| 1. |
- Donat-Vargas, Carolina, et al.
(författare)
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Associations between repeated measure of plasma perfluoroalkyl substances and cardiometabolic risk factors
- 2019
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Ingår i: Environment International. - : Elsevier. - 0160-4120 .- 1873-6750. ; 124, s. 58-65
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Tidskriftsartikel (refereegranskat)abstract
- Background: Perfluoroalkyl substances (PFAS) are persistent synthetic chemicals that may affect components of metabolic risk through the peroxisome proliferator-activated receptor but epidemiological data remain scarce and inconsistent.Objective: To estimate associations between repeated measurements of the main PFAS in plasma and total cholesterol, triglycerides and hypertension among the control subjects from a population-based nested case-control study on diabetes type 2 in middle-aged women and men.Methods: Participants (n = 187) were free of diabetes at both baseline and follow-up visits to the Västerbotten Intervention Programme, 10 years apart: during 1990 to 2003 (baseline) and 2001 to 2013 (follow-up). Participants left blood samples, completed questionnaires on diet and lifestyle factors, and underwent medical examinations, including measurement of blood pressure. PFAS and lipids were later determined in stored plasma samples. Associations for the repeated measurements were assessed using generalized estimating equations.Results: Six PFAS exceeded the limit of quantitation. Repeated measures of PFAS in plasma, cardiometabolic risk factors and confounders, showed an average decrease of triglycerides from −0.16 mmol/l (95% confidence interval [CI]: −0.33, 0.02 for PFOA) to −0.26 mmol/l (95% CI: −0.50, −0.08 for PFOS), when comparing the highest tertile of PFAS plasma levels with the lowest. Associations based on average PFAS measurements and follow-up triglycerides revealed similar inverse associations, although attenuated. The estimates for cholesterol and hypertension were inconsistent and with few exception non-significant.Conclusions: This study found inverse associations between PFAS and triglycerides, but did not support any clear link with either cholesterol or hypertension.
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| 2. |
- Donat-Vargas, Carolina, et al.
(författare)
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Perfluoroalkyl substances and risk of type II diabetes : A prospective nested case-control study
- 2019
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Ingår i: Environment International. - : Elsevier. - 0160-4120 .- 1873-6750. ; 123, s. 390-398
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Tidskriftsartikel (refereegranskat)abstract
- Background: Perfluoroalkyl substances (PFAS) have drawn much attention due to bioaccumulation potential and their current omnipresence in human blood. We assessed whether plasma PFAS, suspected to induce endocrine-disrupting effects, were prospectively associated with clinical type 2 diabetes (T2D) risk.Methods: We established a nested case-control study within the Swedish prospective population-based Västerbotten Intervention Programme cohort. Several PFAS were measured in plasma from a subset of 124 case-control pairs at baseline (during 1990–2003) and at 10-year follow-up. T2D cases were matched (1:1) according to gender, age and sample date with participants without T2D (controls).Conditional logistic regressions were used to prospectively assess risk of T2D by baseline PFAS plasma concentrations. Associations between long-term PFAS plasma levels (mean of baseline and follow-up) and insulin resistance (HOMA2-IR) and beta-cell function (HOMA2-B%) at follow-up were prospectively explored among 178 and 181 controls, respectively, by multivariable linear regressions.Results: After adjusting for gender, age, sample year, diet and body mass index, the odds ratio of T2D for the sum of PFAS (Σ z-score PFAS) was 0.52 (95% confidence interval, CI: 0.20, 1.36), comparing third with first tertile; and 0.92 (95% CI: 0.84, 1.00) per one standard deviation increment of sum of log-transformed PFAS. Among the controls, the adjusted β of HOMA2-IR and HOMA-B% for the sum of PFAS were −0.26 (95% CI: −0.52, −0.01) and −9.61 (95% CI: −22.60, 3.39) respectively comparing third with first tertile.Conclusions: This prospective nested case-control study yielded overall inverse associations between individual PFAS and risk of T2D, although mostly non-significant. Among participants without T2D, long-term PFAS exposure was prospectively associated with lower insulin resistance.
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| 3. |
- Donat-Vargas, Carolina, et al.
