Reaching the sustainable development goals through healthy environments: are we on track?

The adoption of the 2030 Agenda for Sustainable Development in 2015 opened new opportunities to work towards healthy environments through 'whole of government' and 'whole of society' approaches. It created a strong policy platform that acknowledges health as a result and an enabler of sustainable policies across all sectors of government. Five years into the process, an initial analysis of emerging trends indicates that, despite some encouraging developments in policy as well as overall progress in economy and technology, there remains a gap between rhetoric, ambition and reality. In particular, the monitoring system for environment and health-related sustainable development goals (SDGs) and targets requires further development; inequalities in environment and health persist and in some areas have increased; equity is not yet a central element of implementation and reporting on the achievement of the SDGs; and, most worrying of all, trends in key environmental indicators that are vital to the survival of the human species, such as those related to climate change and biodiversity, are still on an overall negative path. In summary, governments must significantly and rapidly increase action to secure the habitability and safety of planet Earth. The public health community assumes an unprecedented role in placing and maintaining health and equity at the heart of the political agenda. This demands new governance models conferring on the health sector a clear mandate and legitimacy to operate across sectors. It also requires enhancing capacities among health professionals to embrace this new level of complexity, understand the multiple links between sectoral policies and health, and successfully engage with other government sectors and stakeholders.

Mortality associated with exposure to carbon monoxide in WHO European Member States.

In closed environments, the concentration of carbon monoxide (CO) can easily rise to health-threatening levels. CO-related incidents are often caused by poor condition or inappropriate use of indoor combustion devices as well as structure fires but are also due to suicides. To evaluate the incidence of CO poisoning in Europe, national data on CO-related mortality and morbidity were compiled from Member States of the WHO European Region using a standardized data collection form. National data on CO poisoning were provided by 28 Member States. Within the maximum reporting period (1980-2008), a total of 140 490 CO-related deaths were reported (annual death rate of 2.2/100 000). The number of hospital admissions available from six countries was 31 473. Unintentional CO deaths accounted for 54.7% of the CO-related deaths (35.9%: unintentional inhalation; 18.8%: related to structure fires). The intentional deaths related to CO exposure account for 38.6% of all CO-related deaths (38.1%: suicides; 0.5%: homicides). CO exposure is preventable but causes a substantial amount of deaths in many European countries. More efficient measures and policies to prevent CO poisoning and better reporting of CO mortality are necessary.

Imidazole-induced contractility of vascular smooth muscle cells in the presence of U-73122, ODQ, indomethacin and 7-nitroindazole.

The aim of the study was to assess the impact of modulating factors on vascular smooth muscle cells reactivity. Vascular resistance was induced by the administration of increasing concentrations of imidazole. The experiments were performed on isolated and perfused tail artery of Wistar rats (weight 250 g - 350 g). Rats were been narcotized by urethane (intraperitoneal injection) at a dose of 120 mg/kg, stunned and then sacrificed by cervical dislocation. In the following investigation classical pharmacometric methods were used. Relationships between concentration-response curves (CRCs) for imidazole observed in the presence of ODQ [(1H-(1,2,4)oxadiazolo-[4,3-a]quinoxalin-1-one)], 7-nitroindazole and indomethacin were analyzed. Imidazole-induced contractility of vascular smooth muscle cells was independent from alpha-adrenergic receptors and PLC activity. Reactivity of VSMCsinduced by imidazole, was significantly changed in the presence of ODQ and 7-nitroindazole.

[The main conclusions about the medical aspects of air pollution: the projects REVIHAAP and HRAPIE WHO/EC].

For the time present the World Health Organization (WHO) is coordinating two major international projects aimed to provide the European Union (EU) with science-based information on health aspects of air pollution for a comprehensive analysis of EU policy in the field of air quality, scheduled for 2013. The information provided is structured in the form of answers to 26 policy-forming key questions, defined by the European Commission (EC). The questions cover the both general aspects that are important for air quality management, and also specific topics related to the health effects of certain air pollutants. Texts of the answers to the questions were provided on requests of large group of invited experts from leading specialized institutions around the world. First stages of the overview of existing data have shown that in recent years there has been published a significant amount of information proving adverse health effects of suspended particulate matter (PM), ozone (O3) and nitrogen dioxide (NO2) in an amount, which typically occurs in the air in Europe. These new data confirm the findings reported in renewed in 2005 WHO Guidelines for Air Quality (GAQ), and show that the negative health effects in some cases may take place at concentrations of aeropollutants in the air below mentioned in the GAQ in 2005. In the review there are presented the scientific arguments in favor of adoption of strong measures to improvement air quality and reduction of the burden of diseases associated with air pollution in Europe. The conclusions formulated within a framework of these projects, are equally referred to all Member States and can become a basis for the development and implementation of effective strategies to reduce air pollution and reduction of its negative impact on the health of the population.

