Kjell Torén

Università degli Studi di Perugia, Perugia, Umbria, Italy

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Publications (248)1282.95 Total impact

  • European Respiratory Journal 09/2015; 46(suppl 59):PA4048. DOI:10.1183/13993003.congress-2015.PA4048 · 7.64 Impact Factor
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    ABSTRACT: Background: Although active tobacco smoking is the main risk factor for COPD, COPD is not uncommon also among never-smokers. Different study locations along with different spirometric definitions of COPD have historically yielded different prevalence estimates of the disease. Aim: To study current prevalence and risk factors of COPD among never-smokers in two areas of Sweden. Methods: Data collected in 2008-2012 within the West Sweden Asthma Study and Obstructive Lung Disease in Northern Sweden Studies was pooled. The study population consisted of 1839 subjects who participated in spirometry and interviews. COPD was defined as post-bronchodilator a) FEV1/(F)VC < 0.7, b) FEV1/FVC < 0.7 and c) FEV1/FVC < lower limit of normal. Results: Of the 1839 subjects, 967 (52.6%) were never-smokers. Among the never-smoking subjects, the prevalence of COPD according to definitions a-c was 7.7%, 4.9% and 3.0%, respectively. The corresponding prevalence of GOLD grade ≥2 was 2.0%, 1.4% and 1.3%. No significant difference in prevalence between the two study areas was observed. In never-smokers, occupational exposure to gas, dust or fumes (GDF) was significantly associated with both COPD (OR 1.85, 95% CI 1.03-3.33), and GOLD ≥2 (OR 4.51, 1.72-11.9) according to definition a), after adjusting for age, educational level and exposure to passive smoking at work. Conclusion: Depending on definition, prevalence of COPD among never-smokers was 3.0-7.7%, whereas GOLD ≥2 was present in 1.3-2.0%. Occupational exposure to GDF remained independently and significantly associated with COPD regardless of spirometric definition of the disease.
    Respiratory medicine 09/2015; 46(suppl 59). DOI:10.1016/j.rmed.2015.09.012 · 3.09 Impact Factor

  • European Respiratory Journal 09/2015; 46(suppl 59):OA2941. DOI:10.1183/13993003.congress-2015.OA2941 · 7.64 Impact Factor

  • European Respiratory Journal 09/2015; 46(suppl 59):PA5065. DOI:10.1183/13993003.congress-2015.PA5065 · 7.64 Impact Factor

