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The association between industrial pollution and human health is of high importance for public health. Living near industrially contaminated sites (ICSs) and being exposed to increasing concentrations of environmental pollutants along with disadvantaged social and economic conditions result in an increased occurrence of diseases. There are 16 identified industrially contaminated sites in the Republic of North Macedonia, and of all of them, chemical industry AD OHIS - Skopje and lindane dump located near the plant, according to almost all categorizations,has been evaluated to pose the highest level of ecological and health risk, although there has been no recent evidence about these issues. The main aim of this study was to obtain general information about risk perception of resident population living around and near AD OHIS in the Skopje region. Methods: A standardized and modified questionnaire was sent to the participants in an electronic form by e-mail and was published on social networks and municipalities’ web sites. The responses to the questionnaire were given anonymously and voluntarily. The results were analyzed using descriptive statistical methods with calculating central tendency parameters and analytical statistical methods with correlation and Pearson χ2 test and independent sample test. Results: During the observation period, 220 people responded to the survey, with female respondents being predominant (70%). Analysis showed that there was no significant difference between genders regarding risk perception. According to Likert scale, with 95% CI, among anthropogenic sources, respondents stated they were extremely worried about air pollution and very worried or worried about water pollution, noise, waste and dangerous industry. The diseases that trigger a response of greater concern were those related to allergies, respiratory diseases and cancer. Age, education and information related to ecological risks significantly influenced on judgement of the environmental conditions in the living area of resident population (p, Врската помеѓу загадувањето кое потекнува од индустријата и човековото здравје е од високо значење за јавното здравје. Животот во непосредна близина на индустриски контаминираните точки (ИКТ) и експонираноста на високи концентрации на еколошки полутанти, придружени со нарушени социјални и економски услови, резултира со зголемена појава на заболувања. Од вкупно 16 идентификувани контаминирани точки во Република Северна Македонија, хемиската индустрија во АД ОХИС - Скопје и депонијата со линдан која се наоѓа во непосредна близина, безмалку во сите категоризации правени досега е оценета со највисок еколошки но и јавноздравствен ризик иако никогаш не е правено опсежно истражување на тие аспекти.Главната цел на ова истражување беше да се добијат основни податоци за перцепцијата на ризик на резидентното население кое живее во околината или непосредна близина на ИКТ АД Скопје во скопскиот регион. Методи. Истражувањето беше спроведено со доставување на стандардизиран модифициран прашалник во електронска форма преку електронска пошта и објавен на социјалните мрежи и интернет страницата на скопските општини. Пополнувањето беше анонимно и доброволно.За анализа на резултатите беа користени дескриптивни статистички методи со одредување мерки на централна тенденција и аналитички статистички методи со корелација и Pearson χ2 (хи-квадрат тест) и t-тест за независни примероци и анализа на варијанса. Резултати.Вкупно 220 испитаници доброволно го пополнија прашалникот, од кои поголемиот дел (70%) беа испитаници од женски пол, меѓутоа анализата покажа дека нема сигнификантна разлика меѓу половите во однос на перцепција на ризикот. Според Likert-овата скала, со 95% CI од антропогените извори како најголем ризик со екстремна изложеност испитаниците го чувствуваат загадувањето на воздухот,a со значително до умерено загадувањето на водата, бучавата, отпадот и опасната индустрија.Како три најчести патолошки состојби кои може да се појават при изложеност на контаминирана средина ги сметаат алергиите, респираторните заболувања и канцерот. Возраста, степенот на образование и информираноста за еколошките ризици сигнификантно влијаат на мислењето поврзано со условите на животната средина во која живее резидентното население (p

Despite the increasing number of studies on industrially contaminated sites (ICS) and their health effects, there are very few studies on perinatal health outcomes in ICSs. In the present study, we examined the perinatal health inequalities by comparing adverse birth outcomes (ABOs) in the oil shale industry region of Ida-Viru County in Estonia with national-level figures and investigated the effects of maternal environmental and sociodemographic factors. Based on the 208,313 birth records from 2004–2018, Ida-Viru ICS has a birth weight 124.5 g lower than the average of 3544 g in Estonia. A higher prevalence of preterm birth (4.3%) and low birth weight (4.8%) in Ida-Viru ICS is found compared to 3.3% on both indicators at the national level. Multiple logistic regression analysis shows the statistically significant association of ABOs with fine particle (PM2.5) air pollution, mother’s ethnicity, and education throughout Estonia. However, in Ida-Viru ICS, the ABOs odds are remarkably higher in these characteristics except for the mother’s ethnicity. Furthermore, the ABOs are associated with the residential proximity to ICS. Thus, the Ida-Viru ICS has unequally higher odds of adverse perinatal health across the environmental and sociodemographic factors. In addition to reducing the air pollutants, policy actions on social disparities are vital to address the country’s unjustly higher perinatal health inequalities, especially in the Ida-Viru ICS.

