Long-term ambient air pollution and coronary atherosclerosis: Results from the Swedish SCAPIS study.

BACKGROUND AND AIMS: Despite firm evidence for an association between long-term ambient air pollution exposure and cardiovascular morbidity and mortality, results from epidemiological studies on the association between air pollution exposure and atherosclerosis have not been consistent. We investigated associations between long-term low-level air pollution exposure and coronary atherosclerosis. METHODS: We performed a cross-sectional analysis in the large Swedish CArdioPulmonary bioImaging Study (SCAPIS, n = 30 154), a random general population sample. Concentrations of total and locally emitted particulate matter <2.5 µm (PM2.5), <10 µm (PM10), and nitrogen oxides (NOx) at the residential address were modelled using high-resolution dispersion models. We estimated associations between air pollution exposures and segment involvement score (SIS), coronary artery calcification score (CACS), number of non-calcified plaques (NCP), and number of significant stenoses, using ordinal regression models extensively adjusted for potential confounders. RESULTS: Median 10-year average PM2.5 exposure was 6.2 µg/m3 (range 3.5-13.4 µg/m3). 51 % of participants were women and 51 % were never-smokers. None of the assessed pollutants were associated with a higher SIS or CACS. Exposure to PM2.5 was associated with NCP (adjusted OR 1.34, 95 % CI 1.13, 1.58, per 2.05 µg/m3). Associations with significant stenoses were inconsistent. CONCLUSIONS: In this large, middle-aged general population sample with low exposure levels, air pollution was not associated with measures of total burden of coronary atherosclerosis. However, PM2.5 appeared to be associated with a higher prevalence of non-calcified plaques. The results suggest that increased risk of early-stage atherosclerosis or rupture, but not increased total atherosclerotic burden, may be a pathway for long-term air pollution effects on cardiovascular disease.

COVID-19: incidence and mortality in Sweden comparing all foreign-born to all Swedish-born individuals in different occupations in an unvaccinated cohort of year 2020.

OBJECTIVES: The aim was to analyse the incidence and mortality of COVID-19 in immigrants compared with Swedish born in inpatients and outpatient registers, respectively. METHODS: The study population included all persons 20-88 years of age living in Sweden, 31 December 2019, including 1 676 516 foreign-born persons and 6 037 151 Swedish-born persons. The outcome was clinical cases of COVID-19 with a positive PCR test (ICD-10 U07.01) or without a positive PCR test (U07.2) from 1 January to 31 December 2020. Persons 20-64 years of age were classified with occupational titles according to the Swedish Standard Classification of Occupations. Residing municipality of each individual was coded according to the Swedish Association of Local Authorities. Relative risks (RR) were calculated by sex in 5 years age bands using Swedish born as reference. Age-adjusted RRs (adj RR) with 95% CIs were calculated in a Poisson regression model. Rural municipalities were used as the reference category. RESULTS: Foreign born had consistently higher RRs in COVID-19, regardless of sex, with a peak in 50-69 years of age. Foreign born had a higher RR of death in COVID-19 above 50 years and 40 years of age in women and men, respectively. Among occupations, male drivers had the highest adj RR 4.37 (95% CI 3.45 to 5.54) and 5.09 (4.26 to 6.07) in outpatients and inpatients, respectively (U07.1). Persons living in commuting municipalities did not show any consistent increased risk for COVID-19. CONCLUSION: Foreign born have a higher risk of COVID-19 compared with Swedish-born individuals at any age and occupation before vaccination began in 2021.

Hexavalent chromium still a concern in Sweden - Evidence from a cross-sectional study within the SafeChrom project.

