| 1. |
- Berg, Vivian, et al.
(författare)
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Pre- and post-diagnostic blood profiles of chlorinated persistent organic pollutants and metabolic markers in type 2 diabetes mellitus cases and controls : a pilot study
- 2021
-
Ingår i: Environmental Research. - : Elsevier. - 0013-9351 .- 1096-0953. ; 195
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Several risk factors for type 2 diabetes mellitus (T2DM) are also associated with blood concentrations of persistent organic pollutants (POPs), and factors related to the disease may affect POP concentrations, and subsequent associations between POPs and T2DM. The purpose of this pilot study was to investigate the change in concentrations of lipids, hormones and POPs pre- and post-diagnosis in T2DM cases compared to healthy controls and their associations with T2DM.Methods: We measured POPs, lipids, and thyroid and steroid hormones in plasma from 44 female cases collected prior to (pre-diagnostic) and following (post-diagnostic) T2DM diagnosis, and in 44 healthy female age-matched controls. We compared cross-sectional differences and longitudinal changes within and between matched cases and controls with t-tests and multivariable linear regression models. Associations between POP concentrations and T2DM were investigated using conditional logistic regression.Results: Between the pre- and post-diagnostic measurement, cases developed more favorable lipid profiles and the longitudinal changes in lipid-normalized concentrations of non-dioxin-like polychlorinated biphenyls (PCBs), dioxin-like PCBs, beta-hexachlorocyclohexane (HCH), HCB, and 1,1,1-trichloro-2,2-bis(4-chlorophenyl) ethane (p,p'-DDE) differed significantly between cases and controls. The longitudinal changes in POPs were mainly driven by changes in bodyweight, total lipids and T2DM status. Cases had significantly higher pre-diagnostic concentrations of POPs and triglycerides, and lower concentrations of high-density lipoprotein cholesterol and free thyroxin than controls. Pre-diagnostic POP concentrations were not significantly associated with incident T2DM, whereas several post-diagnostic POP concentrations were significantly positively associated with prevalent T2DM.Conclusions: This pilot study suggests that factors related to T2DM affect blood concentrations of POPs and may partly explain the positive associations between POPs and T2DM.
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| 2. |
- Björ, Bodil, et al.
(författare)
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Hälsorelaterad miljöövervakning. : Cancerframkallande ämnen i tätortsluft i Umeå 2021
- 2021
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Undersökningen kartlägger allmänbefolkningens exponering via luften för vissa cancerframkallande ämnen (bensen, 1,3-butadien, formaldehyd) och kvävedioxid. Undersökningen genomfördes i centrala Umeå under hösten 2021, och inkluderade totalt 40 slumpvis utvalda personer i åldrarna 20-60 år.Mätningarna upprepades på 20 personer. Utöver de personburna mätningarna genomfördes även stationära mätningar på två platser utomhus. Svarsfrekvensen var 61% och medelåldern var 41 år. Medianhalten för personburna mätningar av bensen och 1,3-butadien var 0,57 µg/m3respektive 0,03µg/m3 vilket är lägre än tidigare mätomgångar i Umeå. Motsvarande medianhalt för formaldehyd var 8,3µg/m3, där halterna var högre bland de som bodde i radhus eller villa jämfört med lägenhet. Medianhalten för de personburna mätningarna av kvävedioxid var 7,6 µg/m3, vilket var i samma storleksordning uppmätt i Umeå 2001, men lägre än övriga mättillfällen. Ingen signifikant skillnad i halter för något av ämnena kunde påvisas mellan män och kvinnor.De stationära mätningarna genomfördes som veckomätningar vid kommunens urbana bakgrundsstationsamt vid en gatustation. Medianhalt av bensen, 1,3-butadien, formaldehyd samt kvävedioxid vid respektive mätstation var samtliga lägre jämfört med tidigare år
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| 3. |
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| 4. |
- Bäcklund, Nils, 1987-, et al.
(författare)
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Salivary cortisol and cortisone can circumvent confounding effects of oral contraceptives in the short synacthen test
- 2024
-
Ingår i: Journal of Clinical Endocrinology and Metabolism. - : Oxford University Press. - 0021-972X .- 1945-7197. ; 109:7, s. 1899-1906
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Tidskriftsartikel (refereegranskat)abstract
- Context: Adrenal insufficiency (AI) is usually diagnosed by low plasma cortisol levels following a short Synacthen test (SST). Most plasma cortisol is bound to corticosteroid-binding globulin, which is increased by estrogen in combined estrogen-progestin oral contraceptives (COCs). Women with AI using COCs are therefore at risk of having an apparently normal plasma cortisol level during SST, which would not adequately reflect AI.Objective: To test whether salivary cortisol or cortisone during SST is more robust against the COC effect and to calculate the lower reference limits (LRLs) for these to be used as tentative diagnostic cutoffs to exclude AI.Methods: Forty-one healthy women on COCs and 46 healthy women without exogenous estrogens performed an SST with collection of plasma and salivary samples at 0, 30, and 60 min after Synacthen injection. The groups were compared using regression analysis with age as covariate and the LRLs were calculated parametrically.Results: SST-stimulated plasma cortisol levels were significantly higher in the COC group versus controls, while mean salivary cortisol and cortisone levels were slightly lower in the COC group. Importantly, COC use did not significantly alter LRLs for salivary cortisol or cortisone. The smallest LRL difference between groups was seen for salivary cortisone.Conclusion: Salivary cortisol and especially salivary cortisone are considerably less affected by COC use than plasma cortisol during SST. Due to similar LRLs, a common cutoff for salivary cortisol and cortisone during SST can be used to exclude AI in premenopausal women irrespective of COC use.
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| 5. |
- Donat-Vargas, Carolina, et al.
