The emergence of Clostridium difficile ribotype 027 raised the question of sporicidal surface disinfectants are also effective against spores of C. difficile ribotype 027.
Three surface disinfectants based on magnesium monoperoxyphthalate hexahydrate (Dismozon pur), a combination of (ethylenedioxy)dimethanol, glutaral and benzyl-C12-18-alkyldimethylammonium chlorides (Kohrsolin extra) and a combination of glutaral, benzyl-C12-18-alkyldimethylammonium chlorides and didecyl-dimethylammonium chloride (Kohrsolin FF) were tested in a suspension test in various concentrations and contact times against spores of three C. difficile strains including ribotype 027.
All three surface disinfectant reduced the number of spores by ≥4 log(10) steps, e.g. Dismozon pur at 1.5% and 2 h exposure time, Kohrsolin extra at 2% and 4 h exposure time, and Kohrsolin FF at 2% and 6 h exposure time. Spores of ribotype 027 did not show a lower susceptibility to Dismozon pur compared to the other two C. difficile strains.
All three tested surface disinfectants should be effective for surface disinfection in outbreaks caused by C. difficile ribotype 027.
Polybrominated diphenyl ethers (PBDE) are used in high amounts as flame retardants in plastic materials and textiles. Due to their persistence, their accumulation in the food chain and their toxic properties they have been integrated in the human biomonitoring program of the Baden-Württemberg State Health Office since 2002. In repeated cross-sectional studies in winter 2002/03 (n=162), 2004/05 (n=194), 2005/06 (n=411) and 2008/09 (n=770) blood samples of 9-11-year-old pupils were taken, pooled and analysed for PBDE after extraction and purification by silica gel using HRGC/HRMS. Samples were pooled according to region, gender, and breast feeding. PBDE in the pooled samples ranged from 1.9 to 12.5 ng/g blood fat (sum of all PBDE). Mean concentrations of PBDE, calculated for the four investigation periods, were 6.2 ng/g (2002/03), 5.4 ng/g (2004/05), 7.8 ng/g (2005/06) and 6.7 ng/g (2008/09). While the concentration of the decabrominated diphenyl ether (BDE-209) increased, the concentration of other congeners (BDE-47, BDE-99, BDE-100, BDE-153, BDE-154, BDE-183) decreased slightly or remained at the same level. Consistent differences with respect to gender and breast-feeding were not recognizable. Concentrations of PBDE in children range on the same level as in adults and do not seem to be critical from the toxicological point of view. Because of the slight increase of BDE 209, the internal concentrations of BDE should be monitored in the future. The strong variations in PBDE concentration between the different pooled samples indicate that, apart from ingestion, other routes of exposure (dermal, inhalation) and additional sources (textiles, building materials) must be taken into consideration.
The possibly carcinogenic properties of naphthalene are, regarding to its ubiquitary presence, of environmental-medical and occupational-medical importance. Seven isomeric dihydroxynaphthalenes (DHN) were examined for their suitability as biomarkers in human biomonitoring and to get insights in human naphthalene metabolism.
We developed a GC-MS-method for the quantification of 1,2-, 1,4-, 1,5-, 1,6-, 1,7-, 2,6- and 2,7-DHN after solid phase extraction and derivatization with BSA/TMCS. The internal burden of DHN after exposure to naphthalene was determined by measuring urine collected from smokers and non-smokers among the general population and among occupationally exposed persons.
The elaborated method can be regarded as specific and sensitive procedure to quantify the seven different DHN. In human urine, we detected 1,2-DHN as main metabolite in 54 of the 55 analysed samples. Median 1,2-DHN values (range) were 1012 μg/L (22-6477 μg/L) for workers and 8 μg/L (<LOD-62 μg/L) for controls. 1,4-, 1,7-, 2,6- and 2,7-DHN were quantified in 61-89% of the samples (range <LOD-113 μg/L). 1,5- and 1,6-DHN were not detected in human urine. In the urine samples of workers, median-concentrations of 1,2-DHN were about tenfold higher than those of the established biomarkers 1- and 2-naphthol, while in our control collective comparable concentration of 1,2-DHN and 1- and 2-naphthol were found. 1,2-DHN showed to be the most sensitive biomarker for an internal exposure to naphthalene. It is clearly superior to 1- and 2-naphthol which up till now have been used for biomonitoring purposes. Moreover 1,2-DHN is the precursor of the possibly ultimate carcinogenic metabolite of naphthalene, 1,2-naphthoquinone. This way the diagnostical reliability of 1,2-DHN predominates the other naphthalene metabolites. So out of analytical and diagnostical reasons 1,2-DHN seems to be the most promising biomarker for the estimation of environmentally and occupationally caused internal exposures to naphthalene.
Possible human health effects of phthalate plasticizers have been intensely discussed during the last decade. Di(2-ethylhexyl) phthalate (DEHP), the phthalate acid ester with the largest production volume worldwide, has been substituted by new compounds like Diisononyl 1,2-cyclohexanedicarboxylic acid (DINCH) or Di(2-ethylhexyl) terephthalate (DEHT) in many applications. There are numerous reports about concentration levels of phthalates in indoor environments, but data on concentrations of these alternative plasticizers are not available yet. Also, the methods for the determination of phthalate substitutes are not yet established. This study presents the results achieved by quantification using different analytical methods. Data on the concentration of DEHT and DINCH in 953 dust samples from German households are presented. These samples were obtained in four different studies conducted from 1997 to 2009. Maximum concentrations of 110 mg DINCH/kg dust and 440 mg DEHT/kg dust were found. Especially the amount of DINCH has increased significantly after the market introduction of this plasticizer in 2002. Up to the beginning of 2006, DINCH was found in 44% of the dust samples. Dust samples collected in 2009 indicate an increased concentration for both softeners.
This study assessed personal exposure to 1,3-butadiene (BD) and styrene in three plants manufacturing styrene-butadiene (SB) copolymers. Air samples were collected from the breathing zone of 28 workers over 4 months in three SB plants using diffusive samplers. The total number of samples was 885 with the number of samples per participant varying from 19 to 39. Samples were collected by use of 3M 3500 passive monitors and analyzed with a gas chromatograph (GC). Sampling proved to be simple and inexpensive and laboratory analysis of BD could detect 0.01 and 0.007 part per millions (ppm) of styrene in the 8h samples. In the case of BD, 624 samples were below the limit of quantification (LOQ), 240 samples were between the LOQ and 1 ppm, and 21 samples exceeded the threshold limit value (TLV). In the case of styrene 336 samples were below the LOQ, 548 samples were between the LOQ and 20 ppm. The TLV was exceeded once. The data gives a comprehensive picture of personal exposure of workers in modern SB latex manufacturing plants. The study illustrates also how the new TLV of BD is being implemented.
The population-based cross-sectional study including 1004 Bavarian volunteers aged 3 up to 84 years (median: 42 years) was aimed to quantify the internal burden of monocyclic arylamines in the general population and to yield reference values.
Participants were asked to complete a questionnaire, to give a venous blood sample and a urinary sample. The selected monoarylamines (aniline, o-anisidine, all isomers of toluidine, single and double chlorinated anilines) represent main sources of potential environmental exposure. The venous blood sample was taken to determine the smoking-specific acrylonitrile-adduct N-cyanoethylvaline.
Detectable levels of aniline were found in the urine of 93.9% of the participants, whereas 3-chloroaniline was only detected in 16% of the samples. The influence of smoking on the urinary arylamine concentration was weak. Only for o-toluidine, m-toluidine and o-anisidine values were significantly higher in smokers. Therefore, while the 95th percentile based on the total sample (n=1004) is the best reference value for all other arylamines (i.e. p-toluidine, 3-chloroaniline, 4-chloroaniline, 3,4-dichloroaniline) we suggest separate reference values for smokers and non-smokers for the former three compounds. A statistically significant difference in urinary arylamine concentration between men and women was observed for 3,5-dichloroaniline, o-anisidine and aniline (p<0.001). Therefore we suggest gender-specific reference values for dichloroaniline and aniline; for o-anisidine we suggest gender- and smoking-specific reference values. The observation of o-toluidine in 178 urinary samples in concentration above the limit of quantification raises concern regarding human carcinogenicity.
This study supports the notion of further relevant sources of o-toluidine exposure except smoking and occupation. Compared to other environmental risk factors (e.g. environmental tobacco smoke) the risk of o-toluidine-induced cancer seems to be extremely low for the general population.
