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Sopranzi FM, Faragalli A, Pompili M, Carle F, Gesuita R, Ceravolo MG. Incidence of amyotrophic lateral sclerosis before and during the COVID-19 pandemic: evidence from an 8-year population-based study in Central Italy based on healthcare utilization databases. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-9. [PMID: 38557366 DOI: 10.1080/21678421.2024.2336127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disorder with a high multidimensional burden, with an obscure etiopathogenesis. METHODS We designed a longitudinal, population-based study of people residing in Central Italy (Marche Region) who were beneficiaries of the National Health System. People with an unprecedented ALS hospitalization (335.20 ICD-9 CM) or tagged with an ALS exemption between 2014 and 2021 were considered incident cases. ALS cases residing in the region for <3 years or with an active ALS exemption or hospitalized for ALS before 2014 were excluded. We used secondary sources to identify new ALS diagnoses. The regional referral center for ALS's database was used to test the accuracy of secondary sources in detecting cases. ALS mean incidence was compared to that reported in similar studies conducted in Italy. The incidence rate trend adjusted by sex and age was evaluated using the Poisson regression model. RESULTS We detected 425 new ALS cases (median age: 70y) in the 2014-2021 period, with a mean incidence of 3.5:100,000 py (95%CI: 3.2-3.8; M:F = 1.2), similar to that reported in similar studies conducted in Italy. No trend was observed during 2014-2019. After including 2020-2021 in the model, we observed a mean decrease in incidence of 5.8% (95% CI 2.0%; 9.5%, p = 0.003). CONCLUSION We show a decrease in the incidence rate of ALS in Marche, during the 2014-2021 period, as a possible outcome of a delayed neurological assessment and diagnosis during the pandemic. An ad hoc developed identification algorithm, based on healthcare utilization databases, is a valuable tool to assess the health impact of global contingencies.
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Affiliation(s)
- Federico Maria Sopranzi
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Faragalli
- Center of Epidemiology, Biostatistics and Medical Information Technology, Polytechnic University of Marche, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy, and
| | | | - Flavia Carle
- Center of Epidemiology, Biostatistics and Medical Information Technology, Polytechnic University of Marche, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy, and
| | - Rosaria Gesuita
- Center of Epidemiology, Biostatistics and Medical Information Technology, Polytechnic University of Marche, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy, and
| | - Maria Gabriella Ceravolo
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
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Goutman SA, Savelieff MG, Jang DG, Hur J, Feldman EL. The amyotrophic lateral sclerosis exposome: recent advances and future directions. Nat Rev Neurol 2023; 19:617-634. [PMID: 37709948 PMCID: PMC11027963 DOI: 10.1038/s41582-023-00867-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/16/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal disease of motor neuron degeneration with typical survival of only 2-5 years from diagnosis. The causes of ALS are multifactorial: known genetic mutations account for only around 70% of cases of familial ALS and 15% of sporadic cases, and heritability estimates range from 8% to 61%, indicating additional causes beyond genetics. Consequently, interest has grown in environmental contributions to ALS risk and progression. The gene-time-environment hypothesis posits that ALS onset occurs through an interaction of genes with environmental exposures during ageing. An alternative hypothesis, the multistep model of ALS, suggests that several hits, at least some of which could be environmental, are required to trigger disease onset, even in the presence of highly penetrant ALS-associated mutations. Studies have sought to characterize the ALS exposome - the lifetime accumulation of environmental exposures that increase disease risk and affect progression. Identifying the full scope of environmental toxicants that enhance ALS risk raises the prospect of preventing disease by eliminating or mitigating exposures. In this Review, we summarize the evidence for an ALS exposome, discussing the strengths and limitations of epidemiological studies that have identified contributions from various sources. We also consider potential mechanisms of exposure-mediated toxicity and suggest future directions for ALS exposome research.
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Affiliation(s)
- Stephen A Goutman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Masha G Savelieff
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, ND, USA
| | - Dae-Gyu Jang
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Junguk Hur
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, ND, USA
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA.
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Zhu Q, Zhou J, Zhang Y, Huang H, Han J, Cao B, Xu D, Zhao Y, Chen G. Risk factors associated with amyotrophic lateral sclerosis based on the observational study: a systematic review and meta-analysis. Front Neurosci 2023; 17:1196722. [PMID: 37284659 PMCID: PMC10239956 DOI: 10.3389/fnins.2023.1196722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Objective Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder affecting the upper and lower motor neurons. Though the pathogenesis of ALS is still unclear, exploring the associations between risk factors and ALS can provide reliable evidence to find the pathogenesis. This meta-analysis aims to synthesize all related risk factors of ALS to understand this disease comprehensively. Methods We searched the following databases: PubMed, EMBASE, Cochrane library, Web of Science, and Scopus. Moreover, observational studies, including cohort studies, and case-control studies, were included in this meta-analysis. Results A total of 36 eligible observational studies were included, and 10 of them were cohort studies and the rest were case-control studies. We found six factors exacerbated the progression of disease: head trauma (OR = 1.26, 95% CI = 1.13, 1.40), physical activity (OR = 1.06, 95% CI = 1.04, 1.09), electric shock (OR = 2.72, 95% CI = 1.62, 4.56), military service (OR = 1.34, 95% CI = 1.11, 1.61), pesticides (OR = 1.96, 95% CI = 1.7, 2.26), and lead exposure (OR = 2.31, 95% CI = 1.44, 3.71). Of note, type 2 diabetes mellitus was a protective factor for ALS. However, cerebrovascular disease (OR = 0.99, 95% CI = 0.75, 1.29), agriculture (OR = 1.22, 95% CI = 0.74, 1.99), industry (OR = 1.24, 95% CI = 0.81, 1.91), service (OR = 0.47, 95% CI = 0.19, 1.17), smoking (OR = 1.25, 95% CI = 0.5, 3.09), chemicals (OR = 2.45, 95% CI = 0.89, 6.77), and heavy metal (OR = 1.5, 95% CI = 0.47, 4.84) were not risk factors for ALS based on meta-analyses. Conclusions Head trauma, physical activity, electric shock, military service, pesticides, and lead were risk factors for ALS onset and progression. But DM was a protective factor. This finding provides a better understanding of ALS risk factors with strong evidence for clinicians to rationalize clinical intervention strategies. INPLSY registration number https://inplasy.com/inplasy-2022-9-0118/, INPLASY202290118.
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Affiliation(s)
- Qiaochu Zhu
- Department of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
| | - Jing Zhou
- Department of Tuina and Rehabilitation Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Hubei Institute of Traditional Chinese Medicine, Wuhan, China
- Department of First Clinical Medical College, Hubei University of Chinese Medicine, Wuhan, China
| | - Yijie Zhang
- School of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Hai Huang
- Department of Tuina and Rehabilitation Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Hubei Institute of Traditional Chinese Medicine, Wuhan, China
| | - Jie Han
- Department of Tuina and Rehabilitation Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Hubei Institute of Traditional Chinese Medicine, Wuhan, China
| | - Biwei Cao
- Department of Tuina and Rehabilitation Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Hubei Institute of Traditional Chinese Medicine, Wuhan, China
| | - Dandan Xu
- Department of Tuina and Rehabilitation Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Hubei Institute of Traditional Chinese Medicine, Wuhan, China
| | - Yan Zhao
- Department of Tuina and Rehabilitation Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Hubei Institute of Traditional Chinese Medicine, Wuhan, China
- Department of First Clinical Medical College, Hubei University of Chinese Medicine, Wuhan, China
| | - Gang Chen
- Department of Tuina and Rehabilitation Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
- Department of Tuina and Rehabilitation Medicine, Hubei Institute of Traditional Chinese Medicine, Wuhan, China
- Department of First Clinical Medical College, Hubei University of Chinese Medicine, Wuhan, China
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Zhang G, E M, Zhou X. Environmental and Occupational solvents exposure and amyotrophic lateral sclerosis: a systematic review and meta-analysis. Neurol Sci 2023:10.1007/s10072-023-06718-8. [PMID: 36897461 DOI: 10.1007/s10072-023-06718-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
Studies focusing on the association between environmental and occupational solvent exposure and amyotrophic lateral sclerosis (ALS) have yielded inconsistent results. Herein we present the results of a meta-analysis on the correlation between solvent exposure and ALS. We searched for eligible studies that reported ALS with exposure to solvents in PubMed, Embase, and Web of Science up to December 2022. The Newcastle-Ottawa scale was used to evaluate the quality of the article and a meta-analysis was performed using a random effect model. Thirteen articles, including two cohort studies and 13 case-control studies with 6365 cases and 173,321 controls were selected. The odds ratio (OR) for the association between solvent exposure and ALS was 1.31 (95% confidence interval [CI], 1.11-1.54) with moderate heterogeneity (I2 = 59.7%; p = 0.002). Subgroup and sensitivity analyses confirmed the results, and publication bias was not detected. These results indicated that environmental and occupational solvent exposure was associated with the risk of ALS.
