Metabolic activation of WHO-congeners PCB28, 52, and 101 by human CYP2A6: evidence from in vitro and in vivo experiments.

Despite extensive research on the metabolism of polychlorinated biphenyls (PCBs), knowledge gaps persist regarding their isoform-specific biotransformation pathways. This study aimed to elucidate the role of different cytochrome P450 enzymes in PCB metabolism, focusing on WHO-congeners 2,4,4'-trichlorobiphenyl (PCB28), 2,2',5,5'-tetrachlorobiphenyl (PCB52), and 2,2',4,5,5'-pentachlorobiphenyl (PCB101). Utilizing engineered HEK293 cell lines, we investigated the in vitro metabolism of these PCBs by CYP1A2, CYP2C8, CYP2C9, CYP3A4, CYP2A6, and CYP2E1, revealing robust production of hydroxylated metabolites. Our results show that CYP2A6 plays a major role in the metabolism of these congeners responsible for predominant formation of para-position hydroxylated metabolites, with concentrations reaching up to 1.61 µg/L (5,89 nM) for PCB28, 316.98 µg/L (1,03 µM) for PCB52, and 151.1 µg/L (441 nM) for PCB101 from a 20 µM parent PCB concentration. Moreover, concentration-dependent cytotoxic and cytostatic effects induced by reactive intermediates of the PCB hydroxylation pathway were observed in HEK293CYP2A6 cells, for all three congeners tested. CYP2A6 was specifically capable of activating PCBs 28 and 101 to genotoxic metabolites which produced genetic defects which were propagated to subsequent generations, potentially contributing to carcinogenesis. In a clinical study examining CYP2A6 enzyme activity in formerly exposed individuals with elevated internal PCB levels, a participant with increased enzyme activity showed a direct association between the phenotypic activity of CYP2A6 and the metabolism of PCB28, confirming the role of CYP2A6 in the in vivo metabolism of PCB28 also in humans. These results altogether reinforce the concept that CYP2A6 plays a pivotal role in PCB congener metabolism and suggest its significance in human health, particularly in the metabolism of lower chlorinated, volatile PCB congeners.

The impact of the 2021 flood on the outpatient care in the North Rhine region, Germany: a cross-sectional study.

BACKGROUND: In the summer of 2021, heavy precipitation led to extreme flooding across Western Europe. In Germany, North Rhine-Westphalia and Rhineland-Palatinate were particularly affected. More than 180 people lost their lives, and over 700 were left injured and traumatized. In the North Rhine district alone, more than 120 practices were only able to operate to a limited extent or had to close their practices completely. The aim of this study was to assess the impact of the 2021 flood on the outpatient care in the North Rhine region. METHODS: The cross-sectional study was conducted in January 2022 in practices affected by the flood in the North Rhine region. For this purpose, 210 affected practices were identified using a list of the Association of Statutory Health Insurance Physicians for North Rhine (KVNO) and via telephone and/or e-mail. These practices were forwarded a questionnaire that addressed, among other things, the local accessibility of the practices before and after the flood, possibilities of patient care in different premises and received support. RESULTS: A total of 103 practices (49.1%) returned the completed questionnaire, of which 1/4 were general practitioners. 97% of the practices reported power failure, more than 50% water supply damage and nearly 40% the loss of patient records. 76% of the participating practices stated that they needed to close their practice at least temporarily. 30 doctors took up patient care in alternative premises. The average number of patients seen by doctors per week before the flood was 206.5. In the first week working in alternative premises, doctors saw an average of 66.2 patients (-50.3%). Especially elderly/geriatric patients and patients with disabilities were identified as particularly vulnerable in terms of access to health care after the flood. CONCLUSIONS: The flood had a significant negative impact on outpatient care. We determined not only a high number of closed practices and a large decrease in patient numbers but also differences in patient care assessment depending on the type of alternative premises. To address outpatient care disruptions after extreme weather events more effectively, appropriate measures should be implemented pre-emptively.

The effects of gender discrimination on medical students' choice of specialty for their (junior) residency - a survey among medical students in Germany.

