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Acute fatal effects of short-lasting extreme temperatures in Stockholm, Sweden: evidence across a century of change.

https://arctichealth.org/en/permalink/ahliterature107127
Source
Epidemiology. 2013 Nov;24(6):820-9
Publication Type
Article
Date
Nov-2013
Author
Daniel Oudin Åström
Bertil Forsberg
Sören Edvinsson
Joacim Rocklöv
Author Affiliation
From the aDepartment of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden; bAgeing and Living Conditions Programme, Umeå University, Umeå, Sweden; cCentre for Population Studies, Umeå University, Umeå, Sweden; and dDepartment of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Source
Epidemiology. 2013 Nov;24(6):820-9
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Child
Child, Preschool
Extreme Cold - adverse effects
Extreme Heat - adverse effects
Female
Humans
Infant
Male
Middle Aged
Mortality - trends
Risk
Sex Distribution
Sweden - epidemiology
Time Factors
Young Adult
Abstract
Climate change is projected to increase the frequency of extreme weather events. Short-term effects of extreme hot and cold weather and their effects on mortality have been thoroughly documented, as have epidemiologic and demographic changes throughout the 20th century. We investigated whether sensitivity to episodes of extreme heat and cold has changed in Stockholm, Sweden, from the beginning of the 20th century until the present.
We collected daily mortality and temperature data for the period 1901-2009 for present-day Stockholm County, Sweden. Heat extremes were defined as days for which the 2-day moving average of mean temperature was above the 98th percentile; cold extremes were defined as days for which the 26-day moving average was below the 2nd percentile. The relationship between extreme hot/cold temperatures and all-cause mortality, stratified by decade, sex, and age, was investigated through time series modeling, adjusting for time trends.
Total daily mortality was higher during heat extremes in all decades, with a declining trend over time in the relative risk associated with heat extremes, leveling off during the last three decades. The relative risk of mortality was higher during cold extremes for the entire period, with a more dispersed pattern across decades. Unlike for heat extremes, there was no decline in the mortality with cold extremes over time.
Although the relative risk of mortality during extreme temperature events appears to have fallen, such events still pose a threat to public health.
PubMed ID
24051892 View in PubMed
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Air Pollution and Dispensed Medications for Asthma, and Possible Effect Modifiers Related to Mental Health and Socio-Economy: A Longitudinal Cohort Study of Swedish Children and Adolescents.

https://arctichealth.org/en/permalink/ahliterature291426
Source
Int J Environ Res Public Health. 2017 11 16; 14(11):
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
11-16-2017
Author
Anna Oudin
Lennart Bråbäck
Daniel Oudin Åström
Bertil Forsberg
Author Affiliation
Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden. anna.oudin@umu.se.
Source
Int J Environ Res Public Health. 2017 11 16; 14(11):
Date
11-16-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Air Pollutants - analysis
Air Pollution - analysis
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy
Child
Child, Preschool
Cohort Studies
Female
Humans
Logistic Models
Longitudinal Studies
Male
Mental health
Nitrogen Dioxide - analysis
Odds Ratio
Social Class
Socioeconomic Factors
Sweden
Abstract
It has been suggested that children that are exposed to a stressful environment at home have an increased susceptibility for air pollution-related asthma. The aim here was to investigate the association between air pollution exposure and asthma, and effect modification by mental health and by socio-economic status (as markers of a stressful environment). All individuals under 18 years of age in four Swedish counties during 2007 to 2010 (1.2 million people) were included. The outcome was defined as dispensing at least two asthma medications during follow up. We linked data on NO2 from an empirical land use regression to data from national registers on outcome and potential confounders. Data was analyzed with logistic regression. There was an odds ratio (OR) of 1.02 (95% Confidence Interval (CI: 1.01-1.03) for asthma associated with a 10 µg·m-3 increase in NO2. The association only seemed to be present in areas where NO2 was higher than 15 µg·m-3 with an OR of 1.09 (95% CI: 1.07-1.12), and the association seemed stronger in children with parents with a high education, OR = 1.05 (95% CI: 1.02-1.09) and OR = 1.04 (95% CI: 1.01-1.07) in children to mothers and father with a high education, respectively. The association did not seem to depend on medication history of psychiatric disorders. There was weak evidence for the association between air pollution and asthma to be stronger in neighborhoods with higher education levels. In conclusion, air pollution was associated with dispensed asthma medications, especially in areas with comparatively higher levels of air pollution, and in children to parents with high education. We did not observe support for our hypothesis that stressors linked to socio-economy or mental health problems would increase susceptibility to the effects of air pollution on the development of asthma.
Notes
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PubMed ID
29144419 View in PubMed
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Air pollution, physical activity and ischaemic heart disease: a prospective cohort study of interaction effects.

