Urban green spaces and behavioral and cognitive development in children: A health impact assessment of the Barcelona "Eixos Verds" Plan (Green Axis Plan).

BACKGROUND: Urban environments lack natural features, while nature exposure in cities has been associated with health benefits, including children's neurodevelopment. Through extensive street greening, Barcelona's Eixos Verds (Green Axis) Plan enhances safety, environment, and climate resilience. We aimed to assess the Eixos Verds Plan's potential impact on children's behavioral and cognitive development due to the increased green space expected under the Eixos Verds implementation. METHODS: We performed a quantitative health impact assessment for Barcelona children at census-tract level (n = 1068). We assessed the Eixos Verds Plan's impact by comparing baseline green space distribution with the proposed plan, translating it into percentage green area (%GA) and Normalized Difference Vegetation Index (NDVI). By combining these exposure metrics with child-specific risk estimates and population data, we estimated potential improvements in children's behavioral and cognitive development due to full Eixos Verds implementation. RESULTS: With the full Eixos Verds implementation, citywide, %GA increased by 6.9% (IQR: 6.4%; range: 0-23.1%) and NDVI by 0.065 (IQR: 0.083; range: 0.000-0.194). Child behavioral and cognitive development outcomes are expected to improve compared to the baseline. Based on NDVI increases, children's Total Difficulties and Hyperactivity/Inattention scores, based on the Strengths and Difficulties Questionnaire (SDQ), are projected to decrease by 5% (95% CI: 0-15%) and 6% (95% CI: 0-17%). Working Memory and Superior Working Memory scores are expected to increase by 4% and 5%, respectively, based on the computerized n-back test, while the Inattentiveness score could be reduced by 1%, based on the computerized attentional test (ANT). INTERPRETATION: Urban greening as planning tool can improve behavioral and cognitive development in city children. Methods and results of our study are applicable to many cities worldwide, and similar results for children of real-life urban greening interventions can be expected.

Health effects of green prescription: A systematic review of randomized controlled trials.

An increasing number of studies have examined the effects of green prescription on various health outcomes. The aim of this study was to systematically review published randomized controlled trial studies on the health benefits of green prescriptions. We searched PubMed, Scopus, and Web of Science for the relevant original articles published in English until June 30, 2023. Our search initially retrieved 26176 articles, of which 31 studies were included in our review after removing the duplicates and excluding ineligible articles based on their titles, abstracts, and full-text review. Consistent positive health benefits of green prescription were reported for psychological health and wellbeing (16 out of 24 studies), cardiometabolic health (five out of nine studies), physical activity (eight out of nine studies), and inflammation (two out of two studies). The reviewed studies did not report any significant benefits in orthopedic conditions, pain, and recovery from exhaustion disorder due to their implemented green prescriptions; however, the number of studies was too small to generalize the effect of green prescriptions on these outcomes. The quality of these studies was generally acceptable, with 28 studies having some concerns regarding their overall risk of bias and only three studies with a high risk of bias. All in all, this systematic review suggests that green prescriptions can be effective in improving various health outcomes, but further studies with larger sample sizes and objective measures are needed.

Residential green space improves cognitive performances in primary schoolchildren independent of traffic-related air pollution exposure.

