1
|
Fischer C, Fischer R, Kirsten AM, Holle R, Klütsch K, Stoleriu C, Göres R, Schultz K, Kahnert K, Alter P, Nowak D, Jörres R. [Development of two questionnaires for the assessment of knowledge and self-management in patients with chronic-obstructive pulmonary disease (COPD)]. Pneumologie 2024. [PMID: 38670146 DOI: 10.1055/a-2310-1887] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
INTRODUCTION As with other chronic diseases, the course of chronic obstructive pulmonary disease (COPD) can be expected to be positively influenced if patients are well informed about their disease and undertake appropriate self-management. Assessments of the level of knowledge and management that are comparable should benefit from structured, systematically developed questionnaires. These, however, have not been published in Germany. METHODS A total of 310 patients with COPD were recruited from three pneumological practices and one hospital to develop the questionnaires. Based on statistical criteria and content assessments by medical specialists, two questionnaires on knowledge (17 questions) and self-management (25 questions) were developed by selecting and modifying questions from published studies and training programs. In addition, two short versions with 5 and 3 questions were created to enable a quick assessment of the patients' knowledge and self-management. All questionnaires also included a visual analogue scale for self-assessment of knowledge and self-management. The statistical procedures for systematically guided selection comprised correlation and regression analyses. RESULTS The questionnaires revealed considerable knowledge deficits in many patients and remarkably unsystematic, incoherent knowledge. The extent of this knowledge was negatively correlated with higher age and positively correlated with participation in training programs; this also applied to self-management. Correlations between the answers to the knowledge questions were higher in patients who had participated in training programs. The visual analogue scales for self-assessment of knowledge and management always correlated with the total number of correct answers. DISCUSSION The questionnaires on knowledge and self-management in patients with COPD could be used in outpatient settings, including by non-medical staff, in order to quickly identify and correct deficits or as a reason to recommend training programs. The short versions and the analogue scales for self-assessment can give at least first hints. Potentially, training programs should focus more on promoting the coherence of knowledge through better understanding, as this presumably favors long-term knowledge. Older patients and those with a low level of education appear to be particularly in need of specially adapted training programs.
Collapse
Affiliation(s)
- Carolina Fischer
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, München, Deutschland
| | | | - Anne-Marie Kirsten
- Pneumologisches Forschungsinstitut an der LungenClinic Grosshansdorf, Grosshansdorf, Deutschland
| | - Rolf Holle
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Klinikum der Universität, LMU München, München, Deutschland
| | | | | | - Ralf Göres
- Lungenheilkunde München-Pasing, München, Deutschland
| | | | - Kathrin Kahnert
- Department of Medicine V, University of Munich LMU, Munich, Germany
- MediCenterGermering, Germering, Deutschland
| | - Peter Alter
- Klinik für Innere Medizin, Pneumologie und Intensivmedizin, Philipps-Universitat Marburg, Marburg, Deutschland
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, München, Deutschland
| | - Rudolf Jörres
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, München, Deutschland
| |
Collapse
|
2
|
Hurraß J, Nowak D, Heinzow B, Joest M, Stemler J, Wiesmüller GA. Indoor Mold—Important Considerations for Medical Advice to Patients. Dtsch Arztebl Int 2024:arztebl.m2024.0018. [PMID: 38381662 DOI: 10.3238/arztebl.m2024.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND According to self-reported frequencies, every fifth or sixth dwelling in Germany is affected by dampness and/or mold. This carries a potential risk to health. METHODS This review is based on pertinent publications retrieved by a selective literature search and inquiry in the GENESIS database, on the AWMF guideline on the medical clinical diagnosis of indoor mold exposure, as updated in 2023, and on the relevant contents of other current guidelines. Based on this research, we present an algorithm for the evaluation of health problems that may be due to mold in indoor environments. RESULTS A rational diagnostic work-up begins with history-taking and physical examination, with attention to risk factors-above all, immune compromise and atopy. If there is evidence of atopy, targeted allergy diagnostics should be performed, consisting of a skin prick test and/or measurement of specific IgE antibodies, supplemented whenever indicated by provocative testing and cellular test systems. If the patient's immune response is compromised, the immediate cessation of mold exposure has absolute priority. Any suspected invasive fungal infection should be evaluated with radiological, microbiological, serological, and immunological testing. Indoor measurements of mold fungi, microbial volatile organic compounds (MVOC), and/or mycotoxins are generally not indicated as part of the medical evaluation; nor are blood or urine tests for particular mold components or metabolites. CONCLUSION Mold in indoor environments should be dealt with by rapid exposure elimination for patients at risk, the rational diagnostic evaluation of any symptoms and signs of disease, and patient education about the possibilities and limitations of diagnostic testing and the generally limited utility of measurements in the affected interior spaces.
Collapse
|
3
|
Rabenstein A, Czermak L, Fischer E, Kahnert K, Pogarell O, Jörres RA, Nowak D, Rüther T. Implications of Switching from Conventional to Electronic Cigarettes on Quality of Life and Smoking Behaviour: Results from the EQualLife Trial. Eur Addict Res 2024:1-9. [PMID: 38626733 DOI: 10.1159/000536255] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 01/02/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Electronic cigarettes and "vaping" have become popular since their appearance in Europe and the USA in approximately 2006. They are often perceived as having fewer health risks than conventional cigarettes, which makes them of interest as a support tool in smoking cessation. However, its efficacy regarding cessation or reduction of smoking under real-life conditions remains controversial. Our objective was to clarify this question in an observational study of smoking habits after initiating vaping without targeted intervention, as compared to a validated cessation programme. METHODS From October 2015 to April 2018, 80 subjects (60 in the e-cigarette group and 20 in the supervised smoking cessation group) were included in two trial visits, one at the start of the trial and the second after 3 months, plus 4 questionnaire surveys: at the start of the trial and after a 1, 2, and 3 month period. The questionnaire included a nicotine use inventory, a modified Fagerström test for nicotine dependence, and the WHO-QOL-BREF survey. RESULTS E-cigarettes were effective, leading to a significant (p < 0.03) reduction (p < 0.03) in tobacco consumption and nicotine dependence, with an abstinence rate of 43% after 3 months. Compared to participants in the smoking cessation programme, their use was not associated with an improvement in quality of life during the quitting attempt, and there were no significant differences in clinical symptoms between groups. The reduction in nicotine dependence was more pronounced (p < 0.012) for the smoking cessation programme, with higher abstinence rates (p = 0.011 after 12 weeks) and lower (p < 0.003) remaining tobacco consumption compared to electronic cigarettes. DISCUSSION/CONCLUSIONS The use of electronic cigarettes reduced nicotine dependence and tobacco consumption, but a supervised smoking cessation programme was superior in terms of achieved cessation in both regards. Electronic cigarettes did not improve the quality of life. Since e-cigarettes could be associated with long-term health risks, their usefulness in smoking cessation remains questionable, and a professionally guided and validated smoking cessation programme still appears to be superior and preferable, in terms of achieved cessation. Although this trial is limited regarding the number of participants and follow-up time, it highlights the need for additional, large clinical trials evaluating the efficacy of e-cigarettes for smoking cessation in comparison to a professionally guided smoking cessation programme.
Collapse
Affiliation(s)
- Andrea Rabenstein
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Lilian Czermak
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Elke Fischer
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, German Center for Lung Research (DZL Munich), CPD (Comprehensive Pneumology Center Munich), Munich, Germany
| | - Kathrin Kahnert
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
- MediCenter Germering, Germering, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, German Center for Lung Research (DZL Munich), CPD (Comprehensive Pneumology Center Munich), Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, German Center for Lung Research (DZL Munich), CPD (Comprehensive Pneumology Center Munich), Munich, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
4
|
Strieker S, Radon K, Forster F, Örnek ÖK, Wengenroth L, Schmotz W, Sonnemann F, Hoopmann M, Hepp M, Nowak D, Weinmann T, Rakete S. Biomonitoring of lead in blood of children living in a former mining area in Lower Saxony, Germany. Environ Sci Pollut Res Int 2024:10.1007/s11356-024-32719-x. [PMID: 38594562 DOI: 10.1007/s11356-024-32719-x] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/26/2024] [Indexed: 04/11/2024]
Abstract
Environmental exposure to lead substantially decreased over the past decades. However, soil of former mining areas still contains high lead levels. We therefore performed a biomonitoring study among children living in two former mining communities in Lower Saxony, Germany. In these communities, soil contains lead levels of 1000 to 30,000 mg/kg. Overall, 75 children (6-10 years of age) attending the two primary schools of the study area took part in the study. Parents completed a short questionnaire on sociodemographics, and children provided capillary whole blood samples. We analysed lead using inductively coupled plasma tandem mass spectrometer. We compared the results to current German (20 μg/l for boys, 15 μg/l for girls) and US (35 μg/l) reference values. Potential associations between questionnaire information and lead results were tested using lead as continuous outcome and using lead dichotomized at the reference values. Finally, we analysed spatial patterns of elevated biomonitoring results. Of all children, 48% exceeded the German reference values for lead (5% expected) and 8% the US reference value (2.5% expected). Children 6-8 years of age were more likely to exceed German reference values (63%) than 9-10 year old children were (32%; pFisher = 0.01). No other questionnaire information was statistically significantly associated with biomonitoring results. Additionally, we did not find any indication of spatial clustering. In conclusion, we observed elevated blood lead levels in primary school children living in a former mining area. In the next step, exposure pathways need to be identified to implement effective public health measures.
Collapse
Affiliation(s)
- Sonja Strieker
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany
| | - Felix Forster
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany
| | - Özlem Köseoglu Örnek
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany
- Department of Nursing Science, Universität Witten/Herdecke, Witten, Germany
| | - Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany.
| | - Walter Schmotz
- District of Goslar, Department of Construction & Environment-Soil Protection and Waste Monitoring, Goslar, Germany
| | - Finn Sonnemann
- District of Goslar, Department of Construction & Environment-Soil Protection and Waste Monitoring, Goslar, Germany
| | | | - Martin Hepp
- District of Goslar, Department of Public Health Services, Goslar, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany
| | - Stefan Rakete
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany
| |
Collapse
|
5
|
Ebert F, Ballenberger N, Hayden MC, Möller D, Limbach M, Schuler M, Nowak D, Schultz K. [Effects of pulmonary rehabilitation on dysfunctional respiratory patterns in patients with uncontrolled asthma]. Rehabilitation (Stuttg) 2024; 63:100-106. [PMID: 38244536 DOI: 10.1055/a-2192-3377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
PURPOSE Dysfunctional breathing patterns (DAM) are deviations from physiologic breathing patterns. DAM seem to be associated with lower asthma control. To date, it is unclear what effect inpatient rehabilitation can have on this problem. The aim of this work is to investigate the effect of pulmonary rehabilitation (PR) on DAM. METHODS The data are based on a randomized controlled trial with a waiting control group. The intervention group (IG) received PR 4 weeks after application approval and the control group (KG) after 5 months. Dysfunctional breathing was assessed by Nijmegen-Questionnaire (NQ). Values ≥ 23 points indicate an existing DAM. Values at the end of rehabilitation (T2) and after three months (T3) were compared (analysis of covariance). Supplemental moderator analysis was performed to examine whether the effect of PR was related to baseline NQ scores. RESULTS Significant differences in NQ score are found between IG (n=202) and KG (n=210) at T2 (AMD=10.5; 95%CI [9; 12]; d=1.4; p<0.001) and at T3 (AMD=5.8; 95%CI [4.3; 7.3]; d=0.8; p<0.001). There is an interaction effect between the difference in NQ score between the groups at T2 and baseline at T0 (b=5.6; 95%CI [2.2; 11.9]; p<0.001). At T3, this interaction effect was no longer detectable (b=4.5; 95%CI [-3.1; 14.1]; p=807). CONCLUSION Inpatient, multimodality, and interdisciplinary PR is associated with significant and clinically relevant improvement in DAM both at discharge and 3 months later. In the short term, patients with existing DAM benefit more from PR than patients without DAM.
Collapse
Affiliation(s)
- Franziska Ebert
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie der Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall
| | | | - Markus C Hayden
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie der Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall
| | - Dirk Möller
- Fakultät Wirtschafts- und Sozialwissenschaften, Hochschule Osnabrück
| | - Matthias Limbach
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie der Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall
| | - Michael Schuler
- Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit Bochum
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits- und Umweltmedizin, Klinikum der Universität München
| | - Konrad Schultz
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie der Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall
| |
Collapse
|
6
|
Markowitz S, Ringen K, Dement JM, Straif K, Christine Oliver L, Algranti E, Nowak D, Ehrlich R, McDiarmid MA, Miller A. Occupational lung cancer screening: A Collegium Ramazzini statement. Am J Ind Med 2024; 67:289-303. [PMID: 38440821 DOI: 10.1002/ajim.23572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Steven Markowitz
- Barry Commoner Center for Health & the Environment, Queens College, City University of New York, New York, New York State, USA
| | - Knut Ringen
- CPWR-The Center for Construction Research and Training, Silver Spring, Maryland, USA
| | - John M Dement
- Duke University School of Medicine, Division of Occupational & Environmental Medicine, Durham, North Carolina, USA
| | - Kurt Straif
- ISGlobal, Barcelona, Spain
- Boston College, Chestnut Hill, Massachusetts, USA
| | - L Christine Oliver
- Dalla Lana School of Public Health, Division of Occupational and Environmental Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU Klinikum, LMU Munich, CPC Munich, Comprehensive Pneumology Center Munich, #DZL, Deutsches Zentrum für Lungenforschung, Munich, Germany
| | - Rodney Ehrlich
- Division of occupational Medicine, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Melissa A McDiarmid
- Division of Occupational & Environmental Medicine, University of Maryland School of Medicine, USA
| | - Albert Miller
- Barry Commoner Center for Health & the Environment, Queens College, City University of New York, New York, New York State, USA
- Department of Medicine, Mount Sinai School of Medicine, New York, New York State, USA
| |
Collapse
|
7
|
Frei-Stuber L, Wächter A, Benthaus T, Ochmann U, Nowak D. [Prevention of progression of allergic bronchial asthma as an occupational disease]. Pneumologie 2024; 78:269-275. [PMID: 37857319 DOI: 10.1055/a-2185-0896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/21/2023]
Abstract
Since January 1st, 2021, termination of a harmful activity as a requirement for its recognition as an occupational disease (OD) has been abolished in Germany. This also includes the OD No. 4301 in accordance with Appendix 1 of the Occupational Diseases Ordinance (ODO) (obstructive respiratory diseases caused by allergenic substances). There has already been a significant increase in the number of diseases recognized under this OD. In this article, we present two patients with allergic (in the second case report mixed-form) bronchial asthma, in whom a medically easily preventable disease progression occurred as a result of continued occupational exposure to allergens as a farmer. According to § 3 (1) ODO, if there is a "risk that an occupational disease will develop, recur or worsen", the statutory accident insurance institutions are obliged to "counteract this danger with all suitable means". These individual preventive measures are compulsory by law and medically sensible, even under circumstances where only the risk of the genesis of an OD is given. Nonetheless, they are likely to be indicated and offered more frequently in the future due to an increased recognition of ODs. Unfavorable clinical courses such as those described in the two case reports presented here should therefore occur less frequently in the future.
Collapse
Affiliation(s)
- Ludwig Frei-Stuber
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Deutschland
| | - Annabelle Wächter
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Deutschland
| | - Tobias Benthaus
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Deutschland
- Betriebsärztlicher Dienst, Bayerischer Rundfunk, München, Deutschland
| | - Uta Ochmann
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Deutschland
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Deutschland
| |
Collapse
|
8
|
Wolfschmidt-Fietkau A, Ochmann U, Hiller J, Nowak D, Schöffski O, Drexler H. [Economic Relevance of Preventable Prohibitions of Employment in Bavarian Schools]. Gesundheitswesen 2024. [PMID: 38467151 DOI: 10.1055/a-2251-5727] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
INTRODUCTION According to the Maternity Protection Act, an occupational risk of infection (e. g. in childcare) - combined with individual immunity gaps - can result in an irresponsible risk for pregnant women in the workplace. If this risk cannot be eliminated by any other means, the employer must impose a prohibition of employment (PE) for the pregnant woman concerned. We classified PE as preventable if the underlying immunity gaps could have been closed by immunisation prior to pregnancy. METHODS From 01.09.2016 to 25.03.2020, 1922 pregnant employees of Bavarian state schools obtained medical counselling on their occupational risk of infection as part of a research project. If the individual combination of occupational-risk profile and immunity status resulted in an irresponsible risk for the pregnancy, a PE was recommended by the attending physician. We determined the proportion of PE that would have theoretically been preventable by full immunisation prior to pregnancy and approximated the resulting - theoretically preventable - loss of working hours and personnel costs. RESULTS In 425 cases (22%), a PE was deemed necessary by the attending physician, whereby 193 (45%) were retrospectively classified as theoretically preventable. Of these cases, 53 PE (27%) were temporary (valid until the 20th week of pregnancy) and 140 were long-term (valid for the complete duration of the pregnancy). Based on these results, we approximated a loss of 2,746 working weeks for our collective, which entails theoretically preventable personnel costs totalling 5,763,305 € for the observation period of our study (3.6 years). We then extrapolated estimates for all employees of Bavarian state schools and found a loss of 4,260 working weeks and theoretically preventable personnel costs amounting to almost 8,941,000 € per year during our observation period. CONCLUSION Theoretically preventable PE caused by immunity gaps can entail a considerable loss of working hours and high personnel costs. Therefore, we should step up measures aimed at improving vaccination rates in women and increasing their willingness to be vaccinated. In view of the changes in legal and regulatory conditions in Germany since 2020, new investigations should be made as soon as there is sufficient data after the general employment prohibitions due to the SARS-CoV-2-pandemic have been lifted.
