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  • 1.
    Carlsen, Hanne Krage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Univ Iceland, Engn & Nat Sci, Reykjavik, Iceland; Univ Gothenburg, Inst Med, Sect Occupat & Environm Med, Dept Publ Hlth & Community Med,Sahlgrenska Acad, Gothenburg, Sweden.
    Bäck, E.
    Eneroth, K.
    Gislason, T.
    Holm, M.
    Janson, C.
    Jensen, S. S.
    Johannessen, A.
    Kaasik, M.
    Modig, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Segersson, D.
    Sigsgaard, T.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Univ Tartu, Dept Family Med & Publ Hlth, Tartu, Estonia.
    Indicators of residential traffic exposure: Modelled NOX, traffic proximity, and self-reported exposure in RHINE III2017In: Atmospheric Environment, ISSN 1352-2310, Vol. 167, p. 416-425Article in journal (Refereed)
    Abstract [en]

    Few studies have investigated associations between self-reported and modelled exposure to traffic pollution. The objective of this study was to examine correlations between self-reported traffic exposure and modelled (a) NOx and (b) traffic proximity in seven different northern European cities; Aarhus (Denmark), Bergen (Norway), Gothenburg, Ulna and Uppsala (Sweden), Reykjavik (Iceland), and Tartu (Estonia). We analysed data from the RHINE III (Respiratory Health in Northern Europe, www.rhine.nu) cohorts of the seven study cities. Traffic proximity (distance to the nearest road with >10,000 vehicles per day) was calculated and vehicle exhaust (NOx) was modelled using dispersion models and land-use regression (LUR) data from 2011. Participants were asked a question about self-reported traffic intensity near bedroom window and another about traffic noise exposure at the residence. The data were analysed using rank correlation (Kendall's tau) and inter-rater agreement (Cohen's Kappa) between tertiles of modelled NOx and traffic proximity tertile and traffic proximity categories (0-150 metres (m), 150 -200 m, >300 m) in each centre. Data on variables of interest were available for 50-99% of study participants per each cohort. Mean modelled NOx levels were between 6.5 and 16.0 mu g/m(3); median traffic intensity was between 303 and 10,750 m in each centre. In each centre, 7.7-18.7% of respondents reported exposure to high traffic intensity and 3.6-16.3% of respondents reported high exposure to traffic noise. Self-reported residential traffic exposure had low or no correlation with modelled exposure and traffic proximity in all centres, although results were statistically significant (tau = 0.057-0.305). Self reported residential traffic noise correlated weakly (tau = 0.090-0.255), with modelled exposure in all centres except Reykjavik. Modelled NOx\] had the highest correlations between self-reported and modelled traffic exposure in five of seven centres, traffic noise exposure had the highest correlation with traffic proximity in tertiles in three centres. Self-reported exposure to high traffic intensity and traffic noise at each participant's residence had low or weak although statistically significant correlations with modelled vehicle exhaust pollution levels and traffic proximity.

  • 2. Demuzere, M
    et al.
    Orru, K
    Heidrich, O
    Olazabal, E
    Geneletti, D
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. University of Tartu, Department of Public Health, Tartu, Estonia.
    Bhave, AG
    Mittal, N
    Feliu, E
    Faehnle, M
    Mitigating and adapting to climate change: multi-functional and multi-scale assessment of green urban infrastructure2014In: Journal of Environmental Management, ISSN 0301-4797, E-ISSN 1095-8630, Vol. 146, p. 107-115Article in journal (Refereed)
    Abstract [en]

    In order to develop climate resilient urban areas and reduce emissions, several opportunities exist starting from conscious planning and design of green (and blue) spaces in these landscapes. Green urban infrastructure has been regarded as beneficial, e.g. by balancing water flows, providing thermal comfort. This article explores the existing evidence on the contribution of green spaces to climate change mitigation and adaptation services. We suggest a framework of ecosystem services for systematizing the evidence on the provision of bio-physical benefits (e.g. CO2 sequestration) as well as social and psychological benefits (e.g. improved health) that enable coping with (adaptation) or reducing the adverse effects (mitigation) of climate change. The multi-functional and multi-scale nature of green urban infrastructure complicates the categorization of services and benefits, since in reality the interactions between various benefits are manifold and appear on different scales. We will show the relevance of the benefits from green urban infrastructures on three spatial scales (i.e. city, neighborhood and site specific scales). We will further report on co-benefits and trade-offs between the various services indicating that a benefit could in turn be detrimental in relation to other functions. The manuscript identifies avenues for further research on the role of green urban infrastructure, in different types of cities, climates and social contexts. Our systematic understanding of the bio-physical and social processes defining various services allows targeting stressors that may hamper the provision of green urban infrastructure services in individual behavior as well as in wider planning and environmental management in urban areas.

  • 3. Heidrich, O
    et al.
    Reckien, D
    Olazabal, M
    Foley, A
    Salvia, M
    de Gregorio Hurtado, S
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Flacke, J
    Geneletti, D
    Pietrapertosa, F
    Hamann, J J-P
    Tiwary, A
    Feliu, E
    Dawson, R J
    National climate policies across Europe and their impacts on cities strategies.2016In: Journal of Environmental Management, ISSN 0301-4797, E-ISSN 1095-8630, Vol. 168, p. 36-45Article in journal (Refereed)
    Abstract [en]

    Globally, efforts are underway to reduce anthropogenic greenhouse gas emissions and to adapt to climate change impacts at the local level. However, there is a poor understanding of the relationship between city strategies on climate change mitigation and adaptation and the relevant policies at national and European level. This paper describes a comparative study and evaluation of cross-national policy. It reports the findings of studying the climate change strategies or plans from 200 European cities from Austria, Belgium, Estonia, Finland, France, Germany, Ireland, Italy, Netherlands, Spain and the United Kingdom. The study highlights the shared responsibility of global, European, national, regional and city policies. An interpretation and illustration of the influences from international and national networks and policy makers in stimulating the development of local strategies and actions is proposed. It was found that there is no archetypical way of planning for climate change, and multiple interests and motivations are inevitable. Our research warrants the need for a multi-scale approach to climate policy in the future, mainly ensuring sufficient capacity and resource to enable local authorities to plan and respond to their specific climate change agenda for maximising the management potentials for translating environmental challenges into opportunities.

  • 4. Idavain, J.
    et al.
    Julge, K.
    Rebane, T.
    Lang, A.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. University of Tartu, Institute of Family Medicine and Public Health, Ravila 19, 50411 Tartu, Estonia.
    Respiratory symptoms, asthma and levels of fractional exhaled nitric oxide in schoolchildren in the industrial areas of Estonia2019In: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 650, no Pt 1, p. 65-72Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Exposure to air pollutants in the ambient environment has been associated with various respiratory symptoms, and with increased asthma diagnosis, in both children and adults. Most research to date has focussed on core pollutants, such as PM10, PM2.5, SO2 and NO2, and less attention has been given to the effects of industry-specific contamination. The current study aimed to examine the associations between respiratory symptoms, asthma, increased levels of fractional exhaled nitric oxide (FeNO) (as a marker of eosinophilic airway inflammation) and ambient levels of industrial pollutants (such as benzene, phenol, formaldehyde and non-methane hydrocarbons) for schoolchildren living near oil shale industries in Ida-Viru County, Estonia.

    METHODS: A total of 1326 schoolchildren from Ida-Viru, Lääne-Viru and Tartu Counties participated in a cross-sectional study, consisting of questionnaires on respiratory symptoms and asthma, as well as clinical examinations to measure FeNO. Dispersion modelling was used to characterize individual-level exposure to industrial air pollutants at each subject's home address. Associations between exposure and respiratory health were investigated using logistic regression analysis, and differences in results between regions were analysed using the Chi-squared test.

    RESULTS: The prevalence of respiratory symptoms (p < 0.05) in children living near (i.e. within 5 km) of an oil shale industry site in Ida-Viru County was 2-4 times higher than in children living in the reference area of Tartu County. Children exposed to 1 μg/m3 higher levels of benzene and formaldehyde had a higher odds ratio (OR) of having rhinitis without a cold (OR 1.03, 95% confidence interval (CI) 1.01-1.06), of ever having had attacks of asthma (OR 1.05, 95% CI 1.01-1.10) and of having a dry cough a few days per year (OR 1.05, 95% CI 1.01-1.10). Children exposed to 1 μg/m3 higher levels of benzene, formaldehyde, phenol and non-methane hydrocarbons had a higher odds ratio of having high FeNO levels (≥30 ppb): OR and 95% CI of 1.05, 1.01-1.09; 1.22, 1.06-1.41; 1.01, 1.00-1.01; and 1.75, 1.75-2.62, respectively.

