Showing papers by "Stockholm County Council published in 2001"

Using geographic information systems to assess individual historical exposure to air pollution from traffic and house heating in Stockholm.

Abstract: A specific aim of a population-based case-control study of lung cancer in Stockholm, Sweden, was to use emission data, dispersion models, and geographic information systems (GIS) to assess historical exposure to several components of ambient air pollution. Data collected for 1,042 lung cancer cases and 2,364 population controls included information on residence from 1955 to the end of follow-up for each individual, 1990-1995. We assessed ambient air concentrations of pollutants from road traffic and heating throughout the study area for three points in time (1960, 1970, and 1980) using reconstructed emission data for the index pollutants nitrogen oxides (NO(x)/NO(2)) and sulfur dioxide together with dispersion modeling. NO(2) estimates for 1980 compared well with actual measurements, but no independently measured (study-external) data were available for SO(2), precluding similar validation. Subsequently, we used linear intra- and extrapolation to obtain estimates for all other years 1955-1990. Eleven thousand individual addresses were transformed into geographic coordinates through automatic and manual procedures, with an estimated error of < 100 m for 90% of the addresses. Finally, we linked annual air pollution estimates to annual residence coordinates, yielding long-term residential exposure indices for each individual. There was a wide range of individual long-term average exposure, with an 11-fold interindividual difference in NO(2) and an 18-fold difference in SO(2). The 30-year average for all study subjects was 20 microg/m(3) NO(2) from traffic and 53 microg/m(3) SO(2) from heating. The results indicate that GIS can be useful for exposure assessment in environmental epidemiology studies, provided that detailed geographically related exposure data are available for relevant time periods.

Breastfeeding in countries of the European Union and EFTA: current and proposed recommendations, rationale, prevalence, duration and trends.

Abstract: Recommendations suggest exclusive breast feeding for at least the first 4 to 6 months after birth. Paradoxically, an overwhelming proportion of breast feeding (BF) data in Europe refers to all BF, ...

Increased prevalence of hypertension in a population exposed to aircraft noise.

Abstract: Objectives—To investigate whether there is a relation between residential exposure to aircraft noise and hypertension. Methods—The study population comprised two random samples of subjects aged 19‐80 years, one including 266 residents in the vicinity of Stockholm Arlanda airport, and another comprising 2693 inhabitants in other parts of Stockholm county. The subjects were classified according to the time weighted equal energy and maximum aircraft noise levels at their residence. A questionnaire provided information on individual characteristics including history of hypertension. Results—The prevalence odds ratio for hypertension adjusted for age, sex, smoking, and education was 1.6 (95% confidence interval (95% CI) 1.0 to 2.5) among those with energy averaged aircraft noise levels exceeding 55 dBA, and 1.8 (95% CI 1.1 to 2.8) among those with maximum aircraft noise levels exceeding 72 dBA. An exposure-response relation was suggested for both exposure measures. The exposure to aircraft noise seemed particularly important for older subjects and for those not reporting impaired hearing ability. Conclusions—Community exposure to aircraft noise may be associated with hypertension. (Occup Environ Med 2001;58:769‐773)

Antiepileptic drug therapy and its management in sudden unexpected death in epilepsy : A case-control study

Abstract: Summary: Purpose: Because frequent seizures constitute a major risk factor for sudden unexpected death in epilepsy (SUDEP), the treatment with antiepileptic drugs (AEDs) may play a role for the occurrence of SUDEP. We used data from routine therapeutic drug monitoring (TDM) to study the association between various aspects of AED treatment and the risk of SUDEP. Methods: A nested case–control study was based on a cohort consisting of 6,880 patients registered in the Stockholm County In Ward Care Register with a diagnosis of epilepsy. Fifty-seven SUDEP cases, and 171 controls, living epilepsy patients, were selected from the cohort. Clinical data including data on TDM were collected through medical record review. Results: The relative risk (RR) of SUDEP was 3.7 (95% CI, 1.0–13.1) for outpatients who had no TDM compared with those who had one to three TDMs during the 2 years of observation. RR was 9.5 (1.4–66.0) if carbamazepine (CBZ) plasma levels at the last TDM were above and not within the common target range (20–40 μM). High CBZ levels were associated with a higher risk in patients receiving polytherapy and in those with frequent dose changes. Although the subgroup of patients with high CBZ levels was small (six cases of 33 with CBZ therapy), and the result should be interpreted with caution, no similar associations were demonstrated for phenytoin plasma levels and risk of SUDEP. No association was found between SUDEP risk and within-patient variation in AED levels over time. Conclusions: Polytherapy, frequent dose changes, and high CBZ levels as identified risk factors for SUDEP all point to the risks associated with an unstable severe epilepsy. It is unclear whether high CBZ levels per se represent a risk factor or just reflect other unidentified aspects of a severe epilepsy. Our results, however, prompt further detailed analyses of the possible role of AEDs in SUDEP in larger cohorts and suggest that reasonable monitoring of the drug therapy may be useful to reduce risks.

