Airway diseases and allergies in East and West German children during the first 5 years after reunification: time trends and the impact of sulphur dioxide and total suspended particles.

BACKGROUND: East-West comparison studies in Europe find higher prevalences of infectious airway diseases and lower prevalences of allergies in eastern areas. Pollution from sulphur dioxide (SO2) or total suspended particles (TSP) are discussed as causes of this difference. METHODS: In four differently polluted areas of East Germany where pollution decreased dramatically between 1989 and 1995 cross-sectional studies in about 7-year-old children were repeated every year between 1991 and 1995. In two differently polluted areas of West Germany studies with the same design were done in 1991 and 1994. In all, 19090 children participated in the study. Thirteen different questions about airway diseases and allergies were evaluated. Logistic regression was used to adjust for confounding. RESULTS: With the exception of pneumonia, all infectious airway diseases and irritations of the airways show a steeper temporal decrease in East than in West Germany or are positively associated with either SO2 or TSP in East Germany. For allergies and related symptoms no differences in time trends could be detected or no association with SO2 or TSP could be seen in East Germany. CONCLUSION: Most airway diseases were more frequent in East than in West Germany in 1991 and were associated with SO2 or TSP. The decrease in these pollutants between 1991 and 1995 has already had a favourable effect. An effect of SO2 or TSP pollution on allergies and related symptoms could not be detected. This pollution does not protect against the development of allergies.

Influence of air pollution on humoral immune response.

To learn more about the effects of ambient air pollution on the human immune system, immunological parameters-16 serum proteins and circulating immune complexes--were determined for more than 500 women from the polluted area of Cologne, Germany, and a control area, Borken. The geometric mean values for immunoglobulins, complement components, haptoglobin, alpha 1-acid glycoprotein, alpha 1-antitrypsin, ceruloplasmin, alpha 2-macroglobulin, prealbumin, and transferrin were statistically significantly higher in Cologne than in Borken. No difference were found for C-reactive protein, rheumatoid factors, and anti-streptolysin O. For each of the parameters a logistic regression was fitted, thus controlling for the influence of a number of confounding factors. After controlling for possible confounders, the percentages of values above the norm for immunoglobulins, complement components, haptoglobin, and alpha-1-glycoprotein were statistically significantly higher in Cologne than in Broken. Important confounders included overweight, high blood pressure, acute cold, fever in the preceding week, and smoking. The biochemical mechanisms underlying the observed interarea differences in protein profiles are as yet unknown and should be the subject of further, nonepidemiological research.

[Blood lead and blood cadmium concentrations in 55-66-year-old women fron different areas of Nordrhein-Westfalen--chronological trends during 1982-1988]. / Blutblei- und Blutcadmiumkonzentrationen bei 55-66jährigen Frauen aus verschiedenen Gebieten Nordrhein-Westfalens--Entwicklungstrends 1982-1988.

Blood lead levels were determined in 3098 55-66 year-old women living in different areas of Northrhine-Westphalia (F.R.G.). Blood cadmium levels were determined in a subgroup of 2538 women. The studies were performed between 1982 and 1988. The results show that there has been a further fall of blood lead levels in the general population of West-Germany since the CEC blood lead surveys of 1979 and 1981. A comparable reduction of blood cadmium was not noted. Residents of large urban agglomerations had, on average, slightly higher blood lead levels than residents of small cities located in rural areas (+0.2-0.5 microgram/dl). With regard to blood cadmium, no differences were seen. Smokers were found to have, on average, 3-4 times higher blood cadmium levels than non-smokers. Blood lead was also elevated in smokers when compared to non-smokers. The highest blood lead levels recorded were in the range of 15-30 micrograms/dl. The data further suggest that lead mobilization during conditions of bone demineralization, e.g. in cases of osteoporosis, does not result in toxic blood lead levels in postmenopausal women.

