Showing papers by "Bertil Forsberg published in 2014"

Long-term exposure to air pollution and cardiovascular mortality: an analysis of 22 European cohorts.

Abstract: Background: Air pollution has been associated with cardiovascular mortality, but it remains unclear as to whether specific pollutants are related to specific cardiovascular causes of death. Within ...

Association of ambient air pollution with the prevalence and incidence of COPD

Abstract: The role of air pollution in chronic obstructive pulmonary disease (COPD) remains uncertain. The aim was to assess the impact of chronic exposure to air pollution on COPD in four cohorts using the standardised ESCAPE exposure estimates. Annual average particulate matter (PM), nitrogen oxides (NOx) and road traffic exposure were assigned to home addresses using land-use regression models. COPD was defined by NHANES reference equation (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) less than the lower limit of normal) and the Global Initiative for Chronic Obstructive Lung Disease criterion (FEV1/FVC <0.70) and categorised by severity in non-asthmatics. We included 6550 subjects with assigned NOx and 3692 with PM measures. COPD was not associated with NO2 or PM10 in any individual cohort. In meta-analyses only NO2, NOx, PM10 and the traffic indicators were positively, although not significantly, associated with COPD. The only statistically significant associations were seen in females (COPD prevalence using GOLD: OR 1.57, 95% CI 1.11-2.23; and incidence: OR 1.79, 95% CI 1.21-2.68). None of the principal results were statistically significant, the weak positive associations of exposure with COPD and the significant subgroup findings need to be evaluated in further well standardised cohorts followed up for longer time, and with time-matched exposure assignments.

Arterial Blood Pressure and Long-Term Exposure to Traffic-Related Air Pollution : An Analysis in the European Study of Cohorts for Air Pollution Effects (ESCAPE)

Abstract: Background: Long-term exposure to air pollution has been hypothesized to elevate arterial blood pressure (BP). The existing evidence is scarce and country specific. Objectives: We investigated the cross-sectional association of long-term traffic-related air pollution with BP and prevalent hypertension in European populations. Methods: We analyzed 15 population-based cohorts, participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE). We modeled residential exposure to particulate matter and nitrogen oxides with land use regression using a uniform protocol. We assessed traffic exposure with traffic indicator variables. We analyzed systolic and diastolic BP in participants medicated and nonmedicated with BP-lowering medication (BPLM) separately, adjusting for personal and area-level risk factors and environmental noise. Prevalent hypertension was defined as ≥ 140 mmHg systolic BP, or ≥ 90 mmHg diastolic BP, or intake of BPLM. We combined cohort-specific results using random-effects meta-analysis. Results: In the main meta-analysis of 113,926 participants, traffic load on major roads within 100 m of the residence was associated with increased systolic and diastolic BP in nonmedicated participants [0.35 mmHg (95% CI: 0.02, 0.68) and 0.22 mmHg (95% CI: 0.04, 0.40) per 4,000,000 vehicles × m/day, respectively]. The estimated odds ratio (OR) for prevalent hypertension was 1.05 (95% CI: 0.99, 1.11) per 4,000,000 vehicles × m/day. Modeled air pollutants and BP were not clearly associated. Conclusions: In this first comprehensive meta-analysis of European population-based cohorts, we observed a weak positive association of high residential traffic exposure with BP in nonmedicated participants, and an elevated OR for prevalent hypertension. The relationship of modeled air pollutants with BP was inconsistent.

Susceptibility to mortality related to temperature and heat and cold wave duration in the population of Stockholm County, Sweden.

