Air quality mitigation in European cities: Status and challenges ahead.

Cities are currently at the core of air quality (AQ) improvement. The present work provides an overview of AQ management strategies and outcomes in 10 European cities (Antwerp, Berlin, Dublin, Madrid, Malmö, Milan, Paris, Plovdiv, Prague, Vienna) in 2018, and their evolution since 2013 (same cities, plus Ploiesti and Vilnius), based on first-hand input from AQ managers. The status of AQ mitigation in 2018, and its evolution since 2013, were assessed. While results evidenced that the majority of mitigation strategies targeted road traffic, emerging sources such as inland shipping, construction/demolition and recreational wood burning were identified. Several cities had in 2018 the ambition to continue decreasing air pollution concentrations to meet WHO guidelines, an ambition which had not yet been identified in 2013. Specific needs identified by all of the cities assessed were tools to quantify the effectiveness of mitigation strategies and for cost-benefit analysis, as well as specific and up to date technical guidance on real-world road vehicle emissions. The cities also requested guidance to identify mitigation measures promoting co-benefits, e.g., in terms of AQ, climate change, and noise. Support from administrations at local-regional-national-EU scales, and especially involving local policy-makers early on in the air quality management process, was considered essential. This work provides insight into the drivers of successful/unsuccessful AQ policies as well as on the challenges faced during their implementation. We identify knowledge gaps and provide input to the research and policy-making communities as to specific needs of cities.

Towards an alternative testing strategy for nanomaterials used in nanomedicine: lessons from NanoTEST.

In spite of recent advances in describing the health outcomes of exposure to nanoparticles (NPs), it still remains unclear how exactly NPs interact with their cellular targets. Size, surface, mass, geometry, and composition may all play a beneficial role as well as causing toxicity. Concerns of scientists, politicians and the public about potential health hazards associated with NPs need to be answered. With the variety of exposure routes available, there is potential for NPs to reach every organ in the body but we know little about the impact this might have. The main objective of the FP7 NanoTEST project ( www.nanotest-fp7.eu ) was a better understanding of mechanisms of interactions of NPs employed in nanomedicine with cells, tissues and organs and to address critical issues relating to toxicity testing especially with respect to alternatives to tests on animals. Here we describe an approach towards alternative testing strategies for hazard and risk assessment of nanomaterials, highlighting the adaptation of standard methods demanded by the special physicochemical features of nanomaterials and bioavailability studies. The work has assessed a broad range of toxicity tests, cell models and NP types and concentrations taking into account the inherent impact of NP properties and the effects of changes in experimental conditions using well-characterized NPs. The results of the studies have been used to generate recommendations for a suitable and robust testing strategy which can be applied to new medical NPs as they are developed.

Chlorpyrifos and neurodevelopmental effects: a literature review and expert elicitation on research and policy

Organophosphate pesticides are widely used on food crops grown in the EU. While they have been banned from indoor use in the US for a decade due to adverse health effects, they are still the most prevalent pesticides in the EU, with Chlorpyrifos (CPF) being the most commonly applied. It has been suggested CPF affects neurodevelopment even at levels below toxicity guidelines. Younger individuals may be more susceptible than adults due to biological factors and exposure settings.

The use of biomarkers for risk assessment: Reporting from the INTARESE/ENVIRISK Workshop in Prague.

This publication is a report on the workshop "The use of biomarkers for risk assessment" which took place in November 2007 in Prague, the Czech Republic. The main aim of the workshop was to bring together a broad international audience with a particular interest in the development and application of human biomonitoring (HBM) and biomarkers for environmental health research, and to provide a state-of-the art overview of the potential values and pitfalls of biomarkers in risk assessment. Throughout the presentations and the subsequent discussions, it was shown that human biomonitoring is a highly plastic and versatile tool for the unraveling of the link between contaminants in the environment and potentially associated health effects in the general population. Although it offers a means to integrate exposure through different environmental compartments, to integrate exposure over time, to include individual risk factors and genetic susceptibility, exposure biomarkers would greatly benefit from standardized, accurate and sensitive detection methods and toxicokinetic data. Effect biomarkers on the other hand need to be put into their relevant public health perspective, and well validated, mechanistically sound dose-response relationships are essential. New developments, such as in vitro assays and "-omics", may drastically improve our knowledge on the causal mechanisms behind environmental health associations and will allow for a more informed linkage of toxicological and epidemiological reality.

