Health Effects Of Long-term Exposure Research Articles

Modelling nationwide spatial variation of ultrafine particles based on mobile monitoring

BackgroundLarge nation- and region-wide epidemiological studies have provided important insights into the health effects of long-term exposure to outdoor air pollution. Evidence from these studies for the long-term effects of ultrafine particles (UFP), however is lacking. Reason for this is the shortage of empirical UFP land use regression models spanning large geographical areas including cities with varying topographies, peri-urban and rural areas. The aim of this paper is to combine targeted mobile monitoring and long-term regional background monitoring to develop national UFP models. MethodWe used an electric car to monitor UFP concentrations in selected cities and towns across the Netherlands over a 14-month period in 2016–2017. Routes were monitored 3 times and concentrations were averaged per road segment. In addition, we used kriging maps based on regional background monitoring (20 sites; 3 × 2 weeks) over the same period to assess annual average regional background concentrations. All road segments were used to model spatial variation of UFP with three different land-use (regression) approaches: supervised stepwise regression, LASSO and random forest. For each approach, we also tested a deconvolution method, which segregates the average concentration at each road segment into a local and background signal. Model performance was evaluated with short-term (400 sites across the Netherlands; 3 × 30 minutes) and external longer-term measurements (42 sites in two major cities; 3 × 24 hours). We also compared predictions of all six models at 1000 random addresses spread over the country. ResultsWe found similar predictive performance for the six models, with validation R2 values from 0.25 to 0.35 for short-term measurements and 0.52 to 0.60 for longer-term external measurements. Models with and without deconvolution had similar predictive performance. All models based on the deconvolution method included a regional background kriging map as important predictor. Correlations between predictions at random addresses were high with Pearson correlations from 0.84 to 0.99. Models overestimated exposure at the short-term and long-term sites by about 20–30% in all cases, with small differences between regions and road types. ConclusionWe developed robust nation-wide models for long-term UFP exposure combining mobile monitoring with long-term regional background monitoring. Minor differences in predictive performance between different algorithms were found, but the deconvolution approach is considered more physically realistic. The models will be applied in Dutch nation-wide health studies.

Systematic Review on the Health Effects of Long-term Exposure to Traffic-Related Air Pollution

The health effects of traffic-related air pollution (TRAP) continue to be of important public health interest. Following its well-cited 2010 critical review, the Health Effects Institute (HEI) is conducting a systematic review of the epidemiological literature on the health effects of long-term exposure to TRAP, with a new expert Panel. The Panel consists of 14 experts in epidemiology, exposure assessment and biostatistics, and is chaired by Francesco Forastiere (King’s College London) and Fred Lurmann (Sonoma Technology). Results are being combined quantitatively to evaluate the strength of evidence, where appropriate. The quantitative results of the review may be useful for future risk and health impact assessments of TRAP. The Panel is using a systematic approach to search the literature, assess study quality, summarize results, and reach conclusions about the body of evidence. To this end, a review protocol was developed and registered in Prospero. An extensive search was conducted of literature published between January 1980 and July 2019. Selected health outcomes include all-cause and cause-specific mortality, respiratory effects, cardiovascular effects, diabetes, and adverse birth outcomes. In addition, the Panel has developed an exposure framework to guide the selection and evaluation of epidemiological studies on TRAP. The review is now well underway, and preliminary results will be presented. After a broad search, the Panel has identified 1100 studies relevant for further screening; about 400 of which met the inclusion criteria and will be considered in the systematic review. Effect estimates were reported for all-cause mortality (40 papers), cardiovascular effects (70 papers), respiratory effects (180 papers), and birth outcomes (100 papers). The systematic review will undergo peer-review in 2020 and publication is aimed for 2021. The new review will be an authoritative update of HEI’s most-cited report for use by researchers and policymakers.