The Vasilikos Energy Center (VEC) is a large hydrocarbon industrial hub actively operating in Cyprus. There is strong public interest by the communities surrounding VEC to engage with all stakeholders towards the sustainable development of hydrocarbon in the region. The methodological framework of the exposome concept would allow for the holistic identification of all relevant environmental exposures by engaging the most relevant stakeholders in industrially contaminated sites. The main objectives of this study were to: (i) evaluate the stakeholders’ perceptions of the environmental and public health risks and recommended actions associated with the VEC hydrocarbon activities, and (ii) assess the stakeholders’ understanding and interest towards exposome-based technologies for use in oil and gas applications. Methods: Six major groups of stakeholders were identified: local authorities, small-medium industries (SMIs) (including multi-national companies), small-medium enterprises (SMEs), academia/professional associations, government, and the general public residing in the communities surrounding the VEC. During 2019–2021, a suite of stakeholder engagement initiatives was deployed, including semi-structured interviews (n = 32), a community survey for the general public (n = 309), technical meetings, and workshops (n = 4). Results from the semi-structured interviews, technical meetings and workshops were analyzed through thematic analysis and results from the community survey were analyzed using descriptive statistics. Results: Almost all stakeholders expressed the need for the implementation of a systematic health monitoring system for the VEC broader area and its surrounding residential communities, including frequent measurements of air pollutant emissions. Moreover, stricter policies by the government about licensing and monitoring of hydrocarbon activities and proper communication to the public and the mass media emerged as important needs. The exposome concept was not practiced by the SMEs, but SMIs showed willingness to use it in the future as part of their research and development activities. Conclusions: The sustainable development of hydrocarbon exploitation and processing prospects for Cyprus involves the VEC. Continuous and active collaboration and mutual feedback among all stakeholders involved with the VEC is essential, as this may allow future environmental and occupational health initiatives to be formalized.

Risk perception (RP) evaluation during pregnancy and its relationship with lifestyles are considered useful tools for understanding communities living in high-risk areas and preventing dangerous exposure. It is well known that exposure to pollutants and less-healthy lifestyles may result in increased disease occurrence during life. Our work investigated environmental RP through ad hoc questionnaires administered to 611 mothers within the NEHO birth cohort, recruited in three heavily contaminated areas of Southern Italy. Four different RP indices, an exploratory factorial analysis (EFA), and a latent class analysis were evaluated from questionnaires. The highest values of risk perception index were observed in the Milazzo site (0.64 ± 0.16) and the lowest in the Crotone site (0.5 ± 0.18). EFA revealed four latent factors, including different items describing environmental pollution, and subjects were classified into four latent classes with different RP indices. Significant RP profiles were different among the sites (p &lt, 0.001). Our results did not demonstrate any association between RP and lifestyles during pregnancy. Improving healthy lifestyle behaviours, particularly in polluted areas, would generate co-benefits by preventing further risk factors. As remediation interventions can take a long time, it needs to improve healthy lifestyles in residents until remediation is completed.

Pregnant women living in industrially contaminated sites (ICSs) are exposed to environmental contaminants through different pathways, and thus children’s health may be affected by pollutants. We created the Neonatal Environment and Health Outcomes (NEHO) longitudinal birth cohort in three ICSs in the Mediterranean area of southern Italy, collecting comprehensive information on personal data and lifestyles by questionnaire. Through multiple correspondence analysis, we identified possible clusters of enrolled women, and a neural network classifier analysis (NNCA) was performed to identify variables capable of predicting the attrition rate of the study. NEHO recruited 845 mother–child pairs over two years. The mothers’ mean age was 31.1 ± 5.2 SD years. We found significant differences in socioeconomic status (SES) among the three evaluated ICS, and an overall 11.1% prevalence of mothers who actively smoked during pregnancy. Active smoking during pregnancy was strongly associated with the lowest socioeconomic level (p &lt, 0.0001). By means of the NNCA, we found that smoking during pregnancy and the lowest education level characterized the cluster with the highest attrition rate (p &lt, 0.001). Our results demonstrate that reason for public health concern still exists regarding smoking during pregnancy and that SES influences both lifestyles, producing negative pregnancy outcomes and a higher survey attrition rate.

