Respiratory effects of sulphur dioxide: a hierarchical multicity analysis in the APHEA 2 study

Aims: To assess the association between daily levels of SO₂ and daily levels of respiratory admissions in a larger and more recent study.

Methods: Time series of daily counts of hospital emergency admissions were constructed for asthma at ages 0–14 years and 15–64 years, COPD and asthma, and all respiratory admissions at ages 65+ years in the cities of Birmingham, London, Milan, Paris, Rome, Stockholm, and in the Netherlands for periods of varying duration between the years 1988 and 1997. A two stage hierarchical modelling approach was used. In the first stage generalised additive Poisson regression models were fitted in each city controlling for weather and season. These results were then combined across cities in a second stage ecological regression that looked at potential effect modifiers.

Results: For an increase of 10 µg/m³ of SO₂ the daily number of admissions for asthma in children increased 1.3% (95% CI 0.4% to 2.2%). Effect modification among cities by levels of other air pollutants or temperature was not found. The SO₂ effect disappeared after controlling for PM₁₀ or CO, but correlation among these pollutants was very high. Other respiratory admissions were not associated with SO₂.

Conclusion: SO₂ is associated with asthma admissions in children, indicating that reduction in current air pollution levels could lead to a decrease in the number of asthma admissions in children in Europe.

     

Childhood illness in households using biomass fuels in India: secondary data analysis of nationally representative national family health surveys

Abstract

Background: Half of the world’s population uses solid fuels for energy and cooking, resulting in 1·5 million deaths annually, approximately one-third of which occur in India. Most deaths are linked to childhood pneumonia or acute lower respiratory tract infection (ALRI), conditions that are difficult to diagnose. The overall effect of biomass combustion on childhood illness is unclear.

Objectives: To evaluate whether type of household fuel is associated with symptoms of ALRI (cough and difficulty breathing), diarrhea or fever in children aged 0–36 months.

Methods: We analyzed nationally representative samples of households with children aged 0–36 months from three national family health surveys conducted between 1992 and 2006 in India. Households were categorized as using low (liquid petroleum gas/electricity), medium (coal/kerosene) or high polluting fuel (predominantly wood/agricultural waste). Odds ratios adjusted for confounders for exposure to high and medium polluting fuel were compared with low polluting fuel (LPF).

Results: Use of high polluting fuel (HPF) in India changed minimally (82 to 78 %), although LPF use increased from 8% to 18%. HPF was consistently associated with ALRI [adjusted odds ratio (95% confidence interval) 1·48 (1·08–2·03) in 1992–3; 1·54 (1·33–1·77) in 1998–9; and 1·53 (1·21–1·93) in 2005–6). Fever was associated with HPF in the first two surveys but not in the third survey. Diarrhea was not consistently associated with HPF.

Conclusions: There is an urgent need to increase the use of LPF or equivalent clean household fuel to reduce the burden of childhood illness associated with IAP in India.     

Trawler fuel exhaust and respiratory impairments: a cross-sectional pilot study among Indian fishermen working in informal sectors

Abstract

Background:

An estimated half a billion people are engaged in fishing related occupations in India. Exposure to adulterated fuel exhaust is common among deep-sea fishermen, yet little is known about the potential impacts on the exposure to health.

Objective:

The aim of this study was to investigate whether fuel emission exposure was associated with increased respiratory impairments among fishermen who were occupationally exposed to fuel exhaust compared to fisherman occupationally unexposed to fuel exhaust.

Methods:

This cross-sectional study compared the prevalence of respiratory symptoms and lung function variables between 152 marine-water and 107 fresh water fishermen considering the use of fuel-driven trawlers. Data were obtained from questionnaires and computerized spirometer.

Results:

Fishermen exposed to trawler fuel exhaust reported more than double the number of respiratory symptoms compared to the unexposed fisherman (86·2 vs. 40·2%). They also had a significantly higher chance experiencing chronic cough (adjusted OR?=?3·51, 95% confidence interval (CI)?=?2·09–6·35), chronic phlegm (8·61, 4·76–15·97), and wheezing (4·29, 2·55–7·61) symptoms. Finally, there was a significant reduction of the ratio of mid portion of forced expiratory flow rate and forced vital capacity (FEF_25–75/FVC) in the exposed fishermen compared to the unexposed (0·84 vs. 0·73 second^?1, P?=?0·015).

