Personlig eksponering og sundhed for trafikskabt luftforurening

Under Det Strategiske Forskningsprogram (SMP98) er der afsluttet et delprojekt, som fokuserer på udvikling af metoder til vurdering af individuel eksponering med luftforurening fra trafikken, og til at vurdere betydningen af denne forurening også set i forhold til betydningen af indendørs luftforurening. Endvidere belyses eksponering-respons sammenhænge. I projektet gennemføres eksperimentelle studier af den personlige eksponering vha. luftkvalitetsudstyr samt biomarkører. Et delformål med projektet har været at udvikle en personlig eksponeringsmodel for trafikskabt luftforurening vha. luftkvalitetsmodeller, registerdata og GIS samt registrering af færden vha. GPS. Denne korte artikel beskriver summarisk metode og resultater fra denne del af projektet

Systems analysis approach to the design of efficient water pricing policies under the EU Water Framework Directive

Economic theory suggests that water pricing can contribute to efficient management of water scarcity. The European Union (EU) Water Framework Directive (WFD) is a major legislative effort to introduce the use of economic instruments to encourage efficient water use and achieve environmental management objectives. However, the design and implementation of economic instruments for water management, including water pricing, has emerged as a challenging aspect of WFD implementation. This study demonstrates the use of a systems analysis approach to designing and comparing two economic approaches to efficient management of groundwater and surface water given EU WFD ecological flow requirements. Under the first approach, all wholesale water users in a river basin face the same volumetric price for water. This water price does not vary in space or in time, and surface water and groundwater are priced at the same rate. Under the second approach, surface water is priced using a volumetric price, while groundwater use is controlled through adjustments to the price of energy, which is assumed to control the cost of groundwater pumping. For both pricing policies, optimization is used to identify optimal prices, with the objective of maximizing welfare while reducing human water use in order to meet constraints associated with EU WFD ecological and groundwater sustainability objectives. The systems analysis approach demonstrates the successful integration of economic, hydrologic, and environmental components into an integrated framework for the design and testing of water pricing policies. In comparison to the first pricing policy, the second pricing policy, in which the energy price is used as a surrogate for a groundwater price, shifts a portion of costs imposed by higher water prices from low-value crops to high-value crops and from small urban/domestic locations to larger locations. Because growers of low-value crops will suffer the most from water price increases, the use of energy costs to control groundwater use offers the advantage of reducing this burden.The authors would like to thank the Danish Research School of Water Resources (FIVA) for financial support. Three anonymous reviewers made helpful suggestions that were incorporated into the revised version.Riegels, N.; Pulido-Velazquez, M.; Doulgeris, C.; Sturm, V.; Jensen, R.; Moller, F.; Bauer-Gottwein, P. (2013). Systems analysis approach to the design of efficient water pricing policies under the EU Water Framework Directive. Journal of Water Resources Planning and Management. 139(5):574-582. doi:10.1061/(ASCE)WR.1943-5452.0000284S574582139

Higher blood pressure in normal weight women with PCOS compared to controls

Objective: Obesity is considered to be the strongest predictive factor for cardio-metabolic risk in women with polycystic ovary syndrome (PCOS). The aim of the study was to compare blood pressure (BP) in normal weight women with PCOS and controls matched for age and BMI. Methods: From a Nordic cross-sectional base of 2615 individuals of Nordic ethnicity, we studied a sub cohort of 793 normal weight women with BMI = 140/90 mmHg was 11.1% (57/ 512) in women with PCOS vs 1.8% (5/281) in controls, P = 35 years the prevalence of BP >= 140/90 mmHg was comparable in women with PCOS and controls (12.7% vs 9.8%, P = 0.6). Using multiple regression analyses, the strongest association with BP was found for age, waist circumference, and total cholesterol in women with PCOS. Conclusions: Normal weight women with PCOS have higher BP than controls. BP and metabolic screening are relevant also in young normal weight women with PCOS.Peer reviewe

The quality of communication about older patients between hospital physicians and general practitioners: a panel study assessment

