Ksenija Vitale

Respiratory findings in livestock farmworkers

Inthis cross-sectional study, the prevalence of acute and chronic respiratorysymptoms and lung function were investigated in 236 (169 male and 67 female)livestock farmworkers raising domestic animals, including cattle and horses.The prevalence of acute and chronic respiratory symptoms was recorded byadministering a modified version of the British Medical Research Councilquestionnaire on respiratory symptoms. Lung function was measured by recordingthe maximum expiratory flow-volume curves from which the forced vitalcapacity, the one-second forced expiratory volume, and the maximum expiratoryflow rates at 50% and the last 25% were measured. There was a significantlyhigher prevalence of almost all chronic respiratory symptoms in farmerscompared with controls: highest among men for chronic cough (27.2%) andhighest among women for dyspnea (28.3%). Typical symptoms of occupationalasthma were diagnosed in 3.6% of the male and 1.5% of the female livestockfarmers. A logistic regression analysis performed on chronic respiratorysymptoms of livestock workers indicate significant effects of smoking(P < 0.001) on all symptoms exceptoccupational asthma. A large number of male and female livestock farmworkerscomplained of acute work-related symptoms: highest for dry cough (52.2%) andshortness of breath (44.9%). Lung function data among these workersdemonstrated a trend toward lower lung function in general. Multivariateanalysis of lung function parameters indicate significant effects of length ofemployment and smoking in male and length of employment in female livestockfarmworkers. The data suggest that employment in livestock farming may beassociated in a dose-dependent manner with the development of acute andchronic respiratory symptoms and lung functionchanges.: In this cross-sectional study, the prevalence of acute and chronic respiratory symptoms and lung function were investigated in 236 (169 male and 67 female) livestock farmworkers raising domestic animals, including cattle and horses. The prevalence of acute and chronic respiratory symptoms was recorded by administering a modified version of the British Medical Research Council questionnaire on respiratory symptoms. Lung function was measured by recording the maximum expiratory flow-volume curves from which the forced vital capacity, the one-second forced expiratory volume, and the maximum expiratory flow rates at 50% and the last 25% were measured. There was a significantly higher prevalence of almost all chronic respiratory symptoms in farmers compared with controls: highest among men for chronic cough (27.2%) and highest among women for dyspnea (28.3%). Typical symptoms of occupational asthma were diagnosed in 3.6% of the male and 1.5% of the female livestock farmers. A logistic regression analysis performed on chronic respiratory symptoms of livestock workers indicate significant effects of smoking (P < 0.001) on all symptoms except occupational asthma. A large number of male and female livestock farmworkers complained of acute work-related symptoms: highest for dry cough (52.2%) and shortness of breath (44.9%). Lung function data among these workers demonstrated a trend toward lower lung function in general. Multivariate analysis of lung function parameters indicate significant effects of length of employment and smoking in male and length of employment in female livestock farmworkers. The data suggest that employment in livestock farming may be associated in a dose-dependent manner with the development of acute and chronic respiratory symptoms and lung function changes.

Respiratory findings in chemical workers exposed to low concentrations of organic and inorganic air pollutants.

BACKGROUND Occupational exposure to respiratory irritants may effect respiratory function in workers exposed to ambient air pollutants in the workplace. METHODS We studied 567 male and 135 female workers employed in two chemical plants in Zagreb, Croatia. Measurements of the ambient concentrations of air pollutants were performed. The mean age of the men was 37 years and mean duration of employment was 12 years; a majority of these workers were smokers. The mean age of the women was 37 years with a mean duration of employment of 14 years; only one-third of the women smoked. An unexposed group of 340 male and 110 female unexposed workers was also studied. Acute and chronic work related symptoms were recorded for all workers. Ventilatory capacity was measured by recording maximum expiratory flow-volume (MEFV) curves. RESULTS There were higher prevalences for all chronic respiratory symptoms in exposed than in unexposed workers particularly among women, a majority of which were nonsmokers. Occupational asthma was recorded in three (0. 5%) of the men and in two (1.5%) of the women workers. Logistic regression analysis indicated that the presence of chronic respiratory symptoms among exposed workers was primarily associated with the amount of smoking. Additionally, there were high prevalences of acute symptoms during the work shift. Among the chemical workers these were greatest for eye irritation (male: 43. 9%; female: 51.9%), dryness of the throat (male: 43.4%; female: 57. 0%) and irritation of the throat (male: 37.4%; female: 56.6%). Ventilatory capacity data among the chemical workers demonstrated that most of the measured tests, particularly the FVC and FEV1 were significantly decreased compared to predicted (P < 0.01 or P < 0. 05)). In particular nonsmoking women exhibited abnormal lung function. The effect of smoking among exposed workers was demonstrated on all ventilatory capacity tests by regression analysis for all measured respiratory parameters. Both length of exposure and age were correlated with lung function loss for FVC. Measured pollutant levels were for the most part within acceptable standard limits. CONCLUSIONS Our data suggest that in this population of chemical workers exposed to low levels of pollutants respiratory symptoms were primarily associated with smoking. Environmental effects, possibly due to an interaction of pollutants were also suggested.