A somewhat detailed study was carried out in Gaighata, one of the 107 arsenic-affected blocks in West Bengal, India, to determine the degree of groundwater contamination with arsenic, its depth wise distribution, correlation with iron, arsenical health effects to the inhabitants and the factors responsible for arsenic poisoning. Groundwater in all the 107 mouzas over 13 gram-panchayets in Gaighata block contains arsenic above 0.01mgl(-1) and in 91 mouzas, arsenic concentration has been found above 0.05mgl(-1). About 59.2 and 40.3% of the tubewell water samples contain arsenic above 0.01 and 0.05mgl(-1), respectively. The approximate population drinking arsenic-contaminated water above 0.01 and 0.05mgl(-1) are 106,560 and 72,540, respectively. The tubewells that were installed within the depth range of 15.4-30.3m are mostly arsenic-contaminated. Even the shallow groundwater level (7.87-15.1m) is arsenic-contaminated. Both arsenic and iron concentrations in groundwater gradually increase from lower depth to higher depth up to 39.4m, and then decrease with increasing depth. About 58% of the deep tubewell water samples (depth range 122-182m, n=31) contain arsenic ≥0.05mgl(-1). About 72% of the arsenic-contaminated deep tubewells (n=18) were safe when surveyed first time. But within a span of 2-5 years, they became contaminated with arsenic. The linear regression shows direct correlation between arsenic and iron concentrations in groundwater (r(2)=0.8114, p<0.0001, n=912). Intakes of inorganic arsenic from water by an adult male and female in the surveyed areas are 11.7 and 13.1μg/kg body wt./day, respectively and these values are higher than the WHO recommended PTDI value of inorganic arsenic (2.1μg/kg body wt./day). Mean arsenic concentrations in urine, hair and nail samples, collected from the inhabitants of Gutri mouza are higher than their normal level and the values are 292μgl(-1) (range: 8.35-1024μg l(-1), n=193), 2.50mgkg(-1) (range: 0.17-5.99mgkg(-1), n=132), and 6.05mgkg(-1) (range: 0.55-16.7mgkg(-1), n=116), respectively. About 83% and 68% of the urine samples (n=250) contain arsenic above 100 and 200μgl(-1), respectively. Linear regressions show very good correlations between arsenic concentrations in water vs. urine, hair and nail samples from the inhabitants (n=103) of Gutri mouza. About 18.3% of the population (n=930) were registered with arsenical skin lesions.
In the1950s-1970s polychlorinated biphenyls (PCBs) were used in several countries as plasticizers in elastic sealants in buildings.
The primary objective was to study whether residents of PCB-contaminated dwellings had higher plasma levels of PCBs than their neighbours in non-contaminated dwellings. The secondary objective was to study possible associations between concentrations of PCBs in the indoor air and in the plasma of residents.
Stratified cross-sectional study of residents of a housing estate with four sections, of which only one section had PCB-containing sealants. The determination of 27 PCB congeners in plasma was performed among 134 exposed and 139 non-exposed residents. Air measurements were conducted in 104 flats.
Significant differences in plasma PCBs between exposed versus non-exposed were found for most of the lower chlorinated and many of the higher chlorinated congeners. The median of sum of 27 PCBs was approximately four times higher in exposed compared with non-exposed residents. The elevated PCB concentrations persisted in multivariable analyses controlling for relevant cofactors. We found significant correlations between PCB indoor air concentrations and the PCB concentration in the plasma of the residents for ten of the lower chlorinated congeners.
Our study confirms that indoor air exposure to PCBs from PCB containing sealants may result in a considerable internal PCBs exposure of the residents. For the first time we were able to demonstrate that the internal exposure to low chlorinated PCBs is significantly associated with the indoor air concentration of these congeners.
Communities surrounding the Hanford Nuclear Reservation in southeastern Washington were exposed to radionuclides, particularly iodine-131, released during the period 1945 to 1951. This study evaluated whether estimated iodine-131 exposures were risk factors for infant mortality, fetal death, and preterm birth in the years of highest releases, 1945 and 1946. Data on births, fetal deaths, and infant deaths, during the period 1940 to 1950, were abstracted from vital records for an eight county area surrounding the Hanford facility. The analysis included 56,320 births, 1,656 infant deaths, and 806 fetal deaths. The Hanford Environmental Dose Reconstruction project provided iodine-131 dose estimates for the 1,102 grid areas in the study area. The grid areas were collapsed into 4 exposure groups using estimated exposure to iodine-131 during 1945. Each birth and death record was assigned to one of the four grid groups based on mother's residence at the time of birth. Comparisons of preterm birth, infant death, and fetal death rates were made among the grid groupings for the primary exposure period (1945 to 1946) and for other years of the study period (i.e., 1940 to 1944 and 1947 to 1950). In the grid group with the highest estimated iodine-131 exposures, the mother's residence during the latter part of pregnancy was associated with preterm birth (OR = 1.74, 95% CI = 1.09-2.72). An association with infant mortality (OR = 1.26, 95% CI = 0.79-1.97) was suggested. No association was found for fetal deaths. This study found that iodine-131 exposure was associated with increased risk of preterm birth. This finding is biologically plausible because other studies have found that: (1) iodine-131 exposure can cause hypothyroidism, and (2) overt or subclinical hypothyroidism during pregnancy can increase a mother's risk of a preterm delivery.
Growing evidence indicates that environmental exposures are more prevalent among socially disadvantaged groups. We investigated the distribution of environmental exposures and health outcomes in preschool children, and examined the role of social position on their associations.
We analysed data from a cross-sectional study on 968 preschool children from three districts in the Ruhr Area and one rural community in North Rhine-Westphalia in 2000. Parents filled in a questionnaire on socio-demographic characteristics, environmental exposures, respiratory infections and allergic diseases. Residential annual total suspended particulate matter (TSP) mass concentrations were derived from a small-scale interpolation model. Lung function, allergic sensitisation and immunologic function were assessed. We analysed the associations between environmental exposures and health outcomes in social subgroups with logistic regression.
High TSP concentrations at the home address and unfavourable living conditions were more prevalent in the socially disadvantaged groups, while allergic and respiratory infectious diseases were reported more frequently in the privileged groups. The odds ratio for the association between TSP and history of allergic diseases was 1.17 (95% CI 0.95-1.45) in children without immigration background and 0.71 (95% CI 0.53-0.95) with immigration background. Heterogeneity for exposure-outcome associations was also seen between TSP and lung function as well as unfavourable living conditions and allergic diseases.
We found evidence for an influence of social position on environment-health associations. Possible explanations for heterogeneity include social group-specific over- and underreporting and effect measure modification, which need to be taken into account when designing and analysing environmental health studies.
It was the aim of this study to compare the efficacy of alcohol-based hand disinfectants according to European Standard EN 1500 (hygienic handrub), using the routine test organism Escherichia coli and, additionally, Micrococcus luteus as a surrogate for Gram-positive pathogens. One ethanol-based hand disinfectant (product A) and one propanol-based hand disinfectant (product B) were used in all experiments. Product B (propanol-based) was significantly more effective against both test organisms than product A (ethanol-based) in quantitative suspension tests but not in tests simulating practical conditions. In the experiments according to EN 1500 germ reduction rates obtained with the ethanol-containing formulation A were identical for E. coli and M. luteus. Product B was slightly, but not significantly more effective against M. luteus. To conclude, using E. coli as the test organism for evaluating the antibacterial efficacy of alcoholic hand disinfectants under practical conditions even appears to be sufficient to permit the drawing of conclusions for Gram-positive pathogens. However, more alcohol-based hand disinfectants should be tested in further studies to verify the results obtained.
Human biomonitoring is a well-recognized tool for estimating the exposure of human populations to environmental pollutants. However, information regarding biomarker concentrations of many environmental chemicals in the general population is limited for many countries. The Spanish Environment Ministry has recently funded a human biomonitoring study on the Spanish general population. This study aims to determine reference levels for several biomarkers, especially heavy metals, persistent organic pollutants (POPs) and cotinine, in urine, whole blood, serum and hair, and will involve 2000 volunteers throughout Spain. Samples were taken during 2009-2010 and analyses are currently underway. The results presented herein were obtained in a pilot study carried out in the Madrid region. The study group comprised 170 volunteers, of which 79% were female and 21% male (age: 23-66 years). All participants were asked to complete a questionnaire regarding diet and living habits and provides a morning urine sample. The geometric means for total mercury (Hg), lead (Pb) and cadmium (Cd) were 1.23, 1.11 and 0.25 μg/g creatinine, respectively. Levels of Pb and Hg were higher than those reported for the general population in the USA and Germany, whereas Cd was in the same range (CDC, 2009; Becker et al., 2003). The values reported here are similar to those reported in other Spanish studies.
