| 1. |
- Hrubá, Františka, et al.
(författare)
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A regional comparison of children's blood cadmium, lead, and mercury in rural, urban and industrial areas of six European countries, and China, Ecuador, and Morocco
- 2023
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Ingår i: International Journal of Occupational Medicine and Environmental Health. - Poland : Nofer Institute of Occupational Medicine. - 1232-1087 .- 1896-494X .- 2008-6520. ; 36:3, s. 349-364
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The authors aimed to evaluate whether blood cadmium (B-Cd), lead (B-Pb) and mercury (B-Hg) in children differ regionally in 9 countries, and to identify factors correlating with exposure.MATERIAL AND METHODS: The authors performed a cross-sectional study of children aged 7-14 years, living in 2007-2008 in urban, rural, or potentially polluted ("hot spot") areas (ca. 50 children from each area, in total 1363 children) in 6 European and 3 non-European countries. The authors analyzed Cd, Pb, and total Hg in blood and collected information on potential determinants of exposure through questionnaires. Regional differences in exposure levels were assessed within each country.RESULTS: Children living near industrial "hot-spots" had B-Cd 1.6 (95% CI: 1.4-1.9) times higher in the Czech Republic and 2.1 (95% CI:1.6-2.8) times higher in Poland, as compared to urban children in the same countries (geometric means [GM]: 0.13 μg/l and 0.15 μg/l, respectively). Correspondingly, B-Pb in the "hot spot" areas was 1.8 (95% CI: 1.6-2.1) times higher than in urban areas in Slovakia and 2.3 (95% CI: 1.9-2.7) times higher in Poland (urban GM: 19.4 μg/l and 16.3 μg/l, respectively). In China and Morocco, rural children had significantly lower B-Pb than urban ones (urban GM: 64 μg/l and 71 μg/l, respectively), suggesting urban exposure from leaded petrol, water pipes and/or coal-burning. Hg "hot spot" areas in China had B-Hg 3.1 (95% CI: 2.7-3.5) times higher, and Ecuador 1.5 (95% CI: 1.2-1.9) times higher, as compared to urban areas (urban GM: 2.45 μg/l and 3.23 μg/l, respectively). Besides industrial exposure, traffic correlated with B-Cd; male sex, environmental tobacco smoke, and offal consumption with B-Pb; and fish consumption and amalgam fillings with B-Hg. However, these correlations could only marginally explain regional differences.CONCLUSIONS: These mainly European results indicate that some children experience about doubled exposures to toxic elements just because of where they live. These exposures are unsafe, identifiable, and preventable and therefore call for preventive actions.
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| 2. |
- Hruba, Frantiska, et al.
(författare)
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Blood cadmium, mercury, and lead in children : An international comparison of cities in six European countries, and China, Ecuador, and Morocco
- 2012
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Ingår i: Environment International. - Oxford : Elsevier. - 0160-4120 .- 1873-6750. ; 41, s. 29-34
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Tidskriftsartikel (refereegranskat)abstract
- Children's blood-lead concentration (B-Pb) is well studied, but little is known about cadmium (B-Cd) and mercury (B-Hg), in particular for central Europe. Such information is necessary for risk assessment and management. Therefore, we here describe and compare B-Pb, B-Cd and B-Hg in children in six European, and three non-European cities, and identify determinants of these exposures. About 50 school children (7-14 years) from each city were recruited (totally 433) in 2007-2008. Interview and questionnaire data were obtained. A blood sample was analyzed: only two laboratories with strict quality control were used. The European cities showed only minor differences for B-Cd (geometric means 0.11-0.17 mu g/L) and B-Pb (14-20 mu g/L), but larger for B-Hg (0.12-0.94 mu g/L). Corresponding means for the non-European countries were 0.21-0.26, 32-71, and 0.3-3.2 mu g/L, respectively. For B-Cd in European samples, traffic intensity close to home was a statistically significant determinant, for B-Hg fish consumption and amalgam fillings, and for B-Pb sex (boys higher). This study shows that European city children's B-Cd and B-Pb vary only little between countries; B-Hg differs considerably, due to varying tooth restoration practices and fish intake. Traffic intensity seemed to be a determinant for B-Cd. The metal concentrations were low from a risk perspective but the chosen non-European cities showed higher concentrations than the cities in Europe. (C) 2011 Elsevier Ltd. All rights reserved.
