Effects of extremely hot days on people older than 65 years in Seville (Spain) from 1986 to 1997

The effects of heat waves on the population have been described by different authors and a consistent relationship between mortality and temperature has been found, especially in elderly subjects. The present paper studies this effect in Seville, a city in the south of Spain, known for its climate of mild winters and hot summers, when the temperature frequently exceeds 40 degrees C. This study focuses on the summer months (June to September) for the years from 1986 to 1997. The relationships between total daily mortality and different specific causes for persons older than 65 and 75 years, of each gender, were analysed. Maximum daily temperature and relative humidity at 7.00 a.m. were introduced as environmental variables. The possible confounding effect of different atmospheric pollutants, particularly ozone, were considered. The methodology employed was time series analysis using Box-Jenkins models with exogenous variables. On the basis of dispersion diagrams, we defined extremely hot days as those when the maximum daily temperature surpassed 41 degrees C. The ARIMA model clearly shows the relationship between temperature and mortality. Mortality for all causes increased up to 51% above the average in the group over 75 years for each degree Celsius beyond 41 degrees C. The effect is more noticeable for cardiovascular than for respiratory diseases, and more in women than in men. Among the atmospheric pollutants, a relation was found between mortality and concentrations of ozone, especially for men older than 75.     

The meteorological sensitivity of ischaemic heart disease mortality events in Birmingham, UK

Winter ischaemic heart disease (IHD) mortality events (ME) were identified in order to establish their degree of meteorological sensitivity. Sensitivity was evaluated using regression of surface meteorological and large-scale atmospheric circulation variables on daily mortality for each mortality event. Critical meteorological variables affecting IHD mortality appear to be local surface dry-bulb and dew-point temperature and large-scale southerly and westerly wind components, atmospheric pressure and vorticity. The rate of change and departure from normal conditions of these variables appear to be especially important for engendering IHD mortality events. Associated with IHD mortality are two broad types of weather conditions: (1) blustery westerly flows and rapidly changing weather from the west and (2) climatologically strong northeasterly to southeasterly flows of cold air, which bring rapidly changing and anomalous thermal conditions to the study area. The general atmospheric circulation patterns that produce these conditions are identified and the implications of results for weather and health studies are discussed. Received: 24 October 2000 / Revised: 16 April 2001 / Accepted: 18 April 2001     

Influence of weather and climate on subjective symptom intensity in atopic eczema

The frequent clinical observation that the course of atopic eczema, a skin disease involving a disturbed cutaneous barrier function, is influenced by climate and weather motivated us to analyse these relationships biometrically. In the Swiss high-mountain area of Davos the intensity of itching experienced by patients with atopic eczema was evaluated and compared to 15 single meteorological variables recorded daily during an entire 7-year observation period. By means of univariate analyses and multiple regressions, itch intensity was found to be correlated with some meteorological variables. A clear-cut inverse correlation exists with air temperature (coefficient of correlation: –0.235, P<0.001), but the effects of water vapour pressure, air pressure and hours of sunshine are less pronounced. The results show that itching in atopic eczema is significantly dependent on meteorological conditions. The data suggest that, in patients with atopic eczema, a certain range of thermo-hygric atmospheric conditions with a balance of heat and water loss on the skin surface is essential for the skin to feel comfortable. Received: 9 August 1999 / Revised: 10 July 2000 / Accepted: 11 July 2000     

Comparing mortality in renal patients on hemodialysis versus peritoneal dialysis using a marginal structural model

When comparing the causal effect of peritoneal dialysis (PD) and hemodialysis (HD) treatment on lowering mortality in renal patients, using observational data, it is necessary to adjust for different forms of confounding and informative censoring. Both the type of dialysis treatment that is started with and mortality are affected by baseline covariates. Longitudinal and baseline variables can affect both the probability of switching from one type of dialysis to the other, and mortality. Longitudinal and baseline variables can also affect the probability of receiving a kidney transplant, possibly causing informative censoring. Adjusting for longitudinal variables by including them as covariates in a regression model potentially causes bias, for instance by losing a possible indirect effect of dialysis on mortality via these longitudinal variables. Instead, we fitted a marginal structural model (MSM) to estimate the causal effect of dialysis type, adjusted for confounding and informative censoring. We used the MSM to compare the hazard of death as well as cumulative survival between the potential treatment trajectories "always PD" and "always HD" over time, conditional on age and diabetes mellitus status. We used inverse probability weighting (IPW) to fit the MSM.     