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Affiliation(s)
- Guoqiang Zhang
- The First People's Hospital of Lianyungang, 6 Zhenhua East Road, Lianyungang, 222061, Jiangsu, People's Republic of China
| | - Meng E
- Yangzhou Center for Disease Control and Prevention, 52 Shangfangsi Road, Yangzhou, 225001, Jiangsu, People's Republic of China
| | - Xin Zhou
- Yangzhou Center for Disease Control and Prevention, 52 Shangfangsi Road, Yangzhou, 225001, Jiangsu, People's Republic of China.
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Duan QQ, Jiang Z, Su WM, Gu XJ, Wang H, Cheng YF, Cao B, Gao X, Wang Y, Chen YP. Risk factors of amyotrophic lateral sclerosis: a global meta-summary. Front Neurosci 2023; 17:1177431. [PMID: 37168926 PMCID: PMC10165003 DOI: 10.3389/fnins.2023.1177431] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/04/2023] [Indexed: 05/13/2023] Open
Abstract
Background The etiology of amyotrophic lateral sclerosis (ALS) remains largely unknown. This study aimed to summarize the relationship between ALS and its genetic and non-genetic risk factors. Method A search of relevant literature from PubMed, Embase, and Cochrane Database from inception to December 2022 was performed. Random-effects or fixed-effects models were performed by Stata MP 15.0 to pool multivariate or adjusted ratios (OR). PROSPERO registration number: CRD42022301549. Results 230 eligible studies were included, of which 67 involved 22 non-genetic factors, and 163 involved genetic factors. Four aspects of non-genetic factors, including lifestyle, environmental and occupational exposures, pre-existing diseases/comorbidity and medical exposures, and others, were analyzed. Exposure to heavy metals (OR = 1.79), pesticides (OR = 1.46), solvents (OR = 1.37), previous head trauma (OR = 1.37), military service (OR = 1.29), stroke (OR = 1.26), magnetic field (OR = 1.22) and hypertension (OR = 1.04) are significant risk factors, but use of antidiabetics (OR = 0.52), high BMI (OR = 0.60 for obese and overweight vs. normal and underweight), living in urban (OR = 0.70), diabetes mellitus (OR = 0.83), and kidney disease (OR = 0.84) decrease the risk for ALS. In addition, eight common ALS-related genes were evaluated, the mutation frequencies of these genes were ranked from highest to lowest as SOD1 (2.2%), C9orf72 (2.1%), ATXN2 (1.7%), FUS (1.7%), TARDBP (0.8%), VCP (0.6%), UBQLN2(0.6%) and SQSTM1 (0.6%) in all the ALS patients. Conclusions Our findings suggested that effective intervention for risk exposure and timely modification of lifestyle might prevent the occurrence of ALS. Genetic mutations are important risk factors for ALS and it is essential to detect genetic mutations correctly and scientifically. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=301549, identifier: CRD42022301549.
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Affiliation(s)
- Qing-Qing Duan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lab of Neurodegenerative Disorders, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lab of Neurodegenerative Disorders, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Ming Su
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lab of Neurodegenerative Disorders, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiao-Jing Gu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Han Wang
- Department of Pathophysiology, West China College of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Yang-Fan Cheng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lab of Neurodegenerative Disorders, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bei Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lab of Neurodegenerative Disorders, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xia Gao
- Department of Geriatrics, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Yi Wang
- Department of Pathophysiology, West China College of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Yong-Ping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lab of Neurodegenerative Disorders, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Yong-Ping Chen
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Nona RJ, Xu Z, Robinson GA, Henderson RD, McCombe PA. Age of Onset and Length of Survival of Queensland Patients with Amyotrophic Lateral Sclerosis: Details of Subjects with Early Onset and Subjects with Long Survival. NEURODEGENER DIS 2022; 22:104-121. [PMID: 36587610 PMCID: PMC10627495 DOI: 10.1159/000528875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The aims of the study were to document the characteristics of amyotrophic lateral sclerosis (ALS) patients in Queensland, to examine factors influencing age of onset, and survival, and to study those with early-onset (<45 years) disease and those with long (>5 years) survival. METHODS We studied subjects seen at the ALS Clinic at the Royal Brisbane and Women's Hospital. We recorded sex, age of onset, region of onset, length of survival, presence of family history, type of disease, and evidence of cognitive involvement. We analysed the influence of these features on age of onset and survival. We analysed the features of patients with early onset of disease and patients with long survival. RESULTS There were 855 ALS patients (505 males) in the cohort. The age of onset was lower in males than females, in patients with a family history of ALS compared to those without, and in patients with spinal onset compared to bulbar onset. Early-onset disease was seen in 10% of patients, and had a greater proportion of males, spinal onset, and classical ALS phenotype compared to late-onset disease. Survival was shorter in females, in patients with bulbar onset, and in patients with classical ALS. Long survival was seen in 18% of patients. Patients with long survival had younger age of onset, greater proportion of males, spinal onset, and fewer patients with classical ALS. CONCLUSION Our study confirms that ALS is more prevalent in males and that spinal onset is more common than bulbar onset. Males have earlier onset but longer survival. We found that overall, patients with classical ALS have worse survival than ALS variants, but some patients who were considered to have classical ALS had long survival. This study confirms the similarity of ALS in our region to ALS in other geographical regions.
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Affiliation(s)
- Robert J. Nona
- Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia
| | - Zhouwei Xu
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Gail A. Robinson
- Queensland Brain Institute and School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Robert D. Henderson
- Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Pamela A. McCombe
- Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Pierri V, Borghero G, Pili F, Ercoli T, Gigante AF, Lecca LI, Vasta R, Campagna M, Chiò A, Defazio G. Impact of occupational categories on the incidence of amyotrophic lateral sclerosis in Sardinia Island, Italy. Amyotroph Lateral Scler Frontotemporal Degener 2022; 24:212-218. [PMID: 36476139 DOI: 10.1080/21678421.2022.2153606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Occupation is one of the potential risk factors for amyotrophic lateral sclerosis (ALS) for which previous controlled studies produced inconsistent results. The aim of this study is to assess the impact of several groups of occupational categories on ALS incidence. METHODS ALS patients from the southern part of Sardinia who had onset during 2012-2021 and fulfilled El Escorial revised diagnostic criteria were included. The risk of ALS was estimated in relation to the occupation held in 2011, as obtained from the 2011 Census that classified working activities in ten groups. Each occupational group was compared with a reference category represented by all other occupations, and rate ratio were calculated. Additive interaction between activity at work and age at ALS onset/sex on ALS incidence was calculated. RESULTS Employment in agriculture/breeding and in the armed forces were significantly associated with increasing ALS risk. None of the other assessed occupation groups was associated with change in the risk of ALS. Geographic analysis indicated that the effect of agriculture/breeding was particularly evident in the areas of higher risk for the general population. By contrast, an inverse pattern of spatial risk was associated with armed forces activity at work. The increased risk of ALS associated to agriculture/breeding was more evident in older people. No significant interaction was detected between working in the armed forces and older age/sex. CONCLUSIONS The significant interaction between agriculture/breeding and age suggests that the mechanisms leading to ALS are complex and involve several factors.
