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1. Surviving & Thriving; a healthy lifestyle app for new US firefighters: usability and pilot study protocol

Author

Maria Soledad Hershey, Eleni Bouziani, Xin Yu (Maggie) Chen, Irene Lidoriki, Kishor Hadkhale, Ya-Chin Huang, Theodoros Filippou, José Francisco López-Gil, Anne Katherine Gribble, Fan-Yun Lan, Mercedes Sotos-Prieto, and Stefanos N. Kales

Subjects
lifestyle, digital health interventions, health promotion, field-testing, firefighting, workplace interventions, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

In the United States (US), new firefighters’ fitness and health behaviors deteriorate rapidly after fire academy graduation. Over the long-term, this increases their risks for chronic diseases. This study protocol describes the proposed usability testing and pilot study of a newly designed and developed healthy lifestyle smartphone app, “Surviving & Thriving”, tailored towards young US firefighters. “Surviving & Thriving” will provide interactive educational content on four lifestyle factors; nutrition, sleep, physical activity, and resilience, and include a personalized journey, habit tracker, and elements of gamification to promote engagement and long-term healthy behavior change. The first phase of the app development entails alpha testing by the research team and pre-beta testing by a fire service expert panel which will help refine the app into a pre-consumer version. Upon completion of the full app prototype, beta ‘usability’ testing will be conducted among new fire academy graduates from two New England fire academies to collect qualitative and quantitative feedback via focus groups and satisfaction surveys, respectively. A last phase of piloting the app will evaluate the app’s efficacy at maintaining/improving healthy lifestyle behaviors, mental health metrics, and physical fitness metrics. We will also evaluate whether firefighters’ perceived “health cultures” scores (ratings of each fire station’s/fire department’s environments as to encouraging/discouraging healthy behaviors) modify the changes in health metrics after utilizing the app for three to six months. This novel user-friendly app seeks to help new firefighters maintain/improve their health and fitness more effectively, reducing their risk of lifestyle-related chronic disease. Firefighters who can establish healthy habits early in their careers are more likely to sustain them throughout their lives.

Published
2023
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2. The prevalences and levels of occupational exposure to dusts and/or fibres (silica, asbestos and coal): A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

Author

Vivi Schlünssen, Daniele Mandrioli, Frank Pega, Natalie C. Momen, Balázs Ádám, Weihong Chen, Robert A. Cohen, Lode Godderis, Thomas Göen, Kishor Hadkhale, Watinee Kunpuek, Jianlin Lou, Stefan Mandic-Rajcevic, Federica Masci, Ben Nemery, Madalina Popa, Natthadanai Rajatanavin, Daria Sgargi, Somkiat Siriruttanapruk, Xin Sun, Repeepong Suphanchaimat, Panithee Thammawijaya, Yuka Ujita, Stevie van der Mierden, Katya Vangelova, Meng Ye, Muzimkhulu Zungu, and Paul T.J. Scheepers

Subjects
Silica, Asbestos, Coal dust, Exposure prevalence, Exposure levels, Systematic review, Environmental sciences, GE1-350
Abstract

