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1.	Accordini, S., et al. (författare) A three-generation study on the association of tobacco smoking with asthma 2018 Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 47:4, s. 1106-1117 Tidskriftsartikel (refereegranskat)abstract Background: Mothers' smoking during pregnancy increases asthma risk in their offspring. There is some evidence that grandmothers' smoking may have a similar effect, and biological plausibility that fathers' smoking during adolescence may influence offspring's health through transmittable epigenetic changes in sperm precursor cells. We evaluated the three-generation associations of tobacco smoking with asthma. Methods: Between 2010 and 2013, at the European Community Respiratory Health Survey III clinical interview, 2233 mothers and 1964 fathers from 26 centres reported whether their offspring (aged <= 51 years) had ever had asthma and whether it had coexisted with nasal allergies or not. Mothers and fathers also provided information on their parents' (grandparents) and their own asthma, education and smoking history. Multilevel mediation models within a multicentre three-generation framework were fitted separately within the maternal (4666 offspring) and paternal (4192 offspring) lines. Results: Fathers' smoking before they were 15 [relative risk ratio (RRR) = 1.43, 95% confidence interval (CI): 1.01-2.01] and mothers' smoking during pregnancy (RRR = 1.27, 95% CI: 1.01-1.59) were associated with asthma without nasal allergies in their offspring. Grandmothers' smoking during pregnancy was associated with asthma in their daughters [odds ratio (OR) = 1.55, 95% CI: 1.17-2.06] and with asthma with nasal allergies in their grandchildren within the maternal line (RRR = 1.25, 95% CI: 1.02-1.55). Conclusions: Fathers' smoking during early adolescence and grandmothers' and mothers' smoking during pregnancy may independently increase asthma risk in offspring. Thus, risk factors for asthma should be sought in both parents and before conception.
2.	Bake, Björn, 1939, et al. (författare) Exhaled Particles After a Standardized Breathing Maneuver 2017 Ingår i: Journal of Aerosol Medicine and Pulmonary Drug Delivery. - : Mary Ann Liebert Inc. - 1941-2711 .- 1941-2703. ; 30:4, s. 267-273 Tidskriftsartikel (refereegranskat)abstract Background: Particles in exhaled air (PEx) provide samples of respiratory tract lining fluid from small airways and offer a new opportunity to monitor pathological changes. The exhaled particles are produced by reopening of closed small airways and contain surfactant. The amount of PEx varies by orders of magnitude among subjects. A standardized breathing pattern reduces the variation, but it remains large and the reasons are unknown. The aim of the present study was to assess to what extent sex, age, body size, and spirometry results explain the interindividual variation of PEx among healthy middle-aged subjects. Methods: The PExA((R)) instrument was used to measure PEx in 126 healthy middle-aged nonsmoking subjects participating in the European Respiratory Community Health Survey (ERCS-III). The subjects performed a standardized breathing maneuver involving expiration to residual volume, a breath-hold of 3 seconds, a full inspiration, and then a full expiration into the PExA instrument. PEx number concentrations were expressed per exhalation and per exhaled liter. Age and anthropometric and spirometric variables were analyzed as potential predictors. Results: PEx/L was consistently and negatively associated to lung size-related variables and accordingly lower in men than in women. PEx/Exhalation was similar in women and men. Increasing age was associated with increasing PEx. Reference equations are presented based on age, weight, and spirometry variables and independent of sex. These predictors explained 28%-29% of the interindividual variation. Conclusions: The interindividual variation of PEx after a standardized breathing maneuver is large and the considered predictors explain a minor part only.
3.	Bengtsson, Caroline, et al. (författare) Incident chronic rhinosinusitis is associated with impaired sleep quality: Results of the RhiNE study 2019 Ingår i: Journal of Clinical Sleep Medicine. - : American Academy of Sleep Medicine (AASM). - 1550-9389 .- 1550-9397. ; 15:6, s. 899-905 Tidskriftsartikel (refereegranskat)abstract Study Objectives: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nasal cavity and paranasal sinuses. Associations between CRS and poor sleep quality have been reported. This 10-year follow-up study investigates possible associations between incident CRS and sleep quality. Methods: A questionnaire was sent to 16,500 individuals in Sweden, Norway, Denmark, Iceland and Estonia in 2000. It included questions on airway diseases, age, sex, body mass index, smoking habits, comorbidities, education and sleep quality. In 2010, a second questionnaire was sent to the same individuals, with a response rate of 53%. A subgroup of 5,145 individuals without nasal symptoms in 2000 was studied. Multiple logistic regression was performed to examine associations between CRS (defined according to the European position paper on rhinosinusitis and nasal polyps epidemiological criteria) at follow-up and sleep quality, with adjustment for potential confounders. Individuals with the respective sleep problem at baseline were excluded. Results: Over 10 years, 141 (2.7%) of the individuals without nasal symptoms in 2000 had developed CRS. CRS was associated with difficulties inducing sleep (adjusted odds ratio 2.81 [95% CI 1.67–4.70]), difficulties maintaining sleep (2.07 [1.35–3.18]), early morning awakening (3.03 [1.91–4.81]), insomnia (2.21 [1.46–3.35]), excessive daytime sleepiness (2.85 [1.79–4.55]), and snoring (3.31 [2.07–5.31]). Three insomnia symptoms at baseline increased the risk of CRS at follow-up by 5.00 (1.93–12.99). Conclusions: Incident CRS is associated with impaired sleep quality and excessive daytime sleepiness. Insomnia symptoms may be a risk factor for the development of CRS. © 2019 American Academy of Sleep Medicine. All rights reserved.
4.	Carlsen, Hanne Krage, et al. (författare) Indicators of residential traffic exposure: Modelled NOX, traffic proximity, and self-reported exposure in RHINE III 2017 Ingår i: Atmospheric Environment. - : Elsevier BV. - 1352-2310 .- 1873-2844. ; 167, s. 416-425 Tidskriftsartikel (refereegranskat)abstract Few studies have investigated associations between self-reported and modelled exposure to traffic pollution. The objective of this study was to examine correlations between self-reported traffic exposure and modelled (a) NOX and (b) traffic proximity in seven different northern European cities; Aarhus (Denmark), Bergen (Norway), Gothenburg, Umeå, and Uppsala (Sweden), Reykjavik (Iceland), and Tartu (Estonia). We analysed data from the RHINE III (Respiratory Health in Northern Europe, www.rhine.nu) cohorts of the seven study cities. Traffic proximity (distance to the nearest road with >10,000 vehicles per day) was calculated and vehicle exhaust (NOX) was modelled using dispersion models and land-use regression (LUR) data from 2011. Participants were asked a question about self-reported traffic intensity near bedroom window and another about traffic noise exposure at the residence. The data were analysed using rank correlation (Kendall's tau) and inter-rater agreement (Cohen's Kappa) between tertiles of modelled NOX and traffic proximity tertile and traffic proximity categories (0–150 metres (m), 150–200 m, >300 m) in each centre. Data on variables of interest were available for 50–99% of study participants per each cohort. Mean modelled NOX levels were between 6.5 and 16.0 μg/m3; median traffic intensity was between 303 and 10,750 m in each centre. In each centre, 7.7–18.7% of respondents reported exposure to high traffic intensity and 3.6–16.3% of respondents reported high exposure to traffic noise. Self-reported residential traffic exposure had low or no correlation with modelled exposure and traffic proximity in all centres, although results were statistically significant (tau = 0.057–0.305). Self-reported residential traffic noise correlated weakly (tau = 0.090–0.255), with modelled exposure in all centres except Reykjavik. Modelled NOX had the highest correlations between self-reported and modelled traffic exposure in five of seven centres, traffic noise exposure had the highest correlation with traffic proximity in tertiles in three centres. Self-reported exposure to high traffic intensity and traffic noise at each participant's residence had low or weak although statistically significant correlations with modelled vehicle exhaust pollution levels and traffic proximity. © 2017
5.	Christensen, Stine Holmegaard, et al. (författare) A clear urban-rural gradient of allergic rhinitis in a population-based study in Northern Europe 2016 Ingår i: European clinical respiratory journal. - : Informa UK Limited. - 2001-8525. ; 3 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The protective effect of farm upbringing on allergic rhinitis is well known, but how upbringing in other environments influences the development of allergic rhinitis is scarcely investigated. The aim of this study was to investigate the association between place of upbringing and pet keeping in childhood and allergic rhinitis and nasal symptoms in adulthood.METHODS: The population-based Respiratory Health in Northern Europe study includes subjects from Denmark, Norway, Sweden, Iceland, and Estonia born in 1945-1973. This paper analyses 13,376 participants of the third study wave. Six categories of place of upbringing were defined: farm with livestock, farm without livestock, village in rural area, small town, city suburb, and inner city. Pets in the home at birth and during childhood were recorded. Data were analysed using adjusted logistic regression models.RESULTS: Livestock farm upbringing predicted less adult allergic rhinitis [odds ratio (OR) 0.68, 0.54-0.85] and nasal symptoms (OR 0.82, 0.68-0.99) than city upbringing, and an urban-rural gradient with decreasing risk per level of urbanisation was observed (OR 0.92, 0.88-0.94). Pets in the home at birth (OR 0.78, 0.68-0.88) and during childhood (OR 0.83, 0.74-0.93) were associated with less subsequent allergic rhinitis. Pet keeping did not explain the protective effect of place of upbringing.CONCLUSION: Risk of allergic rhinitis and nasal symptoms in adulthood was inversely associated with the level of urbanisation during upbringing. Pets at birth decreased the risk further, but did not explain the urban-rural gradient. Persistent beneficial effects of microbial diversity in early life might be an explanation for the findings.
