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1.
Artigo em Inglês | MEDLINE | ID: mdl-34831873

RESUMO

There is a growing awareness about the need to comprehensively integrate sex and gender into health research in order to enhance the validity and significance of research results. An in-depth consideration of differential exposures and vulnerability is lacking, especially within environmental risk assessment. Thus, the interdisciplinary team of the collaborative research project INGER (integrating gender into environmental health research) aimed to develop a multidimensional sex/gender concept as a theoretically grounded starting point for the operationalization of sex and gender in quantitative (environmental) health research. The iterative development process was based on gender theoretical and health science approaches and was inspired by previously published concepts or models of sex- and gender-related dimensions. The INGER sex/gender concept fulfills the four theoretically established prerequisites for comprehensively investigating sex and gender aspects in population health research: multidimensionality, variety, embodiment, and intersectionality. The theoretical foundation of INGER's multidimensional sex/gender concept will be laid out, as well as recent sex/gender conceptualization developments in health sciences. In conclusion, by building upon the latest state of research of several disciplines, the conceptual framework will significantly contribute to integrating gender theoretical concepts into (environmental) health research, improving the validity of research and, thus, supporting the promotion of health equity in the long term.

2.
Ann Am Thorac Soc ; 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34797737

RESUMO

RATIONALE: Exposure to air pollution is associated with adverse respiratory effects. Omega-3 polyunsaturated fatty acids (n-3 FA) appear to attenuate the health effects to air pollution. OBJECTIVE: This panel study evaluated whether n-3 FA intake and blood levels of omega-6 polyunsaturated fatty acids (n-6 FA) can modulate the associations between respiratory effects and short-term exposure to ambient air pollution in healthy adults. METHODS: Sixty-two healthy adults were enrolled into either high or low n-3 groups based on n-3 FA intake and erythrocytes n-3 FA concentrations. Low and high n-6 groups were dichotomized on blood n-6 FA levels. Participants underwent 3-5 testing sessions separated by at least seven days. At each session, FVC, FEV1, plasma markers of inflammation (IL-6) and oxidative stress (ox-LDL) were measured. Associations between ambient ozone and fine particulate matter (PM2.5) levels and lung function and blood markers were assessed using mixed-effects models stratified by fatty acids levels. RESULTS: Average concentrations of ozone (40.8±11.1 ppb) and PM2.5 (10.2±4.1 µg/m3) were below national ambient air quality standards during the study period. FVC was positively associated with ozone at lag0 in the high n-3 group while the association was null in the low n-3 group [for an IQR increase in ozone, 1.8%(95% CI:0.5-3.2) vs. 0.0%(95% CI:-1.4-1.5)]; however, the association shifted to negative at lag4 [-1.9%(95% CI:-3.2- -0.5) vs. 0.2%(95% CI:-1.2-1.5)] and lag5 [-1.2%(95% CI:-2.4-0.0) vs. 0.9%(-0.4-2.3)]. A similar pattern was observed in the low n-6 group compared to the high n-6 group [lag0:1.7%(95% CI:0.3-3.0) vs. 0.5%(95% CI:-0.9-2.0) and lag4:-1.4%(95% CI:-2.8-0.0) vs. -0.5%(95% CI:-1.8-0.9)]. The associations between FEV1 and ozone and between FVC and PM2.5 also followed a similar pattern. Elevated ozone levels were associated with an immediate decrease in ox-LDL in the high n-3 group atlag0 [-12.3%(95% CI:-24.8-0.1)] while no change in the low n-3 group [-7.5%(95% CI: -21.4-6.5)], and a delayed increase in IL-6 in the high n-3 group compared with the low n-3 group [lag4: 66.9%(95% CI:27.9-106.0) vs. 8.9%(95% CI:-31.8-49.6), lag5: 58.2%(95% CI:22.4-94.1) vs. -7.4%(95% CI:-48.8-34.0), and lag6: 45.8%(95% CI:8.7-82.9) vs. -8.5%(95% CI:-49.7-32.6)]. CONCLUSIONS: We observed lag-dependent associations between short-term ambient air pollutants and lung function that were differentially modulated by n-3 and n-6 FAs, suggesting that n-3 and n-6 FAs counteract the respiratory response to low levels of ambient air pollution in healthy adults. Clinical trial registered with ClinicalTrials.gov (NCT02921048).

