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Ambient ozone and emergency department visits due to lower respiratory condition

100%
Kousha T., Rowe B.
International Journal of Occupational Medicine and Environmental Health
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2014
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vol. 27
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issue 1
50-59
EN
Objectives: Ambient ozone (O₃) exposure is associated with a variety of health conditions. The objective of this study was to examine the effect of increased daily concentrations of ozone on emergency department (ED) visits due to lower respiratory diseases (LRD), such as acute or chronic bronchitis, in Edmonton, Canada. Materials and Methods: Data concerning 10 years (1992-2002) were obtained from 5 Edmonton hospital Emergency Departments. Odds ratios (ORs) for ED visits associated with the increased ozone levels were calculated employing a case-crossover technique with a time-stratified strategy to define controls. In the constructed conditional logistic regression models, adjustments were made for daily number of influenza ED visits and weather variables using natural splines. ORs and their 95% confidence intervals (95% CI) were reported in relation to an increase in the interquartile range (IQR = 17.9 ppb) of the ground-level ozone. Results: Overall, 48 252 ED visits due to LRD were identified, of which 53% were made by males. The presentations peaked in December (12%) and February (11.7%) and were the lowest in August (5.6%). Positive and statistically significant results were obtained for acute bronchitis: for same day (OR = 1.09, 95% CI: 1.05-1.13, lag 0) and for lag 2, lag 3-7 and 9 days; for chronic bronchitis: for lag 6, 7, and lag 9 days (OR = 1.11, 95% CI: 1.05-1.18, lag 9). For all ED visits for LRD, lag 0, lag 1, and lag 3-9 days showed positive and statistically significant associations (OR = 1.06, 95% CI: 1.03-1.09, lag 0). Conclusions: These findings support the hypothesis concerning positive associations between ozone and the ED visits due to LRD.
2
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An approach to represent a combined exposure to air pollution

75%
Szyszkowicz M.
International Journal of Occupational Medicine and Environmental Health
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2015
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vol. 28
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issue 5
823-830
EN
Objectives The objective of this study was to present a technique for estimating the effect of ambient air pollution mix on health outcomes. Material and Methods We created a technique of indexing air pollution mix as a cause of the increased odds of health problems. As an illustrative example, we analyzed the impact of pollution on the frequency of emergency department (ED) visits due to colitis among young patients (age < 15 years, N = 11 110). Our technique involves 2 steps. First, we considered 6 ambient air pollutants (carbon monoxide, nitrogen dioxide, sulphur dioxide, ozone, and 2 measures of particulate matter) treating each pollutant as a single exposure. Odds ratios (ORs) for ED visits associated with a standard increase (interquartile range – IQR) in the pollutants levels were calculated using the case-crossover technique. The ORs and their 95% confidence intervals (95% CIs) were also found for lagged exposures (for lags 1–9 days). Second, we defined a Health Air Study Index (HASI) to represent the combined impact of the 6 air pollutants. Results We obtained positive and statistically significant results for individual air pollutants and among them the following estimations: OR = 1.06 (95% CI: 1.02–1.1, NO₂ lag 3, IQR = 12.8 ppb), OR = 1.04 (95% CI: 1.01–1.07, SO₂ lag 4, IQR = 2.3 ppb), OR = 1.04 (95% CI: 1–1.06, PM lag 3, IQR = 6.2 μg/m³). Among the re-calculated ORs with the HASI values as an exposure, the highest estimated value was OR = 1.37 (95% CI: 1.12–1.68, for 1 unit of the HASI, lag 3). Conclusions The proposed index (HASI) allows to confirm the pattern of associations for lags obtained for individual air pollutants. In the presented example the used index (HASI) indicates the strongest relation with the exposure lagged by 3 days.
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The use of chained two-point clusters for the examination of associations of air pollution with health conditions

