Nonallergic occupational rhinitis.
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Environmental Exposure↗
Biomedical subjects
Kjell Torén
Publications and source records attributed to Kjell Torén.
Incidence of hand eczema in female Swedish hairdressers.
OBJECTIVE: To estimate the occurrence of hand eczema in hairdressers in Sweden. METHODS: The occurrence of hand eczema was estimated in a Swedish longitudinal retrospective cohort study including all female graduates from vocational schools for hairdressers from 1970 to 1995. A stratified sample from the general population acted as controls. A self-administered questionnaire including questions on the occurrence of hand eczema, skin atopy, working periods and number of hair treatments performed per week was sent to the participants. Incidence rate ratios (IRRs) of hand eczema were estimated. RESULTS: The incidence rate of hand eczema in hairdressers was 23.8 cases/1000 person-years, whereas in hairdressers who were aged <25 years it was 37.1/1000 person-years. The corresponding IRR for hairdressers compared with controls was 2.5 (95% confidence interval (CI) 2.2 to 2.8), and that for younger hairdressers was 3.1 (95% CI 2.6 to 3.5). The mean age at onset of hand eczema was 21.6 years for hairdressers and 21.2 years for controls. The 1-year prevalence of hand eczema was 18.0% for hairdressers and 12.1% for controls. A large number of hair treatments involving exposure to skin irritants and sensitisers were reported. The incidence rate of hand eczema was higher among individuals with a history of childhood eczema, both for hairdressers and for controls, giving an (age-adjusted) IRR of 1.9 and 2.2, respectively. The attributable fraction of hand eczema from skin atopy was 9.6%. A synergistic effect of skin atopy and hairdressing was found on the occurrence of hand eczema. The relative excess risk due to interaction was 1.21 (95% CI 0.21 to 2.21; p = 0.01). CONCLUSION: Hairdressers are highly exposed to skin-damaging substances. The self-reported incidence of hand eczema was substantially higher in female hairdressers than in controls from the general population and than that found previously in register-based studies. For many individuals, onset of hand eczema occurs early in life. Only about 10% of the hand eczema cases among hairdressers would be prevented if no one with skin atopy entered the trade.
Adult↗
Perennial non-infectious rhinitis--an independent risk factor for sleep disturbances in Asthma.
AIM OF THE STUDY: To evaluate if perennial non-infectious rhinitis is associated with sleep disturbances in asthma. MATERIALS AND METHODS: This is a questionnaire based study in a random population sample from Denmark, Estonia, Iceland, Norway and Sweden aged 30-54yr. A total of 1127 individuals reporting asthma from an original random population sample of 16,191 were analysed regarding their quality of sleep in relation to perennial non-infectious rhinitis. Perennial non-infectious rhinitis was defined as having nasal symptoms such as nasal blockage and secretion in the absence of common cold, always. Asthma was defined as both ever having had asthma and having physician diagnosed asthma. Odds ratios (OR) for difficulties inducing sleep, difficulties maintaining sleep, early morning awakenings and daytime sleepiness were calculated in a multiple logistic regression controlling for other risk factors for sleep disturbances such as snoring, wheeze, obesity and smoking. RESULTS: The response rate was 74%. A total of 189 (17%) of the subjects with asthma reported perennial non-infectious rhinitis. Perennial non-infectious rhinitis was associated with an increased OR for difficulties maintaining sleep (1.6 (95% confidence interval (CI) 1.1-2.3)), early morning awakenings (1.5 (95% CI 1.1-2.2)) and daytime sleepiness (1.8 (95% CI 1.2-2.9)). The result show that perennial non-infectious rhinitis is an independant risk factor for sleep disturbances in asthma.
Adult↗
Self-reported asthma was biased in relation to disease severity while reported year of asthma onset was accurate.
BACKGROUND AND OBJECTIVES: The aims of the study were to assess the accuracy of self-reported asthma and notified year of asthma onset. METHODS: The study was performed on a sample of 365 subjects, 18-60 years old, with clinically diagnosed onset of asthma between 1983 and 1986. All subjects were investigated 10 years later, in 1996, with a respiratory questionnaire about the items of asthma and year of onset. The material was analyzed with logistic regression models. RESULTS: Of the 289 subjects who returned the questionnaire, asthma was reconfirmed in 251 subjects. In a logistic regression model, asthma severity was significantly associated with confirmation of asthma. The median difference between the "true" year of onset and the reported year 10 years later, the recall period was zero, with a 10th to 90th interpercentile range of -2 to 6 years. The recall period was not associated with asthma severity, bronchial hyperresponsiveness, smoking, atopy, or sex. CONCLUSION: Self-reported asthma is biased in relation to disease severity, meaning that subjects with mild disease were less prone to report their asthma. Reported year of asthma onset among adults seems to be rather accurate, with no obvious dependent misclassifications.
