“New challenges of Environmental Health”
Meeting of the Central and Eastern European Chapter of ISEE June 9-11, 2005, Budapest, Hungary
Abstracts Book ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
Content
Program 2
Keynote lectures 9
Air pollution 15
Socio-Economic Status 22
Housing and health 28
Biological monitoring 33
Global climate change and health 37
Poster section: A 42
Poster section: B 54
1 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
9 June, 2005
1100 Registration, Lunch
1400- 1430 Opening session Chair : Anna Páldy President of the Central-Eastern European Chapter of ISEE Tony Fletcher President of the International Society for Environmental Epidemiology Keynote lectures
1430-1450 01.: Tony Fletcher Arsenic and Cancer in Central Europe: Preliminary results from the ASHRAM Study
1500-1520 02.: Dafina Dalbokova, R. Kim, M. Krzyzanowski Pan-European Environment and Health Information System: a comprehensive WHO/Europe initiative
1530-1550 03.: Gyula Dura Integration of CEHAPE into NEHAP II.
1600 –1615 Coffee Break
1615-1635 04.: Wolfgang Hellmeier, M. Lacombe A new drinking water information system in North-Rhein-Westfalia – a tool for reporting on state level and to the EU
1645-1705 05.: Gabriel Gulis Implementation of Health Impact Assessment
1715-1800 Poster viewing
1800-1900 ISEE CEE Chapter Meeting
2000 Welcome Reception at the Hotel Tulip Inn Budapest
2 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
10 June, 2005
Air pollution Chair: Péter Rudnai, Tanya Turnovska
900 – 915 06. : Éva Vaskövi, T. Beregszászi, M. Endrődy, M. Csík, G. Kovács, G. Török Indoor air quality assessment on tube platform
915 – 930 07.: Dobrinka Lolova, T. Antova Monitoring and assessment of ambient air quality in the region of smelter plant - Plovdiv
930 – 945 08.: Dobrinka Lolova, E. Uzunova, Z. Koleva PM10 and PM2,5 measurement and concentrations in Bulgaria
945 –1015 Coffee Break
1015 – 1030 09.: Judit Szabó, G. Jánossy, Gy. Thuróczy Survey of residental magnetic field above reconstructed 10/04 KV transformer stations
1030 – 1045 10.: Marek Majdan, G. Gulis Using GIS in exposure assessment to study health effects of hazardous waste sites
1045-1100 11.: Péter Rudnai, A. Páldy, Gy. Dura, É. Vaskövi, J. Szaniszló, M. Náray, Á. Moró Setting up an environmental health surveillance system around a toxic waste incinerator
1100-1300 Lunch
3 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
10 June, 2005
Socio-Economic Status Chair: Mária Bényi, Ludmila Sevcikova
1300-1315 12.: Demosthenes B. Panagiotakos, E. Polychronopoulos, C.A. Chrysohoou, C. Pitsavos, C. Stefanadis Socio-economic status in relation to risk factors associated with cardiovascular disease in healthy individuals from the ATTICA study
1315-1330 13.: Ludmila Sevcikova, J. Jurkovicova, Z. Stefanikova, L. Sobotová, L. Aghova, E. Machacova, J. Novakova, J. Hamade The changes in health status and physical development of children and youth in Slovakia
1330-1345 14.: Daniela Marcinkova Socio-economic inequalities as health inequalities determinant in Slovakia
1345-1400 15.: János. M. Varró, Z. Virágh, P. Rudnai Environmental epidemiological associations of psychosomatic symptoms of 7-11-year-old children in Hungary, 1997-2002
1400-1415 16.: Mária Bényi Environmental and social risk factors of injuries among children in Hungary
1415-1445 Coffee Break
Housing and health Chair: Dafina Dalbokova, Tibor Málnási
1445-1500 17.: Matthias Braubach, X. Bonnefoy The WHO Housing and health policy
1500-1515 18.: Matthias Braubach The health relevance of the immediate housing environment
1515-1530 19.: Péter Rudnai, M.J. Varró, T. Málnási, A. Páldy, S. Nicol, A. O’Dell, M. Braubach, X. Bonnefoy Associations between mould/dampness in the home and health status of the inhabitants
4 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
10 June, 2005
1530-1545 20.: Mihály János Varró, M. Posgay, Gy. Ungváry, Zs. Láng Association of lung cancer and mould in the flat in an environmental epidemiological survey
1545-1600 Coffee Break
Biological Monitoring Chair: Bernadette Schoket, Wolfgang Hellmeier
1600-1615 20.: Lívia Anna, B. Schoket, E. Győrffy, E. Erdei, P. Rudnai A pilot study of biomonitoring ambient genotoxic exposure of children
1615-1630 21.: Bernadette Schoket, L. Anna. E. Győrffy, S. Kostic, A. Csekeő, I. Soltész, Z. Győrfi, J. Segesdi, J. Minárovits Molecular mechanism influencing the biomarker levels of environmental genotoxic exposure
1630-1645 22.: Rima Kregzdyte, D. Baranauskiene, R. Naginiene, O. Abdrakhmanovas The comparison of missing values imputation methods in biological monitoring data analysis
2000 “Getting together dinner” in the Restaurant Vörös Postakocsi
5 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
11 June, 2005
Global climate change and health Chair: Anna Páldy, Gabriel Gulis
900-915 23.: Anna Páldy, J. Bobvos, A. Vámos Heat waves in Budapest 2001-2003
915-930 24.: Krisztina Kishonti, A. Páldy, J. Bobvos Heat warning system and communication in Hungary
930-945 25.: József Bakos, J. Szabó, Gy. Thuróczy Sunbed user’s motivations, knowledge and habits in Budapest, Hungary
945-1000 26.: Katalin Fehér, B. Oroszi, J. Pallér, E. István, M.C. Cercato Skin cancer prevention programme among school-age children
1000-1015 Coffee break
Poster section A Chair: Dobrinka Lolova, Mihály J. Varró
1015-1020 P1.: Tanya Turnovska, B. Marinov, S. Mandadjieva Anthropometric nutritional status among adolescents
1020-1025 P2.: Tanya Turnovska, S. Savov, M. Arabova, G. Kavlakov, N. Boyadjiev Nutrition and nutritional status among Bulgarian and Romany children at preschool age
1025-1030 P3.: Ene Indermitte, A. Saava Exposure to different fluoride level in drinking water in Estonian population
1030-1035 P4.: Márta Szalkai Air pollution control of the smoking places
1035-1040 P5.: Tanya Turnovska, S. Mandadzhieva, B. Marinov Pulmonary functions and physical capacity among adolescents attending two schools situated in the districts with different levels of air pollution
1040-1045 P6.: Jeni Staykova, B. Nikiforov, O. Mihaylovskaya, T. Turnovska Status of the vital environment and the health of the population in a lead- zinc output region in Bulgaria, I. Pollution of the vital environment with heavy metals
1045-1050 P7.: Jeni Staykova, B. Nikiforov, O. Mihaylovskaya, T. Turnovska Status of the vital environment and the health of the population in a lead- zinc output region in Bulgaria, II. Biological Monitoring
6 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
11 June, 2005
1050-1055 P8.: O. Mihaylovskaya, Jeni Staykova, T. Turnovska A chronic lead intoxication among occupationally exposed persons
1055-1100 P9.: Zsuzsanna Horváth, E. Józsa, E. Replyuk, D. Apatini, A. Páldy, K. Kishonti Ragweed situtation evaluated by DPSEEA model
1100-1105 P10.: Gyula Dura Site hazard assessment and ranking as a tool of environment and health preparedness
1105-1110 P11.: Gizella Nádor, A. Páldy, G. Galgóczy Analysis of mortality and morbidity data of Mesothelioma in Hungary with the help of spatial and statistical methods
1110-1125 Coffee Break
Poster section B Chair: Gyula Dura, Marek Majdan
1125-1130 P12.: Petra Gergelova, M. Hurbánková, S. Cerná, E. Tátrai, É. Six, Z. Kováciková Inflammatory and cytotoxic effects as well as histological findings after exposure to asbestos substitutes in experiment
1130-1135 P13.: Mihály J. Varró, M. Posgay, Gy. Ungváry, Zs. Láng In a survey to evalute the health impact of environmental asbestos exposure
1135-1140 P14.: János Bobvos, A. Páldy, L. Gorove The effect of temperature and heat waves on daily emergency ambulance calls in Budapest, Hungary, 1998-2004
1140-1145 P15.: Gabriella Bognár, G. Mészáros, K. Szalma, G.J. Köteles Assessment of radiation burden by biological indicators
1145-1150 P16.: Ágnes Drahos, L. Anna, E. Győrffy, B. Schoket, I. Fehér, A.M. Dám In vitro model for study of the genotoxic effects of combined environmental exposures
7 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
11 June, 2005
1150-1155 P17.: Didi Surcel, Cs. Szántó, M. Botoc, M. Hriscu, D. Dabala Free radicals, lipid peroxidation and immune response in experimental exposure to electromagnetic fields
1155-1200 P18.: Didi Surcel, L. Stoica, A. Mocan, M. Beldean, M. Hriscu, M. Butan, R. Ghitulescu Risk assessment for nurses occupationally exposed to antineoplastic drugs
1200-1205 P19.: Gizella Nádor, A. Páldy, P. Rudnai Environmental health impact of an incinerator in Dorog studied by point source analysis
1205-1210 P20.: Pawel Gorynski, B. Wojtyniak, P. Rudnai, K. Kanclerski, J. Świątczak Incineration plant and risk perception assessment by questionnaire method
1210-1215 P21.: Liana M. Deac, D. C. Moga, A. Cracuin, D. Cracuin, D. Proinov, M. Risca, E. Lupu. C. Munteanu, C. Sigartau, T. Vlad Risk factors for cervical cancer in Romania
1215-1220 P22.: Jarmila Korcova, G. Gulis Urban-rural differences in the incidence of digestive tract cancer in Southern Slovakia
1220-1300 Closing ceremony
1300-1400 Lunch
8 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
Keynote lecture
9 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
ARSENIC AND CANCER IN CENTRAL EUROPE: PRELIMINARY RESULTS FROM THE ASHRAM STUDY
Tony Fletcher (1), Giovanni Leonardi (1), Felicity Clemens (1), Eugen Gurzau (2), Kvetoslava Koppova (3), Peter Rudnai (4), Walter Goessler (5), Rajiv Kumar (6), Marie Vahter (7), (1) London School of Hygiene & Tropical Medicine, UK; (2) Environmental Health Centre, Cluj-Napoca, Romania; (3) State Health Institute, Banska Bystrica, Slovakia; (4) ‘Jozef Fodor’ National Centre of Public Health, Budapest, Hungary; (5) Institut für Chemie - Analytische Chemie, Karl-Franzens-Universität, Graz, Austria; (6) DKFZ, German Cancer Research Centre, Heidelberg, Germany; (7) Institute of Environmental Medicine, Karolinska Institute, Sweden.
Introduction: A study of cancer risks in relation to arsenic was conducted in Central Europe with EU support: “ASHRAM” Arsenic Health Risk Assessment and Molecular Epidemiology”. This study has several components including: estimating cancer risk in relation to arsenic intake (principally from drinking water), estimating inter-individual differences in arsenic metabolism, estimating the role of polymorphisms in a number of genes involved in cell cycle regulation and DNA repair. Material and method: Study areas were defined as some counties in Hungary, Romania and Slovakia with known hotspots of current or past exposure to arsenic. Within these areas, new cases of skin, bladder and kidney cancer were identified along with hospital referents and invited to participate in the study. A detailed structured interview was conducted spanning their residential and occupational histories, and including a Food Frequency Questionnaire, and questions on lifestyle, smoking and key potential confounders for these cancers. Urine and blood samples were taken. Data on water consumption and all current and past sources of drinking water were identified. Water samples were taken for laboratory analysis, including wherever possible, the most recent and longest residential and occupational water sources. Some potentially important food items from the study areas have been analysed for arsenic content. Arsenic excretion is compared with current estimates of intake. The risk for each cancer, adjusted for age, demographic variables, smoking, diet, occupation etc are computed in relation to current, cumulative and average measure of arsenic intake, by logistic regression. Results: The following numbers of cases were enrolled: non-melanoma skin cancer (612), bladder cancer (206), kidney cancer (107), referents (495), a total study population of 1420. Water supplies have been described by study participants for their full life history in most cases. Water samples could be taken from most target water supplies, their arsenic concentration determined, and the results matched to residential history to estimate current and past exposure. There is a good correlation between intake and excretion for arsenic in drinking water above 4 µg/l. Below that level, dietary sources tend to predominate. Risk rations by arsenic exposure measures will be presented at the meeting.
10 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
PAN-EUROPEAN ENVIRONMENT AND HEALTH INFORMATION SYSTEM (EHIS): A COMPREHENSIVE WHO/EUROPE INITIATIVE
Dafina Dalbokova, R. Kim, M. Krzyzanowski World Health Organization, European Centre for Environment and Health, Bonn Office
Introduction: Reliable information on the environment, population health and their linkages is essential to optimally prioritise, develop and evaluate policies and actions in order to reduce hazardous environmental exposures and their health effects. The Fourth Ministerial Conference on Environment and Health (Budapest, 2004) reconfirmed the need for a harmonized pan-European system to support with information the policy process, enabling international comparisons and facilitating communication with multiple user groups. Material and method: WHO-ECEH in collaboration with Member States and international organizations is currently implementing projects to develop the EHIS elements such as environmental health indicators, policy review and health impact assessment methods, techniques and tools for information maintenance, analysis and reporting. Experiences gained and pilot products reporting EH indicators will be presented. Results: Examples of EH indicator fact-sheet illustrate the important system element – reporting indicators to support the process of policy analysis and evaluation. The prototype of indicator web ‘portal’ enables reporting to different target users by structuring the information in several ‘levels of detail’ (e.g. data, indicators, fact-sheets etc.). Case studies from the pilot indicator-based report illustrate various methods of coherent reporting on each part of the information as interlinked with processes along the cause – effects stream to assess potential impacts of policies on health. These methods can facilitate answering key questions and, at the same time provide guidance for future policies and actions in the field of environmental public health. Conclusion: An assessment report of the Children’s Environmental Health Action Plan for Europe (CEHAPE) for the mid-term review Intergovernmental meeting in 2007 will be the key deliverable of the entire process.
11 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
INTEGRATION OF CEHAPE INTO NEHAP II.