Considering complicity in ecological health and social aspects of industrial contaminated sites (ICSs), the methodologies and approaches of health impact assessments are very heterogeneous. ICSHNet together with WHO recommend two main methodological approaches: health risk assessments and epidemiological studies. Some countries have necessary experience for impact assessment of ICSs, but others have limited resources and less intensity studies. In the Republic of North Macedonia, 16 ICSs are identified, but one of them, lindane dumpsite in OHIS Plant is characterized as the most ecological and public health risk. The general aim: Systematic review of literature data about methodological approaches for health risk assessment of ICSs on international and national level in order to make comparative analysis of current methodological approaches in the Republic of North Macedonia using the case study of ICS OHIS PLANT SKOPJE. Material and methods: The review of scientific and grey literature was performed. The selected scientific studies were searched in the PubMed and Medline databases from 2000-2017, in English and Macedonian. The selected studies and data were analyzed by required information for identification of hazards, exposure assessment and risk characterization. Additionally, the review was performed on published reports of risk assessment of OHIS Plant. Results: A total of 14 original papers were investigated. Continuous monitoring systems for gathering environmental data related to ICSs were used only in two cases and in other studies the concentrations of contaminants in the source were calculated or several ad hoc monitoring campaigns were performed. Exposure assessment was conducted according to qualitative definition for the presence/absence of a source, distance to a source and biomonitoring in the study. Mortality, cancer incidence, congenital abnormalities and hospitalizations were used health data. The study of risk assessment of OHIS Plant has ecological design and indirect quantitative exposure assessment model was used. Conclusion: All investigated studies used three main methodological approaches for exposure assessment: measurement of hazard concentration, distance from source and biomonitoring. Comparable, conducted risk assessment of OHIS Plant follows the recommendations of US EPA and ATSDR with weakness of no existing continual monitoring process and also deficiency of health data and this is the reason for limitation of health impact assessment and setting up EPHT or other public health surveillance system., Имајќи ја предвид коплексноста во еколошкото здравје и социјалните аспекти на индустриски контаминирани точки (ИКТ), методологијата и пристапот во истражувањето на влијанието на ИКТ врз здравјето се многу хетерогени. ICSHNet во соработка со СЗО препорачуваат два главни методолошки приоди за истражување на ИКТ: проценка на здравствениот ризик и епидемиолошки студии. Некои земји го имаат потребното искуство за проценка на влијанието на ИКТ, а некои, пак, имаат лимитирани ресурси и помалку интензивни студии. Во Република Северна Македонија идентификувани се вкупно 16 ИКТ, од кои депонијата со линдан во АД ОХИС Скопје е оценета со највисок еколошки но и јавноздравствен ризик. Основна цел на студијата беше преку преглед на селектирани литературни податоци поврзани со методолошки приоди за проценка на здравствените ризици во индустриски контаминираните точки на меѓународно и национално ниво да се изврши компаративна анализа на спроведениот методолошки пристап во Република Северна Македонија преку примерот со ИКТ АД ОХИС Скопје. Материјал и методи: Преглед на научна и сива литература, како и селектирање на студии преку базите на податоци PubMed и Medline, изведени во периодот 2000-2017 на англиски и македонски јазик. Селектираната литература и податоци се евалуираа во однос на потребни податоци за идентификација на хазарди, проценка на експозицијата и карактеризацијата на здравствениот ризик. Дополнително, беше извршен преглед на публикувани извештаи од спроведената проценка на ризик на ИКТ АД Охис Скопје. Резултати: Беа анализирани вкупно 14 студии. Континуиран мониторинг систем бил користен само во две студии, а во останатите студии биле пресметувани контаминентите во изворот или биле спроведени краткотрајни мониторинг кампањи. Проценка на експозицијата била спроведена преку одредување на присуството на контаминентот или оддалеченост од изворот и во една студија биомониторингот. Инциденцијата на смртност, појава на канцер и вродени аномалии и број на хоспитализации се користени здравствени податоци. Проценката на ризик на ИКТ АД Охис Скопје по својот дизајн е еколошка студија со примена на индиректна квантитативна проценка на експозицијата. Заклучок: Во сите анализирани студии се применети три главни принципи на проценка на експозицијата: преку одредување на концентрацијата на полутантот, оддалеченоста од изворот и биомониторинг. Споредбено, проценката на ризик на ИКТ АД Охис Скопје методолошки ги следи препораките на US EPA и ATSDR, со слабости во однос на недостаток на континуиран мониторинг систем и недостаток на податоци за здравствениот ефект, што ја лимитира проценката на здравствениот импакт, како и поставување на EPHT или друг систем за јавноздравствен надзор во ИКТ.