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Affiliation(s)
- Vincenzo Pierri
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giuseppe Borghero
- Institute of Neurology, University Hospital of Cagliari, Cagliari, Italy
| | - Francesca Pili
- Institute of Neurology, University Hospital of Cagliari, Cagliari, Italy
| | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Luigi Isaia Lecca
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Rosario Vasta
- ALS Center, Rita Levi Montalcini Department of Neurosciences, University of Turin, Turin, Italy, and
| | - Marcello Campagna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Adriano Chiò
- ALS Center, Rita Levi Montalcini Department of Neurosciences, University of Turin, Turin, Italy, and
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Institute of Neurology, University Hospital of Cagliari, Cagliari, Italy
- Amyotrophic Lateral Sclerosis Center, University of Cagliari, Cagliari, Italy
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Saastamoinen P, Laaksovirta H, Leino-Arjas P, Rahkonen O. New evidence on the association of occupation with amyotrophic lateral sclerosis: A register-based case-control study in Finland. Front Neurol 2022; 13:859824. [PMID: 36188364 PMCID: PMC9515316 DOI: 10.3389/fneur.2022.859824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesAmyotrophic lateral sclerosis (ALS) is a serious neurodegenerative disease that usually leads to death within a few years from diagnosis. The risk factors for ALS are still largely unknown. However, it is assumed that environmental factors play a role in disease onset. Occupation is suggested as a potential risk factor, but findings are inconsistent. The aim of this study was to assess the association of occupation with ALS in Finland. Register data were used to avoid recall bias and to obtain a large enough sample to detect the potential associations.MethodsThis case-control study included ALS cases that occurred between 1980 and 2015 in Finland (n = 4,781). ALS cases were identified from the causes of death register. For each ALS case, six controls were selected matched for sex and birth-year. The date of death of the ALS case was set as index date. Information on occupation was obtained from Statistics Finland for all subjects. The focus was on the longest-held occupation on 2-digit level (70 groups). The association of occupation with ALS was analyzed using conditional logistic regression.ResultsCompared to “clerical work and other office work,” the risk of ALS was increased in “packing and wrapping work” (OR 1.53, 95% CI 1.08–2.17), “laundering, dry cleaning and pressing work” (OR 1.83, 95% CI 1.08–3.08), and “travel service work” (OR 8.75, CI 2.76–27.74). A decreased risk was found in “planning, administrative and research work in the technical fields” (OR 0.69, 95% CI 0.48–0.98). Of the significant associations identified, only “travel service work” was significant after FDR multiple testing correction.ConclusionsThis study identified occupations in which the risk of ALS was increased. Further studies are needed to pinpoint the potential exposures in these occupations that may trigger the disease.
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Affiliation(s)
- Peppiina Saastamoinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Finnish Medical Association, Helsinki, Finland
- *Correspondence: Peppiina Saastamoinen
| | | | | | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Goutman SA, Boss J, Godwin C, Mukherjee B, Feldman EL, Batterman SA. Associations of self-reported occupational exposures and settings to ALS: a case-control study. Int Arch Occup Environ Health 2022; 95:1567-1586. [PMID: 35593931 PMCID: PMC9424174 DOI: 10.1007/s00420-022-01874-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Environmental exposures contribute to the pathogenesis of amyotrophic lateral sclerosis (ALS), a fatal and progressive neurological disease. Identification of these exposures is important for targeted screening and risk factor modification. OBJECTIVE To identify occupational exposures that are associated with a higher risk of ALS using both survey and standard occupational classification (SOC) coding procedures, and to highlight how exposure surveys can complement SOC coding. METHODS ALS participants and neurologically healthy controls recruited in Michigan completed a detailed exposure assessment on their four most recent and longest held occupations. Exposure scores were generated from the exposure survey, and occupations were assigned to SOC codes by experienced exposure scientists. RESULTS This study included 381 ALS and 272 control participants. ALS participants reported higher duration-adjusted occupational exposure to particulate matter (OR = 1.45, 95% CI 1.19-1.78, p < 0.001), volatile organic compounds (OR = 1.22, 95% CI 1.02-1.45, p = 0.029), metals (OR = 1.48, 95% CI 1.21-1.82, p < 0.001), and combustion and diesel exhaust pollutants (OR = 1.20, 95% CI 1.01-1.43, p = 0.041) prior to ALS diagnosis, when adjusted for sex, age, and military service compared to controls. In multivariable models, only occupational exposure to metals remained significant risk (OR = 1.56, 95% CI 1.11-2.20, p = 0.011), although in an adaptive elastic net model, particulate matter (OR = 1.203), pesticides (OR = 1.015), and metals (1.334) were all selected as risk factors. Work in SOC code "Production Occupations" was associated with a higher ALS risk. SOC codes "Building and Grounds Cleaning and Maintenance Occupations", "Construction and Extraction Occupations", "Installation, Maintenance, and Repair Occupations", and "Production Occupations" were all associated with a higher exposure to metals as determined using survey data. DISCUSSION Occupational exposure to particulate matter, volatile organic compounds, metals, pesticides, and combustion and diesel exhaust and employment in "Production Occupations" was associated with an increased ALS risk in this cohort.
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Affiliation(s)
- Stephen A Goutman
- Department of Neurology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109-5223, USA.
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA.
| | - Jonathan Boss
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Christopher Godwin
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Eva L Feldman
- Department of Neurology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109-5223, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Stuart A Batterman
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
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10
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Motataianu A, Serban G, Barcutean L, Balasa R. Oxidative Stress in Amyotrophic Lateral Sclerosis: Synergy of Genetic and Environmental Factors. Int J Mol Sci 2022; 23:ijms23169339. [PMID: 36012603 PMCID: PMC9409178 DOI: 10.3390/ijms23169339] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a grievous neurodegenerative disease whose survival is limited to only a few years. In spite of intensive research to discover the underlying mechanisms, the results are fairly inconclusive. Multiple hypotheses have been regarded, including genetic, molecular, and cellular processes. Notably, oxidative stress has been demonstrated to play a crucial role in ALS pathogenesis. In addition to already recognized and exhaustively studied genetic mutations involved in oxidative stress production, exposure to various environmental factors (e.g., electromagnetic fields, solvents, pesticides, heavy metals) has been suggested to enhance oxidative damage. This review aims to describe the main processes influenced by the most frequent genetic mutations and environmental factors concurring in oxidative stress occurrence in ALS and the potential therapeutic molecules capable of diminishing the ALS related pro-oxidative status.
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Affiliation(s)
- Anca Motataianu
- Department of Neurology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540136 Targu Mures, Romania
- 1st Neurology Clinic, Emergency Clinical County Hospital Targu Mures, 540136 Targu Mures, Romania
| | - Georgiana Serban
- Doctoral School, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- Correspondence: ; Tel.: +40-0724-051-516
| | - Laura Barcutean
- Department of Neurology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540136 Targu Mures, Romania
- 1st Neurology Clinic, Emergency Clinical County Hospital Targu Mures, 540136 Targu Mures, Romania
| | - Rodica Balasa
- Department of Neurology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540136 Targu Mures, Romania
- 1st Neurology Clinic, Emergency Clinical County Hospital Targu Mures, 540136 Targu Mures, Romania
- Doctoral School, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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11
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Newell ME, Adhikari S, Halden RU. Systematic and state-of the science review of the role of environmental factors in Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig's Disease. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 817:152504. [PMID: 34971691 DOI: 10.1016/j.scitotenv.2021.152504] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
The etiology of sporadic amyotrophic lateral sclerosis (ALS) is still unclear. We evaluate environmental factors suspected to be associated with ALS for their potential linkage to disease causality and to model geographic distributions of susceptible populations and expected cases worldwide. A PRISMA systematic literature review was performed 2021. Bradford Hill criteria were used to identify and rank environmental factors and a secondary review of ALS diagnoses in population studies and ALS case or cohort studies was conducted. Prevalence rate projection informed estimates of impacted regions and populations. Among 1710 papers identified, 258 met the inclusion criteria, of which 173 responded to at least one of nine Bradford Hill criteria among 83 literature-identified ALS environmental factors. Environmental determinants of ALS in order of decreasing significance were β-N-methylamino-L-alanine (BMAA), formaldehyde, selenium, and heavy metals including manganese, mercury, zinc, and copper. Murine animal models were the most common methodology for exploring environmental factors. Another line of investigation of 62 population exposure studies implicated the same group of environmental agents (mean odds ratios): BMAA (2.32), formaldehyde (1.54), heavy metals (2.99), manganese (3.85), mercury (2.74), and zinc (2.78). An age-adjusted incidence model estimated current total ALS cases globally at ~85,000 people compared to only ~1600 cases projected from the reported ALS incidence in the literature. Modeling with the prevalence microscope equation forecasted an increase in U.S. ALS cases from 16,707 confirmed in 2015 to ~22,650 projected for 2040. Two orthogonal methods employed implicate BMAA, formaldehyde, manganese, mercury, and zinc as environmental factors with strong ALS associations. ALS cases likely are significantly underreported globally, and high vulnerability exists in regions with large aging populations. Recent studies on other diseases with environmental determinants suggest the need to consider additional potential triggers and mechanisms, including exposures to microbial agents and epigenetic modifications.