<p>Abstract</p> <p>Background</p> <p>Optimal care of patients is dependent on good professional interaction between general practitioners and general hospital physicians. In Norway this is mainly based upon referral and discharge letters. The main objectives of this study were to assess the quality of the written communication between physicians and to estimate the number of patients that could have been treated at primary care level instead of at a general hospital.</p> <p>Methods</p> <p>This study comprised referral and discharge letters for 100 patients above 75 years of age admitted to orthopaedic, pulmonary and cardiological departments at the city general hospital in Trondheim, Norway. The assessments were done using a Delphi technique with two expert panels, each with one general hospital specialist, one general practitioner and one public health nurse using a standardised evaluation protocol with a visual analogue scale (VAS). The panels assessed the quality of the description of the patient's actual medical condition, former medical history, signs, medication, Activity of Daily Living (ADL), social network, need of home care and the benefit of general hospital care.</p> <p>Results</p> <p>While information in the referral letters on actual medical situation, medical history, symptoms, signs and medications was assessed to be of high quality in 84%, 39%, 56%, 56% and 39%, respectively, the corresponding information assessed to be of high quality in discharge letters was for actual medical situation 96%, medical history 92%, symptoms 60%, signs 55% and medications 82%. Only half of the discharge letters had satisfactory information on ADL. Some two-thirds of the patients were assessed to have had large health benefits from the general hospital care in question. One of six patients could have been treated without a general hospital admission. The specialists assessed that 77% of the patients had had a large benefit from the general hospital care; however, the general practitioners assessment was only 59%. One of four of the discharge letters did not describe who was responsible for follow-up care.</p> <p>Conclusion</p> <p>In this study from one general hospital both referral and discharge letters were missing vital medical information, and referral letters to such an extent that it might represent a health hazard for older patients. There was also low consensus between health professionals at primary and secondary level of what was high benefit of care for older patients at a general hospital.</p

Thermoperiodic growth control by gibberellin does not involve changes in photosynthetic or respiratory capacities in pea

Active gibberellin (GA1) is an important mediator of thermoperiodic growth in pea. Plants grown under lower day than night temperature (negative DIF) elongate less and have reduced levels of GA1 compared with plants grown at higher day than night temperature (positive DIF). By comparing the wild type (WT) and the elongated DELLA mutant la crys, this study has examined the effect of impaired GA signalling on thermoperiodic growth, photosynthesis, and respiration in pea. In the WT a negative DIF treatment reduced stem mass ratio and increased both root mass ratio and leaf mass ratio (dry weight of specific tissue related to total plant dry weight). Leaf, root and stem mass ratios of la crys were not affected by DIF. Under negative DIF, specific leaf area (projected leaf area per unit leaf dry mass), biomass, and chlorophyll content of WT and la crys plants were reduced. Young, expanding leaves of plants grown under negative DIF had reduced leaf area-based photosynthetic capacity. However, the highest photosynthetic electron transport rate was found in fully expanded leaves of WT plants grown under negative DIF. Negative DIF increased night respiration and was similar for both genotypes. It is concluded that GA signalling is not a major determinant of leaf area-based photosynthesis or respiration and that reduced dry weight of plants grown under negative DIF is caused by a GA-mediated reduction of photosynthetic stem and leaf tissue, reduced photosynthesis of young, expanding leaves, and reduced growth caused by low temperature in the photoperiod

Sex differences in post-acute neurological sequelae of SARS-CoV-2 and symptom resolution in adults after COVID-19 hospitalization: an international multicenter prospective observational study

Although it is known that coronavirus disease 2019 can present with a range of neurological manifestations and in-hospital complications, sparse data exist on whether these initial neurological symptoms of coronavirus disease 2019 are closely associated with post-acute neurological sequelae of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; PANSC) and whether female versus male sex impacts symptom resolution. In this international, multi-centre, prospective, observational study across 407 sites from 15 countries (30 January 2020 to 30 April 2022), we report the prevalence and risk factors of PANSC among hospitalized adults and investigate the differences between males and females on neurological symptom resolution over time. PANSC symptoms included altered consciousness/confusion, fatigue/malaise, anosmia, dysgeusia and muscle ache/joint pain, on which information was collected at index hospitalization and during follow-up assessments. The analysis considered a time to the resolution of individual and all neurological symptoms. The resulting times were modelled by Weibull regression, assuming mixed-case interval censoring, with sex and age included as covariates. The model results were summarized as cumulative probability functions and age-adjusted and sex-adjusted median times to resolution. We included 6862 hospitalized adults with coronavirus disease 2019, who had follow-up assessments. The median age of the participants was 57 years (39.2% females). Males and females had similar baseline characteristics, except that more males (versus females) were admitted to the intensive care unit (30.5 versus 20.3%) and received mechanical ventilation (17.2 versus 11.8%). Approximately 70% of patients had multiple neurological symptoms at the first follow-up (median = 102 days). Fatigue (49.9%) and myalgia/arthralgia (45.2%) were the most prevalent symptoms of PANSC at the initial follow-up. The reported prevalence in females was generally higher (versus males) for all symptoms. At 12 months, anosmia and dysgeusia were resolved in most patients, although fatigue, altered consciousness and myalgia remained unresolved in >10% of the cohort. Females had a longer time to the resolution (5.2 versus 3.4 months) of neurological symptoms at follow-up for those with more than one neurological symptom. In the multivariable analysis, males were associated with a shorter time to the resolution of symptoms (hazard ratio = 1.53; 95% confidence interval = 1.39–1.69). Intensive care unit admission was associated with a longer time to the resolution of symptoms (hazard ratio = 0.68; 95% confidence interval = 0.60–0.77). Post-discharge stroke was uncommon (0.3% in females and 0.5% in males). Despite the methodological challenges involved in the collection of survey data, this international multi-centre prospective cohort study demonstrated that PANSC following index hospitalization was high. Symptom prevalence was higher and took longer to resolve in females than in males. This supported the fact that while males were sicker during acute illness, females were disproportionately affected by PANSC

