Search

Many studies have been conducted on hospital solid waste management (HSWM) throughout the world, especially developing countries. This interdisciplinary study aims to summarize the available knowledge on the health and environmental risks of hospital solid waste (HSW) and also, develop a dynamic associational assessment among hospital solid waste generation rate (HSWGR), hospital solid waste composition (HSWC), gross domestic product (GDP) per capita, and environmental performance index (EPI) in some developing countries for the first time. The results of this study showed that researchers from India, China, Pakistan, Brazil, and Iran had found more evidence about the health, economic, and environmental issues in HSW than the other developing countries. The literature showed that the highest and lowest reported HSWGR (in national average level) belonged to Ethiopia (6.03) and India (0.24) kg bed -1 day -1 , respectively. It has also been shown that all studied countries except Serbia, have higher levels of hazardous waste in their HSWC, based on the WHO's standard. Furthermore, the quantity and quality of HSW in developing countries depend on the service provided by the hospital, type of hospital, HSWM system, and the level of regional economic and culture. The association analysis showed that the EPI and GDP per capita of developing countries were significantly (p-value <0.05) associated with HSWGR, non-hazardous HSW, and hazardous HSW by the Spearman coefficients equal to 0.389, 0.118, -0.118, and 0.122, 0.216, and -0.346, respectively. However, it can be concluded that GDP per capita and EPI have a weak correlation with hazardous HSW and non-hazardous HSW. Moreover, HSW has many hazardous health and environmental risks such as dioxin and furan, that must be controlled and managed through implementing programs and policies based on sustainable development. As a final point, we believed that the present study can be considered to be a guide for future studies on HSWM in developing countries., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Annually, over 5.5 trillion cigarettes are produced worldwide, and it is estimated that 4.5 trillion cigarette butts (CBs) are still being littered in the world. The dispersal of the CBs has caused this hazardous waste to be considered as one of the most important litters and environmental risks all over the world. This systematic study with the search protocol definition and keyword identification was developed to find the CBs control and recycling methods by searching in five scientific databases. Founded articles were monitored and finally, 35 related articles were selected and studied by the authors. The results of this study showed that CBs recycling methods have been tested in 10 specific categories all over the world. The CBs have been applied without any pre-processing methods in the bricks and asphalt production. However, other applications of the CBs such as the absorbent material production, vector control, and use as a biofilm carrier in wastewater treatment need various processing methods. The researchers also presented models and suggestions such as taxes, penalties, and public education for the control of CBs littering. Despite the innovative methods applied for the CBs recycling in previous studies, CBs have not received much attention in terms of pollutant control and environmental issues in recycling processes.

Background: Healthcare wastes (HCWs) are one of the most hazardous wastes globally; second to only radiation waste. HCW management needs to be prioritized because of the devastating effects on human health and environment if not well managed. Health workers play a crucial role in management of HCWs. This study investigated the management of HCWs among health workers and associated factors in primary health care facilities in Kampala City, Uganda., Methods: We conducted a cross-sectional health facility survey in 8 primary health care facilities in Kampala City from March to April 2017. We interviewed health workers who provided data on socio-demographic characteristics, knowledge, attitudes and practices on HCW management. Prevalence ratios (PRs) and their corresponding 95% confidence intervals were used as a measure of association between HCW management and associated factors. The PRs were obtained using a multivariable modified Poisson regression using a generalized linear model of Poisson family with a logarithm as the canonical link function, with robust standard errors while applying a forward elimination method., Results: A total of 200 health workers responded to the survey; Knowledge of HCW management  was high 143 (71.5%, 95% CI (65.2-77.8)). About 160 (80.0%) wore appropriate personal protective wear when handling HCWs. Overall, 148 (74.0%, 95% CI (67.8-80.1) had satisfactory HCW management practices. Health workers with diploma education (Adjusted PR = 1.49, 95% CI (1.13-1.96), working in the teenage corner (Adjusted PR = 1.10, 95% CI (1.01-1.29), previous training on HCW management (Adjusted PR = 1.19, 95% CI (1.01-1.42) and those who thought HCW management was important (Adjusted PR = 2.81, 95% CI (1.22-6.47) were more likely to have satisfactory HCW management practices., Conclusion: The practices of health workers on HCW management were largely satisfactory. Higher odds of HCW management were determined among health workers with diploma education, previous HCW management trainings and among those who perceived HCW management as important. There is need to organize HCW management trainings in order to improve their HCW management practices among health workers.

The effects of possible changes to the Canadian 2-tiered assessment framework for dredged material based on outcomes of the 2006 Contaminated Dredged Material Management Decisions Workshop (CDMMD) are evaluated. Expanding on the "data mining" approach described in a previous paper, which focused solely on chemical lines of evidence, the efficacy of Tier 1 approaches (increases to the number of chemical analytes, use of mean hazard quotients, and the use of a screening bioassay) in predicting toxicity are evaluated. Results suggest value in additional work to evaluate the following areas: 1) further expanding minimum chemical requirements, 2) using more advanced approaches for chemical interpretation, and 3) using a screening-level bioassay (e.g., Canadian solid-phase photoluminescent bacteria test) to determine whether it would complement Tier 1 chemistry as well as or better than the solvent-based Microtox™ test method evaluated in the present study. Integr Environ Assess Manag 2017;13:1072-1085. © 2017 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC)., (© 2017 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).)

The potential performance (i.e., ability to separate nontoxic from toxic sediments) of a range of international Disposal at Sea (DaS) chemical Action Levels (ALs) was compared using a sediment chemical and toxicological database. The use of chemistry alone (without the use of further lines of evidence) did not perform well at reducing costs and protecting the environment. Although some approaches for interpreting AL1 results are very effective at filtering out the majority of acutely toxic sediments, without subsequent toxicological assessment, a large proportion of nontoxic sediments would be unnecessarily subjected to treatment and containment, and a number of sublethally toxic sediments would be missed. Even the best tiered systems that collect and evaluate information sequentially resulted in the failure to catch at least some sublethally or acutely toxic sediments. None of the AL2s examined were particularly effective in distinguishing between non-, sublethally, or acutely toxic sediments. Thus, this review did not support the use of chemical AL2s to predict the degree to which sediments will be toxic. Integr Environ Assess Manag 2017;13:1086-1099.© 2017 The Authors. Integrated Environmental Assessment and Management Published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC)., (© 2017 The Authors. Integrated Environmental Assessment and Management Published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).)

Household waste has evolved into a core urban challenge, with increased quantities of waste being generated and with more complex material compositions, often containing toxic and hazardous elements. Critical systems theory understands cities as urban metabolisms, with different material and energy flows, highlighting the circularity in production, consumption, and discard. Waste pickers in low- and medium-income countries work on dumps and landfills, sifting through highly contaminated household waste and are exposed to health hazards. This paper discusses the risk factors, hazards, and vulnerabilities waste pickers are exposed to during collection and separation of recyclables, based on the review of literature on waste and environmental health and on findings from participatory research with waste pickers conducted in Brazil. We take a social and environmental justice perspective and identify the vulnerabilities and waste-borne hazards of household waste, associated with these workers, their communities, watersheds, and the environment. Household waste, although not always per se toxic or hazardous, can become a hazard if not collected or inadequately managed. Those communities where household waste is not collected or waste collection is insufficient are the most critical places. Informal and organized waste pickers, municipal or private waste collectors/workers, small waste traders and sometimes residents, particularly small children, may be considered vulnerable if exposed to waste-borne hazards. The results include recommendations to address household waste-borne hazards and vulnerabilities, according to waste workers involved in this research.