(författare)
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Persistent Organochlorine Pollutants in Plasma, Blood Pressure, and Hypertension in a Longitudinal Study
- 2018
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Ingår i: Hypertension. - 0194-911X .- 1524-4563. ; 71:6, s. 1258-1268
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Tidskriftsartikel (refereegranskat)abstract
- Persistent organochlorine pollutants (POPs) have shown to be involved in the atherosclerotic process and to cause endothelial cell dysfunction. To assess longitudinally whether plasma concentrations of different POPs were associated with blood pressure and risk of hypertension in middle-aged women and men. Study subjects were 850 participants in the VIP (Västerbotten Intervention Programme) with 2 blood samples and blood pressure measurements, 10 years apart, during 1990 to 2003 (baseline) and during 2000 to 2013 (follow-up). Dioxin-like and nondioxin-like polychlorinated biphenyls (DL-PCBs, NDL-PCBs) and p,p'-dichlorodiphenyldichloroethylene (DDE) were measured. Associations were assessed using generalized estimating equations. At baseline sampling 49% and at follow-up 64% had hypertension. DL-PCBs and DDE, but not NDL-PCBs or hexachlorobenzene, were associated with hypertension. Only the association for DL-PCBs remained statistically significant after lipid-standardization and adjustment for body mass index and total serum lipids. The multivariable-adjusted odds ratio of hypertension based on repeated measurements were 1.52 (95% confidence interval, 1.08-2.13) for DL-PCBs (third versus first tertile of lipid-standardized POPs). In stratified adjusted analyses, odds ratio for those born after 1950 increased to 3.99 (95% confidence interval, 2.15-7.43), whereas no association was observed among those born earlier. Based on repeated measurements, the accumulated exposure to DL-PCBs and DDE, although less clear for the latter, may disrupt the normal blood pressure levels and increase the odds of hypertension. Moreover, individuals experiencing early-life POP exposure may be at elevated risk of vascular POP effects.
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| 4. |
- Meister, Kadri, et al.
(författare)
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Sambandet mellan luftföroreningshalter och akuta vårdkontakter för luftvägssjukdomar som hälsoindikator för luftkvalitet
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna studie inom den hälsorelaterade miljöövervakningen har genomförts på uppdrag av Naturvårdsverket för att belysa eventuella korttidseffekter av luftföroreningar på akutbesök för astma samt för alla sjukdomar iandningsorganen. Dessa sjukdomar medför ofta ökad känslighet för luftföroreningar. Halternas samband med akutbesök för andningsorganens sjukdomar har tidigare studerats inom miljöövervakningen. För att underlätta jämförelser har metodiken anpassats till tidigare studier där betydelsen av halterna de två senaste dygnen beräknas. Övervakning av denna typ av korttidssamband med halter i miljön är mindre känslig för trender och förändringar i diagnostik och vårdresurser än enklare epidemiologisk bevakning av antalet fall per år etc., eftersom totala antalet fall i sig kan påverkas av en rad olika typer av faktorer utan koppling till luftföroreningssituationen.Uppgifter om den skrivna befolkningens akutbesök (vid akutmottagning samt akuta (inte planerade) inläggningar) under åren 2005 till och med 2013 för andningsorganens sjukdomar inklusive astma vid akutsjukhusen i StorStockholm, Göteborg/Mölndal respektive Malmö/Burlöv har inhämtats från Socialstyrelsens Patientregister. Uppgifterna från registret avser avidentifierade akutbesök med diagnoser dygn för dygn under perioden.Luftföroreningsdata i form av urbana bakgrundshalter har hämtats från Stockholm luft- och bulleranalys (SLB) vid miljöförvaltningen i Stockholm och från IVL Svenska miljöinstitutet data för Göteborg respektive Malmö. Vi har studerat effekterna av partikelhalten (PM10 ~ partiklar mindre än 10 mikrometer i diameter), avgashalten indikerad med kväveoxider (NOx) samt ozon. Analyser har gjorts av akutbesök totalt för alla åldrar samt i olika åldergrupper: barn, vuxna och äldre.Tidsserieanalyserna har utförts med Poisson-regression. I dessa analyser tas hänsyn till tidstrender, årstidsmönster, influensaperioder, väderförhållanden, pollenhalt, veckodag, helgperioder mm. De inkluderade luftföroreningarna är ozon, kvävedioxid och partiklar (PM10). Alla luftföroreningsvariabler kan ses som indikatorer på olika typer av luftföroreningar, och har simultant beaktats i de slutliga analyserna.I alla tre städer hade ozon effekten på akutbesök för andningsorganens sjukdomar totalt och för astma totalt. Effekten av ozon på akutbesök för andningsorganen samt på astma finns även för barn respektive vuxna separat i Stockholm och Göteborg.Effekter av ozon kan ses som inte skiljande sig mellan de tre olika