ALS and environment: Clues from spatial clustering?

A role for environmental factors in the etiology of amyotrophic lateral sclerocis (ALS) has been suspected for many years. A large body of work has implicated common exposures, conjugal cases, at-risk activities, heavy metals, organic solvents, and electric shocks, among others. One of the most demonstrative relationships between ALS and the environment is spatial clustering. We reviewed the most important and recent spatial clusters in a given area, whatever the geographical size, with either substantial epidemiological approaches or with highly significant associations, and with precise hypotheses. We present a broad, albeit incomplete overview of investigations in different areas, including examples of the difficulties and contradictions of some approaches. Most of the time, the implication of neurotoxins is suspected and, although not always strictly identified, some candidates are emerging: cycasin, MAM, L-BMAA, hydrazine, for example. One other important point is the possibility of interaction among risk/causal factors that increase the complexity of investigation. Additionally, with the exception of Western Pacific ALS, studies of spatial clustering are lacking a major methodological approach, namely a large cohort analysis extended over a long period of time, and probably for decades. Nevertheless, any spatial cluster needs to be identified, described and studied as deeply as possible to illuminate knowledge of the origin of this devastating disorder and to promote primary or secondary disease prevention.

The World Federation of Neurology and the challenges in Environment Neurology.

Since its establishment the World Federation of Neurology (WFN) has manifested a keen interest in the environment and its relation to neurological diseases. Thus, in 2007 the WFN renamed the "Neurotoxicological Research Group" to "Environmental Neurology Research Group". In this short article, we review some recent events which illustrate the WFN involvement in Environmental Neurology as well its concerns about global health matters involving environmental issues.

Respiratory gases, air pollution and epilepsy.

A growing number of studies have shown that exposure to air pollutants such as particulate matter and gases can cause cardiovascular, neurodegenerative and psychiatric diseases. The severity of the changes depends on several factors such as exposure time, age and gender. Inflammation has been considered as one of the main factors associated with the generation of these diseases. Here we present some cellular mechanisms activated by air pollution that may represent risk factors for epilepsy and drug resistance associated to epilepsy.

Medical management, prevention and mitigation of environmental risks factors in Neurology.

The human environment and exposures arising therefrom are major contributors to neurological disorders ranging from stroke to neurodegenerative diseases. Reduction of exposure to environmental risk factors, with the goal of disease prevention or control, is addressed at the individual as well as the societal level and in recognition of differential subject vulnerability. We examine some practical solutions in high-income countries that may allow a better adaptation to environmental risks and reduce their adverse impact on the nervous system. We consider the citizen's role in reducing unhealthy exposures and explore new approaches to treatment.

Occurrence of heavy elements in street dust from sub/urban zone of Tianjin: pollution characteristics and health risk assessment.

Main purpose of this study was to determine the concentrations of selected heavy elements (As, Cd, Pb, Cu, Co, Cr and Ni) in the street dust samples (n = 49) collected from seven districts located in suburban/urban zone of Tianjin in order to estimate their possible sources and degree of environmental pollution as well as human health risk. Mean concentrations (mg kg-1) of As (19.3), Cd (0.60), Pb (28.4) and Cu (62.7) were above their corresponding soil background values. According to the results of multivariate statistical analysis, the accumulation of As, Cd, Pb, Cu and Cr in street dust was affected by anthropogenic activities, while the contents of Ni and Co were associated with natural sources. Pollution degree by geo-accumulation index had the following trend: Cd > Cu > As > Pb > Cr > Ni > Co. Dust contamination with Cd ranged from unpolluted to highly polluted. Potential ecological risk indicated low (Pb, Cu, Cr, Co and Ni) to high (Cd) risk, while potential risk index showed moderate and very high risks. Non-carcinogenic risk of the studied elements was below safe level (<1). Data obtained in this investigation gave the additional values to the knowledge needed for future monitoring and risk assessment, relating the presence of heavy elements studied in suburban/urban areas.

Evaluation of PM1, PM2.5, and PM10 exposure and the resultant health risk of preschool children and their caregivers.