[Status of lung function in females of a North Rhine-Westphalia rural and urban-industrial area]. / Lungenfunktionsstatus von Frauen in einem ländlichen und einem städtisch-industriellen Gebiet Nordrhein-Westfalens.

A comparative investigation of the pulmonary function status was carried out in women, aged between 52 and 56 years, from a rural and a municipal industrial area in North Rhine Westphalia. A questionnaire that the subjects had to complete themselves, provided us with information on personal medical history, smoking habits, the nature of domestic heating, and social status (education). The function tests were performed in a mobile pulmonary function laboratory (Jäger, Inc.). The airway resistance (Raw) and the intrathoracic gas volume (ITGV) were measured with the aid of a constant-volume body plethysmograph; a pneumotachographic system was employed to measure the ventilatory pulmonary function. All lung volumes were recalculated in terms of BTPS, and expressed as a percentage of the predicted values. Women from Leverkusen complained somewhat more frequently of hay fever, allergies of all kinds, and non-respiratory disturbances, than did women from Borken. In contrast, respiratory symptoms were indicated equally frequently in both areas. In the case of the Leverkusen group, a mean Raw of 0.323 +/- 0.183 kPa.1-1.s, was obtained, and in the case of the Borken group, a mean Raw of 0.258 +/- 0.182 kPa.1-1.s; this difference is statistically significant (p less than 0.05). On average, the women from Leverkusen also had a significantly higher SRaw (p less than 0.005) and ITGV (p less than 0.05) than did the women from Borken. These results argue in favour of a negative influence of air pollution on the pulmonary function.

C3c concentrations in sera of persons living in areas with different levels of air pollution in Northrhine-Westphalia (Federal Republic of Germany).

A number of air pollutants is known to affect the immune system resulting in alterations of the complement activity in serum. We determined the levels of C3c, one of the activation products of the component C3, in serum samples obtained from various population groups living in areas with different levels of air pollution in Northrhine-Westphalia (FRG). The results show that the serum C3c levels tend to be increased in subjects living in areas with elevated levels of air pollution. By applying a linear regression model it can be demonstrated that a significant part of the variance of the C3c concentrations is explained by the residence area factor after making allowance for the effect of various confounders. The increase of the serum C3c concentrations appears to result from an increased activation of the complement component C3. The underlying mechanisms as well as the pathophysiological significance of these findings are unknown.

Exposure to lead and cadmium of children living in different areas of north-west Germany: results of biological monitoring studies 1982-1986.

Between 1982 and 1986 several surveys were carried out to determine the levels of lead and cadmium in blood, urine, and shed deciduous teeth (incisors only) of children living in rural, suburban, urban, and industrial areas of North-West Germany. Blood lead (PbB) and blood cadmium (CdB) were measured in about 4000 children. In rural, suburban and urban areas the median PbB levels vary between 5.5 and 7 micrograms/dl, with 98th percentiles varying between 10 and 13 micrograms/dl. The median CdB levels are between 0.1 and 0.2 microgram/dl, with 95th percentiles between 0.3 and 0.4 microgram/l. Children from urban areas have significantly higher PbB levels than children from rural and suburban areas. Regarding CdB no differences could be detected. Children living in areas around lead and zinc smelters, particularly those living very close to the smelters, have substantially increased PbB and CdB levels. Children from lead worker families also have substantially increased PbB and CdB levels. The lead levels in shed milk teeth (PbT) were determined in about 3000 children. In rural, suburban and urban areas the median PbT levels are between 2 and 3 micrograms/g, with 95th percentiles between 4 and 7 micrograms/g. Children from urban areas have significantly higher PbT levels than children from rural and suburban areas. The highest PbT levels (on a group basis) are in children from nonferrous smelter areas. The median levels of lead in urine (PbU) are between 6 and 10 micrograms/g creatinine, with 95th percentiles between 20 and 30 micrograms/g creatinine. Children from polluted areas have higher PbU levels than children from less polluted areas. The median levels of cadmium in urine (CdU) are in the order of 0.1 microgram/g creatinine, with 95th percentiles being in the range of 0.5 and 1.0 microgram/g creatinine. Girls have higher CdU levels than boys. There are no differences between groups of children from different areas. Children from lead worker families have higher PbU and CdU levels than otherwise comparable children. The results of the present studies indicate a further decrease of PbB in children from North-West Germany since the CEC blood lead campaigns carried out in 1979 and 1981. The decrease of lead exposure also seems to be reflected by a decrease of tooth lead levels.

