Center for Environmental and Respiratory Health Research, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland; Respiratory Medicine Unit, Department of Medicine, Oulu University Hospital, FI-90029 Oulu, Finland; Medical Research Center Oulu, Oulu, Finland.
The occurrence of cold temperature-related symptoms has not been investigated previously in young adults, although cold weather may provoke severe symptoms leading to activity limitations, and those with pre-existing respiratory conditions may form a susceptible group. We tested the hypothesis that young adults with asthma and allergic rhinitis experience cold-related respiratory symptoms more commonly than young adults in general.
A population-based study of 1623 subjects 20-27 years old was conducted with a questionnaire inquiring about cold weather-related respiratory symptoms, doctor-diagnosed asthma and rhinitis, and lifestyle and environmental exposures.
Current asthma increased the risk of all cold weather-related symptoms (shortness of breath adjusted PR 4.53, 95% confidence interval 2.93-6.99, wheezing 10.70, 5.38-21.29, phlegm production 2.51, 1.37-4.62, cough 3.41, 1.97-5.87 and chest pain 2.53, 0.82-7.79). Allergic rhinitis had additional effect especially on shortness of breath (7.16, 5.30-9.67) and wheezing (13.05, 7.75-22.00), some on phlegm production (3.69, 2.49-5.47), but marginal effect on cough and chest pain.
Our study shows that already in young adulthood those with asthma, and especially those with coexisting allergic rhinitis, experience substantially more cold temperature-related respiratory symptoms than healthy young adults. Hence, young adults with a respiratory disease form a susceptible group that needs special care and guidance for coping with cold weather.
Sudden cardiac death (SCD) is the leading cause of death. The current paradigm in SCD requires the presence of an abnormal myocardial substrate and an internal or external transient factor that triggers cardiac arrest. Based on prior mechanistic evidence, we hypothesized that an unusually cold weather event (a cold spell) could act as an external factor triggering SCD. We tested potential effect modification of prior diagnoses and select pharmacological agents disrupting pathological pathways between cold exposure and death. The home coordinates of 2572 autopsy-verified cases of ischaemic SCD aged =35 in the Province of Oulu, Finland, were linked to 51 years of home-specific weather data. Based on conditional logistic regression, an increased risk of ischaemic SCD associated with a cold spell preceding death (OR 1.49; 95% CI: 1.06-2.09). Cases without a prior diagnosis of ischaemic heart disease seemed more susceptible to the effects of cold spells (OR 1.70; 95% CI: 1.13-2.56) than cases who had been diagnosed during lifetime (OR 1.14; 95% CI: 0.61-2.10). The use of aspirin, ß-blockers, and/or nitrates, independently and in combinations decreased the risk of ischaemic SCD during cold spells. The findings open up new lines of research in mitigating the adverse health effects of weather.
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Cites: Eur Heart J. 2001 Aug;22(16):1374-450 PMID 11482917
To test the a priori hypothesis that the association between cold spells and ischaemic sudden cardiac death (SCD) is modified by the severity of coronary stenosis.
The home coordinates of 2572 autopsy-verified cases of ischaemic SCD aged =35 in the Province of Oulu, Finland, were linked to 51 years of weather data. Cold spell was statistically defined for each home address as unusually cold weather pertinent to the location and time of year. We estimated the occurrence of cold spells during the hazard period (7 days preceding death) and reference periods (the same calendar days over 51 years) in a case-crossover setting applying conditional logistic regression, controlling for temporal trends and stratifying by severity of coronary stenosis.
The association between cold spells and ischaemic SCD was stronger among patients with 75%-95% stenosis (OR 2.03; 95%?CI 1.31 to 3.17), and weaker to non-existent among patients with
Cites: J Am Coll Cardiol. 2005 Oct 18;46(8):1425-33 PMID 16226165
Cites: Br Med J (Clin Res Ed). 1984 Nov 24;289(6456):1405-8 PMID 6437575
Cites: Am J Hypertens. 2014 May;27(5):656-64 PMID 23964061
We conducted a population-based study to assess whether work as a nurse during pregnancy increases the risk of low birth weight, preterm delivery, and small-for-gestational-age.
