The recently established international cystatin C calibrator makes it possible to develop non-laboratory specific glomerular filtration rate (GFR) estimating (eGFR) equations. This study compares the performance of the arithmetic mean of the revised Lund-Malmö creatinine and CAPA cystatin C equations (MEANLM-REV+CAPA), the arithmetic mean of the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) creatinine and cystatin C equations (MEANCKD-EPI), and the composite CKD-EPI equation (CKD-EPICREA+CYSC) with the corresponding single marker equations using internationally standardized calibrators for both cystatin C and creatinine.
The study included 1200 examinations in 1112 adult Swedish patients referred for measurement of GFR (mGFR) 2008-2010 by plasma clearance of iohexol (median 51 mL/min/1.73 m2). Bias, precision (interquartile range, IQR) and accuracy (percentage of estimates ±30% of mGFR; P30) were compared.
Combined marker equations were unbiased and had higher precision and accuracy than single marker equations. Overall results of MEANLM-REV+CAPA/MEANCKD-EPI/CKD-EPICREA+CYSC were: median bias -2.2%/-0.5%/-1.6%, IQR 9.2/9.2/8.8 mL/min/1.73 m2, and P30 91.3%/91.0%/91.1%. The P30 figures were about 7-14 percentage points higher than the single marker equations. The combined equations also had a more stable performance across mGFR, age and BMI intervals, generally with P30 =90% and never
Background Guidelines recommend estimation of glomerular filtration rate (eGFR) prior to iodine contrast media (CM) examinations. It is also recommended that absolute eGFR in mL/min, not commonly used relative GFR (adjusted to body surface area; mL/min/1.73?m(2)), should be preferred when dosing and evaluating toxicity of renally excreted drugs. Purpose To validate the absolute Lund-Malmö equation (LM-ABS) in comparison with the absolute Cockcroft-Gault (CG) equation and the relative equations, revised Lund-Malmö (LM-REV), MDRD, and CKD-EPI, after converting relative estimates to absolute values, and to analyze change in eGFR classification when absolute instead of relative eGFR was used. Material and Methods A total of 3495 plasma clearance of iohexol to measure GFR (mGFR) served as reference test. Bias, precision, and accuracy (percentage of estimates ±30% of mGFR; P30) were compared overall and after stratification for various mGFR, eGFR, age, and BMI subgroups. Results The overall P30 results of CG/LM-ABS/LM-REV/MDRD/CKD-EPI were 62.8%/84.9%/83.7%/75.3%/75.6%, respectively. LM-ABS was the most stable equations across subgroups and the only equation that did not exhibit marked overestimation in underweight patients. For patients with relative eGFR 30-44 and 45-59?mL/min/1.73?m(2), 36% and 58% of men, respectively, and 24% and 32% of women, respectively, will have absolute eGFR values outside these relative eGFR intervals. Conclusion Choosing one equation to estimate GFR prior to contrast medium examinations, LM-ABS may be preferable. Unless absolute instead of relative eGFR are used, systematic inaccuracies in assessment of renal function may occur in daily routine and research on CM nephrotoxicity may be flawed.
Most epidemiologic studies use traffic at residential address as a surrogate for total traffic exposure when investigating effects of traffic on respiratory health. This study used GIS (Geographical Information Systems) to estimate traffic exposure, not only on residential, but also on workplace address, in addition to survey questions on time spent in traffic during commuting or other daily activities.The aim was to investigate 1) if there is an association between traffic exposure and prevalence of adult asthma and asthma symptoms, and 2) if so, does this association become stronger using more complete traffic exposure information.
This study was conducted in two stages: A first cross-sectional survey in Southern Sweden 2004 (n = 24819, 18-80 years, response rate 59%) was followed by a case-control study in 2005 to obtain more detailed exposure and confounder information (n = 2856, asthmatics and controls (1:3), 86% response rate). In the first survey, only residential address was known. In the second survey, questions about workplace addresses and daily time spent in traffic were also included. Residential and workplace addresses were geocoded and linked with GIS to road data and dispersion modelled outdoor concentrations of NOx (annual mean, 250 × 250 m resolution).
