| 1. |
- Dauter, Ulrike Maria, et al.
(författare)
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Cancer-related changes and low-to-moderate exposure to welding fumes : A longitudinal study
- 2022
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 48:1, s. 21-30
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Tidskriftsartikel (refereegranskat)abstract
- Objective This study tested for an association between early cancer-related biomarkers and low-to-moderate exposure to fumes from welding mild steel.Methods Male, non-smoking participants from southern Sweden were recruited and examined (N=338, 171 welders and 167 controls); of these, 78 welders and 96 controls were examined on two occasions six years apart. Exposure to welding fumes was evaluated by measuring respirable dust, welding years, and cumulative exposure. DNA methylation of CpG sites within the cancer-related genes AHRR, F2RL3, and B3GNTL1 was measured by pyrosequencing and relative mitochondrial DNA copy number and telomere length were measured by qPCR in whole-blood samples. Multivariate models were used for longitudinal analysis.Results Median exposure to respirable dust was 0.7 mg/m3 at both timepoints, adjusted for use of personal protective equipment. Compared with controls, welders showed a significant decrease over time in DNA methylation of B3GNTL1 CpG1 and CpG4 [adjusted for age, body mass index, and smoking: β=-0.66, standard error (SE)=0.28; β=-0.48, SE=0.24, respectively]. In addition, exposure to respirable dust and cumulative exposure was associated with a decrease in methylation of F2RL3 CpG2 among all welders (adjusted β=-0.67, SE=0.23 and β=-0.03, SE=0.02, respectively). No significant associations were found for AHRR, mitochondrial DNA copy number, or telomere length.Conclusion Low-to-moderate exposure to welding fumes was associated with a small effect on selected early epigenetic biomarkers of cancer. The direction of the methylation pattern (lower methylation of specific CpG sites) indicates early lung cancer-related changes associated with mild steel welding.
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| 2. |
- Gliga, Anda R., et al.
(författare)
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Exposure to Mild Steel Welding and Changes in Serum Proteins With Putative Neurological Function—A Longitudinal Study
- 2020
-
Ingår i: Frontiers in Public Health. - : Frontiers Media SA. - 2296-2565. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Welders are exposed to high levels of metal particles, consisting mainly of iron and manganese (Mn) oxide. Metal particles, especially those containing Mn can be neurotoxic. In this exploratory study, we evaluated associations between welding and expression of 87 putative neurology-related proteins in serum in a longitudinal approach. The study cohort from southern Sweden included welders working with mild steel (n = 56) and controls (n = 67), all male and non-smoking, which were sampled at two timepoints (T1, T2) 6-year apart. Observed associations in the longitudinal analysis (linear mixed models) were further evaluated (linear regression models) in another cross-sectional sample which included welders (n = 102) and controls (n = 89) who were sampled only once (T1 or T2). The median respirable dust levels for welders after adjusting for respiratory protection was at T1 0.6 (5–95 percentile: 0.2–4.2) and at T2 0.5 (0.1–1.8) mg/m3. The adjusted median respirable Mn concentration was at T2 0.049 mg/m3 (0.003–0.314) with a Spearman correlation between adjusted respirable dust and respirable Mn of rS = 0.88. We identified five neurology-related proteins that were differentially expressed in welders vs. controls in the longitudinal sample, of which one (nicotinamide/nicotinic acid mononucleotide adenylyltransferase 1; NMNAT1) was also differentially expressed in the cross-sectional sample. NMNAT1, an axon-protective protein linked to Alzheimers disease, was upregulated in welders compared with controls but no associations were discerned with degree of exposure (welders only: years welding, respirable dust, cumulative exposure). However, we identified five additional proteins that were associated with years welding (GCSF, EFNA4, CTSS, CLM6, VWC2; welders only) both in the longitudinal and in the cross-sectional samples. We also observed several neurology-related proteins that were associated with age and BMI. Our study indicates that low-to-moderate exposure to welding fumes is associated with changes in circulating levels of neurology-related proteins.
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| 3. |
- Taj, Tahir, et al.