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large number of individual experts. Evidence from human, animal and mechanistic data suggests that occupational exposure to dusts and/or fibres (silica, asbestos and coal dust) causes pneumoconiosis. In this paper, we present a systematic review and meta-analysis of the prevalences and levels of occupational exposure to silica, asbestos and coal dust. These estimates of prevalences and levels will serve as input data for estimating (if feasible) the number of deaths and disability-adjusted life years that are attributable to occupational exposure to silica, asbestos and coal dust, for the development of the WHO/ILO Joint Estimates. Objectives: We aimed to systematically review and meta-analyse estimates of the prevalences and levels of occupational exposure to silica, asbestos and coal dust among working-age (≥ 15 years) workers. Data sources: We searched electronic academic databases for potentially relevant records from published and unpublished studies, including Ovid Medline, PubMed, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews and included study records; and consulted additional experts. Study eligibility and criteria: We included working-age (≥ 15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (< 15 years) and unpaid domestic workers. We included all study types with objective dust or fibre measurements, published between 1960 and 2018, that directly or indirectly reported an estimate of the prevalence and/or level of occupational exposure to silica, asbestos and/or coal dust. Study appraisal and synthesis methods: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, then data were extracted from qualifying studies. We combined prevalence estimates by industrial sector (ISIC-4 2-digit level with additional merging within Mining, Manufacturing and Construction) using random-effects meta-analysis. Two or more review authors assessed the risk of bias and all available authors assessed the quality of evidence, using the ROB-SPEO tool and QoE-SPEO approach developed specifically for the WHO/ILO Joint Estimates. Results: Eighty-eight studies (82 cross-sectional studies and 6 longitudinal studies) met the inclusion criteria, comprising > 2.4 million measurements covering 23 countries from all WHO regions (Africa, Americas, Eastern Mediterranean, South-East Asia, Europe, and Western Pacific). The target population in all 88 included studies was from major ISCO groups 3 (Technicians and Associate Professionals), 6 (Skilled Agricultural, Forestry and Fishery Workers), 7 (Craft and Related Trades Workers), 8 (Plant and Machine Operators and Assemblers), and 9 (Elementary Occupations), hereafter called manual workers. Most studies were performed in Construction, Manufacturing and Mining. For occupational exposure to silica, 65 studies (61 cross-sectional studies and 4 longitudinal studies) were included with > 2.3 million measurements collected in 22 countries in all six WHO regions. For occupational exposure to asbestos, 18 studies (17 cross-sectional studies and 1 longitudinal) were included with > 20,000 measurements collected in eight countries in five WHO regions (no data for Africa). For occupational exposure to coal dust, eight studies (all cross-sectional) were included comprising > 100,000 samples in six countries in five WHO regions (no data for Eastern Mediterranean). Occupational exposure to silica, asbestos and coal dust was assessed with personal or stationary active filter sampling; for silica and asbestos, gravimetric assessment was followed by technical analysis.Risk of bias profiles varied between the bodies of evidence looking at asbestos, silica and coal dust, as well as between industrial sectors. However, risk of bias was generally highest for the domain of selection of participants into the studies.The largest bodies of evidence for silica related to the industrial sectors of Construction (ISIC 41–43), Manufacturing (ISIC 20, 23–25, 27, 31–32) and Mining (ISIC 05, 07, 08). For Construction, the pooled prevalence estimate was 0.89 (95% CI 0.84 to 0.93, 17 studies, I2 91%, moderate quality of evidence) and the level estimate was rated as of very low quality of evidence. For Manufacturing, the pooled prevalence estimate was 0.85 (95% CI 0.78 to 0.91, 24 studies, I2 100%, moderate quality of evidence) and the pooled level estimate was rated as of very low quality of evidence. The pooled prevalence estimate for Mining was 0.75 (95% CI 0.68 to 0.82, 20 studies, I2 100%, moderate quality of evidence) and the pooled level estimate was 0.04 mg/m3 (95% CI 0.03 to 0.05, 17 studies, I2 100%, low quality of evidence). Smaller bodies of evidence were identified for Crop and animal production (ISIC 01; very low quality of evidence for both prevalence and level); Professional, scientific and technical activities (ISIC 71, 74; very low quality of evidence for both prevalence and level); and Electricity, gas, steam and air conditioning supply (ISIC 35; very low quality of evidence for both prevalence and level).For asbestos, the pooled prevalence estimate for Construction (ISIC 41, 43, 45,) was 0.77 (95% CI 0.65 to 0.87, six studies, I2 99%, low quality of evidence) and the level estimate was rated as of very low quality of evidence. For Manufacturing (ISIC 13, 23–24, 29–30), the pooled prevalence and level estimates were rated as being of very low quality of evidence. Smaller bodies of evidence were identified for Other mining and quarrying (ISIC 08; very low quality of evidence for both prevalence and level); Electricity, gas, steam and air conditioning supply (ISIC 35; very low quality of evidence for both prevalence and level); and Water supply, sewerage, waste management and remediation (ISIC 37; very low quality of evidence for levels).For coal dust, the pooled prevalence estimate for Mining of coal and lignite (ISIC 05), was 1.00 (95% CI 1.00 to 1.00, six studies, I2 16%, moderate quality of evidence) and the pooled level estimate was 0.77 mg/m3 (95% CI 0.68 to 0.86, three studies, I2 100%, low quality of evidence). A small body of evidence was identified for Electricity, gas, steam and air conditioning supply (ISIC 35); with very low quality of evidence for prevalence, and the pooled level estimate being 0.60 mg/m3 (95% CI −6.95 to 8.14, one study, low quality of evidence). Conclusions: Overall, we judged the bodies of evidence for occupational exposure to silica to vary by industrial sector between very low and moderate quality of evidence for prevalence, and very low and low for level. For occupational exposure to asbestos, the bodies of evidence varied by industrial sector between very low and low quality of evidence for prevalence and were of very low quality of evidence for level. For occupational exposure to coal dust, the bodies of evidence were of very low or moderate quality of evidence for prevalence, and low for level. None of the included studies were population-based studies (i.e., covered the entire workers’ population in the industrial sector), which we judged to present serious concern for indirectness, except for occupational exposure to coal dust within the industrial sector of mining of coal and lignite. Selected estimates of the prevalences and levels of occupational exposure to silica by industrial sector are considered suitable as input data for the WHO/ILO Joint Estimates, and selected estimates of the prevalences and levels of occupational exposure to asbestos and coal dust may perhaps also be suitable for estimation purposes.Protocol identifier:https://doi.org/10.1016/j.envint.2018.06.005.PROSPERO registration number:CRD42018084131.

Published
2023
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3. Groundwater radon exposure and risk of lung cancer: A population-based study in Finland

Author

Kishor Hadkhale, Janne Atosuo, and Tuula Putus

Subjects
cancer, exposure, groundwater, lung, radon, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Naturally occurring radioactive elements can be found in groundwater and exposure to such elements is associated with an increased risk of lung cancer. In this study, we aimed to observe the association between exposure to these radioactive elements in groundwater and the risk of lung cancer in selected regions in Finland. This is a population-based study from 1955 to 2019 in Finland. The exposed municipalities with their corresponding hospital districts were selected based on radon measurements at groundwater treatment plants. Lung cancer cases were obtained from the Finnish cancer registry. The 5-year incidence rates for lung cancer were calculated and a comparison was made between each of the hospital districts with radon exposure. More than 93,000 cases of lung cancer were reported in the radon-exposed regions over the examined period of 64 years. The highest number of cases was recorded in the Helsinki University hospital district and the least in the Southern Savo hospital district. Similarly, the lung cancer incidence rate was highest in Lapland and lowest in the Southern Savo hospital district. The number of daily smokers in the working-age population appears to have decreased in all the hospital districts from 2013 to 2018. A statistically significant increased risk of lung cancer was observed in the high radon-exposed hospital districts compared to those with lower exposure. Groundwater radon exposure is observed to be associated with an increased risk of lung cancer.

