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Studies of the relationships between low socio-economic status and impaired lung function were conducted mainly in Western European countries and North America. East–West differences remain unexplored. Associations between parental education and lung function were explored using data on 24,010 school-children from eight cross-sectional studies conducted in North America, Western and Eastern Europe. Parental education was defined as low and high using country-specific classifications. Country-specific estimates of effects of low parental education on volume and flow parameters were obtained using linear and logistic regression, controlling for early life and other individual risk factors. Meta-regressions were used for assessment of heterogeneity between country-specific estimates. The association between low parental education and lung function was not consistent across the countries, but showed a more pronounced inverse gradient in the Western countries. The most consistent decrease associated with low parental education was found for peak expiratory flow (PEF), ranging from −2.80 to −1.14%, with statistically significant associations in five out of eight countries. The mean odds ratio for low PEF (

BACKGROUND: Although in the last few years some European countries have implemented smoking bans in hospitality venues, the levels of secondhand smoke (SHS) in this occupational sector Could still be extremely high in most countries. OBJECTIVE: The aim of this study, was to assess exposure to SHS in hospitality venues in 10 European cities. METHODS: We included 167 hospitality venues (58 discotheques and pubs, 82 restaurants and cafeterias, and 27 fast-food restaurants) in this cross-sectional study. We carried Out fieldwork in 10 European cities: Vienna (Austria), Paris (France), Athens (Greece), Florence and Belluno (Italy), Galway (Ireland), Barcelona (Spain), Warsaw and Lublin (Poland), and Bratislava (Slovak Republic). We measured vapor-phase nicotine as an SHS marker. RESULTS: We analyzed 504 samples and found nicotine in most samples (97.4%). We found the highest median concentrations in discos/pubs [32.99 mu g/m(3); interquartile range (IQR), 8.06-66.84 mu g/m(3)] and lower median concentrations in restaurants/cafeterias (2.09 mu g/m(3); IQR, 0.49-6.73 mu g/m(3)) and fast-food restaurants (0.31 mu g/m(3); IQR, 0.11-1.30 mu g/m(3)) (p < 0.05). We found differences of exposure between countries that may be related to their smoking regulations. Where we sampled smoking and nonsmoking areas, nicotine concentrations were significantly lower in nonsmoking areas. CONCLUSIONS: Hospitality venues from European cities without smoking regulations have very high levels of SHS exposure. Monitoring of SHS on a regular basis as well as a total smoking ban in hospitality sector would be needed.

To study the predictive power of respiratory screening examinations a cohort of asbestos workers was followed from active work in an asbestos cement plant until death. From a cohort with data on individual exposure since first employment 309 workers who had a preventive medical examination in 1989/1990 were observed until death or the end of 2006. The impact of asbestos exposure (fibre years) and of smoking history on lung function was examined by linear regression, on specific causes of death and total mortality by Cox regression. The prognostic value of lung function, chest X-ray, and various clinical findings regarding total mortality was also examined by Cox regression. Lung function proved to be the best predictor of survival apart from current smoking. Depending on the lung function variable an impairment by the interquartile range resulted in a hazard ratio of 1.5–1.6 while for current smokers it was 2.3. An increase of 70 fibre years (interquartile range) led to a hazard ratio of only 1.1. Lung function was influenced by asbestos exposure, current (but not former) smoking, and by pathological X-ray findings. The risk for pleural mesothelioma was dominated by time since first exposure to crocydolite in the pipe factory while the risk for bronchial cancer increased with smoking and total fibre years. An unexpected finding was an increase of gastric cancer in asbestos cement workers. Lung function decrease predicts risk of premature death better than exposure history and regular spirometry should therefore be offered as primary screening to all former asbestos workers. In workers with a history of high cumulative exposure or rapid lung function decrease or radiological signs (diffuse pleural thickening or small irregular opacities) more sensitive techniques (high resolution computer tomography) need to be applied. All smokers with a history of asbestos exposure should be given free smoking cessation therapy to prevent premature death and lung cancer in particular.