BACKGROUND: Cognitive performances of schoolchildren have been adversely associated with both recent and chronic exposure to ambient air pollution at the residence. In addition, growing evidence indicates that exposure to green space is associated with a wide range of health benefits. Therefore, we aimed to investigate if surrounding green space at the residence improves cognitive performance of primary schoolchildren while taking into account air pollution exposure. METHODS: Cognitive performance tests were administered repeatedly to a total of 307 primary schoolchildren aged 9-12y, living in Flanders, Belgium (2012-2014). These tests covered three cognitive domains: attention (Stroop and Continuous Performance Tests), short-term memory (Digit Span Forward and Backward Tests), and visual information processing speed (Digit-Symbol and Pattern Comparison Tests). Green space exposure was estimated within several radii around their current residence (50 m to 2000 m), using a aerial photo-derived high-resolution (1 m2) land cover map. Furthermore, air pollution exposure to PM2.5 and NO2 during the year before examination was modelled for the child's residence using a spatial-temporal interpolation method. RESULTS: An improvement of the children's attention was found with more residential green space exposure independent of traffic-related air pollution. For an interquartile range increment (21%) of green space within 100 m of the residence, a significantly lower mean reaction time was observed independent of NO2 for both the sustained-selective (-9.74 ms, 95% CI: -16.6 to -2.9 ms, p = 0.006) and the selective attention outcomes (-65.90 ms, 95% CI: -117.0 to -14.8 ms, p = 0.01). Moreover, green space exposure within a large radius (2000 m) around the residence was significantly associated with a better performance in short-term memory (Digit-Span Forward Test) and a higher visual information processing speed (Pattern Comparison Test), taking into account traffic-related exposure. However, all associations were attenuated after taking into account long-term residential PM2.5 exposure. CONCLUSIONS: Our panel study showed that exposure to residential surrounding green space was associated with better cognitive performances at 9-12 years of age, taking into account traffic-related air pollution exposure. These findings support the necessity to build attractive green spaces in the residential environment to promote healthy cognitive development in children.

Is indoor and outdoor greenery associated with fewer depressive symptoms during COVID-19 lockdowns? A mechanistic study in Shanghai, China.

Increasing numbers of studies have observed that indoor and outdoor greenery are associated with fewer depressive symptoms during COVID-19 lockdowns. However, most of these studies examined direct associations without sufficient attention to underlying pathways. Furthermore, few studies have combined different types of indoor and outdoor greenery to examine their effects on the alleviation of depressive symptoms. The present study hypothesized that indoor and outdoor exposure to greenery increased the perceived restorativeness of home environments, which, in turn, reduced loneliness, COVID-related fears, and, ultimately, depressive symptoms. To test our hypotheses, we conducted an online survey with 386 respondents in Shanghai, China, from April to May 2022, which corresponded to strict citywide lockdowns that resulted from the outbreak of the Omicron variant. Indoor greenery measures included the number of house plants, gardening activities, and digital nature exposure as well as semantic image segmentation applied to photographs from the most viewed windows to quantify indoor exposure to outdoor trees and grass. Outdoor greenery measures included total vegetative cover (normalized difference vegetation index [NDVI]) within a 300 m radius from the home and perceived quality of the community's greenery. Associations between greenery and depressive symptoms/clinical levels of depression, as measured by the Patient Health Questionnaire-9 (PHQ-9), were examined using generalized linear and logistic regression models. Structural equation modeling (SEM) was used to test pathways between greenery exposure, restorativeness, loneliness, fear of COVID-19, and depressive symptoms. The results showed that: 1) indoor and outdoor greenery were associated with fewer depressive symptoms; 2) greenery could increase the restorativeness of the home environment, which, in turn, was associated with fewer COVID-related mental stressors (i.e., loneliness and fear of COVID-19), and ultimately depressive symptoms; and 3) gender, education, and income did not modify associations between greenery and depressive symptoms. These findings are among the first to combine objective and subjective measures of greenery within and outside of the home and document their effects on mental health during lockdowns. Comprehensive enhancements of greenery in living environments could be nature-based solutions for mitigating COVID-19 related mental stressors.

Exposure to road traffic noise and cognitive development in schoolchildren in Barcelona, Spain: A population-based cohort study.

