Assessment of radiation dose to people and wildife inhabiting the Grote Nete catchment in Belgium.

We evaluate the impact of the radiological contamination of the Grote Nete catchment in Belgium to people and non-human biota. This region has received effluents from the phosphate and nuclear industries via tributaries of the Grote Nete river in past decades, resulting in the presence of radionuclides such as 241Am, 60Co, 137Cs, 40K, 210Pb, 238Pu, 239,240Pu, 226Ra, 228Ra, 228Th, 232Th, 234U, 235U and 238U. During the period 2016-2021, we measured these radionuclides in the water column, the bed sediment and riverbanks. Additionally, we carried out radon measurements on the riverbanks in 2022. Based on these measurements, the dose rates to people were calculated for different potential exposure scenarios, using the SCK CEN biosphere tool. We also performed an assessment of exposure of ionising radiation to non-human biota (including 222Rn and its daughters) using the ERICA Tool. We observed three types of areas at the Grote Nete riverbank: (a) a lower category exposure with 226Ra concentrations reflecting purely Belgian background values; (b) a middle category with enhanced 226Ra, mainly adsorbed on clay minerals and (c) an upper category extending to maximum values in the order of 103 Bq kg-1. The main component of the dose rate for terrestrial and aquatic organisms is 226Ra followed by 210Pb (terrestrial) or 228Ra, (aquatic). The anthropogenic vector of the contamination (40K, 60Co, 90Sr, 137Cs, 228Th, 232Th, 234,235,238U, 238,239Pu, 241Am) makes a negligible contribution to dose. Overall, the Grote Nete wildlife is not under significant risk from exposure to soil or water-borne radionuclides and radon emanating from the soil, even if the ERICA benchmark of 10 µGy h-1 is occasionally exceeded for 226Ra, 210Pb or 228Ra, because exposures are below the levels at which effects are known to occur. For people, radon inhalation is the main exposure pathway and exposures can reach 1 mSv y-1 for hypothetical residents living at the riverbanks and remaining most of their time in the area, but it can be expected that exposures are much lower at increasing distances from the river. It is concluded that neither people nor the environment are at any significant radiological risk from this situation.

Impact of medical radionuclide discharges on people and the environment.

We present a novel methodology to dynamically calculate dose rates to people and wildlife from hospital-released radionuclides reaching the environment through water treatment plants (WTPs), using the biokinetic model D-DAT for aquatic wildlife, applied to 18F, 123I, 131I, 153Sm, 99mTc and 201Tl. We have also developed a method to calculate doses to WTP workers and to farmers from agricultural practices. This proof-of-concept study simulates a generic source term of radionuclide levels in the Belgian Molse Nete River during the year 2018, chosen because the river flow was very low during that year, which constitutes a very conservative, bounding case. The dose rates to wildlife calculated for this hypothetical scenario under conservative assumptions, are well below the ERICA predicted no effects dose rate to wildlife of 10 µGy h-1. Human exposures are also very low, in most cases not exceeding 10 µSv y-1. This work identifies important data gaps and areas of uncertainty in the assessment of radiopharmaceutical effluents. The study, which is part of the EC project SINFONIA, paves the way for a dynamic screening assessment methodology able to perform consistently assessments of the impact of radiopharmaceuticals on people and wildlife. This is particularly relevant since discharges of radiopharmaceuticals in rivers are on the increase and it is necessary to explicitly demonstrate that people and the environment are adequately protected.

Comparison of methods for the radiological impact assessment of aquatic releases to the waters in the low countries.

