Publications by authors named "Alexandra Schneider"

145 Publications

Sex/Gender-Differences in the Health Effects of Environmental Noise Exposure on Hypertension and Ischemic Heart Disease-A Systematic Review.

Int J Environ Res Public Health 2021 Sep 18;18(18). Epub 2021 Sep 18.

Institute of Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.

Previous studies have demonstrated cardiovascular health effects of environmental noise exposure, partly showing different effect estimates for males and females. This cannot be explained by biological differences between males and females alone. It is assumed that health outcomes and exposure patterns also depend on gender, determined by social, economic, and cultural factors in society. This systematic review evaluated the current state of how sex/gender is integrated in studies on environmental noise associated with hypertension, blood pressure, and ischemic heart diseases. A systematic literature search was conducted in three different databases, identifying thirty studies published between 1 January 2000 and 2 February 2020. Effects varied, with no consistent findings for both males and females. All studies used a binary operationalization of sex/gender, assuming static differences between males and females. The differentiation between biological and social dimensions of sex/gender was not present in any of the studies and the terms "sex" and "gender" were used interchangeably. However, biological and social dimensions of sex/gender were unconsciously taken up in the discussion of the results. Integrating sex/gender-theoretical concepts into future studies offers great potential to increase the validity of research findings, thus making them more useful for prevention efforts, health promotion, and health care.
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http://dx.doi.org/10.3390/ijerph18189856DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8465564PMC
September 2021

Mortality risk attributable to wildfire-related PM pollution: a global time series study in 749 locations.

Lancet Planet Health 2021 09;5(9):e579-e587

Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Background: Many regions of the world are now facing more frequent and unprecedentedly large wildfires. However, the association between wildfire-related PM and mortality has not been well characterised. We aimed to comprehensively assess the association between short-term exposure to wildfire-related PM and mortality across various regions of the world.

Methods: For this time series study, data on daily counts of deaths for all causes, cardiovascular causes, and respiratory causes were collected from 749 cities in 43 countries and regions during 2000-16. Daily concentrations of wildfire-related PM were estimated using the three-dimensional chemical transport model GEOS-Chem at a 0·25° × 0·25° resolution. The association between wildfire-related PM exposure and mortality was examined using a quasi-Poisson time series model in each city considering both the current-day and lag effects, and the effect estimates were then pooled using a random-effects meta-analysis. Based on these pooled effect estimates, the population attributable fraction and relative risk (RR) of annual mortality due to acute wildfire-related PM exposure was calculated.

Findings: 65·6 million all-cause deaths, 15·1 million cardiovascular deaths, and 6·8 million respiratory deaths were included in our analyses. The pooled RRs of mortality associated with each 10 μg/m increase in the 3-day moving average (lag 0-2 days) of wildfire-related PM exposure were 1·019 (95% CI 1·016-1·022) for all-cause mortality, 1·017 (1·012-1·021) for cardiovascular mortality, and 1·019 (1·013-1·025) for respiratory mortality. Overall, 0·62% (95% CI 0·48-0·75) of all-cause deaths, 0·55% (0·43-0·67) of cardiovascular deaths, and 0·64% (0·50-0·78) of respiratory deaths were annually attributable to the acute impacts of wildfire-related PM exposure during the study period.

Interpretation: Short-term exposure to wildfire-related PM was associated with increased risk of mortality. Urgent action is needed to reduce health risks from the increasing wildfires.

Funding: Australian Research Council, Australian National Health & Medical Research Council.
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http://dx.doi.org/10.1016/S2542-5196(21)00200-XDOI Listing
September 2021

Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: a three-stage modelling study.

Lancet Planet Health 2021 07;5(7):e415-e425

Department of Earth Sciences, University of Turin, Turin, Italy.

Background: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures.

Methods: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature-mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature-mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division.

Findings: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967-5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58-11·07) of all deaths (8·52% [6·19-10·47] were cold-related and 0·91% [0·56-1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60-87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000-03 to 2016-19, the global cold-related excess death ratio changed by -0·51 percentage points (95% eCI -0·61 to -0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13-0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe.

Interpretation: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios.

Funding: Australian Research Council and the Australian National Health and Medical Research Council.
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http://dx.doi.org/10.1016/S2542-5196(21)00081-4DOI Listing
July 2021

Association of persistent organic pollutants with sensorimotor neuropathy in participants with and without diabetes or prediabetes: Results from the population-based KORA FF4 study.

Int J Hyg Environ Health 2021 06 19;235:113752. Epub 2021 May 19.

Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany.

Background: Concentrations of persistent organic pollutants (POPs) have been associated with an increased type 2 diabetes (T2D) risk. It remains unclear whether POPs are also associated with the risk of diabetes complications including neuropathy and evidence on this topic is scarce. We aimed to investigate the hypothesis that low-dose background concentrations of POPs were positively associated with distal sensorimotor polyneuropathy (DSPN).

Methods: This cross-sectional study was based on data from the second follow-up (FF4, 2013-2014, N = 2279) of the population-based KORA S4 study (Augsburg, Germany). The study sample consisted of 200 participants, including four groups of 50 persons each with known T2D, prediabetes, newly diagnosed diabetes, and normal glucose tolerance (NGT) based on an oral glucose tolerance test. We analyzed the association of six most abundant serum concentrations of POPs, including polychlorinated biphenyls (PCBs) as well as organochlorine (OC) pesticides, with DSPN by multivariable logistic regression adjusted for age, sex, glycaemic status, body mass index, physical activity, smoking and alcohol consumption. We assessed effect modification by age, sex, glycaemic status and obesity and conducted two-pollutant models to check the robustness of the estimates.

Results: For all pollutants, the main models indicated no significant association of having DSPN but pointed to rather decreased odds for DSPN. Two-pollutant models supported these findings, though only the association between the combination of PCB-138 and beta-hexachlorocyclohexane (β-HCH) (OR: 0.59; 95% CI: 0.35-0.99) with DSPN became significant. No effect modification was found by age, sex, glycaemic status and obesity.

Conclusion: Low-dose concentrations of POPs were not associated with increased odds of having DSPN in T2D, prediabetes and NGT.
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http://dx.doi.org/10.1016/j.ijheh.2021.113752DOI Listing
June 2021

Evaluation of the ERA5 reanalysis-based Universal Thermal Climate Index on mortality data in Europe.

Environ Res 2021 07 8;198:111227. Epub 2021 May 8.

Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom; The Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom; Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, United Kingdom.

