| 1. |
- Arnardottir, Erna S I F, et al.
(författare)
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Sleep-related sweating in obstructive sleep apnoea: association with sleep stages and blood pressure
- 2010
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Ingår i: JOURNAL OF SLEEP RESEARCH. - : Wiley. - 0962-1105 .- 1365-2869. ; 19:1, s. 122-130
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Tidskriftsartikel (refereegranskat)abstract
- Pandgt;The aim of this study was to investigate sleep-related sweating as a symptom of obstructive sleep apnoea (OSA). Fifteen otherwise healthy male non-smoking patients with untreated moderate-to-severe OSA underwent polysomnography, including measurements of skin and core body temperature and electrodermal activity (EDA) as an objective indicator of sweating. Evening and morning blood pressure was measured as well as catecholamines in nocturnal urine. All measurements were repeated after 3 months on successful continuous positive airway pressure (CPAP) treatment. The untreated OSA subjects had a mean (+/- SD) apnoea-hypopnoea index of 45.3 +/- 3.9 and a mean EDA index during sleep of 131.9 +/- 22.4 events per hour. Patients with higher EDA indices had higher systolic blood pressure in the evening and morning (P = 0.001 and 0.006) and lower rapid eye movement (REM) sleep percentage (P = 0.003). The EDA index decreased significantly to 78.5 +/- 17.7 in the patients on CPAP treatment (P = 0.04). The decrease correlated with lower evening systolic and diastolic blood pressure (P = 0.05 and 0.006) and an increase in REM% (P = 0.02). No relationship was observed between EDA and skin or core body temperature, or to catecholamine levels in urine. OSA patients who experience sleep-related sweating may have increased blood pressure and decreased REM sleep compared with other OSA patients. CPAP treatment appears to lower blood pressure and increase REM sleep to a higher extent in these patients compared with other OSA patients.
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| 2. |
- Arnardottir, Erna Sif, et al.
(författare)
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Nocturnal sweating - a common symptom of obstructive sleep apnoea : the Icelandic sleep apnoea cohort
- 2013
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 3:5, s. e002795-
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To estimate the prevalence and characteristics of frequent nocturnal sweating in obstructive sleep apnoea (OSA) patients compared with the general population and evaluate the possible changes with positive airway pressure (PAP) treatment. Nocturnal sweating can be very bothersome to the patient and bed partner. Design: Case-control and longitudinal cohort study. Setting: Landspitali-The National University Hospital, Iceland. Participants: The Icelandic Sleep Apnea Cohort consisted of 822 untreated patients with OSA, referred for treatment with PAP. Of these, 700 patients were also assessed at a 2-year follow-up. The control group consisted of 703 randomly selected subjects from the general population. Intervention: PAP therapy in the OSA cohort. Main outcome measures: Subjective reporting of nocturnal sweating on a frequency scale of 1-5: (1) never or very seldom, (2) less than once a week, (3) once to twice a week, (4) 3-5 times a week and (5) every night or almost every night. Full PAP treatment was defined objectively as the use for = 4 h/day and = 5 days/week. Results: Frequent nocturnal sweating (= 3x a week) was reported by 30.6% of male and 33.3% of female OSA patients compared with 9.3% of men and 12.4% of women in the general population (p<0.001). This difference remained significant after adjustment for demographic factors. Nocturnal sweating was related to younger age, cardiovascular disease, hypertension, sleepiness and insomnia symptoms. The prevalence of frequent nocturnal sweating decreased with full PAP treatment (from 33.2% to 11.5%, p<0.003 compared with the change in non-users). Conclusions: The prevalence of frequent nocturnal sweating was threefold higher in untreated OSA patients than in the general population and decreased to general population levels with successful PAP therapy. Practitioners should consider the possibility of OSA in their patients who complain of nocturnal sweating.
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| 3. |
- Benediktsdottir, Bryndis, et al.
