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

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

Exposure to long-term source-specific transportation noise and incident breast cancer: A pooled study of eight Nordic cohorts.

BACKGROUND: Environmental noise is an important environmental exposure that can affect health. An association between transportation noise and breast cancer incidence has been suggested, although current evidence is limited. We investigated the pooled association between long-term exposure to transportation noise and breast cancer incidence. METHODS: Pooled data from eight Nordic cohorts provided a study population of 111,492 women. Road, railway, and aircraft noise were modelled at residential addresses. Breast cancer incidence (all, estrogen receptor (ER) positive, and ER negative) was derived from cancer registries. Hazard ratios (HR) were estimated using Cox Proportional Hazards Models, adjusting main models for sociodemographic and lifestyle variables together with long-term exposure to air pollution. RESULTS: A total of 93,859 women were included in the analyses, of whom 5,875 developed breast cancer. The median (5th-95th percentile) 5-year residential road traffic noise was 54.8 (40.0-67.8) dB Lden, and among those exposed, the median railway noise was 51.0 (41.2-65.8) dB Lden. We observed a pooled HR for breast cancer (95 % confidence interval (CI)) of 1.03 (0.99-1.06) per 10 dB increase in 5-year mean exposure to road traffic noise, and 1.03 (95 % CI: 0.96-1.11) for railway noise, after adjustment for lifestyle and sociodemographic covariates. HRs remained unchanged in analyses with further adjustment for PM2.5 and attenuated when adjusted for NO2 (HRs from 1.02 to 1.01), in analyses using the same sample. For aircraft noise, no association was observed. The associations did not vary by ER status for any noise source. In analyses using <60 dB as a cutoff, we found HRs of 1.08 (0.99-1.18) for road traffic and 1.19 (0.95-1.49) for railway noise. CONCLUSIONS: We found weak associations between road and railway noise and breast cancer risk. More high-quality prospective studies are needed, particularly among those exposed to railway and aircraft noise before conclusions regarding noise as a risk factor for breast cancer can be made.

Long-term exposure to traffic noise and risk of incident colon cancer: A pooled study of eleven Nordic cohorts.

Background Colon cancer incidence is rising globally, and factors pertaining to urbanization have been proposed involved in this development. Traffic noise may increase colon cancer risk by causing sleep disturbance and stress, thereby inducing known colon cancer risk-factors, e.g. obesity, diabetes, physical inactivity, and alcohol consumption, but few studies have examined this. Objectives The objective of this study was to investigate the association between traffic noise and colon cancer (all, proximal, distal) in a pooled population of 11 Nordic cohorts, totaling 155,203 persons. Methods We identified residential address history and estimated road, railway, and aircraft noise, as well as air pollution, for all addresses, using similar exposure models across cohorts. Colon cancer cases were identified through national registries. We analyzed data using Cox Proportional Hazards Models, adjusting main models for harmonized sociodemographic and lifestyle data. Results During follow-up (median 18.8 years), 2757 colon cancer cases developed. We found a hazard ratio (HR) of 1.05 (95% confidence interval (CI): 0.99-1.10) per 10-dB higher 5-year mean time-weighted road traffic noise. In sub-type analyses, the association seemed confined to distal colon cancer: HR 1.06 (95% CI: 0.98-1.14). Railway and aircraft noise was not associated with colon cancer, albeit there was some indication in sub-type analyses that railway noise may also be associated with distal colon cancer. In interaction-analyses, the association between road traffic noise and colon cancer was strongest among obese persons and those with high NO2-exposure. Discussion A prominent study strength is the large population with harmonized data across eleven cohorts, and the complete address-history during follow-up. However, each cohort estimated noise independently, and only at the most exposed façade, which may introduce exposure misclassification. Despite this, the results of this pooled study suggest that traffic noise may be a risk factor for colon cancer, especially of distal origin.

Long-Term Exposure to Transportation Noise and Ischemic Heart Disease: A Pooled Analysis of Nine Scandinavian Cohorts.

