Ulrich Ranft’s research while affiliated with Leibniz Research Institute for Environmental Medicine and other places

Air pollution has been associated with impaired lung and cognitive function, especially impairment in visuo-construction performance (VCP). In this article, we evaluate whether the effect of air pollution on VCP is mediated by lung function. We used data from the SALIA cohort (baseline 1985–1994 and follow-up 2007–2010) including 587 women aged 55 years at baseline. Particulate matter (PM) and nitrogen dioxide (NO 2 ) exposures at baseline were estimated via land-use regression models. Lung function was characterised by averages between baseline and follow-up. We used age- and height-controlled Global Lung Initiative (GLI) z-scores of forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC) and FEV 1 /FVC. VCP was assessed at follow-up with the CERAD-Plus neuropsychological test battery and causal mediation analysis was conducted. An increase of one interquartile range in FEV 1 and FVC was positively associated with VCP (β=0.18 (95% CI 0.02–0.34) and β=0.23 (95% CI 0.07–0.39), respectively). The proportion of the association between NO 2 on VCP mediated by FEV 1 was 6.2% and this was higher in never smokers (7.2%) and non-carriers of the APOE-ε4 allele (11.2%). However, none of the mediations were statistically significant. In conclusion, air pollution associated VCP was partially mediated by lung function. Further studies on the mechanisms underlying this pathway are required to develop new strategies to prevent air pollution induced cognitive impairment.

Aim Mutual Health Organizations (MHOs) can be a potential means to reduce barriers to health care in low-income countries with poor access to health care and high health care costs for the population. One important challenge is the relationship between MHOs and health care professionals (HCPs). Our study evaluates HCPs experiences of, and attitudes towards MHOs. Subjects and Methods A total of 210 HCPs from three private and two public clinics in Kumbo and Bamenda (Cameroon) were interviewed with a structured questionnaire, where answers are quantified by a five-point ordinal scale. Results We identified regional and institutional differences. HCPs in Kumbo and in private clinics tend to have a more positive attitude towards MHOs than in Bamenda and in public clinics (mean 1.66 vs. 2.02, respectively 1.72 vs. 2.05,). HCPs in Bamenda and in public clinics report more negative experiences with MHO members (mean 2.86 vs. 3.67, respectively 2.72 vs. 3.56) and rank quality of health care lower. Conclusion Our findings underline the important role of HCPs in the context of MHOs; therefore, programs should aim to involve HCPs in respect of regional and institutional differences.

Background. Epidemiological studies have shown effects of long-term exposure to air pollution on cardiovascular and respiratory health. However, studies investigating the effects of air pollution on cognition and brain function are limited. We investigated if neurocognitive functions are associated with air pollution exposure and whether apolipoprotein E (ApoE) alleles modify the association of air pollution exposure with cognition. Methods. We investigated 789 women from the SALIA cohort during the 22-year follow-up examination (2008-2009). Exposure to particulate matter (PM) size fractions and nitrogen oxides (NOx) were assigned to home addresses. Traffic indicators were used to assess residential proximity to high traffic load. Level of cognitive performance was assessed using the CERAD-Plus test. Air pollution effects on cognitive functioning were estimated using adjusted linear regression models. Results. Air pollution was negatively associated with cognitive function and cognitive performance in the subtests for semantic memory and visuoconstruction. Significant associations could be observed for figure copying with an interquartile range increase of NO2 (β=-0.28 (95%CI:-0.44;-0.12)), NOx (β=-0.25 (95%CI:-0.40;-0.09)), PM10 (β=-0.14 (95%CI:-0.26;-0.02)) and PM2.5 (β=-0.19 (95%CI:-0.36;-0.02)). The association with traffic load was significant in carriers of one or two ApoE ɛ4 risk alleles. Conclusion. In this study of elderly women, markers of air pollution were associated with cognitive impairment in the visuospatial domain. The association of traffic exposure is significant in participants carrying the ApoE ε4 risk allele.

