Lung cancer risk by polycyclic aromatic hydrocarbons in a Mediterranean industrialized area.

This study focuses on characterizing the chronic risk assessment from inhalation of polycyclic aromatic hydrocarbons (PAHs) for people living near the largest chemical complex in the Mediterranean area. Eighteen PAHs were determined in the atmospheric gas and particle phases, counting PM10 and total suspended particles. The lifetime lung cancer risk from PAH exposure was estimated, and the contribution was assessed by phases. The results obtained with the continuous lifetime scenario were compared with those obtained with different chronic scenarios. The estimated chronic risk was also compared with those reported in previous studies. PAHs were present at higher concentration in the gas phase (>84 %) with a major contribution of the most volatile PAHs, and an equitable distribution of heavy PAHs between gas and particle phases was observed. Petroleum combustion and traffic emissions were suggested as the main sources, but the influence of petrogenic sources cannot be ruled out. The estimated average lifetime lung cancer risk in this study ranged between 3.2 × 10-5 and 4.3 × 10-5. The gas phase accounted for the most significant contribution to the total risk (>60 %). Fluoranthene (FluT), dibenzo(a,h)anthracene (DahA) and benzo(a)pyrene (BaP), as a whole, made the greatest contribution to the total risk (>80 %). BaP-bound PM10 accounted for a small contribution of the total risk (10 %). Chronic exposures lower than total lifetime hours could even pose a risk >10-5. The results also showed that BaP-bound PM10, according to current legislation, may not be a good indicator of the real risk by PAH exposure. Concerning previous studies, the economic situation may have an impact on reducing the cancer risk by PAH inhalation.

Asthma, respiratory symptoms and lung function in children living near a petrochemical site.

Residential proximity to environmental hazards has been related to adverse health outcomes. Respiratory health and allergies in children living near petrochemical sites have not been extensively studied. We evaluated the association between residential proximity to the petrochemical site of Tarragona (Catalonia, Spain) and the prevalence of asthma, respiratory symptoms and lung function in children. Children aged 6-7 (n=2672) and adolescents aged 13-14 (n=2524) residing near two large petrochemical sites and those living in a city with medium vehicular traffic were cross-sectionally compared with children from an area with low vehicular traffic and without industry. The prevalence of symptoms was measured using the International Study of Asthma and Allergies in Childhood written and video questionnaires. Lung function measurements were done in a subsample of 959 adolescents in the four areas. Multivariable analyses were done to estimate the effects of the residential area on symptoms and lung function adjusted for potential confounders. Crude prevalence of symptoms was similar across the studied areas. After adjustment, children and adolescents living near a petrochemical site had a statistically significant higher prevalence of respiratory hospitalizations in the previous year (Prevalence Ratio (PR)=1.49; 95%CI, 1.06-2.09) and of nocturnal cough (PR=1.29; 95%CI 1.05-1.57), respectively. Reduced lung function values among adolescents residing near the petrochemical areas were not observed. Although a higher prevalence of asthma in children and adolescents living near the petrochemical sites could not be demonstrated, as described in other studies, respiratory hospitalizations and nocturnal cough could be related to short-term exposures to pollutants. Other clinical and sub-clinical respiratory health effects in the petrochemical industry areas should be investigated.

Chronic risk assessment of exposure to volatile organic compounds in the atmosphere near the largest Mediterranean industrial site.

This study focuses on characterising the risk of exposure to volatile organic compounds (VOCs) by means of inhalation in people living in the vicinity of the largest chemical production site in the Mediterranean area. Eighty-six VOCs were initially selected for this study based on their adverse environmental and health effects. The monitoring campaign was conducted for 276 days in three different locations around the chemical site. The analytical method used for the characterisation was based on European standard method EN-14662-2, which consists of the active sampling of air for 24h in charcoal tubes, followed by extraction with carbon disulphide and GC-MS analysis. Forty-four VOCs with toxicological data available concerning their carcinogenic and non-carcinogenic health effects were quantified during the monitoring campaign. None of the quantified VOCs showed average concentrations exceeding their chronic reference concentrations and, therefore, no non-carcinogenic health effects are expected as a result of this exposure. However, the global average cancer risk due to VOC exposure in the area (3.3×10(-4)) was found to be above the values recommended by the WHO and USEPA. The influence of the analytical method was also evaluated by comparing cancer risk estimates using a thermal desorption (TD) method based on method EN-14662-1. The results of the 24-h samples for the solvent extraction method were compared with the average of 12 daily samples of 2-h for the TD method for 24 sampling days. Although the global estimated lifetime cancer risk was statistically comparable for both methods, some differences were found in individual VOC risks. To our knowledge, this is the first study that estimates the carcinogenic and non-carcinogenic risks posed by the inhalation of VOCs in people living near a chemical site of this size, and compares the estimated cancer risk obtained using two different standard analytical methods.

