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Zarokanellou V, Gryparis A, Papatheodorou P, Tatsis G, Tafiadis D, Papadopoulos A, Voniati L, Siafaka V. Societal Attitudes Towards Autism (SATA): Validation of the Greek Version in the General Population. J Autism Dev Disord 2024; 54:1582-1593. [PMID: 36626003 PMCID: PMC10981628 DOI: 10.1007/s10803-022-05842-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 01/11/2023]
Abstract
This study examined the validity of the Greek version of the Societal Attitudes Towards Autism (SATA) scale in a Greek community sample (n = 633) and explored how the demographic variables of the sample modulate knowledge and attitudes regarding people with Autism Spectrum Disorder (ASD). The principal component analysis confirmed the three-dimension model and explained 40.5% of the variance. All Cronbach's alpha values obtained were over 0.70. SATA's subscales were significantly and positively correlated, indicating good internal reliability. Participants presented moderate knowledge about ASD and mediocre positive attitudes towards people with ASD. Gender, age, and educational level significantly affected SATA total scores. Overall, this Greek version of SATA showed acceptable psychometric properties, indicating that can be a reliable scale for use.
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Affiliation(s)
- Vasiliki Zarokanellou
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 4th Km National Road Ioannina-Athens, 45500, Ioannina, Greece
| | - Alexandros Gryparis
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 4th Km National Road Ioannina-Athens, 45500, Ioannina, Greece
| | - Paraskevi Papatheodorou
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 4th Km National Road Ioannina-Athens, 45500, Ioannina, Greece
| | - Giorgos Tatsis
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 4th Km National Road Ioannina-Athens, 45500, Ioannina, Greece
| | - Dionysios Tafiadis
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 4th Km National Road Ioannina-Athens, 45500, Ioannina, Greece
| | | | - Louiza Voniati
- Department of Speech & Language Therapy, Faculty of Sciences, European University, Nicosia, Cyprus
| | - Vassiliki Siafaka
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 4th Km National Road Ioannina-Athens, 45500, Ioannina, Greece.
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Papaleontiou A, Voniati L, Gryparis A, Georgiou R, Siafaka V, Tafiadis D. Cross-Cultural Adaptation and Validation of the Greek Cypriot Montreal Children's Hospital Feeding Scale. Folia Phoniatr Logop 2024:000538427. [PMID: 38508159 DOI: 10.1159/000538427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Assessing pediatric feeding difficulties (PFD) is essential for a child's development to prevent severe consequences. The assessment procedures for PFD may include parents' questionnaires such as the Montreal Children's Hospital Feeding Scale (MCH-FS). The aim of this study was the cross-cultural adaptation of the MCH-FS to the Greek language. METHODS 100 parents of Greek Cypriot children with PFD (clinical group) and 100 parents of healthy Greek Cypriot children (control group) aged six months to 16 years old participated in the study and completed the MCH-FS. World Health Organization (WHO) guidelines were implemented for translation and cultural adaptation. RESULTS The internal consistency was excellent α= 0.85 (ICC: 0.817-0.891). Content validity was significant (S-CVI=1) with an agreement equal to 14. A strong and significant correlation of MCH-FS was computed according to Principal Component Αnalysis (PCA) [14 items ranging between -0.6 and 0.7]. The Kaiser-Meyer-Olkin (KMO) Factor analysis was equal to 0.91 with substantial correlations (Bartlett's test= 0.001654804). The MCH-FS cut-off point between the two groups was 38.00 [AUC 0.901, (95% CI: 0.859-0.942), p<0.001; sensitivity= 0.800 and 1-specificity= 0.630]. A statistically significant difference between the two groups was observed for the MCH-FS total score, with the clinical group scoring higher [U= 992.00, p< 0.001]. Likewise, the same differences were observed among children with different PFD, H (3) = 96.715, p< 0.001. CONCLUSION The MCH-FS had good psychometric properties in its current form in Greek. It is suggested that the MCH-FS can be used as a valid tool for children with PFD in the Greek Cypriot population.
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Zarokanellou V, Tafiadis D, Gryparis A, Prentza A, Voniati L, Ziavra N. The effect of real word stimuli versus non-word stimuli on oral diadochokinetic rates across the life span: An item discrimination analysis. Int J Lang Commun Disord 2024; 59:728-743. [PMID: 37815842 DOI: 10.1111/1460-6984.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Diadochokinetic (DDK) rate tasks are extensively used in the evaluation of speech disorders; however, it is unclear how the different types of speech stimuli affect DDK rate performance. AIMS To investigate the effect of age, gender and type of stimuli (non-words versus real words) on the DDK rates in individuals across the lifespan and to provide normative data for Greek. Also to examine the discrimination ability of the speech DDK stimuli administered (non-words and real words) based on a dual DDK assessment protocol using a polytomous item response theory (IRT) model. METHODS & PROCEDURE The participants were 1747 monolingual Greek speakers (376 children, aged 4-17 years; and 1371 adults, aged 18-90+ years). All participants had normal hearing acuity which allowed them to understand and follow instructions. Participants with a medical condition or a language disorder which would affect DDK rate performance were excluded from the study. The time-by-count method was used, and all participants had to repeat as accurately and fast as possible: (1) four disyllabic non-words (/'gaba/, /'taka/, /'kata/, /'baga/), (2) four disyllabic real words (/'kapa/, /'tapa/, /ka'la/, /'paka/) and (3) two trisyllabic non-words (/'pataka/, /'badaga/). All responses were recorded and the speech samples that did not include at least 5 s of correct repetitions were excluded from the analysis. OUTCOMES & RESULTS Age affected significantly DDK rates with performance increasing gradually until approximately the age of 40 and then gradually decreasing. Gender had no effect. Overall, there was a significant advantage of disyllabic real word stimuli over disyllabic non-word stimuli and of trisyllabic non-word stimuli over disyllabic non-word stimuli on DDK rates performance. IRT analysis suggested that the data fit the polytomous model reasonably well and all DDK stimuli (real words and non-words) showed a strong relationship (loadings > 0.50) with the latent trait. CONCLUSIONS & IMPLICATIONS The current study complements prior research which supports that age and type of stimuli significantly affect DDK rates performance. It is the first study, that testifies to the benefit of real-word stimuli over non-word stimuli on DDK rates across the lifespan in a large representative sample. The implementation of IRT analysis provides empirical evidence about the discrimination ability of the DDK stimuli administered and confirms the reliability of this dual DDK assessment protocol. These findings are valuable for clinicians who work with motor speech disorders. WHAT THIS PAPER ADDS What is already known on this subject Age, type of stimuli (real words versus non-words) and language significantly affect DDK rates performance. Current research strongly suggests the administration of language-specific norms since language-dependent features seem to have a noteworthy effect on the DDK rates, but scarce evidence exists about the discriminatory ability of the DDK speech stimuli commonly administered. What this study adds to the existing knowledge Conflicting findings have been reported about the effect of different types of DDK speech stimuli (real words and non-words) but no study to date has evaluated their discriminatory abilities. The current study is the first to implement a polytomous IRT model to examine this issue. This is also the first study to attempt an investigation of the effect of types of stimuli (real words versus non-words) on a large representative sample across the lifespan (4-90+ years) and to provide normative data for Greek. What are the practical and clinical implications of this work? The present study offers concrete evidence about the advantage of real-word stimuli over non-word stimuli in Greek, as well as normative data for the Greek-speaking populations. Moreover, the IRT analysis testifies to the discriminatory ability of real-word and non-word stimuli affirming the reliability of the present dual DDK assessment protocol as a psychometrically sound measure of DDK ability. The above has significant value for clinicians who work with individuals with motor speech disorders as the protocol can help them with the diagnosis and differential diagnosis of motor speech disorders.
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Affiliation(s)
| | - Dionysios Tafiadis
- Department of Speech & Language Therapy, University of Ioannina, Ioannina, Greece
- Department of Speech & Language Therapy, Faculty of Health Sciences, European University, Engomi Nicosia, Cyprus
| | - Alexandros Gryparis
- Department of Speech & Language Therapy, University of Ioannina, Ioannina, Greece
| | - Alexandra Prentza
- Department of Linguistics, School of Philology, Faculty of Philosophy, University of Ioannina, Ioannina, Greece
| | - Louiza Voniati
- Department of Speech & Language Therapy, Faculty of Health Sciences, European University, Engomi Nicosia, Cyprus
| | - Nafsika Ziavra
- Department of Speech & Language Therapy, University of Ioannina, Ioannina, Greece
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Matsas A, Panopoulou P, Antoniou N, Bargiota A, Gryparis A, Vrachnis N, Mastorakos G, Kalantaridou SN, Panoskaltsis T, Vlahos NF, Valsamakis G. Chronic Stress in Pregnancy Is Associated with Low Birth Weight: A Meta-Analysis. J Clin Med 2023; 12:7686. [PMID: 38137756 PMCID: PMC10743391 DOI: 10.3390/jcm12247686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic activation of the stress system has cumulative effects on the body, and it places individuals at risk for adverse health outcomes. Chronic stress has been assessed by health questionnaires in pregnancy. During the perinatal period, mothers experience increased physical and emotional demands. Chronic stress interferes with hormonal functions in mothers and infants. This meta-analysis studies the effect of maternal chronic stress during pregnancy, as assessed by established stress questionnaires, on the birth weight of their full-term infants. DESIGN AND METHODS According to our criteria and after research collection, we obtained 107 studies and we conducted two types of analyses: a logistic (N = 22,342) and linear regression analysis (N = 7431). RESULTS Our results show that chronic stress is associated with a statistically significant risk of low birth weight (OR = 1.50, CI 95% = [1.13; 1.99], p ≤ 0.02). CONCLUSIONS Increased maternal chronic stress, as assessed by questionnaires, in pregnancy is associated with a low-birth-weight baby. The above meta-analysis indicates that maternal high chronic stress questionnaire scores could be used as a clinical tool in order to assess low-birth-weight risk.
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Affiliation(s)
- Alkis Matsas
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76 Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Panagiota Panopoulou
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76 Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Neofyta Antoniou
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, Chaidari, 12462 Athens, Greece
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Disorders, University Hospital of Larissa, Medical School of Larissa, University of Thessaly, 41334 Larissa, Greece
| | - Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Goudi, 11527 Athens, Greece
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, Chaidari, 12462 Athens, Greece
| | - George Mastorakos
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76 Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Sophia N. Kalantaridou
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, Chaidari, 12462 Athens, Greece
| | - Theodoros Panoskaltsis
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76 Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Nikos F. Vlahos
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76 Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Georgios Valsamakis
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76 Vasilisis Sofias Avenue, 11528 Athens, Greece
- Department of Endocrinology and Metabolic Disorders, University Hospital of Larissa, Medical School of Larissa, University of Thessaly, 41334 Larissa, Greece
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Tigka M, Metallinou D, Nanou C, Iliodromiti Z, Gryparis A, Lykeridou K. Medication Intake as a Factor for Non-Initiation and Cessation of Breastfeeding: A Prospective Cohort Study in Greece during the COVID-19 Pandemic. Children 2023; 10:children10030586. [PMID: 36980144 PMCID: PMC10047701 DOI: 10.3390/children10030586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/22/2023]
Abstract
Pharmacological treatment may become a barrier for a mother’s breastfeeding goals. We aimed to investigate maternal medication intake as a factor for non-initiation and cessation of breastfeeding and the effect of professional counseling on maternal decision-making. Throughout 2020,847 women were recruited from five healthcare institutions. Information was gathered prospectively with an organized questionnaire through interview during hospitalization and through telephone at 1, 3 and 6 months postpartum. Results revealed that from the 57 cases of breastfeeding cessation due to medication intake, only 10.5%received evidence-based counseling from a physician. Unfortunately, 68.4% (n = 39/57) of the participants ceased breastfeeding due to erroneous professional advice. The compatibility of medicines with breastfeeding was examined according to the Lactmed and Hale classification systems, which showed discrepancy in 8 out of 114 medicines used, while 17.5% and 13.2% of the medicines, respectively, were not classified. Educational level, employment at six months postpartum, mode of delivery, previous breastfeeding experience, medication intake for chronic diseases, physician’s recommendation and smoking before pregnancy were factors significantly correlated with breastfeeding discontinuation due to medication intake. The COVID-19 restrictions protected women from ceasing breastfeeding due to medication intake. Maternal and lactation consultancy should be strictly related to evidence-based approaches.
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Affiliation(s)
- Maria Tigka
- Department of Midwifery, University of West Attica, 12243 Athens, Greece; (M.T.)
- Department of Obstetric Emergency, General and Maternity Hospital “Helena Venizelou”, 11521 Athens, Greece
| | - Dimitra Metallinou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece; (M.T.)
| | - Christina Nanou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece; (M.T.)
| | - Zoi Iliodromiti
- Department of Neonatology, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Alexandros Gryparis
- Department of Speech and Language Therapy, University of Ioannina, 45500 Ioannina, Greece
| | - Katerina Lykeridou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece; (M.T.)