6.	Ekbom, Emil, et al. (författare) Asthma and treatment with inhaled corticosteroids: associations with hospitalisations with pneumonia 2019 Ingår i: Bmc Pulmonary Medicine. - : Springer Science and Business Media LLC. - 1471-2466. ; 19:1 Tidskriftsartikel (refereegranskat)abstract Background: Pneumonia is an important cause of morbidity and mortality. COPD patients using inhaled corticosteroids (ICS) have an increased risk of pneumonia, but less is known about whether ICS treatment in asthma also increases the risk of pneumonia. The aim of this analysis was to examine risk factors for hospitalisations with pneumonia in a general population sample with special emphasis on asthma and the use of ICS in asthmatics. Methods: In 1999 to 2000, 7340 subjects aged 28 to 54 years from three Swedish centres completed a brief health questionnaire. This was linked to information on hospitalisations with pneumonia from 2000 to 2010 and treatment with ICS from 2005 to 2010 held within the Swedish National Patient Register and the Swedish Prescribed Drug Register. Results: Participants with asthma (n = 587) were more likely to be hospitalised with pneumonia than participants without asthma (Hazard Ratio (HR 3.35 (1.97-5.02)). Other risk factors for pneumonia were smoking (HR 1.93 (1.22-3.06)), BMI < 20 kg/m(2) (HR 2.74 (1.41-5.36)) or BMI > 30 kg/m(2) (HR 2.54 (1.39-4.67)). Asthmatics (n = 586) taking continuous treatment with fluticasone propionate were at an increased risk of being hospitalized with pneumonia (incidence risk ratio (IRR) 7.92 (2.32-27.0) compared to asthmatics that had not used fluticasone propionate, whereas no significant association was found with the use of budesonide (IRR 1.23 (0.36-4.20)). Conclusion: Having asthma is associated with a three times higher risk of being hospitalised for pneumonia. This analysis also indicates that there are intraclass differences between ICS compounds with respect to pneumonia risk, with an increased risk of pneumonia related to fluticasone propionate.
7.	Flexeder, Claudia, et al. (författare) Second-hand smoke exposure in adulthood and lower respiratory health during 20 year follow up in the European Community Respiratory Health Survey 2019 Ingår i: Respiratory Research. - : BioMed Central. - 1465-9921 .- 1465-993X. ; 20 Tidskriftsartikel (refereegranskat)abstract Early life exposure to tobacco smoke has been extensively studied but the role of second-hand smoke (SHS) for new-onset respiratory symptoms and lung function decline in adulthood has not been widely investigated in longitudinal studies. Our aim is to investigate the associations of exposure to SHS in adults with respiratory symptoms, respiratory conditions and lung function over 20 years. We used information from 3011 adults from 26 centres in 12 countries who participated in the European Community Respiratory Health Surveys I-III and were never or former smokers at all three surveys. Associations of SHS exposure with respiratory health (asthma symptom score, asthma, chronic bronchitis, COPD) were analysed using generalised linear mixed-effects models adjusted for confounding factors (including sex, age, smoking status, socioeconomic status and allergic sensitisation). Linear mixed-effects models with additional adjustment for height were used to assess the relationships between SHS exposure and lung function levels and decline. Reported exposure to SHS decreased in all 26 study centres over time. The prevalence of SHS exposure was 38.7% at baseline (1990-1994) and 7.1% after the 20-year follow-up (2008-2011). On average 2.4% of the study participants were not exposed at the first, but were exposed at the third examination. An increase in SHS exposure over time was associated with doctor-diagnosed asthma (odds ratio (OR): 2.7; 95% confidence interval (95%-CI): 1.2-5.9), chronic bronchitis (OR: 4.8; 95%-CI: 1.6-15.0), asthma symptom score (count ratio (CR): 1.9; 95%-CI: 1.2-2.9) and dyspnoea (OR: 2.7; 95%-CI: 1.1-6.7) compared to never exposed to SHS. Associations between increase in SHS exposure and incidence of COPD (OR: 2.0; 95%-CI: 0.6-6.0) or lung function (beta: - 49 ml; 95%-CI: -132, 35 for FEV1 and beta: - 62 ml; 95%-CI: -165, 40 for FVC) were not apparent. Exposure to second-hand smoke may lead to respiratory symptoms, but this is not accompanied by lung function changes.
8.	Fuertes, Elaine, et al. (författare) Leisure-time vigorous physical activity is associated with better lung function : the prospective ECRHS study 2018 Ingår i: Thorax. - : BMJ Publishing Group Ltd. - 0040-6376 .- 1468-3296. ; 73:4, s. 376-384 Tidskriftsartikel (refereegranskat)abstract Objective: We assessed associations between physical activity and lung function, and its decline, in the prospective population-based European Community Respiratory Health Survey cohort. Methods: FEV1 and FVC were measured in 3912 participants at 27-57 years and 39-67 years (mean time between examinations= 11.1 years). Physical activity frequency and duration were assessed using questionnaires and used to identify active individuals (physical activity >= 2 times and >= 1 hour per week) at each examination. Adjusted mixed linear regression models assessed associations of regular physical activity with FEV1 and FVC. Results: Physical activity frequency and duration increased over the study period. In adjusted models, active individuals at the first examination had higher FEV1 (43.6 mL (95% CI 12.0 to 75.1)) and FVC (53.9 mL (95% CI 17.8 to 89.9)) at both examinations than their non-active counterparts. These associations appeared restricted to current smokers. In the whole population, FEV1 and FVC were higher among those who changed from inactive to active during the follow-up (38.0 mL (95% CI 15.8 to 60.3) and 54.2 mL (95% CI 25.1 to 83.3), respectively) and who were consistently active, compared with those consistently non-active. No associations were found for lung function decline. Conclusion: Leisure-time vigorous physical activity was associated with higher FEV1 and FVC over a 10-year period among current smokers, but not with FEV1 and FVC decline.
9.	Fuertes, Elaine, et al. (författare) Residential air pollution does not modify the positive association between physical activity and lung function in current smokers in the ECRHS study 2018 Ingår i: Environment International. - : Elsevier. - 0160-4120 .- 1873-6750. ; 120, s. 364-372 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Very few studies have examined whether a long-term beneficial effect of physical activity on lung function can be influenced by living in polluted urban areas.OBJECTIVE: We assessed whether annual average residential concentrations of nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters < 2.5 μm (PM2.5) and <10 μm (PM10) modify the effect of physical activity on lung function among never- (N = 2801) and current (N = 1719) smokers in the multi-center European Community Respiratory Health Survey.METHODS: Associations between repeated assessments (at 27-57 and 39-67 years) of being physically active (physical activity: ≥2 times and ≥1 h per week) and forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were evaluated using adjusted mixed linear regression models. Models were conducted separately for never- and current smokers and stratified by residential long-term NO2, PM2.5 mass and PM10 mass concentrations (≤75th percentile (low/medium) versus >75th percentile (high)).RESULTS: Among current smokers, physical activity and lung function were positively associated regardless of air pollution levels. Among never-smokers, physical activity was associated with lung function in areas with low/medium NO2, PM2.5 mass and PM10 mass concentrations (e.g. mean difference in FVC between active and non-active subjects was 43.0 mL (13.6, 72.5), 49.5 mL (20.1, 78.8) and 49.7 mL (18.6, 80.7), respectively), but these associations were attenuated in high air pollution areas. Only the interaction term of physical activity and PM10 mass for FEV1 among never-smokers was significant (p-value = 0.03).CONCLUSIONS: Physical activity has beneficial effects on adult lung function in current smokers, irrespective of residential air pollution levels in Western Europe. Trends among never-smokers living in high air pollution areas are less clear.
10.	Holm, Hannes, et al. (författare) A Bayesian network model for likelihood estimations of acquirement of critical software vulnerabilities and exploits 2015 Ingår i: Information and Software Technology. - : Elsevier BV. - 0950-5849 .- 1873-6025. ; 58, s. 304-318 Tidskriftsartikel (refereegranskat)abstract Context: Software vulnerabilities in general, and software vulnerabilities with publicly available exploits in particular, are important to manage for both developers and users. This is however a difficult matter to address as time is limited and vulnerabilities are frequent. Objective: This paper presents a Bayesian network based model that can be used by enterprise decision makers to estimate the likelihood that a professional penetration tester is able to obtain knowledge of critical vulnerabilities and exploits for these vulnerabilities for software under different circumstances. Method: Data on the activities in the model are gathered from previous empirical studies, vulnerability databases and a survey with 58 individuals who all have been credited for the discovery of critical software vulnerabilities. Results: The proposed model describes 13 states related by 17 activities, and a total of 33 different datasets. Conclusion: Estimates by the model can be used to support decisions regarding what software to acquire, or what measures to invest in during software development projects.
11.	Holm, Hannes, et al. (författare) P2CySeMoL : Predictive, Probabilistic Cyber Security Modeling Language 2015 Ingår i: IEEE Transactions on Dependable and Secure Computing. - : IEEE Press. - 1545-5971 .- 1941-0018. ; 12:6, s. 626-639 Tidskriftsartikel (refereegranskat)abstract This paper presents the Predictive, Probabilistic Cyber Security Modeling Language ((PCySeMoL)-Cy-2), an attack graph tool that can be used to estimate the cyber security of enterprise architectures. (PCySeMoL)-Cy-2 includes theory on how attacks and defenses relate quantitatively; thus, users must only model their assets and how these are connected in order to enable calculations. The performance of (PCySeMoL)-Cy-2 enables quick calculations of large object models. It has been validated on both a component level and a system level using literature, domain experts, surveys, observations, experiments and case studies.