The aim of the study is to evaluate the performance of various mathematical modelling methods, while forecasting medical waste generation using Lithuania's annual medical waste data. Only recently has a hazardous waste collection system that includes medical waste been created and therefore the study access to gain large sets of relevant data for its research has been somewhat limited. According to data that was managed to be obtained, it was decided to develop three short and extra short datasets with 20, 10 and 6 observations. Spearman's correlation calculation showed that the influence of independent variables, such as visits at hospitals and other medical institutions, number of children in the region, number of beds in hospital and other medical institutions, average life expectancy and doctor's visits in that region are the most consistent and common in all three datasets. Tests on the performance of artificial neural networks, multiple linear regression, partial least squares, support vector machines and four non-parametric regression methods were conducted on the collected datasets. The best and most promising results were demonstrated by generalised additive (R(2) = 0.90455) in the regional data case, smoothing splines models (R(2) = 0.98584) in the long annual data case and multilayer feedforward artificial neural networks in the short annual data case (R(2) = 0.61103)., (© The Author(s) 2016.)

Background: "Green" haemodialysis management to reduce the environmental impact of haemodialysis is growing., Objectives: Dealing with hazardous waste production could heighten healthcare professionals' awareness of this problem, and improve their healthcare involvement in environmental sustainability and environmental-friendliness., Design and Measurements: A list of for-profit outpatient haemodialysis centres in the Valencian Community (E Spain) was compiled. Data on their hazardous waste production from 2008 to 2012 through the annual waste reports issued by official organisations competent in environmental issues were collected., Results: There are 22 for-profit dialysis centres, that managed the treatment for 69.1% of all dialysis patients in the region. Data were collected from 16 centres that collectively offer 350 dialysis places (33.8% of all the places in this region). Mean annual hazardous waste production per dialysis session increased by 14% during the study period: 0.640 kg per session in 2008 vs. 0.740 kg in 2012., Discussion and Conclusions: As hazardous waste production is high, we must examine the reasons why it is growing. Information about haemodialysis waste production and management is scarce and difficult to access. Having an evaluation of its production would motivate further research, especially as end-stage kidney disease is increasing, and whose main long-term treatment, haemodialysis, produces hazardous waste and employs substantial natural resources. Minimising its environmental impact is not mission impossible., (© 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Legislation published in December 2014 revised both the List of Waste (LoW) and amended Appendix III of the revised Waste Framework Directive 2008/98/EC; the latter redefined hazardous properties HP 1 to HP 13 and HP 15 but left the assessment of HP 14 unchanged to allow time for the Directorate General of the Environment of the European Commission to complete a study that is examining the impacts of four different calculation methods for the assessment of HP 14. This paper is a contribution to the assessment of the four calculation methods. It also includes the results of a fifth calculation method; referred to as "Method 2 with extended M-factors". Two sets of data were utilised in the assessment; the first (Data Set #1) comprised analytical data for 32 different waste streams (16 hazardous (H), 9 non-hazardous (NH) and 7 mirror entries, as classified by the LoW) while the second data set (Data Set #2), supplied by the eco industries, comprised analytical data for 88 waste streams, all classified as hazardous (H) by the LoW. Two approaches were used to assess the five calculation methods. The first approach assessed the relative ranking of the five calculation methods by the frequency of their classification of waste streams as H. The relative ranking of the five methods (from most severe to less severe) is: Method 3>Method 1>Method 2 with extended M-factors>Method 2>Method 4. This reflects the arithmetic ranking of the concentration limits of each method when assuming M=10, and is independent of the waste streams, or the H/NH/Mirror status of the waste streams. A second approach is the absolute matching or concordance with the LoW. The LoW is taken as a reference method and the H wastes are all supposed to be HP 14. This point is discussed in the paper. The concordance for one calculation method is established by the number of wastes with identical classification by the considered calculation method and the LoW (i.e. H to H, NH to NH). The discordance is established as well, that is when the waste is classified "H" in the LoW and "NH" by calculation (i.e. an under-estimation of the hazard). For Data Set #1, Method 2 with extended M-factors matches best with the LoW (80% concordant H and non-H by LoW, and 13% discordant for H waste by LoW). This method more correctly classifies wastes containing substances with high ecotoxicity. Methods 1 and 3 have nearly as good matches (76% and 72% concordant H and non-H by LoW, and 13% and 6% respectively discordant for H waste by LoW). Method 2 with extended M-factors, but limited to the M-factors published in the CLP has insufficient concordance (64% concordant H and non-H by LoW, and 50% discordant for H waste by LoW). As the same method with extended M-factors gives the best performance, the lower performance is due to the limited set of M-factors in the CLP. Method 4 is divergent (60% concordant H and non-H by LoW, and 56% discordant for H waste by LoW). For Data Set #2, Methods 2 and 4 do not correctly classify 24 air pollution control residues from incineration 19 01 07(∗) (3/24 and 2/24 respectively), and should not be used, while Methods 3, 1 and 2 with extended M-factors successfully classify 100% of them as hazardous. From the two sets of data, Method 2 with extended M-factors (corresponding more closely to the CLP methods used for products) matches best with the LoW when the LoW code is safely known, and Method 3 and 1 will deviate from the LoW if the samples contain substances with high ecotoxicity (in particular PAHs). Methods 2 and 4 are not recommended. Formally, this conclusion depends on the waste streams that are used for the comparison of methods and the relevancy of the classification as hazardous for ecotoxicity in the LoW. Since the set is large (120 waste streams) and no selection has been made here in the available data, the conclusion should be robust., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The production of cement in China is accompanied by various emissions, such as fine particulate matter, heavy metals, nitrogen oxides, sulfur oxides, carbon dioxide…. Moreover, cement kiln presents a potential health risk to its surroundings, linking to emissions of persistent organic pollutants (POPs), such as polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), in brief dioxins. Flue gas samples were collected from five typical cement kilns during twelve runs and were used to evaluate the levels and distribution of PCDD/Fs in the emissions from cement kilns. The PCDD/Fs concentrations (136 congeners) and I-TEQ values ranged from 2.3 to >40 ng/m(3) and 9.3~90.8 × 10(-3) ng I-TEQ/m(3), respectively, which were lower than the emission standard in China (0.1 ng I-TEQ/m(3)). In weight units, the dominant congeners were OCDD, 1,2,3,4,6,7,8-HpCDF, and OCDF; 2,3,4,7,8-PeCDF is the largest contributor (36-66 %) to the total I-TEQ value of twelve runs. HxCDF and TCDF were the first two most abundant homologue groups (12-85 and 4-52 %), and the homologue concentration decreased with rising chlorine number for PCDDs. In addition, there was no marked difference in homologue profiles when solid wastes (refuse-derived fuel and municipal solid waste) and hazardous wastes (DDT and POPs) were combusted as supplemental fuels. The use of various supplemental fuels had no obvious effect on the fingerprint of PCDD/F homologues. Moreover, there was no significant difference in levels of PCDD/Fs emission due to the diversity of production capacity, which were consistent with reported previously. Air pollution control device had effect on the homologue profiles, and cement system with electrostatic precipitators (ESP) had more fractions of octachloro congeners to the total.