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Affiliation(s)
- Melanie Engstrom Newell
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Building B, Arizona State University, 1001 S McAllister Ave, Tempe, AZ 85281-8101, USA; School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, AZ, USA.
| | - Sangeet Adhikari
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Building B, Arizona State University, 1001 S McAllister Ave, Tempe, AZ 85281-8101, USA; School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ, USA.
| | - Rolf U Halden
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Building B, Arizona State University, 1001 S McAllister Ave, Tempe, AZ 85281-8101, USA; School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, AZ, USA; School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ, USA; OneWaterOneHealth, Arizona State University Foundation, 1001 S. McAllister Avenue, Tempe, AZ 85287-8101, USA; Global Futures Laboratory, Arizona State University, 800 S. Cady Mall, Tempe, AZ 85281, USA.
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12
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Chen GX, Douwes J, van den Berg L, Pearce N, Kromhout H, Glass B, McLean DJ, 't Mannetje AM. Occupational exposures to pesticides and other chemicals: a New Zealand motor neuron disease case–control study. Occup Environ Med 2022; 79:412-420. [DOI: 10.1136/oemed-2021-108056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/17/2022] [Indexed: 11/04/2022]
Abstract
ObjectivesTo assess associations between occupational exposures to pesticides and other chemicals and motor neuron disease (MND).MethodsA population-based case–control study that included 319 MND cases (64% male/36% female) recruited through the New Zealand MND Association complemented with hospital discharge data, and 604 controls identified from the Electoral Roll. For each job held, a questionnaire collected information on 11 exposure categories (dust, fibres, tobacco smoke, fumes, gas, fumigants, oils/solvents, acids/alkalis, pesticides, other chemicals and animals/animal products). ORs were estimated using logistic regression adjusting for age, sex, ethnicity, socioeconomic status, education, smoking, alcohol consumption, physical activities, head/spine injury and other occupational exposures.ResultsTwo exposure categories were associated with increased MND risks: pesticides (OR 1.70, 95% CI 1.17 to 2.48) and fumigants (OR 3.98, 95% CI 1.81 to 8.76), with risks increasing with longer exposure duration (p<0.01). Associations were also observed for: methyl bromide (OR 5.28, 95% CI 1.63 to 17.15), organochlorine insecticides (OR 3.28, 95% CI 1.18 to 9.07), organophosphate insecticides (OR 3.11, 95% CI 1.40 to 6.94), pyrethroid insecticides (OR 6.38, 95% CI 1.13 to 35.96), inorganic (copper) fungicides (OR 4.66, 95% CI 1.53 to 14.19), petrol/diesel fuel (OR 2.24, 95% CI 1.27 to 3.93) and unspecified solvents (OR 1.91, 95% CI 1.22 to 2.99). In women, exposure to textile fibres (OR 2.49, 95% CI 1.13 to 5.50), disinfectants (OR 9.66, 95% CI 1.29 to 72.44) and cleaning products (OR 3.53, 95% CI 1.64 to 7.59) were also associated with MND; this was not observed in men (OR 0.80, 95% CI 0.44 to 1.48; OR 0.72, 95% CI 0.29 to 1.84; OR 0.57, 95% CI 0.21 to 1.56, respectively).ConclusionsThis study adds to the evidence that pesticides, especially insecticides, fungicides, and fumigants, are risk factors for MND.
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13
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Edgar JA, Molyneux RJ, Colegate SM. 1,2-Dehydropyrrolizidine Alkaloids: Their Potential as a Dietary Cause of Sporadic Motor Neuron Diseases. Chem Res Toxicol 2022; 35:340-354. [PMID: 35238548 DOI: 10.1021/acs.chemrestox.1c00384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sporadic motor neuron diseases (MNDs), such as amyotrophic lateral sclerosis (ALS), can be caused by spontaneous genetic mutations. However, many sporadic cases of ALS and other debilitating neurodegenerative diseases (NDDs) are believed to be caused by environmental factors, subject to considerable debate and requiring intensive research. A common pathology associated with MND development involves progressive mitochondrial dysfunction and oxidative stress in motor neurons and glial cells of the central nervous system (CNS), leading to apoptosis. Consequent degeneration of skeletal and respiratory muscle cells can lead to death from respiratory failure. A significant number of MND cases present with cancers and liver and lung pathology. This Perspective explores the possibility that MNDs could be caused by intermittent, low-level dietary exposure to 1,2-dehydropyrrolizidine alkaloids (1,2-dehydroPAs) that are increasingly recognized as contaminants of many foods consumed throughout the world. Nontoxic, per se, 1,2-dehydroPAs are metabolized, by particular cytochrome P450 (CYP450) isoforms, to 6,7-dihydropyrrolizines that react with nucleophilic groups (-NH, -SH, -OH) on DNA, proteins, and other vital biochemicals, such as glutathione. Many factors, including aging, gender, smoking, and alcohol consumption, influence CYP450 isoform activity in a range of tissues, including glial cells and neurons of the CNS. Activation of 1,2-dehydroPAs in CNS cells can be expected to cause gene mutations and oxidative stress, potentially leading to the development of MNDs and other NDDs. While relatively high dietary exposure to 1,2-dehydroPAs causes hepatic sinusoidal obstruction syndrome, pulmonary venoocclusive disease, neurotoxicity, and diverse cancers, this Perspective suggests that, at current intermittent, low levels of dietary exposure, neurotoxicity could become the primary pathology that develops over time in susceptible individuals, along with a tendency for some of them to also display liver and lung pathology and diverse cancers co-occurring with some MND/NDD cases. Targeted research is recommended to investigate this proposal.
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Affiliation(s)
- John A Edgar
- CSIRO Agriculture and Food, 11 Julius Avenue, North Ryde, New South Wales 2113, Australia
| | - Russell J Molyneux
- Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, 200 West Kawili Street, Hilo, Hawaii 96720, United States
| | - Steven M Colegate
- Poisonous Plant Research Laboratory, ARS/USDA, 1150 East 1400 North, Logan, Utah 84341, United States
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14
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Koski L, Ronnevi C, Berntsson E, Wärmländer SKTS, Roos PM. Metals in ALS TDP-43 Pathology. Int J Mol Sci 2021; 22:12193. [PMID: 34830074 PMCID: PMC8622279 DOI: 10.3390/ijms222212193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS), Alzheimer's disease, Parkinson's disease and similar neurodegenerative disorders take their toll on patients, caregivers and society. A common denominator for these disorders is the accumulation of aggregated proteins in nerve cells, yet the triggers for these aggregation processes are currently unknown. In ALS, protein aggregation has been described for the SOD1, C9orf72, FUS and TDP-43 proteins. The latter is a nuclear protein normally binding to both DNA and RNA, contributing to gene expression and mRNA life cycle regulation. TDP-43 seems to have a specific role in ALS pathogenesis, and ubiquitinated and hyperphosphorylated cytoplasmic inclusions of aggregated TDP-43 are present in nerve cells in almost all sporadic ALS cases. ALS pathology appears to include metal imbalances, and environmental metal exposure is a known risk factor in ALS. However, studies on metal-to-TDP-43 interactions are scarce, even though this protein seems to have the capacity to bind to metals. This review discusses the possible role of metals in TDP-43 aggregation, with respect to ALS pathology.
