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  • 1.
    Frisk, Margot
    et al.
    Örebro University, Department of Health Sciences.
    Arvidsson, Helena
    Arbets- och miljömed. kliniken, USÖ.
    Kiviloog, Jaak
    Lungkliniken, USÖ.
    Ivarsson, Ann-Britt
    Örebro University, Department of Health Sciences.
    Kamwendo, Kitty
    Örebro University, Department of Health Sciences.
    Stridh, Göran
    Örebro University, Department of Technology.
    An investigation of the housing environment for persons with asthma and persons without asthma2006In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 13, no 1, p. 4-12Article in journal (Refereed)
    Abstract [en]

    Asthma is a chronic disease affected by environmental factors that may increase symptoms that impact on a persons' well-being. An important issue in occupational therapy is to improve the relationship between a person's functional capacity and the physical environment. The aim of the study was to compare the housing environment of persons with asthma (cases, n=49) and persons without asthma (controls, n=48), with regard to building construction and condition, physical, chemical and biological factors, and cleaning routines. A secondary aim was to compare different types of accommodation within cases and controls. A specialist team, including a construction engineer, a biological scientist, and an occupational therapist, conducted the study. Data were collected using protocols, as well as a number of established technical methods from the field of occupational and environmentsl medicine. The primary results showed no major differences in the housing environment between the two groups. However, in individual homes environmental factors at levels that could increase symptoms were identified. When single-familyhouses were compared with multi-family houses, significant differences were found indicating that preventive interventions may be needed in some single-family houses. Further studies are needed to clarify the person-environment relationship for persons with asthma, focusing on their ability to perform daily activities.

  • 2.
    Frisk, Margot
    et al.
    Örebro University, Department of Health Sciences.
    Blomqvist, Anna
    Stridh, Göran
    Sjödén, Per-Olow
    Kiviloog, Jaak
    Occupational therapy adaptation of the home environment in Sweden for people with asthma2002In: Occupational Therapy International, ISSN 0966-7903, Vol. 9, no 4, p. 294-311Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to evaluate changes of lung function, respiratory symptoms and indoor air quality after reducing allergens and indoor pollutants in the home environment of people with asthma (n = 21). A quasi-experimental pre-/post-test design with one group of participants was implemented. The interventions included removal of wall-to-wall carpets (n = 14) or improvement of indoor air exchange (n = 7). Participants' lung function, symptoms, medication and type-1 allergy were recorded before and after the intervention. The indoor environment was monitored at house calls by an occupational therapist using conventional physical, biological and chemical methods. There was an improvement of lung function evidenced by an increased mean Forced Expiratory Volume (FEV(1) %) and a reduction of airway obstruction (reversibility, % of baseline value), which indicate an improved asthmatic condition. Lung function assessed by vital capacity, bronchial hyper-responsiveness, mean of Peak Expiratory Flow, symptom score and medicine consumption did not change significantly. There was a tendency that the amount of airborne dust (p=0.06) was reduced in the indoor environment. Relative humidity, carbon dioxide, formaldehyde and house dust mite levels had decreased after the intervention, but not significantly. Asthma symptoms related to the home environment are probably caused by several factors. When people with asthma suffer from increased symptoms in the home, house calls should be performed routinely. Dust samples from beds and carpets for analysis of allergens give information about exposure, and environmental assessments should be performed before interventions. Occupational therapists can make a valuable contribution in evaluating the home environment and suggesting ergonomic adaptations for individuals with asthma.

  • 3.
    Frisk, Margot L. A.
    Örebro University, Department of Health Sciences.
    Asthma and respiratory symptoms related to the housing environment2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this dissertation was to study the housing environment with a focus on indoor climate factors which may maintain or worsen respiratory symptoms among persons with asthma.

    Quasi-experimental and cross-sectional designs and a case-control approach were used. In Study I data was collected from a consecutive series of patients with asthma (n=21) and in the three other studies from a randomly selected sample, representative of the general population (n=6732). This sample was classified into subgroups (Study II): persons with asthma (n=261), healthy persons (n=5266) and persons with symptoms (n=1205). In Study III persons with asthma (n=49) were compared to persons without asthma (n=48), and the same group, persons with asthma (n=49) was also included in Study IV. Data were gathered using subjective information from diaries and questionnaires as well as objective measurements of medical and environmental factors.