Published
2022
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4. The effect of occupational exposure to noise on ischaemic heart disease, stroke and hypertension: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-Related Burden of Disease and Injury

Author

Liliane R. Teixeira, Frank Pega, Angel M. Dzhambov, Alicja Bortkiewicz, Denise T. Correa da Silva, Carlos A.F. de Andrade, Elzbieta Gadzicka, Kishor Hadkhale, Sergio Iavicoli, Martha S. Martínez-Silveira, Małgorzata Pawlaczyk-Łuszczyńska, Bruna M. Rondinone, Jadwiga Siedlecka, Antonio Valenti, and Diana Gagliardi

Subjects
Global burden of disease, Systematic review, Noise, Ischaemic heart disease, Stroke, Hypertension, Environmental sciences, GE1-350
Abstract

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large number of individual experts. Evidence from mechanistic data suggests that occupational exposure to noise may cause cardiovascular disease (CVD). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from CVD that are attributable to occupational exposure to noise, for the development of the WHO/ILO Joint Estimates. Objectives: We aimed to systematically review and meta-analyse estimates of the effect of any (high) occupational exposure to noise (≥85 dBA), compared with no (low) occupational exposure to noise (

Published
2021
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5. Life expectancy and disease burden in the Nordic countries: results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Author

Ann Kristin Knudsen, Peter Allebeck, Mette C Tollånes, Jens Christoffer Skogen, Kim Moesgaard Iburg, John J. McGrath, Knud Juel, Emilie Elisabet Agardh, Johan Ärnlöv, Tone Bjørge, Juan J Carrero, Christopher R. Cederroth, Anne Elise Eggen, Ziad El-Khatib, Christian Lycke Ellingsen, Seyed-Mohammad Fereshtehnejad, Mika Gissler, Kishor Hadkhale, Rasmus Havmoeller, Lars Johansson, Peter Benedikt Juliusson, Aliasghar A Kiadaliri, Sezer Kisa, Adnan Kisa, Tea Lallukka, Teferi Mekonnen, Tuomo J Meretoja, Atte Meretoja, Mohsen Naghavi, Subas Neupane, Truc Trung Nguyen, Max Petzold, Oleguer Plana-Ripoll, Rahman Shiri, Rannveig Sigurvinsdottir, Vegard Skirbekk, Søren T Skou, Inga Dora Sigfusdottir, Timothy J Steiner, Gerhard Sulo, Thomas Clement Truelsen, Tommi Juhani Vasankari, Elisabete Weiderpass, Stein Emil Vollset, Theo Vos, and Simon Øverland

Subjects
Public aspects of medicine, RA1-1270
Abstract

Summary: Background: The Nordic countries have commonalities in gender equality, economy, welfare, and health care, but differ in culture and lifestyle, which might create country-wise health differences. This study compared life expectancy, disease burden, and risk factors in the Nordic region. Methods: Life expectancy in years and age-standardised rates of overall, cause-specific, and risk factor-specific estimates of disability-adjusted life-years (DALYs) were analysed in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Data were extracted for Denmark, Finland, Iceland, Norway, and Sweden (ie, the Nordic countries), and Greenland, an autonomous area of Denmark. Estimates were compared with global, high-income region, and Nordic regional estimates, including Greenland. Findings: All Nordic countries exceeded the global life expectancy; in 2017, the highest life expectancy was in Iceland among females (85·9 years [95% uncertainty interval [UI] 85·5–86·4] vs 75·6 years [75·3–75·9] globally) and Sweden among males (80·8 years [80·2–81·4] vs 70·5 years [70·1–70·8] globally). Females (82·7 years [81·9–83·4]) and males (78·8 years [78·1–79·5]) in Denmark and males in Finland (78·6 years [77·8–79·2]) had lower life expectancy than in the other Nordic countries. The lowest life expectancy in the Nordic region was in Greenland (females 77·2 years [76·2–78·0], males 70·8 years [70·3–71·4]). Overall disease burden was lower in the Nordic countries than globally, with the lowest age-standardised DALY rates among Swedish males (18 555·7 DALYs [95% UI 15 968·6–21 426·8] per 100 000 population vs 35 834·3 DALYs [33 218·2–38 740·7] globally) and Icelandic females (16 074·1 DALYs [13 216·4–19 240·8] vs 29 934·6 DALYs [26 981·9–33 211·2] globally). Greenland had substantially higher DALY rates (26 666·6 DALYs [23 478·4–30 218·8] among females, 33 101·3 DALYs [30 182·3–36 218·6] among males) than the Nordic countries. Country variation was primarily due to differences in causes that largely contributed to DALYs through mortality, such as ischaemic heart disease. These causes dominated male disease burden, whereas non-fatal causes such as low back pain were important for female disease burden. Smoking and metabolic risk factors were high-ranking risk factors across all countries. DALYs attributable to alcohol use and smoking were particularly high among the Danes, as was alcohol use among Finnish males. Interpretation: Risk factor differences might drive differences in life expectancy and disease burden that merit attention also in high-income settings such as the Nordic countries. Special attention should be given to the high disease burden in Greenland. Funding: Bill & Melinda Gates Foundation. The work on this paper was supported by the Research Council of Norway through FRIPRO (project number 262030) and by the Norwegian Institute of Public Health.

