| 311. |
- Torén, Kjell, et al.
(författare)
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Occupational exposure to vapors, gases, dusts and fumes and mortality in relation to chronic obstructive pulmonary disease among Swedish construction workers : a longitudinal cohort study
- 2014
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Ingår i: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 145:5, s. 992-997
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of the present study was to elucidate whether occupational exposure to vapors, gases, dusts and fumes increases the mortality risk for chronic obstructive pulmonary disease (COPD), especially among never-smokers.METHODS: The study population was a cohort of 354,718 male construction workers; of these 196,329 were exposed to vapors, gases, dusts and fumes and 117,964 were unexposed. Exposure to inorganic dust, wood dust, vapors, fumes and gases, and irritants was based on a job-exposure matrix with a focus on exposure in the mid-1970s. The cohort was followed from 1972 to 2011. Relative risks (RR) were obtained using Poisson regression models adjusting for age, body mass index and smoking habits.RESULTS: There were 1,085 deaths from COPD among the exposed workers, including 49 never-smokers. Workers with any occupational exposure to vapors, gases, fumes and dust showed an increased mortality due to COPD (RR=1.32, 95% confidence interval (CI) 1.18-1.47). When comparing different exposure groups, there was a significantly increased mortality due to COPD among those exposed to fumes (RR 1.20, 95% CI 1.07-1.36) and inorganic dust (RR 1.19, 95% CI 1.07-1.33) . Among never-smokers, there was high mortality due to COPD among workers with any occupational airborne exposure (RR 2.11, 95% CI 1.17-3.83). The fraction of COPD attributable to occupational exposure was 0.24 among all workers and 0.53 among never-smoking workers.CONCLUSIONS: Occupational exposure to airborne pollution increases the mortality risk for COPD, especially among never-smokers.
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| 312. |
- Torén, Kjell, 1952
(författare)
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Occupational exposures should be considered in all patients with non-malignant respiratory diseases : Viktigt att överväga yrke som orsak till lungsjukdom - Exponeringar på arbetet kan förklara insjuknandet hos mer än var tionde vuxen med astma, KOL, lungfibros eller pneumoni
- 2019
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Ingår i: Läkartidningen. - 1652-7518. ; 116
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Occupational exposures to gas, fumes, dust and chemicals contribute to non-malignant respiratory diseases like asthma, chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis and community-acquired pneumonia in more than one in ten patients. They may be sick due to inhaling various particles, gases, fumes, or chemicals in the workplace. Hence, these exposures should be considered in all patients with non-malignant respiratory diseases. In an international literature review the occupational burden of asthma was 16%, chronic obstructive pulmonary disease 14%, idiopathic pulmonary fibrosis 26% and community-acquired pneumonia 10%.
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| 313. |
- 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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| 314. |
- Torén, Kjell, 1952, et al.
(författare)
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Occupational risks for infection with influenza A and B: a national case-control study covering 1 July 2006-31 December 2019
- 2023
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Ingår i: Occupational and Environmental Medicine. - 1351-0711 .- 1470-7926. ; 80:7, s. 377-383
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesWe investigated whether crowded workplaces, sharing surfaces and exposure to infections were factors associated with a positive test for influenza virus. MethodsWe studied 11 300 cases with a positive test for influenza A and 3671 cases of influenza B from Swedish registry of communicable diseases. Six controls for each case were selected from the population registry, with each control being assigned the index date of their corresponding case. We linked job histories to job-exposure matrices (JEMs), to assess different transmission dimensions of influenza and risks for different occupations compared with occupations that the JEM classifies as low exposed. We used adjusted conditional logistic analyses to estimate the ORs for influenza with 95% CI. ResultsThe highest odds were for influenza were: regular contact with infected patients (OR 1.64, 95% CI 1.54 to 1.73); never maintained social distance (OR 1.51, 95% CI 1.43 to 1.59); frequently sharing materials/surfaces with the general public (OR 1.41, 95% CI 1.34 to 1.48); close physical proximity (OR 1.54, 95% CI 1.45 to 1.62) and high exposure to diseases or infections (OR 1.54, 95% CI 1.44 to 1.64). There were small differences between influenza A and influenza B. The five occupations with the highest odds as compared with low exposed occupations were: primary care physicians, protective service workers, elementary workers, medical and laboratory technicians, and taxi drivers. ConclusionsContact with infected patients, low social distance and sharing surfaces are dimensions that increase risk for influenza A and B. Further safety measures are needed to diminish viral transmission in these contexts.
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| 315. |
- Torén, Kjell, 1952, et al.