Air temperature has been the most commonly used exposure metric in assessing relationships between thermal stress and mortality. Lack of the high-quality meteorological station data necessary to adequately characterize the thermal environment has been one of the main limitations for the use of more complex thermal indices. Global climate reanalyses may provide an ideal platform to overcome this limitation and define complex heat and cold stress conditions anywhere in the world. In this study, we explored the potential of the Universal Thermal Climate Index (UTCI) based on ERA5 - the latest global climate reanalysis from the European Centre for Medium-Range Weather Forecasts (ECMWF) - as a health-related tool. Employing a novel ERA5-based thermal comfort dataset ERA5-HEAT, we investigated the relationships between the UTCI and daily mortality data in 21 cities across 9 European countries. We used distributed lag nonlinear models to assess exposure-response relationships between mortality and thermal conditions in individual cities. We then employed meta-regression models to pool the results for each city into four groups according to climate zone. To evaluate the performance of ERA5-based UTCI, we compared its effects on mortality with those for the station-based UTCI data. In order to assess the additional effect of the UTCI, the performance of ERA5-and station-based air temperature (T) was evaluated. Whilst generally similar heat- and cold-effects were observed for the ERA5-and station-based data in most locations, the important role of wind in the UTCI appeared in the results. The largest difference between any two datasets was found in the Southern European group of cities, where the relative risk of mortality at the 1st percentile of daily mean temperature distribution (1.29 and 1.30 according to the ERA5 vs station data, respectively) considerably exceeded the one for the daily mean UTCI (1.19 vs 1.22). These differences were mainly due to the effect of wind in the cold tail of the UTCI distribution. The comparison of exposure-response relationships between ERA5-and station-based data shows that ERA5-based UTCI may be a useful tool for definition of life-threatening thermal conditions in locations where high-quality station data are not available.
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http://dx.doi.org/10.1016/j.envres.2021.111227DOI Listing
July 2021

Significant Impact of Coffee Consumption on MR-Based Measures of Cardiac Function in a Population-Based Cohort Study without Manifest Cardiovascular Disease.

Nutrients 2021 Apr 13;13(4). Epub 2021 Apr 13.

Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany.

Subclinical effects of coffee consumption (CC) with regard to metabolic, cardiac, and neurological complications were evaluated using a whole-body magnetic resonance imaging (MRI) protocol. A blended approach was used to estimate habitual CC in a population-based study cohort without a history of cardiovascular disease. Associations of CC with MRI markers of gray matter volume, white matter hyperintensities, cerebral microhemorrhages, total and visceral adipose tissue (VAT), hepatic proton density fat fraction, early/late diastolic filling rate, end-diastolic/-systolic and stroke volume, ejection fraction, peak ejection rate, and myocardial mass were evaluated by linear regression. In our analysis with 132 women and 168 men, CC was positively associated with MR-based cardiac function parameters including late diastolic filling rate, stroke volume ( < 0.01 each), and ejection fraction ( < 0.05) when adjusting for age, sex, smoking, hypertension, diabetes, Low-density lipoprotein (LDL), triglycerides, cholesterol, and alcohol consumption. CC was inversely associated with VAT independent of demographic variables and cardiovascular risk factors ( < 0.05), but this association did not remain significant after additional adjustment for alcohol consumption. CC was not significantly associated with potential neurodegeneration. We found a significant positive and independent association between CC and MRI-based systolic and diastolic cardiac function. CC was also inversely associated with VAT but not independent of alcohol consumption.
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http://dx.doi.org/10.3390/nu13041275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069927PMC
April 2021

Significant Impact of Coffee Consumption on MR-Based Measures of Cardiac Function in a Population-Based Cohort Study without Manifest Cardiovascular Disease.

Nutrients 2021 Apr 13;13(4). Epub 2021 Apr 13.

Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany.

Subclinical effects of coffee consumption (CC) with regard to metabolic, cardiac, and neurological complications were evaluated using a whole-body magnetic resonance imaging (MRI) protocol. A blended approach was used to estimate habitual CC in a population-based study cohort without a history of cardiovascular disease. Associations of CC with MRI markers of gray matter volume, white matter hyperintensities, cerebral microhemorrhages, total and visceral adipose tissue (VAT), hepatic proton density fat fraction, early/late diastolic filling rate, end-diastolic/-systolic and stroke volume, ejection fraction, peak ejection rate, and myocardial mass were evaluated by linear regression. In our analysis with 132 women and 168 men, CC was positively associated with MR-based cardiac function parameters including late diastolic filling rate, stroke volume ( < 0.01 each), and ejection fraction ( < 0.05) when adjusting for age, sex, smoking, hypertension, diabetes, Low-density lipoprotein (LDL), triglycerides, cholesterol, and alcohol consumption. CC was inversely associated with VAT independent of demographic variables and cardiovascular risk factors ( < 0.05), but this association did not remain significant after additional adjustment for alcohol consumption. CC was not significantly associated with potential neurodegeneration. We found a significant positive and independent association between CC and MRI-based systolic and diastolic cardiac function. CC was also inversely associated with VAT but not independent of alcohol consumption.
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http://dx.doi.org/10.3390/nu13041275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069927PMC
April 2021

Ambient carbon monoxide and daily mortality: a global time-series study in 337 cities.

Lancet Planet Health 2021 04;5(4):e191-e199

Environmental and Occupational Medicine, National Taiwan University and NTU Hospital, Taipei, Taiwan; National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan.

Background: Epidemiological evidence on short-term association between ambient carbon monoxide (CO) and mortality is inconclusive and limited to single cities, regions, or countries. Generalisation of results from previous studies is hindered by potential publication bias and different modelling approaches. We therefore assessed the association between short-term exposure to ambient CO and daily mortality in a multicity, multicountry setting.

Methods: We collected daily data on air pollution, meteorology, and total mortality from 337 cities in 18 countries or regions, covering various periods from 1979 to 2016. All included cities had at least 2 years of both CO and mortality data. We estimated city-specific associations using confounder-adjusted generalised additive models with a quasi-Poisson distribution, and then pooled the estimates, accounting for their statistical uncertainty, using a random-effects multilevel meta-analytical model. We also assessed the overall shape of the exposure-response curve and evaluated the possibility of a threshold below which health is not affected.

Findings: Overall, a 1 mg/m increase in the average CO concentration of the previous day was associated with a 0·91% (95% CI 0·32-1·50) increase in daily total mortality. The pooled exposure-response curve showed a continuously elevated mortality risk with increasing CO concentrations, suggesting no threshold. The exposure-response curve was steeper at daily CO levels lower than 1 mg/m, indicating greater risk of mortality per increment in CO exposure, and persisted at daily concentrations as low as 0·6 mg/m or less. The association remained similar after adjustment for ozone but was attenuated after adjustment for particulate matter or sulphur dioxide, or even reduced to null after adjustment for nitrogen dioxide.