BACKGROUND: Road traffic noise is a prevalent and known health hazard. However, little is known yet about its effect on children's cognition. We aimed to study the association between exposure to road traffic noise and the development of working memory and attention in primary school children, considering school-outdoor and school-indoor annual average noise levels and noise fluctuation characteristics, as well as home-outdoor noise exposure. METHODS AND FINDINGS: We followed up a population-based sample of 2,680 children aged 7 to 10 years from 38 schools in Barcelona (Catalonia, Spain) between January 2012 to March 2013. Children underwent computerised cognitive tests 4 times (n = 10,112), for working memory (2-back task, detectability), complex working memory (3-back task, detectability), and inattentiveness (Attention Network Task, hit reaction time standard error, in milliseconds). Road traffic noise was measured indoors and outdoors at schools, at the start of the school year, using standard protocols to obtain A-weighted equivalent sound pressure levels, i.e., annual average levels scaled to human hearing, for the daytime (daytime LAeq, in dB). We also derived fluctuation indicators out of the measurements (noise intermittency ratio, %; and number of noise events) and obtained individual estimated indoor noise levels (LAeq) correcting for classroom orientation and classroom change between years. Home-outdoor noise exposure at home (Lden, i.e., EU indicator for the 24-hour annual average levels) was estimated using Barcelona's noise map for year 2012, according to the European Noise Directive (2002). We used linear mixed models to evaluate the association between exposure to noise and cognitive development adjusting for age, sex, maternal education, socioeconomical vulnerability index at home, indoor or outdoor traffic-related air pollution (TRAP) for corresponding school models or outdoor nitrogen dioxide (NO2) for home models. Child and school were included as nested random effects. The median age (percentile 25, percentile 75) of children in visit 1 was 8.5 (7.8; 9.3) years, 49.9% were girls, and 50% of the schools were public. School-outdoor exposure to road traffic noise was associated with a slower development in working memory (2-back and 3-back) and greater inattentiveness over 1 year in children, both for the average noise level (e.g., ‒4.83 points [95% CI: ‒7.21, ‒2.45], p-value < 0.001, in 2-back detectability per 5 dB in street levels) and noise fluctuation (e.g., ‒4.38 [‒7.08, ‒1.67], p-value = 0.002, per 50 noise events at street level). Individual exposure to the road traffic average noise level in classrooms was only associated with inattentiveness (2.49 ms [0, 4.81], p-value = 0.050, per 5 dB), whereas indoor noise fluctuation was consistently associated with all outcomes. Home-outdoor noise exposure was not associated with the outcomes. Study limitations include a potential lack of generalizability (58% of mothers with university degree in our study versus 50% in the region) and the lack of past noise exposure assessment. CONCLUSIONS: We observed that exposure to road traffic noise at school, but not at home, was associated with slower development of working memory, complex working memory, and attention in schoolchildren over 1 year. Associations with noise fluctuation indicators were more evident than with average noise levels in classrooms.

A study on exposure to greenspace during pregnancy and lipid profile in cord blood samples.

Although evidence reporting the beneficial associations of prenatal greenspace exposure with pregnancy outcomes is increasing, there is still a lack of evidence on the potential association of such exposure to greenspace on fetal lipid profile. We aimed to first-time investigate the associations between prenatal exposure to greenspace and lipid levels in the cord blood. The present study was based on data from 150 expectant mothers, residents of Sabzevar city in Iran (2018). For each participant, we identified exposure to greenspace in residential surroundings, residential accessibility to green space, use of green spaces, and the number of plant pots inside the home. Measures of levels of triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and TC/HDL-C and TG/HDL-C ratios in samples of cord blood were applied to identify the lipid profile. We developed adjusted linear regression models to estimate the associations of each indicator of greenspace exposure with each cord blood lipid. We found increased greenspace in residential surroundings across a 100 m buffer, higher residential accessibility to green space, and more use of green spaces were associated with decreased cord blood lipid levels. The remainder findings regarding the greenspace in residential surroundings across 300 m and 500 m buffers and the number of plant pots were null. Some suggestions were observed for a potential mediatory role of air pollution. This study suggests that greenspace exposure during pregnancy may influence positively fetal lipid levels in the cord blood.

The evaluation of the 3-30-300 green space rule and mental health.