The Waste Framework Directive (WFD; 2008/98/EC) states that classification of hazardous ecotoxicological properties of wastes (i.e. criteria H-14), should be based on the Community legislation on chemicals (i.e. CLP Regulation 1272/2008). However, harmonizing the waste and chemical classification may involve drastic changes related to choice of leaching tests as compared to e.g. the current European standard for ecotoxic characterization of waste (CEN 14735). The primary aim of the present study was therefore to evaluate the influence of leaching conditions, i.e. pH (inherent pH (∼10), and 7), liquid to solid (L/S) ratio (10 and 1000 L/kg) and particle size (<4 mm, <1 mm, and <0.125 mm), for subsequent chemical analysis and ecotoxicity testing in relation to classification of municipal waste incineration bottom ash. The hazard potential, based on either comparisons between element levels in leachate and literature toxicity data or ecotoxicity testing of the leachates, was overall significantly higher at low particle size (<0.125 mm) as compared to particle fractions <1mm and <4mm, at pH 10 as compared to pH 7, and at L/S 10 as compared to L/S 1000. These results show that the choice of leaching conditions is crucial for H-14 classification of ash and must be carefully considered in deciding on future guidance procedures in Europe., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: The population exposed to potentially hazardous substances through inappropriate and unsafe management practices related to disposal and recycling of end-of-life electrical and electronic equipment, collectively known as e-waste, is increasing. We aimed to summarise the evidence for the association between such exposures and adverse health outcomes., Methods: We systematically searched five electronic databases (PubMed, Embase, Web of Science, PsycNET, and CINAHL) for studies assessing the association between exposure to e-waste and outcomes related to mental health and neurodevelopment, physical health, education, and violence and criminal behaviour, from Jan 1, 1965, to Dec 17, 2012, and yielded 2274 records. Of the 165 full-text articles assessed for eligibility, we excluded a further 142, resulting in the inclusion of 23 published epidemiological studies that met the predetermined criteria. All studies were from southeast China. We assessed evidence of a causal association between exposure to e-waste and health outcomes within the Bradford Hill framework., Findings: We recorded plausible outcomes associated with exposure to e-waste including change in thyroid function, changes in cellular expression and function, adverse neonatal outcomes, changes in temperament and behaviour, and decreased lung function. Boys aged 8-9 years living in an e-waste recycling town had a lower forced vital capacity than did those living in a control town. Significant negative correlations between blood chromium concentrations and forced vital capacity in children aged 11 and 13 years were also reported. Findings from most studies showed increases in spontaneous abortions, stillbirths, and premature births, and reduced birthweights and birth lengths associated with exposure to e-waste. People living in e-waste recycling towns or working in e-waste recycling had evidence of greater DNA damage than did those living in control towns. Studies of the effects of exposure to e-waste on thyroid function were not consistent. One study related exposure to e-waste and waste electrical and electronic equipment to educational outcomes., Interpretation: Although data suggest that exposure to e-waste is harmful to health, more well designed epidemiological investigations in vulnerable populations, especially pregnant women and children, are needed to confirm these associations., Funding: Children's Health and Environment Program, Queensland Children's Medical Research Institute, The University of Queensland, Australia., (Copyright © 2013 Grant et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by .. All rights reserved.)

A total of 26.1Mg of residual waste from 3129 households in 12 Danish municipalities was analysed and revealed that 89.6kg of Waste Electrical and Electronic Equipment (WEEE), 11kg of batteries, 2.2kg of toners and 16kg of cables had been wrongfully discarded. This corresponds to a Danish household discarding 29g of WEEE (7 items per year), 4g of batteries (9 batteries per year), 1g of toners and 7g of unidentifiable cables on average per week, constituting 0.34% (w/w), 0.04% (w/w), 0.01% (w/w) and 0.09% (w/w), respectively, of residual waste. The study also found that misplaced WEEE and batteries in the residual waste constituted 16% and 39%, respectively, of what is being collected properly through the dedicated special waste collection schemes. This shows that a large amount of batteries are being discarded with the residual waste, whereas WEEE seems to be collected relatively successfully through the dedicated special waste collection schemes. Characterisation of the misplaced batteries showed that 20% (w/w) of the discarded batteries were discarded as part of WEEE (built-in). Primarily alkaline batteries, carbon zinc batteries and alkaline button cell batteries were found to be discarded with the residual household waste. Characterisation of WEEE showed that primarily small WEEE (WEEE directive categories 2, 5a, 6, 7 and 9) and light sources (WEEE directive category 5b) were misplaced. Electric tooth brushes, watches, clocks, headphones, flashlights, bicycle lights, and cables were items most frequently found. It is recommended that these findings are taken into account when designing new or improving existing special waste collection schemes. Improving the collection of WEEE is also recommended as one way to also improve the collection of batteries due to the large fraction of batteries found as built-in. The findings in this study were comparable to other western European studies, suggesting that the recommendations made in this study could apply to other western European countries as well., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The concentrations of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) were determined in breast milk from women living in the vicinity of a hazardous waste incinerator (HWI) in Catalonia, Spain. The results were compared with the levels obtained in previous surveys carried out in the same area in 1998 (baseline study), 2002 and 2007. The current total concentrations of 2,3,7,8-chlorinated PCDD/Fs in breast milk ranged from 18 to 126 pg g(-1)fat (1.1-12. 3 pg WHO2005-TEQPCDD/F), while the total levels of PCBs ranged from 27 to 405 pg g(-1)fat(0.7-5.3 pg WHO2005-TEQPCB). In turn, PBDE concentrations (sum of 15 congeners) ranged 0.3-5.1 g g(-1)fat, with a mean value of 1.3 ng g(-1)fat. A general decrease in the concentrations for PCDD/Fs, both planar and total PCBs, and PBDEs in breast milk was observed. The levels of PCDD/Fs, PCBs, and PBDEs in milk of women living in urban zones were higher than those corresponding to industrial zones (41%, 26%, and 8%, respectively). For PCDD/Fs and PCBs, the current decreases are in accordance with the reduction in the dietary intake of these pollutants that we have also observed in recent studies carried out in the same area of study., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

NIOSH recommends that employers establish a medical surveillance program as part of a comprehensive program to minimize worker exposure to hazardous drugs., (Copyright 2013, SLACK Incorporated.)

