In the HYENA study (HYpertension and Exposure to Noise near Airports) noise annoyances due to aircraft and road traffic noise were assessed in subjects that lived in the vicinity of 6 major European ...airports using the 11-point ICBEN scale (International Commission on Biological Effects of Noise). A distinction was made between the annoyance during the day and during the night.
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den and
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night were considered as indicators of noise exposure. Pooled data analyses showed clear exposure–response relationships between the noise level and the noise annoyance for both exposures. The exposure–response curves for road noise were congruent with the EU standard curves used for predicting the number of highly noise annoyed subjects in European communities. Annoyance ratings due to aircraft noise, however, were higher than predicted by the EU standard curves. The data supports other findings suggesting that the people's attitude towards aircraft noise has changed over the years, and that the EU standard curve for aircraft noise should be modified.
Sickle cell disease is an increasing global health burden. This inherited disease is characterized by a remarkable phenotypic heterogeneity, which can only partly be explained by genetic factors. ...Environmental factors are likely to play an important role but studies of their impact on disease severity are limited and their results are often inconsistent. This study investigated associations between a range of environmental factors and hospital admissions of young patients with sickle cell disease in London and in Paris between 2008 and 2012. Specific analyses were conducted for subgroups of patients with different genotypes and for the main reasons for admissions. Generalized additive models and distributed lag non-linear models were used to assess the magnitude of the associations and to calculate relative risks. Some environmental factors significantly influence the numbers of hospital admissions of children with sickle cell disease, although the associations identified are complicated. Our study suggests that meteorological factors are more likely to be associated with hospital admissions for sickle cell disease than air pollutants. It confirms previous reports of risks associated with wind speed (risk ratio: 1.06/standard deviation; 95% confidence interval: 1.00-1.12) and also with rainfall (1.06/standard deviation; 95% confidence interval: 1.01-1.12). Maximum atmospheric pressure was found to be a protective factor (0.93/standard deviation; 95% confidence interval: 0.88-0.99). Weak or no associations were found with temperature. Divergent associations were identified for different genotypes or reasons for admissions, which could partly explain the lack of consistency in earlier studies. Advice to patients with sickle cell disease usually includes avoiding a range of environmental conditions that are believed to trigger acute complications, including extreme temperatures and high altitudes. Scientific evidence to support such advice is limited and sometimes confusing. This study shows that environmental factors do explain some of the variations in rates of admission to hospital with acute symptoms in sickle cell disease, but the associations are complex, and likely to be specific to different environments and the individual's exposure to them. Furthermore, this study highlights the need for prospective studies with large numbers of patients and standardized protocols across Europe.
Several studies have reported significant health effects of air pollution even at low levels of air pollutants, but in most of theses studies linear nonthreshold relations were assumed. We ...investigated the exposure-response association between ambient particles and mortality in the 22 European cities participating in the APHEA (Air Pollution and Health-A European Approach) project, which is the largest available European database. We estimated the exposure-response curves using regression spline models with two knots and then combined the individual city estimates of the spline to get an overall exposure-response relationship. To further explore the heterogeneity in the observed city-specific exposure-response associations, we investigated several city descriptive variables as potential effect modifiers that could alter the shape of the curve. We conclude that the association between ambient particles and mortality in the cities included in the present analysis, and in the range of the pollutant common in all analyzed cities, could be adequately estimated using the linear model. Our results confirm those previously reported in Europe and the United States. The heterogeneity found in the different city-specific relations reflects real effect modification, which can be explained partly by factors characterizing the air pollution mix, climate, and the health of the population.