Accurate assessment of the radiological impact of liquid discharges on the marine environment is challenging despite all developments in recent years. The lack of consensus on this type of assessment manifests itself even stronger when transborder issues are expected, such as in the Low Countries. Belgium and the Netherlands operate nuclear power plants with discharges in the shared estuary of the Western Scheldt, therefore if there are safety concerns, information on both sides of the border must be coherent. This work provides a comparison of two computational methods used for assessment of aquatic releases in the Western Scheldt estuary and the adjacent North Sea.The work demonstrates a fair degree of consistency in modelling the uptake and fate of key anthropogenic radionuclides. Nevertheless, there are also considerable differences found in sediment and sea species with concentrations ranging by over two orders of magnitude in some cases. These explainable differences are methodological in nature, occurring in codes that underwent extensive validation during development. Therefore, the outcomes of this work clearly demonstrate the need to produce explicit guidance that is specifically tailored to the (inter)national water system of concern. This should not be limited to releases from nuclear power plants, but also include other nuclear applications. For all these reasons, more intensive collaboration and model harmonisation across borders is essential, signalling the direction for future investigations.

Ensuring robust radiological risk assessment for wildlife: insights from the International Atomic Energy Agency EMRAS and MODARIA programmes.

In response to changing international recommendations and national requirements, a number of assessment approaches, and associated tools and models, have been developed over the last circa 20 years to assess radiological risk to wildlife. In this paper, we summarise international intercomparison exercises and scenario applications of available radiological assessment models for wildlife to aid future model users and those such as regulators who interpret assessments. Through our studies, we have assessed the fitness for purpose of various models and tools, identified the major sources of uncertainty and made recommendations on how the models and tools can best be applied to suit the purposes of an assessment. We conclude that the commonly used tiered or graded assessment tools are generally fit for purpose for conducting screening-level assessments of radiological impacts to wildlife. Radiological protection of the environment (or wildlife) is still a relatively new development within the overall system of radiation protection and environmental assessment approaches are continuing to develop. Given that some new/developing approaches differ considerably from the more established models/tools and there is an increasing international interest in developing approaches that support the effective regulation of multiple stressors (including radiation), we recommend the continuation of coordinated international programmes for model development, intercomparison and scenario testing.

Evolution of the consumption trend of proton pump inhibitors in the Lleida Health Region between 2002 and 2015.

BACKGROUND: Proton pump inhibitors (PPIs) are one of the most commonly prescribed pharmacological groups. Their high prevalence and duration of use are of important health concern due to the risk they can cause to patients. Despite these risks, their use remains particularly high, especially in the elderly population. We determined the trend in the prevalence of PPI consumption in the population of the Lleida Health Region between 2002 and 2015 to explore patterns of use and associated characteristics. METHODS: An analysis of secular trends between 2002 and 2015 was performed. The database included all individuals who used PPIs in the Lleida Health Region, which had 358.070 inhabitants in 2015. PPI use was evaluated using prescription dispensing data from the public health system. All types of PPIs approved by the pharmaceutical agency were included. Trends were investigated by age and sex. RESULTS: For the whole study period, a total of 215,417 individuals accounted for 292,122 dispensations. Overall, 48% were women, and the mean age was 62 years. The dispensing prevalence of PPI use in 2015 was 18.0% overall-20.4% for women and 15.7% for men-and was 54.6% for those over 65 years. In terms of the subtypes of PPIs, 16.8% of prescriptions were for omeprazole, 0.66% were for pantoprazole, and 0.48% were for lansoprazole. The evolution of the annual PPIs dispensation prevalence showed a progressive increase from 11.3% in 2002 to 18.0% in 2015, which was attributable to an increase in the use of omeprazole (9.0% vs. 16.8%) and, to a lesser extent, esomeprazole (0.02% vs. 0.4%). CONCLUSION: An increase in the prevalence of PPI dispensation was observed over 14 years of follow-up. The prevalence of dispensation was especially high for the population older than 65 years, despite the risk of cognitive decline and falls. Comprehensive actions are required to to increase rational prescribing of PPIs, especially in high-risk populations.

Towards an ecological modelling approach for assessing ionizing radiation impact on wildlife populations.

