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- Franklin, Karl, et al.
(author)
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Early life environment and snoring in adulthood
- 2008
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In: Respiratory Research. - : Springer Science and Business Media LLC. - 1465-9921 .- 1465-993X. ; 9:1, s. 63-
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Journal article (peer-reviewed)abstract
- BACKGROUND: To our knowledge, no studies of the possible association of early life environment with snoring in adulthood have been published. We aimed to investigate whether early life environment is associated with snoring later in life. METHODS: A questionnaire including snoring frequency in adulthood and environmental factors in early life was obtained from 16,190 randomly selected men and women, aged 25-54 years, in Sweden, Norway, Iceland, Denmark and Estonia (response rate 74%). RESULTS: A total of 15,556 subjects answered the questions on snoring. Habitual snoring, defined as loud and disturbing snoring at least 3 nights a week, was reported by 18%. Being hospitalized for a respiratory infection before the age of two years (adjusted odds ratio (OR) = 1.27; 95% confidence interval (CI) 1.01-1.59), suffering from recurrent otitis as a child (OR = 1.18; 95%CI 1.05-1.33), growing up in a large family (OR = 1.04; 95%CI 1.002-1.07) and being exposed to a dog at home as a newborn (OR = 1.26; 95%CI 1.12-1.42) were independently related to snoring later in life and independent of a number of possible confounders in adulthood. The same childhood environmental factors except household size were also related with snoring and daytime sleepiness combined. CONCLUSION: The predisposition for adult snoring may be partly established early in life. Having had severe airway infections or recurrent otitis in childhood, being exposed to a dog as a newborn and growing up in a large family are environmental factors associated with snoring in adulthood.
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| 3. |
- Dratva, Julia, et al.
(author)
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Validation of self-reported figural drawing scales against anthropometric measurements in adults
- 2016
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In: Public Health Nutrition. - : Cambridge University Press. - 1368-9800 .- 1475-2727. ; 19:11, s. 1944-1951
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Journal article (peer-reviewed)abstract
- Objective: The aim of the present study was to validate figural drawing scales depicting extremely lean to extremely obese subjects to obtain proxies for BMI and waist circumference in postal surveys.Design: Reported figural scales and anthropometric data from a large population-based postal survey were validated with measured anthropometric data from the same individuals by means of receiver-operating characteristic curves and a BMI prediction model.Setting: Adult participants in a Scandinavian cohort study first recruited in 1990 and followed up twice since.Subjects: Individuals aged 38-66 years with complete data for BMI (n 1580) and waist circumference (n 1017).Results: Median BMI and waist circumference increased exponentially with increasing figural scales. Receiver-operating characteristic curve analyses showed a high predictive ability to identify individuals with BMI > 25.0 kg/m(2) in both sexes. The optimal figural scales for identifying overweight or obese individuals with a correct detection rate were 4 and 5 in women, and 5 and 6 in men, respectively. The prediction model explained 74% of the variance among women and 62% among men. Predicted BMI differed only marginally from objectively measured BMI.Conclusions: Figural drawing scales explained a large part of the anthropometric variance in this population and showed a high predictive ability for identifying overweight/obese subjects. These figural scales can be used with confidence as proxies of BMI and waist circumference in settings where objective measures are not feasible.
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| 5. |
- Hellgren, Johan, 1965, et al.
(author)
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Perennial non-infectious rhinitis--an independent risk factor for sleep disturbances in Asthma.
- 2007
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In: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 101:5, s. 1015-20
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Journal article (peer-reviewed)abstract
- Aim of the studyTo evaluate if perennial non-infectious rhinitis is associated with sleep disturbances in asthma.Materials and methodsThis is a questionnaire based study in a random population sample from Denmark, Estonia, Iceland, Norway and Sweden aged 30–54 yr. A total of 1127 individuals reporting asthma from an original random population sample of 16,191 were analysed regarding their quality of sleep in relation to perennial non-infectious rhinitis. Perennial non-infectious rhinitis was defined as having nasal symptoms such as nasal blockage and secretion in the absence of common cold, always. Asthma was defined as both ever having had asthma and having physician diagnosed asthma. Odds ratios (OR) for difficulties inducing sleep, difficulties maintaining sleep, early morning awakenings and daytime sleepiness were calculated in a multiple logistic regression controlling for other risk factors for sleep disturbances such as snoring, wheeze, obesity and smoking.ResultsThe response rate was 74%. A total of 189 (17%) of the subjects with asthma reported perennial non-infectious rhinitis. Perennial non-infectious rhinitis was associated with an increased OR for difficulties maintaining sleep (1.6 (95% confidence interval (CI) 1.1–2.3)), early morning awakenings (1.5 (95% CI 1.1–2.2)) and daytime sleepiness (1.8 (95% CI 1.2–2.9)). The result show that perennial non-infectious rhinitis is an independant risk factor for sleep disturbances in asthma.
