Testing the reliability and effectiveness of a new tool for assessing urban blue spaces:The BlueHealth environmental assessment tool (BEAT)

In order to understand how blue spaces may influence health-promoting behaviours, a reliable and effective assessment tool is needed. The Blue Health Environment Assessment Tool (BEAT) was developed to meet this need. A two-stage approach to testing the reliability of the tool is presented here. At Stage-1, one common and several different expert assessors rated 16 sites independently and their results compared. In Stage-2, two assessors rated 21 sites independently and their results were compared. The Inter-class correlation coefficient (ICC) was calculated to assess inter-rater reliability to both stages. Stage-2 results showed greater reliability after enhanced training of the assessors. To demonstrate the effectiveness of the tool at revealing differences between sites and for identifying health promoting affordances we carried out intra and inter-site comparisons of a subset of six sites for the Stage-1 and 18 sites for Stage-2. The results showed that overall the tool performs consistently and compares well to the reliability shown by other similar tools. The tool is also highly effective in identifying site-specific differences across the test sample of blue spaces. The results demonstrate that the tool can be used reliably (with training and guidance) and that it provides meaningful data to help planners and designers assess different sites

General health and residential proximity to the coast in Belgium : results from a cross-sectional health survey

The health risks of coastal areas have long been researched, but the potential benefits for health are only recently being explored. The present study compared the general health of Belgian citizens a) according to the EU's definition of coastal ( 50 km), and b) between eight more refined categories of residential proximity to the coast ( 250 km). Data was drawn from the Belgian Health Interview Survey (n = 60,939) and investigated using linear regression models and mediation analyses on several hypothesized mechanisms. Results indicated that populations living 50-100 km. Four commonly hypothesized mechanisms were considered but no indirect associations were found: scores for mental health, physical activity levels and social contacts were not higher at 0-5 km from the coast, and air pollution (PM ic , concentrations) was lower at 0-5 km from the coast but not statistically associated with better health. Results are controlled for typical variables such as age, sex, income, neighbourhood levels of green and freshwater blue space, etc. The spatial urban-rural-nature mosaic at the Belgian coast and alternative explanations are discussed. The positive associations between the ocean and human health observed in this study encourage policy makers to manage coastal areas sustainably to maintain associated public health benefits into the future

The development of a tool for assessing the environmental qualities of urban blue spaces

It is well established that outdoor natural environments - or green spaces - have the potential to serve as therapeutic landscapes and are a public health resource. Less is known about the extent to which “water-related environments (blue spaces) - may benefit health. As with green space, health benefits resulting from blue space use probably depend on place quality. However, the lack of comparable environmental quality data hampers planning and design of blue spaces and their inclusion in public health-related policies. This paper presents a novel tool - the BlueHealth Environmental Assessment Tool (BEAT) - which enables comparable assessment of environmental aspects and attributes that influence access to, use of and health-promoting activities in blue spaces. The tool is based on a review of published evidence and rigorous evaluation of 28 existing place assessment tools developed by and used in different disciplines including urban and transport planning, landscape architecture and management, urban design and public health. The environmental attributes identified were assessed using a place affordance-affect scale based on their relevance to the interaction between the environment and human behaviour. This provided a framework for extracting those environmental variables especially relevant to blue spaces and for health determinants. These were incorporated into the BEAT as a set of domains each comprising several physical, social, aesthetic and environmental aspects. The BEAT uses a questionnaire-based approach to examine each domain and aspect and to obtain both qualitative and quantitative measures using experience and judgment by either experts or stakeholders. The tool is freely available via an online interface featuring comprehensive guidance for assessors and a means of presenting results graphically. The tool can be used to compare sites before and after design interventions at a site. The BEAT enables rigorous and comparable assessment of the environment and strengthens the role of evidence-based planning in the development of urban blue spaces as a public health resource

Health benefits of physical activity related to an urban riverside regeneration

The promotion of physical activity through better urban design is one pathway by which health and well-being improvements can be achieved. This study aimed to quantify health and health-related economic impacts associated with physical activity in an urban riverside park regeneration project in Barcelona, Spain. We used data from Barcelona local authorities and meta-analysis assessing physical activity and health outcomes to develop and apply the “Blue Active Tool”. We estimated park user health impacts in terms of all-cause mortality, morbidity (ischemic heart disease; ischemic stroke; type 2 diabetes; cancers of the colon and breast; and dementia), disability-adjusted life years (DALYs) and health-related economic impacts. We estimated that 5753 adult users visited the riverside park daily and performed different types of physical activity (walking for leisure or to/from work, cycling, and running). Related to the physical activity conducted on the riverside park, we estimated an annual reduction of 7.3 deaths (95% CI: 5.4; 10.2), and 6.2 cases of diseases (95% CI: 2.0; 11.6). This corresponds to 11.9 DALYs (95% CI: 3.4; 20.5) and an annual health-economic impact of 23.4 million euros (95% CI: 17.2 million; 32.8 million). The urban regeneration intervention of this riverside park provides health and health-related economic benefits to the population using the infrastructure

