Ethical evaluation of compulsory measles immunisation as a benchmark for good health management in the European Union.

The results of the study Benchmarking Regional Health Management II suggest that compulsory measles immunisation is a good practice in public health management. Yet, the potential achievement of the desired health outcome alone is not a sufficient reason to make the immunisation obligatory. Rather, compulsory measles immunisation is a morally challenging measure. In this article, compulsory measles immunisation is critically evaluated from a public health ethics point of view. For this evaluation, a set of ethical criteria is proposed: respect for autonomy, health maximisation, efficiency, proportionality and social justice. The authors suggest it should not be taken for granted that compulsory measles immunisation should be championed, rather, health policy makers in the European Union should try to raise immunisation rates with non-compulsory means.

Levels of PCDDs, PCDFs, and PCBs in the blood of the non-occupationally exposed residents living in the vicinity of a chemical plant in the Czech Republic.

In 2003, concentrations of altogether 17 PCDD/Fs congeners and 12 non-ortho and mono-ortho dioxin-like PCBs were measured in the blood of 60 randomly selected adults who lived in three settlements surrounding a chemical plant that had been producing chlorinated herbicides (mainly HCHs, HCB, pentachlorophenole, 2,4,5-T) in the 1960's; subjects consuming home-produced animal foods were chosen. Twenty blood donors with similar characteristics from the locality with about 80 km distance were used as control subjects. The factors that influenced the dioxin levels were investigated on the basis of a questionnaire. The aim of our study was to find out whether the residents living in the surroundings of the chemical plant are at a greater exposure risk than the controls. To calculate TEQ values, WHO-TEFs were used. The concentrations of four PCDD and six PCDF congeners were below the LOD in more than 50% of samples. Significantly higher WHO-TEQ levels (p<0.05) were found for PCDDs, PCDFs, or PCBs in all three followed up groups compared with controls. The geometric means of the total TEQ values for PCDD/F/PCBs were 43.8, 50.2, and 40.0 pg/g fat compared to 23.2 pg/g fat in the control. The percentages of TEQ due to the measured congeners in exposed groups were 9-10.3% for PCDDs, 20.5-26.9% for PCDFs, 19.2-23.1% for coplanar and 43.6-47.2% for mono-ortho PCBs. In control, the percentage of TEQ was 11.6, 26.7, 24.1, and 37.5%. PCBs, predominantly PCB156, followed by PCB126 contributed 60 to 70% of the total TEQ value. Positive correlation of the PCDD/PCDF/PCB blood levels with age and with consumption of locally produced eggs was found.

Reference frameworks for the health management of measles, breast cancer and diabetes (type II).

This paper presents reference frameworks which order effective and feasible policies and interventions for the health management of measles, breast cancer and diabetes (type II). These reference frameworks can be used to rapidly appraise regional health policy documents and existing health management systems. Furthermore, the reference frameworks can serve health policy makers for the planning of health management measures.

Effects of occupational exposure to diesel exhaust on porphyrin metabolism in lymphocytes of workers employed at black coal and oil-shale mines.

BACKGROUND: This pilot study was conducted to investigate biochemical effects of exposure to diesel engine exhaust at two mines. For this purpose, heme biosynthesis, and PP association with DNA (PP/DNA) in lymphocytes of miners exposed to diesel exhaust were determined. METHODS: The pilot study was carried out at a black coal mine in Czech Republic, and at an oil-shale mine in Estonia. The subjects were ten drivers from each mine, who were exposed to diesel exhaust (underground workers). Control groups consisted of ten maintenance workers from each mine (surface workers). The content of 1-nitropyrene (NP) in respirable dust was measured using GC-MS. The levels of PP, PP/DNA, heme, and activity of ferrochelatase (FC) were determined by spectrophotometry. RESULTS: The exposure to diesel exhaust evaluated as the level of NP associated to particulate matter in air. NP level was significantly higher in oil-shale mine compared with coal mine. The values of PP and PP/DNA in lymphocytes appeared to be significantly increased only in miners in the oil-shale mine. There was no difference in the levels of PP and PP/DNA and FC activity between surface workers and miners at the coal mine. The level of heme in lymphocytes of coal mine miners was significantly higher than in miners of the oil-shale mine. The activity of FC was significantly lower in underground workers compared to surface workers at this mine. High level of NP was accompanied by an increase of alterations in cells porphyrin metabolism in lymphocytes of miners. CONCLUSIONS: Alterations of porphyrin and heme metabolism in peripheral lymphocytes may serve as biomarker in assessment of exposure to diesel exhaust effects.