Preschool children have a higher respiratory rate per unit body weight than adults, and their respiratory systems are not mature. Hence, children may have more health risks associated with particulate matter (PM) exposure. In this study, we assessed the exposure of preschool children and their caregivers to PM and the resulting health risks. The PM concentrations at heights of 60-80 cm (preschool children) and 150 cm (adults) were measured at ten indoor and eight outdoor sites in the Taipei metropolitan area from March 2015 to February 2017. Four PM2.5 and seven PM10 indoor measurements exceeded the indoor air quality standard of Taiwan, whereas only two PM2.5 outdoor measurements exceeded the ambient air quality standard. The outdoor PM concentrations were related to traffic emissions, whereas the indoor PM concentrations were associated with ventilation rate and occupant density. The chronic daily PM1, PM2.5, and PM10 intakes of preschool children were notably higher than those of adults. In addition, the hazard quotient resulting from PM2.5 exposure indicated a significant health risk for preschool children (93.74% greater than 1). Consequently, reducing the exposure of preschool children to PM2.5 is an emerging issue in the Taipei metropolitan area.

Impact of improved cookstoves on women's and child health in low and middle income countries: a systematic review and meta-analysis.

OBJECTIVES: Improved biomass cookstoves may help reduce the substantial global burden of morbidity and mortality due to household air pollution (HAP) that disproportionately affects women and children in low and middle income countries (LMICs). DESIGN: Systematic review and meta-analysis of (quasi-)experimental studies identified from 13 electronic databases (last update: 6 April 2018), reference and citation searches and via expert consultation. SETTING: LMICs PARTICIPANTS: Women and children INTERVENTIONS: Improved biomass cookstoves MAIN OUTCOME MEASURES: Low birth weight (LBW), preterm birth, perinatal mortality, paediatric acute respiratory infections (ARIs) and COPD among women. RESULTS: We identified 53 eligible studies, including 24 that met prespecified design criteria. Improved cookstoves had no demonstrable impact on paediatric lower ARIs (three studies; 11 560 children; incidence rate ratio (IRR)=1.02 (95% CI 0.84 to 1.24)), severe pneumonia (two studies; 11 061 children; IRR=0.88 (95% CI 0.39 to 2.01)), LBW (one study; 174 babies; OR=0.74 (95% CI 0.33 to 1.66)) or miscarriages, stillbirths and infant mortality (one study; 1176 babies; risk ratio (RR) change=15% (95% CI -13 to 43)). No (quasi-)experimental studies assessed preterm birth or COPD. In observational studies, improved cookstoves were associated with a significant reduction in COPD among women: two studies, 9757 participants; RR=0.74 (95% CI 0.61 to 0.90). Reductions in cough (four studies, 1779 participants; RR=0.72 (95% CI 0.60 to 0.87)), phlegm (four studies, 1779 participants; RR=0.65 (95% CI 0.52 to 0.80)), wheezing/breathing difficulty (four studies; 1779 participants; RR=0.41 (95% CI 0.29 to 0.59)) and conjunctivitis (three studies, 892 participants; RR=0.58 (95% CI 0.43 to 0.78)) were observed among women. CONCLUSION: Improved cookstoves provide respiratory and ocular symptom reduction and may reduce COPD risk among women, but had no demonstrable child health impact. REGISTRATION: PROSPERO: CRD42016033075.

Prevalence of various environmental intolerances in a Swedish and Finnish general population.