Background: Healthcare waste management options are varying in Ethiopia. One of the first critical steps in the process of developing a reliable waste management plan requires a widespread understanding of the amount and the management system. This study aimed to assess the health care waste generation rate and its management system in some selected hospitals located in Addis Ababa, Ethiopia., Methods: Six hospitals in Addis Ababa, (three private and three public), were selected using simple random sampling method for this work. Data was recorded by using an appropriately designed questionnaire, which was completed for the period of two months. The calculations were based on the weights of the health care wastes that were regularly generated in the selected hospitals over a one week period during the year 2011. Average generation indexes were determined in relation to certain important factors, like the type of hospitals (public vs private)., Results: The median waste generation rate was found to be varied from 0.361- 0.669 kg/patient/day, comprised of 58.69% non-hazardous and 41.31% hazardous wastes. The amount of waste generated was increased as the number of patients flow increased (rs=1). Public hospitals generated high proportion of total health care wastes (59.22%) in comparison with private hospitals (40.48%). The median waste generation rate was significantly vary between hospitals with Kruskal-Wallis test (X2=30.65, p=0.0001). The amount of waste was positively correlated with the number of patients (p < 0.05). The waste separation and treatment practices were very poor. Other alternatives for waste treatment rather than incineration such as a locally made autoclave should be evaluated and implemented., Conclusion: These findings revealed that the management of health care waste at hospitals in Addis Ababa city was poor.

Background: Waste treatment plants release toxic emissions into the environment which affect neighboring towns., Objectives: To investigate whether there might be excess cancer mortality in towns situated in the vicinity of Spanish-based incinerators and installations for the recovery or disposal of hazardous waste, according to the different categories of industrial activity., Methods: An ecologic study was designed to examine municipal mortality due to 33 types of cancer, across the period 1997-2006. Population exposure to pollution was estimated on the basis of distance from town of residence to pollution source. Using Besag-York-Mollié (BYM) regression models with Integrated Nested Laplace approximations for Bayesian inference, and Mixed Poisson regression models, we assessed the risk of dying from cancer in a 5-kilometer zone around installations, analyzed the effect of category of industrial activity, and conducted individual analyses within a 50-kilometer radius of each installation., Results: Excess cancer mortality (BYM model: relative risk, 95% credible interval) was detected in the total population residing in the vicinity of these installations as a whole (1.06, 1.04-1.09), and, principally, in the vicinity of incinerators (1.09, 1.01-1.18) and scrap metal/end-of-life vehicle handling facilities, in particular (1.04, 1.00-1.09). Special mention should be made of the results for tumors of the pleura (1.71, 1.34-2.14), stomach (1.18, 1.10-1.27), liver (1.18, 1.06-1.30), kidney (1.14, 1.04-1.23), ovary (1.14, 1.05-1.23), lung (1.10, 1.05-1.15), leukemia (1.10, 1.03-1.17), colon-rectum (1.08, 1.03-1.13) and bladder (1.08, 1.01-1.16) in the vicinity of all such installations., Conclusions: Our results support the hypothesis of a statistically significant increase in the risk of dying from cancer in towns near incinerators and installations for the recovery or disposal of hazardous waste., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The concentrations of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) were determined in a number of foodstuffs purchased in various locations near a hazardous waste incinerator (HWI) in Tarragona County (Catalonia, Spain). The dietary intake of PCDD/Fs by the population of the area under potential influence of the HWI was subsequently estimated. The results were compared with previous surveys performed in the same area in 1998 (baseline), 2002 and 2006. In the present study, the highest WHO-TEQ corresponded to industrial bakery (0.183 ng/kg wet weight, ww), followed by fish (0.156 ng/kg ww), oils and fats (0.112 ng/kg fat weight), and seafood (0.065 ng/kg ww). In contrast, the lowest values were observed in pulses and tubers (0.003 ng/kg ww), and cereals and fruits (0.004 ng/kg ww). The dietary intake of PCDD/Fs by the general population was 33.1pg WHO-TEQ/day, having fish and seafood (11.6 pg WHO-TEQ), oils and fats (4.61pg WHO-TEQ), dairy products (3.79 pg WHO-TEQ), and industrial bakery (3.49 pg WHO-TEQ) as the groups showing the highest contribution to the total TEQ. The lowest daily contributions corresponded to pulses (0.08 pg WHO-TEQ) and tubers (0.25 pg WHO-TEQ). This intake was considerably lower than that found in the baseline study, 210.1 pgI-TEQ/day, and also notably lower than that found in the 2002 survey (59.6 pgI-TEQ/day), but slightly higher than the intake estimated in the 2006 survey, 27.8 pgWHO-TEQ/day. The results of this study show that any increase potentially found in the biological monitoring of the general population living in the area under evaluation should not be attributed to dietary exposure to PCDD/Fs., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The solid-phase microextraction (SPME) method was developed to determine PAH free dissolved concentration (C(free)) in field leachates from hazardous waste disposal. SPME technique, involving a 100-μm polydimethylsiloxane (PDMS) fiber coupled to GC-MS was optimized for determination of C(free). The following PAH were found in bioavailable form: acenaphthylene, acenaphthene, fluorene, phenanthrene, anthracene, fluoranthene, pyrene, with C(free) varying between 2.38 and 62.35 ng/L. Conventional solvent extraction was used for measurement of total concentration (C(total)) in the same samples, and ranging from 1.26 to 77.56 μg/L. Determining C(free) of the hydrophobic toxic pollutants could give useful information for risk assessment of the hazardous waste.

The objective of this work was to determine the composition and production rates of pharmaceutical and chemical waste produced by Xanthi General Hospital in Greece (XGH). This information is important to design and cost management systems for pharmaceutical and chemical waste, for safety and health considerations and for assessing environmental impact. A total of 233 kg pharmaceutical and 110 kg chemical waste was collected, manually separated and weighed over a period of five working weeks. The total production of pharmaceutical waste comprised 3.9% w/w of the total hazardous medical waste produced by the hospital. Total pharmaceutical waste was classified in three categories, vial waste comprising 51.1%, syringe waste with 11.4% and intravenous therapy (IV) waste with 37.5% w/w of the total. Vial pharmaceutical waste only was further classified in six major categories: antibiotics, digestive system drugs, analgesics, hormones, circulatory system drugs and "other". Production data below are presented as average (standard deviation in parenthesis). The unit production rates for total pharmaceutical waste for the hospital were 12.4 (3.90) g/patient/d and 24.6 (7.48) g/bed/d. The respective unit production rates were: (1) for vial waste 6.4 (1.6) g/patient/d and 13 (2.6) g/bed/d, (2) for syringe waste 1.4 (0.4) g/patient/d and 2.8 (0.8) g/bed/d and (3) for IV waste 4.6 (3.0) g/patient/d and 9.2 (5.9) g/bed/d. Total chemical waste was classified in four categories, chemical reagents comprising 18.2%, solvents with 52.3%, dyes and tracers with 18.2% and solid waste with 11.4% w/w of the total. The total production of chemical waste comprised 1.8% w/w of the total hazardous medical waste produced by the hospital. Thus, the sum of pharmaceutical and chemical waste was 5.7% w/w of the total hazardous medical waste produced by the hospital. The unit production rates for total chemical waste for the hospital were 5.8 (2.2) g/patient/d and 1.1 (0.4) g/exam/d. The respective unit production rates were: (1) for reagents 1.7 (2.4) g/patient/d and 0.3 (0.4) g/examination/d, (2) for solvents 248 (127) g/patient/d and 192 (101) g/examination/d, (3) for dyes and tracers 4.7 (1.4) g/patient/d and 2.5 (0.9) g/examination/d and (4) for solid waste 54 (28) g/patient/d and 42 (22) g/examination/d., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Goal of this work was to calculate the hazardous medical waste unit generation rates (HMWUGR), in kg bed(-1)d(-1), using data from 132 health-care facilities in Greece. The calculations were based on the weights of the hazardous medical wastes that were regularly transferred to the sole medical waste incinerator in Athens over a 22-month period during years 2009 and 2010. The 132 health-care facilities were grouped into public and private ones, and, also, into seven sub-categories, namely: birth, cancer treatment, general, military, pediatric, psychiatric and university hospitals. Results showed that there is a large variability in the HMWUGR, even among hospitals of the same category. Average total HMWUGR varied from 0.012 kg bed(-1)d(-1), for the public psychiatric hospitals, to up to 0.72 kg bed(-1)d(-1), for the public university hospitals. Within the private hospitals, average HMWUGR ranged from 0.0012 kg bed(-1)d(-1), for the psychiatric clinics, to up to 0.49 kg bed(-1)d(-1), for the birth clinics. Based on non-parametric statistics, HMWUGR were statistically similar for the birth and general hospitals, in both the public and private sector. The private birth and general hospitals generated statistically more wastes compared to the corresponding public hospitals. The infectious/toxic and toxic medical wastes appear to be 10% and 50% of the total hazardous medical wastes generated by the public cancer treatment and university hospitals, respectively., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Groundwater contamination by leachate is the most damaging environmental impact over the entire life of a hazardous waste landfill (HWL). With the number of HWL facilities in China rapidly increasing, and considering the poor status of environmental risk management, it is imperative that effective environmental risk management methods be implemented. A risk assessment indices system for HWL groundwater contamination is here proposed, which can simplify the risk assessment procedure and make it more user-friendly. The assessment framework and indices were drawn from five aspects: source term, underground media, leachate properties, risk receptors and landfill management quality, and a risk assessment indices system consisting of 38 cardinal indicators was established. Comparison with multimedia models revealed that the proposed indices system was integrated and quantitative, that input data for it could be easily collected, and that it could be widely used for environmental risk assessment (ERA) in China., (Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.)