Collapse
Affiliation(s)
- Anna Wolfschmidt-Fietkau
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Uta Ochmann
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Julia Hiller
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Oliver Schöffski
- Gesundheitsmanagement, Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Hans Drexler
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
9
|
Pan H, Jarvis D, Potts J, Casas L, Nowak D, Heinrich J, Aymerich JG, Urrutia I, Martinez-Moratalla J, Gullón JA, Pereira-Vega A, Raherison C, Chanoine S, Demoly P, Leynaert B, Gislason T, Probst N, Abramson MJ, Jõgi R, Norbäck D, Sigsgaard T, Olivieri M, Svanes C, Fuertes E. Gas cooking indoors and respiratory symptoms in the ECRHS cohort. Int J Hyg Environ Health 2024; 256:114310. [PMID: 38183794 DOI: 10.1016/j.ijheh.2023.114310] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/22/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Gas cooking is an important source of indoor air pollutants, and there is some limited evidence that it might adversely be associated with respiratory health. Using repeated cross-sectional data from the multi-centre international European Community Respiratory Health Survey, we assessed whether adults using gas cookers have increased risk of respiratory symptoms compared to those using electric cookers and tested whether there was effect modification by a priori selected factors. METHODS Data on respiratory symptoms and gas cooking were collected from participants at 26-55 and 38-67 years (median time between examinations 11.4 years) from interviewer-led questionnaires. Repeated associations between gas cooking (versus electric) and respiratory symptoms were estimated using multivariable mixed-effects logistic regression models adjusted for age, sex, study arm, smoking status, education level, and included random intercepts for participants within study centres. Analyses were repeated using a 3-level variable for type of cooker and gas source. Effect modification by ventilation habits, cooking duration, sex, age atopy, asthma, and study arm were examined. RESULTS The sample included 4337 adults (43.7% males) from 19 centres in 9 countries. Gas cooking increased the risk of "shortness of breath whilst at rest" (OR = 1.38; 95%CI: 1.06-1.79) and "wheeze with breathlessness" (1.32; 1.00-1.74). For several other symptoms, effect estimates were larger in those who used both gas hobs and ovens, had a bottled gas source and cooked for over 60 min per day. Stratifying results by sex and age found stronger associations in females and younger adults. CONCLUSION This multi-centre international study, using repeat data, suggested using gas cookers in the home was more strongly associated than electric cookers with certain respiratory symptoms in adults. As gas cooking is common, these results may play an important role in population respiratory health.
Collapse
Affiliation(s)
- Holly Pan
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Debbie Jarvis
- National Heart and Lung Institute, Imperial College London, London, UK; MRC Centre for Environment & Health, London, UK
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Lidia Casas
- Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Germany
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Germany
| | - Judith Garcia Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Isabel Urrutia
- Respiratory Department, Galdakao Hospital, OSI Barrualde-Galdakao, Biscay, Spain
| | - Jesus Martinez-Moratalla
- Servicio de Neumología del Complejo Hospitalario Universitario de Albacete. (CHUA) Albacete, Spain; Servicio de Salud de Castilla - La Mancha (SESCAM), Spain; Facultad de Medicina de Albacete. Universidad de Castilla - La Mancha, Albacete, Spain
| | | | | | | | | | - Pascal Demoly
- University Hospital of Montpellier, IDESP, Univ Montpellier - Inserm, Montpellier, France
| | - Bénédicte Leynaert
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Center for Epidemiology and Population Health (CESP), Integrative Respiratory Epidemiology Team, 94807, Villejuif, France; Landspitali University Hospital, Department of Sleep, Reykjavik Iceland
| | - Thorarinn Gislason
- University of Iceland, Medical Faculty, Reykjavik, Iceland; Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Rain Jõgi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Dan Norbäck
- Occupational and Environmental Medicine, Department of Medical Science, University Hospital, Uppsala University, 75237, Uppsala, Sweden
| | - Torben Sigsgaard
- Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Mario Olivieri
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, Policlinico "G. Rossi", Verona, Italy; Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, UK; MRC Centre for Environment & Health, London, UK.
| |
Collapse
|
10
|
Kaltenegger HC, Marques MD, Becker L, Rohleder N, Nowak D, Wright BJ, Weigl M. Prospective associations of technostress at work, burnout symptoms, hair cortisol, and chronic low-grade inflammation. Brain Behav Immun 2024; 117:320-329. [PMID: 38307447 DOI: 10.1016/j.bbi.2024.01.222] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Working conditions in the age of digitalization harbor risks for chronic stress and burnout. However, real-world investigations into biological effects of technostress, that is stress in the context of digital technology use, are sparse. This study prospectively assessed associations between technostress, general work stress, burnout symptoms, hair cortisol, and chronic low-grade inflammation. METHODS Hospital employees (N = 238, 182 females, Mage = 28.5 years) participated in a prospective cohort study with two follow-ups six months apart (T2, T3). Participants answered standardized questionnaires on general job strain (job demand-control ratio), technostressors (work interruptions, multitasking, information overload), burnout symptoms (exhaustion, mental distance), and relevant confounders. Moreover, they provided capillary blood samples for C-reactive protein (CRP) and hair strands for hair cortisol concentration (HCC) analysis. Structural equation modelling was performed. RESULTS The factorial structure of survey measures was confirmed. Burnout symptoms (MT2 = 2.17, MT3 = 2.33) and HCC (MT2 = 4.79, MT3 = 9.56; pg/mg) increased over time, CRP did not (MT2 = 1.15, MT3 = 1.21; mg/L). Adjusted path models showed that technostress was negatively associated with HCC (β = -0.16, p =.003), but not with burnout and CRP. General work stress in contrast, was not significantly associated with burnout, HCC or CRP. Furthermore, there were reciprocal effects of CRP on HCC (β = 0.28, p =.001) and of HCC on CRP (β = -0.10, p ≤.001). Associations were robust in additional analyses including further confounders. CONCLUSION This is the first study on prospective effects of technostress on employees' endocrine and inflammatory systems. Results suggest differential effects of technostress on the hypothalamic-pituitary-adrenocortical axis activity. Given its key role for long-term health, the findings have important implications for occupational health and safety in digitalized work environments.
Collapse
Affiliation(s)
- Helena C Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Mathew D Marques
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Linda Becker
- Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Humanwissenschaftliche Fakultät, Vinzenz Pallotti University gGmbH, Vallendar, Germany
| | - Nicolas Rohleder
- Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Bradley J Wright
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
11
|
Bojahr J, Jörres RA, Kronseder A, Weber F, Ledderhos C, Roiu I, Karrasch S, Nowak D, Teupser D, Königer C. Effects of training flights of combat jet pilots on parameters of airway function, diffusing capacity and systemic oxidative stress, and their association with flight parameters. Eur J Med Res 2024; 29:100. [PMID: 38317201 PMCID: PMC10840181 DOI: 10.1186/s40001-024-01668-z] [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] [Received: 06/22/2023] [Accepted: 01/12/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Fighter aircraft pilots are regularly exposed to physiological challenges from high acceleration (Gz) forces, as well as increased breathing pressure and oxygen supply in the support systems. We studied whether effects on the lung and systemic oxidative stress were detectable after real training flights comprising of a wide variety of exposure conditions, and their combinations. METHODS Thirty-five pilots of the German Air Force performed 145 flights with the Eurofighter Typhoon. Prior to and after flight lung diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO), alveolar volume (VA), and diffusing capacities per volume (KCO, KNO) were assessed. In addition, the fractional concentration of exhaled nitric oxide (FeNO) was determined, and urine samples for the analysis of molecular species related to 8-hydroxy-2'-deoxyguanosine (8-OHdG) were taken. For statistical analysis, mixed ANOVA models were used. RESULTS DLNO, DLCO, KNO, KCO and VA were reduced (p < 0.001) after flights, mean ± SD changes being 2.9 ± 5.0, 3.2 ± 5.2, 1.5 ± 3.7, 1.9 ± 3.7 and 1.4 ± 3.1%, respectively, while FeNO decreased by 11.1% and the ratio of 8-OHdG to creatinine increased by 15.7 ± 37.8%. The reductions of DLNO (DLCO) were smaller (p < 0.001) than those of KNO (KCO). In repeated flights on different days, baseline values were restored. Amongst various flight parameters comprising Gz-forces and/or being indicative of positive pressure breathing and oxygenation support, the combination of long flight duration and high altitude appeared to be linked to greater changes in DLNO and DLCO. CONCLUSIONS The pattern of reductions in diffusing capacities suggests effects arising from atelectasis and increased diffusion barrier, without changes in capillary blood volume. The decrease in exhaled endogenous NO suggests bronchial mucosal irritation and/or local oxidative stress, and the increase in urinary oxidized guanosine species suggests systemic oxidative stress. Although changes were small and not clinically relevant, their presence demonstrated physiological effects of real training flights in a modern 4th generation fighter jet.
Collapse
Affiliation(s)
- Janina Bojahr
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.
- Federal Armed Forces Hospital, Lesserstr. 180, 22049, Hamburg, Germany.
- Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Cologne, Germany.
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Angelika Kronseder
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Frank Weber
- Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Cologne, Germany
| | - Carla Ledderhos
- Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Cologne, Germany
| | - Immanuel Roiu
- 74th Tactical Air Wing of the German Air Force, Neuburg, Germany
| | - Stefan Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Daniel Teupser
- Institute for Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Christian Königer
- Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Cologne, Germany
- Occupational Medicine Department, Medical Support Center Munich, Munich, Germany
| |
Collapse
|
12
|
Carsin AE, Garcia-Aymerich J, Accordini S, Dharmage S, Leynaert B, de Las Heras M, Casas L, Caviezel S, Demoly P, Forsberg B, Gislason T, Corsico AG, Janson C, Jogi R, Martínez-Moratalla J, Nowak D, Gómez LP, Pin I, Probst-Hensch N, Raherison-Semjen C, Squillacioti G, Svanes C, Torén K, Urrutia I, Huerta I, Anto JM, Jarvis D, Guerra S. Spirometric patterns in young and middle-aged adults: a 20-year European study. Thorax 2024; 79:153-162. [PMID: 37758456 DOI: 10.1136/thorax-2022-219696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/06/2022] [Accepted: 07/19/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Understanding the natural history of abnormal spirometric patterns at different stages of life is critical to identify and optimise preventive strategies. We aimed to describe characteristics and risk factors of restrictive and obstructive spirometric patterns occurring before 40 years (young onset) and between 40 and 61 years (mid-adult onset). METHODS We used data from the population-based cohort of the European Community Respiratory Health Survey (ECRHS). Prebronchodilator forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were assessed longitudinally at baseline (ECRHS1, 1993-1994) and again 20 years later (ECRHS3, 2010-2013). Spirometry patterns were defined as: restrictive if FEV1/FVC≥LLN and FVC<10th percentile, obstructive if FEV1/FVC RESULTS Among 3502 participants (mean age=30.4 (SD 5.4) at ECRHS1, 50.4 (SD 5.4) at ECRHS3), 2293 (65%) had a normal, 371 (11%) a young restrictive, 301 (9%) a young obstructive, 187 (5%) a mid-adult onset restrictive and 350 (10%) a mid-adult onset obstructive spirometric pattern. Being lean/underweight in childhood and young adult life was associated with the occurrence of the young spirometric restrictive pattern (relative risk ratio (RRR)=1.61 95% CI=1.21 to 2.14, and RRR=2.43 95% CI=1.80 to 3.29; respectively), so were respiratory infections before 5 years (RRR=1.48, 95% CI=1.05 to 2.08). The main determinants for young obstructive, mid-adult restrictive and mid-adult obstructive patterns were asthma, obesity and smoking, respectively. CONCLUSION Spirometric patterns with onset in young and mid-adult life were associated with distinct characteristics and risk factors.
Collapse
Affiliation(s)
- Anne-Elie Carsin
- ISGlobal, Campus mar, Barcelona, Catalunya, Spain
- Universita Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Spain
- Biometrics, RTI-Health Solutions, Barcelona, Spain
| | - Judith Garcia-Aymerich
- ISGlobal, Campus mar, Barcelona, Catalunya, Spain
- Universita Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Spain
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Shyamali Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Bénédicte Leynaert
- Université Paris-Saclay, UVSQ, Univ Paris-Sud, Inserm, INSERM, Paris, France
| | - Marti de Las Heras
- ISGlobal, Campus mar, Barcelona, Catalunya, Spain
- Universita Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Spain
| | - Lidia Casas
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
- Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Antwerpen, Belgium
| | - Seraina Caviezel
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Pascal Demoly
- Département de Pneumologie et Addictologie, University Hospital of Montpellier, Montpellier, France
- IDESP, University of Montpellier - Inserm UMR UA11, Montpellier, France
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland
- Medical Faculty, University of Iceland, Iceland, Iceland
| | - Angelo Guido Corsico
- Department of Internal Medicine and Therapeutics, University of Pavia, Italy, Italy
- Division of Respiratory Diseases, Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia, Italy
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | | | - Dennis Nowak
- Institute and Clinic for Occupational and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Centre Munich, member DZL, German Centre for Lung Research, Munich, Germany
| | | | - Isabelle Pin
- Department of Pediatrics, CHU de Grenoble Alpes, Grenoble, France
- Inserm, UMR 1209, Institute for Advanced Biosciences, Grenoble, France
| | - Nicole Probst-Hensch
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Giulia Squillacioti
- Department of Public Health and Pediatrics, University of Turin, Torino, Piemonte, Italy
| | - Cecilie Svanes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kjell Torén
- Department of Occupational and Environmental, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Isabel Urrutia
- Pulmonology Department, Galdakao Hospital, Biocruces Bizkaia, Spain
| | - Ismael Huerta
- Epidemiological Surveillance Section, Directorate General of Public Health, Oviedo, Spain
| | - Josep Maria Anto
- ISGlobal, Campus mar, Barcelona, Catalunya, Spain
- Universita Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Spain
| | - Debbie Jarvis
- National Heart and Lung Institute, Imperial College, London, UK
| | - Stefano Guerra
- ISGlobal, Campus mar, Barcelona, Catalunya, Spain
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| |
Collapse
|
13
|
Wibowo R, Do V, Quartucci C, Koller D, Daanen HAM, Nowak D, Bose-O'Reilly S, Rakete S. Effects of heat and personal protective equipment on thermal strain in healthcare workers: part B-application of wearable sensors to observe heat strain among healthcare workers under controlled conditions. Int Arch Occup Environ Health 2024; 97:35-43. [PMID: 37947815 DOI: 10.1007/s00420-023-02022-2] [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] [Received: 06/07/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE As climate change accelerates, healthcare workers (HCW) are expected to be more frequently exposed to heat at work. Heat stress can be exacerbated by physical activity and unfavorable working requirements, such as wearing personal protective equipment (PPE). Thus, understanding its potential negative effects on HCW´s health and working performance is becoming crucial. Using wearable sensors, this study investigated the physiological effects of heat stress due to HCW-related activities. METHODS Eighteen participants performed four experimental sessions in a controlled climatic environment following a standardized protocol. The conditions were (a) 22 °C, (b) 22 °C and PPE, (c) 27 °C and (d) 27 °C and PPE. An ear sensor (body temperature, heart rate) and a skin sensor (skin temperature) were used to record the participants´ physiological parameters. RESULTS Heat and PPE had a significant effect on the measured physiological parameters. When wearing PPE, the median participants' body temperature was 0.1 °C higher compared to not wearing PPE. At 27 °C, the median body temperature was 0.5 °C higher than at 22 °C. For median skin temperature, wearing PPE resulted in a 0.4 °C increase and higher temperatures in a 1.0 °C increase. An increase in median heart rate was also observed for PPE (+ 2/min) and heat (+ 3/min). CONCLUSION Long-term health and productivity risks can be further aggravated by the predicted temperature rise due to climate change. Further physiological studies with a well-designed intervention are needed to strengthen the evidence for developing comprehensive policies to protect workers in the healthcare sector.