OBJECTIVES: Hexavalent chromium (Cr(VI)) is classified as a human carcinogen. Occupational Cr(VI) exposure can occur during different work processes, but the current exposure to Cr(VI) at Swedish workplaces is unknown. METHODS: This cross-sectional study (SafeChrom) recruited non-smoking men and women from 14 companies with potential Cr(VI) exposure (n = 113) and controls from 6 companies without Cr(VI) exposure (n = 72). Inhalable Cr(VI) was measured by personal air sampling (outside of respiratory protection) in exposed workers. Total Cr was measured in urine (pre- and post-shift, density-adjusted) and red blood cells (RBC) (reflecting Cr(VI)) in exposed workers and controls. The Bayesian tool Expostats was used to assess risk and evaluate occupational exposure limit (OEL) compliance. RESULTS: The exposed workers performed processing of metal products, steel production, welding, plating, and various chemical processes. The geometric mean concentration of inhalable Cr(VI) in exposed workers was 0.15 µg/m3 (95% confidence interval: 0.11-0.21). Eight of the 113 exposed workers (7%) exceeded the Swedish OEL of 5 µg/m3, and the Bayesian analysis estimated the share of OEL exceedances up to 19.6% for stainless steel welders. Median post-shift urinary (0.60 µg/L, 5th-95th percentile 0.10-3.20) and RBC concentrations (0.73 µg/L, 0.51-2.33) of Cr were significantly higher in the exposed group compared with the controls (urinary 0.10 µg/L, 0.06-0.56 and RBC 0.53 µg/L, 0.42-0.72). Inhalable Cr(VI) correlated with urinary Cr (rS = 0.64) and RBC-Cr (rS = 0.53). Workers within steel production showed the highest concentrations of inhalable, urinary and RBC Cr. Workers with inferred non-acceptable local exhaustion ventilation showed significantly higher inhalable Cr(VI), urinary and RBC Cr concentrations compared with those with inferred acceptable ventilation. Furthermore, workers with inferred correct use of respiratory protection were exposed to significantly higher concentrations of Cr(VI) in air and had higher levels of Cr in urine and RBC than those assessed with incorrect or no use. Based on the Swedish job-exposure-matrix, approximately 17 900 workers were estimated to be occupationally exposed to Cr(VI) today. CONCLUSIONS: Our study demonstrates that some workers in Sweden are exposed to high levels of the non-threshold carcinogen Cr(VI). Employers and workers seem aware of Cr(VI) exposure, but more efficient exposure control strategies are required. National strategies aligned with the European strategies are needed in order to eliminate this cause of occupational cancer.

Average uranium bedrock concentration in Swedish municipalities predicts male lung cancer incidence rate when adjusted for smoking prevalence: Indication of a cumulative radon induced detriment.

Bedrock U has been used as a proxy for local indoor radon exposure. A preliminary assessment of cancer incidence rate in a cohort of 809,939 adult males living in 9 different Swedish counties in 1986 has been used to correlate the cumulative lung cancer and total cancer (excluding lung) incidence rates between 1986 and 2020, respectively with the municipality average value of bedrock U concentration obtained from Swedish geological Survey (SGU). To control for regional difference in tobacco smoking, data on county average smoking prevalence, obtained from a survey conducted by the Public Health Agency of Sweden from 2001 to 2004, was used. Regression analysis shows that there is a significant positive correlation between smoking prevalence adjusted lung cancer incidence rate in males and the municipality bedrock U concentration (R2 = 0.273 with a slope 5.0 ±â€¯0.87·10-3 ppm-1). The correlation is even more significant (R2 = 0.759 with a slope = 4.8 ±â€¯0.25·10-3 ppm-1) when assessed on population weighted cancer incidence data binned in nine intervals of municipality average bedrock U concentration (ranging from 0.97 to 4.9 ppm). When assessing the corresponding correlations for total cancer incidence rate (excluding cancer of the lung) with adjustment for smoking prevalence, there appears to be no or little correlation with bedrock U concentration (R2 = 0.031). We conclude that an expanded future study needs age-standardized cancer incidence data to obtain a more consistent exposure-response model. Such model could be used to predict future lung cancer cases based on geological survey maps of bedrock U as an alternative to laborious indoor radon measurements, and to discern what future lung cancer rates can be expected for a population nearing zero smoking prevalence, with and without radon prevention.

Overqualification at work and risk of hospitalization for psychiatric and somatic diseases among immigrants in Sweden - a prospective register-based study.

