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1.	Djekic, Demir, et al. (author) Body Mass Index in Adolescence and Long-Term Risk of Early Incident Atrial Fibrillation and Subsequent Mortality, Heart Failure, and Ischemic Stroke 2022 In: Journal of the American Heart Association. - : John Wiley & Sons. - 2047-9980. ; 11:21 Journal article (peer-reviewed)abstract Background: We sought to determine the role of obesity in adolescent men on development of atrial fibrillation (AF) and subsequent associated clinical outcomes in subjects diagnosed with AF.Methods and Results: We conducted a nationwide, register-based, cohort study of 1 704 467 men (mean age, 18.3±0.75 years) enrolled in compulsory military service in Sweden from 1969 through 2005. Height and weight, blood pressure, fitness, muscle strength, intelligence quotient, and medical disorders were recorded at baseline. Records obtained from the National Inpatient Registry and the Cause of Death Register were used to determine incidence and clinical outcomes of AF. During a median follow-up of 32 years (interquartile range, 24-41 years), 36 693 cases (mean age at diagnosis, 52.4±10.6 years) of AF were recorded. The multivariable-adjusted hazard ratio (HR) for AF increased from 1.06 (95% CI, 1.03-1.10) in individuals with body mass index (BMI) of 20.0 to <22.5 kg/m2 to 3.72 (95% CI, 2.44-5.66) among men with BMI of 40.0 to 50.0 kg/m2, compared with those with BMI of 18.5 to <20.0 kg/m2. During a median follow-up of ≈6 years in patients diagnosed with AF, we identified 3767 deaths, 3251 cases of incident heart failure, and 921 cases of ischemic stroke. The multivariable-adjusted HRs for all-cause mortality, incident heart failure, and ischemic stroke in AF-diagnosed men with baseline BMI >30 kg/m2 compared with those with BMI <20 kg/m2 were 2.86 (95% CI, 2.30-3.56), 3.42 (95% CI, 2.50-4.68), and 2.34 (95% CI, 1.52-3.61), respectively.Conclusions: Increasing BMI in adolescent men is strongly associated with early AF, and with subsequent worse clinical outcomes in those diagnosed with AF with respect to all-cause mortality, incident heart failure, and ischemic stroke.
2.	Djekic, Demir, et al. (author) Body Mass Index in Adolescence and Long-Term Risk of Early Incident Atrial Fibrillation and Subsequent Mortality, Heart Failure, and Ischemic Stroke 2022 In: Journal of the American Heart Association. - : Ovid Technologies (Wolters Kluwer Health). - 2047-9980. ; 11:21 Journal article (peer-reviewed)abstract Background We sought to determine the role of obesity in adolescent men on development of atrial fibrillation (AF) and subsequent associated clinical outcomes in subjects diagnosed with AF. Methods and Results We conducted a nationwide, register-based, cohort study of 1 704 467 men (mean age, 18.3 +/- 0.75 years) enrolled in compulsory military service in Sweden from 1969 through 2005. Height and weight, blood pressure, fitness, muscle strength, intelligence quotient, and medical disorders were recorded at baseline. Records obtained from the National Inpatient Registry and the Cause of Death Register were used to determine incidence and clinical outcomes of AF. During a median follow-up of 32 years (interquartile range, 24-41 years), 36 693 cases (mean age at diagnosis, 52.4 +/- 10.6 years) of AF were recorded. The multivariable-adjusted hazard ratio (HR) for AF increased from 1.06 (95% CI, 1.03-1.10) in individuals with body mass index (BMI) of 20.0 to <22.5 kg/m(2) to 3.72 (95% CI, 2.44-5.66) among men with BMI of 40.0 to 50.0 kg/m(2), compared with those with BMI of 18.5 to <20.0 kg/m(2). During a median follow-up of approximate to 6 years in patients diagnosed with AF, we identified 3767 deaths, 3251 cases of incident heart failure, and 921 cases of ischemic stroke. The multivariable-adjusted HRs for all-cause mortality, incident heart failure, and ischemic stroke in AF-diagnosed men with baseline BMI >30 kg/m(2) compared with those with BMI <20 kg/m(2) were 2.86 (95% CI, 2.30-3.56), 3.42 (95% CI, 2.50-4.68), and 2.34 (95% CI, 1.52-3.61), respectively. Conclusions Increasing BMI in adolescent men is strongly associated with early AF, and with subsequent worse clinical outcomes in those diagnosed with AF with respect to all-cause mortality, incident heart failure, and ischemic stroke.
3.	Lindgren, Martin, et al. (author) Cardiorespiratory fitness and muscle strength in late adolescence and long-term risk of early heart failure in Swedish men. 2017 In: European journal of preventive cardiology. - : Oxford University Press (OUP). - 2047-4881 .- 2047-4873. ; 24:8, s. 876-884 Journal article (peer-reviewed)abstract Aims To investigate the association between cardiorespiratory fitness (CRF) and muscle strength in late adolescence and the long-term risk of heart failure (HF). Methods A cohort was created of Swedish men enrolled in compulsory military service between 1968 and 2005 with measurements for CRF and muscle strength ( n=1,226,623; mean age 18.3 years). They were followed until 31 December 2014 for HF hospitalization as recorded in the Swedish national inpatient registry. Results During the follow-up period (median (interquartile range) 28.4 (22.0-37.0) years), 7656 cases of first HF hospitalization were observed (mean±SD age at diagnosis 50.1±7.9 years). CRF and muscle strength were estimated by maximum capacity cycle ergometer testing and strength exercises (knee extension, elbow flexion and hand grip). Inverse dose-response relationships were found between CRF and muscle strength with HF as a primary or contributory diagnosis with an adjusted hazards ratio (95% confidence interval) of 1.60 (1.44-1.77) for low CRF and 1.45 (1.32-1.58) for low muscle strength categories. The associations of incident HF with CRF and muscle strength persisted, regardless of adjustments for the other potential confounders. The highest risk was observed for HF associated with coronary heart disease, diabetes or hypertension. Conclusions In this longitudinal study of young men, we found inverse and mutually independent associations between CRF and muscle strength with risk of hospitalization for HF. If causal, these results may emphasize the importance of the promotion of CRF and muscle strength in younger populations.
4.	Lindgren, Martin, et al. (author) Cognitive performance in late adolescence and long-term risk of early heart failure in Swedish men. 2018 In: European journal of heart failure. - : Wiley. - 1879-0844 .- 1388-9842. ; 20:6, s. 989-97 Journal article (peer-reviewed)abstract Heart failure (HF) incidence appears to increase among younger individuals, raising questions of how risk factors affect the younger population. We investigated the association of cognitive performance in late adolescence with long-term risk of early HF.We followed a cohort of Swedish men enrolled in mandatory military conscription in 1968-2005 (n=1 225 300; mean age 18.3years) until 2014 for HF hospitalization, using data from the Swedish National Inpatient Registry. Cognitive performance (IQ) was measured through a combination of tests, separately evaluating logical, verbal, visuospatial, and technical abilities. The results were standardized, weighted, and presented as stanines of IQ. The association between IQ and risk of HF was estimated using Cox proportional hazards models. In follow-up, there were 7633 cases of a first HF hospitalization (mean age at diagnosis 50.1years). We found an inverse relationship between global IQ and risk of HF hospitalization. Using the highest IQ stanine as reference, the adjusted hazard ratio for the lowest IQ with risk of HF was 3.11 (95% confidence interval 2.60-3.71), corresponding to a hazard ratio of 1.32 (95% CI 1.28-1.35) per standard deviation decrease of IQ. This association proved persistent across predefined categories of HF with respect to pre-existing or concomitant co-morbidities; it was less apparent among obese conscripts (P for interaction =0.0004).In this study of young men, IQ was strongly associated with increased risk of early HF. The medical profession needs to be aware of this finding so as to not defer diagnosis.
5.	Lindgren, Martin, et al. (author) Elevated resting heart rate in adolescent men and risk of heart failure and cardiomyopathy. 2020 In: ESC heart failure. - : Wiley. - 2055-5822. ; 7:3, s. 1178-1185 Journal article (peer-reviewed)abstract This study aims to investigate the association of resting heart rate (RHR) measured in late adolescence with long-term risk of cause-specific heart failure (HF) and subtypes of cardiomyopathy (CM), with special attention to cardiorespiratory fitness.We performed a nation-wide, register-based cohort study of all Swedish men enrolled for conscription in 1968-2005 (n=1008363; mean age=18.3years). RHR and arterial blood pressure were measured together with anthropometrics as part of the enlistment protocol. HF and its concomitant diagnoses, as well as all CM diagnoses, were collected from the national inpatient, outpatient, and cause of death registries. Risk estimates were calculated by Cox-proportional hazards models while adjusting for potential confounders. During follow-up, there were 8400 cases of first hospitalization for HF and 3377 for CM. Comparing the first and fifth quintiles of the RHR distribution, the hazard ratio (HR) for HF associated with coronary heart disease, diabetes, or hypertension was 1.25 [95% confidence interval (CI)=1.13-1.38] after adjustment for body mass index, blood pressure, and cardiorespiratory fitness. The corresponding HR was 1.43 (CI=1.08-1.90) for HF associated with CM and 1.34 (CI=1.16-1.54) for HF without concomitant diagnosis. There was an association between RHR and dilated CM [HR=1.47 (CI=1.27-1.71)] but not hypertrophic, alcohol/drug-induced, or other cardiomyopathies.Adolescent RHR is associated with future risk of HF, regardless of associated aetiological condition. The association was strongest for HF associated with CM, driven by the association with dilated CM. These findings indicate a causal pathway between elevated RHR and myocardial dysfunction that warrants further investigation.
