Objectives: We investigated the association between outdoor air pollutants exposure in the first trimester of pregnancy, and growth and cardio-metabolic risk at four years of age, and evaluated the mediating role of birth weight. Methods: We included mother-child pairs (N = 1,724) from the Spanish INMA birth cohort established in 2003-2008. First trimester of pregnancy nitrogen dioxide (NO2) and fine particles (PM2.5) exposure levels were estimated. Height, weight, waist circumference, blood pressure, and lipids were measured at four years of age. Body mass index (BMI) trajectories from birth to four years were identified. Results: Increased PM2.5 exposure in the first trimester of pregnancy was associated with decreased z-scores of weight (zWeight) and BMI (zBMI) (zWeight change per interquartile range increase in PM2.5 exposure = -0.12; 95% CI: -0.23, -0.01; zBMI change = -0.12; 95% CI: -0.23, -0.01). Higher NO2 and PM2.5 exposure was associated to a reduced risk of being in a trajectory with accelerated BMI gain, compared to children with the average trajectory. Birth weight partially mediated the association between PM2.5 and zWeight and zBMI. PM2.5 and NO2 were not associated with the other cardio-metabolic risk factors. Conclusions: This comprehensive study of many growth and cardio-metabolic risk related outcomes suggests that air pollution exposure during pregnancy may be associated with delays in physical growth in the early years after birth. These findings imply that pregnancy exposure to air pollutants has a lasting effect on growth after birth and require follow-up at later child ages.

Rothmund-Thomson syndrome (RTS) is characterized by a rash that begins in the first few months of life and eventually develops into poikiloderma. Associated symptoms are alterations in the teeth, sparse hair, thin eyebrows, lack of eyelashes, low stature, bone abnormalities, hematological illnesses, gastrointestinal disease, malnutrition, cataracts, and predisposition to cancer, principally to bone tumors and skin cancer. Diagnostic certitude is provided by a genetic study involving detection of pathogenic variants of the RECQL4 gene. We hereby present a familiar case of RTS in two siblings from a Portuguese family, both diagnosed with osteosarcoma. Genomic analysis (203 genes) of both tumors as well as germline analysis of the RECQL4 gene, thus confirming the syndrome in the family, have been performed. The relevance of clinical recognition of the hallmarks of the disease and thus early diagnosis with early intervention is highlighted.

BACKGROUND Growing evidence exists about the fetal and environmental origins of hypertension, but mainly limited to single-exposure studies. The exposome has been proposed as a more holistic approach by studying many exposures simultaneously. OBJECTIVES This study aims to evaluate the association between a wide range of prenatal and postnatal exposures and blood pressure (BP) in children. METHODS Systolic and diastolic BP were measured among 1,277 children from the European HELIX (Human Early-Life Exposome) cohort aged 6 to 11 years. Prenatal (n = 89) and postnatal (n = 128) exposures include air pollution, built environment, meteorology, natural spaces, traffic, noise, chemicals, and lifestyles. Two methods adjusted for confounders were applied: an exposome-wide association study considering the exposures independently, and the deletion-substitution-addition algorithm considering all the exposures simultaneously. RESULTS Decreases in systolic BP were observed with facility density (beta change for an interquartile-range increase in exposure: -1.7 mm Hg [95% confidence interval (CI): -2.5 to -0.8 mm Hg]), maternal concentrations of polychlorinated biphenyl 118 (-1.4 mm Hg [95% CI: -2.6 to -0.2 mm Hg]) and child concentrations of dichlorodiphenyldichloroethylene (DDE: -1.6 mm Hg [95% CI: -2.4 to -0.7 mm Hg]), hexachlorobenzene (-1.5 mm Hg [95% CI: -2.4 to -0.6 mm Hg]), and mono -benzyl phthalate (-0.7 mm Hg [95% CI: -1.3 to -0.1 mm Hg]), whereas increases in systolic BP were observed with outdoor temperature during pregnancy (1.6 mm Hg [95% CI: 0.2 to 2.9 mm Hg]), high fish intake during pregnancy (2.0 mm Hg [95% CI: 0.4 to 3.5 mm Hg]), maternal cotinine concentrations (1.2 mm Hg [95% CI: -0.3 to 2.8 mm Hg]), and child perfluorooctanoate concentrations (0.9 mm Hg [95% CI: 0.1 to 1.6 mm Hg]). Decreases in diastolic BP were observed with outdoor temperature at examination (-1.4 mm Hg [95% CI: -2.3 to -0.5 mm Hg]) and child DDE concentrations (-1.1 mm Hg [95% CI: -1.9 to -0.3 mm Hg]), whereas increases in diastolic BP were observed with maternal bisphenol-A concentrations (0.7 mm Hg [95% CI: 0.1 to 1.4 mm Hg]), high fish intake during pregnancy (1.2 mm Hg [95% CI: -0.2 to 2.7 mm Hg]), and child copper concentrations (0.9 mm Hg [95% CI: 0.3 to 1.6 mm Hg]). CONCLUSIONS This study suggests that early-life exposure to several chemicals, as well as built environment and meteorological factors, may affect BP in children. (C) 2019 by the American College of Cardiology Foundation.

BACKGROUND: The exposome is defined as the totality of environmental exposures from conception onwards. It calls for providing a holistic view of environmental exposures and their effects on human health by evaluating multiple environmental exposures simultaneously during critical periods of life. OBJECTIVE: We evaluated the association of the urban exposome with birth weight. METHODS: We estimated exposure to the urban exposome, including the built environment, air pollution, road traffic noise, meteorology, natural space, and road traffic (corresponding to 24 environmental indicators and 60 exposures) for nearly 32,000 pregnant women from six European birth cohorts. To evaluate associations with either continuous birth weight or term low birth weight (TLBW) risk, we primarily relied on the Deletion-Substitution-Addition (DSA) algorithm, which is an extension of the stepwise variable selection method. Second, we used an exposure-by-exposure exposome-wide association studies (ExWAS) method accounting for multiple hypotheses testing to report associations not adjusted for coexposures. RESULTS: The most consistent statistically significant associations were observed between increasing green space exposure estimated as Normalized Difference Vegetation Index (NDVI) and increased birth weight and decreased TLBW risk. Furthermore, we observed statistically significant associations among presence of public bus line, land use Shannon's Evenness Index, and traffic density and birth weight in our DSA analysis. CONCLUSION: This investigation is the first large urban exposome study of birth weight that tests many environmental urban exposures. It confirmed previously reported associations for NDVI and generated new hypotheses for a number of built-environment exposures.

BackgroundEnvironmental exposures are related to the risk of some types of cancer, and children are the most vulnerable group of people. This study seeks to present the methodological approaches used in the papers of our group about risk of childhood cancers in the vicinity of pollution sources (industrial and urban sites). A population-based case-control study of incident childhood cancers in Spain and their relationship with residential proximity to industrial and urban areas was designed. Two methodological approaches using mixed multiple unconditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) were developed: (a) near vs. far analysis, where possible excess risks of cancers in children living near (near) versus those living far (far) from industrial and urban areas were assessed; and (b) risk gradient analysis, where the risk gradient in the vicinity of industries was assessed. For each one of the two approaches, three strategies of analysis were implemented: joint, stratified, and individualized analysis. Incident cases were obtained from the Spanish Registry of Childhood Cancer (between 1996 and 2011).ResultsApplying this methodology, associations between proximity (2km) to specific industrial and urban zones and risk (OR; 95% CI) of leukemias (1.31; 1.04-1.65 for industrial areas, and 1.28; 1.00-1.53 for urban areas), neuroblastoma (2.12; 1.18-3.83 for both industrial and urban areas), and renal (2.02; 1.16-3.52 for industrial areas) and bone (4.02; 1.73-9.34 for urban areas) tumors have been suggested.ConclusionsThe two methodological approaches were used as a very useful and flexible tool to analyze the excess risk of childhood cancers in the vicinity of industrial and urban areas, which can be extrapolated and generalized to other cancers and chronic diseases, and adapted to other types of pollution sources.