(författare)
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Effect of welding fumes on the cardiovascular system: a six-year longitudinal study
- 2021
-
Ingår i: Scandinavian Journal of Work Environment & Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 47:1, s. 52-61
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Tidskriftsartikel (refereegranskat)abstract
- Objective This study investigated whether low-to-moderate exposure to welding fumes is associated with adverse effects on the cardiovascular system. Methods To test this, we performed a longitudinal analysis of 78 mild steel welders and 96 controls; these subjects were examined twice, six years apart (ie, timepoints 1 and 2). All subjects (male and non-smoking at recruitment) completed questionnaires describing their health, work history, and lifestyle. We measured their blood pressure, endothelial function (by EndoPAT), and risk markers for cardiovascular disease [low-density lio-protein (LDL), homocysteine, C-reactive protein]. Exposure to welding fumes was assessed from the responses to questionnaires and measurements of respirable dust in their breathing zones adjusted for use of respiratory protection equipment. Linear mixed-effect regression models were used for the longitudinal analysis. Results Median respirable dust concentrations, adjusted for respirable protection, of the welders were 0.7 (5-95 percentile range 0.2-4.2) and 0.5 (0.1-1.9) mg/m 3 at timepoints 1 and 2, respectively. Over the six-year period, welders showed a statistically significant increase in systolic [5.11 mm Hg, 95% confidence interval (CI) 1.92-8.31] and diastolic (3.12 mm Hg, 95% CI 0.74-5.5) blood pressure compared with controls (multi-variable adjusted mixed effect models). Diastolic blood pressure increased non-significantly by 0.22 mm Hg (95% CI-0.02-0.45) with every additional year of welding work. No consistent significant associations were found between exposure and endothelial function, LDL, homocysteine, or C-reactive protein. Conclusion Exposure to welding fumes at low-to-moderate levels is associated with increased blood pressure, suggesting that reducing the occupational exposure limit (2.5 mg/m(3) for inorganic respirable dust in Sweden) is needed to protect cardiovascular health of workers.
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| 4. |
- Torén, Kjell, 1952, et al.
(författare)
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Occupational risks associated with severe COVID-19 disease and SARS-CoV-2 infection-a Swedish national case-control study conducted from October 2020 to December 2021
- 2023
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Ingår i: Scandinavian Journal of Work Environment & Health. - 0355-3140. ; 49:6, s. 386-394
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Tidskriftsartikel (refereegranskat)abstract
- Objective This study aimed to investigate whether workplace factors and occupations are associated with SARSCoV-2 infection or severe COVID-19 in the later waves of the pandemic.Methods We studied 552 562 cases with a positive test for SARS-CoV-2 in the Swedish registry of communicable diseases, and 5985 cases with severe COVID-19 based on hospital admissions from October 2020 to December 2021. Four population controls were assigned the index dates of their corresponding cases. We linked job histories to job-exposure matrices to assess the odds for different transmission dimensions and different occupations. We used adjusted conditional logistic analyses to estimate odds ratios (OR) for severe COVID-19 and SARS-CoV-2 with 95% confidence intervals (CI).Results The highest OR for severe COVID-19 were for: regular contact with infected patients, (OR 1.37, 95% CI 1.23-1.54), close physical proximity (OR 1.47, 95% CI 1.34-1.61), and high exposure to diseases or infections (OR 1.72, 95% CI 1.52-1.96). Mostly working outside had lower OR (OR 0.77, 95% CI 0.57-1.06). The odds for SARS-CoV-2 when mostly working outside were similar (OR 0.83, 95% CI 0.80-0.86). The occupation with the highest OR for severe COVID-19 (compared with low-exposure occupations) was certified specialist physician (OR 2.05, 95% CI 1.31-3.21) among women and bus and tram drivers (OR 2.04, 95% CI 1.49-2.79) among men.Conclusions Contact with infected patients, close proximity and crowded workplaces increase the risks for severe COVID-19 and SARS-CoV-2 infection. Outdoor work is associated with decreased odds for SARS-CoV-2 infection and severe COVID-19.
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| 5. |
- Torén, Kjell, 1952, et al.
(författare)
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Transmission factors and exposure to infections at work and invasive pneumococcal disease
- 2022
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Ingår i: American Journal of Industrial Medicine. - : Wiley. - 0271-3586 .- 1097-0274. ; 66:1, s. 65-74
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundWorking in close contacts with coworkers or the general public may be associated with transmission of invasive pneumococcal disease (IPD). We investigated whether crowded workplaces, sharing surfaces, and exposure to infections were factors associated with IPD. MethodsWe studied 3,968 cases of IPD, and selected six controls for each case from the Swedish population registry with each control being assigned the index date of their corresponding case. We linked job histories to job-exposure matrices to assess different transmission dimensions of pneumococci, as well as occupational exposure to fumes. We used adjusted conditional logistic analyses to estimate the odds ratios (ORs) for IPD with 95% confidence intervals (95% CI). ResultsORs for IPD for the different transmission dimensions were increased moderately but were statistically significant. Compared to home-working or working alone, the highest odds was for Working mostly outside, or partly inside (OR 1.19, 95% CI 1.04-1.38). Estimates were higher in men for all dimensions, compared to women. The odds for IPD for Working mostly outside, or partly inside were 1.33 (95% CI 1.13-1.56) and 0.79 (95% CI 0.55-1.14) for men and women, respectively. Higher odds were seen for all transmission dimensions among those exposed to fumes, although CIs included unity. Contact with ill or infected patients did not increase the odds for IPD. ConclusionIPD was associated with working in close contact with coworkers or the general public, and with outside work, especially for men. Contact with infected patients or persons was not associated with IPD.
