%0 Journal Article %J Clinical and Translational Allergy %D 2023 %T Daily allergy burden and heart rate characteristics in adults with allergic rhinitis based on a wearable telemonitoring system %A Joren Buekers %A Michiel Stas %A Raf Aerts %A Nicolas Bruffaerts %A Sebastien Dujardin %A An Van Nieuwenhuyse %A Jos Van Orshoven %A Guillaume Chevance %A Ben Somers %A Jean‐Marie Aerts %A Judith Garcia‐Aymerich %K Allergy %K heart rate monitoring %K rhinitis %K stress %X

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.

%B Clinical and Translational Allergy %V 13 %8 Jan-04-2023 %G eng %N 4 %R 10.1002/clt2.12242 %0 Generic %D 2022 %T Daily heart rate characteristics, allergy symptom severity and mood in adults with allergic rhinitis %A J Buekers %A M Stas %A Raf Aerts %A Nicolas Bruffaerts %A S Dujardin %A An Van Nieuwenhuyse %A J Van Orshoven %A G Chevance %A B Somers %A Aerts %A Garcia-Aymerich, J %X

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).

%B ERS International Congress 2022 %I European Respiratory Journal %V 60: Suppl. 66, 2487 %8 December 2022 %G eng %U https://erj.ersjournals.com/content/60/suppl_66/2487 %N European Respiratory Journal %R 10.1183/13993003.congress-2022.2487 %0 Journal Article %J Landscape and Urban Planning %D 2022 %T Mapping abundance distributions of allergenic tree species in urbanized landscapes: A nation-wide study for Belgium using forest inventory and citizen science data %A Sébastien Dujardin %A Michiel Stas %A Camille Van Eupen %A Raf Aerts %A Marijke Hendrickx %A Andy W. Delcloo %A François Duchêne %A Rafiq Hamdi %A Tim S. Nawrot %A An Van Nieuwenhuyse %A Jean-Marie Aerts %A Jos Van Orshoven %A Ben Somers %A Catherine Linard %A Nicolas Dendoncker %K Allergenic trees %K Citizen science %K Forest mapping %K respiratory health %K Species distribution modelling %K Urban vegetation %X

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.

%B Landscape and Urban Planning %V 218 %8 Jan-02-2022 %G eng %R 10.1016/j.landurbplan.2021.104286 %0 Journal Article %J Environmental Health Perspectives %D 2022 %T Residential Exposure to Urban Trees and Medication Sales for Mood Disorders and Cardiovascular Disease in Brussels, Belgium: An Ecological Study %A Dengkai, Chi %A Raf Aerts %A An Van Nieuwenhuyse %A Mariska, Bauwelinck %A Claire Demoury %A Michelle, Plusquin %A Tim S., Nawrot %A Lidia, Casas %A Ben, Somers %X

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

%B Environmental Health Perspectives %V 130 %8 Jan-05-2022 %G eng %N 5 %R 10.1289/EHP9924 %0 Journal Article %J Environmental Research %D 2022 %T Residential green space and mental health-related prescription medication sales: An ecological study in Belgium. %A Raf Aerts %A Naomi Vanlessen %A Sébastien Dujardin %A Nemery, Benoit %A An Van Nieuwenhuyse %A Mariska Bauwelinck %A Casas, Lidia %A Claire Demoury %A Michelle Plusquin %A Nawrot, Tim S %K Environmental epidemiology %K medication sales %K Mental health %K mood disorders %K Residential green space %X

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.

%B Environmental Research %V 211 %8 2022 Mar 04 %G eng %R 10.1016/j.envres.2022.113056 %0 Journal Article %J Epigenetics %D 2022 %T Residential green space in association with the methylation status in a CpG site within the promoter region of the placental serotonin receptor HTR2A %A Yinthe Dockx %A Esmée, Bijnens %A Nelly, Saenen %A Raf Aerts %A Jean-Marie, Aerts %A Lidia, Casas %A Andy, Delcloo %A Nicolas, Dendoncker %A Catherine, Linard %A Michelle, Plusquin %A Michiel, Stas %A An Van Nieuwenhuyse %A Jos, Van Orshoven %A Ben, Somers %A Tim, Nawrot %K Aserotonin %K DNA Methylation %K epigenetic %K Green space %K HTR2 %K Placenta %X

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.

%B Epigenetics %8 Jul-06-2022 %G eng %R 10.1080/15592294.2022.2088464 %0 Journal Article %J Science of The Total Environment %D 2022 %T Variability in the association between long-term exposure to ambient air pollution and mortality by exposure assessment method and covariate adjustment: A census-based country-wide cohort study %A Mariska Bauwelinck %A Chen, Jie %A Kees de Hoogh %A Klea Katsouyanni %A Sophia Rodopoulou %A Evangelia Samoli %A Zorana J. Andersen %A Richard Atkinson %A Casas, Lidia %A Deboosere, Patrick %A Claire Demoury %A Nicole Janssen %A Jochem O. Klompmaker %A Wouter Lefebvre %A Amar Jayant Mehta %A Tim S. Nawrot %A Bente Oftedal %A Matteo Renzi %A Massimo Stafoggia %A Maciek Strak %A Vandenheede, Hadewijch %A Charlotte Vanpoucke %A An Van Nieuwenhuyse %A Danielle Vienneau %A Bert Brunekreef %A Gerard Hoek %K cause-specific mortality %K Environmental hazard %K exposure assessment %K health effects %K population-based %K Survival Analysis %X

Background

Ambient air pollution exposure has been associated with higher mortality risk in numerous studies. We assessed potential variability in the magnitude of this association for non-accidental, cardiovascular disease, respiratory disease, and lung cancer mortality in a country-wide administrative cohort by exposure assessment method and by adjustment for geographic subdivisions.

Methods

We used the Belgian 2001 census linked to population and mortality register including nearly 5.5 million adults aged ≥30 (mean follow-up: 9.97 years). Annual mean concentrations for fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone (O3) were assessed at baseline residential address using two exposure methods; Europe-wide hybrid land use regression (LUR) models [100x100m], and Belgium-wide interpolation-dispersion (RIO-IFDM) models [25x25m]. We used Cox proportional hazards models with age as the underlying time scale and adjusted for various individual and area-level covariates. We further adjusted main models for two different area-levels following the European Nomenclature of Territorial Units for Statistics (NUTS); NUTS-1 (n = 3), or NUTS-3 (n = 43).

Results

We found no consistent differences between both exposure methods. We observed most robust associations with lung cancer mortality. Hazard Ratios (HRs) per 10 μg/m3 increase for NO2 were 1.060 (95%CI 1.042-1.078) [hybrid LUR] and 1.040 (95%CI 1.022-1.058) [RIO-IFDM]. Associations with non-accidental, respiratory disease and cardiovascular disease mortality were generally null in main models but were enhanced after further adjustment for NUTS-1 or NUTS-3. HRs for non-accidental mortality per 5 μg/m3 increase for PM2.5 for the main model using hybrid LUR exposure were 1.023 (95%CI 1.011-1.035). After including random effects HRs were 1.044 (95%CI 1.033-1.057) [NUTS-1] and 1.076 (95%CI 1.060-1.092) [NUTS-3].

Conclusion

Long-term air pollution exposure was associated with higher lung cancer mortality risk but not consistently with the other studied causes. Magnitude of associations varied by adjustment for geographic subdivisions, area-level socio-economic covariates and less by exposure assessment method.

%B Science of The Total Environment %V 804 %8 15 January 2022 %G eng %R 10.1016/j.scitotenv.2021.150091 %0 Journal Article %J Urban Forestry & Urban Greening %D 2021 %T Association between local airborne tree pollen composition and surrounding land cover across different spatial scales in Northern Belgium %A Michiel Stas %A Raf Aerts %A Marijke Hendrickx %A Nicolas Bruffaerts %A Nicolas Dendoncker %A Lucie Hoebeke %A Catherine Linard %A Nawrot, Tim %A An Van Nieuwenhuyse %A Jean-Marie Aerts %A Jos Van Orshoven %A Ben Somers %K Aerobiology %K Allergy %K NMDS %K Passive sampling %K Urban green areas %X

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.

%B Urban Forestry & Urban Greening %V 61 %8 Jan-06-2021 %G eng %R 10.1016/j.ufug.2021.127082 %0 Journal Article %J Cancer Epidemiology %D 2021 %T Childhood leukemia near nuclear sites in Belgium: An ecological study at small geographical level %A Claire Demoury %A Faes, Christel %A De Schutter, Harlinde %A Sylviane Carbonnelle %A Michael Rosskamp %A Francart, Julie %A Van Damme, Nancy %A Van Bladel, Lodewijk %A An Van Nieuwenhuyse %A Eva M De Clercq %B Cancer Epidemiology %V 72 %8 Jan-06-2021 %G eng %R 10.1016/j.canep.2021.101910 %0 Journal Article %J Cancer Epidemiol %D 2021 %T Childhood leukemia near nuclear sites in Belgium: An ecological study at small geographical level. %A Claire Demoury %A Faes, Christel %A De Schutter, Harlinde %A Sylviane Carbonnelle %A Michael Rosskamp %A Francart, Julie %A Van Damme, Nancy %A Van Bladel, Lodewijk %A An Van Nieuwenhuyse %A Eva M De Clercq %K ADOLESCENT %K Belgium %K Child %K Child, Preschool %K Female %K Humans %K incidence %K Leukemia %K Male %K Nuclear Power Plants %K REGISTRIES %K Small-Area Analysis %X

BACKGROUND: A previous investigation of the occurrence of childhood acute leukemia around the Belgian nuclear sites has shown positive associations around one nuclear site (Mol-Dessel). In the following years, the Belgian Cancer Registry has made data available at the smallest administrative unit for which demographic information exists in Belgium, i.e. the statistical sector. This offers the advantage to reduce the potential misclassification due to large geographical scales.

METHODS: The current study performed for the period 2006-2016 uses Poisson models to investigate (i) the incidence of childhood acute leukemia within 20 km around the four Belgian nuclear sites, (ii) exposure-response relationships between cancer incidence and surrogate exposures from the nuclear sites (distance, wind direction frequency and exposure by hypothetical radioactive discharges taking into account historical meteorological conditions). All analyses are carried out at statistical sector level.

RESULTS: Higher incidence rate ratios were found for children <15 years (7 cases, RR = 3.01, 95% CI: 1.43;6.35) and children <5 years (< 5 cases, RR = 3.62, 95% CI: 1.35;9.74) living less than 5 km from the site of Mol-Dessel. In addition, there was an indication for positive exposure-response relationships with the different types of surrogate exposures.

CONCLUSION: Results confirm an increased incidence of acute childhood leukemia around Mol-Dessel, but the number of cases remains very small. Random variation cannot be excluded and the ecological design does not allow concluding on causality. These findings emphasize the need for more in-depth research into the risk factors of childhood leukemia, for a better understanding of the etiology of this disease.

%B Cancer Epidemiol %V 72 %8 2021 06 %G eng %R 10.1016/j.canep.2021.101910 %0 Journal Article %J Science of The Total Environment %D 2021 %T Exposure to green space and pollen allergy symptom severity: A case-crossover study in Belgium %A Michiel Stas %A Raf Aerts %A Marijke Hendrickx %A Delcloo, Andy %A Nicolas Dendoncker %A Sébastien Dujardin %A Catherine Linard %A Nawrot, Tim %A An Van Nieuwenhuyse %A Jean-Marie Aerts %A Jos Van Orshoven %A Ben Somers %K Air pollution; Allergic rhinitis; Biodiversity; Birch pollen allergy; Personal exposure %X

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.

%B Science of The Total Environment %V 781 %8 Jan-08-2021 %G eng %R 10.1016/j.scitotenv.2021.146682 %0 Journal Article %J Environ Int %D 2021 %T Lessons learned from Chernobyl and Fukushima on thyroid cancer screening and recommendations in case of a future nuclear accident. %A Enora Cléro %A Evgenia Ostroumova %A Claire Demoury %A Bernd Grosche %A Ausrele Kesminiene %A Liudmila Liutsko %A Yvon Motreff %A Deborah Oughton %A Philippe Pirard %A Agnès Rogel %A An Van Nieuwenhuyse %A Dominique Laurier %A Elisabeth Cardis %K Chernobyl Nuclear Accident %K Child %K Early Detection of Cancer %K Fukushima Nuclear Accident %K Humans %K Japan %K Quality of Life %K Republic of Korea %K Thyroid Neoplasms %X

Exposure of the thyroid gland to ionizing radiation at a young age is the main recognized risk factor for differentiated thyroid cancer. After the Chernobyl and Fukushima nuclear accidents, thyroid cancer screening was implemented mainly for children, leading to case over-diagnosis as seen in South Korea after the implementation of opportunistic screening (where subjects are recruited at healthcare sites). The aim of cancer screening is to reduce morbidity and mortality, but screening can also cause negative effects on health (with unnecessary treatment if over-diagnosis) and on quality of life. This paper from the SHAMISEN special issue (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) presents the principles of cancer screening, the lessons learned from thyroid cancer screening, as well as the knowledge on thyroid cancer incidence after exposure to iodine-131. The SHAMISEN Consortium recommends to envisage systematic health screening after a nuclear accident, only when appropriately justified, i.e. ensuring that screening will do more good than harm. Based on the experience of the Fukushima screening, the consortium does not recommend mass or population-based thyroid cancer screening, as the negative psychological and physical effects are likely to outweigh any possible benefit in affected populations; thyroid health monitoring should however be made available to persons who request it (regardless of whether they are at increased risk or not), accompanied with appropriate information and support.

