Danish Nurses Research Articles

Danish GPs’ and practice nurses’ management of acute sore throat and adherence to guidelines

Sore throat is a frequent presentation of acute respiratory tract infections in general practice. Though these infections are often harmless and self-limiting, antibiotics are frequently prescribed. In Denmark, practice nurses manage an increasing part of patients with acute minor illnesses. We aimed (i) to investigate Danish practice nurses' and GPs' management of patients presenting with a sore throat and (ii) to explore to what extent management is according to current Danish guidelines. A cross-sectional study was conducted during winter 2017, involving GPs and practice nurses in Danish general practices. Patients with a sore throat were registered according to the Audit Project Odense method. A total of 44 practices participated with the registration of 1503 patients presenting with a sore throat. Most patients had a strep A test performed, especially when managed by a practice nurse (84.6% versus 61.8%, χ2 = 90.1, P < 0.05). In total, 40.6% of performed strep A tests were not according to guideline recommendations. Antibiotics were prescribed for about one-third of patients, regardless whether managed by a practice nurse or a GP (χ2 = 0.33, P = 0.57). However, 32.4% of these prescriptions were not in line with Danish guidelines. Patients with acute sore throat were managed similarly by GPs and practice nurses, apart from a higher use of strep A tests in patients seen by practice nurses. Importantly, this study demonstrated that there is still room for improvement of the management of these patients in Danish general practice.

Formal and informal inter-organizational coordination: How nurses adapt in complex pathways.

With the coordination of health care services becoming increasingly complex, the challenges of fragmentation cannot be solved by administrative restructuring alone. Attention must also be given to the coordination practices of professional groups, and, in this respect, the nursing profession is a particularly interesting case. Based on a qualitative case study of Danish nurses in hospital, municipality, and general practice, this article addresses the following question: How does the nursing profession practice formal and informal inter-organisational coordination in complex pathways, and what is the interplay between the 2 types of coordination? The findings contribute to our knowledge of coordination at the operative level of health care by identifying specific informal practices in inter-organisational coordination and by showing how informal coordination is activated to support formal coordination in a concurrent organisational and professional ambition of integration. The nurses studied here proved very loyal to formal inter-organisational coordination mechanisms, prioritising them as first choices of action. When formal procedures were found insufficient, however, the nurses temporarily switched to informal coordination. This was triggered by random encounters with fragmentation, a strong professional engagement in making things work in the interest of the patient, and a constant striving to be on top of things. Informal inter-organisational coordination is broken down into supplementary and by-passing practices, and 4 specific by-passing practices are identified. The discussion offers insight into how a lack of agency related to formal inter-organisational coordination can be related to negotiated settlements, and informal coordination is considered in terms of "rule bending" within complex systems.

Long-Term Exposure to Traffic Related Noise and Incidence of Diabetes: A Danish Nurse Cohort Study

Background/Aim: Well-established risk factors for diabetes include diet, body mass index and physical activity, all of which are individually modifiable factors. However, recent evidence suggests that environmental factors including road traffic noise and air pollution may affect the risk of developing diabetes. Here we examine whether road traffic noise is associated with diabetes incidence, when accounting for air pollution exposure. Methods: 28,731 female nurses from the Danish Nurse cohort (&gt;44 years old at recruitment in 1993 or 1999) were linked to the Danish Diabetes Register with information on incidence of diabetes from 1995 until 2013. The annual mean weighted levels of 24-hour average road traffic noise (Lden) were modeled with Nord2000. Annual mean concentrations of PM2.5 at residence were modeled with Danish AirGIS system. Cox proportional hazards regression models with age as underlying time was used to examine the association between annual mean Lden at the study baseline (1995 or 1999) and the incidence of diabetes in a model adjusted for lifestyle factors and additionally, for annual mean PM2.5 concentration at the study baseline (1995 or 1999). Results: Of 23,169 nurses free of diabetes at the cohort enrolment, 1,099 developed diabetes during a mean follow-up of 15.2 years. The diabetes risk was increased among those exposed to high (&gt;57 dB) when compared to low (≤ 47 dB) Lden in crude model (hazard ratio (HR); 1.25 (95% confidence interval (CI): 1.06-1.47), and adjusted for diabetes risk factors (1.18; 1.00-1.39). However, the effect of Lden diminished (HR 1.03; 0.86-1.24) when adjusting for PM2.5. In the fully adjusted model, an interquartile range (3.89 µg/m3) increase in PM2.5 was associated with 18% (HR: 1.18, 95% CI: 1.09-1.29) increase in diabetes risk. Conclusions: We detected association between road traffic noise and diabetes risk, but which disappeared after adjustment for PM2.5.

