A call from 40 public health scientists for an end to the continuing humanitarian and environmental catastrophe in Gaza.

An under-recognised aspect of the current humanitarian catastrophe in Gaza is the impact of the war on the environment and the associated risks for human health. This commentary contextualises these impacts against the background of human suffering produced by the overwhelming violence associated with the use of military force against the general population of Gaza. In calling for an immediate cessation to the violence, the authors draw attention to the urgent need to rebuild the health care system and restore the physical and human infrastructure that makes a liveable environment possible and promotes human health and well-being, especially for the most vulnerable in the population. Environmental remediation should therefore form one of the most important parts of international efforts to assist reconstruction, through which we hope Palestinians and Israelis will achieve lasting peace, health, and sustainable development, all as part of accepted international human rights obligations.

Occupational health protection for health workers during the coronavirus disease 2019 (COVID-19) pandemic: 6P-approach in China.

Health workers (HW) are on the frontline fighting against the COVID-19 pandemic, they are exposed to multiple occupational hazards. This article analyzed the comprehensive measures of protecting HWs during the COVID-19 response in China. Occupational health protection of HWs was one of the key strategies of the public health measures adopted against the COVID-19 outbreak from the earliest stage in China. This prioritization of HWs health protection was based on the technical and policy guidance of WHO and International Labor Organization as well as the experiences from previous outbreaks in China. The comprehensive measures in China can be summarized as '6P-approach': public health emergency response, prompt learning from lessons, proactive measures of occupational health, precaution strategies against occupational hazards, personal protective equipment and medical devices supply, and professional networking. Through this 6P-approach, China was able to minimize the incidence of COVID-19 infection among HWs, while successfully containing the outbreak during the first quarter of 2020. Although the COVID-19 vaccines have been rolled out, however, the COVID-19 pandemic is still under rapidly evolving situation. Experiences from China may provide other countries with an example of prioritizing and incorporating occupational health protection of HWs in their public health measures responding to the COVID-19 pandemic.

Lead contamination of the mining and smelting district in Mitrovica, Kosovo.

Lead contamination in topsoil of the mining and smelting area of Mitrovica, Kosovo, was investigated for total concentrations and chemical fractions by sequential extraction analysis, mineralogical fractions by X-ray diffraction (XRD) and scanning electron microscopy with energy-dispersive X-ray spectrometer (SEM-EDX). The study revealed that all samples contained Pb exceeding USEPA standard of 400 mg kg-1. The highest total concentration of Pb (125,000 mg kg-1) was the soil from the former smelter. Sequential extraction results showed that the predominant form of Pb was associated with Fe-Mn oxide-bound fraction which ranged from 45.37 to 71.61% of total concentrations, while carbonate and silicate Pb-binding fractions were dominant when physical measurements (XRD and SEM-EDX) were applied. Application of Pb isotope ratios (206Pb/207Pb and 208Pb/206Pb), measured by inductively coupled plasma mass spectrometry, identified that Pb contamination is originated from similar anthropogenic source. The results reflected that the Pb contamination in the soil of this area is serious. In order to provide proper approaches on remediation and prevention of health impacts to the people in this area, a continuous monitoring and health risk assessment are recommended.

Status of water, sanitation and hygiene services for childbirth and newborn care in eight countries in East Asia and the Pacific.

Background: Water, sanitation and hygiene (WASH) services are critical to providing quality maternal and neonatal care in health facilities. This study aimed to investigate availability of WASH policies, standards, and services for childbirth and newborn care in hospitals in East Asia and the Pacific. Methods: Descriptive analysis of survey data and observations of water, sanitation and hygiene services in maternity and neonatal care rooms and of deliveries in 147 hospitals in Cambodia, Lao People's Democratic Republic, Mongolia, Papua New Guinea, Philippines, Solomon Islands, and Viet Nam. The main outcome measures were availability of national policies and standards; availability of water, sanitation, and hygiene services in maternity rooms and neonatal care units; and practice of hygiene at childbirth. Results: Four of eight countries had national WASH policies and four had standards for health facilities. Seventy-seven percent of hospitals had a sink with water and soap or alcohol hand rub in delivery rooms, 78% in neonatal care rooms and 43% in postnatal care rooms. Only 45% of hospitals had clean sinks with water, soap and hand drying methods in the delivery room, 37% in neonatal care units and 10% in postnatal care rooms. Flush toilets were available in or next to delivery rooms and neonatal care units in 53% of 15 hospitals with data. Countries with WASH standards had a higher proportion of hospitals with water and hand hygiene services. Appropriate hygiene was practiced by health workers in 66% of 388 deliveries observed, and more likely in delivery rooms with a sink, water and soap. Conclusions: Coverage of WASH services for maternal and newborn care must be improved to reduce risks of maternal and newborn morbidity and mortality.