A Transdisciplinary Approach to Recovering Natural and Cultural Landscape and Place Identification : A Case Study of Can Moritz Spring (Rubí, Spain)

Altres ajuts: Mireia Gascon holds a Miguel Servet fellowship (Grant CP19/00183) funded by Acción Estratégica de Salud-Instituto de Salud Carlos III, co-funded by the European Social Fund "Investing in your future". ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation through the "Centro de Excelencia Severo Ochoa 2019-2023" Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program.The perception of the quality of green and blue spaces can be key in the relationship between a community and its local landscape (i.e., place identification). The lack of transdisciplinary training and social-specific education of landscape architects regarding the complexity of landscape as a participative cultural artefact limits reaching the general population. Bridging this gap of landscape and place identification and evaluation by a local community was the main objective of the present case study conducted at an abandoned spring and seasonal stream area in Rubí (Spain). The "Steinitz method" of landscape evaluation was used as a participatory method to activate community members to learn about and express their visual preferences regarding this neglected landscape. Bottom-up interventions applying an "urban acupuncture" approach in the area identified as the least attractive by the residents were co-designed and combined with a top-down restoration of a nearby, existing but derelict and hidden, spring. In addition, before and after planning and implementing the intervention, we conducted surveys about the community perception, sense of belonging and use of the space. We observed that the lack of awareness of the inhabitants about this spring was an obstacle preventing the community from embracing the potential for health and wellbeing presented by the spring and adjacent landscape. Following the work, the landscape saw increasing use, and the historic spring was brought back to life as a resource to help people to improve their health and wellbeing

Chlorination Disinfection By-Products in Drinking Water and Congenital Anomalies: Review and Meta-Analyses

This study aims to review epidemiologic evidence of the association between exposure to chlorination disinfection by-products (DBPs) and congenital anomalies. All epidemiologic studies that evaluated a relationship between an index of DBP exposure and risk of congenital anomalies were analyzed. For all congenital anomalies combined, the meta-analysis gave a statistically significant excess risk for high versus low exposure to water chlorination or TTHM (17%; 95% CI, 3-34) based on a small number of studies. The meta-analysis also suggested a statistically significant excess risk for ventricular septal defects (58%; 95% CI, 21-107), but based on only three studies, and there was little evidence of an exposure-response relationship. It was observed no statistically significant relationships in the other meta-analyses and little evidence for publication bias, except for urinary tract defects and cleft lip and palate. Although some individual studies have suggested an association between chlorination disinfection by-products and congenital anomalies, meta-analyses of all currently available studies demonstrate little evidence of such association

Applying an ecosystem services framework on nature and mental health to recreational blue space visits across 18 countries

The effects of ‘nature’ on mental health and subjective well-being have yet to be consistently integrated into ecosystem service models and frameworks. To address this gap, we used data on subjective mental well-being from an 18-country survey to test a conceptual model integrating mental health with ecosystem services, initially proposed by Bratman et al. We analysed a range of individual and contextual factors in the context of 14,998 recreational visits to blue spaces, outdoor environments which prominently feature water. Consistent with the conceptual model, subjective mental well-being outcomes were dependent upon on a complex interplay of environmental type and quality, visit characteristics, and individual factors. These results have implications for public health and environmental management, as they may help identify the bluespace locations, environmental features, and key activities, that are most likely to impact well-being, but also potentially affect recreational demand on fragile aquatic ecosystems