- Correspondence:
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Kyritsi EM, Vasilakis IA, Kosteria I, Mantzou A, Gryparis A, Kassi E, Kaltsas G, Kanaka-Gantenbein C. High frequency of autoimmune thyroiditis in euthyroid girls with premature adrenarche. Front Pediatr 2023; 11:1064177. [PMID: 37009276 PMCID: PMC10060666 DOI: 10.3389/fped.2023.1064177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Objective The purpose of this study was to investigate the frequency of autoimmune thyroiditis (AT) among euthyroid prepubertal girls presenting with premature adrenarche (PA). We also aimed to identify the clinical, metabolic, and endocrine profile of girls with AT and concurrent PA and compare them to girls with AT without PA, PA alone and healthy controls. Methods Ninety-one prepubertal girls aged 5-10 years, who attended our department for AT, PA and normal variants of growth and puberty were recruited for the study: 73 girls had PA, 6 AT without PA and 12 were referred for investigation of growth. All girls underwent clinical examination, detailed biochemical and hormonal screen. Standard dose Synachten stimulation test (SDSST) and oral glucose tolerance test (OGTT) were performed in all girls with PA. The whole study population was divided in 4 groups: Group PA-/AT+ included 6 girls with AT without PA; Group PA+/AT- PA subjects without AT; Group PA+/AT+ girls with PA and concomitant AT; Group PA-/AT- twelve healthy girls without PA nor AT (controls). Results Among 73 girls presenting with PA 19 had AT (26%). BMI, systolic blood pressure (SBP) and the presence of goiter significantly differed between the four groups (p = 0.016, p = 0.022 and p < 0.001, respectively). When comparing hormonal parameters among the four groups significant differences were found in leptin (p = 0.007), TSH (p = 0.044), anti-TPO (p = 0.002), anti-TG (p = 0.044), IGF-BP1 (p = 0.006), Δ4-Α (p = 0.01), DHEA-S (p = <0.001), IGF-1 (p = 0.012) and IGF-BP3 (p = 0.049) levels. TSH levels were significantly higher in Group PA+/AT+ compared to PA+/AT- and PA-/AT- (p = 0.043 and p = 0.016, respectively). Moreover, girls with AT (Groups PA-/AT+ and PA+/AT+) had higher TSH levels than those in Group PA+/AT- (p = 0.025). Girls in Group PA+/AT + showed higher cortisol response at 60 min post-SDSST than girls in Group PA+/AT- (p = 0.035). During the OGTT, insulin concentrations at 60 min were significantly higher in Group PA+/AT + compared to Group PA+/AT- (p = 0.042). Conclusion A high frequency of AT among euthyroid prepubertal girls with PA was observed. The combination of PA with AT even in euthyroid state may be associated with a greater degree of insulin resistance, than PA alone.
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Affiliation(s)
- Eleni Magdalini Kyritsi
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Ioannis-Anargyros Vasilakis
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Ioanna Kosteria
- Department of Endocrinology, Growth and Development, P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Aimilia Mantzou
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Alexandros Gryparis
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Eva Kassi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Endocrine Unit, 1st Department of Propaedeutic Internal Medicine, “Laiko” General Hospital, Medical School, National and Kapodistrian University of Athens,Athens, Greece
| | - Gregory Kaltsas
- Endocrine Unit, 1st Department of Propaedeutic Internal Medicine, “Laiko” General Hospital, Medical School, National and Kapodistrian University of Athens,Athens, Greece
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
- Correspondence: Christina Kanaka-Gantenbein
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Duracinsky M, Chassany O, Gryparis A, Bodeveix A. Psychometrics properties of a new scale to evaluate the impact of dry eye on daily life and the patient satisfaction using eye drops. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.0632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Martin Duracinsky
- Hotel‐Dieu Hospital, AP‐HP & University Paris Cité, Patient‐Reported Outcomes, Health Economics Clinical Trial unit Paris France
| | - Olivier Chassany
- Hotel‐Dieu Hospital, AP‐HP & University Paris Cité, Patient‐Reported Outcomes, Health Economics Clinical Trial unit Paris France
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Anagnostopoulou K, Tzanakaki D, Gryparis A, Demeridou S, Baka S. Seminal plasma visfatin levels negatively correlate with sperm concentration. Folia Med (Plovdiv) 2022; 64:283-287. [DOI: 10.3897/folmed.64.e61657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/08/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction: Visfatin is involved in nicotinamide adenine dinucleotide biosynthesis, with a possible role in spermatogenesis. We investigated seminal plasma visfatin levels and its possible correlations with sperm parameters (concentration, motility, morphology) and BMI.
Materials and methods: We included 79 semen samples obtained from men from infertile couples presenting for sperm analysis. The samples were divided into 2 groups: a group of 35 samples with normal sperm parameters and another group of 44 samples with at least one abnormal sperm parameter. Seminal plasma visfatin levels were determined using commercially available enzyme-linked immunosorbent assay kits.
Results: Demographic data and body mass index (BMI) were similar in our subjects. As expected, the sperm parameters were significantly different between the 2 groups we studied. Visfatin levels did not differ between groups (66.6 ng/ml in normal samples and 72.7 ng/ml in abnormal samples, p=0.114) and did not correlate with sperm motility, sperm morphology, and BMI. However, a negative correlation between visfatin levels and sperm concentration (r=−0.28; p=0.014) and sperm count (r=−0.3; p=0.009), respectively, was detected.
Conclusions: Visfatin was detected in all human seminal plasma samples. Although its levels were similar in subjects with and without normal sperm parameters, a role for visfatin in sperm physiology cannot be ruled out at this point and further research is required.
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Halkiadakis I, Gryparis A, Markopoulos I, Konstadinidou V, Zintzaras E, Tzakos M. Evaluation of Corvis ST tonometer with the updated software in glaucoma practice. Int J Ophthalmol 2022; 15:438-445. [DOI: 10.18240/ijo.2022.03.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
AIM: To evaluate the agreement of biomechanically corrected intraocular pressure (b-IOP) and central corneal thickness (CCT) measurements obtained with the updated Corvis ST tonometer versus Goldmann applanation tonometry (GAT) and optical-based corneal pachymetry (OB-CCT) in controls, patients with ocular hypertension (OHT) and primary open angle glaucoma (POAG). Additionally, we examined the differences in corneal deformation parameters provided by the updated Corvis ST among the three groups.
METHODS: For each participant, GAT IOP, OB-CCT and measurements with a Corvis ST with updated software were obtained. Bland-Altman analysis was used to assess the agreement between the two measurement methods.
RESULTS: A consecutive series of 80 eyes from 80 participants (30 with POAG, 25 with OHT and 25 normal controls) were included in this prospective study. The mean GAT IOP of all eyes was 17.2±3.6 mm Hg, and the mean b-IOP was 15.9±3.7 mm Hg (Spearman's rho=0.767, P<0.001). The 95% limits of agreement (LoAs) ranged from -3.1 mm Hg to 5.5 mm Hg for GAT IOP and b-IOP. b-IOP was not correlated with OB-CCT (Spearman's rho=-0.13 P=0.917). Meanwhile there was a weak positive corelation between OB-CCT and GAT IOP–b-IOP difference (Spearman's rho=0.378, P=0.001). The mean OB-CCT was 549.5±36.4 µm, and the Corvis-CCT was 556.1±41.5 µm (Spearman's rho=0.900, P<0.001). No statistically significant difference in the new indices provided by the updated Corvis ST was detected among the three groups. Compared with control eyes, POAG eyes had a significantly reduced applanation time 2 after adjusting for OB-CCT and GAT IOP (P=0.048).
CONCLUSION: Corvis b-IOP and CCT correlate well with GAT IOP and OB-CCT. b-IOP is not affected by CCT, which might be an advantage, especially in thick or thin corneas. Corvis ST yields shorter applanation time 2 measurements in patients with POAG, which might reflect altered corneal viscoelasticity.
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Konstantakou P, Chalarakis N, Valsamakis G, Sakkas EG, Vousoura E, Gryparis A, Sakkas GE, Papadimitriou G, Zervas I, Mastorakos G. Associations of Thyroid Hormones Profile During Normal Pregnancy and Postpartum With Anxiety, Depression, and Obsessive/Compulsive Disorder Scores in Euthyroid Women. Front Neurosci 2021; 15:663348. [PMID: 34421508 PMCID: PMC8371251 DOI: 10.3389/fnins.2021.663348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Thyroid dysfunction (overt and subclinical) has been consistently linked to pregnancy adversity and abnormal fetal growth and development. Mood disorders such as anxiety, depression, and obsessive-compulsive disorder (OCD) are frequently diagnosed during pregnancy and at postpartum, and emerging evidence suggests association with impaired offspring neurodevelopment and growth. This study aimed to examine potential associations between thyroid function and mood symptoms during pregnancy and postpartum. Design This is a prospective study measuring thyroid hormones and assessing mood symptoms by employing specific questionnaires in the same cohort of 93 healthy pregnant women at the 24th (2nd trimester) and 36th (3rd trimester) gestational weeks and at the 1st postpartum week. Methods Serum thyroid hormones, TSH, anti-TPO, and anti-Tg antibodies were measured at the 24th (2nd trimester) and 36th (3rd trimester) gestational weeks and at the 1st postpartum week. Specific validated questionnaires were employed at the same time-points to assess separately symptoms of anxiety [Generalized Anxiety Disorder Inventory (GADI), Penn State Worry Questionnaire (PSWQ), STAI-State Anxiety inventory (STAI-S), STAI-Trait Anxiety Inventory (STAI-T)], depression [Edinburgh Postnatal Depression Scale (EPDS), Stein’s Blues Scale (BLUES), Beck Depression Inventory (BDI)], and obsessive compulsive disorder (OCD) [Yale-Brown Obsessive Compulsive scale (Y-BOCS)]. Results At the 2nd trimester, GADI score correlated negatively with FT3 (p < 0.010, r = −0.545) and positively with TSH (p < 0.050, r = 0.837) concentrations; GADI, PSWQ, EPDS and Y-BOCS scores correlated negatively with FT4 concentrations (p < 0.010, r = −0.768; p < 0.010, r = −0.384; p < 0.050, r = −0.364; p < 0.010, r = −0.544, respectively). At the 3rd trimester, BLUES score correlated positively with rT3 concentrations (p = 0.00, r = 0.89); GADI, EPDS, and Y-BOCS scores correlated negatively with FT4 concentrations (p = 0.001, r = − 0.468; p = 0.036, r = −0.39; p = 0.001, r = −0.625, respectively); GADI, STAI-S, and Y-BOCS scores correlated positively with TSH concentrations (p = 0.015, r = 0.435; p = 0.024, r = 0.409 p = 0.041, r = 0.389, respectively). At postpartum, PSWQ, STAI-T, EPDS, and BDI scores correlated positively with rT3 concentrations (p = 0.024, r = 0.478; p = 0.014, r = 0.527; p = 0.046, r = 0.44; p = 0.021, r = 0.556, respectively, Y-BOCS score correlated positively with TSH (p = 0.045, r = 0.43), and BLUES score correlated positively with anti-TPO antibody concentrations (p = 0.070, r = 0.586). Conclusion The reported findings demonstrate positive associations between low-normal thyroid function at the 2nd and 3rd trimesters of pregnancy and postpartum with anxiety, depression, and OCD scores.
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Affiliation(s)
- Panagiota Konstantakou
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Medical School, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Unit of Endocrinology, Diabetes Mellitus and Metabolism, Alexandra General Hospital, Athens, Greece
| | - Nikos Chalarakis
- Department of Psychiatry, Eginition Hospital, Athens University Medical School, Athens, Greece
| | - Georgios Valsamakis
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Medical School, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Grigoriou Sakkas
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Medical School, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Rea Maternity, Private Hospital, Athens, Greece
| | - Eleni Vousoura
- Department of Psychiatry, Eginition Hospital, Athens University Medical School, Athens, Greece
| | - Alexandros Gryparis
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Medical School, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - George Papadimitriou
- Department of Psychiatry, Eginition Hospital, Athens University Medical School, Athens, Greece
| | - Ioannis Zervas
- Department of Psychiatry, Eginition Hospital, Athens University Medical School, Athens, Greece
| | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Medical School, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
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11
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Voulgaris N, Tyfoxylou E, Vlachou S, Kyriazi E, Gravvanis C, Kapsali C, Markou A, Papanastasiou L, Gryparis A, Kassi E, Chrousos G, Kaltsas G, Piaditis G. Prevalence of Primary Aldosteronism Across the Stages of Hypertension Based on a New Combined Overnight Test. Horm Metab Res 2021; 53:461-469. [PMID: 34282597 DOI: 10.1055/a-1507-5226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Primary aldosteronism (PA) is the most common endocrine cause of arterial hypertension. Despite the increasing incidence of hypertension worldwide, the true prevalence of PA in hypertension was only recently recognized. The objective of the work was to estimate the prevalence of PA in patients at different stages of hypertension based on a newly developed screening-diagnostic overnight test. This is a prospective study with hypertensive patients (n=265) at stage I (n=100), II (n=88), and III (n=77) of hypertension. A group of 103 patients with essential hypertension without PA was used as controls. PA diagnosis was based on a combined screening-diagnostic overnight test, the Dexamethasone-Captopril-Valsartan Test (DCVT) that evaluates aldosterone secretion after pharmaceutical blockade of angiotensin-II and adrenocorticotropic hormone. DCVT was performed in all participants independently of the basal aldosterone to renin ratio (ARR). The calculated upper normal limits for post-DCVT aldosterone levels [3 ng/dl (85 pmol/l)] and post-DCVT ARR [0.32 ng/dl/μU/ml (9 pmol/IU)] from controls, were applied together to establish PA diagnosis. Using these criteria PA was confirmed in 80 of 265 (30%) hypertensives. The prevalence of PA was: 21% (21/100) in stage I, 33% (29/88) in stage II, and 39% (30/77) in stage III. Serum K+ levels were negatively correlated and urinary K+ was positively correlated in PA patients with post-DCVT ARR (r=-0.349, p <0.01, and r=0.27, p <0.05 respectively). In conclusion, DCVT revealed that PA is a highly prevalent cause of hypertension. DCVT could be employed as a diagnostic tool in all subjects with arterial hypertension of unknown cause.