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| 6. |
- Albin, Maria, et al.
(författare)
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Ska alla behöva arbeta längre?
- 2020
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Ingår i: Förlängt arbetsliv – förutsättningar, utmaningar och konsekvenser. - Stockholm : Försäkringskassan. ; , s. 72-83
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Det finns flera skäl till att öppna för att människor skall ha möjlighet att arbeta längre. Hit hör en i allmänhet förbättrad folkhälsa, behovet av arbetskraft och att ett gott och meningsfullt arbete kan berika livet för den enskilde samtidigt som det bidrar till samhällets välstånd och finansieringen av välfärdssystemen. Men ett arbetsmedicinskt svar på om alla ska behöva arbeta längre är klart Nej. Det grundar sig på: • folkhälsans ojämlika utveckling • att de fysiska kraven fortfarande är höga i många yrken, främst arbetaryrken • att arbetets fysiska krav är det som främst är begränsande vid högre åldrar • att många rapporterar att arbetets fysiska krav överstiger deras förmåga • den sjunkande tillgången till kvalificerad arbetsanpassning genom exempelvis företagshälsovård, särskilt för kvinnor och i arbetaryrken.
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| 7. |
- Albin, Maria, et al.
(författare)
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Sustainable work for health and job longevity
- 2021
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Ingår i: European Journal of Workplace Innovation. - : University of Agder. - 2387-4570. ; 6:2, s. 147-162
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Tidskriftsartikel (refereegranskat)abstract
- While improved public health in groups with high or middle socioeconomic status (e.g. educational level) permits many to work for more years, the gap is widening for less advantaged groups, such as those with only compulsory level education. Within manual jobs, individual health status and the challenges of physical demands exceed the physical capacity of many middle-aged, and with a low bargaining power, constitute major threats to job longevity. Artificial intelligence and digitization are also rapidly transforming the labour market, especially for low-mid grade (level) white-collar workers. Young workers often have insecure job contracts, while older workers may have a permanent position but have a fear of leaving a safe position for a new one, and ultimately may be forced to leave their job when they are unable to meet the demands.Current economic incentives to prolong working life – often combined with more restrictive unemployment and disability benefits – may overall increase work participation but may also decrease sustainability in the more disadvantaged part of the labour market.Recent research suggests that unemployment is the most important factor behind lost working years among workers with less education, and that primary prevention focused on the work environment rather than individual health promotion (lifestyle habits), will enhance sustainability together with inclusive welfare systems. Resilience, or reduced vulnerability, in the workforce on a macro- and workplace level can be achieved by well-established societal measures.
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| 8. |
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| 9. |
- Alhamdow, Ayman, et al.
(författare)
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Fluorene exposure among PAH-exposed workers is associated with epigenetic markers related to lung cancer
- 2020
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Ingår i: Occupational and Environmental Medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 77:7, s. 488-495
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Exposure to high-molecular-weight polycyclic aromatic hydrocarbons (PAHs) may cause cancer in chimney sweeps and creosote-exposed workers, however, knowledge about exposure to low-molecular-weight PAHs in relation to cancer risk is limited. In this study, we aimed to investigate occupational exposure to the low-molecular-weight PAHs phenanthrene and fluorene in relation to different cancer biomarkers. Methods We recruited 151 chimney sweeps, 19 creosote-exposed workers and 152 unexposed workers (controls), all men. We measured monohydroxylated metabolites of phenanthrene and fluorene in urine using liquid chromatography coupled to tandem mass spectrometry. We measured, in peripheral blood, the cancer biomarkers telomere length and mitochondrial DNA copy number using quantitative PCR; and DNA methylation ofF2RL3andAHRRusing pyrosequencing. Results Median PAH metabolite concentrations were higher among chimney sweeps (up to 3 times) and creosote-exposed workers (up to 353 times), compared with controls (p<0.001; adjusted for age and smoking). n-ary sumation OH-fluorene (sum of 2-hydroxyfluorene and 3-hydroxyfluorene) showed inverse associations with percentage DNA methylation ofF2RL3andAHRRin chimney sweeps (B (95% CI)=-2.7 (-3.9 to -1.5) forF2RL3_cg03636183, and -7.1 (-9.6 to -4.7) forAHRR_cg05575921: adjusted for age and smoking), but not in creosote-exposed workers. In addition, n-ary sumation OH-fluorene showed a 42% mediation effect on the inverse association between being a chimney sweep and DNA methylation ofAHRRCpG2. Conclusions Chimney sweeps and creosote-exposed workers were occupationally exposed to low-molecular-weight PAHs. Increasing fluorene exposure, among chimney sweeps, was associated with lower DNA methylation ofF2RL3andAHRR, markers for increased lung cancer risk. These findings warrant further investigation of fluorene exposure and toxicity.