BACKGROUND: Transportation noise may induce cardiovascular disease, but the public health implications are unclear. OBJECTIVES: The study aimed to assess exposure-response relationships for different transportation noise sources and ischemic heart disease (IHD), including subtypes. METHODS: Pooled analyses were performed of nine cohorts from Denmark and Sweden, together including 132,801 subjects. Time-weighted long-term exposure to road, railway, and aircraft noise, as well as air pollution, was estimated based on residential histories. Hazard ratios (HRs) were calculated using Cox proportional hazards models following adjustment for lifestyle and socioeconomic risk factors. RESULTS: A total of 22,459 incident cases of IHD were identified during follow-up from national patient and mortality registers, including 7,682 cases of myocardial infarction. The adjusted HR for IHD was 1.03 [95% confidence interval (CI) 1.00, 1.05] per 10 dB Lden for both road and railway noise exposure during 5 y prior to the event. Higher risks were indicated for IHD excluding angina pectoris cases, with HRs of 1.06 (95% CI: 1.03, 1.08) and 1.05 (95% CI: 1.01, 1.08) per 10 dB Lden for road and railway noise, respectively. Corresponding HRs for myocardial infarction were 1.02 (95% CI: 0.99, 1.05) and 1.04 (95% CI: 0.99, 1.08). Increased risks were observed for aircraft noise but without clear exposure-response relations. A threshold at around 55 dB Lden was suggested in the exposure-response relation for road traffic noise and IHD. DISCUSSION: Exposure to road, railway, and aircraft noise in the prior 5 y was associated with an increased risk of IHD, particularly after exclusion of angina pectoris cases, which are less well identified in the registries. https://doi.org/10.1289/EHP10745.

Cross-sectional associations of different types of nature exposure with psychotropic, antihypertensive and asthma medication.

BACKGROUND: Exposure to natural environments is thought to be beneficial for human health, but the evidence is inconsistent. OBJECTIVE: To examine whether exposure to green and blue spaces in urban environments is associated with mental and physical health in Finland. METHODS: The Helsinki Capital Region Environmental Health Survey was conducted in 2015-2016 in Helsinki, Espoo and Vantaa in Finland (n=7321). Cross-sectional associations of the amounts of residential green and blue spaces within 1 km radius around the respondent's home (based on the Urban Atlas 2012), green and blue views from home and green space visits with self-reported use of psychotropic (anxiolytics, hypnotics and antidepressants), antihypertensive and asthma medication were examined using logistic regression models. Indicators of health behaviour, traffic-related outdoor air pollution and noise and socioeconomic status (SES) were used as covariates, the last of these also as a potential effect modifier. RESULTS: Amounts of residential green and blue spaces or green and blue views from home were not associated with medications. However, the frequency of green space visits was associated with lower odds of using psychotropic medication (OR=0.67, 95% CI 0.55 to 0.82 for 3-4 times/week; 0.78, 0.63 to 0.96 for ≥5 times/week) and antihypertensive (0.64, 0.52 to 0.78; 0.59, 0.48 to 0.74, respectively) and asthma (0.74, 0.58 to 0.94; 0.76, 0.59 to 0.99, respectively) medication use. The observed associations were attenuated by body mass index, but no consistent interactions with SES indicators were observed. CONCLUSIONS: Frequent green space visits, but not the amounts of residential green or blue spaces, or green and blue views from home, were associated with less frequent use of psychotropic, antihypertensive and asthma medication in urban environments.

Occupational noise exposure and risk of incident stroke: a pooled study of five Scandinavian cohorts.

