in 117 (76%) patients, with 28 (18%) at target dose. Mineralocorticoidreceptor antagonists were prescribed in 54 (35%) patients and daily diuretics in 96 (62%). The recommended combination of RAS-inhibitors and BBs was prescribed to 92 (59%), but only 14 (9%) at target dose. The mean score on the EHFScBS-9 was 29 (SD 6) with the lowest adherence to daily weighing and consulting behaviour.

    CONCLUSION: Adherence to guidelines has improved since prior studies but is still suboptimal particularly with regards to medication dosage. There is also room for improvement in patient education and self-care behaviour.

  • 28.
    Gonzalez Lindh, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Koyi, Hirsh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Blom Johansson, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Bendrik, Regina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Prevalence of subjective swallowing dysfunction in patients with stable COPD: Results from the TIE-study2017Conference paper (Other academic)
  • 29.
    Gonzalez Lindh, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Koyi, Hirsh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Blom Johansson, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Bröms, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Swallowing dysfunction in COPD: Is it more related to burden of disease than lung function: Results from the TIE-study2017Conference paper (Other academic)
  • 30. Guerra, Stefano
    et al.
    Carsin, Anne-Elie
    Keidel, Dirk
    Sunyer, Jordi
    Leynaert, Bénédicte
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jarvis, Debbie
    Stolz, Daiana
    Rothe, Thomas
    Pons, Marco
    Turk, Alexander
    Anto, Josep M
    Probst-Hensch, Nicole
    Health-related quality of life and risk factors associated with spirometric restriction2017In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 49, no 5, article id 1602096Article in journal (Refereed)
    Abstract [en]

    The restrictive spirometric pattern is associated with a substantial morbidity and mortality burden. We sought to determine to what extent spirometric restriction is associated with impaired quality of life.

    We used data from two large population-based European cohorts: 6698 European Community Respiratory Health Survey (ECRHS) and 6069 Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA) adult participants. The restrictive pattern was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥lower limit of normal (LLN) and FVC <LLN; an obstructive pattern was defined as FEV1/FVC <LLN independent of FVC. The Physical Component Summary and Mental Component Summary of quality of life were computed using the Short Form-36 questionnaire.

    In both cohorts, the restrictive pattern was associated with heavy smoking, being underweight or obese and the coexistence of respiratory symptoms. In univariate analyses, compared with the normal group, both the restrictive and obstructive pattern had significant Physical Component Summary deficits (−2.77 and −2.08, respectively, in ECRHS; −3.25 and −2.14, respectively, in SAPALDIA; all p-values <0.001). However, in models adjusted for sex, age, education, body mass index, smoking, comorbidities and respiratory symptoms, only the restrictive pattern remained significantly associated with Physical Component Summary deficits (p=0.004 in ECRHS; p=0.001 in SAPALDIA).

    The restrictive spirometric pattern is associated with deficits in the physical component of quality of life that are partly independent of the presence of respiratory symptoms.

  • 31.
    Hallberg, Pär
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Nagy, Julia
    Karawajczyk, Malgorzata
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Nordang, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Islander, Gunilla
    Norling, Pia
    Johansson, Hans-Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Kämpe, Mary
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Hugosson, Svante
    Yue, Qun-Ying
    Wadelius, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Comparison of Clinical Factors Between Patients With Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema and Cough2017In: The Annals of Pharmacotherapy, ISSN 1060-0280, E-ISSN 1542-6270, Vol. 51, no 4, p. 293-300Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Angioedema is a rare and serious adverse drug reaction (ADR) to angiotensin-converting enzyme (ACE) inhibitor treatment. Dry cough is a common side effect of ACE inhibitors and has been identified as a possible risk factor for angioedema.

    OBJECTIVE: We compared characteristics between patients with ACE inhibitor-induced angioedema and cough with the aim of identifying risk factors that differ between these adverse events.

    METHODS: Data on patients with angioedema or cough induced by ACE inhibitors were collected from the Swedish database of spontaneously reported ADRs or from collaborating clinicians. Wilcoxon rank sum test, Fisher's exact test, and odds ratios (ORs) with 95% CIs were used to test for between-group differences. The significance threshold was set to P <0.00128 to correct for multiple comparisons.

