Kim de Jong

Perceived green qualities were associated with neighborhood satisfaction, physical activity, and general health : Results from a cross-sectional study in suburban and rural Scania, southern Sweden

In this study using cross-sectional survey data from suburban and rural Scania, Sweden (N=24,847), we assessed how the recently validated index score of area-aggregated perceived green neighborhood qualities (Scania Green Score; SGS), and the five distinct qualities within this index were associated with three self-reported indicators of well-being: neighborhood satisfaction, physical activity and general health. Effect sizes were compared with objective (GIS-based) assessments of the same five qualities. Area-aggregated SGS was positively associated with neighborhood satisfaction, physical activity and general health. The association with general health was mediated by physical activity and neighborhood satisfaction. Three perceived qualities had salutogenic potential: historical remains (culture), silence such that sounds of nature can be heard (serene) and species richness (lush). Spacious and wild were not appreciated. Some independent positive effects of the GIS-based index were noted, but could not be consistently attributed to specific qualities. Perceived qualities within green areas, not merely quantity, are related to aspects of well-being in suburban and rural areas.

Genetic loci associated with chronic obstructive pulmonary disease overlap with loci for lung function and pulmonary fibrosis

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide. We performed a genetic association study in 15,256 cases and 47,936 controls, with replication of select top results (P < 5 × 10−6) in 9,498 cases and 9,748 controls. In the combined meta-analysis, we identified 22 loci associated at genome-wide significance, including 13 new associations with COPD. Nine of these 13 loci have been associated with lung function in general population samples, while 4 (EEFSEC, DSP, MTCL1, and SFTPD) are new. We noted two loci shared with pulmonary fibrosis (FAM13A and DSP) but that had opposite risk alleles for COPD. None of our loci overlapped with genome-wide associations for asthma, although one locus has been implicated in joint susceptibility to asthma and obesity. We also identified genetic correlation between COPD and asthma. Our findings highlight new loci associated with COPD, demonstrate the importance of specific loci associated with lung function to COPD, and identify potential regions of genetic overlap between COPD and other respiratory diseases.

Area-aggregated assessments of perceived environmental attributes may overcome single-source bias in studies of green environments and health: results from a cross-sectional survey in southern Sweden

BackgroundMost studies assessing health effects of neighborhood characteristics either use self-reports or objective assessments of the environment, the latter often based on Geographical Information Systems (GIS). While objective measures require detailed landscape data, self-assessments may yield confounded results. In this study we demonstrate how self-assessments of green neighborhood environments aggregated to narrow area units may serve as an appealing compromise between objective measures and individual self-assessments.MethodsThe study uses cross-sectional data (N = 24,847) from a public health survey conducted in the county of Scania, southern Sweden, in 2008 and validates the Scania Green Score (SGS), a new index comprising five self-reported green neighborhood qualities (Culture, Lush, Serene, Spacious and Wild). The same qualities were also assessed objectively using landscape data and GIS. A multilevel (ecometric) model was used to aggregate individual self-reports to assessments of perceived green environmental attributes for areas of 1,000 square meters. We assessed convergent and concurrent validity for self-assessments of the five items separately and for the sum score, individually and area-aggregated.ResultsCorrelations between the index scores based on self-assessments and the corresponding objective assessments were clearly present, indicating convergent validity, but the agreement was low. The correlation was even more evident for the area-aggregated SGS. All three scores (individual SGS, area-aggregated SGS and GIS index score) were associated with neighborhood satisfaction, indicating concurrent validity. However, while individual SGS was associated with vitality, this association was not present for aggregated SGS and the GIS-index score, suggesting confounding (single-source bias) when individual SGS was used.ConclusionsPerceived and objectively assessed qualities of the green neighborhood environment correlate but do not agree. An index score based on self-reports but aggregated to narrow area units can be a valid approach to assess perceived green neighborhood qualities in settings where objective assessments are not possible or feasible.

