Short-term health effects in the general population following a major train accident with acrylonitrile in Belgium.

BACKGROUND: Following a train derailment, several tons of acrylonitrile (ACN) exploded, inflamed and part of the ACN ended up in the sewage system of the village of Wetteren. More than 2000 residents living in the close vicinity of the accident and along the sewage system were evacuated. A human biomonitoring study of the adduct N-2-cyanoethylvaline (CEV) was carried out days 14-21 after the accident. OBJECTIVES: (1) To describe the short-term health effects that were reported by the evacuated residents following the train accident, and (2) to explore the association between the CEV concentrations, extrapolated at the time of the accident, and the self-reported short-term health effects. METHODS: Short-term health effects were reported in a questionnaire (n=191). An omnibus test of independence was used to investigate the association between the CEV concentrations and the symptoms. Dose-response relationships were quantified by Generalized Additive Models (GAMs). RESULTS: The most frequently reported symptoms were local symptoms of irritation. In non-smokers, dose-dependency was observed between the CEV levels and the self-reporting of irritation (p=0.007) and nausea (p=0.007). Almost all non-smokers with CEV concentrations above 100pmol/g globin reported irritation symptoms. Both absence and presence of symptoms was reported by non-smokers with CEV concentrations below the reference value and up to 10 times the reference value. Residents who visited the emergency services reported more symptoms. This trend was seen for the whole range of CEV concentrations, and thus independently of the dose. DISCUSSION AND CONCLUSION: The present study is one of the first to relate exposure levels to a chemical released during a chemical incident to short-term (self-reported) health effects. A dose-response relation was observed between the CEV concentrations and the reporting of short-term health effects in the non-smokers. Overall, the value of self-reported symptoms to assess exposure showed to be limited. The results of this study confirm that a critical view should be taken when considering self-reported health complaints and that ideally biomarkers are monitored to allow an objective assessment of exposure.

Acrylonitrile exposure in the general population following a major train accident in Belgium: a human biomonitoring study.

BACKGROUND: On Saturday May 4, 2013, a train transporting chemicals derailed in the village of Wetteren (Belgium) and caused a leak of acrylonitrile (ACN). OBJECTIVES: To assess the human exposure to acrylonitrile in the local population with the highest suspected exposure. METHODS: Between May 18-25, 242 residents participated in the study. N-2-cyanoethylvaline (CEV), a biomarker that is highly specific for ACN exposure, was measured in the blood. To account for potential influence by smoking, cotinine was determined in the urine. Participants also filled in a short questionnaire. RESULTS: In the evacuated zone, 37.3% of the non-smokers and 40.0% of the smokers had CEV concentrations above the reference values of 10 and 200 pmol/g globin, respectively, at the time of the train accident. Spatial mapping of the CEV concentrations depending on the residential address showed a distribution pattern following the sewage system. DISCUSSION AND CONCLUSION: The train derailment resulted in a highly atypical sequence-of-events. In addition to exposure in the direct vicinity of the site of the train derailment, exposure also occurred via the sewage system, into which acrylonitrile had entered shortly after the accident.

Acrylonitrile exposure assessment in the emergency responders of a major train accident in Belgium: a human biomonitoring study.

BACKGROUND: On May 4, 2013, a train transporting chemicals derailed in Wetteren, Belgium. Several tanks loaded with acrylonitrile (ACN) exploded, resulting in a fire and a leakage of ACN. OBJECTIVES: To determine exposure to ACN and to assess discriminating factors for ACN exposure in the emergency responders involved in the on-site management of the train accident. METHODS: The study population consisted of 841 emergency responders. Between May 21 and June 28, they gave blood for the determination of N-2-cyanoethylvaline (CEV) hemoglobin adducts and urine for the measurement of cotinine. They also filled in a short questionnaire. RESULTS: 163 (26%) non-smokers and 55 (27%) smokers showed CEV concentrations above the reference values of 10 and 200 pmol/g globin, respectively. The 95th percentile in the non-smokers was 73 pmol/g globin and the maximum was 452 pmol/g globin. ACN exposure among the non-smokers was predicted by (1) the distance to the accident, (2) the duration of exposure, and (3) the occupational function. DISCUSSION AND CONCLUSION: Emergency responders involved in the on-site management of the train accident were clearly exposed to ACN from the accident. However, the extent of exposure remained relatively moderate with CEV concentrations staying within the ranges described in literature as background for a smoking population. Moreover, the exposure was less pronounced in the emergency responders as compared to that in the local population.

