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  • 2301. Xu, Tianwei
    et al.
    Magnusson Hanson, Linda
    Lange, Theis
    Starkopf, Liis
    Westerlund, Hugo
    Madsen, Ida
    Rugulies, Reiner
    Pentti, Jaana
    Stenholm, Sari
    Vahtera, Jussi
    Hansen, Åse M
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Kivimäki, Mika
    Rod, Naja
    Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study2019In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, no 14, p. 1124-1134Article in journal (Refereed)
    Abstract [en]

    Aims:

    To assess the associations between bullying and violence at work and cardiovascular disease (CVD).

    Methods and results:

    Participants were 79 201 working men and women, aged 18–65 years and free of CVD and were sourced from three cohort studies from Sweden and Denmark. Exposure to workplace bullying and violence was measured at baseline using self-reports. Participants were linked to nationwide health and death registers to ascertain incident CVD, including coronary heart disease and cerebrovascular disease. Study-specific results were estimated by marginal structural Cox regression and were combined using fixed-effect meta-analysis. Nine percent reported being bullied at work and 13% recorded exposure to workplace violence during the past year. We recorded 3229 incident CVD cases with a mean follow-up of 12.4 years (765 in the first 4 years). After adjustment for age, sex, country of birth, marital status, and educational level, being bullied at work vs. not was associated with a hazard ratio (HR) of 1.59 [95% confidence interval (CI) 1.28–1.98] for CVD. Experiencing workplace violence vs. not was associated with a HR of 1.25 (95% CI 1.12–1.40) for CVD. The population attributable risk was 5.0% for workplace bullying and 3.1% for workplace violence. The excess risk remained similar in analyses with different follow-up lengths, cardiovascular risk stratifications, and after additional adjustments. Dose–response relations were observed for both workplace bullying and violence (Ptrend < 0.001). There was only negligible heterogeneity in study-specific estimates.

    Conclusion:

    Bullying and violence are common at workplaces and those exposed to these stressors are at higher risk of CVD.

  • 2302. Yamamoto, Shelby
    et al.
    Sie, Ali
    Sauerborn, Rainer
    Institute of Public Health, University of Heidelberg .
    Cooking fuels and the push for cleaner alternatives: a case study from Burkina Faso2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, p. 156-164Article in journal (Refereed)
    Abstract [en]

    Introduction: More than 95% of the population in Burkina Faso uses some form of solid biomass fuel. When these fuels are burned in traditional, inefficient stoves, pollutant levels within and outside the home can be very high. This can have important consequences for both health and climate change. Thus, the push to switch to cleaner burning fuels is advantageous. However, there are several considerations that need to be taken into account when considering the use and promotion of different fuel types.

    Objective: In the setting of the semi-urban area of Nouna, Burkina Faso, we examine the common fuel types used (wood, charcoal and liquid petroleum gas (LPG)) in terms of consumption, energy, availability, air pollution and climate change.

    Results and conclusion: Although biomass solid fuel does offer some advantages over LPG, the disadvantages make this option much less desirable. Lower energy efficiencies, higher pollutant emission levels, the associated health consequences and climate change effects favour the choice of LPG over solid biomass fuel use. Further studies specific to Burkina Faso, which are lacking in this region, should also be undertaken in this area to better inform policy decisions.

  • 2303.
    Yang, Lei
    et al.
    School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, PR China.
    Zhang, Jianping
    School of Clinical Medicine, Hainan Medical University, Haikou, PR China.
    Zhao, Guanghui
    Hong Hui Hospital, Health Science Center, Xi'an Jiaotong University, Xi'an, PR China.
    Wu, Cuiyan
    School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, PR China.
    Ning, Yujie
    School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, PR China.
    Wang, Xi
    School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, PR China.
    Lammi, Mikko
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, PR China.
    Guo, Xiong
    School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, PR China.
    Gene expression profiles and molecular mechanism of cultured human chondrocytes' exposure to T-2 toxin and deoxynivalenol2017In: Toxicon, ISSN 0041-0101, E-ISSN 1879-3150, Vol. 140, p. 38-44Article in journal (Refereed)
    Abstract [en]

    T-2 toxin and deoxynivalenol (DON) are secondary metabolites produced by Fusarium fungi and are commonly found on food and feed. Although T-2 toxin and DON have been suggested as the etiology of Kashin-Beck disease (KBD), an endemic osteochondropathy, little is known about the mechanism when human chondrocytes are exposed to T-2 toxin and DON. The purpose of this study is to identify the gene expression differences and underlying molecular changes modulated by T-2 toxin and DON in vitro in human chondrocytes. After the experiments of cell viability, the gene expression profiles were analyzed in cells that were treated with 0.01 μg/ml T-2 toxin and 1.0 μg/ml DON for 72 h by Affymetrix Human Gene Chip. The array results showed that 882 and 2118 genes were differentially expressed for T-2 toxin and DON exposure, respectively. Enrichment analysis revealed that diverse cellular processes including DNA damage, cell cycle regulation and metabolism of extracellular matrix were affected when human chondrocytes were exposed to T-2 toxin and DON. These results demonstrate the gene expression differences and molecular mechanism of cultured human chondrocytes exposure to T-2 toxin and DON, and provide a new insight into future research in the etiology of KBD.

  • 2304.
    Yang, Liyun
    et al.
    KTH Royal Institute of Technology.
    Lu, Ke
    KTH Royal Institute of Technology.
    Forsman, Mikael
    KTH Royal Institute of Technology.
    Lindecrantz, Kaj
    Karolinska Institutet.
    Seoane, Fernando
    University of Borås.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Eklund, Jörgen
    KTH Royal Institute of Technology.
    Evaluation of physiological workload assessment methods using heart rate and accelerometry for a smart wearable system.2019In: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, p. 1-12Article in journal (Refereed)
    Abstract [en]

    Work metabolism (WM) can be accurately estimated by oxygen consumption (VO2), which is commonly assessed by heart rate (HR) in field studies. However, the VO2-HR relationship is influenced by individual capacity and activity characteristics. The purpose of this study was to evaluate three models for estimating WM compared with indirect calorimetry, during simulated work activities. The techniques were: the HR-Flex model; HR branched model, combining HR with hip-worn accelerometers (ACC); and HR + arm-leg ACC model, combining HR with wrist- and thigh-worn ACC. Twelve participants performed five simulated work activities and three submaximal tests. The HR + arm-leg ACC model had the overall best performance with limits of agreement (LoA) of -3.94 and 2.00 mL/min/kg, while the HR-Flex model had -5.01 and 5.36 mL/min/kg and the branched model, -6.71 and 1.52 mL/min/kg. In conclusion, the HR + arm-leg ACC model should, when feasible, be preferred in wearable systems for WM estimation. Practitioner Summary: Work with high energy demand can impair employees' health and life quality. Three models were evaluated for estimating work metabolism during simulated tasks. The model combining heart rate, wrist- and thigh-worn accelerometers showed the best accuracy. This is, when feasible, suggested for wearable systems to assess work metabolism.

  • 2305.
    Yngve, Agneta
    et al.
    Karolinska Inst, Dept Biosci Novum, Unit Prevent Nutr, Stockholm, Sweden.
    De Bourdeaudhuij, Ilse
    Univ Ghent, Dept Movement & Sport Sci, B-9000 Ghent, Belgium.
    Wolf, Alexandra
    Austrian Agcy Hlth & Food Safety, Vienna, Austria.
    Grjibovski, Andrej
    Karolinska Inst, Dept Biosci Novum, Unit Prevent Nutr, Stockholm, Sweden; Norwegian Inst Publ Hlth, Div Epidemiol, Oslo, Norway.
    Brug, Johannes
    Vrije Univ Amsterdam Med Ctr, Amsterdam, Netherlands.
    Due, Pernille
    Univ Copenhagen, Dept Social Med, DK-1168 Copenhagen, Denmark.
    Ehrenblad, Bettina
    Karolinska Inst, Dept Biosci Novum, Unit Prevent Nutr, Stockholm, Sweden.
    Elmadfa, Ibrahim
    Univ Vienna, Inst Nutr Sci, A-1010 Vienna, Austria.
    Franchini, Bela
    Univ Porto, Fac Nutr & Food Sci, Oporto, Portugal.
    Klepp, Knut-Inge
    Univ Oslo, Dept Nutr, Fac Med, N-0316 Oslo, Norway.
    Poortvliet, Eric
    Karolinska Inst, Dept Biosci Novum, Unit Prevent Nutr, Stockholm, Sweden.
    Rasmussen, Mette
    Univ Copenhagen, Dept Social Med, DK-1168 Copenhagen, Denmark.
    Thorsdottir, Inga
    Landspitali Univ Hosp, Unit Nutr Res, Reykjavik, Iceland.
    Perez Rodrigo, Carmen
    Community Nutr Unit, Bilbao, Spain.
    Differences in prevalence of overweight and stunting in 11-year olds across Europe: The Pro Children Study2008In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, no 2, p. 126-130Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess country differences in prevalence of overweight, obesity, underweight and stunting in the Pro Children Survey.Methods: A cross-sectional study conducted in a random sample of schools in nine European countries in 2003. The subjects were 8317 11-year-old children from Austria, Belgium, Denmark, Iceland, The Netherlands, Norway, Portugal, Spain and Sweden. Parents reported height and weight of the children, and BMI values were analysed using the US Centers of Disease Control and Prevention and the International Obesity Task Force reference populations. Continuous variables were compared with one-way analysis of variance (ANOVA) with Games-Howell post hoc tests. Categorical variables were analysed using chi-square tests.Results: The prevalence of overweight + obesity varied between the countries from 8.6% to 30.6% and 5.9% to 26.5%, respectively, depending on the reference population, with the lowest prevalence in Dutch girls, the highest in Portuguese boys. Obesity prevalence varied from 1.1% (Dutch and Danish girls) to 10.7% (Portuguese boys) and from 0.3% (Dutch girls) to 6.2% (Portuguese boys), respectively. Portugal and Spain had the highest prevalence of overweight and obesity for both genders. The ranking of the countries according to overweight and obesity prevalence was roughly the same, independent of reference population. The prevalence of underweight varied from 2.3% (Swedish boys) to 12.3% (Belgian boys), using the American reference population. The proportion of stunted children was highest in Portugal, Spain and Belgium.Conclusions: The highest levels of overweight, obesity and stunting in the pro children material are found in Portugal and Spain.