Objectives: To evaluate existing research on the environmental health of children and provide a prioritised list of risk factors and policy recommendations for action, the Policy Interpretation Network on Children's Health and Environment (PINCHE) was set up within EU FP5 (QLK4-2002-02395). The project focused on air pollutants, carcinogens, neurotoxicants and noise. PINCHE was a multidisciplinary and multinational network of representatives from science, industry, NGOs, and consumer and patient organisations in Europe. Materials and methods: A literature search was performed using the Pubmed, Embase and Toxline databases. The quality of the gathered articles was assessed and their information and relevance was interpreted within a systematic framework. Information related to exposure, epidemiology, and toxicology was analysed separately and then a risk evaluation of particular environmental factors was made. Socioeconomic factors were specifically taken into account. The results were compiled, and considering the present regulatory situation, policy recommendations for action were made. Finally, the risk factors and policy recommendations were prioritised through a process of discussion between all the partners. Results and conclusions: PINCHE concluded that outdoor air pollutants (especially traffic-related), environmental tobacco smoke, allergens, and mercury were high priorities with an urgent need for action. Brominated flame retardants, lead, PCBs and dioxins, ionising and solar radiation, and some noise sources were classified as being of medium priority. Some toxins were given low priority, based on few exposed children, relatively mild health effects or an improving situation due to past policy measures. We recognise the shortcomings of such a prioritisation and, though some measures are more urgent than others, emphasise that ideally all policy measures should be carried out without delay for all toxins. This priority list must be continuously revised, the precautionary principle should be central to all decisions, and the focus should be on safe exposure levels for children.

Background/methods : Current air pollution levels pose a threat to the health of children starting from conception. The scientific evidence is presented for mortality, morbidity, and sub-clinical effects. The first section deals with exposure data, the following sections with the evidence of health effects from epidemiology and toxicology leading to recommendations. Results : Improved air quality reduces the number of infants’ deaths as well as disease and pain. Conclusions: Medical doctors have a responsibility to know the facts and to advise their patients. Doctors when visiting their patients’ homes should be aware of the possibly grave impact of the indoor environment for the respiratory health of their patients. They should recognize and advise the parents on problems associated with environmental tobacco smoke, poor ventilation, mould growth, and maintenance of heating installations. With regard to outdoor air pollution, doctors could serve as role models and also advise their patients and parents on environmentally friendly behaviour. Such behaviour not only calls for personal commitment but also for the right infrastructure to be provided (e.g. public transport, district heating). Doctors should be proactive in the community and in their country as advocates for a healthier environment for our children.

BACKGROUND: The hot summer of 2003 brought about increased mortality in southern and western Europe, highlighting the health impact of heatwaves. No Austrian mortality data have yet been reported for this summer period. METHODS: Daily mortality data for Vienna between 1998 and 2004 were obtained from Statistics Austria and meteorological data from the Austrian Central Institute for Meteorology and Geodynamics. Heatwaves were defined using the Kysely criterion. Daily mortality for May to September was predicted by a generalized additive model considering over-dispersion with Poisson deviates and a log link. Seasonal trend was accounted for by a natural spline, weekdays were modeled by dummy variables and heatwave days were included as dichotomous predictor. RESULTS: The average seasonal temperature for May to September in Vienna has increased by more than 1.7 °C during the last 35 years. In 2003 there was an excess of heatwave days, 44 overall, that resulted in an increased number of deaths, approximately 180, most of which were not due to 'harvesting'. Heatwave days between 1998 and 2004 were associated with a significantly increased relative mortality risk of 1.13 [95% confidence interval 1.09–1.17]. This increase was stronger in females than in males. Although excess mortality was seen in all age groups, it reached significance only in the elderly population over 65 years. DISCUSSION: An impact of heatwaves on mortality was apparent in Vienna, although not as pronounced as in France and south-western Europe. In 2003 at least 130 heatwave-related deaths in Vienna could have been avoided by prompt medical assistance and proper advice about how to cope with excessive thermal conditions. Preventive programs are warranted during heatwaves, especially to target elderly people, because the likelihood of heatwaves as a consequence of global warming is increasing.

In search of sensitive screening parameters for assessing acute effects of ambient air pollutants in young schoolchildren, the impact of 8-h average air pollution before lung function testing was investigated by oscillatory measurements of resistance and spirometry with flow-volume loops. At a central elementary school in Linz, the capital of Upper Austria, 163 children aged 7-10 yrs underwent repeated examinations at the same time of day during 1 school year, yielding a total of 11-12 lung function tests per child. Associations to mass concentrations of particulate matter and nitrogen dioxide (NO(2)) measured continuously at a nearby monitoring station were tested, applying the Generalised Estimating Equations model. Reductions per 10 microg.m(-3) (both for particles and for NO(2)) were in the magnitude of 1% for most lung function parameters. The most sensitive indicator for acute effects of combustion-related pollutants was a change in maximal expiratory flow in small airways. NO(2) at concentrations below current standards reduced (in the multipollutant model) the forced expiratory volume in one second by 1.01%, maximal instantaneous forced flow when 50% of the forced vital capacity remains to be exhaled (MEF(50%)) by 1.99% and MEF(25%) by 1.96%. Peripheral resistance increased by 1.03% per 10 microg.m(-3) of particulate matter with a 50% cut-off aerodynamic diameter of 2.5 mum (PM(2.5)). Resistance is less influenced by the child's cooperation and should be utilised more often in environmental epidemiology when screening for early signs of small airway dysfunction from urban air pollution, but cannot replace the measurement of MEF(50%) and MEF(25%). In the basic model, the reduction of these parameters per 10 microg.m(-3) was highest for NO(2), followed by PM(1), PM(2.5) and PM(10), while exposure to coarse dust (PM(10)-PM(2.5)) did not change end-expiratory flow significantly. All acute effects of urban air pollution found on the lung function of healthy pupils were evident at levels below current European limit values for nitrogen dioxide. Thus, planned reduction of nitrogen dioxide emission (Euro 5; vehicles that comply with the emission limits as defined in Directive 99/96/EC) of 20% in 2010 would seem to be insufficient.

