Long-term exposure to air pollution and road traffic noise and incidence of dementia in the Danish Nurse Cohort.

INTRODUCTION: We examined the association of long-term exposure to air pollution and road traffic noise with dementia incidence in the Danish Nurse Cohort. METHODS: Female nurses were followed for dementia incidence (hospital contact or medication prescription) from 1993/1999 to 2020. Air pollution and road traffic noise levels were estimated at nurses' residences, and their associations with dementia were examined using Cox regression models. RESULTS: Of 25,233 nurses 1409 developed dementia. Particulate matter with a diameter of ≤2.5 µm (PM2.5) was associated with dementia incidence, after adjusting for lifestyle, socioeconomic status, and road traffic noise (hazard ratio [95% confidence interval] 1.35 [1.15-1.59] per interquartile range of 2.6 µg/m3). There was no association of PM2.5 with dementia in physically active nurses. Association with road traffic noise diminished after adjusting for PM2.5 (1.02 [0.93-1.11] per 7.6 dB). DISCUSSION: Long-term exposure to air pollution increases risk of dementia, and physical activity may moderate this risk. HIGHLIGHTS: Long-term exposure to air pollution was associated with increased risk of dementia among female nurses from the Danish Nurse Cohort. Association of air pollution with dementia was independent of road traffic noise. Association of road traffic noise with dementia diminished after adjusting for air pollution. Physical activity moderated adverse effects of air pollution on dementia.

Proficiency of Medical Students at Obtaining Pressure Measurement Readings Using Automated Ankle and Toe Measuring Devices for Diagnosis of Lower Extremity Peripheral Artery Disease.

BACKGROUND: Pressure measurement is a key component in the diagnosis of lower extremity peripheral artery disease (PAD) but is technically challenging and time-consuming for nonvascular specialists, thus hindering its wider implementation. The aim of this study was to assess the proficiency of students at obtaining satisfactory ankle or toe pressure readings for PAD diagnosis using 2 automated devices. METHODS: Medical students followed a training session after which they performed ankle and toe pressure measurements to calculate the ankle-brachial index (ABI) using the MESI ABPI MD® device, and the toe-brachial index (TBI) using the SYSTOE® device. Blinded vascular specialists took the same measurements. Use of the automated devices was considered satisfactory when a valid reading was measured in as few attempts as possible. A comparison was made of each student's proficiency at performing valid ankle and toe pressure measurements. The secondary objective was to compare the readings taken by the vascular specialists with those of the students. RESULTS: Forty-three medical students were included. Mean number of attempts was 1.23 ± 0.48 with the MESI ABPI MD device and 1.44 ± 0.55 with the SYSTOE device (P = 0.04). There was no statistically significant difference between ABI readings taken by the students and those taken by the vascular specialists, 1.17 (0.90; 1.39) vs. 1.18 (0.86; 1.39) (P = 0.33), contrary to TBI readings 0.70 (0.22; 1.74) vs. 0.72 (0.23; 1.16) (P = 0.03). Measurement duration for the students and vascular specialists was 3.75 min ± 1.12 min and 2.26 min ± 0.82 min (P < 0.01) with the MESI ABPI MD device and 4.30 min ± 1.23 min and 3.33 min ± 1.49 min (P = 0.03) with the SYSTOE device. Correlation coefficients between the students and the vascular specialists were 0.56 and 0.34 with the MESI ABPI MD and SYSTOE devices (P < 0.05). CONCLUSIONS: After a brief theoretical training session, the medical students were better at taking ankle pressure measurements than toe pressure measurements with an automated device for the purposes of PAD diagnosis. It would be of value to assess the advantages of these automated devices in primary care practice in future research.

Assessment of endothelial function and myocardial flow reserve using (15)O-water PET without attenuation correction.