    RESULTS: Clinical characteristics were compared between 168 patients with angioedema and 121 with cough only. Smoking and concomitant selective calcium channel blocker treatment were more frequent among patients with angioedema than cough: OR = 4.3, 95% CI = 2.1-8.9, P = 2.2 × 10(-5), and OR = 3.7, 95% CI = 2.0-7.0, P = 1.7 × 10(-5). Angioedema cases were seen more often in male patients (OR = 2.2, 95% CI = 1.4-3.6, P = 1.3 × 10(-4)) and had longer time to onset and higher doses than those with cough ( P = 3.2 × 10(-10) and P = 2.6 × 10(-4)). A multiple model containing the variables smoking, concurrent calcium channel blocker treatment, male sex, and time to onset accounted for 26% of the variance between the groups.

    CONCLUSION: Smoking, comedication with selective calcium channel blockers, male sex, and longer treatment time were associated with ACE inhibitor-induced angioedema rather than cough.

  • 32.
    Heijkenskjöld Rentzhog, Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Berglund, L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Borres, Magnus P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Nordvall, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Overall and peripheral lung function assessment by spirometry and forced oscillation technique in relation to asthma diagnosis and control.2017In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 47, no 12, p. 1546-1554Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Classic spirometry is effort dependent and of limited value in assessing small airways. Peripheral airway involvement, and relation to poor control, in asthma, has been highlighted recently. Forced oscillation technique (FOT) offers an effort-independent assessment of overall and peripheral lung mechanics. We studied the association between lung function variables, obtained either by spirometry or multifrequency (5, 11 and 19 Hz) FOT, and asthma diagnosis and control.

    METHODS: ), resistance difference between 5-19 Hz (R5-R19) and Asthma Control Test scores were determined in 234 asthmatic and 60 healthy subjects (aged 13-39 years). We used standardized lung function variables in logistic regression analyses, unadjusted and adjusted for age, height, gender and weight.

    RESULTS: and R5-R19) were associated with uncontrolled asthma (P-values < .05).

    CONCLUSIONS: /FVC, supporting a complementary role for FOT. Asthma control was related to FOT measures of peripheral airways, suggesting a potential use in identifying such involvement. Further studies are needed to determine a clinical value and relevant reference values in children, for the multifrequency FOT measurements.

  • 33.
    Holm, Mathias
    et al.
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, Box 414, SE-40530 Gothenburg, Sweden..
    Schioler, Linus
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, Box 414, SE-40530 Gothenburg, Sweden..
    Andersson, Eva
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, Box 414, SE-40530 Gothenburg, Sweden..
    Forsberg, Bertil
    Umea Univ, Div Occupat & Environm Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Gislason, Thorarinn
    Univ Iceland, Med Fac, Reykjavik, Iceland.;Landspitali Univ Hosp, Dept Resp Med & Sleep, Reykjavik, Iceland..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jogi, Rain
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Tartu Univ Hosp, Lung Clin, Tartu, Estonia..
    Schlunssen, Vivi
    Aarhus Univ, Sect Environm Occupat & Hlth, Dept Publ Hlth, Aarhus, Denmark.;Natl Res Ctr Working Environm, Copenhagen, Denmark..
    Svanes, Cecilie
    Haukeland Hosp, Dept Occupat Med, Bergen, Norway.;Univ Bergen, Ctr Int Hlth, Bergen, Norway..
    Toren, Kjell
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, Box 414, SE-40530 Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Sect Occupat & Environm Med, Gothenburg, Sweden..
    Predictors of smoking cessation: A longitudinal study in a large cohort of smokers2017In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 132, p. 164-169Article in journal (Refereed)
    Abstract [en]

    Background: There are few studies on predictors of smoking cessation in general populations. We studied the smoking cessation rate in relation to several potential predictors, with special focus on respiratory and cardiovascular disease. Methods: Smokers (n = 4636) from seven centres in Northern Europe, born between 1945 and 1973, who answered a questionnaire in 1999-2001 (the RHINE study) were followed up with a new questionnaire in 2010-2012. Altogether 2564 answered the questionnaire and provided complete data on smoking. Cox regression analyses were performed to calculate hazard ratios (HRs). Results: A total of 999 subjects (39%) stopped smoking during the study period. The smoking cessation rate was 44.9/1000 person-years. Smoking cessation was more common with increasing age, higher education and fewer years of smoking. Asthma, wheeze, hay fever, chronic bronchitis, diabetes and hypertension did not significantly predict smoking cessation, but smokers hospitalized for ischaemic heart dis