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1.
  • Andersen, Zorana J., et al. (författare)
  • Long-term exposure to ambient air pollution and incidence of postmenopausal breast cancer in 15 European cohorts within the ESCAPE project
  • 2017
  • Ingår i: Journal of Environmental Health Perspectives. - Research triangle park : US department of health. - 0091-6765 .- 1552-9924. ; 125:10
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Epidemiological evidence on the association between ambient air pollution and breast cancer risk is inconsistent.OBJECTIVE: We examined the association between long-term exposure to ambient air pollution and incidence of postmenopausal breast cancer in European women.METHODS: In 15 cohorts from nine European countries, individual estimates of air pollution levels at the residence were estimated by standardized land-use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE) and Transport related Air Pollution and Health impacts – Integrated Methodologies for Assessing Particulate Matter (TRANSPHORM) projects: particulate matter (PM) ≤2.5μm, ≤10μm, and 2.5–10μm in diameter (PM2.5, PM10, and PMcoarse, respectively); PM2.5 absorbance; nitrogen oxides (NO2 and NOx); traffic intensity; and elemental composition of PM. We estimated cohort-specific associations between breast cancer and air pollutants using Cox regression models, adjusting for major lifestyle risk factors, and pooled cohort-specific estimates using random-effects meta-analyses.RESULTS: Of 74,750 postmenopausal women included in the study, 3,612 developed breast cancer during 991,353 person-years of follow-up. We found positive and statistically insignificant associations between breast cancer and PM2.5 {hazard ratio (HR)=1.08 [95% confidence interval (CI): 0.77, 1.51] per 5 μg/m(3)}, PM10 [1.07 (95% CI: 0.89, 1.30) per 10 μg/m(3)], PMcoarse[1.20 (95% CI: 0.96, 1.49 per 5 μg/m(3)], and NO(2) [1.02 (95% CI: 0.98, 1.07 per 10 μg/m(3)], and a statistically significant association with NOx [1.04 (95% CI: 1.00, 1.08) per 20 μg/m(3), p=0.04].CONCLUSIONS: We found suggestive evidence of an association between ambient air pollution and incidence of postmenopausal breast cancer in European women.
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2.
  • Bengtsson, Caroline, et al. (författare)
  • Chronic rhinosinusitis impairs sleep quality : results of the GA(2)LEN study
  • 2017
  • Ingår i: Sleep. - : Oxford University Press. - 0161-8105 .- 1550-9109. ; 40:1
  • Tidskriftsartikel (refereegranskat)abstract
    • STUDY OBJECTIVES: To analyse the prevalence of sleep problems in subjects with CRS and to determine whether the disease severity of CRS affects sleep quality.METHODS: Questionnaires were sent to a random sample of 45 000 adults in four Swedish cities. Questions on CRS, asthma, allergic rhinitis, co-morbidities, tobacco use, educational level and physical activity were included. CRS was defined according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) epidemiological criteria. The disease severity of CRS was defined by the number of reported CRS symptoms. Sleep quality was assessed using the Basic Nordic Sleep Questionnaire.RESULTS: Of the 26 647 subjects, 2249 (8.4%) had CRS. Reported sleep problems were 50-90% more common among subjects with CRS compared with those without or the total population. The prevalence of reported sleep problems increased in conjunction with the severity of CRS. After adjusting for gender, BMI, age, tobacco use, asthma, somatic diseases, physical activity level and educational level, participants with four symptoms of CRS (compared with subjects without CRS symptoms) displayed a higher risk of snoring (adj. OR (95% CI): 3.13 (2.22-4.41)), difficulties inducing sleep (3.98 (2.94-5.40)), difficulties maintaining sleep (3.44 (2.55-4.64)), early morning awakening (4.71 (3.47-6.38)) and excessive daytime sleepiness (4.56 (3.36-6.18)). The addition of persistent allergic rhinitis to CRS further increased the risk of sleep problems.CONCLUSIONS: Sleep problems are highly prevalent among subjects with CRS. The disease severity of CRS negatively affects sleep quality.