PURPOSE: Myocardial blood flow (MBF) measurement using positron emission tomography (PET) from the washout rate of (15)O-water is theoretically independent of tissue attenuation. The aim of this study was to evaluate the impact of not using attenuation correction in the assessment of coronary endothelial function and myocardial flow reserve (MFR) using (15)O-water PET. METHODS: We retrospectively processed 70 consecutive (15)O-water PET examinations obtained at rest and during cold pressor testing (CPT) in patients with dilated cardiomyopathy (n = 58), or at rest and during adenosine infusion in heart transplant recipients (n = 12). Data were reconstructed with attenuation correction (AC) and without attenuation correction (NAC) using filtered backprojection, and MBF was quantified using a single compartmental model. The agreement between AC and NAC data was assessed using Lin's concordance correlation coefficient followed by Bland-Altman plot analysis. RESULTS: Regarding endothelial function, NAC PET showed poor reproducibility and poor agreement with AC PET data. Conversely, NAC PET demonstrated high reproducibility and a strong agreement with AC PET for the assessment of MFR. CONCLUSION: Non-attenuation-corrected (15)O-water PET provided an accurate measurement of MFR compared to attenuation-corrected PET. However, non-attenuation-corrected PET data were less effective for the assessment of endothelial function using CPT in this population.

Long-term exposure to green and blue space and incidence of cardiovascular disease: A Danish Nurse Cohort study.

BACKGROUND: Few cohort studies have examined the associations of natural surroundings (green and blue space) with cardiovascular disease (CVD) and show mixed findings. We aimed to investigate the associations between long-term exposure to green and blue space and incidence of CVD in the Danish Nurse Cohort. METHODS: We followed 19,070 female nurses living in Denmark from 1993/1999 to 2018. The shortest Euclidian distance from a residence to three types of green space (park, woodland, and heathland) and four types of blue space (lake, river, coast, and wetland), along with total count of all types of natural surroundings within a 500 meter (m), 1000 m, and 5000 m radius from a residence, were calculated using GeoDanmark data from 2005. Distance was log-transformed to correct for a right-skewed data distribution. Residential air pollution and road traffic noise data for 2005 were estimated by the Danish air pollution modeling system ('DEHM/UBM/AirGIS') and Nord2000 model, respectively. Cox proportional hazards models were used to estimate associations between green and blue space and the first-ever incidence of total CVD and certain CVD subtypes after adjusting for individual factors, air pollution, and noise. We examined effect modification by age, smoking status, occupational status, household income, and urbanicity level. Hazard ratio (HR) and 95% confidence interval (95% CI) were presented per e unit (equivalent to ∼2.72 fold) increase in distance. RESULTS: 8179 new cases of CVD were observed over 344,084 person-years. Living further from woodland was associated with higher stroke incidence (HR: 1.153; 95% CI: 1.029-1.293), while living further from heathland was associated with reduced total CVD incidence (HR: 0.975; 95% CI: 0.955-0.996). No associations were found between distance to park, woodland, lake, river, coast, or wetland and total CVD incidence. Total count of all types of green and blue spaces within a 5000 m radius was linked to a reduced risk of CVD incidence. Adjusting for air pollution or road traffic noise did not alter observed associations. Younger individuals (<50 years old) were observed to have lower HRs when living closer to all types of natural surroundings. CONCLUSION: We found that proximity to woodland was associated with a reduced risk of stroke, whilst no significant or even inverse associations were observed between proximity to other types of natural surroundings and CVD incidence. Total count of all types of natural surroundings within a 5000 m radius was negatively associated with CVD incidence, suggesting cumulative benefits of these areas.

Long-term exposure to road traffic noise and acute lower respiratory infections in the Danish Nurse Cohort.

