Association between occupational noise exposure and diabetes: A systematic review and meta-analysis.

BACKGROUND: In addition to the well-known risk factors of diabetes, evidence is accumulating on the negative role of environmental and occupational factors such as noise exposure. We conducted a systematic review and meta-analysis on the association between long-term occupational noise exposure and diabetes. METHODS: We systematically searched evidence in PubMed, Scopus, and Web of Science (until August 2022) according to the PRISMA protocol. Risk of bias was assessed using the Newcastle-Ottawa scale. Random-effects meta-analysis was applied separately for risk ratio (odds ratio, relative risk) and hazard ratio. We evaluated the heterogeneity and publication bias. We applied meta-regressions to identify sources of heterogeneity. The overall body of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. RESULTS: Of 533 retrieved articles, twelve studies (11 on non-gestational, and one on gestational diabetes) on total 106,045 population (23,996 diabetic cases) met our inclusion criteria; of which eight studies were cross-sectional, three were cohorts, and one was case-control. Only 40% of papers (five out of 12) had fair, good or very good quality, and most of the papers had poor or very poor quality in terms of risk of bias. We observed a non-significant increased risk of diabetes in association with occupational noise exposure (combined risk estimates: 1.16, 95% confidence interval [CI]: 0.97: 1.34; I2 = 57.7%). Doing separate meta-analyses on cohort and rest of studies, we found similar findings (cohort studies (n = 3): combined risk estimate: 1.17; 95% CI: 0.84: 1.50; I2 = 79%; cross-sectional studies (n = 8): combined risk estimate: 1.26; 95% CI: 0.93: 1.58; I2 = 50.4%). We found no indication of publication bias. CONCLUSIONS: The overall evidence on the association between occupational noise exposure and diabetes is heterogeneous, limited, and mostly with low quality. More robust studies in terms of population selection, exposure and outcome assessment, and adjustment for confounders are necessary.

Residential greenspace and lung function decline over 20 years in a prospective cohort: The ECRHS study.

BACKGROUND: The few studies that have examined associations between greenspace and lung function in adulthood have yielded conflicting results and none have examined whether the rate of lung function decline is affected. OBJECTIVE: We explored the association between residential greenspace and change in lung function over 20 years in 5559 adults from 22 centers in 11 countries participating in the population-based, international European Community Respiratory Health Survey. METHODS: Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured by spirometry when participants were approximately 35 (1990-1994), 44 (1999-2003), and 55 (2010-2014) years old. Greenness was assessed as the mean Normalized Difference Vegetation Index (NDVI) in 500 m, 300 m, and 100 m circular buffers around the residential addresses at the time of lung function measurement. Green spaces were defined as the presence of agricultural, natural, or urban green spaces in a circular 300 m buffer. Associations of these greenspace parameters with the rate of lung function change were assessed using adjusted linear mixed effects regression models with random intercepts for subjects nested within centers. Sensitivity analyses considered air pollution exposures. RESULTS: A 0.2-increase (average interquartile range) in NDVI in the 500 m buffer was consistently associated with a faster decline in FVC (-1.25 mL/year [95% confidence interval: -2.18 to -0.33]). These associations were especially pronounced in females and those living in areas with low PM10 levels. We found no consistent associations with FEV1 and the FEV1/FVC ratio. Residing near forests or urban green spaces was associated with a faster decline in FEV1, while agricultural land and forests were related to a greater decline in FVC. CONCLUSIONS: More residential greenspace was not associated with better lung function in middle-aged European adults. Instead, we observed slight but consistent declines in lung function parameters. The potentially detrimental association requires verification in future studies.

Female sex hormones and symptoms of obstructive sleep apnea in European women of a population-based cohort.