Inequalities in health between socio-economic groups are a major public health concern. The current authors studied associations between parental socio-economic status (SES) and children's respiratory and allergic symptoms in 13 diverse countries, including the Russian Federation, North America (Canada and the USA), and countries across Eastern and Western Europe. Data of 57,000 children aged 6-12 yrs, originating from eight cross-sectional studies, were analysed. SES was defined by parental education. Respiratory and allergic symptoms were defined by parental questionnaire reports. Multiple logistic regressions showed that low parental education was associated with a decreased risk of inhalant allergy and itchy rash in school children. Furthermore, low parental education was associated with an increased prevalence of wheeze and nocturnal dry cough. No clear association was found between parental education and prevalence of doctor-diagnosed asthma and bronchitis. Part of the difference between socio-economic groups with regard to their children's symptoms was explained by established risk factors, such as parental allergy, smoking during pregnancy, pet ownership, crowding, mould/moisture in the home, use of gas for cooking, and air pollution (particulate matter with a diameter of

Item does not contain fulltext Introduction: All children are exposed to multiple physical, chemical and biological challanges that can result in adverse health effects before and after birth. In this context, the danger of multiple exposures cannot be assessed from a single-chemical approach as used in classical toxicology. Aim: To open up a 'negotiation space' for the problem of multiple exposure to environmental stressors, defined as any physical, chemical or biological entity that can induce an adverse response. In this context, two further questions obtain: to what extent can synergistic risks be assessed, and how far could potential adverse effects be prevented by enhanced regulation? Methods: A discussion of two general approaches is taken: 1) the investigation of mixtures such as smoking or air pollution without specifying the individual agents, and 2) the investigation of individual substances with a focus on possible interactions in the context of dose to receptor. Results: Although mixtures of compounds can have effects, it may not be possible to ascribe causation to a single compound. Furthermore, cumulative low-dose insult can, in some circumstances, be more toxic than a single high-dose exposure, e.g. endocrine disruptive effects of a combination of PCBs and dioxins which disrupt the thyroid hormone status; this tends to contradict elements of classical toxicology, . These cumulative insults may further combine with heavy metals and can disrupt the heme synthesis. It is possible that groups of pollutants could be used to test their cumulative capacity to multiple stress-susceptible receptor targets as is done in smoking and air pollution. This methodology could be used for further groups of potential pollutants, for example those associated with cleaning products, or cosmetics. Testing individual substances with a focus on interactions means that not only chemicals but also concurrent diseases should be taken into account. We suggest that the enhanced regulation of potential multiple stressors falls into two discrete categories. The first comprises a more precautionary approach (as demonstrated by the banning of chemicals such as some brominated flame retardants in Europe). The second comprises a more 'permissive' liberal approach involving the initial study of an individual compound, and subsequent interrogation of that compound in combination with another (as demonstrated by lowering the carcinogenicity of aflatoxin by vaccination against hepatitis B).Conclusions: It is necessary to define and study groups of multiple stressors as in US EPA's Framework for Cumulative Risk Assessment (U.S. EPA 2003). Recent increased knowledge of the greater sensitivity of the unborn baby, the infant and the child, has led to general recognition that a higher degree of precaution is now needed in regulating for multiple stressors on the young. The more liberal permissive approach proceeding from established effects of the individual exposures is becoming less acceptable now that we know that there is much we do not understand about chronic effects of stressors during the early development phases. Conflicts over which approach to take may have to be resolved through engagement and negotiation with a wide community of stakeholders. This "community of interest" may include fundamental research scientists, practicing clinical paediatricians, patient groups, and others concerned with the health and wellbeing of infants and children.