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| 10. |
- Almroth, Melody, 1989-, et al.
(författare)
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Labour market exit routes in high- and low-educated older workers before and after social insurance and retirement policy reforms in Sweden
- 2024
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Ingår i: Ageing & Society. - 0144-686X .- 1469-1779.
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Tidskriftsartikel (refereegranskat)abstract
- Few previous studies have investigated how socioeconomic differences in labour market exit have changed after restrictions in social insurance policies. The aim of this register-based study is to investigate how early labour market exit pathways among older men and women with different levels of education changed after major restrictive social insurance and retirement policy reforms in Sweden. Cohort 1 (pre-reform) consisted of individuals who were 60 or 61 years old in 2005 (N = 186,145) and Cohort 2 (post-reform) consisted of individuals who were 60 or 61 years old in 2012 (N = 176,216). Educational differences in four labour market exit pathways were investigated using Cox proportional hazards regression; the exit pathways were disability pension, early old-age pension with and without income respectively, and no income for two consecutive years. As expected, exits through disability pension were rarer in Cohort 2. Lower education was also more strongly associated with disability pension in Cohort 2. Parallel to this, lower education showed a stronger association with both early old-age pension types in Cohort 2. Additionally, a tendency towards a relatively higher likelihood of earning no income was seen among the less educated. Increases in inequalities tended to be greater for women. Our results indicate that educational inequalities in labour market exit have grown significantly after restrictions in social insurance and changes in retirement policies, which can have negative financial repercussions for those already in a vulnerable position. These results indicate that careful analyses of effects on disparities are needed before making major changes in welfare systems.
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| 11. |
- Andersson, Tommy, et al.
(författare)
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Multiple Pricing for Personal Assistance Services
- 2022
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This paper provides a general theoretical framework that captures the essential features ofa Swedish reform where private and public health care providers serve patients with certainfunctional impairments. Because providers receive a fixed hourly compensation for theirservices (identical across patient types) and only private providers can reject service requestsfrom patients, private providers avoid the costliest patients, resulting in a monetary deficitfor public providers. To partially overcome this problem, a multiple pricing (reimbursement)scheme is proposed and its solution is characterized. The results suggest that there are somefundamental trade-offs, e.g., between the goals of containing costs and restricting choicesfor patients, but that the suggested pricing scheme may substantially reduce the deficits forpublic providers without affecting the total budget set by the central government.
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| 12. |
- Badarin, Kathryn, et al.
(författare)
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Safety and health among undeclared workers : A mixed methods study investigating social partner experiences and strategies
- 2024
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Ingår i: Safety Science. - : Elsevier B.V.. - 0925-7535 .- 1879-1042. ; 175
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about the experiences of the social partners in helping undeclared workers resist Occupational Safety and Health (OSH) issues. This study draws upon Walter Korpi’s ‘power resource theory’ to gain a deeper understanding of how power resources within the construction, transport, and cleaning sectors influence the ability of social partners to respond to OSH issues related to undeclared work. This mixed-method study uses survey data from employer representatives in the construction (n = 686) and transport (n = 650) sectors in Sweden in 2019 to estimate the nature and magnitude of undeclared work-related problems. To also study the view of union representatives, a duplicate survey was sent to union representatives in the transport, construction, and cleaning sectors (n = 57) in 2020, followed by 13 semi-structured interviews with Regional Safety Representatives (RSRs) in 2021–2023. Our findings show that employer representatives in construction and transport reported that the violation of OSH regulations was uncommon and remained unchanged, most union representatives said the opposite. We found a gradient of activism among the unions towards OSH issues related to undeclared work dependent on their power resources. Furthermore, structural and organizational factors limited the RSRs’ ability to address undeclared work. The RSRs identified strategies to tackle OSH issues related to undeclared work in their sectors, these included but were not limited to, dismantling the language barrier between unions and undeclared foreign-born workers, for OSH coordinators and main contractors to be held responsible for OSH violations and greater cooperation between the relevant authorities dealing with undeclared work.
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| 13. |
- Bodin, Theo, et al.
(författare)
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Trends in Precarious Employment in Sweden 1992–2017 : A Social Determinant of Health
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:19
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to identify trends in precarious employment in the Swedish workforce from 1992 to 2017. This is a repeated cross-sectional study, analyzing the total working population aged 16–75 in Sweden at five-year intervals. We used version 2.0 of the Swedish Register-based Operationalization of Precarious Employment, covering the following dimensions: employment insecurity, income inadequacy, lack of rights and protection. The proportion in precarious employment increased from 9.7 to 12% between 1992 and 2017, a relative increase of 24%. The prevalence was higher among those of lower age, of low education, and immigrants. Differences between sexes converged, and there were slightly more precarious men than women in 2017. The relative increase was most pronounced among men, especially those with low educational attainment and of European origin. The increasing proportion of precarious employees is a clear challenge to the tripartite Nordic model, which requires sufficient trade-union bargaining power.
