Air pollution, traffic noise, greenness, and temperature and the risk of incident type 2 diabetes: Results from the KORA cohort study

Introduction

Type 2 diabetes (T2D) is a major public health concern, and various environmental factors have been associated with the development of this disease. This study aimed to investigate the longitudinal effects of multiple environmental exposures on the risk of incident T2D in a German population-based cohort.

Methods

We used data from the KORA cohort study (Augsburg, Germany) and assessed exposure to air pollutants, traffic noise, greenness, and temperature at the participants' residencies. Cox proportional hazard models were used to analyze the associations with incident T2D, adjusting for potential confounders.

Results

Of 7736 participants included in the analyses, 10.5% developed T2D during follow-up (mean: 15.0 years). We found weak or no association between environmental factors and the risk of T2D, with sex and education level significantly modifying the effects of air pollutants.

Conclusion

Our study contributes to the growing body of literature investigating the impact of environmental factors on T2D risks and suggests that the impact of environmental factors may be small.

Outdoor Light at Night and Children's Body Mass: A Cross-Sectional Analysis in the Fr1da Study

BACKGROUND

Emerging evidence supports an association between light at night (LAN) exposure with obesity or overweight in adults. However, effects of LAN exposure during childhood have yet to be further investigated.

OBJECTIVE

In this study, we aimed to determine whether LAN exposure is associated with body mass in young children.

RESEARCH DESIGN AND METHOD

We used data from the Fr1da cohort study which screened children for early-stage islet autoimmunity in Bavaria, Germany from February 2015 to March 2019. A total of 62,212 children aged <11 years with complete residential information was included in the analysis. Self-reported weight and height were used to calculate age- and sex-specific body mass index (BMI) z-scores. LAN exposure was based on remotely sensed images from Visible Infrared Imaging Radiometer Suite and assigned to the children's residencies. We used generalized additive models to estimate the associations between LAN exposure and BMI adjusting for potential confounders.

RESULTS

We observed an increase in BMI z-scores of 34.0% (95% confidence interval (CI): 25.4-42.6) per 10 nW/cm2/sr increment in LAN exposure at baseline (2015) and of 32.6% (24.3-41.0) for LAN exposure one year prior to screening, both adjusted for age and sex. Similar associations were observed after adjustment for socioeconomic status and urbanization degree.

CONCLUSION

Our findings suggest that outdoor light exposure may be a risk factor for weight gain during childhood.

Association of long-term environmental exposures in pregnancy and early life with islet autoimmunity development in children in Bavaria, Germany

OBJECTIVE

Incidence of early-onset type 1 diabetes (T1D) has been increasing worldwide. Only few studies examined the relationship between geographical environmental variation and T1D incidence or its presymptomatic stage of islet autoimmunity. Our study aimed to investigate the effect of long-term environmental exposures during pregnancy and early life on childhood islet autoimmunity.

RESEARCH DESIGN AND METHODS

We used data from the Fr1da cohort study which screened children aged 1.75-5.99 years for multiple islet autoantibodies in Bavaria, Germany between 2015 and 2019. We included 85,251 children with valid residential information. Daily averages for particulate matter with a diameter <2.5 μm, nitrogen dioxide, ozone, air temperature, and greenness were averaged for each zip-code or directly assigned to the addresses. The exposure windows included pregnancy, the first year and the first two years of life. Generalized additive models adjusting for individual and socioeconomic variables were used to investigate associations between environmental exposures and islet autoimmunity development.

RESULTS

Islet autoimmunity was diagnosed in 272 children. Colder air temperature during pregnancy was associated with developing islet autoimmunity at the address (per 2.2 °C decrease, Odds ratio (OR): 1.49; 95% Confidence interval (CI): 1.21-1.83) and zip-code level (per 2.4 °C decrease, OR: 1.31; 95% CI: 1.08-1.59). Using the addresses, significant associations were also observed during the first years of life.

CONCLUSION

In this study, children's residential exposure to lower levels of air temperature during pregnancy and early life increased the risk of islet autoimmunity before the age of six.

The association between ambient NO2 and PM2.5 with the respiratory health of school children residing in informal settlements: A prospective cohort study

BACKGROUND

No previous epidemiological study has investigated the combined association of long-term ambient nitrogen dioxide (NO₂) and particulate matter of diameter size-2.5 (PM_2.5) exposure with asthma outcomes among schoolchildren in Africa.