Children are reliable reporters of common symptoms: results from a self-reported symptom diary for primary school children.

BACKGROUND: Collecting information on subjective symptoms in children by parental reports or physician's interview is indirect and not suited for prospective data collection over extended time periods. AIM: To examine the reliability of a diary for symptom self-reports by primary school children. METHODS: Children aged 7-8 or 11-12 were recruited from primary school and a paediatric outpatient department. A picture-based symptom diary was completed individually. Children were asked about presence of 10 specified subjective symptoms for five time periods covering the previous 24 h. The diary was completed twice for test-retest and answers were compared with semi structured physician's interviews. RESULTS: Test-retest reliability for reporting a symptom during the previous 24 h gave reliable kappa values of 0.64-0.91. Comparison with physician's interview gave kappas of 0.18-0.68. Requiring correct time of day for each symptom reduced reliability and validity. Kappa values for test-retest and child-physician agreement for the individual symptoms were respectively: sneezing, 0.80 and 0.30; sore throat, 0.89, 0.30; tiredness, 0.88, 0.65; headache, 0.64, 0.66; runny nose, 0.91, 0.68; sore eyes, 0.67, 0.18; cough, 0.73, 0.58; stomach ache, 0.69, 0.45. CONCLUSION: Our symptom diary gives reliable self-report data from primary school children. It may be used for prospective symptom monitoring.

Agreement of a child's respiratory symptom diary with parental reports and peak expiratory flow.

OBJECTIVE: To assess the agreement of a self-completed diary to monitor respiratory symptoms in children aged 6-12 years with parental symptom reports and fluctuations in lung function. DESIGN: We created a text- and symbol-based questionnaire for daily completion by children at school. Using a screening questionnaire completed by the parents, we selected 101 children with lower respiratory symptoms in the last year or doctor-diagnosed asthma to complete the diary. We assessed the agreement with a parent-completed daily symptom diary and measurements of peak expiratory flow (PEF) over 5 weeks, estimating % agreement and the kappa statistic (kappa) for pairwise comparisons. RESULTS: Simple agreement between PEF variability, parent-reported and child-reported symptoms was moderate to high. Using kappa, agreement between children's and parents' reports of respiratory symptoms was only fair to moderate, and agreement with lung function measurements was poor for both parent- and child-reported symptoms. CONCLUSION: Agreement between children's and parents' reports on day-to-day respiratory symptoms was fair to moderate. The children's symptom diary agreed poorly with lung function measurements, but was neither worse nor better than the parent-completed diary.

Air pollution exposure monitoring and estimation VII. Estimation of population exposure in a central European airshed.

In order to clarify the local variation in exposure and source-receptor relationships, a dispersion model for estimating air pollution concentrations was developed for a polluted area in the Czech Republic. Three models characterized by different spatial resolution were integrated into one modelling tool. A regional-scale dispersion model accounted for pollution contribution from sources outside the modelling area. Local- and urban-scale dispersion models were used to calculate local concentration distributions. Calculated concentration distributions were evaluated. Deviations between observed and calculated concentrations were not correlated in space, except in episodes, and concentrations measured at spatially representative stations were assimilated into the model results using statistical interpolation (simple kriging). The results indicated that centralized heating plants and local home heating were the most important sources for sulfur dioxide (SO2) pollution. Both high and low level sources may contribute to the accumulation of pollution concentrations in episodes. The measured concentrations were important for the description of distributions in episodes characterized by complex wind and dispersion conditions. The applicability of source oriented model calculations to correctly represent measured concentrations in the pollution episodes was limited due to the fact that meteorological conditions representative of high concentration episodes were characterized by very low wind speed and variable wind directions. About 8,000 individuals were given an exposure estimate representing contribution from local emissions, based on the estimated hourly outdoor exposure to SO2 at their home/work addresses in the 3 month study period in the autumn of 1991. The results showed that, for 5% of participants, the maximum hourly contribution of local emissions was over 380 microg m(-3). For the 3 month average, both large-scale and local-scale pollution contribute significantly. For primary compounds, such as SO2, steep gradients are observed in the vicinity of strong local sources. These gradients are important for exposure characteristics and health effect quantification, and often will not be captured by an existing monitoring network. The calculations can be extended to other periods or to different compounds.