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| 14. |
- Bohgard, Mats, et al.
(författare)
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Nu krävs satsning på forskning för ett hållbart arbetsliv
- 2021
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Ingår i: Dagens Medicin. - 1104-7488.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Debatt: Vi vill att forskningsråden skapar tvärvetenskapliga regionala forskningscentrum för arbetslivsforskning, som är internationellt konkurrenskraftiga och ger nationellt och regionalt kunskapsstöd. Dessa centrum ska ge kunskaper för både befintliga och framtida utmaningar. Stora vinster kan fås om forskning om folkhälsa och yttre miljö samordnas i centrumen. Arbetslivet är grunden för hälsa, välstånd och ett välfungerande samhälle. För att säkra att framtidens arbetsliv bidrar till hälsa och välstånd behövs både kunskap om hur det ska utformas och en uthållig infrastruktur för forskning. Tyvärr saknas detta. Gammal kunskap faller i glömska.
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| 15. |
- Bonde, Jens Peter Ellekilde, et al.
(författare)
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Occupational risk of COVID-19 related hospital admission in Denmark 2020–2021 : a follow-up study
- 2023
-
Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 49:1, s. 84-94
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Mounting evidence indicates increased risk of COVID-19 among healthcare personnel, but the evidence on risks in other occupations is limited. In this study, we quantify the occupational risk of COVID-19-related hospital admission in Denmark during 2020-2021.Methods: The source population included 2.4 million employees age 20-69 years. All information was retrieved from public registers. The risk of COVID-19 related hospital admission was examined in 155 occupations with at least 2000 employees (at-risk, N=1 620 231) referenced to a group of mainly office workers defined by a COVID-19 job exposure matrix (N=369 341). Incidence rate ratios (IRR) were computed by Poisson regression.Results: During 186 million person-weeks of follow-up, we observed 2944 COVID-19 related hospital admissions in at-risk occupations and 559 in referents. Adjusted risk of such admission was elevated in several occupations within healthcare (including health care assistants, nurses, medical practitioners and laboratory technicians but not physiotherapists or midwives), social care (daycare assistants for children aged 4-7, and nursing aides in institutions and private homes, but not family daycare workers) and transportation (bus drivers, but not lorry drivers). Most IRR in these at-risk occupations were in the range of 1.5-3. Employees in education, retail sales and various service occupations seemed not to be at risk.Conclusion: Employees in several occupations within and outside healthcare are at substantially increased risk of COVID-19. There is a need to revisit safety measures and precautions to mitigate viral transmission in the workplace during the current and forthcoming pandemics.
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| 16. |
- Ekblom Bak, Elin, 1981-, et al.
(författare)
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Accelerometer derived physical activity patterns in 27.890 middle‐aged adults : The SCAPIS cohort study
- 2022
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Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : John Wiley & Sons. - 0905-7188 .- 1600-0838. ; 32:5, s. 866-880
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Tidskriftsartikel (refereegranskat)abstract
- The present study aims to describe accelerometer-assessed physical activity (PA) patterns and fulfillment of PA recommendations in a large sample of middle-aged men and women, and to study differences between subgroups of socio-demographic, socio-economic, and lifestyle-related variables. A total of 27 890 (92.5% of total participants, 52% women, aged 50–64 years) middle-aged men and women with at least four days of valid hip-worn accelerometer data (Actigraph GT3X+, wGT3X+ and wGT3X-BT) from the Swedish CArdioPulmonary bioImage Study, SCAPIS, were included. In total, 54.5% of daily wear time was spent sedentary, 39.1% in low, 5.4% in moderate, and only 0.1% in vigorous PA. Male sex, higher education, low financial strain, born in Sweden, and sedentary/light working situation were related to higher sedentary time, but also higher levels of vigorous PA. High BMI and having multiple chronic diseases associated strongly with higher sedentary time and less time in all three PA intensities. All-year physically active commuters had an overall more active PA pattern. The proportion fulfilling current PA recommendations varied substantially (1.4% to 92.2%) depending on data handling procedures and definition used. Twenty-eight percent was defined as having an “at-risk” behavior, which included both high sedentary time and low vigorous PA. In this large population-based sample, a majority of time was spent sedentary and only a fraction in vigorous PA, with clinically important variations between subgroups. This study provides important reference material and emphasizes the importance of a comprehensive assessment of all aspects of the individual PA pattern in future research and clinical practice.
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| 17. |
- Enache, Andreea, et al.