BACKGROUND AND AIMS: Urban green space has many health benefits, but it is still unclear how much actually is needed for better health. Recently a new 3-30-300 rule of thumb for urban forestry and urban greening has been proposed, but this rule has not been evaluated for benefits on health. The rule requires that every citizen should be able to see at least three trees from their home, have 30 percent tree canopy cover in their neighbourhood and not live more than 300 m away from the nearest park or green space. The aim of this study was to evaluate the relationship between the 3-30-300 green space rule and its components in relation to mental health. METHODS: We conducted a cross-sectional study based on a population-based sample of 3145 individuals aged 15-97 years from in Barcelona, Spain who participated in the Barcelona Health Survey (2016-2017). We created 3-30-300 green space indicators using questionnaire data, GIS, remote sensing and land cover maps. Mental health status was assessed with the 12-item General Health Questionnaire (GHQ-12) and also the use of tranquilizer/sedatives or antidepressants and psychiatrist or psychologist visits. Analyses were conducted using mixed effects logistic regression models with districts as the random effect, adjusted for relevant covariates. RESULTS: We found that people in Barcelona had relatively little exposure to green space, whether through window view, living in an area with sufficient greenness, or access to a major green space, and only 4.7% met a surrogate 3-30-300 green space rule. Residential surrounding greenness, but not tree window view or access to major green space, was significantly associated with better mental health, less medication use, and fewer psychologist or psychiatrist visits. Meeting the full surrogate 3-30-300 green space rule was associated with better mental health, less medication use, and fewer psychologist or psychiatrist visits, but only for the latter combined the association was statistically significant (Odds ratio = 0.31, 95% CI: 0.11, 0.91). CONCLUSION: Few people achieved the 3-30-300 green space in Barcelona and we used a surrogate measure. We observed health benefits when the full surrogate rule was met.

Maternal short-term exposure to NO2 during pregnancy and its relationship with Doppler markers of placental function.

BACKGROUND: Maternal exposure to air pollution has been associated with poor obstetric outcomes. However, the available evidence on the impact of maternal exposure to air pollution on placental function is still scarce and is based on estimated ambient levels of air pollutants. OBJECTIVE: To evaluate the association between short-term maternal exposure to NO2 based on the objective personal measure of NO2 exposure and Doppler markers of placental function. METHODS: This study was based on a prospective cohort of 101 pregnant women, recruited at Hospital Sant Joan de Déu, Barcelona (Spain), between January 2017 and April 2018. NO2 diffusion tubes were worn by pregnant women to measure personal exposure to NO2 between weeks 28 and 32 of their pregnancy. Placental function was evaluated at the 32nd week of gestation by Doppler evaluation of mean uterine arteries pulsatility index (PI), umbilical artery PI, middle cerebral artery PI, cerebroplacental ratio (CPR) and ductus venosus PI. Linear regression models were applied to estimate the association of personal NO2 exposure and Doppler markers of placental function (one at a time), controlled for relevant covariates. RESULTS: Higher personal exposure to NO2 was significantly associated with lower mean uterine artery PI. Each one-interquartile range (IQR) increase in the exposure to NO 2 was associated with -0.07 (95% confidence intervals (CIs): -0.12, -0.02) decrease in uterine arteries PI. We also observed some suggestions for an inverse association between this exposure and CPR. A one-IQR increase in NO2 was associated with -0.18 (95% CIs: -0.37, 0.01) decrease in CPR. The findings for the rest of Doppler markers were not conclusive. CONCLUSIONS: Maternal exposure to NO2 could interfere with Doppler markers of placental function, potentially indicating a certain degree of cerebral vasodilatation with a decrease of mean uterine arteries PI.

Associations of objective and perceived greenness measures with cardiovascular risk factors in Philadelphia, PA: A spatial analysis.

There is mounting scientific evidence that greenness is associated with improved cardiovascular health. However, few studies have distinguished between vegetation type, measured perceived green space access, or investigated heterogeneity of associations across categories of neighborhood sociodemographic and racial/ethnic composition. We conducted an ecologic spatial analysis of associations of three objective measures of greenness (percent vegetation cover, percent tree canopy cover, and greenness density), and one measure of perceived access to green spaces with census tract level percentages of the adult population who were obese, ever had a high blood pressure diagnosis, and ever had a diabetes diagnosis, in the city of Philadelphia, PA, year 2013. We explored effect modification by census-tract level percent living in poverty and percent non-Hispanic Black categories. We used data from the Southeastern Pennsylvania Household Health Survey (SEPAHH) linked with high-resolution landcover, remotely sensed, and American Community Survey data and estimated associations using spatial lag models. We observed modest protective associations between percent of the adult population reporting perceived access to green spaces and percent with the cardiovascular risk factors, particularly in moderate and high poverty census tracts. Percent tree canopy cover was also protective against the cardiovascular risk factors, particularly in census tracts with low percentages of the population living in poverty and with low percent non-Hispanic Black populations. These results suggest that perceived access to green spaces and objectively measured high tree canopy cover, may protect against cardiovascular disease, but associations may vary across neighborhood sociodemographic categories.

