Self-Assessed Threshold Temperature for Cold among Poultry Industry Workers in Thailand.

The self-assessed threshold temperature for cold in the workplace is not well known. We asked 392 chicken industry workers in Thailand what they regard as the cold threshold (CT) and compared subgroups of workers using linear and quantile regressions by CT sextiles (percentiles P17, P33, P50, P67, and P83, from warmest to coldest). The variables of interest were sex, office work, and sedentary work, with age, clothing thermal insulation, and alcohol consumption as adjustment factors. The mean CT was 14.6 °C. Office workers had a 6.8 °C higher mean CT than other workers, but the difference ranged from 3.8 °C to 10.0 °C from P17 to P83. Sedentary workers had a 2.0 °C higher mean CT than others, but the difference increased from 0.5 °C to 3.0 °C through P17-P83. The mean CT did not differ between sexes, but men had a 1.6-5.0 °C higher CT at P17-P50 (>20 °C) and a 5.0 °C lower CT at P83 (<10 °C). The CT was relatively high at warm (≥10 °C), dry (relative humidity <41%), and drafty (air velocity > 0.35 m/s) worksites. We conclude that office, sedentary, and female workers and those working at warm, dry, and draughty sites are sensitive to the coldest temperatures, whereas male workers are sensitive even to moderate temperatures.

Workplace Cold and Perceived Work Ability: Paradoxically Greater Disadvantage for More vs. Less-Educated Poultry Industry Workers in Thailand.

The association between worksite temperature and perceived work ability (WA) in various educational classes remains unknown. Therefore, we interviewed 286 poultry industry workers in Thailand about their WA and linked their responses to worksite temperature. WA was based on the self-assessment of current work ability compared with their lifetime best ability (scores 0-10). Education was classified as high (university or vocational school) or low (less education). Temperature was classified as cold (-22-10°C) or warm (10-23°C). WA and the occurrence of a low WA were regressed on worksite temperature, education, and their interaction with the adjustment for sex, age, job category, physical work strain, moving between cold and warm sites, thermal insulation of clothing, relative humidity, and air velocity. The average worksite temperature was 10°C for high- and 1°C for low-educated workers. The average WA score was 8.32 (SD, 1.33; range, 4-10) and classified as low (<8) in 23% of the workers. In highly-educated workers, the adjusted mean WA decreased from 9.11 in the warm areas to 8.02 in the cold areas and the prevalence of a low WA increased from 11 to 30%, while no significant change was observed in less-educated workers. The WA score was estimated to decline by 10% more (95% CI, 4-16%) in the cold areas for the more vs. less-educated workers and the prevalence of a poor WA was estimated to increase 3.09 times (95% CI, 1.43-5.45) more. Highly-educated workers in this industry are a risk group that should be given customized advice.

Coronary deaths during Midsummer festival in Finland: miseries of long, light nights.

This paper examines whether the anomalous summer peak in deaths from coronary heart disease (CHD) in Finland could be attributed to adverse effects of the Midsummer festival and alcohol consumption during the festival. Daily deaths from CHD and alcohol poisoning in Finland, 1961-2014, that occurred during the 7 days centering on Midsummer Day were analysed in relation to deaths during 14 to 4 days before and 4 to 14 after Midsummer Day. Daily counts of deaths from CHD among persons aged 35-64 years were regressed on days around the Midsummer period by negative binomial regression. Mortality from CHD was highest on Midsummer Day (RR 1.25 (95% confidence interval 1.12-1.31), one day after the peak in deaths from alcohol poisonings. RR for CHD on Midsummer Day was particulary high (RR = 1.43; 1.09-1.86) in the 2000s, 30% of deaths being attributable to that day. In conclusion, the anomalous and prominent summer peak in deaths from CHD in Finland is an adverse consequence of the Midsummer festival. The most likely underlying reason is heavy alcohol consumption during the festival period, especially on Midsummer Eve. In the 2000s, one third of deaths from CHD on Midsummer Day are preventable.