Interpretation: This international study is by far the largest epidemiological investigation on short-term CO-related mortality. We found significant associations between ambient CO and daily mortality, even at levels well below current air quality guidelines. Further studies are warranted to disentangle its independent effect from other traffic-related pollutants.

Funding: EU Horizon 2020, UK Medical Research Council, and Natural Environment Research Council.
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http://dx.doi.org/10.1016/S2542-5196(21)00026-7DOI Listing
April 2021

Ambient carbon monoxide and daily mortality: a global time-series study in 337 cities.

Lancet Planet Health 2021 04;5(4):e191-e199

Environmental and Occupational Medicine, National Taiwan University and NTU Hospital, Taipei, Taiwan; National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan.

Background: Epidemiological evidence on short-term association between ambient carbon monoxide (CO) and mortality is inconclusive and limited to single cities, regions, or countries. Generalisation of results from previous studies is hindered by potential publication bias and different modelling approaches. We therefore assessed the association between short-term exposure to ambient CO and daily mortality in a multicity, multicountry setting.

Methods: We collected daily data on air pollution, meteorology, and total mortality from 337 cities in 18 countries or regions, covering various periods from 1979 to 2016. All included cities had at least 2 years of both CO and mortality data. We estimated city-specific associations using confounder-adjusted generalised additive models with a quasi-Poisson distribution, and then pooled the estimates, accounting for their statistical uncertainty, using a random-effects multilevel meta-analytical model. We also assessed the overall shape of the exposure-response curve and evaluated the possibility of a threshold below which health is not affected.

Findings: Overall, a 1 mg/m increase in the average CO concentration of the previous day was associated with a 0·91% (95% CI 0·32-1·50) increase in daily total mortality. The pooled exposure-response curve showed a continuously elevated mortality risk with increasing CO concentrations, suggesting no threshold. The exposure-response curve was steeper at daily CO levels lower than 1 mg/m, indicating greater risk of mortality per increment in CO exposure, and persisted at daily concentrations as low as 0·6 mg/m or less. The association remained similar after adjustment for ozone but was attenuated after adjustment for particulate matter or sulphur dioxide, or even reduced to null after adjustment for nitrogen dioxide.

Interpretation: This international study is by far the largest epidemiological investigation on short-term CO-related mortality. We found significant associations between ambient CO and daily mortality, even at levels well below current air quality guidelines. Further studies are warranted to disentangle its independent effect from other traffic-related pollutants.

Funding: EU Horizon 2020, UK Medical Research Council, and Natural Environment Research Council.
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http://dx.doi.org/10.1016/S2542-5196(21)00026-7DOI Listing
April 2021

Institutional betrayal and help-seeking among women survivors of military sexual trauma.

Psychol Trauma 2021 Mar 25. Epub 2021 Mar 25.

Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.

Women veterans experience disproportionately high rates of military sexual trauma (MST). Nonetheless, many MST survivors delay or forgo health care, particularly within Veterans Health Administration (VHA) settings. Institutional betrayal (IB) has been posited as a potential explanation for this.

Objective: The current study examined if IB was associated with women veterans' willingness to seek VHA and non-VHA mental health and medical care, prior use of VHA care, past year use of VHA care, and use of VHA and non-VHA MST-related care.

Method: Participants were 242 women veterans who screened positive for MST and completed self-report measures of IB and willingness to seek VHA and non-VHA mental health and medical care. Use of VHA care was assessed through VA Corporate Data Warehouse data.

Results: IB was associated with lower willingness to use VHA medical care and higher willingness to use non-VHA mental health care. Although IB was not significantly associated with prior use of VHA care, participants who reported more IB were more likely to have used VHA care in the past year and to have used both VHA and non-VHA MST-related care.

Conclusion: These findings illuminate the relationship between the institutional response to MST with women's help-seeking willingness and use. Addressing IB may be important for increasing women MST survivors' willingness to use VHA medical care. Additionally, as IB was associated with greater willingness to use non-VHA mental health care, non-VHA institutions and providers should be prepared to serve women veterans who have experienced MST-related IB. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/tra0001027DOI Listing
March 2021

Short term associations of ambient nitrogen dioxide with daily total, cardiovascular, and respiratory mortality: multilocation analysis in 398 cities.

BMJ 2021 03 24;372:n534. Epub 2021 Mar 24.

Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal.

Objective: To evaluate the short term associations between nitrogen dioxide (NO) and total, cardiovascular, and respiratory mortality across multiple countries/regions worldwide, using a uniform analytical protocol.

Design: Two stage, time series approach, with overdispersed generalised linear models and multilevel meta-analysis.

Setting: 398 cities in 22 low to high income countries/regions.

Main Outcome Measures: Daily deaths from total (62.8 million), cardiovascular (19.7 million), and respiratory (5.5 million) causes between 1973 and 2018.

Results: On average, a 10 μg/m increase in NO concentration on lag 1 day (previous day) was associated with 0.46% (95% confidence interval 0.36% to 0.57%), 0.37% (0.22% to 0.51%), and 0.47% (0.21% to 0.72%) increases in total, cardiovascular, and respiratory mortality, respectively. These associations remained robust after adjusting for co-pollutants (particulate matter with aerodynamic diameter ≤10 μm or ≤2.5 μm (PM and PM, respectively), ozone, sulfur dioxide, and carbon monoxide). The pooled concentration-response curves for all three causes were almost linear without discernible thresholds. The proportion of deaths attributable to NO concentration above the counterfactual zero level was 1.23% (95% confidence interval 0.96% to 1.51%) across the 398 cities.

Conclusions: This multilocation study provides key evidence on the independent and linear associations between short term exposure to NO and increased risk of total, cardiovascular, and respiratory mortality, suggesting that health benefits would be achieved by tightening the guidelines and regulatory limits of NO.
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http://dx.doi.org/10.1136/bmj.n534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988454PMC
March 2021

Short term associations of ambient nitrogen dioxide with daily total, cardiovascular, and respiratory mortality: multilocation analysis in 398 cities.

BMJ 2021 03 24;372:n534. Epub 2021 Mar 24.

Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal.

Objective: To evaluate the short term associations between nitrogen dioxide (NO) and total, cardiovascular, and respiratory mortality across multiple countries/regions worldwide, using a uniform analytical protocol.

Design: Two stage, time series approach, with overdispersed generalised linear models and multilevel meta-analysis.

Setting: 398 cities in 22 low to high income countries/regions.

Main Outcome Measures: Daily deaths from total (62.8 million), cardiovascular (19.7 million), and respiratory (5.5 million) causes between 1973 and 2018.