Gyula Dura, PhD National Institute of Environmental Health, “József Fodor” National Centre for Public Health, Budapest
The aim of the new Environmental Health Strategy of the EU supports the complex assessment of the relationship between the environment and health, which would result – among others – the elaboration of an information system related to human health, environment and ecosystem. The objectives of the strategy are to lower the burden of disease due to environmental pollution, to decrease environmental risks, to identify new sources of exposure, to improve the policymaking capacity of EU. Initiation based on the Strategy is the SCALE Project (Science, Children, Awareness raising, Legal instruments, Evaluation) focusing on children. A new challenge for Hungary is the harmonisation of the Health Decade “Béla Johan” National Program strengthened by the Parliament Resolution in 2003, with the environmental health issues of the National Environmental Protection Program (II) as well as with the proposals of the Fourth Environment and Health Ministerial Conference, 23-25 June, 2004, Budapest, Hungary and the Environmental Health Strategy of the EU. The National Environmental Health Action Program II (NEHAPII) serves as a framework in which sectorial policy related to prevent health impact of environmental pollution can be fulfilled professional actions can be harmonised in an optimal and cost-effective way meeting national needs and EU requirements. Main objectives of the NEHAP II are to link the information systems necessary for developing environmental health issues (environmental and health indicators, exposure assessment, biomonitoring development of methods), to reduce exposure and risk, awareness raising, risk communication, education and information.
12 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
A NEW DRINKING WATER INFORMATION SYSTEM IN NORTH RHEIN-WESTFALIA – A TOOL FOR REPORTING ON STATE LEVEL AND TO THE EUROPEAN UNION.
Wolfgang Hellmeier, M. Lacombe Institute for Public Health North Rhein-Westfalia, Bielefeld, Germany
Objective: The council directive 98/83/EC of November 1998 on the quality of water intended for human consumption - set into German law with the Trinkwasserverordnung 2001 – required some changes in the local drinking water surveillance of North Rhein-Westfalia. This was taken as an opportunity to improve the drinking water surveillance system with a special focus on the reporting features on state level. Material and method: The software which was used on local and on state level for drinking water surveillance (Trinkwassererfassungs- und Informationssystem 2.0) was developed into a new version. It had to meet the following conditions: User-friendly interface and useful features for the drinking water surveillance on local level; flexible ways to import data from laboratories on local level; features to export data to the state level and to business software for analyses and reports; identically structured databases on the local and the state level; reduction of the workload for reports to the national level; possibility to incorporate the new concept of water supply zones. Water supply zones were defined and were stored in a geo information system, together with addresses of sample points within the drinking water networks and with links to the results of the analyses. Results: The new user interface is very similar to generally used business software; data export and import is much easier than in older versions; additional reporting apart of the data exchange within the system to fulfil national reporting requirements is no longer necessary, reports to higher levels can be produced using only the data of the system on state level; water supply zones are included in the system and enable detailed analyses about the water quality in different parts of the country and of the number of people who are served water of a certain quality. This link between water quality and number of consumers gives an important information for policies for future water supply. Water supply zone is defined as a region which is served by a single water work. Some exceptions are accepted. The zones differ very much in size, some of them cover parts of several counties (Kreise). In the geo information system the water supply zones with the corresponding water works and sample points can be presented together with administrative boundaries, different maps and aerial views. By choosing the appropriate scale either overview over regions or details of spots can be shown. Conclusion: The new version of the drinking water surveillance system in North Rhein-Westfalia meets the requirements of the new drinking water directive and is a tool to produce reports for the national and European level. Analyses on state and regional level are much more elaborated than before and will improve reporting about drinking water supply in North Rhein-Westfalia.
13 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
IMPLEMENTATION OF HEALTH IMPACT ASSESSMENT
Dr. Gabriel Gulis1,2, PhD
1. University of Southern Denmark, Unit of health promotion research, Esbjerg, Denmark 2. Trnava University, Faculty of Health Care and Social Work, Department of Hygiene and Epidemiology, Trnava, Slovakia.
Objective: Health impact assessment (HIA) has different meanings for different groups o public health workers. The objective of this presentation is to discuss at what extent and how is health impact assessment implemented in different countries of Europe. Material and method: A qualitative questionnaire based survey has been conducted among people enrolled in health impact assessment mailing list of European Centre for Health Policy (ECHP). Results: Legislation, education, infrastructure and research were the main issues to be evaluated as key implementation methods. Methodological issues were addressed as well. HIA is rarely required by law, only few countries do so, and in some cases it is within the environmental impact assessment law. Implementation via regular training within existing education systems is heterogenous by countries. Institutional set up seems to be the most frequent way of implementation; many of respondents reported existence of national or local leadership organization. Conclusions: Although acceptance of HIA has increased significantly during last years, there is still a need to address more clearly appropriate and effective methods of implementation. It seems to be clear, that HIA is more value as legislation driven in many countries. This might be related to some differences between implementation on research or routine practice level. There is a different understanding of health impact assessment across Europe. Consequently, its implementation differs by country. There is a need to compare different methods of implementation and their effectiveness. A major research project coordinated by ECHP launched in fall 2004 addresses this issue.
14 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
Air pollution
15 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
INDOOR AIR QUALITY ASSESSMENT ON TUBE PLATFORM
Éva Vaskövi, T. Beregszászi, M. Endrődy, M. Csík, G. Kovács, G. Török National Institute of Environmental Health, Budapest, Hungary
Introduction: People are exposed to air pollution both indoor and outdoor circumstances. Indoor air quality has become the centre of interest during the last twenty years. There are no enough available data to assess the exposure level in the different microenvironments. As people spend about 10% of their time a day with transportation, and a huge number of people are exposed to traffic-related pollution in big cities every day, it is substantial to know the exposure level used by different means of communication. The aim of the study was to assess the air pollution in metro areas considering its important role in the urban mass transportation in Budapest. Material and method: A pilot study was carried out in 2003. The measurement program planed for 5 workday’s consecutive weeks. Tube platforms at a deep (Klinikák) and subsurface underground (Nagyvárad square) stations and one control location were selected for sampling sites. Daily average concentrations of PM10 and PM2,5 were measured continuously. To determine the peak (1-hour) concentrations, short-term measurements for TSP elaborated by 3-hour period in the late morning. PM10 and PM2,5 pollution levels were controlled by gravimetric method using Harvard impactors. High volume samplers measured TSP concentrations. Exposed particulate samplings were analysed gravimetrically. Results: 60-percentile of TSP hourly concentrations exceeded the national short-term limit value (200 µg/m3) at both platforms. The pollution trend at deep-level station was alternate during the week. The three-hour averages ranged from 140-286 µg/m3 at subsurface underground station and 140-441 µg/m3 at deep site. 3 Daily averages (206, 198 µg/m ) for PM10 were came near to each other during the studied period. It means that the daily exposure 3-5 times were higher than the threshold limit. Differences in PM2,5 pollution were found between two sites. Indoor air was more polluted at tube platform at Nagyvárad square (weekly average: 88 µg/m3 ) than at Klinikák station (64 µg/m3 ). Exposure at control site was lower (44% and 29%) than the pollution level at both tube platforms. As regards the PM2,5 pollution, the tube platforms were most polluted areas than the control site (Nagyvárad square: 1,4-1,9; Klinikák: 1,5-2,1) Somewhat higher fine fraction in PM10 was found at tube platform on subsurface underground station (41%) than at deep metro station (31%). In contrast, PM2,5/PM10 ratio was the same (61-63 %) during the two consecutive weeks at control site. Conclusion: Results demonstrated the exposure level exceeded the threshold limit for particulate matters. Although during travelling by underground, short-term exposure has to be considered, many people are exposed.
16 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
MONITORING AND ASSESSMENT OF AMBIENT AIR QUALITY IN THE REGION OF SMELTER PLANT – PLOVDIV
Dobrinka Lolova, T. Antova, National Centre of Hygiene, Medical Ecology and Nutrition, Sofia, Bulgaria, St. Todorova , Hygiene & Epidemiological Inspectorate, Plovdiv, Bulgaria
The smelter plant – Plovdiv in the region of South Bulgaria produces lead, hard-alloy products, sulfuric acid, precious metals, cadmium, etc. Such productions are known to emit into the atmosphere particulates, sulfur dioxide, and airborne lead, cadmium and the other heavy metals. The presence of such powerful source of hazardous emissions, with potential risk for the population health requested exposure assessment by monitoring of ambient air pollution. The hygiene and Epidemiological Inspectorate (HEI ) – Plovdiv has been monitoring the ambient air pollution in the region at three sampling sites – Assenovgrad, Kuklen and Dolno Voden. The data from the monitoring of ambient air in this region are statistically processed. The integral values for airborne lead and cadmium are calculated for monthly and yearly exposure of the population over the period 1991-1999.
All results are presented in tables and graphs.
17 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
PM10 AND PM2,5 MEASUREMENT AND CONCENTRATIONS IN BULGARIA
Dobrinka Lolova National Centre of Hygiene, Medical Ecology and Nutrition Ef. Uzunova – Hygiene Epidemiological Inspectorate – Sofia Zv. Koleva – Hygiene Epidemiological Inspectorate – Vratsa
PM10 and PM2.5 are among the most harmful of all air pollutants. When inhaled these particles evade the respiratory system’s natural defenses and lodge deep in the lungs. Health problems begin as the body reacts to these foreign particles. PM can increase the number and severity of asthma attacks, cause or aggravate bronchitis and other lung diseases, and reduce the body’s ability to fight infections. The goals of ambient air monitoring of particulate matter are following: - to obtain detailed information of the ambient particle size distribution, - to improve the quality of sampling results, independent of wind, and - to comply with health related particle size fraction definitions. Sampling site HEI -Sofia is situated in the lower central part of Sofia with traffic jam. The sampling site Centre of Hygiene - Sofia is situated 50 meters from highway with traffic jam. The sampling site HEI – Vratsa is about 1000 meters from the Chemical plant, producing fertilizers. Exposure assessment is based on a long term of measurements of PM10 and PM2.5. Sampling (24 hours) of PM10 and PM2.5 is carried out with Harvard impactors every sixth day on fixed urban sites. The analysis of PM10 and PM2.5 is performed by gravimetric, using microbalance techniques. The collection filters are weighed (using microbalance) before and after use to determine the net weight (mass) gain due to the collected particulate matter. The blank and loaded filters must be temperature and moisture equilibrated prior to weighting. The mass concentration in ambient air is calculated as the extra mass of collected particles on the filters divided by the volume of air sampled corrected to standard temperature and pressure.
The concentrations of PM10 and PM2.5 are presented in tables and graphs for entire year, heating and non- heating seasons.
18 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
SURVEY OF RESIDENTIAL MAGNETIC FIELD ABOVE RECONSTRUCTED 10/04 KV TRANSFORMER STATIONS
Judit Szabó, G. Jánossy, G. Thuróczy National Research Institute for Radiobiology and Radiohygiene, “József Fodor” National Centre for Public Health, Budapest
Objective: Results of epidemiological studies pointed to a causal link between ELF-MF and childhood leukemia above a threshold (0,3 µT - 0,4 µT) of chronic exposure (WHO Fact Sheet No.263). Previously we reported that residential extremely low frequency (ELF) magnetic field (MF) above transformer stations represented higher than usual exposure in residences (ISEE 2003). Objective of the present survey was to measure the magnetic field above 21 reconstructed transformer stations. Material and method: Reconstruction focused mainly on the expansion of the distance between the 0,4 kV connection of the transformer and the floor of the residence above it. Spot MF measurements were made by magnetic field loggers at 1-m height. Maximum (MMF) was measured at 1-m height and at floor level. Current on the bus bars was measured by lock-holder type current meter according to the three phases. Results: Average amperage of reconstructed transformers was 195 A (66 A - 462 A). Average magnetic field in the residences above reconstructed transformers was 0,61 µT (0,18 µT – 1,17 µT). Average MF and MMF at floor level correlated with the average amperage statistically significantly. Correlation of MF and amperage shows that MF of reconstructed transformers is much lower, compared to the magnetic field of the non- reconstructed transformers of the same current load. Reduction of the MMF was most pronounced. Conclusion: Reconstruction of transformer stations in accordance with the precautionary framework of the EU/WHO resulted significant reduction of the MF in the residences directly above the transformer stations. MF of reconstructed transformers compared to the magnetic field of the non-reconstructed transformers of the same current load decreased by about an order.
19 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
USING GIS IN EXPOSURE ASSESMENT TO STUDY HEALTH EFFECTS OF HAZARDOUS WASTE SITES (HWS). THE SITUATION IN SLOVAKIA (SK).
Dr. Marek Majdan1 and Dr. Gabriel Gulis1,2, PhD
1Trnava University, Faculty of Health Care and Social Work, Department of Hygiene and Epidemiology, Trnava, Slovakia. 2University of Southern Denmark, Unit of health promotion research, Esbjerg, Denmark
Objective: The objective of this presentation is to show the possibility and relevance of using GIS as a tool in exposure assessment in environmental health studies. It is focused on the case of studying the health effects of exposure of populations to HWS. Material and method: HWS are a potential source of hazardous pollutants. We chose one of the HWSs in SK and will demonstrate our methodology of assessing the exposure of population living near HWSs. Three buffer zones were created around the site (zone 1 beeing the closest to the site) with a diameter of 5, 10 and 15km. Additionally a research on existing data about environmental pollution in the area was conducted. A dataset of birth-weights of all of the newborns in SK through 1997-2002 served as health outcome dataset. An information about the age of the mother and the name of the place she lived was attached to every birth- weight. We conducted a case-control study considering the closer buffer to be the most exposed population. Results: Odds ratios were calculated. The OR for zone1 vs. zone2 was 1,22(CI95:0,87-1,70), for zone1 vs. zone3 was 0,92(0,66-1,27) and for zone2 vs. zone3 was 0,76(0,54-1,06). We found also data on environmental pollution. Results asks for very careful interpretatio due to many possible confounding factors such are socio-economical, life-style, occupational risks or educational factors. Conclusions: In SK using GIS in this area of research is relevant although there is a need for additional data to describe exposure more precisely. More detailed geographical data and as precise as possible personal exposure data would make the result more relevant. It is crucial to consider the possible confounders due to the health effect studied.
20 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
SETTING UP AN ENVIRONMENTAL HEALTH SURVEILLANCE SYSTEM AROUND A TOXIC WASTE INCINERATOR
Péter Rudnai1, A. Páldy1, Gy. Dura1, É. Vaskövi1, J. Szaniszló2, M. Náray2, Á. Moró3 1National Institute of Environmental Health and 2Central Chemical Laboratory, „József Fodor” National Centre for Public Health, Budapest, 3Public Health Institute of Town Dorog, Hungary
Introduction: Dorog is a small town with about 13,000 inhabitants. It used to be a coal-mining area. In the 1980’-s an incinerator was built here for burning wastes of a pharmaceutical plant. In 1996 this was converted into a big toxic waste incinerator with a capacity of 30,000 tons per year. In the frame of an EU-funded project an environmental health surveillance system (EHSS) is being set up in Dorog to monitor the possible environmental contamination on one side and the changes in the health status of the population on the other side. Elements of the EHSS: Besides the data on air pollution (PM10, SO2, NO2, CO, O3, benzene) provided by an on-line monitor, yearly average concentrations of PM2.5 and its metal components as well as dioxin and furan compounds will be measured complemented by determination of dioxins in samples of mother's milk. The health status of the population is followed by monitoring 1.) the children's acute respiratory morbidity, using the local paediatricians' weekly report, 2.) outcome of the pregnancies (normal or preterm births, birth weight, spontaneous abortions or stillbirths etc), with the participation of the district nurses, 3) the weekly number of patients with acute allergic conditions admitted to the local allergological outpatient unit and 4.) yearly analysis of the mortality patterns of Dorog and its neighbourhood. A risk perception component is also built in which will be accomplished in the last year of the project. Acknowledgment: The project is supported by the INTERREG III.C. Programme of the EU.