studieområdena och därför har även en sammanvägd skattning för ozon beräknats gällande antalet akutbesök för andningsorganen totalt, akutbesök för astma totalt samt akutbesök för astma bland barn. När resultaten vägdes ihop för de tre studieområdena beräknas att antalet akutbesök för andningsorganen totalt ökar med 1,6% (95% KI=1,1-2%) per 10 g/m3 haltökning av ozon, akutbesök för astma totalt med 2,5% (95% KI=1,5-3,6% ) per 10 g/m3 haltökning, medan akutbesök för astma bland barn med 3,9% (95% KI=1,7- 4%) per 10 g/m3 haltökning av ozon.Eftersom föroreningssituationen som indikatorerna representerar kan förändras med tiden har analyserna gjorts även för två olika tidsperioder: 2005-2008 samt 2009-2013. Analysen för Malmö visade på vissa statistiskt säkerställda skillnader. Effekten av ozon på akutbesök för andningsorganen totalt var högre under den senare tidsperioden, 2009-2013. Denna trend finns även för barn respektive vuxna separat.Att analysera variationen i telefonsamtal till 1177-Vårdguiden har tidigare visat sig vara en fördelaktig metod vid studier gällande magsjuka och den mest lämpliga metoden för att tidigt detektera utbrott av magsjuka. Till följd av detta var det angeläget att undersöka om denna relativt nya databas innehållande 1177-samtal även kan vara lämplig att använda i studier som avser akuta hälsoproblem av sjukdomar i andningsorganen som kan påverkas av luftföroreningshalterna.Som tillägg har en pilotstudie gjorts i Göteborg, där uppgifter om dygnsvisa antal samtal medkontaktorsakerna andningsproblem respektive hosta från 1177-Vårdguiden under perioden 2007-11-30 - 2013-12-01 har använts för att jämföra sambanden till luftföroreningshalter. Även här är antalsuppgifter uppdelade i olika åldersgrupper. I likhet med besöksdata påvisades effekter av luftföroreningar där ökning av PM10-halten ökade antalet samtal gällande andningsbesvär och hosta bland barn. Samtal gällande andningsbesvär hos vuxna ökade med ökande halter av ozon. Studien visar att denna typ av data kananvändas för att övervaka luftföroreningsexponeringens effekter.
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| 5. |
- Olstrup, Henrik, et al.
(författare)
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A Multi-Pollutant Air Quality Health Index (AQHI) Based on Short-Term Respiratory Effects in Stockholm, Sweden
- 2019
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- In this study, an Air Quality Health Index (AQHI) for Stockholm is introduced as a tool to capture the combined effects associated with multi-pollutant exposure. Public information regarding the expected health risks associated with current or forecasted concentrations of pollutants and pollen can be very useful for sensitive persons when planning their outdoor activities. For interventions, it can also be important to know the contribution from pollen and the specific air pollutants, judged to cause the risk. The AQHI is based on an epidemiological analysis of asthma emergency department visits (AEDV) and urban background concentrations of NOx, O-3, PM10 and birch pollen in Stockholm during 2001-2005. This analysis showed per 10 mu gm(-3) increase in the mean of same day and yesterday an increase in AEDV of 0.5% (95% CI: -1.2-2.2), 0.3% (95% CI: -1.4-2.0) and 2.5% (95% CI: 0.3-4.8) for NOx, O-3 and PM10, respectively. For birch pollen, the AEDV increased with 0.26% (95% CI: 0.18-0.34) for 10 pollen grainsm(-3). In comparison with the coefficients in a meta-analysis, the mean values of the coefficients obtained in Stockholm are smaller. The mean value of the risk increase associated with PM10 is somewhat smaller than the mean value of the meta-coefficient, while for O-3, it is less than one fifth of the meta-coefficient. We have not found any meta-coefficient using NOx as an indicator of AEDV, but compared to the mean value associated with NO2, our value of NOx is less than half as large. The AQHI is expressed as the predicted percentage increase in AEDV without any threshold level. When comparing the relative contribution of each pollutant to the total AQHI, based on monthly averages concentrations during the period 2015-2017, there is a tangible pattern. The AQHI increase associated with NOx exhibits a relatively even distribution throughout the year, but with a clear decrease during the summer months due to less traffic. O-3 contributes to an increase in AQHI during the spring. For PM10, there is a significant increase during early spring associated with increased suspension of road dust. For birch pollen, there is a remarkable peak during the late spring and early summer during the flowering period. Based on monthly averages, the total AQHI during 2015-2017 varies between 4 and 9%, but with a peak value of almost 16% during the birch pollen season in the spring 2016. Based on daily mean values, the most important risk contribution during the study period is from PM10 with 3.1%, followed by O-3 with 2.0%.