https://arctichealth.org/en/permalink/ahliterature311484
Source
BMJ Open. 2021 Apr 13; 11(4):e040912
Publication Type
Journal Article
Date
Apr-13-2021
Author
Wasif Raza
Benno Krachler
Bertil Forsberg
Johan Nilsson Sommar
Author Affiliation
Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umea, Sweden wasif.raza@umu.se.
Source
BMJ Open. 2021 Apr 13; 11(4):e040912
Date
Apr-13-2021
Language
English
Publication Type
Journal Article
Abstract
To assess a possible interaction effect between physical activity and air pollution on first incidence of ischaemic heart disease (IHD).
Prospective cohort study.
Umeå, Northern Sweden.
We studied 34?748 adult participants of Västerbotten Intervention Programme cohort from 1990 to January 2014. Annual particulate matter concentrations (PM2.5 and PM10) at the participants' residential addresses were modelled and a questionnaire on frequency of exercise and active commuting was completed at baseline. Cox proportional hazards modelling was used to estimate (1) association with physical activity at different levels of air pollution and (2) the association with particulate matter at different levels of physical activity.
First incidence of IHD.
Over a mean follow-up of 12.4 years, there were 1148 IHD cases. Overall, we observed an increased risk of IHD among individuals with higher concentrations of particles at their home address. Exercise at least twice a week was associated with a lower risk of IHD among participants with high residential PM2.5 (hazard ratio (HR) 0.60; 95%?CI: 0.44 to 0.82) and PM10 (HR 0.55; 95%?CI: 0.4 to 0.76). The same beneficial effect was not observed with low residential PM2.5 (HR 0.94; 95%?CI: 0.72 to 1.22) and PM10 (HR 0.99; 95%?CI: 0.76 to 1.29). An increased risk associated with higher long-term exposure to particles was only observed among participants that exercised in training clothes at most one a week and among those not performing any active commuting. However, only the interaction effect on HRs for exercise was statistically significant.
Exercise was associated with a lower risk of first incidence of IHD among individuals with higher residential particle concentrations. An air pollution-associated risk was only observed among those who exercised less. The findings support the promotion of physical activity and a mitigation of air pollution.
PubMed ID
33849846 View in PubMed
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An investigation on the use of snus and its association with respiratory and sleep-related symptoms: a cross-sectional population study.

