Øyvind Omland

Aalborg University Hospital, Ålborg, North Denmark, Denmark

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Publications (65)197.16 Total impact

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    ABSTRACT: Abstract The aim was to explore the impact of occupation on chronic obstructive pulmonary disease (COPD) in a cross-sectional population-based study among subjects aged 45 to 84 years. In a stratified sampling 89 general practitioners practices (GPP) in Denmark recruited 3106 males and 1636 females through the Danish Civil Registration System. COPD was defined by spirometry by the 2.5(th)-centile Lower Limit of Normal of FEV1 and FEV1/FVC. Information about smoking, occupational exposure and the respective occupations were obtained from questionnaires. Occupations followed the Danish adaptation of The International Standard Classification of Occupations, revision 1988 (DISCO-88). Exposure to vapour, gas, dust (organic and inorganic), and fume (VGDF) in each occupation (yes/no) was evaluated by two independent specialist in occupational medicine. Exposures were divided in no, low, medium, and high exposure as 0, <5, 5-14, and ≥ 15 years in the job, respectively. Data was analysed by a mixed random effect logistic regression model. The age-standardised COPD study prevalence was 5.0%. Of 372 DISCO-88 codes 72 were identified with relevant exposure to VGDF. 46% of the participants reported at least one occupation with VGDF exposure. Adjusted for smoking, age, sex, and GPP a dose-dependent association of COPD was found among workers in jobs with high organic dust exposure, with OR 1.56 (95% CI 1.09-2.24). Restricted to agriculture the OR was 1.59 (95% CI: 1.08-2.33). No association was observed for workers in jobs with inorganic dust, fume/gas, or vapour exposures. In summary, occupational organic dust exposure was associated to the prevalence of COPD.
    COPD. 11/2014;
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    The European respiratory journal. 09/2014;
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    ABSTRACT: Studies on determinants of dairy farmers' exposure to dust and endotoxin have been sparse and so far none has addressed the combined effect of tasks and farm characteristics. To study whether and how work tasks and specific stable characteristics influence the level of dairy farmers' personal exposure to inhalable dust and endotoxin. We applied an observational design involving full-shift repeated personal measurements of inhalable dust and endotoxin exposure among 77 subjects (owners and farm workers) from 26 dairy farms. Performed tasks were self-registered in activity diaries, and information on stable characteristics was collected through personal interviews and walk-through surveys. Associations between exposure, tasks, and stable characteristics were examined in linear mixed-effect models with individual and farm treated as random effects. Separate as well as combined models for tasks and stable characteristics were elaborated. The 124 personal samples collected had a geometric mean level (geometric standard deviation) of 360 EU m(-3) (3.8) for endotoxin exposure and of 1.0mg m(-3) (2.7) for dust exposure. Identified factors that increased endotoxin exposure included a lower outdoor temperature and use of slope-based or back-flushed slurry systems along with milking, distribution of bedding, and handling of feed and seeds in barns. For dust, exposure was higher when fully automatic (robotic) milking was used and during re-penning of animals, handling of feed and seeds, handling of silos and when distributing bedding. Dust exposure increased also as a result of use of rail feed dispensers in a model without fully automatic milking. The current exposure to dust and in particular endotoxin among Danish dairy farmers demand effective strategies to reduce their exposure. The present findings suggest that future interventions should focus on feeding and manure handling systems. Use of respirators during handling of feed and distribution of bedding should be advised until adequate risk management measures have been established. The expected increased use of fully automatic milking in the future might increase dust exposure of dairy farmers.
    Annals of Occupational Hygiene 04/2014; · 2.16 Impact Factor
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    ABSTRACT: Occupational-attributable chronic obstructive pulmonary disease (COPD) presents a substantial health challenge. Focusing on spirometric criteria for airflow obstruction, this review of occupational COPD includes both population-wide and industry-specific exposures. We used PubMed and Embase to identify relevant original epidemiological peer-reviewed articles, supplemented with citations identified from references in key review articles. This yielded 4528 citations. Articles were excluded for lack of lung function measurement, insufficient occupational exposure classification, lack of either external or internal referents, non-accounting of age or smoking effect, or major analytic inadequacies preventing interpretation of findings. A structured data extraction sheet was used for the remaining 147 articles. Final inclusion was based on a positive qualitative Scottish Intercollegiate Guidelines Network (SIGN) score (≥2+) for study quality, yielding 25 population-wide and 34 industry/occupation-specific studies, 15 on inorganic and 19 on organic dust exposure, respectively. There was a consistent and predominantly significant association between occupational exposures and COPD in 22 of 25 population-based studies, 12 of 15 studies with an inorganic/mineral dust exposure, and 17 of 19 studies on organic exposure, even though the studies varied in design, populations, and the use of measures of exposure and outcome. A nearly uniform pattern of a dose-response relationship between various exposures and COPD was found, adding to the evidence that occupational exposures from vapors, gas, dust, and fumes are risk factors for COPD. There is strong and consistent evidence to support a causal association between multiple categories of occupational exposure and COPD, both within and across industry groups.
