TY - JOUR T1 - Impact of short-term exposure to air pollution on natural mortality and vulnerable populations: a multi-city case-crossover analysis in Belgium JF - Environmental Health Y1 - 2024 A1 - Claire Demoury A1 - Raf Aerts A1 - Finaba Berete A1 - Wouter Lefebvre A1 - Arno Pauwels A1 - Charlotte Vanpoucke A1 - Johan Van der Heyden A1 - Eva M De Clercq VL - 23 CP - 1 M3 - 10.1186/s12940-024-01050-w ER - TY - JOUR T1 - Daily allergy burden and heart rate characteristics in adults with allergic rhinitis based on a wearable telemonitoring system JF - Clinical and Translational Allergy Y1 - 2023 A1 - Joren Buekers A1 - Michiel Stas A1 - Raf Aerts A1 - Nicolas Bruffaerts A1 - Sebastien Dujardin A1 - An Van Nieuwenhuyse A1 - Jos Van Orshoven A1 - Guillaume Chevance A1 - Ben Somers A1 - Jean‐Marie Aerts A1 - Judith Garcia‐Aymerich KW - Allergy KW - heart rate monitoring KW - rhinitis KW - stress AB -

Background

Allergic rhinitis includes a certain degree of autonomic imbalance. However, no information is available on how daily changes in allergy burden affect autonomic imbalance. We aimed to estimate associations between daily allergy burden (allergy symptoms and mood) and daily heart rate characteristics (resting heart rate and sample entropy, both biomarkers of autonomic balance) of adults with allergic rhinitis, based on real-world measurements with a wearable telemonitoring system.

Methods

Adults with a tree pollen allergy used a smartphone application to self-report daily allergy symptoms (score 0–44) and mood (score 0–4), and a Mio Alpha 2 wristwatch to collect heart rate characteristics during two pollen seasons of hazel, alder and birch in Belgium. Associations between daily allergy burden and heart rate characteristics were estimated using linear mixed effects distributed lag models with a random intercept for individuals and adjusted for potential confounders.

Results

Analyses included 2497 participant-days of 72 participants. A one-point increase in allergy symptom score was associated with an increase in next-day resting heart rate of 0.08 (95% CI: 0.02–0.15) beats per minute. A one-point increase in mood score was associated with an increase in same-day sample entropy of 0.80 (95% CI: 0.34–1.26) × 10−2. No associations were found between allergy symptoms and heart rate sample entropy, nor between mood and resting heart rate.

Conclusion

Daily repeated measurements with a wearable telemonitoring system revealed that the daily allergy burden of adults with allergic rhinitis has systemic effects beyond merely the respiratory system.

VL - 13 CP - 4 M3 - 10.1002/clt2.12242 ER - TY - JOUR T1 - Environmental degradation and the increasing burden of allergic disease: The need to determine the impact of nitrogen pollution JF - Frontiers in Allergy Y1 - 2023 A1 - Tobias Ceulemans A1 - Paulien Verscheure A1 - Caroline Shadouh A1 - Kasper Van Acker A1 - Brecht Devleesschauwer A1 - Catherine Linard A1 - Nicolas Dendoncker A1 - Speybroeck, Niko A1 - Nicolas Bruffaerts A1 - Olivier Honnay A1 - Schrijvers, Rik A1 - Raf Aerts KW - Allergic disease KW - Biodiversity loss KW - Environmental degradation KW - Environmental Pollution KW - epidemiology KW - Nitrogen deposition KW - Pollen allergy KW - respiratory health AB -

Allergic diseases are a major public health problem and their burden is expected to keep increasing as a result of various interactions between changes in the environment and lifestyle.

We argue that environmental degradation, driven by environmental nitrogen pollution from industry, agriculture and traffic, may be an important yet underexplored global driver of increased aeroallergen abundance and potency, leading to 1) altered allergenic landscapes, 2) higher allergy prevalence, and 3) higher allergy symptom severity.  Through multiple impacts on multiple traits at multiple levels, environmental nitrogen pollution may lead to changes in plant community composition and plant pollen biochemical properties that result in an escalating burden of allergic disease.

It is urgently needed to quantify the impact of nitrogen pollution on plant and pollen traits that determine allergenicity and symptom severity to understand, prevent, and control nitrogen-driven allergy risks to public health.  These insights are needed to better inform environmental policy with respect to the reduction of nitrogen pollution, which at present only aims to support the conservation of biodiversity and not to protect public health.  Improved policy measures may help to maintain the favorable conservation status of vulnerable habitats such as heathlands, but also help to sustain the habitability of areas prone to nitrogen pollution, such as urbanized and industrialized regions, and regions with intensive agriculture.

VL - 4 M3 - 10.3389/falgy.2023.1063982 ER - TY - JOUR T1 - Impact of environmental nitrogen pollution on pollen allergy: A scoping review JF - Sci Total Environ Y1 - 2023 A1 - Paulien Verscheure A1 - Olivier Honnay A1 - Niko Speybroeck A1 - Robin Daelemans A1 - Nicolas Bruffaerts A1 - Brecht Devleesschauwer A1 - Tobias Ceulemans A1 - Laura Van Gerven A1 - Raf Aerts A1 - Rik Schrijvers KW - Allergic disease KW - Environmental Pollution KW - Nitrogen KW - OneHealth KW - Planetary health KW - pollen AB -

The current rise in the prevalence of allergies to aeroallergens is incompletely understood and attributed to interactions with environmental changes and lifestyle changes. Environmental nitrogen pollution might be a potential driver of this increasing prevalence. While the ecological impact of excessive nitrogen pollution has been widely studied and is relatively well understood, its indirect effect on human allergies is not well documented. Nitrogen pollution can affect the environment in various ways, including air, soil, and water. We aim to provide a literature overview of the nitrogen-driven impact on plant communities, plant productivity, and pollen properties and how they lead to changes in allergy burden. We included original articles investigating the associations between nitrogen pollution, pollen, and allergy, published in international peer-reviewed journals between 2001 and 2022. Our scoping review found that the majority of studies focus on atmospheric nitrogen pollution and its impact on pollen and pollen allergens, causing allergy symptoms. These studies often examine the impact of multiple atmospheric pollutants and not just nitrogen, making it difficult to determine the specific impact of nitrogen pollution. There is some evidence that atmospheric nitrogen pollution affects pollen allergy by increasing atmospheric pollen levels, altering pollen structure, altering allergen structure and release, and causing increased allergenic reactivity. Limited research has been conducted on the impact of soil and aqueous nitrogen pollution on pollen allergenic reactivity. Further research is needed to fill the current knowledge gap about the impact of nitrogen pollution on pollen and their related allergic disease burden.

VL - 893 M3 - 10.1016/j.scitotenv.2023.164801 ER - TY - JOUR T1 - Non-response bias in the analysis of the association between mental health and the urban environment: a cross-sectional study in Brussels, Belgium JF - Archives of Public Health Y1 - 2023 A1 - Madeleine Guyot A1 - Ingrid Pelgrims A1 - Raf Aerts A1 - Keune, Hans A1 - Roy Remmen A1 - Eva M De Clercq A1 - Isabelle Thomas A1 - Sophie O. Vanwambeke, KW - Brussels KW - Mental health KW - Non-response KW - Urban Environment AB -

Background

This paper aims at analysing the impact of partial non-response in the association between urban environment and mental health in Brussels. The potential threats of the partial non-response are biases in survey estimates and statistics. The effect of non-response on statistical associations is often overlooked and evidence in the research literature is lacking.

Methods

Data from the Belgian Health Interview Survey 2008 and 2013 were used. The association between non-response and potential determinants was explored through logistic regressions.

Results

Participants with low income, low educational levels, lower or higher age or in households with children were less likely to respond. When adjusting for socio-economic variables, non-response was higher in areas which are less vegetated, more polluted or more urbanised. Because the determinants of non-response and depressive disorders were similar, it is reasonable to assume that there will be more people with mental health problems among the non-respondents. And because more non-responses were found in low vegetation areas, the protective association between green spaces and mental health may be underestimated.

Conclusion

Our capacity to measure the association between the urban environment and health is affected by non-response in surveys. The non-random spatial and socio-economic distribution of this bias affects the research findings.

VL - 81 CP - 1 M3 - 10.1186/s13690-023-01118-y ER - TY - JOUR T1 - Association between temperature and natural mortality in Belgium: Effect modification by individual characteristics and residential environment JF - Science of The Total Environment Y1 - 2022 A1 - Claire Demoury A1 - Katrien, De Troeyer A1 - Finaba Berete A1 - Raf Aerts A1 - Bert, Van Schaeybroeck A1 - Johan Van der Heyden A1 - Eva M De Clercq KW - air pollution KW - Effect modification KW - Preexisting conditions KW - TemperatureMortality KW - Vulnerability AB -

Background

There is strong evidence of mortality being associated to extreme temperatures but the extent to which individual or residential factors modulate this temperature vulnerability is less clear.

Methods

We conducted a multi-city study with a time-stratified case-crossover design and used conditional logistic regression to examine the association between extreme temperatures and overall natural and cause-specific mortality. City-specific estimates were pooled using a random-effect meta-analysis to describe the global association. Cold and heat effects were assessed by comparing the mortality risks corresponding to the 2.5th and 97.5th percentiles of the daily temperature, respectively, with the minimum mortality temperature. For cold, we cumulated the risk over lags of 0 to 28 days before death and 0 to 7 days for heat. We carried out stratified analyses and assessed effect modification by individual characteristics, preexisting chronic health conditions and residential environment (population density, built-up area and air pollutants: PM2.5, NO2, O3 and black carbon) to identify more vulnerable population subgroups.

Results

Based on 307,859 deaths from natural causes, we found significant cold effect (OR = 1.42, 95%CI: 1.30–1.57) and heat effect (OR = 1.17, 95%CI: 1.12–1.21) for overall natural mortality and for respiratory causes in particular. There were significant effects modifications for some health conditions: people with asthma were at higher risk for cold, and people with psychoses for heat. In addition, people with long or frequent hospital admissions in the year preceding death were at lower risk. Despite large uncertainties, there was suggestion of effect modification by air pollutants: the effect of heat was higher on more polluted days of O3 and black carbon, and a higher cold effect was observed on more polluted days of PM2.5 and NO2 while for O3, the effect was lower.

Conclusions

These findings allow for targeted planning of public-health measures aiming to prevent the effects of extreme temperatures.

VL - 851 M3 - 10.1016/j.scitotenv.2022.158336 ER - TY - Generic T1 - Daily heart rate characteristics, allergy symptom severity and mood in adults with allergic rhinitis Y1 - 2022 A1 - J Buekers A1 - M Stas A1 - Raf Aerts A1 - Nicolas Bruffaerts A1 - S Dujardin A1 - An Van Nieuwenhuyse A1 - J Van Orshoven A1 - G Chevance A1 - B Somers A1 - Aerts A1 - Garcia-Aymerich, J AB -

Background: Adults with allergic rhinitis experience elevated resting heart rates and altered heart rate variability in comparison to healthy peers. However, no information is available on acute, daily changing factors that could underlie these cardiac alterations.

Aim: To estimate associations between daily heart rate characteristics (i.e. resting heart rate, autocorrelation and sample entropy) and allergy symptom severity and mood in adults with allergic rhinitis.

Methods: Adults with a tree pollen allergy (n=82) self-reported daily symptom severity (score: 0-44) and mood (score: 0-4) in a mobile health application during two pollen seasons of hazel, alder and birch trees. Heart rate characteristics were extracted from daytime heart rate measurements (Mio Alpha 2 wristwatch; 1 Hz; >6 hours/day). Associations between heart rate characteristics and allergy symptom severity or mood (lag 0-2) were estimated using linear mixed effects regressions, adjusted for potential confounders with a random intercept for individuals.

