Effects on pulmonary health of neighboring residents of concentrated animal feeding operations: exposure assessed using optimized estimation technique.

Potential adverse health effects of concentrated animal feeding operations (CAFOs), which were also shown in the authors' Lower Saxony Lung Study, are of public concern. The authors aimed to investigate pulmonary health effect of neighboring residents assessed using optimized estimation technique. Annual ammonia emission was measured to assess the emission from CAFO and from surrounding fields. Location of sampling points was optimized using cluster analysis. Individual exposure of 457 nonfarm subjects was interpolated by weighting method. Mean estimated annual ammonia levels varied between 16 and 24 µg/m³. Higher exposed participants were more likely to be sensitized against ubiquitous allergens as compared to lower exposed subjects (adjusted odds ratio [OR] 4.2; 95% confidence interval [CI] 1.2-13.2). In addition, they showed a significantly lower forced expiratory volume in 1 second (FEV1) (adjusted mean difference in % of predicted -8%; 95% CI -13% to -3%). The authors' previous findings that CAFOs may contribute to burden of respiratory diseases were confirmed by this study.

Case based e-learning in occupational medicine--a European approach.

OBJECTIVE: The main aim of the European Union project NetWoRM (Net-based training for Work-Related Medicine) is an international case-based e-learning curriculum for occupational medicine (OM). METHODS: To improve teaching in OM, web-based cases have been created and implemented at the University of Munich since 1999. In the last 5 years, the project has been further developed with a view to implement the methods internationally. RESULTS: Overall, 26 cases were developed in a standard English version and 10 cases each were made available for several national European curricula. The evaluation of cases showed easiness in accepting the cases and high level of interest in working with them. CONCLUSIONS: Case-based e-learning on an international platform is a unique tool, which supports the quality improvement of education and training in OM throughout Europe in the longer term.

Exposure to mobile telecommunication networks assessed using personal dosimetry and well-being in children and adolescents: the German MobilEe-study.

BACKGROUND: Despite the increase of mobile phone use in the last decade and the growing concern whether mobile telecommunication networks adversely affect health and well-being, only few studies have been published that focussed on children and adolescents. Especially children and adolescents are important in the discussion of adverse health effects because of their possibly higher vulnerability to radio frequency electromagnetic fields. METHODS: We investigated a possible association between exposure to mobile telecommunication networks and well-being in children and adolescents using personal dosimetry. A population-based sample of 1.498 children and 1.524 adolescents was assembled for the study (response 52%). Participants were randomly selected from the population registries of four Bavarian (South of Germany) cities and towns with different population sizes. During a Computer Assisted Personal Interview data on participants' well-being, socio-demographic characteristics and potential confounder were collected. Acute symptoms were assessed three times during the study day (morning, noon, evening).Using a dosimeter (ESM-140 Maschek Electronics), we obtained an exposure profile over 24 hours for three mobile phone frequency ranges (measurement interval 1 second, limit of determination 0.05 V/m) for each of the participants. Exposure levels over waking hours were summed up and expressed as mean percentage of the ICNIRP (International Commission on Non-Ionizing Radiation Protection) reference level. RESULTS: In comparison to non-participants, parents and adolescents with a higher level of education who possessed a mobile phone and were interested in the topic of possible adverse health effects caused by mobile telecommunication network frequencies were more willing to participate in the study. The median exposure to radio frequency electromagnetic fields of children and adolescents was 0.18% and 0.19% of the ICNIRP reference level respectively. CONCLUSION: In comparison to previous studies this is one of the first to assess the individual level of exposure to mobile telecommunication networks using personal dosimetry, enabling objective assessment of exposure from all sources and longer measurement periods. In total, personal dosimetry was proofed to be a well accepted tool to study exposure to mobile phone frequencies in epidemiologic studies including health effects on children and adolescents.

Personal exposure to mobile phone frequencies and well-being in adults: a cross-sectional study based on dosimetry.