Conclusion:

Fuel exhaust may negatively impact on the respiratory health of Indian fishermen. More attention and surveillance of occupational health for fishermen in India is needed.     

A follow-up of cancer incidence among former Finnish dump site residents: 1999–2011

Abstract

Background:

In an analysis of the years 1976–1998, a 50% excess in cancer incidence was observed among residents in twelve blockhouses in Helsinki, Finland on a former dump area containing industrial and household waste.

Objective:

To assess cancer risk over a 13-year period 1999–2011 among residents formerly living in houses built on a dump area.

Methods:

All 1879 persons who ever lived in the former dump area were identified and the number of cancer cases in this population was obtained from the Finnish Cancer Registry.

Results:

After 5 years of residence at the dump site, the standardized incidence ratio of cancer (all sites combined) was 1·32 (95% CI: 0·94–1·79) in men and 0·53 (95% CI: 0·33–0·82) for women, in comparison with the general Helsinki population (1999–2011). No significant excess cancer risks were found.

Conclusions:

Residing on a former dump area was not found to result in an increased risk of cancer.     

Health risk assessment of zinc,chromium, and nickel from cow meat consumption in an urban Nigerian population

Abstract

Background:

Meat consumption is increasingly becoming a larger part of diets worldwide. However, the bioaccumulation of toxic metals from anthropogenic pollution is a potential health risk to human health.

Objective:

To measure the daily intake of zinc, chromium, and nickel from cow meat consumption and assess the possible health risks in an urban population in Nigeria.

Methods:

Dried meat samples were digested with 3 : 2HNO3 : HClO4 v/v. Zinc, chromium, and nickel concentrations were determined with atomic absorption spectrophotometer. Daily intakes of meat were obtained using a food frequency questionnaire (FFQ).

Results:

The estimated daily intakes (EDI) (μg/person/day) ranges were: zinc (10?496–13?459), chromium (310·90–393·73), and nickel (26·72–34·87). Estimated daily intake for zinc was 15–30% of provisional maximum tolerable daily intake (PMTDI) and for nickel it was 8–15% of tolerable daily intake (TDI).

Conclusion:

Chromium intakes were above recommended daily intake (RDI). Target hazard quotient (THQ) for nickel and zinc were within WHO/FAO limit. There was no evidence of possible health risk to consumers with regard to zinc and nickel. However, chromium intake should be of utmost concern, while disposal of tanning waste should be checked.     

China and the US: asbestos in common

Abstract

Background: Gender inequalities in the exposure to work-related psychosocial hazards are well established. However, little is known about how welfare state regimes influence these inequalities.

Objectives: To examine the relationship between welfare state regimes and gender inequalities in the exposure to work-related psychosocial hazards in Europe, considering occupational social class.

Methods: We used a sample of 27,?465 workers from 28 European countries. Dependent variables were high strain, iso-strain, and effort-reward imbalance, and the independent was gender. We calculated the prevalence and prevalence ratio separately for each welfare state regime and occupational social class, using multivariate logistic regression models.

Results: More female than male managers/professionals were exposed to: high strain, iso-strain, and effort–reward imbalance in Scandinavian [adjusted prevalence ratio (aPR)?=?2·26; 95% confidence interval (95% CI): 1·87–2·75; 2·12: 1·72–2·61; 1·41: 1·15–1·74; respectively] and Continental regimes (1·43: 1·23–1·54; 1·51: 1·23–1·84; 1·40: 1·17–1·67); and to high strain and iso-strain in Anglo-Saxon (1·92: 1·40–2·63; 1·85: 1·30–2·64; respectively), Southern (1·43: 1·14–1·79; 1·60: 1·18–2·18), and Eastern regimes (1·56: 1·35–1·81; 1·53: 1·28–1·83).

Conclusion: Gender inequalities in the exposure to work-related psychosocial hazards were not lower in those welfare state regimes with higher levels of universal social protection policies.     

