Jenny Selander

Research problem and specific questionsUrban living environments challenge the individual’s capacity to maintain a good health throughout the course of life. In Sweden, current trends in housing and neighborhood conditions tend to further increase disparities in health. The rapid urbanization and densification of Stockholm County makes it an optimal setting for studying health effects of urban living, for example in relation to air quality, transportation noise, urban greenness, climate change and overcrowded housing. In this program, we aim to assess and develop strategies for building a sustainable city promoting equitable public health among inhabitants of urbanized areas.Data and methodsThe program will use a variety of different data materials and methods. To map environmental hazards in Stockholm County, a new GIS-based tool aimed at regional stakeholders will be developed. A new cohort, based on the National Environmental Health Survey 2023, will form the basis for analyses of environmental health associations and estimates of disease burden. Furthermore, the effects on children’s development, education and health from overcrowded housing will be investigated in a nation-wide cohort study and in an intervention setting. In a literature review, we will summarize evidence on environmental interventions which can guide stakeholders in implementing planning and mitigation measures.Relevance and utilizationThe national Commission for Equity in Health listed 7 key areas of life which determine health inequalities. Among these, the intended program has a focus on Housing and neighborhood conditions but is also of relevance for aspects of Early life development, Health behavior, and Control, influence and participation. By this program, we aim to establish a strong research infrastructure for monitoring and assessing the impact of the built environment on public health and for the promotion of environmental health equity. This is in line with several other initiatives and governing documents within Sweden, e.g. “Health as a driving force for the environmental goals and sustainable development”, initiated by Miljömålsrådet.Plan for program realizationThe program will be carried out at the Institute of Environmental Medicine, Karolinska Institutet, in collaboration with the Center for Occupational and Environmental medicine, Region Stockholm, and builds on six different work packages, each with its specific aims, activities, and deliverables. The researchers of the program represent many different disciplines, spanning from environmental medicine, public health and epidemiology to GIS, nursing and multicultural psychiatry, and will work closely together in the different work-packages. To ensure a good dialogue with end-users of our research, we will host, and take part in, an array of activities throughout the program progression, e.g. via reference groups, seminars, workshops, regional networks and other applied activities.

Research problem and specific questions: The number of children with neurodevelopmental disorders have increased during the last coupleof years. Physical, psychosocial, and chemical exposures in residential settings during pregnancy have been indicated as possible risk factors in relation to neurodevelopmental disorders in children. However, few studies have assessed these associations in occupational settings even though the exposure levels usually are much higher.Specific questions: Does occupational exposure to chemicals, particles, noise, whole body vibration, or psychosocial work during pregnancy increase the risk of neurodevelopmental disorders in children? Do residential exposures and socioeconomic factors modify that association?Data and method: A national cohort of 1,5 million births in Sweden between 1994 and 2014, with data on occupational title, full-time/part-time work and leave of absence during pregnancy will be used. Individual information on the mother’s lifestyle (smoking, BMI etc.), heredity of neurodevelopmental disorders, socioeconomic factors (education, income etc.) and residential exposure (noise, air pollution, green/blue space etc.) during pregnancy is also attached. Occupational exposure to stone/concreate, silica, organic particles, combustion particles, welding fumes, oil mist, noise, solvents, whole body vibration, physically strenuous work, psychosocial work will be classified through job-exposure matricesbased on measurements and questionnaire data. Diagnosis of neurological disorders are gathered through the national Swedish inpatient registry.Plan for project realisation: The project build on existing data that will be linked to new exposure assessments and registry data. The research group has vast experience preforming these kind of studies.Relevance: More and more women start working in exposed occupations previously only held by men. Risk assessments are lacking, especially regarding occupational exposures during pregancy. Better assessments of which occupational exposures during pregnancy that might increasethe risk of neurological disorders will give better guidance for preventive work in these exposed occupations.

Research problem and specific questionsOccupational noise affects a large number of the workforce in Sweden and globally. Cardiometabolic diseases such as diabetes, metabolic syndrome and cardiovascular illness are prevalent with substantial consequences for the individual and society. While there is growing evidence on the detrimental effects of occupational noise on cardiometabolic health, the mechanisms are still unclarified, also given the influence of social vulnerability. To understand how occupational noise affects cardiometabolic health, we will apply multiple exposure rationale, focusing on biopsychosocial mechanisms. Specific research questions are: Is occupational noise associated with cardiometabolic diseases (diabetes, metabolic syndrome)? How can an early-stage association be identified, using biomarkers of unhealthy fat-glucose metabolism? What roles do occupational psychosocial stressors, sleep quality and social vulnerability have in these associations?Data and methodWe will use unique data from the SCAPIS cohort with over 30,000 participants aged between 50 and 64, in Sweden. The data includes extensive clinical and laboratory measurements of cardiometabolic health, and questionnaire data covering self‐reported health, occupational and environmental exposures, lifestyle factors and socioeconomic status. A subsample (n=5300) of SCAPIS has occupational history available, allowing retrospective analyses of exposure. Registry data on diabetes 3-5 years after baseline will be used to strengthen causality inferences. We will use different analytical approaches: cross-sectional, retrospective, and prospective.Plan for project realizationThis research project will be developed on a three-year structure. Data is already collected, although extensive data management will be required. Other steps include advanced data analysis, reporting and communication with stakeholders. The research group is multi-disciplinary including expertise in areas of psychology, medicine, acoustics, epidemiology, statistics, occupational health and public health.RelevanceThis project relates to Forte’s areas of responsibility health/working life and is aligned with the goal to achieve equal health and sustainable working life. Our findings will clarify biopsychosocial mechanisms from occupational noise to cardiometabolic health, assisting in new preventive strategies. The focus on social vulnerability will inform policies targeting specific groups and working conditions.