Abstract: Background : Ambient temperatures can cause an increase in mortality. A better understanding is needed of how health status and other factors modify the risk associated with high and low temperatures, to improve the basis of preventive measures. Differences in susceptibility to temperature and to heat and cold wave duration are relatively unexplored. Objectives : We studied the associations between mortality and temperature and heat and cold wave duration, stratified by age and individual and medical factors. Methods : Deaths among all residents of Stockholm County between 1990 and 2002 were linked to discharge diagnosis data from hospital admissions, and associations were examined using the time stratified case-crossover design. Analyses were stratified by gender, age, pre-existing disease, country of origin, and municipality level wealth, and adjusted for potential confounding factors. Results : The effect on mortality by heat wave duration was higher for lower ages, in areas with lower wealth, for hospitalized patients younger than age 65. Odds were elevated among females younger than age 65, in groups with a previous hospital admission for mental disorders, and in persons with previous cardiovascular disease. Gradual increases in summer temperatures were associated with mortality in people older than 80 years, and with mortality in groups with a previous myocardial infarction and with chronic obstructive pulmonary disease (COPD) in the population younger than 65 years. During winter, mortality was associated with a decrease in temperature particularly in men and with the duration of cold spells for the population older than 80. A history of hospitalization for myocardial infarction increased the odds associated with cold temperatures among the population older than 65. Previous mental disease or substance abuse increased the odds of death among the population younger than 65. Conclusion : To increase effectiveness, we suggest preventive efforts should not assume susceptible groups are the same for warm and cold days and heat and cold waves, respectively. Keywords : mortality; hospitalization; heat; cold; temperature; weather (Published: 12 March 2014) To access the supplementary material for this article, please see Supplementary files under Article Tools. Citation : Glob Health Action 2014, 7: 22737 - http://dx.doi.org/10.3402/gha.v7.22737

Precipitation effects on microbial pollution in a river: lag structures and seasonal effect modification.

Abstract: Background: The river Gota Alv is a source of freshwater for 0.7 million swedes. The river is subject to contamination from sewer systems discharge and runoff from agricultural lands. Climate models projects an increase in precipitation and heavy rainfall in this region. This study aimed to determine how daily rainfall causes variation in indicators of pathogen loads, to increase knowledge of variations in river water quality and discuss implications for risk management. Methods: Data covering 7 years of daily monitoring of river water turbidity and concentrations of E. coli, Clostridium and coliforms were obtained, and their short-term variations in relation with precipitation were analyzed with time series regression and non-linear distributed lag models. We studied how precipitation effects varied with season and compared different weather stations for predictive ability. Results: Generally, the lowest raw water quality occurs 2 days after rainfall, with poor raw water quality continuing for several more days. A rainfall event of >15 mm/24-h (local 95 percentile) was associated with a three-fold higher concentration of E. coli and 30% higher turbidity levels (lag 2). Rainfall was associated with exponential increases in concentrations of indicator bacteria while the effect on turbidity attenuated with very heavy rainfall. Clear associations were also observed between consecutive days of wet weather and decreased water quality. The precipitation effect on increased levels of indicator bacteria was significant in all seasons. Conclusions: Rainfall elevates microbial risks year-round in this river and freshwater source and acts as the main driver of varying water quality. Heavy rainfall appears to be a better predictor of fecal pollution than water turbidity. An increase of wet weather and extreme events with climate change will lower river water quality even more, indicating greater challenges for drinking water producers, and suggesting better control of sources of pollution.

Longterm follow-up in European respiratory health studies – patterns and implications

Abstract: Background: Selection bias is a systematic error in epidemiologic studies that may seriously distort true measures of associations between exposure and disease. Observational studies are highly susceptible to selection bias, and researchers should therefore always examine to what extent selection bias may be present in their material and what characterizes the bias in their material. In the present study we examined long-term participation and consequences of loss to follow-up in the studies Respiratory Health in Northern Europe (RHINE), Italian centers of European Community Respiratory Health Survey (I-ECRHS), and the Italian Study on Asthma in Young Adults (ISAYA). Methods: Logistic regression identified predictors for follow-up participation. Baseline prevalence of 9 respiratory symptoms (asthma attack, asthma medication, combined variable with asthma attack and/or asthma medication, wheeze, rhinitis, wheeze with dyspnea, wheeze without cold, waking with chest tightness, waking with dyspnea) and 9 exposure-outcome associations (predictors sex, age and smoking; outcomes wheeze, asthma and rhinitis) were compared between all baseline participants and long-term participants. Bias was measured as ratios of relative frequencies and ratios of odds ratios (ROR). Results: Follow-up response rates after 10 years were 75% in RHINE, 64% in I-ECRHS and 53% in ISAYA. After 20 years of follow-up, response was 53% in RHINE and 49% in I-ECRHS. Female sex predicted long-term participation (in RHINE OR (95% CI) 1.30(1.22, 1.38); in I-ECRHS 1.29 (1.11, 1.50); and in ISAYA 1.42 (1.25, 1.61)), as did increasing age. Baseline prevalence of respiratory symptoms were lower among long-term participants (relative deviations compared to total baseline population 0-15% (RHINE), 0-48% (I-ECRHS), 3-20% (ISAYA)), except rhinitis which had a slightly higher prevalence. Most exposure-outcome associations did not differ between long-term participants and all baseline participants, except lower OR for rhinitis among ISAYA long-term participating smokers (relative deviation 17% (smokers) and 44% (10–20 pack years)). Conclusions: We found comparable patterns of long-term participation and loss to follow-up in RHINE, I-ECRHS and ISAYA. Baseline prevalence estimates for long-term participants were slightly lower than for the total baseline population, while exposure-outcome associations were mainly unchanged by loss to follow-up.