6.	Lindgren, Martin, et al. (author) Resting heart rate in late adolescence and long term risk of cardiovascular disease in Swedish men 2018 In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 259, s. 109-115 Journal article (peer-reviewed)abstract Aim: To investigate the association of resting heart rate (RHR) measured in late adolescence with the long term risk of myocardial infarction (MI), ischemic stroke (IS), heart failure (HF), atrial fibrillation (AF), cardiovascular- and all-cause death. Methods and results: We followed a cohort of Swedish men enrolled for conscription in 1968–2005 (n = 1,008,485; mean age = 18.3 years) until December 2014. Outcomes were collected from the national inpatient - (IPR), outpatient - (OPR) and cause of death registries. Cox proportional hazard models were used to analyze the longitudinal association between RHR and outcomes while adjusting for potential confounders. While we found no independent association between RHR and risk of IS or MI when comparing the highest with the lowest quintile of the RHR distribution, but a positive association persisted between RHR and incident HF (Hazard ratio (HR) = 1.39 [95% confidence interval (CI) = 1.29–1.49]) after adjustment for body mass index (BMI) and blood pressure (BP). In similarly adjusted models, an inverse association was found for AF while there were weaker associations with death from cardiovascular disease (CVD) and all causes (adjusted HR = 1.12 [CI = 1.04–1.21] and 1.20 [CI = 1.17–1.24]). After further adjustment for cardiorespiratory fitness (CRF), the associations persisted for HF (HR = 1.26 [1.17–1.35] for any diagnostic position and HR = 1.43 [1.28–1.60] for HF as a main diagnosis) and for all-cause death (HR 1.09 [1.05–1.12]) but not for CVD death. Conclusion: Adolescent RHR is associated with future risk of HF and death, independently of BP, BMI and CRF, but not with CVD death, MI or IS, suggesting a causal pathway between elevated heart rate and myocardial dysfunction. © 2018 The Authors
7.	Nyberg, Jenny, 1976, et al. (author) Cardiovascular fitness in late adolescent males and later risk of serious non-affective mental disorders: a prospective, population-based study. 2018 In: Psychological medicine. - 1469-8978. ; 48:3, s. 416-425 Journal article (peer-reviewed)abstract Cardiovascular fitness in late adolescence is associated with future risk of depression. Relationships with other mental disorders need elucidation. This study investigated whether fitness in late adolescence is associated with future risk of serious non-affective mental disorders. Further, we examined how having an affected brother might impact the relationship.Prospective, population-based cohort study of 1 109 786 Swedish male conscripts with no history of mental illness, who underwent conscription examinations at age 18 between 1968 and 2005. Cardiovascular fitness was objectively measured at conscription using a bicycle ergometer test. During the follow-up (3-42 years), incident cases of serious non-affective mental disorders (schizophrenia and schizophrenia-like disorders, other psychotic disorders and neurotic, stress-related and somatoform disorders) were identified through the Swedish National Hospital Discharge Register. Cox proportional hazards models were used to assess the influence of cardiovascular fitness at conscription and risk of serious non-affective mental disorders later in life.Low fitness was associated with increased risk for schizophrenia and schizophrenia-like disorders [hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.29-1.61], other psychotic disorders (HR 1.41, 95% CI 1.27-1.56), and neurotic or stress-related and somatoform disorders (HR 1.45, 95% CI 1.37-1.54). Relationships persisted in models that included illness in brothers.Lower fitness in late adolescent males is associated with increased risk of serious non-affective mental disorders in adulthood.
8.	Rosengren, Annika, 1951, et al. (author) Body weight in adolescence and long-term risk of early heart failure in adulthood among men in Sweden 2017 In: European heart journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 38:24, s. 1926-1933 Journal article (peer-reviewed)abstract AIMS: To study the relation between body mass index (BMI) in young men and risk of early hospitalization with heart failure. METHODS AND RESULTS: In a prospective cohort study, men from the Swedish Conscript Registry investigated 1968-2005 (n = 1 610 437; mean age, 18.6 years were followed 5-42 years (median, 23.0 years; interquartile range, 15.0-32.0), 5492 first hospitalizations for heart failure occurred (mean age at diagnosis, 46.6 (SD 8.0) years). Compared with men with a body mass index (BMI) of 18.5-20.0 kg/m2, men with a BMI 20.0-22.5 kg/m2 had an hazard ratio (HR) of 1.22 (95% CI, 1.10-1.35), after adjustment for age, year of conscription, comorbidities at baseline, parental education, blood pressure, IQ, muscle strength, and fitness. The risk rose incrementally with increasing BMI such that men with a BMI of 30-35 kg/m2 had an adjusted HR of 6.47 (95% CI, 5.39-7.77) and those with a BMI of >/=35 kg/m2 had an HR of 9.21 (95% CI, 6.57-12.92). The multiple-adjusted risk of heart failure per 1 unit increase in BMI ranged from 1.06 (95% CI, 1.02-1.11) in heart failure associated with valvular disease to 1.20 (95% CI, 1.18-1.22) for cases associated with coronary heart disease, diabetes, or hypertension. CONCLUSION: We found a steeply rising risk of early heart failure detectable already at a normal body weight, increasing nearly 10-fold in the highest weight category. Given the current obesity epidemic, heart failure in the young may increase substantially in the future and physicians need to be aware of this.
9.	Wiberg, Karin, et al. (author) Model Selection and Evaluation for Risk Assessment of Dioxin-contaminated Sites 2007 In: AMBIO: A Journal of the Human Environment. ; 36:6, s. 458-66 Journal article (peer-reviewed)abstract The general European population has a total intake of dioxins and dioxin-like chemicals near the limit recommended by the European Union, making additional exposure above background levels undesirable. For populations living near dioxin-contaminated sites, additional exposure may occur by intake of locally produced food, inhalation of particles, dermal contact with soils, or other exposure pathways. Risk assessment tools are required to estimate risks associated with contaminated sites and to set priorities for site remediation. Here, we review several multimedia models that can be applied as tools to support risk assessment. We then present a strategy to select, apply, evaluate, and adapt a model to address a specific situation. The case study we consider is a risk assessment of generic background dioxin exposure in Sweden, and we compare the predictions with environmental observations and exposure data from Sweden. Arguments are presented for selecting the CalTOX model for this case study. We demonstrate the application, evaluation, and adaptation of the model and discuss the requirements for extending the analysis to conduct risk assessment for subpopulations living near dioxin-contaminated sites.
10.	Åberg, Annika, et al. (author) Exposure assessment at a PCDD/F contaminated site in Sweden : field measurements of exposure media and serum analysis 2010 In: Environmental Science and Pollution Research. - Berlin / Heidelberg : Springer. - 0944-1344 .- 1614-7499. ; 17:1, s. 26-39 Journal article (peer-reviewed)abstract BACKGROUND, AIM, AND SCOPE: The main pathway for human exposure to the highly toxic polychlorinated-p-dioxins and polychlorinated furans [polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs)] is via dietary intake. Other exposure pathways may, however, be important in close proximity to point sources, such as wood preservation sites, where PCDD/F contaminated chlorophenols (CP) were previously used. In this study, a heavily PCDD/F contaminated CP saw mill site in Sweden was investigated. Human exposure through a broad spectrum of exposure pathways was assessed. Such studies are in demand since the question whether contaminated sites represent a current or future risk can only be answered by detailed site-specific risk assessments. MATERIALS AND METHODS: Sampling of exposure media (soil, air, groundwater, raspberries, carrots, potatoes, grass, milk, eggs, and chicken fodder) was made. Exposure media concentrations and congener distribution patterns were used to investigate the mobilization of PCDD/Fs from soil to the environment and to calculate exposure levels for adults. Blood serum levels from site-exposed and control individuals were also analyzed. RESULTS: Congener distribution patterns at the site were generally dominated by a specific marker congener (1234678-HpCDF), which is highly abundant in the polluted soil. The dioxin toxic equivalents (TEQ) concentrations were notably elevated as compared to national reference samples for most exposure media, and the marker congener was a major contributor to increased TEQ levels. There were also indications of soil-to-air volatilization of tetra- and penta-CDD/Fs. People who participated in the restoration of a contaminated building showed higher levels of 1234678-HpCDF compared to controls, and calculated exposure levels suggest that several site-specific exposure routes may be of importance for the daily intake of PCDD/F. CONCLUSIONS, RECOMMENDATIONS, AND PERSPECTIVES: Despite low mobility of higher chlorinated PCDD/Fs, these contaminants were transferred from the polluted soil to the surroundings and into human tissue. The extent of increased exposure from contaminated sites depends on the PCDD/F source strength of the soil, composition of the pollution, human activities, and dietary patterns of the residents. Impact from the contaminated soil on other exposure media was seen also for areas with low to moderate soil contamination. In the future, not only the levels of PCDD/F soil pollution but also the composition must be considered in risk assessments of contaminated sites.