Risk assessment related to atmospheric polycyclic aromatic hydrocarbons in gas and particle phases near industrial sites.

BACKGROUND: Inhalation is one of the main means of human exposure to polycyclic aromatic hydrocarbons (PAHs) because of their ubiquitous presence in the atmosphere. However, most studies have considered only PAHs found in the particle phase and have omitted the contribution of the gas-phase PAHs to the risk. OBJECTIVE: We estimated the lifetime lung cancer risk from PAH exposure by inhalation in people living next to the largest chemical site in Southern Europe and the Mediterranean area. METHODS: We determined 18 PAHs in the atmospheric gas and particle phase. We monitored the PAHs for 1 year in three locations near the chemical site in different seasons. We used toxic equivalence factors to calculate benzo[a]pyrene (BaP) equivalents (BaP-eq) for individual PAHs and applied the World Health Organization unit risk (UR) for BaP (UR = 8.7 × 10-5) to estimate lifetime cancer risks due to PAH exposures. RESULTS: We observed some spatial and seasonal variability in PAH concentrations. The contribution of gas-phase PAHs to the total BaP-eq value was between 34% and 86%. The total estimated average lifetime lung cancer risk due to PAH exposure in the study area was 1.2 × 10-4. CONCLUSIONS: The estimated risk was higher than values recommended by the World Health Organization and U.S. Environmental Protection Agency but lower than the threshold value of 10-3 that is considered an indication of definite risk according to similar risk studies. The results also showed that risk may be underestimated if the contributions of gas-phase PAHs are not considered.

Comparative study of solvent extraction and thermal desorption methods for determining a wide range of volatile organic compounds in ambient air.

This paper compares two analytical methods for determining levels of 90 volatile organic compounds (VOCs) commonly found in industrial and urban atmospheres. Both methods are based on two official methods for determining benzene levels and involve collecting samples by active adsorptive enrichment on solid sorbents. The first method involves solvent extraction and uses activated charcoal as a sorbent. After sampling, the sorbent is extracted with 1 mL of carbon disulfide and then 1 microL of the extract is analysed in a GC-MS. The second method involves thermal desorption (TD) and uses Tenax TA and Carbograph 1TD as sorbents, which allows the whole sample to be analysed. In general, the thermal desorption method showed the best repetitivity and recovery and the lowest limit of detection and quantification for all target compounds. Because of its lower sensitivity, the solvent extraction method needs the preconcentration of large sample volumes of air (720 L vs. 2.64 L for the thermal desorption method) to yield similar limits of detection. The performance of both methods in real samples was tested in a location near to a petrochemical complex. The results of the 24-h samples for the solvent extraction method were compared with the average of 12 2-h samples for the TD method. In some cases, both methods found differences in the VOC concentrations, especially in those compounds whose concentrations fluctuate significantly during the day.

[Soybean hull unloading in Tarragona (Spain) and asthma outbreak risk]. / Descargas de cascarilla de soja en Tarragona y riesgo de epidemias de asma.

OBJECTIVES: From 2007 to 2008, 215,000 tons of soybean hull were unloaded in the Port of Tarragona. Soybean hull was identified as the etiologic agent causing bronchial asthma outbreaks. The aim of the present study was to identify the characteristics of soybean unloading, soybean allergen dispersion, and the population risk. METHODS: Data on soybean hull unloading, carriage and storage, meteorological conditions and the number of emergency room admissions for asthma were recorded. Allergen concentrations were obtained by sampling PM(10) filters retaining particles of less than 10 microns for 24 hours in the atmospheric contamination surveillance stations. Sensitized patients underwent clinical examination consisting of skin prick test, total and specific IgE and immunoblotting to soybean extracts. RESULTS: Allergen emissions were moderate at one kilometer from the unloading source (above 300 U/m(3) on 3 days, maximum 441 U/m(3)). The protein pattern of hull soybean extracts was similar to that found in asthma epidemics in Barcelona. Ninety-two percent of the patients were sensitized to soybean hull extracts. No asthma epidemic was detected during unloading days. In addition to the low molecular weight soybean proteins identified in previous studies (6 and 14-17 kDa), high molecular weight proteins were found (14-49 kDa). CONCLUSIONS: There is allergen dispersion at a short distance from the unloading source, posing a risk to sensitized patients. Technical measures are required during soybean hull operations to reduce particle emissions.