Geographical variation in the prevalence of sensitization to common aeroallergens in adults: the GA(2) LEN survey.

Abstract: Background Geographical variation in the prevalence of sensitization to aeroallergens may reflect differences in exposure to risk factors such as having older siblings, being raised on a farm or ot ...

Air pollution and nonmalignant respiratory mortality in 16 cohorts within the ESCAPE project

Abstract: RATIONALE: Prospective cohort studies have shown that chronic exposure to particulate matter and traffic-related air pollution is associated with reduced survival. However, the effects on nonmalignant respiratory mortality are less studied, and the data reported are less consistent. OBJECTIVES: We have investigated the relationship of long-term exposure to air pollution and nonmalignant respiratory mortality in 16 cohorts with individual level data within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE). METHODS: Data from 16 ongoing cohort studies from Europe were used. The total number of subjects was 307,553. There were 1,559 respiratory deaths during follow-up. MEASUREMENTS AND MAIN RESULTS: Air pollution exposure was estimated by land use regression models at the baseline residential addresses of study participants and traffic-proximity variables were derived from geographical databases following a standardized procedure within the ESCAPE study. Cohort-specific hazard ratios obtained by Cox proportional hazard models from standardized individual cohort analyses were combined using metaanalyses. We found no significant associations between air pollution exposure and nonmalignant respiratory mortality. Most hazard ratios were slightly below unity, with the exception of the traffic-proximity indicators. CONCLUSIONS: In this study of 16 cohorts, there was no association between air pollution exposure and nonmalignant respiratory mortality.

Cross-sectional associations between air pollution and chronic bronchitis: an ESCAPE meta-analysis across five cohorts

Abstract: Background This study aimed to assess associations of outdoor air pollution on prevalence of chronic bronchitis symptoms in adults in five cohort studies (Asthma-E3N, ECRHS, NSHD, SALIA, SAPALDIA) participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE) project. Methods Annual average particulate matter (PM 10 , PM 2.5 , PM absorbance , PM coarse ), NO 2 , nitrogen oxides (NO x ) and road traffic measures modelled from ESCAPE measurement campaigns 2008–2011 were assigned to home address at most recent assessments (1998–2011). Symptoms examined were chronic bronchitis (cough and phlegm for ≥3 months of the year for ≥2 years), chronic cough (with/without phlegm) and chronic phlegm (with/without cough). Cohort-specific cross-sectional multivariable logistic regression analyses were conducted using common confounder sets (age, sex, smoking, interview season, education), followed by meta-analysis. Results 15 279 and 10 537 participants respectively were included in the main NO 2 and PM analyses at assessments in 1998–2011. Overall, there were no statistically significant associations with any air pollutant or traffic exposure. Sensitivity analyses including in asthmatics only, females only or using back-extrapolated NO 2 and PM 10 for assessments in 1985–2002 (ECRHS, NSHD, SALIA, SAPALDIA) did not alter conclusions. In never-smokers, all associations were positive, but reached statistical significance only for chronic phlegm with PM coarse OR 1.31 (1.05 to 1.64) per 5 µg/m 3 increase and PM 10 with similar effect size. Sensitivity analyses of older cohorts showed increased risk of chronic cough with PM 2.5abs (black carbon) exposures. Conclusions Results do not show consistent associations between chronic bronchitis symptoms and current traffic-related air pollution in adult European populations.