Background: Particulate air pollution is associated with increased mortality. There is a need for European results from multicountry databases concerning cause-specific mortality to obtain more ...accurate effect estimates. Methods: We report the estimated effects of ambient particle concentrations (black smoke and particulate matter less than 10 μm PM₁₀) on cardiovascular and respiratory mortality, from 29 European cities, within the Air Pollution and Health: a European Approach (APHEA2) project. We applied a 2-stage hierarchical modeling approach assessing city-specific effects first and then overall effects. City characteristics were considered as potential effect modifiers. Results: An increase in PM₁₀ by 10 μg/m³ (lag 0 + 1) was associated with increases of 0.76% (95% confidence interval = 0.47 to 1.05%) in cardiovascular deaths and 0.58% (0.21 to 0.95%) in respiratory deaths. The same increase in black smoke was associated with increases of 0.62% (0.35 to 0.90%) and 0.84% (0.11 to 1.57%), respectively. Conclusions: These effect estimates are appropriate for health impact assessment and standard-setting procedures.
The number of ultrafine particles in urban air may be more health relevant than the usually measured mass of particles smaller than 2.5 or 10
μm. Epidemiological studies typically assess exposure by ...measurements at a central site. Limited information is available about how well measurements at a central site reflect exposure to ultrafine particles.
The goals of this paper are to assess the relationships between particle number (PN) and mass concentrations measured outdoors at a central site, right outside and inside the study homes. The study was conducted in four European cities: Amsterdam, Athens, Birmingham and Helsinki. Particle mass (PM
10 and PM
2.5), PN, soot and sulfate concentrations were measured at these sites. Measurements of indoors and outdoors near the home were made during 1 week in 152, mostly non-smoking, homes. In each city continuous measurements were also performed at a central site during the entire study period.
The correlation between 24-h average central site outdoor and indoor concentrations was lower for PN (correlation among cities ranged from 0.18 to 0.45) than for PM
2.5 (0.40–0.80), soot (0.64–0.92) and sulfate (0.91–0.99). In Athens, the indoor–central site correlation was similar for PN and PM
2.5. Infiltration factors for PN and PM
2.5 were lower than for sulfate and soot. Night-time hourly average PN concentrations showed higher correlations between indoor and central site, implying that indoor sources explained part of the low correlation found for 24-h average concentrations.
Measurements at a central site may characterize indoor exposure to ambient particles less well for ultrafine particles than for fine particle mass, soot and sulfate.
Exposure to air pollution, especially from particulate matter, is generally
accepted to be one of the most important public health problems in Europe and
worldwide. The effects caused in the general ...population are associated with
relatively small relative risks, but if the ubiquity of exposure is
considered, the attributable number of events is large. Furthermore, there is
evidence that the effects in sensitive population subgroups (such as the
elderly, those with chronic diseases and children) are stronger. Within large
European Union funded collaborative projects (such as the Air Pollution and
Health: a European Approach-APHEA), effect modification by geographical
characteristics has been investigated and it was found that in warmer
countries, in locations where particles come from traffic and where the
proportion of the elderly is greater, particle toxicity is increased. These
characteristics are particularly relevant to Southern European locations.
From other projects we know that meteorological, climatic, environmental and
socioeconomic factors are effect modifiers of the effects of specific air
pollutants. In this presentation we will show the evidence on the short-term
health effects of particulate and gaseous air pollutants and emphasize
particularly results concerning southern Europe and potential effect
modifiers. The gaps in knowledge and the need to study air pollution in
Southern European countries more extensively will be demonstrated. To conduct
useful research, good quality air pollution and health data are needed.