The impact of daily temperature on renal disease incidence: an ecological study

Background

Extremely high temperatures over many consecutive days have been linked to an increase in renal disease in several cities. This is becoming increasingly relevant with heatwaves becoming longer, more intense, and more frequent with climate change. This study aimed to extend the known relationship between daily temperature and kidney disease to include the incidence of eight temperature-prone specific renal disease categories – total renal disease, urolithiasis, renal failure, acute kidney injury (AKI), chronic kidney disease (CKD), urinary tract infections (UTIs), lower urinary tract infections (LUTIs) and pyelonephritis.

Methods

Daily data was acquired for maximum, minimum and average temperature over the period of 1 July 2003 to 31 March 2014 during the warm season (October to March) in Adelaide, South Australia. Data for daily admissions to all metropolitan hospitals for renal disease, including 83,519 emergency department admissions and 42,957 inpatient admissions, was also obtained. Renal outcomes were analyzed using time-stratified negative binomial regression models, with the results aggregated by day. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated for associations between the number of admissions and daily temperature.

Results

Increases in daily temperature per 1 °C were associated with an increased incidence for all renal disease categories except for pyelonephritis. Minimum temperature was associated with the greatest increase in renal disease followed by average temperature and then maximum temperature. A 1°C increase in daily minimum temperature was associated with an increase in daily emergency department admissions for AKI (IRR 1.037, 95% CI: 1.026–1.048), renal failure (IRR 1.030, 95% CI: 1.022–1.039), CKD (IRR 1.017, 95% CI: 1.001–1.033) urolithiasis (IRR 1.015, 95% CI: 1.010–1.020), total renal disease (IRR 1.009, 95% CI: 1.006–1.011), UTIs (IRR 1.004, 95% CI: 1.000–1.007) and LUTIs (IRR 1.003, 95% CI: 1.000–1.006).

Conclusions

An increased frequency of renal disease, including urolithiasis, acute kidney injury and urinary tract infections, is predicted with increasing temperatures from climate change. These results have clinical and public health implications for the management of renal diseases and demand tailored health services. Future research is warranted to analyze individual renal diseases with more comprehensive information regarding renal risk factors, and studies examining mortality for specific renal diseases.

     

The impact of childhood pneumococcal conjugate vaccine immunisation on all-cause pneumonia admissions in Hong Kong: A 14-year population-based interrupted time series analysis

BackgroundNine years after the introduction of pneumococcal conjugate vaccine (PCV) in the United States, Hong Kong (HK) introduced the vaccine to its universal childhood immunisation programme in 2009. We aimed to assess the impact of childhood PCV immunisation on all-cause pneumonia (ACP) admissions among the overall population of HK.MethodsIn this population-based interrupted time series analysis, we used territory-wide population-representative electronic health records in HK to evaluate the vaccine impact. We identified hospitalised patients with a diagnosis of pneumonia from any cause between 2004 and 2017. We applied segmented Poisson regression to assess the gradual change in the monthly incidence of ACP admissions between pre- and post-vaccination periods. Negative outcome control, subgroup and sensitivity analyses were used to test the robustness of the main analysis.FindingsOver the 14-year study period, a total of 587,607 ACP episodes were identified among 357,950 patients. The monthly age-standardised incidence of ACP fluctuated between 33.42 and 87.44 per 100,000-persons. There was a marginal decreasing trend in pneumonia admissions after PCV introduction among overall population (incidence rate ratio [IRR]: 0·9965, 95% confidence interval [CI]: 0·9932–0·9998), and older adults (≥65 years, IRR: 0·9928, 95% CI: 0·9904–0·9953) but not in younger age groups.InterpretationThere was a marginally declining trend of overall ACP admissions in HK up to eight years after childhood PCV introduction. The significance disappeared when fitting sensitivity analyses. The results indicate the complexities of using non-specific endpoints for measuring vaccine effect and the necessity of enhancing serotype surveillance systems for replacement monitoring.FundingHealth and Medical Research Fund, Food and Health Bureau of the Government of Hong Kong (Reference number: 18171272).     

The coffee paradox in stroke: Increased consumption linked with fewer strokes

Objective: To determine the association in amount of daily coffee consumption with incidence of stroke in a broad cohort, considering other vascular risk factors.