Systematic Review on the Health Effects of Long-term Exposure to Nontailpipe Traffic Emissions

With reductions in tailpipe emissions of particulate matter, there is an increasing interest in public health impacts of non-tailpipe emissions, specifically tire and brake wear and road dust. Following its well-cited 2010 critical review, a new Health Effects Institute (HEI) expert panel is conducting a systematic review of the epidemiological literature on the health effects of long-term exposure to TRAP, including non-tailpipe emissions. The Panel is using a systematic approach to search the literature, assess study quality, summarize results, and reach conclusions about the body of evidence. They developed a review protocol and registered it in Prospero. An extensive search was conducted of literature published between January 1980 and July 2019. Selected health outcomes include all-cause and cause-specific mortality, respiratory effects, cardiovascular effects, diabetes, and birth outcomes. In addition, the Panel has developed an exposure framework to guide the selection and evaluation of epidemiological studies on TRAP. The review is now well underway, and preliminary results will be presented. After a broad search identifying 1100 studies potentially relevant to the broader review, the panel included 14 studies reporting both relevant health outcomes and epidemiological results for non-tailpipe pollutants. Effect estimates were reported for all-cause mortality (3 papers), circulatory mortality (1 paper), cardiovascular effects (2 papers), respiratory effects (3 papers), and neurodevelopment in children (2 papers). Ten of the papers evaluated effects of copper (Cu) and iron (Fe); others evaluated only Cu (2 papers) or non-exhaust PM2.5 mass (2 papers). Further evaluation of these papers will inform future research questions related to health effects of non-tailpipe emissions from motor vehicles.

Associations of air pollution and greenness with all-cause mortality in Greece: an ecological study

Background/Aim: Epidemiological studies have documented the health effects of long-term exposure to fine particulate matter (PM2.5), while fewer studies have investigated the effects of exposure to nitrogen dioxide (NO2), black carbon (BC) and even less to ozone (O3). There is limited evidence for the synergistic effects of exposure to pollutants and proximity to green spaces. We investigated the association of long-term exposure to air pollution and greenness with all-cause mortality in Greece using a geographical ecological study. Methods: Mortality and socioeconomic data were obtained from 1035 municipal units from the 2011 census data. Annual average PM2.5, NO2, BC and O3 concentrations for 2010 were derived from 100x100m surfaces predicted by hybrid LUR models developed within the ELAPSE project. The normalized difference vegetation index was used for greenness. We applied generalized additive models on standardized total mortality rates (SMRs) adjusted for socioeconomic indicators and lung cancer rates and accounting for spatial autocorrelation. The analysis was conducted for the whole country and by urban and rural areas. We assessed interactions between pollutants and green space and two-exposure models. Results: PM2.5, NO2 and BC were significantly associated with mortality: an interquartile range (IQR) increase was associated with a Relative Risk (RR)of 1.09, (95% confidence interval (CI): 1.08-1.11), 1.03 (95% CI: 1.03-1.04) and 1.02(95% CI: 1.02-1.03), respectively. The associations were stronger in urban areas. Greenness was associated with lower mortality (RR: 0.95, 95% CI: 0.94 - 0.96 per IQR). An inverse association with O3 was found. We did not find any statistically significant interaction between pollution and green spaces, while estimates were mostly robust to co-exposure adjustment. Conclusions: Our findings support independent associations of air pollution exposure and green spaces with total mortality, both in the urban and rural areas in Greece that are of importance for public health policy and urban development.

A systematic review on health effects following long-term exposure to temperature

Background/Aim Health effects of long-term exposure to temperature have only recently received attention. We performed a systematic review to assess health associations with long-term (exceeding three months) exposure to temperature metrics in the framework of the EXHAUSTION project.Methods We performed a systematic search in PubMed and Web of Science databases up to October 2019. The search resulted in 61 studies meeting inclusion criteria from the 2946 records screened.We identified 14 studies including total mortality, 16 including cardiovascular outcomes, 11 including respiratory outcomes, 16 with birth outcomes and 15 on outcomes other than those above.Results Studies investigating annual mortality changes in relation to annual temperature metrics show that extreme and variable temperature is associated with adverse health outcomes at an annual level, indicating that aggregate effects of temperature extremes cannot be attributed to short-term mortality displacement. Studies on cardiovascular mortality show stronger associations with low rather than high temperature, whilst those on blood pressure report that in populations living in warmer climates levels tend to be lower. Studies on respiratory outcomes generally report effects of both heat and cold, but they are limited in number and use diverse health endpoints. Several studies report on birth outcomes as well as other outcomes with less consistent results. Air pollution interaction effects have not been assessed in any study. Other potential effect modifiers that were investigated in a limited number of studies, indicate stronger effects among the elderly and socially deprived.Conclusions Our review revealed gaps in previous research related to the study of long-term effects of temperature. More and better designed studies are needed. The investigation of effect modification by air pollutants and other environmental factors will add valuable information for policy decisions on climate change adaptation and mitigation.