(författare)
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Multiple Pricing for Personal Assistance Services
- 2024
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Ingår i: SSRN Electronic Journal. - : Elsevier BV. - 1556-5068.
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This paper provides a general theoretical framework that captures the essential features of a Swedish reform where private and public health care providers serve patients with certain functional impairments. Because providers receive a fixed hourly compensation for their services (identical across patient types) and only private providers can reject service requests from patients, private providers avoid the costliest patients, resulting in a monetary deficit for public providers. To partially overcome this problem, a multiple pricing (reimbursement) scheme is proposed and its solution is characterized. The results suggest that there are some fundamental trade-offs, e.g., between the goals of containing costs and restricting choices for patients, but that the suggested pricing scheme may substantially reduce the deficits for public providers without affecting the total budget set by the central government
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| 18. |
- Engholm, Albin, 1991-
(författare)
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Driverless trucks in the Swedish freight transport system : An analysis of future impacts on the transport system and the emerging innovation system
- 2021
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A large-scale introduction of driverless trucks could start taking place during the next decade. While this could bring several economic benefits for freight transport actors and society, it may also change the freight transport system and exacerbate the negative effects of road transport. This thesis aims to increase the understanding of how an introduction of driverless trucks could materialize and impact the freight transport system in Sweden. Two overarching issues are addressed. The first is how freight transport patterns will change due to the impacts of driverless trucks on road transport supply. This is addressed in Paper 1 and Paper 2. The second issue, which is studied in Paper 3, is what factors are shaping the ongoing development towards an introduction of driverless trucks in Sweden. In Paper 1, the impact of driverless trucks on the costs for long-distance road freight transport is studied through a total cost of ownership analysis which shows that driverless trucks could enable cost reductions of around 30%-40% per ton-kilometer. A key determinant of the cost reduction is to what extent reduced driver costs will be offset by other forms of human labor that may be required for driverless truck operations. Other factors, including changes to the truck acquisition cost, have marginal importance. The cost-saving potential provides a strong motivation for freight transport actors to develop and adopt driverless trucks. In Paper 2, the impacts of driverless trucks on road transport demand, utilization of different truck types, modal split, and total logistics costs are studied by using the Swedish national freight transport model Samgods. Two scenario types are studied, one in which driverless trucks substitute manually driven trucks and one where driverless trucks capable of operating between logistics hubs are introduced as a complement to manually driven trucks. The analysis shows that in both scenarios, driverless trucks could reduce total costs for Swedish freight transport in the range of billions of SEK per year. Road transport demand and truck traffic volumes may increase significantly through modal shifts from rail and sea. This could lead to increased societal costs through, for instance, increased CO2 emissions and congestion which are, however, not quantified in the study. In Paper 3, an analysis of the innovation system of driverless trucks based on an interview study with actors involved in the development and introduction of driverless trucks in Sweden is presented. The findings suggest that there are several favorable factors for a successful introduction of driverless trucks, but also that the innovation system is characterized by a high degree of uncertainty related to what infrastructure will be required and available, what business models will be emerging, and which actors will be able to capitalize on the development and which actors that become marginalized in a future with driverless trucks. The findings from this thesis can be of interest for policymakers since it highlights potential benefits and challenges associated with driverless trucks from a transport-system perspective and the provided indicative quantitative estimates on system-level impacts offer a glimpse into a future freight transport system with driverless trucks. Also, the thesis highlights critical challenges for the innovation system of driverless trucks which could guide efforts to improve its performance.
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| 19. |
- Enkvist, Hampus, et al.
(författare)
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Stress, mental ill-health and functional somatic syndromes in incident and chronic sleep disturbance in a general adult population
- 2023
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Ingår i: Health Psychology and Behavioral Medicine. - : Taylor & Francis. - 2164-2850. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Sleep disturbance may constitute health problems for the afflicted individual, but documentation of its chronicity is sparse. The objective was to investigate the extent to which incident and chronic sleep disturbance are associated with stress, mental ill-health and functional somatic syndromes.Design: This was a prospective, longitudinal study with 3-year interval between two assessments (T1 and T2), with a population-based sample forming groups with incident sleep disturbance (disturbance only at T2; n = 303), chronic sleep disturbance (disturbance at T1 and T2; n = 343) and without sleep disturbance (neither at T1 nor T2; n = 1421). Questionnaire data were used at T2 of physician-based diagnosis of anxiety disorder, depression, exhaustion syndrome, and functional somatic syndrome as well as of degree of stress, burnout, anxiety and depression.Results: Significant associations were found between chronic sleep disturbance and all four diagnoses (odds ratios = 1.74–2.19), whereas incident sleep disturbance was associated only with exhaustion syndrome and depression (odds ratios = 2.18–2.37). Degree of stress, burnout, anxiety and depression increased significantly from the referents to incident and chronic sleep disturbance, in that order (eta2 = 0.083–0.166), except for the two latter groups not differing in depression.Conclusion: The findings imply that healthcare professionals should be observant regarding various conditions of, apart from stress, mental ill-health and functional somatic syndromes in patients who present themselves with sleep disturbance, and in particular chronic disturbance.
