Denis Infanger

Associations of daily levels of PM10 and NO2 with emergency hospital admissions and mortality in Switzerland : trends and missed prevention potential over the last decade

BACKGROUNDnIn most regions of the world, levels and constituents of the air pollution mixture have substantially changed over the last decades.nnnAIMSnTo evaluate if the effects of PM10 and NO2 on daily emergency hospital admissions and mortality have changed during a ~10 year period in Switzerland; to retrospectively estimate prevention potential of different policy choices.nnnMETHODSnThirteen Poisson-regression models across Switzerland were developed using daily PM10 and NO2 levels from central monitors and accounting for several temporal and seasonal confounders. Time trends of effects were evaluated with an interaction variable. Distributed lag models with 28 days exposure window were used to retrospectively predict missed prevention potential for each region.nnnRESULTSnOverall, emergency hospitalizations and mortality from any medical cause increased by 0.2% (95% Confidence Interval [95% CI]: 0.01, 0.33) and 0.2% (95% CI: -0.1, 0.6) for a 10 µg/m(3) increment of PM10, and 0.7% (95% CI: 0.1, 1.3) for NO2 and mortality. Over the study period, the association between respiratory emergencies and PM10 changed by a factor of 1.017 (95% CI: 1.001, 1.034) and by a factor of 0.977 [95% CI: 0.956, 0.998]) for respiratory mortality among the elderly for NO2. During the study period, abatement strategies targeting a 20% lower overall mean would have prevented four times more cases than abating days exceeding daily standards.nnnCONCLUSIONnDuring the last decade, the short term effects of PM10 and NO2 on hospitalizations and mortality in Switzerland have almost not changed. More ambitious strategies of air pollutant reduction in Switzerland would have had non negligible public health benefits.

Atopic conditions and brain tumor risk in children and adolescents—an international case–control study (CEFALO)

BACKGROUNDnA number of epidemiological studies indicate an inverse association between atopy and brain tumors in adults, particularly gliomas. We investigated the association between atopic disorders and intracranial brain tumors in children and adolescents, using international collaborative CEFALO data.nnnPATIENTS AND METHODSnCEFALO is a population-based case-control study conducted in Denmark, Norway, Sweden, and Switzerland, including all children and adolescents in the age range 7-19 years diagnosed with a primary brain tumor between 2004 and 2008. Two controls per case were randomly selected from population registers matched on age, sex, and geographic region. Information about atopic conditions and potential confounders was collected through personal interviews.nnnRESULTSnIn total, 352 cases (83%) and 646 controls (71%) participated in the study. For all brain tumors combined, there was no association between ever having had an atopic disorder and brain tumor risk [odds ratio 1.03; 95% confidence interval (CI) 0.70-1.34]. The OR was 0.76 (95% CI 0.53-1.11) for a current atopic condition (in the year before diagnosis) and 1.22 (95% CI 0.86-1.74) for an atopic condition in the past. Similar results were observed for glioma.nnnCONCLUSIONSnThere was no association between atopic conditions and risk of all brain tumors combined or of glioma in particular. Stratification on current or past atopic conditions suggested the possibility of reverse causality, but may also the result of random variation because of small numbers in subgroups. In addition, an ongoing tumor treatment may affect the manifestation of atopic conditions, which could possibly affect recall when reporting about a history of atopic diseases. Only a few studies on atopic conditions and pediatric brain tumors are currently available, and the evidence is conflicting.BACKGROUNDnA number of epidemiological studies indicate an inverse association between atopy and brain tumors in adults, particularly gliomas. We investigated the association between atopic disorders and intracranial brain tumors in children and adolescents, using international collaborative CEFALO data.nnnPATIENTS AND METHODSnCEFALO is a population-based case-control study conducted in Denmark, Norway, Sweden, and Switzerland, including all children and adolescents in the age range 7-19 years diagnosed with a primary brain tumor between 2004 and 2008. Two controls per case were randomly selected from population registers matched on age, sex, and geographic region. Information about atopic conditions and potential confounders was collected through personal interviews.nnnRESULTSnIn total, 352 cases (83%) and 646 controls (71%) participated in the study. For all brain tumors combined, there was no association between ever having had an atopic disorder and brain tumor risk [odds ratio 1.03; 95% confidence interval (CI) 0.70-1.34]. The OR was 0.76 (95% CI 0.53-1.11) for a current atopic condition (in the year before diagnosis) and 1.22 (95% CI 0.86-1.74) for an atopic condition in the past. Similar results were observed for glioma.nnnCONCLUSIONSnThere was no association between atopic conditions and risk of all brain tumors combined or of glioma in particular. Stratification on current or past atopic conditions suggested the possibility of reverse causality, but may also the result of random variation because of small numbers in subgroups. In addition, an ongoing tumor treatment may affect the manifestation of atopic conditions, which could possibly affect recall when reporting about a history of atopic diseases. Only a few studies on atopic conditions and pediatric brain tumors are currently available, and the evidence is conflicting.