Effects of short-term exposures to ultrafine particles near an airport in healthy subjects

BackgroundRecent studies reported elevated concentrations of ultrafine particles (UFP) near airports. Little is known about the health effects of UFP from aviation. Since UFP can deposit deep into the lungs and other organs, they may cause significant adverse health effects. ObjectiveWe investigated health effects of controlled short-term human exposure to UFP near a major airport. MethodsIn this study, 21 healthy non-smoking volunteers (age range: 18–35 years) were repeatedly (2–5 visits) exposed for 5 h to ambient air near Schiphol Airport, while performing intermittent moderate exercise (i.e. cycling). Pre- to post-exposure changes in cardiopulmonary outcomes (spirometry, forced exhaled nitric oxide, electrocardiography and blood pressure) were assessed and related to total- and size-specific particle number concentrations (PNC), using linear mixed effect models. ResultsThe PNC was on average 53,500 particles/cm3 (range 10,500–173,200). A 5–95th percentile increase in exposure to UFP (i.e. 125,400 particles/cm3) was associated with a decrease in FVC of −73.8 mL (95% CI −138.8 – −0.4) and a prolongation of the corrected QT (QTc) interval by 9.9 ms (95% CI 2.0 – 19.1). These effects were associated with particles < 20 nm (mainly UFP from aviation), but not with particles > 50 nm (mainly UFP from road traffic). DiscussionShort-term exposures to aviation-related UFP near a major airport, was associated with decreased lung function (mainly FVC) and a prolonged QTc interval in healthy volunteers. The effects were relatively small, however, they appeared after single exposures of 5 h in young healthy adults. As this study cannot make any inferences about long-term health impacts, appropriate studies investigating potential health effects of long-term exposure to airport-related UFP, are urgently needed.

Road traffic noise, air pollution and cardiovascular events in a Swedish cohort

Urbanization and increasing road traffic cause exposure to both noise and air pollution. While the levels of air pollutants such as nitrogen oxides (NOx) have decreased in Sweden during the past decades, exposure to traffic noise has increased. The association with cardiovascular morbidity is less well established for noise than for air pollution, and most studies have only studied one of the two highly spatially correlated exposures.The Swedish Primary Prevention Study cohort consists of men aged 47 to 55 when first examined in 1970–1973. The cohort members were linked to the Swedish patient registry through their personal identity number and followed until first cardiovascular event 1970–2011. The address history during the entire study period was used to assign annual modelled residential exposure to road traffic noise and NOx. The Cox proportional hazards model with age on the time axis and time-varying exposures were used in the analysis.The results for 6304 men showed a non-significant increased risk of cardiovascular disease for long-term road traffic noise at the home address, after adjusting for air pollution. The hazard ratios were 1.08 (95% CI 0.90–1.28) for cardiovascular mortality, 1.14 (95% CI 0.96–1.36) for ischemic heart disease incidence and 1.07 (95% CI 0.85–1.36) for stroke incidence, for noise above 60 dB, compared to below 50 dB.This study found some support for cardiovascular health effects of long-term exposure to road traffic noise above 60 dB, after having accounted for exposure to air pollution.