BACKGROUND: Gender discrimination is known to affect societies in many different settings. Medical education is no exception. This study focusses on the consequences, gender discrimination can have on medical students and their choice of (junior) residency specialty. METHODS: An online questionnaire was developed and distributed among the 40 medical faculties in Germany. The study population contained medical students in their fifth and sixth academic year. RESULTS: The survey's participants consisted of 759 students from 31 universities. Female medical students experienced significantly more gender discrimination compared to their male colleagues (f = 487, 87.9% vs. m = 76, 45.8%, p < 0.0001). The specialties with the most reported gender discrimination were family medicine (f = 180, 42.9% vs. m = 15, 23.8%, p < 0.05), followed by surgery (f = 369, 87.4% vs. m = 44, 69.8%, p < 0.05), internal medicine (f = 282, 67.3% vs. m = 37, 58.7%, ns), orthopaedics/casualty surgery (f = 270, 65.1% vs. m = 32, 50.8%, p < 0.05), and gynaecology (women (f = 142, 34.1% vs. m = 34, 54.0%, p < 0.05). Gynaecology was the only specialty, men experienced more discrimination compared to women. Among the students that ever changed their specialty of choice (f = 346 (73.3%) m = 95 (72%)), significantly more women than men claimed gender discrimination to be one of the main three reasons for their specialty choice (f = 42, 12.1% vs. m = 1, 1.1%, p < 0.05). In addition, 53 students (f = 50 (10.6%) m = 3 (2.3%)) stated to rule out a specialty from the beginning due to gender discrimination. CONCLUSION: Gender discrimination is frequently experienced by medical students in Germany. It influences their choice of medical specialty directly. Our data suggest a fundamental problem that proposes and implicates certain specialties to be attractive for only one gender.

[Nutrition counseling in medical practices-a cross-sectional study]. / Ernährungsberatung in ärztlichen Praxen verschiedener Fachrichtungen ­ eine Querschnittsstudie.

INTRODUCTION: The purpose of this study was to assess the status of nutrition care and counseling in German medical practices, including physicians' nutrition interest and knowledge, existing obstacles, and possible ways of improving nutrition care. METHODS: After development and a two-stage pretest, questionnaires with 32 items were distributed to all resident doctors of general medicine, internal medicine, gynecology and obstetrics, orthopedics, and occupational medicine in Aachen (n = 360) in early spring 2022. RESULTS: The response rate was 29.2% and n = 105 participants were included in the analysis. During their consultation hours, 85.7% of the doctors conducted nutrition counseling (NC). While doctors estimated that 39.5% of their patients need NC, they counseled only 28.1%. General practitioners spent an average of 13 min on NC; all other specialties spent 9.5 min. Most participants felt well informed about healthy nutrition (95.2%). Nutrition was of high personal interest to 57.7% of the participants, and 47.6% considered it important for their work as a doctor. Barriers preventing better NC included the lack of nutrition education during medical studies (89.5%) and specialist training (79.6%), and the lack of time (75.2%). Most participants were willing to conduct more NC if they were paid better and had more time for NC during their working hours. DISCUSSION: Doctors consider NC a relevant part of their work, despite many barriers. To make better use of NC as a measure for treating and preventing common diseases, improvements like better nutrition education for doctors, better funding, and more time for NC are required.

Healthcare for individuals without health insurance in Germany - a mixed methods approach to assess the situation and current challenges.

BACKGROUND: Health insurance is mandatory in Germany; nevertheless, many individuals there have no health insurance and depend on a parallel healthcare structure. Voluntary associations, such as MediNetz and healthcare vouchers ("Anonymer Krankenschein" - AKS), support uninsured citizens. This study aimed to provide insights into associations, such as MediNetz and AKS that provide healthcare for individuals without health insurance in North Rhine-Westphalia, the largest federal state in Germany. METHODS: A mixed methods approach was chosen. A qualitative study using interviews with experts was performed to gain their knowledge and explore the various challenges that AKS and MediNetz associations faced and the possible improvements that could be made. A quantitative survey was conducted to analyse the demographic data of the patients who required AKS or MediNetz's assistance and the characteristics of each association through a separate questionnaire. Data was received from the association in Aachen, Bielefeld, Bonn, Düsseldorf, and Essen. RESULTS: More women than men sought medical care; most were between 25 and 49 years old. The proportion of individuals without residency status accounted for the largest share (53.6%). Common reasons for patients to make contact were acute illnesses (40.2%) and pregnancies (22.3%). Most patients were sent to gynaecologists and general practitioners. Asking the experts, it became apparent that the existing system could not reach the standard of the regular healthcare in Germany. Financial and human resources were insufficient. Therefore, prevention was limited, especially chronically ill patients or patients with a severe illness requiring hospitalisation could not be treated. AKS had advantages compared to MediNetz, as the care came closer to the expected German medical standards. CONCLUSIONS: The results showed a demand for associations providing healthcare for individuals without health insurance. However, the healthcare provided by MediNetz and AKS did not reach the standard of healthcare in Germany and mainly depended on the organisations' resources. Funded projects such as an AKS combined with clearing centres significantly improved healthcare. Until structural measures are implemented, they can be a transitional solution by spreading nationwide.