  • 5. Lee, Jae Young
    et al.
    Kim, Ho
    Gasparrini, Antonio
    Armstrong, Ben
    Bell, Michelle L
    Sera, Francesco
    Lavigne, Eric
    Abrutzky, Rosana
    Tong, Shilu
    Coelho, Micheline de Sousa Zanotti Stagliorio
    Saldiva, Paulo Hilario Nascimento
    Correa, Patricia Matus
    Ortega, Nicolas Valdes
    Kan, Haidong
    Garcia, Samuel Osorio
    Kyselý, Jan
    Urban, Aleš
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Indermitte, Ene
    Jaakkola, Jouni J K
    Ryti, Niilo R I
    Pascal, Mathilde
    Goodman, Patrick G
    Zeka, Ariana
    Michelozzi, Paola
    Scortichini, Matteo
    Hashizume, Masahiro
    Honda, Yasushi
    Hurtado, Magali
    Cruz, Julio
    Seposo, Xerxes
    Nunes, Baltazar
    Teixeira, João Paulo
    Tobias, Aurelio
    Íñiguez, Carmen
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Vicedo-Cabrera, Ana Maria
    Ragettli, Martina S
    Guo, Yue-Liang Leon
    Chen, Bing-Yu
    Zanobetti, Antonella
    Schwartz, Joel
    Dang, Tran Ngoc
    Do Van, Dung
    Mayvaneh, Fetemeh
    Overcenco, Ala
    Li, Shanshan
    Guo, Yuming
    Predicted temperature-increase-induced global health burden and its regional variability2019In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 131, article id 105027Article in journal (Refereed)
    Abstract [en]

    An increase in the global health burden of temperature was projected for 459 locations in 28 countries worldwide under four representative concentration pathway scenarios until 2099. We determined that the amount of temperature increase for each 100 ppm increase in global CO2 concentrations is nearly constant, regardless of climate scenarios. The overall average temperature increase during 2010-2099 is largest in Canada (1.16 °C/100 ppm) and Finland (1.14 °C/100 ppm), while it is smallest in Ireland (0.62 °C/100 ppm) and Argentina (0.63 °C/100 ppm). In addition, for each 1 °C temperature increase, the amount of excess mortality is increased largely in tropical countries such as Vietnam (10.34%p/°C) and the Philippines (8.18%p/°C), while it is decreased in Ireland (-0.92%p/°C) and Australia (-0.32%p/°C). To understand the regional variability in temperature increase and mortality, we performed a regression-based modeling. We observed that the projected temperature increase is highly correlated with daily temperature range at the location and vulnerability to temperature increase is affected by health expenditure, and proportions of obese and elderly population.

  • 6. Liu, Cong
    et al.
    Chen, Renjie
    Sera, Francesco
    Vicedo-Cabrera, Ana M
    Guo, Yuming
    Tong, Shilu
    Coelho, Micheline S Z S
    Saldiva, Paulo H N
    Lavigne, Eric
    Matus, Patricia
    Valdes Ortega, Nicolas
    Osorio Garcia, Samuel
    Pascal, Mathilde
    Stafoggia, Massimo
    Scortichini, Matteo
    Hashizume, Masahiro
    Honda, Yasushi
    Hurtado-Díaz, Magali
    Cruz, Julio
    Nunes, Baltazar
    Teixeira, João P
    Kim, Ho
    Tobias, Aurelio
    Íñiguez, Carmen
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ragettli, Martina S
    Guo, Yue-Leon
    Chen, Bing-Yu
    Bell, Michelle L
    Wright, Caradee Y
    Scovronick, Noah
    Garland, Rebecca M
    Milojevic, Ai
    Kyselý, Jan
    Urban, Aleš
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. The Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Indermitte, Ene
    Jaakkola, Jouni J K
    Ryti, Niilo R I
    Katsouyanni, Klea
    Analitis, Antonis
    Zanobetti, Antonella
    Schwartz, Joel
    Chen, Jianmin
    Wu, Tangchun
    Cohen, Aaron
    Gasparrini, Antonio
    Kan, Haidong
    Ambient Particulate Air Pollution and Daily Mortality in 652 Cities2019In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 381, no 8, p. 705-715Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias.

    METHODS: We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 μm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions. We used overdispersed generalized additive models with random-effects meta-analysis to investigate the associations. Two-pollutant models were fitted to test the robustness of the associations. Concentration-response curves from each city were pooled to allow global estimates to be derived.

    RESULTS: On average, an increase of 10 μg per cubic meter in the 2-day moving average of PM10 concentration, which represents the average over the current and previous day, was associated with increases of 0.44% (95% confidence interval [CI], 0.39 to 0.50) in daily all-cause mortality, 0.36% (95% CI, 0.30 to 0.43) in daily cardiovascular mortality, and 0.47% (95% CI, 0.35 to 0.58) in daily respiratory mortality. The corresponding increases in daily mortality for the same change in PM2.5 concentration were 0.68% (95% CI, 0.59 to 0.77), 0.55% (95% CI, 0.45 to 0.66), and 0.74% (95% CI, 0.53 to 0.95). These associations remained significant after adjustment for gaseous pollutants. Associations were stronger in locations with lower annual mean PM concentrations and higher annual mean temperatures. The pooled concentration-response curves showed a consistent increase in daily mortality with increasing PM concentration, with steeper slopes at lower PM concentrations.

    CONCLUSIONS: Our data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies. (Funded by the National Natural Science Foundation of China and others.).

  • 7. Merisalu, E.
    et al.
    Vähi, M.
    Kinnas, S.
    Oja, M.
    Sarapuu, K.
    Novikov, O.
    Pärnapuu, M.
    Indermitte, E.
    Lea, K.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Public Health, University of Tartu, Estonia.
    Job specific risk factors, demographic parameters and musculoskeletal disorders among military personnel depending on type of service2015In: Agronomy Research, ISSN 1406-894X, Vol. 13, no 3, p. 775-785Article in journal (Refereed)
    Abstract [en]

    Current study aimed to analyse the prevalence of job specific risk factors (JSRF) and musculoskeletal disorders (MSDs) among military personnel depending on demographic factors and type of service. An anonymous questionnaire study was carried out in five departments of Estonian Defence Forces (EDF) among local service personnel (LSP) and the Peace Corp personnel (PCP) arrived back from mission. The average response rate was 38.7% (LSP 31.9% and PCP 77.6%). In LSP group there were 44.7% male participants, with mean age 39.2 ± 11 years, length of service in present position 5.8 ± 4.9 years and work load of 37.9 ± 8.4 hours per week. In PCP group 97.4% were males, with mean age 27.5 ± 5.7 years, service length on present position 3.1 ± 2.6 years and work load of 84.3 ± 60.9 hours per week. The dominant JSRF in LSP was 'demand for constant concentration' (76.5%) and night work (57%) in PCP (group difference p < 0.0001). 'Fast movements' and 'lifting loads >40 kg' were the specific tasks most often reported in mission. 'Job insecurity' was more often reported by the female; 'night work' and 'work-rest disbalance' by the male military personnel (p< 0.001).The prevalence of MSDs was higher among women and LSP than in men and PCP group (p< 0.05). In LSP mild to moderate discomfort reported by 2/3 because of neck-shoulder strain and by ½ because of lower back pain. In conclusion, MSDs seems to depend more on demographic parameters and type of service than JSRFs. Further studies are needed to focus on predictive factors of MSDs among military personnel.

  • 8.
    Olstrup, Henrik
    et al.
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, 10691, Sweden.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Family Medicine and Public Health, University of Tartu, Tartu, 500 90, Estonia; Environment Department, City of Malmö, Malmö, 205 80, Sweden..
    Spanne, Mårten
    Environment Department, City of Malmö, 205 80 Malmö, Sweden.
    Nguyen, Hung
    Environmental Administration in Gothenburg, P.O. Box 7012, Gothenburg, 402 31, Sweden.
    Molnár, Peter
    Occupational and Environmental Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, 40530, Sweden..
    Johansson, Christer
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, 10691, Sweden; Environment and Health Administration, SLB, P.O. Box 8136, Stockholm, 104 20, Sweden..
    Trends in air pollutants and health impacts in three Swedish cities over the past three decades2018In: Atmospheric Chemistry And Physics, ISSN 1680-7316, E-ISSN 1680-7324, Vol. 18, no 21, p. 15705-15723Article in journal (Refereed)
    Abstract [en]

    Air pollution concentrations have been decreasing in many cities in the developed countries. We have estimated time trends and health effects associated with exposure to NOx, NO2, O3, and PM10 (particulate matter) in the Swedish cities Stockholm, Gothenburg, and Malmö from the 1990s to 2015. Trend analyses of concentrations have been performed by using the Mann–Kendall test and the Theil–Sen method. Measured concentrations are from central monitoring stations representing urban background levels, and they are assumed to indicate changes in long-term exposure to the population. However, corrections for population exposure have been performed for NOx, O3, and PM10 in Stockholm, and for NOx in Gothenburg. For NOx and PM10, the concentrations at the central monitoring stations are shown to overestimate exposure when compared to dispersion model calculations of spatially resolved, population-weighted exposure concentrations, while the reverse applies to O3. The trends are very different for the pollutants that are studied; NOx and NO2 have been decreasing in all cities, O3 exhibits an increasing trend in all cities, and for PM10, there is a slowly decreasing trend in Stockholm, a slowly increasing trend in Gothenburg, and no significant trend in Malmö. Trends associated with NOxand NO2 are mainly attributed to local emission reductions from traffic. Long-range transport and local emissions from road traffic (non-exhaust PM emissions) and residential wood combustion are the main sources of PM10. For O3, the trends are affected by long-range transport, and there is a net removal of O3 in the cities. The increasing trends are attributed to decreased net removal, as NOx emissions have been reduced.

    Health effects in terms of changes in life expectancy are calculated based on the trends in exposure to NOx, NO2, O3, and PM10 and the relative risks associated with exposure to these pollutants. The decreased levels of NOx are estimated to increase the life expectancy by up to 11 months for Stockholm and 12 months for Gothenburg. This corresponds to up to one-fifth of the total increase in life expectancy (54–70 months) in the cities during the period of 1990–2015. Since the increased concentrations in O3 have a relatively small impact on the changes in life expectancy, the overall net effect is increased life expectancies in the cities that have been studied.

