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  • 1.
    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, Sweden.
    Gustavsson, Per
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine (CAMM), Stockholm County Council, 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.

  • 2. 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).

  • 3.
    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.

  • 4.
    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.

  • 5. 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.

  • 6.
    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.

  • 7.
    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.

  • 8.
    Arnell, Susann
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center, Region Örebro County, 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
    University Health Care Research Center, Region Örebro County, 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.

  • 9.
    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.

  • 10.
    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, ISSN 1471-2288, 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.

  • 11.
    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)
  • 12. 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, Assesment 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.

  • 13.
    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.

  • 14.
    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.

  • 15.
    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.

  • 16.
    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.

  • 17.
    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.

  • 18.
    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, 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.

  • 19.
    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.

  • 20.
    Carlberg, Michael
    et al.
    Örebro University Hospital. 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
    Örebro University Hospital. 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.

  • 21.
    Carlberg, Michael
    et al.
    Dept Oncol, Örebro University Hospital, Örebro, Sweden.
    Soderqvist, 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, ISSN 1476-069X, 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.

  • 22.
    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

  • 23.
    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.

  • 24. 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. 

  • 25.
    Elgazali, Abdelkarem A. S.
    et al.
    Trace Element Speciation Laboratory, University of Aberdeen, Department of Chemistry, Aberdeen, UK.
    Gajdosechova, Zuzana
    Trace Element Speciation Laboratory, University of Aberdeen, Department of Chemistry, Aberdeen, UK.
    Abbas, Zaigham
    Government of Pakistan Ministry of Climate Change, LG & RD Complex, Islamabad, Pakistan.
    Lombi, Enzo
    Future Industries Institute, University of South Australia, Building X, Mawson Lakes Campus, Mawson Lakes, South Australia, Australia.
    Scheckel, Kirk G.
    Future Industries Institute, University of South Australia, Building X, Mawson Lakes Campus, Mawson Lakes, South Australia, Australia; United States Environmental Protection Agency, National Risk Management Research Laboratory, Cincinnati, OH, USA.
    Donner, Erica
    Future Industries Institute, University of South Australia, Building X, Mawson Lakes Campus, Mawson Lakes, South Australia, Australia.
    Fiedler, Heidelore
    Örebro University, School of Science and Technology. United Nations Environmental Programme, Chemicals Branch, DTIE, Chatelaine, Switzerland.
    Feldmann, Jörg
    Trace Element Speciation Laboratory, University of Aberdeen, Department of Chemistry, Aberdeen, UK.
    Krupp, Eva M.
    Trace Element Speciation Laboratory, University of Aberdeen, Department of Chemistry, Aberdeen.
    Reactive gaseous mercury is generated from chloralkali factories resulting in extreme concentrations of mercury in hair of workers2018In: Scientific Reports, ISSN 2045-2322, 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.

  • 26.
    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, 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.

  • 27. Eriksson, Kåre
    et al.
    Hagstrom, Katja
    Örebro University, Department of Natural Sciences.
    Axelsson, Sara
    Nylander-French, Leena
    Tape-stripping as a method for measuring dermal exposure to resin acids during wood pellet production2008In: Journal of Environmental Monitoring, ISSN 1464-0325, E-ISSN 1464-0333, Vol. 10, no 3, p. 345-352Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to develop a sensitive and specific method for quantifying dermal exposure to the resin acids 7-oxodehydroabietic acid (7-OXO), dehydroabietic acid (DHAA), abietic acid ( AA), and pimaric acid (PA). In addition the method was evaluated in occupational settings during production of wood pellets. Tape-strips were spiked with the substances to evaluate the recovery of the acids from the tape. The removal efficiency of the tape was assessed by tape-stripping a specified area on a glass plate spiked with resin acids. The recovery of the acids from human skin in vivo was evaluated by applying acids in methanol onto the skin of volunteers. Occupational dermal exposure to the resin acids was assessed by tape-stripping the skin of workers involved in the production of wood pellets. The resin acids were analyzed by liquid chromatography mass spectrometry (LC-MS). The limit of detection was 15 pg (7-OXO), 150 pg ( DHAA), 285 pg ( AA) and 471 pg ( PA) per injection. The recovery from spiked tapes was in general 100%. The removal efficiency of the tape was 48-101%. Recovery tests from human skin in vivo showed a mean recovery of 27%. Quantifiable amounts of resin acids were observed on four different skin areas with an increase in exposure during a work shift. This study shows that occupational dermal exposure to resin acids can be assessed by tape-stripping and quantified by LC-MS.

  • 28. Eriksson, Kåre
    et al.
    Hagström, Katja
    Örebro University, Department of Natural Sciences.
    Axelsson, Sara
    Nylander-French, Leena
    Tape-stripping as a method for measuring dermal exposure to resin acids during wood pellet productionManuscript (preprint) (Other academic)
  • 29.
    Eriksson, Ulrika
    et al.
    Örebro University, School of Science and Technology.
    Haglund, Peter
    Department of Chemistry, Umeå University, Umeå, Sweden.
    Kärrman, Anna
    Örebro University, School of Science and Technology.
    Contribution of precursor compounds to the release of per- and polyfluoroalkyl substances (PFASs) from waste water treatment plants (WWTPs)2017In: Journal of Environmental Sciences(China), ISSN 1001-0742, E-ISSN 1878-7320, Vol. 61, p. 80-90Article in journal (Refereed)
    Abstract [en]

    Per- and polyfluoroalkyl substances (PFASs) are ubiquitous in sludge and water from waste water treatment plants, as a result of their incorporation in everyday products and industrial processes. In this study, we measured several classes of persistent PFASs, precursors, transformation intermediates, and newly identified PFASs in influent and effluent sewage water and sludge from three municipal waste water treatment plants in Sweden, sampled in 2015. For sludge, samples from 2012 and 2014 were analyzed as well. Levels of precursors in sludge exceeded those of perfluoroalkyl acids and sulfonic acids (PFCAs and PFSAs), in 2015 the sum of polyfluoroalkyl phosphoric acid esters (PAPs) were 15-20ng/g dry weight, the sum of fluorotelomer sulfonic acids (FTSAs) was 0.8-1.3ng/g, and the sum of perfluorooctane sulfonamides and ethanols ranged from non-detected to 3.2ng/g. Persistent PFSAs and PFCAs were detected at 1.9-3.9ng/g and 2.4-7.3ng/g dry weight, respectively. The influence of precursor compounds was further demonstrated by an observed substantial increase for a majority of the persistent PFCAs and PFSAs in water after waste water treatment. Perfluorohexanoic acid (PFHxA), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), and perfluorooctane sulfonic acid (PFOS) had a net mass increase in all WWTPs, with mean values of 83%, 28%, 37% and 58%, respectively. The load of precursors and intermediates in influent water and sludge combined with net mass increase support the hypothesis that degradation of precursor compounds is a significant contributor to PFAS contamination in the environment.