The study population was selected from The Finnish Prenatal Environment and Health Study of 2568 newborns (response 94%) and included 128 (5.0%) newborns of nurses and 559 newborns of office workers (21.8%) as a reference group.
The risk of low birth weight (adjusted odds ratio = 1.02; 95% confidence interval = 0.32-3.22) and preterm delivery (0.81; 0.32-2.05) did not differ between newborns of nurses and office workers, but the risk of small-for-gestational-age was substantially higher among newborns of nurses (1.99; 1.10-3.59). This corresponds to a population attributable fraction of 2.5%.
The results indicate that working as a nurse during pregnancy could reduce fetal growth.
This review synthesizes current knowledge of the effects of prenatal and postnatal exposure to environmental tobacco smoke on the respiratory health of children. A Medline database search was conducted for 1966 through October 2000. Limited evidence was found that exposure in pregnancy influences fetal growth, increases the risk of preterm delivery, and predicts the development of asthma and reduced lung function later in life. Both occupational and home environments contribute to the exposure of pregnant women and thus indirectly to adverse effects on children. There is strong and consistent evidence that exposure in childhood causes chronic respiratory symptoms (eg, cough, phlegm, and wheezing) and induces asthma. Limited evidence supports the role of childhood exposure in the poor overall control of established disease. Postnatal exposure is likely to have a small adverse impact on lung function growth. Prenatal and postnatal exposures have an important impact on children's respiratory health. These effects are preventable if pregnant women and children are protected from exposure to environmental tobacco smoke.
The authors assessed the effects of environmental tobacco smoke (ETS) on the development of asthma in adults.
In the Pirkanmaa district of South Finland, all 21- to 63-year-old adults with new cases of asthma diagnosed during a 2.5-year period (n = 521 case patients, out of 441 000 inhabitants) and a random sample of control subjects from the source population (932 control subjects) participated in a population-based incident case-control study.
Risk of asthma was related to workplace ETS exposure (adjusted odds ratio [OR] = 2.16; 95% confidence interval [CI] = 1.26, 3.72) and home exposure (OR = 4.77; 95% CI = 1.29, 17.7) in the past year. Cumulative ETS exposure over a lifetime at work and at home increased the risk.
This study indicates for the first time that both cumulative lifetime and recent ETS exposures increase the risk of adult-onset asthma.
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Organic solvents are among the most common exposures in the workplace. Our objective was to elaborate the relationship between prenatal occupational solvent exposure and fetal growth as well as duration of pregnancy, and to quantify the impact of occupational organic solvent exposure.
We conducted a population-based study of 1670 singleton newborns of women who participated in The Finnish Prenatal Environment and Health Study after their delivery (response rate 94%) and who were working during pregnancy (65%). Exposure information was based on questions about exposure to solvents at work before and during pregnancy. The health outcomes, based on information from a questionnaire and the Finnish Medical Birth Registry, were low birth weight (
Despite the recent developments in physically and chemically based analysis of atmospheric particles, no models exist for resolving the spatial variability of pollen concentration at urban scale.
We developed a land use regression (LUR) approach for predicting spatial fine-scale allergenic pollen concentrations in the Helsinki metropolitan area, Finland, and evaluated the performance of the models against available empirical data.
We used grass pollen data monitored at 16 sites in an urban area during the peak pollen season and geospatial environmental data. The main statistical method was generalized linear model (GLM).
GLM-based LURs explained 79% of the spatial variation in the grass pollen data based on all samples, and 47% of the variation when samples from two sites with very high concentrations were excluded. In model evaluation, prediction errors ranged from 6% to 26% of the observed range of grass pollen concentrations. Our findings support the use of geospatial data-based statistical models to predict the spatial variation of allergenic grass pollen concentrations at intra-urban scales. A remote sensing-based vegetation index was the strongest predictor of pollen concentrations for exposure assessments at local scales.
The LUR approach provides new opportunities to estimate the relations between environmental determinants and allergenic pollen concentration in human-modified environments at fine spatial scales. This approach could potentially be applied to estimate retrospectively pollen concentrations to be used for long-term exposure assessments.