Interleukin-6 (IL-6) gene is a multifunctional cytokine which is expressed in lymphocytes, fibroblasts, macrophages, in response to different types of inflammatory stimuli. IL-6 also controls induction and expression of metallothioneins (MTs) which maintain homeostasis of zinc and copper. In human, IL-6 gene is located on chromosome 7p21 and -174 G/C polymorphism located in its promoter region. Recently, genetic studies showed that IL-6 -174 G/C promoter polymorphism influences IL-6 gene transcription and plasma cytokine levels. The aim of this study is to determine the IL-6 promoter polymorphism effect on trace element levels and toxic metal accumulation in the kidney and liver tissues. Kidney and liver tissues were collected from 122 autopsy cases in Ankara district. IL-6 promoter polymorphism was detected by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis. The genotype frequencies were found as 54.9% homozygote typical (GG), 39.3% heterozygote (GC) and 5.7% homozygote atypical (CC). The allele frequencies in all subjects were consistent with Hardy-Weinberg equilibrium (χ(2) = 0.179; p > 0.05). In order to assess the cadmium (Cd), lead (Pb), zinc (Zn) and copper (Cu) levels in the autopsy tissues, a dual atomic absorption spectrophotometer system was used. As a result, no statistical association was found between the IL-6 promoter polymorphism and Pb, Cd, and Cu (p > 0.05) levels in the kidney and liver tissues but statistically significant differences were detected with the Zn concentration (p < 0.05).
The potential of the cluster fly, Pollenia rudis sensu stricto, to transmit bacterial pathogens was investigated during a mass infestation that took place in a German hospital. Cluster flies were individually examined for mesophilic bacteria carried on the exoskeleton. Bacterial growth could only be detected by using the enrichment culture technique to increase sensitivity, but not by direct intoculation of fly samples to agar plates. All 50 cluster fly samples that were tested carried opportunistic aerobic mesophilic Bacillus spp., whereas 41 fly samples were positive for Erwinia spp., 16 samples for Erwinia amylovara, 24 samples for Stenotrophomonas maltophilia, and 4 samples for Flavobacterium odoratum. Staphylococcus lugdunensis and Pseudomonas aeruginosa were found in 5 samples. No bacteriologically sterile cluster fly samples were obtained. The whole bacterial pattern found on P. rudis s. s. is known for its potential to cause opportunistic and/or nosocomial infections in humans. The results obtained led to the assumption that mass infestations of cluster flies occurring in sensitive areas, especially in hospitals, may cause a low, but not neglectable health threat due to mechanical transmission of bacterial pathogens.
The accuracy of a traditional method (lactose utilization with acid and gas production) for the detection of coliform bacteria and E. coli was tested in comparison with method ISO 9308-1 (based on acid formation from lactose) and the Colilert-18 system (detection of beta-galactosidase). A total of 345 isolates were identified after isolation from water samples using API 20E strips. The Colilert-18 led to the highest number of positive findings (95% of the isolates were assigned to coliforms), whereas the ISO-9308-1 method resulted only in 29% coliform findings. With the traditional method only 15% were rated positive. Most of the isolates were identified by the API 20E system as Enterobacter spp. (species of the Enterobacter cloacae complex), Serratia spp., Citrobacter spp.and Klebsiella spp.; but species identification remained vague in several cases. A more detailed identification of 126 pure cultures by using 16S rRNA gene sequence analysis and analysis of the hsp60 gene resulted in the identification of Enterobacter nimipressuralis, E. amnigenus, E. asburiae, E. hormaechei, and Serratia fonticola as predominat coliforms. These species are beta-galactosidase positive, but show acid formation from lactose often after a prolonged incubation time. They are often not of fecal origin and may interfere with the ability to accurately detect coliforms of fecal origin.
The aim of this study was to examine the genotype properties of Staphylococcus aureus of phage type 187 strains that constitute a separate group among the strains of S. aureus. Sixteen strains were collected from the hospital patients (n=12) and the healthy carriers (n=4) in 13 medical centres in Poland during 1991 and 2005. Biotyping, antibiotic susceptibility, phage typing, detection the genes of enterotoxins and toxic shock syndrome toxin, genotyping of chromosomal DNA by pulsed-field gel electrophoresis (PFGE), also amplification and restriction analysis of the coagulase (coa) and the protein A genes (spa) (PCR/restriction fragment length polymorphism (RFLP)) was tested. The results of this study showed that all staphylococcus of phage type 187 belonged to the human biotype (A) and appeared to be sensitive to all of the tested antibiotics, including methicillin (MSSA). Finding out the toxin genes showed that almost all of them (93.8%) had the enterotoxin C gene (sec) and TSST-1 gene (tst). The PFGE typing proved that the phage type 187 strains (except for one) constitute one PFGE type. These results and the identical restriction patterns in the PCR/RFLP method, also the same biotype, sensitivity to antibiotics and the presence genes of the same type of toxins confirmed that the phage type 187 strains constitute one clone within our country. Additionally, the fact that almost all of them have the enterotoxin genes and tst gene allows to consider them the strains of potentially high virulence.
To investigate associations of gene polymorphisms of the apoE-CI-CII gene cluster and the LDL-R gene on coronary artery disease (CAD) and their interactions with alcohol drinking and smoking in the Chinese Han population.
A questionnaire survey of the behaviors of smoking and drinking, dietary patterns and anamnesis was conducted among 203 patients of CAD, aged 65.0 +/- 11.1 years, and 365 controls, aged 63.6 +/- 12.0 years. Peripheral blood samples were colleted and the total DNA was extracted. The apoE genotypes were identified by multiplex amplification refractory mutation system (multi-AMRS), the apoCI promoter polymorphisms and AvaII polymorphisms of the apoCII and LDL-R gene were detected by using PCR-RFLP. Pairwise linkage disequilibrium coefficients (D, D') were estimated by the LINKAGE program. The interactions between genes with alcohol drinking and smoking were analyzed by using multivariate logistic regression models.
The differences of systolic/diastolic blood pressure, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) concentrations, smoking and drinking were significant between subjects with CAD and controls. The frequencies of apoE gene epsilon 3/4 genotype (25.9%) and epsilon 4 (13.9%) in CAD were significantly higher than those in controls (12.5% and 6.9%, respectively, p < 0.05). A significant difference was also found for the apoCI locus, the frequencies of H2 allele were 20.5% in the CAD and 11.3% in the control. Linkage disequilibrium coefficient D' was 0.672 (p < 0.01) between apoE and apoCI genes. Significant differences for a deficit of epsilon 3-H1-T1 and excess of epsilon 4-H2-T1 was found in CAD by estimation of the haplotype frequencies. After control for possible confounding factors, the multivariate logistic analysis showed that epsilon 4, H2 allele, smoking and drinking were risk factors of CAD. A significant interaction among epsilon 4, H2 and smoking was observed (OR 18.3, 95% CI: 2.35-150.81, p < 0.05), it was a multiplicative model. An additive model was shown among epsilon 4, H2 and drinking (OR12.7, 95% CI: 2.8-58.6, p < 0.05).
The results suggested that both apoE and apoCI on chromosome 19 were the susceptibility locus for CAD, their linkage disequilibrium should be responsible for the development of CAD. Drinking and smoking enhance the genetic predisposition to CAD.