Ten years after: findings from the medical surveillance program on Health Effects in High-Level Exposure to PCB (HELPcB).

After the detection of high environmental and occupational exposure to polychlorinated biphenyls (PCBs) in a German recycling company for transformers and capacitors in 2010, the multidisciplinary medical surveillance program "HELPcB" (Health Effects in High-Level Exposure to PCB) was established for former PCB-exposed workers of the company, their family members, employees of surrounding companies, and area residents to investigate potential adverse health effects by PCB exposure in a longitudinal study approach with up to seven examination time points between 2010 and 2019. More than 300 individuals were enrolled into the program. Assessments particularly included plasma and urine concentrations of PCB congeners and their metabolites, clinical laboratory parameters, Comet assay, analysis of telomere length, neuropsychological examinations, psychological screening, abdominal and thyroid ultrasound examination. This review summarizes the main results of the studies conducted in the HELPcB program yielding relevant new data on potential adverse effects of PCB exposure in humans and potential mechanisms that underlie these effects. Even larger studies in PCB-exposed individuals are warranted to confirm the results of this program and to further establish causality between PCB exposure and clinical effects in humans.

Oral health, stress and barriers accessing dental health care among war-affected Ukrainian refugees in Germany.

BACKGROUND: After Russian invasion many Ukrainians fled to European countries including Germany. In this context, the German health care system faced challenges delivering dental care to a displaced population. Recently surfaced obstacles as well as different cultural and medical traits need to be considered in order to deliver appropriate medical care. The aim of this study was to evaluate oral health and hygiene of Ukrainian refugees, identify barriers accessing dental health care and explore the relation to their mental health state. METHODS: This cross-sectional study was conducted using a self-assessment questionnaire, distributed via non-probability snowball sampling method among war-affected Ukrainians, who fled to Germany. The online form was distributed via web-based platforms, the printed version was hand-delivered across diverse local venues. Chi-Square Tests, T-Tests and Mann-Whitney-U Tests were performed. Analysis of variance and Spearman correlation coefficient analysis were also conducted. RESULTS: From 819 completed questionnaires, 724 questionnaires were included in the analysis with 78 males (10.8%) and 640 females (88.6%) and a mean age of 37.5 years (SD = 10.5). The majority of participants rated their state of teeth (77%) and gums (81%) as average or better. The main problems, caused by state of their teeth, were: "Have avoided smiling because of teeth" (23.6%) or "Felt embarrassed due to appearance of teeth" (22.2%). The most frequent limiting factors to access dental care were finances (82.6%), language (82.2%) and complicated health care system (74.1%). 45.8% of the participants scored 10 or more in the Patient Health Questionnaire and 37.4% in the Generalized Anxiety Disorder 7-item scale, respectively. These participants were more likely to report pain, poor state of teeth and gums and to fail a dental consultation. Overall, 59.6% participants reported not consulting a dentist, when needed. Failed consultations were associated with a poorer reported state of teeth and gums. CONCLUSIONS: Ukrainian refugees reported barriers accessing dental health care in Germany. It is important to improve oral health literacy and dental services for displaced people and provide help and guidance in seeking dental care.

Human detection thresholds of DC, AC, and hybrid electric fields: a double-blind study.