In their article “Pulmonary Effects of Indoor- and Outdoor-Generated Particles in Children with Asthma,” Koenig et al. (2005) made use of their really interesting model that enables them to discern exposure from indoor- and outdoor-generated particles. They concluded that The ambient-generated component of PM2.5 [particulate matter ≤2.5 μm in aerodynamic diameter] exposure is consistently associated with increases in eNO [exhaled nitric oxide] and the indoor-generated component is less strongly associated with eNO. This finding should not lead to the assumption that particles generated indoors are in general not able to induce endogenous NO production. The authors themselves pointed out one limitation of their study: Children in the Seattle panel study spent an average of 66% of their time indoors at home and 21% indoors away from home (primarily at school) … (Koenig et al. 2005) However, contribution of indoor sources to PM exposure was only estimated on the basis of measurement data from the subjects’ residences. This could have led to uncertainties in the exposure assessment, biasing the effect estimates toward null. I also want to mention the great variability in possible indoor sources of PM. In their article, Koenig et al. (2005) provided no information on the smoking status of household members. If the 19 children under study lived in nonsmoking households, the results might be true for this setting but not for others. Finally, I suggest that time of measurement and exposure should be considered. If the children attend school in the morning, they might go home (maybe in high traffic) at noon or early afternoon for lunch. [NO] samples were collected in the afternoon or early evening at the child’s residence. Children were asked to forgo food intake for 1 hr before collection of exhaled breath. If NO production peaks several hours after exposure, it could be possible that the children’s exposure on their way home from school was the most influential one (not because of the origin of the particles but because of the study’s lag structure). It would be interesting and rather rewarding to study the short-term lag structure between PM exposure and both exhaled NO and lung function [for which Koenig et al. (2005) found an association with exposure due to sources in the residents’ homes]. I would expect an increase of exhaled NO to be a rather late reaction to inflammatory stimuli. For example Rolla et al. (2004) reported that after aspirin inhalation by subjects with aspirin-inducible asthma, NO increased significantly reaching the peak value 4 hr after bronchoconstriction.

Background: Exposure to environmental tobacco smoke (ETS) has important public health implications. The results of the first European multi-centre study that measured ETS exposure in a range of public places (transport, educational settings, and leisure facilities such as bars and restaurants) are presented. Method: Nicotine vapour phase was measured using ETS passive samplers containing a filter treated with sodium bisulfate. Results: Bars and discos are the places with the highest concentrations of nicotine from ETS, median ranging from 19 to 122 µg/m3. Restaurants had the next highest values. Concentrations of nicotine generally range from 0.1–5 µg/m3 in airports, and from 0.5–10 µg/m3 in train stations. Nicotine was also found in schools and universities, yet schools tended to have the lowest concentrations compared to all the other public places sampled. In hospitals levels were generally below 5 µg/m3. Conclusions: Although there is some variability between cities, this study shows that tobacco smoke is present in most of the studied public places. The study also showed that in areas where smoking is prohibited, concentrations of nicotine are lower than in areas where smoking is allowed but they are not zero. The results of this study indicate that policies should be implemented that would effectively reduce levels of tobacco smoke in public areas.

After moving into a new office building, employees complained about eye irritations, sore throats and unspecific symptoms. They were concerned about visible dust as a potential cause of adverse health effects. An external working group was appointed to investigate indoor air pollution and health complaints and to suggest measures to improve the situation. Air samples and floor dust samples for analysis of organic compounds were collected in three offices. Bimonthly during 8 months, measurement campaigns were conducted to assess the trend of air pollutants. A questionnaire was administered concerning environmental conditions at the work place and complaints before and after moving into the new office building. Overall the concentrations of volatile organic compounds (VOC) and formaldehyde were fairly low. However, initially high concentrations (4300-7800 mg/kg) of tris-(2-butoxyethyl)-phosphate (TBEP) and diethylhexylphthalate (DEHP: 980-3000 mg/kg) were found in dust samples. The coating of the rubber floor was identified as the source of TBEP, while no single predominant source of DEHP was found. Results of the questionnaire demonstrated an increased irritation of the mucous membranes and a reduction of well-being after the employees had moved into the new building. Perception of low relative humidity and high temperature as well as unpleasant odors were associated with respiratory complaints. After removal of the coating of the rubber floor throughout the whole building, a reduction up to 90% of TBEP in the dust samples was found. In spite of several attempts, no such marked reduction was achieved with the concentration of phthalates. Although there was no significant association between visible dust exposure and increase of complaints after moving in, room climate conditions that could increase the deposition of dust in the airways were associated with the complaints. Hence it cannot be ruled out that fine dust containing TBEP together with unfavorable indoor factors were responsible for the development of the complaints.