Polycyclic aromatic hydrocarbons exposures and telomere length: A cross-sectional study on preschool children.

Exposure to polycyclic aromatic hydrocarbons (PAHs) has been associated with shorter telomere length (TL), a marker of ageing at cellular level. However, the available evidence on this association among children is still scarce. We therefore aimed to assess, the relationship between urinary 1-hydroxipayrene (1-OHP), a marker of exposure to PAHs, and relative leukocyte TL (LTL) in children at preschool age. Our study was based on 200 children enrolled from 27 randomly-selected kindergartens in the city of Sabzevar, Iran (2017). 1-OHP levels in the participants' urine samples were measured using solid phase extraction (SPE) method and high-performance liquid chromatography (HPLC). Moreover, real-time PCR was used to measure the LTL in the participants' blood samples. Linear mixed effects models, controlled for relevant covariates, were applied to investigate the association of 1-OHP concentration and LTL. The median (interquartile range (IQR)) of relative LTL and urinary 1-OHP were 0.83 (0.7) and 257 (375.5) ng/L, respectively. In the fully adjusted model, an IQR increase in urinary 1-OHP was related to -0.05 (95% confidence interval (CI): 0.09, -0.01, P-value = 0.02) decrease in relative LTL. This association was similar among boys and girls; however, we observed indications for a stronger association for those children whose parents had university education. Our study suggested an inverse relationship between urinary 1-OHP and LTL in children at preschool age. However, further longitudinal research with repeated measures of PAHs and LTL are needed to confirm these findings.

Urban-Related Environmental Exposures during Pregnancy and Placental Development and Preeclampsia: a Review.

PURPOSE OF REVIEW: To summarize the current knowledge of the pathophysiological implications and the clinical role of urban-related environmental exposures in pregnancy. RECENT FINDINGS: The ongoing urbanization worldwide is leading to an increasing number of pregnant women being exposed to higher levels of urban-related environmental hazards such as air pollution and noise and, at the same time, having less contact with natural environments. Pregnancy represents a particular and vulnerable life period both for women and their children. Extensive physiological and metabolic changes, as well as changes to the cardiovascular and respiratory systems during pregnancy, could result in increased sensitivity to damage by environmental factors. Exposure to air pollution and noise is associated with placental dysfunction and damage, which, in turn, could lead to maternal complications such as preeclampsia. In contrast, more contact with greenspace during pregnancy seems to mitigate these adverse impacts. These findings open up new challenges for our understanding of the potential effect of urban living on placental function and preeclampsia, and offer new clinical and research opportunities.

Exposure to greenspace and birth weight in a middle-income country.

An emerging body of evidence has associated exposure to greenspace during pregnancy with improved fetal growth; however, all available studies have been conducted in high-income countries and the available evidence evaluating such an association for visual access to greenspace, use of green spaces and indoor plants is non-existent. We aimed to evaluate the association between a comprehensive array of indicators of exposure to greenspace during pregnancy, including the aforementioned indicators, and birth weight, in a middle-income country and evaluating air pollution and visual access as possible mechanisms underlying the association. This study was based on 301 pregnant women residing in Su et al. (2019). For each pregnant woman, we characterized exposure to residential surrounding greenspace, visual access to greenspace, residential proximity to green space, use of green spaces, and the number of plant pots at home. We used linear regression models adjusted for relevant covariates including measures of socioeconomic status. We found positive associations of maternal exposure to residential surrounding greenspace across a 100 m buffer, frequent viewing of greenspace through the window, percentage of window area covered by greenspace, residential proximity to any green space regardless of its area, time spent in public green spaces and total time spent in public and private green spaces with birth weight. We also observed positive associations of maternal exposure to residential surrounding greenspace across 300 m and 500 m buffers, residential proximity to a green space with an area ≥5000 m2, and indoor plant pots with birth weight, but none of these associations were statistically significant. The magnitude of the associations tended to be higher among parents with lower socioeconomic status. Mediation through air pollution or visual access was not established. Findings from this study suggested a positive role of different aspects of exposure to greenspace during pregnancy on birth weight in a middle-income country.