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| 6. |
- Johannessen, Ane, et al.
(author)
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Longterm follow-up in European respiratory health studies : patterns and implications
- 2014
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In: BMC Pulmonary Medicine. - : BioMed Central. - 1471-2466. ; 14, s. 63-
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Journal article (peer-reviewed)abstract
- BACKGROUND: Selection bias is a systematic error in epidemiologic studies that may seriously distort true measures of associations between exposure and disease. Observational studies are highly susceptible to selection bias, and researchers should therefore always examine to what extent selection bias may be present in their material and what characterizes the bias in their material. In the present study we examined long-term participation and consequences of loss to follow-up in the studies Respiratory Health in Northern Europe (RHINE), Italian centers of European Community Respiratory Health Survey (I-ECRHS), and the Italian Study on Asthma in Young Adults (ISAYA). METHODS: Logistic regression identified predictors for follow-up participation. Baseline prevalence of 9 respiratory symptoms (asthma attack, asthma medication, combined variable with asthma attack and/or asthma medication, wheeze, rhinitis, wheeze with dyspnea, wheeze without cold, waking with chest tightness, waking with dyspnea) and 9 exposure-outcome associations (predictors sex, age and smoking; outcomes wheeze, asthma and rhinitis) were compared between all baseline participants and long-term participants. Bias was measured as ratios of relative frequencies and ratios of odds ratios (ROR). RESULTS: Follow-up response rates after 10 years were 75% in RHINE, 64% in I-ECRHS and 53% in ISAYA. After 20 years of follow-up, response was 53% in RHINE and 49% in I-ECRHS. Female sex predicted long-term participation (in RHINE OR (95%CI) 1.30(1.22, 1.38); in I-ECRHS 1.29 (1.11, 1.50); and in ISAYA 1.42 (1.25, 1.61)), as did increasing age. Baseline prevalence of respiratory symptoms were lower among long-term participants (relative deviations compared to total baseline population 0-15% (RHINE), 0-48% (I-ECRHS), 3-20% (ISAYA)), except rhinitis which had a slightly higher prevalence. Most exposure-outcome associations did not differ between long-term participants and all baseline participants, except lower OR for rhinitis among ISAYA long-term participating smokers (relative deviation 17% (smokers) and 44% (10-20 pack years)). CONCLUSIONS: We found comparable patterns of long-term participation and loss to follow-up in RHINE, I-ECRHS and ISAYA. Baseline prevalence estimates for long-term participants were slightly lower than for the total baseline population, while exposure-outcome associations were mainly unchanged by loss to follow-up.
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| 7. |
- Real, Francisco Gomez, et al.
(author)
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The Association of Gum Bleeding with Respiratory Health in a Population Based Study from Northern Europe
- 2016
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:1
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Journal article (peer-reviewed)abstract
- Background There is little knowledge about how oral and respiratory health is interrelated even though the mucosa of the oral cavity and airways constitutes a continuum and the exposures to these are partly similar. Aims To investigate whether gum bleeding is related to asthma, respiratory symptoms and self-reported COPD. Methods A postal questionnaire including questions about respiratory and oral health was sent to general population samples in seven Northern European centres. In 13,409 responders, gum bleeding when brushing teeth was reported always/often by 4% and sometimes by 20%. Logistic regressions accounted for age, smoking, educational level, centre and gender. Effects of BMI, cardio-metabolic diseases, early life factors, gastro-oesophageal reflux, dental hygiene, nasal congestion, and asthma medication were addressed. Results Gum bleeding always/often was significantly associated with >= 3 asthma symptoms (OR 2.58, 95% CI 2.10-3.18), asthma (1.62 [1.23-2.14]) and self-reported COPD (2.02 [1.283.18]). There was a dose-response relationship between respiratory outcomes and gum bleeding frequency (>= 3 symptoms: gum bleeding sometimes 1.42 [1.25-1.60], often/always 2.58 [2.10-3.18]), and there was no heterogeneity between centres (p(heterogeneity) = 0.49). None of the investigated risk factors explained the associations. The observed associations were significantly stronger among current smokers (p(interaction) = 0.004). Conclusions A consistent link between gum bleeding and obstructive airways disease was observed, not explained by common risk factors or metabolic factors. We speculate that oral pathogens might have unfavourable impact on the airways, and that the direct continuity of the mucosa of the oral cavity and the airways reflects a pathway that might provide novel opportunities for interventions.
