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  • 1.
    Abdolahpur Monikh, Fazel
    et al.
    Institute of Environmental Sciences (CML), Leiden University, Leiden, Netherlands; Department of Environmental & Biological Sciences, University of Eastern Finland, Joensuu, Finland.
    Chupani, Latifeh
    Örebro University, School of Science and Technology. University of South Bohemia in Ceske Budejovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Vodňany, Czech Republic.
    Vijver, Martina G.
    Institute of Environmental Sciences (CML), Leiden University, Leiden, Netherlands.
    Peijnenburg, Willie J. G. M.
    Institute of Environmental Sciences (CML), Leiden University, Leiden, Netherlands; National Institute of Public Health and the Environment (RIVM), Center for Safety of Substances and Products, Bilthoven, Netherlands.
    Parental and trophic transfer of nanoscale plastic debris in an assembled aquatic food chain as a function of particle size2021In: Environmental Pollution, ISSN 0269-7491, E-ISSN 1873-6424, Vol. 269, article id 116066Article in journal (Refereed)
    Abstract [en]

    The existing limitations in analytical techniques for characterization and quantification of nanoscale plastic debris (NPD) in organisms hinder understanding of the parental and trophic transfer of NPD in organisms. Herein, we used iron oxide-doped polystyrene (PS) NPD (Fe-PS-NPD) of 270 nm and Europium (Eu)-doped PS-NPD (Eu-PS-NPD) of 640 nm to circumvent these limitations and to evaluate the influence of particle size on the trophic transfer of NPD along an algae-daphnids food chain and on the reproduction of daphnids fed with NPD-exposed algae. We used Fe and Eu as proxies for the Fe-PS-NPD and Eu-Ps-NPD, respectively. The algae cells (Pseudokirchinella subcapitata) were exposed to 4.8 × 1010 particles/L of Fe-PS-NPD or Eu-PS-NPD for 72 h. A high percentage (>60%) of the NPD was associated with algal cells. Only a small fraction (<11%) of the NPD, however, was transferred to daphnids fed for 21 days on the NPD-exposed algae. The uptake and trophic transfer of the 270 nm Fe-PS-NPD were higher than those for the 640 nm Eu-PS-NPD, indicating that smaller NPD are more likely to transfer along food chains. After exposure to Fe-PS-NPD, the time to first brood was prolonged and the number of neonates per adult significantly decreased compared to the control without any exposure and compared to daphnids exposed to the Eu-Ps-NPD. The offspring of daphnids exposed to Eu-PS-NPD through algae, showed a traceable concentration of Eu, suggesting that NPD are transferred from parents to offspring. We conclude that NPD can be transferred in food chains and caused reproductive toxicity as a function of NPD size. Studies with prolonged exposure and weathered NPD are endeavored to increase environmental realism of the impacts determined.

  • 2.
    Alhamdow, Ayman
    et al.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lindh, Christian
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Hagberg, Jessika
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Graff, Pål
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; National Institute of Occupational Health, Oslo, Norway.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Krais, Annette M.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Albin, Maria
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden; Centre for Occupational and Environmental Medicine (CAMM), Stockholm County Council, Stockholm, Sweden.
    Gustavsson, Per
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine (CAMM), Stockholm County Council, Stockholm, Sweden.
    Tinnerberg, Håkan
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Broberg, Karin
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    DNA-methylation of the cancer-related genes F2RL3 and AHRR is associated with occupational exposure to polycyclic aromatic hydrocarbons2018In: Carcinogenesis, ISSN 0143-3334, E-ISSN 1460-2180, Vol. 39, no 7, p. 869-878Article in journal (Refereed)
    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.

  • 3.
    Ali, Nurshad
    et al.
    Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi, Bangladesh.
    Hoque, Ashraful
    Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi, Bangladesh.
    Haque, Abedul
    Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi, Bangladesh.
    Abdus Salam, Kazi
    Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi, Bangladesh.
    Karim, Rezaul
    Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi, Bangladesh; Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh.
    Rahman, Aminur
    Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi, Bangladesh.
    Islam, Khairul
    Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi, Bangladesh.
    Alam Saud, Zahangir
    Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi, Bangladesh.
    Khalek, Abdul
    Department of Statistics, Rajshahi University, Rajshahi, Bangladesh.
    Azim Akhand, Anwarul
    Department of Genetic Engineering and Biotechnology, Dhaka University, Dhaka, Bangladesh.
    Hossain, Mostaque
    Department of Medicine, Rajshahi Medical College Hospital, Rajshahi, Bangladesh.
    Mandal, Abul
    School of Life Sciences, University of Skövde, Skövde, Sweden.
    Karim, Rezaul
    Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh.
    Miyataka, Hideki
    Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima, Japan.
    Himeno, Seiichiro
    Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima, Japan.
    Hossain, Khaled
    Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi, Bangladesh.
    Association between arsenic exposure and plasma cholinesterase activity: a population based study in Bangladesh2010In: Environmental Health, E-ISSN 1476-069X, Vol. 9, article id 36Article in journal (Refereed)
    Abstract [en]

    Background: Arsenic is a potent pollutant that has caused an environmental catastrophe in certain parts of the world including Bangladesh where millions of people are presently at risk due to drinking water contaminated by arsenic. Chronic arsenic exposure has been scientifically shown as a cause for liver damage, cancers, neurological disorders and several other ailments. The relationship between plasma cholinesterase (PChE) activity and arsenic exposure has not yet been clearly documented. However, decreased PChE activity has been found in patients suffering liver dysfunction, heart attack, cancer metastasis and neurotoxicity. Therefore, in this study, we evaluated the PChE activity in individuals exposed to arsenic via drinking water in Bangladesh.

    Methods: A total of 141 Bangladeshi residents living in arsenic endemic areas with the mean arsenic exposure of 14.10 ± 3.27 years were selected as study subjects and split into tertile groups based on three water arsenic concentrations: low (< 129 μg/L), medium (130-264 μg/L) and high (> 265 μg/L). Study subjects were further sub-divided into two groups (≤50 μg/L and > 50 μg/L) based on the recommended upper limit of water arsenic concentration (50 μg/L) in Bangladesh. Blood samples were collected from the study subjects by venipuncture and arsenic concentrations in drinking water, hair and nail samples were measured by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS). PChE activity was assayed by spectrophotometer.

    Results: Arsenic concentrations in hair and nails were positively correlated with the arsenic levels in drinking water. Significant decreases in PChE activity were observed with increasing concentrations of arsenic in water, hair and nails. The average levels of PChE activity in low, medium and high arsenic exposure groups were also significantly different between each group. Lower levels of PChE activity were also observed in the > 50 μg/L group compared to the ≤50 μg/L group. Moreover, PChE activity was significantly decreased in the skin (+) symptoms group compared to those without (-).

    Conclusions: We found a significant inverse relationship between arsenic exposure and PChE activity in a human population in Bangladesh. This research demonstrates a novel exposure-response relationship between arsenic and PChE activity which may explain one of the biological mechanisms through which arsenic exerts its neuro-and hepatotoxicity in humans.

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    Association between arsenic exposure and plasma cholinesterase activity: a population based study in Bangladesh
  • 4.
    Anderson, J. K.
    et al.
    GSI Environmental Inc, Austin, TX, United States.
    Brecher, R. W.
    Canada.
    Cousins, I. T.
    Department of Environmental Science, Stockholm University, Stockholm, Sweden.
    DeWitt, J.
    Department of Pharmacology & Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, United States.
    Fiedler, Heidelore
    Örebro University, School of Science and Technology.
    Kannan, K.
    New York University School of Medicine, United States.
    Kirman, C. R.
    SciPinion, Bozeman, MT, United States.
    Lipscomb, J.
    Lipscomb and Associates, Little Rock, AR, United States.
    Priestly, B.
    Monash University, Austra.
    Schoeny, R.
    Rita Schoeny LLC, United States.
    Seed, J.
    United States.
    Verner, M.
    Universite de Montreal, Canada.
    Hays, S. M.
    SciPinion, Bozeman, MT, United States.
    Grouping of PFAS for human health risk assessment: Findings from an independent panel of experts2022In: Regulatory toxicology and pharmacology, ISSN 0273-2300, E-ISSN 1096-0295, Vol. 134, article id 105226Article in journal (Refereed)
    Abstract [en]

    An expert panel was convened to provide insight and guidance on per- and polyfluoroalkyl substances (PFAS) grouping for the purposes of protecting human health from drinking water exposures, and how risks to PFAS mixtures should be assessed. These questions were addressed through multiple rounds of blind, independent responses to charge questions, and review and comments on co-panelists responses. The experts agreed that the lack of consistent interpretations of human health risk for well-studied PFAS and the lack of information for the vast majority of PFAS present significant challenges for any mixtures risk assessment approach. Most experts agreed that "all PFAS" should not be grouped together, persistence alone is not sufficient for grouping PFAS for the purposes of assessing human health risk, and that the definition of appropriate subgroups can only be defined on a case-by-case manner. Most panelists agreed that it is inappropriate to assume equal toxicity/potency across the diverse class of PFAS. A tiered approach combining multiple lines of evidence was presented as a possible viable means for addressing PFAS that lack analytical and/or toxicological studies. Most PFAS risk assessments will need to employ assumptions that are more likely to overestimate risk than to underestimate risk, given the choice of assumptions regarding dose-response model, uncertainty factors, and exposure information.

  • 5. Andersson, Eva
    et al.
    Persson, Bodil
    Bryngelsson, Ing-Liss
    Magnuson, Anders
    Torén, Kjell
    Wingren, Gun
    Westberg, Håkan
    Örebro University, School of Health and Medical Sciences.
    Cohort mortality study of Swedish pulp and paper mill workers-nonmalignant diseases2007In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 33, no 6, p. 470-478Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to determine mortality among pulp and paper mill workers according to the main mill pulping process, department, and gender, particular reference being given to diseases of the circulatory and respiratory systems.

    Methods The cohort of 18 163 men and 2 291 women employed between 1939 and 1999 and with >1 year of employment was followed for mortality from 1952 to 2001 (acute myocardial infarction from 1969). Standardized mortality ratios (SMR) with 95% confidence intervals (95% CI) were estimated by comparing the observed number of deaths with the expected number for the entire Swedish population. Exposure was assessed from personnel files in the mills. Data from an exposure measurement database are also presented.

    Results There were 5898 deaths in the cohort. Total mortality had an SMR of 1.02 (95% CI 0.98–1.06) for the men in the sulfate mills and an SMR of 0.93 (95% CI 0.90–0.97) for the men in the sulfite mills. Mortality from acute myocardial infarction was increased among the men in both the sulfate and sulfite mills [SMR 1.22 (95% CI 1.12–1.32) and SMR 1.11 (95% CI 1.02–1.21), respectively] and by department in sulfate pulping (SMR 1.29, 95% CI 1.07–1.54), paper production (SMR 1.26, 95% CI 1.06–1.49), and maintenance (SMR 1.16, 95% CI 1.02–1.30). Mortality from cerebrovascular disease, diabetes mellitus, and nonmalignant respiratory diseases was not increased.

    Conclusions Death from acute myocardial infarction, but not cerebrovascular diseases, was increased in this cohort and was probably related to a combination of different occupational exposures (eg, dust, sulfur compounds, shift work, and noise).

