Kjell Torén

University of Gothenburg, Goeteborg, Västra Götaland, Sweden

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Publications (240)1197.94 Total impact

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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diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns.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 · 5.79 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; DOI:10.1161/STROKEAHA.115.009008 · 6.02 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; DOI:10.1016/j.amjmed.2015.05.001 · 5.30 Impact Factor
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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; DOI:10.5271/sjweh.3495 · 3.10 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 · 6.00 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 · 3.10 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 · 2.76 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 · 6.00 Impact Factor
  • Kjell Torén, Bengt Järvholm
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    ABSTRACT: To investigate the association between living near dense traffic and lung function in a cohort of adults from a single urban region. Cross-sectional results from a cohort study. 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). 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. 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. 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%). 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. 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.
    BMJ Open 01/2015; 5(6):e007624. DOI:10.1136/bmjopen-2015-007624 · 2.06 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 · 3.23 Impact Factor
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    ABSTRACT: A spirometric reference equation consists of a mathematical model with constants and coefficients optimized to fit a specific data set from healthy individuals. Commonly applied models are selected on statistical rather than physiological considerations. A predetermined model with constants and coefficients optimized to various populations would enable interpretable and interesting comparisons between populations. Lubiński and Gólczewski recently presented a piecewise linear model with constants and coefficients claimed to be physiologically interpretable (Lubiński model). Three questions were addressed: Is the Lubiński model as useful clinically as other models: multiple linear, piecewise polynomial and exponential with splines? Will reference equations based on the Lubiński model and optimized to a Swedish and to a Polish population allow for interpretable comparisons? Are three well-known reference equations clinically useful in the Swedish adult population? A recent Swedish random population sample with high-quality spirometric measurements enabled the present analyses. When optimized to fit the Swedish population sample, the Lubiński model and two other models provided accurate predictive normal values. Interesting differences were demonstrated between the Polish and Swedish populations. The proportion of subjects below lower limit normal was adequate for the piecewise polynomial equations but too low and not clinically useful for the advocated exponential equations with splines. It is concluded that the Lubiński model is clinically as useful as other models, and it adds important value and is recommended for future spirometric reference equations for adults. The advocated exponential equations with splines are not recommended for Swedish adults because of too wide normal limits.
    Clinical Physiology and Functional Imaging 10/2014; DOI:10.1111/cpf.12198 · 1.33 Impact Factor
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    ABSTRACT: Alcohol consumption at moderate levels has been associated with decreased risk of coronary heart disease (CHD). However, the cardio-protective effect of alcohol may be restricted to subjects with a particular genotype of the cholesterol ester transfer protein (CETP) polymorphism. There is evidence for this from one study in men, but the finding has not been confirmed since. The present study specifically re-examines the potential modification of the association between alcohol consumption and CHD by the CETP TaqIB (rs708272) polymorphism in a sample including both men and women. The INTERGENE case-control study consists of 618 patients with CHD and 2921 control subjects, of whom 19% were homozygous for the CETP TaqIB B2 allele. Alcohol consumption was categorized into sex-specific tertiles of ethanol intake, with non-drinkers constituting a separate category. Logistic regression was used to determine the association between CHD with genotype, ethanol intake, and their interaction. Participants with intermediate ethanol intake (2nd tertile) had lower risk of CHD than those with low ethanol intake (OR = 0.65; 95% CI 0.50–0.85). The strongest protective association was seen in theCETP TaqIB B2 homozygotes for intermediate vs. low ethanol intake (odds ratio [OR] = 0.21; 95% confidence interval [CI] 0.10–0.44). The interaction between ethanol intake and genotype was statistically significant (p = 0.008), and of similar size in men and women though significant only in men (p = 0.01). The effect modification could not be explained by differences in lifestyle, socioeconomics, or alcohol-related biological variables such as HDL-cholesterol. Our study is the first to replicate previous findings of an effect modification in men. It gives only suggestive results for women, possibly due to the small number of female cases (n = 165). The prevented fraction for the favorable combination of genotype and alcohol consumption is about 6%, a value suggesting that the cardio-protective effect of moderate alcohol consumption applies only to a small segment of the general population.