Impact of extreme temperatures on daily mortality in Madrid (Spain) among the 45–64 age-group

This paper analyses the relationship between extreme temperatures and mortality among persons aged 45–64 years. Daily mortality in Madrid was analysed by sex and cause, from January 1986 to December 1997. Quantitative analyses were performed using generalised additive models, with other covariables, such as influenza, air pollution and seasonality, included as controls. Our results showed that impact on mortality was limited for temperatures ranging from the 5th to the 95th percentiles, and increased sharply thereafter. During the summer period, the effect of heat was detected solely among males in the target age group, with an attributable risk (AR) of 13.3% for circulatory causes. Similarly, NO₂ concentrations registered the main statistically significant associations in females, with an AR of 15% when circulatory causes were considered. During winter, the impact of cold was exclusively observed among females having an AR of 7.7%. The magnitude of the AR indicates that the impact of extreme temperature is by no means negligible.Julio Díaz is adviser to the Madrid Autonomous University General Foundation, on behalf of the Department of Education for Sustainable Development, Madrid City Council, Madrid, Spain     

Opportunity for natural selection and gene flow in an isolated Zapotec-speaking community in southern Mexico in the throes of a secular increase in size

Our object in this paper is to analyze the opportunity for natural selection and gene flow in an isolated Zapotec-speaking community in the valley of Oaxaca, southern Mexico, that is undergoing a secular increase in body size. Surveys were conducted in the community in 1968, 1978, and 2000, including anthropometric and census data. No secular change was found in the growth status of schoolchildren and adult height between 1968 and 1978; subsequently, major secular gains in height occurred among children and adolescents between 1978 and 2000. The 1978 household data were used to compute gene flow (3.3%) and opportunity for selection intensity (I = 1.312). Migration and other demographic information was obtained from household census data for 1978 and 2000, and mortality information was extracted from community records and archives. These data were used to compute gene flow and opportunity for natural selection. Gene flow increased from 3.3% to 4.7% and intensity of natural selection decreased from 1.312 to 0.272 from 1978 to 2000. Variance in fertility increased slightly over time (12.25 to 13.69). Opportunity for selection was dominant during the prereproductive period in 1978, but approached 0 for the mortality component in 2000, resulting in a marked decrease in the mortality component (Im) of selection (0.626 and 0.019, respectively) and total opportunity for selection (I = 1.312 and 0.272, respectively). Secular increase in height and markedly decreased opportunity for natural selection (1) were associated with better health and nutritional conditions. Genotype-environment interaction and environmental influences are apparently the predominant causes of the secular trend. If natural selection plays a role in causing the secular trend, it is a small one.     

Age correction in dementia--matching to a healthy brain

In recent research, many univariate and multivariate approaches have been proposed to improve automatic classification of various dementia syndromes using imaging data. Some of these methods do not provide the possibility to integrate possible confounding variables like age into the statistical evaluation. A similar problem sometimes exists in clinical studies, as it is not always possible to match different clinical groups to each other in all confounding variables, like for example, early-onset (age<65 years) and late-onset (age≥65) patients with Alzheimer's disease (AD). Here, we propose a simple method to control for possible effects of confounding variables such as age prior to statistical evaluation of magnetic resonance imaging (MRI) data using support vector machine classification (SVM) or voxel-based morphometry (VBM). We compare SVM results for the classification of 80 AD patients and 79 healthy control subjects based on MRI data with and without prior age correction. Additionally, we compare VBM results for the comparison of three different groups of AD patients differing in age with the same group of control subjects obtained without including age as covariate, with age as covariate or with prior age correction using the proposed method. SVM classification using the proposed method resulted in higher between-group classification accuracy compared to uncorrected data. Further, applying the proposed age correction substantially improved univariate detection of disease-related grey matter atrophy using VBM in AD patients differing in age from control subjects. The results suggest that the approach proposed in this work is generally suited to control for confounding variables such as age in SVM or VBM analyses. Accordingly, the approach might improve and extend the application of these methods in clinical neurosciences.     