  • 6.
    Andersson, Eva
    et al.
    Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Westberg, Håkan
    Örebro University Hospital.
    Bryngelsson, Ing-Liss
    Dept Occupat & Environm Med, Örebro Univ Hosp, Örebro, Sweden.
    Magnuson, Anders
    Clin Epidemiol & Biostat Unit, Örebro Univ Hosp, Örebro, Sweden.
    Persson, Bodil
    Dept Occupat & Environm Med, Linköping Univ Hosp, Linköping, Sweden; Dept Occupat & Environm Med, Univ Lund Hosp, Lund, Sweden.
    Cancer incidence among Swedish pulp and paper mill workers: a cohort study of sulphate and sulphite mills2013In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 86, no 5, p. 529-540Article in journal (Refereed)
    Abstract [en]

    Associations between various malignancies and work in the pulp and paper industry have been reported but mostly in analyses of mortality rather than incidence. We aimed to study cancer incidence by main mill pulping process, department and gender in a Swedish cohort of pulp and paper mill workers. The cohort (18,113 males and 2,292 females, enrolled from 1939 to 1999 with > 1 year of employment) was followed up for cancer incidence from 1958 to 2001. Information on the workers' department and employment was obtained from the mills' personnel files, and standardized incidence ratios (SIRs) were calculated using the Swedish population as reference. Overall cancer incidence, in total 2,488 cases, was not increased by work in any department. However, risks of pleural mesothelioma were increased among males employed in sulphate pulping (SIR, 8.38; 95 % CI, 3.37-17) and maintenance (SIR, 6.35; 95 % CI, 3.47-11), with no corresponding increase of lung cancer. Testicular cancer risks were increased among males employed in sulphate pulping (SIR, 4.14; 95 % CI, 1.99-7.61) and sulphite pulping (SIR, 2.59; 95 % CI, 0.95-5.64). Female paper production workers showed increased risk of skin tumours other than malignant melanoma (SIR, 2.92; 95 % CI, 1.18-6.02). Incidence of pleural mesothelioma was increased in the cohort, showing that asbestos exposure still has severe health consequences, and highlighting the exigency of strict asbestos regulations and elimination. Testicular cancer was increased among pulping department workers. Shift work and endocrine disruptors could be of interest in this context.

  • 7.
    Andersson, Lena
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Occupational and Environmental Medicine.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hedbrant, Alexander
    Örebro University, School of Medical Sciences.
    Persson, Alexander
    Örebro University, School of Medical Sciences.
    Johansson, Anders
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ericsson, Annette
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lindell, Ina
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Stockfelt, Leo
    Unit of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Särndahl, Eva
    Örebro University, School of Medical Sciences. Inflammatory Response and Infection Susceptibility Centre (iRiSC).
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine.
    Respiratory health and inflammatory markers: Exposure to respirable dust and quartz and chemical binders in Swedish iron foundries2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 11, article id e0224668Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To study the relationship between respirable dust, quartz and chemical binders in Swedish iron foundries and respiratory symptoms, lung function (as forced expiratory volume FEV1 and vital capacity FVC), fraction of exhaled nitric oxide (FENO) and levels of club cell secretory protein 16 (CC16) and CRP.

    METHODS: Personal sampling of respirable dust and quartz was performed for 85 subjects in three Swedish iron foundries. Full shift sampling and examination were performed on the second or third day of a working week after a work free weekend, with additional sampling on the fourth or fifth day. Logistic, linear and mixed model analyses were performed including, gender, age, smoking, infections, sampling day, body mass index (BMI) and chemical binders as covariates.

    RESULTS: The adjusted average respirable quartz and dust concentrations were 0.038 and 0.66 mg/m3, respectively. Statistically significant increases in levels of CC16 were associated with exposure to chemical binders (p = 0.05; p = 0.01) in the regression analysis of quartz and respirable dust, respectively. Non-significant exposure-responses were identified for cumulative quartz and the symptoms asthma and breathlessness. For cumulative chemical years, non-significant exposure-response were observed for all but two symptoms. FENO also exhibited a non significant exposure-response for both quartz and respirable dust. No exposure-response was determined for FEV1 or FVC, CRP and respirable dust and quartz.

    CONCLUSIONS: Our findings suggest that early markers of pulmonary effect, such as increased levels of CC16 and FENO, are more strongly associated with chemical binder exposure than respirable quartz and dust in foundry environments.

  • 8.
    Andersson, Lena
    et al.
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden; Man-Technology-Environment Research Centre (MTM), Department of Science, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Ngo, Yen
    Swedish Institute for Infectious Disease Control, Solna, Sweden.
    Ohlson, Carl-Göran
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Medicines, Örebro University, Örebro, Sweden; Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Exposure assessment and modeling of quartz in Swedish iron foundries for a nested case-control study on lung cancer2012In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 9, no 2, p. 110-119Article in journal (Refereed)
    Abstract [en]

    Exposure assessment of quartz in Swedish iron foundries was performed based on historical and present measurement data. To evaluate the exposure response relationship between quartz exposure and lung cancer, we modeled quartz exposure from our database of measurements using determinants job title, time period and company. Based on these modeled exposure data, we conducted a nested case– control evaluation.

    In our database, the overall individual daily time-weighted average (TWA) quartz concentrations of current and historical data varied between 0.0018 and 4.9 mg/m3, averaging 0.083 mg/m3. The job titles with mean TWAs for the whole study period exceeding the European Union recommended occupational exposure limit of 0.05 mg/m3 were fettlers (0.087 mg/m3), furnace and ladle repair (0.42 mg/m3) and maintenance (0.054 mg/m3) workers.

    The mixed model analysis demonstrated significant determinants on the job level for furnace and ladle repair (β=4.06; 95% CI 2.78-5.93). For all jobs significantly higher exposure levels occurred only during the first time period, 1968-1979 (β=2.08; 95% CI 1.75-2.47), and a decreasing but not significant trend was noted for the three following 10 year time periods up to 2006 (β=1.0, 0.96 and 1, respectively). Two iron foundries had significantly higher quartz concentration levels than the others (β=1.31; 95% CI 1.00-1.71 and β=1.63; 95% CI 1.00-2.65, respectively). The individual cumulative quartz exposure measures were categorized in low, medium and high exposure (0.5-<1, 1-1.9 and ≥2 mg/m3 *years, respectively).

    In the nested case-control analysis, we found the highest odds ratios of lung cancer (OR 1.17; 95% CI 0.53-2.55) for the medium exposure group. No dose– response trend or significantly increased risk was determined for our high exposed group (≥2 mg/m3), representing 40 years of exposure at >0.05 mg/m3 of quartz. To conclude, certain foundry workers are still exposed to high levels of quartz, but an increased risk of lung cancer caused by quartz exposure in these Swedish iron foundries could not be confirmed at our exposure levels.

  • 9. Andersson, Lena
    et al.
    Bryngelsson, Ing-Liss
    Ohlson, Carl-Göran
    Nayström, Peter
    Lilja, Bengt-Gunnar
    Westberg, Håkan
    Örebro University, School of Health and Medical Sciences.
    Quartz and dust exposure in Swedish iron foundries2009In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 6, no 1, p. 9-18Article in journal (Refereed)
    Abstract [en]

    Exposure to respirable quartz continues to be a major concern in the Swedish iron foundry industry. Recommendations for reducing the European occupational exposure limit (EU-OEL) to 0.05 mg/m3 and the corresponding ACGIH® threshold limit value (ACGIH-TLV) to 0.025 mg/m3 prompted this exposure survey. Occupational exposure to respirable dust and respirable quartz were determined in 11 Swedish iron foundries, representing different sizes of industrial operation and different manufacturing techniques. In total, 436 respirable dust and 435 respirable quartz exposure measurements associated with all job titles were carried out and are presented as time-weighted averages. Our sampling strategy enabled us to evaluate the use of respirators in certain jobs, thus determining actual exposure. In addition, measurements using real-time dust monitors were made for high exposure jobs. For respirable quartz, 23% of all the measurements exceeded the EU-OEL, and 56% exceeded the ACGIH-TLV. The overall geometric mean (GM) for the quartz levels was 0.028 mg/m3, ranging from 0.003 to 2.1 mg/m3. Fettler and furnace and ladle repair operatives were exposed to the highest levels of both respirable dust (GM = 0.69 and 1.2 mg/m3; range 0.076-31 and 0.25-9.3 mg/m3 and respirable quartz (GM = 0.041 and 0.052 mg/m3; range 0.004-2.1 and 0.0098-0.83 mg/m3. Fettlers often used respirators and their actual quartz exposure was lower (range 0.003-0.21 mg/m3, but in some cases it still exceeded the Swedish OEL (0.1 mg/m3. For furnace and ladle repair operatives, the actual quartz exposure did not exceed the OEL (range 0.003-0.08 mg/m3, but most respirators provided insufficient protection, i.e., factors less than 200. In summary, measurements in Swedish iron foundries revealed high exposures to respirable quartz, in particular for fettlers and furnace and ladle repair workers. The suggested EU-OEL and the ACGIH-TLV were exceeded in, respectively, 23% and 56% of all measurements regardless of the type of foundry. Further work on elimination techniques to reduce quartz concentrations, along with control of personal protection equipment, is essential.

  • 10.
    Andersson, Lena
    et al.
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Burdorf, Alex
    Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Estimating trends in quartz exposure in Swedish iron foundries: predicting past and present exposures2012In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 56, no 3, p. 362-372Article in journal (Refereed)
    Abstract [en]

    Background: Swedish foundries have a long tradition of legally required surveys in the work place that, from the late 1960s onwards, included measurements of quartz. The availability of exposure data spanning almost 40 years presents a unique opportunity to study trends over that time and to evaluate the validity of exposure models based on data from shorter time spans. The aims of this study were (i) to investigate long term trends in quartz exposure over time, (ii) using routinely collected quartz exposure measurements to develop a mathematical model that could predict both historical and current exposure patterns, and (iii) to validate this exposure model with up-to-date measurements from a targeted survey of the industry.

    Methods: Eleven foundries, representative of the Swedish iron foundry industry, were divided into three groups based on the size of the companies, i.e. the number of employees. A database containing 2333 quartz exposure measurements for 11 different job descriptionswas used to create three models that covered time periods which reflected different work conditions and production processes: a historical model (1968– 1989), a development model (1990–2004), and a validation model (2005–2006). A linear mixed model for repeated measurements was used to investigate trends over time. In all mixed models, time period, company size, and job title were included as fixed (categorical) determinants of exposure. The within- and between-worker variances were considered to be random effects. A linear regression analysis was erformed to investigate agreement between the models. The average exposure was estimated for each combination of job title and company size.

    Results: A large reduction in exposure (51%) was seen between 1968 and 1974 and between 1975 and 1979 (28%). In later periods, quartz exposure was reduced by 8% per 5 years at best. In the first period, employees at smaller companies experienced ~50%higher exposure levels than those at large companies, but these differences became much smaller in later years. The furnace and ladle repair job were associated with the highest exposure, with 3.9–8.0 times the average exposure compared to the lowest exposed group. Without adjusting for this autonomous trend over time, predicting early historical exposures using our development model resulted in a statistically significant regression coefficient of 2.42 (R2 5 0.81), indicating an underestimation of historical exposure levels. Similar patterns were seen for other historical time periods. Comparing our development model with our validation model resulted in a statistically significant regression coefficient of 0.31, indicating an overestimation of current exposure levels.

    Conclusion: To investigate long-term trends in quartz exposure over time, overall linear trends can be determined by using mixed model analysis. To create individual exposure measures to predict historical exposures, it is necessary to consider factors such as the time period, type of job, type of company, and company size. The mixed model analysis showed systematic changes in concentration levels, implying that extrapolation of exposure estimates outside the range of years covered by measurements may result in underestimation or overestimation of exposure.

  • 11.
    Andersson, Lena
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Occupational and Environmental Medicine.
    Hedbrant, Alexander
    Örebro University, School of Medical Sciences.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden .
    Persson, Alexander
    Örebro University, School of Medical Sciences.
    Johansson, Anders
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Sweden .
    Ericsson, Annette
    Örebro University, School of Health Sciences. Department of Occupational and Environmental Medicine.
    Vihlborg, Per
    Örebro University, School of Medical Sciences. Department of Occupational and Environmental Medicine.
    Sjögren, Bengt
    Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Särndahl, Eva
    Örebro University, School of Medical Sciences.
    Stockfelt, Leo
    Unit of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine.
    Respiratory Health and Inflammatory Markers: Exposure to Cobalt in the Swedish Hard Metal Industry2020In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 62, no 10, p. 820-829Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the relationship between inhalable dust and cobalt and respiratory symptoms, lung function, exhaled nitric oxide in expired air and CC16 in the Swedish hard metal industry.

    METHODS: Personal sampling of inhalable dust and cobalt, medical examination including blood sampling was performed for 72 workers. Exposure-response relationships was determined using logistic, linear and mixed model analysis.