A multinational case-control study on childhood brain tumours, anthropogenic factors, birth characteristics and prenatal exposures: A validation of interview data

Little is known about the aetiology of childhood brain tumours. We investigated anthropometric factors (birth weight, length, maternal age), birth characteristics (e.g. vacuum extraction, preterm delivery, birth order) and exposures during pregnancy (e.g. maternal: smoking, working, dietary supplement intake) in relation to risk of brain tumour diagnosis among 7-19 year olds. The multinational case-control study in Denmark, Sweden, Norway and Switzerland (CEFALO) included interviews with 352 (participation rate=83.2%) eligible cases and 646 (71.1%) population-based controls. Interview data were complemented with data from birth registries and validated by assessing agreement (Cohens Kappa). We used conditional logistic regression models matched on age, sex and geographical region (adjusted for maternal age and parental education) to explore associations between birth factors and childhood brain tumour risk. Agreement between interview and birth registry data ranged from moderate (Kappa=0.54; worked during pregnancy) to almost perfect (Kappa=0.98; birth weight). Neither anthropogenic factors nor birth characteristics were associated with childhood brain tumour risk. Maternal vitamin intake during pregnancy was indicative of a protective effect (OR 0.75, 95%-CI: 0.56-1.01). No association was seen for maternal smoking during pregnancy or working during pregnancy. We found little evidence that the considered birth factors were related to brain tumour risk among children and adolescents.

Does obesity attenuate the beneficial cardiovascular effects of cardiorespiratory fitness

BACKGROUND AND AIMSnHigher cardiorespiratory fitness is associated with lower pulse wave velocity and arterial stiffness in normal weight individuals, and this has not been examined in obese individuals. It is unclear whether an altered body composition acts as a modifier of the association between cardiorespiratory fitness and arterial stiffness. We examined the association between peak oxygen uptake and brachial-ankle pulse wave velocity and analysed whether body composition attenuates this association in obese middle-aged individuals.nnnMETHODSnBio-impedance analysis-derived body composition assessment in 212 healthy and sedentary either overweight or obese individuals was followed by measurement of brachial-ankle pulse wave velocity and spiroergometric peak oxygen uptake. Multivariate analysis was performed to analyse the association between peak oxygen uptake and brachial-ankle pulse wave velocity and to assess the moderating effect of several body composition-related interaction terms (BMI, total body mass, body fat mass, waist circumference, waist-to-height ratio) on this association.nnnRESULTSnPeak oxygen uptake was inversely associated with brachial-ankle pulse wave velocity (βu202f=u202f-0.059, 95% CIu202f=u202f-0.099;xa0-0.018, pu202f=u202f0.005). Testing for the impact of different body composition-related interaction terms on this association showed no significance, 95% CI lateralized towards positivity.nnnCONCLUSIONSnThis study shows an inverse association between cardiorespiratory fitness and arterial stiffness in middle-aged obese individuals. We also found a tendency towards an attenuating impact of an obese body composition on this association. Physical fitness seems to be a stronger modulator of cardiovascular risk than body composition but the success of training efforts may be compromised by obesity.

Validity of activity trackers, smartphones, and phone applications to measure steps in various walking conditions.