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| 20. |
- Falkstedt, Daniel, et al.
(författare)
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Disability pensions related to heavy physical workload : a cohort study of middle-aged and older workers in Sweden
- 2021
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 94, s. 1851-1861
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of the study was to examine the associations between heavy physical workload among middle-aged and older workers and disability pension due to any diagnosis, as well as musculoskeletal, psychiatric, cardiovascular or respiratory diagnoses. The population-based design made it possible to examine dose-response and potential gender differences in the associations. Methods About 1.8 million men and women aged 44-63 years and registered as living in Sweden in 2005 were followed regarding disability pension during 2006-2016, until ages 55-65 years. Mean values of physical workload and job control, estimated through gender-specific job-exposure matrices (JEMs), were assigned to individuals through their occupational titles in 2005. Exposure values were ranked separately for women and men and divided into quintiles. Associations were analyzed with Cox proportional-hazards regression. Results The analyses showed robust, dose-response associations between physical workload and disability pension with a musculoskeletal diagnosis in both genders: the adjusted hazard ratio and 95% confidence interval for those with the heaviest exposure was 2.58 (2.37-2.81) in women and 3.34 (2.83-3.94) in men. Dose-response associations were also seen in relation to disability pension with a cardiovascular or a respiratory diagnosis, though the hazard ratios were smaller. Physical workload was not associated with disability pension with a psychiatric diagnosis after adjustment for job control. Conclusion This study of the entire Swedish population of middle-aged and older workers suggests that higher degrees of physical workload may increase the risk of disability pension overall, and specifically with musculoskeletal, cardiovascular or respiratory diagnosis, in both women and men.
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| 21. |
- Falkstedt, Daniel, et al.
(författare)
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Job demands and job control and their associations with disability pension—a register-based cohort study of middle-aged and older Swedish workers
- 2023
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Ingår i: International Archives of Occupational and Environmental Health. - 0340-0131 .- 1432-1246. ; 96:8, s. 1137-1147
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Job demands and control at work and their combination, job strain, have been studied in relation to risk of disability pension (DP) previously. In the present study, based on registry data, we aimed to deepen the knowledge by analyzing major disease groups among the DPs, dose–response shape of the associations, and potential confounding effects of physical workload.Methods Approximately 1.8 million workers aged 44 or older and living in Sweden in 2005 were followed up for 16 years, up to a maximum of 65 years of age. We linked mean values of job demands and job control, estimated in a job-exposure matrice (JEM) by gender, to individuals through their occupational titles in 2005. These values were categorized by rank order, and, for the construction of job-strain quadrants, we used a median cut-off. Associations with DP were estimated in Cox proportional-hazards models.Results In models accounting for covariates including physical workload, low levels of job control were associated with higher risk of DP among both men and women. This association was most clear for DP with a psychiatric diagnosis, although a dose–response shape was found only among the men. High levels of job demands were associated with decreased risk of DP across diagnoses among men, but the same association varied from weak to non-existing among women. The high- and passive job-strain quadrants both showed increased risk of DP with a psychiatric diagnosis.Conclusion The results suggest that, at the occupational level, low job control, but not high job demands, contributes to an increased incidence of DP, particularly regarding DP with a psychiatric diagnosis.
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| 22. |
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| 23. |
- Gliga, Anda R., et al.
(författare)
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Short and long-term associations between serum proteins linked to cardiovascular disease and particle exposure among constructions workers
- 2023
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 49:2, s. 145-154
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Construction workers are exposed to respirable dust, including respirable crystalline silica (RCS), which is a potential risk factor for cardiovascular disease (CVD). The aim of this study was to evaluate whether exposure to particles among construction workers is associated with short-and long-term alterations in CVD-related serum proteins. Methods Using proximity extension assay, we measured 92 serum proteins linked to CVD among active male construction workers (N=65, non-smokers) sampled on two occasions: during work and after vacation. First, we used linear models to identify short-term changes in proteins associated with particle exposure (assessed as respirable dust and RCS) during work. Secondly, we used linear mixed models to evaluate whether these associations were long-term, ie, persistent after vacation. Results The median exposure to respirable dust and RCS during work were 0.25 mg/m3 and 0.01 mg/m3, respec-tively. Respirable dust was associated with short-term changes in six proteins (tissue factor, growth hormone, heme oxygenase-1, dickkopf-related protein-1, platelet-derived growth factor-B, stem cell factor); long-term associations were observed for the former three proteins. RCS was associated with short-term changes in five proteins (carcinoembryonic antigen-related cell adhesion molecule-8, hydroxyacid oxidase-1, tissue factor, car-bonic anhydrase-5A, lectin-like oxidized LDL receptor-1); long-term associations were observed for the former four proteins. Conclusions Moderate exposure to particles in the construction industry is associated with both short-and long-term changes in circulating CVD-related proteins. Further studies are needed to evaluate if these changes are predictors of occupationally induced clinical CVD.