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Szyszkowicz M., Burr W. S.
International Journal of Occupational Medicine and Environmental Health
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2016
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vol. 29
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issue 4
613-622
EN
Objectives There are a few accepted and intensively applied statistical methods used to study associations of ambient air pollution with health conditions. Among the most popular methods applied to assess short term air health effects are case-crossover (using events) and time-series methodologies (using counts). A few other techniques for studying counts of events have been proposed, including the Generalized Linear Mixed Models (GLMM). One suggested GLMM technique uses cluster structures based on natural embedded hierarchies: days are nested in the days of a week (dow), which, in turn, are nested in months and months in years (< dow, month, years >). Material and Methods In this study the authors considered clusters with hierarchical structures in a form of < dow, 14-days, year >, where the 14-days hierarchy determines 7 clusters composed of 2 days (the same days) of a week (2 Mondays, 2 Tuesdays, etc.), in 1 year. In this work the authors proposed hierarchical chained clusters in which 2 days of a week are grouped as follows: (first, second), (second, third), (third, fourth) and so on. Such an approach allows determination of an additional series of the slopes on the clusters (second, third), (fourth, fifth), etc., i.e., estimation of the coefficients for other configurations of air pollutant levels. The authors considered a series of 2 point chained clusters covering a year. In such a construction each cluster has one common data point (day) with another one. Results The authors estimated coefficients (slopes) related to the ambient ozone exposure (mortality) and to 3 selected air pollutants (particulate matter, nitrogen dioxide and ozone) combined into index and considered as health risk exposure (emergency department (ED) visits). The generated results were compared to the estimations obtained from the time-series method and the time-stratified case-crossover method applied to the same data. Conclusions The proposed statistical method, based on the chained hierarchical clusters (< dow, 14-days, year >), generated results with shorter confidence intervals than the other methods.
4
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Air pollution and emergency department visits for conjunctivitis: A case-crossover study

75%
Szyszkowicz M., Kousha T., Castner J.
International Journal of Occupational Medicine and Environmental Health
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2016
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vol. 29
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issue 3
381-393
EN
Objectives The purpose of this study was to examine the associations between emergency department (ED) visits for conjunctivitis and ambient air pollution levels in urban regions across the province of Ontario, Canada. Material and Methods Information from the National Ambulatory Care Reporting System was used to create time-series records, for the period of April 2004 to December 2011, on emergency department visits of patients suffering from conjunctivitis. A total of 77 439 emergency department visits for conjunctivitis were analyzed. A time-stratified case-crossover design was applied, completed with meta-analysis in order to pool inter-city results. Odds ratio (OR) for an emergency department visit was calculated in different population strata per one-unit increase (one interquartile range – IQR increase in a pollutant’s daily level) while controlling for the impacts of temperature and relative humidity. Results Statistically significant positive results were observed in the female population sample, for nitrogen dioxide (NO₂) exposure lagged 5–8 days, with the highest result for the 7-day lag (OR = 1.035, 95% CI: 1.018–1.052) and for fine particulate matter with a median aerodynamic diameter of less than 2.5 μm ($\text{PM}_\text{2.5}$), for lags 6 and 7 days, with the highest result for lag 7 (OR = 1.017, 95% CI: 1.003–1.031). In the male population sample, statistically significant positive results were observed for NO₂ at lag 5 days (OR = 1.024, 95% CI: 1.004–1.045) and for ozone (O₃), at lags 0–3 and 7 days, with the highest result for lag 0 (OR = 1.038, 95% CI: 1.012–1.056). Also for males, statistically significant results were observed in the case of $\text{PM}_\text{2.5}$ exposure lagged by 5 days (OR = 1.003, 95% CI: 1.000–1.038) and sulfur dioxide (SO₂) exposure lagged by 1 and 2 days (OR = 1.016, 95% CI: 1.000–1.031 and OR = 1.018, 95% CI: 1.002–1.033). Conclusions The findings of this study suggest that there are associations between levels of air pollution and ED visits for conjunctivitis, with different temporal trends and strength of association by age, sex, and season.
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A case-crossover study of sleep, fatigue, and other transient exposures at workplace and the risk of non-fatal occupational injuries among the employees of an Italian academic hospital

75%
Valent F., Mariuz M., Liva G., Bellomo F., De Corti D., Degan S., Ferrazzano A., Brusaferro S.
International Journal of Occupational Medicine and Environmental Health
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2016
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vol. 29
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issue 6
1001-1009
EN
Objectives Transient exposure with acute effect has been shown to affect the risk of occupational injuries in various industrial settings and at the healthcare workplace. The objective of this study has been to identify transient exposures related to occupational injury risk in an Italian teaching hospital. Material and Methods A case-crossover study was conducted among the employees of the University Hospital of Udine who reported an occupational injury, commuting accident, or incident involving biological risk in a 15-month period in the years 2013 and 2014. The matched-pair interval approach was used to assess the role of acute sleep deprivation whereas the usual frequency approach was used for other 13 transient exposures. Results Sleep hours were not associated with the risk of injuries whereas a significant risk increase was associated with fatigue, rush, distraction, emergency situations, teaching to or being taught by someone, non-compliant patients, bloody operative/work field, excess noise, complex procedures, and anger. Conclusions We identified transient exposures that increased the risk of occupational injuries in an Italian teaching hospital, providing indications for interventions to increase workers’ safety at the healthcare workplace. Int J Occup Med Environ Health 2016;29(6):1001–1009
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