[Show description][Hide description] DESCRIPTION: Abstract
Aim: We have analysed the effect of co-cancer morbidity on the mortality in subjects with malignant mesothelioma(MM) in the Danish Cancer Registry (DCR).
Methods:The DCR has data on cancer diagnosis in Denmark. Cancers are classified according to the international Classification of Diseases ICD-0 for the period 1943 – 1977 and ICD-10 for the period 1978 – to now. DCR has been found to be 95%-98% complete and valid. We identified patients with MM, the disease localisation and previous cancer in MM patients. Civil Registration System (CRS) provided information on date of birth, sex, marital status and date of death. Person-years at risk were computed from the date of diagnosis until the date of death, emigration or the 28th of January 2013, wichever came first. Study outcome was time to death.
Results: We identified 3638 patients with MM in pleura or peritoneum diagnosed between 1943 and 2011. Of these, 267 patients were previously diagnosed with cancer. For these 267 patients there was no association between the localization of MM and that of previous cancer. Previous cancer was associated with an increased mortality in MM patients with a MRR of 1.15 (95% confidence interval (CI): 1.01 - 1.31). Median survival in MM patients with previous cancer was 0.38 years (95% CI: 0.30 – 0.54 years) compared to a median survival of 0.50 years (95% CI: 0.46 – 0.53 years) in patients without previous cancer. Colon cancer N = 13 (MRR: 2.13 (95% CI: 1.23 - 3.68)), N = 4 lung cancer (MRR: 3.42 (95% CI: 1.28 - 9.13)) and leukemia N = 15 (MRR: 1.78 (95% CI: 1.05 - 3.01)) were associated with increased mortality.
Conclusion: Co-cancer morbidity in patients with MM reduces the median survival.
[Show abstract][Hide abstract] ABSTRACT: Longitudinal studies on the effect of farming on lung function in young participants are few. Our objective was to explore if exposure to farming impaired lung function in young adults.
We studied 1964 farming students and 407 controls in 1992/2004, and carried out follow-up in 2007/2008. Spirometry, skin prick test and bronchial hyper-responsiveness (BHR) were assessed, height and weight measured, and questionnaires covering health and occupation were collected. Cumulative dust and endotoxin exposures were estimated from modelled personal dust measurements. Lung function effect was expressed as change in z-score during follow-up using the Global Lung Initiative 2012 project prediction equations. Longitudinal data were available for 1134 young participants ≤25 years at baseline.
We found no differences in lung function Δz-scores between farmers and controls, however, adjusted multivariable linear regression showed a negative effect among current farmers on ΔzFEV1 (forced expiratory volume in 1 s; -0.12, p=0.006) and ΔzFEV1/FVC (forced vital capacity; -0.15, p=0.009) compared to ex-farmers. An interaction was found between sex and farming, showing that current farming suppresses ΔzFEV1 and ΔzFVC more among females. Smoking in farmers had a deleterious effect on ΔzFEV1, which was not seen in controls, though no significant interaction was found. Farm upbringing protected against impairment of lung function, and BHR at baseline had a deleterious effect on ΔzFEV1 only in those not raised on a farm.
We conclude that being a current farmer is associated with a negative effect on lung function, when compared to ex-farmers, with females being more susceptible. Being raised on a farm protects against the adverse effect of BHR on change in lung function.
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Occupational and environmental medicine 08/2015; 72(10). DOI:10.1136/oemed-2014-102726 · 3.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The reported prevalence of allergic sensitization among children is lower in rural areas than in urban areas of the world. The aim was to investigate the urban-rural differences of allergic sensitization to inhalant allergens in adults depending on childhood exposure living in an industrialized country as Denmark.
A total of 1236 male participants of 30-40 years of age recruited from two epidemiological studies were divided into four groups with regard to place of upbringing; city, town, rural area, and farm. Allergic sensitization was assessed by skin prick tests (SPTs) to 10 inhalant allergens and measurements of serum specific IgE (sIgE) to four inhalant allergens (grass, birch, cat, and house dust mite).