The human exposome affects child development and health later in life, but its personal external levels, variability, and correlations are largely unknown. We characterized the personal external exposome of pregnant women and children in eight European cities. Panel studies included 167 pregnant women and 183 children (aged 6-11 years). A personal exposure monitoring kit composed of smartphone, accelerometer, ultraviolet (UV) dosimeter, and two air pollution monitors were used to monitor physical activity (PA), fine particulate matter (PM2.5), black carbon, traffic-related noise, UV-B radiation, and natural outdoor environments (NOE). 77% of women performed the adult recommendation of >= 150 min/week of moderate to vigorous PA (MVPA), while only 3% of children achieved the childhood recommendation of >= 60 min/day MVPA. 11% of women and 17% of children were exposed to daily PM2.5 levels higher than recommended >= 25 mu g/m(3)). Mean exposure to noise ranged from Lden 51.1 dB in Kaunas to Lden 65.2 dB in Barcelona. 4% of women and 23% of children exceeded the recommended maximum of 2 Standard-Erythemal-Dose of UV-B at least once a week. 33% of women and 43% of children never reached the minimum NOE contact recommendation of >= 30 min/week. The variations in air and noise pollution exposure were dominated by between-city variability, while most of the variation observed for NOE contact and PA was between-participants. The correlations between all personal exposures ranged from very low to low (Rho < 0.30). The levels of personal external exposures in both pregnant women and children are above the health recommendations, and there is little correlation between the different exposures. The assessment of the personal external exposome is feasible but sampling requires from one day to more than one year depending on exposure due to high variability between and within cities and participants.

BACKGROUND: Telomere length is a molecular marker of biological aging. OBJECTIVE: Here we investigated whether early-life exposure to residential air pollution was associated with leukocyte telomere length (LTL) at 8 y of age. METHODS: In a multicenter European birth cohort study, HELIX (Human Early Life Exposome) (n = 1,396), we estimated prenatal and 1-y childhood exposure to nitrogen dioxide (NO2), particulate matter with aerodynamic diameter <= 2.5 mu m (PM2.5), and proximity to major roads. Average relative LTL was measured using quantitative real-time polymerase chain reaction (qPCR). Effect estimates of the association between LTL and prenatal, 1-y childhood air pollution, and proximity to major roads were calculated using multiple linear mixed models with a random cohort effect and adjusted for relevant covariates. RESULTS: LTL was inversely associated with prenatal and 1-y childhood NO2 and PM2.5 exposures levels. Each standard deviation (SD) increase in prenatal NO(2 )was associated with a -1.5% (95% CI: -2.8, -0.2) change in LTL. Prenatal PM 2 . 5 was nonsignificantly associated with LTL (-0.7% per SD increase; 95% CI: -2.0, 0.6). For each SD increment in 1-y childhood NO2 and PM 2 . 5 exposure, LTL shortened by -1.6% (95% CI: -2.9, -0.4) and -1.4% (95% CI: -2.9, 0.1), respectively. Each doubling in residential distance to nearest major road during childhood was associated with a 1.6% (95% CI: 0.02, 3.1) lengthening in LTL. CONCLUSION: Lower exposures to air pollution during pregnancy and childhood were associated with longer telomeres in European children at 8 y of age. These results suggest that reductions in traffic-related air pollution may promote molecular longevity, as exemplified by telomere length, from early life onward.

Characterization of the "exposome", the set of all environmental factors that one is exposed to from conception onwards, has been advocated to better understand the role of environmental factors on chronic diseases. Here, we aimed to describe the early-life exposome. Specifically, we focused on the correlations between multiple environmental exposures, their patterns and their variability across European regions and across time (pregnancy and childhood periods). We relied on the Human Early-Life Exposome (HELIX) project, in which 87 environmental exposures during pregnancy and 122 during the childhood period (grouped in 19 exposure groups) were assessed in 1301 pregnant mothers and their children at 6-11 years in 6 European birth cohorts. Some correlations between exposures in the same exposure group reached high values above 0.8. The median correlation within exposure groups was > 0.3 for many exposure groups, reaching 0.69 for water disinfection by products in pregnancy and 0.67 for the meteorological group in childhood. Median correlations between different exposure groups rarely reached 0.3. Some correlations were driven by cohort-level associations (e.g. air pollution and chemicals). Ten principal components explained 45% and 39% of the total variance in the pregnancy and childhood exposome, respectively, while 65 and 90 components were required to explain 95% of the exposome variability. Correlations between maternal (pregnancy) and childhood exposures were high (> 0.6) for most exposures modeled at the residential address (e.g. air pollution), but were much lower and even close to zero for some chemical exposures. In conclusion, the early life exposome was high dimensional, meaning that it cannot easily be measured by or reduced to fewer components. Correlations between exposures from different exposure groups were much lower than within exposure groups, which have important implications for co-exposure confounding in multiple exposure studies. Also, we observed the early life exposome to be variable over time and to vary by cohort, so measurements at one time point or one place will not capture its complexities.

From 1992 to 2018, cytogenetic analyses were successfully performed to explore the chromosomal abnormalities of 729 patients, who utilised a pioneering counselling service in the city of Passo Fundo in the northern part of the Brazilian state of Rio Grande do Sul. This city is characterised by a large conglomerate of private and public hospitals. A classical cytogenetic analysis and G-banding were performed using the patient samples. Although normal karyotypes were observed for 562 of the cases, 167 individuals evidenced chromosomal alterations. Among those, 110 exhibited numerical alterations (65.86%), 41 demonstrated structural modifications (24.55%) and 16 showed both numerical and structural chromosomal changes (9.58%). This study describes the diversity of the chromosomal alterations in this region, which have not been previously examined. After 26years of study, the findings are discussed herein in a self-critical form.

The brown rat lives with man in a wide variety of environmental contexts and adversely affects public health by transmission of diseases, bites, and allergies. Understanding behavioral and spatial correlation aspects of pest species can contribute to their effective management and control. Rat sightings can be described by spatial coordinates in a particular region of interest defining a spatial point pattern. In this paper, we investigate the spatial structure of rat sightings in the Latina district of Madrid (Spain) and its relation to a number of distance-based covariates that relate to the proliferation of rats. Given a number of locations, biologically considered as attractor points, the spatial dependence is modeled by distance-based covariates and angular orientations through copula functions. We build a particular spatial trivariate distribution using univariate margins coming from the covariate information and provide predictive distributions for such distances and angular orientations.

Air pollution has been classified as carcinogenic to humans. However, to date little is known about the relevance for cancers of the stomach and upper aerodigestive tract (UADT). We investigated the association of long-term exposure to ambient air pollution with incidence of gastric and UADT cancer in 11 European cohorts. Air pollution exposure was assigned by land-use regression models for particulate matter (PM) below 10 mu m (PM10), below 2.5 mu m (PM2.5), between 2.5 and 10 mu m (PMcoarse), PM2.5 absorbance and nitrogen oxides (NO2 and NOx) as well as approximated by traffic indicators. Cox regression models with adjustment for potential confounders were used for cohort-specific analyses. Combined estimates were determined with random effects meta-analyses. During average follow-up of 14.1 years of 305,551 individuals, 744 incident cases of gastric cancer and 933 of UADT cancer occurred. The hazard ratio for an increase of 5 mu g/m(3) of PM2.5 was 1.38 (95% CI 0.99; 1.92) for gastric and 1.05 (95% CI 0.62; 1.77) for UADT cancers. No associations were found for any of the other exposures considered. Adjustment for additional confounders and restriction to study participants with stable addresses did not influence markedly the effect estimate for PM2.5 and gastric cancer. Higher estimated risks of gastric cancer associated with PM2.5 was found in men (HR 1.98 [1.30; 3.01]) as compared to women (HR 0.85 [0.5; 1.45]). This large multicentre cohort study shows an association between long-term exposure to PM2.5 and gastric cancer, but not UADT cancers, suggesting that air pollution may contribute to gastric cancer risk.