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Affiliation(s)
- Lassi Koski
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | | | - Elina Berntsson
- Department of Biochemistry and Biophysics, Stockholm University, 106 91 Stockholm, Sweden;
- Department of Chemistry and Biotechnology, Tallinn University of Technology, 12616 Tallinn, Estonia
| | | | - Per M. Roos
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Capio St. Göran Hospital, 112 19 Stockholm, Sweden;
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15
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Zhang J, Qiu W, Hu F, Zhang X, Deng Y, Nie H, Xu R. The rs2619566, rs10260404, and rs79609816 Polymorphisms Are Associated With Sporadic Amyotrophic Lateral Sclerosis in Individuals of Han Ancestry From Mainland China. Front Genet 2021; 12:679204. [PMID: 34421992 PMCID: PMC8378233 DOI: 10.3389/fgene.2021.679204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/25/2021] [Indexed: 11/21/2022] Open
Abstract
The pathogenesis of sporadic amyotrophic lateral sclerosis (sALS) remains unknown; however, recent research suggests that genetic factors may play an important role. This study aimed at investigating possible genetic risk factors for the pathogenesis of sALS. In our previous study, we conducted a genome-wide association study (GWAS) in 250 sALS patients and 250 control participants of Han ancestry from mainland China (HACM) and retrospectively analyzed the previously reported candidate loci related with sALS including our GWAS investigated results. In this study, twenty-seven candidate loci that were most likely associated with sALS were selected for further analysis in an independent case/control population of 239 sALS patients and 261 control subjects of HACM ethnicity using sequenom massARRAY methodology and DNA sequencing. We discovered that the polymorphism rs2619566 located within the contactin-4 (CNTN4) gene, rs10260404 in the dipeptidyl-peptidase 6 (DPP6) gene, and rs79609816 in the inositol polyphosphate-5-phosphatase B (INPP5B) gene were strongly associated with sALS in subjects of HACM ethnicity. Subjects harboring the minor C allele of rs2619566 and the minor T allele of rs79609816 exhibited an increased risk for sALS development, while carriers of the minor C allele of rs10260404 showed a decreased risk of sALS development compared to the subjects of other genotypes. The polymorphisms of rs2619566, rs10260404, and rs79609816 may change or affect the splicing, transcription, and translation of CNTN4, DPP6, and INPP5B genes and may play roles in the pathogenesis of sALS roles in the pathogenesis of sALS.
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Affiliation(s)
- Jie Zhang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weiwen Qiu
- Department of Neurology, The Affiliated People's Hospital of Nanchang University, The First Affiliated Hospital of Nanchang Medical College, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Fan Hu
- Department of Neurology, The Affiliated People's Hospital of Nanchang University, The First Affiliated Hospital of Nanchang Medical College, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Xiong Zhang
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Youqing Deng
- Department of Neurology, The Third Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hongbing Nie
- Department of Neurology, The Affiliated People's Hospital of Nanchang University, The First Affiliated Hospital of Nanchang Medical College, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Renshi Xu
- Department of Neurology, The Affiliated People's Hospital of Nanchang University, The First Affiliated Hospital of Nanchang Medical College, Jiangxi Provincial People's Hospital, Nanchang, China
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16
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Rana I, Rieswijk L, Steinmaus C, Zhang L. Formaldehyde and Brain Disorders: A Meta-Analysis and Bioinformatics Approach. Neurotox Res 2021; 39:924-948. [PMID: 33400181 PMCID: PMC8102312 DOI: 10.1007/s12640-020-00320-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
While there is significant investigation and investment in brain and neurodegenerative disease research, current understanding of the etiologies of illnesses like Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and brain cancer remains limited. Environmental exposure to the pollutant formaldehyde, an emerging neurotoxin widely used in industry, is suspected to play a critical role in mediating these disorders, although findings are limited and inconsistent. Focusing on highly exposed groups, we performed a meta-analysis of human epidemiological studies of formaldehyde and neurodegenerative disease (N = 19) or brain tumors (N = 12). To assess the biological plausibility of observed associations, we then conducted a bioinformatics analysis using WikiPathways and the Comparative Toxicogenomics Database and identified candidate genes and pathways that may be related to these interactions. We reported the meta-relative risk (meta-RR) of ALS following high exposures to formaldehyde was increased by 78% (meta-RR = 1.78, 95% confidence interval, CI 1.20-2.65). Similarly, the meta-RR for brain cancer was increased by 71% (meta-RR = 1.71; 95% CI 1.07-2.73) among highly exposed individuals. Multiple sensitivity analyses did not reveal sources of heterogeneity or bias. Our bioinformatics analysis revealed that the oxidative stress genes superoxide dismutase (SOD1, SOD2) and the pro-inflammatory marker tumor necrosis factor (TNF) were identified as the top relevant genes, and the folate metabolism, vitamin B12 metabolism, and the ALS pathways were highly affected by formaldehyde and related to the most brain diseases of interest. Further inquiry revealed the two metabolic pathways are also intimately tied with the formaldehyde cycle. Overall, our bioinformatics analysis supports the link of formaldehyde exposure to ALS or brain tumor reported from our meta-analysis. This new multifactorial approach enabled us to both interrogate the robustness of the epidemiological data and identify genes and pathways that may be involved in these interactions, ultimately lending strong evidence and potential biological plausibility for the association between formaldehyde exposure and brain disease.
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Affiliation(s)
- Iemaan Rana
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Linda Rieswijk
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
- Institute of Data Science, Maastricht University, Maastricht, Netherlands
| | - Craig Steinmaus
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Luoping Zhang
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
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17
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Jalilian H, Najafi K, Khosravi Y, Röösli M. Amyotrophic lateral sclerosis, occupational exposure to extremely low frequency magnetic fields and electric shocks: a systematic review and meta-analysis. REVIEWS ON ENVIRONMENTAL HEALTH 2021; 36:129-142. [PMID: 32946420 DOI: 10.1515/reveh-2020-0041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
Exposure to extremely low frequency magnetic fields (ELF-MF) and electric shocks occurs in many workplaces and occupations but it is unclear whether any of these exposures cause Amyotrophic lateral sclerosis (ALS). The aim of this systematic review and meta-analysis is to explore whether occupational exposure to ELF-MF and/or electric shocks are risk factor for ALS. We searched PubMed, Embase, and Web of Science databases up to the end of 2019. Pooled risk estimates were calculated using random-effects meta-analysis including exploration of the sources of heterogeneity between studies and publication bias. Twenty-seven publications fulfilled the inclusion criteria. We found a weak, significant, association between occupational exposure to ELF-MF and the risk of ALS (RRPooled estimate: 1.20; 95%CI: 1.05, 1.38) with moderate to high heterogeneity (I2=66.3%) and indication of publication bias (PEgger's test=0.03). No association was observed between occupational exposure to electric shocks and risk of ALS (RRPooled estimate: 0.97; 95%CI: 0.80, 1.17) with high heterogeneity (I2=80.5%), and little indication for publication bias (PEgger's test=0.24). The findings indicate that occupational exposure to ELF-MF, but not electric shocks, might be a risk factor for ALS. However, given the moderate to high heterogeneity and potential publication bias, the results should be interpreted with caution.
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Affiliation(s)
- Hamed Jalilian
- Department of Occupational Health and Safety Engineering, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - Kamran Najafi
- Student Research Committee, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Yahya Khosravi
- Department of Occupational Health and Safety Engineering, School of Health, Research Center for Health, Safety and Environment, Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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18
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McKay KA, Smith KA, Smertinaite L, Fang F, Ingre C, Taube F. Military service and related risk factors for amyotrophic lateral sclerosis. Acta Neurol Scand 2021; 143:39-50. [PMID: 32905613 PMCID: PMC7756624 DOI: 10.1111/ane.13345] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The cause of amyotrophic lateral sclerosis (ALS) is unknown, but occupations have been explored as a potential proxy measure of risk. There is a substantial body of literature connecting military service to ALS. We aimed to summarize and assess the quality of this evidence. METHODS Systematic review of the literature, including observational studies which explored one of the following exposures: general military service (army, air force, marines, or navy); or specific exposures associated with military service measured among military personnel. The outcome of interest was ALS incidence, which could include onset, diagnosis, or death from ALS. RESULTS A total of 2642 articles were screened. Following exclusion, 19 articles remained for inclusion in the systematic review, including 1 meta-analysis and 18 original observational studies. Most studies were of moderate quality. In general, the relationship between military service was suggestive of an increased risk, particularly among Gulf War and WWII veterans. Exposure to pesticides (including Agent Orange) certain chemicals (exhaust, burning agents), heavy metals, and head trauma appeared to increase the risk of ALS among military personnel. CONCLUSIONS There is a possible association between military service and the subsequent development of ALS; however, the evidence was limited. Studies were generally hindered by small sample sizes and inadequate follow-up time. Future studies should endeavor to objectively measure specific exposures, or combinations thereof, associated with military service, as this will be of vital importance in implementing preventative strategies into military organizations.