Mapping snakebite epidemiology in Nicaragua : pitfalls and possible solutions

Background Snakebites are a public health problem in Nicaragua: it is a tropical developing country, venomous snakes are present and there are reports of snakebites treated both in the formal and informal health care system. We aimed to produce an incidence map using data reported by the health care system that would be used to allocate resources. However, this map may suffer from case detection bias and decisions based on this map will neglect snakebite victims who do not receive healthcare. To avoid this error, we try to identify where underreporting is likely based on available information. Method and Findings The Nicaraguan municipalities are categorized by precipitation, altitude and geographical location into regions of assumed homogenous snake prevalence. Socio-economic and healthcare variables hypothesized to be related to underreporting of snakebites are aggregated into an index. The environmental region variable, the underreporting index and three demographic variables (rurality, sex and age distribution) are entered in a Poisson regression model of municipality-level snakebite incidence. In this model, the underreporting index is non-linearly associated with snakebite incidence, a finding we attribute to underreporting in the most deprived municipalities. The municipalities with the worst scoring on the underreporting index and those with combined low reported incidence and large rural population are identified as likely underreporting. 3,286 snakebite cases were reported in 2005–2009, corresponding to a 5-year incidence of 56 bites per 100,000 inhabitants (municipality range: 0–600 cases per 100,000 inhabitants). Conclusions Using publicly available data, we identified areas likely to be underreporting snakebites and highlighted these areas instead of leaving them “white” on the incidence map. The effects of the case detection bias on the distribution of resources against snakebites could decrease. Although not yet verified empirically, our study provides an example of how snake bite epidemiology may be investigated in similar settings worldwide at a low cost.

Association of Occupational Pesticide Exposure With Accelerated Longitudinal Decline in Lung Function

Cross-sectional studies have shown that occupational exposure to vapors, gases, dusts, and fumes (VGDF) and pesticides is associated with a lower level of lung function. These associations seem to be stronger in ever smokers. In the current study, we aimed to assess whether occupational exposure to VGDF and pesticides is associated with longitudinal decline in lung function. We used 12,772 observations from 2,527 participants in the Vlagtwedde-Vlaardingen Study, a general-population-based cohort study that followed subjects for 25 years, from 1965 to the last survey in 1989/1990. Job-specific exposure was estimated with the ALOHA+ job exposure matrix. Associations between exposures and annual changes in forced expiratory volume in 1 second (FEV1) and FEV1 as a percentage of inspiratory vital capacity (FEV1%VC) were assessed with linear mixed-effect models including sex, age, and level of lung function at the first measurement and pack-years of smoking at the last measurement. We tested for interaction between smoking and occupational exposure and assessed associations separately for never smokers and ever smokers. Exposure to VGDF was not associated with accelerated lung function decline after adjustment for co-exposure to pesticides. Exposure to pesticides, both in the last-held job and as a cumulative measure, was associated with accelerated decline in FEV1 and FEV1%VC, especially among ever smokers, where we found an excess change in FEV1 of -6.9 mL/year (95% confidence interval: -10.2, -3.7) associated with high pesticide exposure.

Genome-wide association study on the FEV1/FVC ratio in never-smokers identifies HHIP and FAM13A.

Background: Although a striking proportion (25% to 45%) of patients with chronic obstructive pulmonary disease are never‐smokers, most genetic susceptibility studies have not focused on this group exclusively. Objective: The aim of this study was to identify common genetic variants associated with FEV1 and its ratio to forced vital capacity (FVC) in never‐smokers. Methods: Genome‐wide association studies were performed in 5070 never‐smokers of the identification cohort LifeLines, and results (P < 10−5) were verified by using a meta‐analysis of the Vlagtwedde‐Vlaardingen study and the Rotterdam Study I‐III (total n = 1966). Furthermore, we aimed to assess the effects of the replicated variants in more detail by performing genetic risk score, expression quantitative trait loci, and variant*ever‐smoking interaction analyses. Results: We identified associations between the FEV1/FVC ratio and 5 common genetic variants in the identification cohort, and 2 of these associations were replicated. The 2 variants annotated to the genes hedgehog interacting protein (HHIP) and family with sequence similarity 13 member A (FAM13A) were shown to have an additive effect on FEV1/FVC levels in the genetic risk score analysis; were associated with gene expression of HHIP and FAM13A in lung tissue, respectively; and were genome‐wide significant in a meta‐analysis including both identification and 4 verification cohorts (P < 2.19 × 10−7). Finally, we did not identify significant interactions between the variants and ever smoking. Results of the FEV1 identification analysis were not replicated. Conclusion: The genes HHIP and FAM13A confer a risk for airway obstruction in general that is not driven exclusively by cigarette smoking, which is the main risk factor for chronic obstructive pulmonary disease.