3.
Lancet Planet Health ; 5(9): e579-e587, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34508679

RESUMO

BACKGROUND: Many regions of the world are now facing more frequent and unprecedentedly large wildfires. However, the association between wildfire-related PM2·5 and mortality has not been well characterised. We aimed to comprehensively assess the association between short-term exposure to wildfire-related PM2·5 and mortality across various regions of the world. METHODS: For this time series study, data on daily counts of deaths for all causes, cardiovascular causes, and respiratory causes were collected from 749 cities in 43 countries and regions during 2000-16. Daily concentrations of wildfire-related PM2·5 were estimated using the three-dimensional chemical transport model GEOS-Chem at a 0·25°â€ˆ× 0·25° resolution. The association between wildfire-related PM2·5 exposure and mortality was examined using a quasi-Poisson time series model in each city considering both the current-day and lag effects, and the effect estimates were then pooled using a random-effects meta-analysis. Based on these pooled effect estimates, the population attributable fraction and relative risk (RR) of annual mortality due to acute wildfire-related PM2·5 exposure was calculated. FINDINGS: 65·6 million all-cause deaths, 15·1 million cardiovascular deaths, and 6·8 million respiratory deaths were included in our analyses. The pooled RRs of mortality associated with each 10 µg/m3 increase in the 3-day moving average (lag 0-2 days) of wildfire-related PM2·5 exposure were 1·019 (95% CI 1·016-1·022) for all-cause mortality, 1·017 (1·012-1·021) for cardiovascular mortality, and 1·019 (1·013-1·025) for respiratory mortality. Overall, 0·62% (95% CI 0·48-0·75) of all-cause deaths, 0·55% (0·43-0·67) of cardiovascular deaths, and 0·64% (0·50-0·78) of respiratory deaths were annually attributable to the acute impacts of wildfire-related PM2·5 exposure during the study period. INTERPRETATION: Short-term exposure to wildfire-related PM2·5 was associated with increased risk of mortality. Urgent action is needed to reduce health risks from the increasing wildfires. FUNDING: Australian Research Council, Australian National Health & Medical Research Council.


Assuntos
Poluentes Atmosféricos , Incêndios Florestais , Poluentes Atmosféricos/análise , Austrália , Exposição Ambiental , Material Particulado/análise
4.
Artigo em Inglês | MEDLINE | ID: mdl-34574779

RESUMO

Previous studies have demonstrated cardiovascular health effects of environmental noise exposure, partly showing different effect estimates for males and females. This cannot be explained by biological differences between males and females alone. It is assumed that health outcomes and exposure patterns also depend on gender, determined by social, economic, and cultural factors in society. This systematic review evaluated the current state of how sex/gender is integrated in studies on environmental noise associated with hypertension, blood pressure, and ischemic heart diseases. A systematic literature search was conducted in three different databases, identifying thirty studies published between 1 January 2000 and 2 February 2020. Effects varied, with no consistent findings for both males and females. All studies used a binary operationalization of sex/gender, assuming static differences between males and females. The differentiation between biological and social dimensions of sex/gender was not present in any of the studies and the terms "sex" and "gender" were used interchangeably. However, biological and social dimensions of sex/gender were unconsciously taken up in the discussion of the results. Integrating sex/gender-theoretical concepts into future studies offers great potential to increase the validity of research findings, thus making them more useful for prevention efforts, health promotion, and health care.


Assuntos
Hipertensão , Isquemia Miocárdica , Pressão Sanguínea , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Masculino , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/etiologia , Ruído/efeitos adversos
5.
Lancet Planet Health ; 5(7): e415-e425, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34245712

RESUMO

BACKGROUND: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures. METHODS: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5°â€ˆ× 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature-mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature-mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division. FINDINGS: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967-5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58-11·07) of all deaths (8·52% [6·19-10·47] were cold-related and 0·91% [0·56-1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60-87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000-03 to 2016-19, the global cold-related excess death ratio changed by -0·51 percentage points (95% eCI -0·61 to -0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13-0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe. INTERPRETATION: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios. FUNDING: Australian Research Council and the Australian National Health and Medical Research Council.


Assuntos
Temperatura Baixa , Temperatura Alta , Austrália , Mudança Climática , Temperatura
6.
Environ Res ; 198: 111227, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33974842

