Association between active commuting and low-grade inflammation: a population-based cross-sectional study.

BACKGROUND: Prior studies suggest that physical activity lowers circulating C-reactive protein (CRP) levels. However, little is known about the association between regular active commuting, i.e. walking or cycling to work, and CRP concentrations. This study examines whether active commuting is associated with lower CRP. METHODS: We conducted a cross-sectional study using population-based FINRISK data from 1997, 2002, 2007 and 2012. Participants were working adults living in Finland (n = 6208; mean age = 44 years; 53.6% women). We used linear and additive models adjusted for potential confounders to analyze whether daily active commuting, defined as the time spent walking or cycling to work, was associated with lower high-sensitivity (hs-) CRP serum concentrations compared with passive commuting. RESULTS: We observed that daily active commuting for 45 min or more (vs. none) was associated with lower hs-CRP [% mean difference in the main model: -16.8%; 95% confidence interval (CI) -25.6% to -7.0%), and results were robust to adjustment for leisure-time and occupational physical activity, as well as diet. Similarly, active commuting for 15-29 min daily was associated with lower hs-CRP in the main model (-7.4; 95% CI -14.1 to -0.2), but the association attenuated to null after further adjustments. In subgroup analyses, associations were only observed for women. CONCLUSIONS: Active commuting for at least 45 min a day was associated with lower levels of low-grade inflammation. Promoting active modes of transport may lead not only to reduced emissions from motorized traffic but also to population-level health benefits.

Associations of leisure-time physical activity and active school transport with mental health outcomes: A population-based study.

Promoting physical activity can improve population health. This study aimed to examine associations of leisure-time moderate-to-vigorous physical activity and active school transport with mental health, that is, symptoms of depression and anxiety, among 15- to 16-year-old adolescents. We also assessed the relationships with less-studied outcomes, such as chronic stress and visits to school psychologist. A nationwide Finnish cohort of eighth and ninth graders from the School Health Promotion study (32 829 participants; mean age 15.4 years; 53% girls) was studied. We used logistic regression to estimate odds ratios (OR), with models adjusted for major sociodemographic, health behavior, and physical activity variables. Key findings suggest that leisure-time moderate-to-vigorous physical activity is associated with better mental health in a dose-response manner. Even the smallest dose, 30 weekly minutes, was linked to 17% lower odds of chronic stress symptoms compared to inactivity (OR 0.83, 95% CI 0.71-0.96). Compared to non-active transportation, more than 30 min of daily active school transport yielded 19% (OR 1.19, 95% CI 1.07-1.31) and 33% (OR 1.33, 95% CI 1.12-1.58) higher odds of depression symptoms and school psychologist visits, respectively. However, no associations were found for low-to-moderate daily active school transport levels (<30 min). This large-scale study further highlights a positive association between leisure-time physical activity and mental health among youth. Future research should explore what factors might explain the potential adverse mental health outcomes of active school transport.

Are active school transport and leisure-time physical activity associated with performance and wellbeing at secondary school? A population-based study.

BACKGROUND: Physically active pupils may be better and more resilient learners. However, it is unclear whether walking or cycling to school yields similar educational and school-related mental health benefits as leisure-time physical activity. We examined the associations of active school transport and leisure-time moderate-to-vigorous physical activity with perceived academic performance, competency in academic skills, school burnout and school enjoyment. METHODS: We included 34 103 Finnish adolescents (mean age 15.4 years; 53% girls) from the 2015 School Health Promotion study cohort. For the analyses, we used logistic regression, adjusting for major sociodemographic, environmental, lifestyle and physical activity covariates. RESULTS: Active school transport was positively associated with educational outcomes and school enjoyment, but not with school burnout. For example, compared with non-active transport, 10-30 min of daily active school transport was linked to 30% [odds ratio (OR) 1.30, 95% confidence interval (CI) 1.21-1.40] and 17% (OR 1.17, 95% CI 1.08-1.27) higher odds of high perceived academic performance and high reading competency, respectively. Leisure-time physical activity was robustly associated with all outcomes. For example, compared with the inactive, the most physically active adolescents had 86% higher odds of high perceived academic performance (OR 1.86, 95% CI 1.66-2.08), 57% higher odds of high competency in mathematics (OR 1.57, 95% CI 1.39-1.77) and 40% lower odds of school burnout (OR 0.60, 95% CI 0.52-0.69). CONCLUSIONS: Compared with active school transport, leisure-time physical activity was more strongly associated with educational and school-related mental health outcomes. Nevertheless, walking or cycling to school might lead to improvements in classroom performance and school enjoyment.

