A review of exposure assessment methods for epidemiological studies of health effects related to industrially contaminated sites.

BACKGROUND: this paper is based upon work from COST Action ICSHNet. Health risks related to living close to industrially contaminated sites (ICSs) are a public concern. Toxicology-based risk assessment of single contaminants is the main approach to assess health risks, but epidemiological studies which investigate the relationships between exposure and health directly in the affected population have contributed important evidence. Limitations in exposure assessment have substantially contributed to uncertainty about associations found in epidemiological studies. OBJECTIVES: to examine exposure assessment methods that have been used in epidemiological studies on ICSs and to provide recommendations for improved exposure assessment in epidemiological studies by comparing exposure assessment methods in epidemiological studies and risk assessments. METHODS: after defining the multi-media framework of exposure related to ICSs, we discussed selected multi-media models applied in Europe. We provided an overview of exposure assessment in 54 epidemiological studies from a systematic review of hazardous waste sites; a systematic review of 41 epidemiological studies on incinerators and 52 additional studies on ICSs and health identified for this review. RESULTS: we identified 10 multi-media models used in Europe primarily for risk assessment. Recent models incorporated estimation of internal biomarker levels. Predictions of the models differ particularly for the routes 'indoor air inhalation' and 'vegetable consumption'. Virtually all of the 54 hazardous waste studies used proximity indicators of exposure, based on municipality or zip code of residence (28 studies) or distance to a contaminated site (25 studies). One study used human biomonitoring. In virtually all epidemiological studies, actual land use was ignored. In the 52 additional studies on contaminated sites, proximity indicators were applied in 39 studies, air pollution dispersion modelling in 6 studies, and human biomonitoring in 9 studies. Exposure assessment in epidemiological studies on incinerators included indicators (presence of source in municipality and distance to the incinerator) and air dispersion modelling. Environmental multi-media modelling methods were not applied in any of the three groups of studies. CONCLUSIONS: recommendations for refined exposure assessment in epidemiological studies included the use of more sophisticated exposure metrics instead of simple proximity indicators where feasible, as distance from a source results in misclassification of exposure as it ignores key determinants of environmental fate and transport, source characteristics, land use, and human consumption behaviour. More validation studies using personal exposure or human biomonitoring are needed to assess misclassification of exposure. Exposure assessment should take more advantage of the detailed multi-media exposure assessment procedures developed for risk assessment. The use of indicators can be substantially improved by linking definition of zones of exposure to existing knowledge of extent of dispersion. Studies should incorporate more often land use and individual behaviour.

Assessment of essential and nonessential dietary exposure to trace elements from homegrown foodstuffs in a polluted area in Makedonska Kamenica and the Kocani region (FYRM).

UNLABELLED: The main purpose of the present study is to assess human dietary exposure to essential and non-essential trace elements via consumption of selected homegrown foodstuffs. Twelve essential and non-essential trace elements (Cd, Co, Cu, Cr, Hg, Mo, Ni, Pb, Sb, Se, Zn and As) were detected in various homegrown foodstuffs. Detailed questionnaires were also applied among a sample of the local population to collect information on sociodemographic characteristics. The results of the present study clearly indicate that the majority of the trace elements are at highly elevated levels in the studied foodstuffs, in comparison to international recommendations. The maximum measured levels of ETE and NETE are as follows [µgkg(-1)]: Cd 873, Co 1370, Cu 21700, Cr 59633, Hg 26, Mo 6460, Ni14.5, Pb 11100, Sb 181, Se 0.30, Zn 102 and As 693. Additionally, age, body mass index and gender were significantly associated with levels of dietary exposure. Further research is warranted on the potential health implication of this exposure. CAPSULE ABSTRACT: The study merges the accumulation of ETE and NETE in home-grown foodstuffs and reflects considerably high health risks for inhabitants.

Sonographic quantification of a hepato-renal index for the assessment of hepatic steatosis in comparison with 3T proton magnetic resonance spectroscopy.

CONTEXT: Nonalcoholic fatty liver disease is the most frequent hepatic disorder in the developed world. Currently, liver biopsy and proton magnetic resonance spectroscopy (H-MRS) are considered the gold standard methods for the quantification of liver fat deposits. OBJECTIVE: To determine whether a Sonographic Hepato-Renal Index (SHRI) calculated using a standard workstation, without a specifically designed software, is an adequate alternative to H-MRS for the quantification of fat liver content and diagnosis of steatosis in the general population. METHODS: A total of 121 volunteers (mean age=46 years, range=21-77 years) were recruited at three medical centers in Granada (Southern Spain) from among individuals attending routine general checkups. All participants were examined by ultrasound and by H-MRS 3T, which served as a reference for the diagnosis of steatosis. The SHRI was calculated as the ratio between the echogenicity of the liver and that of the right renal parenchyma. The validity of the methodology was assessed by receiver operating characteristic curves and correlation tests. RESULTS: The quantitative SHRI showed a strong correlation (Spearman's coefficient=0.89, P<0.001) with the H-MRS 3T. The optimal SHRI cutoff points of 1.21, 1.28, and 2.15 yielded 100% sensitivity for the diagnoses of steatosis greater than 5, 25, and 50%, respectively, with a specificity greater than 70%. CONCLUSION: This study shows that the SHRI is a valid, simple, reliable, and cost-effective screening tool for the identification, assessment, and quantification of hepatic steatosis in the general population.

Relationship between occupational social class and exposure to organochlorine pesticides during pregnancy.

BACKGROUND: Little evidence is available on the influence of socioeconomic factors on exposure to persistent organic pollutants, especially during vulnerable periods such as pregnancy and early life. OBJECTIVE: To investigate the relationship of maternal social class with placental concentrations of organochlorine pesticides (OCPs) and their combined estrogenic activity measured with a biomarker of exposure. METHODS: Exposure to 16 OCPs (DDTs, endosulfans, and seven other compounds) and the total effective xenoestrogenic burden (TEXB) were analyzed in placentas from a mother-child cohort. OCP concentrations were quantified by gas chromatography and mass spectrometry, and TEXB was assessed with the E-Screen bioassay. Social class was classified according to maternal occupation. Multivariate regression analysis was conducted to examine variations in pesticide exposure and TEXB as a function of maternal social class in 257 subjects. RESULTS: Placental p,p'-DDT concentrations were higher in social classes III and IV than in classes I-II (the most affluent); concentrations of the sum of DDTs were higher in class IV; and exposure to the sum of endosulfans was greater in class III. HCB concentrations were higher among women in class IV than in classes I-II and among manual (classes III-V) than non-manual workers. However, the trend across social classes was only statistically significant for HCB. Social class significantly explained 10% of the variability in concentrations of the sum of endosulfans. CONCLUSION: There is a need to explore whether more disadvantaged populations suffer higher levels of exposure to pesticides or other environmental chemicals and how different social processes contribute to this exposure.