12.	Holm, Mathias, 1969, et al. (författare) Incidence of new-onset wheeze: a prospective study in a large middle-aged general population 2015 Ingår i: Bmc Pulmonary Medicine. - : Springer Science and Business Media LLC. - 1471-2466. ; 15 Tidskriftsartikel (refereegranskat)abstract Background: Wheeze is a very common respiratory symptom, which is associated with several factors and diseases. Studies on incidence of new-onset wheeze in general adult populations are rare. The present prospective study aimed to investigate the incidence rate of new-onset wheeze, and predictors for wheeze, in a general, middle-aged population. Methods: Individuals, born 1943-1973, who had participated in a previous Swedish study in 1993 (n = 15,813), were mailed a new respiratory questionnaire in 2003. The questionnaire, which included items about respiratory symptoms, atopy, and smoking was answered by 11,463 (72 %). Incidence rates of new-onset wheeze were calculated. Cox regression analyses were performed with incident wheeze as an event and person-years under observation as dependent variable. Results: Among those free of wheeze at baseline (n = 8885), there were 378 new cases of wheeze during the study period (1993-2003). The incidence rate was 4.3/1000 person-years. The adjusted risk was increased in relation to smoking (HR 2.1;95 % CI 1.7-2.7), ex-smoking (HR 1.4;95 % CI 1.1-1.9), young age (HR 1.7;95 % CI 1.3-2.2), chronic bronchitis (HR 2.3;95 % CI 0.96-5.7), and rhinitis (HR 1.8;95 % CI 1.4-2.2) at baseline, and body mass index = 30 (HR 1.9;95 % CI 1.5-2.6) at follow-up. Conclusions: This is a unique study that presents an incidence rate for new-onset wheeze in a middle-aged, general population sample previously free of adult wheeze. The results indicate that new-onset wheeze is quite common in this age group. Health care staff should bear this in mind since new-onset wheeze could be one of the earliest symptoms of severe respiratory disease. Special attention should be paid to patients with a smoking history, chronic bronchitis, rhinitis or obesity.
13.	Holm, Mathias, 1969, et al. (författare) Predictors of smoking cessation : A longitudinal study in a large cohort of smokers 2017 Ingår i: Respiratory Medicine. - : Saunders Elsevier. - 0954-6111 .- 1532-3064. ; 132, s. 164-169 Tidskriftsartikel (refereegranskat)abstract Background: There are few studies on predictors of smoking cessation in general populations. We studied the smoking cessation rate in relation to several potential predictors, with special focus on respiratory and cardiovascular disease. Methods: Smokers (n = 4636) from seven centres in Northern Europe, born between 1945 and 1973, who answered a questionnaire in 1999-2001 (the RHINE study) were followed up with a new questionnaire in 2010-2012. Altogether 2564 answered the questionnaire and provided complete data on smoking. Cox regression analyses were performed to calculate hazard ratios (HRs). Results: A total of 999 subjects (39%) stopped smoking during the study period. The smoking cessation rate was 44.9/1000 person-years. Smoking cessation was more common with increasing age, higher education and fewer years of smoking. Asthma, wheeze, hay fever, chronic bronchitis, diabetes and hypertension did not significantly predict smoking cessation, but smokers hospitalized for ischaemic heart disease during the study period were more prone to stopping smoking (HR 3.75 [2.62-5.37]). Conclusions: Successful smoking cessation is common in middle-aged smokers, and is associated with few smoking years and higher education. A diagnosis of respiratory disease does not appear to motivate people to quit smoking, nor do known cardiovascular risk factors; however, an acute episode of ischaemic heart disease encouraged smoking cessation in our study population.
14.	Janson, Christer, et al. (författare) Pharmacological treatment of asthma in a cohort of adults during a 20-year period : results from the European Community Respiratory Health Survey I, II and III 2019 Ingår i: ERJ Open Research. - : European Respiratory Society. - 2312-0541. ; 5:1 Tidskriftsartikel (refereegranskat)abstract Asthma often remains uncontrolled, despite the fact that the pharmacological treatment has undergone large changes. We studied changes in the treatment of asthma over a 20-year period and identified factors associated with the regular use of inhaled corticosteroid (ICS) treatment. Changes in the use of medication were determined in 4617 randomly selected subjects, while changes in adults with persistent asthma were analysed in 369 participants. The study compares data from three surveys in 24 centres in 11 countries. The use of ICSs increased from 1.7% to 5.9% in the general population and the regular use of ICSs increased from 19% to 34% among persistent asthmatic subjects. The proportion of asthmatic subjects reporting asthma attacks in the last 12 months decreased, while the proportion that had seen a doctor in the last 12 months remained unchanged (42%). Subjects with asthma who had experienced attacks or had seen a doctor were more likely to use ICSs on a regular basis. Although ICS use has increased, only one-third of subjects with persistent asthma take ICSs on a regular basis. Less than half had seen a doctor during the last year. This indicates that underuse of ICSs and lack of regular healthcare contacts remains a problem in the management of asthma.
15.	Johannessen, Ane, et al. (författare) Long-term air pollution exposure is associated with sick leave 20 years later 2018 Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Background: Little is known on outdoor air pollution in a long-term perspective and societal costs such as sick leave. In the Nordic countries, recent pollution health impact assessments have had to rely on outdated studies.Aims: To investigate if air pollution exposure is associated with sick leave 20 years later.Methods: We analysed self-reported sick leave (all-cause and respiratory) in 7 466 subjects from Bergen, Gothenburg, Umea, Uppsala in the RHINE3 study in 2010-12. Home addresses were geocoded and linked to annual average concentrations of PM2.5, PM10 and NO2 at RHINE3, 10 years earlier and 20 years earlier, using existing land-use regression (LUR) models. We performed multilevel logistic regression clustered by centre, and adjusted for sex, smoking, education and previous health-related workplace change.Results: Age range in RHINE3 was 40-66 yrs, 34% and 4% reported all-cause and respiratory sick leave during the last year. In the adjusted analyses all-cause sick leave was associated with PM2.520 years earlier (OR per interquartile range (IQR) difference (2.6 µg/m³) 1.12 (95%CI 1.01, 1.24)), and borderline with NO2 (OR per IQR diff (8.1 µg/m³) 1.09 (95%CI 0.99, 1.19)). Respiratory sick leave was associated with PM10 20 years earlier (OR per IQR diff (3.92 µg/m³) 1.54 (95%CI 1.06, 2.25)), and borderline with PM2.5 (OR per IQR diff 1.31 (95%CI 0.97, 1.76)). Pollution exposures at present as well as 10 years earlier were not significantly associated with sick leave.Conclusions: Air pollution exposure in a general population is associated with sick leave in a 20-year perspective. Our findings suggest that even low air pollution levels such as in Northern Europe have societal costs over time.
16.	Kim, Jeong-Lim, et al. (författare) Impact of occupational exposures on exacerbation of asthma: a population-based asthma cohort study. 2016 Ingår i: BMC pulmonary medicine. - : Springer Science and Business Media LLC. - 1471-2466. ; 16:1 Tidskriftsartikel (refereegranskat)abstract Asthma is a prevalent chronic disease and occupation contributes to approximately 15% of cases among adults. However, there are still few studies on risk factors for work-exacerbated asthma. The current study investigated the association between asthma exacerbations and occupational exposures.The study comprised all currently working adults (n=1356) who reported ever asthma in prior population-based cohorts. All subjects completed a questionnaire about exposures, occupations and exacerbations of asthma. Exposure to high and low molecular weight agents, irritating agents and asthmagens were classified using the asthma-specific job exposure matrix for northern Europe (N-JEM). Severe exacerbation of asthma was defined as sought emergency care at a hospital, admitted to a hospital overnight, or made an urgent visit to a primary care physician or district medical office due to breathing problems during the last 12months. Moderate exacerbation was defined as both being not severe exacerbation and an additional visit to a primary care physician or district medical office, or had extra treatments with corticosteroid tablets. Mild exacerbation was defined as being neither severe nor moderate exacerbation, and increasing usage of inhaled corticosteroids. Multiple logistic regression was applied to investigate the association between exacerbation of asthma and occupational exposures while adjusting for potential confounders.Approximately 26% of the working asthmatics reported exacerbation, and more than two-thirds of them had moderate or severe exacerbation. From 23 to 49% of the asthmatics reported occupational exposure to a variety of different types of agents. Exposure to any gas, smoke or dust (OR 1.7[95 % CI 1.2-2.6]) was associated with severe exacerbation of asthma, as were organic dust (OR 1.7[1.2-2.5]), dampness and mold (OR 1.8[1.2-2.7]), cold conditions (OR 1.7[1.1-2.7]), and a physically strenuous job (OR 1.6[1.03-2.3]). Asthmagens and low molecular weight agents classified by the N-JEM were associated with mild exacerbation, with OR 1.6[1.1-2.5] and OR 2.2[1.1-4.4], respectively.Self-reported exposure to any gas, smoke or dust, organic dust, dampness and mold, cold conditions and physically strenuous work, and jobs handling low molecular weight agents were associated with exacerbation of asthma. Reduction of these occupational exposures may help to reduce exacerbation of asthma.