    Lung function was improved and there was a tendency for the indoor climate to improve after the removal of textile wall-to-wall carpets or the increase of air exchange rate. No statistically significant differences were found in the housing environment when persons with and without asthma were compared. However in some individual homes, environmental factors at levels that could increase symptoms were identified. In single-family houses higher levels of humidity, insufficient ventilation and the occurrence of house dust mites indicated a less favorable indoor climate compared to multi-family houses. Respiratory symptoms attributed to specific environmental exposures increased in both healthy and unhealthy persons when they reported occurrence of indoor climate risk indicators. No statistically significant associations were found between separate risk indicators, identified by a ‘Housing Environmental-index’, or the frequency of indicators and clinical tests. The lack of significant associations may show that the chosen cut-off levels in the index were too high in reference to persons with asthma and further research is needed to establish relevant cut-off levels.

    In some of the investigated houses there was a need for secondary preventive interventions to improve the indoor climate in order to decrease the exposure of allergens and airway irritants. In this dissertation one aspect of the complex relationship between the person and the environment, i.e. accessibility, has been studied. Further research is needed to address the aspect of usability, i.e. the person’s own evaluation of the degree to which they can be in and use the environment.

    List of papers
    1. Occupational therapy adaptation of the home environment in Sweden for people with asthma
    Open this publication in new window or tab >>Occupational therapy adaptation of the home environment in Sweden for people with asthma
    Show others...
    2002 (English)In: Occupational Therapy International, ISSN 0966-7903, Vol. 9, no 4, p. 294-311Article in journal (Refereed) Published
    Abstract [en]

    The purpose of this study was to evaluate changes of lung function, respiratory symptoms and indoor air quality after reducing allergens and indoor pollutants in the home environment of people with asthma (n = 21). A quasi-experimental pre-/post-test design with one group of participants was implemented. The interventions included removal of wall-to-wall carpets (n = 14) or improvement of indoor air exchange (n = 7). Participants' lung function, symptoms, medication and type-1 allergy were recorded before and after the intervention. The indoor environment was monitored at house calls by an occupational therapist using conventional physical, biological and chemical methods. There was an improvement of lung function evidenced by an increased mean Forced Expiratory Volume (FEV(1) %) and a reduction of airway obstruction (reversibility, % of baseline value), which indicate an improved asthmatic condition. Lung function assessed by vital capacity, bronchial hyper-responsiveness, mean of Peak Expiratory Flow, symptom score and medicine consumption did not change significantly. There was a tendency that the amount of airborne dust (p=0.06) was reduced in the indoor environment. Relative humidity, carbon dioxide, formaldehyde and house dust mite levels had decreased after the intervention, but not significantly. Asthma symptoms related to the home environment are probably caused by several factors. When people with asthma suffer from increased symptoms in the home, house calls should be performed routinely. Dust samples from beds and carpets for analysis of allergens give information about exposure, and environmental assessments should be performed before interventions. Occupational therapists can make a valuable contribution in evaluating the home environment and suggesting ergonomic adaptations for individuals with asthma.

    National Category
    Nursing
    Research subject
    Nursing Science w. Occupational Therapy Focus
    Identifiers
    urn:nbn:se:oru:diva-2831 (URN)10.1002/oti.170 (DOI)
    Available from: 2007-05-03 Created: 2007-05-03 Last updated: 2017-10-18Bibliographically approved
    2. Increased occurrence of respiratory symptoms is associated with indoor climate risk indicators: a cross-sectional study in a Swedish population
    Open this publication in new window or tab >>Increased occurrence of respiratory symptoms is associated with indoor climate risk indicators: a cross-sectional study in a Swedish population
    Show others...
    2007 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, no 9, p. 2031-2035Article in journal (Refereed) Published
    Abstract [en]

    A basic assumption was that exposure to the indoor environment would increase the manifestation of respiratory symptoms in predisposed individuals. The aim was to investigate the proportion of perceived respiratory symptoms attributed to specific environmental exposures, and associations related to indoor climate risk indicators, i.e. occurrence of damp or mould, insufficient ventilation and condensation on windows.

    Method

    A questionnaire was mailed to a random sample of 8008 individuals, stratified for gender and age. The response rate was 84% (n=6732). Established criteria for current asthma were used to classify subjects into three subgroups: asthmatics, healthy and symptomatics (but without current asthma).

