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Graff, P., Bryngelsson, I.-L., Fredrikson, M. & Flodin, U. (2019). Adult onset asthma in non-allergic women working in dampness damaged buildings: A retrospective cohort study. American Journal of Industrial Medicine, 62(4), 357-363
Open this publication in new window or tab >>Adult onset asthma in non-allergic women working in dampness damaged buildings: A retrospective cohort study
2019 (English)In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 62, no 4, p. 357-363Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is still no consensus about the association between working in dampness-damaged buildings and new onset of asthma among adults. The purpose of this study was to assess asthma in the staff of two psychiatric clinics where some premises were suffering from dampness.

METHODS: A 20-year retrospective cohort study was performed using questionnaires.

RESULTS: Incidence rate ratios (IRR) for asthma were non-significantly elevated (IRR = 2.3) among exposed individuals. The risk was greater among females (IRR = 3.5, 95% CI 1.0-16). IRR for non-atopic women was 8.8 (95% CI 1.4-196). Adjusting for smoking habits weakened the risks marginally (IRR = 7.3, 95% CI 1.1-167). The number of male participants was too low to draw conclusion regarding the risk for men.

CONCLUSION: The results suggest that working in dampness-damaged buildings might be a possible health hazard. This finding is most pronounced in non-atopic females.

Place, publisher, year, edition, pages
Wiley-Liss Inc., 2019
Keywords
Asthma, dampness damaged buildings, retrospective cohort study, susceptible groups
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-71850 (URN)10.1002/ajim.22952 (DOI)000460561500010 ()30677156 (PubMedID)2-s2.0-85060620336 (Scopus ID)
Note

Funding Agency:

Medical Research Council of Southeast Sweden  FORSS-10103

Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-06-18Bibliographically approved
Westerlund, J., Bryngelsson, I.-L., Löfstedt, H., Eriksson, K., Westberg, H. & Graff, P. (2019). Occupational exposure to trichloramine and trihalomethanes: adverse health effects among personnel in habilitation and rehabilitation swimming pools. Journal of Occupational and Environmental Hygiene, 16(1), 78-88
Open this publication in new window or tab >>Occupational exposure to trichloramine and trihalomethanes: adverse health effects among personnel in habilitation and rehabilitation swimming pools
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2019 (English)In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 16, no 1, p. 78-88Article in journal (Refereed) Published
Abstract [en]

Personnel in swimming pool facilities typically experience ocular, nasal, and respiratory symptoms due to water chlorination and consequent exposure to disinfection by-products in the air. The aim of the study was to investigate exposure to trichloramine and trihalomethanes (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) from the perspective of adverse health effects on the personnel at Swedish habilitation and rehabilitation swimming pools. The study included ten habilitation and rehabilitation swimming pool facilities in nine Swedish cities. The study population comprised 24 exposed swimming pool workers and 50 unexposed office workers. Personal and stationary measurements of trichloramine and trihalomethanes in air were performed at all the facilities. Questionnaires were distributed to exposed workers and referents. Spirometry, fraction of exhaled nitric oxide (FENO) and peak expiratory flow (PEF) were measured. Personal and stationary measurements yielded trichloramine levels of 1-76 µg/m3 (average: 19 µg/m3) and 1-140 µg/m3 (average: 23 µg/m3), respectively. A slightly higher, but not significant, prevalence of reported eye- and throat-related symptoms occurred among the exposed workers than among the referents. A significantly increased risk of at least one ocular symptom was attributed to trichloramine exposure above the median (20 µg/m3). Lung function (FVC and FEV1) was in the normal range according to the Swedish reference materials, and no significant change in lung function before and after shift could be established between the groups. Average FENO values were in the normal range in both groups, but the difference in the values between the exposed workers and referents showed a significant increase after shift. Hourly registered PEF values during the day of the investigation did not show any unusual individual variability. In conclusion, the increased risk of developing at least one ocular symptom at personal trichloramine concentrations over 20 µg/m3 combined with an increase in the difference in FENO during the work shift of the exposed workers should not be neglected as an increased risk of respiratory inflammation in the habilitation and rehabilitation swimming pool environment.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Occupational exposure, respiratory symptoms, swimming pool, trichloramine, trihalomethanes
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-69906 (URN)10.1080/15459624.2018.1536825 (DOI)000471113200011 ()30335595 (PubMedID)2-s2.0-85060177023 (Scopus ID)
Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2019-07-22Bibliographically approved
Nosratabadi, A. R., Graff, P., Karlsson, H., Ljungman, A. G. & Leanderson, P. (2019). Use of TEOM monitors for continuous long-term sampling of ambient particles for analysis of constituents and biological effects. Air quality, atmosphere and health, 12(2), 161-171
Open this publication in new window or tab >>Use of TEOM monitors for continuous long-term sampling of ambient particles for analysis of constituents and biological effects
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2019 (English)In: Air quality, atmosphere and health, ISSN 1873-9318, E-ISSN 1873-9326, Vol. 12, no 2, p. 161-171Article in journal (Refereed) Published
Abstract [en]