11.	Åberg, Annika, et al. (author) Hälsoriskbedömning av exponering relaterad till dioxinförorenad mark 2009 Reports (other academic/artistic)abstract Sammanfattning I två projekt som har finansierats av kunskapsprogrammet Hållbar Sanering har en kombinerad spridnings- och exponeringsmodell (CalTOX) utvärderats som ett verktyg för riskbedömning av dioxinförorenad mark. Modellens styrka jämfört med liknande modeller är dels att den inkluderar livsmedelsbaserade exponeringsvägar, dels att den kan hantera både bakgrundshalter i luft i kombination med förhöjda halter i marken samt att den är anpassad för att beskriva förändringar över tiden (dynamiska situationer). En initial utvärdering av modellen gjordes med ett generellt bakgrundscenario där modellresultaten jämfördes mot svenska mätdata. I en andra fas utvärderades modellen i ett platsspecifikt förorenad markscenario, där analyser av fältprover på ett dioxinförorenat område utgjorde basen för att kunna avgöra modellens användbarhet ur riskbedömningssynpunkt. De övergripande erfarenheterna som erhållits då CalTOX har tillämpats för beräkningar av dioxinhalter i olika delar av miljön har sammanställts i tabell A och B. Syftet med sammanställningarna är att ge en vägledning av förväntade resultat från modellen samt att visa på hur omständigheter i både modelleringen och utvärderingen som kan leda till avvikelser. Som grund för utvärderingen användes uppmätta halter i miljöprover som ”sanna” värden. En avvikelse på 1-4 gånger mellan uppmätta och beräknade halter betraktades som bra, 5-9 gånger som godkänd och >10 som tveksam. Eftersom avvikelserna mellan beräknade och uppmätta halter varierade för olika kongener var den slutliga bedömningen ändå något subjektiv. Vid slutbedömningen vägdes även exponeringens betydelse in. Dessutom bedömdes en överskattning lindrigare än en underskattning eftersom den senare leder till en underskattad exponeringsrisk. I tabell A återfinns utvärderingen av Bakgrundsscenariot, d.v.s. det scenario som förutsatte svenska bakgrundsnivåer och som är utvärderat med hjälp av analysdata från typiska svenska bakgrundsbelastade prover. Eftersom mätdata för både luft och mark utgjorde ingångsvärden till bakgrundsscenariot har modellresultat för dessa medier ej inkluderats i tabell A. De övergripande erfarenheterna som gjorts då CalTOX tillämpades för ett förorenad markscenario har sammanställts i tabell B. Sediment, ytvatten och fisk uteslöts från utvärderingen eftersom det detaljkunskap om det akvatiska systemet saknades för den specifika platsen. Utvärderingen av CalTOX har visat att verktyget är användbart för att bedöma spridningen av dioxiner till omgivande miljö, både i syfte att återspegla en bakgrundssituation och en situation med förorenad mark. Med hjälp av modellberäkningar har bidraget från flera olika exponeringsvägar jämförts i olika scenarier med ökande koncentration av dioxiner i marken. De exponeringsvägar som uppenbart kan ge en ett väsentligt bidrag till en ökad yttre exponering om marken är förorenad är; • intag av jord • intag av ägg • intag av mjölk • intag av kött • intag av ovanjordiska växter 8HÅLLBAR SANERING Rapport 5929 - Hälsoriskbedömning av exponering relaterad till dioxinförorenad mark • intag av underjordiska växter • hudkontakt med jord Tabell A. Sammanfattning av övergripande erfarenheter från modellberäkningar som erhölls då CalTOX tillämpades på ett bakgrundsscenario. Som grund för utvärderingen användes uppmätta halter i miljöprover som ”sanna” värden. En avvikelse på 1-4 gånger mellan uppmätta och beräknade halter betraktades som bra, 5-9 gånger som godkänd och >10 som tveksam. Tabellen bör endast betraktas som en vägledning av förväntat resultat från en modellering. För förklaring and kommentarer till fotnoter, se kapitel 6.1. Ovanjordiska Underjordiska Ytvatten Grundvatten Sediment växtdelar växtdelar a b Överensstämmelse Bra Godkänd Tveksamc d Bra EA Risk för överskattning xdRisk för underskattning xa xb xc xdKött Mjölk Ägg Fisk e e Överensstämmelse Bra Bra Tveksamf g GodkändRisk för överskattning xe xe xfRisk för underskattning xe xe xf xgTabell B Sammanfattning av övergripande erfarenheter från modellberäkningar som erhölls då CalTOX tillämpades på förorenad markscenario. Som grund för utvärderingen användes platsspecifika uppmätta halter som ”sanna” värden. En avvikelse på 1-4 gånger mellan uppmätta och beräknade halter betraktades som bra, 5-9 gånger som godkänd och >10 som tveksam. Tabellen bör endast betraktas som en vägledning av förväntat resultat från en modellering. Överensstämmelsen är en sammanvägd bedömning av avvikelser mellan modellscenariot/ verkligheten och konsekvenser av avvikelserna. Avvikelser som ger en viss (om än rimlig) säkerhetsmarginal i t.ex. exponeringsberäkningarna har bedömts som godkända. För förklaring och kommentarer till fotnoter, se kapitel 6.1. Ovanjordiska Underjordiska Luft Ytvatten Grundvatten växtdelar växtdelar a Överensstämmelse Godkänd EA Godkändb c d Godkänd GodkändRisk för överskattning xa xb xcRisk för underskattning xdKött Mjölk Ägg f e Överensstämmelse EA Bra TveksamfRisk för överskattning xe xfRisk för underskattning xfFigur A sammanfattar kritiska exponeringsvägar vid olika grad av dioxinförorenad jord identifierade med CalTOX. Intag av animaliska livsmedel (t.ex. kött, mjölk och ägg) som producerats på förorenad mark står sannolikt för de största potentiella exponeringsriskerna eftersom fettinnehållet i dessa produkter bidrar till att dioxiner ackumuleras i dessa produkter. Redan vid låga markkoncentrationer kan livsmedlen kontamineras i relativt hög utsträckning. Områden som förorenats diffust eller som har fläckvis förhöjda halter kan därför utgöra en större risk än ett begränsat hot-spot område där ringa aktivitet pågår. Förorenade objekt med nära läge till betesmarker eller äggproduktion bör således ges hög prioritet vid miljöutredningar. Sannolikt är det spridning av förorenade jordpartiklar till betesväxters bladytor samt direkt intag av förorenad jord vid betning som bidrar till att djuren exponeras. Förhöjda halter av dioxiner i luft och växter (utan jordpartiklar) bidrar i lägre utsträckning. 9HÅLLBAR SANERING Rapport 5929 - Hälsoriskbedömning av exponering relaterad till dioxinförorenad mark 10 100 1000ng TEQ/kg TS i jord Intag av kött/mjölk/ägg Intag av jord Intag av rotfrukter/grönsaker Inhalering av utomhusluft Hudkontakt jord Intag av grundvatten Figur A. Kritiska exponeringsvägar vid olika grad av dioxinförorenad jord identifierade med CalTOX modellering. Antaganden av tillgänglighet: 3 % för hudkontakt, 50 % för intag av jord, samt 100 % för övriga exponeringsvägar. Utöver att fettfraktionen bidrar till att ackumulera dioxiner i mjölk, kött, ägg och andra animaliska livsmedel bidrar den också till att öka tillgängligheten av dioxinerna i magtarmkanalen. Intag av föroreningar via en fettfraktion, t.ex. genom att äta animalisk föda, resulterar i ett större upptag av föroreningarna jämfört med om intaget sker via intag av förorenade partiklar (t.ex. damm eller jord). Intag av jord kan ge ett väsentligt bidrag om markkoncentrationerna är höga. Då jord är den bärande matrisen bör dock hänsyn tas till den lägre tillgängligheten för upptag jämfört med andra matriser (t.ex. livsmedel). Vid bakgrundskoncentrationer i miljön ger intag av jord inget väsentligt bidrag till exponeringen. Exponeringsrisker vid intag av bär och grönsaker från ett förorenat område beror på damm och jord som fastnar på ytorna. Rotupptag och upptag av gasfas från luften är av mindre betydelse. Risker genom intag av bär och grönsaker kan därmed minskas genom att skölja produkterna. Vissa rotfrukter, som morötter, kan ta upp dioxiner i relativt hög utsträckning medan andra rotfrukter, som potatis, tar upp betydligt mindre. Eftersom dioxinerna framförallt anrikas i skalen kan exponeringsriskerna minskas betydligt om produkterna skalas. Hudkontakt kan ge ett väsentligt bidrag till exponeringen om markkoncentrationen är hög. Hur ofta och hur länge man exponeras via hudkontakt samt den hudyta som utsätts för exponeringen är dock avgörande för denna exponeringsvägs betydelse. Hänsyn måste också tas till den markant lägre tillgängligheten för absorbering genom huden då jord är den bärande matrisen. I de generaliserade scenarier som använts befanns inhalering utomhus och intag vatten ej utgöra väsentliga exponeringsvägar. Inhalering torde dock kunna utgöra en exponeringsrisk i byggnader som innehåller förorenat damm och partiklar, t.ex. vid renoveringsarbete i kontaminerade lokaler. 10HÅLLBAR SANERING Rapport 5929 - Hälsoriskbedömning av exponering relaterad till dioxinförorenad mark Erfarenheterna från detta projekt visar att bidraget från en exponeringsväg kan variera kraftigt från situation till situation och att bidraget är starkt beroende av de olika antaganden som görs när exponeringen modelleras. För att få en bra uppfattning om vilka risker som är styrande bör dessa givetvis motsvara den verkliga situationen så långt det är möjligt. Fördelen med att modellera exponeringsriskerna i CalTOX är att varje given situation kan bedömas utifrån en helhet och man kan tydliggöra vilka spridnings- och upptagsvägar som kan bidra till en väsentlig påverkan på omgivningen. För varje exponeringsväg är det möjligt att se vilket medium (t.ex. luft, jord, grundvatten, etc.) som bidrar mest till exponeringsdosen. Detta innebär att en situation där risker för förhöjd exponering föreligger kan detaljstuderas. Eftersom bakgrundshalter kan inkluderas i form av t.ex. luftemissioner och markkoncentr
12.	Åberg, Maria A I, 1972, et al. (author) Body Weight in Adolescent Men in Sweden and Risk of an Early Acute Coronary Event: A Prospective Population-Based Study 2023 In: Journal of the American Heart Association (JAHA). - 2047-9980. ; 12:12 Journal article (peer-reviewed)abstract BackgroundCoronary heart disease remains the dominant cause of death worldwide. To improve cardiovascular disease prevention, knowledge of early key risk factors, especially those that are modifiable, is essential. The ongoing global obesity epidemic is of particular concern. We aimed to determine whether body mass index at conscription predicts early acute coronary events among men in Sweden. Methods and ResultsThis was a population-based Swedish cohort study of conscripts (n=1 668 921; mean age, 18.3 years; 1968-2005), with follow-up through linkage to the nationwide Swedish patient and death registries. Risk of a first acute coronary event (hospitalization for acute myocardial infarction or coronary death) during follow-up (1-48 years) was calculated with generalized additive models. Objective baseline measures of fitness and cognition were included in the models in secondary analyses. During follow-up, there were 51 779 acute coronary events, of which 6457 (12.5%) were fatal within 30 days. Compared with men at the lowest end of the normal body mass index spectrum (body mass index, 18.5 kg/m(2)), an increasing risk for a first acute coronary event was observed, with hazard ratios (HRs) peaking at 40 years of age. After multivariable adjustments, men with a body mass index of 35 kg/m(2) had an HR of 4.84 (95% CI, 4.29-5.46) for an event before the age of 40 years. ConclusionsAn increased risk of an early acute coronary event was detectable within normal levels of body weight at the age of 18 years, increasing to almost 5-fold in the highest weight category at 40 years of age. Given increasing levels of body weight and prevalence of overweight and obesity in young adults, the current decrease in coronary heart disease incidence in Sweden may flatten or even reverse in the near future.
