Temporal changes in blood lead levels of children in east Germany.

This analysis investigates the temporal changes in blood lead levels (BLL) in repeated cross-sectional surveys of 5-7 year old children conducted in 1992-93, 1995-96 and 1998-99 and in a prospective cohort from a smelter town and an agricultural control region in east Germany. The region of Hettstedt has a long history of mining and smelting resulting in high levels of heavy metal pollution whereas the region of Zerbst has no known industrial sources of heavy metals. In the region of Hettstedt lead content in ambient dust fall declined since the early 1990s due to the closure of many factories, whilst in Zerbst lead in ambient dust fall was constantly low in the 1990s. Blood lead levels decreased during the observation period both in children from the smelter town and in children from the agricultural control region. From 1992-93 to 1998-99 the mean BLLs of school entrants fell by 20% (41.6 to 33.3 micrograms/l) in Hettstedt and by 30% (34.2 to 23.8 micrograms/l) in Zerbst. In the same observation period mean BLLs of cohort children declined by 35% (41.9 to 27.3 micrograms/l) in Hettstedt and by 39% (32.3 to 19.8 micrograms/l) in Zerbst. At the beginning of the observation period cohort children were 5-7 years of age and were followed up to the age of 11-14. Adjustment for sociodemographic factors, city area and environmental uptake of lead did not influence the percentage changes in BLL of school-entrants. It seems that the decline in ambient lead fall had an impact on the body burden of lead, but the overall decrease in BLL in these two regions is caused by the overall decrease of lead in gasoline and thus in food.

Hay fever and predictive value of prick test and specific IgE antibodies: a prospective study in children.

Little is known from population-based studies in children about the diagnostic values of allergen-specific IgE antibodies (RAST) and skin prick test (SPT) with respect to hay fever. We aimed to determine and compare the diagnostic values of SPT and RAST to aeroallergens with respect to the incidence of hay fever cases in schoolchildren at different cut-off points. A prospective cohort study was performed on 1100 school children (5-7 and 8-10 years). Information on a doctor's diagnosis of hay fever was obtained by questionnaire and allergic sensitization to grass and birch pollen, cat, and Dermatophagoides pteronyssinus were measured using SPT and RAST between September 1992 and July 1993. Thirty-eight children give a history of hay fever (3.5%) in 1992/93 and additionally 37 cases occurred until 1996. Allergic sensitization was present in 17.9% (SPT), 30.2% (RAST) and more frequent in children with a history of hay fever (SPT: OR 11.7, 5.5-24.7; RAST: OR 10.6, 4.3-26.4). This difference was most pronounced for sensitization to pollen allergens. The sensitivity, specificity, positive and negative predictive values (PPV, NPV) for SPT and RAST were 65.6, 83.7, 11.9, 98.6 and 79.3, 71.6, 9.3, 99.0, respectively, with differences for specificity being significant (p < 0.001). Whereas NPV were equally high for SPT (99.2) and RAST (99.3), the incidence of hay fever cases were predicted rather poorly though somewhat better by SPT than by RAST (PPV 16.7 vs. 9.8; p < 0.001) initially. With increasing cut-off point for RAST reactivity, the PPV increased and reached 25.0 at 17.5 kU/l, whereas the NPV decreased to 97.9, which was lower than that of SPT reactivity (p < 0.01). At the cut-off point of 1.5 kU/l almost identical predictive values for SPT and RAST were obtained. SPT and RAST perform better in the negative than positive prediction of hay fever cases in epidemiological studies. Differences in the predictive capabilities depend on the chosen cut-off point for RAST reactivity.

Association of lung function with declining ambient air pollution.

Recent studies have found a declining prevalence of respiratory infections in East German children, along with a tremendous improvement of air pollution since 1990. The present study evaluates the effects of improved air quality on lung function. Three consecutive cross-sectional surveys of schoolchildren ages 11-14 years from three communities in East Germany were performed in 1992-1993, 1995-1996, and 1998-1999. Lung function tests were available from 2,493 children. The annual mean of total suspended particulates (TSP) declined from 79 to 25 micro g/m(3), whereas levels for sulfur dioxide declined from 113 to 6 micro g/m(3). Mean forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV(1)) of the children increased from 1992-1993 to 1998-1999. The adjusted percent change of the geometric mean of FVC was 4.7% for a 50 micro g/m(3) decrease of TSP (p = 0.043) and 4.9% for a decrement of 100 micro g/m(3) SO(2) (p = 0.029). Effects on FEV(1) were smaller and not statistically significant. Our study indicates that a reduction of air pollution in a short time period may improve children's lung function.

Improved air quality in reunified Germany and decreases in respiratory symptoms.

BACKGROUND: Previous research on air pollution effects has found associations with chronic adverse health effects even at the relatively low levels of ambient particulates currently measured in most urban areas. METHODS: We assessed the impact of declines of total suspended particulates and sulfur dioxide in eastern Germany after reunification on the prevalence of nonallergic respiratory disorders in children. In the 1990s, particle mass (total suspended particulates) and sulfur dioxide declined, whereas number concentrations of nucleation-mode particles (10-30 nm) increased. In three study areas, questionnaires for 7,632 children between 5 and 14 years of age were collected in three phases: 1992-1993, 1995-1996, and 1998-1999. RESULTS: Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for a 50-microg/m3 increment in total suspended particulates were 3.0 (CI = 1.7-5.3) for bronchitis, 2.6 (CI = 1.0-6.6) for sinusitis, and 1.9 (CI = 1.2-3.1) for frequent colds. The effect sizes for a 100-microg/m3 increment in sulfur dioxide were similar. The effect estimates for ambient total suspended particulates and sulfur dioxide were stronger among children not exposed to gas stove emissions, visible molds or dampness, cats, or environmental tobacco smoke. CONCLUSIONS: The decreasing prevalence of nonallergic respiratory symptoms, along with improvements in ambient particle mass and sulfur dioxide (but not in nucleation-mode particles), indicates the reversibility of adverse health effects in children. This adds further evidence of a causal association between combustion-related air pollutants and childhood respiratory symptoms.