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  • Lee, Whanhee, et al. (författare)
  • Mortality burden of diurnal temperature range and its temporal changes : a multi-country study
  • 2018
  • Ingår i: Environment International. - : Elsevier. - 0160-4120 .- 1873-6750. ; 110, s. 123-130
  • Tidskriftsartikel (refereegranskat)abstract
    • Although diurnal temperature range (DTR) is a key index of climate change, few studies have reported the health burden of DTR and its temporal changes at a multi-country scale. Therefore, we assessed the attributable risk fraction of DTR on mortality and its temporal variations in a multi-country data set. We collected time-series data covering mortality and weather variables from 308 cities in 10 countries from 1972 to 2013. The temporal change in DTR-related mortality was estimated for each city with a time-varying distributed lag model. Estimates for each city were pooled using a multivariate meta-analysis. The results showed that the attributable fraction of total mortality to DTR was 2.5% (95% eCI: 2.3-2.7%) over the entire study period. In all countries, the attributable fraction increased from 2.4% (2.1-2.7%) to 2.7% (2.4-2.9%) between the first and last study years. This study found that DTR has significantly contributed to mortality in all the countries studied, and this attributable fraction has significantly increased over time in the USA, the UK, Spain, and South Korea. Therefore, because the health burden of DTR is not likely to reduce in the near future, countermeasures are needed to alleviate its impact on human health.
  • Liu, Cong, et al. (författare)
  • Ambient Particulate Air Pollution and Daily Mortality in 652 Cities
  • 2019
  • Ingår i: New England Journal of Medicine. - Waltham : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 381:8, s. 705-715
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias.METHODS: We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 μm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions. We used overdispersed generalized additive models with random-effects meta-analysis to investigate the associations. Two-pollutant models were fitted to test the robustness of the associations. Concentration-response curves from each city were pooled to allow global estimates to be derived.RESULTS: On average, an increase of 10 μg per cubic meter in the 2-day moving average of PM10 concentration, which represents the average over the current and previous day, was associated with increases of 0.44% (95% confidence interval [CI], 0.39 to 0.50) in daily all-cause mortality, 0.36% (95% CI, 0.30 to 0.43) in daily cardiovascular mortality, and 0.47% (95% CI, 0.35 to 0.58) in daily respiratory mortality. The corresponding increases in daily mortality for the same change in PM2.5 concentration were 0.68% (95% CI, 0.59 to 0.77), 0.55% (95% CI, 0.45 to 0.66), and 0.74% (95% CI, 0.53 to 0.95). These associations remained significant after adjustment for gaseous pollutants. Associations were stronger in locations with lower annual mean PM concentrations and higher annual mean temperatures. The pooled concentration-response curves showed a consistent increase in daily mortality with increasing PM concentration, with steeper slopes at lower PM concentrations.CONCLUSIONS: Our data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies. (Funded by the National Natural Science Foundation of China and others.).
  • Lodge, Caroline J., et al. (författare)
  • Grandmaternal smoking increases asthma risk in grandchildren : a nationwide Swedish cohort
  • 2018
  • Ingår i: Clinical and Experimental Allergy. - : John Wiley & Sons. - 0954-7894 .- 1365-2222. ; 48:2, s. 167-174
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: There is growing interest in exposures prior to conception as possible risk factors for offspring asthma. Although partially supported by evidence from limited human studies, current evidence is inconsistent, and based on recall of exposure status.OBJECTIVE: We aimed to investigate grandmaternal smoking during pregnancy and the risk of asthma in grandchildren using prospectively collected population-based data.METHODS: Information on grandmaternal and maternal smoking during pregnancy and grandchild use of asthma medications was collected from national Swedish registries. Associations between grandmaternal smoking during pregnancy (10-12 weeks), and asthma medication use in grandchildren were investigated using generalized estimating equations. Ages at which asthma medications were prescribed classified childhood asthma into never, early transient (0-3years), late onset (3-6 years) and early persistent (0-3 and 3-6 years) phenotypes.RESULTS: From 1982 to 1986, 44,583 grandmothers gave birth to 46,197 mothers, who gave birth to 66,271 grandchildren (born 1996-2010). Children aged 1-6 years had an increased asthma risk if their grandmothers had smoked during pregnancy, with a higher risk for more exposure (10+ cigs/day; adjusted OR 1·23; 1·17, 1·30). Maternal smoking did not modify this relationship.CONCLUSIONS & CLINICAL RELEVANCE: Children had an increased risk of asthma in the first six years of life if their grandmothers smoked during early pregnancy, independent of maternal smoking. Importantly this exhibited a dose-response relationship and was associated with a persistent childhood asthma phenotype. These findings support possible epigenetic transmission of risk from environmental exposures in previous generations. 
