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Biomedical subjects

M Krzyzanowski

Publications and source records attributed to M Krzyzanowski.

At least 19 recordsLinked to original sources
PubMed1995

Epidemiologic studies on short-term effects of low levels of major ambient air pollution components.

Since the development of the World Health Organization (WHO) Air Quality Guidelines for Europe, a large number of epidemiologic studies have been published documenting effects of major air pollutants on health at concentrations below existing guidelines and standards. In this review, recent studies are discussed that permit some evaluation of short-term health effects observed at exposure levels lower than the current WHO Guidelines or U.S. Environmental Protection Agency (U.S. EPA) standards. Some studies have been conducted at concentration levels that never exceeded existing guidelines or standards. Other studies have been conducted at exposure levels sometimes exceeding current guidelines or standards. The published analyses of several of these studies permit evaluation of low-level health effects either because analyses were restricted to levels not exceeding the guidelines or graphic analyses were reported suggesting effects at these low levels. For ambient ozone, effects on lung function of subjects exercising outdoors have now been documented at 1-hr maximum levels not exceeding 120 micrograms/m3, i.e., half the current U.S. EPA standard. One study even suggests that such effects occur at levels below 100 micrograms/m3. Several studies are now available documenting effects of particulate air pollution on health in the virtual absence of SO2. Effects on mortality and hospital admissions for asthma have been documented at levels not exceeding 100 micrograms/m3, expressed as 24-hr average inhalable particles PM10 concentration. Effects on lung function, acute respiratory symptoms, and medication use have been found at 24-hr average PM10 levels not exceeding 115 micrograms/m3. When the WHO Air Quality Guidelines and the U.S. EPA standard for PM10 were developed, there were no studies available on health effects of PM10. In this review, we include nine studies documenting health effects of measured PM10 at low levels of exposure, indicating that there is now an entirely new epidemiologic database that can be evaluated in the process of revising current guidelines and standards. The low levels of exposure at which effects on health were seen underscore the urgent need for such reevaluations.

Air Pollutants↗
PubMed1993

Smoking cessation and changes in respiratory symptoms in two populations followed for 13 years.

To investigate the relationship between persistence and incidence rates of respiratory symptoms, and the cessation of cigarette smoking, the data from longitudinal studies conducted in Cracow, Poland and Tucson, USA were analysed jointly. Among 1722 subjects smoking at the beginning of the study, 468 had given up smoking at the 13-year follow-up. The persistence and incidence rates of chronic cough, chronic phlegm, wheeze and attacks of breathlessness were reduced by 50% in ex-smokers compared to the subjects continuing to smoke. The beneficial effects of smoking cessation were decreased in subjects smoking more cigarettes per day in the past and starting to smoke at a younger age. The symptoms were less likely if smoking ceased before the onset of any respiratory disease. These results were similar in the Cracow and Tucson populations, confirming the universal nature of the observations.

Adult↗
PubMed1992

[Studies of methotrexate pharmacokinetics in children with neoplasms of the hematopoietic system after administration of different doses of the drug].

Concentration of MTX was determined in the serum after the infusion of MTX in a dose of 0.5 g/m2, 1.0 g/m2 and 5.0 g/m2 to 24 children with ALL/NHL. The mean value of steady-state concentrations of MTX was two-fold greater after the infusion of a dose of 1.0 g/m2 and ten-fold greater after the infusion of a dose 5.0 g/m2 than at dose 0.5 g/m2. Great inpatient and interpatient variations of serum MTX concentrations were observed. Pharmacokinetic analysis of the data revealed biphasic model of the elimination. Statistically significant differences were found between the half-life MTX values (ti/2 alpha) in the first postinfusion day: the higher the dose, the shorter ti/2 was observed. The ti/2 of MTX during the second postinfusion day was significantly longer than that of the first day after infusion, but values for the higher doses were not significantly shorter than those for 0.5 g/m2. Systemic clearance (Cl) of MTX showed inpatient and interpatient variations of the values. However, no statistically significant difference was found between Cl values at doses of 0.5 g/m2, 1.0 g/m2 and 5.0 g/m2.