  • 30.
    Eriksson, Ulrika
    et al.
    Örebro University, School of Science and Technology.
    Mueller, Jochen F.
    Entox, Queensland Alliance for Environmental Health Sciences, The University of Queensland, Coopers Plains, Australia.
    Toms, Leisa-Maree L.
    School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia.
    Hobson, Peter
    Sullivan and Nicolaides Pathology, Taringa, Australia.
    Kärrman, Anna
    Örebro University, School of Science and Technology.
    Temporal trends of PFSAs, PFCAs and selected precursors in Australian serum from 2002 to 20132017In: Environmental Pollution, ISSN 0269-7491, E-ISSN 1873-6424, Vol. 220, no Pt A, p. 168-177Article in journal (Refereed)
    Abstract [en]

    Per- and polyfluoroalkyl substances (PFASs) are a family of compounds that includes numerous compound classes. To date, only a subset of these PFASs have been studied thoroughly in the general population. In this study, pooled serum samples from Australia collected in 2002-2013 were analyzed for PFASs according to gender and age (age categories of 0-4 years, 5-15 years, 16-30 years, 31-45 years, 46-60 years, and >60 years), in total 54 pooled samples and 4920 individuals. Compound classes included were perfluorocarboxylic acids (PFCAs), perfluorosulfonic acids (PFSAs), and two groups of PFCA precursor compounds; polyfluoroalkyl phosphate diesters (diPAPs), and fluorotelomer sulfonic acids (FTSAs). Several PFASs that were not reported in previous studies of Australian serum samples were found in this sample set including; diPAPs, FTSAs, perfluoropentane sulfonic acid (PFPeS), perfluoroheptane sulfonic acid (PFHpS), perfluoroheptane carboxylic acid (PFHpA), perfluoroundecanoic acid (PFUnDA), perfluorododecanoic acid (PFDoDA), and perfluorotridecanoic acid (PFTrDA). Various temporal trends were observed with a significant reduction (p < 0.05) between 2002 and 2013 for 8:2 FTSA, perflurohexane sulfonic acid (PFHxS), PFHpS, PFOS, and perflurooctanoic acid (PFOA). Levels of longer-chained PFDA and PFUnDA started to decrease more recently, between 2006 and 2013, while PFDoDA increased during the same time period. Higher levels in younger age groups (0-4 and 5-15 years) compared to adults (>15 years) were found for 8:2 FTSA and PFHpA, while levels of PFHpS, PFOS, PFUnDA, PFDoDA and PFTrDA were higher in adult age groups compared to younger age groups. Gender-specific patterns were seen for PFOA, PFHxS, PFHpS and PFOS, where levels were lower in women. Changes in manufacturing processes were reflected in the temporal time trends, and differences in bioaccumulation potential between homologues could be associated with age trends. Our results emphasize the importance of including emerging classes of PFASs in biomonitoring studies.

  • 31.
    Fan, Chenjing
    et al.
    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. National Institute of Occupational Health (STAMI), Oslo, Norway.
    Vihlborg, Per
    Örebro University, School of Medical Sciences.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Andersson, Lena
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Silica exposure increases the risk of stroke but not myocardial infarction: A retrospective cohort study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 2, article id e0192840Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 32.
    Fang, Xin
    et al.
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fang, Bo
    Division of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China; Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China.
    Wang, Chunfang
    Division of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
    Xia, Tian
    Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
    Bottai, Matteo
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fang, Fang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Relationship between fine particulate matter, weather condition and daily non-accidental mortality in Shanghai, China: A Bayesian approach2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 11, article id e0187933Article in journal (Refereed)
    Abstract [en]

    There are concerns that the reported association of ambient fine particulate matter (PM2.5) with mortality might be a mixture of PM2.5 and weather conditions. We evaluated the effects of extreme weather conditions and weather types on mortality as well as their interactions with PM2.5 concentrations in a time series study. Daily non-accidental deaths, individual demographic information, daily average PM2.5 concentrations and meteorological data between 2012 and 2014 were obtained from Shanghai, China. Days with extreme weather conditions were identified. Six synoptic weather types (SWTs) were generated. The generalized additive model was set up to link the mortality with PM2.5 and weather conditions. Parameter estimation was based on Bayesian methods using both the Jeffreys' prior and an informative normal prior in a sensitivity analysis. We estimate the percent increase in non-accidental mortality per 10 mu g/m(3) increase in PM2.5 concentration and constructed corresponding 95% credible interval (CrI). In total, 336,379 non-accidental deaths occurred during the study period. Average daily deaths were 307. The results indicated that per 10 mu g/m(3) increase in daily average PM2.5 concentration alone corresponded to 0.26-0.35% increase in daily non-accidental mortality in Shanghai. Statistically significant positive associations between PM2.5 and mortality were found for favorable SWTs when considering the interaction between PM2.5 and SWTs. The greatest effect was found in hot dry SWT (percent increase = 1.28, 95% CrI: 0.72, 1.83), followed by warm humid SWT (percent increase = 0.64, 95% CrI: 0.15, 1.13). The effect of PM2.5 on non-accidental mortality differed under specific extreme weather conditions and SWTs. Environmental policies and actions should take into account the interrelationship between the two hazardous exposures.

  • 33.
    Fornander, Louise
    Institutionen för klinisk och experimentell medicin, Linköpings universitet, Linköping, Sweden.
    Upper Airway Mucosal Inflammation: Proteomic Studies after Exposure to Irritants and Microbial Agents2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    People are, in their daily lives, exposed to a number of airborne foreign compounds that do not normally affect the body. However, depending on the nature of these compounds, dose and duration of exposure, various airway symptoms may arise. Early symptoms are often manifested as upper airway mucosal inflammation which generates changes in protein composition in the airway lining fluid.

    This thesis aims at identifying, understanding mechanisms and characterizing protein alterations in the upper airway mucosa that can be used as potential new biomarkers for inflammation in the mucosa. The protein composition in the mucosa was studied by sampling of nasal lavage fluid that was further analyzed with a proteomic approach using twodimensional gel electrophoresis and mass spectrometry. Additionally, by studying factors on site through environmental examination, health questionnaires and biological analyses, we have tried to understand the background to these protein alterations and their impact on health.