  • 9.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Exposure to particulate matter and the related health impacts in major Estonian cities2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Particulate matter (PM) is one of the most studied and problematic pollutants due to its toxicity and relati­vely high concentrations. This thesis aims to clarify the main sources and exposures of PM in Tallinn and Tartu, study the associations with health effects, and estimate the extent of those effects with health impact assessment (HIA).

    It appeared that the main sources of particulate air pollution in Tallinn (the capital of Estonia) and Tartu (the second largest city of Estonia) are local heating and traffic, inclu­ding road dust. In addition to local emissions, particulate levels are affected by transboundary pollution. If the transboundary air masses originated from the Eastern European areas, the concentration as well as the oxidative capacity of fine particles was significantly higher in urban background air in Tartu compared to air masses coming from Scandinavian areas (Paper I).

    During the last 15 years, traffic increase has been very fast in Tartu. However, due to the improvement in vehicle technology during this period, there has been only a slight increase in concentration of exhaust particles (Paper II). Nevertheless, a greater increase in road dust emissions was detected.

    A statistically significant relationship between long-term exposure to those traffic induced par­tic­les and cardiac disease in the RHINE (Respiratory Health in Northern Europe) Tartu cohort was shown (Paper III). However, no significant associations with respira­tory health were found.

    The HIA in Tallinn demonstrated 296 (95% CI = 76–528) premature deaths annually, because of PM (Paper IV). The average decrease in life expectancy was predicted to be 0.64 (95% CI 0.17–1.10) years. However, among risk groups it can be higher. In addi­tion, several cardiovascular hospitalizations are related. The costs to society be­cause of health effects reach up to €150 million annually (95% CI = 40–260) from pre­mature deaths and hospitali­zation constitute an additional €0.3 million (95% CI = 0.2–0.4).

    The special HIA scenario, when more pollution fuel peat will be used in boiler houses was analysed as well (Paper V). It indicated that peat bur­ning would result in up to 55.5 YLL per year within the population of Tartu. However, the health effects of pollution from current traffic, local heating, and industry are at least 28 times bigger.

    In conclusion, exposure to PM cause considerable health effects in the form of cardio­pulmo­nary diseases in main Estonian cities.

  • 10.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Andersson, Camilla
    Swedish Meteorological and Hydrological Institute, Norrköping, Sweden.
    Ebi, Kristie L
    ClimAdapt, Los Altos, California, USA.
    Langner, Joakim
    Swedish Meteorological and Hydrological Institute, Norrköping, Sweden.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Impact of climate change on ozone-related mortality and morbidity in Europe2013In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 41, no 2, p. 285-294Article in journal (Refereed)
    Abstract [en]

    Ozone is a highly oxidative pollutant formed from precursors in the presence of sunlight, associated with respiratory morbidity and mortality. All else being equal, concentrations of ground-level ozone are expected to increase due to climate change.Ozone-related health impacts under a changing climate are projected using emission scenarios, models and epidemiological data. European ozone concentrations are modelled with MATCH-RCA3 (50×50 km). Projections from two climate models, ECHAM4 and HadCM3, are applied, under greenhouse gas emission scenarios A2 and A1B respectively. We apply a European-wide exposure-response function to gridded population data and country-specific baseline mortality and morbidity.Comparing the current situation (1990-2009) with the baseline period (1961-1990), the largest increase in ozone-associated mortality and morbidity due to climate change (4-5%) have occurred in Belgium, Ireland, Netherlands and UK. Comparing the baseline period and the future periods (2021-2050 and 2041-2060), much larger increase in ozone-related mortality and morbidity are projected for Belgium, France, Spain and Portugal with the impact being stronger using the climate projection from ECHAM4 (A2). However, in Nordic and Baltic countries the same magnitude of decrease is projected.The current study suggests that projected effects of climate change on ozone concentrations could differentially influence mortality and morbidity across Europe.

  • 11.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Family Medicine and Public Health, University of Tartu.
    Ebi, K. L.
    Center for Health and the Global Environment, University of Washington, Seattle, WA, USA.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    The interplay of climate change and air pollution on health2017In: Current environmental health reports, ISSN 2196-5412, Vol. 4, no 4, p. 504-513Article in journal (Refereed)
    Abstract [en]

    Purpose of review: Air pollution significantly affects health, causing up to 7 million premature deaths annually with an even larger number of hospitalizations and days of sick leave. Climate change could alter the dispersion of primary pollutants, particularly particulate matter, and intensify the formation of secondary pollutants, such as near-surface ozone. The purpose of the review is to evaluate the recent evidence on the impacts of climate change on air pollution and air pollution-related health impacts and identify knowledge gaps for future research.

    Recent findings: Several studies modelled future ozone and particulate matter concentrations and calculated the resulting health impacts under different climate scenarios. Due to climate change, ozone- and fine particle-related mortalities are expected to increase in most studies; however, results differ by region, assumed climate change scenario and other factors such as population and background emissions.

    Summary: This review explores the relationships between climate change, air pollution and air pollution-related health impacts. The results highly depend on the climate change scenario used and on projections of future air pollution emissions, with relatively high uncertainty. Studies primarily focused on mortality; projections on the effects on morbidity are needed.

  • 12.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Assessment of long-term health impacts of air quality with different guideline values for NOX in the planned by-pass tunnel Förbifart Stockholm2016Report (Other academic)
    Abstract [en]

    To meet increased needs of transports in the Stockholm region and reduce the problems with traffic congestion in central parts, a 21 km long by-pass (18 km in a tunnel) is planned. The bypass is expected to reduce traffic and emissions in central Stockholm, but at the same time tunnel users could be exposed to high concentrations of air pollutants from traffic. Thus to control the air quality in the tunnel system, air pollution guideline values have been proposed. The current study is initiated and funded by the Swedish Transport Administration (Trafikverket), and the aim is to assess the potential health impacts of applying different NOX guideline values (1000, 2000, 3000 and 4000 μg/m3 as hourly average max values all-over the tunnel system). The passengers’ exposure was estimated based on annual average NOX exposures, time spent in the tunnel and the number of tunnel users. Health impacts were assessed following health impact assessment principles using equations and WHO’s software AirQPlus.

    With minimal ventilation and maximal traffic amounts during rush hours the NOX hourly average concentrations could raise up to 3500 μg/m3 and even when the planned maximum ventilation would be in use, the maximum concentration would stay as high as 1789 μg/m3. Thus, it is in principle with planned the technology impossible to meet the lowest proposed guideline value of 1000 μg/m3 in the whole tunnel system. However, the effects would be with this guideline still the smallest, resulting annually in 22.2 (CI 95% 16.8–30.1) more premature deaths and 480.4 (95% CI 364.1–650.6) years of life lost (assuming travellers to come from the age group 30–74). If the guideline value would be 2000 μg/m3, the exposure would annually in the same age group cause 35.2 (CI 95% 26.7–47.6) premature deaths with 760.9 (480.4–650.6) years of life lost. With the lowest guideline level, passing the whole tunnel during rush hours on working days would increase mortality risk by 7.4% (95% CI 5.5-10.1), on average corresponding to a life expectancy decrease by 0.27 (95% CI 0.20-0.37) years for people aged 30–74 years.

    Among different tunnel links, the biggest exposure is expected in link 5N, where 28.6-37.2% (depending on limit value scenario) of the total health impact could be generated. The link 3N has high NOX concentration, large number of passengers and long exposure time (time spent in the tunnel link). Even the NOX concentrations are expected to be highest in links 411 and 314, the exposure time there would be shorter and the number of exposed passengers smaller. For the separate links the differences in exposure between limit value scenarios could also vary largely: while the difference was big for link 5N, it was rather small for link 7N.

    If we compare these results with the previously estimated beneficial effect on the health of the local population due to decrease of urban air pollution exposure (expecting annually 23.7 (95% CI 17.7–32.3) fewer premature deaths), only with most favourable assumptions as less older persons using tunnel and with highest ventilation the tunnel could have smaller negative health effects compared to the alternative current open road E4. In all other cases the health effects in the by-pass tunnel Förbifart Stockholm are expected to be higher. Also the exposure levels in the tunnel are expected to be somewhat higher compared to previous analysis due to more 5 enhanced dispersion modelling for the tunnel, including also ramps in the impact assessment and predicting higher numbers of cars than previously.

  • 13.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Estonia.
    Idavain, Jane
    Pindus, Mihkel
    Orru, Kati
    Kesanurm, Kaisa
    Lang, Aavo
    Tomasova, Jelena
    Residents' Self-Reported Health Effects and Annoyance in Relation to Air Pollution Exposure in an Industrial Area in Eastern-Estonia2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 2, article id 252Article in journal (Refereed)
    Abstract [en]

    Eastern Estonia has large oil shale mines and industrial facilities mainly focused on electricity generation from oil shale and shale oil extraction, which produce high air pollution emissions. The "Study of the health impact of the oil shale sector-SOHOS" was aimed at identifying the impacts on residents' health and annoyance due to the industrial processing. First, a population-wide survey about health effects and annoyance was carried out. Second, the total and oil shale sectors' emitted concentrations of benzene, phenol, and PM2.5 were modelled. Third, the differences between groups were tested and relationships between health effects and environmental pollution studied using multiple regression analysis. Compared to the control groups from non-industrial areas in Tartu or Laane-Viru, residents of Ida-Viru more frequently (p < 0.05) reported wheezing, chest tightness, shortness of breath, asthma attacks, a long-term cough, hypertension, heart diseases, myocardial infarction, stroke, and diabetes. All health effects except asthma were reported more frequently among non-Estonians. People living in regions with higher levels of PM2.5, had significantly higher odds (p < 0.05) of experiencing chest tightness (OR = 1.13, 95% CI 1.02-1.26), shortness of breath (1.16, 1.03-1.31) or an asthma attack (1.22, 1.04-1.42) during the previous year. People living in regions with higher levels of benzene had higher odds of experiencing myocardial infarction (1.98, 1.11-3.53) and with higher levels of phenol chest tightness (1.44, 1.03-2.00), long-term cough (1.48, 1.06-2.07) and myocardial infarction (2.17, 1.23-3.83). The prevalence of adverse health effects was also higher among those who had been working in the oil shale sector. Next to direct health effects, up to a quarter of the residents of Ida-Viru County were highly annoyed about air pollution. Perceived health risk from air pollution increased the odds of being annoyed. Annoyed people in Ida-Viru had significantly higher odds of experiencing respiratory symptoms during the last 12 months, e.g., wheezing (2.30, 1.31-4.04), chest tightness (2.88, 1.91-4.33 or attack of coughing (1.99, 1.34-2.95).

