Claudia Hornberg

Environmental burden of disease in Europe : assessing nine risk factors in six countries

Background: Environmental health effects vary considerably with regard to their severity, type of disease, and duration. Integrated measures of population health, such as environmental burden of disease (EBD), are useful for setting priorities in environmental health policies and research. This review is a summary of the full Environmental Burden of Disease in European countries (EBoDE) project report. Objectives: The EBoDE project was set up to provide assessments for nine environmental risk factors relevant in selected European countries (Belgium, Finland, France, Germany, Italy, and the Netherlands). Methods: Disability-adjusted life years (DALYs) were estimated for benzene, dioxins, secondhand smoke, formaldehyde, lead, traffic noise, ozone, particulate matter (PM2.5), and radon, using primarily World Health Organization data on burden of disease, (inter)national exposure data, and epidemiological or toxicological risk estimates. Results are presented here without discounting or age-weighting. Results: About 3–7% of the annual burden of disease in the participating countries is associated with the included environmental risk factors. Airborne particulate matter (diameter ≤ 2.5 μm; PM2.5) is the leading risk factor associated with 6,000–10,000 DALYs/year and 1 million people. Secondhand smoke, traffic noise (including road, rail, and air traffic noise), and radon had overlapping estimate ranges (600–1,200 DALYs/million people). Some of the EBD estimates, especially for dioxins and formaldehyde, contain substantial uncertainties that could be only partly quantified. However, overall ranking of the estimates seems relatively robust. Conclusions: With current methods and data, environmental burden of disease estimates support meaningful policy evaluation and resource allocation, including identification of susceptible groups and targets for efficient exposure reduction. International exposure monitoring standards would enhance data quality and improve comparability. Citation: Hänninen O, Knol AB, Jantunen M, Lim TA, Conrad A, Rappolder M, Carrer P, Fanetti AC, Kim R, Buekers J, Torfs R, Iavarone I, Classen T, Hornberg C, Mekel OC, EBoDE Working Group. 2014. Environmental burden of disease in Europe: assessing nine risk factors in six countries. Environ Health Perspect 122:439–446; http://dx.doi.org/10.1289/ehp.1206154

Sociodemographic and health-(care-)related characteristics of online health information seekers: a cross-sectional German study

BackgroundAlthough the increasing dissemination and use of health-related information on the Internet has the potential to empower citizens and patients, several studies have detected disparities in the use of online health information. This is due to several factors. So far, only a few studies have examined the impact of socio-economic status (SES) on health information seeking on the Internet. This study was designed to identify sociodemographic and health-(care-)related differences between users and non-users of health information gleaned from the Internet with the aim of detecting hard-to-reach target groups.MethodsThis study analyzed data from the NRW Health Survey LZG.NRW 2011 (n = 2,000; conducted in North Rhine–Westphalia, Germany, via telephone interviews). Logistic regression analysis was used to examine the determinants of online health information seeking behavior.Results68% of Internet users refer to the Internet for health-related purposes. Of the independent variables tested, SES proved to exert the strongest influence on searching the Internet for health information. The final multivariate regression model shows that people from the middle (OR: 2.2, 95% CI: 1.6–3.2) and upper (OR: 4.0, 95% CI: 2.7–6.2) social classes are more likely to seek health information on the Internet than those from the lower class. Also, women are more likely to look for health information on the Internet than men (OR: 1.5, 95% CI: 1.1–2.1). Individuals with a migration background are less likely to conduct health searches on the Internet (OR: 0.6, 95% CI: 0.4–0.8). Married people or individuals in a stable relationship search the Internet more often for health information than do singles (OR: 1.9, 95% CI: 1.2–2.9). Also, heavy use of health-care services compared to non-use is associated with a higher likelihood of using the Internet for health-related matters (OR: 1.7, 95% CI: 1.2–2.5).ConclusionsIn order to achieve equity in health, health-related Internet use by the socially deprived should be promoted through measures to increase their level of e-health literacy. Furthermore, longitudinal studies are needed in order to gain reliable data/results on determinants of health-related Internet use.