17.	Klionsky, Daniel J, et al. (författare) Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition). 2016 Ingår i: Autophagy. - : Informa UK Limited. - 1554-8635 .- 1554-8627. ; 12:1, s. 1-222 Tidskriftsartikel (refereegranskat)
18.	Kuiper, I. N., et al. (författare) Agreement in reporting of asthma by parents or offspring - the RHINESSA generation study 2018 Ingår i: Bmc Pulmonary Medicine. - : Springer Science and Business Media LLC. - 1471-2466. ; 18:122 Tidskriftsartikel (refereegranskat)abstract Background: Self-report questionnaires are commonly used in epidemiology, but may be susceptible to misclassification, especially if answers are given on behalf of others, e.g. children or parents. The aim was to determine agreement and analyse predictors of disagreement in parents' reports of offspring asthma, and in offspring reports of parents' asthma. Methods: In the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study, 6752 offspring (age range 18-51 years) and their parents (age range 39-66 years) reported their own and each other's asthma status. Agreement between asthma reports from offspring and parents was determined by calculating sensitivity, specificity, positive and negative predictive value and Cohen's kappa. The participants' own answers regarding themselves were defined as the gold standard. To investigate predictors for disagreement logistic regression analyses were performed to obtain odds ratios (OR) with 95% confidence intervals (CI) for sex, smoking status, education, comorbidity and severity of asthma. Results: Agreement was good for parental report of offspring early onset asthma (< 10 years, Cohen's kappa 0.72) and moderate for offspring later onset asthma (Cohen's kappa 0.46). Specificity was 0.99 for both, and sensitivity was 0.68 and 0.36, respectively. For offspring report of maternal and paternal asthma the agreement was good (Cohen's kappa 0.69 and 0.68), specificity was 0.96 and 0.97, and sensitivity was 0.72 and 0.68, respectively. The positive predictive value (PPV) was lowest for offspring report of maternal asthma (0.75), and highest for parents' report of early onset asthma in the offspring (0.83). The negative predictive value (NPV) was high for all four groups (0.94-0.97). In multivariate analyses current smokers (OR = 1.46 [95% CI 1.05, 2.02]) and fathers (OR = 1.31 [95% CI 1. 08, 1.59]) were more likely to report offspring asthma incorrectly. Offspring wheeze was associated with reporting parental asthma incorrectly (OR = 1.60 [95% CI 1.21, 2.11]), both under- and over reporting. Conclusions: Asthma reports across generations show moderate to good agreement, making information from other generations a useful tool in the absence of direct reports.
19.	Kuiper, Ingrid Nordeide, et al. (författare) Lung health in adulthood after childhood exposure to air pollution and greenness 2018 Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Background: Little is known on childhood exposure to air pollution and adult chronic respiratory outcomes.Aim: To investigate associations between air pollution and greenness in childhood and adult lung health.Methods: In selected centres of the RHINESSA study (age 18-52) we analysed the outcomes respiratory symptoms (≥3 symptoms), severe wheeze (wheeze last year with breathlessness, no cold) and late onset asthma (>10 years). We calculated mean annual exposures of PM2.5, PM10, NO2 (µg/m³) and greenness (Normalized Difference Vegetation Index, 100m buffer) from offspring's birth till age 18, categorised into mean exposure <10 years and 11-18 years. We performed multilevel logistic regression clustered by family, stratified by centre and adjusted for childhood passive smoke and parental asthma.Results: 12% had ≥3 respiratory symptoms, 7.7% severe wheeze, and 9.4% late onset asthma. Overall estimates: greenness was associated with less respiratory symptoms, PM2.5 and NO2 with more late onset asthma. Exposure <10 years: Greenness was associated with less wheeze in Tartu (OR 0.29, 95%CI 0.11-0.73). PM2.5 (OR 1.22, 95%CI 1.00-1.48) and NO2 (OR 1.06, 95%CI 1.01-1.11) were risk factors for late onset asthma in Bergen. PM10 was a risk factor for respiratory symptoms (OR 1.21, 95%CI 1.04-1.41) in Uppsala and late onset asthma (OR 1.23, 95%CI 1.02-1.45) in Bergen. Exposure 11-18 years: Greenness was protective for respiratory symptoms (OR 0.29, 95%CI 0.10-0.86) and wheeze (OR 0.39, 95%CI 0.19-0.80) in Tartu.Conclusions: Childhood exposure to greenness was associated with less respiratory symptoms, while air pollutants were associated with more respiratory symptoms (some centres) and late onset asthma.
20.	Kuiper, Ingrid Nordeide, et al. (författare) Preconception air pollution exposure and early onset asthma and hay fever in the offspring 2019 Ingår i: European Respiratory Journal. - Sheffield : European Respiratory Society Journals. - 0903-1936 .- 1399-3003. ; 54 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
21.	Lindberg, Eva, et al. (författare) Women with symptoms of sleep-disordered breathing are less likely to be diagnosed and treated for sleep apnea than men 2017 Ingår i: Sleep Medicine. - : ELSEVIER SCIENCE BV. - 1389-9457 .- 1878-5506. ; 35, s. 17-22 Tidskriftsartikel (refereegranskat)abstract Background: Women are often underrepresented at sleep clinics evaluating sleep-disordered breathing (SDB). The aim of the present study was to analyze gender differences in sleep apnea diagnosis and treatment in men and women with similar symptoms of SDB.Methods: Respiratory Health in Northern Europe (RHINE) provided information about snoring, excessive daytime sleepiness (EDS), BMI and somatic diseases at baseline (1999-2001) and follow-up (2010-2012) from 4962 men and 5892 women. At follow-up participants were asked whether they had a diagnosis of and/or treatment for sleep apnea.Results: Among those with symptoms of SDB (snoring and EDS), more men than women had been given the diagnosis of sleep apnea (25% vs. 14%, p < 0.001), any treatment (17% vs. 11%, p = 0.05) and CPAP (6% vs. 3%, p = 0.04) at follow-up. Predictors of receiving treatment were age, BMI, SDB symptoms at baseline and weight gain, while female gender was related to a lower probability of receiving treatment (adj OR 0.3, 95% CI 0.3-0.5). In both genders, the symptoms of SDB increased the risk of developing hypertension (adj OR, 95% CI: 1.5, 1.2-1.8); and diabetes (1.5, 1.05-2.3), independent of age, BMI, smoking and weight gain.Conclusions: Snoring females with daytime sleepiness may be under-diagnosed and under-treated for sleep apnea compared with males, despite running a similar risk of developing hypertension and diabetes.
22.	Lonnebotn, Marianne, et al. (författare) Late Breaking Abstract - Associations of fathers and their offsprings weight gain with non-allergic asthma 2018 Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Background: We found that a father’s overweight in puberty was associated with non-allergic asthma in his future offspring.Aim: We explored the associations of both fathers and their offsprings own weight gain throughout the lifespan with offspring non-allergic asthma.Methods: We analysed questionnaire data from 3018 adult offspring (age 18-50) and their 2153 fathers (age 39-66) participating in the RHINESSA/RHINE generation study in 10 ECRHS centres in North Europe, Spain and Australia. The associations of fathers' and their offsprings weight gain was assessed by 9 body silhouettes (from lean to fat) self-reported for childhood, puberty and adult ages with non-allergic asthma in the offspring. It was analysed using a logistic regression model adjusted for parents and offspring variables, and cluster by family.Results: Non-allergic asthma was related to a weight gain of ≥2 body silhouettes from 8 years to puberty, both for fathers’ weight gain (OR 1.69; 95% CI 1.05-2.72; adjusted for fathers asthma, offspring body mass index, smoking and education) and for their offspring weight gain (1.77 [1.12-2.79], adjusted for parents´ education, smoking and asthma, and fathers´ weight gain from age 8 to puberty). If the father was overweight at puberty, in addition to having gained weight, non-allergic asthma in the offspring was more than tripled (3.53[1.80-6.94]; weight gain and adjustment as given above). No effect of weight gain from puberty or within adulthood in fathers’ or their offspring was observed.Conclusion: Non-allergic asthma was associated with weight gain from childhood to puberty. This was found both for personal weight gain and for having a father who gained weight.
23.	Lønnebotn, Marianne, et al. (författare) Body silhouettes as a tool to reflect obesity in the past 2018 Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 13:4 Tidskriftsartikel (refereegranskat)abstract Life course data on obesity may enrich the quality of epidemiologic studies analysing health consequences of obesity. However, achieving such data may require substantial resources. We investigated the use of body silhouettes in adults as a tool to reflect obesity in the past. We used large population-based samples to analyse to what extent self-reported body silhouettes correlated with the previously measured (9-23 years) body mass index (BMI) from both measured (European Community Respiratory Health Survey, N = 3 041) and selfreported (Respiratory Health In Northern Europe study, N = 3 410) height and weight. We calculated Spearman correlation between BMI and body silhouettes and ROC-curve analyses for identifying obesity (BMI >= 30) at ages 30 and 45 years. Spearman correlations between measured BMI age 30 (+/- 2y) or 45 (+/- 2y) and body silhouettes in women and men were between 0.62-0.66 and correlations for self-reported BMI were between 0.58-0.70. The area under the curve for identification of obesity at age 30 using body silhouettes vs previously measured BMI at age 30 (+/- 2y) was 0.92 (95% CI 0.87, 0.97) and 0.85 (95% CI 0.75, 0.95) in women and men, respectively; for previously self-reported BMI, 0.92 (95% CI 0.88, 0.95) and 0.90 (95% CI 0.85, 0.96). Our study suggests that body silhouettes are a useful epidemiological tool, enabling retrospective differentiation of obesity and non-obesity in adult women and men.
24.	Lønnebotn, Marianne, et al. (författare) Polycystic ovary syndrome, body mass index and hypertensive disorders in pregnancy 2018 Ingår i: Pregnancy Hypertension. - : Elsevier. - 2210-7789 .- 2210-7797. ; 11, s. 32-37 Tidskriftsartikel (refereegranskat)abstract Objective: Some studies of women with polycystic ovary syndrome (PCOS) report increased prevalence of hypertensive disorders in pregnancy, while others do not. Several of these studies do not control for obesity. We aimed to study whether PCOS is associated with hypertensive disorders in pregnancy and whether it is dependent on body mass index (BMI).Study design: We present a cross-sectional analysis of 3732 women from Denmark, Estonia, Iceland, Norway and Sweden, born in 1945-72, who participated in the Respiratory Health In Northern Europe (RHINE) study and answered an extensive women's health questionnaire on menstruation, PCOS, infertility, pregnancy history and childbirth. The main outcome measurement was hypertensive disorders of pregnancy. We adjusted for smoking, age, infertility treatment and study center. Effect modification by BMI was assessed.Results: PCOS was related to hypertensive disorders in pregnancy with a relative risk (RR) of 1.62 (95% CI 1.09-2.42). This relationship was found among underweight women with a BMI of <18.5 kg/m(2) [RR=5.2 (95% CI 1.66-16.5)] and obese women with a BMI of >= 30 kg/m(2) [RR=2.36 (95% CI 1.29-4.31)], but not among normal-weight women, BMI 18.5-25 kg/m(2) [1.08 (0.53-2.20)], or overweight women, BMI 25-30 kg/m(2) [1.24 (0.50-3.08)] (p-interaction=0.041).Conclusion: Polycystic ovary syndrome is associated with hypertensive disorders in pregnancy. This association only occurs among underweight and obese women and not among normal-weight and slightly overweight women.