BACKGROUND: Long-term exposure to road traffic noise is associated with cardiovascular disease, but the evidence on respiratory diseases is just emerging. We aimed to examine the association between long-term exposure to road traffic noise and the incidence of acute lower respiratory infections (ALRIs) in adults. METHODS: We followed 23,141 female nurses (age ≥ 44 years) from the Danish Nurse Cohort from baseline (1993 or 1999) to their first hospital contact (inpatient, outpatient, or emergency room) for ALRI, death, emigration or the end of 2015. The residential annual mean levels of road traffic noise (Lden) during the follow-up were estimated using the Nord2000 model. We applied time-varying Cox models to estimate the association of 3-year mean exposure to Lden with ALRIs incidence and piecewise analysis to estimate the threshold of Lden. We examined the robustness of the results by adjusting for residential exposure to air pollution, and the effect modification by attained age, socioeconomic status (SES), comorbidity, and lifestyle. RESULTS: During 18.5 years of follow-up, 2,004 nurses developed ALRIs. In a linear model, we detected a statistically significant positive association between Lden and ALRI, with a hazard ratio (HR) of 1.11 (95 % confidence interval (CI): 1.04, 1.17) per 9.2 dB (interquartile range, IQR). We observed non-linear association with a threshold at 57 dB, above which the HR was 1.25 (95 % CI: 1.09, 1.43) per IQR. Further adjustment for PM2.5 reduced the HRs slightly to 1.21 (95 % CI: 1.04, 1.40). The associations were stronger for nurses with asthma, and in those with lowest SES. CONCLUSION: We present novel findings in support of the association between long-term exposure to road traffic noise and ALRIs, independent of air pollution, suggesting noise as a risk factor for infectious respiratory diseases.

Long-Term Exposure to Air Pollution and Risk of Acute Lower Respiratory Infections in the Danish Nurse Cohort.

Rationale: Air pollution is a major risk factor for chronic cardiorespiratory diseases, affecting the immune and respiratory systems' functionality, but epidemiological evidence in respiratory infections remains sparse. Objectives: We aimed to assess the association of long-term exposure to ambient air pollution with the risk of developing new and recurrent acute lower respiratory infections (ALRIs), characterized by persistently severe symptoms necessitating hospital contact, and identify the potential susceptible populations by socioeconomic status, smoking, physical activity status, overweight, and comorbidity with chronic lung disease. Methods: We followed 23,912 female nurses from the Danish Nurse Cohort (age >44 yr) from baseline (1993 or 1999) until 2018 for incident and recurrent ALRIs defined by hospital contact (inpatient, outpatient, and emergency room) data from the National Patient Register. Residential annual mean concentrations of fine particulate matter, nitrogen dioxide (NO2), and black carbon were modeled using the Danish Eulerian Hemispheric Model/Urban Background Model/Air Geographic Information System. We used marginal Cox models with time-varying exposures to assess the association of 3-year running mean air pollution level with incident and recurrent ALRIs and examined effect modification by age, socioeconomic status, smoking, physical activity, body mass index, and comorbidity with asthma or chronic obstructive pulmonary disease (COPD). Results: During a 21.3-year mean follow-up, 4,746 ALRIs were observed, of which 2,553 were incident. We observed strong positive associations of all three pollutants with incident ALRIs, with hazard ratios and 95% confidence intervals of 1.19 (1.08-1.31) per 2.5 µg/m3 for fine particulate matter, 1.17 (1.11-1.24) per 8.0 µg/m3 for NO2, and 1.09 (1.05-1.12) per 0.3 µg/m3 for black carbon, and slightly stronger associations with recurrent ALRIs. Associations were strongest in patients with COPD and nurses with low physical activity. Conclusions: Long-term exposure to air pollution at low levels was associated with risks of new and recurrent ALRIs, with patients with COPD and physically inactive subjects most vulnerable.

Lifetime exposure to air pollution and academic achievement: A nationwide cohort study in Denmark.