    Scandinavian Journal of Work, Environment & Health 11/2013; · 3.10 Impact Factor
  • The Journal of allergy and clinical immunology 08/2013; · 12.05 Impact Factor
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    ABSTRACT: To identify working tasks and stable characteristics that determine intensity and variability of personal exposure to dust and endotoxin among pig farmers. Three hundred fifty-four personal full-shift measurements were performed in 231 farmers employed in 53 Danish pig farms. Filters were gravimetrically analysed for inhalable dust and for endotoxin by the Limulus amebocyte lysate assay. Information on working tasks and stable characteristics were collected using self-reported activity diaries and walk-through surveys performed in conjunction with the measurements. Associations between log-transformed dust and endotoxin exposure and working tasks and stable characteristics were examined using linear mixed-effects analysis. In these models, worker and farm identity were treated as random effects and working tasks and stable characteristics as fixed effects. Both separate and combined models for tasks and stable characteristics were elaborated. Inhalable dust concentrations ranged between 0.1 and 48mg m(-3) and endotoxin concentrations varied between 9.2 and 370 000 EU m(-3). Field work activities played a dominant role on the exposure variability. Indoor working tasks with intense animal activity or handling of feed materials increased exposure concentrations, whereas engagement in field work was associated with lower exposure concentrations. High-pressure water cleaning increased endotoxin exposure but did not affect exposure to inhalable dust. Stable characteristics related to feeding practices and type of ventilation were determinants of exposure to inhalable dust. For endotoxin, the most important determinants were use of dry feed and slatted floor coverage. Feeding practices solely explained all between-farms variability in exposure to inhalable dust and endotoxin. These findings suggest feeding systems, flooring and ventilation to be potential areas where improved methods can reduce exposure to dust and endotoxin among pig farmers. Further, they highlight particular tasks involving feeding and intense animal handling as sources of very high levels of exposure. The pig farming industry is encouraged to focus on exposure reduction. Use of respirators during performance of working tasks where levels of exposure are particularly high ought to be considered until adequate hygienic solutions have been established.
    Annals of Occupational Hygiene 06/2013; · 2.16 Impact Factor
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    ABSTRACT: Some patients with chronic obstructive pulmonary disease (COPD) are never-smokers, which suggests that there must be other important risk factors. This paper describes the evidence for an association between occupational exposure and COPD. In several studies a consistent and predominantly significant association between occupational exposures and COPD is found, even though the studies vary in design, enrolled populations and in measures of exposure and outcome. Strong evidence supports a causal association between multiple categories of occupational exposure and COPD, both within and across industry groups.
    Ugeskrift for laeger 04/2013; 175(18):1253-1256.
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    ABSTRACT: The incidence of malignant mesothelioma (MM) in Denmark has been rising rapidly since the 1950s. The aim of this study was to determine temporal developments of MM incidence and survival in Denmark as a whole and in the individual regions. Data from the Danish Cancer Registry were used. Cases of MM of the pleura, peritoneum and pericardium occurring in the 1943-2009 period were included. National and regional incidence rates were calculated, age-standardised and stratified by various variables. Survival was calculated using Kaplan Meier plot. The total national incidence of MM for men has been rising throughout the period and reached its maximum of 1.76 in 2008-2009. For women, the incidence rate has remained relatively steady, with a maximum of 0.5 in 1973-1977. Since the late 1980s, the Region of Northern Jutland has had the highest male incidence rate. The difference in relative risk for men in the Region of Southern Denmark and the Region of Northern Jutland was 1.53 in 2008-2009, and the relative risk of developing MM in the Region of Northern Jutland for the entire period collectively compared with Denmark as a whole was 1.38. No notable regional difference exists for women. Survival has improved for both men and women, but remains poor with a median survival of 12.5 months for men and 13.3 months for women in 2008-2009. The national MM incidence for men continues to increase, perhaps showing a slight tendency towards deceleration in the most recent decade. A clear long-term effect of the Danish asbestos ban has not yet occurred. not relevant. not relevant.
