Department of Medical Sciences

Occupational and environmental medicine

Occupational and environmental medicine is a research area studying the significance of environmental factors and exposure on human health in a wide context, covering all age groups. The environmental factors can be from the workplace, the indoor environment, or the outdoor environment. The type of exposures can be physical, chemical, biological, psychosocial or organisational. The research methodology mainly includes epidemiological methods, either in specific groups or in the general population, as well as experimental intervention field studies.

The research is focused on health effects of the indoor environment and outdoor environment, with respect to asthma, ocular and respiratory symptoms, rhinitis and allergic symptoms. The indoor studies have covered schools, day care centres, hospitals, dwelling, and stables. In various research project effects on airways, ionizing radiation, physical activity and noise linked to auditory are investigated. Exposure to endocrine disrupting chemicals, and the contribution of these chemicals to potential progression of major common diseases are also studied. Furthermore, our research is focusing on work organization, social factors including immigrant and workplace design, and their importance for the good work environment, health and productivity. We also develop and use different measurements of physical activity, lung function, sleep and organizational justice.

We have an international profile with contacts with various research groups in Europe and are involved in EU-financed projects. Furthermore, there are bilateral research collaborations with Estonia, Norway, Iran, China, Japan, Korea, Singapore and Canada. There have also been collaborations in teaching, including development of courses in occupational and environmental medicine in the Baltic States and Russia. We have also been consulted by WHO, Europe and the European Commission as experts on indoor environment and health.

Guihong Cai

EpiHealth kohort om sömnproblem och lungfunktion

Ansvarig: Guihong Cai
Period: 2011-2019

EpiHealth (Epidemiologi för hälsa, www.epihealth.se) är ett storskaligt forskningssamarbete mellan Uppsala universitet och Lunds universitet. Projekt har 19,135 deltagare hos medelålders och äldre personer (45-75 år gammal). EpiHealth syftar är att kartlägga orsakerna till våra vanligaste folksjukdomar. Tidigare studier har visat att sömnstörningar/sömnproblem har negativ inverkan på livskvaliteten såsom diabetes, hjärtinfarkt, demens och dödlighet. Denna delstudie av EpiHealth kohort handlar om kopplingen mellan lungfunktion och sömn (t.ex. insomnia och sömnapne), sömnstid, viktuppgång, fetma, central fetma och miljöpåverkan och livsstilsfaktorer. Ytterligare forskning är nödvändig t.ex. fokus på sömnkvaliteten och så att i en framtid skall kunna förebygga och behandla dessa

Hand-intensive work: A methology for risk assessment, medical examination and evaluation.

Responsible researcher: Teresia Nyman
Period: 2017-2019

The aim of the project is to develop, test and evaluate a model for medical examinations for workers exposed to hand-intensive work with regard to feasibility (benefits and values for employers and employees) as well as effects regarding work-related ill health and improved working environment. The project is expected to specifically increase knowledge about effective and feasible methodologies for implementing medical examinations for workers exposed to hand-intensive work, and more generally provide support to the Swedish Work Environment Authority with regard to relevant key figures and factors for monitoring and evaluation in their supervisory work in terms of application and effects of regulations. In addition, the project is expected to contribute knowledge of gender differences in exposure and ill health in a number of industries with hand-intensive work in which women are overrepresented.

Monica Lind

Does exposure to perfluorinated substances affect the risk of developing cardiometabolic diseases?

Responsible researcher: Monica Lind
Period: 2015-2019

Previous studies have shown associations between environmental pollutants, such as PCBs, pesticides, bisphenol A, phthalates and cardiometabolic disorders. In this current research project we are investigation if another group of environmental pollutants; perfluorinated substances (shortened PFASs) may cause similar disorders. In order to study this we use data from the PIVUS cohort (1016 men and women, all 70 years in 2001-2004) where 14 different PFASs have been measured in serum. Repeated measurements were performed at 75 (n=826) and 80 (n=606) years of age. The overall hypothesis for the project is that PFASs, through the influence on hormones that control fat metabolism, affects fat metabolism and that this effect leads to, for example, increased amount of abdominal fat, altered levels of blood lipids and fatty acids that can induce future cardiometric disease.

Does development exposure to Bisphenol A contribute to the development of obesity and osteoporosis?