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Affiliation(s)
- Kyla A. McKay
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Centre for Molecular Medicine Karolinska Institutet Stockholm Sweden
| | - Kelsi A. Smith
- Clinical Epidemiology Division Department of Medicine Solna, Karolinska Institutet Stockholm Sweden
| | - Lidija Smertinaite
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Fang Fang
- Unit of Integrative Epidemiology Insitute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Caroline Ingre
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Fabian Taube
- School of Public Health and Community Medicine Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Swedish Armed Forces Center for Defence Medicine Gothenburg Sweden
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19
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Dickerson AS, Hansen J, Gredal O, Weisskopf MG. Study of Occupational Chromium, Iron, and Nickel Exposure and Amyotrophic Lateral Sclerosis in Denmark. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8086. [PMID: 33147887 PMCID: PMC7663552 DOI: 10.3390/ijerph17218086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/19/2022]
Abstract
Studies of occupational metal exposures and amyotrophic lateral sclerosis (ALS) have focused primarily on known neurotoxicants, including lead, mercury, selenium, and cadmium. However, these exposures are often co-occurring with other lesser studied metals. We conducted a population-based case-control study with the aim of assessing associations between occupational chromium, iron, and nickel exposures and risk of ALS. We identified ALS cases in Denmark from 1982 through 2013 from the Danish National Patient Registry and matched them to 100 controls based on birth year and sex. Cumulative metal exposures were estimated using job exposure matrices applied to occupational history from the Danish Pension Fund. Although mutually adjusted odds of ALS were higher in men with chromium exposures in the third quartile (aOR = 1.24; 95% CI 0.91, 1.69) and fourth quartile (aOR = 1.19; 95% CI: 0.80, 1.76) compared to those with no exposure, differences did not reach statistical significance. We also observed higher odds of ALS in women with nickel exposures in the third quartile (aOR = 2.21; 95% CI: 1.14, 4.28), but not for the fourth quartile (aOR = 0.61; 95% CI: 0.23, 1.64). Our findings do not suggest associations between occupational exposures to these metals and ALS. However, unavoidable non-differential misclassification from the use of JEMs may have masked truly increased risk.
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Affiliation(s)
- Aisha S. Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark;
| | - Ole Gredal
- National Rehabilitation Center for Neuromuscular Disorders, 8000 Copenhagen, Denmark;
| | - Marc G. Weisskopf
- Departments Epidemiology of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
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20
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Andrew AS, Bradley WG, Peipert D, Butt T, Amoako K, Pioro EP, Tandan R, Novak J, Quick A, Pugar KD, Sawlani K, Katirji B, Hayes TA, Cazzolli P, Gui J, Mehta P, Horton DK, Stommel EW. Risk factors for amyotrophic lateral sclerosis: A regional United States case-control study. Muscle Nerve 2020; 63:52-59. [PMID: 33006184 PMCID: PMC7821307 DOI: 10.1002/mus.27085] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022]
Abstract
Most amyotrophic lateral sclerosis (ALS) cases are considered sporadic, without a known genetic basis, and environmental exposures are thought to play a causal role. To learn more about sporadic ALS etiology, we recruited n = 188 ALS patients from northern New England and Ohio and matched controls 2:1 from the general population of the same regions. Questionnaires evaluated the association between a variety of lifestyle, behavioral (ie, hobbies and activities), and occupational factors and the risk of ALS, including the duration of time between exposure and ALS onset, and exposure frequency. Head trauma was associated with increased ALS risk (adjusted odds ratio [OR] 1.60 95% confidence interval [CI] 1.04‐2.45), with significantly greater effects for injuries occurring 10 or more years prior to symptom onset (P = .037). ALS risk was increased for those reporting severe electrical burns (adjusted OR 2.86, 95% CI 1.37‐6.03), with odds ratios highest for burns after age 30 (OR 3.14), and for burns 10 or more years prior to symptom onset (OR 3.09). Hobbies involving lead were the most strongly associated with ALS risk (adjusted OR 2.92, 95% CI 1.45‐5.91). Exposures to lead 20 or more years prior to diagnosis had larger effect sizes compared to those occurring more recently. Holding a job in mechanics, painting, or construction was associated with ALS. The identification of these specific environmental factors associated with ALS highlight the need for future prospective and laboratory studies to assess causality, biological mechanisms, and find prevention or treatment opportunities.
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Affiliation(s)
| | - Walter G Bradley
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel Peipert
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Tanya Butt
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Kwadwo Amoako
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Erik P Pioro
- Center for ALS and Related Disorders, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rup Tandan
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - John Novak
- Ohio Health Physician Group, Westerville, Ohio, USA
| | - Adam Quick
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - K Doug Pugar
- Dayton Center for Neurological Disorders, Dayton, Ohio, USA
| | - Komal Sawlani
- Department of Neurology, University Hospital Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
| | - Bashar Katirji
- Department of Neurology, University Hospital Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | - Jiang Gui
- Department of Biomedical Data Science, Dartmouth College, Hanover, New Hampshire, USA
| | - Paul Mehta
- Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia, USA
| | - D Kevin Horton
- Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia, USA
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21
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KAWAI T, SAKURAI H, IKEDA M. Biological monitoring of occupational exposure to dichloromethane by means of urinalysis for un-metabolized dichloromethane. INDUSTRIAL HEALTH 2020; 58:22-25. [PMID: 30996213 PMCID: PMC6997715 DOI: 10.2486/indhealth.2018-0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
The objective of the study is to establish exposure-excretion relationship between dichlorometane (DCM) in air (DCM-A) and in urine (DCM-U) in workplace to confirm a previous report. Male workers in a screen-printing plant participated in the study. Time-weighted average DCM-A was measured by diffusive sampling followed by gas-chromatography (GC), and DCM in end-of-shift urine samples was by head-space GC. The data were subjected to regression and other statistical analyses. In practice, 30 sets of DCM-A and DCM-U values were available. The geometric mean DCM-A was 8.4 ppm and that of DCM-U (as observed) was 41.1 µg/l. The correlation coefficients (0.70-0.85) were statistically significant across the correction for urine density. Thus, the analysis for un-metabolized DCM in end-of-shift urine samples is applicable for biological monitoring of occupational exposure to DCM, in support of and in agreement with the previous report. In conclusion, biological monitoring of occupational DCM exposure is possible by use of analysis for un-metabolized DCM in end-of-shift urine.
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Affiliation(s)
- Toshio KAWAI
- Kansai Technical Center for Occupational Medicine,
Japan
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22
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Meng E, Mao Y, Yao Q, Han X, Li X, Zhang K, Jin W. Population-based study of environmental/occupational lead exposure and amyotrophic lateral sclerosis: a systematic review and meta-analysis. Neurol Sci 2019; 41:35-40. [DOI: 10.1007/s10072-019-04067-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022]
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23
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Dickerson AS, Hansen J, Specht AJ, Gredal O, Weisskopf MG. Population-based study of amyotrophic lateral sclerosis and occupational lead exposure in Denmark. Occup Environ Med 2019; 76:208-214. [PMID: 30705111 DOI: 10.1136/oemed-2018-105469] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/16/2018] [Accepted: 11/28/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Previous research has indicated links between lead (Pb) exposure and increased risk of neurodegenerative disorders, including amyotrophic lateral sclerosis (ALS). In this study, we evaluated the association between occupational Pb exposures and ALS. METHODS ALS cases were ascertained through the Danish National Patient Registry from 1982 to 2013 and age and sex-matched to 100 controls. Using complete employment history since 1964 from the Danish Pension Fund, cumulative Pb exposure was estimated for each subject via a Danish job exposure matrix. Associations were evaluated using conditional logistic regression analyses and stratified by sex. RESULTS For men with >50% probability of exposure, there was an increase in odds of ALS for exposures in the 60th percentile or higher during any time 5 years prior to diagnosis (aOR: 1.35; 95% CI 1.04 to 1.76) and 10 years prior to diagnosis (aOR: 1.33; 95% CI 1.03 to 1.72). No significant associations were observed in women, and there were no linear trends seen for Pb exposures for either sex. CONCLUSIONS Our study indicates an association between consistently higher occupational Pb exposures and ALS. These findings support those of previously reported associations between ALS and specific occupations that commonly experience Pb exposure.