Based on several severe air pollution episodes, a temporal correlation between high concentrations of particulate matter (PM) and SO2 pollution and acute increases in respiratory and cardiopulmonary mortality had been established in Vienna for the 1970's. After air pollution had decreased in Austria in the 1980's--as documented by data on SO2, and total suspended particles (TSP)--no such associations between day-to-day changes of SO2 and TSP and mortality have been documented any more, however, traffic related pollutants like fine particles and NO2 remained a problem. Therefore, short term effects of PM on lung function, morbidity and mortality were investigated in Vienna, Linz, Graz and a rural control area. Long-term exposure and chronic disease--even more important for public health--were studied in repeated cross-sectional, a mixed longitudinal and a birth cohort study on school children in the city of Linz. Lung function growth was found impaired from long-term exposure to air pollutants and improved in districts where ambient air pollution had decreased. Where only TSP and SO2 had decreased, no continuous improvement of small airway function was found and end-expiratory flow rates stayed impaired where NO2-reduction from technical improvements of cars and industry was counterbalanced by increase of motorized (diesel) traffic. Remaining acute effects of ambient air pollution in 2001 from PM, NO2 and co-pollutants found in a time series study also show that continuing efforts are necessary. Active surface of particles inhaled several hours to days before spirometry was found related to short-term reductions in forced vital capacity-FVC (p0.01), forced expiratory volume in one second-FEV1 (p0.01) and maximal expiratory flow rate at 50% of vital capacity-MEF50 (p0.05). In pupils with asthma or previous airway obstruction 4-week-diaries proved that the following symptoms increased with acute exposure to higher active surface of particles: wheezing (p0.01), dyspnea, cough when going to sleep, cough at night (p0.05). Efforts to reduce exposure to fine particles from motor traffic and passive smoking have to be increased if we want to achieve full recovery of children from air pollution effects and best respiratory performance in adulthood. Surveillance seems to be necessary not only for particle mass but also for particle number and surface. Little is known on the mechanisms of irreversible long-term effects of PM such as myocardial infarction and cancer. In a prospective cohort study on 1630 dust-exposed and 1630 non dust-exposed workers matched for smoking we found an increase of lung cancer related to nonfibrous insoluble PM. Other studies were able to relate lung cancer to specific particles like those from diesel engines, and a large prospective study of the American Cancer Society was able to link lung cancer in the general population with long-term exposure to fine particles from combustion processes. All these recent epidemiological findings will have consequences for occupational and ambient air PM standards.

As part of a Europe-wide project the amount of exposure to environmental tobacco smoke (ETS) in public places like schools, restaurants, and public transport facilities was investigated. Three methods were applied: nicotine passive samplers (with a filter treated with sodium bisulphate), the same filters with an active sampling device, and the measurement of fine particles' active surface by unipolar diffusion charging. Settings were selected where either high or low ETS concentrations were expected and where non-smokers would have to stay or at least to pass by. Highest ETS concentrations were found in discos (mean nicotine concentration 154.4 maximum 487.1 microg/m3) and intermediate concentrations in restaurants with no significant difference between smoking (21.3 +/- 6.1 microg/m3) and non-smoking areas (23.3 +/- 15.9 microg/m3) but on average higher values in restaurants with no separation between smoking and non-smoking areas (38.0 +/- 60.6 microg/m3). Concentrations usually below 10 microg/m3 were found in transport facilities (8.9 +/- 8.0 microg/m3, maximum 20.6 in the restaurant section of a railway station's waiting room) and in schools (3.0 +/- 4.6 microg/m3). In hospitals "problem spots" were sought and so concentrations from very low to as high as 45.1 microg/m3 next to a smoking area with no physical barrier or separation and 47.7 microg/m3 inside a smoking room could be documented (21.4 +/- 39.3 microg/m3). The fine particle's surface correlated well with the nicotine concentration (r = 0.8; p < 0.001). Only in one instance (in a pizza restaurant on a busy road with heavy duty diesel traffic and the sampling spot next to the pizza stove) high concentration of fine particles was detected without high nicotine. Tobacco smoke is a key source of indoor fine particles. Health policy must intervene to change the situation found at present in many public places in Austria.

Objective: The controversy about health risks of electromagnetic fields (EMF) has contributed in raising fears concerning emissions from celltowers. The study was to examine whether or not neighbours of celltowers are particularly concerned about adverse health effects of mobile phones and their base stations. Methods: Prior to information delivered by medical doctors of the Institute of Environmental Health at public hearings a questionnaire was handed out to participants asking for their personal rating of several environmental health risks including those of mobile telecommunication (n=123, response rate approx. 48%). Medical students (n=366) served as a contrast group. Results: Participants rated health risk for both, mobile phones and celltowers higher as students. A trend for higher ratings was also seen with older subjects and female sex. The risk ratings of both exposures correlated well with each other. The magnitude of the perceived risks, however, resembled that of other ubiquitous exposures like traffic noise and air pollution. Conclusion: Contrary to the claims of the telecommunication industry, opponents of celltowers generally do not express unusual fears concerning electromagnetic field exposure. The outcome of our study indicates that the risk rating is comparable with other perceived common hazards of the civilised world. It is hypothesised that offering information and participation to the concerned population will be efficient in reducing exaggerated fears.