  • 14.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jõgi, Rain
    Lung Clinic, Tartu University Hospital.
    Kaasik, Marko
    Institute of Physics, University of Tartu.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Chronic traffic-induced PM exposure and self-reported respiratory and cardiovascular health in the RHINE Tartu cohort2009In: International journal of environmental research and public health, ISSN 1660-4601, Vol. 6, no 11, p. 68p. 2740-2751Article in journal (Refereed)
    Abstract [en]

    The relationship between exposure to traffic induced particles and respiratory health, and cardiac diseases was studied in the RHINE Tartu cohort. A postal questionnaire with commonly used questions regarding respiratory symptoms, cardiac disease, lifestyle as smoking habits, indoor environment, occupation, early life exposure and sleep disorders was sent to 2460 adults. The annual concentrations of local traffic induced particles were modelled with an atmospheric dispersion model with traffic flow data, and obtained PMexhaust concentrations in 40x40 m grids were linked with home addresses with GIS. The relationship between the level of exhaust particles outside home and self-reported health problems were analyzed using a multiple logistic regression model. We found a significant relation between fine exhaust particles and cardiac disease, OR = 1.64 (95% CI 1.12-2.43) for increase in PMexhaust corresponding to the fifth to the 95th percentile range. The associations also were positive but non-significant for hypertension OR = 1.42 (95% CI 0.94-2.13), shortness of breath OR = 1.27 (95% CI 0.84-1.94) and other respiratory symptoms.

  • 15.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Kaasik, M
    Antov, D
    Forsberg, B
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Evolution of traffic flows and traffic induced air pollution due to structural changes and development during 1993-2006 in Tartu (Estonia)2008In: Baltic journal of road and bridge engineering, ISSN 1822-427X, Vol. 3, no 4, p. 206-212Article in journal (Refereed)
    Abstract [en]

    Traffic is the main factor affecting air quality in most cities. After the Estonian re-independence in 1991, the increase of motorization has been fast and car usage has intensified. During the same period, the average age of cars has decreased and thanks to improvements in engine technology, the emissions per km have been reduced. The objective was to see how these factors have reflected in air quality. This paper also aim to present an analytical approach to estimate the air pollution levels in recent years, when air quality monitoring has not been conducted, and available traffic data are limited. Based on traffic counts in 25 points across the city the amounts of traffic were modelled for 680 street segments with CUBE software. As air quality is monitored irregularly in Tartu, dispersion modelling was used to estimate pollution levels. Annual concentrations of exhaust particles (PMexhaust), particulate matter (PM10) and nitrogen oxides (NOx) in 1993, 2000 and 2006 were calculated with AEROPOL software. The traffic increase in the city centre of Tartu was especially rapid in the 1990s. In recent years, it has slowed due to congestion. Overall, traffic levels have increased more than 3 times since 1993. In residential areas, the increase is still rapid – up to 6 times from 1993 to 2006. However, the changes in air quality are less dramatic. Increases from 1993 to 2000 were followed by stable or slightly increasing pollution levels in recent years, especially in case of PMexhaust. The study showed that 2 factors, namely, increase of traffic and improvement of vehicles, have been compensating each other in the dynamics of air pollution.

  • 16.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Kaasik, Marko
    Institute of Physics, University of Tartu.
    Merisalu, Eda
    Department of Public Health, University of Tartu.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Health impact assess­ment in case of peat: co-use of environmental scenarios and exposure-response functions2009In: Biomass and Bioenergy, ISSN 0961-9534, E-ISSN 1873-2909, Vol. 33, no 8, p. 1080-1086Article in journal (Refereed)
    Abstract [en]

    Peat will be used more widely for heating in Tartu (Estonia), therefore the potential health effects needed to be assessed. In transition from today's gas heating to burning of peat, the amount of exhaust gases emitted will increase and more than 100 000 people will be exposed to greater health risks. Based on the peat quality data, the emissions were calculated and their dispersion in Tartu was modelled using the air pollution dispersion and deposition model AEROPOL. The AirQ software, developed by the WHO, was used for calculating the health impacts. The number of years of life lost (YLL) due to the emissions from peat burning was estimated to be up to 55.5 in a year within the population of Tartu (101 000 citizens). However, in perspective, this would be about 28 times less than YLL calculated due to emissions from traffic, local heating etc.

  • 17.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Public Health, University of Tartu, Ravila 19, Tartu 50411, Estonia.
    Kimmel, Veljo
    Estonian University of Life Sciences.
    Kikas, Ülle
    University of Tartu.
    Soon, Argo
    Archimedes Foundation.
    Künzli, Nino
    CREAL.
    Schins, Roel
    University of Dusseldorf.
    Borm, Paul
    Centre of Expertise Life Sciences .
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Elemental composition and oxidative properties of PM2.5 in Estonia in relation to origin of air masses: results from the ECRHS II in Tartu2010In: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 408, no 7, p. 1515-1522Article in journal (Refereed)
    Abstract [en]

    Fine particulate matter (PM2.5) was sampled at an urban background site in Tartu, Estonia over one-year period during the ECRHS II study. The elemental composition of 71 PM2.5 samples was analyzed for different chemical elements using energy-dispersive X-ray fluorescence spectrometry (ED-XRF). The oxidative activity of 36 samples was assessed by measuring their ability to generate hydroxyl radicals in the presence of hydrogen peroxide.

    The origin of air masses was determined by computing 96-hour back trajectories of air masses with the HYSPLIT Model. The trajectories of air masses were divided into four sectors according to geographical patterns: “Russia,” “Eastern Europe,” “Western Europe,” and “Scandinavia.”

    During the study period, approximately 30% of air masses originated from “Scandinavia.”  The other three sectors had slightly lower values (between 18 and 22%). In spring, summer, and winter, higher total PM levels originated from air masses from continental areas, namely “Russia” and “Eastern Europe” (18.51±7.33 and 19.96±9.23 μgm-3, respectively). In autumn, the PM levels were highest in “Western Europe”. High levels of Fe, Ti, and AlCaSi (Al, Ca, Si) were also detected in air masses from the Eurasian continent. The oxidative properties were correlated to the origin of air masses. The ∙OH values were approximately 1.5 times higher when air masses originated from the direction of “Eastern Europe” or “Russia.”

    The origin of measured particles was evaluated using principal compo­nent factor analysis. When comparing the PM2.5 elemental composition with seasonal variation, factor scores, and other studies, the factors represent: (1) combustion of biomass; (2) crustal dust; (3) traffic; and (4) power plants and industrial processes associated with oil burning.

    The total PM2.5 is driven mainly by biomass and industrial combustion (63%) and other unidentified sources (23%). Other sources of PM, such as crustal dust and traffic, contribute a total of 13%.

  • 18.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Laukaitiene, Aida
    Zurlyte, Ingrida
    Particulate Air Pollution and Its Impact on Health in Vilnius and Kaunas2012In: Medicina (Kaunas), ISSN 1010-660X, E-ISSN 1648-9144, Vol. 48, no 9, p. 472-477Article in journal (Refereed)
    Abstract [en]

    Particulate matter in outdoor air has a significant impact on health. Small particles, composed of a variety of organic and inorganic compounds, are inhaled deep into the respiratory tract. The mechanisms and outcomes are manifold, resulting mainly in cardiopulmonary diseases. The current study aimed to quantify the health effects of particulate pollutants in Vilnius and Kaunas. Material and Methods. For risk estimation, the methodology of health impact assessment was employed. The exposure was defined as annual PM2.5 levels for long-term exposure effects and daily PM10 averages for short-term exposure effects. The baseline mortality/morbidity data were retrieved from health registers and exposure-response relationships from previous epidemiological studies. For health impact calculations, the WHO-developed tool AirQ was also applied. Results. The annual average concentration of PM2.5 was 11 mu g/m(3) in Vilnius and 17.5 mu g/m(3) in Kaunas. The exposure above the natural background corresponded annually to 263 (95% CI, 68-464) and 338 (95% CI, 86-605) premature deaths in Vilnius and Kaunas. This resulted in 3438 (95% CI, 905-5952) and 3693 (95% CI, 983-6322) years of life lost and in an average decrease in life expectancy of 0.43 (95% CI, 0.11-0.74) and 0.69 (95% CI, 0.18-1.19) years, respectively. In addition, 143 (95% CI, 86-200) and 129 (95% CI, 78-179) respiratory and 297 (95% CI, 188-377) and 267 (95% CI. 169-338) cardiovascular hospitalizations per year could be expected in Vilnius and Kaunas, respectively. Conclusions. There is substantial exposure to particulate matter in the main Lithuanian cities, which causes considerable adverse health effects. Traffic and domestic heating are considered locally the most important contributing factors to the degradation of air quality.

