Long-term exposure to air pollution and road traffic noise and incidence of dementia in the Danish Nurse Cohort.

INTRODUCTION: We examined the association of long-term exposure to air pollution and road traffic noise with dementia incidence in the Danish Nurse Cohort. METHODS: Female nurses were followed for dementia incidence (hospital contact or medication prescription) from 1993/1999 to 2020. Air pollution and road traffic noise levels were estimated at nurses' residences, and their associations with dementia were examined using Cox regression models. RESULTS: Of 25,233 nurses 1409 developed dementia. Particulate matter with a diameter of ≤2.5 µm (PM2.5) was associated with dementia incidence, after adjusting for lifestyle, socioeconomic status, and road traffic noise (hazard ratio [95% confidence interval] 1.35 [1.15-1.59] per interquartile range of 2.6 µg/m3). There was no association of PM2.5 with dementia in physically active nurses. Association with road traffic noise diminished after adjusting for PM2.5 (1.02 [0.93-1.11] per 7.6 dB). DISCUSSION: Long-term exposure to air pollution increases risk of dementia, and physical activity may moderate this risk. HIGHLIGHTS: Long-term exposure to air pollution was associated with increased risk of dementia among female nurses from the Danish Nurse Cohort. Association of air pollution with dementia was independent of road traffic noise. Association of road traffic noise with dementia diminished after adjusting for air pollution. Physical activity moderated adverse effects of air pollution on dementia.

Long-Term Exposure to Air Pollution and Risk of Acute Lower Respiratory Infections in the Danish Nurse Cohort.

RATIONALE: Air pollution is a major risk factor for chronic cardiorespiratory diseases, affecting both the immune and respiratory systems' functionality, while the epidemiological evidence on respiratory infections remains sparse. OBJECTIVE: We aimed to assess the association of long-term exposure to ambient air pollution with risk of developing new and recurrent ALRIs that characterized by persistently severe symptoms necessitating hospital contact, and identify the potential susceptible populations by socio-economic status (SES), smoking, physical activity status, overweight, and co-morbidity with chronic lung disease. METHODS: We followed 23,912 female nurses from the Danish Nurse Cohort (> 44 years) from baseline (1993 or 1999) until 2018 for the incident and recurrent ALRIs defined by hospital contact (in-, outpatient, and emergency room) data from the National Patient Register. Residential annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and black carbon (BC) were modelled using Danish DEHM/UBM/AirGIS system. We used marginal Cox models with time-varying exposures to assess the association of 3-year running-mean air pollution with incident and recurrent ALRIs and examine effect modification by age, socio-economic status (SES), smoking, physical activity, body mass index, and comorbidity with asthma or chronic obstructive pulmonary disease (COPD). RESULTS: During a 21.3 years mean follow-up, 4,746 ALRIs were observed, of which 2,553 were incident. We observed strong positive associations of all three pollutants with incident ALRIs, with hazard ratios and 95% confidence intervals of 1.19 (1.08-1.31) per 2.5 µg/m3 for PM2.5, 1.17 (1.11-1.24) per 8.0 µg/m3 for NO2, and 1.09 (1.05-1.12) per 0.3 µg/m3 for BC, and slightly stronger associations with recurrent ALRIs. Associations were strongest in COPD patients and nurses with low physical activity. CONCLUSION: Long-term exposure to air pollution at low levels was associated with risk of new and recurrent ALRIs, with COPD patients and physically inactive subjects most vulnerable. Primary Source of Funding: This study was supported by the Novo Nordisk Foundation Challenge Programme (NNF17OC0027812).

Harnessing AI to unmask Copenhagen's invisible air pollutants: A study on three ultrafine particle metrics.