  • 2306.
    Yngve, Agneta
    et al.
    Karolinska Inst, Dept Biosci Novum, Unit Prevent Nutr, Stockholm, Sweden.
    De Bourdeaudhuij, Ilse
    Univ Ghent, Dept Movement & Sport Sci, B-9000 Ghent, Belgium.
    Wolf, Alexandra
    Austrian Agcy Hlth & Food Safety, Vienna, Austria.
    Grjibovski, Andrej
    Karolinska Inst, Dept Biosci Novum, Unit Prevent Nutr, Stockholm, Sweden; Norwegian Inst Publ Hlth, Div Epidemiol, Oslo, Norway.
    Brug, Johannes
    Vrije Univ Amsterdam Med Ctr, Amsterdam, Netherlands.
    Due, Pernille
    Univ Copenhagen, Dept Social Med, DK-1168 Copenhagen, Denmark.
    Ehrenblad, Bettina
    Karolinska Inst, Dept Biosci Novum, Unit Prevent Nutr, Stockholm, Sweden.
    Elmadfa, Ibrahim
    Univ Vienna, Inst Nutr Sci, A-1010 Vienna, Austria.
    Franchini, Bela
    Univ Porto, Fac Nutr & Food Sci, Oporto, Portugal.
    Klepp, Knut-Inge
    Univ Oslo, Dept Nutr, Fac Med, N-0316 Oslo, Norway.
    Poortvliet, Eric
    Karolinska Inst, Dept Biosci Novum, Unit Prevent Nutr, Stockholm, Sweden.
    Rasmussen, Mette
    Univ Copenhagen, Dept Social Med, DK-1168 Copenhagen, Denmark.
    Thorsdottir, Inga
    Landspitali Univ Hosp, Unit Nutr Res, Reykjavik, Iceland.
    Perez Rodrigo, Carmen
    Community Nutr Unit, Bilbao, Spain.
    Differences in prevalence of overweight and stunting in 11-year olds across Europe: The Pro Children Study2008In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, no 2, p. 126-130Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess country differences in prevalence of overweight, obesity, underweight and stunting in the Pro Children Survey.Methods: A cross-sectional study conducted in a random sample of schools in nine European countries in 2003. The subjects were 8317 11-year-old children from Austria, Belgium, Denmark, Iceland, The Netherlands, Norway, Portugal, Spain and Sweden. Parents reported height and weight of the children, and BMI values were analysed using the US Centers of Disease Control and Prevention and the International Obesity Task Force reference populations. Continuous variables were compared with one-way analysis of variance (ANOVA) with Games-Howell post hoc tests. Categorical variables were analysed using chi-square tests.Results: The prevalence of overweight + obesity varied between the countries from 8.6% to 30.6% and 5.9% to 26.5%, respectively, depending on the reference population, with the lowest prevalence in Dutch girls, the highest in Portuguese boys. Obesity prevalence varied from 1.1% (Dutch and Danish girls) to 10.7% (Portuguese boys) and from 0.3% (Dutch girls) to 6.2% (Portuguese boys), respectively. Portugal and Spain had the highest prevalence of overweight and obesity for both genders. The ranking of the countries according to overweight and obesity prevalence was roughly the same, independent of reference population. The prevalence of underweight varied from 2.3% (Swedish boys) to 12.3% (Belgian boys), using the American reference population. The proportion of stunted children was highest in Portugal, Spain and Belgium.Conclusions: The highest levels of overweight, obesity and stunting in the pro children material are found in Portugal and Spain.

  • 2307.
    Younan, Diana
    et al.
    Keck School of Medicine, University of Southern California, Los Angeles CA, USA.
    Tuvblad, Catherine
    Örebro University, School of Law, Psychology and Social Work. Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles CA, USA.
    Franklin, Meredith
    Keck School of Medicine, University of Southern California, Los Angeles CA, USA.
    Lurmann, Fred
    Sonoma Technology, Inc., Petaluma CA, USA.
    Li, Lianfa
    Keck School of Medicine, University of Southern California, Los Angeles CA, USA.
    Wu, Jun
    Irvine College of Health Sciences, University of California, Irvine CA, USA.
    Berhane, Kiros
    Keck School of Medicine, University of Southern California, Los Angeles CA, USA.
    Baker, Laura A.
    Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles CA, USA.
    Chen, Jiu-Chiuan
    Keck School of Medicine, University of Southern California, Los Angeles CA, USA.
    Longitudinal Analysis of Particulate Air Pollutants and Adolescent Delinquent Behavior in Southern California2018In: Journal of Abnormal Child Psychology, ISSN 0091-0627, E-ISSN 1573-2835, Vol. 46, no 6, p. 1283-1293Article in journal (Refereed)
    Abstract [en]

    Animal experiments and cross-sectional human studies have linked particulate matter (PM) with increased behavioral problems. We conducted a longitudinal study to examine whether the trajectories of delinquent behavior are affected by PM2.5 (PM with aerodynamic diameter ≤ 2.5 μm) exposures before and during adolescence. We used the parent-reported Child Behavior Checklist at age 9-18 with repeated measures every ~2-3 years (up to 4 behavioral assessments) on 682 children from the Risk Factors for Antisocial Behavior Study conducted in a multi-ethnic cohort of twins born in 1990-1995. Based on prospectively-collected residential addresses and a spatiotemporal model of ambient air concentrations in Southern California, monthly PM2.5 estimates were aggregated to represent long-term (1-, 2-, 3-year average) exposures preceding baseline and cumulative average exposure until the last assessment. Multilevel mixed-effects models were used to examine the association between PM2.5 exposure and individual trajectories of delinquent behavior, adjusting for within-family/within-individual correlations and potential confounders. We also examined whether psychosocial factors modified this association. The results sμggest that PM2.5 exposure at baseline and cumulative exposure during follow-up was significantly associated (p < 0.05) with increased delinquent behavior. The estimated effect sizes (per interquartile increase of PM2.5 by 3.12-5.18 μg/m3) were equivalent to the difference in delinquency scores between adolescents who are 3.5-4 years apart in age. The adverse effect was stronger in families with unfavorable parent-to-child relationships, increased parental stress or maternal depressive symptoms. Overall, these findings sμggest long-term PM2.5 exposure may increase delinquent behavior of urban-dwelling adolescents, with the resulting neurotoxic effect aggravated by psychosocial adversities.

  • 2308.
    Yu, Zhaohua
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ophthalmology.
    Persson, Rolf
    Swedish Defence Research Agency.
    Öhgren, Johan
    Swedish Defence Research Agency.
    Sandberg, Stig
    Swedish Defence Research Agency.
    Hörberg, Ulf
    Swedish Defence Research Agency.
    Berglund, Folke
    Swedish Defence Research Agency.
    Karlsson, Kjell
    Swedish Defence Research Agency.
    Steinvall, Ove
    Swedish Defence Research Agency.
    Söderberg, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ophthalmology.
    Green light laser exposure at 532nm near the exposure limit during a human volunteer vehicle driving task does not alter structure or function in the visual system2014In: Journal of laser applications, ISSN 1042-346X, E-ISSN 1938-1387, Vol. 26, no 2, p. 022009-1-022009-7Article in journal (Refereed)
    Abstract [en]

    This study aimed to verify nonexistence of clinically important pathological effects to the visual system after exposure to 532 nm green laser light close to the exposure limit. The present medical surveillance of vision and visual health reported in this paper is the conjunction with a study of driver performance in the presence of 532 nm laser induced glare. The driving time varied between 25 and 55 s, depending on background luminance. The laser was on during the complete test drive. The peak corneal irradiance typically was 3.5Wm2 in one test drive. Considering a typical test drive, the typical time integrated corneal radiant exposure for one test drive was estimated to be 53 J/m2. The number of test drives varied among drivers but was typically 50, thus resulting in a cumulative corneal exposure dose of approximately 2.7 kJ/m2. Altogether, ten subjects were recruited according to inclusion and exclusion criteria. All ten subjects were examined for visual acuity, intraocular pressure, contrast sensitivity, color vision, monocular reading speed, and eye structure with clinical slit-lamp microscopy examination and indirect retinoscopy. All subjects were examined before exposure, immediately after exposure, and finally within an interval between 1 week and 4 weeks after exposure. There was no significant change of visual acuity, intraocular pressure, contrast sensitivity, color vision, or monocular reading speed between before and after exposure. No abnormal ocular structure was detected after exposure. This study demonstrates that close to exposure limit, exposure to 532 nm green laser light during a vehicle driving task does not induce structural or functional damage to the human visual system as observed in the interval minutes to weeks after exposure.

  • 2309.
    Zafar, Hamayun
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
    Alghadir, A. H.
    Iqbal, Z. A.
    Effect of different head-neck-jaw postures on cervicocephalic kinesthetic sense2017In: Journal of Musculoskeletal and Neuronal Interactions - JMNI, ISSN 1108-7161, Vol. 17, no 4, p. 341-346Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the effect of different induced head-neck-jaw postures on head-neck relocation error among healthy subjects.

    Methods: 30 healthy adult male subjects participated in this study. Cervicocephalic kinesthetic sense was measured while standing, habitual sitting, habitual sitting with clenched jaw and habitual sitting with forward head posture during right rotation, left rotation, flexion and extension using kinesthetic sensibility test.

    Results: Head-neck relocation error was least while standing, followed by habitual sitting, habitual sitting with forward head posture and habitual sitting with jaw clenched. However, there was no significant difference in error between different tested postures during all the movements.

    Conclusions: To the best of our knowledge, this is the first study to see the effect of different induced head-neck-jaw postures on head-neck position sense among healthy subjects. Assuming a posture for a short duration of time doesn’t affect head-neck relocation error in normal healthy subjects.

  • 2310.
    Zafar, Hamayun
    et al.
    University of Gävle, Centre for Musculoskeletal Research. Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden.
    Nordh, E
    Department of Clinical Neurophysiology, Umeå University Hospital, Sweden.
    Eriksson, Per Olof
    University of Gävle, Centre for Musculoskeletal Research. Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden.
    Impaired positioning of the gape in whiplash-associated disorders2006In: Swedish Dental Journal, ISSN 0347-9994, Vol. 30, no 1, p. 9-15Article in journal (Refereed)
    Abstract [en]

    We have previously introduced anew concept for natural jaw function suggesting that "functional jaw movements" are the result of coordinated jaw and neck muscle activation, leading to simultaneous movements in the temporomandibular, atlanto-occipital and cervical spine joints. Thus, jaw function requires a healthy state of both the jaw and the neck motor systems. The aim of this study was to examine the positioning of the gape in space during maximal jaw opening at fast and slow speed in healthy as well as whiplash-associated disorders (WAD) individuals. A wireless optoelectronic technique for three-dimensional movement recording was used. Subjects were seated in an upright position,with back support up to the mid-scapular level without headrest. The position of the gape in space was defined as the vertical midpoint position of the gape at maximal jaw opening (MP). In healthy, the MP generally coincided with the reference position at the start of jaw opening. In the WAD group, the MID was significantly lower than the reference position. No sex or speed related differences were found. The results suggest that both the width and orientation of the gape in space relies on coordinated jaw and neck muscle activation and mandibular and head-neck movements. This study also suggests an association between neck pain and dysfunction following trauma, and reduced width and impaired positioning of the gape in space. Finally, the MP seems to be a useful marker in evaluation of the functional state of the jaw-neck motor system.