Hjort J, Hugg TT, Antikainen H, Rusanen J, Sofiev M, Kukkonen J, Jaakkola MS, Jaakkola JJ. 2016. Fine-scale exposure to allergenic pollen in the urban environment: evaluation of land use regression approach. Environ Health Perspect 124:619-626; http://dx.doi.org/10.1289/ehp.1509761.
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(1) To develop a framework for understanding the holistic effects of climate change on the Saami people; (2) to summarize the scientific evidence about the primary, secondary, and tertiary effects of climate change on Saami culture and Sápmi region; and (3) to identify gaps in the knowledge of the effects of climate change on health and well-being of the Saami.
The Saami health is on average similar, or slightly better compared to the health of other populations in the same area. Warming climate has already influenced Saami reindeer culture. Mental health and suicide risk partly linked to changing physical and social environments are major concerns. The lifestyle, diet, and morbidity of the Saami are changing to resemble the majority populations posing threats for the health of the Saami and making them more vulnerable to the adverse effects of climate change. Climate change is a threat for the cultural way of life of Saami. Possibilities for Saami to adapt to climate change are limited.
We studied housing characteristics, parental factors, and respiratory health conditions in Russian children.
We studied a population of 5951 children from 9 Russian cities, whose parents answered a questionnaire on their children's respiratory health, home environment, and housing characteristics. The health outcomes were asthma conditions, current wheeze, dry cough, bronchitis, and respiratory allergy.
Respiratory allergy and dry cough increased in association with the home being adjacent to traffic. Consistent positive associations were observed between some health conditions and maternal smoking during pregnancy, many health conditions and lifetime exposure to environmental tobacco smoke (ETS), and nearly all health conditions and water damage and molds in the home.
Vicinity to traffic, dampness, mold, and ETS are important determinants of children's respiratory health in Russia.
The authors conducted a population-based incident case-control study to assess the relations between different types of interior surface materials and recent renovations at home and at work and the risk of asthma in adults. The authors systematically recruited all new cases of asthma during a 2.5-year study period (1997-2000) and randomly selected controls from a source population consisting of adults 21-63 years of age living in south Finland. The clinically diagnosed cases consisted of 521 adults with new asthma, and the controls consisted of 932 adults fulfilling eligibility criteria. In logistic regression analysis adjusting for confounding, the risk of asthma was related to the presence of plastic wall materials (adjusted odds ratio (OR) = 2.43, 95% confidence interval (CI): 1.03, 5.75) and wall-to-wall carpet at work (adjusted OR = 1.73, 95% CI: 0.74, 4.09), the latter in particular in the presence of mold problems (adjusted OR = 4.64, 95% CI: 1.11, 19.4). Use of floor-leveling plaster at home during the past 12 months was also a determinant of onset of asthma (adjusted OR = 1.81, 95% CI: 1.06, 3.08). These findings underline the need to consider the health aspects of materials used in floor, wall, and other indoor surfaces.
Office exposures have been linked to symptoms of sick building syndrome, but their relation to the development of asthma has not been studied previously. These exposures have increasing importance because an increasing proportion of the workforce is working in office environments.
The aim of this study was to assess the relations of exposure to carbonless copy paper (CCP), paper dust, and fumes from photocopiers and printers to adult-onset asthma.
We conducted a population-based incident case-control study of adults 21-63 years of age living in the Pirkanmaa District in South Finland. All new clinically diagnosed cases (n = 521) of asthma were recruited during a 3-year study period. A random sample of the source population formed the controls (n = 1,016). This part focused on 133 cases and 316 controls who were office workers according to their current occupation classified by the 1988 International Standard Classification of Occupations. All participants answered a questionnaire on health, smoking, occupation, and exposures at work and home. Subjects with previous asthma were excluded.
Exposures to paper dust [adjusted odds ratio (OR) = 1.97; 95% confidence interval (CI), 1.25-3.10] and CCP (OR = 1.66; 95% CI, 1.03-2.66) were related to significantly increased risk of adult-onset asthma. An exposure-response relation was observed between exposure to paper dust and risk of asthma.