Ventilatory lung function and chronic chest symptoms among the inhabitants of urban areas with various levels of acid aerosols: prospective study in Cracow.

The analysis carried out earlier in Cracow showed that the high level of SO2 and particulate matter (PM) alone cannot be responsible for an excess of chronic chest symptoms and faster lung function deterioration in the population at large. To check the hypothesis that acid aerosols present in the urban air may cause substantial damage of the lungs, data from a 13-year follow-up survey of chronic chest diseases in Cracow (1968-1981) have been reanalyzed. In the plan of the analysis, three areas of the city with various levels of sulfate and sulfur transformation ratio (STR) in the urban air have been defined. In each of the defined areas, the prevalence of chronic chest symptoms, as well as lung function decline, have been studied. In total, the lung function study group consisted of 1414 persons (584 males and 830 females). Those men who lived in the area with the higher sulfate and STR had lower FEV1 levels by about 151 mL than did the residents of the other areas, and this was equivalent to the effect of smoking. In females, the pattern was generally the same. In men, the FEV1 decline rate (mL/year) over the 13-year period was significantly faster by about 11 mL/year in the areas with higher and intermediate STR, which was again equivalent to the effect of smoking. It was found that the level of SO2 and PM in the urban air correlated with the symptom prevalence in women; however, it had no clear impact on lung function deterioration.

Epidemiologic studies on short-term effects of low levels of major ambient air pollution components.

Since the development of the World Health Organization (WHO) Air Quality Guidelines for Europe, a large number of epidemiologic studies have been published documenting effects of major air pollutants on health at concentrations below existing guidelines and standards. In this review, recent studies are discussed that permit some evaluation of short-term health effects observed at exposure levels lower than the current WHO Guidelines or U.S. Environmental Protection Agency (U.S. EPA) standards. Some studies have been conducted at concentration levels that never exceeded existing guidelines or standards. Other studies have been conducted at exposure levels sometimes exceeding current guidelines or standards. The published analyses of several of these studies permit evaluation of low-level health effects either because analyses were restricted to levels not exceeding the guidelines or graphic analyses were reported suggesting effects at these low levels. For ambient ozone, effects on lung function of subjects exercising outdoors have now been documented at 1-hr maximum levels not exceeding 120 micrograms/m3, i.e., half the current U.S. EPA standard. One study even suggests that such effects occur at levels below 100 micrograms/m3. Several studies are now available documenting effects of particulate air pollution on health in the virtual absence of SO2. Effects on mortality and hospital admissions for asthma have been documented at levels not exceeding 100 micrograms/m3, expressed as 24-hr average inhalable particles PM10 concentration. Effects on lung function, acute respiratory symptoms, and medication use have been found at 24-hr average PM10 levels not exceeding 115 micrograms/m3. When the WHO Air Quality Guidelines and the U.S. EPA standard for PM10 were developed, there were no studies available on health effects of PM10. In this review, we include nine studies documenting health effects of measured PM10 at low levels of exposure, indicating that there is now an entirely new epidemiologic database that can be evaluated in the process of revising current guidelines and standards. The low levels of exposure at which effects on health were seen underscore the urgent need for such reevaluations.

A study of the self-perception of being overweight in adult inhabitants of Cracow.

The self-assessment of body weight (normal vs overweight) reported in an interview in a group of 783 men and 1085 women aged 32-83, was compared with weight and height measurements taken a few days after the interview. Among subjects with body mass indices revealing excess weight (over 27 kg/m2 in men and 45 kg/m in women), 24% of men and 15% of women reported having normal body weight. The proportion of overweight persons unaware of their condition was related to age, smoking habit, education and physical activity. In men with hypertension, the proportion of subjects unaware of being overweight was smaller by 25% compared with others. This was not the case in women. A history of cardiovascular disease, diabetes, dyspnea or poor health status had no effect on the awareness of being overweight.