  • 19.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lövenheim, Boel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Johansson, Christer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Estimated health impacts of changes in air pollution exposure associated with the planned by-pass Förbifart Stockholm2013Report (Other academic)
    Abstract [en]

    To reduce problems with traffic congestion and meet increased needs of transports, a 21 km long by-pass (18 km in a tunnel) is planned. The by-pass is expected to reduce traffic emissions in central Stockholm but at the same time tunnel users could be exposed to high concentrations of air pollutants from traffic.

    For the reduction in urban air pollution concentrations, the change in annual ambient NOX and PM10 levels were modelled using 100x100 m grids and the population (1 628 528 inhabitants) average exposure was calculated for Greater Stockholm area. The tunnel exposure was estimated based on annual average NOX and PM10 levels, time spent in tunnel and number of persons using the tunnel. Health risks were calculated based on health impact assessment principles using equations and the WHO AirQ software. In these calculations the E-R coefficient for non-external mortality was 8% per 10 μgm-3 increase of NOX (vehicle exhaust indicator) and for daily number of deaths 1.68% per 10 μgm-3 increase of non-exhaust (road dust) PM10.

    It appeared that for the general population there would be annually 23.7 (95% CI 17.7–32.3) premature deaths less; mainly from lower exposure to vehicle exhaust (indicated by NOX) and somewhat from a reduction in coarse particles (indicated by PM10), contributing 23.2 and 0.5 fewer deaths, respectively. Other adverse health effects of exposure are also expected to be reduced. At the same time, tunnel users will be exposed to vehicle exhaust components in terms of NOX up to near 2000 μgm-3 during rush-hours. Passing the whole tunnel twice on working days would correspond to an additional annual NOX exposure of 9.6 μgm-3. Assuming there would be on average approximately 55 000 vehicles per day each way and 1.3 persons in each vehicle from the range 30–74 years of age, this exposure would result in 20.6 (95% CI 14.1–25.6) more premature deaths. If there would be more persons per vehicle or older and more vulnerable people travelling, the adverse effect of exposure in traffic could become larger. Hence, the effects in reality may be different as these results are based on now presented scenarios.

  • 20.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Public Health, University of Tartu, Estonia.
    Lövenheim, Boel
    Johansson, Christer
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Potential health impacts of changes in air pollution exposure associated with moving traffic into a road tunnel2015In: Journal of Exposure Science and Environmental Epidemiology, ISSN 1559-0631, E-ISSN 1559-064X, Vol. 25, no 5, p. 524-531Article in journal (Refereed)
    Abstract [en]

    A planned 21 km bypass (18 km within a tunnel) in Stockholm is expected to reduce ambient air exposure to traffic emissions, but same time tunnel users could be exposed to high concentrations of pollutants. For the health impacts calculations in 2030, the change in annual ambient NOX and PM10 exposure of the general population was modelled in 100 × 100 m(2) grids for Greater Stockholm area. The tunnel exposure was estimated based on calculated annual average NOX concentrations, time spent in tunnel and number of tunnel users. For the general population, we estimate annually 23.7 (95% CI: 17.7-32.3) fewer premature deaths as ambient concentrations are reduced. At the same time, tunnel users will be exposed to NOX levels up to 2000 μg/m(-3). Passing through the whole tunnel two times on working days would correspond to an additional annual NOX exposure of 9.6 μg/m(3). Assuming that there will be ~55,000 vehicles daily each way and 1.3 persons of 30-74 years of age in each vehicle, we estimate the tunnel exposure to result in 20.6 (95% CI: 14.1-25.6) premature deaths annually. If there were more persons per vehicle, or older and vulnerable people travelling, or tunnel dispersion conditions worsen, the adverse effect would become larger.

  • 21.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Maasikmets, Marek
    Estonian Environmental Research Centre Marja 4d Tallinn 10617 Estonia.
    Lai, Taavi
    University of Tartu Department of Public Health Ravila 19 Tartu 50411 Estonia.
    Tamm, Tanel
    University of Tartu Department of Ecology and Geography Vanemuise 46 Tartu 50414 Estonia.
    Kaasik, Marko
    University of Tartu Department of Physics Riia 142 Tartu 50414 Estonia.
    Kimmel, Veljo
    Estonian University of Life Sciences Institute of Agricultural and Environmental Sciences Kreutzwaldi 64 Tartu 50414 Estonia.
    Orru, Kati
    King’s College London Department of Geography Strand London WC2R 2LS UK.
    Merisalu, Eda
    University of Tartu Department of Public Health Ravila 19 Tartu 50411 Estonia.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Health impacts of particulate matter in five major Estonian towns: main sources of exposure and local differences2011In: Air quality, atmosphere and health, ISSN 1873-9318, E-ISSN 1873-9326, Vol. 4, no 3-4, p. 247-258Article in journal (Refereed)
    Abstract [en]

    Particulate matter (PM) is the major air pollution problem with health impacts in Estonia. The prevailing sources of particles are traffic and local heating. In this study, we quantified the health effects of PM in neighbourhoods of five main cities with a health impact assessment (HIA) approach that uses information on exposure, baseline mortality/morbidity and exposure–response relationships from previous epidemiological studies. The exposure was defined as modelled PM2.5 annual levels and daily averages of PM10 (monitoring data in Tallinn and Kohtla-Järve and modelled levels in Tartu, Narva and Pärnu). The modelled results were validated with data from monitoring stations and additional measuring programmes. The annual average concentration of PM2.5 in the neighbourhoods studied varied from 7.6 to 23.6 μg m−3. The analysis indicated that the exposure above natural background corresponds to 462 [95% confidence interval (CI) 120–815] premature deaths, resulting in 6,034 (95% CI 1,583–10,309) years of life lost per year. The average decrease in life-expectancy at birth per resident of Tallinn was estimated to be 0.63 (95% CI 0.16–1.08) years. In the polluted city centres, this average decrease may reach >1 year and in Pärnu, it may reach 0.95 year. However, in the least polluted neighbourhood, the decrease of life expectancy was only 0.17 years. In addition, 231 (95% CI 145–306) respiratory and 338 (95% CI 205–454) cardiovascular hospitalisations per year could be expected. The majority of the external costs are related to the long-term effects on mortality and amount to €270 (95% CI 190–350) million annually. In comparison, the costs of hospitalisations contribute just €1.1 (95% CI 0.6–1.6) million. The main differences in health impacts were mostly driven by differences in the pollution sources, the magnitude of such sources and distribution patterns in the atmosphere. The smallest health effects, with the exception of the green residential areas, were observed in the industrial cities Kohtla-Järve and Narva (due to the small share contributed by local residential heating and relatively little car traffic). However, it is questionable whether the mass of fine particles is the best indicator of air pollution risk in such areas.

  • 22.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Institute of Family Medicine and Public Health, University of Tartu.
    Pindus, Mihkel
    Harro, Haldo-Rait
    Maasikmets, Marek
    Herodes, Koit
    Metallic Fumes at Indoor Military Shooting Ranges: Lead, Copper, Nickel, and Zinc in Different Fractions of Airborne Particulate Matter2018In: Propellants, explosives, pyrotechnics, ISSN 0721-3115, E-ISSN 1521-4087, Vol. 43, no 3, p. 228-233Article in journal (Refereed)
    Abstract [en]

    Small firearm shooting emits residues of energetic materials as well as heavy metals of different particle sizes into the air, posing a risk to human health. The current study assessed concentrations of Pb, Cu, Ni and Zn in 14 different size fractions of particulate matter at indoor military shooting ranges. Air samples were collected using ELPI+ over two hour period and filters analysed with ICP-MS and ICP-OES.

  • 23.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Teinemaa, Erik
    Lai, Taavi
    Tamm, Tanel
    Kaasik, Marko
    Kimmel, Veljo
    Kangur, Kati
    Merisalu, Eda
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Health impact assessment of particulate pollution in Tallinn using fine spatial resolution and modeling techniques2009In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 8, p. 7-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health impact assessments (HIA) use information on exposure, baseline mortality/morbidity and exposure-response functions from epidemiological studies in order to quantify the health impacts of existing situations and/or alternative scenarios. The aim of this study was to improve HIA methods for air pollution studies in situations where exposures can be estimated using GIS with high spatial resolution and dispersion modeling approaches.

    METHODS: Tallinn was divided into 84 sections according to neighborhoods, with a total population of approx. 390,000 persons. Actual baseline rates for total mortality and hospitalization with cardiovascular and respiratory diagnosis were identified. The exposure to fine particles (PM2.5) from local emissions was defined as the modeled annual levels. The model validation and morbidity assessment were based on 2006 PM10 or PM2.5 levels at 3 monitoring stations. The exposure-response coefficients used were for total mortality 6.2% (95% CI 1.6-11%) per 10 microg/m3 increase of annual mean PM2.5 concentration and for the assessment of respiratory and cardiovascular hospitalizations 1.14% (95% CI 0.62-1.67%) and 0.73% (95% CI 0.47-0.93%) per 10 microg/m3 increase of PM10. The direct costs related to morbidity were calculated according to hospital treatment expenses in 2005 and the cost of premature deaths using the concept of Value of Life Year (VOLY).