BACKGROUND: The prevalence of obstructive sleep apnea is higher in women after menopause. This is suggested to be a result of an altered sex hormone balance but has so far not been confirmed in a population-based study. OBJECTIVE: To investigate whether serum concentration of estrogens and progesterone are associated with the prevalence of sleep apnea symptoms in middle-aged women of the general population. METHODS: We analyzed data from 774 women (40-67 years) from 15 study centers in seven countries participating in the second follow-up of the European Community Respiratory Health Survey (2010-2012). Multiple logistic regression models were fitted with self-reported symptoms of sleep apnea as outcomes and serum concentrations of various estrogens and progesterone as predictors. All analyses were adjusted for relevant covariates including age, BMI, education, study center, smoking habits, and reproductive age. RESULTS: Among all included women, a doubling of serum concentrations of estrone and progesterone was associated with 19% respectively 9% decreased odds of snoring. Among snorers, a doubling of the concentrations of 17ß-estradiol, estrone and estrone 3-sulfate was associated with 18%, 23% and 17% decreased odds of breathing irregularly, and a doubling of the progesterone concentration was further associated with 12% decreased odds of waking up suddenly with a chocking sensation. Other evaluated associations were not statistically significant. CONCLUSIONS: Middle-aged women with low serum estrogen and progesterone levels are more likely to snore and report symptoms of obstructive sleep apnea.

Exposure to greenspace and cancer incidence, prevalence, and mortality: A systematic review and meta-analyses.

We conducted a systematic review and meta-analysis of the available literature on the association between greenspace exposure and all-sites and site-specific cancer incidence, prevalence, and mortality in adults. We searched PubMed, Scopus, and Web of Science for original articles published, without language restriction until September 2021. We assessed the risk of bias in each study and the overall quality of evidence for exposure-outcome pairs that were reported in two or more studies. Out of the 18 included studies, cross-sectional studies were the most common study design (n = 8), and most of the studies were conducted in Europe (n = 8). In terms of risk of bias, the majority of cohorts (four out of six) and case-control studies (three out of four) were of good or very good quality, and cross-sectional studies were mostly (five out of eight) of poor quality. Outcomes (incidence, prevalence, mortality) on different cancer sites were reported: lung cancer (n = 9), prostate cancer (n = 4), breast cancer (n = 4), skin cancer (n = 3), colorectal cancer (n = 2), all-sites cancer (n = 2), brain cancer (n = 1), mouth and throat cancer (n = 1), and esophageal cancer (n = 1). The meta-analyses for the breast, lung, and prostate cancer incidence did not show statistically significant associations (for example for breast cancer: hazard ratio = 0.83; 95% confidence interval: 0.47-1.48). For skin cancer, the available evidence suggests that greenspace could be a potential risk factor. For the other cancers, the evidence was non-conclusive. The overall quality of evidence of all of the exposure-outcome pairs was very low. Given the wide confidence interval of the pooled estimates and very low quality of evidence, the findings should be interpreted with caution. Future large and longitudinal studies are needed to assess the potential association of greenspace exposure with cancers, considering types and quality of greenspace, evaluation of cancer sub-types, and adjustment for a sufficient set of covariates.

Determinants of carbon load in airway macrophages in pregnant women.

The airway macrophages carbon loading (AMCL) has been suggested to be a biomarker of the long-term exposure to air pollution; however, to date no study has characterized AMCL for the pregnancy period. Therefore, this study aimed to assess the determinants of AMCL during pregnancy in Iran, a middle-income country. This study was based on a sample of 234 pregnant women with term and normal vaginal delivery who were residing in Sabzevar, Iran (2019). We characterized 35 potential determinants of personal exposure to air pollution for each participant, including six personal, nine indoor, and 20 home-outdoor factors. We applied Deletion/Substitution/Addition algorithm to identify the most relevant determinants that could predict AMCL levels. The median (IQR) of AMCL level was 0.12 (0.30) µm2 with a successful sputum induction in 82.9% (194) of participants. Ambient residential PM2.5 levels were positively associated with higher AMCL levels. On the other hand, increased residential distance to the traffic lights, squares and ring-roads, the duration of opening window per day, and opening window during cooking were inversely associated with AMCL levels. Our findings provide novel insights on the different personal, indoor, and outdoor determinants of personal exposure to air pollution during pregnancy in a middle-income country.

Childhood lung function as a determinant of menopause-dependent lung function decline.