(författare)
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Pneumococcal pneumonia on the job: Uncovering the past story of occupational exposure to metal fumes and dust
- 2022
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Ingår i: American Journal of Industrial Medicine. - : Wiley. - 0271-3586 .- 1097-0274. ; 65:7, s. 517-524
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Tidskriftsartikel (refereegranskat)abstract
- The objectives of this study are to elucidate the early history of risk for pneumococcal pneumonia from occupational exposure to metal fumes and dusts, and to demonstrate the importance of searching older literature when performing reviews. We performed manual searching for articles in the Library of the Surgeon General's Office (the precursor to Index Medicus), in the Hathi Trust database, in PubMed, andby screening reference lists in literature appearing before the introduction of PubMed. An early body of literature, from the 1890s onward, recognized that pneumonia was linked to "Thomas slag," a steel industry byproduct containing iron, manganese, and lime. Researchers, mainly in Germany, showed that workers in metal-dust-exposed occupations, especially using manganese, manifested an increased incidence of pneumococcal pneumonia. An outbreak of pneumococcal pneumonia in the 1930s implicated manganese fume in its etiology. In the immediate post-World War II period, there was a brief flurry of interest in pneumonia from exposure to potassium permanganate that was soon dismissed as a chemical pneumonitis. After a hiatus of two decades, epidemiologic investigations drew attention to the pneumonia risks of welding and related metal fume exposure, bringing renewed interest to the forgotten role of pneumococcal pneumonia as an occupational disease. Occupational or environmental inhalation of manganese, iron, or irritants may be causally related to increased pneumococcal pneumonia risk. In particular, the risk associated with manganese seems to be overlooked in recent literature. An important conclusion is the importance of obtaining additional evidence through a deeper assessment of the literature in a broad historical context.
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| 316. |
- Torén, Kjell, 1952, et al.
(författare)
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Reference values of fractional excretion of exhaled nitric oxide among non-smokers and current smokers
- 2017
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Ingår i: BMC Pulmonary Medicine. - : Springer Science and Business Media LLC. - 1471-2466. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fractional exhaled nitric oxide (FENO) is used to assess of airway inflammation; diagnose asthma and monitor adherence to advised therapy. Reliable and accurate reference values for FENO are needed for both non-smoking and current smoking adults in the clinical setting. The present study was performed to establish reference adult FENO values among never-smokers, former smokers and current smokers. Methods: FENO was measured in 5265 subjects aged 25-75years in a general-population study, using a chemiluminescence (Niox ™) analyser according to the guidelines of the American Thoracic Society and the European Respiratory Society. Atopy was based on the presence of immunoglobulin E (IgE) antibodies to common inhalant allergens (measured using Phadiatop® test). Spirometry without bronchodilation was performed and forced vital capacity (FVC), forced expired volume in 1 s (FEV1) and the ratio of FEV1 to FVC values were obtained. After excluding subjects with asthma, chronic bronchitis, spirometric airway obstruction and current cold, 3378 subjects remained. Equations for predictions of FENO values were modelled using nonparametric regression models. Results: FENO levels were similar in never-smokers and former smokers, and these two groups were therefore merged into a group termed "non-smokers". Reference equations, including the 5th and 95th percentiles, were generated for female and male non-smokers, based on age, height and atopy. Regression models for current smokers were unstable. Hence, the proposed reference values for current smokers are based on the univariate distribution of FENO and fixed cut-off limits. Conclusions: Reference values for FENO among respiratory healthy non-smokers should be outlined stratified for gender using individual reference values. For current smokers separate cut-off limits are proposed. © 2017 The Author(s).
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| 317. |
- Torén, Kjell, et al.
(författare)
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Restrictive Spirometric Pattern and Preserved Ratio Impaired Spirometry in a Population 50-64 Years.
- 2024
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Ingår i: Annals of the American Thoracic Society. - 2329-6933 .- 2325-6621.
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Tidskriftsartikel (refereegranskat)abstract
- RATIONALE: Knowledge regarding prevalence and shared and unique characteristics of Restrictive spirometric pattern (RSP) and Preserved ratio impaired spirometry (PRISm) is lacking for a general population investigated with post-bronchodilator spirometry and computed tomography of the lungs.OBJECTIVES: To investigate shared and unique features for RSP and PRISm.METHODS: In the Swedish CArdioPulmonary bioImage Study (SCAPIS), a general population sample of 28,555 people aged 50 - 64 years (including 14,558 never-smokers) was assessed. The participants answered a questionnaire and underwent computed tomography of the lungs, post-bronchodilator spirometry, and coronary artery calcification score (CACS). Odds ratios (OR) with 95% confidence intervals (CI) were calculated using adjusted logistic regression. RSP was defined as FEV1/FVC≥0.70 and FVC<80%. PRISm was defined as FEV1/FVC≥0.70 and FEV1<80%. A local reference equation was applied.MEASUREMENTS AND RESULTS: The prevalence of RSP and PRISm were 5.1% (95% CI 4.9 - 5.4) and 5.1% (95% CI 4.8 - 5.3), respectively, with similar values seen in never-smokers. For RSP and PRISm, shared features were current smoking, dyspnea, chronic bronchitis, rheumatic disease, diabetes, ischemic heart disease (IHD), bronchial wall thickening, interstitial lung abnormalities (ILA), and bronchiectasis. Emphysema was uniquely linked to PRISm (OR 1.69, 1.36-2.10) vs 1.10 (0.84-1.43) for RSP. CACS≥300 was related to PRISm, but not among among never-smokers.CONCLUSIONS: PRISm and RSP have respiratory, cardiovascular, and metabolic conditions as shared features. Emphysema is only associated with PRISm. Coronary atherosclerosis may be associated with PRISm. Our results indicate that RSP and PRISm may share more features than not. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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| 318. |
- Torén, Kjell, 1952, et al.