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3.
  • 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
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5.
  • Elm, Klas, et al. (författare)
  • En ny nollvision som både räddar och förlänger liv
  • 2017
  • Ingår i: Dagens Samhälle. - Stockholm. - 2002-5548. ; :24 november
  • Tidskriftsartikel (populärvet., debatt m.m.)abstract
    • Nollvisionen för trafiksäkerheten är cynisk. Infrastrukturminister Tomas Eneroth måste ta fram ett nytt mål bortom nollvisionen som inte bara förhindrar dödsolyckor i trafiken, utan som också räddar, förbättrar och förlänger liv i hela samhället. Ett transportsystem där folkhälsan går plus är möjligt nu när elcykelförsäljningen ökar dramatiskt, skriver forskare och initiativtagare till Moving Beyond Zero. Varje person som väljer att cykla istället för att ta bilen räddar liv. Minskad biltrafik leder till mindre avgasutsläpp och vägslitage. Det förbättrar livskvaliteten hos personer med andningsbesvär och gör att de globala klimatförändringarna som påverkar allas hälsa negativt minskar. Dessutom vet vi sedan länge att motion förbättrar hälsan.Sedan 20 år tillbaka styrs det svenska trafiksäkerhetsarbetet av målet att ingen ska dödas eller skadas allvarligt i trafiken. Inledningsvis var arbetet framgångsrikt och antalet omkomna i trafikolyckor minskade från omkring 540 per år till fjolårets 270. Varje dödsfall är ett för mycket, men i dag framstår nollvisionen som cynisk.Bilarnas trafiksäkerhet har under dessa år ökat på cyklisternas bekostnad. Nya vajerräcken är den vägåtgärd som i störst utsträckning bidragit till att minska olyckorna för bilister. Men det har gjort det omöjligt att cykla på vägen. Det är en förklaring till att cyklandet har minskat på landsbygden. Trafikverket slår sig för bröstet för att antalet dödade och skadade har minskat i en del av samhället när det samtidigt har inneburit att personer dör i en annan del.Trafikverkets översyn av Nollvisionen från 2016 beskriver hur olyckor för bilister ska förhindras. För cyklisterna ses olyckorna som “oundvikliga” och att skadorna ska lindras genom att cyklisterna ska sänka hastigheten samt bära fluorescerande kläder och skyddsutrustning. Krav på att cyklister ska skydda sig själva från farliga vägar och bilar riskerar att minska cyklandet.Detta är cyniskt, då det finns flera åtgärder som Trafikverket kan göra för att också förhindra cykelolyckor. Trafikverkets egna beräkningar visar att säkrare cykelinfrastruktur skulle leda till 78 färre allvarligt skadade cyklister per år.  Sänkt hastighet i tätbebyggt område och bättre vinterväghållning för cyklister skulle leda till 48 respektive 38 färre allvarligt skadade per år.Men istället för att satsa på det som skulle öka cyklingen och göra den säkrare har de senaste tjugo åren inneburit motsatsen. Nu gör elcykelpremien att försäljningen av elcyklar ökar dramatiskt och nyligen utsågs elcykeln till årets julklapp. Nu finns det möjligheter att tänka nytt i trafikpolitiken.Nyttorna med ökad aktiv mobilitet, såsom gång och cykling, är så mycket större än trafiksäkerhet. I jämförelse med olycksriskerna är hälsoeffekterna 20 gånger större. I Sverige dör varje år 1 500 personer på grund av luftföroreningar och vägdamm från trafiken, och flera 1000-tals personer dör varje år i förtid på grund av fysiskt inaktiv livsstil.Därför behöver Sverige en ny nollvision som räddar, förbättrar och förlänger liv istället för att så få som möjligt ska dödas eller skadas. Ett sådant mål kan bara nås genom att främja aktiv mobilitet. Klas ElmSvensk Cykling Gunilla Brynell JohanssonVD, Vätternrundan Lars StrömgrenEuropean Cyclists’ Federation Lovisa LarssonTrafiksäkerhetsrådet Peter SchantzProfessor, Gymnastik- och idrottshögskolan (GIH) Arijana MarjanovicCykelfrämjandet Henrik OretorpSvenska Cykelstäder Bertil ForsbergProfessor, Umeå Universitet
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6.
