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Accuracy of GFR estimating equations combining standardized cystatin C and creatinine assays: a cross-sectional study in Sweden.

https://arctichealth.org/en/permalink/ahliterature270880
Source
Clin Chem Lab Med. 2015 Feb;53(3):403-14
Publication Type
Article
Date
Feb-2015
Author
Jonas Björk
Anders Grubb
Anders Larsson
Lars-Olof Hansson
Mats Flodin
Gunnar Sterner
Veronica Lindström
Ulf Nyman
Source
Clin Chem Lab Med. 2015 Feb;53(3):403-14
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Biomarkers - blood
Cohort Studies
Creatinine - blood
Cross-Sectional Studies
Cystatin C - blood
Female
Glomerular Filtration Rate
Humans
Male
Middle Aged
Renal Insufficiency, Chronic - blood - epidemiology
Sweden - epidemiology
Young Adult
Abstract
The recently established international cystatin C calibrator makes it possible to develop non-laboratory specific glomerular filtration rate (GFR) estimating (eGFR) equations. This study compares the performance of the arithmetic mean of the revised Lund-Malmö creatinine and CAPA cystatin C equations (MEANLM-REV+CAPA), the arithmetic mean of the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) creatinine and cystatin C equations (MEANCKD-EPI), and the composite CKD-EPI equation (CKD-EPICREA+CYSC) with the corresponding single marker equations using internationally standardized calibrators for both cystatin C and creatinine.
The study included 1200 examinations in 1112 adult Swedish patients referred for measurement of GFR (mGFR) 2008-2010 by plasma clearance of iohexol (median 51 mL/min/1.73 m2). Bias, precision (interquartile range, IQR) and accuracy (percentage of estimates ±30% of mGFR; P30) were compared.
Combined marker equations were unbiased and had higher precision and accuracy than single marker equations. Overall results of MEANLM-REV+CAPA/MEANCKD-EPI/CKD-EPICREA+CYSC were: median bias -2.2%/-0.5%/-1.6%, IQR 9.2/9.2/8.8 mL/min/1.73 m2, and P30 91.3%/91.0%/91.1%. The P30 figures were about 7-14 percentage points higher than the single marker equations. The combined equations also had a more stable performance across mGFR, age and BMI intervals, generally with P30 =90% and never
PubMed ID
25274955 View in PubMed
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Accuracy of GFR estimating equations in a large Swedish cohort: implications for radiologists in daily routine and research.

https://arctichealth.org/en/permalink/ahliterature280255
Source
Acta Radiol. 2017 Mar;58(3):367-375
Publication Type
Article
Date
Mar-2017
Author
Ulf Nyman
Anders Grubb
Veronica Lindström
Jonas Björk
Source
Acta Radiol. 2017 Mar;58(3):367-375
Date
Mar-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cohort Studies
Contrast Media - pharmacokinetics
Female
Glomerular Filtration Rate - physiology
Humans
Iohexol - pharmacokinetics
Kidney Function Tests - methods - statistics & numerical data
Male
Middle Aged
Radiologists
Radiology
Reproducibility of Results
Research
Sweden
Young Adult
Abstract
Background Guidelines recommend estimation of glomerular filtration rate (eGFR) prior to iodine contrast media (CM) examinations. It is also recommended that absolute eGFR in mL/min, not commonly used relative GFR (adjusted to body surface area; mL/min/1.73?m(2)), should be preferred when dosing and evaluating toxicity of renally excreted drugs. Purpose To validate the absolute Lund-Malmö equation (LM-ABS) in comparison with the absolute Cockcroft-Gault (CG) equation and the relative equations, revised Lund-Malmö (LM-REV), MDRD, and CKD-EPI, after converting relative estimates to absolute values, and to analyze change in eGFR classification when absolute instead of relative eGFR was used. Material and Methods A total of 3495 plasma clearance of iohexol to measure GFR (mGFR) served as reference test. Bias, precision, and accuracy (percentage of estimates ±30% of mGFR; P30) were compared overall and after stratification for various mGFR, eGFR, age, and BMI subgroups. Results The overall P30 results of CG/LM-ABS/LM-REV/MDRD/CKD-EPI were 62.8%/84.9%/83.7%/75.3%/75.6%, respectively. LM-ABS was the most stable equations across subgroups and the only equation that did not exhibit marked overestimation in underweight patients. For patients with relative eGFR 30-44 and 45-59?mL/min/1.73?m(2), 36% and 58% of men, respectively, and 24% and 32% of women, respectively, will have absolute eGFR values outside these relative eGFR intervals. Conclusion Choosing one equation to estimate GFR prior to contrast medium examinations, LM-ABS may be preferable. Unless absolute instead of relative eGFR are used, systematic inaccuracies in assessment of renal function may occur in daily routine and research on CM nephrotoxicity may be flawed.
PubMed ID
27166345 View in PubMed
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Adult asthma and traffic exposure at residential address, workplace address, and self-reported daily time outdoor in traffic: A two-stage case-control study.

