Is the association between temperature and mortality modified by age, gender and socio-economic status?

Background

A number of studies have examined the relationship between high ambient temperature and mortality. Recently, concern has arisen about whether this relationship is modified by socio-demographic factors. However, data for this type of study is relatively scarce in subtropical/tropical regions where people are well accustomed to warm temperatures.

Objective

To investigate whether the relationship between daily mean temperature and daily all-cause mortality is modified by age, gender and socio-economic status (SES) in Brisbane, Australia.

Methods

We obtained daily mean temperature and all-cause mortality data for Brisbane, Australia during 1996-2004. A generalised additive model was fitted to assess the percentage increase in all deaths with every one degree increment above the threshold temperature. Different age, gender and SES groups were included in the model as categorical variables and their modification effects were estimated separately.

Results

A total of 53,316 non-external deaths were included during the study period. There was a clear increasing trend in the harmful effect of high temperature on mortality with age. The effect estimate among women was more than 20 times that among men. We did not find an SES effect on the percent increase associated with temperature.

Conclusions

The effects of high temperature on all deaths were modified by age and gender but not by SES in Brisbane, Australia.     

Respiratory effects of indoor particles in young children are size dependent

Background

Extensive epidemiological studies have provided evidence of an association between elevated outdoor particulate air pollution and adverse health effects. However, while people typically spend majority of time indoors, there is limited knowledge on airborne indoor particles and on the correlation between the concentrations of indoor particles and health effects. Even insights into the influence of differently sized indoor particles on human health are still rare.

Objective

The association between differentially sized indoor air particles and the development of respiratory diseases was studied for three year aged children.

Methods

Short-term measurements of particle mass and number concentrations were carried out in children's rooms. Information on possible particle sources (smoking habits, type of heating, and traffic) and respiratory outcomes were obtained from questionnaires. Measured indoor particle concentrations were correlated with possible sources of indoor particles and with respiratory health impacts.

Results

Daily smoking, smoking more than 5 cigarettes per day at home and traffic density in front of the window of children's room were found to be related to indoor exposure by particles of different diameters. High indoor particle exposures were associated with an increased risk for the development of obstructive bronchitis and in some extent of non-obstructive bronchitis. The strongest impact was observed for the mass concentration of particles < 1 μm and the number concentration of particles > 0.5 μm. The risk increases still remain significant if tested for stability changing the number of adjustment variables or omitting randomly selected cases, respectively.

Conclusion

Our results show significant associations between indoor particle concentrations and the risks for respiratory diseases in young children. The applied short-term measurements can help to assess the health risks of indoor particles with different sizes within epidemiological studies.     

Mortality due to tumours of the digestive system in towns lying in the vicinity of metal production and processing installations

Background

Releases to the environment of pollutants from industrial metal production and processing installations can pose a health problem to humans, owing to the toxic substances that such emissions contain.

Objectives

To investigate whether there might be excess mortality due to tumours of the digestive system among the population residing near Spanish metal production and processing installations included in the European Pollutant Emission Register.

Methods

Ecological study designed to examine mortality due to malignant tumours of the digestive system (oral cavity and pharynx, oesophagus, stomach, pancreas, liver, gallbladder, and colon-rectum) at the municipal level, over the period 1994-2003. Population exposure to pollution was estimated on the basis of distance from town of residence to the pollution source. Using mixed Poisson regression models, we analysed: risk of dying from cancer in a 5-kilometre zone around installations by year of commencement of operations; effect of pollution discharge route (air or water) and type of industrial activity; and risk gradient within a 50-kilometre radius of such installations.

Results

Excess mortality (relative risk, 95% confidence interval) was detected in the vicinity of pre-1990 installations for colorectal cancer (1.05, 1.02-1.08 in men; 1.04, 1.00-1.07 in women) and liver cancer (1.06, 1.00-1.12 in men), with this risk being concentrated in installations that released pollution to air. On stratifying by type of industrial activity, statistically significant associations were also observed between the remaining tumours and certain metal production and processing activities. There was also a gradient effect in the proximity to a number of installations.

Conclusions

The results support the existence of an association between risk of dying due to some tumours of the digestive system and residential proximity to the Spanish metal production and processing installations studied.     