  • Garcia-Larsen, Vanessa, et al. (författare)
  • Is fruit and vegetable intake associated with asthma or chronic rhino-sinusitis in European adults? : Results from the Global Allergy and Asthma Network of Excellence (GA(2)LEN) Survey
  • 2017
  • Ingår i: Clinical and Translational Allergy. - : BIOMED CENTRAL LTD. - 2045-7022 .- 2045-7022. ; 7
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Fruits and vegetables are rich in compounds with proposed antioxidant, anti-allergic and anti-inflammatory properties, which could contribute to reduce the prevalence of asthma and allergic diseases. Objective: We investigated the association between asthma, and chronic rhino-sinusitis (CRS) with intake of fruits and vegetables in European adults. Methods: A stratified random sample was drawn from the Global Allergy and Asthma Network of Excellence (GA(2)LEN) screening survey, in which 55,000 adults aged 15-75 answered a questionnaire on respiratory symptoms. Asthma score (derived from self-reported asthma symptoms) and CRS were the outcomes of interest. Dietary intake of 22 subgroups of fruits and vegetables was ascertained using the internationally validated GA(2)LEN Food Frequency Questionnaire. Adjusted associations were examined with negative binomial and multiple regressions. Simes procedure was used to control for multiple testing. Results: A total of 3206 individuals had valid data on asthma and dietary exposures of interest. 22.8% reported having at least 1 asthma symptom (asthma score >= 1), whilst 19.5% had CRS. After adjustment for potential confounders, asthma score was negatively associated with intake of dried fruits (beta-coefficient -2.34;95% confidence interval [CI] -4.09,-0.59), whilst CRS was statistically negatively associated with total intake of fruits (OR 0.73; 95% CI 0.55, 0.97). Conversely, a positive association was observed between asthma score and alliums vegetables (adjusted beta-coefficient 0.23; 95% CI 0.06, 0.40). None of these associations remained statistically significant after controlling for multiple testing. Conclusion and clinical relevance: There was no consistent evidence for an association of asthma or CRS with fruit and vegetable intake in this representative sample of European adults.
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7.
  • Gasparrini, Antonio, et al. (författare)
  • Projections of temperature-related excess mortality under climate change scenarios
  • 2017
  • Ingår i: The Lancet Planetary Health. - 2542-5196. ; 1:9, s. e360-e367
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Climate change can directly affect human health by varying exposure to non-optimal outdoor temperature. However, evidence on this direct impact at a global scale is limited, mainly due to issues in modelling and projecting complex and highly heterogeneous epidemiological relationships across different populations and climates.Methods: We collected observed daily time series of mean temperature and mortality counts for all causes or non-external causes only, in periods ranging from Jan 1, 1984, to Dec 31, 2015, from various locations across the globe through the Multi-Country Multi-City Collaborative Research Network. We estimated temperature-mortality relationships through a two-stage time series design. We generated current and future daily mean temperature series under four scenarios of climate change, determined by varying trajectories of greenhouse gas emissions, using five general circulation models. We projected excess mortality for cold and heat and their net change in 1990-2099 under each scenario of climate change, assuming no adaptation or population changes.Findings: Our dataset comprised 451 locations in 23 countries across nine regions of the world, including 85 879 895 deaths. Results indicate, on average, a net increase in temperature-related excess mortality under high-emission scenarios, although with important geographical differences. In temperate areas such as northern Europe, east Asia, and Australia, the less intense warming and large decrease in cold-related excess would induce a null or marginally negative net effect, with the net change in 2090-99 compared with 2010-19 ranging from -1·2% (empirical 95% CI -3·6 to 1·4) in Australia to -0·1% (-2·1 to 1·6) in east Asia under the highest emission scenario, although the decreasing trends would reverse during the course of the century. Conversely, warmer regions, such as the central and southern parts of America or Europe, and especially southeast Asia, would experience a sharp surge in heat-related impacts and extremely large net increases, with the net change at the end of the century ranging from 3·0% (-3·0 to 9·3) in Central America to 12·7% (-4·7 to 28·1) in southeast Asia under the highest emission scenario. Most of the health effects directly due to temperature increase could be avoided under scenarios involving mitigation strategies to limit emissions and further warming of the planet.Interpretation: This study shows the negative health impacts of climate change that, under high-emission scenarios, would disproportionately affect warmer and poorer regions of the world. Comparison with lower emission scenarios emphasises the importance of mitigation policies for limiting global warming and reducing the associated health risks.