Contact: Linda Dunder
Period: 2013-2019

Already in the 30's, it was known that bisphenol A (BPA) had estrogenic properties and therefore BPA was intended to be launched as a drug. However, another drug, diethylstilbestrol, was found to be more potent than BPA and therefore another use for found for BPA. In the 1950s, the properties of the substance were discovered as an efficient plastic hardener. Since 1957, BPA has been widely used in plastic production. BPA is used, for example, in the manufacturing of polycarbonate plastic (PC) and as an additive in other plastics, as well as in epoxy phenolic coatings used e.g. on the inside of canned cans and water pipelines ("relining"). BPA and its analogues are used today not only in plastics but also in eg. inks and receipts. Therefore, we are exposed to BPA not only via food but also via drinking water and dust, and it is therefore not surprising that BPA can be detected in the circulation of almost all people being investigated. Because of its endocrine properties, BPA has become a highly controversial chemical and although hundreds of experimental studies and several epidemiological studies have shown possible adverse effects of BPA on health, the authorities still require more data to make decisions about regulation of BPA. No previous studies have investigated how the bone tissue is affected by BPA or if the balance between fat and bone tissue is disturbed by early exposure to BPA. The overall aim of this research project is therefore to in a rat model study whether premature low dose exposure (in utero and during lactation) to BPA interferes with the sensitive balance between fat and bone tissue and if this causes permanent changes. Such changes could manifest as obesity and/or osteoporosis in adulthood.

Relevant publications:

Dan Norbäck

Schools in Europe and Asia - Associations between the school environment and asthma symptoms, rhinitis, respiratory infections and sick building syndrome (SBS)

Responsible researcher: Professor Dan Norbäck

Associations between exposures in the school environment and asthma symptoms, rhinitis, respiratory infections and sick building syndrome (SBS) is studied in a number of environment projects, both multi-center studies in the EU and national school environment studies in Sweden, Iceland, China, Japan, South Korea, Malaysia, Indonesia, Iran, Thailand and Cambodia. Studies in Sweden and China have also been investigating the indoor environment in day care centers for pre-school children (kindergartens). A number of scientific articles have been published. Moisture damage, mould and the level of microbial components of mold and bacteria (such as fungal DNA and endotoxin) in the dust of the schools are important risk factors. Other risk factors in the schools include furry pet allergens, particulate matters (PM10), insufficient ventilation flow (CO2 levels) and air pollutants from the outside air, e.g. traffic exhausts.
 

Risk factors for asthma, rhinitis and respiratory infections among adults in the home environment

Responsible researcher: Professor Dan Norbäck

Juan Wang is a PhD student in the project. Associations between asthma, rhinitis and respiratory infections and exposures in the home environment is studied among randomly selected adults in the general population in Sweden and China. Data on health and the home environment is collected through standardized questionnaire studies. In a sub-sample of the dwellings building inspections and measurements of the indoor environment have been performed. Several articles have been published within the project. Moisture and mold in the home and insufficient ventilation flow can be important risk factors for asthma, rhinitis and respiratory infections. Moisture in the floor construction was an important risk factor as well as high absolute air humidity in the home. Other significant risk factors include interior painting, cockroaches and a location close to busy roads.
 

Self-rated health (SRH) and respiratory symptoms among commercial pilots - occupational and non-occupational risk factors

Responsible researcher: Professor Dan Norbäck

Xi Fu is a PhD student in the project. Self-rated health, headache, fatigue, asthma, allergies, respiratory symptoms and symptoms from the eyes, nose, throat and skin have been studied among pilots at a Scandinavian Airlines. These health outcomes have been related to personal risk factors, lifestyle factors such as exercise and obesity, sense of coherence (SOC), sleep problems, psychosocial work environment and the physical environment. Measurements of furry pet allergens (cat, dog, horse), fungal DNA and volatile organic compounds of possible microbial origin (MVOCs) has been measured on board on flight deck and in the cabin. The project includes both prevalence studies and a three-year follow up of a cohort of pilots. The PhD student will defend her thesis on May 22, 2017.

Magnus Svartengren

STAMINA - Structured and Time-Effective Approach through Methods for an Inclusive and Active working life.

Responsible researcher: Magnus Svartengren
Period: 2016-2019

Developing and maintaining good health and productivity in the Swedish businesses requires a structured process that supports the development of good working environments. In Sweden, the regulation of Systematic work environment (SAM) (AFS 2001:1) addresses employer’s obligations to investigate, carry out and follow up activities in such a way that ill health and accidents at work are prevented and a satisfactory working environment is achieved. The methods, when applied, is very effective but it is not seldom experienced as time consuming, and somewhat abstract. In a report from the Swedish Work Environment Authority (SWEA) it emerged that despite legal requirements, there are still employers in Sweden who’s not fulfilling their legal obligations. It often fails with regard to the concretization of goals, communication, participation and follow-up / evaluation. The Stamina model is a structured, time efficient and participatory method aiming to improve work environment, productivity and quality.