(författare)
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Associations between repeated measure of plasma perfluoroalkyl substances and cardiometabolic risk factors
- 2019
-
Ingår i: Environment International. - : Elsevier. - 0160-4120 .- 1873-6750. ; 124, s. 58-65
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Tidskriftsartikel (refereegranskat)abstract
- Background: Perfluoroalkyl substances (PFAS) are persistent synthetic chemicals that may affect components of metabolic risk through the peroxisome proliferator-activated receptor but epidemiological data remain scarce and inconsistent.Objective: To estimate associations between repeated measurements of the main PFAS in plasma and total cholesterol, triglycerides and hypertension among the control subjects from a population-based nested case-control study on diabetes type 2 in middle-aged women and men.Methods: Participants (n = 187) were free of diabetes at both baseline and follow-up visits to the Västerbotten Intervention Programme, 10 years apart: during 1990 to 2003 (baseline) and 2001 to 2013 (follow-up). Participants left blood samples, completed questionnaires on diet and lifestyle factors, and underwent medical examinations, including measurement of blood pressure. PFAS and lipids were later determined in stored plasma samples. Associations for the repeated measurements were assessed using generalized estimating equations.Results: Six PFAS exceeded the limit of quantitation. Repeated measures of PFAS in plasma, cardiometabolic risk factors and confounders, showed an average decrease of triglycerides from −0.16 mmol/l (95% confidence interval [CI]: −0.33, 0.02 for PFOA) to −0.26 mmol/l (95% CI: −0.50, −0.08 for PFOS), when comparing the highest tertile of PFAS plasma levels with the lowest. Associations based on average PFAS measurements and follow-up triglycerides revealed similar inverse associations, although attenuated. The estimates for cholesterol and hypertension were inconsistent and with few exception non-significant.Conclusions: This study found inverse associations between PFAS and triglycerides, but did not support any clear link with either cholesterol or hypertension.
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| 6. |
- Donat-Vargas, Carolina, et al.
(författare)
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Perfluoroalkyl substances and risk of type II diabetes : A prospective nested case-control study
- 2019
-
Ingår i: Environment International. - : Elsevier. - 0160-4120 .- 1873-6750. ; 123, s. 390-398
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Perfluoroalkyl substances (PFAS) have drawn much attention due to bioaccumulation potential and their current omnipresence in human blood. We assessed whether plasma PFAS, suspected to induce endocrine-disrupting effects, were prospectively associated with clinical type 2 diabetes (T2D) risk.Methods: We established a nested case-control study within the Swedish prospective population-based Västerbotten Intervention Programme cohort. Several PFAS were measured in plasma from a subset of 124 case-control pairs at baseline (during 1990–2003) and at 10-year follow-up. T2D cases were matched (1:1) according to gender, age and sample date with participants without T2D (controls).Conditional logistic regressions were used to prospectively assess risk of T2D by baseline PFAS plasma concentrations. Associations between long-term PFAS plasma levels (mean of baseline and follow-up) and insulin resistance (HOMA2-IR) and beta-cell function (HOMA2-B%) at follow-up were prospectively explored among 178 and 181 controls, respectively, by multivariable linear regressions.Results: After adjusting for gender, age, sample year, diet and body mass index, the odds ratio of T2D for the sum of PFAS (Σ z-score PFAS) was 0.52 (95% confidence interval, CI: 0.20, 1.36), comparing third with first tertile; and 0.92 (95% CI: 0.84, 1.00) per one standard deviation increment of sum of log-transformed PFAS. Among the controls, the adjusted β of HOMA2-IR and HOMA-B% for the sum of PFAS were −0.26 (95% CI: −0.52, −0.01) and −9.61 (95% CI: −22.60, 3.39) respectively comparing third with first tertile.Conclusions: This prospective nested case-control study yielded overall inverse associations between individual PFAS and risk of T2D, although mostly non-significant. Among participants without T2D, long-term PFAS exposure was prospectively associated with lower insulin resistance.
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| 7. |
- Donat-Vargas, Carolina, et al.
(författare)
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Persistent Organochlorine Pollutants in Plasma, Blood Pressure, and Hypertension in a Longitudinal Study
- 2018
-
Ingår i: Hypertension. - 0194-911X .- 1524-4563. ; 71:6, s. 1258-1268
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Tidskriftsartikel (refereegranskat)abstract
- Persistent organochlorine pollutants (POPs) have shown to be involved in the atherosclerotic process and to cause endothelial cell dysfunction. To assess longitudinally whether plasma concentrations of different POPs were associated with blood pressure and risk of hypertension in middle-aged women and men. Study subjects were 850 participants in the VIP (Västerbotten Intervention Programme) with 2 blood samples and blood pressure measurements, 10 years apart, during 1990 to 2003 (baseline) and during 2000 to 2013 (follow-up). Dioxin-like and nondioxin-like polychlorinated biphenyls (DL-PCBs, NDL-PCBs) and p,p'-dichlorodiphenyldichloroethylene (DDE) were measured. Associations were assessed using generalized estimating equations. At baseline sampling 49% and at follow-up 64% had hypertension. DL-PCBs and DDE, but not NDL-PCBs or hexachlorobenzene, were associated with hypertension. Only the association for DL-PCBs remained statistically significant after lipid-standardization and adjustment for body mass index and total serum lipids. The multivariable-adjusted odds ratio of hypertension based on repeated measurements were 1.52 (95% confidence interval, 1.08-2.13) for DL-PCBs (third versus first tertile of lipid-standardized POPs). In stratified adjusted analyses, odds ratio for those born after 1950 increased to 3.99 (95% confidence interval, 2.15-7.43), whereas no association was observed among those born earlier. Based on repeated measurements, the accumulated exposure to DL-PCBs and DDE, although less clear for the latter, may disrupt the normal blood pressure levels and increase the odds of hypertension. Moreover, individuals experiencing early-life POP exposure may be at elevated risk of vascular POP effects.
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| 8. |
- Forsberg, Bertil, professor, 1956-, et al.
