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The aim of this randomized controlled study was to explore if an intervention with biofeedback training in combination with ergonomic discussions, could improve working technique and work postures, and reduce pain intensity and perceived exertion in young adult computer users with ongoing neck and upper extremity symptoms. 39 participants were divided into an intervention group and a control group. The intervention consisted of 4 sessions during a three-month period. Working technique, working postures, rated perceived exertion, pain intensity, and duration of computer use were measured at baseline and follow ups after 6 and 12 months. The intervention did not significantly improve working technique and working postures, nor reduce pain intensity and perceived exertion in the intervention group compared to the control group. However, there was a statistically significant reduction in reported pain intensity in the neck/shoulder for the whole group. Also, there was a trend that time spent with computer work without breaks was more reduced in the intervention group than in the control group.

The literature on Raynaud's phenomenon (RP) in the feet is scarce, especially in the occupational setting. The primary aim of our study was to investigate the occurrence of RP in the feet of miners. As part of the MineHealth project, written surveys and clinical examinations were completed by 260 Arctic open-pit miners working in northern Sweden and Norway (participation rate 53.6%). Data on RP were collected using standardised colour charts and questionnaire items. Clinical examination included assessing the perception of vibration and pain in both feet. There were eight women and three men who reported RP in the feet. Four also had RP in their hands but none acknowledged any first-degree relatives with the condition. Nine reported exposure to foot-transmitted vibration and one to hand-arm vibration. Seven showed signs of neurosensory injury in the feet. To conclude, the occurrence of RP in the feet of miners was 4.4%. Most cases with RP in the feet did not report the condition in the hands and were exposed to vibration transmitted directly to the feet. There were no reports of a hereditary component. Most cases with RP in the feet also had clinical findings suggestive of peripheral neuropathy in the feet., Funding Agencies:European UnionThe Swedish Research Council for Health, Working Life and Welfare (FORTERegion Västerbotten

The aim of this randomized controlled study was to explore if an intervention with biofeedback training in combination with ergonomic discussions, could improve working technique and work postures, and reduce pain intensity and perceived exertion in young adult computer users with ongoing neck and upper extremity symptoms. 39 participants were divided into an intervention group and a control group. The intervention consisted of 4 sessions during a three-month period. Working technique, working postures, rated perceived exertion, pain intensity, and duration of computer use were measured at baseline and follow ups after 6 and 12 months. The intervention did not significantly improve working technique and working postures, nor reduce pain intensity and perceived exertion in the intervention group compared to the control group. However, there was a statistically significant reduction in reported pain intensity in the neck/shoulder for the whole group. Also, there was a trend that time spent with computer work without breaks was more reduced in the intervention group than in the control group.

Objective: Retinal detachment (RD) has been associated with exposure to heavy lifting. Many occupations within the construction industry are likely to involve lifting tasks. We investigated the association between occupational heavy lifting and rhegmatogenous RD in a retrospective cohort study of Swedish construction workers. Methods: We studied Swedish construction workers who participated in an industry-wide health and safety program from 1971 to 1993. Individual occupation codes were linked to a job exposure matrix, assigning intensity of exposure to heavy lifting to each worker. The Swedish National Patient Register was used to identify cases of RD that occurred during follow-up through the end of 2012. We used Poisson regression modeling to calculate incidence rates of RD associated with heavy lifting, age and other covariates. A subcohort of those age ≤25 years at enrollment was studied to reduce bias from missing exposure information from work prior to enrollment. Results: Of 256 241 construction workers, 17% were classified with high exposure to heavy lifting in their occupation. Within the cohort, 1588 cases of RD were identified. Average exposure intensity of heavy lifting was not associated with risk of RD. However, RD risk increased with increasing cumulative exposure to heavy lifting, both in the full cohort and subcohort of those who were ≤25 years old at entry into the construction-worker cohort. Conclusion: Construction workers' risk of RD appeared to increase with time spent exposed to heavy lifting.

OBJECTIVE: We investigated and compared temporal sitting patterns among male and female hybrid office workers when working at the office (WAO), working from home (WFH), and for non-working days (NWD). METHODS: We analyzed data collected in 2020 among 165 hybrid office workers, carrying thigh-worn accelerometers for 938 days in total. Day type (WAO, WFH, or NWD) and time in bed were identified using diaries. Time awake was exhaustively classified as non-sitting time and time sitting in short, moderate, and long bouts. Effects of day type and gender on the 24-h compositions of physical behaviors were analyzed using multilevel linear mixed models. RESULTS: During workdays (both WAO and WFH), workers spent less time in bed and more time sitting, particularly in moderate and long bouts, than during NWD. Time in bed was longer when working from home than when working at the office, and more of the awake time was spent sitting. Differences between WAO and WFH in ratios between short, moderate, and long bouts of sitting were small and inconsistent. Men spent more time sitting than women, and more time in moderate and long sitting bouts relative to short bouts. CONCLUSIONS: When working from home, hybrid office workers sat more during their hours awake compared to when working at the office. Sitting time was larger during working days than during non-working days and was higher in men than in women. These results may contribute to support organizational policies for hybrid work.

The designs of in vivo, in vitro and in silico studies do not adequately reflect the characteristics of long-term occupational EMF exposure; the higher exposure levels permitted for employees are nevertheless extrapolated on this basis. Epidemiological studies consider occupational exposure only in a very general way, if at all. There is a lack of detailed descriptive data on long-term occupational exposure over the duration of the working life. Most studies reflect exposure characteristics of the general population, exposures which are long-term, but at a comparably low level. Occupational exposure is often intermittent with high peak power followed by periods with no exposure. Furthermore, the EU EMF-Directive 2013/35/EU states a demand for occupational health surveillance, the outcome of which would be of great help to epidemiologists studying the health effects of EMF exposure. This paper thus aims to outline and specify differences between public and occupational exposure and to increase the understanding of specific aspects of occupational exposure which are important for long-term health considerations. This could lead to a future protection concept against possible hazards based on adequate descriptions of long-term exposures and also include supplementary descriptive features such as a “reset time” of biological systems and accurate dose quantities.

OBJECTIVE: This study investigated the association between occupational physical activity (OPA) and resting blood pressure in a cohort of Swedish construction workers. METHODS: The final sample included 241,176 male construction workers. Occupations with low OPA were foremen and white-collar workers. The most frequent occupations in the medium OPA group were electricians, pipe workers, and machine operators, and in the high OPA group woodworkers, concrete workers, and painters. RESULTS: Mixed effects models showed higher systolic and lower diastolic blood pressure with higher OPA, but the associations varied depending on the year of participation and participant age as shown by significant interaction terms (OPA*age, OPA*calendar year, age*calendar year). Age-stratified linear regression analyses showed a pattern of slightly higher systolic (1.49, 95% confidence interval: 1.08-1.90 mmHg) and lower diastolic (0.89, 95% confidence interval: 0.65-1.13 mmHg) blood pressure when comparing low with high OPA, but not among the oldest age groups. CONCLUSION: Despite a rather large contrast in OPA, the differences in systolic and diastolic blood pressure according to OPA were small.