Ultrafine particles (UFPs) are airborne particles with a diameter of less than 100 nm. They are emitted from various sources, such as traffic, combustion, and industrial processes, and can have adverse effects on human health. Long-term mean ambient average particle size (APS) in the UFP range varies over space within cities, with locations near UFP sources having typically smaller APS. Spatial models for lung deposited surface area (LDSA) within urban areas are limited and currently there is no model for APS in any European city. We collected particle number concentration (PNC), LDSA, and APS data over one-year monitoring campaign from May 2021 to May 2022 across 27 locations and estimated annual mean in Copenhagen, Denmark, and obtained additionally annual mean PNC data from 6 state-owned continuous monitors. We developed 94 predictor variables, and machine learning models (random forest and bagged tree) were developed for PNC, LDSA, and APS. The annual mean PNC, LDSA, and APS were, respectively, 5523 pt/cm3, 12.0 µm2/cm3, and 46.1 nm. The final R2 values by random forest (RF) model were 0.93 for PNC, 0.88 for LDSA, and 0.85 for APS. The 10-fold, repeated 10-times cross-validation R2 values were 0.65, 0.67, and 0.60 for PNC, LDSA, and APS, respectively. The root mean square error for final RF models were 296 pt/cm3, 0.48 µm2/cm3, and 1.60 nm for PNC, LDSA, and APS, respectively. Traffic-related variables, such as length of major roads within buffers 100-150 m and distance to streets with various speed limits were amongst the highly-ranked predictors for our models. Overall, our ML models achieved high R2 values and low errors, providing insights into UFP exposure in a European city where average PNC is quite low. These hyperlocal predictions can be used to study health effects of UFPs in the Danish Capital.

Short-term exposure to ultrafine particles and mortality and hospital admissions due to respiratory and cardiovascular diseases in Copenhagen, Denmark.

Ultrafine particles (UFP; particulate matter <0.1 µm in diameter) may be more harmful to human health than larger particles, but epidemiological evidence on their health effects is still limited. In this study, we examined the association between short-term exposure to UFP and mortality and hospital admissions in Copenhagen, Denmark. Daily concentrations of UFP (measured as particle number concentration in a size range 11-700 nm) and meteorological variables were monitored at an urban background station in central Copenhagen during 2002-2018. Daily counts of deaths from all non-accidental causes, as well as deaths and hospital admissions from cardiovascular and respiratory diseases were obtained from Danish registers. Mortality and hospital admissions associated with an interquartile range (IQR) increase in UFP exposure on a concurrent day and up to six preceding days prior to the death or admission were examined in a case-crossover study design. Odds ratios (OR) with 95% confidence intervals (CI) per one IQR increase in UFP were estimated after adjusting for temperature and relative humidity. We observed 140,079 deaths in total, 236,003 respiratory and 342,074 cardiovascular hospital admissions between 2002 and 2018. Hospital admissions due to respiratory and cardiovascular diseases were significantly positively associated with one IQR increase in UFP (OR: 1.04 [95% CI: 1.01, 1.07], lag 0-4, and 1.02 [1.00, 1.04], lag 0-1, respectively). Among the specific causes, the strongest associations were found for chronic obstructive pulmonary disease (COPD) mortality and asthma hospital admissions and two-day means (lag 0-1) of UFP (OR: 1.13 [1.01, 1.26] and 1.08 [1.00, 1.16], respectively, per one IQR increase in UFP). Based on 17 years of UFP monitoring data, we present novel findings showing that short-term exposure to UFP can trigger respiratory and cardiovascular diseases mortality and morbidity in Copenhagen, Denmark. The strongest associations with UFP were observed with COPD mortality and asthma hospital admissions.

Long-term exposure to elemental components of fine particulate matter and all-natural and cause-specific mortality in a Danish nationwide administrative cohort study.