RESUMO

Air temperature has been the most commonly used exposure metric in assessing relationships between thermal stress and mortality. Lack of the high-quality meteorological station data necessary to adequately characterize the thermal environment has been one of the main limitations for the use of more complex thermal indices. Global climate reanalyses may provide an ideal platform to overcome this limitation and define complex heat and cold stress conditions anywhere in the world. In this study, we explored the potential of the Universal Thermal Climate Index (UTCI) based on ERA5 - the latest global climate reanalysis from the European Centre for Medium-Range Weather Forecasts (ECMWF) - as a health-related tool. Employing a novel ERA5-based thermal comfort dataset ERA5-HEAT, we investigated the relationships between the UTCI and daily mortality data in 21 cities across 9 European countries. We used distributed lag nonlinear models to assess exposure-response relationships between mortality and thermal conditions in individual cities. We then employed meta-regression models to pool the results for each city into four groups according to climate zone. To evaluate the performance of ERA5-based UTCI, we compared its effects on mortality with those for the station-based UTCI data. In order to assess the additional effect of the UTCI, the performance of ERA5-and station-based air temperature (T) was evaluated. Whilst generally similar heat- and cold-effects were observed for the ERA5-and station-based data in most locations, the important role of wind in the UTCI appeared in the results. The largest difference between any two datasets was found in the Southern European group of cities, where the relative risk of mortality at the 1st percentile of daily mean temperature distribution (1.29 and 1.30 according to the ERA5 vs station data, respectively) considerably exceeded the one for the daily mean UTCI (1.19 vs 1.22). These differences were mainly due to the effect of wind in the cold tail of the UTCI distribution. The comparison of exposure-response relationships between ERA5-and station-based data shows that ERA5-based UTCI may be a useful tool for definition of life-threatening thermal conditions in locations where high-quality station data are not available.


Assuntos
Clima , Temperatura Alta , Cidades , Europa (Continente)/epidemiologia , Vento
7.
Int J Hyg Environ Health ; 235: 113752, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34020228

RESUMO

BACKGROUND: Concentrations of persistent organic pollutants (POPs) have been associated with an increased type 2 diabetes (T2D) risk. It remains unclear whether POPs are also associated with the risk of diabetes complications including neuropathy and evidence on this topic is scarce. We aimed to investigate the hypothesis that low-dose background concentrations of POPs were positively associated with distal sensorimotor polyneuropathy (DSPN). METHODS: This cross-sectional study was based on data from the second follow-up (FF4, 2013-2014, N = 2279) of the population-based KORA S4 study (Augsburg, Germany). The study sample consisted of 200 participants, including four groups of 50 persons each with known T2D, prediabetes, newly diagnosed diabetes, and normal glucose tolerance (NGT) based on an oral glucose tolerance test. We analyzed the association of six most abundant serum concentrations of POPs, including polychlorinated biphenyls (PCBs) as well as organochlorine (OC) pesticides, with DSPN by multivariable logistic regression adjusted for age, sex, glycaemic status, body mass index, physical activity, smoking and alcohol consumption. We assessed effect modification by age, sex, glycaemic status and obesity and conducted two-pollutant models to check the robustness of the estimates. RESULTS: For all pollutants, the main models indicated no significant association of having DSPN but pointed to rather decreased odds for DSPN. Two-pollutant models supported these findings, though only the association between the combination of PCB-138 and beta-hexachlorocyclohexane (ß-HCH) (OR: 0.59; 95% CI: 0.35-0.99) with DSPN became significant. No effect modification was found by age, sex, glycaemic status and obesity. CONCLUSION: Low-dose concentrations of POPs were not associated with increased odds of having DSPN in T2D, prediabetes and NGT.


Assuntos
Diabetes Mellitus Tipo 2 , Poluentes Ambientais , Hidrocarbonetos Clorados , Bifenilos Policlorados , Estado Pré-Diabético , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Poluentes Orgânicos Persistentes , Estado Pré-Diabético/epidemiologia
8.
Lancet Planet Health ; 5(4): e191-e199, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33838734

RESUMO

BACKGROUND: Epidemiological evidence on short-term association between ambient carbon monoxide (CO) and mortality is inconclusive and limited to single cities, regions, or countries. Generalisation of results from previous studies is hindered by potential publication bias and different modelling approaches. We therefore assessed the association between short-term exposure to ambient CO and daily mortality in a multicity, multicountry setting. METHODS: We collected daily data on air pollution, meteorology, and total mortality from 337 cities in 18 countries or regions, covering various periods from 1979 to 2016. All included cities had at least 2 years of both CO and mortality data. We estimated city-specific associations using confounder-adjusted generalised additive models with a quasi-Poisson distribution, and then pooled the estimates, accounting for their statistical uncertainty, using a random-effects multilevel meta-analytical model. We also assessed the overall shape of the exposure-response curve and evaluated the possibility of a threshold below which health is not affected. FINDINGS: Overall, a 1 mg/m3 increase in the average CO concentration of the previous day was associated with a 0·91% (95% CI 0·32-1·50) increase in daily total mortality. The pooled exposure-response curve showed a continuously elevated mortality risk with increasing CO concentrations, suggesting no threshold. The exposure-response curve was steeper at daily CO levels lower than 1 mg/m3, indicating greater risk of mortality per increment in CO exposure, and persisted at daily concentrations as low as 0·6 mg/m3 or less. The association remained similar after adjustment for ozone but was attenuated after adjustment for particulate matter or sulphur dioxide, or even reduced to null after adjustment for nitrogen dioxide. INTERPRETATION: This international study is by far the largest epidemiological investigation on short-term CO-related mortality. We found significant associations between ambient CO and daily mortality, even at levels well below current air quality guidelines. Further studies are warranted to disentangle its independent effect from other traffic-related pollutants. FUNDING: EU Horizon 2020, UK Medical Research Council, and Natural Environment Research Council.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Doenças Cardiovasculares , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Monóxido de Carbono , Cidades , Humanos
9.
Nutrients ; 13(4)2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33924572