Residential urban greenspace and hypertension: A comparative study in two European cities.

BACKGROUND: Living in green areas has been associated with several health benefits; however, the available evidence on such benefits for hypertension is still limited. This study aimed to investigate and compare the association between residential exposure to greenspace and hypertension in Barcelona, Spain and Brussels, Belgium. METHODS: This cross-sectional study was based on data from the 2016 Barcelona Health Interview Survey (HIS) (n = 3400) and the 2013 Belgian HIS (n = 2335). Both surveys were harmonized in terms of outcomes, confounders and exposure assessment. Residential exposure to greenspace was characterized as 1) surrounding greenspace (normalized difference vegetation index (NDVI) and modified soil-adjusted vegetation index 2 (MSAVI2)) across buffers of 100 m, 300 m, and 500 m; 2) surrounding green space across 300 m and 500 m buffers; and 3) Euclidean distance to the nearest green space. Our outcome was self-reported hypertension. We developed logistic regression models to evaluate the city-specific association between each greenspace measure and hypertension, adjusting for relevant covariates. RESULTS: One interquartile range (IQR) increase in residential distance to the nearest green space was associated with higher risk of hypertension in Barcelona [odds ratio (OR): 1.15; 95%CI 1.03-1.29 (IQR: 262.2)], but not in Brussels [OR: 0.95; 95%CI 0.77-1.17 (IQR: 215.2)]. Stratified analyses suggested stronger associations in older participants (≥65 years) for both cities. Findings for residential surrounding green space and greenspace were not conclusive. However, in Brussels, we found protective associations in older participants for both residential surrounding greenspace metrics [NDVI 300 m buffer OR: 0.51; 95%CI 0.32-0.81 (IQR: 0.21) and MSAVI2 300 m buffer OR: 0.51; 95%CI 0.32-0.83 (IQR: 0.18)]. We did not find any indication for the modification of our evaluated associations by sex and education level. CONCLUSION: Our study suggests that living closer to greenspace could be associated with lower risk of hypertension, particularly in older age. Future research is needed to replicate our findings in other settings and shed light on potential underlying mechanism(s).

Maternal exposure to ambient particulate matter and green spaces and fetal renal function.

Exposure to air pollution has been associated with different harmful effects and exposure to greenspace has been related to improved human health. However, the available evidence on the impact of these exposures on renal function is still scarce. The aim of this study was to determine the relationship between exposure to ambient levels of PM1, PM2.5, PM10 and indicators of exposure to traffic as well as greenspace during pregnancy and fetal renal function based on the umbilical cord blood. This study was based on 150 pregnant women residing in Sabzevar, Iran (2018). Multiple linear regression models were developed to estimate the association of glomerular filtration rate (GFR), creatinine (Cr) and blood urea nitrogen (BUN) with exposure to air pollution, traffic, and greenspace (one at a time) controlled for relevant covariates. There was an inverse significant association between exposure to PM1, PM2.5, PM10 and total street length in a 100 m buffer around the home and eGFR. Increase in distance to major road and residential surrounding greenness (100 m buffer) was associated with increase in eGFR. We observed a significant direct association between exposure to PMs as well as street length in 100 m buffer and serum level of Cr. There was also an inverse association between distance to major road and NDVI in 100 m buffer and Cr. The associations for blood urea nitrogen (BUN) were not statistically significant. Our results suggest that exposure to air pollution during pregnancy could have negative impact and exposure to greenspace could have positive impact on renal function of fetal.

Association of exposure to air pollution and green space with ovarian reserve hormones levels.