The prevalence of allergic sensitization to inhalant allergens decreased with decreasing degree of urbanized childhood. The risk of being sensitized to one or more allergens also decreased with decreasing degree of urbanized upbringing measured by sIgE to 4 common allergens as odds ratio with 95% confidence intervals with city as reference; town 0.60 (0.39 - 0.92), rural area 0.34 (0.22 - 0.52) and farm 0.31 (0.21 - 0.46). Furthermore it was measured by SPT to 10 common allergens; town 0.52 (0.33 - 0.84), rural area 0.34 (0.21 - 0.53), farm 0.29 (0.19 - 0.45). This urban rural association was also seen for the risk of sensitization to specific allergens, rhinitis and allergic asthma.
This is the first study to show an urban rural gradient of overall allergic sensitization and specific allergen sensitization in adults depending on their childhood exposure. In this highly homogenous Western population exposure to a less urbanized childhood was associated with lower risk of allergic sensitization and disease as an adult. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: Background
Skin prick tests (SPT) are widely used both in clinical diagnostics and in research. The standardization of allergen extracts is well documented to be crucial for the validity of SPT, whereas less emphasis has been placed on reproducibility and the SPT procedure itself. The objectives of this study are to clarify how the double skin prick test procedure influence the sensitivity and specificity of the test and to analyse the differences in weal size in skin prick tests between two batches of allergen extracts from the same vendor.
The association between rhinitis and SPT was assessed among 1135 persons from a general population sample. SPT was performed twice with 10 common aeroallergens. In a subsample of 90 persons SPT was performed simultaneously with five of the allergens using different batches.
Thirty percent had at least one positive SPT. Among asthmatics this number was 62%. Only minor differences were seen between the sizes of two weals from the same batch. A second SPT with the same batch did not change the association between rhinitis and sensitization. When performing SPT with two different batches disagreement was observed in 2% (Birch) to 11% (Cat) of the subjects.
Performing SPT twice with the same allergen batch does not enhance the validity of the test, and value of double testing can be questioned. Considerable differences in SPT response with different batches from the same manufacturer were observed. Thus inter batch differences in allergen extracts might be a source of variability.
BMC Pulmonary Medicine 04/2015; 15(1). DOI:10.1186/s12890-015-0021-3 · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Work intensification is a popular management strategy to increase productivity, but at the possible expense of employee mental stress. This study examines associations between ratings of work intensification and psychological distress, and the level of agreement between compared employee-rated and manager-rated work intensification. Multi-source survey data were collected from 3,064 employees and 573 company managers from the private sector in 2010. Multilevel regression models were used to compare different work intensification ratings across psychological distress strata. Distressed employees rated higher degree of total work intensification compared to non-distressed employees, and on three out of five sub ratings there were an increased prevalence of work intensification in the case group. In general, there was poor agreement between employee and company work intensification rating. Neither manager-rated work intensification nor employee/manager discrepancy in work intensification ratings was associated with psychological distress. Distressed employees had a higher total score of employee/manager agreed work intensification, and a higher prevalence of increased demands of labour productivity. This study demonstrates higher ratings of employee/manager agreed work intensification in distressed employees compared to non-distressed employees, challenging previous findings of reporting bias in distressed employees' assessment of work environment.
Industrial Health 03/2015; DOI:10.2486/indhealth.2014-0176 · 1.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Occupational exposures have been shown to be risk factors for chronic obstructive pulmonary disease (COPD) among never-smokers. In a Danish population-based cohort, we analysed this association and the population attributable fraction. The study population (N=1575) was aged 45-84, COPD was defined by lung function measurements and the method of lower limit of normal (LLN), and occupational exposure was assessed by questionnaire and expert judgement. Furthermore, the estimates additionally were provided according to the Global Initiative for Chronic Obstructive Lung Diseases. More than a threefold increased risk (LLN OR=3.69 (95% CI 1.36 to 10.04) was found for occupational exposure to vapour, gas, dust and fumes (predominantly organic dust) in this never-smoking population, with a corresponding 48% (95% CI 30% to 65%) population attributable fraction among never-smokers.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Occupational and Environmental Medicine 01/2015; 72(6). DOI:10.1136/oemed-2014-102589 · 3.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Musculoskeletal pain from the upper extremity and shoulder region is commonly reported by computer users. However, the functional status of central pain mechanisms, i.e., central sensitization and conditioned pain modulation (CPM), has not been investigated in this population. The aim was to evaluate sensitization and CPM in computer users with and without chronic musculoskeletal pain.