The emphasis of the international system of radiological protection of the environment is to protect populations of flora and fauna. Throughout the MODARIA programmes, the United Nations' International Atomic Energy Agency (IAEA) has facilitated knowledge sharing, data gathering and model development on the effect of radiation on wildlife. We present a summary of the achievements of MODARIA I and II on wildlife dose effect modelling, extending to a new sensitivity analysis and model development to incorporate other stressors. We reviewed evidence on historical doses and transgenerational effects on wildlife from radioactively contaminated areas. We also evaluated chemical population modelling approaches, discussing similarities and differences between chemical and radiological impact assessment in wildlife. We developed population modelling methodologies by sourcing life history and radiosensitivity data and evaluating the available models, leading to the formulation of an ecosystem-based mathematical approach. This resulted in an ecologically relevant conceptual population model, which we used to produce advice on the evaluation of risk criteria used in the radiological protection of the environment and a proposed modelling extension for chemicals. This work seeks to inform stakeholder dialogue on factors influencing wildlife population responses to radiation, including discussions on the ecological relevance of current environmental protection criteria. The area of assessment of radiation effects in wildlife is still developing with underlying data and models continuing to be improved. IAEA's ongoing support to facilitate the sharing of new knowledge, models and approaches to Member States is highlighted, and we give suggestions for future developments in this regard.

[Implementation of simplified diagnostic method Apnealink™Air® to diagnose sleep apnea by general practioners of primary care]. / Implementación del método simplificado Apnealink™Air® por médicos de atención primaria para el diagnóstico del síndrome de apnea-hipopnea durante el sueño.

OBJECTIVES: To assess diagnosis and therapeutic decisions-making by General Practitioners (GP) using ApnealinkTM® (AL) in patients with high suspicion of obstructive sleep apnea (OSA), in comparison with conclusions of Hospital Sleep Unit (HSU) specialists based on home respiratory polygraphy (PGR) results. METHODS: This study involved patients previously selected by HSU for sleep testing by PGR. After it, patients were offered to complete AL test. PGR was checked at HSU; AL was checked by hemoglobin desaturation index of 4% (4% ODI), (4% AL) and 3% (3% ODI) patients with positive test to proceed with CPAP; and those with negative test for further testing. Automatically adjusted 4% AL, was considered valid as it was demonstrated to be equivalent to manual AL. Results were compared by automatically adjusted 3%AL against PGR results. RESULTS: 48 patients were collected. 43 had AL valid test, 45 had PGR valid study, and 41 had both valid test. 27 patients (62,8%) had positive 4% AL (OR 5,51, p < 0,05), that showed AHI ≥ 15/h at 3% AL test; and 19 patients (42,2%) had a positive PGR test. 31 (72%) patients had a positive 3% AL. AL had shown to be a good screening method of SAHS. CONCLUSIONS: There is equivalence between the decisions of GP and HSU. AL is a good diagnostic tool and screening method for OSA in primary care when it is used in patients with high suspicion of moderate-severe OSA.

Circulating MicroRNA Profile Associated with Obstructive Sleep Apnea in Alzheimer's Disease.

The diagnosis of obstructive sleep apnea (OSA) in Alzheimer's disease (AD) by polysomnography (PSG) is challenging due to the required collaboration of the patients. In addition, screening questionnaires have demonstrated limited usefulness with this subpopulation. Considering this, we investigated the circulating microRNA (miRNA) profile associated with OSA in AD patients. This study included a carefully selected cohort of females with mild-moderate AD confirmed by biological evaluation (n = 29). The individuals were submitted to one-night PSG to diagnose OSA (apnea-hypopnea index ≥ 15/h) and the blood was collected in the following morning. The plasma miRNA profile was evaluated using RT-qPCR. The patients had a mean (SD) age of 75.8 (5.99) years old with a body mass index of 28.6 (3.83) kg m-2. We observed a subset of 15 miRNAs differentially expressed between OSA and non-OSA patients, of which 10 were significantly correlated with the severity of OSA. Based on this, we built a prediction model that generated an AUC (95% CI) of 0.95 (0.88-1.00) including 5 of the differentially expressed miRNAs that correlated with OSA severity: miR-26a-5p, miR-30a-3p, miR-374a-5p, miR-377-3p, and miR-545-3p. Our preliminary results suggest a plasma miRNA signature associated with the presence of OSA in AD patients. Further studies will be necessary to validate these findings.