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Affiliation(s)
- Aisha S Dickerson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Johnni Hansen
- Occupation Research Unit, Institute of Cancer Epidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Aaron J Specht
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ole Gredal
- Occupation Research Unit, Institute of Cancer Epidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marc G Weisskopf
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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24
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Gunnarsson LG, Bodin L. Occupational Exposures and Neurodegenerative Diseases-A Systematic Literature Review and Meta-Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030337. [PMID: 30691095 PMCID: PMC6388365 DOI: 10.3390/ijerph16030337] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 12/13/2022]
Abstract
Objectives: To carry out an integrated and stratified meta-analysis on occupational exposure to electromagnetic fields (EMFs), metals and pesticides and its effects on amyotrophic lateral sclerosis (ALS) and Parkinson's and Alzheimer's disease, and investigate the possibility of publication bias. Methods: In the current study, we updated our recently published meta-analyses on occupational exposures in relation to ALS, Alzheimer's and Parkinson's disease. Based on 66 original publications of good scientific epidemiological standard, according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines, we analysed subgroups by carrying out stratified meta-analyses on publication year, statistical precision of the relative risk (RR) estimates, inspection of the funnel plots and test of bias. Results: Based on 19 studies the weighted RR for occupational exposure to EMFs was 1.26 (95% confidence interval (CI) 1.07⁻1.50) for ALS, 1.33 (95% CI 1.07⁻1.64) for Alzheimer's disease and 1.02 (95% CI 0.83⁻1.26) for Parkinson's disease. Thirty-one studies concerned occupational exposure to pesticides and the weighted RR was 1.35 (95% CI 1.02⁻1.79) for ALS, 1.50 (95% CI 0.98⁻2.29) for Alzheimer's disease and 1.66 (95% CI 1.42⁻1.94) for Parkinson's disease. Finally, 14 studies concerned occupational exposure to metals and only exposure to lead (five studies) involved an elevated risk for ALS or Parkinson's disease and the weighted RR was 1.57 (95% CI 1.11⁻2.20). The weighted RR for all the non-lead exposures was 0.97 (95% CI 0.88⁻1.06). Conclusions: Exposure to pesticides increased the risk of getting the mentioned neurodegenerative diseases by at least 50%. Exposure to lead was only studied for ALS and Parkinson's disease and involved 50% increased risk. Occupational exposure to EMFs seemed to involve some 10% increase in risk for ALS and Alzheimer's disease only.
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Affiliation(s)
- Lars-Gunnar Gunnarsson
- Department of Occupational and Environmental Medicine, School of Medicine, Örebro University, 701 82 Örebro, Sweden.
| | - Lennart Bodin
- Department of Statistics, Örebro University, 701 82 Örebro, Sweden.
- Institute of Environmental Medicine, Karolinska Institute, SE 177 77 Stockholm, Sweden.
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25
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Palese F, Sartori A, Verriello L, Ros S, Passadore P, Manganotti P, Barbone F, Pisa FE. Epidemiology of amyotrophic lateral sclerosis in Friuli-Venezia Giulia, North-Eastern Italy, 2002-2014: a retrospective population-based study. Amyotroph Lateral Scler Frontotemporal Degener 2018; 20:90-99. [PMID: 30430867 DOI: 10.1080/21678421.2018.1511732] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe the epidemiology of Amyotrophic Lateral Sclerosis (ALS) in Friuli-Venezia Giulia (FVG) region, Italy, over a 13-year period (2002-2014), estimating ALS (a) incidence, prevalence, and clinical features; (b) mortality, also comparing Udine municipality to the rest of FVG. METHODS We conducted a retrospective population-based study. ALS incident cases were ascertained using multiple sources and validated through expert review. We calculated crude and standardized incidence rate (IR), point prevalence and mortality rate (MR), each with 95% confidence interval. Standardized incidence (SIR) and mortality (SMR) ratio were calculated to compare Udine to FVG. RESULTS Among 444 incident cases (50.0% men, median age 68.5 years), onset was bulbar in 30.2%, spinal in 59.9%, mixed in 9.9%; 3.6% had familial ALS. Crude and 2000 European population standardized IR was respectively 2.81 (2.56-3.09) and 2.09 (1.89-2.29) per 100,000 person-years. Standardized male-to-female incidence ratio was 1.05. IR peaked at age 65-74 years (men: 9.93, 8.04-12.32; women: 7.74, 6.18-9.67) and decreased thereafter. Prevalence was 8.36 (6.74-9.97) cases per 100,000 inhabitants on 30 June 2009 and 7.98 (6.40-9.56) on 30 June 2014. SIR was 1.20 and SMR 1.11. CONCLUSIONS When assessed over a long period, incidence of ALS was in the range of Italian and European population-based registries and showed a consistent pattern by age and sex. IR and MR were only slightly higher in Udine vs. FVG.
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Affiliation(s)
| | - Arianna Sartori
- b Neurologic Clinic, Department of Medical, Surgical and Health Sciences , Azienda Sanitaria Universitaria Integrata di Trieste, University Hospital of Trieste , Trieste , Italy
| | - Lorenzo Verriello
- c Neurologic Clinic, Department of Neurological Sciences , Azienda Sanitaria Universitaria Integrata di Udine , Udine , Italy
| | - Silvia Ros
- d Neurologic Clinic , Hospital of Gorizia , Gorizia , Italy
| | - Paolo Passadore
- e Neurologic Clinic , Hospital of Pordenone , Pordenone , Italy
| | - Paolo Manganotti
- b Neurologic Clinic, Department of Medical, Surgical and Health Sciences , Azienda Sanitaria Universitaria Integrata di Trieste, University Hospital of Trieste , Trieste , Italy
| | - Fabio Barbone
- a Medical Area Department , University of Udine , Udine , Italy
| | - Federica Edith Pisa
- a Medical Area Department , University of Udine , Udine , Italy.,f Leibniz Institute for Prevention Research and Epidemiology - BIPS , Bremen , Germany.,g Institute of Hygiene and Clinical Epidemiology , University Hospital of Udine , Udine , Italy
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26
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Gunnarsson LG, Bodin L. Amyotrophic Lateral Sclerosis and Occupational Exposures: A Systematic Literature Review and Meta-Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112371. [PMID: 30373166 PMCID: PMC6265680 DOI: 10.3390/ijerph15112371] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/16/2018] [Accepted: 10/24/2018] [Indexed: 11/16/2022]
Abstract
Objectives: We conducted a systematic literature review to identify studies fulfilling good scientific epidemiological standards for use in meta-analyses of occupational risk factors for amyotrophic lateral sclerosis (ALS). Methods: We identified 79 original publications on associations between work and ALS. The MOOSE (Meta-analysis Of Observational Studies in Epidemiology) and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) guidelines were used to ensure high scientific quality, and reliable protocols were applied to classify the articles. Thirty-seven articles fulfilled good scientific standards, while 42 were methodologically deficient and thus were excluded from our meta-analyses. Results: The weighted relative risks for the various occupational exposures were respectively; 1.29 (95% confidence interval (CI): 0.97–1.72; six articles) for heavy physical work, 3.98 (95% CI: 2.04–7.77; three articles) for professional sports, 1.45 (95% CI: 1.07–1.96; six articles) for metals, 1.19 (95% CI: 1.07–1.33; 10 articles) for chemicals, 1.18 (95% CI: 1.07–1.31; 16 articles) for electromagnetic fields or working with electricity, and 1.18 (95% CI: 1.05–1.34; four articles) for working as a nurse or physician. Conclusions: Meta-analyses based only on epidemiologic publications of good scientific quality show that the risk of ALS is statistically significantly elevated for occupational exposures to excessive physical work, chemicals (especially pesticides), metals (especially lead), and possibly also to electromagnetic fields and health care work. These results are not explained by publication bias.
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Affiliation(s)
- Lars-Gunnar Gunnarsson
- School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden.
- Department of Occupational and Environmental Medicine, Örebro University, SE 701 82 Örebro, Sweden.
| | - Lennart Bodin
- Department of Statistics, Örebro University, SE 701 82 Örebro, Sweden.
- Institute of Environmental Medicine, Karolinska Institute, SE 177 77 Stockholm, Sweden.