    Respiratory symptoms from the upper airways are common among people who are exposed to irritative and microbial agents. This thesis have focused on personnel in swimming pool facilities exposed to trichloramine, metal industry workers exposed to metalworking fluids, employees working in damp and moldy buildings and infants diagnosed with respiratory syncytial virus infection. The common denominator in these four studies is that the subjects experience upper airway mucosal inflammation, which is manifested as cough, rhinitis, phlegm etc. In the three occupational studies, the symptoms were work related. Notably, a high prevalence of perceived mucosal symptoms was shown despite the relatively low levels of airborne irritants revealed by the environmental examination. Protein profiling verified an ongoing inflammatory response by identification of several proteins that displayed altered levels. Interestingly, innate immune proteins dominated and four protein alterations occurred in most of the studies; SPLUNC1, protein S100A8 and S100A9 and alpha-1-antitrypsin. Similarly, these proteins were also found in nasal fluid from children with virus infection and in addition a truncated form of SPLUNC1 and two other S100 proteins (S100A7-like 2 and S100A16), not previously found in nasal secretion, were identified.

    Altogether, the results indicate the potential use of a proteomic approach for identifying new biomarkers for the upper respiratory tract at an early stage in the disease process after exposure to irritant and microbial agents. The results indicate an effect on the innate immunity system and the proteins; SPLUNC1, protein S100A8 and S100A9 and alpha-1-antitrypsin are especially promising new biomarkers. Moreover, further studies of these proteins may help us to understand the molecular mechanisms involved in irritant-induced airway inflammation.

  • 34.
    Graff, Pål
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Ståhlbom, Bengt
    Occupational and Environmental Medicine Center, Linköping University, Linköping, Sweden.
    Nordenberg, Eva
    Siemens Industrial Turbomachinery AB, Finspång, Sweden.
    Graichen, Andreas
    Siemens Industrial Turbomachinery AB, Finspång, Sweden.
    Johansson, Pontus
    Occupational and Environmental Medicine Center, Linköping University, Linköping, Sweden.
    Karlsson, Helen
    Occupational and Environmental Medicine Center, Linköping University, Linköping, Sweden.
    Evaluating Measuring Techniques for Occupational Exposure during Additive Manufacturing of Metals: A Pilot Study2017In: Journal of Industrial Ecology, ISSN 1088-1980, E-ISSN 1530-9290, Vol. 21, no Suppl. 1, p. S120-S129Article in journal (Refereed)
    Abstract [en]

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

  • 35.
    Gunnarsson, Lars-Gunnar
    et al.
    Örebro University, School of Medical Sciences. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bodin, Lennart
    Örebro University, Örebro University School of Business. Department of Statistics, Örebro University, Örebro, Sweden; Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institute Solna, Stockholm, Sweden.
    Parkinson's disease and occupational exposures: a systematic literature review and meta-analyses2017In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 43, no 3, p. 197-209, article id 3641Article in journal (Refereed)
    Abstract [en]

    Objectives: We conducted a systematic literature review to identify studies fulfilling good scientific epidemiological standards for use in meta-analyses of relevant risk factors for Parkinson's disease.

    Methods: Our search identified 103 original publications on associations between work and Parkinson's disease. GRADE guidelines were used to ensure high scientific quality, and reliable guidelines were applied to classify the papers. Of the 103 articles, 47 fulfilled good scientific standards while 56 were methodologically deficient and thus excluded from our meta-analyses.

    Results: A total of 23 publications concerned work exposure to pesticides. The weighted relative risk estimate was 1.67 (95% confidence interval 1.42-1.97). A funnel plot and bias test indicated that some publication bias concerning smaller studies might have been present. The risk estimate was not influenced by study design (case-control, cohort, or cross-sectional study) or gender. Higher estimates were found when there was a hereditary taint or onset below age 60. Studies on exposure to metals or electromagnetic fields did not show increased risk.

    Conclusions: Using an elaborated quality protocol, there is now strong evidence that exposure to any pesticide involves a ≥50% increased risk for developing Parkinson's disease.

  • 36.
    Gunnarsson, Lars-Gunnar
    et al.
    Örebro University, School of Medicine, Örebro University, Sweden.
    Bodin, Lennart
    Örebro University, Örebro University School of Business. Karolinska institutet, Stockholm, Sweden.
    Systematiska kunskapsöversikter;: 7. Epidemiologiskt påvisade samband mellan Amyotrofisk Lateral Skleros (ALS) och faktorer i arbetsmiljön2014Report (Refereed)
    Abstract [sv]

    Metod

    Vid systematisk litteraturgenomgång identifierade vi 61 relevanta epidemiologiska publikationer med originaldata över samband mellan ALS och exponeringar i arbetslivet. Samtliga artiklar granskades och 34 av dessa studier uppfyllde kriterierna för god vetenskaplig kvalitet

    Resultat

    Bekämpningsmedel och andra kemikalier har i sju studier värderats med hjälp av fråge­formulär/intervjuer. Våra metaanalyser visade att riskskattningarna var något högre för fall-kontrollstudier än för kohortstudier (1,82 respektive 1,47) och sammantaget blev riskmåttet 1,67 (95% konfidensintervall 1,14-2,44). Höga och statistiskt signifikant ökade risker rapporteras i de tre studier som fokuserade på jordbruksarbete; riskmått 2,4-4,7. Ett möjligt samband finns också mellan ALS och yrkesmässig exponering för metaller.

    Tungt och långvarigt muskelarbete ofta i kombination med muskeltrauma kunna öka risken för ALS med RR runt 2,0. Till denna risk grupp hör professionella fotbolls­spelare i europeisk och amerikansk fotboll. Däremot verkar inte fysisk aktivitet i arbetet och på fritiden påverka risken för att drabbas av ALS.

    I 14 metodologiskt relevanta publikationer granskas eventuellt samband mellan ALS och exponering för elektromagnetiska fält (EMF) och/eller arbete med elektriskt utrustning. Våra egna metaanalyser samt tre publicerade metaanalyser indikerade en låg riskökning. Samman­vägd analys av exponeringar och resultat indikerar att också andra exponeringar än EMF skulle kunna förklara sambandet, t ex muskeltrauma till följd av elstötar.

    Diskussion

    Longitudinella epidemiologiska studier indikerar att ALS huvudsakligen drabbar personer som har en ökad sårbarhet (en genetisk disposition) för att sjukdomsprocessen skall starta. I kombination med olika exponeringar blir nervcellens sjukdomsbörda för stor så att sjukdomsprocessen startar.

  • 37.
    Hagström, Katja
    Örebro University, Department of Natural Sciences.
    Occupational exposure during production of wood pellets in Sweden2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aims of the studies underlying this thesis were to assess workers’ air exposure to wood dust and various chemicals, and to evaluate the variability in exposure and occupational dermal exposure to resin acids during the production of wood pellets in Sweden. Personal air measurements of wood dust, monoterpenes, resin acids and nitrogen dioxide (as a marker of diesel exhaust), accompanied by area measurements of these substances, VOCs and carbon monoxide, were performed at up to ten plants. Repeated measurements were also performed to evaluate within- and between-worker variability, determinants of exposure, the probability that a worker’s mean exposure exceeded the occupational exposure limit, OEL (overexposure), and the bias in the exposure-response relationship (attenuation).