BACKGROUND: Fine particulate matter (PM2.5) is a well-recognized risk factor for premature death. However, evidence on which PM2.5 components are most relevant is unclear. METHODS: We evaluated the associations between mortality and long-term exposure to eight PM2.5 elemental components [copper (Cu), iron (Fe), zinc (Zn), sulfur (S), nickel (Ni), vanadium (V), silicon (Si), and potassium (K)]. Studied outcomes included death from diabetes, chronic kidney disease (CKD), dementia, and psychiatric disorders as well as all-natural causes, cardiovascular disease (CVD), respiratory diseases (RD), and lung cancer. We followed all residents in Denmark (aged ≥30 years) from January 1, 2000 to December 31, 2017. We used European-wide land-use regression models at a 100 × 100 m scale to estimate the residential annual mean levels of exposure to PM2.5 components. The models were developed with supervised linear regression (SLR) and random forest (RF). The associations were evaluated by Cox proportional hazard models adjusting for individual- and area-level socioeconomic factors and total PM2.5 mass. RESULTS: Of 3,081,244 individuals, we observed 803,373 death from natural causes during follow-up. We found significant positive associations between all-natural mortality with Si and K from both exposure modeling approaches (hazard ratios; 95% confidence intervals per interquartile range increase): SLR-Si (1.04; 1.03-1.05), RF-Si (1.01; 1.00-1.02), SLR-K (1.03; 1.02-1.04), and RF-K (1.06; 1.05-1.07). Strong associations of K and Si were detected with most causes of mortality except CKD and K, and diabetes and Si (the strongest associations for psychiatric disorders mortality). In addition, Fe was relevant for mortality from RD, lung cancer, CKD, and psychiatric disorders; Zn with mortality from CKD, RD, and lung cancer, and; Ni and V with lung cancer mortality. CONCLUSIONS: We present novel results of the relevance of different PM2.5 components for different causes of death, with K and Si seeming to be most consistently associated with mortality in Denmark.

Stringency of COVID-19 Containment Response Policies and Air Quality Changes: A Global Analysis across 1851 Cities.

The COVID-19 containment response policies (CRPs) had a major impact on air quality (AQ). These CRPs have been time-varying and location-specific. So far, despite having numerous studies on the effect of COVID-19 lockdown on AQ, a knowledge gap remains on the association between stringency of CRPs and AQ changes across the world, regions, nations, and cities. Here, we show that globally across 1851 cities (each more than 300 000 people) in 149 countries, after controlling for the impacts of relevant covariates (e.g., meteorology), Sentinel-5P satellite-observed nitrogen dioxide (NO2) levels decreased by 4.9% (95% CI: 2.2, 7.6%) during lockdowns following stringent CRPs compared to pre-CRPs. The NO2 levels did not change significantly during moderate CRPs and even increased during mild CRPs by 2.3% (95% CI: 0.7, 4.0%), which was 6.8% (95% CI: 2.0, 12.0%) across Europe and Central Asia, possibly due to population avoidance of public transportation in favor of private transportation. Among 1768 cities implementing stringent CRPs, we observed the most NO2 reduction in more populated and polluted cities. Our results demonstrate that AQ improved when and where stringent COVID-19 CRPs were implemented, changed less under moderate CRPs, and even deteriorated under mild CRPs. These changes were location-, region-, and CRP-specific.

Long-term exposure to air pollution and mortality in a Danish nationwide administrative cohort study: Beyond mortality from cardiopulmonary disease and lung cancer.

BACKGROUND: The association between long-term exposure to air pollution and mortality from cardiorespiratory diseases is well established, yet the evidence for other diseases remains limited. OBJECTIVES: To examine the associations of long-term exposure to air pollution with mortality from diabetes, dementia, psychiatric disorders, chronic kidney disease (CKD), asthma, acute lower respiratory infection (ALRI), as well as mortality from all-natural and cardiorespiratory causes in the Danish nationwide administrative cohort. METHODS: We followed all residents aged ≥ 30 years (3,083,227) in Denmark from 1 January 2000 until 31 December 2017. Annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), and ozone (warm season) were estimated using European-wide hybrid land-use regression models (100 m × 100 m) and assigned to baseline residential addresses. We used Cox proportional hazard models to evaluate the association between air pollution and mortality, accounting for demographic and socioeconomic factors. We additionally applied indirect adjustment for smoking and body mass index (BMI). RESULTS: During 47,023,454 person-years of follow-up, 803,881 people died from natural causes. Long-term exposure to PM2.5 (mean: 12.4 µg/m3), NO2 (20.3 µg/m3), and/or BC (1.0 × 10-5/m) was statistically significantly associated with all studied mortality outcomes except CKD. A 5 µg/m3 increase in PM2.5 was associated with higher mortality from all-natural causes (hazard ratio 1.11; 95% confidence interval 1.09-1.13), cardiovascular disease (1.09; 1.07-1.12), respiratory disease (1.11; 1.07-1.15), lung cancer (1.19; 1.15-1.24), diabetes (1.10; 1.04-1.16), dementia (1.05; 1.00-1.10), psychiatric disorders (1.38; 1.27-1.50), asthma (1.13; 0.94-1.36), and ALRI (1.14; 1.09-1.20). Associations with long-term exposure to ozone (mean: 80.2 µg/m3) were generally negative but became significantly positive for several endpoints in two-pollutant models. Generally, associations were attenuated but remained significant after indirect adjustment for smoking and BMI. CONCLUSION: Long-term exposure to PM2.5, NO2, and/or BC in Denmark were associated with mortality beyond cardiorespiratory diseases, including diabetes, dementia, psychiatric disorders, asthma, and ALRI.