Methods: We utilized the Third National Health and Nutrition Examination Survey (1988–1994; NHANES III) data on participants aged ≥17 years old to examine coffee consumption and stroke. Multivariate logistic regression models related the amount of coffee use reported in a food frequency questionnaire with stroke, controlling for other vascular risk factors.

Results: Of 33?994 NHANES III subjects, coffee consumption and stroke data in adults ≥17 years old were available in 19?994. Daily coffee consumption ranged from 0 to 20 (median 1) cups and 644 (3.2%) participants had a stroke diagnosed by a physician. Coffee intake varied with age, gender, and ethnicity (P?<?0.001). Interestingly, heart failure, diabetes, and hypertension were less frequent, and high cholesterol more frequent in those consuming ≥3 cups per day (P?<?0.001). Smoking was more frequent in all coffee drinkers (P?<?0.0001). Multivariate analyses revealed an independent effect of heavier coffee consumption (≥3 cups/day) on reduced stroke (OR 0.44, 95% CI 0.22–0.87, P?<?0.02) in healthy subjects that was attenuated by vascular risk factors (OR 0.78, 95% CI 0.58–1.07, P?≈?0.12).

Conclusion: Heavier daily coffee consumption is associated with decreased stroke prevalence, despite smoking tendency in heavy coffee drinkers.     

Workplace injuries and risk reduction practices in Malaysia

Abstract

Introduction:

This study on workplace injuries and risk reduction practices was part of the Malaysia National Health Morbidity Survey III (NHMS III) conducted in 2006.

Methods:

This cross-sectional population-based survey was conducted to determine the incidence of workplaces injuries and assess the magnitude of some important risk reduction practices among workers. Data were gathered through face-to-face household interviews using a pre-coded questionnaire.

Results:

Of the 22?880 eligible respondents, 88·2% (20?180) responded. The incidence rate for injuries at the workplace was 4·9 per 100 (95% CI: 4·6–5·2). The overall proportion of workers who had received occupational safety and health (OSH) training before or within 1 month of starting work was 33·6%. Among respondents who perceived that personal protective equipment (PPE) was required at their workplace, only 38·9% (95% CI: 37·8–39·4) were provided with it by their employers.

Discussion:

Further studies are urgently needed to identify reasons for and management of the low uptake of risk reduction practices. This issue needs to be addressed to ensure the safety and health of our working population.     

A cross-sectional survey of environmental health in remote Aboriginal communities in Western Australia

Introduction: The Australian Aboriginal population experiences significantly poorer health than the non-Aboriginal population. The contribution of environmental risk factors in remote communities to this health disparity is poorly understood.

Objective: To describe and quantify major environmental risk factors and associated health outcomes in remote Aboriginal communities in Western Australia.

Methods: The association between environmental health indicators, community infrastructure and reported health outcomes was analysed using linear and logistic regression of survey data.

Results: Housing/overcrowding was significantly associated with increased reports of hearing/eyesight (OR 3.01 95?% CI 1.58–5.73), skin (OR 2.71 95?% CI 1.31–5.60), gastrointestinal (OR 3.51 95 % CI 1.49–8.26) and flu/colds (OR 2.47 95 % CI 1.27–4.78) as health concerns. Dust was significantly associated with hearing/eyesight (OR 3.16 95 % CI 1.82–5.48), asthma/respiratory (OR 2.48 95 % CI 1.43–4.29) and flu/colds (OR 3.31 95 % CI 1.88–5.86) as health concerns.

Conclusion: Poor environmental health is prevalent in remote Aboriginal communities and requires further delineation to inform environmental health policy.     

Economic burden of hospital admissions for patients with acute bacterial skin and skin structure infections in the United States

ABSTRACT

Objectives: We estimated the total US hospital costs associated with acute bacterial skin and skin structure infection (ABSSSI) admissions as well as the admissions that may have been potential candidates for outpatient parenteral antimicrobial therapy (OPAT).

Methods: We assessed inpatient admissions for ABSSSI from the Premier database (2011–2014), focusing on all admissions of adults with length of stay (LOS) ≥ 1 days and a primary diagnosis of erysipelas, cellulitis/abscess, or wound infection. We performed a detailed analysis of 2014 admissions for patient, treatment, hospital, and economic characteristic variables. Using published selection criteria, we identified a subset of patients admitted in 2014 who may have been potential candidates for OPAT.

