Search

Objectives: There are regional differences in mortality in Bavaria. Although these regional dif-ferences in mortality were associated with behavioural risk factors and socioeconomic factors in a study conducted for this reason, the quantitative effect of behavioural risk factors and socio-economic factors as well as the regional structure on the individual health as a predictor of mortality were not known., Methods: Persons between the age of 18 and 80 were interviewed with the Behavioral Risk Factor Surveillance System (BRFSS) in two Bavarian regions with high mortality, two Bavarian regions with low mortality and in the capital of Bavaria, Munich. For regional structural data, the INKAR database was used. Data were analysed descriptively, with a multivariable-adjusted logistic regression and with a multilevel analysis., Results: There were lower proportions of persons with a good or very good state of health as well as adverse results for overweight/adipositas, the behavioural risk factors for doing sports, smoking and consuming fruits and vegetables and the socioeconomic factors education and unemployment in the two regions with high mortality "Ostbayerische Grenzregion" and "Oberfranken". In a multivariable adjusted logistic regression, the body mass index, smoking, doing sports, climbing stairs, consuming alcohol, being satisfied with the job and the interaction between education and marital status were found to have an influence on the individual health. The small remaining regional component could be explained in the multilevel analysis by different variables which describe the economical situation of the regions., Conclusions: In accordance with the study hypotheses, a consistency between behavioural risk factors and regional differences in mortality could be observed. Socioeconomic influences and a small regional component are involved. In addition to specific prevention programmes for the target groups, structural support is also meaningful with regard to its potential health impact.

Objective: In completion of a decision of the Bavarian Parliament we examined the regional mortality differences within Bavaria., Data: The analysis was based on the number of deaths in Bavaria in the years of 2000-2002. Data on regional demographic and socioeconomic indicators were used to identify potential associations., Methods: Deaths were analysed by cause of death and region. Crude and age standardised mortality rates were calculated. Additionally, we assessed the potential years of life lost in order to obtain some indication of the potential effects of preventive action. The association with likely explanatory factors was investigated on an ecological level., Results: The regional mortality differences in Bavaria show a northeast-southwest gradient favouring the southwest, which reflects the socioeconomic situation within Bavaria. This may be due to the economic disadvantage northeast Bavaria had to endure as a result of its marginal location within a divided Europe. We found strong bivariate correlations of the mortality rate with individual socioeconomic factors (e. g. with available income: -0.582; with unemployment: +0.416; with the immigration rate: -0.473). Exploratory analysis suggest that about 50 % of the regional variation in mortality could be explained by socioeconomic factors., Discussion: The results for cause of death indicate that behavioural factors in relation to socioeconomic aspects may well play a role in the mortality gradient. This will be the focus of a future piece of research of our unit.

Polychlorinated biphenyls (PCB) were manufactured between 1929 and 1989. Due to their great chemical persistence, these substances have been used for many different purposes. These chemical properties, however, caused PCB to accumulate in the food chain and resulted in background exposure of the general population. PCB has also been used as plasticizer for sealants in prefabricated buildings, thus causing problems to the present date. At the end of the 90-ties in a school in Nuremberg, Germany, elevated PCB concentrations were measured in indoor air. Some of these results were higher than 3,000 ng/m(3) which means decontamination according to the German "PCB directive". Press coverage made these results a matter of public debate, so that teachers, school children and parents were highly worried because of possible health effects. The Bavarian Minister for Health, Nutrition and Consumer Protection asked us to examine school children and teachers with regard to their internal PCB exposure and health complaints. A group of school children from a non-contaminated school served as controls. For the determination of PCB levels the plasma samples were blinded before analysis. Lower chlorinated PCB (PCB 28, 52, 101) were detected more often and in higher concentrations in plasma samples of school children of the contaminated school compared to the controls. The plasma levels of the higher chlorinated PCBs (PCB 138, 153, 180) did not show similar differences between exposed and non-exposed school children. The relative PCB doses additionally taken up in the contaminated school were less then 5 % of the background exposure of the children. That is why it could finally be concluded that no appreciable additional health risk may result from inhalation of PCB contaminated indoor air in this school. Due to the design, performance and interpretation of this study, including representatives of parents and teachers, these results were widely accepted by most of the parents who initially had been very concerned about possible health effects.

Some aspects of development in modern public health services are described by the example of their function in the fields of environmental and social medicine and hygiene. New public management and quality management are important factors in this development. For some parts of the public health services a renewed structure in organisation seems to be necessary. To give quality assured and evidence based advice to policy, public health services need cooperation with scientific institutes and other partners in the field of public health, nowadays just because of reduced resources.

Elevated concentrations of polycyclic aromatic hydrocarbons (PAK) are often found in the soil of former waste disposal sites, industrial areas, etc. It is desirable and useful to determine orientation values to facilitate and unify the evaluation of contaminations under the aspects of present or planned uses of an area, health protection and decision-making on remedial measures. In the present paper we wish to draw attention to, and discuss problems resulting from, particular characteristics of PAK, e.g. the toxicological property "complete carcinogens" or the necessity of taking into account oral, inhalative and dermal exposure of children on a playground. Based on the discussion, orientation values for benzo[a]pyrene and PAK ("normal" pattern) of 0.5 mg/kg soil and 5 mg/kg soil, respectively, are recommended for top soil of vegetation-free playgrounds. In comparison, deductions carried out by other working groups are presented.

Several working groups of the "Academy of Public Health in the Bavarian State Ministry of Labour and Social Affairs, Family, Women and Health" are asked to make suggestions for quality assurance in the fields of activity of the public health services. A first conception is now brought up for discussion by the "Working Group for Quality Assurance in Environmental Medicine". Necessarily, it is based on the actual legal status, but it is also influenced by the political discussion in Bavaria concerning a new organisation of the public health services and the possibility to denationalise functions. The conception is meant to be part of an inventory of the functions in environmental medicine. Some suggestions for quality assurance are made.

The evaluation of indoor pollution by wood preservatives and pesticides has been a matter of increasing interest for the past years. The present paper reviews actual knowledge. The so-called "wood preservative syndrome" is referred to. Basics and evaluation criteria concerning the investigation of external exposure (wood, dust, air) and human biomonitoring is summarized. Several substances, in particular pentachlorophenol, lindane and pyrethroids, and principle possibilities to decrease exposure are considered.

Up to now no uniform procedure and no generally accepted values exist for health evaluation of pollutants in soil. Aim of the working group for environmental hygiene (AGU) of the Bavarian Ministry of Labour and Social Order, Family, Women and Health is to propose health-based procedures and values for assessment, in consideration of existing concepts and regulations. Basis for health evaluation is the existence of appropriate soil investigations. This refers to the sampling scheme (sampling depth, sampling site and manner, number and representativity of samples) as well as sample preparation and analysis. The "still tolerable pollutant concentration in soil" (TSKB) is supposed to mark a threshold which separates a range of tolerable pollutant concentration from a range where soil-related measures are indicated. Basis for determination of a TSKB-value is the estimation of the average uptake of the respective substance via air, drinking water and food. From this the average level of a tolerable dosis without health risk by regular long-term uptake by humans is calculated. From the remaining portion of tolerable uptake the TSKB-value for the additional pathway of uptake by soil is derived. The estimations are representatively performed for 3-year old children, because small children are especially endangered by uptake of polluted soil. TSKB-values were determined by this procedure for the metals As, Cd, Cr, Cu, Hg, Ni, Pb, Zn and compared with assessment criteria and values of other working groups.