Mining and mineral processing is still a vital source of income in Serbia, due to mineral abundance in copper, lead, zinc, antimony. Copper mining and metal-processing are located in the east: Bor, Veliki Krivelj, Cerovo, Majdanpek. Abandoned sites from antimony mining and processing and secondary lead smelter are at the western border: Zajaca, Krupanj, Stolice. Coal mining and power plants are surrounding Belgrade: Obrenovac (2 power plants), Grabovac (plant ash landfill), Kolubara and Kostolac. Main objective is to focus on potential public health hazards from industrial contamination in Serbia. Key public health issue is presence of As and Cd in ambient air PM10 close to industrially contaminated sites due to the fact that ores have high naturally occurring contents of heavy metals and metalloids. Data originate from Serbian Environmental Protection Agency, Mining and Metallurgy Institute Bor, Belgrade Institute of Public Health, as part of continuous measurement of air quality within State network of automatic stations. Concentration of As in PM10 are extremely above the limit value in Bor and Lazarevac, with Cd values slightly increased in Bor. Serbia lacks the legal framework for continuous and institutionalized follow-up of population groups vulnerable to hazardous environmental exposure, although measured concentration indicate urgent need for such activities.

In the WHO European Region the topic of contaminated sites is considered a priority among environment and health themes. Communities living in or close to contaminated sites tend to be characterized by a high prevalence of ethnic minorities and by an unfavorable socioeconomic status so rising issues of environmental justice. A structured review was undertaken to describe the contents of original scientific studies analyzing distributive and procedural justice in industrially contaminated sites carried out in the WHO European Region in the period 2010–2017. A systematic search of the literature was performed. In total, 14 articles were identified. Wherever assessments on environmental inequalities were carried out, an overburden of socioeconomic deprivation or vulnerability, with very few exemptions, was observed. The combined effects of environmental and socioeconomic pressures on health were rarely addressed. Results show that the studies on environmental and health inequalities and mechanisms of their generation in areas affected by industrially contaminated sites in the WHO European Region are in their early stages, with exemption of UK. Future efforts should be directed to improve study strategies with national and local assessments in order to provide evidence for equity-oriented interventions to reduce environmental exposure and related health risks caused by industrial contamination.

João Paulo Teixeira - trabalho desenvolvido também como investigador do INSA (Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal) BACKGROUND: this paper is based upon work from COST Action ICSHNet. Health risks related to living close to industrially contaminated sites (ICSs) are a public concern. Toxicology-based risk assessment of single contaminants is the main approach to assess health risks, but epidemiological studies which investigate the relationships between exposure and health directly in the affected population have contributed important evidence. Limitations in exposure assessment have substantially contributed to uncertainty about associations found in epidemiological studies. OBJECTIVES: to examine exposure assessment methods that have been used in epidemiological studies on ICSs and to provide recommendations for improved exposure assessment in epidemiological studies by comparing exposure assessment methods in epidemiological studies and risk assessments. METHODS: after defining the multi-media framework of exposure related to ICSs, we discussed selected multi-media models applied in Europe. We provided an overview of exposure assessment in 54 epidemiological studies from a systematic review of hazardous waste sites; a systematic review of 41 epidemiological studies on incinerators and 52 additional studies on ICSs and health identified for this review. RESULTS: we identified 10 multi-media models used in Europe primarily for risk assessment. Recent models incorporated estimation of internal biomarker levels. Predictions of the models differ particularly for the routes 'indoor air inhalation' and 'vegetable consumption'. Virtually all of the 54 hazardous waste studies used proximity indicators of exposure, based on municipality or zip code of residence (28 studies) or distance to a contaminated site (25 studies). One study used human biomonitoring. In virtually all epidemiological studies, actual land use was ignored. In the 52 additional studies on contaminated sites, proximity indicators were applied in 39 studies, air pollution dispersion modelling in 6 studies, and human biomonitoring in 9 studies. Exposure assessment in epidemiological studies on incinerators included indicators (presence of source in municipality and distance to the incinerator) and air dispersion modelling. Environmental multi-media modelling methods were not applied in any of the three groups of studies. CONCLUSIONS: recommendations for refined exposure assessment in epidemiological studies included the use of more sophisticated exposure metrics instead of simple proximity indicators where feasible, as distance from a source results in misclassification of exposure as it ignores key determinants of environmental fate and transport, source characteristics, land use, and human consumption behaviour. More validation studies using personal exposure or human biomonitoring are needed to assess misclassification of exposure. Exposure assessment should take more advantage of the detailed multi-media exposure assessment procedures developed for risk assessment. The use of indicators can be substantially improved by linking definition of zones of exposure to existing knowledge of extent of dispersion. Studies should incorporate more often land use and individual behaviour. info:eu-repo/semantics/publishedVersion