RESUMO

Subclinical effects of coffee consumption (CC) with regard to metabolic, cardiac, and neurological complications were evaluated using a whole-body magnetic resonance imaging (MRI) protocol. A blended approach was used to estimate habitual CC in a population-based study cohort without a history of cardiovascular disease. Associations of CC with MRI markers of gray matter volume, white matter hyperintensities, cerebral microhemorrhages, total and visceral adipose tissue (VAT), hepatic proton density fat fraction, early/late diastolic filling rate, end-diastolic/-systolic and stroke volume, ejection fraction, peak ejection rate, and myocardial mass were evaluated by linear regression. In our analysis with 132 women and 168 men, CC was positively associated with MR-based cardiac function parameters including late diastolic filling rate, stroke volume (p < 0.01 each), and ejection fraction (p < 0.05) when adjusting for age, sex, smoking, hypertension, diabetes, Low-density lipoprotein (LDL), triglycerides, cholesterol, and alcohol consumption. CC was inversely associated with VAT independent of demographic variables and cardiovascular risk factors (p < 0.05), but this association did not remain significant after additional adjustment for alcohol consumption. CC was not significantly associated with potential neurodegeneration. We found a significant positive and independent association between CC and MRI-based systolic and diastolic cardiac function. CC was also inversely associated with VAT but not independent of alcohol consumption.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Doenças Cardiovasculares/epidemiologia , Ingestão de Líquidos/fisiologia , Doenças Neurodegenerativas/epidemiologia , Adiposidade/fisiologia , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Café , Feminino , Seguimentos , Alemanha/epidemiologia , Coração/diagnóstico por imagem , Coração/fisiologia , Fatores de Risco de Doenças Cardíacas , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/fisiologia , Fígado/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/fisiopatologia , Doenças Neurodegenerativas/prevenção & controle , Fatores de Proteção , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Imagem Corporal Total/métodos
10.
Suicide Life Threat Behav ; 51(2): 344-351, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33876499

RESUMO

OBJECTIVE: To develop and use planning maps to prioritize and facilitate county-level recruitment for Together With Veterans (TWV), community-based rural Veteran suicide prevention program. METHOD: Choropleth maps were created for 49 U.S. states, with four mutually exclusive categories indicating eligibility for the TWV program and increasing levels of need assigned to each county based on (a) percent Veterans Health Administration enrollees residing in rural communities, (b) percent population that are Veterans, and (c) crude suicide mortality rate. RESULTS: Of 3113 counties, 78.2% were eligible for TWV and 25.8% met our highest priority definition. A national map and state map were provided to demonstrate final products used to engage stakeholders. A table of recommendations for creating and using planning maps was provided for future projects to reference. CONCLUSIONS: Geographic information system (GIS) is useful for identifying and prioritizing counties that may benefit most from a rural Veteran suicide prevention program. Choropleth maps allow for dissemination of information about county suicide risk and need for suicide prevention to community members, researchers, and others with a vested interest in suicide reduction. The maps are one tool among many which can support decision-makers in focusing available resources on populations with the most need.


Assuntos
Suicídio , Veteranos , Humanos , Projetos de Pesquisa , População Rural , Suicídio/prevenção & controle , Estados Unidos/epidemiologia , United States Department of Veterans Affairs
11.
Arch Phys Med Rehabil ; 102(9): 1729-1734, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33811852

