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European Union's Green Deal is a legal obligation to EU countries to shift towards environment-friendly energy systems from fossil-fuel-based systems. This transition will bring significant global health benefits by combating climate change, but it is crucial to understand the so far understudied impacts on local communities' lives and, thus, on their health and well-being. The study proposes a novel conceptual framework based on socio-technical systems theory and the production of space theory to identify the interacting points between energy systems and health and well-being systems in the energy transition context. This framework is tested in Estonia's transitioning fossil fuel oil-shale-based energy system based on four focus group discussions, ten expert interviews, and document analysis. We innovatively pinpoint pathways, including feedback loops, through a causal loop diagram (CLD) impacting inhabitants' health and well-being from the interplay between energy and health and well-being systems. The analysis indicates that protecting and promoting health and well-being has been a challenge not only due to disruption created by the energy transition process but also due to the accumulated problems regarding socioeconomic conditions, environmental health impacts, and well-being at the local level. The compound effects of multiple existing and emerging issues, including the divergent interpretations of health and the lack of holistic support mechanisms for inhabitants to navigate the changes in sociocultural and economic space, can harm locals' health and well-being. The developed conceptual framework provides an important theoretical background to study the impacts on the mental and physical health, including social health and well-being, of the inhabitants living in the fossil-fuel-based industrial area. The CLD developed using this framework demonstrates the interacting points to avoid unintended consequences of energy transition.

Indoor bacteria, mold, allergens, and selected volatile organic compounds (VOC) were measured at home in three Nordic cities. Data on self-reported tear film break-up time (SBUT), weekly oculo-nasal symptoms during the past three months, and allergic rhinitis of 159 adults were obtained. Among them, 58 % were females, 24.5 % were atopics, and 41 % reported home dampness. The median SBUT was 22.3 s. Oculo-nasal symptoms (15.3 %) and allergic rhinitis (32.7 %) were common. A higher level of 2-hexanone was linked to lower SBUT (p = 0.036). Higher levels of total mold (p = 0.038), allergen Fel d 1 from cat (p = 0.045), and allergen Der p 1 (p = 0.012) and Der f 1 (p = 0.036) from house dust mite (HDM), were related to more oculo-nasal symptoms. Higher levels of 3-methylfuran (p = 0.003), 2-hexanone (p = 0.037), 2-heptanone (p = 0.018), and 1-octen-3-ol (p = 0.001) were linked to oculo-nasal symptoms. Higher levels of viable bacteria (p = 0.015), 3-octanone (p = 0.049) and formaldehyde (p = 0.039) were linked to allergic rhinitis. The association between 2-heptanone and oculo-nasal symptoms (interaction p = 0.012), and between isobutyl acetate and allergic rhinitis (interaction p = 0.084) were more pronounced in women. The negative association between 2-hexanone and SBUT was stronger among atopics (interaction p = 0.098), and the links between viable bacteria and allergic rhinitis (interaction p = 0.003) and between Der f 1 and oculo-nasal symptoms (interaction p = 0.1) were more pronounced among non-atopics.

In conclusion, airborne mold and bacteria, and allergens in dust were associated with oculo-nasal symptoms or allergic rhinitis. 3-Methylfuran, 2-hexanone, 1-octen-3-ol, and 2-heptanone were associated with adult oculo-nasal symptoms. Increased 3-octanone and formaldehyde were related to allergic rhinitis.

Epidemiologic research and quantitative risk assessment play a crucial role in transferring fundamental scientific knowledge to policymakers so they can take action to reduce the burden of ambient air pollution. This commentary addresses several challenges in quantitative risk assessment of air pollution that require close attention. The background to this discussion provides a summary of and conclusions from the epidemiological evidence on ambient air pollution and health outcomes accumulated since the 1990s. We focus on identifying relevant exposure-health outcome pairs, the associated concentration-response functions to be applied in a risk assessment, and several caveats in their application. We propose a structured and comprehensive framework for assessing the evidence levels associated with each exposure-health outcome pair within a health impact assessment context. Specific issues regarding the use of global or regional concentration-response functions, their shape, and the range of applicability are discussed.

Background and aims: Climate change affects our societies and lives through our economies, our livelihoods, and our health. Economic losses of climate change are estimated at $23 trillion, largely through externalities due to premature mortality, healthcare expenditure, and health-related work losses. Even if there are established methods to quantify the health economic burden, there is limited information on how people perceive this information. The current study aimed to examine different health cost evaluation methods and observe perceptions of stakeholders in the climate change context.