BACKGROUND: this paper is based upon work from COST Action ICSHNet. Health risks related to living close to industrially contaminated sites (ICSs) are a public concern. Toxicology-based risk assessment of single contaminants is the main approach to assess health risks, but epidemiological studies which investigate the relationships between exposure and health directly in the affected population have contributed important evidence. Limitations in exposure assessment have substantially contributed to uncertainty about associations found in epidemiological studies. OBJECTIVES: to examine exposure assessment methods that have been used in epidemiological studies on ICSs and to provide recommendations for improved exposure assessment in epidemiological studies by comparing exposure assessment methods in epidemiological studies and risk assessments. METHODS: after defining the multi-media framework of exposure related to ICSs, we discussed selected multi-media models applied in Europe. We provided an overview of exposure assessment in 54 epidemiological studies from a systematic review of hazardous waste sites; a systematic review of 41 epidemiological studies on incinerators and 52 additional studies on ICSs and health identified for this review. RESULTS: we identified 10 multi-media models used in Europe primarily for risk assessment. Recent models incorporated estimation of internal biomarker levels. Predictions of the models differ particularly for the routes 'indoor air inhalation' and 'vegetable consumption'. Virtually all of the 54 hazardous waste studies used proximity indicators of exposure, based on municipality or zip code of residence (28 studies) or distance to a contaminated site (25 studies). One study used human biomonitoring. In virtually all epidemiological studies, actual land use was ignored. In the 52 additional studies on contaminated sites, proximity indicators were applied in 39 studies, air pollution dispersion modelling in 6 studies, and human biomonitoring in 9 studies. Exposure assessment in epidemiological studies on incinerators included indicators (presence of source in municipality and distance to the incinerator) and air dispersion modelling. Environmental multi-media modelling methods were not applied in any of the three groups of studies. CONCLUSIONS: recommendations for refined exposure assessment in epidemiological studies included the use of more sophisticated exposure metrics instead of simple proximity indicators where feasible, as distance from a source results in misclassification of exposure as it ignores key determinants of environmental fate and transport, source characteristics, land use, and human consumption behaviour. More validation studies using personal exposure or human biomonitoring are needed to assess misclassification of exposure. Exposure assessment should take more advantage of the detailed multi-media exposure assessment procedures developed for risk assessment. The use of indicators can be substantially improved by linking definition of zones of exposure to existing knowledge of extent of dispersion. Studies should incorporate more often land use and individual behaviour.

BACKGROUND: this paper is based upon work from COST Action ICSHNet. Industrial contaminated sites (ICSs) are of high concern since industrial plants have produced widespread contamination potentially affecting the health of local population OBJECTIVES: to assess the types of epidemiological designs applied in studies of health effects related to ICSs according to time periods, type of ICS, and geography. METHODS: a literature search was conducted in Medline (OVID) through June 30th, 2018, using MeSH and customized terms, and no restrictions on publication year or language. We included all studies throughout the world where a potential contamination of industrial origin occurred, an epidemiological approach (including biomonitoring, HBM) was applied, and health outcomes or exposure biomarkers among residents were investigated. Data on publication year, geographical localization and ICS characterization, study design (systematic reviews, cohort, case-control, temporal changes, cross-sectional, ecological, descriptive - area-level, case-series, narrative reviews, and HBM), and health outcomes were extracted from the abstracts. To check the sensitivity of the main search strategy, a case-study on Italy was conducted applying an ad-hoc search. RESULTS: from a literature search capturing 5,485 studies, 655 studies on resident populations were identified. The review includes more than 376 different ICSs, 86% from Europe, North America, and Asia combined, mostly dealing with nuclear sites and mining industries, waste and petrochemical activities. Most of the studies were descriptive (32.5%), cross-sectional (16.3%), or narrative review (14.8%), while analytical studies - case-control and cohort studies (9.6% and 8.4%, respectively) - were rarer; HBM were only 6.9%. A total of 235 studies, conducted mostly in Asia (34.5%), Europe (25.5%), and North America (22.3%), included children. The most frequently studied outcome was cancer (33.7%), followed by respiratory diseases (11.4%), and reproductive health (11.4%). The ad-hoc strategy greatly increased the number of detected papers (+122%). CONCLUSIONS: future research should adopt the most valid and suitable study design, according to the area-specific social and environmental context, also in areas of the world which are less studied, but with very high environmental worries of the resident population suffering the industrial contamination. Involvement of local experts on ICSs and local inventories are recommended to improve the coverage of the present inventory.