Max von Pettenkofer - founder of scientific hygiene, preventive medicine and public health sciencesThe Society for Hygiene and Environmental Medicine commemorates the 100th anniversary of the death of the great hygienist and physician Max von Pettenkofer (1818-1901) who died in Munich on February 10, 1901.Max von Pettenkofer laid the foundations of modern hygiene, and used scientific approach to determine environmental health hazards present in air, water, ground, homes, hospitals and public facilities. Due to his encouragement for sanitation of towns by supplying hygienically safe water and by appropriate sewage disposal, the death toll in towns like Munich due to epidemics such as cholera and typhus was drastically reduced long before the discovery of their bacterial etiology. Pettenkofer's influence on the development of fields of hygiene and public health reached far beyond the national borders. Today, in view of the new global challenges, his concepts in research, teaching and sanitation are of the highest topicality in both the developed and the developing countries.Pettenkofer's scientific developmentPettenkofer was born on December 3, 1818 in Lichtenheim by Neuburg (Danube). After the studies of pharmacy and medicine he became Professor of Dietetic Hygiene, and in 1853 he was named Germany's first Professor of Hygiene. In recognition of the importance of the field of hygiene and as a support to his pioneering work, Ludwig II of Bavaria, created chairs of hygiene in medical schools of all three Bavarian universities of that time. These chairs became a model for all other German universities.In 1879, Pettenkofer's new Institute of Hygiene at Munich Medical School was opened; the institute was built according to Pettenkofer's design, and was generously financed. It was considered the world's most modern institute of hygiene, and it attracted many foreign visitors who considered this institute and the Pettenkofer's concept of hygiene and sanitation a model approach. The Johns Hopkins School of Hygiene and Public Health in Baltimore, Maryland, built in 1916, is an example of the influence Pettenkofer's concept had on the outside world. The aim of this American school was to apply Pettenkofer's approach to the teaching and exploration of the fields of hygiene and sanitation. Even today, the ecological aspects of hygiene taught during medical studies are based on Pettenkofer's concepts.Despite Pettenkofer's rejection of the solely bacterial etiology of numerous epidemical diseases, already by then unequivocally proven by the 25 years younger Robert Koch, Pettenkofer's secular significance and his sanitation concepts did not lose any of their topicality.Success of hygiene and sanitationThe World Health Organization (WHO) and the American Centers for Disease Control and Prevention (CDC) have stated that the 20th century was highly successful in terms of a significant improvement of life quality, and of an extension of the average life expectancy by at least 30 years. Of this enormous life expectancy extension, 25 years can be attributed to the success of hygiene and public health, while only 5 years to the improvements in the curative medicine. Thus the 20th century can be seen the century of the curative medicine, while the 21st century will be the century of preventive medicine and hygiene.In January 2001, the Pasteur Institute in Paris organized an outstanding Congress on Hygiene and Health in which it was announced that this institute would become the center of hygiene strategies of the 21st century.Challenges of the futureThe WHO is warning us of the dramatic challenges of the coming decades due to the rapid increase in the world population. Additional 2 billion people are expected to be living on this planet within the next 15-20 years. But already now, 1 billion people have no access to hygienically safe water, and 3 billion people live in communities with no sanitation. The revived Pettenkofer's scientific hygiene, together with its concepts and strategies, is thus becoming the strategy of survival.Dr. Gro Bruntland, Director-General of the WHO, announced on January 15, 2001, that the organization needs considerable support in order to recognize the threatening health risk factors and to develop new prevention strategies. The current BSE crisis shows clearly what risks are encompassed in an insufficient risk assessment concerning foodstuffs.These are the reasons why the theme of the WHO's report 2002 will be “Health Hazards”. With this report the WHO intends to encourage the countries and societies of the world to critically survey health risks linked to air, water and foodstuffs, and thus to promote the development of international health regulations and conventions. This approach is the best Acknowledgement of the significance of the work of Max von Pettenkofer.Current state of hygiene at German universitiesIn 1882 Pettenkofer wrote, “I wish that my publications made the medical schools and state governments recognize the significance of the scientific hygiene and sanitation, and realize that care must be taken of the research in and the teaching of hygiene at the universities”.It is a rather unfortunate fact that this old Pettenkofer's appeal, together with the current urgent warnings by hygienic and medical societies, still falls on deaf ears in some of the German federal states. Bavaria, the cradle of the scientific hygiene, has currently no independent Chair of Hygiene, and no physicians specialized in hygiene and environmental medicine are currently being educated there. A similar development can be seen also in other federal states. In Baden-Württemberg, e. g., the School of Medicine of the Tübingen University has decided to stop occupying the Chair of Hygiene, while in Hessen, the Chair of Hygiene of the Frankfurt University might be dismantled altogether. Yet not in every German federal state is the situation bad. In sharp contrast to the unfortunate situation in the mentioned regions, the state of Nordrhein-Westfalen has flourishing independent institutes of hygiene at the universities in Aachen, Bochum, Bonn and Düsseldorf.The centenary of death of Max von Pettenkofer and the increasing challenges of the current world are therefore a good opportunity to make an urgent appeal to the universities and the German federal states to reconsider the current policy of dismantling the chairs of hygiene and public health.President of the Society of Hygiene and Environmental Medicine
Because crude oil and refined petroleum products can contain benzene and benzene is considered a known carcinogen by numerous independent and governmental agencies, including the International Agency for Cancer Research, the petroleum industry has implemented exposure control programs for decades. As part of the benzene control programs, significant exposure assessments have been performed; both qualitatively and through quantitative measurements. In this study, we evaluated the airborne concentrations of benzene and their variability over time at the ExxonMobil refinery in Beaumont, TX between 1976 and 2007. The results of 5854 personal air samples are included in this analysis; 3761 were considered non-task (> or =180 min) personal samples, and 2093 were considered task-related (<180 min) personal samples. Dock and loading rack samples were analyzed separately from the refinery samples because in addition to refinery products, employees at the dock and loading rack also handled chemical plant products. In general, the non-task personal refinery air samples indicated that exposures of the past 30 years were generally below the occupational exposure limit of 1 ppm (mean=0.30 ppm, SD=3.1), were higher during routine (mean=0.32 ppm, SD=3.3) than turnaround operations (mean=0.16 ppm, SD=0.87), and decreased slightly over time. The job sampled most frequently during routine operations was that of process technician, and, as broken down by area, resulted in the following mean benzene air concentrations: coker (n=146, mean=0.014 ppm, SD=0.036), lube extraction unit (n=31, mean<0.070 ppm), pipestills (n=136, mean=0.12, SD=0.47), waste treatment (n=107, mean=0.20, SD=0.28), and all other areas (n=1115, mean=0.059 ppm, SD=0.36). Task-based samples indicated that the highest exposures resulted from the tank cleaning tasks, although the overall task mean benzene air concentration was 1.4 ppm during routine operations. The most frequently sampled task during routine operations was blinding and breaking, and the mean benzene air concentrations associated with this task were statistically higher in the reformer area of the refinery (n=311, mean=3.2 ppm, SD=7.9) than in all other areas (n=200, mean=0.92 ppm, SD=3.1). However, task-related exposures were found to be statistically similar across job categories for a given task. This study thus provides a task-focused analysis for occupational exposure to benzene during refinery operations, and will be useful for understanding exposures at this refinery.
In January 1985 an extended smog episode occurred in Central Europe. The Rhine-Ruhr area (Western Germany) was affected for 5 days with maximum concentrations of 0.8 mg/m3 SO2 and 0.6 mg/m3 TSP (24h averages). Health effects were investigated during the smog period and a control period before and after the smog. Daily mortality increased by 8%, hospital admissions (for respiratory and cardiovascular causes, RC) by 15%, outpatients (RC) by 12% and ambulance transports (RC) by 28%. Patients with chronic bronchitis from the Ruhr area cities showed more exacerbations during the episode, and in school children from the Netherlands lung function was reduced. In Augsburg (Southern Germany) the smog episode was less severe (maximum concentrations 0.2 mg/m3 SO2 and 0.1 mg/m3 TSP, 24 h averages). Here--by chance--the prospective MONICA study was ongoing. During the episode a significant increase of plasma viscosity, C-reactive protein and heart rate was observed in the participants. The highest ambient concentrations (maximum 24h average of 3.6 mg/m3 SO2) were measured in Erfurt (Eastern Germany). Surprisingly, no measurable increase of mortality occurred. This was explained by premature deaths during the period before the smog, were the concentrations had already been clearly above 1 mg/m3 SO2. An earlier episode took place in December 1962 in the Rhine-Ruhr area for 5 days with maximum concentrations of 5.0 mg/m3 SO2 and 2.4 mg/m3 TSP (24 h average). Daily mortality on average increased by 19%. In 1962 and 1985 the effects were stronger in cities with pollution mainly from traffic than in areas with pollution from industrial sources. In total, between 1962 and 1987 two major and several smaller smog episodes occurred in Central Europe. Patients with cardiovascular diseases were more severely affected than patients with respiratory diseases. Health effects were more strongly correlated with TSP than with SO2.
