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  • 1. Andersson, E
    et al.
    Knutsson, A
    Hagberg, S
    Nilsson, T
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Karlsson, B
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Alfredsson, L
    Torén, K
    Incidence of asthma among workers exposed to sulphur dioxide and other irritant gases.2006In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 27, no 4, p. 720-725Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to investigate whether repeated peak exposure (gassings) to sulphur dioxide (SO2) and other irritant gases increases the risk of new-onset asthma. A questionnaire was sent to 4,112 sulphite workers, of whom 1,919 completed the questionnaire and 396 completed the short-form questionnaire, which was sent out as a last reminder. A sample of 130 nonrespondents completed a telephone interview using the short-form questionnaire. The incidence of adult-onset, physician-diagnosed asthma during employment duration was analysed in relation to exposure to SO2 and gassings giving rise to respiratory symptoms. Incidence rates, as well as incidence rate ratios with 95% confidence interval (CI), were calculated. Further Cox regression models were used allowing assessment of hazard ratios (HR) stratified for sex and adjusted for atopy, smoking habits and age. The incidence rate for asthma among sulphite mill workers reporting gassings of SO2 was 6.2 out of 1,000 person-yrs, compared with 1.9 out of 1,000 person-yrs among subjects unexposed to SO2 and any gassings (HR (95% CI) 4.0 (2.1-7.7)). Among males reporting gassings to SO2, the HR (95% CI) for asthma was 5.8 (2.6-13) compared with unexposed males. In conclusion, repeated peak exposure to sulphur dioxide increased the incidence of asthma during work in sulphite pulp mills, which supports the hypothesis of irritant-induced asthma.

  • 2. Andersson, Eva
    et al.
    Murgia, Nicola
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, Sweden.
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Torén, Kjell
    Incidence of chronic bronchitis in a cohort of pulp mill workers with repeated gassings to sulphur dioxide and other irritant gases2013In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 12, article id 113Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Occupational exposure to irritants is associated with chronic bronchitis. The aim of this study was to elucidate whether repeated peak exposures with respiratory symptoms, gassings, to sulphur dioxide (SO2) and other irritant gases could increase the risk of chronic bronchitis.

    METHODS: The study population comprised 3,060 Swedish pulp mill workers (84% males) from a cohort study, who completed a comprehensive questionnaire with items on chronic bronchitis symptoms, smoking habit, occupational history, and specific exposures, including gassings. 2,037 have worked in sulphite mills. Incidence rates and hazard ratios (HRs) for the observation period, 1970-2000, in relation to exposure and the frequency of repeated gassings to SO2 and other irritant gases were calculated.

    RESULTS: The incidence rate for chronic bronchitis among workers with repeated gassings was 3.5/1,000 person-years compared with 1.5/1,000 person-years among unexposed workers (HR 2.1, 95% confidence interval (CI) 1.4-3.1). The risk was even higher in the subgroup with frequent gassings (HR 3.2, 95% CI 2.0-5.2), particularly among never-smokers (HR 8.7, 95% CI 3.5-22).

    CONCLUSIONS: Repeated gassings to irritant gases increased the incidence of chronic bronchitis in our study population during and after work in pulp mills, supporting the hypothesis that occupational exposures to irritants negatively affect the airways. These results underscore the importance of preventive actions in this work environment.

  • 3. Garde, Anne Helene
    et al.
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hansen, Åse Marie
    Persson, Roger
    Åkerstedt, Torbjörn
    Sleep and Salivary Cortisol2012In: The Role of Saliva Cortisol Measurement in Health and Disease / [ed] Margareta Kristenson, Peter Garvin, Ulf Lundberg, Bentham eBooks, 2012, p. 116-128Chapter in book (Other academic)
    Abstract [en]

    The aim of the present chapter was to analyze whether measures of cortisol in saliva were associated with measures of sleep and to explore if divergent results were related to underlying differences in theoretic assumptions and methods. Measures of sleep quality included sleep duration, overall sleep quality, difficulty falling asleep, disturbed sleep, and sleep deprivation. Twenty-three papers were found to fulfil the inclusion criteria. Cortisol measures were grouped into single time points at different times during the day, deviations at different time periods during the day, reactivity and recovery after a standardized laboratory test, area under the curve and response to dexamethasone test. A large proportion of the studies included showed nonsignificant findings, which, in several cases, may be a result of low power. The most consistent results were a positive association between sleep duration and single measures of salivary cortisol at awakening, which was observed in 3 studies. In these studies, sleep duration was also associated with low evening cortisol levels, steep diurnal deviation of cortisol and/or high area under the curve. Together these findings suggest that longer sleep duration is related to a more dynamic cortisol secretion. Two of the 6 studies on disturbed or restless sleep showed relations to flat diurnal deviation and low laboratory stress test reactivity. This to some extent corroborates the findings on sleep duration. However, the many nonsignificant findings as well as the theoretical and methodological differences (e.g., heterogeneity in measures) complicate comparisons. Conflicting results may be at least partially due to differences in methods and underlying assumptions.

