Ambient nitrogen dioxide is associated with emergency hospital visits for atrial fibrillation: a population-based case-crossover study in Reykjavik, Iceland.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: In Iceland air quality is generally good; however, previous studies indicate that there is an association between air pollution in Reykjavik and adverse health effects as measured by dispensing of medications, mortality, and increase in health care utilisation. The aim was to study the association between traffic-related ambient air pollution in the Reykjavik capital area and emergency hospital visits for heart diseases and particularly atrial fibrillation and flutter (AF). Methods: A multivariate time-stratified case-crossover design was used to study the association. Cases were those patients aged 18 years or older living in the Reykjavik capital area during the study period, 2006-2017, who made emergency visits to Landspitali University Hospital for heart diseases. In this population-based study, the primary discharge diagnoses were registered according to International Classification of Diseases, 10th edition (ICD-10). The pollutants studied were NO2, PM10, PM2.5, and SO2, with adjustment for H2S, temperature, and relative humidity. The 24-h mean of pollutants was used with lag 0 to lag 4. Results: During the study period 9536 cases of AF were identified. The 24-h mean NO2 was 20.7 μg/m3. Each 10 μg/m3 increase in NO2 was associated with increased risk of heart diseases (ICD-10: I20-I25, I44-I50), odds ratio (OR) 1.023 (95% CI 1.012-1.034) at lag 0. Each 10 μg/m3 increase in NO2 was associated with an increased risk of AF (ICD-10: I48) on the same day, OR 1.030 (95% CI: 1.011-1.049). Females were at higher risk for AF, OR 1.051 (95% CI 1.019-1.083) at lag 0, and OR 1.050 (95% CI 1.019-1.083) at lag 1. Females aged younger than 71 years had even higher risk for AF, OR 1.077 (95% CI: 1.025-1.131) at lag 0. Significant associations were found for other pollutants and emergency hospital visits, but they were weaker and did not show a discernable pattern. Conclusions: Short-term increase in NO2 concentrations was associated with heart diseases, more precisely with AF. The associations were stronger among females, and among females at younger age. This is the first study in Iceland that finds an association between air pollution and cardiac arrhythmias, so the results should be interpreted with caution. Keywords: Atrial fibrillation; Cardiac arrhythmia; Case-crossover; Hospital registry; Ischemic heart diseases; Nitrogen dioxide; Population-based

Ambient air pollution and emergency department visits and hospitalisation for cardiac arrest : a population-based case-crossover study in Reykjavik, Iceland

Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Publisher Copyright: © 2023 Authors. All rights reserved.OBJECTIVES: To assess the association between traffic-related ambient air pollution and emergency hospital visits for cardiac arrest. DESIGN: Case-crossover design was used with a lag time to 4 days. SETTING: The Reykjavik capital area and the study population was the inhabitants 18 years and older identified by encrypted personal identification numbers and zip codes. PARTICIPANTS AND EXPOSURE: Cases were those with emergency visits to Landspitali University Hospital during the period 2006-2017 and who were given the primary discharge diagnosis of cardiac arrest according to the International Classification of Diseases 10th edition (ICD-10) code I46. The pollutants were nitrogen dioxide (NO2), particulate matter with aerodynamic diameter less than 10 µm (PM10), particulate matter with aerodynamic diameter less than 2.5 µm (PM2.5) and sulfur dioxide (SO2) with adjustment for hydrogen sulfide (H2S), temperature and relative humidity. MAIN OUTCOME MEASURE: OR and 95% CIs per 10 µg/m3 increase in concentration of pollutants. RESULTS: The 24-hour mean NO2 was 20.7 µg/m3, mean PM10 was 20.5 µg/m3, mean PM2.5 was 12.5 µg/m3 and mean SO2 was 2.5 µg/m3. PM10 level was positively associated with the number of emergency hospital visits (n=453) for cardiac arrest. Each 10 µg/m3 increase in PM10 was associated with increased risk of cardiac arrest (ICD-10: I46), OR 1.096 (95% CI 1.033 to 1.162) on lag 2, OR 1.118 (95% CI 1.031 to 1.212) on lag 0-2, OR 1.150 (95% CI 1.050 to 1.261) on lag 0-3 and OR 1.168 (95% CI 1.054 to 1.295) on lag 0-4. Significant associations were shown between exposure to PM10 on lag 2 and lag 0-2 and increased risk of cardiac arrest in the age, gender and season strata. CONCLUSIONS: A new endpoint was used for the first time in this study: cardiac arrest (ICD-10 code: I46) according to hospital discharge registry. Short-term increase in PM10 concentrations was associated with cardiac arrest. Future ecological studies of this type and their related discussions should perhaps concentrate more on precisely defined endpoints.Peer reviewe

