Association of environmental tobacco smoke at work and forced expiratory lung function among never smoking asthmatics and non-asthmatics

Inconsistencies across studies on the association of environmental tobacco smoke (ETS) and pulmonary function may be dlarified addressing potentially susceptible subgroups. We determined the association of ETS exposure at work with FVC, FEV1, and FEF 25-75% in life-time never smokers (N=3534) of the SAPALDIA random population sample (age 18-60). We considered sex, bronchial reactivity, and asthma status as a priori indicators to identify susceptible riskgroups. The multivariate regression models adjusted for height, age, education, dustlaerosol exposure, region, and ETS at home. Overall, ETS was not significantly associated with FVC (0.7%; −0.4 to +1.8), FEV1 (−0.1%; 95% Cl:−1.3 to +1.1) or FEF 25-75% (−1.9%;−4.2 to +0.5). Effects were observed among asthmatics (n=325), FEV1 (−4.8%; 0 to−9.2); FEF 25-75% (−12.4%; −3.7 to −20.4); FVC; (−1.7%; +2.1 to −5.5), particularly in asthmatic women (n=183): FVC −4.4% (−9.6 to +1.1); FEV1: −8.7% (−14.5 to −2.5); FEF 25-75%; −20.8% (−32 to −7.6), where duration of ETS exposure at work was associated with lung function (FEV 1-6% per hour of ETS exposure at work (p=0.01); FEF 25-75%: −3.4%/h (p<0.05). In non-asthmatic women (n=1963) and in men no significant effect was observed. The size of the observed effect among susceptible subgroups has to be considered clinically relevant. However, due to inherent limitations of this cross-sectional analysis, selection or information biases may not be fully controlled. For example, asthmatic women reported higher ETS exposure at work than asthmatic men. Given the public health importance to identify susceptible subgroups, these results ought to be replicate

Validity of Annoyance Scores for Estimation of Long Term Air Pollution Exposure in Epidemiologic Studies: The Swiss Study on Air Pollution and Lung Diseases in Adults (SAPALDIA)

In air pollution epidemiology, estimates of long term exposure are often based on measurements made at one fixed site monitor per area. This may lead to exposure misclassification. The present paper validates a questionnaire-based indicator of ambient air pollution levels and its applicability to assess their within-area variability. Within the framework of the SAPALDIA (Swiss Study on Air Pollution and Lung Diseases in Adults) cross-sectional study (1991), 9,651 participants reported their level of annoyance caused by air pollution on an 11-point scale. This subjective measure was compared with annual mean concentrations of particulate matter less than 10 μm in diameter (PM10) and nitrogen dioxide. The impact of individual factors on reported scores was evaluated. Nitrogen dioxide concentrations at home outdoors (measured in 1993), smoking, workplace dust exposure, and respiratory symptoms were found to be predictors of individual annoyance scores. Regression of population mean annoyance scores against annual mean PM10 and nitrogen dioxide concentrations (measured in 1993 and 1991, respectively) across areas showed a linear relation and strong correlations (r > 0.85). Analysis within areas yielded consistent results. The observed associations between subjective and objective air pollution exposure estimates suggest that population mean scores, but not individual scores, may serve as a simple tool for grading air quality within areas. Reported annoyance due to air pollution should be considered an indicator for a complex environmental condition and thus might be used for evaluating the implementation of environmental policie

Effects of passive smoking on heart rate variability, heart rate and blood pressure: an observational study

Background Exposure to environmental tobacco smoke (ETS) has been shown to increase the risk for cardiovascular diseases and death, and autonomic dysfunction (specifically, reduced heart rate variability (HRV)) is a predictor of increased cardiac risk. This study tests the hypothesis that ETS exposure reduces HRV in the general population and discusses possible pathways. Methods This cross-sectional study was conducted between 2001 and 2003 and is part of the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung Diseases in Adults) study. The analysis included 1218 randomly selected non-smokers aged 50 and above who participated in 24-h electrocardiogram recordings. Other examinations included an interview, investigating health status (especially respiratory and cardiovascular health and health relevant behaviours and exposure to ETS) and measurements of blood pressure, body height and weight. Results Subjects exposed to ETS at home or at work for more than 2 h/day had a difference of −15% in total power (95%CI: −26 to −3%), low frequency power (−28 to −1%), low/high frequency ratio (−26 to −3%) and −18% (−29 to −4%) in ultralow frequency power of HRV compared with subjects not exposed to ETS at home or work. We also found a 2.7% (−0.01 to 5.34%) higher heart rate during the recording in exposed subjects. Conclusions Exposure to ETS at home and work is associated with lower HRV and with higher heart rate in an ageing population. Our findings suggest that exposure to ETS increases cardiac risk through disturbances in the autonomic nervous syste

