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St. Eriks Eye Hospital in Stockholm Sweden built a new hospital faced with the challenge of designing new examination rooms. The hospital collaborated with a group of researchers for guidelines in designing the internal building environment due to the narrow and specialized field of eye healthcare. A prototype examination room (PER) was subsequently made in reflection to their guidelines and in 2019 an assessment on the new design was needed. The new design includes an automated lighting program with multiple stages in addition to other elements like LED lights. The elements assessed           here include illuminance, luminance, glare, flicker, illuminance uniformity, color temperature, color rendering, and layout. The results of the PER assessment are compared to that of current examination rooms to further contrast the new design. Swedish and European Standards of the work environment were used as a base for the assessment. Additional resources include field specific literature, the researcher’s guidelines, and additional hospital design guides. This information formed the theoretical basis and was used to create a dialogue for interviews. The qualitative data retrieved from the interviews included information about work routine and technology challenges. The interview data was analyzed to identify emerging themes used to propose suggestions for improvements including remote control designs. Technical measurements of illuminance and luminance were performed with a Hagner S2 and Hagner Screenmaster. Measurements of glare were performed with a Nikon 4D camera and LMK software from TechnoTeam (Germany) to generate UGR values. Energy saving features were identified and implications on energy use was calculated from the specifications of the luminaires in each examination room. Results show the PER met European standard EN 12464-1:2011 requirements for glare, desk workstation illuminance/luminance, flicker, color rendering, color temperature, and illuminance. Requirements not met include poor illuminance uniformity in stage 2 and 3 of the PER’s automated lighting program. The new PER design leans toward sustainability and reduced energy consumption by incorporating efficient LED luminaires and an energy saving program. When compared to the current rooms, the PER features trends of improvement in illuminance, luminance, glare, flicker, color temperature and color rendering. Recommendations for improvement include new designs of the PER remote control and a proposal to use video technology as a learning tool of the new automated program.

People are, in their daily lives, exposed to a number of airborne foreign compounds that do not normally affect the body. However, depending on the nature of these compounds, dose and duration of exposure, various airway symptoms may arise. Early symptoms are often manifested as upper airway mucosal inflammation which generates changes in protein composition in the airway lining fluid. This thesis aims at identifying, understanding mechanisms and characterizing protein alterations in the upper airway mucosa that can be used as potential new biomarkers for inflammation in the mucosa. The protein composition in the mucosa was studied by sampling of nasal lavage fluid that was further analyzed with a proteomic approach using twodimensional gel electrophoresis and mass spectrometry. Additionally, by studying factors on site through environmental examination, health questionnaires and biological analyses, we have tried to understand the background to these protein alterations and their impact on health. Respiratory symptoms from the upper airways are common among people who are exposed to irritative and microbial agents. This thesis have focused on personnel in swimming pool facilities exposed to trichloramine, metal industry workers exposed to metalworking fluids, employees working in damp and moldy buildings and infants diagnosed with respiratory syncytial virus infection. The common denominator in these four studies is that the subjects experience upper airway mucosal inflammation, which is manifested as cough, rhinitis, phlegm etc. In the three occupational studies, the symptoms were work related. Notably, a high prevalence of perceived mucosal symptoms was shown despite the relatively low levels of airborne irritants revealed by the environmental examination. Protein profiling verified an ongoing inflammatory response by identification of several proteins that displayed altered levels. Interestingly, innate immune proteins dominated and four protein alterations occurred in most of the studies; SPLUNC1, protein S100A8 and S100A9 and alpha-1-antitrypsin. Similarly, these proteins were also found in nasal fluid from children with virus infection and in addition a truncated form of SPLUNC1 and two other S100 proteins (S100A7-like 2 and S100A16), not previously found in nasal secretion, were identified. Altogether, the results indicate the potential use of a proteomic approach for identifying new biomarkers for the upper respiratory tract at an early stage in the disease process after exposure to irritant and microbial agents. The results indicate an effect on the innate immunity system and the proteins; SPLUNC1, protein S100A8 and S100A9 and alpha-1-antitrypsin are especially promising new biomarkers. Moreover, further studies of these proteins may help us to understand the molecular mechanisms involved in irritant-induced airway inflammation.