https://arctichealth.org/en/permalink/ahliterature139159
Source
BMC Public Health. 2010;10:716
Publication Type
Article
Date
2010
Author
Anna Lindgren
Jonas Björk
Emilie Stroh
Kristina Jakobsson
Author Affiliation
Department of Occupational and Environmental Medicine, Lund University, Sweden. anna.lindgren@med.lu.se
Source
BMC Public Health. 2010;10:716
Date
2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Air Pollution - adverse effects
Asthma - epidemiology - physiopathology
Cross-Sectional Studies
Environmental Exposure - adverse effects
Female
Geographic Information Systems
Humans
Male
Middle Aged
Residence Characteristics
Sweden - epidemiology
Transportation
Young Adult
Abstract
Most epidemiologic studies use traffic at residential address as a surrogate for total traffic exposure when investigating effects of traffic on respiratory health. This study used GIS (Geographical Information Systems) to estimate traffic exposure, not only on residential, but also on workplace address, in addition to survey questions on time spent in traffic during commuting or other daily activities.The aim was to investigate 1) if there is an association between traffic exposure and prevalence of adult asthma and asthma symptoms, and 2) if so, does this association become stronger using more complete traffic exposure information.
This study was conducted in two stages: A first cross-sectional survey in Southern Sweden 2004 (n = 24819, 18-80 years, response rate 59%) was followed by a case-control study in 2005 to obtain more detailed exposure and confounder information (n = 2856, asthmatics and controls (1:3), 86% response rate). In the first survey, only residential address was known. In the second survey, questions about workplace addresses and daily time spent in traffic were also included. Residential and workplace addresses were geocoded and linked with GIS to road data and dispersion modelled outdoor concentrations of NOx (annual mean, 250 × 250 m resolution).
Living within 50 m of a road (measured by GIS) with traffic intensity of >10 cars/minute (compared with no road within this distance) was associated with an increased prevalence of asthma, (OR = 1.8, 95% CI = (1.1-2.8), and with asthma symptoms last 12 months. No statistically significant effects were seen for traffic exposure at workplace address, daily time spent in traffic, or commuting time to work, after adjustment for confounders. A combined total exposure estimate did not give a stronger association with asthma prevalence or asthma symptoms.
Traffic exposure at close proximity to residential address showed association with asthma prevalence and asthma symptoms last 12 months, among adults in southern Sweden. The associations were not stronger when accounting for total traffic exposure. This could reflect exposure misclassfication at workplace address and for other daily time in traffic, but also that residential address remains the main determinant for traffic exposure among adults.
Notes
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PubMed ID
21092159 View in PubMed
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Annoyance, sleep and concentration problems due to combined traffic noise and the benefit of quiet side.