Results: On average, a 10 μg/m increase in NO concentration on lag 1 day (previous day) was associated with 0.46% (95% confidence interval 0.36% to 0.57%), 0.37% (0.22% to 0.51%), and 0.47% (0.21% to 0.72%) increases in total, cardiovascular, and respiratory mortality, respectively. These associations remained robust after adjusting for co-pollutants (particulate matter with aerodynamic diameter ≤10 μm or ≤2.5 μm (PM and PM, respectively), ozone, sulfur dioxide, and carbon monoxide). The pooled concentration-response curves for all three causes were almost linear without discernible thresholds. The proportion of deaths attributable to NO concentration above the counterfactual zero level was 1.23% (95% confidence interval 0.96% to 1.51%) across the 398 cities.

Conclusions: This multilocation study provides key evidence on the independent and linear associations between short term exposure to NO and increased risk of total, cardiovascular, and respiratory mortality, suggesting that health benefits would be achieved by tightening the guidelines and regulatory limits of NO.
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http://dx.doi.org/10.1136/bmj.n534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988454PMC
March 2021

Association between short-term exposure to ambient fine particulate matter and myocardial injury in the CATHGEN cohort.

Environ Pollut 2021 Apr 5;275:116663. Epub 2021 Feb 5.

Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.

Exposure to fine particulate matter (PM) has been associated with a higher risk for coronary events. Elevated circulating cardiac troponins (cTn) are suggestive of myocardial injury in both ischemic and non-ischemic conditions. However, little is known about the association between PM and cTn. In this study, we investigated short-term PM effects on cardiac troponin T (cTnT), as well as N-terminal-pro brain natriuretic peptide (NT-pro BNP) and inflammatory biomarkers among cardiac catheterized participants. We analyzed 7444 plasma cTnT measurements in 2732 participants who presented to Duke University Hospital with myocardial infarction symptoms between 2001 and 2012, partly along with measurements of NT-pro BNP and inflammatory biomarkers. Daily PM concentrations were predicted by a neural network-based hybrid model and were assigned to participants' residential addresses. We applied generalized estimating equations to assess associations of PM with biomarker levels and the risk of a positive cTnT test (cTnT > 0.1 ng/mL). The median plasma cTnT concentration at presentation was 0.05 ng/mL and the prevalence of a positive cTnT test was 35.4%. For an interquartile range (7.6 μg/m) increase in PM on the previous day, cTnT concentrations increased by 7.7% (95% CI: 3.4-12.3) and the odds ratio of a positive cTnT test was 1.08 (1.01-1.16). Participants under 60 years (effect estimate: 15.2%; 95% CI: 7.4-23.5) or living in rural areas (12.3%; 95% CI: 4.8-20.3) were more susceptible. There was evidence for increases in fibrinogen and NT-pro BNP associated with elevated PM on the concurrent and previous two days. Our study suggests that acute PM exposure may elevate indicators of myocardial tissue damage. This finding substantiates the association of air pollution exposure with adverse cardiovascular events.
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http://dx.doi.org/10.1016/j.envpol.2021.116663DOI Listing
April 2021

A systematic review on the association between total and cardiopulmonary mortality/morbidity or cardiovascular risk factors with long-term exposure to increased or decreased ambient temperature.

Sci Total Environ 2021 Jun 27;772:145383. Epub 2021 Jan 27.

Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece; Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, UK. Electronic address:

The health effects of acute exposure to temperature extremes are established; those of long-term exposure only recently received attention. We performed a systematic review to assess the associations of long-term (>3 months) exposure to higher or lower temperature on total and cardiopulmonary mortality and morbidity, screening 3455 studies and selecting 34. The studies were classified in those observing associations within a population over years with changing annual temperature indices and those comparing areas with a different climate. We also assessed the risk of bias, adapting appropriately an instrument developed by the World Health Organization for air pollution. Studies reported that annual temperature indices for extremes and variability were associated with annual increases in mortality, indicating that effects of temperature extremes cannot be attributed only to short-term mortality displacement. Studies on cardiovascular mortality indicated stronger associations with cold rather than hot temperature, whilst those on respiratory outcomes reported effects of both heat and cold but were few and used diverse health outcomes. Interactions with air pollution were not generally assessed. The few studies investigating effect modification showed stronger effects among the elderly and those socially deprived. Comparisons of health outcome prevalence between areas reported lower blood pressure and a tendency for higher obesity in populations living in warmer climates. Our review indicated interesting associations between long-term exposure to unusual temperature levels in specific areas and differences in health outcomes and cardiovascular risk factors between geographical locations with different climate, but the number of studies by design and health outcome was small. Risk of bias was identified because of the use of crude exposure assessment and inadequate adjustment for confounding. More and better designed studies, including the investigation of effect modifiers, are needed.
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http://dx.doi.org/10.1016/j.scitotenv.2021.145383DOI Listing
June 2021

A systematic review on the association between total and cardiopulmonary mortality/morbidity or cardiovascular risk factors with long-term exposure to increased or decreased ambient temperature.

Sci Total Environ 2021 Jun 27;772:145383. Epub 2021 Jan 27.

Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece; Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, UK. Electronic address:

The health effects of acute exposure to temperature extremes are established; those of long-term exposure only recently received attention. We performed a systematic review to assess the associations of long-term (>3 months) exposure to higher or lower temperature on total and cardiopulmonary mortality and morbidity, screening 3455 studies and selecting 34. The studies were classified in those observing associations within a population over years with changing annual temperature indices and those comparing areas with a different climate. We also assessed the risk of bias, adapting appropriately an instrument developed by the World Health Organization for air pollution. Studies reported that annual temperature indices for extremes and variability were associated with annual increases in mortality, indicating that effects of temperature extremes cannot be attributed only to short-term mortality displacement. Studies on cardiovascular mortality indicated stronger associations with cold rather than hot temperature, whilst those on respiratory outcomes reported effects of both heat and cold but were few and used diverse health outcomes. Interactions with air pollution were not generally assessed. The few studies investigating effect modification showed stronger effects among the elderly and those socially deprived. Comparisons of health outcome prevalence between areas reported lower blood pressure and a tendency for higher obesity in populations living in warmer climates. Our review indicated interesting associations between long-term exposure to unusual temperature levels in specific areas and differences in health outcomes and cardiovascular risk factors between geographical locations with different climate, but the number of studies by design and health outcome was small. Risk of bias was identified because of the use of crude exposure assessment and inadequate adjustment for confounding. More and better designed studies, including the investigation of effect modifiers, are needed.
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http://dx.doi.org/10.1016/j.scitotenv.2021.145383DOI Listing
June 2021

ENVINT-D-20-01309: Long-term exposure to air pollution, road traffic noise, residential greenness, and prevalent and incident metabolic syndrome: Results from the population-based KORA F4/FF4 cohort in Augsburg, Germany.