Background: Research indicates that good organizational and psychosocial environments are vital to well-functioning workplaces and employee health. Working in the municipal sector and in the rural context may contribute to more health problems, poorer organizational and psychosocial work environments, and higher sick-leave rates. Objective: The aim of this study was to explore organizational and psychosocial environmental work factors among municipal employees with or without self-rated exhaustion disorder (s-ED) in rural northern Sweden. Methods: The Modern Work Life Questionnaire and the Self-Rated Exhaustion Disorder Scale were used among 1093 municipal employees. Results: The results showed that there were significant differences between the s-ED and the non-s-ED group in all but one of the organizational and psychosocial environmental work factors. Various demands, i.e. quantitative, emotional, intellectual, and IT demands were some factors associated with the s-ED group. Social support, resources, and time for work and reflection were some factors associated with the non-s-ED group. Both the s-ED and the non-s-ED groups assessed significantly higher emotional demands and less resources compared to national reference values. Conclusion: Findings from this study are relevant to a better understanding what organizational and psychosocial work environmental work factor the employer need to pay extra attention to. Addressing risk and protective factors in the work environment could tribute to promote occupational well-being, preventing exhaustion disorder and long-term sick leave among municipal employees in rural northern Sweden., Originally included in thesis in manuscript form.

Recent studies indicate that monitoring only fine particulate matter (PM2.5) may not be enough to understand and tackle the health risk caused by particulate pollution. Health effects per unit PM2.5 seem to increase in countries with low PM2.5, but also near local pollution sources (e.g., traffic) within cities. The aim of this study is to understand the differences in the characteristics of lung-depositing particles in different geographical regions and urban environments. Particle lung deposited surface area (LDSAal) concentrations and size distributions, along with PM2.5, were compared with ambient measurement data from Finland, Germany, Czechia, Chile, and India, covering traffic sites, residential areas, airports, shipping, and industrial sites. In Finland (low PM2.5), LDSAal size distributions depended significantly on the urban environment and were mainly attributable to ultrafine particles (<100 nm). In Central Europe (moderate PM2.5), LDSAal was also dependent on the urban environment, but furthermore heavily influenced by the regional aerosol. In Chile and India (high PM2.5), LDSAal was mostly contributed by the regional aerosol despite that the measurements were done at busy traffic sites. The results indicate that the characteristics of lung-depositing particles vary significantly both within cities and between geographical regions. In addition, ratio between LDSAal and PM2.5 depended notably on the environment and the country, suggesting that LDSAal exposure per unit PM2.5 may be multiple times higher in areas having low PM2.5 compared to areas with continuously high PM2.5. These findings may partly explain why PM2.5 seems more toxic near local pollution sources and in areas with low PM2.5. Furthermore, performance of a typical sensor based LDSAal measurement is discussed and a new LDSAal2.5 notation indicating deposition region and particle size range is introduced. Overall, the study emphasizes the need for country-specific emission mitigation stra

This cross-sectional study aimed to describe exposure to cold climate and hand-arm vibration (HAV) as well as neurosensory and vascular symptoms and clinical findings among open-pit Arctic miners. It was based on data from questionnaires and physical examinations, including 177 men and 75 women from two open-pit mines in Sweden and Norway (response rate 54%). Working outdoors or in an unheated building or machine for at least two hours per day was reported by 44% and HAV exposure of the same duration by 10%. Neurosensory symptoms (e.g. reduced perception of touch) in the hands were reported by 47% and Raynaud’s phenomenon by 14%. In brief conclusion, the study showed that Arctic miners were commonly exposed to both cold temperatures and HAV. They also reported a broad range of neurosensory and vascular symptoms in their hands and had abnormal clinical findings related to the symptoms. The results emphasise the need for additional preventive measures in this occupational setting.

Additive manufacturing (AM), or 3D printing, is a growing industry involving a wide range of different techniques and materials. The potential toxicological effects of emissions produced in the process, involving both ultrafine particles and volatile organic compounds (VOCs), are unclear, and there are concerns regarding possible health implications among AM operators.The objective of this study was to screen the presence of respiratory health effects among people working with liquid, powdered, or filament plastic materials in AM. MethodsIn total, 18 subjects working with different additive manufacturing techniques and production of filament with polymer feedstock and 20 controls participated in the study. Study subjects filled out a questionnaire and underwent blood and urine sampling, spirometry, impulse oscillometry (IOS), exhaled NO test (FeNO), and collection of particles in exhaled air (PEx), and the exposure was assessed. Analysis of exhaled particles included lung surfactant components such as surfactant protein A (SP-A) and phosphatidylcholines. SP-A and albumin were determined using ELISA. Using reversed-phase liquid chromatography and targeted mass spectrometry, the relative abundance of 15 species of phosphatidylcholine (PC) was determined in exhaled particles. The results were evaluated by univariate and multivariate statistical analyses (principal component analysis). ResultsExposure and emission measurements in AM settings revealed a large variation in particle and VOC concentrations as well as the composition of VOCs, depending on the AM technique and feedstock. Levels of FeNO, IOS, and spirometry parameters were within clinical reference values for all AM operators. There was a difference in the relative abundance of saturated, notably dipalmitoylphosphatidylcholine (PC16:0_16:0), and unsaturated lung surfactant lipids in exhaled particles between controls and AM operators. ConclusionThere were no statistically significant differences between AM ope

Introduction Turnover intentions (TI) in healthcare staff relate to high workload and high emotional exhaustion. Nurses have higher TI than other healthcare professionals. Few studies have focused on TI in healthcare staff as a group within the Job Demand-Resources (JD-R) theory. Aim To investigate healthcare staffs’ TI in relation to JD-R theory and relationships with staff wellbeing. Method A cross-sectional correlational and comparative study using a survey to healthcare staff in Sweden, in 2022. The survey contained questions of work environment, wellbeing and TI. Data were analysed with SPSS. Results The survey had 416 responders from different professions (response rate 31%). Fourteen percent rated their TI as high. High TI related to high emotional exhaustion. Moderate relationships were seen between high TI and high job demands/low resources. Weak relationships were seen between high TI and high workload and low satisfaction with given care. TI was also related to age, but no differences were seen for gender or level of education. Conclusions The results resemble earlier research regarding TI, stress and burnout. The results suggest that high demands and low resources are related to healthcare staffs’ TI. More studies with similar design are needed to confirm and broaden the results.

PURPOSE: Testosterone analysis in hair allows for retrospective evaluation of endogenous testosterone concentrations, but studies devoted to investigating confounders in hair testosterone analysis have hitherto been scarce. The current study examined the stability of testosterone concentrations between two hair samples collected three months apart and investigated two potential confounding factors: natural hair colour and cosmetic hair treatments. METHODS: Testosterone was analysed with an in-house radioimmunoassay with a limit of detection adequate for the purpose. RESULTS: The testosterone concentrations from the two samplings, at baseline and three months later, had an intra-individual correlation of moderate strength (rho = 0.378, p<0.001, n = 146). Hair treatment, such as colouring or bleaching, seemed to increase testosterone concentrations (p = 0.051, n = 191, and in a paired analysis in a subset of the cohort p = 0.005, n = 24), while no effect of natural colour in untreated hair (p = 0.133) could be detected. CONCLUSION: The current results suggest that cosmetic hair treatments need to be considered in hair testosterone analyses and demonstrate the utility of a radioimmunoassay to reliably measure testosterone concentrations in small hair samples in women.