The article considers the characteristics of mining-ecological monitoring of environmental objects changing under the influence of toxic waste tailing dump (OAO "Solnechny GOK" Company).

Seven major contaminations of the landfill were selected from northeast of China, and the migration and transformation of contaminations environmental medias were studied by using the multimedia multipathway and multireceptor risk assessment (3MRA) model. The results show, the order of the radical concentration of the seven contaminations is Ni2+ > Benzene > Cd > Pb > Cr6+ > As > Hg. The radical concentration of benzene, As and Hg in human is similar to that of ecology, respectively. The radical concentration of Cd and Ni2+ in human is higher than that of ecology, while the radical concentration of Cr6+ in ecology is higher than that of human. The risk and hazard quotient of the groundwater in the landfill is 5.06 x 10(-7), 2.3 x 10(-1), respectively.

Medical surveillance is mandated for workers with potential exposure to hazardous materials. However, little guidance is provided regarding the components of a medical surveillance testing program for these individuals. This article describes the medical surveillance program for a group of 72 employees who respond to hazardous material releases throughout the United States. Conditions related to chemical exposures were not identified in this group. However, several non-occupational health conditions were identified, including a relatively high prevalence of one or more signs of metabolic syndrome. Medical surveillance may provide valuable information regarding an individual's underlying health status and non-occupational health conditions to be addressed at an early stage., (Copyright 2011, SLACK Incorporated.)

The use of deprivation indices in small-area studies of environment and health is described, with particular reference to the Italian context. Deprivation indices can represent a proxy for individual deprivation and/or contextual deprivation. In Italy, deprivation indices have been constructed using Census variables. They are applied at census tract level in studies with a local basis; in national based studies, they can be used at municipality level. In SENTIERI Project (Mortality study of residents in Italian polluted sites) an ad hoc deprivation index at municipal level was used (DI SENTIERI). Its strength and weaknesses are discussed. In addition, suggestions about the use of socioeconomic indices in small area studies of environment and health are given. For a description of SENTIERI, refer to the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI Project.

SENTIERI Project is the first comprehensive study of the health impact of residence in Italian polluted sites (IPSs). The present Chapter examines the main validity aspects of the present mortality investigation and the evaluation of causality of the observed associations; in addition, some recommendations for public health intervention and research priorities in epidemiological studies on environment and health are given. Exposure ascertainment is a key aspect when an ecological study design is adopted in environmental epidemiology, therefore any exposure potentially affecting the population at study should be described in detail. This is here discussed. SENTIERI is an ecological study, based on a priori hypotheses, in which each IPS's types of exposure were described with specific attention to human exposure. Though, when commenting the results, the problem of concurrent air pollution exposure and/or industrial activities implying occupational risk, if present in the IPSs, was taken into account. Socioeconomic status is a determinant of health and disease, therefore in SENTIERI the Standardized Mortality Ratios were computed both crude and adjusted for an ad hoc deprivation index. About 60% versus an expected 40% of IPSs residents are in the two most deprived quintiles of the index. This hints to a possible problem of environmental justice that should be taken into account when planning remediation intervention. The mortality results here presented are a first step in the epidemiological IPSs' characterization, and some developments have been made or planned. Firstly, a mortality analysis was performed combining mortality data in IPSs presenting similar pollution, i.e. asbestos, or industrial hazardous wastes or dumping sites; secondly, the mortality analysis will be extended beyond 2002, namely the year when ICD X started to be in use in Italy. In addition, disease prevalence will be investigated using hospital discharge records; cancer incidence and congenital anomalies incidence will be studied in IPSs in which a Cancer Register or a Congenital Anomalies Register are active. The above described activities will lead to a more valid estimate of the disease burden of IPSs residents, and allow to identify priorities of remediation activities. The method adopted in SENTIERI, specifically the ecological design and the use of mortality data at municipal level, in general does not grant the evaluation of the causal association between environmental exposure and adverse health effects. However, it allows etiological observations that make unacceptable the delay of remediation intervention.

The collaborative study between Istituto superiore di sanità and Associazione italiana registri tumori (ISS-AIRTUM) aims at investigating cancer incidence in polluted sites for adults and for children (0-14 years) and adolescents (15-19 years) to comment the study results in the light of a set of a priori hypotheses. On the whole, 141 out of 298 municipalities included in SENTIERI Project are served by a Cancer Register participating to the AIRTUM network. For a description of SENTIERI, refer to the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI Project. The time window of the study is the period 1996-2005. The number of expected cases in each polluted site will be estimated by applying incidence rates of the national pool of cancer registries and of the pool of the geographic macroarea in which each site is located: Northern, Central, Southern Italy and Islands. Cancer incidence in children and adolescents is one of the main priorities of international public health institutions, because of the need to protect childhood health from involuntary exposure to environmental risk factors. Standardized incidence ratios (SIRs) will be computed using expected figures derived from the national pool of cancer registries.