Living near Main Streets and Respiratory Symptoms in Adults: The Swiss Cohort Study on Air Pollution and Lung Diseases in Adults

The Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA), conducted in 1991 (SAPALDIA 1) in eight areas among 9,651 randomly selected adults aged 18-60 years, reported associations among the prevalence of respiratory symptoms, nitrogen dioxide, and particles with an aerodynamic diameter of less than 10 μg/m3. Later, 8,047 subjects reenrolled in 2002 (SAPALDIA 2). The effects of individually assigned traffic exposures on reported respiratory symptoms were estimated, while controlling for socioeconomic and exposure- and health-related factors. The risk of attacks of breathlessness increased for all subjects by 13% (95% confidence interval: 3, 24) per 500-m increment in the length of main street segments within 200 m of the home and decreased in never smokers by 12% (95% confidence interval: 0, 22) per 100-m increment in distance from home to a main street. Living within 20 m of a main street increased the risks of regular phlegm by 15% (95% confidence interval: 0, 31) and wheezing with breathing problems by 34% (95% confidence interval: 0, 79) in never smokers. In 2002, the effects related to road distance were different from those in 1991, which could be due to changes in the traffic pollution mixture. These findings among a general population provide strong confirmation that living near busy streets leads to adverse respiratory health effect

Prevalence of renal impairment and its association with cardiovascular risk factors in a general population: results of the Swiss SAPALDIA study

Background. Impaired renal function is evolving as an independent marker of the risk of cardiovascular morbidity and mortality. Little is known about the prevalence of impaired renal function and its relationship to cardiovascular risk factors in the Swiss general population. Methods. SAPALDIA comprises a random sample of the Swiss population established in 1991, originally to investigate the health effects of long-term exposure to air pollution. Participants were reassessed in 2002/3 and blood measurements were obtained (n = 6317). Renal function was estimated using the Cockcroft-Gault equation and the modified MDRD (four-component) equation incorporating age, race, gender and serum creatinine level. Results. The estimated prevalence of impaired renal function [estimated glomerular filtration rate <60 ml/min/1.73 m2] differed substantially between men and women, particularly at higher ages, and amounted to 13% [95% confidence interval (CI) 10-16%] and 36% (95% CI 32-40%) in men and women, respectively, of 65 years or older. Smoking, obesity, blood lipid levels, high systolic blood pressure and hyperuricaemia were all more common in men when compared with women. These cardiovascular risk factors were also associated independently with creatinine in both women and men. Women were less likely to receive cardiovascular drugs, in particular angiotensin-converting enzyme inhibitors and β-blockers, when compared with men of the same age. Conclusion. Moderate renal impairment seems to be prevalent in the general population, with an apparent excess in females which is not explained by conventional cardiovascular risk factors. The unexpected finding questions the validity of the prediction equations, in particular in female

Does eHealth Literacy Impact Patients' Opinion on the EHR?

An electronic health record (EHR) will be established nationwide in Switzerland in 2020. Patients can decide on their own whether they open an EHR. It is still unclear what might influence the patient decision. For this reason, we performed an online survey among the Swiss population to study whether there is a lack of knowledge on the EHR which impacts the willingness to open a personal health record and agree to health data sharing. A questionnaire with 13 question was distributed in a period of 4 weeks. More than 1200 participants replied to the survey. The results were analyzed with statistical methods. There are correlations between some of the questions in our survey. We conclude that the willingness to open a personal health record directly depends on the trust into the enabling technology

Follow-up of the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA 2) 1991-2003: methods and characterization of participants

Summary.: Objectives: The Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) was designed to investigate the health effects from long-term exposure to air pollution. Methods: The health assessment at recruitment (1991) and at the first reassessment (2001-3) consisted of an interview about respiratory health, occupational and other exposures, spirometry, a methacholine bronchial challenge test, end-expiratory carbon monoxide (CO) measurement and measurement for atopy. A bio bank for DNA and blood markers was established. Heart rate variability was measured using a 24-hour ECG (Holter) in a random sample of participants aged 50years and older. Concentrations of nitrogen dioxide (NO2), sulphur dioxide (SO2), ozone (O3) and particulates in ambient air have been monitored in all study areas since 1991. Residential histories collected over the 11year follow-up period coupled with GIS modelling will provide individual long-term air pollutant exposure estimates. Results: Of 9651 participants examined in 1991, 8715 could be traced for the cohort study and 283 died. Basic information about health status was obtained for 8047 individuals (86% of alive persons), 6528 individuals (70%) agreed to the health examination and 5973 subjects (62%) completed the entire protocol. Non-participants in the reassessment were on average younger than participants and more likely to have been smokers and to have reported respiratory symptoms in the first assessment. Average weight had increased by 5.5kg in 11years and 28% of smokers in 1991 had quit by the time of the reassessmen