A participatory-based intervention was performed in Sweden, aimed at improving the sound environment in one preschool (n = 20) and one obstetric ward (n = 50), with two controls each (n = 28, n = 66). Measured sound levels, and surveys of noise annoyance, hearing-related symptoms and emotional exhaustion were collected before, and three and nine months after the interventions, comparing intervention and control groups over time. The results of this first implementation in a limited number of workplaces showed significantly worsening of hyperacusis, sound-induced auditory fatigue, emotional exhaustion and increased sound levels in the preschool, and worsening of noise annoyance in both intervention groups. Increased risk awareness, limited implementation support and lack of psychosocial interventions may explain the worsening in outcomes, as might the worse baseline in the intervention groups. The complexity of the demands in human-service workplaces calls for further intervention studies.

BACKGROUND: Diseases affecting the lungs and airways contribute significantly to the global burden of disease. The problem in low- and middle-income countries appears to be exacerbated by a shift in global manufacturing base to these countries and inadequate enforcement of environmental and safety standards. In Ghana, the potential adverse effects on respiratory function associated with occupational wood dust exposure have not been thoroughly investigated. METHODS: Sixty-four male sawmill workers and 64 non-woodworkers participated in this study. The concentration of wood dust exposure, prevalence and likelihood of association of respiratory symptoms with wood dust exposure and changes in pulmonary function test (PFT) parameters in association with wood dust exposure were determined from dust concentration measurements, symptoms questionnaire and lung function test parameters. RESULTS: Sawmill workers were exposed to inhalable dust concentration of 3.09 ± 0.04 mg/m3 but did not use respirators and engaged in personal grooming habits that are known to increase dust inhalation. The sawmill operators also showed higher prevalence and likelihoods of association with respiratory symptoms, a significant cross-shift decline in some PFT parameters and a shift towards a restrictive pattern of lung dysfunction by end of daily shift. The before-shift PFT parameters of woodworkers were comparable to those of non-woodworkers, indicating a lack of chronic effects of wood dust exposure. CONCLUSIONS: Wood dust exposure at the study site was associated with acute respiratory symptoms and acute changes in some PFT parameters. This calls for institution and enforcement of workplace and environmental safety policies to minimise exposure at sawmill operating sites, and ultimately, decrease the burden of respiratory diseases., Fundning Agency:Carl Erik Levins Stiftelse Foundation

Purpose: This embedded qualitative study explored the acceptability, feasibility, and fidelity of two multi-level RCT interventions among office workers, aiming at improving movement behaviour to enhance mental health and cognition. The interventions addressed the organizational, environmental, and individual level. Methods: Semi-structured interviews and focus group discussions were conducted with 38 stakeholders after completion of the interventions. Data were analysed using reflexive thematic analysis. Results: The interventions were well appreciated, and office workers attributed improvements in movement behaviour and wellbeing to the interventions. Especially the cognitive behavioural therapy (CBT) based counselling and free gym access were appreciated, feasible and delivered as planned. Participants described existing workplace norms as barriers to more activity, particularly for reducing sitting. Support from managers and team support were considered crucial components. However, delivering these components was difficult. Conclusions: The findings support the design of the multi-level interventions for changing movement behaviour. Results highlight the potential of CBT for this target group and the importance of manager and team support. Desired effects of similar multi-level interventions, including CBT, might be achieved in future studies that carefully address the issues with feasibility and acceptability and the resulting low fidelity of some intervention components that were identified in this study., At the time of Lisa-Marie Larisch's dissertation this article was in press at the International Journal of Qualitative Studies in Health and Well-being.

Introduction: Additive manufacturing is a novel state-of-the art technology with significant economic and practical advantages, including the ability to produce complex structures on demand while reducing the need of stocking materials and products. Additive manufacturing is a technology that is here to stay; however, new technologies bring new challenges, not only technical but also from an occupational health and safety perspective. Herein, leading Swedish companies using metal additive manufacturing were studied with the aim of investigating occupational exposure and the utility of chosen exposure- and clinical markers as predictors of potential exposure-related health risks.Methods: Exposure levels were investigated by analysis of airborne dust and metals, alongside particle counting instruments measuring airborne particles in the range of 10 nm-10 mu m to identify dusty work tasks. Health examinations were performed on a total of 48 additive manufacturing workers and 39 controls. All participants completed a questionnaire, underwent spirometry, and blood and urine sampling. A subset underwent further lung function tests.Results: Exposure to inhalable dust and metals were low, but particle counting instruments identified specific work tasks with high particle emissions. Examined health parameters were well within reference values on a group level. However, statistical analysis implied an impact on workers kidney function and possible airway inflammation.Conclusion: The methodology was successful for investigating exposure-related health risks in additive manufacturing. However, most participants have been working <5 years. Therefore, long-term studies are needed before we can conclusively accept or reject the observed effects on health., Funding Agencies|Swedish Innovation Agency (Vinnova), HAMAT2 [2018-03336]; Swedish Research Council for Health, Working Life and Welfare (Forte) [2018-00290]

The dominant road traffic particle sources are wear particles from the road and tire interface, and from vehicle brake pads. The aim of this work was to investigate the effect of road and brake wear particles on pulmonary function and biomarkers in isolated perfused rat lungs. Particles were sampled from the studded tire wear of three road pavements containing different rock materials in a road simulator; and from the wear of two brake pad materials using a pin-on-disk machine. Isolated rat lungs inhaled the coarse and fine fractions of the sampled particles resulting in an estimated total particle lung dose of 50 mu g. The tidal volume (TV) was measured during the particle exposure and the following 50 min. Perfusate and BALF were analyzed for the cytokines TNF, CXCL1 and CCL3. The TV of lungs exposed to rock materials was significantly reduced after 25 min of exposure compared to the controls, for quartzite already after 4 min. The particles of the heavy-duty brake pads had no effect on the TV. Brake particles resulted in a significant elevation of CXCL1 in the perfusate. Brake particles showed significant elevations of all three measured cytokines, and quartzite showed a significant elevation of TNF in BALF. The study shows that the toxic effect on lungs exposed to airborne particles can be investigated using measurements of tidal volume. Furthermore, the study shows that the choice of rock material in road pavements has the potential to affect the toxicity of road wear PM10., Funding Agencies|This work is supported by Trafikverket

Soon approaching its 50th anniversary, Journal of Analytical Toxicology (JAT) is an international scholarly publication specializing in analytical and forensic aspects of toxicology. Science Citation Index (SCI) and Journal Citation Reports (JCR), both of which are part of the Web-of-Science (WOS) database, were used to make a bibliometric evaluation of JAT articles. Between 1977 (volume 1) and 2023 (volume 47), a total of n = 4,785 items were published in JAT; the top-ten most highly cited articles and the most prolific authors were identified. Changes in the journal impact factor (JIF) were studied between 1997 and 2022, and this metric varied from a low of 1.24 (2006) to a high of 3.36 (2020).The most recent JIF (2022) dropped to 2.5 and the corresponding 5 year JIF was 2.6. JATs most highly cited article (590 cites) was a working group (SWGTOX) report dealing with standard practices for the validation of analytical methods in forensic toxicology laboratories. JAT published 62 articles each of which were cited over 100 times and the H-index for JAT was 89. The most prolific author of JAT articles was credited with 119 items, the first in 1980 (volume 4) and the latest in 2023 (volume 47). JAT articles were cited 4,537 times in 2022 by all journals in the JCR database, although 520 of these were self-citations (11.5%). Bibliometric methods are increasingly used to evaluate the published work of individual scientists, university departments, entire universities and whole countries. Highly cited articles are considered more influential and authoritative compared with papers that are seldom or never cited.