(författare)
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Prevalence of restless legs syndrome among adults in Iceland and Sweden : Lung function, comorbidity, ferritin, biomarkers and quality of life
- 2010
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Ingår i: Sleep Medicine. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 11:10, s. 1043-1048
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study investigates the prevalence and the association between restless legs syndrome (RLS) and a large variety of health variables in two well-characterized random samples from the general population in Reykjavik, Iceland, and Uppsala, Sweden. Methods: Using the national registries of inhabitants, a random sample from adults aged 40 and over living in Reykjavík, Iceland (n= 939), and Uppsala, Sweden (n= 998), were invited to participate in a study on the prevalence of COPD (response rate 81.1% and 62.2%). In addition, the participants were asked to answer the following questionnaires: International RLS Rating Scale, Short Form-12, the Epworth Sleepiness Scale, and questions about sleep, gastroeosophageal reflux, diabetes and hypertension, as well as pharmacological treatment. Interleukin-6 (IL-6), C-reactive protein (CRP) and ferritin were measured in serum. Results: RLS was more commonly reported in Reykjavik (18.3%) than in Uppsala (11.5%). Icelandic women reported RLS almost twice as often as Swedish women (24.4 vs. 13.9% p= 0.001), but there was no difference in prevalence of RLS between Icelandic and Swedish men. RLS was strongly associated with sleep disturbances and excessive daytime sleepiness. Subjects with RLS were more likely to be ex- and current smokers than subjects without RLS (p< 0.001). Respiratory symptoms and airway obstruction were more prevalent among those reporting RLS and they also estimated their physical quality of life lower than those without RLS (p< 0.001). RLS was not associated with symptoms of the metabolic syndrome like hypertension, obesity, markers of systemic inflammation (IL-6 and CRP) or cardiovascular diseases. Ferritin levels were significantly lower in RLS participants (p= 0.0002), but not (p= 0.07) after adjustment for center, age, sex and smoking history. Conclusion: Restless legs syndrome was twice as common among Icelandic women compared to Swedish women. No such difference was seen for men. RLS was strongly associated with smoking and respiratory symptoms, decreased lung function, sleep disturbances, excessive daytime sleepiness, and physical aspects of life quality. RLS was not associated with markers of the metabolic syndrome like hypertension, obesity, cardiovascular diseases or biomarkers of systemic inflammation.
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| 4. |
- Bjornsdottir, Erla, et al.
(författare)
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Symptoms of Insomnia among Patients with Obstructive Sleep Apnea Before and After Two Years of Positive Airway Pressure Treatment
- 2013
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Ingår i: Sleep. - : Oxford University Press (OUP). - 0161-8105 .- 1550-9109. ; 36:12, s. 1901-1909
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Tidskriftsartikel (refereegranskat)abstract
- Study Objectives: To assess the changes of insomnia symptoms among patients with obstructive sleep apnea (OSA) from starting treatment with positive airway pressure (PAP) to a 2-y follow-up. Design: Longitudinal cohort study. Setting: Landspitali-The National University Hospital of Iceland. Participants: There were 705 adults with OSA who were assessed prior to and 2 y after starting PAP treatment. Intervention: PAP treatment for OSA. Measurements and Results: All patients underwent a medical examination along with a type 3 sleep study and answered questionnaires on health and sleep before and 2 y after starting PAP treatment. The change in prevalence of insomnia symptoms by subtype was assessed by questionnaire and compared between individuals who were using or not using PAP at follow-up. Symptoms of middle insomnia were most common at baseline and improved significantly among patients using PAP (from 59.4% to 30.7%, P < 0.001). Symptoms of initial insomnia tended to persist regardless of PAP treatment, and symptoms of late insomnia were more likely to improve among patients not using PAP. Patients with symptoms of initial and late insomnia at baseline were less likely to adhere to PAP (odds ratio [OR] 0.56, P = 0.007, and OR 0.53, P < 0.001, respectively). Conclusion: Positive airway pressure treatment significantly reduced symptoms of middle insomnia. Symptoms of initial and late insomnia, however, tended to persist regardless of positive airway pressure treatment and had a negative effect on adherence. Targeted treatment for insomnia may be beneficial for patients with obstructive sleep apnea comorbid with insomnia and has the potential to positively affect adherence to positive airway pressure.
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| 5. |
- Björnsdóttir, Erla, et al.