The use of mobile phone telecommunication has increased in recent years. In parallel, there is growing concern about possible adverse health effects of cellular phone networks. We used personal dosimetry to investigate the association between exposure to mobile phone frequencies and well-being in adults. A random population-based sample of 329 adults living in four different Bavarian towns was assembled for the study. Using a dosimeter (ESM-140 Maschek Electronics), we obtained an exposure profile over 24 h for three mobile phone frequency ranges (measurement interval 1 s, limit of determination 0.05 V/m). Exposure levels over waking hours were totalled and expressed as mean percentage of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) reference level. Each participant reported acute symptoms in a day-long diary. Data on five groups of chronic symptoms and potential confounders were assessed during an interview. The overall exposure to high-frequency electromagnetic fields was markedly below the ICNIRP reference level. We did not find any statistically significant association between the exposure and chronic symptoms or between the exposure and acute symptoms. Larger studies using mobile phone dosimetry are warranted to confirm these findings.

Environmental exposure to confined animal feeding operations and respiratory health of neighboring residents.

BACKGROUND: Despite public concern about potential adverse health effects of concentrated animal feeding operations, objectively assessed data on environmental exposure to concentrated animal feeding operations and respiratory health are sparse. We aimed to assess respiratory health in neighbors of confined animal feeding operations. METHODS: A survey was done in 2002-2004 among all adults (18-45 years old) living in 4 rural German towns with a high density of confined animal feeding operations. Questionnaire data were available for 6937 (68%) eligible subjects. In a random sample we measured the following outcomes: specific IgE to common and farm-specific allergens, lung function, and bronchial hyperresponsiveness to methacholine. Exposure was measured by collecting data on odor annoyance and geo-coded data on the number of animal houses within 500 m of the home. Locally optimal estimating and smoothing scatter plots were used to model the association between exposure and outcome. Analyses were restricted to subjects without private or professional contact with farming environments. RESULTS: The prevalence of self-reported asthma symptoms and nasal allergies increased with self-reported odor annoyance. The number of animal houses was a predictor of self-reported wheeze and decreased forced expiratory volume in 1 second, but not allergic rhinitis or specific sensitization. Self-reported exposure and results of clinical measurements were poorly correlated. CONCLUSIONS: Confined animal feeding operations may contribute to the burden of respiratory disease among their neighbors. Our findings underline the importance of objective assessment of exposure and outcome in environmental epidemiology.

Case-based e-learning in occupational medicine--The NetWoRM Project in Germany.

The aim of the NetWoRM Project is the development, evaluation and implementation of a case-based e-learning tool for occupational medicine to increase the knowledge in clinical aspects of occupational medicine. To date, 19 e-learning cases have been developed. Cases were validated by 2 experts and user evaluated. Results of the user evaluation at 3 German Medical Schools are presented. Of 557 medical students registered for the online course 377 answered the online evaluation form (68%). Depending on the case, the median time spent on a case ranged from 25-43 minutes. Students enjoyed working with the cases and asked to replace more seminars by case-based e-learning. The level of knowledge required to work on the cases was rated high. This was supported by the fact that on median only 47-71% of the questions were answered correctly. Cases focusing on occupational health problems such as needle stick injuries were rated highest with respect to fun, importance for future career and the overall score. Students enjoy working on e-learning cases as an add-on to traditional teaching. Because of the high international interest the NetWoRM project is currently shared on an international base.

Personal dosimetry of exposure to mobile telephone base stations? An epidemiologic feasibility study comparing the Maschek dosimeter prototype and the Antennessa SP-090 system.

The aim of our study was to test the feasibility and reliability of personal dosimetry. Twenty-four hour exposure assessment was carried out in 42 children, 57 adolescents, and 64 adults using the Maschek dosimeter prototype. Self-reported exposure to mobile phone frequencies were compared with the dosimetry results. In addition, dosimetry readings of the Maschek device and those of the Antennessa DSP-090 were compared in 40 subjects. Self-reported exposures were not associated with dosimetry readings. The measurement results of the two dosimeters were in moderate agreement (r(Spearman) = 0.35; P = .03). Personal dosimetry for exposure to mobile phone base station might be feasible in epidemiologic studies. However, the consistency seems to be moderate.

The physical and biological doses of methacholine are different for Mefar MB3 and Jaeger APS sidestream nebulizers.