Place of upbringing in early childhood as related to inflammatory bowel diseases in adulthood: a population-based cohort study in Northern Europe

Abstract: Background The two inflammatory bowel diseases (IBD), ulcerative colitis and Crohn's disease, has increased rapidly during the twentieth century, but the aetiology is still poorly understood. Impaired immunological competence due to decreasing biodiversity and altered microbial stimulation is a suggested explanation. Objective Place of upbringing was used as a proxy for the level and diversity of microbial stimulation to investigate the effects on the prevalence of IBD in adulthood. Methods Respiratory Health in Northern Europe (RHINE) III is a postal follow-up questionnaire of the European Community Respiratory Health Survey (ECRHS) cohorts established in 1989–1992. The study population was 10,864 subjects born 1945–1971 in Denmark, Norway, Sweden, Iceland and Estonia, who responded to questionnaires in 2000–2002 and 2010–2012. Data were analysed in logistic and Cox regression models taking age, sex, smoking and body mass index into consideration. Results Being born and raised on a livestock farm the first 5 years of life was associated with a lower risk of IBD compared to city living in logistic (OR 0.54, 95 % CI 0.31; 0.94) and Cox regression models (HR 0.55, 95 % CI 0.31; 0.98). Random-effect meta-analysis did not identify geographical difference in this association. Furthermore, there was a significant trend comparing livestock farm living, village and city living (p < 0.01). Sub-analyses showed that the protective effect was only present among subjects born after 1952 (OR 0.25, 95 % CI 0.11; 0.61). Conclusion This study suggests a protective effect from livestock farm living in early childhood on the occurrence of IBD in adulthood, however only among subjects born after 1952. We speculate that lower microbial diversity is an explanation for the findings.

The association of asthma, nasal allergies, and positive skin prick tests with obesity, leptin, and adiponectin

Abstract: BACKGROUND: Cross-sectional and longitudinal reports show that obese adults have more asthma than non-obese adults. A proposed mechanism is via effects of adipokines (leptin and adiponectin) on the ...

Developing a Heatwave Early Warning System for Sweden: Evaluating Sensitivity of Different Epidemiological Modelling Approaches to Forecast Temperatures

Abstract: Over the last two decades a number of heatwaves have brought the need for heatwave early warning systems (HEWS) to the attention of many European governments. The HEWS in Europe are operating under the assumption that there is a high correlation between observed and forecasted temperatures. We investigated the sensitivity of different temperature mortality relationships when using forecast temperatures. We modelled mortality in Stockholm using observed temperatures and made predictions using forecast temperatures from the European Centre for Medium-range Weather Forecasts to assess the sensitivity. We found that the forecast will alter the expected future risk differently for different temperature mortality relationships. The more complex models seemed more sensitive to inaccurate forecasts. Despite the difference between models, there was a high agreement between models when identifying risk-days. We find that considerations of the accuracy in temperature forecasts should be part of the design of a HEWS. Currently operating HEWS do evaluate their predictive performance; this information should also be part of the evaluation of the epidemiological models that are the foundation in the HEWS. The most accurate description of the relationship between high temperature and mortality might not be the most suitable or practical when incorporated into a HEWS.

Natural History of Perceived Food Hypersensitivity and IgE Sensitisation to Food Allergens in a Cohort of Adults

Abstract: BACKGROUND:No longitudinal studies exist on the natural history of food hypersensitivity and IgE sensitisation to food allergens in adults.OBJECTIVE:To examine the natural history of food hypersens ...

The relation of airway obstruction to asthma, chronic rhinosinusitis and age: results from a population survey of adults

Abstract: Rationale: There is conflicting evidence on whether patients with asthma experience an accelerated decline in lung function with age. We examined the association between postbronchodilator lung fun ...

Quality of life in relation to the traffic pollution indicators NO2 and NOx: results from the Swedish GA2LEN survey

Abstract: Background Asthma is a chronic disease that may affect daily activities and quality of life. Asthmatics have higher incidence of chronic rhinosinusitis (CRS) and asthma is associated with sinonasal ...