Collapse
Affiliation(s)
- Razan Wibowo
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Viet Do
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Caroline Quartucci
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
- Institute for Occupational Safety and Environmental Health Protection, Bavarian Health and Food Safety Authority, 80538, Munich, Germany
| | - Daniela Koller
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, 81377, Munich, Germany
| | - Hein A M Daanen
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Stephan Bose-O'Reilly
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Stefan Rakete
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany.
| |
Collapse
|
14
|
Gerlich J, Ohlander J, Kromhout H, Vermeulen R, Söhler S, Radon K, Nowak D, Karrasch S, Adaskina N, Vogelmeier C, Ochmann U, Jörres RA. Cumulative occupational exposure to gases and fumes is associated with impairment in lung function and disease-related quality of life in a German COPD patient cohort. Occup Environ Med 2023; 81:oemed-2023-108908. [PMID: 38160050 PMCID: PMC10850675 DOI: 10.1136/oemed-2023-108908] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The impact of occupational exposures on lung function impairments and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) was analysed and compared with that of smoking. METHODS Data from 1283 men and 759 women (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1-4 or former grade 0, without alpha-1-antitrypsin deficiency) of the COPD and Systemic Consequences Comorbidities Network cohort were analysed. Cumulative exposure to gases/fumes, biological dust, mineral dust or the combination vapours/gases/dusts/fumes was assessed using the ALOHA job exposure matrix. The effect of both occupational and smoking exposure on lung function and disease-specific QoL (St George's Respiratory Questionnaire) was analysed using linear regression analysis adjusting for age, body mass index, diabetes, hypertension and coronary artery disease, stratified by sex. RESULTS In men, exposure to gases/fumes showed the strongest effects among occupational exposures, being significantly associated with all lung function parameters and QoL; the effects were partially stronger than of smoking. Smoking had a larger effect than occupational exposure on lung diffusing capacity (transfer factor for carbon monoxide) but not on air trapping (residual volume/total lung capacity). In women, occupational exposures were not significantly associated with QoL or lung function, while the relationships between lung function parameters and smoking were comparable to men. CONCLUSIONS In patients with COPD, cumulative occupational exposure, particularly to gases/fumes, showed effects on airway obstruction, air trapping, gas uptake capacity and disease-related QoL, some of which were larger than those of smoking. These findings suggest that lung air trapping and QoL should be considered as outcomes of occupational exposure to gases and fumes in patients with COPD. TRIAL REGISTRATION NUMBER NCT01245933.
Collapse
Affiliation(s)
- Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Johan Ohlander
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Sandra Söhler
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Member of the German Center for Lung Research (DZL), Philipps-Universität Marburg, Marburg, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
| | | | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Member of the German Center for Lung Research (DZL), Philipps-Universität Marburg, Marburg, Germany
| | - Uta Ochmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Rudolf A Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| |
Collapse
|
15
|
Landesberger V, Grenzebach K, Schreiber F, Nowak D, Gröger M, Oppel E, Schaub B, French LE, Kutzora S, Quartucci C, Herr C, Heinze S. Conception and pilot testing of a self-management health application for patients with pollen-related allergic rhinitis and allergic asthma-the APOLLO app. Sci Rep 2023; 13:21568. [PMID: 38057347 PMCID: PMC10700582 DOI: 10.1038/s41598-023-48540-4] [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] [Received: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
It has been shown that pollen information services are an important self-management tool for patients with pollen-related allergic rhinitis (AR) and allergic asthma (AA). This study aimed to design an online application for patients with AR and AA, which supports patients to better manage their disease as well as to evaluate the app and present the first results of the pilot study. The pollen data were obtained from the electronic pollen information network of Bavaria, Germany. Participants were asked to fill in their allergy-related complaints in the app over a 60-day period. Subsequently, the app was evaluated. Indices and diagrams visualized the participants' individual complaints as well as the daily pollen concentration in the air. In order to motivate participants to complete the app on a daily basis, we used elements of gamification. Two thirds of the participants (N = 46) reported feeling better informed about pollen counts and their allergy when using the app. The app's simple and comprehensible design was rated positively. More than 80% of the participants would recommend the app to their family and friends. The app can be a tool for patients with AR and AA to better understand their disease.
Collapse
Affiliation(s)
- V Landesberger
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - K Grenzebach
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - F Schreiber
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - D Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC) Munich, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - M Gröger
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - E Oppel
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - B Schaub
- LMU Munich, University Children's Hospital, Munich, Germany
- Member of the German Center of Lung Research (DZL), Munich, Germany
| | - L E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - S Kutzora
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany.
| | - C Quartucci
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC) Munich, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - C Herr
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC) Munich, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - S Heinze
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC) Munich, Member of the German Center of Lung Research (DZL), Munich, Germany
| |
Collapse
|
16
|
Hayden MC, Schuler M, Limbach M, Schwarzl G, Stenzel N, Nowak D, Schultz K. [Patient-Reported Outcomes (PROs) 3 and 6 Months After Pulmonary Rehabilitation Following COVID-19]. Rehabilitation (Stuttg) 2023; 62:349-358. [PMID: 37907217 DOI: 10.1055/a-2134-2142] [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] [Indexed: 11/02/2023]
Abstract
PURPOSE If COVID-19 disease sequelae also (co-)affect the respiratory organs, national and international guidelines recommend pulmonary rehabilitation (PR). So far, however, no studies are available from Germany on the course after PR, nor on possible course differences between the two Long COVID subgroups "Ongoing symptomatic COVID-19" and "Post-COVID-19 syndrome" (PCS). METHODS In a prospective observational study, patient-reported outcomes (PROs) regarding exertional dyspnea, quality of life, pain, fatigue, depression, and anxiety were assessed at the beginning of PR (T1), end of PR (T2), and after 3 (T3) and 6 months (T4). Statistical analyses were performed using latent difference models. RESULTS There were 224 rehabilitation patients (MAge=54.4; SDAge=10.4; 42.0% female) included in the study. During PR, all PROs improved significantly. After PR, improvements either persisted with large pre-post effect sizes (exertional dyspnea, quality of life), decreased slightly to small pre-post effect sizes (depression, fatigue), or decreased to baseline levels (anxiety, pain). PCS patients had greater burdens in depression, fatigue, and pain at baseline, but did not differ in trajectories. Indicators of the severity of the preceding acute phase (oxygen therapy, ICU treatment, ventilation) were associated with higher burdens at T0 in depression, fatigue, and pain, but not with the courses during and after PR. In contrast, female patients showed higher burdens in both depression and fatigue at T1 and higher pre-post effects than male patients. CONCLUSION The fact that improvements in PROs occurred in both subgroups only during PR, but not during the follow-up period suggests that the changes are not due to the natural healing process but at least partly due to PR. Moreover, the results suggest that both patient groups may benefit from PR. Persisting improvements in exertional dyspnea and quality of life and, to a reduced extent, in depression and fatigue until 6 months after PR, but not in pain and anxiety warrant study of additional multimodal interventions that may be needed to maintain these effects.
Collapse
Affiliation(s)
- Markus C Hayden
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall
| | - Michael Schuler
- Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit, Bochum
| | - Matthias Limbach
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall
| | - Gabriele Schwarzl
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall
| | - Nikola Stenzel
- Klinische Psychologie und Psychotherapie, Psychologische Hochschule Berlin gGmbH, Berlin
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin Umweltmedizin, Klinikum der Universität München, LMU München
| | - Konrad Schultz
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall
| |
Collapse
|
17
|
Gigl R, Quartucci C, Nowak D, Ochmann U, Garrido MV, Preisser AM, Harth V, Herr CEW, Heinze S. [Patient Care in German Outpatient Clinics for Environmental Medicine Illustrated by the Examples of Hamburg and Munich University Hospitals]. Gesundheitswesen 2023; 85:1110-1114. [PMID: 38081172 DOI: 10.1055/a-2183-8119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/18/2023]
Abstract
People can be affected by various environmental factors (e. g., odor, noise) which can lead to medical complaints or illnesses. Few adequate contact points are available for patients with suspected environmental complaints in Germany. Illustrated by the outpatient clinics for environmental medicine in Hamburg and Munich, this report shows how patients with suspected environmental medical diseases are cared for in Germany. For the exemplary presentation, the data of the environmental medicine outpatient clinics of both the university hospitals from 01.01.2019 to 31.03.2021 are presented and compared. Overall, more female than male patients were treated at both facilities. Suspected exposure to "heavy metals" was most frequently mentioned by patients as the assumed reason for their complaints. Nonetheless, the suspected exposure or "intoxication" could be ruled out in the majority of cases by appropriate examination methods in accordance to current medical guidelines. The data provided by the environmental medicine outpatient clinics show that there is a continuous demand for environmental medical care. A close cooperation between the private practice sector and the outpatient clinics for environmental medicine providing medical care to patients should therefore be sought.
Collapse
Affiliation(s)
- Ramona Gigl
- Arbeits- und Umweltbezogener Gesundheitsschutz, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit München, München, Germany
| | - Caroline Quartucci
- Arbeits- und Umweltbezogener Gesundheitsschutz, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit München, München, Germany
- Institut und Poliklinik für Arbeit-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität, München, Bayern, Deutschland. Comprehensive Pneumology Center (CPC) München, Deutsches Zentrum für Lungenforschung, DZL
| | - Dennis Nowak
- Institut und Poliklinik für Arbeit-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität, München, Bayern, Deutschland. Comprehensive Pneumology Center (CPC) München, Deutsches Zentrum für Lungenforschung, DZL
| | - Uta Ochmann
- Institut und Poliklinik für Arbeit-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität, München, Bayern, Deutschland. Comprehensive Pneumology Center (CPC) München, Deutsches Zentrum für Lungenforschung, DZL
| | - Marcial Velasco Garrido
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra M Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Volker Harth
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Caroline Eva Wella Herr
- Arbeits- und Umweltbezogener Gesundheitsschutz, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit München, München, Germany
- Institut und Poliklinik für Arbeit-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität, München, Bayern, Deutschland. Comprehensive Pneumology Center (CPC) München, Deutsches Zentrum für Lungenforschung, DZL
| | - Stefanie Heinze
- Arbeits- und Umweltbezogener Gesundheitsschutz, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit München, München, Germany
- Institut und Poliklinik für Arbeit-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität, München, Bayern, Deutschland. Comprehensive Pneumology Center (CPC) München, Deutsches Zentrum für Lungenforschung, DZL
| |
Collapse
|
18
|
Jordakieva G, Nowak D. Editorial: Occupational immunology: current knowledge and future perspectives. Front Med (Lausanne) 2023; 10:1322157. [PMID: 38020110 PMCID: PMC10667930 DOI: 10.3389/fmed.2023.1322157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Galateja Jordakieva
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| |
Collapse
|
19
|
Haddad P, Ogurtsova K, Lucht S, Glaubitz L, Höppe P, Nowak D, Angerer P, Hoffmann B. Short-term exposure to ultrafine and fine particulate matter with multipollutant modelling on heart rate variability among seniors and children from the CorPuScula (coronary, pulmonary, sanguis) longitudinal study in Germany. Front Epidemiol 2023; 3:1278506. [PMID: 38455908 PMCID: PMC10910943 DOI: 10.3389/fepid.2023.1278506] [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] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/19/2023] [Indexed: 03/09/2024]
Abstract
Background Short-term exposure particulate matter with a diameter of 10 µm or less (PM10) and fine particulate matter (PM2.5) has been associated with heart rate variability (HRV), but exposure to ultrafine particles (UFP) has been less well examined. We investigated the associations between the HRV outcomes and short-term exposure to UFP, PM10 and PM2.5 among school-aged children and seniors. Methods CorPuScula (Coronary, Pulmonary and Sanguis) is a longitudinal, repeated-measure panel study conducted in 2000-2002 in Munich, Germany including 52 seniors (58-94 years old) with 899 observations and 50 children (6-10 years old) with 925 observations. A 10-min resting electrocardiogram was performed to assess resting HRV outcomes [Standard Deviation of Normal to Normal Intervals (SDNN), Root Mean Square of Successive Differences between Normal Heartbeats (RMSSD), Low Frequency power (LF), High Frequency power (HF), ration between low and high frequency (LF/HF)]. UFP and PM exposures were measured near the care home and school yard for seniors and children, respectively. Mean exposures during the day of examination (9-21 h) as well as 3-h, 12-h, 24-h, one-day, and two-day lags were assessed. Linear mixed-effect models were used to investigate the associations between short-term air pollution and HRV outcomes separately in children and seniors. The models were adjusted for sex, age, weather conditions (temperature, precipitation, and water vapor pressure), BMI, lifestyle and medical information. Two and multipollutant models adjusted for NO2 and O3 were performed. Results Among seniors, we observed increases in SDNN, LF, HF and LF/HF ratio after short-term exposure to UFP (hourly and daily lags) in contrast to decreases in SDNN and RMSSD after exposure to PM10. Associations were generally robust to two- and multipollutant adjustment. Among children, we observed increases of the LF/HF ratio after short-term exposures to UFP at lags 12 and 24 h. In contrast, we observed decreases of the ratio after exposure to PM2.5 and PM10. Results were largely unchanged for multipollutant modelling, however we found a more pronounced increase in SDNN and LF/HF (UFP lag 12 and 24 h) after adjusting for NO2. Conclusions Overall, among seniors, we observed associations of UFP and PM10 exposure with sympathetic responses of the ANS, which play an important role in sudden heart attacks or arrhythmia. Among children we found more inconsistent associations between UFP and a delayed increase in HRV. Adjusting for co-pollutants including NO2 and O3 yielded robust results.
Collapse
Affiliation(s)
- Pascale Haddad
- Institute for Occupational Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Katherine Ogurtsova
- Institute for Occupational Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sarah Lucht
- Institute for Occupational Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Real-World Evidence & Insights, Cardinal Health, Dublin, OH, United States
| | - Lina Glaubitz
- Institute for Occupational Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Peter Höppe
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Peter Angerer
- Institute for Occupational Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Barbara Hoffmann
- Institute for Occupational Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
20
|
Zhao T, Markevych I, Fuertes E, de Hoogh K, Accordini S, Boudier A, Casas L, Forsberg B, Garcia Aymerich J, Gnesi M, Holm M, Janson C, Jarvis D, Johannessen A, Jörres RA, Karrasch S, Leynaert B, Maldonado Perez JA, Malinovschi A, Martínez-Moratalla J, Modig L, Nowak D, Potts J, Probst-Hensch N, Sánchez-Ramos JL, Siroux V, Urrutia Landa I, Vienneau D, Villani S, Jacquemin B, Heinrich J. Impact of long-term exposure to ambient ozone on lung function over a course of 20 years (The ECRHS study): a prospective cohort study in adults. Lancet Reg Health Eur 2023; 34:100729. [PMID: 37691742 PMCID: PMC10482740 DOI: 10.1016/j.lanepe.2023.100729] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
Background While the adverse effects of short-term ambient ozone exposure on lung function are well-documented, the impact of long-term exposure remains poorly understood, especially in adults. Methods We aimed to investigate the association between long-term ozone exposure and lung function decline. The 3014 participants were drawn from 17 centers across eight countries, all of which were from the European Community Respiratory Health Survey (ECRHS). Spirometry was conducted to measure pre-bronchodilation forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) at approximately 35, 44, and 55 years of age. We assigned annual mean values of daily maximum running 8-h average ozone concentrations to individual residential addresses. Adjustments were made for PM2.5, NO2, and greenness. To capture the ozone-related change in spirometric parameters, our linear mixed effects regression models included an interaction term between long-term ozone exposure and age. Findings Mean ambient ozone concentrations were approximately 65 μg/m³. A one interquartile range increase of 7 μg/m³ in ozone was associated with a faster decline in FEV1 of -2.08 mL/year (95% confidence interval: -2.79, -1.36) and in FVC of -2.86 mL/year (-3.73, -1.99) mL/year over the study period. Associations were robust after adjusting for PM2.5, NO2, and greenness. The associations were more pronounced in residents of northern Europe and individuals who were older at baseline. No consistent associations were detected with the FEV1/FVC ratio. Interpretation Long-term exposure to elevated ambient ozone concentrations was associated with a faster decline of spirometric lung function among middle-aged European adults over a 20-year period. Funding German Research Foundation.
