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  • 101.
    Aronsson, Gunnar
    et al.
    University of Stockholm, Sweden.
    Theorell, Tores
    University of Stockholm, Sweden; Karolinska Institute, Sweden.
    Grape, Tom
    Health Care Centre, Sweden.
    Hammarstrom, Anne
    University of Umeå, Sweden.
    Högstedt, Christer
    Karolinska Institute, Sweden.
    Marteinsdottir, Ina
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Psykiatriska kliniken.
    Skoog, Ingmar
    University of Gothenburg, Sweden.
    Traskman-Bendz, Lil
    Lund University, Sweden.
    Hall, Charlotte
    Swedish Council Health Technology Assessment, Sweden.
    A systematic review including meta-analysis of work environment and burnout symptoms2017Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, 264Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies -original as well as reviews-restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms. Methods: A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990-2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1-5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used. Results: Most of the 25 studies focused emotional exhaustion, fewer cynicism and still fewer personal accomplishment. Moderately strong evidence (grade 3) was concluded for the association between job control and reduced emotional exhaustion and between low workplace support and increased emotional exhaustion. Limited evidence (grade 2) was found for the associations between workplace justice, demands, high work load, low reward, low supervisor support, low co-worker support, job insecurity and change in emotional exhaustion. Cynicism was associated with most of these work factors. Reduced personal accomplishment was only associated with low reward. There were few prospective studies with sufficient quality on adverse chemical, biological and physical factors and burnout. Conclusion: While high levels of job support and workplace justice were protective for emotional exhaustion, high demands, low job control, high work load, low reward and job insecurity increased the risk for developing exhaustion. Our approach with a wide range of work exposure factors analysed in relation to the separate dimensions of burnout expanded the knowledge of associations, evidence as well as research needs. The potential of organizational interventions is illustrated by the findings that burnout symptoms are strongly influenced by structural factors such as job demands, support and the possibility to exert control.

  • 102. Aronsson, Gunnar
    et al.
    Theorell, Tores
    Grape, Tom
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Hogstedt, Christer
    Marteinsdottir, Ina
    Skoog, Ingmar
    Traskman-Bendz, Lil
    Hall, Charlotte
    A systematic review including meta-analysis of work environment and burnout symptoms2017Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, 264Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies – original as well as reviews - restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms.

    Methods: A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990–2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1–5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used.

    Results: Most of the 25 studies focused emotional exhaustion, fewer cynicism and still fewer personal accomplishment. Moderately strong evidence (grade 3) was concluded for the association between job control and reduced emotional exhaustion and between low workplace support and increased emotional exhaustion. Limited evidence (grade 2) was found for the associations between workplace justice, demands, high work load, low reward, low supervisor support, low co-worker support, job insecurity and change in emotional exhaustion. Cynicism was associated with most of these work factors. Reduced personal accomplishment was only associated with low reward. There were few prospective studies with sufficient quality on adverse chemical, biological and physical factors and burnout.

    Conclusion: While high levels of job support and workplace justice were protective for emotional exhaustion, high demands, low job control, high work load, low reward and job insecurity increased the risk for developing exhaustion. Our approach with a wide range of work exposure factors analysed in relation to the separate dimensions of burnout expanded the knowledge of associations, evidence as well as research needs. The potential of organizational interventions is illustrated by the findings that burnout symptoms are strongly influenced by structural factors such as job demands, support and the possibility to exert control.

  • 103.
    Aronsson, K
    et al.
    Karolinska Institutet.
    Teär Fahnehjelm, K
    Karolinska Institutet.
    Nylén, P
    KTH, Skolan för teknik och hälsa (STH), Ergonomi.
    Eklund, Jörgen
    KTH, Skolan för teknik och hälsa (STH), Ergonomi.
    Synergonomi och ögonbesvär hos personal på ögonsjukhus.2012Konferansepaper (Annet vitenskapelig)
    Abstract [sv]

    Ögonläkare, ögonsjuksköterskor, optiker och annan personal på ögonsjukhus arbetar ofta med synkrävande arbetsuppgifter i dämpad belysning eller helt utan allmänbelysning. Inför den planerade byggnationen av ett nytt ögonsjukhus i Stockholm ca år 2018 gjordes en enkätstudie för att kartlägga ögonbesvär och trötthet hos personalen på S:t Eriks Ögonsjukhus. Studien som är ett multidisciplinärt samarbetsprojekt mellan S:t Erik, Karolinska Institutet och Kungliga Tekniska Högskolan, syftar till att optimera belysning, dagsljusinsläpp och ljusmiljö vid det nya ögonsjukhuset.

    Totalt 265 anställda på S:t Eriks Ögonsjukhus samt 60 röntgenläkare och 45 barnläkare, varav de senare två  utgjorde jämförelsegrupper, inviterades till  studien.  Enkäten som distribuerades baserades på synergonomienkäter av Knave och Hemphälä och bestod av 31 validerade frågor om subjektiva ögonbesvär, nuvarande belysning, tillgång till dagsljus och välbefinnande. Ögonbesvären räknades om till ett gruppmedelvärde (ögonbesvärsindex) med avseende på svårighetsgrad och frekvens. Studien är godkänd av Etikprövningsnämnden. 

    Nittiosex av 265 (33%) anställda på S:t Eriks Ögonsjukhus hade t o m juni 2012 besvarat enkäten tillsammans med 23 röntgenläkare (38%) och 14 barnläkare (31%). Ögonbesvär som torrhets- och gruskänsla var vanligt förekommande hos alla yrkesgrupper på ögonsjukhuset och generellt vanligare hos kvinnor. Då samtliga grupper jämfördes med avseende på ögonbesvärsindex var skillnaden mellan män och kvinnor statistiskt säkerställd (p<0,05). Röntgenläkarna rapporterade högst ögonbesvärsindex och barnläkarna lägst, skillnaden mellan dessa yrkesgrupper var signifikant (p<0,05). Ögonpersonal och röntgenläkare som rapporterade att de ofta arbetade i mörker, associerade detta med  ökad trötthet i högre grad än  med barnläkarna (p<0,05).

    Ögonbesvär var vanliga hos ögonpersonalen inkluderade i studien. Den grupp som arbetade mest i mörker hade mer ögonbesvär än den grupp som arbetade minst i mörker. Kvinnor hade mer ögonbesvär än män. Arbete i mörker ökade den subjektiva känslan av trötthet . Optimala ljusförhållanden och bra synergonomi bör ges hög prioritet vid planering av ett nytt ögonsjukhus.

  • 104.
    Aronsson, K
    et al.
    Karolinska Institutet.
    Teär Fahnhjelm, K
    Karolinska Institutet.
    Nylén, P
    KTH, Skolan för teknik och hälsa (STH), Ergonomi.
    Eklund, Jörgen
    KTH, Skolan för teknik och hälsa (STH), Ergonomi.
    Visual ergonomics and eye strain in eye careprofessionals2012Inngår i: NES2012 Proceedings: Ergonomics for sustainability and growth / [ed] Ann-Beth Antonsson, Göran M Hägg, 2012Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Eye care professionals spend many hours a day in darkness performing visually demanding tasks. A new eye hospital will be built in Stockholm 2018. The current lighting, logistics, and working conditions are analysed in a multidisciplinary project aiming to optimise settings in the new hospital. The main purpose of the present project was to study visual ergonomics and current eye strain in employees at an eye hospital. Ninety-six employees answered a validated questionnaire regarding their experiences of light, visual ergonomics and eye strain problems. Twenty-three radiologists and 14 paediatricians at a university hospital were used as comparison groups. Eye strain was common in all departments at the hospital but was significantly more common only among radiologists compared to paediatricians. Overall, women experienced significantly more eye strain than men.

  • 105. Arsalani, Narges
    et al.
    Fallahi-Khoshknab, Masoud
    Josephson, Malin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lagerstrom, Monica
    Musculoskeletal Disorders and Working Conditions Among Iranian Nursing Personnel2014Inngår i: International Journal of Occupational Safety and Ergonomics, ISSN 1080-3548, E-ISSN 2376-9130, Vol. 20, nr 4, 671-680 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study investigated the prevalence of musculoskeletal disorders (MSDs) and associations with organizational, physical and psychosocial working conditions among 520 nursing personnel in Tehran, Iran. The results of the cross-sectional study on aids and different educational levels of nurses showed that the participants experienced 88% of MSDs in at least one body region during the past 12 months. The 3 most prevalent body regions were the low back (65.3%), knee (56.2%) and neck (49.8%). The participants reported inflexible work schedule, poor quality of devices for transferring patients, overexertion and job dissatisfaction. Physical and psychosocial exposure revealed an elevated odds ratio (95% confidence interval) of MSDs. The results showed a combination of high physical and psychosocial work demands along with low control over the work which increased work-related stress and enhanced the risk of MSDs. This study findings could help to understand work-related MSDs among nursing personnel in a developing country where the work situation and sociocultural context differ from other countries.

  • 106.
    Arvidsson, Inger
    et al.
    Division of Occupational and Environmental Medicine, University Hospital, Lund, Sweden.
    Hansson, Gert-Ake
    Division of Occupational and Environmental Medicine, University Hospital, Lund, Sweden.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Skerfving, Staffan
    Division of Occupational and Environmental Medicine, University Hospital, Lund, Sweden.
    Neck postures in air traffic controllers with and without neck/shoulder disorders2008Inngår i: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 39, nr 2, 255-260 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Prolonged computer work with an extended neck is commonly believed to be associated with an increased risk of neck-shoulder disorders. The aim of this study was to compare neck postures during computer work between female cases with neck-shoulder disorders, and healthy referents. Based on physical examinations, 13 cases and 11 referents were selected among 70 female air traffic controllers with the same computer-based work tasks and identical work stations. Postures and movements were measured by inclinometers, placed on the forehead and upper back (C7/Th1) during authentic air traffic control. A recently developed method was applied to assess flexion/extension in the neck, calculated as the difference between head and upper back flexion/extension. Results: Cases and referents did not differ significantly in neck posture (median neck flexion/extension: -10° vs. -9°; p=0.9). Hence, the belief that neck extension posture is associated with neck-shoulder disorders in computer work is not supported by the present data

  • 107.
    Arvidsson, Inger
    et al.
    Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden.
    Hansson, Gert-Åke
    Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap.
    Skerfving, Staffan
    Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden.
    Changes in physical workload with implementation of mouse-based information technology in air traffic control2006Inngår i: International Journal of Industrial Ergonomics, ISSN 0169-8141, E-ISSN 1872-8219, Vol. 36, nr 7, 613-622 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Effects on physical workload were quantified when introducing new information technology in air traffic control. Seven female and seven male air traffic controllers were studied in an old control system, and during simulated - but similar - work in a new, mouse-based system. Postures, movements and muscular load were recorded (inclinometry for head, neck, back and upper arms; goniometry for wrists; electromyography for the trapezius and forearm extensor muscles). The new system was associated with lower movement velocities than the old one (examples; [50th percentiles] head flexion: 2 vs. 5 o/s, P<0.01; right arm elevation: 3 vs. 6 o/s; P<0.01; [90th percentile] wrist flexion: 19 vs. 50 o/s, P<0.01), less varying postures (head: 95th-5th percentile range 17° vs. 34o; P<0.01), and less muscular rest in the right forearm extensors (3.5 vs. 9% of time; P<0.05). The old/new system differences were amplified at high work intensities. The new air traffic control system caused a major change of physical exposures, probably associated with an increased risk of musculoskeletal disorders in arms and hands.