  • 2311.
    Zetterberg, Camilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Högskolan i Gävle, Avdelningen för arbets- och folkhälsovetenskap, Centrum för belastningsskadeforskning. University of Gävle, Department of Occupational and Public Health Sciences, Centre for Musculoskeletal Research..
    The impact of visually demanding near work on neck/shoulder discomfort and trapezius muscle activity: Laboratory studies2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Musculoskeletal discomfort in the neck and shoulders is common among workers performing visually demanding near work, e.g., on a computer screen, and sustained low-level muscle activity during such work can lead to work-related pain. The relationships between visual demands and muscle activity and discomfort in the neck/shoulder region are at present unclear. Aim: The aims of this thesis were to determine whether neck/shoulder discomfort and trapezius muscle activity increases during visually demanding experimental near work, and to investigate whether eye-lens accommodation is a mediating mechanism behind increased trapezius muscle activity. Methods: The four papers included are based on two experiments with different visually demanding near work tasks (duration 5 and 7 min). Trial lenses of different diopters were used to manipulate the visual demands (i.e., induce more or less accommodation) and thereby create different viewing conditions. Monocular viewing, which does not require active convergence, was used to examine the isolated effect of accommodation. Eye-lens accommodation and trapezius muscle activity were measured continuously during the visual tasks, and in one experiment the participants rated their eye and neck/shoulder discomfort at baseline and after each visual task. Results: Neck/shoulder discomfort and trapezius muscle activity increased during the visually demanding near work and participants experiencing a greater increase in eye discomfort (compared with baseline) also developed more neck/shoulder discomfort with time. There were no significant differences in muscle activity among the viewing conditions, and no effect of isolated accommodation response within the monocular viewing conditions. Conclusion: These findings indicate that accommodation per se is unlikely to mediate trapezius muscle activity. Instead, the increase in trapezius muscle activity observed here may be due to a combination of high visual attention and enhanced requirement for eye-neck (head) stabilisation. Since these results suggest that neck/shoulder discomfort may aggravate with time when the visual demands are high, it is important to provide good visual conditions in connection with visually demanding occupations.

  • 2312.
    Zetterberg, Camilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Uppsala universitet, Arbets- och miljömedicin.
    The impact of visually demanding near work on neck/shoulder discomfort and trapezius muscle activity: Laboratory studies2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Musculoskeletal discomfort in the neck and shoulders is common among workers performing visually demanding near work, e.g., on a computer screen, and sustained low-level muscle activity during such work can lead to work-related pain. The relationships between visual demands and muscle activity and discomfort in the neck/shoulder region are at present unclear. Aim: The aims of this thesis were to determine whether neck/shoulder discomfort and trapezius muscle activity increases during visually demanding experimental near work, and to investigate whether eye-lens accommodation is a mediating mechanism behind increased trapezius muscle activity. Methods: The four papers included are based on two experiments with different visually demanding near work tasks (duration 5 and 7 min). Trial lenses of different diopters were used to manipulate the visual demands (i.e., induce more or less accommodation) and thereby create different viewing conditions. Monocular viewing, which does not require active convergence, was used to examine the isolated effect of accommodation. Eye-lens accommodation and trapezius muscle activity were measured continuously during the visual tasks, and in one experiment the participants rated their eye and neck/shoulder discomfort at baseline and after each visual task. Results: Neck/shoulder discomfort and trapezius muscle activity increased during the visually demanding near work and participants experiencing a greater increase in eye discomfort (compared with baseline) also developed more neck/shoulder discomfort with time. There were no significant differences in muscle activity among the viewing conditions, and no effect of isolated accommodation response within the monocular viewing conditions. Conclusion: These findings indicate that accommodation per se is unlikely to mediate trapezius muscle activity. Instead, the increase in trapezius muscle activity observed here may be due to a combination of high visual attention and enhanced requirement for eye-neck (head) stabilisation. Since these results suggest that neck/shoulder discomfort may aggravate with time when the visual demands are high, it is important to provide good visual conditions in connection with visually demanding occupations.

  • 2313.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Forsman, Mikael
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Richter, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Effects of visually demanding near work on trapezius muscle activity2013In: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 23, no 5, p. 1190-1198Article in journal (Refereed)
    Abstract [en]

    Poor visual ergonomics is associated with visual and neck/shoulder discomfort, but the relation between visual demands and neck/shoulder muscle activity is unclear. The aims of this study were to investigate whether trapezius muscle activity was affected by: (i) eye-lens accommodation; (ii) incongruence between accommodation and convergence; and (iii) presence of neck/shoulder discomfort. Sixty-six participants (33 controls and 33 with neck pain) performed visually demanding near work under four different trial-lens conditions. Results showed that eye-lens accommodation per se did not affect trapezius muscle activity significantly. However, when incongruence between accommodation and convergence was present, a significant positive relationship between eye-lens accommodation and trapezius muscle activity was found. There were no significant group-differences. It was concluded that incongruence between accommodation and convergence is an important factor in the relation between visually demanding near work and trapezius muscle activity. The relatively low demands on accommodation and convergence in the present study imply that visually demanding near work may contribute to increased muscle activity, and over time to the development of near work related neck/shoulder discomfort.

  • 2314.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Forsman, Mikael
    Karolinska Institutet.
    Richter, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Undermålig synergonomi kan påverka muskelaktivitet och nacksmärta2011Conference paper (Refereed)
    Abstract [sv]

    Bakgrund och syfte:Det är väl dokumenterat att kroppen kompenserar undermåliga synergonomiska förhållanden med ogynnsamma arbetsställningar. Det är däremot inte klarlagt om ökad belastning av ögats muskler påverkar muskelaktivitet och smärta i nackens muskulatur. Syftet med studien var att experimentellt fastställa om ökad belastning på ögats fokuseringsmuskler vid simulerat bildskärmsarbete ger ökad aktivitet i m. trapezius och ökad upplevd nacksmärta.Metoder:Sextiosex forskningspersoner (20-47 år, 54 kvinnor, 12 män) utförde en synuppgift under tre olika randomiserade synförhållanden (binokulärt -3.5D, monokulärt -3.5D och ±0D). Uppgiften var att fokusera blicken på ett mönster på en bildskärm, placerad på 1.5 m avstånd, under 7 minuter. Förhållanden med -3.5D gjorde mönstret oskarpt och personen instruerades att viljemässigt fokusera bort oskärpan. Belastning på ögats fokuseringsmuskel mättes indirekt med en kamera (Plusoptix, Nürnberg, Tyskland). Muskelaktivitet i m. trapezius mättes med EMG. Före och efter experimentet skattade personen sin upplevda nacksmärta med Borgs CR10-skala. Under experimentet satt försökspersonen lätt tillbakalutad i en kontorsstol med nackstöd. Personerna instruerades att sitta bekvämt och avslappnat och att upprätthålla kontakt med nackstödet.Resultat:Resultatet visade att personer med en högre grad av fokusering i binokulärt förhållande (-3.5D), hade högre amplitud EMG i m. trapezius. De två monokulära förhållandena visade inget samband mellan grad av fokuserig och EMG amplitud. Detta tyder på ett positivt samband mellan ögats fokusering (ackommodation och konvergens) och aktivering i trapezius muskulaturen. Resultatet visar också att personer skattar högre nacksmärta efter experimentet jämfört med före. Konklusion:Vid simulerat bildskärmsarbete med undermåliga synförhållanden, kan förhöjd aktivitet i m. trapezius och ökad upplevd nacksmärta uppkomma efter kort tid, även om arbetsställningen är god.

  • 2315.
    Zetterberg, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Högskolan i Gävle, Avdelningen för arbets- och folkhälsovetenskap, Centrum för belastningsskadeforskning. University of Gävle, Department of Occupational and Public Health Sciences, Centre for Musculoskeletal Research..
    Forsman, Mikael
    Karolinska Institutet, Institutet för miljömedicin.
    Richter, Hans O
    Högskolan i Gävle, Avdelningen för arbets- och folkhälsovetenskap, Centrum för belastningsskadeforskning. University of Gävle, Department of Occupational and Public Health Sciences, Centre for Musculoskeletal Research..
    Neck/shoulder discomfort due to visually demanding near work is influenced by previous neck pain, task duration, astigmatism, eye discomfort and accommodation.Manuscript (preprint) (Other academic)
    Abstract [en]

    Visually demanding near work can cause eye discomfort, and eye and neck/shoulder discomfort during, e.g., computer work are associated. Here, to investigate direct effects of experimental near work on eye and neck/shoulder discomfort, 33 individuals with chronic neck pain and 33 healthy control subjects performed four visual tasks, rating eye and neck/shoulder discomfort at baseline and after each task. The cumulative performance time (reflected in the temporal order of the tasks), astigmatism, concurrent eye discomfort, and extent of accommodation all aggravated neck/shoulder discomfort. There was an interaction effect between the temporal order and eye discomfort: participants with a greater mean increase in eye discomfort also developed more neck/shoulder discomfort with time. Since moderate musculoskeletal symptoms are a risk factor for more severe symptoms, it is important to ensure a good visual environment in occupations involving visually demanding near work.

  • 2316.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Uppsala universitet, Arbets- och miljömedicin.
    Forsman, Mikael
    Institutet för miljömedicin, Karolinska Institutet, Stockholm, Sverige.
    Richter, Hans O.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Neck/shoulder discomfort due to visually demanding near work is influenced by previous neck pain, task duration, astigmatism, eye discomfort and accommodation2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 8, article id e0182439Article in journal (Refereed)
    Abstract [en]

    Visually demanding near work can cause eye discomfort, and eye and neck/shoulder discomfort during, e.g., computer work are associated. Here, to investigate direct effects of experimental near work on eye and neck/shoulder discomfort, 33 individuals with chronic neck pain and 33 healthy control subjects performed four visual tasks, rating eye and neck/shoulder discomfort at baseline and after each task. The cumulative performance time (reflected in the temporal order of the tasks), astigmatism, concurrent eye discomfort, and extent of accommodation all aggravated neck/shoulder discomfort. There was an interaction effect between the temporal order and eye discomfort: participants with a greater mean increase in eye discomfort also developed more neck/shoulder discomfort with time. Since moderate musculoskeletal symptoms are a risk factor for more severe symptoms, it is important to ensure a good visual environment in occupations involving visually demanding near work.