Environ Int 2021 02 6;147:106364. Epub 2021 Jan 6.

Institute for Medical Information Processing, Biometry and Epidemiology - IBE, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany.

Background: A growing number of epidemiological studies show associations between environmental factors and impaired cardiometabolic health. However, evidence is scarce concerning these risk factors and their impact on metabolic syndrome (MetS). This analysis aims to investigate associations between long-term exposure to air pollution, road traffic noise, residential greenness, and MetS.

Methods: We used data of the first (F4, 2006-2008) and second (FF4, 2013-2014) follow-up of the population-based KORA S4 survey in the region of Augsburg, Germany, to investigate associations between exposures and MetS prevalence at F4 (N = 2883) and MetS incidence at FF4 (N = 1192; average follow-up: 6.5 years). Residential long-term exposures to air pollution - including particulate matter (PM) with a diameter < 10 µm (PM), PM < 2.5 µm (PM), PM between 2.5 and 10 µm (PM), absorbance of PM (PM2.5), particle number concentration (PNC), nitrogen dioxide (NO), ozone (O) - and road traffic noise were modeled by land-use regression models and noise maps. For greenness, the Normalized Difference Vegetation Index (NDVI) was obtained. We estimated Odds Ratios (OR) for single and multi-exposure models using logistic regression and generalized estimating equations adjusted for confounders. Joint Odds Ratios were calculated based on the Cumulative Risk Index. Effect modifiers were examined with interaction terms.

Results: We found positive associations between prevalent MetS and interquartile range (IQR) increases in PM (OR: 1.15; 95% confidence interval [95% CI]: 1.02, 1.29), PM (OR: 1.14; 95% CI: 1.02, 1.28), PM (OR: 1.14; 95% CI: 1.02, 1.27), and PMabs (OR: 1.17; 95% CI: 1.03, 1.32). Results further showed negative, but non-significant associations between exposure to greenness and prevalent and incident MetS. No effects were seen for exposure to road traffic noise. Joint Odds Ratios from multi-exposure models were higher than ORs from models with only one exposure.
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http://dx.doi.org/10.1016/j.envint.2020.106364DOI Listing
February 2021

Longitudinal associations between ambient air pollution and insulin sensitivity: results from the KORA cohort study.

Lancet Planet Health 2021 01;5(1):e39-e49

Institute of Epidemiology, Helmholtz Centre Munich, German Research Centre for Environmental Health, Neuherberg, Germany; German Centre for Diabetes Research, DZD, Munich-Neuherberg, Germany.

Background: Impaired insulin sensitivity could be an intermediate step that links exposure to air pollution to the development of type 2 diabetes. However, longitudinal associations of air pollution with insulin sensitivity remain unclear. Our study investigated the associations of long-term air pollution exposure with the degree and rate of change of insulin sensitivity.

Methods: In this longitudinal study, we analysed data from the Cooperative Health Research in the Region of Augsburg (KORA) cohort from Augsburg, Germany, which recruited participants aged 25-74 years in the survey between 1999 and 2001 (KORA S4), with two follow-up examinations in 2006-08 (KORA F4) and 2013-14 (KORA FF4). Serum concentrations of fasting insulin and glucose, and homoeostasis model assessment of insulin resistance (HOMA-IR, a surrogate measure of insulin sensitivity) and β-cell function (HOMA-B, a surrogate marker for fasting insulin secretion) were assessed at up to three visits between 1999 and 2014. Annual average air pollutant concentrations at the residence were estimated by land-use regression models. We examined the associations of air pollution with repeatedly assessed biomarker levels using mixed-effects models, and we assessed the associations with the annual rate of change in biomarkers using quantile regression models.

Findings: Among 9620 observations from 4261 participants in the KORA cohort, we included 6008 (62·5%) observations from 3297 (77·4%) participants in our analyses. Per IQR increment in annual average air pollutant concentrations, HOMA-IR significantly increased by 2·5% (95% CI 0·3 to 4·7) for coarse particulate matter, by 3·1% (0·9 to 5·3) for PM, by 3·6% (1·0 to 6·3) for PM, and by 3·2% (0·6 to 5·8) for nitrogen dioxide, and borderline significantly increased by 2·2% (-0·1 to 4·5) for ozone, whereas it did not significantly increase for the whole range of ultrafine particles. Similar positive associations in slightly smaller magnitude were observed for HOMA-B and fasting insulin levels. In addition, air pollutant concentrations were positively associated with the annual rate of change in HOMA-IR, HOMA-B, and fasting insulin. Neither the level nor the rate of change of fasting glucose were associated with air pollution exposure.

Interpretation: Our study indicates that long-term air pollution exposure could contribute to the development of insulin resistance, which is one of the key factors in the pathogenesis of type 2 diabetes.

Funding: German Federal Ministry of Education and Research.
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http://dx.doi.org/10.1016/S2542-5196(20)30275-8DOI Listing
January 2021

Assessing Institutional Betrayal Among Female Veterans Who Experienced Military Sexual Trauma: A Rasch Analysis of the Institutional Betrayal Questionnaire.2.

J Interpers Violence 2021 Jan 6:886260520983959. Epub 2021 Jan 6.

Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA.

Military sexual trauma (MST; i.e., sexual harassment and/or sexual assault during one's military service) is highly prevalent among female veterans and is associated with numerous adverse health and psychosocial sequelae. When institutions fail to prevent sexual trauma from happening or respond in an unsupportive manner (i.e., institutional betrayal [IB]), MST survivors typically report more severe health-related outcomes. Although the Institutional Betrayal Questionnaire.2 (IBQ.2) was developed to assess IB, no studies have examined the factor structure or dimensionality of the IBQ.2 among MST survivors. In addition, initial research has reported differing factor structures for this measure. The present study examined the dimensionality and factor structure of the IBQ.2, and tested for differential item functioning (DIF) based on whether military sexual assault was experienced. The sample comprised 235 female veterans who reported a history of MST in an anonymous national survey. Rasch analysis suggested multidimensionality and DIF based on history of military sexual assault. Exploratory factor analysis and parallel analysis suggested the IBQ.2 comprises three factors: (1) Environment Leading to MST, (2) Institutional Response to MST, and (3) Institutional Belongingness following MST. Although these results suggest that the IBQ.2 is multidimensional, the three-factor model had significant issues with respect to dimensionality, item fit, and person separation and reliability. Thus, using the full IBQ.2 may be more advantageous. Further examination of the IBQ.2 is warranted to ensure optimal assessment of IB in relation to MST, irrespective of whether the MST comprised sexual harassment or sexual assault, as well as to ensure that the IBQ.2 is culturally meaningful for MST survivors.
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January 2021

Acceptability of cognitive anxiety sensitivity treatment among veterans with mTBI.