OBJECTIVES: To investigate the association between occupational noise exposure and stroke incidence in a pooled study of five Scandinavian cohorts (NordSOUND). METHODS: We pooled and harmonised data from five Scandinavian cohorts resulting in 78 389 participants. We obtained job data from national registries or questionnaires and recoded these to match a job-exposure matrix developed in Sweden, which specified the annual average daily noise exposure in five exposure classes (LAeq8h): <70, 70-74, 75-79, 80-84, ≥85 dB(A). We identified residential address history and estimated 1-year average road traffic noise at baseline. Using national patient and mortality registers, we identified 7777 stroke cases with a median follow-up of 20.2 years. Analyses were conducted using Cox proportional hazards models adjusting for individual and area-level potential confounders. RESULTS: Exposure to occupational noise at baseline was not associated with overall stroke in the fully adjusted models. For ischaemic stroke, occupational noise was associated with HRs (95% CI) of 1.08 (0.98 to 1.20), 1.09 (0.97 to 1.24) and 1.06 (0.92 to 1.21) in the 75-79, 80-84 and ≥85 dB(A) exposure groups, compared with <70 dB(A), respectively. In subanalyses using time-varying occupational noise exposure, we observed an indication of higher stroke risk among the most exposed (≥85 dB(A)), particularly when restricting analyses to people exposed to occupational noise within the last year (HR: 1.27; 95% CI: 0.99 to 1.63). CONCLUSIONS: We found no association between occupational noise and risk of overall stroke after adjustment for confounders. However, the non-significantly increased risk of ischaemic stroke warrants further investigation.

Exposure-Response Functions for the Effects of Traffic Noise on Self-Reported Annoyance and Sleep Disturbance in Finland: Effect of Exposure Estimation Method.

Large variations in transportation noise tolerance have been reported between communities. In addition to population sensitivity, exposure-response functions (ERFs) for the effects of transportation noise depend on the exposure estimation method used. In the EU, the new CNOSSOS-EU method will change the estimations of exposure by changing the assignment of noise levels and populations to buildings. This method was officially used for the first time in the strategic noise mapping performed by Finnish authorities in 2017. Compared to the old method, the number of people exposed to traffic noise above 55 dB decreased by 50%. The main aim of this study, conducted in the Helsinki Capital Region, Finland, was to evaluate how the exposure estimation method affects ERFs for road traffic noise. As an example, with a façade road traffic noise level of 65 dB, the ERF based on the highest façade noise level of the residential building resulted in 5.1% being highly annoyed (HAV), while the ERF based on the exposure estimation method that is similar to the CNOSSOS-EU method resulted in 13.6%. Thus, the substantial increase in the health effect estimate compensates for the reduction in the number of highly exposed people. This demonstrates the need for purpose-fitted ERFs when the CNOSSOS-EU method is used to estimate exposure in the health impact assessment of transportation noise.

Long-Term Exposure to Transportation Noise and Risk of Incident Stroke: A Pooled Study of Nine Scandinavian Cohorts.

BACKGROUND: Transportation noise is increasingly acknowledged as a cardiovascular risk factor, but the evidence base for an association with stroke is sparse. OBJECTIVE: We aimed to investigate the association between transportation noise and stroke incidence in a large Scandinavian population. METHODS: We harmonized and pooled data from nine Scandinavian cohorts (seven Swedish, two Danish), totaling 135,951 participants. We identified residential address history and estimated road, railway, and aircraft noise for all addresses. Information on stroke incidence was acquired through linkage to national patient and mortality registries. We analyzed data using Cox proportional hazards models, including socioeconomic and lifestyle confounders, and air pollution. RESULTS: During follow-up (median=19.5y), 11,056 stroke cases were identified. Road traffic noise (Lden) was associated with risk of stroke, with a hazard ratio (HR) of 1.06 [95% confidence interval (CI): 1.03, 1.08] per 10-dB higher 5-y mean time-weighted exposure in analyses adjusted for individual- and area-level socioeconomic covariates. The association was approximately linear and persisted after adjustment for air pollution [particulate matter (PM) with an aerodynamic diameter of ≤2.5µm (PM2.5) and NO2]. Stroke was associated with moderate levels of 5-y aircraft noise exposure (40-50 vs. ≤40 dB) (HR=1.12; 95% CI: 0.99, 1.27), but not with higher exposure (≥50 dB, HR=0.94; 95% CI: 0.79, 1.11). Railway noise was not associated with stroke. DISCUSSION: In this pooled study, road traffic noise was associated with a higher risk of stroke. This finding supports road traffic noise as an important cardiovascular risk factor that should be included when estimating the burden of disease due to traffic noise. https://doi.org/10.1289/EHP8949.

Mortality risk related to heatwaves in Finland - Factors affecting vulnerability.