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| 24. |
- Gren, Louise, et al.
(författare)
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Lung function and self-rated symptoms in healthy volunteers after exposure to hydrotreated vegetable oil (HVO) exhaust with and without particles
- 2022
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Ingår i: Particle and Fibre Toxicology. - : Springer Science and Business Media LLC. - 1743-8977. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Diesel engine exhaust causes adverse health effects. Meanwhile, the impact of renewable diesel exhaust, such as hydrotreated vegetable oil (HVO), on human health is less known. Nineteen healthy volunteers were exposed to HVO exhaust for 3 h in a chamber with a double-blind, randomized setup. Exposure scenarios comprised of HVO exhaust from two modern non-road vehicles with 1) no aftertreatment system ('HVOPM+NOx' PM1: 93 mu g-m(-3), EC: 54 mu g-m(-3), NO: 3.4 ppm, -NO2: 0.6 ppm), 2) an aftertreatment system containing a diesel oxidation catalyst and a diesel particulate filter ('HVONOx' PM1: similar to 1 mu g-m(-3), NO: 2.0 ppm, -NO2: 0.7 ppm) and 3) filtered air (FA) as control. The exposure concentrations were in line with current EU occupational exposure limits (OELs) of NO, -NO2, formaldehyde, polycyclic aromatic hydrocarbons (PAHs), and the future OEL (2023) of elemental carbon (EC). The effect on nasal patency, pulmonary function, and self-rated symptoms were assessed. Calculated predicted lung deposition of HVO exhaust particles was compared to data from an earlier diesel exhaust study. Results: The average total respiratory tract deposition of PM1 during -HVO(PM+ NO)x was 27 mu g-h(-1). The estimated deposition fraction of HVO PM1 was 40-50% higher compared to diesel exhaust PM1 from an older vehicle (earlier study), due to smaller particle sizes of the -HVOPM+ NOx exhaust. Compared to FA, exposure to -HVOPM+ NOx and -HVONOx caused higher incidence of self-reported symptoms (78%, 63%, respectively, vs. 28% for FA, p < 0.03). Especially, exposure to -HVOPM+ NOx showed 40-50% higher eye and throat irritation symptoms. Compared to FA, a decrement in nasal patency was found for the -HVONOx exposures (- 18.1, 95% CI: - 27.3 to - 8.8 L-min(-1), p < 0.001), and for the -HVOPM+ NOx (- 7.4 (- 15.6 to 0.8) L -min(-1), p = 0.08). Overall, no clinically significant change was indicated in the pulmonary function tests (spirometry, peak expiratory flow, forced oscillation technique). Conclusion: Short-term exposure to HVO exhaust concentrations corresponding to EU OELs for one workday did not cause adverse pulmonary function changes in healthy subjects. However, an increase in self-rated mild irritation symptoms, and mild decrease in nasal patency after both HVO exposures, may indicate irritative effects from exposure to HVO exhaust from modern non-road vehicles, with and without aftertreatment systems.
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| 25. |
- Gunn, Virginia, et al.
(författare)
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Initiatives Addressing Precarious Employment and Its Effects on Workers' Health and Well-Being : A Systematic Review
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:4
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Forskningsöversikt (refereegranskat)abstract
- The prevalence of precarious employment has increased in recent decades and aspects such as employment insecurity and income inadequacy have intensified during the COVID-19 pandemic. The purpose of this systematic review was to identify, appraise, and synthesise existing evidence pertaining to implemented initiatives addressing precarious employment that have evaluated and reported health and well-being outcomes. We used the PRISMA framework to guide this review and identified 11 relevant initiatives through searches in PubMed, Scopus, Web of Science, and three sources of grey literature. We found very few evaluated interventions addressing precarious employment and its impact on the health and well-being of workers globally. Ten out of 11 initiatives were not purposefully designed to address precarious employment in general, nor specific dimensions of it. Seven out of 11 initiatives evaluated outcomes related to the occupational health and safety of precariously employed workers and six out of 11 evaluated worker health and well-being outcomes. Most initiatives showed the potential to improve the health of workers, although the evaluation component was often described with less detail than the initiative itself. Given the heterogeneity of the 11 initiatives regarding study design, sample size, implementation, evaluation, economic and political contexts, and target population, we found insufficient evidence to compare outcomes across types of initiatives, generalize findings, or make specific recommendations for the adoption of initiatives.
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