Childhood leukaemia risks: from unexplained findings near nuclear installations to recommendations for future research.

Recent findings related to childhood leukaemia incidence near nuclear installations have raised questions which can be answered neither by current knowledge on radiation risk nor by other established risk factors. In 2012, a workshop was organised on this topic with two objectives: (a) review of results and discussion of methodological limitations of studies near nuclear installations; (b) identification of directions for future research into the causes and pathogenesis of childhood leukaemia. The workshop gathered 42 participants from different disciplines, extending widely outside of the radiation protection field. Regarding the proximity of nuclear installations, the need for continuous surveillance of childhood leukaemia incidence was highlighted, including a better characterisation of the local population. The creation of collaborative working groups was recommended for consistency in methodologies and the possibility of combining data for future analyses. Regarding the causes of childhood leukaemia, major fields of research were discussed (environmental risk factors, genetics, infections, immunity, stem cells, experimental research). The need for multidisciplinary collaboration in developing research activities was underlined, including the prevalence of potential predisposition markers and investigating further the infectious aetiology hypothesis. Animal studies and genetic/epigenetic approaches appear of great interest. Routes for future research were pointed out.

A randomized controlled trial comparing anatomical and functional outcome between vaginal colposuspension and transvaginal mesh.

INTRODUCTION AND HYPOTHESIS: Our aim was to compare anatomical and functional outcome between vaginal colposuspension and transvaginal mesh. METHODS: This was a prospective randomized controlled trial in a teaching hospital. Sixty-eight women with stage ≥3 anterior vaginal wall prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system were assessed, randomized, and analyzed. Patients were randomized to anterior colporrhaphy with vaginal colposuspension (n = 35) or transvaginal mesh (n = 33). Primary outcome was objective cure rate of the anterior vaginal wall, defined as POP-Q ≤1 at 2 years. Secondary outcomes were functional results, quality-of-life (QoL) scores, mesh-related morbidity, and onset of urinary incontinence. RESULTS: The anatomical result for point Ba was significantly better at 2 years in the mesh group (-2.8 cm) than in the colposuspension group (-2.4 cm) (p = 0.02). Concerning POP-Q stages, the anatomical success rate at 2 years was 84.4 % for colposuspension and 100 % for mesh (p = 0.05). There were 5 anatomic recurrences (15.6 %) in the colposuspension group. The erosion rate was 6 % (n = 2). No significant difference was noted regarding minor complications. Analysis of QoL questionnaires showed overall improvement in both groups, with no significant difference between them. CONCLUSIONS: The vaginal colposuspension technique of anterior vaginal wall prolapse repair gave good anatomical and functional results at 2 years. Transobturator vaginal mesh gave better 2-year anatomical results than vaginal colposuspension, with overall improvement in QoL in both groups.

Distortion of the anterior part of the interhemispheric fissure: significance and implications for prenatal diagnosis.

In order to illustrate the significance of a new anatomical finding, distortion of the interhemispheric fissure (DIHF) associated with impacted medial borders of the frontal lobes, we report a retrospective observational study of 13 fetuses in which DIHF was identified on prenatal imaging. In 10 cases there were associated anatomical anomalies, including mainly midline anomalies (syntelencephaly (n=2), lobar holoprosencephaly (n=1), Aicardi syndrome (n=2)), but also schizencephaly (n=1), cortical dysplasia (n=1) and more complex cerebral malformations (n=3), including neural tube defect in two cases. Chromosomal anomaly was identified in two cases, including 6p deletion in a case without associated central nervous system anomalies and a complex mosaicism in one of the cases with syntelencephaly. In two cases, the finding was apparently isolated on both pre- and postnatal imaging, and the children were doing well at follow-up, aged 4 and 5 years. The presence of DIHF on prenatal imaging may help in the diagnosis of cerebral anomalies, especially those involving the midline. If DIHF is apparently isolated on prenatal ultrasound, magnetic resonance imaging is recommended for careful analysis of gyration and midline, especially optic and olfactory structures. Karyotyping is also recommended.

Sick leave due to back pain in a cohort of young workers.