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Affiliation(s)
- Nick Voulgaris
- Department of Endocrinology and Diabetes Center, "G. Gennimatas" General Hospital of Athens, Athens, Greece
- Department of Endocrinology, Athens Naval and Veterans Hospital, Athens, Greece
| | - Ernestini Tyfoxylou
- Department of Endocrinology and Diabetes Center, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Sophia Vlachou
- Department of Endocrinology and Diabetes Center, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Evagelia Kyriazi
- Department of Endocrinology and Diabetes Center, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Chris Gravvanis
- Department of Endocrinology and Diabetes Center, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Chara Kapsali
- Department of Endocrinology and Diabetes Center, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Athina Markou
- Department of Endocrinology and Diabetes Center, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Labrini Papanastasiou
- Department of Endocrinology and Diabetes Center, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Alexandros Gryparis
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, Medical National and Kapodistrian University of Athens, Athens, Greece
| | - Eva Kassi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Athens, Greece
| | - Gregory Kaltsas
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Piaditis
- Department of Endocrinology and Diabetes Center, "G. Gennimatas" General Hospital of Athens, Athens, Greece
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12
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Laios A, Gryparis A, DeJong D, Hutson R, Theophilou G, Leach C. Predicting complete cytoreduction for advanced ovarian cancer patients using nearest-neighbor models. J Ovarian Res 2020; 13:117. [PMID: 32993745 PMCID: PMC7526140 DOI: 10.1186/s13048-020-00700-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022] Open
Abstract
Background The foundation of modern ovarian cancer care is cytoreductive surgery to remove all macroscopic disease (R0). Identification of R0 resection patients may help individualise treatment. Machine learning and AI have been shown to be effective systems for classification and prediction. For a disease as heterogenous as ovarian cancer, they could potentially outperform conventional predictive algorithms for routine clinical use. We investigated the performance of an AI system, the k-nearest neighbor (k-NN) classifier, to predict R0, comparing it with logistic regression. Patients diagnosed with advanced stage, high grade serous ovarian, tubal and primary peritoneal cancer, undergoing surgical cytoreduction from 2015 to 2019, was selected from the ovarian database. Performance variables included age, BMI, Charlson Comorbidity Index, timing of surgery, surgical complexity and disease score. The k-NN algorithm classified R0 vs non-R0 patients using 3–20 nearest neighbors. Prediction accuracy was estimated as percentage of observations in the training set correctly classified. Results 154 patients were identified, with mean age of 64.4 + 10.5 yrs., BMI of 27.2 + 5.8 and mean SCS of 3 + 1 (1–8). Complete and optimal cytoreduction was achieved in 62 and 88% patients. The mean predictive accuracy was 66%. R0 resection prediction of true negatives was as high as 90% using k = 20 neighbors. Conclusions The k-NN algorithm is a promising and versatile tool for R0 resection prediction. It slightly outperforms logistic regression and is expected to improve accuracy with data expansion.
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Affiliation(s)
- Alexandros Laios
- Department of Gynaecological Oncology, St James's University Hospital, Leeds Teaching Hospitals, Leeds, LS9 7TF, UK.
| | - Alexandros Gryparis
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaion Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Diederick DeJong
- Department of Gynaecological Oncology, St James's University Hospital, Leeds Teaching Hospitals, Leeds, LS9 7TF, UK
| | - Richard Hutson
- Department of Gynaecological Oncology, St James's University Hospital, Leeds Teaching Hospitals, Leeds, LS9 7TF, UK
| | - Georgios Theophilou
- Department of Gynaecological Oncology, St James's University Hospital, Leeds Teaching Hospitals, Leeds, LS9 7TF, UK
| | - Chris Leach
- School of Human & Health Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK.,Department of Psychology Services, South West Yorkshire Mental Health NHS Foundation Trust, The Laura Mitchell Health & Wellbeing Centre, Halifax, HX1 1YR, UK
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13
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Benetou V, Tavoulari E, Gryparis A, Linos A. Reducing Caesarean sections and smoking after delivery could help to tackle shorter exclusive breastfeeding duration. Acta Paediatr 2019; 108:2107-2108. [PMID: 31273844 DOI: 10.1111/apa.14927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Vassiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics School of Medicine National and Kapodistrian University of Athens Athens Greece
| | | | - Alexandros Gryparis
- Unit of Endocrinology Diabetes Mellitus and Metabolism 2nd Department of Obstetrics and Gynecology Aretaieion Hospital School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Athina Linos
- Institute of Preventive Medicine Environmental and Occupational Health Athens Greece
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14
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Legakis I, Adamopoulos D, Stamatiou I, Gryparis A, Chrousos GP. Divergent Patterns of Thyrotropin and Other Thyroidal Parameters in Relationship with the Sex of Healthy Neonates and Infants Less than Two Years Old: A Longitudinal Study. Thyroid 2019; 29:920-927. [PMID: 31084414 DOI: 10.1089/thy.2018.0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: A longitudinal study was conducted in full-term healthy infants who were born between 2015 and 2017 in Athens, Greece, to elucidate the evolution of thyrotropin (TSH) and other thyroidal parameters according to sex, from their day of birth until two years old. Other thyroidal parameters that were taken into account include antithyroid peroxidase antibody (TPO-Ab) and antithyroglobulin antibody (TG-Ab), total triiodothyronine (T3), and free triiodothyronine (fT3), along with total thyroxine (T4) and free thyroxine (fT4). Methods: Blood samples were taken at 5-day intervals from the day of birth until the 31st day of life, and then every 5th month until 2 years of age. All thyroid parameters were measured by electrochemiluminescence immunoassays. The study took place at the Iaso General, Maternity and Gynecological Clinic in Athens, Greece. Results: The sample consisted of 2916 full-term healthy neonates/infants: 1507 (51.7%) boys and 1409 (48.3%) girls. There were no significant differences in TSH levels between boys and girls in all time periods from birth up to 2 years except between 11 and 15 months of age (p = 0.038). Mean TSH levels for boys exhibited much more fluctuation and variability than for girls. In boys we found a significant association between TSH levels and fT4 (p < 0.001), while we found a significant association between TSH levels and T3 in girls (p = 0.045). Furthermore, we found that mean TPO-Ab and TG-Ab levels for boys exhibited larger variability than those for girls. Conclusions: In this study, we were able to plot the development of TSH and other thyroidal parameters by sex from birth up to two years of age. In terms of clinical practice, our findings suggest the need for a re-evaluation of the reference ranges of the studied parameters according to sex, especially in the first months of life and until the first year. Furthermore, our results suggest new optimal ranges for thyroid hormone replacement for that specific period.
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Affiliation(s)
- Ioannis Legakis
- 1Department of Endocrinology and Metabolism, Iaso General Hospital, Athens, Greece
| | - Dimitrios Adamopoulos
- 2Biomedical Support Service, and IASO, General Maternity and Gynecology Clinic, Marousi-Athens, Greece
| | - Ioannis Stamatiou
- 3Department of Obstetrics and Gynecology, IASO, General Maternity and Gynecology Clinic, Marousi-Athens, Greece
| | - Alexandros Gryparis
- 4Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - George P Chrousos
- 5First Department of Pediatrics, Aghia Sophia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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15
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Harris MH, Gold DR, Rifas-Shiman SL, Melly SJ, Zanobetti A, Coull BA, Schwartz JD, Gryparis A, Kloog I, Koutrakis P, Bellinger DC, White RF, Sagiv SK, Oken E. Erratum: Prenatal and Childhood Traffic-Related Pollution Exposure and Childhood Cognition in the Project Viva Cohort (Massachusetts, USA). Environ Health Perspect 2019; 127:69001. [PMID: 31180240 PMCID: PMC6791570 DOI: 10.1289/ehp5476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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16
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Sakkas EG, Paltoglou G, Linardi A, Gryparis A, Nteka E, Chalarakis N, Mantzou A, Vrachnis N, Iliodromiti Z, Koukkou E, Deligeoroglou E, Sakkas GE, Mastorakos G. Associations of maternal oestradiol, cortisol, and TGF-β1 plasma concentrations with thyroid autoantibodies during pregnancy and postpartum. Clin Endocrinol (Oxf) 2018; 89:789-797. [PMID: 30151971 DOI: 10.1111/cen.13843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thyroid physiology and autoimmunity are altered in pregnancy. While oestradiol, cortisol, and TGF-β1 are implicated in these phenomena outside pregnancy, their associations with thyroid autoantibodies during pregnancy and postpartum are not thoroughly examined. This study aimed to unravel their eventual associations during pregnancy and postpartum in the same cohort of 93 pregnant women studied prospectively from 2015 to 2017. METHODS Blood samples were drawn at the 24th and the 36th gestational week and at the 1st postpartum week for measurements of thyroid hormones, TSH, anti-TPO, anti-Tg, oestradiol, cortisol, and TGF-β1. RESULTS Serum anti-TPO was greater (P < 0.05) at the 1st postpartum than at the 24th and 36th gestational weeks. At the 36th gestational week, cortisol was greater (P < 0.05) and TGF-β1 lower (P < 0.05) than at the 24th gestational and the 1st postpartum weeks. At the 1st postpartum week, cortisol correlated negatively with anti-Tg (r = -0.419) (P < 0.05). ΔTGF-β1 was the best negative and Δoestradiol the best positive predictor of the 1st postpartum week anti-TPO (P < 0.05, b = -0.509; P < 0.05, b = 0.459 respectively). CONCLUSIONS At postpartum, increased TGF-β1 is related to a less pronounced anti-TPO increase as compared to the 3rd trimester, suggesting an immunosuppressive role for TGF-β1. During pregnancy and postpartum, oestradiol, cortisol, and TGF-β1 are associated with suppression of thyroid autoantibodies.
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Affiliation(s)
- Evangelos G Sakkas
- Unit of Endocrinology, Diabetes mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Paltoglou
- Department of Endocrinology and Diabetes, Great Ormond Street Hospital, London, UK
| | | | - Alexandros Gryparis
- Unit of Endocrinology, Diabetes mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Nteka
- Unit of Endocrinology, Diabetes mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikos Chalarakis
- Unit of Endocrinology, Diabetes mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aimilia Mantzou
- Department of Endocrinology, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Vrachnis
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoe Iliodromiti
- Department of Neonatology, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eftychia Koukkou
- Endocrine Unit, Elena Venizelou Maternity Hospital, Athens, Greece
| | - Efthymios Deligeoroglou
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - George Mastorakos
- Unit of Endocrinology, Diabetes mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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17
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Rokoff LB, Rifas-Shiman SL, Coull BA, Cardenas A, Calafat AM, Ye X, Gryparis A, Schwartz J, Sagiv SK, Gold DR, Oken E, Fleisch AF. Cumulative exposure to environmental pollutants during early pregnancy and reduced fetal growth: the Project Viva cohort. Environ Health 2018; 17:19. [PMID: 29458383 PMCID: PMC5819079 DOI: 10.1186/s12940-018-0363-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/11/2018] [Indexed: 05/06/2023]
Abstract
BACKGROUND Reduced fetal growth is associated with perinatal and later morbidity. Prenatal exposure to environmental pollutants is linked to reduced fetal growth at birth, but the impact of concomitant exposure to multiple pollutants is unclear. The purpose of this study was to examine interactions between early pregnancy exposure to cigarette smoke, traffic pollution, and select perfluoroalkyl substances (PFASs) on birth weight-for-gestational age (BW/GA). METHODS Among 1597 Project Viva mother-infant pairs, we assessed maternal cigarette smoking by questionnaire, traffic pollution at residential address by black carbon land use regression model, and plasma concentration of select PFASs in early pregnancy. We calculated sex-specific BW/GA z-scores, an index of fetal growth, from national reference data. We fit covariate-adjusted multi-pollutant linear regression models and examined interactions between exposures, using a likelihood-ratio test to identify a best-fit model. RESULTS Two hundred six (13%) mothers smoked during pregnancy. Mean [standard deviation (SD)] for black carbon was 0.8 (0.3) μg/m3, perfluorooctane sulfonate (PFOS) was 29.1 (16.5) ng/mL, and BW/GA z-score was 0.19 (0.96). In the best-fit model, BW/GA z-score was lower in infants of mothers exposed to greater black carbon [- 0.08 (95% CI: -0.15, - 0.01) per interquartile range (IQR)]. BW/GA z-score (95% CI) was also lower in infants of mothers who smoked [- 0.09 (- 0.23, 0.06)] or were exposed to greater PFOS [- 0.03 (- 0.07, 0.02) per IQR], although confidence intervals crossed the null. There were no interactions between exposures. In secondary analyses, instead of PFOS, we examined perfluorononanoate (PFNA) [mean (SD): 0.7 (0.4) ng/mL], a PFAS more closely linked to lower BW/GA in our cohort. The best-fit multi-pollutant model included positive two-way interactions between PFNA and both black carbon and smoking (p-interactions = 0.03). CONCLUSIONS Concurrent prenatal exposures to maternal smoking, black carbon, and PFOS are additively associated with lower fetal growth, whereas PFNA may attenuate associations of smoking and black carbon with lower fetal growth. It is important to examine interactions between multiple exposures in relation to health outcomes, as effects may not always be additive and may shed light on biological pathways.