Quantification of population exposure to NO2, PM2.5 and PM10 and estimated health impacts in Sweden 2010

Abstract: Sweden is one of the countries in Europe which experiences the lowest concentrations of air pollutants in urban areas Despite this, health impacts of exposure to ambient air pollution is still an

Short-term exposure to ozone and levels of exhaled nitric oxide

Abstract: Background: Adverse effects of air pollution include respiratory inflammation. A few epidemiologic studies have shown elevations in the fraction of exhaled nitric oxide, a marker of airway inflamma ...

Determinants of personal exposure to some carcinogenic substances and nitrogen dioxide among the general population in five Swedish cities.

Abstract: Environmental levels of airborne carcinogenic and related substances are comparatively better known than individual exposure and its determinants. We report on a personal monitoring program involving five Swedish urban populations. The aim of the program was to investigate personal exposure to benzene, 1,3-butadiene, formaldehyde, and nitrogen dioxide (NO2). The measurements were performed among 40 inhabitants during seven consecutive days, in one urban area each year, during 2000-2008. The estimated population exposure levels were 1.95 mu g/m(3) for benzene, 0.56 mu g/m(3) for 1,3-butadiene, 19.4 mu g/m(3) for formaldehyde, and 14.1,mu g/m(3) for NO2. Statistical analysis using a mixed-effects model revealed that time spent in traffic and time outdoors contributed to benzene and 1,3- butadiene exposure. For benzene, refueling a car was an additional determinant influencing the exposure level. Smoking or environmental tobacco smoke were significant determinants of exposure to NO2, benzene, and 1, 3-butadiene. Those with a gas stove had higher NO2 exposure. Living in a single-family house increased the exposure to formaldehyde significantly. In a variance component model, the between-subject variance dominated for 1,3-butadiene and formaldehyde, whereas the between-city variance dominated for NO2. For benzene, the between-subject and between-cities variances were similar.

Vedrök i Västerbotten - mätningar, beräkningar och hälsokonsekvenser

Abstract: Smaskalig vedeldning ar en betydande kalla till bl a partiklar, polyaromatiska kolvaten (PAH) och sot, fororeningar som paverkar luftkvaliten negativt Kunskapen ar dock begransad Pa uppdrag av N

Comparing land use regression and dispersion modelling to assess residential exposure to ambient air pollution for epidemiological studies

Abstract: BACKGROUND Land-use regression (LUR) and dispersion models (DM) are commonly used for estimating individual air pollution exposure in population studies. Few comparisons have however been made of the performance of these methods. OBJECTIVES Within the European Study of Cohorts for Air Pollution Effects (ESCAPE) we explored the differences between LUR and DM estimates for NO2, PM10 and PM2.5. METHODS The ESCAPE study developed LUR models for outdoor air pollution levels based on a harmonised monitoring campaign. In thirteen ESCAPE study areas we further applied dispersion models. We compared LUR and DM estimates at the residential addresses of participants in 13 cohorts for NO2; 7 for PM10 and 4 for PM2.5. Additionally, we compared the DM estimates with measured concentrations at the 20-40 ESCAPE monitoring sites in each area. RESULTS The median Pearson R (range) correlation coefficients between LUR and DM estimates for the annual average concentrations of NO2, PM10 and PM2.5 were 0.75 (0.19-0.89), 0.39 (0.23-0.66) and 0.29 (0.22-0.81) for 112,971 (13 study areas), 69,591 (7) and 28,519 (4) addresses respectively. The median Pearson R correlation coefficients (range) between DM estimates and ESCAPE measurements were of 0.74 (0.09-0.86) for NO2; 0.58 (0.36-0.88) for PM10 and 0.58 (0.39-0.66) for PM2.5. CONCLUSIONS LUR and dispersion model estimates correlated on average well for NO2 but only moderately for PM10 and PM2.5, with large variability across areas. DM predicted a moderate to large proportion of the measured variation for NO2 but less for PM10 and PM2.5.