Many countries have implemented exposure limits for the concentration of ambient particular matter and do therefore have to monitor their concentration. This could be performed with TEOM monitors (Tapered Element Oscillating Microbalance-monitors) that contain a filter on which particles are collected. These filters are regularly exchanged for new ones. The aim of this study was to test the feasibility of collecting used filters from monitors at different locations and establishing a method to extract particles and then study them with respect to their ability to generate oxidants, their endotoxin content, and ability to activate inflammatory cells. Filters from nine geographically spread locations in Sweden were collected during a 21-month period by local technicians who then sent them to the laboratory where they were extracted and analyzed. The procedure to let local technicians perform the filter exchange and send used TEOM filters to the laboratory worked well. A method was established in which pyrogen-free water was used to extract particles that then were aliquoted and stored for later analysis. Particulate matter (PM 10 ) from different locations showed both a considerable seasonal and spatial-dependent difference with respect to oxidative potential (oxidize glutathione), endotoxin content, and ability to activate blood monocytes to release interleukin-1β. This study shows that, instead of discarding TEOM filters, they can be collected and extracted so that particles that have been sampled in a standardized way could be analyzed with respect to variables that reflect their toxicity. This could be done at a low cost. In combination with information about the ambient particle concentration, such information could be helpful in the evaluation of differences in the risk of breathing air at various locations.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Air pollution, Ambient particles, Endotoxin, Seasonal variation, Surface reactivity, TEOM monitor, atmospheric pollution, blood, concentration (composition), detection method, particle size, particulate matter, sampling, toxicity, toxin, Sweden
National Category
Environmental Sciences
Identifiers
urn:nbn:se:oru:diva-73681 (URN)10.1007/s11869-018-0638-5 (DOI)000458121600004 ()2-s2.0-85056389584 (Scopus ID)
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-12Bibliographically approved
Alhamdow, A., Lindh, C., Hagberg, J., Graff, P., Westberg, H., Krais, A. M., . . . Broberg, K. (2018). DNA-methylation of the cancer-related genes F2RL3 and AHRR is associated with occupational exposure to polycyclic aromatic hydrocarbons. Carcinogenesis, 39(7), 869-878
Open this publication in new window or tab >>DNA-methylation of the cancer-related genes F2RL3 and AHRR is associated with occupational exposure to polycyclic aromatic hydrocarbons
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2018 (English)In: Carcinogenesis, ISSN 0143-3334, E-ISSN 1460-2180, Vol. 39, no 7, p. 869-878Article in journal (Refereed) Published
Abstract [en]

Some polycyclic aromatic hydrocarbons (PAH) are known carcinogens and workplace PAH exposure may increase the risk of cancer. Monitoring early cancer-related changes can indicate whether the exposure is carcinogenic. Here, we enrolled 151 chimney sweeps, 152 controls, and 19 creosote-exposed male workers from Sweden. We measured urinary PAH metabolites using LC/MS/MS, the cancer-related markers telomere length (TL) and mitochondrial DNA copy number (mtDNAcn) using qPCR, and DNA methylation of lung cancer-related genes F2RL3 and AHRR using pyrosequencing. The median 1-hydroxypyrene (PAH metabolite) concentrations were highest in creosote-exposed workers (8.0 μg/g creatinine) followed by chimney sweeps (0.34 μg/g creatinine) and controls (0.05 μg/g creatinine). TL and mtDNAcn did not differ between study groups. Chimney sweeps and creosote-exposed workers had significantly lower methylation of AHRR CpG site cg05575921 (88.1% and 84.9%, respectively) than controls (90%). Creosote-exposed workers (73.3%), but not chimney sweeps (76.6%) had lower methylation of F2RL3 cg03636183 than controls (76.7%). Linear regression analyses showed that chimney sweeps had lower AHRR cg05575921 methylation (B=-2.04; P<0.057, adjusted for smoking and age) and lower average AHRR methylation (B=-2.05; P<0.035), and non-smoking chimney sweeps had lower average F2RL3 methylation (B=-0.81; P<0.042, adjusted for age) compared with controls. These cancer-related markers were not associated with urinary concentrations of PAH metabolites. In conclusion, although we found no associations with PAH metabolites in urine (short-term exposure), our results suggest dose-response relationship between PAH exposure and DNA hypomethylation of lung cancer-related loci. These findings indicate that further protective measures should be taken to reduce PAH exposure.