Attendance at cultural events,reading books or periodicals,and making music or singing in a choir as determinants for survival: Swedish interview survey of living conditions.

OBJECTIVES: To investigate the possible influence of attendance at cultural events, reading books or periodicals, making music or singing in a choir as determinants for survival. DESIGN: A simple random sample was drawn of 15,198 individuals aged 16-74 years. Of these, 85% (12,982) were interviewed by trained non-medical interviewers between 1982 and 1983 about cultural activities. They were followed up with respect to survival until 31 December 1991. SETTING: Swedish interview survey of living conditions comprising a random sample of the adult Swedish population. SUBJECTS: 12,675 people interviewed between 1982 and 1983. MAIN OUTCOME MEASURES: Survival of subjects after controlling for eight confounding variables: age, sex, education level, income, long term disease, social network, smoking, and physical exercise. RESULTS: 6,301 men and 6,374 women were followed up; 533 men and 314 women died during this period. The control variables influenced survival in the expected directions except for social network for men; a significant negative effective was found when the analysis was made separately for men and women. We found an influence on mortality when the eight control variables were controlled for in people who rarely attended events compared with those attending most often, the relative risk being 1.57 (95% confidence interval 1.18 to 2.09). CONCLUSION: Attendance at cultural events may have a positive influence on survival. Long term follow up of large samples with confounders that are well controlled for and with the cultural stimulation more highly specified should be used to try to falsify the hypothesis before experiments start.     

Natural environmental associations in a 50-day human electrocardiogram

Meteorotropic associations of heart rate (HR) and HR variability (HRV) were investigated in a clinically healthy 48-year-old man in Kiev. His electrocardiogram (ECG) was determined over 50 days by fitting him with an ambulatorily wearable device; various natural physical environmental variables were also monitored. The mean inter-beat interval, the standard deviation of these intervals, the spectral power in several frequency ranges, the power ratio of the approx. 10.5-s/approx. 3.6-s spectral components and other aspects of HRV were computed over consecutive 14.4-min intervals. Together with ordinary meteorological variables, geomagnetic disturbances (GMD) and fluctuations of atmospheric pressure (FAP) in the range 0.01–0.10 Hz (10–100 s) were measured. The assessable infradian spectra (with frequencies lower than 1 cycle/28 hours) of all HRV parameters showed two major components with periods of about 3.5 and 10 days. Two environmental variables, FAP and wind speed (with which FAP is closely related), revealed both of these rhythms and showed the greatest cross-spectral coherence (0.70–0.98) with corresponding oscillations of HRV. Less specific but statistically significant product-moment correlations with major HRV indices were also found; most of these were with FAP, but correlations with air temperature, humidity, wind speed and geomagnetic disturbances were also found. Long-term ECG recording, essential in the detection of infradian rhythms, proved to be sensitive to physical environmental variables, notably meteorological ones. FAP, usually neglected since its role has not been considered in previous biometeorological studies, or some factor closely related to FAP is probably involved in synchronizing or influencing the approximately 3.5-day HR and HRV rhythms in humans. Received: 27 July 2000 / Revised: 13 November 2000 / Accepted: 28 November 2000     

Assessing the effects of nitrogen deposition and climate on carbon isotope discrimination and intrinsic water‐use efficiency of angiosperm and conifer trees under rising CO2 conditions

The objective of this study is to globally assess the effects of atmospheric nitrogen deposition and climate, associated with rising levels of atmospheric CO₂, on the variability of carbon isotope discrimination (Δ¹³C), and intrinsic water‐use efficiency (iWUE) of angiosperm and conifer tree species. Eighty‐nine long‐term isotope tree‐ring chronologies, representing 23 conifer and 13 angiosperm species for 53 sites worldwide, were extracted from the literature, and used to obtain long‐term time series of Δ¹³C and iWUE. Δ¹³C and iWUE were related to the increasing concentration of atmospheric CO₂ over the industrial period (1850–2000) and to the variation of simulated atmospheric nitrogen deposition and climatic variables over the period 1950–2000. We applied generalized additive models and linear mixed‐effects models to predict the effects of climatic variables and nitrogen deposition on Δ¹³C and iWUE. Results showed a declining Δ¹³C trend in the angiosperm and conifer species over the industrial period and a 16.1% increase of iWUE between 1850 and 2000, with no evidence that the increased rate was reduced at higher ambient CO₂ values. The temporal variation in Δ¹³C supported the hypothesis of an active plant mechanism that maintains a constant ratio between intercellular and ambient CO₂ concentrations. We defined linear mixed‐effects models that were effective to describe the variation of Δ¹³C and iWUE as a function of a set of environmental predictors, alternatively including annual rate (N_rate) and long‐term cumulative (N_cum) nitrogen deposition. No single climatic or atmospheric variable had a clearly predominant effect, however, Δ¹³C and iWUE showed complex dependent interactions between different covariates. A significant association of N_rate with iWUE and Δ¹³C was observed in conifers and in the angiosperms, and N_cum was the only independent term with a significant positive association with iWUE, although a multi‐factorial control was evident in conifers.     