Occurrence and human health risks of phthalates in indoor air of laboratories

Phthalate acid esters (PAEs) are of serious concern as a human health risk due to their ubiquitous presence in indoor air. In the present study, fifteen PAEs in the indoor air samples from physical, chemical, and biological laboratories in Guangzhou, southern China were analysed using gas chromatography mass spectrometry. Extremely high levels of PAEs of up to 6.39 × 104 ng/m3 were detected in some laboratories. Diisobutyl phthalate (DiBP), di(methoxyethyl) phthalate (DMEP), and di-n-butyl phthalate (DBP) were the dominant PAEs with median levels of 0.48 × 103, 0.44 × 103, and 0.39 × 103 ng/m3, respectively, followed by di-(2-propylheptyl) phthalate (DPHP) and di(2-ethylhexyl) phthlate (DEHP) (median levels: 0.16 × 103 and 0.13 × 103 ng/m3, respectively). DMEP and DPHP were found for the first time in indoor air. Principal component analysis indicated that profiles of PAEs varied greatly among laboratory types, suggesting notable variations in sources. The results of independent samples t-tests showed that levels of PAEs were significantly influenced by various environmental conditions. Both the non-carcinogenic and carcinogenic health risks from human exposure to PAEs based on the daily exposure dose in laboratory air were acceptable. Further research should be conducted to investigate the long-term health effects of exposure to PAEs in laboratories.

Traffic contribution to PM2.5 increment in the near-road environment

A growing number of studies have reported the adverse health effects of long-term exposure to air pollutants, especially fine particulate matter (PM2.5). Vehicular emission sources have been shown to contribute to elevated air pollution concentrations in the near-road environment, including PM2.5, based on monitoring data collected mainly during short-term campaigns. The United States Environmental Protection Agency (EPA) added near-road monitors to its national network to collect long-term National Ambient Air Quality Standard (NAAQS)–comparable data in the near-road environment. The EPA also mandated inclusion of near-road monitoring data in the Air Quality Index to reflect the elevated level of near-road PM2.5 concentrations to which millions of people in major urban areas are exposed to on a daily basis. For the first time, PM2.5 data collected at one of these near-road monitors were compared with those of other NAAQS monitors during 2016 in Houston, Texas. One of these NAAQS monitors was selected based on EPA guidance for quantitative hotspot analyses of particulate matter to represent background concentrations. The near-road PM2.5 increment was statistically significant. The traffic contribution to 24-h PM2.5 increment in the near-road environment was estimated to be about 23% of background concentration, which is close to estimates given by previous studies (22%) and is greater than a recent estimate based on a national-scale data analysis (17%), emphasizing the importance of background monitor selection criteria. Wind speed and direction were shown to have a considerable effect on PM2.5 increment in the near-road environment. A multiple linear regression model was developed to predict 24-h near-road PM2.5 concentrations using background PM2.5 concentration, wind speed, and wind direction. This model explained 83% of the variability of 24-h PM2.5 concentrations in the near-road environment and showed improvement in near-road concentration predictions when accounting for wind speed and wind direction.

Long-term residential exposure to PM2.5 constituents and mortality in a Danish cohort

Studies on health effects of long-term exposure to specific PM2.5 constituents are few. Previous studies have reported an association between black carbon (BC) exposure and cardiovascular diseases (CVD) and a few studies have found an association between sulfate exposure and mortality. These studies, however, relied mainly on exposure data from centrally located air-monitoring stations, which is a crude approximation of personal exposure.We focused on specific chemical constituents of PM2.5, i.e. elemental and primary organic carbonaceous particles (BC/OC), sea salt, secondary inorganic aerosols (SIA, i.e. NO3–, NH4+, and SO42-), and secondary organic aerosols (SOA), in relation to all-cause, CVD and respiratory disease mortality.We followed a Danish cohort of 49,564 individuals from enrollment in 1993–1997 through 2015. We combined residential address history from 1979 onwards with mean annual air pollution concentrations obtained by the AirGIS air pollution modelling system, lifestyle information from baseline questionnaires and socio-demography obtained by register linkage.During 895,897 person-years of follow-up, 10,193 deaths from all causes occurred – of which 2319 were CVD-related and 870 were related to respiratory disease. The 15-year time-weighted average concentrations of PM2.5, BC/OC, sea salt, SIA and SOA were 13.8, 2.8, 3.4, 4.9, and 0.3 µg/m3, respectively. For all-cause mortality, a higher risk was observed with higher exposure to PM2.5, BC/OC and SOA with adjusted hazard ratios of 1.03 (95% confidence intervals: 1.01, 1.05), 1.06 (1.03, 1.09), and 1.08 (1.03, 1.13) per interquartile range, respectively. The associations for BC/OC and SOA remained after adjustment for PM2.5 in two-pollutant models. For CVD mortality, we observed elevated risks with higher exposure to PM2.5, BC/OC and SIA. The results showed no clear relationship between sea salt and mortality.In this study, we observed a relationship between long-term exposure to PM2.5, BC/OC, and SOA and all-cause mortality and between PM2.5, BC/OC, and SIA and CVD mortality.