Influence of Parity and Lactation on Hip Fracture Risk

Abstract: Several studies indicate that parity and lactation are associated with modest, short-term bone loss, but the long-term effect on osteoporotic fracture risk is uncertain. The authors therefore analyzed data from a population-based case-control study among Swedish postmenopausal women aged 50-81 years between October 1993 and February 1995. Mailed questionnaires and telephone interviews were used to collect data on 1,328 incident cases with hip fracture and 3,312 randomly selected controls. In age-adjusted analyses, the risk of hip fracture among all women was reduced by 10% per child (95% confidence interval (CI): 5, 14). After multivariate adjustment including body mass index as a covariate, the risk reduction was 5% per child (95% CI: 0, 10). Oral contraceptive use modified the association of parity with hip fracture risk. Among never users of oral contraceptives, the risk of hip fracture was reduced by 8% per child (95% CI: 2, 13), whereas among ever users of oral contraceptives, the risk was in the opposite direction, with an increase in risk by 19% per child (95% CI: 0, 41). After parity was considered, there was no association of duration of lactation period with fracture risk. The authors conclude that parity is modestly associated with a reduced hip fracture risk among women who had not used oral contraceptives previously.

Self-diagnosed dermatitis in adults. Results from a population survey in Stockholm.

Abstract: In a population-based survey of public health issues in Stockholm, Sweden, self-reported hand eczema, history of childhood eczema, nickel allergy, occurrence of skin symptoms on the face and intolerance to cosmetics and hygiene products, were investigated. A postal questionnaire was sent to 15,000 inhabitants aged 19–80 years. The response rate was 73%. The 1-year prevalence of hand eczema was 8% (females 10%, males 6%). History of childhood eczema was reported by 15% and, of these, 42% also stated positively that they had had hand eczema at some time. Hypersensitivity to nickel was owned to 15% of the females and 3% of the males. Of the nickel-sensitive, 30% reported ever having had hand eczema. The combination of nickel allergy and history of childhood eczema resulted in a cumulative prevalence of hand eczema of 56%. Females reported more hand-washings per day than did males, and a relation between number of hand-washings and hand eczema was found. Self-reported 1-year prevalence of skin symptoms on the face was 14% and, of these, 33% also owned to hypersensitivity to cosmetics. Dermatitis appears to be a common health problem. This fact should be made clear to those who give priority and allocate resources to health problems, e.g., by participation of dermatologists in performing population-based surveys.

Nickel release from coins

Abstract: Nickel allergy is the most frequent contact allergy and is also one of the major background factors for hand eczema. The clinical significance of nickel release from coins was discussed when the composition of euro coins was decided. Current European coinage is dominated by cupro-nickel coins (Cu 75; Ni 25); other nickel-containing and non-nickel alloys are also used. Nickel release from used coinage from the UK, Sweden and France was determined. It was shown that nickel ions are readily available on the surface of used coins. After 2 min in artificial sweat, approximately 2 microg of nickel per coin was extracted from cupro-nickel coins. Less nickel was extracted from non-nickel coins. Nickel on the surface was mainly present as chloride. After 1 week in artificial sweat approximately 30 microg/cm2 was released from cupro-nickel coins: less nickel was released from coins made of other nickel alloys. Theoretically, several microg of nickel salts may be transferred daily onto hands by intense handling of high-nickel-releasing coins.