Clinical rationale for administering fentanyl to cancer pain patients: Two Delphi surveys of pain management experts in Denmark

To describe the rationale behind the choice of fentanyl administration forms as reported by Danish nurses and physicians specializing in pain management. Sixty nurses and 60 physicians specializing in pain management in Denmark were contacted via an Internet survey system to perform two Delphi surveys. In the brainstorming phase, the main reasons for administering and not administering fentanyl patches and oral transmucosal fentanyl citrate (OTFC) were identified. In the second phase, the nursing and medical experts rated the importance of these reasons on an 11-point Numerical Rating Scale. Responses from 10 pain nurses and 14 pain doctors were used for the final analysis. Impossible or difficult oral intake of analgesia was the most important reason to administer fenantyl patches, whereas patients' dermatological problems and neuropathic pain origin were the most important reasons for not administering fenantyl patches in both panels. OTFC was presented as an alternative or second choice administration form for breakthrough cancer pain by both nurses and doctors. A damaged mouth, the high cost, and energy required for administration of this medication were reported as the main reasons why OTFC was only rarely prescribed to cancer pain patients in Denmark. The reasons for administering fentanyl in different administration forms reported by Danish pain nurses and pain specialists partly differed from those derived from the literature. Studies of pain management traditions could improve the understanding of the reasons for analgesic administration.

The impact of shift work on intensive care nurses’ lives outside work: A cross‐sectional study

To examine how shift work affects intensive care nurses' lives outside work. Shift work is unavoidable for many nurses. When attempting to minimise negative effects of shift work, it is important to identify areas which affect nurses working shifts. A cross-sectional study. A questionnaire survey among Danish intensive care nurses concerning experiences with shift work and family life, spare time activities, sleep and health. A total of 114 nurses (88%) participated. Shift work was found to influence the opportunities for spare time activities, and about 25% of both evening- and night-shift groups found that working shifts sometimes led to social isolation. A total of 58% of nurses working evening shifts sometimes to very often experienced having trouble falling asleep when working shifts. Night-shift workers had a higher percentage of physical and mental symptoms when working shifts compared with evening-shift workers, with mood swings and headaches being the most common. The median score for thriving on working shifts was 8 (IQR 5-9) for evening-shift workers and 8 (IQR 7-9) for night-shift workers (scale 0-10 with 10 being the highest level of thriving). Shift workers reported that working shifts had a negative impact on life outside work. Opportunities for participating in spare time activities and difficulties falling asleep after shifts were the main issues for evening-shift workers, whereas physical symptoms such as headaches and mood swings were more dominant among night-shift workers. Despite the negative effects, the participants generally thrived on working shifts. By identifying modifiable areas which negatively influence life outside work when working shifts, it will be possible subsequently to plan interventions aimed at decreasing the negative effects. Interventions may include nurses having increased influence on their work schedules and education in sleep hygiene and dietary habits.

Changes in job strain and subsequent weight gain: a longitudinal study, based on the Danish Nurse Cohort.

Obesity as well as job strain is increasing, and job strain might contribute to weight gain. The objective of the current study was to examine associations between longitudinal alterations in the components of job strain and subsequent weight gain. The study was designed as a prospective cohort study with three questionnaire surveys enabling measurement of job-strain alterations over 6 years and subsequent measurements of weight gain after further 10 years of follow-up. ANCOVA and trend analyses were conducted. Job demands were measured as job busyness and speed, and control as amount of influence. Employed nurses in Denmark. We included a sub-sample of 6188 female nurses from the Danish Nurse Cohort, which consisted of the nurses who participated in surveys in 1993, 1999 and 2009. A linear trend in weight gain was seen in nurses who were often busy in 1999 between those who were rarely v. sometimes v. often busy in 1993 (P=0·03), with the largest weight gain in individuals with sustained high busyness in both years. Loss of influence between 1993 and 1999 was associated with larger subsequent weight gain than sustained high influence (P=0·003) or sustained low influence (P=0·02). For speed, no associations were found. Busyness, speed and influence differed in their relationship to subsequent weight gain. A decrease in job influence and a sustained burden of busyness were most strongly related to subsequent weight gain. Focus on job strain reduction and healthy diet is essential for public health.