(författare)
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Insomnia in untreated sleep apnea patients compared to controls
- 2012
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 21:2, s. 131-138
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Tidskriftsartikel (refereegranskat)abstract
- Insomnia and obstructive sleep apnea (OSA) often coexist, but the nature of their relationship is unclear. The aims of this study were to compare the prevalence of initial and middle insomnia between OSA patients and controls from the general population as well as to study the influence of insomnia on sleepiness and quality of life in OSA patients. Two groups were compared, untreated OSA patients (n = 824) and controls ≥ 40 years from the general population in Iceland (n = 762). All subjects answered the same questionnaires on health and sleep and OSA patients underwent a sleep study. Altogether, 53% of controls were males compared to 81% of OSA patients. Difficulties maintaining sleep (DMS) were more common among men and women with OSA compared to the general population (52 versus 31% and 62 versus 31%, respectively, P < 0.0001). Difficulties initiating sleep (DIS) and DIS + DMS were more common among women with OSA compared to women without OSA. OSA patients with DMS were sleepier than patients without DMS (Epworth Sleepiness Scale: 12.2 versus 10.9, P < 0.001), while both DMS and DIS were related to lower quality of life in OSA patients as measured by the Short Form 12 (physical score 39 versus 42 and mental score 36 versus 41, P < 0.001). DIS and DMS were not related to OSA severity. Insomnia is common among OSA patients and has a negative influence on quality of life and sleepiness in this patient group. It is relevant to screen for insomnia among OSA patients and treat both conditions when they co-occur.
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| 6. |
- Carlsen, Hanne Krage, et al.
(författare)
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A survey of early health effects of the Eyjafjallajökull 2010 eruption in Iceland: A population-based study
- 2012
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To estimate physical and mental health effects of the Eyjafjallajökull volcanic eruption on nearby residents. Design: Cross-sectional study. Setting: The Icelandic volcano Eyjafjallajökull erupted on 14 April 2010. The eruption lasted for about 6 weeks and was explosive, ejecting some 8 million tons of fine particles into the atmosphere. Due to prevailing winds, the ash spread mostly to the south and south-east, first over the rural region to the south, later over the Atlantic Ocean and Europe, closing European air space for several days. Participants: Residents (n=207) of the most ash-exposed rural area south and east of the volcano. Methods: The study period was from 31 May to 11 June 2010. Participants were examined by a physician. To ascertain respiratory health, standardised spirometry was performed before and after the use of a bronchodilator. All adult participants answered questionnaires about mental and physical health, their children's health and the use of protective equipment. Results: Every other adult participant reported irritation in eyes and upper airway when exposed to volcanic ash. Adults (n=26) and children (n=5) with pre-existing asthma frequently reported worsening of their symptoms. No serious health problems requiring hospitalisation could be attributed to the eruption. The majority of the participants reported no abnormal physical or mental symptoms to the examining physician. Compared to an age- and gender-matched reference group, the ash-exposed participants reported lower smoking rates and were less likely to have ventilation impairment. Less than 10% of the participants reported symptoms of stress, anxiety or depression. Conclusions: Short-term ash exposure was associated with upper airway irritation symptoms and exacerbation of pre-existing asthma but did not contribute to serious health problems. The exposure did not impair respiratory function compared to controls. Outdoor use of protective glasses and face masks was considered protective against irritation in eyes and upper airway.
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| 7. |
- Carlsen, Hanne Krage, et al.
(författare)
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Health effects following the Eyjafjallajökull volcanic eruption : a cohort study
- 2012
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Ingår i: BMJ Open. - : BMJ Publishing Group. - 2044-6055. ; 2:6
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The study aimed to determine whether exposure to a volcanic eruption was associated with increased prevalence of physical and/or mental symptoms.DESIGN: Cohort, with non-exposed control group.SETTING: Natural disasters like volcanic eruptions constitute a major public-health threat. The Icelandic volcano Eyjafjallajökull exposed residents in southern Iceland to continuous ash fall for more than 5 weeks in spring 2010. This study was conducted during November 2010-March 2011, 6-9 months after the Eyjafjallajökull eruption.PARTICIPANTS: Adult (18-80 years of age) eruption-exposed South Icelanders (N=1148) and a control population of residents of Skagafjörður, North Iceland (N=510). The participation rate was 72%.MAIN OUTCOME MEASURES: Physical symptoms in the previous year (chronic), in the previous month (recent), General Health Questionnaire (GHQ-12) measured psychological morbidity.RESULTS: The likelihood of having symptoms during the last month was higher in the exposed population, such as; tightness in the chest (OR 2.5; 95% CI 1.1 to 5.8), cough (OR 2.6; 95% CI 1.7 to 3.9), phlegm (OR 2.1; 95% CI 1.3 to 3.2), eye irritation (OR 2.9; 95% CI 2.0 to 4.1) and psychological morbidity symptoms (OR 1.3; 95% CI 1.0 to 1.7). Respiratory symptoms during the last 12 months were also more common in the exposed population; cough (OR 2.2; 95% CI 1.6 to 2.9), dyspnoea (OR 1.6; 95% CI 1.1 to 2.3), although the prevalence of underlying asthma and heart disease was similar. Twice as many in the exposed population had two or more symptoms from nose, eyes or upper-respiratory tract (24% vs 13%, p<0.001); these individuals were also more likely to experience psychological morbidity (OR 4.7; 95% CI 3.4 to 6.5) compared with individuals with no symptoms. Most symptoms exhibited a dose-response pattern within the exposed population, corresponding to low, medium and high exposure to the eruption.CONCLUSIONS: 6-9 months after the Eyjafjallajökull eruption, residents living in the exposed area, particularly those closest to the volcano, had markedly increased prevalence of various physical symptoms. A portion of the exposed population reported multiple symptoms and may be at risk for long-term physical and psychological morbidity. Studies of long-term consequences are therefore warranted.