Background: Current evidence suggests that childhood leukaemia can be associated with residential traffic exposure; nevertheless, more results are needed to support this conclusion. Objectives: To ascertain the possible effects of residential proximity to road traffic on childhood leukaemia, taking into account traffic density, road proximity and the type of leukaemia (acute lymphoid leukaemia or acute myeloid leukaemia). Methods: We conducted a population-based case-control study of childhood leukaemia in Spain, covering the period 1990-2011. It included 1061 incidence cases gathered from the Spanish National Childhood Cancer Registry and those Autonomous Regions with 100% coverage, and 6447 controls, individually matched by year of birth, sex and autonomous region of residence. Distances were computed from the respective participant's residential locations to the different types of roads and four different buffers. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (95%CIs), were calculated for four different categories of distance to roads. Results: Cases of childhood leukaemia had more than three-fold increased odds of living at < 50 m of the busiest motorways compared to controls (OR = 2.90; 95%CI = 1.30-6.49). The estimates for acute lymphoid leukaemia (ALL) were slightly higher (OR = 2.95; 95%CI = 1.22-7.14), while estimates for cases with the same address at birth and at diagnosis were lower (OR = 2.40; 95%CI = 0.70-8.30). Conclusions: Our study agrees with the literature and furnishes some evidence that living near a busy motorway could be a risk factor for childhood leukaemia.

Purpose Essential to exposome research is the collection of data on many environmental exposures from different domains in the same subjects. The aim of the Human Early Life Exposome (HELIX) study was to measure and describe multiple environmental exposures during early life (pregnancy and childhood) in a prospective cohort and associate these exposures with molecular omics signatures and child health outcomes. Here, we describe recruitment, measurements available and baseline data of the HELIX study populations. Participants The HELIX study represents a collaborative project across six established and ongoing longitudinal population-based birth cohort studies in six European countries (France, Greece, Lithuania, Norway, Spain and the UK). HELIX used a multilevel study design with the entire study population totalling 31472 mother-child pairs, recruited during pregnancy, in the six existing cohorts (first level); a subcohort of 1301 mother-child pairs where biomarkers, omics signatures and child health outcomes were measured at age 6-11 years (second level) and repeat-sampling panel studies with around 150 children and 150 pregnant women aimed at collecting personal exposure data (third level). Findings to date Cohort data include urban environment, hazardous substances and lifestyle-related exposures for women during pregnancy and their offspring from birth until 6-11 years. Common, standardised protocols were used to collect biological samples, measure exposure biomarkers and omics signatures and assess child health across the six cohorts. Baseline data of the cohort show substantial variation in health outcomes and determinants between the six countries, for example, in family affluence levels, tobacco smoking, physical activity, dietary habits and prevalence of childhood obesity, asthma, allergies and attention deficit hyperactivity disorder. Future plans HELIX study results will inform on the early life exposome and its association with molecular omics signatures and child health outcomes. Cohort data are accessible for future research involving researchers external to the project.

Background: Ambient air pollution contains low concentrations of carcinogens implicated in the etiology of urinary bladder cancer (BC). Little is known about whether exposure to air pollution influences BC in the general population. Objective: To evaluate the association between long-term exposure to ambient air pollution and BC incidence. Design, setting and participants: We obtained data from 15 population-based cohorts enrolled between 1985 and 2005 in eight European countries (N = 303 431; mean follow-up 14.1 yr). We estimated exposure to nitrogen oxides (NO2 and NOx), particulate matter (PM) with diameter <10 mu m (PM10), <2.5 mu m (PM2.5). between 2.5 and 10 mu m (PM2.5-10). PM2.5 absorbance (soot), elemental constituents of PM, organic carbon, and traffic density at baseline home addresses using standardized land-use regression models from the European Study of Cohorts for Air Pollution Effects project. Outcome measurements and statistical analysis: We used Cox proportional-hazards models with adjustment for potential confounders for cohort-specific analyses and meta-analyses to estimate summary hazard ratios (HRS) for BC incidence. Results and limitations: During follow-up, 943 incident BC cases were diagnosed. In the meta-analysis, none of the exposures were associated with BC risk. The summary HRs associated with a 10-mu g/m(3) increase in NO2 and 51-mu g/m(3) increase in PM2.5 were 0.98 (95% confidence interval [CI] 0.89-1.08) and 0.86 (95% CI 0.63-1.18), respectively. Limitations include the lack of information about lifetime exposure. Conclusions: There was no evidence of an association between exposure to outdoor air pollution levels at place of residence and risk of BC. Patient summary: We assessed the link between outdoor air pollution at place of residence and bladder cancer using the largest study population to date and extensive assessment of exposure and comprehensive data on personal risk factors such as smoking. We found no association between the levels of outdoor air pollution at place of residence and bladder cancer risk. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Climate change impacts on the hydrological cycle are altering the quantity, quality, and temporal distribution of riverine discharge, necessitating a more rigorous consideration of changes in land cover and land use. This study establishes relationships between different land cover combinations (e.g. percentages of forest - both native and exotic - and pastureland) and hydrological services, using hydrological indices estimated at annual and seasonal timescales in an area with a steep precipitation gradient (900-2600 mm yr(-1)). Using discharge data from 20 catchments in the Bay of Biscay, a climate transition zone, the study applied multiple regression models to better understand how the interaction between precipitation and land cover combinations influence hydrological services. Findings showed the relationship between land cover combinations and hydrological services is highly dependent on the amount of precipitation, even in a climatically homogeneous and relatively small area. In general, in the Bay of Biscay area, the greater presence of any type of forests is associated with lower annual water resources, especially with greater percentages of exotic plantations and high annual precipitation. Where precipitation is low, forests show more potential to reduce annual and winter high flows than pasturelands, but this potential decreases as annual or seasonal precipitation increases. As annual precipitation increases, low flows increase as the percentage of exotic plantations decreases and pasturelands increase. Results obtained in this study improve understanding of the multiple effects of land cover on hydrological services, and illustrate the relevance of land planning to the management of water resources, especially under a climate change scenario.

The brown rat has been living with humans in a wide variety of environmental contexts; it adversely affects public health by transmission of pathogens that can cause human diseases and allergies. Understanding behavioral aspects and environmental factors of pest species can contribute to their effective management and control. This aim of this study was to investigate the spatial distribution of rats in Latina district of Madrid (Spain), and its relationship with several potential multi-source foci. A focus is any particular social and environmental urban scenario that favors the clustering and proliferation of rats. We have developed a statistical framework to provide valid information on the spatial distribution and behavior of the rats around identified potential foci that favor the concentration of rats in urban environments. We extended the standard Poisson regression model by the inclusion of a multiplicative non-linear function of the distance, an unstructured random effect, and a spatial random effect to account for the spatial structure of socio-demographic and environmental covariates were also considered in the model to control for potential confusion. We found evidence of an association between the spatial distribution of rats aggregated by census tracts and distance to foci, and this association was controlled by the covariates considered in this study. (C) 2018 The Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences.