Children's Environmental Health Indicators in Context of the Sustainable Development Goals for Small Island Developing States.

The unique environmental vulnerability of small island developing states (SIDS) is likely to impact negatively on children's health. Children's environmental health indicators (CEHI) are standardized measures that can be used to assess the environmental exposures and their resulting health outcomes in children. This study sought to utilize the United Nations (UN) global Sustainable Development Goals (SDGs), with their associated targets and indicators, as a framework for a CEHI proposal for SIDS. Exposure-side indicators were taken from key themes from the 2012 Rio+20 UN Conference on Sustainable Development, and health-side indicators were selected based on the most significant contributors to the burden of disease in children. The multiple-exposures⁻multiple-effect (MEME) framework was then used to show the relationships between environmental exposures and children's health outcomes. The framework was populated with available data from the World Bank's DataBank. Whilst there was some data available at a population level, major gaps in both exposure-side and health-side indicators were revealed. In order to progress children's environmental health in SIDS, a further piece of work is required to propose a fully prioritized set of exposure-side and health-side CEHIs; based on, but not exclusively linked to, the SDGs.

Health Impacts of Climate Change in Pacific Island Countries: A Regional Assessment of Vulnerabilities and Adaptation Priorities.

BACKGROUND: Between 2010 and 2012, the World Health Organization Division of Pacific Technical Support led a regional climate change and health vulnerability assessment and adaptation planning project, in collaboration with health sector partners, in 13 Pacific island countries-Cook Islands, Federated States of Micronesia, Fiji, Kiribati, Marshall Islands, Nauru, Niue, Palau, Samoa, Solomon Islands, Tonga, Tuvalu, and Vanuatu. OBJECTIVE: We assessed the vulnerabilities of Pacific island countries to the health impacts of climate change and planned adaptation strategies to minimize such threats to health. METHODS: This assessment involved a combination of quantitative and qualitative techniques. The former included descriptive epidemiology, time series analyses, Poisson regression, and spatial modeling of climate and climate-sensitive disease data, in the few instances where this was possible; the latter included wide stakeholder consultations, iterative consensus building, and expert opinion. Vulnerabilities were ranked using a "likelihood versus impact" matrix, and adaptation strategies were prioritized and planned accordingly. RESULTS: The highest-priority climate-sensitive health risks in Pacific island countries included trauma from extreme weather events, heat-related illnesses, compromised safety and security of water and food, vector-borne diseases, zoonoses, respiratory illnesses, psychosocial ill-health, non-communicable diseases, population pressures, and health system deficiencies. Adaptation strategies relating to these climate change and health risks could be clustered according to categories common to many countries in the Pacific region. CONCLUSION: Pacific island countries are among the most vulnerable in the world to the health impacts of climate change. This vulnerability is a function of their unique geographic, demographic, and socioeconomic characteristics combined with their exposure to changing weather patterns associated with climate change, the health risks entailed, and the limited capacity of the countries to manage and adapt in the face of such risks. Citation: McIver L, Kim R, Woodward A, Hales S, Spickett J, Katscherian D, Hashizume M, Honda Y, Kim H, Iddings S, Naicker J, Bambrick H, McMichael AJ, Ebi KL. 2016. Health impacts of climate change in Pacific island countries: a regional assessment of vulnerabilities and adaptation priorities. Environ Health Perspect 124:1707-1714; http://dx.doi.org/10.1289/ehp.1509756.

Asbestos: use, bans and disease burden in Europe.