This study provides new evidence that exposures to paper dust and CCP in office work are related to increased risk of adult-onset asthma. Reduction of these exposures could prevent asthma in office workers. Clinicians seeing asthma patients should be aware of this link to office exposures.
Cites: Am J Epidemiol. 1999 Dec 1;150(11):1223-810588083
To assess the relation between exposure to carbonless copy paper (CCP), paper dust, and fumes from photocopiers and printers (FPP), and the occurrence of sick building syndrome (SBS)-related symptoms, chronic respiratory symptoms and respiratory infections.
A population-based cross-sectional study with a random sample of 1016 adults, 21-63 years old, living in Pirkanmaa District in South Finland was conducted. This study focused on 342 office workers classified as professionals, clerks or administrative personnel according to their current occupation by the International Standard Classification of Occupations-88. They answered a questionnaire about personal information, health, smoking, occupation, and exposures in the work environment and at home.
In logistic regression analyses adjusting for age, sex and a set of other confounders, all three exposures were related to a significantly increased risk of general symptoms (headache and fatigue). Exposure to paper dust and to FPP was associated with upper respiratory and skin symptoms, breathlessness, tonsillitis and middle ear infections. Exposure to CCP increased the risk of eye symptoms, chronic bronchitis and breathlessness. It was also associated with increased occurrence of sinus and middle ear infections and diarrhoea. A dose-response relations was observed between the number of exposures and occurrence of headache. The risk of tonsillitis and sinus infections also increased with increasing number of exposures. All chronic respiratory symptoms, apart from cough, were increased in the highest exposure category (including all three exposures).
This study provides new evidence that exposure to paper dust and to FPP is related to the risk of SBS symptoms, breathlessness and upper respiratory infections. It strengthens the evidence that exposure to CCP increases the risk of eye symptoms, general symptoms, chronic respiratory symptoms and some respiratory infections. Reduction of these exposures could improve the health of office workers.
Cites: Am J Epidemiol. 1999 Dec 1;150(11):1223-810588083
Cites: Environ Res. 2000 Jun;83(2):162-7310856189
Cites: Appl Occup Environ Hyg. 2000 Aug;15(8):629-3410957818
There is little information on potential differences in smoking behaviour of parents between Finland and Russia and on the effects of environmental tobacco smoke (ETS) exposure on allergic and respiratory diseases among Finnish and Russian children. The aim of the study was to compare the smoking behaviour of parents and school children and to assess the relations of tobacco smoke exposure during pregnancy and childhood with occurrence of allergic diseases and respiratory infections among school children.
We conducted a population-based cross-sectional study in the neighbour towns across the border of Imatra in Finland and Svetogorsk in Russia. The study population consisted of 512 Finnish and 581 Russian school children aged 7-16 years (response rate 79%).
Children's tobacco smoke exposure differed markedly between Finland and Russia. The risk of asthma was particularly related to high maternal smoking exposure during pregnancy (adjusted OR 3.51, 95% CI 1.00-12.3), infancy (3.34, 1.23-9.07) and currently (3.27, 1.26-8.48), and the risk of common cold was related to high combined parental smoking during infancy (1.83, 1.06-3.17) in Finnish children. Among Russian children allergic conjunctivitis was related to maternal smoking during infancy (4.53, 1.49-13.8) and currently (2.82, 1.07-7.44).
Smoking behaviour of parents and ETS exposure during childhood differed markedly between Finland and Russia. Asthma was particularly increased in relation to high exposure to maternal smoking in Finland. The results suggest that more efforts should be directed to reducing tobacco smoke exposure of children in both Finland and Russia. (250 words).
We assessed whether paternal exposure prior to conception and maternal exposure during pregnancy to welding fumes (WF) and metal dusts or fumes (MD/F) independently and jointly increases the risk of preterm delivery, low birth weight, and small-for-gestational age.
The study population was selected from The Finnish Prenatal Environment and Health Study of 2,568 newborns (response rate 94%) and included 1,670 women who worked during pregnancy of which 68 were exposed either to WF and/or MD/F.