To examine the validity of popular smartphone accelerometer applications and a consumer activity wristband compared to a widely used research accelerometer while assessing the impact of the phones position on the accuracy of step detection. Twenty volunteers from 2 different age groups (Group A: 18‐25 years, n = 10; Group B 45‐70 years, n = 10) were equipped with 3 iPhone SE smartphones (placed in pants pocket, shoulder bag, and backpack), 1 Samsung Galaxy S6 Edge (pants pocket), 1 Garmin Vivofit 2 wristband, and 2 ActiGraph wGTX+ devices (worn at wrist and hip) while walking on a treadmill (1.6, 3.2, 4.8, and 6.0 km/h) and completing a walking course. All smartphones included 6 accelerometer applications. Video observation was used as gold standard. Validity was evaluated by comparing each device with the gold standard using mean absolute percentage errors (MAPE). The MAPE of the iPhone SE (all positions) and the Garmin Vivofit was small (<3) for treadmill walking ≥3.2 km/h and for free walking. The Samsung Galaxy and hip‐worn ActiGraph showed small MAPE only for treadmill walking at 4.8 and 6.0 km/h and for free walking. The wrist‐worn ActiGraph showed high MAPE (17‐47) for all walking conditions. The iPhone SE and the Garmin Vivofit 2 are accurate tools for step counting in different age groups and during various walking conditions, even during slow walking. The phones position does not impact the accuracy of step detection, which substantially improves the versatility for physical activity assessment in clinical and research settings.

Obesity, Blood Pressure, and Retinal Vessels: A Meta-analysis

Retinal microvascular alterations can be diagnosed early in life, and timely risk stratification in children may help to counteract development of CVD in adulthood. CONTEXT: Retinal vessel imaging is a noninvasive diagnostic tool used to evaluate cardiovascular risk. Childhood obesity and elevated blood pressure (BP) are associated with retinal microvascular alterations. OBJECTIVE: To systematically review and meta-analyze associations between obesity, BP, and physical activity with retinal vessel diameters in children. DATA SOURCES: We conducted a literature search through the databases of PubMed, Embase, Ovid, Web of Science, and the Cochrane Register of Controlled Trials. STUDY SELECTION: School- and population-based cross-sectional data. DATA EXTRACTION: General information, study design, participants, exposure, and outcomes. RESULTS: A total of 1751 studies were found, and 30 full-text articles were analyzed for eligibility. Twenty-two articles (18u2009865 children and adolescents) were used for further assessment and reflection. Eleven articles were finally included in the meta-analysis. We found that a higher BMI is associated with narrower retinal arteriolar (pooled estimate effect size −0.37 [95% confidence interval (CI): −0.50 to −0.24]) and wider venular diameters (0.35 [95% CI: 0.07 to 0.63]). Systolic and diastolic BP are associated with retinal arteriolar narrowing (systolic BP: −0.63 [95% CI: −0.92 to −0.34]; diastolic BP: −0.60 [95% CI −0.95 to −0.25]). Increased physical activity and fitness are associated with favorable retinal vessel diameters. LIMITATIONS: Long-term studies are needed to substantiate the prognostic relevance of retinal vessel diameters for cardiovascular risk in children. CONCLUSIONS: Our results indicate that childhood obesity, BP, and physical inactivity are associated with retinal microvascular abnormalities. Retinal vessel diameters seem to be sensitive microvascular biomarkers for cardiovascular risk stratification in children.

The Obesity Factor: How Cardiorespiratory Fitness is Estimated More Accurately in People with Obesity: The Obesity Factor: VO2peak and Body Composition

Cardiopulmonary exercise testing is clinically used to estimate cardiorespiratory fitness (CRF). The relation to total body mass (TBM) leads to an underestimation of CRF in people with obesity and to inappropriate prognostic and therapeutic decisions. This study aimed to determine body composition‐derived bias in the estimation of CRF in people with obesity.

Association of cardiorespiratory fitness with retinal vessel diameters as a biomarker of cardiovascular risk

