| 311. |
- 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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| 312. |
- 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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| 313. |
- 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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| 314. |
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| 315. |
- 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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| 316. |
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| 317. |
- Torén, Kjell, 1952, et al.
(författare)
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Self-reported asthma was biased in relation to disease severity while reported year of asthma onset was accurate
- 2006
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Ingår i: J Clin Epidemiol.. ; 59:1, s. 90-3.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: The aims of the study were to assess the accuracy of self-reported asthma and notified year of asthma onset. METHODS: The study was performed on a sample of 365 subjects, 18-60 years old, with clinically diagnosed onset of asthma between 1983 and 1986. All subjects were investigated 10 years later, in 1996, with a respiratory questionnaire about the items of asthma and year of onset. The material was analyzed with logistic regression models. RESULTS: Of the 289 subjects who returned the questionnaire, asthma was reconfirmed in 251 subjects. In a logistic regression model, asthma severity was significantly associated with confirmation of asthma. The median difference between the "true" year of onset and the reported year 10 years later, the recall period was zero, with a 10th to 90th interpercentile range of -2 to 6 years. The recall period was not associated with asthma severity, bronchial hyperresponsiveness, smoking, atopy, or sex. CONCLUSION: Self-reported asthma is biased in relation to disease severity, meaning that subjects with mild disease were less prone to report their asthma. Reported year of asthma onset among adults seems to be rather accurate, with no obvious dependent misclassifications.
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| 318. |
- Torén, Kjell, et al.
(författare)
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Så fick läkaren en viktig roll vid sjukersättning
- 2023
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Ingår i: Läkartidningen. - 0023-7205. ; 2023:20-21
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Bedömning av varaktig oförmåga till arbete kom att vara av-görande för majoriteten av de beviljade förtidspensionerna under den allmänna pensionens första dryga 20 år. Till en början krävdes inte läkarintyg för att ansöka om förtidspension. Förslag om krav på läkarintyg framkom dock vid flera tillfällen – men läkarkåren var inte odelat positiv till den ökade arbetsbördan med intyg.
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| 319. |
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| 320. |
- Torén, Kjell, 1952, et al.
(författare)
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The association between job strain and atrial fibrillation in Swedish men
- 2015
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Ingår i: Occupational and Environmental Medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 72:3, s. 177-180
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The purpose of this study was to investigate whether psychosocial stress defined as high strain based on the job demand-control model increases risk for atrial fibrillation. Methods The present study comprised 6035 men born between 1915 and 1925 and free from previous coronary heart disease, atrial fibrillation and stroke at baseline (1974-1977). Work-related psychosocial stress was measured using a job-exposure matrix for the job demand-control model based on occupation at baseline. The participants were followed from baseline examination until death, hospital discharge or 75 years of age, using the Swedish national register on cause of death and the Swedish hospital discharge register for any registration for atrial fibrillation, resulting in the identification of 436 cases. Data were analysed with Cox regression models with atrial fibrillation as the outcome using high strain as the explanatory variable adjusted for age, smoking, body mass index, hypertension, diabetes and socioeconomic status. Results There was an increased risk for atrial fibrillation in relation to high strain (HR 1.32, 95% CI 1.003 to 1.75). When the four categories of the job-strain model were included and low strain was used as reference, the risk for high strain decreased (HR 1.23, 95% CI 0.84 to 1.82). Conclusions Exposure to occupational psychosocial stress defined as high strain may be associated with increased risk for atrial fibrillation. The observed increase in risk is small and residual confounding may also be present.
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