OBJECTIVES: This study aimed to (i) describe the prevalence of overqualification at work among immigrants in Sweden and (ii) analyze any association between overqualification and the risk of hospitalization for somatic and psychiatric disease among refugees and labor immigrants. METHODS: We performed a prospective register study in a cohort of 120 339 adults who immigrated to Sweden in 1991-2005 and were employed in 2006. Education-occupation status was defined as the combination of an individual's highest level of education and their occupation skill level. Individuals were followed from 2007 to 2016 with regard to hospitalization for a psychiatric, cardiovascular, respiratory or musculoskeletal disease or diabetes. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated in a multivariate Cox regression analysis adjusted for age, gender, reason for residence and duration of residence. RESULTS: The overall prevalence of overqualification among immigrants with an academic education was 39%. Overqualified individuals had an increased risk of hospitalization for any disease (HR 1.33, 95% CI 1.21-1.46) compared to "job-matched with an academic education". However, the risk estimates were lower than that of "job-matched with no academic education" (HR 1.56, 1.46-1.68). The increased risk of hospitalization for a psychiatric disease of overqualified individuals did not differ from that of job-matched with no academic education. CONCLUSION: Our study showed that being overqualified was associated with poorer health outcomes than job-matched individuals with an academic education. Considering the high prevalence of overqualification in immigrants, this constitutes a concern, for both society and individuals.

Cancer incidence in a male adult population in relation to estimated protracted colon dose - A nested case control study in Northern Sweden after the Chernobyl Nuclear Power Plant accident.

INTRODUCTION: Uncertainty in the dose-response of low dose radiation raised concern of an increased cancer incidence in Sweden after the Chernobyl Nuclear Power Plant (NPP) accident. MATERIAL AND METHODS: A closed cohort was created of all males ≥18 years of age living in the Northern Sweden in 1986. In total 826,400 individuals were enrolled including 40,874 hunters. A nested case-control design was used with five controls randomly selected for each cancer case matched on year of diagnosis and year of birth. Individual absorbed colon dose was calculated 1986 to 2015. Allowing for a 5-year latency period Hazard Ratios (HR) per mGy with 95% Confidence Intervals (95% CI) were calculated in a conditional logistic regression adjusted by rural/non-rural living, length of education and pre-Chernobyl cancer incidence 1980 to 1985. A total of 127,109 cancer cases occurred from 1 January 1991 to 31 December 2015. Cancer was classified in: 1) Organ-specific (stomach, colon, liver, lung, prostate, urinary bladder, thyroid and leukaemia), 2) Other and 3) Not previously associated to ionizing radiation. RESULTS: The average colon dose in cases was 1.77 mGy compared to controls 1.73 mGy. Hunters average colon dose was 2.32 mGy. Organ-specific cancers showed the highest HR per mGy both in the full cohort, adj HR 1.019 (1.014-1.024) and the hunter subcohort, adj HR 1.014 (1.001-1.027) during follow-up 1991 to 2015. Other cancer and Not previously associated with ionizing radiation showed lower HR per mGy. Therefore, the adj HR per mGy for Total cancer, 1.013 (1.009-1.017) was explained by Organ-specific cancer. Increased adj HR per mGy was seen in stomach, colon and prostate cancer, respectively in the full cohort and lung cancer in hunters. CONCLUSIONS: Some cancer sites previously associated with ionizing radiation showed a positive adjusted HR per mGy both in the full cohort and in the hunter subcohort.

Sustainable Earnings among Immigrants, and the Role of Health Status for Self-Sufficiency: A 10-Year Follow-Up Study of Labour Immigrants and Refugees to Sweden 2000-2006.