%B Environ Int %V 146 %8 2021 01 %G eng %R 10.1016/j.envint.2020.106230 %0 Journal Article %J Landscape and Urban Planning %D 2021 %T Residential green space types, allergy symptoms and mental health in a cohort of tree pollen allergy patients %A Michiel Stas %A Raf Aerts %A Marijke Hendrickx %A Nicolas Dendoncker %A Sébastien Dujardin %A Catherine Linard %A Tim S. Nawrot %A An Van Nieuwenhuyse %A Jean-Marie Aerts %A Jos Van Orshoven %A Ben Somers %X

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%B Landscape and Urban Planning %V 210 %8 Jan-06-2021 %G eng %R 10.1016/j.landurbplan.2021.104070 %0 Journal Article %J Environment International %D 2021 %T 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 %A Mariska Bauwelinck %A Casas, Lidia %A Tim S. Nawrot %A Nemery, Benoit %A Sonia Trabelsi %A Isabelle Thomas %A Raf Aerts %A Wouter Lefebvre %A Charlotte Vanpoucke %A An Van Nieuwenhuyse %A Deboosere, Patrick %A Vandenheede, Hadewijch %K COPD %K Greenness %K Greenspace %K Ischemic heart disease %K Perception %K population-based %X

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.

%B Environment International %V 148 %8 Jan-03-2021 %G eng %R 10.1016/j.envint.2020.106365 %0 Journal Article %J Landscape and Urban Planning %D 2020 %T An evaluation of species distribution models to estimate tree diversity at genus level in a heterogeneous urban-rural landscape %A Michiel Stas %A Raf Aerts %A Marijke Hendrickx %A Nicolas Dendoncker %A Dujardin,S. %A Catherine Linard %A Nawrot, Tim %A An Van Nieuwenhuyse %A Jean-Marie Aerts %A Jos Van Orshoven %A Ben Somers %X

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.

%B Landscape and Urban Planning %V 198 %8 Jan-06-2020 %G eng %R 10.1016/j.landurbplan.2020.103770 %0 Journal Article %J Landscape and Urban Planning %D 2020 %T An evaluation of species distribution models to estimate tree diversity at genus level in a heterogeneous urban-rural landscape %A Michiel Stas %A Raf Aerts %A Marijke Hendrickx %A Nicolas Dendoncker %A Sébastien Dujardin %A Catherine Linard %A Nawrot, Tim %A An Van Nieuwenhuyse %A Jean-Marie Aerts %A Jos Van Orshoven %A Ben Somers %K allergenic tree species %K Belgium %K Maxent %K species distribution models %K stacking %X

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.

%B Landscape and Urban Planning %V 198 %8 Jan-06-2020 %G eng %& 103770 %R https://doi.org/10.1016/j.landurbplan.2020.103770 %0 Journal Article %J Environmental Research %D 2020 %T Heat related mortality in the two largest Belgian urban areas: A time series analysis %A Katrien De Troeyer %A Mariska Bauwelinck %A Raf Aerts %A Dimitrios Profer %A Julie Berckmans %A Delcloo, Andy %A Rafiq Hamdi %A Bert Van Schaeybroeck %A Hans Hooyberghs %A Dirk Lauwaet %A Claire Demoury %A An Van Nieuwenhuyse %K Ambient temperature %K Belgium %K mortality %K Short-term effect %K Urban heat island %X

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.

%B Environmental Research %V 188 %8 sep 2020 %G eng %R 10.1016/j.envres.2020.109848 %0 Journal Article %J Science of The Total Environment %D 2020 %T Residential green space, air pollution, socioeconomic deprivation and cardiovascular medication sales in Belgium: A nationwide ecological study %A Raf Aerts %A Nemery, Benoit %A Mariska Bauwelinck %A Sonia Trabelsi %A Deboosere, Patrick %A An Van Nieuwenhuyse %A Tim S. Nawrot %A Casas, Lidia %K Cardiovascular disease %K environment %K epidemiology %K exposure %K medication sales %K public health %K Structural equation model %X

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.

%B Science of The Total Environment %V 712 %8 Jan-07-2020 %G eng %R https://doi.org/10.1016/j.scitotenv.2019.136426 %0 Journal Article %J Environmental Research %D 2020 %T Residential green space and medication sales for childhood asthma: A longitudinal ecological study in Belgium %A Raf Aerts %A Sébastien Dujardin %A Nemery, Benoit %A An Van Nieuwenhuyse %A Jos Van Orshoven %A Jean-Marie Aerts %A Ben Somers %A Marijke Hendrickx %A Nicolas Bruffaerts %A Mariska Bauwelinck %A Casas, Lidia %A Claire Demoury %A Michelle Plusquin %A Tim S. Nawrot %K Environmental epidemiology %K medication sales %K Pediatric asthma %K Residential green space %K respiratory health %X

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.

%B Environmental Research %V 189 %8 Jan-10-2020 %G eng %& 109914 %R https://doi.org/10.1016/j.envres.2020.109914 %0 Journal Article %J International Journal of Hygiene and Environmental Health %D 2020 %T Residential green space and seasonal distress in a cohort of tree pollen allergy patients %A Raf Aerts %A Michiel Stas %A Naomi Vanlessen %A Marijke Hendrickx %A Nicolas Bruffaerts %A Lucie Hoebeke %A Nicolas Dendoncker %A Sébastien Dujardin %A Nelly D. Saenen %A An Van Nieuwenhuyse %A Jean-Marie Aerts %A Jos Van Orshoven %A Tim S. Nawrot %A Ben Somers %K Emotional distress %K GHQ-12 %K Mental health %K Residential green space %K Respiratory Hypersensitivity %K Tree pollen allergy %X

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.

%B International Journal of Hygiene and Environmental Health %V 223 %8 Jan-01-2020 %G eng %N 1 %R 10.1016/j.ijheh.2019.10.004 %0 Journal Article %J Int J Cancer %D 2020 %T Thyroid cancer incidence near nuclear sites in Belgium: An ecological study at small geographical level. %A Claire Demoury %A De Schutter, Harlinde %A Faes, Christel %A Sylviane Carbonnelle %A Sébastien Fierens %A Molenberghs, Geert %A Van Damme, Nancy %A Van Bladel, Lodewijk %A An Van Nieuwenhuyse %A Christiane Vleminckx %K ADOLESCENT %K Adult %K Aged %K Aged, 80 and over %K Belgium %K Child %K Child, Preschool %K environmental exposure %K Female %K Geography %K Humans %K incidence %K Infant %K Infant, Newborn %K Iodine Radioisotopes %K Male %K middle aged %K Neoplasms, Radiation-Induced %K Nuclear Power Plants %K Radiation, Ionizing %K Radioactive Hazard Release %K Thyroid Neoplasms %K Weather %K Young adult %X

In Belgium, variations in thyroid cancer incidence were observed around the major nuclear sites. The present ecological study investigates whether there is an excess incidence of thyroid cancer among people living in the vicinity of the four nuclear sites at the smallest Belgian geographical level. Rate ratios were obtained from a Bayesian hierarchical model for areas of varying sizes around the nuclear sites. Focused hypothesis tests and generalized additive models were performed to test the hypothesis of a gradient in thyroid cancer incidence with increasing levels of surrogate exposures. No evidence was found for more incident cases of thyroid cancer near the two nuclear power plants. Regarding the two industrial and research nuclear sites, no evidence for a higher incidence in the vicinity of Mol-Dessel was observed, whereas a slightly nonsignificant higher incidence was found in the close vicinity of Fleurus. In addition, significant gradients for thyroid cancer incidence were observed with the different types of surrogate exposure considered in the 20 km area around the site of Fleurus (decreasing distance, increasing wind direction frequency and increasing exposure to estimated hypothetical radioactive discharges of iodine-131). In the investigation at the smallest Belgian geographical level, variations in thyroid cancer incidence were found around the Belgian nuclear sites. Significant exposure-response relationships were also observed for the site of Fleurus. Further investigations into these findings could be useful to allow inferring causal relationships on the origin of variations in incidence and to provide information at the individual level.

%B Int J Cancer %V 146 %8 2020 06 01 %G eng %N 11 %R 10.1002/ijc.32796 %0 Journal Article %J BMJ Open %D 2020 %T Urban environment and mental health: the NAMED project, protocol for a mixed-method study. %A Laura Lauwers %A Sonia Trabelsi %A Ingrid Pelgrims %A Hilde Bastiaens %A Eva M De Clercq %A Ariane Guilbert %A Madeleine Guyot %A Michael Leone %A Nawrot, Tim %A An Van Nieuwenhuyse %A Roy Remmen %A Nelly Saenen %A Isabelle Thomas %A Keune, Hans %K air pollution %K Belgium %K Cities %K Environment Design %K Humans %K Mental health %K noise %K Research Design %K Residence Characteristics %K social class %K Social Environment %K Urban Health %K Urban Population %X

INTRODUCTION: Mental health issues appear as a growing problem in modern societies and tend to be more frequent in big cities. Where increased evidence exists for positive links between nature and mental health, associations between urban environment characteristics and mental health are still not well understood. These associations are highly complex and require an interdisciplinary and integrated research approach to cover the broad range of mitigating factors. This article presents the study protocol of a project called Nature Impact on Mental Health Distribution that aims to generate a comprehensive understanding of associations between mental health and the urban residential environment.

METHODS AND ANALYSIS: Following a mixed-method approach, this project combines quantitative and qualitative research. In the quantitative part, we analyse among the Brussels urban population associations between the urban residential environment and mental health, taking respondents' socioeconomic status and physical health into account. Mental health is determined by the mental health indicators in the national Health Interview Survey (HIS). The urban residential environment is described by subjective indicators for the participant's dwelling and neighbourhood present in the HIS and objective indicators for buildings, network infrastructure and green environment developed for the purpose of this project. We assess the mediating role of physical activity, social life, noise and air pollution. In the qualitative part, we conduct walking interviews with Brussels residents to record their subjective well-being in association with their neighbourhood. In the validation part, results from these two approaches are triangulated and evaluated through interviews and focus groups with stakeholders of healthcare and urban planning sectors.

ETHICS AND DISSEMINATION: The Privacy Commission of Belgium and ethical committee from University Hospital of Antwerp respectively approved quantitative database merging and qualitative interviewing. We will share project results with a wide audience including the scientific community, policy authorities and civil society through scientific and non-expert communication.

%B BMJ Open %V 10 %8 2020 02 20 %G eng %N 2 %R 10.1136/bmjopen-2019-031963 %0 Journal Article %J BMJ Open %D 2020 %T Urban environment and mental health: the NAMED project, protocol for a mixed-method study %A Laura Lauwers %A Sonia Trabelsi %A Ingrid Pelgrims %A Hilde Bastiaens %A Eva M De Clercq %A Ariane Guilbert %A Madeleine Guyot %A Michael Leone %A Nawrot, Tim %A An Van Nieuwenhuyse %A Roy Remmen %A Nelly Saenen %A Isabelle Thomas %A Keune, Hans %X

Introduction Mental health issues appear as a growing problem in modern societies and tend to be more frequent in big cities. Where increased evidence exists for positive links between nature and mental health, associations between urban environment characteristics and mental health are still not well understood. These associations are highly complex and require an interdisciplinary and integrated research approach to cover the broad range of mitigating factors. This article presents the study protocol of a project called Nature Impact on Mental Health Distribution that aims to generate a comprehensive understanding of associations between mental health and the urban residential environment.

Methods and analysis Following a mixed-method approach, this project combines quantitative and qualitative research. In the quantitative part, we analyse among the Brussels urban population associations between the urban residential environment and mental health, taking respondents’ socioeconomic status and physical health into account. Mental health is determined by the mental health indicators in the national Health Interview Survey (HIS). The urban residential environment is described by subjective indicators for the participant’s dwelling and neighbourhood present in the HIS and objective indicators for buildings, network infrastructure and green environment developed for the purpose of this project. We assess the mediating role of physical activity, social life, noise and air pollution. In the qualitative part, we conduct walking interviews with Brussels residents to record their subjective well-being in association with their neighbourhood. In the validation part, results from these two approaches are triangulated and evaluated through interviews and focus groups with stakeholders of healthcare and urban planning sectors.

Ethics and dissemination The Privacy Commission of Belgium and ethical committee from University Hospital of Antwerp respectively approved quantitative database merging and qualitative interviewing. We will share project results with a wide audience including the scientific community, policy authorities and civil society through scientific and non-expert communication.

%B BMJ Open %V 10 %8 Feb-02-2021 %G eng %N 2 %R 10.1136/bmjopen-2019-031963 %0 Journal Article %J Environment International %D 2019 %T Determinants of persistent organic pollutant (POP) concentrations in human breast milk of a cross-sectional sample of primiparous mothers in Belgium %A Raf Aerts %A Ilse Van Overmeire %A Ann Colles %A Mirjana Andjelkovic %A Govindan Malarvannan %A Giulia Poma %A Elly Den Hond %A Els Van de Mieroop %A Marie-Christine Dewolf %A François Charlet %A An Van Nieuwenhuyse %A Joris Van Loco %A Adrian Covaci %X

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.

%B Environment International %V 131 %G eng %& 104979 %0 Journal Article %J Environment International %D 2019 %T Determinants of persistent organic pollutant (POP) concentrations in human breast milk of a cross-sectional sample of primiparous mothers in Belgium %A Raf Aerts %A Ilse Van Overmeire %A Ann Colles %A Mirjana Andjelkovic %A Malarvannan, Govindan %A Poma, Giulia %A Den Hond, Elly %A Van De Mieroop, Els %A Dewolf, Marie-Christine %A François Charlet %A An Van Nieuwenhuyse %A Joris Van Loco %A Covaci, Adrian %K brominated flame retardants %K Human biomonitoring %K Human breast milk %K Organochlorine pesticides %K PERSISTENT ORGANIC POLLUTANTS %K Primipara mothers %X

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.