Exposure to air pollution has been associated with adverse health effects while exposure to greenspace has been associated with public health benefits. However, the available evidence on the association of exposure to air pollution with ovarian reserve markers is still scarce, with no study on such an association with greenspace exposure. Therefore, this study aimed to investigate the association of exposure to particulate matter with diameter of less than 1, 2.5 and 10 µm (PM1, PM2.5, PM10), traffic indicators (distance from women's residence to major roads and total street length in different buffers around women's residential address) and greenspace indicators (residential surrounding greenspace and distance to green spaces) with serum levels of anti-müllerian hormone (AMH) and follicle stimulating hormone (FSH) as markers of ovarian reserve. This cross-sectional study was based on 67 women residing in Sabzevar, Iran (2018). Basal serum levels of FSH and AMH were measured by the enzyme-linked immunosorbent assays (ELISA). Land use regression models were used to estimate PMs concentrations at residential addresses and the average of normalized difference vegetation index (NDVI) in different buffers was used to characterize residential surrounding greenspace. Multiple linear regression models were developed to estimate the association of AMH and FSH with exposure to air pollution, traffic, and greenspace (one at a time) controlled for relevant covariates. In fully adjusted models, there was an inverse association between exposure to PM1, PM2.5 as well as total street length in 100 m buffer around women's residence and AMH level (ß = -0.89, 95% confidence interval (CI): -1.43, -0.35, P-value ≤ 0.01, ß = -1.11, 95% CI: -1.67, -0.55, P-value ≤ 0.01 and ß = -0.76, 95% CI: -1.48, -0.50, P-value = 0.03, respectively). Moreover, increase in distance from home to nearest major road as well as residential surrounding greenspace (100 m buffer) and decrease in residential distance to a green space larger than 5000 m2 were associated with increase in serum level of AMH. However, we did not observe any significant association between exposure to air pollution, traffic, and greenspace with FSH level. Overall, our findings supported a beneficial association of exposure to greenspace and detrimental association of exposure to air pollution with ovarian reserve.

Prenatal Omega-6:Omega-3 Ratio and Attention Deficit and Hyperactivity Disorder Symptoms.

OBJECTIVE: To evaluate whether higher omega-6:omega-3 (n-6:n-3) long-chain polyunsaturated fatty acid ratio in cord plasma is associated with more symptoms of attention deficit and hyperactivity disorder (ADHD) at 4 and 7 years of age. STUDY DESIGN: This study was based on a population-based birth cohort in Spain. N-6 arachidonic acid and n-3 eicosapentaenoic and docosahexaenoic acid concentrations were measured in cord plasma. At 4 years old, ADHD symptoms were reported by teachers through the ADHD Diagnostic and Statistical Manual of Mental Disorders, 4th ed checklist (n = 580). At 7 years old, ADHD symptoms were reported by parents through the Conners' Rating Scale-Revised (short form; n = 642). The ADHD variable was treated as continuous (score) and as dichotomous (symptom diagnostic criteria). Child and family general characteristics were prospectively collected through questionnaires. We applied pooled zero-inflated negative binomial and logistic regressions adjusted for covariates. RESULTS: A higher omega-6:omega-3 long-chain polyunsaturated fatty acid ratio in cord plasma was associated with a higher ADHD index (incidence rate ratio, 1.13; 95% CI, 1.03, 1.23) at 7 years old. The association was not observed at 4 years old (incidence rate ratio, 1.04; 95% CI, 0.92-1.18). No associations were found using ADHD symptom diagnostic criteria. CONCLUSIONS: High prenatal omega-6:omega-3 long-chain polyunsaturated fatty acid ratio preceded the appearance of subclinical ADHD symptoms during mid-childhood. Our findings suggest that maternal diet during pregnancy may modulate the risk to develop long-term ADHD symptoms in the offspring.

Urban natural environments and motor development in early life.