OBJECTIVE: To analyse national data on asbestos use and related diseases in the European Region of the World Health Organization (WHO). METHODS: For each of the 53 countries, per capita asbestos use (kg/capita/year) and age-adjusted mortality rates (deaths/million persons/year) due to mesothelioma and asbestosis were calculated using the databases of the United States Geological Survey and WHO, respectively. Countries were further categorized by ban status: early-ban (ban adopted by 2000, n = 17), late-ban (ban adopted 2001-2013, n = 17), and no-ban (n = 19). FINDINGS: Between 1920-2012, the highest per capita asbestos use was found in the no-ban group. After 2000, early-ban and late-ban groups reduced their asbestos use levels to less than or equal to 0.1 kg/capita/year, respectively, while the no-ban group maintained a very high use at 2.2 kg/capita/year. Between 1994 and 2010, the European Region registered 106,180 deaths from mesothelioma and asbestosis, accounting for 60% of such deaths worldwide. In the early-ban and late-ban groups, 16/17 and 15/17 countries, respectively, reported mesothelioma data to WHO, while only 6/19 countries in the no-ban group reported such data. The age-adjusted mortality rates for mesothelioma for the early-ban, late-ban and no-ban groups were 9.4, 3.7 and 3.2 deaths/million persons/year, respectively. Asbestosis rates for the groups were 0.8, 0.9 and 1.5 deaths/million persons/year, respectively. CONCLUSION: Within the European Region, the early-ban countries reported most of the current asbestos-related deaths. However, this might shift to the no-ban countries, since the disease burden will likely increase in these countries due the heavy use of asbestos.

Environmental burden of disease in Europe: assessing nine risk factors in six countries.

BACKGROUND: Environmental health effects vary considerably with regard to their severity, type of disease, and duration. Integrated measures of population health, such as environmental burden of disease (EBD), are useful for setting priorities in environmental health policies and research. This review is a summary of the full Environmental Burden of Disease in European countries (EBoDE) project report. OBJECTIVES: The EBoDE project was set up to provide assessments for nine environmental risk factors relevant in selected European countries (Belgium, Finland, France, Germany, Italy, and the Netherlands). METHODS: Disability-adjusted life years (DALYs) were estimated for benzene, dioxins, secondhand smoke, formaldehyde, lead, traffic noise, ozone, particulate matter (PM2.5), and radon, using primarily World Health Organization data on burden of disease, (inter)national exposure data, and epidemiological or toxicological risk estimates. Results are presented here without discounting or age-weighting. RESULTS: About 3-7% of the annual burden of disease in the participating countries is associated with the included environmental risk factors. Airborne particulate matter (diameter ≤ 2.5 µm; PM2.5) is the leading risk factor associated with 6,000-10,000 DALYs/year and 1 million people. Secondhand smoke, traffic noise (including road, rail, and air traffic noise), and radon had overlapping estimate ranges (600-1,200 DALYs/million people). Some of the EBD estimates, especially for dioxins and formaldehyde, contain substantial uncertainties that could be only partly quantified. However, overall ranking of the estimates seems relatively robust. CONCLUSIONS: With current methods and data, environmental burden of disease estimates support meaningful policy evaluation and resource allocation, including identification of susceptible groups and targets for efficient exposure reduction. International exposure monitoring standards would enhance data quality and improve comparability.

Serum polychlorinated biphenyls concentrations and hearing impairment in adults.

Experimental studies have suggested the potential link between exposure to polychlorinated biphenyls (PCBs) and auditory impairment, but little evidence exists to support the ototoxicity of PCBs in human. Only a few studies have implicated PCB-induced hearing loss in children. This study investigated the association between serum PCB levels and hearing impairment in US adults. We analyzed data from 1946 adults aged 20 years and older in the National Health and Nutrition Examination Survey 1999-2004: eleven PCB congeners detected in 60-90% of the samples at greater than the limit of detection (LOD) were selected, and hearing impairment was defined as a pure-tone average of the thresholds at 0.5, 1, 2 and 4 kHz of >25 dB hearing level in better ear. The adjusted odds ratio of hearing impairment was significantly increased comparing the highest quartile (Q4) of detectable PCB range with the reference (below LOD): 5.83 (95% CI: 1.20-28.24) for 2,2',3,3',4,4',5-heptachlorobiphenyl (PCB-170), 7.79(95% CI: 1.81-33.44) for 2,2',3,4,4',5,5'-heptachlorobiphenyl (PCB-180), 7.46 (95% CI: 1.62-34.47) for 2,2',3,4',5,5',6-heptachlorobiphenyl (PCB-187), 8.59 (95% CI: 1.26-58.73) for 2,2',3,3',4,4',5,5'-octachlorobiphenyl (PCB-194), 11.62 (95% CI: 2.20-61.55) for 2,2',3,3',4,4',5,6'-octachlorobiphenyl (PCB-196). Our findings suggest that specific classes of PCB levels may be associated with hearing impairment in a general sample of adults.