Regulatory toxicologists, when going into assessment of a new analyte in drinking-water, very often miss the occasion to revert to scientifically consensual virtually safe lifetime exposure reference doses and corresponding health-related guide values (HRGV) for drinking-water, be those derived either to avoid concern over "threshold effects" or concern over exceedance of an unacceptable non-threshold cancer risk level. They then need a more restrictive precautionary yet science-compatible approach to directly avoid concern over the presence (measured concentration) of a new analyte in drinking-water. Therefore, the German Environment Agency (UBA, Umweltbundesamt) decided in 2003 to extrapolate international toxicological expertise collected since 1993 from assessing "old" analytes in drinking-water on new ones in form of five HRIV=health related indication values. They indicate the reasonable lowest maximal concentration from which on tiered or stepwise human toxicological evaluation of a new analyte might be necessary and meaningful. Their regulatory-toxicological function is that of placeholders as long as a possibly higher scientific HRGV or a surrogate value based on a threshold of toxicological concern (TTC) was not broadly agreed by science. The five-step HRIV scale between 0.01 and 3.0 μg/l combines international toxicological experience gained from "old" analytes since 1993 with the concepts of safety factors (SF(D)) to assess database deficiency and science-related extrapolation factors (EF) to extrapolate experimental data on humans. Each HRIV is valid and safe for a 2 l/day drinking-water exposure scenario either counting for 10% relative source contribution (compounds with threshold effects) or for a lifetime non-threshold cancer risk of up to 10(-6) and is the higher the more positive information exists regarding possible effects at critical toxic endpoints and for length of possible exposure. Past (historical) and present evaluations of "old" analytes were available in form of hundreds of HRGVs to count in 2 liters per day and person for 10% RSC or a 10(-6) non-threshold risk. These HRGVs were calculated by the present author either from ADI-, TDI- or RfD-values derived since 1993 by six large health authorities or they were identified directly at their websites or in the literature, always looking for confirmed or assumed worldwide relevance for drinking-water (resources). 36 of these up to 200 "old" analytes were ascribed since 1993 at least once an HRGV at or below 1 μg/l for (confirmed or provisionally assumed) "high" or "very high" threshold chronic toxicity. None but one of the corresponding 113 scientific HRGVs fell distinctly short of 0.3 μg/l. Only 14 carcinogens turned out as being relevant for drinking-water due to confirmed occurrence and coincident toxicological significance there. 13 of these exhibited a structural alert for genotoxicity. Ten of these 13 were "high-potency" genotoxic carcinogens with presently calculated non-threshold 10(-6) risk minimal HRGVs between 0.06 μg/l and 0.005 μg/l (9 compounds) or possibly down to 0.0007 μg/l (1 compound). This motivated UBA to propose a precautionary range between a minimal HRIV0=0.01 and a HRIV1=0.1 μg/l to assess new analytes bearing a structural alert for genotoxicity. The HRGVs for the remaining three (from 13) carcinogens with alerts for genotoxicity were at best similar for both genotoxic and non-genotoxic effects and higher or equal to 0.3 μg/l. Therefore, a minimal HRIV of 0.01 μg/l (HRIV0) or even 0.1 μg/l (HRIV1) would have appeared too low for assessing the presence in drinking-water of new analytes with no other human toxicity data than proven absence of both genotoxicity and of structural alerts for such. Instead, UBA proposes to provisionally assess such compounds by its next higher precautionary of HRIV3=0.3 μg/l. Any value once set is open for falsification upwards to either 1.0 μg/l (HRIV4) or 3.0 μg/l (HRIV5) or even for being replaced by an HRGV>3.0 μg/l if pertinent high toxicity effect potentials different from genotoxicity are similarly ruled out by either mechanistic and TTC-based arguments or a tiered experimental (in vitro and/or in vivo) approach.
Regulatory-toxicological expertise gained since 1993 with "old" analytes in drinking-water (resources) and its extrapolation by analogy on new analytes with patchy human toxicological database allows for provisional assessment of their presence in drinking-water in form of five precautionary HRIVs. Selecting a HRIV, instead referring to a TTC or a virtually safe reference dose, just asks an expert judgment on the degree of formal completeness and informational potential of a new analyte's human toxicity database. Exceedance of a HRIV indicates need for supplementary toxicological data to improve assessment, their nature and comprehensiveness depending on degree and expected length of exceedance. The regulatory function of a HRIV is that of a placeholder for a possibly higher TTC-based surrogate HRGVTTC or a highest possible science-based HRGV.
From 1996/1997 to 2008/2009, blood and urine were sampled from 9- to 11-year-old pupils in the state of Baden-Württemberg, South-West Germany. In blood samples the chlororganics DDE, HCB, PCB-138, PCB-153 and PCB-180 were analysed by gas chromatography and ECD detection. PCDD/PCDF were measured in pooled blood samples using GC/MS. Lead concentrations in blood were quantified by graphite furnace atomic absorption spectrometry (AAS), mercury in urine by using cold vapour AAS. For all chlororganics and heavy metals a distinct decrease of the internal concentration could be shown within the 12-year investigation period. For DDE, the median decreased from 0.32 μg/l to 0.11 μg/l. The median of HCB fell from 0.19 μg/l to 0.07 μg/l. The median of the sum of the three PCB-congeners PCB-138, PCB-153 and PCB-180 decreased from 0.47 μg/l to 0.18 μg/l. The burden of PCDD/PCDF in pooled blood samples resulted in approximately half the concentration after the 12-year period. The internal concentrations of the chlororganics were distinctly higher in breastfed children than in non-breastfed children. In 2008/2009, these differences were strongest for PCB and DDE (2-fold), moderate for PCDD/PCDF (1.6-fold), and slight for HCB (1.2-fold). The median of lead concentrations in blood dropped from 23.6 μg/l to 15.9 μg/l. The median of mercury concentrations in urine decreased from 0.25 μg/l to a value below the limit of quantification of 0.2 μg/l; the 95th percentile was reduced from 3.1 μg/l to less than 0.2 μg/l. The decline of amalgam fillings in children during the investigation period had a strong influence on internal concentrations of mercury. The internal concentration of the persistent xenobiotics investigated here decreased to a low level not likely to be of concern for human health.
Farm workers seem to be at an increased risk of developing some cancers, notably in the brain. One of the hypotheses rose to explain such elevated risk is the intense exposure to pesticides.
To estimate the brain cancer mortality risk among agricultural workers exposed to pesticides in the State of Rio de Janeiro, Brazil.
A case-control study based on death certificates of males, 18 years or older, resident in the State Rio de Janeiro who died between 1996 and 2005. Cases (n=2040) were defined as individuals with brain cancer as the underlying cause of death. For each case two controls (n=4140) were randomly selected in the same database, matched for age group and region of residence. Besides the descriptive analysis, crude and adjusted odds ratios and mortality odds ratio (MOR) according to quartiles of potential exposure to pesticides, were calculated.
Agricultural workers showed higher brain cancer mortality risk estimates when compared with non-farm workers (aOR: 1.82, 95% CI 1.21-2.71). In addition, the magnitude of this association was higher among white patients, with higher education, and residence in an agricultural region.
This study suggests an association between agricultural work and brain cancer mortality in Rio de Janeiro state. It also suggests that pesticide exposure may play a role in such risk.
The environmental health surveillance system in the Federal State of Baden-Wuerttemberg (South Germany), among others, was implemented to monitor pollutant exposures and their temporal and regional trends in children at the age of about 10 years. The investigations were performed in two larger cities, one small city and one rural area. Between 1996 and 2003, in total 5470 children were investigated in consideration of environmental health parameters in four cross-sectional studies. The data presented here cover the results of the determination of the internal load with toxic metals. The median values observed in the investigation in 2002/03 were: 4.6 microg/l urine for arsenic, less than 0.2 microg/l urine for mercury, 20.7 microg/l blood for lead, and 0.25 microg/l blood for cadmium. From 1996 to 2003, mercury concentrations showed a substantial decrease (-0.027 microg/l/year) and lead levels also decreased (-0.25 microg/l/year), whereas arsenic and cadmium levels did not change significantly over time. There was no consistent difference in the mean internal load of the metals between the four investigation areas. Important factors influencing the measured concentrations were consumption of fish in the last 48 h, which had an impact on arsenic (factor 2), and amalgam fillings, which accounted for an increase in mercury (factor 4.6). In the 2002/03 study period, levels above the limit of health concern for children (German HBM values) were found in about 0.5% of the lead measurements (maximum value 180 microg/l blood) and in about 0.2% of the mercury measurements (maximum value 8.2 microg/l urine). In conclusion, this environmental health survey generates objective data on secular trends and regional differences and provides insight into probable sources of toxic metal exposure in children.
