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  • 1.
    Antoniewicz, Lukasz
    et al.
    Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
    Brynedal, Amelie
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lundbäck, Magnus
    Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
    Bosson, Jenny A
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Acute Effects of Electronic Cigarette Inhalation on the Vasculature and the Conducting Airways2019In: Cardiovascular Toxicology, ISSN 1530-7905, E-ISSN 1559-0259Article in journal (Refereed)
    Abstract [en]

    The use of electronic cigarettes has increased exponentially since its introduction onto the global market in 2006. However, short- and long-term health effects remain largely unknown due to the novelty of this product. The present study examines the acute effects of e-cigarette aerosol inhalation, with and without nicotine, on vascular and pulmonary function in healthy volunteers. Seventeen healthy subjects inhaled electronic cigarette aerosol with and without nicotine on two separate occasions in a double-blinded crossover fashion. Blood pressure, heart rate, and arterial stiffness measured by pulse wave velocity and pulse wave analysis were assessed at baseline, and then at 0 h, 2 h, and 4 h following exposure. Dynamic spirometry and impulse oscillometry were measured following vascular assessments at these time points, as well as at 6 h following exposure. e-Cigarette aerosol with nicotine caused a significant increase in heart rate and arterial stiffness. Furthermore, e-cigarette aerosol-containing nicotine caused a sudden increase in flow resistance as measured by impulse oscillometry, indicating obstruction of the conducting airways. Both aerosols caused an increase in blood pressure. The present study indicates that inhaled e-cigarette aerosol with nicotine has an acute impact on vascular and pulmonary function. Thus, chronic usage may lead to long-term adverse health effects. Further investigation is warranted.

  • 2.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Eriksson, Berne
    Department of Internal Medicine, Central County Hospital of Halmstad, Halmstad.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Sovijärvi, Anssi
    Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Centre, Helsinki University Central Hospital.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Lundbäck, Bo
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Restrictive spirometric pattern in the general adult population: Methods of defining the condition and consequences on prevalence2016In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 120, p. 116-123Article in journal (Refereed)
    Abstract [en]

    Background

    Attempts have been made to use dynamic spirometry to define restrictive lung function, but the definition of a restrictive spirometric pattern (RSP) varies between studies such as BOLD and NHANES. The aim of this study was to estimate the prevalence and risk factors of RSP among adults in northern Sweden based on different definitions.

    Methods

    In 2008–2009 a general population sample aged 21–86y within the obstructive lung disease in northern Sweden (OLIN) studies was examined by structured interview and spirometry, and 726 subjects participated (71% of invited). The prevalence of RSP was calculated according to three different definitions based on pre-as well as post-bronchodilator spirometry:

    1) FVC < 80% & FEV1/FVC > 0.7

    2) FVC < 80% & FEV1/FVC > LLN

    3) FVC < LLN & FEV1/FVC > LLN

    Results

    The three definitions yielded RSP prevalence estimates of 10.5%, 11.2% and 9.4% respectively, when based on pre-bronchodilator values. The prevalence was lower when based on post-bronchodilator values, i.e. 7.3%, 7.9% and 6.6%. According to definition 1 and 2, the RSP prevalence increased by age, but not according to definition 3. The overlap between the definitions was substantial. When corrected for confounding factors, manual work in industry and diabetes with obesity were independently associated with an increased risk for RSP regardless of definition.

    Conclusions

    The prevalence of RSP was 7–11%. The prevalence estimates differed more depending on the choice of pre- compared to post-bronchodilator values than on the choice of RSP definition. RSP was, regardless of definition, independently associated with manual work in industry and diabetes with obesity.

  • 3.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    A population-based cohort of adults with asthma: mortality and participation in a long-term follow-up2017In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 4, no 1, article id 1334508Article in journal (Refereed)
    Abstract [en]

    Background and objective: Asthma is a major public health concern. The aim of this study was to characterize a large population-based cohort of adults with asthma, and to study factors associated with all-cause mortality and non-participation in a long-term follow-up. Design: Random and stratified samples from five population-based cohorts were clinically examined during 1986-2001, and all subjects with asthma were included in the study (n = 2055, age 19-72 years, 55% women). Independent associations between different risk factors and (i) mortality and (ii) non-participation in a clinical follow-up in 2012-2014 were estimated. Results: In 1986-2001, 95% reported any wheeze and/or attacks of shortness of breath in the past 12 months, and/or asthma medication use. Over the up to 28 years of follow-up time, the cumulative mortality was 22.7%. Male gender, current smoking, and lower forced expiratory volume in 1 sec of predicted (FEV1% of predicted) were independent risk factors for mortality, while obesity was associated with non-participation in the follow-up. Older ages, ischemic heart disease, and low socioeconomic status were associated with both mortality and non-participation. Conclusions: The risk factors associated with mortality in this adult population-based asthma cohort were similar to those commonly identified in general population samples, i.e. male gender, current smoking, and lower FEV1% of predicted, while obesity was associated with non-participation in a long-term follow-up. Ischemic heart disease, low socioeconomic status, and older ages were associated with both mortality and non-participation.

