Decrease of internal exposure to chlororganic compounds and heavy metals in children in Baden-Württemberg between 1996/1997 and 2008/2009.

From 1996/1997 to 2008/2009, blood and urine were sampled from 9- to 11-year-old pupils in the state of Baden-Württemberg, South-West Germany. In blood samples the chlororganics DDE, HCB, PCB-138, PCB-153 and PCB-180 were analysed by gas chromatography and ECD detection. PCDD/PCDF were measured in pooled blood samples using GC/MS. Lead concentrations in blood were quantified by graphite furnace atomic absorption spectrometry (AAS), mercury in urine by using cold vapour AAS. For all chlororganics and heavy metals a distinct decrease of the internal concentration could be shown within the 12-year investigation period. For DDE, the median decreased from 0.32 µg/l to 0.11 µg/l. The median of HCB fell from 0.19 µg/l to 0.07 µg/l. The median of the sum of the three PCB-congeners PCB-138, PCB-153 and PCB-180 decreased from 0.47 µg/l to 0.18 µg/l. The burden of PCDD/PCDF in pooled blood samples resulted in approximately half the concentration after the 12-year period. The internal concentrations of the chlororganics were distinctly higher in breastfed children than in non-breastfed children. In 2008/2009, these differences were strongest for PCB and DDE (2-fold), moderate for PCDD/PCDF (1.6-fold), and slight for HCB (1.2-fold). The median of lead concentrations in blood dropped from 23.6 µg/l to 15.9 µg/l. The median of mercury concentrations in urine decreased from 0.25 µg/l to a value below the limit of quantification of 0.2 µg/l; the 95th percentile was reduced from 3.1 µg/l to less than 0.2 µg/l. The decline of amalgam fillings in children during the investigation period had a strong influence on internal concentrations of mercury. The internal concentration of the persistent xenobiotics investigated here decreased to a low level not likely to be of concern for human health.

Polybrominated diphenyl ethers (PBDE) in blood of children in Baden-Württemberg between 2002/03 and 2008/09.

Polybrominated diphenyl ethers (PBDE) are used in high amounts as flame retardants in plastic materials and textiles. Due to their persistence, their accumulation in the food chain and their toxic properties they have been integrated in the human biomonitoring program of the Baden-Württemberg State Health Office since 2002. In repeated cross-sectional studies in winter 2002/03 (n=162), 2004/05 (n=194), 2005/06 (n=411) and 2008/09 (n=770) blood samples of 9-11-year-old pupils were taken, pooled and analysed for PBDE after extraction and purification by silica gel using HRGC/HRMS. Samples were pooled according to region, gender, and breast feeding. PBDE in the pooled samples ranged from 1.9 to 12.5 ng/g blood fat (sum of all PBDE). Mean concentrations of PBDE, calculated for the four investigation periods, were 6.2 ng/g (2002/03), 5.4 ng/g (2004/05), 7.8 ng/g (2005/06) and 6.7 ng/g (2008/09). While the concentration of the decabrominated diphenyl ether (BDE-209) increased, the concentration of other congeners (BDE-47, BDE-99, BDE-100, BDE-153, BDE-154, BDE-183) decreased slightly or remained at the same level. Consistent differences with respect to gender and breast-feeding were not recognizable. Concentrations of PBDE in children range on the same level as in adults and do not seem to be critical from the toxicological point of view. Because of the slight increase of BDE 209, the internal concentrations of BDE should be monitored in the future. The strong variations in PBDE concentration between the different pooled samples indicate that, apart from ingestion, other routes of exposure (dermal, inhalation) and additional sources (textiles, building materials) must be taken into consideration.

Reduced incidence of blindness in relation to diabetes mellitus in southern Germany?