Collapse
Affiliation(s)
- Tianyu Zhao
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
- “Health and Quality of Life in a Green and Sustainable Environment”, SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- MRC Centre for Environment & Health, London, UK
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Anne Boudier
- University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
- Pediatric Department, CHU Grenoble Alpes, Grenoble, France
| | - Lidia Casas
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Belgium
| | - Bertil Forsberg
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Judith Garcia Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Marco Gnesi
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Deborah Jarvis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- MRC Centre for Environment & Health, London, UK
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rudolf A. Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Benedicte Leynaert
- Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Center for Epidemiology and Population Health (CESP) - Integrative Respiratory Epidemiology Team, 94807, Villejuif, France
| | | | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | | | - Lars Modig
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Valerie Siroux
- University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
| | | | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Simona Villani
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Bénédicte Jacquemin
- University Rennes, Inserm, EHESP, Irset (Institut de recherche en Santé, Environnement et travail), UMR_S 1085, F-35000 Rennes, France
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
21
|
Larisch C, Markowiak T, Ried M, Nowak D, Hofmann HS, Rakete S. The Excretion of Cisplatin after Hyperthermic Intrathoracic Chemotherapy. Cancers (Basel) 2023; 15:4872. [PMID: 37835566 PMCID: PMC10571901 DOI: 10.3390/cancers15194872] [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: 07/25/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Hyperthermic intrathoracic chemotherapy (HITOC) is an additional intraoperative treatment option within the multimodality therapy of pleural malignancies. A chemotherapy perfusion with high-dose cisplatin is performed over a period of 60 min after surgical cytoreduction to improve local tumour control through the eradication of residual tumour cells. Although HITOC is increasingly used, there is only little scientific evidence about the necessary safety measures after HITOC. Therefore, the objective of this study was an analysis of cisplatin excretion via various body fluids after HITOC, with the aim of providing recommendations on occupational health and safety. Five patients undergoing HITOC were included. Before and after the HITOC, as well as during the following days, serum, urine, and bronchial secretion, as well as pleural effusion, were sampled. The platinum levels in the samples were measured using ICP-MS (inductively coupled plasma-mass spectrometry). Immediately after the HITOC, the mean levels of cisplatin increased dramatically in the serum (from 0.79 to 1349 µg/L), urine (from 3.48 to 10,528 µg/g creatinine), and bronchial secretion (from 0.11 to 156 µg/L). Thereafter, the cisplatin levels dropped to 133 µg/L in the serum and 994 µg/g creatinine in the urine within nine days after the HITOC. The AUC ratio shows 59% of the cisplatin being excreted via the urine after 48 h. The sampling of pleural effusion started 24 h after the HITOC, and the cisplatin levels decreased from 618 to 93 µg/L within nine days. Although the cisplatin levels in the body fluids of HITOC patients are much lower compared to patients receiving intravenous chemotherapy, a significant amount of cisplatin is excreted via these body fluids. Consequently, safety precautions must be implemented in the post-HITOC care of patients to avoid occupational exposure to cisplatin.
Collapse
Affiliation(s)
- Christopher Larisch
- Department of Thoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Till Markowiak
- Department of Thoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80539 Munich, Germany
- Comprehensive Pneumology Center Munich, German Center for Lung Research, 81377 Munich, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Department of Thoracic Surgery, Hospital Barmherzige Brueder, 93047 Regensburg, Germany
| | - Stefan Rakete
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80539 Munich, Germany
| |
Collapse
|
22
|
Becker L, Kaltenegger HC, Nowak D, Weigl M, Rohleder N. Biological stress responses to multitasking and work interruptions: A randomized controlled trial. Psychoneuroendocrinology 2023; 156:106358. [PMID: 37542740 DOI: 10.1016/j.psyneuen.2023.106358] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/13/2023] [Accepted: 08/01/2023] [Indexed: 08/07/2023]
Abstract
In the course of digitalization, new stressors are emerging. In modern working and living environments, two ubiquitous, technology-mediated stressors are multitasking demands and work interruptions. However, biological stress response patterns to multitasking and work interruptions have been sparsely investigated so far. We thus aimed to comprehensively assess biological stress response patterns to both stressors and, additionally, test whether responses differ between digital and partially non-digital settings. A controlled experimental set-up was established and humans' biological markers of the Sympathetic Nervous System (SNS), the hypothalamic-pituitary adrenal (HPA) axis, and the immune system were assessed. N = 186 healthy participants (mean age: 23.2 ± 4.3 years, 74.7% female, body mass-index: 22.3 ± 3.1 kg/m2) took part in this pre-registered study. Each participant was randomly assigned to one of 6 experimental conditions (1 digital single-task, 3 dual-tasks [2 parallel tasks and 1 interruption], 1 multitasking, and 1 passive, control condition). Each one of the dual-tasking as well as the multitasking conditions included a non-digital sub-task, i.e., performing a task in presence of an examiner. All other conditions involved digital tasks only. Salivary alpha-amylase (sAA) levels as a marker for SNS reactivity significantly changed in work interruptions, parallel dual-tasking, and multitasking conditions. No changes were found for control conditions. Furthermore, no significant changes over time and no differences between the conditions were identified for three biological markers: cortisol as marker for HPA axis activity as well as for two immune system markers (secretory Immunoglobulin-A, C-reactive protein). A time course similar to sAA was found for perceived stress: with increases during task execution and decreases afterwards in multitasking and parallel dual-tasking. Yet, it did not change for the work interruption, passive control, and single-tasking condition. Overall, our findings show that dual- and multitasking are perceived as stressful and are associated with an activation of the SNS, but not with responses of HPA axis or immune system. This was consistent for digital as well as partially digital task demands. Our findings will also inform future research into the differential stress effects of digital and non-digital tasks to advance our understanding of biological stress response-patterns to multitasking and work interruptions. Therefore, our findings are highly relevant for understanding the long-term biological health effects of stress in modern (digitalized) environments.
Collapse
Affiliation(s)
- Linda Becker
- Chair of Health Psychology, Department of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Helena C Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, Munich, Germany
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, Munich, Germany; Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Nicolas Rohleder
- Chair of Health Psychology, Department of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
23
|
Lommatzsch M, Criée CP, de Jong CCM, Gappa M, Geßner C, Gerstlauer M, Hämäläinen N, Haidl P, Hamelmann E, Horak F, Idzko M, Ignatov A, Koczulla AR, Korn S, Köhler M, Lex C, Meister J, Milger-Kneidinger K, Nowak D, Nothacker M, Pfaar O, Pohl W, Preisser AM, Rabe KF, Riedler J, Schmidt O, Schreiber J, Schuster A, Schuhmann M, Spindler T, Taube C, Christian Virchow J, Vogelberg C, Vogelmeier CF, Wantke F, Windisch W, Worth H, Zacharasiewicz A, Buhl R. [Diagnosis and treatment of asthma: a guideline for respiratory specialists 2023 - published by the German Respiratory Society (DGP) e. V.]. Pneumologie 2023; 77:e3. [PMID: 38513695 DOI: 10.1055/a-2284-8593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Marek Lommatzsch
- Zentrum für Innere Medizin, Abt. für Pneumologie, Universitätsmedizin Rostock
| | | | - Carmen C M de Jong
- Abteilung für pädiatrische Pneumologie, Abteilung für Pädiatrie, Inselspital, Universitätsspital Bern
| | - Monika Gappa
- Klinik für Kinder und Jugendliche, Evangelisches Krankenhaus Düsseldorf
| | | | | | | | - Peter Haidl
- Abteilung für Pneumologie II, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg
| | - Eckard Hamelmann
- Kinder- und Jugendmedizin, Evangelisches Klinikum Bethel, Bielefeld
| | | | - Marco Idzko
- Abteilung für Pulmologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien
| | - Atanas Ignatov
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum Magdeburg
| | - Andreas Rembert Koczulla
- Schön-Klinik Berchtesgadener Land, Berchtesgaden
- Klinik für Innere Medizin Schwerpunkt Pneumologie, Universitätsklinikum Marburg
| | - Stephanie Korn
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg
| | - Michael Köhler
- Deutsche Patientenliga Atemwegserkrankungen, Gau-Bickelheim
| | - Christiane Lex
- Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Göttingen
| | - Jochen Meister
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Aue
| | | | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V
| | - Oliver Pfaar
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Sektion für Rhinologie und Allergie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg
| | - Wolfgang Pohl
- Gesundheitszentrum Althietzing, Karl Landsteiner Institut für klinische und experimentelle Pneumologie, Wien
| | - Alexandra M Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Klaus F Rabe
- Pneumologie, LungenClinic Großhansdorf, UKSH Kiel
| | - Josef Riedler
- Abteilung für Kinder- und Jugendmedizin, Kardinal Schwarzenberg Klinikum Schwarzach
| | | | - Jens Schreiber
- Universitätsklinik für Pneumologie, Universitätsklinikum Magdeburg
| | - Antje Schuster
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf
| | | | | | - Christian Taube
- Klinik für Pneumologie, Universitätsmedizin Essen-Ruhrlandklinik
| | | | - Christian Vogelberg
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | - Wolfram Windisch
- Lungenklinik Köln-Merheim, Lehrstuhl für Pneumologie, Universität Witten/Herdecke
| | - Heinrich Worth
- Pneumologische & Kardiologische Gemeinschaftspraxis, Fürth
| | | | - Roland Buhl
- Klinik für Pneumologie, Zentrum für Thoraxerkrankungen, Universitätsmedizin Mainz
| |
Collapse
|
24
|
Markevych I, Zhao T, Fuertes E, Marcon A, Dadvand P, Vienneau D, Garcia Aymerich J, Nowak D, de Hoogh K, Jarvis D, Abramson MJ, Accordini S, Amaral AF, Bentouhami H, Jacobsen Bertelsen R, Boudier A, Bono R, Bowatte G, Casas L, Dharmage SC, Forsberg B, Gislason T, Gnesi M, Holm M, Jacquemin B, Janson C, Jogi R, Johannessen A, Keidel D, Leynaert B, Maldonado Perez JA, Marchetti P, Migliore E, Martínez-Moratalla J, Orru H, Pin I, Potts J, Probst-Hensch N, Ranzi A, Sánchez-Ramos JL, Siroux V, Soussan D, Sunyer J, Urrutia Landa I, Villani S, Heinrich J. Residential greenspace and lung function decline over 20 years in a prospective cohort: The ECRHS study. Environ Int 2023; 178:108036. [PMID: 37336027 DOI: 10.1016/j.envint.2023.108036] [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: 10/17/2022] [Revised: 02/14/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND The few studies that have examined associations between greenspace and lung function in adulthood have yielded conflicting results and none have examined whether the rate of lung function decline is affected. OBJECTIVE We explored the association between residential greenspace and change in lung function over 20 years in 5559 adults from 22 centers in 11 countries participating in the population-based, international European Community Respiratory Health Survey. METHODS Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured by spirometry when participants were approximately 35 (1990-1994), 44 (1999-2003), and 55 (2010-2014) years old. Greenness was assessed as the mean Normalized Difference Vegetation Index (NDVI) in 500 m, 300 m, and 100 m circular buffers around the residential addresses at the time of lung function measurement. Green spaces were defined as the presence of agricultural, natural, or urban green spaces in a circular 300 m buffer. Associations of these greenspace parameters with the rate of lung function change were assessed using adjusted linear mixed effects regression models with random intercepts for subjects nested within centers. Sensitivity analyses considered air pollution exposures. RESULTS A 0.2-increase (average interquartile range) in NDVI in the 500 m buffer was consistently associated with a faster decline in FVC (-1.25 mL/year [95% confidence interval: -2.18 to -0.33]). These associations were especially pronounced in females and those living in areas with low PM10 levels. We found no consistent associations with FEV1 and the FEV1/FVC ratio. Residing near forests or urban green spaces was associated with a faster decline in FEV1, while agricultural land and forests were related to a greater decline in FVC. CONCLUSIONS More residential greenspace was not associated with better lung function in middle-aged European adults. Instead, we observed slight but consistent declines in lung function parameters. The potentially detrimental association requires verification in future studies.
Collapse
Affiliation(s)
- Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Tianyu Zhao
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, UK; MRC Centre for Environment & Health, London, UK
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Judith Garcia Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Deborah Jarvis
- National Heart and Lung Institute, Imperial College London, London, UK; MRC Centre for Environment & Health, London, UK
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Andre Fs Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Hayat Bentouhami
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Randi Jacobsen Bertelsen
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anne Boudier
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France; Pediatric Department, CHU Grenoble Alpes, Grenoble, France
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Gayan Bowatte
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia; Faculty of Allied Health, University of Peradeniya, Kandy, Sri Lanka; National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Lidia Casas
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Belgium
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Bertil Forsberg
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Marco Gnesi
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Benedicte Jacquemin
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, F-35000 Rennes, France
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Dirk Keidel
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Benedicte Leynaert
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Center for Epidemiology and Population Health (CESP) - Integrative Respiratory Epidemiology Team, 94807 Villejuif, France
| | | | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | | | - Hans Orru
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Isabelle Pin
- Pediatric Department, CHU Grenoble Alpes, Grenoble, France; CHU de Grenoble Alpes, Department of Pédiatrie, Inserm, Grenoble, France
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Andrea Ranzi
- Centre for Environmental Health and Prevention, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena, Italy
| | | | - Valerie Siroux
- Pediatric Department, CHU Grenoble Alpes, Grenoble, France
| | - David Soussan
- Paris Diderot University, Faculty of Medicine, Paris, France; Laboratory of Excellence, INFLAMEX, Université Sorbonne Paris Cité and DHU FIRE, Paris, France
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Simona Villani
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany; Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| |
Collapse
|
25
|
Lommatzsch M, Criée CP, de Jong CCM, Gappa M, Geßner C, Gerstlauer M, Hämäläinen N, Haidl P, Hamelmann E, Horak F, Idzko M, Ignatov A, Koczulla AR, Korn S, Köhler M, Lex C, Meister J, Milger-Kneidinger K, Nowak D, Nothacker M, Pfaar O, Pohl W, Preisser AM, Rabe KF, Riedler J, Schmidt O, Schreiber J, Schuster A, Schuhmann M, Spindler T, Taube C, Christian Virchow J, Vogelberg C, Vogelmeier CF, Wantke F, Windisch W, Worth H, Zacharasiewicz A, Buhl R. [Diagnosis and treatment of asthma: a guideline for respiratory specialists 2023 - published by the German Respiratory Society (DGP) e. V.]. Pneumologie 2023; 77:461-543. [PMID: 37406667 DOI: 10.1055/a-2070-2135] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 07/07/2023]
Abstract
The management of asthma has fundamentally changed during the past decades. The present guideline for the diagnosis and treatment of asthma was developed for respiratory specialists who need detailed and evidence-based information on the new diagnostic and therapeutic options in asthma. The guideline shows the new role of biomarkers, especially blood eosinophils and fractional exhaled NO (FeNO), in diagnostic algorithms of asthma. Of note, this guideline is the first worldwide to announce symptom prevention and asthma remission as the ultimate goals of asthma treatment, which can be achieved by using individually tailored, disease-modifying anti-asthmatic drugs such as inhaled steroids, allergen immunotherapy or biologics. In addition, the central role of the treatment of comorbidities is emphasized. Finally, the document addresses several challenges in asthma management, including asthma treatment during pregnancy, treatment of severe asthma or the diagnosis and treatment of work-related asthma.