The overall aim is to examine how the implementation and long-term usage of the Stamina model is applied in municipalities in Sweden and to investigate the effects of for example HRI and perceived productivity over time.

Method for assessing the employee functional capacity in current work – a key to successful cooperation between supervisor, employee and occupational health professional

Responsible researcher: Magnus Svartengren
Contact: Sofia Åström Paulsson
Period: 2013-2017

Krav- och funktionsschemat(KOF) – eng. Demands and Functional Schedule - is a method used by occupational health services for assessing employee´s capacity to work. It was originally developed in the Netherlands and Norway and has been translated in to Swedish. The method is conducted as a structured conversation between the employee and the manager under the guidance of a professional from the occupational health service. During the conversation, the employee and the manager agrees on the level of demands in the current work and the employee´s correspondent functional capacity. Compilation is made of areas where the functional capacity is less than the job's requirements and suggestions for adaptation measures are noted. The purpose of the project is to investigate the method´s:

  • usefulness for employees, employers and occupational health services.
  • impact on the company / workplace's rehabilitation process, employee sickness absence and trust in the supervisors (organizational justice).

Martin Tondel

Working environment and health among immigrants - a systematic literature review.

Responsible researcher: Martin Tondel
Contact: Bo Johansson

The aim of this literature review is to identify risk factors for illness among immigrants, but also to describe psychosocial conditions that can improve participation in working life. The project is funded by the Nordic Council of Ministers.

Health and labour market attachment among immigrants.

Responsible researcher: Martin Tondel
Contact: Bo Johansson
Period:2018-2020

The aim of this project is to illustrate and analyze labour market participation and health status for different groups of immigrants to Sweden, based on geographical origin and reason for migration/settling. We are using a longitudinal design and register data to identify factors that can be considered as prognostic markers for inclusion/exclusion in the labour market and are protective or harmful to health. The project will also scrutinize the established "healthy migrant effect" hypothesis (that immigrants are generally healthier than the native population on arrival in the new country).

Estimated lifetime effective dose to hunters and their families in Gävleborg, Västernorrland and Uppsala county after the Chernobyl accident in 1986 – a pilot study

Responsible researcher: Martin Tondel
Period: 2013-2017

In this pilot study we use existing registries and whole-body measurements to develop algorithms to calculate lifetime effective doses and collective doses to some hunters in Sweden. Internal effective doses will be estimated using aggregated transfer factors from ground deposition to in vivo body concentration for 134Cs and 137Cs. External effective doses will also be calculated for 134Cs, 137Cs and short-lived nuclides in these three counties. Internal and external doses will be added annually on an individual level and then cumulated to a lifetime dose. 

Lena Elfman, Anna Rask Andersen

Allergi mot häst allergen- från miljöexponering till diagnostik

Responsible researchers: Lena Elfman, Anna Rask Andersen
Contact: Susanne Victor, PhD student
Period: 2013-2020

The number of horses in Sweden is very large and, of course, is related to the great interest for horse sports. It is the second largest sport in the country. For many, togetherness with horses contributes to a good quality of life. Horse allergy therefore presents a problem for many. Allergic reactions are triggered by allergens consisting of water-soluble proteins dispersed in small particles. Allergens are spread both in the air and for example through clothes and hair and can therefore also affect people who themselves have not been close to any animal. Allergens are present in the animal's skin epithelia, dandruff, saliva and urine. Horse allergens are today less studied than allergens from other pets and domestic animals. So far four horse allergens are identified; Equ c1, Ecu c2, Ecu c3 and Ecu c4. According to available data, Equ c1, a lipocalin, is the main allergen.


The purpose of this project is to analyze the differences in horse allergen profiles in the epithelia, saliva and urine from ten common horse breeds in Sweden. We have previously used a diagnostic ELISA test for quantitative determination of the horse allergen Equ c 4. Now the development of antibodies to Equ c 1 and c 2 is ongoing. With these tools we will investigate the allergen profile of the various horse breeds. Then we will study the corresponding horse allergen profile in horse allergic patients. The question is whether the patient's symptoms correlate with the reaction to the various horse allergen components. In addition to identifying horse breeds or individuals with low / different allergen profiles, we will hopefully be able to identify horse breeds that are better suited for horse allergic patients, which could mean that they can engage in horse sports and get a better quality of life.

Robert Wålinder

Hälsa och produktivitet bland vårdpersonal i Uppsala län

Ansvarig: Robert Wålinder
Period: 2015-2021

Det är känt att vårdpersonal har höga ohälsotal samtidigt som de utsätts för ovanligt många av arbetslivets riskfaktorer. De vårdanställda är utsatta för bl.a. obekväma arbetstider, långa arbetspass, nattarbete, våld- och hot, stress, underbemanning, tunga lyft, infektioner och smitta, narkosgaser, kemikalier, läkemedelshantering, joniserande strålning, organisationsförändringar, otydlig ledning mm.