25.	Marcon, A., et al. (författare) Trends in smoking initiation in Europe over 40 years: A retrospective cohort study 2018 Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 13:8 Tidskriftsartikel (refereegranskat)abstract Background Tobacco consumption is the largest avoidable health risk. Understanding changes of smoking over time and across populations is crucial to implementing health policies. We evaluated trends in smoking initiation between 1970 and 2009 in random samples of European populations. We pooled data from six multicentre studies involved in the Ageing Lungs in European Cohorts consortium, including overall 119,104 subjects from 17 countries (range of median ages across studies: 33-52 years). We estimated retrospectively trends in the rates of smoking initiation (uptake of regular smoking) by age group, and tested birth cohort effects using Age-Period-Cohort (APC) modelling. We stratified all analyses by sex and region (North, East, South, West Europe). Smoking initiation during late adolescence (16-20 years) declined for both sexes and in all regions (except for South Europe, where decline levelled off after 1990). By the late 2000s, rates of initiation during late adolescence were still high (40-80 per 1000/year) in East, South, and West Europe compared to North Europe (20 per 1000/year). Smoking initiation rates during early adolescence (11-15 years) showed a marked increase after 1990 in all regions (except for North European males) but especially in West Europe, where they reached 40 per 1000/year around 2005. APC models supported birth cohort effects in the youngest cohorts. Smoking initiation is still unacceptably high among European adolescents, and increasing rates among those aged 15 or less deserve attention. Reducing initiation in adolescents is fundamental, since youngsters are particularly vulnerable to nicotine addiction and tobacco adverse effects.
26.	Markevych, Iana, et al. (författare) Residential greenness and lung function in a prospective cohort of European adults : The ECRHS study 2019 Ingår i: European Respiratory Journal. - : European Respiratory Society Journals. - 0903-1936 .- 1399-3003. ; 54 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
27.	Mindus, Stephanie, et al. (författare) Asthma and COPD overlap (ACO) is related to a high burden of sleep disturbance and respiratory symptoms: Results from the RHINE and Swedish GA(2)LEN surveys 2018 Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 13:4 Tidskriftsartikel (refereegranskat)abstract Background The term Asthma and COPD Overlap (ACO) describes a condition where asthma and COPD overlap. We aimed to investigate associations between ACO and insomnia and respiratory symptoms, and to investigate the prevalence of ACO and the characteristics of subjects with ACO in two Northern European population studies. The study comprised 25 429 subjects aged >40 years who participated in one of two Northern European general population surveys. Both surveys included questions on asthma, COPD, respiratory and sleep-related symptoms, including difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and excessive daytime sleepiness. ACO was defined as having both self-reported asthma and COPD. The prevalence of ACO was 1.0%. The group with ACO had a higher prevalence of both insomnia and respiratory symptoms than subjects with only asthma or COPD. Having ACO was independently associated with a 2-3 times higher probability of having sleep-related symptoms as compared with the group without asthma or COPD, after adjustment for age, sex, BMI, smoking history and educational level (adjusted odds ratio 2.14-3.36, 95% CI). Subjects with ACO have a high prevalence of insomnia and respiratory symptoms. To our knowledge, this is the first study to assess the association between sleep-related symptoms and ACO.
28.	Norqvist, Mathias, et al. (författare) Investigating algorithmic and creative reasoning strategies by eye tracking 2019 Ingår i: Journal of Mathematical Behavior. - : Elsevier. - 0732-3123 .- 1873-8028. ; 55 Tidskriftsartikel (refereegranskat)abstract Imitative teaching and learning approaches have been dominating in mathematics education. Although more creative approaches (e.g. problem-based learning) have been proposed and implemented, a main challenge of mathematics education research is to document robust links between teaching, tasks, student activities and learning. This study investigates one aspect of such links, by contrasting tasks providing algorithmic solution templates with tasks requiring students’ constructions of solutions and relating this to students’ learning processes and outcomes. Information about students’ task solving strategies are gathered by corneal eye-tracking, which is related to subsequent post-test performances and individual variation in cognitive proficiency. Results show that students practicing by creative tasks outperform students practicing by imitative algorithmic tasks in the post-test, but also that students that perform less well on creative tasks tend to try ineffective imitative strategies.
29.	Pape, Kathrine, et al. (författare) Agreement of offspring-reported parental smoking status : the RHINESSA generation study 2019 Ingår i: BMC Public Health. - : BMC. - 1471-2458. ; 19 Tidskriftsartikel (refereegranskat)abstract Background: With increasing interest in exposure effects across generations, it is crucial to assess the validity of information given on behalf of others.Aims: To compare adult's report of their parent’s smoking status against parent's own report and examine predictors for discrepant answers.Methods: We studied 7185 offspring (18-51 years) and one of their parents, n = 5307 (27-67 years) participating in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study. Information about parent's smoking status during offspring's childhood and mother's smoking status during pregnancy was obtained by questionnaires from parents and their offspring. We calculated sensitivity, specificity and Cohen's Kappa [κ] for agreement using parent's own report as the gold standard. We performed logistic regression to examine if offspring's sex, age, educational level, asthma status, own smoking status or parental status, as well as the parent's sex and amount of smoking during childhood predicted disagreement.Results: The sensitivity for offspring's correct report of parent's smoking status during childhood (0-10 years) was 0.82 (95% CI 0.81–0.84), specificity was 0.95 (95% CI 0.95–0.96) and a good agreement was observed, κ = 0.79 (95% CI 0.78–0.80). Offspring's report of mothers' smoking status during pregnancy showed a lower sensitivity, 0.66 (95% CI 0.60–0.71), a slightly lower specificity, 0.92 (95% CI 0.90–0.95) and a good agreement, κ = 0.61 (95% CI 0.55–0.67). In multivariate logistic regression analysis, offspring not having children was a predictor for discrepant answers (odds ratio [OR] 2.11 [95% CI 1.21–3.69]). Low amount of parents' tobacco consumption, < 10 cigarettes/day (OR 2.72 [95% CI 1.71–4.31]) also predicted disagreement compared to ≥10 cigarettes per day, and so did offspring's reports of fathers' smoking status (OR 1.73 [95% CI 1.09–2.74]) compared to mothers' smoking status. Offspring's sex, asthma status, educational level, smoking status or age was not related to discrepant answers.Conclusions: Adults report their parent's smoking status during their childhood, as well as their mothers' smoking status when pregnant with them, quite accurately. In the absence of parents' direct report, offspring's reports could be valuable.
30.	Pekkanen, Juha, et al. (författare) Indoor bacteria and asthma in adults : a multicentre case-control study within ECRHS II 2018 Ingår i: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 51:2 Tidskriftsartikel (refereegranskat)abstract Both protective and adverse effects of indoor microbial exposure on asthma have been reported, but mostly in children. To date, no study in adults has used non-targeted methods for detection of indoor bacteria followed by quantitative confirmation. A cross-sectional study of 198 asthmatic and 199 controls was conducted within the European Community Respiratory Health Survey (ECRHS) II. DNA was extracted from mattress dust for bacterial analysis using denaturing gradient gel electrophoresis (DGGE). Selected bands were sequenced and associations with asthma confirmed with four quantitative PCR (qPCR) assays. 15 out of 37 bands detected with DGGE, which had at least a suggestive association (p<0.25) with asthma, were sequenced. Of the four targeted qPCRs, Clostridium cluster XI confirmed the protective association with asthma. The association was dose dependent (aOR 0.43 (95% CI 0.22-0.84) for the fourth versus first quartile, p for trend 0.009) and independent of other microbial markers. Few significant associations were observed for the three other qPCRs used. In this large international study, the level of Clostridium cluster XI was independently associated with a lower risk of prevalent asthma. Results suggest the importance of environmental bacteria also in adult asthma, but need to be confirmed in future studies.
31.	Peralta, Gabriela P., et al. (författare) Body mass index trajectories during adult life and lung function decline 2018 Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Body mass index (BMI) has been associated with lung function. Whether distinct BMI trajectories during adult life affect lung function differently is unknown. We assessed associations of BMI trajectories from 34 to 54 years with lung function decline over the same period of time in the ECRHS cohort.BMI trajectories were developed using Group-Based Trajectory Modeling on data collected at least twice between ECRHS I and ECRHS III (n=9327). Associations of these trajectories with lung function decline were assessed using mixed linear regression models (adjusted for sex, age, age2, height, smoking status and baseline lung function) in a subgroup (n=3534) with lung function data at ECRHS I and III. As sex-specific analyses showed similar findings, males and females were combined.Four parallel trajectories were identified: ‘normal’, ‘overweight’, ‘obese’ and ‘morbidly obese’ (Fig. 1). Those with higher BMI trajectories had greater decline of FEV1 and FVC than those with ‘normal BMI’ trajectory (Fig. 2).Overweight and obese trajectories of BMI during adult life were associated with greater lung function decline in the ECRHS cohort.