  • European Respiratory Journal 09/2015; 46(suppl 59):PA2090. DOI:10.1183/13993003.congress-2015.PA2090 · 7.64 Impact Factor
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    European Respiratory Journal 09/2015; 46(suppl 59):PA340. DOI:10.1183/13993003.congress-2015.PA340 · 7.64 Impact Factor
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    European Respiratory Journal 09/2015; 46(suppl 59):PA2027. DOI:10.1183/13993003.congress-2015.PA2027 · 7.64 Impact Factor
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    ABSTRACT: Welding-related asthma is well recognised but less is known about rhinitis in relation to welding. The aim here, was to study associations between welding, rhinitis and asthma in a general population sample, and factors influencing selection into and out of a welding occupation.Adult-onset asthma and non-infectious rhinitis were investigated in the international multicentre population-based Respiratory Health in Northern Europe (RHINE) study, including 16 191 responders aged 26-54 years. Ever welding (n=2181), welding >25% of working time (n=747), and welding in stainless steel >6 months (n=173) were assessed by questionnaire. Subjects with rhinitis or asthma onset when aged <18 years were excluded. Incidence rates for asthma and rhinitis were calculated from year of disease onset, and start and end of welding job. Cox's proportional hazard models adjusting for age, sex, parental education and study centre, and Kaplan-Meier curves were used.Rhinitis incidence was higher among welders (hazard ratio (HR) 1.4, 95% CI 1.3-1.6), consistent in men and women, and across centres (pheterogeneity=0.4). In men, asthma incidence was higher among welders (HR 1.4, 95% CI 1.04-1.97). Quitting welding was indicated higher after adult-onset rhinitis (HR 1.1, 95% CI 1.0-1.3).Adult-onset rhinitis and asthma was higher among welders, consistent across population samples from Northern Europe. No pre-employment selection was found, whereas selection out of welding jobs was suggested. Copyright ©ERS 2015.
    European Respiratory Journal 07/2015; 46(5). DOI:10.1183/13993003.02345-2014 · 7.64 Impact Factor
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    ABSTRACT: Objectives To investigate the association between living near dense traffic and lung function in a cohort of adults from a single urban region. Design Cross-sectional results from a cohort study. Setting The adult-onset asthma and exhaled nitric oxide (ADONIX) cohort, sampled during 2001–2008 in Gothenburg, Sweden. Exposure was expressed as the distance from participants’ residential address to the nearest road with dense traffic (>10 000 vehicles per day) or very dense traffic (>30 000 vehicles per day). The exposure categories were: low (>500 m; reference), medium (75–500 m) or high (<75 m). Participants The source population was a population-based cohort of adults (n=6153). The study population included 5441 participants of European descent with good quality spirometry and information about all outcomes and covariates. Outcome measures Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured at a clinical examination. The association with exposure was examined using linear regression adjusting for age, gender, body mass index, smoking status and education in all participants and stratified by sex, smoking status and respiratory health status. Results We identified a significant dose–response trend between exposure category and FEV1 (p=0.03) and borderline significant trend for FVC (p=0.06) after adjusting for covariates. High exposure was associated with lower FEV1 (−1.0%, 95% CI −2.5% to 0.5%) and lower FVC (−0.9%, 95% CI −2.2% to 0.4%). The effect appeared to be stronger in women. In highly exposed individuals with current asthma or chronic obstructive pulmonary disease, FVC was lower (−4.5%, 95% CI −8.8% to −0.1%). Conclusions High traffic exposure at the residential address was associated with lower than predicted FEV1 and FVC lung function compared with living further away in a large general population cohort. There were particular effects on women and individuals with obstructive disease.
    BMJ Open 06/2015; 5(6):e007624. DOI:10.1136/bmjopen-2015-007624 · 2.27 Impact Factor