OBJECTIVE: To determine the prevalence of various environmental intolerances (EIs), using several criteria in a Swedish and a Finnish general population. Ill-health attributed to low-level environmental exposures is a commonly encountered challenge in occupational and environmental medicine. METHODS: In population-based questionnaire surveys, the Västerbotten Environmental Health Study (Sweden) and the Österbotten Environmental Health Study (Finland), EI was inquired by one-item questions on symptom attribution to chemicals, certain buildings, or electromagnetic fields (EMFs), and difficulties tolerating sounds. The respondents were asked whether they react with central nervous system (CNS) symptoms or have a physician-diagnosed EI attributed to the corresponding exposures. Prevalence rates were determined for different age and sex groups and the Swedish and Finnish samples in general. RESULTS: In the Swedish sample (n = 3406), 12.2% had self-reported intolerance to chemicals, 4.8% to certain buildings, 2.7% to EMFs, and 9.2% to sounds. The prevalence rates for the Finnish sample (n = 1535) were 15.2%, 7.2%, 1.6%, and 5.4%, respectively, differing statistically significantly from the Swedish. EI to chemicals and certain buildings was more prevalent in Finland, while EI to EMFs and sounds more prevalent in Sweden. The prevalence rates for EI with CNS-symptoms were lower and physician-diagnosed EIs considerably lower than self-reported EIs. Women reported EI more often than men and the young (18-39 years) to a lesser degree than middle-aged and elderly. CONCLUSIONS: The findings reflect the heterogeneous nature of EI. The differences in EI prevalence between the countries might reflect disparities concerning which exposures people perceive harmful and focus their attention to.

Characteristics of perceived electromagnetic hypersensitivity in the general population.

Health problems evoked in the presence of electrical equipment is a concern, calling for better understanding for characteristics of electromagnetic hypersensitivity (EHS) in the general population. The present study investigated demographics, lifestyle factors, frequency and duration, coping strategies, proportion meeting clinical criteria for intolerance attributed to electromagnetic fields (EMF) and comorbidity. Using data from a large-scale population-based questionnaire study, we investigated persons with self-reported (n = 91) EHS in comparison to referents (n = 3,250). Middle age, female sex and poor perceived health was found to be associated with EHS. More than 50% in the EHS group reported having EMF-related symptoms more often than once a week, and the mean number of years experiencing EHS was 10.5. More than half of the EHS group reported that their symptoms started after a high-dose or long-term EMF exposure, that they actively tried to avoid EMF sources and that they mostly could affect the EMF environment. A minority of the EHS group had sought medical attention, been diagnosed by a physician or received treatment. Exhaustion syndrome, anxiety disorder, back/joint/muscle disorder, depression, functional somatic syndrome and migraine were comorbid with EHS. The results provide ground for future study of these characteristic features being risk factors for development of EHS and or consequences of EHS.

[Monitoring methods and their results in environmental medicine - implications for medical counsellors]. / Monitoringverfahren in der Umweltmedizin und die ärztliche Befunderstellung.

Besides effect and environmental monitoring, human biomonitoring (HBM) offers an attractive method for analyzing the distribution and intensity of anthropogenic environmental pollutants in individuals or in particular groups of the population. However, no assessment values of comparable reliability are available to enable an interpretation of the results of environmental studies from the viewpoint of environmental health. This must be taken into account when reporting findings of such studies as well as in medical consultation, in order to avoid overdiagnosis and unnecessary anxiety for the participant. In medical practice, care should be taken when dealing with monitoring results outside the normal range! Environmental or biomonitoring results provide only a part of the available information alongside medical history and clinical examinations. In the case of tests performed for private interests as well as tests carried out within the framework of an epidemiological environmental survey, communication of results and findings can be problematic. In epidemiological studies, a close co-operation between the participant's consultant physician and physicians conducting the study is beneficial in order to ensure professional advisory counselling for subjects with results outside the normal range.

[Allergy - an environmental disease]. / Allergie ­ eine Umwelterkrankung!

The increase in allergies is a phenomenon that is being observed in all fast-developing countries. For a long time, science has taken as a starting point that solely a genetic predisposition is a precondition for the development of an allergy. Today, knowledge of environmental factors that can alter genes or the transcription of genes in the cells, has improved. Epidemiological studies have meanwhile identified several environmental factors that have a protective or supporting effect on allergy development. The environmental microbiome has recently gained central interest. A common theme in most of the studies is diversity: reduced diversity is correlated with enhanced risk for chronic inflammatory diseases and allergy.It is now of great interest for research to further analyze such environment-gene and/or environment-human interactions on all levels - from organs to cells to small and microstructures such as genes. For immunologists, it is specifically about understanding the influencing factors and effector pathways of allergens, and to apply thereby obtained insights in the follow-up for the ultimate goal of allergy research - prevention.

[Ecological-hygienic evaluation of the environment of territories being adjacent to decultivated uranium mines].