BACKGROUND: In the course of the ongoing transition of electric energy systems, transmission corridors are often upgraded to higher voltages and other technologies leading to another quality of human exposure. The study aims to determine human detection thresholds for direct current (DC), alternating current (AC), and hybrid electric fields (various DC; constant AC). METHODS: A total of 203 participants were exposed to DC, AC, and hybrid electric fields (EFs) in a highly specialized whole-body exposure laboratory using a double-blind experimental setting. Additionally, the participants were exposed to ion currents in part of the DC and hybrid sessions. To investigate environmental influences, relative humidity was changed in two subgroups during EF perception. Methods derived from the signal detection theory and the adaptive staircase procedure based on the single interval adjustment matrix were used to assess individual sensitivity and detection thresholds, respectively. RESULTS: The results indicated that detection thresholds of hybrid EF were lower compared to single EF presentation of DC or AC. Ion current exposure enhanced EF perception. High relative humidity facilitated DC EF perception, whereas low relative humidity reinforced the perception of AC EFs. CONCLUSIONS: With this systematic investigation of human perception of DC, AC, and hybrid EFs, detection thresholds were provided, which can help improve the construction processes of energy transmission systems and the prevention of unwanted sensory perception by contributing to the determination of limit values.

Which factors influence the frequency of participation in longitudinal cohort studies? - An analysis of demographics, social factors, and medical preconditions in participants of the health effects in high level exposure to polychlorinated biphenyls (HELPcB) cohort.

The continuous drop out of participants in longitudinal studies is a trend that may be observed in nearly all fields of medical research. A reduced participation rate might compromise the power of statistical analysis as well as lead to an attrition bias of the study. The aim of this analysis was to identify influencing factors on participation frequency in the monitoring program Health Effects in High Level Exposure to polychlorinated biphenyls (HELPcB) study, a cohort investigation of occupationally polychlorinated biphenyls (PCB) exposed individuals. The HELPcB study was initiated in 2010 and consisted of 7 study visits. At the last cross-section in 2019, less than one third of the included patients still actively participated. As possible influencing factors on study participation frequency, demographic, social, and medical characteristics of the participants were examined. In addition, a logistic regression model to predict study participation behavior was calculated. An overall higher frequency of participation was observed, if participants joined the program together with relatives or friends and had a higher age. For PCB plasma levels, an exceedance of the biological reference value (BAR) and further factors, such as (1) professional qualification, (2) later inclusion, (3) type of participant and (4) occupational-related disease notification, significant differences in the participation frequency were observed in the univariate analysis. Only age and joined study participation remained significant in the multivariate logistic regression. In conclusion, it was possible to identify several social and occupational-related factors that influence the frequency of participation of study attendees.

Identification of Environmental and Experimental Factors Influencing Human Perception of DC and AC Electric Fields.

As part of the energy transition in Germany, high-voltage direct current (HVDC) lines producing DC electric fields (EF) are in planning. Since the human perception of DC EF was rarely investigated in the past, we aimed to identify environmental and experimental factors influencing the human perception of direct current (DC) EF, alternating current (AC) EF, and the co-exposure of DC EF and AC EF (hybrid EF) under whole-body exposure. Additionally, first estimates of DC EF and AC EF perception thresholds as well as differences in human perception of DC EF and AC EF concerning the type of sensation experienced and the affected body part were evaluated. A highly sophisticated exposure lab was built to expose participants to various EF strengths and ask for their assessment concerning the presence of an EF. To estimate the individual perception thresholds of 11 participants, the signal detection theory as well as the single-interval-adjustment matrix procedure were applied. Relative humidity could be identified as an environmental factor influencing the perception of AC EF and DC EF in different ways. An appropriate ramp slope and an exposure duration for future studies could be elaborated. Additionally, perception thresholds were lower under hybrid EF exposure than under DC EF or AC EF exposure alone. Cutaneous sensations evoked under DC EF and AC EF exposure were individually different and attributed to various parts of the body. Several environmental and experimental factors influencing the human perception of EF could be identified and provide an essential basis for a large-scale study. © 2021 Bioelectromagnetics Society.

PCB plasma level in different occupational groups in Iran.