BACKGROUND: The urban exposome is the set of environmental factors that arc experienced in the outdoor urban environment and that may influence child development. OBJECTIVE: The authors' goal was to describe the urban exposome among European pregnant women and understand its socioeconomic determinants. METHODS: Using geographic information systems, remote sensing and spatio-temporal modeling we estimated exposure during pregnancy to 28 environmental indicators in almost 30,000 women from six population-based birth cohorts, in nine urban areas from across Europe. Exposures included meteorological factors, air pollutants, traffic noise, traffic indicators, natural space, the built environment, public transport, facilities, and walkability. Socioeconomic position (SEP), assessed at both the area and individual level, was related to the exposome through an exposome-wide association study and principal component (PC) analysis. RESULTS: Mean standard deviation (SD) NO, levels ranged from 13.6 +/- 5.1 mu g/m(3) (in Heraklion, Crete) to 43.2 +/- 11 mu g/m(3) (in Sabaclell, Spain), mean +/- SD walkability score ranged from 0.22 +/- 0.04 (Kaunas, Lithuania) to 0.32 +/- 0.07 (Valencia, Spain) and mean +/- SD Normalized Difference Vegetation Index ranged from 0.21 +/- 0.05 in Heraklion to 0.51 +/- 0.1 in Oslo, Norway. Four PCs explained more than half of variation in the urban exposome. There was considerable heterogeneity in social patterning of the urban exposome across cities. For example, high-SEP (based on family education) women lived in greener, less noisy, and less polluted areas in Bradford, UK (0.39 higher PC1 score, 95% confidence interval (CI): 0.31, 0.47), hut the reverse was observed in Oslo (-0.57 PC1 score, 95% CI: 0.73, 0.41). For most cities, effects were stronger when SEP was assessed at the area level: In Bradford, women living in high SEP areas had a 1.34 higher average PC1 score (95% CI: 1.21, 1.48). CONCLUSIONS: The urban exposome showed considerable variability across Europe. Pregnant women of low SEP were exposed to higher levels of environmental hazards in some cities, but not others, which may contribute to inequities in child health and development.

BACKGROUND: Epidemiological evidence on the association between ambient air pollution and breast cancer risk is inconsistent. OBJECTIVE: We examined the association between long-term exposure to ambient air pollution and incidence of postmenopausal breast cancer in European women. METHODS: In 15 cohorts from nine European countries, individual estimates of air pollution levels at the residence were estimated by standardized land-usc regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE) and Transport related Air Pollution and Health impacts - Integrated Methodologies for Assessing Particulate Mattcr (TRANSPHORM) projects: particulate matter (PM) <= 2.5 mu m, <= 10 mu m, and 2.5-10 mu m in diameter (PM2.5, PM10, and PMcoarse, respectively); PM2.5 absorbance; nitrogen oxides (NO2 and NOx); traffic intensity; and elemental composition of PM. We estimated cohort-specific associations between breast cancer and air pollutants using Cox regression models, adjusting for major lifestyle risk factors, and pooled cohort-specific estimates using random-effects meta-analyses. RESULTS: Of 74,750 postmenopausal women included in the study, 3,612 developed breast cancer during 991,353 person-years of follow-up. We found positive and statistically insignificant associations between breast cancer and PM2.5 [hazard ratio (FIR) = 1.08 [95% confidence interval (Cl): 0.77, 1.51] per 5 mu g/m(3)}, PM10 [1.07 (95% CI: 0.89, 1.30) per 10 mu g/m(3)], PMcoarse [1.20 (95% Cl: 0.96, 1.49 per 5 mu g/m(3)], and NO2 [1.02 (95% CI: 0.98, 1.07 per 10 mu g/m(3)], and a statistically significant association with NOx [1.04 (95% CI: 1.00, 1.08) per 20 mu g/m(3), p = 0.04]. CONCLUSIONS: We-found suggestive evidence of an association between ambient air pollution and incidence of postmenopausal breast cancer in European women.

Several studies have indicated weakly increased risk for kidney cancer among occupational groups exposed to gasoline vapors, engine exhaust, polycyclic aromatic hydrocarbons and other air pollutants, although not consistently. It was the aim to investigate possible associations between outdoor air pollution at the residence and the incidence of kidney parenchyma cancer in the general population. We used data from 14 European cohorts from the ESCAPE study. We geocoded and assessed air pollution concentrations at baseline addresses by land-use regression models for particulate matter (PM10, PM2.5, PMcoarse, PM2.5 absorbance (soot)) and nitrogen oxides (NO2, NOx), and collected data on traffic. We used Cox regression models with adjustment for potential confounders for cohort-specific analyses and random effects models for meta-analyses to calculate summary hazard ratios (HRs). The 289,002 cohort members contributed 4,111,908 person-years at risk. During follow-up (mean 14.2 years) 697 incident cancers of the kidney parenchyma were diagnosed. The meta-analyses showed higher HRs in association with higher PM concentration, e.g. HR=1.57 (95%CI: 0.81-3.01) per 5 g/m(3) PM2.5 and HR=1.36 (95%CI: 0.84-2.19) per 10(-5)m(-1) PM2.5 absorbance, albeit never statistically significant. The HRs in association with nitrogen oxides and traffic density on the nearest street were slightly above one. Sensitivity analyses among participants who did not change residence during follow-up showed stronger associations, but none were statistically significant. Our study provides suggestive evidence that exposure to outdoor PM at the residence may be associated with higher risk for kidney parenchyma cancer; the results should be interpreted cautiously as associations may be due to chance.

Background Central nervous system tumors ( CNS) are the most frequent solid tumor in children. Causes of CNS tumors are mainly unknown and only 5% of the cases can be explained by genetic predisposition. We studied the effects of environmental exposure on the incidence of CNS tumors in children by subtype, according to exposure to industrial and/or urban environment, exposure to crops and according to socio-economic status of the child. Methods We carried out a population-based case-control study of CNS tumors in Spain, covering 714 incident cases collected from the Spanish Registry of Childhood Tumors ( period 1996-2011) and 4284 controls, individually matched by year of birth, sex, and autonomous region of residence. We built a covariate to approximate the exposure to industrial and/or urban environment and a covariate for the exposure to crops ( GCI) using the coordinates of the home addresses of the children. We used the 2001 Census to obtain information about socio-economic status ( SES). We fitted logistic regression models to estimate odds ratios ( ORs) and 95% confidence intervals ( 95% CIs). Results The results for all CNS tumors showed an excess risk ( OR = 1.37; 95%CI = 1.09-1.73) for SES, i.e., children living in the least deprived areas had 37% more risk of CNS tumor than children living in the most deprived areas. For GCI, an increase of 10% in crop surface in the 1-km buffer around the residence implied an increase of 22% in the OR ( OR = 1.22; 95%CI = 1.15-1.29). Children living in the intersection of industrial and urban areas could have a greater risk of CNS tumors than children who live outside these areas ( OR = 1.20; 95%CI = 0.82-1.77). Living in urban areas ( OR = 0.90; 95%CI = 0.65-1.24) or industrial areas ( OR = 0.96; 95%CI = 0.81-1.77) did not seem to increase the risk for all CNS tumors together. By subtype, Astrocytomas, Intracranial and intraspinal embryonal tumors, and other gliomas showed similar results. Conclusion Our results suggest that higher socioeconomic status and exposure to crops could increase the risk of CNS tumors in children.