  • 2317.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Lindberg, Per
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Nylén, Per
    The Swedish Work Environment Authority, and The Royal Institute of Technology.
    Hemphälä, Hillevi
    Lund University.
    Intra-rater reliability of the Visual Ergonomics Risk Assessment Method (VERAM)2018Conference paper (Refereed)
    Abstract [en]

    Introduction: Visually demanding near work can cause eye discomfort, and eye and neck/shoulder discomfort during, e.g., computer work are associated. Apart from visual demands and dryness a number of environmental factors including design of the work station, lighting, glare, and the quality of the computer screen might exert an impact on eye-related symptoms. To date, there is a lack of valid and reliable instruments assessing factors associated with eye- or visual symptoms. Therefore, a new method to assess visual ergonomics at workplaces was developed in Sweden between 2014 and 2016, the Visual Ergonomics Risk Assessment Method - VERAM. A first version of the method was drafted by the researchers mainly from existing checklists and instruments, and tested in the field by trained visual ergonomists. The method was then revised and used in the field to collect data for validity and reliability analyses. The final version of VERAM includes both a questionnaire for the employee, and an expert evaluation of the employee’s workplace. The questionnaire consists of subjective ratings in six domains: eye discomfort (frequency and intensity), musculoskeletal discomfort (frequency and intensity), ratings of visual symptoms (e.g. blurred and double vision) and ratings of the visual environment (e.g. illumination levels, glare and reflexes from a work object or a computer screen). The expert evaluation consists of both objective measurements and subjective assessments resulting in an overall expert risk assessment (no risk, low risk or high risk) of eight factors: daylight, lighting, illuminance, glare, flicker, work space, work object and work posture.

    Aim: At the IEA conference 2018 the new VERAM method will be presented together with results from intra-rater reliability analyses.

    Results: Intra-rater reliability was evaluated with a re-test interval of minimum two and maximum three weeks. 99 employees were included in the analyses and 32 visual ergonomists performed the corresponding expert evaluations. The Intraclass Correlations (ICC) were between 0.70 and 0.87 for the six subjective domains, and there were no significant systematic differences between the first and second rating for any of the subjective domains (rmANOVA, p > 0.05, α = 0.008). For the eight environmental factors the expert estimated the risk equally during the first and the second assessment in 69-92% of the cases, and, as seen for the subjective domains, there were no significant systematic differences for any of the eight factors (Wilcoxon sign rank test, p > 0.014, α = 0.006). To control for multiple comparisons the Bonferroni method was used.

    Conclusion: The Visual Ergonomics Risk Assessment Method – VERAM showed good intra-rater reliability, both for the subjective questionnaire for the employee, and for the expert evaluation of the employee’s workplace when performed by a trained visual ergonomist.

  • 2318.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Lindberg, Per
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Nylén, Per
    Swedish Work Environment Authority, Stockholm, Sweden.
    Hemphälä, Hillevi
    Division of Ergonomics and Aerosol Technology, Design Sciences, Lund University, Lund, Sweden.
    Reliability of a new risk assessment method for visual ergonomics2019In: International Journal of Industrial Ergonomics, ISSN 0169-8141, E-ISSN 1872-8219, Vol. 72, p. 71-79Article in journal (Refereed)
    Abstract [en]

    Introduction

    The Visual Ergonomics Risk Assessment Method (VERAM) is a newly developed and validated method to assess visual ergonomics at workplaces. VERAM consists of a questionnaire and an objective evaluation.

    Objective

    To evaluate reliability of VERAM by assessing test-retest reliability of the questionnaire, and intra- and inter-rater reliability of the objective evaluation.

    Methods

    Forty-eight trained evaluators used VERAM to evaluate visual ergonomics at 174 workstations. The time interval for test-retest and intra-rater evaluations was 2–3 weeks, and the time interval for inter-rater evaluations was 0–2 days. Test-retest reliability was assessed by intraclass correlation (ICC), the standard error of measurement (SEM) and the smallest detectable change (SDC). Intra- and inter-rater reliability were assessed with weighted kappa coefficients and absolute agreement. Systematic changes were analysed with repeated measures analyses of variance and Wilcoxon sign rank test.

    Results

    The ICC of the questionnaire indices ranged from 0.69 to 0.87, while SEM ranged from 7.21 to 10.19 on a scale from 1 to 100, and SDC from 14.42 to 20.37. Intra-rater reliability of objective evaluations ranged from 0.57 to 0.85 (kappa coefficients) and the agreement from 69 to 91%. Inter-rater reliability of objective evaluations ranged from 0.37 to 0.72 (kappa coefficients) and the agreement from 52 to 87%.

    Conclusion

    VERAM is a reliable instrument for assessing risks in visual work environments. However, the reliability might increase further by improving the quality of training for evaluators. Complementary evaluations of VERAM's sensitivity to changes in the visual environment are needed.

    Relevance to industry

    It is advantageous to set up a work environment for maximal visual comfort to avoid negative effects on work postures and movements and thus prevent visual- and musculoskeletal symptoms. This method, VERAM, satisfies the need of a valid and reliable tool for determining risks associated with the visual work environment.

  • 2319.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Department of Medical Sciences, Section of Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden..
    Hemphälä, Hillevi
    Ergonomics, Design Sciences, Lund University, Lund, Sweden.
    Nylén, Per
    The Swedish Work Environment Authority, and The Royal Institute of Technology.
    Lighting, visual ergonomics and health implications : A workshop2014Conference paper (Refereed)
    Abstract [en]

    Aim of the workshop:

    Deficient visual ergonomics is a problem across many occupations. Poor viewingand lighting conditions is associated with both visual and neck/shoulder discomfort,and can also impact productivity. According to the provision from the Swedish WorkEnvironment Authority on prevention of musculoskeletal disorders (AFS 2012:02), riskassessment of the visual conditions are mandatory. The aim of this workshop is toincrease knowledge about visual ergonomics among practitioners working with riskassessment, and to allow participants hands-on practice in assessing the visual environment.

    Format of the workshop:

    The first part of the workshop will involve a brief presentation of the subject visualergonomics and its implications on health and performance. The impact of progressiveglasses, too small or blurred font letters, or blurred vision on posture at e.g. computerwork will be demonstrated together with advice how to proceed to improve the conditions.The second part of the workshop will allow participants some hands-on practicein for example; how to measure light (luminance and illuminance); how different lightconditions impact pupil size and visual comfort; how to measure and quantify amountof flicker, light modulation and colour rendering in different light sources. Several usefulmobile phone applications concerning light and vision will be demonstrated.

  • 2320.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Hemphälä, Hillevi
    Lund University.
    Nylén, Per
    The Swedish Work Environment Authority, and The Royal Institute of Technology.
    Workshop in visual ergonomics2013Conference paper (Refereed)
    Abstract [en]

    Increased use of computers is common across many work sectors. Prolonged near work at a computer screen is associated with both visual discomfort and neck/shoulder discomfort and pain. Inadequate visual ergonomics at a computer workstation can also influence both visual and neck/shoulder discomfort. The new provision from the Swedish Work Environment Authority on prevention of musculoskeletal disorders includes risk assessment of occupational visual conditions. These assessments require practitioners to have knowledge of the topic, as well as experience with practical assessment tools.

    The first part of the workshop proposed here will involve a presentation of the theories underlying visual ergonomic practices and a discussion of the most important factors to assess at a computer workstation. These factors include contrast, font size, resolution, glare, reflexion, non-visual flicker, and edge sharpness. The second part of the workshop, will allow participants hands-on practice in measuring and evaluating visual ergonomics at a computer workstation.

  • 2321.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Department of Medical Sciences, Section of Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden..
    Richter, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Forsman, Mikael
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Temporal co-variation between eye lens accommodation and trapezius muscle activity during a dynamic near-far visual task2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0126578Article in journal (Refereed)
    Abstract [en]

    Near work is associated with increased activity in the neck and shoulder muscles, but the underlying mechanism is still unknown. This study was designed to determine whether a dynamic change in focus, alternating between a nearby and a more distant visual target, produces a direct parallel change in trapezius muscle activity. Fourteen healthy controls and 12 patients with a history of visual and neck/shoulder symptoms performed a Near-Far visual task under three different viewing conditions; one neutral condition with no trial lenses, one condition with negative trial lenses to create increased accommodation, and one condition with positive trial lenses to create decreased accommodation. Eye lens accommodation and trapezius muscle activity were continuously recorded. The trapezius muscle activity was significantly higher during Near than during Far focusing periods for both groups within the neutral viewing condition, and there was a significant co-variation in time between accommodation and trapezius muscle activity within the neutral and positive viewing conditions for the control group. In conclusion, these results reveal a connection between Near focusing and increased muscle activity during dynamic changes in focus between a nearby and a far target. A direct link, from the accommodation/vergence system to the trapezius muscles cannot be ruled out, but the connection may also be explained by an increased need for eye-neck (head) stabilization when focusing on a nearby target as compared to a more distant target.

  • 2322.
    Zetterberg, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. University of Gävle, Department of Occupational and Public Health Sciences, Centre for Musculoskeletal Research.
    Richter, Hans O.
    Forsman, Mikael
    Temporal Co-Variation between Eye Lens Accommodation and Trapezius Muscle Activity during a Dynamic Near-Far Visual Task2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0126578Article in journal (Refereed)
    Abstract [en]

    Near work is associated with increased activity in the neck and shoulder muscles, but the underlying mechanismis still unknown. This study was designed to determine whether a dynamic change in focus, alternating between a nearby and a more distant visual target, produces a direct parallel change in trapezius muscle activity. Fourteen healthy controls and 12 patients with a history of visual and neck/shoulder symptoms performed a Near-Far visual task under three different viewing conditions; one neutral condition with no trial lenses, one condition with negative trial lenses to create increased accommodation, and one condition with positive trial lenses to create decreased accommodation. Eye lens accommodation and trapeziusmuscle activity were continuously recorded. The trapezius muscle activity was significantly higher during Near than during Far focusing periods for both groups within the neutral viewing condition, and there was a significant co-variation in time between accommodation and trapezius muscle activity within the neutral and positive viewing conditions for the control group. In conclusion, these results reveal a connection between Near focusing and increased muscle activity during dynamic changes in focus between a nearby and a far target. A direct link, from the accommodation/vergence system to the trapezius muscles cannot be ruled out, but the connection may also be explained by an increased need for eye-neck (head) stabilization when focusing on a nearby target as compared to a more distant target.