    Danish Medical Journal 03/2013; 60(3):A4592. · 0.76 Impact Factor
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    ABSTRACT: The present study compared health care-related costs and the use of social benefits and transfer payments in participants with and without chronic obstructive pulmonary disease (COPD), and related the costs to the severity of the COPD. Spirometry data from a cohort study performed in Denmark during 2004-2006 were linked with national register data that identified the costs of social benefits and health-care services. The cohort comprised 546 participants with COPD (forced expiratory volume in the first sec. (FEV1)/forced vital capacity (FVC) ratio < 0.7 following bronchodilator administration) and 3,995 without COPD (in addition, 9,435 invited participants were non-responders and 331 were excluded). The costs were adjusted for gender, age, co-morbidity and educational level. Health care-related costs were 4,779 (2,404-7,154) Danish kroner (DKK) higher for participants with COPD than for those without COPD, and 2,882 (556-5,208) DKK higher than for non-responders. The higher costs were mainly due to the cost of medicines and inpatient care. The health-care costs increased with disease severity Global Initiative for Chronic Obstructive Lung Disease (GOLD grade). In participants < 65 years of age, the annual cost of social benefits and transfer payments was 15,901 (5,966-25,837) DKK higher and the total costs were 20,454 (7,559-33,350) DKK higher in those with COPD than in those without COPD; this was due mostly to the high cost of dis-ability pensions. Health care-related costs and costs for social benefits and transfer payments were higher for participants with COPD than for non-COPD participants and non-responders. This study was supported by The Obel Family Foundation, The Danish Lung Association and The Health Insurance Foundation. not relevant.
    Danish Medical Journal 01/2013; 60(1):A4557. · 0.76 Impact Factor
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    ABSTRACT: Former studies of professional fishing activities have indicated that movements of a ship, in itself, may increase the energy expenditure in addition to the traditional work carried out by fishermen. We have studied the effects of exposure to the ships movement during calm weather by examining the crude relation between the ship movement and the energy expenditure of the fishermen, thus ignoringthe various tasks undertaken on board. We have recruited 4 fishermen on 2 contemporary steel trawlers who participatedduring the whole study period. Each of 4 participants recorded his activities and health conditions oncean hour in a registration scheme for 4 days. Estimations of energy expenditure were done with a bodymonitoring system (SenseWear Pro 3) carried as an armband, placed at the surface on the right upper arm. Measurements of sea movements were obtained by a gyroscope placed in the vessels wheelhouse during fishing expeditions in the North Sea off the coast of Bergen. Data were analysed by linear regression. The exposure monitored in calm weather conditions was small for all measurements of heelingand pitch being less than 10o for both vessels. However, the fishermen's energy expenditure was influenced by these minor sea motions. Trends were seen in the individual graphs with increasing energy expenditureat higher exposures. Our data suggest that even the heel and pitch in calm weather have an impact on the fishermen by increasing their energy consumption, but without any observation of discomfort or negative health outcomes. This study has demonstrated the feasibility of the applied methods, which should be repeated with larger samples and in rough weather.
    International maritime health. 01/2013; 64(3):114-20.
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    ABSTRACT: INTRODUCTION: The quality of life (QOL) in persons with asthma is reduced and different factors such as demography, asthma severity and psychiatric comorbidity play an influential role. However, little is known about the interplay of these factors. OBJECTIVE: To describe QOL in relation to asthma and analyse for the relative impact of asthma severity, psychiatric comorbidity, lifestyle (smoking and obesity) and demographic determinants on QOL in persons with asthma. METHODS: One thousand one hundred sixty-one subjects from an earlier cohort with and without asthma were sent an asthma screening questionnaire and a generic QOL measuring instrument (15D). RESULTS: Seven hundred seventy-eight valid responses (67%). QOL was significantly reduced in persons with asthma compared with controls (P = 0.001), almost on all domains of 15D. In the adjusted regression model, asthma severity, depression, female gender and smoking were associated with reduced QOL, suggesting that these factors play an independent role on lowering QOL. Depression did not inflate the relationship between asthma severity and worse QOL, suggesting that asthma severity plays an independent role on everyday life regardless of psychological state. CONCLUSION: Asthma severity, psychiatric comorbidity, female gender and smoking were identified in this study to be major contributors to decreased QOL in asthmatics. Health professionals should be aware of this complex picture and take these factors into consideration when choosing the proper treatment of asthma patients. Asthma, asthma severity, epidemiology, psychiatric comorbidity, QOL.