Airborne pollen concentrations and daily mortality from respiratory and cardiovascular causes.

We conducted a time-series analysis of the relations between daily levels of allergenic pollen and mortality in the Helsinki Metropolitan Area with 153 378 deaths; 9742 from respiratory and 57 402 from cardiovascular causes. Daily (average) pollen counts of alder, birch, mugwort and grass were measured. In quasi-Poisson regression analysis, abundant alder pollen increased the risk of non-accidental deaths with an adjusted cumulative mortality rate ratio (acMRR) of 1.10 (95% CI 1.01-1.19) and of deaths from respiratory-diseases with acMRR of 1.78 (95% CI 1.19-2.65). Abundant mugwort pollen increased cardiovascular mortality (1.41, 1.02-1.95). These findings identify an important global public health problem.

Climate Warming and Occupational Heat and Hot Environment Standards in Thailand.

BACKGROUND: During the period 2001 to 2016, the maximum temperatures in Thailand rose from 38-41oC to 42-44oC. The current occupational heat exposure standard of Thailand issued in 2006 is based on wet bulb globe temperature (WBGT) defined for three workload levels without a work-rest regimen. This study examined whether the present standard still protects most workers. METHODS: The sample comprised 168 heat acclimatized workers (90 in construction sites, 78 in foundries). Heart rate and auditory canal temperature were recorded continuously for 2 hours. Workplace WBGT, relative humidity, and wind velocity were monitored, and the participants' workloads were estimated. Heat-related symptoms and signs were collected by a questionnaire. RESULTS: Only 55% of the participants worked in workplaces complying with the heat standard. Of them, 79% had auditory canal temperature ≤ 38.5oC, compared with only 58% in noncompliant workplaces. 18% and 43% of the workers in compliant and noncompliant workplaces, respectively, had symptoms from heat stress, the trend being similar across all workload levels. An increase of one degree (C) in WBGT was associated with a 1.85-fold increase (95% confidence interval: 1.44-2.48) in odds for having symptoms. CONCLUSION: Compliance with the current occupational heat standard protects 4/5 of the workers, whereas noncompliance reduces this proportion to one half. The reasons for noncompliance include the gaps and ambiguities in the law. The law should specify work/rest schedules; outdoor work should be identified as an occupational heat hazard; and the staff should include occupational personnel to manage heat stress in establishments involving heat exposure.

Cold-related pain in the face, upper limbs, and lower body among Thai chicken industry workers: a cross-sectional study.

OBJECTIVE: There is limited information on cold-related pain (CRP) in various parts of the body among workers employed in cold environments. We, therefore, determined the prevalence of CRP among Thai chicken industry workers and attempted to identify vulnerable subgroups. METHODS: Four hundred and twenty-two workers in four chicken meat factories in Thailand were asked about CRP in the face, upper limbs, and lower body. The results were expressed as adjusted prevalence and prevalence differences [PD; in percentage points (pp)] and their 95% confidence intervals (CI). RESULTS: Overall, 80% of the subjects suffered from CRP in at least one site on the body: 66% in the upper limbs, 65% in the lower body, and 44% in the face. In most sites, CRP increased from the lowest to the highest educational level, notably in the nose with a PD of 36 pp [95% CI 23, 49]. Forklift drivers experienced knee pain [PD 21 pp (0, 41)], and manufacturing [PD 27 pp (15, 38)] and storage workers [PD 24 pp (10, 37)] experienced thigh pain more often than office workers, while office workers reported CRP in the cheeks, ears, wrists, and fingers more often than other workers. Women had more CRP than men in several body sites. CONCLUSIONS: The majority of workers suffered from CRP. Intensified protective measures should be targeted not only for forklift drivers and storage and manufacturing workers, but also for the highly educated as well as the office staff who showed excessive prevalence of CRP in several body sites.

Satellite Imaging-Based Residential Greenness and Accelerometry Measured Physical Activity at Midlife-Population-Based Northern Finland Birth Cohort 1966 Study.