Collapse
Affiliation(s)
- Marek Lommatzsch
- Zentrum für Innere Medizin, Abt. für Pneumologie, Universitätsmedizin Rostock
| | | | - Carmen C M de Jong
- Abteilung für pädiatrische Pneumologie, Abteilung für Pädiatrie, Inselspital, Universitätsspital Bern
| | - Monika Gappa
- Klinik für Kinder und Jugendliche, Evangelisches Krankenhaus Düsseldorf
| | | | | | | | - Peter Haidl
- Abteilung für Pneumologie II, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg
| | - Eckard Hamelmann
- Kinder- und Jugendmedizin, Evangelisches Klinikum Bethel, Bielefeld
| | | | - Marco Idzko
- Abteilung für Pulmologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien
| | - Atanas Ignatov
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum Magdeburg
| | - Andreas Rembert Koczulla
- Schön-Klinik Berchtesgadener Land, Berchtesgaden
- Klinik für Innere Medizin Schwerpunkt Pneumologie, Universitätsklinikum Marburg
| | - Stephanie Korn
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg
| | - Michael Köhler
- Deutsche Patientenliga Atemwegserkrankungen, Gau-Bickelheim
| | - Christiane Lex
- Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Göttingen
| | - Jochen Meister
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Aue
| | | | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V
| | - Oliver Pfaar
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Sektion für Rhinologie und Allergie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg
| | - Wolfgang Pohl
- Gesundheitszentrum Althietzing, Karl Landsteiner Institut für klinische und experimentelle Pneumologie, Wien
| | - Alexandra M Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Klaus F Rabe
- Pneumologie, LungenClinic Großhansdorf, UKSH Kiel
| | - Josef Riedler
- Abteilung für Kinder- und Jugendmedizin, Kardinal Schwarzenberg Klinikum Schwarzach
| | | | - Jens Schreiber
- Universitätsklinik für Pneumologie, Universitätsklinikum Magdeburg
| | - Antje Schuster
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf
| | | | | | - Christian Taube
- Klinik für Pneumologie, Universitätsmedizin Essen-Ruhrlandklinik
| | | | - Christian Vogelberg
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | - Wolfram Windisch
- Lungenklinik Köln-Merheim, Lehrstuhl für Pneumologie, Universität Witten/Herdecke
| | - Heinrich Worth
- Pneumologische & Kardiologische Gemeinschaftspraxis, Fürth
| | | | - Roland Buhl
- Klinik für Pneumologie, Zentrum für Thoraxerkrankungen, Universitätsmedizin Mainz
| |
Collapse
|
26
|
Marutescu LG, Popa M, Gheorghe-Barbu I, Barbu IC, Rodríguez-Molina D, Berglund F, Blaak H, Flach CF, Kemper MA, Spießberger B, Wengenroth L, Larsson DGJ, Nowak D, Radon K, de Roda Husman AM, Wieser A, Schmitt H, Pircalabioru Gradisteanu G, Vrancianu CO, Chifiriuc MC. Wastewater treatment plants, an "escape gate" for ESCAPE pathogens. Front Microbiol 2023; 14:1193907. [PMID: 37293232 PMCID: PMC10244645 DOI: 10.3389/fmicb.2023.1193907] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Antibiotics are an essential tool of modern medicine, contributing to significantly decreasing mortality and morbidity rates from infectious diseases. However, persistent misuse of these drugs has accelerated the evolution of antibiotic resistance, negatively impacting clinical practice. The environment contributes to both the evolution and transmission of resistance. From all anthropically polluted aquatic environments, wastewater treatment plants (WWTPs) are probably the main reservoirs of resistant pathogens. They should be regarded as critical control points for preventing or reducing the release of antibiotics, antibiotic-resistant bacteria (ARB), and antibiotic-resistance genes (ARGs) into the natural environment. This review focuses on the fate of the pathogens Enterococcus faecium, Staphylococcus aureus, Clostridium difficile, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae spp. (ESCAPE) in WWTPs. All ESCAPE pathogen species, including high-risk clones and resistance determinants to last-resort antibiotics such as carbapenems, colistin, and multi-drug resistance platforms, were detected in wastewater. The whole genome sequencing studies demonstrate the clonal relationships and dissemination of Gram-negative ESCAPE species into the wastewater via hospital effluents and the enrichment of virulence and resistance determinants of S. aureus and enterococci in WWTPs. Therefore, the efficiency of different wastewater treatment processes regarding the removal of clinically relevant ARB species and ARGs, as well as the influence of water quality factors on their performance, should be explored and monitored, along with the development of more effective treatments and appropriate indicators (ESCAPE bacteria and/or ARGs). This knowledge will allow the development of quality standards for point sources and effluents to consolidate the WWTP barrier role against the environmental and public health AR threats.
Collapse
Affiliation(s)
- Luminita Gabriela Marutescu
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Marcela Popa
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Irina Gheorghe-Barbu
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Ilda Czobor Barbu
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Daloha Rodríguez-Molina
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology – IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Fanny Berglund
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Hetty Blaak
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Carl-Fredrik Flach
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Merel Aurora Kemper
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Beate Spießberger
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Munich, Germany
- Department of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
| | - Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - D. G. Joakim Larsson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Ana Maria de Roda Husman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Andreas Wieser
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Munich, Germany
- Department of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
| | - Heike Schmitt
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Gratiela Pircalabioru Gradisteanu
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Romanian Academy of Sciences, Bucharest, Romania
| | - Corneliu Ovidiu Vrancianu
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Mariana Carmen Chifiriuc
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- The Romanian Academy, Bucharest, Romania
| |
Collapse
|
27
|
Kaltenegger HC, Becker L, Rohleder N, Nowak D, Quartucci C, Weigl M. Associations of technostressors at work with burnout symptoms and chronic low-grade inflammation: a cross-sectional analysis in hospital employees. Int Arch Occup Environ Health 2023:10.1007/s00420-023-01967-8. [PMID: 37148328 PMCID: PMC10163295 DOI: 10.1007/s00420-023-01967-8] [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: 12/23/2022] [Accepted: 02/25/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Despite the increasing scholarly interest in the phenomenon technostress, associated biological effects on employee health are under-researched. Chronic low-grade inflammation is suggested as a central pathway linking stress experience to disease development. The aim of this study was to assess associations of technology-related work stressors (technostressors) with low-grade inflammation and burnout symptoms. METHODS N = 173 (74.6% women, Mage = 31.0 years) university hospital employees participated in a cross-sectional study. Self-report questionnaires were used for the assessment of general psychosocial working conditions (work overload, job control, social climate), a range of different technostressors, burnout symptoms, and relevant confounders. Participants provided capillary blood samples, and high-sensitivity C-reactive protein (hs-CRP) as an inflammatory biomarker was analyzed from dried blood spots. RESULTS Based on a factor analysis, we identified four underlying dimensions of technostressors: techno- and information overload, techno-complexity, interruptions and multitasking as well as usability and technical support. In multivariate linear regressions, techno-/information overload and techno-complexity were associated with core (exhaustion, mental distance) and secondary (psychosomatic complaints) symptoms of burnout. Techno-/information overload was a significant predictor of burnout core symptoms, even when general work overload was controlled for. The technostressors were not associated with hs-CRP. CONCLUSION This is the first study on technology-related stress at work and chronic low-grade inflammation. The results suggest that (information) overload caused by digital technology use is a distinct work stressor with genuine consequences for psychological health. To what extent these effects also manifest on a physiological level needs to be subjected to future studies, ideally with prospective designs.
Collapse
Affiliation(s)
- Helena C Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany.
| | - Linda Becker
- Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nicolas Rohleder
- Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Caroline Quartucci
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
- Bavarian Health and Food Safety Authority, Institute for Occupational Health and Product Safety, Environmental Health, Munich, Germany
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
28
|
Frei-Stuber L, Drexler H, Heutelbeck A, Nowak D. [Occupational obstructive airway diseases: How can early diagnosis be made to avoid chronic courses?]. Pneumologie 2023. [PMID: 37068510 DOI: 10.1055/a-2055-0806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Since abolishing the obligation to terminate the harmful professional activity from January 1st, 2021 onwards for some occupational diseases including obstructive respiratory diseases in Germany, the recognition of occupational diseases coded under 4301, 4302 and 1315 according the Occupational Diseases Ordinance has increased significantly. By the time these diseasese are recognized, they are usually already at an advanced stage. Therefore, early detection will play a greater role in the future, as the statutory accident insurance can offer individual preventive measures in order to minimize the consequences of illness and thus also the socio-economic burden. However, precursors of such obstructive airway diseases are often overlooked. For optimizing early detection, the statutory accident insurance worked out an early notification procedure for the respiratory tract - comparable to the already well-established dermatological procedure. "Early cases" from the pilot regions can be reported there; to qualify for being reported as early cases, patients must persue insured professional activity with potential effects on the respiratory tract and suffer from a disease of the upper or lower respiratory tract according to the ICD-10 code (e.g. J31.0 chronic rhinitis).
Collapse
Affiliation(s)
- Ludwig Frei-Stuber
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Deutschland
| | - Hans Drexler
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Friedrich-Alexander-Universität Erlangen-Nürnberg, Medizinische Fakultät, Erlangen, Deutschland
| | - Astrid Heutelbeck
- Institut für Arbeits-, Sozial- und Umweltmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Deutschland
| |
Collapse
|
29
|
Kreuter M, Behr J, Bonella F, Costabel U, Gerber A, Hamer OW, Heussel CP, Jonigk D, Krause A, Koschel D, Leuschner G, Markart P, Nowak D, Pfeifer M, Prasse A, Wälscher J, Winter H, Kabitz HJ. [Consensus guideline on the interdisciplinary diagnosis of interstitial lung diseases]. Pneumologie 2023; 77:269-302. [PMID: 36977470 DOI: 10.1055/a-2017-8971] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
The evaluation of a patient with interstitial lung disease (ILD) includes assessment of clinical, radiological, and often histopathological data. As there were no specific recommendations to guide the evaluation of patients under the suspicion of an ILD within the German practice landscape, this position statement from an interdisciplinary panel of ILD experts provides guidance related to the diagnostic modalities which should be used in the evaluation of ILD. This includes clinical assessment rheumatological evaluation, radiological examinations, histopathologic sampling and the need for a final discussion in a multidisciplinary team.
Collapse
Affiliation(s)
- Michael Kreuter
- Universitäres Lungenzentrum Mainz, Abteilungen für Pneumologie, ZfT, Universitätsmedizin Mainz und Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg und Klinik für Pneumologie, Klinikum Ludwigsburg
- Deutsches Zentrum für Lungenforschung
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München
- Deutsches Zentrum für Lungenforschung
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Alexander Gerber
- Rheumazentrum Halensee, Berlin und Institut für Arbeits- Sozial- und Umweltmedizin, Goetheuniversität Frankfurt am Main
| | - Okka W Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg und Abteilung für Radiologie, Klinik Donaustauf, Donaustauf
| | - Claus Peter Heussel
- Diagnostische und interventionelle Radiologie, Thoraxklinik Heidelberg, Universitätsklinikum Heidelberg
- Deutsches Zentrum für Lungenforschung
| | - Danny Jonigk
- Institut für Pathologie, Medizinische Hochschule Hannover und Institut für Pathologie, RWTH Universitätsklinikum Aachen
- Deutsches Zentrum für Lungenforschung
| | - Andreas Krause
- Abteilung für Rheumatologie, klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin
| | - Dirk Koschel
- Abteilung für Innere Medizin und Pneumologie, Fachkrankenhaus Coswig, Lungenzentrum, Coswig und Bereich Pneumologie der Medizinischen Klinik, Carl Gustav Carus Universitätsklinik, Dresden
| | - Gabriela Leuschner
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München
- Deutsches Zentrum für Lungenforschung
| | - Philipp Markart
- Medizinische Klinik V, Campus Fulda, Universitätsmedizin Marburg und Medizinische Klinik und Poliklinik, Universitätsklinikum Gießen
- Deutsches Zentrum für Lungenforschung
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München
| | - Michael Pfeifer
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg
| | - Antje Prasse
- Klinik für Pneumologie und Infektionsmedizin, Medizinische Hochschule Hannover und Abteilung für Fibroseforschung, Fraunhofer ITEM
- Deutsches Zentrum für Lungenforschung
| | - Julia Wälscher
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Hauke Winter
- Abteilung für Thoraxchirurgie, Thoraxklinik, Universität Heidelberg, Heidelberg
- Deutsches Zentrum für Lungenforschung
| | - Hans-Joachim Kabitz
- II. Medizinische Klinik, Pneumologie und Internistische Intensivmedizin, Klinikum Konstanz, GLKN, Konstanz
| |
Collapse
|
30
|
Andreas S, Kotz D, Batra A, Hellmann A, Mühlig S, Nowak D, Schultz K, Worth H, Schüler S. [Smoking Cessation in Patients with COPD]. Pneumologie 2023; 77:206-219. [PMID: 36958341 DOI: 10.1055/a-2020-4284] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Tobacco dependence is a common comorbidity in patients with COPD (Chronic Obstructive Pulmonary Disease) that negatively affects the course of the disease. However, clinically relevant improvement in COPD can only be achieved by complete and permanent abstinence. Therefore, abstinence from tobacco use is a central therapeutic concept in smoking patients with COPD and requires specific and targeted treatment.After detailed documentation of smoking behaviour and motivational counseling outlining the risks of smoking, all such patients shall be offered a structured therapy for tobacco cessation. There is high-quality evidence for the effectiveness of a combination therapy of behavioral therapy and medication (to treat the withdrawal syndrome). Due to insufficient data, there is currently no recommendation for the use of e-cigarettes as a primary option for a cessation attempt.Smoking is the most important cause of COPD. Smoking cessation is the most effective and cost-efficient single intervention to reduce the risk of developing and progressing COPD.
Collapse
Affiliation(s)
- Stefan Andreas
- Lungenfachklinik Immenhausen; Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Deutsches Zentrum für Lungenforschung (DZL)
| | - Daniel Kotz
- Institut für Allgemeinmedizin (ifam), Schwerpunkt Suchtforschung und klinische Epidemiologie, Centre for Health and Society (chs), Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf
| | - Anil Batra
- Klinik für Psychatrie und Psychotherapie, Sektion Suchtmedizin und Suchtforschung, Universitätsklinikum Tübingen
| | - Andreas Hellmann
- Praxis für Pneumologie, Onkologie und Schlafmedizin am Diako, die Stadtklinik, Augsburg
| | - Stephan Mühlig
- Institut für Psychologie, Klinische Psychologie und Psychotherapie, Technische Universität Chemnitz
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center (CPC) Munich, Deutsches Zentrum für Lungenforschung (DZL)
| | - Konrad Schultz
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern Süd
| | | | - Sabine Schüler
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin
| |
Collapse
|
31
|
Garí M, Moos R, Bury D, Kasper-Sonnenberg M, Jankowska A, Andysz A, Hanke W, Nowak D, Bose-O'Reilly S, Koch HM, Polańska K. Correction: Human-Biomonitoring derived exposure and Daily Intakes of Bisphenol A and their associations with neurodevelopmental outcomes among children of the Polish Mother and Child Cohort Study. Environ Health 2023; 22:24. [PMID: 36927715 PMCID: PMC10018935 DOI: 10.1186/s12940-023-00977-w] [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: 06/18/2023]
Affiliation(s)
- Mercè Garí
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich. Institute of Computational Biology, Helmholtz Zentrum München, Munich, Germany.
| | - Rebecca Moos
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Daniel Bury
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Monika Kasper-Sonnenberg
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Agnieszka Jankowska
- Department of Environmental and Occupational Health Hazards, Nofer Institute of Occupational Medicine (NIOM), Lodz, Poland
| | - Aleksandra Andysz
- Department of Health and Work Psychology, Nofer Institute of Occupational Medicine (NIOM), Lodz, Poland
| | - Wojciech Hanke
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine (NIOM), Lodz, Poland
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Stephan Bose-O'Reilly
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Holger M Koch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Kinga Polańska
- Department of Environmental and Occupational Health Hazards, Nofer Institute of Occupational Medicine (NIOM), Lodz, Poland
| |
Collapse
|
32
|
Quartucci C, Rooney JPK, Nowak D, Rakete S. Evaluation of long-term data on surface contamination by antineoplastic drugs in pharmacies. Int Arch Occup Environ Health 2023; 96:675-683. [PMID: 36877242 DOI: 10.1007/s00420-023-01963-y] [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: 08/18/2022] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE The handling of antineoplastic drugs represents an occupational health risk for employees in pharmacies. To minimize exposure and to evaluate cleaning efficacy, wipe sampling was used to analyze antineoplastic drugs on surfaces. In 2009, guidance values were suggested to facilitate the interpretation of results, leading to a decrease in surface contamination. The goal of this follow-up was to evaluate the time trend of surface contamination, to identify critical antineoplastic drugs and sampling locations and to reassess guidance values. METHODS Platinum, 5-fluorouracil, cyclophosphamide, ifosfamide, gemcitabine, methotrexate, docetaxel and paclitaxel were analyzed in more than 17,000 wipe samples from 2000 to 2021. Statistical analysis was performed to describe and interpret the data. RESULTS Surface contaminations were generally relatively low. The median concentration for most antineoplastic drugs was below the limit of detection except for platinum (0.3 pg/cm2). Only platinum and 5-fluorouracil showed decreasing levels over time. Most exceedances of guidance values were observed for platinum (26.9%), cyclophosphamide (18.5%) and gemcitabine (16.6%). The most affected wipe sampling locations were isolators (24.4%), storage areas (17.6%) and laminar flow hoods (16.6%). However, areas with no direct contact to antineoplastic drugs were also frequently contaminated (8.9%). CONCLUSION Overall, the surface contaminations with antineoplastic drugs continue to decrease or were generally at a low level. Therefore, we adjusted guidance values according to the available data. The identification of critical sampling locations may help pharmacies to further improve cleaning procedure and reduce the risk of occupational exposure to antineoplastic drugs.
