Vitamin D and UV exposure in construction workers-a randomized control trial using text messaging to promote positive behaviours.

BACKGROUND: The aim of this study was to determine whether a text messaging intervention (supported by a smartphone application) would be effective in the promotion of sun-safe behaviours. Both excessive and insufficient exposure to ultra-violet (UV) radiation were considered. METHODS: A randomized control crossover trial was conducted. 112 participants from nine sites in the United Kingdom contributed to the study. There were three intervention waves, two in winter (Vitamin D-focussed) and one in summer (UV exposure-focussed). Stages of Change, Standard Erythemal (UV) Dose and assayed blood samples (Vitamin D) were employed to evaluate the effectiveness throughout the 21-day data collection periods. RESULTS: The intervention was effective in promoting positive progression in Stages of Change for Vitamin D; and this in turn was predictive of increased Vitamin D levels in participants. More limited positive findings were found with respect to UV exposure. Overall, for those in the Intervention, Vitamin D levels were significantly predicted to increase during both of the winter data collection waves. CONCLUSIONS: Interventions of this type are recommended to promote healthy Vitamin-D levels in construction workers.

Integrating health and environmental impact analysis.

Scientific investigations have progressively refined our understanding of the influence of the environment on human health, and the many adverse impacts that human activities exert on the environment, from the local to the planetary level. Nonetheless, throughout the modern public health era, health has been pursued as though our lives and lifestyles are disconnected from ecosystems and their component organisms. The inadequacy of the societal and public health response to obesity, health inequities, and especially global environmental and climate change now calls for an ecological approach which addresses human activity in all its social, economic and cultural complexity. The new approach must be integral to, and interactive, with the natural environment. We see the continuing failure to truly integrate human health and environmental impact analysis as deeply damaging, and we propose a new conceptual model, the ecosystems-enriched Drivers, Pressures, State, Exposure, Effects, Actions or 'eDPSEEA' model, to address this shortcoming. The model recognizes convergence between the concept of ecosystems services which provides a human health and well-being slant to the value of ecosystems while equally emphasizing the health of the environment, and the growing calls for 'ecological public health' as a response to global environmental concerns now suffusing the discourse in public health. More revolution than evolution, ecological public health will demand new perspectives regarding the interconnections among society, the economy, the environment and our health and well-being. Success must be built on collaborations between the disparate scientific communities of the environmental sciences and public health as well as interactions with social scientists, economists and the legal profession. It will require outreach to political and other stakeholders including a currently largely disengaged general public. The need for an effective and robust science-policy interface has never been more pressing. Conceptual models can facilitate this by providing theoretical frameworks and supporting stakeholder engagement process simplifications for inherently complex situations involving environment and human health and well-being. They can be tools to think with, to engage, to communicate and to help navigate in a sea of complexity. We believe models such as eDPSEEA can help frame many of the issues which have become the challenges of the new public health era and can provide the essential platforms necessary for progress.

Contribution of solid fuel, gas combustion, or tobacco smoke to indoor air pollutant concentrations in Irish and Scottish homes.

UNLABELLED: There are limited data describing pollutant levels inside homes that burn solid fuel within developed country settings with most studies describing test conditions or the effect of interventions. This study recruited homes in Ireland and Scotland where open combustion processes take place. Open combustion was classified as coal, peat, or wood fuel burning, use of a gas cooker or stove, or where there is at least one resident smoker. Twenty-four-hour data on airborne concentrations of particulate matter<2.5 µm in size (PM2.5), carbon monoxide (CO), endotoxin in inhalable dust and carbon dioxide (CO2), together with 2-3 week averaged concentrations of nitrogen dioxide (NO2) were collected in 100 houses during the winter and spring of 2009-2010. The geometric mean of the 24-h time-weighted-average (TWA) PM2.5 concentration was highest in homes with resident smokers (99 µg/m3--much higher than the WHO 24-h guidance value of 25 µg/m3). Lower geometric mean 24-h TWA levels were found in homes that burned coal (7 µg/m3) or wood (6 µg/m3) and in homes with gas cookers (7 µg/m3). In peat-burning homes, the average 24-h PM2.5 level recorded was 11 µg/m3. Airborne endotoxin, CO, CO2, and NO2 concentrations were generally within indoor air quality guidance levels. PRACTICAL IMPLICATIONS: Little is known about indoor air quality (IAQ) in homes that burn solid or fossil-derived fuels in economically developed countries. Recent legislative changes have moved to improve IAQ at work and in enclosed public places, but there remains a real need to begin the process of quantifying the health burden that arises from indoor air pollution within domestic environments. This study demonstrates that homes in Scotland and Ireland that burn solid fuels or gas for heating and cooking have concentrations of air pollutants generally within guideline levels. Homes where combustion of cigarettes takes place have much poorer air quality.

The health safety and health promotion needs of older workers.