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8.
  • Gudnadottir, A. Y., et al. (författare)
  • An investigation on the use of snus and its association with respiratory and sleep-related symptoms: a cross-sectional population study
  • 2017
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction Studies of the health effects of moist oral tobacco, snus, have produced inconsistent results. The main objective of this study is to examine the health effects of snus use on asthma, respiratory symptoms and sleep-related problems, a field that has not been investigated before. Methods and material This cross-sectional study was based on a postal questionnaire completed by 26 697 (59.3%) participants aged 16 to 75 years and living in Sweden. The questionnaire included questions on tobacco use, asthma, respiratory symptoms and sleeping problems. The association of snus use with asthma, respiratory symptoms and sleep-related symptoms was mainly tested in never-smokers (n=16 082). Results The current use of snus in never-smokers was associated with an increased risk of asthma (OR 1.51 (95% CI 1.28 to 1.77)), asthmatic symptoms, chronic bronchitis and chronic rhinosinusitis. This association was not present among ex-snus users. Snoring was independently related to both the former and current use of snus ((OR 1.37 (95% CI 1.12 to 1.68)) and (OR 1.59 (95% CI 1.34 to 1.89), respectively)). A higher risk of difficulty inducing sleep was seen among snus users. Conclusion Snus use was associated with a higher prevalence of asthma, respiratory symptoms and snoring. Healthcare professionals should be aware of these possible adverse effects of snus use.
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9.
  • 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.
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10.
  • James, A., et al. (författare)
  • Serum periostin relates to type-2 inflammation and lung function in asthma : Data from the large population-based cohort Swedish GA(2)LEN
  • 2017
  • Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - : Wiley. - 0105-4538 .- 1398-9995. ; 72:11, s. 1753-1760
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundPeriostin has been suggested as a novel, phenotype-specific biomarker for asthma driven by type 2 inflammation. However, large studies examining relationships between circulating periostin and patient characteristics are lacking and the suitability of periostin as a biomarker in asthma remains unclear.AimTo examine circulating periostin in healthy controls and subjects with asthma from the general population with different severity and treatment profiles, both with and without chronic rhinosinusitis (CRS), in relation to other biomarkers and clinical characteristics.MethodsSerum periostin was examined by ELISA in 1100 subjects aged 17-76 from the Swedish Global Allergy and Asthma European Network (GA(2)LEN) study, which included 463 asthmatics with/without chronic rhinosinusitis (CRS), 98 individuals with CRS only, and 206 healthy controls. Clinical tests included measurement of lung function, Fraction of exhaled NO (FeNO), IgE, urinary eosinophil-derived neurotoxin (U-EDN), and serum eosinophil cationic protein (S-ECP), as well as completion of questionnaires regarding respiratory symptoms, medication, and quality of life.ResultsAlthough median periostin values showed no differences when comparing disease groups with healthy controls, multiple regression analyses revealed that periostin was positively associated with higher FeNO, U-EDN, and total IgE. In patients with asthma, an inverse relationship with lung function was also observed. Current smoking was associated with decreased periostin levels, whereas increased age and lower body mass index (BMI) related to higher periostin levels in subjects both with and without asthma.ConclusionWe confirm associations between periostin and markers of type 2 inflammation, as well as lung function, and identify novel constitutional factors of importance to the use of periostin as a phenotype-specific biomarker in asthma.
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