Nickel on the Swedish market before the Nickel Directive.

Abstract: Nickel allergy is by far the most frequent contact allergy, affecting 10-15% of women in the general population, and causing dermatitis and hand eczema. The EU Nickel Directive, aimed at the prevention of nickel allergy, comes fully into force by July 2001. The Directive covers piercing materials, items in contact with the skin, and requirements on resistance to wear. We carried out a study of the prevalence on the market, before the Nickel Directive, of items that release nickel and of nickel in piercing posts. Nickel release, as shown by a positive dimethylglyoxime (DMG) test, was detected in 25% of 725 items intended for direct and prolonged contact with the skin. Of 15 posts intended for use during epithelialization after piercing, 60% contained more than 0.05% nickel. These products do not comply with the requirements of the EU Nickel Directive. It is suggested that experts in contact dermatitis participate in the prevention of nickel allergy by explaining its effects: the r le of skin exposure and which parts of an item are in contact with the skin, and the crucial question of nickel release versus nickel content.

Occupational dermatitis in dental personnel: contact dermatitis with special reference to (meth)acrylates in 174 patients.

Abstract: Between 1995 and 1998, 174 dental personnel were referred as patients to the Department of Occupational and Environmental Dermatology, Stockholm. After clinical examination, 131 were patch tested with the Swedish standard series and 109 with a dental screening series. Furthermore, 137 were tested for IgE-mediated allergy to natural rubber latex (NRL). Hand eczema was diagnosed in 109/174 (63%), 73 (67%) being classified as irritant contact dermatitis and 36 (33%) as allergic. Further diagnoses included other eczemas, urticaria, rosacea, psoriasis, tinea pedis, bullous pemphigoid or no skin disease. 77/131 (59%) had positive reactions to substances in the standard series and 44/109 (40%) to substances exclusive to the dental series. 24/109 (22%) patients had positive reactions to (meth)acrylates, the majority with reactions to several test preparations. Reactions to HEMA (2-hydroxyethyl methacrylate), EGDMA (ethyleneglycol dimethacrylate) and MMA (methyl methacrylate) were most frequent. 9 of the 24 were positive only to (meth)acrylates, the remaining 15 also had reactions to allergens in the standard series. 23 of these had hand eczema and 1 facial eczema. In 17 of the 24 allergic to (meth)acrylates, the dermatitis had started in 1995 or later, in 15 within the previous 12 months. Of 8 who had been sick-listed, 7 also had a history of atopy and 6 were allergic to nickel. The most frequent allergens besides (meth)acrylates were nickel, cobalt, palladium, fragrance mix, colophonium and thiuram mix. Allergy to natural rubber latex was diagnosed in 14/137 (10%). In conclusion, irritant hand dermatitis was the dominant diagnosis. Contact allergy to (meth)acrylate was seen in 22% of the patch tested patients, with reactions to 3 predominant test substances. 1/3 of the patients with allergy to (meth)acrylates had been sick-listed for dermatitis, but in all these cases the (meth)acrylate allergy was seen together with atopy and/or further contact allergies.

A population-based case-referent study of myocardial infarction and occupational exposure to motor exhaust, other combustion products, organic solvents, lead, and dynamite. Stockholm Heart Epidemiology Program (SHEEP) Study Group.

Abstract: This case-referent study investigated the risk of myocardial infarction from occupational exposure to motor exhaust, other combustion products, organic solvents, lead, and dynamite. We identified first-time, nonfatal myocardial infarctions among men and women 45-70 years of age in Stockholm County from 1992 through 1994. We selected referent subjects from the population to match the demographic characteristics of the cases. A lifetime history of occupations was obtained by questionnaire. The response rate was 81% for the cases and 74% for the referents, with 1,335 cases and 1,658 referents included in the study. An occupational hygienist assessed occupational exposures, coding the intensity and probability of exposure for each subject. We adjusted relative risk estimates for tobacco smoking, alcohol drinking, hypertension, diabetes mellitus, overweight, and physical inactivity at leisure time. The relative risk of myocardial infarction was 2.11 (95% confidence interval = 1.23-3.60) among those who were highly exposed and 1.42 (95% confidence interval = 1.05-1.92) among those who were intermediately exposed to combustion products from organic material. We observed an exposure-response pattern, in terms of both maximum exposure intensity and cumulative dose. Exposure to dynamite and organic solvents was possibly associated with an increased risk. The other exposures were not consistently associated with myocardial infarction.