Results: We analyzed 277,971 admissions. In 2014, most admissions were for cellulitis without major complications or comorbidities; mean ± SD LOS was 4.0 ± 3.0 days, and total hospital cost per admission was $6400 ± $6874, 54% of which was attributable to room costs. Among 2014 admissions, 14% involved patients with clinical characteristics suggesting that they were consistent with guideline recommendations for exclusive treatment with OPAT. Compared with all admissions in the year, these admissions were of younger patients (aged 50 vs. 55 years), admitted more frequently for cellulitis (90% vs. 70%), with shorter LOS (2.8 ± 1.8 days), and lower mean total hospital cost per admission ($4080 ± $3066).

Conclusions: Admissions for ABSSSI impose a substantial cost to US hospitals, with half of costs attributable to room costs. When extrapolated to all US patients admitted to the hospital for ABSSSI during 2014, had OPAT guidelines been universally followed, admissions may have been reduced by 14%, thereby saving US hospitals $161 million.     

Contributions of inhalation and dermal exposure to chlorpyrifos dose in Egyptian cotton field workers

Abstract

Objective: Chlorpyrifos exposures were assessed in 12 Egyptian cotton field workers.

Methods: 3,5,6-trichloro-2-pyridinol (TCPy) was measured in 24-hour urine samples to estimate absorbed dose. Workshift air samples were used to calculate chlorpyrifos inhalation dose.

Results: Patches on legs had the highest chlorpyrifos loading rates among body regions sampled. Geometric mean chlorpyrifos air concentrations were 5·1, 8·2, and 45·0 μg/m³ for engineers, technicians, and applicators, respectively; peak TCPy urinary concentrations were 75–129, 78–261, and 487–1659 μg/l, respectively; geometric mean doses were 5·2–5·4, 8·6–9·7, and 50–57 μg/kg, respectively, considering TCPy excretion half-life values of 27 and 41 hours. All worker doses exceeded the acceptable operator exposure level of 1·5 μg/kg/day. An estimated 94–96% of the dose was attributed to dermal exposure, calculated as the difference between total dose and inhalation dose.

Discussion: Interventions to reduce dermal exposure are warranted in this population, particularly for the hands, feet, and legs.     

A new perspective on metals and other contaminants in fluoridation chemicals

Abstract

Background:

Fluoride additives contain metal contaminants that must be diluted to meet drinking water regulations. However, each raw additive batch supplied to water facilities does not come labeled with concentrations per contaminant. This omission distorts exposure profiles and the risks associated with accidents and routine use.

Objectives:

This study provides an independent determination of the metal content of raw fluoride products.

Methods:

Metal concentrations were analyzed in three hydrofluorosilicic acid (HFS) and four sodium fluoride (NaF) samples using inductively coupled plasma-atomic emission spectrometry. Arsenic levels were confirmed using graphite furnace atomic absorption analysis.

Results:

Results show that metal content varies with batch, and all HFS samples contained arsenic (4·9–56·0 ppm) or arsenic in addition to lead (10·3 ppm). Two NaF samples contained barium (13·3–18·0 ppm) instead. All HFS (212–415 ppm) and NaF (3312–3630 ppm) additives contained a surprising amount of aluminum.

Conclusions:

Such contaminant content creates a regulatory blind spot that jeopardizes any safe use of fluoride additives.     

Acute effects of urban air pollution on respiratory emergency hospital admissions in the Canary Islands