    RESULTS: The average inhalable dust and cobalt concentrations were 0.079 and 0.0017 mg/m, respectively. Statistically significant increased serum levels of CC16 were determined when the high and low cumulative exposures for cobalt were compared. Non-significant exposure-response relationships was observed between cross-shift inhalable dust or cobalt exposures and asthma, nose dripping and bronchitis.

    CONCLUSIONS: Our findings suggest an exposure-response relationship between inhalable cumulative cobalt exposure and CC16 levels in blood, which may reflect an injury or a reparation process in the lungs.

  • 12.
    Andersson, Lena
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Occupational and Environmental Medicine,.
    Hedbrant, Alexander
    Örebro University, School of Medical Sciences.
    Persson, Alexander
    Örebro University, School of Medical Sciences.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sjögren, Bengt
    Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Stockfelt, Leo
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Occupational and Environmental Medicine, and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Särndahl, Eva
    Örebro University, School of Medical Sciences.
    Westberg, Håkan
    Örebro University, School of Medical Sciences. Department of Occupational and Environmental Medicine.
    Inflammatory and coagulatory markers and exposure to different size fractions of particle mass, number and surface area air concentrations in the Swedish hard metal industry, in particular to cobalt2021In: Biomarkers, ISSN 1354-750X, E-ISSN 1366-5804, Vol. 26, no 6, p. 557-569Article in journal (Refereed)
    Abstract [en]

    Purpose: To study the relationship between inhalation of airborne particles and cobalt in the Swedish hard metal industry and markers of inflammation and coagulation in blood.

    Methods: Personal sampling of inhalable cobalt and dust were performed for subjects in two Swedish hard metal plants. Stationary measurements were used to study concentrations of inhalable, respirable, and total dust and cobalt, PM10 and PM2.5, the particle surface area and the particle number concentrations. The inflammatory markers CC16, TNF, IL-6, IL-8, IL-10, SAA and CRP, and the coagulatory markers FVIII, vWF, fibrinogen, PAI-1 and D-dimer were measured. A complete sampling was performed on the second or third day of a working week following a work-free weekend, and additional sampling was taken on the fourth or fifth day. The mixed model analysis was used, including covariates.

    Results: The average air concentration of inhalable dust and cobalt were 0.11 mg/m3 and 0.003 mg/m3, respectively. For some mass-based exposure measures of cobalt and total dust, statistically significant increased levels of FVIII, vWF and CC16 were found.Conclusions: The observed relationships between particle exposure and coagulatory biomarkers may indicate an increased risk of cardiovascular disease. 

  • 13.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University, Örebro, Sweden.
    Lundholm, Ulla Persson
    Nora Health Care Centre, Örebro County Council, Nora, Sweden.
    Kohn, Monica
    Nora Health Care Centre, Örebro County Council, Nora, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University, Örebro, Sweden.
    Medical yoga: another way of being in the world-A phenomenological study from the perspective of persons suffering from stress-related symptoms2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, article id 23033Article in journal (Refereed)
    Abstract [en]

    The prevalence of stress-related illness has grown in recent years. Many of these patients seek help in primary health care. Yoga can reduce stress and thus complements pharmacological therapy in medical practice. To our knowledge, no studies have investigated patients' experiences of yoga treatment in a primary health care setting or, specifically, the experiences of yoga when suffering from stress-related illness. Thus, the aim of the present study was to explore the meaning of participating in medical yoga as a complementary treatment for stress-related symptoms and diagnosis in a primary health care setting. This study has a descriptive phenomenological design and took place at a primary health care centre in Sweden during 2011. Five women and one man (43-51 years) participated. They were recruited from the intervention group (n = 18) in a randomized control trial, in which they had participated in a medical yoga group in addition to standard care for 12 weeks. Data were collected by means of qualitative interviews, and a phenomenological data analysis was conducted. The essential meaning of the medical yoga experience was that the medical yoga was not an endpoint of recovery but the start of a process towards an increased sense of wholeness. It was described as a way of alleviating suffering, and it provided the participants with a tool for dealing with their stress and current situation on a practical level. It led to greater self-awareness and self-esteem, which in turn had an implicit impact on their lifeworld. In phenomenological terms, this can be summarized as Another way of being in the world, encompassing a perception of deepened identity. From a philosophical perspective, due to using the body in a new way (yoga), the participants had learnt to see things differently, which enriched and recast their perception of themselves and their lives.

  • 14.
    Arnell, Susann
    et al.
    Örebro University, School of Health Sciences. Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden; School of Health Sciences, The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden; School of Health Sciences, The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden.
    Jerlinder, Kajsa
    School of Health Sciences, The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden; Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Lundqvist, Lars-Olov
    Örebro University, School of Health Sciences. Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden; School of Health Sciences, The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden .
    Perceptions of Physical Activity Participation Among Adolescents with Autism Spectrum Disorders: A Conceptual Model of Conditional Participation2018In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 48, no 5, p. 1792-1802Article in journal (Refereed)
    Abstract [en]

    Adolescents with an autism spectrum disorder (ASD) are less physically active compared to typically developing peers. The reasons for not being physically active are complex and depend on several factors, which have not been comprehensively described from the adolescent's perspective. Therefore, the aim was to describe how adolescents with an ASD perceive, experience and reflect on their participation in physical activity. Interviews with 24 adolescents diagnosed with high-functioning ASD, aged 12-16 years, were analysed with qualitative content analysis with an inductive approach. They expressed a variety of reasons determining their willingness to participate, which were conceptualized as: Conditional participation in physical activities. The present study presents an alternative perspective on participation in physical activity, with impact on intervention design.

  • 15.
    Awad, Raed
    et al.
    Department of Environmental Science (ACES), Stockholm University, Stockholm, Sweden; Swedish Environmental Research Institute (IVL), Stockholm, Sweden.
    Zhou, Yihui
    State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai, China.
    Nyberg, Elisabeth
    Department of Contaminants, Swedish Environmental Protection Agency, Stockholm, Sweden.
    Namazkar, Shahla
    Department of Environmental Science (ACES), Stockholm University, Stockholm, Sweden.
    Wu, Yongning
    NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China.
    Xiao, Qianfen
    State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai, China.
    Sun, Yaije
    Key Laboratory of Yangtze River Water Environment (Ministry of Education), College of Environmental Science and Engineering, Tongji University, Shanghai, China.
    Zhu, Zhiliang
    Key Laboratory of Yangtze River Water Environment (Ministry of Education), College of Environmental Science and Engineering, Tongji University, Shanghai, China.
    Bergman, Åke
    Örebro University, School of Science and Technology. Department of Environmental Science (ACES), Stockholm University, Stockholm, Sweden; State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai, China.
    Benskin, Jonathan P.
    Department of Environmental Science (ACES), Stockholm University, Stockholm, Sweden.
    Emerging per- and polyfluoroalkyl substances (PFAS) in human milk from Sweden and China (vol 22, pg 2023, 2020)2021In: Environmental Science: Processes & Impacts, ISSN 2050-7887, E-ISSN 2050-7895, Vol. 23, no 1, p. 188-188Article in journal (Refereed)
  • 16.
    Awad, Raed
    et al.
    Department of Environmental Science (ACES), Stockholm University, Stockholm, Sweden; Swedish Environmental Research Institute (IVL), Stockholm, Sweden .
    Zhou, Yihui
    State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai, China.
    Nyberg, Elisabeth
    Department of Contaminants, Swedish Environmental Protection Agency, Stockholm, Sweden.
    Namazkar, Shahla
    Department of Environmental Science (ACES), Stockholm University, Stockholm, Sweden.
    Yongning, Wu
    NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China.
    Xiao, Qianfen
    State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai, China.
    Sun, Yaije
    Key Laboratory of Yangtze River Water Environment (Ministry of Education), College of Environmental Science and Engineering, Tongji University, Shanghai, China.
    Zhu, Zhiliang
    Key Laboratory of Yangtze River Water Environment (Ministry of Education), College of Environmental Science and Engineering, Tongji University, Shanghai, China.
    Bergman, Åke
    Örebro University, School of Science and Technology. Department of Environmental Science (ACES), Stockholm University, Stockholm, Sweden; State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai, China .
    Benskin, Jonathan P.
    Department of Environmental Science (ACES), Stockholm University, Stockholm, Sweden.
    Emerging per- and polyfluoroalkyl substances (PFAS) in human milk from Sweden and China2020In: Environmental Science: Processes & Impacts, ISSN 2050-7887, E-ISSN 2050-7895, Vol. 22, no 10, p. 2023-2030Article in journal (Refereed)
    Abstract [en]

    Twenty per- and polyfluoroalkyl substances (PFAS) were determined in human milk from residents of three Chinese cities (Shanghai, Jiaxing, and Shaoxing; [n = 10 individuals per city]), sampled between 2010 and 2016. These data were compared to a combination of new and previously reported PFAS concentrations in human milk from Stockholm, Sweden, collected in 2016 (n = 10 individuals). Across the three Chinese cities, perfluorooctanoate (PFOA; sum isomers), 9-chlorohexadecafluoro-3-oxanone-1-sulfonic acid (9Cl-PF3ONS; also known as 6:2 Cl-PFESA or by its trade name "F53-B"), and perfluorooctane sulfonate (PFOS; sum isomers) occurred at the highest concentrations among all PFAS (up to 411, 976, and 321 pg mL-1, respectively), while in Stockholm, PFOA and PFOS were dominant (up to 89 and 72 pg mL-1, respectively). 3H-Perfluoro-3-[(3-methoxy-propoxy)propanoic acid] (ADONA) was intermittently detected but at concentrations below the method quantification limit (i.e. <10 pg mL-1) in Chinese samples, and was non-detectable in Swedish milk. The extremely high concentrations of F53-B in Chinese milk suggest that human exposure assessments focused only on legacy substances may severely underestimate overall PFAS exposure in breastfeeding infants.

  • 17.
    Axén, Iben
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Using few and scattered time points for analysis of a variable course of pain can be misleading: an example using weekly text message data2014In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 14, no 8, p. 1454-1459Article in journal (Refereed)
    Abstract [en]

    Background context: Because low back pain (LBP) is a fluctuating condition, the diversity in the prediction literature may be due to when the outcome is measured.

    Purpose: The objective of this study was to investigate the prediction of LBP using an outcome measured at several time points.

    Study design/setting: A multicenter clinical observational study in Sweden.

    Patient sample: Data were collected on 244 subjects with nonspecific LBP. The mean age of the subjects was 44 years, the mean pain score at inclusion was 4.4/10, and 51% of the sample had experienced LBP for more than 30 days the previous year.

    Outcome measures: The outcome used in this study was the “number of days with bothersome pain” collected with weekly text messages for 6 months.

    Methods: In subjects with nonspecific LBP, weekly data were available for secondary analyses. A few baseline variables were chosen to investigate prediction at different time points: pain intensity, the presence of leg pain, duration of LBP the previous year, and self-rated health at baseline. Age and gender acted as additional covariates.

    Results: In the multilevel models, the predictive variables interacted with time. Thus, the risk of experiencing a day with bothersome LBP varied over time. In the logistic regression analyses, the predictive variable's previous duration showed a consistent predictive ability for all the time points. However, the variables pain intensity, leg pain, and self-rated health showed inconsistent predictive patterns.

    Conclusions: An outcome based on frequently measured data described the variability in the prediction of future LBP over time. Prediction depended on when the outcome was measured. These results may explain the diversity of the results of the predictor studies in the literature.

  • 18.
    Axén, Iben
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research in Worker Health, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research in Worker Health, Karolinska Institutet, Stockholm, Sweden.
    Searching for the optimal measuring frequency in longitudinal studies: an example utilizing short message service (SMS) to collect repeated measures among patients with low back pain2016In: BMC Medical Research Methodology, E-ISSN 1471-2288, Vol. 16, no 1, article id 119Article in journal (Refereed)
    Abstract [en]

    Background: Mobile technology has opened opportunities within health care and research to allow for frequent monitoring of patients. This has given rise to detailed longitudinal information and new insights concerning behaviour and development of conditions over time.