    Relevance to industry

    While this study concerned the specific changes in the introduction of a new air traffic control system, we believe that the findings are applicable to similar technological developments in other settings.

  • 108. Arvidsson, Inger
    et al.
    Hansson, Gert-Åke
    Mathiassen, Svend Erik
    Högskolan i Gävle, Belastningsskadecentrum.
    Skerfving, Staffan
    "Gamnacke" och nackbesvär vid datorarbete: finns det något samband?2005Inngår i: Svenska Läkaresällskapets Riksstämma, 2005Konferansepaper (Annet vitenskapelig)
  • 109. Astell-Burt, Thomas
    et al.
    Mitchell, Richard
    Hartig, Terry
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutet för bostads- och urbanforskning (IBF).
    The association between green space and mental health varies across the lifecourse. A longitudinal study2014Inngår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, nr 6, 578-583 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Epidemiological studies on green space and health have relied almost exclusively on cross-sectional designs, restricting understanding on how this relationship could vary across the lifecourse. Methods We used multilevel linear regression to analyse variation in minor psychiatric morbidity over nine annual waves of the British Household Panel Survey (1996-2004). The sample was restricted to residents of urban areas who remained within their neighbourhoods for at least 12 months. The 12-item General Health Questionnaire and confounders were reported for 29 626 male and 35 781 female observations (person-years). This individual-level dataset was linked to a measure of green space availability within each ward of residence. Regression models included age, gender, employment status, household tenure, marital status, education, smoking status and household income. Results When not considering age, green space was associated with better mental health among men, but not women. Interaction terms fitted between age and green space revealed variation in the association between green space and mental health across the lifecourse and by gender. For men, the benefit of more green space emerged in early to mid-adulthood. Among older women, a curvilinear association materialised wherein those with a moderate availability of green space had better mental health. Conclusions These findings illustrate how the relationship between urban green space and health can vary across the lifecourse, and they highlight the need for longitudinal studies to answer why green space may be better for health at some points in the lifecourse than others.

  • 110.
    Aström, Daniel Oudin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Edvinsson, Sören
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS). Ageing & Living Condit Programme, Umeå University.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Acute Fatal Effects of Short-Lasting Extreme Temperatures in Stockholm, Sweden: Evidence Across a Century of Change.2013Inngår i: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 24, nr 6, 820-829 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Climate change is projected to increase the frequency of extreme weather events. Short-term effects of extreme hot and cold weather and their effects on mortality have been thoroughly documented, as have epidemiologic and demographic changes throughout the 20th century. We investigated whether sensitivity to episodes of extreme heat and cold has changed in Stockholm, Sweden, from the beginning of the 20th century until the present.

    METHODS: We collected daily mortality and temperature data for the period 1901-2009 for present-day Stockholm County, Sweden. Heat extremes were defined as days for which the 2-day moving average of mean temperature was above the 98th percentile; cold extremes were defined as days for which the 26-day moving average was below the 2nd percentile. The relationship between extreme hot/cold temperatures and all-cause mortality, stratified by decade, sex, and age, was investigated through time series modeling, adjusting for time trends.

    RESULTS: Total daily mortality was higher during heat extremes in all decades, with a declining trend over time in the relative risk associated with heat extremes, leveling off during the last three decades. The relative risk of mortality was higher during cold extremes for the entire period, with a more dispersed pattern across decades. Unlike for heat extremes, there was no decline in the mortality with cold extremes over time.

    CONCLUSIONS: Although the relative risk of mortality during extreme temperature events appears to have fallen, such events still pose a threat to public health.

  • 111.
    August, Furaha
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Pembe, Andrea B.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Kayombo, Edmund
    Mbekenga, Columba
    Axemo, Pia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Darj, Elisabeth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Birth preparedness and complication readiness - a qualitative study among community members in rural Tanzania2015Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, 1-U12 s., 26922Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. Design: A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. Results: The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. Conclusions: This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers.

  • 112.
    Augustsson, Anna
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för biologi och miljö (BOM).
    Uddh-Söderberg, Terese
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för biologi och miljö (BOM).
    Alriksson, Stina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för biologi och miljö (BOM).
    Helmfrid, Ingela
    Berglund, Marika
    Karlsson, Helen
    Filipsson, Monika
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för biologi och miljö (BOM).
    Challenges in assessing metal exposure around contaminated sites: the example of local vegetable consumption in the Swedish glassworks district2017Inngår i: 26th SRA-E annual conference (SRA-E Lisbon 2017): Lisbon, Portugal, June 19-21, 2017, 2017Konferansepaper (Fagfellevurdert)
  • 113.
    Ax, Erika
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Lampa, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Salihovic, Samira
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    van Bavel, Bert
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Sjögren, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Lind, P Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Circulating levels of environmental contaminants are associated with dietary patterns in older adults2015Inngår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 75, 93-102 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Food intake contributes substantially to our exposure to environmental contaminants. Still, little is known about our dietary habits' contribution to exposure variability.

    OBJECTIVE: The aim of this study was to assess circulating levels of environmental contaminants in relation to predefined dietary patterns in an elderly Swedish population.

    METHODS: Dietary data and serum concentrations of environmental contaminants were obtained from 844 70-year-old Swedish subjects (50% women) in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Dietary data from 7-day food records was used to assess adherence to a Mediterranean-like diet, a low carbohydrate-high protein diet and the WHO dietary recommendations. Circulating levels of 6 polychlorinated biphenyl markers, 3 organochlorine pesticides, 1 dioxin and 1 polybrominated diphenyl ether, the metals cadmium, lead, mercury and aluminum and serum levels of bisphenol A and 4 phthalate metabolites were investigated in relation to dietary patterns in multivariate linear regression models.

    RESULTS: A Mediterranean-like diet was positively associated with levels of several polychlorinated biphenyls (118, 126, 153, and 209), trans-nonachlor and mercury. A low carbohydrate-high protein diet was positively associated with polychlorinated biphenyls 118 and 153, trans-nonachlor, hexachlorobenzene and p, p'-dichlorodiphenyldichloroethylene, mercury and lead. The WHO recommended diet was negatively related to levels of dioxin and lead, and borderline positively to polychlorinated biphenyl 118 and trans-nonachlor.

    CONCLUSION: Dietary patterns were associated in diverse manners with circulating levels of environmental contaminants in this elderly Swedish population. Following the WHO dietary recommendations seems to be associated with a lower burden of environmental contaminants.

  • 114. Axelsson, Malin
    et al.
    Ekerljung, Linda
    Eriksson, Jonas
    Hagstad, Stig
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Research and Development, Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå.
    Lötvall, Jan
    Lundbäck, Bo
    Chronic bronchitis in West Sweden - a matter of smoking and social class2016Inngår i: European clinical respiratory journal, ISSN 2001-8525, Vol. 3, 30319Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Although chronic bronchitis is associated with impaired quality of life, hospitalisations and increased mortality, it has been less in focus after the introduction of the term chronic obstructive pulmonary disease (COPD). There are no recent published data on the prevalence of chronic bronchitis from the Scandinavian countries.

    AIM: The main aim of the present study was to estimate the prevalence of chronic bronchitis in West Sweden by using data from a large-scale epidemiological study of the general population. A further aim was to identify current risk factors for chronic bronchitis in a population with a major decrease in the proportion of smokers.

    METHODS: From the 18,087 questionnaire responders out of 30,000 invited to participate at the West Sweden Asthma Study, 2,000 subjects were randomly selected and invited to detailed clinical examinations performed during 2009-2013. A total of 1,172 subjects aged 17-79 participated in the examinations which included, among others, spirometry and structured interviews. Chronic bronchitis was defined according to reported symptoms.

    RESULTS: The overall prevalence of chronic bronchitis was 7.2% (men 7.6%; women 6.8% ns), and it was 8.7% in subjects older than age 60. Chronic bronchitis was strongly associated with smoking, defined both as current smoking status and pack-years. Other risk factors were increasing age, low socio-economic class and urban living. Of those with chronic bronchitis, 22% fulfilled the GOLD criteria of COPD.

    CONCLUSION: The prevalence of chronic bronchitis was somewhat lower than found by studies in Sweden in the 1980s and the prevalence was now similar in men and women. Although smoking was still the dominating risk factor for chronic bronchitis, the relative importance of smoking had decreased parallel with a decreasing smoking prevalence, while the relative importance of other factors than smoking had increased compared to previous studies.

  • 115. Axelsson, Malin
    et al.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Kainu, Annette
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Jansson, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Respiratory symptoms increase health care consumption and affect everyday life: a cross-sectional population-based study from Finland, Estonia, and Sweden2016Inngår i: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 3, 31024Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Even though respiratory symptoms are common in the adult population, there is limited research describing their impact on everyday life and association with health care consumption.

    AIM: The main objective of this population-based study was to estimate and compare the prevalence of respiratory symptoms among adults in Finland, Estonia, and Sweden in relation to health care consumption and to identify factors influencing health care consumption. A secondary aim was to assess to which extent the presence of respiratory symptoms affect everyday life.

    METHOD: In the population-based FinEsS studies consisting of random samples of subjects aged 20 to 69 years from Finland (n=1,337), Estonia (n=1,346), and Sweden (n=1,953), data on demographics, respiratory health, and health care consumption were collected by structured interviews. Prevalence was compared and multiple logistic regression analyses were performed.

    RESULTS: Respiratory symptoms were significantly more common in Finland (66.0%) and Estonia (65.2%) than in Sweden (54.1%). Among subjects with respiratory symptoms, the proportion reporting outpatient care during the past year was fairly similar in the three countries, while specialist consultations were more common in Finland (19.1%), and hospitalisations more common in Estonia (15.0%). Finnish and Estonian residency, female sex, and BMI>25 increased the risk for outpatient care consumption. Wheeze and attacks of shortness of breath in the past 12 months, recurrent sputum production, and cough were associated with an increased risk for health care consumption. Increasing number of respiratory symptoms increased the risk for consuming health care. A larger proportion of subjects in Estonia and Sweden experienced their everyday life being affected by respiratory symptoms compared with subjects in Finland.