In the cities of Las Palmas (L/P) de Gran Canaria and Santa Cruz (S/C) de Tenerife, Canary Islands, particulate matter is highly influenced by mineral dust because their proximity to the Sahara desert (PM_10–2.5 levels are higher than PM_2.5). In this context, the short-term association between different PM fractions and gaseous pollutants with emergency hospital admissions for all respiratory, chronic obstructive pulmonary disease (COPD) and asthma was analyzed, evaluating the potential independent effect of PM_10–2.5. A generalized additive model was fitted controlling for seasonal patterns and time varying confounders. Different lag structures, polynomial distributed lag models, and two-pollutant models were examined. Under Lag01, in S/C de Tenerife, a 10 μg/m³ increase in PM_2.5 and PM_10–2.5 was associated with a 5.1 % risk increase (95 % confidence interval [CI] 1.0 to 9.2) in all respiratory and with a 7.7 % increase (95 % CI 0.9 to 14.9) in COPD emergency admissions, respectively. In L/P de Gran Canaria, a positive association between PM_10–2.5, PM_2.5, and NO₂ with the increased risk of asthma hospitalization was found: 11.2 % (95 % CI 0.5 to 22.9), 21.9 % (95 % CI 6.9 to 39.0), and a 17.4 % (95 % CI 6.6 to 29.4), respectively. The overall findings suggest that in these cities, (1) PM_2.5, PM_10–2.5, and NO₂ are associated with the risk of emergency hospital admission for respiratory diseases; (2) there is no evidence of confounding for the associations observed; and (3) PM_10–2.5 may have an impact on public health.     

Contrasting patterns of mortality and hospital admissions during hot weather and heat waves in Greater London, UK

Background: Epidemiological research has shown that mortality increases during hot weather and heat waves, but little is known about the effect on non-fatal outcomes in the UK.

Aims and Methods: The effects of hot weather and heat waves on emergency hospital admissions were investigated in Greater London, UK, for a range of causes and age groups. Time series analyses were conducted of daily emergency hospital admissions, 1 April 1994 to 31 March 2000, using autoregressive Poisson models with adjustment for long term trend, season, day of week, public holidays, the Christmas period, influenza, relative humidity, air pollution (ozone, PM₁₀), and overdispersion. The effects of heat were modelled using the average of the daily mean temperature over the index and previous two days.

Results: There was no clear evidence of a relation between total emergency hospital admissions and high ambient temperatures, although there was evidence for heat related increases in emergency admissions for respiratory and renal disease, in children under 5, and for respiratory disease in the 75+ age group. During the heat wave of 29 July to 3 August 1995, hospital admissions showed a small non-significant increase: 2.6% (95% CI –2.2 to 7.6), while daily mortality rose by 10.8% (95% CI 2.8 to 19.3) after adjusting for time varying confounders.

Conclusions: The impact of hot weather on mortality is not paralleled by similar magnitude increases in hospital admissions in the UK, which supports the hypothesis that many heat related deaths occur in people before they come to medical attention. This has evident implications for public health, and merits further enquiry.

     

Fine particulate matter (PM2.5) association with peripheral artery disease admissions in northeastern United States

Background: Current evidence, on the association of PM_2.5 and peripheral artery disease (PAD) is very sparse. Methods: We use novel PM_2.5 prediction models to investigate associations between chronic and acute PM_2.5 exposures and hospital PAD admissions across the northeast USA. Poisson regression analysis was preformed where daily admission counts in each zip code are regressed against both chronic and acute PM_2.5 exposure, temperature, socio-economic characteristics and time to control for seasonal patterns. Results: Positive significant associations were observed between both chronic and acute exposure to PM_2.5 and PAD hospitalizations. Every 10-μg/m³ increase in acute PM_2.5 exposure was associated with a 0.26 % increase in admissions (CI = 0.08 – 0.45 %) and every 10-μg/m³ increase in chronic PM _2.5 exposure was associated with a 4.4 % increase in admissions (CI = 3.50 – 5.35 %). Conclusions: The study supports the hypothesis that acute and chronic exposure to PM_2.5 can increase the risk of PAD.     

Association between ambient ozone and health outcomes in Prague

Purpose

Though numerous studies investigating ambient ozone (O₃) effects on human health were published, such a study for Central Europe is still lacking. We have investigated the association between ozone (O₃) levels and hospital admissions and mortality due to cardiovascular and respiratory diseases for Prague inhabitants for summer months (April–September) over the 5-year period 2002–2006. Our hypothesis was that ambient O₃ levels in Prague resulted in adverse health outcomes and were associated with increased mortality and hospital admissions.

Methods

The effect of O₃ on mortality and hospital admissions was investigated using the negative binomial regression after controlling for the influence of meteorological factors (air temperature and relative humidity) and calendar effects (seasonal patterns, long-term trends and day of week).