  • 4. Goine, Hans
    et al.
    Knutsson, Anders
    Marklund, Staffan
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Sickness absence and early retirement at two workplaces--effects of organisational intervention in Sweden.2004In: Soc Sci Med, ISSN 0277-9536, Vol. 58, no 1, p. 99-108Article in journal (Refereed)
  • 5. Hermansson, J.
    et al.
    Hallqvist, J.
    Karlsson, B.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Knutsson, A.
    Gillander Gådin, K.
    Shift work, parental cardiovascular disease and myocardial infarction in males2018In: Occupational Medicine, ISSN 0962-7480, E-ISSN 1471-8405, Vol. 68, no 2, p. 120-125Article in journal (Refereed)
    Abstract [en]

    Background: Shift work has been associated with an increased risk of cardiovascular disease (CVD). However, there is a need for more studies to determine whether there is an interaction between shift work and other risk factors of CVD, thereby increasing the risk of CVD in shift workers. Aims: To discern whether shift work and parental mortality from myocardial infarction (MI) or sudden cardiac death (SCD) interact to increase the risk of MI in men. Methods: A case-control dataset was used to assess interaction between shift work and parental history of CVD, using death from MI or SCD, or death before age 65, on an additive scale. Results were reported as relative excess risk due to interaction, attributable proportion due to interaction (AP) and synergy index (SI). Results: There was an interaction between shift work and paternal mortality from MI or SCD, when both factors were present [SI = 2.39; 95% confidence interval (CI) 1.02. 5.6 and AP = 0.4; 95% CI 0.08. 0.73]. Conclusions: Paternal mortality from MI or SCD interacts with shift work to increase the risk of MI in men.

  • 6. Hermansson, Jonas
    et al.
    Bøggild, Henrik
    Hallqvist, Johan
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Knutsson, Anders
    Nilsson, Tohr
    Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, Sweden..
    Reuterwall, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gillander Gådin, Katja
    Interaction between Shift Work and Established Coronary Risk Factors2019In: International Journal of Occupational and Environmental Medicine, ISSN 2008-6520, E-ISSN 2008-6814, Vol. 10, no 2, p. 57-65, article id 1466Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Shift work is associated with increased risk of cardiovascular disease, but the causes have not yet been fully established. It has been proposed that the coronary risk factors are more hazardous for shift workers, resulting in a potential interaction effect with shift work.

    OBJECTIVE: To analyse interaction effects of work schedule and established risk factors for coronary artery disease on the risk of myocardial infarction.

    METHODS: This analysis was conducted in SHEEP/VHEEP, a case-control study conducted in two counties in Sweden, comprising all first-time cases of myocardial infarction among men and women 45-70 years of age with controls stratified by sex, age, and hospital catchment area, totalling to 4648 participants. Synergy index (SI) was used as the main outcome analysis method for interaction analysis.

    RESULTS: There was an interaction effect between shift work and physical inactivity on the risk of myocardial infarction with SI of 2.05 (95% CI 1.07 to 3.92) for male shift workers. For female shift workers, interaction effects were found with high waist-hip ratio (SI 4.0, 95% CI 1.12 to 14.28) and elevated triglycerides (SI 5.69, 95% CI 1.67 to 19.38).

    CONCLUSION: Shift work and some established coronary risk factors have significant interactions.

  • 7. Hermansson, Jonas
    et al.
    Gillander Gådin, Katja
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Knutsson, Anders
    Ischemic stroke and shift work.2007In: Scand J Work Environ Health, ISSN 0355-3140, Vol. 33, no 6, p. 435-9Article in journal (Refereed)
  • 8. Hermansson, Jonas
    et al.
    Gillander Gådin, Katja
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Reuterwall, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hallqvist, Johan
    Knutsson, Anders
    Case fatality of myocardial infarction among shift workers2015In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 88, no 5, p. 599-605Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Shift work has been associated with an excess risk of cardiovascular disease (CVD) and more specifically myocardial infarction (MI). The majority of the studies that found a positive association between shift work and CVD have been based on incidence data. The results from studies on cardiovascular-related mortality among shift workers have shown little or no elevated mortality associated with shift work. None of the previous studies have analysed short-term mortality (case fatality) after MI. Therefore, we investigated whether shift work is associated with increased case fatality after MI compared with day workers.