BACKGROUND: Within a study on respiratory symptoms in rural areas, we used the European Community Respiratory Health Survey methacholine challenge protocol. For quicker and more reliable handling, we had to change the nebulizer in the bronchial challenge system from Mefar model MB3 (Bovezzo, Italy) to Jaeger APS Sidestream (similar to Mefar; Würzburg, Germany). Therefore, we compared the physical properties of the two systems, adapted the challenge protocol, and compared the results of both systems in subjects with and without airway hyperresponsiveness to methacholine. METHOD: The physical properties of both systems were characterized by the residual method indicating a similar particle size distribution and an average output of 6 muL/s for Mefar MB3 and 1.25 muL/s for APS Sidestream. In the comparison study, 34 subjects were included. Airway responsiveness was quantified by provocative dose of methacholine causing a 20% fall in FEV(1). RESULTS: A significant difference was found between the two challenge systems (p =0.004, McNemar test). Nine subjects reached a 20% drop in FEV(1) with the APS Sidestream only. The FEV(1) dropped by > 20% using either system in eight subjects. In 17 subjects, none of the two systems caused a 20% decrease in FEV(1). CONCLUSION: Even if the physical dose is determined with elaborate methods, the biological dose may vary between two nebulizer systems, causing incomparable outcomes for subjects tested with different systems.

Childhood visits to animal buildings and atopic diseases in adulthood: an age-dependent relationship.

BACKGROUND: Several studies reported protective effects of farming environments against atopic diseases. Therefore, we aimed to establish the relevant timing of exposure in early life. METHODS: A cross-sectional study was carried out in a rural town. Overall, 4,537 inhabitants aged 18-44 years were eligible. Of these, 3,112 (69%) responded to a postal questionnaire on atopic diseases, life-time exposure to farming environments, and potential confounders. RESULTS: Those with regular childhood exposure to animal buildings had a significantly reduced risk of nasal allergies. The greatest reduction in risk was seen for respondents starting regular visits to animal stables during the 1st year of life or between ages 3 and 5. Participants reporting start of exposure after age 5 remained at a lower risk for nasal allergies (0.70, 0.49-1.01). CONCLUSIONS: The preventive effect of animal buildings' exposure against atopic respiratory diseases continues into adulthood. The magnitude of the effect appears to be age-dependent.

Livestock odours and quality of life of neighbouring residents.

Neighbours of intensive livestock production facilities frequently complain of odour annoyance. They are also concerned about potential negative health effects of environmental exposures to livestock emissions. Quality of life (QoL) was assessed in residents of a rural community neighbouring an area with high concentration of animal farms. A postal cross-sectional survey was carried out among the 4,537 residents, aged 18-44 years. Of these, 3,112 (69 %) responded to questions on annoyance by livestock odours (4-point scale), on QoL (assessed by the short form 12, SF-12), and on potential confounders (age, gender, respiratory symptoms, smoking, living on or close to a farm, and employment status). SF-12 scores were available for 2745 (88 %) subjects. Sixty-one percent of the respondents complained about unpleasant odours, 91 % of these accused livestock as source of these odours. Physical and emotional SF-12 scores were inversely related to annoyance scores. Better risk communication might improve QoL in concerned neighbours of intensive livestock production facilities.

Environmental ozone effects in different population subgroups.

The study objective was to get more information on characteristics of ozone risk groups. We performed repeated (on average 16 times) lung function tests and interviews with 171 persons belonging to four different population subgroups (44 healthy children, 43 juvenile asthmatics, 43 athletes, and 41 elderly). The environmental half hour mean ozone concentrations ranged from 8 to 99 ppb. For two groups there was significant NO2 co-pollution. The asthmatics showed statistically significant ozone related increased ORs for eye irritations, the elderly for nose irritations. Significant lung function decrements (increase in ozone by 50 ppb) were found for asthmatics (FVC -4.3% afternoon one day lag, -4.9% afternoon two day lag, -3.6% morning one day lag) and children (FVC -3.2% same morning, PEF -11.9% same morning, PEF -4.6% morning one day lag). In the group of elderly, however, there were also some significant FVC and PEF increments. Ozone responders were found more often in the groups of asthmatics and children (21% resp. 18%) compared with elderly and athletes (both 5%). The results suggest that children and asthmatics have a higher risk of being ozone sensitive showing more ozone related acute lung function decrements than other population groups.