Variability in the chemistry of private drinking water supplies and the impact of domestic treatment systems on water quality.

Tap water from 497 properties using private water supplies, in an area of metalliferous and arsenic mineralisation (Cornwall, UK), was measured to assess the extent of compliance with chemical drinking water quality standards, and how this is influenced by householder water treatment decisions. The proportion of analyses exceeding water quality standards were high, with 65 % of tap water samples exceeding one or more chemical standards. The highest exceedances for health-based standards were nitrate (11 %) and arsenic (5 %). Arsenic had a maximum observed concentration of 440 µg/L. Exceedances were also high for pH (47 %), manganese (12 %) and aluminium (7 %), for which standards are set primarily on aesthetic grounds. However, the highest observed concentrations of manganese and aluminium also exceeded relevant health-based guidelines. Significant reductions in concentrations of aluminium, cadmium, copper, lead and/or nickel were found in tap waters where households were successfully treating low-pH groundwaters, and similar adventitious results were found for arsenic and nickel where treatment was installed for iron and/or manganese removal, and successful treatment specifically to decrease tap water arsenic concentrations was observed at two properties where it was installed. However, 31 % of samples where pH treatment was reported had pH < 6.5 (the minimum value in the drinking water regulations), suggesting widespread problems with system maintenance. Other examples of ineffectual treatment are seen in failed responses post-treatment, including for nitrate. This demonstrates that even where the tap waters are considered to be treated, they may still fail one or more drinking water quality standards. We find that the degree of drinking water standard exceedances warrant further work to understand environmental controls and the location of high concentrations. We also found that residents were more willing to accept drinking water with high metal (iron and manganese) concentrations than international guidelines assume. These findings point to the need for regulators to reinforce the guidance on drinking water quality standards to private water supply users, and the benefits to long-term health of complying with these, even in areas where treated mains water is widely available.

Surface wipe and bulk sampling of household dust: arsenic exposure in Cornwall, UK.

Dust elemental levels can be expressed as concentrations (bulk samples) or surface loadings (wipe samples). Wipe sampling has not been widely adopted for elements other than lead (Pb). In this study, 433 wipe samples from 130 households in south west England - a region of widespread, natural and anthropogenic arsenic contamination linked with previous mining activities-were analysed to (i) quantify loadings of arsenic (As); (ii) assess the quality of wipe data using QA/QC criteria; (iii) estimate, using published ingestion rates, human exposure to As in dust using loadings and concentrations from 97 bulk samples and (iv) comparatively assess the performance of wipe and bulk sampling using associations with As biomonitoring data (urine, toenails and hair). Good QC performance was observed for wipes: strong agreement between field duplicates, non-detectable contamination of field blank wipes and good reference material recoveries. Arsenic loadings exceeded an existing urban background benchmark in 67 (52%) households. No exceedances of tolerable daily As intake were observed for adult exposure estimates but infant estimates exceeded for 1 household. Infant estimates calculated using bulk concentrations resulted in 4 (3%) exceedances. Neither wipe nor bulk As metrics were sufficiently better predictors of As in biospecimens. Sampling strategies, analytical protocols, exposure metrics and assessment criteria require refinement to validate dust sampling methodologies.

Prolonged exposure to arsenic in UK private water supplies: toenail, hair and drinking water concentrations.

Chronic exposure to arsenic (As) in drinking water is an established cause of cancer and other adverse health effects. Arsenic concentrations >10 µg L(-1) were previously measured in 5% of private water supplies (PWS) in Cornwall, UK. The present study investigated prolongued exposure to As by measuring biomarkers in hair and toenail samples from 212 volunteers and repeated measurements of As in drinking water from 127 households served by PWS. Strong positive Pearson correlations (rp = 0.95) indicated stability of water As concentrations over the time period investigated (up to 31 months). Drinking water As concentrations were positively correlated with toenail (rp = 0.53) and hair (rp = 0.38) As concentrations - indicative of prolonged exposure. Analysis of washing procedure solutions provided strong evidence of the effective removal of exogenous As from toenail samples. Significantly higher As concentrations were measured in hair samples from males and smokers and As concentrations in toenails were negatively associated with age. A positive association between seafood consumption and toenail As and a negative association between home-grown vegetable consumption and hair As was observed for volunteers exposed to <1 As µg L(-1) in drinking water. These findings have important implications regarding the interpretation of toenail and hair biomarkers. Substantial variation in biomarker As concentrations remained unaccounted for, with soil and dust exposure as possible explanations.

Urinary arsenic profiles reveal exposures to inorganic arsenic from private drinking water supplies in Cornwall, UK.