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| 6. |
- Oudin Åström, Daniel, et al.
(författare)
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Evolution of Minimum Mortality Temperature in Stockholm, Sweden, 1901-2009
- 2016
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Ingår i: Journal of Environmental Health Perspectives. - : Environmental Health Perspectives. - 0091-6765 .- 1552-9924. ; 124:6, s. 740-744
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The mortality impacts of hot and cold temperatures have been thoroughly documented, with most locations reporting a U-shaped relationship with a minimum mortality temperature (MMT) at which mortality is lowest. How MMT may have evolved over past decades as global mean surface temperature increased has not been thoroughly explored.OBJECTIVE: We used observations of daily mean temperatures to investigate whether MMT changed in Stockholm, Sweden, from the beginning of the 20th century until 2009.METHODS: Daily mortality and temperature data for the period 1901-2009 in Stockholm, Sweden were used to model the temperature-mortality relationship. We estimated MMT using distributed lag non-linear Poisson regression models considering lags up to 21 days of daily mean temperature as the exposure variable. To avoid large influences on the MMT from intra and inter annual climatic variability, we estimated MMT based on 30-year periods. Further, we investigated whether there were trends in the absolute value of the MMT and the relative value of the MMT (the corresponding percentile of the same day temperature distribution) over the study period.RESULTS: Our findings suggest that both the absolute MMT and the relative MMT increased in Stockholm, Sweden over the course of the last century.CONCLUSIONS: The increase in MMT over the course of the last century suggests autonomous adaptation within the context of the large epidemiological, demographical and societal changes that occurred. Whether the rate of increase will be sustained with climate change is an open question.
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| 7. |
- Tornevi, Andreas, et al.
(författare)
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Chlorinated persistent organic pollutants and type 2 diabetes - A population-based study with pre- and post- diagnostic plasma samples
- 2019
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Ingår i: Environmental Research. - : Elsevier. - 0013-9351 .- 1096-0953. ; 174, s. 35-45
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Persistent organic pollutants (POPs) have been associated with type 2 diabetes (T2D), but causality is uncertain.OBJECTIVE: Within longitudinal population-based data from northern Sweden, we assessed how POPs associated with T2D prospectively and cross-sectionally, and further investigated factors related to individual changes in POP concentrations.METHODS: For 129 case-controls pairs matched by age, sex and date of sampling, plasma concentrations of hexachlorobenzene (HCB), dichlorodiphenyl-dichloroethylene (p,p'-DDE), dioxin-like (DL) polychlorinated biphenyl congeners (PCB-118 and PCB-156), and non-dioxin like (NDL-PCB: PCB-74, -99, -138 -153, -170, -180, -183 and PCB-187) were analyzed twice (baseline and follow-up, 9-20 years apart). The cases received their T2D diagnose between baseline and follow-up. Prospective (using baseline data) and cross-sectional (using follow-up data) odds ratios (ORs) for T2D on lipid standardized POPs (HCB, p,p'-DDE, ∑DL-PCBs, ∑NDL-PCBs) were estimated using conditional logistic regression, adjusting for body mass index (BMI) and plasma lipids. The influence of BMI, weight-change, and plasma lipids on longitudinal changes in POP concentrations were evaluated among non-diabetic individuals (n = 306).RESULTS: POPs were associated with T2D in both the prospective and cross-sectional assessments. Of a standard deviation increase in POPs, prospective ORs ranged 1.42 (95% CI: 0.99, 2.06) for ∑NDL-PCBs to 1.55 (95% CI: 1.01, 2.38) for HCB (p < 0.05 only for HCB), and cross-sectional ORs ranged 1.62 (95% CI: 1.13; 2.32) for p,p'-DDE to 2.06 (95% CI: 1.29, 3.28) for ∑DL-PCBs (p < 0.05 for all POPs). In analyses of non-diabetic individuals, higher baseline BMI, decreased weight and decreased plasma lipid concentrations were associated with a slower decrease of POPs. Cases had, besides a higher BMI, reduced cholesterol and weight gain at follow-up compared to controls, which can explain the higher ORs in the cross-sectional assessments.DISCUSSION: The association between POPs and T2D was confirmed, but an indication that individuals body fat history might influence POP-T2D associations weakens the epidemiological support for a causal association. It also warrants studies based on other exposure metrics than biomonitoring. In addition, we note that a cross-sectional design overestimates the ORs if T2D cases have successfully intervened on weight and/or blood lipids, as changes in these factors cause changes in POPs.