Primacy of existential pain and suffering in residents in chronic pain in nursing homes: a phenomenological study

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldThe study's rationale: Chronic pain is a major health problem among the elderly, both in the community and within nursing homes. Aims and objectives: The purpose of the study was to examine the essentials of the experience of residents in chronic pain in nursing homes. Methodological design and methods: The research approach was interpretive phenomenology. Data were collected in 23 dialogues with 12 residents, ages 74-97. Mean age was 86 years. Results: The main finding is the primacy of existential pain and suffering in residents in chronic pain in nursing homes. Indeed they recounted a culmination of existential pain and suffering, e.g. loss of loved ones, loss of former home, health and independence, as well as loss of connectedness. Many seemed to be in some kind of grief and their work towards reconciliation to their life and circumstances seemed an ongoing process with successful results while others seemed more haltering or even stuck. Living with chronic pain in a nursing home is indeed a challenge and many blocks to successful pain management were identified. The main sources of strength were loved ones who were seen as lifelines. Nurses seemed distant in their narratives of pain management. Study limitations: Frailty of residents is a limitation as a few were starting to forget from one interview to the other and some were actually in pain at the time of our dialogue. Conclusions: It is important to support a healthy process of grieving and reconciliation in elderly people who live with chronic pain in nursing homes. Those who suffer in silence with their pain and discomforts and do not seek help should be identified and cared for. The residents' own sources of strength should be identified and supported. Multi-professional collaboration with educational thrust is needed towards quality pain management of elderly people in nursing homes where existential pain and suffering is not excluded

Patients and families realising their future with chronic obstructive pulmonary disease-A qualitative study

To access publisher's full text version of this article click on the hyperlink belowAIMS AND OBJECTIVES: To gain insight into the lived experience of learning about having chronic obstructive pulmonary disease for patients and their families. BACKGROUND: Chronic obstructive pulmonary disease often progresses for years. Adjustment to declining health is gradual, and the disease may have developed considerably when health care is sought and people are diagnosed. Reaching patients at early stages is necessary to delay progression of the disease. DESIGN: Interpretive phenomenology. METHODS: Data were collected in four family focus group interviews (N = 37) and a subsample of eight family-dyad interviews. Patients were eight men, and 14 women aged 51-68 years. Majority of the patients (n = 19) were at GOLD grades II and III, with three at grade IV. The family members were eight men, and seven women aged 29-73 years. Data were collected between June-November 2012. RESULTS: Five, not mutually exclusive themes, revealed a long and arduous process of learning about and becoming diagnosed with chronic obstructive pulmonary disease and how unaware participants were of the imminent threat that the disease imposes on life. The themes were as follows: burden of shame and self-blame, enclosed in addiction, living in parallel worlds, realising the existence of the disease and a cry for empathy. CONCLUSIONS: Learning about and realising the existence of chronic obstructive pulmonary disease and what it entails at present time and in the future was bleak for the participants. The patients tended to put aside the thought of being a person with chronic obstructive pulmonary disease and defer actions that might halter progression of the disease, particularly to quit smoking. RELEVANCE TO CLINICAL PRACTICE: Individuals and families need support early in the disease process to realise and accept the existence of chronic obstructive pulmonary disease and particularly to deal with the challenges that nicotine addiction, shame and self-blame present. Increased public awareness about this enormous, but hidden, health problem is necessary.Icelandic Research Fund University of Iceland, Landspitali National University Hospital of Iceland Icelandic Nurses' Associatio