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    ABSTRACT: Cardiopulmonary diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns. The Swedish CArdioPulmonarybioImage Study (SCAPIS) combines the use of new imaging technologies, advances in large-scale 'omics' and epidemiological analyses to extensively characterize a Swedish cohort of 30 000 men and women aged between 50 and 64 years. The information obtained will be used to improve risk prediction of cardiopulmonary diseases and optimize the ability to study disease mechanisms. A comprehensive pilot study in 1111 individuals, which was completed in 2012, demonstrated the feasibility and financial and ethical consequences of SCAPIS. Recruitment to the national, multicentre study has recently started. © 2015 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.
    Journal of Internal Medicine 06/2015; DOI:10.1111/joim.12384 · 6.06 Impact Factor
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    ABSTRACT: 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. 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. 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. 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. © 2015 American Heart Association, Inc.
    Stroke 06/2015; 46(7). DOI:10.1161/STROKEAHA.115.009008 · 5.72 Impact Factor
  • Paul D Blanc · Bengt Järvholm · Kjell Torén ·
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    ABSTRACT: The association between occupational exposure and autoimmune disease is well recognized for silica and suspected for other inhalants. We used a large cohort to estimate the risks rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis and dermatomyositis associated with silica and other occupational exposures. We analyzed data for male Swedish construction industry employees. Exposure was defined by a job exposure matrix for silica and for other inorganic dusts those with other job exposure matrix exposures but not to either of the two inorganic dusts categories were excluded. National hospital treatment data were linked for ICD-10 coded diagnoses of rheumatoid arthritis (seronegative and positive), systemic lupus erythematosus, systemic sclerosis, and dermatomyositis. The two occupational exposures were tested as independent predictors of prospective hospital-based treatment for these diagnoses using age adjusted Poisson multivariable regression analyses to calculate relative risk (RR). We analyzed hospital-based treatment data (1997 through 2010) for 240,983 males aged 30 to 84. There were 713 incident cases of rheumatoid arthritis (467 seropostive; 195 seronegative; 51 not classified) and 128 cases combined for systemic lupus erythematosus, systemic sclerosis, and dermatomyositis. Adjusted for smoking, age, the two occupational exposures (silica and other inorganic dusts) were each associated with increased risk of rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis , and dermatomyositis combined: RR 1.39 (95% CI 1.17-1.64) and RR 1.31 (95% CI 1.11-1.53), respectively. Among ever smokers, both silica and other inorganic dust exposure were associated with increased risk of rheumatoid arthritis (RRs 1.36; 95% CI 1.11-1.68 and 1.42; 95% CI 1.17-1.73, respectively), while among never smokers neither exposure was associated with statistically significant increased risk of rheumatoid arthritis. This analysis reaffirms the link between occupational silica and a range of auto-immune diseases, while also suggesting that other inorganic dusts, may also impart excess risk of such disease. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American journal of medicine 05/2015; 128(10). DOI:10.1016/j.amjmed.2015.05.001 · 5.00 Impact Factor
  • Shadi Amid Hägg · Kjell Torén · Eva Lindberg ·
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    ABSTRACT: This population-based cohort study was performed to assess the association between sleep disturbances and the risk of occupational accidents among women. Data were collected by questionnaires on two different occasions (2000 and 2010) and data on work injuries were also collected from Swedish government records (ISA). Insomnia symptoms were defined as having severe or very severe problems with (i) difficulty initiating sleep, (ii) difficulty maintaining sleep, or (iii) early morning awakening. Symptom of obstructive sleep apnea syndrome (OSAS) was defined as reporting both snoring and daytime sleepiness. Working-age respondents (20-67 years of age) who responded to both baseline and follow-up questionnaires and had worked for part or all of the 10-year follow-up period (N=4320) were included in the study. Of the subjects responding to the questionnaire, 12.2% reported ≥1 accident and 6.3% reported an accident requiring sick leave in the government register. Blue-collar workers and night and shift work were more common in the group with occupational accidents. Subjects with insomnia symptoms both at baseline and follow-up (persistent insomnia symptoms) ran a higher