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Hansen KK, Schlünssen V, Broberg K, Østergaard K, Frederiksen MW, Madsen AM, Kolstad HA. Exposure levels of dust, endotoxin, and microorganisms in the Danish recycling industry. Ann Work Expo Health 2023; 67:816-830. [PMID: 37191914 PMCID: PMC10410489 DOI: 10.1093/annweh/wxad025] [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: 12/22/2022] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Recycling of domestic waste and a number of employees in the recycling industry is expected to increase. This study aims to quantify current exposure levels of inhalable dust, endotoxin, and microorganisms and to identify determinants of exposure among recycling workers. METHODS This cross-sectional study included 170 full-shift measurements from 88 production workers and 14 administrative workers from 12 recycling companies in Denmark. The companies recycle domestic waste (sorting, shredding, and extracting materials from waste). We collected inhalable dust with personal samplers that were analysed for endotoxin (n = 170) and microorganisms (n = 101). Exposure levels of inhalable dust, endotoxin, and microorganisms and potential determinants of exposure were explored by mixed-effects models. RESULTS The production workers were 7-fold or higher exposed to inhalable dust, endotoxin, bacteria, and fungi than the administrative workers. Among production workers recycling domestic waste, the geometric mean exposure level was 0.6 mg/m3 for inhalable dust, 10.7 endotoxin unit (EU)/m3 for endotoxin, 1.6 × 104 colony forming units (CFU)/m³ of bacteria, 4.4 × 104 CFU/m³ of fungi (25 °C), and 1.0 × 103 CFU/m³ of fungi (37 °C). Workers handling paper or cardboard had higher exposure levels than workers handling other waste fractions. The temperature did not affect exposure levels, although there was a tendency toward increased exposure to bacteria and fungi with higher temperatures. For inhalable dust and endotoxin, exposure levels during outdoor work were low compared to indoor work. For bacteria and fungi, indoor ventilation decreased exposure. The work task, waste fraction, temperature, location, mechanical ventilation, and the company size explained around half of the variance of levels of inhalable dust, endotoxin, bacteria, and fungi. CONCLUSION The production workers of the Danish recycling industry participating in this study had higher exposure levels of inhalable dust, endotoxin, bacteria, and fungi than the administrative workers. Exposure levels of inhalable dust and endotoxin among recycling workers in Denmark were generally below established or suggested occupational exposure limits (OEL). However, 43% to 58% of the individual measurements of bacteria and fungi were above the suggested OEL. The waste fraction was the most influential determinant for exposure, and the highest exposure levels were seen during handling paper or cardboard. Future studies should examine the relationship between exposure levels and health effects among workers recycling domestic waste.
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Affiliation(s)
- Karoline Kærgaard Hansen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Research Unit for Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, DK-8000 Aarhus C, Denmark
| | - Karin Broberg
- Division of Occupational and Environmental Medicine, Lund University, SE-221 85 Lund, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Kirsten Østergaard
- Department of Public Health, Research Unit for Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, DK-8000 Aarhus C, Denmark
| | - Margit W Frederiksen
- National Research Centre of the Working Environment, DK-2100 Copenhagen Ø, Denmark
| | - Anne Mette Madsen
- National Research Centre of the Working Environment, DK-2100 Copenhagen Ø, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
- Institute of Clinical Medicine, Occupational Medicine, Aarhus University, DK-8200 Aarhus N, Denmark
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Klausen FB, Amidi A, Kjærgaard SK, Schlünssen V, Ravn P, Østergaard K, Gutzke VH, Glasius M, Grønborg TK, Hansen SN, Zachariae R, Wargocki P, Sigsgaard T. The effect of air quality on sleep and cognitive performance in school children aged 10-12 years: a double-blinded, placebo-controlled, crossover trial. Int J Occup Med Environ Health 2023; 36:177-191. [PMID: 36861764 PMCID: PMC10464806 DOI: 10.13075/ijomeh.1896.02032] [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: 06/09/2022] [Accepted: 11/09/2022] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVES To investigate the effect of CO2 during sleep on next-morning cognitive performance in young schoolchildren, the authors performed a double-blind fully balanced crossover placebo-controlled study. MATERIAL AND METHODS The authors included 36 children aged 10-12 years in the climate chamber. The children slept at 21°C in 6 groups each at 3 different conditions separated by 7 days in a random order. Conditions were as follows: high ventilation with CO2 at 700 ppm, high ventilation with added pure CO2 at 2000-3000 ppm, and reduced ventilation with CO2 at 2-3000 ppm and bioeffluents. Children were subjected to a digital cognitive test battery (CANTAB) in the evening prior to sleep and on the next morning after breakfast. Sleep quality was monitored with wrist actigraphs. RESULTS There were no significant exposure effects on cognitive performance. Sleep efficiency was significantly lower at high ventilation with CO2 at 700 ppm which is considered to be a chance effect. No other effects were seen, and no relation between air quality during sleep and next-morning cognitive performance was observed in the children emitting an estimated 10 lCO2/h per child. CONCLUSIONS No effect of CO2 during sleep was found on next day cognition. The children were awakened in the morning, and spent from 45-70 min in well-ventilated rooms before they were tested. Hence, it cannot be precluded that the children have benefitted from the good indoor air quality conditions before and during the testing period. The slightly better sleep efficiency during high CO2 concentrations might be a chance finding. Hence, replication is needed in actual bedrooms controlling for other external factors before any generalizations can be made. Int J Occup Med Environ Health. 2023;36(2):177-91.