21 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
Socio-Economic Status
22 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
SOCIO-ECONOMIC STATUS IN RELATION TO RISK FACTORS ASSOCIATED WITH CARDIOVASCULAR DISEASE, IN HEALTHY INDIVIDUALS FROM THE ATTICA STUDY
Demosthenes B. Panagiotakos, Evangelos Polychronopoulos, Christina A. Chrysohoou, Christos Pitsavos, and Christodoulos Stefanadis.
Background:. Social status has been related with the prevalence and incidence of cardiovascular disease. We sought to investigate the relationships between socio economic status (SES) and clinical and biochemical factors related to coronary heart disease, in a sample of cardiovascular disease free men and women. Design: Cross sectional survey. Material and method: A random algorithm was developed and stratified, by sex- age; multistage sampling was performed, during 2001 - 2002. In this work we analyzed data from 1514 men (18-87 years old) and 1528 women (18-89 years old). Trends in established and emerging cardiovascular risk factors were examined across the participants’ educational level (years of school) and annual income. A special index was developed (years of school times annual income) and 3 socio-economic classes were created (lowest, middle and highest tertile of the index). Results: An inverse relationship was found regarding all lipids and glucose levels across the tertiles of the SES index (all p’s < 0.001). Moreover, an inverse association was observed between body mass index, waist- to-hip ratio and SES in men, but not in women. Furthermore, compared to the lowest tertile individuals who were classified in the highest SES tertile had lower levels of C-reactive protein, fibrinogen, homocysteine, tumor necrosis factor – α, interleukin-6 levels and white blood cell counts, even after adjusting for various potential confounders (all p’s < 0.001). Finally, a considerable proportion of men and women reported lack of health knowledge and education. Conclusion: We revealed an inverse association between SES and factors related to cardiovascular risk. However, the causal pathway itself requires more detailed explication before the social status can have explanatory power.
23 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
THE CHANGES IN HEALTH STATUS AND PHYSICAL DEVELOPMENT OF CHILDREN AND YOUTH IN SLOVAKIA
Ludmila Sevcikova1, Jurkovicova J.1, Stefanikova Z. 1, Sobotová, L. 1, Aghova L. 1, Machacova E. 2, Novakova J. 3, Hamade J. 3
Institute of Hygiene1, Institute of Epidemiology2, Faculty of Medicine, Comenius University, Bratislava, Slovak Institute of Public Health3, Bratislava
Objective: The changes in growth, development and morbidity of children and adolescents belong to the most important public health indicators. These trends are conditioned by genetic and environmental factors. Material and method: Nation-wide Slovak anthropometric surveys of children and youth during 2 decades (1981 – 2001) have been compared. Prevalence trends of chronic diseases in young population on the basis of national health statistical data were evaluated during this period. The development of the selected environmental contaminants has been also assessed. Results: The changes of growth in Slovak children and youth during last decades confirmed continuing growth acceleration particularly in boys. The positive secular trend in boys continues, in 18 years old girls it stagnates. The trend of the body proportionality is not parallel with growth. Prevalence of chronic diseases and disorders has revealed as the most frequently occurring and sharply increasing respiratory diseases with dominant prevalence of asthma, vision disorders, orthopaedic diseases, mental disorders, congenital disorders and defects. These results are partly different in the other European countries and could be caused by transformation of society (changes in family living standards, in health care system etc.). Conclusion: The growth acceleration of children and youth during the last decade could indicate improving of the life conditions. Increase of chronic diseases prevalence is in contrast and shows the impact of present big social disparities. Prevention requires identification and elimination of known environmental risk factors for children and youth health. The health educational activities should become materialized in healthy life conditions and environment of houses, of schools, playgrounds and communications.
24 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
SOCIOECONOMIC INEQUALITIES AS HEALTH INEQUALITIES DETERMINANT IN SLOVAKIA
Daniela Marcinkova1 1Department of Hygiene and Epidemiology, Faculty of Health Care and Social Work, Trnava University, Hornopotocna 23, 918 03 Trnava, Slovak Republic
Poverty and related concepts such as social exclusion and deprivation differ from inequality in that they relate only to the bottom end of the distribution or to characteristics of less advantaged social groups. Poverty, social exclusion and deprivation are defined and measured in different ways. Absolute poverty defined in terms of lack of the basic necessities for subsistence such as food, clean water, sanitation, shelter, health and relative definitions is about those who are excluded from participation in normal activities in society because they lack the necessary resources. Purpose: Refer to existing health inequalities according to socioeconomic inequalities among inhabitants in Slovakia. Assess knowledge and information level regarding health inequalities of public policy and decision makers. Material and method: We used data from EUROHIS (European health interview survey), questionnaire based survey, (401 respondents in Slovakia in age range 18-69) and from EHBS (European Health and Behaviour Survey), questionnaire based survey among 1248 Slovak university students in years 1999-2000). We used questionnaire based survey to assess health inequalities attitudes among decision makers. 534 questionnaires were distributed among Government ministers, Members of Parliament, Mayors of towns, small cities, villages in Slovakia in February 2004. Results: Socioeconomic inequalities as health inequalities determinant in European health interview survey and in European health and behaviour survey will be discussing by poster presentation. 88,2 % decision makers answered, health inequalities are presented in our society and influences health. 48,5 % answered they do not influence health inequalities by their own decision making and only 10,3 % answered they influence health inequalities by their decision making. Conclusions: The modern public health paradigm and recently accepted health models claims that about 75- 80% of intervention possibilities are outside of health sector and there is need to improve cooperation between decision makers and public health professionals in the field of socioeconomic inequalities.
25 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
ENVIRONMENTAL EPIDEMIOLOGICAL ASSOCIATIONS OF PSYCHOSOMATIC SYMPTOMS OF 7–11 YEAR OLD CHILDREN IN HUNGARY, 1997–2002
Dr. Mihály János Varró, Z. Virágh, P. Rudnai “József Fodor” National Centre for Public Health, National Institute of Environmental Health, Budapest
In a survey series, data on respiratory/other symptoms, hereditary, perinatal, environmental etc. factors of 7– 11 year old children were collected by highly standardised questionnaires in Hungary. Objective: To assess associations between environmental factors and psychosomatic symptoms of school children. Material and method: “Psychosomatic symptom” was defined as having at least one symptom out of fatigue, headache, irritability and anxiety. After data entry (by Epi Info 6.0x), crude (cORs) and adjusted odds ratios (aORs: in a validated backward model), moreover, 95% confidence intervals (95% CI) were calculated (by Stata 7.0; p<0.05). Results: Out of 13 973 children 4 038 (28.9%) had any psychosomatic symptom. – Boys and girls were about equally distributed; boys had somewhat higher risk (cOR=1.09, 95% CI=1.01–1.17; aOR=1.05, 95% CI=0.96–1.16). The following factors were found to have significant association with psychosomatic symptoms: age (aOR/1 year rise=1.18, 95% CI=1.12–1.24), living in villages (aOR=1.33, 95% CI=1.22– 1.45; this not in the backward model); illnesses: the parents had any respiratory/allergic illness (aOR=1.57, 95% CI=1.38–1.77), serious chest illness of the child during the first two years of life (aOR=1.73, 95% CI=1.56–1.92); environmental factors: use of the kitchen gas cooker for additional heating (aOR=1.80, 95% CI=1.47–2.21), mouldy flat (aOR=1.61, 95% CI=1.44–1.79), >20 cigarettes/day smoked in the flat (aOR=2.16; 95% CI=1.64–2.84), reported house/garden exposure to airborne sprays (aOR=1.84, 95% CI=1.28–2.65; in one survey only), and, as a social factor: mother with low education (eight or less elementary school classes; aOR=1.37, 95% CI=1.20–1.57). Conclusions: The environmental factors (found to be associated with respiratory symptoms) had strong associations with psychosomatic symptoms, too.
26 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
ENVIRONMENTAL AND SOCIAL RISK FACTORS OF INJURIES AMONG CHILDREN IN HUNGARY
Mária Bényi “József Fodor” National Centre for Public Health, Budapest
Objective: Injuries are leading causes of death among children. The hospital and outpatient clinics data usually not completed with external causes by health personal. The exact number of non-fatal injuries are not registered nowadays in Hungary. Material and method: To estimate the number of injuries among children age 0-18 we collected case reports involving district nurses in 2004 for year 2003. 211 nurses attended to the program (from 2500 of total active district nurses). The number of case reports were: 1222. On the basis of description of the accidents the following data were registered and analysed: Gender and age of children; reason of injuries (accidents), health consequences, social and physical environment. Results: From environmental health aspects the last two indicators should be taken into consideration: 63% of the accidents happened at home, 3% in kindergarten, 9 % at school, 3% on playgrounds, 6% on sport grounds. The most frequent injuries were burns, scalds (20%), in age 1-3 years. Reasons: the equipments are not safe for small children, the homes are very often crowded and the stoves are not protected. In addition, the parents and the grandparents were very often not careful. The crowdedness and poor housing are important in falls of few months old babies too. Poisoning (83 cases) happened very often at houses, where chemicals, medicines stored not safe. The accidental poisonings were typical for 2-4 years old children, who stayed at grandparents for a shorter period. The drowning of the small children happened very often on the wild waters and at homes where sludge water cisterns were not safely covered. Conclusion: The systematic data collection based on this pilot survey could help in understanding of environmental risk factors of injuries, and could give starting points for the injury prevention among children.
27 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
Housing and health
28 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
THE WHO HOUSING AND HEALTH POLICY
Xavier Bonnefoy (presented by: Matthias Braubach) Regional Adviser Noise and Housing, World Health Organization, European Centre for Environment and Health, Bonn Office
Objective: To present the WHO Housing and Health policy to environmental epidemiologists and health professionals working in public health and especially the housing area. Material and method: The WHO Housing and Health policy has been developed by the Housing Programme of the European Centre for Environment and Health in WHO EURO and is based on (a) literature reviews, (b) expert interviews, (c) analysis of policy documents, and (d) a pan-European study on housing and health in eight European and one Central Asian city. Results: The WHO Housing and Health policy has two main components: 1) Housing is considered as a wide-ranging construct, based on four dimensions (home, house, neighbourhood, community) that involve physical, social and psychological conditions. The health-relevance of housing conditions has therefore always to be evaluated in the context of all four dimensions. Having identified that most housing and health research is done in a compartmentalized approach (noise studies, indoor air studies, mould studies, infestation studies, thermal comfort studies…), the WHO Housing and Health unit suggests to bring all these individual areas together. Results of literature reviews and the WHO housing and health survey LARES have shown that there seem to be more associations between all these aspects than the current knowledge provides. 2) Work on cross-cutting issues that are affected and influenced by various housing factors (technical, financial, material, architectural and user-related) is to be prioritised. Relevant working fields are e.g. noise, energy efficiency and thermal comfort, indoor air quality, home safety and accessibility issues. Improvements of these cross-cutting issues are likely to provide large health gains which need to be quantified through intervention studies and cost-benefit analyses. Conclusion: Housing and health is increasingly considered as a public health issue and seems especially relevant in transition countries with partially inadequate housing stocks. To improve social security and individual health, housing interventions can provide various benefits but it is crucial that housing policies consider the complexity of housing and do not focus on individual topics only. In CEE countries, housing aspects of importance are suggested to be related to interventions and new policies in the areas of (a) housing access and equity / social housing, (b) maintenance of the existing housing stock, and (c) energy use and efficiency of the housing stock.
29 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
THE HEALTH RELEVANCE OF THE IMMEDIATE HOUSING ENVIRONMENT
Matthias Braubach Regional Adviser Noise and Housing, World Health Organization, European Centre for Environment and Health, Bonn Office
Objective: Residential conditions are shaped by both the in-house physical and social conditions and by the outside environment and its quality. The surrounding of the house covers a variety of factors that are capable of influencing health, well-being and quality of life of the residents. Among these factors, there are e.g. noise, public safety, open and public spaces, playgrounds and green areas, pollution and graffiti, maintenance, and air pollution. The identification of specific characteristics in the housing environment would allow to develop a targeted program aiming at preventing detrimental social, mental and physical health effects. Material and method: The proposed contribution will rely on the data collected during the WHO LARES survey (based on eight European and one Central Asian city). The analysis through logistic regression draws from over 8000 individuals in more than 3300 households. Results: The results identify a number of health effects that can be associated with the specific problem patterns in the immediate housing environment. Impacts of the housing environment are identified for (as) self-rated health, (b) depression, (c) sleep disturbance, and (d) cardiovascular symptoms. Noise, residential safety and presence of green and open spaces for recreation and leisure are among the main determinants of the quality and healthfulness of urban environments. Conclusion: It is possible and necessary to consider specific amenities and living conditions to be provided in neighbourhoods and residential places in order to turn them into liveable and health-supportive places.
30 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
ASSOCIATIONS BETWEEN MOULD/DAMPNESS IN THE HOME AND HEALTH STATUS OF THE INHABITANTS
Péter Rudnai1, M.J. Varró1, T. Málnási1, A. Páldy1, S. Nicol2, A. O’Dell2 , M. Braubach3, X. Bonnefoy3 1National Institute of Environmental Health, „József Fodor” National Centre for Public Health, Budapest, Hungary and 2Building Research Establishment, United Kingdom, 3WHO Regional Office for Europe, Office for Environment and Health, Bonn, Germany
Introduction: In 2002/2003 a WHO-coordinated Pan-European Housing and Health Survey (LARES Study) was conducted in 8 European cities/towns of various size, with different climatic conditions and various types of houses: Angers, Bonn, Bratislava, Budapest, Ferreira, Forli, Geneva and Vilnius. Objective: Using the large LARES database, to explore the associations between damp/mouldy homes and the health status of the inhabitants. Material and method: Three types of questionnaires were used for the study: one on the housing characteristics, one on the physical state of the home, and one on the health status of the inhabitants. The associations between mould growth and the inhabitants’ health condition were evaluated by using the LARES database covering 8519 persons. A mould variable was created incorporating all available information (both objective inspection of the interviewers and subjective declaration by the interviewees) on the size and appearance frequency of mould growth and dampness. This way four categories of people living in homes with no (n=4,404), little (n=1239), some (n=1,365) or much (n=1,392) mould and dampness could be identified. Associations between mould growth and disease prevalence were analysed with adjustments for age, gender, town, socio-economic status, smoking and environmental tobacco smoke. Results: There was an obvious dose-response relationship between exposure to mould and dampness and the prevalences of chronic bronchitis and bronchial asthma, as well as depression, migraine-type frequent headache, and – to a less extent – arthrosis or arthritis. Conclusion: Mouldy homes were found to be associated with adverse health conditions.