(författare)
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Coronanedstängningens betydelse för luftföroreningshalter, beräknade hälsokonsekvenser och registrerade uttag av astmaläkemedel i Stockholmsområdet
- 2022
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Nedstängningen av samhällen på grund av pandemin våren 2020 skedde tämligen globalt, varför åtföljande förändringar av utsläpp både lokalt och på långt avstånd kan ha påverkat luftkvaliteten i Stockholm. Denna rapport redovisar tre delstudier: en analys av hur föroreningshalterna i Stockholmsområdet påverkades av den inledande nedstängningen av samhället, en hälsokonsekvensberäkning av vilka hälsoeffekter en sådan förändring av halterna antas medföra, samt en epidemiologisk tidsseriestudie av sambanden mellan registrerat dagligt antal utköp av astmamediciner och halter av luftföroreningar under den inledande nedstängningen och före/efter denna period.Vi har i detta projekt använt två metoder, spridningsmodellering med emissionsdata respektive regressionsanalys med mätdata, för att beräkna hur främst kväveoxidhalterna påverkades av minskade emissioner lokalt, samt hur bl.a halterna av kvävedioxid och ozon i staden avvek ifrån förväntade värden efter hänsyn till meteorologins inverkan på halterna.Spridningsberäkningarna visade att halterna av kvävedioxid minskade med 0,7 μg/m3 under mars-juli till följd av minskad lokal trafik. Utifrån sammanvägningar av publicerade epidemiologiska samband skulle detta leda till cirka 2 dödsfall färre i 9 kommuner med totalt drygt 1,5 miljoner invånare, medan besök och inläggningar på sjukhus för andningsorganen förväntas minska med drygt 24 fall genom minskade lokala utsläpp.Den väderjusterade minskningen av totala NO2 halterna var 2,8 μg/m3, vilket skulle förväntas leda till ungefär 97 färre besök och inläggningar på sjukhus för andningsorganen under samma 5 månader. Men eftersom minskade utsläpp av kväveoxider även följdes av en oväntat stor väderjusterad ökning av marknära ozon förväntas för vissa hälsoutfall en nettoökning av antalet fall, exempelvis av patienter med problem i andningsorganen.Eftersom utköp av förskrivna läkemedel inte kräver att man besöker sjukvården, inte ens att man besöker ett apotek, studerades dagligt antal utköp av astmaläkemedel i relation till variationer i luftföroreningshalterna. Trots en inledande hamstringsvåg med efterföljande svacka i utköp under maj och lägre uppmätta halter av kväveoxider (NOx) och partiklar <10 mikrometer (PM10) än normalt, fanns sammantaget även under april-juli 2020 en statistiskt säkerställd effekt av PM10 och NOx på dagligt antal utköp. När relativa riskökningen per 10 μg/m3 jämförs mellan denna nedstängningsperiod och övrig studieperiod kan konstateras att ökningen av utköp per haltökning var högre under april-juli 2020. För hela perioden 2018 - 2021 visade en meta-skattning över 21 kommuner i Stockholms län på 2,6 procent ökning i uttag av lång- och korttidsverkande astmaläkemedel per 10 μg/m3 ökning av PM10 (medelvärde för samma dygn och det föregående).
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| 9. |
- Hagenbjörk-Gustafsson, Annika, et al.
(författare)
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Determinants of personal exposure to some carcinogenic substances and nitrogen dioxide among the general population in five Swedish cities
- 2014
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Ingår i: Journal of Exposure Science and Environmental Epidemiology. - : Springer Science and Business Media LLC. - 1559-0631 .- 1559-064X. ; 24:4, s. 437-443
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Tidskriftsartikel (refereegranskat)abstract
- Environmental levels of airborne carcinogenic and related substances are comparatively better known than individual exposure and its determinants. We report on a personal monitoring program involving five Swedish urban populations. The aim of the program was to investigate personal exposure to benzene, 1,3-butadiene, formaldehyde, and nitrogen dioxide (NO2). The measurements were performed among 40 inhabitants during seven consecutive days, in one urban area each year, during 2000-2008. The estimated population exposure levels were 1.95 mu g/m(3) for benzene, 0.56 mu g/m(3) for 1,3-butadiene, 19.4 mu g/m(3) for formaldehyde, and 14.1,mu g/m(3) for NO2. Statistical analysis using a mixed-effects model revealed that time spent in traffic and time outdoors contributed to benzene and 1,3- butadiene exposure. For benzene, refueling a car was an additional determinant influencing the exposure level. Smoking or environmental tobacco smoke were significant determinants of exposure to NO2, benzene, and 1, 3-butadiene. Those with a gas stove had higher NO2 exposure. Living in a single-family house increased the exposure to formaldehyde significantly. In a variance component model, the between-subject variance dominated for 1,3-butadiene and formaldehyde, whereas the between-city variance dominated for NO2. For benzene, the between-subject and between-cities variances were similar.
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| 10. |
- Hagenbjörk-Gustafsson, Annika, et al.
(författare)
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Field validation of the Ogawa diffusive sampler for NO(2) and NO(x) in a cold climate
- 2010
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Ingår i: Journal of Environmental Monitoring. - : Royal Society of Chemistry. - 1464-0325 .- 1464-0333. ; 12:6, s. 1315-24
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Tidskriftsartikel (refereegranskat)abstract
- A small-scale field trial in Umeå, Sweden with Ogawa samplers and a chemiluminescence instrument indicated that the NO(2) concentration was underestimated with respect to the reference monitor, if calculated according to the manufacturer's Ogawa sampling protocol. By co-locating Ogawa samplers and reference monitors at six sites in two Swedish cities, uptake rates were determined for NO(2) and NO(x) better applicable to the Swedish conditions and climate. The concentrations of NO(2) and NO(x) calculated according to the instruction manual of the sampler and using the field-determined uptake rates were compared with values derived from chemiluminescence monitors for each week over which samples were taken. When calculated according to the manufacturer's suggested protocol, the Ogawa sampler underestimated the NO(2) concentrations by 9.1% on average for all samples (N = 53), with respect to the reference monitor. In contrast, NO(x) concentrations were overestimated by a mean value of 15% for all samples (N = 45). By using the field determined uptake rates for the calculation of NO(2) and NO(x) a better estimation of the concentrations was obtained. The ratio between concentrations determined with the Ogawa samplers and chemiluminescence monitors was then 1.02 for all measurements of NO(2) and 1.00 for NO(x). Precision, expressed as the mean coefficient of variation, was 6.4% for six, 6-replicate measurements of NO(2) and 3.7% for five, 6-replicate measurements of NO(x).
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| 11. |
- Meister, Kadri, et al.