    METHODS: Data on incident cases with first MI were obtained from case-control study conducted in two geographical sites in Sweden (Stockholm Heart Epidemiology Program and Västernorrland Heart Epidemiology Program), including 1,542 cases (1,147 men and 395 women) of MI with complete working time information and 65 years or younger. Case fatality was defined as death within 28 days of onset of MI. Risk estimates were calculated using logistic regression.

    RESULTS: The crude odds ratios for case fatality among male shift workers were 1.63 [95 % confidence interval (CI) 1.12, 2.38] and 0.56 (95 % CI 0.26, 1.18) for female shift workers compared with day workers. Adjustments for established cardiovascular risk factors such as diabetes type II and socio-economic status did not alter the results.

    CONCLUSION: Shift work was associated with increased risk of case fatality among male shift workers after the first MI.

  • 9.
    Järvholm, Bengt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Mannelqvist, Ruth
    Umeå University, Faculty of Social Sciences, Department of Law.
    Work capacity in the health insurance: how the concept is described in the legislation2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 17, p. 1178-1181Article in journal (Refereed)
  • 10.
    Järvholm, Bengt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stattin, Mikael
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Robroek, Suzan JW
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Karlsson, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burdorf, Alex
    Heavy work and disability pension: a long term follow-up of Swedish construction workers2014In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 40, no 4, p. 335-342Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objective of this study was to investigate the occurrence of disability pensions over time among workers with physically demanding jobs.

    METHODS: The occurrence of disability pension was prospectively studied between 1980-2008 among 325 549 Swedish construction workers. The risks for disability pension and years lost of working life were compared among 22 occupational groups, adjusting for age, body mass index, height, and smoking habits.

    RESULTS: The risk varied considerably among blue-collar workers. For example, rock workers had double the risk of disability pension [relative risk (RR) 2.16, 95% confidence interval (95% CI) 1.96-2.39] compared to electricians. Most working years lost due to disability pensions (about 75%) were found among men >50 years, mainly due to musculoskeletal and cardiovascular diseases. The years of working life lost due to disability pension varied from 0.7 (salaried employees) to 3.2 years (rock workers) among occupational groups.

    CONCLUSION: Work environment is an important predictor for disability pension among construction workers with those in physically heavy jobs having the highest burden of disability. If the purpose is to increase labor force participation for workers with heavy jobs, strategies to reduce physical demands at work among elderly workers are important.

  • 11.
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational Medicine.
    Metabolic disturbances in shift workers2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    An increased risk for coronary heart disease among shift workers is earlier shown in the epidemiological literature. The aim of this thesis has been to penetrate metabolic disturbances and obesity among shift workers compared to day workers, and to compare if there are differences in total mortality or cause specific mortality of coronary heart disease (CHD), diabetes or ischaemic stroke in between the two groups.

    In an intervention study on female nurses (N=11), on night schedules in Umeå hospital, the highest peak value of glucose and insulin after meal ingestion was seen in the late evening (23:30). The post-prandial area under curve (AUC) of glucose and insulin was correspondingly largest after meal ingestion the same clock hour compared to meal ingestion other clock times.

    In two different cross-sectional studies Västerbotten Inventory Study (VIP) (N= 27,485) and in a subset of Work, Lipids and Fibrinogen Study (WOLF) (N= 1,324) metabolic differences in between shift and day workers has been evaluated. In both studies have obesity, high triglycerides and low HDL-cholesterol been more prevalent among the shift-working group compared to the day-working group. After adjustments for age and socio-economic factors in the VIP-study obesity and high triglycerides remained as risk factors in shift workers in both men and women. After directly age standardisation, a clustering effect, simultaneously, of two or more metabolic risk factors (obesity, hypertension, and high triglycerides) was seen in both genders among the shift workers compared to the day workers. Correspondingly, in the Wolf study low HDL-cholesterol and high triglycerides remained as significant risk factors after adjustments of confounders as age, socio-economic group, physical activity, current smoking, low social support and high job strain.