SENTIERI Project (Mortality study of residents in Italian polluted sites) studies mortality of residents in 44 sites of national interest for environmental remediation (Italian polluted sites, IPSs). A development of the Project is the investigation of adverse reproductive effects. This issue is of the utmost importance in the field of environmental epidemiology, both in analytical studies and in surveillance activity. An environmental factor can be at play either as a preconception mutagen (maternal or paternal exposure) or as a postconceptional teratogen. The US-Agency for Toxic Substances and Disease Registry (ATSDR) and the US-Environmental Protection Agency (USEPA), indicate as a priority the study of congenital anomalies (CA) and reproductive disorders. The choice of congenital anomalies to be included in the study is mainly based on the results of the evaluation of the epidemiological evidence completed for SENTIERI Project. The epidemiological knowledge on congenital anomalies in polluted sites is lacking, therefore main groups of CA will also be included for descriptive purposes. Data on CA are produced by seven registers located in Italy, either in regional or sub-regional areas, which are included in the National Committee of Congenital Malformations Registers hosted by the National Center for Rare Diseases at Istituto Superiore di Sanità. The study periods are: a) 1995-2002 (1996-2002 for the Region Campania), namely the same years as SENTIERI mortality study; b) for the years 2003-2008 different time windows will be chosen on the basis of data availability in single registers. Registers of CA are active in 16 out of 44 polluted sites included in SENTIERI, for a total of 119 municipalities. In each polluted site the number of expected cases for each CA will be estimated from the prevalence at birth of the same anomaly as from regional registers active in the polluted site at study. For a description of SENTIERI, refer to the 2010 Supplement of Epidemiology & Prevention devoted to the Project.

The methods of mortality analysis in Italian polluted sites (IPS) are described. The study concerned 44 IPSs; each one included one or more municipalities. Mortality at municipality level was studied in the period 1995-2002, using the following indicators: crude rate, standardized rate, standardized mortality ratio (SMR), and SMR adjusted for an ad hoc deprivation index. Regional populations were used as reference for indirect standardization. The deprivation index was constructed using the 2001 national census variables representing the following socioeconomic domains: education, unemployment, dwelling ownership, overcrowding. Mortality indicators were computed for 63 single or grouped causes. The results for all the 63 analysed causes of death are available for each IPS, and in this Chapter the results for each IPS for causes selected on the basis of a priori evidence of risk from local sources of environmental pollution are presented. The procedures and results of the evidence evaluation have been published in the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI.

SENTIERI Project has assessed the overall mortality profile in all the IPSs combined, and performed IPS-specific analyses. The epidemiological evidence of the causal association between cause of death and exposure was classified into one of these three categories: Sufficient (S), Limited (L) and Inadequate (I). The procedures and results of the evidence evaluation have been presented in a 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI. Mortality for causes of death with a priori Sufficient or Limited evidence of association with the environmental exposure exceeds the expected figures, with a SMR of 115.8 for men (90%CI 114.4-117.2; 2 439 extra deaths) and 114.4 for women (90% CI 112.4-116.5; 1 069 extra deaths). These excesses are also observed when analysis is extended to all the causes of death (i.e. with no restriction to the ones with a priori Sufficient or Limited evidence): for a total of 403 692 deaths (men and women combined), an excess of 9 969 deaths is observed, with an average of around 1 200 extra deaths per year. Most of these excesses are observed in IPSs located in Southern and Central Italy. The distribution of the causes of deaths shows that the excesses are not evenly distributed: cancer mortality accounts for 30%of all deaths, but is 43.2%of the excess deaths (4 309 cases of 9 969). Conversely, the percentage of excesses in non cancer causes, 19%, is lower than their share of total mortality (42%). Consistently with previous studies, the results suggest that the health status of populations living in the IPSs is worse than what regional averages show. Compared to previous studies, the analysis of the causes selected in SENTIERI, on the basis of a priori Sufficient or Limited evidence of association with the environmental exposures, provides additional information on their role, though some limitations, due to methodology and data used, should be considered.

In Italy, complete municipality-level data on specific-cause mortality have been available at central level since 1980; Italy's National Institute of Statistics (Istat) collects data from all municipalities using two sources: i) the Office of Vital Statistics; and ii) the Civil Status Office. The Office of Vital Statistics records data on events such as births, deaths and migration for the population with official residence in the municipality, with the aim of describing the resident population's structure and composition. The Civil Status Office records data on the demographic dynamics (not only marital status but also causes of death); the data refer to the population living in the municipality, independently of official residence. Changes in the status of a municipality (e.g., the creation of a new municipality or the unification of diverse municipalities) are often not recorded simultaneously by these two offices, so that the data do not correspond.

SENTIERI Project (Mortality study of residents in Italian polluted sites) studies mortality of residents in 44 sites of national interest for environmental remediation (Italian polluted sites, IPS). The epidemiological evidence of the causal association between causes of death and exposures was a priori classified into one of these three categories: Sufficient (S), Limited (L) and Inadequate (I). In these sites various environmental exposures are present. Asbestos (or asbestiform fibres as in Biancavilla) has been the motivation for defining six sites as IPSs (Balangero, Emarese, Casale Monferrato, Broni, Bari-Fibronit, Biancavilla). In five of these, increases in malignant neoplasm or pleura mortality are detected; in four of them, results are consistent in both genders. In six other sites (Pitelli, Massa Carrara, Aree del Litorale Vesuviano, Tito, "Aree industriali della Val Basento", Priolo), where other sources of environmental pollution in addition to asbestos are reported, mortality from malignant neoplasm of pleura is increased in both genders in Pitelli, Massa Carrara, Priolo, "Litorale vesuviano". In the time span 1995-2002, a total of 416 extra cases of malignant neoplasm of pleura are detected in the twelve asbestos-polluted sites. Asbestos and pleural neoplasm represent an unique case. Unlike mesothelioma, most causes of death analyzed in SENTIERI have multifactorial etiology; furthermore, in most IPSs multiple sources of different pollutants are present, sometimes concurrently with air pollution from urban areas: in these cases, drawing conclusions on the association between environmental exposures and specific health outcomes might be complicated. Notwithstanding these difficulties, in a number of cases an etiological role could be attributed to some environmental exposures. The attribution could be possible on the basis of increases observed in both genders and in different age classes, and the exclusion of a major role of occupational exposures was thus allowed. For example, a role of emissions from refineries and petrochemical plants was hypothesized for the observed increases in mortality from lung cancer and respiratory diseases in Gela and Porto Torres; a role of emissions from metal industries was suggested to explain increased mortality from respiratory diseases in Taranto and in Sulcis-Iglesiente-Guspinese. An etiological role of air pollution in the raise in congenital anomalies and perinatal disorders was suggested in Falconara Marittima, Massa-Carrara, Milazzo and Porto Torres. A causal role of heavy metals, PAH's and halogenated compounds was suspected for mortality from renal failure in Massa Carrara, Piombino, Orbetello, "Basso bacino del fiume Chienti" and Sulcis-Iglesiente-Guspinese. In Trento-Nord, Grado and Marano, and "Basso bacino del fiume Chienti" increases in neurological diseases, for which an etiological role of lead, mercury and organohalogenated solvents is possible, were reported. The increase for non-Hodgkin lymphomas in Brescia was associated with the widespread PCB pollution. Mortality for causes of death with a priori Sufficient or Limited evidence of association with the environmental exposure exceeds the expected figures, with a SMR of 115.8% for men (90% IC 114.4-117.2; 2 439 extra deaths) and 114.4% for women (90% CI 112.4-116.5; 1 069 extra deaths). These excesses are also observed when analysis is extended to all the causes of death (i.e. with no restriction to the ones with a priori Sufficient or Limited evidence): for a total of 403 692 deaths (both men and women), an excess of 9 969 deaths is observed, with an average of about 1 200 extra deaths per year. Most of these excesses are observed in IPSs located in Southern and Central Italy. The procedures and results of the evidence evaluation are presented in a 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI.