(författare)
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Restrictive spirometric pattern and true pulmonary restriction in a general population sample aged 50-64 years
- 2020
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Ingår i: BMC Pulmonary Medicine. - : Springer Science and Business Media LLC. - 1471-2466. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background There is low diagnostic accuracy of the proxy restrictive spirometric pattern (RSP) to identify true pulmonary restriction. This knowledge is based on patients referred for spirometry and total lung volume determination by plethysmograpy, single breath nitrogen washout technique or gas dilution and selected controls. There is, however, a lack of data from general populations analyzing whether RSP is a valid proxy for true pulmonary restriction. We have validated RSP in relation to true pulmonary restriction in a general population where we have access to measurements of total lung capacity (TLC) and spirometry. Methods The data was from the Swedish CArdioPulmonary bioImage Study (SCAPIS Pilot), a general population-based study, comprising 983 adults aged 50-64. All subjects answered a respiratory questionnaire. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were obtained before and after bronchodilation. TLC and residual volume (RV) was recorded using a body plethysmograph. All lung function values are generally expressed as percent predicted (% predicted) or in relation to lower limits of normal (LLN). True pulmonary restriction was defined as TLC < LLN5 defined as a Z score < - 1.645, i e the fifth percentile. RSP was defined as FEV1/FVC >= LLN and FVC < LLN after bronchodilation. Specificity, sensitivity, positive and negative likelihood ratios were calculated, and 95% confidence intervals (CIs) were calculated. Results The prevalence of true pulmonary restriction was 5.4%, and the prevalence of RSP was 3.4%. The sensitivity of RSP to identify true pulmonary restriction was 0.34 (0.20-0.46), the corresponding specificity was 0.98 (0.97-0.99), and the positive likelihood ratio was 21.1 (11.3-39.4) and the negative likelihood ratio was 0.67 (0.55-0.81). Conclusions RSP has low accuracy for identifying true pulmonary restriction. The results support previous observations that RSP is useful for ruling out true pulmonary restriction.
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| 319. |
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| 320. |
- Torén, Kjell, 1952, et al.
(författare)
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Risk factors for norovirus infection in healthcare workers during nosocomial outbreaks: a cross-sectional study
- 2021
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Ingår i: Antimicrobial Resistance and Infection Control. - : Springer Science and Business Media LLC. - 2047-2994. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Norovirus outbreaks cause severe medico-socio-economic problems affecting healthcare workers and patients. The aim of the study was to investigate prevalence of norovirus infection and risk factors for infection in healthcare workers during nosocomial outbreaks. Methods A cross-sectional study of norovirus infections in healthcare workers was performed in seven outbreak wards in a large university hospital. Packs (swab for rectal sampling, and questionnaire) were posted to healthcare workers on notification of a ward outbreak. Rectal samples were examined with norovirus-specific real-time PCR. Replies from questionnaires were analysed using logistic regression models with norovirus genogroup (G)II positive findings as dependent variable. The results are expressed as odds ratios (OR) with 95% confidence intervals (CI). Sequencing and phylogenetic analyses (1040 nucleotides) were used to characterize norovirus strains from healthcare workers. Cluster analyses included norovirus GII.4 strains detected in ward patients during the ongoing outbreaks. Results Of 308 packs issued to healthcare workers, 129 (42%) were returned. norovirus GII was detected in 26 healthcare workers (20.2%). Work in cohort care (OR 4.8, 95% CI 1.4-16.3), work in wards for patients with dementia (OR 13.2, 95% CI 1.01-170.7), and having diarrhoea, loose stools or other gastrointestinal symptoms the last week (OR 7.7, 95% CI 2.5-27.2) were associated with increased norovirus prevalence in healthcare workers. Sequencing revealed norovirus GII.4 in healthcare workers samples, and strains detected in healthcare workers and ward patients during a given ward outbreak showed >= 99% similarity. Conclusion Norovirus positive findings in healthcare workers were strongly associated with symptomatic infection, close contact with sick patients, and dementia nursing.
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