Developing an Exposure Framework to Systematically Review the Health Effects of Long-term Exposure to Traffic-Related Air Pollution

Developing an Exposure Framework to Systematically Review the Health Effects of Long-term Exposure to Traffic-Related Air Pollution

Systematic Review on the Health Effects of Long-term Exposure to Traffic-Related Air Pollution

Systematic Review on the Health Effects of Long-term Exposure to Traffic-Related Air Pollution

Land use regression models for ultrafine particles, fine particles, and black carbon in Southern California

Exposure models are needed to evaluate health effects of long-term exposure to ambient ultrafine particles (UFP; <0.1 μm) and to disentangle their association from other pollutants, particularly PM2.5 (<2.5 μm). We developed land use regression (LUR) models to support UFP exposure assessment in the Los Angeles Ultrafines Study, a cohort in Southern California. We conducted a short-term measurement campaign in Los Angeles and parts of Riverside and Orange counties to measure UFP, PM2.5, and black carbon (BC), collecting three 30-minute average measurements at 215 sites across three seasons. We averaged concentrations for each site and evaluated geographic predictors including traffic intensity, distance to airports, land use, and population and building density by supervised stepwise selection to develop models. UFP and PM2.5 measurements (r = 0.001) and predictions (r = 0.05) were uncorrelated at the sites. UFP model explained variance was robust (R2 = 0.66) and 10-fold cross-validation indicated good performance (R2 = 0.59). Explained variation was moderate for PM2.5 (R2 = 0.47) and BC (R2 = 0.38). In the cohort, we predicted a 2.3-fold exposure contrast from the 5th to 95th percentiles for all three pollutants. The correlation between modeled UFP and PM2.5 at cohort residences was weak (r = 0.28), although higher than between measured levels. LUR models, particularly for UFP, were successfully developed and predicted reasonable exposure contrasts.

Secondhand exposure to e-cigarette aerosols among smokers: A cross-sectional study in six European countries of the EUREST-PLUS ITC Europe Surveys.

INTRODUCTIONElectronic cigarette (e-cigarette) use has grown significantly in some European Union (EU) Member States (MS). A better understanding of the exposure to secondhand e-cigarette aerosols (SHA) is necessary to develop and implement comprehensive regulations on e-cigarette use in public places. This study aims to assess the observation of e-cigarette use in public places, the self-reported exposure to SHA, and the level of users’ comfort using e-cigarettes in the presence of others.METHODSThis is a cross-sectional study of the Wave 1 International Tobacco Control 6 European Countries Survey recruiting adult smokers (n=6011) across six EU MS: Germany, Greece, Hungary, Poland, Romania, and Spain, within the EURESTPLUS Project. A descriptive analysis was conducted to estimate the prevalence (%) of observed e-cigarette use in different places, frequency of self-reported exposure to SHA, and level of comfort using e-cigarettes in the presence of others.RESULTSIn all, 31.0% of smokers observed others using e-cigarette in public places, 19.7% in indoor places where smoking is banned, and 14.5% indoors at work. Almost 37% of smokers reported to be ever exposed to SHA, ranging from 17.7% in Spain to 63.3% in Greece. The higher prevalence of observed e-cigarette use and passive exposure to SHA was reported by smokers of younger age, of higher educational level and those being current or former e-cigarette users. Part (8.8%) of the smokers who were also e-cigarette users reported feeling uncomfortable using e-cigarettes in the presence of others.CONCLUSIONSA third of smokers from six EU MS reported being exposed to SHA. Prevalence differences were observed among the countries. In the context of scarce evidence on long-term health effects of exposure to SHA, precautionary regulations protecting bystanders from involuntary exposure should be developed.