Results: The analyses included 3800 participant-days. A one-point increase in symptom severity was associated with an increase in resting heart rate of 0.07 (0.02 to 0.13) beats per minute on the next day. A one-point improvement in mood was associated with a decrease in autocorrelation of -0.00027 (-0.00052 to -0.00001) and an increase in sample entropy of 0.0087 (0.0049 to 0.0125) on the same day.

Conclusion: Results suggest that a higher symptom burden provokes the cardiovascular system (higher resting heart rate on the next day), while a better mood might be related to a healthier, more adaptable cardiovascular system (more irregular heart rate on the same day).

JF - ERS International Congress 2022 PB - European Respiratory Journal VL - 60: Suppl. 66, 2487 UR - https://erj.ersjournals.com/content/60/suppl_66/2487 CP - European Respiratory Journal M3 - 10.1183/13993003.congress-2022.2487 ER - TY - JOUR T1 - Higher buccal mtDNA content is associated with residential surrounding green in a panel study of primary school children JF - Environmental Research Y1 - 2022 A1 - Pauline Hautekiet A1 - Nelly D., Saenen A1 - Raf Aerts A1 - Dries S., Martens A1 - Harry A., Roels A1 - Esmée M., Bijnens A1 - Tim S., Nawrot KW - Agriculture KW - CHILDREN KW - Green space KW - Mitochondrial DNA content KW - mtDNA AB -

Background

Mitochondria are known to respond to environmental stressors but whether green space is associated with mitochondrial abundance is unexplored. Furthermore, as exposures may affect health from early life onwards, we here evaluate if residential green space is associated with mitochondria DNA content (mtDNAc) in children.

Methods

In primary schoolchildren (COGNAC study), between 2012 and 2014, buccal mtDNAc was repeatedly (three times) assessed using qPCR. Surrounding low (<3m), high (≥3m) and total (sum of low and high) green space within different radii (100m–1000m) from the residence and distance to the nearest large green space (>0.5ha) were estimated using a remote sensing derived map. Given the repeated measures design, we applied a mixed-effects model with school and subject as random effect while adjusting for a priori chosen fixed covariates.

Results: mtDNAc was assessed in 246 children with a total of 436 measurements (mean age 10.3 years). Within a 1000m radius around the residential address, an IQR increment in low (11.0%), high (9.5%), and total (13.9%) green space was associated with a respectively 15.2% (95% CI: 7.2%–23.7%), 10.8% (95% CI: 4.5%–17.5%), and 13.4% (95% CI: 7.4%–19.7%) higher mtDNAc. Conversely, an IQR increment (11.6%) in agricultural area in the same radius was associated with a −3.4% (95% CI: 6.7% to −0.1%) lower mtDNAc. Finally, a doubling in distance to large green space was associated with a −5.2% (95% CI: 7.9 to −2.4%) lower mtDNAc.

Conclusion

To our knowledge, this is the first study evaluating associations between residential surrounding green space and mtDNAc in children. Our results showed that green space was associated with a higher mtDNAc in children, which indicates the importance of the early life environment. To what extent these findings contribute to later life health effects should be further examined.

VL - 213 M3 - 10.1016/j.envres.2022.113551 ER - TY - JOUR T1 - Impact of Short-Term Exposure to Extreme Temperatures on Mortality: A Multi-City Study in Belgium JF - International Journal of Environmental Research and Public Health Y1 - 2022 A1 - Claire Demoury A1 - Raf Aerts A1 - Bram Vandeninden A1 - Bert Van Schaeybroeck A1 - Eva M De Clercq VL - 19 CP - 7 M3 - 10.3390/ijerph19073763 ER - TY - JOUR T1 - Mapping abundance distributions of allergenic tree species in urbanized landscapes: A nation-wide study for Belgium using forest inventory and citizen science data JF - Landscape and Urban Planning Y1 - 2022 A1 - Sébastien Dujardin A1 - Michiel Stas A1 - Camille Van Eupen A1 - Raf Aerts A1 - Marijke Hendrickx A1 - Andy W. Delcloo A1 - François Duchêne A1 - Rafiq Hamdi A1 - Tim S. Nawrot A1 - An Van Nieuwenhuyse A1 - Jean-Marie Aerts A1 - Jos Van Orshoven A1 - Ben Somers A1 - Catherine Linard A1 - Nicolas Dendoncker KW - Allergenic trees KW - Citizen science KW - Forest mapping KW - respiratory health KW - Species distribution modelling KW - Urban vegetation AB -

Mapping the distribution of allergenic plants in urbanized landscapes is of high importance to evaluate its impact on human health. However, data is not always available for the allergy-relevant species such as alder, birch, hazel, especially within cities where systematic inventories are often missing or not readily available. This research presents an approach to produce high-resolution abundance maps of allergenic tree species using existing forest inventories and opportunistic open-access citizen science data. Following a two-step approach, we first built species distribution models (SDMs) to predict species habitat suitability, using environmental characteristics as predictors. Second, we used statistical regressions to model the relationships between abundance, the habitat suitability predicted by the SDMs, and additional vegetation cover covariates. The combination of forest inventory data with citizen science data improves the accuracy of abundance distribution models of allergenic tree species. This produces a continuous, 1-hectare resolution map of alder, birch, and hazel showing spatial variations of abundance distributions both within the urban fabric and along the urban–rural gradient. Species abundance modelling can offer a better understanding of the existing and potential future allergy risk posed by green spaces and pave the way for a wide variety of applications at fine-scale, which is indispensable for evidence-based urban green space policy and planning in support of public health.

VL - 218 M3 - 10.1016/j.landurbplan.2021.104286 ER - TY - JOUR T1 - Quality control and correction method for air temperature data from a citizen science weather station network in Leuven, Belgium JF - Earth System Science Data Y1 - 2022 A1 - Eva Beele A1 - Maarten Reyniers A1 - Raf Aerts A1 - Ben Somers AB -

The growing trend toward urbanisation and the increasingly frequent occurrence of extreme weather events emphasise the need for further monitoring and understanding of weather in cities. In order to gain information on these intra-urban weather patterns, dense high-quality atmospheric measurements are needed. Crowdsourced weather stations (CWSs) could be a promising solution to realise such monitoring networks in a cost-efficient way. However, due to their nontraditional measuring equipment and installation settings, the quality of datasets from these networks remains an issue. This paper presents crowdsourced data from the “Leuven.cool” network, a citizen science network of around 100 low-cost weather stations (Fine Offset WH2600) distributed across Leuven, Belgium ( N,  E). The dataset is accompanied by a newly developed station-specific temperature quality control (QC) and correction procedure. The procedure consists of three levels that remove implausible measurements while also correcting for inter-station (between-station) and intra-station (station-specific) temperature biases by means of a random forest approach. The QC method is evaluated using data from four WH2600 stations installed next to official weather stations belonging to the Royal Meteorological Institute of Belgium (RMI). A positive temperature bias with a strong relation to the incoming solar radiation was found between the CWS data and the official data. The QC method is able to reduce this bias from 0.15 ± 0.56 to 0.00 ± 0.28 K. After evaluation, the QC method is applied to the data of the Leuven.cool network, making it a very suitable dataset to study local weather phenomena, such as the urban heat island (UHI) effect, in detail. (https://doi.org/10.48804/SSRN3F, Beele et al., 2022).

VL - 14 CP - 10 M3 - 10.5194/essd-14-4681-2022 ER - TY - JOUR T1 - Residential Exposure to Urban Trees and Medication Sales for Mood Disorders and Cardiovascular Disease in Brussels, Belgium: An Ecological Study JF - Environmental Health Perspectives Y1 - 2022 A1 - Dengkai, Chi A1 - Raf Aerts A1 - An Van Nieuwenhuyse A1 - Mariska, Bauwelinck A1 - Claire Demoury A1 - Michelle, Plusquin A1 - Tim S., Nawrot A1 - Lidia, Casas A1 - Ben, Somers AB -

Background:

The available evidence for positive associations between urban trees and human health is mixed, partly because the assessment of exposure to trees is often imprecise because of, for instance, exclusion of trees in private areas and the lack of three-dimensional (3D) exposure indicators (e.g., crown volume).

Objectives:

We aimed to quantify all trees and relevant 3D structural traits in Brussels (Belgium) and to investigate associations between the number of trees, tree traits, and sales of medication commonly prescribed for mood disorders and cardiovascular disease.

Methods:

We developed a workflow to automatically isolate all individual trees from airborne light detection and ranging (LiDAR) data collected in 2012. Trait data were subsequently extracted for 309,757 trees in 604 census tracts. We used the average annual age-standardized rate of medication sales in Brussels for the period 2006 to 2014, calculated from reimbursement information on medication prescribed to adults (19–64 years of age). The medication sales data were provided by sex at the census tract level. Generalized log-linear models were used to investigate associations between the number of trees, the crown volume, tree structural variation, and medication sales. Models were run separately for mood disorder and cardiovascular medication and for men and women. All models were adjusted for indicators of area-level socioeconomic status.

Results:

Single-factor models showed that higher stem densities and higher crown volumes are both associated with lower medication sales, but opposing associations emerged in multifactor models. Higher crown volume [an increase by one interquartile range (IQR) of 1.4×104 m³/hainterquartile range (IQR) of 1.4×104 m³/ha] was associated with 34% lower mood disorder medication sales [women, β=−0.341β=−0.341 (95% CI: −0.379−0.379, −0.303−0.303); men, β=−0.340β=−0.340 (95% CI: −0.378−0.378, −0.303−0.303)] and with 21–25% lower cardiovascular medication sales [women, β=−0.214β=−0.214 (95% CI: −0.246−0.246, −0.182−0.182); men, β=−0.252β=−0.252 (95% CI: −0.285−0.285, −0.219−0.219)]. Conversely, a higher stem density (an increase by one IQR of 21.8 trees/haIQR of 21.8 trees/ha) was associated with 28–32% higher mood disorder medication sales [women, β=0.322β=0.322 (95% CI: 0.284, 0.361); men, β=0.281β=0.281 (95% CI: 0.243, 0.319)] and with 20–24% higher cardiovascular medication sales [women, β=0.202β=0.202 (95% CI: 0.169, 0.236); men, β=0.240β=0.240 (95% CI: 0.206, 0.273)].

Discussion:

We found a trade-off between the number of trees and the crown volumes of those trees for human health benefits in an urban environment. Our results demonstrate that conserving large trees in urban environments may not only support conservation of biodiversity but also human health. https://doi.org/10.1289/EHP9924

VL - 130 CP - 5 M3 - 10.1289/EHP9924 ER - TY - JOUR T1 - Residential green space and mental health-related prescription medication sales: An ecological study in Belgium. JF - Environmental Research Y1 - 2022 A1 - Raf Aerts A1 - Naomi Vanlessen A1 - Sébastien Dujardin A1 - Nemery, Benoit A1 - An Van Nieuwenhuyse A1 - Mariska Bauwelinck A1 - Casas, Lidia A1 - Claire Demoury A1 - Michelle Plusquin A1 - Nawrot, Tim S KW - Environmental epidemiology KW - medication sales KW - Mental health KW - mood disorders KW - Residential green space AB -

BACKGROUND: Residential green space has been associated with mental health benefits, but how such associations vary with green space types is insufficiently known.

OBJECTIVE: We aimed to investigate associations between types and quantities of green space and sales of mood disorder medication in Belgium.

METHODS: We used aggregated sales data of psycholeptics and psychoanaleptics prescribed to adults from 2006 to 2014. Generalized mixed effects models were used to investigate associations between relative covers of woodland, low-green, grassland, and garden, and average annual medication sales. Models were adjusted for socio-economic background variables, urban-rural differences, and administrative region, and included random effects of latitude and longitude.