https://arctichealth.org/en/permalink/ahliterature291181
Source
BMJ Open. 2017 May 29; 7(5):e015486
Publication Type
Journal Article
Date
May-29-2017
Author
Arna Ýr Gudnadóttir
Inga Sif Ólafsdóttir
Roelinde Middelveld
Linda Ekerljung
Bertil Forsberg
Karl Franklin
Eva Lindberg
Christer Janson
Author Affiliation
Deparment of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
Source
BMJ Open. 2017 May 29; 7(5):e015486
Date
May-29-2017
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Asthma - epidemiology - etiology
Cross-Sectional Studies
Female
Humans
Logistic Models
Male
Middle Aged
Risk factors
Sex Distribution
Sleep Wake Disorders - epidemiology - etiology
Smoking
Snoring - epidemiology - etiology
Surveys and Questionnaires
Sweden - epidemiology
Tobacco Use Disorder - epidemiology
Tobacco, Smokeless - adverse effects
Young Adult
Abstract
Studies of the health effects of moist oral tobacco, snus, have produced inconsistent results. The main objective of this study is to examine the health effects of snus use on asthma, respiratory symptoms and sleep-related problems, a field that has not been investigated before.
This cross-sectional study was based on a postal questionnaire completed by 26?697 (59.3%) participants aged 16 to 75 years and living in Sweden. The questionnaire included questions on tobacco use, asthma, respiratory symptoms and sleeping problems. The association of snus use with asthma, respiratory symptoms and sleep-related symptoms was mainly tested in never-smokers (n=16?082).
The current use of snus in never-smokers was associated with an increased risk of asthma (OR 1.51 (95%?CI 1.28 to 1.77)), asthmatic symptoms, chronic bronchitis and chronic rhinosinusitis. This association was not present among ex-snus users. Snoring was independently related to both the former and current use of snus ((OR 1.37 (95%?CI 1.12 to 1.68)) and (OR 1.59 (95%?CI 1.34 to 1.89), respectively)). A higher risk of difficulty inducing sleep was seen among snus users.
Snus use was associated with a higher prevalence of asthma, respiratory symptoms and snoring. Healthcare professionals should be aware of these possible adverse effects of snus use.
Notes
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PubMed ID
28554933 View in PubMed
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Association between air pollution from residential wood burning and dementia incidence in a longitudinal study in Northern Sweden.

https://arctichealth.org/en/permalink/ahliterature292308
Source
PLoS One. 2018; 13(6):e0198283
Publication Type
Journal Article
Date
2018
Author
Anna Oudin
David Segersson
Rolf Adolfsson
Bertil Forsberg
Author Affiliation
Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Source
PLoS One. 2018; 13(6):e0198283
Date
2018
Language
English
Publication Type
Journal Article
Abstract
There is highly suggestive evidence for an effect of air pollution exposure on dementia-related outcomes, but evidence is not yet present to clearly pinpoint which pollutants are the probable causal agents. The aims of this study was to assess the longitudinal association between exposures of fine ambient particulate matter (PM2.5) from residential wood burning, and vehicle exhaust, with dementia.
We used data from the Betula study, a longitudinal study of dementia in Umeå, Northern Sweden. The study size was 1 806 and the participants were followed from study entry (1993-1995) to 2010. Modelled levels of source-specific fine particulate matter at the residential address were combined with information on wood stoves or wood boilers, and with validated data on dementia diagnosis and individual-level characteristics from the Betula study. Cox proportional hazards models were used to estimate Hazard Ratios (HRs) and their 95% CIs for dementia incidence (vascular dementia and Alzheimer's disease), adjusted for individual-level characteristics.
The emission of PM2.5 from local residential wood burning was associated with dementia incidence with a hazard ratio of 1.55 for a 1 µg/m3 increase in PM2.5 (95% Confidence Interval (CI): 1.00-2.41, p-value 0.05). Study participants with an address in an area with the highest quartile of PM2.5 from residential wood burning and who also had a wood-burning stove were more likely to develop dementia than those in the lower three quartiles without a wood-burning stove with hazard ratios of 1.74 (CI: 1.10-2.75, p-value 0.018). Particulate matter from traffic exhaust seemed to be associated with dementia incidence with hazard ratios of 1.66, (CI: 1.16-2.39), p-value 0.006, and 1.41 (CI: 0.97-2.23), p-value 0.07, in the third and fourth quartiles, respectively.
If the associations we observed are causal, then air pollution from residential wood burning, and air pollution from traffic, might be independent important risk factors for dementia.
Notes
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PubMed ID
29897947 View in PubMed
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Association between air pollution from residential wood burning and dementia incidence in a longitudinal study in Northern Sweden.