  • 4.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Muellerova, Hana
    Real-World Evidence&Epidemiology, GSK R&D.
    Wurst, Keele
    Real-World Evidence&Epidemiology, GSK R&D.
    Hedman, Linnea
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN Unit, Umeå University.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University.
    Chronic airway obstruction in a population-based adult asthma cohort: Prevalence, incidence and prognostic factors2018In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 138, p. 115-122Article in journal (Refereed)
    Abstract [en]

    Background

    Asthma and COPD may overlap (ACO) but information about incidence and risk factors are lacking. This study aimed to estimate prevalence, incidence and risk factors of chronic airway obstruction (CAO) in a population-based adult asthma cohort.

    Methods

    During 1986–2001 a large population-based asthma cohort was identified (n = 2055, 19-72y). Subsamples have participated in clinical follow-ups during the subsequent years. The entire cohort was invited to a clinical follow-up including interview, spirometry, and blood sampling in 2012–2014 when n = 983 subjects performed adequate spirometry. CAO was defined as post-bronchodilator FEV1/FVC<0.7.

    Results

    At study entry, asthmatics with prevalent CAO (11.4%) reported more respiratory symptoms, asthma medication use, and ischemic heart disease than asthmatics without CAO (asthma only). Subjects who developed CAO during follow-up (17.6%; incidence rate of 16/1000/year) had a more rapid FEV1 decline and higher levels of neutrophils than asthma only. Smoking, older age and male sex were independently associated with increased risk for both prevalent and incident CAO, while obesity had a protective effect.

    Conclusions

    In this prospective adult asthma cohort, the majority did not develop CAO. Smoking, older age and male sex were risk factors for prevalent and incident CAO, similar to risk factors described for COPD in the general population.

  • 5.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Räisänen, Petri
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Hedman, Linnea
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Increased prevalence of allergic asthma from 1996 to 2006 and further to 2016: results from three population surveys2017In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 47, no 11, p. 1426-1435Article in journal (Refereed)
    Abstract [en]

    Background

    During the latter half of the 20th century, the prevalence of asthma and many other allergic diseases has increased. Information on asthma prevalence trends among adults after 2010, especially regarding studies separating allergic asthma from non-allergic asthma, is lacking.

    Objective

    The aim was to estimate prevalence trends of current asthma among adults, both allergic and non-allergic, from 1996 to 2016.

    Methods

    Three cross-sectional samples from the same area of Sweden, 20-69 years, participated in surveys with the same questionnaire in 1996 (n=7104 participants, 85% response rate), 2006 (n=6165, 77%) and 2016 (n=5466, 53%), respectively. Allergic rhino-conjunctivitis (ARC) was used as a marker for allergic sensitization to define allergic asthma.

    Results

    The prevalence of current asthma increased from 8.4% (95% CI: 7.8-9.0) in 1996 to 9.9% (95% CI: 9.2-10.6) in 2006 and 10.9% (95% CI: 10.1-11.7) in 2016 (P<.001). Allergic asthma increased from 5.0% (95% CI: 4.5-5.5) in 1996 to 6.0% (95% CI: 5.4-6.6) in 2006 and further to 7.3% (95% CI: 6.6-8.0) in 2016 (P<.001), while the prevalence of non-allergic asthma remained stable around 3.4%-3.8%. The increase in current asthma was most pronounced among women and among the middle-aged. Physician-diagnosed asthma, asthma medication use and ARC also increased significantly, while the prevalence of symptoms common in asthma such as wheeze and attacks of shortness of breath decreased slightly or was stable. The prevalence of current smoking decreased from 27.4% in 1996 to 12.3% in 2016.

    Conclusions and Clinical Relevance

    The prevalence of allergic asthma increased from 1996 to 2006 and further to 2016, while the prevalence of non-allergic asthma remained on a stable prevalence level. The prevalence of symptoms common in asthma decreased slightly or was stable despite a substantial decrease in the prevalence of current smoking. Clinicians should be aware that the previously observed increase in prevalence of allergic asthma is still ongoing.

  • 6.
    Bunne, Joakim
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University.
    Moberg, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University.
    Bjerg, Anders
    Department of Women's and Children's Health, Karolinska Institutet.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University.
    Increase of allergic sensitization in schoolchildren: two cohorts compared 10 years apart2017In: The Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, Vol. 5, no 2, p. 457-463Article in journal (Refereed)
    Abstract [en]

    Background

    Time trends of incidence of allergic sensitization are unknown and recent trends of prevalence and risk factors are lacking.

    Objective

    To estimate the incidence, prevalence, remission, risk factors, and time trends for allergic sensitization among schoolchildren followed from age 7 to 8 years to age 11 to 12 years.

    Methods

    In 2006, all children in grades 1 and 2 aged 7 to 8 years in 2 municipalities in northern Sweden were invited to a questionnaire survey and to skin prick testing to 10 common airborne allergens. The cohort was reexamined in 2010, with additional blood sampling for specific IgE. Participation rates were 90% (n = 1700) at age 7 to 8 years and 85% (n = 1657) at age 11 to 12 years. The results were compared with a cohort examined by identical methods 10 years earlier.

    Results

    The prevalence of positive skin prick test result to any allergen increased from 30% at age 7 to 8 years to 41% at age 11 to 12 years (P < .001). The cumulative 4-year incidence was 18%, while remission was low. Sensitization to pollen and furred animals was most common. A family history of allergy was significantly associated with incident sensitization, whereas the presence of furred animals at home was negatively associated. The prevalence at age 7 to 8 years and at age 11 to 12 years and the 4-year incidence were all significantly higher compared with the cohort examined 10 years earlier.