RESULTS: Urban census tracts were associated with 9-10% higher medication sales. In nationwide models, a 10% increase in relative cover of woodland, garden, and grass was associated with a 1-2% decrease in medication sales. The same association was found for low green but only for men. In stratified models, a 10% increase in relative cover of any green space type in urban census tracts was associated with a decrease of medication sales by 1-3%. In rural census tracts, no protective associations between green space and mood disorder medication sales were observed, with the exception of relative woodland cover for women (-1%), and low green was associated with higher medication sales (+6-7%).

CONCLUSIONS: Taken together, these results suggest that living in green environments may be beneficial for adult mental health. Woodland exposure seemed the most beneficial, but the amount of green space was more important than the type. Results underline the importance of conserving green space in our living environment, for the conservation of biodiversity and for human health.

VL - 211 M3 - 10.1016/j.envres.2022.113056 ER - TY - JOUR T1 - Residential green space, gardening, and subjective well-being: A cross-sectional study of garden owners in northern Belgium JF - Landscape and Urban Planning Y1 - 2022 A1 - Jeroen Krols A1 - Raf Aerts A1 - Naomi Vanlessen A1 - Valerie Dewaelheyns A1 - Sébastien Dujardin A1 - Ben Somers KW - biodiversity KW - garden KW - gardening KW - Mental health KW - nature relatedness KW - stress AB -

Urban green spaces and the biodiversity therein have been associated with human health and well-being benefits, but the contribution of domestic gardens to those benefits is insufficiently known.

Using data from a cross-sectional sample (n=587) of domestic garden owners in Flanders and Brussels (northern Belgium), associations between residential green space quality in and around domestic gardens, green space related activities and socioeconomic background variables of the gardeners, and self-reported health (stress and depression) were investigated with structural equation models.

Socioeconomic security was associated with lower stress and depression.  Nature relatedness and green space in the neighbourhood of the house were associated with higher exposure to green space, which was in turn negatively associated with stress and depression. Garden quality, indicated by biodiversity values and size, and nature relatedness were associated with being active in the garden, which was in turn associated with lower values of depression, but not stress.

Nature relatedness seems to play a key role in the pathway linking gardens to improved health. Improving biodiversity and ecosystems services in gardens may increase exposure to green space and help to restore and enhance nature relatedness. This, in turn, could potentially improve human health and well-being, and contribute to the conservation of biodiversity in urban environments.

VL - 223 M3 - 10.1016/j.landurbplan.2022.104414 ER - TY - JOUR T1 - Residential green space in association with the methylation status in a CpG site within the promoter region of the placental serotonin receptor HTR2A JF - Epigenetics Y1 - 2022 A1 - Yinthe Dockx A1 - Esmée, Bijnens A1 - Nelly, Saenen A1 - Raf Aerts A1 - Jean-Marie, Aerts A1 - Lidia, Casas A1 - Andy, Delcloo A1 - Nicolas, Dendoncker A1 - Catherine, Linard A1 - Michelle, Plusquin A1 - Michiel, Stas A1 - An Van Nieuwenhuyse A1 - Jos, Van Orshoven A1 - Ben, Somers A1 - Tim, Nawrot KW - Aserotonin KW - DNA Methylation KW - epigenetic KW - Green space KW - HTR2 KW - Placenta AB -

Green space could influence adult cognition and childhood neurodevelopment , and is hypothesized to be partly driven by epigenetic modifications. However, it remains unknown whether some of these associations are already evident during foetal development. Similar biological signals shape the developmental processes in the foetal brain and placenta.Therefore, we hypothesize that green space can modify epigenetic processes of cognition-related pathways in placental tissue, such as DNA-methylation of the serotonin receptor HTR2A. HTR2A-methylation was determined within 327 placentas from the ENVIRONAGE (ENVIRonmental influence ON early AGEing) birth cohort using bisulphite-PCR-pyrosequencing. Total green space exposure was calculated using high-resolution land cover data derived from the Green Map of Flanders in seven buffers (50 m-3 km) and stratified into low (<3 m) and high (≥3 m) vegetation. Residential nature was calculated using the Land use Map of Flanders. We performed multivariate regression models adjusted for several a priori chosen covariables. For an IQR increment in total green space within a 1,000 m, 2,000 m and 3,000 m buffer the methylation of HTR2A increased with 1.47% (95%CI:0.17;2.78), 1.52% (95%CI:0.21;2.83) and 1.42% (95%CI:0.15;2.69), respectively. Additionally,, we found 3.00% (95%CI:1.09;4.91) and 1.98% (95%CI:0.28;3.68) higher HTR2A-methylation when comparing residences with and without the presence of nature in a 50 m and 100 m buffer, respectively. The methylation status of HTR2A in placental tissue is positively associated with maternal green space exposure. Future research is needed to understand better how these epigenetic changes are related to functional modifications in the placenta and the consequent implications for foetal development.

M3 - 10.1080/15592294.2022.2088464 ER - TY - JOUR T1 - Association between local airborne tree pollen composition and surrounding land cover across different spatial scales in Northern Belgium JF - Urban Forestry & Urban Greening Y1 - 2021 A1 - Michiel Stas A1 - Raf Aerts A1 - Marijke Hendrickx A1 - Nicolas Bruffaerts A1 - Nicolas Dendoncker A1 - Lucie Hoebeke A1 - Catherine Linard A1 - Nawrot, Tim A1 - An Van Nieuwenhuyse A1 - Jean-Marie Aerts A1 - Jos Van Orshoven A1 - Ben Somers KW - Aerobiology KW - Allergy KW - NMDS KW - Passive sampling KW - Urban green areas AB -

Airborne pollen are important aeroallergens affecting human health. Local airborne pollen compositions can pose health-risks for the sensitized population, but at present little is known about fine-scale pollen composition patterns.

The overall objective of this study is to determine local variations in tree pollen composition with passive samplers and to identify the surrounding landscape characteristics that drive them. In February–May 2017, during the tree pollen season, airborne tree pollen were measured by passive sampling at 2 m height above ground-level in 14 sites in the Flanders and Brussels-Capital region (Belgium). Non-metric multidimensional scaling was used to investigate environmental gradients that determine the pollen composition and amounts. Land cover types were identified across spatial scales ranging between 20 m and 5 km.

The passive samplers detected the same pollen taxa during the same time windows as the validated volumetric Burkard samplers. Using passive samplers, we were able to measure local airborne pollen compositions. Corylus and Platanus pollen were associated to urban areas; Populus, Juglans and Fraxinus pollen to agricultural areas; forests and wetlands were sources of Alnus and Quercus pollen. Salix, Populus and Betula pollen were also mainly associated to wetlands. The landscape context drives the airborne tree pollen composition at a meso-scale (1−5 km) rather than at finer scale (20−500 m). Thus, land cover types (e.g. forest, bush land, agricultural lands and wetlands) surrounding urban areas may increase exposure to allergenic pollen in the urban area, potentially affecting the health of a large proportion of the population.

VL - 61 M3 - 10.1016/j.ufug.2021.127082 ER - TY - JOUR T1 - Association between urban environment and mental health in Brussels, Belgium JF - BMC Public Health Y1 - 2021 A1 - Ingrid Pelgrims A1 - Brecht Devleesschauwer A1 - Madeleine Guyot A1 - Keune, Hans A1 - Tim S. Nawrot A1 - Roy Remmen A1 - Nelly D. Saenen A1 - Sonia Trabelsi A1 - Isabelle Thomas A1 - Raf Aerts A1 - Eva M De Clercq KW - air pollution KW - Building morphology KW - Environmental epidemiology KW - Green space KW - Mental health KW - noise AB -

Background: Mental health disorders appear as a growing problem in urban areas. While common mental health disorders are generally linked to demographic and socioeconomic factors, little is known about the interaction with the urban environment. With growing urbanization, more and more people are exposed to environmental stressors potentially contributing to increased stress and impairing mental health. It is therefore important to identify features of the urban environment that affect the mental health of city dwellers. The aim of this study was to define associations of combined long-term exposure to air pollution, noise, surrounding green at different scales, and building morphology with several dimensions of mental health in Brussels. Methods: Research focuses on the inhabitants of the Brussels Capital Region older than 15 years. The epidemiological study was carried out based on the linkage of data from the national health interview surveys (2008 and 2013) and specifically developed indicators describing each participant’s surroundings in terms of air quality, noise, surrounding green, and building morphology. These data are based on the geographical coordinates of the participant’s residence and processed using Geographical Information Systems (GIS). Mental health status was approached through several validated indicators: the Symptom Checklist-90-R subscales for depressive, anxiety and sleeping disorders and the 12-Item General Health Questionnaire for general well-being. For each mental health outcome, single and multi-exposure models were performed through multivariate logistic regressions. Results: Our results suggest that traffic-related air pollution (black carbon, NO2, PM10) exposure was positively associated with higher odds of depressive disorders. No association between green surrounding, noise, building morphology and mental health could be demonstrated. Conclusions: These findings have important implications because most of the Brussel’s population resides in areas where particulate matters concentrations are above the World Health Organization guidelines. This suggests that policies aiming to reduce traffic related-air pollution could also reduce the burden of depressive disorders in Brussels

VL - 21 CP - 1 M3 - 10.1186/s12889-021-10557-7 ER - TY - JOUR T1 - Exposure to green space and pollen allergy symptom severity: A case-crossover study in Belgium JF - Science of The Total Environment Y1 - 2021 A1 - Michiel Stas A1 - Raf Aerts A1 - Marijke Hendrickx A1 - Delcloo, Andy A1 - Nicolas Dendoncker A1 - Sébastien Dujardin A1 - Catherine Linard A1 - Nawrot, Tim A1 - An Van Nieuwenhuyse A1 - Jean-Marie Aerts A1 - Jos Van Orshoven A1 - Ben Somers KW - Air pollution; Allergic rhinitis; Biodiversity; Birch pollen allergy; Personal exposure AB -

Background: The prevalence of pollen allergy has increased due to urbanization, climate change and air pollution. The effects of green space and air pollution on respiratory health of pollen allergy patients are complex and best studied in spatio-temporal detail.

Methods: We tracked 144 adults sensitized to Betulaceae pollen during the tree pollen season (January-May) of 2017 and 2018 and assessed their spatio-temporal exposure to green space, allergenic trees, air pollutants and birch pollen. Participants reported daily symptom severity scores. We extracted 404 case days with high symptom severity scores and matched these to 404 control days. The data were analyzed using conditional logistic regression with a 1:1 case-crossover design.

Results: Case days were associated with exposure to birch pollen concentration (100 grains/m3) [adjusted odds ratio 1.045 and 95% confidence interval (1.014-1.078)], O3 concentration (10 μg/m3) [1.504 (1.281-1.766)] and PM10 concentration (10 μg/m3) [1.255 (1.007-1.565)] on the day of the severe allergy event and with the cumulative exposure of one and two days before. Exposure to grass cover (10% area fraction) [0.655 (0.446-0.960)], forest cover (10% area fraction) [0.543 (0.303-0.973)] and density of Alnus (10%) [0.622 (0.411-0.942)] were protective for severe allergy, but only on the day of the severe allergy event. Increased densities of Betula trees (10%) were a risk factor [unadjusted OR: 2.014 (1.162-3.490)].

Conclusion: Exposure to green space may mitigate tree pollen allergy symptom severity but only when the density of allergenic trees is low. Air pollutants contribute to more severe allergy symptoms. Spatio-temporal tracking allows for a more realistic exposure assessment.