BACKGROUND: Heatwaves are known to increase mortality. However, there is a need for more quantitative information on factors affecting sensitivity to the adverse health effects, particularly in countries with cool summer temperatures. OBJECTIVES: We evaluated mortality risk related to heatwave days in Finland. Risk was examined by age, sex, cause of death, and place of death, including health and social care facilities and homes. Mortality was also analysed for different patient subgroups in healthcare facilities. METHODS: Heatwaves were defined as periods when the daily average temperature exceeded the 90th percentile of that from May to August in 2000-2014 for ≥4 days. In addition to all heatwave days, risk was analysed for short (4-5 days) and long (≥10 days) heatwaves. Mortality analyses were based on linking registry data on i) daily non-accidental and cause-specific mortality and ii) admissions to a health or social care facility. Statistical analyses were conducted using generalised estimating equations for longitudinal data analysis, assuming a Poisson distribution for the daily mortality count. RESULTS: During all heatwave days, mortality increased among those aged 65-74 years (6.7%, 95% confidence interval 2.9-10.8%) and ≥75 years (12.8%, 95% CI 9.8-15.9%). Mortality increased in both sexes, but the risk was higher in women. Positive associations were observed for deaths due to respiratory diseases, renal diseases, mental and behavioural disorders, diseases of the nervous system, and cardiovascular diseases. Overall, effects were stronger for long than short heatwaves. During all heatwave days, mortality increased in healthcare facilities in outpatients (26.9%, 95% CI 17.3-37.2%) and inpatients. Among inpatients, the risk was higher in long-term inpatients (stay in ward > 30 days, 13.1%, 95% CI 8.6-17.7%) than others (5.8%, 95% CI 2.7-9.0%). At homes, mortality increased by 8.1% (95% CI 1.9-14.6%). Elevated risk estimates were also detected for social care facilities. CONCLUSIONS: In Finland, a cold-climate Northern country, heatwaves increase mortality risk significantly among the elderly. Women are more susceptible than men, and many chronic diseases are important risk factors. To reduce heatwave-related deaths, preparedness should be improved particularly in hospital and healthcare centre wards, where the most vulnerable are long-term inpatients. However, measures are also needed to protect the elderly at home and in social care facilities, especially during prolonged hot periods.

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

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

Self-reported health in the vicinity of five wind power production areas in Finland.

In many countries, some people living in the vicinity of wind power production areas report having symptoms that they intuitively associate with wind turbines. Recently public discussions have focused especially on wind turbine infrasound. However, scientific evidence supporting an association is lacking. The aim of this study was to assess the association between exposure to wind turbines and the prevalence of self-reported symptoms, diseases and medications. A cross-sectional questionnaire study (n = 2,828) was conducted in the vicinity of five wind power production areas in Finland in 2015-2016. Each area had 3-16 turbines with a nominal power of 2.4-3.3 MW. The response rate was 50% (n = 1,411). Continuous and categorised (≤ 2.5, > 2.5-5, > 5-10 km) distance between the respondents' home and the closest wind turbine was used to represent exposure to wind turbines. Wind turbine sound pressure level outdoors could be reliably modelled only for the closest distance zone where the yearly average was 34 dB and maximum 43 dB. The data on symptoms (headache, nausea, dizziness, tinnitus, ear fullness, arrhythmia, fatigue, difficulties in falling asleep, waking up too early, anxiety, stress), diseases (hypertension, heart insufficiency, diabetes), and medications (analgesics for headache, joint/muscle pain and other pain, and medication for sleep disturbance, anxiety and depression, and hypertension) was obtained from the questionnaire. Logistic regression analyses were adjusted for age, sex, marital status, education, work situation, smoking, alcohol consumption, physical activity, body mass index, and hearing problems. Annoyance and sleep disturbance due to wind turbine noise were inversely associated with the distance to the closest wind turbine. The prevalence of symptoms, diseases and medications was essentially the same in all distance categories. In multivariate regression modelling, the odds ratio estimates were generally close to unity and statistically non-significant. Beyond annoyance and sleep disturbance, there were no consistent associations between exposure to wind turbines and self-reported health problems. The results do not support the hypothesis that broadband sound or infrasound from wind turbines could cause the proposed health problems.