Detta aktionsforskningsprojektet avser att interaktivt samla data om yrkes- och livsstilsfaktorer bland vårdpersonal för att skapa en risk- och hälsoprofil. Denna hälsoprofil återförs sedan till den anställda med en uppföljning av hälsodata.

Genom en webb-baserad enkät erbjuds samtliga anställda inom hälso- och sjukvården i Uppsala län svara på frågor om hälsa, arbete och livsstil. För varje anställd skapas en risk- och hälsoprofil som återförs till den anställde, tillsammans med ett evidensbaserat åtgärdsprogram med syfte att reducera risker och främja hälsa. En uppföljning sker efter 3 och 6 år.

Cancerförekomst i Sverige 25 år efter Tjernobylolyckan

Ansvarig: Robert Wålinder
Period: 2012-2018

Sverige erhöll relativt stor del av det radioaktiva nedfallet (jod-131 och cesium-137) från reaktorhaveriet i Tjernobyl 1986. Cesium-137 har en fysikalisk halveringstid på 30 år och inträffade cancerfall sker ofta med en latenstid på 20-30 år efter exponering. Den radioaktiva kontamineringen har haft stora samhällskonsekvenser i vissa delar av Mellansverige där viltkött, insjöfisk, bär och svamp fortfarande har hög radioaktivitet.

Studera om cancerförekomsten är högre i de områden som har högre nedfall av cesium-137 för att avgöra vilka hälsokonsekvenser den radioaktiva kontaminationen har.

Flygning med gammakamera har givit kartor med markstrålningen från cesium-137. Exponering av joniserande strålning från det radioaktiva nedfallet för befolkningen i norra Sverige skattas för deras bostäders värde på strålningskartan. Uppgifter om cancerdiagnos och dödsfall i befolkningen hämtas från nationella cancerregistret vid Epidemiologiskt centrum på Socialstyrelsen. Sambandet mellan bostadens strålvärde och risken att få cancer under 25 år skattas.

Greta Smedje

Sambandsstudie mellan byggnadens status och boendes upplevda innemiljö och ohälsa med hjälp av BETSI-databasen

Ansvarig: Greta Smedje
Kontaktperson: Dan Norbäck
Period: 2013-2017

Forskning har belagt att fukt i byggnader och för låga luftflöden kan ge hälsobesvär. Omfattningen av fuktskador och låga luftflöden i svenska bostäder gör det viktigt att värdera nivåer och flöden och typ av skada i relation till olika hälsosymtom.  Det insamlade BETSI materialet ger en unik möjlighet att studera samband mellan byggnaden som system ända fram till brukaren, liksom metoder för att göra detta. Huvudsyftet med projektet BETSI-DATE (Building Energy use, Technical Status and Indoor environment and Dampness, Air quality, Temperature and perceived indoor Environment and health) är att undersöka bostäder och hur olika slags innemiljöproblem i byggnader med olika inneklimat, luftflöde och fuktskada kan orsaka hälsobesvär. Samband som kan bero på byggnadens karaktär och de boendes beteende vid användning av bostaden samt personrelaterade egenskaper. Med hjälp av BETSI databasen ska vi studera samband mellan;

  • självrapporterad och observerad fukt i bostäder och astmatiska och allergiska symtom och SBS symtom bland vuxna
  • uppmätta luftflöden i bostäder och astmatiska och allergiska symtom och SBS symtom bland vuxna
  • uppmätt rumstemperatur i bostaden och de boendes bedömning av värmekomforten
  • självrapporterad och oberoende observationer av fukt och mögel (valideringsstudie)
  • självrapporterad bedömning av ventilation och inomhusluften och faktiska mätningar av ventilationsflöden (valideringsstudie)

Martin Anderson

Life Gene Spirometry  

Responsible researcher: Martin Anderson
Contact: Mikaela Qvarfordt;
Mikaela.Qvarfordt@medsci.uu.se
Period: 2012-2019.

Lifegene is a research initiative conducted as a collaboration project between six medical faculties in Sweden. Data is collected by questionnaires, blood and urine samples, together with physiological testing, including spirometry, in order to create new tools for assessing, preventing and treating our most common diseases. We are responsible for the spirometry, quality and use. A large number of individuals from the population between 18-45 years have been investigated. So far, 9000 lung function tests have been reviewed and results show that direct feedback to the test leader during the spirometry test is of great importance and that you can carry out very high quality testing even after a very short (hours) training of the test leaders.