Andreja Kukec

Integral Control of Health Hazards in Hospital Environment

Hospitals present complex indoor environment with various users, health hazards and specific activities. This paper classifies health hazards specific to the hospital environment (HE), defines their interactions and possible impacts on human health and summarizes recommendations for biological and chemical hazards. A detailed literature review clearly shows that there is no developed system or method for integral control of health hazards in HE. There is no appropriate technology available that would allow development of optimal thermal comfort conditions for individual users in HE. For integral control of physical hazards, an innovative low exergy (LowEx) system was designed and tested. The system enables individual control of thermal comfort parameters to meet the needs of various users in the same room. It enables the design of optional conditions for healthcare and treatment considering the different requirements of individual patients and thermally neutral zones for other users. The system application is presented in a model room for burns patient. The measured energy use was lower by 11–27% for space heating and by 32–73% for cooling, when using LowEx system as compared to the conventional system. Owning to its flexibility, the system can also be used for other potential users.

A Prevalence Study on Outdoor Air Pollution and Respiratory Diseases in Children in Zasavje, Slovenia, as a Lever to Trigger Evidence-Based Environmental Health Activities

The aim of this study was to estimate the population burden of respiratory diseases in the Zasavje region of Slovenia that can be attributed to outdoor air pollution in order to gain relevant grounds for evidencebased public health activities. In 2008, 981 schoolchildren (age 6 to 12 years) were observed in a prevalence study. The prevalence of chronic respiratory diseases (CRD) and frequent acute respiratory symptoms (FARS) was related to the level of outdoor air pollution in the local environment (low, moderate and high pollution areas). Logistic regression was used as a method for statistical analysis. The prevalence of CRD was 3.0 % in low pollution areas, 7.5 % in moderate pollution areas, and 9.7 % in high pollution areas (p=0.005). After adjustment for the effects of confounders, 2.91-times higher odds for CRD were registered in high pollution areas in comparison to low pollution areas (p=0.017). The prevalence of FARS was: 7.8 % in low pollution areas, 13.3 % in moderate pollution areas and 15.9 % in high pollution areas (p=0.010). After adjustment for the effects of confounders, 2.02-times higher odds for FARS were registered in high pollution areas in comparison to low pollution areas (p=0.023). The study confirmed a significantly higher prevalence of CRD and FARS in children living in high pollution areas of Zasavje. These results at least partially prompted mutual understanding and cross-sectoral cooperation - prerequisites for solving complex problems involving the impact of air pollution on health.

Number of Heat Wave Deaths by Diagnosis, Sex, Age Groups, and Area, in Slovenia, 2015 vs. 2003

Background: Number of deaths increases during periods of elevated heat. Objectives: To examine whether differences in heat-related deaths between 2003 and 2015 occurred in Slovenia. Materials and Methods: We estimated relative risks for deaths for the observed diagnoses, sex, age, and area, as well as 95% confidence intervals and excess deaths associated with heat waves occurring in 2015 and 2003. For comparison between 2015 and 2003, we calculated relative risks ratio and 95% confidence intervals. Results: Statistically significant in 2015 were the following: age group 75+, all causes of deaths (RR = 1.10, 95% CI 1.00–1.22); all population, circulatory system diseases (RR = 1.14, 95% CI 1.01–1.30) and age group 75+, diseases of circulatory system (RR = 1.17, 95% CI 1.01–1.34). Statistically significant in 2003 were the following: female, age group 5–74, circulatory system diseases (RR = 1.69, 95% CI 1.08–2.62). Discussion: Comparison between 2015 and 2003, all, circulatory system diseases (RRR = 1.25, 95% CI 1.01–1.55); male, circulatory system diseases (RRR = 1.85, 95% CI 1.41–2.43); all, age group 75+ circulatory system diseases (RRR = 1.34, 95% CI 1.07–1.69); male, age group 75+, circulatory system diseases (RRR = 1.52, 95% CI 1.03–2.25) and female, age group 75+, circulatory system diseases (RRR = 1.43, 95% CI 1.08–1.89). Conclusions: Public health efforts are urgent and should address circulatory system causes and old age groups.