BACKGROUND: Recently, the importance of light physical activity (LPA) for health has been emphasized, and residential greenness has been positively linked to the level of LPA and a variety of positive health outcomes. However, people spend less time in green environments because of urbanization and modern sedentary leisure activities. AIMS: In this population-based study, we investigated the association between objectively measured residential greenness and accelerometry measured physical activity (PA), with a special interest in LPA and gender differences. METHODS: The study was based on the Northern Finland Birth Cohort 1966 (5433 members). Participants filled in a postal questionnaire and underwent clinical examinations and wore a continuous measurement of PA with wrist-worn Polar Active Activity Monitor accelerometers for two weeks. The volume of PA (metabolic equivalent of task or MET) was used to describe the participant's total daily activity (light: 2-3.49 MET; moderate: 3.5-4.99 MET; vigorous: 5-7.99 MET; very vigorous: ≥8 MET). A geographic information system (GIS) was used to assess the features of each individual's residential environment. The normalized difference vegetation index (NDVI) was used for the objective quantification of residential greenness. Multiple linear regression and a generalized additive model (GAM) were used to analyze the association between residential greenness and the amount of PA at different intensity levels. RESULTS: Residential greenness (NDVI) was independently associated with LPA (unadjusted ß = 174; CI = 140, 209) and moderate physical activity (MPA) (unadjusted ß = 75; CI = 48, 101). In the adjusted model, residential greenness was positively and significantly associated with LPA (adjusted ß = 70; CI = 26, 114). In men, residential greenness was positively and significantly associated with LPA (unadjusted ß = 224; CI = 173, 275), MPA (unadjusted ß = 75; CI = 48, 101), and moderate to vigorous physical activity (MVPA) (unadjusted ß = 89; CI = 25, 152). In women, residential greenness was positively related to LPA (unadjusted ß = 142; CI = 96, 188) and inversely associated with MPA (unadjusted ß = -22; CI = -36, -8), vigorous/very vigorous physical activity (VPA/VVPA) (unadjusted ß = -49; CI = -84, -14), and MVPA (unadjusted ß = -71; CI = -113, -29). In the final adjusted models, residential greenness was significantly associated only with the amount of LPA in men (adjusted ß = 140; CI = 75, 204). CONCLUSIONS: Residential greenness was positively associated with LPA in both genders, but the association remained significant after adjustments only in men. Residential greenness may provide a supportive environment for promoting LPA.

Cold-related symptoms and performance degradation among Thai poultry industry workers with reference to vulnerable groups: a cross-sectional study.

BACKGROUND: Few studies have examined cold-related symptoms among cold workplace workers in Thailand. This study aimed to determine the prevalence of cold-related cardiorespiratory, circulatory, and general symptoms and performance degradation among Thai chicken industry workers and identify vulnerable groups. METHODS: Overall, 422 workers aged from 18 to 57 years at four chicken meat factories in Thailand were interviewed for cold-related symptoms and complaints. The results were expressed in terms of model-based adjusted prevalence and prevalence differences (PDs) in percentage points (pp) with 95% confidence intervals (CIs). RESULTS: In total, 76.1% of the respondents reported cold-related respiratory symptoms, 24.6% reported cardiac symptoms, 68.6% reported circulatory symptoms, and 72.1% reported general symptoms. In addition, 82.7% of the respondents reported performance degradation. Cold-related respiratory symptoms increased by PD 29.0 pp. (95% CI 23.4-34.6) from the lowest to the highest educational group, with a similar pattern observed in performance degradation. Forklift drivers and storage and manufacturing workers complained of cold-related respiratory symptoms more than office staff (PD 22.1 pp., 95% CI 12.8-31.3; 12.0 pp., 95% CI 2.4-21.6; and 17.5 pp., 95% CI 11.5-23.6, respectively); they also reported more performance degradation (PD 24.1 pp., 95% CI 17.0-31.2; 19.8 pp., 95% CI 14.1-25.6; and 14.8 pp., 95% CI 8.0-22.6, respectively). Weekly alcohol consumers reported more performance problems owing to cold (PD 18.2 pp., 95% CI 13.9-22.6) than non-consumers of alcohol. Cardiac and circulation symptoms were more common in women than men (PD 10.0 pp., 95% CI 1.1-18.9; and 8.4 pp., 95% CI 0.5-16.4, respectively). The age trend in performance issues was curved, with the highest prevalence among those aged 35-44 years, while the oldest workers (45-57 years) perceived less cold-related symptoms, particularly thirst. CONCLUSIONS: Cold-related symptoms and performance degradation were found to be common in this industry, with vulnerable groups comprising of highly educated workers, forklift drivers, storage and manufacturing workers, weekly alcohol consumers, aging workers, and women. The results demonstrate a need for further research on the adequacy of protection provided against the cold, particularly given that global warming will increase the contrast between cold workplaces and outdoor heat.