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Affiliation(s)
- Lisa B. Rokoff
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215 USA
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215 USA
| | - Brent A. Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Andres Cardenas
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215 USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Sharon K. Sagiv
- Center for Environmental Research and Children’s Health, University of California, Berkeley, CA USA
- Division of Epidemiology, University of California, Berkeley School of Public Health, Berkeley, CA USA
| | - Diane R. Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215 USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Abby F. Fleisch
- Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, ME USA
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME USA
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18
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Marakaki C, Karapanou O, Gryparis A, Hochberg Z, Chrousos G, Papadimitriou A. Early Adiposity Rebound and Premature Adrenarche. J Pediatr 2017; 186:72-77. [PMID: 28457524 DOI: 10.1016/j.jpeds.2017.03.058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/28/2017] [Accepted: 03/27/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To examine differences in the growth pattern and the age at adiposity rebound (AR) between children with premature adrenarche (PA) and their healthy peers (controls). STUDY DESIGN In this cross-sectional study of 82 prepubertal children with PA and 63 controls, the main outcome measures were height and body mass index SDS progression, from birth to presentation at the clinic, baseline biochemical and hormonal evaluation, bone age determination, and age at AR. RESULTS Children with PA were significantly taller and more adipose than controls from the first years of life. 33% of children with PA presented the growth pattern of constitutional advancement of growth (ie, early growth acceleration) vs 19% of controls (P = .045). Children with PA had an earlier AR compared with controls; mean age at AR in girls with PA was 3.73 (1.03) years vs 4.93 (1.36) years for control girls (P = .001) and in boys with PA was 3.45 (0.73) vs 5.10 (1.50) years in control boys (P = .048). Both obese and nonobese girls with PA were taller and had earlier age at AR compared with nonobese controls. CONCLUSIONS Early AR and constitutional advancement of growth may be triggering factors for adrenal androgen production and PA.
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Affiliation(s)
- Chrisanthi Marakaki
- Third Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Olga Karapanou
- Third Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Ze'ev Hochberg
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - George Chrousos
- First Department of Pediatrics, Division of Endocrinology, Metabolism and Diabetes, National and Kapodistrian University of Athens School of Medicine, Aghia Sophia Children's Hospital, Athens, Greece
| | - Anastasios Papadimitriou
- Third Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine, "Attikon" University Hospital, Athens, Greece.
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Tavoulari EF, Benetou V, Vlastarakos PV, Psaltopoulou T, Chrousos G, Kreatsas G, Gryparis A, Linos A. Factors affecting breastfeeding duration in Greece: What is important? World J Clin Pediatr 2016; 5:349-357. [PMID: 27610353 PMCID: PMC4978630 DOI: 10.5409/wjcp.v5.i3.349] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate factors associated with breastfeeding duration (BD) in a sample of mothers living in Greece.
METHODS: Four hundred and twenty-eight mothers (438 infants) were initially recruited in a tertiary University Hospital. Monthly telephone interviews (1665 in total) using a structured questionnaire (one for each infant) were conducted until the sixth postpartum month. Cox regression analysis was used to assess factors influencing any BD.
RESULTS: Any breastfeeding rates in the first, third, and sixth month of the infant’s life reached 87.5%, 57.0% and 38.75%, respectively. In the multivariate analysis, maternal smoking in the lactation period [hazard-ratio (HR) = 4.20] and psychological status (HR = 1.72), and the introduction of a pacifier (HR = 2.08), were inversely associated, while higher maternal education (HRuniversity/collegevsprimary/high school = 0.53, HRmaster’svsprimary/high school = 0.20), and being an immigrant (HR = 0.35) were positively associated with BD.
CONCLUSION: Public health interventions should focus on campaigns against smoking during lactation, target women of lower educational status, and endorse the delayed introduction of pacifiers.
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Nezi M, Christopoulos P, Paltoglou G, Gryparis A, Bakoulas V, Deligeoroglou E, Creatsas G, Mastorakos G. Focus on BMI and subclinical hypothyroidism in adolescent girls first examined for amenorrhea or oligomenorrhea. The emerging role of polycystic ovary syndrome. J Pediatr Endocrinol Metab 2016; 29:693-702. [PMID: 27089404 DOI: 10.1515/jpem-2015-0312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/09/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Primary amenorrhea, oligomenorrhea and secondary amenorrhea are diagnosed commonly during adolescence. Weight aberrations are associated with menstrual disorders. Autoimmune thyroiditis is frequent during adolescence. In this study, the commonest clinical and hormonal characteristics of amenorrhea or oligomenorrhea during adolescence were investigated. METHODS In this cross-sectional study, one hundred and thirty-eight consecutive young patients presenting with amenorrhea or oligomenorrhea referred to an adolescent endocrinology and gynecology university clinic were studied. Clinical examination and an abdominal ultrasound were performed. Testosterone, free-testosterone, estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), dehydroepiandrosterone sulfate (DHEA-S), 17-OH progesterone, sex hormone binding globulin (SHBG), Δ4-androstenedione (Δ4A), free androgen index (FAI), insulin, glucose, thyroid stimulating hormone (TSH), total thyroxine (T4) (TT4), free T4 (FT4), total triiodothyronine (T3) (TT3) and free T3 (FT3). Concentrations were measured in blood samples. RESULTS Patients with primary and secondary amenorrhea presented more often with body mass index (BMI) <18.5 and BMI >25 kg/m2, respectively. BMI values correlated positively with insulin (r=0.742) and glucose (r=0.552) concentrations and negatively with glucose/insulin ratio values (r=-0.54); BMI values and insulin concentrations correlated positively with FAI values (r=0.629 and r=0.399, respectively). In all patients, BMI values correlated positively and negatively with free testosterone (r=0.249) and SHBG (r=-0.24) concentrations, respectively. In patients with secondary amenorrhea insulin concentrations correlated negatively with SHBG concentrations (r=-0.75). In patients with oligomenorrhea BMI values correlated positively with insulin (r=0.490) and TSH (r=0.325) concentrations, and negatively with SHBG (r=-0.33) concentrations. Seventy-two percent, 21% and 7% of patients presented with TSH concentrations <2.5 μIU/mL, between 2.5 μIU/mL, 4.5 μIU/mL and >4.5 μIU/mL (subclinical hypothyroidism), respectively. Following the definition of polycystic ovary syndrome (PCOS) according to either the National Institutes of Health (NIH) criteria or those proposed in the literature by Carmina and his team, patients presented mainly with oligomenorrhea or secondary amenorrhea. There was good agreement between patients with amenorrhea or oligomenorrhea fulfilling both of the PCOS definition criteria employed. CONCLUSIONS Among adolescent patients presenting with amenorrhea or oligomenorrhea for the first time those with low and high BMI present more often with primary and secondary amenorrhea, respectively. Obesity is involved in the development of hyperandrogenemia and hyperinsulinemia, particularly in PCOS patients. In these patients, subclinical hypothyroidism may be concealed and it should be investigated. These patients should be treated for abnormally increased or decreased BMI and be investigated for autoimmune thyroiditis.
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Tsai MY, Hoek G, Eeftens M, de Hoogh K, Beelen R, Beregszászi T, Cesaroni G, Cirach M, Cyrys J, De Nazelle A, de Vocht F, Ducret-Stich R, Eriksen K, Galassi C, Gražuleviciene R, Gražulevicius T, Grivas G, Gryparis A, Heinrich J, Hoffmann B, Iakovides M, Keuken M, Krämer U, Künzli N, Lanki T, Madsen C, Meliefste K, Merritt AS, Mölter A, Mosler G, Nieuwenhuijsen MJ, Pershagen G, Phuleria H, Quass U, Ranzi A, Schaffner E, Sokhi R, Stempfelet M, Stephanou E, Sugiri D, Taimisto P, Tewis M, Udvardy O, Wang M, Brunekreef B. Spatial variation of PM elemental composition between and within 20 European study areas--Results of the ESCAPE project. Environ Int 2015; 84:181-92. [PMID: 26342569 DOI: 10.1016/j.envint.2015.04.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 04/30/2015] [Accepted: 04/30/2015] [Indexed: 05/12/2023]
Abstract
An increasing number of epidemiological studies suggest that adverse health effects of air pollution may be related to particulate matter (PM) composition, particularly trace metals. However, we lack comprehensive data on the spatial distribution of these elements. We measured PM2.5 and PM10 in twenty study areas across Europe in three seasonal two-week periods over a year using Harvard impactors and standardized protocols. In each area, we selected street (ST), urban (UB) and regional background (RB) sites (totaling 20) to characterize local spatial variability. Elemental composition was determined by energy-dispersive X-ray fluorescence analysis of all PM2.5 and PM10 filters. We selected a priori eight (Cu, Fe, K, Ni, S, Si, V, Zn) well-detected elements of health interest, which also roughly represented different sources including traffic, industry, ports, and wood burning. PM elemental composition varied greatly across Europe, indicating different regional influences. Average street to urban background ratios ranged from 0.90 (V) to 1.60 (Cu) for PM2.5 and from 0.93 (V) to 2.28 (Cu) for PM10. Our selected PM elements were variably correlated with the main pollutants (PM2.5, PM10, PM2.5 absorbance, NO2 and NOx) across Europe: in general, Cu and Fe in all size fractions were highly correlated (Pearson correlations above 0.75); Si and Zn in the coarse fractions were modestly correlated (between 0.5 and 0.75); and the remaining elements in the various size fractions had lower correlations (around 0.5 or below). This variability in correlation demonstrated the distinctly different spatial distributions of most of the elements. Variability of PM10_Cu and Fe was mostly due to within-study area differences (67% and 64% of overall variance, respectively) versus between-study area and exceeded that of most other traffic-related pollutants, including NO2 and soot, signaling the importance of non-tailpipe (e.g., brake wear) emissions in PM.
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Affiliation(s)
- Ming-Yi Tsai
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland; Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA.
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Marloes Eeftens
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland; Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Kees de Hoogh
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland; MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Rob Beelen
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Timea Beregszászi
- Department of Air Hygiene, National Institute of Environmental Health, Budapest, Hungary
| | - Giulia Cesaroni
- Epidemiology Department, Lazio Regional Health Service, Rome, Italy
| | - Marta Cirach
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain
| | - Josef Cyrys
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany; Environmental Science Center, Universität Augsburg, Augsburg, Germany
| | - Audrey De Nazelle
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Centre for Environmental Policy, Faculty of Natural Sciences, Imperial College London, London, United Kingdom
| | - Frank de Vocht
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, England, United Kingdom; School of Social and Community Medicine, University of Bristol, Bristol, England, United Kingdom
| | - Regina Ducret-Stich
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland
| | | | - Claudia Galassi
- AOU Città della Salute e della Scienza - CPO Piemonte, Turin, Italy
| | | | | | - Georgios Grivas
- School of Chemical Engineering, National Technical University of Athens, Greece
| | - Alexandros Gryparis
- Division of Hygiene - Epidemiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Joachim Heinrich
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - Barbara Hoffmann
- IUF Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Minas Iakovides
- Environmental Chemical Processes Laboratory, Department of Chemistry, University of Crete, Heraklion, Greece
| | - Menno Keuken
- TNO, Applied Research Organization, The Netherlands
| | - Ursula Krämer
- IUF Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Nino Künzli
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland
| | - Timo Lanki
- Department of Environmental Health, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Christian Madsen
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Kees Meliefste
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Anne-Sophie Merritt
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mölter
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, England, United Kingdom; Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Gioia Mosler
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Mark J Nieuwenhuijsen
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Harish Phuleria
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland; Centre for Environmental Science and Engineering, Indian Institute of Technology Bombay Powai, Mumbai 400076, India
| | - Ulrich Quass
- Air Quality & Sustainable Nanotachnology, IUTA Institut für Energie- und Umwelttechnik e.V., Duisburg, Germany
| | - Andrea Ranzi
- Regional Reference Centre on Environment and Health, ARPA Emilia Romagna, Modena, Italy
| | - Emmanuel Schaffner
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, 4002 Basel, Switzerland; University of Basel, 4003 Basel, Switzerland
| | - Ranjeet Sokhi
- Centre for Atmospheric and Instrumentation Research (CAIR), University of Hertfordshire, College Lane, Hatfield, United Kingdom
| | - Morgane Stempfelet
- French Institute for Public Health Surveillance (InVS), Saint-Maurice Cedex, France
| | - Euripides Stephanou
- Environmental Chemical Processes Laboratory, Department of Chemistry, University of Crete, Heraklion, Greece
| | - Dorothea Sugiri
- IUF Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Pekka Taimisto
- Department of Environmental Health, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Marjan Tewis
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Orsolya Udvardy
- Department of Air Hygiene, National Institute of Environmental Health, Budapest, Hungary
| | - Meng Wang
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands; Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Fountoulakis S, Papanastasiou L, Gryparis A, Markou A, Piaditis G. Impact and duration effect of telemonitoring on ΗbA1c, BMI and cost in insulin-treated Diabetes Mellitus patients with inadequate glycemic control: A randomized controlled study. Hormones (Athens) 2015; 14:632-43. [PMID: 26188234 DOI: 10.14310/horm.2002.1603] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/17/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To monitor and control the blood glucose levels in inefficiently insulin-treated patients with type 1 and 2 diabetes mellitus (DM) using a telemonitoring system and determine whether the improvement of HbA1c has a lasting effect following its discontinuation. DESIGN Seventy inefficiently controlled insulin-treated DM patients using telemonitoring (telemonitoring group-TG) [HbA1c 9.9±2.3% (85±24.9mmol/mol)] and 35 age-, body mass index (BMI)- and Hba1c-matched insulin-treated patients receiving outpatient care (control group-CG) [HbA1c 9.7±2.1% (82±23.4mmol/mol)] were enrolled. Data of TG were transmitted from the glucose-meters to our computers via modem. Communication was achieved via e-mails and mobile phone text-messages through integrated software. HbA1c and BMI were evaluated at enrollment, 3 and 6 months, and 6 months after telemonitoring discontinuation. Frequency of hypo- and hyperglycemias and cost were also analyzed. RESULTS Significant reduction in HbA1c was observed in TG both at 3 [7.1±1.0% (54±10.5mmol/mol) p<0.001] and 6 months [6.9±0.9% (52±9.5mmol/mol) p<0.001], compared to the CG group at the same timepoints. Significant reduction was also observed in the TG subgroups with ΗbA1c≥10% and 10>HbA1c≥7.5% at 3 and 6 months, compared to CG. No statistically significant differences in BMI were observed between TG and CG. Six months after telemonitoring discontinuation, HbA1c in TG was slightly increased [7.3±1.0% (56±10.4mol/mol)]. Attenuation was also observed in both TG subgroups. Compared to CG, the number of monthly hypo- and hyperglycemias was reduced in TG. The intervention had a financial benefit for patients living more than 100 km from the health care provider. CONCLUSIONS Telemonitoring can result in reduction of HbA1c and frequency of hypo- and hyperglycemias. This beneficial effect is slightly attenuated 6 months after terminating telemonitoring.
