Impacts of highway traffic exhaust in alpine valleys on the respiratory health in adults: a cross-sectional study

BACKGROUND: Most studies having shown respiratory health effects from traffic exhaust were conducted in urban areas with a complex mixture of air pollution sources. This study has investigated the potential impact of traffic exhaust on respiratory symptoms among adults living along a Swiss alpine highway corridor, where traffic exhaust from the respective trans-Alpine highway is the predominant source of air pollution. METHODS: In summer 2005, we recruited 1839 adults aged 15 to 70 from a random sample of 10 communities along the Swiss alpine highway corridors. Subjects answered a questionnaire on respiratory health (asthmatic and bronchitic symptoms), risk factors, and potential confounding variables. We used logistic regression models to assess associations between respiratory symptoms and traffic exposure being defined a) as living within 200 m of the highway, and b) as a bell-shaped function simulating the decrease of pollution levels with increasing distance to the highway. RESULTS: Positive associations were found between living close to a highway and wheezing without cold (OR = 3.10, 95%-CI: 1.27-7.55) and chronic cough (OR = 2.88, 95%-CI: 1.17-7.05). The models using a bell-shaped function suggested that symptoms reached background levels after 400-500 m from the highway. The association with chronic cough was driven by a subgroup reporting hay fever or allergic rhinitis. CONCLUSIONS: Highway traffic exhaust in alpine highway corridors, in the absence of other industrial sources, showed negative associations with the respiratory health of adults, higher than those previously found in urban areas

A school-based physical activity program to improve health and fitness in children aged 6–13 years ("Kinder-Sportstudie KISS"): study design of a randomized controlled trial [ISRCTN15360785]

BACKGROUND: Childhood obesity is the result of a long lasting imbalance between energy intake and energy expenditure. A major contributing factor is physical inactivity which is closely linked to bone health, cardiovascular disease risk, fitness and psychological factors. The school seems to provide an excellent setting to enhance levels of physical activity (PA). However, there is insufficient data from previous school-based intervention trials on how to enhance overall PA. It is also unknown whether an intervention aimed at increasing PA is effective in improving the children's health. The purpose of this paper is to outline the design of a school-based randomized, controlled trial (RCT) aiming to increase overall PA and to improve fitness and health in 6- to 13-year-old children. METHODS/DESIGN: 15 schools were randomized to the intervention (n = 9) or the control (n = 6) group, stratified by geographic region (urban vs. rural) and by age (1(st )and 5(th )grade). Participation was given for all children in the intervention group since in this group the intervention was part of the normal school curriculum. The intervention during one academic year consisted of: 1. two additional physical education classes per week given by trained physical education teachers adding up to a total of five PA classes per week, 2. short PA breaks (2–5 min each) during academic lessons, 3. PA home work, and 4. adaptation of recreational areas around the school. All children underwent anthropometric measurements, blood pressure assessment, fitness testing, measurement of PA and they filled out questionnaires. At least 70% of all children agreed to blood sampling and measurements of body composition and bone mineral measurements by dual energy x-ray absorptiometry. The primary endpoints of the study after one year were an increase in total PA by accelerometry, an increase in aerobic fitness measured by the 20 m shuttle run, a decrease in percent body fat derived from skinfold measurements and an increase in quality of life as assessed by the child health questionnaire in the intervention group compared to the control group. Secondary outcomes were overall fitness, differences in body composition including body fat distribution, cardiovascular risk factors, psychosocial health, bone mineral content and density of femur, lumbar spine and total body and food intake. DISCUSSION: Our preliminary data suggest that the children were representative of Swiss children with respect to sex, socio-demographic status, and body mass index. Short-term results can be expected by the beginning of 2007. We hypothesized that our intervention will lead to an increase in PA, fitness and overall health. Based on our data, we aim to provide important information regarding the influence of such an intervention on these outcome measures in school-aged children and to provide nationwide guidelines to improve PA in children

Meta-analysis identifies seven susceptibility loci involved in the atopic March

Eczema often precedes the development of asthma in a disease course called the a 'atopic march'. To unravel the genes underlying this characteristic pattern of allergic disease, we conduct a multi-stage genome-wide association study on infantile eczema followed by childhood asthma in 12 populations including 2,428 cases and 17,034 controls. Here we report two novel loci specific for the combined eczema plus asthma phenotype, which are associated with allergic disease for the first time; rs9357733 located in EFHC1 on chromosome 6p12.3 (OR 1.27; P=2.1 × 10 a'8) and rs993226 between TMTC2 and SLC6A15 on chromosome 12q21.3 (OR 1.58; P=5.3 × 10 a'9). Additional susceptibility loci identified

Rule-Based Models of the Interplay between Genetic and Environmental Factors in Childhood Allergy