Cold weather-related cardiorespiratory symptoms predict higher morbidity and mortality.

BACKGROUND: Symptoms perceived in cold weather reflect physiological responses to body cooling and may worsen the course of a pre-existing disease or precipitate disease events in ostensibly healthy individuals. However, the associations between cold-related symptoms and their health effects have remained unknown. We examined whether cold-related cardiac and respiratory symptoms perceived in cold weather predict future morbidity and mortality. METHODS: Cold-related symptoms were inquired in four national FINRISK surveys conducted in 1997, 2002, 2007, 2012 in Finland including altogether 17 040 respondents. A record linkage was made to national hospital discharge and cause-of-death registers. The participants were followed up until the first hospital admission due to a cardiovascular or respiratory disease or death, or until the end of 2015. The individual follow-up times ranged from 0 to 18 years (mean 11 years). The association of cold-related symptoms with morbidity and mortality was examined by Kaplan-Meyer and Cox-regression analyses. RESULTS: Cold-related cardiac [hazard ratio (HR), 1.76 and its 95% confidence interval (95% CI), 1.44-2.15] and combined cardiac and respiratory symptoms [1.50 (1.29-1.73)] were associated with hospitalization due to cardiovascular causes. The respective HRs for admissions due to respiratory causes were elevated for cold-related respiratory [1.22 (1.07-1.40)], cardiac [1.24 (0.88-1.75)] and cardiorespiratory [1.82 (1.50-2.22)] symptoms. Cold-related cardiorespiratory symptoms were associated with deaths from all natural [1.38 (1.11-1.72)], cardiovascular [1.77 (1.28-2.44)] and respiratory [2.19 (0.95-5.06)] causes. INTERPRETATION: Cold weather-related symptoms predict a higher occurrence of hospital admissions and mortality. The information may prove useful in planning measures to reduce cold-related adverse health effects.

Prevalence of cold-related symptoms among Thai chicken meat industry workers: association with workplace temperature and thermal insulation of clothing.

This study determined the association of cold-related symptoms with workplace temperature and thermal insulation of clothing among Thai chicken industry workers. Three hundred workers were interviewed regarding cold-related symptoms, which were regressed on worksite temperature and protective clothing. In total, 80% of workers reported respiratory symptoms; 23%, cardiac symptoms; 62%, circulation disturbances; 42%, thirst; 56%, drying of the mouth; and 82%, degradation of their performance. When adjusted for personal characteristics, respiratory symptoms were 1.1‒2.2 times more prevalent at -22‒10°C than at 10‒23°C. At -22‒10°C, cardiac symptoms increased by 45%, chest pain by 91%, peripheral circulation disturbances by 25%, and drying of the mouth by 57%. Wearing protective clothing with at least 1.1 clo units was associated with marked reductions in symptom prevalence. Therefore, temperatures lower than 10°C increased prevalence of cold-related symptoms, which are largely preventable by appropriate clothing use.

Association of biomass fuel use with reduced body weight of adult Ghanaian women.