Few epidemiologic studies have explored risk factors for bone tumors in children, and the role of environmental factors needs to be analyzed. Our objective was to ascertain the association between residential proximity to industrial plants and urban areas and risk of bone tumors in children, taking into account industrial groups and toxic pollutants released. A population-based case-control study of childhood bone cancer in Spain was carried out, covering 114 incident cases obtained from the Spanish Registry of Childhood Tumors (between 1996 and 2011), and 684 controls individually matched by sex, year of birth, and autonomous region of residence. Distances from the subject's residences to the 1271 industries and the 30 urban areas (towns) with >= 75,000 inhabitants located in the study area were computed. Unconditional logistic regression models were fitted to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for categories of distance (from 1 km to 3 km) to industrial and urban areas, with adjustment for matching variables and sociodemographic indicators. Excess risk (OR; 95% CI) of bone tumors in children was detected for children close to industrial facilities as a whole (2.33; 1.17-4.63 at 3 km) - particularly surface treatment of metals (OR=2.50; 95% CI=1.13-5.56 at 2 km), production and processing of metals (OR = 3.30; 95% CI = 1.41-7.77 at 2.5 km), urban waste-water treatment plants (OR= 4.41; 95% CI= 1.62-11.98 at 2 km), hazardous waste (OR= 4.63; 95% CI= 1.37-15.61 at 2 km), disposal or recycling of animal waste (OR = 4.73; 95% CI = 1.40-15.97 at 2 km), cement and lime (OR = 3.89; 95% CI = 1.19-12.77 at 2.5 km), and combustion installations (OR= 3.85; 95% CI= 1.39-10.66 at 3 km)-, and urban areas (4.43; 1.80-10.92). These findings support the need for more detailed exposure assessment of certain toxics released by these facilities. (C) 2016 Elsevier B.V. All rights reserved.

Background: Childhood cancer is the main cause of disease-related death in children in Spain. Although little is known about the etiology, environmental factors are potential explanations for a fraction of the cases. Previous studies have shown pesticides to be associated with childhood cancer. The difficulty of collecting personal environmental exposure data is an important limitation; this lack of information about pesticides motivates the development of new methods to subrogate this exposure. We developed a crop exposure index based on geographic information to study the relationship between exposure to different types of crops and risk of childhood tumors. Methods: We conducted a population-based case-control study of childhood cancer covering 3350 cases and 20,365 controls in two Spanish regions. We used CORINE Land Cover to obtain data about agricultural land use. We created a 1 km buffer around every child and calculated the percentage of crop surface within the buffer (Global Crop Index) for total crops and for individual types of crops. We fitted mixed multiple unconditional logistic regression models by diagnostic group. Results: We found excess of risk among children living in the proximity of crops. For total crops our results showed excesses of risk for almost all diagnostic groups and increasing risk with increasing crop index value. Analyses by region and individual type of crop also showed excess of risk. Conclusion: The results suggest that living in the proximity of cultivated land could be a risk factor for several types of cancer in children.

Background: Few risk factors for childhood renal tumors are well established. While a small fraction of cases might be attributable to susceptibility genes and congenital anomalies, the role of environmental factors needs to be assessed. Objectives: To explore the possible association between residential proximity to environmental pollution sources (industrial and urban areas, and agricultural crops) and childhood renal cancer, taking into account industrial groups and toxic substances released. Methods: We conducted a population-based case-control study of childhood renal cancer in Spain, including 213 incident cases gathered from the Spanish Registry of Childhood Tumors (period 1996-2011), and 1278 controls individually matched by year of birth, sex, and region of residence. Distances were computed from the respective subject's residences to the 1271 industries, the 30 urban areas with 75,000 inhabitants, and the agricultural crops located in the study area. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance to pollution sources were calculated, with adjustment for matching variables and socioeconomic confounders. Results: Excess risk (OR; 95%CI) of childhood renal tumors was observed for children living near (<= 2.5 km) industrial installations as a whole (1.97; 1.13-3.42) - particularly glass and mineral fibers (2.69; 1.19-6.08), galvanization (2.66; 1.14-6.22), hazardous waste (2.59; 1.25-5.37), ceramic (2.35; 1.06-5.21), surface treatment of metals (2.25; 1.24-4.08), organic chemical industry (2.22; 1.15-4.26), food and beverage sector (2.19; 1.18-4.07), urban and waste-water treatment plants (2.14; 1.07-4.30), and production and processing of metals (1.98; 1.03-3.82) -, and in the proximity of agricultural crops (3.16; 1.54-8.89 for children with percentage of crop surface >= 24.35% in a 1-km buffer around their residences). Conclusions: Our study provides some epidemiological evidence that living near certain industrial areas and agricultural crops may be a risk factor for childhood renal cancer. (C) 2016 Elsevier Inc. All rights reserved.

Chronic obstructive pulmonary disease (COPD) is a prevalent condition in adults aged >= 40years characterized by progressive airflow limitation associated with chronic inflammatory response to noxious particles in the airways and lungs. Smoking, genetics, air pollution, nutrition and other factors may influence COPD development. Most hospitalizations and deaths for COPD are caused by its acute exacerbations, which greatly affect the health and quality of life of COPD patients and pose a high burden on health services. The aims of this project were to identify trends, geographic patterns and risk factors for COPD exacerbations, as revealed by hospitalizations and deaths, in the Basque Country, Spain, over a period of 12 years (2000-2011). Hospitalization and mortality rates for COPD were 262 and 18 per 100,000 population, respectively, with clusters around the biggest cities. Hospital mortality was 7.4%. Most hospitalized patients were male (77.4%) and accounted for 72.1% of hospital mortality. Hospitalizations decreased during the study period, except for 50-64year-old women, peaking significantly. Using a multivariate modeling approach it was shown that hospitalizations were positively correlated with increased atmospheric concentrations of NO2, CO, PM10, and SO2, and increased influenza incidence, but were negatively associated with increased temperatures and atmospheric O-3 concentration. COPD exacerbations decreased in the Basque Country during 2000-2011, but not among 50-64-year-old women, reflecting the high smoking prevalence among Spanish women during the 1970-1990s. The main metropolitan areas were those with the highest risk for COPD exacerbations, calling attention to the role of heavy car traffic. Influenza virus, cold temperatures, and increased atmospheric NO2, CO, PM10, and SO2 (but decreased O-3) concentrations were identified as potential contributors to the burden of COPD exacerbations in the community. These findings are important for both the understanding of the disease process and in providing potential targets for COPD-reducing initiatives and new avenues for research.

Background: Self-management may be an option to monitor oral anticoagulant therapy in health systems, but before recommending it, we need to assess patients' ability to take on this task. The purpose of the study was to describe patients' ability to self-manage and associated factors. Methods: This was a 3-year prospective quasi-experimental study with a control group. Overall, 333 patients on anticoagulant therapy from seven primary care health centres of the Basque Health Service were included in the intervention group and followed up for 6 months after the intervention, assessing their ability to self-test and self-manage. The intervention consisted of a patient training programme, providing detailed information on their condition and its treatment, and practical training in how to use a portable blood coagulation monitor and adjust their anticoagulant dose. Comparisons were made with a control group (333 patients receiving OAT under usual care from the same seven health centres). Outcome variables were ability to self-manage, quality of the outcome (in terms of time in therapeutic range), and quality of life in the intervention group, and general patient characteristics (age and sex), clinical variables (reason for OAT, INR range), and quality of the outcome (in terms of percentage of INR measurements in range and complications) in both groups. Results: Overall, 26.13 % of patients invited to participate in the intervention agreed. Of these, 99 % successfully learned to self-manage their OAT. Just 4.2 % did not complete the follow-up, in all cases for reasons unrelated to self-management, and 4.5 % required additional learning support. Outcomes were better than under usual care in terms of percentage of INR measurements in range (12 %), rate of complications (4 %) and quality of life (9.2 %). Limitations: Patients were only followed-up period for 6 months and the study was conducted in a single health organization. Though patients eligible to participate were selected randomly, they were not randomly allocated to the groups. This is a potential source of selection bias. Data needed to calculate in-range time were not collected from controls; rather the results for the self-management group were compared with external data from other studies. Conclusions: Almost all participants achieved competency in self-management, with no differences by age, sex, concurrent illnesses, polypharmacy or educational level. The greatest barrier to self-management was the attitude of patients themselves and those around them. Self-management in primary care is a good alternative to usual care, patients having longer times in therapeutic range and fewer complications, and improving their quality of life. Remote management is a good support tool.