  • 2323.
    Zetterlund, Christina
    et al.
    Centre for Rehabilitation Research, Örebro University Hospital.
    Lundqvist, Lars-Olof
    Centre for Rehabilitation Research, Örebro University Hospital.
    Richter, Hans
    University of Gävle, Centre for Musculoskeletal Research. University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science.
    The relationship between low vision and musculoskeletal complaints: A case control study between age-related macular degeneration patients and age-matched controls with normal vision2009In: Journal of Optometry, ISSN 1888-4296, Vol. 2, no 3, p. 127-133Article in journal (Refereed)
    Abstract [en]

    Introduction: Age-related Macular Degeneration (AMD) patients often describe complaints from neck and scapula area muscles and a decreased postural control. In clinical assessment, these complaints are considered to be due to old age. Purpose: This study focuses on low vision patients with AMD, compared to age matched controls, without eye disease, in order to evaluate if a linkage between self-rated visual and muskuloskeletal complaints are more prominent when low vision is present. Methods: In a cross-sectional study, 24 AMD patients, aged 65-85 years, were compared to 24 controls of similar ages without visual problems. Visual acuity, the need for magnification plus other optical and visual data, were obtained. Visual, muskuloskeletal and balance/propriopceptive complaints were collected with a self-rating questionnaire. The Visual Functioning Questionnaire -Near Activities Subscale (VFQ-NAS) was used to evaluate visual function and related complaints. Results: The correlation coefficient between visual and musculoskeletal complaints yielded significant values when computed separately within each group as well as when calculated on the entire material (AMD ρ = 0.60, P = 0.002; control group ρ = 0.59, P = 0.004; both groups together ρ = 0.50 P < 0.001). Stepwise multiple regression analysis supported the hypothesized effect of vision (Visual complaints + Minimal readable typefaces) on musculoskeletal complaints, (R2 = 0.42, P < 0.05). Conclusions: The results in this study support the hypothesis of a relationship between visual and muskuloskeletal problems.

  • 2324.
    Zetterlund, Christina
    et al.
    School of Health and Medicine, Örebro University, Örebro, Sweden.
    Lundqvist, Lars-Olov
    Centre for Rehabilitiation Research, Örebro County Council, Örebro, Sweden.
    Richter, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Visual, musculoskeletal and balance symptoms in individuals with visual impairment and with age-normal vision2019In: Clinical and experimental optometry, ISSN 0816-4622, E-ISSN 1444-0938, Vol. 102, no 1, p. 63-69Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Visual impairment is globally among the most prevalent disabilities. Research concerning the health consequences of visual deficits is challenged by confounding effects of age, because visual impairment becomes more prevalent with age. This study investigates the influence of visual deficits on visual, musculoskeletal and balance symptoms in adults with and without visual impairment, while controlling for age effects.

    METHODS:

    Thirty-nine patients with visual impairment, aged 18-72 years, were compared to 37 age-matched controls with normal vision, allocated to two age groups: < 45 and ≥ 45 years. Self-reported symptoms were measured using the Visual, Musculoskeletal and Balance Symptoms Questionnaire and compared with demographic and optometric variables.

    RESULTS:

    In total, patients with visual impairment reported more symptoms than age-matched normally sighted controls. Younger adults in the control group were almost free from symptoms, whereas younger adults with visual impairment reported levels of symptoms equal to older adults with visual impairment. Multiple logistic regression modelling identified use of eyeglasses, magnifying aids and presence of anisometropia to be the most influential risk factors for reporting visual, musculoskeletal and balance symptoms, with accentuated influence on balance symptoms.

    CONCLUSIONS:

    People with visual impairments and people with age-related normal visual deficits are both predisposed to report visual, musculoskeletal and balance symptoms relative to people without visual defects or need for eye-wear correction. Age-related variations in symptoms were observed in the control groups but not in the visual impairment groups, with younger visual impairment patients reporting as many symptoms as older visual impairment patients. These findings indicate a need for a wider interdisciplinary perspective on eye care concerning people with visual impairment and people with need for habitual daily use of eye wear correction.

  • 2325.
    Zetterlund, Christina
    et al.
    The Low Vision Centre, Region Örebro County, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Richter, Hans O.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Lundqvist, Lars-Olov
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Visual, Musculoskeletal, and Balance Complaints in AMD: A Follow-Up Study2016In: Journal of Ophthalmology, ISSN 2090-004X, E-ISSN 2090-0058, Vol. 2016, article id 2707102Article in journal (Refereed)
    Abstract [en]

    Purpose. To investigate whether patients with age-related macular degeneration (AMD) run a potentially higher risk of developing visual, musculoskeletal, and balance complaints than age-matched controls with normal vision. Methods. Visual assessments, self-rated visual function, self-rated visual, musculoskeletal, and balance complaints, and perceived general health were obtained in 37 AMD patients and 18 controls, at baseline and after an average of 3.8 years later. Results. At follow-up both groups reported decreased visual acuity (VA) and visual function, but only AMD patients reported significantly increased visual, musculoskeletal, and balance complaints. Decreased VA, need for larger font size when reading, need for larger magnification, and decreased self-rated visual function were identified as risk markers for increased complaints in AMD patients. These complaints were also identified as risk markers for decreased health. For controls, decreased VA and self-reported visual function were associated with increased visual and balance complaints. Conclusions. Visual deterioration was a risk marker for increased visual, musculoskeletal, balance, and health complaints in AMD patients. Specifically, magnifying visual aids, such as CCTV, were a risk marker for increased complaints in AMD patients. This calls for early and coordinated actions to treat and prevent visual, musculoskeletal, balance, and health complaints in AMD patients.

  • 2326.
    Zhang, Jiming
    et al.
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Guo, Jianqiu
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Lu, Dasheng
    Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
    Qi, Xiaojuan
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China; Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
    Chang, Xiuli
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Wu, Chunhua
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Zhang, Yubin
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Liang, Weijiu
    Shanghai Center for Disease Control and Prevention, Shanghai, China.
    Fang, Xin
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Zhou, Zhijun
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Maternal urinary carbofuranphenol levels before delivery and birth outcomes in Sheyang Birth Cohort2018In: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 625, p. 1667-1672Article in journal (Refereed)
    Abstract [en]

    Exposure to carbamates has been linked with adverse health effects on developmental period. This study aimed to monitor exposure to carbofuranphenol of pregnant women from Sheyang Birth Cohort and investigate associations between prenatal exposure to carbofuranphenol and birth outcomes. During June 2009 to January 2010, 1100 pregnant women living in Sheyang County participated in our study and donated urine sample. Urinary carbofuranphenol concentration was measured by gas chromatography-tandem mass spectrometry. Associations between urinary carbofuranphenol levels and infant birth outcomes were assessed by generalized linear models. Urinary carbofuranphenol concentrations varied from 0.01 to 395.40μg/L (0.01-303.93μg/g for creatinine adjusted), the geometric mean, median and inter quartile range are 0.81μg/L (1.28μg/g cr), 0.80μg/L (1.23μg/g cr) and 0.27-2.20μg/L (0.47-3.11μg/g cr), respectively. No statistically significant association between maternal urinary carbofuranphenol levels and birth outcomes was found in total infants and female infants. In male neonates, carbofuranphenol level was significantly associated with head circumference (b=-0.226; 95% confidence interval: -0.411, -0.041; P=0.01) and ponderal index (b=0.043, 95% CI: 0.004, 0.083; P=0.03). These findings suggested that the pregnant women were generally exposed to carbofuranphenol and prenatal exposure to carbofuranphenol might have adverse effects on fetal development.

  • 2327.
    Zhang, Jiming
    et al.
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Guo, Jianqiu
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Wu, Chunhua
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Qi, Xiaojuan
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Jiang, Shuai
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Lu, Dasheng
    Shanghai Center for Disease Control and Prevention, Shanghai, China.
    Feng, Chao
    ai Center for Disease Control and Prevention, Shanghai, China.
    Liang, Weijiu
    Changning Center for Disease Control and Prevention, Shanghai, China.
    Chang, Xiuli
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Zhang, Yubin
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Wang, Guoquan
    Shanghai Center for Disease Control and Prevention, Shanghai, China.
    Zhou, Zhijun
    School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
    Exposure to carbamate and neurodevelopment in children: Evidence from the SMBCS cohort in China2019In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 177, article id 108590Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Carbamate pesticides exposure have been linked with adverse health effects during developmental period. Based on 377 mother-child pairs from Sheyang Mini Birth Cohort Study, the present study aimed to assess carbofuranphenol exposure of three-year-old children and explore the associations between prenatal or postnatal carbofuranphenol exposures and neurodevelopmental indicators.

    METHODS: Urinary carbofuranphenol concentrations were measured by gas chromatography-tandem mass spectrometry. Neural developmental quotient (DQ) of children was evaluated using Gesell Developmental Schedules. Generalized linear models were used to examine the associations between carbofuranphenol concentrations and neurodevelopment.

    RESULTS: Geometric mean, geometric standard deviation, median, inter quartile range of postnatal urinary carbofuranphenol concentrations were 0.653 μg/L, 9.345 μg/L, 0.413 μg/L, 0.150-1.675 μg/L, respectively. Postnatal carbofuranphenol level showed negatively significant trend in language DQ [beta (β) = -0.121; 95% confidence interval (95% CI): 0.212, -0.031; p value (p) = 0.008] and total average DQ (β = -0.059, 95% CI: 0.115, -0.003; p = 0.035). Prenatal carbofuranphenol level showed negative correlations with children's adaptive DQ (β = -0.755; 95% CI: 1.257, -0.254; p = 0.003), social DQ (β = -0.341; 95% CI: 0.656, -0.027; p = 0.032) and total average DQ (β = -0.349; 95% CI: 0.693, -0.005; p = 0.047).

    CONCLUSION: The results of the present study supposed children in agricultural region of China are widely exposed to carbamate pesticides, and both prenatal and postnatal exposure to carbamate pesticides may lead to neurodevelopmental effect.