    In a cohort study from one company (MoDo) with two plants in the pulp and paper industry 2,354 male shift workers and 3,088 male day workers were followed from January 1, 1952 to December 31, 2001 regarding total and cause specific mortality due to CHD, diabetes and ischaemic stroke. Groups of workers defined by different duration of shift exposure were compared with day workers by calculating standardised relative rates (SRR). No increased risk of total mortality was seen among shift workers compared to day workers. Higher duration of shift work was associated with increased risk for CHD, and shift workers with 30 years or more had the highest risk. Diabetes was more common with increasing number of shift year exposure. Compared to day workers shift workers had also an increased risk to die because of ischaemic stroke, with the highest relative difference in the least shift exposed group (< 5 years).

  • 12.
    Karlsson, Berndt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Alfredsson, Lars
    Knutsson, Anders
    Andersson, Eva
    Torén, Kjell
    Total mortality and cause-specific mortality of Swedish shift- and dayworkers in the pulp and paper industry in 1952-2001.2005In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 31, no 1, p. 30-35Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The study investigated the relationship between shiftwork and mortality, both total mortality and cause-specific mortality from coronary heart disease (CHD), stroke, and diabetes. Methods The cohort consisted of 2354 shiftworkers and 3088 dayworkers in two pulp and paper manufacturing plants. The mortality of the cohort was monitored from 1 January 1952 to 31 December 2001 by linkage to the national Cause of Death Register. Groups of workers defined by different durations of shiftwork exposure were compared with dayworkers by calculating standardized relative rates (SRR). RESULTS: Death due to any cause (total mortality) was not higher among the shiftworkers than among the dayworkers [SRR 1.02, 95% confidence interval (95% CI) 0.93-1.11]. A longer duration of shiftwork was associated with an increased risk of CHD, and shiftworkers with >30 years of shiftwork had the highest risk of CHD (SRR 1.24, 95% CI 1.04-1.49) Diabetes was more common as the number of shift years of exposure increased [b(linear coefficient) = 4.14 x 10(-5), 95% CI 2.46 x 10(-5) -5.81 x 10(-5)]. Compared with dayworkers, shiftworkers had a greater risk of death due to stroke (SRR 1.56, 95% CI 0.98-2.51). CONCLUSIONS: In the present study, no general increase in mortality was observed among shiftworkers when they were compared with dayworkers. However, the results demonstrate an increased mortality from CHD among shiftworkers with a long duration of shiftwork exposure. Mortality due to diabetes also increased as the number of shift years and mortality due to ischemic stroke in shiftworkers increased.

  • 13.
    Karlsson, Berndt H
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational Medicine.
    Knutsson, Anders K
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational Medicine.
    Lindahl, Bernt O
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Alfredsson, Lars S
    Metabolic disturbances in male workers with rotating three-shift work: results of the WOLF study2003In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 76, no 6, p. 424-430Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of the present study was to investigate the relationship between important metabolic risk factors for coronary heart disease (CHD) and type 2 diabetes in shift workers and day workers.

    Methods: Cross-sectional data from a sub-population in the WOLF study consisting of 665 day workers and 659 three-shift workers in two plants were analysed.

    Results: A higher proportion of shift workers than day workers had high triglyceride levels (‡1.7 mmol/l), low levels of HDL-cholesterol (<0.9 mmol/l) and abdominal obesity (waist/hip ratio>0.9). The risk of low HDLcholesterol was doubled in shift workers, (odds ratio (OR): 2.02, 95% confidence interval (95% CI): 1.24– 3.28) after being adjusted for age, socio-economic factors, physical activity, current smoking, social support and job strain. High levels of triglycerides were also significantly associated with shift work (OR: 1.40, 95% CI: 1.08–1.83). The OR for abdominal obesity was 1.19, (95% CI: 0.92–1.56). The prevalence of hyperglycaemia (serum glucose ‡7.0 mmol/l) was similar in day and shift workers. No significant interaction was seen between shift work and abdominal obesity with regard to the associations with triglycerides and HDL-cholesterol.

    Conclusions: We found a significant association between shift work and lipid disturbances (i.e. low HDL-cholesterol and high triglyceride levels). We did not find any association with hyperglycaemia.

  • 14.
    Karlsson, Berndt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational Medicine.
    Knutsson, A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational Medicine.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Is there an association between shift work and having a metabolic syndrome?: results from a population based study of 27,485 people2001In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 58, no 11, p. 747-752Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES To explore how metabolic risk factors for cardiovascular disease (CVD) differ between shift workers and day workers in a defined population. Shift work has been associated with an increased risk of CVD. Risk factors and causal pathways for this association are only partly known.