Mercury exposure in female artisanal small-scale gold miners (ASGM) in Mongolia: An analysis of human biomonitoring (HBM) data from 2008

BACKGROUND Many poor in developing countries have turned to artisanal small-scale gold mining (ASGM) in an attempt to improve their situation. However, the mercury used to extract gold from ore is discharged in vaporized form into the environment, where it poses a hazard for human health. METHODS As part of an environmental epidemiological study in Mongolia-to evaluate the burden of environmental mercury contamination-urine, blood and hair samples were collected from residents of areas with or without mercury contamination. A total of 200 blood, urine and hair samples were analyzed for mercury and divided into three subgroups according to mercury content: (1) occupational exposure (high/medium); (2) environmental exposure (low); and (3) no exposure. Internal mercury distributions of the subgroups were compared using the Kruskal-Wallis and Mann-Whitney U-test. The Chi-square test and likelihood ratio proportion were used to compare the findings with threshold limits. RESULTS The highest values and greatest differences were seen in the urine samples (p<0.001, Kruskal-Wallis). The occupational group showing the highest exposure with a median mercury level of 4.36μg/l (control group: 0.10μg/l, p<0.001), 7.18μg/g creatinine and 12 results above the threshold limit HBM I (Human Biomonitoring I). Even participants from the low-exposure subgroup showed elevated mercury levels (median 2.88μg/l urine and 2.98μg/g creatinine, p<0.001), with 10 individuals above the HBM I threshold limits. DISCUSSION The body burden resulting from the use of mercury in artisanal gold mining is high not only in the miners themselves, an increased mercury hazard was also found for inhabitants of mining areas who were not actively involved in mining. Public health support measures are urgently needed to alleviate the situation.

Trends in Disease Burden in Germany: Results, Implications and Limitations of the Global Burden of Disease Study

BACKGROUND The Global Burden of Disease (GBD) study is designed to give a comprehensive and standardized assessment of the health of populations around the world. It measures the burden of disease by considering years of life lost due to premature death as well as years lived with disability. The findings enable the identification of secular trends and disparities between countries and can serve as a basis for decision-making in health policy. METHOD In cooperation with the authors of the GBD study, we summarize the key methods used to assess the burden of disease in terms of disability-adjusted life years (DALYs). We present findings that specifically pertain to Germany, drawn from freely available data of the most recent round of analysis for the years 1990 and 2010. RESULTS According to the GBD study, life expectancy in Germany rose from 75.4 years in 1990 to 80.2 years in 2010. Ischemic heart disease and back pain caused the largest number of DALYs lost (2.5 million and 2.1 million, respectively). Over the period of the study, the absolute number of DALYs due to ischemic heart disease dropped by 33%, while the number of DALYs due to low back pain rose by 11%. Nutrition-related risks ranked first among all risk factors considered, accounting for 13.8% of total DALYs, followed by high blood pressure and high body-mass index, accounting for 10.9% each. CONCLUSION In Germany, important changes have been seen over time in the burden of disease attributable to different chronic diseases. Some of these changes reflect the successful interventions of the past, while others indicate a need for new action. The data from Germany that went into the GBD study must be systematically assessed and supplemented by further data relating to questions of specific relevance in this country.

Gesundheit und Krankheit

Frauen und Manner weisen auserst heterogene Morbiditats- und Mortalitatsprofile auf (vgl. Lademann/ Kolip 2005, RKI 2006). Frauen verbringen im Vergleich zu Mannern mehr Lebensjahre mit beeintrachtigter Lebensqualitat bzw. weniger Lebenszeit bei guter Gesundheit (vgl. Eurostat 2000, Klotz 2006), haben aber zugleich gegenuber den Mannern einen Uberlebensvorteil von etwa sechs bis sieben Jahren (80,8 vs. 74,8 Jahre) (vgl. Statistisches Bundesamt 2002, Lademann/ Kolip 2005). Dieser geschlechtsspezifische Lebenserwartungsunterschied ist in nahezu allen Nationen, vor allem der westlichen Hemisphare, nachzuweisen (vgl. Luy 2002, Klotz 2006). Insbesondere in der Altersspanne zwischen 15 und 65 Jahren ist die mannliche Mortalitatsrate etwa doppelt so hoch wie bei Frauen dieses Alters (vgl. Brahler/Goldschmidt/Kupfer 2001). Das sog. „Geschlechterparadox“ (vgl. Kolip 2003), demzufolge Frauen als vermeintlich „krankeres Geschlecht“ (vgl. Maschewsky-Schneider 1996, Sieverding 1998) eine hohere Lebenserwartung haben, beschaftigt die Wissenschaften bereits seit Jahrzehnten (vgl. Verbrugge 1976, 1990). Auch innerhalb von Public Health, als Wissenschaft und Praxis zur Verbesserung der bevolkerungsbezogenen Gesundheit und der gesundheitsbezogenen Lebensqualitat sowie zur Reduzierung von Gesundheitsbelastungen und Krankheitsrisiken (vgl. Flick 2002), hat sich die Frage, inwieweit Unterschiede in Gesundheit und Krankheit allein auf biologische oder eher auf verhaltens- und/oder bzw. umweltbezogene Faktoren zuruckgehen zu einem bedeutsamen Schwerpunkt entwickelt.