The association of biomass fuel use with body weight has never been investigated. We therefore examined the effect of biomass fuel use on body weight of adult Ghanaian women. Data from the 2014 Ghana Demographic and Health Survey, a nationally representative population-based survey was analysed for this study. A total of 4751 women who had anthropometric (height and weight) data qualified for inclusion in this study. In linear regression modelling, charcoal use resulted in 3.08 kg (95% CI: 2.04, 4.12) and 0.81 kg/m2 (95%CI: 0.29, 1.33) reduction in weight and body mass index (BMI), respectively, compared to clean fuel (electricity, liquefied petroleum gas and natural gas) use. Use of wood resulted in much higher reduction in weight and BMI. In modified Poisson regression, charcoal users had 19% (Adjusted Prevalence Ratio [aPR] = 0.81; 95%CI: 0.71, 0.92) and 29% (aPR = 0.71; 95%CI: 0.61, 0.83) decreased risk of overweight and obesity, respectively, compared to clean fuel users. Wood users had much higher decreased risk of overweight and obesity. In conclusion, biomass fuel use was associated with reduced body weight and BMI of Ghanaian women and is the first report on the relationship. However, it is important that our findings are confirmed and the biological mechanisms elucidated through rigorous study designs.

Diverse age-incidence patterns of atopic sensitization in an unselected Finnish population up to 12 years.

BACKGROUND: The temporal sequence in which allergic sensitization to different allergens emerges is not well characterized at the level of general population. OBJECTIVE: We describe the incidence patterns of atopic sensitization to different allergens from birth up to 12 years of age in an unselected Finnish population. METHODS: The study population comprised all children born between 2001 and 2006 identified from the nationwide population register as residents of the province of South Karelia, Finland (n = 5564). The results of allergy tests (22,380 results from skin prick tests, immunoglobulin E [IgE] antibodies, and open food challenges [OFCs], performed in 1827 children) were collected from patient records of all the health care units in the area. RESULTS: The incidence rates of positive results for food and animal allergens as well as positive OFCs for cow's milk showed prominent peaks at 5 months of age. Positive results for pollen allergens started to emerge after 1.5 years of age. The 12-year cumulative incidence of sensitization to food, animal, pollen, and any allergens was 12%, 8%, 10%, and 18%, respectively. The cumulative incidence of sensitization to house dust mites was 1% and to molds or latex less than 1%. Firstborn boys had the highest, and those who were not firstborn girls and children born in rural municipalities had the lowest early incidence of sensitization to inhalation allergens. CONCLUSION: In the unselected population, the atopic sensitization against food and animal allergens began before 6 months of age and was followed by sensitization to pollen allergens before 2 years of age. Primary prevention of sensitization to food and inhalation allergens should therefore occur in early infancy.

Lunar cycle in homicides: a population-based time series study in Finland.

OBJECTIVE: To test whether homicides in Finland vary according to moon phases. DESIGN: A time series study. SETTING: Finland. PARTICIPANTS: 6808 homicides committed in 1961-2014. OUTCOME: Daily numbers of homicides. METHOD: The daily numbers of homicides were related to eight moon phases and the illuminated percentage of the moon disc using negative binomial regression. To identify lunar patterns, piecewise linear terms of lunar days were used, together with changes from one moon phase to another. Homicides were similarly regressed on quintiles of the illuminated percentage of the moon disc. A periodic term of length 29.53 days was included to detect cyclic patterns. The results were adjusted for sex, age, secular trend, distance from the moon, seasons, weekday, major holidays and temperature. RESULTS: During the full moon, 15% less homicides were committed than during the new moon (RR 0.85; 95% CI 0.77 to 0.94) and 86% less during the lightest quintile of illumination compared with the darkest quintile (RR 0.14; 95% CI 0.04 to 0.50). Adjustments did not change the results. Piecewise linear regressions showed a significant decline in homicides at the full moon and a rise thereafter. The full moon drop in homicides was directionally similar for seasons, weekdays, sex, age and time periods, and it was particularly pronounced in the early part of period studied (1961-1974). Periodic regression showed a regular cyclic pattern of length 29.53 days (p~0.035). CONCLUSIONS: Contrary to current scientific opinion, an association exists between moon phases and homicides, and contrary to what has been previously assumed, homicides declined during the full moon, especially in earlier decades. However, the causality of the association remains elusive.