Patient Transfers and Risk of Back Injury: Protocol for a Prospective Cohort Study With Technical Measurements of Exposure.

BackgroundMore than one third of nurses experience musculoskeletal pain several times during a normal work week. Consistent use of assistive devices during patient transfers is associated with a lower risk of occupational back injuries and low back pain (LBP). While uncertainties exist regarding which type of assistive devices most efficiently prevent LBP, exposure assessments using technological advancements allow for quantification of muscle load and body positions during common work tasks.ObjectiveThe main objectives of this study are (1) to quantify low back and neck/shoulder muscle load in Danish nurses during patient transfers performed with different types of assistive devices, and (2) to combine the exposure profile for each type of assistive device with fortnightly questionnaires to identify the importance of muscle load (intensity and frequency of transfers) and body position (degree of back inclination and frequency) on LBP intensity and risk of back injury during a patient transfer.MethodsA combination of technical measurements (n=50) and a prospective study design (n=2000) will be applied on a cohort of female nurses in Danish hospitals. The technical measurements will be comprised of surface electromyography and accelerometers, with the aim of quantifying muscle load and body positions during various patient transfers, including different types of assistive devices throughout a workday. The study will thereby gather measurements during real-life working conditions. The prospective cohort study will consist of questionnaires at baseline and 1-year follow-up, as well as follow-up via email every other week for one year on questions regarding the frequency of patient transfers, use of assistive devices, intensity of LBP, and back injuries related to patient transfers. The objective measurements on muscle load and body positions during patient handlings will be applied to the fortnightly replies regarding frequency of patient transfer and use of different assistive devices, in order to identify risk factors for back injuries related to patient transfers and intensity of LBP.ResultsData collection is scheduled to commence during the winter of 2017.ConclusionsThe design of this study is novel in its combination of technical measurements applied on a prospective cohort, and the results will provide important information about which assistive devices are associated with intensity of LBP and risk of back injury related to patient transfers. Furthermore, this study will shed light on the dose-response relationship between intensity, duration, and frequency of patient transfers and the intensity of LPB in Danish nurses, and will thereby help to guide and improve electronic health practices among this population.

Active smoking and risk of breast cancer in a Danish nurse cohort study

BackgroundNo scientific consensus has been reached on whether active tobacco smoking causes breast cancer. We examine the association between active smoking and breast cancer risk in Denmark, which has some of the highest smoking and breast cancer rates in women worldwide.MethodsWe used the data from a nationwide Danish Nurse Cohort on 21,867 female nurses (age > 44 years) who at recruitment in 1993 or 1999 reported information on smoking status, onset, duration, and intensity, as well as breast cancer risk factors. We obtained data on incidence of breast cancer from Danish Cancer Registry until 2013, and used Cox regression models to analyze the association between smoking and breast cancer.ResultsOf 21,831 women (mean age 53.2 years) 1162 developed breast cancer during 15.7 years of follow-up. 33.7% of nurses were current and 30.0% former smokers at cohort baseline. Compared to never smokers, we found increased risk of breast cancer of 18% in ever (hazard ratio and 95% confidence interval: 1.18; 1.04–1.34) and 27% in current (1.27; 1.11–1.46) smokers. We detected a dose-response relationship with smoking intensity with the highest breast cancer risk in women smoking >15 g/day (1.31; 1.11–1.56) or >20 pack-years (1.32; 1.12–1.55). Parous women who smoked heavily (>10 pack-years) before first childbirth had the highest risk of breast cancer (1.58; 1.20–2.10). Association between smoking and breast cancer was not modified by menopausal status, obesity, alcohol or hormone therapy use, and seemed to be limited to the estrogen receptor positive breast cancer subtype.ConclusionsActive smoking increases risk of breast cancer, with smoking before first birth being the most relevant exposure window.