Method: The participatory research approach of the World Café with 41 participants was applied to explore four topics associated with valuing the costs of climate change. The data were analyzed following an inductive approach.

Results: Despite the willingness-to-pay approach being widely applied, many experts see actual healthcare costs as a more explicit indicator of costs; however, this approach might underestimate actual costs. Participants experienced difficulties accepting and understanding cost estimates that indicated very high externalities as a percentage of gross domestic product. The cost-effectiveness of mitigation and adaptation measures was also challenged by a concern that while the costs of such measures are incurred now, the benefits do not come to fruition until later, for example, when building bike lanes or dams.

Conclusions: Policies should favor environmentally friendly activities such as making cycling more convenient in cities with the health benefits presented in monetary terms, while limiting car driving. Moreover, the public might better understand the costs of climate change via tools that map how solutions influence different sectors and outlining the costs in evaluating the benefits for health and the environment.

Defining and measuring progress in adaptation are important questions for climate adaptation science, policy, and practice. Here, we assess the progress of urban adaptation planning in 327 European cities between 2005 and 2020 using three 'ADAptation plan Quality Assessment' indices, called ADAQA-1/ 2/ 3, that combine six plan quality principles. Half of the cities have an adaptation plan and its quality significantly increased over time. However, generally, plan quality is still low in many cities. Participation and monitoring and evaluation are particularly weak aspects in urban adaptation policy, together with plan 'consistency'. Consistency connects impacts and vulnerabilities with adaptation goals, planned measures, actions, monitoring and evaluation, and participation processes. Consistency is a key factor in the overall quality of plans. To help evaluate the quality of plans and policies and promote learning, we suggest incorporating our ADAptation plan Quality Assessment indices into the portfolio of adaptation progress assessments and tracking methodologies.

Background: The few studies that have examined associations between greenspace and lung function in adulthood have yielded conflicting results and none have examined whether the rate of lung function decline is affected.

Objective: We explored the association between residential greenspace and change in lung function over 20 years in 5559 adults from 22 centers in 11 countries participating in the population-based, international European Community Respiratory Health Survey.

Methods: Forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC) were measured by spirometry when participants were approximately 35 (1990–1994), 44 (1999–2003), and 55 (2010–2014) years old. Greenness was assessed as the mean Normalized Difference Vegetation Index (NDVI) in 500 m, 300 m, and 100 m circular buffers around the residential addresses at the time of lung function measurement. Green spaces were defined as the presence of agricultural, natural, or urban green spaces in a circular 300 m buffer. Associations of these greenspace parameters with the rate of lung function change were assessed using adjusted linear mixed effects regression models with random intercepts for subjects nested within centers. Sensitivity analyses considered air pollution exposures.

Results: A 0.2-increase (average interquartile range) in NDVI in the 500 m buffer was consistently associated with a faster decline in FVC (−1.25 mL/year [95% confidence interval: −2.18 to −0.33]). These associations were especially pronounced in females and those living in areas with low PM10 levels. We found no consistent associations with FEV₁ and the FEV₁/FVC ratio. Residing near forests or urban green spaces was associated with a faster decline in FEV₁, while agricultural land and forests were related to a greater decline in FVC.

Conclusions: More residential greenspace was not associated with better lung function in middle-aged European adults. Instead, we observed slight but consistent declines in lung function parameters. The potentially detrimental association requires verification in future studies.

Background: Previous research suggests an association between road traffic noise and obesity, but current evidence is inconclusive. The aim of this study was to assess the association between nocturnal noise exposure and markers of obesity and to assess whether sleep disturbance might be a mediator in this association.

Methods: We applied data from the Respiratory Health in Northern Europe (RHINE) cohort. We used self-measured waist circumference (WC) and body mass index (BMI) as outcome values. Noise exposure was assessed as perceived traffic noise in the bedroom and/or the bedroom window’s location towards the street. We applied adjusted linear, and logistic regression models, evaluated effect modifications and conducted mediation analysis.

Results: Based on fully adjusted models we found that women, who reported very high traffic noise levels in bedroom, had 1.30 (95% CI 0.24–2.37) kg/m2 higher BMI and 3.30 (95% CI 0.39–6.20) cm higher WC compared to women, who reported no traffic noise in the bedroom. Women who reported higher exposure to road traffic noise had statistically significant higher odds of being overweight and have abdominal obesity with OR varying from 1.15 to 1.26 compared to women, who reported no traffic noise in the bedroom. For men, the associations were rather opposite, although mostly statistically insignificant. Furthermore, men, who reported much or very much traffic noise in the bedroom, had a statistically significantly lower risk of abdominal obesity. Sleep disturbance fully or partially mediated the association between noise in bedroom and obesity markers among women.