Published
2019
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6. Cancer and Potential Prevention with Lifestyle among Career Firefighters: A Narrative Review

Author

Amalia Sidossis, Fan-Yun Lan, Maria S. Hershey, Kishor Hadkhale, and Stefanos N. Kales

Subjects
Cancer Research, Oncology
Abstract

Career firefighters are at considerable risk for chronic diseases, including an increased risk of various cancers, compared to the general population. Over the last two decades, several systematic reviews and large cohort studies have demonstrated that firefighters have statistically significant increases in overall and site-specific cancer incidence and site-specific cancer mortality compared to the general population. Exposure assessment and other studies have documented exposures to a variety of carcinogens in fire smoke and within the fire station. Other occupational factors such as shift work, sedentary behavior, and the fire service food culture may also contribute to this working population’s increased cancer risk. Furthermore, obesity and other lifestyle behaviors such as tobacco use, excessive alcohol consumption, poor diet, inadequate physical activity, and short sleep duration have also been associated with an increased risk of certain firefighting-associated cancers. Putative prevention strategies are proposed based on suspected occupational and lifestyle risk factors.

Published
2023

7. Risk factors, epidemiology and prognosis of cholangiocarcinoma in Finland

Author

Kishor Hadkhale, Eero Pukkala, Martti Färkkilä, Nina Barner-Rasmussen, HUS Abdominal Center, Gastroenterologian yksikkö, Centre of Excellence in Complex Disease Genetics, Department of Medicine, Clinicum, University of Helsinki, Tampere University, and Health Sciences

Subjects
Male, Cirrhosis, Gastroenterology, DISEASE, 0302 clinical medicine, Epidemiology, risk factors, Registries, Intrahepatic Cholangiocarcinoma, Finland, POPULATION, Aged, 80 and over, education.field_of_study, Incidence, Incidence (epidemiology), primary sclerosing cholangitis, Middle Aged, Prognosis, 3. Good health, Oncology, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Original Article, epidemiology, cholangiocarcinoma, Adult, medicine.medical_specialty, EXTRAHEPATIC CHOLANGIOCARCINOMA, Population, CANCER-RISK, liver, DIAGNOSIS, Primary sclerosing cholangitis, Young Adult, 03 medical and health sciences, Age Distribution, Internal medicine, parasitic diseases, medicine, MANAGEMENT, Humans, Sex Distribution, education, Aged, business.industry, MORTALITY, Inflammatory Bowel Disease, Odds ratio, medicine.disease, TRENDS, Cancer registry, 3141 Health care science, Bile Ducts, Intrahepatic, Bile Duct Neoplasms, 3121 General medicine, internal medicine and other clinical medicine, Hepatobiliary, business
Abstract

Background: Cholangiocarcinoma (CCA) is a cancer arising from the intra- and extrahepatic bile ducts. The early stages are often asymptomatic, CCA is frequently diagnosed in an advanced stage and the prognosis of CCA is often dismal. Objective: Our objective was to estimate the incidence of CCA in Finland and to identify risk factors for CCA, with a special interest in primary sclerosing cholangitis (PSC). Methods: We identified all CCA cases during 1974–2018 from the Finnish Cancer Registry and calculated age-standardised incidence rates. Five controls for each case were extracted from the Population Registry, matched by age, gender and municipality of residence at the time of diagnosis. Odds ratios (ORs) for risk factors were estimated with conditional logistic regression and survival estimates with the Kaplan–Meier method. Results: Incidence of CCA remained stable in both genders; the age-standardised rate (World Standard) in 2013–2017 in males and females was 1.7 per 100,000 person years and 1.3 per 100,000 person years, respectively. Primary sclerosing cholangitis carried a 30-fold risk of intrahepatic cholangiocarcinoma (iCCA) and 25-fold risk of extrahepatic cholangiocarcinoma (eCCA). Diabetes, inflammatory bowel disease and liver cirrhosis were associated with iCCA, whereas cholelithiasis and viral hepatitis C were associated with eCCA. The cumulative 5-year survival was 4.6%. Conclusions: The incidence of CCA has been stable. Known risk factors for CCA were confirmed, with PSC having the highest OR. Survival remains poor. publishedVersion

Published
2021

8. The effect of occupational exposure to noise on ischaemic heart disease, stroke and hypertension: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-Related Burden of Disease and Injury

Author

Sergio Iavicoli, Denise Torres da Silva, Małgorzata Pawlaczyk-Łuszczyńska, Alicja Bortkiewicz, Antonio Valenti, Liliane Reis Teixeira, Kishor Hadkhale, Bruna Maria Rondinone, Martha Sílvia Martinez-Silveira, Diana Gagliardi, Frank Pega, Carlos Augusto Ferreira de Andrade, Elżbieta Gadzicka, Angel M. Dzhambov, Jadwiga Siedlecka, Tampere University, and Health Sciences

Subjects
Burden of disease, Male, medicine.medical_specialty, Adolescent, Myocardial Ischemia, World Health Organization, Work related, Article, Cost of Illness, Occupational Exposure, medicine, Humans, GE1-350, Stroke, General Environmental Science, Ischaemic heart disease, business.industry, medicine.disease, 3142 Public health care science, environmental and occupational health, 3141 Health care science, Global burden of disease, Environmental sciences, Europe, Occupational Diseases, Meta-analysis, Emergency medicine, Hypertension, Systematic review, Noise, Occupational, Female, Occupational exposure, business, Noise
Abstract