Sports activities, body weight and smoking in relation to low-back pain: a population-based case-referent study.

Abstract: The study aims to describe the influence of sports activities, high body weight and smoking on low-back pain. The results were obtained from a population-based case-referent study, the Musculoskeletal Intervention Center (MUSIC)-Norrtalje study. In all, 342 male and 449 female cases, and 662 male and 948 female referents participated. Neither low-intensity training many hours/week (> or = 5 h) nor high-intensity training few (1-2 h), intermediate (3-4 h) or many hours (> or = 5 h) per week affected the risk of low-back pain among men. Few (1-2) hours with high-intensity training increased the relative risk of low-back pain among women, RR 1.6 (1.1-2.4). An increased risk of low-back pain was found for men with high body weight, RR 2.2 (CI 1.2-3.9) but not for women. Smoking did not influence the risk of low-back pain.

Emotional isolation: prevalence and the effect on well-being among 50-80-year-old prostate cancer patients.

Abstract: Objective: To investigate to what extent prostate cancer patients confide their emotional concerns, and whether having no one to confide in affects well-being. Material and methods: A population-based study using epidemiological methods. A questionnaire was mailed to all 431 living prostate cancer patients aged 50-80 at the time of selection, diagnosed 1.5-2 years previously in Stockholm County, and 435 randomly selected men in the same age group. The questionnaire was completed anonymously. The main outcome measures included questions assessing the extent to which the men could share emotionally taxing feelings with their partner or others and questions assessing well-being. Results: The questionnaire was returned by 79% of the patients and by 73% of the randomly selected men. Approximately one in five patients had no one to confide in. Of patients living with a partner, only one in 10 confided in someone other than their partner. Three out of 10 patients living in a relationship could not confide in the...

Legislative and preventive measures related to contact dermatitis.

Abstract: Legislation can be a useful tool in the prevention of contact dermatitis. This is particularly true for dermatitis due to exposure to the many contact allergens that are chemical substances in products. A brief review is given of the most important European legislation – the EU Nickel Directive, the Cosmetics Directive, the Hazardous Substances Directive and the Hazardous Preparations Directive – and of some national regulations and standardization projects. It is concluded that it is essential that experts on contact dermatitis support, with their expert knowledge, national and European authorities.

Breast cancer, occupation, and exposure to electromagnetic fields among Swedish men.

Abstract: Background Investigations of breast cancer among men may provide clues for environmental and occupational risk factors that may be difficult to study in women, because of confounding or effect modification from reproductive female characteristics. The objective was to estimate occupation-specific risks of male breast cancer and to assess the effect of occupational exposure to extremely low-frequency magnetic fields (ELFMF). Methods Standardized incidence ratios were computed for the period 1971–1989 among Swedish men who were 25–59 years of age at start of follow-up and gainfully employed in 1970. Log-linear Poisson models were fitted to adjust for geographical area. A job exposure matrix was used to classify occupational ELFMF exposure. Results A marked and consistent excess risk was found for machinery repairers. Increased relative risks based on few cases were also noted for librarians/archivists/curators, bank employees, non-specified clerical workers, metal processing workers, tanners/fur dressers, policemen, and custom surveillance officials. The relative risk among subjects with an estimated ELFMF exposure above the first quartile (0.12 μT) was 1.31 (95% confidence interval = 0.94–1.81), without a clear exposure–response pattern. Indications of an exposure–response relationship were found in workers with intermittent ELFMF exposure. Conclusions The findings give no clear evidence for an etiological role of ELFMF in the development of breast cancer in men, but suggest that large variations in exposure over the work-day may be associated with an increased risk. Am. J. Ind. Med. 39:276–285, 2001. © 2001 Wiley-Liss, Inc.

