Kjell Torén

University of Gothenburg, Goeteborg, Västra Götaland, Sweden

Are you Kjell Torén?

Claim your profile

Publications (227)1078.29 Total impact

  • [Show abstract] [Hide abstract]
    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. · 2.76 Impact Factor
  • [Show abstract] [Hide abstract]
    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; · 6.00 Impact Factor
  • [Show abstract] [Hide abstract]
    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; · 3.23 Impact Factor
  • [Show abstract] [Hide abstract]
    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; · 1.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    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; · 2.04 Impact Factor
  • [Show abstract] [Hide abstract]
    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; · 2.92 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: 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.
    BMJ Open 08/2014; 4(8):e005593. · 2.06 Impact Factor
  • M. Holm, K. Torén, E. Andersson
    [Show abstract] [Hide abstract]
    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). · 2.76 Impact Factor
  • [Show abstract] [Hide abstract]
    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. · 2.32 Impact Factor
    This article is viewable in ResearchGate's enriched format
  • Source
    [Show abstract] [Hide abstract]
    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). · 5.15 Impact Factor
  • [Show abstract] [Hide abstract]
    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; · 4.32 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Trends in prevalence of asthma and allergic diseases are still controversial, and rarely studied among adolescents at midpoint of puberty. Methods In 2000, a questionnaire was mailed to adolescents (n=18,158) attending 9th grade at school and living in Västra Götaland County, Sweden. Eight years later, the same questionnaire was mailed to adolescents (n=21,651), using identical inclusion criteria as previously. Altogether, 10,837 adolescents completed the questionnaire in 2000 and 11,754 in 2008. Differences in prevalence of physician diagnosed asthma, asthma symptoms, rhinitis, and eczema between the periods were analyzed by Chi-square test. Multiple logistic regression models were performed to test for trends in prevalence of these diseases, adjusting for potential confounders. Results Physician diagnosed asthma and lifetime and current rhinitis were increased in 2008, while wheeze decreased (p<0.05). Taking sex, foreign descent, body mass index, and parents’ education into account, the prevalence of physician diagnosed asthma (OR 1.3 [95% CI 1.2–1.4]) and lifetime (1.7 [1.6–1.8]) and current rhinitis (1.5 [1.4–1.6]) had increased. Eczema had decreased (0.9 [0.8–0.98]). These trends were consistent in boys and girls, but more prominent in those with obesity. In physician diagnosed asthmatics, there was no change in wheeze, asthma symptoms, or asthma medication. Conclusions The prevalence of physician diagnosed asthma has increased over the last decade, maybe due to combinations of changes in diagnostics and increased general awareness, rather than a real increase. Results showed an increase in rhinitis and a decrease in eczema. Obesity seems to have a modifying effect, which calls for further investigation.
    Respiratory medicine 05/2014; · 2.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: RationaleThere is conflicting evidence on whether patients with asthma experience an accelerated decline in lung function with age. We examined the association between post-bronchodilator lung function, asthma, chronic rhinosinusitis (CRS), and atopy with age using a large European cohortMethods In 17 centres in 11 European countries, case-control studies were nested within representative cross-sectional surveys of adults aged under 75 years. Representative samples of participants with asthma, CRS or both and controls were assessed for post-bronchodilator ventilatory function, smoking history, atopy and treatment. Multiple regression was used to assess the interactive effects of age and diagnostic group on decline in post-bronchodilator ventilatory function.ResultsA total of 3,337 participants provided adequate data (778 with asthma, 399 with CRS, 244 with both asthma and CRS and 1916 controls who had neither asthma nor CRS). Participants with asthma had lower FEV1/FVC (-4.09% (95% CI: -5.02, -3.15, p <0.001) and a steeper slope of FEV1/FVC against age (-0.14%/annum (95%CI: -0.19, -0.08)) equivalent to smoking 1-2 packs of cigarettes/day. Those with atopy had a slope equivalent to controls.Conclusions People with asthma have a steeper decline in post-bronchodilator lung function with age, but neither CRS nor atopy alone were associated with such decline.This article is protected by copyright. All rights reserved.
    Allergy 05/2014; · 6.00 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Asthma medication was increasingly used during the second part of the past century. There are few detailed data from population studies on use of asthma medication. The current study aimed to determine the use and determinants of asthma medication in West Sweden and to assess changes during the last two decades. From a random population sample participating in a survey on respiratory symptoms, 2000 individuals were randomly selected for clinical examinations and structured interviews, 1172 participated. All subjects reporting asthma (n=1524) were also invited, and 834 participated. In total, 964 subjects with asthma participated. Asthma medication use was assessed in the general population and among two severity categories of asthma: multi-symptom asthma (MSA) and "other" asthma (having fewer symptoms). Current data, from 2010, was compared with data from 1992. Asthma medication was used by 11% of the population, 4.4% used ICS with concurrent use of LABA, 3.3% used ICS without LABA, while 3.2% only used SABA. Compared with 1992, the prevalence of asthma medication use had increased with 54%, and use of ICS had increased from 1.5% to 7.7%. Subjects with MSA reported using asthma medication more frequently and at higher doses, and a higher proportion used ICS. A shift in asthma medication use has occurred since 1992, with increased use of ICS and decreased use of SABA only, implying better asthma control on a population level. Multi-symptom asthma should alert the treating physician to consider under-medication and/or poor treatment adherence.