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Affiliation(s)
- Frida Bejder Klausen
- Aarhus University, Department of Public Health, Section for Environment, Occupation and Health, Aarhus, Denmark
| | - Ali Amidi
- Aarhus University, Department of Psychology and Behavioural Sciences, Aarhus, Denmark
| | - Søren K. Kjærgaard
- Aarhus University, Department of Public Health, Section for Environment, Occupation and Health, Aarhus, Denmark
| | - Vivi Schlünssen
- Aarhus University, Department of Public Health, Section for Environment, Occupation and Health, Aarhus, Denmark
| | - Peter Ravn
- Aarhus University, Department of Public Health, Section for Environment, Occupation and Health, Aarhus, Denmark
| | - Kirsten Østergaard
- Aarhus University, Department of Public Health, Section for Environment, Occupation and Health, Aarhus, Denmark
| | - Vibeke Heitmann Gutzke
- Aarhus University, Department of Public Health, Section for Environment, Occupation and Health, Aarhus, Denmark
| | | | - Therese Koops Grønborg
- Aarhus University, Department of Public Health, Research Section of Biostatistics, Aarhus, Denmark
| | - Stefan Nygaard Hansen
- Aarhus University, Department of Public Health, Research Section of Biostatistics, Aarhus, Denmark
| | - Robert Zachariae
- Aarhus University, Department of Psychology and Behavioural Sciences, Aarhus, Denmark
| | - Pawel Wargocki
- Technical University of Denmark, Department of Environmental and Resource Engineering, Lyngby, Denmark
| | - Torben Sigsgaard
- Aarhus University, Department of Public Health, Section for Environment, Occupation and Health, Aarhus, Denmark
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Laursen KR, Rasmussen BB, Rosati B, Gutzke VH, Østergaard K, Ravn P, Kjaergaard SK, Bilde M, Glasius M, Sigsgaard T. Acute health effects from exposure to indoor ultrafine particles-A randomized controlled crossover study among young mild asthmatics. Indoor Air 2021; 31:1993-2007. [PMID: 34235780 DOI: 10.1111/ina.12902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/12/2021] [Revised: 06/09/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
Particulate matter is linked to adverse health effects, however, little is known about health effects of particles emitted from typical indoor sources. We examined acute health effects of short-term exposure to emissions from cooking and candles among asthmatics. In a randomized controlled double-blinded crossover study, 36 young non-smoking asthmatics attended three exposure sessions lasting 5 h: (a) air mixed with emissions from cooking (fine particle mass concentration): (PM2.5 : 96.1 μg/m3 ), (b) air mixed with emissions from candles (PM2.5 : 89.8 μg/m3 ), and c) clean filtered air (PM2.5 : 5.8 μg/m3 ). Health effects (spirometry, fractional exhaled Nitric Oxide [FeNO], nasal volume and self-reported symptoms) were evaluated before exposure start, then 5 and 24 h after. During exposures volatile organic compounds (VOCs), particle size distributions, number concentrations and optical properties were measured. Generally, no statistically significant changes were observed in spirometry, FeNO, or nasal volume comparing cooking and candle exposures to clean air. In males, nasal volume and FeNO decreased after exposure to cooking and candles, respectively. Participants reported additional and more pronounced symptoms during exposure to cooking and candles compared to clean air. The results indicate that emissions from cooking and candles exert mild inflammation in asthmatic males and decrease comfort among asthmatic males and females.