Heterogeneous Urban Exposures and Prevalent Hypertension in the Helsinki Capital Region, Finland.

Urban dwellers are simultaneously exposed to several environmental health risk factors. This study aimed to examine the relationship between long-term exposure to fine particulate matter (PM2.5, diameter < 2.5 µm) of residential-wood-burning and road-traffic origin, road-traffic noise, green space around participants' homes, and hypertension. In 2015 and 2016, we conducted a survey of residents of the Helsinki Capital Region to determine their perceptions of environmental quality and safety, lifestyles, and health statuses. Recent antihypertensive medication was used as an indicator of current hypertensive illness. Individual-level exposure was estimated by linking residential coordinates with modelled outdoor levels of wood-smoke- and traffic-related PM2.5, road-traffic noise, and coverage of natural spaces. Relationships between exposure and hypertension were modelled using multi-exposure and single-exposure binary logistic regression while taking smooth functions into account. Twenty-eight percent of the participants were current users of antihypertensive medication. The odds ratios (95% confidence interval) for antihypertensive use were 1.12 (0.78-1.57); 0.97 (0.76-1.26); 0.98 (0.93-1.04) and 0.99 (0.94-1.04) for wood-smoke PM2.5, road-traffic PM2.5, road-traffic noise, and coverage of green space, respectively. We found no evidence of an effect of the investigated urban exposures on prevalent hypertension in the Helsinki Capital Region.

Symptoms intuitively associated with wind turbine infrasound.

In many countries, a certain proportion of individuals living in the vicinity of wind power areas have reported symptoms that they have intuitively associated with infrasound from wind turbines. While the reason for these symptoms remains under debate, this is the first study to describe the phenomenon by assessing the prevalence and severity of these wind turbine infrasound related symptoms as well as factors associated with being symptomatic. Four wind power areas in Finland assessed to have the most problems intuitively associated with wind turbine infrasound were selected for the study. The questionnaire was mailed to 4847 adults in four distance zones (≤ 2.5 km, > 2.5-5 km, > 5-10 km, > 10-20 km from the closest wind turbine), and 28% responded. In the closest distance zone, 15% of respondents reported having symptoms that they have intuitively associated with wind turbine infrasound. In the whole study area, the symptom prevalence was 5%. Many of the symptomatic respondents were annoyed by audible wind turbine sound and associated their symptoms also with vibration or electromagnetic field from wind turbines. One third of the symptomatic respondents rated their symptoms severe, and the symptom spectrum was very broad covering several organ systems. In multivariate models, many factors such as proximity to wind turbines, impaired health status, being annoyed by different aspects of wind turbines and considering wind turbines as a health risk were associated with having wind turbine infrasound related symptoms. Although causal relationships cannot be assessed based on a cross-sectional questionnaire study, it can be speculated that interpretations of symptoms are affected by many other factors in addition to actual exposure.

Heat, Heatwaves and Cardiorespiratory Hospital Admissions in Helsinki, Finland.

Background: There is a lack of knowledge concerning the effects of ambient heat exposure on morbidity in Northern Europe. Therefore, this study aimed to evaluate the relationships of daily summertime temperature and heatwaves with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. Methods: Time series models adjusted for potential confounders, such as air pollution, were used to investigate the associations of daily temperature and heatwaves with cause-specific cardiorespiratory hospital admissions during summer months of 2001-2017. Daily number of hospitalizations was obtained from the national hospital discharge register and weather information from the Finnish Meteorological Institute. Results: Increased daily temperature was associated with a decreased risk of total respiratory hospital admissions and asthma. Heatwave days were associated with 20.5% (95% CI: 6.9, 35.9) increased risk of pneumonia admissions and during long or intense heatwaves also with total respiratory admissions in the oldest age group (≥75 years). There were also suggestive positive associations between heatwave days and admissions due to myocardial infarction and cerebrovascular diseases. In contrast, risk of arrhythmia admissions decreased 20.8% (95% CI: 8.0, 31.8) during heatwaves. Conclusions: Heatwaves, rather than single hot days, are a health threat affecting morbidity even in a Northern climate.