The effects of 3 weeks of oral glutathione supplementation on whole body insulin sensitivity in obese males with and without type 2 diabetes: a randomized trial.

The effect of oral glutathione (GSH) supplementation was studied in obese subjects with and without type 2 diabetes (T2DM) on measures of glucose homeostasis and markers of oxidative stress. Twenty subjects (10 patients with T2DM and 10 obese subjects) were recruited for the study, and randomized in a double-blinded placebo-controlled manner to consume either 1000 mg GSH per day or placebo for 3 weeks. Before and after the 3 weeks insulin sensitivity was measured with the hyperinsulinemic-euglycemic clamp and a muscle biopsy was obtained to measure GSH and skeletal muscle mitochondrial hydrogen peroxide (H2O2) emission rate. Whole body insulin sensitivity increased significantly in the GSH group. Skeletal muscle GSH was numerically increased (∼19%) in the GSH group; no change was seen in GSH to glutathione disulfide ratio. Skeletal muscle mitochondrial H2O2 emission rate did not change in response to the intervention and neither did the urinary excretion of the RNA oxidation product 8-oxo-7,8-dihydroguanosine or the DNA oxidation product 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), although 8-oxodG decreased as a main effect of time. Oral GSH supplementation improves insulin sensitivity in obese subjects with and without T2DM, although it does not alter markers of oxidative stress. The study has been registered in clinicaltrials.gov (NCT02948673). Novelty: Reduced glutathione supplementation increases insulin sensitivity in obese subjects with and without T2DM. H2O2 emission rate from skeletal muscle mitochondria was not affected by GSH supplementation.

Risk and Protective Factors of Child-to-Parent Violence: A Comparison Between Physical and Verbal Aggression.

Child-to-parent violence (CPV) is a social problem that remains vastly understudied compared with other forms of family violence. The aim of this study is to identify family and child risk and protective factors of CPV, and to investigate whether they differentially predict physical and verbal parent-directed violence among boys and girls. Predictors include parenting behavior during childhood (physical and verbal violence, warmth, monitoring) and respondents' individual characteristics (suicidal ideation, self-control, problematic substance use). Data were examined from a large representative sample of ninth graders (N = 6,444) in Lower Saxony, Germany. Bivariate analyses showed that female adolescents were more likely to aggress verbally, while no gender differences were found for physical CPV. Multilevel logistic regression models revealed that direct experiences of parental physical and verbal violence during childhood were among the strongest predictors of physical and verbal CPV, both among males and females. While parental monitoring was not significantly associated with CPV, parental warmth protected girls from physical parent-directed aggression. Furthermore, high self-control was protective against verbal CPV as well as boys' physical CPV, while problematic substance use predicted physical violence toward parents in both sexes but only boys' verbal CPV. Suicidal ideation was a risk factor of aggression in males only. Except for parental warmth, the importance of risk and protective factors did not substantially vary across child gender. These findings broaden our understanding of different family and child-related factors that either promote or prevent CPV. Specifically, they point to the importance of the parenting context and especially harsh discipline practices for the occurrence of both physical and verbal CPV.

Associations Between Classroom Normative Climate and the Perpetration of Teen Dating Violence Among Secondary School Students.