Living within 50 m of a road (measured by GIS) with traffic intensity of >10 cars/minute (compared with no road within this distance) was associated with an increased prevalence of asthma, (OR = 1.8, 95% CI = (1.1-2.8), and with asthma symptoms last 12 months. No statistically significant effects were seen for traffic exposure at workplace address, daily time spent in traffic, or commuting time to work, after adjustment for confounders. A combined total exposure estimate did not give a stronger association with asthma prevalence or asthma symptoms.
Traffic exposure at close proximity to residential address showed association with asthma prevalence and asthma symptoms last 12 months, among adults in southern Sweden. The associations were not stronger when accounting for total traffic exposure. This could reflect exposure misclassfication at workplace address and for other daily time in traffic, but also that residential address remains the main determinant for traffic exposure among adults.
Cites: BMC Pulm Med. 2009;9:4219703291
Cites: Environ Sci Technol. 2009 Jul 1;43(13):4659-6419673248
Cites: Environ Health Perspect. 2010 Jul;118(7):1021-620371422
Cites: Environ Health Perspect. 2002 May;110(5):543-712003761
Access to a quiet side in one's dwelling is thought to compensate for higher noise levels at the most exposed façade. It has also been indicated that noise from combined traffic sources causes more noise annoyance than equal average levels from either road traffic or railway noise separately.
2612 persons in Malmö, Sweden, answered to a residential environment survey including questions on outdoor environment, noise sensitivity, noise annoyance, sleep quality and concentration problems. Road traffic and railway noise was modeled using Geographic Information System.
Access to a quiet side, i.e., at least one window facing yard, water or green space, was associated with reduced risk of annoyance OR (95%CI) 0.47 (0.38-0.59), and concentration problems 0.76 (0.61-0.95). Bedroom window facing the same environment was associated to reduced risk of reporting of poor sleep quality 0.78 (0.64-1.00). Railway noise was associated with reduced risk of annoyance below 55 dB(A) but not at higher levels of exposure.
Having a window facing a yard, water or green space was associated to a substantially reduced risk of noise annoyance and concentration problems. If this window was the bedroom window, sleeping problems were less likely.
Most studies assessing health effects of neighborhood characteristics either use self-reports or objective assessments of the environment, the latter often based on Geographical Information Systems (GIS). While objective measures require detailed landscape data, self-assessments may yield confounded results. In this study we demonstrate how self-assessments of green neighborhood environments aggregated to narrow area units may serve as an appealing compromise between objective measures and individual self-assessments.
The study uses cross-sectional data (N = 24,847) from a public health survey conducted in the county of Scania, southern Sweden, in 2008 and validates the Scania Green Score (SGS), a new index comprising five self-reported green neighborhood qualities (Culture, Lush, Serene, Spacious and Wild). The same qualities were also assessed objectively using landscape data and GIS. A multilevel (ecometric) model was used to aggregate individual self-reports to assessments of perceived green environmental attributes for areas of 1,000 square meters. We assessed convergent and concurrent validity for self-assessments of the five items separately and for the sum score, individually and area-aggregated.
Correlations between the index scores based on self-assessments and the corresponding objective assessments were clearly present, indicating convergent validity, but the agreement was low. The correlation was even more evident for the area-aggregated SGS. All three scores (individual SGS, area-aggregated SGS and GIS index score) were associated with neighborhood satisfaction, indicating concurrent validity. However, while individual SGS was associated with vitality, this association was not present for aggregated SGS and the GIS-index score, suggesting confounding (single-source bias) when individual SGS was used.
