Effects of an aged copper contamination on distribution of earthworms, reproduction and cocoon hatchability.

Contaminated soil is a problem throughout the industrialized world, and a significant proportion of these sites are polluted with heavy metals such as copper. Ecological risk assessment of contaminated sites requires ecotoxicological studies with spiked soils as well as in-situ ecological observations. Here, we report laboratory and field assessment of copper toxicity for earthworms at a Danish site (Hygum) exclusively contaminated with an increasing gradient in copper from background to highly toxic levels (>1000mgkg-1 dry soil). More specifically, we report effects on field populations, body contents of copper, hatching of earthworm cocoons and reproduction of the common species Aporrectodea tuberculata. Abundance of earthworms and cocoons decreased significantly from about 400-150m-2 along the gradient as the soil copper concentration increased from ca. 50 to ca. 1000mgkg-1. At lower concentrations, the population was dominated by endogeic species, whereas at high concentrations the population was dominated by epigeic species. At high copper contents the internal concentration of copper was in the range 100-160mgkg-1 dry tissue. Despite the high internal copper contents, hatchability of field collected cocoons was not impaired in any species. The EC50 reproduction value of A. tuberculata was about 220mg copper kg-1 dry soil in the first two exposure periods, but nearly doubled in the third period suggesting that an acclimation response had occurred. Also in the laboratory reproduction test, cocoon hatchability was not reduced, but rather slightly stimulated by copper. Based on these results we discuss the possibility that acute exposure in laboratory experiments is more detrimental than exposure in a field situation, perhaps because increased tolerance may be acquired through natural selection and genetic adaptation through increased use of defense mechanisms such as metallothioneins. Further, we discuss that the rather high tissue copper level of earthworms from the Hygum site may have smaller effects in these free-ranging worms than it would have in acute-exposure laboratory tests because the copper is more efficiently sequestered and detoxified in the field situation where populations have been exposed for many generations.

Patients referred with type 2 diabetes remain in specialist care for a long period.

INTRODUCTION: Patients with uncomplicated type 2 diabetes are usually managed in general practice. The aim of this study was to describe the duration of contact for patients referred from primary care to a diabetes outpatient clinic. MATERIAL AND METHODS: The present study is a retrospective study with follow-up of at least 12 months or until discharged. Risk stratification was performed at referral and when patients were returned to primary care. A total of 154 patients with type 2 diabetes were referred to the clinic in the 2004-2009 period. The main outcome measure was the duration of contact with the diabetes clinic. RESULTS: In all, 105 patients were returned to primary care after a median of ten months (range 1-64 months) and six visits (1-25 visits). Half of the patients were returned to primary care after 18 months, and 20% were still in contact with the diabetes clinic after six years. The majority were classified as high-risk patients with no difference in risk level between patients followed ≤ 12 or > 12 months. CONCLUSION: The complication level was high even among discharged patients. The long duration of the contact for the patients who were returned to primary health care should stimulate initiatives leading to a faster course in the secondary care setting. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.