Place, publisher, year, edition, pages
Oxford University Press, 2018
National Category
Occupational Health and Environmental Health Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-67021 (URN)10.1093/carcin/bgy059 (DOI)000438289600003 ()29722794 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-00402AFA Insurance, 120115The Karolinska Institutet's Research Foundation
Note

Funding Agency:

Medical Training and Research Agreement (ALF grants; Region Örebro län)  OLL-550721

Available from: 2018-06-04 Created: 2018-06-04 Last updated: 2018-09-11Bibliographically approved
Fan, C., Graff, P., Vihlborg, P., Bryngelsson, I.-L. & Andersson, L. (2018). Silica exposure increases the risk of stroke but not myocardial infarction: A retrospective cohort study. PLoS ONE, 13(2), Article ID e0192840.
Open this publication in new window or tab >>Silica exposure increases the risk of stroke but not myocardial infarction: A retrospective cohort study
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 2, article id e0192840Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Work-related exposure to silica is a global health hazard that causes diseases such as silicosis. Some studies have also reported that silica exposure is linked to elevated cardiovascular disease mortality. However, these diagnoses have not been investigated in detail and there have been few studies on morbidity. The aim of this study is to examine morbidity and mortality from different cardiovascular diseases among silica-exposed Swedish foundry workers.

METHODS: Historical and contemporary measurements (1968-2006) of respiratory silica exposure were matched to job categories, individual foundries, and 4 time periods (1968-1979, 1980-1989, 1990-1999, 2000-2006) using a mixed model. Morbidity and mortality data for the studied cohorts were matched against the General Population Registry. Statistical analyses were performed with SPSS and STATA, and the data were stratified by age, gender, and year.

RESULTS: Mortality from cardiovascular disease (SMR 1.3; 95% CI 1.2-1.4) and stroke (SMR 1.6, 95% CI 1.2-2.1) was significantly elevated among the studied population. The cohort also exhibited significantly elevated morbidity from stroke (SIR 1.34; 95% CI 1.2-1.5) but not myocardial infarction. The mean age at the time of first morbidity from stroke was 64 years, with 36% of the cases occurring before the age of 60.

CONCLUSIONS: Swedish foundry workers exposed to respirable silica exhibit elevated morbidity and mortality from stroke, but not from myocardial infarction. Our results also suggest a relationship between silica exposure and morbidity from stroke at a younger age than the general population.

Place, publisher, year, edition, pages
Public Library of Science, 2018
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-65449 (URN)10.1371/journal.pone.0192840 (DOI)000426202700006 ()29481578 (PubMedID)2-s2.0-85042761948 (Scopus ID)
Available from: 2018-03-02 Created: 2018-03-02 Last updated: 2018-08-20Bibliographically approved
Vihlborg, P., Bryngelsson, I.-L., Lindgren, B., Gunnarsson, L.-G. & Graff, P. (2017). Association between vibration exposure and hand-arm vibration symptoms in a Swedish mechanical industry. International Journal of Industrial Ergonomics, 62, 77-81
Open this publication in new window or tab >>Association between vibration exposure and hand-arm vibration symptoms in a Swedish mechanical industry
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2017 (English)In: International Journal of Industrial Ergonomics, ISSN 0169-8141, E-ISSN 1872-8219, Vol. 62, p. 77-81Article in journal (Refereed) Published
Abstract [en]

Work with vibrating tools is common in many industries. Exposure to hand-arm vibrations is associated with a risk of hand injury in the form of: Vascular disorders, nerve malfunction, and effects on the musculoskeletal system. The aim of this study was to investigate the prevalence of hand-arm vibration symptoms among employees at a mechanical company, as well as to follow-up with patients presenting symptoms and evaluate the effects of certain proposed measures. We found that 21% of the employees were judged to have vibration-related problems even though the exposure to vibrations was judged to be relatively low. There seems to be an over-representation of Carpal tunnel syndrome among participants; this may suggest that ergonomic conditions at the investigated company, such as grinding with flexed wrists, are unfavorable.