RESUMO

OBJECTIVE: To evaluate risk for suicide among veterans with a history of stroke, seeking care within the Veterans Health Administration (VHA), we analyzed existing clinical data. DESIGN: This retrospective cohort study was approved and performed in accordance with the local Institutional Review Board. Veterans were identified via the VHA's Corporate Data Warehouse. Initial eligibility criteria included confirmed veteran status and at least 90 days of VHA utilization between fiscal years 2001-2015. Cox proportional hazards models were used to assess the association between history of stroke and suicide. Among those veterans who died by suicide, the association between history of stroke and method of suicide was also investigated. SETTING: VHA. PARTICIPANTS: Veterans with at least 90 days of VHA utilization between fiscal years 2001-2015 (N=1,647,671). Data from these 1,647,671 veterans were analyzed (1,405,762 without stroke and 241,909 with stroke). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Suicide and method of suicide. RESULTS: The fully adjusted model, which controlled for age, sex, mental health diagnoses, mild traumatic brain injury, and modified Charlson/Deyo Index (stroke-related diagnoses excluded), demonstrated a hazard ratio of 1.13 (95% confidence interval, 1.02-1.25; P=.02). The majority of suicides in both cohorts was by firearm, and a significantly larger proportion of suicides occurred by firearm in the group with stroke than the cohort without (81.2% vs 76.6%). CONCLUSIONS: Findings suggest that veterans with a history of stroke are at increased risk for suicide, specifically by firearm, compared with veterans without a history of stroke. Increased efforts are needed to address the mental health needs and lethal means safety of veterans with a history of stroke, with the goal of improving function and decreasing negative psychiatric outcomes, such as suicide.


Assuntos
Reabilitação do Acidente Vascular Cerebral/psicologia , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Serviços de Saúde para Veteranos Militares , Veteranos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
12.
BMJ ; 372: n534, 2021 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-33762259

RESUMO

OBJECTIVE: To evaluate the short term associations between nitrogen dioxide (NO2) and total, cardiovascular, and respiratory mortality across multiple countries/regions worldwide, using a uniform analytical protocol. DESIGN: Two stage, time series approach, with overdispersed generalised linear models and multilevel meta-analysis. SETTING: 398 cities in 22 low to high income countries/regions. MAIN OUTCOME MEASURES: Daily deaths from total (62.8 million), cardiovascular (19.7 million), and respiratory (5.5 million) causes between 1973 and 2018. RESULTS: On average, a 10 µg/m3 increase in NO2 concentration on lag 1 day (previous day) was associated with 0.46% (95% confidence interval 0.36% to 0.57%), 0.37% (0.22% to 0.51%), and 0.47% (0.21% to 0.72%) increases in total, cardiovascular, and respiratory mortality, respectively. These associations remained robust after adjusting for co-pollutants (particulate matter with aerodynamic diameter ≤10 µm or ≤2.5 µm (PM10 and PM2.5, respectively), ozone, sulfur dioxide, and carbon monoxide). The pooled concentration-response curves for all three causes were almost linear without discernible thresholds. The proportion of deaths attributable to NO2 concentration above the counterfactual zero level was 1.23% (95% confidence interval 0.96% to 1.51%) across the 398 cities. CONCLUSIONS: This multilocation study provides key evidence on the independent and linear associations between short term exposure to NO2 and increased risk of total, cardiovascular, and respiratory mortality, suggesting that health benefits would be achieved by tightening the guidelines and regulatory limits of NO2.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/mortalidade , Saúde Global/estatística & dados numéricos , Dióxido de Nitrogênio/toxicidade , Doenças Respiratórias/mortalidade , Saúde da População Urbana/estatística & dados numéricos , Doenças Cardiovasculares/induzido quimicamente , Cidades , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Exposição Ambiental/efeitos adversos , Humanos , Modelos Lineares , Doenças Respiratórias/induzido quimicamente
13.
Arch Suicide Res ; : 1-13, 2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33689600

RESUMO

OBJECTIVE: The Suicide Cognitions Scale (SCS) may be beneficial for suicide risk assessment. However, research has identified diverging factor structures and focused primarily on samples composed of males. Given limited prior research with female veterans, who have experienced increased rates of suicide, we examined the factor structure of the SCS among a national sample of female veterans. METHOD: Four-hundred thirty-one female veterans using and not using Veterans Health Administration care participated in an anonymous survey. RESULTS: Exploratory factor analysis identified a three-factor solution, consistent with some prior research. This factor structure was not replicated in a confirmatory factor analysis. CONCLUSIONS: Findings did not identify a consistent factor structure for the SCS among a sample of female veterans. Research is warranted to determine if suicide-specific cognitions differ among female veterans and to identify SCS items that should be added or removed to produce a more consistent factor structure among female veterans.HighlightsA consistent factor structure of the SCS among female Veterans was not identifiedSuicide-specific cognitions may differ among female VeteransAddition or removal of SCS items may be warranted in this population.