Without hesitation we cordially thank Dr Verbeek1 for his comments on our article about temporary threshold shift (TTS) at 4 kHz as a predictor of noise induced hearing loss (NIHL).2 This gives us the opportunity to discuss some important issues in greater detail. Dr Verbeek correctly mentioned that we have chosen to predict hearing level rather than hearing loss. This choice was taken due to the fact that the hearing level is what guides the decisions in occupational examinations. However, from a more fundamental perspective, hearing loss would definitely be the more important parameter to predict. Especially if workers with previous noise exposure and …

Objectives Occupational mineral dust exposure is a well-known risk factor for numerous respiratory and systemic diseases. Stone work with high quartz exposure in quarries and in consecutive industries is a common situation in Austria. The aim of the present study employing a longitudinal design was to assess the influence of occupational dust exposure on lung function results. Further, the impact of implementation of stricter limit values for work-related contact with Quartz dust on lung function was evaluated. Method Anthropometric data (age, gender, BMI), smoking behaviour, and lung function parameters (FVC, FEV1, MEF50) of 7204 medical examinations of 3229 female and male workers during the years 2002 to 2010 were analysed following Austrian standards for occupational medicine and ERS guidelines. Analysis of data was performed using models of linear regression. Results Lung function parameters decreased with duration of occupational dust exposure and smoking. Occupational quartz exposure negatively influenced lung function parameters (FVC -173.98 ml, FEV1 -127.94 ml, MEF50 -200.44 ml/s; all p Conclusions The decrease of lung function is correlated with individual smoking habits and the duration of occupational dust exposure. Smoking cessation is especially recommended to workers exposed to Quartz dust to reduce the risk of increase of poor lung function. Adaptation of current limit values towards stricter limit values could decrease chronic occupational damage of the respiratory system.

Objectives A multinational occupational epidemiological study of workers exposed to tungsten carbide with a cobalt binder (WCCo) is underway in the US and Europe. The epidemiological component will investigate total and cause-specific mortality risks and exposure-response relationships with focus on lung cancer. We designed the study to overcome certain limitations of earlier epidemiology studies. Method The epidemiological and exposure assessment components of the study are coordinated by the University of Pittsburgh and the University of Illinois at Chicago, respectively. Our cohort comprises 12 manufacturing sites in the US and nine sites in Europe, and represents three companies, five countries (US, Austria, Germany, Sweden and UK) and multiple manufacturing processes and exposures. Statistical analyses will adjust external and internal mortality rate comparisons for potential co-exposures, including smoking histories obtained via a nested case-control study. The study will include separate and pooled analyses. Results Our data collection effort identified two additional US study sites and additional subjects in the German and Swedish sites. Accordingly, our originally projected cohort size of 21 000 subjects has increased to 35 508 (US-7005; Europe-33 508). Vital status tracing, cause of death determination and identification of subjects for the nested case-control study are ongoing. Conclusions Our study will enable country-specific and pooled analyses of mortality rates and exposure-response relationships among workers from 21 study sites and the opportunity to compare and contrast findings across countries, sites, companies and/or manufacturing processes and exposures involved in this global industry. We will detail progress to date on the US and combined epidemiological component of the study.

Objectives Noise-induced hearing loss (NIHL) is the most prevalent occupational disease in Austria and among the most frequent in many other countries. Because of the large inter-individual variation in hearing loss after equal exposures it has long been assumed that some individuals are more vulnerable to NIHL. Earlier attempts to define predictors of NIHL before commencing occupational noise exposure have largely failed. From a preventive point of view it would be essential to study predictive factors. Method Between 1982 and 1989 overall 311 apprentices were included into a prospective study during their initial health screening visit. At this occasion a standardised noise exposure was applied (20 min 200–500 Hz, 100 dBA) and the temporal threshold shift (TTS) at 4 kHz was determined during 2–10 min after exposure. Hearing loss was monitored at follow-up visits every 3–5 years. Follow-up was 13 years on average. Permanent threshold shift was predicted by noise years, frequency of wearing noise protectors, but also by the initial TTS at 4 kHz. Results In this longitudinal study again the importance of personal protective measures was documented, it was also established that individual susceptibility plays an important role. The TTS peak at 4 kHz occurring independent of exposure frequency but especially after low-frequency exposure is a predictor of long-term hearing loss. Conclusions Considering the importance of individual susceptibility current occupational limit values are likely not protective for everybody. This underlines the necessity of individualised screening programs and a strong commitment towards personal protection measures.

