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Abstract. The impact of air pollution on human health and the associated external costs in Europe and the United States (U.S.) for the year 2010 is modelled by a multi-model ensemble of regional models in the frame of the third phase of the Air Quality Modelling Evaluation International Initiative (AQMEII3). This is the first study known to use a common health assessment approach across the two continents. The modelled surface concentrations of O3, CO, SO2 and PM2.5 from each model are used as input to the Economic Valuation of Air Pollution (EVA) system to calculate the resulting health impacts and the associated external costs. Along with a base case simulation, additional runs were performed introducing 20 % emission reductions both globally and regionally in Europe, North America and East Asia. Health impacts estimated by different models can vary up to a factor of three in Europe (twelve models) and the United States (three models). In Europe, the multi-model mean number of premature deaths is calculated to be 414 000 while in the U.S., it is estimated to be 160 000, in agreement with previous global and regional studies. In order to estimate the impact of biases coming from each model, two multi-model ensembles were produced, the first attributing an equal weight to each member of the ensemble, and the second where the subset of models that produce the smallest error compared to the surface observations at each time step. The latter results in increase of health impacts by up to 30 % in Europe, thus giving significantly higher mortality estimates compared to available literature. This is mostly due to a 27 % increase in the domain mean PM2.5 levels, along with a slight increase in O3 by ~ 1 %. Over the U.S., the mean PM2.5 and O3 levels decrease by 11 % and 2 %, respectively, when the optimal ensemble mean is used, leading to a decrease in the calculated health impacts by ~ 11 %. These differences encourage the use of optimal-reduced multi-model ensembles over traditional all model-mean ensembles, in particular for policy applications. Finally, the role of domestic versus foreign emission sources on the related health impacts is investigated using the 20 % emission reduction scenarios applied over the source regions as defined in the frame of HTAP2. The differences are calculated based on the models that are common in the basic multi-model ensemble and the perturbation scenarios, resulting in five models in Europe and all three models in the U.S. A 20 % reduction of global anthropogenic emissions avoids 54 000 and 27 500 premature deaths in Europe and the U.S., respectively. A 20 % reduction of North American emissions foreign emissions avoids ~ 1000 premature deaths in Europe and 25 000 premature deaths in the U.S. A 20 % decrease of emissions within the European source region avoids 47 000 premature deaths in Europe. Reducing the East Asian emission by 20 % avoids ~ 2000 premature deaths in the U.S. These results show that the domestic emissions make the largest impacts on premature death, while foreign sources make a minor contributing to adverse impacts of air pollution.

Abstract Background Individuals from melanoma-prone families have similar or reduced sun-protective behaviors compared to the general population. Studies on trends in sun-related behaviors have been temporally and geographically limited. Methods Individuals from an international consortium of melanoma-prone families (GenoMEL) were retrospectively asked about sunscreen use, sun exposure (time spent outside), sunburns, and sunbed use at several timepoints over their lifetime. Generalized linear mixed models were used to examine the association between these outcomes and birth cohort defined by decade spans, after adjusting for covariates. Results A total of 2407 participants from 547 families across 17 centers were analyzed. Sunscreen use increased across subsequent birth cohorts, and although the likelihood of sunburns increased until the 1950s birth cohort, it decreased thereafter. Average sun exposure did not change across the birth cohorts, and the likelihood of sunbed use increased in more recent birth cohorts. We generally did not find any differences in sun-related behavior when comparing melanoma cases to non-cases. Melanoma cases had increased sunscreen use, decreased sun exposure, and decreased odds of sunburn and sunbed use after melanoma diagnosis compared to before diagnosis. Conclusions Although sunscreen use has increased and the likelihood of sunburns has decreased in more recent birth cohorts, individuals in melanoma-prone families have not reduced their overall sun exposure and had an increased likelihood of sunbed use in more recent birth cohorts. These observations demonstrate partial improvements in melanoma prevention and suggest that additional intervention strategies may be needed to achieve optimal sun-protective behavior in melanoma-prone families.