RATIONALE: The naturally occurring age-dependent decline in lung function accelerates after menopause, likely due to the change of the endocrine balance. Although increasing evidence shows suboptimal lung health in early life can increase adult  susceptibility to insults, the potential effect of poor childhood lung function on menopause-dependent lung function decline has not yet been investigated. OBJECTIVES: To study whether menopause-dependent lung function decline, assessed as forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), is determined by childhood lung function. METHODS: The Tasmanian Longitudinal Health Study, a cohort born in 1961, underwent spirometry at age seven.  At ages 45 and 50 serum samples, spirometry and questionnaire data were collected (N = 506). We measured follicle stimulating and luteinizing hormones to determine menopausal status using latent profile analysis. The menopause-dependent lung function decline was investigated using linear mixed models, adjusted for anthropometrics, occupational level, smoking, asthma, asthma medication and study year, for the whole study population and stratified by tertiles of childhood lung function. MEASUREMENTS AND MAIN RESULTS: The overall menopause-dependent lung function decline was 19.3 mL/y (95%CI 2.2 to 36.3) for FVC and 9.1 mL/y (-2.8 to 21.0) for FEV1. This was most pronounced (pinteraction=0.03) among women within the lowest tertile of childhood lung function [FVC 22.2 mL/y (1.1 to 43.4); FEV1 13.9 mL/y (-1.5 to 29.4)]. CONCLUSIONS: Lung function declines especially rapidly in postmenopausal women who had poor low lung function in childhood. This provides novel insights into respiratory health during reproductive aging and emphasizes the need for holistic public health strategies covering the whole lifespan.

The early-life exposome and epigenetic age acceleration in children.

The early-life exposome influences future health and accelerated biological aging has been proposed as one of the underlying biological mechanisms. We investigated the association between more than 100 exposures assessed during pregnancy and in childhood (including indoor and outdoor air pollutants, built environment, green environments, tobacco smoking, lifestyle exposures, and biomarkers of chemical pollutants), and epigenetic age acceleration in 1,173 children aged 7 years old from the Human Early-Life Exposome project. Age acceleration was calculated based on Horvath's Skin and Blood clock using child blood DNA methylation measured by Infinium HumanMethylation450 BeadChips. We performed an exposure-wide association study between prenatal and childhood exposome and age acceleration. Maternal tobacco smoking during pregnancy was nominally associated with increased age acceleration. For childhood exposures, indoor particulate matter absorbance (PMabs) and parental smoking were nominally associated with an increase in age acceleration. Exposure to the organic pesticide dimethyl dithiophosphate and the persistent pollutant polychlorinated biphenyl-138 (inversely associated with child body mass index) were protective for age acceleration. None of the associations remained significant after multiple-testing correction. Pregnancy and childhood exposure to tobacco smoke and childhood exposure to indoor PMabs may accelerate epigenetic aging from an early age.

Greenspace exposure and cancer incidence: A 27-year follow-up of the French GAZEL cohort.

BACKGROUND: Greenspace exposure has been suggested to be associated with a range of health outcomes. The available evidence on the association of this exposure with cancer is still very scarce and inconsistent. OBJECTIVES: We aimed to study the association between greenspace exposure and all-site and site-specific (prostate, breast, colorectal, bladder, lung, and malignant melanoma of skin) cancer incidence in the GAZEL cohort. METHODS: This study was based on over 27 years of follow-up (1989-2016) of 19,408 participants across France. We assessed the residential greenspace exposure within several buffers as well as residential proximity to green spaces (agricultural, urban, and forests) in each follow-up. We used time-dependent Cox models, controlling for time-varying personal and area-level variables, with different lags between exposure and outcome. Additional analysis was conducted according to the urban-rural residence of the participants' over follow-up. RESULTS: Over the 294,645 person-years of follow-up, we registered 4075 incident cases of cancer. We found an increase in the risk for all-sites cancer with an inter-quartile range increase of Normalized Difference in Vegetation Index across different buffers (hazard ratio (HR) of 1.08; 95% CI: 1.02, 1.14 for the 100 m buffer). We found a positive association of all-sites cancer with proximity to agricultural lands (HR: 1.03; 95% CI: 1.00, 1.05), and forests (HR:1.04; 95% CI: 1.00, 1.07), but not with urban green spaces. The cancer site-specific analyses suggested a protective role of greenspace for breast, lung, and colorectal cancers (e.g. breast cancer HR at 100 m buffer: 0.82; 95% CI: 0.69, 0.99). Non-significant associations were observed for prostate, bladder, and skin cancer. Stratified analyses based on urban, semi-urban, and rural classification did not suggest any differential pattern. CONCLUSION: We identified an increased risk of all-site cancer with increased greenspace and proximity to agricultural lands and forests; whereas potential protective role of greenspace for breast cancer.

