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  • 2351.
    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.

  • 2352.
    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.

  • 2353.
    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.

  • 2354.
    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.

  • 2355.
    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.

  • 2356.
    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.

  • 2357.
    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.

  • 2358. 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.

  • 2359.
    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.

  • 2360. 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)
  • 2361.
    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)
  • 2362.
    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.

  • 2363. 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.

  • 2364. 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.

  • 2365. 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.

  • 2366.
    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.

  • 2367.
    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.

  • 2368.
    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)
  • 2369.
    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)
  • 2370.
    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.

  • 2371.
    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.

  • 2372.
    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.

  • 2373.
    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.

  • 2374.
    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.

  • 2375.
    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)
  • 2376.
    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.

  • 2377.
    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.                                

     

  • 2378.
    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)
  • 2379.
    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)
  • 2380.
    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.

  • 2381.
    Öman, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Fredriksson, Rikard
    Bylund, Per-Olof
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Analysis of the mechanism of injury in non-fatal vehicle-to-pedestrian and vehicle-to-bicyclist frontal crashes in Sweden2016In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, E-ISSN 1745-7319, Vol. 23, no 4, p. 405-412Article in journal (Refereed)
    Abstract [en]

    The aim of this paper is to analyse and compare injuries and injury sources in pedestrian and bicyclist non-fatal real-life frontal passengercar crashes, considering in what way pedestrian injury mitigation systems also might be adequate for bicyclists. Data from 203 non-fatal vehicle-to-pedestrian and vehicle-to-bicyclist crashes from 1997 through 2006 in a city in northern Sweden were analysed by use of the hospitals injury data base in addition to interviews with the injured. In vehicle-to-pedestrian crashes (n = 103) head and neck injuries were in general due to hitting the windscreen frame, while in vehicle-to-bicycle crashes (n = 100) head and neck injuries were typically sustained by ground impact. Abdominal, pelvic and thoracic injuries in pedestrians and thoracic injuries in bicyclists were in general caused by impacting the bonnet. In vehicle-to-pedestrian crashes, energy reducing airbags at critical impact points with low yielding ability on the car, as the bonnet and the windscreen frame, might reduce injuries. As vehicle-to-bicyclist crashes occurred mostly in good lighting conditions and visibility and the ground impact causing almost four times as many injuries as an impact to the different regions of the car, crash avoidance systems as well as separating bicyclists from motor traffic, may contribute to mitigate these injuries.

  • 2382.
    Österman, Cecilia
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. IVL Swedish Environmental Research Institute Ltd.
    Langer, Sarka
    IVL Swedish Environmental Research Institute Ltd..
    Moldanová, Jana
    IVL Swedish Environmental Research Institute Ltd..
    Personal exposure of seafarers to air pollutants and perceived indoor air quality on a passenger ferry2016In: Proceedings of Indoor Air 2016, International Society of Indoor Air Quality and Climate - ISIAQ , 2016Conference paper (Refereed)
    Abstract [en]

    The purpose of this study is to examine crew members’ personal exposure and perceived air quality on board a Swedish passenger ferry before and after a change of fuel type. Personal exposure was measured in the breathing zone of 20 crew members and quantified in terms of concentrations of nitrogen dioxide (NO2) and total volatile organic compounds (TVOC) with focus on benzene. Measured concentrations are compared with international indoor air quality guidelines and occupational exposure limit values. The perceived indoor air quality was assessed through a self-reporting questionnaire. The results show that the measured personal exposure was largely below Swedish occupational exposure limit values and international guideline values. Elevated levels were found especially in the engine crew samples. The subjective assessment of the air quality showed the air to be perceived as just acceptable with a slight odour, and a sense of the air being dry and stuffy.

  • 2383.
    Čechová, Eliška
    et al.
    Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University Kamenice, Brno, Czech Republic.
    Seifertová, Marta
    Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University Kamenice, Brno, Czech Republic.
    Kukučka, Petr
    Örebro University, School of Science and Technology. Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University Kamenice, Brno, Czech Republic.
    Vojta, Šimon
    Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University Kamenice, Brno, Czech Republic.
    Quaak, Ilona
    Department of Health and Life Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
    de Cock, Marijke
    Department of Health and Life Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
    van de Bor, Margot
    Department of Health and Life Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
    Kočan, Anton
    Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University Kamenice, Brno, Czech Republic.
    An effective clean-up technique for GC/EI-HRMS determination of developmental neurotoxicants in human breast milk2017In: Analytical and Bioanalytical Chemistry, ISSN 1618-2642, E-ISSN 1618-2650, Vol. 409, no 5, p. 1311-1322Article in journal (Refereed)
    Abstract [en]

    The increasing number of children suffering from developmental disorders has raised questions regarding their association with the presence of environmental contaminants in mothers and children. We therefore developed a new method for the determination of 78 proven and potential developmental neurotoxicants, including polychlorinated biphenyls, legacy pesticides, pyrethroids, and old and new halogenated flame retardants in breast milk. The essential part of sample preparation was dialysis as a non-destructive clean-up step which was newly used at 10 °C and showed more efficient lipid removal (up to 96%) than the conventional methods such as gel permeation chromatography or freezing-lipid filtration and thus ensured low limits of detection (LOD) by reducing the sample volume prior to injection. Next advantages were significant solvent reduction and no risk of sample cross-contamination. Gas chromatography coupled with high resolution mass spectrometry (GC-HRMS) was subsequently used for the separation and compound quantification. The method was validated using breast milk samples fortified with the analyzed compounds. Recoveries for most of the compounds ranged from 63 to 121% with a relative standard deviation of 2-25%, and LODs ranged between 0.001 and 0.87 ng g(-1) lipid weight. The method was applied to breast milk samples from a Dutch birth cohort where 35 out of the 78 compounds were quantified in more than 60% of the samples. For novel flame retardants, the method provides unique results regarding their occurrence in human matrices in Europe. Overall, the analysis of a complex mixture of developmental neurotoxicants could be useful for the assessment of the influence of the studied compounds to child health and development. Graphical abstract Flow diagram of the method and levels of the developmental neurotoxicants in Dutch human milk samples.

  • 2384.
    Dynamisk-antropometrisk undersökning av flygande personal1964Report (Refereed)
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