Programa piloto para la mejora de la certificación de las causas de muerte en atención primaria en Cataluña / A pilot program to improve causes of death certification in primary care of Catalonia, Spain

Objetivo: El programa piloto BEDTAR (Boletín Estadístico de Defunción en Tarragona) evaluó el cambio en la calidad de la certificación de las defunciones, tras una intervención formativa a los médicos de atención primaria del Ámbito de Tarragona, en Cataluña. Diseño: Estudio evaluativo «antes-después» con intervención y sin grupo control. Emplazamiento y participantes: La población objeto de estudio estaba constituida por los médicos de la red reformada de atención primaria del AT. Material y métodos: Se iniciaba la sesión con el ejercicio «antes», que consistía en certificar 3 defunciones. Luego le seguía el seminario teórico-práctico y, finalmente, el ejercicio «después», en el que se certificaban de nuevo las defunciones del primer ejercicio. Las variables utilizadas para evaluar la calidad de la certificación fueron: certificación de las causas en secuencia lógica, posición correcta en el boletín estadístico de defunción de las causas inmediatas, intermedia y fundamental, uso del paro cardiorrespiratorio y otras entidades mal definidas, uso adecuado de las abreviaturas, letra ilegible, vocabulario y uso de toda la información disponible. Resultados: La participación final de los profesionales en el programa fue del 71% y la eficacia de cambio para la mejora global que podemos atribuir al programa fue del 59%. Conclusiones: El programa BEDTAR mejoró la calidad de la certificación y puso de manifiesto la relevancia y la aplicabilidad de los resultados obtenidos

Objective: The BEDTAR pilot program assessed changes in the quality of certification of death's causes after a training session for the primary care physicians in the Tarragona's Area of Catalonia, in the Northeast of the Iberian Peninsula. Design: Before-after evaluative study with intervention and without control group. Setting and participants: The study population was the physicians of the reformed primary health care network of the AT. Material and methods: The training session began with a test consisting of certifying 3 deaths. This test was followed by a theoretical and practical seminar. The session concluded with a final test consisting on certifying the same 3 cases. The variables used to evaluate the quality the certification were: logical sequence the death causes, correct position on death certificate of the immediate, intermediate and basic causes, precise use of cardiac arrest and other ill-defined diseases, appropriate use of abbreviations, legibility, vocabulary and, finally, use of all the available information. Results: The final participation of the study population was 71% and the global program efficacy was 59%. Conclusions: The BEDTAR program improved the quality of certification and emphasized the relevancy and the applicability of the results

[A pilot program to improve causes of death certification in primary care of Catalonia, Spain]. / Programa piloto para la mejora de la certificación de las causas de muerte en atención primaria en Cataluña.

OBJECTIVE: The BEDTAR pilot program assessed changes in the quality of certification of death's causes after a training session for the primary care physicians in the Tarragona's Area of Catalonia, in the Northeast of the Iberian Peninsula. DESIGN: Before-after evaluative study with intervention and without control group. SETTING AND PARTICIPANTS: The study population was the physicians of the reformed primary health care network of the AT. MATERIAL AND METHODS: The training session began with a test consisting of certifying 3 deaths. This test was followed by a theoretical and practical seminar. The session concluded with a final test consisting on certifying the same 3 cases. The variables used to evaluate the quality the certification were: logical sequence the death causes, correct position on death certificate of the immediate, intermediate and basic causes, precise use of cardiac arrest and other ill-defined diseases, appropriate use of abbreviations, legibility, vocabulary and, finally, use of all the available information. RESULTS: The final participation of the study population was 71% and the global program efficacy was 59%. CONCLUSIONS: The BEDTAR program improved the quality of certification and emphasized the relevancy and the applicability of the results.

Stroke in young patients: a diagnostic challenge in the emergency room.

Stroke in young adults has been related to mechanisms different to those found in older individuals. Cardiogenic embolism, arteritis, atherosclerosis, fibromuscular dysplasia, pregnancy-related angiopathy, migrainous stroke, anaemia, antiphospholipid syndrome, arterial dissection, the consumption of toxic substances and head trauma have been described. We present a young man with a case history of tobacco and cocaine abuse who suffered a mild head trauma, with normal neurological examination, and a computed tomography scan image of a right anterior cerebral infarction. Serum biochemistry showed no alterations according to the diagnosis protocol for stroke in young patients. Various mechanisms have been involved, such as vasospasm, increasing arterial pressure and embolism. Considering the cocaine abuse and the mild head trauma, in our patient vasospasm was thought to be the mechanism involved in the cerebral infarction, which proved a challenge to diagnose in the emergency room.