Ultraviolet radiation as a predictor of sex hormone levels in postmenopausal women: A European multi-center study (ECRHS).

BACKGROUND: Solar ultraviolet radiation (UVR) affects the body through pathways that exhibit positive as well as negative health effects such as immunoregulation and vitamin D production. Different vitamin D metabolites are associated with higher or lower concentrations of estrogens and may thus alter the female sex hormone balance. OBJECTIVE: To study whether exposure to UVR, as a modifiable lifestyle factor, is associated with levels of sex hormones (17ß-estradiol, estrone, estrone 3-sulfate, testosterone, dehydroepiandrosterone sulfate), gonadotropins (follicle stimulating hormone, luteinizing hormone) as well as sex hormone binding globulin in postmenopausal women, and thus investigate whether managing UVR exposure can influence the hormone balance, with potential benefits for the biological aging process. METHODS: The study included 580 postmenopausal women from six European countries, participating in the European Community Respiratory Health Survey (2010-2014). Average UVR exposure during the month before blood sampling was estimated based on personal sun behavior and ambient levels. Hormone concentrations were measured in serum using state-of-the-art methods. Subsequently we applied linear mixed-effects models, including center as random intercept, hormone concentrations (one at a time) as outcome and UVR, age, skin type, body mass index, vitamin D from dietary sources, smoking, age at completed full-time education and season of blood sampling as fixed-effect predictors. RESULTS: One interquartile range increase in UVR exposure was associated with decreased levels of 17ß-estradiol (-15.6 pmol/L, 95 % Confidence Interval (CI): -27.69, -3.51) and estrone (-13.36 pmol/L, 95 % CI: -26.04, -0.68) and increased levels of follicle stimulating hormone (9.34IU/L, 95 % CI: 2.91, 15.77) and luteinizing hormone (13.86 IU/daL, 95 % CI: 2.48, 25.25). CONCLUSIONS: Exposure to UVR is associated with decreased estrogens and increased gonadotropins in postmenopausal women, a status associated with osteoporosis, lung function decline and other adverse health effects. This study indicates that managing UVR exposure has potential to influence the hormone balance and counteract adverse health conditions after menopause.

Residential surrounding greenspace and age at menopause: A 20-year European study (ECRHS).

BACKGROUND: Menopause is associated with a number of adverse health effects and its timing has been reported to be influenced by several lifestyle factors. Whether greenspace exposure is associated with age at menopause has not yet been investigated. OBJECTIVE: To investigate whether residential surrounding greenspace is associated with age at menopause and thus reproductive aging. METHODS: This longitudinal study was based on the 20-year follow-up of 1955 aging women from a large, population-based European cohort (ECRHS). Residential surrounding greenspace was abstracted as the average of satellite-based Normalized Difference Vegetation Index (NDVI) across a circular buffer of 300 m around the residential addresses of each participant during the course of the study. We applied mixed effects Cox models with centre as random effect, menopause as the survival object, age as time indicator and residential surrounding greenspace as time-varying predictor. All models were adjusted for smoking habit, body mass index, parity, age at menarche, ever-use of contraception and age at completed full-time education as socio-economic proxy. RESULTS: An increase of one interquartile range of residential surrounding greenspace was associated with a 13% lower risk of being menopausal (Hazard Ratio: 0.87, 95% Confidence Interval: 0.79-0.95). Correspondingly the predicted median age at menopause was 1.4 years older in the highest compared to the lowest NDVI quartile. Results remained stable after additional adjustment for air pollution and traffic related noise amongst others. CONCLUSIONS: Living in greener neighbourhoods is associated with older age at menopause and might slow reproductive aging. These are novel findings with broad implications. Further studies are needed to see whether our findings can be replicated in different populations and to explore the potential mechanisms underlying this association.