Is herbal tea consumption a factor in endemic nephropathy

Endemic (Balkan) nephropathy (EN) is a chronic tubulointerstitial nephropathy frequently associated with upper urothelial cancer exclusively affecting farming villagers [1–3]. Based on our results, EN is considered to be an environmental form of aristolochic acid nephropathy (AAN) [1–3]. AAN was first reported in 1993 in Belgium and subsequently more AAN cases were reported worldwide as AA has been an integral part of traditional herbal medicines [4]. The extent of this problem was recently documented in Taiwan where precise data on prescriptions of herbal products containing AA is available [5]. Aristolochia spp. has been used for more than 2,000 years in the practice of traditional medicine and European physicians were familiar with the use of this plant as well. After its intrinsic toxicity became known, importing Aristolochia herbs was banned in many countries, including Croatia. Nevertheless, products containing AA remain a part of traditional medicine and are sold in many countries that do not have strict control protocols. Recently we reported that AA DNA adducts were present in 95 % of patients with EN who underwent surgery for upper urothelial cancers [2] and affirmed the idea that bread contaminated with AA might be the cause of EN [6, 7]. However, the causative relationship between AA and EN again raised the question whether bread intake is the only route of ingestion or whether AA was ingested also in EN as a part of folkloric medicine. Gluhovschi et al. [8] reported that although therapeutic remedies based on AA products are used in the EN affected area in Romania, no relationship between these remedies and the development of EN or of tumors was observed. However, they used HPLC for detection of AA in plasma, which is less sensitive than the mass spectrometry we recently used in tissue samples [1, 2]. In addition, when re-analyzing their data, it does appear that AA was used more frequently in the endemic area. In our opinion, this leaves the question whether herbal tea may play a role in EN still unanswered. In our preliminary study we failed to find any evidence in the group of 1,041 Croatian farmers that herbal tea or traditional medicine use is related to EN [9]. The observed differences between

Integral Management of Water Resources in Croatia: Step Towards Water Security and Safety for All

The article investigates the number and the technical conditions of local water supply systems in Croatia. So far they have been poorly maintained, delivering water that is both microbiologically and chemically contaminated, to around 6% of Croatian population. Even when possible, users of local water supply systems prefer to stay outside bigger, communally controlled water supply systems, due to the pricing. Implementation of Water Safety Plans is recommended, as possible tool for improvement of the local water supply systems weather through merging with bigger systems, remaining as local units or preserving as an additional system in time of need. In addition these plans would help to classify the possible risks of each local water supply system and identify possible burden of disease as a consequence. That information could be point of arguing with local governments and communities. Better technical conditions of local water supply systems and sanitary acceptable water that is delivered are the starting point for the creation of alternative water sources network, essential for the crisis mitigation, by mapping preserved or those still in use.

Patients Practice and Knowledge of Pharmaceuticals Disposal: Example from Some Rural Areas of Croatia

Consumption of the pharmaceutical products for both human and veterinary use is constantly increasing. As the consequence considerable amount of pharmaceuticals and its metabolites is released into the environment at therapeutic concentrations. The aim of this article is to describe patient practice and knowledge of unused drugs disposal in some rural areas of Croatia. Results showed that mostly older population live in these areas with considerable co morbidity of various chronic diseases, using considerable number of pharmaceuticals. Educational level and therapy compliance is low, as well as knowledge on how to dispose unused pharmaceuticals. On the other hand, due to the relative geographical isolation there is tendency to stock various pharmaceuticals as well as self-medication. Unused drugs end up improperly disposed in the ecologically delicate environment rich in drinking water supply. Strong support from primary health care is needed as well from pharmacies for returning of unused pharmaceutical when possible or clear advice how to properly dispose them if they cannot be returned.

Is salt intake hidden risk for rural population: case study Village of Sjeverovac, County Sisacko-moslavacka?

Nutritional habits between urban and rural population differ as much as life style and socioeconomic standards of these populations. In Croatia, rural populations are mostly live stock producers. Their nutrition frequently depends on their own production, which includes high quantity of cured meat products, eggs and dairy products. Data were obtained from longitudinal the Croatian Adult health Survey and pilot cross-sectional survey in three villages in Sisacko-moslavacka county. Our findings show that there is no great difference between urban and rural population regarding salt intake. The difference is in the type of food and food preparation, as well as life style. We propose combination of more culturally and socially sensitive questionnaires along with analytical methods that include biological matrix, such as 24-hour urine collection.

Angiotensin-converting enzyme gene polymorphism and N-Acetyl-β-D-glucosaminidase excretion in endemic nephropathy.