    Respiratory medicine 05/2014; · 2.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Selection bias is a systematic error in epidemiologic studies that may seriously distort true measures of associations between exposure and disease. Observational studies are highly susceptible to selection bias, and researchers should therefore always examine to what extent selection bias may be present in their material and what characterizes the bias in their material. In the present study we examined long-term participation and consequences of loss to follow-up in the studies Respiratory Health in Northern Europe (RHINE), Italian centers of European Community Respiratory Health Survey (I-ECRHS), and the Italian Study on Asthma in Young Adults (ISAYA). Logistic regression identified predictors for follow-up participation. Baseline prevalence of 9 respiratory symptoms (asthma attack, asthma medication, combined variable with asthma attack and/or asthma medication, wheeze, rhinitis, wheeze with dyspnea, wheeze without cold, waking with chest tightness, waking with dyspnea) and 9 exposure-outcome associations (predictors sex, age and smoking; outcomes wheeze, asthma and rhinitis) were compared between all baseline participants and long-term participants. Bias was measured as ratios of relative frequencies and ratios of odds ratios (ROR). Follow-up response rates after 10 years were 75% in RHINE, 64% in I-ECRHS and 53% in ISAYA. After 20 years of follow-up, response was 53% in RHINE and 49% in I-ECRHS. Female sex predicted long-term participation (in RHINE OR (95%CI) 1.30(1.22, 1.38); in I-ECRHS 1.29 (1.11, 1.50); and in ISAYA 1.42 (1.25, 1.61)), as did increasing age. Baseline prevalence of respiratory symptoms were lower among long-term participants (relative deviations compared to total baseline population 0-15% (RHINE), 0-48% (I-ECRHS), 3-20% (ISAYA)), except rhinitis which had a slightly higher prevalence. Most exposure-outcome associations did not differ between long-term participants and all baseline participants, except lower OR for rhinitis among ISAYA long-term participating smokers (relative deviation 17% (smokers) and 44% (10-20 pack years)). We found comparable patterns of long-term participation and loss to follow-up in RHINE, I-ECRHS and ISAYA. Baseline prevalence estimates for long-term participants were slightly lower than for the total baseline population, while exposure-outcome associations were mainly unchanged by loss to follow-up.
    BMC Pulmonary Medicine 04/2014; 14(1):63. · 2.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Conclusion: This study shows that gastroesophageal reflux and tobacco smoke are associated with adult-onset non-infectious rhinitis (NIR). The results support an association between gastroesophageal reflux and upper airway inflammation. Objectives: To examine the incidence of adult-onset NIR in relation to several risk factors. Methods: This is a follow-up study of 3307 randomly selected men and women aged 25-75 years from a general population-based sample. At baseline, the subjects were investigated with questionnaires, a pulmonary function test, blood samples, and FENO. At follow-up 4 years later, all the subjects were mailed a respiratory questionnaire. The incidence of NIR and associated risk factors, such as smoking, atopy, asthma, cough, obesity, and gastroesophageal reflux, was assessed. Results: The response rate at follow-up was 92%. The incidence of new-onset NIR was 14.9/1000 person-years (n = 247). In a regression model including age, gender, obesity, asthma, cough, and atopy, both current smoking (OR 1.7, 95% CI 1.2-2.5, p = 0.002) and gastroesophageal reflux (OR 2.5, 95% CI 1.4-3.1, p < 0.001) were significantly associated with adult-onset NIR.
    Acta oto-laryngologica 03/2014; · 0.98 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The diagnosis of chronic obstructive pulmonary disease (COPD) is based on airflow obstruction. In epidemiological studies, spirometric data have often been lacking and researchers have had to rely almost solely on questionnaire answers. The aim of this study is to assess the diagnostic accuracy of questionnaire answers to detect COPD. A sample of the Swedish general population without physician-diagnosed asthma was randomly selected and interviewed using a respiratory questionnaire. All eligible subjects aged 25-75 years (n = 3892) performed spirometry for detection of airflow obstruction using Global Initiative for Chronic Obstructive Lung Disease (GOLD) or American Thoracic Society (ATS)/European Respiratory Society (ERS) criteria. Sensitivity, specificity, positive likelihood ratio (LR+), positive predictive values (PPVs), and negative predictive values (NPVs) were calculated to define diagnostic accuracy of questionnaire answers. The sensitivity of the question "Have you been diagnosed by a physician as having COPD or emphysema?" in detecting airflow obstruction was 5.7% using GOLD, and 9.8% using ATS/ERS, criteria; specificity was 99.7% for GOLD and 99.5% for ATS/ERS. Sensitivity, specificity, and PPV were higher for the question compared to self-reported symptoms of chronic bronchitis in identifying subjects with airflow obstruction. The high specificity and good PPV suggest that the question "Have you been diagnosed by a physician as having COPD or emphysema?" is more likely to identify those who do not have airflow obstruction, whereas the low sensitivity of this question could underestimate the real burden of COPD in the general population.