14.
Psychol Trauma ; 13(7): 814-823, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33764096

RESUMO

Women veterans experience disproportionately high rates of military sexual trauma (MST). Nonetheless, many MST survivors delay or forgo health care, particularly within Veterans Health Administration (VHA) settings. Institutional betrayal (IB) has been posited as a potential explanation for this. OBJECTIVE: The current study examined if IB was associated with women veterans' willingness to seek VHA and non-VHA mental health and medical care, prior use of VHA care, past year use of VHA care, and use of VHA and non-VHA MST-related care. METHOD: Participants were 242 women veterans who screened positive for MST and completed self-report measures of IB and willingness to seek VHA and non-VHA mental health and medical care. Use of VHA care was assessed through VA Corporate Data Warehouse data. RESULTS: IB was associated with lower willingness to use VHA medical care and higher willingness to use non-VHA mental health care. Although IB was not significantly associated with prior use of VHA care, participants who reported more IB were more likely to have used VHA care in the past year and to have used both VHA and non-VHA MST-related care. CONCLUSION: These findings illuminate the relationship between the institutional response to MST with women's help-seeking willingness and use. Addressing IB may be important for increasing women MST survivors' willingness to use VHA medical care. Additionally, as IB was associated with greater willingness to use non-VHA mental health care, non-VHA institutions and providers should be prepared to serve women veterans who have experienced MST-related IB. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

15.
Sci Total Environ ; 772: 145383, 2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-33578152

RESUMO

The health effects of acute exposure to temperature extremes are established; those of long-term exposure only recently received attention. We performed a systematic review to assess the associations of long-term (>3 months) exposure to higher or lower temperature on total and cardiopulmonary mortality and morbidity, screening 3455 studies and selecting 34. The studies were classified in those observing associations within a population over years with changing annual temperature indices and those comparing areas with a different climate. We also assessed the risk of bias, adapting appropriately an instrument developed by the World Health Organization for air pollution. Studies reported that annual temperature indices for extremes and variability were associated with annual increases in mortality, indicating that effects of temperature extremes cannot be attributed only to short-term mortality displacement. Studies on cardiovascular mortality indicated stronger associations with cold rather than hot temperature, whilst those on respiratory outcomes reported effects of both heat and cold but were few and used diverse health outcomes. Interactions with air pollution were not generally assessed. The few studies investigating effect modification showed stronger effects among the elderly and those socially deprived. Comparisons of health outcome prevalence between areas reported lower blood pressure and a tendency for higher obesity in populations living in warmer climates. Our review indicated interesting associations between long-term exposure to unusual temperature levels in specific areas and differences in health outcomes and cardiovascular risk factors between geographical locations with different climate, but the number of studies by design and health outcome was small. Risk of bias was identified because of the use of crude exposure assessment and inadequate adjustment for confounding. More and better designed studies, including the investigation of effect modifiers, are needed.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Doenças Cardiovasculares , Idoso , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Doenças Cardiovasculares/epidemiologia , Exposição Ambiental/efeitos adversos , Fatores de Risco de Doenças Cardíacas , Humanos , Morbidade , Fatores de Risco , Temperatura
16.
Environ Pollut ; 275: 116663, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33581627

RESUMO

Exposure to fine particulate matter (PM2.5) has been associated with a higher risk for coronary events. Elevated circulating cardiac troponins (cTn) are suggestive of myocardial injury in both ischemic and non-ischemic conditions. However, little is known about the association between PM2.5 and cTn. In this study, we investigated short-term PM2.5 effects on cardiac troponin T (cTnT), as well as N-terminal-pro brain natriuretic peptide (NT-pro BNP) and inflammatory biomarkers among cardiac catheterized participants. We analyzed 7444 plasma cTnT measurements in 2732 participants who presented to Duke University Hospital with myocardial infarction symptoms between 2001 and 2012, partly along with measurements of NT-pro BNP and inflammatory biomarkers. Daily PM2.5 concentrations were predicted by a neural network-based hybrid model and were assigned to participants' residential addresses. We applied generalized estimating equations to assess associations of PM2.5 with biomarker levels and the risk of a positive cTnT test (cTnT > 0.1 ng/mL). The median plasma cTnT concentration at presentation was 0.05 ng/mL and the prevalence of a positive cTnT test was 35.4%. For an interquartile range (7.6 µg/m3) increase in PM2.5 on the previous day, cTnT concentrations increased by 7.7% (95% CI: 3.4-12.3) and the odds ratio of a positive cTnT test was 1.08 (1.01-1.16). Participants under 60 years (effect estimate: 15.2%; 95% CI: 7.4-23.5) or living in rural areas (12.3%; 95% CI: 4.8-20.3) were more susceptible. There was evidence for increases in fibrinogen and NT-pro BNP associated with elevated PM2.5 on the concurrent and previous two days. Our study suggests that acute PM2.5 exposure may elevate indicators of myocardial tissue damage. This finding substantiates the association of air pollution exposure with adverse cardiovascular events.


