Air pollution and daily mortality in Erfurt, east Germany, 1980-1989.

In Erfurt, Germany, unfavorable geography and emissions from coal burning lead to very high ambient pollution (up to about 4000 micrograms/m3 SO2 in 1980-89). To assess possible health effects of these exposures, total daily mortality was obtained for this same period. A multivariate model was fitted, including corrections for long-term fluctuations, influenza epidemics, and meterology, before analyzing the effect of pollution. The best fit for pollution was obtained for log (SO2 daily mean) with a lag of 2 days. Daily mortality increased by 10% for an increase in SO2 from 23 to 929 micrograms/m3 (5% quantile to 95% quantile). A harvesting effect (fewer people die on a given day if more deaths occurred in the last 15 days) may modify this by +/- 2%. The effect for particulates (SP, 1988-89 only) was stronger than the effect of SO2. Log SP (daily mean) increasing from 15 micrograms/m3 to 331 micrograms/m3 (5% quantile to 95% quantile) was associated with a 22% increase in mortality. Depending on harvesting, the observable effect may lie between 14% and 27%. There is no indication of a threshold or synergism. The effects of air pollution are smaller than the effects of influenza epidemics and are of the same size as meterologic effects. The results for the lower end of the dose range are in agreement with linear models fitted in studies of moderate air pollution and episode studies.     

Daily mortality and particulate matter in different size classes in Erfurt, Germany

The link between elevated concentrations of ambient particulate matter (PM) and increased mortality has been investigated in numerous studies. Here we analyzed the role of different particle size fractions with respect to total and cardio-respiratory mortality in Erfurt, Germany, between 1995 and 2001. Number concentrations (NC) of PM were measured using an aerosol spectrometer consisting of a Differential Mobility Particle Sizer and a Laser Aerosol Spectrometer to characterize particles between 0.01 and 0.5 and between 0.1 and 2.5 microm, respectively. We derived daily means of particle NC for ultrafine (0.01-0.1 microm) and for fine particles (0.01-2.5 microm). Assuming spherical particles of a constant density, we estimated the mass concentrations (MC) of particles in these size ranges. Concurrently, data on daily total and cardio-respiratory death counts were obtained from local health authorities. The data were analyzed using Poisson Generalized Additive Models adjusting for trend, seasonality, influenza epidemics, day of the week, and meteorology using smooth functions or indicator variables. We found statistically significant associations between elevated ultrafine particle (UFP; diameter: 0.01-0.1 microm) NC and total as well as cardio-respiratory mortality, each with a 4 days lag. The relative mortality risk (RR) for a 9748 cm(-3) increase in UFP NC was RR=1.029 and its 95% confidence interval (CI)=1.003-1.055 for total mortality. For cardio-respiratory mortality we found: RR=1.031, 95% CI: 1.003-1.060. No association between fine particle MC and mortality was found. This study shows that UFP, representing fresh combustion particles, may be an important component of urban air pollution associated with health effects.     

Air quality assessment in passenger trains: the impact of smokestack emissions

The influence of the smokestack emissions of a ground-level train in the air quality of the passenger carriages through the ventilation system was investigated in this work. To this end, a monitoring campaign was designed and implemented at 20 different in-train sites, e.g., conductor’s cabin, carriages with passenger seats, boarding carriages, spaces for disabled people, etc., during its journey between urban and rural areas. Measurements of inorganic (NO_x, SO₂, CO) and organic (benzene, polyaromatic hydrocarbons, total volatile organic compounds) compounds as well as airborne particulate matter (PM) in different size ranges (ΡΜ10, ΡΜ2.5, ΡΜ1) were carried out in the interior of the carriages of a diesel engine-powered train (type KAT 2000) during fixed round trips. An exhaust dispersion cone hook was used for intervention purposes leading to the reassessment of the in-train air quality at the most contaminated sites. In order to produce reliable and comparable data, targeted measurements were conducted in a railbus which was used as reference. Based on the analysis, the air pollutants and particle levels exhibit significant variations at the same sampling point during the train journey, possibly due to the route characteristics (tunnels, uphills, turns, speed). Significant spatial fluctuations in the same train depending on the position and the proximity to the smokestack plume and the ventilation system inlet were observed as well. It is worthy to note that decreased pollutant values were observed during the intervention.     