Pressure pain threshold (PPT) mapping in the neck-shoulder (15 points) and the elbow (12 points) was assessed together with PPT measurement at mid-point in the tibialis anterior (TA) muscle among 47 computer users with chronic pain in the upper extremity and/or neck-shoulder pain (pain group) and 17 pain-free computer users (control group). Induced pain intensities and profiles over time were recorded using a 0 -10 cm electronic visual analogue scale (VAS) in response to different levels of pressure stimuli on the forearm with a new technique of dynamic pressure algometry. The efficiency of CPM was assessed using cuff-induced pain as conditioning pain stimulus and PPT at TA as test stimulus.
The demographics, job seniority and number of working hours/week using a computer were similar between groups. The PPTs measured at all 15 points in the neck-shoulder region were not significantly different between groups. There were no significant differences between groups neither in PPTs nor pain intensity induced by dynamic pressure algometry. No significant difference in PPT was observed in TA between groups. During CPM, a significant increase in PPT at TA was observed in both groups (P < 0.05) without significant differences between groups. For the chronic pain group, higher clinical pain intensity, lower PPT values from the neck-shoulder and higher pain intensity evoked by the roller were all correlated with less efficient descending pain modulation (P < 0.05).
This suggests that the excitability of the central pain system is normal in a large group of computer users with low pain intensity chronic upper extremity and/or neck-shoulder pain and that increased excitability of the pain system cannot explain the reported pain. However, computer users with higher pain intensity and lower PPTs were found to have decreased efficiency in descending pain modulation.
[Show abstract][Hide abstract] ABSTRACT: Abstract The aim was to explore the impact of occupation on chronic obstructive pulmonary disease (COPD) in a cross-sectional population-based study among subjects aged 45 to 84 years. In a stratified sampling 89 general practitioners practices (GPP) in Denmark recruited 3106 males and 1636 females through the Danish Civil Registration System. COPD was defined by spirometry by the 2.5(th)-centile Lower Limit of Normal of FEV1 and FEV1/FVC. Information about smoking, occupational exposure and the respective occupations were obtained from questionnaires. Occupations followed the Danish adaptation of The International Standard Classification of Occupations, revision 1988 (DISCO-88). Exposure to vapour, gas, dust (organic and inorganic), and fume (VGDF) in each occupation (yes/no) was evaluated by two independent specialist in occupational medicine. Exposures were divided in no, low, medium, and high exposure as 0, <5, 5-14, and ≥ 15 years in the job, respectively. Data was analysed by a mixed random effect logistic regression model. The age-standardised COPD study prevalence was 5.0%. Of 372 DISCO-88 codes 72 were identified with relevant exposure to VGDF. 46% of the participants reported at least one occupation with VGDF exposure. Adjusted for smoking, age, sex, and GPP a dose-dependent association of COPD was found among workers in jobs with high organic dust exposure, with OR 1.56 (95% CI 1.09-2.24). Restricted to agriculture the OR was 1.59 (95% CI: 1.08-2.33). No association was observed for workers in jobs with inorganic dust, fume/gas, or vapour exposures. In summary, occupational organic dust exposure was associated to the prevalence of COPD.
[Show abstract][Hide abstract] ABSTRACT: Studies on determinants of dairy farmers' exposure to dust and endotoxin have been sparse and so far none has addressed the combined effect of tasks and farm characteristics.
To study whether and how work tasks and specific stable characteristics influence the level of dairy farmers' personal exposure to inhalable dust and endotoxin.
We applied an observational design involving full-shift repeated personal measurements of inhalable dust and endotoxin exposure among 77 subjects (owners and farm workers) from 26 dairy farms. Performed tasks were self-registered in activity diaries, and information on stable characteristics was collected through personal interviews and walk-through surveys. Associations between exposure, tasks, and stable characteristics were examined in linear mixed-effect models with individual and farm treated as random effects. Separate as well as combined models for tasks and stable characteristics were elaborated.
The 124 personal samples collected had a geometric mean level (geometric standard deviation) of 360 EU m(-3) (3.8) for endotoxin exposure and of 1.0mg m(-3) (2.7) for dust exposure. Identified factors that increased endotoxin exposure included a lower outdoor temperature and use of slope-based or back-flushed slurry systems along with milking, distribution of bedding, and handling of feed and seeds in barns. For dust, exposure was higher when fully automatic (robotic) milking was used and during re-penning of animals, handling of feed and seeds, handling of silos and when distributing bedding. Dust exposure increased also as a result of use of rail feed dispensers in a model without fully automatic milking.