    Conclusions

    The prevalence of allergic sensitization increased by age as a consequence of a high incidence and a low remission. The trends of increasing incidence and prevalence among schoolchildren imply future increases in the prevalence of allergic diseases.

  • 7.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Aktivitet: Riskfaktorer för incidens av astma under tonåren2012Conference paper (Other (popular science, discussion, etc.))
  • 8.
    Hedman, Linnea
    Umeå University, Department of Public Health and Clinical Medicine, Occupational Medicine.
    Epidemiological studies of asthma and allergic diseases in teenagers: methodological aspects and tobacco use. The Obstructive Lung Disease in Northern Sweden - Thesis X.2010Doctoral thesis, comprehensive summary (Other academic)
  • 9.
    Hedman, Linnea
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. he Obstructive Lung Disease in Northern Sweden Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Backman, Helena
    The Obstructive Lung Disease in Northern Sweden Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Bosson, Jenny A.
    Division of Respiratory Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Lundbäck, Magnus
    Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden.
    Lindberg, Anne
    The Obstructive Lung Disease in Northern Sweden Unit, Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    The Obstructive Lung Disease in Northern Sweden Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Ekerljung, Linda
    Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Association of Electronic Cigarette Use With Smoking Habits, Demographic Factors, and Respiratory Symptoms2018In: JAMA Network Open, E-ISSN 2574-3805, Vol. 1, no 3, article id e180789Article in journal (Refereed)
    Abstract [en]

    Importance  Increases in total knee arthroplasty (TKA) utilization rates suggest that its indications have been expanded to include patients with less severe symptoms. A recent study challenged the cost-effectiveness of TKA in this group of patients.

    Objective  To determine the association of the 36-Item Short Form Health Survey physical component summary score (SF-36 PCS) with patient satisfaction 2 years after TKA.

    Design, Setting, and Participants  This cohort study reviewed registry data from 2 years of follow-up of patients who underwent unilateral TKA from January 1, 2010, to December 31, 2014, at a single-center tertiary institution in Singapore. Data were acquired on April 27, 2017, and analyzed from August 15, 2017, to December 22, 2017.

    Main Outcomes and Measures  Patient satisfaction and SF-36 PCS. Preoperative disability and postoperative function as measured by the SF-36 PCS were correlated with Δ (2-year end point score minus baseline score) and patient satisfaction, scored on a 6-point Likert scale, with lower scores indicating greater satisfaction.

    Results  Of the 6659 patients, 5234 (78.6%) were female and 5753 (86.4%) were of Chinese ethnicity. Mean (SD) age was 67.0 (7.7) years, and mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 27.7 (4.6). At 2-year follow-up, the mean (SD) SF-36 PCS score improved from 32.2 (10.1) to 48.2 (9.5) (P < .001). There were 1680 patients (25.2%) who described their satisfaction as excellent, 2574 (38.7%) very good, 1879 (28.2%) good, 382 (5.7%) fair, 96 (1.4%) poor, and 48 (0.7%) terrible. The minimal clinically important difference (change in SF-36 PCS of 10 from baseline) was met in 4515 patients (67.8%), and overall satisfaction was 97.8% (6515 patients). Covariance analysis showed significantly higher satisfaction in patients with preoperative scores of 40 to less than 50. Patients who were unlikely to meet the minimal clinically important difference compared with those who were likely to meet it (SF-36 PCS of ≥42.1 vs <42.1) had significantly higher 2-year satisfaction (mean [SD], 2.15 [0.9] vs 2.23 [1.0]; P = .009).

    Conclusions and Relevance  The findings suggest that a general health score, such as SF-36, is not associated with patient satisfaction 2 years after TKA. Functional assessment, preoperative counseling, and modification of expectations appear to remain vital before TKA.

  • 10.
    Hedman, Linnea
    et al.
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Bjerg, Anders
    OLIN studies, Norrbotten County Council.
    Lundbäck, Bo
    Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, University of Gothenburg.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Conventional epidemiology underestimates the incidence of asthma and wheeze – a longitudinal population-based study among teenagers2012In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 2Article in journal (Refereed)
  • 11.
    Hedman, Linnea
    et al.
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Bjerg, Anders
    OLIN studies, Norrbotten County Council.
    Perzanowski, Matthew
    Department of Environmental Health Sciences, Columbia University, New York.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Good agreement between parental and self-completed questionnaires about allergic diseases and environmental factors in teenagers2010In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 63, no 7, p. 783-789Article in journal (Refereed)
  • 12.
    Hedman, Linnea
    et al.
    OLIN studies, Norrbotten County Council.
    Bjerg, Anders
    OLIN studies, Norrbotten County Council.
    Perzanowski, Matthew
    Department of Environmental Health Sciences, Columbia University, New York.
    Sundberg, Sigrid
    OLIN studies, Norrbotten County Council.
    Rönmark, Eva
    Karolinska Institutet, Lung and Allergy Research.
    Factors related to tobacco use2007In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, p. 496-502Article in journal (Refereed)
  • 13.
    Hedman, Linnea
    et al.
    OLIN studies, Sunderby Hospital.
    Lindgren, Berit
    Perzanowski, Matthew
    Department of Environmental Health Sciences, Columbia University, New York.
    Rönmark, Eva
    Karolinska Institutet, Lung and Allergy Research.
    Agreement between parental and self-completed questionnaires about asthma in teenagers2005In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 16, no 2, p. 176-181Article in journal (Refereed)
    Abstract [en]