The disappearing Salton Sea: A critical reflection on the emerging environmental threat of disappearing saline lakes and potential impacts on children's health

Changing weather patterns, droughts and competing water demands are dramatically altering the landscape and creating conditions conducive to the production of wind-blown dust and dust storms. In California, such factors are leading to the rapid shrinking of the Salton Sea, a 345 mile2 land-locked “sea” situated near the southeastern rural border region known as the Imperial Valley. The region is anticipated to experience a dramatic increase in wind-blown dust and existing studies suggest a significant impact on the health and quality of life for nearby residents of this predominantly low-income, Mexican-American community. The discussion calls attention to the public health dimensions of the Salton Sea crisis. We know little about the possible long-term health effects of exposure to mobilized lakebed sediments or the numerous toxic contaminants that may become respirable on entrained particles. We draw on existing epidemiological literature of other known sources of wind-blown dust, such as desert dust storms, and related health effects to begin to understand the potential public health impact of wind-blown dust exposure. The increased production of wind-blown dust and environmental exposures to such non-combustion related sources of particulate matter are a growing health threat, due in part to drought coupled with increasing pressures on limited water resources. Recent population-based studies have linked dust storms with cardiovascular mortality, asthma hospitalization and decrease in pulmonary function in both adults and children. A growing number of studies provide evidence of the acute health effects of wind-blown dust exposures among children, which with repeated insults have the potential to influence respiratory health over time. The shrinking of the Salton Sea illustrates a public health and environmental justice crisis that requires action and attention to protect the health and well-being of local communities.

전국 시군구 PM2.5 연평균 농도 추정 방법 제안: 전국규모 국가대기오염측정망 측정 자료가 없는 2001~2014년을 중심으로

Previous national cohort studies in Europe and North America have reported the relationship between longterm exposure to fine particulate matter air pollution and human health. However, there have been few studies in South Korea, because nationwide PM2.5 regulatory air quality monitoring data were not available before 2015. This study aimed to develop an approach to predicting nationwide annual average PM2.5 concentrations for 2001~2014 using the ratios of PM2.5 to PM10. We used regulatory air quality monitoring data for PM2.5 available only in Seoul for 2001~2014 and for the entire country in 2015, as well as national-scale data for PM10 for 2001~2015. Our approach is based on multiplication of the districtspecific annual means of PM10 for 2001~2014 predicted from a previously-developed approach by ratios of annual average PM2.5 to PM10. Given the limited data availability to match PM2.5 and PM10 data over time and space, we explored five approaches for computing ratios of PM2.5 to PM10: 1) an overall ratio based on national data in 2015; 2) a ratio for 2001~2014 in Seoul; 3) annual ratios for 2001~2014 in Seoul; 4) regional ratios in 2015; 5) regional ratios in 2015 with a spatial adjustment factor. We validated the models using PM2.5 data for 2011~2014 collected at 24 regulatory monitoring sties in the second largest metropolitan city in South Korea, Busan. Whereas R² was computed over all sites and all years, spatial R² was computed by using 4-year averages at each site focusing on spatial prediction ability. In our validation, the approach 5 gave the largest overall and spatial R² of 0.79 and 0.84. Our highly predictive approach for estimating national-scale annual-average PM2.5 concentrations for 15 years will allow future cohort studies to investigate health effects of long-term exposure to PM2.5 in South Korea.

Analyses of Air Pollution and Mortality in the American Cancer Society Cancer Prevention Study-II

Over the past two decades, the American Cancer Society Cancer Prevention Study-II (CPS-II) has provided valuable information regarding the mortality health effects of long-term exposure to ambient ...

Annoyance in Response to Vibrations from Railways.