Adolescent↗
Height, age, and atopy are associated with fraction of exhaled nitric oxide in a large adult general population sample.
STUDY OBJECTIVES: The fraction of exhaled nitric oxide (Feno) is elevated in subjects with asthma and atopy, and it has been proposed to be a noninvasive marker of airway inflammation. In addition to asthma and atopy, there is limited information about the determinants of Feno in a general population. DESIGN: Cross-sectional. SETTING: A random adult general population sample. PARTICIPANTS: A total of 2,200 subjects, 1,111 women and 1,089 men, aged 25 to 75 years. INTERVENTIONS: The subjects were examined with regard to Feno, pulmonary function, anthropometric variables, and blood samples for Ig E, and completed a respiratory questionnaire. The associations between different determinants and Feno were analyzed with multiple linear regression models. RESULTS: The median value of Feno was 16.0 parts per billion (ppb), ranging from 2.4 to 199 ppb. Height, age, atopy, reporting of asthma symptoms in the last month, and reported use of inhaled steroids were positively associated with Feno. Current smokers had lower values of Feno. Gender was not associated with Feno. CONCLUSIONS: In this random adult population sample, height, but not gender, was associated with Feno. Furthermore, asthma symptoms in the last month, reported use of inhaled steroids, and atopy were positively and independently associated with Feno, while there was a negative association with smoking.
Administration, Inhalation↗
Occupational skin exposure and hand eczema among dental technicians-need for improved prevention.
OBJECTIVES: The aims of this study were to estimate occupational skin exposure, the use of skin protection, and the incidence of hand eczema among dental technicians. METHODS: In a retrospective cohort study, dental technicians (N=2139) and randomly selected population controls (N=2288) received a postal questionnaire on occupational skin exposure, protective glove use, and hand eczema, including the year of onset. The response rate was 57% for the dental technicians and 58% for the controls. RESULTS: Altogether 80% of the dental technicians reported skin exposure to uncured (meth)acrylates (MA), and 87% had skin contact with grinding dust from MA. Thirty-nine percent used protective gloves when handling uncured MA. Twenty-two percent of the currently employed technicians reported participation in obligatory training concerning the handling of thermosetting plastics, and 58% did not know how long normally used gloves protected the skin against uncured MA. Altogether 48% of the dental technicians and 30% of the controls reported more than 10 hand washings a day (P<0.001). For the dental technicians, the incidence of hand eczema was 8.5 cases/1000 person-years during MA-exposed time. For the controls, the incidence was 3.3. The incidence rate ratio for the men was 3.6 (95% CI 2.3-5.6), and for the women it was 2.4 (95% CI 1.7-3.3). CONCLUSIONS: The work of dental technicians involves frequent and unprotected exposure to MA and frequent hand washings. Dental technicians have twice the risk of hand eczema than the general population. Efforts to improve skin protection and increase participation in obligatory training about handling thermosetting plastics are important.
Dental Technicians↗
Optimization and validation of an ion chromatographic method for the simultaneous determination of sodium, ammonium and potassium in exhaled breath condensate.
An ion chromatographic method with conductivity detection for the simultaneous quantification of sodium, ammonium and potassium in exhaled breath condensate (EBC) was developed and validated. A factorial design was used to optimize the chromatographic conditions, which resulted in baseline separations of the cations within 6 min. The method requires no pre-treatment of EBC samples. The optimized method was used for the intra-individual screening of cations in EBC of 10 healthy volunteers. The LOQs were low (0.3, 0.1 and 0.2 microM for sodium, ammonium and potassium, respectively), compared with levels detected in healthy volunteers. The responses were linear with good precision, and samples could be stored for at least 10 weeks at refrigerating conditions.
Breath Tests↗
A randomized controlled study of a computerized limited education program among young adults with asthma.
The aim of the study was to assess the effectiveness of a computerized limited asthma education program, designed to suit young people. The study was conducted with 97 young adults (18-25 years) with asthma, 48 were randomized to the intervention group and 49 to the control group, and they were followed for 12 months. The intervention group completed an interactive computer program of 30-min duration providing information about asthma, mechanisms, trigger factors, allergies and medication use, which was followed by a 30-min discussion with a specialized asthma nurse. The control group followed the routine schedule for asthma outpatients. The outcomes of the study were number of hospital admissions, emergency visits, asthma symptoms, knowledge about asthma, lung function and quality of life. No effect was found regarding admission to hospital, emergency visits, prevalence of respiratory symptoms, knowledge of asthma or quality of life. However, forced exhaled volume in 1s (FEV(1)) increased significantly, mainly among the atopic subjects. In conclusion, an intervention with a limited asthma education program did not show an effect on asthma symptoms, asthma knowledge or quality of life parameters.