The aim of this study was to investigate how classroom normative climate regarding the perpetration of teen dating violence (TDV) was related to adolescents' self-reported perpetration of (verbal/emotional, threatening, relational, physical, and sexual) violence within romantic relationships in the previous 12 months. Based on Theory of Normative Conduct, we hypothesized that higher classroom levels of TDV perpetration were associated with a higher likelihood of individual TDV perpetration. Data were drawn from a large survey of ninth-grade students conducted in the state of Lower Saxony, Germany (n = 10,638). From this sample, an analysis sample of n = 4,351 students at risk was drawn (mean age: 15.0, SD: 0.76; 46.6% male). More than half (54.8%) of the at-risk sample reported engagement in any form of TDV within the previous 12 months, whereby rates varied considerably by the dimension of TDV. Controlling for a range of risk factors on the classroom level (proportion of students dependent on social welfare, proportion of students with migration background) and individual level (exposure to family violence, sociodemographic characteristics, TDV victimization, and peer- and school-related factors), regression analyses showed that higher rates of classroom-level TDV perpetration were positively related to individual verbal/emotional TDV perpetration. This pattern of results was observable across all dimensions of TDV. Furthermore, gender-specific patterns of TDV perpetration were observable: Girls were more affected by classroom levels of verbal/emotional and physical TDV than boys, while boys were more affected by classroom levels of relational and sexual TDV. Results highlight the role of the wider peer context in shaping adolescent dating experiences and specifically point to the relevance of the classroom ecology for the socialization of dating violence in adolescents.

Factor Structure of the Inventory of Callous-Unemotional Traits in a Representative Sample of German 9th Grade Students.

Callous-unemotional (CU) traits represent the affective components of the psychopathy construct and show a strong relationship to violence and conduct-disorder in children. The Inventory of Callous-Unemotional Traits (ICU) is the current standard to assess CU traits. Despite the ICU having originally been constructed as a four-dimensional instrument, several studies found a three-factorial structure in combination with a general ICU-factor to be the best fitting factor-model. An imbalance in the number of positively and negatively worded items can be observed between the identified ICU dimensions. To investigate the effect of item keying on the factor structure we tested different factor-models in data stemming from a large sample (N = 3878) of German ninth grade students. Our findings suggest that the original four-factorial structure with a method factor shows good model fit. This solution is furthermore in line with the specifiers of the additional coding of Limited Prosocial Emotions for Conduct Disorder in the DSM-V.

Epidemiology of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background: a representative study.

BACKGROUND: Data on the prevalence of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background are scarce. There are hints that this population is at risk. The aim of the study is to investigate the epidemiology of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background in Germany while taking gender-specific differences into consideration. METHODS: A representative study with N = 10,638 students (mean age 14.91 years, SD = .73).) in the state of Lower Saxony in Germany was conducted. In the 2014-2015 school year, 672 classes were selected by randomly sampling different school types. The participation rate was 84.1%, excluding any classes for which the director refused to provide consent. A total of 49.8% were female adolescents, and 23.3% of the participants had a migration background. Target variables were assessed with items from the Ottawa Self-Injury Inventory, the Self-Harm Behavior Questionnaire and the Self-Harm Inventory, partly adapted. RESULTS: Of all students, 7.6% had a lifetime history of suicide attempts, and 36.6% answered with a rating of at least "rarely" when asked to rate the lifetime prevalence of suicidal ideation. The 12-month prevalence of direct self-injurious behavior was 17.8%. Adolescents with a migration background showed a significantly higher prevalence of all three constructs (p = .006; p < .001; p = .006). Male students with a migration background reported a significantly higher lifetime prevalence of suicide attempts (4.7% vs. 3.1%) than native males (p = .009). Female students with a migration background reported a significantly higher lifetime prevalence of suicide attempts (15.9% vs. 10.4%) and suicidal ideation ("often" 12.1% vs. 8.9%) than native female students (p < .001; p = .008). CONCLUSION: Our assessment indicates an elevated risk for suicidal behaviors in adolescents with a migration background. From research on adults, it is known that the dominant motives for suicidal behavior in migrants are associated with their migration history/situation. As suggested by Cramer and Kapusta's (Front Psychol 8:1756, 2017) theoretical model, the Social-Ecological Framework of Theory, Assessment, and Prevention, there is a need for culturally sensitive preventions that take into account the specific reasons for suicide attempts in migrants.

Importation and deprivation factors influencing teacher-targeted aggression among secondary school students in Germany: A multilevel analysis.