OBJECTIVES

This study investigated the independent and co-pollutant association of long-term exposures to ambient air pollutants on asthma-associated outcomes in a cohort of schoolchildren in the Western Cape Province of South Africa.

METHODS

A total of 590 grade-4 schoolchildren residing in four informal settlements were studied. Spirometry and fractional exhaled nitric-oxide (FeNO) measurements were conducted, including a standardized questionnaire administered to caregivers at baseline and 12-months follow-up. Annual NO₂ and PM_2.5 levels were estimated for each child's home using land-use regression modelling. Single- and two-pollutant models were constructed to assess the independent and co-pollutant association of both air pollutants (NO₂ and PM_2.5) on new cases of asthma-associated outcomes adjusting-for host characteristics, indoor exposures and study area.

RESULTS

The annual average concentration of PM_2.5 and NO₂ were 10.01μg/m³ and 16.62μg/m³ respectively, across the four study areas, and were below the local Standards of 20μg/m³ and 40μg/m³, for both pollutants, respectively. In the two-pollutant-adjusted models, an interquartile range (IQR) increase of 14.2μg/m³ in NO₂ was associated with an increased risk of new onset of ocular-nasal symptoms (adjusted odds ratio-aOR: 1.63, 95% CI: 1.01-2.60), wheezing (aOR: 3.57, 95% CI: 1.18-10.92), more than two or more asthma symptom score (aOR: 1.71, 95% CI: 1.02-2.86), and airway inflammation defined as FeNO > 35 ppb (aOR: 3.10, 95% CI: 1.10-8.71), independent of PM_2.5 exposures.

CONCLUSION

This study provided evidence that ambient NO₂ levels below local standards and international guidelines, independent of PM_2.5 exposure, increases new cases of asthma-associated outcomes after 12-months.

Assessing mental health literacy: What medical sciences students' know about depression

BACKGROUND

Mental health literacy is an individual's knowledge and belief about mental disorders which aid their recognition, management and prevention. The aim of this study was to investigate mental health literacy among students of Tehran University of Medical Sciences.

METHODS

In this cross-sectional study, data were collected by the anonymous self-administered questionnaires and finally 324 students participated in the study. Random cluster sampling was used. Questions were in different areas of the mental health literacy for depression include recognition of disorder, intended actions to seek help and perceived barriers, beliefs about interventions, prevention, stigmatization and impact of media. T-test was used for statistical analysis.

RESULTS

The mean (±SD) age was 23.5±2.8. The participants were 188 (58.1%) females and 136 (41.9%) males. In response to the recognition of the disorder 115 (35.6%) students mentioned the correct answer. In help-seeking area, 208 (64.3%) gave positive answer. The majority of affected students sought for help from their friends and parents. Stigma was the greatest barrier for seeking help. Television and Internet were the most common sources of information related to mental health.

CONCLUSION

Generally students' mental health literacy on depression was low in some areas. Appropriate educational programs specifically for reducing mental disorders stigma seems necessary. Organizing networks of co-helper students for mental health could be considered.

A survey on clinical governance awareness among clinical staff: a cross-sectional study

Objective:

Clinical Governance (CG) program has been raised in Iran in order to improve the quality of clinical care. The purpose of this study is to investigate the awareness of clinical governance program among clinical staff working in selected teaching hospitals in Tehran, Iran.

Methods:

To investigate the CG awareness, a cross-sectional survey was conducted among 345 clinical staff working in 20 selected public hospitals in Tehran. Data were gathered using the standardized clinical governance awareness questionnaire. Descriptive statistics were used to analyze the data.

Result:

The results showed that the level of staff awareness about the concept of CG was low. They perceived continuous quality improvement, responsibility, medical errors reduction and patient safety as the main concepts of the CG framework. Reaching agreement of standards concepts among staff and positive changes in attitudes were considered as two most observed changes. The main perceived barriers to the implementation of clinical governance included lack of proper management and leadership, lack of full support, inappropriate organizational culture, lack of knowledge, poor communication system and insufficient training.

Conclusions:

The concepts and goals of clinical governance have not been effectively conveyed to the staff and despite its implementation in the hospitals, there has been low clinical governance awareness among the staff. Clinical Governance must be implemented through comprehensive management support and participation of all staff and health professionals at both hospital and policy making level.