    Dermal exposure was measured at the forehead, neck, forearm and hand using a tape-stripping method, in which a strip of adhesive tape is applied to the skin and then removed along with the outermost layer of the skin and chemicals adsorbed to this layer. The workers’ exposure to wood dust was high (mean: 2.4 mg/m3), with 35−42 % of the measurements above the Swedish OEL of 2 mg/m3. The exposure is also classified as unacceptable due to the calculated levels of overexposure. Exposure to resin acids like 7-oxodehydroabietic acid and dehydroabietic acid was identified, which has not been previously observed in the wood industry, with mean sum levels of 2.4 _g/m3. Levels of monoterpenes, nitrogen dioxide, VOCs and carbon monoxide were all below their Swedish OELs. A factor that influenced the level of exposure to wood dust and resin acids was the nature of the work done, notably cleaning operations, like sweeping, which increased the exposure slightly. The attenuation was high for the individual-based model, and at least 12 repeated measurements were needed to yield a bias in the exposureresponse relationship of _10 %. The results also showed that dermal exposure to resin acids occurs in these plants, which has not been shown before, and provided indications of both increased exposure during a work shift and diffusion into the skin. The main conclusion is that wood dust exposure at these levels is likely to have implications for the workers’ health in the long run, and, therefore, it is important to reduce exposure to wood dust in this industry.

    List of papers
    1. Exposure assessment to alpha- and beta-pinene, delta(3)-carene and wood dust in industrial production of wood pellets
    Open this publication in new window or tab >>Exposure assessment to alpha- and beta-pinene, delta(3)-carene and wood dust in industrial production of wood pellets
    Show others...
    2003 (English)In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 47, no 3, p. 219-226Article in journal (Refereed) Published
    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

    National Category
    Occupational Health and Environmental Health
    Research subject
    Enviromental Science
    Identifiers
    urn:nbn:se:oru:diva-2859 (URN)12639835 (PubMedID)
    Available from: 2008-02-01 Created: 2008-02-01 Last updated: 2018-01-13Bibliographically approved
    2. Exposure to wood dust, resin acids and volatile organic compounds during production of wood pellets
    Open this publication in new window or tab >>Exposure to wood dust, resin acids and volatile organic compounds during production of wood pellets
    Show others...
    2008 (English)In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 5, no 5, p. 296-304Article in journal (Refereed) Published
    Abstract [en]

    The main aim of this study was to investigate exposure to airborne substances that are potentially harmful to health during the production of wood pellets, including wood dust, monoterpenes, and resin acids, and as an indicator of diesel exhaust nitrogen dioxide. In addition, area measurements were taken to assess background exposure levels of these substances, volatile organic compounds (VOCs), and carbon monoxide. Measurements were taken at four wood pellet production plants from May 2004 to April 2005. Forty-four workers participated in the study, and a total of 68 personal measurements were taken to determine personal exposure to wood dust (inhalable and total dust), resin acids, monoterpenes, and nitrogen dioxide. In addition, 42 measurements of nitrogen dioxide and 71 measurements of total dust, resin acids, monoterpenes, VOCs, and carbon monoxide were taken to quantify their indoor area concentrations. Personal exposure levels to wood dust were high, and a third of the measured levels of inhalable dust exceeded the Swedish occupational exposure limit (OEL) of 2 mg/m3. Parallel measurements of inhalable and total dust indicated that the former were, on average, 3.2 times higher than the latter. The data indicate that workers at the plants are exposed to significant amounts of the resin acid 7-oxodehydroabietic acid in the air, an observation that has not been recorded previously at wood processing and handling plants. The study also found evidence of exposure to dehydroabietic acid, and exposure levels for resin acids approached 74% of the British OEL for colophony, set at 50 microg/m3. Personal exposure levels to monoterpenes and nitrogen dioxide were low. Area sampling measurements indicated that aldehydes and terpenes were the most abundant VOCs, suggesting that measuring personal exposure to aldehydes might be of interest. Carbon monoxide levels were under the detection limit in all area measurements. High wood dust exposure levels are likely to have implications for worker health; therefore, it is important to reduce exposure to wood dust in this industry.

    Place, publisher, year, edition, pages
    Philadelphia, PA: Taylor and Francis, 2008
    National Category
    Occupational Health and Environmental Health Medical and Health Sciences
    Research subject
    Occupational and Environmental Medicine
    Identifiers
    urn:nbn:se:oru:diva-2860 (URN)10.1080/15459620801957225 (DOI)
    Available from: 2008-02-01 Created: 2008-02-01 Last updated: 2018-01-13Bibliographically approved
    3. Variability and determinants of wood dust and resin acid exposure during wood pellet production: measurement strategies and bias in assessing exposure-response relationships
    Open this publication in new window or tab >>Variability and determinants of wood dust and resin acid exposure during wood pellet production: measurement strategies and bias in assessing exposure-response relationships
    2008 (English)In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 52, no 8, p. 685-694Article in journal (Refereed) Published
    Abstract [en]

    Production of wood pellets is a relatively new and expanding industry in which the exposure profiles differ from those in other wood-processing industries like carpentries and sawmills where there are lower levels of wood dust. Sixty-eight personal exposure measurements of wood dust (inhalable and total dust) and resin acids were collected for 44 participants at four production plants located in Sweden. Results were used to estimate within- and between-worker variability and to identify uniformly exposed groups and determinants of exposure. In addition, overexposure, whether the risk of the long-term mean exposure of a randomly selected worker exceeding the occupational exposure limit is acceptably low, was calculated as well as the underestimation of the exposure–response relationship (attenuation). Greater variability in exposure between work shifts than between workers was observed with the within-worker variation accounting for 57–99% of the total variance in the individual-based model. Several uniformly exposed groups were detected but were mostly associated with a between-worker variation of zero which is an underestimation of the between-worker variation but an indication of uniformly exposed groups. Cleaning was identified as a work task that increases exposure slightly; so reducing workers’ exposure during this operation is advisable. The levels of wood dust were high and were found to pose unacceptable risks of overexposure at all plants for inhalable dust and at three out of four plants for total dust. These findings show that exposure to dust needs to be reduced in this industry. For resin acids, the exposure was classed as acceptable at all plants. According to an individual-based model constructed from the data, the level of attenuation was high, and thus there would be substantial bias in derived dose–response relationships.