Relevance to industry: Regular screening for early signs of vibration-related damage, even if workers are subject to only moderate vibration exposure, is an important part of preventing the aggravation of health problems.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Hand-arm vibration, Hand-arm vibration syndrome, Quantitative sensory testing, Carpal tunnel syndrome, Vibration exposure
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-62842 (URN)10.1016/j.ergon.2017.02.010 (DOI)000414879600010 ()2-s2.0-85014872924 (Scopus ID)
Note

Funding Agency:

Region Örebro County 

Available from: 2017-11-27 Created: 2017-11-27 Last updated: 2019-03-04Bibliographically approved
Graff, P., Ståhlbom, B., Nordenberg, E., Graichen, A., Johansson, P. & Karlsson, H. (2017). Evaluating Measuring Techniques for Occupational Exposure during Additive Manufacturing of Metals: A Pilot Study. Journal of Industrial Ecology, 21(Suppl. 1), S120-S129
Open this publication in new window or tab >>Evaluating Measuring Techniques for Occupational Exposure during Additive Manufacturing of Metals: A Pilot Study
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2017 (English)In: Journal of Industrial Ecology, ISSN 1088-1980, E-ISSN 1530-9290, Vol. 21, no Suppl. 1, p. S120-S129Article in journal (Refereed) Published
Abstract [en]

Additive manufacturing that creates three-dimensional objects by adding layer uponlayer of material is a new technique that has proven to be an excellent tool for themanufacturing of complex structures for a variety of industrial sectors. Today, knowl-edge regarding particle emissions and potential exposure-related health hazards forthe operators is limited. The current study has focused on particle numbers, masses,sizes, and identities present in the air during additive manufacturing of metals. Mea-surements were performed during manufacturing with metal powder consisting es-sentially of chromium, nickel, and cobalt. Instruments used were Nanotracer (10 to300 nanometers [nm]), Lighthouse (300 nm to 10 micrometers), and traditional filter-basedparticle mass estimation followed by inductively coupled plasma mass spectrometry. Resultsshowed that there is a risk of particle exposure at certain operations and that particle sizestended to be smaller in recycled metal powder compared to new. In summary, nanosizedparticles were present in the additive manufacturing environment and the operators wereexposed specifically while handling the metal powder. For the workers’ safety, improvedpowder handling systems and measurement techniques for nanosized particles will possiblyhave to be developed and then translated into work environment regulations. Until then,relevant protective equipment and regular metal analyses of urine is recommended.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
3D printing; Additive manufacturing; Industrial ecology; Lighthouse; Nanotracer; Particle exposure
National Category
Occupational Health and Environmental Health Production Engineering, Human Work Science and Ergonomics
Identifiers
urn:nbn:se:oru:diva-57645 (URN)10.1111/jiec.12498 (DOI)000415151600012 ()2-s2.0-84991113134 (Scopus ID)
Available from: 2017-05-12 Created: 2017-05-12 Last updated: 2018-07-31Bibliographically approved
Vihlborg, P., Bryngelsson, I.-L., Andersson, L. & Graff, P. (2017). Risk of sarcoidosis and seropositive rheumatoid arthritis from occupational silica exposure in Swedish iron foundries: a retrospective cohort study. BMJ Open, 7(7), Article ID e016839.
Open this publication in new window or tab >>Risk of sarcoidosis and seropositive rheumatoid arthritis from occupational silica exposure in Swedish iron foundries: a retrospective cohort study
2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 7, article id e016839Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To study the impact of occupational silica exposure on the incidence rates of sarcoidosis and rheumatoid arthritis (RA) in a cohort of exposed workers in Swedish iron foundries.

DESIGN: The prevalence of sarcoidosis and RA in a cohort of silica exposed workers was compared with the prevalence in the general Swedish population in this register study. A mixed model was used to calculate silica exposure, and individual silica exposures were used to compute dose responses.

SETTING: Personnel records from 10 iron foundries were used to identify workers whose employment began before 2005 which was then linked to the national non-primary outpatient visits register.

PARTICIPANTS: The final cohort consisted of 2187 silica-exposed male workers who had been employed for at least 1 year and were still alive without having emigrated when the follow-up study began. The cohort's employment period covers 23 807 person-years at risk.

MAIN OUTCOME: The presented results indicate that moderate to high levels of silica exposure increase risks for sarcoidosis and seropositive RA.

RESULTS: Mean levels of airborne silica dust in the foundries decreased significantly between the 1970s and 2000s. Incidence rates of sarcoidosis (3.94; 95% CI 1.07 to 10.08) and seropositive RA (2.59; 95% CI 1.24 to 4.76) were significantly higher among highly exposed individuals.