Air pollution exposure during pregnancy and infancy and childhood asthma

Abstract: Recent reviews support an association between exposure to air pollution from traffic and incidence of asthma in children. However, inconsistent results and the risk of awareness bias in parental-reported data motivate further analyses in large studies using objective air pollution data and registry-based outcome data. Our aim was to study the associations between early-life exposure to traffic-related air pollution and childhood asthma in Greater Stockholm. We constructed a register-based cohort by linking data from the Swedish Medical Birth Register, the Swedish Prescribed Drug Register and the Swedish Patient Register. We included all children born between June 2000 and November 2005, n = 78,770. Asthma was defined as receiving prescribed asthma medication during the 6 th year of life. NO x levels at residence were estimated using a dispersion model and used as an indicator of motor vehicle exhaust. 9.7 % of the children were classified as having asthma. Asthma was more common among children who were born preterm, were small for gestational age, or had a family history of asthma. There was no association between NO x levels during pregnancy or infancy and asthma; the tendency was even negative (ORs = 0.97 and 0.98). However, we found a tendency that moving to a residence with higher concentrations than the first was associated with an increased risk for asthma (OR = 1.04). We observed no evidence suggesting that the vehicle exhaust level at home during gestation or infancy, using NO x as a proxy, is associated with the risk of childhood asthma.

Air Pollution and Nonmalignant Respiratory Mortality in 16 Cohorts within the ESCAPE Project

Abstract: RATIONALE: Prospective cohort studies have shown that chronic exposure to particulate matter and traffic-related air pollution is associated with reduced survival. However, the effects on nonmalignant respiratory mortality are less studied, and the data reported are less consistent. OBJECTIVES: We have investigated the relationship of long-term exposure to air pollution and nonmalignant respiratory mortality in 16 cohorts with individual level data within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE). METHODS: Data from 16 ongoing cohort studies from Europe were used. The total number of subjects was 307,553. There were 1,559 respiratory deaths during follow-up. MEASUREMENTS AND MAIN RESULTS: Air pollution exposure was estimated by land use regression models at the baseline residential addresses of study participants and traffic-proximity variables were derived from geographical databases following a standardized procedure within the ESCAPE study. Cohort-specific hazard ratios obtained by Cox proportional hazard models from standardized individual cohort analyses were combined using metaanalyses. We found no significant associations between air pollution exposure and nonmalignant respiratory mortality. Most hazard ratios were slightly below unity, with the exception of the traffic-proximity indicators. CONCLUSIONS: In this study of 16 cohorts, there was no association between air pollution exposure and nonmalignant respiratory mortality.

Traffic pollution at home address and pregnancy outcomes

Abstract: Background Air pollution exposure has been shown to have adverse effects on several health outcomes, and numerous studies have reported associations with cardiovascular morbidity, respiratory disease, and mortality. Over the last decade, an increasing number of studies have investigated possible associations with pregnancy outcomes, including preterm delivery. High levels of vehicle exhaust in residential neighborhoods have been associated with respiratory effects, including childhood asthma, and preterm birth is also associated with childhood asthma.The first aim of this thesis was to investigate possible associations between air pollution exposure and pregnancy outcomes – primarily preterm delivery but also small for gestational age (SGA) and pre-eclampsia – in a large Swedish population (Papers I–III). The second aim was to study any association between exposure to high levels of vehicle exhaust during pregnancy and infancy and prescribed asthma medication in childhood (Paper IV).Methods The study cohorts were constructed by matching other individual data to the Swedish Medical Birth Register. In the first two studies, air pollution data from monitoring stations were used, and in the third and fourth studies traffic intensity and dispersion model data were used.Preterm delivery was defined as giving birth before 37 weeks of gestation. SGA was defined as having a birth weight below the 10th percentile for a given duration of gestation. Pre-eclampsia was defined as having any of the ICD-10 diagnosis codes O11 (pre-existing hypertension with pre-eclampsia), O13 (gestational hypertension without significant proteinuria), O14 (gestational hypertension with significant proteinuria), or O15 (eclampsia). Childhood asthma medication was defined as having been prescribed asthma medication between the ages of five and six years.Results We observed an association between ozone exposure during the first trimester and preterm delivery. First trimester ozone exposure was also associated with pre-eclampsia. The modeled concentration of nitrogen oxides at the home address was associated with pre-eclampsia, but critical time windows were not possible to investigate due to high correlations between time windows. We did not observe any association between air pollution exposure and SGA. High levels of vehicle exhaust at the home address, estimated by nitrogen oxides and traffic intensity, were associated with a lower risk of asthma medication.Conclusion Air pollution exposure during pregnancy was associated with preterm delivery and pre-eclampsia. We did not observe any association between air pollution levels and intrauterine growth measured as SGA. No harmful effect of air pollution exposure during pregnancy or infancy on the risk of being prescribed asthma medication between five and six years of age was observed.