Relationships between pulmonary function and changes in chronic respiratory symptoms. Comparison of Tucson and Cracow longitudinal studies.

Parallel analyses of data from two longitudinal studies, one in Poland and one in the United States, were performed to assess the relationships between pulmonary function and respiratory symptoms. Similar relationships were seen in the both cities using the same methods of analysis. The rate of FEV1 decline and its final level were related to the prior presence of attacks of breathlessness or to a syndrome that also included wheezing and diagnosed asthma. Initial FEV1 level was lower in subjects with dyspnea appearing during the follow-up than in the never-symptom group. These relationships were independent of smoking habits. The consistencies in the parallel analyses strengthen the relationships observed. In Tucson, Ariz, the FEV1 decline in smokers with persistent chronic cough was greater than that due to separate effects of the symptom and smoking. This suggests that chronic cough may be an indicator of an increased effect of tobacco smoke on pulmonary function.

The relation of thirteen-year mortality to ventilatory impairment and other respiratory symptoms: the Cracow Study.

The relation of mortality to ventilatory function and some respiratory symptoms detected during interview has been studied in 3047 men and women followed-up for 13 years. The analysis was performed for all natural causes of death, and separately for deaths due to circulatory diseases and neoplasms. The results confirm the strong predictive power of ventilatory impairment for overall and circulatory mortality, even after adjustment for age, cigarette smoking and other factors in logistic regression models. The risk of cancer death in men increased with decrease of FEV1. However, chronic cough, mucus hypersecretion or asthmatic syndrome were not related to subsequent mortality. A strong predictor of overall and circulatory 'mortality' in men was also self-assessed health status. This was independent of other factors.

The relation of respiratory symptoms and ventilatory function to moderate occupational exposure in a general population. Results from the French PAARC study of 16,000 adults.

Data from the French PAARC (Pollution Atmosphérique et Affections Respiratoires Chroniques) study were used to assess the effect of a priori moderate occupational exposure to dust, gases or chemical fumes on the prevalence of respiratory symptoms and ventilatory function. In this community-based population, without households 'headed' by manual workers, 34% of the 8692 men and 23% of the 7772 women, 25-59 years of age, ever occupationally active, reported some exposure. The studied relationships were adjusted for age, height, smoking habits, socio-occupational class, education and air pollution by logistic or linear regression methods. For men and women, some 50% increase (p less than 0.01) in chronic cough, chronic bronchitis, dyspnoea grade 2 and wheezing prevalence was observed in the exposed group compared to the never exposed, with the strongest association for wheezing. FEV1 and FEF25-75% were not associated with occupational exposure. Among men, FEV1/FVC and FEF25-75%/FVC were significantly lower (p less than 0.001 and p less than 0.05) among the exposed compared to never exposed, but FVC was significantly greater (p less than 0.05). Among women, occupational exposure was significantly related to a lower FEV1/FVC in the subgroup with a history of asthma or wheezing. Results suggest that occupational exposures of relatively low intensity, encountered in the non-industrial work places may constitute a non-negligible risk for respiratory health.

Smoking cessation and changes in respiratory symptoms in two populations followed for 13 years.

To investigate the relationship between persistence and incidence rates of respiratory symptoms, and the cessation of cigarette smoking, the data from longitudinal studies conducted in Cracow, Poland and Tucson, USA were analysed jointly. Among 1722 subjects smoking at the beginning of the study, 468 had given up smoking at the 13-year follow-up. The persistence and incidence rates of chronic cough, chronic phlegm, wheeze and attacks of breathlessness were reduced by 50% in ex-smokers compared to the subjects continuing to smoke. The beneficial effects of smoking cessation were decreased in subjects smoking more cigarettes per day in the past and starting to smoke at a younger age. The symptoms were less likely if smoking ceased before the onset of any respiratory disease. These results were similar in the Cracow and Tucson populations, confirming the universal nature of the observations.

Respiratory effects of non-tobacco cigarettes: a longitudinal study in general population.