    In studies of asthma in children, a common method is for the parents to complete questionnaires about their child's asthma symptoms. With longitudinal studies of asthma, children reach an age when they can complete the questionnaire themselves. The aim of this paper was to compare the prevalence of asthma symptoms as well as the agreement between responses to an asthma questionnaire completed by teenagers and their parents. As a part of the Obstructive Lung Disease in Northern Sweden Study (OLIN) pediatric study, where 3345, 13-14-yr-old children completed an asthma questionnaire, 294 (84%) randomly selected parents also completed the questionnaire, which included the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. There were no significant differences in the prevalence of wheeze in the last 12 months, ever asthma, or physician diagnosed asthma as reported by the parents compared with the teenagers. However, the teenagers reported a significantly higher prevalence of wheeze during or after exercise. The absolute agreement was generally very high while the level of agreement (kappa-value) was slightly lower. The highest results in both absolute agreement and kappa-value, were reached by the questions on diagnosis of asthma (98.9% and 0.93), use of asthma medicines (95.5% and 0.78), and whether the child ever had had asthma (97.2% and 0.86), respectively. In conclusion, the agreement between the parents' and the teenagers' responses to the asthma questionnaire was good. The change in methodology from parental to self-completion of the questionnaire did not affect the results in the study.

  • 14.
    Hedman, Linnea
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Population-based study shows that teenage girls with asthma had impaired health-related quality of life2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, p. 1128-1135Article in journal (Refereed)
    Abstract [en]

    Aim

    This study examined the health-related quality of life (HRQoL) of teenagers with and without asthma, including the impact of their sex, allergic conditions, smoking, living conditions and physical activity.

    Methods

    The Obstructive Lung Disease in Northern Sweden (OLIN) studies recruited a cohort of schoolchildren in 2006. The parents of all children aged seven to eight years in three municipalities were invited to complete a questionnaire and 2585 (96%) participated. The cohort was followed up at the ages of 11–12 years and 14–15 years with high participation rates. At 14–15 years, the HRQoL questionnaire KIDSCREEN-10 and Asthma Control Test were added.

    Results

    Girls with current asthma at 14–15 years had a lower mean HRQoL score than girls without asthma (46.4 versus 49.3, p < 0.001), but this was not seen among boys (53.8 versus 52.8, p = 0.373). Poor HRQoL was related to current asthma, uncontrolled asthma and teenage onset of asthma. It was also related to eczema, living in a single-parent household, maternal smoking, daily smoking and inversely related to physical activity.

    Conclusion

    Teenage girls with asthma had lower HRQoL than girls without asthma. Possible interventions to improve HRQoL among teenagers with asthma were identified as follows: increasing asthma control, preventing smoking and promoting physical activity.

  • 15.
    Jansson, Sven-Arne
    et al.
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Axelsson, Malin
    Department of Care Sciences, Faculty of Health and Society, Malmö University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Leander, Mai
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Rönmark, Eva
    6Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Subjects with well-controlled asthma have similar health-related quality of life as subjects without asthma2016In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 120, p. 64-69Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The burden of asthma and rhinitis on health-related quality of life (HRQL) among adults has been assessed mainly in studies of patients seeking health-care, while population-based studies are relatively scarce. The objective of this study was to investigate HRQL among subjects with asthma and rhinitis derived from a random population sample and to identify factors related to impairment of HRQL.

    METHODS:

    A randomly selected cohort was invited to participate in a postal questionnaire survey. Of those who responded, a stratified sample of 1016 subjects was invited to clinical examinations and interviews, and 737 subjects in ages 21-86 years participated. Of these, 646 completed HRQL questions. HRQL was assessed with the generic SF-36 Health Survey.

    RESULTS:

    The physical score was lower among subjects with asthma vs. subjects without asthma (p < 0.001). No significant difference was found in the mental score. Subjects with well-controlled asthma had higher physical score compared to subjects with partly and un-controlled asthma (p = 0.002). Actually, subjects with well-controlled asthma had similar physical HRQL as subjects without asthma. Asthmatics who were current smokers had lower physical score compared to those who were non-smokers (p = 0.021). No significant differences in physical or mental scores were found between subjects with and without rhinitis. Subjects with both asthma and rhinitis had lower physical score compared to subjects without these conditions (p < 0.001), but subjects with asthma alone had even worse physical score.

    CONCLUSIONS:

    The physical score was significantly lower in asthmatics compared to subjects without asthma. Importantly, non-smoking and well-controlled asthmatics have similar HRQL compared to subjects without asthma. Thus, subjects with asthma should be supported to achieve and maintain good asthma control and if they smoke, be offered smoking cessation as means to improve their HRQL.

    Copyright © 2016 Elsevier Ltd. All rights reserved.