Environmental and behavioral determinants affecting the association of airway macrophages carbon load with distance to major roads and traffic density.

Biomarkers are promising indicators to evaluate human exposure to air pollutants and to predict the health outcomes. Area of Airway macrophages that is occupied by Black Carbon could be used as a biomarker of personal long term exposure to traffic related air pollution. Association of airway macrophages carbon load with weighted average distance and environmental and subject-specific behavior are considered in this study. Sputum samples were taken from 160 healthy adult women and airway macrophages carbon load (AMCL) were determined in 93 subjects, which represent a success rate of 62% in sputum induction. Nearest distance of the subjects to major roads and average weighted distance were calculated for each subject. A questionnaire was field according to general and behavioral characteristics of the participants. There was not any significant difference (P-value >0.05) between induced and non-induced subjects. Subjects with indoor kitchen without separation wall, passive smokers and those with longer presence time in high traffic streets showed higher carbon area. Weighted average distance had a better association (ß = -0.186, 95%CI: -0.139, -0.230, P-value = 0.00) with AMCL than nearest distance to major roads (ß = -0.155, 95%CI: -0.109, -0.201, P-value = 0.19). Association of Weighted average distance with AMCL was interrupted in subjects with a garage connected to house environment, those with IK kitchen, those with a hood above the stove and passive smokers. The findings indicated that more generation and distribution of indoor air pollutants can completely enhance the internal exposure and indoor pollution has the same importance as outdoor pollution.

Impact of commuting exposure to traffic-related air pollution on cognitive development in children walking to school.

A few studies have found associations between the exposure to traffic-related air pollution at school and/or home and cognitive development. The impact on cognitive development of the exposure to air pollutants during commuting has not been explored. We aimed to assess the role of the exposure to traffic-related air pollutants during walking commute to school on cognitive development of children. We performed a longitudinal study of children (n = 1,234, aged 7-10 y) from 39 schools in Barcelona (Catalonia, Spain) who commuted by foot to school. Children were tested four times during a 12-month follow-up to characterize their developmental trajectories of working memory (d' of the three-back numbers test) and inattentiveness (hit reaction time standard error of the Attention Network Test). Average particulate matter ≤2.5 µm (PM2.5), Black Carbon (BC) and NO2 concentrations were estimated using Land Use Regression for the shortest walking route to school. Differences in cognitive growth were evaluated by linear mixed effects models with age-by-pollutant interaction terms. Exposure to PM2.5 and BC from the commutes by foot was associated with a reduction in the growth of working memory (an interquartile range increase in PM2.5 and BC concentrations decreased the annual growth of working memory by 5.4 (95% CI [-10.2, -0.6]) and 4.6 (95% CI [-9.0, -0.1]) points, respectively). The findings for NO2 were not conclusive and none of the pollutants were associated with inattentiveness. Efforts should be made to implement pedestrian school pathways through low traffic streets in order to increase security and minimize children's exposure to air pollutants.

Traffic-related air pollution and spectacles use in schoolchildren.