Growth and bone maturation in children from two regions of the F.R.G. differing in the degree of air pollution: results of the 1974 and 1984 surveys.

Growth and bone maturation criteria were used in this collaborative study to assess the potential health risk posed by excessive air pollutant emission. The study consisted of two surveys carried out 10 years apart. During this decade, a substantial emission reduction through the effective control efforts was achieved in the index area, but not so in the reference area where the situation remained virtually unchanged during this period. In terms of body height and height-weight proportionality, no significant differences were found between areas and years of investigation. In contrast, the bone age retardation encountered in the children from the polluted area was statistically significant, both at 1974 and 1984 surveys, despite the appreciable improvement in this developmental criterion for boys in 1984. This was true for both group mean values and the percentages of individuals exhibiting the bone maturation delay greater than 10 months.

[Carboxyhemoglobin levels of selected population segments in variously structured and polluted areas of North Rhine-Westphalia]. / Untersuchungen zum Carboxyhämoglobingehalt ausgewählter Bevölkerungsgruppen in unterschiedlich strukturierten und belasteten Gebieten Nordrhein-Westfalens.

Measurements of carboxyhemoglobin (COHb)-content from about 13,000 inhabitants of various sites in western North Rhine-Westphalia are presented. Analyses were part of surveys on the effects of air pollution conducted between 1975 and 1980 in five designated, polluted areas. Determinations were executed in the Medical Institute for Environmental Hygiene, Duesseldorf, on behalf of the Ministry of Labour, Health and Social Administration. Analysis of blood samples for CO-content was performed by gas chromatography. Carboxyhemoglobin levels were calculated by reference to the individual hemoglobin levels. Our surveys have been conducted during several years and included different seasons. Before 1977, fifty years old men were investigated. Until 1978, sixty years old men were studied. In 1979 and 1980, sixty years old women and ten years old children were additionally incorporated into the survey. Statistical analysis of data included variables which influence personal CO-burden such as smoking, and in the case of non-smokers indoor air exposure through passive smoking, use of gas facilities and heating in the flat, as well as occupational exposure. Besides, the influence of age, sex and location was considered. The average COHb-level of the populations under study was expressed as the median of the distribution. The distribution-free Mann-Whitney U-test served for assessment of differences between groups. As a further parameter, the percentage of the measurements greater than 2,5% COHb was chosen, because it was thought to be more relevant to risk populations, i.e. people suffering from Angina pectoris. As expected, tobacco smoking exerted the greatest influence on COHb-level. In non-smokers a trend, indicating a relationship between indoor air pollution and COHb-content could be observed. If high CO gas such as coke gas was used in flats with gas facilities COHb-levels were significantly raised. Surveys performed in 1979 and in 1980 showed a sex-dependent difference between median COHb saturations, women having lower values than men. The difference of these figures between adults and children is statistically significant. Comparisons between adult nonsmokers from various sites prompted a significant difference only in the case of the Oberbergischer Kreis (County), having the lowest median COHb-value. The highest COHb-levels by far were encountered in the city of Duisburg in January 1979, when very unfavourable meterological conditions (Smog alarm, degree 1) were present. The median COHb saturations reached on this occasion were very near to the limits considered to be critical for populations at special risk.

Environmental exposure to cadmium and renal function of elderly women living in cadmium-polluted areas of the Federal Republic of Germany.

