RESUMEN
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.
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Exposición a Riesgos Ambientales , Ruido del Transporte , Infecciones del Sistema Respiratorio , Humanos , Dinamarca/epidemiología , Femenino , Infecciones del Sistema Respiratorio/epidemiología , Persona de Mediana Edad , Adulto , Exposición a Riesgos Ambientales/estadística & datos numéricos , Ruido del Transporte/efectos adversos , Estudios de Cohortes , Enfermeras y Enfermeros , Incidencia , Modelos de Riesgos Proporcionales , Contaminación del Aire/estadística & datos numéricosRESUMEN
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.
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Contaminación del Aire , Demencia , Exposición a Riesgos Ambientales , Ruido del Transporte , Enfermeras y Enfermeros , Material Particulado , Humanos , Demencia/epidemiología , Femenino , Dinamarca/epidemiología , Contaminación del Aire/efectos adversos , Contaminación del Aire/estadística & datos numéricos , Incidencia , Enfermeras y Enfermeros/estadística & datos numéricos , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Persona de Mediana Edad , Estudios de Cohortes , Ruido del Transporte/efectos adversos , Material Particulado/efectos adversos , Anciano , Factores de Riesgo , AdultoRESUMEN
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.
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Contaminación del Aire , Exposición a Riesgos Ambientales , Infecciones del Sistema Respiratorio , Humanos , Dinamarca/epidemiología , Femenino , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Persona de Mediana Edad , Adulto , Infecciones del Sistema Respiratorio/epidemiología , Exposición a Riesgos Ambientales/efectos adversos , Factores de Riesgo , Material Particulado/efectos adversos , Material Particulado/análisis , Incidencia , Enfermeras y Enfermeros/estadística & datos numéricos , Contaminantes Atmosféricos/efectos adversos , Contaminantes Atmosféricos/análisis , Estudios de Cohortes , Anciano , Enfermedad Aguda , Comorbilidad , Dióxido de Nitrógeno/efectos adversos , Dióxido de Nitrógeno/análisis , Modelos de Riesgos ProporcionalesRESUMEN
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.
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Éxito Académico , Contaminantes Atmosféricos , Contaminación del Aire , Niño , Femenino , Humanos , Estudios de Cohortes , Contaminantes Atmosféricos/análisis , Exposición a Riesgos Ambientales/efectos adversos , Contaminación del Aire/efectos adversos , Material Particulado/análisis , Dinamarca , Dióxido de NitrógenoRESUMEN
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.
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Contaminantes Atmosféricos , Contaminación del Aire , Asma , Enfermedades Cardiovasculares , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Material Particulado/análisis , Enfermedades Cardiovasculares/epidemiología , Estudios Cruzados , Asma/epidemiología , Dinamarca/epidemiología , Hospitales , Contaminantes Atmosféricos/análisis , Tamaño de la PartículaRESUMEN
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.
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Contaminantes Atmosféricos , Contaminación del Aire , Nacimiento Prematuro , Aerosoles/análisis , África del Norte , Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , Región del Caribe , Polvo/análisis , Monitoreo del Ambiente , Femenino , Guadalupe , Humanos , Recién Nacido , Material Particulado/análisis , Embarazo , Estudios RetrospectivosRESUMEN
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.
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Índice Tobillo Braquial/instrumentación , Competencia Clínica , Educación de Postgrado en Medicina , Conocimientos, Actitudes y Práctica en Salud , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/diagnóstico , Estudiantes de Medicina , Anciano , Anciano de 80 o más Años , Automatización , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Enfermedad Arterial Periférica/fisiopatología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
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.