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Biomedical subjects

Daniel Krewski

Publications and source records attributed to Daniel Krewski.

At least 37 records · Page 2Linked to original sources
PubMed2005

Dietary patterns and risk of pancreatic cancer.

To investigate associations between broad dietary patterns and pancreatic cancer risk, we conducted a case-control study of 585 histologically confirmed pancreatic cancer cases and 4,779 population-based controls in 8 Canadian provinces between 1994 and 1997. Dietary intake was assessed using a FFQ. Major dietary patterns were identified by factor analysis. Unconditional logistic regression was used to describe associations between dietary pattern scores and risk of pancreatic cancer. Three dietary patterns were identified: Western, characterized by high intake of processed meats, sweets and desserts, refined grains and potatoes; fruits and vegetables, characterized by high intake of fresh fruits and cruciferous vegetables; drinker, characterized by high consumption of liquor, wine and beer. After adjustment for age, BMI, smoking, physical activity, province, educational attainment and total energy intake, the fruits and vegetables pattern was associated with a 49% reduction in pancreatic risk among men (OR = 0.51, 95% CI 0.29-0.90, p = 0.004) when comparing the highest and lowest quartiles of dietary pattern scores. No significant relationship was observed with the Western and drinker patterns. Although the response rate for eligible, recruited subjects was relatively low, our results suggest that the fruits and vegetables dietary pattern reduces pancreatic cancer risk among men.

Adult↗
PubMed2005

Occurrence and clinical predictors of operative delivery for the vertex second twin after normal vaginal delivery of the first twin.

OBJECTIVE: This study was undertaken to estimate occurrence and explore clinical predictors of abdominal and vaginal operative delivery in vertex second twin after normal vaginal delivery of the first twin. METHODS: Data from a historical cohort study that was based on a twin registry in the United States (1995-1997) were used. RESULTS: Among 42,417 vertex second twins following normal vaginal delivery of the first twins, rates of abdominal and vaginal operative delivery were 6.3% and 8.3%, respectively. Cord prolapse, fetal distress, maternal complications, abnormal labor, and birth weight 25% larger than first twin were the most important predicators for operative deliveries. Fetal distress and cord prolapse had a stronger effect on abdominal than vaginal operative delivery. CONCLUSION: In general population, abdominal and vaginal operative delivery rates were 6.3% and 8.3%, respectively, in vertex second twin after normal vaginal delivery of the first twin. The most important predictors for operative delivery are cord prolapse and fetal distress.

Adult↗
PubMed2005

Neonatal death and morbidity in vertex-nonvertex second twins according to mode of delivery and birth weight.

OBJECTIVE: The purpose of this study was to assess the risk of neonatal death and morbidity in vertex-nonvertex second twins according to the mode of delivery and birth weight. STUDY DESIGN: Data from a retrospective cohort study that was based on all twin births in the United States (1995-1997) were used. RESULTS: A total of 15,185 vertex-nonvertex second twins were classified into 3 groups: (1) both twins were delivered by cesarean delivery (37.7%), (2) both twins were delivered vaginally (46.8%), and (3) the second twin was delivered by cesarean delivery after vaginal delivery of the first twin (15.5%). The risk of asphyxia-related neonatal deaths and morbidity was increased in the group in which both twins were delivered vaginally and the group in which both twins were delivered by cesarean delivery. The increase in neonatal death in the group in which both twins were delivered vaginally was stronger in the birth weight of < 1500 g. In contrast, in the group in which both twins were delivered vaginally and the group in which the second twin was delivered by cesarean delivery after the first twin was delivered vaginally, the increase in neonatal morbidity was greater in the group in which the birth weight was 1500 to 4000 g. CONCLUSION: The risk of neonatal death and morbidity in second-born twins is higher in the group in which both twins were delivered vaginally and the group in which the second twin was delivered by cesarean delivery after the first twin was delivered vaginally compared with the group in which both twins were delivered by cesarean delivery.

Adult↗
PubMed2005

Modeling seasonal variation in indoor radon concentrations.