Environmental tobacco smoke and myocardial infarction among never-smokers in the Stockholm Heart Epidemiology Program (SHEEP).

Abstract: An increased risk for myocardial infarction (MI) related to environmental tobacco smoke (ETS) exposure has previously been reported, but several aspects of the association are still uncertain. We studied the MI risk associated with ETS exposure among 334 nonfatal never-smoking MI cases and 677 population controls, 45-70 years of age, in Stockholm County. A postal questionnaire with a telephone follow-up provided information on ETS exposure and other potential risk factors for MI. After adjustment for age, gender, hospital catchment area, body mass index, socioeconomic status, job strain, hypertension, diet, and diabetes mellitus, the odds ratio for MI was 1.58 (95% confidence interval = 0.97-2.56) for an average daily exposure of 20 cigarettes or more from the spouse. Combined exposure from spouse and work showed an increasing odds ratio for MI, up to 1.55 (95% confidence interval = 1.02-2.34) in the highest category of weighted duration, that is, more than 90 "hour-years" of exposure (1 "hour-year" = 365 hours, or 1 hour per day for 1 year). In addition, more recent exposure appeared to convey a higher risk. Our data confirm an increased risk of MI from exposure to ETS and suggest that intensity of spousal exposure, combined exposure from spouse and work, and time since last exposure are important.

Dispersion of horse allergen in the ambient air, detected with sandwich ELISA.

Abstract: Background: The objective was to establish an ELISA to detect horse allergen in ambient air and settled dust. Methods: Monoclonal antibodies (mAbs) were produced against extracts of horse antigen. Two mAbs were selected and used in a sandwich ELISA. By the aid of portable pumps, air samples were collected in one stable and in the ambient air surrounding this stable. Furthermore, settled dust was collected by wiping spots with pieces of fabric, at sites within 500 m of the stable. Results: Extracts of horsehair could be extensively diluted and still be positive. Extracts of cat and dog allergen failed to be detected. Furthermore, the mAbs were shown to detect an IgE-binding component. This was demonstrated by an ELISA using mAbs as capture antibody and sera from horse-allergic subjects as secondary antibody with readout depending on anti-IgE antibody. The sera with the highest RAST class to horse were positive in this ELISA. Airborne levels of horse allergen were over 500-fold higher in the stable than just outside the stable and over 3000-fold higher than at a residential building located only 12 m from the stable. Similarly, an inverse correlation was found between the distance to the stable and levels of “outdoor settled” horse allergen (r=−0.9, P<0.001). Conclusions: We have developed a sensitive, horse-allergen-specific, mAb assay allowing detection of low levels of horse allergens. Raised levels of horse allergen were found outdoors only in the close vicinity of the stable.

Protective gloves in Swedish dentistry: use and side-effects.

Abstract: Background During the 1980s routine wearing of gloves in dentistry was recommended by health authorities in several countries. However, prolonged glove use is associated with side-effects of irritant and allergic origin. Objectives To investigate the extent of glove use and self-reported glove intolerance reactions among Swedish dentists, and to examine how far IgE-mediated allergy to natural rubber latex (NRL) occurs in subjects who report rapid itching when in contact with protective gloves. Subjects/methods A postal questionnaire was answered by 3083 of 3500 licensed dentists, a response rate of 88%. Of the dentists who reported rapidly occurring itching of the hands from gloves, 131 of 170 attended a clinical examination including a skin prick test (SPT) and a serological examination (RAST) for IgE-mediated allergy. Results Seventy-three per cent of the dentists reported daily glove use of more than 2 h, 48% more than 6 h a day, and 6% reported no use. NRL gloves were used most frequently (P < 0·001) and were the main material that elicited symptoms (P < 0·001). Female dentists reported more frequent glove use than males, as did young dentists (P < 0·001) compared with older ones. Females also preferred vinyl gloves. Glove intolerance reactions were reported by 723 (23%) dentists, [females 28%, males 21% (P < 0·001)] and were more common in younger dentists. Of the 417 dentists with reported hand eczema during the previous year, 54% reported glove intolerance, compared with 20% of the dentists without hand eczema (P < 0·001). A logistic regression analysis including hand eczema, age, sex and atopy showed that all these factors contributed significantly to the risk of glove intolerance, and that hand eczema was a stronger factor than atopy. In 15 of 131 (11%) dentists examined for reported glove-related itch, latex allergy was verified by SPT and/or RAST. Glove-related conjunctivis, rhinitis and asthma, in contrast to skin symptoms, showed a significant association with IgE-mediated allergy to NRL. Conclusions Swedish dentists show good compliance with the recommendations for routine glove use. Intolerance reactions are frequently reported, especially by dentists with hand eczema, which emphasizes the need for preventive skin care programmes. Glove-related symptoms from mucous membranes showed a higher association with IgE-mediated allergy to NRL than reported itching of the skin, a fact that should be considered when composing screening questionnaires for NRL sensitization