The current exposure to dust and in particular endotoxin among Danish dairy farmers demand effective strategies to reduce their exposure. The present findings suggest that future interventions should focus on feeding and manure handling systems. Use of respirators during handling of feed and distribution of bedding should be advised until adequate risk management measures have been established. The expected increased use of fully automatic milking in the future might increase dust exposure of dairy farmers.
[Show abstract][Hide abstract] ABSTRACT: Occupational-attributable chronic obstructive pulmonary disease (COPD) presents a substantial health challenge. Focusing on spirometric criteria for airflow obstruction, this review of occupational COPD includes both population-wide and industry-specific exposures.
We used PubMed and Embase to identify relevant original epidemiological peer-reviewed articles, supplemented with citations identified from references in key review articles. This yielded 4528 citations. Articles were excluded for lack of lung function measurement, insufficient occupational exposure classification, lack of either external or internal referents, non-accounting of age or smoking effect, or major analytic inadequacies preventing interpretation of findings. A structured data extraction sheet was used for the remaining 147 articles. Final inclusion was based on a positive qualitative Scottish Intercollegiate Guidelines Network (SIGN) score (≥2+) for study quality, yielding 25 population-wide and 34 industry/occupation-specific studies, 15 on inorganic and 19 on organic dust exposure, respectively.
There was a consistent and predominantly significant association between occupational exposures and COPD in 22 of 25 population-based studies, 12 of 15 studies with an inorganic/mineral dust exposure, and 17 of 19 studies on organic exposure, even though the studies varied in design, populations, and the use of measures of exposure and outcome. A nearly uniform pattern of a dose-response relationship between various exposures and COPD was found, adding to the evidence that occupational exposures from vapors, gas, dust, and fumes are risk factors for COPD.
There is strong and consistent evidence to support a causal association between multiple categories of occupational exposure and COPD, both within and across industry groups.
Scandinavian Journal of Work, Environment & Health 11/2013; 40(1). DOI:10.5271/sjweh.3400 · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Former studies of professional fishing activities have indicated that movements of a ship, in itself, may increase the energy expenditure in addition to the traditional work carried out by fishermen. We have studied the effects of exposure to the ships movement during calm weather by examining the crude relation between the ship movement and the energy expenditure of the fishermen, thus ignoringthe various tasks undertaken on board.
We have recruited 4 fishermen on 2 contemporary steel trawlers who participatedduring the whole study period. Each of 4 participants recorded his activities and health conditions oncean hour in a registration scheme for 4 days. Estimations of energy expenditure were done with a bodymonitoring system (SenseWear Pro 3) carried as an armband, placed at the surface on the right upper arm. Measurements of sea movements were obtained by a gyroscope placed in the vessels wheelhouse during fishing expeditions in the North Sea off the coast of Bergen. Data were analysed by linear regression.
The exposure monitored in calm weather conditions was small for all measurements of heelingand pitch being less than 10o for both vessels. However, the fishermen's energy expenditure was influenced by these minor sea motions. Trends were seen in the individual graphs with increasing energy expenditureat higher exposures.
Our data suggest that even the heel and pitch in calm weather have an impact on the fishermen by increasing their energy consumption, but without any observation of discomfort or negative health outcomes. This study has demonstrated the feasibility of the applied methods, which should be repeated with larger samples and in rough weather.
[Show abstract][Hide abstract] ABSTRACT: To identify working tasks and stable characteristics that determine intensity and variability of personal exposure to dust and endotoxin among pig farmers.
Three hundred fifty-four personal full-shift measurements were performed in 231 farmers employed in 53 Danish pig farms. Filters were gravimetrically analysed for inhalable dust and for endotoxin by the Limulus amebocyte lysate assay. Information on working tasks and stable characteristics were collected using self-reported activity diaries and walk-through surveys performed in conjunction with the measurements. Associations between log-transformed dust and endotoxin exposure and working tasks and stable characteristics were examined using linear mixed-effects analysis. In these models, worker and farm identity were treated as random effects and working tasks and stable characteristics as fixed effects. Both separate and combined models for tasks and stable characteristics were elaborated.