Ambient nitrogen dioxide is associated with emergency hospital visits for atrial fibrillation: a population-based case-crossover study in Reykjavik, Iceland

Abstract Background In Iceland air quality is generally good; however, previous studies indicate that there is an association between air pollution in Reykjavik and adverse health effects as measured by dispensing of medications, mortality, and increase in health care utilisation. The aim was to study the association between traffic-related ambient air pollution in the Reykjavik capital area and emergency hospital visits for heart diseases and particularly atrial fibrillation and flutter (AF). Methods A multivariate time-stratified case-crossover design was used to study the association. Cases were those patients aged 18 years or older living in the Reykjavik capital area during the study period, 2006–2017, who made emergency visits to Landspitali University Hospital for heart diseases. In this population-based study, the primary discharge diagnoses were registered according to International Classification of Diseases, 10th edition (ICD-10). The pollutants studied were NO2, PM10, PM2.5, and SO2, with adjustment for H2S, temperature, and relative humidity. The 24-h mean of pollutants was used with lag 0 to lag 4. Results During the study period 9536 cases of AF were identified. The 24-h mean NO2 was 20.7 μg/m3. Each 10 μg/m3 increase in NO2 was associated with increased risk of heart diseases (ICD-10: I20-I25, I44-I50), odds ratio (OR) 1.023 (95% CI 1.012–1.034) at lag 0. Each 10 μg/m3 increase in NO2 was associated with an increased risk of AF (ICD-10: I48) on the same day, OR 1.030 (95% CI: 1.011–1.049). Females were at higher risk for AF, OR 1.051 (95% CI 1.019–1.083) at lag 0, and OR 1.050 (95% CI 1.019–1.083) at lag 1. Females aged younger than 71 years had even higher risk for AF, OR 1.077 (95% CI: 1.025–1.131) at lag 0. Significant associations were found for other pollutants and emergency hospital visits, but they were weaker and did not show a discernable pattern. Conclusions Short-term increase in NO2 concentrations was associated with heart diseases, more precisely with AF. The associations were stronger among females, and among females at younger age. This is the first study in Iceland that finds an association between air pollution and cardiac arrhythmias, so the results should be interpreted with caution. </jats:sec

Ambient air pollution and emergency department visits and hospitalisation for cardiac arrest: a population-based case-crossover study

Abstract Background The association between ambient air pollution and cardiac arrhythmia has been explored in numerous studies; however, the small subgroup of cardiac arrest has not been closely studied thus far. The aim of the present study was to assess the association between traffic-related ambient air pollution and emergency hospital visits for cardiac arrest. Methods A bidirectional time-stratified case-crossover design was used. The setting was the Reykjavik capital area and the study population were the inhabitants 18 years and older identified by zip codes. Cases were those who had made emergency visits to Landspitali University Hospital during the period 2006 to 2017 and who were given the primary discharge diagnosis of cardiac arrest according to The International Classification of Diseases 10th edition (ICD-10), code I46. The pollutants were NO2, PM10, PM2.5, and SO2 with adjustment for H2S, temperature and relative humidity. Results The 24-h mean NO2 was 20.7 µg/m3, mean PM10 was 20.5 µg/m3, mean PM2.5 was 12.5 µg/m3, and mean SO2 was 2.5 µg/m3. PM10 level was positively associated with the number of emergency hospital visits (n = 453) for cardiac arrest. Each 10 µg/m3 increase in PM10 was associated with increased risk of cardiac arrest (ICD-10: I46), odds ratio (OR) 1.093 (95%CI 1.033–1.162) on lag 2, and OR 1.118 (95%CI 1.031–1.212) on lag 0–2. Significant associations were shown between exposure to PM10 on lag 2 and on lag 0–2 and increased risk of cardiac arrest in the age, gender, and season strata. Females and those 71 years and older were at higher risk for cardiac arrest, OR 1.193 (95%CI 1.059–1.344), and OR 1.186 (95%CI 1.066–1.320) on lag 2, per 10 µg/m3 increase in PM10, respectively. Significant associations were sporadically found for NO2 and SO2 and emergency hospital visits for cardiac arrest, but these associations were weaker and did not show a discernable pattern. Conclusions A new endpoint was used for the first time in this study: cardiac arrest (ICD-10 code I46). Short-term increase in PM10 concentrations was associated with cardiac arrest. The effect seemed higher among the elderly and females. Future ecological studies of this type and their related discussions should perhaps concentrate more on precisely defined endpoints.</jats:p

Rhesus D alloimmunization in pregnancy from 1996 to 2015 in Iceland: a nation-wide population study prior to routine antenatal anti-D prophylaxis.