https://arctichealth.org/en/permalink/ahliterature296869
Source
PLoS One. 2018; 13(6):e0198283
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
2018
Author
Anna Oudin
David Segersson
Rolf Adolfsson
Bertil Forsberg
Author Affiliation
Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Source
PLoS One. 2018; 13(6):e0198283
Date
2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Age Distribution
Aged
Aged, 80 and over
Air Pollution - adverse effects - analysis
Dementia - chemically induced - epidemiology
Female
Fires
Housing
Humans
Incidence
Longitudinal Studies
Male
Middle Aged
Particulate Matter - adverse effects - analysis
Risk factors
Sweden - epidemiology
Vehicle Emissions - analysis
Wood - adverse effects - chemistry
Abstract
There is highly suggestive evidence for an effect of air pollution exposure on dementia-related outcomes, but evidence is not yet present to clearly pinpoint which pollutants are the probable causal agents. The aims of this study was to assess the longitudinal association between exposures of fine ambient particulate matter (PM2.5) from residential wood burning, and vehicle exhaust, with dementia.
We used data from the Betula study, a longitudinal study of dementia in Umeå, Northern Sweden. The study size was 1 806 and the participants were followed from study entry (1993-1995) to 2010. Modelled levels of source-specific fine particulate matter at the residential address were combined with information on wood stoves or wood boilers, and with validated data on dementia diagnosis and individual-level characteristics from the Betula study. Cox proportional hazards models were used to estimate Hazard Ratios (HRs) and their 95% CIs for dementia incidence (vascular dementia and Alzheimer's disease), adjusted for individual-level characteristics.
The emission of PM2.5 from local residential wood burning was associated with dementia incidence with a hazard ratio of 1.55 for a 1 µg/m3 increase in PM2.5 (95% Confidence Interval (CI): 1.00-2.41, p-value 0.05). Study participants with an address in an area with the highest quartile of PM2.5 from residential wood burning and who also had a wood-burning stove were more likely to develop dementia than those in the lower three quartiles without a wood-burning stove with hazard ratios of 1.74 (CI: 1.10-2.75, p-value 0.018). Particulate matter from traffic exhaust seemed to be associated with dementia incidence with hazard ratios of 1.66, (CI: 1.16-2.39), p-value 0.006, and 1.41 (CI: 0.97-2.23), p-value 0.07, in the third and fourth quartiles, respectively.
If the associations we observed are causal, then air pollution from residential wood burning, and air pollution from traffic, might be independent important risk factors for dementia.
PubMed ID
29897947 View in PubMed
Less detail

The association between asthma and rhinitis is stable over time despite diverging trends in prevalence.