    National Category
    Occupational Health and Environmental Health
    Research subject
    Enviromental Science
    Identifiers
    urn:nbn:se:oru:diva-2861 (URN)10.1093/annhyg/men052 (DOI)
    Available from: 2008-02-01 Created: 2008-02-01 Last updated: 2018-01-13Bibliographically approved
    4. Tape-stripping as a method for measuring dermal exposure to resin acids during wood pellet production
    Open this publication in new window or tab >>Tape-stripping as a method for measuring dermal exposure to resin acids during wood pellet production
    (English)Manuscript (preprint) (Other academic)
    National Category
    Occupational Health and Environmental Health
    Research subject
    Occupational and Environmental Medicine; Enviromental Science
    Identifiers
    urn:nbn:se:oru:diva-2862 (URN)
    Available from: 2008-02-01 Created: 2008-02-01 Last updated: 2018-01-13Bibliographically approved
  • 38.
    Hagström, Katja
    et al.
    Örebro University, Department of Natural Sciences.
    Axelsson, Sara
    Arvidsson, Helena
    Bryngelsson, Ing-Liss
    Lundholm, Cecilia
    Eriksson, Kåre
    Exposure to wood dust, resin acids and volatile organic compounds during production of wood pellets2008In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 5, no 5, p. 296-304Article in journal (Refereed)
    Abstract [en]

    The main aim of this study was to investigate exposure to airborne substances that are potentially harmful to health during the production of wood pellets, including wood dust, monoterpenes, and resin acids, and as an indicator of diesel exhaust nitrogen dioxide. In addition, area measurements were taken to assess background exposure levels of these substances, volatile organic compounds (VOCs), and carbon monoxide. Measurements were taken at four wood pellet production plants from May 2004 to April 2005. Forty-four workers participated in the study, and a total of 68 personal measurements were taken to determine personal exposure to wood dust (inhalable and total dust), resin acids, monoterpenes, and nitrogen dioxide. In addition, 42 measurements of nitrogen dioxide and 71 measurements of total dust, resin acids, monoterpenes, VOCs, and carbon monoxide were taken to quantify their indoor area concentrations. Personal exposure levels to wood dust were high, and a third of the measured levels of inhalable dust exceeded the Swedish occupational exposure limit (OEL) of 2 mg/m3. Parallel measurements of inhalable and total dust indicated that the former were, on average, 3.2 times higher than the latter. The data indicate that workers at the plants are exposed to significant amounts of the resin acid 7-oxodehydroabietic acid in the air, an observation that has not been recorded previously at wood processing and handling plants. The study also found evidence of exposure to dehydroabietic acid, and exposure levels for resin acids approached 74% of the British OEL for colophony, set at 50 microg/m3. Personal exposure levels to monoterpenes and nitrogen dioxide were low. Area sampling measurements indicated that aldehydes and terpenes were the most abundant VOCs, suggesting that measuring personal exposure to aldehydes might be of interest. Carbon monoxide levels were under the detection limit in all area measurements. High wood dust exposure levels are likely to have implications for worker health; therefore, it is important to reduce exposure to wood dust in this industry.

  • 39.
    Hagström, Katja
    et al.
    Örebro University, Department of Natural Sciences.
    Lundholm, Cecilia
    Eriksson, Kåre
    Liljelind, Ingrid
    Variability and determinants of wood dust and resin acid exposure during wood pellet production: measurement strategies and bias in assessing exposure-response relationships2008In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 52, no 8, p. 685-694Article in journal (Refereed)
    Abstract [en]

    Production of wood pellets is a relatively new and expanding industry in which the exposure profiles differ from those in other wood-processing industries like carpentries and sawmills where there are lower levels of wood dust. Sixty-eight personal exposure measurements of wood dust (inhalable and total dust) and resin acids were collected for 44 participants at four production plants located in Sweden. Results were used to estimate within- and between-worker variability and to identify uniformly exposed groups and determinants of exposure. In addition, overexposure, whether the risk of the long-term mean exposure of a randomly selected worker exceeding the occupational exposure limit is acceptably low, was calculated as well as the underestimation of the exposure–response relationship (attenuation). Greater variability in exposure between work shifts than between workers was observed with the within-worker variation accounting for 57–99% of the total variance in the individual-based model. Several uniformly exposed groups were detected but were mostly associated with a between-worker variation of zero which is an underestimation of the between-worker variation but an indication of uniformly exposed groups. Cleaning was identified as a work task that increases exposure slightly; so reducing workers’ exposure during this operation is advisable. The levels of wood dust were high and were found to pose unacceptable risks of overexposure at all plants for inhalable dust and at three out of four plants for total dust. These findings show that exposure to dust needs to be reduced in this industry. For resin acids, the exposure was classed as acceptable at all plants. According to an individual-based model constructed from the data, the level of attenuation was high, and thus there would be substantial bias in derived dose–response relationships.

  • 40.
    Hao, Yanfen
    et al.
    State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China.
    Li, Yingming
    State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China.
    Wang, Thanh
    Örebro University, School of Science and Technology.
    Hu, Yongbiao
    State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China.
    Sun, Huizhong
    State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China.
    Matsiko, Julius
    State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China.
    Zheng, Shucheng
    State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China.
    Wang, Pu
    State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China.
    Zhang, Qinghua
    State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China.
    Distribution, seasonal variation and inhalation risks of polychlorinated dibenzo-p-dioxins and dibenzofurans, polychlorinated biphenyls and polybrominated diphenyl ethers in the atmosphere of Beijing, China.2017In: Environmental Geochemistry and Health, ISSN 0269-4042, E-ISSN 1573-2983Article in journal (Refereed)
    Abstract [en]

    Spatial distribution, seasonal variation and potential inhalation risks of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) were investigated in the atmosphere of Beijing, using passive air samplers equipped with polyurethane foam disks. Concentrations of ΣPCDD/Fs, ΣPCBs and ΣPBDEs ranged from 8.4 to 179 fg WHO2005-TEQ/m(3), 38.6-139 and 1.5-176 pg/m(3), respectively. PCDFs showed higher air concentrations than those of PCDDs, indicating the influence of industrial activities and other combustion processes. The non-Aroclor congener, PCB-11, was detected in air (12.3-99.4 pg/m(3)) and dominated the PCB congener profiles (61.7-71.5% to ∑PCBs). The congener patterns of PBDEs showed signatures from both penta-BDE and octa-BDE products. Levels of PCDD/Fs, PCBs and PBDEs at the industrial and residential sites were higher than those at rural site, indicating human activities in urban area as potential sources. Higher air concentrations of PCDD/Fs, PCBs and PBDEs were observed in summer, which could be associated with atmospheric deposition process, re-volatilization from soil surface and volatilization from use of technical products, respectively. Results of inhalation exposure and cancer risk showed that atmospheric PCDD/Fs, dioxin-like PCBs and PBDEs did not cause high risks to the local residents of Beijing. This study provides further aid in evaluating emission sources, influencing factors and potential inhalation risks of the persistent organic pollutants to human health in mega-cities of China.