Private water supplies (PWS) in Cornwall, South West England exceeded the current WHO guidance value and UK prescribed concentration or value (PCV) for arsenic of 10 µg/L in 5% of properties surveyed (n = 497). In this follow-up study, the first of its kind in the UK, volunteers (n = 207) from 127 households who used their PWS for drinking, provided urine and drinking water samples for total As determination by inductively coupled plasma mass spectrometry (ICP-MS) and urinary As speciation by high performance liquid chromatography ICP-MS (HPLC-ICP-MS). Arsenic concentrations exceeding 10 µg/L were found in the PWS of 10% of the volunteers. Unadjusted total urinary As concentrations were poorly correlated (Spearman's ρ = 0.36 (P < 0.001)) with PWS As largely due to the use of spot urine samples and the dominance of arsenobetaine (AB) from seafood sources. However, the osmolality adjusted sum, U-As(IMM), of urinary inorganic As species, arsenite (As(III)) and arsenate (As(V)), and their metabolites, methylarsonate (MA) and dimethylarsinate (DMA), was found to strongly correlate (Spearman's ρ: 0.62 (P < 0.001)) with PWS As, indicating private water supplies as the dominant source of inorganic As exposure in the study population of PWS users.

What lies beneath?--issues in the representation of air quality management data for public consumption.

Policy developments in the UK and the European Union (EU) now require local authorities to engage the general public within the whole process of local air quality management (AQM). Indeed, this is considered to be one of the means by which air quality issues can gain public support and help ensure future improvements. One of the outcomes of this is that data sets associated with air quality management must now be disseminated to nonscientific audiences. This is a problematic task for a number of reasons. One of these relates to the fact that air quality data are complex and variable, yet the public demand representations that are clear and unambiguous. Another important issue is associated with the increasing use of geographical information systems (GIS) and mapping tools, which allow data to be generated and summarised in many different ways without due regard to the effects that the choice of methodology can have on the way data are interpreted. The variation in information obtained using different techniques can represent a problem, but is also an opportunity to further explore data sets and to draw out specific information for complementary air quality management tasks. However, at present, the lack of a well-grounded methodology and guidance for handling and representing the spatial aspects of data sets means that consistency between areas and authorities is not maintained. Such a situation fosters ambiguity at several levels, from the individual's perception of public health-related information to an Authority's rationale for the selection of air quality management areas (AQMAs). This paper investigates a number of issues relating to spatial data generation and representation in the field of air quality management, particularly in relation to emissions inventory data. The examples are UK based, but the issues raised are applicable to other examples and areas. One case study examines the difference in information gained through a number of common mapping techniques and shows how different 'problems' can be identified merely as an artefact of the dissemination technique itself. To further illustrate the difficulties and conflicts faced in representing and explaining these data in a practical context, reference is then also made to the methods recently considered by an example London authority. The paper concludes with a call for the development of a more standardised method for representing different types of air quality management-related data, which may help to overcome these problems in the future.

Local air quality management: a practical approach to air quality assessment and emissions audit.

This paper reviews the results of the practical application of national UK tools of air quality management on a local scale, to show their usefulness and application. Such tools include an urban emissions inventory, dispersion modelling and the review and assessment guidance procedures of the National Air Quality Strategy.

The use of a European telemedicine system to examine the effects of pollutants and allergens on asthmatic respiratory health.

The experience of using a telemedicine feasibility study to integrate respiratory health response and environmental stimuli information is presented. The effects of ambient air quality, pollen and local environment conditions on asthmatic patients' lung function were investigated through the use of a novel European health telematic system. The Medical Diagnosis, Communication and Analysis Throughout Europe (MEDICATE) project developed and tested the feasibility of using a telemedicine system for chronic asthmatics in London, UK, and Barcelona, Spain. The key to this was the determination of the real time health (lung function) response to the ambient environment and allergens. Air quality, pollen and environmental lifestyle information were related to respiratory measurements for recruited asthmatic patients in the study through the design of a dedicated environmental management system (EMS) database. In total, 28 patients completed the study trial, subject to ambulatory monitoring of spirometric lung function (PEF, FEV(1) and FVC) up to four times a day over a 2-week period recorded during the year 2000. Alongside this, ambient air quality and pollen counts were used to represent local exposure to potential environmental stimuli. Personal questionnaire interviewing collected additional data about patient lifestyles, social-economic conditions and quality of life perceptions. The methods and indicative results of integrating environmental and health data in this respect are examined. Assessment tools such as GIS and object-orientated databases were designed to locate and compile environmental information about the patients' locations and lifestyles in the study areas (London and Barcelona). Socioeconomic and lifestyle factors, such as exposure to smoking, pets, personal journey lengths and modes, income, household occupancy and domestic fuel use, were found to have limited detectable effects on the patients' basic lung function levels. Patients' gender, age and predicted PEFR were significantly associated with the 2-week mean and minimum respiratory measurements. Lung function data were compared with air quality and pollen indicators to examine relationships on a daily or lagged-day basis controlling for confounding factors. The paper discusses the new methodology and the practicalities of using the telemedical system as a tool for assessing the impacts of environmental stimuli on respiratory health.