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Affiliation(s)
| | | | - Bernadette Rosati
- Department of Chemistry, Aarhus University, Aarhus, Denmark
- Faculty of Physics, University of Vienna, Vienna, Austria
| | - Vibeke Heitmann Gutzke
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kirsten Østergaard
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Ravn
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Merete Bilde
- Department of Chemistry, Aarhus University, Aarhus, Denmark
| | | | - Torben Sigsgaard
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
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Rosenkilde Laursen K, Bønløkke JH, Bendstrup E, Bilde M, Glasius M, Heitmann Gutzke V, Puthukkadan Moosakutty S, Olin AC, Ravn P, Østergaard K, Sigsgaard T. An RCT of acute health effects in COPD-patients after passive vape exposure from e-cigarettes. Eur Clin Respir J 2020; 8:1861580. [PMID: 33456728 PMCID: PMC7781946 DOI: 10.1080/20018525.2020.1861580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/06/2020] [Indexed: 12/30/2022] Open
Abstract
Background: E-cigarette use has been shown to have short-term acute effects among active users but less is known of the acute passive effects, particularly among individuals with existing respiratory diseases. Objective: To investigate local and systemic effects of short-term passive vape exposure among patients with mild or moderate chronic obstructive pulmonary disease (COPD). Methods: In a double-blinded crossover study 16 non-smoking COPD-patients (mean age 68) were randomly exposed for 4 h to passive vape (median PM2.5: 18 µg/m3 (range: 8-333)) and clean air (PM2.5 < 6 µg/m3) separated by 14 days. Particles were measured using an ultrafine particle counter (P-TRAK) and a scanning mobility particle sizer (SMPS). Health effects including Surfactant Protein-A (SP-A) and albumin in exhaled air, spirometry, FeNO, and plasma proteins were evaluated before, right after, and 24 hours after exposure. Participants reported symptoms throughout exposure sessions. Data were analyzed using mixed models. Results: SP-A in exhaled air was negatively affected by exposure to vape and several plasma proteins increased significantly. Throat irritation was more pronounced during passive vape exposure, while FVC and FEV1 decreased, however, not significantly. Conclusions: SP-A in exhaled air and some plasma proteins were affected by passive vape in patients with COPD indicating inflammation, showing that passive vape exposure is potentially harmful.
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Affiliation(s)
| | - Jakob Hjort Bønløkke
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Occupational and Environmental Medicine, Aalborg University Hospital, Danish Ramazzini Centre, Aalborg, Denmark
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Merete Bilde
- Department of Chemistry, Aarhus University, Aarhus, Denmark
| | | | - Vibeke Heitmann Gutzke
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Anna-Carin Olin
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Peter Ravn
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kirsten Østergaard
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Torben Sigsgaard
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
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Juel Holst G, Pørneki A, Lindgreen J, Thuesen B, Bønløkke J, Hyvärinen A, Elholm G, Østergaard K, Loft S, Brooks C, Douwes J, Linneberg A, Sigsgaard T. Household dampness and microbial exposure related to allergy and respiratory health in Danish adults. Eur Clin Respir J 2020; 7:1706235. [PMID: 32128077 PMCID: PMC7034447 DOI: 10.1080/20018525.2019.1706235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 12/11/2019] [Indexed: 11/03/2022] Open
Abstract
Background: Indoor dampness has consistently been associated with respiratory symptoms and exacerbations. The causal mechanisms may involve increased microbial exposures. However, the evidence regarding the influence of indoor microbial exposures under damp- and non-damp conditions on the risk of asthma and allergy has been inconclusive. Objective: The aim of this study was to investigate the association between dampness and microbial exposure with allergy and respiratory health in Danish adults using a cross-sectional design. Methods: From 1,866 participants of the Health2006 cohort, we selected three non-overlapping groups: 196 at random, 107 with confirmed atopy, and 99 without atopy. Bedroom dust was sampled using electrostatic dust fall collectors and analysed for endotoxin, β-(1,3)-D-glucan, 19 microbial species or groups, and total fungal load. Household moisture-related problems and asthma were self-reported by questionnaire. Atopy was determined by skin-prick-testing and lung function was measured by spirometry. Results: Household moisture damage was positively associated with asthma outcomes, although this was statistically significant only in atopics for self-reported asthma (odds ratio (OR) 3.52; 95%CI 1.01-12.7). Mould odor was positively associated with wheezing (OR 6.05; 95%CI 1.19-30.7) in atopics. Inconsistent associations were found for individual microbial exposures and health outcomes. Inverse associations were observed between microbial diversity and rhinitis in the random sample and both doctor-diagnosed and self-reported asthma in non-atopics. Conclusions: In conclusion, our findings suggest that household moisture damage may increase the risk of asthma and wheeze with mould odor in atopics. In addition, asthma and allergy may be affected by the indoor microbial composition in urban domestic environments. Further studies are needed to identify and understand the causal agents and underlying mechanisms behind the potential effects of environmental microbial exposure on human health.