Potential years of life lost (PYLL) caused by asbestos-related diseases in the world.

BACKGROUND: We applied the well-established, but rather under-utilized, indicator of Potential Years of Life Lost (PYLL) to estimate the global burden of mesothelioma and asbestosis. METHODS: We analyzed all deaths caused by mesothelioma and asbestosis that were reported by 82 and 55 countries, respectively, to the World Health Organization (WHO) from 1994 to 2010. RESULTS: The 128,015 and 13,885 persons who died of mesothelioma and asbestosis, potentially lost a total of 2.18 million and 180,000 years of life (PYLL), or, an annual average PYLL of 201,000 years and 17,000 years, respectively. The average PYLL per decedent were 17.0 and 13.0 years for mesothelioma and asbestosis, respectively. CONCLUSIONS: The current burden of asbestos-related diseases (ARDs) in terms of PYLL is substantial. The future burden of ARDs can be eliminated by stopping the use of asbestos.

Assessment of noise measurements made with a continuous monitoring in time.

The World Health Organization has stated that hearing loss is one of the top 10 health problems worldwide and that noise-induced hearing loss is the leading occupational disease. This work evaluated the noise exposure levels of several job categories for 24-h periods over 7 days to determine the contribution of each microenvironment to total noise exposure. The noise exposure levels of 47 individuals were continuously measured using personal noise dosimeters in metropolitan Seoul, Korea. Participants ranged in age from 20 to 50 yr and represented eight occupational groups. Participants were asked to attach the noise dosimeters and complete a time-activity diary 24 h a day for 7 days. The average Leq 24 h,w among these individuals was 74 dBA, which ranged from 64 to 96 dBA. The average Leq 24 h,w was highest for Korean traditional music apprentices, followed by heavy equipment operators, firefighters, service workers, office workers, industrial hygienists, graduate and undergraduate students, and housewives (89, 77, 76, 76, 75, 71, 71, and 71 dBA, respectively, p < 0.001). 38 (80.9%) were exposed to noise levels greater than 70 dBA, which corresponds to the World Health Organization's exposure limit.

Incidence of hip fractures in Jeju Island, South Korea: a prospective study (2002-2006).

BACKGROUND: This study was performed to estimate the incidence of hip fractures of people older than 50 years in South Korea. METHODS: Information of patients over 50 years of age who had sustained a hip fracture were obtained from the records of eight hospitals in Jeju Island between 2002 and 2006 to calculate the incidence of hip fractures in this age group. RESULTS: There were 820 hip fractures during the study period. The mean age of the patients at the time of fracture was 77.8 years (71.3 years in 181 men, 79.7 years in 639 women). The crude incidence was 128/100,000 (66.1/100,000 in men, 174.4/100,000 in women). The age-specific incidence according to the 10-year age groups increased from 19.3/100,000 for those 50 to 59 years of age to 1,095.4/100,000 for those over 90 years of age (18.9/100,000-960.4/100,000 in men and 19.7/100,000-1112.1/100,000 in women). The standardized incidence of hip fracture to the Caucasian population in the United States in 1990 was 100/100,000 for men and 207/100,000 for women. CONCLUSIONS: Hip fractures will become an important socioeconomic problem in South Korea due to the rapid aging of the population.

Summary of night noise guidelines for Europe.

Considering the scientific evidence on the threshold of night noise exposure indicated by L night as defined in the Environmental Noise Directive (2002/49/EC), L night value of 40 dB should be the target of the night noise guideline (NNG) to protect the public, including the most vulnerable groups such as children, the chronically ill and the elderly. L night value of 55 dB is recommended as an interim target for countries which cannot follow NNG in the short term for various reasons and where policy-makers choose to adopt a stepwise approach. These guidelines may be considered an extension to the previous World Health Organization (WHO) guidelines for community noise (1999).

Low-dose amitriptyline for treatment of persistent arm pain due to repetitive use.