On the territory of Kazakhstan there are uranium deposits, many ofwhich are in mothballed since times of perestroika. Often, the mines are flooded and represent a "time-delay bomb". Inside of mines various there are accumulated gases of both organic and inorganic nature, periodically thrown out and adversely affecting on the health of local populations. The aim of the study was the investigation of the state of the environment of Esilsky district of the Akmola region by common pollutants and chemicals. As the basic variable for the investigation of ambient air there was accepted the maximum one-time concentration of suspended substances, phenol, nitrogen dioxide, sulfur dioxide. The results were evaluated in relation to the MPC for the analyzed substance in the air according to maximal single MPC (MPCms) and daily average MPC (MPCda). The content of metals in the water was determined with the use of spectrophotometer PD-303S. Evaluation of the results was executed in relation of the MPC of substances in water, by means of the comparison with the requirements of Federal standards for drinking water, samples from drinking water sources. There were executed calculations of the overall index of water pollution (IWVgen), the index of water pollution by heavy metals (IWVhm). Chemical analysis of soil was carried out with the use of spectrophotometer PD- 303S (Japan), the photometer expert-003 "Ekoniks". Evaluation of the results was carried out with the respect to the MPC in the soil, the toxicity of all components. Summarizing soil pollution index was evaluated for metals contained in the soil at the level of more than or equal to 1 MAC. The settlement Krasnogorskiy and the village of Kalachi were found to be characterized by a low level of air pollution, increased rigidity of drinking water exceeded the maximum permissible concentrations of copper by 3.45 times and chloride by 1.17 times in the soil cover.

Environmental risk factors for autism spectrum disorders.

BACKGROUND: Autism spectrum disorders (ASD) are syndromes that are predominantly defined by behavioral features such as impaired social interactions, restricted verbal and nonverbal communication, and repetitive or stereotyped behavior. In the past few decades, the reported prevalence of ASD has increased dramatically. This growth can be partially explained by an increased level of awareness of the problem among professionals and better diagnostic methods. Nevertheless, underpinning causes of ASD have not yet been detailed and explained. It is suggested that rather than having a single causative factor, ASD pathogenesis is influenced by environmental or genetic factors, or a combination of both. The aims of this review are to describe the environmental risk factors associated with ASD so as to provide a reference basis for current and future clinical and experimental work. MATERIALS AND METHODS: On the basis of a PubMed search, we review the existing knowledge on environmental factors associated with ASD. RESULTS: A series of environmental factors have been repeatedly reported as risk factors for ASD in existing studies. CONCLUSION: Air pollution, organic toxicants, seasonal factors, psychological stress, migration, birth order, and nutrition may have a close relationship with the incidence of ASD.

[Methodical complex for the assessment of mass noninfectious prevalence rate and the medico-ecological situation in the territory].

The purpose of this article - the narration of main provisions of the algorithm of the system use of techniques and methods for the determination of the epidemiological risk for the morbidity of the population for the identification and assessment of mass noninfectious diseases, local variants ofpopulation health and the degree of stringency of medical and environmental conditions (or ecological trouble), in areas of industrial and non-administrative units of the area (region). Control-flow chartfor the evaluation of mass non-communicable diseases and medical-ecological situation in the territory on the basis of techniques and methods of risk assessment for decision-making control includes the following steps: 1) determination of the conditional regional level of the background prevalence rate as the unit of regional type of population health, shaped by regional climatic and geographic and other features of the environmental conditions; 2) detection of the epidemiological relative risk of the morbidity rate and mass non-infectious diseases; 3) determination of the wave-like character of the dynamics of the riskfor mass non-infectious morbidity rate of the population and the adaptation process shaping it in the territories; 4) separating the leading mass non-communicable diseases, especially shaping peculiarities of local variants of population health in the special industrial and non-industrial areas; 5) determination of the degree of stringency of medical and environmental situation (or ecological trouble) in the studied area, with local variants ofpopulation health; 6) a forecast of the expected trends in the dynamics of the risk for mass non-infectious prevalence rate; 7) justification of the main directions of the development of medical and environmental preventive measures on the reduction of mass non-infectious diseases and the improvement of the quality of health of the population in the studied areas. The given methodical complex will allow to more effectively solve problems ofprevention of mass non-infectious prevalence of the population and improve health and environmental conditions in the study area based on public health monitoring data.