Educational interventions for preventing lead poisoning in workers.

BACKGROUND: Occupational lead exposure can lead to serious health effects that range from general symptoms (depression, generalised ache, and digestive signs, such as loss of appetite, stomach ache, nausea, diarrhoea, and constipation) to chronic conditions (cerebrovascular and cardiovascular diseases, cognitive impairment, kidney disease, cancers, and infertility). Educational interventions may contribute to the prevention of lead uptake in workers exposed to lead, and it is important to assess their effectiveness. OBJECTIVES: To assess the effect of educational interventions for preventing lead uptake in workers exposed to lead. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, and OSH UPDATE to 5 June 2020, with no language restrictions. SELECTION CRITERIA: We sought randomised controlled trials (RCT), cluster-RCTs (cRCT), interrupted time series (ITS), controlled before-after studies (CBA) and uncontrolled before-after studies that examined the effects of an educational intervention aimed at preventing lead exposure and poisoning in workers who worked with lead, for which effectiveness was measured by lead levels in blood and urine, blood zinc protoporphyrin levels and urine aminolevulinic acid levels. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results, assessed studies for eligibility, and extracted data using standard Cochrane methods. We used the ROBINS-I tool to assess the risk of bias, and GRADE methodology to assess the certainty of the evidence. MAIN RESULTS: We did not find any RCT, cRCT, ITS or CBA studies that met our criteria. We included four uncontrolled before-after studies studies, conducted between 1982 and 2004. Blood lead levels Educational interventions may reduce blood lead levels, but the evidence is very uncertain. In the short-term after the educational intervention, blood lead levels may decrease (mean difference (MD) 9.17 µg/dL, 95% confidence interval (CI) 4.14 to 14.20; one study with high baseline blood lead level, 18 participants; very low-certainty evidence). In the medium-term, blood lead levels may decrease (MD 3.80 µg/dL, 95% CI 1.48 to 6.12; one study with high baseline blood lead level, 34 participants; very low-certainty evidence). In the long-term, blood lead levels may decrease when the baseline blood lead levels are high (MD 8.08 µg/dL; 95% CI 3.67 to 12.49; two studies, 69 participants; very low-certainty evidence), but not when the baseline blood lead levels are low (MD 1.10 µg/dL, 95% CI -0.11 to 2.31; one study, 52 participants, very low-certainty evidence). Urine lead levels In the long-term, urinary lead levels may decrease after the educational intervention, but the evidence is very uncertain (MD 42.43 µg/L, 95% CI 29.73 to 55.13; one study, 35 participants; very low-certainty evidence). Behaviour change The evidence is very uncertain about the effect of educational intervention on behaviour change. At medium-term follow-up after the educational intervention, very low-certainty evidence from one study (89 participants) found inconclusive results for washing before eating (risk ratio (RR) 1.71, 95% CI 0.42 to 6.91), washing before drinking (RR 1.37, 95% CI 0.61 to 3.06), and not smoking in the work area (RR 1.04, 95% CI 0.74 to 1.46). Very low-certainty evidence from one study (21 participants) suggested that employers may improve the provision of fit testing for all respirator users (RR 1.87, 95% CI 1.16 to 3.01), and prohibit eating, drinking, smoking, and other tobacco use in the work area (RR 4.25, 95% CI 1.72 to 10.51), however, the results were inconclusive for the adequate provision of protective clothing (RR 1.40, 95% CI 0.82 to 2.40). At long-term follow-up, very low-certainty evidence from one study (89 participants) suggested that workers may improve washing before drinking (RR 3.24, 95% CI 1.09 to 9.61), but results were inconclusive for washing before eating (RR 11.71, 95% CI 0.66 to 208.33), and for not smoking in the work area (RR 1.56, 95% CI 0.98 to 2.50). Very low-certainty evidence from one study (21 participants) suggested that employers may improve the provision of fit testing for all respirator users (RR 1.70, 95% CI 1.09 to 2.63), may provide adequate protective clothing (RR 2.80, 95% CI 1.23 to 6.37), and may prohibit eating, drinking, smoking, and other tobacco use in the work area (RR 2.13, 95% CI 1.19 to 3.81). Improved knowledge or awareness of the adverse health effects of lead The evidence is very uncertain about the effect of educational intervention on workers' knowledge. At medium-term follow-up, questionnaires found that workers' knowledge may improve (MD 5.20, 95% CI 3.29 to 7.11; one study, 34 participants; very low-certainty evidence). At long-term follow-up, there may be an improvement in workers' knowledge (MD 5.80, 95% CI 3.89 to 7.71; one study, 34 participants; very low-certainty evidence), but results were inconclusive for employers' knowledge (RR 1.67, 95% CI 0.74 to 3.75; one study, 21 participants; very low-certainty evidence). None of the studies measured the other outcomes of interest: blood zinc protoporphyrin levels, urine aminolevulinic acid levels, air lead levels, and harms. One study provided the costs of each component of the intervention. AUTHORS' CONCLUSIONS: Educational interventions may prevent lead poisoning in workers with high baseline blood lead levels and urine lead levels but this is uncertain. Educational interventions may not prevent lead poisoning in workers with low baseline blood lead levels but this is uncertain.