This study aimed to investigate economic self-sufficiency for immigrants, and how health status affected self-sufficiency. The proportion of self-sufficiency during years 1-10 after receiving a residence permit is presented for all non-European labour immigrants (n = 1259) and refugees (n = 23,859), aged 18-54, who immigrated to Sweden 2000-2006, and compared to a control group of Swedish-born (n = 144,745). The risk of not being self-sufficient in year 10 was analysed with Cox regression models, and the results are presented as hazard ratios (HRs) with 95% confidence intervals (CIs). Moreover, the impact on the self-sufficiency of having a diagnosis from specialised health care during the first five years in Sweden was analysed. The results showed that half of the refugees and three-quarters of the labour immigrants were self-sufficient 10 years after residency. The adjusted risk of not being self-sufficient at year 10 was 80% higher among labour immigrants (HR = 1.8; CI = 1.6-2.0) and more than two-fold among refugees (HR = 2.7; CI = 2.6-2.8) compared to the Swedish-born. Having a diagnosis from specialised health care during the first five years in Sweden had an impact on self-sufficiency in all groups; however, the impact of having a diagnosis did not differ between refugees and Swedish-born. Measures must be taken to increase immigrants' work participation.

Absorbed dose rate coefficients for134Cs and137Cs with steady-state distribution in the human body:S-coefficients revisited.

In the event of an accidental release of radioactive elements from a nuclear power plant, it has been shown that the radionuclides contributing the most to long-term exposure are134Cs and137Cs. In the case of nuclear power plant fallout, with subsequent intake of radionuclides through the food chain, the internal absorbed dose to target tissues from protracted intake of radionuclides needs to be estimated. Internal contamination from food consumption is not caused by a single intake event; hence, the committed equivalent dose, calculated by a dose coefficient or dose per content function, cannot be easily used to calculate the cumulative absorbed dose to relevant target tissues in the body. In this study, we calculated updated absorbed dose rate coefficients for134Cs and137Cs based on data from the International Commission on Radiological Protection (ICRP) on specific absorbed fractions. The absorbed dose rate coefficients are provided for male and female adult reference phantoms, respectively, assuming a steady-state distribution of Cs that we calculated from the ICRP biokinetic model for Cs. With these coefficients, the absorbed dose to the listed target tissues, separately and to the total body, are related to the number of nuclear transitions (time-integrated activity) in each listed source region. Our new absorbed dose rate coefficients are given for the complete set of target tissues and have not been presented before. They are also provided for aggregated categories of organs to facilitate epidemiological studies.

Introduction of a method to calculate cumulative age- and gender-specific lifetime attributable risk (LAR) of cancer in populations after a large-scale nuclear power plant accident.

The effect of age and gender in risk estimates related to long-term residence in areas contaminated by nuclear power plant fallout was evaluated by applying the lifetime attributable risk (LAR) concept to an existing exposure model that was previously used for cumulative effective dose estimates. In this study, we investigated the influence of age distribution on the number of cancer cases by applying five different age distributions from nuclear power-producing countries (India, Japan, South Korea, and the United States), and Egypt because of intentions to develop nuclear power. The model was also used to estimate the effective dose and gender-specific LAR as a function of time after fallout for the offspring of the population living in 137Cs fallout areas. The principal findings of this study are that the LAR of cancer incidence (excluding non-fatal skin cancers) over 70 y is about 4.5 times higher for newborn females (5.4% per MBq m-2 of initial 137Cs ground deposition) than the corresponding values for 30 y old women (1.2% per MBq m-2 137Cs deposition). The cumulative LAR for newborn males is more than 3 times higher (3.2% versus 1.0% per MBq m-2 137Cs deposition). The model predicts a generally higher LAR for women until 50 y of age, after which the gender difference converges. Furthermore, the detriment for newborns in the fallout areas initially decreases rapidly (about threefold during the first decade) and then decreases gradually with an approximate half-time of 10-12 y after the first decade. The age distribution of the exposed cohort has a decisive impact on the average risk estimates, and in our model, these are up to about 65% higher in countries with high birth rates compared to low birth rates. This trend implies larger average lifetime attributable risks in countries with a highly proportional younger population. In conclusion, the large dispersion (up to a factor of 4 between newborns and 30 y olds) in the lifetime detriment per unit ground deposition of 137Cs over gender and age in connection with accidental nuclear releases justifies the effort in developing risk models that account for the higher radiation sensitivity in younger populations.

Increased cancer risk in male hunters compared to the general male population in Northern Sweden after the Chernobyl Nuclear Power Plant accident?