[Hygienic aspects of the occurrence of ecology-dependent diseases in children and adolescents of the Primorsky Krai].

With the use of the methodology of the system approach there were obtained results of the evaluation of the occurrence of ecology-dependent diseases in children and adolescents in bioclimatic zones of the Primorsky Krai. Analysis of the prevalence of the main classes of ecologically dependent diseases according to the appealability (diseases of the respiratory system, diseases of digestive organs, diseases of blood and blood-forming organs, diseases of the circulatory system, diseases of the skin and subcutaneous tissue, diseases of the genitourinary system, neoplasms, congenital anomalies, infectious diseases) was performed with the use of official statistical report forms No. 12 (ICD-10) over the period of2000-2014. Informational Database of parameters of the environment was represented by the factor modules: 6 - sanitary, and 5-environmental ones). By means of the method of the regression analysis there was established the relationship between environmental factors and the prevalence of ecological-dependent diseases, there were calculated values of the factor loads influencing on the indices of the morbidity rate in children and adolescents. The analysis of morbidity according to classes showed that during the study period, in the total there was a gain in the indicator ecologically dependent morbidity rate in children by 33.3%, in adolescents - by 35.3%. In the children and adolescent population there are prevalent diseases of the respiratory system - 67.3% and 52.45%, respectively; further in children and adolescent groups diseases of the digestive system - 9.45% and 17.08% take place; then in the children cohort are infectious diseases, and in adolescents - diseases of the genitourinary system. The level of ecologically dependent morbidity rate is determined by the complex impact of environmental and hygienic factors, with a predominance of sanitary-hygienic component and related with it parameters of the environment of habitation, such as chemical pollution of urban areas (soil, air, water sources), nevertheless biotropic factors (temperature, humidity, fog, number of days with biologically active solar radiation) make a significant contribution. The revealed various degree of the response of children and adolescents through the prevalence rate level to the exposure of ecological and hygienic factors of environment should be taken into account in the development and carrying out medical-preventive measures.

[Features of physical development of girls residing in the altai territory with the different level of the environmental load].

There was performed the determination of the characteristics of the physical development of 660 girls aged of from 6 years 6 months to 17years 5 months 29 days, residing in the Blagoveshchenskiy and the Ust-Pristanskiy regions of the Altai Krai. The Blagoveshchenskiy region is characterized by a high level of ambient air pollution (potential of the atmospheric pollution accounts for 2.7-3.0). Sodium sulfate, sulfur dioxide, hydrogen sulfide, carbonic oxide, nitrogen dioxide, vanadium pentoxide, ammonia, manganese and its compounds, hexavalent chromium make the greatest contribution to the atmospheric pollution. The Ust-Pristanskiy region is referred to the least polluted territories of the Altai Krai. Living conditions in the Blagoveshchenskiy region of the Altai Krai were found to influence on the girls ' physical and sexual development. The girls living in the Blagoveshchenskiy region show the pubertal growth spurt one year later, which is lasting longer. As a result, by the age of 17, measurements of the body and leg length are almost 6 cm higher in girls of the Blagoveshchenskiy region. 97% of the Blagoveshchenskiy region residents have pathological (trochanter index ≤ 1.85) and disevolutive (trochanter index = 1.86 - 1.91) types of age evolution which testifies to the thyroid and reproductive hormones deficiency. Among the residents of the Ust-Pristanskiy region, 80% have either normal values of the trochanter index (1.95 - 2.0) or slightly deviated from the norm (hypoevolutive, normoevolutive, and hyperevolutive types of age evolution). The level of the endocrine system diseases prevalence, nutrition and metabolic disorders among the teenagers of the Blagoveshchenskiy region are 2.5 times higher than in the rural area of the Altai Krai. The relative risk of the endocrine system diseases occurrence, nutrition disturbances and metabolic disorders in the teenagers of the Blagoveshchenskiy region equals to OR=1.87 (x=272.7, p<0.001).