Long-term exposure to ambient fine particulate matter originating from traffic and residential wood combustion and the prevalence of depression.

INTRODUCTION: Air pollution has been suggested to be associated with depression. However, current evidence is conflicting, and no study has considered different sources of ambient particulate matter with an aerodynamic diameter below 2.5 µm (PM2.5). We evaluated the associations of long-term exposure to PM2.5 from road traffic and residential wood combustion with the prevalence of depression in the Helsinki region, Finland. METHODS: We conducted a cross-sectional analysis based on the Helsinki Capital Region Environmental Health Survey 2015-2016 (N=5895). Modelled long-term outdoor concentrations of PM2.5 were evaluated using high-resolution emission and dispersion modelling on an urban scale and linked to the home addresses of study participants. The outcome was self-reported doctor-diagnosed or treated depression. We applied logistic regression and calculated the OR for 1 µg/m3 increase in PM2.5, with 95% CI. Models were adjusted for potential confounders, including traffic noise and urban green space. RESULTS: Of the participants, 377 reported to have been diagnosed or treated for depression by a doctor. Long-term exposure to PM2.5 from road traffic (OR=1.23, 95% CI 0.86 to 1.73; n=5895) or residential wood combustion (OR=0.78, 95% CI 0.43 to 1.41; n=5895) was not associated with the prevalence of depression. The estimates for PM2.5 from road traffic were elevated, but statistically non-significant, for non-smokers (OR=1.38, 95% CI 0.94 to 2.01; n=4716). CONCLUSIONS: We found no convincing evidence of an effect of long-term exposure to PM2.5 from road traffic or residential wood combustion on depression.

Five indicators were developed to assess the quality of reviews on preventive interventions.

OBJECTIVES: The objective of the study was to develop quality indicators for preventive effectiveness and to evaluate their use with Cochrane Reviews of primary preventive interventions. STUDY DESIGN AND SETTING: Based on the quality of care framework, we searched the literature to develop a set of quality indicators. Two authors applied the quality indicators independently to a sample of Cochrane systematic reviews of primary prevention. RESULTS: Five quality indicators were developed: sample size, directness of evidence, adherence, harm, and costs. We applied the quality indicators to a random sample of 84 of a total of 264 Cochrane reviews of primary preventive interventions. Only 70% reviews (n = 59) complied with the indicator sample size, whereas 61% (n = 51) complied with directness of the outcome, 48% (n = 40) with adherence, 76% (n = 64) with harm, and 46% (n = 39) with the indicator cost. CONCLUSION: Applying the five quality indicators is feasible. The quality of evidence in reviews of primary prevention can be substantially improved. Trialists and review authors should provide more information especially on adherence, costs, and indirectness of the outcome. Methodological research is needed on how to incorporate cost information in systematic reviews and how to better deal with indirectness.