Administration, Oral↗
PubMed1992

[Cerebrospinal fluid methotrexate level in children treated with medium-high and high doses of the drug].

Concentrations of MTX were determined in the cerebrospinal fluid (csf) and serum after intravenous infusion of MTX at intermediate dose (0.5-1.0 g/m2) and at high dose (5.0 g/m2) to 20 children (33 infusions) with ALL/NHL. The cytotoxic concentrations of MTX in csf (> 1.0 microM/l) were reached in half of the cases after the infusion of MTX at intermediate dose and in all patients after the infusion of 5.0 g/m2. Great inpatient and interpatient variations of MTX concentrations in csf were observed. No statistically significant difference was found between mean systemic clearance of MTX in patients with MTXcsf concentrations > 1.0 microM/l and < 1.0 microM/l after infusion of MTX at intermediate dose.

Adolescent↗
PubMed1992

Changes in chronic respiratory symptoms in two populations of adults studied longitudinally over 13 years.

Data from two longitudinal studies conducted in Cracow, Poland, and Tucson, Arizona, USA, were used to evaluate the differences in period prevalence, incidence and remission rates of respiratory symptoms between two populations, as well as to assess the between-cities similarities in the relationships of the symptoms to age and smoking habit. The analysis was based on data from 3,082 adult Cracow residents, interviewed twice 13 yrs apart, and from 1,452 Tucson adults, with mean period between initial and final survey of 12.2 yrs. Log-linear models were used to consider possible interactions of the symptoms, age, smoking, gender and city. The relationship of the symptoms to smoking was similar in both cities, after adjustment for age and gender, with at least doubled incidence rates of most symptoms in continuous smokers compared to lifetime nonsmokers. The between-population differences in the symptoms were related to age, indicating onset of bronchitic symptoms occurring earlier in life in Cracow, and of asthmatic symptoms in Tucson. These differences were due to factors other than tobacco smoking e.g. various types of ambient air pollution.

Adult↗
PubMed1991

Respiratory effects of non-tobacco cigarettes: a longitudinal study in general population.

Data from four consecutive surveys of Tucson longitudinal study of airways obstructive disease were used to examine the relation of respiratory symptoms and pulmonary function to non-tobacco cigarette smoking. The surveys were conducted over a six-year period and provided data on 1802 subjects 15-60 years of age, with a total of 5659 individual questionnaires. Estimated odds ratio (OR) of current non-tobacco smoking for chronic cough was 1.73, for chronic phlegm: 1.53, and for wheeze: 2.01 (p less than 0.05). These estimates were adjusted for age, tobacco smoking and occurrence of the symptom in preceding survey. The increased risk of the symptoms was related to the habit continued for several years, and there was no immediate remission of the symptoms after quitting smoking. A significant (p less than 0.05) reduction in pulmonary function (FEV1, Vmax50 and their ratios with FVC) was found a year or more after current non-tobacco smoking was reported. Although the average consumption of non-tobacco cigarettes, believed to be marijuana smoking, was less than one per day, significant effects were still detectable in both pulmonary function and respiratory symptoms.

Adolescent↗
PubMed1991

Risk factors of cardiovascular death in diabetic patients.

In 1974 a cross-sectional study was conducted on 4591 out-patients (2095 males and 2496 females) aged 18-67 years, with diabetes of 1-10 years duration, and cardiovascular fatalities followed for 10 years. A multiple logistic regression was then performed on total cardiovascular deaths, deaths from ischaemic heart disease, and from stroke on selected baseline variables related to the course and control of diabetes, selected symptoms of macroangiopathy, and other risk factors, separately for insulin-treated and non-insulin-treated patients. Hyperglycaemia, proteinuria, arterial hypertension, various symptoms of ischaemic heart disease, age, and current cigarette smoking were found to be important predictors of cardiovascular mortality, more so in non-insulin-treated than in insulin-treated patients. Proteinuria and arterial hypertension carried a greater risk in females than males, but the opposite was true for the signs and symptoms of ischaemic heart disease. Relative body mass was found to correlate inversely with probability of cardiovascular death among insulin-treated males but not in non-insulin-treated males, whereas duration of diabetes was a significant factor only among non-insulin-treated females.