Radon, a well-established risk factor for human lung cancer, is present at low concentrations in most homes. Consequently, many countries have established national guidelines for residential radon concentrations. In this article, we evaluate two models for describing seasonal variation in residential radon concentrations based on the data from a large case-control study conducted in Winnipeg, Canada. In this study, radon levels in homes were monitored during two successive 6-month periods, with integrated annual radon concentrations obtained using CR-39 alpha-track detectors. Significant differences were noted among measurements taken during different seasons of the year. Using the model introduced by Pinel et al. (1995) to describe temporal variation in residential radon levels in southwest England using seasonal adjustment factors, reasonable predictions of annual average radon concentrations were obtained from the 6-month integrated radon measurements. However, a simple multiplicative model was found to provide better predictions than the seasonal adjustment model. Although model coefficients vary somewhat from one geographic location to another, the concordance with respect discriminating between results above and below 150 Bq/m(3) in Winnipeg was in the range 85-90% using seasonal adjustment models with coefficients derived from data in either Winnipeg or southwest England.

Air Pollution, Indoor↗
PubMed2005

The effect of censoring on cancer risk estimates based on the Canadian National Dose Registry of occupational radiation exposure.

Cohort studies represent an important epidemiological tool for exploring the potential adverse health effects of low-dose exposure to ionizing radiation in the workplace. Analyses of data from the National Dose Registry of Canada have suggested that occupational radiation exposure leads to increased risk of several specific types of cancer, as well as increased overall risk of cancer. An important aspect of such studies is the censoring in recorded exposures induced by dosimetry detection limits. Such a censoring effect can lead to significant underestimation of cumulative doses which, in turn, can result in overestimation of the excess cancer risk associated with occupational radiation exposure. In this article, we present analytic results, supported by a simulation study, on the magnitude of overestimation of risk based on the additive relative risk model used in the analysis of the NDR data that can occur due to censoring. Our results indicate that overestimation of risk is modest, being less than 20% in all situations considered here. Because censoring also results in ovestimation of the precision of the risk estimates, the significance levels of Wald-type statistical tests for increased risk based on the ratio of the estimate to its standard error are virtually unaffected by censoring. These results suggest that although the application of the additive excess relative risk model in the presence of censoring may lead to some overestimation of risk, the model does not lead to invalid conclusions regarding the association between occupational radiation exposure and cancer risk based on data from the NDR.

Canada↗
PubMed2005

The effect of coarse ambient particulate matter on first, second, and overall hospital admissions for respiratory disease among the elderly.

The objective of this article is to examine differences in the effect of ambient particulate matter on first, second, and overall hospital admissions for respiratory disease among the elderly. We studied 8989 adults 65 yr of age or older living in the greater Vancouver area who were admitted to hospital for any acute respiratory disease (ICD-9 codes 460-519) between June 1, 1995, and March 31, 1999. Time-series analysis was used to evaluate the association between respiratory admissions and daily measures of particulate matter (PM10, PM2.5, and PM10 - 2.5) in urban air, after adjustment for gaseous copollutants (CO, O3, NO2, and SO2) and meteorological variables. Repeated admissions for respiratory disease were common among the elderly. Approximately 30% of the subjects were readmitted to hospital after the first admission; 9% had more than 2 admissions for respiratory disease during the 4-yr study period. PM10 - 2.5 was significantly associated with the second and overall admissions for respiratory disease, but not with the first admission. The adjusted relative risks for an increment of 4.2 microg/m(3) in -day average PM10 - 2.5 concentrations were 1.03 (95% confidence interval: 0.98-1.09) for the first admission, 1.22 (1.10-1.36) for the second admission, and 1.06 (1.02, 1.11) for overall admissions. There was no significant association between PM2.5 and hospital admissions for respiratory disease among the elderly. Our data suggest that (1) people with a history of respiratory admissions are at a higher risk of respiratory disease in relation to particulate air pollution in urban areas, (2) analyses based on overall rather than repeated hospital admissions lead to lower estimates of the risk of respiratory disease associated with particulate air pollution, and (3) PM10 - 2.5 has a larger effect on respiratory admissions than PM2.5.

Aged↗
PubMed2005

A psychosocial risk assessment and management framework to enhance response to CBRN terrorism threats and attacks.

Evidence in the disaster mental health literature indicates that psychosocial consequences of terrorism are a critical component of chemical, biological, radiological, and nuclear (CBRN) events, both at the clinical level and the normal behavioral and emotional levels. Planning for such psychosocial aspects should be an integral part of emergency preparedness. As Canada and other countries build the capacity to prevent, mitigate, and manage CBRN threats and events, it is important to recognize the range of social, psychological, emotional, spiritual, behavioral, and cognitive factors that may affect victims and their families, communities, children, the elderly, responders, decision makers, and others at all phases of terrorism, from threat to post-impact recovery. A structured process to assist CBRN emergency planners, decision makers, and responders in identifying psychosocial risks, vulnerable populations, resources, and interventions at various phases of a CBRN event to limit negative psychosocial impacts and promote resilience and adaptive responses is the essence of our psychosocial risk assessment and management (P-RAM) framework. This article presents the evidence base and conceptual underpinnings of the framework, the principles underlying its design, its key elements, and its use in the development of decision tools for responders, planners, decision makers, and the general public to better assess and manage psychosocial aspects of CBRN threats or attacks.