The use of ionising radiation (IR) for medical diagnosis and treatment procedures has had a major impact on the survival of paediatric patients. Although the benefits of these techniques lead to efficient health care, evaluation of potential associated long-term health effects is required. HARMONIC aims to better understand the increased risk of cancer and non-cancer effects after exposure to medical IR in children with cancer treated with modern external beam radiotherapy (EBRT) – radiation energy in MeV range – and in children with cardiac defects diagnosed and treated with cardiac fluoroscopy procedures (CFP) – radiation energy in keV range. The project investigates, among survivors of paediatric cancer, potential endocrine dysfunction, cardiovascular and neurovascular damage, health-related quality of life and second (and subsequent) primary cancer (SPC). The cardiac component builds a pooled cohort of approximately 90 000 paediatric patients who underwent CFP during childhood and adolescence to investigate cancer risk following exposure to IR and explore the potential effects of conditions predisposing to cancer. HARMONIC develops software tools to allow dose reconstruction in both EBRT and CFP to enable epidemiological investigations and future optimisation of treatments. With the creation of a biobank of blood and saliva samples, HARMONIC aims to provide a mechanistic understanding of radiation-induced adverse health effects and identify potential biomarkers that can predict these effects.

AbstractBackgroundClimate change is set to exacerbate occupational heat strain, the combined effect of environmental and internal heat stress on the body, threatening human health and wellbeing. Therefore, identifying effective, affordable, feasible and sustainable solutions to mitigate the negative effects on worker health and productivity, is an increasingly urgent need.ObjectivesTo systematically identify and evaluate methods that mitigate occupational heat strain in order to provide scientific-based guidance for practitioners.MethodsAn umbrella review was conducted in biomedical databases employing the following eligibility criteria: 1) ambient temperatures > 28 °C or hypohydrated participants, 2) healthy adults, 3) reported psychophysiological (thermal comfort, heart rate or core temperature) and/or performance (physical or cognitive) outcomes, 4) written in English, and 5) published before November 6, 2019. A second search for original research articles was performed to identify interventions of relevance but lacking systematic reviews. All identified interventions were independently evaluated by all co-authors on four point scales for effectiveness, cost, feasibility and environmental impact.ResultsFollowing screening, 36 systematic reviews fulfilled the inclusion criteria. The most effective solutions at mitigating occupational heat strain were wearing specialized cooling garments, (physiological) heat acclimation, improving aerobic fitness, cold water immersion, and applying ventilation. Although air-conditioning and cooling garments in ideal settings provide best scores for effectiveness, the limited applicability in certain industrial settings, high economic cost and high environmental impact are drawbacks for these solutions. However, (physiological) acclimatization, planned breaks, shading and optimized clothing properties are attractive alternative solutions when economic and ecological sustainability aspects are included in the overall evaluation.DiscussionChoosing the most effective solution or combinations of methods to mitigate occupational heat strain will be scenario-specific. However, this paper provides a framework for integrating effectiveness, cost, feasibility (indoors and outdoor) and ecologic sustainability to provide occupational health and safety professionals with evidence-based guidelines.

Allergic diseases affect millions of children and adolescents worldwide. In this Review, we focus on allergies to food and airborne allergens and provide examples of prevalence trends during a time when climate change is of increasing concern. Profound environmental changes have affected natural systems in terms of biodiversity loss, air pollution, and climate. We discuss the potential links between these changes and allergic diseases in children, and the clinical implications. Several exposures of relevance for allergic disease also correlate with epigenetic changes such as DNA methylation. We propose that epigenetics could be a promising tool by which exposures and hazards related to a changing environment can be captured. Epigenetics might also provide promising biomarkers and help to elucidate the mechanisms related to allergic disease initiation and progress.

A compact antibiotic delivery system based on enzymatic biofuel cells was prepared, in which ampicillin was released when discharged in the presence of glucose and O2.