VL - 781 M3 - 10.1016/j.scitotenv.2021.146682 ER - TY - JOUR T1 - Exposure to green spaces may strengthen resilience and support mental health in the face of the covid-19 pandemic JF - BMJ Y1 - 2021 A1 - Raf Aerts A1 - Naomi Vanlessen A1 - Olivier Honnay AB -

Mughal and colleagues provide a useful overview of mental health support during the covid-19 pandemic.

Outdoor recreation in green spaces has emerged during the present pandemic as an essential tool to combat distress. The mental health benefits of exposure to green spaces has been documented extensively before. Here we briefly demonstrate that such exposure may restore and improve aspects of resilience and complement other means of mental health support, such as that offered by GPs.

Firstly, exposure to green spaces facilitates recovery from physiological stress, restoration of directed attention, and improvement of cognitive performance. This aids in strengthening mental resilience by dampening the body’s stress response, allowing for a more mindful thinking style and supporting adaptive thinking styles. Secondly, green spaces may stimulate physical activity and improve physical resilience. Thirdly, purposeful or pro-environmental behaviour and the anticipation of seeing interesting species (birds or orchids, for example) may activate positive emotions and improve emotional resilience. And finally, gathering outdoors, even at a safe distance, improves social cohesion and helps people to feel connected to the outside world, thus reinforcing social resilience.

To unlock the potential of green spaces for human health, it is recommended that they are more explicitly included in public health and spatial planning policies, and that prescribed exposure to green spaces is more often used to complement mental health management in primary care, now and post-covid-19. In highly urbanised and densely populated regions, however, natural areas are usually too small to accommodate increasing recreational pressure without jeopardising their biodiversity. As the mental health benefits of green spaces often depend more on perceived biodiversity than true species richness, we argue that pressure on nature could be alleviated by greening and improving recreation infrastructure in cities and rural landscapes. Investing in natural resilience is investing in human resilience.

M3 - 10.1136/bmj.n1601 ER - TY - JOUR T1 - Residential green space types, allergy symptoms and mental health in a cohort of tree pollen allergy patients JF - Landscape and Urban Planning Y1 - 2021 A1 - Michiel Stas A1 - Raf Aerts A1 - Marijke Hendrickx A1 - Nicolas Dendoncker A1 - Sébastien Dujardin A1 - Catherine Linard A1 - Tim S. Nawrot A1 - An Van Nieuwenhuyse A1 - Jean-Marie Aerts A1 - Jos Van Orshoven A1 - Ben Somers AB -

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VL - 210 M3 - 10.1016/j.landurbplan.2021.104070 ER - TY - JOUR T1 - Residing in urban areas with higher green space is associated with lower mortality risk: A census-based cohort study with ten years of follow-up JF - Environment International Y1 - 2021 A1 - Mariska Bauwelinck A1 - Casas, Lidia A1 - Tim S. Nawrot A1 - Nemery, Benoit A1 - Sonia Trabelsi A1 - Isabelle Thomas A1 - Raf Aerts A1 - Wouter Lefebvre A1 - Charlotte Vanpoucke A1 - An Van Nieuwenhuyse A1 - Deboosere, Patrick A1 - Vandenheede, Hadewijch KW - COPD KW - Greenness KW - Greenspace KW - Ischemic heart disease KW - Perception KW - population-based AB -

Background

Epidemiological studies suggest that residing close to green space reduce mortality rates. We investigated the relationship between long-term exposure to residential green space and non-accidental and cardio-respiratory mortality.

Methods

We linked the Belgian 2001 census to population and mortality register follow-up data (2001–2011) among adults aged 30 years and older residing in the five largest urban areas in Belgium (n = 2,185,170 and mean follow-up time 9.4 years). Residential addresses were available at baseline. Exposure to green space was defined as 1) surrounding greenness (2006) [normalized difference vegetation index (NDVI) and modified soil-adjusted vegetation index (MSAVI2)] within buffers of 300 m, 500 m, and 1000 m; 2) surrounding green space (2006) [Urban Atlas (UA) and CORINE Land Cover (CLC)] within buffers of 300 m, 500 m, and 1000 m; and 3) perceived neighborhood green space (2001). Cox proportional hazards models with age as the underlying time scale were used to probe into cause-specific mortality (non-accidental, respiratory, COPD, cardiovascular, ischemic heart disease (IHD), and cerebrovascular). Models were adjusted for several sociodemographic variables (age, sex, marital status, country of birth, education level, employment status, and area mean income). We further adjusted our main models for annual mean (2010) values of ambient air pollution (PM2.5, PM10, NO2 and BC, one at a time), and we additionally explored potential mediation with the aforementioned pollutants.

Results

Higher degrees of residential green space were associated with lower rates of non-accidental and respiratory mortality. In fully adjusted models, hazard ratios (HR) per interquartile range (IQR) increase in NDVI 500 m buffer (IQR: 0.24) and UA 500 m buffer (IQR: 0.31) were 0.97 (95%CI 0.96–0.98) and 0.99 (95%CI 0.98–0.99) for non-accidental mortality, and 0.95 (95%CI 0.93–0.98) and 0.97 (95%CI 0.96–0.99) for respiratory mortality. For perceived neighborhood green space, HRs were 0.93 (95%CI 0.92–0.94) and 0.94 (95%CI 0.91–0.98) for non-accidental and respiratory mortality, respectively. The observed lower mortality risks associated with residential exposure to green space were largely independent from exposure to ambient air pollutants.

Conclusion

We observed evidence for lower mortality risk in associations with long-term residential exposure to green space in most but not all studied causes of death in a large representative cohort for the five largest urban areas in Belgium. These findings support the importance of the availability of residential green space in urban areas.

VL - 148 M3 - 10.1016/j.envint.2020.106365 ER - TY - JOUR T1 - Tree pollen allergy risks and changes across scenarios in urban green spaces in Brussels, Belgium JF - Landscape and Urban Planning Y1 - 2021 A1 - Raf Aerts A1 - Nicolas Bruffaerts A1 - Ben Somers A1 - Claire Demoury A1 - Michelle Plusquin A1 - Tim S. Nawrot A1 - Marijke Hendrickx KW - Allergenic trees KW - Allergy risk scenarios KW - Climate change KW - Index of allergenicity KW - pollen allergy risk KW - Urban green areas KW - Urban parks AB -

Urban green spaces may improve human health and well-being. However, green spaces may also emit allergenic pollen and these may trigger asthma, allergic disease, and respiratory infections.  How allergy risks in green spaces may be modified by environmental change is still not widely understood.

This study analyzed tree inventory data of 18 urban green spaces (5940 trees; 278 taxa; 93 ha) in the Brussels Capital Region, Belgium. We investigated present tree pollen allergy risk (AR) and changes in AR driven by changes in tree species composition, allergenic potential and pollen season duration.  AR was estimated by calculating the allergenicity index IUGZA (range 0–1, 1 worst) for the present situation and 13 scenarios.

The average AR was 0.08 (SD 0.05; range 0.002–0.17). The AR increased by 11–27% in increased allergenic potential scenarios, and by 44% in the increased pollen season duration scenario. Preventive removal of birch, hazel and alder reduced the AR by 13%. The AR increased by 99–111% in combined scenarios with and without preventive removal of the main allergenic taxa.

These findings indicate that tree pollen allergy risks could considerably rise when ongoing environmental changes lead to a combination of longer pollen seasons, increased pollen allergen potency, and increased sensitization for one or more species.  The preventive removal of the main allergenic tree species cannot sufficiently counter allergy risks caused by other species and that are amplified by environmental change, highlighting the importance of careful tree species selection in urban green space policy and planning.

VL - 207 M3 - 10.1016/j.landurbplan.2020.104001 ER - TY - Generic T1 - Allergenic potential of urban green spaces and changes across scenarios: a case-study in Brussels, Belgium Y1 - 2020 A1 - Raf Aerts JF - 7th ESA – European Symposium on Aerobiology. “Bioaerosols and Environmental Impacts”. Virtual Symposium, Cordoba, Spain. 16-20 November 2020. ER - TY - JOUR T1 - An evaluation of species distribution models to estimate tree diversity at genus level in a heterogeneous urban-rural landscape JF - Landscape and Urban Planning Y1 - 2020 A1 - Michiel Stas A1 - Raf Aerts A1 - Marijke Hendrickx A1 - Nicolas Dendoncker A1 - Sébastien Dujardin A1 - Catherine Linard A1 - Nawrot, Tim A1 - An Van Nieuwenhuyse A1 - Jean-Marie Aerts A1 - Jos Van Orshoven A1 - Ben Somers KW - allergenic tree species KW - Belgium KW - Maxent KW - species distribution models KW - stacking AB -

Trees provide ecosystem services that improve the environment and human health. The magnitude of these improvements may be related to tree diversity within green spaces, yet spatially explicit diversity data necessary to investigate such associations are often missing. Here, we evaluate two methods to model tree diversity at genus level based on environmental covariates and presence point data. We aimed to identify the drivers and suitable methods for urban and rural tree diversity models in the heterogeneous region of Flanders, Belgium.

We stratified our research area into dominantly rural and dominantly urban areas and developed distribution models for 13 tree genera for both strata as well as for the area as a whole. Occurrence data were obtained from an open-access presence-only database of validated observations of vascular plants. These occurrence data were combined with environmental covariates in MaxEnt models. Tree diversity was modelled by adding up the individual species distribution models.

Models in the dominantly rural areas were driven by soil characteristics (soil texture and drainage class). Models in the dominantly urban areas were driven by environmental covariates explaining urban heterogeneity. Nevertheless, the stratification into urban and rural did not contribute to a higher model quality. Generic tree diversity estimates were better when presences derived from distribution models were simply added up (binary stacking, True Positive Rate of 0.903). The application of macro-ecological constraints resulted in an underestimation of generic tree diversity (probability stacking, True Positive Rate of 0.533). We conclude that summing presences derived from species distribution models (binary stacking) is a suitable approach to increase knowledge on regional diversity.

VL - 198 M3 - https://doi.org/10.1016/j.landurbplan.2020.103770 ER - TY - JOUR T1 - An evaluation of species distribution models to estimate tree diversity at genus level in a heterogeneous urban-rural landscape JF - Landscape and Urban Planning Y1 - 2020 A1 - Michiel Stas A1 - Raf Aerts A1 - Marijke Hendrickx A1 - Nicolas Dendoncker A1 - Dujardin,S. A1 - Catherine Linard A1 - Nawrot, Tim A1 - An Van Nieuwenhuyse A1 - Jean-Marie Aerts A1 - Jos Van Orshoven A1 - Ben Somers AB -

Trees provide ecosystem services that improve the environment and human health. The magnitude of these improvements may be related to tree diversity within green spaces, yet spatially explicit diversity data necessary to investigate such associations are often missing. Here, we evaluate two methods to model tree diversity at genus level based on environmental covariates and presence point data. We aimed to identify the drivers and suitable methods for urban and rural tree diversity models in the heterogeneous region of Flanders, Belgium.

We stratified our research area into dominantly rural and dominantly urban areas and developed distribution models for 13 tree genera for both strata as well as for the area as a whole. Occurrence data were obtained from an open-access presence-only database of validated observations of vascular plants. These occurrence data were combined with environmental covariates in MaxEnt models. Tree diversity was modelled by adding up the individual species distribution models.

Models in the dominantly rural areas were driven by soil characteristics (soil texture and drainage class). Models in the dominantly urban areas were driven by environmental covariates explaining urban heterogeneity. Nevertheless, the stratification into urban and rural did not contribute to a higher model quality. Generic tree diversity estimates were better when presences derived from distribution models were simply added up (binary stacking, True Positive Rate of 0.903). The application of macro-ecological constraints resulted in an underestimation of generic tree diversity (probability stacking, True Positive Rate of 0.533). We conclude that summing presences derived from species distribution models (binary stacking) is a suitable approach to increase knowledge on regional diversity.