Rehabil Psychol 2021 May 31;66(2):118-127. Epub 2020 Dec 31.

VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC).

Objective: Anxiety sensitivity (AS) is a transdiagnostic risk factor for persistent physical and psychological symptoms relevant to veterans, such as postconcussive symptoms following mild traumatic brain injury (mTBI). The Cognitive Anxiety Sensitivity Treatment (CAST) computerized intervention has been shown to reduce AS but has not been widely used among veterans. The purpose of this study was to assess the acceptability and feasibility of CAST among veterans with elevated AS and mTBI eligible to receive Veterans Health Administration (VHA) care.

Design: Twenty-two veterans with mTBI, elevated cognitive AS, and history of deployment to Iraq and/or Afghanistan completed a single assessment and intervention session. Acceptability was assessed with the Client Satisfaction Quesitonnaire-8 (CSQ-8) and a qualitative interview. Measures of feasibility included study enrollment, ease of participation, and intervention completion. AS was assessed pre- and post-CAST completion.

Results: Consistent with interview responses, 77.3% of participants' CSQ-8 scores indicated that veterans found the intervention acceptable. Technological issues, such as internet connectivity, decreased feasibility of consistently delivering the intervention in the research setting readily available to the study team. Decreases on pre-to-post intervention AS outcomes were observed.

Conclusions: Acceptability of the CAST intervention in this sample was generally supported. Feasibility of implementing CAST in this study was limited by technological issues. Data did not indicate a critical need to revise content of the CAST intervention. Identified strategies for increasing the feasibility of future research and clinical implementation of CAST are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000365DOI Listing
May 2021

Association of Long-Term Air Pollution with Prevalence and Incidence of Distal Sensorimotor Polyneuropathy: KORA F4/FF4 Study.

Environ Health Perspect 2020 12 23;128(12):127013. Epub 2020 Dec 23.

Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Background: Air pollution contributes to type 2 diabetes and cardiovascular diseases, but its relevance for other complications of diabetes, in particular distal sensorimotor polyneuropathy (DSPN), is unclear. Recent studies have indicated that DSPN is also increasingly prevalent in obesity.

Objectives: We aimed to assess associations of air pollutants with prevalent and incident DSPN in a population-based study of older individuals with high rates of type 2 diabetes and obesity.

Methods: Cross-sectional analyses on prevalent DSPN were based on 1,075 individuals 62-81 years of age from the German Cooperative Health Research in the Region of Augsburg (KORA) F4 survey (2006-2008). Analyses on incident DSPN included 424 individuals without DSPN at baseline (KORA F4), of whom 188 had developed DSPN by the KORA FF4 survey (2013-2014). Associations of annual average air pollutant concentrations at participants' residences with prevalent and incident DSPN were estimated using Poisson regression models with a robust error variance adjusting for multiple confounders.

Results: Higher particle number concentrations (PNCs) were associated with higher prevalence [risk ratio (RR) per interquartile range (IQR) (95% CI: 1.01, 1.20)] and incidence [1.11 (95% CI: 0.99, 1.24)] of DSPN. In subgroup analyses, particulate (PNC, , , , and ) and gaseous (, ) pollutants were positively associated with prevalent DSPN in obese participants, whereas corresponding estimates for nonobese participants were close to the null [e.g., for an IQR increase in PNC, (95% CI: 1.05, 1.31) vs. 1.06 (95% CI: 0.95, 1.19); ]. With the exception of , corresponding associations with incident DSPN were positive in obese participants but null or inverse for nonobese participants, with [e.g., for PNC, (95% CI: 1.08, 1.51) vs. 1.03 (95% CI: 0.90, 1.18); ].

Discussion: Both particulate and gaseous air pollutants were positively associated with prevalent and incident DSPN in obese individuals. Obesity and air pollution may have synergistic effects on the development of DSPN. https://doi.org/10.1289/EHP7311.
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http://dx.doi.org/10.1289/EHP7311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757787PMC
December 2020

De Novo variants in EEF2 cause a neurodevelopmental disorder with benign external hydrocephalus.

Hum Mol Genet 2021 02;29(24):3892-3899

Department of Human Genetics, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behavior, 6525 GA Nijmegen, The Netherlands.

Eukaryotic translation elongation factor 2 (eEF2) is a key regulatory factor in gene expression that catalyzes the elongation stage of translation. A functionally impaired eEF2, due to a heterozygous missense variant in the EEF2 gene, was previously reported in one family with spinocerebellar ataxia-26 (SCA26), an autosomal dominant adult-onset pure cerebellar ataxia. Clinical exome sequencing identified de novo EEF2 variants in three unrelated children presenting with a neurodevelopmental disorder (NDD). Individuals shared a mild phenotype comprising motor delay and relative macrocephaly associated with ventriculomegaly. Populational data and bioinformatic analysis underscored the pathogenicity of all de novo missense variants. The eEF2 yeast model strains demonstrated that patient-derived variants affect cellular growth, sensitivity to translation inhibitors and translational fidelity. Consequently, we propose that pathogenic variants in the EEF2 gene, so far exclusively associated with late-onset SCA26, can cause a broader spectrum of neurologic disorders, including childhood-onset NDDs and benign external hydrocephalus.
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http://dx.doi.org/10.1093/hmg/ddaa270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907856PMC
February 2021

Cardiovascular risks of climate change.

Nat Rev Cardiol 2021 01;18(1):1-2

Helmholtz Center Munich - German Research Center for Environmental Health, Neuherberg, Germany.

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http://dx.doi.org/10.1038/s41569-020-00473-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649889PMC
January 2021

Heat, Heatwaves and Cardiorespiratory Hospital Admissions in Helsinki, Finland.

Int J Environ Res Public Health 2020 10 28;17(21). Epub 2020 Oct 28.

Department of Environmental and Biological Sciences, University of Eastern Finland, 70211 Kuopio, Finland.