  • 16.
    Rankin, Gregory D.
    et al.
    Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine and Allergy, Umeå University, Umeå, Sweden.
    Wingfors, Håkan
    Swedish Defence Research Agency, CBRN Defence and Security, Umeå, Sweden.
    Uski, Oskari
    Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine and Allergy, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Hammarström, Barbro Ekstrand
    Swedish Defence Research Agency, CBRN Defence and Security, Umeå, Sweden.
    Bosson, Jenny
    Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine and Allergy, Umeå University, Umeå, Sweden.
    Lundbäck, Magnus
    Karolinska Institutet, Department of Clinical Sciences, Division of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
    The toxic potential of a fourth-generation E-cigarette on human lung cell lines and tissue explants2019In: Journal of Applied Toxicology, ISSN 0260-437X, E-ISSN 1099-1263, Vol. 39, no 8, p. 1143-1154Article in journal (Refereed)
    Abstract [en]

    The use of electronic cigarettes (E-cigs) is rapidly increasing. The latest generation of E-cigs is highly customizable, allowing for high heating coil temperatures. The aim of this study was to assess the toxic potential of a fourth-generation E-cig. Aerosols generated from E-liquid with (24 mg/mL) and without nicotine, using a fourth-generation E-cig, were chemically analysed and compared with cigarette smoke (K3R4F). Human lung epithelial cell lines and distal lung tissue explants were exposed to E-cig vapour extract (EVE) and cigarette smoke extract for 24 hours and assessed for viability, inflammation, oxidative stress and genotoxicity. E-cig aerosols contained measurable levels of volatile organic compounds, aldehydes and polycyclic aromatic hydrocarbons, in general, to a much lesser extent than cigarette smoke. Higher levels of certain carbonyls, e.g. formaldehyde, were detected in the E-cig aerosols. EVEs decreased cell viability of BEAS-2B cells, whereas little effect was seen in A549 cells and distal lung tissue. The nicotine-containing EVE caused a greater decrease in cell viability and significant increase in DNA damage than the nicotine-free EVE. Increased cytotoxicity, reactive oxygen species production and genotoxicity were seen with cells and tissue exposed to cigarette smoke extract compared with EVEs. Although E-cig aerosols were less toxic than cigarette smoke, it was not benign. Moreover, the EVE containing nicotine was more toxic than the nicotine-free EVE. More research is needed on the short- and long-term health effects of vaping and the usage of newly emerging E-cig devices to evaluate better the potential negative effects of E-cigs on human health.

  • 17.
    Rönmark, Eva
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Warm, Katja
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University; Division of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Bjerg, Anders Munch
    Department of Women's and Children's Health, Karolinska Institutet.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg.
    High incidence and persistence of airborne allergen sensitization up to age 19 years2017In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 72, no 5, p. 723-730Article in journal (Refereed)
    Abstract [en]

    Background

    Longitudinal population-based studies about the natural history of allergic sensitization are rare. The aim was to study incidence and persistence of airborne allergen sensitization up to young adulthood and risk factors for early and late onset of sensitization.

    Methods

    All children aged 7–8 years in two municipalities in Northern Sweden were invited to a parental questionnaire and skin prick tests (SPTs) to ten airborne allergens, and 2148 (88%) participated. The protocol was repeated at age 11–12 and 19 years, and 1516 participated in all three examinations.

    Results

    Prevalence of any positive SPT increased from 20.6% at age 7–8 years to 30.6% at 11–12 years, and 42.1% at 19 years. Animals were the primary sensitizers at age 7–8 years, 16.3%, followed by pollen, 12.4%. Mite and mold sensitization was low. Mean annual incidence of any positive SPT varied between 2.8 and 3.4/100 per year, decreased by age for animal, and was stable for pollen. Sensitization before age 7–8 years was independently associated with family history of allergy, OR 2.1 (95% CI 1.6–2.8), urban living, OR 1.9 (95% CI 1.2–2.9), and male sex, OR 1.3 (95% CI 1.0–1.7), and negatively associated with birth order, OR 0.8 (95% CI 0.7–1.0), and furry animals at home, OR 0.7 (95% CI 0.7–0.9). Incidence after age 11–12 years was associated only with family history of allergy. Multisensitization at age 19 years was significantly associated with early age at sensitization. Remission of sensitization was uncommon.

    Conclusion

    The increasing prevalence of allergic sensitization by age was explained by high incidence and persistence. After age 11–12 years, the factors urban living, number of siblings, and male sex lost their importance.

  • 18.
    Sawalha, Sami
    et al.
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, SwedenDivision of Respiratory Medicine, Sunderby Hospital, Luleå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå.
    Backman, Helena
    Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, .
    Stenfors, Nikolai
    Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, .
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research center, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study2019In: Therapeutic Advances in Respiratory Disease, ISSN 1753-4658, Vol. 13, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background:

    Comorbidities probably contribute to the increased mortality observed among subjects with chronic obstructive pulmonary disease (COPD), but sex differences in the prognostic impact of comorbidities have rarely been evaluated in population-based studies. The aim of this study was to evaluate the impact of common comorbidities, cardiovascular disease (CVD), diabetes mellitus (DM), and anxiety/depression (A/D), on mortality among men and women with and without airway obstruction in a population-based study.

    Methods:

    All subjects with airway obstruction [forced expiratory volume in 1 second (FEV1)/(forced) vital capacity ((F)VC) <0.70, n = 993] were, together with age- and sex-matched referents, identified after examinations of population-based cohorts in 2002–2004. Spirometric groups: normal lung function (NLF) and COPD (post-bronchodilator FEV1/(F)VC <0.70) and additionally, LLN-COPD (FEV1/(F)VC <lower limit of normal). Mortality data was collected until December 2015.