Danish Perioperative Nurses’ Documentation: A Complex, Multifaceted Practice Connected With Unit Culture and Nursing Leadership

Researchers have described the documentation practices of perioperative nurses as flawed and characterized by subjectivity and poor quality, which is often related to both the documentation tool and the nurses’ level of commitment. Studies suggest that documentation of nursing care in the OR places special demands on electronic health records (EHRs). The purpose of this study was to explore how the use of an EHR tailored to perioperative practice affects Danish perioperative nurses’ documentation practices. This study was a follow-up to a baseline study from 2014. For three months in the winter of 2015 to 2016, six participants tested an EHR containing a Danish edition of a selected section of the Perioperative Nursing Data Set. This study relied on realistic evaluation and participant observations to generate data. We found that nursing leadership was essential for improving perioperative nurses’ documentation practices and that a tailored EHR may improve documentation practices.

Long-term Exposure to Fine Particulate Matter and Breast Cancer Incidence in the Danish Nurse Cohort Study.

Background: An association between air pollution and breast cancer risk has been suggested, but evidence is sparse and inconclusive.Methods: We included 22,877 female nurses from the Danish Nurse Cohort who were recruited in 1993 or 1999 and followed them for incidence of breast cancer (N = 1,145) until 2013 in the Danish Cancer Register. We estimated annual mean concentrations of particulate matter with diameter <2.5 μg/m3 (PM2.5) and <10 μg/m3 (PM10), and nitrogen dioxide (NO2) at nurses' residences since 1990 using an atmospheric chemistry transport model. We examined the association between the 3-year running mean of each pollutant and breast cancer incidence using a time-varying Cox regression.Results: We found no association between breast cancer and PM2.5 (HR, 0.99; 95% confidence interval, 0.94-1.10 per interquartile range of 3.3 μg/m3), PM10 (1.02; 0.94-1.10 per 2.9 μg/m3), or NO2 (0.99; 0.93-1.05 per 7.4 μg/m3).Conclusions: Air pollution is not associated with breast cancer risk.Impact: Exposure to air pollution in adulthood does not increase the risk of breast cancer, but more data on the effects of early exposure, before first birth, are needed. Cancer Epidemiol Biomarkers Prev; 26(3); 428-30. ©2016 AACR.

Prolonged job strain and subsequent risk of cancer in women – a longitudinal study, based on the Danish Nurse Cohort

Background: The role of psychological stress in cancer risk is continuously debated. Stress at work is the most common form of stress and previous studies have shown inconsistent results regarding cancer risk. In this longitudinal study, we examined the association between prolonged job strain across six years and subsequent cancer risk.Methods and materials: We used data from 6571 cancer-free women from the Danish Nurse Cohort aged 45–70 years at inclusion, and self-reported questionnaires on job strain at baseline in 1993 and again in 1999. Prolonged job strain was defined as high job busyness and speed, and low control in both 1993 and 1999. Information on cancer diagnosis was obtained from the Danish Cancer Registry. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for overall cancer as well as subgroups of virus immune-related, hormone-related, digestive and lung cancers according to level of prolonged job strain. The women were followed from 1 January 2000 until cancer diagnosis, emigration, death or 31 December 2013 (mean follow-up 13 years) and models were adjusted for potential confounders. Effect modification was examined according to working nightshifts and full time.Results: No significant differences in the risk of overall cancer or any of the cancer subgroups were identified in relation to prolonged busyness, speed, influence, or overall job strain. Effect modification by working full time was observed when examining job influence in relation to overall cancer risk, and by working nightshifts when examining job influence in relation to hormone related cancer risk. However, none of the associations were significant in stratified analyses.Conclusion: We found no evidence of an increased risk of any cancer among women with prolonged job strain. Since a large proportion of cancer patients perceive psychological stress as a possible cause of their cancer disease, it is of importance to communicate these findings to the public.

