| 1. |
- Malinovschi, Andrei, 1978-, et al.
(författare)
-
Consequences of Using Post- or Prebronchodilator Reference Values in Interpreting Spirometry
- 2023
-
Ingår i: American Journal of Respiratory and Critical Care Medicine. - : American Thoracic Society. - 1073-449X .- 1535-4970. ; 208:4, s. 461-471
-
Tidskriftsartikel (refereegranskat)abstract
- RATIONALE: Post-bronchodilator (BD) spirometry is used for diagnosis of chronic obstructive pulmonary disease (COPD). However, pre-BD reference values are used for spirometry interpretation.OBJECTIVES: To compare the resulting prevalence rates of abnormal spirometry and study the consequences of using pre- or post-BD reference values generated within the Swedish CArdioPulmonary bioImage Study (SCAPIS) when interpreting post-BD spirometry in a general population.METHODS: SCAPIS reference values for post-BD and pre-BD spirometry were based on 10,156 and 1,498 never-smoking, healthy participants, respectively. We studied the associations of abnormal spirometry, defined by using pre- or post-BD reference values, with respiratory burden in the SCAPIS general population (28,851 individuals).MEASUREMENTS AND MAIN RESULTS: Bronchodilation resulted in higher predicted median and lower limit of normal (LLN) for FEV1/FVC ratio. The prevalence of post-BD FEV1/FVC < pre-bronchodilator LLN was 4.8% and that of post-BD FEV1/FVC < post-bronchodilator LLN was 9.9% for the general population. An additional 5.1% was identified as having an abnormal post-BD FEV1/FVC ratio and this group had more respiratory symptoms, emphysema (13.5% vs. 4.1%, p<0.001) and self-reported physician-diagnosed COPD (2.8% vs. 0.5%, p<0.001) than subjects with post-BD FEV1/FVC ratio > LLN for both pre- and post-bronchodilation).CONCLUSIONS: Pre- and post-bronchodilator spirometry reference values differ with regard to FEV1/FVC ratio. Use of post-bronchodilator reference values doubled the population prevalence of airflow obstruction; this was related to a higher respiratory burden. Using post-bronchodilator reference values when interpreting post-bronchodilator spirometry might enable identification of individuals with mild disease and be clinically relevant.
|
|
| 2. |
- Glimne, Susanne, et al.
(författare)
-
Headaches in combination with visual ability, eye- and musculoskeletal strain in connection with visually demanding work tasks
- 2022
-
Konferensbidrag (refereegranskat)abstract
- Suboptimal visual ergonomics (i.e., the interaction between our vision, the light, the visual object, and the influence of other factors which impairs visibility) in work environment such as glare can cause headache in combination with eyestrain, visual ability, and musculoskeletal strain. Symptoms constituted to the syndrome of eyestrain has been well described among computer workers (see for example Han et al., 2013; Portello et al., 2012; Bhanderi et al., 2008; Mocci et al., 2001; Sanchez-Roman et al., 1996). However, research has not focused on investigating the presence of headaches associated with eye-related and musculoskeletal disorders among employees and visual related environmental factors.The purpose of presented research was to study the presence of headaches in combination with visual ability, eye- and musculoskeletal strain, and work ability in connection with visually demanding work. Trained assessors recruited study participants primarily from their regular clients in the OHS field. Evaluators were instructed to recruit participants with a variety of characteristics to ensure highly variable data, such as different work tasks, age, and gender. The participants mean age was 48.3 years (±10.3); 66% were women.A visual ergonomics risk assessment method (VERAM, Heiden et al. 2019; Zetterberg et al. 2017) was used to compile the participated workers subjective grading of headache, eye- and musculoskeletal strain using a questionnaire (n=430). At the same time, an evaluation of the visual environment was carried out, which established if there was a risk of glare associated with the implementation of work task (e.g., computer work and other related work such as industry, healthcare, and shipping industry). The frequency of headaches was divided into three categories; (1) no headache, (2) headache occasionally, and (3) headache a few times per week/almost every day. The measurements regarding evaluation of the visual environment used a photometer, an instrument which was available and that the assessors could use, usually a Hagner ScreenMaster or Hagner S1 / S2 / S3.About 65% of the workers reported headaches occasionally, a few times/week or almost every day. Among the workers with headaches reported about 29% of them that they experienced the headaches a few times/week or almost every day.Out of the workers with headaches reported 37% a severity of the headaches of more than 3 (on a scale of 1-10) and 5 % reported a severity of more than 6. About 40% of the workers also stated that the headaches affected their working ability. The headaches were mainly located around the eyes, forehead, or temples (70%) and came in the afternoon (69%). About 75% of the workers also reported that the headache disappeared or were reduced when they were off work for one night or over the weekend. The data collection showed that visual- related symptoms increased the higher the estimated headaches was.The musculoskeletal strain increased when the headache increased. When workers reported a high frequency of headaches 95% of them reported neck strain, 86% shoulder strain, 73% upper back strain, and 61% were reported arm strain.Moreover, only 8.2% of the workers rated their visual ability as bad or very bad, but at the same time, about 60% reported dim vision, 14% diplopia, and 59% problems changing focus at some time.Dividing the data into workers with experienced or unexperienced headaches this study has shown that there was a significant presence of headaches in combination with visual related symptoms regarding experienced photophobia (p=0.011), eye pain (p=0.015), diplopia (p=0.029), and arm strain (p=0.006). Further, the statistical analysis showed that there was a tendency of combination regarding headaches and visual ability (p=0.070).Dividing the data into workers with experienced or unexperienced headaches, our study showed that the frequency of headache increased due to high luminance levels within the visual field (p=0.044).This study concludes presence of headaches in combination with eye- and musculoskeletal strain performing work task such as computer work. Further, the presence of headaches is due to visual ability induced by high luminance levels within the visual field.