SAPALDIA: Methods and participation in the cross-sectional part of the Swiss Study on Air Pollution and Lung Diseases in Adults

Summary: SAPALDIA-the Swiss Study on Air Pollution and Lung Diseases in Adults-focuses on the long term health effects of low to moderate levels of air pollutants as typically seen in different parts of Switzerland. The aim of the SAPALDIA cross-sectional study carried out in 1991 was to determine the prevalence of bronchial asthma, chronic bronchitis and allergic conditions in the adult population of Switzerland and to identify and to determine the respective importance of potentially influencing factors. These could be both personal (smoking habits, allergy status, family history, occupation) and environmental (outdoor and indoor pollution, aeroallergens, climate). A further aim of the cross-sectional study consisted in the identification of individuals susceptible to present symptoms during a two year observation period and to be included in the SAPALDIA follow-up study. This technical report represents the methodological documentation for the cross-sectional study of SAPALDIA. The instruments and the methods of standardisation are presented and discussed. The medical examination consisted of a computerised interview using a standardised questionnaire, the taking of a blood sample for serological tests, allergy skin testing, the measurement of endexpiratory CO and body height, and pulmonary function testing followed by methacholine challenge testing or bronchodilatation testing. The pattern of participation and the 9651 participants of the study, representing 59.3% of the sample, are described. Based on information on non-participants gained by telephone interviews and mailed short questionnaires, possible selection biases are quantified and discusse

CO2 surface fluxes at grid point scale estimated from a global 21 year reanalysis of atmospheric measurements

This paper documents a global Bayesian variational inversion of CO2 surface fluxes during the period 1988–2008. Weekly fluxes are estimated on a 3.75° × 2.5° (longitude-latitude) grid throughout the 21 years. The assimilated observations include 128 station records from three large data sets of surface CO2 mixing ratio measurements. A Monte Carlo approach rigorously quantifies the theoretical uncertainty of the inverted fluxes at various space and time scales, which is particularly important for proper interpretation of the inverted fluxes. Fluxes are evaluated indirectly against two independent CO2 vertical profile data sets constructed from aircraft measurements in the boundary layer and in the free troposphere. The skill of the inversion is evaluated by the improvement brought over a simple benchmark flux estimation based on the observed atmospheric growth rate. Our error analysis indicates that the carbon budget from the inversion should be more accurate than the a priori carbon budget by 20% to 60% for terrestrial fluxes aggregated at the scale of subcontinental regions in the Northern Hemisphere and over a year, but the inversion cannot clearly distinguish between the regional carbon budgets within a continent. On the basis of the independent observations, the inversion is seen to improve the fluxes compared to the benchmark: the atmospheric simulation of CO2 with the Bayesian inversion method is better by about 1 ppm than the benchmark in the free troposphere, despite possible systematic transport errors. The inversion achieves this improvement by changing the regional fluxes over land at the seasonal and at the interannual time scales.This work was performed using HPC resources from GENCI‐ (CCRT/CINES/IDRIS; grant 2009‐ t2009012201). It was cofunded by the European Commission under the EU Seventh Research Framework Programme (grant agreements 212196, COCOS, and 218793, MACC)

Greenland Temperature Response to Climate Forcing during the Last Deglaciation

Greenland ice core water isotopic composition (δ¹⁸O) provides detailed evidence for abrupt climate changes, but is by itself insufficient for quantitative reconstruction of past temperatures and their spatial patterns. We investigate Greenland temperature evolution during the last deglaciation using independent reconstructions from three ice cores and simulations with a coupled ocean-atmosphere climate model. Contrary to the traditional δ¹⁸O interpretation, the Younger Dryas period was 4.5±2°C warmer than the Oldest Dryas, due to increased CO₂ forcing and summer insolation. The magnitude of abrupt temperature changes is larger in central Greenland (9-14°C) than in the northwest (5-9°C), fingerprinting a North-Atlantic origin. Simulated changes in temperature seasonality closely track changes in the Atlantic overturning strength, and support the hypothesis that abrupt climate change is mostly a winter phenomenon