COPD-treating nurses’ preferences for inhaler attributes – a discrete choice experiment

Objective: To assess nurses’ preferences for various attributes of chronic obstructive pulmonary disease (COPD) inhalation devices in order to obtain information about the relative importance of the different attributes and their assigned levels.Methods: Data from a web-based questionnaire among Danish nurses who treat patients with COPD (accomplished in the spring/summer of 2015) was used. A total of 222 nurses completed the questionnaire which was based on discrete choice experiment (DCE) methodology. The probability of choosing an alternative from a number of choices in a discrete choice game was estimated by means of the conditional logit model.Results: The two most important attributes according to the COPD-treating nurses were “Indicator when empty” and “Inspiratory flow rate”. In addition, the nurses considered the attribute “Obvious that dose is given” important. The three least-valued attributes were frequency of doses, whether the inhaler requires fine motor skills and whether it requires hand strength.Conclusion: Inhalation devices can be classified into five categories, where the soft mist inhaler (SMI) includes the three most important attributes among its characteristics.Limitations: The study sample size does not allow for subgroup analysis, which would have been valuable. The questionnaire design gives an indication of nurses’ preferences and it is assumed that these are similar to real life choices, but the current study cannot conclude on the nurses’ actual choices.

Self-rated health and cancer risk – a prospective cohort study among Danish women

Background: Self-rated health (SRH) has been shown to be a strong predictor of mortality from a number of major chronic diseases, however, the association with cancer remains unclear. The aim of this study was to investigate a possible association between change in SRH and cancer incidence.Materials and methods: SRH and information on lifestyle and other risk factors were obtained for 13–636 women in the Danish Nurse Cohort. Cancers that developed during 12 years of follow-up were identified in the National Patient Registry. An association between SRH and cancer was examined in a Cox proportional hazards model with adjustment for age, smoking, alcohol, marital status, physical activity, body mass index and estrogen replacement therapy.Results: No significant association was found between SRH and overall cancer incidence in the age-adjusted Cox proportional hazards model (1.04; 95% CI 0.93–1.16), even after adjustment for potential confounding factors (HR 1.08; 95% CI 0.96–1.21). Likewise, there was no significant association between SRH and breast cancer (HR 1.09; 95% CI 0.89–1.33), lung cancer (HR 1.03; 95% CI 0.71–1.49) or colon cancer (HR 1.08; 95% CI 0.75–1.54).Conclusion: SRH is not significantly associated with the incidence of all cancers or breast, lung or colon cancer among Danish female nurses. Women who reported a decrease in SRH between 1993 and 1999 had the same risk for cancer as those who reported unchanged or improved SRH.

Long-term Exposure to Ambient Air Pollution and Incidence of Brain Cancer: The Danish Nurse Cohort

Introduction: Experimental studies suggest that traffic-related ultrafine particles can cross blood-brain barrier leading to neurotoxicity and development of brain tumors in animals, but epidemiological evidence in humans is sparse. We examine association between long-term exposure to air pollution and incidence of brain cancer, for the first time with particulate matter with diameter &lt; 2.5 (PM2.5). Methods: For 28,731 nurses (age ≥ 44 years) from the Danish Nurse Cohort, recruited in 1993 or 1999, we obtained data on brain cancer incidence until 2013 from Danish Cancer Register, and estimated levels of PM2.5, particulate matter with diameter &lt;10 µm (PM10), nitrogen oxides (NOx) and nitrogen dioxide (NO2) at residence since 1990 using a dispersion model. We examined association between 3-year running mean of pollutants and brain tumor incidence using a time-varying Cox regression, separately for total brain cancer, and for subtypes by location (brain or meninges) and malignancy (malignant or benign). Results: Of 25,143 cancer-free nurses at recruitment 121 developed brain tumor during 15.7 years of follow-up. We found weak positive association between total brain cancer and PM2.5 (Hazard Ratio: 1.06; 95% Confidence Interval: 0.80-1.40) per interquartile range (IQR, 3.37 µg/m3) and NO2 (1.09; 0.91-1.29) per 7.5 µg/m3 and none with NOx or PM10. Associations with PM2.5 and NO2 were stronger for tumor located in meninges than in brain, and for benign than for malignant tumors. Finally, associations of total brain cancer with PM2.5 were modified by body mass index and were statistically significantly enhanced in obese women (2.03; 1.35-3.05). Conclusion: We found weak evidence of association between long-term exposure to PM2.5 and development of brain cancer in women older than 44 years. Findings of relevance of air pollution for meninges and benign tumors, as well that obese women may be most susceptible, requires further investigation.