  • 41.
    Hardell, Lennart
    Örebro University Hospital.
    Effects of Mobile Phones on Children's and Adolescents' Health: A Commentary2017In: Child Development, ISSN 0009-3920, E-ISSN 1467-8624, Vol. 89, no 1, p. 137-140Article in journal (Refereed)
    Abstract [en]

    The use of digital technology has grown rapidly during the last couple of decades. During use, mobile phones and cordless phones emit radiofrequency (RF) radiation. No previous generation has been exposed during childhood and adolescence to this kind of radiation. The brain is the main target organ for RF emissions from the handheld wireless phone. An evaluation of the scientific evidence on the brain tumor risk was made in May 2011 by the International Agency for Research on Cancer at World Health Organization. The scientific panel reached the conclusion that RF radiation from devices that emit nonionizing RF radiation in the frequency range 30 kHz-300 GHz is a Group 2B, that is, a "possible" human carcinogen. With respect to health implications of digital (wireless) technologies, it is of importance that neurological diseases, physiological addiction, cognition, sleep, and behavioral problems are considered in addition to cancer. Well-being needs to be carefully evaluated as an effect of changed behavior in children and adolescents through their interactions with modern digital technologies.

  • 42.
    Hardell, Lennart
    et al.
    Örebro University Hospital. Dept Oncol, Örebro University, Örebro, Sweden.
    Carlberg, Michael
    Univ Hosp, Dept Oncol, Örebro University, Örebro, Sweden.
    Reply: Mobile phone use and brain tumours in the CERENAT case-control study2015In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 72, no 1, p. 79-79Article in journal (Refereed)
  • 43.
    Hardell, Lennart
    et al.
    Örebro University Hospital.
    Carlberg, Michael
    Department of Oncology, University Hospital, Örebro, Sweden.
    Using the Hill viewpoints from 1965 for evaluating strengths of evidence of the risk for brain tumors associated with use of mobile and cordless phones2013In: Reviews on environmental health, ISSN 0048-7554, Vol. 28, no 2-3, p. 97-106, article id /j/reveh.2013.28.issue-2-3/reveh-2013-0006/reveh-2013-0006.xmlArticle in journal (Refereed)
    Abstract [en]

    BACKGROUND: Wireless phones, i.e., mobile phones and cordless phones, emit radiofrequency electromagnetic fields (RF-EMF) when used. An increased risk of brain tumors is a major concern. The International Agency for Research on Cancer (IARC) at the World Health Organization (WHO) evaluated the carcinogenic effect to humans from RF-EMF in May 2011. It was concluded that RF-EMF is a group 2B, i.e., a "possible", human carcinogen. Bradford Hill gave a presidential address at the British Royal Society of Medicine in 1965 on the association or causation that provides a helpful framework for evaluation of the brain tumor risk from RF-EMF.

    METHODS: All nine issues on causation according to Hill were evaluated. Regarding wireless phones, only studies with long-term use were included. In addition, laboratory studies and data on the incidence of brain tumors were considered.

    RESULTS: The criteria on strength, consistency, specificity, temporality, and biologic gradient for evidence of increased risk for glioma and acoustic neuroma were fulfilled. Additional evidence came from plausibility and analogy based on laboratory studies. Regarding coherence, several studies show increasing incidence of brain tumors, especially in the most exposed area. Support for the experiment came from antioxidants that can alleviate the generation of reactive oxygen species involved in biologic effects, although a direct mechanism for brain tumor carcinogenesis has not been shown. In addition, the finding of no increased risk for brain tumors in subjects using the mobile phone only in a car with an external antenna is supportive evidence. Hill did not consider all the needed nine viewpoints to be essential requirements.

    CONCLUSION: Based on the Hill criteria, glioma and acoustic neuroma should be considered to be caused by RF-EMF emissions from wireless phones and regarded as carcinogenic to humans, classifying it as group 1 according to the IARC classification. Current guidelines for exposure need to be urgently revised.

  • 44.
    Hardell, Lennart
    et al.
    Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Carlberg, Michael
    Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Hansson Mild, Kjell
    Department of Radiation Physics, Umeå University, Umeå, Sweden.
    Use of mobile phones and cordless phones is associated with increased risk for glioma and acoustic neuroma2013In: Pathophysiology : the official journal of the International Society for Pathophysiology, ISSN 0928-4680, Vol. 2013, no 20, p. S0928-4680(12)00110-1-110, article id 2Article in journal (Refereed)
    Abstract [en]

    The International Agency for Research on Cancer (IARC) at WHO evaluation of the carcinogenic effect of RF-EMF on humans took place during a 24-31 May 2011 meeting at Lyon in France. The Working Group consisted of 30 scientists and categorised the radiofrequency electromagnetic fields from mobile phones, and from other devices that emit similar non-ionising electromagnetic fields (RF-EMF), as Group 2B, i.e., a 'possible', human carcinogen. The decision on mobile phones was based mainly on the Hardell group of studies from Sweden and the IARC Interphone study. We give an overview of current epidemiological evidence for an increased risk for brain tumours including a meta-analysis of the Hardell group and Interphone results for mobile phone use. Results for cordless phones are lacking in Interphone. The meta-analysis gave for glioma in the most exposed part of the brain, the temporal lobe, odds ratio (OR)=1.71, 95% confidence interval (CI)=1.04-2.81 in the ≥10 years (>10 years in the Hardell group) latency group. Ipsilateral mobile phone use ≥1640h in total gave OR=2.29, 95% CI=1.56-3.37. The results for meningioma were OR=1.25, 95% CI=0.31-4.98 and OR=1.35, 95% CI=0.81-2.23, respectively. Regarding acoustic neuroma ipsilateral mobile phone use in the latency group ≥10 years gave OR=1.81, 95% CI=0.73-4.45. For ipsilateral cumulative use ≥1640h OR=2.55, 95% CI=1.50-4.40 was obtained. Also use of cordless phones increased the risk for glioma and acoustic neuroma in the Hardell group studies. Survival of patients with glioma was analysed in the Hardell group studies yielding in the >10 years latency period hazard ratio (HR)=1.2, 95% CI=1.002-1.5 for use of wireless phones. This increased HR was based on results for astrocytoma WHO grade IV (glioblastoma multiforme). Decreased HR was found for low-grade astrocytoma, WHO grades I-II, which might be caused by RF-EMF exposure leading to tumour-associated symptoms and earlier detection and surgery with better prognosis. Some studies show increasing incidence of brain tumours whereas other studies do not. It is concluded that one should be careful using incidence data to dismiss results in analytical epidemiology. The IARC carcinogenic classification does not seem to have had any significant impact on governments' perceptions of their responsibilities to protect public health from this widespread source of radiation.