(författare)
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Sambandet mellan luftföroreningshalter och akuta vårdkontakter för luftvägssjukdomar som hälsoindikator för luftkvalitet
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna studie inom den hälsorelaterade miljöövervakningen har genomförts på uppdrag av Naturvårdsverket för att belysa eventuella korttidseffekter av luftföroreningar på akutbesök för astma samt för alla sjukdomar iandningsorganen. Dessa sjukdomar medför ofta ökad känslighet för luftföroreningar. Halternas samband med akutbesök för andningsorganens sjukdomar har tidigare studerats inom miljöövervakningen. För att underlätta jämförelser har metodiken anpassats till tidigare studier där betydelsen av halterna de två senaste dygnen beräknas. Övervakning av denna typ av korttidssamband med halter i miljön är mindre känslig för trender och förändringar i diagnostik och vårdresurser än enklare epidemiologisk bevakning av antalet fall per år etc., eftersom totala antalet fall i sig kan påverkas av en rad olika typer av faktorer utan koppling till luftföroreningssituationen.Uppgifter om den skrivna befolkningens akutbesök (vid akutmottagning samt akuta (inte planerade) inläggningar) under åren 2005 till och med 2013 för andningsorganens sjukdomar inklusive astma vid akutsjukhusen i StorStockholm, Göteborg/Mölndal respektive Malmö/Burlöv har inhämtats från Socialstyrelsens Patientregister. Uppgifterna från registret avser avidentifierade akutbesök med diagnoser dygn för dygn under perioden.Luftföroreningsdata i form av urbana bakgrundshalter har hämtats från Stockholm luft- och bulleranalys (SLB) vid miljöförvaltningen i Stockholm och från IVL Svenska miljöinstitutet data för Göteborg respektive Malmö. Vi har studerat effekterna av partikelhalten (PM10 ~ partiklar mindre än 10 mikrometer i diameter), avgashalten indikerad med kväveoxider (NOx) samt ozon. Analyser har gjorts av akutbesök totalt för alla åldrar samt i olika åldergrupper: barn, vuxna och äldre.Tidsserieanalyserna har utförts med Poisson-regression. I dessa analyser tas hänsyn till tidstrender, årstidsmönster, influensaperioder, väderförhållanden, pollenhalt, veckodag, helgperioder mm. De inkluderade luftföroreningarna är ozon, kvävedioxid och partiklar (PM10). Alla luftföroreningsvariabler kan ses som indikatorer på olika typer av luftföroreningar, och har simultant beaktats i de slutliga analyserna.I alla tre städer hade ozon effekten på akutbesök för andningsorganens sjukdomar totalt och för astma totalt. Effekten av ozon på akutbesök för andningsorganen samt på astma finns även för barn respektive vuxna separat i Stockholm och Göteborg.Effekter av ozon kan ses som inte skiljande sig mellan de tre olika studieområdena och därför har även en sammanvägd skattning för ozon beräknats gällande antalet akutbesök för andningsorganen totalt, akutbesök för astma totalt samt akutbesök för astma bland barn. När resultaten vägdes ihop för de tre studieområdena beräknas att antalet akutbesök för andningsorganen totalt ökar med 1,6% (95% KI=1,1-2%) per 10 g/m3 haltökning av ozon, akutbesök för astma totalt med 2,5% (95% KI=1,5-3,6% ) per 10 g/m3 haltökning, medan akutbesök för astma bland barn med 3,9% (95% KI=1,7- 4%) per 10 g/m3 haltökning av ozon.Eftersom föroreningssituationen som indikatorerna representerar kan förändras med tiden har analyserna gjorts även för två olika tidsperioder: 2005-2008 samt 2009-2013. Analysen för Malmö visade på vissa statistiskt säkerställda skillnader. Effekten av ozon på akutbesök för andningsorganen totalt var högre under den senare tidsperioden, 2009-2013. Denna trend finns även för barn respektive vuxna separat.Att analysera variationen i telefonsamtal till 1177-Vårdguiden har tidigare visat sig vara en fördelaktig metod vid studier gällande magsjuka och den mest lämpliga metoden för att tidigt detektera utbrott av magsjuka. Till följd av detta var det angeläget att undersöka om denna relativt nya databas innehållande 1177-samtal även kan vara lämplig att använda i studier som avser akuta hälsoproblem av sjukdomar i andningsorganen som kan påverkas av luftföroreningshalterna.Som tillägg har en pilotstudie gjorts i Göteborg, där uppgifter om dygnsvisa antal samtal medkontaktorsakerna andningsproblem respektive hosta från 1177-Vårdguiden under perioden 2007-11-30 - 2013-12-01 har använts för att jämföra sambanden till luftföroreningshalter. Även här är antalsuppgifter uppdelade i olika åldersgrupper. I likhet med besöksdata påvisades effekter av luftföroreningar där ökning av PM10-halten ökade antalet samtal gällande andningsbesvär och hosta bland barn. Samtal gällande andningsbesvär hos vuxna ökade med ökande halter av ozon. Studien visar att denna typ av data kananvändas för att övervaka luftföroreningsexponeringens effekter.
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| 12. |
- Olstrup, Henrik, et al.
(författare)
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A Multi-Pollutant Air Quality Health Index (AQHI) Based on Short-Term Respiratory Effects in Stockholm, Sweden
- 2019
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- In this study, an Air Quality Health Index (AQHI) for Stockholm is introduced as a tool to capture the combined effects associated with multi-pollutant exposure. Public information regarding the expected health risks associated with current or forecasted concentrations of pollutants and pollen can be very useful for sensitive persons when planning their outdoor activities. For interventions, it can also be important to know the contribution from pollen and the specific air pollutants, judged to cause the risk. The AQHI is based on an epidemiological analysis of asthma emergency department visits (AEDV) and urban background concentrations of NOx, O-3, PM10 and birch pollen in Stockholm during 2001-2005. This analysis showed per 10 mu gm(-3) increase in the mean of same day and yesterday an increase in AEDV of 0.5% (95% CI: -1.2-2.2), 0.3% (95% CI: -1.4-2.0) and 2.5% (95% CI: 0.3-4.8) for NOx, O-3 and PM10, respectively. For birch pollen, the AEDV increased with 0.26% (95% CI: 0.18-0.34) for 10 pollen grainsm(-3). In comparison with the coefficients in a meta-analysis, the mean values of the coefficients obtained in Stockholm are smaller. The mean value of the risk increase associated with PM10 is somewhat smaller than the mean value of the meta-coefficient, while for O-3, it is less than one fifth of the meta-coefficient. We have not found any meta-coefficient using NOx as an indicator of AEDV, but compared to the mean value associated with NO2, our value of NOx is less than half as large. The AQHI is expressed as the predicted percentage increase in AEDV without any threshold level. When comparing the relative contribution of each pollutant to the total AQHI, based on monthly averages concentrations during the period 2015-2017, there is a tangible pattern. The AQHI increase associated with NOx exhibits a relatively even distribution throughout the year, but with a clear decrease during the summer months due to less traffic. O-3 contributes to an increase in AQHI during the spring. For PM10, there is a significant increase during early spring associated with increased suspension of road dust. For birch pollen, there is a remarkable peak during the late spring and early summer during the flowering period. Based on monthly averages, the total AQHI during 2015-2017 varies between 4 and 9%, but with a peak value of almost 16% during the birch pollen season in the spring 2016. Based on daily mean values, the most important risk contribution during the study period is from PM10 with 3.1%, followed by O-3 with 2.0%.