https://arctichealth.org/en/permalink/ahliterature272613
Source
Int J Environ Res Public Health. 2015 Feb;12(2):1612-28
Publication Type
Article
Date
Feb-2015
Author
Theo Bodin
Jonas Björk
Jonas Ardö
Maria Albin
Source
Int J Environ Res Public Health. 2015 Feb;12(2):1612-28
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anger
Attention
Female
Geographic Information Systems
Health Surveys
Housing
Humans
Male
Middle Aged
Noise, Transportation - adverse effects - prevention & control
Risk Reduction Behavior
Sleep
Sweden
Abstract
Access to a quiet side in one's dwelling is thought to compensate for higher noise levels at the most exposed façade. It has also been indicated that noise from combined traffic sources causes more noise annoyance than equal average levels from either road traffic or railway noise separately.
2612 persons in Malmö, Sweden, answered to a residential environment survey including questions on outdoor environment, noise sensitivity, noise annoyance, sleep quality and concentration problems. Road traffic and railway noise was modeled using Geographic Information System.
Access to a quiet side, i.e., at least one window facing yard, water or green space, was associated with reduced risk of annoyance OR (95%CI) 0.47 (0.38-0.59), and concentration problems 0.76 (0.61-0.95). Bedroom window facing the same environment was associated to reduced risk of reporting of poor sleep quality 0.78 (0.64-1.00). Railway noise was associated with reduced risk of annoyance below 55 dB(A) but not at higher levels of exposure.
Having a window facing a yard, water or green space was associated to a substantially reduced risk of noise annoyance and concentration problems. If this window was the bedroom window, sleeping problems were less likely.
Notes
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PubMed ID
25642690 View in PubMed
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Area-aggregated assessments of perceived environmental attributes may overcome single-source bias in studies of green environments and health: results from a cross-sectional survey in southern Sweden.

https://arctichealth.org/en/permalink/ahliterature137891
Source
Environ Health. 2011;10(1):4
Publication Type
Article
Date
2011
Author
Kim de Jong
Maria Albin
Erik Skärbäck
Patrik Grahn
John Wadbro
Juan Merlo
Jonas Björk
Author Affiliation
Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
Source
Environ Health. 2011;10(1):4
Date
2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Bias (epidemiology)
Cross-Sectional Studies
Environment
Female
Geographic Information Systems
Health Surveys
Humans
Male
Middle Aged
Models, Econometric
Public Health
Public Opinion
Residence Characteristics
Sweden
Young Adult
Abstract
Most studies assessing health effects of neighborhood characteristics either use self-reports or objective assessments of the environment, the latter often based on Geographical Information Systems (GIS). While objective measures require detailed landscape data, self-assessments may yield confounded results. In this study we demonstrate how self-assessments of green neighborhood environments aggregated to narrow area units may serve as an appealing compromise between objective measures and individual self-assessments.
The study uses cross-sectional data (N = 24,847) from a public health survey conducted in the county of Scania, southern Sweden, in 2008 and validates the Scania Green Score (SGS), a new index comprising five self-reported green neighborhood qualities (Culture, Lush, Serene, Spacious and Wild). The same qualities were also assessed objectively using landscape data and GIS. A multilevel (ecometric) model was used to aggregate individual self-reports to assessments of perceived green environmental attributes for areas of 1,000 square meters. We assessed convergent and concurrent validity for self-assessments of the five items separately and for the sum score, individually and area-aggregated.
Correlations between the index scores based on self-assessments and the corresponding objective assessments were clearly present, indicating convergent validity, but the agreement was low. The correlation was even more evident for the area-aggregated SGS. All three scores (individual SGS, area-aggregated SGS and GIS index score) were associated with neighborhood satisfaction, indicating concurrent validity. However, while individual SGS was associated with vitality, this association was not present for aggregated SGS and the GIS-index score, suggesting confounding (single-source bias) when individual SGS was used.
Perceived and objectively assessed qualities of the green neighborhood environment correlate but do not agree. An index score based on self-reports but aggregated to narrow area units can be a valid approach to assess perceived green neighborhood qualities in settings where objective assessments are not possible or feasible.
Notes
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PubMed ID
21235826 View in PubMed
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Asthma incidence in children growing up close to traffic: a registry-based birth cohort.

