Green Space Visits among Adolescents: Frequency and Predictors in the PIAMA Birth Cohort Study.

Green space may influence health through several pathways, for example, increased physical activity, enhanced social cohesion, reduced stress, and improved air quality. For green space to increase physical activity and social cohesion, spending time in green spaces is likely to be important

The effect of the urban exposome on COVID-19 health outcomes: A systematic review and meta-analysis

BACKGROUND: The global severity of SARS-CoV-2 illness has been associated with various urban characteristics, including exposure to ambient air pollutants. This systematic review and meta-analysis aims to synthesize findings from ecological and non-ecological studies to investigate the impact of multiple urban-related features on a variety of COVID-19 health outcomes. METHODS: On December 5, 2022, PubMed was searched to identify all types of observational studies that examined one or more urban exposome characteristics in relation to various COVID-19 health outcomes such as infection severity, the need for hospitalization, ICU admission, COVID pneumonia, and mortality. RESULTS: A total of 38 non-ecological and 241 ecological studies were included in this review. Non-ecological studies highlighted the significant effects of population density, urbanization, and exposure to ambient air pollutants, particularly PM 2.5. The meta-analyses revealed that a 1 μg/m 3 increase in PM 2.5 was associated with a higher likelihood of COVID-19 hospitalization (pooled OR 1.08 (95% CI:1.02-1.14)) and death (pooled OR 1.06 (95% CI:1.03-1.09)). Ecological studies, in addition to confirming the findings of non-ecological studies, also indicated that higher exposure to nitrogen dioxide (NO 2), ozone (O 3), sulphur dioxide (SO 2), and carbon monoxide (CO), as well as lower ambient temperature, humidity, ultraviolet (UV) radiation, and less green and blue space exposure, were associated with increased COVID-19 morbidity and mortality. CONCLUSION: This systematic review has identified several key vulnerability features related to urban areas in the context of the recent COVID-19 pandemic. The findings underscore the importance of improving policies related to urban exposures and implementing measures to protect individuals from these harmful environmental stressors

Green space, air pollution, traffic noise and mental wellbeing throughout adolescence: Findings from the PIAMA study

BACKGROUND: Green space, air pollution and traffic noise exposure may be associated with mental health in adolescents. We assessed the associations of long-term exposure to residential green space, ambient air pollution and traffic noise with mental wellbeing from age 11 to 20 years. METHODS: We included 3059 participants of the Dutch PIAMA birth cohort who completed the five-item Mental Health Inventory (MHI-5) at ages 11, 14, 17 and/or 20 years. We estimated exposure to green space (the average Normalized Difference Vegetation Index (NDVI) and percentages of green space in circular buffers of 300 m, 1000 m and 3000 m), ambient air pollution (particulate matter (PM10 and PM2.5), nitrogen dioxide, PM2.5 absorbance and the oxidative potential of PM2.5) and road traffic and railway noise (Lden) at the adolescents' home addresses at the times of completing the MHI-5. Associations with poor mental wellbeing (MHI-5 score ≤ 60) were assessed by generalized linear mixed models with a logit link, adjusting for covariates. RESULTS: The odds of poor mental wellbeing at age 11 to 20 years decreased with increasing exposure to green space in a 3000 m buffer (adjusted odds ratio (OR) 0.78 [95% CI 0.68-0.88] per IQR increase in the average NDVI; adjusted OR 0.77 [95% CI 0.67-0.88] per IQR increase in the total percentage of green space). These associations persisted after adjustment for air pollution and road traffic noise. Relationships between mental wellbeing and green space in buffers of 300 m and 1000 m were less consistent. Higher air pollution exposure was associated with higher odds of poor mental wellbeing, but these associations were strongly attenuated after adjustment for green space in a buffer of 3000 m, traffic noise and degree of urbanization. Traffic noise was not related to mental wellbeing throughout adolescence. CONCLUSIONS: Residential exposure to green space may be associated with a better mental wellbeing in adolescents

Identifying risk factors for COPD and adult-onset asthma: an umbrella review

BACKGROUND: COPD and adult-onset asthma (AOA) are the most common noncommunicable respiratory diseases. To improve early identification and prevention, an overview of risk factors is needed. We therefore aimed to systematically summarise the nongenetic (exposome) risk factors for AOA and COPD. Additionally, we aimed to compare the risk factors for COPD and AOA. METHODS: In this umbrella review, we searched PubMed for articles from inception until 1 February 2023 and screened the references of relevant articles. We included systematic reviews and meta-analyses of observational epidemiological studies in humans that assessed a minimum of one lifestyle or environmental risk factor for AOA or COPD. RESULTS: In total, 75 reviews were included, of which 45 focused on risk factors for COPD, 28 on AOA and two examined both. For asthma, 43 different risk factors were identified while 45 were identified for COPD. For AOA, smoking, a high body mass index (BMI), wood dust exposure and residential chemical exposures, such as formaldehyde exposure or exposure to volatile organic compounds, were amongst the risk factors found. For COPD, smoking, ambient air pollution including nitrogen dioxide, a low BMI, indoor biomass burning, childhood asthma, occupational dust exposure and diet were amongst the risk factors found. CONCLUSIONS: Many different factors for COPD and asthma have been found, highlighting the differences and similarities. The results of this systematic review can be used to target and identify people at high risk for COPD or AOA