VL - 198 M3 - 10.1016/j.landurbplan.2020.103770 ER - TY - JOUR T1 - Heat related mortality in the two largest Belgian urban areas: A time series analysis JF - Environmental Research Y1 - 2020 A1 - Katrien De Troeyer A1 - Mariska Bauwelinck A1 - Raf Aerts A1 - Dimitrios Profer A1 - Julie Berckmans A1 - Delcloo, Andy A1 - Rafiq Hamdi A1 - Bert Van Schaeybroeck A1 - Hans Hooyberghs A1 - Dirk Lauwaet A1 - Claire Demoury A1 - An Van Nieuwenhuyse KW - Ambient temperature KW - Belgium KW - mortality KW - Short-term effect KW - Urban heat island AB -

Background

Summer temperatures are expected to increase and heat waves will occur more frequently, be longer, and be more intense as a result of global warming. A growing body of evidence indicates that increasing temperature and heatwaves are associated with excess mortality and therefore global heating may become a major public health threat. However, the heat-mortality relationship has been shown to be location-specific and differences could largely be explained by the most frequent temperature. So far, in Belgium there is little known regarding the heat-mortality relationship in the different urban areas.

Objectives

The objective of this study is to assess the heat-mortality relationship in the two largest urban areas in Belgium, i.e. Antwerp and Brussels for the warm seasons from 2002 until 2011 taking into account the effect of air pollution.

Methods

The threshold in temperature above which mortality increases was determined using segmented regressions for both urban areas. The relationship between daily temperature and mortality above the threshold was investigated using a generalized estimated equation with Poisson distribution to finally determine the percentage of deaths attributable to the effect of heat.

Results

Although only 50 km apart, the heat-mortality curves for the two urban areas are different. More specifically, an increase in mortality occurs above a maximum temperature of 25.2 °C in Antwerp and 22.8 °C in Brussels. We estimated that above these thresholds, there is an increase in mortality of 4.9% per 1 °C in Antwerp and of 3.1% in Brussels. During the study period, 1.5% of the deaths in Antwerp and 3.5% of the deaths in Brussels can be attributed to the effect of heat. The thresholds differed considerably from the most frequent temperature, particularly in Antwerp. Adjustment for air pollution attenuated the effect of temperature on mortality and this attenuation was more pronounced when adjusting for ambient ozone.

Conclusion

Our results show a significant effect of temperature on mortality above a city-specific threshold, both in Antwerp and in Brussels. These findings are important given the ongoing global warming. Recurrent, intense and longer episodes of high temperature and expected changes in air pollutant levels will have an important impact on health in urban areas.

VL - 188 M3 - 10.1016/j.envres.2020.109848 ER - TY - JOUR T1 - Maturation of Esophageal Motility and Esophagogastric Junction in Preterm Infants JF - Neonatology Y1 - 2020 A1 - Rayyan, Maissa A1 - Taher Omari A1 - Gunnar Naulaers A1 - Raf Aerts A1 - Karel Allegaert A1 - Nathalie Rommel KW - Esophageal motility KW - Esophagogastric junction KW - Lower esophageal sphincter KW - Maturation KW - Preterm infant AB -

Background: Preterm infants commonly present with oral feeding problems. The role of maturation of esophageal bolus transport mechanisms herein remains unclear.
Objectives: To characterize esophageal motility and function of esophagogastric junction (EGJ) during deglutitive swallowing in healthy preterm infants and to describe maturational changes.
Methods: Four consecutive high-resolution manometry studies with impedance studies were performed weekly to investigate esophageal motility and EGJ function. Esophageal pressure topography and pressure impedance metrics were derived. Mixed models with repeated measures were used for statistical analysis.
Results: We analyzed 137 nutritive swallows from 36 motility studies in 10 preterm infants. The mean gestational age was 30.17 ± 0.94 weeks; the mean postmenstrual age at time point 1 and 4 was 34.42 ± 0.86 and 37.45 ± 1.16 weeks, respectively. Esophageal peristaltic wave patterns in response to nutritive swallows were observed in all patients. At later time points, esophageal body peristalsis became more rapid, evidenced by a faster distal contractile velocity and shorter distal latency (p = 0.002 and p < 0.0001, respectively). In addition, 4-s integrated relaxation pressures increased and distal contractile integral decreased at later time points (p = 0.003 and p = 0.021, respectively). Bolus clearance also improved at later age (p = 0.008).
Conclusions: Preterm infants demonstrate peristaltic esophageal motility following nutritive swallows. However, alterations in esophageal bolus transport in relation to peristalsis are demonstrated. Peristaltic progression becomes more rapid, while deglutitive relaxation pressures increase with increasing age. These maturational changes may suggest further development of the enteric nervous system after birth in former preterm neonates.

M3 - https://doi.org/10.1159/000506481 ER - TY - JOUR T1 - Residential green space, air pollution, socioeconomic deprivation and cardiovascular medication sales in Belgium: A nationwide ecological study JF - Science of The Total Environment Y1 - 2020 A1 - Raf Aerts A1 - Nemery, Benoit A1 - Mariska Bauwelinck A1 - Sonia Trabelsi A1 - Deboosere, Patrick A1 - An Van Nieuwenhuyse A1 - Tim S. Nawrot A1 - Casas, Lidia KW - Cardiovascular disease KW - environment KW - epidemiology KW - exposure KW - medication sales KW - public health KW - Structural equation model AB -

Green space may improve cardiovascular (CV) health, for example by promoting physical activity and by reducing air pollution, noise and heat.  Socioeconomic and environmental factors may modify the health effects of green space. We examined the association between residential green space and reimbursed CV medication sales in Belgium between 2006 and 2014, adjusting for socioeconomic deprivation and air pollution.  We analyzed data for 11,575 census tracts using structural equation models for the entire country and for the administrative regions.  Latent variables for green space, air pollution and socioeconomic deprivation were used as predictors of CV medication sales and were estimated from the number of patches of forest, census tract relative forest cover and relative forest cover within a 600 m buffer around the census tract; annual mean concentrations of PM2.5, BC and NO2; and percentages of inhabitants that were foreign-born from lower- and mid-income countries, unemployed or had no higher education. A direct association between socioeconomic deprivation and CV medication sales [parameter estimate (95% CI): 0.26 (0.25; 0.28)] and inverse associations between CV medication sales and green space [–0.71 (–0.80; –0.61)] and air pollution [–1.62 (–1.69; –0.61)] were observed.  In the regional models, the association between green space and CV medication sales was stronger in the region with relatively low green space cover (Flemish Region, standardized estimate –0.16) than in the region with high green space cover (Walloon Region, –0.10).  In the highly urbanized Brussels Capital Region the association tended towards the null. In all regions, the associations between CV medication sales and socioeconomic deprivation were direct and more prominent. Our results suggest that there may be an inverse association between green space and CV medication sales, but socioeconomic deprivation was always the strongest predictor of CV medication sales.

VL - 712 M3 - https://doi.org/10.1016/j.scitotenv.2019.136426 ER - TY - JOUR T1 - Residential green space and medication sales for childhood asthma: A longitudinal ecological study in Belgium JF - Environmental Research Y1 - 2020 A1 - Raf Aerts A1 - Sébastien Dujardin A1 - Nemery, Benoit A1 - An Van Nieuwenhuyse A1 - Jos Van Orshoven A1 - Jean-Marie Aerts A1 - Ben Somers A1 - Marijke Hendrickx A1 - Nicolas Bruffaerts A1 - Mariska Bauwelinck A1 - Casas, Lidia A1 - Claire Demoury A1 - Michelle Plusquin A1 - Tim S. Nawrot KW - Environmental epidemiology KW - medication sales KW - Pediatric asthma KW - Residential green space KW - respiratory health AB -

Background: Living in green environments has been associated with various health benefits, but the evidence for positive effects on respiratory health in children is ambiguous.

Objective: To investigate if residential exposure to different types of green space is associated with childhood asthma prevalence in Belgium.

Methods: Asthma prevalence was estimated from sales data of reimbursed medication for obstructive airway disease (OAD) prescribed to children between 2010 and 2014, aggregated at census tract level (n = 1872) by sex and age group (6–12 and 13–18 years). Generalized log-linear mixed effects models with repeated measures were used to estimate effects of relative covers of forest, grassland and garden in the census tract of the residence on OAD medication sales. Models were adjusted for air pollution (PM10), housing quality and administrative region.

Results: Consistent associations between OAD medication sales and relative covers of grassland and garden were observed (unadjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.15–0.17; garden, β = 0.13–0.17).  The associations remained significant after adjusting for housing quality and chronic air pollution (adjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.10–0.14; garden, β = 0.07–0.09). There was no association between OAD medication sales and forest cover.

Conclusions: Based on aggregated data, we found that living in close proximity to areas with high grass cover (grasslands, but also residential gardens) may negatively impact child respiratory health. Potential allergic and non-allergic mechanisms that underlie this association include elevated exposure to grass pollen and fungi and reduced exposure to environmental biodiversity. Reducing the dominance of grass in public and private green space might be beneficial to reduce the childhood asthma burden and may simultaneously improve the ecological value of urban green space.

VL - 189 M3 - https://doi.org/10.1016/j.envres.2020.109914 ER - TY - JOUR T1 - Residential green space and seasonal distress in a cohort of tree pollen allergy patients JF - International Journal of Hygiene and Environmental Health Y1 - 2020 A1 - Raf Aerts A1 - Michiel Stas A1 - Naomi Vanlessen A1 - Marijke Hendrickx A1 - Nicolas Bruffaerts A1 - Lucie Hoebeke A1 - Nicolas Dendoncker A1 - Sébastien Dujardin A1 - Nelly D. Saenen A1 - An Van Nieuwenhuyse A1 - Jean-Marie Aerts A1 - Jos Van Orshoven A1 - Tim S. Nawrot A1 - Ben Somers KW - Emotional distress KW - GHQ-12 KW - Mental health KW - Residential green space KW - Respiratory Hypersensitivity KW - Tree pollen allergy AB -

Background

Residential green space may improve human health, for example by promoting physical activity and by reducing stress. Conversely, residential green space may increase stress by emitting aeroallergens and exacerbating allergic disease. Here we examine impacts of exposure to residential green space on distress in the susceptible subpopulation of adults sensitized to tree pollen allergens.

Methods

In a panel study of 88 tree pollen allergy patients we analyzed self-reported mental health (GHQ-12), perceived presence of allergenic trees (hazel, alder, birch) near the residence and residential green space area within 1 km distance [high (≥3 m) and low (<3 m) green]. Results were adjusted for patients’ background data (gender, age, BMI, smoking status, physical activity, commuting distance, education level, allergy medication use and chronic respiratory problems) and compared with distress in the general population (N = 2467).

Results

Short-term distress [mean GHQ-12 score 2.1 (95% confidence interval 1.5–2.7)] was higher in the study population than in the general population [1.5 (1.4–1.7)]. Residential green space had protective effects against short-term distress [high green, per combined surface area of 10 ha: adjusted odds ratio OR = 0.94 (95% confidence interval 0.90–0.99); low green, per 10 ha: OR = 0.85 (0.78–0.93)]. However, distress was higher in patients who reported perceived presence of allergenic trees near their residence [present vs. absent: OR = 2.04 (1.36–3.07)].

Conclusions

Perceived presence of allergenic tree species in the neighbourhood of the residence of tree pollen allergy patients modulates the protective effect of residential green space against distress during the airborne tree pollen season.