Adolescent↗
Trends in blood lipid levels, blood pressure, alcohol and smoking habits from 1985 to 2002: results from INTERGENE and GOT-MONICA.
BACKGROUND: Favourable trends in cardiovascular disease have been observed in Sweden. The aim of this study was to study secular trends in a variety of cardiovascular risk factors. METHODS: Total-, low-density (LDL) and high-density lipoprotein (HDL) serum cholesterol; serum triglycerides; systolic and diastolic blood pressure; self-reported smoking and alcohol consumption were studied in repeated cross-sectional surveys. Data from four population-based samples in Goteborg, Sweden were used-WHO MONICA project 1985, 1990 and 1995, and INTERGENE 2002. A total of 2931 females and 2691 males aged 25-64 consisting of 1021-1624 randomly selected subjects at each survey period participated. RESULTS: Serum cholesterol levels showed downward trends but the decline in both total- and LDL-cholesterol seems to be levelling off from 1995 and onwards. No significant changes were observed in serum triglyceride, HDL-serum cholesterol or blood pressure levels. The majority of the participants had higher total- and LDL-serum cholesterol levels than currently recommended. Antihypertensive medical treatment increased in women and the oldest men. The prevalence of smoking decreased from 39 to 25% in women and 35 to 20% in men respectively from 1985-2002. In contrast, the prevalence of subjects consuming strong beer and wine, respectively, at least once a week almost doubled from 1990-2002. CONCLUSIONS: Cardiovascular risk factor patterns change continuously and need to be monitored. The favourable trends in LDL-serum cholesterol and smoking in the Goteborg surveys were paralleled by less favourable trends in being overweight and alcohol consumption.
Adult↗
The incidence of respiratory symptoms and diseases among pulp mill workers with peak exposures to ozone and other irritant gases.
OBJECTIVES: Pulp mills in Sweden started to use ozone as a bleaching agent in the early 1990s. The goal of this study was to investigate whether the incidence of selected respiratory outcomes was associated with peak exposures to ozone or other irritant gases (ie, chlorine dioxide [ClO2] or sulfur dioxide [SO2]) used in these mills. METHODS: Bleachery workers (n = 245) from three pulp mills where ozone was used participated in surveys in the mid- to late-1990s. Comparison workers (n = 80) were from two adjacent paper mills. The person-time at risk was calculated for each participant, covering the period of employment when ozone was used. Data were collected by questionnaire, and a peak exposure was defined as a self-reported exposure to an irritant gas resulting in acute respiratory symptoms. The outcomes analyzed were self-reports of physician-diagnosed asthma, attacks of wheeze, and chronic bronchitis (ie, chronic cough with phlegm). Participants also reported when the peak exposures and outcomes occurred. RESULTS: Based on proportional hazards regression (controlling for gender, age, cigarette smoking, atopy, and peak irritant exposures that occurred before follow-up), workers who reported both ozone and ClO2/SO2 peak exposures had elevated hazard ratios (HRs) for all three outcomes. Those who reported only ozone peak exposures had elevated HRs of 6.5 (95% confidence interval [CI], 1.2 to 36.3) for asthma and 3.3 (95% CI, 1.1 to 10.2) for attacks of wheeze but no increase in risk for chronic bronchitis. Workers with only ClO2/SO2 peak exposures had elevated HRs for attacks of wheeze (HR, 7.5; 95% CI, 1.9 to 29.3) and chronic bronchitis (HR, 22.9; 95% CI, 4.5 to 118.2) but not for asthma. CONCLUSIONS: These findings suggest the need for additional efforts to prevent peak exposures in pulp-bleaching operations.
Asthma↗
Total mortality and cause-specific mortality of Swedish shift- and dayworkers in the pulp and paper industry in 1952-2001.