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| 8. |
- Tornevi, Andreas, et al.
(författare)
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Effekter på luft och hälsa i områden utsatta för rök från skogsbränder med fokus på Jämtland 2018
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna studie syftar till att följa upp episoden med skogsbrandrök som drabbade Östersund och Jämtland Härjedalen sommaren 2018, samt att belysa vilka erfarenheter man har från andra länder om nivåer för exponering och risker.Tyvärr hade ingen av regionens tätorter kontinuerliga partikelmätningar sommaren 2018. En spridningsmodell vid SMHI användes för att beskriva spridning av rök från skogsbränderna 2018, samt en jämförbar period 2017 (då antalet bränder var färre), med fokus på fina partiklar (PM2.5) och sot-partiklar. Utifrån halt- och befolkningsskikt användes befolkningsviktade dygnsmedelhalter som mått på exponeringen i respektive kommun. Statistik över dagligt antal akuta besök för problem från andnings-organen vid sjukhuset i Östersund och regionens olika vårdcentraler och mottagningar, samt över antalet samtal till sjukvårdsupplysningen 1177 om andningsproblem, användes för att studera eventuella akuta hälsoeffekter inom respektive kommuns befolkning.Enligt beräkningarna förekom befolkningsviktade dygnsmedelhalter på upp till 97 μg/m3. I verkligheten förekom sannolikt, under kortare tid och avgränsade platser, betydligt högre halter. När brand-röksepisoder definierades som dygn med PM2.5>20 μg/m3 beräknades den sammanviktade relativa ökningen av akuta besök gällande astma till 68% (RR=1.68, 95% KI:1.09-2.57). För diagnoser gällande nedre luftvägar totalt observerades en ökning med 40% (RR=1.4, 95% KI:1.01-1.92). I genomsnitt innebar brandröksepisoder en ökning av halten PM2.5 med 28 μg/m3 i jämförelse med referensdygnen.Analyserna av förhöjda partikelhalter i Jämtland-Härjedalen under brandröksperioden sommaren 2018 tyder på att en ökning av akuta problem gällande de nedre luftvägarna kan förväntas från dygns-medelhalter på 20-40 μg/m3 av PM2.5 med ursprung i huvudsak från bränder. För information och varningar under pågående exponering för PM2.5 i skogsbrandrök torde de kriterier för korttidshalter som finns i USA och Kanada vara tillämpliga även för Sverige. Om haltbidraget från branden förväntas bli omkring 60-90 μg/m3 av PM2.5 under 1 timme eller längre bör känsliga grupper uppmanas att begränsa sin exponering.
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| 9. |
- Tornevi, Andreas, et al.