    CONCLUSION: Respiratory symptoms are common in Finland, Estonia, and Sweden and contribute to a negative impact on everyday life as well as increased health care consumption. The observed differences in health care consumption between countries are probably related to national differences in health care structure.

  • 116. Ayres, JG
    et al.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Annesi-Maesano, I
    Dey, R
    Ebi, KL
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Helms, PJ
    Medina-Ramón, M
    Windt, M
    Forastiere, F
    Climate change and respiratory disease: European Respiratory Society position statement2009Inngår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 34, nr 2, 295-302 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Climate change will affect individuals with pre-existing respiratory disease, but the extent of the effect remains unclear. The present position statement was developed on behalf of the European Respiratory Society in order to identify areas of concern arising from climate change for individuals with respiratory disease, healthcare workers in the respiratory sector and policy makers. The statement was developed following a 2-day workshop held in Leuven (Belgium) in March 2008. Key areas of concern for the respiratory community arising from climate change are discussed and recommendations made to address gaps in knowledge. The most important recommendation was the development of more accurate predictive models for predicting the impact of climate change on respiratory health. Respiratory healthcare workers also have an advocatory role in persuading governments and the European Union to maintain awareness and appropriate actions with respect to climate change, and these areas are also discussed in the position statement.

  • 117.
    Back, A.
    et al.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    von Thiele Schwarz, U.
    Karolinska Institute, Sweden.
    Richter, A.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Hasson, H.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Walking the tightrope-perspectives on local politicians role in implementing a national social care policy on evidence-based practice2016Inngår i: INTERNATIONAL JOURNAL OF MENTAL HEALTH SYSTEMS, ISSN 1752-4458, Vol. 10, 75Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Despite national policy recommending evidence-based practice (EBP), its application in social care has been limited. While local politicians can affect the process, little is known about their knowledge, attitudes and roles regarding EBP. The aim here is twofold: to explore the role of local politicians in the implementation of EBP in social care from both their own and a management perspective; and to examine factors politicians perceive as affecting their decisions and actions concerning the implementation of EBP policy. Methods: Local politicians (N = 13) and managers (N = 22) in social care were interviewed. Qualitative thematic analysis with both inductive and deductive codes was used. Results: Politicians were rather uninformed regarding EBP and national policy. The factors limiting their actions were, beside the lack of awareness, lack of ability to question existing working methods, and a need for support in the steering of EBP. Thus, personal interest played a significant part in what role the politicians assumed. This resulted in some politicians taking a more active role in steering EBP while others were not involved. From the managers perspective, a more active steering by politicians was desired. Setting budget and objectives, as well as active follow-up of work processes and outcomes, were identified as means to affect the implementation of EBP. However, the politicians seemed unaware of the facilitating effects of these actions. Conclusions: Local politicians had a possibility to facilitate the implementation of EBP, but their role was unclear. Personal interest played a big part in determining what role was taken. The results imply that social care politicians might need support in the development of their steering of EBP. Moving the responsibility for EBP facilitation upwards in the political structure could be an important step in developing EBP in social care.

  • 118.
    Backman, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lung function and prevalence trends in asthma and COPD: the Obstructive Lung Disease in Northern Sweden Thesis XVI2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background

    Asthma and chronic obstructive pulmonary disease (COPD) are common obstructive airway diseases with a substantial burden in terms of morbidity, mortality and costs. Smoking is the single most important risk factor for COPD, and is associated with incident asthma. It is important to know if the prevalence of asthma and COPD is increasing or decreasing in the population in order to effectively allocate health care resources. The definitions of these diseases have varied over time which makes it difficult to measure changes in prevalence. The preferred method is to estimate the prevalence with the same procedures and definitions based on cross-sectional population samples with identical age distributions in the same geographical area at different time points. Measurements of lung function (spirometry) are required to diagnose COPD, and spirometry is used to evaluate disease severity and progress of both asthma and COPD, where observed values are compared to reference values. The most commonly used reference values in Sweden are published during the mid 1980s, and there are few evaluations of how appropriate they are today based on Swedish population samples. The aim of the thesis was to estimate trends in the prevalence of asthma and COPD in relation to smoking habits, and to evaluate and estimate reference values for spirometry.

    Methods

    The project was based on population-based samples of adults from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. Postal questionnaires were sent to large cohorts, recruited in 1992 (n=4851, 20-69 years), 1996 (n=7420, 20-74 years) and 2006 (n=6165, 20-69 years), respectively. The questionnaire included questions on respiratory symptoms and diseases, their comorbidities and several possible risk factors including smoking habits. Structured interviews and spirometry were performed in random samples of the responders to the 1992 and 2006 surveys, of which n=660 (in 1994) and n=623 (in 2009) were within identical age-spans (23-72 years). The trend in asthma prevalence was estimated by comparing the postal questionnaire surveys in 1996 and 2006, and the trend in COPD prevalence was estimated by comparing the samples participating in dynamic spirometry in 1994 and 2009, respectively. The prevalence of COPD was estimated based on two different definitions of COPD. Commonly used reference values for spirometry were evaluated based on randomly sampled healthy non-smokers defined in clinical examinations of participants in the 2006 postal questionnaire (n=501). The main focus of the evaluation was the global lung function initiative (GLI) reference values published in 2012, for which Z-scores and percent of predicted values were analysed. New sex-specific reference values for spirometry were estimated by linear regression, with age and height as predictors. These new OLIN reference values were also evaluated on a sample of healthy non-smokers identified in the population-based West Sweden Asthma Study.

    Results

    Although the prevalence of smoking decreased from 27.4% to 19.1%, p<0.001, between 1996 and 2006, the prevalence of physician-diagnosed asthma increased from 9.4% to 11.6%, p<0.001. The prevalence of symptoms common in asthma such as recurrent wheeze did not change significantly between the surveys or tended to decrease, while bronchitis symptoms such as cough and sputum production decreased significantly. The evaluation of the GLI reference values showed that the predicted values were significantly lower compared to the observed values in Norrbotten, which makes the percent of predicted too high. This was especially true for FVC percent predicted with a mean of 106%. In general, the deviations were more pronounced among women. New OLIN reference values valid for the Norrbotten sample were modelled and showed a high external validity when applied on the sample from western Sweden. The prevalence of moderate to severe COPD decreased substantially over the 15-year period between 1994 and 2009, regardless of definition.

    Conclusions

    In parallel with substantially decreased smoking habits in the population between 1996 and 2006, the prevalence of several airway symptoms decreased while the prevalence of physician-diagnosed asthma increased. These results suggest increased diagnostic activity for asthma, but may also suggest that the asthma prevalence has continued to increase. In contrast to asthma, the prevalence of COPD tended to decrease and moderate to severe COPD decreased substantially. The continuous decrease in smoking in Sweden during several decades prior to the study period is most likely contributing to these results. The evaluation of reference values showed that the GLI reference values were lower than the observed spirometric values in the population, especially for women, why the new up-to date reference values may be of importance for disease evaluation in epidemiology and in the health care as well.

  • 119.
    Backman, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Eriksson, Berne
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden.
    Stridsman, Caroline
    Jansson, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Sovijärvi, Anssi
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundbäck, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Restrictive spirometric pattern in the general adult population: methods of defining the condition and consequences on prevalence2016Inngår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 120, 116-123 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Attempts have been made to use dynamic spirometry to define restrictive lung function, but the definition of a restrictive spirometric pattern (RSP) varies between studies such as BOLD and NHANES. The aim of this study was to estimate the prevalence and risk factors of RSP among adults in northern Sweden based on different definitions.

    METHODS: In 2008-2009 a general population sample aged 21-86y within the obstructive lung disease in northern Sweden (OLIN) studies was examined by structured interview and spirometry, and 726 subjects participated (71% of invited). The prevalence of RSP was calculated according to three different definitions based on pre-as well as post-bronchodilator spirometry: 1) FVC < 80% & FEV1/FVC > 0.7 2) FVC < 80% & FEV1/FVC > LLN 3) FVC < LLN & FEV1/FVC > LLN RESULTS: The three definitions yielded RSP prevalence estimates of 10.5%, 11.2% and 9.4% respectively, when based on pre-bronchodilator values. The prevalence was lower when based on post-bronchodilator values, i.e. 7.3%, 7.9% and 6.6%. According to definition 1 and 2, the RSP prevalence increased by age, but not according to definition 3. The overlap between the definitions was substantial. When corrected for confounding factors, manual work in industry and diabetes with obesity were independently associated with an increased risk for RSP regardless of definition.

    CONCLUSIONS: The prevalence of RSP was 7-11%. The prevalence estimates differed more depending on the choice of pre- compared to post-bronchodilator values than on the choice of RSP definition. RSP was, regardless of definition, independently associated with manual work in industry and diabetes with obesity.

  • 120.
    Backman, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Eriksson, Berne
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stridsman, Caroline
    Jansson, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindberg, Anne
    Lundbäck, Bo
    Decreased prevalence of moderate to severe COPD over 15 years in northern Sweden2016Inngår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 114, 103-110 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The burden of COPD in terms of mortality, morbidity, costs and prevalence has increased worldwide. Recent results on prevalence in Western Europe are conflicting. In Sweden smoking prevalence has steadily decreased over the past 30 years.

    AIM: The aim was to study changes in prevalence and risk factor patterns of COPD in the same area and within the same age-span 15 years apart.

    MATERIAL AND METHODS: Two population-based cross-sectional samples in ages 23-72 years participating at examinations in 1994 and 2009, respectively, were compared in terms of COPD prevalence, severity and risk factor patterns. Two different definitions of COPD were used; FEV1/FVC < LLN and FEV1/FVC < 0.7. The severity of COPD was assessed by FEV1, both as % of predicted and in relation to the LLN.

    RESULTS: The prevalence of COPD decreased significantly from 9.5% to 6.3% (p = 0.030) according to the FEV1/FVC < LLN criterion, while the decrease based on the FEV1/FVC < 0.7 criterion from 10.5% to 8.5% was non-significant. The prevalence of moderate to severe COPD decreased substantially and significantly, and the risk factor pattern was altered in 2009 when, beside age and smoking, also socio-economic status based on occupation was significantly associated with COPD.

    CONCLUSIONS: Changes in both prevalence and risk factor patterns of COPD were observed between surveys. Following a continuing decrease in smoking habits over several decades, a decrease in the prevalence of moderate to severe COPD was observed from 1994 to 2009 in northern Sweden.