Trends in the consumption rates of benzodiazepines and benzodiazepine-related drugs in the health region of Lleida from 2002 to 2015.

BACKGROUND: The high prevalence and long-term use of benzodiazepines (BZDs) treatment are debated topics because of the risk they can cause to the patients. Despite the current information on the risk-benefit balance of these drugs, their consumption remains particularly high. We determined the trend in the consumption prevalence of benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs) in the population of the Health Region of Lleida to explore patterns of use and the associated characteristics associated between 2002 and 2015. METHODS: An analysis of secular trends was carried out between 2002 and 2015; the databased included all individuals from the Health Region of Lleida, which had 358,157 inhabitants in 2015, that consumed BZDs. The consumption of BZDs was evaluated using prescription billing data from the Public Health System. All types of BZDs and BZD analogues that had been approved by the drug agency were included. Trends by age and sex were investigated. RESULTS: Over the whole study period, a total of 161,125 individuals accounted for 338,148 dispensations. Overall, 59% were women, and the mean age was 56 years. The dispensing prevalence of BZDs use in 2015 was 14.2% overall -18.8% in women and 9.6% in men-and was 36% in those over 65 years. According to the half-life of BZDs, the prevalence of short-intermediate BZD use, intermediate-long BZD use, and Z-drugs use was 9.7, 5.5 and 0.8%, respectively. The evolution of the annual prevalence of BZD dispensing showed a progressive decline, from 15.3% in 2002 to 14.2% in 2015, which was attributed to a decrease in the consumption of intermediate-long half-life BZDs (8.0% vs. 5.5%) and Z-drugs (1.4% vs. 0.8%). CONCLUSION: The dispensing prevalence of BZDs and Z-drugs was high, although a small reduction was observed during this time period. The dispensing prevalence was especially high in the population over 65, despite the risk of cognitive decline and falls. Integral actions are required to lower the BZD prescription rate.

ALLIANCE perspectives on integration of humans and the environment into the system of radiological protection.

Risks posed by the presence of radionuclides in the environment require an efficient, balanced, and adaptable assessment for protecting exposed humans and wildlife, and managing the associated radiological risk. Exposure of humans and wildlife originate from the same sources releasing radionuclides to the environment. Environmental concentrations of radionuclides serve as inputs to estimate the dose to man, fauna, and flora, with transfer processes being, in essence, similar, which calls for a common use of transport models. Dose estimates are compared with the radiological protection criteria for humans and wildlife, such as those developed by the International Commission on Radiological Protection. This indicates a similarity in the approaches for impact assessment in humans and wildlife, although some elements are different (e.g. the protection endpoint for humans is stochastic effects on individuals, whereas for wildlife, it is deterministic effects on species and ecosystems). Human and environmental assessments are consistent and complementary in terms of how they are conducted and in terms of the underlying databases (where appropriate). Not having an integrated approach may cause difficulties for operators and regulators, for communication to stakeholders, and may even hamper decision making. For optimised risk assessment and management, the impact from non-radiation contaminants and stressors should also be considered. Both in terms of the underlying philosophy and the application via appropriate tools, the European Radioecology Alliance (ALLIANCE) upholds that integration of human and ecological impact and risk assessment is recommended from several perspectives (e.g. chemical/radiological risks).

Síndrome de pinzamiento isquiofemoral: a propósito de un caso. Diagnóstico diferencial y manejo rehabilitador / Ischiofemoral impingement syndrome: a case report. Differential diagnosis and rehabilitation management

Hay múltiples causas de dolor de cadera. Entre ellas se encuentra el síndrome de pinzamiento isquiofemoral, actualmente de etiología desconocida, aunque inicialmente relacionado con historia previa de traumatismo o cirugía, para el cual no existe un protocolo de actuación unificado (AU)

There are multiple causes of hip pain, including ischiofemoral impingement syndrome. The aetiology of this syndrome is currently unknown, although it is associated with a history of trauma or surgery. Currently, there is no standard of care for this syndrome (AU)

Marine radioecology after the Fukushima Dai-ichi nuclear accident: Are we better positioned to understand the impact of radionuclides in marine ecosystems?