Air pollution exposure monitoring and estimating. Part I. Integrated air quality monitoring system.

This paper presents an integrated exposure monitoring system, based on an expansion of existing air quality monitoring systems using dispersion modelling. The system allows: (1) identifying geographical areas whose inhabitants are most exposed to ambient pollution; (2) identifying how many people in an area are exposed to concentrations of pollution exceeding air quality guidelines; (3) describing the exposure of population subgroups (e.g. children); (4) planning pollution abatement measures and quantifying their effects; (5) establishing risk assessment and management programs, and (6) investigating the short- and long-term effects of both pollutants and pollution sources on public health. The effect of pollution is rarely very large and in order to discover it, exposure estimation must provide data that reflects both spatial and temporal variations. Estimates of pollution exposure are obtained using an integrated approach that combines results of measurements from monitoring programs with dispersion calculations. These values can serve as estimates for individual short-term or long-term exposure. The grouped data allows the expression of ambient pollution concentrations as the spatial distribution of estimates such as the mean or 98th percentile of such compounds as SO2, O3, NO2, PM10 and PM2.5. This integrated approach has been combined into a single software package, AirQUIS.

Air pollution exposure monitoring and estimation. Part III. Development of new types of air quality indicators.

The temporal pattern of exposure to a specific compound may affect health in several ways. Exposure to pollution can have short-term effects or long-term effects. For some compounds there is a threshold under which there is no presumed measurable effect, whereas for other compounds, there is no presumed threshold. For short-term effects, the exposure to a high concentration of a compound one day may either increase or decrease the response if values of the same compound become high again the next day. Adaptation to effects of short-term exposure to ozone, for example, is reported. Similarly, health response to sudden high peaks of concentration may also possibly differ in effect from those to peaks attained more gradually. For long-term effects of some compounds, the cumulative exposure may be more decisive in influencing health. This paper proposes and describes in detail several air quality indicators that reflect the time variability and the episodic nature of air pollution exposure, as an attempt to represent the temporal aspects of pollution exposure that may have important effects on health. Mean concentrations, 98th percentile and maximum values are the traditional indicators for estimating exposure. The temporal variability of particulate matter (PM10) and NO2, however, is here described by means of: (1) the rate of change of pollution as the difference between two consecutive hourly or daily values, and of (2) episodes, described in terms of number, duration and inter-episode period, maximum concentration in the episode, and integrated episode exposure.

Air pollution exposure monitoring and estimation. Part IV. Urban exposure in children.

In the winter of 1994, 2300 school-age children in Oslo participated in a panel study of the role of traffic pollution on the exacerbation of diseases of the respiratory system and other symptoms of reduced health and well being in children. The children filled out a diary daily with information for five time points over six weeks. In order to quantify exposure-effect relationships for the symptoms, individual exposure to NO2 and particulate matter (PM2.5) was estimated, using the DINEX method a combination of information from the diary as to the children's whereabouts during the five time points each day, coupled with continuous dispersion modelling. An individual exposure estimate for each time point for each child was defined. Individual exposure estimated using dispersion modelling can be used to examine patterns of exposure such as isolating geographic areas with higher concentrations or describing concentrations of pollution by time of day. The diary allowed the time-use of the children to be described.

Air pollution exposure monitoring and estimation. Part V. Traffic exposure in adults.