There is a lack of knowledge concerning the effects of ambient heat exposure on morbidity in Northern Europe. Therefore, this study aimed to evaluate the relationships of daily summertime temperature and heatwaves with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. : Time series models adjusted for potential confounders, such as air pollution, were used to investigate the associations of daily temperature and heatwaves with cause-specific cardiorespiratory hospital admissions during summer months of 2001-2017. Daily number of hospitalizations was obtained from the national hospital discharge register and weather information from the Finnish Meteorological Institute. : Increased daily temperature was associated with a decreased risk of total respiratory hospital admissions and asthma. Heatwave days were associated with 20.5% (95% CI: 6.9, 35.9) increased risk of pneumonia admissions and during long or intense heatwaves also with total respiratory admissions in the oldest age group (≥75 years). There were also suggestive positive associations between heatwave days and admissions due to myocardial infarction and cerebrovascular diseases. In contrast, risk of arrhythmia admissions decreased 20.8% (95% CI: 8.0, 31.8) during heatwaves. : Heatwaves, rather than single hot days, are a health threat affecting morbidity even in a Northern climate.
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http://dx.doi.org/10.3390/ijerph17217892DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663418PMC
October 2020

Meta-analysis on short-term exposure to ambient ultrafine particles and respiratory morbidity.

Eur Respir Rev 2020 Dec 28;29(158). Epub 2020 Oct 28.

Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.

Aim: There is growing interest in the health effects following exposure to ambient particles with a diameter <100 nm defined as ultrafine particles (UFPs), although studies so far have reported inconsistent results. We have undertaken a systematic review and meta-analysis for respiratory hospital admissions and emergency room visits following short-term exposure to UFPs.

Methods: We searched PubMed and the Web of Science for studies published up to March 2019 to update previous reviews. We applied fixed- and random-effects models, assessed heterogeneity between cities and explored possible effect modifiers.

Results: We identified nine publications, reporting effects from 15 cities, 11 of which were European. There was great variability in exposure assessment, outcome measures and the exposure lags considered. Our meta-analyses did not support UFP effects on respiratory morbidity across all ages. We found consistent statistically significant associations following lag 2 exposure during the warm period and in cities with mean daily UFP concentrations <6000 particles·cm, which was approximately the median of the city-specific mean levels. Among children aged 0-14 years, a 10 000 particle·cm increase in UFPs 2 or 3 days before was associated with a relative risk of 1.01 (95% CI 1.00-1.02) in respiratory hospital admissions.

Conclusions: Our study indicates UFP effects on respiratory health among children, and during the warm season across all ages at longer lags. The limited evidence and the large heterogeneity of previous reports call for future exposure assessment harmonisation and expanded research.
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http://dx.doi.org/10.1183/16000617.0116-2020DOI Listing
December 2020

Microbial Diversity and Community Structures Among Those With Moderate to Severe TBI: A United States-Veteran Microbiome Project Study.

J Head Trauma Rehabil 2020 Sep/Oct;35(5):332-341

Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Drs Brenner, Stamper, Hoisington, Stearns-Yoder, Stanislawksi, Brostow, Hoffmire, Forster, Schneider, Postolache, and Lowry); Department of Physical Medicine and Rehabilitation (Drs Brenner, Stamper, Hoisington, Stearns-Yoder, Brostow, Hoffmire, Forster, and Lowry), Departments of Psychiatry and Neurology (Dr Brenner), Division of Biomedical Informatics and Personalized Medicine (Dr Stanislawksi), and Center for Neuroscience (Dr Lowry), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Military and Veteran Microbiome: Consortium for Research and Education, Aurora, Colorado (Drs Brenner, Stamper, Hoisington, Stearns-Yoder, Brostow, Hoffmire, Forster, Schneider, Postolache, and Lowry); Department of Systems Engineering and Management, Air Force Institute of Technology, Wright-Patterson AFB, Ohio (Dr Hoisington); Mood and Anxiety Program, University of Maryland School of Medicine, and VISN 5 MIRECC, Department of Veterans Affairs, Baltimore, Maryland (Dr Postolache); and Department of Integrative Physiology, and Center for Neuroscience, University of Colorado Boulder, Boulder (Dr Lowry).

Objective: To evaluate the association between distal moderate/severe traumatic brain injury (TBI) history and the human gut microbiome.

Setting: Veterans Affairs Medical Center.

Participants: Veterans from the United States-Veteran Microbiome Project (US-VMP). Veterans with moderate/severe TBI (n = 34) were compared with (1) Veterans with a history of no TBI (n = 79) and (2) Veterans with a history of no TBI or mild TBI only (n = 297).

Design: Microbiome analyses from 16S rRNA gene sequencing with gut microbiota function inferred using PICRUSt2.

Main Measures: α-Diversity and β-diversity of the gut microbiome, as well as taxonomic and functional signatures associated with moderate/severe TBI.

Results: There were no significant differences in gut bacterial α- and β-diversity associated with moderate/severe TBI status. No differentially abundant taxa were identified when comparing samples from moderate/severe TBI to those with no TBI or no TBI/mild TBI.

Conclusion: Results suggest that moderate/severe TBI-related changes to the gut microbiome do not persist for years postinjury.
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September 2021

Microbial Diversity and Community Structures Among Those With Moderate to Severe TBI: A United States-Veteran Microbiome Project Study.

J Head Trauma Rehabil 2020 Sep/Oct;35(5):332-341

Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Drs Brenner, Stamper, Hoisington, Stearns-Yoder, Stanislawksi, Brostow, Hoffmire, Forster, Schneider, Postolache, and Lowry); Department of Physical Medicine and Rehabilitation (Drs Brenner, Stamper, Hoisington, Stearns-Yoder, Brostow, Hoffmire, Forster, and Lowry), Departments of Psychiatry and Neurology (Dr Brenner), Division of Biomedical Informatics and Personalized Medicine (Dr Stanislawksi), and Center for Neuroscience (Dr Lowry), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Military and Veteran Microbiome: Consortium for Research and Education, Aurora, Colorado (Drs Brenner, Stamper, Hoisington, Stearns-Yoder, Brostow, Hoffmire, Forster, Schneider, Postolache, and Lowry); Department of Systems Engineering and Management, Air Force Institute of Technology, Wright-Patterson AFB, Ohio (Dr Hoisington); Mood and Anxiety Program, University of Maryland School of Medicine, and VISN 5 MIRECC, Department of Veterans Affairs, Baltimore, Maryland (Dr Postolache); and Department of Integrative Physiology, and Center for Neuroscience, University of Colorado Boulder, Boulder (Dr Lowry).

Objective: To evaluate the association between distal moderate/severe traumatic brain injury (TBI) history and the human gut microbiome.

Setting: Veterans Affairs Medical Center.

Participants: Veterans from the United States-Veteran Microbiome Project (US-VMP). Veterans with moderate/severe TBI (n = 34) were compared with (1) Veterans with a history of no TBI (n = 79) and (2) Veterans with a history of no TBI or mild TBI only (n = 297).

Design: Microbiome analyses from 16S rRNA gene sequencing with gut microbiota function inferred using PICRUSt2.

Main Measures: α-Diversity and β-diversity of the gut microbiome, as well as taxonomic and functional signatures associated with moderate/severe TBI.