PURPOSE: Evidence on risk factors for sick leave from prospective studies in work settings is limited. Furthermore, most available studies focused on workers with substantial low back disorders. These studies consistently report that physical work factors constitute a hindrance to work. However, it remains unclear whether the same risk factors are relevant in workers with less severe conditions or in early phases of the development of back pain. Therefore, this article aims to study risk factors for the occurrence of sick leave due to low back pain (LBP) among young workers with no or a modest history of back pain. METHODS: Participants were 716 young healthcare or distribution workers with no or minimal antecedents of LBP in the year before inclusion. We investigated the role of potential physical, psychosocial and individual risk factors at baseline on the occurrence of sick leave due to LBP 1 year later. To this purpose, we used Cox regression with a constant risk period. RESULTS: Six per cent (95 % CI 4.1-7.6) of the workers reported sick leave 1 year later; they accounted for 12 % of the sick-leave days independent of cause. A non-stimulating psychosocial work environment turned out to be the strongest risk factor for sick leave due to LBP (RR 6.08; 95 % CI 1.42-26.07). Physical factors were not predictive. CONCLUSIONS: In the early phases of back pain and in less severe conditions, the main benefit of interventions lies in targeting the organisation and design of jobs to create a challenging professional environment.

The role of physical workload and pain related fear in the development of low back pain in young workers: evidence from the BelCoBack Study; results after one year of follow up.

AIMS: To study the influence of work related physical and psychosocial factors and individual characteristics on the occurrence of low back pain among young and pain free workers. METHODS: The Belgian Cohort Back Study was designed as a prospective cohort study. The study population of this paper consisted of 716 young healthcare or distribution workers without low back pain lasting seven or more consecutive days during the year before inclusion. The median age was 26 years with an interquartile range between 24 and 29 years. At baseline, these workers filled in a questionnaire with physical exposures, work related psychosocial factors and individual characteristics. One year later, the occurrence of low back pain lasting seven or more consecutive days and some of its characteristics were registered by means of a questionnaire. To assess the respective role of predictors at baseline on the occurrence of low back pain in the following year, Cox regression with a constant risk period for all subjects was applied. RESULTS: After one year of follow up, 12.6% (95% CI 10.1 to 15.0) of the 716 workers had developed low back pain lasting seven or more consecutive days. An increased risk was observed for working with the trunk in a bent and twisted position for more than two hours a day (RR 2.2, 95% CI 1.2 to 4.1), inability to change posture regularly (RR 2.1, 95% CI 1.3 to 3.5), back complaints in the year before inclusion (RR 1.7, 95% CI 1.1 to 2.8), and high scores of pain related fear (RR 1.8, 95% CI 1.0 to 3.1). Work related psychosocial factors and physical factors during leisure time were not predictive. CONCLUSION: This study highlighted the importance of physical work factors and revealed the importance of high scores of pain related fear in the development of low back pain among young workers.

Risk factors for first-ever low back pain among workers in their first employment.

BACKGROUND: Low back pain has been estimated to be the most costly ailment of people of working age. Both work characteristics and individual factors have been identified as risk factors. The first interaction between work characteristics and individual factors occurs when workers start in their first job. AIMS: To investigate work-related risk factors for first-ever low back pain in young workers in their first employment. METHODS: A cross-sectional analysis was performed on 278 young workers in their first employment and without a history of low back pain prior to working. Work-related physical factors, psychosocial work characteristics, individual variables and first-ever low back pain were queried by means of a questionnaire. RESULTS: About half of the workers who developed low back pain after job start did so in the first year of employment. An increased risk was observed for (i) long periods of seated work [relative risk (RR) = 3.2, 95% confidence interval (CI) = 1.6-6.4]; (ii) more than 12 flexion or rotation movements of the trunk per hour (RR = 3.0, 95%CI = 1.4-6.4); and (iii) more than 3 years seniority in a job involving lifting more than 25 kg at least once an hour (RR = 3.7, 95%CI = 1.4-9.4). As to psychosocial work characteristics, first-ever low back pain was associated with a combination of low psychological job demands and low supervisor support. CONCLUSION: Work-related physical factors and psychosocial work characteristics should be considered as risk factors for first-ever low back pain. First-ever episodes of low back pain are common in the first year of employment. This may reflect a lack of work experience or training.