Medication use in uncontrolled pediatric asthma:Results from the SysPharmPediA study

Background: Uncontrolled pediatric asthma has a large impact on patients and their caregivers. More insight into determinants of uncontrolled asthma is needed. We aim to compare treatment regimens, inhaler techniques, medication adherence and other characteristics of children with controlled and uncontrolled asthma in the: Systems Pharmacology approach to uncontrolled Paediatric Asthma (SysPharmPediA) study. Material and methods: 145 children with moderate to severe doctor-diagnosed asthma (91 uncontrolled and 54 controlled) aged 6–17 years were enrolled in this multicountry, (Germany, Slovenia, Spain, and the Netherlands) observational, case-control study. The definition of uncontrolled asthma was based on asthma symptoms and/or exacerbations in the past year. Patient-reported adherence and clinician-reported medication use were assessed, as well as lung function and inhalation technique. A logistic regression model was fitted to assess determinants of uncontrolled pediatric asthma. Results: Children in higher asthma treatment steps had a higher risk of uncontrolled asthma (OR (95%CI): 3.30 (1.56–7.19)). The risk of uncontrolled asthma was associated with a larger change in FEV1% predicted post and pre-salbutamol (OR (95%CI): 1.08 (1.02–1.15)). Adherence and inhaler techniques were not associated with risk of uncontrolled asthma in this population. Conclusion: This study showed that children with uncontrolled moderate-to-severe asthma were treated in higher treatment steps compared to their controlled peers, but still showed a higher reversibility response to salbutamol. Self-reported adherence and inhaler technique scores did not differ between controlled and uncontrolled asthmatic children. Other determinants, such as environmental factors and differences in biological profiles, may influence the risk of uncontrolled asthma in this moderate to severe asthmatic population

The disease-specific clinical trial network for primary ciliary dyskinesia: PCD-CTN

Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by impaired mucociliary clearance leading to irreversible lung damage. In contrast to other rare lung diseases like cystic fibrosis (CF), there are only few clinical trials and limited evidence-based treatments. Management is mainly based on expert opinions and treatment is challenging due to a wide range of clinical manifestations and disease severity. To improve clinical and translational research and facilitate development of new treatments, the clinical trial network for PCD (PCD-CTN) was founded in 2020 under the framework of the European Reference Network (ERN)-LUNG PCD Core. Applications from European PCD sites interested in participating in the PCD-CTN were requested. Inclusion criteria consisted of patient numbers, membership of ERN-LUNG PCD Core, use of associated standards of care, experience in PCD and/or CF clinical research, resources to run clinical trials, good clinical practice (GCP) certifications and institutional support. So far, applications from 22 trial sites in 18 European countries have been approved, including >1400 adult and >1600 paediatric individuals with PCD. The PCD-CTN is headed by a coordinating centre and consists of a steering and executive committee, a data safety monitoring board and committees for protocol review, training and standardisation. A strong association with patient organisations and industrial companies are further cornerstones. All participating trial sites agreed on a code of conduct. As CTNs from other diseases have demonstrated successfully, this newly formed PCD-CTN operates to establish evidence-based treatments for this orphan disease and to bring new personalised treatment approaches to patients

Panel studies of air pollution in patients with COPD : Systematic review and meta-analysis

BACKGROUND: Epidemiological studies have shown an increase in morbidity and mortality rates in patients with chronic obstructive pulmonary disease (COPD) following exposure to elevated levels of air pollution. Panel studies have been used to assess short-term effects of air pollution which are not detected by registry studies, specifically lung function and symptoms. The aim of this systematic review was to assess the evidence of panel studies on acute effects of air pollution among patients with COPD. METHODS: We searched the PubMed database, and identified additional studies by inspecting reference lists and literature reviews. We identified and summarized 25 panel studies that were published between 1993 and February 2016. Results were presented in forest plots and effect estimates of sufficiently comparable outcomes and pollutants were summarized by a random-effects meta-analysis. RESULTS: Meta-analysis showed that a 10µg/m(3) increase in ambient levels of particles less than 10µm in diameter (PM10) had a small, but statistically significant impact on FEV1 (-3.38mL, 95% CI -6.39 to -0.37) and PEF (-0.61L/min, -1.20 to -0.01). There was significant heterogeneity across the included studies. A forest plot showing associations between PM10 and respiratory symptoms was also suggestive of an adverse effect of particulate air pollution, but this was not formally tested in a meta-analysis due to the heterogeneity of outcomes. Results for gaseous pollutants were inconsistent for lung function or symptoms. CONCLUSIONS: Evidence from the identified panel studies indicated statistically significant associations of particulate matter air pollution with lung function in patients with COPD