    RESULTS: The annual population-weighted-modeled exposure to locally emitted PM2.5 in Tallinn was 11.6 microg/m3. Our analysis showed that it corresponds to 296 (95% CI 76528) premature deaths resulting in 3859 (95% CI 10236636) Years of Life Lost (YLL) per year. The average decrease in life-expectancy at birth per resident of Tallinn was estimated to be 0.64 (95% CI 0.17-1.10) years. While in the polluted city centre this may reach 1.17 years, in the least polluted neighborhoods it remains between 0.1 and 0.3 years. When dividing the YLL by the number of premature deaths, the decrease in life expectancy among the actual cases is around 13 years. As for the morbidity, the short-term effects of air pollution were estimated to result in an additional 71 (95% CI 43-104) respiratory and 204 (95% CI 131-260) cardiovascular hospitalizations per year. The biggest external costs are related to the long-term effects on mortality: this is on average euro 150 (95% CI 40-260) million annually. In comparison, the costs of short-term air-pollution driven hospitalizations are small euro 0.3 (95% CI 0.2-0.4) million.

    CONCLUSION: Sectioning the city for analysis and using GIS systems can help to improve the accuracy of air pollution health impact estimations, especially in study areas with poor air pollution monitoring data but available dispersion models.

  • 24.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Andersson, Camilla
    Tamm, Tanel
    Ebi, Kristie L.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ozone and heat-related mortality in Europe in 2050 significantly affected by changes in climate, population and greenhouse gas emission2019In: Environmental Research Letters, ISSN 1748-9326, E-ISSN 1748-9326, Vol. 14, no 7, article id 074013Article in journal (Refereed)
    Abstract [en]

    Climate change is expected to increase to extreme temperatures and lead to more intense formation of near-surface ozone. Higher temperatures can cause heat stress and ozone is a highly oxidative pollutant; both increase cardiorespiratory mortality. Using greenhouse gas and ozone precursor emission scenarios, global and regional climate and chemistry-transport models, epidemiological data, and population projections, we projected ozone- and heat-related health risks under a changing climate. European near-surface temperature was modelled with the regional climate model (RCA4), forced by the greenhouse gas emission scenario RCP4.5 and the global climate model EC-EARTH, and near-surface ozone was modelled with the Multi-scale Atmospheric Transport and Chemistry (MATCH) model. Two periods were compared: recent climate in 1991-2000 and future climate in 2046-2055, projecting around a 2 degrees increase in global temperatures by that time. Projections of premature mortality considered future climate, future population, and future emissions separately and jointly to understand the relative importance of their contributions. Ozone currently causes 55 000 premature deaths annually in Europe due to long-term exposure, including a proportion of the estimated 26 000 deaths per year due to short-term exposures. When only taking into account the impact of a changing climate, up to an 11% increase in ozone-associated mortality is expected in some countries in Central and Southern Europe in 2050. However, projected decreases in ozone precursor emissions are expected to result in a decrease in ozone-related mortality (-30% as EUaverage). Due to aging and increasingly susceptible populations, the decrease in 2050 would be smaller, up to -24%. During summer months, ozone risks could combine with increasing temperatures, especially during the hottest periods and in densely populated urban areas. While the heat burden is currently of the same order of magnitude as ozone, due to increasing temperatures and decreasing ozone precursor emissions, heat-related mortality could be twice as large as ozone-related mortality in 2050.

  • 25.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Åström, Daniel Oudin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Centre for Primary Health Care Research, Department of Clinical Science, Lund University, Lund, Sweden.
    Increases in external cause mortality due to high and low temperatures: evidence from northeastern Europe2017In: International journal of biometeorology, ISSN 0020-7128, E-ISSN 1432-1254, Vol. 61, no 5, p. 963-966Article in journal (Refereed)
    Abstract [en]

    The relationship between temperature and mortality is well established but has seldom been investigated in terms of external causes. In some Eastern European countries, external cause mortality is substantial. Deaths owing to external causes are the third largest cause of mortality in Estonia, after cardiovascular disease and cancer. Death rates owing to external causes may reflect behavioural changes among a population. The aim for the current study was to investigate if there is any association between temperature and external cause mortality, in Estonia. We collected daily information on deaths from external causes (ICD-10 diagnosis codes V00-Y99) and maximum temperatures over the period 1997-2013. The relationship between daily maximum temperature and mortality was investigated using Poisson regression, combined with a distributed lag non-linear model considering lag times of up to 10 days. We found significantly higher mortality owing to external causes on hot (the same and previous day) and cold days (with a lag of 1-3 days). The cumulative relative risks for heat (an increase in temperature from the 75th to 99th percentile) were 1.24 (95% confidence interval, 1.14-1.34) and for cold (a decrease from the 25th to 1st percentile) 1.19 (1.03-1.38). Deaths due to external causes might reflect changes in behaviour among a population during periods of extreme hot and cold temperatures and should therefore be investigated further, because such deaths have a severe impact on public health, especially in Eastern Europe where external mortality rates are high.

  • 26.
    Orru, Kati
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Institute of Social Studies, Tartu University, Tartu, Estonia.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Harzia, Hedi
    Estonian Health Board, Tallinn, Estonia.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Institute of Family Medicine and Public Health, Tartu University, Tartu, Estonia.
    The role of perceived air pollution and health risk perception in health symptoms and disease: a population-based study combined with modelled levels of PM102018In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 91, no 5, p. 581-589Article in journal (Refereed)
    Abstract [en]

    Purpose: Adverse health impact of air pollution on health may not only be associated with the level of exposure, but rather mediated by perception of the pollution and by top-down processing (e.g. beliefs of the exposure being hazardous), especially in areas with relatively low levels of pollutants. The aim of this study was to test a model that describes interrelations between air pollution (particles < 10 μ m, PM10), perceived pollution, health risk perception, health symptoms and diseases.

    Methods: A population-based questionnaire study was conducted among 1000 Estonian residents (sample was stratified by age, sex, and geographical location) about health risk perception and coping. The PM10 levels were modelled in 1 × 1 km grids using a Eulerian air quality dispersion model. Respondents were ascribed their annual mean PM10 exposure according to their home address. Path analysis was performed to test the validity of the model.

    Results: The data refute the model proposing that exposure level significantly influences symptoms and disease. Instead, the perceived exposure influences symptoms and the effect of perceived exposure on disease is mediated by health risk perception. This relationship is more pronounced in large cities compared to smaller towns or rural areas.

    Conclusions: Perceived pollution and health risk perception, in particular in large cities, play important roles in understanding and predicting environmentally induced symptoms and diseases at relatively low levels of air pollution.

  • 27. Orru, Kati
    et al.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Maasikmets, Marek
    Hendrikson, Reigo
    Ainsaar, Mare
    Well-being and environmental quality: Does pollution affect life satisfaction?2016In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 25, no 3, p. 699-705Article in journal (Refereed)
    Abstract [en]

    PURPOSE: We aimed to explore the effect of ambient air pollution on individual persons' levels of subjective well-being. Our research question was: to what extent is an individual's life satisfaction shaped by exposure to PM10?

    METHODS: We used regression models to analyse data on subjective well-being indicators from the last two waves of the European social survey (ESS) and detailed information on local levels of the air pollutant PM10.

    RESULTS: An increase in PM10 annual concentrations by 1 μg/m(3) was associated with a significant reduction in life satisfaction of .017 points on the ESS 10-point life satisfaction scale.

    CONCLUSIONS: Our findings suggest that even in cases of relatively low levels of PM10 air pollution (mean annual concentration of 8.3 ± 3.9 μg/m(3)), in addition to the effects on physical health, exposure negatively affects subjective assessments of well-being.

  • 28.
    Orru, Kati
    et al.
    Institute of Social Sciences, University of Tartu, Lossi 36, Tartu, 51003, Estonia..
    Tillmann, Mari
    Estonian Police and Border Guard Board, Pärnu mnt 139, Tallinn, 15060, Estonia..
    Ebi, Kristie L.
    Department of Global Health, University ofWashington, Seattle, WA 98105, United States..
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Making Administrative Systems Adaptive to Emerging Climate Change-Related Health Effects: Case of Estonia2018In: Atmosphere, ISSN 2073-4433, E-ISSN 2073-4433, Vol. 9, no 6, article id 221Article in journal (Refereed)
    Abstract [en]

    To facilitate resilience to a changing climate, it is necessary to go beyond quantitative studies and take an in-depth look at the functioning of health systems and the variety of drivers shaping its effectiveness. We clarify the factors determining the effectiveness of the Estonian health system in assessing and managing the health risks of climate change. Document analyses, expert interviews with key informants from health systems whose responsibilities are relevant to climate change, and analysis of a population-based survey conducted in 2015, indicate that the health effects of climate change have not been mainstreamed into policy. Therefore, many of the potential synergistic effects of combining information on health systems, environment, and vulnerable populations remain unexploited. The limited uptake of the issue of climate change-related health risks may be attributed to the lack of experience with managing extreme weather events; limited understanding of how to incorporate projections of longer-term health risks into policies and plans; unclear divisions of responsibility; and market liberal state approaches. Minority groups and urban dwellers are placing strong pressure on the health system to address climate change-related risks, likely due to their lower levels of perceived control over their physical wellbeing. The results have implications for national, community, and individual resilience in upper-middle income countries in Eastern Europe.

  • 29. Orru, Mall
    et al.
    Ots, Katri
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Re-vegetation processes in cutaway peat production fields in Estonia in relation to peat quality and water regime2016In: Environmental Monitoring & Assessment, ISSN 0167-6369, E-ISSN 1573-2959, Vol. 188, no 12, article id 655Article in journal (Refereed)
    Abstract [en]

    Eighty-one cutaway peat production fields with a total area of about 9000 ha exist and were studied in Estonia in 2005-2015. Only a very small number of the fields (seven) have been restored-either afforested or used for growing berries. The re-vegetation of Estonian cutaway peat production fields is mainly the result of natural processes, which are generally very slow due to an unfavourable water regime or a too thin remaining peat layer. The fields are mostly covered by cotton grass and birches. Often sparse vegetation covers 15-20% of a peat field, but some fields have turned into heaths or grasslands with plant coverage up to 60%. However, due to changes in environmental (mainly hydrological) conditions and peat characteristics (mainly peat type), these areas can also be new niches for several species. A number of moss species new to or rare in Estonia, e.g. Pohlia elongata, Ephemerum serratum, Campylopus introflexus and Bryum oblongum, were recorded.