|
|
| 3. |
- Hemphälä, Hillevi, et al.
(författare)
-
Objective risk assessment of glare and subjective rating of the frequency of glare ‐ a visual ergonomics risk assessment, VERAM
- 2022
-
Konferensbidrag (refereegranskat)abstract
- Insufficient lighting conditions and glare from luminaires in the visual environment can affect our visual ability and cause eyestrain, headache, and musculoskeletal strain. Knave et al. found that the frequency of reported glare was associated with more eyestrain. In this study a subjectively rated frequency of glare was compared to an objectively rated risk for glare made by trained assessors.A visual ergonomics risk assessment method (VERAM) was used to gather data at workplaces, mainly computer workstations (n=420). Trained assessors (ergonomists) measured the luminance ratio and assessed the risk for glare (objective risk for glare) divided into three categories high risk (red), low risk (yellow) and no risk (green).Workers rated the frequency of experienced glare at their workplaces (subjective assessment of glare) via questionnaires. The frequency of subjective strain was divided into three categories; no, never; occasionally; a few times a week/almost always.Workers rated the frequency of glare present more seldom than the trained assessors rated the presence for risk for glare, at the same workplaces. One factor behind this might be individuals’ ability to evaluate the visual environment such as risk for glare. A trained assessor can easier evaluate any risks in the visual environment.When the objective risk for glare was assessed to be high (red) or low (yellow) the percentage of individuals reporting strain, such as eyestrain and musculoskeletal strain, increased for most symptoms compared to when there was no risk (green). An objective risk assessment for glare needs to be performed together with a subjective rating of the frequency of glare to find the individuals with problems.
|
|
| 4. |
- Hemphälä, Hillevi, et al.
(författare)
-
Risks in the visual environment such as glare, illuminance, and luminance ratio - risk assessments made with visual ergonomics risk assessment method - VERAM - a descriptive paper
- 2021
-
Ingår i: Proceedings of the Conference CIE 2021 : September 27 - 29, 2021 hosted by the CIE National Committee (NC) Malaysia online - September 27 - 29, 2021 hosted by the CIE National Committee (NC) Malaysia online. - 9783902842299
-
Konferensbidrag (refereegranskat)abstract
- The visual environment has an impact on subjective strain and headaches. A visual ergonomics risk assessment method, VERAM, was used on 217 workplaces, and consists of both of a subjective questionnaire and an objective risk assessment, the objective risks are presented in this paper. The risk for daylight was assessed to be yellow (risk) or red (high risk) at 53% of the workplaces and the risk for glare was yellow or red at 66%. The assessment of the lighting design showed a yellow or red risk at 44% of the workplaces and the illuminance was assessed to be insufficient at 49% of the workplaces. Flicker or TLM (temporal light modulation) was assessed to be a problem among 33%. These results show that the design of the visual environment is in most cases not performed in a satisfying way. To increase wellbeing, health and performance a good visual environment is essential.
|
|
| 5. |
- Hemphälä, Hillevi, et al.