  • 121.
    Backman, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Eriksson, Berne
    Halmstad, Sweden.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stridsman, Caroline
    Luleå, Sweden.
    Jansson, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lundbäck, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Decreased prevalence of moderate to severe COPD over 15 years in northern SwedenManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background: The burden of COPD in terms of mortality, morbidity, costs and prevalence has increased worldwide. Recent results on prevalence in Western Europe are conflicting. In Sweden smoking prevalence has steadily decreased over the past 30 years. 

    Aim: The aim was to study changes in prevalence and risk factor patterns of COPD in the same area and within the same age-span 15 years apart.

    Material and methods: Two population-based cross-sectional samples in ages 23-72 years participating at examinations in 1994 and 2009, respectively, were compared in terms of COPD prevalence, severity and risk factor patterns. Two different definitions of COPD were used; FEV1/FVC<LLN and FEV1/FVC<0.7. The severity of COPD was assessed by FEV1, both as % of predicted and in relation to the LLN.

    Results: The prevalence of COPD decreased significantly from 9.5% to 6.3% (p=0.030) according to the FEV1/FVC<LLN criterion, while the decrease based on the FEV1/FVC<0.7 criterion from 10.5% to 8.5% was non-significant. The prevalence of moderate to severe COPD decreased substantially and significantly, and the risk factor pattern was altered in 2009 when, beside age and smoking, also socio-economic status based on occupation was significantly associated with COPD. 

    Conclusions: Changes in both prevalence and risk factor patterns of COPD were observed between surveys. Following a continuing decrease in smoking habits over several decades, a decrease in the prevalence of moderate to severe COPD was observed from 1994 to 2009 in northern Sweden.

  • 122.
    Backman, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Oden, Anders
    Ekerljung, Linda
    Hedman, Linnéa
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Kainu, Annette
    Sovijärvi, Anssi
    Lundbäck, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Reference values for spirometry - report from the Obstructive Lung Disease in Northern Sweden studies2015Inngår i: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 2, 26375Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Abnormal lung function is commonly identified by comparing observed spirometric values to corresponding reference values. It is recommended that such reference values for spirometry are evaluated and updated frequently. The aim of this study was to estimate new reference values for Swedish adults by fitting a multivariable regression model to a healthy non-smoking general population sample from northern Sweden. Further aims were to evaluate the external validity of the obtained reference values on a contemporary sample from south-western Sweden, and to compare them to the Global Lung Function Initiative (GLI) reference values.

    Method: Sex-specific multivariable linear regression models were fitted to the spirometric data of n=501 healthy non-smoking adults aged 22–91 years, with age and height as predictors. The models were extended to allow the scatter around the outcome variable to depend on age, and age-dependent spline functions were incorporated into the models to provide a smooth fit over the entire age range. Mean values and lower limits of normal, defined as the lower 5th percentiles, were derived.

    Result: This modelling approach resulted in unbiased estimates of the spirometric outcomes, and the obtained estimates were appropriate not only for the northern Sweden sample but also for the south-western Sweden sample. On average, the GLI reference values for forced expiratory volume in one second (FEV1) and, in particular, forced expiratory vital capacity (FVC) were lower than both the observed values and the new reference values, but higher for the FEV1/FVC ratio.

    Conclusion: The evaluation based on the sample of healthy non-smokers from northern Sweden show that the Obstructive Lung Disease in Northern Sweden reference values are valid. Furthermore, the evaluation based on the south-western Sweden sample indicates a high external validity. The comparison with GLI brought further evidence to the consensus that, when available, appropriate local population-specific reference values may be preferred.

  • 123.
    Backman, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Räisänen, Petri
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Health Sciences, Luleå University, Luleå, Sweden.
    Stridsman, Caroline
    Department of Health Sciences, Luleå University, Luleå, Sweden.
    Andersson, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Increased prevalence of allergic asthma from 1996 to 2006 and further to 2016: results from three population surveys2017Inngår i: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 47, nr 11, 1426-1435 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: During the latter half of the 20th century, the prevalence of asthma and many other allergic diseases has increased. Information on asthma prevalence trends among adults after 2010, especially regarding studies separating allergic asthma from non-allergic asthma, is lacking.

    Objective: The aim was to estimate prevalence trends of current asthma among adults, both allergic and non-allergic, from 1996 to 2016.

    Methods: Three cross-sectional samples from the same area of Sweden, 20-69 years, participated in surveys with the same questionnaire in 1996 (n=7104 participants, 85% response rate), 2006 (n=6165, 77%) and 2016 (n=5466, 53%), respectively. Allergic rhino-conjunctivitis (ARC) was used as a marker for allergic sensitization to define allergic asthma.

    Results: The prevalence of current asthma increased from 8.4% (95% CI: 7.8-9.0) in 1996 to 9.9% (95% CI: 9.2-10.6) in 2006 and 10.9% (95% CI: 10.1-11.7) in 2016 (P<.001). Allergic asthma increased from 5.0% (95% CI: 4.5-5.5) in 1996 to 6.0% (95% CI: 5.4-6.6) in 2006 and further to 7.3% (95% CI: 6.6-8.0) in 2016 (P<.001), while the prevalence of non-allergic asthma remained stable around 3.4%-3.8%. The increase in current asthma was most pronounced among women and among the middle-aged. Physician-diagnosed asthma, asthma medication use and ARC also increased significantly, while the prevalence of symptoms common in asthma such as wheeze and attacks of shortness of breath decreased slightly or was stable. The prevalence of current smoking decreased from 27.4% in 1996 to 12.3% in 2016.

    Conclusions and clinical relevance: The prevalence of allergic asthma increased from 1996 to 2006 and further to 2016, while the prevalence of non-allergic asthma remained on a stable prevalence level. The prevalence of symptoms common in asthma decreased slightly or was stable despite a substantial decrease in the prevalence of current smoking. Clinicians should be aware that the previously observed increase in prevalence of allergic asthma is still ongoing.

  • 124.
    Backman, Thomas
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Söderholm, Richard
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Interaktivt idrottande?: En studie av energiutgiften vid användandet av dansmatta kontra ett traditionellt danspass2011Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Sammanfattning

    Syfte och frågeställningar: Syftet var att undersöka energiutgifterna vid användandet av en dansmatta respektive ett traditionellt danspass.

    Våra frågeställningar var: Hur skiljer sig energiutgiften för ett traditionellt danspass mot ett pass med dansmatta? Samt: hur förhåller sig energiutgiften i de olika aktiviteterna till de dagliga rekommendationer för fysisk aktivitet?

    Metod: Försöksgruppen som genomförde studien bestod av fyra män och fyra kvinnor i åldrarna 23-26 år. Försökspersonerna har sedan tidigare blandad vana av fysisk aktivitet. Metoden utarbetades utifrån sambandet mellan hjärtfrekvens (HF) och arbetsbelastning (w). Försökspersonerna fick genomgå tre olika typer av tester. I det första testet fick de på ergonometercykel cykla på olika belastningar och utifrån deras HF vid olika arbetsbelastningar bestämdes ett linjärt samband. Det andra testet bestod av ett danspass på dansmatta till given musik. Under detta pass registrerades deras genomsnittliga HF. I det tredje testet fick försökspersonerna dansa utifrån en förutbestämd koreografi under samma musik som vid dansmattan. Även här registrerades genomsnittlig HF. Värdena från de två sista testerna användes i det linjära sambandet och gav sedan värden för genomsnittlig arbetsbelastning under aktiviteterna. Från arbetsbelastningen kunde sedan syreupptag (l/min), och energiutgift (kcal) räknas ut. 

    Resultat: Resultaten för studien visade att danspasset (7,4kcal/min) hade en 40 % högre energiutgift än ett pass med dansmatta(4,6kcal/min). Danspasset nådde således upp till, och översteg de dagliga rekommendationerna för fysisk aktivitet medan passet med dansmatta inte gjorde det.

    Slutsats: Dansmatta kan rent energimässigt fungera som substitut till ett danspass, men att valet av teknik är av avgörande betydelse för vilken energiutgift aktiviteterna har, trots det kan det fungera som pedagogiskt hjälpmedel.

     

  • 125.
    Backteman-Erlanson, Susann
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Padyab, Mojgan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Brulin, Christine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Prevalence of burnout and associations with psychosocial work environment, physical strain, and stress of conscience among Swedish female and male police personnel2012Inngår i: Police Practice & Research, ISSN 1561-4263, E-ISSN 1477-271XArtikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Focus of this study was to investigate prevalence of burnout and relation to psychosocial work environment, physical strain, and stress of conscience amongst female and male police personnel in Sweden. The questionnaire was answered by 856 (55%) patrolling police officers, 437 (56%) women vs. 419 (53%) men. Prevalence and mean values for emotional exhaustion (EE) and depersonalization (DP) was higher in our study compared to other studies including police personnel in Norway and the Netherlands. A multiple logistic regressions showed that for women stress of conscience, high demand, and organizational climate was significant associated with EE, for men it was stress of conscience, decision, and high demand. For DP only stress of conscience contributed statistically significant in our model, respectively, of gender. Further research is needed to develop interventions aiming to reduce levels of burnout among police personnel in Sweden.

  • 126. Baker, Ulrika
    et al.
    Peterson, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Marchant, Tanya
    Mbaruku, Godfrey
    Temu, Silas
    Manzi, Fatuma
    Hanson, Claudia
    Identifying implementation bottlenecks for maternal and newborn health interventions in rural districts of the United Republic of Tanzania2015Inngår i: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 93, nr 6, 380-389 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective To estimate effective coverage of maternal and newborn health interventions and to identify bottlenecks in their implementation in rural districts of the United Republic of Tanzania. Methods Cross-sectional data from households and health facilities in Tandahimba and Newala districts were used in the analysis. We adapted Tanahashi's model to estimate intervention coverage in conditional stages and to identify implementation bottlenecks in access, health facility readiness and clinical practice. The interventions studied were syphilis and pre-eclampsia screening, partograph use, active management of the third stage of labour and postpartum care. Findings Effective coverage was low in both districts, ranging from only 3% for postpartum care in Tandahimba to 49% for active management of the third stage of labour in Newala. In Tandahimba, health facility readiness was the largest bottleneck for most interventions, whereas in Newala, it was access. Clinical practice was another large bottleneck for syphilis screening in both districts. Conclusion The poor effective coverage of maternal and newborn health interventions in rural districts of the United Republic of Tanzania reinforces the need to prioritize health service quality. Access to high-quality local data by decision-makers would assist planning and prioritization. The approach of estimating effective coverage and identifying bottlenecks described here could facilitate progress towards universal health coverage for any area of care and in any context.