Canada↗
PubMed2005

Dietary intake of lycopene is associated with reduced pancreatic cancer risk.

Although fruits and vegetables have been implicated in the etiology of pancreatic cancer, the role of phytochemicals in these food groups has received little attention to date. In this study, we investigated the possible association between dietary carotenoids and pancreatic cancer risk. A case-control study of 462 histologically confirmed pancreatic cancer cases and 4721 population-based controls in 8 Canadian provinces took place between 1994 and 1997. Dietary intake was assessed by a self-administered FFQ. Unconditional logistic regression was used to assess associations between specific and total carotenoid intakes and the risk of pancreatic cancer. All tests of statistical significance were 2-sided. After adjustment for age, province, BMI, smoking, educational attainment, dietary folate, and total energy intake, lycopene, provided mainly by tomatoes, was associated with a 31% reduction in pancreatic cancer risk among men [odds ratio (OR) = 0.69; 95% CI: 0.46-0.96; P = 0.026 for trend] when comparing the highest and lowest quartiles of intake. Both beta-carotene (OR = 0.57; 95% CI: 0.32-0.99; P = 0.016 for trend) and total carotenoids (OR = 0.58; 95% CI: 0.34-1.00; P = 0.02 for trend) were associated with a significantly reduced risk among those who never smoked. The results of this study suggest that a diet rich in tomatoes and tomato-based products with high lycopene content may help reduce pancreatic cancer risk.

Adult↗
PubMed2005

Residential radon and risk of lung cancer: a combined analysis of 7 North American case-control studies.

BACKGROUND: Underground miners exposed to high levels of radon have an excess risk of lung cancer. Residential exposure to radon is at much lower levels, and the risk of lung cancer with residential exposure is less clear. We conducted a systematic analysis of pooled data from all North American residential radon studies. METHODS: The pooling project included original data from 7 North American case-control studies, all of which used long-term alpha-track detectors to assess residential radon concentrations. A total of 3662 cases and 4966 controls were retained for the analysis. We used conditional likelihood regression to estimate the excess risk of lung cancer. RESULTS: Odds ratios (ORs) for lung cancer increased with residential radon concentration. The estimated OR after exposure to radon at a concentration of 100 Bq/m3 in the exposure time window 5 to 30 years before the index date was 1.11 (95% confidence interval = 1.00-1.28). This estimate is compatible with the estimate of 1.12 (1.02-1.25) predicted by downward extrapolation of the miner data. There was no evidence of heterogeneity of radon effects across studies. There was no apparent heterogeneity in the association by sex, educational level, type of respondent (proxy or self), or cigarette smoking, although there was some evidence of a decreasing radon-associated lung cancer risk with age. Analyses restricted to subsets of the data with presumed more accurate radon dosimetry resulted in increased estimates of risk. CONCLUSIONS: These results provide direct evidence of an association between residential radon and lung cancer risk, a finding predicted using miner data and consistent with results from animal and in vitro studies.

Adult↗
PubMed2005

Spatial analysis of air pollution and mortality in Los Angeles.

BACKGROUND: The assessment of air pollution exposure using only community average concentrations may lead to measurement error that lowers estimates of the health burden attributable to poor air quality. To test this hypothesis, we modeled the association between air pollution and mortality using small-area exposure measures in Los Angeles, California. METHODS: Data on 22,905 subjects were extracted from the American Cancer Society cohort for the period 1982-2000 (5,856 deaths). Pollution exposures were interpolated from 23 fine particle (PM2.5) and 42 ozone (O3) fixed-site monitors. Proximity to expressways was tested as a measure of traffic pollution. We assessed associations in standard and spatial multilevel Cox regression models. RESULTS: After controlling for 44 individual covariates, all-cause mortality had a relative risk (RR) of 1.17 (95% confidence interval=1.05-1.30) for an increase of 10 mug/m PM2.5 and a RR of 1.11 (0.99-1.25) with maximal control for both individual and contextual confounders. The RRs for mortality resulting from ischemic heart disease and lung cancer deaths were elevated, in the range of 1.24-1.6, depending on the model used. These PM results were robust to adjustments for O3 and expressway exposure. CONCLUSION: Our results suggest the chronic health effects associated with within-city gradients in exposure to PM2.5 may be even larger than previously reported across metropolitan areas. We observed effects nearly 3 times greater than in models relying on comparisons between communities. We also found specificity in cause of death, with PM2.5 associated more strongly with ischemic heart disease than with cardiopulmonary or all-cause mortality.