  • 2328. Zhang, Xin
    et al.
    Li, Fan
    Zhang, Li
    Zhao, Zhuohui
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    A Longitudinal Study of Sick Building Syndrome (SBS) among Pupils in Relation to SO2, NO2, O-3 and PM10 in Schools in China2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 11, p. e112933-Article in journal (Refereed)
    Abstract [en]

    There are fewer longitudinal studies from China on symptoms as described for the sick building syndrome (SBS). Here, we performed a two-year prospective study and investigated associations between environmental parameters such as room temperature, relative air humidity (RH), carbon dioxide (CO2), nitrogen dioxide (NO2), sulphur dioxide (SO2), ozone (O-3), particulate matter (PM10), and health outcomes including prevalence, incidence and remission of SBS symptoms in junior high schools in Taiyuan, China. Totally 2134 pupils participated at baseline, and 1325 stayed in the same classrooms during the study period (2010-2012). The prevalence of mucosal symptoms, general symptoms and symptoms improved when away from school (school-related symptoms) was 22.7%, 20.4% and 39.2%, respectively, at baseline, and the prevalence increased during follow-up (P<0.001). At baseline, both indoor and outdoor SO2 were found positively associated with prevalence of school-related symptoms. Indoor O-3 was shown to be positively associated with prevalence of skin symptoms. At follow-up, indoor PM10 was found to be positively associated with new onset of skin, mucosal and general symptoms. CO2 and RH were positively associated with new onset of mucosal, general and school-related symptoms. Outdoor SO2 was positively associated with new onset of skin symptoms, while outdoor NO2 was positively associated with new onset of skin, general and mucosal symptoms. Outdoor PM10 was found to be positively associated with new onset of skin, general and mucosal symptoms as well as school-related symptoms. In conclusion, symptoms as described for SBS were commonly found in school children in Taiyuan City, China, and increased during the two-year follow-up period. Environmental pollution, including PM10, SO2 and NO2, could increase the prevalence and incidence of SBS and decrease the remission rate. Moreover, parental asthma and allergy (heredity) and pollen or pet allergy (atopy) can be risk factors for SBS.

  • 2329.
    Zhang, Xin
    et al.
    Shanxi Univ, Inst Environm Sci, Taiyuan, Shanxi, Peoples R China.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Shanxi Univ, Inst Environm Sci, Taiyuan, Shanxi, Peoples R China.
    Fan, Qiannan
    Shanxi Univ, Inst Environm Sci, Taiyuan, Shanxi, Peoples R China.
    Bai, Xu
    Shanxi Univ, Inst Environm Sci, Taiyuan, Shanxi, Peoples R China.
    Li, Tian
    Shanxi Univ, Inst Environm Sci, Taiyuan, Shanxi, Peoples R China.
    Zhang, Yinping
    Tsinghua Univ, Sch Architecture, Beijing, Peoples R China.
    Li, Baizhan
    Chongqing Univ, Key Lab Three Gorges Reservoir Reg Ecoenvironm, Chongqing, Peoples R China.
    Zhao, Zhuohui
    Fudan Univ, Dept Environm Hlth, Shanghai, Peoples R China.
    Huang, Chen
    Univ Shanghai Sci & Technol, Dept Bldg Environm & Energy Engn, Sch Environm & Architecture, Shanghai, Peoples R China.
    Deng, Qihong
    Cent S Univ, XiangYa Sch Publ Hlth, Changsha, Hunan, Peoples R China;Cent S Univ, Sch Energy Sci & Engn, Changsha, Hunan, Peoples R China.
    Lu, Chan
    Cent S Univ, XiangYa Sch Publ Hlth, Changsha, Hunan, Peoples R China;Cent S Univ, Sch Energy Sci & Engn, Changsha, Hunan, Peoples R China.
    Qian, Hua
    Southeast Univ, Sch Energy & Environm, Nanjing, Jiangsu, Peoples R China.
    Xu, Yang
    Cent China Normal Univ, Coll Life Sci, Wuhan, Hubei, Peoples R China.
    Sun, Yuexia
    Tianjin Univ, Sch Environm Sci & Engn, Tianjin, Peoples R China.
    Sundell, Jan
    Tianjin Univ, Sch Environm Sci & Engn, Tianjin, Peoples R China.
    Wang, Juan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Dampness and mold in homes across China: Associations with rhinitis, ocular, throat and dermal symptoms, headache and fatigue among adults2019In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 29, no 1, p. 30-42Article in journal (Refereed)
    Abstract [en]

    We studied dampness and mold in China in relation to rhinitis, ocular, throat and dermal symptoms, headache and fatigue. A questionnaire study was performed in six cities including 36 541 randomized parents of young children. Seven self-reported signs of dampness were evaluated. Multilevel logistic regression models were used to calculate odds ratios (ORs). Totally, 3.1% had weekly rhinitis, 2.8% eye, 4.1% throat and 4.8% skin symptoms, 3.0% headache and 13.9% fatigue. Overall, 6.3% of the homes had mold, 11.1% damp stains, 35.3% damp bed clothing, 12.8% water damage, 45.4% window pane condensation, 11.1% mold odor, and 37.5% humid air. All dampness signs were associated with symptoms (ORs from 1.2 to 4.6; P < 0.001), including rhinitis (ORs from 1.4 to 3.2; P < 0.001), and ORs increased by number of dampness signs. The strongest associations were for mold odor (ORs from 2.3 to 4.6) and humid air (ORs from 2.8 to 4.8). Associations were stronger among men and stronger in Beijing as compared to south China. In conclusion, dampness and mold are common in Chinese homes and associated with rhinitis and ocular, throat and dermal symptoms, headache and fatigue. Men can be more sensitive to dampness and health effects of dampness can be stronger in northern China.

  • 2330. Zhang, Y
    et al.
    Li, B
    Huang, C
    Norback, D
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Ten cities cross-sectional questionnaire survey of children asthma and other allergies in China2013In: Chinese Science Bulletin, ISSN 1001-6538, E-ISSN 1861-9541, Vol. 58, no 34, p. 4182-4189Article in journal (Refereed)
  • 2331.
    Zhao, Z
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Zhang, X
    Liu, R
    Norback, D
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Prenatal and early life home environment exposure in relation to preschool childrens asthma, allergic rhinitis and eczema in Taiyuan, China.2013In: Chinese Science Bulletin, ISSN 1001-6538, E-ISSN 1861-9541, Vol. 58, no 34, p. 4245-4251Article in journal (Refereed)
  • 2332.
    Zhao, Zhuohui
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Zhang, Zheng
    Wang, Zhuanhua
    Ferm, Martin
    Liang, Yanling
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Asthmatic Symptoms among Pupils in Relation to Winter Indoor and Outdoor Air Pollution in Schools in Taiyuan, China2008In: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 116, no 1, p. 90-97Article in journal (Refereed)
    Abstract [en]

    Background: There are few studies on associations between children's respiratory heath and air pollution in schools in China. The industrial development and increased traffic may affect the indoor exposure to air pollutants in school environment. Moreover, there is a need to study respiratory effects of environmental tobacco smoke (ETS) and emissions from new building materials in homes in China.

    Objectives: We studied the associations between pupils' asthmatic symptoms and indoor and outdoor air pollution in schools, as well as selected home exposures, in a coal-burning city in north China.

    Methods: A questionnaire survey was administered to pupils (11–15 years of age) in 10 schools in urban Taiyuan, collecting data on respiratory health and selected home environmental factors. Indoor and outdoor school air pollutants and climate factors were measured in winter.

    Results: A total of 1,993 pupils (90.2%) participated ; 1.8% had cumulative asthma, 8.4% wheezing, 29.8% had daytime attacks of breathlessness. The indoor average concentrations of sulfur dioxide, nitrogen dioxide, ozone, and formaldehyde by class were 264.8, 39.4, 10.1, and 2.3 µg/m3, respectively. Outdoor levels were two to three times higher. Controlling for possible confounders, either wheeze or daytime or nocturnal attacks of breathlessness were positively associated with SO2, NO2, or formaldehyde. In addition, ETS and new furniture at home were risk factors for wheeze, daytime breathlessness, and respiratory infections.

    Conclusions: Indoor chemical air pollutants of mainly outdoor origin could be risk factors for pupils' respiratory symptoms at school, and home exposure to ETS and chemical emissions from new furniture could affect pupils' respiratory health.

  • 2333. Zheng, Guang
    et al.
    Tian, Liting
    Liang, Yihuai
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Broberg, Karin
    Lei, Lijian
    Guo, Weijun
    Nilsson, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bergdahl, Ingvar A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Skerfving, Staffan
    Jin, Taiyi
    δ-Aminolevulinic acid dehydratase genotype predicts toxic effects of lead on workers' peripheral nervous system2011In: Neurotoxicology, ISSN 0161-813X, E-ISSN 1872-9711, Vol. 32, no 4, p. 374-382Article in journal (Refereed)
    Abstract [en]

    There is a wide variation in sensitivity to lead (Pb) exposure, which may be due to genetic susceptibility towards Pb. We investigated whether a polymorphism (rs1800435) in the δ-aminolevulinic acid dehydratase (ALAD) gene affected the toxicokinetics and toxicodynamics of Pb. Among 461 Chinese Pb-exposed storage battery and 175 unexposed workers, allele frequencies for the ALAD1 and ALAD2 alleles were 0.968 and 0.032, respectively. The Pb-exposed workers had a higher fraction of the ALAD1-2/2-2 genotype than unexposed workers (7.8% vs. 2.3%, p=0.01). The Pb levels in blood (B-Pb) and urine (U-Pb) were higher in Pb-exposed workers carrying the ALAD2 allele compared to homozygotes for ALAD1 (median B-Pb: 606 vs. 499 μg/L; U-Pb: 233 vs. 164 μg/g creatinine), while there was no statistically significant difference in the unexposed controls (median: 24 vs. 37 μg/L, and 3.9 vs. 6.4μg/g creatinine, respectively). High B-Pb and U-Pb were associated with statistically significantly lower sensory and motor conduction velocities in the median, ulnar and peroneal nerves. At the same B-Pb and U-Pb, ALAD1 homozygotes had lower conduction velocities than the ALAD2 carriers. There were similar trends for toxic effects on haem synthesis (zinc protoporphyrin and haemoglobin in blood) and renal function (albumin and N-acetyl-d-β-acetylglucosaminidase in urine), but without statistical significance. There was no difference in Pb toxicokinetics and toxicodynamics associated with VDR BsmI polymorphism. Our results show that the ALAD genotype modifies the relationship between Pb and its toxic effects on the peripheral nervous system. This must be considered in the assessment of risks at Pb exposure.