Occupational Class Inequalities in All-Cause and Cause-Specific Mortality among Middle-Aged Men in 14 European Populations during the Early 2000s

This study analyses occupational class inequalities in all-cause mortality and four specific causes of death among men, in Europe in the early 2000s, and is the most extensive comparative analysis of occupational class inequalities in mortality in Europe so far. Longitudinal data, obtained from population censuses and mortality registries in 14 European populations, from around the period 2000–2005, were used. Analyses concerned men aged 30–59 years and included all-cause mortality and mortality from all cancers, all cardiovascular diseases (CVD), all external, and all other causes. Occupational class was analysed according to five categories: upper and lower non-manual workers, skilled and unskilled manual workers, and farmers and self-employed combined. Inequalities were quantified with mortality rate ratios, rate differences, and population attributable fractions (PAF). Relative and absolute inequalities in all-cause mortality were more pronounced in Finland, Denmark, France, and Lithuania than in other populations, and the same countries (except France) also had the highest PAF values for all-cause mortality. The main contributing causes to these larger inequalities differed strongly between countries (e.g., cancer in France, all other causes in Denmark). Relative and absolute inequalities in CVD mortality were markedly lower in Southern European populations. We conclude that relative and absolute occupational class differences in all-cause and cause specific mortality have persisted into the early 2000''s, although the magnitude differs strongly between populations. Comparisons with previous studies suggest that the relative gap in mortality between occupational classes has further widened in some Northern and Western European populations.     

Multiple imputation in the presence of an incomplete binary variable created from an underlying continuous variable

Multiple imputation (MI) is used to handle missing at random (MAR) data. Despite warnings from statisticians, continuous variables are often recoded into binary variables. With MI it is important that the imputation and analysis models are compatible; variables should be imputed in the same form they appear in the analysis model. With an encoded binary variable more accurate imputations may be obtained by imputing the underlying continuous variable. We conducted a simulation study to explore how best to impute a binary variable that was created from an underlying continuous variable. We generated a completely observed continuous outcome associated with an incomplete binary covariate that is a categorized version of an underlying continuous covariate, and an auxiliary variable associated with the underlying continuous covariate. We simulated data with several sample sizes, and set 25% and 50% of data in the covariate to MAR dependent on the outcome and the auxiliary variable. We compared the performance of five different imputation methods: (a) Imputation of the binary variable using logistic regression; (b) imputation of the continuous variable using linear regression, then categorizing into the binary variable; (c, d) imputation of both the continuous and binary variables using fully conditional specification (FCS) and multivariate normal imputation; (e) substantive-model compatible (SMC) FCS. Bias and standard errors were large when the continuous variable only was imputed. The other methods performed adequately. Imputation of both the binary and continuous variables using FCS often encountered mathematical difficulties. We recommend the SMC-FCS method as it performed best in our simulation studies.     

Geographical variation in antibiotic resistance profiles of Escherichia coli isolated from swine, poultry, beef and dairy cattle farm water retention ponds in Florida

AIMS: The aim of this study was to assess geographical variation in multiple antibiotic resistance (MAR) profiles of livestock Escherichia coli as well as to evaluate the ability of MAR profiles to differentiate sources of faecal pollution. METHODS AND RESULTS: More than 2000 E. coli isolates were collected from water retention ponds and manure of swine, poultry, beef and dairy farms in south, central and north Florida, and analysed for MAR using nine antibiotics. There were significant differences in antibiotic resistance of E. coli by season and livestock type for more than one antibiotic, but regional differences were significant only for ampicillin. Over the three regions, discriminant analysis using MAR profiles correctly classified 27% of swine, 49% of poultry, 56% of beef and 51% of dairy isolates. CONCLUSIONS: Regional variations in MAR combined with moderate discrimination success suggest that MAR profiles of E. coli may only be marginally successful in identifying sources of faecal pollution. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates the existence of regional and seasonal differences in MAR profiles as well as the limited ability of MAR profiles to discriminate among livestock sources.     