Collapse
Affiliation(s)
- Caroline Quartucci
- Bavarian Health and Food Safety Authority, Institute for Occupational Health and Product Safety, Environmental Health, Munich, Germany.,Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - James P K Rooney
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Stefan Rakete
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.
| |
Collapse
|
33
|
Weinmann T, Forster F, Hell K, Gerlich J, Wengenroth L, Schlotz W, Vogelberg C, von Mutius E, Nowak D, Radon K. Work-related stress and atopic dermatitis: Results from the study on occupational allergy risks. J Occup Environ Hyg 2023; 20:109-119. [PMID: 36441057 DOI: 10.1080/15459624.2022.2151604] [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] [Indexed: 06/16/2023]
Abstract
Chronic stress at work is ubiquitous in modern societies. However, its influence on atopic dermatitis (AD) has hardly been investigated. This study aimed to elucidate the association between work-related stress and AD via a longitudinal study. The analysis comprised data from three phases (2002-2003, 2007-2009, 2017-2018) of the prospective Study on Occupational Allergy Risks (SOLAR), including 1,240 young adults aged 16 to 18 years at baseline (61% female) who were originally recruited for the International Study of Asthma and Allergies in Childhood Phase II in 1995-1996. AD was assessed at all three phases based on self-reports of a physician's diagnosis and symptoms. Work-related stress was measured at all three periods using the work discontent and work overload scales from the Trier Inventory for the Assessment of Chronic Stress with adaptions to school and university. Generalized estimating equations were used to analyze the association between stress and AD, treating work discontent and work overload first as continuous and then as categorical exposure variables. We observed 50 AD cases (4%) at SOLAR I, 48 (4%) at SOLAR II, and 42 (3%) at SOLAR III. A one-point increase in the work discontent score was associated with an odds ratio (OR) for AD of 1.05 (95% confidence interval [CI], 1.00-1.10). The respective increase in the work overload score led to an OR of 1.03 (95% CI, 0.99-1.06). In the categorical analysis, there was no clear indication of elevated odds of AD in the highest vs. lowest exposure group (4th vs. 1st quartile: OR, 1.53; 95% CI, 0.92-2.53 for work discontent; OR, 1.38, 95% CI, 0.83-2.27 for work overload). Altogether, we observed limited to no evidence for an association between work-related stress and AD. Our study's ability to detect stronger evidence may have been compromised by shortcomings such as nondifferential misclassification of the outcome or insufficient statistical precision due to small numbers of AD cases. Another explanation could be that AD predominantly becomes evident in childhood, not in adulthood.
Collapse
Affiliation(s)
- Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Felix Forster
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Hell
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Wolff Schlotz
- Max Planck Institute of Empirical Aesthetics, Frankfurt am Main, Germany
| | - Christian Vogelberg
- Paediatric Department, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Erika von Mutius
- Dr. v. Haunersches Kinderspital, University Hospital, LMU Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
34
|
Moitra S, Carsin AE, Abramson MJ, Accordini S, Amaral AFS, Anto J, Bono R, Casas Ruiz L, Cerveri I, Chatzi L, Demoly P, Dorado-Arenas S, Forsberg B, Gilliland F, Gislason T, Gullón JA, Heinrich J, Holm M, Janson C, Jogi R, Gómez Real F, Jarvis D, Leynaert B, Nowak D, Probst-Hensch N, Sánchez-Ramos JL, Raherison-Semjen C, Siroux V, Guerra S, Kogevinas M, Garcia-Aymerich J. Long-term effect of asthma on the development of obesity among adults: an international cohort study, ECRHS. Thorax 2023; 78:128-135. [PMID: 35477559 DOI: 10.1136/thoraxjnl-2021-217867] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 06/28/2021] [Accepted: 03/16/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Obesity is a known risk factor for asthma. Although some evidence showed asthma causing obesity in children, the link between asthma and obesity has not been investigated in adults. METHODS We used data from the European Community Respiratory Health Survey (ECRHS), a cohort study in 11 European countries and Australia in 3 waves between 1990 and 2014, at intervals of approximately 10 years. We considered two study periods: from ECRHS I (t) to ECRHS II (t+1), and from ECRHS II (t) to ECRHS III (t+1). We excluded obese (body mass index≥30 kg/m2) individuals at visit t. The relative risk (RR) of obesity at t+1 associated with asthma at t was estimated by multivariable modified Poisson regression (lag) with repeated measurements. Additionally, we examined the association of atopy and asthma medication on the development of obesity. RESULTS We included 7576 participants in the period ECRHS I-II (51.5% female, mean (SD) age of 34 (7) years) and 4976 in ECRHS II-III (51.3% female, 42 (8) years). 9% of participants became obese in ECRHS I-II and 15% in ECRHS II-III. The risk of developing obesity was higher among asthmatics than non-asthmatics (RR 1.22, 95% CI 1.07 to 1.38), and particularly higher among non-atopic than atopic (1.47; 1.17 to 1.86 vs 1.04; 0.86 to 1.27), those with longer disease duration (1.32; 1.10 to 1.59 in >20 years vs 1.12; 0.87 to 1.43 in ≤20 years) and those on oral corticosteroids (1.99; 1.26 to 3.15 vs 1.15; 1.03 to 1.28). Physical activity was not a mediator of this association. CONCLUSION This is the first study showing that adult asthmatics have a higher risk of developing obesity than non-asthmatics, particularly those non-atopic, of longer disease duration or on oral corticosteroids.
Collapse
Affiliation(s)
- Subhabrata Moitra
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada .,Non-Communicable Diseases and Environment Programme, ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Anne-Elie Carsin
- Non-Communicable Diseases and Environment Programme, ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Andre F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Josep Anto
- Non-Communicable Diseases and Environment Programme, ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Torino, Italy
| | - Lidia Casas Ruiz
- Epidemiology and Social Medicine, University of Antwerp, Antwerpen, Belgium.,Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Isa Cerveri
- Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Leda Chatzi
- Department of Social Medicine, University of Crete, Rethimno, Greece.,Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, California, USA.,Department of Genetics & Cell Biology, Maastricht University, Maastricht, The Netherlands
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, University Hospital of Montpellier, Montpellier, France.,Inserm, Sorbonne Université, Equipe, EPAR - IPLESP, Paris, France
| | - Sandra Dorado-Arenas
- Osakidetza Basque Health Service, Department of Respiratory Medicine, Galdakao University Hospital, Galdakao, Spain
| | - Bertil Forsberg
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Frank Gilliland
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, California, USA
| | - Thorarinn Gislason
- Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jose A Gullón
- Department of Pneumology, Universitary Hospital San Agustín, Avilés, Spain
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University Munich, University Hospital Munich, Munich, Germany.,Institut of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Oberschleissheim, Germany
| | - Mathias Holm
- Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Francisco Gómez Real
- Department of Gynaecology and Obstetrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Debbie Jarvis
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Bénédicte Leynaert
- Inserm - U1168, VIMA (Aging and Chronic Diseases. Epidemiological and Public Health Approaches), INSERM, Villejuif, France.,UMR-S 1168, Université de Versailles Saint-Quentin-en-Yvelines - UVSQ, Saint-Quentin-en-Yvelines, France
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University Munich, University Hospital Munich, Munich, Germany
| | - Nicole Probst-Hensch
- Department Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | | | | | - Valerie Siroux
- Team of Environemental Epidemiology, Inserm U1209, Univ Grenoble Alpes, La Tronche, France
| | - Stefano Guerra
- Arizona Respiratory Center, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
| | - Manolis Kogevinas
- Non-Communicable Diseases and Environment Programme, ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Judith Garcia-Aymerich
- Non-Communicable Diseases and Environment Programme, ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| |
Collapse
|
35
|
Behr J, Bonella F, Frye BC, Günther A, Hagmeyer L, Henes J, Klemm P, Koschel D, Kreuter M, Leuschner G, Nowak D, Prasse A, Quadder B, Sitter H, Costabel U. [Pharmacological treatment of idiopathic pulmonary fibrosis (update) and progressive pulmonary fibrosis - S2k Guideline of the German Respiratory Society]. Pneumologie 2023; 77:e1. [PMID: 36858353 DOI: 10.1055/a-2043-4482] [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: 03/03/2023]
Affiliation(s)
- Jürgen Behr
- Medizinische Klinik und Polklinik V, LMU Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung; Delegierte/r der DGP
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen; Delegierter der DGP
| | - Björn C Frye
- Klinik für Pneumologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland; Delegierter der DGP
| | - Andreas Günther
- Center for Interstitial and Rare Lung Diseases, University Hospital Giessen Marburg, Giessen, Agaplesion Evangelisches Krankenhaus Mittelhessen, Giessen, Germany; Delegierter der DGP
| | - Lars Hagmeyer
- Krankenhaus Bethanien Solingen, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Institut für Pneumologie an der Universität zu Köln; Delegierter der DGP
| | - Jörg Henes
- Zentrum für interdisziplinäre Rheumatologie, Immunologie und Autoimmunerkrankungen (INDIRA) und Innere Medizin II; Delegierter DGRh
| | - Philipp Klemm
- Abt. Rheumatologie und klinische Immunologie, Kerckhoff Klinik und Campus Kerckhoff der Justus-Liebig-Universität Gießen, Bad Nauheim; Delegierter der DGRh
| | - Dirk Koschel
- Fachkrankenhaus Coswig, Lungenzentrum und Medizinische Klinik 1, Universitätsklinik Carl Gustav Carus der TU Dresden; Delegierter der DGP
| | - Michael Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen & interdisziplinäres Sarkoidosezentrum, Thoraxklinik, Universitätsklinikum Heidelberg, Deutsches Zentrum für Lungenforschung Heidelberg und Klinik für Pneumologie, Interdisziplinäres Lungenzentrum Ludwigsburg, RKH Klinik Ludwigsburg; Delegierter der DGIM
| | - Gabriela Leuschner
- Medizinische Klinik und Polklinik V, LMU Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung; Delegierte/r der DGP
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum der Universität München, Comprehensive Pneumology Center (CPC) München, Mitglied des Deutsches Zentrums für Lungenforschung; Delegierter der DGAUM
| | - Antje Prasse
- Klinik für Pneumologie und Infektiologie, Medizinische Hochschule Hannover, DZL BREATH und Abteilung für Fibroseforschung, Fraunhofer ITEM, Hannover, Delegierte der DGP
| | | | - Helmut Sitter
- Institut für Theoretische Chirurgie, Philipps-Universität Marburg, Moderator
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen; Delegierter der DGP
| |
Collapse
|
36
|
Witt C, Kienast C, Bölke G, Hoffmann C, Roehle R, Bender O, Nowak D, Tauber R, Gunga HC, Hoffmann P, Coats AJS, Liebers U. Long-term indoor gunshot exposure of special police forces induces bronchitic reactions and elevated blood lead levels-The Berlin shooting range study. J Cachexia Sarcopenia Muscle 2023; 14:452-463. [PMID: 36539958 PMCID: PMC9891938 DOI: 10.1002/jcsm.13147] [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: 07/26/2022] [Revised: 10/11/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Gunshot emissions contain toxic elements that can harm those frequently exposed, such as police officers. Several years ago, police indoor firing ranges were closed by the Berlin municipality in response to police officer health complaints, and an investigation was launched into the possible respiratory health risks of frequent gunshot emission exposure. We, therefore, conducted an exploratory cross-sectional study to investigate clinical and functional parameters of respiratory health as well as the burden of trace elements in policemen with long-term high exposure to indoor gunshot emissions, compared to low-exposure and control groups. METHODS We conducted lung function tests and collected blood and urine samples from Berlin police officers and government employees who were divided into three subject groups based on exposure to gunshot emissions: high exposure (n = 53), low exposure (n = 94) and no exposure (n = 76). Lung function was examined using body plethysmography. Blood and urine samples were tested via inductively coupled plasma mass spectrometry for the presence of common gunshot powder elements (antimony, lead and manganese). Exposure and symptoms were assessed using records as well as questionnaires. RESULTS Higher exposure was associated with more respiratory symptoms during gun shooting practice (64% vs. 21%, P < 0.001) compared to the low-exposure group. Headache, cough, discoloured mucous and shortness of breath were also more common as were some other symptoms. The cough symptomatology of the high-exposure group also persisted significantly longer (median: 0.67 vs. 0.01 days, range: 0 to 5 days, P = 0.029) compared to the low-exposure group. They also showed a lower forced expiratory volume in 1 s/forced vital capacity quotient (Tiffeneau index), P = 0.018 between the three groups and P = 0.005 for the high-exposure group, a possible marker of early, subclinical bronchial obstruction. We observed increased blood lead concentrations depending on subject's age (+1.2% per year, 95% confidence interval: 0.5-1.9%, P < 0.001) and cumulative gunshot exposure (+0.34% per 100 000 shots, 0.02-0.66%, P = 0.037). CONCLUSIONS These first results suggest that long-term exposure to indoor gunshot emissions induces bronchitic reactions due to repeated irritation of the airways. Higher levels of exposure lead to more negatively impacted lung function and higher blood lead levels with the possible reason that more frequent exposure may mean shorter regeneration phases for the respiratory mucous membrane. We recommend a reduction of exposure to gunshot emissions in order to decrease symptoms and avoid any-even small-deterioration in spirometry.
Collapse
Affiliation(s)
- Christian Witt
- Department of Outpatient Pneumology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Camilla Kienast
- Department of Outpatient Pneumology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Georg Bölke
- Department of Outpatient Pneumology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christina Hoffmann
- Department of Outpatient Pneumology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Roehle
- Charité Coordinating Center for Clinical Studies (KKS), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Olaf Bender
- Charité Coordinating Center for Clinical Studies (KKS), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig Maximilian University of Munich; Comprehensive Pneumology Center (CPC) Munich, member DZL, German Center for Lung Research, Munich, Germany
| | - Rudolf Tauber
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hanns-Christian Gunga
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter Hoffmann
- Department of Outpatient Pneumology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Uta Liebers
- Department of Outpatient Pneumology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
37
|
Behr J, Bonella F, Frye BC, Günther A, Hagmeyer L, Henes J, Klemm P, Koschel D, Kreuter M, Leuschner G, Nowak D, Prasse A, Quadder B, Sitter H, Costabel U. [Pharmacological treatment of idiopathic pulmonary fibrosis (update) and progressive pulmonary fibrosis - S2k Guideline of the German Respiratory Society]. Pneumologie 2023; 77:94-119. [PMID: 36791790 DOI: 10.1055/a-1983-6796] [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: 02/17/2023]
Affiliation(s)
- Jürgen Behr
- Medizinische Klinik und Polklinik V, LMU Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung; Delegierte/r der DGP
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen; Delegierter der DGP
| | - Björn C Frye
- Klinik für Pneumologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland; Delegierter der DGP
| | - Andreas Günther
- Center for Interstitial and Rare Lung Diseases, University Hospital Giessen Marburg, Giessen, Agaplesion Evangelisches Krankenhaus Mittelhessen, Giessen, Germany; Delegierter der DGP
| | - Lars Hagmeyer
- Krankenhaus Bethanien Solingen, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Institut für Pneumologie an der Universität zu Köln; Delegierter der DGP
| | - Jörg Henes
- Zentrum für interdisziplinäre Rheumatologie, Immunologie und Autoimmunerkrankungen (INDIRA) und Innere Medizin II; Delegierter DGRh
| | - Philipp Klemm
- Abt. Rheumatologie und klinische Immunologie, Kerckhoff Klinik und Campus Kerckhoff der Justus-Liebig-Universität Gießen, Bad Nauheim; Delegierter der DGRh
| | - Dirk Koschel
- Fachkrankenhaus Coswig, Lungenzentrum und Medizinische Klinik 1, Universitätsklinik Carl Gustav Carus der TU Dresden; Delegierter der DGP
| | - Michael Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen & interdisziplinäres Sarkoidosezentrum, Thoraxklinik, Universitätsklinikum Heidelberg, Deutsches Zentrum für Lungenforschung Heidelberg und Klinik für Pneumologie, Interdisziplinäres Lungenzentrum Ludwigsburg, RKH Klinik Ludwigsburg; Delegierter der DGIM
| | - Gabriela Leuschner
- Medizinische Klinik und Polklinik V, LMU Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung; Delegierte/r der DGP
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum der Universität München, Comprehensive Pneumology Center (CPC) München, Mitglied des Deutsches Zentrums für Lungenforschung; Delegierter der DGAUM
| | - Antje Prasse
- Klinik für Pneumologie und Infektiologie, Medizinische Hochschule Hannover, DZL BREATH und Abteilung für Fibroseforschung, Fraunhofer ITEM, Hannover, Delegierte der DGP
| | | | - Helmut Sitter
- Institut für Theoretische Chirurgie, Philipps-Universität Marburg, Moderator
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen; Delegierter der DGP
| |
Collapse
|
38
|
Forster F, Heumann C, Schaub B, Böck A, Nowak D, Vogelberg C, Radon K. Parental occupational exposures prior to conception and offspring wheeze and eczema during first year of life. Ann Epidemiol 2023; 77:90-97. [PMID: 36476404 DOI: 10.1016/j.annepidem.2022.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/12/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Parental exposures prior to conception might influence asthma and allergy risk in offspring. As occupational exposures are established risk factors for asthma and allergies, we investigated if parental occupational exposures prior to conception cause wheeze and eczema in offspring during the first year of life. METHODS We analysed data of 436 families from an offspring cohort based on a follow-up study of German participants of the International Study of Asthma and Allergies in Childhood (ISAAC). Offspring cohort data was collected between 2009 and 2019. Occupational exposures were based on participants' work histories and measured by a Job-Exposure-Matrix. We used Bayesian logistic regression models for analysis. Inference and confounder selection were based on directed acyclic graphs. RESULTS In mothers, for both allergic and irritative occupational exposures prior to conception suggestive effects on offspring eczema during the first year of life were found (allergens: odds ratio (OR) 1.22, 95% compatibility interval (CI) 0.92-1.57; irritants: OR 1.36, 95% CI 0.99-1.77), while no relation with wheeze was suggested. CONCLUSIONS Our results suggest that reduction of asthma-related occupational exposures might not only reduce the burden of disease for occupationally induced or aggravated asthma and allergies in employees but also in their children.