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| 8. |
- Schyllert, Christian, 1983-
(author)
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Social determinants in asthma : population-based studies on asthma and respiratory symptoms in relation to occupation, occupational exposure and socioeconomic status
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Background: Asthma is one of the most common chronic obstructive airway diseases among children and adults, with a prevalence between 6-11% in European countries. It is also the most common work-related occupational respiratory disease. There are different methods to classify occupational exposure and, even though there is no clear consensus on which method is the most accurate, the single-item question on exposure to the composite measure vapour, gas, dust or fumes (VGDF) is commonly used in epidemiological research. Low socioeconomic status is associated with asthma and also behavioural factors such as smoking and over-weight, which by themselves are risk factors for asthma. Socioeconomic status is, however, truly a multifaceted concept and using only one measure does not encompass its entire effect on health-related outcomes. Asthma does also have a negative impact on the quality of life among adolescents: they report less physical fitness compared to their peers and more school absenteeism due to respiratory symptoms. Still, research on whether childhood asthma has any impact on socioeconomic status in young adulthood is scarce.Aim: The overall aim is to study social determinants of health such as socioeconomic status, occupation and occupational exposure and their relationship with asthma and respiratory symptoms among adults and further, to evaluate if asthma during childhood or adolescence is associated with social determinants in young adulthood.Method: This thesis includes four papers based on data from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. Papers I-III are cross-sectional studies among adults; a structured interview from clinical examinations between 2002-04 (paper I, n=4036) and postal questionnaire surveys from 2006 (paper II, n=9992) and 2016 (paper III, n=6854) with the addition of register-based data in paper III. Paper IV is a longitudinal prospective cohort study; the first OLIN paediatric cohort followed from 7 to 19 years of age and a postal questionnaire follow-up at ages 27-28 in 2015 (n=2017). Asthma was defined as physician diagnosis (paper I) together with respiratory symptoms (paper II-IV) or use of asthma medication (paper IV). In paper IV asthma was further categorized based on age of onset and p v and adolescence. Main or longest held occupation was used to categorize occupational and socioeconomic groups. In papers III and IV additional measures of socioeconomic status were included; educational level (papers III and IV) and income (paper III). In all papers, occupational exposure to vapour and/or gas, dust and fumes (VGDF or GDF) were taken into consideration and in paper I further divided into subgroups based on a detailed questionnaire on occupational exposure.Results: In paper I we found that the association between occupational exposure to VGDF and asthma and rhinitis was driven by the component of chemicals rather than dusts. In paper II, the ISCO-based manual Swedish Standard Classification of Occupations (SSYK) and the manual Socioeconomic classification (SEI), could both identify occupational and socioeconomic groups at risk for respiratory symptoms and asthma, while the older ISCO-based manual Nordic Classification of Occupations (NYK) was not as sensitive.In paper III, behavioural risk factors for respiratory symptoms and asthma such as smoking and obesity and, occupational exposure to GDF were associated with low educational level. Interaction analyses between income level and sex revealed different patterns among women and men. Among women, low income was associated with all respiratory symptoms as well as asthma, while among men only with productive cough.In paper IV, early onset asthma was associated with lower educational level in young adulthood, especially not continuing after compulsory school. Further, those with asthma during childhood or adolescence did not seem to refrain from smoking at age 19, nor did they as young adults seem to avoid occupations with known or expected exposure to GDF.Conclusions: Increased automation in industries have decreased the number of manual workers in industries with typically dirty tasks, meaning that the interrelationships between the subgroups included in VGDF may have changed. This may also affect the meaning of occupational exposure to VGDF, at least with regard to asthma and rhinitis, and according to our findings exposure to the component of chemicals may be the most important. We also found that the use of an ISCO-based manual (SSYK) as well as socioeconomic classification based on job-title (SEI) can be useful and easily applicable tools to identify occupational and socioeconomic groups at risk for respiratory symptoms and asthma. Further, low socioeconomic status is associated with respiratory vi symptoms and asthma. It seems as these associations relies more on low income than low educational level. Low educational level as well as low income are furthermore related to known behavioural risk factors for respiratory symptoms and asthma such as obesity, smoking and, also potentially modifiable risk factors as occupational exposure to gas dust or fumes. Having a persisting asthma since childhood is associated with lower educational level as a young adult. This may, in turn, be related with behavioural risk factors as discussed above and, there were no indications that those with child or adolescent asthma refrained from smoking at age 19. Neither did they in young adulthood avoid occupations with known or expected exposure to gas, dust or fumes, such as manufacturing, construction and transportation work. To conclude, our results indicate a vicious circle with regard to the relationship between the studied social determinants of health and asthma and respiratory symptoms.
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