    Responding to frequent questionnaires delivered through mobile technology has also shown good compliance, far exceeding that of traditional paper questionnaires. However, to optimize compliance, the burden on the subjects should be kept at a minimum.

    In this study, the effect of using fewer data points compared to the full data set was examined, assuming that fewer measurements would lead to better compliance.

    Method: Weekly text-message responses for 6 months from subjects recovering from an episode of low back pain (LBP) were available for this secondary analysis. Most subjects showed a trajectory with an initial improvement and a steady state thereafter.

    The data were originally used to subgroup (cluster) patients according to their pain trajectory. The resulting 4-cluster solution was compared with clusters obtained from five datasets with fewer data-points using Kappa agreement as well as inspection of estimated pain trajectories. Further, the relative risk of experiencing a day with bothersome pain was compared week by week to show the effects of discarding some weekly data.

    Results: One hundred twenty-nine subjects were included in this analysis. Using data from every other weekly measure had the highest agreement with the clusters from the full dataset, weighted Kappa = 0.823. However, the visual description of pain trajectories favoured using the first 18 weekly measurements to fully capture the phases of improvement and steady-state. The weekly relative risks were influenced by the pain trajectories and 18 weeks or every other weekly measure were the optimal designs, next to the full data set.

    Conclusions: A population recovering from an episode of LBP could be described using every other weekly measurement, an option which requires fewer weekly measures than measuring weekly for 18 weeks. However a higher measuring frequency might be needed in the beginning of a clinical course to fully map the pain trajectories.

  • 19.
    Beales, Darren
    et al.
    Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia.
    Larsson, Maria Eh
    Department of Health and Rehabilitation, Institute of Neuroscience and, Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Education, Research and Development Primary Health Care, Region Västra Götaland, Sweden.
    O'Sullivan, Peter
    Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia.
    Straker, Leon
    Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Smith, Anne
    Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia.
    The Predictive Ability of the Full and Short Versions of the Orebro Questionnaire for Absenteeism and Presenteeism Over the Subsequent 12 months, in a Cohort of Young Community-Based Adult Workers2021In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 63, no 12, p. 1058-1064Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The primary purpose of this study was to investigate the predictive ability of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) in regard to work productivity (absenteeism and presenteeism) in early adulthood.

    METHODS: A prospective study was performed using data from the Raine Study Generation 2 (Gen2) 22-year follow-up. The ÖMPSQ was completed at baseline, and absenteeism and presenteeism assessed at 4 intervals over the following 12 months.

    RESULTS: In early adulthood, the full and short versions of the ÖMPSQ showed some predictive ability for work absenteeism but the Receiver Operator Characteristic demonstrated poor discrimination. There was no evidence of predictive ability for presenteeism.

    CONCLUSION: Further work is required to increase the fidelity of screening for risk of reduced work productivity at the population level.

  • 20.
    Bejerot, Eva
    Faculty of Social Sciences, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Re:: Läkarna som grupp har förlorat känslan av att ha en ansvarsposition2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 12, p. 637-638Article in journal (Refereed)
  • 21.
    Bellanger, Martine
    et al.
    EHESP School of Public Health, Paris, France.
    Demeneix, Barbara
    Unité Mixte de Recherche, Muséum National d'Histoire Naturelle, Paris, France.
    Grandjean, Philippe
    Harvard School of Public Health, Boston, USA; University of Southern Denmark, Odense, Denmark.
    Zoeller, R. Thomas
    University of Massachusetts, Amherst, USA.
    Trasande, Leonardo
    Department of Pediatrics, NYU, New York, USA; Wagner School of Public Service, New York, USA; Department of Nutrition, Food and Public Health, Steinhardt School of Culture, Education, and Human Development, New York, USA; Global Institute of Public Health, New York, USA.
    Neurobehavioral deficits, diseases, and associated costs of exposure to endocrine-disrupting chemicals in the European Union2015In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 100, no 4, p. 1256-1266Article in journal (Refereed)
    Abstract [en]

    CONTEXT: Epidemiological studies and animal models demonstrate that endocrine-disrupting chemicals (EDCs) contribute to cognitive deficits and neurodevelopmental disabilities.

    OBJECTIVE: The objective was to estimate neurodevelopmental disability and associated costs that can be reasonably attributed to EDC exposure in the European Union.

    DESIGN: An expert panel applied a weight-of-evidence characterization adapted from the Intergovernmental Panel on Climate Change. Exposure-response relationships and reference levels were evaluated for relevant EDCs, and biomarker data were organized from peer-reviewed studies to represent European exposure and approximate burden of disease. Cost estimation as of 2010 utilized lifetime economic productivity estimates, lifetime cost estimates for autism spectrum disorder, and annual costs for attention-deficit hyperactivity disorder. Setting, Patients and Participants, and Intervention: Cost estimation was carried out from a societal perspective, ie, including direct costs (eg, treatment costs) and indirect costs such as productivity loss.

    RESULTS: The panel identified a 70-100% probability that polybrominated diphenyl ether and organophosphate exposures contribute to IQ loss in the European population. Polybrominated diphenyl ether exposures were associated with 873,000 (sensitivity analysis, 148,000 to 2.02 million) lost IQ points and 3290 (sensitivity analysis, 3290 to 8080) cases of intellectual disability, at costs of €9.59 billion (sensitivity analysis, €1.58 billion to €22.4 billion). Organophosphate exposures were associated with 13.0 million (sensitivity analysis, 4.24 million to 17.1 million) lost IQ points and 59 300 (sensitivity analysis, 16,500 to 84,400) cases of intellectual disability, at costs of €146 billion (sensitivity analysis, €46.8 billion to €194 billion). Autism spectrum disorder causation by multiple EDCs was assigned a 20-39% probability, with 316 (sensitivity analysis, 126-631) attributable cases at a cost of €199 million (sensitivity analysis, €79.7 million to €399 million). Attention-deficit hyperactivity disorder causation by multiple EDCs was assigned a 20-69% probability, with 19 300 to 31 200 attributable cases at a cost of €1.21 billion to €2.86 billion.

    CONCLUSIONS: EDC exposures in Europe contribute substantially to neurobehavioral deficits and disease, with a high probability of >€150 billion costs/year. These results emphasize the advantages of controlling EDC exposure.

  • 22.
    Bergman, Stefan
    et al.
    Spenshult sjukhus Halmstad, Landstinget Halland, Sweden.
    Gerdle, Björn
    Linköpings universitet, Universitetssjukhuset i Linköping, Sweden.
    Hagberg, Mats
    Göteborgs universitet, Sahlgrenska universitetssjukhuset, Göteborg, Sweden.
    Jacobsson, Ulf
    Lunds universitet, Lund, Sweden.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Strender, Lars-Erik
    Karolinska institutet, Huddinge, Sweden.
    Stålnacke, Britt-Marie
    Umeå universitet, Norrlands universitetssjukhus, Umeå, Sweden.
    Söderlund, Anne
    Mälardalens högskola, Hälsa och välfärd, Västerås, Sweden.
    Långvarig smärta i nacke, skuldror och rygg i Nationella riktlinjer för rörelseorganens sjukdomar 2010 – stöd för styrning och ledning: Preliminär version2010Report (Other academic)
    Abstract [sv]

    Nationella riktlinjer för rörelseorganens sjukdomar belyser områden där behovet av vägledning är stort på grund av att det finns praxisskillnader, kontroversiella frågor eller behov av kvalitetsutveckling.

    De här riktlinjerna berör åtgärder som utförs inom hälso- och sjukvården och utgår från diagnostik, behandling och rehabilitering. Nationella riktlinjer för rörelseorganens sjukdomar omfattar:

    • reumatoid artrit
    • ankyloserande spondylit
    • psoriasisartrit
    • artros i höft och knä
    • osteoporos (benskörhet)
    • långvarig smärta i nacke, skuldror och rygg
  • 23.
    Bergman, Stefan
    et al.
    Spenshult sjukhus i Halmstad, Landstinget Halland, Sweden.
    Gerdle, Björn
    Linköpings universitet, Universitetssjukhuset i Linköping; Sweden.
    Hagberg, Mats
    Göteborgs universitet, Sahlgrenska Universitetssjukhuset i Göteborg, Sweden.
    Jakobsson, Ulf
    Lunds universitet, Lund, Sweden.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Strender, Lars-Erik
    Karolinska Institutet i Huddinge, Sweden.
    Stålnacke, Britt-Marie
    Umeå universitet, Norrlands universitetssjukhus i Umeå, Sweden.
    Söderlund, Anne
    Mälardalens högskola i Västerås, Sweden.
    Långvarig smärta i nacke, skuldror och rygg i Nationella riktlinjer för rörelseorganens sjukdomar 2012: Osteoporos, artros, inflammatorisk ryggsjukdom och ankyloserande spondylit ,psoriasisartrit och reumatoid artrit - Stöd för styrning och ledning2012Report (Other academic)
    Abstract [sv]

    Dessa riktlinjer innehåller rekommendationer om åtgärder vid sjukdomar i rörelseorganen. De innehåller också bedömningar av rekommendatio-nernas ekonomiska och organisatoriska konsekvenser och indikatorer för uppföljning. Riktlinjerna omfattar följande diagnosområden:

    • osteoporos (benskörhet)
    • artros i knä och höft (nedbrytning av ledbrosk)
    • inflammatorisk ryggsjukdom (axial spondylartrit) och ankylose-rande spondylit
    • psoriasisartrit (en kombination av psoriasis och ledinflammationer)
    • reumatoid artrit (ledgångsreumatism)
  • 24. Bergström, Gunnar
    et al.
    Björklund, Christina
    Fried, Ingegärd
    Lisspers, Jan
    Nathell, Lennart
    Hermansson, Ulric
    Helander, Anders
    Bodin, Lennart
    Örebro University, School of Health and Medical Sciences.
    Jensen, Irene B.
    A comprehensive workplace intervention and its outcome with regard to lifestyle, health and sick leave: the AHA study2008In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 31, no 2, p. 167-180Article in journal (Refereed)
    Abstract [en]

    This study is a prospective multicentre cohort study entitled Work and Health in the Processing and Engineering Industries, the AHA Study (AHA is the Swedish abbreviation for the study). Four large workplaces in Sweden participated during the years from 2000 to 2003. The present report has two objectives: (1) to present a comprehensive occupational health intervention programme and (2) to evaluate this programme with a focus on lifestyle (smoking and exercise), health related quality of life (HRQoL) and sick leave. Interventions were provided on an individual and group level, including evidence-based methods for four health/focus areas (individual level) and a group intervention based on a survey-feedback methodology. The analyses in this report were exclusively employed at an organizational level. The proportion of smokers decreased at three companies and the course of the HRQoL was advantageous at two of the companies as compared to a gainfully employed reference group. A significant decrease in sick leave was revealed at one company, whereas a break in an ascending sick-leave trend appeared at a second company as compared to their respective corporate groups. This comprehensive workplace intervention programme appears to have had positive effects on smoking habits, HRQoL and sick leave.

  • 25.
    Bjurlid, Filip
    Örebro University, School of Science and Technology. Örebro University Hospital.
    Jämförelse av halter av läkemedel i utgående vatten från avloppsreningsverk i Sörmlands läns landsting mellan 2008/2009 och 2013-20172018Report (Other academic)
  • 26.
    Blom, Victoria
    et al.
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Swedish School of Sport and Health Sciences, Stockholm, Sweden.
    Sverke, Magnus
    Department of Psychology, Stockholm University, Stockholm, Sweden; WorkWell, Research Unit for Economic and Management Sciences, North-West University, Westonaria, South Africa.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Division of Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lindfors, Petra
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Svedberg, Pia
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Work-Home Interference and Burnout A Study Based on Swedish Twins2014In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 56, no 4, p. 361-366Article in journal (Refereed)
    Abstract [en]

    Objective: This study sets out to investigate the impact of work-home interference on burnout in women and men, while taking genetic and family environmental factors into account.

    Methods: A total of 4446 Swedish twins were included in the study. The effects of work-home conflict (WHC) and home-work conflict (HWC) on burnout between and within pairs were analyzed with co-twin control analyses.