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| 13. |
- Oudin Åström, Daniel, et al.
(författare)
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Evolution of Minimum Mortality Temperature in Stockholm, Sweden, 1901-2009
- 2016
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Ingår i: Journal of Environmental Health Perspectives. - : Environmental Health Perspectives. - 0091-6765 .- 1552-9924. ; 124:6, s. 740-744
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The mortality impacts of hot and cold temperatures have been thoroughly documented, with most locations reporting a U-shaped relationship with a minimum mortality temperature (MMT) at which mortality is lowest. How MMT may have evolved over past decades as global mean surface temperature increased has not been thoroughly explored.OBJECTIVE: We used observations of daily mean temperatures to investigate whether MMT changed in Stockholm, Sweden, from the beginning of the 20th century until 2009.METHODS: Daily mortality and temperature data for the period 1901-2009 in Stockholm, Sweden were used to model the temperature-mortality relationship. We estimated MMT using distributed lag non-linear Poisson regression models considering lags up to 21 days of daily mean temperature as the exposure variable. To avoid large influences on the MMT from intra and inter annual climatic variability, we estimated MMT based on 30-year periods. Further, we investigated whether there were trends in the absolute value of the MMT and the relative value of the MMT (the corresponding percentile of the same day temperature distribution) over the study period.RESULTS: Our findings suggest that both the absolute MMT and the relative MMT increased in Stockholm, Sweden over the course of the last century.CONCLUSIONS: The increase in MMT over the course of the last century suggests autonomous adaptation within the context of the large epidemiological, demographical and societal changes that occurred. Whether the rate of increase will be sustained with climate change is an open question.
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| 14. |
- Rolandsson, Olov, et al.
(författare)
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Acute Hyperglycemia Induced by Hyperglycemic Clamp Affects Plasma Amyloid-β in Type 2 Diabetes.
- 2024
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Ingår i: Journal of Alzheimer's disease : JAD. - 1875-8908.
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Tidskriftsartikel (refereegranskat)abstract
- Individuals with type 2 diabetes (T2D) have an increased risk of cognitive symptoms and Alzheimer's disease (AD). Mis-metabolism with aggregation of amyloid-β peptides (Aβ) play a key role in AD pathophysiology. Therefore, human studies on Aβ metabolism and T2D are warranted.The objective of this study was to examine whether acute hyperglycemia affects plasma Aβ 1-40 and Aβ 1-42 concentrations in individuals with T2D and matched controls.Ten participants with T2D and 11 controls (median age, 69 years; range, 66-72 years) underwent hyperglycemic clamp and placebo clamp (saline infusion) in a randomized order, each lasting 4 hours. Aβ 1-40, Aβ 1-42, and insulin-degrading enzyme (IDE) plasma concentrations were measured in blood samples taken at 0 and 4hours of each clamp. Linear mixed-effect regression models were used to evaluate the 4-hour changes in Aβ 1-40 and Aβ 1-42 concentrations, adjusting for body mass index, estimated glomerular filtration rate, and 4-hour change in insulin concentration.At baseline, Aβ 1-40 and Aβ 1-42 concentrations did not differ between the two groups. During the hyperglycemic clamp, Aβ decreased in the control group, compared to the placebo clamp (Aβ 1-40: p=0.034, Aβ 1-42: p=0.020), IDE increased (p=0.016) during the hyperglycemic clamp, whereas no significant changes in either Aβ or IDE was noted in the T2D group.Clamp-induced hyperglycemia was associated with increased IDE levels and enhanced Aβ 40 and Aβ 42 clearance in controls, but not in individuals with T2D. We hypothesize that insulin-degrading enzyme was inhibited during hyperglycemic conditions in people with T2D.
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| 15. |
- Rolandsson, Olov, et al.
(författare)
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Acute hyperglycemia induced by hyperglycemic clamp affects plasma Amyloid-β in type 2 diabetes
- 2024
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Ingår i: Journal of Alzheimer's Disease. - : IOS Press. - 1387-2877 .- 1875-8908. ; 99:3, s. 1033-1046
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Tidskriftsartikel (refereegranskat)abstract
- Background: Individuals with type 2 diabetes (T2D) have an increased risk of cognitive symptoms and Alzheimer's disease (AD). Mis-metabolism with aggregation of amyloid-β peptides (Aβ) play a key role in AD pathophysiology. Therefore, human studies on Aβ metabolism and T2D are warranted.Objective: The objective of this study was to examine whether acute hyperglycemia affects plasma Aβ1-40 and Aβ1-42 concentrations in individuals with T2D and matched controls.Methods: Ten participants with T2D and 11 controls (median age, 69 years; range, 66-72 years) underwent hyperglycemic clamp and placebo clamp (saline infusion) in a randomized order, each lasting 4 hours. Aβ1-40, Aβ1-42, and insulin-degrading enzyme (IDE) plasma concentrations were measured in blood samples taken at 0 and 4 hours of each clamp. Linear mixed-effect regression models were used to evaluate the 4-hour changes in Aβ1-40 and Aβ1-42 concentrations, adjusting for body mass index, estimated glomerular filtration rate, and 4-hour change in insulin concentration.Results: At baseline, Aβ1-40 and Aβ1-42 concentrations did not differ between the two groups. During the hyperglycemic clamp, Aβ decreased in the control group, compared to the placebo clamp (Aβ1-40: p = 0.034, Aβ1-42: p = 0.020), IDE increased (p = 0.016) during the hyperglycemic clamp, whereas no significant changes in either Aβ or IDE was noted in the T2D group.Conclusions: Clamp-induced hyperglycemia was associated with increased IDE levels and enhanced Aβ40 and Aβ42 clearance in controls, but not in individuals with T2D. We hypothesize that insulin-degrading enzyme was inhibited during hyperglycemic conditions in people with T2D.
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| 16. |
- Schillemans, Tessa, et al.