AIMS: We estimated the incidence of blindness in the diabetic and non-diabetic population in 2008 and compared it with results from 1990-1998 in a neighbouring region. METHODS: All newly registered blindness allowance recipients in 2008 were drawn up in a German region (population 4.5 million). We estimated sex-specific, age-specific and standardized incidence rates of blindness in the diabetic and the non-diabetic population and relative and attributable risks as a result of diabetes. A comparison to the data from 1990-1998 was performed using log-linear Poisson regression. RESULTS: Four-hundred and sixty-eight cases were drawn up (63% female). One-hundred and twenty-two (26.1%) had diabetes. Blindness incidence rates (per 100, 000 person-years) standardized to the 2008 German population were: men 9.1 (95% confidence interval 7.8-10.5), women 9.9 (8.8-11.1); diabetic population: men 21.8 (11.6-31.9), women 19.7 (9.2-30.1); non-diabetic population: men 8.0 (6.6-9.5), women 9.1 (7.9-10.3). Relative risk of blindness, diabetic vs. non-diabetic population: men 2.7 (1.6-4.5), women 2.2 (1.3-3.8). Attributable risk among exposed: 63% in men, 54% in women. Population attributable risk: 12% in men, 8% in women. Incidences of blindness were significantly lower than in all years of the period 1990-1998 in both the diabetic and the non-diabetic population. CONCLUSIONS: We found the incidence of blindness to be approximately 2.5-fold higher in the diabetic compared with the non-diabetic population. Fifty-eight per cent of the risk to become blind in diabetic individuals and 9% of the risk to become blind in the entire population were attributable to diabetes. The decrease of the blindness incidence observed during the 1990s may have continued.

No increase in the prevalence of asthma, allergies, and atopic sensitisation among children in Germany: 1992-2001.

BACKGROUND: From 1970 to 1990 increasing rates of asthma and allergic sensitisation were observed in several countries. The aim of this study was to investigate time trends in the prevalence of asthma and allergic sensitisation among school children in Germany between 1992 and 2001. METHODS: Parental reports of asthma, hay fever, and wheezing and measurements of specific serum IgE antibodies were investigated in six serial cross sectional surveys of 9-11 year old school children in three study areas in south west Germany. RESULTS: A total of 6762 school children of mean age 10 years (mean participation rate 77.9%) took part in the investigation in the three study areas. Over the 9 year study period no increase in the prevalence of current wheezing and asthma was observed. In addition, the prevalence of atopic sensitisation remained unchanged during the observation period. CONCLUSIONS: These data, using parental reports and objective measures of allergy, suggest that there has been no further increase in the prevalence of asthma and atopy since 1992. The epidemic may thus have reached a plateau.

[Human biomonitoring investigations of organochlorine compounds -- PCB, DDE, HCB, beta- and gamma-HCH, PCDD/PCDF, Dioxin-like PCB's and polybrominated biphenyl ethers]. / Humanbiomonitoring-Untersuchungen von Organohalogenverbindungen -- PCB, DDE; HCB, beta- und gamma-HCH, PCDD/PCDF, koplanaren PCB sowie polybromierten Biphenylethern.

Although PCB and PCB-containing materials are not processed for a long time, PCB is under discussion again and again caused by the pollution of indoor environments. To objectify the discussion, the dates of the PCB-biomonitoring, the organochlorine-compounds (DDE, HCB, beta-/gamma -HCH, PCDD/PCDF) and the polybrominated biphenyl ethers concerning the investigations within the project "Sentinel Health Departments" in Baden-Wurttemberg are represented. Additionally results from children from Kazakhstan (Aral-Sea area) and from teachers which are working in PCB polluted schools as well as from a long term investigated test person are reported. Blood concentrations of the following compounds decreased from 1996/97 to 2002/03: the sum of the concentration of PCB 138,153 and 180 decreased from 0.46 microg/L to 0.20 microg/L, DDE from 0.32 microg/L to 0.17 microg/, HCB from 0.20 microg/L to 0.08 microg/L, beta-HCH below the level of detection, I-TEQ NATO to 4.8 pg/g blood fat, TEQ WHO (without PCB) to 5.5 pg/g blood fat, PCB 126 to 18,8,pg/g blood fat and PCB 169 to 12.8 pg/g blood fat. The influence of breast feeding and the gender on the level of the pollution is conspicious. No local correlations were found in Baden-Wurttemberg, but they were found in comparison with the results of Kazakhstan (Aral-Sea area). The difficulty to produce time series while the analyzing pollutants are more and more decreasing, as well as the change of the calculation base of the summation of parameters like I-TEQ NATO to TEQ WHO are discussed.