    Alcohol 09/2014; 48(7). DOI:10.1016/j.alcohol.2014.08.011 · 2.04 Impact Factor
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    ABSTRACT: Psychological factors such as anxiety and depression are prevalent in patients with asthma. The purpose of this study was to investigate the relationship between respiratory symptoms and psychological status and to estimate the importance of psychological status in comparison with other factors that are known to be associated with respiratory symptoms. This study included 2270 subjects aged 20–44 (52% female) from Sweden, Iceland, and Norway. Each participant underwent a clinical interview including questions on respiratory symptoms. Spirometry and methacholine challenge were performed. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Eighty-two percent of the subjects reported no anxiety or depression whatsoever, 11% reported anxiety, 2.5% depression and 4% reported both anxiety and depression. All respiratory symptoms, such as wheezing, breathlessness and nightly symptoms, were more common, at a statistically significant level, in participants who had depression and anxiety, even after adjusting for confounders (ORs 1.33 – 1.94). The HADS score was the most important determinant for nightly symptoms and attacks of breathlessness when at rest whereas bronchial responsiveness was the most important determinant for wheezing, and breathlessness when wheezing. The probability of respiratory symptoms related to HADS score increased with increasing HADS score for all respiratory symptoms. In conclusion, there is a strong association between respiratory symptoms and psychological status. There is therefore a need for interventional studies designed to improve depression and anxiety in patients with respiratory symptoms.
    Respiratory Medicine 09/2014; 108(11). DOI:10.1016/j.rmed.2014.09.007 · 2.92 Impact Factor
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    ABSTRACT: INTRODUCTION: Respiratory symptoms at work are common and may lead to change of workplace. So far no data has been available regarding the change of workplace due to respiratory symptoms in Norway. The county of Telemark is of particular interest because it is one of the most industrialized onshore parts of Norway.METHOD: A self-administered respiratory and work exposurequestionnaire was mailed to a random sample of 50.000 inhabitants aged 16 to 50 years living in Telemark County, Norway. The response rate was 33%. Prevalence of asthma was 12% both in responders and in non-responders (contacted by telephone, n=183), suggesting the sample is representative.RESULTS: Fifteen percent of the sample reported exposure to vapor, gas, dust and fumesat work on a daily basis. Twenty-six percent reported asthma symptoms (wheezing, chest tightness or dyspnoea) during the past 12 months, and 1.5% had ever changed their work due to respiratory symptoms. The most frequently reported exposures, based on an asthma-specific job-exposure matrix (the Nordic JEM), leading to change of work were irritative-agents (62%), low-molecular weight-agents (25%) and high-molecular weight-agents (15%). The most prevalent reported single exposures associated with workplace change due to respiratory symptoms were: low temperatures 52% and odds ratio (OR) 2.0 (95% CI 1.4, 2.8), welding fumes 40% and OR 3.7 (2.6, 5.3), paint 40% and OR 3.7 (2.6, 5.3), and metal dust 39% and OR 3.6 (2.5, 5.1).CONCLUSION: Exposures to low temperatures, welding fumes, paints and metal dust were associated with increased risk of change of workplace due to respiratory symptoms in this sample from the general population of Norway.
    European Respiratory Society Congress 2014, Munich, Germany; 09/2014
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    ABSTRACT: Objectives Little is known about the Hymenoptera venom allergy impact on work ability and the effect of venom immunotherapy (VIT) on work. The objective of this study was to evaluate the prevalence and predictors of work disability in patients treated with VIT and the effects of VIT on occupational functioning. Methods 181 patients, aged 18–71 years, treated with VIT while working, were investigated by questionnaire. Participants were classified into employed and self-employed and, based on work exposure to Hymenoptera, into three risk categories: high risk, occasionally high risk and low risk. Work disability was defined as having to have changed jobs/tasks and/or suffered economic loss because of Hymenoptera venom allergy. Predictors of work disability were assessed in logistic regression models. Results 31 (17%) patients reported work disability. Being self-employed and having the severe reaction at work were associated with work disability (p<0.01). Having a high-risk job for exposure to Hymenoptera was a significant predictor of work disability (OR 2.66, 95% CI 1.04 to 6.75). 24% of patients referred a positive effect of VIT on work. Determinants of the positive effect of VIT on work were having a high-risk job for exposure to hymenoptera (OR 3.60, 95% CI 1.52 to 8.51) and having already concluded VIT (OR 2.82, 95% CI 1.30 to 6.14). Conclusions Hymenoptera venom allergy could determine work disability. Patients with Hymenoptera venom allergy having a high-risk job for exposure to Hymenoptera seem to have higher risk of work disability and refer more frequently a positive effect of VIT on work.
    BMJ Open 08/2014; 4(8):e005593. DOI:10.1136/bmjopen-2014-005593 · 2.06 Impact Factor
  • M. Holm, K. Torén, E. Andersson