    Results: Both WHC and HWC were significantly associated with burnout. Genetic factors may be involved in the association between HWC and burnout in women. Familial factors were not involved for WHC and burnout, neither for women nor for men.

    Conclusions: This study shows the importance to encounter WHC per se to prevent burnout. Because of genetic confounding in HWC and burnout in women, preventive efforts may also take into account individual characteristics.

  • 27.
    Borgestig, Maria
    Linköpings universitet, Linköping, Sweden.
    The impact of gaze-based assistive technology on daily activities in children with severe physical impairments2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The aim of the thesis was to investigate the impact of gaze-based assistive technology on daily activities in children with severe physical impairments and without speech. The objectives were to develop and pilot a gaze-based assistive technology intervention (GAT intervention) at home and in school for these children and to understand its impact on daily activities as experienced by their parents.

    Methods: Study I was a pilot study in which the basic components that were developed for the intervention were evaluated for students with physical impairments. The study aimed at improving the use of computers as assistive technology (AT) in school. Based on the findings in Study I, the GAT intervention was developed. The GAT intervention aimed at implementing gaze-based AT in daily activities. It consisted of two parts; having access to gaze-based AT and having access to services from a multi professional communication team during nine to ten months. Studies II-IV concerned gazebased AT for children with severe physical impairments without speech who participated in the GAT intervention. The participants were ten children (ages 1-15) (Studies II, III), and their parents (Study IV). Studies II and III had longitudinal designs and children were followed during 15-20 months with repeated measurements before, after and at follow-up. In Study II children’s repertoire of computer activities, extent of use, and goal attainment with gaze-based AT was evaluated, as well as parents’ satisfaction with the AT and with services. In Study III children’s eye gaze performance when using gaze-based AT was examined. In Study IV, parents were interviewed twice with the aim of  exploring their experiences of children’s gaze-based AT use in daily life. In Study IV a hermeneutical approach was used.

    Results: The findings of Study I showed that the basic components of intervention improved the use of computers in school. Study II showed an increased repertoire of computer activities with the gazebased AT, maintained use in daily activities for all at follow up, and that all children attained goals for gaze-based AT use in daily activities. Parents were satisfied with the gaze-based AT, and with the services in the GAT intervention. In study III, nine children improved in eye gaze performance over time when using the gaze-based AT in daily activities. Study IV revealed that children’s gaze-based AT usage in daily activities made a difference to parents since the children demonstrated agency, and showed their personality and competencies by using gaze-based AT, and for the parents this opened up infinite possibilities for the child to do and learn things. Overall, children’s gaze-based AT usage provided parents with hope of a future in which their children could develop and have influence in life.

    Conclusions: This thesis shows that these children with severe physical impairments and without speech acquired sufficient gaze control skills to use gaze-based AT for daily activities in the home and at school. The gaze-based AT had a positive impact on performing activities, for example, play activities and communication- and interaction-related activities. For the parents, children’s gaze-based AT usage made a difference since it shaped a hope of a better future for their children, where they can develop and gain influence in their future life. Furthermore, the children continued to perform daily activities with gaze-based AT over time. This finding suggests that key persons were provided with sufficient knowledge and skills to support children in maintained use of gaze-based AT after withdrawal of the services provided in the GAT intervention.

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  • 28.
    Borgestig, Maria
    et al.
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden; Folke Bernadotte Regional Habilitation Centre and Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
    Rytterström, Patrik
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
    Hemmingsson, Helena
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
    Gaze-based assistive technology used in daily life by children with severe physical impairments: parents’ experiences2017In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 20, no 5, p. 301-308Article in journal (Refereed)
    Abstract [en]

    Objective: To describe and explore parents’ experiences when their children with severe physical impairments receive gaze-based assistive technology (gaze-based assistive technology (AT)) for use in daily life.

    Methods: Semi-structured interviews were conducted twice, with one year in between, with parents of eight children with cerebral palsy that used gaze-based AT in their daily activities. To understand the parents’ experiences, hermeneutical interpretations were used during data analysis.

    Results: The findings demonstrate that for parents, children’s gaze-based AT usage meant that children demonstrated agency, provided them with opportunities to show personality and competencies, and gave children possibilities to develop. Overall, children’s gaze-based AT provides hope for a better future for their children with severe physical impairments; a future in which the children can develop and gain influence in life.

    Conclusion: Gaze-based AT provides children with new opportunities to perform activities and take initiatives to communicate, giving parents hope about the children’s future.

  • 29.
    Borgestig, Maria
    et al.
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden; Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden; Folke Bernadotte Regional Habilitation Centre, Uppsala University, Uppsala, Sweden.
    Sandqvist, Jan
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
    Ahlsten, Gunnar
    School of Occupational Therapy & Social Work, Curtin University, Perth WA, Australia; School of Occupational Therapy, La Trobe University, Melbourne VIC, Australia; Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University & Pain and Rehabilitation Centre (UHL), County Council, Linköping, Sweden.
    Falkmer, Torbjorn
    Avdelningen för samhällsmedicin, Linköpings universitet, Linköping, Sweden.
    Hemmingsson, Helena
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
    Gaze-based assistive technology in daily activities in children with severe physical impairments: an intervention study2017In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 20, no 3, p. 129-141Article in journal (Refereed)
    Abstract [en]

    Objective: To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents’ satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention.

    Methods: Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1–15 years) participated in gaze-based AT intervention for 9–10 months, during which period the gaze-based AT was implemented in daily activities.

    Results: Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents’ satisfaction with the AT and with services was high.

    Discussion: The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.

  • 30.
    Bornehag, Carl-Gustaf
    et al.
    Karlstad University, Karlstad, Sweden; Icahn School of Medicine at Mount Sinai, New York City, USA.
    Engdahl, Elin
    Uppsala University, Uppsala, Sweden.
    Unenge Hallerbäck, Maria
    Karlstad University, Karlstad, Sweden.
    Wikström, Sverre
    Örebro University, School of Medical Sciences.
    Lindh, Christian
    Lund University, Lund, Sweden.
    Rüegg, Joëlle
    Karlstad University, Karlstad, Sweden; Uppsala University, Uppsala, Sweden.
    Tanner, Eva
    Icahn School of Medicine at Mount Sinai, New York City, USA.
    Gennings, Chris
    Icahn School of Medicine at Mount Sinai, New York City, USA.
    Prenatal exposure to bisphenols and cognitive function in children at 7 years of age in the Swedish SELMA study2021In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 150, article id 106433Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experimental evidence demonstrates that exposure to bisphenol A (BPA), and the recently introduced alternatives bisphenol S (BPS) and bisphenol F (BPF) alter normal neurodevelopment. More research is needed to evaluate the associations between exposure to individual BPA alternatives and neurodevelopmental outcomes in humans.

    OBJECTIVE: The present study aimed at examining the individual associations between prenatal BPA, BPS and BPF exposure and cognitive outcomes in children at age 7 years.

    METHOD: Women were enrolled in the Swedish Environmental Longitudinal Mother and Child, Asthma and Allergy (SELMA) study, at gestational median week 10.0, and their children were examined for cognitive function at 7 years of age (N = 803). Maternal urinary BPA, BPS, and BPF concentrations were measured at enrollment and childreńs cognitive function at the age of 7 years was measured using the Wechsler Intelligence Scale for Children IV (WISC-IV).

    RESULTS: All three bisphenols were detected in over 90% of the women, where BPA had the highest geometric mean concentrations (1.55 ng/mL), followed by BPF (0.16 ng/mL) and BPS (0.07 ng/mL). Prenatal BPF exposure was associated with decreased full scale IQ (β = -1.96, 95%CI; -3.12; -0.80), as well as with a decrease in all four sub scales covering verbal comprehension, perceptual reasoning, working memory and processing speed. This association corresponded to a 1.6-point lower IQ score for an inter-quartile-range (IQR) change in prenatal BPF exposure (IQR = 0.054-0.350 ng/mL). In sex-stratified analyses, significant associations with full scale IQ were found for boys (β = -2.86, 95%CI; -4.54; -1.18), while the associations for girls did not reach significance (β = -1.38, 95%CI; -2.97; 0.22). No significant associations between BPA nor BPS and cognition were found.

    DISCUSSION: Prenatal exposure to BPF was significantly associated with childreńs cognitive function at 7 years. Since BPF is replacing BPA in numerous consumer products globally, this finding urgently call for further studies.

  • 31.
    Brännström, Jonas
    et al.
    Department of Clinical Science, Section of Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden.
    Båsjö, Sara
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Larsson, Josefina
    ORCA Europe, Stockholm, Sweden.
    Lood, Sofie
    Hörseltjänst i Skåne AB, Malmö, Sweden .
    Lundå, Stefan
    Section of Audiology, Ryhov Hospital, Jönköping, Sweden,.
    Notsten, Margareta
    Section of Audiology, Kalix Hospital, Kalix, Sweden,.
    Turunen Taheri, Satu
    Department of CLINTEC, Unit of Audiology, Karolinska Institutet, Huddinge, Sweden; Department of Audiology and Neurology, Karolinska University Hospital, Stockholm, Sweden.
    Psychosocial work environment among Swedish audiologists2013In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 52, no 3, p. 151-161Article in journal (Refereed)
    Abstract [en]

    Objective: The study examined the self-reported psychosocial work environment for audiologists working in three practice types (public, completely private, and private but publicly funded).

    Design: A cross-sectional e-mail survey using the demand-control-support questionnaire, a short version of the effort-reward imbalance (ERI) questionnaire, and descriptive data.

    Study sample: Five-hundred Swedish licensed audiologists.

    Results: Overall, the results indicate differences in psychosocial work environment pertaining to the practice types. These differences are small and the type explains few percent of the variability accounted in the measures of psychosocial work environment. Social support seems important for the psychosocial work environment and is considered a reward in itself. Using the demand-control model, 29% of the audiologists reported working in a high-stress psychosocial work environment. Using the ERI-ratio to estimate the imbalance between effort and reward it was shown that that 86% of the participants experienced an unfavorable work situation where the rewards do not correspond to the efforts made.

    Conclusions: The organizational framework has minor effect on self-reported psychosocial work environment for Swedish licensed audiologists. The percentage of unfavorable ERI-ratios seen in Swedish audiologists seems conspicuously high compared to other working populations in general, but also compared to other health service workers.

  • 32.
    Busch, Hillevi
    et al.
    Public Health Agency of Sweden, Stockholm, Sweden.
    Björk Brämberg, Elisabeth
    Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Hagberg, Jan
    Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Jensen, Irene
    Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    The effects of multimodal rehabilitation on pain-related sickness absence: an observational study2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 14, p. 1646-1653Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the current study was to examine the effects on sickness absence of multimodal rehabilitation delivered within the framework of a national implementation of evidence based rehabilitation, the rehabilitation guarantee for nonspecific musculoskeletal pain.

    Method: This was an observational matched controlled study of all persons receiving multimodal rehabilitation from the last quarter of 2009 until the end of 2010. The matching was based on age, sex, sickness absence the quarter before intervention start and pain-related diagnosis. The participants were followed by register data for 6 or 12 months. The matched controls received rehabilitation in accordance with treatment-as-usual.

    Results: Of the participants, 54% (N = 3636) were on registered sickness absence at baseline and the quarter before rehabilitation. The average difference in number of days of sickness absence between the participants who received multimodal rehabilitation and the matched controls was to the advantage of the matched controls, 14.7 days (CI 11.7; 17.7, p ≤ 0.001) at 6-month follow-up and 9.5 days (CI 6.7; 12.3, p ≤ 0.001) at 12-month follow-up. A significant difference in newly granted disability pensions was found in favor of the intervention.

    Conclusions: When implemented nationwide, multimodal rehabilitation appears not to reduce sickness absence compared to treatment-as-usual.

    Implications for Rehabilitation

    • A nationwide implementation of multimodal rehabilitation was not effective in reducing sickness absence compared to treatment-as-usual for persons with nonspecific musculoskeletal pain.

    • Multimodal rehabilitation was effective in reducing the risk of future disability pension for persons with nonspecific musculoskeletal pain compared to treatment-as-usual.

    • To be effective in reducing sick leave multimodal rehabilitation must be started within 60 days of sick leave.