Air pollutant exposure field modeling using air quality model-data fusion methods and comparison with satellite AOD-derived fields: application over North Carolina,USA

In order to generate air-pollutant exposure fields for health studies, a data fusion (DF) approach is developed that combines observations from ambient monitors and simulated data from the Community Multiscale Air Quality (CMAQ) model. These resulting fields capture the spatiotemporal information provided by the air quality model, as well as the finer temporal scale variations from the pollutant observations and decrease model biases. Here, the approach is applied to develop daily concentration fields for PM_2.5 total mass, five major particulate species (OC, EC, SO₄ ^2?, NO₃ ^?, and NH₄ ⁺), and three gaseous pollutants (CO, NO _x , and NO₂) from 2006 to 2008 over North Carolina (USA). Several data withholding methods are then conducted to evaluate the data fusion method, and the results suggest that typical approaches may overestimate the ability of spatiotemporal estimation methods to capture pollutant concentrations in areas with limited or no monitors. The results show improvements in capturing spatial and temporal variability compared with CMAQ results. Evaluation tests for PM_2.5 led to an R ² of 0.95 (no withholding) and 0.82 when using 10% random data withholding. If spatially based data withholding is used, the R ² is 0.73. Comparisons of DF-developed PM_2.5 total mass concentration with the spatiotemporal fields derived from two other methods (both use satellite aerosol optical depth (AOD) data) find that, in this case, the data fusion fields have slightly less overall error, with an RMSE of 1.28 compared with 3.06 μg/m³ (two-stage statistical model) and 2.74 (neural network-based hybrid model). Applying the Integrated Mobile Source Indicator (IMSI) method shows that the data fusion fields can be used to estimate mobile source impacts. Overall, the growing availability of chemically detailed air quality model fields and the accuracy of the DF field, suggest that this approach is better able to provide spatiotemporal pollutant fields for gaseous and speciated particulate pollutants for health and planning studies.     

Neonatal serum p,p'-DDE concentrations in Germany: chronological changes during the past 20 years and proposed tolerance level

p,p'-DDE, the main metabolite of the insecticide DDT, is prenatally transmitted from mother to fetus. Many potential effects of low-level exposure have been reported, including preterm delivery, growth retardation and neurological impairment, although scientific evidence is still lacking. We present p,p'-DDE concentrations in full-term human neonates over a time period of 20 years in Germany. Peripheral venous blood samples were taken from neonates born in 1984-85 (n=80) and 1994-95 (n=80), as well as cord blood samples from neonates born in 1998 (n=199), and peripheral venous blood samples from neonates born in 2002 (n=20). Blood specimens were immediately centrifuged, and serum was stored at -20 degrees C until analysis. Serum p,p'-DDE concentrations were determined with capillary gas chromatography followed by electron capture detection. Differences between study groups were tested for mean differences with the Kruskal-Wallis test. There were no differences between the study groups with regard to sex distribution, birthweight, gestational age, age of the mother, and smoking behaviour of the parents. We found a significant (P <0.0001) chronological decline of neonatal serum p,p'-DDE concentrations, with the highest values in 1984-85 (mean=1.49 microg/L; range: 0.30-5.58) and the lowest in 2002 [mean=0.18 microg/L; range: 0.07-0.54; tolerance level (95th percentile by rank)=0.30 microg/L]. Neonatal p,p'-DDE concentrations today are significantly lower than in the mid-1990s, when many studies of adverse side effects of p,p'-DDE were performed. The present results suggest that the neonatal burden of p,p'-DDE now is so low that there may be no attendant health risks for newborns and children, however, further studies are warranted to elucidate possible long-term health effects even of low-level organochlorine pollution.     