Results

We found a statistically significant association between O₃ levels and daily mortality from respiratory diseases. Relative risk of 1.080 (95% CI: 1.031–1.132) was observed for mortality from respiratory diseases per 10 μg m^?3 increase in 1-day lagged daily mean O₃ concentration. No statistically significant association was detected between O₃ concentrations and daily mortality from all causes, daily mortality from cardiovascular diseases and hospital admissions for respiratory and cardiovascular diseases. The O₃ effects differed in men and women, nevertheless, the results were ambiguous with respect to used lag and O₃ metrics. No significant confounding effects of PM₁₀ on the investigated association were observed.

Conclusions

O₃ exposure in Prague, though lower as compared to many other cities in Europe, is high enough to cause adverse health effects.     

Cancer incidence and mortality among temporary maintenance workers in a refinery/petrochemical complex in Korea

Abstract

Background:

Petrochemical plant maintenance workers are exposed to various carcinogens such as benzene and metal fumes. In Korea, maintenance operations in petrochemical plants are typically performed by temporary employees hired as contract workers.

Objectives:

The purpose of this retrospective study was to evaluate cancer risk in temporary maintenance workers in a refinery/petrochemical complex in Korea.

Methods:

Subjects consisted of 14 698 male workers registered in a regional petrochemical plant maintenance workers union during 2002–2007. Cancer mortality and incidence were identified by linking with the nationwide death and cancer registries during 2002–2007 and 2002–2005, respectively. Standardized mortality ratios (SMRs) and standardized incidence ratios (SIRs) were calculated for each cancer.

Results:

Increased SMR 3·61 (six cases, 95% CI: 1·32–7·87) and SIR 3·18 (five cases, 95% CI: 1·03–7·42) were observed in oral and pharyngeal cancers.

Conclusion:

Our findings may suggest a potential association between oral and pharyngeal cancers and temporary maintenance jobs in the petrochemical industry. Future studies should include a longer follow-up period and a quantitative exposure assessment.     

Emergency ambulance dispatches and apparent temperature: a time series analysis in Emilia-Romagna, Italy

IntroductionIncreases in mortality associated with oppressive weather have been widely investigated in several epidemiological studies. However, to properly understand the full public health significance of heat-related health effects, as well as to develop an effective surveillance system, it is also important to investigate the impact of stressful meteorological conditions on non-fatal events. The objective of our study was to evaluate the exposure–response relationship of ambulance dispatch data in association with biometeorological conditions using time series techniques similar to those used in previous studies on mortality.MethodsDaily data of emergency ambulance dispatches for people aged 35 or older in the summer periods from 2002 to 2006 were collected for the major towns in the Emilia–Romagna region. In the first stage of the analysis, the city-specific relationship between daily ambulance dispatches and increasing apparent temperature was explored using Generalized Additive Models while controlling for air pollution, seasonality, long-term trend, holidays and weekends. The relationship between ambulance dispatches and apparent temperature was approximated by linear splines. The effects of high temperatures on health were evaluated for respiratory and cardiovascular diseases as well as for all non-traumatic conditions. In the second stage of the analysis, city-specific effects were combined in fixed or random effect meta-analyses.ResultsThe percent change in the ambulance dispatches associated with every 1 °C increase in the mean apparent temperature between 25 and 30 °C was 1.45% (95% confidence interval: 0.95, 1.95) for non-traumatic diseases and 2.74% (95% CI: 1.34, 4.14) for respiratory diseases. The percent increase in risk was greater on days in which the mean apparent temperature exceeded 30 °C (8.85%, 95% CI: 7.12, 10.58 for non-traumatic diseases). In this interval of biometeorological conditions, cardiovascular diseases became positively associated with the apparent temperature. The risks increased with age. The increase in risk for the non-traumatic diseases reached 13.34% for people aged 75 or older compared to 4.75% for those aged 35–64.ConclusionTime series analysis techniques were adopted for the first time to investigate emergency ambulance dispatches to evaluate the risks associated with biometeorological discomfort. Our findings show a strong relationship between biometeorological conditions and ambulance dispatches.