Ambient air pollution and pregnancy outcomes: A comprehensive review and identification of environmental public health challenges

ABSTRACT There is a growing number of studies on the association between ambient air pollution and adverse pregnancy outcomes, but their results have been inconsistent. Consequently, a comprehensive review of this research area is needed. There was a wide variability in studied pregnancy outcomes, observed gestational windows of exposure, observed ambient air pollutants, applied exposure assessment methods and statistical analysis methods Gestational duration, preterm birth, (low) birth weight, and small for gestational age/intrauterine growth restriction were most commonly investigated pregnancy outcomes. Gestational windows of exposure typically included were whole pregnancy period, 1st, 2nd, 3rd trimester, first and last gestational months. Preterm birth was the outcome most extensively studied across various gestational windows, especially at the beginning and at the end of pregnancy. Particulate matter, nitrogen dioxide, ozone, and carbon monoxide were the most commonly used markers of ambient air pollution. Continuous monitoring data were frequently combined with spatially more precisely modelled estimates of exposure. Exposure to particulate matter and ozone over the entire pregnancy was significantly associated with higher risk for preterm birth: the pooled effect estimates were 1.09 (1.03–1.16) per 10 &mgr;g/m3 increase in particulate matter with an aerodynamic diameter of 10 &mgr;m or less (PM10),1.24 (1.08–1.41) per 10 &mgr;g/m3 increase in particulate matter with an aerodynamic diameter of 2.5 &mgr;m or less (PM2.5), and 1.03 (1.01–1.04) per 10 ppb increase in ozone. For pregnancy outcomes other than PTB, ranges of observed effect estimates were reported due to smaller number of studies included in each gestational window of exposure. Further research is needed to link the routine pregnancy outcome data with spatially and temporally resolved ambient air pollution data, while adjusting for commonly defined confounders. Methods for assessing exposure to mixtures of pollutants, indoor air pollution exposure, and various other environmental exposures, need to be developed.

Food safety knowledge, self-reported practices and attitude of poultry meat handling among Slovenian consumers

Purpose The purpose of this paper is to investigate Slovenian consumers’ knowledge and self-reported practices in poultry meat handling during purchase, transport, and preparation in home kitchens and to assess the awareness of the microbiological risk associated with poultry meat, with an emphasis on Campylobacter. Design/methodology/approach A cross-sectional study of consumers’ food safety knowledge, self-reported practices, and awareness of the microbiological risk was conducted from March to April 2015 at supermarkets in different parts of Slovenia. A convenience sample of 560 consumers was obtained. Gender and age distribution were controlled by 28 interviewers, each of whom distributed 20 questionnaires. The questionnaire included 33 questions divided into four parts. Findings The results revealed consumers awareness of food safety issues. Respondents have some basic knowledge about proper food handling. However, a substantial number of consumers still lacks knowledge of the microbiological risk and has bad habits in domestic poultry meat preparation. Research limitations/implications The research did not reflect a representative sample of Slovenian consumers. Practical implications The results indicate some gaps in consumers’ food safety knowledge and self-reported practices. Current Campylobacter preventive strategies regarding retail poultry meat contamination are not yet sufficiently successful. Originality/value The study provides valuable insight into consumers’ food safety knowledge and self-reported practices in poultry meat handling from shopping to eating. Opportunities for improvement in consumers’ formal and informal education and training should be offered.

Health-related behaviour among managers of Slovenian hospitals and institutes of public health

Aim: Behavioural risk factors have a significant impact on health. We aimed to assess health-related behaviour, health status, and use of healthcare services among managers of Slovenian hospitals and institutes of public health. Methods: This was a cross-sectional study which included management (directors, scientific directors, directors’ deputies) of Slovenian hospitals and institutes of public health (63 respondents; 57% women; overall mean age: 51±7 years; response rate: 74%). Data were obtained using an anonymous self-administered questionnaire. Results: About 35% of respondents were directors. More than half of the respondents were overweight or obese (52%), the majority were not sufficiently physically active (59%) and overloaded with stress (87%). Hypercholesterolemia (36%), spinal disease (17%), and arterial hypertension (16%) were most common chronic diseases. Whilst only few participants visited their general practitioner due their health complaints, blood pressure (76%), cholesterol (51%), and glucose (54%) were measured within last year in most of the respondents. Conclusion: Our findings point to a high prevalence of overweight and obesity as well as workplace-related stress among Slovenian public health managers. Therefore, effective preventive strategies should be focused on stress management along with promotion of healthy behavioural patterns.