  • 127.
    Bakker, Roel H.
    et al.
    Department of Applied Research in Care, University Medical Center Groningen, University of Groningen, The Netherlands.
    Pedersen, Eja
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS).
    van den Berg, Godefridus Petrus
    GGD Amsterdam Public Health Service, Amsterdam, The Netherlands.
    Stewart, R.E.
    Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, The Netherlands.
    Lok, W.
    Department of Applied Research in Care, University Medical Center Groningen, University of Groningen, The Netherlands.
    Bouma, J.
    Department of Health Care, Science shop, University Medical Center Groningen, University of Groningen, The Netherlands.
    Impact of wind turbine sound on annoyance, self-reported sleep disturbance and psychological distress2012Inngår i: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 425, 42-51 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose of the research: The present government in the Netherlands intends to realize a substantial growth ofwind energy before 2020, both onshore and offshore. Wind turbines, when positioned in the neighborhood ofresidents may cause visual annoyance and noise annoyance. Studies on other environmental sound sources,such as railway, road traffic, industry and aircraft noise show that (long-term) exposure to sound can havenegative effects other than annoyance from noise. This study aims to elucidate the relation between exposureto the sound of wind turbines and annoyance, self-reported sleep disturbance and psychological distress ofpeople that live in their vicinity. Data were gathered by questionnaire that was sent by mail to a representativesample of residents of the Netherlands living in the vicinity of wind turbinesPrincipal results: A dose–response relationship was found between immission levels of wind turbine soundand selfreported noise annoyance. Sound exposure was also related to sleep disturbance and psychologicaldistress among those who reported that they could hear the sound, however not directly but with noiseannoyance acting as a mediator. Respondents living in areas with other background sounds were less affectedthan respondents in quiet areas.Major conclusions: People living in the vicinity of wind turbines are at risk of being annoyed by the noise, anadverse effect in itself. Noise annoyance in turn could lead to sleep disturbance and psychological distress. Nodirect effects of wind turbine noise on sleep disturbance or psychological stress has been demonstrated,which means that residents, who do not hear the sound, or do not feel disturbed, are not adversely affected.

  • 128. Bakolis, I
    et al.
    Heinrich, J
    Zock, J P
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Svanes, C
    Chen, C M
    Accordini, S
    Verlato, G
    Olivieri, M
    Jarvis, D
    House dust-mite allergen exposure is associated with serum specific IgE but not with respiratory outcomes2015Inngår i: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 25, nr 3, 235-244 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Exposure to house dust has been associated with asthma in adults, and this is commonly interpreted as a direct immunologic response to dust-mite allergens in those who are IgE sensitized to house dust-mite. Mattress house dust-mite concentrations were measured in a population-based sample of 2890 adults aged between 27 and 56 years living in 22 centers in 10 countries. Generalized linear mixed models were employed to explore the association of respiratory symptoms with house dust-mite concentrations, adjusting for individual and household confounders. There was no overall association of respiratory outcomes with measured house dust-mite concentrations, even in those who reported they had symptoms on exposure to dust and those who had physician-diagnosed asthma. However, there was a positive association of high serum specific IgE levels to HDM (>3.5 kUA /l) with mattress house dust-mite concentrations and a negative association of sensitization to cat with increasing house dust-mite concentrations. In conclusion, there was no evidence that respiratory symptoms in adults were associated with exposure to house dust-mite allergen in the mattress, but an association of house mite with strong sensitization was observed.

  • 129. Baltar, Valéria Troncoso
    et al.
    Xun, Wei W
    Johansson, Mattias
    International Agency for Research on Cancer, Lyon, France.
    Ferrari, Pietro
    Chuang, Shu-Chun
    Relton, Caroline
    Ueland, Per Magne
    Midttun, Oivind
    Slimani, Nadia
    Jenab, Mazda
    Clavel-Chapelon, Françoise
    Boutron-Ruault, Marie-Christine
    Fagherazzi, Guy
    Kaaks, Rudolf
    Rohrmann, Sabine
    Boeing, Heiner
    Weikert, Cornelia
    Bueno-de-Mesquita, Bas
    Boshuizen, Hendriek
    van Gils, Carla H
    Onland-Moret, N Charlotte
    Agudo, Antonio
    Barricarte, Aurelio
    Navarro, Carmen
    Rodríguez, Laudina
    Castaño, José Maria Huerta
    Larrañaga, Nerea
    Khaw, Kay-Tee
    Wareham, Nick
    Allen, Naomi E
    Crowe, Francesca
    Gallo, Valentina
    Norat, Teresa
    Krogh, Vittorio
    Masala, Giovanna
    Panico, Salvatore
    Sacerdote, Carlotta
    Tumino, Rosario
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Rasmuson, Torgny
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Roswall, Nina
    Tjønneland, Anne
    Riboli, Elio
    Brennan, Paul
    Vineis, Paolo
    A structural equation modelling approach to explore the role of B vitamins and immune markers in lung cancer risk2013Inngår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 28, nr 8, 677-688 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The one-carbon metabolism (OCM) is considered key in maintaining DNA integrity and regulating gene expression, and may be involved in the process of carcinogenesis. Several B-vitamins and amino acids have been implicated in lung cancer risk, via the OCM directly as well as immune system activation. However it is unclear whether these factors act independently or through complex mechanisms. The current study applies structural equations modelling (SEM) to further disentangle the mechanisms involved in lung carcinogenesis. SEM allows simultaneous estimation of linear relations where a variable can be the outcome in one equation and the predictor in another, as well as allowing estimation using latent variables (factors estimated by correlation matrix). A large number of biomarkers have been analysed from 891 lung cancer cases and 1,747 controls nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Four putative mechanisms in the OCM and immunity were investigated in relation to lung cancer risk: methionine-homocysteine metabolism, folate cycle, transsulfuration, and mechanisms involved in inflammation and immune activation, all adjusted for tobacco exposure. The hypothesized SEM model confirmed a direct and protective effect for factors representing methionine-homocysteine metabolism (p = 0.020) and immune activation (p = 0.021), and an indirect protective effect of folate cycle (p = 0.019), after adjustment for tobacco smoking. In conclusion, our results show that in the investigation of the involvement of the OCM, the folate cycle and immune system in lung carcinogenesis, it is important to consider complex pathways (by applying SEM) rather than the effects of single vitamins or nutrients (e.g. using traditional multiple regression). In our study SEM were able to suggest a greater role of the methionine-homocysteine metabolism and immune activation over other potential mechanisms.

  • 130.
    Barath, Stefan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Mills, Nicholas L.
    Ädelroth, Ellinor
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Olin, Anna-Carin
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Diesel exhaust but not ozone increases fraction of exhaled nitric oxide in a randomized controlled experimental exposure study of healthy human subjects2013Inngår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 12, 36- s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Fraction of exhaled nitric oxide (FENO) is a promising non-invasive index of airway inflammation that may be used to assess respiratory effects of air pollution. We evaluated FENO as a measure of airway inflammation after controlled exposure to diesel exhaust or ozone. Methods: Healthy volunteers were exposed to either diesel exhaust (particle concentration 300 mu g/m(3)) and filtered air for one hour, or ozone (300 ppb) and filtered air for 75 minutes. FENO was measured in duplicate at expiratory flow rates of 10, 50, 100 and 270 mL/s before, 6 and 24 hours after each exposure. Results: Exposure to diesel exhaust increased FENO at 6 hours compared with air at expiratory flow rates of 10 mL/s (p = 0.01) and at 50 mL/s (p = 0.011), but FENO did not differ significantly at higher flow rates. Increases in FENO following diesel exhaust were attenuated at 24 hours. Ozone did not affect FENO at any flow rate or time point. Conclusions: Exposure to diesel exhaust, but not ozone, increased FENO concentrations in healthy subjects. Differences in the induction of airway inflammation may explain divergent responses to diesel exhaust and ozone, with implications for the use of FENO as an index of exposure to air pollution.

  • 131.
    Barbieri, Dechristian
    et al.
    Department of Physical Therapy, Federal University of São Carlos, São Paulo, BRAZIL.
    dos Santos, Wilian
    Department of Mechatronics Engineering, University of São Paulo, BRAZIL.
    Inoue, Roberto Santos
    Department of Electrical Engineering, Federal University of São Carlos, São Paulo, BRAZIL.
    Gonçalves Siqueira, Adriano Almeida
    Department of Mechatronics Engineering, University of São Paulo, BRAZIL.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Srinivasan, Divya
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Oliveira, Ana Beatriz
    Department of Physical Therapy, Federal University of São Carlos, São Paulo, BRAZIL.
    Adjustable sit-stand tables in office settings: development of a system for controlled posture changes2015Inngår i: Proceedings of the 19th Triennial Congress of the International Ergonomics Association, Melbourne 9-14 August 2015, 2015Konferansepaper (Fagfellevurdert)
  • 132.
    Barbieri, Dechristian Franca
    et al.
    Department of Physical Therapy, Federal University of São Carlos, Brazil.
    Srinivasan, Divya
    Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Oliveira, Ana Beatriz
    Department of Physical Therapy, Federal University of São Carlos, Brazil.
    Comparison of sedentary behaviors in office workers using sit-stand tables with and without semi-automated position changes2017Inngår i: Human Factors, ISSN 0018-7208, E-ISSN 1547-8181, Vol. 59, nr 5, 782-795 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: This study compared usage patterns of two different electronically controlled sit-stand tables during a 2-month intervention period among office workers.

    Background: Office workers spend most of their working time sitting, which is likely detrimental to health. Although the introduction of sit-stand tables has been suggested as an effective intervention to decrease sitting time, limited evidence is available on usage patterns of sit-stand tables, and whether patterns   are influenced by table configuration.

    Methods: Twelve workers were provided with standard sit-stand tables (non-automated table group) and 12 with semi-automated sit-stand tables programmed to change table position according to a pre-set pattern, if the user agreed to the system-generated prompt (semi-automated table group). Table position was monitored continuously for two months after introducing the tables, as a proxy for sit-stand behavior.

    Results: On average, the table was in a “sit” position for 85% of the work-day in both groups; this did not change significantly during the 2-month period. Switches in table position from sit to stand were, however, more frequent in the semi-automated table group than in the non-automated table group (0.65 vs. 0.29 hr-1; p=0.001).

    Conclusion: Introducing a semi-automated sit-stand table appeared to be an attractive alternative to a standard sit-stand table, since it led to more posture variation.

    Application: A semi-automated sit-stand table may effectively contribute to making postures more variable among office workers, and thus aid in alleviating negative health effects of extensive sitting.

