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.

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.

[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.

The relationship of modern health worries to non-specific physical symptoms and perceived environmental sensitivity: A study combining self-reported and general practice data.

OBJECTIVE: The present study investigates the association of modern health worries (MHW) with self-reported as well as general practitioner (GP)-registered non-specific physical symptoms (NSPS), medication use, alternative therapy consultations, sleep quality and quality of life. The interrelation between MHW, general environmental sensitivity and the aforementioned outcomes is also explored. METHODS: Self-reported questionnaires and data from electronic medical records from 21 general practices in The Netherlands were combined in a sample of 5933 adult participants. RESULTS: The majority of the participants reported increased worries about potential health effects from environmental exposures. The highest worry scores were reported by people who perceived themselves as more vulnerable to environmental stressors. After adjustment for socio-demographic characteristics and diagnosed psychiatric morbidity, higher MHW were significantly associated with increased self-reported prevalence and duration of NSPS, symptom-related healthcare utilization, GP-registered NSPS, alternative therapy consultations and lower sleep quality and quality of life. These associations were statistically mediated by perceived environmental sensitivity. No association was observed between worries and GP-registered medication prescriptions. CONCLUSION: Modern health worries are very common in the general population. They are associated with self-reported as well as clinically defined NSPS and as such might play a key role in the process of developing and maintaining environmental sensitivities and related symptoms. A large cross-cultural longitudinal study would help to determine important aspects such as temporal precedence and stability of MHW and the relevant psychosocial context within which symptomatic conditions occur.

Prevalence of ragweed allergy in rural Geneva - a pilot study.

OBJECTIVE: The prevalence of ragweed allergy is increasing worldwide. Ragweed distribution and abundance is spreading in Europe in a wide area ranging from the Rhone valley in France to Hungary and Ukraine, where the rate of the prevalence can peak at as high as 12%. Low-grade ragweed colonisation was seen in Geneva and Ticino, less than two decades ago. There were fears that allergies to ragweed would increase Switzerland. The intent of this study was to assess the rate of prevalence of sensitisation and allergy to ragweed in the population living in the first rural Swiss setting where ragweed had been identified in 1996, and to evaluate indirectly the efficacy of elimination and containment strategies. MATERIAL AND METHODS: In 2009, 35 adults in a rural village in the Canton of Geneva were recruited. Data were collected by means of questionnaires and skin-prick tests were done on each participant. The study was approved by the local Ethics Committee. RESULTS: Based on questionnaires, 48.6% had rhinitis (95% confidence interval [CI] 32.9-64.4; n = 17/35) and 17.1% asthma (95% CI 8.1-32.6; n = 6/35). Atopy was diagnosed in 26.4% (95% CI 12.9-44.4) of the sample (n = 9/34). Ragweed sensitisation was found in 2.9% (95% CI 0.7-19.7; n = 1/34), mugwort sensitisation in 2.9% (95% CI 0.1-14.9; n = 1/35), alder sensitisation in 17.1% (95% CI 6.6-33.6; n = 6/35), ash sensitisation in 12.5% (95% CI 3.5-29.0; n = 4/32) and grass sensitisation in 22.9% (95% CI 10.4-40.1; n = 8/35). Ragweed (95% CI 0.1-14.9; n = 1/34) and mugwort allergies (95% CI 0.1-14.9; n = 1/35) were both found in 2.9% of the population. CONCLUSION: This study showed a surprisingly low incidence of ragweed sensitisation and allergy, of 2.9% and 2.9%, respectively, 20 years after the first ragweed detection in Geneva. The feared rise in ragweed allergy seems not to have happened in Switzerland, compared with other ragweed colonised countries. These results strongly support early field strategies against ragweed.

Fine particulate air pollution and outpatient department visits for headache in Taipei, Taiwan.

This study was undertaken to determine whether there was an association between fine particle matter (PM(2.5)) levels and daily outpatient department visits (OPD) for headaches in Taipei, Taiwan. Daily OPD visits for headaches and ambient air pollution data for Taipei were obtained for the period 2006-2011. The relative risk of visits for OPD headaches was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased OPD visits for headaches were significantly associated with levels of PM(2.5) both on warm days (>23°C) and cool days (<23°C), with an interquartile range rise associated with a 12% (95% CI = 10-14%) and 3% (95% CI = 1-5%) elevation in OPD visits for headaches, respectively. In the two-pollutant models, PM(2.5) remained significant after inclusion of sulfur dioxide (SO2) or ozone (O3) on both warm and cool days. This study provides evidence that higher levels of PM(2.5) increase the risk of OPD visits for headaches in Taipei, Taiwan.