Bioaccessibility of lead in sand intended for playground sandboxes in Slovenia: a preliminary study

Slovene press has recently expressed concern for the health of children who ingest playground sand contaminated with lead. However, current assessments may be overestimating the health risk, as they assume that human body absorbs the whole amount of a contaminant. The aim of our study was to see how much lead in sand intended for playground sandboxes in Slovenia really is absorbed and what health risk it may present. To do that, we ran bioaccessibility tests to simulate metabolism and see how digestion affects lead levels. Our results show low bioaccessibility of lead from sand (0.01- 36.84 %). Taking into account lead bioaccessibility, we ran several scenarios of sand ingestion in children and established that in general the risk is negligible, except for pica behaviour with extremely high (20 g) ingestion of sand with highly mobilised lead (2.69 μg g-1). Further research should assess real-life exposure to lead from playground sand in children and perhaps update these preliminary bioaccessibility data. V zadnjem obdobju so se v Sloveniji pojavili številni pomisleki o varnosti mivke, ki je namenjena za otroške peskovnike. Ocena tveganja otrok, ki so izpostavljeni svincu temelji na predpostavki, da je celotna količina toksične kovine biološko dostopna. Zato je bil namen raziskave analizirati biološko dostopnost svinca v mivki, ki je namenjen za peskovnike otroških igrišč. Z simulacijo prebavnega trakta smo analizirali vpliv prebavnih sokov za izplavljanje svinca iz mivke. Rezultati kažejo na majhno biodostopnost svinca v mivki (0,01-36,84 %) slovenskih proizvajalcev. Na podlagi biološke dostopnosti smo simulirali različne scenarije vnosa in ugotovili, da je tveganje zanemarljivo, razen v primeru pica sindroma (zaužitje 20 g mivke) ter ob predpostavki največje dokazane biološke dostopnosti (2,69 μg g-1). Raziskave v prihodnosti bodo vključevale realno izpostavljenost otrok svincu iz peskovnikov in bodo morda nadgradile preliminarno raziskavo.

Impact of air pollution with PM10 on primary health care consultations for respiratory diseases in children in Zasavje, Slovenia: a time-trend study

Abstract Aim: The aim of our study was to assess the temporal association between the number of consultations in the primary health care unit due to respiratory diseases in children and the level of particular matter of 10 micrometres in diameter (PM10) pollution in the Zasavje region. Methods: A time-trend ecological study was carried out for the period between 1 January 2006 and 31 December 2011. The daily number of first consultations for respiratory diseases among children in the Zasavje region was observed as the outcome. Poisson regression analysis was used to investigate the association between the observed outcome and the daily PM10 concentrations, adjusted to other covariates. Results: The results showed that the daily number of first consultations were highly significantly associated with the daily concentrations of PM10 in the Zagorje (p<0.001) and Trbovlje (p<0.001) municipalities. In the Hrastnik municipality, a significant association was not observed in all models. Conclusions: It can be concluded that evidence of association between the daily PM10 concentration and the daily number of first consultations for respiratory diseases among children exists, indicating that there is still a need for public health activities in the sense of reduction of harmful environmental factors in the region. Additionally, on the basis of these results, it can be assumed that with some improvements linkage of existing health and environmental data in Slovenia in general could be feasible in identifying a grounded need for future public health action. Izvleček Namen: Namen študije je bil oceniti časovno povezanost med številom obiskov v primarnem zdravstvenem varstvu zaradi bolezni dihal pri otrocih in prašnimi delci premera 10 mikrometrov (PM10) v Zasavju. Metode: Ekološka študija časovnega trenda je bila izvedena za obdobje od 1. januarja 2006 do 31. decembra 2011. Opazovani izid je bil dnevno število prvih obiskov zaradi bolezni dihal pri otrocih v Zasavju. Za oceno povezanosti med opazovanim izidom in dnevnimi koncentracijami PM10, standardizirano na preostale pojasnjevalne dejavnike, je bila uporabljena Poissonova regresijska analiza. Rezultati: Rezultati so pokazali močno statistično povezanost med dnevnim številom prvih obiskov in dnevnimi koncentracijami PM10 v občinah Zagorje (p < 0,001) in Trbovlje (p < 0,001). V občini Hrastnik nismo opazili značilne povezanosti pri vseh modelih. Zaključek: Sklenemo lahko, da v Zasavju obstaja povezanost med boleznimi dihal pri otrocih in koncentracijo PM10, kar kaže na to, da je v tej slovenski regiji še vedno prisotna potreba po javnozdravstvenih ukrepih v smislu zmanjševanja škodljivih okoljskih dejavnikov. Dodatno lahko na podlagi rezultatov študije sklepamo, da bi bilo lahko v prihodnje v Sloveniji povezovanje okoljskih in zdravstvenih podatkov z nekaterimi izboljšavami uporabno pri ocenjevanju utemeljenih potreb za javnozdravstveno ukrepanje.