%B Environment International %V 131 %8 01-oct-2019 %G eng %R 10.1016/j.envint.2019.104979 %0 Generic %D 2019 %T Evaluation de l’exposition humaine aux résidus de pesticides à l’aide de bracelets en silicone %A Laure Joly %A Raf Aerts %A Philippe Szternfeld %A K Tsilikas %A Koen De Cremer %A Philippe Castelain %A M Aerts %A J Van Orshoven %A B Somers %A M Ghendrickx %A Mirjana Andjelkovic %A An Van Nieuwenhuyse %B 49e congrès du Groupe Français de recherche sur les Pesticides %8 2019 nov 20 %G eng %0 Journal Article %J Sci Total Environ %D 2019 %T 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. %A Ariane Guilbert %A Koen De Cremer %A Billie Heene %A Claire Demoury %A Raf Aerts %A Declerck, Priscilla %A Brasseur, Olivier %A An Van Nieuwenhuyse %K Air Pollutants %K Belgium %K benzene %K Cities %K cross-sectional studies %K environmental exposure %K Environmental Monitoring %K Humans %K Inflammation %K Oxidative Stress %K Pilot Projects %K Polycyclic Aromatic Hydrocarbons %K Respiratory System %K Soot %K Urban Population %K Vehicle Emissions %X

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.

%B Sci Total Environ %V 649 %8 2019 Feb 01 %G eng %R 10.1016/j.scitotenv.2018.08.338 %0 Journal Article %J Science of The Total Environment %D 2019 %T 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 %A Ariane Guilbert %A Koen De Cremer %A Billie Heene %A Claire Demoury %A Raf Aerts %A Declerck, Priscilla %A Brasseur, Olivier %A An Van Nieuwenhuyse %K Belgium %K Black carbon %K Health outcomes %K Human biomonitoring %K Polycyclic Aromatic Hydrocarbons %X

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.

%B Science of The Total Environment %V 649 %8 Jan-02-2019 %G eng %& 620 %R 10.1016/j.scitotenv.2018.08.338 %0 Journal Article %J Journal of Chromatography B %D 2019 %T Simultaneous determination of parabens, bisphenols and alkylphenols in human placenta by ultra-high performance liquid chromatography-tandem mass spectrometry %A Ilse Van Overmeire %A Karen Vrijens %A Nawrot, Tim %A An Van Nieuwenhuyse %A Joris Van Loco %A Tim Reyns %K Alkylphenol %K Bisphenol %K endocrine disruptor %K Paraben %K Placenta %K UHPLC-MS/MS %X

This study presents de development and validation of an ultra- high performance liquid chromatography – tandem mass spectrometry (UHPLC-MS/MS) method for the simultaneous determination of four parabens (methyl-, ethyl-, propyl-, and butyl-paraben (MeP, EtP, PrP, BuP), four bisphenols (BP) (BPA, BPB, BPF, and BPS) and two alkylphenols (nonyl phenol (NP) and tert-octylphenol (OP) in human placenta samples. After a short sample preparation time the extracts are analysed by UHPLC-MS/MS using negative electrospray ionization. Labeled internal standards and matrix-matched calibration are used for quantification of the compounds. The method was validated according FDA guideline for bio analytical methods using spiked samples at three concentration levels (0.5–5 and 25 ng g−1). The parameters accuracy and precision fulfill the criteria. Calibration curves are linear between 0.5 and 50 ng −1. The limits of detection and quantification are in the range of 0.1–0.3 ng g−1 and 0.2–0.7 ng g−1, respectively. The applicability of the method was demonstrated on 71 human placenta samples from a Belgian cohort. The detection frequency was highest for OP (95%), EtP (86%), BPA (49%) and BPS (44%). Among the quantified compounds the highest quantification frequency was observed for OP (85%), EtP (65%) and BPA (25%). The concentrations of parabens ranged from 0.5 to 7.1 ng g−1 for MeP, from 0.5 to 4.5 ng g−1 for EtP and from 0.5 to 9.1 ng g−1 for PrP. The levels of bisphenols ranged from 0.5 to 3.9 ng g−1 for BPA, from 0.6 to 2.1 ng g−1 for BPF and from 0.8 to 1.3 ng g−1 for BPS. BPB and NP were not detected and OP levels ranged from 0.5 to 3.7 ng g g−1. The results demonstrate that the developed analytical method is very sensitive and that levels of several compounds with known /suspected endocrine disrupting properties could be detected or quantified in human placenta samples. The results therefore suggest that fetal exposure to these compounds occurs. The method will be useful for studies to evaluate the health effects associated with this prenatal exposure.

%B Journal of Chromatography B %V 1121 %8 15-07-2019 %G eng %& 96 %R 10.1016/j.jchromb.2019.05.012 %0 Journal Article %J Journal of Chromatography B %D 2019 %T Simultaneous determination of parabens, bisphenols and alkylphenols in human placenta by ultra-high performance liquid chromatography - tandem mass spectrometry %A Ilse Van Overmeire %A K. Vrijens %A Nawrot, T. %A An Van Nieuwenhuyse %A Joris Van Loco %A Tim Reyns %K Alkylphenol %K Bisphenol %K endocrine disruptor %K Paraben %K Placenta %K UHPLC-MS/MS %X

This study presents de development and validation of an ultra- high performance liquid chromatography – tandem mass spectrometry (UHPLC-MS/MS) method for the simultaneous determination of four parabens (methyl-, ethyl-, propyl-, and butyl-paraben (MeP, EtP, PrP, BuP), four bisphenols (BP) (BPA, BPB, BPF, and BPS) and two  alkylphenols (nonyl phenol (NP) and tert-octylphenol (OP) in human placenta samples.  After a short sample preparation time the extracts are analysed by UHPLC-MS/MS using negative electrospray ionization.  Labeled internal standards and matrix-matched calibration are used for quantification of the compounds. The method was validated according FDA guideline for bio analytical methods using spiked samples at three concentration levels (0.5-5 and 25 ng g−1). The parameters accuracy and precision fulfill the criteria. Calibration curves are linear between 0.5 and 50 ng −1. The limits of detection and quantification are in the range of 0.1-0.3 ng g−1 and 0.2 -0.7 ng g−1, respectively. The applicability of the method was demonstrated on  71 human placenta samples from a Belgian cohort. The detection frequency was highest for OP (95%), EtP (86%), BPA (49%) and BPS (44%). Among the quantified compounds the highest quantification frequency was observed for OP (85%), EtP (65%) and BPA (25%). The concentrations of parabens ranged from 0.5-7.1 ng g−1 for MeP, from 0.5-4.5 ng g−1 for EtP and from 0.5-9.1 ng g−1 for PrP. The levels of bisphenols ranged from 0.5-3.9 ng g−1 for BPA, from 0.6-2.1 ng g−1 for BPF and from 0.8-1.3 ng g−1 for BPS. BPB and NP were not detected and OP levels ranged from 0.5-3.7 ng g−1. The results demonstrate that the developed analytical method is very sensitive and that levels of several compounds with known /suspected endocrine disrupting properties could be detected or quantified in human placenta samples. The results therefore suggest that fetal exposure to these compounds occurs. The method will be useful for studies to evaluate the health effects associated with this prenatal exposure.

%B Journal of Chromatography B %V 1121 %8 May 2019 %G eng %& 96 %0 Journal Article %J International Journal of Cancer %D 2019 %T Thyroid cancer incidence near nuclear sites in Belgium: An ecological study at small geographical level %A Claire Demoury %A De Schutter, Harlinde %A Faes, Christel %A Sylviane Carbonnelle %A Sébastien Fierens %A Molenberghs, Geert %A Van Damme, Nancy %A Van Bladel, Lodewijk %A An Van Nieuwenhuyse %A Christiane Vleminckx %K ecological study %K incidence %K Nuclear sites %K statistical sector %K thyroid cancer %X

In Belgium, variations in thyroid cancer incidence were observed around the major nuclear sites. The present ecological study investigates whether there is an excess incidence of thyroid cancer among people living in the vicinity of the four nuclear sites at the smallest Belgian geographical level. Rate ratios were obtained from a Bayesian hierarchical model for areas of varying sizes around the nuclear sites. Focused hypothesis tests and generalized additive models were performed to test the hypothesis of a gradient in thyroid cancer incidence with increasing levels of surrogate exposures. No evidence was found for more incident cases of thyroid cancer near the two nuclear power plants. Regarding the two industrial and research nuclear sites, no evidence for a higher incidence in the vicinity of Mol‐Dessel was observed, whereas a slightly nonsignificant higher incidence was found in the close vicinity of Fleurus. In addition, significant gradients for thyroid cancer incidence were observed with the different types of surrogate exposure considered in the 20 km area around the site of Fleurus (decreasing distance, increasing wind direction frequency and increasing exposure to estimated hypothetical radioactive discharges of iodine‐131). In the investigation at the smallest Belgian geographical level, variations in thyroid cancer incidence were found around the Belgian nuclear sites. Significant exposure–response relationships were also observed for the site of Fleurus. Further investigations into these findings could be useful to allow inferring causal relationships on the origin of variations in incidence and to provide information at the individual level.

%B International Journal of Cancer %8 Oct-12-2019 %G eng %R 10.1002/ijc.32796 %0 Journal Article %J Br Med Bull %D 2018 %T Biodiversity and human health: mechanisms and evidence of the positive health effects of diversity in nature and green spaces. %A Raf Aerts %A Olivier Honnay %A An Van Nieuwenhuyse %X

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.

%B Br Med Bull %V 127 %8 2018 09 01 %G eng %N 1 %R 10.1093/bmb/ldy021 %0 Journal Article %J European Journal of Cancer Prevention %D 2018 %T Childhood leukaemia near nuclear sites in Belgium, 2002–2008 %A Bollaerts, Kaatje %A Simons, Koen %A Van Bladel, Lodewijk %A De Smedt, Tom %A Sonck, Michel %A Sébastien Fierens %A E Poffijn %A Geraets, David %A Gosselin, Pol %A Herman Van Oyen %A Francart, Julie %A An Van Nieuwenhuyse %K Child %K data interpretation %K incidence %K leukaemia %K nuclear reactors %K radioactive pollutants %K Statistical analysis %X

This paper describes an ecological study investigating whether there is an excess incidence of acute leukaemia among children aged 0-14 years living in the vicinity of the nuclear sites in Belgium. Poisson regression modelling was carried out for proximity areas of varying sizes. In addition, the hypothesis of a gradient in leukaemia incidence with increasing levels of surrogate exposures was explored by means of focused hypothesis tests and generalized additive models. For the surrogate exposures, three proxies were used, that is, residential proximity to the nuclear site, prevailing winds and simulated radioactive discharges, on the basis of mathematical dispersion modelling. No excess incidence of acute leukaemia was observed around the nuclear power plants of Doel or Tihange nor around the nuclear site of Fleurus, which is a major manufacturer of radioactive isotopes in Europe. Around the site of Mol-Dessel, however, two- to three-fold increased leukaemia incidence rates were found in children aged 0-14 years living in the 0-5, 0-10 and the 0-15 km proximity areas. For this site, there was evidence for a gradient in leukaemia incidence with increased proximity, prevailing winds and simulated radioactive discharges, suggesting a potential link with the site that needs further investigation. An increased incidence of acute leukaemia in children aged 0-14 years was observed around one nuclear site that hosted reprocessing activities in the past and where nuclear research activities and radioactive waste treatment are ongoing.

%B European Journal of Cancer Prevention %V 27 %8 Jan-01-2018 %G eng %N 2 %R 10.1097/CEJ.0000000000000272 %0 Journal Article %J Int J Biometeorol %D 2018 %T Comparative long-term trend analysis of daily weather conditions with daily pollen concentrations in Brussels, Belgium. %A Nicolas Bruffaerts %A Tom De Smedt %A Andy Delcloo %A Koen Simons %A Lucie Hoebeke %A Caroline Verstraeten %A An Van Nieuwenhuyse %A Ann Packeu %A Marijke Hendrickx %K Allergy %K Climate change %K Meteorological factors %K pollen %X

A clear rise in seasonal and annual temperatures, a gradual increase of total radiation, and a relative trend of change in seasonal precipitation have been observed for the last four decades in Brussels (Belgium). These local modifications may have a direct and indirect public health impact by altering the timing and intensity of allergenic pollen seasons. In this study, we assessed the statistical correlations (Spearman's test) between pollen concentration and meteorological conditions by using long-term daily datasets of 11 pollen types (8 trees and 3 herbaceous plants) and 10 meteorological parameters observed in Brussels between 1982 and 2015. Furthermore, we analyzed the rate of change in the annual cycle of the same selected pollen types by the Mann-Kendall test. We revealed an overall trend of increase in daily airborne tree pollen (except for the European beech tree) and an overall trend of decrease in daily airborne pollen from herbaceous plants (except for Urticaceae). These results revealed an earlier onset of the flowering period for birch, oak, ash, plane, grasses, and Urticaceae. Finally, the rates of change in pollen annual cycles were shown to be associated with the rates of change in the annual cycles of several meteorological parameters such as temperature, radiation, humidity, and rainfall.

%B Int J Biometeorol %V 62 %8 2018 March %G eng %N 3 %& 483 %R 10.1007/s00484-017-1457-3 %0 Generic %D 2018 %T Determination of endocrine disrupting compounds in human placenta by UPLC-ESI-MS/MS: a preliminary study on parabens, bisphenols and alkyl phenols %A Ilse Van Overmeire %A K. Vrijens %A Nawrot, T. %A An Van Nieuwenhuyse %A Joris Van Loco %A Tim Reyns %B International symposium on halogenated Persistent Organic Pollutants (POPs) DIOXIN 2018 %G eng %0 Journal Article %J Environ Int %D 2018 %T Heat and health in Antwerp under climate change: Projected impacts and implications for prevention. %A Martinez, Gerardo Sanchez %A Julio Diaz %A Hans Hooyberghs %A Dirk Lauwaet %A Koen De Ridder %A Cristina Linares %A Rocio Carmona %A Cristina Ortiz %A Vladimir Kendrovski %A Raf Aerts %A An Van Nieuwenhuyse %A Dunbar, Maria Bekker-Nielsen %K Antwerp %K Climate change %K Heat-related hospital admissions %K Heat-related mortality %K Heatwaves %X

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.