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Affiliation(s)
- Stelios Fountoulakis
- Department of Endocrinology and Diabetes Center, "G. Gennimatas", General Hospital of Athens, Athens, Greece
| | - Labrini Papanastasiou
- Department of Endocrinology and Diabetes Center, "G. Gennimatas", General Hospital of Athens, Athens, Greece
| | - Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics, National and KapodistrianUniversity of Athens Medical School; Athens, Greece
| | - Athina Markou
- Department of Hygiene, Epidemiology and Medical Statistics, National and KapodistrianUniversity of Athens Medical School; Athens, Greece
| | - George Piaditis
- Department of Endocrinology and Diabetes Center, "G. Gennimatas", General Hospital of Athens, Athens, Greece
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Harris MH, Gold DR, Rifas-Shiman SL, Melly SJ, Zanobetti A, Coull BA, Schwartz JD, Gryparis A, Kloog I, Koutrakis P, Bellinger DC, White RF, Sagiv SK, Oken E. Prenatal and Childhood Traffic-Related Pollution Exposure and Childhood Cognition in the Project Viva Cohort (Massachusetts, USA). Environ Health Perspect 2015; 123:1072-8. [PMID: 25839914 PMCID: PMC4590752 DOI: 10.1289/ehp.1408803] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 03/31/2015] [Indexed: 05/17/2023]
Abstract
BACKGROUND Influences of prenatal and early-life exposures to air pollution on cognition are not well understood. OBJECTIVES We examined associations of gestational and childhood exposure to traffic-related pollution with childhood cognition. METHODS We studied 1,109 mother-child pairs in Project Viva, a prospective birth cohort study in eastern Massachusetts (USA). In mid-childhood (mean age, 8.0 years), we measured verbal and nonverbal intelligence, visual motor abilities, and visual memory. For periods in late pregnancy and childhood, we estimated spatially and temporally resolved black carbon (BC) and fine particulate matter (PM2.5) exposures, residential proximity to major roadways, and near-residence traffic density. We used linear regression models to examine associations of exposures with cognitive assessment scores, adjusted for potential confounders. RESULTS Compared with children living ≥ 200 m from a major roadway at birth, those living < 50 m away had lower nonverbal IQ [-7.5 points; 95% confidence interval (CI): -13.1, -1.9], and somewhat lower verbal IQ (-3.8 points; 95% CI: -8.2, 0.6) and visual motor abilities (-5.3 points; 95% CI: -11.0, 0.4). Cross-sectional associations of major roadway proximity and cognition at mid-childhood were weaker. Prenatal and childhood exposure to traffic density and PM2.5 did not appear to be associated with poorer cognitive performance. Third-trimester and childhood BC exposures were associated with lower verbal IQ in minimally adjusted models; but after adjustment for socioeconomic covariates, associations were attenuated or reversed. CONCLUSIONS Residential proximity to major roadways during gestation and early life may affect cognitive development. Influences of pollutants and socioeconomic conditions on cognition may be difficult to disentangle.
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Affiliation(s)
- Maria H Harris
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Michalakis K, Venihaki M, Mantzoros C, Vazaiou A, Ilias I, Gryparis A, Margioris AN. In prostate cancer, low adiponectin levels are not associated with insulin resistance. Eur J Clin Invest 2015; 45:572-8. [PMID: 25833038 DOI: 10.1111/eci.12445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 03/29/2015] [Indexed: 01/02/2023]
Abstract
PURPOSE Adiponectin, an adipose tissue-derived hormone with insulin-sensitizing effect, has been inversely associated with several hormonally dependent malignancies. Prostate cancer is associated with low levels of adiponectin, which have been proposed as an independent risk factor for this malignancy. Aim of this study was to examine whether hypoadiponectinaemia in prostate is associated with insulin resistance. EXPERIMENTAL DESIGN Plasma samples and covariate data in the context of a case-control study of 300 Greek men were evaluated including 75 patients with prostate cancer, 75 patients with benign prostatic hyperplasia (BPH) and 150 age-matched healthy controls. RESULTS Patients with prostate cancer had significantly lower plasma adiponectin levels compared with the other two groups, that is BPH patients and healthy controls (7.4 ± 5 ng/mL vs. 11.5 ± 6.4 ng/mL and 12.8 ± 8 ng/mL, respectively). On the other hand, no statistically significant differences were found between patients with prostate cancer and the other two groups for both HOMA-IR and QUICKI (P-value = 0.551). As expected, in all three groups, the levels of adiponectin correlated negatively with HOMA-IR (rho = -0.214, P-value = 0.006), QUICKI (rho = 0.214, P-value = 0.006) and insulin levels (rho = 0.942, P-value < 0.001). CONCLUSION In spite of what would have been expected from the relevant literature, our data suggest that the hypoadiponectinaemia in prostatic cancer does not appear to be associated with insulin resistance.
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Affiliation(s)
- Konstantinos Michalakis
- First Department of Internal Medicine, National and Kapodestrian University of Athens, School of Medicine, 'Laiko' General Hospital, Athens, Greece.,Department of Clinical Chemistry, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Maria Venihaki
- Department of Clinical Chemistry, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos Mantzoros
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andriani Vazaiou
- Second Department of Pediatrics & Diabetes Center, P & A Kyriakou Children's Hospital, Athens, Greece
| | - Ioannis Ilias
- Endocrine Department, E. Venizelou Hospital, Athens, Greece
| | - Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Andrew N Margioris
- Department of Clinical Chemistry, School of Medicine, University of Crete, Heraklion, Crete, Greece
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25
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Lakshmanan A, Chiu YHM, Coull BA, Just AC, Maxwell SL, Schwartz J, Gryparis A, Kloog I, Wright RJ, Wright RO. Associations between prenatal traffic-related air pollution exposure and birth weight: Modification by sex and maternal pre-pregnancy body mass index. Environ Res 2015; 137:268-277. [PMID: 25601728 PMCID: PMC4354711 DOI: 10.1016/j.envres.2014.10.035] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 05/15/2023]
Abstract
BACKGROUND Prenatal traffic-related air pollution exposure is linked to adverse birth outcomes. However, modifying effects of maternal body mass index (BMI) and infant sex remain virtually unexplored. OBJECTIVES We examined whether associations between prenatal air pollution and birth weight differed by sex and maternal BMI in 670 urban ethnically mixed mother-child pairs. METHODS Black carbon (BC) levels were estimated using a validated spatio-temporal land-use regression (LUR) model; fine particulate matter (PM2.5) was estimated using a hybrid LUR model incorporating satellite-derived Aerosol Optical Depth measures. Using stratified multivariable-adjusted regression analyses, we examined whether associations between prenatal air pollution and calculated birth weight for gestational age (BWGA) z-scores varied by sex and maternal pre-pregnancy BMI. RESULTS Median birth weight was 3.3±0.6kg; 33% of mothers were obese (BMI ≥30kg/m(3)). In stratified analyses, the association between higher PM2.5 and lower birth weight was significant in males of obese mothers (-0.42 unit of BWGA z-score change per IQR increase in PM2.5, 95%CI: -0.79 to -0.06) ( PM2.5×sex×obesity Pinteraction=0.02). Results were similar for BC models (Pinteraction=0.002). CONCLUSIONS Associations of prenatal exposure to traffic-related air pollution and reduced birth weight were most evident in males born to obese mothers.
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Affiliation(s)
- Ashwini Lakshmanan
- Division of Neonatal Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Brent A. Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Allan C. Just
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Sarah L. Maxwell
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA
| | - Joel Schwartz
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School of Athens, Athens, Greece
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Rosalind J. Wright
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert O. Wright
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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26
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de Hoogh K, Korek M, Vienneau D, Keuken M, Kukkonen J, Nieuwenhuijsen MJ, Badaloni C, Beelen R, Bolignano A, Cesaroni G, Pradas MC, Cyrys J, Douros J, Eeftens M, Forastiere F, Forsberg B, Fuks K, Gehring U, Gryparis A, Gulliver J, Hansell AL, Hoffmann B, Johansson C, Jonkers S, Kangas L, Katsouyanni K, Künzli N, Lanki T, Memmesheimer M, Moussiopoulos N, Modig L, Pershagen G, Probst-Hensch N, Schindler C, Schikowski T, Sugiri D, Teixidó O, Tsai MY, Yli-Tuomi T, Brunekreef B, Hoek G, Bellander T. Comparing land use regression and dispersion modelling to assess residential exposure to ambient air pollution for epidemiological studies. Environ Int 2014; 73:382-92. [PMID: 25233102 DOI: 10.1016/j.envint.2014.08.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/14/2014] [Accepted: 08/19/2014] [Indexed: 05/13/2023]
Abstract
BACKGROUND Land-use regression (LUR) and dispersion models (DM) are commonly used for estimating individual air pollution exposure in population studies. Few comparisons have however been made of the performance of these methods. OBJECTIVES Within the European Study of Cohorts for Air Pollution Effects (ESCAPE) we explored the differences between LUR and DM estimates for NO2, PM10 and PM2.5. METHODS The ESCAPE study developed LUR models for outdoor air pollution levels based on a harmonised monitoring campaign. In thirteen ESCAPE study areas we further applied dispersion models. We compared LUR and DM estimates at the residential addresses of participants in 13 cohorts for NO2; 7 for PM10 and 4 for PM2.5. Additionally, we compared the DM estimates with measured concentrations at the 20-40 ESCAPE monitoring sites in each area. RESULTS The median Pearson R (range) correlation coefficients between LUR and DM estimates for the annual average concentrations of NO2, PM10 and PM2.5 were 0.75 (0.19-0.89), 0.39 (0.23-0.66) and 0.29 (0.22-0.81) for 112,971 (13 study areas), 69,591 (7) and 28,519 (4) addresses respectively. The median Pearson R correlation coefficients (range) between DM estimates and ESCAPE measurements were of 0.74 (0.09-0.86) for NO2; 0.58 (0.36-0.88) for PM10 and 0.58 (0.39-0.66) for PM2.5. CONCLUSIONS LUR and dispersion model estimates correlated on average well for NO2 but only moderately for PM10 and PM2.5, with large variability across areas. DM predicted a moderate to large proportion of the measured variation for NO2 but less for PM10 and PM2.5.