[Determination of mold concentrations in homes and schools in Baden-Württemberg]. / Bestimmung der Schimmelpilzkonzentration in Wohnungen und Schulen Baden-Württembergs.

So far there have been rather few reliable and comparable data available on indoor pollution with mould. Following the publication of the Federal Environmental Agency and the Health Agency Baden-Württemberg which supports the assessment of mould pollution of indoor air, it seemed advisable to investigate as to how far these criteria can be used for the assessing the mould pollution in daily practice. The results of investigations of 130 homes and 117 classrooms in Baden-Württemberg. will be represented.

[Application of the Breuer-Weuffen Discrimination test as a preschool screening test in Baden-Württemberg]. / Anwendung der Differenzierungsprobe nach Breuer und Weuffen als Screeningverfahren bei Einschulungsuntersuchungen in Baden-Württemberg.

From 1997 to 2002 a total of 597 school children aged 6-7 years and 41,919 preschool children (5-7 years) were examined using the Breuer-Weuffen Discrimination test (DP). For 20 to 23% of all children a further training of perceptual and language abilities was found necessary to avoid or reduce learning difficulties at school. The DP can be used as a screening method in an average time of 7 minutes. The results obtained were well comparable for different samples of preschool children. Further, the DP allows the derivation of specific needs for the training of children who fail to meet the test criteria. Mild perceptual disturbances or light graphomotoric problems can be improved by specific training before school offered by parents and kindergarten teachers, whereas severe problems should be treated by professionals.

[Exposition and sensitisation to indoor allergens, house dust mite allergen and cat allergens]. / Exposition und Sensibilisierung gegenüber Milben- und Katzenallergenen bei Kindern in Baden-Württemberg.

The study examined the exposure to biological indoor air agents and their possible role for allergies and respiratory tract illnesses of children. It was conducted as a case control study (atopic vs non-atopic children) at the four surveillance public health departments in Baden-Württemberg in the winter season 1999/2000 and included 379 children of the fourth class. The concentrations of the house dust mite antigens Der F1, Der p1, and Der Gr2 as well as cat allergen Fel d1 were determined in the children's bedrooms on the ground and in the mattress. Specific IgE-antibodies against allergens from house dust, mites and cat were determined in the serum of the children. For mite allergens the following medians ( micro g/g) were estimated in floor dust: Der p1 = 0.6, Der f1 = 2.3, Gr2 = 0.1; in mattresses: Der p1 = 1.2, Der f1 = 3.4, Gr2 = 0.3. The median of Fel d1 in floor dust was 0.2 microg/g, in mattresses 0.1 microg/g. Sensitisation to dust mite allergen was found to be more prevalent than sensitisation to cat. The distribution of sensitisation among the cases and controls is different. Among the cases, more subjects were sensitised to dust mites (32.9 %) and cat (13.1 %). Among the controls, 17.1 % were sensitised to dust mites and 4.1 % to cat. The results showed no direct association between the prevalence of allergies or respiratory tract illnesses and the indoor concentrations of the allergens. Possible reasons for these findings are discussed.

[10 years of observation by public health offices in Baden-Württemberg--assessment of human biomonitoring for mercury due to dental amalgam fillings and other sources]. / 10 Jahre Beobachtungsgesundheitsämter in Baden-Württemberg--Beurteilung der Human-Biomonitoring-Untersuchungen bezüglich der Quecksilber-Belastung durch Amalgamfüllungen und andere Quellen.