    • The evidence for positive effect of multimodal rehabilitation is mainly for sick listed patients. Prevention of sick leave for persons not being on sick leave should not be extrapolated from evidence for multimodal rehabilitation.

  • 33.
    Callan, Anna
    et al.
    School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia; Centre for Ecosystem Management, Edith Cowan University, Joondalup, Australia.
    Rotander, Anna
    National Research Centre for Environmental Toxicology (Entox), The University of Queensland, Coopers Plains, Australia.
    Thompson, Kristie
    National Research Centre for Environmental Toxicology (Entox), The University of Queensland, Coopers Plains, Australia.
    Heyworth, Jane
    School of Population Health, The University of Western Australia, Crawley, Australia.
    Mueller, Jochen F.
    National Research Centre for Environmental Toxicology (Entox), The University of Queensland, Coopers Plains, Australia.
    Odland, Jon Øyvind
    Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway.
    Hinwood, Andrea
    Centre for Ecosystem Management, Edith Cowan University, Joondalup, Australia.
    Maternal exposure to perfluoroalkyl acids measured in whole blood and birth outcomes in offspring2016In: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 569-570, p. 1107-1113Article in journal (Refereed)
    Abstract [en]

    Perfluoralkyl and polyfluoralkyl substances have been measured in plasma and serum of pregnant women as a measure of prenatal exposure. Increased concentrations of individual perfluoroalkyl acids (PFAAs), (typically perfluorooctanoic acid (PFOA) and perfluoroctane sulfonate (PFOS) have been reported to be associated with reductions in birth weight and other birth outcomes. We undertook a study of 14 PFAAs in whole blood (including PFOS, PFHxS, PFHpA, PFOA, PFNA, PFDA and PFUnDA) from 98 pregnant women in Western Australia from 2008 to 2011. Median concentrations (in μg/L) were: PFOS 1.99; PFHxS 0.33; PFOA 0.86; PFNA 0.30; PFDA 0.12 and PFUnDA 0.08. Infants born to women with the highest tertile of PFHxS exposure had an increased odds of being < 95% of their optimal birth weight (OR 3.5, 95% CI 1.1–11.5). Conversely, maternal blood concentrations of PFUnDA were associated with non-significant increases in average birth weight (+ 102 g, 95% CI − 41, 245) and significant increases in proportion of optimal birth weight (+ 4.7%, 95% CI 0.7, 8.8) per ln-unit change. This study has reported a range of PFAAs in the whole blood of pregnant women and suggests that PFHxS and PFUnDA may influence foetal growth and warrant further attention. Additional studies are required to identify the sources of PFAA exposure with a view to prevention, in addition to further studies investigating the long term health effects of these ubiquitous chemicals.

  • 34.
    Cao, Yang
    et al.
    Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA; Department of Health Statistics, Faculty of Health Services, Second Military Medical University, Shanghai, China.
    Blount, Benjamin C.
    Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
    Valentin-Blasini, Liza
    Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
    Bernbaum, Judy C.
    Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
    Phillips, Terry M.
    Ultramicro Immunodiagnostics Laboratory, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland, USA.
    Rogan, Walter J
    Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA.
    Goitrogenic anions, thyroid-stimulating hormone, and thyroid hormone in infants2010In: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 118, no 9, p. 1332-1337Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Environmental exposure of infants to perchlorate, thiocyanate, nitrate, might interfere with thyroid function. U.S. women with higher background perchlorate exposure have higher thyroid-stimulating hormone (TSH) and lower thyroxine (T4). There are no studies with individual measures of thyroid function and these goitrogens available in infants.

    OBJECTIVE: We examined the association of urinary perchlorate, nitrate, iodide, and thiocyanate with urinary T4 and TSH in infants and whether that association differed by sex or iodide status.

    METHODS: We used data and samples from the Study of Estrogen Activity and Development, which assessed hormone levels of full-term infants over the first 12 months of life. The study included 92 full-term infants between birth and 1 year of age seen up to four times. Perchlorate, thiocyanate, nitrate, and iodide were measured in 206 urine samples; TSH and T4 and were measured in urines and in 50 blood samples.

    RESULTS: In separate mixed models, adjusting for creatinine, age, sex, and body mass index, infants with higher urinary perchlorate, nitrate or thiocyanate had higher urinary TSH. With all three modeled, children with higher nitrate and thiocyanate had higher TSH, but higher perchlorate was associated with TSH only in children with low iodide. Unexpectedly, exposure to the three chemicals was generally associated with higher T4.

    CONCLUSIONS: The association of perchlorate exposure with increased urinary TSH in infants with low urinary iodide is consistent with previous findings. Higher thiocyanate and nitrate exposure were also associated with higher TSH in infants.

  • 35.
    Cao, Yang
    et al.
    Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA; Department of Health Statistics, Faculty of Health Services, Second Military Medical University, Shanghai, China.
    Chen, Aimin
    Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, Nebraska, USA.
    Radcliffe, Jerilynn
    Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
    Dietrich, Kim N.
    Department of Environmental Health, Division of Epidemiology and Biostatistics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
    Jones, Robert L.
    Inorganic and Radiation Analytical Toxicology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
    Caldwell, Kathleen
    Inorganic and Radiation Analytical Toxicology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
    Rogan, Walter J.
    Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA.
    Postnatal cadmium exposure, neurodevelopment, and blood pressure in children at 2, 5, and 7 years of age2009In: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 117, no 10, p. 1580-1586Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Adverse health effects of cadmium in adults are well documented, but little is known about the neuropsychological effects of cadmium in children, and no studies of cadmium and blood pressure in children have been conducted.

    OBJECTIVE: We examined the potential effects of low-level cadmium exposure on intelligence quotient, neuropsychological functions, behavior, and blood pressure among children, using blood cadmium as a measure of exposure.

    METHODS: We used the data from a multicenter randomized clinical trial of lead-exposed children and analyzed blood cadmium concentrations using the whole blood samples collected when children were 2 years of age. We compared neuropsychological and behavioral scores at 2, 5, and 7 years of age by cadmium level and analyzed the relationship between blood cadmium levels at 2 years of age and systolic and diastolic blood pressure at 2, 5, and 7 years of age.

    RESULTS: The average cadmium concentration of these children was 0.21 microg/L, lower than for adults in the National Health and Nutrition Examination Survey (NHANES), but comparable to concentrations in children < 3 years of age in NHANES. Except for the California Verbal Learning Test for Children, there were no differences in test scores among children in different cadmium categories. For children with detectable pretreatment blood cadmium, after adjusting for a variety of covariates, general linear model analyses showed that at none of the three age points was the coefficient of cadmium on Mental Development Index or IQ statistically significant. Spline regression analysis suggested that behavioral problem scores at 5 and 7 years of age tended to increase with increasing blood cadmium, but the trend was not significant. We found no significant associations between blood cadmium levels and blood pressure.

    CONCLUSION: We found no significant associations between background blood cadmium levels at 2 years of age and neurodevelopmental end points and blood pressure at 2, 5, and 7 years of age. The neuropsychological or hypertensive effects from longer background exposures to cadmium need further study.

  • 36.
    Carlberg, Michael
    et al.
    Department of Oncology, University Hospital, Örebro, Sweden.
    Hardell, Lennart
    Örebro University Hospital. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Decreased Survival of Glioma Patients with Astrocytoma Grade IV (Glioblastoma Multiforme) Associated with Long-Term Use of Mobile and Cordless Phones2014In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 11, no 10, p. 10790-10805Article in journal (Refereed)
    Abstract [en]

    On 31 May 2011 the WHO International Agency for Research on Cancer (IARC) categorised radiofrequency electromagnetic fields (RF-EMFs) from mobile phones, and from other devices that emit similar non-ionising electromagnetic fields, as a Group 2B, i.e., a "possible", human carcinogen. A causal association would be strengthened if it could be shown that the use of wireless phones has an impact on the survival of glioma patients. We analysed survival of 1678 glioma patients in our 1997-2003 and 2007-2009 case-control studies. Use of wireless phones in the >20 years latency group (time since first use) yielded an increased hazard ratio (HR) = 1.7, 95% confidence interval (CI) = 1.2-2.3 for glioma. For astrocytoma grade IV (glioblastoma multiforme; n = 926) mobile phone use yielded HR = 2.0, 95% CI = 1.4-2.9 and cordless phone use HR = 3.4, 95% CI = 1.04-11 in the same latency category. The hazard ratio for astrocytoma grade IV increased statistically significant per year of latency for wireless phones, HR = 1.020, 95% CI = 1.007-1.033, but not per 100 h cumulative use, HR = 1.002, 95% CI = 0.999-1.005. HR was not statistically significant increased for other types of glioma. Due to the relationship with survival the classification of IARC is strengthened and RF-EMF should be regarded as human carcinogen requiring urgent revision of current exposure guidelines.

  • 37.
    Carlberg, Michael
    et al.
    Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Koppel, Tarmo
    Department of Labour Environment and Safety, Tallinn University of Technology, Tallinn, Estonia.
    Ahonen, Mikko
    Department of Information Technology and Media, Mid Sweden University, Sundsvall, Sweden.
    Hardell, Lennart
    Faculty of Medicine and Health, Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Case-control study on occupational exposure to extremely low-frequency electromagnetic fields and glioma risk2017In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 60, no 5, p. 494-503Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exposure to extremely low-frequency electromagnetic fields (ELF-EMF) was in 2002 classified as a possible human carcinogen, Group 2B, by the International Agency for Research on Cancer at WHO.

    METHODS: Life time occupations were assessed in case-control studies during 1997-2003 and 2007-2009. An ELF-EMF Job-Exposure Matrix was used for associating occupations with ELF exposure (μT). Cumulative exposure (μT-years), average exposure (μT), and maximum exposed job (μT) were calculated.

    RESULTS: Cumulative exposure gave for astrocytoma grade IV (glioblastoma multiforme) in the time window 1-14 years odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.4-2.6, p linear trend <0.001, and in the time window 15+ years OR = 0.9, 95%CI = 0.6-1.3, p linear trend = 0.44 in the highest exposure categories 2.75+ and 6.59+ μT years, respectively.

    CONCLUSION: An increased risk in late stage (promotion/progression) of astrocytoma grade IV for occupational ELF-EMF exposure was found.

  • 38.
    Carlberg, Michael
    et al.
    Dept Oncol, Örebro University Hospital, Örebro, Sweden.
    Söderqvist, Fredrik
    Dept Oncol, Örebro University Hospital, Örebro, Sweden; Dept Publ Hlth & Community Med, City Council Västmanland, Västerås, Sweden; Cent Hosp Västerås, Ctr Clin Res, Uppsala University, Västerås, Sweden.
    Mild, Kjell Hansson
    Dept Radiat Phys, Umeå University Umeå, Sweden.
    Hardell, Lennart
    Dept Oncology, Örebro University Hospital, Örebro, Sweden.
    Meningioma patients diagnosed 2007-2009 and the association with use of mobile and cordless phones: a case-control study2013In: Environmental Health, E-ISSN 1476-069X, Vol. 12, article id 60Article in journal (Refereed)
    Abstract [en]

    Background: To study the association between use of wireless phones and meningioma. Methods: We performed a case-control study on brain tumour cases of both genders aged 18-75 years and diagnosed during 2007-2009. One population-based control matched on gender and age was used to each case. Here we report on meningioma cases including all available controls. Exposures were assessed by a questionnaire. Unconditional logistic regression analysis was performed. Results: In total 709 meningioma cases and 1,368 control subjects answered the questionnaire. Mobile phone use in total produced odds ratio (OR) = 1.0, 95% confidence interval (CI) = 0.7-1.4 and cordless phone use gave OR = 1.1, 95% CI = 0.8-1.5. The risk increased statistically significant per 100 h of cumulative use and highest OR was found in the fourth quartile (>2,376 hours) of cumulative use for all studied phone types. There was no statistically significant increased risk for ipsilateral mobile or cordless phone use, for meningioma in the temporal lobe or per year of latency. Tumour volume was not related to latency or cumulative use in hours of wireless phones. Conclusions: No conclusive evidence of an association between use of mobile and cordless phones and meningioma was found. An indication of increased risk was seen in the group with highest cumulative use but was not supported by statistically significant increasing risk with latency. Results for even longer latency periods of wireless phone use than in this study are desirable.