Relying on an importation and deprivation framework, the study assessed a variety of risk factors associated with self-reported teacher-targeted aggression among ninth grade students (n = 5,673). Using a cross-sectional school survey conducted in one German federal state, two forms of teacher-targeted aggression were assessed: verbal (insulting, threatening, and mocking) and physical (beating and pushing) aggression. Every ninth student reported verbal aggression, while 0.5% of students reported physical aggression against teachers. Multilevel probability models showed that individual importation factors (low self-control, male gender, and exposure to severe parental violence), together with individual deprivation factors (repeated victimization by teachers and low school achievement) play a role in explaining teacher-targeted aggression. The school-level deprivation factor of negative teacher-student relationships was also relevant, whereas low teacher control and attending lower-level schools were unrelated to the perpetration of teacher-targeted aggression. The present study stresses the need to acknowledge the multilevel etiology of teacher-targeted aggression.

Prevalence and Correlates of Cyberbullying Perpetration. Findings from a German Representative Student Survey.

Based on a survey of 9512 ninth-grade students conducted in Lower Saxony in 2013, this paper examines the prevalence of cyberbullying perpetration and the correlates of this behavior. Binary logistic multilevel regression was used in order to analyze correlates of sexual and psychological cyberbully perpetration. In the preceding semester, 2.4% of the adolescents were perpetrators of psychological cyberbullying and 0.4% bullied someone online sexually. Low levels of empathy, frequent consumption of violent media, and being victims of aggressive online behaviors are correlated with the risk that a child will become a bully. Female adolescents are less likely than boys to engage in sexual cyberbullying perpetration, but they are more likely to engage in psychological cyberbullying perpetration. Only a small share of adolescents engage in sexual and psychological cyberbullying perpetration. Both behaviors differ in their correlates, however being a victim of aggressive online behaviors increase the risk for perpetration of both behaviors, respectively.

Cyber-Dependent Crime Victimization: The Same Risk for Everyone?

The Internet has simplified daily life activities. However, besides its comfortability, the Internet also presents the risk of victimization by several kinds of crimes. The present article addresses the question of which factors influence cyber-dependent crime and how they vary between three kinds of cyber-dependent offences: malware infection, ransomware infection, and misuse of personal data. According to the Routine Activity Approach, it is assumed that crime is determined by a motivated offender, the behavior of the Internet user, and the existence of prevention factors. Our analyses were based on a random sample of 26,665 Internet users in two federal states in Germany, aged 16 years and older; 16.6 percent of the respondents had experienced at least one form of cyber-dependent victimization during the year 2014. The results indicate that individual and household factors, as well as online and prevention behavior, influence the risk of cyber-dependent victimization. Furthermore, the effects differ between the three types of offences. In conclusion, the risk of being victimized by cyber-dependent crime is not the same for anyone, but depends on multivariate factors according to the idea of Routine Activity Approach. However, in view of the fact that crime-related factors also matter, studying different cybercrime offences separately seems to be an appropriate research approach.

Differential Influences of Parenting Dimensions and Parental Physical Abuse during Childhood on Overweight and Obesity in Adolescents.

Besides other explanatory variables, parenting styles and parental violence might also be responsible for setting a path towards overweight/obesity in childhood. While this association has consistently been observed for adults, findings for adolescents still remain scarce and inconsistent. Therefore, the goal of this study is to add evidence on this topic for children and adolescents. Analyses are based on a sample of 1729 German, ninth-grade students. To analyze associations between parenting dimensions and weight status, non-parametric conditional inference trees were applied. Three gender-specific pathways for a heightened risk of overweight/obesity were observed: (1) female adolescents who report having experienced severe parental physical abuse and medium/high parental warmth in childhood; (2) male adolescents who report having experienced low or medium parental monitoring in childhood; and (3) this second pathway for male adolescents is more pronounced if the families receive welfare. The importance of promoting parenting styles characterized by warmth and a lack of physical abuse is also discussed. This is one of only a few studies examining the association of parenting dimensions/parental physical abuse and weight status in adolescence. Future studies should include even more parenting dimensions, as well as parental physical abuse levels, in order to detect and untangle gender-specific effects on weight status.