13.	Åberg, Maria A I, 1972, et al. (author) Nonpsychotic Mental Disorders in Teenage Males and Risk of Early Stroke A Population-Based Study 2016 In: Stroke. - : Ovid Technologies (Wolters Kluwer Health). - 0039-2499 .- 1524-4628. ; 47:3, s. 814-821 Journal article (peer-reviewed)abstract Background and Purpose- Although the incidence of stroke is on the decline worldwide, this is not the case for early stroke. We aimed to determine whether nonpsychotic mental disorder at the age of 18 years is a risk factor for early stroke, and if adolescent cardiovascular fitness and intelligence quotient might attenuate the risk. Population-based Swedish cohort study of conscripts (n=1 163 845) who enlisted during 1968 to 2005. At conscription, 45 064 males were diagnosed with nonpsychotic mental disorder. Risk of stroke during follow-up (5-42 years) was calculated with Cox proportional hazards models. Objective baseline measures of fitness and cognition were included in the models in a second set of analyses. There were 7770 first-time stroke events. In adjusted models, increased risk for stroke was observed in men diagnosed with depressive/neurotic disorders (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.11-1.37), personality disorders (HR, 1.52; 95% CI, 1.29-1.78), and alcohol/substance use disorders (HR, 1.61; 95% CI, 1.41-1.83) at conscription. Corresponding figures for fatal stroke were HR, 1.38; 95% CI, 1.06 to 1.79; HR, 2.26; 95% CI, 1.60 to 3.19; and HR, 2.20; 95% CI, 1.63 to 2.96. HRs for stroke were attenuated when fitness level and intelligence quotient were introduced. Associations remained significant for personality disorders and alcohol/substance use in the fully adjusted models. The interaction term was statistically significant for fitness but not for intelligence quotient. Our findings suggest that fitness may modify associations between nonpsychotic disorders and stroke. It remains to be clarified whether interventions designed to improve fitness in mentally ill youth can influence future risk of early stroke.
14.	Åberg, N David, 1970, et al. (author) Diverging trends for onset of acute myocardial infarction, heart failure, stroke and mortality in young males: role of changes in obesity and fitness 2021 In: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 290:2, s. 373-385 Journal article (peer-reviewed)abstract Background As opposed to the decreasing overall rates of coronary heart disease (CHD) incidence and overall cardiovascular disease (CVD) mortality, heart failure (HF) and stroke incidence are increasing in young people, potentially due to rising rates of obesity and reduced cardiorespiratory fitness (CRF). Objectives We investigated trends in early major CVD outcomes in a large cohort of young men. Methods Successive cohorts of Swedish military conscripts from 1971 to 1995 (N = 1,258,432; mean age, 18.3 years) were followed, using data from the National Inpatient and Cause of Death registries. Cox proportional hazard models were used to analyse changes in 21-year CVD event rates. Results 21-year CVD and all-cause mortality and incidence of acute myocardial infarction (AMI) decreased progressively. Compared with the cohort conscripted in 1971-1975 (reference), the hazard ratios (HRs) for the last 1991-1995 cohort were 0.50 [95% confidence interval (CI) 0.42-0.59] for CVD mortality; 0.57 (95% CI 0.54-0.60) for all-cause mortality; and 0.63 (95% CI 0.53-0.75) for AMI. In contrast, the incidence of ischaemic stroke, intracerebral haemorrhage and HF increased with HRs of 1.43 (95% CI 1.17-1.75), 1.30 (95% CI 1.01-1.68) and 1.84 (95% CI 1.47-2.30), respectively. During the period, rates of obesity increased from 1.04% to 2.61%, whilst CRF scores decreased slightly. Adjustment for these factors influenced these secular trends only moderately. Conclusion Secular trends of young-onset CVD events demonstrated a marked shift from AMI and CVD mortality to HF and stroke incidence. Trends were significantly, though moderately, influenced by changing baseline BMI and CRF.
15.	Åberg, N David, 1970, et al. (author) Influence of Cardiovascular Fitness and Muscle Strength in Early Adulthood on Long-Term Risk of Stroke in Swedish Men 2015 In: Stroke. - : Ovid Technologies (Wolters Kluwer Health). - 0039-2499 .- 1524-4628. ; 46:7, s. 1769-1776 Journal article (peer-reviewed)abstract Background and Purpose Low cardiovascular fitness (fitness) in mid- and late life is a risk factor for stroke. However, the respective effects on long-term stroke risk of fitness and muscle strength in early adulthood are unknown. Therefore, we analyzed these in a large cohort of young men. Method We performed a population-based longitudinal cohort study of Swedish male conscripts registered in 1968 to 2005. Data on fitness (by the cycle ergometric test; n=1 166 035) and muscle strength (n=1 563 750) were trichotomized (low, medium, and high). During a 42-year follow-up, risk of stroke (subarachnoidal hemorrhage, intracerebral hemorrhage, and ischemic stroke) and fatality were calculated with Cox proportional hazards models. To identify cases, we used the International Classification of Diseases-Eighth to Tenth Revision in the Hospital Discharge Register and the Cause of Death Register. Results First-time stroke events were identified (subarachnoidal hemorrhage, n=895; intracerebral hemorrhage, n=2904; ischemic stroke, n=7767). For all stroke and fatality analysis any type of first-time stroke was recorded (n=10 917). There were inverse relationships in a dose-response fashion between fitness and muscle strength with any stroke (adjusted hazard ratios for the lowest, compared with the highest, tertile of each 1.70 [1.50-1.93] and 1.39 [1.27-1.53], respectively). There were stronger associations for fatal stroke. All 3 stroke types displayed similar associations. Associations between fitness and stroke remained when adjusted for muscle strength, whereas associations between muscle strength and stroke weakened/disappeared when adjusted for fitness. Conclusions At the age of 18 years, low fitness and to a lesser degree low muscle strength were independently associated with an increased future stroke risk.
16.	af Geijerstam, Agnes, et al. (author) Fitness, strength and severity of COVID-19: a prospective register study of 1 559 187 Swedish conscripts 2021 In: BMJ Open. - : BMJ. - 2044-6055. ; 11:7 Journal article (peer-reviewed)abstract Objective To investigate the possible connection between cardiorespiratory fitness (CRF) and muscle strength in early adulthood and severity of COVID-19 later in life. Design Prospective registry-based cohort study. Participants 1 559 187 Swedish men, undergoing military conscription between 1968 and 2005 at a mean age of 18.3 (SD 0.73) years. Main outcome measures Hospitalisation, intensive care or death due to COVID-19 from March to September 2020, in relation to CRF and muscle strength. Results High CRF in late adolescence and early adulthood had a protective association with severe COVID-19 later in life with OR (95% CI) 0.76 (0.67 to 0.85) for hospitalisation (n=2 006), 0.61 (0.48 to 0.78) for intensive care (n=445) and 0.56 (0.37 to 0.85) for mortality (n=149), compared with the lowest category of CRF. The association remains unchanged when controlled for body mass index (BMI), blood pressure, chronic diseases and parental education level at baseline, and incident cardiovascular disease before 2020. Moreover, lower muscle strength in late adolescence showed a linear association with a higher risk of all three outcomes when controlled for BMI and height. Conclusions Physical fitness at a young age is associated with severity of COVID-19 many years later. This underscores the necessity to increase the general physical fitness of the population to offer protection against future viral pandemics.
17.	Andréasson, Karin, et al. (author) Body mass index in adolescence, risk of type 2 diabetes and associated complications: A nationwide cohort study of men 2022 In: EClinicalMedicine. - : Elsevier BV. - 2589-5370. ; 46 Journal article (peer-reviewed)abstract Background Obesity is a predominant factor in development of type 2 diabetes but to which extent adolescent obesity influences adult diabetes is unclear. We investigated the association between body mass index (BMI) in young men and subsequent type 2 diabetes and how, in diagnosed diabetes, adolescent BMI relates to glycemic control and diabetes complications. Methods Baseline data from the Swedish Conscript Register for men drafted 1968-2005 was combined with data from the National Diabetes and Patient registries. Diabetes risk was estimated through Cox regression and Kaplan-Meier survival estimates. Relationships between BMI, glycemic control and diabetes complications were assessed through multiple linear and logistic regression. Findings Among 1,647,826 men, 63,957 (3.88%) developed type 2 diabetes over a median follow-up of 29.0 years (IQR[21.0-37.0]). The risk of diabetes within 40 years after conscription was nearly 40% in individuals with adolescent BMI >= 35 kg/m(2). Compared to BMI 18.5-<20 kg/m(2) (reference), diabetes risk increased in a linear fashion from HR 1.18(95%CI 1.15-1.21) for BMI 20-<22.5 kg/m(2) to HR 15.93(95%CI 14.88-17.05) for BMI >= 35 kg/m(2), and a difference in age at onset of 11.4 years was seen. Among men who developed diabetes, higher adolescent BMI was associated with higher HbA1c levels and albuminuria rates. Interpretation Rising adolescent BMI was associated with increased risk of type 2 diabetes diagnosed at a younger age, with poorer metabolic control, and a greater prevalence of albuminuria, all suggestive of worse prognosis. Copyright (C) 2022 The Authors. Published by Elsevier Ltd.