Short-term effects of airborne ragweed pollen on clinical symptoms of hay fever in a panel of 30 patients

Objectives: Ragweed, Ambrosia artemisiifolia , is a highly allergenic annual herbaceous plant that is spreading quickly across the globe. Few studies have investigated the relationship between ragweed pollen counts and hay fever symptoms. We investigate the dose-response relationship between ragweed exposure in patients sensitized to ragweed and daily hay fever symptoms. Method: A panel study was conducted among 31 adult patients sensitized to A artemisiifolia in France and Switzerland. Rhinitis, conjunctivitis, and bronchial symptoms were recorded daily, as well as daily pollen counts of ragweed, air pollutants, and meteorological data over 2 successive years. Data were analyzed with generalized estimating equation models to quantify effects of ragweed pollen whilst controlling for confounders. Results: The relationship between ragweed pollen and the percentage of patients with nasal, ocular, and bronchial symptoms was linear. For every increase of 10 grains/m 3 , the odds ratio (OR) (95% confidence interval) for nasal symptoms was, in 2009, 1.18 [1.04-1.35] on weekdays and 1.43 [1.16-1.75] at weekends, and in 2010, 1.04 [1.00-1.07] on weekdays and 1.25 [1.06-1.46] at weekends. The OR for ocular symptoms was 1.32 [1.16-1.56] in 2009 and 1.05 [1.02-1.07] in 2010. Finally, the OR for bronchial symptoms was 1.14 [1.03- 1.25] in 2009 and 1.03 [0.97-1.08] in 2010. Conclusion: There is a statistically significant linear relationship between ragweed pollen counts and hay fever symptoms. Our study shows that nasal symptoms differ on weekdays and at weekends (AU)

Objetivos: La Ambrosia artemisiifolia es una planta herbácea, altamente alergénica, que tiende a extenderse mundialmente muy rápidamente. Muy pocos estudios han investigado la relación de los contajes de polen de ambrosia con la intensidad de los síntomas. En este trabajo hemos documentado la relación dosis/respuesta entre la exposición a ambrosia, en pacientes sensibilizados a este polen, y la intensidad de su sintomatología Métodos: En el estudio se incluyeron 31 pacientes residentes en Francia o Suiza y sensibilizados a Ambrosia artemisiifolia . Durante dos años consecutivos, se registraron diariamente los síntomas oculares, nasales y bronquiales de los pacientes, los niveles de polen de ambrosía, los niveles de contaminantes ambientales junto con los datos. El análisis de los datos se realizó mediante la construcción de modelos de ecuaciones de estimación generalizada, de forma que se pudiera cuantificar los efectos del polen de ambrosia y controlando las variables de confusión. Resultados: La relación entre los recuentos de polen de ambrosía y el porcentaje de pacientes con síntomas nasales, oculares y bronquiales fue linear. Para cada incremento de 10 granos/m 3 , el OR para los síntomas nasales, en el año 2009, fue 1.18 [1.04-1.35] durante los días entre semana, y 1.43 [1.16-1.75] durante el fin de semana, y en 2010, 1.04 [1.00-1.07] durante los días entre semana y 1.25 [1.06-1.46] durante el fin de semana; el OR para los síntomas oculares fue de 1.32 [1.16-1.56] en el 2009 y 1.05 [1.02-1.07] en el 2010; el OR para los síntomas bronquiales fue 1.14 [1.03-1.25] en 2009 y 1.03 [0.97-1.08] en 2010. Conclusión: Hemos demostrado una relación lineal significativa entre los recuentos de polen de ambrosía y los síntomas de la polinosis en los pacientes sensibilizados. Nuestro estudio también demostró que el nivel de molestias difiere entre los días entre semana comparados con los del fin de semana (AU)

Characterization of profilin and polcalcin panallergens from ash pollen

Background: Ash ( Fraxinus excelsior ) is an important source of allergenic pollen in temperate areas of Europe. Profilin and polcalcin are 2 important panallergens involved in cross-reactivity between different sources. Objective: To clone and produce Fra e 2 (profilin) and Fra e 3 (polcalcin) as recombinant proteins and evaluate their immunological properties using the natural forms obtained from ash pollen. Methods: Total RNA from ash pollen was used as a template to obtain the specific complementary DNA (cDNA) sequences of the 2 panallergens. The cDNA-encoding sequences were cloned into the pET11b expression vector and used to transform BL21 (DE3) Escherichia coli cells. Proteins were expressed, purified by chromatography, and characterized structurally by circular dichroism, mass spectrometry, and immunologically by western blot and ELISA using profilin and polcalcin polyclonal antibodies and human sera from ash pollen-sensitized patients. Results: Profilin and polcalcin amino acid sequences from ash pollen showed a high degree of identity with homologous allergens from different sources. The cDNA-encoding allergen sequences were expressed as nonfusion recombinant proteins and purified to homogeneity. Secondary structure values were similar to those obtained from other members of these families. Allergenic properties of the recombinant allergens were observed to be equivalent to those of the natural counterparts of F excelsior pollen. Conclusions: Fra e 2 and Fra e 3 recombinant allergens might be used in clinical diagnosis to determine profilin- and polcalcin-specific IgE levels present in the sera of ash pollen-sensitized patients, thus facilitating the finding of the sensitizing source in areas with complex sensitization profiles (AU)