Male hunters in Swedish counties with high fallout of 137Cs after the Chernobyl Nuclear Power Plant (NPP) accident have higher radiation exposure due to higher consumption of game compared with the general population. METHODS: Cancer incidence in Sweden was studied in 9 counties with different 137Cs fallout after the Chernobyl NPP accident in 1986. In total, 9,267 cancer cases occurred in hunters and 138,909 cancer cases in non-hunters to 31 December 2015. Incidence rate ratios (IRR) with 95% confidence intervals (CI) were calculated using unexposed hunters, or non-hunters, as reference to study internal radiation exposure or hunter life style, respectively. RESULTS: Directly age standardized total cancer incidence showed an increasing trend in non-hunters. For hunters, the total cancer incidence was significantly lower up to 2001 when the total cancer incidence crossed over the weaker non-hunter trend and remained higher for the following 15 years. IRRs for total cancer in hunters versus non-hunters for each county did not show any clear exposure response pattern. IRRs for hunters versus non-hunters were higher regardless of rural/non-rural status with slightly higher risk estimates for the rural settings. The IRR for hunters was 1.06 (95% CI 1.04-1.08) 1986-2015, representing an excess of 531 cancer cases in hunters. CONCLUSION: An increased total incidence of cancer was identified for male hunters compared with male non-hunters. No obvious association between cancer and 137Cs from the Chernobyl NPP accident could be identified, although the exposure classification was too crude to exclude such an association.

Intergenerational Ethical Issues and Communication Related to High-Level Nuclear Waste Repositories.

PURPOSE OF REVIEW: The nuclear power industry started in the 1950s and has now reached a phase of disposing high-level nuclear waste. Since the 1980s, the United Nations has developed a concept of sustainable development and governments have accordingly made ethical commitments to take responsibility towards future generations. The purpose of this review is to examine ethical dilemmas related to high-level nuclear waste disposal in a long-term perspective including potential access to the waste in the future. The time span considered here is 100,000 years based on current experts' assessment of the radiological toxicity of the waste. RECENT FINDINGS: In this review, we take into account findings on ethical issues related to the disposal of high-level nuclear waste put forward by the Radioactive Waste Management Committee (RWMC), the International Commission on Radiological Protection (ICRP), nuclear waste management companies (SKB in Sweden and Posiva Oy in Finland), and several researchers. Some historical examples are presented for potential guidance on methods of communication into the future. According to the sustainable development ethical principle, adopted by the United Nations, we conclude that governments with nuclear energy have committed themselves to protect future generations from harm related to high-level nuclear waste. This commitment involves the necessity to convey information together with the nuclear waste. Our paper examines disposal options chosen by Sweden and Finland, as well as some contemporary and historical efforts to design messages towards the future. We conclude that the international community still needs to find methods to communicate in an intelligible way over long periods of time.

Corrigendum to: A model for estimating the total absorbed dose to the thyroid in Swedish inhabitants following the Chernobyl Nuclear Power Plant accident: implications for existing international estimates and future model applications (2019 J. Rad. Prot. 39(2) 522: doi: 10.1088/1361-6498/ab0577).

Four of the equations in the article "A model for estimating the total absorbed dose to the thyroid in Swedish inhabitants following the Chernobyl Nuclear Power Plant accident: implications for existing international estimates and future model applications " were incomplete or erroneously expressed. A corrigendum is attached with the amended equations.

Modelling the effective dose to a population from fallout after a nuclear power plant accident-A scenario-based study with mitigating actions.