risk of being involved in an self-reported occupational accident [adjusted OR (OR adj) 1.5, 95% confidence interval (95% CI) 1.2-2.0] after adjusting for age, body mass index, smoking, alcohol dependency, white- or blue-collar worker, years at work, night work, and physical activity. Persistent insomnia symptoms did not reach statistical significance as an independent predictor of register-reported occupational accident with sick leave (OR adj1.4, 95% CI 0.99-2.1). No significant association was found between symptoms of OSAS and self-reported or register-based occupational accidents. Persistent insomnia symptoms were associated with an increased risk of self-reported occupational accidents, while no significant association was found with occupational accidents with sick leave reported to government register.
    Scandinavian Journal of Work, Environment & Health 04/2015; 41(4). DOI:10.5271/sjweh.3495 · 3.45 Impact Factor
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    ABSTRACT: It has been suggested that gastroesophageal reflux disease (GERD) is a risk factor for developing rhinitis/rhinosinusitis, but data are lacking. This is a prospective 10-year follow-up study of a large multicenter cohort from Northern Europe, evaluating the relationship between nocturnal GERD and non-infectious rhinitis (NIR) METHODS: The study comprised 5,417 subjects born between 1945 and 1973, who answered a questionnaire in 1999-2001 and again in 2010-2012. Non-infectious rhinitis was defined as having nasal obstruction, secretion and/or sneezing without having the common cold. Odds ratios for developing NIR in relation to age, gender, BMI, smoking, asthma and nocturnal GERD were calculated RESULTS: During the 10-year observation period, 1,034 subjects (19.1%) developed NIR. Subjects reporting nocturnal gastroesophageal reflux in both 1999 and 2010 had more NIR in 2010 (2.8% vs 1.2%, p<0.001). There was a significant dose-response relationship between the number of reflux episodes/week in 1999 and the risk of having NIR in 2010, p=0.02. In the multiple regression adjusted for age, gender, BMI, tobacco smoke and asthma, those with nocturnal GERD in 1999 (≥3 episodes of nocturnal gastroesophageal reflux symptoms per week) had an OR of 1.6 (95% CI 1.0-2.5, p=0.03) to develop NIR in 2010. Smoking was associated both with an increased risk of developing NIR (30.7% vs 24.0%, p<0.001) and with the development of nocturnal GERD CONCLUSION: This large, population-based, 10-year study indicates that nocturnal GERD was a risk factor for non-infectious rhinitis/rhinosinusitis. GERD should therefore be considered in patients with rhinitis of known and unknown origin This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Allergy 03/2015; 70(6). DOI:10.1111/all.12615 · 6.03 Impact Factor
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    ABSTRACT: The present study aimed to investigate whether different dimensions of psychosocial stress, as measured by the job demand-control model (JDC), were associated with increased risks of ischemic stroke and coronary heart disease (CHD). A cohort of 75 236 male construction workers was followed from 1989-2004. Exposure to psychosocial stress was determined by a questionnaire answered in 1989-1993. Events of ischemic stroke and CHD were found by linkage to the Swedish Causes of Death and National Patient registers. Hazard ratios (HR) were obtained from Cox regression models, adjusted for age, smoking habits, body mass index and systolic blood pressure. There were 1884 cases of CHD and 739 cases of ischemic stroke. Regarding ischemic stroke, no association was found between job demands [HR 1.12, 95% confidence interval (95% CI) 0.89-1.40, highest versus lowest quintile] or job control (HR 1.04, 95% CI 0.82-1.32, lowest versus highest quintile). Regarding CHD, job demands were associated to CHD (HR 1.18, 95% CI 1.02-1.37, highest vs. lowest quintile), but no consistent trend was seen among quintiles. The results were inconsistent in relation to job control. The division of JDC into four categories showed no significant associations with either ischemic stroke or CHD. This exploratory study showed no significant associations between psychosocial work environment and ischemic stroke, and the associations between job demands and control and CHD were inconsistent and weak. The combination of job control and job demand showed no significant associations with either ischemic stroke or CHD.
    Scandinavian Journal of Work, Environment & Health 03/2015; 41(3). DOI:10.5271/sjweh.3491 · 3.45 Impact Factor
  • Kjell Torén · Bengt Järvholm ·