Respiratory health, effects of ambient air pollution and its modification by air humidity in Drobeta-Turnu Severin, Romania

Background

Associations between ambient air pollution and respiratory health have been mainly reported for Western Europe and Northern America.

Objectives

Our goal was to investigate such associations among the population of Drobeta-Turnu Severin, Romania, a city in Central Eastern Europe (CEE), and to quantify their modification by air humidity. The latter is of increased interest for the current discussion about the potential effects of climate change on human health.

Methods

We investigated (study period: 23.01.2001-31.08.2002) the associations between chronic obstructive pulmonary disease (COPD), asthma and chronic bronchitis (CB) and total suspended particles (TSP), sulphur dioxide (SO₂) and nitrogen dioxide (NO₂). Generalized additive models (GAM) controlling for time patterns and weather effects were applied. Delayed effects up to seven days were analysed in single lag and polynomial distributed lag models (PDLMs).

Results

An increase of 10 µg/m³ TSP was related to a 3.3% (95% CI: 0.3%-6.4%) and a 2.8% (95% CI: 0.1%-5.7%) increase for hospital admissions for chronic bronchitis with a lag of one and four days, respectively. The adverse effect of TSP on chronic bronchitis was reduced by higher humidity. An increase of 10 µg/m³ SO₂ was related to a 6% (95% CI: 7%-25%) increase, with a two days lag, for hospital admissions for chronic bronchitis. We have not been able to identify a threshold, below which ambient TSP and SO₂ concentrations have no effect on hospital admissions for chronic bronchitis. We found adverse but nonsignificant influences of TSP, SO₂ and NO₂ on total respiratory hospital admissions, COPD and asthma and NO₂ on chronic bronchitis.

Conclusions

We conclude that in Drobeta-Turnu Severin CB is associated with TSP and mainly SO₂. Dry air aggravates the adverse effect of TSP.     

Lead exposure is associated with a delay in the onset of puberty in South African adolescent females: Findings from the Birth to Twenty cohort

Introduction

One of the suggested, yet under-researched, causes of pubertal delay is lead exposure. In South Africa blood lead levels are generally higher than in resource-rich countries. Thus the effects of lead exposure on pubertal development may be significant.

Objective

The objective of this study is to determine the association between lead exposure and pubertal development in adolescent females in the Birth to Twenty cohort (Bt20).

Methods

Bt20 is a Johannesburg based birth cohort study that commenced in 1990 and includes 1682 girls. At 13 years of age venous blood samples were collected from 725 adolescent female participants for lead content analyses; of these, 712 had menarche data. Pubertal measurement was based on age of menarche and self-reported Tanner staging for pubic hair (n = 684) and breast development (n = 682).

Results

The mean blood lead level for the sample was 4.9 μg/dl. Fifty percent had blood lead levels < 5.0 μg/dl, 49% were ≥ 5.0 μg/dl and 1% was > 10.0 μg/dl. The average age of menarche was 12.7 years. At 13 years, 4% and 7% had reached Tanner stage 5 for pubic hair and breast development, respectively. Analyses showed that higher blood lead levels were associated with significant delays in the onset of puberty (p < 0.001).

Conclusion

The study found that higher blood lead levels were associated with a delay in the onset of puberty, after adjustment for confounders. Lead exposure in resource-poor countries is generally higher compared to resource-rich countries and thus the effects of high blood levels have personal and public health significance.     

Exposures to PM₂.₅ components and heart rate variability in taxi drivers around the Beijing 2008 Olympic Games

Background

Carbonaceous and metallic components of particles have been shown to play a role in particles' effects on cardiac autonomic function as measured by heart rate variability (HRV). Previously we reported the association of HRV with marked changes in traffic-related particulate air pollution around the Beijing 2008 Olympic Games in a panel of taxi drivers.

Objective

We further investigated the relationship between exposures to the carbonaceous and metallic components of traffic-related particles and HRV in the same population.

Methods

Repeated measurements of in-car exposures to particulate matter ≤ 2.5 μm in aerodynamic diameter (PM_2.5), carbon monoxide and nitrogen oxides were conducted in a group of 14 taxi drivers for one work shift in four study periods around the Beijing 2008 Olympics. The quantities of organic/elemental carbons and 27 elements of the in-car PM_2.5 mass were determined laboratorially. Linear mixed-effects models were used to evaluate the impact of exposures to different PM_2.5 components on HRV while controlling for potential confounders.