  • Lytras, T., et al. (författare)
  • Occupational exposures and 20-year incidence of COPD: the European Community Respiratory Health Survey
  • 2018
  • Ingår i: Thorax. - : BioMed Central. - 0040-6376 .- 1468-3296. ; 73:11
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Occupational exposures have been associated with an increased risk of COPD. However, few studies have related objectively assessed occupational exposures to prospectively assessed incidence of COPD, using postbronchodilator lung function tests. Our objective was to examine the effect of occupational exposures on COPD incidence in the European Community Respiratory Health Survey. Methods General population samples aged 20-44 were randomly selected in 1991-1993 and followed up 20 years later (2010-2012). Spirometry was performed at baseline and at follow-up, with incident COPD defined using a lower limit of normal criterion for postbronchodilator FEV1/FVC. Only participants without COPD and without current asthma at baseline were included. Coded job histories during follow-up were linked to a Job-Exposure Matrix, generating occupational exposure estimates to 12 categories of agents. Their association with COPD incidence was examined in log-binomial models fitted in a Bayesian framework. Findings 3343 participants fulfilled the inclusion criteria; 89 of them had COPD at follow-up (1.4 cases/1000 person-years). Participants exposed to biological dust had a higher incidence of COPD compared with those unexposed (relative risk (RR) 1.6, 95% CI 1.1 to 2.3), as did those exposed to gases and fumes (RR 1.5, 95% CI 1.0 to 2.2) and pesticides (RR 2.2, 95% CI 1.1 to 3.8). The combined population attributable fraction for these exposures was 21.0%. Interpretation These results substantially strengthen the evidence base for occupational exposures as an important risk factor for COPD.
  • Lytras, T., et al. (författare)
  • Occupational exposures and incidence of chronic bronchitis and related symptoms over two decades: The European Community Respiratory Health Survey
  • 2019
  • Ingår i: Occupational and environmental medicine. - : BMJ Publishing Group Ltd. - 1351-0711 .- 1470-7926. ; 76:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Chronic bronchitis (CB) is an important chronic obstructive pulmonary disease (COPD)-related phenotype, with distinct clinical features and prognostic implications. Occupational exposures have been previously associated with increased risk of CB but few studies have examined this association prospectively using objective exposure assessment. We examined the effect of occupational exposures on CB incidence in the European Community Respiratory Health Survey. Methods: Population samples aged 20-44 were randomly selected in 1991-1993, and followed up twice over 20 years. Participants without chronic cough or phlegm at baseline were analysed. Coded job histories during follow-up were linked to the ALOHA Job Exposure Matrix, generating occupational exposure estimates to 12 categories of chemical agents. Their association with CB incidence over both follow-ups was examined with Poisson models using generalised estimating equations. Results: 8794 participants fulfilled the inclusion criteria, contributing 13 185 observations. Only participants exposed to metals had a higher incidence of CB (relative risk (RR) 1.70, 95% CI 1.16 to 2.50) compared with non-exposed to metals. Mineral dust exposure increased the incidence of chronic phlegm (RR 1.72, 95% CI 1.43 to 2.06). Incidence of chronic phlegm was increased in men exposed to gases/fumes and to solvents and in women exposed to pesticides. Conclusions: Occupational exposures are associated with chronic phlegm and CB, and the evidence is strongest for metals and mineral dust exposure. The observed differences between men and women warrant further investigation. © Author(s) (or their employer(s)) 2019.