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Affiliation(s)
- Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.
| | - Michal Korek
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Menno Keuken
- Netherlands Organization for Applied Research, Utrecht, The Netherlands
| | | | - Mark J Nieuwenhuijsen
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Chiara Badaloni
- Epidemiology Department, Lazio Regional Health Service, Rome, Italy
| | - Rob Beelen
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | | | - Giulia Cesaroni
- Epidemiology Department, Lazio Regional Health Service, Rome, Italy
| | - Marta Cirach Pradas
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Josef Cyrys
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institutes of Epidemiology I and II, Neuherberg, Germany; University of Augsburg, Environmental Science Center, Augsburg, Germany
| | - John Douros
- Laboratory of Heat Transfer and Environmental Engineering, Aristotle University of Thessaloniki, Aristotle University, Thessaloniki, Greece
| | - Marloes Eeftens
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | | | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Sweden
| | - Kateryna Fuks
- IUF Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics University of Athens, Medical School, Athens, Greece
| | - John Gulliver
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Anna L Hansell
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom; Directorate of Public Health and Primary Care, Imperial College Healthcare NHS Trust, London, UK
| | - Barbara Hoffmann
- IUF Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Düsseldorf, Germany; Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Christer Johansson
- Department of Applied Environmental Science, Stockholm University, Stockholm, Sweden
| | - Sander Jonkers
- Netherlands Organization for Applied Research, Utrecht, The Netherlands
| | - Leena Kangas
- Finnish Meteorological Institute, Helsinki, Finland
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics University of Athens, Medical School, Athens, Greece; Department of Primary Care & Public Health Sciences and Environmental Research Group, King's College London, United Kingdom
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Timo Lanki
- Department of Environmental Health, National Institute for Health and Welfare (THL), Kuopio, Finland
| | | | - Nicolas Moussiopoulos
- Laboratory of Heat Transfer and Environmental Engineering, Aristotle University of Thessaloniki, Aristotle University, Thessaloniki, Greece
| | - Lars Modig
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Tamara Schikowski
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; IUF Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Dorothee Sugiri
- IUF Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Oriol Teixidó
- Energy and Air quality Department, Barcelona Regional, Barcelona, Spain
| | - Ming-Yi Tsai
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Tarja Yli-Tuomi
- Department of Environmental Health, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Papanastasiou L, Gryparis A, Piaditis G. Letter in reply on Primary aldosteronism in hypertensive patients: clinical implications and target therapy. Eur J Clin Invest 2014; 44:1141. [PMID: 25207389 DOI: 10.1111/eci.12334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Labrini Papanastasiou
- Department of Endocrinology and Diabetes Center, 'G Gennimatas' General Hospital, Athens, Greece
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Katsoulis M, Dimakopoulou K, Pedeli X, Trichopoulos D, Gryparis A, Trichopoulou A, Katsouyanni K. Long-term exposure to traffic-related air pollution and cardiovascular health in a Greek cohort study. Sci Total Environ 2014; 490:934-40. [PMID: 24908651 DOI: 10.1016/j.scitotenv.2014.05.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/08/2014] [Accepted: 05/09/2014] [Indexed: 05/06/2023]
Abstract
Our objective is to evaluate the association of exposure to traffic-related air pollution with the incidence of fatal and non-fatal ischemic heart disease (IHD), stroke and total cardiovascular disease (CVD) events in a Greek cohort. We used data from the European Prospective Investigation on Nutrition and Cancer (EPIC) for 2752 subjects followed from 1997 to 2011, whose residence was in 10 municipalities of the Greater Athens area. Air pollution exposure estimation was based on a spatio-temporal land use regression model linking geo-coded residential addresses to long-term average NO2 and PM10 concentrations. We conducted Cox proportional hazards regression analysis, adjusting for potential confounders. Hazard ratios (HR) above 1 (not all statistically significant) were associated with higher PM10 exposure for all outcomes. Weaker associations were found with NO2 exposure. Specifically, the estimated HR for a CVD event associated with 10 μg/m(3) increase in long-term exposure to PM10 was 1.50 (1.05-2.16, p-value: 0.027). The relationship was more evident for subjects ≤50 years old at recruitment. Associations of PM10 and NO2 exposure with IHD events were found only among women with HRs respectively of 2.24 (0.89-5.64, p-value: 0.086) and 1.54 (1.01-2.37, p-value: 0.046) associated with 10 μg/m(3) increase in the corresponding pollutant. In conclusion, the present study suggests that long-term exposure to traffic-related air pollution has an impact on CVD and IHD morbidity, particularly among women and younger subjects.
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Affiliation(s)
- Michail Katsoulis
- Hellenic Health Foundation, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Konstantina Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Xanthi Pedeli
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Dimitrios Trichopoulos
- Department of Epidemiology, Harvard School of Public Health, Boston MA, USA; Bureau of Epidemiologic Research, Academy of Athens, Greece
| | - Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; Department of Primary Care & Public Health Sciences, Environmental Research Group, King's College London, London, UK.
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Papanastasiou L, Markou A, Pappa T, Gouli A, Tsounas P, Fountoulakis S, Kounadi T, Tsiama V, Dasou A, Gryparis A, Samara C, Zografos G, Kaltsas G, Chrousos G, Piaditis G. Primary aldosteronism in hypertensive patients: clinical implications and target therapy. Eur J Clin Invest 2014; 44:697-706. [PMID: 24909545 DOI: 10.1111/eci.12286] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 06/03/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND The prevalence of primary aldosteronism (PA) in hypertensive patients varies according to diagnostic testing and ascertained normal cut-offs. The aim of this case-control study was to confirm the high prevalence of PA in a large hypertensive population and evaluate the antihypertensive effect of mineralocorticoid receptor antagonists (MRA) treatment. MATERIAL AND METHODS We investigated 327 hypertensive and 90 matched normotensive subjects with normal adrenal imaging. Serum aldosterone (ALD), active renin (REN) levels and aldosterone/active renin (ALD/REN) ratio were measured before and after a combined sodium chloride, fludrocortisone and dexamethasone suppression test (FDST). Post-FDST values were compared to cut-offs obtained from controls (post-FDST ALD 2·96 ng/dL and post-FDST ALD/REN 0·93 ng/dL/μU/mL). PA patients received MRA treatment. RESULTS By applying the combination of post-FDST ALD levels and ALD/REN ratio, 28·7% of the hypertensive patients had PA. There was a positive, albeit weak, correlation between systolic (SBP) and diastolic blood pressure (DBP) and ALD levels and/or ALD/REN ratio after the FDST (P < 0·0001). SBP was associated with a post-FDST ALD of 3·24 ng/dL and ALD/REN ratio of 0·90 ng/dL/μU/mL, whereas post-FDST ALD had an inverse association at serum K+ values of less than 3·9 mEq/L. MRA treatment in 69 PA patients, resulted in a significant reduction in the maximum SBP and DBP values (28 ± 15 and 14 ± 7 mmHg, respectively, P < 0·0001). CONCLUSIONS Using the FDST, an increased prevalence of PA in hypertensives was observed. Α significant blood pressure lowering effect was obtained with MRA treatment, implying that these agents may be beneficial in a significant number of hypertensive patients.
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Affiliation(s)
- Labrini Papanastasiou
- Department of Endocrinology and Diabetes Center, 'G Gennimatas' General Hospital, Athens, Greece
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30
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Perrakis K, Gryparis A, Schwartz J, Tertre AL, Katsouyanni K, Forastiere F, Stafoggia M, Samoli E. Controlling for seasonal patterns and time varying confounders in time-series epidemiological models: a simulation study. Stat Med 2014; 33:4904-18. [DOI: 10.1002/sim.6271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Konstantinos Perrakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School; University of Athens; Athens Greece
| | - Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School; University of Athens; Athens Greece
| | - Joel Schwartz
- Department of Environmental Health; Harvard School of Public Health; Boston MA U.S.A
| | - Alain Le Tertre
- Environmental Health Department; French Institute for Public Health Surveillance (InVS); Saint-Maurice France
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School; University of Athens; Athens Greece
| | | | | | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School; University of Athens; Athens Greece
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31
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Krieger N, Waterman PD, Gryparis A, Coull BA. Black carbon exposure more strongly associated with census tract poverty compared to household income among US black, white, and Latino working class adults in Boston, MA (2003-2010). Environ Pollut 2014; 190:36-42. [PMID: 24704809 PMCID: PMC4701574 DOI: 10.1016/j.envpol.2014.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/13/2014] [Accepted: 03/12/2014] [Indexed: 05/02/2023]
Abstract
We investigated the association of individual-level ambient exposure to black carbon (spatiotemporal model-based estimate for latitude and longitude of residential address) with individual, household, and census tract socioeconomic measures among a study sample comprised of 1757 US urban working class white, black and Latino adults (age 25-64) recruited for two studies conducted in Boston, MA (2003-2004; 2008-2010). Controlling for age, study, and exam date, the estimated average annual black carbon exposure for the year prior to study enrollment at the participants' residential address was directly associated with census tract poverty (beta = 0.373; 95% confidence interval (CI) 0.322, 0.423) but not with annual household income or education; null associations with race/ethnicity became significant only after controlling for socioeconomic position.
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Affiliation(s)
- Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Kresge 717, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Pamela D Waterman
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
| | - Brent A Coull
- Department of Biostatistics and Department of Environmental Health, 655 Huntington Avenue, Building II, Room 413, Boston, MA 02115, USA.
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Wang Y, Eliot MN, Koutrakis P, Gryparis A, Schwartz JD, Coull BA, Mittleman MA, Milberg WP, Lipsitz LA, Wellenius GA. Ambient air pollution and depressive symptoms in older adults: results from the MOBILIZE Boston study. Environ Health Perspect 2014; 122:553-8. [PMID: 24610154 PMCID: PMC4050499 DOI: 10.1289/ehp.1205909] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 03/06/2014] [Indexed: 05/19/2023]
Abstract
BACKGROUND Exposure to ambient air pollution, particularly from traffic, has been associated with adverse cognitive outcomes, but the association with depressive symptoms remains unclear. OBJECTIVES We investigated the association between exposure to ambient air and traffic pollution and the presence of depressive symptoms among 732 Boston-area adults ≥ 65 years of age (78.1 ± 5.5 years, mean ± SD). METHODS We assessed depressive symptoms during home interviews using the Revised Center for Epidemiological Studies Depression Scale (CESD-R). We estimated residential distance to the nearest major roadway as a marker of long-term exposure to traffic pollution and assessed short-term exposure to ambient fine particulate matter (PM2.5), sulfates, black carbon (BC), ultrafine particles, and gaseous pollutants, averaged over the 2 weeks preceding each assessment. We used generalized estimating equations to estimate the odds ratio (OR) of a CESD-R score ≥ 16 associated with exposure, adjusting for potential confounders. In sensitivity analyses, we considered CESD-R score as a continuous outcome and mean annual residential BC as an alternate marker of long-term exposure to traffic pollution. RESULTS We found no evidence of a positive association between depressive symptoms and long-term exposure to traffic pollution or short-term changes in pollutant levels. For example, we found an OR of CESD-R score ≥ 16 of 0.67 (95% CI: 0.46, 0.98) per interquartile range (3.4 μg/m(3)) increase in PM2.5 over the 2 weeks preceding assessment. CONCLUSIONS We found no evidence suggesting that ambient air pollution is associated with depressive symptoms among older adults living in a metropolitan area in attainment of current U.S. regulatory standards.
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Affiliation(s)
- Yi Wang
- Department of Epidemiology, Brown University, Providence, Rhode Island, USA
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Gryparis A, Dimakopoulou K, Pedeli X, Katsouyanni K. Spatio-temporal semiparametric models for NO₂ and PM₁₀ concentration levels in Athens, Greece. Sci Total Environ 2014; 479-480:21-30. [PMID: 24531337 DOI: 10.1016/j.scitotenv.2014.01.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 01/21/2014] [Accepted: 01/21/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIMS Studies of air pollution effects on health are often based on ecological measurements. Our aim was to develop spatio-temporal models that estimate daily levels of NO2 and PM10 at every point in space, within the greater Athens area. METHODS We applied a semiparametric approach using spatial and temporal covariates and a bivariate smooth thin plate function. We evaluated the predictions of our models against the exposure estimates that are typically used in health studies. For model validation we used a temporal and a spatial approach. RESULTS The adjusted-R(2) of the developed exposure models was 0.53 and 0.75 for PM10 and NO2 respectively; the spatial terms in our models explained 41.5% and 64.5% and the temporal explained 52.85% and 32.0% of the variability in PM10 and NO2, respectively. There was no temporal or spatial left over autocorrelation in the residuals. We performed a leave-one-out cross validation and the adjusted-R(2) were 0.41 for PM10 and 0.71 for NO2. The developed model showed good validity when comparing predicted and observed measures for the 2010 data. Our models performed better compared to the "ecological" estimates and estimates based on the "nearest monitoring site". CONCLUSIONS Our spatio-temporal model makes valid predictions, it introduces substantial geographical variability, it reduces the bias when compared with the "ecological" estimates and the estimates based on the "nearest monitoring site" and it can be used for a more personalized exposure assessment in health studies.
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Affiliation(s)
- Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics, Bldg 12, Medical School of Athens, 75 Mikras Asias, Athens 11527, Greece.
| | - Konstantina Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Bldg 12, Medical School of Athens, 75 Mikras Asias, Athens 11527, Greece
| | - Xanthi Pedeli
- Department of Hygiene, Epidemiology and Medical Statistics, Bldg 12, Medical School of Athens, 75 Mikras Asias, Athens 11527, Greece
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Bldg 12, Medical School of Athens, 75 Mikras Asias, Athens 11527, Greece
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Zanobetti A, Coull BA, Gryparis A, Kloog I, Sparrow D, Vokonas PS, Wright RO, Gold DR, Schwartz J. Associations between arrhythmia episodes and temporally and spatially resolved black carbon and particulate matter in elderly patients. Occup Environ Med 2013; 71:201-7. [PMID: 24142987 DOI: 10.1136/oemed-2013-101526] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Ambient air pollution has been associated with sudden deaths, some of which are likely due to ventricular arrhythmias. Defibrillator discharge studies have examined the association of air pollution with arrhythmias in sensitive populations. No studies have assessed this association using residence-specific estimates of air pollution exposure. METHODS In the Normative Aging Study, we investigated the association between temporally resolved and spatially resolved black carbon (BC) and PM2.5 and arrhythmia episodes (bigeminy, trigeminy or couplets episodes) measured as ventricular ectopy (VE) by 4 min ECG monitoring in repeated measures of 701 subjects, during the years 2000-2010. We used a binomial distribution (having or not a VE episode) in a mixed effect model with a random intercept for subject, controlling for seasonality, temperature, day of the week, medication use, smoking, having diabetes, body mass index and age. We also examined whether these associations were modified by genotype or phenotype. RESULTS We found significant increases in VE with both pollutants and lags; for the estimated concentration averaged over the 3 days prior to the health assessment, we found increases in the odds of having VE with an OR of 1.52 (95% CI 1.19 to 1.94) for an IQR (0.30 μg/m(3)) increase in BC and an OR of 1.39 (95% CI 1.12 to 1.71) for an IQR (5.63 μg/m(3)) increase in PM2.5. We also found higher effects in subjects with the glutathione S-transferase theta-1 and glutathione S-transferase mu-1 variants and in obese (p<0.05). CONCLUSIONS Increased levels of short-term traffic-related pollutants may increase the risk of ventricular arrhythmia in elderly subjects.