  • 30.
    Oudin Åström, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Veber, Triin
    Martinsone, Žanna
    Kaļužnaja, Darja
    Indermitte, Ene
    Oudin, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia.
    Mortality Related to Cold Temperatures in Two Capitals of the Baltics: Tallinn and Riga2019In: Medicina (Kaunas), ISSN 1010-660X, E-ISSN 1648-9144, Vol. 55, no 8, article id 429Article in journal (Refereed)
    Abstract [en]

    Background and objectives: Despite global warming, the climate in Northern Europe is generally cold, and the large number of deaths due to non-optimal temperatures is likely due to cold temperatures. The aim of the current study is to investigate the association between cold temperatures and all-cause mortality, as well as cause-specific mortality, in Tallinn and Riga in North-Eastern Europe.

    Materials and Methods: We used daily information on deaths from state death registries and minimum temperatures from November to March over the period 1997-2015 in Tallinn and 2009-2015 in Riga. The relationship between the daily minimum temperature and mortality was investigated using the Poisson regression, combined with a distributed lag non-linear model considering lag times of up to 21 days.

    Results: We found significantly higher all-cause mortality owing to cold temperatures both in Tallinn (Relative Risk (RR) = 1.28, 95% Confidence Interval (CI) 1.01-1.62) and in Riga (RR = 1.41, 95% CI 1.11-1.79). In addition, significantly increased mortality due to cold temperatures was observed in the 75+ age group (RR = 1.64, 95% CI 1.17-2.31) and in cardiovascular mortality (RR = 1.83, 95% CI 1.31-2.55) in Tallinn and in the under 75 age group in Riga (RR = 1.58, 95% CI 1.12-2.22). In this study, we found no statistically significant relationship between mortality due to respiratory or external causes and cold days. The cold-related attributable fraction (AF) was 7.4% (95% CI -3.7-17.5) in Tallinn and 8.3% (95% CI -0.5-16.3) in Riga. This indicates that a relatively large proportion of deaths in cold periods can be related to cold in North-Eastern Europe, where winters are relatively harsh.

  • 31.
    Oudin Åström, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Centre for Primary Health Care Research, Department of Clinical Science, Malmö, Lund University, Lund, Sweden.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Rekker, Kaidi
    Indermitte, Ene
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    High Summer Temperatures and Mortality in Estonia2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, article id e0155045Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: On-going climate change is predicted to result in a growing number of extreme weather events-such as heat waves-throughout Europe. The effect of high temperatures and heat waves are already having an important impact on public health in terms of increased mortality, but studies from an Estonian setting are almost entirely missing. We investigated mortality in relation to high summer temperatures and the time course of mortality in a coastal and inland region of Estonia.

    METHODS: We collected daily mortality data and daily maximum temperature for a coastal and an inland region of Estonia. We applied a distributed lag non-linear model to investigate heat related mortality and the time course of mortality in Estonia.

    RESULTS: We found an immediate increase in mortality associated with temperatures exceeding the 75th percentile of summer maximum temperatures, corresponding to approximately 23°C. This increase lasted for a couple of days in both regions. The total effect of elevated temperatures was not lessened by significant mortality displacement.

    DISCUSSION: We observed significantly increased mortality in Estonia, both on a country level as well as for a coastal region and an inland region with a more continental climate. Heat related mortality was higher in the inland region as compared to the coastal region, however, no statistically significant differences were observed. The lower risks in coastal areas could be due to lower maximum temperatures and cooling effects of the sea, but also better socioeconomic condition. Our results suggest that region specific estimates of the impacts of temperature extremes on mortality are needed.

  • 32. Pindus, Mihkel
    et al.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. University of Tartu, Department of Family Medicine and Public Health, Tartu, Estonia.
    Maasikmets, Marek
    Kaasik, Marko
    Jõgi, Rain
    Association Between Health Symptoms and Particulate Matter from Traffic and Residential Heating: Results from RHINE III in Tartu2016In: Open Respiratory Medicine Journal, ISSN 1874-3064, Vol. 10, p. 58-69Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Traffic and residential heating are the main sources of particulate matter (PM) in Northern Europe. Wood is widely used for residential heating and vehicle numbers are increasing. Besides traffic exhaust, studded tires produce road dust that is the main source of traffic-related PM10. Several studies have associated total PM mass with health symptoms; however there has been little research on the effects of PM from specific sources.

    OBJECTIVE: To study the health effects resulting from traffic and local heating PM.

    METHODS: Data on respiratory and cardiac diseases were collected within the framework of RHINE III (2011/2012) in Tartu, Estonia. Respondents' geocoded home addresses were mapped in ArcGIS and linked with local heating-related PM2.5, traffic-related PM10 and total PM2.5 concentrations. Association between self-reported health and PM was assessed using multiple logistic regression analysis.

    RESULTS: The annual mean modelled exposure for local heating PM2.5 was 2.3 μg/m(3), for traffic PM10 3.3 μg/m(3) and for all sources PM2.5 5.6 μg/m(3). We found relationship between traffic induced PM10 as well as all sources induced PM2.5 with cardiac disease, OR=1.45 (95% CI 1.06-1.93) and 1.42 (95% CI 1.02-1.95), respectively. However, we did not find any significant association between residential heating induced particles and self-reported health symptoms. People with longer and better confirmed exposure period were also significantly associated with traffic induced PM10, all sources induced PM2.5 and cardiac diseases.

    CONCLUSION: Traffic-related PM10 and all sources induced PM2.5 associated with cardiac disease; whereas residential heating induced particles did not.

  • 33. Pindus, Mihkel
    et al.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Public Health, University of Tartu, Tartu, Estonia.
    Modig, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Close proximity to busy roads increases the prevalence and onset of cardiac disease: results from RHINE Tartu2015In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 129, no 10, p. 1398-1405Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To analyze whether living close to a busy road would increase the risk of having cardiac disease and hypertension.

    STUDY DESIGN: Longitudinal cross-sectional study.

    METHODS: We used cross-sectional longitudinal questionnaire data from the RHINE study for Tartu in 2000/2001 and 2011/2012. Home addresses of the respondents were geocoded and traffic data obtained from annually conducted traffic counts in Tartu. Relationships between proximity to a busy road and self-reported cardiac disease and hypertension were analyzed with multiple logistic regression.

    RESULTS: In terms of total traffic (≥10,000 vehicles per day) within a 150-m zone of a busy road, the odds ratio (OR) for prevalence of cardiac disease was significant in 2000/2001 (1.91, 95% CI 1.15-3.16) and 2011/2012 (1.58, 95% CI 1.01-2.47). Prevalence of hypertension was significant only in 2011/2012 (1.61, 95% CI 1.08-2.39). In terms of heavy duty vehicle traffic (≥500 vehicles per day) within a 150-m zone in 2000/2001, the OR was 1.52 (95% CI 1.04-2.24) and 1.49 (95% CI 1.02-2.17) respectively for the prevalence of cardiac disease and hypertension. In 2011/2012 no significant relationship between heavy duty vehicle traffic and cardiac disease or hypertension was found. We also saw a significant relationship between total traffic and the onset of cardiac disease (OR = 2.04, 95% CI 1.07-3.87).

    CONCLUSIONS: This study showed that living closer than 150 m to a busy road can increase the odds of having cardiac disease and hypertension, which should be taken into account in city planning.

  • 34. Reckien, D
    et al.
    Flacke, J
    Dawson, RJ
    Heidrich, O
    Olazabal, M
    Foley, A
    Hamann, J J-P
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Salvia, M
    Hurtado, S De Gregorio
    Geneletti, D
    Pietrapertosa, F
    Climate change response in Europe: what's the reality? Analysis of adaptation and mitigation plans from 200 urban areas in 11 countries2014In: Climatic Change, ISSN 0165-0009, E-ISSN 1573-1480, Vol. 122, no 1-2, p. 331-340Article in journal (Refereed)
    Abstract [en]

    Urban areas are pivotal to global adaptation and mitigation efforts. But how do cities actually perform in terms of climate change response? This study sheds light on the state of urban climate change adaptation and mitigation planning across Europe. Europe is an excellent test case given its advanced environmental policies and high urbanization. We performed a detailed analysis of 200 large and medium-sized cities across 11 European countries and analysed the cities' climate change adaptation and mitigation plans. We investigate the regional distribution of plans, adaptation and mitigation foci and the extent to which planned greenhouse gas (GHG) reductions contribute to national and international climate objectives. To our knowledge, it is the first study of its kind as it does not rely on self-assessment (questionnaires or social surveys). Our results show that 35 % of European cities studied have no dedicated mitigation plan and 72 % have no adaptation plan. No city has an adaptation plan without a mitigation plan. One quarter of the cities have both an adaptation and a mitigation plan and set quantitative GHG reduction targets, but those vary extensively in scope and ambition. Furthermore, we show that if the planned actions within cities are nationally representative the 11 countries investigated would achieve a 37 % reduction in GHG emissions by 2050, translating into a 27 % reduction in GHG emissions for the EU as a whole. However, the actions would often be insufficient to reach national targets and fall short of the 80 % reduction in GHG emissions recommended to avoid global mean temperature rising by 2 A degrees C above pre-industrial levels.