Despite the ban of polychlorinated biphenyls (PCBs) some decades ago, concerns regarding their adverse health effects are continuing, because the workers employed for installation and repair of electrical equipment may be still exposed to PCBs. This study aimed to assess serum PCBs levels in workers in different industries. To do this, we determined the serum concentrations of 9 non-dioxin-like PCBs and 12 dioxin-like PCBs in 147 workers from seven occupational groups and 35 housewives. An electrical distribution company, paint manufacturer, and pesticide manufacturer were categorized as high probability exposure jobs, whereas turning and casting operations, polymer plastic manufacturing, professional driving, and office work were categorized as low probability exposure jobs. In addition, the average of PCB 138, 153, and 180 and PCB sums were observed to be significantly higher in paint manufacture workers compared to the another groups. In addition, the average PCB 118 level was higher in electrical distribution workers and housewives. Following the adjustment for age, blood lipid, residency place, and seafood in the regression model, the association of PCB 118 in electrical distribution workers and PCB 153 in paint manufacture workers remained significant. The results of this study served as further support for the hypothesis for an occupational basis for bioaccumulation of some PCB types. However, the plasma levels of almost all PCB congeners in Iran were found to be lower than many other countries.

Functional and structural liver abnormalities in former PCB exposed workers - analyses from the HELPcB cohort.

The effects of polychlorinated biphenyls (PCB) on liver function and structure are still under debate. Although higher transaminase activity and tumor promoting potential of PCB reported for animal and human studies was suggested, these studies were not able to provide definitive evidence on the ability of these chemicals to affect liver function and contribution to tumor development. The aim of this study was to determine the influence of PCB on liver function and morphology in a cohort of former PCB exposed workers. Over 5 years, a longitudinal analysis of the association between PCB concentration and hepatic transaminases such as alanine transaminase (ALT) aspartate amino transaminase (AST) and gamma glutamyltransferase (γGT), as well as liver size and structure was undertaken. Data demonstrated a significant inverse association between PCB concentration and γGT activity levels but there was no marked relationship with AST and ALT activities. Regarding sonographic examination, a significant association was found between liver size and PCB concentration. This association remained, even after adjusting for alcohol consumption, liver affecting drugs, timespan of internal exposure, or age. No marked correlation was noted between PCB concentration and liver structure changes. In summary, an association was observed between PCB concentration and γGT activity levels as well as liver size in humans. The long-term health consequences attributed to PCB on liver and in particular in tumorigenesis are not foreseeable in our cohort thus far, but remain a focus in further ongoing surveillance.

[The distribution of cardiovascular risk factors in employees from small- and medium-sized enterprises in Germany]. / Die Verteilung von kardiovaskulären Risikofaktoren bei Beschäftigten in kleinen und mittleren Unternehmen in Deutschland.

BACKGROUND: The German Prevention Act, the main parts of which came into force on 25 July 2015, encourages health promotion and prevention programs for people in their living environment. Through this act, preventive measures could reach employees at work that hardly seek medical services. This is of importance since employees with a low occupational position often show risk factors that increase morbidity and mortality. METHODS: In this study, clinical data from n = 2280 employees from small and medium sized enterprises (SME) were analyzed for economic sector, sex, socioeconomic position (SEP), economic sector cardiovascular risk factors, musculoskeletal and psychological diseases. The socioeconomic position was categorized using the European Socioeconomic Classification into an intermediate/high and a low SEP category. RESULTS: Male employees showed a significantly higher occurrence of risk factors, such as smoking, diabetes or hypertension in comparison to female employees. In the manufacturing industry, male employees with a low SEP showed a higher prevalence of diabetes (2.3 vs. 5.9%), smoking (27.4 vs. 46.5%), and physical inactivity (sports: 55.0 vs. 37.1%) in comparison to employees with an intermediate/high SEP. Male employees with a low SEP from health and social services reported psychiatric disorders more frequently in comparison to those with an intermediate/high SEP (0.7 vs. 5.9%). CONCLUSION: Male employees with a low SEP should be given special consideration in the implementation of preventive measures at work within the framework of the Prevention Act.

Telomeres and Telomerase in Hematopoietic Dysfunction: Prognostic Implications and Pharmacological Interventions.