Background: Few epidemiologic studies have explored risk factors for rare tumors in children, and the role of environmental factors needs to be assessed. Objectives: To ascertain the effect of residential proximity to both industrial and urban areas on childhood cancer risk, taking industrial groups into account. Methods: We conducted a population-based case-control study of five childhood cancers in Spain (retinoblastoma, hepatic tumors, soft tissue sarcomas, germ cell tumors, and other epithelial neoplasms/melanomas), including 557 incident cases from the Spanish Registry of Childhood Tumors (period 19962011), and 3342 controls individually matched by year of birth, sex, and region of residence. Distances were computed from the residences to the 1271 industries and the 30 urban areas with >= 75,000 inhabitants located in the study area. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance to industrial and urban pollution sources were calculated, with adjustment for matching variables and socioeconomic confounders. Results: Children living near industrial and urban areas as a whole showed no excess risk for any of the tumors analyzed. However, isolated statistical associations (OR; 95%CI) were found between retinoblastoma and proximity to industries involved in glass and mineral fibers (2.49; 1.01-6.12 at 3 km) and organic chemical industries (2.54; 1.10-5.90 at 2 km). Moreover, soft tissue sarcomas registered the lower risks in the environs of industries as a whole (0.59; 0.38-0.93 at 4 km). Conclusions: We have found isolated statistical associations between retinoblastoma and proximity to industries involved in glass and mineral fibers and organic chemical industries. (C) 2016 Elsevier Inc. All rights reserved.

Background: Neuroblastoma it the most common extracranial solid tumor in children but its etiology is not clearly understood. While a small fraction of cases might be attributable to genetic factors, the role of environmental pollution factors needs to be assessed. Objectives: To ascertain the effect of residential proximity to both industrial and urban areas on neuroblastoma risk, taking into account industrial groups and toxic substances released. Methods: We conducted a population-based case-control study of neuroblastoma in Spain, including 398 incident cases gathered from the Spanish Registry of Childhood Tumors (period 1996-2011), and 2388 controls individually matched by year of birth, sex, and region of residence. Distances were computed from the respective subject's residences to the 1271 industries and the 30 urban areas with >= 75,000 inhabitants located in the study area. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance (from 1 km to 5 km) to industrial and urban pollution sources were calculated, with adjustment for matching variables and socioeconomic confounders. Results: Excess risk (OR; 95%CI) of neuroblastoma was detected for the intersection between industrial and urban areas: (2.52; 1.20-530) for industrial distance of 1 km, and (1.99;1.17-337) for industrial distance of 2 km. By industrial groups, excess risks were observed near 'Production of metals' (OR = 2.05; 95%CI = 1.16-3.64 at 1.5 km), 'Surface treatment of metals' (OR = 1.89; 95%CI = 1.10-3.28 at 1 km), 'Mines' (OR = 5.82; 95%CI = 1.04-32.43 at 1.5 km), 'Explosives/pyrotechnics' (OR = 4.04; 95%CI = 131-12.42 at 4 km), and 'Urban wastewater treatment plants' (OR = 2.14; 95%CI = 1.08-4.27 at 1.5 km): Conclusions: These findings support the need for more detailed exposure assessment of certain substances released by these industries. (C) 2016 Elsevier Ltd. All rights reserved.

This study aimed to describe the degree of annoyance among pregnant women in a Spanish cohort and to examine associations with proximity to traffic, NO2 and benzene exposure. We included 2457 participants from the Spanish Childhood and Environment study. Individual exposures to outdoor NO2 and benzene were estimated, temporally adjusted for pregnancy. Interviews about sociodemographic variables, noise and air pollution were carried out. Levels of annoyance were assessed using a scale from 0 (none) to 10 (strong and unbearable); a level of 8 to 10 was considered high. The reported prevalence of high annoyance levels from air pollution was 11.2% and 15.0% from noise; the two variables were moderately correlated (0.606). Significant correlations between NO2 and annoyance from air pollution (0.154) and that from noise (0.181) were observed. Annoyance owing to noise and air pollution had a low prevalence in our Spanish population compared with other European populations. Both factors were associated with proximity to traffic. In multivariate models, annoyance from air pollution was related to NO2, building age, and country of birth; annoyance from noise was only related to the first two. The health burden of these exposures can be increased by stress caused by the perception of pollution sources.

Background: Few risk factors for the childhood leukemia are well established. While a small fraction of cases of childhood leukemia might be partially attributable to some diseases or ionizing radiation exposure, the role of industrial and urban pollution also needs to be assessed. Objectives: To ascertain the possible effect of residential proximity to both industrial and urban areas on childhood leukemia, taking into account industrial groups and toxic substances released. Methods: We conducted a population-based case-control study of childhood leukemia in Spain, covering 638 incident cases gathered from the Spanish Registry of Childhood Tumors and for those Autonomous Regions with 100% coverage (period 1990-2011), and 13,188 controls, individually matched by year of birth, sex, and autonomous region of residence. Distances were computed from the respective subject's residences to the 1068 industries and the 157 urban areas with >= 10,000 inhabitants, located in the study area. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance to industrial and urban pollution sources were calculated, with adjustment for matching variables. Results: Excess risk of childhood leukemia was observed for children living near (<= 25 km) industries (OR=131; 95%CI=1.03-1.67) - particularly glass and mineral fibers (OR=2.42; 95%CI=1.49-3.92), surface treatment using organic solvents (OR=1.87; 95%CI=124-2.83), galvanization (OR=1.86; 95%CI=1.07-3.21), production and processing of metals (OR=1.69; 95%CI=1.22-2.34), and surface treatment of metals (OR=1.62; 95%CI=1.22-2.15) -, and urban areas (OR=1.36; 95%CI=1.02-1.80). Conclusions: Our study furnishes some evidence that living in the proximity of industrial and urban sites may be a risk factor for childhood leukemia. (C) 2015 Elsevier Inc. All rights reserved.

BackgroundAsthma is a highly prevalent chronic inflammatory disease characterised by reversible airflow obstruction and hyperreactivity and inflammation of the airways. Factors that cause and/or trigger asthma attacks include host-related factors (genetic predisposition, obesity and sex) and environmental factors (allergens, infections, occupational sensitisation, smoking status, pollution and diet). ObjectiveTo describe the epidemiology of asthma exacerbations (AEs) in the Basque Country and to explore its relationship with potentially associated environmental variables. We studied a total of 31579 emergency department (ED) visits and 28189 hospitalisations due to asthma. We describe the trends, incidence, seasonality and the influence of age and sex, as well as of exposure to NO2, CO, PM, O-3, and pollen, temperature, relative humidity and flu status. We calculated the Pearsons R correlation coefficient for the study variables. ResultsThe incidence was 486 and 88.9 cases per 100000 people for ED visits and hospitalisations, respectively. Slightly over half (53.5%) of the ED cases were male, while females represented 62.6% of the hospital admissions. Hospitalisations are tending to decrease in children and increase in over 64-year-olds. Peaks in cases occur at the beginning of autumn in children and in winter in adults. AEs were correlated positively with exposure to NO2, CO and to the influenza virus and negatively with temperature and exposure to O-3. These relationships vary, however, with age and season. Conclusions and Clinical RelevanceRates of hospitalisation for AEs and trends in these rates over time are different in adults and children with the patterns varying by sex, season and environmental conditions.