Wood stove use and other determinants of personal and indoor exposures to particulate air pollution and ozone among elderly persons in a Northern Suburb.

A six-month winter-spring study was conducted in a suburb of the northern European city of Kuopio, Finland, to identify and quantify factors determining daily personal exposure and home indoor levels of fine particulate matter (PM2.5 , diameter <2.5 µm) and its light absorption coefficient (PM2.5abs ), a proxy for combustion-derived black carbon. Moreover, determinants of home indoor ozone (O3 ) concentration were examined. Local central site outdoor, home indoor, and personal daily levels of pollutants were monitored in this suburb among 37 elderly residents. Outdoor concentrations of the pollutants were significant determinants of their levels in home indoor air and personal exposures. Natural ventilation in the detached and row houses increased personal exposure to PM2.5 , but not to PM2.5abs , when compared with mechanical ventilation. Only cooking out of the recorded household activities increased indoor PM2.5 . The use of a wood stove room heater or wood-fired sauna stove was associated with elevated concentrations of personal PM2.5 and PM2.5abs , and indoor PM2.5abs . Candle burning increased daily indoor and personal PM2.5abs , and it was also a determinant of indoor ozone level. In conclusion, relatively short-lasting wood and candle burning of a few hours increased residents' daily exposure to potentially hazardous, combustion-derived carbonaceous particulate matter.

Restorative effects of urban green environments and the role of urban-nature orientedness and noise sensitivity: A field experiment.

In this experiment we investigated how individual differences in orientation towards built vs. nature environment as well as noise sensitivity affect psychological and physiological restoration in a constructed urban park, urban woodland and city centre of Helsinki, Finland. The participants, 30-61-year-old healthy women (N = 83), visited each study site once. The experiment consisted of a 15-min viewing session, followed by a 30-min walking session in each environment. We measured restorative effects: perceived restorative outcomes, vitality, and blood pressure in these three environments. The data were analysed in SAS with a linear mixed model. We found significant differences between environments in psychological restorative effects, but not in blood pressure. The urban-nature orientedness, and to a lesser extent noise sensitivity, modified the effect of environment on restoration. In conclusion, individual characteristics affect psychological restoration provided by various urban environments. Varying needs of individuals should be taken into account in city planning.

Traffic noise, noise annoyance and psychotropic medication use.

BACKGROUND: Road-traffic noise can induce stress, which may contribute to mental health disorders. Mental health problems have not received much attention in noise research. People perceive noise differently, which may affect the extent to which noise contributes to poor mental health at the individual level. This paper aims to assess the relationships between outdoor traffic noise and noise annoyance and the use of psychotropic medication. METHODS: We conducted a survey to assess noise annoyance and psychotropic medication among residents of the Helsinki Capital Region of Finland. We also assessed the associations of annoyance and road-traffic noise with sleep disorders, anxiety and depression. Respondents were randomly sampled from the Finnish Population registry, and data was collected using a self-administered questionnaire. Outdoor traffic noise was modelled using the Nordic prediction model. Associations between annoyance and modelled façade-noise levels with mental health outcome indicators were assessed using a binary logistic regression while controlling for socioeconomic, lifestyle and exposure-related factors. RESULTS: A total of 7321 respondents returned completed questionnaires. Among the study respondents, 15%, 7% and 7% used sleep medication, anxiolytic and antidepressant medications, respectively, in the year preceding the study. Noise annoyance was associated with anxiolytic drug use, OR = 1.41 (95% CI: 1.02-1.95), but not with sedative or antidepressant use. There was suggestive association between modelled noise at levels higher than 60 dB and anxiolytic or antidepressant use. In respondents whose bedroom windows faced the street, modelled noise was definitively associated with antidepressant use. Noise sensitivity did not modify the effect of noise but was associated with an increased use of psychotropic medication. CONCLUSION: We observed suggestive associations between high levels of road-traffic noise and psychotropic medication use. Noise sensitivity was associated with psychotropic medication use.

Statins do not Increase the Rate of Bleeding Among Warfarin Users.