(författare)
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Plasma metabolites associated with exposure to perfluoroalkyl substances and risk of type 2 diabetes – A nested case-control study
- 2021
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Ingår i: Environment International. - : Elsevier BV. - 0160-4120 .- 1873-6750. ; 146
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Tidskriftsartikel (refereegranskat)abstract
- Perfluoroalkyl substances (PFAS) are widespread persistent environmental pollutants. There is evidence that PFAS induce metabolic perturbations in humans, but underlying mechanisms are still unknown. In this exploratory study, we investigated PFAS-related plasma metabolites for their associations with type 2 diabetes (T2D) to gain potential mechanistic insight in these perturbations. We used untargeted LC-MS metabolomics to find metabolites related to PFAS exposures in a case-control study on T2D (n = 187 matched pairs) nested within the Västerbotten Intervention Programme cohort. Following principal component analysis (PCA), six PFAS measured in plasma appeared in two groups: 1) perfluorononanoic acid, perfluorodecanoic acid and perfluoroundecanoic acid and 2) perfluorohexane sulfonic acid, perfluorooctane sulfonic acid and perfluorooctanoic acid. Using a random forest algorithm, we discovered metabolite features associated with individual PFAS and PFAS exposure groups which were subsequently investigated for associations with risk of T2D. PFAS levels correlated with 171 metabolite features (0.16 ≤ |r| ≤ 0.37, false discovery rate (FDR) adjusted p < 0.05). Out of these, 35 associated with T2D (p < 0.05), with 7 remaining after multiple testing adjustment (FDR < 0.05). PCA of the 35 PFAS- and T2D-related metabolite features revealed two patterns, dominated by glycerophospholipids and diacylglycerols, with opposite T2D associations. The glycerophospholipids correlated positively with PFAS and associated inversely with risk for T2D (Odds Ratio (OR) per 1 standard deviation (1-SD) increase in metabolite PCA pattern score = 0.2; 95% Confidence Interval (CI) = 0.1–0.4). The diacylglycerols also correlated positively with PFAS, but they associated with increased risk for T2D (OR per 1-SD = 1.9; 95% CI = 1.3–2.7). These results suggest that PFAS associate with two groups of lipid species with opposite relations to T2D risk.
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| 17. |
- Stoltz Sjöström, Elisabeth, 1967-, et al.
(författare)
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Intake and macronutrient content in human milk given to extremely preterm infants
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Human milk (HM) is the preferred basis of nutrition for infants, including those born prematurely. Information on macronutrient content in HM is necessary to optimize nutritional support of preterm infants.Objectives: To describe the types and amounts of enteral feeds given to Swedish extremely preterm infants during hospitalization and to investigate the energy and macronutrient content in HM given to these infants.Methods: A population-based study of Swedish extremely preterm infants (n=586) born before 27 gestational weeks. Data on ingested volumes of different milks during hospitalization and analyses of macronutrient content in HM samples were obtained from hospital records. Nutritional content of HM was determined by mid-infrared spectrophotometry analysis.Results: During the first four weeks of life, 99% of the infants were exclusively fed HM and at four weeks of life, 70% of the infants received only mother’s own milk (MOM). Nutritional content in 821 MOM samples were analyzed. Protein content in MOM decreased significantly from 2.2g to 1.2g/100 mL during the first 112 postpartum days, while fat and energy content were highly variable within and between MOM samples. Additionally, 354 samples of donor milk were analyzed. Content of protein, fat and energy in pooled donor milk (n=129) were lower compared to single donor milk.Conclusions: Swedish extremely preterm infants receive MOM to a large extent during hospitalization. Protein, carbohydrates and energy in MOM changed significantly with time. Weekly analyses of MOM during the first month of lactation would allow a more individualized nutritional support to these vulnerable infants.
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| 18. |
- Stoltz Sjöström, Elisabeth, et al.
(författare)
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Intake and macronutrient content of human milk given to extremely preterm infants
- 2014
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Ingår i: Journal of Human Lactation. - : SAGE Publications. - 0890-3344 .- 1552-5732. ; 30:4, s. 442-449
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Tidskriftsartikel (refereegranskat)abstract
- Background: Human milk (HM) is the preferred basis of nutrition for infants, including those born prematurely. Information on HM macronutrient content is necessary to optimize nutritional support of preterm infants. Objectives: This study aimed to describe the types and amounts of enteral feeds given to Swedish extremely preterm infants during hospitalization and to investigate the energy and macronutrient contents in HM given to these infants. Methods: A population-based study of Swedish extremely preterm infants (n = 586) born before 27 gestational weeks was conducted. Data on ingested volumes of different milk during hospitalization and analyses of macronutrient content in HM samples were obtained from hospital records. Nutritional content of HM was determined by mid-infrared spectrophotometry analysis. Results: During the first 4 weeks of life, 99% of the infants were exclusively fed HM, and at 4 weeks of life, 70% of the infants received only mother’s own milk (MOM). Nutritional content in 821 MOM samples was analyzed. Protein content in MOM decreased significantly from 2.2 to 1.2 g/100 mL during the first 112 postpartum days, whereas fat and energy content were highly variable within and between MOM samples. In addition, 354 samples of donor milk were analyzed. Content of protein, fat, and energy in pooled donor milk (n = 129) was lower compared to single donor milk. Conclusion: Swedish extremely preterm infants receive MOM to a large extent during hospitalization. Protein, carbohydrates, and energy in MOM changed significantly with time. Weekly analyses of MOM during the first month of lactation would allow more individualized nutritional support for these vulnerable infants.
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| 19. |
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| 20. |
- Tornevi, Andreas, et al.
(författare)
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Association between precipitation upstream of a drinking water utility and nurse advice calls relating to acute gastrointestinal illnesses
- 2013
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:7
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Tidskriftsartikel (refereegranskat)abstract
- Background: The River Göta Älv is a source of fresh-water for the City of Gothenburg (Sweden). We recently identified a clear association between upstream precipitation and indicator bacteria concentrations in the river water outside the intake to the drinking water utility. This study aimed to determine if variation in the incidence of acute gastrointestinal illnesses is associated with upstream precipitation. Methods: We acquired data, covering 1494 days, on the daily number of telephone calls to the nurse advice line from citizens in Gothenburg living in areas with Göta Älv as a fresh-water supply. We separated calls relating to gastrointestinal illnesses from other medical concerns, and analyzed their association with precipitation using a distributed lag non-linear Poisson regression model, adjusting for seasonal patterns and covariates. We used a 0–21-day lag period for precipitation to account for drinking water delivery times and incubation periods of waterborne pathogens. Results: The study period contained 25,659 nurse advice calls relating to gastrointestinal illnesses. Heavy rainfall was associated with increased calls the same day and around 5–6 days later. Consecutive days of wet weather were also found to be associated with an increase in the daily number of gastrointestinal concerns. No associations were identified between precipitation and nurse advice calls relating to other medical concerns. Conclusion: An increase in nurse advice calls relating to gastrointestinal illnesses around 5–6 days after heavy rainfall is consistent with a hypothesis that the cause could be related to drinking water due to insufficient barriers in the drinking water production, suggesting the need for improved drinking water treatment.