Results

Taxi drivers' exposures to in-car PM_2.5 and its components showed dramatic changes across the four study periods around the Beijing 2008 Olympics. Differences in associations of in-car PM_2.5 components with HRV were found. An interquartile range (IQR: 917.9 ng/m³) increase in calcium was associated with a 5.48 millisecond [ms, 95% confidence interval (CI): 0.71, 10.24] increase in standard deviations of normal-to-normal (SDNN) intervals, while an IQR (4.1 ng/m³) increase in nickel was associated with a 1.53 ms (95% CI: 0.14, 2.92) increase in SDNN index. Additionally, a decline of 8.11 ms (95% CI: − 15.26, − 0.97) in SDNN per IQR (481.4 ng/m³) increase in iron was also found.

Conclusion

The results support associations of PM_2.5 metallic components with HRV in younger healthy individuals. Future studies are needed to clarify the interaction among different PM_2.5 components or the role of PM_2.5 mixtures.     

Sub-micrometer particulate air pollution and cardiovascular mortality in Beijing, China

Background

While the link between particulate matter and cardiovascular mortality is well established, it is not fully investigated and understood which properties of the aerosol might be responsible for the health effects, especially in polluted mega-city areas.

Objectives

Our goal was to explore the association between daily cardiovascular mortality and different particle metrics in the sub-micrometer range in Beijing, China.

Methods

We obtained daily counts of cause-specific cardiovascular deaths in the Beijing urban area for the period March 2004 to August 2005. Concurrently, continuous measurements of particle number size distributions were performed. Particle number concentrations (NC) between 0.003 μm and 0.8 μm were converted to particle mass and surface area concentrations assuming spherical particles. Semi-parametric Poisson regression models adjusting for trend, seasonality, day of the week, and meteorology were used to estimate immediate, delayed and cumulative particle effects. Additionally, effect modification by air mass origin was investigated.

Results

We observed associations between daily cardiovascular mortality and particle NC for a 2-days delay. Moreover, nearly all particle metrics showed 2-days delayed associations with ischemic heart disease mortality. The strongest association was found for particle NC in the size range 0.03-0.1 μm (7.1% increase in daily mortality with a 95%-confidence interval of 2.9%-11.5%, per an increase of 6250 particles/cm³). Results for surface and mass concentrations with a lag of two days indicated effect modification by air mass origin, whereas effects of particle NC were not modified.

Conclusions

Results show an elevated risk of cardiovascular mortality in Beijing from short-term exposure to particulate air pollution in the sub-micrometer range. Results also indicate that locally produced smaller particles and regionally transported particles may exhibit different effects in Beijing.     

Relative survival after exposure to polychlorinated biphenyls and dioxins: a follow-up of Japanese patients affected in the Yusho incident

Objectives

Little information is available on conditional survival among Yusho patients, who were accidentally exposed to PCBs and other dioxin-related compounds. In this study, we estimated relative survival among Yusho patients to quantify time trends in excess mortality compared to the general population.

Methods

A total of 1664 Yusho patients (860 males, and 804 females) were analyzed as Yusho cohort subjects. Relative survival ratio (RSR) was calculated as a measure of patient survival.

Results

Overall, 1-, 5-, 10-, and 15-year RSRs were 1.00 (95% confidence interval (CI): 0.99, 1.00), 1.00 (95% CI: 0.99, 1.01), 0.99 (95% CI: 0.98, 1.00), and 0.99 (95% CI: 0.98, 1.01), respectively. We did not observe meaningful increases or decreases in RSRs in either sex, which remained the same in all age groups for 1-, 5-, 10-, and 15-year RSRs.

Conclusions

This study provides quantitative evidence that Yusho patients have no significant difference in relative survival compared with the general Japanese population. Our results suggest that PCBs and dioxin exposure confers no excess mortality. This information may be important for both the clinical management of and patient coping with Yusho disease.     

A biomonitoring framework to support exposure and risk assessments

Background

Biomonitoring is used in exposure and risk assessments to reduce uncertainties along the source-to-outcome continuum. Specifically, biomarkers can help identify exposure sources, routes, and distributions, and reflect kinetic and dynamic processes following exposure events. A variety of computational models now utilize biomarkers to better understand exposures at the population, individual, and sub-individual (target) levels. However, guidance is needed to clarify biomonitoring use given available measurements and models.