In Oslo, traffic has been one of the dominating sources of air pollution in the last decade. In one part of the city where most traffic collects, two tunnels were built. A series of before and after studies was carried out in connection with the tunnels in use. Dispersion models were used as a basis for estimating exposure to nitrogen dioxide and particulate matter in two fractions. Exposure estimates were based on the results of the dispersion model providing estimates of outdoor pollutant concentrations on an hourly basis. The estimates represent concentrations in receptor points and in a square kilometre grid. The estimates were used to assess development of air pollution load in the area, compliance with air quality guidelines, and to provide a basis for quantifying exposure-effect relationships in epidemiological studies. After both tunnels were taken in use, the pollution levels in the study area were lower than when the traffic was on the surface (a drop from 50 to 40 micrograms m-3). Compliance with air quality guidelines and other prescribed values has improved, even if high exposures still exist. The most important residential areas are now much less exposed, while areas around tunnel openings can be in periods exposed to high pollutant concentrations. The daily pattern of exposure shows smaller differences between peak and minimum concentrations than prior to the traffic changes. Exposures at home (in the investigation area) were reduced most, while exposures in other locations than at home showed only a small decrease. Highest hourly exposures are encountered in traffic.

Air pollution exposure monitoring and estimation. Part VI. Ambient exposure of adults in an industrialised region.

This paper presents methodology and results of a dynamic individual air pollution exposure model (DINEX) that calculates the hourly exposure for each adult in a panel study. Each of over 260 participants, through the use of a diary, provided information used in the model to calculate his/her personal, individualised exposure. The participants filled out the diary daily, hour by hour, over two, two month periods. The exposure assessment model coupled the diary information and results of an indoor/outdoor measurement program, with the results of dispersion modelling on an hourly basis for an industrial area in Norway. The estimated air pollution concentrations from the dispersion model, based on continuous meteorological measurements, were calibrated with air pollutant concentrations measured continuously.

Childhood asthma in four regions in Scandinavia: risk factors and avoidance effects.

BACKGROUND: The high and increasing prevalence of childhood asthma is a major public health issue. Various risk factors have been proposed in local studies with different designs. METHODS: We have made a questionnaire study of the prevalence of childhood asthma, potential risk factors and their relations in four regions in Scandinavia (Umeå and Malmö in Sweden, Kuopio in eastern Finland and Oslo, Norway). One urban and one less urbanized area were selected in each region, and a study group of 15962 children aged 6-12 years was recruited. RESULTS: The prevalence of symptoms suggestive of asthma varied considerably between different areas (dry cough 8-19%, asthma attacks 4-8%, physician-diagnosed asthma 4-9%), as did the potential risk factors. Urban residency was generally not a risk factor. However, dry cough was common in the most traffic polluted area. Exposure to some of the risk factors. such as smoking indoors and moisture stains or moulds at home during the first 2 years of life, resulted in an increased risk. However, current exposure was associated with odds ratios less than one. CONCLUSIONS: Our findings were probably due to a combination of early impact and later avoidance of these risk factors. The effects of some risk factors were found to differ significantly between regions. No overall pattern between air pollution and asthma was seen, but air pollution differed less than expected between the areas.

Prevalence of bronchial asthma in schoolchildren in Oslo, Norway. Comparison of data obtained in 1993 and 1981.

In 1993, 4521 schoolchildren in Oslo, Norway, participated in a European study on air pollution and respiratory health. Incorporated in the primary questionnaire were five questions taken from a study performed 12 years earlier on 1772 schoolchildren in the same city. The response rate was 85% in 1993 vs 95% in 1981. The current and cumulative prevalences of doctor-diagnosed asthma in 1993 were 4.2% and 8.0%, respectively, compared to 2.2% (P < 0.01) and 3.4% (P < 0.01) in 1981. Attacks of breathlessness during the last 3 years were experienced by 7.1% in 1993 and 3.3% in 1981 (P < 0.05). Wheezing or breathlessness on exposure to pollen in 1993 and 1981 was reported by 6.1% and 3.7% (P < 0.01), respectively; to animals by 4.0% and 2.8% (P < 0.05); and to exercise by 10.2% and 4.8% (P < 0.01). The prevalence of occasional wheezing and the cumulative prevalence of doctor-diagnosed eczema, urticaria, and hay fever were not significantly altered. To summarize, a higher prevalence of both doctor-diagnosed asthma and symptoms of obstructive airways disease was reported by children attending primary school in Oslo in 1993 than 12 years earlier. No increase was observed in the prevalence of other atopic diseases.

Cohort study of the relationship between air pollution and short term health effects as determined by peak expiratory flow measurements.