31 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
ASSOCIATION OF LUNG CANCER AND MOULD IN THE FLAT IN AN ENVIRONMENTAL EPIDEMIOLOGICAL SURVEY
Dr. Mihály János Varró1, Dr. Mária Posgay2, Prof. Dr. György Ungváry3, Mr. Zsolt Lang4 1”József Fodor” National Centre for Public Health, National Institute of Environmental Health, Budapest 2National Institute of Occupational Health, Budapest 3NCPH, Budapest 4Nomogram Ltd., Budapest
Objective: To assess associations between mould in the flat and lung cancer in an adult town population. Material and method: By interviewers, 2007 standardized questionnaires were filled in Nyergesújfalu, Hungary, on people of >35 years. Data entry was performed by Epi Info 6.04d and analysis by Stata 7.0. Occupationally exposed to asbestos were excluded from the analysis, so calculations of odds ratios (ORs: crude, cOR; adjusted to gender, age groups of 10 years and smoking behaviour: aOR) and of 95% confidence intervals, 95% CI, were performed on 1470 subjects. Results: Of 1465 people, 630 (43.0%) were male and 835 (57.0%) female. The median age was 53 years (interquartile range=44–63 years). 745 (of 1466, 50.8%) subjects smoked currently or formerly. 11 (of 1450, 0.8%) people had lung cancer. 92 (of 1354, 6.8%) people worked >20 years in a dusty workplace (cOR=6.10, 95% CI=1.55–23.99; aOR=4.17, 95% CI=1.02–16.88) and 132 (of 1437, 9.2%) had persistent mould in the flat (cOR=5.76, 95% CI=1.66–19.96; aOR=6.13, 95% CI=1.73–21.67). Conclusions: A strong (either adjusted) association of mould in the flat was found with lung cancer. Aflatoxin B1 is a class 1 human carcinogen – it is to consider the possible carcinogenic role of aerial mycotoxins. Albeit the number of lung cancer cases were few in the study, the association was highly significant. Further literature and field research needs to evaluate these findings.
32 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
Biological Monitoring
33 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
A PILOT STUDY OF BIOMONITORING AMBIENT GENOTOXIC EXPOSURE OF CHILDREN
Lívia Anna, B. Schoket, E. Győrffy, E. Erdei, P. Rudnai National Institute of Environmental Health, “József Fodor” National Centre Public Health, Budapest, Hungary
Biomonitoring of genotoxic exposure of children is a recently developing field in environmental health research. Biological response of children to environmental genotoxic exposure and the usefulness of the usual biomarkers for their biomonitoring is still largely unexplored. The objective of our pilot project was to study the detectability of genotoxic exposure of children to air pollution by using bulky DNA adducts as biomarker of exposure. The present work was built on a former epidemiological research performed in 1998 that investigated the respiratory health of 1700 school children aged 7 to 9 years in three industrialised and three urban background areas in Hungary. Traffic-related and environmental tobacco-smoke (ETS) exposure was assessed by questionnaire. DNA was isolated from archived frozen whole blood samples from a total of 90 individuals who were stratified into different exposure categories based on township, traffic and ETS exposure. DNA was analysed for PAH exposure-related DNA adducts by 32P-postlabelling using electronic autoradiography for detection of DNA adduct fingerprints. Many of the samples presented one or two characteristic spots, in a very low range of 0.1-1 adducts in 108 normal nucleotides, that could be related to the exposure. In the highest-exposed group (n=18) 83% of the samples presented the major spot and 27% the secondary spot, whereas in the lowest-exposed group (n=29) the corresponding ratios were 35% and 14%, respectively. The odds ratio for the formation of the major DNA adduct due to multiple exposure was 2.42 (95% Cl 0.90-6.53) as compared to the lowest exposure category. The results open novel perspectives in environmental exposure monitoring of children. Supported by the National Environmental Health Action Programme.
34 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
MOLECULAR MECHANISMS INFLUENCING THE BIOMARKER LEVELS OF ENVIRONMENTAL GENOTOXIC EXPOSURE
Bernadette Schoket1, L. Anna1, E. Győrffy1, S. Kostic3, A. Csekeő3, I. Soltész3, Z. Győri2, J. Segesdi2, J. Minárovits2 1”József Fodor” National Centre for Public Health, 2Béla Johan National Center for Epidemiology, 3Korányi National Institute of Pulmonology; Budapest, Hungary
Objective: The use of surrogate and target tissues to estimate environmental exposure and the influence of genetic susceptibility factors on biomarkers are key issues of human biomonitoring. Cigarette smoking can be a model for complex environmental genotoxic exposure, in which these aspects can be investigated. In the present research we compared smoking-related bulky DNA adduct formation in lung tissues and white blood cells and measured the influence of genetic polymorphisms of glutathione S-transferase (GST) biotransformation enzymes on the DNA adduct levels. Material and method: The study population comprised two hundred lung cancer patients who underwent lung resection. Levels of bulky DNA adducts were determined from samples of histologically normal bronchial tissue and blood lymphocytes by the 32P-postlabelling method. GSTM1, GSTT1 and GSTP1 Ile105Val genotypes were determined by PCR-based methods. Results: Significantly increased DNA adduct levels were detected in bronchial tissues of smokers as compared to non-smokers. A statistically significant correlation was observed between bronchial and lymphocyte DNA adduct levels for the non-smokers only. GSTP1 Val105 variant homozygous genotype decreased, and GSTM1 - GSTT1 double homozygous deletion increased bronchial DNA adduct level in smokers significantly. Conclusions: Our results suggest that the exposure level and the tissue capacity to metabolise xenobiotics influence the biomarker levels. Metabolism polymorphisms may modulate biomarker levels of exposure, which should be taken into account at exposure assessment. Acknowledgement: The research was supported by the Hungarian OTKA T034616 grant.
35 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
THE COMPARISON OF MISSING VALUES IMPUTATION METHODS IN BIOLOGICAL MONITORING DATA ANALYSIS
Dr. Rima Kregzdyte, Dr. Dale Baranauskiene, Ms. Rima Naginiene, Dr. Olegas Abdrakhmanovas Institute for Biomedical Research, Kaunas University of Medicine, Kaunas, Lithuania
Introduction: Most of biological monitoring studies require repeated measures analysis. But the common problem of longitudinal studies is incompleteness of data. Missing data may reduce the precision of calculated statistics. Most analysis methods cannot be performed if data set is incomplete. The objective of this study was to find an appropriate method for estimation of missing values in the assessment of changes of one of the most sensitive biomarkers of lead toxicity, delta- aminolevulinic acid dehydratase (delta-ALAD) activity and lead concentration in blood (PbB). Material and method: The biological monitoring of workers, occupationally exposed to lead, has been conducted over six years (1998-2003). Changes of delta-ALAD activity in blood were investigated in dependence on PbB. PbB was determined by atomic absorption spectrophotometer with Zeeman effect. Delta-ALAD activity in blood was measured according to the European standardized spectrophotometric method. Five methods of dealing with missing values were applied: listwise deletion, imputing mean of time- adjacent measurements, expectation-maximization, multiple regression, and multiple imputation. Repeated measures analysis of variance was applied for evaluation of changes in delta-ALAD activity and PbB concentration over the all period. Results: All methods produced similar results: the long-term exposure to lead was related to negative changes in delta-ALAD activity and might cause disorders in heme biosynthesis. Conclusions: Listwise deletion is easy but inefficient method for handling missing data. Filling missing data with plausible values is more efficient. Regardless of the single imputation methods merits, imputed values are only estimates of the unknown true values. The imputed data sets fail to provide accurate measures of variability. More advanced multiple imputation methods are preferable.
36 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
Global climate change and health
37 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
HEAT WAVES IN BUDAPEST, 2001-2003
Anna Páldy1, J. Bobvos2, A. Vámos2 1“Fodor József” National Centre for Public Health, National Institute of Environmental Health, Budapest 2Capital Institute of the National Public Health Service, Budapest
We investigated the health impact of extreme temperature episodes between 2001-2003 by applying the modified methodology of ENHIS1 House_E1 indicator and byown method. The mean daily temperature was considered, three categories were examined: temperature recorded above 97%, 98% and 99% frequency. The “heatwave” periods were identified: 3 or more consecutive days when daily mean temperature was above >26,6 oC The health outcomes were all cause, cardiovascular and respiratory deaths for the permanent population of Budapest. The mortality data source was the Central Statistical Office, the temperature data were retrieved from the National Meteorological Service, (Pestlőrinc Station). The number of excess death was calculated in 2 ways: a): excess summer death calculation for each heatwave acc. to WHO method: Cumulated daily mortality following the onset of the period of extreme heat with a 3-day delay was extracted from the average of the cumulated daily mortality calculated from the previous 3 years for the same period.. The same procedure was carried out for cardiovascular and respiratory deaths. b) Cumulated daily mortality for the identical period of extreme heat was extracted from the average of the cumulated daily mortality calculated from the previous 3 years for the same period. Results: the descriptive analysis of the data showed that the mean temperature was the highest in 2002 (15,9 oC), the highest daily mean was recorded in 2003 (29,5 oC) The daily mean of total death counts showed a decreasing tendency from 67.5 to 61.1, however the daily mean counts of cardiovascular deaths did not changed (32.6 cases). The number of extreme hot days increased from 9 to 32 days. The number of heatwaves were 1 in 2001, and 2 in 2002 and in, 2003 – the longest one was in 2003, 06.06.- 13.06.2003. The number of days with mean temperature >26,5 °C (97 %) was 3 (2001, 9(2002) and 11 in 2003. TM_WHO CM_WHO RM_WHO TM_HUN CM_HUN RM_HUN total number of excess death 29,67 109,67 13,0 178,33 161,67 10,3 mean excess death count/day 1,29 4,8 0,6 7,8 7,0 0,4 % of daily excess death 2,0 14,6 28,5 12,3 21,5 22,6
By comparing the two methods for evaluating the effect of heat waves it seems that in case of Budapest extreme heat has an impact on mortality on the hot days. We can not state a delayed effect of extreme temperature on mortality using 3-day-lag. In case when 2 heatwaves occurred in one summer period, the effect of the first heatwave was much stronger than the second one.
38 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
HEAT WARNING SYSTEM AND COMMUNICATION IN HUNGARY
Krisztina Kishonti1, A. Páldy1, J. Bobvos2
1„József Fodor” National Centre for Public Health, National Institute of Environmental Health 2National Public Health and Medical Officier’s Service
„József Fodor” National Centre for Public Health, National Institute of Environmental Health (NIEH) has cooperated with the NPHMOS and the National Meteorological Service (NMS) to take part in a 3-year project named PHEWE 2003-2005. (EU/QLKA-CT-2001-00152 Sz) Aim of the PHEWE is to analyse the effect of heat waves on daily death (cardiovascular, respiratory and cerebrovascular diseases) and hospital intake as well as to process a weather forecast system to facilitate the adaptation to weather changes. The Hungarian weather forecast system with the help of the University in Birmingham was set up in 2003 based on the data by the NMS. The NIEH sends the forecast based on the „heat-wave” criteria to National Ambulance Service in order to announce “heatwarning” to the public and pay the population’s attention to the risks of the heat, the symptoms and the methods of the prevention. For 2005 our communication objective is to - create a national network in which medical chief and medical officers, local governments and GP-s work together for better communication, - keep informative presentations with regard to the teachers at the beginning of summer - make informative posters and leaflets for schools, pharmacies, local governments, - publications in daily free newspapers, monthly magazines for males and females - operate free green info line in Budapest and in the counties through Hungary.
39 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
SUNBED USER’S MOTIVATIONS, KNOWLEDGE AND HABITS IN BUDAPEST, HUNGARY
József Bakos, J. Szabó, Gy. Thuróczy National Research Institute for Radiobiology and Radiohygiene, “József Fodor” National Centre for Public Health, Budapest
Objective: The aim of this study was: to recognise the main motivations of sunbed use of the Hungarian public, the user’s knowledge of health effects and their habits related to tanning in sunbed and/or by sunlight. Material and method: The study was performed in five sunbed salons in Budapest. Sunbed users were asked to complete a questionnaire containing 59 questions. Results: 443 of 500 questionnaires (88,6 %) were completed by customers of five sunbed salons in the Hungarian capital between 24/03/2004 and 31/05/2004. The results of statistical evaluation of the 442 completed questionnaires are the following: 87 % of users were regular sunbed user, 64.7 % of users were women. The average age was similar in both gender: 27.1 and 27.8 years in case of men (M) and women(W), respectively. Most participants finished secondary school (66 %) and college (26 %). 52 % of participants (56 %/50 % M/W) classified their skin as “tan well” (Fitzpatrick skin Type 3). 53 % of individuals reported rarely occurring “sun”burn due to sunbed use (15 % once, 16 % never) and 7 %(18 women and 10 men) frequent burning. 25 % of men and 30 % of women are suffering from some kind of allergic disease. Conclusions: Most participants are younger than 30 years old and fairly educated. Although, almost everybody is aware of the cosmetical risks (ageing and burning of the skin), their knowledge of the health hazards is inconsistent. As the main information source about the health risks was found to be the electronic media (while the school is the last), public relations campaigns must be undertaken, and children’s awareness of the health risks of natural and artificial UV radiation is needed to be raised at schools.
40 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
SKIN CANCER PREVENTION PROGRAMME AMONG SCHOOL-AGE CHILDREN
Katalin Fehér1, B. Oroszi1, J. Paller1, I. Ember2, M. C. Cercato3 1County Győr-Moson-Sopron, Institute of National Public Health and Medical Officier’s Service 2Medical Public Health Insitute of Medical Faculty, University Pécs 3Regina Elena Institute, Rome. Objective: The incidence and mortality of skin cancer are increasing worldwide. Our Institute has joined cooperating with the Medical Public Health Institute of Medical Faculty, University Pécs to the international skin cancer prevention programme of Regina Elena Institute, Rome. The program is focused on the primary prevention of melanoma malignum, specially among 6-10 years old children. Material and method: We spread questionnaires concerning the known genetic, environmental and behavioural risk factors and by this we classified the children into low, medium or high risk group considering the skin sensitivity to sun radiation. Before the summer holiday we send to the children their result and a recommendation letter on sun safety. Result: In city Győr we have been spread 2 000 questionnaires to primary schools children, and we have collected 1 330 filled questionnaires. 11.45% of children belong to the low risk group, 62% to the medium risk group and 26.6% to the high risk group. Conclusion: We are planning to continue the program and extend it to other cities and regions. The questionnaire and the evaluation are unified, so it gives the possibility of regional and international comparing. The program helps to make an effective primary prevention and according to our plan repeating the survey on the same population in every 2-3 years the change of the risk and the effectiveness of the program would be measured.