Arsenic is a well-known lung carcinogen in humans. In 2006, IARC upgraded inorganic lead as a possible human carcinogen (2A). The aim of this thesis has been to evaluate the lung cancer mortality and incidence in long-term exposed primary lead smelter workers and also to estimate present exposures to arsenic and lead in relation to those occurring in the past. The basic cohort (N=3832 workers; hired before 1967 and followed up from 1950-1981; SMR comparisons with general and local reference populations) showed an excess of deaths for total mortality, malignant neoplasms (e.g. lung and stomach cancer), ischaemic heart diseases, and cerebrovascular diseases compared to the general population. In a subcohort of lead workers (N=437; regular blood lead sampling since 1950) only the raised SMR for lung cancer (162) was sustained. In a follow-up study of the basic cohort (N=3979), a subcohort of lead exposed workers (N=1992) was formed. The expected mortality in 1955-1987 and cancer incidence in 1958-1987 were calculated relative to county rates. A cumulative blood lead index (CBLI) was used for dose-response analyses. The lung cancer incidence was raised in the total cohort (SIR 2.8; 95 % CI 2.1 3.8). A higher lung cancer risk was observed in workers hired before 1950 (SIR 3.6; 95 % CI 2.6-5.0). The increased lung cancer risks were further elevated in the subcohort of lead exposed workers, especially in the highest exposed subgroup (SIR 5.1; 95 % 2.0-10.5; latency period of 15 y). No excesses of other malignancies were observed. The increased relative risks for lung cancer may have been caused by interactions between inorganic lead and other substances at the smelter, e.g. arsenic. To further analyze the effects from inorganic lead, two subcohorts of workers at the lead departments were formed from the original cohort (N=3979), one of 710 workers and the other of 383 workers. The lung cancer incidence was raised in both subcohorts (Lead subcohort 1; SIR 2.4; 95 % CI 1.2-4.5; Lead subcohort 2; SIR 3.6; 95 % CI 1.2-8.3). Among the 10 workers that had developed lung cancer in lead subcohort 1 all but one had a considerable exposure also to arsenic. Thus, a possible interaction effect between lead and arsenic may explain the increased lung cancer risks. To further elucidate the impact from lead and arsenic a case control study was undertaken. In the basic cohort (N=3979), 46 male workers had contracted respiratory malignancies. They were compared with 141 agematched male referents from the primary smelter by conditional logistic regression analysis using smoking habits, cumulative blood lead and air arsenic exposure as predictor variables. The lung cancer cases showed a significantly higher smoking rate than referents (Odds ratio, OR = 4.0; 95 % CI 1.6-10.1; p=0.003). When restricted to smokers, the cumulative arsenic air exposure index, but not the lead exposure indices, were significantly higher among the cases (OR=1.07; 95 % CI 1.02-1.11; p = 0.005). Accordingly, cumulative arsenic exposure and smoking were identified as significant risk factors for the development of lung cancer in the final analyses, while lead exposure was not a significant risk factor. However, inorganic lead still may play a minor role in the multifactorial genesis of lung cancer. These studies describe risks from exposures occurring from time periods before 1950 up to 1981. Because of the long latency period for lung cancer, exposures after 1970 probably have had limited impact on the reported results. Compared to the levels in the early 1970´s present exposures to arsenic are lower by a factor of ten or more and risks probably correspondingly lower.