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Affiliation(s)
- G Juel Holst
- Section of Environment, Occupation and Health, Aarhus University, Aarhus, Denmark
| | | | | | - B Thuesen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - J Bønløkke
- Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark
| | - A Hyvärinen
- Environment and Health Unit, National Institute for Health and Welfare - THL, Kuopio, Finland
| | - G Elholm
- Section of Environment, Occupation and Health, Aarhus University, Aarhus, Denmark
| | - K Østergaard
- Section of Environment, Occupation and Health, Aarhus University, Aarhus, Denmark
| | - S Loft
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C Brooks
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - J Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - A Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - T Sigsgaard
- Section of Environment, Occupation and Health, Aarhus University, Aarhus, Denmark
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Gersel Stokholm M, Iranzo A, Østergaard K, Serradell M, Otto M, Bacher Svendsen K, Garrido A, Vilas D, Fedorova T, Santamaria J, Møller A, Gaig C, Hiraoka K, Brooks D, Okamura N, Borghammer P, Tolosa E, Pavese N. Cholinergic denervation in patients with idiopathic rapid eye movement sleep behaviour disorder. Eur J Neurol 2019; 27:644-652. [DOI: 10.1111/ene.14127] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 11/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- M. Gersel Stokholm
- Department of Nuclear Medicine & PET Centre Aarhus University Hospital Aarhus Denmark
| | - A. Iranzo
- Department of Neurology Hospital Clínic de Barcelona Barcelona
- Centro de Investigación Biomédica en Red sobre Enfermedades eurodegenerativas (CIBERNED) Hospital Clínic IDIBAPS Universitat de Barcelona Catalonia
- Multidisciplinary Sleep Unit Hospital Clinic Barcelona Spain
| | - K. Østergaard
- Department of Neurology Aarhus University Hospital Aarhus
| | - M. Serradell
- Department of Neurology Hospital Clínic de Barcelona Barcelona
- Multidisciplinary Sleep Unit Hospital Clinic Barcelona Spain
| | - M. Otto
- Department of Clinical Neurophysiology Aarhus University Hospital Aarhus Denmark
| | | | - A. Garrido
- Centro de Investigación Biomédica en Red sobre Enfermedades eurodegenerativas (CIBERNED) Hospital Clínic IDIBAPS Universitat de Barcelona Catalonia
- Movement Disorders Unit Neurology Service Hospital Clínic de Barcelona Catalonia Spain
| | - D. Vilas
- Centro de Investigación Biomédica en Red sobre Enfermedades eurodegenerativas (CIBERNED) Hospital Clínic IDIBAPS Universitat de Barcelona Catalonia
- Movement Disorders Unit Neurology Service Hospital Clínic de Barcelona Catalonia Spain
| | - T.D. Fedorova
- Department of Nuclear Medicine & PET Centre Aarhus University Hospital Aarhus Denmark
| | - J. Santamaria
- Department of Neurology Hospital Clínic de Barcelona Barcelona
- Centro de Investigación Biomédica en Red sobre Enfermedades eurodegenerativas (CIBERNED) Hospital Clínic IDIBAPS Universitat de Barcelona Catalonia
- Multidisciplinary Sleep Unit Hospital Clinic Barcelona Spain
| | - A. Møller
- Department of Nuclear Medicine & PET Centre Aarhus University Hospital Aarhus Denmark
| | - C. Gaig
- Department of Neurology Hospital Clínic de Barcelona Barcelona
- Centro de Investigación Biomédica en Red sobre Enfermedades eurodegenerativas (CIBERNED) Hospital Clínic IDIBAPS Universitat de Barcelona Catalonia