Inhalable dust concentrations ranged between 0.1 and 48mg m(-3) and endotoxin concentrations varied between 9.2 and 370 000 EU m(-3). Field work activities played a dominant role on the exposure variability. Indoor working tasks with intense animal activity or handling of feed materials increased exposure concentrations, whereas engagement in field work was associated with lower exposure concentrations. High-pressure water cleaning increased endotoxin exposure but did not affect exposure to inhalable dust. Stable characteristics related to feeding practices and type of ventilation were determinants of exposure to inhalable dust. For endotoxin, the most important determinants were use of dry feed and slatted floor coverage. Feeding practices solely explained all between-farms variability in exposure to inhalable dust and endotoxin.
These findings suggest feeding systems, flooring and ventilation to be potential areas where improved methods can reduce exposure to dust and endotoxin among pig farmers. Further, they highlight particular tasks involving feeding and intense animal handling as sources of very high levels of exposure. The pig farming industry is encouraged to focus on exposure reduction. Use of respirators during performance of working tasks where levels of exposure are particularly high ought to be considered until adequate hygienic solutions have been established.
[Show abstract][Hide abstract] ABSTRACT: Some patients with chronic obstructive pulmonary disease (COPD) are never-smokers, which suggests that there must be other important risk factors. This paper describes the evidence for an association between occupational exposure and COPD. In several studies a consistent and predominantly significant association between occupational exposures and COPD is found, even though the studies vary in design, enrolled populations and in measures of exposure and outcome. Strong evidence supports a causal association between multiple categories of occupational exposure and COPD, both within and across industry groups.
[Show abstract][Hide abstract] ABSTRACT: The incidence of malignant mesothelioma (MM) in Denmark has been rising rapidly since the 1950s. The aim of this study was to determine temporal developments of MM incidence and survival in Denmark as a whole and in the individual regions.
Data from the Danish Cancer Registry were used. Cases of MM of the pleura, peritoneum and pericardium occurring in the 1943-2009 period were included. National and regional incidence rates were calculated, age-standardised and stratified by various variables. Survival was calculated using Kaplan Meier plot.
The total national incidence of MM for men has been rising throughout the period and reached its maximum of 1.76 in 2008-2009. For women, the incidence rate has remained relatively steady, with a maximum of 0.5 in 1973-1977. Since the late 1980s, the Region of Northern Jutland has had the highest male incidence rate. The difference in relative risk for men in the Region of Southern Denmark and the Region of Northern Jutland was 1.53 in 2008-2009, and the relative risk of developing MM in the Region of Northern Jutland for the entire period collectively compared with Denmark as a whole was 1.38. No notable regional difference exists for women. Survival has improved for both men and women, but remains poor with a median survival of 12.5 months for men and 13.3 months for women in 2008-2009.
The national MM incidence for men continues to increase, perhaps showing a slight tendency towards deceleration in the most recent decade. A clear long-term effect of the Danish asbestos ban has not yet occurred.
Danish Medical Journal 03/2013; 60(3):A4592. · 1.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study compared health care-related costs and the use of social benefits and transfer payments in participants with and without chronic obstructive pulmonary disease (COPD), and related the costs to the severity of the COPD.
Spirometry data from a cohort study performed in Denmark during 2004-2006 were linked with national register data that identified the costs of social benefits and health-care services. The cohort comprised 546 participants with COPD (forced expiratory volume in the first sec. (FEV1)/forced vital capacity (FVC) ratio < 0.7 following bronchodilator administration) and 3,995 without COPD (in addition, 9,435 invited participants were non-responders and 331 were excluded). The costs were adjusted for gender, age, co-morbidity and educational level.
Health care-related costs were 4,779 (2,404-7,154) Danish kroner (DKK) higher for participants with COPD than for those without COPD, and 2,882 (556-5,208) DKK higher than for non-responders. The higher costs were mainly due to the cost of medicines and inpatient care. The health-care costs increased with disease severity Global Initiative for Chronic Obstructive Lung Disease (GOLD grade). In participants < 65 years of age, the annual cost of social benefits and transfer payments was 15,901 (5,966-25,837) DKK higher and the total costs were 20,454 (7,559-33,350) DKK higher in those with COPD than in those without COPD; this was due mostly to the high cost of dis-ability pensions.
Health care-related costs and costs for social benefits and transfer payments were higher for participants with COPD than for non-COPD participants and non-responders.
This study was supported by The Obel Family Foundation, The Danish Lung Association and The Health Insurance Foundation.
Danish Medical Journal 01/2013; 60(1):A4557. · 1.07 Impact Factor