High transformation frequency of tobacco and rice via Agrobacterium-mediated gene transfer by flanking a tobacco matrix attachment region

Nuclear matrix attachment regions (MARs) are suggested to regulate chromatin structure and influence the expression of flanking genes. Our previous study showed that TM2, a new DNA fragment isolated from tobacco, can bind with the rice nuclear matrix in vitro and increase transgene expression in vivo. Here, we investigated the role of TM2 MAR in improving transformation frequency of Agrobacterium -mediated transformation in tobacco and rice. The gusA reporter gene flanked by TM2 MAR in pBI121 and pCAMBIA-1301 vectors was controlled by a constitutive promoter or a photosynthetic tissue-specific promoter. The presence of TM2 MAR in different expression cassettes significantly increased the numbers of kanamycin-resistant tobacco shoots, hygromycin-resistant rice calli and shoots. Seeds from the independent transgenic lines with TM2 MAR can germinate normally on the medium containing 500 mg l⁻¹ kanamycin, whereas none of the seeds from the transgenic lines without TM2 MAR survived. Furthermore, RNA gel blot analysis revealed that nptII messenger RNA levels are more abundant in the independent transgenic lines with TM2 MAR than in the lines without TM2 MAR. Altogether, these data reveal a possible mechanism that TM2 MAR improves the transformation frequency by increasing nptII gene expression.     

Bacterioplankton Community Composition in Five Lakes Differing in Trophic Status and Humic Content

Abstract To investigate the relation between lake type and bacterioplankton community composition, five Swedish lakes, which differed from each other in nutrient content and water color, were studied. Denaturing gradient gel electrophoresis (DGGE) of 16S rDNA was used to examine community composition. The DGGE-patterns of the different samples were analyzed in relation to physical, chemical, and biological data from the lakes by canonical correspondence analysis (CCA). The three variables found to most strongly correlate with the DGGE patterns were biomasses of microzooplankton, cryptophytes, and chrysophytes, suggesting that these biota had an impact on bacterioplankton community structure. Two of the three factors were, in turn, significantly correlated to parameters associated with the trophic status of the lakes, indicating that the nutrient content of the lakes, at least indirectly, influenced the structure of the bacterioplankton community. The relation to water color was less pronounced. Received: 16 February 2000; Accepted: 27 April 2000; Online Publication: 18 July 2000     

A retrospective mortality study of workers exposed to radon in a Brazilian underground coal mine

Recently a high radon concentration was detected in the underground coal mine of Figueira, located in the south of Brazil. This coal mine has been operating since 1942 without taking cognizance of the high radon environment. In order to assess possible radon-related health effects on the workers, a retrospective (1979-2002) mortality study of 2,856 Brazilian coal miners was conducted, with 2,024 underground workers potentially exposed to radon daughters. Standard mortality ratio (SMR) analysis hints at lower mortality from all causes for both underground (SMR = 88, 95% CI = 78-98) and surface workers (SMR = 96, 95% CI = 80-114). A high statistically significant SMR for lung cancer mortality was observed only in the underground miners (SMR = 173, 95% CI = 102-292), with a statistically significant trend reflecting the duration of underground work. High statistically significant SMRs were observed for pneumonia as a cause of death between both surface (SMR = 304, 95% CI = 126-730) and underground miners (SMR = 253, 95% CI = 140-457). Because mortality from smoking-related cancers other than lung cancer was not found elevated in underground workers and because diesel equipments were not used in this mine, it can be concluded that the enhanced lung cancer mortality observed for underground miners is associated with exposure to radon and radon daughters, rather than other confounding risk factors.     

Weight and mortality in the Whitehall Study.