  • 2334. Zhong, Jia
    et al.
    Karlsson, Oskar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences. Center for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden.
    Wang, Guan
    Li, Jun
    Guo, Yichen
    Lin, Xinyi
    Zemplenyi, Michele
    Sanchez-Guerra, Marco
    Trevisi, Letizia
    Urch, Bruce
    Speck, Mary
    Liang, Liming
    Coull, Brent A
    Koutrakis, Petros
    Silverman, Frances
    Gold, Diane R
    Wu, Tangchun
    Baccarelli, Andrea A
    B vitamins attenuate the epigenetic effects of ambient fine particles in a pilot human intervention trial2017In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 114, no 13, p. 3503-3508Article in journal (Refereed)
    Abstract [en]

    Acute exposure to fine particle (PM2.5) induces DNA methylation changes implicated in inflammation and oxidative stress. We conducted a crossover trial to determine whether B-vitamin supplementation averts such changes. Ten healthy adults blindly received a 2-h, controlled-exposure experiment to sham under placebo, PM2.5 (250 μg/m(3)) under placebo, and PM2.5 (250 μg/m(3)) under B-vitamin supplementation (2.5 mg/d folic acid, 50 mg/d vitamin B6, and 1 mg/d vitamin B12), respectively. We profiled epigenome-wide methylation before and after each experiment using the Infinium HumanMethylation450 BeadChip in peripheral CD4(+) T-helper cells. PM2.5 induced methylation changes in genes involved in mitochondrial oxidative energy metabolism. B-vitamin supplementation prevented these changes. Likewise, PM2.5 depleted 11.1% [95% confidence interval (CI), 0.4%, 21.7%; P = 0.04] of mitochondrial DNA content compared with sham, and B-vitamin supplementation attenuated the PM2.5 effect by 102% (Pinteraction = 0.01). Our study indicates that individual-level prevention may be used to complement regulations and control potential mechanistic pathways underlying the adverse PM2.5 effects, with possible significant public health benefit in areas with frequent PM2.5 peaks.

  • 2335. Zoeller, R. Thomas
    et al.
    Bergman, Ake
    Becher, Georg
    Bjerregaard, Poul
    Bornman, Riana
    Brandt, Ingvar
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Organismal Biology, Environmental toxicology.
    Iguchi, Taisen
    Jobling, Susan
    Kidd, Karen A.
    Kortenkamp, Andreas
    Skakkebaek, Niels E.
    Toppari, Jorma
    Vandenberg, Laura N.
    A path forward in the debate over health impacts of endocrine disrupting chemicals2014In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 13, p. 118-Article in journal (Refereed)
    Abstract [en]

    Several recent publications reflect debate on the issue of "endocrine disrupting chemicals" (EDCs), indicating that two seemingly mutually exclusive perspectives are being articulated separately and independently. Considering this, a group of scientists with expertise in basic science, medicine and risk assessment reviewed the various aspects of the debate to identify the most significant areas of dispute and to propose a path forward. We identified four areas of debate. The first is about the definitions for terms such as "endocrine disrupting chemical", "adverse effects", and "endocrine system". The second is focused on elements of hormone action including "potency", "endpoints", "timing", "dose" and "thresholds". The third addresses the information needed to establish sufficient evidence of harm. Finally, the fourth focuses on the need to develop and the characteristics of transparent, systematic methods to review the EDC literature. Herein we identify areas of general consensus and propose resolutions for these four areas that would allow the field to move beyond the current and, in our opinion, ineffective debate.

  • 2336.
    Åhlin, Julia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rhythm of the job stress blues: Psychosocial working conditions and depression in working life and across retirement2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A work environment characterized by poor psychosocial working conditions may lead to stress and mental health problems such as depression, a common and burdensome public health problem with significant consequences for individuals and for society at large. A number of psychosocial working characteristics have been found to be associated with increased depressive symptoms or clinical depression. This thesis aims to further examine how certain psychosocial working conditions predict depressive symptoms over time, in working life and across retirement. This was done by using several repeated measures from the Swedish Longitudinal Occupational Survey of Health (SLOSH) in 2006–2018.

    In study I, we investigated how long-term patterns of exposure to job demands and job control were associated with major depressive symptoms. Those with high strain (high demands, low control) and active (high demands, high control) jobs were more likely to have subsequent major depressive symptoms compared to those with low strain jobs (low demands, high control). However, after adjusting for baseline depressive symptoms and various demographic factors, the associations did not remain statistically significant.

    In study II, we assessed how job demands, job control and workplace social support were related to long-term development of depressive symptoms. A perception of high job demands and low social support predicted higher or increasing depressive symptom trajectories. In addition, negative changes in job demands, job control and social support were associated with increased symptoms, indicating that the onset of poor working conditions could negatively impact depressive symptoms.

    In study III, we investigated simultaneous and lagged bidirectional associations between job demands, job control, balance between demands and control, social support, procedural justice, effort, reward, balance between efforts and rewards, and depressive symptoms, while controlling for individual time-stable characteristics. There were associations between all work stressors and depressive symptoms when measured simultaneously, except for job control. However, only efforts, were prospectively associated with depressive symptoms measured later.

    In study IV, we examined how the same psychosocial working characteristics as in study III were associated with the development of depressive symptoms across retirement. Generally, depressive symptoms appeared to decrease across retirement. Job demands, job strain, social support, rewards, effort-reward imbalance and procedural justice, but to a lesser extent job control and efforts, were associated with a more negative and positive course of depressive symptoms across retirement. Especially, depressive symptoms decreased in relation to retirement for a small group with previously high exposure to work stress.

    In conclusion, this thesis indicates that particularly perceptions of high job demands, low workplace social support and high work effort predict subsequent higher levels of depressive symptoms, and/or influence the course of symptoms both in working life and past retirement. In addition, changes in these types of conditions seemed to influence the course of depressive symptoms. Especially, the relief from previous exposure to work stress at retirement seemed to have a clear positive impact on depressive symptoms. These results contribute to strengthen the evidence of causality between these types of work stressors and depressive symptoms.

  • 2337.
    Åhlin, Julia
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    LaMontagne, Anthony
    Magnusson Hanson, Linda
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Are there bidirectional relationships between psychosocial work characteristics and depressive symptoms? A fixed effects analysis of Swedish national panel survey data2019In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 76, no 7, p. 455-461Article in journal (Refereed)
    Abstract [en]

    Objectives Psychosocial work characteristics have been prospectively associated with depressive symptoms. However, methodological limitations have raised questions regarding causality. It is also unclear to what extent depressive symptoms affect the experience of the psychosocial work environment. We examined contemporaneous (measured simultaneously) and lagged bidirectional relationships between psychosocial work characteristics and depressive symptoms, simultaneously controlling for time-stable individual characteristics.

    Methods We included 3947 subjects in the Swedish Longitudinal Occupational Survey of Health (SLOSH), with self-reported job demands, control, social support, work efforts, rewards, procedural justice and depressive symptoms in four waves 2010–2016. We applied dynamic panel models with fixed effects, using structural equation modelling, adjusting for all time-stable individual characteristics such as personality and pre-employment factors.

    Results Higher levels of job demands, job demands in relation to control, work efforts and efforts in relation to rewards were contemporaneously associated with more depressive symptoms (standardised β: 0.18–0.25, p<0.001), while higher levels of workplace social support, rewards at work and procedural justice were associated with less depressive symptoms (β: −0.18, p<0.001, β: –0.16, p<0.001 and β: −0.09, p<0.01, respectively). In contrast, only work efforts predicted higher levels of depressive symptoms 2 years later (β:0.05, p<0.05). No other lagged associations were foundin any direction.

    Conclusions After controlling for all time-invariant confounding, our results suggest that psychosocial work characteristics predominantly affect depressive symptoms immediately or with only a short time lag. Furthermore, we found no evidence of reverse causation. This indicates short-term causal associations, although the temporal precedence of psychosocial work characteristics remains uncertain.

  • 2338.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sleep, Work, and Occupational Stress2012In: The Oxford Handbook of Sleep and Sleep disorders / [ed] Charles M. Morin, Colin Espie, New York: Oxford University Press , 2012, p. 248-265Chapter in book (Refereed)
  • 2339.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Säkerhet, arbetstider och trötthet2013In: Patientsäkerhet: teori och praktik / [ed] Synnöve Ödegård, Stockholm: Liber, 2013Chapter in book (Other academic)
  • 2340.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    What work schedule characteristics constitute a problem to the individual? A representative study of Swedish shift workers2017In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 59, p. 320-325Article in journal (Refereed)
    Abstract [en]

    The purpose was to investigate which detailed characteristics of shift schedules that are seen as problems to those exposed. A representative national sample of non-day workers (N = 2031) in Sweden was asked whether they had each of a number of particular work schedule characteristics and, if yes, to what extent this constituted a "big problem in life". It was also inquired whether the individual's work schedules had negative consequences for fatigue, sleep and social life. The characteristic with the highest percentage reporting a big problem was "short notice (<1 month) of a new work schedule" (30.5%), <11 h off between shifts (27.8%), and split duty (>1.5 h break at mid-shift, 27.2%). Overtime (>10 h/week), night work, morning work, day/night shifts showed lower prevalences of being a "big problem". Women indicated more problems in general. Short notice was mainly related to negative social effects, while <11 h off between shifts was related to disturbed sleep, fatigue and social difficulties. It was concluded that schedules involving unpredictable working hours (short notice), short daily rest between shifts, and split duty shifts constitute big problems. The results challenge current views of what aspects of shift work need improvement, and negative social consequences seem more important than those related to health.

  • 2341.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lekander, Mats
    Petersén, Helena
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Axelsson, John
    Sleep Polysomnography and Reported Stress across 6 Weeks2014In: Industrial Health, ISSN 0019-8366, E-ISSN 1880-8026, Vol. 52, no 1, p. 36-42Article in journal (Refereed)
    Abstract [en]

    Despite the common notion that stress impairs sleep there is little published data showing that sleep (polysomnography [PSG]) is impaired across several sleep episodes in individuals who complain of daily stress during the same period. The present paper aimed at investigating such a connection. 33 subjects had 3 sleeps recorded with PSG at home across 6 weeks and kept a sleep/wake diary each day, including 3-hourly ratings of stress (scale 1-9). The stress ratings and the conventional PSG parameters were averaged across time. A stepwise multiple regression analysis showed that the best predictors of stress were Stage 1 sleep (beta=0.49), latency to Stage 1 sleep (0.47) (adjusted for anxiety and age). Other sleep continuity variables had significant correlations with stress (reversed) but did not enter the multiple regression analysis. The correlation between stress before the start of the study and PSG data was not significant. It was concluded that moderately increased stress over a longer period of time is related to moderate signs of disturbed sleep during that period. This may be of importance when considering stress as a work environment problem.

  • 2342.
    Åsell, Malin
    et al.
    University of Gävle, Centre for Musculoskeletal Research. Svenska Rygginstitutet AB, Sundsvall, Sweden; Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden.
    Sjölander, Per
    University of Gävle, Centre for Musculoskeletal Research. Southern Lapland Research Department, Vilhelmina, Sweden.
    Kerschbaumer, Helmut
    Svenska Rygginstitutet AB, Sundsvall, Sweden.
    Djupsjöbacka, Mats
    University of Gävle, Centre for Musculoskeletal Research.
    Are lumbar repositioning errors larger among patients with chronic low back pain compared with asymptomatic subjects?2006In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 87, no 9, p. 1170-1176Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To resolve the debate over whether lumbar repositioning acuity is reduced in patients with chronic low back pain (CLBP) by using a study design and methodology to minimize the effects of potential confounders. DESIGN: A single-blinded, controlled, multigroup comparative study.