To access publisher's full text version of this article click on the hyperlink belowBackground: Rhesus D (RhD) incompatibility is still the most important cause of hemolytic disease of the fetus and newborn (HDFN) worldwide. The aim of this study was to investigate the incidence, causes, and consequences of anti-D alloimmunizations in pregnancy in Iceland, prior to implementation of targeted routine antenatal anti-D prophylaxis (RAADP) in 2018. Study design and methods: This was a nation-wide cohort study of 130 pregnancies affected by RhD alloimmunization in Iceland in the period from 1996 through 2015. Data were collected from transfusion medicine databases, medical records, and the Icelandic Medical Birth Register. Results: Of 130 RhD alloimmunizations, 80 cases (61.5%) represented new RhD immunization in the current pregnancy. Sensitization was discovered in the third trimester in 41 (51.3%) and occurred in the first pregnancy in 14 cases (17.5%). The most likely causative immunization event was the index pregnancy for 45 (56.25%), a previous pregnancy/birth for 26 (32.5%), abortion for 3 (3.75%), and unknown for 6 women (7.5%). Higher anti-D titers were associated with shorter gestational length, cesarean sections, positive direct antiglobulin test (DAT), and severe HDFN. Intrauterine transfusion (IUT) was performed in five pregnancies (3.8%), and 35 of 132 (26.5%) live-born neonates received treatment for HDFN; 32 received phototherapy (24.2%), 13 exchange transfusion (9.8%), and seven simple blood transfusion (5.3%). Conclusion: In about half of cases, RhD alloimmunization was caused by the index pregnancy and discovered in the third trimester. Thus, the newly implemented RAADP protocol should be effective in reducing the incidence of RhD immunization in Iceland in the future

Additional file 1 of Ambient nitrogen dioxide is associated with emergency hospital visits for atrial fibrillation: a population-based case-crossover study in Reykjavik, Iceland

Additional file 1: Table A. Odds ratios (OR) and 95% confidence intervals (CI) for the daily emergency hospital visits for ischemic heart diseases (ICD-10 codes: I20-I25) in Reykjavik capital area associated with 10 μg/m3 increase in NO2, PM10, PM2.5, SO2 and H2S, adjusted for each pollutant, temperature and relative humidity, at lag 0 to lag 4. Table B. Odds ratios (OR) and 95% confidence intervals (CI) for the daily emergency hospital visits for cardiac arrhythmias or heart failure (ICD-10 codes: I44-I50) in Reykjavik capital area associated with 10 μg/m3 increase in NO2, PM10, PM2.5, SO2 and H2S, adjusted for each pollutant, temperature and relative humidity, at lag 0 to lag 4. Table C. Odds ratios (OR) and 95% confidence intervals (CI) for the daily emergency hospital visits for heart diseases (ICD-10 codes: I20-I25, I44-I50; I20-I25; I44-I50; and I48) in Reykjavik capital area associated with 10 μg/m3 increase in NO2, PM10, PM2.5, SO2 and H2S, adjusted for each pollutant, temperature and relative humidity, at lag 0–1 (moving average of lags 0, and 1) and at lag 0–2 (moving average of lags 0, 1, and 2). Table D. Odds ratios (OR) and 95% confidence intervals (CI) for the daily emergency hospital visits for heart diseases (ICD-10 codes: I20-I25, I44-I50; I20-I25; I44-I50; and I48) in Reykjavik capital area associated with 10 μg/m3 increase in NO2, PM10, PM2.5, SO2 and H2S, in single pollutant models, at lag 0 to lag 4