    METHODS A working population of 27 485 people from the Västerbotten intervention program (VIP) has been analysed. Cross sectional data, including blood sampling and questionnaires were collected in a health survey.

    RESULTS Obesity was more prevalent among shift workers in all age strata of women, but only in two out of four age groups in men. Increased triglycerides (>1.7 mmol/l) were more common among two age groups of shift working women but not among men. Low concentrations of high density lipoprotein (HDL) cholesterol (men<0.9 and women<1.0 mmol/l) were present in the youngest age group of shift workers in both men and women. Impaired glucose tolerance was more often found among 60 year old women shift workers. Obesity and high triglycerides persisted as risk factors in shift working men and women after adjusting for age and socioeconomic factors, with an OR of 1.4 for obesity and 1.1 for high triglyceride concentrations. The relative risks for women working shifts versus days with one, two, and three metabolic variables were 1.06, 1.20, and 1.71, respectively. The corresponding relative risks for men were 0.99, 1.30, and 1.63, respectively.

    CONCLUSIONS In this study, obesity, high triglycerides, and low concentrations of HDL cholesterol seem to cluster together more often in shift workers than in day workers, which might indicate an association between shift work and the metabolic syndrome.

  • 15.
    Karlsson, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Commentary: Metabolic syndrome as a result of shift work exposure?2009In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 38, no 3, p. 854-855Article in journal (Refereed)
  • 16. Knutsson, Anders
    et al.
    Alfredsson, Lars
    Karlsson, Berndt
    Clinic of Occupational and Environmental Medicine, Norrlands University Hospital, Umeå, Sweden.
    Åkerstedt, Torbjörn
    Fransson, Eleonor I
    Westerholm, Peter
    Westerlund, Hugo
    Breast cancer among shift workers: results of the WOLF longitudinal cohort study2013In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 39, no 2, p. 170-177Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate whether shift work (with or without night work) is associated with increased risk of breast cancer.

    METHODS: The population consisted of 4036 women. Data were obtained from WOLF (Work, Lipids, and Fibrinogen), a longitudinal cohort study. Information about baseline characteristics was based on questionnaire responses and medical examination. Cancer incidence from baseline to follow-up was obtained from the national cancer registry. Two exposure groups were identified: shift work with and without night work. The group with day work only was used as the reference group in the analysis. Cox regression analysis was used to calculate relative risk.

    RESULTS: In total, 94 women developed breast cancer during follow-up. The average follow-up time was 12.4 years. The hazard ratio for breast cancer was 1.23 [95% confidence interval (95% CI) 0.70-2.17] for shifts without night work and 2.02 (95% CI 1.03-3.95) for shifts with night work. When including only women >60 years of age, the risk estimates were 1.18 (95% CI 0.67-2.07) for shifts without night work, and 2.15 (95% CI 1.10-4.21) for shifts with night work.

    CONCLUSIONS: Our results indicate an increased risk for breast cancer among women who work shifts that includes night work.

  • 17. Knutsson, Anders
    et al.
    Hammar, Niklas
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Shift workers' mortality scrutinized.2004In: Chronobiol Int, ISSN 0742-0528, Vol. 21, no 6, p. 1049-53Article in journal (Refereed)
  • 18.
    Knutsson, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational Medicine.
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational Medicine.
    Örnkloo, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational Medicine.
    Landström, U
    Lennernäs, M
    Eriksson, K
    Postprandial responses of glucose, insulin and triglycerides: influence of the timing of meal intake during night work2002In: Nutrition and health, ISSN 0260-1060, Vol. 16, no 2, p. 133-141Article in journal (Refereed)
    Abstract [en]

    The objective was to study the postprandial responses of glucose, insulin and triglycerides to meal intake at different clock times during night work. Eleven night shift working nurses participated. Identical test meals were ingested at 19:30, 23:30 and 03:30, and contained 440 kcal/1,860 kJ of energy (33 E% fat, 51 E% carbohydrate, 16 E% protein). The food intake was standardized three days before the first test meal. Blood samples were drawn just before the test meals were ingested and thereafter at 30, 60, 90, 120, 180 and 240 minutes. The postprandial responses were estimated as the total area under the curve (AUC) and significance testing was done using repeated measures ANOVA. The highest insulin level was found after meal intake at 23:30, and the lowest after meal intake 03:30. The glucose response showed the same pattern. The insulin response to food intake in night working nurses is more pronounced in the night compared with morning and evening. The results would have implications for metabolic and cardiovascular disorders in night workers.