  • Lövenheim, Boel, et al. (författare)
  • Health risk assessment of reduced air pollution exposure when changing commuting by car to bike
  • 2016
  • Konferensbidrag (refereegranskat)abstract
    • In this study we have assessed the reduction in traffic emissions and population exposure assuming all potential car commuters would switch to biking if they live within 30 minute travel by bike. The scenario would result in more than 100 000 new bikers and due to the reduced traffic emissions 42 premature deaths would be avoided per year. This is almost twice as large effect as the congestion tax in Stockholm.  Introduction Regular physical activity has important and wide-ranging health benefits including reduced risk of chronic disease, and physical inactivity is mentioned as perhaps the most important public health problem of the 21st century. At the same time, the direct effects of traffic emissions is a major health problem. Transferring commuting by car to bike will increase physical activity and reduce emissions and reduce population exposure to traffic pollution. The exposure of commuters will also change; new bikers may get higher exposure whilst old bikers and car drivers may get lower exposures, depending on commuting route and distance. Methodology In this study we have calculated the potential number of car-to-bike switching commuters depending on distance, travel time, age of commuters, etc. We have made calculations for a 30-minute biking scenario, i.e. transferring all car commuters to bike if their travel time by bike is less than or equal to 30 minutes. The commuting distance depends on age and sex. For the travel and traffic modelling the LuTrans model was used. It includes all different modes of travel; walking, bicycling, public transport systems and car traffic. The model was developed based on travel survey data and is regularly calibrated using traffic counts. Emissions from road traffic were calculated based on HBEFA 3.2. A Gaussian dispersion model was used estimate exposures over the county of Stockholm. Results The 30 min scenario resulted in 106 881 more bikers, an increase of 2.6 times compared to base scenario. Of all bikers 50% were men and the mean age of all bikers was 42. The traffic emissions of NOx was reduced by up to 7%. Up to 20% reduction in traffic contribution to NOx concentrations was calculated as shown in Figure 1. The mean reduction in concentration for the whole area is 6% and the largest occur were most people live.The population weighted mean NOx concentration for 1.6 million people in Greater Stockholm is estimated to be reduced by 0.41 μg m-3. Assuming that the premature mortality is reduced by 8% per 10 μg m-3 (Nafstad et al., 2004), this corresponds to 42 avoided premature deaths every year or 514 gained life years gained. This is even somewhat more beneficial than the effects of the congestion charge in Stockholm (Johansson et al., 2009), which was estimated to save 27 premature deaths per year. The gain in reduced mortality is almost as large as the gain in health of the increased physical activity. Conclusions Transferring car commuters to bike is not only beneficial for the physical activity, but will also lead to reduced traffic emissions and reduced population exposure. Our estimates show that it may be even more beneficial for mortality due to air pollution exposure than the congestion charge in Stockholm. Acknowledgement This project was funded by the Swedish Research Council for Health, Working life and Welfare. References Johansson, C., Burman, L., Forsberg, B. 2009. The effects of congestions tax on air quality and health. Atmos. Environ. 43, 4843-4854.Nafstad, P., Lund Håheim, L., Wisloeff, T., Gram, G., Oftedal, B., Holme, I., Hjermann, I. and Leren, P. 2004. Urban Air Pollution and Mortality in a Cohort of Norwegian Men. Environ. Health Perspect. 112, 610-615.