  • 133.
    Barbieri, Dechristian
    et al.
    Department of Physical Therapy, Federal University of São Carlos.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Srinivasan, Divya
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    de Oliveira, Ana Beatriz
    Department of Physical Therapy, Federal University of São Carlos.
    The effect of non-computer tasks on job exposure variability in computer-intensive office work2013Inngår i: Eighth International Conference on Prevention of Work-related Musculoskeletal Disorders; Abstracts, 2013, 334- s.Konferansepaper (Fagfellevurdert)
  • 134.
    Barbieri, Dechristian
    et al.
    Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Srinivasan, Divya
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    dos Santos, Wilian Miranda
    Department of Mechanical Engineering, University of São Paulo, São Carlos, Brazil.
    Inoue, Roberto Santos
    Department of Electrical Engineering, Federal University of São Carlos, São Carlos, Brazil.
    Siqueira, Adriano
    Department of Mechanical Engineering, University of São Paulo, São Carlos, Brazil.
    Nogueira, Helen
    Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
    Oliveira, Ana Beatriz
    Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
    Sit-stand tables with semi-automated position changes: a new interactive approach for reducing sitting in office work2017Inngår i: IISE Transactions on Occupational Ergonomics and Human Factors, ISSN 2472-5838, Vol. 5, nr 1, 39-46 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Introduction of sit-stand tables has been proposed as an initiative to decrease sedentary behavior among office workers and thus reduce risks of negative cardiometabolic health effects. However, ensuring proper and sustainable use of such tables has remained a challenge for successful implementation. Objective: We developed a new system to promote and sustain the use of sit-stand tables. Methods: The system was programmed to change the position of the table between “sit” and “stand” positions according to a regular pre-set pattern, if the user agreed to the system-generated prompts prior to each change. The user could respond to the system-generated prompts by agreeing, refusing or delaying the changes by 2 minutes. We obtained user compliance data when this system was programmed to a schedule of 10 minutes of standing after every 50 minutes of sitting. Compliance was investigated in nine office workers who were offered the semi-automated sit-stand table for two months. Results: On average, the system issued 12-14 alerts per day throughout the period. Average acceptance rate ranged from 75.0-82.4%, and refusal rate ranged from 11.8-10.1% between the first and eighth weeks of intervention (difference not statistically significant). During the first week after introduction, the table was in a standing position for 75.2 min on average, increasing slightly to 77.5 min in the eighth week. Conclusion: Since the workers were essentially sitting down before the table was introduced, these results suggest that the system was accepted well, and led to an effective reduction of sitting during working hours. Users also reported that the system contributed positively to their health and wellbeing, without interrupt their regular work, and that they would like to continue using the sit-stand table even beyond the two-month period, as part of their regular work. Compliance beyond two months of use, however, needs to be verified.

  • 135.
    Barbieri, Dechristian
    et al.
    Department of Physical Therapy, Federal University of São Carlos.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Srinivasan, Divya
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    dos Santos, Willian Miranda
    Department of Mechanical Engineering, University of São Paulo.
    Oliveira, Ana Beatriz
    Department of Physical Therapy, Federal University of São Carlos.
    Use of sit-stand stations during the first 2 months after their introduction2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background. There is increasing evidence that sedentary behaviour during the workday is associated with negative health effects. In this context, interventions to reduce total sedentary time and breaking up periods of continuous sitting during computerized office work are urgently needed. Several reviews conclude that introducing sit-stand stations may lead to positive effects, but they also state that long-term interventions in real occu-pational settings are still rare. Therefore, the aim of this study was to investigate usage of sit-stand tables among Brazilian office workers during an intervention lasting two months.

    Methods.Nine office workers (6 females, 3 males; age 42 [SD 12] years) participated. The workers received traditional sit-stand tables and ergonomics information. They then used the workstation for two months. The tables were furnished with a system that recorded and kept track of table use during the intervention period. Table use early and late in the intervention period was compared using the Wilcoxon signed-rank test for repeated measurements.

    Results. In the beginning of the eight-week intervention period, workers, in median, changed table position 2.4 (1.9 – 4.7) times per day, decreasing to 2.3 (1.0 – 3.3) times at the end (P=0.09). Moreover, we also found a non-significant decrease in total time stand-ing per day, from 88.6 (67.4 – 94.3) minutes to 58.8 (33.1 – 95.7) minutes (P=0.31).

    Discussion. Two months after introducing sit-stand tables, some decrease in usage could be seen, if not statistically significant. Based on this, we emphasize that introduction of sit-stand tables should be accompanied by continued encouragement of the workers, preferably informed by a personalized follow up of actual use.

  • 136.
    Barbieri, Dechristian
    et al.
    Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Srinivasan, Divya
    Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, USA.
    Oliveira, Ana Beatriz
    Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil.
    For sit-stand desks, semiautomated prompting may lead the way2017Inngår i: Industrial and Systems Engineering at Work, ISSN 2168-9210, Vol. 49, nr 5, 51-52 s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 137.
    Barbieri, Dechristian
    et al.
    Universidade Federal de São Carlos.
    Srinivasan, Divya
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Nogueira, Helen
    Universidade Federal de São Carlos.
    Oliveira, Ana Beatriz
    Universidade Federal de São Carlos.
    The ability of non-computer tasks to increase biomechanical exposure variability in computer-intensive office work2015Inngår i: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 58, nr 1, 50-64 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Postures and muscle activity in the upper body were recorded from 50 academics office workers during 2 hours of normal work, categorised by observation into computer work (CW) and three non-computer (NC) tasks (NC seated work, NC standing/walking work and breaks). NC tasks differed significantly in exposures from CW, with standing/walking NC tasks representing the largest contrasts for most of the exposure variables. For the majority of workers, exposure variability was larger in their present job than in CW alone, as measured by the job variability ratio (JVR), i.e. the ratio between min–min variabilities in the job and in CW. Calculations of JVRs for simulated jobs containing different proportions of CW showed that variability could, indeed, be increased by redistributing available tasks, but that substantial increases could only be achieved by introducing more vigorous tasks in the job, in casu illustrated by cleaning.

  • 138.
    Barbieri, Dechristian
    et al.
    Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brasil.
    Srinivasan, Divya
    Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Oliveira, Ana Beatriz
    Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brasil.
    The effect of sit-stand workstations to decrease sedentariness in office work: tests of 2 systems with and without automatic reminders2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Sedentary behaviors in office workers has become a major public health concern and several initiatives have been proposed to break up sedentary behavior patterns during the performance of computer-intensive office work. Among such initiatives, the use of sit-stand workstations has been suggested to be one of the most promising by recent reviews. However, there still is only limited scientific evidence showing how effective sit-stand workstations are, in reducing sedentary behaviors and also documentation of their sustainability of use in studies of regular office work (i.e. as the “newness” of the system wears off, with time since introduction). This study aimed to document user behaviors and compare the use of two sit-stand workstation based interventions among two groups of administrative office workers: an “autonomous” group in which these workstations were introduced following some general ergonomic guidelines, and another “feedback-system” group in which the sit-stand tables were furnished with a semi-automatic reminder system, programmed to raise the table to a high (i.e. standing) position for 10 minutes after every accumulated 50 minutes of the table being in a low (i.e. sitting) position, i.e. to result in about 83% sitting per day. In addition, the sustainability of the use of these two kinds of sit-stand workstation interventions over two continuous months since their introduction was also studied. The results averaged over two months of usage of the two interventions showed that the percentage (%) sitting time was 87.4 (84.9-89.2) on average in the autonomous group and 84.0 (83.5-85.4) on average in the feedback-system group (P=0.001), and the frequency of switches between sitting and standing was 0.3 (0.2-0.3) per hour in the autonomous group and 0.7 (0.6-0.7) per hour in the feedback-system group (P=0.001). Thus, the sit-stand table system integrated with the automatic reminder system led to more reduction in sitting time and more switches in posture between sitting and standing as compared to the traditional sit-stand table, and behaviors of both groups were seen to be sustained over the 2-month intervention period (no difference across time for any of the variables tested for any group).

  • 139.
    Barbieri, Dechristian
    et al.
    Department of Physical Therapy, Federal University of São Carlos.
    Srinivasan, Divya
    Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Oliveira, Ana Beatriz
    Department of Physical Therapy, Federal University of São Carlos.
    Variation in upper extremity, neck and trunk postures when performing computer work at a sit-stand station2017Inngår i: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    The aim of this study was to determine the extent of upper arm, neck and trunk posture variation that can be obtained by combining seated and standing computer work, compared to performing only seated computer work. Posture data were recorded for two hours during each of three days of ordinary work from 24 office workers that had been using a sit-stand station for two months. Periods with sitting and standing computer work were identified using on-site observations, and posture means and minute-to-minute variance were determined for both. Expected minute-to-minute posture variability in different temporal combinations of sitting and standing computer work were determined by simulation, and expressed in terms of a Job Variance Ratio, i.e. the relative increase in variability compared to sitting-only work. For all three postures, mean values differed between sitting and standing computer work, and both showed a notable minute-to-minute variability. For most workers, posture variability was larger when combining sitting and standing than when sitting only, and simulations suggested to introduce more standing than what the worker currently practiced. The results indicate that introducing a sit-stand table could, for most office workers, have a positive effect on upper arm, neck and trunk posture variability.

  • 140.
    Barnekow-Bergkvist, Margareta
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Hedberg, Gudrun
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Pettersson, Ulf
    Sports Medicine Unit, Department of Surgical and Perioperative Sciences, University of Umeå, Umeå, Sweden; Clinical Pharmacology, Department of Pharmacology and Clinical Neuroscience, University of Umeå, Umeå, Sweden.
    Lorentzon, R.
    Sports Medicine Unit, Department of Surgical and Perioperative Sciences, University of Umeå, Umeå, Sweden.
    Relationships between physical activity and physical capacity in adolescent females and bone mass in adulthood2006Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 16, nr 6, 447-455 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study investigates whether physical activity and physical performance in adolescence are positively related to adult bone mineral density (BMD). In 1974, physical activity, endurance, and muscular strength were measured in 204 randomly selected female students, age 16.1 +/- 0.3 year (range 15-17 years). Twenty years later, 36 of the women volunteered to undergo a measurement of their BMD. Women who were members in a sports club in adolescence had significantly higher adult BMD (mean differences of 5% to 17% depending on site) compared with subjects who were not engaged in a sports club. Furthermore, women with persistent weight-bearing activity in adulthood had significantly higher BMD compared with women who had stopped being active or had never been active. The differences ranged between 5% and 19% with the highest difference found in trochanter BMD. Stepwise regression analyses showed that membership in a sports club at baseline was a significant independent predictor of BMD in the total body, lumbar spine, legs, trochanter, and femoral neck, explaining 17-26% of the variation in BMD. Change in body weight was a strong independent predictor of BMD of the total body and arms, explaining 8% of the variation in both sites. In addition, running performance at baseline was an independent predictor of total body BMD, whereas the two-hand lift performance significantly predicted BMD of the total body, legs and trochanter. The hanging leg-lift and handgrip were both significant predictors of arm BMD. In conclusion, membership in a sports club and site-specific physical performance in adolescence together with the change in body weight were significantly associated with adult BMD in premenopausal women