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| 21. |
- Tornevi, Andreas, et al.
(författare)
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Chlorinated persistent organic pollutants and type 2 diabetes - A population-based study with pre- and post- diagnostic plasma samples
- 2019
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Ingår i: Environmental Research. - : Elsevier. - 0013-9351 .- 1096-0953. ; 174, s. 35-45
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Persistent organic pollutants (POPs) have been associated with type 2 diabetes (T2D), but causality is uncertain.OBJECTIVE: Within longitudinal population-based data from northern Sweden, we assessed how POPs associated with T2D prospectively and cross-sectionally, and further investigated factors related to individual changes in POP concentrations.METHODS: For 129 case-controls pairs matched by age, sex and date of sampling, plasma concentrations of hexachlorobenzene (HCB), dichlorodiphenyl-dichloroethylene (p,p'-DDE), dioxin-like (DL) polychlorinated biphenyl congeners (PCB-118 and PCB-156), and non-dioxin like (NDL-PCB: PCB-74, -99, -138 -153, -170, -180, -183 and PCB-187) were analyzed twice (baseline and follow-up, 9-20 years apart). The cases received their T2D diagnose between baseline and follow-up. Prospective (using baseline data) and cross-sectional (using follow-up data) odds ratios (ORs) for T2D on lipid standardized POPs (HCB, p,p'-DDE, ∑DL-PCBs, ∑NDL-PCBs) were estimated using conditional logistic regression, adjusting for body mass index (BMI) and plasma lipids. The influence of BMI, weight-change, and plasma lipids on longitudinal changes in POP concentrations were evaluated among non-diabetic individuals (n = 306).RESULTS: POPs were associated with T2D in both the prospective and cross-sectional assessments. Of a standard deviation increase in POPs, prospective ORs ranged 1.42 (95% CI: 0.99, 2.06) for ∑NDL-PCBs to 1.55 (95% CI: 1.01, 2.38) for HCB (p < 0.05 only for HCB), and cross-sectional ORs ranged 1.62 (95% CI: 1.13; 2.32) for p,p'-DDE to 2.06 (95% CI: 1.29, 3.28) for ∑DL-PCBs (p < 0.05 for all POPs). In analyses of non-diabetic individuals, higher baseline BMI, decreased weight and decreased plasma lipid concentrations were associated with a slower decrease of POPs. Cases had, besides a higher BMI, reduced cholesterol and weight gain at follow-up compared to controls, which can explain the higher ORs in the cross-sectional assessments.DISCUSSION: The association between POPs and T2D was confirmed, but an indication that individuals body fat history might influence POP-T2D associations weakens the epidemiological support for a causal association. It also warrants studies based on other exposure metrics than biomonitoring. In addition, we note that a cross-sectional design overestimates the ORs if T2D cases have successfully intervened on weight and/or blood lipids, as changes in these factors cause changes in POPs.
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| 22. |
- Tornevi, Andreas, et al.
(författare)
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Effekter på luft och hälsa i områden utsatta för rök från skogsbränder : med fokus på Jämtland Härjedalen 2018
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna studie syftar till att följa upp episoden med skogsbrandrök som drabbade Östersund och Jämtland Härjedalen sommaren 2018, samt att belysa vilka erfarenheter man har från andra länder om nivåer för exponering och risker.Tyvärr hade ingen av regionens tätorter kontinuerliga partikelmätningar sommaren 2018. En spridningsmodell vid SMHI användes för att beskriva spridning av rök från skogsbränderna 2018, samt en jämförbar period 2017 (då antalet bränder var färre), med fokus på fina partiklar (PM2.5) och sot-partiklar. Utifrån halt- och befolkningsskikt användes befolkningsviktade dygnsmedelhalter som mått på exponeringen i respektive kommun. Statistik över dagligt antal akuta besök för problem från andnings-organen vid sjukhuset i Östersund och regionens olika vårdcentraler och mottagningar, samt över antalet samtal till sjukvårdsupplysningen 1177 om andningsproblem, användes för att studera eventuella akuta hälsoeffekter inom respektive kommuns befolkning.Enligt beräkningarna förekom befolkningsviktade dygnsmedelhalter på upp till 97 μg/m3. I verkligheten förekom sannolikt, under kortare tid och avgränsade platser, betydligt högre halter. När brand-röksepisoder definierades som dygn med PM2.5>20 μg/m3 beräknades den sammanviktade relativa ökningen av akuta besök gällande astma till 68% (RR=1.68, 95% KI:1.09-2.57). För diagnoser gällande nedre luftvägar totalt observerades en ökning med 40% (RR=1.4, 95% KI:1.01-1.92). I genomsnitt innebar brandröksepisoder en ökning av halten PM2.5 med 28 μg/m3 i jämförelse med referensdygnen.Analyserna av förhöjda partikelhalter i Jämtland-Härjedalen under brandröksperioden sommaren 2018 tyder på att en ökning av akuta problem gällande de nedre luftvägarna kan förväntas från dygns-medelhalter på 20-40 μg/m3 av PM2.5 med ursprung i huvudsak från bränder. För information och varningar under pågående exponering för PM2.5 i skogsbrandrök torde de kriterier för korttidshalter som finns i USA och Kanada vara tillämpliga även för Sverige. Om haltbidraget från branden förväntas bli omkring 60-90 μg/m3 av PM2.5 under 1 timme eller längre bör känsliga grupper uppmanas att begränsa sin exponering.
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| 23. |
- Tornevi, Andreas, et al.