Air pollution and attention in Polish schoolchildren with and without ADHD

Background: Development and functioning of attention—a key component of human cognition—can be affected by en vironmental factors. We investigated whether long- and short-term exposure to particulate matter with aerodynamic diameter < 10 μm (PM10) and nitrogen dioxide (NO2) are related to attention in 10- to 13-year-old children living in Polish towns recruited in the NeuroSmog case-control study. Methods: We investigated associations between air pollution and attention separately in children with attention deficit hyperactivity disorder (ADHD, n = 187), a sensitive, at-risk population with impaired attention and in population based typically developing children (TD, n = 465). Alerting, orienting, and executive aspects of attention were mea sured using the attention network test (ANT), while inhibitory control was measured with the continuous performance test (CPT). We assessed long-term exposure to NO2 and PM10 using novel hybrid land use regression (LUR) models. Short-term exposures to NO2 and PM10 were assigned to each subject using measurements taken at the air pollution monitoring station nearest to their home address. We tested associations for each exposure-outcome pair using adjusted linear and negative binomial regressions. Results: We found that long-term exposures to both NO2 and PM10 were associated with worse visual attention in chil dren with ADHD. Short-term exposure to NO2 was associated with less efficient executive attention in TD children and more errors in children with ADHD. It was also associated with shorter CPT response times in TD children; however, this effect was accompanied by a trend towards more CPT commission errors, suggestive of more impulsive performance in these subjects. Finally, we found that short-term PM10 exposure was associated with fewer omission errors in CPT in TD children. Conclusions: Exposure to air pollution, especially short-term exposure to NO2, may have a negative impact on attention in children. In sensitive populations, this impact might be different than in the general population

Environmental risk factors of pregnancy outcomes: A summary of recent meta-analyses of epidemiological studies.

Background Various epidemiological studies have suggested associations between environmental exposures and pregnancy outcomes. Some studies have tempted to combine information from various epidemiological studies using meta-analysis. We aimed to describe the methodologies used in these recent meta-analyses of environmental exposures and pregnancy outcomes. Furthermore, we aimed to report their main findings. Methods We conducted a bibliographic search with relevant search terms. We obtained and evaluated 16 recent meta-analyses. Results The number of studies included in each reported meta-analysis varied greatly, with the largest number of studies available for environmental tobacco smoke. Only a small number of the studies reported having followed meta-analysis guidelines or having used a quality rating system. Generally they tested for heterogeneity and publication bias. Publication bias did not occur frequently. The meta-analyses found statistically significant negative associations between environmental tobacco smoke and stillbirth, birth weight and any congenital anomalies; PM2.5 and preterm birth; outdoor air pollution and some congenital anomalies; indoor air pollution from solid fuel use and stillbirth and birth weight; polychlorinated biphenyls (PCB) exposure and birth weight; disinfection by-products in water and stillbirth, small for gestational age and some congenital anomalies; occupational exposure to pesticides and solvents and some congenital anomalies; and agent orange and some congenital anomalies. Conclusions The number of meta-analyses of environmental exposures and pregnancy outcomes is small and they vary in methodology. They reported statistically significant associations between environmental exposures such as environmental tobacco smoke, air pollution and chemicals and pregnancy outcomes

Risk of lung cancer mortality in nuclear workers from internal exposure to alpha particle-emitting radionuclides

BACKGROUND: Carcinogenic risks of internal exposures to alpha-emitters (except radon) are poorly understood. Since exposure to alpha particles-particularly through inhalation-occurs in a range of settings, understanding consequent risks is a public health priority. We aimed to quantify dose-response relationships between lung dose from alpha-emitters and lung cancer in nuclear workers. METHODS: We conducted a case-control study, nested within Belgian, French, and UK cohorts of uranium and plutonium workers. Cases were workers who died from lung cancer; one to three controls were matched to each. Lung doses from alpha-emitters were assessed using bioassay data. We estimated excess odds ratio (OR) of lung cancer per gray (Gy) of lung dose. RESULTS: The study comprised 553 cases and 1,333 controls. Median positive total alpha lung dose was 2.42 mGy (mean: 8.13 mGy; maximum: 316 mGy); for plutonium the median was 1.27 mGy and for uranium 2.17 mGy. Excess OR/Gy (90% confidence interval)-adjusted for external radiation, socioeconomic status, and smoking-was 11 (2.6, 24) for total alpha dose, 50 (17, 106) for plutonium, and 5.3 (-1.9, 18) for uranium. CONCLUSIONS: We found strong evidence for associations between low doses from alpha-emitters and lung cancer risk. The excess OR/Gy was greater for plutonium than uranium, though confidence intervals overlap. Risk estimates were similar to those estimated previously in plutonium workers, and in uranium miners exposed to radon and its progeny. Expressed as risk/equivalent dose in sieverts (Sv), our estimates are somewhat larger than but consistent with those for atomic bomb survivors.See video abstract at, http://links.lww.com/EDE/B232