Assuntos
Infarto do Miocárdio , Material Particulado , Biomarcadores , Estudos de Coortes , Humanos , Miocárdio , Troponina T
17.
J Interpers Violence ; 36(23-24): 10861-10883, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33403916

RESUMO

Military sexual trauma (MST; i.e., sexual harassment and/or sexual assault during one's military service) is highly prevalent among female veterans and is associated with numerous adverse health and psychosocial sequelae. When institutions fail to prevent sexual trauma from happening or respond in an unsupportive manner (i.e., institutional betrayal [IB]), MST survivors typically report more severe health-related outcomes. Although the Institutional Betrayal Questionnaire.2 (IBQ.2) was developed to assess IB, no studies have examined the factor structure or dimensionality of the IBQ.2 among MST survivors. In addition, initial research has reported differing factor structures for this measure. The present study examined the dimensionality and factor structure of the IBQ.2, and tested for differential item functioning (DIF) based on whether military sexual assault was experienced. The sample comprised 235 female veterans who reported a history of MST in an anonymous national survey. Rasch analysis suggested multidimensionality and DIF based on history of military sexual assault. Exploratory factor analysis and parallel analysis suggested the IBQ.2 comprises three factors: (1) Environment Leading to MST, (2) Institutional Response to MST, and (3) Institutional Belongingness following MST. Although these results suggest that the IBQ.2 is multidimensional, the three-factor model had significant issues with respect to dimensionality, item fit, and person separation and reliability. Thus, using the full IBQ.2 may be more advantageous. Further examination of the IBQ.2 is warranted to ensure optimal assessment of IB in relation to MST, irrespective of whether the MST comprised sexual harassment or sexual assault, as well as to ensure that the IBQ.2 is culturally meaningful for MST survivors.


Assuntos
Militares , Delitos Sexuais , Transtornos de Estresse Pós-Traumáticos , Veteranos , Traição , Feminino , Humanos , Reprodutibilidade dos Testes , Trauma Sexual , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Inquéritos e Questionários
18.
Environ Int ; 147: 106364, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33421766

RESUMO

BACKGROUND: A growing number of epidemiological studies show associations between environmental factors and impaired cardiometabolic health. However, evidence is scarce concerning these risk factors and their impact on metabolic syndrome (MetS). This analysis aims to investigate associations between long-term exposure to air pollution, road traffic noise, residential greenness, and MetS. METHODS: We used data of the first (F4, 2006-2008) and second (FF4, 2013-2014) follow-up of the population-based KORA S4 survey in the region of Augsburg, Germany, to investigate associations between exposures and MetS prevalence at F4 (N = 2883) and MetS incidence at FF4 (N = 1192; average follow-up: 6.5 years). Residential long-term exposures to air pollution - including particulate matter (PM) with a diameter < 10 µm (PM10), PM < 2.5 µm (PM2.5), PM between 2.5 and 10 µm (PMcoarse), absorbance of PM2.5 (PM2.5abs), particle number concentration (PNC), nitrogen dioxide (NO2), ozone (O3) - and road traffic noise were modeled by land-use regression models and noise maps. For greenness, the Normalized Difference Vegetation Index (NDVI) was obtained. We estimated Odds Ratios (OR) for single and multi-exposure models using logistic regression and generalized estimating equations adjusted for confounders. Joint Odds Ratios were calculated based on the Cumulative Risk Index. Effect modifiers were examined with interaction terms. RESULTS: We found positive associations between prevalent MetS and interquartile range (IQR) increases in PM10 (OR: 1.15; 95% confidence interval [95% CI]: 1.02, 1.29), PM2.5 (OR: 1.14; 95% CI: 1.02, 1.28), PMcoarse (OR: 1.14; 95% CI: 1.02, 1.27), and PM2.5abs (OR: 1.17; 95% CI: 1.03, 1.32). Results further showed negative, but non-significant associations between exposure to greenness and prevalent and incident MetS. No effects were seen for exposure to road traffic noise. Joint Odds Ratios from multi-exposure models were higher than ORs from models with only one exposure.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Síndrome Metabólica , Ruído dos Transportes , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Exposição Ambiental , Alemanha/epidemiologia , Humanos , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etiologia , Dióxido de Nitrogênio/análise , Material Particulado/análise
19.
Med Care ; 59: S77-S83, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33438887