International trends in the study of room air quality and conclusions for East Germany

The international literature is analyzed in order to recognize recent developments in the field of investigations of indoor air quality. Special attention is paid to the papers of the 4th International Conference on Indoor Air Quality and Climate, held in Berlin (West) August 1987. It is noticed that a certain emphasis is put on the investigation of volatile organic compounds and of radon and their effects on human health. General conclusions are drawn for the research on these problems in the GDR.     

Trends in overweight and obesity and changes in the distribution of body mass index in schoolchildren of Jena, East Germany

OBJECTIVE: Data of Jena children (Germany) show increases in the prevalence estimates of overweight and obesity between 1975 and 2001. Our objective was to determine if these increases contribute to changes in the distribution of body mass index (BMI) in the entire population of children. The decade 1985-1995, which includes the time of German reunification, is of particular interest because of the significant socio-economic changes in East Germany, in which Jena is located. DESIGN AND SUBJECTS: The analyses were based on data from four cross-sectional growth studies in 7- to 14-year-old children performed in Jena, Germany, in 1975 (n=2013), 1985 (n=1534), 1995 (n=1906) and 2001 (n=1918). Overweight and obesity were estimated by German reference data and the reference of Cole et al. Mean difference plots were used to investigate the changes in the BMI distributions within sexes between the studies. RESULTS: Between 1985 and 1995, the prevalence of overweight and obesity increased significantly in both sexes, whereas nonsignificant changes were found between 1975 and 1985. Although there is a tendency towards increased overweight between 1995 and 2001, the differences were nonsignificant. Comparing data from 1975 and 1985, the mean difference plots showed virtually no changes in the BMI distribution. In the plots comparing the BMI distribution for 1985 data and 1995 data, the whole distribution tended to shift upwards with a greater shift in the upper BMI range. The entire population of children in Jena gained weight during this period of time. This increase may be linked to a transition towards a more Western lifestyle, that is, usually by lower energy expenditure and nutritional transitions, caused by the process of reunification of Germany in 1989. CONCLUSIONS: Weight gain appears to be a characteristic feature of the entire population studied and does not seem to be a separate problem of the obese children. This suggests that reported changes in the prevalence may be underestimating the looming public health crisis.     

Variation in indoor air pollutant concentrations with time in a newly constructed private house

An indoor air quality research project was conducted in a new private house built in January 1997 to investigate time course changes in formaldehyde concentrations during an 11-month period from April 1997 to February 1998. Indoor and outdoor concentrations of volatile organic compounds (VOCs) and nitrogen dioxide were also measured in August 1997 and February 1998. Indoor formaldehyde concentrations were measured 14 times (48 hrs sampling for each measurement) for 28 days in the living room, a bedroom and the kitchen in April '97. The concentrations exceeded the Japanese Government's guideline value of 0.08 ppm in 34 of the 42 (81.0%). Day to day variation in the formaldehyde concentration was found to be substantial, the range being between 0.073 and 0.232 ppm for the bedroom, for example. In June and August '97, values for 20 of 21 measurements exceeded the guideline, the results suggesting that indoor formaldehyde concentrations remain high until 7 months after the completion of construction. There were positive correlations between the formaldehyde concentrations in the living room and the kitchen and personal exposure levels to formaldehyde, the result indicating a direct influence of the home environment. The formaldehyde concentration in the living room also exhibited a positive correlation with the room temperature. Natural ventilation by opening windows was found to be effective for decreasing the concentration of formaldehyde in the indoor air. Indoor VOC concentrations decreased rapidly after the completion of construction except for that of toluene, which was higher than the outdoor concentration even after 7 months. Indoor concentrations of all of the VOCs were, however, found to be almost the same as those outdoor at the 13 month time point. Indoor nitrogen dioxide concentrations measured in the bedroom in winter (February '98) exceeded the Environmental Air Quality Standard in Japan, this result being considered due to use of an oil fan heater. These data suggest that personal exposure levels to formaldehyde and nitrogen dioxide are high in newly constructed private homes in Japan. In order to avoid prolonged exposure to high concentrations of indoor air pollutants, it is considered very important to take measures such as of use building materials with low formaldehyde emissions and to discontinue the use of oil fan heaters.     