We investigated the cardiorespiratory health effects of smoke exposure from the 1997 Southeast Asian Forest Fires among persons who were hospitalized in the region of Kuching, Malaysia. We selected admissions to seven hospitals in the Kuching region from a database of all hospital admissions in the state of Sarawak during January 1, 1995 and December 31, 1998. For several cardiorespiratory disease classifications we used Holt-Winters time-series analyses to determine whether the total number of monthly hospitalizations during the forest fire period (August 1 to October 31, 1997), or post-fire period (November 1, 1997 to December 31, 1997) exceeded forecasted estimates established from a historical baseline period of January 1, 1995 to July 31, 1997. We also identified age-specific cohorts of persons whose members were admitted for specific cardiorespiratory problems during January 1 to July 31 of each year (1995--1997). We compared Kaplan-Meier survival curves of time to first readmission for the 1997 cohorts (exposed to the forest fire smoke) with the survival curves for the 1995 and 1996 cohorts (not exposed, pre-fire cohorts). The time-series analyses indicated that statistically significant fire-related increases were observed in respiratory hospitalizations, specifically those for chronic obstructive pulmonary disease (COPD) and asthma. The survival analyses indicated that persons over age 65 years with previous hospital admissions for any cause (chi2(1df) = 5.98, p = 0.015), any cardiorespiratory disease (chi2(1df) = 5.3, p = 0.02), any respiratory disease (chi2(1df) = 7.8, p = 0.005), or COPD (chi2(1df) = 3.9, p = 0.047), were significantly more likely to be rehospitalized during the follow-up period in 1997 than during the follow-up periods in the pre-fire years of 1995 or 1996. The survival functions of the exposed cohorts resumed similar trajectories to unexposed cohorts during the post-fire period of November 1, 1997 to December 31, 1998. Communities exposed to forest fire smoke during the Southeast Asian forest fires of 1997 experienced short-term increases in cardiorespiratory hospitalizations. When an air quality emergency is anticipated, persons over age 65 with histories of respiratory hospitalizations should be preidentified from existing hospitalization records and given priority access to interventions.
The exceptional flood of the river Odra in July/August 1997 caused severe damage, especially on the Polish side of the Odra valley. An additional 5 km3 of water were discharged during the flood. This represents about a third of the normal annual Odra discharge of 17 km3. Large agricultural and industrial areas were submerged, as well as towns and villages. However, as regards the Odra lagoon and the beaches of the Isle of Usedom, the substances transported, such as nutrients and pollutants, did not cause much damage, due to strong dilution. Hygienic investigations (human pathogenic bacteria and viruses) showed that the water had bathing quality during the whole flood.
The German Environmental Survey was conducted for the third time in 1998 (GerES III). The probability sample of about 4800 subjects was selected to be representative for the German population with regard to region (East-/West-Germany), community size, age (18 to 69 years) and gender. Blood samples were taken from each study participant and questionnaires were used to get exposure-related information. Cadmium, lead, mercury, hexachlorobenzene (HCB), hexachlorocyclohexane (alpha-HCH, beta-HCH, gamma-HCH), 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p, p'-DDE) and polychlorinated biphenyls (PCB-138, PCB-153, PCB-180) were analysed in whole blood to document the extent, distribution, and determinants of exposure of the general population to these substances. The geometric means of Cd, Pb, and Hg in blood amounted to 0.44, 31, and 0.58 microgram/l, respectively. Smokers showed a Cadmium level of 1.1 micrograms/l and non-smokers a level of 0.28 microgram/l. The geometric mean of lead was higher in the blood of males than of females (36 micrograms/l vs. 26 micrograms/l). The concentration of mercury in blood depends on fish consumption and the number of teeth with amalgam fillings. The mean concentrations of HCB and p, p'-DDE in blood were 0.44 microgram/l and 1.6 micrograms/l, respectively. In East-Germany (the former GDR) the DDE concentration in blood was more than twice as high as in West-Germany. Geometric means for PCB were 0.42, 0.68 and 0.44 microgram/l for PCB-138, PCB-153, and PCB-180, respectively. A marked increase of HCB, DDE and PCB levels with age could be observed. alpha-HCH and gamma-HCH could be detected in 1.7% and 5.2% of the samples only. beta-HCH was quantified in 34% of the samples with a 95th percentile of 0.5 microgram/l.
Even though increased environmental platinum levels were found since the introduction of automobile catalytic converters, little is known about the pathways of corporal uptake and the bioavailability of platinum in the general adult population. The aim of this study is to identify and quantify the main exposure pathways of gold and platinum in the general adult population.
The German Environmental Survey 1998 (GerES III) collected population-based data on the corporal gold and platinum burden from a large sample of 1080 persons, 18-69 years of age. Urinary metal concentration was analysed by SF-ICP-MS. Exposure data were assessed by standardized questionnaires. Data were log transformed and analysed using multiple linear regression analysis with respect to exposure variables.
The R2 of the linear regression model of urinary gold and platinum (ng/l) burden is 0.349 and 0.235, respectively. In both models, the number of teeth with noble metal dental alloy restorations (NMDAR) is the most important exposure pathway. One versus no tooth with NMDAR is associated with an increase of 23.7% in urinary gold and 35.6% in platinum concentration. Chewing gum intensifies the release of gold and platinum from NMDAR: every additional day per week when gum is chewed is associated with an increased gold (5.6%) and platinum (6.9%) burden. Furthermore, elevated urinary gold and platinum concentrations were found for higher creatinine concentrations, more frequent coffee consumption and for people from the upper social class. Gold burden is also increased in people with arthritis. Platinum burden is also increased in people living in western or northern Germany. Traffic-related variables had no significant effect on platinum burden.
The non-invasive, stable-isotope-aided Helicobacter pylori (H. pylori) tests--breath and equivalent urine tests--were offered on a voluntary basis as part of the mandatory school entry medical examination to the 1998 school entry cohort of the City of Leipzig (480,000 residents). Parents of participating subjects were asked to fill out a detailed epidemiologic questionnaire. The response rate was 94% (n = 2228 of 2369 school starters born in 1991/92). Parent-completed questionnaires were returned by 1890 (80%) children. The overall H. pylori positive prevalence was 7.2%. The prevalence among children with a test and a parent-completed questionnaire was 6.5%. Prevalences among subsequently tested family members of the positive tested children was 65, 60 and 39% for mothers, fathers and siblings respectively. Though studies have shown that the direct transmission of the bacterium (oral-oral and fecal-oral) is a dominant pathway of infection, the questionnaire analyses indicate associations between H. pylori colonisation and living as well as environmental conditions.
Because children exposed to lead have a very high health risk, surveillance and prevention programs are very important to avoid short- and long-term health effects.
To describe the trend for the blood lead levels over a 12-year period in environmentally exposed children and to document the actions implemented to reduce the blood lead levels.
We performed a retrospective cohort study of children aged 0-15 years who were enrolled in the Coahuila Health Secretary's Childhood Blood Lead Level Surveillance program. This database includes children from the city of Torreon, Coahuila, Mexico, where the biggest smelter in Latin America is located.
A total of 151,322 observations were analyzed in the study. The percentage of samples with elevated blood lead levels decreased from 84.9% to 10.4% during 1998-2010, and the decrease was greater in girls than in boys.
According to the results of our study, the majority of strategies and activities to decrease blood lead levels in an environmentally exposed population should be focused on children aged 0-5 years, on the home environment, on preventing fugitive emissions from smelters and other sources and on the proper disposal and confinement of industrial residues.