Educational attainment modifies the association of wealth status with elevated blood pressure in the Ghanaian population.

The relationship between wealth and blood pressure (BP) in developing countries is unclear and it is important to understand how the socioeconomic environment influences BP in an African setting. Our objective was to determine the wealth differences in BP in the Ghanaian population and to clarify whether the relationship is modified by education level. Data from the 2014 Ghana Demographic and Health Survey was analyzed. A total of 9396 women and 4388 men were sampled nationwide and interviewed for the survey. Prevalence of hypertension in the population was low (10.4%). Systolic BP, diastolic BP, and odds of elevated BP increased with increasing wealth status. A linear trend was noted. Richest respondents recorded a 2.65 mmHg (95% CI: 1.09, 4.21) and 3.14 mmHg (95% CI: 1.97, 4.31) excess in systolic BP and diastolic BP, respectively and also, a 151% (AOR = 2.51, 95% CI: 1.80, 3.48) increased odds of elevated BP compared with the poorest. The wealth trend in BP was strongest among primary educated respondents (Interaction p = 0.0007). We found evidence of a consistent increase in elevated BP with increasing wealth status in this African population, a trend that is contrary to what is seen in high income countries.

Diabetes and impaired glucose metabolism is associated with more cold-related cardiorespiratory symptoms.

AIMS: Diabetes and impaired glucose metabolism cause metabolic, neural and circulatory disturbances that may predispose to adverse cooling and related symptoms during the cold season. This study assessed the prevalence of cold-related cardiorespiratory symptoms in the general population according to glycaemic status. METHODS: The study population consisted of 2436 men and 2708 women aged 45-74years who participated in the National FINRISK cold sub-studies in 2002 and 2007. A questionnaire assessed cold-related symptoms (respiratory, cardiac, peripheral circulation). Glycaemic status was determined based on fasting blood glucose, oral glucose tolerance tests or reported diagnosis of diabetes and categorized into normal glucose metabolism, impaired fasting blood glucose, impaired glucose tolerance, screening-detected type 2 diabetes and type 2 diabetes. RESULTS: Type 2 diabetes was associated with increased odds for cold-related dyspnoea [Adjusted OR 1.72 (95% CI, 1.28-2.30)], chest pain [2.10 (1.32-3.34)] and respiratory symptoms [1.85 (1.44-2.38)] compared with normal glucose metabolism. Screened type 2 diabetes showed increased OR for cold-related dyspnoea [1.36 (1.04-1.77)], cough [1.41 (1.06-1.87)] and cardiac symptoms [1.51 (1.04-2.20)]. Worsening of glycaemic status was associated with increased odds for cold-related dyspnoea (from 1.16 in impaired fasting glucose to 1.72 in type 2 diabetes, P=0.000), cough (1.02-1.27, P=0.032), chest pain (1.28-2.10, P=0.006), arrhythmias (0.87-1.74, P=0.020), cardiac (1.11-1.99, P=0.000), respiratory (1.14-1.84, P=0.000) and all symptoms (1.05-1.66, P=0.003). CONCLUSIONS: Subjects with diabetes and pre-diabetes experience more cold-related cardiorespiratory symptoms and need instructions for proper protection from cold weather to reduce adverse health effects.

Do biomass fuel use and consumption of unsafe water mediate educational inequalities in stillbirth risk? An analysis of the 2007 Ghana Maternal Health Survey.