%B Environ Int %V 111 %8 2018 Feb %G eng %R 10.1016/j.envint.2017.11.012 %0 Generic %D 2018 %T Levels of organochlorinated pesticide residues and other persistent organic pollutants in breast milk: the Belgian results from the 6th WHO-coordinated survey %A Ilse Van Overmeire %A Laure Joly %A Malarvannan,G. %A Poma,G. %A Covaci,A. %A A. Colles %A Koppen, G. %A E. Den Hond %A E. Van de Mieroop %A M.C. De Wolf %A F. Charlet %A Svetlana V. Malysheva %A Vanhouche,M. %A A. Dussart %A Joris Van Loco %A An Van Nieuwenhuyse %A Mirjana Andjelkovic %K breast milk %K organochlorinated pesticide residues %K PERSISTENT ORGANIC POLLUTANTS %X

Conclusions of the presentation given at the International symposium on halogenated Persistent Organic Pollutants (POPs) DIOXIN 2018

%B International symposium on halogenated Persistent Organic Pollutants (POPs) DIOXIN 2018 %8 2018 %G eng %0 Journal Article %J Environ Health %D 2018 %T Relationships between aeroallergen levels and hospital admissions for asthma in the Brussels-Capital Region: a daily time series analysis. %A Ariane Guilbert %A Nicolas Bruffaerts %A Lucie Hoebeke %A Ann Packeu %A Marijke Hendrickx %A Koen De Cremer %A Sandrine Bladt %A Olivier Brasseur %A An Van Nieuwenhuyse %X

BACKGROUND: Outdoor pollen grain and fungal spore concentrations have been associated with severe asthma exacerbations at the population level. The specific impact of each taxon and the concomitant effect of air pollution on these symptoms have, however, still to be better characterized. This study aimed to investigate the short-term associations between ambient concentrations of various aeroallergens and hospitalizations related to asthma in the Brussels-Capital Region (Belgium), an area recording especially high rates of admissions.

METHODS: Based on administrative records of asthma hospitalizations and regular monitoring of 11 tree/herbaceous pollen taxa and 2 fungal spore taxa, daily time series analyses covering the 2008-2013 period were performed. Effects up to 6 days after exposure were captured by combining quasi-Poisson regression with distributed lag models, adjusting for seasonal and long-term trends, day of the week, public holidays, mean temperature and relative humidity. Effect modification by age and air pollution (PM, NO, O) was tested.

RESULTS: A significant increase in asthma hospitalizations was observed for an interquartile range increase in grass (5.9%, 95% CI: 0.0, 12.0), birch (3.2%, 95% CI: 1.1, 5.3) and hornbeam (0.7%, 95% CI: 0.2, 1.3) pollen concentrations. For several taxa including grasses, an age modification effect was notable, the hospitalization risk tending to be higher in individuals younger than 60 years. Air pollutants impacted the relationships too: the risk appeared to be stronger for grass and birch pollen concentrations in case of high PM and O concentrations respectively.

CONCLUSIONS: These findings suggest that airborne grass, birch and hornbeam pollen are associated with severe asthma exacerbations in the Brussels region. These compounds appear to act in synergy with air pollution and to more specifically affect young and intermediate age groups. Most of these life-threatening events could theoretically be prevented with improved disease diagnosis/management and targeted communication actions.

%B Environ Health %V 17 %8 2018 Apr 11 %G eng %N 1 %R 10.1186/s12940-018-0378-x %0 Journal Article %J Environ Sci Technol %D 2018 %T Silicone Wristband Passive Samplers Yield Highly Individualized Pesticide Residue Exposure Profiles. %A Raf Aerts %A Laure Joly %A Philippe Szternfeld %A Khariklia Tsilikas %A Koen De Cremer %A Philippe Castelain %A Jean-Marie Aerts %A Jos Van Orshoven %A Ben Somers %A Marijke Hendrickx %A Mirjana Andjelkovic %A An Van Nieuwenhuyse %K Dietary exposure %K environmental exposure %K LC-MS/MS %K passive sampler %K Pesticide residues %K wristband sampler %X

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.

%B Environ Sci Technol %V 52 %8 2018 Jan 02 %G eng %N 1 %R 10.1021/acs.est.7b05039 %0 Report %D 2017 %T 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. %A Ariane Guilbert %A Koen Simons %A Raf Aerts %A Claire Demoury %A Michele Rasoloharimahefa %A Koen De Cremer %A Nicolas Bruffaerts %A Lucie Hoebeke %A Ann Packeu %A Marijke Hendrickx %A Bianca Cox %A Sophie Viart %A Charles Pilette %A An Van Nieuwenhuyse %K asthme %K bases de données %K Bruxelles %K épidémiologie %K hospitalisations %K médicaments %K mortalité %K rhinite allergique %I WIV-ISP %C Bruxelles, Belgique %P NA %8 06/2017 %G eng %M NA %0 Journal Article %J Int J Hyg Environ Health %D 2017 %T Biomarkers in patients admitted to the emergency department after exposure to acrylonitrile in a major railway incident involving bulk chemical material. %A Colenbie, Sebastiaan %A Buylaert, Walter %A Stove, Christophe %A Deschepper, Ellen %A Vandewoude, Koenraad %A De Smedt, Tom %A Bader, Michael %A Göen, Thomas %A An Van Nieuwenhuyse %A De Paepe, Peter %K acrylonitrile %K ADOLESCENT %K Adult %K Aged %K Aged, 80 and over %K Belgium %K Biomarkers %K Chemical Hazard Release %K Child %K Child, Preschool %K Emergency Service, Hospital %K Environmental Monitoring %K Female %K Humans %K Infant %K Lactic Acid %K Male %K middle aged %K Railroads %K SMOKING %K Thiocyanates %K Valine %K Young adult %X

BACKGROUND: A railway incident with victims of exposure to the cyanogenic substance acrylonitrile (ACN).

AIMS: We retrospectively (i)built an inventory of the clinical characteristics of individuals admitted to surrounding emergency departments (ED's) and (ii)studied the correlation between N-2-cyanoethylvaline (CEV), a biomarker used in a population study for evaluating exposure to ACN, with lactate and thiocyanate (SCN), biomarkers determined during emergency care.

RESULTS: 438 patients from 11 ED's were included and presented with known symptoms of ACN poisoning but also with concern about the risks. A comparison of CEV with lactate or SCN was possible in 108 and 73 patients respectively. CEV was very high in a critically ill patient with a high lactate. There was no correlation with CEV in the patients with normal or slightly elevated lactate concentrations. A correlation of CEV with SCN was only observed in smokers.

LIMITATIONS: First there is a lack of data in some clinical files concerning the time and duration of exposure and the smoking-status. A second limitation is that blood samples for biomarkers were not taken systematically in all patients, which may have induced bias. A third limitation is that blood sampling was possibly done outside the correct time window related to the delayed toxicity of ACN. Finally the number of severely-intoxicated patients was low and ACN exposure may not have taken place e.g. in individuals consulting with psychological symptoms. These aspects may have contributed to the below detection limits' analyses of biomarkers.

CONCLUSIONS: CEV was markedly elevated in a severely-intoxicated patient with high lactate, a sensitive marker for CN intoxication. We found no correlation of CEV with normal or slightly elevated lactate concentrations but clinicians should consider the possibility of subsequent rises due to the delay in ACN toxicity. CEV correlated with SCN in smokers, which may be explained by ACN in tobacco smoke and deserves further exploration. Further studies are necessary to evaluate the correlation between biomarkers in acute chemical exposures to ACN and these should be carried out prospectively using a preplanned template.

%B Int J Hyg Environ Health %V 220 %P 261-270 %8 2017 Mar %G eng %N 2 Pt A %1 http://www.ncbi.nlm.nih.gov/pubmed/28110842?dopt=Abstract %R 10.1016/j.ijheh.2016.12.012 %0 Report %D 2017 %T 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. %A Ariane Guilbert %A Koen De Cremer %A Raf Aerts %A Claire Demoury %A An Van Nieuwenhuyse %K biomonitoring %K Bruxelles %K épidémiologie %K pollution de l’air %K santé %I WIV-ISP %C Bruxelles, Belgique %P NA %8 07/2017 %G eng %M NA %0 Report %D 2017 %T Lessons learned from dosimetric and health screening, evacuation and health surveillance. The SHAMISEN project deliverable D5.56 to OPERRA, a final report, restricted (European commission). ST1 %A Cardis, E %A Barquinero, J.F %A S Della Monaca %A P. Fattibene %A Kesminiene, A. %A Liutsko, L %A Nuccetelli, C %A Ohba,T %A Ostroumova, E %A Tanigawa, K %A An Van Nieuwenhuyse %K dosimetric screening %K health screening %K OPERRAn surveillance %K SHAMISEN %I NA %C NA %P NA %8 2017 %G eng %M NA %0 Report %D 2017 %T Recommendations and procedures for preparedness and health surveillance of populations affected by a radiation accident. Final report. %A Deborah Oughton %A Viviana Albani %A Francesc Barquinero %A Vadim Chumak %A Enora Clero %A Pascal Crouail %A P. Fattibene %A Ausrele Kesminiene %A Dominique Laurier %A Liudmila Liutsko %A Thierry Schneider %A Koichi Tanigawa %A Evgenia Tomkiv %A Luke Vale %A Elisabeth Cardis %A on behalf of the SHAMISEN Consortium %A An Van Nieuwenhuyse %K preparedness %K procedures %K radiation accident %K Recommendations %K SHAMISEN %I NA %C NA %P NA %8 2017 %G eng %M NA %0 Report %D 2016 %T Analyse van de dringende geneeskundige hulpverlening gedurende de acrylonitril treinramp te Wetteren van 04/05/2013 %A Colenbie,S. %A Buylaert,W. %A Stove,C. %A Deschepper,E. %A An Van Nieuwenhuyse %A De Smedt,T. %A Devue,K. %A Vandewoude,K. %A De Paepe,P. %K acrylonitril %K blootstelling %K care %K data %K de %K IS %K Patient %K Test %K toxische %K Wetteren %I UGent %C Gent, Belgie %P NA %8 2016/01/01/ %G eng %M NA %1 2602 %0 Generic %D 2016 %T Assessing spatio-temporal relationships between respiratory health and biodiversity using individual wearable technology - the Respirit project %A Raf Aerts %A Dendoncker,N %A Linard,C %A Marijke Hendrickx %A An Van Nieuwenhuyse %A Nawrot,T. %A Delcloo,A. %A Hamdi,R. %A Aerts,J.M. %A Somers,B %E Van Orshoven,J. %K biodiversity %K European %K health %K ON %K Practice %K Respiratory %B European One Health/EcoHealth Workshop, Belgian Biodiversity Platform, Belgian Community of Practice on Biodiversity and Health %I Belspo %C Brussels %8 10/6/2016 %G eng %N BELSPO %1 2647 %2 06/10/2016 %0 Thesis %D 2016 %T BruxAir. Short-term health effects of air pollution in the Brussels Capital Region 2004-2011: an epidemiological time series approach %A Simons,K. %A An Van Nieuwenhuyse %A Buyl,R. %A Coomans,D. %K air pollution %K an %K approach %K Brussels %K effect %K effects %K health %K health effects %K region %K series %K time %K Time series %7 246 %I VUBPRESS Brussels University Press - Vrije Universiteit Brussel %C Brussels %P 246 %8 0/6/2016 %@ 978 90 5718 553 3 %G eng %1 2566 %0 Journal Article %J Eur J Cancer Prev %D 2016 %T Childhood leukaemia near nuclear sites in Belgium, 2002-2008. %A Bollaerts, Kaatje %A Simons, Koen %A Van Bladel, Lodewijk %A De Smedt, Tom %A Sonck, Michel %A Sébastien Fierens %A Poffijn, André %A Geraets, David %A Gosselin, Pol %A Herman Van Oyen %A Francart, Julie %A An Van Nieuwenhuyse %X

This paper describes an ecological study investigating whether there is an excess incidence of acute leukaemia among children aged 0-14 years living in the vicinity of the nuclear sites in Belgium. Poisson regression modelling was carried out for proximity areas of varying sizes. In addition, the hypothesis of a gradient in leukaemia incidence with increasing levels of surrogate exposures was explored by means of focused hypothesis tests and generalized additive models. For the surrogate exposures, three proxies were used, that is, residential proximity to the nuclear site, prevailing winds and simulated radioactive discharges, on the basis of mathematical dispersion modelling. No excess incidence of acute leukaemia was observed around the nuclear power plants of Doel or Tihange nor around the nuclear site of Fleurus, which is a major manufacturer of radioactive isotopes in Europe. Around the site of Mol-Dessel, however, two- to three-fold increased leukaemia incidence rates were found in children aged 0-14 years living in the 0-5, 0-10 and the 0-15 km proximity areas. For this site, there was evidence for a gradient in leukaemia incidence with increased proximity, prevailing winds and simulated radioactive discharges, suggesting a potential link with the site that needs further investigation. An increased incidence of acute leukaemia in children aged 0-14 years was observed around one nuclear site that hosted reprocessing activities in the past and where nuclear research activities and radioactive waste treatment are ongoing.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0/.