Background: Ambient air pollution is associated with adverse health effects, but the sources and components, which cause these effects is still incompletely understood. The aim of this thesis was to investigate the pulmonary effects of a variety of common air pollutants, including diesel exhaust, biomass smoke, and road tunnel and subway station environments. Healthy non-smoking volunteers were exposed in random order to the specific air pollutants and air/control, during intermittent exercise, followed by bronchoscopy. Methods and results: In study I, exposures were performed with diesel exhaust (DE) generated at transient engine load and air for 1 hour with bronchoscopy at 6 hours post-exposure. Immunohistochemical analyses of bronchial mucosal biopsies showed that DE exposure significantly increased the endothelial adhesion molecule expression of p-selectin and VCAM-1, together with increased bronchoalveolar lavage (BAL) eosinophils. In study II, the subjects were exposed for 1 hour to DE generated during idling with bronchoscopy at 6 hours. The bronchial mucosal biopsies showed significant increases in neutrophils, mast cells and lymphocytes together with bronchial wash neutrophils. Additionally, DE exposure significantly increased the nuclear translocation of the aryl hydrocarbon receptor (AhR) and phosphorylated c-jun in the bronchial epithelium. In contrast, the phase II enzyme NAD(P)H-quinone oxidoreductase 1 (NQO1) decreased after DE. In study III, the 2-hour exposures took place in a road tunnel with bronchoscopy 14 hours later. The road tunnel exposure significantly increased the total numbers of lymphocytes and alveolar macrophages in BAL, whereas NK cell and CD56+/T cell numbers significantly decreased. Additionally, the nuclear expression of phosphorylated c-jun in the bronchial epithelium was significantly increased after road tunnel exposure. In study IV, the subjects were exposed to metal-rich particulate aerosol for 2 hours at a subway station with bronchial biopsy and BAL sampling at 14 hours. The subway exposure significantly increased the concentration of glutathione disulphide (GSSG) in BAL, with no airway inflammatory responses. In contrast, the number of neutrophils in the bronchial mucosa and the nuclear expression of phosphorylated c-jun in the bronchial epithelium tended to decrease after the subway exposure. In study V, the exposure to biomass smoke lasted 3 hours. Bronchoscopy was conducted 24 hours post exposure. The investigated biomass combustion emissions resulted in a significant increase in total glutathione and reduced glutathione in BAL, without any evident acute airway inflammatory responses.     Conclusion: The present thesis presents data from exposures of healthy subjects to a variety of common air pollutants, as compared with an air reference. Oxidative as well as bronchial mucosal and bronchoalveolar responses differed between these air pollutants, with the most pronounced airway effects seen after exposure to diesel exhaust. This may be due to differences in pulmonary deposition, physicochemical characteristics, toxicological pathways and potency. Additional studies will assist in addressing dose-response and time kinetic aspects of the airway responses.

Inom trafikforskningen är det allmänt känt att sömnighet är en starkt bidragande faktor vid trafikolyckor. Tidigare forskning har visat att sömnighet hos förare är närvarande i 16–-23 procent av alla bilolyckor. Inom flyg- och järnvägsdomänen har en metod, med en stark influens från human factors-området, kallad Fatigue risk management (FRM) använts för att undersöka hur sociala och organisatoriska faktorer påverkar personalens sömnighetsnivå. Dock har denna metod inte använts för att undersöka lastbilsförares sömnighetsnivå i någon större utsträckning. Studiens syfte var att undersöka hur lastbilsförare upplever, motarbetar och motverkar sömnighet i deras dagliga arbetssituation. Resultaten visar att lastbilsförare i sitt arbete möter en stor mängd trötthetsbidragande faktorer, som kan härledas både till organisatoriska faktorer och individuellt beteende. Möjliga sätt att motverka sömnighet bland lastbilsförare, riktade mot både individen och organisationen, föreslås. / In the traffic domain it is commonly known that sleepiness is a highly contributing factor in traffic accidents. Research has shown that sleepiness among drivers is present in about 16-–23 per cent of all car accidents. In the aviation and railway industry a method or framework with some shared influences from the Human Factors approach, called Fatigue Risk Management (FRM) has been used to investigate how social and organisational factors affect the personnel’s level of sleepiness. The overall aims of this study are to investigate how truck drivers’ experience, fight and counteract sleepiness in their daily work environment. The results show that drivers face a wide variety of sleep contributing factors, stemming from both organisational factors and individual behaviour. Possible ways of counteracting truck driver sleepiness, concerning both the individual and the organisation, are also suggested.