18.	Back, Pär-Erik, 1961, et al. (author) Markmiljöns skyddsvärde – En härledning med utgångspunkt i miljöetik och lagstiftning 2016 Reports (other academic/artistic)abstract Vid riskbedömning av förorenade områden ska riskerna som föroreningen utgör bedömas för olika skyddsobjekt, främst människor, markmiljö, grund- och ytvatten. I fördjupade riskbedömningar kan det även vara aktuellt att bestämma lämpliga skyddsnivåer för skyddsobjekten. Till vilken nivå vi väljer att skydda ett objekt beror i hög grad på objektets skyddsvärde. Vad detta skyddsvärde består av och hur stort det anses vara beror i sin tur på vem det är som gör värderingen och vilket miljöetiskt synsätt som tillämpas. När skyddsobjektet markmiljö ska värderas uppstår ofta många frågor och oenigheten mellan olika aktörer kan ibland vara stor.Syftet med publikationen är att tydliggöra vad som avses med begreppet markmiljöns skyddsvärde och beskriva vad det består av. Olika miljöetiska synsätt kan leda till att vår markmiljö värderas olika högt beroende på vem som utför värderingen. I syfte att skapa en gemensam grund för denna typ av värderingar har vi här valt att utgå från den miljöetik som ligger till grund för vår miljölagstiftning. Målet med publikationen är att presentera en härledning av markmiljöns skyddsvärde och ge en grund för hur man kan resonera kring flera av de besvärliga frågor som ställs beträffande skyddet av markmiljön.Rapporten innehåller också en allmän diskussion av skyddsvärdet men beskriver inte konkret hur markmiljön bör värderas vid ett enskilt objekt. Publikationen är med andra ord ingen vägledning i den bemärkelsen att den är direkt tillämpbar för värdering i verkliga projekt. Vår förhoppning är istället att publikationen kommer att utgöra en viktig grund för arbetet med att ta fram framtida vägledningsmaterial för ekologisk riskbedömning samt riskvärdering.
19.	Bengtson, Anna, 1968-, et al. (author) Clandestine and Arranged Marriages : a study on business relationships in light of market structures 2010 In: The 26th IMP Conference. Conference paper (peer-reviewed)
20.	Bergviken Rensfeldt, Annika, 1969, et al. (author) Contested Platforms: Parent Resistance Positions and Shadow Infrastructure 2024 In: Paper for the European Conference for Education Research, 26-30 August 2024, Nicosia Cyprus. Conference paper (other academic/artistic)abstract Digital platforms are often seen as given and established parts of educational systems, also in critical research questioning their impact (Nichol & Garcia, 2022). If we instead consider that frictions and resistance are integrally part of their process of becoming (Bowker & Star, 2000; Bates, 2019), new research possibilities open up for investigating counter-positions and unexpected effects of platformisation in education. In this paper, we explore how official platforms for home–school communication met resistance from parents and caretakers in Sweden. The paper will analyse two empirical examples that demonstrate two different positions with regards to parent resistance – and forms of enacting frictions – vis-à-vis the platform-based school. First, based on analyses of media reporting, we discuss an initiative of programming-savvy parents in Stockholm who created an independent, open-source home–school communication app as a response to frustrations with the complexity and information exchange deficiencies of the formal parent communication platform (Skolplattform) issued to schools from a municipal level. While the parent initiative exposed a controversy about the citizen perspective on the platform issue, the municipal school organisation responded with a police report of a data breach by parent software developers that received international attention (Burgess, 2021). Second, based on free-text responses from a survey of more than 700 Swedish teachers conducted in the Nordic SOS project (sosproject.dtu.dk), we analyse how parents have been regularly excluded from platforms despite formal ambitions that they should be able to take part in their children's schooling (Swedish Education Act, 2010), but also explore how alternative ways to grant parents access are realised by teachers or ‘shadow IT’. Through both examples we illustrate how attending to tensions and frictions makes visible the sociomaterial ‘shadow infrastructure of care’ that forms part of digitised welfare sectors today (e.g. Power et al., 2022), also in education (Zakharova & Jarke, 2022), where it replaces or complements official platforms that were supposed to constitute the home–school communication infrastructure. Shadow infrastructures therefore include the reparative work that both shadow IT and social agents do to fulfill ‘democratic purposes’ or rather the ‘coerced digital participation’ (Barassi, 2019) of welfare platformisation. Importantly, our study shows the extent to which processes of platformisation depend on such sociomaterial shadow infrastructures that can cover up or compensate for frictions around accessibility and participation, which in turn raises concerns about the implications of distributing core welfare services to permanent but non-resilient shadow infrastructures.
21.	Echeverri, Per, et al. (author) Dealing with customer misbehavior : The role of practical judgement in service provision 2009 In: QUIS 11: Moving forward with Service Quality, Proceedings of the QUIS 11 – Services Conference, June 11-14, 2009, Wolfsburg, Germany. - 9783000273421 Conference paper (other academic/artistic)abstract Service encounters sometimes involve dealing with annoying or even threatening customers. Employees are being abused by customers and customers are being abused by service employees. However, much of current research on the dynamics of customer and service provider misbehavior fails to account for and explain incidents of customer abuse. Understanding the causes and consequences of misbehavior is important but not sufficient in advancing our knowledge that makes an impact in service industries. Uncovering the underlying knowledge that informs action on employee side seems to be more critical. Much current thinking reveals the significant role of tacit knowledge - a specific mode of knowing - in explaining the actions that may contribute to service interaction breakdowns. What we know less about is how tacit knowledge in service provision informs practical judgments, which in turn dictate how choices are made, decisions are reached and outcomes sought. By unpacking experience of incidents of customer abuse in service encounter interactions from an employee perspective; our paper aims to address the powerful role of practical judgment in service provision. We will, based on a rich empirical material on service interactions show how misbehavior appear in service encounters and by this elaborate on the underlying structures and mechanisms related to tacit knowledge. Supported by empirical data from service provision where the interaction is conditioned by no or limited service alternatives, we explore how employees experience and act on this kind of incidents. The findings are divided into four categories regarding two qualitatively different features of customer misbehavior, firstly the degree of misbehavior and secondly the misbehaviors direction towards the employee or the organization. On basis of different types of customer misbehavior we argue that the employees deal with misbehavior in distinctive ways. Based on these findings we propose some managerial implications.
22.	Echeverri, Per, et al. (author) Dealing with customer misbehaviour : Employees’ tactics, practical judgement and implicit knowledge 2012 In: Marketing Theory. - : SAGE. - 1470-5931 .- 1741-301X. ; 12:4, s. 427-449 Journal article (peer-reviewed)abstract Much current research fails to provide in-depth explanations as to how and with what resources frontline employees deal with incidents where customers display dysfunctional behaviour. By drawing on theory of implicit knowledge and practical judgement this paper aims to explain this and conceptualize inherent structures and sub-mechanisms, central to service marketing. The analysis is based on in-depth interviews and narratives from four different industries, each representing service provision wherein customer misbehaviour is found to be frequent. The results display linkages between the central dimensions of dealing with customer misbehaviour. When incidents of misbehaviour occur they are met by tactics ranging from routinized action to more analytical and strategic approaches. These tactics are guided by underlying mechanisms in the form of practical judgements based on rules, balanced adjustment or reflection, with the judgements in turn being informed by implicit knowledge based on norms, schemes, or multi-perspective thinking. The study reveals patterns of linkages between these.
23.	Ecke, Holger, et al. (author) Quantification of the effects of environmental leaching factors on emissions from bottom ash in road construction 2006 In: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 362:1-3, s. 42-49 Journal article (peer-reviewed)abstract The re-use of bottom ash in road construction necessitates a tool to predict the impact of trace metals on the surroundings over the lifetime of the road. The aim of this work was to quantify the effect of environmental factors that are supposed to influence leaching, so as to suggest guidelines in developing a leaching procedure for the testing of incineration residues re-used in road constructions. The effects of pH, L / S (liquid-to-solid ratio), leaching time, and leaching atmosphere on the leachate concentrations of Cd, Cr, Cu, Ni, Pb, and Zn were studied using a two-level full factorial design. The most significant factor for all responses was the pH, followed by L / S, though the importance of pH and L / S is often ignored in leaching tests. Multiple linear regression models describing the variation in leaching data had R2 values ranging from 61-97%. A two-step pH-stat leaching procedure that considers pH as well as L / S and leaching time was suggested.
24.	Fellesson, Markus, et al. (author) Adding Customer Value through Social Responsibilities : The case of public housing 2009 Conference paper (peer-reviewed)
25.	Fellesson, Markus, et al. (author) I have no idea what I'm doing. Customers as Incompetent Service Workers 2011 Conference paper (peer-reviewed)
26.	Fellesson, Markus, et al. (author) Money in everyday life : New financial services for the paradoxical micro-entrepreneur 2011 Conference paper (peer-reviewed)
27.	Fellesson, Markus, et al. (author) Preventing or promoting customer misbehavior through service design 2010 Conference paper (other academic/artistic)abstract The phenomenon of customer misbehavior, i.e. deviant, threatening or even violent customers, is not unusual and it causes problems for the firm, its employees, and other customers. Hitherto much research has focused on the hospitality industry (e.g. restaurants, hotels and bars) where misbehavior often is explained by service failures or customers’ characteristics. The purpose of this paper is to provide an enriched understanding of antecedents of misbehavior, by considering how the incidents are related to the structural design of the service. An interview study inspired by the critical incident technique, conducted with frontline employees that work onboard busses and trains, resulted in a rich empirical material. The employees reported a number of different types of incidents, ranging from offensive and insulting comments and fare dodging, to threats and even physical violence. The result showed, as could be expected, that some incidents were related to service failures. However, on several occasions, customer misbehavior was triggered by both features of service work and the service design, rather than by service failures. In fact, even managerial interventions to prevent misbehavior sometimes had the opposite effect. For example, procedures intended to create a safe environment generated minor as well as considerable customer misbehavior incidents.