Flood-risk prevention measures are designed to reduce the adverse consequences associated with floods for humans, the environment, cultural heritage and economic activity, as per the EU Floods Directive (2007/60/EC). An economic assessment of the risk provides advantages for the identification of single hazards. Policy makers thus receive relevant information on the sectors and places at risk. This article provides an integrated spatial assessment of the flood risk for human beings and for the residential, non-residential, agricultural and environmental sectors. The methodology used is applied to the city of Zaragoza and downstream municipalities in the Ebro river basin (Spain). The analysis emphasises that flood-risk assessment must account for two measures of risk. The first is the expected annual damage, which is used to prioritise locations and sectors for prevention. The second comprises damage-probability curves, which provide information on the distribution of the risks, taking into account whether they originate from frequent floods with slight consequences or from exceptional floods with major consequences. The spatial assessment of risk reveals how the risk is distributed between upstream and downstream cities. This opens up a discussion on the issue of equity in flood risk-sharing in spatially integrated analysis. (C) 2014 Elsevier Ltd. All rights reserved.

Background Childhood cancer was the leading cause of death among children aged 1-14 years for 2012 in Spain. Leukemia has the highest incidence, followed by tumors of the central nervous system (CNS) and lymphomas (Hodgkin lymphoma, HL, and Non-Hodgkin's lymphoma, NHL). Spatial distribution of childhood cancer cases has been under concern with the aim of identifying potential risk factors. Objective The two objectives are to study overall spatial clustering and cluster detection of cases of the three main childhood cancer causes, looking to increase etiological knowledge. Methods We ran a case-control study. The cases were children aged 0 to 14 diagnosed with leukemia, lymphomas (HL and NHL) or CNS neoplasm in five Spanish regions for the period 1996-2011. As a control group, we used a sample from the Birth Registry matching every case by year of birth, autonomous region of residence and sex with six controls. We geo-coded and validated the address of the cases and controls. For our two objectives we used two different methodologies. For the first, for overall spatial clustering detection, we used the differences of K functions from the spatial point patterns perspective proposed by Diggle and Chetwynd and the second, for cluster detection, we used the spatial scan statistic proposed by Kulldorff with a level for statistical significance of 0.05. Results We had 1062 cases of leukemia, 714 cases of CNS, 92 of HL and 246 of NHL. Accordingly we had 6 times the number of controls, 6372 controls for leukemia, 4284 controls for CNS, 552 controls for HL and 1476 controls for NHL. We found variations in the estimated empirical D(s) for the different regions and cancers, including some overall spatial clustering for specific regions and distances. We did not find statistically significant clusters. Conclusions The variations in the estimated empirical D(s) for the different regions and cancers could be partially explained by the differences in the spatial distribution of the population; however, according to the literature, we cannot discard environmental hazards or infections agents in the etiology of these cancers.

Background Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants. Methods We used data from 22 European cohort studies, which created a total study population of 367 251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 mu m (PM2.5), less than 10 mu m (PM10), and between 10 mu m and 2.5 mu m (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx), with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buff er. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects meta-analysis. Findings The total study population consisted of 367 251 participants who contributed 5 118 039 person-years at risk (average follow-up 13.9 years), of whom 29 076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2.5 of 1.07 (95% CI 1.02-1.13) per 5 mu g/m(3) was recorded. No heterogeneity was noted between individual cohort effect estimates (I-2 p value=0.95). HRs for PM2.5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 mu g/m(3) (HR 1.06, 95% CI 1.00-1.12) or below 20 mu g/m(3) (1.07, 1.01-1.13). Interpretation Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value.

Background: The Basque Country, in Spain, shows one of the highest sporadic Creutzfeldt-Jakob disease (sCJD) incidence rates in Europe. The purpose is to analyse a possible focus of unidentified external or environmental factors which could trigger the high incidence rates of sCJD in the Basque Country. Methods: We estimated the relative risk and the posterior relative risk distribution of sCJD cases for each town of the Basque Country and for the period 1995-2008. Results: 58 sCJD cases (44 definite and 14 probable) were selected for the geographic cluster analysis. In a first approach, referring to the relative risk, several municipalities in the Autonomous Community of the Basque Country showed more sCJD cases than expected. However, the posterior relative risk distribution showed no excess risk areas. Conclusions: Results from this survey indicate that a possible common source of development of the disease does not seem to be the reason of the high sCJD incidence. (C) 2014 S. Karger AG, Basel

Background: Air pollution has been associated with cardiovascular mortality, but it remains unclear as to whether specific pollutants are related to specific cardiovascular causes of death. Within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE), we investigated the associations of long-term exposure to several air pollutants with all cardiovascular disease (CVD) mortality, as well as with specific cardiovascular causes of death. Methods: Data from 22 European cohort studies were used. Using a standardized protocol, study area-specific air pollution exposure at the residential address was characterized as annual average concentrations of the following: nitrogen oxides (NO2 and NOx); particles with diameters of less than 2.5 mu m (PM2.5), less than 10 mu m (PM10), and 10 mu m to 2.5 mu m (PMcoarse); PM2.5 absorbance estimated by land-use regression models; and traffic indicators. We applied cohort-specific Cox proportional hazards models using a standardized protocol. Random-effects meta-analysis was used to obtain pooled effect estimates. Results: The total study population consisted of 367,383 participants, with 9994 deaths from CVD (including 4,992 from ischemic heart disease, 2264 from myocardial infarction, and 2484 from cerebrovascular disease). All hazard ratios were approximately 1.0, except for particle mass and cerebrovascular disease mortality; for PM2.5, the hazard ratio was 1.21 (95% confidence interval = 0.87-1.69) per 5 mu g/m(3) and for PM10, 1.22 (0.91-1.63) per 10 mu g/m(3). Conclusion: In a joint analysis of data from 22 European cohorts, most hazard ratios for the association of air pollutants with mortality from overall CVD and with specific CVDs were approximately 1.0, with the exception of particulate mass and cerebrovascular disease mortality for which there was suggestive evidence for an association.

The brown rat lives with man in a wide variety of environmental contexts and adversely affects public health by transmission of diseases, bites, and allergies. Understanding behavioural aspects of pest species can contribute to their effective management and control. We report an analysis of the spatio-temporal distribution of rat sightings, which are directly related to rat infestation, in a district of Madrid (Spain). We first consider an empirical analysis of the first-order for the first and second order properties of the spatio-temporal point process of rat sightings, in which we model the first-order intensity function as a product of two intensity functions, one spatial and the other temporal, and use the inhomogeneous spatio-temporal K-function to estimate second order properties. We then formulate a more mechanistic model in which the conditional intensity of the point process depends explicitly on its past history. We have found that the sightings show strong seasonal variation and are strongly influenced by environmental factors related to human behaviour. We have also identified spatio-temporal clustering and interaction over and above the separate temporal and spatial components of variation in risk, and have estimated the spatial scale on which the interaction operates. (C) 2014 Elsevier B.V. All rights reserved.

Urban rat infestations have multifactorial causes and may result in severe public health and environmental problems, as well as heavy economic losses. The identification of putative environmental determinants of urban rat infestations and the mapping of areas prone to experiencing such infestations (hot spots) are crucial for effectively addressing intervention efforts. We investigated the associations between a selection of environmental factors and the occurrence of rat infestations in the city of Madrid, Spain. This was done by modelling 10,956 citizen-reported rat sightings from 2002 to 2008 using generalized additive models, both at municipality (Madrid) and district (Latina) levels. Increased age and density of housing, and decreased distance to vegetated areas, markets and cat feeding stations were factors associated with an increased risk of rat infestations. Risk maps for rat infestations were also developed and recurrent hot spots of rat activity were identified. Although a better fit to the data was obtained in the model for the smaller scale and possibly more environmentally homogenous study area of Latina, modelling the spatial distribution of rat sightings was useful for identifying factors associated with an increased risk of urban rat infestations, as well as for identifying hot spots of rat activity, providing local authorities with a practical tool for effectively targeting intervention efforts to high-risk situations based on the local environmental contexts.