Recent research suggests a link between air pollution and cognitive development in children, and studies on air pollution and academic achievement are emerging. We conducted a nationwide cohort study in Denmark to explore the associations between lifetime exposure to air pollution and academic performance in 9th grade. The study encompassed 785,312 children born in Denmark between 1989 and 2005, all of whom completed 9th-grade exit examinations. Using linear mixed models with a random intercept for each school, we assessed the relationship between 16 years of exposure to PM2.5, PM10, and gaseous pollutants and Grade Point Averages (GPA) in exit examinations, covering subjects such as Danish literature, Danish writing, English, mathematics, and natural sciences. The study revealed that a 5 µg/m3 increase in PM2.5 and PM10 was associated with a decrease of 0.99 (95 % Confidence Intervals: -1.05, -0.92) and 0.46 (-0.50, -0.41) in GPA, respectively. Notably, these negative associations were more pronounced in mathematics and natural sciences compared to language-related subjects. Additionally, girls and children with non-Danish mothers were found to be particularly susceptible to the adverse effects of air pollution exposure. These results underscore the potential long-term consequences of air pollution on academic achievement, emphasizing the significance of interventions that foster healthier environments for children's cognitive development.

Short-term exposure to ultrafine particles and mortality and hospital admissions due to respiratory and cardiovascular diseases in Copenhagen, Denmark.

Ultrafine particles (UFP; particulate matter <0.1 µm in diameter) may be more harmful to human health than larger particles, but epidemiological evidence on their health effects is still limited. In this study, we examined the association between short-term exposure to UFP and mortality and hospital admissions in Copenhagen, Denmark. Daily concentrations of UFP (measured as particle number concentration in a size range 11-700 nm) and meteorological variables were monitored at an urban background station in central Copenhagen during 2002-2018. Daily counts of deaths from all non-accidental causes, as well as deaths and hospital admissions from cardiovascular and respiratory diseases were obtained from Danish registers. Mortality and hospital admissions associated with an interquartile range (IQR) increase in UFP exposure on a concurrent day and up to six preceding days prior to the death or admission were examined in a case-crossover study design. Odds ratios (OR) with 95% confidence intervals (CI) per one IQR increase in UFP were estimated after adjusting for temperature and relative humidity. We observed 140,079 deaths in total, 236,003 respiratory and 342,074 cardiovascular hospital admissions between 2002 and 2018. Hospital admissions due to respiratory and cardiovascular diseases were significantly positively associated with one IQR increase in UFP (OR: 1.04 [95% CI: 1.01, 1.07], lag 0-4, and 1.02 [1.00, 1.04], lag 0-1, respectively). Among the specific causes, the strongest associations were found for chronic obstructive pulmonary disease (COPD) mortality and asthma hospital admissions and two-day means (lag 0-1) of UFP (OR: 1.13 [1.01, 1.26] and 1.08 [1.00, 1.16], respectively, per one IQR increase in UFP). Based on 17 years of UFP monitoring data, we present novel findings showing that short-term exposure to UFP can trigger respiratory and cardiovascular diseases mortality and morbidity in Copenhagen, Denmark. The strongest associations with UFP were observed with COPD mortality and asthma hospital admissions.

Retrospective assessment of pregnancy exposure to particulate matter from desert dust on a Caribbean island: could satellite-based aerosol optical thickness be used as an alternative to ground PM10 concentration?

Desert dust transported from the Saharan-Sahel region to the Caribbean Sea is responsible for peak exposures of particulate matter (PM). This study explored the potential added value of satellite aerosol optical thickness (AOT) measurements, compared to the PM concentration at ground level, to retrospectively assess exposure during pregnancy. MAIAC MODIS AOT retrievals in blue band (AOT470) were extracted for the French Guadeloupe archipelago. AOT470 values and PM10 concentrations were averaged over pregnancy for 906 women (2005-2008). Regression modeling was used to examine the AOT470-PM10 relationship during pregnancy and test the association between dust exposure estimates and preterm birth. Moderate agreement was shown between mean AOT470 retrievals and PM10 ground-based measurements during pregnancy (R2 = 0.289). The magnitude of the association between desert dust exposure and preterm birth tended to be lower using the satellite method compared to the monitor method. The latter remains an acceptable trade-off between epidemiological relevance and exposure misclassification, in areas with few monitoring stations and complex topographical/meteorological conditions, such as tropical islands.