The fungicidal substance pentachlorophenol (PCP) had been used commonly for wood protection and leather impregnation in Germany until 1989, when this substance was prohibited by law. Hence, the body burden in the general population in Germany has been steadily declining. The reference values (95th percentiles) in blood plasma decreased from 20 micrograms PCP/l in 1991 to 12 micrograms/l in 1996. In 1998 the current exposure in a large residential population was investigated. 623 persons with an average age of 34.6 years (0-62 years) were investigated. For all of them there was neither evidence of occupational contact with PCP nor of the presence of PCP in the residential indoor environment. The mean PCP concentration in the plasma samples was 2.4 +/- 3.9 micrograms/l, the median 1.7 micrograms/l, and the 95th percentile 6.1 micrograms/l, the maximum value was 59.3 micrograms/l. In children and adolescents higher median and 95th percentiles were obtained than in adults (median 2.5 vs. 1.5 micrograms/l and 95th percentile 7.7 vs. 5.9 micrograms/l). All values above 20 micrograms/l were checked again individually: relationships with the level of PCP in household dust could not be detected. In one family leather clothing containing PCP, however, was found to be the cause of unusually high PCP values in the blood. Our investigations confirm a trend observed in recent years: exposure to PCP in the population in Germany decreases steadily and leads to an actualized reference value of 6.1 micrograms PCP/l plasma. In individual cases, however, greatly increased PCP levels in blood can still occur today, for example due to leather clothing treated with PCP.
The German Environmental Survey (GerES) is a cross-sectional probability study to determine the exposure of the general population to environmental contaminants. The study was repeated for the third time in 1998 (GerES III). Again, a stratified random procedure was used to select the study population taking into account the parameters gender, age, community size and place of residence (West- or East-Germany). A total of 4822 persons between 18 and 69 years of age from 120 localities participated in GerES III. Human biomonitoring comprised the determination of arsenic, cadmium, mercury, metabolites of polycyclic aromatic hydrocarbons (PAH), pentachlorophenol (PCP), other chlorophenols, precious metals (gold, platinum, iridium), nicotine, and cotinine in urine.
We describe the distribution and demographic characteristics of total blood Hg levels in the U.S. general population among persons ages 1 year and older who participated in the 2003-2006 National Health and Nutrition Examination Survey (NHANES). We also describe trends in the total blood Hg of children ages 1-5 (n=3456) and females ages 16-49 during 1999-2006 (n=7245). In the combined 2003-2006 survey periods, the geometric means for non-Hispanic blacks, 0.853microg/L (95% confidence interval [CI], 0.766-0.950microg/L), and non-Hispanic whites, 0.833microg/L (95% CI, 0.752-0.922microg/L), were higher than the geometric mean for Mexican Americans, 0.580microg/L (95% CI, 0.522-0.645microg/L). Also in 2003-2006, regression analysis of log total blood Hg with age, race/ethnicity and gender showed that total blood Hg levels in the population exhibited a quadratic increase with age (p<0.0001), peaking at ages 50-59 in non-Hispanic blacks and whites, at ages 40-49 in Mexican Americans, and then declining at older ages. Over the four survey periods (1999-2006), regression analysis showed that total blood Hg levels increased slightly for non-Hispanic white children and decreased slightly for non-Hispanic black and Mexican American children. Over the same four survey periods, female children had slightly higher total blood Hg levels than males (0.356 vs. 0.313microg/L, p=0.0050) and total blood Hg levels in non-Hispanic black women aged 16-49 years were significantly higher than in non-Hispanic white women (1.081 vs. 0.850microg/L, p<0.0001) and in Mexican American women (1.081 vs. 0.70microg/L, p<0.0001).
The effect of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) on spontaneous IgE production was studied in B cells from atopic patients with allergic rhinitis, atopic eczema/dermatitis syndrome or bronchial asthma, and from non-atopic subjects. TCDD enhanced spontaneous IgE production in B cells from atopic patients without affecting production of IgG1, IgG2, IgG3, IgG4, IgM, IgA1 and IgA2, while TCDD failed to induce IgE production in B cells from non-atopic subjects. Purified surface IgE+ (sIgE+) B cells from atopic patients spontaneously produced IgE, while surface IgE- (sIgE-) B cells failed to do so. TCDD enhanced spontaneous IgE production in sIgE+ B cells, while TCDD with or without IL-4 or anti-CD40 mAb failed to induce IgE production in sIgE-B cells. Collectively, TCDD selectively enhanced ongoing IgE production. These results suggest that TCDD may aggravate allergic diseases by enhancing IgE-mediated allergic responses.
The toxic potential of formaldehyde and other aliphatic/aromatic carbonyl compounds requires the determination of even low amounts of these compounds in indoor air. The existing DFG-method for workplace monitoring using adsorption at 2,4-dinitrophenylhydrazine (DNPH)-coated sorbents followed by HPLC-UV/DAD analysis of the extract was modified in order to decrease detection limits. The improvement included an increase in volume and rate of the air sampling, testing applicability of different adsorption materials and a decrease of the extraction volume of the hydrazones. 13 DNPH-derivatives could be separated well on a RP18-column followed by UV/DAD-detection at 365 nm. Recovery rates of 70-100% were determined (apart from acetone with 19%) using dynamically produced artifical carbonyl atmospheres. Detection limits of 0.05-0.4 microgram/m3 were reached by this method which are sufficient for indoor air monitoring.
The purpose of this study was to observe the erythropoietic changes in rats subchronically exposed to radiofrequency microwave (RF/MW) irradiation at nonthermal level. Adult male Wistar rats (N=40) were exposed to 2.45 GHz continuous RF/MW fields for 2 hours daily, 7 days a week, at 5-10 mW/cm2. Exposed animals were divided into four subgroups (n=10 animals in each subgroup) in order to be irradiated for 2, 8, 15 and 30 days. Animals were sacrified on the final irradiation day of each treated subgroup. Unexposed rats were used as control (N=24). Six animals were included into the each control subgroup. Bone marrow smears were examined to determine absolute counts of anuclear cells and erythropoietic precursor cells. The absolute erythrocyte count, haemoglobin and haematocrit values were observed in the peripheral blood by an automatic cell counter. The bone marrow cytogenetic analysis was accomplished by micronucleus (MN) tests. In the exposed animals erythrocyte count, haemoglobin and haematocrit were increased in peripheral blood on irradiation days 8 and 15. Concurrently, anuclear cells and erythropoietic precursor cells were significantly decreased (p < 0.05) in the bone marrow on day 15, but micronucleated cells' frequency was increased. In the applied experimental condition, RF/MW radiation might cause disturbance in red cell maturation and proliferation, and induce micronucleus formation in erythropoietic cells.
Nowadays, coal workers' pneumoconiosis (CWP) is still believed to be the main occupational disease in China. However, information on the exact prevalence of the disease is not available. Therefore, the aims of our investigation were to provide the missing information in China by conducting a systematic evaluation of published data from 2001 to 2011 and to compare the prevalence of CWP with those in other countries. Published reports about the prevalence of CWP were searched from PudMed(®) (English language databases), Foreign Medical Journal Full-Text Service Database (FMJS, English language databases), Chinese Journal Full-Text Database (CJFD, Chinese language databases), Chongqing VIP Chinese Science and Technology Journals Database (VIP, Chinese language databases), Chinese Biomedical Literature Database (CBM, Chinese language databases) and Chinese Medical Association Journals Database (CMAJ, Chinese language databases). The quality of identified reports was strictly evaluated using predetermined inclusion and exclusion criteria. Based on these criteria, 11 reports were selected. Then, the content of these reports were reviewed and the needed information was extracted. Meta-analysis was performed on the extracted data. The R2.15.1 software was applied for statistical analysis. The total populations from these reports were 173,646 and 10,821 for dust-exposed coal workers and patients with CWP, respectively. The pooled prevalence of CWP was 6.02% (95%CI: 3.43-9.26%) and the pooled rate of CWP patients combined with tuberculosis was 10.82% (95%CI: 8.26-13.66%). The prevalence was analyzed according to the geographic areas of the study, years of the investigation, duration of dust exposure, coal rank, stages of CWP, types of work and coal-mining categories, etc. Among them, the prevalence of CWP in locally owned mines (9.86%; 95%CI: 1.25-25.17%) was significantly higher than that of state-owned mines (4.83%; 95%CI: 2.35-8.13%) (P<0.05). Publication bias was assessed by the Egger's test which showed insignificant results (P>0.05). It was concluded that the prevalence of CWP were still high in China compared to UK (0.8%, during1998-2000) and USA (3.2% in 2000s). In addition, the conditions in locally owned mines had caused more CWP than that of state-owned mines. Our data clearly show that regulatory agencies in China need to step up their effort in implementing more rigorous policies to protect coal miners, especially those in locally owned mines.