VL - 223 CP - 1 M3 - 10.1016/j.ijheh.2019.10.004 ER - TY - Generic T1 - Definition of Areas of Interest in the Study of Long-Term 50 Hz Exposure of Brussels Inhabitants Y1 - 2019 A1 - M. Ledent A1 - Raf Aerts A1 - V Beauvois A1 - M Spirlet A1 - C Geuzaine A1 - I Magne A1 - C Bouland JF - Annual Joint Meeting of the Bioelectromagnetics Society (BEMS) and the European BioElectromagnetics Association (EBEA), Montpellier, France, June 2019 ER - TY - JOUR T1 - Determinants of persistent organic pollutant (POP) concentrations in human breast milk of a cross-sectional sample of primiparous mothers in Belgium JF - Environment International Y1 - 2019 A1 - Raf Aerts A1 - Ilse Van Overmeire A1 - Ann Colles A1 - Mirjana Andjelkovic A1 - Malarvannan, Govindan A1 - Poma, Giulia A1 - Den Hond, Elly A1 - Van De Mieroop, Els A1 - Dewolf, Marie-Christine A1 - François Charlet A1 - An Van Nieuwenhuyse A1 - Joris Van Loco A1 - Covaci, Adrian KW - brominated flame retardants KW - Human biomonitoring KW - Human breast milk KW - Organochlorine pesticides KW - PERSISTENT ORGANIC POLLUTANTS KW - Primipara mothers AB -

Background

Bio-accumulation of persistent organic pollutants (POPs) in the environment and in the food chain can lead to high pollutant concentrations in human fat-containing tissues and breast milk.

Objectives

We aimed to identify the maternal characteristics that determined POP concentrations in breast milk of primiparous mothers in Belgium.

Methods

Breast milk samples were obtained from a cross-sectional sample of 206 primiparous mothers in 2014. POP concentrations in breast milk samples were determined by GC-ECNI-MS and GC-EI-MS/MS depending on the analytes' sensitivity. Associations between POP concentrations in breast milk and potential determinants were investigated using two-way contingency tables and multivariable generalized linear models.

Results

Fifteen of the 23 screened POPs were detected in the breast milk samples. Four organochlorine compounds (p,p′-DDT, p,p′-DDE, HCB and β-HCH) and two brominated flame retardant congeners (BDE-47, BDE-153) were detected at concentrations above the limit of quantification in >50% of the breast milk samples. Maternal age and BMI were usually associated with higher POP concentrations. Rural residency and consumption of home-produced eggs, fatty fish and fish oil supplements were associated with higher concentrations of DDT and DDE. Consumption of fatty fish and being breastfed during childhood were associated with higher concentrations of HCB and β-HCH. Fish oil supplements and home-produced eggs were associated with higher concentrations of BDEs, but for BDE congeners exposure routes other than diet require further investigation.

Conclusions

Dietary and non-dietary determinants predict individual POP concentrations in breast milk.

VL - 131 M3 - 10.1016/j.envint.2019.104979 ER - TY - JOUR T1 - Determinants of persistent organic pollutant (POP) concentrations in human breast milk of a cross-sectional sample of primiparous mothers in Belgium JF - Environment International Y1 - 2019 A1 - Raf Aerts A1 - Ilse Van Overmeire A1 - Ann Colles A1 - Mirjana Andjelkovic A1 - Govindan Malarvannan A1 - Giulia Poma A1 - Elly Den Hond A1 - Els Van de Mieroop A1 - Marie-Christine Dewolf A1 - François Charlet A1 - An Van Nieuwenhuyse A1 - Joris Van Loco A1 - Adrian Covaci AB -

Background: Bio-accumulation of persistent organic pollutants (POPs) in the environment and in the food chain

can lead to high pollutant concentrations in human fat-containing tissues and breast milk.

Objectives: We aimed to identify the maternal characteristics that determined POP concentrations in breast milk

of primiparous mothers in Belgium.

Methods: Breast milk samples were obtained from a cross-sectional sample of 206 primiparous mothers in 2014.

POP concentrations in breast milk samples were determined by GC-ECNI-MS and GC-EI-MS/MS depending on

the analytes' sensitivity. Associations between POP concentrations in breast milk and potential determinants

were investigated using two-way contingency tables and multivariable generalized linear models.

Results: Fifteen of the 23 screened POPs were detected in the breast milk samples. Four organochlorine compounds

(p,p′-DDT, p,p′-DDE, HCB and β-HCH) and two brominated flame retardant congeners (BDE-47, BDE-

153) were detected at concentrations above the limit of quantification in>50% of the breast milk samples.

Maternal age and BMI were usually associated with higher POP concentrations. Rural residency and consumption

of home-produced eggs, fatty fish and fish oil supplements were associated with higher concentrations

of DDT and DDE. Consumption of fatty fish and being breastfed during childhood were associated with higher

concentrations of HCB and β-HCH. Fish oil supplements and home-produced eggs were associated with higher

concentrations of BDEs, but for BDE congeners exposure routes other than diet require further investigation.

Conclusions: Dietary and non-dietary determinants predict individual POP concentrations in breast milk.

VL - 131 ER - TY - Generic T1 - Evaluation de l’exposition humaine aux résidus de pesticides à l’aide de bracelets en silicone Y1 - 2019 A1 - Laure Joly A1 - Raf Aerts A1 - Philippe Szternfeld A1 - K Tsilikas A1 - Koen De Cremer A1 - Philippe Castelain A1 - M Aerts A1 - J Van Orshoven A1 - B Somers A1 - M Ghendrickx A1 - Mirjana Andjelkovic A1 - An Van Nieuwenhuyse JF - 49e congrès du Groupe Français de recherche sur les Pesticides ER - TY - Generic T1 - The HEASP Project: Health, Environment and Susceptible Populations Y1 - 2019 A1 - Claire Demoury A1 - Raf Aerts A1 - Eva M De Clercq JF - Etats généraux de l’air de Bruxelles, Brussels, Belgium ER - TY - JOUR T1 - Long-term outcomes of very low birth weight infants with spontaneous intestinal perforation: A retrospective case-matched cohort study JF - Journal of Pediatric Surgery Y1 - 2019 A1 - Isabelle Adant A1 - Marc Miserez A1 - Gunnar Naulaers A1 - Kate Carkeek A1 - Els Ortibus A1 - Raf Aerts A1 - Rayyan, Maissa KW - Neurodevelopmental outcome KW - Preterm KW - Quality of Life KW - Spontaneous intestinal perforation KW - Very low birthweight infant AB -

Background

Spontaneous intestinal perforation (SIP) is an intestinal complication that occurs in very ill preterms. We investigated whether SIP survivors have worse neurodevelopmental and gastrointestinal outcomes and a poorer quality of life than controls.

Methods

A retrospective case-matched cohort study was performed involving infants treated for SIP in a NICU between August 1994 and April 2014. Controls and SIP patients were matched to gestational age, gender, and birth period. Medical records were reviewed. Telephone surveys were conducted to evaluate the medical condition, quality of life (PedsQL™ 4.0), neuropsychiatric and gastrointestinal outcome. McNemar's and Wilcoxon tests were performed, and generalized linear models were computed.

Results

Forty-nine SIP patients were included. The percentages of children with multiple disabilities (40% vs. 17%, OR = 3.3) and requiring physiotherapy (86% vs. 60%, OR = 4.77) were higher in the SIP group than in the control group. Intraventricular hemorrhage (IVH) led to a worse neurodevelopmental outcome regardless of SIP (OR = 8.79 for disability), and female gender was a protective factor against disability (OR = 0.06). Reported quality of life and gastrointestinal comorbidities did not differ between the two groups.

Conclusion

SIP survivors tend to be at risk of multiple disabilities. IVH and female gender influence the neurodevelopmental outcome regardless of SIP.

VL - 54 CP - 10 M3 - 10.1016/j.jpedsurg.2019.04.012 ER - TY - JOUR T1 - Neonatal factors predictive for respiratory and gastro-intestinal morbidity after esophageal atresia repair JF - Pediatrics & Neonatology Y1 - 2019 A1 - Rayyan, Maissa A1 - Malaika Embrechts A1 - Hans Van Veer A1 - Raf Aerts A1 - Ilse Hoffman A1 - Proesmans, Marijke A1 - Karel Allegaert A1 - Gunnar Naulaers A1 - Nathalie Rommel KW - CHILDREN KW - esophageal atresia KW - morbidity KW - neonatology KW - predictive factors AB -

Background

Esophageal atresia is a major congenital foregut anomaly. Affected patients often suffer from respiratory and gastro-intestinal morbidity. The objective of this study is to identify possible neonatal predictive factors contributing to a long-term complicated clinical course in patients after repair of esophageal atresia.

Methods

A total of 93 patients born between 1993 and 2013, with esophageal atresia and surviving the neonatal period were included in this retrospective study. A complicated clinical course was defined as the occurrence of ≥1 of these complications: severe gastro-esophageal reflux, esophageal stricture requiring dilatations, need for tube feeding for >100 days, severe tracheomalacia, severe chronic respiratory disease and death. We used linear models with a binomial distribution to determine risk factors for gastro-intestinal or respiratory complicated evolution and a backward stepwise elimination procedure to reduce models until only significant variables remained in the model. Multinomial logistic regression was used to assess risk factors for different evolutions of complication. Model parameter estimates were used to calculate odds ratios for significant risk factors.

Results

Fifty-seven patients (61%) had a complicated clinical course in the first year of life and 47 (51%) had a complicated evolution during years 1–6. In the first year, prematurity was a significant factor for complicated gastro-intestinal (OR 2.84) and respiratory evolution (OR 2.93). After 1 year, gastro-intestinal morbidity in childhood was associated with VACTERL association (OR 12.2) and a complicated first year (OR 36.1). Respiratory morbidity was associated with congenital heart disease (OR 12.9) and a complicated first year (OR 86.9). Multinomial logistic regression showed that prematurity (p = 0.018) and VACTERL association (p = 0.003) were significant factors of complications.

Conclusion

Prematurity is an important predictive factor for a complicated clinical course in early life. A complicated first year often predicts a complicated clinical course in childhood. These risk factors may be helpful in counseling of parents in the neonatal period.

VL - 60 CP - 3 M3 - 10.1016/j.pedneo.2018.07.003 ER - TY - JOUR T1 - Personal exposure to traffic-related air pollutants and relationships with respiratory symptoms and oxidative stress: A pilot cross-sectional study among urban green space workers JF - Science of The Total Environment Y1 - 2019 A1 - Ariane Guilbert A1 - Koen De Cremer A1 - Billie Heene A1 - Claire Demoury A1 - Raf Aerts A1 - Declerck, Priscilla A1 - Brasseur, Olivier A1 - An Van Nieuwenhuyse KW - Belgium KW - Black carbon KW - Health outcomes KW - Human biomonitoring KW - Polycyclic Aromatic Hydrocarbons AB -

Exposure to ambient air pollution has been associated with various adverse health effects including respiratory, cardiovascular and neurological diseases. Exposure data for some specific pollutants and settings are however still insufficient and mechanisms underlying negative health outcomes are not fully elucidated. This pilot study aimed to assess individual exposure to three traffic-related air pollutants, black carbon (BC), polycyclic aromatic hydrocarbons (PAHs) and benzene, and the relationship with respiratory and oxidative stress outcomes in a cross-sectional sample of 48 green space workers in Brussels, Belgium. Participants were followed during four consecutive working days in 2016–2017 during which their individual exposure to BC, PAHs, benzene and more generally air pollution was measured using aethalometers, urinary biomarkers (1-hydroxypyrene, 1-naphthol, 2-naphthol, S-phenylmercapturic acid) and questionnaires. Data on respiratory health and oxidative stress were collected using questionnaires and respiratory/urinary biomarkers (exhaled nitric oxide [NO], 8-hydroxydeoxyguanosine [8-OHdG]). Associations between exposure and health outcomes were investigated using comparison tests and linear regression models, after stratification by present-day smoking status. Spatial variation in BC exposure was high, with concentrations varying between 0.26 and 5.69 μg/m3. The highest levels were recorded during transport and, to a lesser extent, in green spaces located in the vicinity of roads with high traffic intensity. Concentrations of PAHs and benzene biomarkers did not systematically exceed the limits of detection. Among smokers, respiratory inflammation increased linearly with exposure to BC measured over the four days of follow-up (β = 8.73, 95% CI: 4.04, 13.41). Among non-smokers, oxidative stress increased linearly with BC measured on the fourth day (β = 2.88, 95% CI: 1.52, 4.24). Despite some limitations, this work supports the hypothesis that BC induces respiratory inflammation and oxidative stress. It also highlights the value of this compound as well as exhaled NO and urinary 8-OHdG biomarkers to detect early/mild effects of air pollution.