The risk of SGA was related to maternal exposure to WF only (adjusted OR = 1.78; 95% CI 0.53-5.99), MD/F only (adjusted OR = 1.77; 95% CI 0.38-8.35) and both exposures (2.92; 1.26-6.78). The corresponding effect estimates for preterm delivery were 2.66 (0.32-22.08), 5.64 (1.14-27.81) and for birth weight below 3,000 g 3.79 (1.09-13.19), 1.85 (0.56-6.14) and 1.70 (0.70-4.15), respectively. There was some suggestive, inconsistent evidence that the risk of preterm delivery and SGA is related to paternal exposure to WF.
The present results provide evidence that maternal exposure to WF or MD/F combination during pregnancy may reduce fetal growth and suggestive evidence that paternal exposure to WF may increase the risk of preterm delivery and small-for-gestational age. The small number of exposed women and the lack of data for exposure concentrations suggest the need for further study to verify our findings.
BACKGROUND: Studies of exposure to pets and the risk of asthma have provided conflicting results. OBJECTIVE: We conducted a population-based incident case-control study to assess the relationship of current and previous pet keeping with the risk of adult-onset asthma. We also investigated whether genetic propensity as a result of parental atopy modifies these relations. METHODS: From the source population of 441,000 inhabitants of a geographically defined area in South Finland, we systematically recruited, during a 2.5-year period, all new cases of asthma in 21- to 63-year-old adults and randomly selected control subjects. The clinically diagnosed case series consisted of 521 adults with newly diagnosed asthma and a control series of 932 control subjects. Information on current and past exposure to hairy pets was collected by using a self-administered questionnaire. RESULTS: In logistic regression analysis the risk of asthma was lower among subjects with pets during the past 12 months (adjusted odds ratio [OR], 0.74; 95% confidence interval [CI], 0.57-0.96) but higher among subjects with pets more than 12 months previously (adjusted OR, 1.39; 95% CI, 1.05-1.84). Parental atopy increased the risk of asthma (OR, 1.88; 95% CI, 1.47-2.41), but there was no interaction between parental atopy and pet exposure. CONCLUSIONS: The present results are consistent with the hypothesis that both keeping furry pets and parental atopy increase the risk of asthma development in adulthood. Parental atopy does not modify the effects of pet exposure. The negative association between current pets and the risk of asthma is consistent with selective avoidance of these pets by symptomatic individuals.
Only few studies have assessed the relative impact of prenatal and postnatal exposure to tobacco smoke on the child's later asthma or chronic respiratory symptoms and to our knowledge no studies have elaborated respiratory infections and allergies in this context.
To assess the effects of prenatal and postnatal exposure to tobacco smoke on respiratory health of Russian school children.
We studied a population of 5951 children (8 to 12 years old) from 9 Russian cities, whose parents answered a questionnaire on their children's respiratory health, home environment, and housing characteristics. The main health outcomes were asthma, allergies, chronic respiratory symptoms, chronic bronchitis, and upper respiratory infections. We used adjusted odds ratios (ORs) from logistic regression analyses as measures of effect.
Prenatal exposure due to maternal smoking had the strongest effects on asthma (adjusted OR 2.46, 95% CI 1.19-5.08), chronic bronchitis (adjusted OR 1.45, 95% CI 1.08-1.96) and respiratory symptoms, such as wheezing (adjusted OR 1.30, 95% CI 0.90-1.89). The associations were weaker for exposure during early-life (adjusted ORs 1.38/1.27/1.15 respectively) and after 2 years of age (adjusted ORs 1.45/1.34/1.18) compared to prenatal exposure and the weakest or non-existent for current exposure (adjusted ORs 1.05/1.09/1.06). Upper respiratory infections were associated more strongly with early-life exposure (adjusted OR 1.25, 95% CI 1.09-1.42) than with prenatal (adjusted OR 0.74, 95% CI 0.54-1.01) or current exposure (adjusted OR1.05, 95% CI 0.92-1.20). The risk of allergies was also related to early life exposure to tobacco smoke (adjusted OR 1.26, 95% CI 1.13-1.42).
Adverse effects of tobacco smoke on asthma, chronic bronchitis, and chronic respiratory symptoms are strongest when smoking takes place during pregnancy. The relations are weaker for exposure during early-life and after 2 years of age and weakest or non-existent for current exposure.