AIMS: To evaluate current research on the health, safety and health promotion needs of older workers by identifying age-related change, whether older workers need support and evidence of successful intervention in the workplace. METHODS: Using a systematic review methodology, databases were searched identifying 180 publications. Each publication was reviewed and data were extracted. Evidence was assessed for quality using the three-star system. RESULTS: The review identified that there are a number of age-related physical and psychological changes. However, these changes can be moderated by increased physical activity, intellectual activity and other lifestyle factors. Sensory abilities are also subject to change but some of these can be accommodated via equipment or workplace adjustments. In reviewing accident data, although older workers are at a reduced risk of accidents, they are more at risk of fatal accidents. Ill-health data identify that many chronic diseases can be controlled and adjustments put in place in the work environment. A number of intervention studies were identified but few were of high quality. The research suggests that occupational health intervention can reduce the risk of early retirement from the workplace; health promotion interventions are seen as positive by older workers but it is important to ensure equal access to all workers in such promotions. CONCLUSIONS: The review identified that there are still a large number of research gaps including the lack of longitudinal research; no further analysis on fatal accidents or understanding of the high prevalence of musculoskeletal disorders and stress and anxiety in older workers.

Mineral dust exposure in young Indian adults: an effect on lung growth?

BACKGROUND/OBJECTIVE: Long-term occupational exposure to mineral dusts including quartz is known to cause pneumoconiosis but little is known about the effects of such exposure during the period of lung development in childhood. The objective of this study was to investigate the effects on young people of exposure to mineral dusts. METHODS: We carried out a cross-sectional study of a group of 81 Indian stone crushers (average age 21) and a control group of 72 nearby slum dwellers (average age 21) in order to assess dust exposures, respiratory symptoms and lung function. RESULTS: Stone crushers' corrected 8-hour time weighted average concentrations of total inhalable dust, respirable dust and respirable crystalline silica were 143 mg/m(3), 39.7 mg/m(3) and 2.29 mg/m(3) respectively, which are 14, 10 and 23 times the UK workplace exposure limits, respectively. Both groups also had high exposures to outdoor and general domestic particulate matter. Compared to controls, stone crushers had significantly more symptoms, lower levels of forced vital capacity (FVC) and forced expiratory time (FET) and higher levels of forced expiratory volume in one second (FEV(1))/FVC ratio and mid-expiratory flow rate (MEF). There were no differences in FEV(1) levels. Symptoms and lung function were not associated with time lived on site or time spent in job. A selection of chest radiographs showed no silicosis by International Labour Office (ILO) criteria. CONCLUSION: Individuals exposed to mixed mineral dust in childhood and early adult life had excess symptoms and reduced vital capacity without airflow obstruction compared with control subjects. We interpret this as evidence of stunting of lung growth caused by exposure to respirable dust.

Exposure to particulate matter on an Indian stone-crushing site.

BACKGROUND/OBJECTIVES: A large number of labourers work in the stone-crushing industry in India. Many of these workers are also exposed to high levels of particulate matter in their homes from the use of biomass fuels. As part of our investigations to examine the health of these workers we characterised their exposure to respirable crystalline silica and a number of other particulate matter exposure metrics in both occupational and domestic settings. METHODS: We used a combination of direct reading and gravimetric sampling of respirable dust, total inhalable dust and particulate matter <2.5 mum in diameter (PM(2.5)) at work (n = 19), within the general environment (n = 6) and inside the home (n = 7). We used x-ray diffraction to quantify the level of crystalline silica in the respirable dust samples. RESULTS: After correcting for the length of the working week, the arithmetic mean 8-hour time-weighted average (TWA) total inhalable dust exposure for this group was 143 mg/m(3), the mean 8-hour TWA respirable dust exposure was 39.7 mg/m(3) and the 8-hour TWA crystalline silica exposure was 2.29 mg/m(3). Our real-time data showed peaks in exposure under certain environmental and/or working conditions. General environmental and domestic PM(2.5) exposures were also high. CONCLUSIONS: Particulate matter exposures experienced by this group of workers and their families are likely to produce impaired lung function within a short time-frame. There is a need to introduce simple measures to reduce particulate matter exposure from both occupational sources and the use of biomass fuels in homes on this and similar sites.

Dust related risks of clinically relevant lung functional deficits.