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| 8. |
- Carlsen, Hanne Krage, 1981-
(författare)
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Health effects of air pollution in Iceland : respiratory health in volcanic environments
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Air pollution has adverse effects on human health. The respiratory system is the most exposed and short-term changes in air pollution levels have been associated with worsening of asthma symptoms and increased rates of heart attacks and stroke. Air pollution in cities due to traffic is the major concern, as many people are exposed. However, natural sources of air pollution such as natural dust storms and ash from volcanic eruptions can also compromise human health. Exposure to volcanic eruptions and other natural hazards can also threaten mental health. Air pollution has not been extensively studied in Iceland, in spite of the presence of several natural pollution sources and a sizeable car fleet in the capital area.The aim of this thesis was to determine if there was a measurable effect on health which could be attributed to air pollution in Iceland. This aim was pursued along two paths; time series studies using register data aimed to determine the short-term association between daily variation in air pollution and on one hand daily dispensing of anti-asthma medication or the daily number of emergency room visits and emergency admissions for cardiopulmonary causes and stroke. The other method was to investigate if exposure to the Eyjafjallajökull volcanic eruption was associated with adverse health outcomes, either at the end of the eruption, or 6 months later.In paper I time series regression was used to investigate the association between the daily number of individuals who were dispensed anti-asthma medication and levels of the air pollutants particle matter with an aerodynamic diameter less than 10 μm (PM10), nitrogen dioxide (NO2), ozone (O3), and hydrogen sulfide (H2S) during the preceding days. For the study period 2006-9, there were significant associations between the daily mean of PM10 and H2S and the sales of anti-asthma medication 3 to 5 days later. Giving the exposure as the highest daily one-hour mean gave more significant results. Air pollution negatively affected the respiratory health of asthma medication users, prompting them to refill their prescriptions before they had originally intended to.In paper II the main outcome was the number of individuals seeking help at Landspitali University Hospital emergency room for cardiopulmonary disease or stroke. Time series regression was used to identify the lag that gave the best predictive power, and models were run for data for 2003-9 pollutants PM10, NO2, and O3. O3 was significantly associated with the number of emergency hospital visits the same day and two days later in all models, and both for men, women and the elderly. Only emergency hospital visits of the elderly were associated with NO2, and there were no associations with PM10.In paper III the aim was to investigate if the health effects of PM10 were affected by the addition of volcanic ash from the 2010 eruption of Eyjafjallajökull and 2011 eruption of Grímsvötn to PM10 in the capital area. Time series regression of emergency hospital visits and PM10 before and after the Eyjafjallajökull eruption showed that the effect tended to be higher after the eruption, but the results were not significant. Analysis with a binary indicator for high levels of PM10 from volcanic ash and other sources showed that volcanic ash was associated with increased emergency hospital visits. There were no associations with high levels of PM10 from other sources.In paper IV, the health of the population exposed to the ongoing eruption of Eyjafjallajökull in 2010 was investigated thoroughly. Lung function in adults was better than in a reference group from the capital area, though many reported sensory organ irritation symptoms and symptoms of stress and mental unhealth, especially those with underlying diseases.Paper V report the results from a questionnaire study which was carried out six months after the Eyjafjallajökull eruption. The study population comprised a cohort of south Icelanders exposed to the eruption to varying degrees and a reference group from north Iceland. Respiratory and eye symptoms were much more common in south Icelanders than in the reference group, after adjusting for demographic characteristics. Mental unhealth rates had declined considerably.In the studies, we found that urban air pollution and natural particles have short-term effects on anti-asthma medication dispensing and emergency room visits and hospital admissions. Exposure to natural particles in the form of volcanic dust was associated with increased respiratory symptoms in a very exposed population. There were indications that volcanic ash particles were associated with increased emergency hospital visits in the following days.