Since 1992, in Baden-Württemberg, ten-year old children have been surveyed in the project "Sentinel Health Departments" to study their exposure to environmental pollutants and possible health effects. In the four study areas 1200 children have been investigated every year initially, since 1996 every second year. The data for mercury in body fluids are reported here. The decrease in the body burden of mercury as a result of the declining usage of dental amalgam fillings, was been verified. In 1992/93, of all the children who had been surveyed, the 95 percentile for the body burden of mercury was 3.1 microg/l and in 2000/01 1.35 microg/l. Also to be discussed is the reason why mercury-based cosmetic ointments seriously exceed the HBM-II-intervention-value. Because of using these ointments, concentrations of mercury in urine up to 1400 microg/l were found. A study within the project "Sentinel Health Departments" compared the concentrations of mercury in the urine of adults with those in blood and salvia. The results support the opinion that mercury in urine is appropriate for estimating the mercury uptake from dental amalgam fillings. It can be assumed that these results reflect the situation in the entire Federal Republic of Germany. The ten years' experience confirms that the concept of the "Sentinel Health Departments" is excellently suited to obtain data relevant for environmental health of children. Environmental health protection and the essential gathering of data for future health observation in Baden-Württemberg.

[Serum selenium levels in school children: results and health assessment]. / Serumselenkonzentrationen bei Schulkindern in Baden-Württemberg und ihre gesundheitliche Bewertung.

BACKGROUND: In Germany, where geogenic selenium concentrations are low, only few data on selenium status in children are available. Aim of the study was to investigate serum selenium concentrations of children in a population-based sample and to additionally investigate spatial and temporal differences. METHOD: In three consecutive cross sectional studies the selenium concentration in serum was determined in 1,918 children (mean age 10.3 years) from four study areas. Potential factors of influence were assessed by questionnaires filled in by parents and physicians, respectively. Selenium determination was done by hydride atomic absorption spectrometry after microwave digestion. RESULTS: Mean selenium concentrations for the subcollectives ranged from 54.5 +/- 10.5 micro g/l to 71.9 +/- 15.1 micro g/l. The minimum observed was 14 micro g/l, the maximum 216 micro g/l. Turkish children had lower selenium concentrations than German children and children of other nationality, respectively. Controlling for sex and year of investigation German children from Stuttgart had significantly lower selenium concentrations than children from Aulendorf/Bad Waldsee. In the same regression model for the period from 1995/96 to 1998/99 a decreasing trend was found to be significant. However, the regression model only explains a very small part of variance. CONCLUSIONS: The selenium concentrations determined in this study are in the range also found in other studies in children from Germany. They are far below the toxicologically relevant range, which starts at about 600 micro g/l. The 5 th percentile in nearly all subcollectives was below the threshold limit of the lower tolerable selenium concentration of 45 micro g/l. For children from south Germany deficiency of selenium is therefore more to be suspected than a burden relevant to health. Selenium supplementation should however be considered thoroughly. Balanced nutrition is also a main factor for an optimum selenial supply.

[Assessment of mould pollution in residences in southwest Germany]. / Abschätzung der Schimmelpilzbelastung in Wohnungen in Südwestdeutschland.

Elevated levels of moulds in homes may represent a risk for development of allergies and respiratory diseases. Little is known about the levels of these biogenic contaminants in homes in South-West Germany. This paper presents the results of a study which was performed between November 1997 and May 1998 in the four Sentinel Health Departments in Baden-Württemberg (Stuttgart, Mannheim, Kehl and Aulendorf/Bad Waldsee). It included 377 households in which children of 10 years of age resided. Moulds were determined in indoor air, outdoor air, household dust from floors and mattresses. Specific home characteristics were assessed by questionnaire. The median value of the number of colony forming units (CFU) in indoor air was 135 CFU/m3 (range 5-17,000) and in outdoor air 145 CFU/m3 (range 15-2,900). The median value of CFU/g dust, collected from the floors, was 15,000 (range 0-700,000) and collected from mattresses was 28,000 (range 1,500-1,350,000). The data suggest that an indoor-outdoor difference exceeding the value of 500 CFU/m3 indicates an elevated mould concentration in indoor air compared to background. This value can be discussed as a temporary reference value for South-West Germany in the winter season. However, a health assessment can not be derived from this value.

[Incidence of neurodermatitis (atopic dermatitis) in students starting school in Ostalbkreis in Baden-Württemberg]. / Häufigkeit von Neurodermitis (atopischer Dermatitis) bei Schulanfängern im Ostalbkreis in Baden-Württemberg.

