Dynamic assessment of economic and environmental performance index and generation, composition, environmental and human health risks of hospital solid waste in developing countries; A state of the art of review.

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.

A systematic review on cigarette butt management as a hazardous waste and prevalent litter: control and recycling.

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.

Health care waste management among health workers and associated factors in primary health care facilities in Kampala City, Uganda: a cross-sectional study.

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.

Anatomy of a decision II: Potential effects of changes to Tier I chemical approaches in Canadian Disposal at Sea program sediment assessment protocols.

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).

Anatomy of a decision III: Evaluation of national disposal at sea program action level efficacy considering 2 chemical action levels.

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).

Household waste and health risks affecting waste pickers and the environment in low- and middle-income countries.

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.

Forecasting medical waste generation using short and extra short datasets: Case study of Lithuania.

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).

Evaluating hazardous waste generation in for-profit outpatient haemodialysis centres.

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.

Assessment of four calculation methods proposed by the EC for waste hazardous property HP 14 'Ecotoxic'.

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.

Influence of leaching conditions for ecotoxicological classification of ash.

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.

Emissions behavior and distribution of polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) from cement kilns in China.

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.

Levels of PCDD/Fs, PCBs and PBDEs in breast milk of women living in the vicinity of a hazardous waste incinerator: assessment of the temporal trend.

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.

WEEE and portable batteries in residual household waste: quantification and characterisation of misplaced waste.

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.

Medical surveillance for workplace exposure to hazardous drugs.

NIOSH recommends that employers establish a medical surveillance program as part of a comprehensive program to minimize worker exposure to hazardous drugs.

Assessment of the health care waste generation rates and its management system in hospitals of Addis Ababa, Ethiopia, 2011.

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.

Cancer mortality in towns in the vicinity of incinerators and installations for the recovery or disposal of hazardous waste.

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.

Health consequences of exposure to e-waste: a systematic review.

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.