Background: Chronic neck pain is a problem that may be prevented and treated by physical activity. Little is known about effective interventions to increase physical activity in workers with neck pain. Objective: To evaluate the effects of an intervention aimed at increasing physical activity among workers with chronic neck pain. Design: A 10-week randomized controlled study in a population of 35 (intervention n= 19, control n= 16) workers. Physical activity was assessed using a tri-axial accelerometer pre and post the intervention. Outcomes: Daily steps, metabolic equivalent, proportions of time spent sitting/lying, standing and walking, and sit-to stand transitions. Linear mixed model was used to analyze the intervention effect (group × time) adjusted for the baseline value for each outcome. Results: There was no significant intervention effect on steps, metabolic equivalent, walking or sit-to stand transitions. There were significant intervention effects on decreased time spent sitting/lying (p=0.010) and increased standing (p=0.017).   Conclusion: No differences between intervention and control groups were found in parameters of total physical activity. However sedentary time decreased substantially in intervention group and was replaced by standing time. Larger studies using objective assessments of physical activity and sedentary behavior, investigating the effects of changes in PA and sedentary behavior on pain and health outcomes, in a working population with chronic neck pain are recommended. / Bakgrund: Kronisk nacksmärta är ett problem som kan vara möjligt att förebygga och behandla med fysisk aktivitet. Det finns begränsad kunskap om effektiva interventioner för att öka fysisk aktivitet hos arbetstagare med nacksmärta. Syfte: Att utvärdera effekten av en intervention riktad mot att öka fysisk aktivitet hos en grupp arbetstagare med kronisk nacksmärta. Design: En 10 veckors randomiserad kontrollerad studie i en population av arbetstagare med kronisk nacksmärta, n= 35 (interventionsgrupp n=19, kontrollgrupp n= 16). Fysisk aktivitet mättes med triaxiell accelerometer före och efter interventionen.  Utfallsmått: Antal steg per dag, metabolisk ekvivalent, förändringar i proportionerna mellan tid i sittande/liggande, stående och gående och antal uppresningar från sittande till stående. Resultat: Det fanns ingen signifikant interventionseffekt avseende steg, metabolisk ekvivalent, tid i gående eller antal uppresningar från sittande. Tid i sittande/liggande minskade signifikant (p=0,010) och tid i stående ökade, också signifikant (p=0,017).  Slutsats: Det fanns ingen skillnad mellan grupperna i total fysisk aktivitet. Däremot minskade tiden i sittande/liggande markant och ersattes av tid i stående. Större studier med objektiva mätningar av fysisk aktivitet och stillasittande beteende som också undersöker effekter av förändringar i fysisk aktivitet på smärta och hälsovariabler bland arbetstagare med kronisk nacksmärta rekommenderas. / STIMUL

Introduction: Significant changes in the global ecosystem, together with a potential shortfall in oil resources, have stimulated intense interest in the development of other sources of energy, and most particularly biofuels since these are basically considered to be less harmful to human health than petroleum-based fuels. However, information about the impact of biofuel-derived vehicle emissions on human health is limited and incomplete.   Aim of the study: To identify those biofuels that are less detrimental to human health on the basis of published results from toxicological and chemical studies of vehicle emission products.   Tasks of the study: To review systematically all conventional and alternative fuels used in internal combustion engines, to identify all known toxic emission products formed by such fuels, to review their toxic effects on human health, and to analyse the data collected in order to develop conclusions concerning the possible health benefits deriving from the use of alternative fuels.   Materials and methods: In order to fulfil the requirements of a complete, comprehensive and up-to-date review of the toxic effects of automotive exhaust, an extensive search of official scientific data sources has been performed. Relevant publications were retrieved from public domain databases with a toxicological focus such as Toxcenter and CAplus, as well as from the websites of the US Environmental Protection Agency and the US Agency for Toxic Substances and Disease Registry. Keywords employed in the literature search were: petrol, gasoline, diesel exhaust, emission, biofuel, biogas, biodiesel, bioethanol, bioalcohol, toxicity, methanol and ethanol. A total of 295 references were initially selected relating to the period 1962 to 2008, and 142 of these presented titles and abstracts that met the main inclusion criteria, i.e. describing toxicological and epidemiological studies in humans. In cases where eligible studies relating to the goals and tasks of the review were limited or not available, some in vitro or in vivo toxicological studies involving animal models were included.   