(författare)
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Efficacy of water treatment processes and endemic gastrointestinal illness : A multi-city study in Sweden
- 2016
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Ingår i: Water Research. - : Elsevier BV. - 0043-1354 .- 1879-2448. ; 102, s. 263-270
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Tidskriftsartikel (refereegranskat)abstract
- Outbreaks of acute gastrointestinal illnesses (AGI) have been linked to insufficient drinking water treatment on numerous occasions in the industrialized world, but it is largely unknown to what extent public drinking water influences the endemic level of AGI. This paper aimed to examine endemic AGI and the relationship with pathogen elimination efficacy in public drinking water treatment processes. For this reason, time series data of all telephone calls to the Swedish National Healthcare Guide between November 2007 and February 2014 from twenty Swedish cities were obtained. Calls concerning vomiting, diarrhea or abdominal pain (AGI calls) were separated from other concerns (non-AGI calls). Information on which type of microbial barriers each drinking water treatment plant in these cities have been used were obtained, together with the barriers' theoretical pathogen log reduction efficacy. The total log reduction in the drinking water plants varied between 0.0 and 6.1 units for viruses, 0.0-14.6 units for bacteria and 0.0-7.3 units regarding protozoans. To achieve one general efficacy parameter for each plant, a weighted mean value of the log reductions (WLR) was calculated, with the weights based on how commonly these pathogen groups cause AGI. The WLR in the plants varied between 0.0 and 6.4 units. The effect of different pathogen elimination efficacy on levels of AGI calls relative non-AGI calls was evaluated in regression models, controlling for long term trends, population size, age distribution, and climatological area. Populations receiving drinking water produced with higher total log reduction was associated with a lower relative number of AGI calls. In overall, AGI calls decreased by 4% (OR = 0.96, CI: 0.96-0.97) for each unit increase in the WLR. The findings apply to both groundwater and surface water study sites, but are particularly evident among surface water sites during seasons when viruses are the main cause of AGI. This study proposes that the endemic level of gastroenteritis can indeed be reduced with more advanced treatment processes at many municipal drinking water treatment plants.
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| 10. |
- Tornevi, Andreas, et al.
(författare)
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Luftföroreningars effekt på akutbesök för andningsorganen och uttag av astmamedicin
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport presenterar den femte studien för Naturvårdsverkets hälsorelaterade miljöövervakning inom detta område, och syftar till att analysera luftföroreningars korttidseffekter på antalet akutbesök för astma och övriga sjukdomar i andningsorganen under perioden 2013-2018 i Sveriges tre största storstadsområden. Som tillägg i denna studie är har även antalet astmamedicinuttag studerats. Uppgifter om akutbesök och läkemedelsuttag kommer från Socialstyrelsens register.I en gemensam analys, med alla tre områden och alla åldersgrupper, visar på att akutbesök för astma påverkas av de senaste två dygnens halt av alla tre studerade föroreningstyper: PM10, ozon och kvävedioxid, medan det för övriga akutbesök för andningsorganen enbart är PM10 som visar ett statistisk säkerställt samband totalt sett. I jämförelse med tidigare analysers resultat angående sambanden mellan PM10 och akutbesök för astma så ses ingen säkerställd trend sedan 2001, men i den senaste analyserade perioden ses den största effekten med omkring 4 % fler akutbesök per 10 μg/m3 för PM10.Medan det främst finns samband mellan partikelkoncentrationen som PM10 och akutbesök, ses för uttag av astmaläkemedel främst ett samband med halten av kvävedioxid, och särskilt för barn 0-17 år. För alla tre studieområdena och båda typerna av astmaläkemedel uppvisades liknande samband mellan NO2 och uttag av medicin, vilket kan motivera fördjupade analyser kring avgaskomponenter och mildare uttryck för astmabesvär än akutbesök.
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| 11. |
- Tornevi, Andreas, et al.
(författare)
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Luftföroreningars effekt på akutbesök för andningsorganen och uttag av astmamedicin
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport presenterar den femte studien för Naturvårdsverkets hälsorelaterade miljöövervakning inom detta område, och syftar till att analysera luftföroreningars korttidseffekter på antalet akutbesök för astma och övriga sjukdomar i andningsorganen under perioden 2013-2018 i tre storstadsområden: Stockholm, Göteborg och Malmö. Som ett tillägg i denna studie har också samband mellan luftföroreningar och läkemedelsuttag för astmabesvär utvärderats som en alternativ indikator på akuta effekter av luftföroreningar på astma. Luftföroreningsdata kommer från respektive miljöförvaltning och avser bakgrundshalter (taknivå) vid huvudmätstationen för respektive studieområde (Stockholm: Södermalm, Malmö: Rådhuset, Göteborg: Femmanhuset). Även pollenhalter, väder, veckodag, tid på året mm har beaktats i analyserna. Uppgifter om akutbesök och läkemedelsuttag kommer från Socialstyrelsens register.Analysen med alla tre områden och hela befolkningen (alla åldrar) visar att akutbesök för astma påverkas av de senaste två dygnens halt av alla tre föroreningstyperna: partiklar som PM10, ozon och kvävedioxid, medan det för övriga akutbesök för andningsorganen enbart är PM10 som visar ett statistisk säkerställt samband totalt sett (alla orter och alla åldrar).I jämförelse med tidigare analysers resultat angående sambanden mellan PM10 och akutbesök för astma så ses ingen säkerställd trend sedan 2001, men den senaste perioden ger störst ökning med omkring 4% fler akutbesök per 10 μg/m3 för PM10 (alla åldrar).Medan det främst finns samband mellan partikelkoncentrationen som PM10 och akutbesök, ses för uttag av astmaläkemedel främst ett samband med halten av kvävedioxid, och särskilt för barn 0-17 år. För alla tre studieområdena och båda typerna av astmaläkemedel uppvisades liknande samband mellan NO2 och uttag av medicin, vilket kan motivera fördjupade analyser kring avgaskomponenter och mildare uttryck för astmabesvär än akutbesök.
