Showing papers by "Klea Katsouyanni published in 1996"

Short term effects of air pollution on health: a European approach using epidemiologic time series data: the APHEA protocol.

Abstract: BACKGROUND AND OBJECTIVES: Results from several studies over the past five years have shown that the current levels of pollutants in Europe and North America have adverse short term effects on health. The APHEA project aims to quantifying these in Europe, using standardised methodology. The project protocol and analytical methodology are presented here. DESIGN: Daily time series data were gathered for several air pollutants (sulphur dioxide; particulate matter, measured as total particles or as the particle fraction with an aerodynamic diameter smaller than a certain cut off, or as black smoke; nitrogen dioxide; and ozone) and health outcomes (the total and cause specific number of deaths and emergency hospital admissions). The data included fulfilled the quality criteria set by the APHEA protocol. SETTING: Fifteen European cities from 10 different countries with a total population over 25 million. METHODOLOGY: The APHEA collaborative group decided on a specific methodological procedure to control for confounding effects and evaluate the hypothesis. At the same time there was sufficient flexibility to allow local characteristics to be taken into account. The procedure included modelling of all potential confounding factors (that is, seasonal and long term patterns, meteorological factors, day of the week, holidays, and other unusual events), choosing the "best" air pollution models, and applying diagnostic tools to check the adequacy of the models. The final analysis used autoregressive Poisson models allowing for overdispersion. Effects were reported as relative risks contrasting defined increases in the corresponding pollutant levels. Each participating group applied the analyses to their own data. CONCLUSIONS: This methodology enabled results from many different European settings to be considered collectively. It represented the best available compromise between feasibility, comparability, and local adaptibility when using aggregated time series data not originally collected for the purpose of epidemiological studies.

Daily mortality and "winter type" air pollution in Athens, Greece--a time series analysis within the APHEA project.

Abstract: STUDY OBJECTIVE: There is evidence that air pollution in Athens between 1975 and 1987 had adverse short term health effects. The short term effects of "winter type" air pollution on the daily total number of deaths are investigated for the period 1987-91 as part of the European Community multi centre APHEA project. DESIGN: A temporal study using aggregated data is presented. The associations of the daily time series of three pollutants, sulphur dioxide (SO2), black smoke (BS), and carbon monoxide (CO) and the daily total number of deaths in the Athens area were assessed. DATA AND METHODS: The average measurement from three stations was used for each pollutant. The daily number of deaths was recorded from the Athens Town Registry and the registries of the 18 municipalities contiguous to Athens. Data on the mean daily temperature (degree C) and relative humidity (%) were also used. Poisson autoregressive models that also allowed for overdispersion were used. Seasonality, other long term patterns, temperature, humidity, day of the week, and holidays were adjusted for. Several a priori defined pollutant transformations and lags were investigated. One day measurements as well as cumulative exposure effects were assessed. Effect modification by season as well as among pollutants was tested. MAIN RESULTS: Linear terms were used for all pollutants. The magnitude of the effect was greater at lags 0 for CO and 1 for BS and SO2 gradually declining after lag 1. For an increase of 100 micrograms/m3 in SO2 and BS there were corresponding increases (95% CI) of 12% (7%, 16%) and 5% (3%, 8%) in the daily total numbers of deaths, while for an increase of 10 micrograms/m3 in CO the increase (95% CI) in the daily total number of deaths was 10% (5%, 15%). A significant interaction of the effects of SO2 with season were found. The strongest effect was observed during the winter, when higher levels of SO2 were observed. A stronger effect of SO2 on the daily total number of deaths was observed when the levels of BS were > 100 micrograms/m3. CONCLUSIONS: These results strengthen the evidence of a causal association between ambient particle, SO2, or CO levels in the air and the daily total number of deaths and points to an important public health issue for the Athens population.

Reliability of information on cigarette smoking and beverage consumption provided by hospital controls.

Abstract: We compared data from interviews of patients admitted to hospital and interviews repeated at home for 400 hospital controls. Of these, 294 (73.5%) could be re-interviewed (responders). Never smoking was reported by 44% of subjects in the in-hospital interviews and by 40% in the repeat at-home interviews. Among those interviewed in hospital, 38% claimed to be nondrinkers, as did 38% of responders, but only 28% characterized themselves as nondrinkers in the repeat interview. For consumption of regular coffee, 15% reported none in the selected sample, 14% among responders, but only 6% in the repeat at-home interview. Agreement was good for decaffeinated coffee and tea consumption.