The effect of supplementary antioxidant therapy in patients who report hypersensitivity to electricity: a randomized controlled trial.

Abstract: CONTEXT Hypersensitivity to electricity is a proposed environmental illness of unknown etiology. Patients report a variety of symptoms that they relate to electric equipment. The afflicted individuals suffer from ill health. Many interventions have been tried but, to date, there is no one specific treatment that has been proven superior to other remedial actions. In general, there is a lack of controlled prospective studies. OBJECTIVE To test the hypothesis that antioxidant therapy reduces symptoms and improves health in patients reporting hypersensitivity to electricity. DESIGN Randomized, double-blind, crossover, placebo-controlled study. SETTING Patients referred to the Environmental Illness Research Centre, Stockholm County Council. PATIENTS Sixteen patients reporting hypersensitivity to electricity. INTERVENTION Antioxidant supplementation (vitamins C and E, selenium). MAIN OUTCOME MEASURES Self-reported symptoms and reported degree of hypersensitivity to electricity, serum levels of uric acid and diphenylpycrylhydrazyl (DPPH). RESULTS The results indicated no significant differences in reported symptoms, reported hypersensitivity to electricity, or oxidative status in serum between periods of antioxidant and placebo treatments. Serum levels of DPPH and uric acid showed no correlation with the reported degree of symptoms or hypersensitivity to electricity. CONCLUSIONS The study did not show any beneficial effect of antioxidant supplementation for patients reporting hypersensitivity to electricity. The results do not support the hypothesis that oxidative stress is a major contributor to ill health in patients who report hypersensitivity to electricity.

Effects of furcation involvements on periodontal status and healing in adjacent proximal sites.

Abstract: Background: In a recent study it was found that following non-surgical treatment, probing depth (PD) reduction in proximal sites is significantly less in the presence of a vertical destruction in the adjacent site of the neighboring tooth. The present investigation was undertaken to study whether the presence of a proximal furcation involvement also influences the periodontal conditions in the adjacent site of the neighboring tooth. Methods: The investigation was conducted as a retrospective study on a consecutive referral population based on full-mouth oral radiographic examinations and PD and plaque score registrations. The statistical analyses were performed on a final sample of 136 patients, with 153 (periodontal status) and 123 (periodontal healing) second maxillary premolars with an adjacent first maxillary molar. Results: Baseline pockets were significantly deeper, relative radiographic attachment levels significantly reduced, and periodontal PD significantly less reduced after non-surgical treatme...

Hospital-managed advanced care of children in their homes.

Abstract: A hospital-managed project for the advanced care of children in their homes (SABH) has been established in Sweden. The aim was to provide an alternative to inpatient paediatric care by providing hospital-at-home care to stable infants and children using mobile units based on advanced information and communication technology. The Karolinska Hospital children's ward and emergency room referred children to SABH care. A medical care plan was drawn up by the physicians and nurses responsible for the patient while in hospital, in conjunction with the parents and the patient. In one year, 350 episodes of care requiring 3000 bed-days were managed by SABH in the children's homes rather than at hospital. Forty-two per cent of the patients were aged less than one year, 41% were between one and six years old, and 17% were older than six years. SABH care was at least 30% cheaper than conventional hospital care and patient satisfaction with the service was high. At the conclusion of the two-year project, the SABH became a permanent unit at the Karolinska Hospital.