    The Clinical Respiratory Journal 09/2012; · 1.66 Impact Factor
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    ABSTRACT: Various social and economic effects are associated with asthma. This quantitative study describes the effects of current asthma on work life evaluated from the number of weeks receiving transfer incomes. The study population comprised 7,241 persons answering the ECRHS II screening questionnaire, which was sent to a random age and gender stratified sample of 10,000 persons aged 20 to 44 years. Participants with current asthma were identified by positive answers to a set of validated questions. Transfer incomes for a five-year period were registered from a study-independent national database, which collects all public administered transfer incomes in Denmark. The numbers of weeks receiving unemployment, welfare, sick-leave and disability benefits were identified for each participant and differences between asthmatics and non-asthmatics were analyzed. Asthmatics had significantly more annual weeks receiving welfare (36.6 vs. 20.7, p=0.00), sick leave (9.2 vs. 6.6, p=0.00) and disability (19.3 vs. 11.4, p=0.00) benefits than non-asthmatics. Adult-onset asthmatics had increased prevalence rate ratios for disability of 2.40 (95% confidence interval 1.70-3.40). Blue collar work significantly increased the probability of all public transfer incomes. Current asthma makes it harder to keep a job. Adult-onset asthmatics and blue collar workers are particularly affected.
    Scandinavian Journal of Public Health 06/2012; 40(4):377-84. · 1.97 Impact Factor
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    ABSTRACT: Although limited evidence is available, organisational change is often cited as the cause of mental health problems. This paper provides an overview of the current literature regarding the impact of organisational change on mental health. A systematic search in PUBMED, PsychInfo and Web of Knowledge combining MeSH search terms for exposure and outcome. The criterion for inclusion was original data on exposure to organisational change with mental health problems as outcome. Both cross-sectional and longitudinal studies were included. We found in 11 out of 17 studies, an association between organisational change and elevated risk of mental health problems was observed, with a less provident association in the longitudinal studies. Based on the current research, this review cannot provide sufficient evidence of an association between organisational change and elevated risk of mental health problems. More studies of long-term effects are required including relevant analyses of confounders.
    Occupational and environmental medicine 04/2012; 69(8):592-8. · 3.64 Impact Factor
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    ABSTRACT: To test the hypotheses that current endotoxin exposure is inversely associated with allergic sensitisation and positively associated with non-allergic respiratory diseases in four occupationally exposed populations using a standardised analytical approach. Data were pooled from four epidemiological studies including 3883 Dutch and Danish employees in veterinary medicine, agriculture and power plants using biofuel. Endotoxin exposure was estimated by quantitative job-exposure matrices specific for the study populations. Dose-response relationships between exposure, IgE-mediated sensitisation to common allergens and self-reported health symptoms were assessed using logistic regression and generalised additive modelling. Adjustments were made for study, age, sex, atopic predisposition, smoking habit and farm childhood. Heterogeneity was assessed by analysis stratified by study. Current endotoxin exposure was dose-dependently associated with a reduced prevalence of allergic sensitisation (ORs of 0.92, 0.81 and 0.66 for low mediate, high mediate and high exposure) and hay fever (ORs of 1.16, 0.81 and 0.58). Endotoxin exposure was a risk factor for organic dust toxic syndrome, and levels above 100 EU/m(3) significantly increased the risk of chronic bronchitis (p<0.0001). Stratification by farm childhood showed no effect modification except for allergic sensitisation. Only among workers without a farm childhood, endotoxin exposure was inversely associated with allergic sensitisation. Heterogeneity was primarily present for biofuel workers. Occupational endotoxin exposure has a protective effect on allergic sensitisation and hay fever but increases the risk for organic dust toxic syndrome and chronic bronchitis. Endotoxin's protective effects are most clearly observed among agricultural workers.