The concept of "polluted site" was firstly introduced in Italy with the definition of "environmental high risk areas" (Rule 349/86). Later, the decree 471/99 stated that a site is considered polluted if the concentration of even just one index pollutant in anyone of the matrices (soil or subsoil, surface or ground waters) exceeds the allowable threshold limit concentration. The boundaries of Italian polluted sites (IPS) were defined (Decree 152/06) on the basis of health, environmental and social criteria. SENTIERI Project includes 44 out of the 57 sites comprised in the "National environmental remediation program"; they correspond to the largest national industrial agglomerates. For each site, characterization data were collected, classified and arranged in tables. A great part of collected data came also from the environmental remediation programmes planned for the sites. These plans show that characterization and risk assessment activities were mainly undertaken for private industrial areas, as they were considered source of pollution. On the other hand, municipal and/or green and agricultural areas included in IPSs were poorly studied. Therefore, it is difficult to assess the exposure of the populations living inside and/or near the IPSs. The most probable population exposure come from the contamination of ground waters utilized for irrigation, or industrial emissions. For a description of SENTIERI, refer to the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI Project.

SENTIERI Project (Mortality study of residents in Italian polluted sites) studied mortality of residents in the sites of national interest for environmental remediation (Italian polluted sites--IPSs). IPSs are in proximity of either active or dismissed industrial areas, near dumping sites of industrial and hazardous waste or incinerators. SENTIERI Project described and evaluated the mortality of the populations residing in IPSs and it specifically focused on causes of death for which environmental exposure is suspected or ascertained to play an etiologic role. The epidemiological evidence of the causal association was classified a priori into one of these three categories: Sufficient (S), Limited (L) and Inadequate (I). The study results will allow the priorities setting in remediation intervention, so as to prevent adverse health effects from environmental exposure. At the time of 2001 Census, about 10%of Italian population resided in the 44 IPSs included in SENTIERI; the mortality analysis was carried out for the years 1995-2002 for 63 causes of death. The study results for the 44 IPSs are here commented and read on the basis the a priori evaluation of the epidemiological evidence in terms of strength of the causal association, and taking into account the limits of a geographic study design and its implied complexities. The procedures and results of the evidence evaluation have been presented in a 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI.

National surveillance systems of occupational diseases may contribute to evaluate the work-related component of diseases investigated in SENTIERI Project. For a description of SENTIERI, refer to the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI Project. The National Workers Compensation Authority (INAIL) archives all occupational diseases claims (more than 230 000 in the period 2000-2007) and is in charge of their compensation. The Italian National Mesothelioma Register (ReNaM) and the Sinonasal Cancer Register (ReNaTuNS) record high occupational etiological fraction neoplasms (i.e. mesothelioma and sinonasal cancers). The former has identified more than 10 000 mesothelioma cases until now, and covers almost the whole country; the latter is active only in three Italian regions, Piemonte, Lombardia and Toscana. The monitoring of cancer sites at lower occupational etiological fraction is based on a record-linkage procedure between population-based cancer registries and employment history data, available at the Italian National Institute for Social Security (INPS). Finally, the informative system Mal.Prof collects and classifies all the diseases possibly related to the work environment reported by the Prevention Services of the Local Health Units.

Cancer incidence is an outcome of interest in studies assessing the health impact of polluted sites, for which an example is represented by SENTIERI Project. Incidence data are characterized by better diagnostic quality and are not influenced by survival factors, furthermore they allow the investigation of high-survival neoplasms (i.e. childhood cancer) and rare malignancies. Furthermore, the study of incidence is more informative than mortality for non-lethal tumours, therefore it represents an advancement in respect to the study of mortality completed in SENTIERI Project. In the last decade in Italy some environmental epidemiology studies used cancer register data, for example the Biancavilla (Sicily) investigation on fluoro-edenite related mesothelioma and the study in an area of Naples Province where hazardous waste was extensively dumped. In this frame, ISS planned some collaborative studies with Siracusa, Mantua and Ferrara cancer Registries, where three major polluted sites are located. Following these pilot studies an ISS-AIRTUM (Italian Association of Cancer Registries) collaborative study has been planned. For a description of SENTIERI, refer to the 2010 supplement of Epidemiology & Prevention, devoted to the Project.

In the present study, the amounts of medical waste materials, sharps, liquid waste, hazardous waste, household waste and recyclables generated from 375 healthcare services including private hospitals, state hospitals, university hospitals, private medical centres, dialysis centres, cottage hospitals and private dentist surgeries were determined, and the relation between the amount of the waste and the bed capacities, inpatient and outpatient numbers were evaluated. The amount of regulated medical waste corresponded to 28.8% of the total waste streams collected from the healthcare services, and the major producers were private hospitals. The major producers of hazardous waste were state hospitals with a generation rate of 57.9%. The main results of the study indicate that the quantities of the waste streams generated from healthcare services in accordance with the outpatient number gave more appropriate results than the other evaluation methods. Furthermore, evaluation based on the bed capacities gave reasonable results except for recyclables and hazardous waste. As a result of the evaluation of the medical waste generation rate with bed capacities, the generation rate was determined as 2.11 ± 3.83 kg bed(-1) day(-1) and this rate was 1.45 ± 9.84 kg outpatient(-1) day(-1) for the evaluation by outpatient numbers. The observed significant P values (P > 0.05) indicate that the evaluation of the waste streams in healthcare services based upon outpatient numbers did not show any reasonable change according to service category.

The accurate calculation of the unit generation rates and composition of medical waste generated from medical facilities is necessary in order to design medical waste treatment systems. In this work, the unit medical waste generation rates of 95 public and private medical facilities in the Attica region were calculated based on daily weight records from a central medical waste incineration facility. The calculated medical waste generation rates (in kg bed(-1) day( -1)) varied widely with average values at 0.27 ± 113% and 0.24 ± 121%, for public and private medical facilities, respectively. The hazardous medical waste generation was measured, at the source, in the 40 bed hospital of the island of Ikaria for a period of 42 days during a 6 month period. The average hazardous medical waste generation rate was 1.204 kg occupied bed(-1) day(-1) or 0.33 kg (official) bed( -1) day(-1). From the above amounts, 54% resulted from the patients' room (solid and liquid wastes combined), 24% from the emergency department (solid waste), 17% from the clinical pathology lab and 6% from the X-ray lab. In average, 17% of the total hazardous medical waste was solely infectious. Conclusively, no correlation among the number of beds and the unit medical waste generation rate could be established. Each hospital should be studied separately, since medical waste generation and composition depends on the number and type of departments/laboratories at each hospital, number of external patients and number of occupied beds.