Patellofemoral Pain Syndrome. Studies on a treatment modality, somatosensory function, pain and psychological parameters

Patellofemoral pain syndrome (PFPS) is characterized by long-term diffuse peripatellar and retropatellar localized pain in one or both knees, which worsens during walking uphill or downhill, squatting, kneeling, or prolonged sitting with flexed knees. There is no consensus in the medical literature concerning the definition, aetiology or diagnosis of PFPS. In this thesis PFPS is described as anterior knee pain excluding intra-articular pathology, peripatellar tendonitis and bursitis. Clinical tests used to diagnose PFPS lack acceptable reliability and validity, and radiographic findings in diagnosing PFPS are inconclusive. These limitations need to be addressed given that PFPS is a common musculoskeletal complaint, especially among adolescents and young active adults. The main purpose of the studies described in this thesis was to determine possible pain mechanisms in PFPS patients and to suggest a suitable treatment modality. The first study reported in the thesis was a randomized clinical trial involving the treatment of 36 PFPS patients with sensory stimulation by 8 acupuncture treatments. The control group consisting of 34 PFPS subjects did not receive any treatment. The two groups did not differ at baseline. The Cincinnati Rating System questionnaire was used as the main outcome measure. The results show that the Numbers Necessary to Treat (NNT) was 3.2 to achieve no pain or occasional pain to strenuous sports at the 12-month follow-up, and 3.7 to achieve no functional limitations or some limitations to heavy labour, in favour of the acupuncture group. Hence, sensory stimulation by acupuncture is recommended as a treatment modality to improve pain and function in PFPS patients. The second study assessed the mental status of 25 PFPS patients and related this to pain and function. The health status was significantly lower and mental distress was significantly higher in PFPS patients than in a comparable group comprising 23 healthy subjects. Further, the level of mental distress increased and the health status deteriorated with increased intensity of pain and impairment of knee function. We hypothesize that pain and reduced function produce mental distress in PFPS patients, and that this influences their experience of pain. The third study measured somatosensory functions related to the painful area using thermal and tactile quantitative sensory testing (QST) and bedside neurological tests in 25 PFPS patients. The results were compared to those obtained in 23 healthy controls. We found that QST can be used to detect sensory dysfunctions in patients with PFPS. Patients suffering from unilateral PFPS demonstrated dysfunction of sensory pathways related to the painful and contralateral areas, which might indicate a pathophysiological basis for pain in PFPS. The fourth study assessed if a subgroup of PFPS patients experienced neuropathic pain related to the painful knee by characterizing the somatosensory phenotype and analysing the sensory and clinical patterns related to the knees. A total of 91 subjects with unilateral PFPS and a comparable group of 23 healthy subjects were included in this study with a case– control design. The degree of knee function and intensity of knee pain were assessed. Somatosensory assessments were carried out by bedside neurological tests and by assessing thermal, tactile and vibration thresholds. There was considerable heterogeneity and overlap in the degree and type of aberrations of the nervous system. However, no subgroup of subjects with neuropathic pain or clustering of features related to neuropathic pain was identified. Conclusions from this thesis: Somatosensory stimulation by acupuncture is recommended as a treatment modality for PFPS. Quantitative sensory testing combined with clinical neurological tests can be used to detect altered somatosensory function in PFPS subjects. Sensory assessments of PFPS patients indicate that the pain can have a pathophysiological component. Somatosensory dysfunctions related to the painful and contralateral areas indicate modulations of central neural mechanisms. Ample signs of sensory aberrations related to the painful area were found but a clear subgroup of subjects with neuropathic pain could not be identified. Mental distress is higher and self-perceived health is lower in PFPS patients than in healthy controls. Further, the intensity of knee pain and degree of knee function are strongly correlated with the degree of mental distress