The radiological consequences of a nuclear power plant (NPP) accident, resulting in the release of radionuclides to the environment, will depend largely on the mitigating actions instigated shortly after the accident. It is therefore important to make predictions of the radiation dose to the affected population, from external as well as internal exposure, soon after an accident, despite the fact that data are scarce. The aim of this study was to develop a model for the prediction of the cumulative effective dose up to 84 years of age based on the ground deposition of 137Cs that is determined soon after fallout. The model accounts for different assumptions regarding external and internal dose contributions, and the model parameters in this study were chosen to reflect various mitigating actions. Furthermore, the relative importance of these parameters was determined by sensitivity analysis. To the best of our knowledge, this model is unique as it allows quantification of both the external and the internal effective dose using only a fallout map of 137Cs after a nuclear power plant accident. The cumulative effective dose over a period of 50 years following the accident per unit 137Cs deposited was found to range from 0.14 mSv/kBq m-2 to 1.5 mSv/kBq m-2, depending on the mitigating actions undertaken. According to the sensitivity analysis, the most important parameters governing the cumulative effective dose to various adult populations during 50 years after the fallout appear to be: the correlation factor between the local areal deposition of 137Cs and the maximum initial ambient dose rate; the maximum transfer from regional average fallout on the ground to body burden; the local areal deposition of 137Cs; and the regional average 137Cs deposition. Therefore, it is important that mapping of local 137Cs deposition is carried out immediately after fallout from a nuclear power plant accident, followed by calculations of radiation doses for different scenarios using well-known parameters, in order to identify the most efficient mitigation strategies. Given this 137Cs mapping, we believe our model is a valuable tool for long-term radiological assessment in the early phase after NPP accidents.

Modelling the external radiation exposure from the Chernobyl fallout using data from the Swedish municipality measurement system.

In connection with the Chernobyl fallout and the subsequent deposition of radionuclides in Sweden, Swedish municipalities launched a measurement program to monitor the external radiation exposure. This program encompasses measurements of the ambient dose equivalent rate 1 m above ground at selected locations, and repeats those measurements at the same locations at 7-month intervals. Measurement data compiled from the seven locations with the highest deposition were combined with data from aerial surveys since May 1986 of ground deposition of 137Cs, high-resolution gamma spectrometry performed at four locations in May 1986, and measurements from fixed continuous air gamma rate monitoring stations from 28 April to 15 May 1986. Based on these datasets, a model of the time pattern of the external dose rate in terms of ambient dose equivalent rate from the Chernobyl fallout was developed. The decrease in the ambient dose equivalent rate could, on average, be described by a four-component exponential decay function with effective half-times of 6.8 ± 0.3 d, 104 ± 26 d, 1.0 ± 0.02 y and 5.5 ± 0.09 y, respectively. The predominant contributions to the external dose rate in the first month were from short-lived fission products superseded by 134Cs and then 137Cs. Integrated over 70 y and using extrapolation of the curve fits, our model predicts that 137Cs contributes about 60% and 134Cs contributes about 30% of the external effective dose at these seven locations. The projected time-integrated 70 y external effective dose to an unshielded person from all nuclides per unit total activity deposition of 137Cs is estimated to be 0.29 ± 0.0.08 mSv/(kBq m-2). These results are in agreement with those found in Chernobyl contaminated Russian forest areas, and emphasize the usefulness of maintaining a long-term and regular measurement program in contaminated areas.

Estimated lifetime effective dose to hunters and their families in the three most contaminated counties in Sweden after the Chernobyl nuclear power plant accident in 1986 - A pilot study.

Hunters and their families were one of the most exposed subpopulations in Sweden after the Chernobyl nuclear power plant accident in 1986. In this pilot study we used existing registries and whole-body measurements to develop algorithms to calculate lifetime effective doses and collective doses to some hunters in Sweden. Ten hunters and their family members were randomly selected from each of the three most contaminated counties in Sweden (Västernorrland, Uppsala, Gävleborg) using the register for hunting weapons from the Police Authority in 1985. Hence, this design can be regarded as a closed cohort only including hunters and their family members living in these three counties at the time of the accident. Statistics Sweden matched these individuals (n = 85) with their dwelling coordinates onto the digital map produced by the Swedish Radiation Safety Authority after aerial measurements of 137Cs (kBq m-2). Internal effective doses were estimated using aggregated transfer factors from ground deposition to in-vivo body concentration for 134Cs and 137Cs in hunters (Bq kg-1). External effective doses were also calculated on the dwelling coordinate for 134Cs, 137Cs and short-lived nuclides in these three counties. Annual effective doses for external and internal doses were then cumulated up to a life expectancy of 80 years for men and 84 years for women, respectively. The total lifetime effective doses to the members of the hunter families in this cohort were on average 8.3 mSv in Västernorrland, 4.7 mSv in Uppsala and 4.1 mSv in Gävleborg. The effective dose to men were about 40% higher than in women. In all counties the internal dose was about 75% of the total lifetime effective dose. The collective dose for all hunters with family members, in total about 44,000 individuals, in these three counties could be approximated at about 256 manSv. This study shows it is possible to use register data to develop algorithms for calculating lifetime effective dose commitments for hunters with relatively accuracy.