Infant exposure to persistent organic pollutants (POPs) may contribute to obesity. However, many studies so far have been small, focused on transplacental exposure, used an inappropriate measure to assess postnatal exposure through breastfeeding if any, or did not discern between prenatal and postnatal effects. We pooled data from 7 European birth cohorts with biomarker concentrations of polychlorinated biphenyl 153 (PCB-153) (n=2487), and p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) (n=1864), estimating prenatal and postnatal POPs exposure using a validated pharmacokinetic model. Growth was change in weight-for-age z-score between birth and 24 months. Per compound, multi-level models were fitted with either POPs total exposure from conception to 24 months, prenatal or postnatal exposure. We found a significant increase in growth associated with p,p'-DDE, seemingly due to prenatal exposure (per interquartile increase in exposure, adjusted β=0.12; 95% CI: 0.03, 0.22). Due to heterogeneity across cohorts, this estimate cannot be considered precise, but does indicate that an association with infant growth is present on average. In contrast, a significant decrease in growth was associated with postnatal PCB-153 exposure (β=-0.10; 95% CI: -0.19, -0.01). To our knowledge, this is the largest study to date of POPs exposure and infant growth, and with state of the art exposure modelling. Prenatal p,p'-DDE was associated with increased infant growth, and postnatal PCB-153 with decreased growth at European exposure levels.

Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and polychlorinated biphenyls (PCBs) are persistent organic pollutants (POPs) that have been characterized as endocrine disrupting chemicals (EDCs). Within the Duisburg birth cohort study we studied associations of prenatal exposure to PCDD/Fs and PCBs with parent-reported sexually dimorphic behavior in children. We measured lipid-based and WHO2005-TEq-standardized PCDD/Fs and PCBs in maternal blood samples and in early breast milk using gas chromatography/high-resolution mass-spectrometry (GC/HRMS). At the age of 6 - 8 years parents (mostly mothers) reported sex-typical characteristics, preferred toys and play activities using the Preschool Activities Inventory (PSAI) which was used to derive feminine, masculine and difference (feminine - masculine) scores. We estimated exposure-outcome associations using multivariate linear regression. Between 91 and 109 children were included in this follow-up. Mean blood levels of WHO2005-TEq-standardized dioxins (Σ PCDD/Fs) were 14.5 ± 6.4 pg/g blood lipids, and of Σ PCBs 6.9 ± 3.8 pg/g blood lipids, with similar values for milk lipids. Regression analyses revealed some highly significant interactions between sex and exposure, e.g. for Σ PCBs in milk, pronounced positive (boys: β = 3.24; CI = 1.35, 5.14) or negative (girls: β = -3.59; CI = -1.10, -6.08) associations with reported femininity. Less pronounced and mostly insignificant but consistent associations were found for the masculinity score, positive for boys and negative for girls. Based on our results and the findings of previous studies, we conclude that there is sufficient evidence that EDCs modify behavioral sexual dimorphism in children, presumably by interacting with the hypothalamic-pituitary-gonadal (HPG) axis.

In 1999–2000 an epidemiological study was carried out to investigate arsenic exposure and risk of non-melanoma skin cancer in the population around a power station in Slovakia. As part of the exposure assessment for that study, markers of physiological exposure to arsenic (urinary arsenic and nail arsenic) and measures of environmental arsenic were taken. Residential history and arsenic emissions were combined in a measure used to classify the study population’s exposure. Here, we take a model designed to estimate the daily arsenic absorption and urinary arsenic excretion developed by the US EPA and compare its output to the values for measured urinary arsenic, measured environmental arsenic and modelled food arsenic used in the previous study. We found that the US EPA model underestimated arsenic exposure in this population. Potential misclassification compared to the exposure used previously was also quantified, with poor agreement between a measured biomarker of current arsenic exposure and modelled estimates of arsenic uptake and excretion.