Cites: Environ Health Perspect. 2000 Jul;108(7):589-9410903609
Identification of the subpopulation especially susceptible to the adverse effects of second-hand smoke exposure (SHS) would be useful for preventive actions and interventions.
To investigate whether asthmatic heredity indicates susceptibility to the effects of SHS on the risk of adult-onset asthma.
A population-based incident case-control study of clinically defined adult-onset asthma and randomly drawn control subjects (adults 21-63 yr old) from a geographically defined area in South Finland. After excluding current and ex-smokers there were 226 cases and 450 disease-free control subjects.
Our outcome measure was new adult-onset asthma. Parental asthma and recent SHS had a synergistic effect on the risk of asthma, the adjusted odds ratio being 1.97 (95% confidence interval, 1.12-3.45) for SHS; 2.64 (1.65-4.24) for parental asthma; and 12.69 (3.44-46.91) for their joint effect (relative excess risk due interaction, 9.08 [-0.22 to 43.18]). Synergistic effect followed a dose-dependent pattern with both recent and cumulative SHS exposures, with relative excess risk due interaction for parental asthma and over 100 SHS cigarette-years of 6.17 (0.57-19.16).
This is the first study showing that individuals with asthmatic heredity have a considerably increased risk of adult-onset asthma when exposed to SHS. SHS exposure has dose-dependent synergism with family history of asthma, the joint effect being stronger with higher exposure levels. Avoiding SHS could be an important preventive measure for reducing the risk of adult-onset asthma among those with asthmatic heredity. Asking about family history of asthma is a useful tool for identifying these susceptible individuals in clinical and preventive settings.
Little is known about the levels of exposure to grass pollen in urban environments. We assessed the spatio-temporal variation of grass pollen concentrations and the role of urbanity as a determinant of grass pollen exposure in the Helsinki Metropolitan area. We monitored grass pollen concentrations in 2013 at 16 sites during the peak pollen season by using rotorod-type samplers at the breathing height. The sites were in the cities of Helsinki and Espoo, Finland, and formed city-specific lines that represented urban-rural gradient. The monitoring sites were both visually and based on land use data ranked as high to low (graded 1 to 8) pollen area. The lowest grass pollen concentrations were observed in the most urban sites compared to the least urban sites (mean 3.6 vs. 6.8 grains/m3 in Helsinki; P
To assess whether work as a nurse and a midwife during pregnancy increases the risk of adverse pregnancy outcomes.
We identified from the 1990-2006 Finnish Medical Birth Registry all singleton births to nurses (n=109,542), midwives (n=3,009), and teachers (n=23,454) (referents). The main outcomes were sexual differentiation, low and high birth weight, preterm and postterm delivery, small and large for gestational age, and perinatal death.
The prevalence of low birth weight (2.9% vs. 2.5%), preterm delivery (4.4% vs. 4.1%), postterm delivery (4.7% vs. 4.1%), small for gestational age (1.8% vs. 1.4%), perinatal death (0.45% vs. 0.41%) and stillbirth (0.30% vs. 0.25%) was higher among the newborns of nurses than those of teachers. The adjusted odds ratio (OR) from generalized estimating equations was 1.17 (95% confidence interval [CI] 1.07-1.26) for low birth weight, 1.09 (95% CI 1.02-1.16) for preterm delivery, 1.11 (95% CI 1.03-1.18) for postterm delivery, 1.17 (95% CI 1.05-1.30) for small for gestational age, 1.12 (95% CI 0.90-1.35) for perinatal death, and 1.27 (95% CI 0.98-1.56) for stillbirth. For midwives, the risk of small for gestational age (OR=1.25, 95% CI 0.95-1.55) was elevated, but the 95% CI included unity. There was no substantial difference in the sex distribution.
This study provides evidence that work as a nurse may reduce fetal growth and duration of pregnancy. The inference is based on the newborns of teachers as the reference group. However, the prevalence of most of the outcomes was higher among the newborns of all other working women combined than in the newborns of both nurses and teachers.