    SETTING: Vocational rehabilitation center.

    PARTICIPANTS: Ninety-two patients with CLBP, divided into subgroups based on severity of symptoms and diagnostic characteristics. An age- and sex-matched group (n=31) of healthy subjects were the control. I

    NTERVENTIONS: Not applicable.

    MAIN OUTCOME MEASURES: We measured repositioning errors (variable, constant) at 3 positions of the lumbar spine. Subjects were guided to a sitting target posture and asked to perform lumbar flexion before reproducing the target posture. Self-assessed pain, self-efficacy, and functional ability were addressed through questionnaires.

    RESULTS: There were no differences in repositioning errors between the patients with CLBP or the subgroups of patients and the control group. We found only weak correlations between the repositioning errors and the self-reported data on functional disability, self-efficacy, and pain.

    CONCLUSIONS: We suggest that sensorimotor dysfunctions in CLBP should be evaluated with methods other than repositioning tests in order to generate data relevant to the development of rational diagnostic methods and rehabilitation programs.

  • 2343.
    Åslund, Cecilia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Larm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Starrin, Bengt
    Nilsson, Kent W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    The buffering effect of tangible social support on financial stress: influence on psychological well-being and psychosomatic symptoms in a large sample of the adult general population2014In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 13, p. 85-Article in journal (Refereed)
    Abstract [en]

    Introduction: Financial stress is an important source of distress and is related to poor mental and physical health outcomes. The present study investigated whether tangible social support could buffer the effect of financial stress on psychological and psychosomatic health. Methods: Two separate postal surveys were sent to random samples in five counties in Sweden in 2004 and 2008, with a total of 84 263 respondents. The questionnaires included questions about financial stress, tangible social support, psychosomatic symptoms, and psychological well-being (General Health Questionnaire-12). Results: Individuals with high financial stress and low tangible social support had six to seven times increased odds ratios for low psychological well-being and many psychosomatic symptoms. By contrast, individuals with high financial stress and high tangible social support had only two to three times increased odds ratios for low psychological well-being and three to four times increased odds ratios for many psychosomatic symptoms, suggesting a buffering effect of tangible social support. Consistent with the buffering hypothesis, there were significant interactions between financial stress and social support, particularly in relation to low psychological well-being. Conclusions: Social support had its strongest effect at high levels of financial stress. The question whether the altering of our social networks may improve physical health is important for the prevention of ill health in people experiencing financial stress. Strengthening social networks may have the potential to influence health-care costs and improve quality of life.

  • 2344.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Health effects of heatwaves: short and long term predictions2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Climate change is defined by the Intergovernmental Panel on Climate Change as changes in the state of the climate associated with changes in the mean and/or the variability of its properties. Climate change will affect temperatures both as an increase in mean temperature as well as changes in the frequency of temperature extremes. Health effects associated with extreme heat, both mortality and morbidity, have been observed all over the globe. Groups that are often found to be more vulnerable are the elderly and people diagnosed with certain diseases and/or on taking some specific types of medication. The health effects from climate change in the future depend on a number of underlying sociodemographic and other factors. It is difficult to predict how the underlying societal factors that are likely to alter the health effects from high temperatures will change. The aim of this thesis is to investigate the influence of the underlying assumptions and factors that are key components when predicting and projecting heat-related illness, both in the short and long term. This work aims to identify and to some extent quantify different sources of uncertainty that will have effects on the outcome of health impact assessments.

    Methods: We wanted to evaluate if different statistical models would alter the ability to identify days with elevated heat-related risk. We used observations of temperatures and daily mortality for Greater Stockholm to model different exposure-response relationships (Paper I). Along the observed data, we collected temperature forecasts for the Stockholm area. We defined what constitutes a risk day and compared the model’s ability to identify these days using both observed and forecasted temperatures to evaluate the predictive performance of models based on the different statistical approaches. To estimate how climate change will alter the heat-related health impacts we used climate change projections from a range of climate change scenarios to be able to get stable estimates as well as a measure of the uncertainty in the climate projections (Paper II-III). We estimated the change in respiratory hospital admissions (Paper II) and the future need for adaptation to keep heat-related mortality at current levels (Paper III) in Europe. We also estimated the change in heat-related mortality due to changes in climate, demographics and health status of the population in Stockholm (Paper IV).

    Results: The models using a highly complex exposure-response relationship showed lower predictive performance, especially when looking at a longer time-scale. The more complex models did also estimate a lower mortality increase compared to the less complex ones. There was however high agreement of which days to be considered risk days. The estimated increase in heat-related illness from the three health impact assessment studies showed impacts on a similar order of magnitude when looking at changes in climate only. Respiratory hospital admissions were estimated to more than double in Europe and heat-related mortality in Stockholm was estimated to increase to around 257% of current levels. Therefore, adaptation needs to lower the vulnerability to heat by around 50% in the European countries. In study III and IV we take changes in demographics into account and find that the future health burden from heat will increase due to the growing elderly population.

    Conclusion: To be able to make predictions of future health burdens from heat, both in the long and short term, we need to consider the properties of the epidemiological models and how the choice of model might limit its use within a health impact assessment. Climate change seems to be the main driver of the future health burden from extreme temperatures, but our results suggests that changing demographics will add to the burden considerably unless relevant adaptation measures are implemented. Adding this on top of the challenges posed by climate change, we find that need for adaptation will increase substantially in the future.

  • 2345.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bjelkmar, Pär
    Folkhälsomyndighe-ten, Stockholm.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ovanligt många dödsfalli Sverige sommaren 2018: drygt 600 kan ha dött till följd av värmeböljan2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, article id FLFHArticle in journal (Refereed)
  • 2346.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ebi, Kristie L
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Langner, Joakim
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Developing a heatwave early warning system for Sweden: evaluating sensitivity of different epidemiological modelling approaches to forecast temperatures2015In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, no 1, p. 254-267Article in journal (Refereed)
    Abstract [en]

    Over the last two decades a number of heatwaves have brought the need for heatwave early warning systems (HEWS) to the attention of many European governments. The HEWS in Europe are operating under the assumption that there is a high correlation between observed and forecasted temperatures. We investigated the sensitivity of different temperature mortality relationships when using forecast temperatures. We modelled mortality in Stockholm using observed temperatures and made predictions using forecast temperatures from the European Centre for Medium-range Weather Forecasts to assess the sensitivity. We found that the forecast will alter the expected future risk differently for different temperature mortality relationships. The more complex models seemed more sensitive to inaccurate forecasts. Despite the difference between models, there was a high agreement between models when identifying risk-days. We find that considerations of the accuracy in temperature forecasts should be part of the design of a HEWS. Currently operating HEWS do evaluate their predictive performance; this information should also be part of the evaluation of the epidemiological models that are the foundation in the HEWS. The most accurate description of the relationship between high temperature and mortality might not be the most suitable or practical when incorporated into a HEWS.

  • 2347.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. orru@ut.ee.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Strandberg, Gustav
    Rossby Centre, SMHI, Norrköping, Sweden.
    Ebi, Kristie L
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 1, p. e001842-Article in journal (Refereed)
    Abstract [en]

    Objectives Respiratory diseases are ranked second in Europe in terms of mortality, prevalence and costs. Studies have shown that extreme heat has a large impact on mortality and morbidity, with a large relative increase for respiratory diseases. Expected increases in mean temperature and the number of extreme heat events over the coming decades due to climate change raise questions about the possible health impacts. We assess the number of heat-related respiratory hospital admissions in a future with a different climate.                                

    Design A Europe-wide health impact assessment.                                

    Setting An assessment for each of the EU27 countries.                                

    Methods Heat-related hospital admissions under a changing climate are projected using multicity epidemiological exposure–response relationships applied to gridded population data and country-specific baseline respiratory hospital admission rates. Times-series of temperatures are simulated with a regional climate model based on four global climate models, under two greenhouse gas emission scenarios.                                

    Results Between a reference period (1981–2010) and a future period (2021–2050), the total number of respiratory hospital admissions attributed to heat is projected to be larger in southern Europe, with three times more heat attributed respiratory hospital admissions in the future period. The smallest change was estimated in Eastern Europe with about a twofold increase. For all of Europe, the number of heat-related respiratory hospital admissions is projected to be 26 000 annually in the future period compared with 11 000 in the reference period.                                

    Conclusions The results suggest that the projected effects of climate change on temperature and the number of extreme heat events could substantially influence respiratory morbidity across Europe.                                

     

  • 2348.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Oudin Åström, Daniel
    Lund Universitet.
    Andersson, Camilla
    SMHI.
    Ebi, Kristie L.
    University of Washington.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Future health impact of higher ambient temperatures in Stockholm, SwedenManuscript (preprint) (Other academic)
  • 2349.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Oudin Åström, Daniel
    Lund Universitet.
    Andersson, Camilla
    SMHI.
    Ebi, Kristie L.
    University of Washington.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Vulnerability reduction needed to adapt to projected future heat exposure in Europe: Magnitude and determinantsManuscript (preprint) (Other academic)
  • 2350.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Åström, Daniel Oudin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
    Andersson, Camilla
    Ebi, Kristie L
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Vulnerability Reduction Needed to Maintain Current Burdens of Heat-Related Mortality in a Changing Climate-Magnitude and Determinants2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 7, article id 741Article in journal (Refereed)
    Abstract [en]

    The health burden from heatwaves is expected to increase with rising global mean temperatures and more extreme heat events over the coming decades. Health-related effects from extreme heat are more common in elderly populations. The population of Europe is rapidly aging, which will increase the health effects of future temperatures. In this study, we estimate the magnitude of adaptation needed to lower vulnerability to heat in order to prevent an increase in heat-related deaths in the 2050s; this is the Adaptive Risk Reduction (ARR) needed. Temperature projections under Representative Concentration Pathway (RCP) 4.5 and RCP 8.5 from 18 climate models were coupled with gridded population data and exposure-response relationships from a European multi-city study on heat-related mortality. In the 2050s, the ARR for the general population is 53.5%, based on temperature projections under RCP 4.5. For the population above 65 years in Southern Europe, the ARR is projected to be 45.9% in a future with an unchanged climate and 74.7% with climate change under RCP 4.5. The ARRs were higher under RCP 8.5. Whichever emission scenario is followed or population projection assumed, Europe will need to adapt to a great degree to maintain heat-related mortality at present levels, which are themselves unacceptably high, posing an even greater challenge.

4445464748 2301 - 2350 of 2354
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