Traffic noise is an environmental exposure of growing concern with mounting evidence of serious adverse health effects. At least one in five Europeans (113 million people) are exposed to noise levels exceeding the European Environment Agency indicator level linked to harmful health effects. Besides the increased risk of cardiovascular and metabolic effects, hearing loss, and sleep disturbance, recent studies have indicated that prolonged exposure to noise might accelerate the risk of cognitive impairment, dementia, anxiety, and depression.We take advantage of the pre-existing data within the Nordic Studies on Occupational and Traffic Noise in Relation to Disease (NordSOUND) project, comprising over 185 000 adults from 5 Swedish and 2 Danish cohorts, to investigate whether exposure to traffic and occupational noise is related to dementia and mental health (depression, and anxiety) and to reveal potential mechanisms. We will adjust for individual- and area-level covariates to enable increased precision in the assessment of associations. We will also adjust for residential air pollution exposure and lack of greenness to explore the potential interactions.This collaborative research effort will address a considerable knowledge gap regarding noise exposure, dementia and mental health. Our results may have significant implications for risk assessment and public health policy, especially considering the recently relaxed noise guidelines in Sweden and the rapid urban growth.

Research problem and specific questions. Traffic noise is an environmental exposure of growing concern with mounting evidence of serious adverse health effects. At least one in five Europeans (approximately 113 million people) are exposed to noise levels exceeding the European Environment Agency indicator level linked to harmful health effects. Besides the increased risk of cardiovascular and metabolic effects, hearing loss, and sleep disturbance, more recent studies have indicated that prolonged exposure to noise might accelerate the risk of cognitive impairment, degenerative dementia, anxiety, and depression.  Data and Methods. We take advantage of the pre-existing data within the Nordic Studies on Occupational and Traffic Noise in Relation to Disease (NordSOUND) project, comprising over 185 000 adults from five Swedish and two Danish cohorts, to investigate whether exposure to traffic and occupational noise is related to dementia and mental health (depression, and anxiety) and to reveal potential mechanisms. We will adjust for individual- and area-level covariates to enable increased precision in the assessment of associations. We will also adjust for residential air pollution exposure and lack of greenness to explore the potential interactions.  Plan for project realization. The research group involved in the project is multidisciplinary, and the complementary expertise of the team members will guarantee a broad perspective considering clinical, social, and public health relevance as well as adequate methodological and management skills. A postdoc research fellow will implement the study plan, coordinated and supervised by project leader and senior researchers. Relevance. This collaborative research effort will address a considerable knowledge gap regarding noise exposure, dementia and mental health. Our results may have significant implications for risk assessment and public health policy, especially considering the recently relaxed noise guidelines in Sweden and the rapid urban growth.

Cardiovascular disease is one of the main causes of disease in Sweden. However, due to advances in care, death and disability resulting from a myocardial infarction (MI) have decreased considerably and the majority of individuals return to work after a MI. Few studies have investigated the impact of occupational exposures on the likelihood of staying at work, as well as on the risk of reinfarction and mortality. Additionally, there are few studies investigating the impact of conditions upon returning to work on the likelihood of remaining in employment.  This study aims to: 1. Investigate the impact of conditions of employment and perceptions after a MI on permanence at work. 2. Investigate the impact of exposures after the MI and permanence at work after a MI

and 3. Investigate the impact of exposures and work participation after an MI on reinfarction and death.This study is based on an existing cohort of MI patients between the years of 2002 and 2017 from the several registers: SWEDEHEART, Longitudinal Integrated Database for Health Insurance and Labour Market Studies, National Patient Registers, and Cause of Death Register, among others. Data will be updated to 2020 and linked to several job exposure matrices (JEMs), which include estimates on several work exposures.  To investigate employment conditions after a MI, we will conduct a qualitative study with semi-structured interviews that assesses whether individuals have returned to the same duties and workload as prior to the MI, their experiences after work continuation, as well as whether routines were in place for their return. This results will be used to develop a questionnarie for a quantitative study to explore the impact of these working conditions on permanence.This study will provide important information regarding modifiable risk factors for remaining, as well as for risk of reinfarction and mortality in order to promote a healthy working life for the Swedish aging workforce.