32.	Rocha Flores, Waldo, et al. (författare) Investigating personal determinants of phishing and the effect of national culture 2015 Ingår i: Information Management & Computer Security. - : Emerald Group Publishing Limited. - 0968-5227 .- 1758-5805. ; 23:2 Tidskriftsartikel (refereegranskat)abstract Purpose – The purpose of the study was twofold: to investigating the correlation between a sample of personal psychological and demographic factors and resistance to phishing; and to investigate if national culture moderates the strength of these correlations.Design/methodology/approach – To measure potential determinants, a survey was distributed to 2099 employees of nine organizations in Sweden, USA, and India. Then, we conducted unannounced phishing exercises in where a phishing attack targeted the same sample.Findings – Intention to resist social engineering, general information security awareness, formal IS training, and computer experience were identified to have a positive significant correlation to phishing resilience. Furthermore, the results showed that the correlation between phishing determinants and employees’ observed phishing behavior differs between Swedish, US and Indian employees in six out of fifteen cases.Research limitations/implications – The identified determinants all had, even though not a strong, a significant positive correlation. This suggests that more work needs to be done in order to more fully understand determinants of phishing. The study assumes that culture effects apply to all individuals in a nation. However, difference based on cultures might exist based on firm characteristics within a country. The Swedish sample is dominating, while only 40 responses from Indian employees were collected. This unequal size of samples suggests that conclusions based on the results from the cultural analysis should be drawn cautiously. A natural continuation of our research is therefore to further explore the generalizability of our findings by collecting data from other nations with similar cultures as Sweden, USA and India.Originality/value – Using direct observations of employees’ security behaviors has rarely been used in previous research. Furthermore, analyzing potential differences in theoretical models based on national culture is an understudied topic in the behavioral information security field. This paper addresses these both two issues.
33.	Rocha Flores, Waldo, et al. (författare) Investigating the correlation between intention and action in the context of social engineering in two different national cultures 2015 Ingår i: Proceedings of the 48th Annual Hawaii International Conference on System Sciences. - : IEEE Computer Society. - 9781479973675 ; , s. 3508-3517, s. 3508-3517 Konferensbidrag (refereegranskat)
34.	Russell, Melissa A., et al. (författare) Physical activity and asthma : a longitudinal and multi-country study 2017 Ingår i: Journal of Asthma. - Abingdon : Taylor & Francis. - 0277-0903 .- 1532-4303. ; 54:9, s. 938-945 Tidskriftsartikel (refereegranskat)abstract Objective: To investigate the impact of physical activity on asthma in middle-aged adults, in one longitudinal analysis, and one multi-centre cross-sectional analysis.Methods: The Respiratory Health in Northern Europe (RHINE) is a population-based postal questionnaire cohort study. Physical activity, height and weight were self-reported in Bergen, Norway, at RHINE II (1999â€“2001) and all centres at RHINE III (2010â€“2012). A longitudinal analysis of Bergen data investigated the association of baseline physical activity with follow-up asthma, incident asthma and symptoms, using logistic and zero-inflated Poisson regression (n = 1782). A cross-sectional analysis of all RHINE III centres investigated the association of physical activity with concurrent asthma and symptoms (n = 13,542) using mixed-effects models. Body mass index (BMI) was categorised (<20, 20â€“24.99, 25â€“29.99, 30+ kg/m2) and physical activity grouped by amount and frequency of lighter (no sweating/heavy breathing) and vigorous (sweating/heavy breathing) activity.Results: In the Bergen longitudinal analysis, undertaking light activity 3+ times/week at baseline was associated with less follow-up asthma (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.22, 0.89), whilst an effect from undertaking vigorous activity 3+ times/week was not detected (OR 1.22, 95% CI 0.44, 2.76). The associations were attenuated with BMI adjustment. In the all-centre cross-sectional analysis an interaction was found, with the association between physical activity and asthma varying across BMI categories.Conclusion: These findings suggest potential longer-term benefit from lighter physical activity, whilst improvement in asthma outcomes from increasing activity intensity was not evident. Additionally, it appears the benefit from physical activity may differ according to BMI.
35.	Rydberg Sterner, Therese, et al. (författare) The Gothenburg H70 Birth cohort study 2014-16: design, methods and study population. 2019 Ingår i: European journal of epidemiology. - : Springer Science and Business Media LLC. - 1573-7284 .- 0393-2990. ; 34:2, s. 191-209 Tidskriftsartikel (refereegranskat)abstract To improve health care for older persons, we need to learn more about ageing, e.g. identify protective factors and early markers for diseases. The Gothenburg H70 Birth Cohort Studies (the H70 studies) are multidisciplinary epidemiological studies examining representative birth cohorts of older populations in Gothenburg, Sweden. So far, six birth cohorts of 70-year-olds have been examined over time, and examinations have been virtually identical between studies. This paper describes the study procedures for the baseline examination of the Birth cohort 1944, conducted in 2014-16. In this study, all men and women born 1944 on specific dates, and registered as residents in Gothenburg, were eligible for participation (n=1839). A total of 1203 (response rate 72.2%; 559 men and 644 women; mean age 70.5years) agreed to participate in the study. The study comprised sampling of blood and cerebrospinal fluid, psychiatric, cognitive, and physical health examinations, examinations of genetics and family history, use of medications, social factors, functional ability and disability, physical fitness and activity, body composition, lung function, audiological and ophthalmological examinations, diet, brain imaging, as well as a close informant interview, and qualitative studies. As in previous examinations, data collection serves as a basis for future longitudinal follow-up examinations. The research gained from the H70 studies has clinical relevance in relation to prevention, early diagnosis, clinical course, experience of illness, understanding pathogenesis and prognosis. Results will increase our understanding of ageing and inform service development, which may lead to enhanced quality of care for older persons.
36.	Storaas, Torgeir, et al. (författare) Incidence of rhinitis and asthma related to welding in Northern Europe 2015 Ingår i: European Respiratory Journal. - : The European Respiratory Society. - 0903-1936 .- 1399-3003. ; 46:5, s. 1290-1297 Tidskriftsartikel (refereegranskat)abstract Welding-related asthma is well recognised but less is known about rhinitis in relation to welding. The aim here, was to study associations between welding, rhinitis and asthma in a general population sample, and factors influencing selection into and out of a welding occupation.Adult-onset asthma and non-infectious rhinitis were investigated in the international multicentre population-based Respiratory Health in Northern Europe (RHINE) study, including 16 191 responders aged 26-54 years. Ever welding (n=2181), welding >25% of working time (n=747), and welding in stainless steel >6 months (n=173) were assessed by questionnaire. Subjects with rhinitis or asthma onset when aged <18 years were excluded. Incidence rates for asthma and rhinitis were calculated from year of disease onset, and start and end of welding job. Cox's proportional hazard models adjusting for age, sex, parental education and study centre, and Kaplan-Meier curves were used.Rhinitis incidence was higher among welders (hazard ratio (HR) 1.4, 95% CI 1.3-1.6), consistent in men and women, and across centres (pheterogeneity=0.4). In men, asthma incidence was higher among welders (HR 1.4, 95% CI 1.04-1.97). Quitting welding was indicated higher after adult-onset rhinitis (HR 1.1, 95% CI 1.0-1.3).Adult-onset rhinitis and asthma was higher among welders, consistent across population samples from Northern Europe. No pre-employment selection was found, whereas selection out of welding jobs was suggested.
37.	Svanes, C., et al. (författare) Father's environment before conception and asthma risk in his children: a multi-generation analysis of the Respiratory Health In Northern Europe study 2017 Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 46:1, s. 235-245 Tidskriftsartikel (refereegranskat)abstract Background: Whereas it is generally accepted that maternal environment plays a key role in child health, emerging evidence suggests that paternal environment before conception also impacts child health. We aimed to investigate the association between children's asthma risk and parental smoking and welding exposures prior to conception. Methods: In a longitudinal, multi-country study, parents of 24 168 offspring aged 2-51 years provided information on their life-course smoking habits, occupational exposure to welding and metal fumes, and offspring's asthma before/after age 10 years and hay fever. Logistic regressions investigated the relevant associations controlled for age, study centre, parental characteristics (age, asthma, education) and clustering by family. Results: Non-allergic early-onset asthma (asthma without hay fever, present in 5.8%) was more common in the offspring with fathers who smoked before conception {odds ratio [OR] = 1.68 [95% confidence interval (CI) = 1.18-2.41]}, whereas mothers' smoking before conception did not predict offspring asthma. The risk was highest if father started smoking before age 15 years [3.24 (1.67-6.27)], even if he stopped more than 5 years before conception [2.68 (1.17-6.13)]. Fathers' pre-conception welding was independently associated with non-allergic asthma in his offspring [1.80 (1.29-2.50)]. There was no effect if the father started welding or smoking after birth. The associations were consistent across countries. Conclusions: Environmental exposures in young men appear to influence the respiratory health of their offspring born many years later. Influences during susceptible stages of spermatocyte development might be important and needs further investigation in humans. We hypothesize that protecting young men from harmful exposures may lead to improved respiratory health in future generations.