While transport is inevitable in our economy and daily lives, it also engenders negative effects on the society and environment. The effects of air pollution are responsible for more than 364,200 premature deaths in Europe each year. Most urban areas still exceed the NOx and PM WHO air quality guidelines, of which a large share of pollutants is attributable to freight transport. The construction sector forms no exception, as it intrinsically strongly relies on off-site logistics activities, i.e. transports to and from sites. Although construction works lead to an urban economic uptake on the long-haul, the environmental nuisances from construction logistic (CL) activities during the works have so far been overlooked. This thesis focuses on the air quality impact of off-site construction transport, covering four main parts. First, as there is a lack of knowledge within cities on how to set construction transport demands and how to involve actors in these processes, a stakeholder framework is presented. Next, I identify the available and required transport data (and digitization possibilities) to assess the sector’s environmental impact, such as On-Board Units. Secondly, impact assessments were conducted across various construction supply chain implementations, on single-site, city-wide and national level. Hence, a methodological approach to derive construction-related vehicles from Heavy-Goods Vehicle (HGV) traffic based on algorithmic and geospatial analyses is proposed. Results indicate that construction transport represents 26.40% of total HGV traffic in the Brussels-Capital Region (BCR), generating €45,631.85 of external costs per workday, and 17.58% in Belgium (or €1.45mio per day). Subsequently, the framework was deployed to assess the transport performance of the multimodal Brussels Construction Consolidation Centre. The use of this setup can mitigate external costs by up to 59% compared to business-as-usual operations, most notably on congestion and climate c

Every year, over 364,200 people in Europe die prematurely due to the effects of air pollution, in which the transportation sector plays an important role. In Brussels, freight transport generates €61,604 of air pollution health costs daily. Research has shown that dynamic spatiotemporal modeling of both emission sources and exposed people (using mobile phone data) renders more accurate impact results when analyzed in microenvi- ronments. However, mobile data underrepresent population segments that are more sensitive to the effects of air pollution, such as toddlers, children and elderly individuals. This paper examined the link between vulnerable people aged 0–3, 3–18 and >65 years and freight transport-related air pollution concentrations in the Brussels- Capital Region (BCR). To this end, dynamic tailpipe emissions and their spatiotemporal dispersion were calcu- lated using output from the Transport Agent-Based Model (TRABAM) on a daily basis. Population densities were calculated as a function of the residences’ occupancy rate and school/class size and opening hours. The effects of exposure were then evaluated using age- and sex-differentiated exposure-response functions and monetized using local hospital cost factors. Data were compiled for 2021. A strong overlap between people’s presence at the institutions’ locations was noticed with a peak in (freight) transportation movements in the city. The results showed that €37,000 [€34,517.47–€40,047.13] of freight transport-related air pollution health costs were incurred daily by vulnerable population segments. While these vulnerable groups made up 25.34% of the total BCR population, they incurred 60% [56.03%–65.01%] of the engendered transportation air pollution costs. The results were then geographically analyzed to identify 465 traffic-related air pollution hotspots across the terri- tory, which accounted for €36,000 [€33,677.85–€39,101.31] of total costs. The latter can be used in future studies to assess secto

IMPORTANCE Understanding the learning curve of a new complex surgical technique helps to reduce potential patient harm. Current series on the learning curve of minimally invasive distal pancreatectomy (MIDP) are mostly small, single-center series, thus providing limited data. OBJECTIVE To evaluate the length of pooled learning curves of MIDP in experienced centers. DESIGN, SETTING, AND PARTICIPANTS This international, multicenter, retrospective cohort study included MIDP procedures performed from January 1, 2006, through June 30, 2019, in 26 European centers from 8 countries that each performed more than 15 distal pancreatectomies annually, with an overall experience exceeding 50 MIDP procedures. Consecutive patients who underwent elective laparoscopic or robotic distal pancreatectomy for all indications were included. Data were analyzed between September 1, 2021, and May 1, 2022. EXPOSURES The learning curve for MIDP was estimated by pooling data from all centers. MAIN OUTCOMES AND MEASURES The learning curvewas assessed for the primary textbook outcome (TBO), which is a composite measure that reflects optimal outcome, and for surgical mastery. Generalized additive models and a 2-piece linear model with a break point were used to estimate the learning curve length of MIDP. Case mix-expected probabilities were plotted and compared with observed outcomes to assess the association of changing case mix with outcomes. The learning curve also was assessed for the secondary outcomes of operation time, intraoperative blood loss, conversion to open rate, and postoperative pancreatic fistula grade B/C. RESULTS From a total of 2610 MIDP procedures, the learning curve analysis was conducted on 2041 procedures (mean [SD] patient age, 58 [15.3] years; among 2040 with reported sex, 1249 were female [61.2%] and 791 male [38.8%]). The 2-piece model showed an increase and eventually a break point for TBO at 85 procedures (95% CI, 13-157 procedures), with a plateau TBO rate at 70%. T

Ambulance personnel in emergency medical services are exposed to physical demands and stress during work, and an increased prevalence of ill health has been observed in this group. The aim was to compare hair cortisol concentration (HCC) among Swedish ambulance personnel with HCC in a population-based reference sample, to analyse differences between women and men, and differences due to work-related factors. Samples of hair 1 cm closest to the skin (5-10 mg) were collected and analysed for cortisol by radioimmunoassay. Moreover, the participants responded to a questionnaire regarding their work environment. The HCC among the ambulance personnel did not differ from the HCC in the population-based reference sample (median 19.2 vs. 22.2 pg/mg, p = 0.319), nor were there statistically significant differences between women and men. Furthermore, no associations were found between HCC and physical and psychosocial work demands, work stress, or rest and recovery from work. However, occupational balance was positively correlated with HCC (r(p) = 0.240; p = 0.044). The association remained statistically significant after adjustment for sex, age, hair bleaching, and corticosteroid treatment in a linear regression model. This study adds knowledge regarding HCC among ambulance personnel, and thus contributes to the overall picture of work environment and health for this group.

Unmanned aerial vehicles (UAVs) can bring many benefits, particularly in emergency response and disaster management. However, they also induce negative effects, such as noise and visual pollution, risk, and integrity concerns. In this work, we study visual pollution, developing a quantitative measure that can calculate the visual pollution from one or multiple UAVs. First, the Analytic Hierarchy Process was utilized in an expert workshop to find and rank factors relevant to visual pollution. Then an image-based questionnaire targeted at the general public was used to find relations between the factors. The results show that the two main factors causing visual pollution are the number of UAVs and the distance between a UAV and the observer. They also show that while a UAV used for emergency medical services is as polluting as any other UAV, it is easier to tolerate this pollution. Based on the questionnaire results, two visual pollution functions were developed that can be used when carrying out path planning for one or multiple UAVs. When combining this function with other existing measures for noise pollution, and ground and air risk, it is possible to find paths that will give as little negative impact as possible from urban air mobility.