- Multidisciplinary Sleep Unit Hospital Clinic Barcelona Spain
| | - K. Hiraoka
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center Tohoku University Sendai Japan
| | - D.J. Brooks
- Department of Nuclear Medicine & PET Centre Aarhus University Hospital Aarhus Denmark
- Division of Neuroscience Newcastle University Newcastle upon Tyne UK
| | - N. Okamura
- Division of Pharmacology Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - P. Borghammer
- Department of Nuclear Medicine & PET Centre Aarhus University Hospital Aarhus Denmark
| | - E. Tolosa
- Centro de Investigación Biomédica en Red sobre Enfermedades eurodegenerativas (CIBERNED) Hospital Clínic IDIBAPS Universitat de Barcelona Catalonia
- Movement Disorders Unit Neurology Service Hospital Clínic de Barcelona Catalonia Spain
| | - N. Pavese
- Department of Nuclear Medicine & PET Centre Aarhus University Hospital Aarhus Denmark
- Division of Neuroscience Newcastle University Newcastle upon Tyne UK
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Sridharan K, Højlund A, Johnsen E, Sunde N, Beniczky S, Østergaard K. Differentiated effects of DBS and dopaminergic medication on somatosensory processing in PD. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sridharan K, Nielsen A, Johnsen E, Sunde N, Beniczky S, Østergaard K. EP 58. Corticomuscular coherence during isotonic contractions with DBS and medication in PD patients. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bang Henriksen M, Johnsen EL, Sunde N, Vase A, Gjelstrup MC, Østergaard K. Surviving 10 years with deep brain stimulation for Parkinson's disease--a follow-up of 79 patients. Eur J Neurol 2014; 23:53-61. [PMID: 25492023 DOI: 10.1111/ene.12614] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 07/30/2014] [Accepted: 10/07/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Deep brain stimulation (DBS) for severe Parkinson's disease (PD) outperforms the best medical treatment in controlling motor symptoms and improving quality of life. Nevertheless disease progression cannot be controlled, and the development of dementia over time is nearly inevitable, often resulting in nursing home placement. Ten-year survival, development of hallucinations, dementia and nursing home placement were examined and adverse events were assessed. METHOD Patient files were scrutinized from baseline up to 10 years of treatment or death on all 79 PD patients treated with DBS of the subthalamic nucleus from 1998 to 2003 at Aarhus University Hospital. RESULTS Twenty-four patients died during the follow-up period of 10 years. Age above 60 years at surgery increased mortality 2.3-fold (P = 0.04). Of the 55 surviving patients 29 (53%) were demented and 19 (35%) were in nursing homes. Average time from operation to dementia was 5.6 ± 2.9 years. Hallucinations and nursing home placement were associated with increased mortality. CONCLUSION Survival of 70% after a mean of 25 years of PD including 10 years with DBS illustrates that this is a selected group of PD patients. The prevalence of dementia steadily increased after surgery as expected from disease progression and can be an early event. Compared with the few similar long-term studies, the present study presents a larger cohort followed at the same DBS center for a longer period of time and none was lost to follow-up, making conclusions more valid. The present findings are of significant prognostic help for the patient, caregiver and physician when treatment with DBS has to be decided.