Leukocyte telomere length (TL) has been suggested as a marker of biological age in healthy individuals, but can also reflect inherited and acquired hematopoietic dysfunctions or indicate an increased turnover of the hematopoietic stem and progenitor cell compartment. In addition, TL is able to predict the response rate of tyrosine kinase inhibitor therapy in chronic myeloid leukemia (CML), indicates clinical outcomes in chronic lymphocytic leukemia (CLL), and can be used as screening tool for genetic sequencing of selected genes in patients with inherited bone marrow failure syndromes (BMFS). In tumor cells and clonal hematopoietic disorders, telomeres are continuously stabilized by reactivation of telomerase, which can selectively be targeted by telomerase-specific therapy. The use of the telomerase inhibitor Imetelstat in patients with essential thrombocythmia or myelofibrosis as well as the use of dendritic cell-based telomerase vaccination in AML patients with complete remissions are promising examples for anti-telomerase targeted strategies in hematologic malignancies. In contrast, the elevation in telomerase levels through treatment with androgens has become an exciting clinical intervention for patients with BMFS. Here, we review recent developments, which highlight the impact of telomeres and telomerase targeted therapies in hematologic dysfunctions.

A high BMI is a risk factor in younger patients with de novo acute myelogenous leukemia.

Overweight and obese patients have an increased risk to develop several malignancies and, additionally, body mass index (BMI) impacts on outcome in several solid tumors. However, little is known for AML. We analyzed a cohort of 3526 patients with AML treated in three prospective multicenter trials within the German Study Alliance Leukemia. In multivariate analyses, we identified BMI as an independent risk factor for both DFS (HR 1.014, P = 0.0217) and OS (HR 1.015, P < 0.0036). Interestingly, overweight and obesity seemed to be a risk factor predominantly in patients with de novo AML younger than 65 yr with intermediate risk and adverse cytogenetics. Overweight with a BMI ≥25 kg/m² best discriminated the worse outcome and led to an absolute reduction in long-term survival of 5-7% in the group of all younger patients (3-yr OS 39.9% vs. 47.3%; 10-yr OS 28.7% vs. 33.8%, P = 0.0002). Additionally, response to induction therapy was significantly reduced in these patients (76.9% vs. 82.8%, P < 0.0001). Thus, in younger patients with de novo AML, overweight and obesity are risk factors for impaired response to induction therapy, DFS and OS. This effect is, in part but not fully, explained by dose reduction such as dose-capping at a body surface area of 2 m².

Bridging the knowledge gap! Health outcomes in informal e-waste workers.

BACKGROUND: Although several studies analyzed the impact of e-waste recycling on human health, most publications did not differ between e-waste workers and bystanders, such as residents. This could lead to an underestimation of health effects in workers. In addition, frequently reported surrogate findings do not properly reflect clinical significant health outcomes. The aim of this review was to analyze the direct health effects of informal e-waste recycling in informal e-waste workers. METHODS: According to PRISMA guidelines, we systematically searched 3 databases (Embase®, PubMed®, Web of Science) for studies from low- and middle-income countries published in German or English between 1980 and 1 November 2021. Of the 2613 hits, 26 studies (cross-sectional, longitudinal and case-control studies) met the specified criteria and were included. We categorized the results into hormonal, respiratory, renal, cardiovascular, musculoskeletal health and general symptoms in informal e-waste workers. RESULTS: Exposure to e-waste was associated with altered lipid metabolism, thyroid hormonal imbalances, impaired fertility, renal dysfunction, increased prevalence of respiratory symptoms, asthma, cardiac arrhythmias, hypertension, musculoskeletal pain, injuries in up to 89% and skin disorders in up to 87.5-100% of e-waste workers. CONCLUSION: Due to inconsistent findings, weak associations or poor study quality, it has rarely been possible to establish a causal relationship between informal e-waste work and health effects, except for injuries or skin conditions. Besides high-quality studies, a collective national and international political focus on e-waste disposal is needed.

The role of the DC component in human perception of AC-DC hybrid electric fields and a comparison with the AC component.