The prevalence of atopic eczematous dermatitis differs considerably between countries. In a former study with preschool children the prevalence in Baden-Württemberg according to data from parent questionnaires was about 10 per cent. Taking into account the expected false positives and false negatives led to the approximated unbiased prevalence of 7 to 8 percent. To evaluate this estimate, the Health Department Ostalbkreis used the same questionnaire in a second study of the same age group. The questionnaires were self-administered by the parents during the medical examination before school entrance. The parents of positive administered cases (11.2 per cent) were asked for permission to contact the family doctor to have the diagnosis confirmed (or not). 75 per cent of the positive identified cases by questionnaires were confirmed by family doctors. Therefore, the prevalence of atopic eczematous dermatitis in preschool children aged six to seven years in the area of Ostalbkreis is about 8.5 per cent.

[Experiences with the intracutaneous Mendel-Mantoux tuberculin test in routine screening in a public health office]. / Erfahrungen mit dem intrakutanen Tuberkulintest nach Mendel-Mantoux bei Routineuntersuchungen in einem Gesundheitsamt.

The intracutaneous tuberculin test according to Mendel-Mantoux is internationally recognised as a standard testing method in all countries of the globe. In routine everyday working of the Public Health Office of the German provincial capital Stuttgart the Mendel-Mantoux tuberculin test was examined in respect of practicability, acceptance and economy and was compared against the multipuncture-stamp test. 2,710 persons for whom the tuberculin test was prescribed according to the German infectious diseases law were tested for tuberculosis by the Stuttgart Public Health Office between August 1995 and February 1996, using the Mendel-Mantoux test with Behring 5 TE GT. Of these, 154 persons did not return for checking the result. Checking was effected on 2,556 persons. The tested persons were 28.4 years old on the average, the majority being female (59.5% against 40.5% males) and of German nationality (60.7% against 39.3% other nationals). A positive reaction was seen in 37% (induration > 6 mm), in 23.3% Germans against 57.5% other nationals. In 65% of the positive results the indurations had a diameter of more than 10 mm, in 29.2% more than 15 mm. 80 probands, i.e. 2.5% of all tested persons, had an excessive reaction; firmation of blisters with local necrosis. The intracutaneous test according to Mendel-Mantoux can be routinely performed by Public Health offices, is well accepted by the persons concerned, and is also economic if 3 tests are conducted per bottle. The proportion of positive findings is similar to that obtained with the multipuncture-stamp test, whereas the significance of the results is more differentiated. The indication should be in accordance with the objective.

[Tools for public health reporting on CD-ROM]. / Werkzeuge zur Gesundheitsberichterstattung auf CD-ROM.

We describe the first CD-ROM published for public health use. It combines data and tools for health reporting, including health reports with full text and graphics, source data, and programming tools for the transformation, statistical evaluation, and mapping of the underlying data.

[EEG changes in rats after subchronic exposure to ethanol]. / EEG-Veränderungen der Ratte nach subchronischer Einwirkung von Ethanol.

EEG-investigations in rats were carried out 2 weeks after finishing a 3-month exposure scheme to ethanol (113 mmol/kg b.w., p.o., 5 times per week). We found pronounced disturbances of the sleep-wake behaviour as a reflection of a serious damage of the alertness-regulating system. The previously exposed animals did show disturbed vigilance and changes in the course and character of sleep, a reduction of power density in the alpha-, and an increase within the beta- and delta frequency bands of the EEG. The essential conclusions drawn from the experiment are comparable with EEG-changes in abstinent alcoholics, as reported in the literature.

Muscle fibre conduction velocity during fatiguing and nonfatiguing isometric arm contractions.

In the present study the behaviour of muscle fibre conduction velocity was investigated by means of a new method for the continuous registration from surface EMGs. During fatiguing isometric arm contractions at 40% of maximum voluntary contraction close relations between conduction velocity and spectral parameters of surface EMG were found. In short nonfatiguing contractions at 15%, 30%, 45%, 60%, and 75% of maximum force no significant differences of conduction velocity could be observed. An example of continuous registration of the parameters is given.