Objectives A multinational occupational epidemiological study is underway to investigate the total and cause-specific mortality of workers exposed to tungsten carbide with a cobalt binder (WCCo). The study includes 12 US and 9 European plants. The objective of the exposure assessment component, coordinated by the University of Illinois at Chicago, is to reconstruct agent-specific exposure estimates for use in the epidemiological analyses. Method Quantitative occupational exposures are being generated through a process of modelling and validation using industrial hygiene data from study plants. Innovative semi-quantitative methods are being developed to extrapolate data for years in which it is missing, and are based on exposure changes due to manufacturing process changes over time (e.g., moving from manual to automated methods). Company work history information is being used to construct a job dictionary. The resulting exposure estimates and job dictionary will form the job-exposure matrix. Results The agents of interest are WCCo, tungsten carbide, tungsten, cobalt, and carbon black. Current and past working environments are being characterised according to products manufactured and operations performed and in relation to potential exposures using sampling data, job descriptions, plant and process histories, and information provided by knowledgeable plant personnel. Conclusions Exposure estimates will be generated for the study plants. The multinational aspect of the study provides the opportunity to pool data and produce exposure estimates for all 21 facilities with potential insight into similarities or differences among countries and/or plants involved in the same global industry. This presentation will detail the progress to date on the exposure assessment effort.

Background: Outdoor secondhand smoke (SHS) concentrations are usually lower than indoor concentrations, yet some studies have shown that outdoor SHS levels could be comparable to indoor levels under specific conditions. The main objectives of this study were to assess levels of SHS exposure in terraces and other outdoor areas of hospitality venues and to evaluate their potential displacement to adjacent indoor areas. Methods: Nicotine and respirable particles (PM2.5) were measured in outdoor and indoor areas of hospitality venues of 8 European countries. Hospitality venues of the study included night bars, restaurants and bars. The fieldwork was carried out between March 2009 and March 2011. Results: We gathered 170 nicotine and 142 PM2.5 measurements during the study. The median indoor SHS concentration was significantly higher in venues where smoking was allowed (nicotine 3.69 mg/m3, PM2.5: 120.51 mg/m3) than in those where smoking was banned (nicotine: 0.48 mg/m3, PM2.5: 36.90 mg/m3). The median outdoor nicotine concentration was higher in places where indoor smoking was banned (1.56 mg/m3) than in venues where smoking was allowed (0.31 mg/m3). Among the different types of outdoor areas, the highest median outdoor SHS levels (nicotine: 4.23 mg/m3, PM2.5: 43.64 mg/ m3) were found in the semi-closed outdoor areas of venues where indoor smoking was banned. Conclusions: Banning indoor smoking seems to displace SHS exposure to adjacent outdoor areas. Furthermore, indoor settings where smoking is banned but which have a semi-closed outdoor area have higher levels of SHS than those with open outdoor areas, possibly indicating that SHS also drifts from outdoors to indoors. Current legislation restricting indoor SHS levels seems to be insufficient to protect hospitality workers – and patrons – from SHS exposure. Tobacco-free legislation should take these results into account and consider restrictions in the terraces of some hospitality venues to ensure effective protection, This work was supported by the Executive Agency for Health and Consumers, DG SANCO, European Commission, grant number 2007313. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The Children's Environment and Health Action Plan for Europe (CEHAPE) of WHO focuses (inter alia) on improving indoor environments where children spend most of their time. At present, only little is known about air pollution in schools and its effect on the lung function of school children. Our project was set up as an Austrian contribution to CEHAPE. In a cross-sectional approach, differences in indoor pollution in nine elementary all-day schools were assessed and 34 of these pollutants were analyzed for a relationship with respiratory health determined by spirometry using a linear regression model. Overall 596 children (aged 6-10 years) were eligible for the study. Spirometry was performed in 433 children. Socio-economic status, area of living (urban/rural), and smoking at home were included in the model as potential confounders with school-related average concentration of air pollutants as the variable of primary interest. A negative association with flow volumes (MEF(75)) was found for formaldehyde in air samples, benzylbutylphthalate and the sum of polybrominated diphenylethers in school dust. FVC and FEV(1) were negatively associated with ethylbenzene and xylenes in air samples and tris(1,3-dichlor-2-propyl)-phosphate on particulates. Although, in general, the quality of school indoor air was not worse than that reported for homes, effects on the respiratory health of children cannot be excluded. A multi-faceted strategy to improve the school environment is needed.