Adult↗
PubMed1991

Relationship of respiratory symptoms and pulmonary function to tar, nicotine, and carbon monoxide yield of cigarettes.

The data from consecutive surveys of the Tucson Epidemiologic Study (1981-1988) were used to evaluate the relationship in cigarette smokers of respiratory symptoms and pulmonary function to tar, nicotine, and carbon monoxide (CO) yields of the cigarette. There were 690 subjects who reported smoking regularly in at least one survey, over age 15. After adjustment for intensity and duration of smoking and for depth of inhalation, the risk of chronic phlegm, cough, and dyspnea were not related to the tar and nicotine yields. In 414 subjects with pulmonary function tested in at least one of the three surveys the spirometric indices used were significantly related to the daily dose of tar, nicotine, and CO (product of the cigarette yield and daily number of cigarettes smoked). The effects were more pronounced for past than for current doses. However, the differentiation of pulmonary function due to various yields of cigarettes was small in comparison to the difference in pulmonary function between smokers and nonsmokers.

Age Factors↗
PubMed1991

The normal range of diurnal changes in peak expiratory flow rates. Relationship to symptoms and respiratory disease.

Measuring peak expiratory flow rates (PEFR) several times a day can provide an objective assessment of functional changes relative to environmental or occupational exposures. This report describes the pattern of diurnal changes in PEFR in a reference population, and defines ranges of "normal" between- and within-day variability. An index of diurnal changes was defined as the ratio between maximal and minimal values, where the maximal value was restricted to PEFR measured at noon or in the evening (N, E) and the minimal value was restricted to the morning or at bedtime (M, B). A ratio greater than normal represented an exaggeration of the normal diurnal pattern in PEFR. Normal limits, based on the ninety-fifth percentile in the reference population, were larger for children (130%) than for adults 15 to 35 yr of age (117%) and those older than 35 yr of age (118%). The meaningfulness of excessive diurnal changes in PEFR was examined by relating this ratio (Max/Min), and a similar measure (the amplitude percent mean) to chronic respiratory symptoms and diseases in 938 adults and children who recorded PEFR values 2 to 4 times per day for as long as 14 days. There was a strong relationship of diurnal changes in PEFR that exceed normal limits with physician-confirmed asthma (relative risk of 2.99 with Max/Min), with exertional dyspnea (Grade 2+), and with more frequent reporting of acute symptoms of wheeze, attacks of wheezing dyspnea, cough, and chest colds. In addition, those exceeding the normal limits had about 2.9 times greater risk of having a FEV1 below 80% of predicted, and nearly 7 times greater risk of being below 70%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Exposure assessment approaches to evaluate respiratory health effects of particulate matter and nitrogen dioxide.

Several approaches can be taken to estimate or classify total personal exposures to air pollutants. While personal exposure monitoring (PEM) provides the most direct measurements, it is usually not practical for extended time periods or large populations. This paper describes the use of indirect approaches to estimate total personal exposure for NO2 and particulate matter (PM), summarizes the distributions of these estimates, and compares the effectiveness of these estimates with microenvironmental concentrations for evaluating effects on respiratory function and symptoms. Pollutant concentrations were measured at several indoor and outdoor locations for over 400 households participating in an epidemiological study in Tucson, Arizona. Central site monitoring data were significantly correlated with samples collected directly outside homes, but the former usually had higher pollutant concentrations. Integrated indices of daily total personal exposure were calculated using micro-environmental (ME) measurements or estimates and time-budget diary information. Peak expiratory flow rates (PEFR) were measured for up to four times a day during two-week study periods. In thirty children (ages 6-15 years) with current diagnosed asthma, a significant reduction in PEFR was associated with NO2 levels measured outside of their homes. Additional decrements of morning PEFR were found in those children sleeping in bedrooms with higher measured NO2 levels. Morning and noon PEFR decrements were also linked to higher morning NO2 levels that were measured at central monitoring stations. Effects of PM were also found, but were limited to morning PEFR. No effects were found in non-asthmatic children. The relationship of PEFR to the calculated indices of daily average total exposure were weaker than to the microenvironment concentrations. This suggests that diary and ME monitoring data need to yield better time resolution in order to incorporate short-term average exposures to higher concentrations into the exposure indices and into the analysis of within day health responses.