The aim of this study is to report the seroprevalence of SARS-CoV-2 antibodies in healthcare workers with various risk of occupational exposure in Kalmar County, Sweden, during the first year of the coronavirus disease 2019 (COVID-19) pandemic. We performed SARS-CoV-2 antibody measurements at four time points, from May 2020 to May 2021, in 401 healthcare workers (HCW) at seven hospital wards and two residential care facilities, with different risk of SARS-CoV-2 exposure. Overall, the prevalence of SARS-CoV-2 antibodies in HCW in Kalmar County was high compared to similar studies from other countries and increased from May 2020 to May 2021. Initially, 14% of the participants were SARS-CoV-2 seropositive. This number increased to 18% in September and 21% in December 2020. In May 2021, the prevalence of antibodies to nucleocapsid antigen had increased to 28%, while antibodies to spike protein had increased to 95% due to vaccination. A large variation in seroprevalence between different wards was detected and HCW in a COVID-19 designated ward had significantly higher seroprevalence than HCW working in wards without COVID-19 patients, with a risk ratio of 7.28, (95% CI 2.38-22.33) in May 2020. Our findings suggest a relationship between occupational COVID-19 exposure and seropositivity which implies that efficient hygiene routines for health- and social care workers are essential to avoid that COVID-19 care will constitute an occupational hazard.

ObjectiveWe investigated and compared temporal sitting patterns among male and female hybrid office workers when working at the office (WAO), working from home (WFH), and for non-working days (NWD). MethodsWe analyzed data collected in 2020 among 165 hybrid office workers, carrying thigh-worn accelerometers for 938 days in total. Day type (WAO, WFH, or NWD) and time in bed were identified using diaries. Time awake was exhaustively classified as non-sitting time and time sitting in short, moderate, and long bouts. Effects of day type and gender on the 24-h compositions of physical behaviors were analyzed using multilevel linear mixed models. ResultsDuring workdays (both WAO and WFH), workers spent less time in bed and more time sitting, particularly in moderate and long bouts, than during NWD. Time in bed was longer when working from home than when working at the office, and more of the awake time was spent sitting. Differences between WAO and WFH in ratios between short, moderate, and long bouts of sitting were small and inconsistent. Men spent more time sitting than women, and more time in moderate and long sitting bouts relative to short bouts. ConclusionsWhen working from home, hybrid office workers sat more during their hours awake compared to when working at the office. Sitting time was larger during working days than during non-working days and was higher in men than in women. These results may contribute to support organizational policies for hybrid work.

This article explores the extent to which spatial and hierarchical divisions of work in grocery stores intersect with gender, and resulting inequalities in employees’ working conditions. Our empirical basis is individual and group interviews conducted with managers and employees at two grocery stores in Sweden. The theoretical concept of inequality regimes serves as an analytical tool for understanding if and how multiple intersecting processes produce and maintain inequalities in working conditions. The findings show that hierarchical and gendered inequalities are (re)created in the stores, for both permanently and temporarily employed workers. The organizing processes include a functional and gendered division of the workforce together with a division based on terms of employment mainly based on the profit generated by the goods handled in each department. The study shows how spatial divisions related to hierarchy, status, and gender intersect in creating inequalities in employees' working conditions, career opportunities, and the physical and psychosocial working environment., Studien har finansierats av ett anslag från Arbetsmiljöverket: 2015/033753-85

Introduction Turnover intentions (TI) in healthcare staff relate to high workload and high emotional exhaustion. Nurses have higher TI than other healthcare professionals. Few studies have focused on TI in healthcare staff as a group within the Job Demand-Resources (JD-R) theory. Aim To investigate healthcare staffs’ TI in relation to JD-R theory and relationships with staff wellbeing. Method A cross-sectional correlational and comparative study using a survey to healthcare staff in Sweden, in 2022. The survey contained questions of work environment, wellbeing and TI. Data were analysed with SPSS. Results The survey had 416 responders from different professions (response rate 31%). Fourteen percent rated their TI as high. High TI related to high emotional exhaustion. Moderate relationships were seen between high TI and high job demands/low resources. Weak relationships were seen between high TI and high workload and low satisfaction with given care. TI was also related to age, but no differences were seen for gender or level of education. Conclusions The results resemble earlier research regarding TI, stress and burnout. The results suggest that high demands and low resources are related to healthcare staffs’ TI. More studies with similar design are needed to confirm and broaden the results.

Purpose: Being outdoors has potential to reduce stress and outdoor office work (OOW) may be an innovative way to decrease workplace stress and offices’ sedentary behaviour. This study aims to assess stress among office workers that are working in their normal indoor office and then starts practicing OOW. Additionally, study participants identified facilitators and barriers for doing OOW. Methods: In a feasibility study conducted in October 2022, nine office workers were instructed to do usual indoors work during the first week and then work outdoors for at least 30 minutes per day during the second week. They wore a Heart Rate Variability (HRV) monitor called FirstBeat BG3 (HRV-FB) for two weeks while at work to assess objective stress. Subjective stress was assessed by sending short daily surveys throughout the 2 weeks of the intervention, using a Likert scale of 1 to 10 from “not stressed at all” to “extremely stressed”. Also, they were instructed to use the app “Stanford Healthy Neighborhood Discovery Tool” to take photos of facilitators or barriers to practicing OOW. Self-reported stress data was analysed using paired sample t-test in SPSS 28, whereas analysis of HRV time and frequency parameters are currently being undertaken. The photos were categorised into themes. Results: Preliminary findings show that daily self-reported stress decreased on group level when comparing week 1 to week 2 when OOW was performed. Categories from picture analysis included themes related to “convenience”, “comfort”, equipment/facilities”, “urban” and “weather” in identified barriers. Out of 76 pictures almost all those themed “nature”, both indoor and outdoor, were marked as positive experiences. Conclusion: Reduction in self-reported stress from week 1 to week 2 suggests OOW could potentially be a useful method to reduce work-related stress. Furthermore, by walking outdoor, the office workers increase their physical activity as compared to being sedentary indoors, which adds a

This study aims to investigate university staff relocation from multiple separate buildings to a new building with activity-based flexible offices (AFOs) at a University in Sweden. The aim was to assess staff perceptions of the physical and psychosocial work environment and whether there were any changes in these perceptions before and after the move. Design/methodology/approachA mixed-methods design was used, analyzing closed-ended survey data at two time points (T1, n = 169 and T2, n = 160) and open-ended responses (n = 180) at T2.FindingsThe main findings revealed that employees started working more from home and that there were significant decreases in perceptions of the physical and psychosocial work environment, as well as job satisfaction, after the move to the new premises. Practical implicationsA comprehensive analysis of existing work processes, tasks and collaborations is crucial when planning new university premises. The planning process needs to be done in close collaboration with different stakeholders with multiple perspectives. Originality/valueIntroduction of AFOs in an academic setting can lead to negative consequences for occupational health and efficiency.