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| 9. |
- Carlsen, Hanne Krage, et al.
(författare)
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Hydrogen sulfide and particle matter levels associated with increased dispensing of anti-asthma drugs in Iceland's capital
- 2012
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Ingår i: Environmental Research. - : Elsevier BV. - 0013-9351 .- 1096-0953. ; 113, s. 33-39
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Tidskriftsartikel (refereegranskat)abstract
- Background: Air pollutants in Iceland's capital area include hydrogen sulfide (H 2S) emissions from geothermal power plants, particle pollution (PM 10) and traffic-related pollutants. Respiratory health effects of exposure to PM and traffic pollutants are well documented, yet this is one of the first studies to investigate short-term health effects of ambient H 2S exposure. Objectives: The aim of this study was to investigate the associations between daily ambient levels of H 2S, PM 10, nitrogen dioxide (NO 2) and ozone (O 3), and the use of drugs for obstructive pulmonary diseases in adults in Iceland's capital area. Methods: The study period was 8 March 2006 to 31 December 2009. We used log-linear Poisson generalized additive regression models with cubic splines to estimate relative risks of individually dispensed drugs by air pollution levels. A three-day moving average of the exposure variables gave the best fit to the data. Final models included significant covariates adjusting for climate and influenza epidemics, as well as time-dependent variables. Results: The three-day moving average of H 2S and PM 10 levels were positively associated with the number of individuals who were dispensed drugs at lag 3-5, corresponding to a 2.0% (95% confidence interval [CI] 0.4, 3.6) and 0.9% (95% CI 0.1, 1.8) per 10μg/m 3 pollutant concentration increase, respectively. Conclusion: Our findings indicated that intermittent increases in levels of particle matter from traffic and natural sources and ambient H 2S levels were weakly associated with increased dispensing of drugs for obstructive pulmonary disease in Iceland's capital area. These weak associations could be confounded by unevaluated variables hence further studies are needed. © 2012 Elsevier Inc.
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| 10. |
- Carlsen, Hanne Krage, et al.
(författare)
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Ozone is associated with cardiopulmonary and stroke emergency hospital visits in Reykjavík, Iceland 2003-2009.
- 2013
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Ingår i: Environmental health : a global access science source. - : BioMed Central (BMC). - 1476-069X. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Air pollution exposure is associated with hospital admissions and emergency room visits for cardiopulmonary disease and stroke. Iceland's capital area, Reykjavik, has generally low air pollution levels, but traffic and natural sources contribute to pollution levels. The objective of this study was to investigate temporal associations between emergency hospital visits and air pollutants ozone (O-3), nitrogen dioxide (NO2), and particulate matter (PM10) in the Icelandic capital area. Methods: We constructed a time series of the daily number of adults who visited the emergency room, or were acutely admitted for stroke or cardiorespiratory causes to Landspitali University Hospital 1 January 2003 - 31 December 2009 from the hospital in-patient register. We used generalized additive models assuming Poisson distribution, to analyze the daily emergency hospital visits as a function of the pollutant levels, and adjusted for meteorological variables, day of week, and time trend with splines. Results: Daily emergency hospital visits increased 3.9% (95% confidence interval (CI) 1.7-6.1%) per interquartile (IQR) change in average O-3 the same and two previous days. For females, the increase was 7.8% (95% CI 3.6-12.1) for elderly (70+), the increase was 3.9% (95% CI 0.6-7.3%) per IQR increase of NO2. There were no associations with PM10. Conclusions: We found an increase in daily emergency hospital visits associated with O-3, indicating that low-level exposure may trigger cardiopulmonary events or stroke.
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