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Affiliation(s)
- Antonella Zanobetti
- Environmental Epidemiology and Risk Program, Harvard School of Public Health, Boston, Massachusetts, USA
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Wilker EH, Mittleman MA, Coull BA, Gryparis A, Bots ML, Schwartz J, Sparrow D. Long-term exposure to black carbon and carotid intima-media thickness: the normative aging study. Environ Health Perspect 2013; 121:1061-7. [PMID: 23820848 PMCID: PMC3764069 DOI: 10.1289/ehp.1104845] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 06/27/2013] [Indexed: 05/20/2023]
Abstract
BACKGROUND Evidence suggests that air pollution is associated with atherosclerosis and that traffic-related particles are a particularly important contributor to the association. OBJECTIVES We investigated the association between long-term exposure to black carbon, a correlate of traffic particles, and intima-media thickness of the common carotid artery (CIMT) in elderly men residing in the greater Boston, Massachusetts, area. METHODS We estimated 1-year average exposures to black carbon at the home addresses of Normative Aging Study participants before their first CIMT measurement. The association between estimated black carbon levels and CIMT was estimated using mixed effects models to account for repeated outcome measures. In secondary analyses, we examined whether living close to a major road or average daily traffic within 100 m of residence was associated with CIMT. RESULTS There were 380 participants (97% self-reported white race) with an initial visit between 2004 and 2008. Two or three follow-up CIMT measurements 1.5 years apart were available for 340 (89%) and 260 (68%) men, respectively. At first examination, the average ± SD age was 76 ± 6.4 years and the mean ± SD CIMT was 0.99 ± 0.18 mm. A one-interquartile range increase in 1-year average black carbon (0.26 µg/m3) was associated with a 1.1% higher CIMT (95% CI: 0.4, 1.7%) based on a fully adjusted model. CONCLUSIONS Annual mean black carbon concentration based on spatially resolved exposure estimates was associated with CIMT in a population of elderly men. These findings support an association between long-term air pollution exposure and atherosclerosis.
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Affiliation(s)
- Elissa H Wilker
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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de Hoogh K, Wang M, Adam M, Badaloni C, Beelen R, Birk M, Cesaroni G, Cirach M, Declercq C, Dėdelė A, Dons E, de Nazelle A, Eeftens M, Eriksen K, Eriksson C, Fischer P, Gražulevičienė R, Gryparis A, Hoffmann B, Jerrett M, Katsouyanni K, Iakovides M, Lanki T, Lindley S, Madsen C, Mölter A, Mosler G, Nádor G, Nieuwenhuijsen M, Pershagen G, Peters A, Phuleria H, Probst-Hensch N, Raaschou-Nielsen O, Quass U, Ranzi A, Stephanou E, Sugiri D, Schwarze P, Tsai MY, Yli-Tuomi T, Varró MJ, Vienneau D, Weinmayr G, Brunekreef B, Hoek G. Development of land use regression models for particle composition in twenty study areas in Europe. Environ Sci Technol 2013; 47:5778-86. [PMID: 23651082 DOI: 10.1021/es400156t] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Land Use Regression (LUR) models have been used to describe and model spatial variability of annual mean concentrations of traffic related pollutants such as nitrogen dioxide (NO2), nitrogen oxides (NOx) and particulate matter (PM). No models have yet been published of elemental composition. As part of the ESCAPE project, we measured the elemental composition in both the PM10 and PM2.5 fraction sizes at 20 sites in each of 20 study areas across Europe. LUR models for eight a priori selected elements (copper (Cu), iron (Fe), potassium (K), nickel (Ni), sulfur (S), silicon (Si), vanadium (V), and zinc (Zn)) were developed. Good models were developed for Cu, Fe, and Zn in both fractions (PM10 and PM2.5) explaining on average between 67 and 79% of the concentration variance (R(2)) with a large variability between areas. Traffic variables were the dominant predictors, reflecting nontailpipe emissions. Models for V and S in the PM10 and PM2.5 fractions and Si, Ni, and K in the PM10 fraction performed moderately with R(2) ranging from 50 to 61%. Si, NI, and K models for PM2.5 performed poorest with R(2) under 50%. The LUR models are used to estimate exposures to elemental composition in the health studies involved in ESCAPE.
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Affiliation(s)
- Kees de Hoogh
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.
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Wellenius GA, Boyle LD, Coull BA, Milberg WP, Gryparis A, Schwartz J, Mittleman MA, Lipsitz LA. Residential proximity to nearest major roadway and cognitive function in community-dwelling seniors: results from the MOBILIZE Boston Study. J Am Geriatr Soc 2012; 60:2075-80. [PMID: 23126566 DOI: 10.1111/j.1532-5415.2012.04195.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the association between residential distance to nearest major roadway, as a marker of long-term exposure to traffic pollution, and cognitive function in older adults. DESIGN Prospective cohort study with median follow-up of 16.8 months. SETTING Community. PARTICIPANTS Seven hundred sixty-five community-dwelling seniors. MEASUREMENTS The Mini-Mental State Examination, Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test (TMT), category and letter fluency tests, and Clock-in-the-Box Test were administered during home visits on two occasions. The residential distance to the nearest major roadway was calculated, and generalized estimating equations were used to evaluate the association between performance on each test and residential distance to nearest major roadway, adjusting for participant demographics, education, socioeconomic status, and past medical history. RESULTS Shorter distance to major roadway was associated with statistically significantly poorer performance on the immediate and delayed recall components of the HVLT-R, TMT Part B, TMT delta, and letter and category fluency tests. Generally, participants residing less than 100 m from a major roadway performed worst. Performance improved monotonically with increasing distance. CONCLUSION In this cohort of community-dwelling older adults, residential proximity to a major roadway was associated with poorer performance on cognitive tests of verbal learning and memory, psychomotor speed, language, and executive functioning. If causal, these results add to the growing evidence that living near major roadways is associated with adverse health outcomes.
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Affiliation(s)
- Gregory A Wellenius
- Department of Epidemiology, Brown University, Providence, Rhode Island 02912, USA.
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Fang SC, Mehta AJ, Alexeeff SE, Gryparis A, Coull B, Vokonas P, Christiani DC, Schwartz J. Residential black carbon exposure and circulating markers of systemic inflammation in elderly males: the normative aging study. Environ Health Perspect 2012; 120:674-80. [PMID: 22336131 PMCID: PMC3346771 DOI: 10.1289/ehp.1103982] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 02/15/2012] [Indexed: 05/19/2023]
Abstract
BACKGROUND Traffic-related particles (TRPs) are associated with adverse cardiovascular events. The exact mechanisms are unclear, but systemic inflammatory responses likely play a role. OBJECTIVES We conducted a repeated measures study among male participants of the Normative Aging Study in the greater Boston, Massachusetts, area to determine whether individual-level residential black carbon (BC), a marker of TRPs, is associated with systemic inflammation and whether coronary heart disease (CHD), diabetes, and obesity modify associations. METHODS We quantified markers of inflammation in 1,163 serum samples from 580 men. Exposure to BC up to 4 weeks prior was predicted from a validated spatiotemporal land-use regression model. Linear mixed effects models estimated the effects of BC on each marker while adjusting for potential confounders. RESULTS Associations between BC and blood markers were not observed in main effects models or when stratified by obesity status. However, BC was positively associated with markers of inflammation in men with CHD (particularly vascular endothelial growth factor) and in men with diabetes (particularly interleukin-1β and tumor necrosis factor-α). Significant exposure time windows varied by marker, although in general the strongest associations were observed with moving averages of 2-7 days after a lag of several days. CONCLUSIONS In an elderly male population, estimated BC exposures were positively associated with markers of systemic inflammation but only in men with CHD or diabetes.
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Affiliation(s)
- Shona C Fang
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
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Schwartz J, Alexeeff SE, Mordukhovich I, Gryparis A, Vokonas P, Suh H, Coull BA. Association between long-term exposure to traffic particles and blood pressure in the Veterans Administration Normative Aging Study. Occup Environ Med 2012; 69:422-7. [PMID: 22383587 DOI: 10.1136/oemed-2011-100268] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Particulate air pollution is associated with cardiovascular events, but the mechanisms are not fully understood. The main objective was to assess the relationship between long-term exposure to traffic-related air pollution and blood pressure (BP). METHODS The authors used longitudinal data from 853 elderly men participating in the Veterans Administration Normative Aging Study, followed during 1996-2008. Long-term average exposures to traffic particles were created from daily predictions of black carbon (BC) exposure at the geocoded address of each subject, using a validated spatiotemporal model based on ambient monitoring at 82 Boston-area locations. The authors examined the association of these exposures with BP using a mixed model. The authors included the following covariates: age, body mass index, smoking, alcohol, fasting glucose, creatinine clearance, use of cardiovascular medication, education, census-level poverty, day of week and season of clinical visit. RESULTS The authors found significant positive associations between 1-year average BC exposure and both systolic and diastolic blood pressure. An IQR increase in 1-year average BC exposure (0.32 μg/m(3)) was associated with a 2.64 mm Hg increase in systolic blood pressure (95% CI 1.47 to 3.80) and a 2.41 mm Hg increase in diastolic blood pressure (95% CI 1.77 to 3.05). CONCLUSIONS Long-term exposure to traffic particles is associated with increased BP, which may explain part of the association with myocardial infarctions and cardiovascular deaths reported in cohort studies.
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Affiliation(s)
- Joel Schwartz
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02215, USA
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Alexeeff SE, Coull BA, Gryparis A, Suh H, Sparrow D, Vokonas PS, Schwartz J. Medium-term exposure to traffic-related air pollution and markers of inflammation and endothelial function. Environ Health Perspect 2011; 119:481-6. [PMID: 21349799 PMCID: PMC3080929 DOI: 10.1289/ehp.1002560] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 02/24/2011] [Indexed: 05/18/2023]
Abstract
BACKGROUND Exposure to traffic-related air pollution (TRAP) contributes to increased cardiovascular risk. Land-use regression models can improve exposure assessment for TRAP. OBJECTIVES We examined the association between medium-term concentrations of black carbon (BC) estimated by land-use regression and levels of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1), both markers of inflammatory and endothelial response. METHODS We studied 642 elderly men participating in the Veterans Administration (VA) Normative Aging Study with repeated measurements of sICAM-1 and sVCAM-1 during 1999-2008. Daily estimates of BC exposure at each geocoded participant address were derived using a validated spatiotemporal model and averaged to form 4-, 8-, and 12-week exposures. We used linear mixed models to estimate associations, controlling for confounders. We examined effect modification by statin use, obesity, and diabetes. RESULTS We found statistically significant positive associations between BC and sICAM-1 for averages of 4, 8, and 12 weeks. An interquartile-range increase in 8-week BC exposure (0.30 μg/m3) was associated with a 1.58% increase in sICAM-1 (95% confidence interval, 0.18-3.00%). Overall associations between sVCAM-1 and BC exposures were suggestive but not statistically significant. We found a significant interaction with diabetes-where diabetics were more susceptible to the effect of BC-for both sICAM-1 and sVCAM-1. We also observed an interaction with statin use, which was statistically significant for sVCAM-1 and suggestive for sICAM-1. We found no evidence of an interaction with obesity. CONCLUSION Our results suggest that medium-term exposure to TRAP may induce an increased inflammatory/endothelial response, especially among diabetics and those not using statins.
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Affiliation(s)
- Stacey E Alexeeff
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA.
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Tonne C, Yanosky J, Gryparis A, Melly S, Mittleman M, Goldberg R, von Klot S, Schwartz J. Traffic particles and occurrence of acute myocardial infarction: a case-control analysis. Occup Environ Med 2009; 66:797-804. [PMID: 19553228 PMCID: PMC2776243 DOI: 10.1136/oem.2008.045047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives: We modelled exposure to traffic particles using a latent variable approach and investigated whether long-term exposure to traffic particles is associated with an increase in the occurrence of acute myocardial infarction (AMI) using data from a population-based coronary disease registry. Methods: Cases of individually validated AMI were identified between 1995 and 2003 as part of the Worcester Heart Attack Study. Population controls were selected from Massachusetts, USA, resident lists. NO2 and PM2.5 filter absorbance were measured at 36 locations throughout the study area. The air pollution data were used to estimate exposure to traffic particles using a semiparametric latent variable regression model. Conditional logistic models were used to estimate the association between exposure to traffic particles and occurrence of AMI. Results: Modelled exposure to traffic particles was highest near the city of Worcester. Cases of AMI were more exposed to traffic and traffic particles compared to controls. An interquartile range increase in modelled traffic particles was associated with a 10% (95% CI 4% to 16%) increase in the odds of AMI. Accounting for spatial dependence at the census tract, but not block group, scale substantially attenuated this association. Conclusions: These results provide some support for an association between long-term exposure to traffic particles and risk of AMI. The results were sensitive to the scale selected for the analysis of spatial dependence, an issue that requires further investigation. The latent variable model captured variation in exposure, although on a relatively large spatial scale.
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Affiliation(s)
- C Tonne
- Environmental Research Group, King's College London, London SE1 9NH, UK.