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| 12. |
- Tornevi, Andreas, et al.
(författare)
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Precipitation and Primary Health Care Visits for Gastrointestinal Illness in Gothenburg, Sweden
- 2015
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 10:5
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Tidskriftsartikel (refereegranskat)abstract
- Background The river Gota Alv is a source of freshwater for the City of Gothenburg, Sweden, and we recently identified a clear influence of upstream precipitation on concentrations of indicator bacteria in the river water, as well as an association with the daily number of phone calls to the nurse advice line related to acute gastrointestinal illnesses (AGI calls). This study aimed to examine visits to primary health-care centers owing to similar symptoms (AGI visits) in the same area, to explore associations with precipitation, and to compare variability in AGI visits and AGI calls. We obtained data covering six years (2007-2012) of daily AGI visits and studied their association with prior precipitation (0-28 days) using a distributed lag nonlinear Poisson regression model, adjusting for seasonal patterns and covariates. In addition, we studied the effects of prolonged wet and dry weather on AGI visits. We analyzed lagged short-term relations between AGI visits and AGI calls, and we studied differences in their seasonal patterns using a binomial regression model. The study period saw a total of 17,030 AGI visits, and the number of daily visits decreased on days when precipitation occurred. However, prolonged wet weather was associated with an elevated number of AGI visits. Differences in seasonality patterns were observed between AGI visits and AGI calls, as visits were relatively less frequent during winter and relatively more frequent in August, and only weak short-term relations were found. AGI visits and AGI calls seems to partly reflect different types of AGI illnesses, and the patients' choice of medical contact (in-person visits versus phone calls) appears to depend on current weather conditions. An association between prolonged wet weather and increased AGI visits supports the hypothesis that the drinking water is related to an increased risk of AGI illnesses.
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| 13. |
- Tornevi, Andreas, 1975-
(författare)
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Precipitation, Raw Water Quality, Drinking Water Treatment and Gastrointestinal Illness
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background On numerous occasions, outbreaks of acute gastrointestinal illnesses (AGI) have been linked to municipal drinking water in the industrialised world. Many of the reported outbreaks were observed after heavy rainfall events, which suggests that such events could result in a deterioration in the quality of drinking water. The observed drinking water-related outbreaks are, however, probably just the tip of the iceberg, and the extent to which public drinking water also influences the endemic level of gastroenteritis during non-outbreak periods is largely unknown. With climate change projected to increase the frequency of extreme weather events, data for preventive actions are needed now, to ensure safe drinking water today and in the future. The primary aim of this thesis is to increase the knowledge of the extent to which rainfall can still be a risk for insufficient drinking water quality, even with modern drinking water production methods. We aim to study if the incidence of gastroenteritis during normal endemic levels can be associated with water quality and the efficacy of pathogen elimination in different treatment processes. The thesis focuses first on AGI in the Gothenburg population and how precipitation affects its main fresh water supply (papers I-III); this is followed by a broader comparison of AGI in 20 cities across Sweden (Paper IV).Methods Observational time series data was used for all papers to construct generalized additive regression models, using smooth functions to adjust for long-term trends. Delayed effects on the outcome were evaluated using distributed lag non-linear models. In Paper I, the raw water-quality data for the river Göta älv were analysed – this water is used to produce drinking water for the population living in the north part of City of Gothenburg. The short-term variation of daily mean turbidity measurements and samples of three different types of indicator bacteria were modelled with daily precipitation using seven years of data. In papers II and III, the analyses aimed to determine whether the daily incidence of AGI in the population which households received drinking water produced from the river water could be associated with precipitation. As a measure of AGI, we used four years of data on the daily number of phone calls to the nurse advice line about vomiting, diarrhoea or abdominal pain (Paper II), and six years of data of the daily number of visits to health care clinics, when individuals were diagnosed with gastrointestinal infections (Paper III). Paper III also evaluates the similarities and differences between