Objective

This article presents a biomonitoring research framework designed to improve biomarker use and interpretation in support of exposure and risk assessments.

Discussion

The biomonitoring research framework is based on a modified source-to-outcome continuum. Five tiers of biomonitoring analyses are included in the framework, beginning with simple cross-sectional and longitudinal analyses, and ending with complex analyses using various empirical and mechanistic models. Measurements and model requirements of each tier are given, as well as considerations to enhance analyses. Simple theoretical examples are also given to demonstrate applications of the framework for observational exposure studies.

Conclusion

This biomonitoring framework can be used as a guide for interpreting existing biomarker data, designing new studies to answer specific exposure- and risk-based questions, and integrating knowledge across scientific disciplines to better address human health risks.     

The relationship between particulate air pollution and emergency hospital visits for hypertension in Beijing, China

Background

A number of epidemiological studies have examined the adverse effect of air pollution on mortality and morbidity. Also, several studies have investigated the associations between air pollution and specific-cause diseases including arrhythmia, myocardial infarction, and heart failure. However, little is known about the relationship between air pollution and the onset of hypertension.

Objective

To explore the risk effect of particulate matter air pollution on the emergency hospital visits (EHVs) for hypertension in Beijing, China.

Methods

We gathered data on daily EHVs for hypertension, fine particulate matter less than 2.5 μm in aerodynamic diameter (PM_2.5), particulate matter less than 10 μm in aerodynamic diameter (PM₁₀), sulfur dioxide, and nitrogen dioxide in Beijing, China during 2007. A time-stratified case-crossover design with distributed lag model was used to evaluate associations between ambient air pollutants and hypertension. Daily mean temperature and relative humidity were controlled in all models.

Results

There were 1,491 EHVs for hypertension during the study period. In single pollutant models, an increase in 10 μg/m³ in PM_2.5 and PM₁₀ was associated with EHVs for hypertension with odds ratios (overall effect of five days) of 1.084 (95% confidence interval (CI): 1.028, 1.139) and 1.060% (95% CI: 1.020, 1.101), respectively.

Conclusion

Elevated levels of ambient particulate matters are associated with an increase in EHVs for hypertension in Beijing, China.     

Prenatal exposure to organochlorine pesticides and TSH status in newborns from Southern Spain

Objective

To investigate the association between prenatal exposure to organochlorine pesticides (OCPs) and thyroid-stimulating hormone (TSH) levels in male newborns.

Methods

Exposure to 17 OCPs was analyzed in 220 placentas from a male birth cohort in Southern Spain, and TSH was measured in the umbilical cord blood. OCP concentrations were quantified by gas chromatography and mass spectrometry. Multivariate regression analysis was conducted to examine the association between pesticide exposure and neonatal TSH levels, adjusting for confounders.

Results

Newborn boys with higher exposure to endrin in placenta had higher odds of TSH cord blood levels ≥ 5 mU/L (80th percentile) (OR = 2.05; 95% CI = 1.01, 4.18; p = 0.05), whereas higher prenatal exposure to endosulfan-sulfate was associated with lower odds of TSH ≥ 5 mU/L (OR = 0.36; 95% CI = 0.17, 0.77; p = 0.008). A marginally significant negative association was found between TSH and hexachlorobenzene levels (β = − 0.15; 95% CI = − 0.31, 0.02; p = 0.09), and exposure to p,p′-DDE showed a marginally-significant higher odds of TSH ≥ 5 mU/L (OR = 1.32; 95% CI = 0.95, 1.83; p = 0.09). No association was found between TSH and the remaining pesticides.

Conclusions

Early exposure to certain environmental chemicals with endocrine-disruption activity may interfere with neonatal thyroid hormone status; however, the pattern of interference is not yet clearly elucidated.     

The association between fine particulate air pollution and hospital emergency room visits for cardiovascular diseases in Beijing, China

Background

Because epidemiological studies have yielded different results, the association between exposure to fine particulate matter less than 2.5 μm in aerodynamic diameter (PM_2.5) and acute events of cardiovascular diseases (CVD) is unknown. Additionally, no research has been conducted to explore the association between PM_2.5 and hospital emergency room (ER) visits of cardiovascular diseases in Beijing, China.