    BMC Pulmonary Medicine 03/2014; 14(1):49. · 2.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with early-onset dementia are a significantly under-recognized subgroup of patients with an increasing prevalence. Epidemiological studies are limited and studies of modifiable risk factors, such as physical fitness, are lacking. We aimed to investigate the associations between cardiovascular fitness individually and in combination with cognitive performance at age 18 and risk of early-onset dementia and mild cognitive impairment later in life. We performed a population-based cohort study of over 1.1 million Swedish, 18-year-old, male conscripts, who underwent conscription exams between 1968 and 2005. These males were then followed for up to 42 years. Objective data on cardiovascular fitness and cognitive performance were collected during conscription exams and were subsequently linked with hospital registries to calculate later risk of early-onset dementia and mild cognitive impairment using Cox proportional hazards models controlling for several confounders. The scores from the exams were divided into tertiles (low, medium, high) for the analyses. The mean follow-up time for the analyses was 25.7 years (standard deviation: 9.3) and the median was 27 years. In total, 30 195 315 person-years of follow-up were included in the study. In fully adjusted models, both low cardiovascular fitness and cognitive performance (compared to high) at age 18 were associated with increased risk for future early-onset dementia (cardiovascular fitness, n = 662 events: hazard ratio 2.49, 95%, confidence interval 1.87-3.32; cognitive performance, n = 657 events: hazard ratio 4.11, 95%, confidence interval 3.19-5.29) and mild cognitive impairment (cardiovascular fitness, n = 213 events: hazard ratio 3.57, 95%, confidence interval 2.23-5.74; cognitive performance, n = 212 events: hazard ratio 3.23, 95%, confidence interval 2.12-4.95). Poor performance on both cardiovascular fitness and cognitive tests was associated with a >7-fold (hazard ratio 7.34, 95%, confidence interval 5.08-10.58) and a >8-fold (hazard ratio 8.44, 95%, confidence interval 4.64-15.37) increased risk of early-onset dementia and early-onset mild cognitive impairment, respectively. In conclusion, lower cardiovascular fitness and cognitive performance in early adulthood were associated with an increased risk of early-onset dementia and mild cognitive impairment later in life, and the greatest risks were observed for individuals with a combination of low cardiovascular fitness and low cognitive performance.
    Brain 03/2014; · 10.23 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim was to investigate whether psychosocial stress based on the job-demand-control (JDC) model increased the risk for coronary heart disease (CHD) and stroke. Swedish men. The Primary Prevention Study (PPS) comprises 6070 men born between 1915 and 1925 free from previous history of CHD and stroke at baseline (1974-1977). Psychosocial workplace exposure was assessed using a job-exposure matrix (JEM) for the JDC model based on occupation at baseline. The participants were followed from baseline examination, until death, until hospital discharge or until 75 years of age, whichever occurred first, using the Swedish national register on cause of death and the Swedish hospital discharge register for non-fatal and fatal stroke and CHD events. Cox regression models were used with stroke or CHD as the outcome, using JDC model and age as explanatory variables, as well as stratified models with regard to smoking, self-reported stress, socioeconomic status, obesity, hypertension and diabetes. Risk for stroke and CHD. There was an increased risk (HR) for CHD in relation to high strain (HR 1.31, 95% CI 1.01 to 1.70). The risk was further increased among ever-smokers and among blue-collar workers. There was a relation between low control and increased risk for CHD (HR 1.19, 95% CI 1.06 to 1.35). There was no increased risk for stroke in any of the JDC categories. Exposure to occupational psychosocial stress defined as job strain or low control increased the risk for CHD, especially among smokers and blue-collar workers. There was no increased risk for stroke in any of the JDC categories.
    BMJ Open 03/2014; 4(3):e004355. · 2.06 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We have recently published a study on new-onset asthma in a large population in northern Europe using a modified job exposure matrix (N-JEM) to better reflect exposure assignment in these countries. The aim of this paper was to investigate how the N-JEM differs in exposure assignment and asthma risks from an already established JEM.Method:The study comprised 6253 men and 7031 women from northern Europe, born 1945-1973, who had answered both a screening (1989-1992) and a follow-up questionnaire (1999-2001). During the study period (1980-2000), there were 136 men and 293 women with new-onset asthma. Hazard ratios of new-onset asthma were calculated for both JEMs using Cox regression models. The analyses were made separately for men and women and were also stratified for atopy. Cohen's kappa (κ) was used to show agreements in exposure assignment (yes/no) between the JEMs. Population attributable risks (PARs) were calculated as well. The agreement in exposure assignment between the JEMs was substantial for the group 'any exposure' to asthma agents (κ = 0.78). The agreement between comparable exposure groups in the JEMs varied from κ = 1.00 (pharmaceutical product antigens, textile dust, cleaning agents) to κ = 0.27 (low molecular weight agents). Significant increased asthma risks were seen for men exposed to isocyanates and accidental peak exposure with both JEMs. With the N-JEM, increased asthma risks were seen for men exposed to plant-associated antigens (all and non-atopic), epoxy compounds (all and non-atopic), and acrylates (non-atopic). With the other JEM, increased asthma risks were seen in men and women exposed to 'possible exposure to irritant gases or fumes' (all and non-atopic), a group classified as having low asthma risk. Men and women exposed to cleaning agents also showed significant asthma risks with both JEMs. PAR with the N-JEM was 14.3% for men and 6.6% for women, compared with 12.9% and 8.3% with the other JEM. Acrylates, epoxy compounds, and isocyanates are three exposure groups in the modified asthma JEM that might better reflect exposure situations in northern Europe than the already established JEM. Exposure to 'possible exposure to irritant gases or fumes', a low asthma risk group in the established JEM, seems to be a group with high asthma risk in northern Europe. It is important to continuously update JEMs, which are based only on occupational titles, in order to find new risk groups and to better reflect changes in work exposures when old risks disappear and new emerge.
    Annals of Occupational Hygiene 02/2014; · 2.07 Impact Factor