Spatial behaviour and habitat selection at stopover sites have a strong influence on the foraging and fuelling performance of migrating birds and hence are important aspects of stopover ecology. The aim of this study was to analyse the spatial behaviour and habitat use of reed warblers Acrocephalus scirpaceus during the autumn migration. We used radio tracking data from reed warblers surveyed at a stopover site in northern Iberia and assigned to three different groups: (1) local adult birds which were still at their breeding site, (2) migrating first-year birds (originating from beyond Iberian peninsula) and (3) migrating adult birds. Overall, migrating first-year birds tended to have larger home ranges than both local and migrating adults and to move more widely in the study area. They also showed lower fat deposition rates than adults. The proportion of habitats in home ranges (reed-beds and tidal flats being the most abundant habitats) was similar amongst groups. The spatial distribution and habitat use of organisms have been theorised to follow an ideal-free or ideal-despotic distribution. However, according to our results, other complex underlying mechanisms may play an important role in shaping the spatial behaviour of birds at stopover sites.

Background Ambient air pollution is suspected to cause lung cancer. We aimed to assess the association between long-term exposure to ambient air pollution and lung cancer incidence in European populations. Methods This prospective analysis of data obtained by the European Study of Cohorts for Air Pollution Effects used data from 17 cohort studies based in nine European countries. Baseline addresses were geocoded and we assessed air pollution by land-use regression models for particulate matter (PM) with diameter of less than 10 mu m (PM10), less than 2.5 mu m (PM2.5), and between 2.5 and 10 mu m (PMcoarse), soot (PM2.5 absorbance), nitrogen oxides, and two traffic indicators. We used Cox regression models with adjustment for potential confounders for cohort-specific analyses and random effects models for meta-analyses. Findings The 312944 cohort members contributed 4 013131 person-years at risk. During follow-up (mean 12.8 years), 2095 incident lung cancer cases were diagnosed. The meta-analyses showed a statistically significant association between risk for lung cancer and PM10 (hazard ratio [HR] 1.22 [95% CI 1.03-1.45] per 10 mu g/m(3)). For PM2.5 the HR was 1.18 (0.96-1.46) per 5 mu g/m(3). The same increments of PM10 and PM2.5 were associated with HRs for adenocarcinomas of the lung of 1.51 (1.10-2.08) and 1.55 (1.05-2.29), respectively. An increase in road traffic of 4000 vehicle-km per day within 100 m of the residence was associated with an HR for lung cancer of 1.09 (0.99-1.21). The results showed no association between lung cancer and nitrogen oxides concentration (HR 1.01 [0.95-1.07] per 20 mu g/m(3)) or traffic intensity on the nearest street (HR 1.00 [0.97-1.04] per 5000 vehicles per day). Interpretation Particulate matter air pollution contributes to lung cancer incidence in Europe.

Using ring recovery data from the EURING databank, the aims of this study were: (1) to identify the chief migration and wintering areas of white-throated bluethroat European subspecies, L. s. namnetum, L. s. cyanecula and L. s. azuricollis, (2) to evaluate the degree of connectivity between breeding and non-breeding regions and determine the migration patterns of each subspecies, and (3) to evaluate whether recovery data are sufficient to answer the previous questions adequately. Most of the recoveries were obtained during the autumn migration period (n = 155, 68.9%), followed by winter (n = 49, 21.8%) and spring (n = 21, 9.3%). For L. s. azuricollis, we did not find any ring recoveries at more than 100 km in autumn or spring, and there were none at all in winter. All analyses thus relate to L. s. cyanecula and L. s. namnetum. Both subspecies move across a NE SW axis from their breeding to their wintering areas within the circum-Mediterranean region, mainly in Iberia, following population-specific parallel migration routes. L. s. namnetum mainly uses the Atlantic coastal marshes from France to south-western Iberia, where the chief wintering areas are found. L. s. cyanecula, however, uses both Atlantic and Mediterranean wetlands in autumn, but only those in the Mediterranean in spring, thus giving rise to a loop-migration pattern. Telescopic migration was demonstrated for L. s. cyanecula. Recovery data were insufficient to identify in detail the entire wintering range for all white-throated bluethroat European populations. Technologies such as the use of geolocators will play a relevant role in this scenario.

Coastal marshes play a relevant role as stopover and fuelling sites for birds during migration period. The importance of tide in such ecosystems is well studied for aquatic species such as waders, but its impact on the stopover behavior of land birds that also depend on these sites is still unknown. Bluethroats Luscinia svecica are small-sized passerines that feed on the ground and low vegetation and, therefore, experience continuous changes of habitat availability due to the tide regimens. The aim of this study was to analyse the habitat use and to test the impact of tide on home range size of Bluethroats stopping over at coastal marshes. For that, we used data on radio-tagged birds at a tidal marsh in Northern Iberia. Bluethroats were radiotracked from the 20th of August to the 20th of September. Individuals were surveyed from 3 to 17 days, and birds with lower body mass at the day of capture stayed for longer period. Mean home range size was 2.0 ha (SE = 0.2), and the main habitats occupied were reedbeds (ca. 30% of a home range area) together with tidal flats with both free- and low-halophytic vegetation (30%). Reedbeds were situated at a higher altitude over the sea level than open waters, mudflats and low halophytic vegetation. Home ranges tended to be larger in birds found to occupy zones close to the sea level, thus with a longer tide-mediated flooding period, suggesting a negative effect of tide on home range size, and/or that Bluethroats staying at lower altitude did not find as much food as at higher altitude, so they were forced to move over larger surfaces.

Urban Norway rats are challenging pests, posing significant health and economic threats. Implementing ecologically based integrated rodent management (EBIRM) programmes relies primarily on the understanding of ecological relationships between rodents and their environments, with emphasis on the processes influencing rodent populations in the target ecosystem. We investigated the temporal distribution of urban Norway rat infestations in Madrid, Spain, and tested for the association of such infestations with temperature, relative humidity and precipitation by fitting a multivariate Poisson generalized linear model to a 3-year (2006-2008) daily time series of 4,689 Norway rat sightings. Norway rat infestations showed a marked seasonality, peaking in the summer. Most Norway rat sightings were reported on Mondays. Minimum temperature and relative humidity were positively associated with Norway rat infestation, whereas the association with precipitation was negative. The time series was adequately explained by the model. We identified previously unrecognized time periods that are more prone to Norway rat infestation than others and generated hypotheses about the association between weather, human outdoor activity, resource availability, rodent activity and population size. This provided local authorities engaged in preserving urban ecosystem health with basic research information to predict future rodent outbreaks and support the implementation of EBIRM programmes in urban areas.

Ecosystem goods and services have been brought to the forefront of policy making all over the world. It is acknowledged that these goods and services underpin human well-being. The provision of water resources is amongst those services that have raised more attention, given its unquestionable value and global threats like climatic change. Nevertheless, the biophysical basis that determines the land-use/water interactions has been often ignored. For the formulation of sound decisions, it is necessary to extend the empirical basis that determines these complex relations. With this aim, the present paper analyses the effect of alternative types of land cover in the provision of water resources. In doing so, we compare hydrological, meteorological and land-cover data obtained in 15 watersheds located in the Basque Country (Northern Spain). Moreover we discuss the implications of including water resources in land-use policy and planning and address areas for further research. (C) 2011 Elsevier Ltd. All rights reserved.