Additional research on human exposures to hazardous substances in community settings and resultant adverse health effects is needed to fill an extensive number of information gaps. For example, information is needed to answer specific public health questions about the toxic effects of specific chemicals, who has been exposed, what the health risks might be, and what interventions are effective. The Agency for Toxic Substances and Disease Registry (ATSDR) is the principal federal agency responsible for addressing issues of public health concerning the human health risks associated with hazardous waste sites and unplanned releases of hazardous substances into the environment. Research is a critical component in how effectively the agency can identify persons exposed, determine health risks, and intervene to reduce exposures and adverse health outcomes. ATSDR has recently developed an agenda for public health environmental research for 2002-2010, divided into the following six research focus areas: exposure assessment; chemical mixtures; susceptible populations; community and tribal involvement; evaluation and surveillance of health effects; and health promotion and intervention. This article discusses the agenda's development, the research issues within each of the six focus areas, and preliminary implementation plans.
Some fragrance compounds are severe contact allergens. According to the so-called "26 allergens rule" (Article 1 (10) of Directive 2003/15/EC) (EC, 2003), 26 supposedly allergenic fragrances must be listed on the containers of cosmetics products if they are present above certain mass percentages in the product. This declaration is meant to inform the consumer of potential risks of skin sensitizers in the products.
The objective of this paper is to validate whether "the 26 allergens rule" meets the expectations to improve consumer protection.
The method used for this validation was on one hand a reflection on the elements of the approach used in "the 26 allergens rule" and on the other hand a product analysis of 742 products by 4 large producers of cosmetic products on the German market.
It was found that more than 50% of these cosmetic and washing and cleansing products contain at least one of the 26 substances above the thresholds for labelling and that there are 14% of all products which contain strong allergens. Many consumers apparently still buy these products. The indirect effect that producers reduce the amounts of these fragrances to avoid declaration seems to be small.
Several arguments were assembled which show that other instruments are needed to ensure consumer protection or protection of the environment. This paper recommends different approaches. The use of a list of single substances in such a directive is not in line with scientific standards. It is recommended to base decision making on comprehensive risk assessments or at least on valid and strong criteria. More parameters need to be involved, not only contact allergy. As illustrated in this article, the roles taken over by authorities and manufacturers in risk management of the "26 allergens" are relatively small compared with the responsibility carried by consumers. However, consumers are only able to take over their part properly if they are sufficiently trained and have the necessary infrastructure, capability and time to inform themselves. Regulations are not effective if they load the major responsibility for risk management on consumers, instead of on authorities and manufacturers. A successful risk management would include bans and restrictions of especially hazardous substances issued by governments, as well as efficient surveys to control the implementation of regulations by the responsible authorities. It would also include that producers meet the legal standards and take over voluntary action to make products safer. The evaluation of "the 26 allergens rule" is an example which can be transferred to other regulations and which could help to improve future regulatory approaches, with a focus on the roles authorities, manufacturers and consumers play in a promising risk management.
Based on the representative data collection of the German Environmental Survey on Children 2003-2006 (GerES IV) the Human Biomonitoring Commission of the German Federal Environment Agency has updated the reference values for a comprehensive number of environmental pollutants in blood and urine of children in Germany. Reference values are statistically derived values that indicate the upper margin of background exposure to a given pollutant in a given population at a given time. They can be used as criteria to classify the measured values of individuals or population groups as being "elevated" or "not elevated". Since environmental conditions are changing, reference values are continuously checked and updated if new information becomes available. Therefore, the previously derived reference values for metabolites of pyrethroids (cis-, trans-Cl(2)Ca and 3-PBA: 1, 2, and 2microg/l), of PAH (1-hydroxypyrene: 0.5microg/l), for arsenic in urine (15microg/l), and for PCB 138, PCB 153, PCB 180 in whole blood (0.3, 0.4, 0.3microg/l) and for DDE (western Germany) in whole blood (0.7microg/l) were confirmed. The following reference values were lowered: lead in blood from 50 to 35microg/l, cadmium in urine from 0.5 to 0.2microg/l, mercury in whole blood from 1.0 to 0.8microg/l, mercury in urine from 0.7 to 0.4microg/l, beta-HCH in whole blood from 0.3 to 0.1microg/l, HCB in whole blood from 0.3 to 0.2microg/l, and DMP in urine from 135 to 75microg/l, and DMTP in urine from 160 to 100microg/l. Based on the extended data set of the GerES IV, the reference value for the sum of PCB 138+153+180 in whole blood of children aged 7 to 14 was raised from 0.9 to 1.0microg/l. The reference value for DEP in urine of children aged 3 to 14 was raised from 16 to 30microg/l. New reference values in urine of children aged 3 to 14 living in Germany were derived for antimony (0.3microg/l), nickel (4.5microg/l), thallium (0.6microg/l), uranium (0.04microg/l), metabolites of organophosphorous compounds (DMDTP, DETP: 10microg/l, 10microg/l) and metabolites of PAH (1-hydroxyphenanthrene: 0.6microg/l; 2/9-hydroxyphenanthrene: 0.4microg/l; 3-hydroxyphenanthrene: 0.5microg/l; 4-hydroxyphenanthrene: 0.2microg/l; Sigma hydroxyphenanthrene (1, 2/9, 3, 4): 1.5microg/l) in urine and for DDE in blood of children aged 7 to 14 years living in eastern Germany (1.4microg/l). If reliable and repeated measurements show a value above the reference value, an environmental hygiene-based search for the causes and sources of this exposure is recommended. After that, it should be checked whether the exposure can be decreased within reasonable bounds.
Contribution of diet and selected risk factors to the levels of four polyfluorinated compounds was evaluated. Data from National Health and Nutrition Examination Survey for the years 2003-2008 were used. Dietary factors accounted for 10.4% to 21.2% of the explained variation. Amount of milk consumed was found to be positively associated (p<0.01) with perfluorononanoic acid (PFNA) but negatively associated with perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) (p<0.01). Amount of meat and fish consumed was positively associated (p<0.01) with PFNA and PFOS. Amount of non-alcoholic beverages consumed was positively associated (p<0.01) with PFNA and PFOA. Levels of PFOS increased (p<0.01) with increase in the amount of alcoholic beverages consumed. Total amount of alcohol consumed was positively associated (p<0.01) with PFNA. Levels of both PFOA and PFOS decreased with increase in total amount of caffeine consumed. Total amount of fat consumed was negatively associated with PFNA and positively associated with PFOS. Total calories consumed were negatively associated with perfluorohexane sulfonate (PFHxS) and PFOS but positively associated with PFNA. New to this study, positive correlations (p<0.01) between serum cholesterol and PFNA, PFOA, and PFOS were found. Serum albumin levels were negatively correlated with PFHxS but positively correlated with PFOA and PFOS. Males had statistically significantly higher levels of all four PFCs as compared to females and Mexican Americans had the lowest levels of all four PFCs than other race/ethnic groups. Levels of all four PFCs increased with increase in family income. Body mass index was negatively correlated with PFNA but positively associated with PFOA. There was a statistically significant decrease in the levels of PFOS over survey years 2003-2008.
Biomonitoring studies show that humans carry a body burden of multiple classes of contaminants which are not often studied together. Many of these chemicals may be hepatotoxic. We used the 2003-2004 National Health and Nutrition Examination Survey to evaluate the relationship between alanine aminotransferase (ALT) and 37 environmental contaminants, comprising heavy metals, non-dioxin-like polychlorinated biphenyls (PCBs), and dioxin-like compounds, using a novel method. Linear regression models were constructed for each chemical separately, then as a class, using quartiles to represent exposure and adjusting for age, sex, race, income, and BMI. We then used an optimization approach to compile a weighted sum of the quartile scores, both within and across chemical classes. Using the optimization approach to construct weighted quartile scores, the dioxin like PCB, the non-dioxin like PCB and metal class-level scores were significantly associated with elevated ALT. A significant interaction was detected between the class-level score for metals, and the score for non-dioxin-like PCBs. When including all chemicals in one model, 3 chemicals accounted for 78% of the weight (mercury, PCB 180, 3,3',4,4',5-PNCB) with the remaining 22% associated with 4 chemicals (a dioxin and 3 PCBs). Validation with a holdout dataset indicated that the weighted quartile sum estimator efficiently identifies reproducible significant associations.