  • 19.
    Mannelqvist, Ruth
    et al.
    Umeå University, Faculty of Social Sciences, Department of Law.
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Arbets- och miljömedicin vid Norrlands universitetssjukhus.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Arbete och arbetsmarknad i sjukförsäkringen2016Report (Refereed)
  • 20.
    Mannelqvist, Ruth
    et al.
    Umeå University, Faculty of Social Sciences, Department of Law.
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Arbetsförmåga i sjukförsäkringen - så beskrivs begreppet i lagstiftningen2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 17, p. 1178-1181Article in journal (Refereed)
  • 21.
    Mannelqvist, Ruth
    et al.
    Umeå University, Faculty of Social Sciences, Department of Law.
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Läkarintyg om bedömning av arbetsförmåga klarar inte alltid rättslig prövning.2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 49, p. 3125-3127Article in journal (Refereed)
  • 22.
    Mannelqvist, Ruth
    et al.
    Umeå University, Faculty of Social Sciences, Department of Law.
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sickness certificates as a basis for decisions regarding work capacity not always sufficient for legal trials: Difficult for the physician to understand law--and for the lawyer to understand medicine2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 49, p. 3125-3127Article in journal (Refereed)
    Abstract [sv]

    I en studie av arbetsförmågebegreppet i sjukförsäkringen har medicinska intyg som använts i förvaltningsdomstol granskats.

    Intygens kvalitet och hur de använts och tolkats i domstolarna har kartlagts. Huvudsakligen beskrevs patientens funktionsförmåga i intygen, och kvaliteten på dessa uppgifter var i allmänhet god.

    I fyra av fem intyg saknades där­emot beskrivning av arbetets krav och bedömning av sambandet mellan funktionsförmåga och arbetets krav.

    I domstolen hänvisades ofta till en samlad bedömning av den medicinska utredningen, och det framgick i mycket få fall om och hur domstolen valt att värdera olika intyg.

    Vidare saknades koppling mellan intyg av god kvalitet och domstolens bedömning; intyg av dålig kvalitet behövde inte innebära att patienten förlorade sin rätt till ersättning i domstolen och intyg av god kvalitet övertygade inte alltid domstolen.

    Detta kan bero på att läkaren inte alltid förstår de rättsliga kraven på intygen eller att juristen inte förstår den medi­cinska informationen.

  • 23.
    Sandström, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Johansson, Amanda
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wilén, Jonna
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Hansson Mild, Kjell
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Arbetare med medicinska implantat: vägledning vid återgång i arbete i miljöer som innebär exponering för elektromagnetiska fält2009Report (Other academic)
    Abstract [sv]

    Allt fler personer bär idag någon form av medicinska implantat. Det kan varaaktiva implantat som pacemakers eller passiva som exempelvis knä eller höftprotes.Återgång till arbetsliv är normalt inget problem, men i vissa yrken kandet kompliceras av den miljö som arbetaren vistas i. Exponering för elektromagnetiskafält, från statiska fält upp till och med mikrovågsområdet, kan påverkasåväl aktiva som passiva implantat. Felfunktion hos implantatet, elektrostimuleringav närliggande nerver och muskler och upphettning av närliggande vävnadär exempel på sådan oönskad påverkan.

    Det ställs idag höga krav på störtålighet hos implanterbar medicinteknisk utrustning.Trots detta finns det en rad situationer där oönskad påverkan kan ske.Individfaktorer, arbetssätt och inte minst att varje utrustning kan sägas varaunik, bidrar till svårigheten att ge generella råd.

    I den riskbedömning som arbetsgivaren är ålagd att utföra enligt arbetsmiljölagenska hänsyn tas till personer med speciella behov, exempelvis personermed olika typer av implantat.

    Vilka som är involverade i riskbedömningen och hur omfattande den bör varaberor på vilken typ av implantat och vilken typ av arbete det gäller. Väsentligtär att såväl medicinsk som teknisk kompetens bör delta i riskbedömningen. Vadgäller störtåligheten för ett specifikt implantat så är tillverkarna av implantatende som bäst kan bistå med information. Riskbedömningen bör inkludera följandemoment:

    Typ av implantat och dess känslighet för yttre påverkan samt medicinskakonsekvenser av felfunktion;Identifiera möjliga källor för påverkan på arbetsplatsen;Sammanställning och analys av insamlad data;Slutsatser och råd om hur arbetet lämpligast ska utformas och utföras;Uppföljande kontroll, speciellt viktigt vid ändrade arbetsuppgifter ellerinförande av nya moment.

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