Peer reviewe

Comparison of Trial Participants and Open Access Users of a Web-Based Physical Activity Intervention Regarding Adherence, Attrition, and Repeated Participation

Background: Web-based interventions are popular for promoting healthy lifestyles such as physical activity. However, little is known about user characteristics, adherence, attrition, and predictors of repeated participation on open access physical activity websites. Objective: The focus of this study was Active-online, a Web-based individually tailored physical activity intervention. The aims were (1) to assess and compare user characteristics and adherence to the website (a) in the open access context over time from 2003 to 2009, and (b) between trial participants and open access users; and (2) to analyze attrition and predictors of repeated use among participants in a randomized controlled trial compared with registered open access users. Methods: Data routinely recorded in the Active-online user database were used. Adherence was defined as: the number of pages viewed, the proportion of visits during which a tailored module was begun, the proportion of visits during which tailored feedback was received, and the time spent in the tailored modules. Adherence was analyzed according to six one-year periods (2003-2009) and according to the context (trial or open access) based on first visits and longest visits. Attrition and predictors of repeated participation were compared between trial participants and open access users. Results: The number of recorded visits per year on Active-online decreased from 42,626 in 2003-2004 to 8343 in 2008-2009 (each of six one-year time periods ran from April 23 to April 22 of the following year). The mean age of users was between 38.4 and 43.1 years in all time periods and both contexts. The proportion of women increased from 49.5% in 2003-2004 to 61.3% in 2008-2009 (P< .001). There were differences but no consistent time trends in adherence to Active-online. The mean age of trial participants was 43.1 years, and 74.9% were women. Comparing contexts, adherence was highest for registered open access users. For open access users, adherence was similar during the first and the longest visits; for trial participants, adherence was lower during the first visits and higher during the longest visits. Of registered open access users and trial participants, 25.8% and 67.3% respectively visited Active-online repeatedly (P< .001). Predictors of repeated use were male sex (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.04-1.38) and increasing age category in registered open access users, and age 46-60 versus < 30 years (OR = 3.04, 95% CI = 1.25-7.38) and Swiss nationality (ORnonSwiss= 0.64, 95% CI = 0.41-1.00) in trial participants. Despite reminder emails, attrition was much higher in registered open access users compared with trial participants, with a median lifetime website usage of 0 days in open access users and 290 days in trial participants. Conclusions: Adherence, patterns of use, attrition, and repeated participation differed between trial participants and open access users. Reminder emails to encourage repeated participation were effective for trial participants but not for registered open access users. These issues are important when interpreting results of randomized controlled effectiveness trials

Simulation of population-based commuter exposure to NO2 using different air pollution models

We simulated commuter routes and long-term exposure to traffic-related air pollution during commute in a representative population sample in Basel (Switzerland), and evaluated three air pollution models with different spatial resolution for estimating commute exposures to nitrogen dioxide (NO2) as a marker of long-term exposure to traffic-related air pollution. Our approach includes spatially and temporally resolved data on actual commuter routes, travel modes and three air pollution models. Annual mean NO2 commuter exposures were similar between models. However, we found more within-city and within-subject variability in annual mean (±SD) NO2 commuter exposure with a high resolution dispersion model (40 ± 7 µg m-3, range: 21-61) than with a dispersion model with a lower resolution (39 ± 5 µg m-3; range: 24-51), and a land use regression model (41 ± 5 µg m-3; range: 24-54). Highest median cumulative exposures were calculated along motorized transport and bicycle routes, and the lowest for walking. For estimating commuter exposure within a city and being interested also in small-scale variability between roads, a model with a high resolution is recommended. For larger scale epidemiological health assessment studies, models with a coarser spatial resolution are likely sufficient, especially when study areas include suburban and rural areas

The relevance of commuter and work/school exposure in an epidemiological study on traffic-related air pollution

Exposure during transport and at non-residential locations is ignored in most epidemiological studies of traffic-related air pollution. We investigated the impact of separately estimating NO2 long-term outdoor exposures at home, work/school, and while commuting on the association between this marker of exposure and potential health outcomes. We used spatially and temporally resolved commuter route data and model-based NO2 estimates of a population sample in Basel, Switzerland, to assign individual NO2-exposure estimates of increasing complexity, namely (1) home outdoor concentration; (2) time-weighted home and work/school concentrations; and (3) time-weighted concentration incorporating home, work/school and commute. On the basis of their covariance structure, we estimated the expectable relative differences in the regression slopes between a quantitative health outcome and our measures of individual NO2 exposure using a standard measurement error model. The traditional use of home outdoor NO2 alone indicated a 12% (95% CI: 11-14%) underestimation of related health effects as compared with integrating both home and work/school outdoor concentrations. Mean contribution of commuting to total weekly exposure was small (3.2%; range 0.1-13.5%). Thus, ignoring commute in the total population may not significantly underestimate health effects as compared with the model combining home and work/school. For individuals commuting between Basel-City and Basel-Country, ignoring commute may produce, however, a significant attenuation bias of 4% (95% CI: 4-5%). Our results illustrate the importance of including work/school locations in assessments of long-term exposures to traffic-related air pollutants such as NO2. Information on individuals' commuting behavior may further improve exposure estimates, especially for subjects having lengthy commutes along major transportation routes