As part of the energy transition in Germany, high-voltage overhead power lines will be operated using hybrid systems that combine alternating and direct current (AC and DC). The degree to which humans perceive hybrid electric fields (EFs) is dependent on the proportion of both EF types. To investigate the impact of the DC component, a study assessed 49 participants with above-average EF detection ability under conditions with a low DC component of 1-4 kilovolts per meter (kV/m) and varying AC EFs between 1 and 14 kV/m. The detection thresholds of combined AC/DC EFs decreased with an increase in the DC component and ranged from 9.6 to 6.83 kV/m on average for the group. The results suggest that even minor variations in the DC component significantly affect human perception of hybrid EFs. These findings complement the results of an earlier study that investigated the AC component in hybrid EFs. Correlational analyses of both studies demonstrated the reliability of participants' performance. This study contributes to our understanding of EF-related effects on human perception and can aid in the planning of energy transmission near areas where humans work or live.

Mercury Exposure and Its Health Effects in Workers in the Artisanal and Small-Scale Gold Mining (ASGM) Sector-A Systematic Review.

Gold is one of the most valuable materials but is frequently extracted under circumstances that are hazardous to artisanal and small-scale gold miners' health. A common gold extraction method uses liquid mercury, leading to a high exposure in workers. Therefore, a systematic review according to the PRISMA criteria was conducted in order to examine the health effects of occupational mercury exposure. Researching the databases PubMed®, EMBASE® and Web of ScienceTM yielded in a total of 10,589 results, which were screened by two independent reviewers. We included 19 studies in this review. According to the quantitative assessment, occupational mercury exposure may cause a great variety of signs and symptoms, in particular in the field of neuro-psychological disorders, such as ataxia, tremor or memory problems. However, many reported symptoms were largely unspecific, such as hair loss or pain. Most of the included studies had a low methodological quality with an overall high risk of bias rating. The results demonstrate that occupational mercury exposure seriously affects miners' health and well-being.

A Changing Home: A Cross-Sectional Study on Environmental Degradation, Resettlement and Psychological Distress in a Western German Coal-Mining Region.

Unwelcome environmental changes can lead to psychological distress, known as "solastalgia". In Germany, the open-pit mining of brown coal results in environmental changes as well as in the resettlement of adjacent villages. In this study, we investigated the risk of open-pit mining for solastalgia and psychological disorders (e.g., depression, generalized anxiety and somatization) in local communities. The current residents and resettlers from two German open-pit mines were surveyed concerning environmental stressors, place attachment, impacts and mental health status. In total, 620 people responded, including 181 resettlers, 114 people from villages threatened by resettlement and 325 people from non-threatened villages near an open-pit mine. All groups self-reported high levels of psychological distress, approximately ranging between 2−7.5 times above the population average. Respondents from resettlement-threatened villages showed the worst mental health status, with 52.7% indicating at least moderate somatization levels (score sum > 9), compared to 28% among resettlers. We observed a mean PHQ depression score of 7.9 (SD 5.9) for people from resettlement-threatened villages, 7.4 (SD 6.0) for people from not-threatened villages, compared to 5.0 (SD 6.5) for already resettled people (p < 0.001). In conclusion, the degradation and loss of the home environment caused by open-pit mining was associated with an increased prevalence of depressive, anxious and somatoform symptoms in local communities. This reveals a need for further in-depth research, targeted psychosocial support and improved policy frameworks, in favor of residents' and resettlers' mental health.

The role of the AC component in human perception of AC-DC hybrid electric fields.

Electric energy is essential to today's society. To cope with global higher demand while minimizing land use, efficient high voltage direct current (HVDC) power lines are planned to be mounted on existing alternating current (AC) structures leading to electric fields (EFs) from both AC and DC transmission lines in hybrid configurations. Due to the close proximity to residential areas, the investigation of human hybrid EF perception and underlying mechanisms will be useful to project permitting. To specify the influence of the AC component on the whole-body detection thresholds of hybrid EFs and to explore the lower bound of human hybrid EF perception, 51 participants with an EF detection ability above average were exposed in a double-blind laboratory study. A psychophysical method based on the signal detection theory was used. Very low EF strength combinations, e.g. 1 kV/m AC combined with 1 kV/m DC, were reliably perceived by at least one participant. Detection thresholds were significantly lower with increased AC EF strengths, underlining the key role of the AC component in the human perception of hybrid EFs. Findings will contribute to the assessment of public reaction to the perception of EFs around hybrid overhead power lines and to their optimal designs.