Geethanjali Ranmuthugala

Effects of Temperature and Ozone on Daily Mortality During the August 2003 Heat Wave in France

During the summer of 2003, Europe experienced a heat wave that lasted almost 2 weeks in which high temperatures were accompanied by exceptionally high ozone levels. Unfortunately, few studies have examined the effects of temperature and ozone simultaneously. The authors use constrained distributed lag models to estimate the effects of daily temperature and peak ozone on mortality in 12 French cities during the heat wave and to estimate the deaths attributable to each component. Elevated minimum and maximum temperature and peak ozone all increase mortality, with substantial interaction effects between temperature and ozone. Researchers expect extreme weather events, along with elevated ozone levels and temperatures, to become more common. Our results suggest that ozone will be an important contributor to the adverse health effects of such events.

Acute skin irritant effects of cyanobacteria (blue-green algae) in healthy volunteers.

Objective: To assess the skin irritant potential of a range of laboratory grown cyanobacterial species using skin‐patch testing on human volunteers.

A Randomised intervention trial to assess two arsenic mitigation options in Bangladesh

Arsenic groundwater contamination in Bangladesh warrants immediate remediation. This randomised controlled intervention trial was conducted to determine the effectiveness of two possible interventions: dug wells and three-pitcher filters. A total of 640 individuals participated with 218 randomised to the dug well group, 216 to the three-pitcher group and 206 to a control group. Data were collected at baseline and at 1, 6 and 12 months after the intervention. Self reported compliance with dug wells remained below 20% during the entire 12 months of the study. The compliance with the three-pitcher filters decreased after 6 months and became similar to the compliance of the dug well group after 12 months. A substantial decrease in urinary arsenic metabolites occurred only among those who were compliant with dug wells and three-pitcher filter systems after 1 month of intervention as opposed to control participants. However, a persistent reduction in urinary arsenic concentrations was observed only among the dug well users after 12 months of intervention. Our results show that a functional dug well could be offered as a long-term alternative to tube wells, but use of this option is likely to be low, unless appropriate behavioural change measures are taken. Our study also demonstrates that arsenic removal technologies such as three-pitcher filters are an effective option as a short-term measure. The three-pitcher filters that are not adequately maintained are not an effective option for a year. These arsenic removal technologies may be even harmful in the long term if the resultant water quality is not properly monitored.

Chlorinated drinking water and micronuclei in urinary bladder epithelial cells.

Background: Evidence for a causal relationship between disinfection byproducts in chlorinated water and cancer is not conclusive. This study investigates the association between disinfection byproducts in chlorinated water, as measured by trihalomethane concentration, and the frequency of micronuclei in urinary bladder epithelial cells, thereby assessing the carcinogenic potential of disinfection byproducts. Methods: A cohort study was undertaken in 1997 in 3 Australian communities with varying levels of disinfection byproducts in the water supply. Exposure was assessed using both available dose (total trihalomethane concentration in the water supply) and intake dose (calculated by adjusting for individual variations in ingestion, inhalation, and dermal absorption). Micronuclei in urinary bladder epithelial cells were used as a preclinical biomarker of genotoxicity. Results: Cells were scored for micronuclei for 228 participants, of whom 63% were exposed to disinfection by products and 37% were unexposed. Available dose of total trihalomethane for the exposed group ranged from 38 to 157 &mgr;g/L, whereas intake dose ranged from 3 to 469 &mgr;g/kg per day. Relative risk for DNA damage to bladder cells, per 10 &mgr;g/L of available dose total trihalomethane, was 1.01 (95% confidence interval [CI] = 0.97–1.06) for smokers and 0.996 (CI = 0.961–1.032) for nonsmokers. Relative risk, per 10 &mgr;g/kg per day of intake dose of total trihalomethane, was 0.99 (CI = 0.96–1.03) for smokers and 1.003 (CI = 0.984-1.023) for nonsmokers. Conclusion: This study provides no evidence that trihalomethane concentrations, at the levels we investigated, are associated with DNA damage to bladder cells.

Identifying the aspects of rural exposure that influence medical students to take up rural practice

Editor – Identifying the factors that influence students to take up rural practice is crucial to ensuring the success and continuing funding of strategies designed to address rural medical workforce shortages. In Australia, strategies to encourage the uptake of rural practice include increasing the intake of students from rural backgrounds, providing students with greater exposure to rural medicine through rural placements, and an increased rural focus in medical curricula. Although evidence testifies to the success of programmes that selectively admit students from rural backgrounds and those who intend to practise as family practitioners (both independent predictors of practice location), the specific contribution of rural exposure to increasing uptake of rural practice is less clear, largely as a result of the lack of empirical evidence controlling for such confounding variables.

Rural Organisation of Acute Stroke Teams project

Background: Improving the care of stroke patients is a national priority for the health system in Australia. In rural areas the challenges may be greater. Although best‐practice guidelines for acute and subacute stroke care are well established, their general uptake appears to be limited and implementation strategies are required to promote the use of this evidence‐based care. The Rural Organisation of Australian Stroke Teams (ROAST) project sought to promote the evidence‐based stroke practice in rural hospitals.

Clinicians' roles in management of arsenicosis in Bangladesh: interview study

The British Geological Survey in 2001 estimated that 46% of all shallow tube wells in Bangladesh contained arsenic at concentrations exceeding the World Health Organizations guideline concentration of 0.01 mg/litre. An estimated 28-35 million people were thought to be exposed to arsenic in their drinking water at concentrations exceeding even Bangladeshs arsenic standard of 0.05 mg/litre.1 Many thousands of cases of chronic arsenic poisoning have now been identified, but the real magnitude of the health impact is still undefined. In the 10 years since the problem of arsenic contamination of tube wells, on which a large proportion of the population depend for their drinking water, was identified the development of a coherent national strategy to manage this problem has been disappointingly slow.2 Doctors have a vital role both in the diagnosis and management of arsenicosis and in the mitigation of this major public …