%B Eur J Cancer Prev %8 2016 Jul 02 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/27380513?dopt=Abstract %R 10.1097/CEJ.0000000000000272 %0 Generic %D 2016 %T Cumulative diversity dose CDD as an integrated measure of human exposure to biodiversity %A Raf Aerts %A An Van Nieuwenhuyse %A Lucie Hoebeke %A Dendoncker,N. %A Linard,C. %A Dujardin,S. %A Verstraeten,W. %A Delcloo,A. %E Marijke Hendrickx %K an %K AS %K biodiversity %K European %K exposure %K health %K Human %K human exposure %K measure %K ON %K Practice %B European One Health/EcoHealth Workshop, Belgian Biodiversity Platform, Belgian Community of Practice on Biodiversity and Health %I Belspo %C Brussels %8 6/10/2016 %G eng %N BELSPO %1 2648 %2 06/10/2016 %0 Generic %D 2016 %T Development of UPLC-MS/MS methods for endocrine disrupting chemicals (EDCs) in placenta in an ongoing mother-birth cohort in Belgium %A Ilse Van Overmeire %A Tim Reyns %A Nawrot,T. %A Vrijens,K. %A Mirjana Andjelkovic %A Joris Van Loco %A An Van Nieuwenhuyse %K an %K Belgium %K biomonitoring %K chemicals %K conference %K Development %K Human %K Human biomonitoring %K International %K method %K methods %K ON %K UPLC-MS/MS %B 2nd International Conference on Human Biomonitoring %I WIV-ISP %C Germany %8 17/4/2016 %G eng %N Federal Ministry for the Environment,Nature Conservation,Building and Nuclear Safety and the German Environment Agency %1 2515 %2 17-19/04/2016 %0 Journal Article %J Sci Total Environ %D 2016 %T Direct cost saving potential in medication costs due to a reduction in outdoor air pollution for the Brussels Capital Region. %A Simons, Koen %A Devos, Stefanie %A Putman, Koen %A Coomans, Danny %A An Van Nieuwenhuyse %A Buyl, Ronald %X

INTRODUCTION: The adverse health effects of exposure to air pollution have been well-established and include mortality, hospital admissions, emergency department visits, etc, but also less severe outcomes such as medication use and purchase. The economic impact, an additional motivator for policy, has been studied primarily for the more severe outcomes.

METHODS: Purchase data of reimbursed medications typically prescribed for asthma and chronic obstructive pulmonary disease, were obtained through the mandatory Belgian health insurance system. A time series analyses approach was used to model daily sales on daily air pollution concentrations (NO2, PM10 and PM2.5) for residents of the Brussels Capital Region as a whole. In addition, a higher geographical resolution of both sales and pollutant concentrations allowed for a multi-sector approach. Annual savings were estimated for the scenario of a 10% reduction in each of the pollutants.

RESULTS: Medication purchase was significantly associated with NO2 concentrations, leading to an annual cost saving potential of € 107,845 [95%CI: € 71,483-€ 143,823] in R03 sales (WHO classification for drugs of obstructive airway diseases). Saving potentials of PM10 and PM2.5 were not significant. Estimates were not sensitive to the geographical resolution, however, higher precision can be obtained with higher resolution data, subject to the condition that the number of sales is sufficiently large.

%B Sci Total Environ %V 562 %P 760-765 %8 2016 Aug 15 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/27110987?dopt=Abstract %R 10.1016/j.scitotenv.2016.04.022 %0 Journal Article %J Air Qual Atmos Health %D 2016 %T Ensemble post-processing is a promising method to obtain flexible distributed lag models: : A simulation study of time series of air pollution and daily mortality. %A Simons,K. %A De Smedt,T. %A An Van Nieuwenhuyse %A Buyl,R. %A Coomans,D. %K air pollution %K an %K approach %K AS %K Benefit %K benefits %K Covariate %K data %K environmental %K epidemiology %K exposure %K IS %K method %K MODEL %K models %K morbidity %K mortality %K Multiple %K national %K regression %K Regression model %K series %K study %K time %K Time series %K variables %X Distributed lag models (DLM) are regression models that include multiple lagged exposure variables as covariates. They are frequently used to model the relationship between daily mortality and short-term air pollution exposures. Specifying a maximum lag number is but one of the difficulties in using a DLM for environmental epidemiology. We propose an easily extendible ensemble post-processing approach. The resultant estimates are both more parsimonious, approaching zero with increasing lag, and more efficient. The benefits are shown to be robust under various simulation scenario's and illustrated with data from the National Morbidity, Mortality and Air Pollution Study. %B Air Qual Atmos Health %V 9 %P 835 - 846 %8 1/11/2016 %G eng %N 7 %1 2565 %& 835 %R http://dx.doi.org/10.1007/s11869-015-0388-6 %0 Generic %D 2016 %T Environnement : impact des sites nucl‚aires sur les leuc‚mies de l'enfant. S‚minaire Pr‚disposition aux cancers de l'enfant : R“le de l'environnement, des facteurs ‚pig‚n‚tiques et g‚n‚tiques %A An Van Nieuwenhuyse %E Cliniques Universitaire Saint-Luc %K cancer %K Cancers %K de %K Impact %K LE %K x %8 2016/02/27/ %G eng %1 2639 %0 Generic %D 2016 %T Human biomonitoring as a tool for objective exposure assessment: A case-study of a major train accident with acrylonitrile in Belgium %A An Van Nieuwenhuyse %A De Smedt,T. %A Smons,K. %A Stove,C. %A De Paepe,P. %A Nemery,B. %A Bader,M. %A Christiane Vleminckx %A Ilse Van Overmeire %A Sébastien Fierens %A Birgit Mertens %A Koen De Cremer %A T. Goen %A Schettgen,T. %A Herman Van Oyen %A Joris Van Loco %K accident %K acrylonitrile %K approach %K AS %K assessment %K biomonitoring %K exposure %K exposure assessment %K health %K Human %K Human biomonitoring %K International %K Objective %K Science %K Societies %K Society %B Interdisciplinary Approaches for Health and the Environment %I NA %C NA %8 10/9/2016 %G eng %N International Society of Exposure Science ISES, %1 2516 %2 9-13/10/2016 %0 Generic %D 2016 %T Human biomonitoring in the Wetteren incident %A An Van Nieuwenhuyse %A De Smedt ,T. %A Simons,K. %A Stove,C. %A De Paepe,P. %A Nemery,B. %A Bader,M. %A Christiane Vleminckx %A Ilse Van Overmeire %A Sébastien Fierens %A Birgit Mertens %A Koen De Cremer %A T. Goen %A Schettgen,T. %A Herman Van Oyen %A Joris Van Loco %K biomonitoring %K Cost %K Diagnosis %K European %K exposure %K Human %K Human biomonitoring %K Monitoring %K prevention %K Wetteren %B European COST project DiMoPEX, Diagnosis, monitoring, prevention of exposure related non-communicable diseases %I NA %C NA %8 0/0/2016 %G eng %N DiMoPEX %1 2642 %2 October 18, 2016. %0 Generic %D 2016 %T Impact of green/blue spaces on specific morbidity and cause-specific mortality in Belgium: the GRESP-HEALTH project %A Mariska Bauwelinck %A Casas,L. %A An Van Nieuwenhuyse %A Deboosere,P. %A Isabelle Thomas %A Nawrot,T. %A Bouland,C. %A Nemery,B. %K Belgium %K European %K Impact %K morbidity %K mortality %K ON %B European OneHealth/EcoHealth workshop %I NA %C NA %8 6/10/2016 %G eng %N Belgian Science Policy %1 2632 %2 6-7/10/2016 %0 Generic %D 2016 %T The impact of neighbourhood perceived greenness on health and mortality inequalities in Belgium: a census-based study. %A Mariska Bauwelinck %A Casas,L. %A An Van Nieuwenhuyse %A Deboosere,P. %K Belgium %K environmental %K epidemiology %K health %K Impact %K inequalities %K inequality %K International %K mortality %K ON %K perceived %K Societies %K Society %K study %B International Society for Environmental Epidemiology 2016 %I NA %C NA %8 1/9/2016 %G eng %N International Society for Environmental Epidemiology (ISEE) %1 2583 %2 1-4/09/2016 %0 Journal Article %J Environ Int %D 2016 %T Respiratory medication sales and urban air pollution in Brussels (2005 to 2011). %A Casas, Lidia %A Simons, Koen %A Nawrot, Tim S %A Brasseur, Olivier %A Declerck, Priscilla %A Buyl, Ronald %A Coomans, Danny %A Nemery, Benoit %A An Van Nieuwenhuyse %K ADOLESCENT %K Adolescents %K age %K Age-group %K Aged %K air pollution %K ALL %K association %K Associations %K Brussels %K Change %K Changes %K CI %K data %K Database %K exposure %K general %K general population %K General-population %K Individuals %K Linear Models %K medication sales %K method %K methods %K MODEL %K models %K Monitoring %K morbidity %K observed %K past %K PM10 %K POISSON %K POPULATION %K RANGE %K Ratio %K region %K Respiratory %K result %K results %K risk %K SOCIAL %K urban %X

BACKGROUND: We investigated the associations between daily sales of respiratory medication and air pollutants in the Brussels-Capital Region between 2005 and 2011.

METHODS: We used over-dispersed Poisson Generalized Linear Models to regress daily individual reimbursement data of prescribed asthma and COPD medication from the social security database against each subject's residential exposure to outdoor particulate matter (PM10) or NO2 estimated, by interpolation from monitoring stations. We calculated cumulative risk ratios (RR) and their 95% confidence intervals (CI) for interquartile ranges (IQR) of exposure for different windows of past exposure for the entire population and for seven age groups.

RESULTS: Median daily concentrations of PM10 and NO2 were 25μg/m(3) (IQR=17.1) and 38μg/m(3) (IQR=20.5), respectively. PM10 was associated with daily medication sales among individuals aged 13 to 64y. For NO2, significant associations were observed among all age groups except >84y. The highest RR were observed for NO2, among adolescents, including three weeks lags (RR=1.187 95%CI: 1.097-1.285).

CONCLUSION: The associations found between temporal changes in exposure to air pollutants and daily sales of respiratory medication in Brussels indicate that urban air pollution contributes to asthma and COPD morbidity in the general population.

%B Environ Int %V 94 %P 576-582 %8 2016 Sep %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/27346740?dopt=Abstract %& 576 %R 10.1016/j.envint.2016.06.019 %0 Generic %D 2016 %T Respiratory medication sales and urban air pollution in Brussels (2005 to 2011). %A An Van Nieuwenhuyse %A Simons,K. %A Nawrot,T. %A Brasseur,O. %A Declerck,P. %A Buyl,R. %A Coomans,D. %A Nemery,B. %A Casas,L. %K air pollution %K Brussels %K electronic %K European %K International %K medication sales %K PRESENTATION %K Respiratory %K Societies %K Society %K urban %B ERS International Congress %I NA %C NA %8 4/9/2016 %G eng %N European Respiratory Society %1 2579 %2 03/09/2016-07/09/2016 %0 Journal Article %J Ecohealth %D 2016 %T Short-term effect of pollen and spore exposure on allergy morbidity in the Brussels-Capital Region. %A Ariane Guilbert %A Simons, Koen %A Lucie Hoebeke %A Ann Packeu %A Marijke Hendrickx %A Koen De Cremer %A Buyl, Ronald %A Coomans, Danny %A An Van Nieuwenhuyse %K Allergic rhinitis %K ecology %K Fungal spore %K Medication %K pollen %K public health %X

Belgium is among the European countries that are the most affected by allergic rhinitis. Pollen grains and fungal spores represent important triggers of symptoms. However, few studies have investigated their real link with disease morbidity over several years. Based on aeroallergen counts and health insurance datasets, the relationship between daily changes in pollen, fungal spore concentrations and daily changes in reimbursable systemic antihistamine sales has been investigated between 2005 and 2011 in the Brussels-Capital Region. A Generalized Linear Model was used and adjusted for air pollution, meteorological conditions, flu, seasonal component and day of the week. We observed an augmentation in drug sales despite no significant increase in allergen levels in the long term. The relative risk of buying allergy medications associated with an interquartile augmentation in pollen distributions increased significantly for Poaceae, Betula, Carpinus, Fraxinus and Quercus. Poaceae affected the widest age group and led to the highest increase of risk which reached 1.13 (95% CI [1.11-1.14]) among the 19- to 39-year-old men. Betula showed the second most consistent relationship across age groups. Clear identification of the provoking agents may improve disease management by customizing prevention programmes. This work also opens several research perspectives related to impact of climate modification or subpopulation sensitivity.

%B Ecohealth %V 13 %P 303-15 %8 2016 Jun %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27174430?dopt=Abstract %R https://doi.org/10.1007/s10393-016-1124-x %0 Journal Article %J Environ Res %D 2016 %T Short-term health effects in the general population following a major train accident with acrylonitrile in Belgium. %A Simons, K %A De Smedt, T %A Stove, C %A De Paepe, P %A Bader, M %A Nemery, B %A Christiane Vleminckx %A Koen De Cremer %A Ilse Van Overmeire %A Sébastien Fierens %A Birgit Mertens %A Göen, T %A Schettgen, T %A Herman Van Oyen %A Joris Van Loco %A An Van Nieuwenhuyse %K acrylonitrile %K Adult %K Belgium %K Chemical Hazard Release %K cotinine %K Dose-Response Relationship, Drug %K Environmental Monitoring %K Female %K Headache %K Humans %K Irritants %K Male %K middle aged %K Nausea %K Railroads %K Self Report %K SMOKING %K Surveys and Questionnaires %K Tremor %K Valine %X

BACKGROUND: Following a train derailment, several tons of acrylonitrile (ACN) exploded, inflamed and part of the ACN ended up in the sewage system of the village of Wetteren. More than 2000 residents living in the close vicinity of the accident and along the sewage system were evacuated. A human biomonitoring study of the adduct N-2-cyanoethylvaline (CEV) was carried out days 14-21 after the accident.

OBJECTIVES: (1) To describe the short-term health effects that were reported by the evacuated residents following the train accident, and (2) to explore the association between the CEV concentrations, extrapolated at the time of the accident, and the self-reported short-term health effects.

METHODS: Short-term health effects were reported in a questionnaire (n=191). An omnibus test of independence was used to investigate the association between the CEV concentrations and the symptoms. Dose-response relationships were quantified by Generalized Additive Models (GAMs).

RESULTS: The most frequently reported symptoms were local symptoms of irritation. In non-smokers, dose-dependency was observed between the CEV levels and the self-reporting of irritation (p=0.007) and nausea (p=0.007). Almost all non-smokers with CEV concentrations above 100pmol/g globin reported irritation symptoms. Both absence and presence of symptoms was reported by non-smokers with CEV concentrations below the reference value and up to 10 times the reference value. Residents who visited the emergency services reported more symptoms. This trend was seen for the whole range of CEV concentrations, and thus independently of the dose.