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| 3. |
- Ljung, Lina, et al.
(författare)
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A Rule-Out Strategy Based on High-Sensitivity Troponin and HEART Score Reduces Hospital Admissions
- 2019
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Ingår i: Annals of Emergency Medicine. - : MOSBY-ELSEVIER. - 0196-0644 .- 1097-6760. ; 73:5, s. 491-499
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Tidskriftsartikel (refereegranskat)abstract
- Study objective: We evaluate whether a combination of a 1-hour high-sensitivity cardiac troponin algorithm and History, ECG, Age, Risk Factors, and Troponin (HEART) score reduces admission rate (primary outcome) and affects time to discharge, health care-related costs, and 30-day outcome (secondary outcomes) in patients with symptoms suggestive of an acute coronary syndrome.Methods: This prospective observational multicenter study was conducted before (2013 to 2014) and after (2015 to 2016) implementation of a strategy including level of high-sensitivity cardiac troponin T or I at 0 and 1 hour, combined with the HEART score. Patients with a nonelevated baseline high-sensitivity cardiac troponin level, a 1-hour change in high-sensitivity cardiac troponin T level less than 3 ng/L, or high-sensitivity cardiac troponin I level less than 6 ng/L and a HEART score less than or equal to 3 were considered to be ruled out of having acute coronary syndrome. A logistic regression analysis was performed to adjust for differences in baseline characteristics.Results: A total of 1,233 patients were included at 6 centers. There were no differences in regard to median age (64 versus 63 years) and proportion of men (57% versus 54%) between the periods. After introduction of the new strategy, the admission rate decreased from 59% to 33% (risk ratio 0.55 [95% confidence interval {CI} 0.48 to 0.63]; odds ratio 0.33 [95% CI 0.26 to 0.42]; adjusted odds ratio 0.33 [95% CI 0.25 to 0.42]). The median hospital stay was reduced from 23.2 to 4.7 hours (95% CI of difference -20.4 to -11.4); median health care-related costs, from $1,748 to $1,079 (95% CI of difference -$953 to -$391). The number of clinical events was very low.Conclusion: In this before-after study, clinical implementation of a 1-hour high-sensitivity cardiac troponin algorithm combined with the HEART score was associated with a reduction in admission rate and health care burden, with very low rates of adverse clinical events.
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| 4. |
- Löfmark, Henrik, et al.
(författare)
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HEART-score can be simplified without loss of discriminatory power in patients with chest pain : Introducing the HET-score
- 2023
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Ingår i: American Journal of Emergency Medicine. - : Elsevier. - 0735-6757 .- 1532-8171. ; 74, s. 104-111
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe History, Electrocardiogram (ECG), Age, Risk factors and Troponin, (HEART) score is useful for early risk stratification in chest pain patients. The aim was to validate previous findings that a simplified score using history, ECG and troponin (HET-score) has similar ability to stratify risk.MethodsPatients presenting with chest pain with duration of ≥10 min and an onset of last episode ≤12 h but without ST-segment elevation on ECG at 6 emergency departments were eligible for inclusion. The HEART-score and the simplified HET-score were calculated. The endpoint was a composite of myocardial infarction (MI) as index diagnosis, readmission due to new MI or death within 30 days.ResultsHEART-score identified 32% as low risk (0-2p), 47% as intermediate risk (3-5p), and 20% as high risk (6-10p) patients. The endpoint occurred in 0.5%, 7.3% and 35.7%, respectively. HET-score identified 39%, 42% and 19% as low- (0p), intermediate- (1-2p) and high-risk (3-6p) patients, with the endpoint occurring in 0.6%, 6.2% and 43.2%, respectively.When all variables included in the HEART-score were included in a multivariable logistic regression analysis, only History (OR, CI [95%]): 2.97(2.16–4.09), ECG (1.61[1.14–2.28]) and troponin level (5.21[3.91–6.95]) were significantly associated with cardiovascular events. When HEART- and HET-score were compared in a ROC-analysis, HET-score had a significantly larger AUC (0.887 vs 0.853, p < 0.001).ConclusionsCompared with HEART-score, HET-score is simpler and appears to have similar ability to discriminate between chest pain patients with and without cardiovascular event.