Postures at work are paramount in ergonomics. They can be determined using observation and inclinometry in a variety of measurement scenarios that may differ both in costs associated with collecting and processing data, and in efficiency, i.e. the precision of the eventual outcome. The trade-off between cost and efficiency has rarely been addressed in research despite the obvious interest of obtaining precise data at low costs. Median trunk and upper arm inclination were determined for full shifts in 28 paper mill workers using both observation and inclinometry. Costs were estimated using comprehensive cost equations; and efficiency, i.e. the inverted standard deviation of the group mean, was assessed on basis of exposure variance components. Cost and efficiency were estimated in simulations of six sampling scenarios: two for inclinometry (sampling from one or three shifts) and four for observation (one or three observers rating one or three shifts). Each of the six scenarios was evaluated for 1 through 50 workers. Cost-efficiency relationships between the scenarios were intricate. As an example, inclinometry was always more cost-efficient than observation for trunk inclination, except for observation strategies involving only few workers; while for arm inclination, observation by three observers of one shift per worker outperformed inclinometry on three shifts up to a budget of €20000, after which inclinometry prevailed. At a budget of €10000, the best sampling scenario for arm inclination was 2.5 times more efficient than the worst. Arm inclination could be determined with better cost-efficiency than trunk inclination. Our study illustrates that the cost-efficiency of different posture measurement strategies can be assessed and compared using easily accessible diagrams. While the numeric examples in our study are specific to the investigated occupation, exposure variables, and sampling logistics, we believe that inclinometry will, in general, outperform observatio

We investigated associations between dampness in Chinese homes and sick building syndrome (SBS) symptoms and studied the role of climate, family size, cleaning and ventilation for dampness, mould and SBS. A questionnaire survey was done in 2019-2020 among adults in five cities (32349 participants) and data on outdoor climate was collected. Multilevel logistic regression was used to calculate adjusted odds ratios (ORs). In total, 2.2% had rhinitis, 1.8% eye, 1.6% throat and 2.9% skin symptoms, 2.1% headache and 8.7% fatigue (weekly symptoms). Overall, 12.1% reported indoor mould, 5.7% damp bedding, 5.3% mould odour and 33.8% humid air in current home. Mould was associated with all symptoms (ORs 1.86-2.15 for minor mold growth and 1.65-3.45 for major mould growth). Damp bedding was associated with all symptoms (ORs 2.18-2.80 for minor dampness and 2.51-8.03 for major dampness). Mould odour was associated with all symptoms (ORs 1.84-2.77 for sometimes odour and ORs 3.78-7.80 for weekly odour). Perception of humid air was associated with all symptoms. ORs increased by number of dampness signs. Precipitation, outdoor relative air humidity and temperature increased dampness, mould and SBS symptoms. Large family size increased dermal symptoms. Daily floor cleaning, airing in winter, putting bedding to sunshine and mechanical ventilation in the bathroom reduced dampness, mould and SBS symptoms. In conclusion, mould and dampness in Chinese homes can increase rhinitis and SBS-symptoms in a dose-response manner. A warmer and more humid climate can increase, and cleaning and ventilation in the home can decrease dampness, mould and SBS symptoms.

Background: Per- and polyfluoroalkyl substances (PFAS) have been suggested to contribute to the development of metabolic diseases such as obesity, diabetes and non-alcoholic fatty liver disease (NAFLD). However, evidence from epidemiological studies remain divergent. The aim of the present study was to evaluate associations between PFAS exposure and prevalent diabetes in a cross-sectional analysis and fasting glucose in a longitudinal analysis. Methods: In 2373 subjects aged 45-75 years from the EpiHealth study, three PFAS; perfluorohexanesulfonic acid (PFHxS), perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) were analyzed in plasma together with information on prevalent diabetes. Participants in the PIVUS study (n = 1016 at baseline, all aged 70 years) were followed over 10 years regarding changes in plasma levels of six PFAS; PFHxS, PFOA, PFOS, perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA), and changes in plasma levels of fasting glucose. Results: In the EpiHealth study, no overall associations could be observed between the levels of PFOA, PFOS or PFHxS and prevalent diabetes. However, there was a significant sex-interaction for PFOA (p = 0.02), and an inverse association could be seen between PFOA (on a SD-scale) and prevalent diabetes in women only (OR: 0.71, 95% CI: 0.52, 0.96, p-value: 0.02). This association showed a non-monotonic dose-response curve. In the PIVUS study, inverse relationships could be observed between the changes in levels (ln-transformed) of PFOA and PFUnDA vs the change in fasting glucose levels (ln-transformed) over 10 years (p = 0.04 and p = 0.02, respectively). As in EpiHealth, these inverse associations were significant only in women (PFOA: beta: -0.03, p = 0.02, PFUnDA: beta: -0.03, p = 0.03). Impact: Exposure to per- and polyfluoroalkyl substances (PFAS) has been linked to unfavorable human health, including metabolic disorders such as obesity, diabetes and no

Background Perfluoroalkyl substances (PFAS) are man-made chemicals with unique properties that are widely distributed in humans and the environment. Recent studies suggest that PFAS are involved in cholesterol metabolism, however, the mechanisms underlying the associations are poorly understood. Objective We aimed to evaluate associations of plasma PFAS with detailed lipid and lipoprotein subfractions in an adult population of men and women. Methods We measured concentrations of cholesterol and triglycerides in lipoprotein subfractions, apolipoprotein subclasses, as well as fatty acid and different phospholipid measures, using serum proton nuclear magnetic resonance (1H-NMR), and four plasma PFAS using liquid chromatography-mass spectrometry (UHPLC-MS/MS). Measurements were available for 493 participants (all aged 50 years, 50% female). Multivariable linear regression was used to estimate the association of four PFAS with 43 different 1H-NMR measures, with adjustment for body mass index (BMI), smoking, education, and physical activity. Results We found that perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorodecanoic acid (PFDA), but not perfluorohexanesulfonate (PFHxS), concentrations were consistently positively associated with concentrations of cholesterol in lipoprotein subfractions, apolipoproteins, as well as composite fatty acid- and phospholipid profiles. The most consistent associations were found for the relationship of PFAS with total cholesterol in intermediate-density lipoprotein (IDL), across all low-density lipoprotein (LDL) subfractions and small high-density lipoprotein (HDL). Moreover, we found weak to null evidence for an association of any of the measured 13 triglyceride lipoprotein subfractions with PFAS. Conclusions Our results suggest that plasma PFAS concentrations are associated with cholesterol in small HDL, IDL and all LDL subfractions, as well as apolipoproteins and composite fatty acid and phospholipid profiles b

Evidence indicates a link between exposure to ambient air pollution and decreased female fertility. The ability of air pollution particles to reach human ovarian tissue and follicles containing the oocytes in various maturation stages has not been studied before. Particulate translocation might be an essential step in explaining reproductive toxicity and assessing associated risks. Here, we analysed the presence of ambient black carbon particles in (i) follicular fluid samples collected during ovum pick-up from 20 women who underwent assisted reproductive technology treatment and (ii) adult human ovarian tissue from 5 individuals. Follicular fluid and ovarian tissue samples were screened for the presence of black carbon particles from ambient air pollution using white light generation by carbonaceous particles under femtosecond pulsed laser illumination. We detected black carbon particles in all follicular fluid (n = 20) and ovarian tissue (n = 5) samples. Black carbon particles from ambient air pollution can reach the ovaries and follicular fluid, directly exposing the ovarian reserve and maturing oocytes. Considering the known link between air pollution and decreased fertility, the impact of such exposure on oocyte quality, ovarian ageing and fertility needs to be clarified urgently.