Air Pollution↗
PubMed2005

Residential radon in Canada: an uncertainty analysis of population and individual lung cancer risk.

Following a comprehensive evaluation of the health risks of radon, the U.S. National Research Council (US-NRC) concluded that the radon inside the homes of U.S. residents is an important cause of lung cancer. To assess lung cancer risks associated with radon exposure in Canadian homes, we apply the new (US-NRC) techniques, tailoring assumptions to the Canadian context. A two-dimensional uncertainty analysis is used to provide both population-based (population attributable risk, PAR; excess lifetime risk ratio, ELRR; and life-years lost, LYL) and individual-based (ELRR and LYL) estimates. Our primary results obtained for the Canadian population reveal mean estimates for ELRR, PAR, and LYL are 0.08, 8%, and 0.10 years, respectively. Results are also available and stratified by smoking status (ever versus never). Conveniently, the three indices (ELRR, PAR, and LYL) reveal similar output uncertainty (geometric standard deviation, GSD approximately 1.3), and in the case of ELRR and LYL, comparable variability and uncertainty combined (GSD approximately 4.2). Simplifying relationships are identified between ELRR, LYL, PAR, and the age-specific excess rate ratio (ERR), which suggest a way to scale results from one population to another. This insight is applied in scaling our baseline results to obtain gender-specific estimates, as well as in simplifying and illuminating sensitivity analysis.

Age Factors↗
PubMed2005

Chlorination disinfection by-products and pancreatic cancer risk.

Chlorination disinfection by-products (CDBPs) are produced during the treatment of water with chlorine to remove bacterial contamination. CDBPs have been associated with an increased risk of bladder cancer. There is also some evidence that they may increase the risk of pancreatic cancer. We report results from a population-based case-control study of 486 incident cases of pancreatic cancer and 3,596 age- and sex-matched controls. Exposure to chlorination by-products was estimated by linking lifetime residential histories to two different databases containing information on CDBP levels in municipal water supplies. Logistic regression analysis found no evidence of increased pancreatic cancer risk at higher CDBP concentrations (all odds ratios < 1.3). Null findings were also obtained assuming a latency period for pancreatic cancer induction of 3, 8, or 13 years.

Adult↗
PubMed2005

Decreases in occupational exposure to ionizing radiation among Canadian dental workers.

OBJECTIVE: To describe doses of ionizing radiation and their possible associations with mortality rates and cancer incidence among Canadian dental workers. METHODS: The National Dose Registry (NDR) of Canada was used to assess occupational dose of ionizing radiation received by dental workers. The NDR cohort includes 42,175 people classified as dental workers. Subjects in the NDR were linked to both the Canadian Mortality Database and the Canadian Cancer Database to ascertain cause of death and cancer incidence, respectively. RESULTS: The cohort consisted of 9,051 male and 33,124 female dental workers. A total of 656 incident cases of cancer and 558 deaths were observed. The standardized mortality ratio associated with all-cause mortality was 0.53 (90% confidence interval [CI] 0.49-0.57). The incidence of cancer among dental workers was lower than that for the Canadian population for all cancers except melanoma of the skin (for melanoma, the standardized incidence ratio was 1.46 [90% CI 1.14-1.85]). Occupational doses of ionizing radiation among dentists and dental workers have decreased markedly since the 1950s. CONCLUSIONS: Dental workers receive very low doses of ionizing radiation, and these doses do not appear to be associated with any increase in cancer incidence; the increased incidence of melanoma is more likely related to other risk factors such as exposure to ultraviolet radiation from sunlight.

Adult↗
PubMed2004

Effect of short-term exposure to low levels of gaseous pollutants on chronic obstructive pulmonary disease hospitalizations.