Total cancer incidence in relation to 137Cs fallout in the most contaminated counties in Sweden after the Chernobyl nuclear power plant accident: a register-based study.

OBJECTIVES: To determine the total cancer incidence in relation to a 5-year exposure to caesium-137 (137Cs) from the 1986 Chernobyl nuclear power plant accident. METHODS: A closed cohort was defined as all individuals living in the three most contaminated counties in mid-Sweden in 1986. Fallout of 137Cs was retrieved as a digital map from the Geological Survey of Sweden, demographic data from Statistics Sweden, and cancer diagnosis from the National Board of Health and Welfare. Individuals were assigned an annual 137Cs exposure based on their place of residence (1986-1990), from which 5-year cumulative 137Cs exposures were calculated, accounting for the physical decay of 137Cs and changing residencies. HRs were adjusted for age, sex, rural/non-rural residence and pre-Chernobyl total cancer incidence. RESULTS: The 734 537 people identified were categorised by exposure: the first quartile was low exposure (0.0-45.4 kBq/m2), the second and third quartiles were intermediate exposure (45.41-118.8 kBq/m2), and the fourth quartile was the highest exposure (118.81-564.71 kBq/m2). Between 1991 and 2010, 82 495 cancer cases were registered in the 3 counties. Adjusted HRs (95% CI) were 1.03 (1.01 to 1.05) for intermediate exposure and 1.05 (1.03 to 1.07) for the highest exposure compared to the reference exposure. CONCLUSIONS: We found a small overall exposure-response pattern of the total cancer incidence related to 137Cs after adjustment for age, sex, rural residence and pre-Chernobyl cancer incidence.

[Immediate and delayed outcomes after electrical injury. A guide for clinicians]. / Elolyckor kan ge skador som visar sig efter lång tid - Det akuta omhändertagandet kan vara avgörande på sikt.

Immediate and delayed outcomes after electrical injury. A guide for clinicians In Sweden about 300 electrical injuries are recorded each year at the Swedish National Electrical Safety Board. Most of our knowledge of the health consequences of these arise from clinical case series. Severe electrical injuries have direct thermal effects and may result in ventricular fibrillation, skin burns, as well as muscular and nerve affection. Long-term consequences include pain, vascular symptoms, cognitive and neurological symptoms and signs. These sequelae may occur even though the initial symptoms were relatively modest. Mechanisms are better understood for the immediate symptoms, compared to long-term and delayed non-thermal medical consequences. Attention to and treatment of patients with electrical injury needs to be improved to minimize long-term consequences. Good medical care in the acute phase and early multidisciplinary follow-up of severe cases will likely reduce associated morbidity. Each electrical injury should result in an inquiry to identify the cause of the accident in order to suggest actions to prevent new incidents.

Risk Communication Strategies: Lessons Learned from Previous Disasters with a Focus on the Fukushima Radiation Accident.

PURPOSE OF THE REVIEW: It has been difficult to both mitigate the health consequences and effectively provide health risk information to the public affected by the Fukushima radiological disaster. Often, there are contrasting public health ethics within these activities which complicate risk communication. Although no risk communication strategy is perfect in such disasters, the ethical principles of risk communication provide good practical guidance. FINDINGS: These discussions will be made in the context of similar lessons learned after radiation exposures in Goiania, Brazil, in 1987; the Chernobyl nuclear power plant accident, Ukraine, in 1986; and the attack at the World Trade Center, New York, USA, in 2001. Neither of the two strategies is perfect nor fatally flawed. Yet, this discussion and lessons from prior events should assist decision makers with navigating difficult risk communication strategies in similar environmental health disasters.