https://arctichealth.org/en/permalink/ahliterature261662
Source
Environ Health. 2013;12:91
Publication Type
Article
Date
2013
Author
Anna Lindgren
Emilie Stroh
Jonas Björk
Kristina Jakobsson
Source
Environ Health. 2013;12:91
Date
2013
Language
English
Publication Type
Article
Keywords
Air Pollutants - toxicity
Asthma - chemically induced - epidemiology
Child
Child, Preschool
Cohort Studies
Environmental Exposure
Female
Humans
Incidence
Infant
Male
Nitrogen Oxides - toxicity
Respiratory Sounds - etiology
Sweden - epidemiology
Vehicle Emissions - toxicity
Abstract
Recent reviews conclude an association between traffic-related pollution and incidence of asthma in children, but not all studies agree. Studies have almost exclusively relied on parental-reported symptoms or parental-reported diagnoses of asthma and wheeze. Our aim was to investigate if traffic exposure is associated with higher incidence of early onset asthma, using registry-based outcome data.
We investigated a birth cohort in southern Sweden, consisting of N = 26,128 children with outcome and exposure data (born July 2005-2010). Of these children, N = 7898 had additional covariate information. The cohort was followed to the end of 2011.Traffic intensity, and dispersion-modeled concentrations of NOX (100×100 m grid), at residential addresses, were linked with registry data on dispensed asthma medication (the Swedish Prescribed Drug Register), and hospital and primary health care diagnoses of bronchiolitis, obstructive bronchitis and asthma (The Scania Health Care Register).Covariate information was obtained from questionnaires distributed to parents at Child Health Care-centre visits, eight months after birth. Cox proportional hazards regression was used for the statistical analyses.
Living in close proximity to a road with =8640 cars/day (compared to 0-8640 cars/day), was not associated with higher incidence of first purchase of inhaled ß2-agonist (adjusted hazard ratio (adj.HR) = 0.9, 95% CI: 0.8-1.0); third year purchase of inhaled ß2-agonist (adj.HR = 0.7, 95% CI: 0.6-0.9); bronchiolitis (adj.HR = 0.7, 95% CI: 0.6-0.9), obstructive bronchitis (adj.HR = 1.0, 95% CI: 0.9-1.2), or asthma (adj.HR = 0.7, 95% CI: 0.6- 0.9). Similar results were found for inhaled corticosteroids, and in relation to NOX.
Traffic-related exposure was not associated with higher incidence of asthma medication, or diagnoses of asthma, bronchiolitis, or obstructive bronchitis, in children 0-6 years in southern Sweden. This may depend on the low levels of traffic pollution in the area, mainly well below the WHO-guideline for NO2.
Notes
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PubMed ID
24160449 View in PubMed
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Burnout among Swedish school teachers - a cross-sectional analysis.

https://arctichealth.org/en/permalink/ahliterature284781
Source
BMC Public Health. 2016 Aug 18;16(1):823
Publication Type
Article
Date
Aug-18-2016
Author
Inger Arvidsson
Carita Håkansson
Björn Karlson
Jonas Björk
Roger Persson
Source
BMC Public Health. 2016 Aug 18;16(1):823
Date
Aug-18-2016
Language
English
Publication Type
Article
Keywords
Adult
Burnout, Professional - psychology
Cross-Sectional Studies
Fatigue - psychology
Female
Humans
Job Satisfaction
Male
Middle Aged
Multivariate Analysis
Poisson Distribution
Risk factors
School Teachers - psychology
Self Efficacy
Surveys and Questionnaires
Sweden
Abstract
Teachers are at high risk of stress-related disorders. This study aimed to examine the occurrence of burnout in a sample of Swedish school-teachers, to test a combined measure of three burnout dimensions on the individual level, to characterize associations between burnout and factors encountered during work and leisure time, and to explore any differences between the genders.
A questionnaire of occupational, sociodemographic and life-style factors was answered by 490 teachers in school years 4-9. Outcome measures were (a) the single burnout dimensions of exhaustion, cynicism and professional efficacy (Maslach Burnout Inventory-General Survey), and (b) a combined measure based on high or low values in the three dimensions. The combined measure was used to stratify the study population into four levels (0-3) of burnout. Multivariable Poisson regression was applied on level 2?+?3 vs. level 0?+?1, for variables that we considered as relevant risk factors for burn out.
Half of the teachers reported low values in all three dimensions (level 0), whereas 15 were classified as having high burnout in at least two out of the three dimensions (level 2?+?3), and 4?% in all three dimensions (level 3). Almost all psychosocial factors were incrementally more unfavourably reported through the rising levels of burnout, and so were dissatisfaction with the computer workstation, pain, sleep problems and lack of personal recovery. There was no association between gender and rising levels of overall burnout (p?>?0.30). Low self-efficacy, poor leadership, high job demands and teaching in higher grades were the variables most clearly associated with burnout in multivariable Poisson regression.
Even if circa 50?% of the teachers appear do well with respect to burnout, the results points to the need of implementing multifaceted countermeasures that may serve to reduce burnout.
Notes
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PubMed ID
27539073 View in PubMed
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Cancer incidence and mortality in Swedish sterilant workers exposed to ethylene oxide: updated cohort study findings 1972-2006.