  • 35. Reckien, D.
    et al.
    Salvia, M.
    Pietrapertosa, F.
    Simoes, S. G.
    Olazabal, M.
    Hurtado, S. De Gregorio
    Geneletti, D.
    Lorencova, E. Krkoska
    D'Alonzo, V
    Krook-Riekkola, A.
    Fokaides, P. A.
    Ioannou, B. I.
    Foley, A.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Faculty of Medicine, University of Tartu, Tartu, Estonia.
    Orru, K.
    Wejs, A.
    Flacke, J.
    Church, J. M.
    Feliu, E.
    Vasilie, S.
    Nador, C.
    Matosovic, M.
    Flamos, A.
    Spyridaki, N-A
    Balzan, M. , V
    Fulop, O.
    Grafakos, S.
    Paspaldzhiev, I
    Heidrich, O.
    Dedicated versus mainstreaming approaches in local climate plans in Europe2019In: Renewable & sustainable energy reviews, ISSN 1364-0321, E-ISSN 1879-0690, Vol. 112, p. 948-959Article in journal (Refereed)
    Abstract [en]

    Cities are gaining prominence committing to respond to the threat of climate change, e.g., by developing local climate plans or strategies. However, little is known regarding the approaches and processes of plan development and implementation, or the success and effectiveness of proposed measures. Mainstreaming is regarded as one approach associated with (implementation) success, but the extent of integration of local climate policies and plans in ongoing sectoral and/or development planning is unclear. This paper analyses 885 cities across the 28 European countries to create a first reference baseline on the degree of climate mainstreaming in local climate plans. This will help to compare the benefits of mainstreaming versus dedicated climate plans, looking at policy effectiveness and ultimately delivery of much needed climate change efforts at the city level. All core cities of the European Urban Audit sample were analyzed, and their local climate plans classified as dedicated or mainstreamed in other local policy initiatives. It was found that the degree of mainstreaming is low for mitigation (9% of reviewed cities; 12% of the identified plans) and somewhat higher for adaptation (10% of cities; 29% of plans). In particular horizontal mainstreaming is a major effort for local authorities; an effort that does not necessarily pay off in terms of success of action implementation. This study concludes that climate change issues in local municipalities are best tackled by either, developing a dedicated local climate plan in parallel to a mainstreamed plan or by subsequently developing first the dedicated and later a mainstreaming plan (joint or subsequent "dual track approach"). Cities that currently provide dedicated local climate plans (66% of cities for mitigation; 26% of cities for adaptation) may follow-up with a mainstreaming approach. This promises effective implementation of tangible climate actions as well as subsequent diffusion of climate issues into other local sector policies. The development of only broad sustainability or resilience strategies is seen as critical.

  • 36. Reckien, Diana
    et al.
    Salvia, Monica
    Heidrich, Oliver
    Church, Jon Marco
    Pietrapertosa, Filomena
    De Gregorio-Hurtado, Sonia
    D'Alonzo, Valentina
    Foley, Aoife
    Simoes, Sofia G.
    Lorencova, Eliska Krkoska
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Faculty of Medicine, University of Tartu, Ravila 19, 51007 Tartu, Estonia.
    Orru, Kati
    Wejs, Anja
    Flacke, Johannes
    Olazabal, Marta
    Geneletti, Davide
    Feliu, Efren
    Vasilie, Sergiu
    Nador, Cristiana
    Krook-Riekkola, Anna
    Matosovic, Marko
    Fokaides, Paris A.
    Ioannou, Byron I.
    Flamos, Alexandros
    Spyridaki, Niki-Artemis
    Balzan, Mario V.
    Fulop, Orsolya
    Paspaldzhiev, Ivan
    Grafakos, Stelios
    Dawson, Richard
    How are cities planning to respond to climate change?: Assessment of local climate plans from 885 cities in the EU-282018In: Journal of Cleaner Production, ISSN 0959-6526, E-ISSN 1879-1786, Vol. 191, p. 207-219Article in journal (Refereed)
    Abstract [en]

    The Paris Agreement aims to limit global mean temperature rise this century to well below 2 degrees C above pre-industrial levels. This target has wide-ranging implications for Europe and its cities, which are the source of substantial greenhouse gas emissions. This paper reports the state of local planning for climate change by collecting and analysing information about local climate mitigation and adaptation plans across 885 urban areas of the EU-28. A typology and framework for analysis was developed that classifies local climate plans in terms of their alignment with spatial (local, national and international) and other climate related policies. Out of eight types of local climate plans identified in total we document three types of stand-alone local climate plans classified as type Al (autonomously produced plans), A2 (plans produced to comply with national regulations) or A3 (plans developed for international climate networks). There is wide variation among countries in the prevalence of local climate plans, with generally more plans developed by central and northern European cities. Approximately 66% of EU cities have a type Al, A2, or A3 mitigation plan, 26% an adaptation plan, and 17% a joint adaptation and mitigation plan, while about 33% lack any form of stand-alone local climate plan (i.e. what we classify as Al, A2, A3 plans). Mitigation plans are more numerous than adaptation plans, but planning for mitigation does not always precede planning for adaptation. Our analysis reveals that city size, national legislation, and international networks can influence the development of local climate plans. We found that size does matter as about 80% of the cities with above 500,000 inhabitants have a comprehensive and stand-alone mitigation and/or an adaptation plan (Al). Cities in four countries with national climate legislation (A2), i.e. Denmark, France, Slovakia and the United Kingdom, are nearly twice as likely to produce local mitigation plans, and five times more likely to produce local adaptation plans, compared to cities in countries without such legislation. Al and A2 mitigation plans are particularly numerous in Denmark, Poland, Germany, and Finland: while Al and A2 adaptation plans are prevalent in Denmark, Finland, UK and France. The integration of adaptation and mitigation is country-specific and can mainly be observed in two countries where local climate plans are compulsory, i.e. France and the UK. Finally, local climate plans produced for international climate networks (A3) are mostly found in the many countries where autonomous (type Al) plans are less common. This is the most comprehensive analysis of local climate planning to date. The findings are of international importance as they will inform and support decision making towards climate planning and policy development at national, EU and global level being based on the most comprehensive and up-to-date knowledge of local climate planning available to date. 

  • 37. Wang, Juan
    et al.
    Pindus, Mihkel
    Janson, Christer
    Sigsgaard, Torben
    Kim, Jeong-Lim
    Holm, Mathias
    Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Estonia.
    Gislason, Thorarinn
    Johannessen, Ane
    Bertelsen, Randi J
    Norbäck, Dan
    Dampness, mould, onset and remission of adult respiratory symptoms, asthma and rhinitis2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 53, no 5, article id 1801921Article in journal (Refereed)
    Abstract [en]

    THE QUESTION ADDRESSED BY THE STUDY: Is dampness and indoor mould associated with onset and remission of respiratory symptoms, asthma and rhinitis among adults?

    MATERIALS AND METHODS: Associations between dampness, mould and mould odour at home and at work and respiratory health were investigated in cohort of 11 506 adults from Iceland, Norway, Sweden, Denmark and Estonia. They answered a questionnaire at baseline and ten years later, with questions on respiratory health, home and work environment.

    RESULTS: Baseline water damage, floor dampness, mould and mould odour at home were associated with onset of respiratory symptoms and asthma (ORs from 1.23 to 2.24). Dampness at home during follow up was associated with onset of respiratory symptoms, asthma and rhinitis (ORs from 1.21 to 1.52). Dampness at work during follow up was associated with onset of respiratory symptoms, asthma and rhinitis (ORs from 1.31 to 1.50). Combined dampness at home and at work increased the risk of onset of respiratory symptoms and rhinitis. Dampness and mould at home and at work decreased remission of respiratory symptoms and rhinitis.

    THE ANSWER TO THE QUESTION: Dampness and mould at home and at work can increase onset of respiratory symptoms, asthma and rhinitis, and decrease remission.

  • 38.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. orru@ut.ee.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Strandberg, Gustav
    Rossby Centre, SMHI, Norrköping, Sweden.
    Ebi, Kristie L
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 1, p. e001842-Article in journal (Refereed)
    Abstract [en]

    Objectives Respiratory diseases are ranked second in Europe in terms of mortality, prevalence and costs. Studies have shown that extreme heat has a large impact on mortality and morbidity, with a large relative increase for respiratory diseases. Expected increases in mean temperature and the number of extreme heat events over the coming decades due to climate change raise questions about the possible health impacts. We assess the number of heat-related respiratory hospital admissions in a future with a different climate.                                

    Design A Europe-wide health impact assessment.                                

    Setting An assessment for each of the EU27 countries.                                

    Methods Heat-related hospital admissions under a changing climate are projected using multicity epidemiological exposure–response relationships applied to gridded population data and country-specific baseline respiratory hospital admission rates. Times-series of temperatures are simulated with a regional climate model based on four global climate models, under two greenhouse gas emission scenarios.                                

    Results Between a reference period (1981–2010) and a future period (2021–2050), the total number of respiratory hospital admissions attributed to heat is projected to be larger in southern Europe, with three times more heat attributed respiratory hospital admissions in the future period. The smallest change was estimated in Eastern Europe with about a twofold increase. For all of Europe, the number of heat-related respiratory hospital admissions is projected to be 26 000 annually in the future period compared with 11 000 in the reference period.                                

    Conclusions The results suggest that the projected effects of climate change on temperature and the number of extreme heat events could substantially influence respiratory morbidity across Europe.                                

     

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