The aim of the study was to establish if air pollution has short term effects on health and well-being for individuals living in an industrialized area of Norway. A cohort study was designed so that two groups (one randomly selected from the general population and one with preexisting lung disease) were followed hour by hour during two months in the winter and in the summer of 1988. In order to minimize the problems of confounding factors, each individual served as her/his own control. Each participant described through the use of a diary the presence of symptoms from the upper and lower respiratory tract as well as general symptoms of ill health. Measurements of lung function by the use of peak expiratory flow meters were done four times a day. In addition, every second week the participants were subjected t a full spirometric test. Samples of urine and blood were examined, and bacteriological test from the throat was performed at the beginning and at the end of the study. A comprehensive measurement program of outdoor air contaminants (including nitrogen oxides, sulphur dioxide) is presented. Estimation of each participant's exposure was performed hour by hour based on detailed modelling of the measured levels, known emissions of pollutants and meteorological conditions, as well as diary information on the participant's movements through the various micro-environments. The estimated exposures were generally low. In this presentation, a linear regression model and their corresponding parameter estimates were applied on an individual basis to evaluate any effect of air contamination on lung function.(ABSTRACT TRUNCATED AT 250 WORDS)

PCDD and PCDF in human milk from Scandinavia, with special emphasis on Norway.

Levels of polychlorinated dibenzo-p-dioxins (PCDD) and polychlorinated dibenzofurans (PCDF) were measured in human milk in a collaborative Scandinavian study with 10 samples from each of 7 locations in Norway and Sweden (total 70 samples) and 10 samples from Denmark. Four locations represented areas with different PCDD and PCDF sources and three background areas. Norwegian results are presented and related to the Danish and Swedish values. No geographical differences were found in total dioxins expressed as Nordic TCDD equivalents. Mean equivalent values (pg/g fat basis) were 15-18 in Norway and Denmark and 20-24 in Sweden, lower than those reported from parts of Western Europe but higher than in the undeveloped countries. When looking at the individual compounds, the highest values of PCDD congeners were observed in industrialized areas of Sweden, while the highest PCDF values were found in a Norwegian area known for dioxin contamination from a magnesium-producing factory.

National prevalence survey of hospital-acquired infections in Czechoslovakia.

A nationwide 1-day prevalence survey of a total of 12,260 patients in 23 hospitals across Czechoslovakia yielded 751 cases of hospital-acquired infection (HAI), a prevalence of 6.1%. Analysis of the data revealed that the prevalence of HAI amongst surgical patients was almost twice that amongst medical patients (8.2% vs. 4.4%). Persons aged over 60 on the urological and surgical wards were at highest risk of acquiring infection. The most frequent site of HAI was the urinary tract (25%), followed by surgical wounds (15%) and the upper respiratory tract (13%). Fifty per cent of infection in gynaecological patients occurred within 6 days of admission compared with 15% in urological patients, and a wide variation was seen in other specialties.

Frequency of nosocomial infections as revealed by a prevalence survey.

In 1984, a prevalence survey based on the methodology, definitions and criteria meeting the WHO requirements was carried out in the Czech Socialist Republic. This prevalence study on a total of 12,260 hospital patients revealed 751 active cases of nosocomial infection (NI). The conclusions emerging from an epidemiological analysis of the collected NI patient records were as follows: 60% of all infections were acquired on the surgical services, predominantly on the surgery service; 60% of those who developed NI were persons over 50 years of age; hospital-associated infections afflicted 366 males and 385 females; the ratio of infections acquired prior to hospital presentation to those originating while in hospital care was about 4:1, with a tendency to vary depending on type of hospital service; the urinary tract was the most frequent site of infection (25%), followed by surgical wounds (15%) and upper respiratory tract (13%); 17% of NI patients contracted the infection in spite of preventive doses of antimicrobials, 28% of NI patients received no antimicrobial prophylaxis; among the 78% (589 out of 751) of patients examined bacteriologically, 46% of infections were caused by Gram-negative rods, 19% by staphylococci, 7% by streptococci and 6% by Pseudomonas aeruginosa; 22% of NI patients were not examined for the pathogen. The prevalence survey methodology turned out to be useful as a tool for detecting the immediate magnitude of the NI problem, but can also be used as a control method.