Highlights • WHO and ILO are developing joint estimates of work-related burden of disease and injury. • We systematically reviewed effect of occupational exposure to noise on CVD. • We found 17 eligible studies with 534,688 participants in 11 countries/3 WHO regions. • We are very uncertain about the effect of occupational exposure to noise on CVD., Background The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large number of individual experts. Evidence from mechanistic data suggests that occupational exposure to noise may cause cardiovascular disease (CVD). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from CVD that are attributable to occupational exposure to noise, for the development of the WHO/ILO Joint Estimates. Objectives We aimed to systematically review and meta-analyse estimates of the effect of any (high) occupational exposure to noise (≥85 dBA), compared with no (low) occupational exposure to noise (

Published
2020

9. Vitamin D intake during the first 4 years and onset of asthma by age 5: A nested case-control study

Author

Anna-Maija Haapala, Suvi Ahonen, Jorma Toppari, Kishor Hadkhale, Hanna-Mari Takkinen, Mikael Knip, Riitta Veijola, Onni Niemelä, Jorma Ilonen, Suvi M. Virtanen, Niina Hamalainen, and Bright I Nwaru

Subjects
Adult, Male, Risk, Allergy, Longitudinal study, Pediatrics, medicine.medical_specialty, Immunology, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Surveys and Questionnaires, medicine, Vitamin D and neurology, Humans, Immunology and Allergy, Longitudinal Studies, 030212 general & internal medicine, Vitamin D, Child, Finland, Asthma, Type 1 diabetes, business.industry, Infant, medicine.disease, ta3123, 030228 respiratory system, Case-Control Studies, Child, Preschool, Dietary Supplements, Pediatrics, Perinatology and Child Health, Nested case-control study, Cohort, Female, business
Abstract

Background Early life vitamin D intake has been linked to asthma risk in childhood, but the role of longitudinal vitamin D exposure has not been previously evaluated. We investigated the association between vitamin D intake during the first 4 years of life and asthma risk by age 5. Methods Within a Finnish population-based birth cohort, 182 incident asthma cases were matched to 728 controls on sex, genetic risk for type 1 diabetes, delivery hospital, and time of birth. Vitamin D intake was assessed by age-specific 3-day food records. Parents completed a validated version of the International Study of Asthma and Allergies in Childhood questionnaire at 5 years. Results At 3 months, supplements were the main source of vitamin D intake; intake from foods increased from 3 months on, mainly from fortified milk products. Vitamin D intake at each specific age was associated with an increased risk of any asthma, atopic and non-atopic asthma, but only intake at 1 and 2 years was statistically significantly associated with asthma. Longitudinal vitamin D intake was associated with an increased risk of asthma (OR 1.24; 95%CI 1.00-1.53) Conclusions Increased vitamin D intake in childhood, particularly intake at 1 and 2 years of age, may increase risk of childhood asthma. This might reflect a true effect or residual confounding by lifestyle or environmental factors. Repeated assessment of vitamin D intake allowed evaluation of the longitudinal and age-dependent impact of vitamin D on the risk of asthma. Further longitudinal studies are required to confirm or question these findings. This article is protected by copyright. All rights reserved.

Published
2017

10. Life expectancy and disease burden in the Nordic countries: results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Author

Mette Christophersen Tollånes, Anne Elise Eggen, Aliasghar Ahmad Kiadaliri, Rasmus Havmoeller, Tone Bjørge, Lars Johansson, Inga Dora Sigfusdottir, Jens Christoffer Skogen, Mohsen Naghavi, Vegard Skirbekk, Kim Moesgaard Iburg, John J. McGrath, Truc Trung Nguyen, Knud Juel, Teferi Mekonnen, Atte Meretoja, Mika Gissler, Theo Vos, Gerhard Sulo, Tuomo J. Meretoja, Oleguer Plana-Ripoll, Emilie Agardh, Tea Lallukka, Rannveig Sigurvinsdottir, Thomas Truelsen, Subas Neupane, Ann Kristin Knudsen, Timothy J. Steiner, Christian Lycke Ellingsen, Stein Emil Vollset, Rahman Shiri, Kishor Hadkhale, Tommi Vasankari, Max Petzold, Juan J Carrero, Peter Allebeck, Simon Øverland, Elisabete Weiderpass, Christopher R. Cederroth, Ziad El-Khatib, Seyed-Mohammad Fereshtehnejad, Sezer Kisa, Peter Benedikt Juliusson, Adnan Kisa, Johan Ärnlöv, Søren Thorgaard Skou, Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, Department of Public Health, University Management, University of Helsinki, Institute for Molecular Medicine Finland, Clinicum, Staff Services, HUS Comprehensive Cancer Center, HUS Neurocenter, Department of Neurosciences, and Neurologian yksikkö

Subjects
Male, Heilsufar, Life expectancy, Health Status, Áhættuþættir, Diseases, Global Health, 01 natural sciences, Global Burden of Disease, 0302 clinical medicine, Cause of Death, Delivery of Health Care/economics, Health care, Global health, Medicine, 030212 general & internal medicine, Konur, Life Expectancy/trends, Public health, education.field_of_study, Life expectancies, Sjúkdómar, VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801, lcsh:Public aspects of medicine, Áfengisneysla, Smoking, DEATH, Norðurlandabúar, Men, 3142 Public health care science, environmental and occupational health, Health policy, 3. Good health, Global burden of disease, Nordic countries, Disease burdens, language, Female, Lýðheilsa, TERRITORIES, Alcohol use, Reykingar, Lífshættir, medicine.medical_specialty, Cost Control, Waiting Lists, Population, Norwegian, Scandinavian and Nordic Countries, Article, 03 medical and health sciences, AGE, Life Expectancy, SMOKING PREVALENCE, SYSTEMATIC ANALYSIS, Heilbrigðisstefna, Humans, Women, Cross-cultural comparison, 0101 mathematics, Risk factor, education, Disease burden, Global Burden of Disease/trends, Heilsugæsla, business.industry, MORTALITY, 010102 general mathematics, Klinisk medicin, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Metabolic diseases, Efnaskiptasjúkdómar, language.human_language, Scandinavian and Nordic Countries/epidemiology, Þvermenningarlegur samanburður, Risk factors, Karlar, Life style, Clinical Medicine, VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801, business, Delivery of Health Care, Demography
Abstract