41 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
Poster Section A
42 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
ANTHROPOMETRIC NUTRITIONAL STATUS AMONG ADOLESCENTS
Tanya Turnovska1, B. Marinov2, S. Mandadjieva2, Hygiene and Ecomedicine1, Pathological Physiology2 , Medical University, Plovdiv, Bulgaria
The nutritional model of people in Bulgaria, especially among children and adolescents, was reflected negatively because of social and economic crises during the last 15 years. An anthropometric characteristic is an indicator for assessing personal nutritional status, and depends on the individual energy expenditure. Objective: To analyse the nutritional status of adolescents by assessment of basic anthropometric parameters. Material and method: The study was carried out during May–June 2003 with 146 participants; 122 girls with mean±SD age of 16.12 ±0.87 y and 24 boys aged 15.79±0.93) y. Height and weight were taken by standard methods and compared with the Bulgarian norms. Body mass index, height for age, weight for age, weight for height, and relative body mass to ideal body mass were also determined. Individual energy expenditure was analysed by the chronometric table method during the morning (E1) and afternoon (E2) education periods and during weekend (E3). Results were processed by descriptive statistics and Student’s t test. Results: Of the subjects, 56.91% of girls and 58.33% of boys fell within the Bulgarian norms regarding level of physical development to their age by height and age. The assessment of BMI showed normal body mass among 96.75% girls and 87.5% boys. Overweight was found among three girls and three boys, and one girl was obese. Stature (cm) by age (P30÷P70) was found among 51 girls (41.46%) and 10 boys (41.67%). For girls versus boys, respectively, E1 was 2883.05 (270.47) versus 3230.87 (443.39) kcal, p<0.001; E2 was 2756.17 (282.27) versus 3054.87 (415.13) kcal; and E3 was 2754.34 (317.32) versus 3194.71 (464.32) kcal. Significant differences between E1, E2, and E3 were not found among boys but E1 was consistently higher than E2 and E3 among girls. The mean level of energy expenditure was higher than the recommended one for the corresponding age and sex group compared with the physiological norms. This possibly means that the chronometric table method is not precise enough. Conclusions: Most of the investigated adolescents, who had been growing up during a severe economic crisis, have normal anthropometric characteristics. The chronometric table method of reporting on the individual energy expenditure needs improving.
43 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
NUTRITION AND NUTRITIONAL STATUS AMONG BULGARIAN AND ROMANY CHILDREN AT PRESCHOOL AGE
Tanya Turnovska1, S. Savov2, M. Arabova3, G. Kavlakov1, N. Boyadjiev1 Medical University1, Plovdiv University2, Kindergarten “Lilia” 3, Plovdiv, Bulgaria
The social and economical status of most Bulgarian people become very hard during last 15 years. Decrease of the real net wage threatens, the nutritional and health status of a mass of people were registered. The problem grows up sharply when added a fact that a series of diseases are associated with nutritional deficit during early childhood as heart diseases for example. The aim of the present study was to make the attempt of nutrition assessment and to analyze anthropometric nutritional status, blood pressure and pulse-rate among Bulgarian and Romany children at preschool age. Material and method: The anthropometric nutritional status of 56 Romany at 4.73±0.98 y (X±SD), attended kindergarten R) and 77 Bulgarian 4.61±1.10 y, attended kindergarten B) by standards methods, and % of mass tissue by method of Weight Calc 2.0 for PDA during December 2003 were analyzed. Two kindergartens are situated in the same district, closely each other. Dietary data was obtained by calculation register of the corresponding kindergarten for every attending day of March and September 2003. Results:
Products March Referents’ September Gr/1child/1day R B levels R B Milk and milk pr. 235.3 192.6 425 310.6 216.41 Meat and meat pr. 50.5 99.1 85 49.2 48.18 Cereals 251.8 155.6 190 214.2 198.8 The mean levels of consumption of milk, fish, meat, fresh vegetables and fruit is low among the two groups; the added fats are predominantly cooking oil; high consumption of salt was found (4.6 g vs. referent level of 2 g). Height → 103.79±6.95 cm (X±SD cm) (Romany) vs. 110.61±9.18 (Bulgarian), p<0.001;Weight → 17.73±2.86 (X±SD kg) (Romany) vs.19.55±3.81 (Bulgarian), p=0.02; Blood pressure → 96.54/54.64 (Romany) vs. 97.78/59.94 (Bulgarian); Pulse-rate → 93.95±13.51 (X±SD) (Romany) vs. 95.04±18.39 (Bulgarian), p>0.05; % of mass tissue → 14.78 % (8.5÷20.6) among Romany vs. 15.39 % (7.7÷22.8). Conclusion: The unfavourable characteristics of nutrients intake were found, which are related to the food consumption pattern. Serious retardation was determined among Romany children.
44 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
EXPOSURE TO DIFFERENT FLUORIDE LEVEL IN DRINKING WATER IN ESTONIAN POPULATION
Ene Indermitte, A. Saava University of Tartu, Estonia
Introduction: Fluoride is a natural element found in various concentrations in all groundwaters. Ingestion of fluoride in the drinking water reduces the prevalence of dental caries due to increase in tooth mineralisation. In high doses of fluoride toxic effect occurs (primarily dental and skeletal fluorosis). In recent years other adverse health effects of fluoride have been studied (neurotoxic effect, bone fractures etc.). Drinking water is the main source of fluorides for humans. The aim of the study was to measure the fluoride content of water in public water supply systems in Estonia and to assess the exposure to different fluoride levels in Estonian population. Material and method: All public water supply systems serving at least 100 inhabitants were included into the study. Water samples were taken from the tap water and fluoride concentration was measured colorimetrically using SPADNS method. Results: The study population was 70,6 % of Estonian population. In total 735 water samples were taken from 44 towns and 473 smaller settlements. Fluoride content in water samples varied in a big range between 0,01 - 6,95 mg/l. National limit (1,5 mg F-/l) was exceeded in 15 % of samples. Over 7,3 % of study population are exposed daily to high-fluoride water, mainly in West-Estonia. Half of the population is consuming water with optimal fluoride content (0,5-1,5 mg/l). At the same time over 40% of consumed water has very low fluoride content (up to 0,5 mg/l). That type of water is prevalent in South-Estonia and in capital Tallinn. As a result of the study a database of drinking water was established characterising the fluoride level in drinking water in Estonian towns and settlements. It can be used by dentists in planning dental care and prevention measures but also in improving public water supply.
45 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
AIR POLLUTION CONTROL OF THE SMOKING PLACES
Márta Szalkai “József Fodor” National Centre for Public Health, National Institute of Environmental Health, Budapest, Hungary
Objective: Tracking of the change on the concentrations of air pollutants: ozone(O3), carbon-monoxid (CO), total suspended particulate (TSP) occuring indoor during smoking within air-cleaner working continuously. Material and method: Air pollution was studied in two places with different function in a restaurant and in a shop floor. O3, CO and TSP concentrations were measured by automatic analysers (Environement type) working continuously. The measurements have been carried out with 15 min average time at the restaurant for four hours. Air pollution was controlled in the shop floor on two different* smoking places for 24-24 hours with 1 hour average time. *A roof shield was used in order to increase the efficiency of the air cleaning above the second smoking place in the shop floor. Results: The air pollution effect of smoking could be tracked in case of the three air pollutions very well. The increase of the concentrations of CO and TSP by smoking were remarkable and O3 level originating from the air cleaner was detectable. Maximum concentrations were in the restaurant the following: total suspended particulate 315µg/m3, carbon-monoxid 4,7mg/m3, ozone 84µg/m3 . After the comparison of air pollution level at the smoking places in the shop floor the following results were obtained: the average concentrations of the studied components were much lower in the case of place with roof shield: the maximum concentration of the TSP was 228µg/m3 on the first place, was 117µg/m3 on the second one: in case of CO 3 3 3 3 were 9,3 mg/m and 7,7 mg/m ; of the O3 were 23µg/m and 4,5µg/m respectively. Conclusion: The studies have established the designation of the smoking places and have helped the development of the suitable ventillation technique.
46 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
PULMONARY FUNCTIONS AND PHYSICAL CAPACITY AMONG ADOLESCENTS ATTENDING TWO SCHOOLS SITUATED IN THE DISTRICTS WITH DIFFERENT LEVELS OF AIR POLLUTION
Tanya Turnovska1, S. Mandadzhieva2, B. Marinov2 Dep. of Hygiene and Ecology1, Dep. of Pathological Physiology2, Medical University - Plovdiv, Bulgaria,
Quantifying and evaluating the health effects of air pollution is an essential part of integrated environmental health-impact assessment and required information on exposures at an appropriate level of aggregation to the various air pollutants concerned. Pupils are inherently mobile and are exposed to pollutants at home, during commuting and at school. Air quality is also highly variable spatially; ten-fold variations may be found in the space of only a hundred meters (WHO, 1997). In fact 6-7 hours daily (without weekends) all pupils at a given school are influenced of air pollution typical for the place of that school. Whether it is enough exposition to be reported any changes of health status? The AIM of the present study was to analyze the pulmonary functions and physical capacity of adolescents attending two schools situated in the districts with different levels of air pollution. Material and method: Pulmonary functions and physical capacity among two groups of pupils (non- smokers) were analyzed during June 2003. Ve, VC, FEV1, FEV1%, PEF, TLco, TLco%, VO2/VO2pred, VO2max, etc. were examined in functional laboratories of Medical University. First group (I) - 20 boys and 29 girls at age 15.97±0.89 y, have attended the school situated closely to street with intensive motor transport 3 3 traffic and high level of air pollution (TSPM → 0.26±0.012 (X±SE) mg/m , NO2 → 0.052±0.003 mg/m ) and the second group (II), formed from 46 girls and 6 boys at age 16.35±0.92 y, attending school situated far 3 3 from massive sources of air pollutants: TSPM → 0.10±0.005 mg/m , NO2 → 0.027±0.003 µg/m . Results: The following significant differences were found among boys: VC %→ 106.7±10.3 (I) vs. 94.6±11.4 (II), p=0.022; FEV1 %→ 114.4±12.9 (I) vs. 100.3±12.8, p=0.02 and girls: Ve→ 62.3 ±11.3 (I) vs. 55.6±12.4 (II), p=0.021; TLco % → 84.58±10.3 (I) vs. 92.8±14.3 (II), p=0.011. Conclusion: There was found some negative effects of established level of air pollution over pulmonary function among the girls during their daily stay at school.
47 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
STATUS OF THE VITAL ENVIRONMENT AND THE HEALTH OF THE POPULATION IN A LEAD-ZINC OUTPUT REGION IN BULGARIA І. POLLUTION OF THE VITAL ENVIRONMENT WITH HEAVY METALS
Jeni Staykova1, B. Nikiforov2, O. Mihaylovskaya1, T. Turnovska3 Hygiene and Epidemiology Inspectorate – Kardzhali1, National Centre of Hygiene, Medical Ecology and Nutrition-Sofia2, Medical University – Plovdiv3 – Bulgaria
One of the main producers of non-ferrous metals in Bulgaria is Lead-Zinc Plant in the town of Kardjali. It was established and started its activity in 1955, metallurgical complex approach an annual output of about 35-40000 t lead metal and up to 30000 t zinc metal in 1970, which exceeds project’s capacity with 25-30 %. Systematic monitoring of the vital environment shows significant exceeding of the top limited for the air emissions and emission levels. As a result after several decades work of the plant it was ascertain pollution not only of the air, but into all the rest components of the vital environment. The aim: the recent study is to analyze results of the investigation of the air, waters, soils and foods for contents of lead and cadmium in Kardjali. Material and method: Taking of samples from the relative components of the environment and bigger part of the researches are realized from the Hygiene and Epidemiology Inspectorate(HEI) Kardjali assistants, according to unified for the country methods, and a less of them are done from the National Centre of Hygiene, Medical Ecology and Nutrition - Sofia. Results: The atmospheric pollution is controlled in three stationary points. The annual average concentrations of lead aerosols for the period 1990 –2002 within the three points are over the top admissible levels (TAL) – 0,5 µg/m3, with few exceptions. The highest maximum values within 24 hours of lead aerosols measured in point HEI vary between 7,7 µg/m3 (1990) and 12,2 µg/m3 (1998); in point CTS relatively between 9,31 µg/m3 (2001) up to 15,8 µg/m3 (2002); in point Veselchane - between 7,7 µg/m3 (1991) and 21,9 µg/m3 (1997). Cadmium aerosols are determined from 1999. Annual average values of Veselchane point in 1999 are 0,22 µg/m3 (22 times TAL), in 2000 – 0,1 µg/m3 (10 times TAL), in 2001 - 0,2 µg/m3 (20 times TAL) and in 2002 – 0,052 µg/m3 (5,2 times TAL);in point CTS they vary from 7 up to 10 times TAL. The highest maximum 24-hours cadmium concentrations are described in point Veselchane in 1999 – 12,79 µg/m3 (639,5 times TAL) and in 2001 – 1,61 µg/m3 (80,5 times TAL); in point CTS in 1999 – 7,3 µg/m3 (365 times TAL) and in 2001–1,32 µg/m3 (66 times TAL). Lead content in the drinking waters in limited maximum value of 10 µg/l, is in order of 1µg/l (range < 0,8µg/l -1,1µg/l); the cadmium vary from “it can not be proved” up to 0,07 µg/l with maximum limited value of 5µg/l; in the town area of Kardjali, around the kindergartens and schools, the lead contents exceeds over twice the TAL, and a cadmium content is in the upper limit level of the TAL for soils. In the research of potatoes, onion and beans were found out concentrations of lead metal between 0.06 and 0.15 mg/kg and cadmium metal–between 0.018 and 0.053 mg/kg. Conclusion: It is defined a risky for the health level of polluting with heavy metals (lead and cadmium) of the vital environment in Kardjali.