  • 45.
    Hardell, Lennart
    et al.
    Örebro University Hospital. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Carlberg, Michael
    Örebro University Hospital. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Koppel, Tarmo
    Department of Labour Environment and Safety, Tallinn University of Technology, Tallinn, Estonia.
    Hedendahl, Lena
    Independent Environment and Health Research Luleå, Luleå, Sweden.
    High radiofrequency radiation at Stockholm Old Town: An exposimeter study including the Royal Castle, Supreme Court, three major squares and the Swedish Parliament2017In: Molecular and clinical oncology, ISSN 2049-9450, E-ISSN 2049-9469, Vol. 6, no 4, p. 462-476Article in journal (Refereed)
    Abstract [en]

    Exposure to radiofrequency (RF) radiation was classified as a possible human carcinogen, Group 2B, by the International Agency for Research on Cancer at WHO in 2011. The exposure pattern is changing due to the rapid development of technology. Outdoor RF radiation level was measured during five tours in Stockholm Old Town in April, 2016 using the EME Spy 200 exposimeter with 20 predefined frequencies. The results were based on 10,437 samples in total. The mean level of the total RF radiation was 4,293 µW/m(2) (0.4293 µW/cm(2)). The highest mean levels were obtained for global system for mobile communications (GSM) + universal mobile telecommunications system (UMTS) 900 downlink and long-term evolution (LTE) 2600 downlink (1,558 and 1,265 µW/m(2), respectively). The town squares displayed highest total mean levels, with the example of Järntorget square with 24,277 µW/m(2) (min 257, max 173,302 µW/m(2)). These results were in large contrast to areas with lowest total exposure, such as the Supreme Court, with a mean level of 404 µW/m(2) (min 20.4, max 4,088 µW/m(2)). In addition, measurements in the streets surrounding the Royal Castle were lower than the total for the Old Town, with a mean of 756 µW/m(2) (min 0.3, max 50,967 µW/m(2)). The BioInitiative 2012 Report defined the scientific benchmark for possible health risks as 30-60 µW/m(2). Our results of outdoor RF radiation exposure at Stockholm Old Town are significantly above that level. The mean exposure level at Järntorget square was 405-fold higher than 60 µW/m(2). Our results were below the reference level on 10,000,000 µW/m(2) established by the International Commission on Non-Ionizing Radiation Protection (ICNIRP), which, however, are less credible, as they do not take non-thermal effects into consideration and are not based on sound scientific evaluation. Our highest measured mean level at Järntorget was 0.24% of the ICNIRP level. A number of studies have found adverse, non-thermal (no measurable temperature increase) health effects far below the ICNIRP guidelines.

  • 46.
    Hardell, Lennart
    et al.
    Dept Oncol, Örebro University Hospital, Örebro, Sweden.
    Carlberg, Michael
    Dept Oncol, Örebro University Hospital, Örebro, Sweden.
    Soderqvist, Fredrik
    Dept Oncol, Örebro University Hospital, Örebro, Sweden.
    Mild, Kjell Hansson
    Dept Radiat Phys, Umeå University, Umeå, Sweden.
    Pooled analysis of case-control studies on acoustic neuroma diagnosed 1997-2003 and 2007-2009 and use of mobile and cordless phones2013In: International Journal of Oncology, ISSN 1019-6439, Vol. 43, no 4, p. 1036-1044Article in journal (Refereed)
    Abstract [en]

    We previously conducted a case-control study of acoustic neuroma. Subjects of both genders aged 20-80 years, diagnosed during 1997-2003 in parts of Sweden, were included, and the results were published. We have since made a further study for the time period 2007-2009 including both men and women aged 18-75 years selected from throughout the country. These new results for acoustic neuroma have not been published to date. Similar methods were used for both study periods. In each, one population-based control, matched on gender and age (within five years), was identified from the Swedish Population Registry. Exposures were assessed by a self-administered questionnaire supplemented by a phone interview. Since the number of acoustic neuroma cases in the new study was low we now present pooled results from both study periods based on 316 participating cases and 3,530 controls. Unconditional logistic regression analysis was performed, adjusting for age, gender, year of diagnosis and socio-economic index (SEI). Use of mobile phones of the analogue type gave odds ratio (OR) = 2.9, 95% confidence interval (CI) = 2.0-4.3, increasing with >20 years latency (time since first exposure) to OR = 7.7, 95% CI = 2.8-21. Digital 20 mobile phone use gave OR = 1.5, 95% CI = 1.1-2.1, increasing with latency >15 years to an OR = 1.8, 95% CI = 0.8-4.2. The results for cordless phone use were OR = 1.5, 95% CI = 1.1-2.1, and, for latency of >20 years, OR = 6.5, 95% CI = 1.7-26. Digital type wireless phones (20 and 3G mobile phones and cordless phones) gave OR = 1.5, 95% CI = 1.1-2.0 increasing to OR = 8.1,95% CI = 2.0-32 with latency >20 years. For total wireless phone use, the highest risk was calculated for the longest latency time >20 years: OR = 4.4, 95% CI = 2.2-9.0. Several of the calculations in the long latency category were based on low numbers of exposed cases. Ipsilateral use resulted in a higher risk than contralateral for both mobile and cordless phones. OR increased per 100 h cumulative use and per year of latency for mobile phones and cordless phones, though the increase was not statistically significant for cordless phones. The percentage tumour volume increased per year of latency and per 100 h of cumulative use, statistically significant for analogue phones. This study confirmed previous results demonstrating an association between mobile and cordless phone use and acoustic neuroma.

  • 47.
    Hardell, Lennart
    et al.
    Örebro University Hospital. Dept Oncol, Örebro University Hospital, Örebro, Sweden.
    Carlberg, Michael
    Dept Oncol, Örebro University Hospital, Örebro, Sweden.
    Söderqvist, Fredrik
    Dept Oncol, Örebro University Hospital, Örebro, Sweden.
    Mild, Kjell Hansson
    Dept Radiat Sci, Umeå University, Umeå, Sweden.
    Case-control study of the association between malignant brain tumours diagnosed between 2007 and 2009 and mobile and cordless phone use2013In: International Journal of Oncology, ISSN 1019-6439, Vol. 43, no 6, p. 1833-1845Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown a consistent association between long-term use of mobile and cordless phones and glioma and acoustic neuroma, but not for meningioma. When used these phones emit radiofrequency electromagnetic fields (RF-EMFs) and the brain is the main target organ for the hand-held phone. The International Agency for Research on Cancer (IARC) classified in May, 2011 RF-EMF as a group 2B, i.e. a possible' human carcinogen. The aim of this study was to further explore the relationship between especially long-term (>10 years) use of wireless phones and the development of malignant brain tumours. We conducted a new case-control study of brain tumour cases of both genders aged 18-75 years and diagnosed during 2007-2009. One population-based control matched on gender and age (within 5 years) was used to each case. Here, we report on malignant cases including all available controls. Exposures on e.g. use of mobile phones and cordless phones were assessed by a self-administered questionnaire. Unconditional logistic regression analysis was performed, adjusting for age, gender, year of diagnosis and socio-economic index using the whole control sample. Of the cases with a malignant brain tumour, 87% (n=593) participated, and 85% (n=1,368) of controls in the whole study answered the questionnaire. The odds ratio (OR) for mobile phone use of the analogue type was 1.8, 95% confidence interval (CI)=1.04-3.3, increasing with >25 years of latency (time since first exposure) to an OR=3.3, 95% CI=1.6-6.9. Digital 2G mobile phone use rendered an OR=1.6, 95% CI=0.996-2.7, increasing with latency >15-20 years to an OR=2.1, 95% CI=1.2-3.6. The results for cordless phone use were OR=1.7, 95% CI=1.1-2.9, and, for latency of 15-20 years, the OR=2.1, 95% CI=1.2-3.8. Few participants had used a cordless phone for >20-25 years. Digital type of wireless phones (2G and 3G mobile phones, cordless phones) gave increased risk with latency >1-5 years, then a lower risk in the following latency groups, but again increasing risk with latency >15-20 years. Ipsilateral use resulted in a higher risk than contralateral mobile and cordless phone use. Higher ORs were calculated for tumours in the temporal and overlapping lobes. Using the meningioma cases in the same study as reference entity gave somewhat higher ORs indicating that the results were unlikely to be explained by recall or observational bias. This study confirmed previous results of an association between mobile and cordless phone use and malignant brain tumours. These findings provide support for the hypothesis that RF-EMFs play a role both in the initiation and promotion stages of carcinogenesis.