    Results

    The proportion of symptoms attributed to specific environmental exposures increased in the total sample and in the three subgroups when indoor climate risk indicators, particularly damp or mould, were reported. Generally, the lowest proportions were found for healthy and the highest for asthmatics. Univariate analyses presented as relative risks (RR) (95% CI) showed significantly increased risks for perceived overall influence on airways for all groups, with RR ranging from 4.3 to 6.8. Although respiratory symptoms attributed to dust, environmental tobacco smoke (ETS) and strong scents increased when risk indicators were reported, RR were generally lower in all groups.

    Conclusion

    The high frequency of respiratory symptoms among asthmatics increased when occurrences of risk indicators were reported. Similarly, increased symptoms were found for healthy indicating that indoor climate risk indicators may affect both healthy and unhealthy individuals.

    Keywords
    asthma, airway symptoms, housing environment, risk indicators
    National Category
    Nursing Public Health, Global Health, Social Medicine and Epidemiology Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Nursing Science w. Occupational Therapy Focus
    Identifiers
    urn:nbn:se:oru:diva-2832 (URN)10.1016/j.rmed.2007.05.002 (DOI)
    Available from: 2007-05-03 Created: 2007-05-03 Last updated: 2017-12-14Bibliographically approved
    3. An investigation of the housing environment for persons with asthma and persons without asthma
    Open this publication in new window or tab >>An investigation of the housing environment for persons with asthma and persons without asthma
    Show others...
    2006 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 13, no 1, p. 4-12Article in journal (Refereed) Published
    Abstract [en]

    Asthma is a chronic disease affected by environmental factors that may increase symptoms that impact on a persons' well-being. An important issue in occupational therapy is to improve the relationship between a person's functional capacity and the physical environment. The aim of the study was to compare the housing environment of persons with asthma (cases, n=49) and persons without asthma (controls, n=48), with regard to building construction and condition, physical, chemical and biological factors, and cleaning routines. A secondary aim was to compare different types of accommodation within cases and controls. A specialist team, including a construction engineer, a biological scientist, and an occupational therapist, conducted the study. Data were collected using protocols, as well as a number of established technical methods from the field of occupational and environmentsl medicine. The primary results showed no major differences in the housing environment between the two groups. However, in individual homes environmental factors at levels that could increase symptoms were identified. When single-familyhouses were compared with multi-family houses, significant differences were found indicating that preventive interventions may be needed in some single-family houses. Further studies are needed to clarify the person-environment relationship for persons with asthma, focusing on their ability to perform daily activities.

    Keywords
    environmental factors, housing, occupational therapy, respiratory symptoms
    National Category
    Social Sciences Interdisciplinary Nursing Occupational Therapy
    Research subject
    Nursing Science w. Occupational Therapy Focus
    Identifiers
    urn:nbn:se:oru:diva-2833 (URN)10.1080/11038120510031824 (DOI)
    Projects
    FinEsS-studies
    Available from: 2007-05-03 Created: 2007-05-03 Last updated: 2018-01-13Bibliographically approved
    4. Are there associations between indoor climate risk indicators, identified by a Housing Environmental index (HE-index), and clinical tests of lung function, allergy and bronchial hyper-responsiveness in persons with asthma?
    Open this publication in new window or tab >>Are there associations between indoor climate risk indicators, identified by a Housing Environmental index (HE-index), and clinical tests of lung function, allergy and bronchial hyper-responsiveness in persons with asthma?
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Nursing Occupational Therapy
    Research subject
    Nursing Science w. Occupational Therapy Focus
    Identifiers
    urn:nbn:se:oru:diva-2834 (URN)
    Available from: 2007-05-03 Created: 2007-05-03 Last updated: 2017-10-18Bibliographically approved
  • 4.
    Frisk, Margot L. A.
    et al.
    Örebro University, Department of Health Sciences.
    Magnuson, Anders
    Statistical and Epidemiological Unit, Center for Clinical Research, Örebro University Hospital.
    Kiviloog, Jaak
    Department of Respiratory Medicine, Örebro University Hospital.
    Ivarsson, Ann-Britt
    Örebro University, Department of Health Sciences.
    Kamwendo, Kitty
    Örebro University, Department of Health Sciences.
    Increased occurrence of respiratory symptoms is associated with indoor climate risk indicators: a cross-sectional study in a Swedish population2007In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, no 9, p. 2031-2035Article in journal (Refereed)
    Abstract [en]

    A basic assumption was that exposure to the indoor environment would increase the manifestation of respiratory symptoms in predisposed individuals. The aim was to investigate the proportion of perceived respiratory symptoms attributed to specific environmental exposures, and associations related to indoor climate risk indicators, i.e. occurrence of damp or mould, insufficient ventilation and condensation on windows.