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27
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Röösli M, Jalilian H. A meta-analysis on residential exposure to magnetic fields and the risk of amyotrophic lateral sclerosis. REVIEWS ON ENVIRONMENTAL HEALTH 2018; 33:309-313. [PMID: 29874196 DOI: 10.1515/reveh-2018-0019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
Abstract
Amyotrophic lateral sclerosis (ALS) is caused by the gradual degeneration and death of motor neurons, with mostly unknown etiology. Some risk factors have been suggested for this disease including extremely low frequency magnetic fields (ELF-MF) exposure. This meta-analysis assesses the association of residential exposure to ELF-MF with the risk of ALS. Five studies have addressed the risk of ALS in relation to overhead power lines. A pooled relative risk (RR) of 0.71 [95% confidence interval (CI): 0.48, 1.07] for the most exposed population group (either <200 m distance from high voltage power lines or >0.1 μT) was found. Little heterogeneity (I2=0.00%, p=0.67) and indication for publication bias (PBegg’s test=0.22; PEgger’s test=0.19) was seen. Overall, we found no evidence for an association between residential exposure to ELF-MF and the risk of ALS, although the number of exposed cases is low.
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Affiliation(s)
- Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, CH-4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Hamed Jalilian
- Facility of Public Health, al-zahra Street, Shiraz, Iran, Phone: +987137251009, Fax: +987132299694
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Health, Safety and Environment, Alborz University of Medical Sciences, Karaj, Iran
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28
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Spencer PS. Formaldehyde, DNA damage, ALS and related neurodegenerative diseases. J Neurol Sci 2018; 391:141-142. [DOI: 10.1016/j.jns.2018.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/19/2018] [Indexed: 12/13/2022]
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29
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Dickerson AS, Hansen J, Gredal O, Weisskopf MG. Amyotrophic Lateral Sclerosis and Exposure to Diesel Exhaust in a Danish Cohort. Am J Epidemiol 2018; 187:1613-1622. [PMID: 29590300 DOI: 10.1093/aje/kwy069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/20/2018] [Indexed: 12/12/2022] Open
Abstract
Previous studies have suggested an increased risk of amyotrophic lateral sclerosis (ALS) and other motor neuron diseases for persons in occupations commonly involving exposure to diesel exhaust (DE). In this study, we investigated the association between occupational exposure to DE and odds of ALS. ALS cases were identified from the Danish National Patient Registry (1982-2013) and individually matched to 100 controls per case on the basis of birth year and sex. Using information on occupational history from 1964 onward obtained from the Danish Pension Fund, we estimated cumulative DE exposures using a job exposure matrix. We evaluated associations using conditional logistic regression analyses and stratified the analyses by sex. Using a 10-year lag period, DE exposure was positively associated with ALS among men who had ever been exposed (adjusted odds ratio (aOR) = 1.20, 95% confidence interval (CI): 1.05, 1.38). For men with greater than 50% probability of DE exposure, we observed a positive association between ALS and highest-quartile exposure during the 5-year (aOR = 1.35, 95% CI: 1.07, 1.70) and 10-year (aOR = 1.41, 95% CI: 1.11, 1.79) lag periods. Our study suggests an association between consistently higher exposures to DE and ALS in men, but not in women. These findings support previous reports of associations between ALS and occupations commonly involving DE exposure.
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Affiliation(s)
- Aisha S Dickerson
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ole Gredal
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marc G Weisskopf
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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30
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Dickerson AS, Hansen J, Kioumourtzoglou MA, Specht AJ, Gredal O, Weisskopf MG. Study of occupation and amyotrophic lateral sclerosis in a Danish cohort. Occup Environ Med 2018; 75:630-638. [PMID: 29941657 DOI: 10.1136/oemed-2018-105110] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Several manuscripts have proposed associations between amyotrophic lateral sclerosis (ALS) and occupational toxicant exposures-not to mention physical activity and trauma/injury. Some have also reported associations in investigations of specific occupations. Using data from a prospective Danish cohort study, we investigated the association between employment in certain industries and ALS diagnosis. METHODS We identified 1826 ALS cases who were 25 years old or less in 1964 and diagnosed from 1982 to 2013 from the Danish National Patient Registry then matched 100 population controls to each case based on birth year and sex. Demographic data were linked to the Danish Pension Fund to determine occupation history. Conditional logistic regression models were adjusted for socioeconomic status, marital status and residential location at the index date. RESULTS There was an increase in odds of ALS among men who worked in agriculture, hunting, forestry or fishing (adjusted OR (aOR)=1.21; 95% CI 1.02 to 1.45). There was also a positive association for men employed in construction (aOR=1.21; 95% CI 1.05 to 1.39). In women, a protective association was seen with employment in the cleaning industry (aOR=0.69; 95% CI 0.52 to 0.93). CONCLUSIONS Our study shows various occupations with exposure to toxicants, such as diesel exhaust and lead, and strenuous physical activity associated with increased odds of ALS in men. Future studies should have a particular focus on gathering detailed information on physical exertion and toxicant exposures specific to certain job tasks.
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Affiliation(s)
- Aisha S Dickerson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Johnni Hansen
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
| | | | - Aaron J Specht
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ole Gredal
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
| | - Marc G Weisskopf
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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31
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Åberg M, Nyberg J, Robertson J, Kuhn G, Schiöler L, Nissbrandt H, Waern M, Torén K. Risk factors in Swedish young men for amyotrophic lateral sclerosis in adulthood. J Neurol 2017; 265:460-470. [PMID: 29285652 PMCID: PMC5834569 DOI: 10.1007/s00415-017-8719-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022]
Abstract
Recent research suggests that the incidence of amyotrophic lateral sclerosis (ALS) may be on the rise. Since ALS becomes predominant in later life, most studies on causal factors are conducted in middle-aged or older populations where potentially important influences from early life can usually not be adequately captured. We aimed to investigate predictors in young Swedish men for ALS in adulthood. Therefore, we performed a prospective cohort study of young men (aged 16-25, n = 1,819,817) who enlisted 1968-2005 and took part in comprehensive conscription examinations. Incident cases of ALS (n = 526) during up to 46 years of follow-up were identified in the National Hospital Register and Swedish Cause of Death Register. Those who developed ALS had lower BMI (body mass index) at conscription than their peers (p = 0.03). The risk of ALS during follow-up was calculated with Cox proportional hazards models. No associations were found with physical fitness, erythrocyte sedimentation rate, or non-psychotic mental disorders. Low overall muscle strength compared to high overall muscle strength [hazard ratio (HR) 1.36; 95% confidence interval (CI) 1.01-1.83] and low BMI (a one-unit increase HR 0.96; 95% CI 0.93-0.99) and lower erythrocyte volume fraction (a one-unit increase HR 0.96; 95% CI 0.92-0.998) were the statistically significant predictors for ALS in adjusted models. These findings provide novel epidemiologic evidence of a prospective association between low overall muscle strength and erythrocyte volume fraction in young men and ALS risk.
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Affiliation(s)
- Maria Åberg
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 454, 405 30, Gothenburg, Sweden.
| | - Jenny Nyberg
- Centre for Brain Repair and Rehabilitation, Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefina Robertson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 454, 405 30, Gothenburg, Sweden
| | - Georg Kuhn
- Centre for Brain Repair and Rehabilitation, Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linus Schiöler
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Nissbrandt
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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32
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Koeman T, Slottje P, Schouten LJ, Peters S, Huss A, Veldink JH, Kromhout H, van den Brandt PA, Vermeulen R. Occupational exposure and amyotrophic lateral sclerosis in a prospective cohort. Occup Environ Med 2017; 74:578-585. [DOI: 10.1136/oemed-2016-103780] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/31/2017] [Accepted: 02/10/2017] [Indexed: 12/12/2022]
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33
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D’Ovidio F, d’Errico A, Calvo A, Costa G, Chiò A. Occupations and amyotrophic lateral sclerosis: are jobs exposed to the general public at higher risk? Eur J Public Health 2017; 27:643-647. [DOI: 10.1093/eurpub/ckx006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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34
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Pearce N, Kromhout H. Occupational causes of amyotrophic lateral sclerosis: where to from here? Occup Environ Med 2016; 74:83-84. [PMID: 27864434 DOI: 10.1136/oemed-2016-103966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/16/2016] [Accepted: 11/02/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Neil Pearce
- Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Public Health Research, Massey University Wellington Campus, Wellington, New Zealand
| | - Hans Kromhout
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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