Cancer incidence in northern Sweden before and after the Chernobyl nuclear power plant accident.

Sweden received about 5 % of the total release of (137)Cs from the Chernobyl nuclear power plant accident in 1986. The distribution of the fallout mainly affected northern Sweden, where some parts of the population could have received an estimated annual effective dose of 1-2 mSv per year. It is disputed whether an increased incidence of cancer can be detected in epidemiological studies after the Chernobyl nuclear power plant accident outside the former Union of Soviet Socialist Republics. In the present paper, a possible exposure-response pattern between deposition of (137)Cs and cancer incidence after the Chernobyl nuclear power plant accident was investigated in the nine northernmost counties of Sweden (2.2 million inhabitants in 1986). The activity of (137)Cs from the fallout maps at 1986 was used as a proxy for the received dose of ionizing radiation. Diagnoses of cancer (ICD-7 code 140-209) from 1980 to 2009 were received from the Swedish Cancer Registry (273,222 cases). Age-adjusted incidence rate ratios, stratified by gender, were calculated with Poisson regression in two closed cohorts of the population in the nine counties 1980 and 1986, respectively. The follow-up periods were 1980-1985 and 1986-2009, respectively. The average surface-weighted deposition of (137)Cs at three geographical levels; county (n = 9), municipality (n = 95) and parish level (n = 612) was applied for the two cohorts to study the pre- and the post-Chernobyl periods separately. To analyze time trends, the age-standardized total cancer incidence was calculated for the general Swedish population and the population in the nine counties. Joinpoint regression was used to compare the average annual percent change in the general population and the study population within each gender. No obvious exposure-response pattern was seen in the age-adjusted total cancer incidence rate ratios. A spurious association between fallout and cancer incidence was present, where areas with the lowest incidence of cancer before the accident coincidentally had the lowest fallout of (137)Cs. Increasing the geographical resolution of exposure from nine county averages to 612 parish averages resulted in a two to three times higher value of variance in the regression model. There was a secular trend with an increase in age-standardized incidence of cancer in both genders from 1980 to 2009, but significant only in females. This trend was stronger and statistically significant for both genders in the general Swedish population compared to the nine counties. In conclusion, using both high quality cancer registry data and high resolution exposure maps of (137)Cs deposition, it was not possible to distinguish an effect of (137)Cs on cancer incidence after the Chernobyl nuclear power plant accident in Sweden.

Urinary 2,5-hexanedione excretion in cryptogenic polyneuropathy compared to the general Swedish population.

BACKGROUND: 2,5-hexanedione (2,5-HD) is the main neurotoxic metabolite of methyl-n-butyl ketone (MBK) and n-hexane, and known to cause polyneuropathy. The aim of our study was to compare the urinary levels of 2,5-HD between cases with cryptogenic polyneuropathy and the general Swedish population, and to elucidate the role of certain external factors. METHODS: Morning urine samples were collected from 114 cases with cryptogenic polyneuropathy (77 men and 37 women) and 227 referents (110 men and 117 women) randomly selected from the population registry. None had any current occupational exposure to n-hexane or MBK. The urine samples were analysed by a gas chromatographic method based on acidic hydrolysis. RESULTS: Cases had statistically higher urinary levels of 2,5-HD (0.48 mg/L) than the general population (0.41 mg/L) and men higher excretion than women (0.48 mg/L and 0.38 mg/L, respectively). There was no difference in 2,5-HD levels between current smokers and non-smokers. Occupational exposure to xylene, alcohol consumption and ever exposed to general anaesthesia were associated with lower excretion in men while for occupational exposure to nitrous oxide in women higher excretion was seen. Higher excretion of 2,5 HD was inversely related to increasing age. CONCLUSIONS: Significantly higher levels of urinary 2,5-HD were seen in men and cryptogenic polyneuropathy cases seemingly unexposed to n-hexane. Hypothetically, this might be due to either differences in metabolic patterns or some concealed exposure. The difference in means between cases and the general population is small and can therefore not allow any firm conclusions of the causality, however.