Health geography in case of Zasavje: Linking of atmospheric air pollution and respiratory diseases data

The aim of the study was to assess the association between atmospheric air pollution and respiratory diseases in children on the level of small spatial units in the Zasavje. The health and environmental data were obtained for the period between January 1 and December 31, 2011. Studied small spatial units were designed on the basis of estimated level of atmospheric air pollution and digital maps and boundaries of local communities and settlements. The impact of atmospheric air pollution on respiratory diseases was analysed by using the Bayesian models. Considering the identified deficiencies, the presented methodolgy can often be used to identify areas with a higher health risks.

Identification and Control of Health Risks in Hospital Environment from the Aspect of Users, Buildings and Systems

Izvleček Izhodišča: Bolnišnice predstavljajo kompleksno notranje okolje, v katerem so bolniki, zaposleni in obiskovalci izpostavljeni številnim dejavnikom tveganja za zdravje. Raziskav, ki bi obravnavale več dejavnikov tveganja hkrati, je danes malo. Ne izhajajo iz povezave med uporabniki, stavbo in sistemi. Namen metaanalize je prepoznati fizikalne, biološke in kemične dejavnike tveganja za zdravje v bolnišničnem okolju ter izdelati izhodišča za pripravo priporočil za njihovo preprečevanje in obvladovanje. Pri tem bomo upoštevali uporabnike ter življenjski cikel stavbe in sistemov. Metode: Opravili smo metaanalizo raziskav na področju fizikalnih, bioloških in kemičnih dejavnikov tveganj za zdravje v bolnišničnem okolju. Zajeli smo dve bibliografski bazi (Pub Med in Science Direct). V analizo je bilo vključenih 634 virov literature, ki so bili objavljeni med letoma 1934 in 2012. Izhodišča za pripravo priporočil smo izdelali po nadgrajeni metodi inženirskega načrtovanja. Rezultati: Na podlagi izsledkov metaanalize smo pripravili izhodišča za pripravo priporočil, ki vključujejo sistematične ukrepe, specifične za bolnišnično okolje. Preprečevanje fizikalnih dejavnikov tveganja za zdravje vključuje ukrepe s področja zakonodaje, načrtovanja stavbe in sistemov ter usposabljanja zaposlenih. Najpomembnejši ukrepi s področja bioloških in kemičnih dejavnikov tveganja za zdravje so: preprečevanje in obvladovanje poti prenosa povzročiteljev bolezni ter nadzor kemičnih onesnaževal v notranjem in zunanjem zraku. Zaključki: Metaanaliza predstavlja nov pristop k preprečevanju in obvladovanju fizikalnih, bioloških in kemičnih dejavnikov tveganja za zdravje v kompleksnem bolnišničnem okolju - od načrtovanja stavbe do njene uporabe in vzdrževanja. Učinkovitost stavbe in sistemov se doseže s celostnim upoštevanjem značilnosti uporabnikov, bolnišničnega okolja in rabe energije. Uporabljen pristop je tudi pogoj za načrtovanje stavb in sistemov; je temelj uspešnih prenov. Abstract Background: Hospitals represent a very complex indoor environment where patients, staff and visitors are exposed to numerous health risk factors. Studies where health risk factors specific to the hospital environment are represented together are for the moment scarce, and they do not arise based on the relationship between users, buildings and systems. The purpose of this study is to identify physical, biological and chemical health risk factors and to prepare starting points for elaboration of recommendations for their prevention and control. In doing so, we took into account users, life cycle of buildings and building systems. Methods: Meta-analysis was carried out studying physical, chemical and biological health risk factors in the hospital environment. We searched Pub Med and Science Direct for peer-reviewed publications from 1934 to 2012. 634 sources of literature were included. The starting points for the preparation of recommendations were made through an upgraded method of engineering design. Results: On the basis of meta-analysis, the starting points for the preparation of recommendations were made. They include systematically defined actions specific for the hospital environment. For the prevention of physical health risk factors, actions are defined on the level of legislation, building and system design as well as worker qualifications. For the prevention of biological health risk factors, actions in the chain of infection are included and control of outdoor and indoor air pollution is provided. Conclusions: This study presents a new approach to the prevention of physical, biological and chemical health risk factors in the complex hospital environment, from the design stages to the stage of usage and maintenance. Efficiency of buildings and systems is attained through a holistic approach, taking into account the characteristics of users, hospital environment and energy use. The presented approach is necessary for the design of buildings and building systems and a basis for successful renovations.