  • Makowska, J. S., et al. (författare)
  • Respiratory hypersensitivity reactions to NSAIDs in Europe: the global allergy and asthma network (GA(2)LEN) survey
  • 2016
  • Ingår i: Allergy. - : Wiley-Blackwell. - 0105-4538 .- 1398-9995. ; 71:11, s. 1603-1611
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) are among the most prevalent drugs inducing hypersensitivity reactions. The aim of this analysis was to estimate the prevalence of NSAID-induced respiratory symptoms in population across Europe and to assess its association with upper and lower respiratory tract disorders. MethodsThe GA(2)LEN survey was conducted in 22 centers in 15 European countries. Each of 19 centers selected random samples of 5000 adults aged 15-74 from their general population, and in three centers (Athens, Munich, Oslo), a younger population was sampled. Questionnaires including questions about age, gender, presence of symptoms of asthma, allergic rhinitis, chronic rhinosinusitis, smoking status, and history of NSAID-induced hypersensitivity reactions were sent to participants by mail. Totally, 62 737 participants completed the questionnaires. ResultsThe mean prevalence of NSAID-induced dyspnea was 1.9% and was highest in the three Polish centers [Katowice (4.9%), Krakow (4.8%), and Lodz (4.4%)] and lowest in Skopje, (0.9%), Amsterdam (1.1%), and Umea (1.2%). In multivariate analysis, the prevalence of respiratory reactions to NSAIDs was higher in participants with chronic rhinosinusitis symptoms (Odds Ratio 2.12; 95%CI 1.78-2.74), asthma symptoms in last 12 months (2.7; 2.18-3.35), hospitalization due to asthma (1.53; 1.22-1.99), and adults vs children (1.53; 1.24-1.89), but was not associated with allergic rhinitis. ConclusionOur study documented significant variation between European countries in the prevalence of NSAID-induced respiratory hypersensitivity reactions, and association with chronic airway diseases, but also with environmental factors.
  • Martens, Dries S, et al. (författare)
  • Neonatal Cord Blood Oxylipins and Exposure to Particulate Matter in the Early-Life Environment : an ENVIRONAGE Birth Cohort Study
  • 2017
  • Ingår i: Journal of Environmental Health Perspectives. - 0091-6765 .- 1552-9924. ; 125:4, s. 691-698
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: As part of the lipidome, oxylipins are bioactive lipid compounds originating from oxidation of different fatty acids. Oxylipins could provide a new target in the developmental origins model or the ability of early life exposure to change biology.OBJECTIVES: We studied the association between in utero PM2.5 (particulate matter with aerodynamic diameter <2.5µm) exposure and oxylipin profiles in newborns.METHODS: Thirty-seven oxylipins reflecting the cyclooxygenase (COX), lipoxygenase (5-LOX and 12/15-LOX) and cytochrome P450 (CYP) pathways were assayed in 197 cord blood plasma samples from the ENVIRONAGE birth cohort. Principal component (PC) analysis and multiple regression models were used to estimate associations of in utero PM2.5 exposure with oxylipin pathways and individual metabolites.RESULTS: A principal component representing the 5-LOX pathway (6 metabolites) was significantly positively associated with PM2.5 exposure during the entire (multiple testing-adjusted q-value = 0.05) and second trimester of pregnancy (q = 0.05). A principal component representing the 12/15-LOX pathway (11 metabolites) was positively associated with PM2.5 exposure during the second trimester of pregnancy (q = 0.05). PM2.5 was not significantly associated with the COX pathway during any time period. There was a positive but non-significant association between second trimester PM2.5 and the CYP pathway (q = 0.16).CONCLUSION: In utero exposure to particulate matter, particularly during the second trimester, was associated with differences in the cord blood levels of metabolites derived from the lipoxygenase pathways. These differences may indicate an effect of air pollution during in utero life on the inflammatory state of the newborn at birth. Oxylipins may be important mediators between early life exposures and health outcomes later in life.