https://arctichealth.org/en/permalink/ahliterature132806
Source
Int J Environ Res Public Health. 2011 Jun;8(6):2009-19
Publication Type
Article
Date
Jun-2011
Author
Zoli Mikoczy
Håkan Tinnerberg
Jonas Björk
Maria Albin
Author Affiliation
Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, and Occupational and Environmental Medicine, Skåne University Hospital, SE-221 85 Lund, Sweden. zoli.mikoczy@med.lu.se
Source
Int J Environ Res Public Health. 2011 Jun;8(6):2009-19
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Cohort Studies
Confidence Intervals
Disinfectants - toxicity
Ethylene Oxide - toxicity
Female
Humans
Incidence
Male
Middle Aged
Neoplasms - mortality
Occupational Exposure - adverse effects - analysis
Sweden - epidemiology
Abstract
To assess whether cancer incidence, mainly from lymphohaematopoietic tumours and breast cancer, and mortality were increased in a cohort of Swedish sterilant workers exposed to low levels of ethylene oxide (EtO), updated with 16 more years of follow up.
The mortality and cancer incidence 1972-2006 experienced by a cohort of 2,171 male and female workers employed for at least one year in two plants producing medical equipment sterilised with EtO were investigated. Individual cumulative exposure to EtO was assessed by occupational hygienists. Cause-specific standardized rate ratios were calculated using the regional general population as a comparison for mortality (SMR) and cancer incidence (SIR). Internal Poisson-regression analyses were performed for selected causes.
The median cumulative exposure to EtO was 0.13 ppm-years. The overall cancer incidence was close to unity (SIR 0.94, 95% CI 0.82-1.08). Eighteen cases of lymphohaematopoietic cancer were observed (SIR 1.25, 95% CI 0.74-1.98). A healthy worker effect was indicated from a significantly decreased overall mortality and mortality from cardiovascular diseases. Internal analyses found significantly increased rate ratios for breast cancer for the two upper quartiles of cumulative exposure as compared to the lowest 50% of the cohort (IRR 2.76, 95% CI 1.20-6.33 and IRR 3.55, 95% CI 1.58-7.93).
The findings from this updated study indicate limited or low risks for human cancer due to occupational exposure from ethylene oxide at the low cumulative exposure levels in this cohort. However a positive exposure-response relation with breast cancer was observed though.
Notes
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PubMed ID
21776215 View in PubMed
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The CKD-EPI and MDRD equations to estimate GFR. Validation in the Swedish Lund-Malmö Study cohort.

https://arctichealth.org/en/permalink/ahliterature138119
Source
Scand J Clin Lab Invest. 2011 Apr;71(2):129-38
Publication Type
Article
Date
Apr-2011
Author
Ulf Nyman
Anders Grubb
Gunnar Sterner
Jonas Björk
Author Affiliation
University of Lund, Department of Radiology, Lasarettet Trelleborg, Trelleborg, Sweden. ulf.nyman@skane.se
Source
Scand J Clin Lab Invest. 2011 Apr;71(2):129-38
Date
Apr-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Bias (epidemiology)
Body mass index
Child
Child, Preschool
Cohort Studies
Diet
Female
Glomerular Filtration Rate - physiology
Humans
Kidney Failure, Chronic - epidemiology - physiopathology
Male
Middle Aged
Sweden
Young Adult
Abstract
To compare the recently developed CKD-EPI equation to estimate GFR in adult Swedish-Caucasians with the MDRD equation.
Swedish-Caucasians (N = 850, 376 females; median age 60, range 5-95 years) referred for plasma iohexol-clearance (median 55, range 5-223 mL/min/1.73 m²) constituted the Lund-Malmö Study cohort. Bias, precision (interquartile range, IQR, of the differences between estimated and measured GFR), accuracy expressed as percentage of estimates ±10% (P10) and ±30% (P30) of measured GFR, and classification ability for five GFR stages
PubMed ID
21208031 View in PubMed
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