This paper focuses on how a community of researchers under the COMET (CO-ordination and iMplementation of a pan European projecT for radioecology) project has improved the capacity of marine radioecology to understand at the process level the behaviour of radionuclides in the marine environment, uptake by organisms and the resulting doses after the Fukushima Dai-ichi nuclear accident occurred in 2011. We present new radioecological understanding of the processes involved, such as the interaction of waterborne radionuclides with suspended particles and sediments or the biological uptake and turnover of radionuclides, which have been better quantified and mathematically described. We demonstrate that biokinetic models can better represent radionuclide transfer to biota in non-equilibrium situations, bringing more realism to predictions, especially when combining physical, chemical and biological interactions that occur in such an open and dynamic environment as the ocean. As a result, we are readier now than we were before the FDNPP accident in terms of having models that can be applied to dynamic situations. The paper concludes with our vision for marine radioecology as a fundamental research discipline and we present a strategy for our discipline at the European and international levels. The lessons learned are presented along with their possible applicability to assess/reduce the environmental consequences of future accidents to the marine environment and guidance for future research, as well as to assure the sustainability of marine radioecology. This guidance necessarily reflects on why and where further research funding is needed, signalling the way for future investigations.

ICRP Publication 136: Dose Coefficients for Non-human Biota Environmentally Exposed to Radiation.

Abstract ­: The diversity of non-human biota is a specific challenge when developing and applying dosimetric models for assessing exposures of flora and fauna from radioactive sources in the environment. Dosimetric models, adopted in Publication 108, provide dose coefficients (DCs) for a group of reference entities [Reference Animals and Plants (RAPs)]. The DCs can be used to evaluate doses and dose rates, and to compare the latter with derived consideration reference levels (DCRLs), which are bands of dose rate where some sort of detrimental effect in a particular RAP may be expected to occur following chronic, long-term radiation exposure, as outlined in Publication 124. These dosimetric models pragmatically assume simple body shapes with uniform composition and density, homogeneous internal contamination, limited sets of idealised sources of external exposure to ionising radiation for aquatic and terrestrial animals and plants, and truncated radioactive decay chains. This pragmatic methodology is further developed and systematically extended in this publication, which supersedes the DC values of Publication 108. Significant methodological changes since Publication 108 include: implementation of a new approach for external exposure of terrestrial animals with an extended set of environmental radioactive sources in soil and in air; considering an extended range of organisms and locations in contaminated terrain; transition to the contemporary radionuclide database of Publication 107; assessment-specific consideration of the contribution of radioactive progeny to DCs of parent radionuclides; and use of generalised allometric relationships in the estimation of biokinetic or metabolic parameter values. These methodological developments result in changes to previously published tables of DCs for RAPs, and revised values are provided in this publication. This publication is complemented by a new software tool, called 'BiotaDC', which enables the calculation of DCs for internal and external exposures of organisms with user-defined masses, shapes, and locations in the environment and for all radionuclides in Publication 107.

Approaches to modelling radioactive contaminations in forests - Overview and guidance.

Modelling the radionuclide cycle in forests is important in case of contamination due to acute or chronic releases to the atmosphere and from underground waste repositories. This article describes the most important aspects to consider in forest model development. It intends to give an overview of the modelling approaches available and to provide guidance on how to address the quantification of radionuclide transport in forests. Furthermore, the most important gaps in modelling the radionuclide cycle in forests are discussed and suggestions are presented to address the variability of forest sites.

Biomarkers of folate and vitamin B12 and breast cancer risk: report from the EPIC cohort.