    Scandinavian Journal of Work, Environment & Health 03/2015; 41(1):102-4. DOI:10.5271/sjweh.3457 · 3.45 Impact Factor
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    ABSTRACT: Objective: There is a lack of research on effects of occupational noise exposure in traditionally female-dominated workplaces. Therefore, the aim of this study was to assess risk of noise-induced hearing-related symptoms among obstetrics personnel. Design: A cross-sectional study was performed at an obstetric ward in Sweden including a questionnaire among all employees and sound level measurements in 61 work shifts at the same ward. Participants: 115 female employees responded to a questionnaire (72% of all 160 employees invited). Main outcome measures: Self-reported hearing-related symptoms in relation to calculated occupational noise exposure dose and measured sound levels. Results: Sound levels exceeded the 80 dB LAeq limit for protection of hearing in 46% of the measured work shifts. One or more hearing-related symptoms were reported by 55% of the personnel. In logistic regression models, a significant association was found between occupational noise exposure dose and tinnitus (OR=1.04, 95% CI 1.00 to 1.09) and sound-induced auditory fatigue (OR=1.04, 95% CI 1.00 to 1.07). Work-related stress and noise annoyance at work were reported by almost half of the personnel. Sound-induced auditory fatigue was associated with work-related stress and noise annoyance at work, although stress slightly missed significance in a multivariable model. No significant interactions were found. Conclusions: This study presents new results showing that obstetrics personnel are at risk of noise-induced hearing-related symptoms. Current exposure levels at the workplace are high and occupational noise exposure dose has significant effects on tinnitus and sound-induced auditory fatigue among the personnel. These results indicate that preventative action regarding noise exposure is required in obstetrics care and that risk assessments may be needed in previously unstudied non-industrial communication-intense sound environments.
    BMJ Open 03/2015; 5(3-3). DOI:10.1136/bmjopen-2014-005793 · 2.27 Impact Factor
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    ABSTRACT: The exacerbation of asthma by workplace conditions is common, but little is known about which agents pose a risk. We used data from an existing survey of adults with asthma to identify occupational exposures associated with severe exacerbation of asthma. Questionnaires were completed by 557 working adults with asthma. Severe exacerbation of asthma in the past 12 months was defined as asthma-related hospitalization, or reports of both unplanned asthma care and treatment with a short course of oral corticosteroids. Occupational exposures for the same time period were assessed using an asthma-specific job exposure matrix. We modeled severe exacerbation to yield prevalence ratios (PRs) for exposures while controlling for potential confounders. A total of 164 participants (29%) were positive for severe exacerbation, and 227 (40.8%) were assessed as being exposed to asthma agents at work. Elevated PRs were observed for several specific agents, notably the irritant subcategories of environmental tobacco smoke (PR 1.84, 95%CI 1.34-2.51) among all participants, inorganic dusts (PR 2.53, 95%CI 1.37-4.67) among men, and the low molecular weight subcategory of other highly reactive agents (PR 1.97, 95%CI 1.08-3.60) among women. Among working adults with asthma, severe exacerbation was associated with several occupational agents.
    The International Journal of Tuberculosis and Lung Disease 02/2015; 19(2):244-250. DOI:10.5588/ijtld.14.0132 · 2.32 Impact Factor
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    ABSTRACT: Occupational exposure to gas, dust and fumes (GDF) increases the risk of asthma and eczema. We investigated the role of sensitisation in the association between GDF and allergic conditions. A population-based sample of 788 adults from the West Sweden Asthma Study completed questionnaires and skin prick tests. After adjustment for confounders GDF exposure was associated with a doubled risk of sensitisation to mites, but not other allergens. Mite sensitisation also modified the effect of GDF on asthma. In mite-sensitised subjects GDF was associated with physician-diagnosed asthma, adjusted OR 2.9 (1.2-7.2) and wheeze, OR 2.4 (1.1-5.3). In non-mite-sensitised subjects the corresponding ORs were 1.1 (0.5-2.6) and 0.6 (0.3-1.3). GDF was independently associated with eczema regardless of mite sensitisation, but not with rhinitis. These novel findings suggest that components of GDF may act as adjuvants that facilitate sensitisation to mites, and that mite-sensitised individuals may be especially susceptible to inhalant occupational exposures.This article is protected by copyright. All rights reserved.
    Allergy 01/2015; 70(5). DOI:10.1111/all.12584 · 6.03 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate whether psychosocial stress defined as high strain based on the job demand-control model increases risk for atrial fibrillation. The present study comprised 6035 men born between 1915 and 1925 and free from previous coronary heart disease, atrial fibrillation and stroke at baseline (1974-1977). Work-related psychosocial stress was measured using a job-exposure matrix for the job demand-control model based on occupation at baseline. The participants were followed from baseline examination until death, hospital discharge or 75 years of age, using the Swedish national register on cause of death and the Swedish hospital discharge register for any registration for atrial fibrillation, resulting in the identification of 436 cases. Data were analysed with Cox regression models with atrial fibrillation as the outcome using high strain as the explanatory variable adjusted for age, smoking, body mass index, hypertension, diabetes and socioeconomic status. There was an increased risk for atrial fibrillation in relation to high strain (HR 1.32, 95% CI 1.003 to 1.75). When the four categories of the job-strain model were included and low strain was used as reference, the risk for high strain decreased (HR 1.23, 95% CI 0.84 to 1.82). Exposure to occupational psychosocial stress defined as high strain may be associated with increased risk for atrial fibrillation. The observed increase in risk is small and residual confounding may also be present. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Occupational and Environmental Medicine 12/2014; 72(3). DOI:10.1136/oemed-2014-102256 · 3.27 Impact Factor

Publication Stats

8k Citations
1,282.95 Total Impact Points


  • 2013-2015
    • Università degli Studi di Perugia
      Perugia, Umbria, Italy
  • 2005-2015
    • University of Gothenburg
      • • Department of Internal Medicine and Clinical Nutrition
      • • Institute of Medicine
      • • Department of Public Health and Community Medicine
      • • Unit of Occupational and Environmental Medicine
      Goeteborg, Västra Götaland, Sweden
  • 1992-2015
    • Sahlgrenska University Hospital
      • Department of Cardiology
      Goeteborg, Västra Götaland, Sweden
  • 2014
    • Haukeland University Hospital
      • Department of Thoracic Medicine
      Bergen, Hordaland, Norway
  • 2004-2013
    • Karolinska Institutet
      • • Institute of Environmental Medicine - IMM
      • • Department of Physiology and Pharmacology
      Solna, Stockholm, Sweden
  • 2010
    • Public Health Agency of Sweden
      Tukholma, Stockholm, Sweden
  • 2008
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2004-2005
    • Umeå University
      • Department of Public Health and Clinical Medicine
      Umeå, Västerbotten, Sweden
  • 2000
    • University of California, San Francisco
      • Department of Medicine
      San Francisco, California, United States