  • Meister, Kadri, et al. (författare)
  • Sambandet mellan luftföroreningshalter och akuta vårdkontakter för luftvägssjukdomar som hälsoindikator för luftkvalitet
  • 2016
  • Rapport (övrigt vetenskapligt)abstract
    • Denna studie inom den hälsorelaterade miljöövervakningen har genomförts på uppdrag av Naturvårdsverket för att belysa eventuella korttidseffekter av luftföroreningar på akutbesök för astma samt för alla sjukdomar iandningsorganen. Dessa sjukdomar medför ofta ökad känslighet för luftföroreningar. Halternas samband med akutbesök för andningsorganens sjukdomar har tidigare studerats inom miljöövervakningen. För att underlätta jämförelser har metodiken anpassats till tidigare studier där betydelsen av halterna de två senaste dygnen beräknas. Övervakning av denna typ av korttidssamband med halter i miljön är mindre känslig för trender och förändringar i diagnostik och vårdresurser än enklare epidemiologisk bevakning av antalet fall per år etc., eftersom totala antalet fall i sig kan påverkas av en rad olika typer av faktorer utan koppling till luftföroreningssituationen.Uppgifter om den skrivna befolkningens akutbesök (vid akutmottagning samt akuta (inte planerade) inläggningar) under åren 2005 till och med 2013 för andningsorganens sjukdomar inklusive astma vid akutsjukhusen i StorStockholm, Göteborg/Mölndal respektive Malmö/Burlöv har inhämtats från Socialstyrelsens Patientregister. Uppgifterna från registret avser avidentifierade akutbesök med diagnoser dygn för dygn under perioden.Luftföroreningsdata i form av urbana bakgrundshalter har hämtats från Stockholm luft- och bulleranalys (SLB) vid miljöförvaltningen i Stockholm och från IVL Svenska miljöinstitutet data för Göteborg respektive Malmö. Vi har studerat effekterna av partikelhalten (PM10 ~ partiklar mindre än 10 mikrometer i diameter), avgashalten indikerad med kväveoxider (NOx) samt ozon. Analyser har gjorts av akutbesök totalt för alla åldrar samt i olika åldergrupper: barn, vuxna och äldre.Tidsserieanalyserna har utförts med Poisson-regression. I dessa analyser tas hänsyn till tidstrender, årstidsmönster, influensaperioder, väderförhållanden, pollenhalt, veckodag, helgperioder mm. De inkluderade luftföroreningarna är ozon, kvävedioxid och partiklar (PM10). Alla luftföroreningsvariabler kan ses som indikatorer på olika typer av luftföroreningar, och har simultant beaktats i de slutliga analyserna.I alla tre städer hade ozon effekten på akutbesök för andningsorganens sjukdomar totalt och för astma totalt. Effekten av ozon på akutbesök för andningsorganen samt på astma finns även för barn respektive vuxna separat i Stockholm och Göteborg.Effekter av ozon kan ses som inte skiljande sig mellan de tre olika studieområdena och därför har även en sammanvägd skattning för ozon beräknats gällande antalet akutbesök för andningsorganen totalt, akutbesök för astma totalt samt akutbesök för astma bland barn. När resultaten vägdes ihop för de tre studieområdena beräknas att antalet akutbesök för andningsorganen totalt ökar med 1,6% (95% KI=1,1-2%) per 10 g/m3 haltökning av ozon, akutbesök för astma totalt med 2,5% (95% KI=1,5-3,6% ) per 10 g/m3 haltökning, medan akutbesök för astma bland barn med 3,9% (95% KI=1,7- 4%) per 10 g/m3 haltökning av ozon.Eftersom föroreningssituationen som indikatorerna representerar kan förändras med tiden har analyserna gjorts även för två olika tidsperioder: 2005-2008 samt 2009-2013. Analysen för Malmö visade på vissa statistiskt säkerställda skillnader. Effekten av ozon på akutbesök för andningsorganen totalt var högre under den senare tidsperioden, 2009-2013. Denna trend finns även för barn respektive vuxna separat.Att analysera variationen i telefonsamtal till 1177-Vårdguiden har tidigare visat sig vara en fördelaktig metod vid studier gällande magsjuka och den mest lämpliga metoden för att tidigt detektera utbrott av magsjuka. Till följd av detta var det angeläget att undersöka om denna relativt nya databas innehållande 1177-samtal även kan vara lämplig att använda i studier som avser akuta hälsoproblem av sjukdomar i andningsorganen som kan påverkas av luftföroreningshalterna.Som tillägg har en pilotstudie gjorts i Göteborg, där uppgifter om dygnsvisa antal samtal medkontaktorsakerna andningsproblem respektive hosta från 1177-Vårdguiden under perioden 2007-11-30 - 2013-12-01 har använts för att jämföra sambanden till luftföroreningshalter. Även här är antalsuppgifter uppdelade i olika åldersgrupper. I likhet med besöksdata påvisades effekter av luftföroreningar där ökning av PM10-halten ökade antalet samtal gällande andningsbesvär och hosta bland barn. Samtal gällande andningsbesvär hos vuxna ökade med ökande halter av ozon. Studien visar att denna typ av data kananvändas för att övervaka luftföroreningsexponeringens effekter.
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