(författare)
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Effekter på luft och hälsa i områden utsatta för rök från skogsbränder med fokus på Jämtland 2018
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna studie syftar till att följa upp episoden med skogsbrandrök som drabbade Östersund och Jämtland Härjedalen sommaren 2018, samt att belysa vilka erfarenheter man har från andra länder om nivåer för exponering och risker.Tyvärr hade ingen av regionens tätorter kontinuerliga partikelmätningar sommaren 2018. En spridningsmodell vid SMHI användes för att beskriva spridning av rök från skogsbränderna 2018, samt en jämförbar period 2017 (då antalet bränder var färre), med fokus på fina partiklar (PM2.5) och sot-partiklar. Utifrån halt- och befolkningsskikt användes befolkningsviktade dygnsmedelhalter som mått på exponeringen i respektive kommun. Statistik över dagligt antal akuta besök för problem från andnings-organen vid sjukhuset i Östersund och regionens olika vårdcentraler och mottagningar, samt över antalet samtal till sjukvårdsupplysningen 1177 om andningsproblem, användes för att studera eventuella akuta hälsoeffekter inom respektive kommuns befolkning.Enligt beräkningarna förekom befolkningsviktade dygnsmedelhalter på upp till 97 μg/m3. I verkligheten förekom sannolikt, under kortare tid och avgränsade platser, betydligt högre halter. När brand-röksepisoder definierades som dygn med PM2.5>20 μg/m3 beräknades den sammanviktade relativa ökningen av akuta besök gällande astma till 68% (RR=1.68, 95% KI:1.09-2.57). För diagnoser gällande nedre luftvägar totalt observerades en ökning med 40% (RR=1.4, 95% KI:1.01-1.92). I genomsnitt innebar brandröksepisoder en ökning av halten PM2.5 med 28 μg/m3 i jämförelse med referensdygnen.Analyserna av förhöjda partikelhalter i Jämtland-Härjedalen under brandröksperioden sommaren 2018 tyder på att en ökning av akuta problem gällande de nedre luftvägarna kan förväntas från dygns-medelhalter på 20-40 μg/m3 av PM2.5 med ursprung i huvudsak från bränder. För information och varningar under pågående exponering för PM2.5 i skogsbrandrök torde de kriterier för korttidshalter som finns i USA och Kanada vara tillämpliga även för Sverige. Om haltbidraget från branden förväntas bli omkring 60-90 μg/m3 av PM2.5 under 1 timme eller längre bör känsliga grupper uppmanas att begränsa sin exponering.
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| 24. |
- Tornevi, Andreas, et al.
(författare)
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Efficacy of water treatment processes and endemic gastrointestinal illness : A multi-city study in Sweden
- 2016
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Ingår i: Water Research. - : Elsevier BV. - 0043-1354 .- 1879-2448. ; 102, s. 263-270
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Tidskriftsartikel (refereegranskat)abstract
- Outbreaks of acute gastrointestinal illnesses (AGI) have been linked to insufficient drinking water treatment on numerous occasions in the industrialized world, but it is largely unknown to what extent public drinking water influences the endemic level of AGI. This paper aimed to examine endemic AGI and the relationship with pathogen elimination efficacy in public drinking water treatment processes. For this reason, time series data of all telephone calls to the Swedish National Healthcare Guide between November 2007 and February 2014 from twenty Swedish cities were obtained. Calls concerning vomiting, diarrhea or abdominal pain (AGI calls) were separated from other concerns (non-AGI calls). Information on which type of microbial barriers each drinking water treatment plant in these cities have been used were obtained, together with the barriers' theoretical pathogen log reduction efficacy. The total log reduction in the drinking water plants varied between 0.0 and 6.1 units for viruses, 0.0-14.6 units for bacteria and 0.0-7.3 units regarding protozoans. To achieve one general efficacy parameter for each plant, a weighted mean value of the log reductions (WLR) was calculated, with the weights based on how commonly these pathogen groups cause AGI. The WLR in the plants varied between 0.0 and 6.4 units. The effect of different pathogen elimination efficacy on levels of AGI calls relative non-AGI calls was evaluated in regression models, controlling for long term trends, population size, age distribution, and climatological area. Populations receiving drinking water produced with higher total log reduction was associated with a lower relative number of AGI calls. In overall, AGI calls decreased by 4% (OR = 0.96, CI: 0.96-0.97) for each unit increase in the WLR. The findings apply to both groundwater and surface water study sites, but are particularly evident among surface water sites during seasons when viruses are the main cause of AGI. This study proposes that the endemic level of gastroenteritis can indeed be reduced with more advanced treatment processes at many municipal drinking water treatment plants.
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| 25. |
- Tornevi, Andreas, et al.
(författare)
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Increase in daily asthma medication sales in association with air pollution levels in Greater Stockholm
- 2023
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Ingår i: Environmental Epidemiology. - : Wolters Kluwer. - 2474-7882. ; 7:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Daily air pollution levels are known to influence the number of patients with acute asthma. We investigated the short-term effects of air pollution exposure on the daily number of asthma medication purchases in the Greater Stockholm area, Sweden.Methods: We conducted a time-series study with data on asthma medication purchases and daily mean values of particulate matter ≤10 µm (PM10), nitrogen oxides (NOx), and ozone during 2018-2019. We used nonlinear distributed lag quasi-Poisson regression models to estimate the associations between air pollution levels and medication purchases, adjusting for meteorological variables, pollen levels, day of the week, and long-term trends. The models established linear relationships between air pollutants and the outcome, and potential delayed effects were smoothed with a spline across a lag period of 2 weeks. We applied separate models for each municipality (n = 21) in Greater Stockholm, and calculated pooled estimates to achieve combined results for the whole region.Results: We observed associations between daily levels of air pollution and purchases of asthma medications, most clearly for PM10. The pooled estimates of the relative risks for asthma medication purchases across all 21 municipalities associated with a 10 μg m-3increase in PM10the same day (lag 0) was 1.7% [95% confidence interval (CI): 1.2%, 2.1%], a cumulative increase of 4.6% (95% CI: 3.7%, 5.6%) over one week (lag 0-6), and a 6.5% (95% CI: 5%, 8%) increase over 2 weeks (lag 0-13). The corresponding pooled effect per 10 μg m-3increase in NOxand ozone were 2.8% (95% CI: 1.6%, 4.1%) and 0.7% (95% CI: 0%, 1.4%) over 2 weeks (lag 0-13), respectively.Conclusions: Our study revealed short-term associations between air pollution, especially PM10, and purchases of asthma medications.
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