Publisher's version (útgefin grein), Background The Nordic countries have commonalities in gender equality, economy, welfare, and health care, but differ in culture and lifestyle, which might create country-wise health differences. This study compared life expectancy, disease burden, and risk factors in the Nordic region.Methods Life expectancy in years and age-standardised rates of overall, cause-specific, and risk factor-specific estimates of disability-adjusted life-years (DALYs) were analysed in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Data were extracted for Denmark, Finland, Iceland, Norway, and Sweden (ie, the Nordic countries), and Greenland, an autonomous area of Denmark. Estimates were compared with global, high-income region, and Nordic regional estimates, including Greenland.Findings All Nordic countries exceeded the global life expectancy; in 2017, the highest life expectancy was in Iceland among females (85·9 years [95% uncertainty interval [UI] 85·5–86·4] vs 75·6 years [75·3–75·9] globally) and Sweden among males (80·8 years [80·2–81·4] vs 70·5 years [70·1–70·8] globally). Females (82·7 years [81·9–83·4]) and males (78·8 years [78·1–79·5]) in Denmark and males in Finland (78·6 years [77·8–79·2]) had lower life expectancy than in the other Nordic countries. The lowest life expectancy in the Nordic region was in Greenland (females 77·2 years [76·2–78·0], males 70·8 years [70·3–71·4]). Overall disease burden was lower in the Nordic countries than globally, with the lowest age-standardised DALY rates among Swedish males (18 555·7 DALYs [95% UI 15 968·6–21 426·8] per 100 000 population vs 35 834·3 DALYs [33 218·2–38 740·7] globally) and Icelandic females (16 074·1 DALYs [13 216·4–19 240·8] vs 29 934·6 DALYs [26 981·9–33 211·2] globally). Greenland had substantially higher DALY rates (26 666·6 DALYs [23 478·4–30 218·8] among females, 33 101·3 DALYs [30 182·3–36 218·6] among males) than the Nordic countries. Country variation was primarily due to differences in causes that largely contributed to DALYs through mortality, such as ischaemic heart disease. These causes dominated male disease burden, whereas non-fatal causes such as low back pain were important for female disease burden. Smoking and metabolic risk factors were high-ranking risk factors across all countries. DALYs attributable to alcohol use and smoking were particularly high among the Danes, as was alcohol use among Finnish males.Interpretation Risk factor differences might drive differences in life expectancy and disease burden that merit attention also in high-income settings such as the Nordic countries. Special attention should be given to the high disease burden in Greenland., This study was funded by the Bill & Melinda Gates Foundation. The authors wish to thank Jonas Minet Kinge (Norwegian Institute of Public Health, Oslo, Norway) for valuable input regarding socioeconomic differences in life expectancy in the Nordic countries. CRC has received research funding from Svenska Läkaresällskapet (SLS-779681), Tysta Skolan, Hörselforskningsfonden (#503), the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 72204655 and the GENDERNET Co-Plus Fund (GNP-182). JJC acknowledges grant support from the Swedish Research Council (grant number 2019-01059). JMcG is supported by the Danish National Research Foundation (Niels Bohr Professorship), and is employed by The Queensland Centre for Mental Health Research which receives core funding from the Queensland Health. STS is currently funded by a grant from Region Zealand and a grant from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (grant agreement No 801790). OP-R has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 837180. TL is supported by the Academy of Finland (Grant #319200). Where authors are identified as personnel of the International Agency for Research on Cancer/WHO, the authors alone are responsible for the views expressed in this Article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/WHO., "Peer Reviewed"

Published
2019

11. Occupational variation in bladder cancer in Nordic males adjusted with approximated smoking prevalence

Author

Kristina Kjærheim, Laufey Tryggvadottir, Jan Ivar Martinsen, Pär Sparén, Eero Pukkala, Elisabete Weiderpass, Elsebeth Lynge, and Kishor Hadkhale

Subjects
Adult, Male, Lung Neoplasms, MEDLINE, Smoking prevalence, Scandinavian and Nordic Countries, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Occupational Exposure, medicine, Prevalence, Humans, Radiology, Nuclear Medicine and imaging, Risk factor, Bladder cancer, business.industry, Smoking, Hematology, General Medicine, Middle Aged, medicine.disease, Variation (linguistics), Smoking epidemiology, Oncology, Urinary Bladder Neoplasms, 030220 oncology & carcinogenesis, Occupational exposure, business
Abstract

Occupational exposure has been identified as the most important risk factor for bladder cancer second to smoking. The objective of this study was to estimate the occupational variation in risk of bladder cancer that is not attributable to smoking.In the Nordic Occupational Cancer study (NOCCA), 111,458 cases of bladder cancer and 208,297 cases of lung cancer cases were observed among men in Denmark, Finland, Iceland, Norway and Sweden during 1961-2005. Relative smoking prevalence in an occupation was estimated based on standardized incidence ratio (SIR) for lung cancer in the given occupation. Crude and smoking-adjusted SIRs with 95% confidence intervals (CI) for bladder cancer were calculated for each occupation.The smoking-adjusted SIR for most of the occupations was closer to 1.00 than the unadjusted SIR. The highest statistically significant smoking-adjusted SIRs were observed among chimney sweeps (SIR 1.29, 95% CI 1.05-1.56), waiters (1.22, 1.07-1.38) hairdressers (1.14, 1.02-1.26), cooks and stewards (1.12, 1.01-1.25), printers (1.11, 1.04-1.18) and seamen (1.09, 1.03-1.14).Smoking is a strong risk factor for bladder cancer but there may also be other factors in some specific occupations in addition to smoking. The occupational variation in risk of bladder cancer is small when adjusted for smoking, but risk increasing factors are indicated in some occupations.