Love Canal, located in Niagara Falls, NY, and among the earliest and most significant hazardous waste sites in the United States, first came to public attention in 1978. In this study, researchers evaluated 1,799 live births from 1960 through 1996 to 980 women who formerly lived in the Love Canal Emergency Declaration Area and were of reproductive age sometime during that time period. Using Upstate New York and Niagara County as external comparison populations, standardized incidence ratios with 95% confidence intervals were calculated for low birth weight, preterm birth, small for gestational age, and congenital malformations, and unadjusted proportions of male to female births were calculated. Internal comparisons among the infants were also performed according to several measures of potential exposure using generalized estimating equations. The results indicated a statistically significant elevated risk of preterm birth among children born on the Love Canal prior to the time of evacuation and relocation of residents from the Emergency Declaration Area, using Upstate New York as the standard population (standardized incidence ratio=1.40; 95% confidence interval: 1.01, 1.90). Additionally, the ratio of male to female births was lower for children conceived in the Emergency Declaration Area (sex ratio=0.94 versus sex ratio=1.05 in the standard population) and the frequency of congenital malformations was greater than expected among Love Canal boys born from 1983 to 1996 (standardized incidence ratio=1.50 when compared to Upstate New York), although in both cases the 95% confidence interval included the null value. Finally, increased risk for low birth weight infants among mothers who lived closest to the Canal as children was found (odds ratio=4.68; 95% confidence interval: 1.24, 17.66), but this estimate was limited due to small numbers (n=4). The study adds to the knowledge of the possible reproductive effects from exposure to chemicals arising from hazardous waste; however, given the small number of some events, the qualitative nature of the exposure assessment, and possibility of spurious associations due to multiple comparisons, the findings should be interpreted cautiously., (Copyright © 2011 Elsevier Inc. All rights reserved.)

In the Flix Reservoir (Ebro River, Spain), ca. 300,000tons of industrial waste were dumped because of the activity of a factory plant in Flix. Within the recovery program implemented, this exceptional situation provides a unique opportunity to test the value of zebra mussel as sentinel organism. Ten metal concentrations were measured in mussels from different sites to assess spatial redistribution of metals and bioavailability to the food web. Our results showed an important metal uptake by mussels; metal concentrations (except As) measured in impacted sites were up to 10 times higher than in control sites, and Mn and Hg exceeded several times the levels previously reported for polluted waters. Concentrations increased downstream showing the metal mobilization from polluted sediments in Flix Reservoir. The higher metal concentrations measured in zebra mussel individuals clearly indicated their bioavailability to the food web, allowing the toxics transfer to predators and occasionally to humans. Thus, zebra mussel is a valuable sentinel organism to identify highly polluted waters, transport routes and trophic transfer., (Copyright © 2010 Elsevier B.V. All rights reserved.)

The European Union (EU) adopted the first legislation on chemicals management in 1967 with the Dangerous Substances Directive (DSD). Over time the underlying concepts evolved: from hazard identification over risk assessment to safety assessment. In 1981 a premarketing notification scheme was introduced. Approximately 10 years later a risk assessment program started for existing substances following a data collection and prioritization exercise. Integration of science into EU chemicals legislation occurred via several technical committees managed by the European Chemicals Bureau (ECB) and resulted in the Technical Guidance Document on Risk Assessment (TGD), which harmonized the risk assessment methodology. The TGD was revised several times to adapt to scientific developments. The revision process, and the risk assessments for new and existing substances, led to scientific research on chemical risk assessment and thus increased in complexity. The new EU chemicals policy REACH (Registration, Evaluation, Authorization and Restriction of CHemicals) builds on previous experiences and aims to further enhance health and safety. REACH places the burden of proof for chemical safety on industry focusing on managing risks. REACH formalizes the precautionary principle. Furthermore, it underlines a continued scientific underpinning in its implementation, also via stakeholder involvement, and a focus on aligning with international fora.

This review paper summarizes the existing knowledge on the chemical hazards associated with recycling and other end-of-life treatment options of waste electrical and electronic equipment (e-waste). The hazards arise from the presence of heavy metals (e.g., mercury, cadmium, lead, etc.), flame retardants (e.g., pentabromophenol, polybrominated diphenyl ethers (PBDEs), tetrabromobisphenol-A (TBBPA), etc.) and other potentially harmful substances in e-waste. If improperly managed, the substances may pose significant human and environmental health risks. The review describes the potentially hazardous content of e-waste, examines the existing e-waste management practices and presents scientific data on human exposure to chemicals, workplace and environmental pollution associated with the three major e-waste management options, i.e., recycling, incineration and landfilling. The existing e-waste management practices and associated hazards are reviewed separately for developed and developing countries. Finally, based on this review, the paper identifies gaps in the existing knowledge and makes some recommendations for future research., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Light-emitting diodes (LEDs) are advertised as environmentally friendly because they are energy efficient and mercury-free. This study aimed to determine if LEDs engender other forms of environmental and human health impacts, and to characterize variation across different LEDs based on color and intensity. The objectives are as follows: (i) to use standardized leachability tests to examine whether LEDs are to be categorized as hazardous waste under existing United States federal and California state regulations; and (ii) to use material life cycle impact and hazard assessment methods to evaluate resource depletion and toxicity potentials of LEDs based on their metallic constituents. According to federal standards, LEDs are not hazardous except for low-intensity red LEDs, which leached Pb at levels exceeding regulatory limits (186 mg/L; regulatory limit: 5). However, according to California regulations, excessive levels of copper (up to 3892 mg/kg; limit: 2500), Pb (up to 8103 mg/kg; limit: 1000), nickel (up to 4797 mg/kg; limit: 2000), or silver (up to 721 mg/kg; limit: 500) render all except low-intensity yellow LEDs hazardous. The environmental burden associated with resource depletion potentials derives primarily from gold and silver, whereas the burden from toxicity potentials is associated primarily with arsenic, copper, nickel, lead, iron, and silver. Establishing benchmark levels of these substances can help manufacturers implement design for environment through informed materials substitution, can motivate recyclers and waste management teams to recognize resource value and occupational hazards, and can inform policymakers who establish waste management policies for LEDs.

Background: This commentary evolved from a workshop sponsored by the National Institute of Environmental Health Sciences titled "Superfund Contaminants: The Next Generation" held in Tucson, Arizona, in August 2009. All the authors were workshop participants., Objectives: Our aim was to initiate a dynamic, adaptable process for identifying contaminants of emerging concern (CECs) that are likely to be found in future hazardous waste sites, and to identify the gaps in primary research that cause uncertainty in determining future hazardous waste site contaminants., Discussion: Superfund-relevant CECs can be characterized by specific attributes: They are persistent, bioaccumulative, toxic, occur in large quantities, and have localized accumulation with a likelihood of exposure. Although still under development and incompletely applied, methods to quantify these attributes can assist in winnowing down the list of candidates from the universe of potential CECs. Unfortunately, significant research gaps exist in detection and quantification, environmental fate and transport, health and risk assessment, and site exploration and remediation for CECs. Addressing these gaps is prerequisite to a preventive approach to generating and managing hazardous waste sites., Conclusions: A need exists for a carefully considered and orchestrated expansion of programmatic and research efforts to identify, evaluate, and manage CECs of hazardous waste site relevance, including developing an evolving list of priority CECs, intensifying the identification and monitoring of likely sites of present or future accumulation of CECs, and implementing efforts that focus on a holistic approach to prevention.