(författare)
-
Visual Symptoms and Risk Assessment Using Visual Ergonomics Risk Assessment Method (VERAM)
- 2021
-
Ingår i: Proceedings of the 21st Congress of the International Ergonomics Association (IEA 2021) - Volume II : Inclusive Design - Inclusive Design. - Cham : Springer International Publishing. - 2367-3389 .- 2367-3370. - 9783030746049 ; 220, s. 729-735, s. 729-735
-
Konferensbidrag (refereegranskat)abstract
- A visual environment impaired by e.g. glare can cause eyestrain, visual symptoms and musculoskeletal strain. A Visual Ergonomics Risk Assessment Method (VERAM) consisting of both a subjective questionnaire and an objective risk assessment, have been used at 217 workplaces, mainly computer work. VERAM can be used to examine and prevent deficiencies and increase wellbeing as well as detecting risks in the visual work environment and suggest measures that can be used to reduce the risks. The questionnaire showed that eyestrain, visual symptoms and musculoskeletal strain are common among Swedish workers. The overall risk assessments for glare and amount of illuminance on work surface are divided into three categories, green – no risk, yellow – risk, and red – high risk. Risk of glare and insufficient illuminance was present at 66% and 49% of the assessed workplaces, respectively. When the risk of glare and illuminance levels was rated as red, the frequency of the subjective strain was higher.
|
|
| 6. |
- Lindberg, Sara, et al.
(författare)
-
Expanded HILUS Trial: A Pooled Analysis of Risk Factors for Toxicity From Stereotactic Body Radiation Therapy of Central and Ultracentral Lung Tumors
- 2023
-
Ingår i: INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS. - 0360-3016 .- 1879-355X. ; 117:5, s. 1222-1231
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: Stereotactic body radiation therapy for tumors near the central airways implies high-grade toxic effects, as concluded from the HILUS trial. However, the small sample size and relatively few events limited the statistical power of the study. We therefore pooled data from the prospective HILUS trial with retrospective data from patients in the Nordic countries treated outside the prospective study to evaluate toxicity and risk factors for high-grade toxic effects. Methods and Materials: All patients were treated with 56 Gy in 8 fractions. Tumors within 2 cm of the trachea, the mainstem bronchi, the intermediate bronchus, or the lobar bronchi were included. The primary endpoint was toxicity, and the secondary endpoints were local control and overall survival. Clinical and dosimetric risk factors were analyzed for treatment-related fatal toxicity in univariable and multivariable Cox regression analyses.Results: Of 230 patients evaluated, grade 5 toxicity developed in 30 patients (13%), of whom 20 patients had fatal bronchopul-monary bleeding. The multivariable analysis revealed tumor compression of the tracheobronchial tree and maximum dose to the mainstem or intermediate bronchus as significant risk factors for grade 5 bleeding and grade 5 toxicity. The 3-year local control and overall survival rates were 84% (95% CI, 80%-90%) and 40% (95% CI, 34%-47%), respectively.Conclusions: Tumor compression of the tracheobronchial tree and high maximum dose to the mainstem or intermediate bronchus increase the risk of fatal toxicity after stereotactic body radiation therapy in 8 fractions for central lung tumors. Simi-lar dose constraints should be applied to the intermediate bronchus as to the mainstem bronchi.
|
|
| 7. |
- Mezheyeuski, Artur, et al.
(författare)
-
An immune score reflecting pro- and anti-tumoural balance of tumour microenvironment has major prognostic impact and predicts immunotherapy response in solid cancers
- 2023
-
Ingår i: EBioMedicine. - : Elsevier. - 2352-3964. ; 88
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Cancer immunity is based on the interaction of a multitude of cells in the spatial context of the tumour tissue. Clinically relevant immune signatures are therefore anticipated to fundamentally improve the accuracy in predicting disease progression.Methods: Through a multiplex in situ analysis we evaluated 15 immune cell classes in 1481 tumour samples. Single-cell and bulk RNAseq data sets were used for functional analysis and validation of prognostic and predictive associations.Findings: By combining the prognostic information of anti-tumoural CD8+ lymphocytes and tumour supportive CD68+CD163+ macrophages in colorectal cancer we generated a signature of immune activation (SIA). The prognostic impact of SIA was independent of conventional parameters and comparable with the state-of-art immune score. The SIA was also associated with patient survival in oesophageal adenocarcinoma, bladder cancer, lung adenocarcinoma and melanoma, but not in endometrial, ovarian and squamous cell lung carcinoma. We identified CD68+CD163+ macrophages as the major producers of complement C1q, which could serve as a surrogate marker of this macrophage subset. Consequently, the RNA-based version of SIA (ratio of CD8A to C1QA) was predictive for survival in independent RNAseq data sets from these six cancer types. Finally, the CD8A/C1QA mRNA ratio was also predictive for the response to checkpoint inhibitor therapy.Interpretation: Our findings extend current concepts to procure prognostic information from the tumour immune microenvironment and provide an immune activation signature with high clinical potential in common human cancer types.
|
|
| 8. |
- Torén, Kjell, 1952, et al.