  • 39.
    Coenen, Pieter
    et al.
    School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia; Department of Public & Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands.
    Smith, Anne
    School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
    Kent, Peter
    School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
    Harris, Mark
    Curtin Business School, Curtin University, Perth, Australia.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Pransky, Glenn
    University of Massachusetts Medical School, Worcester MA, United States.
    Beales, Darren
    School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
    O'Sullivan, Peter
    School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
    Straker, Leon
    School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
    The association of adolescent spinal-pain-related absenteeism with early adulthood work absenteeism: A six-year follow-up data from a population-based cohort2018In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 44, no 5, p. 521-529Article in journal (Refereed)
    Abstract [en]

    Objectives: Spinal (ie, back and neck) pain often develops as early as during adolescence and can set a trajectory for later life. However, whether early-life spinal-pain-related behavioral responses of missing school/work are predictive of future work absenteeism is yet unknown. We assessed the association of adolescent spinal-pain-related work or school absenteeism with early adulthood work absenteeism in a prospective population-based cohort.

    Methods: Six year follow-up data from the Western Australian Pregnancy Cohort (Raine) study were used (N=476; with a 54% response rate). At age 17, participants reported spinal pain (using the Nordic questionnaire) and adolescent spinal-pain-related work/school absenteeism (with a single item question). Annual total and health-related work absenteeism was assessed with the Health and Work Performance questionnaire distributed in four quarterly text messages during the 23rd year of age. We modelled the association of adolescent spinal-pain-related absenteeism with work absenteeism during early adulthood, using negative binomial regression adjusting for sex, occupation and comorbidities.

    Results: Participants with adolescent low-back or neck pain with work/school absenteeism reported higher total work absenteeism in early adulthood [148.7, standard deviation (SD) 243.4 hours/year], than those without pain [43.7 (SD 95.2) hours/year); incidence rate ratio 3.4 (95% CI 1.2-9.2)]. Comparable findings were found when considering low-back and neck separately, and when considering health-related absenteeism.

    Conclusions: We found a more than three-fold higher risk of work absenteeism in early adulthood among those with adolescent spinal-pain-related absenteeism, compared to those without. These findings suggest that, to keep a sustainable workforce, pain prevention and management should focus on pain-related behaviors as early as in adolescence.

  • 40.
    Delanaye, Pierre
    et al.
    Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium; Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France.
    Vidal-Petiot, Emmanuelle
    Assistance Publique-Hôpitaux de Paris, Bichat Hospital, and Université de Paris, INSERM U1149, Paris, France.
    Björk, Jonas
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden.
    Ebert, Natalie
    Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany.
    Eriksen, Björn O.
    Section of Nephrology, University Hospital of North Norway and Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsö, Norway.
    Dubourg, Laurence
    Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.
    Grubb, Anders
    Department of Clinical Chemistry, Skåne University Hospital, Lund, Lund University, Sweden.
    Hansson, Magnus
    Function area Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital Huddinge and Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
    Littmann, Karin
    Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden.
    Mariat, Christophe
    Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, France.
    Melsom, Toralf
    Section of Nephrology, University Hospital of North Norway and Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsö, Norway.
    Schaeffner, Elke
    Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany.
    Sundin, Per-Ola
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Geriatrics.
    Bökenkamp, Arend
    Department of Paediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Berg, Ulla B.
    Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Åsling-Monemi, Kajsa
    Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Åkesson, Anna
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden.
    Larsson, Anders
    Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden.
    Cavalier, Etienne
    Department of Clinical Chemistry, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium.
    Dalton, R. Neil
    The Wellchild Laboratory, Evelina London Children's Hospital, London, United Kingdom.
    Courbebaisse, Marie
    Physiology Department, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris University, INSERM, Paris, France.
    Couzi, Lionel
    CHU de Bordeaux, Nephrologie - Transplantation - Dialyse, Université de Bordeaux, CNRS-UMR Immuno ConcEpT, France.
    Gaillard, Francois
    Service de transplantation et immunologie clinique, Hopital Edouard Herriot, Hospices civils de Lyon, Lyon, France.
    Garrouste, Cyril
    Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
    Jacquemont, Lola
    Renal Transplantation Department, CHU Nantes, Nantes University, Nantes, France.
    Kamar, Nassim
    Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR -BMT, University Paul Sabatier, Toulouse, France.
    Legendre, Christophe
    Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris University, France.
    Rostaing, Lionel
    Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, Hôpital Michallon, CHU Grenoble-Alpes, France.
    Stehlé, Thomas
    Université Paris Est Créteil, INSERM, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France.
    Haymann, Jean-Philippe
    Physiology Department, Assistance Publique- Hôpitaux de Paris, Hôpital Tenon, Paris, France.
    da Silva Selistre, Luciano
    Curso de pós-graduação em Ciências da Saúde, Universidade de Caxias do Sul, Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil.
    Strogoff-de-Matos, Jorge P.
    Nephrology Division, Department of Medicine, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
    Bukabau, Justine B.
    Renal Unit, Department of Internal Medicine, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
    Sumaili, Ernest K.
    Renal Unit, Department of Internal Medicine, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
    Yayo, Eric
    Département de Biochimie, UFR Sciences Pharmaceutiques et Biologiques, Université Felix Houphouët Boigny, Abidjan, Côte d'Ivoire.
    Monnet, Dagui
    Département de Biochimie, UFR Sciences Pharmaceutiques et Biologiques, Université Felix Houphouët Boigny, Abidjan, Côte d'Ivoire.
    Nyman, Ulf
    Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden.
    Pottel, Hans
    Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium.
    Flamant, Martin
    Assistance Publique-Hôpitaux de Paris, Bichat Hospital, and Université de Paris, Cordeliers Research Center, Paris, France.
    Performance of creatinine-based equations to estimate glomerular filtration rate in White and Black populations in Europe, Brazil, and Africa2023In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 38, no 1, p. 106-118Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A new Chronic Kidney Disease Epidemiology equation without race variable has been recently proposed (CKD-EPIAS). This equation has neither been validated outside USA nor compared to the new European Kidney Function Consortium (EKFC) and Lund-Malmö Revised (LMREV) equations, developed in European cohorts.

    METHODS: Standardized creatinine and measured glomerular filtration rate (GFR) from the European EKFC cohorts (n = 13 856 including 6031 individuals in the external validation cohort), from France, (n = 4429, including 964 Black Europeans), from Brazil (n = 100), and from Africa (n = 508) were used to test the performances of the equations. A matched analysis between White Europeans and Black Africans or Black Europeans was performed.

    RESULTS: In White Europeans (n = 9496), both the EKFC and LMREV equations outperformed CKD-EPIAS (bias of -0.6 and -3.2, respectively versus 5.0 mL/min/1.73m², and accuracy within 30% of 86.9 and 87.4, respectively versus 80.9%). In Black Europeans and Black Africans, the best performance was observed with the EKFC equation using a specific Q-value ( = concentration of serum creatinine in healthy males and females). These results were confirmed in matched analyses, which showed that serum creatinine concentrations were different in White Europeans, Black Europeans, and Black Africans for the same measured GFR, age, sex and body mass index. Creatinine differences were more relevant in males.

    CONCLUSION: In a European and African cohort, the performances of CKD-EPIAS remain suboptimal. The EKFC equation, using usual or dedicated, population-specific Q-values presents the best performance in the whole age range in the European and African populations included in this study.

  • 41.
    Delvert, Johanna
    et al.
    Department of Health Sciences, Karlstad University, Karlstad, Sweden; Center for Clinical Research and the Habilitation services, Region Värmland County Council, Sweden.
    Wikström, Sverre
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Health Sciences, Karlstad University, Karlstad, Sweden; Center for Clinical Research and the Habilitation services, Region Värmland County Council, Sweden.
    Bornehag, Carl-Gustaf
    Department of Health Sciences, Karlstad University, Karlstad, Sweden; Icahn School of Medicine at Mount Sinai NY, USA.
    Wadensjö, Heléne V.
    Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Struggling to Enable Physical Activity for Children with Disabilities: A Narrative Model of Parental Roles2022In: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 24, no 1, p. 196-209Article in journal (Refereed)
    Abstract [en]

    This article presents a narrative model based on in-depth interviews with parents of children 6-12 years old with a variety of disabilities. It is a grounded theory study aiming to explore the parents' experiences of enabling health-promoting physical activity (PA) for their children. The core of the generated theory struggling between roles to facilitate PA describes how the parents, in different contexts and over time, are forced to take on roles as experts, coaches, minesweepers, and activists to facilitate adapted PA for their children. How tiresome this struggle became depended on contextual factors, the extent of effort put into the separate roles, and the interaction between them. The study revealed a complex picture unique for each family but at the same time suitable despite the character of the child's disability. This study adds knowledge to better support parents enabling PA on equal terms for all children.

  • 42.
    Dunder, Linda
    et al.
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Lind, P. Monica
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Salihovic, Samira
    Örebro University, School of Medical Sciences. Department of Medical Sciences.
    Stubleski, Jordan
    School of Science and Technology, Örebro University, Örebro, Sweden; Wellington Laboratories Inc, Guelph, ON, Canada.
    Kärrman, Anna
    Örebro University, School of Science and Technology.
    Lind, Lars
    Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden.
    Changes in plasma levels of per- and polyfluoroalkyl substances (PFAS) are associated with changes in plasma lipids: A longitudinal study over 10 years2022In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 211, article id 112903Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Associations between per- and polyfluoroalkyl substances (PFAS), mainly PFOS and PFOA, and increased blood lipids have been reported primarily from cross-sectional studies. The aim of the present study was to investigate associations between multiple PFAS and blood lipids in a longitudinal fashion.

    METHODS: A total of 864 men and women aged 70 years and free from lipid medication were included from the PIVUS study, 614 and 404 of those were reinvestigated at age 75 and 80. At all three occasions, eight PFAS were measured in plasma using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were also measured in plasma at all three occasions. Mixed-effects linear regression models were used to examine the relationship between the changes in PFAS levels and changes in lipid levels.

    RESULTS: Changes in plasma levels of six out of the eight investigated PFAS were positively associated with changes in plasma lipids after adjustment for sex, change in body mass index (BMI), smoking, physical activity, statin use (age was the same in all subjects), and correction for multiple testing. For example, changes in perfluorodecanoic acid (PFDA) were positively associated with the changes in total cholesterol (β: 0.23, 95% confidence interval (CI): 0.14 to 0.32), triglycerides (β: 0.08, 95% CI: 0.04-0.12) and HDL-cholesterol (β: 0.08, 95% CI: 0.04-0.11).

    CONCLUSION: In this longitudinal study with three measurements over 10 years of both plasma PFAS and lipids, changes in six out of the eight investigated PFAS were positively associated with changes in plasma lipids, giving further support for a role of PFAS exposure in human lipid metabolism.

  • 43.
    Dunder, Linda
    et al.
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Salihovic, Samira
    Örebro University, School of Medical Sciences.
    Lind, P. Monica
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Elmståhl, Sölve
    Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
    Lind, Lars
    Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden.
    Plasma levels of per- and polyfluoroalkyl substances (PFAS) are associated with altered levels of proteins previously linked to inflammation, metabolism and cardiovascular disease2023In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 177, article id 107979Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) have been linked to immunotoxic and cardiometabolic effects in both experimental and epidemiological studies, but with conflicting results.

    AIM: The aim of the present study was to investigate potential associations between plasma PFAS levels and plasma levels of preselected proteomic biomarkers previously linked to inflammation, metabolism and cardiovascular disease.

    METHODS: Three PFAS (perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA) and perfluorohexane sulfonic acid (PFHxS)) were measured by non-targeted metabolomics and 249 proteomic biomarkers were measured by the proximity extension assay (PEA) in plasma from 2,342 individuals within the Epidemiology for Health (EpiHealth) study from Sweden (45-75 years old, 50.6 % men).