An emerging body of evidence has associated natural environments with improved brain development in children; however, these studies have mainly focused on cognition and available evidence for motor development is still scarce. This study aimed to evaluate the protective association of neighbourhood greenspace with motor development deficits in children. We obtained data on motor development deficits (separately for fine and gross motor developments) at sub-district level from routine medical check-up of children prior to enrolment into primary schools in the city of Berlin (2015-2016). Neighbourhood natural environments across the sub-districts were measured with three different metrics: the average of satellite-based normalized difference vegetation index (NDVI), the share of public green spaces, and the share of both public blue and green spaces (composite nature) across the sub-district. We applied negative binominal models to estimate the association between neighbourhood natural environments and fine and gross motor development deficits (one at a time), controlled for relevant sociodemographic indicators. Higher neighbourhood public green space and composite nature were significantly associated with lower risk of motor development deficits; however, the association were not statistically significant when using NDVI. Our findings, if confirmed by future studies, could provide evidence for implementing targeted interventions to enhance motor development in urban children.

Use of green spaces, self-satisfaction and social contacts in adolescents: A population-based CASPIAN-V study.

BACKGROUND: A growing body of evidence has associated contact with green spaces with improved mental health and wellbeing in adults. Social contacts has been postulated as a potential mechanism underlying such effects. However, the available evidence on the association between green spaces and self-satisfaction and also the mediatory role of social contacts in health benefits of green spaces in adolescents is still very scarce. We aimed to evaluate the association of time spent in different types of green spaces with self-satisfaction and social contacts in adolescents. We also investigated the mediatory role of social contacts in the association of green space use and self-satisfaction. METHODS: This cross-sectional study was based on a population-representative sample of 10,856 adolescents (10-18 years old) living in urban and rural districts across 30 provinces of Iran (2015). Data on the time spent in green spaces (separately for parks, forests and private gardens), self-satisfaction, social contacts (number of friends and time spent with friends), and socio-demographic characteristics were obtained through questionnaires from parents and children. Logistic mixed effects models with recruitment centre as the random effect were developed to estimate associations adjusted for relevant covariates. RESULTS: More time spent in green spaces was associated with improved self-satisfaction and social contacts. While for the self-satisfaction, there was no indication for effect modification by sex, socioeconomic status (SES), and urbanity, we observed stronger associations for older adolescents (> 14 years old). For social contacts, we found indications for stronger associations for boys, older adolescents, those residing in rural areas, and those from lowest and highest SES groups. Social contacts could explain more than half of the association between green spaces use and self-satisfaction. CONCLUSIONS: Our observed enhanced self-satisfaction and social contacts associated with more time spent in green spaces could provide policymakers with measures to improve mental wellbeing of adolescents. Further studies are required to replicate our findings in other populations with different climates, cultures and lifestyles.

Association of residential air pollution, noise, and greenspace with initial ischemic stroke severity.

BACKGROUND AND PURPOSE: A number of environmental risk factors of acute ischemic stroke have been identified, but few studies have evaluated the influence of the outdoor environment on stroke severity. We assessed the association of residential ambient fine particulate matter air pollution (PM2.5), noise, and surrounding greenspace with initial stroke severity. METHODS: We obtained data on patients hospitalized with acute ischemic stroke from a hospital-based prospective stroke register (2005-2014) in Barcelona. We estimated residential PM2.5 based on an established land use regression model, greenspace as the average satellite-based Normalized Difference Vegetation Index (NDVI) within a 300 m buffer of the residence, and daily (Lday), evening (Levening), night (Lnight) and average noise (Lden) level at the street nearest to the residential address using municipal noise models. Stroke severity was assessed at the time of hospital presentation using the National Institute of Health Stroke Scale (NIHSS).We used logistic regression and binomial models to evaluate the associations of PM2.5, greenspace, and noise with initial stroke severity adjusting for potential confounders. RESULTS: Among 2761 patients, higher residential surrounding greenspace was associated with lower risk of severe stroke (OR for NIHSS>5, 0.75; 95% CI: 0.60-0.95), while, living in areas with higher Lden was associated with a higher risk of severe stroke (OR, 1.30; 95% CI: 1.02-1.65). PM2.5 was not associated with initial stroke severity. CONCLUSIONS: In an urban setting, surrounding greenspace and traffic noise at home are associated with initial stroke severity, suggesting an important influence of the built environment on the global burden of ischemic stroke.