Background: Tubular proteinuria and enzymuria are hallmarks of endemic nephropathy (EN). The role of I/D angiotensin convertase (ACE) gene polymorphism has not yet been elucidated in this peculiar chronic tubulointerstitial nephritis, and our aim was to investigate the role of this polymorphism in EN focusing on the urinary N-acetyl-β-D-glucosaminidase (NAG) excretion, a biomarker of proximal tubular damage. Methods:ACE genotype and allele frequencies were determined in 229 farmers (147 women and 82 men) from an endemic Croatian village. The farmers were stratified according to the WHO criteria into the following subgroups: those ‘at risk’ for EN (n = 37), ‘suspected of having EN’ (n = 57), and ‘others’ (n = 135). Results: There were 74 (32.3%) subjects homozygous for the D allele, 99 (43.2%) heterozygous (ID genotype) and 56 (24.4%) homozygous for the I allele. No differences in allele frequency were found between the established WHO subgroups (p > 0.05). In the whole group, DD subjects had significantly higher values of diastolic blood pressure (p = 0.003) and urinary NAG than subjects with ID and II genotype (5.5 ± 1.2 vs. 4.0 ± 3.0 vs. 3.8 ± 4.2, respectively; p = 0.023). The highest values of serum creatinine (p = 0.02), proteinuria (p = 0.03) and urinary NAG (6.0 ± 3.7 vs. 3.7 ± 2.1 vs. 3.0 ± 1.6, respectively; p = 0.008) were observed in those suspected of having EN group with the DD genotype. Conclusion:ACE gene polymorphism is not a risk factor for EN. However, it might influence the clinical course of EN, and increased excretion of NAG might be a prognostic marker of this chronic tubulointerstitial nephritis.

Rainwater Collecting as a Part of Implementation of the Sustainable Development Principles on Croatian Islands — Old Habits for New Era

The article investigates availability and quality of drinking water along with possibilities of rainwater harvesting, as an element of sustainable development on four Croatian islands. Investigated islands, represent two main regions: northern and southern Adriatic coast. This division corresponds with gravity to two main macro regional centers on the coast and it is common in demographic, economic and sociological research. Data on local water resources, conditions and type of water supply, quality of water, prices, consumption of water, number and condition of cisterns and demographic records are collected and analyzed. Also, meteorological data on annual rainfall in past 26 years are collected and analyzed. Drinking water quality corresponds with Croatian law regarding physical and chemical parameters, while most of microbiological parameters are unacceptable. The results point out modest possibility of developing public water supply on islands. Average annual rainfall indicates that harvesting of rainwater should be integrated as additional water source on investigated islands which would save great quantities of the drinking water that are used as technical water and for the other purposes such as agriculture or forest fires. Also that would lower the household expenses for the water and diminish water crisis during the tourist season months. Natural water resources on Croatian islands are scarce and it is our ethical obligation to preserve them in favor of existing eco systems and long term exploitation.

Fish consumption and mercury body burden in women of reproductive age from urban area in Croatia

Mercury entering aquatic environment can be transformed by microorganisms into toxic methyl-mercury that biomagnifies in aquatic organisms. Seafood consumption is primary exposure route to mercury for humans. The most vulnerable groups are unborn and young children. The aim of this article is to investigate is there possible connection of fish consumption and mercury body burden in women of reproductive age in Croatia. Sample consisted of 75 women age 22 to 40, living in urban area for at least five years, and not occupationally exposed to mercury. They answered questionnaire about fish consumption and living environment as source of possible additional exposure to mercury. Hair samples were used as biomarker of exposure. Total mercury (tHg), that reflects methyl-mercury exposure, were measured using atomic absorption spectrometry method, using a single purpose instrument AMA 254 (Advanced Mercury Analyser), ALTEC Ltd, Praha, Czech Republic, which advantage is no sample pre-treatment. Women were divided in vegetarian 17 (23%) and non vegetarian 58 (77%). Results show that all 74 women had detectable levels of mercury in hair. The range of total mercury values in hair was from highest level of 3.90  g/g to lowest level of 0.08  g/g. Out of 75 women, 11 (14.8%) women were above the most protective reference dose of 1  g Hg/g in hair, calculated by US EPA. The lower values of tHg in hair from 0, 19 to 0, 08  g/g Hg were detected in 17 (22.9%) women who did not consume fish at all. All 75 women had values below the benchmark dose of 10  g/g Hg in the hair, set by WHO. The average fish consumption in sample was 1 meal per week. Mostly consumed fish is predominantly of local origin, canned tuna from unknown origin and rarely frozen imported fish. Although measured values of tHg in hair in some examinees is above most protective values, collected data on fish consumption which correspond with average fish consumption in Croatia show that overall consumption is very low and there is no danger of Hg exposure of vulnerable population. However, further and more detailed investigation is needed, with specific focus on Croatian coastal areas and islands where people consume considerably larger amounts of fish mainly from local sources. The common opinion that locally caught fish is not mercury contaminated become questionable, because latest studies show that 41% of the captive Atlantic bluefin tuna farmed in Adriatic Sea contain mercury above the maximum level of 1µ ; ; ; g/g wet weight defined by the European Commission Decision and Croatian legislation.