  • 48.
    Hiyoshi, Ayako
    et al.
    Epidemiology and Public Health, UCL, London, UK.
    Shipley, M.J.
    Epidemiology and Public Health, UCL, London, UK.
    Fukuda, Y.
    Community Health and Medicine, Yamaguchi University school of Medicine, Yamaguchi, Japan.
    Brunner, E. J.
    Epidemiology and Public Health, UCL, London, UK.
    Health inequalities in Japan 1986 to 2007 based on self-rated health, household income and a novel occupational classification2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no Suppl. 1, p. A13-A13Article in journal (Refereed)
  • 49.
    Howard, Bethany J.
    et al.
    Baker IDI Heart and Diabetes Institute, Melbourne, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.
    Hurtig-Wennlöf, Anita
    Örebro University, School of Health Sciences.
    Olsson, Lovisa A.
    Department of Laboratory Medicine Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nilsson, Torbjörn K.
    Department of Medical Biosciences/Clinical Chemistry, Umeå University, Umeå, Sweden.
    Dunstan, David W.
    Baker IDI Heart and Diabetes Institute, Melbourne, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia; School of Sports Science, Exercise and Health, The University of Western Australia, Perth, Australia; School of Population Health, The University of Queensland, Brisbane, Australia .
    Wennberg, Patrik
    Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden .
    Self-Reported Sitting Time, Physical Activity and Fibrinolytic and Other Novel Cardio-Metabolic Biomarkers in Active Swedish Seniors2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 9, article id e0163409Article in journal (Refereed)
    Abstract [en]

    Background: Too much sitting is linked with an increased risk of cardiovascular disease and mortality. The mediating mechanisms for these associations are largely unknown, however dysregulated fibrinolysis have emerged as a possible contributor.

    Objective: We examined the associations of self-reported overall sitting time and physical activity with fibrinolytic and other novel cardio-metabolic biomarkers in older adults.

    Materials and Methods: Data was analysed for 364 participants (74±7 yrs) of the Active Seniors group (retired, living independently in their own homes). Linear regression analyses examined associations of categories of categories of sitting time (≤3, 3-6, >6 hrs/day) and overall physical activity (Low, Moderate and High) with biomarkers in serum or plasma, adjusting for age, gender and smoking (with further adjustment for either overall physical activity or sitting time and BMI in secondary analyses).

    Results: Compared to sitting ≤ 3 hrs/day, sitting >6 hrs/day was associated with higher tissue plasminogen activator (tPA) and tissue plasminogen activator/plasminogen activator inhibitor-1 complex (tPA-PAI-1 complex). These associations were not independent of overall physical activity or BMI. Compared to those in the high physical activity, low physical activity was associated with a higher BMI, high-sensitivity C-reactive protein (hs-CRP) and tPA-PAI-1 complex levels. Only the associations of BMI and hs-CRP were independent of sitting time.

    Conclusions: These findings provide preliminary cross-sectional evidence for the relationships of sitting time with fibrinolytic markers in older adults. They also reinforce the importance of regular physical activity for cardio-metabolic health.

  • 50.
    Hua, Håkan
    et al.
    Institutet för handikappvetenskap (IHV), Linnaeus Centre HEAD, Linköpings University, Linköping, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Emilsson, Magnus
    Institutet för handikappvetenskap (IHV), Linnaeus Centre HEAD, Linköpings University, Linköping, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Ellis, Rachel
    Institutet för handikappvetenskap (IHV), Linnaeus Centre HEAD, Linköpings University, Linköping, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Widen, Stephen
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Institutet för handikappvetenskap (IHV), Linnaeus Centre HEAD, Linköpings University, Linköping, Sweden.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Institutet för handikappvetenskap (IHV), Linnaeus Centre HEAD, Linköpings University, Linköping, Sweden; Audiological Research Centre, Örebro University Hospital, Örebro, Sweden.
    Lyxell, Björn
    Institutet för handikappvetenskap (IHV), Linnaeus Centre HEAD, Linköpings University, Linköping, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Cognitive skills and the effect of noise on perceived effort in employees with aided hearing impairment and normal hearing2014In: Noise & Health, ISSN 1463-1741, E-ISSN 1998-4030, Vol. 16, no 69, p. 79-88Article in journal (Refereed)
    Abstract [en]

    The aim of the following study was to examine the relationship between working memory capacity (WMC), executive functions (EFs) and perceived effort (PE) after completing a work-related task in quiet and in noise in employees with aided hearing impairment (HI) and normal hearing. The study sample consisted of 20 hearing-impaired and 20 normally hearing participants. Measures of hearing ability, WMC and EFs were tested prior to performing a work-related task in quiet and in simulated traffic noise. PE of the work-related task was also measured. Analysis of variance was used to analyze within-and between-group differences in cognitive skills, performance on the work-related task and PE. The presence of noise yielded a significantly higher PE for both groups. However, no significant group differences were observed in WMC, EFs, PE and performance in the work-related task. Interestingly, significant negative correlations were only found between PE in the noise condition and the ability to update information for both groups. In summary, noise generates a significantly higher PE and brings explicit processing capacity into play, irrespective of hearing. This suggest that increased PE involves other factors such as type of task that is to be performed, performance in the cognitive skill required solving the task at hand and whether noise is present. We therefore suggest that special consideration in hearing care should be made to the individual's prerequisites on these factors in the labor market.

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