Corrigendum: Attributing mortality from extreme temperatures to climate change in Stockholm, Sweden

Abstract: Corrigendum: Attributing mortality from extreme temperatures to climate change in Stockholm, Sweden

ACCEPTED: An Assessment of Changing Conditions, Environmental Policies, Time-Activities, Exposure and Disease

Abstract: Changes in urban design and traffic policy, demography, climate and associated adaptation, mitigation measures and environmental policies are likely to modify both outdoor and indoor air quality and therefore public health. The project aims to improve our understanding of future exposure situations and their impact on health, from an interdisciplinary approach. This will be achieved by using various state-of-the-art atmospheric models, measurements, epidemiological studies and reviews. To assess population full exposure, an integrated view accounting both for indoor and outdoor air pollution as well as for population time activity data will be developed. New dose-response functions will be estimated between health outcome, air pollution and temperature in order to better estimate the effects on the foetus and young children. Ultimately, scenarios of future urban climate and air quality will be simulated, combining future exposure scenarios, population scenarios and exposure-response functions to describe the effects of different trends and relevant policies on relative risk and burden of illness attributed to urban pollutants and their interactions with extreme temperatures. Also the mitigation strategies that can be used to reduce urbanization and climate change effects on the local urban meteorology and air quality will be assessed. With applications in several large European cities, the project will study the impact of several alternative adaptation scenarios on urban air quality and human health to a mid-century horizon (2030–2060) accounting for the effects of a changing urban climate. Scenario-based health impact assessments will combine exposure information from climate models, emission scenarios, policy evaluation studies and concentration calculations with exposure-response functions from epidemiological studies of vulnerable groups within the project and previously published functions for mortality and hospital admissions. The effects of socioeconomic and demographic trends will be discussed, the predicted health impacts and benefits associated with different interventions and policies and other urban changes will be described.

Late-breaking abstract: Parental smoking prior to conception and asthma in offspring

Abstract: Animal models suggest that paternal smoke exposure prior to conception may influence asthma risk in offspring. We studied associations of paternal vs maternal preconception smoking with asthma phenotypes in offspring, and impact of age at smoking debut, duration, and years of quitting before conception. The RHINE III questionnaire study assessed life-course smoking habits of 13499 responders, and year of birth, asthma and hayfever for 26945 offspring age 2-51 years (never-smoking parent 12991; parent smoked only prior to conception 4216, mean duration 8.5 years). Multi-level logistic regressions were adjusted for age, study centre, parental characteristics (age, early-onset asthma, sex) and clustering by family. Allergic asthma (with hayfever) and non-allergic asthma (without hayfever) was present in 3.6% and 7.5%, respectively. Compared to offspring with a never-smoking parent, non-allergic (but not allergic) asthma was significantly more common in those with a father who smoked only prior to conception (OR=1.58[1.15-2.17]). No effect of mother9s pre-conception smoking was observed (1.05[0.79-1.40]; p interaction =0.032). Non-allergic asthma was more common if father started smoking before age 15 (2.81 [1.02-7.76]) and increased with longer duration of smoking (1.12 [0.99-1.27] per 2 years), even if smoking stopped at least 5 years prior to conception. Conclusion : Father9s but not mother9s smoking prior to conception predicted non-allergic asthma in offspring, with higher risk with earlier smoking debut or longer duration of preconception smoking. This suggests a clinically important role of smoking on spermatogenesis with consequences for asthma development, with potentially large impact on public health policies.