RESUMO

BACKGROUND: Female veterans experience interpersonal violence (ie, physical and sexual violence) more often than male veterans and nonveteran females. There is limited knowledge of types of interpersonal violence across the lifespan in relation to suicidal ideation and suicide attempt. Prior research has also focused on those accessing the Veterans Health Administration (VHA) care. OBJECTIVE: This study examined if physical and sexual violence at differing time points (ie, premilitary, during military service) were associated with suicidal ideation and a suicide attempt at subsequent time points. We anticipated that violence would be associated with an increased risk of suicidal ideation and attempt; however, given limited prior research, we were uncertain which types of violence and time points would be associated with risk. RESEARCH DESIGN: Data from a cross-sectional national survey. SUBJECTS: A total of 407 female veterans using, formerly using, or who never used VHA care. MEASURES: Suicidal ideation, suicide attempt, physical violence, and sexual violence were assessed. RESULTS: Premilitary sexual, but not physical, violence was associated with military suicidal ideation. Both premilitary and military sexual and physical violence were associated with postmilitary suicidal ideation. Premilitary and military sexual, but not physical, violence were associated with a postmilitary suicide attempt. These results were maintained after accounting for VHA use. A significant model for military suicide attempt was not generated. CONCLUSIONS: Assessment of premilitary and military sexual violence among female veterans is warranted within the context of suicide risk assessment and prevention. Preventing sexual violence among female veterans may be important for preventing suicidal ideation and attempt.


Assuntos
Abuso Físico/psicologia , Delitos Sexuais/psicologia , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Veteranos/psicologia , Mulheres/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Tempo
20.
Lancet Planet Health ; 5(1): e39-e49, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33421408

RESUMO

BACKGROUND: Impaired insulin sensitivity could be an intermediate step that links exposure to air pollution to the development of type 2 diabetes. However, longitudinal associations of air pollution with insulin sensitivity remain unclear. Our study investigated the associations of long-term air pollution exposure with the degree and rate of change of insulin sensitivity. METHODS: In this longitudinal study, we analysed data from the Cooperative Health Research in the Region of Augsburg (KORA) cohort from Augsburg, Germany, which recruited participants aged 25-74 years in the survey between 1999 and 2001 (KORA S4), with two follow-up examinations in 2006-08 (KORA F4) and 2013-14 (KORA FF4). Serum concentrations of fasting insulin and glucose, and homoeostasis model assessment of insulin resistance (HOMA-IR, a surrogate measure of insulin sensitivity) and ß-cell function (HOMA-B, a surrogate marker for fasting insulin secretion) were assessed at up to three visits between 1999 and 2014. Annual average air pollutant concentrations at the residence were estimated by land-use regression models. We examined the associations of air pollution with repeatedly assessed biomarker levels using mixed-effects models, and we assessed the associations with the annual rate of change in biomarkers using quantile regression models. FINDINGS: Among 9620 observations from 4261 participants in the KORA cohort, we included 6008 (62·5%) observations from 3297 (77·4%) participants in our analyses. Per IQR increment in annual average air pollutant concentrations, HOMA-IR significantly increased by 2·5% (95% CI 0·3 to 4·7) for coarse particulate matter, by 3·1% (0·9 to 5·3) for PM2·5, by 3·6% (1·0 to 6·3) for PM2·5absorbance, and by 3·2% (0·6 to 5·8) for nitrogen dioxide, and borderline significantly increased by 2·2% (-0·1 to 4·5) for ozone, whereas it did not significantly increase for the whole range of ultrafine particles. Similar positive associations in slightly smaller magnitude were observed for HOMA-B and fasting insulin levels. In addition, air pollutant concentrations were positively associated with the annual rate of change in HOMA-IR, HOMA-B, and fasting insulin. Neither the level nor the rate of change of fasting glucose were associated with air pollution exposure. INTERPRETATION: Our study indicates that long-term air pollution exposure could contribute to the development of insulin resistance, which is one of the key factors in the pathogenesis of type 2 diabetes. FUNDING: German Federal Ministry of Education and Research.


Assuntos
Poluição do Ar/efeitos adversos , Diabetes Mellitus Tipo 2/epidemiologia , Exposição Ambiental/efeitos adversos , Resistência à Insulina , Adulto , Idoso , Poluição do Ar/análise , Biomarcadores/sangue , Glicemia/análise , Estudos de Coortes , Exposição Ambiental/análise , Feminino , Alemanha/epidemiologia , Humanos , Insulina/sangue , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Dióxido de Nitrogênio/análise , Ozônio/análise , Material Particulado/efeitos adversos , Material Particulado/análise , Inquéritos e Questionários
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