https://arctichealth.org/en/permalink/ahliterature270044
Source
Respir Med. 2015 Mar;109(3):312-9
Publication Type
Article
Date
Mar-2015
Author
Anders Bjerg
Jonas Eriksson
Inga Sif Ólafsdóttir
Roelinde Middelveld
Karl Franklin
Bertil Forsberg
Kjell Larsson
Kjell Torén
Sven-Erik Dahlén
Christer Janson
Source
Respir Med. 2015 Mar;109(3):312-9
Date
Mar-2015
Language
English
Publication Type
Article
Keywords
Adult
Asthma - epidemiology - etiology
Female
Health Surveys
Humans
Male
Prevalence
Rhinitis, Allergic - epidemiology - etiology
Risk factors
Smoking - adverse effects
Surveys and Questionnaires
Sweden - epidemiology
Abstract
Despite the well-known association between asthma and rhinitis, in Swedish adults the prevalence of rhinitis rose from 22% to 31% between 1990 and 2008 while asthma prevalence was unchanged. We tested whether the association of rhinitis with asthma was stable over time using the same population-based databases.
Two surveys of adults (20-44 years) living in three regions of Sweden, carried out in 1990 (n = 8982) and 2008 (n = 9156) were compared. Identical questions regarding respiratory symptoms, asthma and rhinitis were used. Asthmatic wheeze: Wheeze with breathlessness apart from colds. Current asthma: Asthma attacks and/or asthma medication use.
Subjects with rhinitis had level time trends in asthmatic wheeze, current asthma and most nocturnal respiratory symptoms between 1990 and 2008, adjusted for age, sex, area and smoking. Any wheeze however decreased slightly. In never-smokers asthma symptoms were similarly associated with rhinitis in 1990 and 2008: any wheeze OR 4.0 vs. 4.4 (p = 0.339); asthmatic wheeze OR 6.0 vs. 5.9 (p = 0.937); and current asthma OR 9.6 vs. 7.7 (p = 0.213). In the whole population there were decreases in the asthma symptoms most closely associated to smoking, which decreased by half 1990-2008. Conversely current asthma, which was strongly associated with rhinitis and not with smoking, increased (p
PubMed ID
25638411 View in PubMed
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Association between neighbourhood air pollution concentrations and dispensed medication for psychiatric disorders in a large longitudinal cohort of Swedish children and adolescents.

https://arctichealth.org/en/permalink/ahliterature288095
Source
BMJ Open. 2016 06 03;6(6):e010004
Publication Type
Article
Date
06-03-2016
Author
Anna Oudin
Lennart Bråbäck
Daniel Oudin Åström
Magnus Strömgren
Bertil Forsberg
Source
BMJ Open. 2016 06 03;6(6):e010004
Date
06-03-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Air Pollution - adverse effects
Antipsychotic Agents - therapeutic use
Child
Drug Prescriptions - statistics & numerical data
Environmental Exposure - adverse effects
Environmental monitoring
Female
Follow-Up Studies
Humans
Incidence
Longitudinal Studies
Male
Mental Disorders - drug therapy - epidemiology
Proportional Hazards Models
Social Class
Sweden - epidemiology
Time Factors
Abstract
To investigate associations between exposure to air pollution and child and adolescent mental health.
Observational study.
Swedish National Register data on dispensed medications for a broad range of psychiatric disorders, including sedative medications, sleeping pills and antipsychotic medications, together with socioeconomic and demographic data and a national land use regression model for air pollution concentrations for NO2, PM10 and PM2.5.
The entire population under 18 years of age in 4 major counties. We excluded cohort members whose parents had dispensed a medication in the same medication group since the start date of the register. The cohort size was 552 221.
Cox proportional hazards models to estimate HRs and their 95% CIs for the outcomes, adjusted for individual-level and group-level characteristics.
The average length of follow-up was 3.5 years, with an average number of events per 1000 cohort members of ~21. The mean annual level of NO2 was 9.8 µg/m(3). Children and adolescents living in areas with higher air pollution concentrations were more likely to have a dispensed medication for a psychiatric disorder during follow-up (HR=1.09, 95% CI 1.06 to 1.12, associated with a 10 µg/m(3) increase in NO2). The association with NO2 was clearly present in 3 out of 4 counties in the study area; however, no statistically significant heterogeneity was detected.
There may be a link between exposure to air pollution and dispensed medications for certain psychiatric disorders in children and adolescents even at the relatively low levels of air pollution in the study regions. The findings should be corroborated by others.
Notes
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PubMed ID
27259522 View in PubMed
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Association between precipitation upstream of a drinking water utility and nurse advice calls relating to acute gastrointestinal illnesses.