Antecedentes: El polen de fresno (Fraxinus excelsior ) es una importante fuente alergénica en zonas cálidas de Europa. La profilina y polcalcina son 2 panalérgenos implicados en reactividad cruzada. Objetivos: Clonar y producir Fra e 2 (profilina) y Fra e 3 (polcalcina) como alérgenos recombinantes. Comparar sus propiedades inmunológicas con sus formas naturales del polen de fresno. Métodos: El RNA total de polen de fresno se utilizó como molde para obtener los cDNAs específicos de ambos panalérgenos. Dichos cDNAs se clonaron en el vector de expresión pET11b y se transformaron células de Escherichia coli BL21(DE3). Las proteínas se caracterizaron mediante dicroísmo circular, espectrometría de masas, inmunodetección en membrana y ELISA utilizando anticuerpos policlonales frente a profilina y polcalcina y sueros de pacientes alérgicos al polen de fresno. Resultados: Las secuencias de aminoácidos de la profilina y polcalcina de polen de fresno presentaban una identidad de secuencia elevada con alérgenos homólogos. Dichos alérgenos se expresaron como proteínas recombinantes independientes y se purificaron a homogeneidad. Los valores de estructura secundaria fueron similares a los de otros miembros de estas familias. Las propiedades alergénicas de los alérgenos recombinantes resultaron ser equivalentes a los de sus homólogos naturales del polen. Conclusiones: Los alérgenos recombinantes Fra e 2 y Fra e 3 podrían usarse en diagnóstico clínico para determinar los niveles de IgE específicos para profilina y polcalcina en los sueros de los pacientes sensibilizados al polen de fresno, facilitando así la identificación de la fuente sensibilizante en áreas donde los pacientes presentan perfiles alergénicos complejos (AU)

[Environmental medicine counselling in daily medical practice]. / Erfahrungen des Pilotprojektes "Umweltmedizinisches Beratungsnetz" des Vereins Ärztinnen und Ärzte für Umweltschutz (AefU).

Since 2008, the Swiss Society of Doctors for the Environment runs a small interdisciplinary environmental medicine counselling structure for patients with complaints attributed to environmental exposures. The model is embedded in everyday practice with a central coordination and consultation office as well as a network of general practitioners interested in environmental medicine who make environmental medical assessments and consultations based on a standardised protocol in their practices. If necessary, environmental experts are consulted and home investigations are conducted. An evaluation study concluded that this model is feasible and addresses an existing need. The assessment option is experienced as helpful by patients. The interdisciplinary collaboration with environmental experts has proved to be effective. The aim of the assessment is to detect or to rule out common diseases and to analyse the impact of suspected environmental burden on the complaints in order to find individual therapeutic approaches. The progression of common medical and psychiatric illnesses can be negatively affected by environmental influences, too. The main instrument of the assessment is an extensive medical and psycho-social history with an additional environmental history including a systematic questionnaire and environmental key questions. Close collaboration with the family doctor is crucial. Assessment steps can be streamlined and consultation suggestions can be embedded in the family doctors holistic and lasting concept of treatment. Where possible our society gladly provides family doctors with our practical environment-related expertise. It is an important concern for us to make environmental medicine an integral part of primary care, also in the process of informing the patient about the prevention of and precautions against harmful or potentially harmful environmental burdens. We hope that the experiences made in our project will contribute to this goal.

The search for reliable biomarkers of disease in multiple chemical sensitivity and other environmental intolerances.