Mercury concentrations in urine,scalp hair,and saliva in children from Germany

Mercury levels measured in urine, hair, and saliva of 245 German children (8-10 years old) are reported. Mercury concentrations in urine ranged between <0.1 and 5.3 microg/l [geometric mean (GM) 0.26 microg/l or 0.25 microg/g creatinine; median for both, 0.22 in microg/l and microg/g, respectively]. Using multiple linear regression analysis, two predictors have been found accounting for 25.3% of the variance of mercury levels in urine: the number of teeth with amalgam fillings (23.2%) and the number of defective amalgam fillings (2.1%). The mercury content in hair ranged from <0.06 to 1.7 microg/g (GM 0.18 microg/g; median 0.18 microg/g). The frequency of fish consumption, the smoking habits of the parents, and the age of the children accounted for 20.4% of the variance of mercury levels in hair. The correlation between the hair mercury content and urine mercury concentration was low (r=0.297). Mercury levels in saliva ranged between <0.32 and 4.5 microg/l (median 0.16 microg/l). The mercury concentration in saliva was below the limit of quantification of 0.32 microg/l in more than 70% of the samples. Mercury analysis in urine is suitable to estimate mercury exposure due to amalgam fillings, whereas hair mercury better reflects mercury intake by fish consumption. Up to now, saliva does not seem to be a suitable tool to monitor the mercury burden, at least not at low exposure levels.     

Uranium mining in East Germany ("Wismut"): health consequences, occupational medical care and workers' compensation

Underground uranium mining was performed in East Germany after World War II on a large scale. Working conditions were very poor during the post-war years from approx. 1946 to 1955. During later years mining conditions improved. In 1990, uranium production was generally stopped as a consequence of German reunification. A company-based health care system commenced in the early years with an annual routine medical check-up including chest X-ray. A central Wismut institution for occupational medicine was founded in 1968. Since reunification, the German Workers' Compensation Board is organizing post-exposural occupational medical care and compensation for former miners. Compensable occupational diseases include silicosis and Schneeberg lung disease (bronchial carcinoma of uranium miners). A current topic is the question of acknowledgement of extrapulmonary malignoma as a compensable disease in uranium miners. With a certain cumulated exposure as a prerequisite, bone and liver cancer and certain types of leukemia are likely to be accepted.     

Air pollutant strategies to reduce adverse health impacts and health inequalities: a quantitative assessment for Detroit,Michigan

The development of air quality management (AQM) strategies provides opportunities to improve public health and reduce health inequalities. This study evaluates health and inequality impacts of alternate SO₂ control strategies in Detroit, MI, a designated non-attainment area. Control alternatives include uniform reductions across sources, ranking approaches based on total emissions and health impacts per ton of pollutant emitted, and optimizations that meet concentration and health goals. Using dispersion modeling and quantitative health impact assessment (HIA), these strategies are evaluated in terms of ambient concentrations, health impacts, and the inequality in health risks. The health burden attributable to SO₂ emissions in Detroit falls primarily among children and includes 70 hospitalizations and 6000 asthma-related respiratory symptom days annually, equivalent to 7 disability-adjusted life years (DALYs). The health burden disproportionately falls on Hispanic/Latino residents, residents with less than a high school diploma, and foreign-born residents. Control strategies that target smaller facilities near exposed populations provide the greatest benefit in terms of the overall health burden reductions and the inequality of attributable health risk; conventional strategies that target the largest emission sources can increase inequality and provide only modest health benefits. The assessment is novel in using spatial analyses that account for urban scale gradients in exposure, demographics, vulnerability, and population health. We show that quantitative HIA methods can be used to develop AQM strategies that simultaneously meet environmental, public health, and environmental justice goals, advancing AQM beyond its current compliance-oriented focus.     

Hospital quality reports in Germany: patient and physician opinion of the reported quality indicators

Background  

Starting in 2005, Germany's health law required hospital quality reports to be published every two years by all acute care hospitals. The reports were intended to help patients and physicians make informed choices of hospitals. However, while establishing the quality indicators that form the content of the reports, the information needs of the target groups were not explicitly taken into account. Therefore, the aim of our study was to determine patient and physician opinion of the relevance of the reported quality indicators for choosing or referring to a hospital.     