Results: There were no significant differences in gut bacterial α- and β-diversity associated with moderate/severe TBI status. No differentially abundant taxa were identified when comparing samples from moderate/severe TBI to those with no TBI or no TBI/mild TBI.

Conclusion: Results suggest that moderate/severe TBI-related changes to the gut microbiome do not persist for years postinjury.
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September 2021

[Combined effects of different environmental factors on health: air pollution, temperature, green spaces, pollen, and noise].

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020 Aug;63(8):962-971

Institut für Epidemiologie, Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt GmbH, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland.

Environmental factors affect the health and wellbeing of urban residents. However, they do not act individually on humans, but instead show potential synergistic or antagonistic effects. Questions that arise from this are: How does a combination of air pollutants with other environmental factors impact health? How well are these associations evidenced? What methods can we use to look at them? In this article, methodical approaches regarding the effects of a combination of various environmental factors are first described. Environmental factors are then examined, which together with different air pollutants, have an impact on human health such as ambient temperature, noise, and pollen as well as the effect of green spaces. Physical activity and nutrition are addressed regarding the attenuation of health effects from air pollution.While there is often clear evidence of health effects of single environmental stressors, there are still open questions in terms of their interaction. The research methods required for this still need to be further developed. The interrelationship between the different environmental factors make it clear that (intervention) measures for reducing single indicators are also interlinked. Regarding traffic, switching from passive to active transport (e.g., due to safe cycle paths and other measures) leads to less air pollutants, smaller increases in temperature in the long term, and at the same time improved health of the individual. As a result, sensible planning of the built environment has great potential to reduce environmental stressors and improve people's health and wellbeing.
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http://dx.doi.org/10.1007/s00103-020-03186-9DOI Listing
August 2020

[Combined effects of different environmental factors on health: air pollution, temperature, green spaces, pollen, and noise].

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020 Aug;63(8):962-971

Institut für Epidemiologie, Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt GmbH, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland.

Environmental factors affect the health and wellbeing of urban residents. However, they do not act individually on humans, but instead show potential synergistic or antagonistic effects. Questions that arise from this are: How does a combination of air pollutants with other environmental factors impact health? How well are these associations evidenced? What methods can we use to look at them? In this article, methodical approaches regarding the effects of a combination of various environmental factors are first described. Environmental factors are then examined, which together with different air pollutants, have an impact on human health such as ambient temperature, noise, and pollen as well as the effect of green spaces. Physical activity and nutrition are addressed regarding the attenuation of health effects from air pollution.While there is often clear evidence of health effects of single environmental stressors, there are still open questions in terms of their interaction. The research methods required for this still need to be further developed. The interrelationship between the different environmental factors make it clear that (intervention) measures for reducing single indicators are also interlinked. Regarding traffic, switching from passive to active transport (e.g., due to safe cycle paths and other measures) leads to less air pollutants, smaller increases in temperature in the long term, and at the same time improved health of the individual. As a result, sensible planning of the built environment has great potential to reduce environmental stressors and improve people's health and wellbeing.
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http://dx.doi.org/10.1007/s00103-020-03186-9DOI Listing
August 2020

[Nighttime transportation noise annoyance in Germany: personal and regional differences in the German National Cohort Study].

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020 Mar;63(3):332-343

Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland.

Background: Noise annoyance is associated with adverse health-related conditions and reduced wellbeing. Thereby, subjective noise annoyance depends on the objective noise exposure and is modified by personal and regional factors.

Objective: How many participants of the German National Cohort Study (GNC; NAKO Gesundheitsstudie) were annoyed by transportation noise during nighttime and what factors were associated with noise annoyance?

Materials And Methods: This cross-sectional analysis included 86,080 participants from 18 study centers, examined from 2014 to 2017. We used multinomial logistic regression to investigate associations of personal and regional factors to noise annoyance (slightly/moderately or strongly/extremely annoyed vs. not annoyed) mutually adjusting for all factors in the model.

Results: Two thirds of participants were not annoyed by transportation noise during nighttime and one in ten reported strong/extreme annoyance with highest percentages for the study centers Berlin-Mitte and Leipzig. The strongest associations were seen for factors related to the individual housing situation like the bedroom being positioned towards a major road (OR of being slightly/moderately annoyed: 4.26 [95% CI: 4.01;4.52]; OR of being strongly/extremely annoyed: 13.36 [95% CI: 12.47;14.32]) compared to a garden/inner courtyard. Participants aged 40-60 years and those in low- and medium-income groups reported greater noise annoyance compared to younger or older ones and those in the high-income group.

Conclusion: In this study from Germany, transportation noise annoyance during nighttime varied by personal and regional factors.
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http://dx.doi.org/10.1007/s00103-020-03094-yDOI Listing
March 2020

Short term association between ozone and mortality: global two stage time series study in 406 locations in 20 countries.

BMJ 2020 02 10;368:m108. Epub 2020 Feb 10.

Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain.

Objective: To assess short term mortality risks and excess mortality associated with exposure to ozone in several cities worldwide.

Design: Two stage time series analysis.

Setting: 406 cities in 20 countries, with overlapping periods between 1985 and 2015, collected from the database of Multi-City Multi-Country Collaborative Research Network.

Population: Deaths for all causes or for external causes only registered in each city within the study period MAIN OUTCOME MEASURES: Daily total mortality (all or non-external causes only).

Results: A total of 45 165 171 deaths were analysed in the 406 cities. On average, a 10 µg/m increase in ozone during the current and previous day was associated with an overall relative risk of mortality of 1.0018 (95% confidence interval 1.0012 to 1.0024). Some heterogeneity was found across countries, with estimates ranging from greater than 1.0020 in the United Kingdom, South Africa, Estonia, and Canada to less than 1.0008 in Mexico and Spain. Short term excess mortality in association with exposure to ozone higher than maximum background levels (70 µg/m) was 0.26% (95% confidence interval 0.24% to 0.28%), corresponding to 8203 annual excess deaths (95% confidence interval 3525 to 12 840) across the 406 cities studied. The excess remained at 0.20% (0.18% to 0.22%) when restricting to days above the WHO guideline (100 µg/m), corresponding to 6262 annual excess deaths (1413 to 11 065). Above more lenient thresholds for air quality standards in Europe, America, and China, excess mortality was 0.14%, 0.09%, and 0.05%, respectively.

Conclusions: Results suggest that ozone related mortality could be potentially reduced under stricter air quality standards. These findings have relevance for the implementation of efficient clean air interventions and mitigation strategies designed within national and international climate policies.
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http://dx.doi.org/10.1136/bmj.m108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190035PMC
February 2020
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