VL - 649 M3 - 10.1016/j.scitotenv.2018.08.338 ER - TY - JOUR T1 - Personal exposure to traffic-related air pollutants and relationships with respiratory symptoms and oxidative stress: A pilot cross-sectional study among urban green space workers. JF - Sci Total Environ Y1 - 2019 A1 - Ariane Guilbert A1 - Koen De Cremer A1 - Billie Heene A1 - Claire Demoury A1 - Raf Aerts A1 - Declerck, Priscilla A1 - Brasseur, Olivier A1 - An Van Nieuwenhuyse KW - Air Pollutants KW - Belgium KW - benzene KW - Cities KW - cross-sectional studies KW - environmental exposure KW - Environmental Monitoring KW - Humans KW - Inflammation KW - Oxidative Stress KW - Pilot Projects KW - Polycyclic Aromatic Hydrocarbons KW - Respiratory System KW - Soot KW - Urban Population KW - Vehicle Emissions AB -

Exposure to ambient air pollution has been associated with various adverse health effects including respiratory, cardiovascular and neurological diseases. Exposure data for some specific pollutants and settings are however still insufficient and mechanisms underlying negative health outcomes are not fully elucidated. This pilot study aimed to assess individual exposure to three traffic-related air pollutants, black carbon (BC), polycyclic aromatic hydrocarbons (PAHs) and benzene, and the relationship with respiratory and oxidative stress outcomes in a cross-sectional sample of 48 green space workers in Brussels, Belgium. Participants were followed during four consecutive working days in 2016-2017 during which their individual exposure to BC, PAHs, benzene and more generally air pollution was measured using aethalometers, urinary biomarkers (1-hydroxypyrene, 1-naphthol, 2-naphthol, S-phenylmercapturic acid) and questionnaires. Data on respiratory health and oxidative stress were collected using questionnaires and respiratory/urinary biomarkers (exhaled nitric oxide [NO], 8-hydroxydeoxyguanosine [8-OHdG]). Associations between exposure and health outcomes were investigated using comparison tests and linear regression models, after stratification by present-day smoking status. Spatial variation in BC exposure was high, with concentrations varying between 0.26 and 5.69 μg/m. The highest levels were recorded during transport and, to a lesser extent, in green spaces located in the vicinity of roads with high traffic intensity. Concentrations of PAHs and benzene biomarkers did not systematically exceed the limits of detection. Among smokers, respiratory inflammation increased linearly with exposure to BC measured over the four days of follow-up (β = 8.73, 95% CI: 4.04, 13.41). Among non-smokers, oxidative stress increased linearly with BC measured on the fourth day (β = 2.88, 95% CI: 1.52, 4.24). Despite some limitations, this work supports the hypothesis that BC induces respiratory inflammation and oxidative stress. It also highlights the value of this compound as well as exhaled NO and urinary 8-OHdG biomarkers to detect early/mild effects of air pollution.

VL - 649 M3 - 10.1016/j.scitotenv.2018.08.338 ER - TY - JOUR T1 - Biodiversity and human health: mechanisms and evidence of the positive health effects of diversity in nature and green spaces. JF - Br Med Bull Y1 - 2018 A1 - Raf Aerts A1 - Olivier Honnay A1 - An Van Nieuwenhuyse AB -

Introduction: Natural environments and green spaces provide ecosystem services that enhance human health and well-being. They improve mental health, mitigate allergies and reduce all-cause, respiratory, cardiovascular and cancer mortality. The presence, accessibility, proximity and greenness of green spaces determine the magnitude of their positive health effects, but the role of biodiversity (including species and ecosystem diversity) within green spaces remains underexplored. This review describes mechanisms and evidence of effects of biodiversity in nature and green spaces on human health.

Sources of data: We identified studies listed in PubMed and Web of Science using combinations of keywords including 'biodiversity', 'diversity', 'species richness', 'human health', 'mental health' and 'well-being' with no restrictions on the year of publication. Papers were considered for detailed evaluation if they were written in English and reported data on levels of biodiversity and health outcomes.

Areas of agreement: There is evidence for positive associations between species diversity and well-being (psychological and physical) and between ecosystem diversity and immune system regulation.

Areas of concern: There is a very limited number of studies that relate measured biodiversity to human health. There is more evidence for self-reported psychological well-being than for well-defined clinical outcomes. High species diversity has been associated with both reduced and increased vector-borne disease risk.

Growing points: Biodiversity supports ecosystem services mitigating heat, noise and air pollution, which all mediate the positive health effects of green spaces, but direct and long-term health outcomes of species diversity have been insufficiently studied so far.

Areas timely for research: Additional research and newly developed methods are needed to quantify short- and long-term health effects of exposure to perceived and objectively measured species diversity, including health effects of nature-based solutions and exposure to microbiota.

VL - 127 CP - 1 M3 - 10.1093/bmb/ldy021 ER - TY - JOUR T1 - Heat and health in Antwerp under climate change: Projected impacts and implications for prevention. JF - Environ Int Y1 - 2018 A1 - Martinez, Gerardo Sanchez A1 - Julio Diaz A1 - Hans Hooyberghs A1 - Dirk Lauwaet A1 - Koen De Ridder A1 - Cristina Linares A1 - Rocio Carmona A1 - Cristina Ortiz A1 - Vladimir Kendrovski A1 - Raf Aerts A1 - An Van Nieuwenhuyse A1 - Dunbar, Maria Bekker-Nielsen KW - Antwerp KW - Climate change KW - Heat-related hospital admissions KW - Heat-related mortality KW - Heatwaves AB -

BACKGROUND: Excessive summer heat is a serious environmental health problem in several European cities. Heat-related mortality and morbidity is likely to increase under climate change scenarios without adequate prevention based on locally relevant evidence.

METHODS: We modelled the urban climate of Antwerp for the summer season during the period 1986-2015, and projected summer daily temperatures for two periods, one in the near (2026-2045) and one in the far future (2081-2100), under the Representative Concentration Pathway (RCP) 8.5. We then analysed the relationship between temperature and mortality, as well as with hospital admissions for the period 2009-2013, and estimated the projected mortality in the near future and far future periods under changing climate and population, assuming alternatively no acclimatization and acclimatization based on a constant threshold percentile temperature.

RESULTS: During the sample period 2009-2013 we observed an increase in daily mortality from a maximum daily temperature of 26°C, or the 89th percentile of the maximum daily temperature series. The annual average heat-related mortality in this period was 13.4 persons (95% CI: 3.8-23.4). No effect of heat was observed in the case of hospital admissions due to cardiorespiratory causes. Under a no acclimatization scenario, annual average heat-related mortality is multiplied by a factor of 1.7 in the near future (24.1deaths/year CI 95%: 6.78-41.94) and by a factor of 4.5 in the far future (60.38deaths/year CI 95%: 17.00-105.11). Under a heat acclimatization scenario, mortality does not increase significantly in the near or in the far future.

CONCLUSION: These results highlight the importance of a long-term perspective in the public health prevention of heat exposure, particularly in the context of a changing climate, and the calibration of existing prevention activities in light of locally relevant evidence.

VL - 111 M3 - 10.1016/j.envint.2017.11.012 ER - TY - JOUR T1 - An Iconic Pit Viper of the Central American Rainforests. JF - Wilderness Environ Med Y1 - 2018 A1 - Pablo Deschepper A1 - Raf Aerts KW - snake KW - venom KW - viper M3 - 10.1016/j.wem.2017.11.001 ER - TY - JOUR T1 - Neonatal factors predictive for respiratory and gastro-intestinal morbidity after esophageal atresia repair. JF - Pediatr Neonatol Y1 - 2018 A1 - Rayyan, Maissa A1 - Karel Allegaert A1 - Gunnar Naulaers A1 - Nathalie Rommel ED - Malaika Embrechts ED - Hans Van Veer ED - Raf Aerts ED - Ilse Hoffman ED - Proesmans, Marijke AB -

BACKGROUND: Esophageal atresia is a major congenital foregut anomaly. Affected patients often suffer from respiratory and gastro-intestinal morbidity. The objective of this study is to identify possible neonatal predictive factors contributing to a long-term complicated clinical course in patients after repair of esophageal atresia.

METHODS: A total of 93 patients born between 1993 and 2013, with esophageal atresia and surviving the neonatal period were included in this retrospective study. A complicated clinical course was defined as the occurrence of ≥1 of these complications: severe gastro-esophageal reflux, esophageal stricture requiring dilatations, need for tube feeding for >100 days, severe tracheomalacia, severe chronic respiratory disease and death. We used linear models with a binomial distribution to determine risk factors for gastro-intestinal or respiratory complicated evolution and a backward stepwise elimination procedure to reduce models until only significant variables remained in the model. Multinomial logistic regression was used to assess risk factors for different evolutions of complication. Model parameter estimates were used to calculate odds ratios for significant risk factors.

RESULTS: Fifty-seven patients (61%) had a complicated clinical course in the first year of life and 47 (51%) had a complicated evolution during years 1-6. In the first year, prematurity was a significant factor for complicated gastro-intestinal (OR 2.84) and respiratory evolution (OR 2.93). After 1 year, gastro-intestinal morbidity in childhood was associated with VACTERL association (OR 12.2) and a complicated first year (OR 36.1). Respiratory morbidity was associated with congenital heart disease (OR 12.9) and a complicated first year (OR 86.9). Multinomial logistic regression showed that prematurity (p = 0.018) and VACTERL association (p = 0.003) were significant factors of complications.

CONCLUSION: Prematurity is an important predictive factor for a complicated clinical course in early life. A complicated first year often predicts a complicated clinical course in childhood. These risk factors may be helpful in counseling of parents in the neonatal period.

M3 - 10.1016/j.pedneo.2018.07.003 ER - TY - JOUR T1 - Silicone Wristband Passive Samplers Yield Highly Individualized Pesticide Residue Exposure Profiles. JF - Environ Sci Technol Y1 - 2018 A1 - Raf Aerts A1 - Laure Joly A1 - Philippe Szternfeld A1 - Khariklia Tsilikas A1 - Koen De Cremer A1 - Philippe Castelain A1 - Jean-Marie Aerts A1 - Jos Van Orshoven A1 - Ben Somers A1 - Marijke Hendrickx A1 - Mirjana Andjelkovic A1 - An Van Nieuwenhuyse KW - Dietary exposure KW - environmental exposure KW - LC-MS/MS KW - passive sampler KW - Pesticide residues KW - wristband sampler AB -

Monitoring human exposure to pesticides and pesticide residues (PRs) remains crucial for informing public health policies, despite strict regulation of plant protection product and biocide use. We used 72 low-cost silicone wristbands as noninvasive passive samplers to assess cumulative 5-day exposure of 30 individuals to polar PRs. Ethyl acetate extraction and LC-MS/MS analysis were used for the identification of PRs. Thirty-one PRs were detected of which 15 PRs (48%) were detected only in worn wristbands, not in environmental controls. The PRs included 16 fungicides (52%), 8 insecticides (26%), 2 herbicides (6%), 3 pesticide derivatives (10%), 1 insect repellent (3%), and 1 pesticide synergist (3%). Five detected pesticides were not approved for plant protection use in the EU. Smoking and dietary habits that favor vegetable consumption were associated with higher numbers and higher cumulative concentrations of PRs in wristbands. Wristbands featured unique PR combinations. Our results suggest both environment and diet contributed to PR exposure in our study group. Silicone wristbands could serve as sensitive passive samplers to screen population-wide cumulative dietary and environmental exposure to authorized, unauthorized and banned pesticides.