Long-term Exposure to Fine Particulate Matter and Breast Cancer Incidence: the Danish Nurse Cohort

Long-term Exposure to Fine Particulate Matter and Breast Cancer Incidence: the Danish Nurse Cohort

Physical activity, air pollution and the risk of diabetes in two Danish cohorts

Introduction: Physical activity reduces the risk of diabetes, whereas air pollution increases it. In this study, we examined if air pollution modified the association between physical activity and diabetes. Methods: Data were available from the Danish Diet, Cancer and Health Cohort (DHC) and the Danish Nurse Cohort (DNC), which collected information about lifestyle habits at cohort baseline in 1993-1997 and 1993-99. Both cohorts were linked to the National Danish Diabetes Registers for diabetes status during follow up. Exposure to air pollution was based on estimated levels of NO2 and PM2.5 at baseline residence. Cox proportional hazard model was used to explore the association between physical activity and diabetes and evaluate the interaction between physical activity and air pollution. Results: Out of 51,084 diabetes-free participants in DCH cohort at baseline, 4,996 developed diabetes during an average follow-up of 14.3 years. Out of 18,803 diabetes-free participants at baseline in DNC, 811 developed diabetes during a mean follow-up of 15.5 years. Similarly, in the DCH, a statistically significant inverse association was found between diabetes incidence and participating in sport (adjusted Hazard Ratio (HR)=0.71; 95% CI:0.67-0.76), cycling (0.83; 0.78-0.88) and gardening (0.82; 0.77-0.87), when compared to not performing these activities. In the DNC we found statistically significant between diabetes incidence and high (0.38; 0.29-0.50) and medium (0.54; 0.42-0.68) levels, as compared to low level of physical activity. No significant interaction was found between any type of physical activity and air pollution in either cohort. Conclusions: Leisure-time and transport-related physical activity was found to be inversely associated with diabetes incidence. Long-term exposure to air pollution did not modify the association between physical activity and diabetes. Physical activity should be recommended for prevention of diabetes even in urban areas with air pollution.

Long-term exposure to Ambient Air Pollution and Incidence of Lung Cancer: The Danish Nurse Cohort.

Introduction: In 2013, IARC classified outdoor air pollution as carcinogenic to humans. Evidence from several epidemiological studies suggests that exposure to particulate matter contributes the development of lung cancer, however some studies also indicate that the association may be restricted to or stronger in highly polluted areas, and less prominent in countries with moderate exposure levels. In this study we examine association between long-term exposure to air pollution and incidence of lung cancer in Denmark. Methods: For 28,731 nurses (age ≥ 44 years) from the Danish Nurse Cohort, recruited in 1993 or 1999, we obtained data on lung cancer incidence until 2013 from Danish Cancer Register, and estimated levels of particulate matter with diameter &lt; 2.5 (PM2.5), &lt; 10 (PM10), nitrogen oxides (NOx) and nitrogen dioxide (NO2) at residence since 1990 using a dispersion model. We examined association between 3-year running mean of pollutants and lung cancer incidence using time-varying Cox regression. Results: Of 23,892 cancer-free nurses at recruitment, 246 developed lung cancer during 15.6 years of follow-up. We found no association between the development of lung cancer and exposure to PM2.5 (Hazard Ratio: 0.86; 95% Confidence Interval: 0.78-1-18, per interquartile range (IQR) of 3.36 µg/m3), PM10 (0.98; 0.81-1.19, IQR 3.29 µg/m3), NO2 (0.97; 0.84-1.11, IQR 7.47 µg/m3) or NOx (1.01; 0.95-1.08 IQR 10.21 µg/m3). Conclusion: We found no evidence of an association between long-term exposure to PM2.5, PM10, NO2 or NOx and development of lung cancer in Danish adult women.