PURPOSE: To investigate the association between exposure to traffic-related air pollution and use of spectacles (as a surrogate measure for myopia) in schoolchildren. METHODS: We analyzed the impact of exposure to NO2 and PM2.5 light absorbance at home (predicted by land-use regression models) and exposure to NO2 and black carbon (BC) at school (measured by monitoring campaigns) on the use of spectacles in a cohort of 2727 schoolchildren (7-10 years old) in Barcelona (2012-2015). We conducted cross-sectional analyses based on lifelong exposure to air pollution and prevalent cases of spectacles at baseline data collection campaign as well as longitudinal analyses based on incident cases of spectacles use and exposure to air pollution during the three-year period between the baseline and last data collection campaigns. Logistic regression models were developed to quantify the association between spectacles use and each of air pollutants adjusted for relevant covariates. RESULTS: An interquartile range increase in exposure to NO2 and PM2.5 absorbance at home was respectively associated with odds ratios (95% confidence intervals (CIs)) for spectacles use of 1.16 (1.03, 1.29) and 1.13 (0.99, 1.28) in cross-sectional analyses and 1.15 (1.00, 1.33) and 1.23 (1.03, 1.46) in longitudinal analyses. Similarly, odds ratio (95% CIs) of spectacles use associated with an interquartile range increase in exposures to NO2 and black carbon at school was respectively 1.32 (1.09, 1.59) and 1.13 (0.97, 1.32) in cross-sectional analyses and 1.12 (0.84, 1.50) and 1.27 (1.03, 1.56) in longitudinal analyses. These findings were robust to a range of sensitivity analyses that we conducted. CONCLUSION: We observed increased risk of spectacles use associated with exposure to traffic-related air pollution. These findings require further confirmation by future studies applying more refined outcome measures such as quantified visual acuity and separating different types of refractive errors.

The association of air pollution and greenness with mortality and life expectancy in Spain: A small-area study.

BACKGROUND: Air pollution exposure has been associated with an increase in mortality rates, but few studies have focused on life expectancy, and most studies had restricted spatial coverage. A limited body of evidence is also suggestive for a beneficial association between residential exposure to greenness and mortality, but the evidence for such an association with life expectancy is still very scarce. OBJECTIVE: To investigate the association of exposure to air pollution and greenness with mortality and life expectancy in Spain. METHODS: Mortality data from 2148 small areas (average population of 20,750 inhabitants, and median population of 7672 inhabitants) covering Spain for years 2009-2013 were obtained. Average annual levels of PM10, PM2.5, NO2 and O3 were derived from an air quality forecasting system at 4×4km resolution. The normalized difference vegetation index (NDVI) was used to assess greenness in each small area. Air pollution and greenness were linked to standardized mortality rates (SMRs) using Poisson regression and to life expectancy using linear regression. The models were adjusted for socioeconomic status and lung cancer mortality rates (as a proxy for smoking), and accounted for spatial autocorrelation. RESULTS: The increase of 5µg/m3 in PM10, NO2 and O3 or of 2µg/m3 in PM2.5 concentration resulted in a loss of life in years of 0.90 (95% credibility interval CI: 0.83, 0.98), 0.13 (95% CI: 0.09, 0.17), 0.20years (95% CI: 0.16, 0.24) and 0.64 (0.59, 0.70), respectively. Similar associations were found in the SMR analysis, with stronger associations for PM2.5 and PM10, which were associated with an increased mortality risk of 3.7% (95% CI: 3.5%, 4.0%) and 5.7% (95% CI: 5.4%, 6.1%). For greenness, a protective effect on mortality and longer life expectancy was only found in areas with lower socioeconomic status. CONCLUSIONS: Air pollution concentrations were associated to important reductions in life expectancy. The reduction of air pollution should be a priority for public health.

Residential green spaces and mortality: A systematic review.

BACKGROUND: A number of studies have associated natural outdoor environments with reduced mortality but there is no systematic review synthesizing the evidence. OBJECTIVES: We aimed to systematically review the available evidence on the association between long-term exposure to residential green and blue spaces and mortality in adults, and make recommendations for further research. As a secondary aim, we also conducted meta-analyses to explore the magnitude of and heterogeneity in the risk estimates. METHODS: Following the PRISMA statement guidelines for reporting systematic reviews and meta-analysis, two independent reviewers searched studies using keywords related to natural outdoor environments and mortality. DISCUSSION: Our review identified twelve eligible studies conducted in North America, Europe, and Oceania with study populations ranging from 1645 up to more than 43 million individuals. These studies are heterogeneous in design, study population, green space assessment and covariate data.We found that the majority of studies show a reduction of the risk of cardiovascular disease (CVD) mortality in areas with higher residential greenness. Evidence of a reduction of all-cause mortality is more limited, and no benefits of residential greenness on lung cancer mortality are observed. There were no studies on blue spaces. CONCLUSIONS: This review supports the hypothesis that living in areas with higher amounts of green spaces reduces mortality, mainly CVD. Further studies such as cohort studies with more and better covariate data, improved green space assessment and accounting well for socioeconomic status are needed to provide further and more complete evidence, as well as studies evaluating the benefits of blue spaces.