28.	Fellesson, Markus, et al. (author) The reluctant value co-creators. Young bank customers and their relation to financial services 2009 Conference paper (peer-reviewed)
29.	Fellesson, Markus, et al. (author) Troublesome Travelers : The Service System as a Trigger of Customer Misbehavior 2013 In: International Journal of Quality and Service Sciences. - : Emerald Group Publishing Ltd.. - 1756-669X .- 1756-6703. ; 5:3, s. 256-274 Journal article (peer-reviewed)abstract Purpose – Customer misbehaviour, i.e. behaviour within the exchange setting that deliberately violates the generally accepted norms of conduct in such settings pose a problem for service organizations in several ways. Hitherto much research on customer misbehaviour has focused on psychological explanations and individual characteristics. This study broadens the perspective by taking structural factors of the service system into account. The purpose is to complement the existing literature on customer misbehaviour by investigating how the design and functioning of the service system influences the prevalence of customer misbehaviour. Design/methodology/approach – A critical incident technique was adopted to collect and analyse qualitative data from frontline employees who work on board buses, trains, trams and in metro in the Swedish public transport system. Findings – The study shows that many incidents are triggered by features of the service system. Specifically, three dimensions (service regulations, service resources, and service practice) of the service system are brought forward. The study suggests that customer misbehaviour is caused by an inherent paradox between pre-planned, standardised, mass service solutions and ambitions to adopt a customer orientation. Originality/value – By bringing forward the interactive role of the service system and its functionality the study complements previous research and contributes to a more complete understanding of customer misbehaviour, in particular within the context of system dependent services.
30.	Fellesson, Markus, 1971-, et al. (author) TroublesomeTravelers - Service Design as a Cause of Passenger Misbehavior International Journal ofQuality and Service Sciences. 2013 In: International Journal of Quality and Service Sciences. - 1756-669X .- 1756-6703. ; 5:3, s. 256-274 Journal article (peer-reviewed)abstract Purpose – Customer misbehaviour, i.e. behaviour within the exchange setting that deliberately violates the generally accepted norms of conduct in such settings pose a problem for service organizations in several ways. Hitherto much research on customer misbehaviour has focused on psychological explanations and individual characteristics. This study broadens the perspective by taking structural factors of the service system into account. The purpose is to complement the existing literature on customer misbehaviour by investigating how the design and functioning of the service system influences the prevalence of customer misbehaviour. Design/methodology/approach – A critical incident technique was adopted to collect and analyse qualitative data from frontline employees who work on board buses, trains, trams and in metro in the Swedish public transport system. Findings – The study shows that many incidents are triggered by features of the service system. Specifically, three dimensions (service regulations, service resources, and service practice) of the service system are brought forward. The study suggests that customer misbehaviour is caused by an inherent paradox between pre-planned, standardised, mass service solutions and ambitions to adopt a customer orientation. Originality/value – By bringing forward the interactive role of the service system and its functionality the study complements previous research and contributes to a more complete understanding of customer misbehaviour, in particular within the context of system dependent services.
31.	Glise Sandblad, Katarina, 1982, et al. (author) Obesity in adolescent men increases the risk of venous thromboembolism in adult life 2020 In: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 287:6, s. 734-745 Journal article (peer-reviewed)abstract Background: As the population of obese and severely obese young adults grows, it is becoming increasingly important to recognize the long-term risks associated with adolescent obesity. Objectives: This study aimed to determine the association between body mass index (BMI) in young men at enlistment for military service and later risk of venous thromboembolism (VTE). Methods: Nationwide register-based prospective cohort study of men enlisting 1969 to 2005, followed through the Swedish National Patient and Cause of Death registries. We identified 1639838 men (mean age, 18.3years) free of prior venous thromboembolism, of whom 29342were obese (BMI 30 to <35kgm−2) and 7236 severely obese (BMI≥35kgm−2). The participants were followed until a first registered diagnosis of VTE. Results: During a median follow-up of 28years (interquartile interval, 20 to 36years), 11395 cases of deep vein thrombosis and 7270 cases of pulmonary embolism were recorded. Compared with men with a BMI of 18.5 to <20kgm−2, men with higher BMI in young adulthood showed an incrementally increasing risk of VTE that was moderately but significantly increased already at normal BMI levels. Adolescent obese men with a BMI of 30 to 35kgm−2 had an adjusted hazard ratio of 2.93 (95% confidence interval, 2.65 to 3.24) for VTE. Severely obese men with a BMI of ≥35kgm−2 had a hazard ratio of 4.95 (95% confidence interval, 4.16 to 5.90). Conclusions: Men who were obese or severely obese in young adulthood had a marked increase in risk of VTE.
32.	Johansson-Hidén, Birgitta, et al. (author) The Dominance and Dynamics of Communication in Service Encounters 2006 Conference paper (pop. science, debate, etc.)
33.	Johnson, Randi K., et al. (author) Metabolite-related dietary patterns and the development of islet autoimmunity 2019 In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 9:1 Journal article (peer-reviewed)abstract The role of diet in type 1 diabetes development is poorly understood. Metabolites, which reflect dietary response, may help elucidate this role. We explored metabolomics and lipidomics differences between 352 cases of islet autoimmunity (IA) and controls in the TEDDY (The Environmental Determinants of Diabetes in the Young) study. We created dietary patterns reflecting pre-IA metabolite differences between groups and examined their association with IA. Secondary outcomes included IA cases positive for multiple autoantibodies (mAb+). The association of 853 plasma metabolites with outcomes was tested at seroconversion to IA, just prior to seroconversion, and during infancy. Key compounds in enriched metabolite sets were used to create dietary patterns reflecting metabolite composition, which were then tested for association with outcomes in the nested case-control subset and the full TEDDY cohort. Unsaturated phosphatidylcholines, sphingomyelins, phosphatidylethanolamines, glucosylceramides, and phospholipid ethers in infancy were inversely associated with mAb+ risk, while dicarboxylic acids were associated with an increased risk. An infancy dietary pattern representing higher levels of unsaturated phosphatidylcholines and phospholipid ethers, and lower sphingomyelins was protective for mAb+ in the nested case-control study only. Characterization of this high-risk infant metabolomics profile may help shape the future of early diagnosis or prevention efforts. © 2019, The Author(s).
34.	Krischer, Jeffrey P, et al. (author) Predicting Islet Cell Autoimmunity and Type 1 Diabetes : An 8-Year TEDDY Study Progress Report 2019 In: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 42:6, s. 1051-1060 Journal article (peer-reviewed)abstract OBJECTIVE: Assessment of the predictive power of The Environmental Determinants of Diabetes in the Young (TEDDY)-identified risk factors for islet autoimmunity (IA), the type of autoantibody appearing first, and type 1 diabetes (T1D).RESEARCH DESIGN AND METHODS: A total of 7,777 children were followed from birth to a median of 9.1 years of age for the development of islet autoantibodies and progression to T1D. Time-dependent sensitivity, specificity, and receiver operating characteristic (ROC) curves were calculated to provide estimates of their individual and collective ability to predict IA and T1D.RESULTS: HLA genotype (DR3/4 vs. others) was the best predictor for IA (Youden's index J = 0.117) and single nucleotide polymorphism rs2476601, in PTPN22, was the best predictor for insulin autoantibodies (IAA) appearing first (IAA-first) (J = 0.123). For GAD autoantibodies (GADA)-first, weight at 1 year was the best predictor (J = 0.114). In a multivariate model, the area under the ROC curve (AUC) was 0.678 (95% CI 0.655, 0.701), 0.707 (95% CI 0.676, 0.739), and 0.686 (95% CI 0.651, 0.722) for IA, IAA-first, and GADA-first, respectively, at 6 years. The AUC of the prediction model for T1D at 3 years after the appearance of multiple autoantibodies reached 0.706 (95% CI 0.649, 0.762).CONCLUSIONS: Prediction modeling statistics are valuable tools, when applied in a time-until-event setting, to evaluate the ability of risk factors to discriminate between those who will and those who will not get disease. Although significantly associated with IA and T1D, the TEDDY risk factors individually contribute little to prediction. However, in combination, these factors increased IA and T1D prediction substantially.
35.	Lantz-Andersson, Annika, 1961, et al. (author) Developing a model for teacher professional digital competence 2019 In: The 18th Biennial EARLI Conference, 12-16 August 2019, Aachen, Germany. Book of abstracts, s. 409. Conference paper (other academic/artistic)abstract "Thinking Tomorrow's Education: Learning from the past, in the present and for the future" - Aachen, Germany
36.	Lantz-Andersson, Annika, 1961, et al. (author) Teachers’ collaborative reflective discussions on technology-mediated teaching: Envisioned and enacted transformative agency 2022 In: Learning, Culture and Social Interaction. - : Elsevier BV. - 2210-6561. ; 35 Journal article (peer-reviewed)abstract This study explores teachers’ reflections on the competences that come into play in technology-mediated teaching activities. Underpinned by educational design research, the collaboration between researchers and teachers followed a methodological design involving three iterative phases: (1) workshops in which teachers and researchers collaborated to develop instructional scenarios involving digital technologies, (2) lessons enacting instructional scenarios, and (3) reflective discussions based on video sequences from the instructional scenarios. The researchers selected video clips of instructional sequences involving so-called critical incidents where the teachers encountered some kind of challenge in the technology-mediated teaching activities. The unit of analysis comprised transitional episodes identified in the reflective discussions, where temporal shifts took place as the teachers elaborated on challenges and oriented towards future actions. Theoretically, the study is based on sociocultural perspectives, acknowledging social interaction as collective thinking. To analytically scrutinise temporal shifts in the interaction, interaction analysis was employed. The findings show that while the elicited video clips supported retrospective reflections, the collaborative context with colleagues and researchers interacting supported prospective reflections. These findings are discussed in terms of how the temporal shifts in the reflections can analytically be understood as teachers’ envisioned or enacted transformative agency.