Published
2018

12. 144 Smoking adjusted incidence of bladder cancer using proxy smoking from lung cancer in nordic males

Author

Elisabete Weiderpass, Elsebeth Lynge, Kristina Kjærheim, Laufey Tryggvadottir, Jan Iver Martinsen, Pär Sparén, Kishor Hadkhale, and Eero Pukkala

Subjects
Occupational cancer, Bladder cancer, business.industry, medicine, Smoking prevalence, medicine.disease, business, Lung cancer, Proxy (climate), Confidence interval, Demography
Abstract

Objectives The objective of this study was to observe the occupational variation in risk of bladder cancer that is not attributable to smoking. Methods In the Nordic Occupational Cancer study (NOCCA), 1 11 458 cases of bladder cancer and 2 08 297 cases of lung cancer cases were observed among men in Denmark, Finland, Iceland, Norway and Sweden during 1961–2005. The expected numbers of bladder cancer in occupational category were corrected with smoking prevalence estimated on the basis of lung cancer risk in the category. Crude and smoking-adjusted standardised incidence ratios (SIR) with 95% confidence intervals (CI) were calculated for each occupation. Results The smoking-adjusted SIR for most of the occupations was closer to 1.00 than the unadjusted SIR. It signifies the role of smoking as a risk factor of both bladder and lung cancers. Highest statistically significant smoking-adjusted SIRs were observed among chimney sweeps (SIR 1.33, 95% CI: 1.08 to 1.61), waiters (1.18, 1.04–1.34) hairdressers (1.16, 1.04–1.28), cooks and stewards (1.13, 1.01–1.27) and printers (1.10, 1.03–1.06). Conclusion Smoking is a strong risk factor bladder cancer but there are other factors in some specific occupations in addition to smoking. The occupational variation in risk of bladder cancer is small when adjusted for smoking.

Published
2018

13. Occupation and Risk of Bladder Cancer: A Population Level Comparison of Nordic Countries and Canada

Author

Elisabete Weiderpass, Michael Tjepkema, Laufey Tryggvadottir, M. Anne Harris, Eero PUnited Kingdomkala, Paul A. Demers, Jan Ivar Martinsen, Jill MacLeod, and Kishor Hadkhale

Subjects
Bladder cancer, Population level, business.industry, General Earth and Planetary Sciences, Medicine, business, medicine.disease, Occupational safety and health, General Environmental Science, Demography
Abstract

Background/Aim: Associations with bladder cancer have been observed for more than 40 occupations. While some findings have been consistent, others have been inconsistent or limited. Outside of the ...

Published
2018

14. Occupational variation in incidence of bladder cancer: A comparison of population-representative cohorts from Nordic countries and Canada

Author

Michael Tjepkema, Kristina Kjærheim, Elisabete Weiderpass, Paul A. Demers, Elsebeth Lynge, Jan Ivar Martinsen, Paul A. Peters, Kishor Hadkhale, Jill MacLeod, M. Anne Harris, Pär Sparén, Laufey Tryggvadottir, Eero Pukkala, Yhteiskuntatieteiden tiedekunta - Faculty of Social Sciences, and University of Tampere

Subjects
Male, Occupational cancer, Epidemiology, Cohort Studies, 0302 clinical medicine, Risk Factors, 030212 general & internal medicine, risk, education.field_of_study, VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801, Incidence, Incidence (epidemiology), Smoking, Censuses, General Medicine, Middle Aged, Census, 3. Good health, Occupational Diseases, Nordic countries, Population Surveillance, 030220 oncology & carcinogenesis, Cohort, Female, Adult, Canada, Occupational group, Kansanterveystiede, ympäristö ja työterveys - Public health care science, environmental and occupational health, Population, Scandinavian and Nordic Countries, 03 medical and health sciences, Syöpätaudit - Cancers, Occupational Exposure, medicine, Humans, Occupations, Sex Distribution, education, Aged, Bladder cancer, business.industry, Research, occupational groups, medicine.disease, Urinary Bladder Neoplasms, VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801, business, Demography
Abstract

ObjectivesThe objective of this study was to compare occupational variation of the risk of bladder cancer in the Nordic countries and Canada.MethodsIn the Nordic Occupational Cancer study (NOCCA), 73 653 bladder cancer cases were observed during follow-up of 141.6 million person-years. In the Canadian Census Health and Environment Cohort (CanCHEC), 8170 cases were observed during the follow-up of 36.7 million person-years. Standardised incidence ratios with 95% CI were estimated for 53 occupations in the NOCCA cohort and HR with 95% CIs were estimated for 42 occupations in the CanCHEC.ResultsElevated risks of bladder cancer were observed among hairdressers, printers, sales workers, plumbers, painters, miners and laundry workers. Teachers and agricultural workers had reduced risk of bladder cancer in both cohorts. Chimney-sweeps, tobacco workers and waiters had about 1.5-fold risk in the Nordic countries; no risk estimates for these categories were given from the CanCHEC cohort.ConclusionWe observed different occupational patterns in risk of bladder cancer in Nordic countries and Canada. The only occupation with similarly increased risk was observed among sales workers. Differences in smoking across occupational groups may explain some, but not all, of this variation.