Sun behaviour and personal UVR exposure among Europeans on short term holidays.

Solar ultraviolet radiation (UVR) is known to be the main cause of skin cancer, the incidence of which is rising with national differences across Europe. With this observation study we aimed to determine the impact of nationality on sun behaviour and personal UVR exposure on sun and ski holidays. 25 Danish and 20 Spanish sun-seekers were observed during a sun holiday in Spain, and 26 Danish and 27 Austrian skiers were observed during a ski holiday in Austria. The participants recorded their location and clothing in diaries. Personal time-logged UVR data were recorded as standard erythema doses (SEDs) by an electronic UVR dosimeter worn on the wrist. Danish sun-seekers were outdoors for significantly longer, received significant higher percentages of ambient UVR, and received greater accumulated UVR doses than Spanish sun-seekers. Danish skiers were also outdoors for significantly longer than Austrian skiers, but the behaviour of the Danish skiers did not result in significantly greater accumulated UVR doses. Both Danish and Spanish sun-seekers and Danish and Austrian skiers received substantial UVR doses. The behaviour's influence on the UVR doses received by the Danish participants may indicate an explanation of the higher skin cancer incidence among Scandinavians compared with other European populations.

Sun and ski holidays improve vitamin D status, but are associated with high levels of DNA damage.

Skin cancer is caused by solar UVR, which is also essential for vitamin D production. DNA damage (thymine dimers: T-T dimers) and vitamin D (25(OH)D) synthesis are both initiated by solar UVB. We aimed to investigate the simultaneous adverse and beneficial effects of solar UVB exposure in holidaymakers. Sun-seekers and skiers (n=71) were observed over 6 days through on-site monitoring, personal diary entries, and recording of personal UVB exposure doses with electronic dosimeters. Urine and blood samples were analyzed for T-T dimers and 25(OH)D, respectively. The volunteers had a statistically significant increase in vitamin D. There were strong associations between UVB exposure and post-holiday levels of T-T dimers and vitamin D, as well as between post-holiday T-T dimers and vitamin D. We conclude that UVB-induced vitamin D synthesis is associated with considerable DNA damage in the skin. These data, on two major health predictors, provide a basis for further field studies that may result in better understanding of the risks and benefits of "real life" solar exposure. However, vitamin D status can be improved more safely through the use of vitamin D dietary supplements.

Air pollution and biomarkers of systemic inflammation and tissue repair in COPD patients.

The origin(s) of systemic inflammation in patients with chronic obstructive pulmonary disease (COPD) is unclear. We investigated the impact of exposure to ambient air pollution on systemic biomarkers of inflammation (C-reactive protein (CRP), tumour necrosis factor-α, interleukin (IL)-6, IL-8 and fibrinogen) and tissue repair (hepatocyte growth factor (HGF)) in 242 clinically stable COPD patients (mean age 67.8 years and forced expiratory volume in 1 s 71.3% predicted) in Barcelona, Spain, in 2004-2006. A spatiotemporal exposure assessment framework was applied to predict ambient nitrogen dioxide (NO2) and levels of particles with a 50% cut-off aerodynamic diameter of 2.5 µm (PM2.5) at each participant's home address during 10 periods of 24 h (lags 1-10) and 1 year prior to the blood sampling date. We used linear regression models to estimate associations between biomarkers and exposure levels. An interquartile range (IQR) increase in NO2 exposure in lag 5 was associated with 51%, 10% and 9% increases in CRP, fibrinogen and HGF levels respectively. We also observed 12% and 8% increases in IL-8 associated with an IQR increase in NO2 exposure in lag 3 and over the year before sampling, respectively. These increases were larger in former smokers. The results for PM2.5 were not conclusive. These results show that exposure to ambient NO2 increases systemic inflammation in COPD patients, especially in former smokers.