37.	Lantz, Mikael, et al. (author) Thyrostimulin (a TSH-like Hormone) Expression in Orbital and Thyroid Tissue. 2007 In: Thyroid. - : Mary Ann Liebert Inc. - 1557-9077 .- 1050-7256. ; 17:2, s. 113-118 Journal article (peer-reviewed)abstract Objective: To investigate gene expression of thyrostimulin in orbital and thyroid tissue from patients with and without Graves' disease. Design: Real-time reverse transcriptase polymerase chain reaction (RT-PCR) was used for detection of thyrostimulin gene expression in intraorbital adipose tissue from patients with severe ophthalmopathy and thyroid healthy controls in addition to thyrostimulin expression in normal thyroid tissue, multinodular goiter tissue, and Graves' thyroid tissue. Main Outcome: In intraorbital tissue, thyrostimulin expression was identified in both patients and controls with fluorescence intensities varying between 0.23 and 0.88 in patients and 0.29 and 8.9 in controls before treatment with DNase. The signal of thyrostimulin was weak or absent in intraorbital adipose tissue from patients with ophthalmopathy and thyroid healthy controls after treatment of samples with DNase. This was in contrast to the expression of the thyroid-stimulating hormone (TSH) receptor and the housekeeping gene cyclophilin A that were detected both before and after DNase treatment. Similar results were found when analyzing human and rat thyroid tissue. Conclusions: Neither did we demonstrate gene expression of thyrostimulin in intraorbital adipose tissue or in thyroid tissue, nor could we confirm earlier findings in rat thyroid tissue. Whether thyrostimulin is a regulator of thyroid function has to be further investigated in future studies.
38.	Liedberg, Fredrik, et al. (author) Fast-track access to urologic care for patients with macroscopic haematuria is efficient and cost-effective : results from a prospective intervention study 2016 In: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. ; 115, s. 770-775 Journal article (peer-reviewed)abstract Background:The delay between onset of macroscopic haematuria and diagnosis of bladder cancer is often long.Methods:We evaluated timely diagnosis and health-care costs for patients with macroscopic haematuria given fast-track access to diagnostics. During a 15-month period, a telephone hotline for fast-track diagnostics was provided in nine Swedish municipalities for patients aged ⩾50 years with macroscopic haematuria. The control group comprised 101 patients diagnosed with bladder cancer in the same catchment area with macroscopic haematuria who underwent regular diagnostic process.Results:In all 275 patients who called ‘the Red Phone’ hotline were investigated, and 47 of them (17%) were diagnosed with cancer and 36 of those had bladder cancer. Median time from patient-reported haematuria to diagnosis was 29 (interquartile range (IQR) 14−104) days and 50 (IQR 27−165) days in the intervention and the control group, respectively (P=0.03). The median health-care costs were lower in the intervention group (655 (IQR 655−655) EUR) than in the control group (767 (IQR 490−1096) EUR) (P=0.002).Conclusions:Direct access to urologic expertise and fast-track diagnostics is motivated for patients with macroscopic haematuria to reduce diagnostic intervals and lower health-care expenditures.British Journal of Cancer advance online publication, 25 August 2016; doi:10.1038/bjc.2016.265 www.bjcancer.com.
39.	Lissner, Lauren, 1956, et al. (author) A Growing Social Divide in Body Mass Index, Strength, and Fitness of Swedish Male Conscripts 2019 In: Journal of Adolescent Health. - : Elsevier BV. - 1054-139X. ; 65:2, s. 232-238 Journal article (peer-reviewed)abstract Purpose: The aim of the study was to monitor trends in socioeconomic inequalities in body mass index (BMI), cardiorespiratory fitness (CRF), and muscular strength over several decades in a population of Swedish males aged 18-19 years. Methods: The cohort consists of 1.5 million young men attending military conscript examinations from late 1968 to 2005. Parental education was used as a marker for socioeconomic conditions in the conscripts' families of origin. Changing gradient in BMI, CRF, and muscular strength in sons of parents with higher and lower educational attainment was evaluated during four periods covering 36 years. Results: Over the course of the obesity epidemic, BMI remained higher in conscripts with lesser (vs. higher) parental education. Moreover, the absolute difference in obesity prevalence between groups showed a continuous increase, from .6% to 3.9%, indicating growing inequalities. Regarding fitness, lower CRF was consistently associated with less parental education, but with no clear secular trend in the magnitude of the difference. Finally, social differences in muscular strength changed in direction, from lower strength among conscripts with higher parental education in the initial observation period to lower strength associated with lower parental education in the final decade studied. Conclusions: Among Swedish conscripts entering adulthood, social gradients in BMI and obesity widened continuously between 1968 and 2005. An apparent reversal of the earlier gradient in muscular strength in young men may be related to societal trends in occupational and leisure-time physical activity over the observation period. This cohort is being continually monitored through national registries for obesity-related comorbidities in later life. (C) 2019 Society for Adolescent Health and Medicine. All rights reserved.
40.	Lundberg, Christina, et al. (author) Age and sex differences in cause-specific excess mortality and years of life lost associated with COVID-19 infection in the Swedish population 2023 In: European Journal of Public Health. - : OXFORD UNIV PRESS. - 1101-1262 .- 1464-360X. ; 33:5, s. 916-22 Journal article (peer-reviewed)abstract Background Estimating excess mortality and years of life lost (YLL) attributed to coronavirus disease 19 (COVID-19) infection provides a comprehensive picture of the mortality burden on society. We aimed to estimate the impact of the COVID-19 pandemic on age- and sex-specific excess mortality and YLL in Sweden during the first 17 months of the pandemic. Methods In this population-based observational study, we calculated age- and sex-specific excess all-cause mortality and excess YLL during 2020 and the first 5 months of 2021 and cause-specific death [deaths from cardiovascular disease (CVD), cancer, other causes and deaths excluding COVID-19] in 2020 compared with an average baseline for 2017-19 in the whole Swedish population. Results COVID-19 deaths contributed 9.9% of total deaths (98 441 deaths, 960 305 YLL) in 2020, accounting for 75 151 YLL (7.7 YLL/death). There were 2672 (5.7%) and 1408 (3.0%) excess deaths, and 19 141 (3.8%) and 3596 (0.8%) excess YLL in men and women, respectively. Men aged 65-110 years and women aged 75-110 years were the greatest contributors. Fewer deaths and YLL from CVD, cancer and other causes were observed in 2020 compared with the baseline adjusted to the population size in 2020. Conclusions Compared with the baseline, excess mortality and YLL from all causes were experienced in Sweden during 2020, with a higher excess observed in men than in women, indicating that more men died at a younger age while more women died at older ages than expected. A notable reduction in deaths and YLL due to CVD suggests a displacement effect from CVD to COVID-19.
41.	Lundgren, Markus, et al. (author) Analgesic antipyretic use among young children in the TEDDY study : No association with islet autoimmunity 2017 In: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 17:1 Journal article (peer-reviewed)abstract Background: The use of analgesic antipyretics (ANAP) in children have long been a matter of controversy. Data on their practical use on an individual level has, however, been scarce. There are indications of possible effects on glucose homeostasis and immune function related to the use of ANAP. The aim of this study was to analyze patterns of analgesic antipyretic use across the clinical centers of The Environmental Determinants of Diabetes in the Young (TEDDY) prospective cohort study and test if ANAP use was a risk factor for islet autoimmunity. Methods: Data were collected for 8542 children in the first 2.5 years of life. Incidence was analyzed using logistic regression with country and first child status as independent variables. Holm's procedure was used to adjust for multiplicity of intercountry comparisons. Time to autoantibody seroconversion was analyzed using a Cox proportional hazards model with cumulative analgesic use as primary time dependent covariate of interest. For each categorization, a generalized estimating equation (GEE) approach was used. Results: Higher prevalence of ANAP use was found in the U.S. (95.7%) and Sweden (94.8%) compared to Finland (78.1%) and Germany (80.2%). First-born children were more commonly given acetaminophen (OR 1.26; 95% CI 1.07, 1.49; p = 0.007) but less commonly Non-Steroidal Anti-inflammatory Drugs (NSAID) (OR 0.86; 95% CI 0.78, 0.95; p = 0.002). Acetaminophen and NSAID use in the absence of fever and infection was more prevalent in the U.S. (40.4%; 26.3% of doses) compared to Sweden, Finland and Germany (p < 0.001). Acetaminophen or NSAID use before age 2.5 years did not predict development of islet autoimmunity by age 6 years (HR 1.02, 95% CI 0.99-1.09; p = 0.27). In a sub-analysis, acetaminophen use in children with fever weakly predicted development of islet autoimmunity by age 3 years (HR 1.05; 95% CI 1.01-1.09; p = 0.024). Conclusions: ANAP use in young children is not a risk factor for seroconversion by age 6 years. Use of ANAP is widespread in young children, and significantly higher in the U.S. compared to other study sites, where use is common also in absence of fever and infection.
42.	Mahdi, Soheil, et al. (author) Short ADHD intervention (SAINT) : Psychological treatment for adults with ADHD 2023 Conference paper (other academic/artistic)abstract Objectives: SAINT is based on previous research on a CBT manual for adults with ADHD, now shortened to 5 individual-sessions with a follow-up session one month after treatment. It will be compared to an established self-help manual for adults with ADHD, provided through internet. Will SAINT produce an increased everyday function measured with AAQoL compared to control group? If so, is the increased function related to a higher adherence to treatment methods and homework in SAINT?Methods: A randomized controlled study design is applied where SAINT is compared to an active control condition. Asessments are made before treatment, during treatment, immediately after treatment, one month and three months after treatment. Both groups receive treatment during five weeks with a booster session one month after the fifth session. Outcome measures include everyday function, quality of life and ADHD symptoms, among others. The study is conducted in a specialist health care clinic in Stockholm.Results: To date, 71 participants have been randomized to one of two treatment conditions. 20 more participants will be recruited during 2023 and the final results will be analyzed in early 2024. Preliminary data on the outcome measures will be presented at the ADHD World Congress.Conclusions: In case of promising results, SAINT could be offered to patients immediately after diagnosis, thus increasing access to CBT for adults with ADHD.