DISCUSSION AND CONCLUSION: The present study is one of the first to relate exposure levels to a chemical released during a chemical incident to short-term (self-reported) health effects. A dose-response relation was observed between the CEV concentrations and the reporting of short-term health effects in the non-smokers. Overall, the value of self-reported symptoms to assess exposure showed to be limited. The results of this study confirm that a critical view should be taken when considering self-reported health complaints and that ideally biomarkers are monitored to allow an objective assessment of exposure.

%B Environ Res %V 148 %P 256-263 %8 2016 Jul %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/27085497?dopt=Abstract %R 10.1016/j.envres.2016.03.031 %0 Journal Article %J Springerplus %D 2016 %T Simulation enhanced distributed lag models for mortality displacement. %A Simons, Koen %A Buyl, Ronald %A An Van Nieuwenhuyse %A Coomans, Danny %X

Distributed lag models (DLM) are attractive methods for dealing with mortality displacement, however their estimates can have substantial bias when the data is generated by a multi-state model. In particular DLMs are not valid for mortality displacement. Alternative methods are scarce and lack feasibility and validation. We investigate the breakdown of DLM in three state models by means of simulation and propose simulation enhanced distributed lag models (SEDLM) to overcome the defects. The new method provides simultaneous estimates of the net effect (entry) and the displacement effect (exit). These have improved performance over the singular estimate from a regular DLM. SEDLM entry estimates have negligible bias and their variance is reduced. The exit estimates are unbiased and their variance is one order of magnitude lower with respect to the entry estimates. Applying SEDLM to the original Chicago data, the 95% highest posterior density intervals for both entry and exit contain 0, providing neither evidence for a 'displacement effect' nor for a 'net effect'.

%B Springerplus %V 5 %P 1951 %8 2016 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27933234?dopt=Abstract %R 10.1186/s40064-016-3566-6 %0 Report %D 2016 %T Wonen in de omgeving van nucleaire sites in Belgi‰: acute leukemie bij kinderen en schildklierkanker. %A An Van Nieuwenhuyse %A Bollaerts,K. %A De Smedt,T. %A Sonck,M. %A Francart,J. %A Van Bladel,L. %K Belgi‰ %K de %K nucleaire sites %K schildklierkanker %K x %V X %8 2016/10/01/ %G eng %1 2637 %0 Report %D 2016 %T Zesde WHO-gecoördineerd onderzoek naar persistente organische polluenten (POP's) in moedermelk: Belgische resultaten 2014 %A Ilse Van Overmeire %A Colles,A. %A Raf Aerts %A Janssens,B. %A Covaci,A. %A Mirjana Andjelkovic %A Laure Joly %A Poma,G. %A Malarvannan,G. %A De Smedt,T. %A Koppen,G. %A Joris Van Loco %A An Van Nieuwenhuyse %K Belgische %K moedermelk %K POP %K WHO %X

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.

%B WHO-gecoördineerd onderzoek naar persistente organische polluenten %I WIV-ISP en VITO %C Brussel/Mol %V lot 1 %P 22 %8 2016 %G eng %U NA %M NA %1 2641 %0 Generic %D 2015 %T Analysis of the short-term effect of pollen and spore exposure on allergy medication sales %A Ariane Guilbert %A Koen Simons %A Ann Packeu %A Koen De Cremer %A Lucie Hoebeke %A Marijke Hendrickx %A An Van Nieuwenhuyse %K allergy medication %K exposure %K pollen %K sales %K spores %X

Allergic rhinitis takes a heavy toll in Belgium. Pollen is an important trigger but fungal spores might also influence the onset of symptoms. The purpose of this study was to assess the health impact of these aeroallergens based on their repercussion on allergy medication sales in the Brussels-Capital Region. Methods: The relationship between daily changes in pollen and spore concentrations and daily changes in reimbursable systemic antihistamine sales has been investigated with times series analysis. 8 pollen and 2 spore species were tested for different age and gender categories. A generalized linear model was used and adjusted for air pollutant concentrations, climate factors, flu, seasonal component and day of the week. Analysis focused on the 2005-2011 period. Results: For most age groups, the relative risk of buying allergy medications associated with an interquartile augmentation in pollen concentrations increased significantly for Betula, Carpinus and Gramineae. Associations existed but were less consistent across ages for Quercus, Fraxinus, and Taxus Cupressaceae. Considering a 10 days cumulative effect, the relative risk reached up to 1,11 (95%CI [1,09-1,12]) for Gramineae among the 19-39 years customers. Risk pattern varied according to gender. Discussion: Little research in this field has been carried out worldwide and extrapolation from previous studies is hazardous given the high influence of the local context. This multidisciplinary study is the first of this kind in Belgium and demonstrates the large health consequences of Gramineae and several common tree species for the Brussels area. It distinguishes itself by its duration, sensitivity and completeness of data (any sale of reimbursable drugs was captured, daily data of various cofactors were used). This work opens several research perspectives related to subpopulation sensitivity or impact of climate modification (changes in pollen concentration, occurrence of novel aeroallergens).

%B 27th Conference of the International Society for Environmental Epidemiology %I ISEE %C São Paulo, Brazil %8 2015 %G eng %& ID: 2015-2013 %0 Report %D 2015 %T Etat des lieux de l'allergie en Région de Bruxelles-Capitale. Recensement des bases de données relatives aux allergies respiratoires dans la région. %A Ariane Guilbert %A Camille Chasseur %A Koen De Cremer %A An Van Nieuwenhuyse %K allergique %K asthme %K bases de données %K Bruxelles %K hospitalisations %K médicaments %K mortalité %K Observation %K rhinite %I WIV-ISP %C Bruxelles, Belgique %P NA %8 04/2015 %G eng %M NA %0 Journal Article %J Cancer Epidemiol %D 2015 %T Thyroid cancer incidence around the Belgian nuclear sites: surrogate exposure modelling. %A Bollaerts, Kaatje %A Sonck, Michel %A Simons, Koen %A Sébastien Fierens %A Poffijn, André %A Van Bladel, Lodewijk %A Geraets, David %A Gosselin, Pol %A Herman Van Oyen %A Francart, Julie %A An Van Nieuwenhuyse %K Belgium %K environmental exposure %K Female %K Humans %K incidence %K Male %K Models, Theoretical %K Neoplasms, Radiation-Induced %K Nuclear Power Plants %K REGISTRIES %K Thyroid Neoplasms %X

BACKGROUND: In a recent ecological study among residents living around Belgian nuclear sites (the NUCABEL study), significant increased incidences of thyroid cancer were observed around the two nuclear facilities with industrial and research activities (Mol-Dessel and Fleurus), prompting further research.

METHODS: The data from the NUCABEL study were reanalysed to test the hypothesis of a gradient in cancer incidence with increasing levels of exposure from these sites using three measures of surrogate exposure, being (i) residential proximity, (ii) prevailing wind directions and (iii) simulated dispersion of radioactive discharges. Single-site focussed hypothesis tests were complemented with Generalized Additive Models to estimate the exposure-response relationships.

RESULTS: For Mol-Dessel, the results of the focussed hypothesis tests were far from significant. For Fleurus, the p-values were much closer to significance with p=0.05 for Bithell's Linear Risk Score using radioactive discharge estimates as surrogate.

CONCLUSIONS: The re-analyses refute an association with the nuclear facilities for the site of Mol-Dessel. For the site of Fleurus, one of Europe's major production sites of radio-iodines, the results were less conclusive and further research suggests itself.

%B Cancer Epidemiol %V 39 %P 48-54 %8 2015 Feb %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/25475063?dopt=Abstract %& 48 %R 10.1016/j.canep.2014.10.011 %0 Journal Article %J Toxicol Lett %D 2014 %T Acrylonitrile exposure assessment in the emergency responders of a major train accident in Belgium: a human biomonitoring study. %A An Van Nieuwenhuyse %A Sébastien Fierens %A De Smedt, T %A Koen De Cremer %A Christiane Vleminckx %A Birgit Mertens %A Ilse Van Overmeire %A Bader, M %A De Paepe, P %A Göen, T %A Nemery, B %A Schettgen, T %A Stove, C %A Herman Van Oyen %A Joris Van Loco %K acrylonitrile %K Adult %K Belgium %K Chemical Hazard Release %K Emergency Responders %K Environmental Monitoring %K Female %K Humans %K Male %K middle aged %K Occupational Exposure %K Railroads %K regression analysis %K Surveys and Questionnaires %K Valine %X

BACKGROUND: On May 4, 2013, a train transporting chemicals derailed in Wetteren, Belgium. Several tanks loaded with acrylonitrile (ACN) exploded, resulting in a fire and a leakage of ACN.

OBJECTIVES: To determine exposure to ACN and to assess discriminating factors for ACN exposure in the emergency responders involved in the on-site management of the train accident.

METHODS: The study population consisted of 841 emergency responders. Between May 21 and June 28, they gave blood for the determination of N-2-cyanoethylvaline (CEV) hemoglobin adducts and urine for the measurement of cotinine. They also filled in a short questionnaire.

RESULTS: 163 (26%) non-smokers and 55 (27%) smokers showed CEV concentrations above the reference values of 10 and 200 pmol/g globin, respectively. The 95th percentile in the non-smokers was 73 pmol/g globin and the maximum was 452 pmol/g globin. ACN exposure among the non-smokers was predicted by (1) the distance to the accident, (2) the duration of exposure, and (3) the occupational function.

DISCUSSION AND CONCLUSION: Emergency responders involved in the on-site management of the train accident were clearly exposed to ACN from the accident. However, the extent of exposure remained relatively moderate with CEV concentrations staying within the ranges described in literature as background for a smoking population. Moreover, the exposure was less pronounced in the emergency responders as compared to that in the local population.

%B Toxicol Lett %V 231 %P 352-9 %8 2014 Dec 15 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/25128591?dopt=Abstract %R 10.1016/j.toxlet.2014.08.013 %0 Journal Article %J Toxicol Lett %D 2014 %T Acrylonitrile exposure in the general population following a major train accident in Belgium: a human biomonitoring study. %A De Smedt, T %A Koen De Cremer %A Christiane Vleminckx %A Sébastien Fierens %A Birgit Mertens %A Ilse Van Overmeire %A Bader, M %A De Paepe, P %A Göen, T %A Nemery, B %A Schettgen, T %A Stove, C %A Herman Van Oyen %A Joris Van Loco %A An Van Nieuwenhuyse %K acrylonitrile %K Adult %K Belgium %K Chemical Hazard Release %K environmental exposure %K Environmental Monitoring %K Female %K Humans %K Male %K middle aged %K Railroads %K Sewage %K Surveys and Questionnaires %K Valine %X

BACKGROUND: On Saturday May 4, 2013, a train transporting chemicals derailed in the village of Wetteren (Belgium) and caused a leak of acrylonitrile (ACN).

OBJECTIVES: To assess the human exposure to acrylonitrile in the local population with the highest suspected exposure.

METHODS: Between May 18-25, 242 residents participated in the study. N-2-cyanoethylvaline (CEV), a biomarker that is highly specific for ACN exposure, was measured in the blood. To account for potential influence by smoking, cotinine was determined in the urine. Participants also filled in a short questionnaire.

RESULTS: In the evacuated zone, 37.3% of the non-smokers and 40.0% of the smokers had CEV concentrations above the reference values of 10 and 200 pmol/g globin, respectively, at the time of the train accident. Spatial mapping of the CEV concentrations depending on the residential address showed a distribution pattern following the sewage system.

DISCUSSION AND CONCLUSION: The train derailment resulted in a highly atypical sequence-of-events. In addition to exposure in the direct vicinity of the site of the train derailment, exposure also occurred via the sewage system, into which acrylonitrile had entered shortly after the accident.