  • 141. Barnett, A. G.
    et al.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Commentary: What measure of temperature is the best predictor of mortality?2012Inngår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 118, 149-151 s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 142.
    Basner, Mathias
    et al.
    Department of Psychiatry, Division of Sleep and Chronobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
    Brink, Mark
    Federal Office for the Environment, Noise and NIR Division, Bern, Switzerland.
    Bristow, Abigail
    School of Civil and Building Engineering, Loughborough University, Loughborough, United Kingdom.
    de Kluizenaar, Yvonne
    Department of Urban Environment and Safety, The Netherlands Organization for Applied Scientific Research (TNO), Delft, Netherlands.
    Finegold, Lawrence
    Finegold & So, Consultants, 1167 Bournemouth Court, Centerville, Ohio 45459, USA.
    Hong, Jiyoung
    Eco-Transport Research Division, Korea Railroad Research Institute, Republic of Korea.
    Janssen, Sabine A.
    Department of Urban Environment and Safety, The Netherlands Organization for Applied Scientific Research (TNO), Delft, Netherlands.
    Klaeboe, Ronny
    Department of Safety, Security and Environment, Institute of Transport Economics (TØI), Oslo, Norway.
    Leroux, Tony
    School of Speech Language and Audiology, University of Montreal, Montréal (Québec), Canada.
    Liebl, Andreas
    Department of Acoustics, Fraunhofer Institute for Building Physics IBP, Stuttgart, Germany.
    Matsui, Toshihito
    Department of Environmental Engineering, Hokkaido University, Japan.
    Schwela, Dieter
    University of York, Environment Department, Stockholm Environment Institute, York, United Kingdom.
    Sliwinska-Kowalska, Mariola
    Department of Audiology and Phoniatrics, Nofer Institute of Occupational Medicine, Poland.
    Sörqvist, Patrik
    Högskolan i Gävle, Akademin för teknik och miljö, Avdelningen för bygg- energi- och miljöteknik, Miljöpsykologi. Linnaeus Centre HEAD, Swedish Institute for Disability Research, University of Linköping, Linköping, Sweden.
    ICBEN Review of Research on the Biological Effects of Noise 2011-20142015Inngår i: Noise & Health, ISSN 1463-1741, E-ISSN 1998-4030, Vol. 17, nr 75, 57-82 s.Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    The mandate of the International Commission on Biological Effects of Noise (ICBEN) is to promote a high level of scientific research concerning all aspects of noise-induced effects on human beings and animals. In this review, ICBEN team chairs and co-chairs summarize relevant findings, publications, developments, and policies related to the biological effects of noise, with a focus on the period 2011-2014 and for the following topics: Noise-induced hearing loss; nonauditory effects of noise; effects of noise on performance and behavior; effects of noise on sleep; community response to noise; and interactions with other agents and contextual factors. Occupational settings and transport have been identified as the most prominent sources of noise that affect health. These reviews demonstrate that noise is a prevalent and often underestimated threat for both auditory and nonauditory health and that strategies for the prevention of noise and its associated negative health consequences are needed to promote public health.

  • 143. Baste, Valborg
    et al.
    Moen, Bente E
    Oftedal, Gunnhild
    Strand, Leif Age
    Bjørge, Line
    Hansson Mild, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Pregnancy outcomes after paternal radiofrequency field exposure aboard fast patrol boats2012Inngår i: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 54, nr 4, 431-438 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To investigate adverse reproductive outcomes among male employees in the Royal Norwegian Navy exposed to radiofrequency electromagnetic fields aboard fast patrol boats.

    Methods: Cohort study of Royal Norwegian Navy servicemen linked to the Medical Birth Registry of Norway, including singleton offspring born between 1967 and 2008 (n = 37,920). Exposure during the last 3 months before conception (acute) and exposure more than 3 months before conception (nonacute) were analyzed.

    Results: Perinatal mortality and preeclampsia increased after service aboard fast patrol boats during an acute period and also after increased estimated radiofrequency exposure during an acute period, compared with service aboard other vessels. No associations were found between nonacute exposure and any of the reproductive outcomes.

    Conclusions: Paternal work aboard fast patrol boats during an acute period was associated with perinatal mortality and preeclampsia, but the cause is not clear.

  • 144.
    Beckhusen, Benedict
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Informatik.
    Mobile Apps and the ultimate addiction to the Smartphone: A comprehensive study on the consequences of society’s mobile needs2016Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
    Abstract [en]

    The smartphone is omnipresent and is cherished and held close by people. It allows for constant connection within a digitally connected society, as well as for many other purposes such as leisure activity or informational purpose. Within the Information Systems studies deeper investigation is required as to what impact this “taken – for – granted” mobile access to information and mobile apps has for individuals and society and if a “technological addiction”can be developed when using the smartphone for everything during the day on such a constant basis.

    The aim of this study was to understand the role of the smartphone in society and to shed light on this unclear relationship between the constant use of a smartphone and its development towards an addictive quality. To reach a conclusion, in depth – interviews were conducted with participants about their relationship to the smartphone and their smartphone use based on questions derived from literature on mobile communication technologies and the types of digital addictions existing.

    The results are that the smartphone is a device that seamlessly integrates into our daily lives in that we unconsciously use it as a tool to make our daily tasks more manageable, and enjoyable. It also supports us in getting better organized, to be in constant touch with family and friends remotely, and to be more mobile which is a useful ability in today’s mobility driven society.

    Smartphones have been found to inhabit a relatively low potential to addiction. Traits of voluntary behaviour, habitual behaviour, and mandatory behaviour of smartphone use have been found. All of these behaviours are not considered a true addiction. In the end, it seems that the increase of smartphone use is mainly due to the way we communicate nowadays digitally,and the shift in how we relate to our social peers using digital means.

  • 145. Beelen, Rob
    et al.
    Hoek, Gerard
    Vienneau, Danielle
    Eeftens, Marloes
    Dimakopoulou, Konstantina
    Pedeli, Xanthi
    Tsai, Ming-Yi
    Künzli, Nino
    Schikowski, Tamara
    Marcon, Alessandro
    Eriksen, Kirsten
    Raaschou-Nielsen, Ole
    Stephanou, Euripides
    Evridiki, Patelarou
    Lanki, Timo
    Yli-Tuomi, Tarja
    Declercq, Christophe
    Falq, Grégoire
    Stempfelet, Morgane
    Birk, Matthias
    Cyrys, Josef
    von Klot, Stephanie
    Nádor, Gizella
    Varró, Mihály János
    Dėdelė, Audrius
    Gražulevičienė, Regina
    Mölter, Anna
    Lindley, Sarah
    Madsen, Christian
    Cesaroni, Giulia
    Ranzi, Andrea
    Badaloni, Chiara
    Hoffmann, Barbara
    Nonnemacher, Michael
    Krämer, Ursula
    Kuhlbusch, Thomas
    Cirach, Marta
    de Nazelle, Audrey
    Nieuwenhuijsen, Mark
    Bellander, Tom
    Korek, Michal
    Olsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Strömgren, Magnus
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för geografi och ekonomisk historia.
    Dons, Evi
    Jerrett, Michael
    Fischer, Paul
    Brunekreef, Bert
    de Hoogh, Kees
    Development of NO2 and NOx land use regression models for estimating air pollution exposure in 36 study areas in Europe: the ESCAPE project2013Inngår i: Atmospheric Environment, ISSN 1352-2310, E-ISSN 1873-2844, Vol. 72, 10-23 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Estimating within-city variability in air pollution concentrations is important. Land use regression (LUR) models are able to explain such small-scale within-city variations. Transparency in LUR model development methods is important to facilitate comparison of methods between different studies. We therefore developed LUR models in a standardized way in 36 study areas in Europe for the ESCAPE (European Study of Cohorts for Air Pollution Effects) project.

    Nitrogen dioxide (NO2) and nitrogen oxides (NOx) were measured with Ogawa passive samplers at 40 or 80 sites in each of the 36 study areas. The spatial variation in each area was explained by LUR modeling. Centrally and locally available Geographic Information System (GIS) variables were used as potential predictors. A leave-one out cross-validation procedure was used to evaluate the model performance.

    There was substantial contrast in annual average NO2 and NOx concentrations within the study areas. The model explained variances (R2) of the LUR models ranged from 55% to 92% (median 82%) for NO2 and from 49% to 91% (median 78%) for NOx. For most areas the cross-validation R2 was less than 10% lower than the model R2. Small-scale traffic and population/household density were the most common predictors. The magnitude of the explained variance depended on the contrast in measured concentrations as well as availability of GIS predictors, especially traffic intensity data were important. In an additional evaluation, models in which local traffic intensity was not offered had 10% lower R2 compared to models in the same areas in which these variables were offered.

    Within the ESCAPE project it was possible to develop LUR models that explained a large fraction of the spatial variance in measured annual average NO2 and NOx concentrations. These LUR models are being used to estimate outdoor concentrations at the home addresses of participants in over 30 cohort studies.

  • 146. Beelen, Rob
    et al.
    Raaschou-Nielsen, Ole
    Stafoggia, Massimo
    Andersen, Zorana Jovanovic
    Weinmayr, Gudrun
    Hoffmann, Barbara
    Wolf, Kathrin
    Samoli, Evangelia
    Fischer, Paul
    Nieuwenhuijsen, Mark
    Vineis, Paolo
    Xun, Wei W
    Katsouyanni, Klea
    Dimakopoulou, Konstantina
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Havulinna, Aki S
    Lanki, Timo
    Turunen, Anu
    Oftedal, Bente
    Nystad, Wenche
    Nafstad, Per
    De Faire, Ulf
    Pedersen, Nancy L
    Ostenson, Claes-Göran
    Fratiglioni, Laura
    Penell, Johanna
    Korek, Michal
    Pershagen, Göran
    Eriksen, Kirsten Thorup
    Overvad, Kim
    Ellermann, Thomas
    Eeftens, Marloes
    Peeters, Petra H
    Meliefste, Kees
    Wang, Meng
    Bueno-de-Mesquita, Bas
    Sugiri, Dorothea
    Krämer, Ursula
    Heinrich, Joachim
    de Hoogh, Kees
    Key, Timothy
    Peters, Annette
    Hampel, Regina
    Concin, Hans
    Nagel, Gabriele
    Ineichen, Alex
    Schaffner, Emmanuel
    Probst-Hensch, Nicole
    Künzli, Nino
    Schindler, Christian
    Schikowski, Tamara
    Adam, Martin
    Phuleria, Harish
    Vilier, Alice
    Clavel-Chapelon, Françoise
    Declercq, Christophe
    Grioni, Sara
    Krogh, Vittorio
    Tsai, Ming-Yi
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Galassi, Claudia
    Migliore, Enrica
    Ranzi, Andrea
    Cesaroni, Giulia
    Badaloni, Chiara
    Forastiere, Francesco
    Tamayo, Ibon
    Amiano, Pilar
    Dorronsoro, Miren
    Katsoulis, Michail
    Trichopoulou, Antonia
    Brunekreef, Bert
    Hoek, Gerard
    Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project2014Inngår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 383, nr 9919, 785-795 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants.