The health impact of air pollution is well established. Dose-effect-estimates exist for several outcomes and pollutants. The impact of source specific air pollution is less well studied. However, since abatement measures concern sources and not single pollutants a source specific impact assessment would be very relevant. Burning of wood for heating purposes is deemed an environmental friendly technology because wood is a renewable source. This perception neglects the important contribution of wood burning to air pollution, especially regarding fine particles. In fact, chemical analyses indicate that wood smoke is among the top contributors of particle pollution, particularly in rural regions. Assuming a worst-case scenario in which all existing domestic heating systems based on oil were replaced by wood burning devices we estimated the increase in average particle pollution in Upper Austria. Based on established emission factors using a Lagrangian Particle Diffusion Model, an increase in the average annual PM 10 concentration in Upper Austria by 3-5 µg/m 3 was calculated. Current scientific literature indicates that aerosol from wood incineration is at least as dangerous on a per µg-basis as the total ambient aerosol. Therefore, dose-effect estimates of ambient PM 10 from epidemiological studies were used to estimate the health impact in the worst-case scenario. For the federal country of Upper Austria an increase in the annual average of PM 10 by 3-5 µg/m 3 translated into a relevant public health impact. For example, chronic exposure as reported in cohort studies would lead to up to approximately 170 additional deaths per year, mostly from cardiovascular causes. Stricter emission rules are needed for domestic heating. Climate-change preventing policies targeted at domestic heating should improve the insulation of houses and support district heating and solar energy instead of biomass burning without proper emission control.

Two studies on the lung function of school children are reported. The first is a small (pilot) study investigating the (respiratory) health of 19 children aged 12-13 years. An improved lung function with increased physical activity was shown. The second study was performed in seven elementary schools (mostly in Vienna). Questionnaires were distributed to the parents of the children in the first and second form. In total 353 children (approximately 6-7 years old) participated in the lung function testing that took place in winter 2006/2007. Mould at home and exposure to second-hand smoke lead to significant reductions in some lung function parameters, while breastfeeding was associated with a better lung function.

In 2013–2015, a consortium of European scientists – NEWDANUBE – was established to prepare a birth cohort in the Danube region, including most of the countries with the highest air pollution in Europe, the area being one-fifth of the European Union’s (EU’s) territory, including 14 countries (nine EU member states), over 100 million inhabitants, with numerous challenges: big socioeconomic disparities, and a region-specific environmental pollution. The consortium reflects the EU Strategy for the Danube Region Strategy (2010), which identified 11 thematic Priority Areas – one of which is the environmental risks. Birth cohorts have been established in all other areas of Europe and collaborative efforts in promoting maternal and fetal health by minimizing the environmental exposures have been initiated with national, European, and international financial support. A birth cohort in the Danube area could apply the established methodologies for prenatal exposure and birth outcome measurements and establish a platform for targeted health promotion in couples planning pregnancies. The consortium included a strong socioeconomic part focusing on the participant’s active registration of exposures to environmental toxicants and health indicators of disease and wellbeing, combined with investigation of their risk-reducing behavior and interventions to change their lifestyle to avoid the adverse health risks. Willingness to pay for reducing the health risks in children is also proposed to be estimated. Further collaboration and networking is encouraged as the Danube region has several decades of experience and expertise in biomonitoring adult populations exposed environmentally or occupationally. Additionally, some countries in the Danube region launched small-scale birth cohorts encouraged by participation in several ongoing research projects.

The performance of Grimm optical particle counters (OPC, models 1.108 and 1.109) was characterized under urban aerosol conditions. Number concentrations were well correlated. The different lower cut-off diameters (0.25 and 0.3μm) give an average difference of 23.5%. Both detect less than 10% of the total particle concentration (0.01–1μm; Differential Mobility Analyzer), but in the respective size ranges, differences are

Item does not contain fulltext Background: Facts and hypotheses on the relationship between some children's diseases or disorders and external stressors during the developmental stage of a child, both prenatally and postnatally are described in literature. In this paper the following changes in patterns and causes of the main childhood illnesses are summarized and recommendations for actions are made.PrematurityIntra-uterine growth restrictionTesticular dysgenesis syndromeType I and Type II diabetesAsthma, atopy and hay feverAutismAttention deficit hyperactivity disorder (ADHD)Learning disabilitiesCancerObesityHearing problemsResults: Literature provides a growing amount of information on changing patterns in childhood diseases.Conclusions: The following recommendations for action are formulated:Immediate research on endocrine disrupters in relation to prematurityDiabetes: avoid Maillard Compounds in liquid baby food and in food in general: promote breastfeedingAsthma: avoid exposure to smoking, the use of chemical household products, dioxin and dioxin-like chemicals, and avoid air pollution with high levels of particulate matter, especially around conception, during pregnancy and in the first years of lifeAutism: more research on incidence and causesADHD and learning disabilities: more research on prevalence and causes. Preventions: 1) preconception counselling to avoid potentially harmful substances; 2) controlling and further lowering levels of polychlorinated biphenyls, lead and methyl mercuryCancer: promote breastfeeding, carry out research into effects of foetal exposure to internal fission-product radionuclidesObesity: stop smoking in pregnancy, avoid parental obesity, longer night sleepHearing problems: lower noise levels in discotheques, promote the day-evening-night level to avoid noise (longer night sleep).