Adolescent↗
PubMed1990

The effect of acute broncho-pulmonary infections on the FEV1 change in 13-year follow-up. The Cracow Study.

The aim of this study was to assess the effect of acute bronchitis and pneumonia on the FEV1 decline rate in a random sample of Cracow inhabitants followed over a 13-year period. A total of 718 males and 1029 females completed the spirometric testing and interview in 13-year follow-up period. Acute chest diseases diagnosed and treated by doctors and reported by respondents in surveys were the source of data on broncho-pulmonary infections. The rate of FEV1 change, expressed in ml per year was estimated for each person in 13-year follow-up period. Persons who reported recurrent bronchitis and pneumonia had significantly lower initial FEV1 levels than those without infections. The effect was controlled for confounders like age, height, smoking and chronic chest symptoms. The initial low ventilatory function by itself was not a predisposing factor for chest infections, unless they were associated with chronic respiratory symptoms. Lung function in men decreased steeply after pneumonia infection, but the effect appeared to be reversible. This effect was not limited to people with pre-existing chronic respiratory disease. The data indicated that in some subjects who reported new symptoms of dyspnea on effort, the acceleration of FEV1 decline due to pneumonia was greater than in people without the symptoms. This may result from the fact that in lower respiratory infection, bacterial or viral agents can produce serious dysfunction of small airways.

Acute Disease↗
PubMed1990

Occupational exposure and incidence of chronic respiratory symptoms among residents of Cracow followed for 13 years.

We analyzed the relationship between incidence rates of chronic respiratory symptoms over 13 years and occupational exposure during the first five years of follow-up. The study group contained 1132 males and 1598 females, 19 to 60 years of age, randomly selected from residents of Cracow, Poland. The data was collected in three surveys conducted in 1968, five and 13 years later. Prolonged occupational exposure (i.e. reported in the initial survey and 5 years later) to dusts doubled the odds for the appearance of chronic phlegm and attacks of breathlessness in all men, and of chronic bronchitis in men aged 41 to 50, initially free of the symptom. In women, this exposure doubled the odds for new chronic cough and for chronic bronchitis. Prolonged exposure to chemicals doubled the incidence rates of attacks of breathlessness and dyspnea in all women and of chronic bronchitis in women with the lowest level of education. Prolonged work in variable temperatures doubled the risk of wheeze in women. The effects of discontinuation or start of exposure during the initial 5 years of the study were also seen on the incidence rates of the symptoms but were less pronounced. The detected effects of occupational exposure were not modified by cigarette smoking or living in areas of the city with various levels of air pollution. This longitudinal analysis confirms the results of cross-sectional studies which have indicated deleterious effects of even moderate occupational exposures on respiratory symptoms.

Adult↗
PubMed1990

Chronic respiratory effects of indoor formaldehyde exposure.