Objective

To explore the association between PM_2.5 and the hospital ER visits in Beijing, China for CVD {(International Classification of Diseases, 10th vision (ICD-10): I00~I99)}.

Methods

We collected data for daily hospital ER visits for CVD from the Peking University Third Hospital, daily ambient PM_2.5 data from a fixed monitor site at Peking University, and data on the daily level of gaseous air pollutants {sulfur dioxide (SO₂) and nitrogen dioxide (NO₂)} from the Beijing Municipal Environmental Monitoring Center between June 1, 2004 and December 31, 2006. A time-stratified case-crossover design was used to evaluate associations between CVD health outcomes and ambient air pollutants.

Results

8377 hospital ER visits of CVD were collected in our study. After adjusting the temperature and the relative humidity, the associations for 10 μg/m³ increases in levels of PM_2.5, SO₂, or NO₂ and hospital ER visits for cardiovascular diseases were statistically significant with odds ratios (ORs) of 1.005{95% confidence interval (CI): 1.001-1.009}, 1.014(95% CI: 1.004-1.024), and 1.016(95% CI: 1.003-1.029), respectively.

Conclusion

These findings suggest that elevated levels of ambient air pollutants are associated with the increase in hospital ER visits for CVD in Beijing, China.     

The effect of various temperature indicators on different mortality categories in a subtropical city of Brisbane, Australia

Background

The relationship between temperature and mortality has been explored for decades and many temperature indicators have been applied separately. However, few data are available to show how the effects of different temperature indicators on different mortality categories, particularly in a typical subtropical climate.

Objective

To assess the associations between various temperature indicators and different mortality categories in Brisbane, Australia during 1996-2004.

Methods

We applied two methods to assess the threshold and temperature indicator for each age and death groups: mean temperature and the threshold assessed from all cause mortality was used for all mortality categories; the specific temperature indicator and the threshold for each mortality category were identified separately according to the minimisation of AIC. We conducted polynomial distributed lag non-linear model to identify effect estimates in mortality with one degree of temperature increase (or decrease) above (or below) the threshold on current days and lagged effects using both methods.

Results

Akaike's Information Criterion was minimized when mean temperature was used for all non-external deaths and deaths from 75 to 84 years; when minimum temperature was used for deaths from 0 to 64 years, 65-74 years, ≥ 85 years, and from the respiratory diseases; when maximum temperature was used for deaths from cardiovascular diseases. The effect estimates using certain temperature indicators were similar as mean temperature both for current day and lag effects.

Conclusion

Different age groups and death categories were sensitive to different temperature indicators. However, the effect estimates from certain temperature indicators did not significantly differ from those of mean temperature.     

Heavy metal exposure in patients suffering from electromagnetic hypersensitivity

Background

Risks from electromagnetic devices are of considerable concern. Electrohypersensitive (EHS) persons attribute a variety of rather unspecific symptoms to the exposure to electromagnetic fields. The pathophysiology of EHS is unknown and therapy remains a challenge.

Objectives

Heavy metal load has been discussed as a potential factor in the symptomatology of EHS patients. The main objective of the study was to test the hypothesis of a link between EHS and heavy metal exposure.

Methods

We measured lead, mercury and cadmium concentrations in the blood of 132 patients (n = 42 males and n = 90 females) and 101 controls (n = 34 males and n = 67 females).

Results

Our results show that heavy metal load is of no concern in most cases of EHS but might play a role in exceptional cases.

Conclusions

The data do not support the general advice to heavy metal detoxification in EHS.     

Time trends of persistent organic pollutants in Sweden during 1993-2007 and relation to age, gender, body mass index, breast-feeding and parity

Background

Persistent organic pollutants (POPs) are lipophilic chemicals that bioaccumulate. Most of them were resticted or banned in the 1970s and 1980s to protect human health and the environment. The main source for humans is dietary intake of dairy products, meat and fish. Little data exist on changes of the concentration of POPs in the Swedish population over time.

Objective

To study if the concentrations of polychlorinated biphenyls (PCBs), DDE, hexachlorobenzene (HCB) and chlordanes have changed in the Swedish population during 1993-2007, and certain factors that may influence the concentrations.