48 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
STATUS OF THE VITAL ENVIRONMENT AND THE HEALTH OF THE POPULATION IN A LEAD-ZINC OUTPUT REGION IN BULGARIA ІІ. BIOLOGICAL MONITORING
Jeni Staykova1, B. Nikiforov2, O. Mihaylovskaya1, T. Turnovska3, Hygiene and Epidemiology Inspectorate – Kardzhali1, National Centre of Medical Ecology and Nutrition- Sofia2, Medical University – Plovdiv3 – Bulgaria
With the research held during 1979-1981, when Lead-Zinc Plant in Kardjali has worked with its full capacity, consistent of lead into the blood of 70 % of the students going to a school placed about 500 м far from the plant has been up to 86.1±9.1 µg %. The sudden reducing of the production volume in the crisis period after 1989 year, suppose positive changes in the ecological circumstances and the health status of the population. The aim of the recent study is to present the results of the biological monitoring of children from Kardjali done during 2003. Material and method: The study was carried out in National Center of Hygiene, Medical Ecology and Nutrition. Specified are the levels of Lead (PbK), Cadmium (CdK) and Protoporphiny (EPP) in the blood of 101 children from Kardjali (50 boys and 51 girls) aged 11-13 years old (X±SD). The concentrations of lead and cadmium are defined through electro-thermal nuclear-absorption spectrometry with graphical atomizer, using modifications of the methods, described in “Biological Monitoring of Chemical Exposure in the Workplace”, vol. 1, WHO (1996). EPP is defined through spectral-fluor-metrical Piomelli’s method, 1973. Spectral-fluor-metrically measurements are done on spectral-fluor-metric device Perkin , USA. For comparison are examined the same indexes in relative group (15 boys and 18 girls) from Krumovgrad. Results: The average level of Lead in the blood (PbB) of Kardjali’s children is 92.7 ± 44.7 µg/l, (average 82 µg/l), with registered individual values from 30 up to 259 µg/l. The estimated average concentration of PbB with the children from Krumovgrad is 57.9 ± 15.1 µg/l (average 58 µg/l), with individual values from 30 up to 93 µg/l. The level of the Lead into the blood in Kardjali’s children is statistically approved higher then the children from Krumovgrad (Р<0.0001). The received individual results for Cadmium in the blood of the children in both towns vary within the normal values range, published in the issues ~ 1 µg/l ((Tsalev, 1995). The average level of CdB of Kardjali’s children is 0.43 µg/l, average 0.38 µg/l and a range of vary of different results from 0.14 до 1.04 µg/l. In Krumovgrad these values are respectively 0.22 µg/l, 0.21 µg/l, 0.10-0.47 µg/l. With the children from Kardjali, the average content of EPP is 48,06 ± 18,37 ug/dl RBC, and with the children from Krumovgrad – respectively 47,91 ± 10,69 ug/dl RBC, P>0,05. Conclusion: 1. In 71% of estimated children in Kardjali, there is lack of data for healthy risk – values of a Lead in their blood are under 100 µg/l; in 24 % of the children need additional researches - values of a Lead in their blood are between 100 and 200 µg/l, and in 5% (with values over 200 µg/l), exists healthy risk. Incoming into the blood lead is not reach values, which can lead to breaking of the biosynthesis of the haemoglobine. 2. We have not data for increasing entering of cadmium into the organism.
49 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
A CHRONIC LEAD INTOXICATION AMONG OCCUPATIONALLY EXPOSED PERSONS
O. Mihaylovskaya1, Jeni Staykova1, T. Turnovska2 Hygiene and Epidemiology Inspectorate – Kardzhali1, Medical University – Plovdiv2 – Bulgaria
All the workers in the Lead-Zinc Plant in Kardjali are potentially exposed from the lead intoxication with different degree of it, depending of specific conditions of the environment. The most risky is lead producing factory, where the content of the lead aerosols is significantly over the top admissible concentrations (TAC), in the range from 0.4 up to 1.23 mg/m3. High are the levels of the Cadmium also – 0.167÷0.375 mg/m3. Additionally weighing figures are uncomfortable microclimate (to=24.3÷37.5 Co, heating radiation 120÷780 W/m2), the intensive physical overloading and the compulsory working attitude. The aim of the recent study is to analyze registered into the NSSI cases with chronic Lead intoxication among the workers from the lead factory for the period April 1st 2003 – April 1st 2004. Material and method: Through the appointed period are registered in National Insurance Institute 7 cases of chronically lead intoxication with strong objective symptoms. In all of them are ascertained characteristic clinical and para-clinical symptoms: hematological changes (moderate hypo-chromic anemia, reticulocitsis, hyperciderinems); gastrointestinal syndrome (lead colic, diarrhoea, anorexia), liver malfunctions, kidney syndrome, cardio-vascular diseases (toxic myocardial, early atherosclerosis with cerebral-vascular changes), etc. The all seven workers are men age between 27 and 48. Their labor record into the Lead factory is between 4 and 11 years. Additionally figures for the condition are cigarette smoking (more than 10 years), systematically drinking of alcohol (more than 100 ml concentrated alcohol per day), unhealthy nutrition and requirements by hygiene and safety labor (personal precaution means etc.). We should add in this also the fact, that all of them live in the tow of Kardjali and they are life conditions exposed of lead aerosols from very early age. The blood level into the blood serum of the workers in their first taking in the hospital was: 5.58(1), 5.17(2), 4.21(3), 6.0(4), 6.6(5), 7.12(6) and 5.56(7) Mmol/l. After providing of the detoxicating courses with EDTA it is the next: 2.98(1), 3.08(2), 3.34(3), 4.0(4), 4.22(5), 3.58(6), 3.16(7) Mmol/l. Conclusion: It is defined a very high level chronic lead intoxication among 7 workers in Lead factory in Kardjali. 2. Cigarette smoking, alcohol drinking, unhealthy way of life and parallel-loading of the human body with lead aerosols from life surroundings accelerate the positive lead intoxication
50 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
EVALUATION OF RAGWEED (AMBROSIA) THE MOST IMPORTANT ALLERGIC INDICATOR OF AIRBORNE POLLEN IN HUNGARY IN 2000-2004 MONITORED BY THE HUNGARIAN AEROBIOLOGICAL NETWORK
Collinsné-Horváth, Zs.1, Páldy, A. 1, , Józsa E. 1, Apatini, D. 1, Replyuk E. 1*, Erdei, E. 1, Hardy T. 1, Magyar D.3. Kishonti, K. 1, Farkas I.4: 1„József Fodor” National Centre for Public Health, National Institue of Environmental Health., 3Plant Pathogenic Inst of Hung. Acad Sci,. 4Hung. Allerg. Clin. Immun. Society.
The increasing number of patients has increased three-fold in the last 12 years, 64 % of inhalation sensitivity was proved to be an allergic etiology among new patients. AS the same time new patients with asthma diagnoses increased five fold as well as a remarkable increase in Rhinitis Dg., but in tendency it was decreased according to the Natl. TBC and Pulm. Inst. „Korányi”. Aim: Evaluation of exposition to Ragweed pollen in Hungary in 2000-2004 by using DPSEEA model. Material and method: airborne exposition to aeroallergens is monitoring by Hungarian Network. Were monitoring stations monitor the concentration of pollen applying standard sampling method: Hirst type Burkard trap; samples are stained by para-rose-anilin dye and evaluated under microscope. The Ragweed exposition is evaluated by 3 parameters: → yearly total pollen count/m3, →daily max of the season (pollen count/m3), → number of days (>100 and >500 pollen count/m3).The ragweed covered is used as the state of indicator. Data of monitoring station are used for indicator exposure . As he effect data morbidity due to allergic Rhinitis and Asthma are shown. The modified Law on Plant Protection is cited as action indicator. Nationwide campain are organized to support weed, especially Ragweed eradication. Results: We compared the Ambrosia pollen (AmbP) occurrence at the beginning of Season (S) over a five years period, the date of the highest occurrence (“Maximal yearly” AmbP conc.(c)) the extent of the S and the Number of days (Nd) when AmbP So limits are >30-100/m3, >100/m3 and >500/m3 which are important levels in respect of environmental health. 2 days occurred in Budapest in 2003 and 4 in 2004 when AmbP c levels is >100/m3 2002 was the best year when no days occurred when AmbP in air was >100/m3. There were occurrences of >1000 AmbP/m3 in Kecskemét in 2001, and the decrease is not linear.There were 27 and 32 when AmbP So was >100 /m3. In Debrecen the max. daily recording was 497/m3 (21th Aug in 2004), in Veszprém: 785 /m3 (24 th Aug in 2004), in Zalaegerszeg 700/m3 in 2001 and in 2002, and this decreased to 400 in 2003 and 2004. The tendency Nd with >100 AmbPc is 23, 21. Nyíregyháza: decreased the Mdc the S tendency to 29 days when occurrence was >100AmbP/m3. In Pécs the Mdc of the S is 605/m3 on 31h Aug. in 2004. There is a significance among the pollen counts and the Ragweed weed covering in Hungary. Conclusion: The ragweed eradication program shall contribute to the decrease of incidence of allergic diseases in a medium term.
51 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
SITE HAZARD ASSESSMENT AND RANKING AS A TOOL OF ENVIRONMENT AND HEALTH PREPAREDNESS
Gyula Dura, PhD National Institute of Environmental Health, “József Fodor” National Centre for Public Health, Budapest
Objective: Health threats from physical, chemical or biological sources mean serious and increasing problem to the European Community. Early warning and rapid response is elementary not only dealing with communicable diseases but also in emergency preparedness for industrial chemical accidents. The European Environment and Health Committee and the Italian Ministry for Environment and Territory initiated a proposal to develop a method which is capable for defining potential environmental and health hazards originating from industrial activity. Material and method: International experts worked jointly on the project of which the main purpose was to develop, implement and test an evidence based methodology to assess and rank environment and health risks in a rapid way in selected industrial sites among the area of mean and lower Danube basin. The analysis was directed to risks connected to sudden industrial accidents involving hazardous substances. The method was tested in different plants of three countries of the area: Bulgaria, Hungary and Rumania. Results: The implementation allowed transboundary analysis between participating countries and also gave a good opportunity to bring together relevant authorities and to analyse impacts of industrial plants on environmental safety in a complex meaning. Conclusion: The method could provide information on health relations of risk thus can be useful for local authorities, industrial experts, and emergency preparedness planning managements for supporting decisions on different levels. The poster will share the experiences and results of the implementation process in consideration of their significance in environmental safety.
52 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
ANALYSIS OF MORTALITY AND MORBIDITY DATA OF MESOTHELIOMA IN HUNGARY WITH THE HELP OF SPATIAL AND STATISTICAL METHODS
Gizella Nádor, A. Páldy, G. Galgóczy: “József Fodor” National Centre for Public Health, National Institute of Environmental Health, and National Institute of Occupational Health Budapest, Hungary
Environmental Health Action Programme of Hungary an environmental health geographic information system (HEGIS) has been developed. The system gives tools to evaluate the association between health and environmental factors in order to reveal spatial and temporal changes. With a help of spatial and statistical methods of this system the health impact of factories producing asbestos containing goods on mortality and morbidity due to mesothelioma (C45) stratified by sex was analysed. Mortality data were examined in 3 time periods (1986- 2003, 1986-1993 and 1994-2003), morbidity data were analysed between 1997 and 2002. Mortality and morbidity were characterised by the standardized mortality/morbidity ratio calculated by the method of indirect standardisation. The spatial distribution of SMR values was shown on maps to reveal the unfavourable areas of this disease. In the environment of the settlements with factories (Nyergesújfalu, 11-th district of Budapest and Lőrinci) as point sources) with most unfavourable of mortality and morbidity due to mesothelioma the health impact was studied in people living in the vicinity of these settlements by methods of Bithel and Stone. General Poisson distribution test, Poisson maximum test and Kolmogorov – Szmirnov test with Conover modification were used to calculate the significance of the impact of these settlements as sources of pollution. Common SMR values calculated on concentric circles were analysed in relation to the distance from the point sources. Ratio of the cumulated observed and expected cases in relation to the distance from the point sources was also examined. According to the results the impact of Nyergesújfalu on the environment was significantly (p<0,01) unfavourable in all examined cases both for morbidity and mortality. The impact of the 11-th district of Budapest on their environment is significantly (p<0.01) unfavourable in case of mortality for males in the time period of 1986-2003 and 1986-1993. In any examined cases of morbidity there was no significant unfavourable impact demonstrable. The impact of Lőrinci was significantly (p<0,01) unfavourable in the cases of morbidity for both gender. As for mortality their unfavourable impact on the environment was stronger in the case of males than females. The unfavourable impact is stronger in the later time period than the earlier. Acknowledgement: the study was supported by the National Research-development Program ENRISK (NKFRP 1B6047/2004)
53 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
Poster section B
54 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
INFLAMMATORY AND CYTOTOXIC EFFECTS AS WELL AS HISTOLOGICAL FINDINGS AFTER EXPOSURE TO ASBESTOS AND ASBESTOS SUBSTITUTES IN EXPERIMENT
1Hurbánková, M., 1Černá S., 2Tátrai, E., 2Six, É., 1Kováčiková, Z., 3Gergelová, P., 4 Kyrtopoulos, A. S. 1Slovak Medical University, Bratislava, Slovak Republic 2Fodor József National Centre for Public Health, Department of Pathology, Budapest, Hungary, 3Trnava University, Faculty of Healt Care and Social Work , Trnava, Slovak Republic 4Institute of Biological Research and Biotechnology, National Hellenic Research Foundation, Athens, Greece
The 3 types of asbestos substitute mineral fibres - ASMF (wollastonite, rock wool, glass fibers) as well as amosite asbestos were instilled at 2 doses (2 and 8 mg/animal). Animals (number: 10 – 12 per group) were intratracheally instilled (i.e. noninvasively) with fibrous suspension (2 mg suspended in 0,2 ml of saline solution per animal) or only with 0.2 ml saline per animal (control group). Dose 8 mg was devided and instilladed 4 times (weekly 2 mg/0.2 ml saline solution). After sacrifice (4 or 16 weeks after last intratracheal instillation the animals were anesthetised with thiopental –150 mg/kg of animal) BALF cells were harvested using a modified method of bronchoalveolar lavage by Myrvik. The trachea was cannulated, and the lungs were washed 5 times with 4 ml of saline solution (in situ). Following parameters of bronchoalveolar lavage fluid (BALF) were investigated: a) Inflammatory response biomarkers: The number of BALF cells / ml, the number of alveolar macrophages (AM) / ml, the differential number of cells ( % AM; Gr; Ly), phagocytic activity of AM, multinuclear lung cells, the levels of cytokines (TNF-alpha, IL-1alpha), the total amount of protein. b) Cytotoxic parameters: Phagocytic activity of AM, viability of AM, the lactate dehydrogenase activity (in the cell-free lavage fluid), the acid phosphatase activity (in the cell-free lavage fluid and in the BAL suspension), the cathepsin D activity (in the cell-free lavage fluid and in the BAL suspension). Sequential arrangement of examined fibrous dust according to their harmfulness from the point of view of inflammatory and cytotoxic parameters after intratracheal instillation:
AMOSITE > ROCKWOOL > GLASS FIBRES > WOLLASTONITE Conclusions: Inflammatory parameters •The inflammatory parameters were the most changed after amosite treatment. There were not too many differences between two dose inflammatory effect. It means that lower dose - 2 mg induced inflammation and therefore the threshold dose must be somewhere under 2 mg. The mentioned changes were more explicit after 16 week exposure – it points out on the time dependence. •The second in order which induced inflammatory effect was rockwool. The number of significantly changed inflammatory parameters after rockwool exposure was lower than after corresponding amosite exposure and they were induced only by 8 mg dose. Dose dependence was observed. •After exposure to wollastonite and glass fibers - dose and time dependence from the point of view of inflammatory parameters was not evident. Cytotoxic parameters •Cytotoxic parameters were the most changed after amosite exposure. Time and dose dependence was evident. •Order of other examined fibrous dusts according to their harmfulness from the point of view of cytotoxic parameters was rockwool and glass fibres. In both samples were dose but not time dependence evident. •Wollastonite exposure treated the cytotoxic parameters the less. Neither dose nor time dependence was seen there. Results of histological findings in the lung (grade according to Belt-King scale): AMOSITE: Fibre Dose 4 weeks post-exposure 16 weeks post-exposure Amosite 2 mg II III 4x2 mg III III- IV •Dose- and time-dependent effects were observed, consisting of serious interstitial fibrosis and chronic, progressive inflammation with complete destruction of pulmonary structure. WOLLASTONITE:
55 Fibre Dose 4 weeks post-exposure 16 weeks post-exposure Wollastonite 2 mg I I-II 4x2 mg II II •Mild, dose-dependent histological alterations were seen, including very moderate pulmonary fibrosis and chronic interstitial inflammation, without structural changes, as well as pulmonary fibrosis which did not show time progression. ROCKWOOL: fibre Dose 4 weeks post-exposure 16 weeks post-exposure rockwool 2 mg I I-II 4x2 mg I-II II •This kind of rockwool had a very weak fibrogen effect, similarly to that of wollastonite. The fibrosis observed showed a minimal tendency for progression. Ultrastructural studies confirmed the results of light microscopy. GLASS FIBERS: Fibre Dose 4 weeks post-exposure 16 weeks post-exposure Glass fibers 2 mg I I 4x2 mg II II •Mild, dose-dependent histological alterations were seen. Conclusion: Sequential arrangement of examined fibrous dust according to their harmfulness from the point of view of histological findings after intratracheal instillation: AMOSITE > WOLLASTONITE > ROCKWOOL > GLASS FIBERS The work was supported by an E.U. grant, contract, No. QLK4-CT-1999-01629 (FIBRETOX project
56 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
IN A SURVEY TO EVALUATE THE HEALTH IMPACT OF ENVIRONMENTAL ASBESTOS EXPOSURE, THE ASSOCIATION BETWEEN LUNG CANCER AND MOULD IN THE FLAT WAS STRONG.