    Method

    A questionnaire was mailed to a random sample of 8008 individuals, stratified for gender and age. The response rate was 84% (n=6732). Established criteria for current asthma were used to classify subjects into three subgroups: asthmatics, healthy and symptomatics (but without current asthma).

    Results

    The proportion of symptoms attributed to specific environmental exposures increased in the total sample and in the three subgroups when indoor climate risk indicators, particularly damp or mould, were reported. Generally, the lowest proportions were found for healthy and the highest for asthmatics. Univariate analyses presented as relative risks (RR) (95% CI) showed significantly increased risks for perceived overall influence on airways for all groups, with RR ranging from 4.3 to 6.8. Although respiratory symptoms attributed to dust, environmental tobacco smoke (ETS) and strong scents increased when risk indicators were reported, RR were generally lower in all groups.

    Conclusion

    The high frequency of respiratory symptoms among asthmatics increased when occurrences of risk indicators were reported. Similarly, increased symptoms were found for healthy indicating that indoor climate risk indicators may affect both healthy and unhealthy individuals.

  • 5.
    Frisk, Margot L. A.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Stridh, Göran
    Arbets- och miljömed. kliniken, USÖ.
    Ivarsson, Ann-Britt
    Örebro University, School of Health and Medical Sciences.
    Kamwendo, Kitty
    Örebro University, School of Health and Medical Sciences.
    Can a housing environmental index establish associations between indoor risk indicators and clinical tests in persons with asthma?2009In: International Journal of Environmental Health Research, ISSN 0960-3123, E-ISSN 1369-1619, Vol. 19, no 6, p. 389-404Article in journal (Refereed)
    Abstract [en]

    The aim was to investigate the associations between indoor risk indicators, identified by a Housing Environmental index (HE-index), and clinical tests of lung function, allergy and bronchial hyper-responsiveness (BHR). Forty-nine eligible subjects participated in the investigation. The HE-index was based on national and international guidelines and related to measurements of humidity, temperature, carbon dioxide, formaldehyde, nitrogen dioxide, allergens and occurrence of tobacco smoke and pets. Only 18% of the investigated homes did not have any of the risk indicators. Statistically significant associations were found between exposure to mites and lung function, and to a lesser degree in BHR for subjects living in homes with pets. The cut-off levels in the HE-index were not specifically related to health effects and may therefore have been too high for sensitive persons. Further studies are needed to establish relevant guidelines for the identification of risk indicators in the housing environment for persons with asthma.

  • 6.
    Frisk, Margot
    et al.
    Örebro University, Department of Health Sciences.
    Stridh, Göran
    Magnuson, Anders
    Ivarsson, Ann-Britt
    Kamwendo, Kitty
    Are there associations between indoor climate risk indicators, identified by a Housing Environmental index (HE-index), and clinical tests of lung function, allergy and bronchial hyper-responsiveness in persons with asthma?Manuscript (preprint) (Other academic)
  • 7.
    Pettersson, Ingvor
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Pettersson, Viktor
    Skövde Municipality Rehab, Skövde, Sweden.
    Frisk, Margot L. A.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    ICF from an occupational therapy perspective in adult care: an integrative literature review2012In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 19, no 3, p. 260-273Article in journal (Refereed)
    Abstract [en]

    Since its launch there has been increasing interest in the International Classification of Functioning, Disability and Health (ICF) within occupational therapy (OT). The aim of this study was to perform an integrative literature review, in order to present an overview of knowledge, where the ICF constitutes a significant part in relation to OT. A systematic literature search, covering the period 2001–2008, was performed in the databases MEDLINE, AMED, and CINAHL. A total of 112 articles were included and the majority had exploratory and descriptive designs. The results showed that ICF was valuable for research, clinical practice, and education. ICF was used to link existing instruments and to construct new outcome measures. Occupational therapists have been members of expert groups involved in the development of Core Sets for certain health conditions. Several positive aspects were described, e.g. an effective medium for communication at different levels. Many limitations were mentioned, such as unclear concepts and lack of subjective experiences. Suggestions for improvements were described. The conclusion was that the ICF has been used for a broad spectrum of purposes. The results indicated that further research is needed concerning application of the ICF in clinical practice and education.

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