Results: In comparison with petroleum diesel, the emissions derived from biodiesel contain less particulate matter, carbon monoxide, total hydrocarbons and other toxic compounds including vapour-phase C1-C12 hydrocarbons, aldehydes and ketones (up to C8), selected semi-volatile and particle-phase polycyclic aromatic hydrocarbons (PAHs). Whilst sulphur-containing compounds appear to be undetectable in biodiesel, nitrogen oxide and a soluble organic fraction comprising unregulated pollutants including the “aggregated toxics” (i.e., formaldehyde, acetaldehyde, acrolein, benzene, 1,3-butadiene, ethylbenzene, n-hexane, naphthalene, styrene, toluene and xylene) are present at elevated levels. Toxicological studies have shown that the mutagenicity of exhaust particles from biodiesel is normally lower than those obtained from petroleum diesel, however, rapeseed oil-derived biodiesel exhibits toxic effects that are 4-fold greater than petroleum diesel. Such enhanced toxicity is probably caused by the presence of carbonyl compounds and unburnt fuel. The toxicity of highly volatile components of biofuel exhaust has not yet been evaluated accurately. A substantial portion of these compounds was apparently lost in the process of preparing the test samples used for the assays (during the evaporation). The overall recoveries of these compounds have not been evaluated and the accuracy of the sample preparation method has not been validated. Hence, it could be that the cytotoxic effect of biodiesel exhaust is higher than that reported. Moreover, compared with fossil diesel, fuel derived from rapeseed oil emits particulate matter with increased mutagenic effects. Epidemiological investigations of the effects of biofuels on humans are very sparse but have revealed dose-dependent respiratory symptoms following exposure to rapeseed oil biodiesel, although the observed differences between this fuel and petroleum diesel are not significant. Such data, however, give rise to serious concerns about the future usage of this plant material as a replacement for established diesel fuels. Combustion of alcohol-based fuels leads to a reduced formation of photochemical smog in comparison with gasoline or diesel, however, the emission of aldehydes (officially classified as carcinogenic or potentially carcinogenic) is several times higher. The toxicity of the exhaust emissions of gasoline-fuelled engines is generally significantly greater than that of alcohol-burning engines. However, some harmful effects from ethanol blends might be expected, such as enhanced emissions of carcinogenic PAHs and increased ozone-related toxicity associated with the high level of aldehydes emitted. The use of ethanol–diesel fuel blends gives rise to increases in regulated exhaust emissions and, possibly, to greater emissions of aldehydes and unburnt hydrocarbons. The most promising fuels, in terms of reduced toxicity and genotoxicity of exhaust emissions, are methanol-containing blends. However, the emission from these fuels still contains formaldehyde, which is a carcinogen. The use of biogas can significantly reduce emissions of total PAHs and formaldehyde and, consequently, the risk of lung toxicity. On the other hand, the emissions of particulate matter by compressed natural gas, and the mutagenic potencies of the exhaust, are similar to those associated with gasoline and diesel fuels.   Conclusions: The use of biofuel is currently viewed very favourably and there are suggestions that the exhaust emissions from such fuel are less likely to present risks to human health in comparison with gasoline and diesel emissions. However, the expectation of a reduction in health effects based on the chemical composition of biodiesel exhaust is far from reality. Thus, although toxicological evidence relating to the effects of biofuels on humans is sparse, it is already apparent that emissions from the combustion of biofuel and blends thereof with petroleum-based fuels are toxic. In addition to the regulated toxic compounds, such as total hydrocarbons, carbon monoxide, nitrogen oxides, particulate matter and polycyclic aromatic hydrocarbons, biofuel emissions contain significant amounts of various other harmful substances that are not regulated, e.g. carbonyls (including formaldehyde, acetaldehyde, benzene, 3-butadiene, acrolein, etc.). Whilst biofuels may be potentially less damaging to human health than petroleum fuels, considerable harmful effects must still be expected. Substitution of conventional fuel by biofuel decreases the concentration of regulated toxic pollutants in vehicle exhaust, but increases the concentration of some unregulated toxic pollutants emitted from on-road engines. Generally, the toxicity of biofuels decreases in the order biodiesel>biogas>ethanol>=methanol. In this respect, methanol produced by the oxidation of biogas appears to represent an alternative fuel that exhibits the least potential for damage to human health, however, this alcohol represents a source of formaldehyde pollution and is carcinogenic. .