VL - 52 CP - 1 M3 - 10.1021/acs.est.7b05039 ER - TY - RPRT T1 - Analyse des données sur l’allergie en Région de Bruxelles-Capitale - Exploitation de quatre bases de données relatives à la morbidité et la mortalité associées à l’asthme et la rhinite allergique. Y1 - 2017 A1 - Ariane Guilbert A1 - Koen Simons A1 - Raf Aerts A1 - Claire Demoury A1 - Michele Rasoloharimahefa A1 - Koen De Cremer A1 - Nicolas Bruffaerts A1 - Lucie Hoebeke A1 - Ann Packeu A1 - Marijke Hendrickx A1 - Bianca Cox A1 - Sophie Viart A1 - Charles Pilette A1 - An Van Nieuwenhuyse KW - asthme KW - bases de données KW - Bruxelles KW - épidémiologie KW - hospitalisations KW - médicaments KW - mortalité KW - rhinite allergique PB - WIV-ISP CY - Bruxelles, Belgique ER - TY - JOUR T1 - The Dallol Volcano. JF - Wilderness Environ Med Y1 - 2017 A1 - Raf Aerts A1 - November, Eva J J VL - 28 CP - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28431826?dopt=Abstract M3 - 10.1016/j.wem.2017.03.001 ER - TY - JOUR T1 - Detection of Plasmid-Mediated Colistin Resistance, mcr-1 and mcr-2 Genes, in Salmonella spp. Isolated from Food at Retail in Belgium from 2012 to 2015. JF - Foodborne Pathog Dis Y1 - 2017 A1 - Cristina Garcia-Graells A1 - Sigrid C.J. De Keersmaecker A1 - Nguyen, Quang Trung A1 - Anthonissen,R.. A1 - Raf Aerts A1 - Nancy Roosens A1 - Katelijne Dierick A1 - N Botteldoorn KW - colistin resistance AB -

A collection of 105 colistin-resistant Salmonella isolates collected from 2012 to 2015 in the national surveillance program in Belgium was screened by PCR for the presence of genes mcr-1 and mcr-2. Of these, 1.90% (2/105) and 0.95% (1/105) tested positive for mcr-1 and mcr-2, respectively. The presence of the mcr-1 or mcr-2 determinant has been confirmed by whole genome sequencing and allowed the localization of these two genes on IncX4 type plasmids. We report here the presence of mcr-1 and the first mcr-2 gene in Salmonella ever isolated in the Belgian food chain. Although present at retail since 2012, the occurrence is low and sporadic.

M3 - 10.1089/fpd.2017.2329 ER - TY - RPRT T1 - Evaluation d’impact de l’exposition à la pollution émise par le trafic routier sur la santé de la population bruxelloise : projet pilote pour les personnes à faible et haut niveau d’exposition. Y1 - 2017 A1 - Ariane Guilbert A1 - Koen De Cremer A1 - Raf Aerts A1 - Claire Demoury A1 - An Van Nieuwenhuyse KW - biomonitoring KW - Bruxelles KW - épidémiologie KW - pollution de l’air KW - santé PB - WIV-ISP CY - Bruxelles, Belgique ER - TY - JOUR T1 - Improvised Hand Injury Treatment Using Traditional Veterinary Medicine in Ethiopia. JF - Wilderness Environ Med Y1 - 2017 A1 - Raf Aerts A1 - November, Eva J J A1 - Rayyan, Maissa AB -

In remote wilderness environments, local people with traditional knowledge of medicinal plants are potentially important first-line health care providers. We present a case of a 31-year-old man who fell off a horse while trekking through a remote mountain landscape in Ethiopia and sustained blunt force trauma to the hand. A local mountain hut keeper examined the patient's hand and used heated leaves of the succulent plant Kalanchoe petitiana to treat a suspected metacarpal fracture. As first responder in a low-resource setting, the hut keeper relied on his traditional knowledge of ethnoveterinary medicine to improvise a treatment for a human injury in a remote mountain environment. Although in this case the outcome of the traditional intervention was positive, our analysis shows that the massage component of the intervention could have led to complications. Conversely, reports from the use of related Kalanchoe species suggest that heated Kalanchoe leaves could be useful in the compression component of traditional care for hand injuries. Validation of traditional remedies and their therapeutic potential are needed if they are to complement wilderness wound care safely and reliably. The documentation and validation of these remedies are urgently needed, as many medicinal plants and indigenous knowledge of how to use these valuable natural resources are being lost.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/28917388?dopt=Abstract M3 - 10.1016/j.wem.2017.06.012 ER - TY - JOUR T1 - Invasion by the Alien Tree Alters Ecosystem Functions in a Temperate Deciduous Forest JF - Front Plant Sci Y1 - 2017 A1 - Raf Aerts A1 - Michael Ewald A1 - Manuel Nicolas A1 - Jérôme Piat A1 - Sandra Skowronek A1 - Jonathan Lenoir A1 - Tarek Hattab A1 - Carol X Garzón-López A1 - Hannes Feilhauer A1 - Sebastian Schmidtlein A1 - Rocchini, Duccio A1 - Guillaume Decocq A1 - Ben Somers A1 - Ruben Van De Kerchove A1 - Karolien Denef A1 - Olivier Honnay KW - American black cherry KW - biogeochemical cycles KW - biological invasion KW - canopy foliar nutrients KW - exotic species KW - heterotrophic respiration KW - invasive species KW - litter AB -

Alien invasive species can affect large areas, often with wide-ranging impacts on ecosystem structure, function, and services.is a widespread invader of European temperate forests, where it tends to form homogeneous stands and limits recruitment of indigenous trees. We hypotesized that invasion bywould be reflected in the nutrient contents of the native species' leaves and in the respiration of invaded plots as efficient resource uptake and changes in nutrient cycling byprobably underly its aggressive invasiveness. We combined data from 48 field plots in the forest of Compiègne, France, and data from an experiment using 96 microcosms derived from those field plots. We used general linear models to separate effects of invasion byon heterotrophic soil and litter respiration rates and on canopy foliar nutrient content from effects of soil chemical properties, litter quantity, litter species composition, and tree species composition. In invaded stands, average respiration rates were 5.6% higher for soil (without litter) and 32% higher for soil and litter combined. Compared to indigenous tree species,exhibited higher foliar N (+24.0%), foliar P (+50.7%), and lower foliar C:N (-22.4%) and N:P (-10.1%) ratios.affected foliar nutrient contents of co-occuring indigenous tree species leading to decreased foliar N (-8.7 %) and increased C:N ratio (+9.5%) in, decreased foliar N:P ratio in(-13.5%) and(-11.8%), and increased foliar P in(+12.3%) in invaded vs. uninvaded stands. Our results suggest thatis changing nitrogen, phosphorus, and carbon cycles to its own advantage, hereby increasing carbon turnover via labile litter, affecting the relative nutrient contents in the overstory leaves, and potentially altering the photosynthetic capacity of the long-lived indigenous broadleaved species. Uncontrolled invasion of European temperate forests bymay affect the climate change mitigation potential of these forests in the long term, through additive effects on local nutrient cycles.

VL - 8 M3 - 10.3389/fpls.2017.00179 ER - TY - Generic T1 - Assessing spatio-temporal relationships between respiratory health and biodiversity using individual wearable technology - the Respirit project Y1 - 2016 A1 - Raf Aerts A1 - Dendoncker,N A1 - Linard,C A1 - Marijke Hendrickx A1 - An Van Nieuwenhuyse A1 - Nawrot,T. A1 - Delcloo,A. A1 - Hamdi,R. A1 - Aerts,J.M. A1 - Somers,B ED - Van Orshoven,J. KW - biodiversity KW - European KW - health KW - ON KW - Practice KW - Respiratory JF - European One Health/EcoHealth Workshop, Belgian Biodiversity Platform, Belgian Community of Practice on Biodiversity and Health PB - Belspo CY - Brussels CP - BELSPO U1 - 2647 U2 - 06/10/2016 ER - TY - Generic T1 - Cumulative diversity dose CDD as an integrated measure of human exposure to biodiversity Y1 - 2016 A1 - Raf Aerts A1 - An Van Nieuwenhuyse A1 - Lucie Hoebeke A1 - Dendoncker,N. A1 - Linard,C. A1 - Dujardin,S. A1 - Verstraeten,W. A1 - Delcloo,A. ED - Marijke Hendrickx KW - an KW - AS KW - biodiversity KW - European KW - exposure KW - health KW - Human KW - human exposure KW - measure KW - ON KW - Practice JF - European One Health/EcoHealth Workshop, Belgian Biodiversity Platform, Belgian Community of Practice on Biodiversity and Health PB - Belspo CY - Brussels CP - BELSPO U1 - 2648 U2 - 06/10/2016 ER - TY - RPRT T1 - Zesde WHO-gecoördineerd onderzoek naar persistente organische polluenten (POP's) in moedermelk: Belgische resultaten 2014 Y1 - 2016 A1 - Ilse Van Overmeire A1 - Colles,A. A1 - Raf Aerts A1 - Janssens,B. A1 - Covaci,A. A1 - Mirjana Andjelkovic A1 - Laure Joly A1 - Poma,G. A1 - Malarvannan,G. A1 - De Smedt,T. A1 - Koppen,G. A1 - Joris Van Loco A1 - An Van Nieuwenhuyse KW - Belgische KW - moedermelk KW - POP KW - WHO AB -

In 2014 werd gestart met de vijfde WHO-gecoördineerde studie over de aanwezigheid van POPs in moedermelk begonnen. De verzamelde stalen werden in het huidig kader naar WIVISP overgebracht. Binnen gegeven tijdskader van zes maanden werden 206 melkstalen geanalyseerd. Deze werden na een initiële voorbereiding in het WIV-ISP (coördinator van de studie) en aanmaak van de mengstalen per provincie (en een geweest) verder geanalyseerd in het WIV-ISP, UA en EUROFINS. De mengstalen waren gemaakt door een bepaalde hoeveelheid van elk individuel staal in elk provincie samen te voegen.Sommige van de gevraagde en de gemeten POPs waren op verschillende niveaus teruggevonden. In algemeen werden er p,p-DDE (8-256ppb), HCB (2-17ppb) en BDE-153 (0-2ppb) in bijna elk individueel staal teruggevonden. Behalve alpha-HBCD (38-153ng/g) was geen andere gevraagde POP in melk mengstalen terug gevonden. Aan de andere kanten werden er chlordane-cis, chlordane-trans, nonachlore-trans, HCH-a, o,p-DDE, o,p-DDT en BDE 183 in geen enkele individuele melkstaal gedetecteerd. POPszoals hexachloorbutadieen, heptachloor, chloordecone, dieldrin, hexabromocyclododecanes (HBCDs) die enkel in de gemengde stalen waren geanalyseerd werden niet terug gevonden.

JF - WHO-gecoördineerd onderzoek naar persistente organische polluenten PB - WIV-ISP en VITO CY - Brussel/Mol VL - lot 1 UR - NA U1 - 2641 ER -