BACKGROUND: Numerous studies have explored the association between educational inequalities and stillbirth but most have failed to elaborate how low educational attainment leads to an increased risk of stillbirth. We hypothesised that use of biomass fuels and consumption of unsafe water related to low educational attainment could explain the stillbirth burden in Ghana attributable to socioeconomic disadvantage. METHODS: Data from the 2007 Ghana Maternal Health Survey, a nationally representative population-based survey were analysed for this study. Of the10 370 women aged 15-49 years interviewed via structured questionnaires for the survey, 7183 primiparous and multiparous women qualified for inclusion in the present study. RESULTS: In a logistic regression analysis that adjusted for age, area of residence, marital status and ethnicity of women, lower maternal primary education was associated with a 62% (OR=1.62; 95% CI 1.04 to 2.52) increased lifetime risk of stillbirth. Biomass fuel use and consumption of unsafe water mediated 18% and 8% of the observed effects, respectively. Jointly these two exposures explained 24% of the observed effects. The generalised additive modelling revealed a very flat inverted spoon-shaped smoothed curve which peaked at low levels of schooling (2-3 years) and confirms the findings from the logistic regression analysis. CONCLUSIONS: Our results show that biomass fuel use and unsafe water consumption could be important pathways through which low maternal educational attainment leads to stillbirths in Ghana and similar developing countries. Addressing educational inequalities in developing countries is thus essential for ensuring household choices that curtail environmental exposures and help improve pregnancy outcomes.

The prevalence of heat-related cardiorespiratory symptoms: the vulnerable groups identified from the National FINRISK 2007 Study.

The prevalence of heat-related cardiorespiratory symptoms among vulnerable groups is not well known. We therefore estimated the prevalence of heat-related cardiorespiratory symptoms among the Finnish population and their associations with social and individual vulnerability factors. The data came from the National FINRISK 2007 Study, in which 4007 men and women aged 25-74 answered questions on heat-related cardiorespiratory symptoms in the Oulu Cold and Heat Questionnaire 2007. Logistic regression was used to calculate odds ratios (ORs), their 95 % confidence intervals (CIs), and model-predicted prevalence figures. The prevalence of heat-related cardiorespiratory symptoms was 12 %. It increased with age, from 3 % at the age of 25 years to 28 % at the age of 75 years. The symptoms were associated with pre-existing lung (OR 3.93; CI 3.01-5.13) and cardiovascular diseases (OR 2.27; 1.78-2.89); being a pensioner (OR 2.91; 1.65-5.28), unemployed (OR 2.82; 1.47-5.48), or working in agriculture (OR 2.27; 1.14-4.46) compared with working in industry; having only basic vs academic education (OR 1.98; 1.31-3.05); being female (OR 1.94; 1.51-2.50); being heavy vs light alcohol consumer (OR 1.89; 1.02-3.32); undertaking hard vs light physical work (OR 1.48;1.06-2.07); and being inactive vs active in leisure time (OR 1.97; 1.39-2.81). The adjusted prevalence of symptoms showed a wide range of variation, from 3 to 61 % depending on sex, age, professional field, education, and pre-existing lung and cardiovascular diseases. In conclusion, heat-related cardiorespiratory symptoms are commonly perceived among people with pre-existing lung or cardiovascular disease, agricultural workers, unemployed, pensioners, and people having only basic education. This information is needed for any planning and targeting measures to reduce the burden of summer heat.

Early Respiratory Infections and Dental Caries in the First 27 Years of Life: A Population-Based Cohort Study.

Early-life respiratory tract infections (RTIs) and dental caries are among the most common infectious diseases worldwide. The relations between early RTIs and development of caries in permanent teeth have not been studied earlier. We assessed childhood RTIs as potential predictors of caries in young adulthood in a 20-year prospective population-based cohort study (The Espoo Cohort Study). Information on lower respiratory tract infections (LRTIs) that had required hospitalization was retrieved from the National Hospital Discharge Registry (n = 1623). Additional information on LRTIs and upper RTIs (URTIs) was assessed based on the questionnaire reports that covered the preceding 12 months. Caries was measured as the number of teeth with fillings (i.e. filled teeth, FT) reported in the 20-year follow-up questionnaire. The absolute and relative excess numbers of FT were estimated applying negative binomial regression. The mean number of FT in young adulthood was 1.4 greater among subjects who had experienced LRTIs requiring hospitalization before the age of 2 years (SD 4.8) compared to those without any such infections (SD 3.4), and the adjusted relative excess number of FT was 1.5 (95% CI 1.0-2.2). LRTIs up to 7 years were associated with an absolute increase of 0.9 in the mean FT number, the adjusted relative excess being 1.3 (1.0-1.8). Also the questionnaire-based LRTIs (adjusted relative excess 1.3; 95% CI 0.9-1.8) and URTIs (adjusted relative excess 1.4, 1.0-1.8) before the age of 2 years predicted higher occurrence of FT. Findings suggest that early RTIs have a role in the development of dental caries in permanent teeth.