Conclusion: Our results suggest that self-reported traffic noise in the bedroom may be associated to being overweight or obese trough sleep disturbance among women, but associations were inconclusive among men.

Associations between measured specific VOC reported to be associated with dampness and microbial growth in dwellings and asthma, lung function were investigated in 159 adults (one adult/home) from three North European cities (Reykjavik, Uppsala and Tartu). Spirometry was performed and forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and FEV1/FVC were measured. Among 159 participants, 58% were females, 24.5% atopics, 25.8% current smokers and 41% reported dampness or mold at home. Dimethyl disulphide (p = 0.004), ethyl isobutyrate (p = 0.021) and ethyl 2-methylbutyrate (p = 0.035) were associated with asthma. Isobutanol (p = 0.043), 3-methyl-1-butanol (p = 0.020), 2-hexanone (p = 0.033), 1-octen-3-ol (p = 0.027), 2-methyl-1-butanol (p = 0.022) and 2-ethyl-1-hexanol (p = 0.045) were associated with lower FEV1. Isobutanol (p = 0.004), 3-methyl-1-butanol (p = 0.001), 2-heptanone (p = 0.047) and 2-methyl-1-butanol (p = 0.002) were associated with lower FEV1/FVC. The association between dimethyl disulphide and asthma was more pronounced in females (p for interaction 0.099). The association between 1-butanol and lower FEV1 was more pronounced in males (p for interaction 0.046). The associations between 3-octanone (p for interaction 0.064), 2-ethyl-1-hexanol (p for interaction 0.049) and lower FEV1, and between 2-heptanone (p for interaction 0.021), 3-octanone (p for interaction 0.008) and lower FEV1/FVC were stronger in homes with dampness/mold. Factor analysis identified one VOC factor related to asthma and two VOC factors related to lower lung function. Increased air concentrations of 2-heptanone, ethyl 2-methylbutyrate and ethyl isobutyrate were related to prescence of certain mold species (Aspergillus sp., Cladosporum sp. and Penicillium sp.) or building dampness. Some VOC were associated with type of dwelling, building age and pet keeping. In conclusion, some VOC reported to be associated with dampness and microbial growth can be associated with asthma and lower lung function in adults. Associations between these VOC and respiratory illness can be stronger in homes with dampness/mold. There can be gender differences in respiratory health effects when exposed to indoor VOC.

RATIONALE: The associations between ambient coarse particulate matter (PM2.5-10) and daily mortality is not fully understood at a global scale.

OBJECTIVES: To evaluate the short-term associations between PM2.5-10 and total, cardiovascular, and respiratory mortality across multiple countries/regions worldwide.

METHODS: We collected daily mortality (total, cardiovascular, respiratory) and air pollution data from 205 cities in 20 countries/regions. Concentrations of PM2.5-10 were computed as the difference between inhalable and fine particulate matter. A two-stage time-series analytic approach was applied, with over-dispersed generalized linear models and multilevel meta-analysis. We fitted two-pollutant models to test the independent effect of PM2.5-10 from co-pollutants (fine particulate matter, nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide). Exposure-response relationship curves were pooled and regional analyses were conducted.

MEASUREMENTS AND MAIN RESULTS: A 10 μg/m3 increase in PM2.5-10 concentration on lag 0-1 day was associated with increments of 0.51% (95% confidence interval [CI]: 0.18%, 0.84%), 0.43% (95%CI: 0.15%, 0.71%) and 0.41% (95%CI: 0.06%, 0.77%) in total, cardiovascular, and respiratory mortality, respectively. The associations varied by country and region. These associations were robust to adjustment by all co-pollutants in two-pollutant models, especially for PM2.5. The exposure-response curves for total, cardiovascular, and respiratory mortality were positive, with steeper slopes at lower exposure ranges and without discernible thresholds.

CONCLUSIONS: This study provides novel global evidence on the robust and independent associations between short-term exposure to ambient PM2.5-10 and total, cardiovascular and respiratory mortality, suggesting the need to establish a unique guideline or regulatory limit for daily concentrations of PM2.5-10.