An epidemiological study was performed to assess whether environmental pollution by cadmium as found in cadmium-polluted areas of the Federal Republic of Germany is associated with an increased prevalence of biological signs of kidney dysfunction in population groups non-occupationally exposed to heavy metals. The study was run in two industrial areas known to be highly contaminated by cadmium, lead and other heavy metals, viz. Stolberg and Duisburg. Düsseldorf was selected as a reference area. As a study population we selected 65- and 66-year-old women (n = 286) who had spent the major part of their lives in one of these areas. The average cadmium levels in blood (CdB) and urine (CdU) revealed significant differences in exposure to cadmium in the order Stolberg greater than Duisburg greater than Düsseldorf. Serum creatinine levels were, on average, significantly higher in the Stolberg group than in the Duisburg and Düsseldorf groups. However, with respect to the urinary excretion of low molecular weight proteins (beta 2-microglobulin, retinol-binding protein), albuminuria, total proteinuria, aminoaciduria, phosphaturia and some other biological findings, no significant differences between the study populations were noted. Similarly, the prevalence of clinically-confirmed hypertension as well as the relative frequency of hypertensive subjects (systolic greater than or equal to 160 and/or diastolic greater than or equal to 95 mm Hg) did not differ significantly among the three study groups. There was no exposure-response relationship between CdU and tubular proteinuria in the range of the CdU-levels found (0.1 to 5.2 micrograms/g creatinine). However, albuminuria tended to be increased at CdU levels greater than 2 micrograms/g creatinine.

Levels of cadmium and lead in blood in relation to smoking, sex, occupation, and other factors in an adult population of the FRG.

Levels of cadmium (CdB) and lead (PbB) were determined in the blood of 579 60-65 year-old residents of Cologne and two small cities near Cologne. CdB-levels in cigarette smokers are on the average 3-4 times higher than in non-smokers (geometric means: non-smokers, 0.44 micrograms/l; less than or equal to 10 cigarettes/d, 1.16 micrograms/l; greater than 10 cigarettes/d, 1.85 micrograms/l). The results indicate that, with regard to the internal dose, cadmium exposure via smoking may contribute even more than does exposure via food. PbB-levels (geometric mean: 8.49 micrograms/100 ml; range: 2.9-30.3 micrograms/100 ml) are in the acceptable range as defined by the CEC reference values. Male smokers have on the average slightly higher PbB-levels than male non-smokers. In women PbB-levels are on the average lower than in men.

Repeated surveillance of exposure to thallium in a population living in the vicinity of a cement plant emitting dust containing thallium.

From 1979 to 1981, several medical surveys were carried out among a population living in the vicinity of a cement plant that emitted dust containing thallium until August, 1979. Air, soil, plants, and domestic animals in the area were contaminated by thallium and this led to an increased intake of thallium in the population, mainly due to the consumption of home-grown vegetables and fruit. In order to assess the degree of the individuals' exposure to thallium, thallium levels in 24-h urine samples (TlU) were determined. Three surveys were carried out from September to December, 1979 to assess the degree of thallium exposure of different parts of the general population. Subjects with relatively high exposure, as indicated by the results of the above mentioned population surveys, or those suffering from health disorders that might be related to an increased intake of thallium, were reexamined several times from 1979-1981. Special attention was also given to children attending a kindergarten situated about 0.5 km from the cement plant. As compared to an "unexposed" reference population (mean TlU: 0.3 microgram/l), the majority of the population living in the cement plant area had significantly elevated urinary thallium levels (range: less than 0.1-76.5 micrograms/l) indicating a substantially increased environmental exposure. A reduction of the intake of thallium was mainly achieved by the fact that the population, as advised by the authorities, largely avoided the consumption of home-grown, potentially contaminated foodstuffs. Reports on the teratogenicity of thallium in certain animal species caused great concern that thallium might have exerted teratogenic effects on the newborn of women exposed to thallium during pregnancy. Therefore, an investigation of children born between January, 1978 and August, 1979 (n = 297) was carried out. Although the number of congenital malformations was greater than expected, we conclude, considering carefully all data available, that there is likely no causal relationship between thallium and the occurrence of congenital malformations in the children investigated.