https://arctichealth.org/en/permalink/ahliterature108558
Source
PLoS One. 2013;8(7):e69918
Publication Type
Article
Date
2013
Author
Andreas Tornevi
Gösta Axelsson
Bertil Forsberg
Author Affiliation
Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. andreas.tornevi@envmed.umu.se
Source
PLoS One. 2013;8(7):e69918
Date
2013
Language
English
Publication Type
Article
Keywords
Drinking Water - analysis
Gastrointestinal Diseases - epidemiology
Humans
Nurses
Rain
Sweden
Water Microbiology
Weather
Abstract
The River Göta Älv is a source of fresh-water for the City of Gothenburg (Sweden). We recently identified a clear association between upstream precipitation and indicator bacteria concentrations in the river water outside the intake to the drinking water utility. This study aimed to determine if variation in the incidence of acute gastrointestinal illnesses is associated with upstream precipitation.
We acquired data, covering 1494 days, on the daily number of telephone calls to the nurse advice line from citizens in Gothenburg living in areas with Göta Älv as a fresh-water supply. We separated calls relating to gastrointestinal illnesses from other medical concerns, and analyzed their association with precipitation using a distributed lag non-linear Poisson regression model, adjusting for seasonal patterns and covariates. We used a 0-21-day lag period for precipitation to account for drinking water delivery times and incubation periods of waterborne pathogens.
The study period contained 25,659 nurse advice calls relating to gastrointestinal illnesses. Heavy rainfall was associated with increased calls the same day and around 5-6 days later. Consecutive days of wet weather were also found to be associated with an increase in the daily number of gastrointestinal concerns. No associations were identified between precipitation and nurse advice calls relating to other medical concerns.
An increase in nurse advice calls relating to gastrointestinal illnesses around 5-6 days after heavy rainfall is consistent with a hypothesis that the cause could be related to drinking water due to insufficient barriers in the drinking water production, suggesting the need for improved drinking water treatment.
Notes
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PubMed ID
23875009 View in PubMed
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The association of drinking water treatment and distribution network disturbances with Health Call Centre contacts for gastrointestinal illness symptoms.

https://arctichealth.org/en/permalink/ahliterature113096
Source
Water Res. 2013 Sep 1;47(13):4474-84
Publication Type
Article
Date
Sep-1-2013
Author
Annika Malm
Gösta Axelsson
Lars Barregard
Jakob Ljungqvist
Bertil Forsberg
Olof Bergstedt
Thomas J R Pettersson
Author Affiliation
Department of Sustainable Waste and Water, City of Gothenburg, Box 123, SE-424 23 Angered, Sweden. annika.malm@kretsloppochvatten.goteborg.se
Source
Water Res. 2013 Sep 1;47(13):4474-84
Date
Sep-1-2013
Language
English
Publication Type
Article
Keywords
Child, Preschool
Drinking Water
Gastrointestinal Diseases - epidemiology
Health Services - statistics & numerical data
Humans
Sweden - epidemiology
Water Purification
Water supply
Abstract
There are relatively few studies on the association between disturbances in drinking water services and symptoms of gastrointestinal (GI) illness. Health Call Centres data concerning GI illness may be a useful source of information. This study investigates if there is an increased frequency of contacts with the Health Call Centre (HCC) concerning gastrointestinal symptoms at times when there is a risk of impaired water quality due to disturbances at water works or the distribution network. The study was conducted in Gothenburg, a Swedish city with 0.5 million inhabitants with a surface water source of drinking water and two water works. All HCC contacts due to GI symptoms (diarrhoea, vomiting or abdominal pain) were recorded for a three-year period, including also sex, age, and geocoded location of residence. The number of contacts with the HCC in the affected geographical areas were recorded during eight periods of disturbances in the water works (e.g. short stops of chlorine dosing), six periods of large disturbances in the distribution network (e.g. pumping station failure or pipe breaks with major consequences), and 818 pipe break and leak repairs over a three-year period. For each period of disturbance the observed number of calls was compared with the number of calls during a control period without disturbances in the same geographical area. In total about 55, 000 calls to the HCC due to GI symptoms were recorded over the three-year period, 35 per 1000 inhabitants and year, but much higher (>200) for children
PubMed ID
23764597 View in PubMed
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