%B Toxicol Lett %V 231 %P 344-51 %8 2014 Dec 15 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/25223249?dopt=Abstract %R 10.1016/j.toxlet.2014.09.009 %0 Generic %D 2014 %T Biomonitoring survey of residents and emergency responders exposed to acrylonitrile after the train disaster in Wetteren (Belgium) %A Joris Van Loco %A T. De Smedt %A Koen De Cremer %A Sébastien Fierens %A Christiane Vleminckx %A Ilse Van Overmeire %A Gijs,G. %A An Van Nieuwenhuyse %A Herman Van Oyen %K acrylonitrile %K Belgium %K biomonitoring %K chemistry %K Emergencies %K Emergency %K environmental %K International %K ON %K residents %K survey %K symposium %K Wetteren %B 38th International Symposium on Environmental Analytical Chemistry %I NA %C NA %8 20/6/2014 %G eng %N IAEAC %1 2249 %2 17-20/06/2014 %0 Journal Article %J Thyroid %D 2014 %T Thyroid cancer incidence in the vicinity of nuclear sites in Belgium 2000-2008 %A Bollaerts,K. %A Sébastien Fierens %A Van Bladel,L. %A K Simons %A Sonk,M. %A Poffijn,A. %A Geraets,D. %A P Gosselin %A Herman Van Oyen %A Francart,J. %A An Van Nieuwenhuyse %K Activity %K ALL %K an %K Analyses %K analysi %K analysis %K Area %K AS %K Belgian %K Belgium %K cancer %K Cancer incidence %K Combination %K environment %K evidence %K exposure %K Hand %K health %K Health outcome %K incidence %K Increase %K Increases %K Iodine %K IS %K Isotopes %K Leukemia %K living %K nuclear site %K observed %K ON %K outcome %K plant %K Plants %K POISSON %K Poisson regression %K POPULATION %K public %K public health %K Public-health %K regression %K Research %K residents %K result %K results %K SENSITIVITY %K SENSITIVITY analysis %K Size %K study %K THYROID %X

Background:

%B Thyroid %V 24 %P 906 - 917 %8 0/5/2014 %G eng %N 5 %1 35251 %& 906 %R 10.1089/thy.2013.0227 %0 Generic %D 2013 %T Alleviating ecological bias in linking radon exposure to acute childhood leukaemia. %A T. De Smedt %A K Simons %A Poffijn,A. %A Francart,J. %A An Van Nieuwenhuyse %K aims %K Area %K Areas %K AS %K association %K Associations %K bias %K childhood leukaemia %K conference %K Countries %K Development %K disease %K distribution %K ecological bias %K ecological bias,ecological fallacy,ecological study design %K environment %K exposure %K factors %K Geographical %K health %K Indoor %K IS %K leukaemia %K Linear Models %K method %K methodology %K methods %K MODEL %K models %K Multiple %K public %K public health %K Public-health %K Radiation %K radon %K RATES %K regression %K relative %K Relative risk %K result %K results %K risk %K Risk Factors %K study %K threshold %K use %K VALIDATION %K VARIABILITY %X

Background

%B Environment and Health - Bridging South, North, East and West, Conference of ISEE, ISES and ISIAQ %S Environ.Health Perspect. %I NA %C NA %8 19/8/2013 %G eng %N ISEE,ISES and ISIAQ %1 35253 %2 19/08/2013 %0 Generic %D 2013 %T Alleviating ecological bias in linking radon exposure to health outcomes. %A T. De Smedt %A K Simons %A Poffijn,A. %A Francart,J. %A An Van Nieuwenhuyse %K ALL %K alternative %K an %K Area %K Areas %K AS %K association %K Associations %K Belgium %K bias %K cancer %K Cancer incidence %K conference %K Countries %K Development %K distribution %K ecological bias %K ecological fallacy,ecological study design %K environment %K exposure %K function %K health %K Health outcome %K Health outcomes %K incidence %K Indoor %K IS %K Linear Models %K measurement %K method %K methodology %K methods %K MODEL %K models %K need %K outcome %K outcomes %K radon %K RANGE %K RATES %K regression %K relative %K Relative risk %K risk %K SKIN %K study %K use %K VARIABILITY %K Vector %X

Background

%B Environment and Health - Bridging South, North, East and West, Conference of ISEE, ISES and ISIAQ %I NA %C NA %8 19/8/2013 %G eng %N ISEE,ISES and ISIAQ %1 35252 %2 19/08/2013 %0 Generic %D 2013 %T Biomonitoring survey of residents and rescue workers for acrylonitrile after the train disaster in Wetteren (Belgium) %A Joris Van Loco %A T. De Smedt %A Koen De Cremer %A Sébastien Fierens %A Christiane Vleminckx %A Ilse Van Overmeire %A Gijs,G. %A An Van Nieuwenhuyse %A Herman Van Oyen %K Belgium %K residents %K survey %K worker %K Workers %B BEMS meeting %I NA %C NA %8 22/11/2013 %G eng %N Belgian environmental mutagen society %1 2204 %2 22/11/2013 %0 Generic %D 2013 %T Biomonitoring survey of residents and rescue workers for acrylonitrile after the train disaster in Wetteren (Belgium) %A Joris Van Loco %A Koen De Cremer %A T. De Smedt %A Sébastien Fierens %A Ilse Van Overmeire %A Gijs,G. %A An Van Nieuwenhuyse %A Herman Van Oyen %K / %K acrylonitrile %K Belgium %K biomonitoring %K residents %K survey %K Wetteren %K worker %K Workers %B / %I NA %C NA %8 4/12/2013 %G eng %N Vlaamse Wetenschappelijke Vereniging voor Arbeidsgeneeskunde (VWVA) %1 35260 %2 04/12/2013 %0 Generic %D 2013 %T A biomonitoring survey of the residents and the rescue workers for acrylonitrile after the train disaster in Wetteren (Belgium) %A Joris Van Loco %A T. De Smedt %A Koen De Cremer %A Sébastien Fierens %A Ilse Van Overmeire %A An Van Nieuwenhuyse %A Herman Van Oyen %K accident %K acrylonitrile %K ALL %K Analyses %K at %K Belgian %K Belgium %K biomonitoring %K blood %K chemicals %K conference %K data %K Data collection %K demand %K distribution %K ET %K Europe %K European %K exposure %K function %K Half-Life %K health %K Human %K human exposure %K INFORMATION %K IS %K living %K measure %K method %K methods %K nonsmokers %K objectives %K observed %K ON %K Participation %K past %K pattern %K People %K person %K POPULATION %K Populations %K PRODUCTS %K public %K public health %K Public-health %K Questionnaire %K RANGE %K Reference Values %K residence %K residents %K result %K results %K Sample %K Samples %K Service %K Services %K Smoke %K smokers %K SMOKING %K SOCIAL %K specific %K Statistical %K status %K study %K survey %K System %K time %K tobacco %K urine %K values %K Wetteren %K WHO %K worker %K Workers %X presentation at the 6th EUROPEAN PUBLIC HEALTH CONFERENCE - Health in Europe: are we there yet? Learning from the past, building the future %B 6th EUROPEAN PUBLIC HEALTH CONFERENCE Health in Europe: are we there yet? Learning from the past, building the future %I NA %C NA %8 0/0/2013 %G eng %N European Public Health Association (EUPHA) %1 235 %2 13-16/11/2013 %0 Generic %D 2013 %T Childhood Leukaemia incidence around the Belgian nuclear sites: Surrogate exposure modelling. %A K Simons %A Bollaerts,K. %A Sonk,M. %A Sébastien Fierens %A Poffijn,A. %A Van Bladel,L. %A Geraets,D. %A P Gosselin %A Herman Van Oyen %A Francart,J. %A An Van Nieuwenhuyse %K age %K an %K approach %K approaches %K Area %K AS %K association %K Belgian %K Belgium %K cancer %K Cancer incidence %K cancer registry %K childhood leukaemia %K CHILDREN %K comparing %K Control %K data %K evidence %K exposure %K Flemish %K generalized additive models %K health %K Hypothesis %K incidence %K Industries %K Industry %K International %K IS %K Less %K leukaemia %K limitation %K Limitations %K living %K measure %K measures %K method %K methods %K MODEL %K models %K Multiple %K nuclear site %K Nuclear sites %K ON %K Paper %K period %K plant %K Plants %K POPULATION %K Populations %K region %K REGISTRIES %K Registry %K Research %K result %K results %K sex %K Statistical %K Still %K study %K surrogate %K Surrogate-exposure Modelling %K survey %K Test %K tests %K use %K Wind %X Background: Health eects among populations living in the vicinity of nuclear installations have been a major area of concern for several decadesalready. The main focus is on childhood leukaemia. The dominant approach is an ecological study using residential proximity to the nuclear site, however complexradio-active discharge models have also been used. Data: The Belgian Cancer Registry provided data on Childhood leukaemia incidence by commune, age and sex. For the Flemish region this data spans theincidence years 2000-08; for the Walloon and Brussels-Capital Region the data span 2004-08. The study considers four nuclear sites. For each site, the FederalAgency for Nuclear Control used survey stations to measure wind direction and velocity for the period 2003-08.Methods: This paper describes an ecological study on leukaemia incidence in children living in the vicinity of nuclear installations in Belgium. Each nuclear sitewas treated as a point-source and single-site focussed hypothesis tests were used to test for a gradient in childhood leukaemia incidence with residential proximityto the site. In addition, two other surrogate exposures were used: prevailing wind direction and simulated radioactive discharges. The hypothesis tests were com-plemented by estimating the shape of the exposure-response relationship using Generalized Additive Models.Results: For the nuclear power plants of Doel and Tihange, no evidence of a gradient in childhood leukaemia cancer incidence related to any surrogate exposurewas found. For the nuclear research- and industry sites of Mol-Dessel and Fleurus, individual tests were less uniform. Only for Mol-Dessel it can be concludedthat the evidence may be suggestive of a potential association with the site.Conclusions: The use of multiple measures of surrogate exposures and multiple statistical methods has added value when investigating a priori dened point-sources. Each surrogate has implicit assumptions and precision and each statistical method relies on its own assumptions. By combining and comparing theresults of multiple approaches, new insights can be gained. However, it should be noted that the results are still subject to the limitations of the ecological design. %B 28th international workshop on statistical modelling %V 2 %P 773 - 778 %8 8/7/2013 %G eng %N / %1 35258 %2 July 8-12 2013 %& 773 %0 Generic %D 2013 %T Health impact assessment of PM10 and PM2.5 exposure in Wallonia %A Voisin,C. %A Fierens,F. %A Charlier,V. %A An Van Nieuwenhuyse %E The International Federation of Environmental Health %K assessment %K Congresses %K environmental %K exposure %K health %K health impact %K health impact assessment %K Impact %K ON %K PM10 %K PM2.5 %K world %B 12 th World Congress on Environmental Health %8 0/0/2013 %G eng %N THE INTERNATIONAL FEDERATION OF ENVIRONMENTAL HEALTH %1 35265 %2 May 22-27 2012 %0 Report %D 2013 %T Pollution de l'air intérieur : 1) revue de la littérature 2) plans d'action et de communication dans les écoles %A Voisin,C. %A Camille Chasseur %A P Gosselin %A Sébastien Fierens %A An Van Nieuwenhuyse %K Communication %K de %K ET %K LE %K pollution de l'air %I WIV-ISP %C Bruxelles %P 100 %8 0/0/2013 %@ D/2012/2505/11 %G eng %1 35266 %0 Journal Article %J Annalen van de Belgische Vereniging voor Stralingsbescherming (BVSABR) %D 2013 %T Samenvatting resultaten studie "wonen in de omgeving van nucleaire sites in België: monitoring van potentiële gezondheidseffecten" %A K Simons %A Bollaerts,K. %A Sébastien Fierens %A Van Bladel,L. %A Sonk,M. %A Poffijn,A. %A Geraets,D. %A P Gosselin %A Herman Van Oyen %A Francart,J. %A An Van Nieuwenhuyse %K België %K de %K gezondheidseffecten %K Monitoring %K nucleaire sites %X / %B Annalen van de Belgische Vereniging voor Stralingsbescherming (BVSABR) %V 38 %P 27 - 33 %8 0/0/2013 %G eng %N 1 %1 35256 %& 27 %0 Generic %D 2013 %T The setup of a biomonitoring survey of the residents and the rescue workers for acrylonitrile after the train disaster in Wetteren (Belgium) %A Joris Van Loco %A T. De Smedt %A Koen De Cremer %A Sébastien Fierens %A Christiane Vleminckx %A Ilse Van Overmeire %A An Van Nieuwenhuyse %A Herman Van Oyen %K Belgium %K conference %K European %K health %K public %K public health %K Public-health %K residents %K survey %K worker %K Workers %B European Public Health Conference %8 15/11/2013 %G eng %N EUPHA %1 2205 %2 14-16/11/2013 %0 Journal Article %J Int Arch Occup Environ Health %D 2013 %T Sick leave due to back pain in a cohort of young workers. %A An Van Nieuwenhuyse %A Burdorf, A %A Crombez, G %A Verbeke, G %A Masschelein, R %A Mairiaux, Ph %A Moens, G F %K Adult %K Automobile Driving %K Boredom %K Career Mobility %K Female %K Health Care Sector %K Humans %K Low Back Pain %K Male %K Occupational Diseases %K Posture %K Risk Factors %K sick leave %K Surveys and Questionnaires %K Transportation %K Workload %K Workplace %K Young adult %X

PURPOSE: Evidence on risk factors for sick leave from prospective studies in work settings is limited. Furthermore, most available studies focused on workers with substantial low back disorders. These studies consistently report that physical work factors constitute a hindrance to work. However, it remains unclear whether the same risk factors are relevant in workers with less severe conditions or in early phases of the development of back pain. Therefore, this article aims to study risk factors for the occurrence of sick leave due to low back pain (LBP) among young workers with no or a modest history of back pain.

METHODS: Participants were 716 young healthcare or distribution workers with no or minimal antecedents of LBP in the year before inclusion. We investigated the role of potential physical, psychosocial and individual risk factors at baseline on the occurrence of sick leave due to LBP 1 year later. To this purpose, we used Cox regression with a constant risk period.

RESULTS: Six per cent (95 % CI 4.1-7.6) of the workers reported sick leave 1 year later; they accounted for 12 % of the sick-leave days independent of cause. A non-stimulating psychosocial work environment turned out to be the strongest risk factor for sick leave due to LBP (RR 6.08; 95 % CI 1.42-26.07). Physical factors were not predictive.

CONCLUSIONS: In the early phases of back pain and in less severe conditions, the main benefit of interventions lies in targeting the organisation and design of jobs to create a challenging professional environment.