[Air pollution and biological defence (author's transl)]. / Luftverunreinigung und körpereigene Abwehr.

Differences of individual reactivity and, therefore, in the strength of effect air pollution exerts in different subjects of a population under study, are well known. Several experimental and epidemiologic results point to the possibility that this phenomenon is due to variations in the defence mechanisms of the human body. Some important findings relating to this problem are: Deterioration of lung clearance by inhalation of NO2 or lead chloride; damage to alveolar macrophages by air borne particulates in vitro and in vivo; enhanced activation or synthesis of the C'3 complement fraction under the influence of air pollutants; higher frequency of enlarged tonsils and lymph nodes, of pathogenic bacteria on tonsillar surfaces, and of relatively lower lysozyme concentrations in children living in urban or industrialized areas; decreased resistance to infections, elicited by inhalation of O3 or a lead aerosol; immuno-suppressive effect of heavy metals and organic compounds; allergic reactions against quite a number of chemicals; detoxification and toxification, e.g. formation of ultimate carcinogens, of organic molecules; induction or inhibition of the metabolism of benzo(a)pyrene by particulate extracts or by CO, NO2, and lead, resp.; deficiency of DNA--repair in disease conditions predisposing to the development of cancer; tendency, in allergics, to a relatively lower incidence of cancer; adaptation to the effects of CO or SO2. These facts, and knowledge not cited here, are in favour of the existence of close connections between various defence mechanisms, air pollution, and its effects on the human organism.

Intake and health effects of thallium among a population living in the vicinity of a cement plant emitting thallium containing dust.

In order to assess the degree of thallium exposure in a population living around a thallium emitting cement plant in a small city in North-West Germany thallium levels in 24 h urine samples of 1,265 subjects and in hair samples of 1,163 subjects were determined. Urinary thallium levels in two groups of subjects living in an urban and a rural area of West Germany were determined for reference. As compared to these subjects the population living around the cement plant exhibited obvious signs of increased thallium intake. The mean urinary thallium concentration was 2.6 micrograms/l and ranged up to 76.5 micrograms/l. In contrast, the mean urinary thallium levels of the two reference groups were 0.2 and 0.4 micrograms/l, respectively. Hair thallium levels of the population living around the cement plant were also markedly increased (mean: 9.5 ng/g). The major route of the population's increased intake of thallium was found to be the consumption of vegetables and fruit grown in private gardens in the vicinity of the cement plant. As was shown by chemical analyses vegetables and fruit grown in these gardens were contaminated by thallium-containing atmospheric dust fall-out caused by emissions of the cement plant. The pulmonary route of uptake as well as other sources did not seem to play a significant role in the population's exposure to thallium. Polyneuritic symptoms, sleep disorders, headache, fatigue and other signs of psychasthenia were found to be the major health effects associated with increased thallium levels in urine and hair. No positive correlation was found between the thallium levels in hair and urine and the prevalence of skin alterations, hair-loss and gastro-intestinal dysfunctions.

[The oncogenic effect of fibrous dust. Animal experiments and their relationship with human carcinogenesis]. / L'effet oncogène des poussières fibreuses. L'expérimentation animale et ses relations avec la carcinogénèse humaine

The results after intraperitoneal injection of fibrous and granular dusts in rats suggest, that the fibrous shape of asbestos is the cause of its cancerogenicity. Fibrous dusts other than asbestos (for example glass fibers) may induce tumours, when their diameters are like that of asbestos and the fibres are invariable in tissue. It is supposed, that a fibre with a diameter less than 1 mum and a length greater than 3 mum has a cancerogenic effect. The interpretation of the experimental results considering the cancerogenesis in humans is discussed, especially concerning the effect of fibrous glass.