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Affiliation(s)
- M Bang Henriksen
- Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark
| | - E L Johnsen
- Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark
| | - N Sunde
- Department of Neurosurgery, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark
| | - A Vase
- Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark
| | - M C Gjelstrup
- Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark
| | - K Østergaard
- Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark
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Borghammer P, Knudsen K, Østergaard K, Danielsen EH, Pavese N, Arveschoug A, Bluhme H, Bode M, Morsing A. Combined DaT imaging and olfactory testing for differentiating parkinsonian disorders. Int J Clin Pract 2014; 68:1345-51. [PMID: 24754902 DOI: 10.1111/ijcp.12445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Dopamine transporter (DaT) imaging with single photon emission computed tomography (SPECT) detects loss of striatal dopaminergic innervation with very high sensitivity. It cannot readily distinguish idiopathic Parkinson's disease (iPD) and dementia with Lewy bodies (DLB) from atypical disorders (aPD). However, most iPD/DLB patients are hyposmic, whereas the majority of aPD patients were reported to have intact olfaction. For this reason, we conducted a longitudinal follow-up study to investigate the power of combined DaT imaging and olfactory testing to predict the final diagnosis of the patients. MATERIALS AND METHODS A total of 129 patients received [123I]FP-CIT SPECT and olfactory testing at baseline assessment. Clinical follow-up 30 ± 12 months later was the diagnostic standard of truth. A normative dataset of 24 healthy controls was used for comparison. RESULTS Baseline DaT imaging predicted a dopamine-deficient diagnosis with 98% sensitivity and 98% specificity. The combined DaT/olfactory testing correctly classified 91% of patients as iPD/DLB (PPV 91%). The PPV rose to 97% or greater in anosmic patients. In contrast, only 45% of aPD patients were categorised correctly by combined DaT/olfactory testing - mainly because of the presence of normosmic iPD patients. CONCLUSIONS In patients with an abnormal DaT SPECT, hyposmia yields an a posteriori likelihood of iPD/DLB of > 90%. In contrast, a finding of normosmia only increases the a posteriori likelihood of aPD to approximately the 50%.
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Affiliation(s)
- P Borghammer
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus C, Denmark
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11
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Borghammer P, Østergaard K, Cumming P, Gjedde A, Rodell A, Hall N, Chakravarty MM. A deformation-based morphometry study of patients with early-stage Parkinson's disease. Eur J Neurol 2009; 17:314-20. [PMID: 19912319 DOI: 10.1111/j.1468-1331.2009.02807.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Previous volumetric magnetic resonance imaging (MRI) studies of Parkinson's disease (PD) utilized primarily voxel-based morphometry (VBM), and investigated mostly patients with moderate- to late-stage disease. We now use deformation-based morphometry (DBM), a method purported to be more sensitive than VBM, to test for atrophy in patients with early-stage PD. METHODS T1-weighted MRI images from 24 early-stage PD patients and 26 age-matched normal control subjects were compared using DBM. Two separate studies were conducted, where two minimally-biased nonlinear intensity-average were created; one for all subjects and another for just the PD patients. The DBM technique creates an average population-based MRI-average in an iterative hierarchical fashion. The nonlinear transformations estimated to match each subject to the MRI-average were then analysed. RESULTS The DBM comparison between patients and controls revealed significant contraction in the left cerebellum, and non-significant trends towards frontal, temporal and cingulate sulcal expansions with frontal and temporal white matter contractions. Within the patient group, the unified PD rating scores were highly correlated with local expansions in or near sulci bordering on frontal and temporal cortex. CONCLUSION Our results suggest that DBM could be a sensitive method for detecting morphological changes in early-stage PD.
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Affiliation(s)
- P Borghammer
- PET Centre, Aarhus University Hospitals, Aarhus, Denmark.