    Results:

    In COPD, the prevalence of CVD and DM was higher in men, whereas the prevalence of A/D was higher in women. The cumulative mortality was significantly higher in COPD than NLF, and higher in men than women in both groups. Among women with COPD, CVD and A/D but not DM increased the risk of death independent of age, body mass index, smoking habits, and disease severity, whereas among men DM and A/D but not CVD increased the risk for death. When the LLN criterion was applied, the pattern was similar.

    Conclusion:

    There were sex-dependent differences regarding the impact of comorbidities on prognosis in COPD. Even though the prevalence of CVD was higher in men, the impact of CVD on mortality was higher in women, and despite higher prevalence of A/D in women, the impact on mortality was similar in both sexes.

  • 19.
    Schyllert, Christian
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umea University.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umea University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umea University.
    Ekström, Magnus
    Department of Respiratory Medicine and Allergology, Institution for Clinical Sciences, Lund University.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Job titles classified into socioeconomic and occupational groups identify subjects with increased risk for respiratory symptoms independent of occupational exposure to vapour, gas, dust, or fumes2018In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 5, no 1, article id 1468715Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the ability of three different job title classification systems to identify subjects at risk for respiratory symptoms and asthma by also taking the effect of exposure to vapours, gas, dust, and fumes (VGDF) into account. Background: Respiratory symptoms and asthma may be caused by occupational factors. There are different ways to classify occupational exposure. In this study, self-reported occupational exposure to vapours, gas, dust and fumes was used as well as job titles classifed into occupational and socioeconomic Groups according to three different systems. Design: This was a large population-based study of adults aged 30-69 years in Northern Sweden (n = 9,992, 50% women). Information on job titles, VGDF-exposure, smoking habits, asthma and respiratory symptoms was collected by a postal survey. Job titles were used for classification into socioeconomic and occupational groups based on three classification systems; Socioeconomic classification (SEI), the Nordic Occupations Classification 1983 (NYK), and the Swedish Standard Classification of Occupations 2012 (SSYK). Associations were analysed by multivariable logistic regression. Results: Occupational exposure to VGDF was a risk factor for all respiratory symptoms and asthma (odds ratios (ORs) 1.3-2.4). Productive cough was associated with the socioeconomic groups of manual workers (ORs 1.5-2.1) and non-manual employees (ORs 1.6-1.9). These groups include occupations such as construction and transportation workers, service workers, nurses, teachers and administration clerks which by the SSYK classification were associated with productive cough (ORs 2.4-3.7). Recurrent wheeze was significantly associated with the SEI group manual workers (ORs 1.5-1.7). After adjustment for also VGDF, productive cough remained significantly associated with the SEI groups manual workers in service and non-manual employees, and the SSYK-occupational groups administration, service, and elementary occupations. Conclusions: In this cross-sectional study, two of the three different classification systems, SSYK and SEI gave similar results and identified groups with increased risk for respiratory symptoms while NYK did not give conclusive results. Furthermore, several associations were independent of exposure to VGDF indicating that also other job-related factors than VGDF are of importance.

  • 20.
    Selberg, Stina
    et al.
    The OLIN Studies, Norrbotten County Council, Luleå.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. The OLIN Studies, Norrbotten County Council, Luleå. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå.
    Backman, Helena
    The OLIN Studies, Norrbotten County Council, Luleå. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Medical Science. Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Asthma control and acute health care visits among young adults with asthma: A population‐based study2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    Aims

    To study asthma control and acute health care visits among young adults with asthma.

    Background

    Despite the access to effective treatment and nursing interventions, poor asthma control is still common among individuals with asthma. However, studies describing clinical characteristics among young adults with asthma are rare.

    Design

    A population‐based cohort study.

    Methods

    In 2015, as a part of the OLIN pediatric cohort I (recruited in 1996 at age 7‐8yr), N=2291 young adults (27‐28 yr) completed a postal questionnaire survey including questions on asthma and respiratory symptoms. Of these, N=280 (12%) were identified as having current asthma and were further studied.

    Results

    Of those with current asthma, women reported respiratory symptoms and smoking to a greater extent than men. Approximately one‐fourth had uncontrolled asthma and acute health care visits due to asthma was reported by 15% of women and 8% of men. Uncontrolled asthma was associated with smoking, lower educational level, use of reliever treatment most days and acute health care visits. Acute health care visits due to asthma were associated with periodic use of regular controller treatment also after adjustment for uncontrolled asthma.

    Conclusion

    The result indicate poor adherence to asthma treatment which may lead to decreased asthma control and acute health care visits.

    Impact

    Most young adults with asthma are diagnosed and treated in primary care, ideally in a team with a nurse. The main findings highlight the need for evidenced‐based nursing interventions, contributing to a more efficient asthma management in primary care.

  • 21.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Eklund, Britt-Marie
    The OLIN Studies, Norrbotten County Council.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University.
    Adolescent girls with asthma have worse asthma control and health-related quality of life than boys: A population based study2017In: Pediatric Pulmonology, ISSN 8755-6863, E-ISSN 1099-0496, Vol. 52, no 7, p. 866-872Article in journal (Refereed)
    Abstract [en]

    Background

    Population-based studies investigating health-related quality of life (HRQoL) among asthmatic adolescents are rare. Further, among subjects with asthma, HRQoL may be affected by asthma control and severity.