Perceived and objectively assessed qualities of the green neighborhood environment correlate but do not agree. An index score based on self-reports but aggregated to narrow area units can be a valid approach to assess perceived green neighborhood qualities in settings where objective assessments are not possible or feasible.
Cites: Occup Environ Med. 1997 Jan;54(1):44-89072033
Cites: Environ Health. 2004 Mar 31;3(1):315056391
Cites: Am J Prev Med. 2005 Feb;28(2 Suppl 2):126-3315694520
Cites: Scand J Work Environ Health. 2005 Jun;31(3):184-9015999570
Cites: J Epidemiol Community Health. 2006 Jul;60(7):587-9216790830
Cites: BMC Public Health. 2006;6:14916759375
Cites: Int J Epidemiol. 2006 Oct;35(5):1361-317008359
Cites: Am J Epidemiol. 2007 Apr 15;165(8):858-6717329713
Cites: Health Place. 2007 Dec;13(4):839-5017392016
Cites: Int Arch Occup Environ Health. 2007 Nov;81(2):179-9117541626
Cites: J Epidemiol Community Health. 2007 Dec;61(12):1042-918000125
Cites: Am J Epidemiol. 2000 Jul 1;152(1):75-8310901332
Cites: J Epidemiol Community Health. 2003 Aug;57(8):550-212883048
Recent reviews conclude an association between traffic-related pollution and incidence of asthma in children, but not all studies agree. Studies have almost exclusively relied on parental-reported symptoms or parental-reported diagnoses of asthma and wheeze. Our aim was to investigate if traffic exposure is associated with higher incidence of early onset asthma, using registry-based outcome data.
We investigated a birth cohort in southern Sweden, consisting of N = 26,128 children with outcome and exposure data (born July 2005-2010). Of these children, N = 7898 had additional covariate information. The cohort was followed to the end of 2011.Traffic intensity, and dispersion-modeled concentrations of NOX (100×100 m grid), at residential addresses, were linked with registry data on dispensed asthma medication (the Swedish Prescribed Drug Register), and hospital and primary health care diagnoses of bronchiolitis, obstructive bronchitis and asthma (The Scania Health Care Register).Covariate information was obtained from questionnaires distributed to parents at Child Health Care-centre visits, eight months after birth. Cox proportional hazards regression was used for the statistical analyses.
Living in close proximity to a road with =8640 cars/day (compared to 0-8640 cars/day), was not associated with higher incidence of first purchase of inhaled ß2-agonist (adjusted hazard ratio (adj.HR) = 0.9, 95% CI: 0.8-1.0); third year purchase of inhaled ß2-agonist (adj.HR = 0.7, 95% CI: 0.6-0.9); bronchiolitis (adj.HR = 0.7, 95% CI: 0.6-0.9), obstructive bronchitis (adj.HR = 1.0, 95% CI: 0.9-1.2), or asthma (adj.HR = 0.7, 95% CI: 0.6- 0.9). Similar results were found for inhaled corticosteroids, and in relation to NOX.
Traffic-related exposure was not associated with higher incidence of asthma medication, or diagnoses of asthma, bronchiolitis, or obstructive bronchitis, in children 0-6 years in southern Sweden. This may depend on the low levels of traffic pollution in the area, mainly well below the WHO-guideline for NO2.
Teachers are at high risk of stress-related disorders. This study aimed to examine the occurrence of burnout in a sample of Swedish school-teachers, to test a combined measure of three burnout dimensions on the individual level, to characterize associations between burnout and factors encountered during work and leisure time, and to explore any differences between the genders.
A questionnaire of occupational, sociodemographic and life-style factors was answered by 490 teachers in school years 4-9. Outcome measures were (a) the single burnout dimensions of exhaustion, cynicism and professional efficacy (Maslach Burnout Inventory-General Survey), and (b) a combined measure based on high or low values in the three dimensions. The combined measure was used to stratify the study population into four levels (0-3) of burnout. Multivariable Poisson regression was applied on level 2?+?3 vs. level 0?+?1, for variables that we considered as relevant risk factors for burn out.