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Rasmussen VG, Poulsen SH, Dupont E, Østergaard K, Safikhany G, Egeblad H. Heart valve disease associated with treatment with ergot-derived dopamine agonists: a clinical and echocardiographic study of patients with Parkinson's disease. J Intern Med 2008; 263:90-8. [PMID: 18036161 DOI: 10.1111/j.1365-2796.2007.01874.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 10/22/2022]
Abstract
OBJECTIVE To elucidate the association between treatment with ergot-derived dopamine agonists (EDDA) and valvular abnormalities amongst patients with idiopathic Parkinson's disease (IPD) and secondly, to analyse the yield of clinical screening for valvular heart disease. DESIGN A cross-sectional controlled study. SETTING The cohort of IPD patients treated in the outpatient clinic, Department of Neurology, Aarhus University Hospital, Denmark. SUBJECTS A total of 138 IPD patients [median age 64 (39-87) years, 62% men] treated with either EDDA (n = 85) or non-EDDA (n = 53) for at least 6 months. Interventions. Patients were screened for valvular heart disease by clinical means and by examiner-blinded echocardiography. Main outcome measure was valvular regurgitation revealed by echocardiography. RESULTS Severe aortic regurgitation (n = 4) or moderate aortic (n = 12), mitral (n = 3) or tricuspidal valve regurgitation (n = 5) was found in 22 EDDA patients (25.9%). Two patients had coexistent moderate mitral and tricuspid valvular regurgitation. Two non-EDDA patients had moderate valve insufficiency (3.8%, P < 0.05). The adjusted relative risk for at least moderate valve insufficiency in the EDDA patients was 7.2% (P < 0.05). The sensitivity of detecting at least moderate valvular disease by cardiac murmur, dyspnoea, or the heart failure marker NT-proBNP (natriuretic peptide) was 62% for the neurologists and 93% for the cardiologist but with equally low specificity (30-35%). CONCLUSION EDDA was associated with a clinically important and statistically significant risk of at least moderate valve regurgitation. Clinical screening for valve disease was inadequate and it seems advisable to offer EDDA patients control with echocardiography.
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Affiliation(s)
- V G Rasmussen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
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Nielsen MS, Bjarkam CR, Sørensen JC, Bojsen-Møller M, Sunde NA, Østergaard K. Chronic subthalamic high-frequency deep brain stimulation in Parkinson's disease ? a histopathological study. Eur J Neurol 2007; 14:132-8. [PMID: 17250719 DOI: 10.1111/j.1468-1331.2006.01569.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [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: 11/27/2022]
Abstract
This study describes the pathological findings in the brain of a patient with Parkinson's disease (PD) treated with bilateral subthalamic high-frequency deep brain stimulation (STN DBS) for 29 months prior to death. After routine neuropathological examination, tissue blocks containing the electrode tracts, the subthalamic nucleus (STN), the substantia nigra and the pre-frontal cortex were paraffin embedded and cut into 5-microm-thick serial sections and stained with several conventional staining methods and immunohistochemistry. Bilateral nigral depigmentation, cell loss and Lewy body formation confirmed the diagnosis of PD. Microscopic evaluation furthermore confirmed the location of the electrodes in the STN. The electrode tracts were surrounded by a 150-microm-wide glial fibrillary acidic protein (GFAP)-positive capsule consisting of a thin collagen layer lining the lumen of the tract, whilst an area with few cells and axons constituted the capsule wall towards the surrounding normal brain tissue. The brain tissue appeared normal outside the capsule boundaries with no difference in areas of stimulation compared with areas of no stimulation. Our results correspond with previous studies performed after fewer months of STN DBS and indicate mild histopathological changes in the vicinity of the electrode tract, appearing to result from the electrode placement and not from the electrical stimulation.
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Affiliation(s)
- M S Nielsen
- Department of Neurobiology, Institute of Anatomy, University of Aarhus, Aarhus, Denmark.
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Vesper J, Chabardes S, Fraix V, Sunde N, Østergaard K. Dual channel deep brain stimulation system (Kinetra) for Parkinson's disease and essential tremor: a prospective multicentre open label clinical study. J Neurol Neurosurg Psychiatry 2002; 73:275-80. [PMID: 12185158 PMCID: PMC1738018 DOI: 10.1136/jnnp.73.3.275] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of a new dual channel stimulator (Kinetra) in patients with severe Parkinson's disease (PD) or essential tremor (ET). METHODS 111 patients with PD and 18 with ET were studied. Leads were implanted into the subthalamic nucleus (STN) or internal globus pallidus of patients with the akinetic/rigid type of PD. Leads were implanted into the ventral intermediate nucleus (VIM) of the thalamus or the STN in patients with the tremor dominant type of PD and in those with ET. Technical data on the device and adverse events occurring during the study were documented. Patients were assessed with established and validated clinical scales before surgery and at three and six months' follow up. RESULTS No device failure or unexpected adverse events occurred during the study. The dual channel stimulator used in stimulation of the STN, internal globus pallidus, and VIM in PD and ET was as safe and effective as the single channel stimulators in use. Mortality, morbidity, and infections were documented in the 129 treated patients. The parameter settings were similar to those usually programmed with single channel stimulators. Time spent in the operating room to implant the Kinetra system was systematically documented. In the PD group, improvement in the unified Parkinson's disease rating scale motor score, decrease in medication OFF periods, and reduced levodopa induced dyskinesia by bilateral STN stimulation were similar to those previously reported with bilaterally applied single channel stimulators. In the ET group upper and lower limb tremor scores were reduced by VIM stimulation. Activities of daily living improved in both disease groups. CONCLUSION The Kinetra facilitated bilateral deep brain stimulation implantation surgery and is easy to use. It offers more advantages for the patient than the single channel stimulators; consequently, this new device may be recommended to treat patients with severe PD and ET.