Clinical significance of potential interaction between warfarin and statins is unclear. Our objective was to determine whether use of statins as a class or use of simvastatin modulates the rate of bleeding requiring hospitalization among new warfarin users. Using Finnish healthcare databases, we identified a cohort of 101,588 warfarin initiators between 1 January 2009 and 30 June 2012. By the end of 2012, these patients accumulated 92,695 person-years of exposure to warfarin-only and 60,253 years of exposure to warfarin-with-statin. The outcome was a composite of gastrointestinal, intracranial or other bleeding leading to hospitalization. A Poisson generalized estimating equation model was employed to estimate rate ratios (RR) and their 95% confidence intervals (CI) for exposure to warfarin-with-statin compared to warfarin-only and to allow multiple episodes per patient and time-dependent covariates. In multivariable models, we found no difference in the bleeding rate in association with exposure to any statin (multivariable-adjusted RR = 0.98, 95% CI 0.89-1.07) or to simvastatin (RR = 1.01, 95% CI 0.91-1.11) with warfarin compared to exposure to warfarin-only. We conclude that concomitant use of statins and warfarin was not associated with an increased rate of bleeding requiring hospitalization.

Biometeorological Assessment of Mortality Related to Extreme Temperatures in Helsinki Region, Finland, 1972-2014.

Climate change is expected to increase heat-related and decrease cold-related mortality. The extent of acclimatization of the population to gradually-changing thermal conditions is not well understood. We aimed to define the relationship between mortality and temperature extremes in different age groups in the Helsinki-Uusimaa hospital district in Southern Finland, and changes in sensitivity of the population to temperature extremes over the period of 1972-2014. Time series of mortality were made stationary with a method that utilizes 365-day Gaussian smoothing, removes trends and seasonality, and gives relative mortality as the result. We used generalized additive models to examine the association of relative mortality to physiologically equivalent temperature (PET) and to air temperature in the 43-year study period and in two 21-year long sub-periods (1972-1992 and 1994-2014). We calculated the mean values of relative mortality in percentile-based categories of thermal indices. Relative mortality increases more in the hot than in the cold tail of the thermal distribution. The increase is strongest among those aged 75 years and older, but is somewhat elevated even among those younger than 65 years. Above the 99th percentile of the PET distribution, the all-aged relative mortality decreased in time from 18.3 to 8.6%. Among those ≥75 years old, the decrease in relative mortality between the sub-periods were found to be above the 90th percentile. The dependence of relative mortality on cold extremes was negligible, except among those ≥75 years old, in the latter period. Thus, heat-related mortality is also remarkable in Finland, but the sensitivity to heat stress has decreased over the decades.

Acute effects of visits to urban green environments on cardiovascular physiology in women: A field experiment.

BACKGROUND: Epidemiological studies have reported positive associations between the amount of green space in the living environment and mental and cardiovascular human health. In a search for effect mechanisms, field studies have found short-term visits to green environments to be associated with psychological stress relief. Less evidence is available on the effect of visits on cardiovascular physiology. OBJECTIVES: To evaluate whether visits to urban green environments, in comparison to visits to a built-up environment, lead to beneficial short-term changes in indicators of cardiovascular health. METHODS: Thirty-six adult female volunteers visited three different types of urban environments: an urban forest, an urban park, and a built-up city centre, in Helsinki, Finland. The visits consisted of 15min of sedentary viewing, and 30min of walking. During the visits, blood pressure and heart rate were measured, and electrocardiogram recorded for the determination of indicators of heart rate variability. In addition, levels of respirable ambient particles and environmental noise were monitored. RESULTS: Visits to the green environments were associated with lower blood pressure (viewing period only), lower heart rate, and higher indices of heart rate variability [standard deviation of normal-to-normal intervals (SDNN), high frequency power] than visits to the city centre. In the green environments, heart rate decreased and SDNN increased during the visit. Associations between environment and indicators of cardiovascular health weakened slightly after inclusion of particulate air pollution and noise in the models. CONCLUSIONS: Visits to urban green environments are associated with beneficial short-term changes in cardiovascular risk factors. This can be explained by psychological stress relief with contribution from reduced air pollution and noise exposure during the visits. Future research should evaluate the amount of exposure to green environments needed for longer-term benefits for cardiovascular health.