Environmental justice: Social disparities in environmental exposures and health: Overview

This article covers theoretical background, concepts, methods, and results of environmental justice as a growing field of community-based public health activities and as an academic issue with increasing research activities in several countries. It gives an introduction to the roots of the environmental justice movement within and outside of the USA and addresses core topics and subsequent development of environmental justice as a useful analytic concept for social disparities in environmental exposures and health. Current research and empiric findings from different countries are used to illustrate possible underlying mechanisms of social disparities in environmental health and the importance of the physical, social, and man-made environment. Research approaches that might help environmental justice research are also discussed, as are implications for preventive measures, public health promotion, and policy interventions intended to address social and environmental factors but leading to inequalities in health.

The burden of chronic mercury intoxication in artisanal small-scale gold mining in Zimbabwe: data availability and preliminary estimates

BackgroundArtisanal small-scale gold mining (ASGM) is a poverty-driven activity practiced in over 70 countries worldwide. Zimbabwe is amongst the top ten countries using large quantities of mercury to extract gold from ore. This analysis was performed to check data availability and derive a preliminary estimate of disability-adjusted life years (DALYs) due to mercury use in ASGM in Zimbabwe.MethodsCases of chronic mercury intoxication were identified following an algorithm using mercury-related health effects and mercury in human specimens. The sample prevalence amongst miners and controls (surveyed by the United Nations Industrial Development Organization in 2004 and the University of Munich in 2006) was determined and extrapolated to the entire population of Zimbabwe. Further epidemiological and demographic data were taken from the literature and missing data modeled with DisMod II to quantify DALYs using the methods from the Global Burden of Disease (GBD) 2004 update published by the World Health Organization (WHO). While there was no disability weight (DW) available indicating the relative disease severity of chronic mercury intoxication, the DW of a comparable disease was assigned by following the criteria 1) chronic condition, 2) triggered by a substance, and 3) causing similar health symptoms.ResultsMiners showed a sample prevalence of 72% while controls showed no cases of chronic mercury intoxication. Data availability is very limited why it was necessary to model data and make assumptions about the number of exposed population, the definition of chronic mercury intoxication, DW, and epidemiology. If these assumptions hold, the extrapolation would result in around 95,400 DALYs in Zimbabwe’s total population in 2004.ConclusionsThis analysis provides a preliminary quantification of the mercury-related health burden from ASGM based on the limited data available. If the determined assumptions hold, chronic mercury intoxication is likely to have been one of the top 20 hazards for population health in Zimbabwe in 2004 when comparing with more than 130 categories of diseases and injuries quantified in the WHO’s GBD 2004 update. Improving data quality would allow more accurate estimates. However, the results highlight the need to reduce a burden which could be entirely avoided.

[The importance of MRSA in patient care. Epidemiology, prevention and therapy].