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Affiliation(s)
- J Vesper
- University Medical Centre Benjamin Franklin, Berlin, Germany CHU de Grenoble, Grenoble, France Arhus Kommunehospital, Arhus, Denmark
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Sunde NA, Østergaard K. [Functional neurosurgery and neuromodulation. The Danish Society of Neurosurgery and the Danish Society of Neurology]. Ugeskr Laeger 2001; 163:1704. [PMID: 11284404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- N A Sunde
- Neurokirurgisk afdeling GS, Arhus Kommunehospital, DK-8000 Arhus C
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Dam-Johansen K, Hansen P, Østergaard K. High-temperature reaction between sulphur dioxide and limestone—III. A grain-micrograin model and its verification. Chem Eng Sci 1991. [DOI: 10.1016/0009-2509(91)80191-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dam-Johansen K, Østergaard K. High-temperature reaction between sulphur dioxide and limestone—II. An improved experimental basis for a mathematical model. Chem Eng Sci 1991. [DOI: 10.1016/0009-2509(91)80190-a] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dam-Johansen K, Østergaard K. High-temperature reaction between sulphur dioxide and limestone—IV. A discussion of chemical reaction mechanisms and kinetics. Chem Eng Sci 1991. [DOI: 10.1016/0009-2509(91)80192-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Woźniak M, Østergaard K. On gas absorption with autocatalytic reaction. Chem Eng Sci 1978. [DOI: 10.1016/0009-2509(78)85102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Christiansen JA, Skarbye-Nielsen H, Østergaard K, Berndt W. Nucleation Kinetics. VI. Steady State Treatment of Nucleation and Growth of Crystalline Precipitates. ACTA ACUST UNITED AC 1954. [DOI: 10.3891/acta.chem.scand.08-1665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bredenberg JBS, Gripenberg J, Østergaard K, Berndt W. The Chemistry of the Natural Order Cupressales. XIII. The Presence of Sugiol in the Wood of Juniperus communis L. ACTA ACUST UNITED AC 1954. [DOI: 10.3891/acta.chem.scand.08-1728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Dyrssen D, Kauranen P, Østergaard K, Berndt W. Studies on the Extraction of Metal Complexes. XVIII. The Dissociation Constants and Partition Coefficient of Tropolone. ACTA ACUST UNITED AC 1954. [DOI: 10.3891/acta.chem.scand.08-1394] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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von Sydow E, Skarbye-Nielsen H, Østergaard K, Berndt W. A Microscopic Investigation of Binary Systems of Long Normal and Iso-Chain Carboxylic Acids. ACTA ACUST UNITED AC 1954. [DOI: 10.3891/acta.chem.scand.08-1513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fronæus S, Skarbye-Nielsen H, Østergaard K, Berndt W. An Ion Exchange Study of the Formation of Anionic Complexes in the Cupric and Cadmium Sulphate Systems. ACTA ACUST UNITED AC 1954. [DOI: 10.3891/acta.chem.scand.08-1174] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tommila E, Kauranen P, Østergaard K, Berndt W. The Influence of the Solvent on Reaction Velocity. VII. The Reaction between Triethylamine and Ethyl Iodide in Acetone-Benzene and Acetone-Dioxane Mixtures. ACTA ACUST UNITED AC 1954. [DOI: 10.3891/acta.chem.scand.08-1152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Spetsig LO, Limborg F, Østergaard K, Berndt W. Ascorbic Acid and Ascorbyl Palmitate as Synergistic Antioxidants for Methyl Linoleate in the Presence of Water. ACTA ACUST UNITED AC 1954. [DOI: 10.3891/acta.chem.scand.08-1646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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