Amitriptyline is sometimes used to treat arm pain related to repetitive use, but rigorous evidence of its benefit is lacking. This randomized controlled trial investigated whether amitriptyline provided greater pain relief or improved arm function than a placebo pill in adults with arm pain associated with repetitive use that had persisted for at least 3 months. Participants (N=118) were randomly assigned to receive 25mg of amitriptyline or a placebo pill for 6 weeks. The primary outcome was intensity of pain (10-point numerical rating scale) and secondary outcomes were arm symptoms, arm function, grip strength, mood, and sleep. Assessments were done at baseline, 3 and 6 weeks of treatment, and 1 month after the treatment ended. Changes in arm pain were not statistically significant. However, the amitriptyline group improved more than the placebo group in arm function (p=0.023) and sense of well being (p=0.034). In a longitudinal analysis, the amitriptyline group's arm function score improved 0.45 points per week faster than placebo after adjusting for subject characteristics (p=0.015). At the treatment's midpoint, the amitriptyline group reported more "troublesome side-effects" than the placebo group (52.5% vs. 27.1%, p=0.005), but this difference decreased by the end of the treatment (30.5% vs. 22.0%, p=0.30). The most frequent side effect was drowsiness. In conclusion, this study found that low-dose amitriptyline did not significantly decrease arm pain among these participants but did significantly improve arm function and well being. Future research is needed to explore the effects of higher doses and longer duration of treatment.

Lead poisoning among internally displaced Roma, Ashkali and Egyptian children in the United Nations-Administered Province of Kosovo.

BACKGROUND: This study assessed the association between lead poisoning prevention activities and blood lead levels (BLLs) among children living in lead-contaminated camps for internally displaced persons in the United Nations-Administered Province of Kosovo. METHODS: We conducted a population-based study to examine the relationship among geometric mean BLLs in children (i) born before any lead poisoning prevention activities were instituted, (ii) born when specific interim interventions were instituted and (iii) born after relocation and medical therapy were available. The study population consisted of 145 of the 186 children born in the camps between December 1999 and July 2007. RESULTS: Lower mean BLLs were found in children born following implementation of the interventions as compared with the children born before the interventions. However, this decrease in mean BLLs was attenuated in children born into families suspected of informal lead smelting. CONCLUSION: Despite lower BLLs following interventions, children living in these camps have BLLs that remain unacceptably high. Further efforts are urgently needed to control or eliminate lead exposure in this population. Continued blood lead monitoring of the population is also warranted.

Blood lead levels and increased bronchial responsiveness.

The immune system is one of the targets most sensitive to lead toxicity, and the association between lead exposure and serum immunoglobulin E (IgE) has been published. Recent studies also reported that lead caused the development of IgE-mediated allergy. To investigate whether blood lead levels contribute to other allergic conditions, we examined the effect of blood lead on bronchial responsiveness (BR) in the general population. We performed a cross-sectional study with adults aged 19 to 58 years in a Korean community. Blood lead level and the methacholine provocation test were performed. The overall mean blood lead level was 2.9 microg/dl, and the mean BR index was 1.14. The percent of subjects with clinically diagnosed asthma was 21 (4%) and there was no difference in blood lead level with and without asthma. In the multiple regression model, the elevation of blood lead level was related to the increase of BR after adjusting for age, sex, height, smoking status, and the presence of asthma. Blood lead level was significantly associated with increased BR that came from the elevation of the IgE level with lead exposure. Lead may contribute to the increase of asthma and other allergic conditions.

Acupuncture for treatment of persistent arm pain due to repetitive use: a randomized controlled clinical trial.

OBJECTIVE: To compare true and sham acupuncture in their abilities to relieve arm pain and improve arm function in individuals with arm pain due to repetitive use. METHODS: Participants with persistent arm pain (N=123) were randomly assigned to true or sham acupuncture groups and received 8 treatments over 4 weeks. The primary outcome was intensity of pain (10-point scale) and secondary outcomes were arm symptoms, arm function, and grip strength. Outcomes were measured during treatment (at 2 and 4 wk) and 1 month after treatment ended. RESULTS: Arm pain scores improved in both groups during the treatment period, but improvements were significantly greater in the sham group than in the true acupuncture group. This difference disappeared by 1 month after treatment ended. The true acupuncture group experienced more side effects, predominantly mild pain at time of treatments. DISCUSSION: Sham acupuncture reduced arm pain more than true acupuncture during treatment, but the difference did not persist after 1 month. Mild side effects from true acupuncture may have blunted any positive treatment effects. Overall, this study did not find evidence to support the effectiveness of true acupuncture in treatment of persistent arm pain due to repetitive use.