Background: Concerns have been raised whether exposure to endocrine-disrupting chemicals (EDCs) can alter reproductive functions and play a role in the aetiology of infertility in women. With increasing evidence of adverse effects, information on factors associated with exposure is necessary to form firm recommendations aiming at reducing exposure. Objective: Our aim was to identify associations between lifestyle factors including the home environment, use of personal care products (PCP), and dietary habits and concentrations of EDCs in ovarian follicular fluid. Methods: April-June 2016, 185 women undergoing ovum pick-up for in vitro fertilisation in Sweden were recruited. Correlation analyses were performed between self-reported lifestyle factors and concentration of EDCs analysed in follicular fluid. Habits related to cleaning, PCPs, and diet were assessed together with concentration of six per- and polyfluoroalkyl substances (PFASs) [PFHxS, PFOA, PFOS, PFNA, PFDA and PFUnDA], methyl paraben and eight phthalate metabolites [MECPP, MEHPP, MEOHP, MEHP, cxMinCH, cxMiNP, ohMiNP, MEP, MOHiBP]. Spearman's partial correlations were adjusted for age, parity and BMI. Results: Significant associations were discovered between multiple lifestyle factors and concentrations of EDCs in ovarian follicular fluid. After correcting p values for multiple testing, frequent use of perfume was associated with MEP (correlation rho = 0.41 (confidence interval 0.21-0.47), p < 0.001); hens' egg consumption was positively associated with PFOS (rho = 0.30 (0.15-0.43), p = 0.007) and PFUnDA (rho = 0.27 (0.12-0.40), p = 0.036). White fish consumption was positively associated with PFUnDA (rho = 0.34 (0.20-0.47), p < 0.001) and PFDA (rho = 0.27 (0.13-0.41), p = 0.028). More correlations were discovered when considering the raw uncorrected p values. Altogether, our results suggest that multiple lifestyle variables affect chemical contamination of follicular fluid. Impact statement: This stu

Background: Adult males in Sweden exhibit an increased risk of cancer associated with an increased absorbed dose to the colon from the Chernobyl accident. Methods: A closed cohort, with information on hunter status, included all individuals living in northern Sweden in 1986. Complete annual information on exposure to 137Cs at the dwelling coordinate was available for a total of 2,104,101 individuals. A nested case-control method with four controls matched for year of cancer diagnosis and year of birth, was used. Individual absorbed organ doses were calculated between 1986 and 2020 including external and internal exposure. Hazard ratios (HR) per mGy with 95% confidence intervals (95% CI) were calculated using conditional logistic regression adjusted for rural/nonrural habitat, education level and pre-Chernobyl cancer incidence 1980 to 1985. A total of 161,325 cancer cases in males and 144,439 in females were included. Results: The adjusted HR per mGy for all cancer sites combined was 1.027 (95% CI = 1.022, 1.031) in males and 1.011 (95% CI = 1.006, 1.017) in females. In a post hoc analysis accounting for both remaining confounding from hunter lifestyle and the pre-Chernobyl cancer incidence by county, the adjusted HR per mGy for all cancer sites combined was 1.014 (95% CI = 1.009, 1.019) in males and 1.000 (95% CI = 0.994, 1.006) in females. The post hoc analysis suggested an increased risk of cancer in the colon, pancreas, and stomach, respectively, in males, and lymphoma in females. Conclusions: Increased cancer risk estimates were found for some specific cancer sites but remaining uncontrolled confounding due to hunter lifestyle could not be ruled out.

Background: Per- and polyfluoroalkyl substances (PFAS) are persistent chemicals that have been linked to increased cholesterol levels and thus may have a role in the development of cardiovascular disease (CVD). Objectives: To investigate associations between PFAS exposure and incident CVD (a combined CVD end-point consisting of myocardial infarction, ischemic stroke, or heart failure) in two independent population-based cohorts in Sweden. In addition, we performed a meta-analysis also including results from previous studies. Methods: In 2,278 subjects aged 45-75 years from the EpiHealth study, the risk of incident CVD in relation to relative plasma levels of perfluorohexanesulfonic acid (PFHxS), perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) was investigated. Associations between plasma levels of six PFAS and incident CVD were also examined in the PIVUS-study (n = 1,016, all aged 70 years). In addition, a meta-analysis was performed including three previous prospective studies, together with the results from the present study. Results: There were no overall statistically significant associations between levels of the different PFAS and incident CVD, neither in EpiHealth nor in PIVUS. However, there was a significant sex interaction for PFOS in EpiHealth (p = 0.008), and an inverse association could be seen only in men (Men, HR: 0.68, 95 % CI: 0.52, 0.89) (Women, HR: 1.13, 95 % CI: 0.82, 1.55). A meta-analysis of five independent studies regarding PFOA and incident CVD showed a risk ratio (RR) of 0.80 (CI: 0.66, 0.94) when high levels were compared to low levels. Conclusions: This longitudinal study using data from two population-based cohort studies in Sweden did not indicate any increased risk of incident CVD for moderately elevated PFAS levels. A meta-analysis of five independent cohort studies rather indicated a modest inverse association between PFOA levels and incident CVD, further supporting that increasing PFAS levels are not linked to

Introduction: Good relations are important at work, leading to well-being among coworkers. Since the latest research in nursing is mostly about bullying, and lateral violence, it was important to study what healthy relations mean. Objectives: The aim was to identify and synthesize qualitative studies that describe healthy relations, creating health and well-being between colleagues at work. Methods: A meta-synthesis approach, inspired by Sherwood's steps of analysis, was chosen for this study. Ten articles from three continents, comprising 230 participants, were included. Results: Two themes were identified as follows: (a) creating a mutual bond on a personal level and a permissive atmosphere through the human warmth; and (b) sharing togetherness in a greater whole, offering unconditional help and devoting themselves to taking care of each other. An overarching metaphor implicating the home/homeness was abstracted from the two themes: "Healthy relations between colleagues at work constitute the community as a common world, containing feelings of being at home, implying acting in an expression of the ethos and dignity, a culture created that makes the ideal form of healthy relations visible." Conclusion: Nurses find their meaning when they work in a permissive environment, and when they are allowed to be themselves. Such meaning can be found through their engagement with one another, by offering each other unconditional help. Good relationships lead to a place they call their home, where there is trust and friendship.