38.	Svanes, O., et al. (författare) Respiratory Health in Cleaners in Northern Europe: Is Susceptibility Established in Early Life? 2015 Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 10:7 Tidskriftsartikel (refereegranskat)abstract Rationale There is some evidence that maternal smoking increases susceptibility to personal smoking's detrimental effects. One might question whether early life disadvantage might influence susceptibility to occupational exposure. In this cross-sectional study we investigated respiratory symptoms, asthma and self-reported chronic obstructive pulmonary disease (COPD) as related to working as a cleaner in Northern European populations, and whether early life factors influenced susceptibility to occupational cleaning's unhealthy effects. The RHINE III questionnaire study assessed occupational cleaning in 13,499 participants. Associations with respiratory symptoms, asthma and self-reported COPD were analysed with multiple logistic regressions, adjusting for sex, age, smoking, educational level, parent's educational level, BMI and participating centre. Interaction of occupational cleaning with early life disadvantage (maternal smoking, severe respiratory infection < 5 years, born during winter months, maternal age at birth > 35 years) was investigated. Among 2138 ever-cleaners the risks of wheeze (OR 1.4, 95% CI 1.3-1.6), adult-onset asthma (1.5 [1.2-1.8]) and self-reported COPD (1.7 [1.3-2.2]) were increased. The risk increased with years in occupational cleaning (adult-onset asthma: <= 1 year 0.9 [0.7-1.3]; 1-4 years 1.5 [1.1-2.0]; >= 4 years 1.6 [1.2-2.1]). The association of wheeze with cleaning activity >= 4 years was significantly stronger for those with early life disadvantage than in those without (1.8 [1.5-2.3] vs. 1.3 [0.96-1.8]; pinteraction 0.035). Occupational cleaners had increased risk of asthma and self-reported COPD. Respiratory symptom risk was particularly increased in persons with factors suggestive of early life disadvantage. We hypothesize that early life disadvantage may increase airway vulnerability to harmful exposure from cleaning agents later in life.
39.	Svanes, Øistein, et al. (författare) Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction 2018 Ingår i: American Journal of Respiratory and Critical Care Medicine. - 1073-449X .- 1535-4970. ; 197:9, s. 1157-1163 Tidskriftsartikel (refereegranskat)abstract Rationale: Cleaning tasks may imply exposure to chemical agents with potential harmful effects to the respiratory system, and increased risk of asthma and respiratory symptoms among professional cleaners and in persons cleaning at home has been reported. Long-term consequences of cleaning agents on respiratory health are, however, not well described.Objectives: This study aimed to investigate long-term effects of occupational cleaning and cleaning at home on lung function decline and airway obstruction.Methods: The European Community Respiratory Health Survey (ECRHS) investigated a multicenter population-based cohort at three time points over 20 years. A total of 6,235 participants with at least one lung function measurement from 22 study centers, who in ECRHS II responded to questionnaire modules concerning cleaning activities between ECRHS I and ECRHS II, were included. The data were analyzed with mixed linear models adjusting for potential confounders.Measurements and Main Results: As compared with women not engaged in cleaning (ΔFEV1 = −18.5 ml/yr), FEV1 declined more rapidly in women responsible for cleaning at home (−22.1; P = 0.01) and occupational cleaners (−22.4; P = 0.03). The same was found for decline in FVC (ΔFVC = −8.8 ml/yr; −13.1, P = 0.02; and −15.9, P = 0.002; respectively). Both cleaning sprays and other cleaning agents were associated with accelerated FEV1 decline (−22.0, P = 0.04; and −22.9, P = 0.004; respectively). Cleaning was not significantly associated with lung function decline in men or with FEV1/FVC decline or airway obstruction.Conclusions: Women cleaning at home or working as occupational cleaners had accelerated decline in lung function, suggesting that exposures related to cleaning activities may constitute a risk to long-term respiratory health.
40.	Tagesson, Torbern, et al. (författare) Ecosystem properties of semiarid savanna grassland in West Africa and its relationship with environmental variability 2015 Ingår i: Global Change Biology. - : Wiley. - 1354-1013 .- 1365-2486. ; 21:1, s. 250-264 Tidskriftsartikel (refereegranskat)abstract The Dahra field site in Senegal, West Africa, was established in 2002 to monitor ecosystem properties of semiarid savanna grassland and their responses to climatic and environmental change. This article describes the environment and the ecosystem properties of the site using a unique set of in situ data. The studied variables include hydroclimatic variables, species composition, albedo, normalized difference vegetation index (NDVI), hyperspectral characteristics (350-1800nm), surface reflectance anisotropy, brightness temperature, fraction of absorbed photosynthetic active radiation (FAPAR), biomass, vegetation water content, and land-atmosphere exchanges of carbon (NEE) and energy. The Dahra field site experiences a typical Sahelian climate and is covered by coexisting trees (similar to 3% canopy cover) and grass species, characterizing large parts of the Sahel. This makes the site suitable for investigating relationships between ecosystem properties and hydroclimatic variables for semiarid savanna ecosystems of the region. There were strong interannual, seasonal and diurnal dynamics in NEE, with high values of similar to-7.5g Cm(-2)day(-1) during the peak of the growing season. We found neither browning nor greening NDVI trends from 2002 to 2012. Interannual variation in species composition was strongly related to rainfall distribution. NDVI and FAPAR were strongly related to species composition, especially for years dominated by the species Zornia glochidiata. This influence was not observed in interannual variation in biomass and vegetation productivity, thus challenging dryland productivity models based on remote sensing. Surface reflectance anisotropy (350-1800nm) at the peak of the growing season varied strongly depending on wavelength and viewing angle thereby having implications for the design of remotely sensed spectral vegetation indices covering different wavelength regions. The presented time series of in situ data have great potential for dryland dynamics studies, global climate change related research and evaluation and parameterization of remote sensing products and dynamic vegetation models.
41.	Tarp, Julie Bjerre, et al. (författare) Subclinical atherosclerosis in patients with cyanotic congenital heart disease 2019 Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 277, s. 97-103 Tidskriftsartikel (refereegranskat)abstract Introduction: Survival in patients with cyanotic congenital heart disease (CCHD) has improved dramatically. The result is an ageing population with risk of acquired heart disease. Previous small uncontrolled studies suggested that these patients are protected against the development of atherosclerosis. To test this hypothesis, we sought to determine the prevalence of subclinical atherosclerosis in a larger population of patients with CCHD. Method: We compared the prevalence of subclinical atherosclerosis in adult CCHD patients from Denmark, Sweden, Norway and Australia, with that in age-, sex-, smoking status-, and body mass index matched controls. Coronary artery atherosclerosis was assessed on computed tomography with coronary artery calcification (CAC) score. Subclinical atherosclerosis was defined by CAC-score > 0. Carotid artery atherosclerosis was evaluated using ultrasound by measuring carotid plaque thickness (cPT-max) and carotid intima media thickness (CIMT). Lipid status was evaluated as an important atherosclerotic risk factor. Results: Seventy-four patients with CCHD (57% women, median age 49.5 years) and 74 matched controls (57% women, median age 50.0 years) were included. There were no differences between the groups in: CAC-score > 0 (21% vs. 19%, respectively; p = 0.8), carotid plaques (19% vs. 9%, respectively; p = 0.1), cPT-max (2.3 mm vs. 2.8 mm, respectively; p = 0.1) or CIMT (0.61 mm vs. 0.61 mm, respectively; p = 0.98). And further no significant differences in lipoprotein concentrations measured by ultracentrifugation. Conclusion: Young adults with CCHD have similar cardiovascular risk factor profiles and measures of subclinical atherosclerosis, compared with controls. Given their increasing life expectancies, athero-preventive strategies should be an important part of their clinical management.
42.	Timm, Signe, et al. (författare) Asthma and selective migration away from farming environments in a three-generation cohort study 2018 Ingår i: European Respiratory Journal. - : EUROPEAN RESPIRATORY SOC JOURNALS LTD. - 0903-1936 .- 1399-3003. ; 52 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
43.	Timm, Signe, et al. (författare) Asthma and selective migration from farming environments in a three-generation cohort study 2019 Ingår i: European Journal of Epidemiology. - : Springer. - 0393-2990 .- 1573-7284. ; 34:6, s. 601-609 Tidskriftsartikel (refereegranskat)abstract Individuals raised on a farm appear to have less asthma than individual raised elsewhere. However, selective migration might contribute to this as may also the suggested protection from farm environment. This study investigated if parents with asthma are less likely to raise their children on a farm. This study involved three generations: 6045 participants in ECRHS/RHINE cohorts (born 1945-1973, denoted G1), their 10,121 parents (denoted G0) and their 8260 offspring participating in RHINESSA (born 1963-1998, denoted G2). G2-offspring provided information on parents not participating in ECRHS/RHINE. Asthma status and place of upbringing for all three generations were reported in questionnaires by G1 in 2010-2012 and by G2 in 2013-2016. Binary regressions with farm upbringing as outcome were performed to explore associations between parental asthma and offspring farm upbringing in G0-G1 and G1-G2. Having at least one parent with asthma was not associated with offspring farm upbringing, either in G1-G2 (RR 1.11, 95% CI 0.81-1.52) or in G0-G1 (RR 0.99, 0.85-1.15). G1 parents with asthma born in a city tended to move and raise their G2 offspring on a farm (RR 2.00, 1.12-3.55), while G1 parents with asthma born on a farm were less likely to raise their G2 offspring on a farm (RR 0.34, 0.11-1.06). This pattern was not observed in analyses of G0-G1. This study suggests that the protective effect from farm upbringing on subsequent asthma development could not be explained by selective migration. Intriguingly, asthmatic parents appeared to change environment when having children.