Data from four consecutive surveys of Tucson longitudinal study of airways obstructive disease were used to examine the relation of respiratory symptoms and pulmonary function to non-tobacco cigarette smoking. The surveys were conducted over a six-year period and provided data on 1802 subjects 15-60 years of age, with a total of 5659 individual questionnaires. Estimated odds ratio (OR) of current non-tobacco smoking for chronic cough was 1.73, for chronic phlegm: 1.53, and for wheeze: 2.01 (p less than 0.05). These estimates were adjusted for age, tobacco smoking and occurrence of the symptom in preceding survey. The increased risk of the symptoms was related to the habit continued for several years, and there was no immediate remission of the symptoms after quitting smoking. A significant (p less than 0.05) reduction in pulmonary function (FEV1, Vmax50 and their ratios with FVC) was found a year or more after current non-tobacco smoking was reported. Although the average consumption of non-tobacco cigarettes, believed to be marijuana smoking, was less than one per day, significant effects were still detectable in both pulmonary function and respiratory symptoms.

Ten-year mortality in a sample of an adult population in relation to air pollution.

The 10-year mortality in a sample of adult inhabitants of Cracow, Poland, was analysed according to the levels of air pollution in the area of residence. Smoking habit and several social and occupational factors were considered in the analysis, which was carried out with the use of a multivariate method for categorical variables. Among men the main effect of air pollution was marginally significant, but there was a significant interaction between air pollution and smoking. Among women no such relation could be detected. Also, the association between female mortality and smoking was not significant. From other factors considered in the analysis, only exposure at work to dust, high humidity, and variable temperature was related to mortality in both men and women. In addition among women higher mortality was related to a lower level of education.

A modified method for isolating alpha-amylase from rabbit skeletal muscle.

A modified method for purifying alpha-amylase from rabbit skeletal muscle is described, which in comparison with the previously published method gives better results of isolation and is economical, less time-consuming, and require less material. The former method gave 1,340-fold purification of the enzyme with a yield of 0-6%, and the new method 2,014-fold purification and 7-6% yield. Electrophoresis in polyacrylamide gel showed absence of a strictly defined zone of enzyme activity and presence of inactive proteins.

Exposure assessment approaches to evaluate respiratory health effects of particulate matter and nitrogen dioxide.

Several approaches can be taken to estimate or classify total personal exposures to air pollutants. While personal exposure monitoring (PEM) provides the most direct measurements, it is usually not practical for extended time periods or large populations. This paper describes the use of indirect approaches to estimate total personal exposure for NO2 and particulate matter (PM), summarizes the distributions of these estimates, and compares the effectiveness of these estimates with microenvironmental concentrations for evaluating effects on respiratory function and symptoms. Pollutant concentrations were measured at several indoor and outdoor locations for over 400 households participating in an epidemiological study in Tucson, Arizona. Central site monitoring data were significantly correlated with samples collected directly outside homes, but the former usually had higher pollutant concentrations. Integrated indices of daily total personal exposure were calculated using micro-environmental (ME) measurements or estimates and time-budget diary information. Peak expiratory flow rates (PEFR) were measured for up to four times a day during two-week study periods. In thirty children (ages 6-15 years) with current diagnosed asthma, a significant reduction in PEFR was associated with NO2 levels measured outside of their homes. Additional decrements of morning PEFR were found in those children sleeping in bedrooms with higher measured NO2 levels. Morning and noon PEFR decrements were also linked to higher morning NO2 levels that were measured at central monitoring stations. Effects of PM were also found, but were limited to morning PEFR. No effects were found in non-asthmatic children. The relationship of PEFR to the calculated indices of daily average total exposure were weaker than to the microenvironment concentrations. This suggests that diary and ME monitoring data need to yield better time resolution in order to incorporate short-term average exposures to higher concentrations into the exposure indices and into the analysis of within day health responses.

The post-mortem concentration of glutamate in the structures of rat brain as an exponent of short aversive sensory stimulation preceding death.