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Abstract
In many environmental epidemiology studies, the locations and/or times of exposure measurements and health assessments do not match. In such settings, health effects analyses often use the predictions from an exposure model as a covariate in a regression model. Such exposure predictions contain some measurement error as the predicted values do not equal the true exposures. We provide a framework for spatial measurement error modeling, showing that smoothing induces a Berkson-type measurement error with nondiagonal error structure. From this viewpoint, we review the existing approaches to estimation in a linear regression health model, including direct use of the spatial predictions and exposure simulation, and explore some modified approaches, including Bayesian models and out-of-sample regression calibration, motivated by measurement error principles. We then extend this work to the generalized linear model framework for health outcomes. Based on analytical considerations and simulation results, we compare the performance of all these approaches under several spatial models for exposure. Our comparisons underscore several important points. First, exposure simulation can perform very poorly under certain realistic scenarios. Second, the relative performance of the different methods depends on the nature of the underlying exposure surface. Third, traditional measurement error concepts can help to explain the relative practical performance of the different methods. We apply the methods to data on the association between levels of particulate matter and birth weight in the greater Boston area.
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Franco Suglia S, Gryparis A, Schwartz J, Wright RJ. Association between traffic-related black carbon exposure and lung function among urban women. Environ Health Perspect 2008; 116:1333-7. [PMID: 18941574 PMCID: PMC2569091 DOI: 10.1289/ehp.11223] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Accepted: 06/03/2008] [Indexed: 05/17/2023]
Abstract
BACKGROUND Although a number of studies have documented the relationship between lung function and traffic-related pollution among children, few have focused on adult lung function or examined community-based populations. OBJECTIVE We examined the relationship between black carbon (BC), a surrogate of traffic-related particles, and lung function among women in the Maternal-Infant Smoking Study of East Boston, an urban cohort in Boston, Massachusetts. METHODS We estimated local BC levels using a validated spatiotemporal land-use regression model, derived using ambient and indoor monitor data. We examined associations between percent predicted pulmonary function and predicted BC using linear regression, adjusting for sociodemographics (individual and neighborhood levels), smoking status, occupational exposure, type of cooking fuel, and a diagnosis of asthma or chronic bronchitis. RESULTS The sample of 272 women 18-42 years of age included 57% who self-identified as Hispanic versus 43% white, and 18% who were current smokers. Mean +/- SD predicted annual BC exposure level was 0.62 +/- 0.2 microg/m3. In adjusted analysis, BC (per interquartile range increase) was associated with a 1.1% decrease [95% confidence interval (CI), -2.5% to 0.3%] in forced expiratory volume in 1 sec, a 0.6% decrease (95% CI, -1.9% to 0.6%) in forced vital capacity, and a 3.0% decrease (95% CI, -5.8% to -0.2%) in forced mid-expiratory flow rate. We noted differential effects by smoking status in that former smokers were most affected by BC exposure, whereas current smokers were not affected. CONCLUSION In this cohort, exposure to traffic-related BC, a component of particulate matter, independently predicted decreased lung function in urban women, when adjusting for tobacco smoke, asthma diagnosis, and socioeconomic status.
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Affiliation(s)
- Shakira Franco Suglia
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA.
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Suglia SF, Gryparis A, Wright RO, Schwartz J, Wright RJ. Association of black carbon with cognition among children in a prospective birth cohort study. Am J Epidemiol 2008; 167:280-6. [PMID: 18006900 DOI: 10.1093/aje/kwm308] [Citation(s) in RCA: 276] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
While studies show that ultrafine and fine particles can be translocated from the lungs to the central nervous system, the possible neurodegenerative effect of air pollution remains largely unexplored. The authors examined the relation between black carbon, a marker for traffic particles, and cognition among 202 Boston, Massachusetts, children (mean age = 9.7 years (standard deviation, 1.7)) in a prospective birth cohort study (1986-2001). Local black carbon levels were estimated using a validated spatiotemporal land-use regression model (mean predicted annual black carbon level, 0.56 mug/m(3) (standard deviation, 0.13)). The Wide Range Assessment of Memory and Learning and the Kaufman Brief Intelligence Test were administered for assessment of cognitive constructs. In analysis adjusting for sociodemographic factors, birth weight, blood lead level, and tobacco smoke exposure, black carbon (per interquartile-range increase) was associated with decreases in the vocabulary (-2.2, 95% confidence interval (CI): -5.5, 1.1), matrices (-4.0, 95% CI: -7.6, -0.5), and composite intelligence quotient (-3.4, 95% CI: -6.6, -0.3) scores of the Kaufman Brief Intelligence Test and with decreases on the visual subscale (-5.4, 95% CI: -8.9, -1.9) and general index (-3.9, 95% CI: -7.5, -0.3) of the Wide Range Assessment of Memory and Learning. Higher levels of black carbon predicted decreased cognitive function across assessments of verbal and nonverbal intelligence and memory constructs.
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Affiliation(s)
- S Franco Suglia
- Department of Environmental Health, Harvard School of Public Health, Boston, MA 02215, USA.
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Gryparis A, Coull BA, Schwartz J. Controlling for confounding in the presence of measurement error in hierarchical models: a Bayesian approach. J Expo Sci Environ Epidemiol 2007; 17 Suppl 2:S20-S28. [PMID: 18079761 DOI: 10.1038/sj.jes.7500624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 09/12/2007] [Indexed: 05/25/2023]
Abstract
A major concern in studies that address the health effects of air pollution is whether an observed association between concentrations of a pollutant and a health outcome is all, or in part, due to the correlation between that exposure and either a second pollutant or a confounder. The addition of exposure measurement error to such data complicates matters further. To account for measurement error when data come from a multi-city study, Schwartz and Coull (2003) proposed a two-stage estimator. These authors showed via both first principles and simulation that their approach yields unbiased estimates for the parameters of interest. However, these estimates have large variability. In this paper, we describe a fully Bayesian approach that yields estimators that are much more efficient than the existing two-stage measurement error correction yet still unbiased. The proposed approach can also incorporate additional exposures or confounders without requiring strict assumptions that are necessary in existing formulations of the model. We compare the properties of the Bayesian estimators to existing approaches via simulation.
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Affiliation(s)
- Alexandros Gryparis
- Department of Biostatistics, Harvard School of Public Health, 655 Huntington Avenue, Boston, Massachusetts 02115, USA.
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Maynard D, Coull BA, Gryparis A, Schwartz J. Mortality risk associated with short-term exposure to traffic particles and sulfates. Environ Health Perspect 2007; 115:751-5. [PMID: 17520063 PMCID: PMC1867995 DOI: 10.1289/ehp.9537] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 01/29/2007] [Indexed: 05/15/2023]
Abstract
BACKGROUND Many studies have shown that airborne particles are associated with increased risk of death, but attention has more recently focused on the differential toxicity of particles from different sources. Geographic information system (GIS) approaches have recently been used to improve exposure assessment, particularly for traffic particles, but only for long-term exposure. OBJECTIVES We analyzed approximately 100,000 deaths from all, cardiovascular, and respiratory causes for the years 1995-2002 using a case-crossover analysis. METHODS Estimates of exposure to traffic particles were geocoded to the address of each decedent on the day before death and control days, with these estimates derived from a GIS-based exposure model incorporating deterministic covariates, such as traffic density and meteorologic factors, and a smooth function of latitude and longitude. RESULTS We estimate that an IQR increase in traffic particle exposure on the day before death is associated with a 2.3% increase [95% confidence interval (CI), 1.2 to 3.4%] in all-cause mortality risk. Stroke deaths were particularly elevated (4.4%; 95% CI, -0.2 to 9.3%), as were diabetes deaths (5.7%; 95% CI, -1.7 to 13.7%). Sulfate particles are spatially homogeneous, and using a central monitor, we found that an IQR increase in sulfate levels on the day before death is associated with a 1.1% (95% CI, 0.1 to 2.0%) increase in all-cause mortality risk. CONCLUSIONS Both traffic and powerplant particles are associated with increased deaths in Boston, with larger effects for traffic particles.
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Affiliation(s)
| | | | | | - Joel Schwartz
- Department of Environmental Health and
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Address correspondence to J. Schwartz, Department of Environmental Health, Exposure Epidemiology and Risk Program, Harvard School of Public Health, 401 Park Dr., Landmark Center, Suite 415, PO Box 15698, Boston, MA 02215 USA. Telephone: (617) 384-8752. Fax: (617) 384-8745. E-mail:
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Kassomenos PA, Gryparis A, Katsouyanni K. On the association between daily mortality and air mass types in Athens, Greece during winter and summer. Int J Biometeorol 2007; 51:315-22. [PMID: 17096079 DOI: 10.1007/s00484-006-0062-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2006] [Revised: 08/24/2006] [Accepted: 08/24/2006] [Indexed: 05/12/2023]
Abstract
In this study, we examined the short-term effects of air mass types on mortality in Athens, Greece. An objective air mass types classification was used, based on meteorological parameters measured at the surface. Mortality data were treated with generalized additive models (GAM) and extending Poisson regression, using a LOESS smoother to control for the confounding effects of seasonal patterns, adjusting also for temperature, long-term trends, day of the week, and ambient particle concentrations. The introduced air mass classification explains the daily variation of mortality to a statistically significant degree. The highest daily mortality was observed on days characterized by southerly flow conditions for both the cold (increase in relative risk for mortality 9%; with a 95% confidence interval: 3-14%), and the warm period (7%; with a 95% confidence interval: 2-13%) of the year. The northeasterly flow is associated with the lowest mortality. Effects on mortality, independent of temperature, are observed mainly for lag 0 during the cold period, but persist longer during the warm period. Not adjusting for temperature and/or ambient particle levels slightly alters the results, which then reflect the known temperature and particle effects, already reported in the literature. In conclusion, we find that air mass types have independent effects on mortality for both the cold and warm season and may be used to predict weather-related adverse health effects.
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Affiliation(s)
- Pavlos A Kassomenos
- Physics Department, Laboratory of Meteorology, University Campus, University of Ioannina, Ioannina, Greece.
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Gryparis A, Coull BA, Schwartz J, Suh HH. Semiparametric latent variable regression models for spatiotemporal modelling of mobile source particles in the greater Boston area. J R Stat Soc Ser C Appl Stat 2007. [DOI: 10.1111/j.1467-9876.2007.00573.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gryparis A, Forsberg B, Katsouyanni K, Analitis A, Touloumi G, Schwartz J, Samoli E, Medina S, Anderson HR, Niciu EM, Wichmann HE, Kriz B, Kosnik M, Skorkovsky J, Vonk JM, Dörtbudak Z. Acute Effects of Ozone on Mortality from the “Air Pollution and Health. Am J Respir Crit Care Med 2004; 170:1080-7. [PMID: 15282198 DOI: 10.1164/rccm.200403-333oc] [Citation(s) in RCA: 221] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
In the Air Pollution and Health: A European Approach (APHEA2) project, the effects of ambient ozone concentrations on mortality were investigated. Data were collected on daily ozone concentrations, the daily number of deaths, confounders, and potential effect modifiers from 23 cities/areas for at least 3 years since 1990. Effect estimates were obtained for each city with city-specific models and were combined using second-stage regression models. No significant effects were observed during the cold half of the year. For the warm season, an increase in the 1-hour ozone concentration by 10 mug/m3 was associated with a 0.33% (95% confidence interval [CI], 0.17-0.52) increase in the total daily number of deaths, 0.45% (95% CI, 0.22-0.69) in the number of cardiovascular deaths, and 1.13% (95% CI, 0.62-1.48) in the number of respiratory deaths. The corresponding figures for the 8-hour ozone were similar. The associations with total mortality were independent of SO2 and particulate matter with aerodynamic diameter less than 10 mum (PM10) but were somewhat confounded by NO2 and CO. Individual city estimates were heterogeneous for total (a higher standardized mortality rate was associated with larger effects) and cardiovascular mortality (larger effects were observed in southern cities). The dose-response curve of ozone effects on total mortality during the summer did not deviate significantly from linearity.
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Affiliation(s)
- Alexandros Gryparis
- Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece
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Zanobetti A, Schwartz J, Samoli E, Gryparis A, Touloumi G, Peacock J, Anderson RH, Le Tertre A, Bobros J, Celko M, Goren A, Forsberg B, Michelozzi P, Rabczenko D, Hoyos SP, Wichmann HE, Katsouyanni K. The temporal pattern of respiratory and heart disease mortality in response to air pollution. Environ Health Perspect 2003; 111:1188-93. [PMID: 12842772 PMCID: PMC1241573 DOI: 10.1289/ehp.5712] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Short-term changes in ambient particulate matter with aerodynamic diameters < 10 micro m (PM10) have been associated with short-term fluctuations in mortality or morbidity in many studies. In this study, we tested whether those deaths are just advanced by a few days or weeks using a multicity hierarchical modeling approach for all-cause, respiratory, and cardiovascular deaths, for all ages and stratifying by age groups, within the APHEA-2 (Air Pollution and Health: A European Approach) project. We fit a Poisson regression and used an unconstrained distributed lag to model the effect of PM10 exposure on deaths up to 40 days after the exposure. In baseline models using PM10 the day of and day before the death, we found that the overall PM10 effect (per 10 micro g/m3) was 0.74% [95% confidence interval (95% CI), -0.17 to 1.66] for respiratory deaths and 0.69% (95% CI, 0.31-1.08) for cardiovascular deaths. In unrestricted distributed lag models, the effect estimates increased to 4.2% (95% CI, 1.08-7.42) for respiratory deaths and to 1.97% (95% CI, 1.38-2.55) for cardiovascular deaths. Our study confirms that most of the effect of air pollution is not simply advanced by a few weeks and that effects persist for more than a month after exposure. The effect size estimate for PM10 doubles when we considered longer-term effects for all deaths and for cardiovascular deaths and becomes five times higher for respiratory deaths. We found similar effects when stratifying by age groups. These larger effects are important for risk assessment.
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Affiliation(s)
- Antonella Zanobetti
- Environmental Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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