44.	Timm, Signe, et al. (författare) Offspring reports on parental place of upbringing : is it valid? 2019 Ingår i: Epidemiology. - : Wolters Kluwer. - 1044-3983 .- 1531-5487. ; 30:3, s. e16-e18 Tidskriftsartikel (refereegranskat)
45.	Timm, Signe, et al. (författare) The Urban-Rural Gradient In Asthma : A Population-Based Study in Northern Europe 2016 Ingår i: International Journal of Environmental Research and Public Health. - Basel, Switzerland : MDPI AG. - 1661-7827 .- 1660-4601. ; 13:1 Tidskriftsartikel (refereegranskat)abstract The early life environment appears to have a persistent impact on asthma risk. We hypothesize that environmental factors related to rural life mediate lower asthma prevalence in rural populations, and aimed to investigate an urban-rural gradient, assessed by place of upbringing, for asthma. The population-based Respiratory Health In Northern Europe (RHINE) study includes subjects from Denmark, Norway, Sweden, Iceland and Estonia born 1945-1973. The present analysis encompasses questionnaire data on 11,123 RHINE subjects. Six categories of place of upbringing were defined: farm with livestock, farm without livestock, village in rural area, small town, city suburb and inner city. The association of place of upbringing with asthma onset was analysed with Cox regression adjusted for relevant confounders. Subjects growing up on livestock farms had less asthma (8%) than subjects growing up in inner cities (11%) (hazard ratio 0.72 95% CI 0.57-0.91), and a significant urban-rural gradient was observed across six urbanisation levels (p = 0.02). An urban-rural gradient was only evident among women, smokers and for late-onset asthma. Analyses on wheeze and place of upbringing revealed similar results. In conclusion, this study suggests a protective effect of livestock farm upbringing on asthma development and an urban-rural gradient in a Northern European population.
46.	Triebner, Kai, et al. (författare) Exogenous female sex steroids may reduce lung ageing after menopause : A 20-year follow-up study of a general population sample (ECRHS) 2019 Ingår i: Maturitas. - : ELSEVIER IRELAND LTD. - 0378-5122 .- 1873-4111. ; 120, s. 29-34 Tidskriftsartikel (refereegranskat)abstract Objectives: Menopause involves hypoestrogenism, which is associated with numerous detrimental effects, including on respiratory health. Hormone replacement therapy (HRT) is often used to improve symptoms of menopause. The effects of HRT on lung function decline, hence lung ageing, have not yet been investigated despite the recognized effects of HRT on other health outcomes. Study design: The population-based multi-centre European Community Respiratory Health Survey provided complete data for 275 oral HRT users at two time points, who were matched with 383 nonusers and analysed with a two-level linear mixed effects regression model. Main outcome measures: We studied whether HRT use was associated with the annual decline in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Results: Lung function of women using oral HRT for more than five years declined less rapidly than that of nonusers. The adjusted difference in FVC decline was 5.6 mL/y (95%CI: 1.8 to 9.3, p = 0.01) for women who had taken HRT for six to ten years and 8.9 mL/y (3.5 to 14.2, p = 0.003) for those who had taken it for more than ten years. The adjusted difference in FEV1 decline was 4.4 mL/y (0.9 to 8.0, p = 0.02) with treatment from six to ten years and 5.3 mL/y (0.4 to 10.2, p = 0.048) with treatment for over ten years. Conclusions: In this longitudinal population-based study, the decline in lung function was less rapid in women who used HRT, following a dose-response pattern, and consistent when adjusting for potential confounding factors. This may signify that female sex hormones are of importance for lung ageing.
47.	Triebner, K., et al. (författare) Menopause as a predictor of new-onset asthma: A longitudinal Northern European population study 2016 Ingår i: Journal of Allergy and Clinical Immunology. - : Elsevier BV. - 0091-6749 .- 1097-6825. ; 137:1 Tidskriftsartikel (refereegranskat)abstract Background: There is limited and conflicting evidence on the effect of menopause on asthma. Objectives: We sought to study whether the incidence of asthma and respiratory symptoms differ by menopausal status in a longitudinal population-based study with an average follow-up of 12 years. Methods: The Respiratory Health in Northern Europe study provided questionnaire data pertaining to respiratory and reproductive health at baseline (1999-2001) and follow-up (2010-2012). The study cohort included women aged 45 to 65 years at follow-up, without asthma at baseline, and not using exogenous hormones (n = 2322). Menopausal status was defined as nonmenopausal, transitional, early postmenopausal, and late postmenopausal. Associations with asthma (defined by the use of asthma medication, having asthma attacks, or both) and respiratory symptoms scores were analyzed by using logistic (asthma) and negative binomial (respiratory symptoms) regressions, adjusting for age, body mass index, physical activity, smoking, education, and study center. Results: The odds of new-onset asthma were increased in women who were transitional (odds ratio, 2.40; 95% CI, 1.09-5.30), early postmenopausal (odds ratio, 2.11; 95% CI, 1.06-4.20), and late postmenopausal (odds ratio, 3.44; 95% CI, 1.31-9.05) at follow-up compared with nonmenopausal women. The risk of respiratory symptoms increased in early postmenopausal (coefficient, 0.40; 95% CI, 0.06-0.75) and late postmenopausal (coefficient, 0.69; 95% CI, 0.15-1.23) women. These findings were consistent irrespective of smoking status and across study centers. Conclusions: New-onset asthma and respiratory symptoms increased in women becoming postmenopausal in a longitudinal population-based study. Clinicians should be aware that respiratory health might deteriorate in women during reproductive aging. RAMSON MJ, 1991, JOURNAL OF ASTHMA, V28, P129
48.	Triebner, K., et al. (författare) Menopause Is Associated with Accelerated Lung Function Decline 2017 Ingår i: American Journal of Respiratory and Critical Care Medicine. - : AMER THORACIC SOC. - 1073-449X .- 1535-4970. ; 195:8, s. 1058-1065 Tidskriftsartikel (refereegranskat)abstract Rationale: Menopause is associated with changes in sex hormones, which affect immunity, inflammation, and osteoporosis and may impair lung function. Lung function decline has not previously been investigated in relation to menopause. Objectives: To study whether lung function decline, assessed by FVC and FEV1, is accelerated in women who undergo menopause. Methods: The population-based longitudinal European Community Respiratory Health Survey provided serum samples, spirometry, and questionnaire data about respiratory and reproductive health from three study waves (n = 1,438). We measured follicle-stimulating hormone and luteinizing hormone and added information on menstrual patterns to determine menopausal status using latent class analysis. Associations with lung function decline were investigated using linear mixed effects models, adjusting for age, height, weight, pack-years, current smoking, age at completed full-time education, spirometer, and including study center as random effect. Measurements and Main Results: Menopausal status was associated with accelerated lung function decline. The adjusted mean FVC decline was increased by -10.2 ml/yr (95% confidence interval [CI], -13.1 to -7.2) in transitional women and -12.5 ml/yr (95% CI, -16.2 to -8.9) in post-menopausal women, compared with women menstruating regularly. The adjusted mean FEV1 decline increased by -3.8 ml/yr (95% CI, -6.3 to -2.9) in transitional women and -5.2 ml/yr (95% CI, -8.3 to -2.0) in post-menopausal women. Conclusions: Lung function declined more rapidly among transitional and post-menopausal women, in particular for FVC, beyond the expected age change. Clinicians should be aware that respiratory health often deteriorates during reproductive aging.
49.	Triebner, Kai, et al. (författare) Residential surrounding greenspace and age at menopause : A 20-year European study (ECRHS) 2019 Ingår i: Environment International. - : Elsevier. - 0160-4120 .- 1873-6750. ; 132 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Menopause is associated with a number of adverse health effects and its timing has been reported to be influenced by several lifestyle factors. Whether greenspace exposure is associated with age at menopause has not yet been investigated.OBJECTIVE: To investigate whether residential surrounding greenspace is associated with age at menopause and thus reproductive aging.METHODS: This longitudinal study was based on the 20-year follow-up of 1955 aging women from a large, population-based European cohort (ECRHS). Residential surrounding greenspace was abstracted as the average of satellite-based Normalized Difference Vegetation Index (NDVI) across a circular buffer of 300 m around the residential addresses of each participant during the course of the study. We applied mixed effects Cox models with centre as random effect, menopause as the survival object, age as time indicator and residential surrounding greenspace as time-varying predictor. All models were adjusted for smoking habit, body mass index, parity, age at menarche, ever-use of contraception and age at completed full-time education as socio-economic proxy.RESULTS: An increase of one interquartile range of residential surrounding greenspace was associated with a 13% lower risk of being menopausal (Hazard Ratio: 0.87, 95% Confidence Interval: 0.79-0.95). Correspondingly the predicted median age at menopause was 1.4 years older in the highest compared to the lowest NDVI quartile. Results remained stable after additional adjustment for air pollution and traffic related noise amongst others.CONCLUSIONS: Living in greener neighbourhoods is associated with older age at menopause and might slow reproductive aging. These are novel findings with broad implications. Further studies are needed to see whether our findings can be replicated in different populations and to explore the potential mechanisms underlying this association.
50.	Valkonen, Maria, et al. (författare) Microbial characteristics in homes of asthmatic and non-asthmatic adults in the ECRHS cohort 2018 Ingår i: Indoor Air. - : John Wiley & Sons. - 0905-6947 .- 1600-0668. ; 28:1, s. 16-27 Tidskriftsartikel (refereegranskat)abstract Microbial exposures in homes of asthmatic adults have been rarely investigated; specificities and implications for respiratory health are not well understood. The objectives of this study were to investigate associations of microbial levels with asthma status, asthma symptoms, bronchial hyperresponsiveness (BHR), and atopy. Mattress dust samples of 199 asthmatics and 198 control subjects from 7 European countries participating in the European Community Respiratory Health Survey II study were analyzed for fungal and bacterial cell wall components and individual taxa. We observed trends for protective associations of higher levels of mostly bacterial markers. Increased levels of muramic acid, a cell wall component predominant in Gram-positive bacteria, tended to be inversely associated with asthma (OR's for different quartiles: II 0.71 [0.39-1.30], III 0.44 [0.23-0.82], and IV 0.60 [0.31-1.18] P for trend .07) and with asthma score (P for trend .06) and with atopy (P for trend .02). These associations were more pronounced in northern Europe. This study among adults across Europe supports a potential protective effect of Gram-positive bacteria in mattress dust and points out that this may be more pronounced in areas where microbial exposure levels are generally lower.

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