OBJECTIVES: The study investigated the relationship between shiftwork and mortality, both total mortality and cause-specific mortality from coronary heart disease (CHD), stroke, and diabetes. Methods The cohort consisted of 2354 shiftworkers and 3088 dayworkers in two pulp and paper manufacturing plants. The mortality of the cohort was monitored from 1 January 1952 to 31 December 2001 by linkage to the national Cause of Death Register. Groups of workers defined by different durations of shiftwork exposure were compared with dayworkers by calculating standardized relative rates (SRR). RESULTS: Death due to any cause (total mortality) was not higher among the shiftworkers than among the dayworkers [SRR 1.02, 95% confidence interval (95% CI) 0.93-1.11]. A longer duration of shiftwork was associated with an increased risk of CHD, and shiftworkers with >30 years of shiftwork had the highest risk of CHD (SRR 1.24, 95% CI 1.04-1.49) Diabetes was more common as the number of shift years of exposure increased [b(linear coefficient) = 4.14 x 10(-5), 95% CI 2.46 x 10(-5) -5.81 x 10(-5)]. Compared with dayworkers, shiftworkers had a greater risk of death due to stroke (SRR 1.56, 95% CI 0.98-2.51). CONCLUSIONS: In the present study, no general increase in mortality was observed among shiftworkers when they were compared with dayworkers. However, the results demonstrate an increased mortality from CHD among shiftworkers with a long duration of shiftwork exposure. Mortality due to diabetes also increased as the number of shift years and mortality due to ischemic stroke in shiftworkers increased.
Adolescent↗
Determination of hydrogen peroxide in exhaled breath condensate by flow injection analysis with fluorescence detection.
A method for the determination of hydrogen peroxide in exhaled breath condensate (EBC) by automated flow injection analysis (FIA) with fluorescence detection was developed and validated. In the enzymatic assay a fluorescent dimer of para-hydroxyphenyl acetic acid (HPAA) was formed by the redox coupling reaction between hydrogen peroxide and horseradish peroxidase (HRP). The calibration curve of hydrogen peroxide was linear over a range of 40-5000 nM. The coefficient of variation (CV) for within-day precision was 1-3%; for between-day precision, it was 2-5% over the validated range. The assay requires a small sample aliquot (150 microl) and no incubation time, and has an analytical runtime of < 2 min. It is therefore suitable for larger studies. The method was used to detect hydrogen peroxide in EBC of asthmatic patients and healthy volunteers. A statistically significant difference was found between patients with asthma (n = 19) and control subjects without asthma (n = 19), 780 nM versus 480 nM (P = 0.03).
Asthma↗
The influence of active and passive smoking on habitual snoring.
The impact of active smoking, passive smoking, and obesity on habitual snoring in the population is mainly unknown. We aimed to study the relationship of habitual snoring with active and passive tobacco smoking in a population-based sample. A total of 15,555 of 21,802 (71%) randomly selected men and women aged 25-54 years from Iceland, Estonia, Denmark, Norway, and Sweden answered a postal questionnaire. Habitual snoring, defined as loud and disturbing snoring at least 3 nights a week, was more prevalent among current smokers (24.0%, p < 0.0001) and ex-smokers (20.3%, p < 0.0001) than in never-smokers (13.7%). Snoring was also more prevalent in never-smokers exposed to passive smoking at home on a daily basis than in never-smokers without this exposure (19.8% vs. 13.3%, p < 0.0001). The frequency of habitual snoring increased with the amount of tobacco smoked. Active smoking and passive smoking were related to snoring, independent of obesity, sex, center, and age. Ever smoking accounted for 17.1% of the attributable risk of habitual snoring, obesity (body mass index > or = 30 kg/m(2)) for 4.3%, and passive smoking for 2.2%. Smoking, both current and ex-smoking, is a major contributor to habitual snoring in the general population. Passive smoking is a previously unrecognized risk factor for snoring among adults.
Adult↗
Exposure to ozone gases in pulp mills and the onset of rhinitis.
OBJECTIVE: Rhinitis is a common upper respiratory disease influenced by both genetic and environmental factors. It is also accepted that allergic rhinitis may precede asthma, a disease with more serious consequences. The purpose of this study was to determine whether the risk of noninfectious rhinitis is increased after accidental gassings with ozone among bleachery workers in two pulp mills. METHODS: Bleachery workers (N=120) from two Swedish pulp mills using ozone as their bleaching agent were compared with control workers (N=80) not exposed to ozone in two adjacent paper mills. All of the participants were mailed a respiratory questionnaire that included items about asthma, noninfectious rhinitis, self-reported gassings, and smoking. Hazard ratios (HR) were calculated with proportional hazards regression models. RESULTS: The bleachery workers who reported gassings from ozone were found to be at increased risk of noninfectious rhinitis [HR 3.4, 95% confidence interval (95% CI) 1.3-8.7] when compared with control workers. Bleachery workers without self-reported ozone gassings were not at increased risk (HR 0.9, 95% CI 0.3-2.4). CONCLUSION: Acute exposure to high levels of ozone increases the risk of noninfectious rhinitis. This finding supports the view that peak exposures to irritants should be prevented in pulp mills.