A case-control study of lactation and cancer of the breast.

Abstract: We have examined the relation of lactation, by total duration, with breast cancer risk among pre- and post-menopausal women. In a hospital-based case-control study conducted in Athens (1989-91), involving 820 patients with confirmed breast cancer and 795 orthopaedic patient controls and 753 hospital visitor controls, logistic regression was used to analyse the data controlling for demographic, nutritional and reproductive factors, including parity and age at any birth. Among post-menopausal women, there was no association between breastfeeding and breast cancer risk, but among premenopausal women those who has breastfed for > or = 24 months had an odds ratio of 0.50 (95% confidence interval 0.23-1.41). A reduction of the odds ration was also evident among premenopausal women who had breastfed between 12 and 23 months (odds ratio 0.70; 95% confidence interval 0.34-1.60). In conjunction with several other recent reports these results support the hypothesis that breastfeeding of prolonged duration may reduce the risk of breast cancer among premenopausal women but not among post-menopausal women. The biology underlying this different effect remains unknown, and the practical implication of the finding is a marginal importance.

Short term effects of air pollution on health

Abstract: The health effects following short-term exposure to particulate and gaseous air pollutants are presented based on results from major reviews and meta-analyses, including WHO reports, and results published mainly since the year 2013 from time series and panel studies. The largest amount of research has reported results on the adverse effects of particulate matter, although recently the interest of the research community is also focusing on some gaseous pollutants. Reviews and consensus guidelines suggest increases in all-age all-cause daily number of deaths associated with an increase of 10 μg/m 3 in short-term exposure to PM 2.5 ranging between 0.25% and 2.08% depending on the geographical region of the study. Similar increases are observed for exposure to PM 10 but smaller and more inconsistent effects are reported after exposure to the coarse particles fraction PM 10–2.5 . Recent studies report on the effects of PM 2.5 exposure on cardiovascular and respiratory hospital admissions, as well as other morbidity indicators (e.g., incidence of myocardial infarction or hypertension). Nitrogen dioxide (NO 2 ), ozone (O 3 ), and carbon monoxide (CO) have also been associated with adverse short-term effects including increases in daily mortality. NO 2 and O 3 are found to affect mainly respiratory outcomes while CO affects mainly the cardiac system. Recently, novel designs allow the reduction of exposure measurement error for a more accurate assessment of individual exposure and try to disentangle the effects following short-term exposures and those observed following long-term exposures. Further research leading to a better understanding of the various components of PM and the intercorrelations of the various pollutants is needed.

Endothelin 1-21 plasma concentrations in children and adolescents with insulin-dependent diabetes mellitus

Abstract: This study is based on the hypothesis that endothelins (ETs), which are 21-amino acid peptides with vasoactive and proliferative properties, could be implicated in the development of complications of insulin dependent diabetes mellitus (IDDM) in children and adolescents. We determined plasma ET 1-21 concentrations by radioimmunoassay in 59 patients with IDDM (32 male, 27 female) and in 41 healthy siblings (20 male, 21 female) and investigated the association of ET 1-21 concentrations with age, sex, control of diabetes (expressed as % of glycosylated hemoglobin), duration of disease and presence of complications. Plasma ET 1-21 concentrations (mean +/- SEM) were 14.12 +/- 0.30 pg/ml in IDDM and 15.34 +/- 0.47 pg/ml in healthy siblings. The difference was statistically significant (p = 0.01) after controlling for age and sex by multiple logistic regression. In the group with IDDM, analysis of covariance showed duration of disease to be the only variable associated with ET 1-21 values (b = 0.2179 pg/ml/yr, p = 0.04). It is concluded that in youngsters with IDDM ET plasma concentrations are lower than in healthy controls, negatively associated with duration of the disease and not directly implicated in diabetic angiopathy.

Epithelial, possibly precancerous, lesions of the lung in relation to smoking, passive smoking, and socio-demographic variables

Abstract: We have undertaken an autopsy-based study to evaluate the etiologic importance of active and passive smoking, as well as socio-demographic variables, in the development of pathologic precursors of