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Previous time series or panel studies of asthmatics have reported respiratory health effects following short-term exposure to ozone (O
). We followed 186 children aged 10 years old in Athens and ...Thessaloniki, Greece for 5 weeks during the academic year 2013-2014 and recorded daily their respiratory symptoms, absenteeism and peak expiratory flow (PEF). We applied mixed models controlling for various possible confounders to investigate the daily associations between O
exposure - derived from weekly personal and fixed school site measurements calibrated using daily values of the fixed monitoring site nearest to the child's school location - and PEF, presence of any symptom, cough and stuffy nose, as well as absenteeism. We tested the robustness of our findings to varying modeling assumptions and confounders and investigated effect modification patterns by medication use, time spent outdoors and prevalence of asthma. A 10 μg/m
increase in O
personal exposure was associated with increased odds of any symptom (odds ratio (OR): 1.19, 95% confidence interval (CI): 0.98, 1.44), largely attributed to the increase in the odds of stuffy nose (OR: 1.23, 95% CI: 1.00, 1.51). PEF and absenteeism were not related to O
exposure. Our results were robust to several sensitivity analyses. Effects were modified by medication use as presence of symptoms but also decreases in PEF were mainly reported among non-users, while our effect estimates were not driven by the asthmatic subgroup of children. Our findings indicate that short-term O
exposure may be associated with respiratory symptoms extending previously reported results for asthmatics to the general population.
We present the results of the Air Pollution and Health: A European Approach 2 (APHEA2) project on short-term effects of ambient particles on mortality with emphasis on effect modification. We used ...daily measurements for particulate matter less than 10 μm in aerodynamic diameter ( PM10) and/or black smoke from 29 European cities. We considered confounding from other pollutants as well as meteorologic and chronologic variables. We investigated several variables describing the cities' pollution, climate, population, and geography as potential effect modifiers. For the individual city analysis, generalized additive models extending Poisson regression, using a smoother to control for seasonal patterns, were applied. To provide quantitative summaries of the results and explain remaining heterogeneity, we applied second-stage regression models. The estimated increase in the daily number of deaths for all ages for a 10 μ g/ m3increase in daily PM10or black smoke concentrations was 0.6% 95% confidence interval (CI) = 0.4-0.8%, whereas for the elderly it was slightly higher. We found important effect modification for several of the variables studied. Thus, in a city with low average NO2, the estimated increase in daily mortality for an increase of 10 μ g/ m3in PM10was 0.19 (95% CI = 0.00-0.41), whereas in a city with high average NO2it was 0.80% (95% CI = 0.67-0.93%); in a relatively cold climate the corresponding effect was 0.29% (95% CI = 0.16-0.42), whereas in a warm climate it was 0.82% (95% CI = 0.69-0.96); in a city with low standardized mortality rate it was 0.80% (95% CI = 0.65-0.95%), and in one with a high rate it was 0.43% (95% CI = 0.24-0.62). Our results confirm those previously reported on the effects of ambient particles on mortality. Furthermore, they show that the heterogeneity found in the effect parameters among cities reflects real effect modification, which is explained by specific city characteristics.
The association between heat and daily mortality and its temporal variation are well known. However, few studies have analyzed the inter-annual variations in both the risk estimates and impacts of ...heat. The aim is to estimate inter-annual variations in the effect of heat for a fixed temperature range, on mortality in 9 European cities included in the PHASE (Public Health Adaptation Strategies to Extreme weather events) project for the period 1990-2010. The second aim is to evaluate overall summer effects and heat-attributable deaths for each year included in the study period, considering the entire air temperature range (both mild and extreme temperatures).
A city-specific daily time-series analysis was performed, using a generalized additive Poisson regression model, restricted to the warm season (April-September). To study the temporal variation for a fixed air temperature range, a Bayesian Change Point analysis was applied to the relative risks of mortality for a 2 °C increase over the 90th percentile of the city-specific distribution. The number of heat attributable deaths in each summer were also calculated for mild (reference to 95th percentile) and extreme heat (95th percentile to maximum value).
A decline in the effects of heat over time was observed in Athens and Rome when considering a fixed interval, while an increase in effects was observed in Helsinki. The greatest impact of heat in terms of attributable deaths was observed in the Mediterranean cities (Athens, Barcelona and Rome) for extreme air temperatures. In the other cities the impact was mostly related to extreme years with 2003 as a record breaking year in Paris (+ 1900 deaths) and London (+ 1200 deaths).
Monitoring the impact of heat over time is important to identify changes in population vulnerability and evaluate adaptation measures.
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