    Occupational and environmental medicine 02/2012; 69(2):99-106. · 3.64 Impact Factor
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    ABSTRACT: Studies on personal dust and endotoxin concentrations among animal farmers have been either small or limited to a few sectors in their investigations. The present study aimed to provide comparable information on the levels and variability of exposure to personal dust and endotoxin in different types of animal farmers. 507 personal inhalable dust samples were collected from 327 farmers employed in 54 pig, 26 dairy, 3 poultry, and 3 mink farms in Denmark. Measurements in pig and dairy farmers were full-shift and performed during summer and winter, while poultry and mink farmers were monitored during 4 well-defined production stages. The collected samples were measured for dust gravimetrically and analyzed for endotoxin by the Limulus amebocyte lysate assay. Simple statistics and random-effect analysis were used to describe the levels and the variability in measured dust and endotoxin exposure concentrations. Measured inhalable dust levels had an overall geometric mean of 2.5 mg m(-3) (range <LOD to 47.8) and endotoxin of 988 EU m(-3) (range <LOD to 374,000). The highest dust and endotoxin concentrations were measured among pig and poultry farmers, and were the lowest among dairy and mink farmers, respectively. Exposure among pig and cattle farmers was characterised by a substantial day-to-day variability that increased from the indoor to outdoor working environment. Only mink farmers complied with the Danish occupational exposure limit for total dust (3 mg m(-3)). More than 93% of our measurements exceeded the recently proposed Dutch exposure-limit for endotoxin (90 EU m(-3)). These findings suggest animal farmers to be exposed to high levels of dust and endotoxin consistent with an increased risk of developing respiratory symptoms and diseases. The development of preventive strategies to reduce exposure will require in-depth identification of factors that affect day-to-day variability in exposure.
    Journal of Environmental Monitoring 12/2011; 14(2):604-14. · 2.09 Impact Factor
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    ABSTRACT: The natural history and etiology of malignant mesothelioma (MM) is already thoroughly described in the literature, but there is still debate on prognostic factors, and details of asbestos exposure and possible context with clinical and demographic data, have not been investigated comprehensively. Description of patients with MM, focusing on exposure, occupation, survival and prognostic factors. Review of medical records of patients with MM from 1984 to 2010 from a Danish Occupational clinic. Survival was estimated using Kaplan-Meier survival analysis and prognostic factors were identified by Cox regression analysis. 110 (90.2%) patients were male, and 12 (9.8%) were female. The median (interquartile rang [IQR]) age was 65 (13) years. Pleural MM was seen in 101 (82.8%) patients, and peritoneal in 11 (9.0%); two (1.6%) had MM to tunica vaginalis testis, and eight (6.6%) to multiple serosal surfaces. We found 68 (55.7%) epithelial tumors, 26 (21.3%) biphasic, and 6 (4.9%) sarcomatoid. 12 (9.8%) patients received tri-modal therapy, 66 (54.1%) received one-/two-modality treatment, and 36 (29.5%) received palliative care. Asbestos exposure was confirmed in 107 (91.0%) patients, probable in four (3.3%), and unidentifiable in 11 (9.0%). The median (IQR) latency was 42 (12.5) years. Exposure predominantly occurred in shipyards. The median overall survival was 1.05 (95% CI: 0.96-1.39) years; 5-year survival was 5.0% (95% CI: 2.0%-13.0%). Female sex, good WHO performance status (PS), epithelial histology and tri-modal treatment were associated with a favorable prognosis. MM continuously presents a difficult task diagnostically and therapeutically, and challenges occupational physicians with regard to identification and characterization of asbestos exposure.
    The international journal of occupational and environmental medicine. 10/2011; 2(4):224-36.
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    ABSTRACT: Many factors, including environmental exposures, have been related to the increase in the prevalence of asthma, but only few have been tested for in longitudinal studies. We studied farming students to determine whether their environment during childhood and as adults was a factor determining subsequent onset of asthma. From 1994 to 1998, new cases of asthma were identified by means of an annual posted questionnaire followed by a telephone interview in a prospective cohort consisting of 1964 farming-school students and 407 nonfarming subjects aged 16 to 26 years. For each case, we selected a control subject from the cohort with no asthma in a case-based design, and all underwent an interview and a clinical examination. We found 122 new cases of asthma. In a multiple regression model the odds ratio for new asthma was 3.3 (95% CI, 1.7-6.3) for smoking; 3.4 (95% CI, 1.6-7.0), 2.5 (95% CI, 1.1-5.3), and 7.0 (95% CI, 1.2-41.6) for exposure to swine, dairy production, and welding, respectively; and 11.7 (95% CI, 2.4-56.4) for bronchial hyperresponsiveness at baseline. Being born and raised on a farm significantly reduced the risk odds ratio (0.5 [95% CI, 0.3-0.98]), whereas atopy had no influence. Exposure to swine and dairy confinements, welding, smoking, and bronchial hyperresponsiveness are risk factors for nonallergic asthma, and being born and raised on a farm reduces the subsequent risk. These findings support the theory that immune and inflammatory responses can be influenced by environmental exposure to early childhood, reducing the risk of asthma later in life.