    RESULTS: After adjustment for age and sex, 92% of the significant associations between PFOS concentrations and proteins were inverse (p < 0.0002, Bonferroni-adjusted). The results were not as clear for PFOA and PFHxS, but still with 80% and 64 % of the significant associations with proteins being inverse. After adjustment for age, sex, smoking, education, exercise habits and alcohol consumption, levels of epidermal growth factor receptor (EGFR), and paraoxonase type 3 (PON3) remained positively associated with all three PFAS, while resistin (RETN) and urokinase plasminogen activator surface receptor (uPAR) showed inverse associations with all three PFAS.

    CONCLUSIONS: Our findings imply that PFAS exposure is cross-sectionally linked to altered levels of proteins previously linked to inflammation, metabolism and cardiovascular disease in middle-aged humans.

  • 44.
    Edman, Katja
    et al.
    Örebro University, Department of Natural Sciences.
    Löfstedt, Håkan
    Berg, Peter
    Eriksson, Kåre
    Axelsson, Sara
    Bryngelsson, Ing-Liss
    Fedeli, Cecilia
    Exposure assessment to alpha- and beta-pinene, delta(3)-carene and wood dust in industrial production of wood pellets2003In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 47, no 3, p. 219-226Article in journal (Refereed)
    Abstract [en]

    The main aim of the study was to measure the exposure to monoterpenes (alpha- and beta-pinene and Delta(3)-carene) and wood dust during industrial production of wood pellets and briquettes. Additional aims were to compare the results from wood dust sampled on a filter with real time measurements using a direct reading instrument and to identify peak exposures to dust. Twenty-four men working at six companies involved in industrial production of wood pellets and briquettes participated in the study. Monoterpenes were measured by diffusive sampling and wood dust was measured as total dust. A data logger (DataRAM) was used for continuous monitoring of dust concentration for 18 of the participants. The sampling time was approximately 8 h. The personal exposure to monoterpenes ranged from 0.64 to 28 mg/m(3) and a statistically significant (Kruskal-Wallis test, P = 0.0002) difference in levels of monoterpenes for workers at different companies was seen. In the companies the personal exposure to wood dust varied between 0.16 and 19 mg/m(3) and for 10 participants the levels exceeded the present Swedish occupational exposure limit (OEL) of 2 mg/m(3). The levels of wood dust during the morning shift were significantly (Mann-Whitney test, P = 0.04) higher compared with the afternoon shift. Continuous registration of dust concentration showed peak values for several working operations, especially cleaning of truck engines with compressed air. For 24 workers in six companies involved in industrial production of wood pellets the personal exposure to monoterpenes was low and to wood dust high compared with the present Swedish OEL and previous studies in Swedish wood industries. Since the DataRAM can identify critical working tasks with high wood dust exposure a reduction in exposure levels could probably be achieved by changes in working routines and by the use of protective equipment

  • 45.
    Edvardsson, Bo
    Örebro University, School of Law, Psychology and Social Work.
    Att omvandla arbetsplatsproblem till problem hos person. Grovt kvinnoförtryck vid en forskningsavdelning på universitet.2011Report (Other academic)
    Abstract [en]

    Critical examination of investigative work in a case with notification of illness in a place of work. Problems in the work environment are transformed to individual problems.

    Download full text (pdf)
    individfeldiva.pdf
  • 46.
    Egfors, Della
    et al.
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Gunnarsson, Anita Gidlöf
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Ricklund, Niklas
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Health.
    Changes in Reported Symptoms Attributed to Office Environments in Sweden between 1995 and 20202022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 18, article id 11434Article in journal (Refereed)
    Abstract [en]

    Non-specific building-related symptoms (NBRSs) describe various symptoms in those affected. Questionnaires are the first step in investigating suspected NBRSs in office environments and have been used for over two decades. However, changes in reporting of symptoms among office workers over time are currently unknown. The overall aim was thus to investigate if reported symptoms and perceived causality to the office environment have changed during 25 years of using the MM 040 NA Office questionnaire. A cross-sectional study of 26,477 questionnaires from 1995-2020 was conducted, where 12 symptoms and perceived causality to office environment were examined using logistic regression analyses of 5-year groups adjusted for sex and atopy. Reporting trends in the year groups varied slightly among symptoms, but eight symptoms were statistically significant in the 2015-2020 group compared to the 1995-1999 group. Seven symptoms had increased: fatigue, heavy-feeling head, headache, difficulties concentrating, itchy/irritated eyes, congested/runny nose, and dry/red hands. One symptom decreased: hoarseness/dry throat. Perceived causality of symptoms to the office environment decreased to a statistically significant degree in 2015-2020 for 11 symptoms, and there was an overall trend of decreasing perceived causality throughout the year groups for most symptoms. The observed time trends suggest a need for up-to-date reference data, to keep up with changes in symptom reporting in office environments over time.

  • 47. Eklund, Mona
    et al.
    Örnsberg, Lena
    Ekström, Christina
    Jansson, Birgitta
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Outcomes of activity-based assessment (BIA) compared with standard assessment in occupational therapy2008In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 15, no 4, p. 196-203Article in journal (Refereed)
    Abstract [en]

    This study was aimed at investigating the outcomes of an activity-based assessment (BIA) compared with standard assessment (SA) for evaluating clients undergoing psychiatric occupational therapy. Patients admitted to a psychiatric occupational therapy unit were randomized into the BIA or the SA assessment. The outcome indicators were (a) clients' satisfaction with the occupational therapy during the assessment period, (b) clients' awareness of capacities and occupational problems, (c) satisfaction with the assessment among the referring physicians, and (d) outcomes of the intervention following the assessment, in terms of changes in occupational performance and satisfaction. The groups did not differ in awareness of occupational problems, but the BIA group was more satisfied than the SA group with the support of their contact person and with the group leader during the period of assessment. Furthermore, physicians receiving feedback on patients in the BIA group were more satisfied than those receiving feedback on patients in the SA group. However, the groups did not differ concerning change during the treatment period in occupational performance or satisfaction. Thus, there was no difference between the assessment methods regarding the outcomes of the treatment following assessment. Minor advantages from the patients' perspective were found, in terms of better satisfaction in the BIA group, and from the referring physicians' perspective the BIA clearly seemed more satisfying than the SA. Thus, the findings showed that the BIA possessed better qualities than the SA regarding the indicators pertaining to satisfaction, but not concerning awareness of capacities and problems or the outcome of the subsequent treatment. 

  • 48.
    Ekman, John
    et al.
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Quartey, Philip
    Department of Biomedical Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
    Ussif, Abdala Mumuni
    Department of Forensic Sciences, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Cape Coast, Ghana.
    Ricklund, Niklas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Occupational and Environmental Health, Faculty of Business, Science and Engineering, Örebro University, Örebro, Sweden.
    Egbenya, Daniel Lawer
    Department of Physiology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
    Wiafe, Gideon Akuamoah
    Department of Physiology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
    Tsegah, Korantema Mawuena
    Department of Biomedical Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
    Karikari, Akua
    Department of Biomedical Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
    Löfstedt, Håkan
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Occupational and Environmental Medicine.
    Djankpa, Francis Tanam
    Department of Physiology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
    Dynamics of pre-shift and post-shift lung function parameters among wood workers in Ghana2023In: Annals of occupational and environmental medicine, E-ISSN 2052-4374, Vol. 35, article id e39Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Diseases affecting the lungs and airways contribute significantly to the global burden of disease. The problem in low- and middle-income countries appears to be exacerbated by a shift in global manufacturing base to these countries and inadequate enforcement of environmental and safety standards. In Ghana, the potential adverse effects on respiratory function associated with occupational wood dust exposure have not been thoroughly investigated.

    METHODS: Sixty-four male sawmill workers and 64 non-woodworkers participated in this study. The concentration of wood dust exposure, prevalence and likelihood of association of respiratory symptoms with wood dust exposure and changes in pulmonary function test (PFT) parameters in association with wood dust exposure were determined from dust concentration measurements, symptoms questionnaire and lung function test parameters.

    RESULTS: Sawmill workers were exposed to inhalable dust concentration of 3.09 ± 0.04 mg/m3 but did not use respirators and engaged in personal grooming habits that are known to increase dust inhalation. The sawmill operators also showed higher prevalence and likelihoods of association with respiratory symptoms, a significant cross-shift decline in some PFT parameters and a shift towards a restrictive pattern of lung dysfunction by end of daily shift. The before-shift PFT parameters of woodworkers were comparable to those of non-woodworkers, indicating a lack of chronic effects of wood dust exposure.

    CONCLUSIONS: Wood dust exposure at the study site was associated with acute respiratory symptoms and acute changes in some PFT parameters. This calls for institution and enforcement of workplace and environmental safety policies to minimise exposure at sawmill operating sites, and ultimately, decrease the burden of respiratory diseases.

  • 49.
    Elgazali, Abdelkarem A. S.
    et al.
    Trace Element Speciation Laboratory, Department of Chemistry, University of Aberdeen, Aberdeen, UK.
    Gajdosechova, Zuzana
    Trace Element Speciation Laboratory, Department of Chemistry, University of Aberdeen, Aberdeen, UK.
    Abbas, Zaigham
    LG & RD Complex, Ministry of Climate Change, Islamabad, Pakistan.
    Lombi, Enzo
    Future Industries Institute, University of South Australia, Mawson Lakes SA, Australia.
    Scheckel, Kirk G.
    Future Industries Institute, University of South Australia, Mawson Lakes SA, Australia; National Risk Management Research Laboratory, United States Environmental Protection Agency, Cincinnati OH, USA.
    Donner, Erica
    Future Industries Institute, University of South Australia, Mawson Lakes SA, Australia.
    Fiedler, Heidelore
    Örebro University, School of Science and Technology. Chemicals Branch, UN Environment PProgramme (UNEP), Division of Technology, Industry and Economics (DTIE), Chatelaine, Switzerland.
    Feldmann, Jörg
    Trace Element Speciation Laboratory, Department of Chemistry, University of Aberdeen, Aberdeen, UK.
    Krupp, Eva M.
    Trace Element Speciation Laboratory, Department of Chemistry, University of Aberdeen, Aberdeen.
    Reactive gaseous mercury is generated from chloralkali factories resulting in extreme concentrations of mercury in hair of workers2018In: Scientific Reports, E-ISSN 2045-2322, Vol. 8, no 1, article id 3675Article in journal (Refereed)
    Abstract [en]

    Occupational exposure of chloralkali workers to highly concentrated mercury (Hg) vapour has been linked to an increased risk of renal dysfunction and behavioural changes. It is generally believed that these workers are exposed to elemental Hg, which is used in abundance during the production process however, the lack in analytical techniques that would allow for identification of gaseous Hg species poses a challenge, which needs to be addressed in order to reach a consensus. Here, we present the results from simulated exposure studies, which provide sound evidence of higher adsorption rate of HgCl2 than Hg-0 and its irreversible bonding on the surface of hair. We found that chloralkali workers were exposed to HgCl2, which accumulated in extremely high concentrations on the hair surface, more than 1,000 times higher than expected from unexposed subjects and was positively correlated with Hg levels in the finger- and toenails.

  • 50.
    Emilsson, Kent
    Department of Clinical Physiology, Örebro University Hospital , Örebro, Sweden.
    Suspected association of ventricular arrhythmia with air pollution in a motorbike rider: a case report2008In: Journal of Medical Case Reports, E-ISSN 1752-1947, Vol. 2, p. 192-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Premature ventricular complexes are to some extent a normal finding in healthy individuals and the prevalence increases with age and is more common in men. Premature ventricular complexes can occur in association with a variety of stimuli, and a lesser known cause is the association between air pollution and ventricular arrhythmias.

    CASE PRESENTATION: A previously healthy man started to ride a lightweight motorbike in heavy traffic. A few weeks later he was admitted to hospital with premature ventricular complexes in bigeminy, which decreased after a few days when he was not exposed to exhaust fumes. A few weeks later he started using the motorbike again and the same symptoms developed once more, only to subside when he stopped riding in heavy traffic.

    CONCLUSION: Studies have shown an association between air pollution and premature ventricular complexes and other kinds of arrhythmias. The mechanism may be changes in cardiac autonomic function, including heart rate and heart rate variability. Air pollution should be considered when patients present with arrhythmias and no other causes are found.

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