Whilst facing a worldwide fast increase of food and environmental allergies, the medical community is also confronted with another inhomogeneous group of environment-associated disabling conditions, including multiple chemical sensitivity (MCS), fibromyalgia, chronic fatigue syndrome, electric hypersensitivity, amalgam disease and others. These share the features of poly-symptomatic multi-organ cutaneous and systemic manifestations, with postulated inherited/acquired impaired metabolism of chemical/physical/nutritional xenobiotics, triggering adverse reactions at exposure levels far below toxicologically-relevant values, often in the absence of clear-cut allergologic and/or immunologic involvement. Due to the lack of proven pathogenic mechanisms generating measurable disease biomarkers, these environmental hypersensitivities are generally ignored by sanitary and social systems, as psychogenic or "medically unexplained symptoms". The uncontrolled application of diagnostic and treatment protocols not corresponding to acceptable levels of validation, safety, and clinical efficacy, to a steadily increasing number of patients demanding assistance, occurs in many countries in the absence of evidence-based guidelines. Here we revise available information supporting the organic nature of these clinical conditions. Following intense research on gene polymorphisms of phase I/II detoxification enzyme genes, so far statistically inconclusive, epigenetic and metabolic factors are under investigation, in particular free radical/antioxidant homeostasis disturbances. The finding of relevant alterations of catalase, glutathione-transferase and peroxidase detoxifying activities significantly correlating with clinical manifestations of MCS, has recently registered some progress towards the identification of reliable biomarkers of disease onset, progression, and treatment outcomes.

[Preclinical health changes upon exposure to hydrocarbons of petroleum genesis].

A full-scale toxicological experiment established a complex of biochemical, clinical, and immunological parameters for the diagnosis of preconditions upon exposure to hydrocarbons, which was tested on children from two towns differing in the degree of ambient air pollution owing to hydrocarbons.

[Practical use of a methodology for assessing an aerogenic risk to human risk in the substantiation of a control area].

The aerogenic risk to health was assessed in the population living in an area under the influence of an petroleum refinery in order to define the ambient pollution hazard, to identify the leading risk factors and their sources for further development of the most effective managerial decisions to reduce the risk, which comprise the substantiation of the extent of a control area.

[Hygienic evaluation of the influence of environmental factors on adolescents' health in a gas-and-oil producing region].

Environmental factors in a gas-and-oil producing region were hygienically evaluated for their influence on the health of adolescents living in the towns of the Khanty-Mansi Autonomous District (KMAD) - Yugry. The air was found to be polluted by incomplete oil and gas combustion products from flares, by emission from emergency conditions at gas-and-oil-producing enterprises. The major ambient air pollutants were formaldehyde, nitrogen dioxide, and suspended solids. The hazard indices upon combined exposure to chemicals were 9.81, 7.65, 4.79, and 4.01 in Nizhnevartovsk, Surgut, Nefteyugansk, Khanty-Mansiysk, respectively. The population's potential health risk associated with a water factor in all the four towns was due to the presence of manganese and silicon. Hazardous substances available in the ambient air and water, as well as natural and climatic living conditions were ascertained to influence the health of adolescents. The results of the study served as a basis for substantiation of measures to reduce pollution of ambient air and drinking water supply objects in the KMAD-Yugry and a package of measures to improve the health of adolescents.

[Naturally caused imbalance of elements in the population of the Yamal Region (a review)].

The study has indicated that microelementosis in the natives and newcomers of Yamal is caused by the geochemical features of the region and supplemented by inadequate zinc intake. The region's waters differ in their hygienic standards and high levels of iron and the air is characterized by the latter's deficiency. Fe is ingested equally with water and foodstuffs while Cu and Zn are mainly with foods. The trace element status of the newcomers is considerably close to that in the natives of the North and associated with the chemical composition of the region's waters.

[Hygienic evaluation of the effects of petroleum hydrocarbons on crops].

Experience in standardizing the soil levels of chemicals suggests that the translocation hazard index is limiting for most standardized substances. The current unavailability of scientifically grounded maximum allowable concentration of soil petroleum generates a need for studies using this hazard index. The studies were made to examine different soil petroleum levels, by employing various test crops.

[Hygienic evaluation of the effect of petroleum hydrocarbons on the soils of megapolises].

The paper gives the results of studying the quantity of petroleum hydrocarbons in the Moscow soil, as well as the latter's hygienic evaluation by the changes in acidity (pH) and redox potential and by the sanitary state (the levels of Escherichia coli and viable helminthic eggs). The study has ascertained that the petroleum-polluted soils show changes in medium pH and redox conditions that determine the biological activity of the substances and the trend in their disintegration processes and revealed a relationship of thy sanitary state of Moscow soils to their level of petroleum hydrocarbons.

[Health effects of exposure to oil spills]. / La exposición a las mareas negras y sus efectos en la salud.

The sinking of the oil tanker Prestige off the coast of Galicia was not only the worst ecological disaster ever to affect Spain, it also led to thousands of people who participated in the cleanup of the contaminated areas being exposed to potentially dangerous toxic substances. As the airway is one of the principal routes of entry into the body of these toxic compounds, the possible effects of exposure to such spills is of particular interest and concern to respiratory specialists. The paucity of clinical information available on the subject was the motive for this paper, which reviews the scientific studies undertaken in the aftermath of other accidents involving oil tankers and concludes with a summary of the clinical and epidemiological data published to date on the Prestige oil spill.