Methods

During 1993-2007 samples from 537 controls in different human cancer studies were collected and analysed. Background information such as body mass index, breast-feeding and parity was assessed by questionaires. Wilcoxon rank-sum test was used to analyse the explanatory factors specimen (blood or adipose tissue), gender, BMI, total breast-feeding and parity in relation to POPs. Time trends for POPs were analysed using linear regression analysis, adjusted for specimen, gender, BMI and age.

Results

The concentration decreased for all POPs during 1993−2007. The annual change was statistically significant for the sum of PCBs −7.2%, HCB −8.8%, DDE −13.5% and the sum of chlordanes −10.3%. BMI and age were determinants of the concentrations. Cumulative breast-feeding > 8 months gave statistically significantly lower concentrations for the sum of PCBs, DDE and the sum of chlordanes. Parity with > 2 children yielded statistically significantly lower sum of PCBs.

Conclusions

All the studied POPs decreased during the time period, probably due to restrictions of their use.     

A rating scale for housing-based health hazards

Objectives

This study investigated the validity and responsiveness of a rating scale designed to assess the housing-based hazards and their relationships to burden of disease symptoms in the building occupants.

Study design

A population-based cross-sectional survey.

Methods

Random-digit dialing with computer-assisted phone interviews was conducted to obtain information from 642 households in the City of Saginaw, Michigan about 71 housing-based hazards, symptoms of 43 diseases often associated with environmental exposures and demographic characteristics. The housing-based hazard index (HHI) was calculated from scores of hazards across the following eight dimensions: structural scale (18 items); moisture/mold scale (8 items), electrical scale (7 items), ventilation and combustion appliances scale (6 items); pest scale (6 items); pets scale (4 items), fire scale (6 items) and lifestyle-associated factors scale (12 items). Each item was assigned a relative score based on the likelihood that the housing occupants would be exposed to the hazard, the potential for serious health impacts, and the reported strength of its association with childhood lead poisoning and respiratory diseases. The psychometric properties of HHI and individual domains (scales) were assessed along with the associations between these indicators and the inventory of disease symptoms.

Results

The reliability of HHI was demonstrated by assessments of its dimensionality and internal consistency. Analysis of the predictive validity and responsiveness indicates that HHI and scores for most of the individual scales can discriminate between households in relation to the burden of reported disease symptoms.

Conclusions

The HHI represents a valid, reasonably reliable, and parsimonious measure of hazards that are congruent with the burden of symptoms generally associated with housing-related diseases.     

The short-term effect of air pollution on cardiovascular mortality in Tianjin, China: comparison of time series and case-crossover analyses

Background

Many studies have illustrated that ambient air pollution negatively impacts on health. However, little evidence is available for the effects of air pollution on cardiovascular mortality (CVM) in Tianjin, China. Also, no study has examined which strata length for the time-stratified case-crossover analysis gives estimates that most closely match the estimates from time series analysis.

Objectives

The purpose of this study was to estimate the effects of air pollutants on CVM in Tianjin, China, and compare time-stratified case-crossover and time series analyses.

Method

A time-stratified case-crossover and generalized additive model (time series) were applied to examine the impact of air pollution on CVM from 2005 to 2007. Four time-stratified case-crossover analyses were used by varying the stratum length (Calendar month, 28, 21 or 14 days). Jackknifing was used to compare the methods. Residual analysis was used to check whether the models fitted well.

Results

Both case-crossover and time series analyses show that air pollutants (PM₁₀, SO₂ and NO₂) were positively associated with CVM. The estimates from the time-stratified case-crossover varied greatly with changing strata length. The estimates from the time series analyses varied slightly with changing degrees of freedom per year for time. The residuals from the time series analyses had less autocorrelation than those from the case-crossover analyses indicating a better fit.

Conclusion

Air pollution was associated with an increased risk of CVM in Tianjin, China. Time series analyses performed better than the time-stratified case-crossover analyses in terms of residual checking.     

Mortality from cold waves in Castile — La Mancha, Spain

Introduction

As is known, the effects of extreme temperatures on mortality are characterised by an annual periodicity, with a rise centred in the winter months. The most recent epidemiological studies show that mortality caused by cold waves is, in many cases, comparable to that caused by the severest heat waves. This study sought to quantify the rise in mortality due to extreme cold and the factors that determine the relationship between these variables in Castile-La Mancha (Spain).