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    ABSTRACT: SettingA county in western Sweden. Objective To prospectively investigate the incidence rate of chronic bronchitis (CB) in relation to smoking, age, sex, atopy and asthma in a large sample of the general population. DesignSubjects from a county in western Sweden born between 1943 and 1973, who had participated in our previous study in 1993, were mailed a new questionnaire in 2003. Altogether 11 463 (72%) answered the questionnaire, which comprised items about smoking, atopy, respiratory symptoms and age at onset of CB symptoms. CB was defined as chronic productive cough for at least 3 months per year for 2 consecutive years. ResultsThere were 98 new cases of CB during 1993–2003 in the study population aged 30-60 years at follow-up. The incidence rate was 0.9/1000 person-years (py); there was no significant difference between women and men or different age groups. However, CB incidence was higher in women in relation to smoking (incidence rate ratio 3.6, 95%CI 1.9–7.3) and in those with ever asthma (hazard ratio 5.6, 95%CI 3.5–9.0). Conclusion This prospective general population-based study shows an incidence rate of CB of 0.9/1000 py. Smoking and asthma were both associated with an increased risk of CB.
    The International Journal of Tuberculosis and Lung Disease 07/2014; 18(7). DOI:10.5588/ijtld.13.0652 · 2.76 Impact Factor
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    ABSTRACT: Throughout the literature, substantial evidence supports associations between poor psychosocial work characteristics and a variety of ill-health outcomes. Yet, few reports strategies workers carry out to improve detrimental work conditions and consequently their health, such as changing jobs. The aim of this study was to examine if adverse psychosocial work exposure, as measured with the job demand-control and effort-reward imbalance models, could predict job mobility over a 5 years observation period.
    BMC Public Health 06/2014; 14(1):605. DOI:10.1186/1471-2458-14-605 · 2.32 Impact Factor
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    ABSTRACT: Background The two inflammatory bowel diseases (IBD), ulcerative colitis and Crohn's disease, has increased rapidly during the twentieth century, but the aetiology is still poorly understood. Impaired immunological competence due to decreasing biodiversity and altered microbial stimulation is a suggested explanation. Objective Place of upbringing was used as a proxy for the level and diversity of microbial stimulation to investigate the effects on the prevalence of IBD in adulthood. Methods Respiratory Health in Northern Europe (RHINE) III is a postal follow-up questionnaire of the European Community Respiratory Health Survey (ECRHS) cohorts established in 1989-1992. The study population was 10,864 subjects born 1945-1971 in Denmark, Norway, Sweden, Iceland and Estonia, who responded to questionnaires in 2000-2002 and 2010-2012. Data were analysed in logistic and Cox regression models taking age, sex, smoking and body mass index into consideration. Results Being born and raised on a livestock farm the first 5 years of life was associated with a lower risk of IBD compared to city living in logistic (OR 0.54, 95 % CI 0.31; 0.94) and Cox regression models (HR 0.55, 95 % CI 0.31; 0.98). Random-effect meta-analysis did not identify geographical difference in this association. Furthermore, there was a significant trend comparing livestock farm living, village and city living (p < 0.01). Sub-analyses showed that the protective effect was only present among subjects born after 1952 (OR 0.25, 95 % CI 0.11; 0.61). Conclusion This study suggests a protective effect from livestock farm living in early childhood on the occurrence of IBD in adulthood, however only among subjects born after 1952. We speculate that lower microbial diversity is an explanation for the findings.
    European Journal of Epidemiology 06/2014; 29(6). DOI:10.1007/s10654-014-9922-3 · 5.15 Impact Factor
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    ABSTRACT: Background Population-based studies on aspirin-intolerant asthma are very few and no previous population study has investigated risk factors for the condition.Objective To investigate the prevalence and risk factors of aspirin-intolerant asthma in the general population.MethodsA questionnaire on respiratory health was mailed to 30 000 randomly selected subjects aged 16-75 years in West Sweden, 29 218 could be traced and 18 087 (62%) responded. The questionnaire included questions on asthma, respiratory symptoms, aspirin-induced dyspnea and possible determinants.ResultsThe prevalence of aspirin-intolerant asthma was 0.5%, 0.3% in men and 0.6% in women (p=0.014). Sick leave, emergency visits due to asthma and all investigated lower respiratory symptoms were more common in aspirin-intolerant asthma than in aspirin-tolerant asthma. Obesity was a strong risk factor for aspirin-intolerant asthma (BMI>35: OR 12.1; 95% CI 2.49-58.5) and there was a dose-response relationship between increasing body mass index and risk of aspirin-intolerant asthma. Obesity, airborne occupational exposure and visible mold at home were considerably stronger risk factors for aspirin-intolerant asthma than for aspirin-tolerant asthma. Current smoking was a risk factor for aspirin-intolerant asthma (OR 2.55; 95% CI 1.47-4.42), but not aspirin-tolerant asthma.Conclusion Aspirin-intolerant asthma identified in the general population was associated with a high burden of symptoms, uncontrolled disease and a high morbidity. Increasing body mass index increased the risk of aspirin-intolerant asthma in a dose-response manner. A number of risk factors, including obesity and current smoking, were considerably stronger for aspirin-intolerant asthma than for aspirin-tolerant asthma.This article is protected by copyright. All rights reserved.
    Clinical & Experimental Allergy 06/2014; DOI:10.1111/cea.12359 · 4.32 Impact Factor