ZusammenfassungDie Entwicklung der epidemiologischen Situation bei Methicillin-resistenten Staphylococcus aureus (MRSA) mit einem seit Jahren ansteigenden Trend der Verbreitung in verschiedenen Einrichtungen der ambulanten und stationären Versorgung stellt ein großes infektiologisches Problem dar. Es ergibt sich damit die Notwendigkeit eines MRSA-Managements, dass einerseits Screening-, Hygiene-, Isolierungs- und Sanierungsmaßnahmen und andererseits auch die Kontrolle des Antibiotikaeinsatzes beinhalten muss. Um die MRSA-Situation auch in Zukunft überwachen und bewerten zu können stehen entsprechende Surveillancesysteme zur Verfügung, die zudem Anhaltspunkte zur stetigen Verbesserung des MRSA-Managements liefern können, um das Problem langfristig zu begrenzen.In diesem Zusammenhang kommt regionalen Netzwerken zur Umsetzung von MRSA-Präventionsstrategien eine besondere Bedeutung zu. Sie haben das Ziel, die Zahl MRSA-bedingter Infektionen in einer Region zu reduzieren und die MRSA-Zirkulation zwischen den verschiedenen Einrichtungen des Gesundheitswesens zu unterbrechen.Bei der Behandlung von MRSA-Infektionen ist ein interdisziplinäres Vorgehen zwischen behandelndem Orthopäden und klinischem Mikrobiologen für die Planung eines effektiven Therapieregims von großer Wichtigkeit, um den Behandlungserfolg sicher zustellen, gerade vor dem Hintergrund knapper werdender Ressourcen im Gesundheitssystem.AbstractMethicillin-resistant Staphylococcus aureus (MRSA) has for several years been increasingly spreading at inpatient and outpatient health care facilities. This constitutes a great epidemiological problem. Measures are needed for MRSA management, including screening, hygiene, containment, and sanitation as well as for a stricter control of antibiotic use. In order to be able to monitor and assess the MRSA problem in the future, there are surveillance systems which can provide approaches for continuously improving MRSA management and thus offer a long-term solution.In this context, regional networks for implementing MRSA prevention strategies are of particular importance. Their goal is reducing MRSA-caused infections in an area and stop circulation of MRSA between the various health care facilities.For the management of MRSA infections, interdisciplinary cooperation between the attending orthopedic specialist and the clinical microbiologist is very important for planning an effective treatment regimen to ensure a successful outcome, particularly in view of the growing shortage of resources in the healthcare system.

Bacterial Density, Serotype Distribution and Antibiotic Resistance of Pneumococcal Strains from the Nasopharynx of Peruvian Children Before and After Pneumococcal Conjugate Vaccine 7.

Background: Pneumococcal conjugate vaccines (PCV) have decreased nasopharyngeal carriage of vaccine types but little data exist from rural areas. We investigated bacterial density, serotype distribution and antibiotic resistance of pneumococcal strains within the nasopharynx of young children in the Peruvian Andes, 2 years after PCV7 was introduced. Methods: Pneumococcal strains were isolated from a subset of 125 children from our Peruvian cohort, who entered the study in 2009 and had pneumococcus detected in the nasopharynx in both 2009 and during follow-up in 2011. Strains were Quellung serotyped and tested for susceptibility to antibiotics. Bacterial density was determined by quantitative polymerase chain reaction. Results: The prevalence of PCV7 strains decreased from 48% in 2009 to 28.8% in 2011, whereas non-PCV7 types increased from 52% to 71.2% (P = 0.002). There was a 3.5-fold increase in carriage of serotype 6C in 2011 (P = 0.026). Vaccination with PCV7 did not affect pneumococcal density in children colonized by a PCV7 type but did increase density in those colonized with a non-PCV7 type. Antibiotic resistance did not change after vaccine introduction; strains were nonsusceptible to tetracycline (97.2%), trimethoprim–sulfamethoxazole (56.4%), penicillin (34%), erythromycin (22.4%), chloramphenicol (18.8%) and clindamycin (12.4%). Conclusions: Serotype replacement was observed post-PCV7 vaccination with a concomitant, not previously recognized, increased nasopharyngeal density.

Clinical Environmental Medicine

INTRODUCTION Clinical environmental medicine deals with environmental effects on human health in individual patients. Patients seek medical advice for problems of many different kinds that may be due to environmental exposures; such exposures must be considered carefully along with other potential causes. An environmental medical assessment should include thorough medical history-taking and physical examination, the formulation of a differential diagnosis, and (whenever indicated) human biomonitoring, site inspections, and ambient monitoring. METHODS This review of clinically relevant environment-related health disturbances is based on a selective evaluation of the pertinent literature and of own experiences. RESULTS Overall, relevant environmental exposures can be identified in up to 15% of patients who attribute their health complaints to environmental factors. (Clinical disorders are more common and more severe in these patients.) 40% to 75% are found to suffer from other physical and/or emotional conditions without any specific environmental aspect, i.e., without any apparent or verifiable exposure. DISCUSSION Despite the relative rarity of verifiable environmentally related health disturbances, these must be clearly identified and delimited to avoid further harmful exposures. Environmental medical counseling should include risk assessment and behavior recommendations for all patients who attribute their medical problems to their environment. Physicians performing specific environmental-medical diagnostic procedures must be aware of their limitations in order to avoid performing tests whose results have no therapeutic consequences and are thus of no help to either the physician or the patient.