Comments on the Causation of Malignant Mesothelioma: Rebutting the False Concept That Recent Exposures to Asbestos Do Not Contribute to Causation of Mesothelioma.

BACKGROUND: European asbestos manufacturers and their expert witnesses have advanced the claim that recent exposures to asbestos are not of significance in the causation of malignant mesothelioma. They argue that in cases of prolonged exposure to asbestos only the earliest exposures contribute to mesothelioma induction. METHODS: The Collegium Ramazzini examined this claim and compared it with the findings of the Epidemiology and Public Health Working Group of the Second Italian Consensus Conference on Pleural Mesothelioma. This independent Working Group noted that earlier exposures are more effective in inducing mesothelioma, but that subsequent exposures also contribute and cannot be excluded. They found convincing evidence to support the conclusion that mesothelioma incidence is proportional to cumulative asbestos exposure. CONCLUSION: The Collegium Ramazzini concludes that risk of malignant mesothelioma is proportional to cumulative exposure to asbestos in which all exposures - early as well as late - contribute to the totality of risk. The Collegium Ramazzini rejects as false and scientifically unfounded the notion that only the earliest exposures to asbestos contribute to mesothelioma induction.

The Global Burden of Lead Toxicity Attributable to Informal Used Lead-Acid Battery Sites.

BACKGROUND: Prior calculations of the burden of disease from environmental lead exposure in low- and middle-income countries (LMICs) have not included estimates of the burden from lead-contaminated sites because of a lack of exposure data, resulting in an underestimation of a serious public health problem. OBJECTIVE: We used publicly available statistics and detailed site assessment data to model the number of informal used lead-acid battery (ULAB) recyclers and the resulting exposures in 90 LMICs. We estimated blood lead levels (BLLs) using the US Environment Protection Agency's Integrated Exposure Uptake Biokinetic Model for Lead in Children and Adult Lead Model. Finally, we used data and algorithms generated by the World Health Organization to calculate the number of attributable disability adjusted life years (DALYs). RESULTS: We estimated that there are 10,599 to 29,241 informal ULAB processing sites where human health is at risk in the 90 countries we reviewed. We further estimated that 6 to 16.8 million people are exposed at these sites and calculate a geometric mean BLL for exposed children (0-4 years of age) of 31.15 µg/dL and a geometric mean BLL for adults of 21.2 µg/dL. We calculated that these exposures resulted in 127,248 to 1,612,476 DALYs in 2013. CONCLUSIONS: Informal ULAB processing is currently causing widespread lead poisoning in LMICs. There is an urgent need to identify and mitigate exposures at existing sites and to develop appropriate policy responses to minimize the creation of new sites.

Implications of the World Trade Center Health Program (WTCHP) for the public health response to the Great East Japan Earthquake.

The attacks on the World Trade Center (WTC) on September 11, 2001 resulted in a serious burden of physical and mental illness for the 50,000 rescue workers that responded to 9/11 as well as the 400,000 residents and workers in the surrounding areas of New York City. The Zadroga Act of 2010 established the WTC Health Program (WTCHP) to provide monitoring and treatment of WTC exposure-related conditions and health surveillance for the responder and survivor populations. Several reports have highlighted the applicability of insights gained from the WTCHP to the public health response to the Great East Japan Earthquake. Optimal exposure monitoring processes and attention to the welfare of vulnerable exposed sub-groups are critical aspects of the response to both incidents. The ongoing mental health care concerns of 9/11 patients accentuate the need for accessible and appropriately skilled mental health care in Fukushima. Active efforts to demonstrate transparency and to promote community involvement in the public health response will be highly important in establishing successful long-term monitoring and treatment programs for the exposed populations in Fukushima.

World Trade Center disaster: assessment of responder occupations, work locations, and job tasks.

BACKGROUND: To date there have been no comprehensive reports of the work performedby 9/11 World Trade Center responders. METHODS: 18,969 responders enrolled in the WTC Medical Monitoring and Treatment Program were used to describe workers' pre-9/11 occupations, WTC work activities and locations from September 11, 2001 to June 2002. RESULTS: The most common pre-9/11 occupation was protective services (47%); other common occupations included construction, telecommunications, transportation, and support services workers. 14% served as volunteers. Almost one-half began work on 9/11 and >80% reported working on or adjacent to the ''pile'' at Ground Zero. Initially,the most common activity was search and rescue but subsequently, the activities of most responders related to their pre-9/11 occupations. Other major activities included security; personnel support; buildings and grounds cleaning; and telecommunications repair. CONCLUSIONS: The spatial, temporal, occupational, and task-related taxonomy reported here will aid the development of a job-exposure matrix, assist in assessment of disease risk, and improve planning and training for responders in future urban disasters.