Background: Air pollution has been linked to mortality, but there are few studies examining the association with different exposure time windows spanning across several decades. The evidence for the effects of green space and mortality is contradictory.Objective: We investigated all-cause mortality in relation to exposure to particulate matter (PM2.5 and PM10), black carbon (BC), nitrogen dioxide (NO2), ozone (O3) and greenness (normalized difference vegetation index NDVI) across different exposure time windows.Methods: The exposure assessment was based on a combination of the Danish Eulerian Hemispheric Model and the Urban Background Model for the years 1990, 2000 and 2010. The analysis included a complete case dataset with 9,135 participants from the third Respiratory Health in Northern Europe study (RHINE III), aged 40-65 years in 2010, with mortality follow-up to 2021. We performed Cox proportional hazard models, adjusting for potential confounders.Results: Altogether, 327 (3.6 %) persons died in the period 2010-2021. Increased exposures in 1990 of PM2.5, PM10, BC and NO2 were associated with increased all-cause mortality hazard ratios of 1.40 (95 % CI1.04-1.87 per 5 mu g/m3), 1.33 (95 % CI: 1.02-1.74 per 10 mu g/m3), 1.16 (95 % CI: 0.98-1.38 per 0.4 mu g/m3) and 1.17 (95 % CI: 0.92-1.50 per 10 mu g/m3), respectively. No statistically significant associations were observed between air pollution and mortality in other time windows. O3 showed an inverse association with mortality, while no association was observed between greenness and mortality. Adjusting for NDVI increased the hazard ratios for PM2.5, PM10, BC and NO2 exposures in 1990. We did not find significant interactions between greenness and air pollution metrics.Conclusion: Long term exposure to even low levels of air pollution is associated with mortality. Opening up for a long latency period, our findings indicate that air pollution exposures over time may be even more harmful than anticipated.

Background: Whereas outdoor temperature is linked to both mortality and hydration status, the hormone vasopressin, measured through the surrogate copeptin, is a marker of cardiometabolic risk and hydration. We recently showed that copeptin has a seasonal pattern with higher plasma concentration in winter. Here, we aimed to investigate the as-sociation between outdoor temperature and copeptin. Methods: Copeptin was analysed in fasting plasma from five cohorts in Malm & ouml;, Sweden (n = 26,753, 49.7% men, age 18-86 years). We utilized a multivariable adjusted non-linear spline model with four knots to investigate the association between short-term temperature (24 h mean apparent) and log copeptin z-score. Findings: We found a distinct non-linear association between temperature and log copeptin z-score, with both moderately low and high temperatures linked to higher copeptin concentration (p < 0.0001). Between 0( ?)C and nadir at the 75th temperature percentile (corresponding to 14.3 ?C), log copeptin decreased 0.13 z-scores (95% CI 0.096; 0.16), which also inversely corresponded to the increase in z-score log copeptin between the nadir and 21.3 C-?. Interpretation: The J-shaped association between short-term temperature and copeptin resembles the J-shaped association between temperature and mortality. Whereas the untangling of temperature from other seasonal effects on hydration warrants further study, moderately increased water intake constitutes a feasible intervention to lower vasopressin and might mitigate adverse health effects of both moderately cold and hot outdoor temperatures. Fundin:g Swedish Research Council, & Aring; Wiberg, M Stephen, A P & aring;hlsson, Crafoord and Swedish Heart-Lung Foun-dations, Swedish Society for Medical Research and Swedish Society of Medicine.

Purpose To explore how patients who participate in an interdisciplinary pain rehabilitation program (IPRP) experience a three-party meeting based on the Demand and Ability Protocol (DAP) to assist in return to work (RTW). The DAP is a employee and his/her immediate manager under the guidance of medical staff with knowledge of the patient’s work requirements and his/her current functional ability. Materials and methods Data included 18 semi structured individual interviews with persons having chronic pain, who participated in a DAP-dialogue during their IPRP. Thematic analysis was used to analyze the data. Results Four themes were identified: A structured dialogue facilitated new insights; the dialogue enabled employer participation; the facilitator enabled experiences of feeling safe during the dialogue; and the dialogue created a link between rehabilitation and work. Conclusions The DAP dialogue was experienced as a supportive measure for RTW where the employer naturally participated in IPRP. The structure of the dialogue supported concrete planning for workplace adaptations. Furthermore, the dialogue enabled a connection between rehabilitation and the activity of work in everyday life. The results reinforce the importance of including efforts close to the workplace in IPRP in order to facilitate rehabilitation outcomes related to RTW.

Working onboard offshore oil platforms, whether for production or drilling, presents a series of risks, involving two substances that are naturally unhealthy and dangerous - crude oil and natural gas. It is therefore necessary to develop integrated management systems that balance business needs, resource constraints, technical capabilities, and emerging risks. In addition, it is necessary to meet the regulatory requirements, which in Brazil are determined by ANP (Agência Nacional do Petróleo, Gás Natural e Biocombustíveis). In view of the Human Reliability regulatory requirements, a dedicated study was developed, seeking to align the expectations of the regulator, the company’s resources and the validated methodologies of analysis, a requirement of the ANP itself. As a result, following HSE publications and ANP guidance, it was observed that the FRAM (Functional Resonance Analysis Method) methodology, simultaneously, can meet both the demands of Human Reliability and Human Factors. From the activities performed onboard offshore units that present the most complex combination of risks, the operations with nitrogen (generation and freezing storage) and the operation of the gas dehydration unit, were selected to be analyzed with FRAM. The results of these analyses, in addition to failures, it was also perceived that human adaptive behavior, a building element of system resilience, promotes safe operational continuity, even with the partial or complete loss of intrinsic safety barriers.

Background: Flexible work arrangements (FWA) are common, but knowledge on how to organize flexible work to reduce negative consequences and preserve positive aspects is currently sparse, which hampers organizational initiatives. Purpose: This study aimed at determining the extent to which work strategies, work-related ICT use outside regular working hours (i.e., use of laptop, tablet, or smartphone, to handle information and facilitate communication), productivity, expectations of availability, and clarity of expectations about availability, had changed among office-based employees with FWA two and four months after a participative two-step workplace intervention. Methods: An intervention group (n=97) was compared to a control group working as usual (n=70). The intervention, initiated and approved by the top management of the organization, included individual education intended to change work strategies, and workshops developing common rules and routines for FWA within the work group. Results: Participants were satisfied with the intervention and reported larger changes than the control group in work strategies. No statistically significant effects were, however, found on ICT use, productivity, or expectations of availability. Conclusions: This participative workplace intervention was successful in changing employees work strategies but may not be effective in influencing ICT use outside regular working hours, productivity, expectations of availability, and clarity of expectations about availability.

Organizing work to promote work-life balance (WLB) in employees with flexible work arrangement (FWA) is an important issue, but intervention studies are sparse. The aim of the present study was to determine the extent to which WLB, work-home interference (WHI), and home-work interference (HWI) changed among office-based employees with FWA after a participative workplace intervention. The researchers co-created an intervention together with a large governmental agency in Sweden. The intervention consisted of two activities; 1) education to change individual work strategies, and 2) workshops to develop common rules and routines within the workgroup. Two similar departments with notable levels of perceived stress participated as an intervention group (n=97) and as a control group (n=70). The control group was aware of the intervention but did not receive any intervention activities. Data were collected using questionnaires on three occasions: prior to the intervention (baseline), after the education (six-month follow-up), and after the workshops (12-month follow-up). Data were analyzed using linear mixed models, with adjustments for candidate confounders. Results indicated marginal and statistically non-significant effects of the intervention on WLB or interference between work and private life. Estimates at the second follow-up pointed to slightly reduced WLB but increased HWI in the intervention group compared with the control group. Further studies are needed to evaluate whether other strategies could be more effective in promoting WLB in FWA.