Long-term exposure to ambient air pollution and incidence of brain tumours: The Danish Nurse Cohort

BackgroundAir pollution has been considered a potent environmental risk factor for neuropathology through neuroinflammation and oxidative stress, which might also cause brain tumour formation. However, epidemiological evidence on the association between air pollution and brain tumours in humans is sparse, with no data on exposure to particles. In this study we aim to examine associations between long-term exposure to ambient air pollution and risk for development of brain tumours. MethodsWe used the Danish Nurse Cohort with 28,731 female nurses (age≥44years) recruited in 1993 or 1999 when self-reported information on lifestyle was collected. We obtained data on the incidence of brain tumours until 2013 from the Danish Cancer Register, and estimated annual mean concentrations of particulate matter with diameter<2.5μm (PM2.5), particulate matter with diameter<10μm (PM10), nitrogen oxides (NOx) and nitrogen dioxide (NO2) at the residence since 1990 using an atmospheric integrated chemistry-transport models system, and examined the association between the 3-year running mean of pollutants and brain tumour incidence using time-varying Cox regression, separately for total brain tumours, and for tumour subtypes by location (brain or meninges), and by malignancy (malignant or benign), and estimated hazard ratios and 95% confidence intervals per increase in interquartile range of exposure. ResultsOf 25,143 tumour-free nurses at recruitment, 121 developed brain cancer during 15.7 years of follow-up. We found a weak positive association between total brain tumours and PM2.5 (1.06; 0.80–1.40 per 3.37μg/m3), NO2 (1.09; 0.91–1.29) per 7.5μg/m3, and NOx (1.02; 0.93–1.12 per 10.22μg/m3), and none with PM10 (0.93; 0.70–1.23 per 3.31μg/m3). Associations with PM2.5 and NO2 were stronger for tumours located in meninges than in brain, and for benign than for malignant tumours. Finally, association of total brain tumours with PM2.5 was modified by BMI, and was statistically significantly enhanced in obese women (2.03; 1.35–3.05). ConclusionWe found weak evidence for association between risk of brain tumours and long-term exposure to air pollution in women older than 44 years. However, we present novel results that obese women may be susceptible, as well as a positive tendency towards elevated risk for meninges and benign tumours, which require further investigation.

Long-term exposure to fine particulate matter and incidence of diabetes in the Danish Nurse Cohort

Aims/hypothesisIt has been suggested that air pollution may increase the risk of type 2 diabetes but data on particulate matter with diameter <2.5μm (PM2.5) are inconsistent. We examined the association between long-term exposure to PM2.5 and diabetes incidence. MethodsWe used the Danish Nurse Cohort with 28,731 female nurses who at recruitment in 1993 or 1999 reported information on diabetes prevalence and risk factors, and obtained data on incidence of diabetes from National Diabetes Register until 2013. We estimated annual mean concentrations of PM2.5, particulate matter with diameter <10μm (PM10), nitrogen oxides (NOx) and nitrogen dioxide (NO2) at their residence since 1990 using a dispersion model and examined the association between the 5-year running mean of pollutants and diabetes incidence using a time-varying Cox regression. ResultsOf 24,174 nurses 1137 (4.7%) developed diabetes. We detected a significant positive association between PM2.5 and diabetes incidence (hazard ratio; 95% confidence interval: 1.11; 1.02–1.22 per interquartile range of 3.1μg/m3), and weaker associations for PM10 (1.06; 0.98–1.14 per 2.8μg/m3), NO2 (1.05; 0.99–1.12 per 7.5μg/m3), and NOx (1.01; 0.98–1.05 per 10.2μg/m3) in fully adjusted models. Associations with PM2.5 persisted in two-pollutant models. Associations with PM2.5 were significantly enhanced in never smokers (1.24; 1.09–1.42), and augmented in obese (1.25; 1.06–1.47) and subjects with myocardial infarction (1.32; 0.86–2.02), but without significant interaction. Conclusions/interpretationFine particulate matter may the most relevant pollutant for diabetes development among women, and non-smokers, obese women, and heart disease patients may be most susceptible.

A tribute to Merry Scheel and her Interactional Nursing Practice Theory.

A tribute to Merry Scheel and her Interactional Nursing Practice Theory.