Methods

We examined the effect of extreme winter temperature on daily non accidental cause mortality in Castile — La Mancha from 1975 to 2003, for all ages. Quantitative analyses were performed using ARIMA models, with other covariates, such as influenza, pressure trends, relative humidity, and cold wave duration and chronological number.

Results

There were two mortality peaks: a short-term peak (with a lag of 3 to 7 days); and a longer term peak (of under two weeks). Excess mortality during cold waves was around 10% per degree centigrade below the threshold temperature for all the provinces except Guadalajara, where an increase of only 4.61% was detected.Mortality increased in response to rises in cold-wave duration and relative humidity. Cold waves occurring at the end of the “winter” season caused the greatest mortality.

Conclusions

This study confirms that daily mortality in Castile — La Mancha increases during cold waves. Efficient cold-wave prevention plans must therefore be implemented. Such plans should be based on in-depth knowledge of the causes that underlie and modulate the relationship between low temperatures and health effects.     

Perinatal lead and mercury exposure in Austria

Objective

The heavy metals lead (Pb) and mercury (Hg) are ubiquitous environmental pollutants with high neurotoxic potential. We aimed to compare perinatal Pb and Hg concentrations and to explore the potential association between Pb and Hg exposure and newborn anthropometry.

Study design

Pregnant women were recruited in 2005 at the General Hospital Vienna for participation in this longitudinal study. Pb and Hg concentrations were measured in maternal blood and hair, placenta, cord blood, meconium, and breast milk of 53 mother-child pairs by CV-AAS, GF-AAS, and HPLC-CV-ICPMS. We conducted bivariate analyses and categorical regression analysis (CATREG) to evaluate the determinants of Pb and Hg exposure, and of infant anthropometry.

Results

Median Pb and total Hg contents were low, i.e., 25 μg/L (maternal blood-Pb), 13 μg/L (cord blood-Pb), 0.7 μg/L (maternal blood-Hg), and 1.1 μg/L (cord blood-Hg). Hg levels in maternal and fetal tissues were frequently correlated (r > 0.3, P < 0.05, respectively). Regarding Pb, only maternal blood and cord blood concentrations correlated (P = 0.043). Cord blood levels indicated higher Hg exposure but lower Pb exposure relative to maternal blood contents. Adjusted CATREG models indicated the significant predictors of birth length (placenta-Pb, gestational length, meconium-Pb), birth weight (placenta-Pb, gestational length, maternal blood-Pb), and head circumference (maternal education, maternal height). Besides one significant correlation between maternal hair Hg and birth length, the mercury levels were not associated with newborn anthropometry.

Conclusions

Our data implicate that different modes of action may exist for placentar transfer of Pb and Hg as well as that low Pb exposure levels can result in lower birth weight. The findings related to newborn anthropometry need to be confirmed by the examination of larger study groups. Further research is needed to clarify the mechanisms of Pb and Hg transfer via the placenta, and to explore how prenatal Pb exposure is related to intrauterine growth.     

Comparison between two methods of defining heat waves: A retrospective study in Castile-La Mancha (Spain)

Introduction

Following the 2003 heat wave, many European countries implemented heat-wave prevention plans. A number of aspects can prove fundamental in determining the effectiveness of such plans, and of these we sought to analyse the criteria used to define threshold temperatures and trigger a higher level of intervention.

Method

Retrospective study of the days on which heat-wave thresholds were exceeded during the period 1974-2003 was conducted. We compared when and at what level the heat-wave prevention plan would have been activated using a statistical-meteorological criterion (as applied by the Spanish Ministry of Health & Consumer Affairs) versus a temperature-mortality criterion.

Results

The number of days on which the threshold was exceeded was far higher when the temperature-mortality criterion was applied.The temperature percentile at which a heat wave occurred was different for each province analysed and was inversely proportional to its respective ageing index.Using both criteria, there was an increase in heat-wave days per decade.

Conclusion

The establishment of a heat-wave threshold temperature must be based on knowledge of the cause-effect relationship between temperature and the health of a given population. Mortality is an appropriate indicator of population health. The future effects of climate change render it essential for this relationship to be studied on a local scale, so as to enable truly efficient prevention plans to be drawn up.