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| 5. |
- Pawlas, Natalia, et al.
(författare)
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Cadmium, mercury and lead in the blood of urban women in Croatia, the Czech Republic, Poland, Slovakia, Slovenia, Sweden, China, Ecuador and Morocco
- 2013
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Ingår i: International Journal of Occupational Medicine and Environmental Health. - 1896-494X .- 1232-1087. ; 26:1, s. 58-72
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to make an international comparison of blood levels of cadmium (B-Cd), lead (B-Pb) and mercury (B-Hg) of women in seven European, and three non-European cities, and to identify determinants. About 50 women (age: 46-62) from each city were recruited (totally 480) in 2006-2009. Interview and questionnaire data were obtained. Blood samples were analysed in one laboratory to avoid interlaboratory variation. Between the European cities, the B-Pb and B-Cd results vary little (range of geometric means: 13.5-27.0 mu g/l and 0.25-0.65 mu g/l, respectively); the variation of B-Hg was larger (0.40-1.38 mu g/l). Between the non-European cities the results for B-Pb, B-Cd and B-Hg were 19.2-68.0, 0.39-0.99 and 1.01-2.73 mu g/l, respectively. Smoking was a statistically significant determinant for B-Cd, while fish and shellfish intakes contributed to B-Hg and B-Pb, amalgam fillings also contributed to B-Hg. The present results confirm the previous results from children; the exposure to lead and cadmium varies only little between different European cities suggesting that other factors than the living area are more important. The study also confirms the previous findings of higher cadmium and lead levels in some non-European cities. The geographical variation for mercury is significant.
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| 6. |
- Rentschler, Gerda, et al.
(författare)
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Katalysatorelement (platina, palladium och rodium) i blod hos unga kvinnor i Skåne samt Norr- och Västerbotten : Slutrapport för projekt 215 0402 inom Nationella Miljöövervakningen
- 2007
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- De tre "katalysator-elementen" platina (Pt), palladium (Pd) och rodium (Rh), som emitteras från katalysatorer i bilarnas avgassystem, har undersökts i blodprover från 100 unga (20-29 år) kvinnor från Norr- ochVästerbotten (2004) och Skåne (2006-2007). Proverna har analyserats med mycket känslig och specifik, högupplösande induktivt kopplad plasma massspektrometri (HR-ICP-MS). Vi fann att genomsnittlig halt av Pt i blod (B-Pt) var 1-2 (högsta värde: 5) ng/L. B-Pd var i genomsnitt <10 (högsta värde: 33) ng/L; om mätvärden under den formella detektionsgränsen beaktas var genomsnittet 7 ng/L. B-Rh var i genomsnitt <5 (samtliga värden <5) ng/L; om värden under den formella detektionsgränsen beaktades, var genomsnittet 1 ng/L. Kvinnorna i Norr- och Västerbotten hade högre B-Pt och B-Pd (men inte B-Rh) än de i Skåne. Det skulle kunna bero på en skillnad i exponering (från emissioner från katalysatorer, miljön eller tandvårdsmaterial), eller på att exponeringen sjunkit mellan 2004 och 2006-2007. Dock måste stor reservation knytas till sådana slutsatser. Det är mer troligt att det beror på att proverna togs i olika rör. Det kan alltså föreligga en viss kontaminering i rören som användes 2004. Vidare - hade emission från bilars katalysatorer varit en viktig exponeringskälla, borde halten vara högre i det biltäta Skåne jämfört med Norr- och Västerbotten. Det fanns ingen säker effekt av ålder, och ingen effekt av rökvanor. Det finns inga skäl att tro att halterna av Pt, Pd eller Rh skulle innebära hälsorisk för kvinnorna. Dessa halter är mycket lägre än vad som tidigare rapporterats. Detta beror säkerligen på att den använda provtagnings- och analysmetodiken varit mycket känsligare. Vi har alltså anledning hävda, att tidigare studier starkt övervärderat halterna. Detta visar vikten av att använda adekvat analysmetodik. Det finns anledning att med tillräckligt känslig metodik följa upp halterna i olika geografiska områden, och att följa utvecklingen över tid, eftersom miljökontamineringen kan förväntas variera och öka.
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| 7. |
- Rentschler, Gerda, et al.