Collapse
Affiliation(s)
- Felix Forster
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.
| | | | - Bianca Schaub
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), Munich, Germany
| | - Andreas Böck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), Munich, Germany
| | - Christian Vogelberg
- Department of Pediatrics, University Hospital Dresden, Technical University, Dresden, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), Munich, Germany
| |
Collapse
|
39
|
Hayden MC, Schwarzl G, Limbach M, Mitrea S, Schuler M, Nowak D, Schultz K. Negative association between fatigue and signs of sleep apnoea in patients after COVID-19. ERJ Open Res 2022; 8:00289-2022. [PMID: 36575709 PMCID: PMC9510902 DOI: 10.1183/23120541.00289-2022] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/18/2022] [Indexed: 12/30/2022] Open
Abstract
Compared to the general population, there are increased apnoea-hypopnoea indices in patients recovering from #COVID19, yet there is a negative correlation to symptoms of fatigue and no significant correlation to daytime sleepiness https://bit.ly/3pEl9C8.
Collapse
Affiliation(s)
- Markus C. Hayden
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern-Süd, Bad Reichenhall, Germany,These authors contributed equally
| | - Gabriele Schwarzl
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern-Süd, Bad Reichenhall, Germany,These authors contributed equally,Gabriele Schwarzl ()
| | - Matthias Limbach
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern-Süd, Bad Reichenhall, Germany
| | - Sorin Mitrea
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern-Süd, Bad Reichenhall, Germany
| | - Michael Schuler
- Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit, Bochum, Germany
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Konrad Schultz
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern-Süd, Bad Reichenhall, Germany
| |
Collapse
|
40
|
Hieronimi A, Elbel J, Schneider M, Wermuth I, Schulte-Körne G, Nowak D, Bose-O’Reilly S. A Qualitative Study to Explain the Factors Influencing Mental Health after a Flooding. Int J Environ Res Public Health 2022; 20:134. [PMID: 36612497 PMCID: PMC9819052 DOI: 10.3390/ijerph20010134] [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: 11/16/2022] [Revised: 12/12/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
Background: Children and adolescents are considered to be particularly vulnerable to the psychological effects of climate change, such as extreme weather events. What are the protective factors and stressors for the mental health of the young population after extreme weather events in Germany? Methods: Nine semi-structured interviews with representatives of occupational groups providing care to children, adolescents, and political stakeholders were conducted in Simbach am Inn, a German town affected by flooding in 2016. The interviews were analyzed using qualitative content analysis according to Mayring. Results: The interviews show that the parents' dealing with what they had experienced and the concern for their relatives were the most influential stressors for children and adolescents. As protective factors, they felt that conversations with familiar people and restoring a certain "normality" were particularly important. The interviewees described both, the time of the flooding, and the time after the initial state of shock had subsided, as particularly stressful. Consequently, the experts reported on children and adolescents acutely complaining of fear, helplessness, and extreme tension. Nevertheless, the demand for psychological care increased only slightly after the flooding in Simbach am Inn. Conclusion: The social environment of children and adolescents is essential for their psychological well-being after an extreme weather event. Research, especially on children and adolescents who have already been affected, must increase in order to be able to describe influencing factors even more precisely, to protect individuals from adverse mental health effects, and to identify healthcare requirements.
Collapse
Affiliation(s)
- Annika Hieronimi
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Johanna Elbel
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Michael Schneider
- Institute of Sociology, Ludwig-Maximilians-University Munich, 80801 Munich, Germany
| | - Inga Wermuth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Stephan Bose-O’Reilly
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
| |
Collapse
|
41
|
Jörres RA, Scholl N, Dressel H, Kauffmann-Guerrero D, Karrasch S, Ochmann U, Kneidinger N, Alter P, Magnussen H, Behr J, Nowak D, Kahnert K. A new approach for the detection of obesity-related airway obstruction in lung-healthy individuals. Respir Med 2022; 205:107025. [PMID: 36399895 DOI: 10.1016/j.rmed.2022.107025] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Subjects with obesity show an increased prevalence of airway obstruction but it is not clear in each case whether this reflects genuine lung disease. Via intentional increase in end-expiratory lung volume we studied the detection of obesity-induced airway obstruction in lung-healthy obese subjects. METHODS The primary study population comprised 66 lung-healthy obese subjects and 23 normal weight subjects. Measurements were performed in a body plethysmograph allowing for recording and quantification of breathing loops in terms of specific airway resistance at both normal and intentionally elevated end-expiratory lung volume. The change in volume was documented by a shutter maneuver. RESULTS The voluntary increase of lung volume led to a significant reduction of expiratory airway resistance in 11 of the 66 obese subjects. This reduction could be quantified by a change of total expiratory resistance (sRtEX) of >1 kPa*s but was also clearly visible in the breathing loops. sRtEX showed the largest change among all resistance parameters. The loops of normal weight subjects remained virtually unaffected by the change in lung volume. Moreover, those of 5 obese patients with COPD who were measured for comparison partially showed a reduction of resistance but airway obstruction remained. CONCLUSION The proposed breathing maneuver was simple to perform and allowed for a quantitative and qualitative detection of obesity-induced airway obstruction. This might help in reducing the likelihood of misdiagnosis and overtreatment of obese patients.
Collapse
Affiliation(s)
- Rudolf A Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Nicola Scholl
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Holger Dressel
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Department of Medicine V, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Uta Ochmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UMR), Marburg, Germany
| | - Helgo Magnussen
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Jürgen Behr
- Department of Medicine V, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Kathrin Kahnert
- Department of Medicine V, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany.
| |
Collapse
|
42
|
Würzner P, Jörres RA, Karrasch S, Quartucci C, Böse-O'Reilly S, Nowak D, Rakete S. Effect of experimental exposures to 3-D printer emissions on nasal allergen responses and lung diffusing capacity for inhaled carbon monoxide/nitric oxide in subjects with seasonal allergic rhinitis. Indoor Air 2022; 32:e13174. [PMID: 36437663 DOI: 10.1111/ina.13174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/16/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
3-D printers are widely used. Based on previous findings, we hypothesized that their emissions could enhance allergen responsiveness and reduce lung diffusing capacity. Using a cross-over design, 28 young subjects with seasonal allergic rhinitis were exposed to 3-D printer emissions, either from polylactic acid (PLA) or from acrylonitrile butadiene styrene copolymer (ABS), for 2 h each. Ninety minutes later, nasal allergen challenges were performed, with secretions sampled after 1.5 h. Besides nasal functional and inflammatory responses, assessments included diffusing capacity. There was also an inclusion day without exposure. The exposures elicited slight reductions in lung diffusing capacity for inhaled nitric oxide (DLNO ) that were similar for PLA and ABS. Rhinomanometry showed the same allergen responses after both exposures. In nasal secretions, concentrations of interleukin 6 and tumor necrosis factor were slightly reduced after ABS exposure versus inclusion day, while that of interleukin 5 was slightly increased after PLA exposure versus inclusion.
Collapse
Affiliation(s)
- Philipp Würzner
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Rudolf A Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Caroline Quartucci
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Bavarian Health and Food Safety Authority, Institute for Occupational Health and Product Safety, Environmental Health, Munich, Germany
| | - Stephan Böse-O'Reilly
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Stefan Rakete
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
43
|
Osadnik T, Banach M, Gierlotka M, Nalewajko K, Nowak D, Zak Z, Skowron L, Lewandowski P, Jozwiak J. Relationship of obesity to mortality in 47,399 patients from nationwide LIPIDOGRAM 2004–2015 cohort studies. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2363] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Evidence suggests that obesity may be associated with lower mortality rates in various cohorts of patients (obesity paradox). One possible explanation is unmeasured confounding factors induced by selection bias (collider stratification bias). Therefore, data from large cohorts with few exclusion criteria are of value as they may minimize this effect.
Purpose
To assess the association between two obesity measures body mass index (BMI; kg/m2) and waist circumference (WC; cm) with mortality in nationwide cohort of 47,399 patients.
Methods
Lipidogram studies were carried out in Poland in 2004, 2006 and 2015 in the population representative for patients in primary care setting. The median follow up was 5570 days. Patients were recruited in all 16 administrative regions in Poland and physicians were proportionally to the number of inhabitants in a given administrative region. Each patient was given a questionnaire on chronic diseases, treatment and lifestyle. Questionnaire was administered by physician. Association between BMI, WC and mortality was assessed by multivariate Cox regression and spline regression models. Weight status was classified as underweight (BMI <18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25–29.9), class I obesity (BMI 30–34.9), class II obesity BMI (35–39.9), and class III obesity BMI (>40).
Results
The prevalence of hypertension, dyslipidemia, diabetes and coronary artery disease, showed a graded association with BMI, whilst smoking was most frequent in underweight patients. Correlation between BMI and WC was 0.748. As compared to normal weight patients' class III obese patients had highest mortality (HR 1.91; 95% CI: 1.650–2.202), following by class II obesity (HR 1.47, 95% CI: 1.33–1.62) and underweight patients (HR 1.47; 95% CI 1.1–1.8). Overweight patients had also slightly increased risk of dying as compared to normal weight patients (HR 1.12; 95% CI: 1.05–1.19). Similar U-shaped curve was observed for waist circumference. After adjustment for age, sex, smoking, diabetes, hypertension and LDL cholesterol highest mortality was observed for underweight patients (HR 1.88; 95% CI: 1.44–2.45), following by class III obesity (HR–1.51; 95% CI 1.31–1.75). Class I obesity and being overweight was associated with lower risk (HR 0.88; 95% CI: 0.82–0.94 and HR 0.86; 95% CI: 0.81–0.92, respectively).
Conclusions
No evidence of obesity paradox was present in unadjusted analysis. Lower mortality was observed in overweight and class I obese patients only after adjustment for risk factors and diseases typically associated with obesity. Results of multivariate analysis indicate that diseases that develop in obese patients are significantly associated with mortality more than obesity itself. Confounding may be responsible for discussed obesity paradox in literature therefore preventive measures to maintain BMI within normal range and prevent development of its complications should not be abolished.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The present study was funded by an unrestricted educational grant from Valeant. As a supporter of the study, Valeant played no role in the study design, data analysis, data interpretation, or writing of the report. The present study was also supported by Silesian Analytical Laboratories (SLA, Katowice, Poland).
Collapse
Affiliation(s)
- T Osadnik
- The Medical University of Silesia, Department of Pharmacology , Zabrze , Poland
| | - M Banach
- Medical University of Lodz, Department of Preventive Cardiology and Lipidology , Lodz , Poland
| | - M Gierlotka
- University of Opole, Department of Cardiology , Opole , Poland
| | - K Nalewajko
- University of Opole, Department of Cardiology , Opole , Poland
| | - D Nowak
- University of Opole, Department of Family Medicine and Public Health , Opole , Poland
| | - Z Zak
- University of Opole, Department of Family Medicine and Public Health , Opole , Poland
| | - L Skowron
- Military Institute of Medicine, Department of Gastroenterology, Endocrinology and Internal Diseases , Warsaw , Poland
| | - P Lewandowski
- The Medical University of Silesia, Department of Pharmacology , Zabrze , Poland
| | - J Jozwiak
- University of Opole, Department of Family Medicine and Public Health , Opole , Poland
| |
Collapse
|
44
|
Gierlotka M, Jozwiak J, Osadnik T, Nalewajko K, Feusette P, Nowak D, Zak Z, Skowron L, Golawski M, Banach M. LDL levels and long-term all-cause mortality in patients from nationwide LIPIDOGRAM 2004–2015 cohort studies. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2677] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Data from multiple randomized clinical trials show that lowering LDL cholesterol with statins is associated with significant reduction of outcomes both in primary and secondary prevention. Despite this some epidemiological studies reported increased risk with lowest LDL levels. The reason for this apparent discrepancy is probably due to unbalanced confounding in epidemiological studies.
Purpose
To assess long term survival in propensity matched cohort from the LIPIDOGRAM study in patients on statin therapy.
Methods
Lipidogram studies were carried out in Poland in 2004, 2006 and 2015 in the population representative for patients in primary care setting. The median follow up was 5570 days. Patients were recruited in all 16 administrative regions in Poland and physicians (n>1100) were proportionally distributed to the number of inhabitants in a given administrative region. Each patient was asked to fill the questionnaire on chronic diseases, treatment and lifestyle. Questionnaire was supervised by physician. Patients who were taking statins at the time of enrollment were matched to patients who were not on statin therapy. Groups were matched with regard to age, sex, body mass index, LDL cholesterol, diabetes mellitus, hypertension, previous myocardial infarction, chronic kidney disease, previous ischemic stroke, and atrial fibrillation. Nearest neighbor matching method was employed.
Results
To 13676 patients (28.9% of the LIPIDOGRAM 2004–2015 cohort) that took statin at the time of enrollment and 13676 patients not on statin treatment were matched. There were no significant differences between two groups with regard to all variables used in matching procedure including LDL cholesterol level. After 15 years of follow up There were 2585 deaths (18.9%) in patients who were treated with statin at the time of enrollment as compared to 2824 (20.6%) in patients with no treatment for dyslipidemia (absolute risk reduction (ARR) of −1.7%, p=0.003) Hazard ratio for mortality in patients who were not treated with statin at the enrollment in this propensity matched cohort was 1.11 (95% CI; 1.05–1.17, p=0.0002).
Conclusions
Despite similar LDL levels patients treated with statin at the time of enrollment had lower mortality risk as compared to patients not taking statins in long-term follow-up. Lower LDL levels that are not due to statin therapy might imply other underlying conditions that influence prognosis. Therefore, data from epidemiological studies that contradict results of balanced randomized trials due to intrinsic limitations should be approached with skepticism.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The present study was funded by an unrestricted educational grant from Valeant. As a supporter of the study, Valeant played no role in the study design, data analysis, data interpretation, or writing of the report. The present study was also supported by Silesian Analytical Laboratories (SLA, Katowice, Poland).
Collapse
Affiliation(s)
- M Gierlotka
- University of Opole, Department of Cardiology , Opole , Poland
| | - J Jozwiak
- University of Opole, Department of Family Medicine and Public Health , Opole , Poland
| | - T Osadnik
- The Medical University of Silesia, Department of Pharmacology , Zabrze , Poland
| | - K Nalewajko
- University of Opole, Department of Cardiology , Opole , Poland
| | - P Feusette
- University of Opole, Department of Cardiology , Opole , Poland
| | - D Nowak
- University of Opole, Department of Family Medicine and Public Health , Opole , Poland
| | - Z Zak
- University of Opole, Department of Family Medicine and Public Health , Opole , Poland
| | - L Skowron
- Military Institute of Medicine, Department of Gastroenterology, Endocrinology and Internal Diseases , Warsaw , Poland
| | - M Golawski
- The Medical University of Silesia, Department of Pharmacology , Zabrze , Poland
| | - M Banach
- Medical University of Lodz, Department of Preventive Cardiology and Lipidology , Lodz , Poland
| |
Collapse
|
45
|
Osadnik T, Banach M, Gierlotka M, Nalewajko K, Nowak D, Zak Z, Skowron L, Osadnik K, Jozwiak J. Lean metabolic syndrome is associated with similar long-term prognosis as metabolic syndrome in overweight/obese patients. Analysis 47,399 Patients from nationwide LIPIDOGRAM 2004–2015 cohort studies. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2396] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obesity was once though as an indispensable component of metabolic syndrome. Therefore, there a lot of definitions of metabolic syndrome with only few not including obesity as a criterion. The necessity of the obesity criterion in the metabolic health assessment is being questioned, as similar metabolic disturbances can occur in normal weight individuals. This relatively new concept is often referred as lean metabolic syndrome. Data on long term prognosis is scarce.