Prenatal exposures to perfluoroalkyl acids and serum lipids at ages 7 and 15 in females.

BACKGROUND: In some cross-sectional epidemiologic studies the shape of the association between serum concentrations of perfluoroalkyl acids (PFAAs) and lipids suggests departures from linearity. OBJECTIVES: We used statistical approaches allowing for non-linearity to determine associations of prenatal exposures of perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) with lipid concentrations. METHODS: PFAAs were measured in serum from pregnant women collected in 1991-1992 at enrollment in the Avon Longitudinal Study of Parents and Children and lipids in serum from their daughters at ages 7 (n=111) and 15 (n=88). The associations of PFAAs with lipids were first explored by cubic splines, followed by piecewise linear regressions by tertiles to obtain regression coefficients (ß) and their 95% confidence limits (95% CL) (in mg/dL per 1ng/mL). RESULTS: At age 7, total cholesterol was positively associated with prenatal PFOA concentrations in the lower tertile (ß=15.01; 95% CL=2.34, 27.69) but not with PFOA concentrations in the middle (ß=-3.63; 95% CL=-17.43, 10.16) and upper (ß=-1.58; 95% CL=-4.58, 1.42) tertiles. At age 15, a similar pattern was noted as well. Positive associations between LDL-C and prenatal PFOA concentration in the lower tertile were observed in daughters at ages 7 (ß=14.91; 95% CL=3.53, 28.12) and 15 (ß=13.93; 95% CL=0.60, 27.26). LDL-C was not associated with PFOA concentrations in the middle or upper tertile at any age. Neither HDL-C nor triglycerides was associated with prenatal PFOA exposure. Non-linear patterns of association of total cholesterol and LDL-C with prenatal PFOS were less consistently noted. CONCLUSION: Exposure to low levels of PFOA during prenatal development may alter lipid metabolism later in life. Given the small sample size further replication of the association in large independent cohorts is important.

Dog and cat exposure and respective pet allergy in early childhood.

BACKGROUND: The association of dog and cat exposure in early childhood with the incidence of respective allergies has remained controversial. The aim of the study was to obtain population-based evidence on the association of early exposure to dog or cat, or both, with dog and cat allergies. METHODS: The study population was identified from the nationwide population register comprising all children aged 1-4 yr (N = 4779) born between 2001 and 2005 and living in the province of South Karelia, Finland. Cross-sectional questionnaire data on pet exposure in infancy and physician-diagnosed pet allergies were obtained from 3024 participants and merged with longitudinally accumulated data on sIgE and skin prick tests indicating allergic sensitization abstracted from all patient records in the area. RESULTS: The adjusted relative incidence of positive test results (with 95% confidence intervals) was 2.69 (1.45-5.02) for dog and 5.03 (2.47-10.2) for cat allergens among children exposed to a respective pet alone compared with children without such exposure. The corresponding adjusted prevalence odds ratios for diagnosed dog and cat allergies were 1.75 (0.77-3.79) and 5.13 (2.30-11.4), respectively. The association between pet exposure and the incidence of positive test results was independent of parents' allergies. CONCLUSIONS: Early exposure to dog and cat at home is associated with a higher incidence of respective pet allergy during the first four years of life. Further evidence from population-based studies with longer follow-up is required to justify any recommendation concerning early pet contacts with a view to preventing pet allergies later in life.