Dr. Mihály János Varró1, Dr. Mária Posgay2, Prof. Dr. György Ungváry3, Mr. Zsolt Lang4 “”József Fodor” National Centre for Public Health, National Institute of Environmental Health, Budapest 2National Institute of Occupational HealthBudapest 3NCPH, Budapest 4Nomogram Ltd., Budapest Association of lung cancer and mould in the flat in an environmental epidemiological survey
Objective: To assess associations between mould in the flat and lung cancer in an adult town population. Material and method: By interviewers, 2007 standardized questionnaires were filled in Nyergesújfalu, Hungary, on people of >35 years. Data entry was performed by Epi Info 6.04d and analysis by Stata 7.0. Occupationally exposed to asbestos were excluded from the analysis, so calculations of odds ratios (ORs: crude, cOR; adjusted to gender, age groups of 10 years and smoking behaviour: aOR) and of 95% confidence intervals, 95% CI, were performed on 1470 subjects. Results: Of 1465 people, 630 (43.0%) were male and 835 (57.0%) female. The median age was 53 years (interquartile range=44–63 years). 745 (of 1466, 50.8%) subjects smoked currently or formerly. 11 (of 1450, 0.8%) people had lung cancer. 92 (of 1354, 6.8%) people worked >20 years in a dusty workplace (cOR=6.10, 95% CI=1.55–23.99; aOR=4.17, 95% CI=1.02–16.88) and 132 (of 1437, 9.2%) had persistent mould in the flat (cOR=5.76, 95% CI=1.66–19.96; aOR=6.13, 95% CI=1.73–21.67). Conclusions: A strong (either adjusted) association of mould in the flat was found with lung cancer. Aflatoxin B1 is a class 1 human carcinogen – it is to consider the possible carcinogenic role of aerial mycotoxins. Albeit the number of lung cancer cases were few in the study, the association was highly significant. Further literature and field research needs to evaluate these findings.
57 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
THE EFFECT OF TEMPERATURE AND HEAT WAVES ON DAILY EMERGENCY AMBULANCE CALLS IN BUDAPEST, HUNGARY, 1998-2004
János Bobvos1, A Páldy2 A Vámos1, L. Gorove3 1 – Capital Institute of the National Public Health Service, Budapest 2 - “József Fodor” National Centre for Public Health, National Institute of Environmental Health, Budapest 3- Budapest Centre of Ambulance Service
The effect of extreme heat on mortality has been thoroughly studied by several expert groups. The impact on heat on emergency ambulance calls are not so widely investigated. The aim of the presentation is to assess the relationship between daily mean temperature and emergency ambulance calls in Budapest in 1998-2004 for the period of April-September for population groups of 0-14, 15-64 years and over 65 years and for the total population in time series analysis using GAM model. Meteorological data were gained from the National Meteorological Service, Pestlőrinc Station next to the Airport. Daily emergency ambulance calls with the following diagnoses were studied: cardiovascular diseases: ICD-9: 386, 394-438, 458, heat stroke 992; respiratory diseases, 490-519; ill-defined symptoms: 780, 781, 784- 786;. Long term, seasonal trend and weekly trends of emergency calls were considered. The effect of heat was studied on lag0-3 days. Results: During the studied period there were 474 507 emergency calls registered, out of them 18.5% the reason was cardiovascular disease, 3.7%- respiratory diseases, 9.4% ill-defined symptoms. The calls due to cardiovascular and ill-defined symptoms showed an increasing tendency. There was a seasonal variation in cardiovascular calls, and a weakly and diurnal variation in each of the calls investigated. In the time series analysis these variations were controlled for. An increase of daily mean temperature by 10 oC significantly increased the risk of emergency ambulance calls due to cardiovascular diseases in the age group of 15-64 years on lag0 day (the risk of increase of emergency calls in percentage is: 5,36 - 95% CI 2,26, 8,46) and on lag1 day (5,38% - 95% CI 2,27, 8,49). There was a much stronger association of extreme temperature on calls due to ill-defined symptoms: the increase of calls in % was 30,2 for the total population (95% CI 27.3, 33.1), and it was significant in each age group on lag0 and lag1. The effect of extreme temperature was not significant on respiratory diseases.
58 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
ASSESSMENT OF RADIATION BURDEN BY BIOLOGICAL INDICATORS
Gabriella Bognár, G. Mészáros, K. Szalma and G.J. Köteles “József Fodor” National Centre for Public Health – „Frédéric Joliot-Curie” National Research Institute for Radiobiology and Radiohygiene, Budapest
Objective: In every workplace the employer’s duty is to assess the health-damage or the risk. The risk estimation is a process consisting of four steps: risk identification; establishment of dose-response; dose assessment; risk evaluation: qualitative and/or quantitative determination. Our aim was the investigation of nuclear workers’ cytogenetic burden. Material and method: In our present work we applied cytogenetic methods for the risk assessment. These methods are not specific, but can be used to detect acute as well as chronic radiation burden. Result: The frequency of the cytogenetic alterations depends on the dose, however, the steepness of the linear dose-response model is decreasing in the low-dose range. Accordingly, the degree of cytogenetic damage – in this range – is not determined by the radiation dose, but is influenced by other organismic factors. Pursuant to our investigations the antioxidant concentration of serum is one of the possible factors. The relationship between the radiation induced micronucleus increment and the antioxidant capacity in serum shows that the quantity of cytogenetic damage is decreasing with higher antioxidant level. Conclusion: It seems, that the antioxidant protection can be increased with suitable vitamin supplementation (vitamin C and E), especially in the so-called low-dose range, which can have an effect on the employees and the population from the operation of artificial radiation sources.
59 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
IN-VITRO MODEL FOR STUDY OF THE GENOTOXIC EFFECTS OF COMBINED ENVIRONMENTAL EXPOSURES
1Ágnes Drahos, 2L. Anna, 2E. Győrffy, 2B. Schoket, 3 I. Fehér, 1A. M. Dám 1 “Frèdèric Joliot-Curie” National Research Institute for Radiobiology and Radiohygiene, Budapest 2József Fodor National Centre for Public Health, Budapest 3KFKI Atomic Energy Research Institute, Budapest
Objective: Very little is known about the cumulative effects of exposure to multiple hazardous agents, that have either similar or different mechanisms of action. Over the past several years, efforts have been made to develop the methodologies for risk assessment of chemical mixtures, but mixed exposures to two or more dissimilar agents such as radiation and one or more chemical agents have not yet been addressed in any substantive way. Polycyclic aromatic hydrocarbons (PAHs) and radon are known to increase risk for lung cancer in human. There is a very scant knowledge of their combined genotoxic mechanism of action. The aim of the study was to elaborate an in-vitro model to explore interaction of environmental PAH and radon exposure. Material and method: Human lung cells were treated separately and in combinations with alpha irradiation and benzo[a]pyrene, benzo[a]anthracene and chrysene. Radon exposure was mimicked by a specially designed device emitting alpha radiation. PAH-DNA adduct levels were determined by 32P-postlabelling. DNA strand breaks were measured by Comet-assay. Results: The combined treatment by benzo[a]pyrene+benzo[a]antracene+chrysene enhanced the DNA adduct level, significantly (synergistic effect). The pre-treatment of 10 mGy dose alpha radiation resulted in the reduction of the adduct level (adaptation). Alpha irradiation significantly induced DNA strand breaks, whereas the PAHs at 0.2 µM did not have measurable effect by the Comet assay. Conclusion: Our preliminary results indicated that combined effects should take into consideration in estimating the risk from complex environmental exposures. Long term genotoxic effects estimated by examining the genomic instability are forthcoming. Research was supported by Hungarian NKFP1/008/2001 and NKFP1/B-047/2004 grants.
60 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
FREE RADICALS, LIPID PEROXIDATION AND IMMUNE RESPONSE IN EXPERIMENTAL EXPOSURE TO ELECTROMAGNETIC FIELDS (EMF )
Didi Surcel, Csaba Szanto, Mariana Botoc, Monica Hriscu, Dana Dabala, Institute of Public Health, Cluj-Napoca, Romania
Introduction: Although the physical techniques for measuring EMF are well developed, adequate characterization of the biological effects induced by EMF is subject of discussion yet. We don’t know the effects that would be after a long term of exposure. Many scientific studies have been devoted to assessing what health risks are associated with EMF exposure. Data from the recent experiments suggest that EMF are associated with the iron-mediated free radical generation, that can cause damage in the biologic molecules such as lipids, proteins and can profundly affect cellular homeostasis. Purpose: The aim of this study was to show the effects of the chronic exposure to EMF on the immune and oxidative response. Material and method: In vivo experiment was carried out on 80 Wistar rats that were divided in 4 groups as following: 1. Control-group, without exposure, sacrificed at 1 month; 2. Control-group, without exposure sacrificed at 3 months; 3.EMF–exposed group, sacrificed at 1 month; 4. EMF – exposed group , sacrificed at 3 months. The rats were exposed to 02-2mT. The following parameters were assessed: a) 3HTdR incorporation test; b) IL-1 assay; c) TNF-assay; d) Chemiluminiscence assay; e) Lipid peroxides. Results: Our results point out an important increased of the oxidative response in the EMF- exposed groups, in special in the group sacrificed at 3 months. An important suppression of the immune response and increased activity of the cytokines in all the groups exposed to EMF were demonstrated. Conclusion: Our results indicate an interaction between intensity and duration of exposure on biologic effects of the magnetic fields.
61 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
RISK ASSESSMENT FOR NURSES OCCUPATIONALLY EXPOSED TO ANTINEOPLASTIC DRUGS
Didi Surcel, Ligia Stoica, A.Mocan, M. Beldean , Monica Hriscu , Mioara Butan, Rita Ghitulescu
Introduction: Cytostatic antineoplastic (CA) drugs are known as carcinogenic, mutagenic and teratogenic risk factors for health care workers who are occupationally exposed during the preparation and administration of such drugs. The purpose of the present study was to evaluate the occupational exposure and biological monitoring of the personnel handling CA. Material and method: Forty two subjects, all women, non-smokers, with the mean age 33 years and the duration of the exposure to the cyclophosphamide (CP), ranged from 1 to 27 years were investigated. Twenty two subjects, all women, non-smokers, with the age ranging from 21 to 57 years, without exposure to antineoplastic drugs were included in control group. Environmental monitoring (EM) and biological monitoring (BM) were performed to measure environmental exposure and uptake (dose), respectively. For environmental monitoring, the level of contamination by CA in drug preparation areas into cancer treatment hospital was determined by the analysis of the air samples. High volume samples were used to detect cyclophosphamide (CP) in the environment of the nurses who were involved in preparing CA. Cyclophosphamide was detected with gas cromatography in tandem with mass spectrometry. For biological monitoring of the occupational exposure to CA were performed the following parameters: tioether assay and CP in urine. Biological effect monitoring was performed by following assays: analysis of chromosomal aberrations (CA) and micronuclei (MN) proliferation in blood lymphocytes. Results: Release of the CP was discovered in 3 drug - preparation sites. Five from 25 air samples were positive for CP, CP concentration ranging from 7 to 73.2 ng/ mc. In personal air samples, the CP concentration ranged up to 10.4 µg / mc. Excretion of the CP in urine in nurses exposed to CP, who were involved in the preparation of CP during 10 week period was detected. The mean excretion of CP was 0.47 µg/ day( range : 0.38 – 25.5 µg/ l urine. In the nurses handling cytotoxic drugs, urinary thioethers excretion, AC and MN were increased in comparison with the control group. Conclusion: Environmental monitoring and biological monitoring have to use to measure environmental exposure and uptake, respectively. To eliminate occupational exposure to cytostatic drugs are needed introduction of the special protective measures and safety guidelines.