43.	Manni, Annika, 1971-, et al. (author) Critical events in the systematic work at an organizational level towards a whole school approach to sustainability in a swedish municipality 2024 In: Whole school approaches to sustainability. - Cham : Springer Nature. - 9783031561719 - 9783031561726 ; , s. 201-213 Book chapter (peer-reviewed)abstract In this chapter, we report from a 4-year study of the systematic work at an organizational level towards a whole school approach to sustainability. Aiming to extend the individual good practices on Education for Sustainable Development (ESD) to include all schools in the municipality, a process of school development began in 2019, and was studied for 4 years until 2022. Through a narrative approach, we describe the process and its critical events. Different dimensions of the school improvement model devised by Scherp and Scherp are also identified and analysed. The results show that a cyclic process, including not only different actions but also reflections, is important for improvement and, furthermore, that the holistic idea is an important dimension that should guide structures as well as teachers’ professional development towards more successful work with ESD in a whole-school organization.
44.	Manni, Annika, et al. (author) HUS Hållbar utevistelse vid storförskolor - Projektbok 2023 In: Naturskolan i Umeå - Lärande för hållbar utveckling. Other publication (other academic/artistic)
45.	Manni, Annika, 1971-, et al. (author) Sammansatta problem i undervisning för hållbar utveckling 2017 In: Nordisk arbeidsmodell for undervisning for bærekraftig utvikling. - Oslo : Naturfagsenteret. ; , s. 14-19 Book chapter (pop. science, debate, etc.)
46.	Näslund, Johan, 1954-, et al. (author) Arbetslivsinriktad rehabilitering på Testa : en intervjustudie 2005 Reports (other academic/artistic)abstract I denna rapport redovisas resultaten av intervjuer med ett antal personer som varit inskrivna i Testa, ett arbetsmarknadsprojekt som bedrivits i Jönköpings kommun. Studien har genomförts av Luppen kunskapscentrum med inriktning mot individ och familj, Kommunförbundet i Jönköpings län.Testa är ett arbetsmarknadsprojekt som drivs i samverkan mellan Jönköpings socialförvaltning, Jönköpings kommuns arbetsmarknadsavdelning, försäkringskassan och arbetsförmedlingen. Projektet har fått ekonomiskt stöd från EU Mål 3.Målgruppen för projektet har varit arbetssökande i behov av arbetsträning och arbetsprövning. Målsättningen med projektet har varit att deltagarna efter deltagande i Testa ska erhålla anställning på den reguljära arbetsmarknaden eller påbörja utbildning inom det reguljära utbildningsväsendet.Det har ansetts viktigt att projektet utvärderas för att ta tillvara erfarenheter och använda det som varit verkningsfullt även efter projekttidens slut. Utöver intervjuer utifrån deltagares personliga erfarenheter ska också en studie av de samhällsekonomiska effekterna av Testa analyseras och redovisas. De samhällsekonomiska effekterna redovisas i en annan rapport.Syftet med denna studie är att fånga de intervjuades uppfattningar och upplevelser av deltagandet i Testa.
47.	Onerup, Aron, et al. (author) Associations between BMI in youth and site-specific cancer in men : A cohort study with register linkage. 2024 In: Obesity. - : John Wiley & Sons. - 1930-7381 .- 1930-739X. ; 32:2, s. 376-389 Journal article (peer-reviewed)abstract OBJECTIVE: This study examined BMI in young men and incident site-specific cancer to estimate population attributable fractions due to BMI based on projected obesity prevalence.METHODS: A population-based cohort study with measured height and weight at age 18. Cox regression models assessed linear associations for BMI and included age, year, and site of conscription as well as parental level of education as covariates.RESULTS: Primary analyses were performed in 1,489,115 men, of whom 78,217 subsequently developed cancer during a mean follow-up of 31 years. BMI was linearly associated with risk of developing all 18 site-specific cancers assessed (malignant melanoma; leukemia; myeloma; Hodgkin lymphoma; non-Hodgkin lymphoma; and cancer in the lungs, head and neck, central nervous system, thyroid, esophagus, stomach, pancreas, liver and gallbladder, colon, rectum, kidney, and bladder), in some instances evident at BMI levels usually defined as normal (20-25 kg/m2 ). Higher BMI was associated with lower risk of prostate cancer. The highest hazard ratios and population attributable fractions were seen for some gastrointestinal cancers.CONCLUSIONS: This study reports linear associations between BMI at age 18 and subsequent site-specific cancers, calling for rapid action to stem the obesity epidemic and to prepare the health care system for steep increases in cancer cases.
48.	Onerup, Aron, 1983, et al. (author) Associations between BMIin youth and site-specific cancer in men-A cohort study with register linkage. 2024 In: Obesity (Silver Spring, Md.). - 1930-739X. ; 32:2, s. 376-389 Journal article (peer-reviewed)abstract This study examined BMI in young men and incident site-specific cancer to estimate population attributable fractions due to BMI based on projected obesity prevalence.A population-based cohort study with measured height and weight at age 18. Cox regression models assessed linear associations for BMI and included age, year, and site of conscription as well as parental level of education as covariates.Primary analyses were performed in 1,489,115 men, of whom 78,217 subsequently developed cancer during a mean follow-up of 31years. BMI was linearly associated with risk of developing all 18 site-specific cancers assessed (malignant melanoma; leukemia; myeloma; Hodgkin lymphoma; non-Hodgkin lymphoma; and cancer in the lungs, head and neck, central nervous system, thyroid, esophagus, stomach, pancreas, liver and gallbladder, colon, rectum, kidney, and bladder), in some instances evident at BMI levels usually defined as normal (20-25kg/m2 ). Higher BMI was associated with lower risk of prostate cancer. The highest hazard ratios and population attributable fractions were seen for some gastrointestinal cancers.This study reports linear associations between BMI at age 18 and subsequent site-specific cancers, calling for rapid action to stem the obesity epidemic and to prepare the health care system for steep increases in cancer cases.
49.	Planck, Tereza, et al. (author) COX-2 and SCD, markers of inflammation and adipogenesis, are related to disease activity in Graves' ophthalmopathy 2007 In: Thyroid. - : Mary Ann Liebert Inc. - 1557-9077 .- 1050-7256. ; 17:6, s. 511-517 Journal article (peer-reviewed)abstract Context: Inflammation and adipogenesis are two parallel processes with increased activity in severe Graves' ophthalmopathy. Objective: The aim of this work was to define target genes for therapeutic intervention in adipogenesis and inflammation in Graves' ophthalmopathy. Design: Orbital tissue was obtained from patients with ophthalmopathy in acute or chronic phase undergoing orbital surgery to study gene expression followed by the study of potential intervention mechanisms in preadipocytes. Setting: Clinic of Endocrinology, University Hospital, Malmo, Sweden. Participants: Patients in acute severe or in chronic phase of ophthalmopathy. Interventions: Lateral orbital decompression in acute phase and restorative surgery in chronic phase. In vitro treatment of preadipocytes with rosiglitazone and diclofenac. Main outcome measure: Gene expression in intraorbital tissue or preadipocytes and differentiation of preadipocytes. Results: A marker of adipose tissue, stearoyl-coenzyme A desaturase (SCD), and the proinflammatory gene, cyclooxygenase-2 (COX-2), were overexpressed in patients in active phase compared to the chronic phase of ophthalmopathy. In growth-arrested preadipocytes stimulated with rosiglitazone, COX-2 expression increased temporarily within 1 hour and decreased to undetectable levels after 48 hours. In contrast, SCD and peroxisome proliferator-activated receptor-gamma (PPAR-gamma) expression increased continuously from day 2 to day 7 during adipogenesis. Diclofenac, an inhibitor of cyclooxygenases with antagonistic effects on PPAR-gamma, reduced the number of mature adipocytes by approximately 50%. Conclusion: We conclude that inflammation and adipogenesis decrease with a decrease in activity of ophthalmopathy and that the nonsteroidal antiinflammatory drug diclofenac inhibits adipogenesis. This may represent a putative future treatment of endocrine ophthalmopathy.
50.	Robertson, Josefina, et al. (author) BMI in early adulthood is associated with severe COVID-19 later in life: A prospective cohort study of 1.5 million Swedish men 2022 In: Obesity. - : Wiley. - 1930-7381 .- 1930-739X. ; 30:3, s. 779-787 Journal article (peer-reviewed)abstract Objective: Overweight and obesity have been identified as risk factors for severe COVID-19; however, prospective cohort studies investigating the association between overweight early in life and severity of COVID-19 are lacking. Methods: This study included 1,551,670 Swedish men, born between 1950 and 1987, with BMI registered at age 18 years. They were followed until January 9, 2021. COVID-19 cases and comorbidities were identified through the National Patient, Intensive Care, and Cause of Death registries. Outcomes included the following: 1) hospitalization; 2) intensive care unit admission; and 3) death. Results: The study found 4,315 cases (mean age = 56.4 years [SD 8.8]) of patients hospitalized because of COVID-19, of which 729 were admitted to an intensive care unit, and altogether there were 224 deaths. The risk for hospital admission increased with higher values of BMI at age 18 years, despite adjustment for comorbidities, from an odds ratio (OR) of 1.19 (95% CI: 1.08-1.31) at BMI = 22.5 to 25 to an OR of 1.68 (95% CI: 1.39-2.02) at BMI >= 30, compared with BMI = 18.5 to 20. ORs for intensive care unit admission were 1.44 (95% CI: 1.13-1.84) at BMI = 22.5 to 25 and 2.61 (95% CI: 1.73-3.93) at BMI >= 30. Conclusions: Higher BMI in early adulthood was associated with severe COVID-19 many years later, with a risk increase starting already at BMI >= 22.5. This underlines the necessity of preventive actions against overweight in youth to offer protection against coming viral pandemics.

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