    METHODS: We used data from 22 European cohort studies, which created a total study population of 367 251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2·5 μm (PM2·5), less than 10 μm (PM10), and between 10 μm and 2·5 μm (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx), with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buffer. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects meta-analysis.

    FINDINGS: The total study population consisted of 367 251 participants who contributed 5 118 039 person-years at risk (average follow-up 13·9 years), of whom 29 076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2·5 of 1·07 (95% CI 1·02-1·13) per 5 μg/m(3) was recorded. No heterogeneity was noted between individual cohort effect estimates (I(2) p value=0·95). HRs for PM2·5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 μg/m(3) (HR 1·06, 95% CI 1·00-1·12) or below 20 μg/m(3) (1·07, 1·01-1·13).

    INTERPRETATION: Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value.

    FUNDING: European Community's Seventh Framework Program (FP7/2007-2011).

  • 147. Beelen, Rob
    et al.
    Stafoggia, Massimo
    Raaschou-Nielsen, Ole
    Andersen, Zorana Jovanovic
    Xun, Wei W
    Katsouyanni, Klea
    Dimakopoulou, Konstantina
    Brunekreef, Bert
    Weinmayr, Gudrun
    Hoffmann, Barbara
    Wolf, Kathrin
    Samoli, Evangelia
    Houthuijs, Danny
    Nieuwenhuijsen, Mark
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Olsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Salomaa, Veikko
    Lanki, Timo
    Yli-Tuomi, Tarja
    Oftedal, Bente
    Aamodt, Geir
    Nafstad, Per
    De Faire, Ulf
    Pedersen, Nancy L
    Östenson, Claes-Göran
    Fratiglioni, Laura
    Penell, Johanna
    Korek, Michal
    Pyko, Andrei
    Eriksen, Kirsten Thorup
    Tjønneland, Anne
    Becker, Thomas
    Eeftens, Marloes
    Bots, Michiel
    Meliefste, Kees
    Wang, Meng
    Bueno-de-Mesquita, Bas
    Sugiri, Dorothea
    Krämer, Ursula
    Heinrich, Joachim
    de Hoogh, Kees
    Key, Timothy
    Peters, Annette
    Cyrys, Josef
    Concin, Hans
    Nagel, Gabriele
    Ineichen, Alex
    Schaffner, Emmanuel
    Probst-Hensch, Nicole
    Dratva, Julia
    Ducret-Stich, Regina
    Vilier, Alice
    Clavel-Chapelon, Françoise
    Stempfelet, Morgane
    Grioni, Sara
    Krogh, Vittorio
    Tsai, Ming-Yi
    Marcon, Alessandro
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Galassi, Claudia
    Migliore, Enrica
    Ranzi, Andrea
    Cesaroni, Giulia
    Badaloni, Chiara
    Forastiere, Francesco
    Tamayo, Ibon
    Amiano, Pilar
    Dorronsoro, Miren
    Katsoulis, Michail
    Trichopoulou, Antonia
    Vineis, Paolo
    Hoek, Gerard
    Long-term exposure to air pollution and cardiovascular mortality: an analysis of 22 European cohorts2014Inngår i: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 25, nr 3, 368-378 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Air pollution has been associated with cardiovascular mortality, but it remains unclear as to whether specific pollutants are related to specific cardiovascular causes of death. Within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE), we investigated the associations of long-term exposure to several air pollutants with all cardiovascular disease (CVD) mortality, as well as with specific cardiovascular causes of death.

    METHODS: Data from 22 European cohort studies were used. Using a standardized protocol, study area-specific air pollution exposure at the residential address was characterized as annual average concentrations of the following: nitrogen oxides (NO2 and NOx); particles with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and 10 μm to 2.5 μm (PMcoarse); PM2.5 absorbance estimated by land-use regression models; and traffic indicators. We applied cohort-specific Cox proportional hazards models using a standardized protocol. Random-effects meta-analysis was used to obtain pooled effect estimates.

    RESULTS: The total study population consisted of 367,383 participants, with 9994 deaths from CVD (including 4,992 from ischemic heart disease, 2264 from myocardial infarction, and 2484 from cerebrovascular disease). All hazard ratios were approximately 1.0, except for particle mass and cerebrovascular disease mortality; for PM2.5, the hazard ratio was 1.21 (95% confidence interval = 0.87-1.69) per 5 μg/m and for PM10, 1.22 (0.91-1.63) per 10 μg/m.

    CONCLUSION: In a joint analysis of data from 22 European cohorts, most hazard ratios for the association of air pollutants with mortality from overall CVD and with specific CVDs were approximately 1.0, with the exception of particulate mass and cerebrovascular disease mortality for which there was suggestive evidence for an association.

  • 148. Beelen, Rob
    et al.
    Stafoggia, Massimo
    Raaschou-Nielsen, Ole
    Andersen, Zorana Jovanovic
    Xun, Wei W.
    Katsouyanni, Klea
    Dimakopoulou, Konstantina
    Brunekreef, Bert
    Weinmayr, Gudrun
    Hoffmann, Barbara
    Wolf, Kathrin
    Samoli, Evangelia
    Houthuijs, Danny
    Nieuwenhuijsen, Mark
    Oudin, Anna
    Forsberg, Bertil
    Olsson, David
    Salomaa, Veikko
    Lanki, Timo
    Yli-Tuomi, Tarja
    Oftedal, Bente
    Aamodt, Geir
    Nafstad, Per
    De Faire, Ulf
    Pedersen, Nancy L.
    Östenson, Claes-Göran
    Fratiglioni, Laura
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Penell, Johanna
    Korek, Michal
    Pyko, Andrei
    Thorup Eriksen, Kirsten
    Tjonneland, Anne
    Becker, Thomas
    Eeftens, Marloes
    Bots, Michiel
    Meliefste, Kees
    Wang, Meng
    Bueno-de-Mesquita, Bas
    Sugiri, Dorothea
    Kraemer, Ursula
    Heinrich, Joachim
    de Hoogh, Kees
    Key, Timothy
    Peters, Annette
    Cyrys, Josef
    Concin, Hans
    Nagel, Gabriele
    Ineichen, Alex
    Schaffner, Emmanuel
    Probst-Hensch, Nicole
    Dratva, Julia
    Ducret-Stich, Regina
    Vilier, Alice
    Clavel-Chapelon, Francoise
    Stempfelet, Morgane
    Grioni, Sara
    Krogh, Vittorio
    Tsai, Ming-Yi
    Marcon, Alessandro
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Galassi, Claudia
    Migliore, Enrica
    Ranzi, Andrea
    Cesaroni, Giulia
    Badaloni, Chiara
    Forastiere, Francesco
    Tamayo, Ibon
    Amiano, Pilar
    Dorronsoro, Miren
    Katsoulis, Michail
    Trichopoulou, Antonia
    Vineis, Paolo
    Hoek, Gerard
    Long-term Exposure to Air Pollution and Cardiovascular Mortality An Analysis of 22 European Cohorts2014Inngår i: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 25, nr 3, 368-378 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Air pollution has been associated with cardiovascular mortality, but it remains unclear as to whether specific pollutants are related to specific cardiovascular causes of death. Within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE), we investigated the associations of long-term exposure to several air pollutants with all cardiovascular disease (CVD) mortality, as well as with specific cardiovascular causes of death. Methods: Data from 22 European cohort studies were used. Using a standardized protocol, study area-specific air pollution exposure at the residential address was characterized as annual average concentrations of the following: nitrogen oxides (NO2 and NOx); particles with diameters of less than 2.5 mu m (PM2.5), less than 10 mu m (PM10), and 10 mu m to 2.5 mu m (PMcoarse); PM2.5 absorbance estimated by land-use regression models; and traffic indicators. We applied cohort-specific Cox proportional hazards models using a standardized protocol. Random-effects meta-analysis was used to obtain pooled effect estimates. Results: The total study population consisted of 367,383 participants, with 9994 deaths from CVD (including 4,992 from ischemic heart disease, 2264 from myocardial infarction, and 2484 from cerebrovascular disease). All hazard ratios were approximately 1.0, except for particle mass and cerebrovascular disease mortality; for PM2.5, the hazard ratio was 1.21 (95% confidence interval = 0.87-1.69) per 5 mu g/m(3) and for PM10, 1.22 (0.91-1.63) per 10 mu g/m(3). Conclusion: In a joint analysis of data from 22 European cohorts, most hazard ratios for the association of air pollutants with mortality from overall CVD and with specific CVDs were approximately 1.0, with the exception of particulate mass and cerebrovascular disease mortality for which there was suggestive evidence for an association.

  • 149.
    Bejerot, Eva
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stockholm, Sweden.
    Re:: Läkarna som grupp har förlorat känslan av att ha en ansvarsposition2012Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, nr 12, 637-638 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 150.
    Bellavia, Andrea
    et al.
    Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol.
    Åkerstedt, Torbjörn
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Bottai, Matteo
    Wolk, Alicja
    Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol.
    Orsini, Nicola
    Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol.
    Sleep Duration and Survival Percentiles Across Categories of Physical Activity2014Inngår i: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 179, nr 4, 484-491 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The association between long sleep duration and death is not fully understood. Long sleep is associated with low physical activity, which is a strong predictor of death. Our aim was to investigate the association between sleep duration and death across categories of total physical activity in a large prospective cohort of Swedish men and women. We followed a population-based cohort of 70,973 participants (37,846 men and 33,127 women), aged 45-83 years, from January 1998 to December 2012. Sleep duration and physical activity levels were assessed through a questionnaire. We evaluated the association of interest in terms of mortality rates by estimating hazard ratios with Cox regression and in terms of survival by evaluating 15th survival percentile differences with Laplace regression. During 15 years of follow-up, we recorded 14,575 deaths (8,436 men and 6,139 women). We observed a significant interaction between sleep duration and physical activity in predicting death (P < 0.001). Long sleep duration (>8 hours) was associated with increased mortality risk (hazard ratio = 1.24; 95% confidence interval: 1.11, 1.39) and shorter survival (15th percentile difference = -20 months; 95% confidence interval: -30, -11) among only those with low physical activity. The association between long sleep duration and death might be partly explained by comorbidity with low physical activity.

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