Use of physical restraints in nursing homes in New South Wales, Australia.

A 48 item postal survey was completed voluntarily by 285/445 (64%) Directors of Nursing (hereafter DONs) of nursing homes in New South Wales, Australia, to obtain information about the use of physical restraints. Of a total of approximately 16,397 (11,719 females; 4678 males) residents of nursing homes from which information was obtained, 15.3% (2516) were physically restrained. Females comprised 11.2% (1839) and males 4.1% (677) of this group. The commonest forms of physical restraint were vests (25.3%), restraining belts (18.9%), bedrails (17.2%), lap trays (14.4%) and gerichairs (10.5%). The commonest patient-oriented reason for using physical restraints was to 'prevent falls' (84.2%) and the commonest nurse-oriented reasons were 'because no alternative exists' (39.6%) and 'to reduce legal liability' (20%). The correlation between the size of nursing homes (bed numbers) and the number of residents who were physically restrained was weak (r = 0.1771, alpha = 0.05), suggesting that nursing home size did not predict the use of physical restraints. Correlations between the total number of staff, the total number of untrained staff (Assistants In Nursing) and the number of residents who were physically restrained were also weak (r = 0.1792; 0.0921 respectively; alpha = 0.05), suggesting that these factors also had little predictive influence on the use of physical restraints. The findings of this research indicate that the extent to which physical restraints are currently being used in nursing homes in New South Wales should be of concern.

Breaking loose. Use of physical restraints in nursing homes in Queensland, Australia.

A survey was completed by 123/203 (61%). Directors of Nursing of Queensland's nursing homes, to obtain information about the use of physical restraints. Of a total of about 6500 (4693 females; 1807 males) nursing home residents in Queensland, Australia, 23.6% (1536) were reported to have been physically restrained at the time the survey was completed. Of this group, females comprised 72.9% (1120) and males 27.1% (416). The commonest forms of physical restraint were bedrails (38.2%) and restraining belts (23.7%). The commonest patient-oriented reason for using physical restraints was to "prevent falls" (85.4%) and the commonest nurse-oriented reason was "because no alternative exists" (39.8%). The correlation between the size of nursing homes (bed numbers) and the number of residents was strong and positive, indicating that Queensland nursing homes were functioning at full capacity (r = 0.999, a = 0.05). The correlation between the size of nursing homes (bed numbers) and the number of residents who were physically restrained was weak and negative (r = 0.002, a = 0.05), suggesting that nursing home size did not predict the use of physical restraints. Correlations between the total number of staff, the total number of untrained staff (assistants in nursing) and the number of residents who were physically restrained were also weak (r = 0.0427; 0.0695 respectively; a = 0.05), suggesting that these factors also had little predictive influence on the use of physical restraints. The findings of this research indicate that the extent to which physical restraints are currently being used in nursing homes in Queensland should be of concern, particularly in the context of a general, contemporary professional belief that the use of physical restraints in nursing homes should be minimised, if not entirely avoided.

EU alerting and reporting systems for potential chemical public health threats and hazards.

A number of European and international IT platforms are used to notify competent authorities of new potential chemical exposures. Recently the European Parliament and the Council of European Union adopted new legislation that aims to improve the co-ordinated response to cross border health threats (Decision 1082/2013/EU). The Decision, inter alia, sets provisions on notification, ad hoc monitoring and coordination of public health measures following serious cross border threats to health from biological, chemical and environmental events as well as events that have an unknown origin. The legal instrument applies to all European Union Member States and is comparable to the International Health Regulations in its content, requirements and adoption of a multiple hazards approach. An inter-sectoral and multidisciplinary response to events with potentially dangerous cross border exposure pathways is often required. For example, European Poisons Centres may be aware of cases of toxic exposure to a product and, in parallel, trading standards may be aware of the same product due to a breach of consumer product standards. Whilst both cases would have been recorded for separate purposes in different alerting systems, they relate to the same exposure pathway; therefore a process for linking these records would allow a more robust approach to risk assessment and risk mitigation. The Decision seeks to reconcile this issue for serious threats by linking relevant platforms into one overarching higher level risk management IT platform called the Early Warning Response System (EWRS). This system will serve to link other sectors within the European Commission (EC) to public health (e.g. medicines), as well as other EU agencies and international bodies via co-notification features. Other European alert systems will be linked to EWRS to facilitate information sharing at both the assessment and management levels. This paper provides a timely overview of the main systems run by the EC and other international organisations that provide alerts following chemical incidents that have, or may have, the potential to affect public health. The advantages and further considerations of linking these different systems and sectors are also highlighted. Recommendations are made with the purpose of ensuring that modifications to these systems made to satisfy with EU legislation enable a more timely coordinated response and greater awareness of events in Europe, thereby reducing the public health impact from chemical exposures.