CONCLUSION: Our results reveal increased risks for sarcoidosis and seropositive RA among individuals with high exposure to silica dust (>0.048 mg/m(3)) compared with non-exposed and less-exposed groups.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
Keywords
rheumatoid arthritis, sarcoidosis, silica
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-61754 (URN)10.1136/bmjopen-2017-016839 (DOI)000410203700206 ()28729325 (PubMedID)2-s2.0-85025163504 (Scopus ID)
Note

Funding Agency:

Region, Örebro County  OLL-554311

Available from: 2017-10-25 Created: 2017-10-25 Last updated: 2019-03-04Bibliographically approved
Wåhlén, K., Fornander, L., Olausson, P., Ydreborg, K., Flodin, U., Graff, P., . . . Ghafouri, B. (2016). Protein profiles of nasal lavage fluid from individuals with work-related upper airway symptoms associated with moldy and damp buildings. Indoor Air, 26(5), 743-754
Open this publication in new window or tab >>Protein profiles of nasal lavage fluid from individuals with work-related upper airway symptoms associated with moldy and damp buildings
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2016 (English)In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 26, no 5, p. 743-754Article in journal (Refereed) Published
Abstract [en]

Upper airway irritation is common among individuals working in moldy and damp buildings. The aim of this study was to investigate effects on the protein composition of the nasal lining fluid. The prevalence of symptoms in relation to work environment was examined in 37 individuals working in two damp buildings. Microbial growth was confirmed in one of the buildings. Nasal lavage fluid was collected from 29 of the exposed subjects and 13 controls, not working in a damp building. Protein profiles were investigated with a proteomic approach and evaluated by multivariate statistical models. Subjects from both workplaces reported upper airway and ocular symptoms. Based on protein profiles, symptomatic subjects in the two workplaces were discriminated from each other and separated from healthy controls. The groups differed in proteins involved in inflammation and host defense. Measurements of innate immunity proteins showed a significant increase in protein S100-A8 and decrease in SPLUNC1 in subjects from one workplace, while alpha-1-antitrypsin was elevated in subjects from the other workplace, compared with healthy controls. The results show that protein profiles in nasal lavage fluid can be used to monitor airway mucosal effects in personnel working in damp buildings and indicate that the profile may be separated when the dampness is associated with the presence of molds.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell Publishing Inc., 2016
Keywords
Sick-building syndrome, Proteomics, Nasal mucosa, SPLUNC1, Alpha-1-antitrypsin, Protein S100-A8
National Category
Respiratory Medicine and Allergy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-52759 (URN)10.1111/ina.12257 (DOI)000387348500009 ()26451694 (PubMedID)2-s2.0-84988485481 (Scopus ID)
Funder
Cancer and Allergy Foundation, 150441
Note

Funding Agency:

Research Council of South East Sweden FORSS-222751  FORSS-389061

Available from: 2016-10-03 Created: 2016-10-03 Last updated: 2018-07-17Bibliographically approved
Löfstedt, H., Westerlund, J., Graff, P., Bryngelsson, I.-L., Mölleby, G., Olin, A.-C., . . . Westberg, H. (2016). Respiratory and Ocular Symptoms Among Employees at Swedish Indoor Swimming Pools. Journal of Occupational and Environmental Medicine, 58(12), 1190-1195
Open this publication in new window or tab >>Respiratory and Ocular Symptoms Among Employees at Swedish Indoor Swimming Pools
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2016 (English)In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 58, no 12, p. 1190-1195Article in journal (Refereed) Published
Abstract [en]

Background: This study investigated trichloramine exposure and prevalence of respiratory and ocular symptoms among Swedish indoor swimming pool workers.

Methods: Questionnaires were distributed to pool workers and referents. Lung function and fraction of exhaled nitric oxide (FeNO) were measured before and after work. Exposure to trichloramine and trihalomethanes was measured over work shifts.

Results: The mean personal trichloramine exposure was 36g/m(3). Significantly more exposed workers reported ocular and nasal symptoms. There were significant differences between groups in FeNO change following work, with exposed showing increased FeNO, which grew when analyses included only nonsmokers.

Conclusions: The findings indicate that indoor swimming pool environments may have irritating effects on mucous membranes. FeNO data also indicate an inflammatory effect on central airways, but the clinical relevance is unclear. Low trichloramine levels found in this study were not associated with health effects.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-54678 (URN)10.1097/JOM.0000000000000883 (DOI)000390238500008 ()2-s2.0-85007337110 (Scopus ID)
Note

Funding Agency:

Department of Occupational and Environmental Medicine, Örebro

Available from: 2017-01-13 Created: 2017-01-13 Last updated: 2018-07-23Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4928-617X

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