Panel studies of air pollution in patients with COPD : Systematic review and meta-analysis

BACKGROUND: Epidemiological studies have shown an increase in morbidity and mortality rates in patients with chronic obstructive pulmonary disease (COPD) following exposure to elevated levels of air pollution. Panel studies have been used to assess short-term effects of air pollution which are not detected by registry studies, specifically lung function and symptoms. The aim of this systematic review was to assess the evidence of panel studies on acute effects of air pollution among patients with COPD. METHODS: We searched the PubMed database, and identified additional studies by inspecting reference lists and literature reviews. We identified and summarized 25 panel studies that were published between 1993 and February 2016. Results were presented in forest plots and effect estimates of sufficiently comparable outcomes and pollutants were summarized by a random-effects meta-analysis. RESULTS: Meta-analysis showed that a 10µg/m(3) increase in ambient levels of particles less than 10µm in diameter (PM10) had a small, but statistically significant impact on FEV1 (-3.38mL, 95% CI -6.39 to -0.37) and PEF (-0.61L/min, -1.20 to -0.01). There was significant heterogeneity across the included studies. A forest plot showing associations between PM10 and respiratory symptoms was also suggestive of an adverse effect of particulate air pollution, but this was not formally tested in a meta-analysis due to the heterogeneity of outcomes. Results for gaseous pollutants were inconsistent for lung function or symptoms. CONCLUSIONS: Evidence from the identified panel studies indicated statistically significant associations of particulate matter air pollution with lung function in patients with COPD

Effects of exposure to surrounding green, air pollution and traffic noise with non-accidental and cause-specific mortality in the Dutch national cohort.

We followed approximately 10.5 million adults (aged ≥ 30 years) living in the Netherlands from 1 January 2013 until 31 December 2018. We used Cox proportional hazard models to evaluate associations of residential surrounding green (including the average Normalized Difference Vegetation Index (NDVI) in buffers of 300 and 1000 m), annual average ambient air pollutant concentrations [including particulate matter (PM2.5), nitrogen dioxide (NO2)] and traffic noise with non-accidental and cause-specific mortality, adjusting for potential confounders

Effects of exposure to surrounding green, air pollution and traffic noise with non-accidental and cause-specific mortality in the Dutch national cohort

BACKGROUND: Everyday people are exposed to multiple environmental factors, such as surrounding green, air pollution and traffic noise. These exposures are generally spatially correlated. Hence, when estimating associations of surrounding green, air pollution or traffic noise with health outcomes, the other exposures should be taken into account. The aim of this study was to evaluate associations of long-term residential exposure to surrounding green, air pollution and traffic noise with mortality. METHODS: We followed approximately 10.5 million adults (aged ≥ 30 years) living in the Netherlands from 1 January 2013 until 31 December 2018. We used Cox proportional hazard models to evaluate associations of residential surrounding green (including the average Normalized Difference Vegetation Index (NDVI) in buffers of 300 and 1000 m), annual average ambient air pollutant concentrations [including particulate matter (PM2.5), nitrogen dioxide (NO2)] and traffic noise with non-accidental and cause-specific mortality, adjusting for potential confounders. RESULTS: In single-exposure models, surrounding green was negatively associated with all mortality outcomes, while air pollution was positively associated with all outcomes. In two-exposure models, associations of surrounding green and air pollution attenuated but remained. For respiratory mortality, in a two-exposure model with NO2 and NDVI 300 m, the HR of NO2 was 1.040 (95%CI: 1.022, 1.059) per IQR increase (8.3 µg/m3) and the HR of NDVI 300 m was 0.964 (95%CI: 0.952, 0.976) per IQR increase (0.14). Road-traffic noise was positively associated with lung cancer mortality only, also after adjustment for air pollution or surrounding green. CONCLUSIONS: Lower surrounding green and higher air pollution were associated with a higher risk of non-accidental and cause-specific mortality. Studies including only one of these correlated exposures may overestimate the associations with mortality of that exposure