%B Int Arch Occup Environ Health %V 86 %P 887-99 %8 2013 Nov %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/23111535?dopt=Abstract %R 10.1007/s00420-012-0824-y %0 Generic %D 2012 %T Absentéisme pour douleurs lombaires au sein d'une cohorte de jeunes travailleurs en Belgique. %A An Van Nieuwenhuyse %A Burdorf,A. %A Crombez,G. %A Verbeke,G. %A Mairiaux,P. %A G.F. Moens %K cohorte %K de %K douleurs lombaires %K EN %K International %B Ve Congrès International de l'Epidémiologie ADELF EPITER %S Revue d'Epidémiologie et de Santé Publique %V 60 %P S142 %8 0/0/2012 %G eng %N / %1 35261 %2 September 12-14 2012 %& S142 %0 Generic %D 2012 %T Evaluation de l'incidence de leucémie chez les enfants habitants à proximité de sites nucléaires en Belgique %A Sébastien Fierens %A Bollaerts,K. %A K Simons %A Francart,J. %A Poffijn,A. %A Sonk,M. %A Van Bladel,L. %A Geraets,D. %A P Gosselin %A Herman Van Oyen %A Van Eycken,L. %A An Van Nieuwenhuyse %E Société Française de Santé environnementale %K de %K EN %K ET %K EVALUATION %K LE %K leucémies %K national %K santé %K sites nucléaires %B 3e congrès national de santé et environnement %I NA %C NA %8 0/0/2012 %G eng %N Société Française de Santé environnementale %1 35254 %2 September 5-6 2012 %0 Report %D 2012 %T Les rayonnements radiofréquences: revue de la littérature de l'impact sanitaire. Support scientifique en vue de la création d'un outil de communication vers la population de la Fédération Wallonie-Bruxelles %A Voisin,C. %A Pirard,W. %A Lowie,M. %A Sébastien Fierens %A An Van Nieuwenhuyse %K Communication %K de %K EN %K LE %K POPULATION %K rayonnements radiofrequences %I WIV-ISP %C Brussels %P 14 %8 0/0/2012 %@ D/2012/2505/52 %G eng %1 35263 %0 Generic %D 2012 %T Monitoring of possible health effects in the vicinity of nuclear sites in Belgium: is there an increases incidence of childhood leukemia? %A Bollaerts,K. %A Sébastien Fierens %A Simmons,K. %A Francart,J. %A Poffijn,A. %A Sonck,M. %A Van Bladel,L. %A Geraerts,D. %A P Gosselin %A Herman Van Oyen %A Van Eycken,L. %A An Van Nieuwenhuyse %K an %K association %K Belgium %K CHILDHOOD %K Childhood leukemia %K Congresses %K effect %K effects %K health %K health effects %K incidence %K Increase %K Increases %K International %K IS %K Leukemia %K Monitoring %K Nuclear %K nuclear site %K Nuclear sites %K protection %K Radiation %K Radiation Protection %K Sites %K Vicinity %B 13th International Congress of the International Radiation Protection Association %C Glasgow, Scotland %8 0/0/2012 %G eng %N ? %1 36371 %2 ? %0 Report %D 2012 %T Monitoring of possible health effects of living in the vicinity of nuclear sites in Belgium %A Bollaerts,K. %A Sébastien Fierens %A K Simons %A Francart,J. %A Poffijn,A. %A Sonk,M. %A Van Bladel,L. %A Geraets,D. %A P Gosselin %A Herman Van Oyen %A Van Eycken,L. %A An Van Nieuwenhuyse %K Belgium %K effect %K effects %K health %K health effects %K living %K Monitoring %I WIV-ISP %C Brussels %P 150 %8 0/0/2012 %@ D/2012/2505/01 %G eng %1 209 %0 Generic %D 2012 %T Monitoring of thyroid cancer incidence in the vicinity of nuclear sites in Belgium %A Bollaerts,K. %A Sébastien Fierens %A K Simons %A Francart,J. %A Poffijn,A. %A Sonk,M. %A Van Bladel,L. %A Geraets,D. %A P Gosselin %A Herman Van Oyen %A Van Eycken,L. %A An Van Nieuwenhuyse %K cancer %K Cancer incidence %K European %K incidence %K International %K Monitoring %K THYROID %B 1 4 th International Workshop Multidisciplinary European Low Dose Initiative (MELODI) %I NA %C NA %8 0/0/2012 %G eng %N MELODI %1 35249 %2 September 12-14 2012 %0 Generic %D 2012 %T On smoothing time series with low average counts %A K Simons %A An Van Nieuwenhuyse %A Coomans,D. %K 2012 %K Analyses %K AS %K Belgian %K city %K conference %K data %K effect %K effects %K generalized additive models %K health %K Health outcome %K Health outcomes %K Impact %K International %K IS %K method %K methods %K MODEL %K models %K Monitoring %K morbidity %K mortality %K ON %K outcome %K outcomes %K scale %K Selection %K series %K study %K summary %K time %K Time series %K Time-series %X Generalized Additive Models have been widely adopted for studies of acute effects of particulate matter on mortality and morbidity. Monitoringof pollutants and health outcomes increased worldwide and investigators thus increasingly relied on automatic selection methods that exist ofsummary statistics such as AIC and PACF. Methodological studies have used simulations to compare selection methods and their impact on largescale multi-city analyses and concluded that aggressive smoothing is to be preferred. For smaller groups, these effects can be visualised with simpleresidual plots. Data from Belgian cities is used to illustrate the effect of over-smoothing on time series with low average counts. %B 20th international conference on computational statistics (Compstat 2012) %8 27/8/2012 %G eng %N / %1 35255 %2 August 27-31 2012 %0 Journal Article %J Eur J Cancer Prev %D 2011 %T Cytological screening for cervical cancer in the province of Limburg, Belgium. %A M. Arbyn %A An Van Nieuwenhuyse %A Bogers, Johannes %A De Jonge, Eric %A De Beeck, Lode Op %A Matheï, Catharina %A Buntinx, Frank %K Adult %K Belgium %K Female %K Humans %K Mass Screening %K middle aged %K Neoplasms, Squamous Cell %K Papanicolaou Test %K REGISTRIES %K Uterine Cervical Neoplasms %K Vaginal Smears %X

Cervical cancer screening in Belgium is mainly opportunistic with periodic attempts to organize it according to the European guidelines. In the province of Limburg (north-east Belgium), a cervical cytology registry was set up in collaboration with local cytopathological laboratories, provincial health authorities and the Limburg Cancer Registry. Laboratories regularly communicated coded results of Pap smears from women residents in Limburg to the provincial cytological registry. All individual records contained a virtually unique identifying code allowing the study of longitudinal histories and linkage with the cancer registry. The screening coverage (percentage of women with a Pap smear in a defined period), the prevalence and incidence of squamous intraepithelial lesions and changes over time and geographical area were evaluated using a database of more than 600 000 Pap smear interpretations between 1996 and 2005. In 2000, 47% of women aged between 25 and 64 years had at least one Pap smear recorded in the last 3 years, and the average number of smears screened for each woman was 1.5. On account of incomplete registration, the coverage was 8% lower than estimated from health insurance data. The modal screening interval was in the range of 12-14 months; the first quartile, median and third quartile were 355, 440 and 676 days, respectively. Over the 10 years, 82% of the target population had their Pap smear recorded. The prevalence of cytological abnormalities was 3.7% (atypical squamous cells of undetermined significance: 2.2%, atypical glandular cells of undetermined significance: 0.1%, low-grade squamous intraepithelial lesion: 1.1%, high-grade squamous intraepithelial lesion or more serious lesions: 0.4%), but varied substantially among laboratories. The prevalence of atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion increased significantly over time. Pathologists from Limburg have pioneered cytology registration in the context of opportunistic screening in Belgium. The estimated screening coverage was slightly underestimated. Obligatory registration, use of a uniform terminology and linkage with population and follow-up data are needed to give a cytology registry its full role in an organized screening programme.

%B Eur J Cancer Prev %V 20 %P 18-24 %8 2011 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/20805755?dopt=Abstract %R 10.1097/CEJ.0b013e32833ecbc6 %0 Report %D 2011 %T Feasibility study for establishing a registration system for studying the relationship between childhood cancer & environment %A P Gosselin %A K Simons %A Luc Verschaeve %A An Van Nieuwenhuyse %K childhood cancer %K environment %K feasibility study %I NEHAP %C Brussels, Belgium %P 135 %8 12/2011 %G eng %M D/2011/2505/62 %& 1 %0 Journal Article %J Arch Public Health %D 2011 %T Human biomonitoring on heavy metals in Ath: methodological aspects. %A Javiera Rebolledo %A Sébastien Fierens %A Versporten, Ann %A Brits, Ethel %A De Plaen, Pierre %A An Van Nieuwenhuyse %X

The municipality of Ath is characterised by the presence, in its center, of two non-ferrous metal industries whose emissions make local residents concerned for their health. Therefore, authorities of the Walloon Region and the municipality of Ath undertook biomonitoring to assess the impact of those industrial emissions on heavy metal body burden in humans.This paper describes the study design and methodology used to carry out this human biomonitoring.A random sampling was done in the general population, in two areas of Ath: an area centered around the industries and a peripheral area. The target population was children (2.5-11 years) and adults (40-60 years) without occupational exposure. The three-stage sampling procedure consisted of a mixture of both mail and telephone recruitment. Firstly, 3259 eligible people, identified from a population register, were mailed an introductory letter. In a second stage, eligible individuals were contacted by phone to propose them to participate in the study. They were randomly contacted until the required sample size was obtained. In the third stage, a second mail was sent to those who agreed to participate with a questionnaire to be filled out. Finally, biological samples (blood and urine) from 278 persons were collected. The final participation rate of this study was 24%.This sampling procedure, especially designed for the purpose of this biomonitoring study in Ath, allowed us to recruit a sample representative of the population of children and adults of Ath, reaching the expected sample size in a short period of time.

%B Arch Public Health %V 69 %P 10 %8 2011 Dec 05 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/22958427?dopt=Abstract %R 10.1186/0778-7367-69-10 %0 Journal Article %J BMC Musculoskelet Disord %D 2009 %T Physical characteristics of the back are not predictive of low back pain in healthy workers: a prospective study. %A An Van Nieuwenhuyse %A Crombez, Geert %A Burdorf, Alex %A Verbeke, Geert %A Masschelein, Raphael %A Moens, Guido %A Mairiaux, Philippe %K Adult %K Back %K Cohort Studies %K comorbidity %K Female %K Humans %K Low Back Pain %K Male %K Mass Screening %K Obesity %K Pain Measurement %K Physical Examination %K Predictive Value of Tests %K prevalence %K Prospective Studies %K Range of Motion, Articular %K Risk Factors %K Sciatica %K Self-Assessment %K Surveys and Questionnaires %K Young adult %X

BACKGROUND: In the working population, back disorders are an important reason for sick leave and permanent work inability. In the context of fitting the job to the worker, one of the primary tasks of the occupational health physician is to evaluate the balance between work-related and individual variables. Since this evaluation of work capacity often consists of a physical examination of the back, the objective of this study was to investigate whether a physical examination of the low back, which is routinely performed in occupational medicine, predicts the development of low back pain (LBP).

METHODS: This study is part of the Belgian Low Back Cohort (BelCoBack) Study, a prospective study to identify risk factors for the development of low back disorders in occupational settings. The study population for this paper were 692 young healthcare or distribution workers (mean age of 26 years) with no or limited back antecedents in the year before inclusion. At baseline, these workers underwent a standardised physical examination of the low back. One year later, they completed a questionnaire on the occurrence of LBP and some of its characteristics. To study the respective role of predictors at baseline on the occurrence of LBP, we opted for Cox regression with a constant risk period. Analyses were performed separately for workers without any back antecedents in the year before inclusion ('asymptomatic' workers) and for workers with limited back antecedents in the year before inclusion ('mildly symptomatic' workers).

RESULTS: In the group of 'asymptomatic' workers, obese workers showed a more than twofold-increased risk on the development of LBP as compared to non-obese colleagues (RR 2.57, 95%CI: 1.09 - 6.09). In the group of 'mildly symptomatic' workers, the self-reports of pain before the examination turned out to be most predictive (RR 3.89, 95%CI: 1.20 - 12.64).

CONCLUSION: This study showed that, in a population of young workers wh no or limited antecedents of LBP at baseline, physical examinations, as routinely assessed in occupational medicine, are not useful to predict workers at risk for the development of back disorders one year later.

%B BMC Musculoskelet Disord %V 10 %P 2 %8 2009 Jan 05 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/19123931?dopt=Abstract %R 10.1186/1471-2474-10-2 %0 Journal Article %D 0 %T Simultaneous determination of parabens, bisphenols and alkylphenols in human placenta by ultra-high performance liquid chromatography - tandem mass spectrometry %A Ilse Van Overmeire %A K. Vrijens %A Nawrot, T. %A An Van Nieuwenhuyse %A Joris Van Loco %A Tim Reyns %K Alkylphenol %K Bisphenol %K endocrine disruptor %K Paraben %K Placenta %K UHPLC-MS/MS %X This study presents de development and validation of an ultra- high performance liquid chromatography – tandem mass spectrometry (UHPLC-MS/MS) method for the simultaneous determination of four parabens (methyl-, ethyl-, propyl-, and butyl-paraben (MeP, EtP, PrP, BuP), four bisphenols (BP) (BPA, BPB, BPF, and BPS) and two alkylphenols (nonyl phenol (NP) and tert-octylphenol (OP) in human placenta samples. After a short sample preparation time the extracts are analysed by UHPLC-MS/MS using negative electrospray ionization. Labeled internal standards and matrix-matched calibration are used for quantification of the compounds. The method was validated according FDA guideline for bio analytical methods using spiked samples at three concentration levels (0.5–5 and 25 ng g−1). The parameters accuracy and precision fulfill the criteria. Calibration curves are linear between 0.5 and 50 ng −1. The limits of detection and quantification are in the range of 0.1–0.3 ng g−1 and 0.2–0.7 ng g−1, respectively. The applicability of the method was demonstrated on 71 human placenta samples from a Belgian cohort. The detection frequency was highest for OP (95%), EtP (86%), BPA (49%) and BPS (44%). Among the quantified compounds the highest quantification frequency was observed for OP (85%), EtP (65%) and BPA (25%). The concentrations of parabens ranged from 0.5 to 7.1 ng g−1 for MeP, from 0.5 to 4.5 ng g−1 for EtP and from 0.5 to 9.1 ng g−1 for PrP. The levels of bisphenols ranged from 0.5 to 3.9 ng g−1 for BPA, from 0.6 to 2.1 ng g−1 for BPF and from 0.8 to 1.3 ng g−1 for BPS. BPB and NP were not detected and OP levels ranged from 0.5 to 3.7 ng g g−1. The results demonstrate that the developed analytical method is very sensitive and that levels of several compounds with known /suspected endocrine disrupting properties could be detected or quantified in human placenta samples. The results therefore suggest that fetal exposure to these compounds occurs. The method will be useful for studies to evaluate the health effects associated with this prenatal exposure. %G eng