Exposure to environmental microorganisms and childhood asthma

BACKGROUND: Children who grow up in environments that afford them a wide range of microbial exposures, such as traditional farms, are protected from childhood asthma and atopy. In previous studies, markers of microbial exposure have been inversely related to these conditions. METHODS: In two cross-sectional studies, we compared children living on farms with those in a reference group with respect to the prevalence of asthma and atopy and to the diversity of microbial exposure. In one study--PARSIFAL (Prevention of Allergy-Risk Factors for Sensitization in Children Related to Farming and Anthroposophic Lifestyle)--samples of mattress dust were screened for bacterial DNA with the use of single-strand conformation polymorphism (SSCP) analyses to detect environmental bacteria that cannot be measured by means of culture techniques. In the other study--GABRIELA (Multidisciplinary Study to Identify the Genetic and Environmental Causes of Asthma in the European Community [GABRIEL] Advanced Study)--samples of settled dust from children's rooms were evaluated for bacterial and fungal taxa with the use of culture techniques. RESULTS: In both studies, children who lived on farms had lower prevalences of asthma and atopy and were exposed to a greater variety of environmental microorganisms than the children in the reference group. In turn, diversity of microbial exposure was inversely related to the risk of asthma (odds ratio for PARSIFAL, 0.62; 95% confidence interval [CI], 0.44 to 0.89; odds ratio for GABRIELA, 0.86; 95% CI, 0.75 to 0.99). In addition, the presence of certain more circumscribed exposures was also inversely related to the risk of asthma; this included exposure to species in the fungal taxon eurotium (adjusted odds ratio, 0.37; 95% CI, 0.18 to 0.76) and to a variety of bacterial species, including Listeria monocytogenes, bacillus species, corynebacterium species, and others (adjusted odds ratio, 0.57; 95% CI, 0.38 to 0.86). CONCLUSIONS: Children living on farms were exposed to a wider range of microbes than were children in the reference group, and this exposure explains a substantial fraction of the inverse relation between asthma and growing up on a farm. (Funded by the Deutsche Forschungsgemeinschaft and the European Commission.)

Exposure to environmental microorganisms and childhood asthma

BACKGROUND: Children who grow up in environments that afford them a wide range of microbial exposures, such as traditional farms, are protected from childhood asthma and atopy. In previous studies, markers of microbial exposure have been inversely related to these conditions. METHODS: In two cross-sectional studies, we compared children living on farms with those in a reference group with respect to the prevalence of asthma and atopy and to the diversity of microbial exposure. In one study--PARSIFAL (Prevention of Allergy-Risk Factors for Sensitization in Children Related to Farming and Anthroposophic Lifestyle)--samples of mattress dust were screened for bacterial DNA with the use of single-strand conformation polymorphism (SSCP) analyses to detect environmental bacteria that cannot be measured by means of culture techniques. In the other study--GABRIELA (Multidisciplinary Study to Identify the Genetic and Environmental Causes of Asthma in the European Community [GABRIEL] Advanced Study)--samples of settled dust from children's rooms were evaluated for bacterial and fungal taxa with the use of culture techniques. RESULTS: In both studies, children who lived on farms had lower prevalences of asthma and atopy and were exposed to a greater variety of environmental microorganisms than the children in the reference group. In turn, diversity of microbial exposure was inversely related to the risk of asthma (odds ratio for PARSIFAL, 0.62; 95% confidence interval [CI], 0.44 to 0.89; odds ratio for GABRIELA, 0.86; 95% CI, 0.75 to 0.99). In addition, the presence of certain more circumscribed exposures was also inversely related to the risk of asthma; this included exposure to species in the fungal taxon eurotium (adjusted odds ratio, 0.37; 95% CI, 0.18 to 0.76) and to a variety of bacterial species, including Listeria monocytogenes, bacillus species, corynebacterium species, and others (adjusted odds ratio, 0.57; 95% CI, 0.38 to 0.86). CONCLUSIONS: Children living on farms were exposed to a wider range of microbes than were children in the reference group, and this exposure explains a substantial fraction of the inverse relation between asthma and growing up on a farm. (Funded by the Deutsche Forschungsgemeinschaft and the European Commission.)