(författare)
-
Chronic airflow limitation and its relation to respiratory symptoms among ever-smokers and never-smokers: a cross-sectional study
- 2020
-
Ingår i: Bmj Open Respiratory Research. - : BMJ. - 2052-4439. ; 7:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background The diagnosis of chronic obstructive pulmonary disease is based on the presence of persistent respiratory symptoms and chronic airflow limitation (CAL). CAL is based on the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1:FVC) after bronchodilation, and FEV1:FVC less than the fifth percentile is often used as a cut-off for CAL. The aim was to investigate if increasing percentiles of FEV1:FVC were associated withany respiratory symptom(cough with phlegm, dyspnoea or wheezing) in a general population sample of never-smokers and ever-smokers. Methods In a cross-sectional study comprising 15 128 adults (50-64 years), 7120 never-smokers and 8008 ever-smokers completed a respiratory questionnaire and performed FEV(1)and FVC after bronchodilation. We calculated theirz-scores for FEV1:FVC and defined the fifth percentile using the Global Lung Function Initiative (GLI) reference value, GLI(5)and increasing percentiles up to GLI(25). We analysed the associations between different strata of percentiles and prevalence ofany respiratory symptomusing multivariable logistic regression for estimation of OR. Results Among all subjects, regardless of smoking habits, the odds ofany respiratory symptomwere elevated up to the GLI(15-20)strata. Among never-smokers, the odds ofany respiratory symptomwere elevated at GLI(<5)(OR 3.57, 95% CI 2.43 to 5.23) and at GLI(5-10)(OR 2.57, 95% CI 1.69 to 3.91), but not at higher percentiles. Among ever-smokers, the odds ofany respiratory symptomwere elevated from GLI(<5)(OR 4.64, 95% CI 3.79 to 5.68) up to GLI(>= 25)(OR 1.33, 95% CI 1.00 to 1.75). Conclusions The association between percentages of FEV1:FVC and respiratory symptoms differed depending on smoking history. Our results support a higher percentile cut-off for FEV1:FVC for never-smokers and, in particular, for ever-smokers.
|
|
| 9. |
- Torén, Kjell, 1952, et al.
(författare)
-
The ratio FEV1/FVC and its association to respiratory symptoms-A Swedish general population study
- 2021
-
Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 41:2, s. 181-191
-
Tidskriftsartikel (refereegranskat)abstract
- Chronic airflow limitation (CAL) can be defined as fixed ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) any respiratory symptom. In a cross-sectional general population study, 15,128 adults (50-64 years of age), 7,120 never-smokers and 8,008 ever-smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated different ratios of FEV1/FVC from 0.40 to 1.0 using 0.70 as reference category. We analysed odds ratios (OR) between different ratios and any respiratory symptom using adjusted multivariable logistic regression. Among all subjects, regardless of smoking habits, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.82, OR 0.48 (95% CI 0.41-0.56). Among never-smokers, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.81, OR 0.53 (95% CI 0.41-0.70). Among ever-smokers, the odds for any respiratory symptom was lowest at FEV1/FVC = 0.81, OR 0.43 (95% CI 0.16-1.19), although the rate of inclining in odds was small in the upper part, that is FEV1/FVC = 0.85 showed similar odds, OR 0.45 (95% CI 0.38-0.55). We concluded that the odds for any respiratory symptoms continuously decreased with higher FEV1/FVC ratios and reached a minimum around 0.80-0.85, with similar results among never-smokers. These results indicate that the optimal threshold associated with respiratory symptoms may be higher than 0.70 and this should be further investigated in prospective longitudinal studies.
|
|
| 10. |
- Ait Ali, Abderrahman, 1991-, et al.
(författare)
-
A disaggregate bundle method for train timetabling problems
- 2020
-
Ingår i: Journal of Rail Transport Planning & Management. - : Elsevier BV. - 2210-9706 .- 2210-9714. ; 16
-
Tidskriftsartikel (refereegranskat)abstract
- The train timetabling problem (TTP) consists of finding a feasible timetable for a number of trains which minimises some objective function, e.g., sum of running times or deviations from ideal departure times. One solution approach is to solve the dual problem of the TTP using so-called bundle methods. This paper presents a new bundle method that uses disaggregate data, as opposed to the standard bundle method which in a certain sense relies on aggregate data. We compare the disaggregate and aggregate methods on realistic train timetabling scenarios from the Iron Ore line in Northern Sweden. Numerical results indicate that the proposed disaggregate method reaches better solutions faster than the standard aggregate approach.
|
|