Rail transport is a key stepping stone in the EU’s transport policy and is pinpointed for investment and growth over the coming decades. This expanding infrastructure implies increased exposure to environmental stressors, such as noise and ground-borne vibrations. Little is known about the health impacts of exposure to these vibrations. The aim of this paper is to examine the association between annoyance from rail vibrations and the distance of residential dwelling from the railway. It reports the first results of a large epidemiological study, EpiVib, which was designed to investigate the long-term health effects of exposure to rail vibrations. The first part of this study examines a self-reported questionnaire. In total, 6894 individuals aged between 18 and 80 living within 1 km of a railway in west Sweden participated. Results presented here examine the association between distance to the railway and annoyance from vibrations and are stratified by train type. A positive association between closer distance and increased annoyance is seen. After adjustment for important modifiers, results showed that vibrations from freight trains and maintenance operations are reported to be moderately and highly annoying at distances of up to 400 m from the railway and diesel up to 300 m. Vibration from passenger and fast trains are significantly annoying up to 200 m from the track. Vibration from freight trains and maintenance operations were considered highly annoying up to 300 m from the track, diesel up to 400 m. Vibration from passenger and fast trains are not reported to be highly annoying after adjustment. Heavier, slower moving locomotives, in the form of diesel and freight trains, appear to be the source of annoyance at distances further from the railway compared to passenger and fast trains. This has implications in terms of property, transport, and infrastructure planning.

Biodiversity and human health: mechanisms and evidence of the positive health effects of diversity in nature and green spaces.

Natural environments and green spaces provide ecosystem services that enhance human health and well-being. They improve mental health, mitigate allergies and reduce all-cause, respiratory, cardiovascular and cancer mortality. The presence, accessibility, proximity and greenness of green spaces determine the magnitude of their positive health effects, but the role of biodiversity (including species and ecosystem diversity) within green spaces remains underexplored. This review describes mechanisms and evidence of effects of biodiversity in nature and green spaces on human health. We identified studies listed in PubMed and Web of Science using combinations of keywords including 'biodiversity', 'diversity', 'species richness', 'human health', 'mental health' and 'well-being' with no restrictions on the year of publication. Papers were considered for detailed evaluation if they were written in English and reported data on levels of biodiversity and health outcomes. There is evidence for positive associations between species diversity and well-being (psychological and physical) and between ecosystem diversity and immune system regulation. There is a very limited number of studies that relate measured biodiversity to human health. There is more evidence for self-reported psychological well-being than for well-defined clinical outcomes. High species diversity has been associated with both reduced and increased vector-borne disease risk. Biodiversity supports ecosystem services mitigating heat, noise and air pollution, which all mediate the positive health effects of green spaces, but direct and long-term health outcomes of species diversity have been insufficiently studied so far. Additional research and newly developed methods are needed to quantify short- and long-term health effects of exposure to perceived and objectively measured species diversity, including health effects of nature-based solutions and exposure to microbiota.

Mortality assessment attributed to long-term exposure to fine particles in ambient air of the megacity of Tehran, Iran.

Few studies regarding the health effects of long-term exposure to particulate matter with an aerodynamic diameter of 2.5μm or less (PM2.5) have been carried out in Asia or the Middle East. The objective of our study was to assess total, lung cancer and chronic obstructive pulmonary disease (COPD) mortality attributed to long-term exposure to PM2.5 among adults aged over 30years in Tehran from March 2013 to March 2016 using AirQ+ software. AirQ+ modeling software was used to estimate the number of deaths attributed to PM2.5 concentrations higher than 10μgm-3. Air quality data were obtained from the Department of Environment (DOE) and Tehran Air Quality Control Company (TAQCC). Only valid stations with data completeness of 75% in all 3years were selected for entry into the model. The 3-year average of the 24-h concentrations was 39.17μgm-3. The results showed that the annual average concentration of PM2.5 in 2015-2016 was reduced by 13% compared to that in 2013-2014. The annual average number of all natural, COPD, and lung cancer deaths attributable to long-term exposure to PM2.5 in adults aged more than 30years was 5073, 158, and 142 cases, respectively. The results of all three health endpoints indicate that the mortality attributable to PM2.5 decreased yearly from 2013 to 2016 and that the reduced mortality was related to a corresponding reduction in the PM2.5 concentration. Considering these first positive results, the steps that have been currently taken for reducing air pollution in Tehran should be continued to further improve the already positive effects of these measures on reducing health outcomes.