Publication Stats

7k Citations
1,197.94 Total Impact Points

Institutions

  • 2000–2015
    • 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
      • • Department of Otorhinolaryngology
      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
  • 2013–2014
    • Università degli Studi di Perugia
      Perugia, Umbria, Italy
  • 2004–2013
    • Karolinska Institutet
      • • Institute of Environmental Medicine - IMM
      • • Department of Physiology and Pharmacology
      Solna, Stockholm, Sweden
  • 2007
    • University of Verona
      Verona, Veneto, Italy
    • CREAL Center for Research in Environmental Epidemiology
      Barcino, Catalonia, Spain
  • 2003–2007
    • Uppsala University
      • Department of Medical Sciences
      Uppsala, Uppsala, Sweden
  • 2000–2007
    • University of California, San Francisco
      • • Division of Occupational and Environmental Medicine
      • • Department of Medicine
      San Francisco, CA, United States
  • 2006
    • Mid Sweden University
      Härnösand, Västernorrland, Sweden
    • University of Oslo
      Kristiania (historical), Oslo, Norway
  • 2005
    • IMIM Hospital del Mar Medical Research Institute
      Barcino, Catalonia, Spain
  • 1999–2004
    • Umeå University
      • Department of Public Health and Clinical Medicine
      Umeå, Västerbotten, Sweden