the frequency of nurse advice calls and primary health care visits. Paper IV analyses and compares the occurrence and seasonal patterns of nurse advice calls in twenty cities in Sweden, using seven years of data. The water treatment technique used by the public drinking water plants was obtained, and the processes theoretical efficacy of pathogen elimination was determined. The extent of AGI calls in relation to the pathogen elimination efficacy was analysed using a binomial regression design, adjusting for population size, age distribution and geographical area.Results We observed a strong relation between precipitation and the water quality in the Göta älv. A heavy rainfall event was related to increased concentrations of E. coli bacteria for several days, with the peak increase two days after the event. Precipitation was found to affect raw water quality parameters across all seasons. Heavy precipitation was also associated with a significant increase in the daily number of nurse advice calls due to AGI symptoms, with the number of calls peaking five days later. Consecutive wet weather periods were associated with both an increased number of AGI calls, as well as visits to clinics that led to diagnoses of AGI. Finally, we observed in Paper IV that cities with a higher pathogen elimination efficacy in their drinking water utility had a lower amount of AGI calls. The relations applied both to surface water and groundwater utilities, although the protective effect of a more advanced drinking water treatment on AGI was observed to be most significant in cities with surface water plants during the winter season.Conclusions The results suggest it is possible to reduce the occurrence of endemic gastroenteritis with a more advanced treatment process for drinking water. The delay between a heavy rainfall event (and the resulting decrease in raw water quality) and the increased number of nurse advice calls suggests viruses are the main cause, as the timing is consistent with viral incubation times. A viral transmission was also proposed when comparing different cities, as a more advanced water treatment process seems to be most beneficial during seasons where viruses are acknowledged as the main cause of AGI. Our research suggests that upgrades to drinking water treatment techniques, especially those aiming to better eliminate viruses, are warranted
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| 14. |
- Tornevi, Andreas, 1975-, et al.
(författare)
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Tidsmässiga samband mellan nederbörd, råvattenkvalitet och magsjuka
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Samband beskrivs mellan kraftigt regn, försämrad råvattenkvalitet och det ett ökat antal fall av magsjuka där den tidsmässiga fördröjningen överensstämmer med inkubationstider gällande virus. Rapporten förslår att ett bättre skydd mot förorening av Göta älv och förbättrade barriärer i dricksvattenproduktionen är motiverade.
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| 15. |
- Zamir, Itay, et al.
(författare)
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Hyperglycemia in Extremely Preterm Infants Insulin Treatment, Mortality and Nutrient Intakes
- 2018
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Ingår i: Journal of Pediatrics. - : Elsevier BV. - 0022-3476 .- 1097-6833. ; 200
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Tidskriftsartikel (refereegranskat)abstract
- Objective To explore the prevalence of hyperglycemia and the associations between nutritional intakes, hyperglycemia, insulin treatment, and mortality in extremely preterm infants. Study design Prospectively collected data from the Extremely Preterm Infants in Sweden Study (EXPRESS) was used in this study and included 580 infants born <27 gestational weeks during 2004-2007. Available glucose measurements (n = 9850) as well as insulin treatment and nutritional data were obtained retrospectively from hospital records for the first 28 postnatal days as well as 28- and 70-day mortality data. Results Daily prevalence of hyperglycemia >180 mg/dL (10 mmol/L) of up to 30% was observed during the first 2 postnatal weeks, followed by a slow decrease in its occurrence thereafter. Generalized additive model analysis showed that increasing parenteral carbohydrate supply with 1 g/kg/day was associated with a 1.6% increase in glucose concentration (P < .001). Hyperglycemia was associated with more than double the 28-day mortality risk (P< .01). In a logistic regression model, insulin treatment was associated with lower 28- and 70-day mortality when given to infants with hyperglycemia irrespective of the duration of the hyperglycemic episode (P< .05). Conclusions Hyperglycemia is common in extremely preterm infants throughout the first postnatal month. Glucose infusions seem to have only a minimal impact on glucose concentrations. In the EXPRESS cohort, insulin treatment was associated with lower mortality in infants with hyperglycemia. Current practices of hyperglycemia treatment in extremely preterm infants should be reevaluated and assessed in randomized controlled clinical trials.
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