    The Journal of allergy and clinical immunology 07/2011; 128(4):761-5. · 12.05 Impact Factor
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    ABSTRACT: In this study, we hypothesised that the genotypes coding for low antioxidative enzyme activity are associated with asthma and reduced lung function. Using the European Community Respiratory Health Survey protocol, we enlisted 1091 Danish subjects in this cross-sectional study. Asthma phenotypes were defined as asthma symptoms in combination with steroid usage, bronchial hyperresponsiveness and atopy. These phenotypes and lung function were analysed with respect to glutathione peroxidase, GPX1 (Pro198Leu, rs1050450), manganese superoxide dismutase, SOD2 (Ala16Val, rs4880) and three glutathione S-transferases; GSTP1 (Ile105Val, rs1695), GSTT1 (gene copy number) and GSTM1 (gene copy number). We found no associations between these genotypes and the asthma phenotypes. For the 201 subjects identified as current smokers and recruited via random sampling, an association was seen between increasing number of genotypes coding for high antioxidative enzyme activity (GPX1 Pro/Pro, SOD2 Val/Val, GSTP1 Ile/Ile, GSTT1 two copies, GSTM1 two copies) and forced expiratory volume in 1 s (FEV1%) predicted. The increase in FEV1% predicted was 2.0% (95% confidence interval 0.3-3.8) per genotype. There was no identified significance for the inverse association between FEV1% predicted and number of genotypes coding for low antioxidative enzyme activity. The present study does not support the hypothesis that asthma is associated with genotypes of these major antioxidative enzymes. However, we speculate that since we see an impact of these genotypes on lung function in young adult smokers, polymorphisms in antioxidative enzymes may contribute to the range of susceptibility of smokers have to Chronic obstructive lung disease.
    The Clinical Respiratory Journal 05/2011; 6(1):46-55. · 1.66 Impact Factor
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    ABSTRACT: Although many studies on asthma have been conducted in farming populations, no longitudinal studies have been published so far. Smoking, work in pig barns, and crop farming together with exposure to endotoxin and quaternary ammonium have been described as environmental risk factors for self-reported asthma and/or wheeze in cross-sectional studies. The prevalence of selfreported asthma has been found to range from 0.7% in female greenhouse workers to 21% in Danish smoking female farming students. Exposure in farming is diverse, but dominated by organic dust containing high amounts of compounds known to trigger the innate immune system. This is confirmed by a wide range of human experimentation where naïve persons have been introduced to swine confinements. Cross-sectional data suggest a protective effect of farming on allergy. However, differences in the diagnostic procedure and the predominantly wheezy asthma type in farming concomitant with a lower rate of allergic asthma makes the comparison difficult. Furthermore, healthy worker selection, misclassification, age differences, difference in time of study and small study populations, resulting in low statistical power, might be factors explaining the findings. Welldesigned longitudinal studies of the incidence of carefully defined phenotypes of asthma and risk factors are needed to clarify the risk of asthma, or wheezy phenotypes related to farming.
    02/2011: pages 163-183;

Publication Stats

629 Citations
197.16 Total Impact Points


  • 1998–2014
    • Aalborg University Hospital
      • Department of Occupational Medicine
      Ålborg, North Denmark, Denmark
  • 2013
    • Copenhagen University Hospital Hvidovre
      • Department of Pulmonary Medicine
      Hvidovre, Capital Region, Denmark
  • 1996–2011
    • Aarhus University
      • Department of Environmental and Occupational Medicine
      Aars, Region North Jutland, Denmark
  • 1985–2011
    • Aarhus University Hospital
      • • Department of Occupational Medicine
      • • Department of Pulmonary Medicine
      Aarhus, Central Jutland, Denmark
  • 2009
    • Glostrup Hospital
      Glostrup, Capital Region, Denmark
  • 1994
    • National Institute of Public Health, Denmark
      København, Capital Region, Denmark
    • Herning Hospital
      Herning, Central Jutland, Denmark