The problem of post-mortem assessment of short central fear reaction preceding death has been obscure till now. The preliminary results obtained by authors have encouraged them to further research on this topic. Time of aversive sensory stimulation in the presented study was considerably decreased in comparison to the preliminary investigations. The concentration of glutamate was assayed in the selected structures of limbic system and in the cerebellum. The rats were subjected to different simultaneous modalities of sensory stimulation. The involvement of the hippocampi and the cerebellum was revealed as measured by glutamate concentration increase in the whole structures homogenates. The dominant role of mechanical stimulus has been suggested based on the measured increase of glutamate concentration in the whole cerebellum homogenate. By using the presented experimental paradigm a possible application of the biochemical assessment of human brain tissue might be developed in the future for implementing in the field of forensic pathology. The biochemical evaluation of "frozen frames" of neurotransmission can possibly help reconstruct the events which had happened just before sudden and violent death.

Haemorrhages in head tissues during the asphyxiation process.

Two rates of carbon dioxide flow into the termination chamber were applied for the euthanasia of rats. The classical phases of asphyxia were observed in both groups of animals although their course was prolonged in rats exposed to the lower gas flow. The haemorrhages were assessed histologically in the following structures: the pericranium, compact bone and diploë of the skull, sagittal suture, nape muscle and its attachment, and the dura. The haemorrhages appeared regularly in the sagittal suture in all cases from both experimental groups. The possible significance of this phenomenon for the forensic practice was pointed out.

Total mercury in human renal cortex, liver, cerebellum and hair.

The aim of this study was: (a) to estimate the concentration of total mercury in the renal cortex, liver, cerebellum and hair of 46 persons who died suddenly in the Gdansk region, northern Poland, between the ages of 17 and 90; and (b) to assess whether a correlation occurs between mercury content in the investigated biological media. The mean concentrations of mercury in the human hair, renal cortex, liver and cerebellum were: 378 +/- 315.4 ng/g; 68.6 +/- 92.3 ng/g; 29.9 +/- 22 ng/g and 5.3 +/- 6.9 ng/g respectively. Positive correlations were found between mercury levels in: cerebellum and liver (r = 0.873), cerebellum and hair (r = 0.853), cerebellum and renal cortex (r = 0.578), hair and liver (r = 0.771), hair and renal cortex (r = 0.478) liver and renal cortex (r = 0.66). The geometric mean levels of mercury in the renal cortex, liver, cerebellum and hair in the residents of the Gdansk region are 15-19 times lower than in the population of Tokyo and its environs [Suzuki T, Hongo T, Yoshinaga J et al. The hair-organ relationship in mercury concentration in contemporary Japanese. Arch Environ Health 1993;44:361-365].

Cadmium content in human kidney and hair in the Gdansk region.

Concentrations of cadmium were determined in the renal cortex and hair of 67 persons who died between 1996 and 1997 in the Gdansk region of Poland. The mean concentrations in the renal cortex and the hair were: 39.8 +/- 21.45 micrograms/g and 0.35 +/- 0.33 microgram/g, respectively. The mean age of the population studied was 47.6 +/- 15.8 years. The concentration of cadmium in the renal cortex was age-dependent. In the age groups: 18-30, 31-40, 41-50, 51-60 and 61-90 it amounted to: 19.1 +/- 11.0 micrograms/g, 43.3 +/- 21.6 micrograms/g, 47.9 +/- 20.8 micrograms/g, 41.5 +/- 20.4 micrograms/g and 33.6 +/- 18.0 micrograms/g, respectively. No correlation between the cadmium contents in the renal cortex and hair has been established. Hair is not a good indicator of exposure to cadmium.

Selenium concentrations in human renal cortex, liver, and hair in northern Poland.

The aim of this study was to (1) determine the selenium concentration in the renal cortex, liver, and hair in 64 residents from northern Poland (Gdansk region) aged 17-81 yr, who died suddenly, and (2) assess whether a correlation between the selenium concentration in hair and in the renal cortex and liver occurs. Selenium was determined by atomic absorption spectrometry using the hydride generation method. The mean selenium concentration in the renal cortex, liver, and hair in the investigated persons was 0.791+/-0.191 microg/g (wet weight), 0.289+/-0.084 microg/g (wet weight), and 0.443+/-0.128 microg/g, respectively. No age-dependent differences in selenium level in the investigated tissues was found. Also, no correlation between the selenium concentrations in hair and in renal cortex and liver was assessed.