62 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
ENVIRONMENTAL HEALTH IMPACT OF AN INCINERATOR IN DOROG STUDIED BY POINT SOURCE ANALYSIS
Gizella Nádor, A. Páldy, P. Rudnai: “József Fodor” National Centre for Public Health, National Institute of Environmental Health, Budapest, Hungary
Within the framework of the National Environmental Health Action Programme of Hungary an environmental health geographic information system (HEGIS) has been developed. The system gives tools to evaluate the association between health and environmental factors in order to reveal spatial and temporal changes. To investigate the impact of a point-like source of pollution on the health of the people living nearby, the methods by Bithel and Stone were applied. General Poisson distribution test, Poisson maximum test and Kolmogorov – Szmirnov test with Conover modification were used to calculate the significance of the impact of the source of pollution. The results of this type of analysis are presented for different kinds of mortality data of chronic aspecific respiratory diseases (J40-J47), malignant tumouros diseases -Lung cancer (C34), mesothelioma (C45)- and diseases of cardiovascular system -ischaemic heart diseases (I20-I25) and cerebrovascular diseases (I60-I69)- in 30 km circle around the incinerator of Dorog. Data were stratified by age, sex and time interval (1986-1993 and 1994-2003). Mortality was characterised by the standardized mortality ratio (SMR) calculated by the method of indirect standardisation. The spatial distribution of SMR values was shown on maps of the environment of 30 km circle of Dorog. Common SMR value calculated on concentric circles were analysed in relation to the distance from the incinerator. Ratio of the cumulated observed and expected cases in relation to the distance from the incinerator was also examined. According to the results significantly (p <0,05) unfavourable impact of the incinerator were found in cases of chronic aspecific respiratory diseases, ischaemic heart diseases and cerebrovascular diseases for males both for the younger and elder age groups in the earlier time period. The evaluation of the mortality data for both periods highlighted that the impact on the environment of the examined diseases was stronger in the first period than for the second one. Acknowledgment: The project is supported by the INTERREG III.C. Programme of the EU
63 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
INCINERATION PLANT AND RISK PERCEPTION ASSESSMENT BY QUESTIONNAIRE METHOD
Pawel Gorynski, Bogdan Wojtyniak, Peter Rudnai, Krzysztof Kanclerski, Janusz Świątczak National Institute of Hygiene, Warsaw, Poland National Institute of Environmental Health, “József Fodor” National Centre for Public Health, Budapest
Construction of communal waists incinerators is not easy accepted by the inhabitants living in the nearby areas. Sometimes it is the subject of long-drawn protests organized by ecological associations with more or less support of local communities. This is the reason that the assessment of potential real risk connected with the incinerator activities is the subject of interest of local authorities responsible for waists utilization. Another problem to be considered by local authorities, usually not exactly connected with the real exposure to the pollution from incinerator is risk perception by people living in the area of incinerator activities. In the framework of EnhanceHealth project carried on under umbrella of Intereg 3 the task of risk perception assessment in association with incineration plan is undertaken. It was decided to use specially designed questionnaire as a method for risk perception assessment. The questionnaire consist of 40 items covering general environmental pollution problems in the place of residence i.e. noise, drinking water and ambient air pollution. Next questions refer to the incineration plant operating nearby and its onerousness. Some questions touch also health problems possibly associated with incinerator. The study area cover 2 km diameter circle around the incineration plant in Warsaw. The area is not very urbanized and first bigger buildings are situated in the distance of about 1 km. The risk perception study will cover random sample of about 5% of inhabitants. To prepare the list for sampling , all buildings at the study area were inventoried and numbers of all apartments in building have been attached to them. In chosen apartments one adult person representing family will be interviewed by trained interviewers. In the next phase the apartments position at the study area will be assign at the prepared computer map of the study area. On the basis of the emission model, exposure to the pollution from the incineration will be assessed in all sites were people will be interviewed. In the final phase the analysis of possible association between risk perception, health effects and distance from incinerator as well as emission will be undertaken.
64 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
RISK FACTORS FOR CERVICAL CANCER ( CC ) IN ROMANIA
Liana M. DEAC, Daniela C. MOGA, Alexandra CRACIUN, Daniela CRACIUN, Daniela PROINOV, M. RISCA, E. LUPU, Cornelia MUNTEANU, Cornelia SIGARTAU, Teodora VLAD ROMANIA MD,s CATHOLIC ASSOCIATION – CLUJ – NAPOCA CENTER
Romania is in an extreem delicate situation with a high risk exposure to cervical cancer at several age women and at their several lifetime. On having the highest mortality rate with CC in Europe, there is necessary to know all risk factors implicated in developing this big morbidity ( quite everywhere in the world this risk factors are well known) . Because there still not exist a pertinent national analyse for the risk factors in Romania, there was a need for a descriptive epidemiological study, which we realised with 600 QUESTIONARIES (with fix 30 well determined asked / questions), on which women with CC answered us. The confidentiality was well respected. There was no descriminative restriction done for selecting females with this illness for our questionarries. The descriptive epidemiological elements, demonstrate the risk exposure at several risk factors for cervical cancer, which were evaluated for the wish to establish a surveillance and control activity in our country. The founded data, suggest the following “ risk variable “ at the women with CC: • smoking under the age of 16 • chronical smoking use • sexual activity before the age of 16 • more then 2 sexual partners during the life time • sexual activity without using condom protection • borning children with risk for infectivity • abortion with risk for infectivity • possible corelation with high number of spontaneus abortions • genital herpetic infections • alcohol use • possible sexual activity with men who had sexual activity with women with CC in the past • use of several anticonceptiv drogs • economical and social low life condition and restrictive food deficiences • less physical activity • less knowledges for cervical cancer A good surveillance for CC, means knowing and accepting well all risk exposures for our women on it. There is necessary to start here, on making open studies for the viral risk etiology (Human Papilloma Virus ) and all other genetical determinations for this illness too. Without a good established National Programme for Surveillance and Control of CC, our women will still be in the big danger for having this pathology sooner or later. All this can be best realised, with a collaborativ international activity , which will have as waited attend , improves for the illness diagnosis and even less morbidity and mortality levels , which has for the moment the mentioned high rata levels .
65 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
URBAN-RURAL DIFFERENCES IN THE INCIDENCE OF DIGESTIVE TRACT CANCER IN SOUTHERN SLOVAKIA
Jarmila Korcova1), Gabriel Gulis2)
1) Department of Hygiene and Epidemiology, Faculty of Health Care and Social Work, Trnava University, , Trnava, Slovak Republic 2) University of Southern Denmark, Unit of Health Promotion Research, Esbjerg, Denmark
Purpose: Urban-rural differences in health and health determinants are aminy the most frequent inequalities worldwide. Is the „healthy“ rural environment so supportive to health as we frequently consider it? Material and method: Using the incidence of digestive tract cancer from a rural district in southern Slovakia the above raised questions will be discussed in this presentation. Incidence data of digestive tract cancer for 1988—2000 were reviewed from oncology department of district hospital; 963 cases were divided by residence to urban and rural categories. Cumulative incidence of digestive cancer over 13 years by as total and sex were calculated and compared. Results: Total cumulative cancer incidences in urban and rural parts of district were 279.32 and 333.14 respectively per 100 000. Total cumulative incidences of digestive tract cancer in urban and rural parts of district were 57.19 and 90.57 respectively per 100 000. Mean age at diagnoses is 76.70 of all population and 74.98 of urban population and 77.50 of rural population. Although there are uncertainties related to ecologic design of analysis, results certainly allows for discussion on the role of environmental and social differences among urban and rural population. Conclusions: Based on results we might expect a considerable higher cancer incidence in rural as in urban Slovakia. More epidemiologic and public health research is needed to provide explanation for that phenomenon.
66 ISEE, New Challenges of Environmental Health, 9-11 June, 2005 Budapest
List of participants and lecturers
67 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
BULGARIA
Jeni Staykova Manager of Hygiene, Epidemiologic Inspectorate General Vladimir, Stoychev str. 2, 6600 Kardjali, Bulgaria Tel: +6 20 97 Fax: +6 20 97 Email: [email protected]
Tanya Hristova Turnovska Department of Hygiene and Ecology, Medical University Vassil Aprilov Blv. 15/A 4002 Plovdiv, Bulgaria Tel: +032 602 543 Fax: +032 271 222 Email: [email protected]
Dobrinka Lolova National Centre of Public Health Protection 15 D. Nestorov str. 1431 Sofia, Bulgaria Tel: +359 2 58 12 735 Email: [email protected]
68 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
ESTONIA
Ene Indermitte University of Tartu, Dept. of Public Health Ravila 19, Tartu 50411 Estonia Tel: +372 7 374 197 Email: [email protected]
DENMARK
Gábor Gulis University of Southern Denmark Unit of Health Promotion Research Niels Bohrsvej 9-10, 6700 Esbjerg, Denmark Tel: +45 6550 4212 [email protected]
GERMANY
Dafina Dalbokova WHO ECEH Bonn Office Goerress strasse 15, 53113 Bonn, Germany Tel: +49 228 2094 408 Fax: +49 228 2094 201 Email: [email protected]
Wolfgang Hellmeier Institute for Public Health North Rhein-Westfalia D 33611 Bielefeld, Westerfeldstrasse 35. Tel: +49 521 8007246 Email: [email protected]
Matthias Braubach WHO ECEH Bon Office Görresstrasse 15, 53113, Bonn, Germany Tel: +49 228 2094 410 Email: [email protected]
69 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
GREECE
Panagiotakos Demosthenes Harokopio University 70 Thiseos st. , 17671 Athens Tel: +302109549332 Email: [email protected]
HUNGARY
Anna Páldy “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 12 15 Fax: +36 1 476 12 15 Email: [email protected]
Gyula Dura “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 218 31 58 Fax: +36 1 215 20 46 Email: [email protected]
Krisztina Kishonti “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 12 15 Fax: +36 1 476 12 15 Email: [email protected]
Mihály János Varró “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 11 00 Email: [email protected]
70 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
HUNGARY
Péter Rudnai “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 12 82 Email: [email protected]
Tibor Málnási “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 11 93 Fax: +36 1 215 20 46 Email: [email protected]
Gizella Nádor “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 13 55 Email: [email protected]
Bernadette Schoket “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 12 93 Fax: +36 1 215 01 48 Email: [email protected]
Zsuzsanna Horváth “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 12 15 Email: [email protected]
71 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
HUNGARY
Judit Szabó “József Fodor” National Centre for Public Health “Frederic Joliot Curie” National Research Institute for Radiobiology and Radiohygiene P.O.Box 101, 1775 Budapest, Hungary Tel: +36 1 482 20 19 Email: [email protected]
János Bobvos Metropolitan Institute of State Public Health and Health Officer Service 174 Váci út, 1138 Budapest, Hungary Tel: +36 1 349 05 55 Email: [email protected]
Mária Bényi National Centre for Public Health 2 Nagyvárad tér, 1096 Budapest Hungary Tel: 06 1 476 11 15 Email: [email protected]
Ágnes Drahos National Research Institute for Radiobiology and Radiohygiene 5 Anna utca, Budapest, Hungary 1222 Tel: +36 1 482 2000/127 Email: [email protected]
Brigitta Reizer “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: 36 1 476 11 00/2571 Email: [email protected]
72 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
HUNGARY
Szalkai Márta “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 1252 Email: [email protected]
Anna Lívia “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 11 00/2384 Email: [email protected]
Éva Vaskövi “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 13 41 Email: [email protected]
József Bakos National Research Institute for Radiobiology and Radiohygiene 101. POB. 1775 Budapest, Hungary Tel: +36 1 482 20 19 Email: [email protected]
Gabriella Bognár “Frederic Joliot-Curie” National Research Institute for Radiobiology and Radiohygiene 5 Anna utca, 1221 Budapest, Hungary Tel: +36 1 482 20 00/121 Email: [email protected]
73 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
HUNGARY
Katalin Szalma “Frederic Joliot-Curie” National Research Institute for Radiobiology and Radiohygiene 5 Anna utca, 1221 Budapest, Hungary Tel: +36 1 482 20 00/121 Email: [email protected]
Gabriella Mészáros “Frederic Joliot-Curie” National Research Institute for Radiobiology and Radiohygiene 5 Anna utca, 1221 Budapest, Hungary Tel: +36 1 482 20 00/121 Email: [email protected]
Katalin Bálintfy “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 12 15 Email: [email protected]
Béla Somogyi “József Fodor” National Centre for Public Health National Institute of Environmental Health 2-6 Gyáli út, 1097 Budapest, Hungary Tel: +36 1 476 11 00 Email: [email protected]
Katalin Fehér Institute of National Public Health and Medical Officier’s, County Győr-Moson-Sopron 16 Jósika utca, 9024 Győr, Hungary Tel: +36 96 513 758 Email: [email protected]
74 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
Beatrix Oroszi Institute of National Public Health and Medical Officier’s, County Győr-Moson-Sopron 16 Jósika utca, 9024 Győr, Hungary Tel: +36 96 513 721 Email: [email protected]
Ida Prantner Medical School Univ. of Pécs Department of Public Health 12 Szigeti út, 7624 Pécs, Hungary Tel: 06/20-5684-886 Email: [email protected]
LITHUANIA
Rima Kregzdyte Institute for Biomedical Research Kaunas University of Medicine Eiveniu str. 4., LT-50009 Kaunas, Lithuania Tel: +370 37 302948 Email: [email protected]
THE NETHERLANDS
Anne Knol National Institute for Public Health and the Environment (RIVM) Centre for Environmental Health Research PO Box 1 3720 BA Bilthoven THE Netherlands Tel: +31 30 274 2869 Fax: +31 30 274 4451 Email: [email protected]
75 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
POLAND Paweł Goryński National Institute of Hygiene Department of Medical Statistics Państwowy Zakład Higieny Chocimska 24 00-791 Warszawa tel. +48 (22) 54-21-236 (315) Email: [email protected]
ROMANIA
Monica Liana Deac Public Health Institute 6 L. Pasteur street 3400 Cluj-Napoca, Romania Tel: +40 264 59 4252 Fax: +40 264 59 3112 Email: [email protected]
Didi Surcel Institute of Public Health Pasteur str. 6., Cluj Napoca 3400 Romania Tel : +40264594252 Email : [email protected]
76 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
SLOVAK REPUBLIC
Jarmila Korcova Trnava University, School of Health Care and Social Work, Department of Hygiene and Epidemiology Univerzity namestie 1 91700 Trnava, Slovak Republic Tel. +421 33 5348 941 Email: [email protected]
Ludmila Sevcikova Institute of Hygiene, Faculty of Medicine, Comenius University 24 Spitalska, 813 27 Bratislava, Slovak Republic Tel: +421 259 357 465 Email: [email protected]
Petra Gergelova Trnava University Faculty of Health and Social care Univerzitne nem 1 918 43 Trnava, Slovakia Tel: 00421903145899 Email: [email protected]
77 ISEE, New challenges of Environmental Health, 9-11 June, 2005 Budapest
SLOVAK REPUBLIC
Daniela Marcinkova Trnava University Faculty of Health Care and Social Work Departmentof Hygiene and Epidemiology Hornpotocna 23. 918 23 Trnava, Slovakia Tel: +421 33 5939402 Email: [email protected]
Marek Majdan Trnava University Faculty of Health and Social Work Department of Hygiene and Epidemiology Univerzitne Namestie 1, Trnava 917 00, Slovakia Tel: +421 33 5939402 Email: [email protected]
UNITED KINGDOM
Tony Fletcher PEHRU Public and Environmental Health Research Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK Tel: +44 20 7927 2429 Email: [email protected]
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