Half of the teachers reported low values in all three dimensions (level 0), whereas 15 were classified as having high burnout in at least two out of the three dimensions (level 2?+?3), and 4?% in all three dimensions (level 3). Almost all psychosocial factors were incrementally more unfavourably reported through the rising levels of burnout, and so were dissatisfaction with the computer workstation, pain, sleep problems and lack of personal recovery. There was no association between gender and rising levels of overall burnout (p?>?0.30). Low self-efficacy, poor leadership, high job demands and teaching in higher grades were the variables most clearly associated with burnout in multivariable Poisson regression.
Even if circa 50?% of the teachers appear do well with respect to burnout, the results points to the need of implementing multifaceted countermeasures that may serve to reduce burnout.
Cites: Scand J Work Environ Health. 1990;16 Suppl 1:55-82345867
Cites: Work. 2012;41 Suppl 1:3657-6222317279
Cites: Scand J Work Environ Health. 2005 Dec;31(6):438-4916425585
Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, and Occupational and Environmental Medicine, Skåne University Hospital, SE-221 85 Lund, Sweden. firstname.lastname@example.org
Int J Environ Res Public Health. 2011 Jun;8(6):2009-19
To assess whether cancer incidence, mainly from lymphohaematopoietic tumours and breast cancer, and mortality were increased in a cohort of Swedish sterilant workers exposed to low levels of ethylene oxide (EtO), updated with 16 more years of follow up.
The mortality and cancer incidence 1972-2006 experienced by a cohort of 2,171 male and female workers employed for at least one year in two plants producing medical equipment sterilised with EtO were investigated. Individual cumulative exposure to EtO was assessed by occupational hygienists. Cause-specific standardized rate ratios were calculated using the regional general population as a comparison for mortality (SMR) and cancer incidence (SIR). Internal Poisson-regression analyses were performed for selected causes.
The median cumulative exposure to EtO was 0.13 ppm-years. The overall cancer incidence was close to unity (SIR 0.94, 95% CI 0.82-1.08). Eighteen cases of lymphohaematopoietic cancer were observed (SIR 1.25, 95% CI 0.74-1.98). A healthy worker effect was indicated from a significantly decreased overall mortality and mortality from cardiovascular diseases. Internal analyses found significantly increased rate ratios for breast cancer for the two upper quartiles of cumulative exposure as compared to the lowest 50% of the cohort (IRR 2.76, 95% CI 1.20-6.33 and IRR 3.55, 95% CI 1.58-7.93).
The findings from this updated study indicate limited or low risks for human cancer due to occupational exposure from ethylene oxide at the low cumulative exposure levels in this cohort. However a positive exposure-response relation with breast cancer was observed though.
Cites: Rev Lat Am Enfermagem. 2006 Mar-Apr;14(2):214-916699695
Cites: Am J Ind Med. 2007 Mar;50(3):199-20717096363
Cites: Cancer Epidemiol Biomarkers Prev. 2007 Apr;16(4):796-80217416773
Cites: Am J Ind Med. 2007 Apr;50(4):293-30217354254
Cites: J Biomed Mater Res B Appl Biomater. 2007 Nov;83(2):527-3717471516
Cites: J Occup Environ Med. 2009 Jun;51(6):714-2319430313
To compare the recently developed CKD-EPI equation to estimate GFR in adult Swedish-Caucasians with the MDRD equation.
Swedish-Caucasians (N = 850, 376 females; median age 60, range 5-95 years) referred for plasma iohexol-clearance (median 55, range 5-223 mL/min/1.73 m²) constituted the Lund-Malmö Study cohort. Bias, precision (interquartile range, IQR, of the differences between estimated and measured GFR), accuracy expressed as percentage of estimates ±10% (P10) and ±30% (P30) of measured GFR, and classification ability for five GFR stages