Youth unemployment is an increasing burden on societies around the world. This prospective, register-based cohort study examined the relationship between unemployment and sickness absence, disability pension, death and future unemployment among youth in Sweden. A comparison was also made between immigrants and native Swedes. Another aim was to see if Active Labour Market Programs (ALMPs) and attained education moderated the outcomes. The baseline year was 1992, a year of severe economic downturn. The follow-up period was from 1993 to 2007, divided into three 5-year periods. The study group of 199,623 individuals comprised all immigrants born between 1968 and 1972 who immigrated before 1990 (25,607) and a random sample of native Swedes in the same age range (174,016). Individuals with unemployment benefit in 1990-1991, disability pension in 1990-1992 or severe disorders leading to hospitalization in 1990-1992 were excluded in order to minimize selection bias. Those who were unemployed in 1992 had elevated risk, measured as odds ratios, of ≥60 days of sickness absence, disability pension, ≥100 days of unemployment and all, except native Swedish women, had elevated risk of death during follow-up. The risk of future unemployment declined until the last follow-up period, while the elevated risk of future sickness absence was about the same in all three follow-up periods. Higher level of education at baseline decreased the risk of future unemployment. Individuals participating in ALMPs had an increased risk of future unemployment, and immigrant women had an increased risk of sickness absence, compared to non-participating individuals. Attained education between 1993 and 1997 decreased the risk of future unemployment and decreased the risk of sickness absence among immigrants. The risk of both future unemployment and future sickness absence increased with the length of unemployment in 1992. Immigrants had higher risk of unemployment both at baseline and follow-up compared with native Swedes, but followed the pattern of native Swedes when unemployed. The conclusion are that exposure to unemployment are associated with elevated risk of future unemployment, sickness absence, disability pension and death fifteen years after exposure. To a society this will mean substantial costs in the form of increased welfare payments and loss of productivity and tax income. Selection to unemployment by individuals already sick, may explain part of the association between unemployment and the studied outcomes.

Företagssköterskan kommer ofta i kontakt med människor i samband medhälsoundersökningar med ogynnsam livsstil för sitt mående. Ökad kunskap kring detta områdekan vägleda och stödja företagssköterskan och företagshälsovården att utveckla strategier för attstödja individen till hälsa.Syftet med denna kvalitativa intervjustudie var att belysa personers upplevelse avföretagshälsovårdens hälsoundersökning som haft betydelse för livsstilsförändring.Urvalskriterierna var en genomförd hälsoundersökning hos företagshälsovården utförd avföretagssköterska och gjorda livsstilsförändringar. Analysen resulterade i två teman med fyrakategorier och åtta underkategorier. De två teman som framkom var “Att bli bemött medintresse och omtanke” och “Att få veta sin ohälsa och få en start till förändring”.Studiens resultat visade att företagssköterskans bemötande och stöd hade avgörande betydelsesamt att få kännedom om sina värden. Personerna kunde reflektera över sin hälsa som gavinsikt och beslut till att starta livsstilsförändring. Detta blev tydligt efter att personerna sågeffekterna av sina livsstilsförändringar. Det upplevdes värdefullt att göra hälsoundersökning avsamtliga deltagare och uppföljande besök ansåg alla vara av stor vikt.Förutsättningar för företagssköterskan att vara i det goda mötet i sitt hälsofrämjande arbetebehöver eftersträvas. Longitudinella studier kring personers upplevelse av företagshälsovårdenshälsoundersöknings betydelse för hållbar livsstilsförändring behövs i framtiden. / The occupational health nurse often comes into contact with clients’ unhealthy lifestyles duringa health examination. An increased knowledge in this area can guide and support theoccupational health nurse and occupational health services to develop strategies to support theindividual's health and well-being in a more efficient way.The purpose of this qualitative study was to examine the person's experience of occupationalhealth services which had significance for lifestyle changes.The selection criteria consisted of completed health examination at an occupational healthcenter conducted by an occupational health nurse. Furthermore, the sample criteria alsoconsisted of changes made by the client after a health examination. The analysis resulted in twothemes with four categories and eight subcategories. The two themes that emerged was "To bemet with interest and concern," and "Getting to know one’s illness and get a starting point howto change."The results showed that the occupational health nurse’s treatment and support were crucial inorder for clients to reflect on their health and be aware of their test results, which in turnmotivated clients to make lifestyle changes. This became clear after clients experienced theeffects of their lifestyle changes. All respondents felt that it was valuable to do a healthexamination and follow-up visits were of great importance.The empirical finding suggests that additional opportunities for the occupational health nurse tobe in the good forum in the work with health promotion are needed.Furthermore, future longitudinal studies regarding clients’ experience of occupational healthexaminations are of importance to sustainable lifestyle changes.