Ten-year mortality rates in men aged 40-64 years in the Whitehall Study were analysed in relation to weight and height at the initial examination. At ages 40-49 "all-causes" mortality increased with increasing body mass index; but this simple relation disappeared at older ages, where there was an increased mortality in the lowest quintile of body mass index. The "all-ages" relation was "J"-shaped, and this could not be explained by the confounding effects of blood pressure, cholesterol values, and cigarette smoking. Some, but not all, of the J shape was due to a high short-term mortality in thin men from cancers (presumably already present at examination). At younger ages mortality from coronary heart disease was positively related to body mass index, but this depended on its association with other risk factors. Mortality from causes other than cancers or coronary heart disease was highest in the lowest quintile of body mass index.     

Second analysis of mortality of nuclear industry workers in Japan, 1986-1997

IA cohort study of nuclear industry workers was initiated in 1990 to determine the possible health effects of low-level radiation. A total of 5,527 deaths were ascertained among 176,000 male workers who had been retrospectively and/or prospectively followed for an average of 7.9 years during the observation period 1986-1997. Statistical analyses were made mainly on the prospective follow-up outcome of 120,000 workers followed for an average of 4.5 years. The standardized mortality ratio (and its 95% confidence interval) was 0.94 (0.90, 0.97) for 2,934 cases of all causes combined and 0.86 (0.82, 0.91) for 1,305 cases of non-malignant diseases combined, which suggested a healthy worker effect. For 1,191 cases of all cancers combined, it was 0.98 (0.93, 1.04), indicating no difference in mortality from that of the general population. In tests for trend of death rate with increasing radiation dose, no significant correlation was found for all cancers combined. For site-specific cancers, most cancers including leukemia showed no positive correlation with dose, except for cancers of the esophagus, stomach and rectum and multiple myeloma. External causes showed a significant correlation with dose. A separate questionnaire study indicated that these positive findings could be ascribed in part to lifestyle characteristics of the workers. For leukemia only, we attempted to estimate the excess relative risk per unit dose of radiation, which, with reservations because of its wide confidence interval, was within the range of variation of the risks reported in other radiation epidemiological studies. This population must be studied for a longer time and with a consideration of the possible effects of confounding factors.     

Relationships between sudden weather changes in summer and mortality in the Czech Republic, 1986–2005

The study examines the relationship between sudden changes in weather conditions in summer, represented by (1) sudden air temperature changes, (2) sudden atmospheric pressure changes, and (3) passages of strong atmospheric fronts; and variations in daily mortality in the population of the Czech Republic. The events are selected from data covering 1986–2005 and compared with the database of daily excess all-cause mortality for the whole population and persons aged 70 years and above. Relative deviations of mortality, i.e., ratios of the excess mortality to the expected number of deaths, were averaged over the selected events for days D−2 (2 days before a change) up to D+7 (7 days after), and their statistical significance was tested by means of the Monte Carlo method. We find that the periods around weather changes are associated with pronounced patterns in mortality: a significant increase in mortality is found after large temperature increases and on days of large pressure drops; a decrease in mortality (partly due to a harvesting effect) occurs after large temperature drops, pressure increases, and passages of strong cold fronts. The relationship to variations in excess mortality is better expressed for sudden air temperature/pressure changes than for passages of atmospheric fronts. The mortality effects are usually more pronounced in the age group 70 years and above. The impacts associated with large negative changes of pressure are statistically independent of the effects of temperature; the corresponding dummy variable is found to be a significant predictor in the ARIMA model for relative deviations of mortality. This suggests that sudden weather changes should be tested also in time series models for predicting excess mortality as they may enhance their performance.     

Mortality impact of extreme winter temperatures

During the last few years great attention has been paid to the evaluation of the impact of extreme temperatures on human health. This paper examines the effect of extreme winter temperature on mortality in Madrid for people older than 65, using ARIMA and GAM models. Data correspond to 1,815 winter days over the period 1986–1997, during which time a total of 133,000 deaths occurred. The daily maximum temperature (T_max) was shown to be the best thermal indicator of the impact of climate on mortality. When total mortality was considered, the maximum impact occured 7–8 days after a temperature extreme; for circulatory diseases the lag was between 7 and 14 days. When respiratory causes were considered, two mortality peaks were evident at 4–5 and 11 days. When the impact of winter extreme temperatures was compared with that associated with summer extremes, it was found to occur over a longer term, and appeared to be more indirect.