AIM: To quantify the risks of clinically important deficits of FEV1 in coal miners in relation to cumulative and average concentrations of respirable dust. METHODS: Data were studied from over 7000 men who had been surveyed in the late 1970s. Linear regression equations for the association between FEV1 and self-reported breathlessness on mild exertion were used to define clinically important levels of FEV1 deficit, and the probabilities that individuals with different dust exposures would experience these deficits were calculated. RESULTS: Levels of FEV1 were lower among breathless men than among others, with a large overlap of the distributions. The relations between standardised FEV1 and breathlessness were constant over all age and smoking groups. A decrease of 100 ml in FEV1 was associated with an increase of 1.12 in the odds of reporting breathlessness. FEV1 deficits of -0.367, -0.627, and -0.993 l (designated as "small", "medium", and "large" deficits) were, on average, associated with proportional increases of risks of breathlessness by factors of 1.5, 2.0, and 3.0 respectively. Cumulative respirable dust exposure ranged up to 726 gh/m3, mean 136 gh/m3 (British Medical Research Council measurement convention). An increase of 50 gh/m3 was associated with an increase of about 2% in the proportion of men with small deficits in FEV1. For medium deficits the increases ranged from 1.5% to 2%, depending on age. A similar pattern was seen for large deficits, but with smaller increases. CONCLUSIONS: In the unlikely event of continuous exposure at the proposed new maximum respirable dust limit for British mines of 3 mg/m3 (ISO-CEN measurement convention) for a working lifetime, the risk of a medium deficit of FEV1 for a non-smoker at age 60 would be estimated to be 34%, compared with 25% for zero dust exposure; for smokers, about 54% compared with 44%.

Transport-related measures to mitigate climate change in Basel, Switzerland: A health-effectiveness comparison study.

BACKGROUND: Local strategies to reduce green-house gases (GHG) imply changes of non-climatic exposure patterns. OBJECTIVE: To assess the health impacts of locally relevant transport-related climate change policies in Basel, Switzerland. METHODS: We modelled change in mortality and morbidity for the year 2020 based on several locally relevant transport scenarios including all decided transport policies up to 2020, additional realistic and hypothesized traffic reductions, as well as ambitious diffusion levels of electric cars. The scenarios were compared to the reference condition in 2010 assumed as status quo. The changes in non-climatic population exposure included ambient air pollution, physical activity, and noise. As secondary outcome, changes in Disability-Adjusted Life Years (DALYs) were put into perspective with predicted changes of CO2 emissions and fuel consumption. RESULTS: Under the scenario that assumed a strict particle emissions standard in diesel cars and all planned transport measures, 3% of premature deaths could be prevented from projected PM2.5 exposure reduction. A traffic reduction scenario assuming more active trips provided only minor added health benefits for any of the changes in exposure considered. A hypothetical strong support to electric vehicles diffusion would have the largest health effectiveness given that the energy production in Basel comes from renewable sources. CONCLUSION: The planned local transport related GHG emission reduction policies in Basel are sensible for mitigating climate change and improving public health. In this context, the most effective policy remains increasing zero-emission vehicles.

Towards an alternative testing strategy for nanomaterials used in nanomedicine: lessons from NanoTEST.

In spite of recent advances in describing the health outcomes of exposure to nanoparticles (NPs), it still remains unclear how exactly NPs interact with their cellular targets. Size, surface, mass, geometry, and composition may all play a beneficial role as well as causing toxicity. Concerns of scientists, politicians and the public about potential health hazards associated with NPs need to be answered. With the variety of exposure routes available, there is potential for NPs to reach every organ in the body but we know little about the impact this might have. The main objective of the FP7 NanoTEST project ( www.nanotest-fp7.eu ) was a better understanding of mechanisms of interactions of NPs employed in nanomedicine with cells, tissues and organs and to address critical issues relating to toxicity testing especially with respect to alternatives to tests on animals. Here we describe an approach towards alternative testing strategies for hazard and risk assessment of nanomaterials, highlighting the adaptation of standard methods demanded by the special physicochemical features of nanomaterials and bioavailability studies. The work has assessed a broad range of toxicity tests, cell models and NP types and concentrations taking into account the inherent impact of NP properties and the effects of changes in experimental conditions using well-characterized NPs. The results of the studies have been used to generate recommendations for a suitable and robust testing strategy which can be applied to new medical NPs as they are developed.

The relationship between fibrosis and cancer in experimental animals exposed to asbestos and other fibers.

The association between occupational asbestos exposure and the development of both pulmonary fibrosis or asbestosis and pulmonary carcinomas is well documented. It has been suggested that the two pathological conditions are associated with asbestos-related carcinomas developing from areas of asbestosis and not occurring when exposure has been too low to produce this type of pulmonary scarring. Experimental inhalation studies so far published have not been designed to examine this association specifically, but many publications have reported that asbestos samples producing high levels of fibrosis is experimental animals are also very carcinogenic. Samples of asbestos or man-made fibers that produce little fibrosis also produce few tumors. These works are reviewed. In order to examine the association between fibrosis and tumor production in more detail, groups of animals with and without pulmonary tumors and with individual fibrosis measurements were assembled from a number of inhalation studies undertaken over a period of years at this Institute. It was found that animals with pulmonary tumors had almost double the amount of pulmonary fibrosis as animals of similar age that did not. In a few of the animals where tumors were found at an early stage of development, their origin from fibrotic areas could be confirmed, although in most cases where tumor deposits were widespread this was not possible. Experimental confirmation of the site of origin of most pulmonary tumors in asbestos-treated rats would require new studies with rats examined specifically at an age when early tumors would be expected.