    Aim

    To investigate HRQoL in relation to asthma control and asthma severity among adolescents.

    Method

    As a part of the population-based OLIN pediatric study, 266 adolescents with current asthma (14-15 yr) were identified. N = 247 completed the DISABKIDS HRQoL asthma module, including the domains impact and worry. The Asthma Control Test (ACT) was used and a disease severity score was calculated based on symptoms and medicine use.

    Results

    The prevalence of current asthma was 11%. Well-controlled asthma was reported by 15% of the adolescents, and 53% had partly controlled asthma. The prevalence of uncontrolled asthma was significantly higher among girls than boys (38% vs 25%), and girls also reported lower HRQoL scores. There was a fairly strong correlation between the ACT and DISABKIDS scores. Independent risk factors for low HRQoL impact (a score <67) were female sex (OR 4.66, 95%CI 1.82-9.54) and decreased ACT scores (1.38, 1.18-1.62). Risk factors for low HRQoL worry (a score <70) were female sex (3.33, 1.41-7.86), decreased ACT scores (1.35, 1.16-1.57), severe asthma (6.23, 1.46-16.50), and having current eczema (2.68, 1.00-7.24).

    Conclusion

    Only a minority of the asthmatic adolescents reported well-controlled asthma, and poor asthma control and female sex were risk factors for low HRQoL. Our results demonstrate that evaluation of asthma control is of great importance for asthma management.

  • 22.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Dahlberg, Elisabeth
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zandrén, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Asthma in adolescence affects daily life and school attendance: Two cross-sectional population-based studies 10 years apart2017In: Nursing Open, E-ISSN 2054-1058, Vol. 4, no 3, p. 143-148Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of this study was to study the impact of asthma on daily life, school absenteeism and physical education. In addition, to describe asthma triggers at school.

    Design

    Two cross-sectional population-based studies ten years apart.

    Method

    Within the OLIN-studies, in 2003 (= 3,327) and in 2013 (= 2,345) adolescents (14–15 years) answered an expanded ISAAC questionnaire. Of these, 8% and 11%, respectively with current asthma participated in this study.

    Results

    Between the years 2003–2013, the proportion of adolescents reporting that asthma interfered with daily life had increased, in 2013, girls were significantly more affected than boys. The proportion reporting a worsening of asthma at school had decreased, but it was still over a quarter. The proportion of absenteeism from school and from physical education was at the same level both years. Asthma triggers were described to be poor air quality, poorly cleaned environment, allergens, strong fragrance, rebuilding projects, physical education and stress.

  • 23.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    Fatigue and decreased health can predict mortality in COPD2013Conference paper (Other academic)
  • 24.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Rönmark, Eva
    Norrbottens Läns Landsting.
    Lindberg, Anne
    OLIN studies, Norrbotten County Council.
    Fatigue affects health status and predicts mortality among subjects with COPD-report from the population-based OLIN COPD study2015In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 12, no 2, p. 199-206Article in journal (Refereed)
    Abstract [en]

    Background: COPD is associated to increased fatigue, decreased health status and mortality. However, these relationships are rarely evaluated in population-based studies. Aims: To describe the relationship between health status, respiratory symptoms and fatigue among subjects with and without COPD. Further, to evaluate whether fatigue and/or health status predicts mortality in these groups. Methods: Data were collected in 2007 from the population-based OLIN COPD study. Subjects participated in lung function tests and structured interviews, and 434 subjects with and 655 subjects without COPD were identified. Fatigue was assessed by FACIT-Fatigue and health status by the generic SF-36 questionnaire including physical (PCS) and mental (MCS) components. Mortality data until February 2012 were collected. Results: Fatigue greatly impacts the physical and mental dimensions of health status, both among subjects with and without COPD. Among subjects with clinically significant fatigue, COPD subjects had significantly lower PCS-scores compared to non-COPD subjects. Fairly strong correlations were found between FACIT-F, SF-36 PCS and MCS, respectively. In multivariate models adjusting for covariates, increased fatigue, decreased physical and mental dimensions of health status were all associated to mortality in subjects with COPD (OR 1.06, CI 1.02-1.10, OR 1.04, CI 1.01-1.08 and OR 1.06, CI 1.02-1.10), but not in non-COPD. Conclusions: Fatigue and decreased health status were closely related among subjects with and without COPD. Not only physical health status, but also fatigue and mental health predicted mortality among subjects with COPD. Fatigue assessed by FACIT-F, can be a useful instrument of prognostic value in the care of subjects with COPD.

  • 25.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. The OLIN Studies.
    Svensson, My
    Department of Public Health and Clinical Medicine, The OLIN Unit/Division of Medicine, Umeå University.
    Johansson Strandkvist, Viktor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, The OLIN Unit/Division of Occupational and Environmental Medicine, Umeå University.
    Backman, Helena
    Department of Public Health and Clinical Medicine, The OLIN Unit/Division of Occupational and Environmental Medicine, Umeå University.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, The OLIN Unit/Division of Medicine, Umeå University.
    The COPD Assessment Test (CAT) can screen for fatigue among patients with COPD2018In: Therapeutic advances in respiratory disease, ISSN 1753-4658, Vol. 12, article id 1753466618787380Article in journal (Refereed)
    Abstract [en]

    Background:

    Fatigue is one of the most common symptoms among subjects with chronic obstructive pulmonary disease (COPD), but is rarely identified in clinical practice. The aim of this study was to evaluate the association between fatigue and health-related quality of life (HRQoL) assessed with clinically useful instruments, both among subjects with and without COPD. Further, to investigate the association between fatigue and the COPD Assessment Test (CAT)-energy question.