Traditional alcoholic beverages of Tanzania: production, quality and changes in quality attributes during storage

Traditional alcoholic beverages of Tanzania play an important role in the daily social, economic, nutritional and cultural life of the people. Production, quality and changes in quality attributes during ambient temperature storage were investigated in traditional Tanzanian beers (Mbege and Komoni) and wines (Mnanasi, Wanzuki and Mofru). The quality attributes of the alcoholic beverages indicated that pH levels were in the range of 4.15-4.20 and 3.9-5.5 for the beers and wines respectively. Total, fixed and volatile acidity in the beers were in the range of 0.41-0.62, 0.28-0.38 and 0.06-0.09 g/100 mL respectively while in the wines acidity levels were in the range of 0.23-0.66, 0.13-0.33 and 0.05-0.06 g/100 mL for the total, fixed and volatile acidity respectively. Concentration of total solids in the beers ranged between 7.00 and 12.80 degrees Brix while in the wines ranged between 3.45 and 6.65 degrees Brix. Specific gravity of the beers ranged between 1.0097 and 1.0374 while for wines the specific gravity was lower, ranging between 0.9971 and 0.9989. Alcohol concentration was higher in wines (range 3.84-9.75 g/100 mL) than in beers (range 1.72-2.76 g/100 mL). Storage of the beverages under ambient temperatures for various lengths of time resulted in significant (P < 0.05) increase in total acidity, volatile acidity and alcohol content and decrease in the total solids and specific gravity. Mbege and Komoni beers indicated the highest rates of deterioration with total acid production rates of 0.3774 g/100 mL and 0.0914 g/100 mL per hour respectively. Wines were more stable during storage than beers, with Mofru wine being the most stable. The rates of total acid production per hour were Mnanasi (0.0196 g/100 mL), Wanzuki (0.0047 g/100 mL) and Mofru (0.0005 g/100 mL). Use of low brewing technologies involving uncontrolled fermentation, unsanitary conditions and use of rudimentary equipment for processing, packaging and storage resulted in beers and wines of low quality and short shelf-life. To foster commercial exploitation of the products, there is a need to develop appropriate small and medium-level brewing technologies that will improve the quality of the traditional alcoholic beverages and extend their shelf-life through hygienic and controlled processing, packaging, and storage.     

Drug prescribing in hospital as experienced by general practitioners: East versus West Germany

BACKGROUND AND OBJECTIVES: Drugs prescribed by the general practitioner (GP) are oftenchanged during hospitalization. This study set out to test thehypothesis that the extent of drug change and the informationprovided by the hospital determines the GPs' assessment of hospitalco-operation. The perception of drug change and hospital co-operationmay also be influenced by the degree of institutional separationof primary and secondary care. Therefore we compared GPs' respectiveattitudes in ‘East’ and ‘West’ Germany. METHOD: In 1993, a representative sample of ‘eastern’ and‘western’ German doctors received a structured questionnaire;554 doctors (63%) participated. RESULTS: Fifty-seven per cent of the western and 39% of the eastern GPsbelieved that their medication was changed in hospital in morethan 60% of their patients. Only a minority of eastern (10%)and western (15%) doctors described the information providedby the hospitals as more or less satisfactory. More westernthan eastern doctors (56% versus 32%) expressed dissatisfactionwith hospital co-operation. Respondents in eastern Germany whofelt sufficiently informed about hospital drug change were morelikely to express satisfaction with the hospital doctors' co-operation.In the former area of West Germany the judgement of co-operationwas significantly better if the extent of drug change and thefrequency of generic drug replacement by original brand-namedrugs were lower. CONCLUSIONS: The study showed that hospital-initiated drug change is a matterof concern, especially for GPs who are working in an area witha tradition of strictly separated primary and secondary care. Keywords. Drug prescribing, family practice, interprofessional relations, health system.