OBJECTIVEnWe aimed to investigate the association of retinal microvascular health with cardiorespiratory fitness (VO2peak) and cardiovascular risk factors.nnnMETHODSnIn a population of 260 obesity-enriched participants we investigated the association of retinal vessel diameters with cardiorespiratory fitness (CRF), body mass index (BMI) and blood pressure (BP). Retinal vessel imaging was performed by use of a fundus camera and a semi-automated processing software, calculating the central retinal arteriolar (CRAE) and venular equivalent (CRVE) as well as the arteriolar-to-venular diameter ratio (AVR).nnnRESULTSnParticipants had a mean age of 45.8u202f±u202f12.5u202fyears and a BMI of 35.8u202f±u202f6.8u202fkg/m2. 45% of patients were diagnosed with hypertension, 26% with diabetes and 30% with dyslipidemia. Increasing VO2peak was independently associated with lower CRVE (βu202f=u202f-0.600; CI -1.141, -0.060; pu202f=u202f0.030). Higher BMI and mean arterial pressure were independently associated with narrower CRAE (βu202f=u202f-0.492; CI -0.909, -0.076; pu202f=u202f0.021 and βu202f=u202f-0.268; CI -0.471, -0.066; pu202f=u202f0.009, respectively) and lower AVR (βu202f=u202f-0.002; CI -0.003, -0.000; pu202f=u202f0.026 and βu202f=u202f-0.001; CI -0.002, -0.000; pu202f=u202f0.001, respectively).nnnCONCLUSIONSnHigher cardiorespiratory fitness is associated with beneficial retinal microvascular health. Higher BMI and BP were associated with an impairment of retinal microvascular health. Exercise is known for its potential to improve body composition and reduce BP but may also prove to be an efficient therapy to counteract small vessel disease in cardiometabolic disease.

Retinal Vessel Diameters and Physical Activity in Patients With Mild to Moderate Rheumatic Disease Without Cardiovascular Comorbidities

Objectives: Low-grade systemic inflammation is responsible for atherosclerotic lesions in patients with rheumatic diseases. Vascular dysfunction is a precursor of atherosclerosis and can be improved by physical activity (PA). Our aim was to asses micro- and macrovascular function as well as PA and cardiorespiratory fitness (CRF) in patients with rheumatic diseases in the absence of cardiovascular (CV) comorbidities compared to controls. Methods: Fifty-one patients without CV comorbidities were compared to 35 controls. Retinal microvascular diameters were assessed using a Retinal Vessel Analyzer. Arterial stiffness (AST) was measured by applanation tonometry. CRF was assessed as peak oxygen consumption and PA was assessed with a questionnaire. Results: Retinal venular diameters were significantly wider in patients [median 221 μm (interquartile range (IQR) 211, 231)] compared to controls [median 215 μm (IQR 196, 223); p = 0.01]. One hour increase of PA per week led to a venular constriction of −0.56 μm (95%CI −1.09, −0.03; p = 0.04). In our patients with low disease activity (median DAS28 1.9; median BASDAI 2.8), no differences in AST were evident compared to controls. The association of PA and CRF with AST was not independent of blood pressure. Conclusions: Patients with rheumatic disease and mild-to-moderate disease activity show an impairment of the retinal microvasculature but not of large artery stiffness. Retinal vessel analysis seems to be a sensitive biomarker to unmask vascular impairments even in the absence of classic CV risk factors. PA may have the potential to counteract the development of small artery disease at early stages of rheumatic disease.

Oxygen uptake during mini trampoline exercise in normal-weight, endurance-trained adults and in overweight-obese, inactive adults: A proof-of-concept study

Abstract Objectives: To examine cardiorespiratory exertion during mini trampoline exercises of different intensities in both endurance-trained athletes and overweight-obese adults. Methods: Physically healthy participants (Group A: normal-weight, endurance-trained athletes; Group B: inactive, overweight-obese adults) participated in two measurement appointments and three training sessions in between appointments, in which participants familiarized themselves with the use of the mini trampoline and the execution of the exercises. The primary outcome was the ⩒O2peak for each of the six mini trampoline exercises relative to the ⩒O2peak as established during an all-out exercise test on a bike ergometer during the first measurement appointment. Secondary outcomes were average ⩒O2 as well as maximum and average heart rate. Results: The six mini trampoline exercises generated ⩒O2peak values between 42% and 81% in the endurance-trained athletes and between 58% and 87% in the overweight-obese participants, both in relation to the bike ergometer ⩒O2peak. Average ⩒O2 values ranged from 35% to 69% (endurance-trained athletes) and from 48% to 71% (overweight-obese participants), depending on exercise. Average heart rate likewise lay in a range that can be categorized as moderate-to-vigorous aerobic exercise for both groups. A moderate-to-strong correlation (0.658 to 0.875, depending on exercise) between bike ergometer ⩒O2peak and mini trampoline ⩒O2peak was found for all six exercises. Conclusions: Mini trampoline exercise has the potential to produce training intensities that concur with established exercise guidelines. The exercise intensity is self-adjusting and allows for an effective and safe workout for different users with a wide range of fitness levels.