Genome-wide interaction study of gene-by-occupational exposure and effects on FEV1 levels

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a complex disease characterized by impaired lung function and airway obstruction resulting from interactions between multiple genes and multiple environmental exposures. Thus far, genome-wide association studies have largely disregarded environmental factors that might trigger the development of lung function impairment and COPD, such as occupational exposures, which are thought to contribute to 15% to 20% of the COPD prevalence. OBJECTIVES We performed a genome-wide interaction study to identify novel susceptibility loci for occupational exposure to biological dust, mineral dust, and gases and fumes in relation to FEV1 levels. METHODS We performed an identification analysis in 12,400 subjects from the LifeLines cohort study and verified our findings in 1436 subjects from a second independent cohort, the Vlagtwedde-Vlaardingen cohort. Additionally, we assessed whether replicated single nucleotide polymorphisms (SNPs) were cis-acting expression (mRNA) quantitative trait loci in lung tissue. RESULTS Of the 7 replicated SNPs that interacted with one of the occupational exposures, several identified loci were plausible candidates that might be involved in biological pathways leading to lung function impairment, such as PCDH9 and GALNT13. Two of the 7 replicated SNPs were cis-acting expression quantitative trait loci associated with gene expression of PDE4D and TMEM176A in lung tissue. CONCLUSION This genome-wide interaction study on occupational exposures in relation to the level of lung function identified several novel genes. Further research should determine whether the identified genes are true susceptibility loci for occupational exposures and whether these SNP-by-exposure interactions consequently contribute to the development of COPD.

Risk factors for chronic mucus hypersecretion in individuals with and without COPD: influence of smoking and job exposure on CMH

Background Chronic mucus hypersecretion (CMH) is highly prevalent in smokers and associated with an accelerated lung function decline and chronic obstructive pulmonary disease (COPD). Several risk factors contribute to CMH and to COPD. It is, however, unknown if risk factors for CMH are similar in persons with and without COPD. Methods 1479 persons with and 8529 without COPD, participating in the general population-based LifeLines cohort, completed questionnaires and underwent spirometry. Occupational exposure was assessed using the ALOHA+ job exposure matrix. Analyses were performed using multiple logistic regression models. Results In COPD, a significantly higher risk for CMH was associated with higher pack-years smoking (per 10 pack-years) (OR=1.28; 1.12 to 1.46) and environmental tobacco smoke (ETS) (OR=2.06; 1.33 to 3.19). In non-COPD; male gender (OR=1.91; 1.51 to 2.41), higher Body Mass Index (OR=1.04; 1.01 to 1.06), higher pack-years smoking (OR=1.28; 1.14 to 1.44), current smoking (OR=1.50; 1.04 to 2.18), low and high exposure to mineral dust (OR=1.39; 1.04 to 1.87 and OR=1.60; 1.02 to 2.52), high exposure to gases & fumes (OR=2.19; 1.49 to 3.22). Significant interactions were found between COPD and exposure to gases & fumes (p=0.018) and aromatic solvents (p=0.038). Conclusions A higher risk for CMH was associated with higher pack-years smoking regardless of COPD status. However, a higher risk for CMH was associated with high occupational exposure to gases & fumes in individuals without COPD only.