Adult↗
Quality of life in non-infectious rhinitis and asthma.
In this study we evaluated how the quality of life in subjects with asthma was affected by a history of non-infectious rhinitis. The study comprised 180 persons with asthma and 156 controls, who answered the Short Form 36 quality of life questionnaire. Both the asthma subjects and the controls were stratified according to a history of non-infectious rhinitis (NIR). The global physical quality of life score (PCS) was significantly lower for all the asthma subjects regardless of their previous history of NIR compared to controls (NIR positive asthma, -8, p=O,001, NIR negative asthma, -9, p=0, 001). The subjects with asthma and a positive history of NIR obtained significantly lower scores for their global mental quality of life (MCS) than the controls (46 vs 51, p=0.004). The subjects with asthma and a negative history of NIR obtained MCS scores that were similar to those of the controls (50 and 51, p=0.9). In this population based study, the physical Qol of the subjects with asthma was lower regardless of a previous history of NIR compared to controls. A positive history of NIR in asthma was however associated with a poorer mental Qol.
Adult↗
Adult-onset asthma and wheeze among irritant-exposed bleachery workers.
BACKGROUND: Whether new-onset asthma is associated with irritant exposure is unclear. The aim was to investigate if occupational exposure to irritant gases, especially repeated peak exposure (gassings), increased the risk of obstructive airways disease. METHODS: Data on airway symptoms and exposure among bleachery (n = 101) and paper department workers (n = 314) were collected by a questionnaire. Incidence rates and hazard ratios (HR) (Cox regression) were calculated. Non-responders were interviewed by telephone. RESULTS: The incidence rate for adult-onset physician-diagnosed asthma among bleachery workers reporting gassings giving rise to respiratory symptoms was 7.6/10(3) person-years and for those without gassings 2.2/10(3) person-years, compared to 1.0/10(3) person-years for paper workers. In a Cox regression model for asthma (n = 12), stratified for sex, HR for gassings were 5.6 (95% confidence intervals (CI) 1.6-20), for hay fever 3.0 (95% CI 0.8-11), and for ever smoking 0.7 (95% CI 0.2-2.4). The same model for adult-onset wheeze gave HR of 5.2 (95% CI 2.2-12), 1.7 (95% CI 0.6-5.4), and 1.1 (95% CI 0.5-2.7), respectively. CONCLUSIONS: Repeated peak exposure to irritant gases, here studied as gassings in the pulp industry, increased the risk for both adult-onset asthma and wheeze.
Adult↗
Testicular cancer among Swedish pulp and paper workers.
BACKGROUND: The incidence of testicular cancer has increased in recent decades. The aims of the present study were to elucidate whether Swedish paper and pulp mill workers had an increased incidence of testicular cancer, and to investigate whether certain occupational groups within the pulp and paper mill workforce were at increased risk. METHODS: The study was based on the Swedish Cancer Environment Register, which links the incidence of cancer for the period 1971-1990 with 1960 and 1970 National Census data on specific industries and occupations for all employed subjects in Sweden. RESULTS: Among maintenance workers employed both in 1960 and in 1970 in paper mills there was an increased risk for testicular cancer (standardized incidence ratio (SIR) 7.4, 95% confidence intervals (CI) 1.5-22), especially for seminomas (SIR 10.1, 95% CI 2.1-29). Maintenance workers were also at increased risk when analyzing workers employed in 1960, 1970, or both years. CONCLUSIONS: This study indicates an increased risk for testicular cancer, especially seminomas, among maintenance workers, but not among process workers, in Swedish paper mills.
Cohort Studies↗
The incidence of respiratory symptoms in female Swedish hairdressers.
BACKGROUND: Airway diseases in hairdressers are a concern. The objective of this investigation is to evaluate the risk for three respiratory symptoms, wheeze, dry cough, and nasal blockage, in hairdressers. METHODS: A questionnaire on respiratory symptoms, atopy, smoking, and work history was answered by 3,957 female hairdressers and 4,905 women from the general population as referents. Incidence rates (IR) and incidence rate ratios (IRRs) for the three symptoms were estimated. RESULTS: The IRs of all three studied symptoms were higher in the hairdressers compared with the referents. Smoking modified the effects of cohort affiliation for all three symptoms; the combined effect from hairdressing work and smoking was less than expected. In addition, the effect of cohort affiliation for wheeze was also modified by atopy, and the effect of cohort affiliation for nasal blockage was also modified by calendar year. CONCLUSIONS: Hairdressing work was associated with increased incidences of respiratory symptoms. Smoking had a negative modifying effect.
Adult↗