The relation of chronic respiratory symptoms and pulmonary function to formaldehyde (HCHO) in homes was studied in a sample of 298 children (6-15 years of age) and 613 adults. HCHO measurements were made with passive samplers during two 1-week periods. Data on chronic cough and phlegm, wheeze, attacks of breathlessness, and doctor diagnoses of chronic bronchitis and asthma were collected with self-completed questionnaires. Peak expiratory flow rates (PEFR) were obtained during the evenings and mornings for up to 14 consecutive days for each individual. Significantly greater prevalence rates of asthma and chronic bronchitis were found in children from houses with HCHO levels 60-120 ppb than in those less exposed, especially in children also exposed to environmental tobacco smoke. In children, levels of PEFR decreased linearly with HCHO exposure, with the estimated decrease due to 60 ppb of HCHO equivalent to 22% of PEFR level in nonexposed children. The effects in asthmatic children exposed to HCHO below 50 ppb were greater than in healthy ones. The effects in adults were less evident: decrements in PEFR due to HCHO over 40 ppb were seen only in the morning, and mainly in smokers.

Adolescent↗
PubMed1990

Longitudinal analysis of the effects of acute lower respiratory illnesses on pulmonary function in an adult population.

The data from a longitudinal population study in Tucson, Arizona, were used to evaluate the effects of acute lower respiratory illnesses on pulmonary function in subjects over 25 years of age. In five of nine surveys performed during the first 13 years of follow-up (1972-1985), similar questions were asked concerning chest colds occurring in the past few years. There were 1,151 men and 1,473 women who had questionnaire and spirometric data collected in at least one of these surveys. The random effects longitudinal model with first-order autoregressive error structure was used in the analysis of changes in pulmonary function after the acute illness episode, adjusted for the effects of age, height, cigarette smoking, and chronic respiratory diseases. The analyses indicated that pulmonary function is reduced for several years after a single chest cold in men and after multiple chest colds in women. After an episode of pneumonia, pulmonary flow indices were reduced, with lower values sometimes persisting for several years.

Adult↗
PubMed1990

Relationships between pulmonary function and changes in chronic respiratory symptoms. Comparison of Tucson and Cracow longitudinal studies.

Parallel analyses of data from two longitudinal studies, one in Poland and one in the United States, were performed to assess the relationships between pulmonary function and respiratory symptoms. Similar relationships were seen in the both cities using the same methods of analysis. The rate of FEV1 decline and its final level were related to the prior presence of attacks of breathlessness or to a syndrome that also included wheezing and diagnosed asthma. Initial FEV1 level was lower in subjects with dyspnea appearing during the follow-up than in the never-symptom group. These relationships were independent of smoking habits. The consistencies in the parallel analyses strengthen the relationships observed. In Tucson, Ariz, the FEV1 decline in smokers with persistent chronic cough was greater than that due to separate effects of the symptom and smoking. This suggests that chronic cough may be an indicator of an increased effect of tobacco smoke on pulmonary function.

Adult↗
PubMed1990

Building materials and risk of leukemia.

Using information data obtained from 958 patients with leukemia and the same number of healthy controls matched for sex, age and place of residence the relative risk of leukemia was calculated in relation to the character of the material from which the building was built where the patients and controls were living. The information on the type of the building materials was obtained by inquiry. Three types of buildings were isolated: buildings built from wood, bricks and concrete or prefabricated products. In the analysis the number of years during which the patients and controls were living in these buildings was considered. No statistically significant correlation was noted between the risk of leukaemia development and the character of the building material. No increase was noted in this probability in relation to the time of living in a building built from any of these building materials. Additional analysis demonstrated that in Poland no so called "leukemic houses" are found, that is houses where during 5 years three of more cases of leukemia occurred.

Adult↗
PubMed1989

A study of the self-perception of being overweight in adult inhabitants of Cracow.

The self-assessment of body weight (normal vs overweight) reported in an interview in a group of 783 men and 1085 women aged 32-83, was compared with weight and height measurements taken a few days after the interview. Among subjects with body mass indices revealing excess weight (over 27 kg/m2 in men and 45 kg/m in women), 24% of men and 15% of women reported having normal body weight. The proportion of overweight persons unaware of their condition was related to age, smoking habit, education and physical activity. In men with hypertension, the proportion of subjects unaware of being overweight was smaller by 25% compared with others. This was not the case in women. A history of cardiovascular disease, diabetes, dyspnea or poor health status had no effect on the awareness of being overweight.

Adult↗