We examined the associations between gaseous pollutants and hospitalization for chronic obstructive pulmonary diseases (COPD) among elderly people living in Vancouver, British Columbia, Canada, a city in which ambient air pollution levels are relatively low. We regressed the logarithm of daily counts of acute COPD hospitalization during the 5-year period from 1994 to 1998 on the daily mean levels of each pollutant, after accounting for seasonal and subseasonal fluctuations, non-Poisson dispersion, and weather variables. Nitrogen dioxide and carbon monoxide were significantly associated with hospitalization for COPD, and the magnitude of effects was increased slightly with increasing days of exposure averaging, with the relative risk for a 7-day average being 1.11 (95%CI: 1.04, 1.20) and 1.08 (1.02, 1.13) for nitrogen dioxide and carbon monoxide, respectively. There was no significant association between either sulfur dioxide or ozone and COPD hospitalization. The combined relative risk for all four gaseous pollutants on COPD hospitalization was 1.21. The effects of gaseous pollutants on COPD hospitalization were not significant after adjustment for PM(10), although its inclusion did not have a marked effect on the point estimates for relative risks. Nitrogen dioxide has a significant impact on COPD hospitalization. Further studies are needed to separate the effects of single pollutants from the combined effects of the complex mixture of air pollutants in urban atmospheres.

Aged↗
PubMed2004

Bias due to aggregation of individual covariates in the Cox regression model.

The impact of covariate aggregation, well studied in relation to linear regression, is less clear in the Cox model. In this paper, the authors use real-life epidemiologic data to illustrate how aggregating individual covariate values may lead to important underestimation of the exposure effect. The issue is then systematically assessed through simulations, with six alternative covariate representations. It is shown that aggregation of important predictors results in a systematic bias toward the null in the Cox model estimate of the exposure effect, even if exposure and predictors are not correlated. The underestimation bias increases with increasing strength of the covariate effect and decreasing censoring and, for a strong predictor and moderate censoring, may exceed 20%, with less than 80% coverage of the 95% confidence interval. However, covariate aggregation always induces smaller bias than covariate omission does, even if the two phenomena are shown to be related. The impact of covariate aggregation, but not omission, is independent of the covariate-exposure correlation. Simulations involving time-dependent aggregates demonstrate that bias results from failure of the baseline covariate mean to account for nonrandom changes over time in the risk sets and suggest a simple approach that may reduce the bias if individual data are available but have to be aggregated.

Bias↗
PubMed2004

Gaseous air pollutants and asthma hospitalization of children with low household income in Vancouver, British Columbia, Canada.

Associations of gaseous air pollutants (including carbon monoxide, sulfur dioxide, nitrogen dioxide, and ozone) with asthma hospitalization, stratified by sex and socioeconomic status, were examined among children 6-12 years of age in Vancouver, British Columbia, Canada, between 1987 and 1998. Relative risks for an exposure increment corresponding to the interquartile range for each gaseous air pollutant were estimated for asthma hospitalization after adjustment for weather conditions, including daily maximum and minimum temperatures as well as average relative humidity. Similar results were obtained by using locally weighted smoothing functions (LOESS) with default convergence criteria and by using natural cubic splines with a more stringent setting. Exposures to nitrogen dioxide were found to be significantly and positively associated with asthma hospitalization for males in the low socioeconomic group but not in the high socioeconomic group. For females, this same pattern of association was observed for exposures to sulfur dioxide. No significantly positive associations were found between carbon monoxide and ozone and asthma hospitalization in either low or high socioeconomic groups.

Air Pollutants↗
PubMed2004

Development of acute exposure guideline levels for airborne exposures to hazardous substances.

Hazardous substances can be released into the atmosphere due to industrial and transportation accidents, fires, tornadoes, earthquakes, and terrorists, thereby exposing workers and the nearby public to potential adverse health effects. Various enforceable guidelines have been set by regulatory agencies for worker and ambient air quality. However, these exposure levels generally are not applicable to rare lifetime acute exposures, which possibly could occur at high concentrations. Acute exposure guideline levels (AEGLs) provide estimates of concentrations for airborne exposures for an array of short durations that possibly could cause mild (AEGL-1), severe, irreversible, potentially disabling adverse health effects (AEGL-2), or life threatening effects (AEGL-3). These levels can be useful for emergency responders and planners in reducing or eliminating potential risks to the public. Procedures and methodologies for deriving AEGLs are reviewed in this paper that have been developed in the United States, with direct input from international representatives of OECD member-countries, by the National Advisory Committee for Acute Exposure Guidelines for Hazardous Substances and reviewed by the National Research Council. Techniques are discussed for the extrapolation of effects across different exposure durations. AEGLs provide a viable approach for assisting in the prevention, planning, and response to acute airborne exposures to toxic agents.

Accidents, Occupational↗