Epidemiological studies have reported inconsistent findings for the association between B vitamins and breast cancer (BC) risk. We investigated the relationship between biomarkers of folate and vitamin B12 and the risk of BC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Plasma concentrations of folate and vitamin B12 were determined in 2,491 BC cases individually matched to 2,521 controls among women who provided baseline blood samples. Multivariable logistic regression models were used to estimate odds ratios by quartiles of either plasma B vitamin. Subgroup analyses by menopausal status, hormone receptor status of breast tumors (estrogen receptor [ER], progesterone receptor [PR] and human epidermal growth factor receptor 2 [HER2]), alcohol intake and MTHFR polymorphisms (677C > T and 1298A > C) were also performed. Plasma levels of folate and vitamin B12 were not significantly associated with the overall risk of BC or by hormone receptor status. A marginally positive association was found between vitamin B12 status and BC risk in women consuming above the median level of alcohol (ORQ4-Q1 = 1.26; 95% CI 1.00-1.58; Ptrend = 0.05). Vitamin B12 status was also positively associated with BC risk in women with plasma folate levels below the median value (ORQ4-Q1 = 1.29; 95% CI 1.02-1.62; Ptrend = 0.03). Overall, folate and vitamin B12 status was not clearly associated with BC risk in this prospective cohort study. However, potential interactions between vitamin B12 and alcohol or folate on the risk of BC deserve further investigation.

Environmental risks of radioactive discharges from a low-level radioactive waste disposal site at Dessel, Belgium.

The potential radiological impact of releases from a low-level radioactive waste (Category A waste) repository in Dessel, Belgium on the local fauna and flora was assessed under a reference scenario for gradual leaching. The potential impact situations for terrestrial and aquatic fauna and flora considered in this study were soil contamination due to irrigation with contaminated groundwater from a well at 70 m from the repository, contamination of the local wetlands receiving the highest radionuclide flux after migration through the aquifer and contamination of the local river receiving the highest radionuclide flux after migration through the aquifer. In addition, an exploratory study was carried out for biota residing in the groundwater. All impact assessments were performed using the Environmental Risk from Ionising Contaminants: Assessment and Management (ERICA) tool. For all scenarios considered, absorbed dose rates to biota were found to be well below the ERICA 10 µGy h-1 screening value. The highest dose rates were observed for the scenario where soil was irrigated with groundwater from the vicinity of the repository. For biota residing in the groundwater well, a few dose rates were slightly above the screening level but significantly below the dose rates at which the smallest effects are observed for those relevant species or groups of species. Given the conservative nature of the assessment, it can be concluded that manmade radionuclides deposited into the environment by the near surface disposal of category A waste at Dessel do not have a significant radiological impact to wildlife.

Inter-comparison of dynamic models for radionuclide transfer to marine biota in a Fukushima accident scenario.

We report an inter-comparison of eight models designed to predict the radiological exposure of radionuclides in marine biota. The models were required to simulate dynamically the uptake and turnover of radionuclides by marine organisms. Model predictions of radionuclide uptake and turnover using kinetic calculations based on biological half-life (TB1/2) and/or more complex metabolic modelling approaches were used to predict activity concentrations and, consequently, dose rates of (90)Sr, (131)I and (137)Cs to fish, crustaceans, macroalgae and molluscs under circumstances where the water concentrations are changing with time. For comparison, the ERICA Tool, a model commonly used in environmental assessment, and which uses equilibrium concentration ratios, was also used. As input to the models we used hydrodynamic forecasts of water and sediment activity concentrations using a simulated scenario reflecting the Fukushima accident releases. Although model variability is important, the intercomparison gives logical results, in that the dynamic models predict consistently a pattern of delayed rise of activity concentration in biota and slow decline instead of the instantaneous equilibrium with the activity concentration in seawater predicted by the ERICA Tool. The differences between ERICA and the dynamic models increase the shorter the TB1/2 becomes; however, there is significant variability between models, underpinned by parameter and methodological differences between them. The need to validate the dynamic models used in this intercomparison has been highlighted, particularly in regards to optimisation of the model biokinetic parameters.