    Methods:

    Data were collected in 2014 within the population-based OLIN COPD study. Subjects with (n = 367) and without (n = 428) COPD participated in clinical examinations including spirometry and completed questionnaires about fatigue (FACIT-Fatigue, clinically relevant fatigue ⩽43), and HRQoL (EQ-5D-VAS, lower score = worse health; CAT, lower score = fewer symptoms/better health).

    Results:

    Subjects with clinically relevant fatigue had worse HRQoL measured with EQ-5D-VAS, regardless of having COPD or not. Decreasing EQ-5D-VAS scores, any respiratory symptoms and anxiety/depression were associated with clinically relevant fatigue also when adjusted for confounders. Among subjects with COPD, clinically relevant fatigue was associated with increasing total CAT score, and CAT score ⩾10. The proportion of subjects with clinically relevant fatigue increased significantly, with a higher score on the CAT-energy question, and nearly 50% of those with a score of 2, and 70% of those with a score of ⩾3, had clinically relevant fatigue.

    Conclusions:

    Fatigue was associated with respiratory symptoms, anxiety/depression and worse HRQoL when using the clinically useful instruments EQ-5D-VAS and CAT. The CAT-energy question can be used to screen for fatigue in clinical practice, using a cut-off of ⩾2.

  • 26.
    Strinnholm, Åsa
    et al.
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Winberg, Anna
    Department of Clinical Sciences, Pediatrics, Umeå University.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Lindh, Viveka
    Department of Clinical Sciences, Pediatrics, Umeå University.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Health Related Quality of Life among schoolchildren aged 12–13 years in relation to food hypersensitivity phenotypes: a population-based study2017In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 7, no 1, article id 20Article in journal (Refereed)
    Abstract [en]

    Background

    While Health Related Quality of Life has been investigated among children with IgE-mediated food allergy, less is known about quality of life among children with other types of hypersensitivity to food. The aim of this study was to investigate Health Related Quality of Life (HRQL) in children with and without food hypersensitivity. Further, we compared HRQL between children with different phenotypes of food hypersensitivity.

    Methods

    In a large population-based cohort of schoolchildren in Northern Sweden, the parents of 2612 (96% of invited) completed a questionnaire. All 125 (5%) children who reported complete elimination of milk, egg, fish or wheat due to food hypersensitivity were invited to a clinical examination and 94 children participated. Of these, 75 children also completed a generic (KIDSCREEN-52) and a disease-specific HRQL questionnaire (FAQLQ-TF). Thereafter, these children were categorised into the different phenotypes: current food allergy, outgrown food allergy, and lactose intolerance. Additionally, 209 children with unrestricted diets answered the generic questionnaire.

    Results

    The median score of all KIDSCREEN-52 domains were above the population norm of 50 both in children with and without food hypersensitivity. No significant differences in distribution in generic or disease-specific HRQL were found between children with or without food hypersensitivity. There were no significant differences in HRQL between children with different phenotypes of food hypersensitivity. However, children with current food allergy tended to have the lowest HRQL. Further, poor HRQL defined as ≥75th percentile for the disease specific score was significantly more common in the current food allergy phenotype in the domain Emotional impact and the total FAQLQ, compared to the other phenotypes.

    Conclusions

    In this population-based study, 12–13 year old children reported good HRQL regardless of having food hypersensitivity or not. However, the children with the current phenotype reported lower HRQL than the other phenotypes.

  • 27.
    Strinnholm, Åsa
    et al.
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Winberg, Anna
    Department of Clinical Sciences, Pediatrics, Umeå University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Lindh, Viveka
    Department of Clinical Sciences, Pediatrics, Umeå University.
    Reintroduction failure is common among adolescents after double-blind placebo-controlled food challenges2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 2, p. 282-287Article in journal (Refereed)
    Abstract [en]

    AIM:

    There has been a lack of research on adolescents' who undergo double-blind placebo-controlled food challenges. The aim of this study was to investigate food allergic adolescents' experiences and consequences of double-blind placebo-controlled food challenges.

    METHODS:

    This qualitative, descriptive interview study included 17 adolescents aged 14-15 years with total elimination of cows' milk, hens' eggs or cod due to food allergies. The participants, who were initially identified from a large population-based cohort study, were interviewed 18 months after completing their challenges.

    RESULTS:

    The double-blind placebo-controlled food challenge proved to be a complex experience for the adolescents, involving fear of potential reactions and the hope that the food could be reintroduced. Experiences during the challenge were described in three themes: facing fears in a secure environment, being hesitant but curious about unknown tastes and waiting for unknown food reactions. Experiences after the challenge were desribed in two themes: gaining control and freedom and continuing old habits. A negative challenge was not consistently associated with the reintroduction of the challenged food.

    CONCLUSION:

    This study highlighted the importance of considering the adolescents' expectations and experiences of the challenge and the reintroduction process to ensure desirable changes in their dietary habits. Follow ups should be performed regardless of the outcome of challenges.

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