Published
2017

16. P032 Occupational solvent exposure and risk of bladder cancer in the nordic countries

Author

Laufey Tryggvadottir, Kristina Kjærheim, Elisabete Weiderpass, Kishor Hadkhale, Eero Pukkala, Elsebeth Lynge, Jan Ivar Martinsen, and Pär Sparén

Subjects
education.field_of_study, Occupational cancer, medicine.medical_specialty, Bladder cancer, business.industry, Incidence (epidemiology), Population, Hazard ratio, Job-exposure matrix, medicine.disease, Confidence interval, Surgery, chemistry.chemical_compound, chemistry, medicine, Solvent exposure, education, business, Demography
Abstract

Introduction Bladder cancer risk is suggested to vary between occupational categories. We assessed the occupational variation in incidence of bladder cancer and relationship with chemical solvent exposures in the Nordic countries. Methods The study is based on Nordic Occupational Cancer Study (NOCCA). Data consist of 14.9 million individuals of age 30 to 64 years from the Nordic countries who participated in one or more population censuses since 1960 and were followed up for 45 years. During the follow-up 148,669 cases of bladder cancer were detected. Standardised incidence ratio with 95% of confidence interval (CI) was used to describe the variation in bladder cancer risk in comparison to the national average. Quantitative estimates of solvents exposure for 113,343 bladder cancer cases and 566,715 population controls were assigned using Nordic job exposure matrix. Hazard ratios (HR) and 95% CI: for each solvent was estimated using conditional logistic regression. Results Highest statistically significant risks were observed among tobacco workers (SIR 1.57, 95% CI: 1.24–1.96), chimney sweeps (1.48, 1.21–1.80), waiters (1.43, 1.33–1.53), hairdressers, seamen, printers, plumbers. Significant decreased risks were observed among farmers (0.70, 0.68–0.71) and forestry workers (0.74, 0.70–0.78). Significantly increasing trends in SIR over the years were observed among drivers and launderers. The occupational risk associated with the chemical solvent at highest exposure levels (>90th percentile of the exposed persons) were aliphatic and alicyclic hydrocarbon solvent (HR 1.08, 95% CI: 1.00–1.23), benzene (1.16, 1.04–1.31), toluene (1.20, 1.00–1.38) and trichloroethylene (1.23, 1.12–1.40). Conclusion Occupation is evidently associated with bladder cancer risk. Part of that variation appears to be attributable to solvent exposures.

Published
2016

17. Occupational exposure to solvents and bladder cancer: A population-based case control study in Nordic countries

Author

Kristina Kjærheim, Elisabete Weiderpass, Elsebeth Lynge, P�r Sparen, Eero Pukkala, Kishor Hadkhale, Jan Ivar Martinsen, and Laufey Tryggvadottir

Subjects
Adult, Male, Cancer Research, Occupational cancer, medicine.medical_specialty, Trichloroethylene, trichloroethylene, Job-exposure matrix, Population, Iceland, 03 medical and health sciences, chemistry.chemical_compound, benzene, 0302 clinical medicine, Risk Factors, Occupational Exposure, Internal medicine, Humans, Medicine, toluene, education, Finland, urothelial carcinoma, Aged, risk, Sweden, education.field_of_study, Bladder cancer, aliphatic and alicyclic hydrocarbon solvents, Norway, business.industry, VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Oncology: 762, Hazard ratio, Case-control study, Middle Aged, medicine.disease, 030210 environmental & occupational health, job exposure matrix, Confidence interval, Occupational Diseases, VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Onkologi: 762, aromatic hydrocarbon solvents, Urinary Bladder Neoplasms, Oncology, chemistry, 030220 oncology & carcinogenesis, Solvents, Female, business
Abstract

Accepted manuscript version. Published version available at https://doi.org/10.1002/ijc.30593. The objective of the study was to assess the relationship between exposure to selected solvents and the risk of bladder cancer. This study is based on the Nordic Occupational Cancer (NOCCA) database and comprises 113,343 cases of bladder cancer diagnosed in Finland, Iceland, Norway and Sweden between 1961 and 2005 and 566,715 population controls matched according to country, sex and birth year. Census‐based occupational titles of the cases and controls were linked with the job exposure matrix created by the NOCCA project to estimate quantitative cumulative occupational exposures. A conditional logistic regression model was used to estimate hazard ratios (HRs) and their 95% confidence intervals (95% CI). Increased risks were observed for trichloroethylene (HR 1.23, 95% CI 1.12–1.40), toluene (HR 1.20, 95% CI 1.00–1.38), benzene (HR 1.16, 95% CI 1.04–1.31), aromatic hydrocarbon solvents (HR 1.10, 95% CI 0.94–1.30) and aliphatic and alicyclic hydrocarbon solvents (HR 1.08, 95% CI 1.00–1.23) at high exposure level versus no exposure. The highest excess for perchloroethylene was observed at medium exposure level (HR 1.12, 95% CI 1.02–1.23). The study provides evidence of an association of occupational exposure to trichloroethylene, perchloroethylene, aromatic hydrocarbon solvents, benzene and toluene and the risk of bladder cancer.

Published
2016

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