Purpose
To evaluate association between metabolic health and long-term prognosis.
Methods
Lipidogram studies were carried out in Poland in 2004, 2006 and 2015 in the population representative for patients in primary care setting. Patients were recruited in all 16 administrative regions in Poland and physicians were proportionally to the number of inhabitants in a given administrative region. Each patient was given a questionnaire on chronic diseases, treatment and lifestyle. Questionnaire was administered by physician. The diagnosis of metabolic syndrome was based on the presence of at least two of the following: 1) systolic blood pressure (SBP) ≥130 mmHg or diastolic blood pressure (DBP) ≥85 mmHg, 2) triglycerides (TG) >150 mg/dl, 3) high-density lipoprotein cholesterol (HDL-C) <40 mg/dl men and <50 mg/dl in women, 4) total cholesterol (TC) >200 mg/dl, and 5) fasting glucose (FBG) >100 mg/dl. Basing on those criteria and BMI with a cut off value of 25 kg/m2, patients were divided into four categories: healthy slim, metabolically healthy overweight/obese, lean metabolic syndrome and overweight/obese metabolic syndrome. The median follow up was 5570. this analysis data were censored at 3650 days.
Results
The median age of the study participants was 56.4 years. 7901 (16.7%) fell into category healthy slim, 14607 (30.8%) were classified as metabolically healthy overweight/obese, 3827 (8.1%) fulfilled criteria for lean metabolic syndrome whilst the remaining 21063 (44.4%) patients were diagnosed with overweight/obese metabolic syndrome. There were 4065 deaths during 10 years follow-up. Patients with lean metabolic syndrome had similar risk as patients with overweight/obese metabolic syndrome (HR=1.33, 95% CI: 1.17–1.52, p<0.001 and HR=1.32, 95% CI: 1.20–1.45, p<0.001). Metabolically heathy overweight/obese patients had only slightly higher risk of dying than healthy slim patients but this difference was less pronounced (HR=1.11, 95% CI: 1.08–1.23, p=0.03).
Conclusions
Lean metabolic syndrome confers similar risk as metabolic syndrome in overweigh/obese patients.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The present study was funded by an unrestricted educational grant from Valeant. As a supporter of the study, Valeant played no role in the study design, data analysis, data interpretation, or writing of the report. The present study was also supported by Silesian Analytical Laboratories (SLA, Katowice, Poland).
Collapse
Affiliation(s)
- T Osadnik
- The Medical University of Silesia, Department of Pharmacology , Zabrze , Poland
| | - M Banach
- Medical University of Lodz, Department of Preventive Cardiology and Lipidology , Lodz , Poland
| | - M Gierlotka
- University of Opole, Department of Cardiology , Opole , Poland
| | - K Nalewajko
- University of Opole, Department of Cardiology , Opole , Poland
| | - D Nowak
- University of Opole, Department of Family Medicine and Public Health , Opole , Poland
| | - Z Zak
- University of Opole, Department of Family Medicine and Public Health , Opole , Poland
| | - L Skowron
- Military Institute of Medicine, Department of Gastroenterology, Endocrinology and Internal Diseases , Warsaw , Poland
| | - K Osadnik
- The Medical University of Silesia, Department of Pharmacology , Zabrze , Poland
| | - J Jozwiak
- University of Opole, Department of Family Medicine and Public Health , Opole , Poland
| |
Collapse
|
46
|
Kaltenegger HC, Weigl M, Becker L, Rohleder N, Nowak D, Quartucci C. Psychosocial working conditions and chronic low-grade inflammation in geriatric care professionals: A cross-sectional study. PLoS One 2022; 17:e0274202. [PMID: 36107874 PMCID: PMC9477283 DOI: 10.1371/journal.pone.0274202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Chronic low-grade inflammation has been suggested as a key factor in the association between stress exposure and long-term health. Care work is recognized as a profession with a high degree of job stress and health risks. However, for care professionals, the study base on inflammatory activity due to adverse working conditions is limited.
Objective
The aim of this study was to explore associations between self-reported psychosocial working conditions and care professionals’ biomarkers of systemic low-grade inflammation.
Methods
N = 140 geriatric care professionals (79.3% females, mean age = 44.1 years) of six care facilities were enrolled in a cross-sectional study consisting of standardized medical examinations and employee surveys. Standardized questionnaires were used for evaluation of psychosocial work characteristics (work overload, job autonomy, social support) based on Karasek’s job strain model. Blood samples were drawn for two biomarkers of inflammatory activity: C-reactive protein (CRP) and leukocyte count. Analyses comprised uni- and multivariate logistic and linear regression analyses.
Results
We determined a proportion of 5.4% of care professionals with increased low-grade inflammation. We further observed a relationship between job autonomy and CRP, such that reports of high job autonomy were associated with increased levels of CRP (adjusted OR = 4.10, 95% CI [1.10, 15.26], p = .035), which was robust in additional analyses on further potential confounders. No significant associations with participants’ leukocyte numbers were found.
Conclusions
This exploratory study contributes to the research base on links between workplace stress and ensuing illness in care professionals. Our findings may help to identify risk and protective factors of the work environment for chronic low-grade inflammation. The results require further scrutiny, and future prospective studies on associations of psychosocial working conditions, low-grade inflammation and long-term health outcomes in care professionals are needed.
Collapse
Affiliation(s)
- Helena C. Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- * E-mail:
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Linda Becker
- Chair of Health Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Nicolas Rohleder
- Chair of Health Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Caroline Quartucci
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Bavarian Health and Food Safety Authority, Institute for Occupational Health and Product Safety, Environmental Health, Munich, Germany
| |
Collapse
|
47
|
Landrigan P, Bose-O'Reilly S, Elbel J, Nordberg G, Lucchini R, Bartrem C, Grandjean P, Mergler D, Moyo D, Nemery B, von Braun M, Nowak D. Reducing disease and death from Artisanal and Small-Scale Mining (ASM) - the urgent need for responsible mining in the context of growing global demand for minerals and metals for climate change mitigation. Environ Health 2022; 21:78. [PMID: 36028832 PMCID: PMC9412790 DOI: 10.1186/s12940-022-00877-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Artisanal and small-scale mining (ASM) takes place under extreme conditions with a lack of occupational health and safety. As the demand for metals is increasing due in part to their extensive use in 'green technologies' for climate change mitigation, the negative environmental and occupational consequences of mining practices are disproportionately felt in low- and middle-income countries. The Collegium Ramazzini statement on ASM presents updated information on its neglected health hazards that include multiple toxic hazards, most notably mercury, lead, cyanide, arsenic, cadmium, and cobalt, as well as physical hazards, most notably airborne dust and noise, and the high risk of infectious diseases. These hazards affect both miners and mining communities as working and living spaces are rarely separated. The impact on children and women is often severe, including hazardous exposures during the child-bearing age and pregnancies, and the risk of child labor. We suggest strategies for the mitigation of these hazards and classify those according to primordial, primary, secondary, and tertiary prevention. Further, we identify knowledge gaps and issue recommendations for international, national, and local governments, metal purchasers, and employers are given. With this statement, the Collegium Ramazzini calls for the extension of efforts to minimize all hazards that confront ASM miners and their families.
Collapse
Affiliation(s)
- Philip Landrigan
- Program for Global Public Health and the Common Good, Global Observatory on Planetary Health, Boston College, Boston, USA.
- Centre Scientifique de Monaco, Monaco City, Monaco.
| | - Stephan Bose-O'Reilly
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Johanna Elbel
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Gunnar Nordberg
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Roberto Lucchini
- Institute of Occupational Health, University of Brescia, Brescia, Italy
| | - Casey Bartrem
- TerraGraphics International Foundation, Moscow, ID 83843, USA
| | - Philippe Grandjean
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | - Donna Mergler
- Centre de recherche interdisciplinaire sur le bien-être, la santé, la société et l'environnement (Center for Interdisciplinary Research in Health, Wellbeing, Society and Environment, Université du Québec à Montréal, Montreal, QC, Canada
| | - Dingani Moyo
- School of Public Health, Faculty of Health Sciences, Occupational Health Division, University of the Witwatersrand, Johannesburg, Republic of South Africa
- Department of Community Medicine, Faculty of Medicine and Health, National University of Science and Technology, Bulawayo, Zimbabwe
- Department of Community Medicine, Faculty of Medicine and Health, Midlands State University, Gweru, Zimbabwe
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Margrit von Braun
- TerraGraphics International Foundation, Moscow, ID 83843, USA
- Environmental Science Program, University of Idaho, Moscow, ID 83843, USA
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
48
|
Holst M, Nowak D, Hoch E. Cannabidiol As a Treatment for COVID-19 Symptoms? A Critical Review. Cannabis Cannabinoid Res 2022. [PMID: 35881839 DOI: 10.1089/can.2021.0135] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 has caused >211 million infections and >5.5 million deaths within 24 months globally (WHO). Internationally, a debate emerged about potential benefits of cannabidiol (CBD) as treatment of corona virus disease-19 (COVID-19). Objective: To assess the effects of CBD in the treatment of COVID-19-related inflammatory symptoms from the literature. Methods: We searched Cochrane COVID-19 study register, CENTRAL (PubMed, Embase, CINAHL, ClinicalTrials.gov, and the WHO's International Clinical Trials Registry Platform), for studies testing CBD as inflammation intervention. All types of studies and populations were considered. All pre-clinical, clinical, and pharmacological outcomes were of interest. Results: Of 18 articles found, 9 were included: 5 in vivo animal studies, 3 in vitro human tissue studies and, 1 randomized clinical trial. Outcomes in four in vivo animal studies and three human tissue studies were immune response markers, which decreased. One in vivo study showed enhancement of monocytes. One human study did not show group differences in COVID-19 evolution. There was no information on adverse effects or drug interaction. Conclusion: There is not enough evidence to support or refute CBD as a repurpose drug to treat inflammation and other symptoms of COVID-19. Clinical trials are needed to test its efficacy and adverse effects.
Collapse
Affiliation(s)
- Manuela Holst
- Department of Psychiatry, Ludwig Maximilians University Munich, Munchen, Germany
| | - Dennis Nowak
- Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Germany
| | - Eva Hoch
- Department of Psychiatry, Ludwig Maximilians University Munich, Munchen, Germany
| |
Collapse
|
49
|
Strieker S, Weinmann T, Gerlich J, von Mutius E, Nowak D, Radon K, Wengenroth L. Farm living and allergic rhinitis from childhood to young adulthood - prospective results of the GABRIEL study. J Allergy Clin Immunol 2022; 150:1209-1215.e2. [PMID: 35779667 DOI: 10.1016/j.jaci.2022.05.027] [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: 01/11/2022] [Revised: 04/19/2022] [Accepted: 05/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Growing up on a farm is associated with a reduced prevalence of respiratory allergies in childhood. It is unknown whether this protective effect remains into adulthood. OBJECTIVES We aimed to prospectively investigate the relationship between farm exposure and prevalence of allergic rhinitis and wheeze from childhood to early adulthood. METHODS Participants from phase 2 of the GABRIEL (Multidisciplinary Study to Identify the Genetic and Environmental Causes of Asthma in the European Community) study living in southern Germany (aged 6-11 years at baseline; 20-25 at follow-up) were invited to complete a questionnaire on sociodemographic data, farm contact, respiratory symptoms, and potential confounders. Odds ratios (OR) with 95% confidence intervals (95% CI) were modelled using generalized estimating equations (GEE). RESULTS Of the 2,276 phase 2 participants, 1,501 (66%) answered the follow-up questionnaire of which 1,333 could be included in the analyses. Living on a farm was associated with reduced prevalence of allergic rhinitis (persistent farm living OR 0.4; 95% CI 0.2-0.6; only baseline farm living 0.4; 0.2-0.8). The odds ratio for developing symptoms from baseline to follow-up was almost three (OR 2.7; 95% CI 2.1-3.3), irrespective of farm living. For symptoms of wheeze, no statistically significant association with farm living was observed. CONCLUSIONS The protective effect of farm living on allergic rhinitis persists from childhood to early adulthood. Continuing exposure over puberty does not add to the effect. This confirms that the window of opportunity for a protective effect might be found in childhood.
Collapse
Affiliation(s)
- Sonja Strieker
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital. LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital. LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital. LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany; Munich Centre of Health Sciences (MC-Health), Munich, Germany
| | - Erika von Mutius
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany; Dr. v. Haunersches Kinderspital, University Hospital, LMU Munich, Munich, Germany; Institute of Asthma and Allergy Prevention (IAP), Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH)
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital. LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital. LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany; Munich Centre of Health Sciences (MC-Health), Munich, Germany
| | - Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital. LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany; Munich Centre of Health Sciences (MC-Health), Munich, Germany.
| |
Collapse
|
50
|
Moonga G, Chisola MN, Berger U, Nowak D, Yabe J, Nakata H, Nakayama S, Ishizuka M, Bose-O'Reilly S. Geospatial approach to investigate spatial clustering and hotspots of blood lead levels in children within Kabwe, Zambia. Environ Res 2022; 207:112646. [PMID: 34979123 DOI: 10.1016/j.envres.2021.112646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/14/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Communities around Kabwe, Zambia are exposed to lead due to deposits from an old lead (Pb) and zinc (Zn) mining site. Children are particularly more vulnerable than adults, presenting with greatest risk of health complications. They have increased oral uptake due to their hand to mouth activities. Spatial analysis of childhood lead exposure is useful in identifying specific areas with highest risk of pollution. The objective of the current study was to use a geospatial approach to investigate spatial clustering and hotspots of blood lead levels in children within Kabwe. METHODS We analysed existing data on blood lead levels (BLL) for 362 children below the age of 15 from Kabwe town. We used spatial autocorrelation methods involving the global Moran's I and local Getis-Ord Gi*statistic in ArcMap 10.5.1, to test for spatial dependency among the blood lead levels in children using the household geolocations. RESULTS BLL in children from Kabwe are spatially autocorrelated with a Moran's Index of 0.62 (p < 0.001). We found distinct hotspots (mean 51.9 μg/dL) in communities close to the old lead and zinc-mining site, lying on its western side. Whereas coldspots (mean 7 μg/dL) where observed in areas distant to the mine and traced on the eastern side. This pattern suggests a possible association between observed BLL and distance from the abandoned lead and zinc mine, and prevailing winds. CONCLUSION Using geocoded data for households, we found clustering of childhood blood lead and identified distinct hotspot areas with high lead levels for Kabwe town. The geospatial approach used is especially valuable in resource-constrained settings like Zambia, where the precise identification of high risk locations allows for the initiation of targeted remedial and treatment programs.
Collapse
Affiliation(s)
- Given Moonga
- Institute and Clinic for Occupational-, Social- and Environmental Medicine, LMU University Hospital Munich, Ziemssenstr. 1, D-80336, Munich, Germany; CIH(LMU) Center for International Health, LMU University Hospital, Munich, Germany; Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia; Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT (Private University for Health Sciences, Medical Informatics and Technology), Hall i.T, Austria.
| | - Moses N Chisola
- Department of Geography and Environmental Studies, University of Zambia, Lusaka, Zambia
| | - Ursula Berger
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational-, Social- and Environmental Medicine, LMU University Hospital Munich, Ziemssenstr. 1, D-80336, Munich, Germany
| | - John Yabe
- School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Hokuto Nakata
- Laboratory of Toxicology, Department of Environmental Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Shouta Nakayama
- Laboratory of Toxicology, Department of Environmental Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Mayumi Ishizuka
- Laboratory of Toxicology, Department of Environmental Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Stephan Bose-O'Reilly
- Institute and Clinic for Occupational-, Social- and Environmental Medicine, LMU University Hospital Munich, Ziemssenstr. 1, D-80336, Munich, Germany; Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT (Private University for Health Sciences, Medical Informatics and Technology), Hall i.T, Austria; University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Clinic St. Hedwig, Regensburg, Germany
| |
Collapse
|