Exposure to high concentrations of persistent organochlorines may cause fetal toxicity, but the evidence at low exposure levels is limited. Large studies with substantial exposure contrasts and appropriate exposure assessment are warranted. Within the framework of the EU (European Union) ENRIECO (ENvironmental Health RIsks in European Birth Cohorts) and EU OBELIX (OBesogenic Endocrine disrupting chemicals: LInking prenatal eXposure to the development of obesity later in life) projects, we examined the hypothesis that the combination of polychlorinated biphenyls (PCBs) and dichlorodiphenyldichloroethylene (DDE) adversely affects birth weight. We used maternal and cord blood and breast milk samples of 7,990 women enrolled in 15 study populations from 12 European birth cohorts from 1990 through 2008. Using identical variable definitions, we performed for each cohort linear regression of birth weight on estimates of cord serum concentration of PCB-153 and p,p´-DDE adjusted for gestational age and a priori selected covariates. We obtained summary estimates by meta-analysis and performed analyses of interactions. The median concentration of cord serum PCB-153 was 140 ng/L (range of cohort medians 20-484 ng/L) and that of p,p´-DDE was 528 ng/L (range of cohort medians 50-1,208 ng/L). Birth weight decreased with increasing cord serum concentration of PCB-153 after adjustment for potential confounders in 12 of 15 study populations. The meta-analysis including all cohorts indicated a birth weight decline of 150 g [95% confidence interval (CI): -250, -50 g] per 1-µg/L increase in PCB-153, an exposure contrast that is close to the range of exposures across the cohorts. A 1-µg/L increase in p,p´-DDE was associated with a 7-g decrease in birth weight (95% CI: -18, 4 g). The findings suggest that low-level exposure to PCB (or correlated exposures) impairs fetal growth, but that exposure to p,p´-DDE does not. The study adds to mounting evidence that low-level exposure to PCBs is inversely associated with fetal growth.

Background: Combined data analyses of birth cohorts can overcome the fragmentation of individual and inconclusive results obtained by analyses based upon single cohorts only. The European project Environmental Health Risks in European Birth Cohorts (ENRIECO) undertook four combined studies to evaluate the concept of added scientific value through harmonisation and exchange of birth cohort data for common analyses on environmental health risks.

Residual tumor resection (RTR) after chemotherapy in patients with advanced germ cell tumors (GCT) is an important part of the multimodal treatment. To provide a complete resection of residual tumor, additional surgical procedures are sometimes necessary. In particular, additional vascular interventions are high-risk procedures that require multidisciplinary planning and adequate resources to optimize outcome. The aim was to identify parameters that predict additional vascular procedures during RTR in GCT patients. A retrospective analysis was performed in 402 GCT patients who underwent 414 RTRs in 9 German Testicular Cancer Study Group (GTCSG) centers. Overall, 339 of 414 RTRs were evaluable with complete perioperative data sets. The RTR database was queried for additional vascular procedures (inferior vena cava [IVC] interventions, aortic prosthesis) and correlated to International Germ Cell Cancer Collaborative Group (IGCCCG) classification and residual tumor volume. In 40 RTRs, major vascular procedures (23 IVC resections with or without prosthesis, 11 partial IVC resections, and 6 aortic prostheses) were performed. In univariate analysis, the necessity of IVC intervention was significantly correlated with IGCCCG (14.1% intermediate/poor vs 4.8% good; p=0.0047) and residual tumor size (3.7% size < 5 cm vs 17.9% size ≥ 5 cm; p < 0.0001). In multivariate analysis, IVC intervention was significantly associated with residual tumor size ≥ 5 cm (odds ratio [OR]: 4.61; p=0.0007). In a predictive model combining residual tumor size and IGCCCG classification, every fifth patient (20.4%) with a residual tumor size ≥ 5 cm and intermediate or poor prognosis needed an IVC intervention during RTR. The need for an aortic prosthesis showed no correlation to either IGCCCG (p=0.1811) or tumor size (p=0.0651). The necessity for IVC intervention during RTR is correlated to residual tumor size and initial IGCCCG classification. Patients with high-volume residual tumors and intermediate or poor risk features must initially be identified as high-risk patients for vascular procedures and therefore should be referred to specialized surgical centers with the ad hoc possibility of vascular interventions.