(författare)
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Platinum, palladium, rhodium, molybdenum and strontium in blood of urban women in nine countries
- 2018
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Ingår i: International journal of hygiene and environmental health (Print). - : Elsevier. - 1438-4639 .- 1618-131X. ; 221:2, s. 223-230
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is little reliable information on human exposure to the metals platinum (Pt), palladium (Pd) and rhodium (Rh), despite their use in enormous quantities in catalytic converters for automobile exhaust systems.OBJECTIVES: To evaluate blood concentrations of Pt (B-Pt), Pd (B-Pd) and Rh (B-Rh) in women from six European and three non-European countries, and to identify potentially influential factors. In addition, molybdenum (Mo) and strontium (Sr) were analysed.METHODS: Blood from 248 women aged 47-61 was analysed by high resolution inductively coupled plasma mass spectrometry under strict quality control.RESULTS: The medians were: B-Pt 0.8 (range <0.6-5.2), B-Pd <5 (<5-9.3), B-Rh <0.4 (<0.4-3.6)ng/L and B-Mo 2.0 (0.2-16) and B-Sr 16.6 (3.5-49) μg/L. Two women with highly elevated B-Pt (242 and 60ng/L), previously cancer treated with cis-platinum, were not included in the data analysis. All elements varied geographically (2-3 times) (B-Pd P=0.05; all other elements P<0.001); variations within each area were generally 5-10 times. Traffic was not associated with increased concentrations.CONCLUSIONS: General population blood concentrations of Pt, Pd and Rh are within or below the single digit ng/L range, much lower than in most previous reports. This is probably due to improved analytical performance, allowing for more reliable information at ultra-trace levels. In general, Mo and Sr agreed with previously reported concentrations. All elements showed geographical and inter-individual variations, but no convincing relationships with self-reported traffic intensity were found. Pt from the antineoplastic drug cis-platinum is retained in the body for years.
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| 8. |
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| 9. |
- Skerfving, Staffan, et al.
(författare)
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Bly, kadmium och kvicksilver i blod hos skånska barn 2009-2011 - med jämförelser bakåt till 1978
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Metallhalter har analyserats i blodprover som tagits 2009 och 2011 från 124 respektive 93 barn (7-8 år) från Landskrona. Halten (geometriska medelvärden) av bly var 2009 13,2 och 2011 11,1 (max 59) μg/L, kadmium 2009 0,10 och 2011 0,10 (max 0,34) μg/L och kvicksilver 2009 0,51 och 2011 0,57 (max 8,2) μg/L.Vi har en helt unik tidsserie av metallhalter i blod hos barn i Landskrona (och Trelleborg). Blyhalten har sjunkit ca sex gånger sedan 1978 och kvicksilver ca två gånger sedan 1990, medan kadmium är väsentligen oförändrat sedan 1986.Jämfört med andra delar av Europa är halten av bly är ungefär lika hög, men på en nivå som kan ge effekter på kognitiva funktioner. Halten av kadmium är låg i jämförelse, men ändå på en nivå som kan tänkas leda till toxiska effekter på lång sikt. Kvicksilverhalten är jämförelsevis hög, men inte på en nivå som kan förväntas ge toxiska effekter.Fortsatt uppföljning av metallhalterna hos barn i Landskrona rekommenderas.
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| 10. |
- Skerfving, Staffan, et al.
(författare)
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Kadmiumhalter i blod och urin hos skånska kvinnor 2010 - med jämförelser bakåt till 1999/2000
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Kadmiumhalter i blod (median 0,28 μg/L) och urin (0,25 μg/g; U-Cd kreatinin) samt bly (15 μg/L) och kvicksilver (1,0 μg/L) i blod bestämdes 2010 hos 128 skånska kvinnor (50-59 år). Jämfört med kvinnor i samma område och åldersklass, som undersökts 1999-2000 och 2007, förefaller det ha skett en sänkning av kadmiumnivåerna i både urin och blod.Det fanns ett signifikant samband mellan α1-miroglobulin i urin och kadmium i urin och blod, vilket skulle kunna tolkas som en lätt påverkan på proximala njurtubuli. Oavsett detta är kadmiumexponeringen på en nivå som sannolikt innebär effekter på bentätheten. Kadmiumexponering hos äldre kvinnor bör därför biomonitoreras kontinuerligt.
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