Publication Stats

6k Citations
1,078.29 Total Impact Points


  • 2002–2014
    • University of Gothenburg
      • • Unit of Occupational and Environmental Medicine
      • • Institute of Medicine
      • • Department of Public Health and Community Medicine
      • • Department of Environment and Health
      Goeteborg, Västra Götaland, Sweden
    • Linköping University
      Linköping, Östergötland, Sweden
  • 1991–2014
    • Sahlgrenska University Hospital
      • Department of Cardiology
      Goeteborg, Västra Götaland, Sweden
  • 2013
    • 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
  • 2012
    • Uppsala University
      • Department of Medical Sciences
      Uppsala, Uppsala, Sweden
    • University of Iceland
      • Faculty of Medicine
      Reikiavik, Capital Region, Iceland
  • 1999–2011
    • Umeå University
      • Department of Public Health and Clinical Medicine
      Umeå, Vaesterbotten, Sweden
  • 2010
    • University of Verona
      • Department of Public Health and Community Medicine
      Verona, Veneto, Italy
  • 2009
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2008
    • Ludwig-Maximilian-University of Munich
      • Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine
      München, Bavaria, Germany
  • 2007
    • Norrlands universitetssjukhus
      Umeå, Västerbotten, Sweden
    • CREAL Center for Research in Environmental Epidemiology
      Barcino, Catalonia, Spain
  • 2005–2007
    • IMIM Hospital del Mar Medical Research Institute
      Barcino, Catalonia, Spain
    • Centers for Disease Control and Prevention
      • Division of Respiratory Disease Studies
      Атланта, Michigan, United States
  • 2000–2007
    • University of California, San Francisco
      • • Division of Occupational and Environmental Medicine
      • • Division of Hospital Medicine
      • • Cardiovascular Research Institute
      San Francisco, CA, United States