GST-omega genes interact with environmental tobacco smoke on adult level of lung function

BackgroundLung growth in utero and lung function loss during adulthood can be affected by exposure to environmental tobacco smoke (ETS). The underlying mechanisms have not been fully elucidated. Both ETS exposure and single nucleotide polymorphisms (SNPs) in Glutathione S-Transferase (GST) Omega genes have been associated with the level of lung function. This study aimed to assess if GSTO SNPs interact with ETS exposure in utero and during adulthood on the level of lung function during adulthood.MethodsWe used cross-sectional data of 8,128 genotyped participants from the LifeLines cohort study. Linear regression models (adjusted for age, sex, height, weight, current smoking, ex-smoking and packyears smoked) were used to analyze the associations between in utero, daily and workplace ETS exposure, GSTO SNPs, the interaction between ETS and GSTOs, and level of lung function (FEV1, FEV1/FVC). Since the interactions between ETS and GSTOs may be modified by active tobacco smoking we additionally assessed associations in never and ever smokers separately. A second sample of 5,308 genotyped LifeLines participants was used to verify our initial findings.ResultsDaily and workplace ETS exposure was associated with significantly lower FEV1 levels. GSTO SNPs (recessive model) interacted with in utero ETS and were associated with higher levels of FEV1, whereas the interactions with daily and workplace ETS exposure were associated with lower levels of FEV1, effects being more pronounced in never smokers. The interaction of GSTO2 SNP rs156697 with in utero ETS associated with a higher level of FEV1 was significantly replicated in the second sample. Overall, the directions of the interactions of in utero and workplace ETS exposure with the SNPs found in the second (verification) sample were in line with the first sample.ConclusionsGSTO genotypes interact with in utero and adulthood ETS exposure on adult lung function level, but in opposite directions.

Air pollution exposure is associated with restrictive ventilatory patterns

Exposure to ambient air pollution is associated with a substantial burden of morbidity and mortality worldwide [1]. In a recent paper, Adam et al. [2] showed significantly impaired levels of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) associated with exposure to the ambient air pollutants nitrogen dioxide (NO2) and particles with a 50% cut-off aerodynamic diameter of 10 μm (PM10) in 7613 adults included in the European Study of Cohorts for Air Pollution Effects (ESCAPE). Effect estimates for FVC were of similar magnitude (for NO2) or larger (for PM10) than those for FEV1. In line with these findings, Forbes et al. [3] showed negative associations of PM10 and NO2 with the level of FEV1 in 40 329 adults included in the Health Survey for England between 1995 and 2001, whereas no significant associations with FEV1/FVC were observed. In 1997, the Swiss Study on Air Pollution and Lung Disease in Adults (SAPALDIA), including 9651 adults, showed negative associations of ambient air pollutants NO2 and PM10 with both FEV1 and FVC [4]. The effect estimates for FVC were stronger than for FEV1 for various pollutants, and this was consistently the case in most subgroups (according to smoking status and respiratory symptoms). Reduced FVC, with FEV1 being normal or reduced to a lesser degree than FVC, suggests restrictive rather than obstructive lung disease (in which FEV1 specifically is reduced, resulting in a low FEV1/FVC ratio). Thus, findings from several European studies suggest that restrictive rather than obstructive ventilatory patterns associate with long-term low levels of exposure to ambient air pollution. A study with slightly different findings is the German Study on the influence of Air Pollution on Lung Function, Inflammation and Ageing (SALIA), including 2593 women. This study also found negative associations of NO2 and PM10 exposure with both FEV1 and FVC, yet the effects estimates for FEV1 were stronger than for FVC, and consequently there were small significant negative associations with the FEV1/FVC ratio [5]. A review article concluded that despite biological plausible mechanisms, there is suggestive, but not conclusive evidence that chronic exposure to air pollution is associated with the prevalence and incidence of chronic obstructive pulmonary disease (COPD), a disease characterised by airway obstruction [6]. Thus far, no studies have focused explicitly on whether air pollution exposure is associated with obstructive or restrictive ventilatory patterns. Exposure to ambient air pollution is associated with restrictive ventilatory patterns http://ow.ly/QWbD30236J1