[Morbidity and content of microelements in the blood of school children residing near chromium enterprises].

For the first time there was investigated the content of certain microelements in the blood of children of school age residing in the city of Aktobe (Kazakhstan), where the global giants, mining andprocessing chrome ore productions are located. There were determined blood levels of chromium, nickel, lead in children. There was shown the difference in the blood content of microelements in children, depending on region of residence and their correlation with the core indices of health and disease.

[Hygienic assessment of living conditions and morbidity of the population in the port cities of the Sakhalin region].

The aim of this study was to perform a comprehensive hygienic assessment of environmental conditions in the port cities of the Sakhalin region to identify priority risk factors affecting on population health and management decisions for the optimization of living conditions. As a result of the assessment of risk and damages for public health from the effects of air pollution on the dose-response, effects were found to excess of impact on the target organs by 10 times. The main ecotoxicant was determined to be manganese oxide, which is associated with a priority manganese content in soil samples ofport cities. The positive dynamics of the gain in the accumulation of soil heavy metals according to the total index indicates to the existence of problems for soil contamination. Analysis of demographic variables shows that the population of the Sakhalin region in general and the port cities in particular relates to a regressive type. The main causes of the population decline are mortality and migration outflow of able-bodied population in other regions of Russia. However, in the port cities there is an increase in the number of work places, contributing to an increase in the labor force. The primary and general morbidity of the population ofport cities is characterized by higher levels compared with the average for the Sakhalin Region and the Far Eastern Federal District. Among all the classes of diseases as priority ones there are marked "neoplasm", "diseases of the nervous system", "respiratory diseases", "diseases of the skin and subcutaneous tissue". Port cities occupy the top ranking places on the incidence of malignant tumors among the cities of the Sakhalin region.

[Methodological problems of noninfectious epidemiology and hygiene under chemical pollution of the environment].

In modern conditions the base of the assurance of the safety of human being from harmful factors of environment is the hygienic rationing for the latters. The use of this methodological principle led to the considerable decline in the level of chemical pollution of environment objects. However tens of millions of Russians are exposed to the impact of chemicals above admissible hygienic level. There was noted the high prevalence and mortality rate due to noninfectious diseases of the population. The hygienic science needs to develop and introduce methodology of personification prevention on protection of the person against chemical environmental pollution.

[About unification of indices of the possibility of disease occurrence in risk assessment methodology and the determination of the probability of non-carcinogenic effects in toxicological-hygienic, clinical and epidemiological studies and according to data about health-seeking behavior].

In the methodology for the assessment of the risk the possibility of the disease occurrence under the impact of carcinogenic and non-carcinogenic substances is measured by different indices. This leads to the fact that within the single methodology there are used various scores for such similar index as the risk of the disease occurrence, as a result carcinogens and systemic toxicants happen to be inconsistent from this point of view. At the same time, unlike carcinogens risk indices for systemic toxicants do not allow to evaluate the number of possible diseases in the population during the corresponding period of time, because they contain no information about their probability. Obviously, from this point of view, the characteristics of carcinogenic risk have certain advantages. Therefore, noncarcinogenic risk should be assessed by the similar indices as carcinogenic ones. However, an obstacle to this is the fact that in toxicological-hygienic, clinical and epidemiological studies, according to the results of which there is determined the risk for systemic toxicants, the impact of non-lethal levels of the exposure is established not in separate individuals, as for carcinogens, but according to mean-group values of indices of the state of the body as the identification of the nonspecific effect under relatively non high doses (concentrations) in the single person is fairly difficult. Such data do not allow to estimate the probability of the break of the effect. Also the data concerning seeking for the medical help, considering repeated medical resource utilization due to protract diseases or afflictions occurring repeatedly in a person several times for the considered period of time fail to be the estimation of the probability for the disease occurrence. For the obtaining of the possibility of unification of the carcinogenic and non-carcinogenic indices of risk in the paper there are presented methods for the determination of the probability of non-carcinogenic effects in toxicological-hygienic, clinical and epidemiological studies, as well as according to statistical data on the seeking for the medical help, taking into account the repeated appeals of the protract or re-emerging diseases.