[The climate crisis as an ethical challenge]. / Die Klimakrise als ethische Herausforderung.

Climate change is a threat to health and social security of billions of people. Health and quality of life are increasingly affected in many ways due to the climate crisis. Rising global temperatures are resulting in increasingly frequent and severe extreme weather events, contributing to further increase in inequality, discrimination, and injustice overall and in health care specifically. Furthermore, climatic conditions are also becoming increasingly suitable for the transmission of infectious diseases and their spread into new regions. Socio-economically disadvantaged regions with weak health infrastructure (e.g. Global South) will be hardly able to cope without specific support. The overriding imperative is to achieve reductions in greenhouse gas emissions from transport, energy and food production at global, national and regional levels to mitigate negative health impacts. The 2015 Paris Agreement must also be seen as crucial health agreement. Our paper aims to highlight ethical aspects of climate change in the health sector.

Health Symptoms Related to Pesticide Use in Farmers and Laborers of Ecological and Conventional Banana Plantations in Ecuador.

Conventional banana farming is pesticide-intensive and leads to high exposure of farmworkers. Ecuador is the world's biggest exporter of bananas. In this field study in 5 communities in Ecuador, we recorded potentially pesticide-associated subjective health symptoms in farmworkers and compared pesticide users to workers in organic farming. With one exception, symptom rates were always higher in the pesticide-exposed group. Significance was reached in 8 out of 19 investigated symptoms with the highest odds ratios (and smallest p-values) for local irritation like skin and eye irritation (OR = 3.58, CI 1.10-11.71, and 4.10, CI 1.37-12.31, respectively) as well as systemic symptoms like dizziness (OR = 4.80, CI 1.55-14.87) and fatigue (OR = 4.96, CI 1.65-14.88). Moreover, gastrointestinal symptoms were reported more frequently by pesticide users: nausea (OR = 7.5, CI 1.77-31.77) and diarrhea (OR = 6.43, CI 1.06-30.00). The majority of farmworkers were not adequately protected from pesticide exposure. For example, only 3 of 31 farmworkers that had used pesticides recently reported using gloves and only 6 reported using masks during active spraying. Improved safety measures and a reduction in pesticide use are necessary to protect the health of banana farmworkers.

Air Pollution Is Associated with COVID-19 Incidence and Mortality in Vienna, Austria.

We determined the impact of air pollution on COVID-19-related mortality and reported-case incidence, analyzing the correlation of infection case numbers and outcomes with previous-year air pollution data from the populations of 23 Viennese districts. Time at risk started in a district when the first COVID-19 case was diagnosed. High exposure levels were defined as living in a district with an average (year 2019) concentration of nitrogen dioxide (NO2) and/or particulate matter (PM10) higher than the upper quartile (30 and 20 µg/m3, respectively) of all districts. The total population of the individual districts was followed until diagnosis of or death from COVID-19, or until 21 April 2020, whichever came first. Cox proportional hazard regression was performed after controlling for percentage of population aged 65 and more, percentage of foreigners and of persons with a university degree, unemployment rate, and population density. PM10 and NO2 were significantly and positively associated with the risk of a COVID-19 diagnosis (hazard ratio (HR) = 1.44 and 1.16, respectively). NO2 was also significantly associated with death from COVID-19 (HR = 1.72). Even within a single city, higher levels of air pollution are associated with an adverse impact on COVID-19 risk.

Nitrogen-Dioxide Remains a Valid Air Quality Indicator.

In epidemiological studies, both spatial and temporal variations in nitrogen dioxide (NO2) are a robust predictor of health risks. Compared to particulate matter, the experimental evidence for harmful effects at typical ambient concentrations is less extensive and not as clear for NO2. In the wake of the "Diesel emission scandal-Dieselgate", the scientific basis of current limit values for ambient NO2 concentrations was attacked by industry lobbyists. It was argued that associations between NO2 levels and medical endpoints were not causal, as NO2 in older studies served as a proxy for aggressive particulate matter from incineration processes. With the introduction of particle filters in diesel cars, NO2 would have lost its meaning as a health indicator. Austria has a high percentage of diesel-powered cars (56%). If, indeed, associations between NO2 concentrations and health risks in previous studies were only due to older engines without a particle filter, we should expect a reduction in effect estimates over time as an increasing number of diesel cars on the roads were outfitted with particle filters. In previous time series studies from Vienna over shorter time intervals, we have demonstrated distributed lag effects over days up to two weeks and previous day effects of NO2 on total mortality. In a simplified model, we now assess the effect estimates for moving 5-year periods from the beginning of NO2 monitoring in Vienna (1987) until the year 2018 of same and previous day NO2 on total daily mortality. Contrary to industry claims of a spurious, no longer valid indicator function of NO2, effect estimates remained fairly stable, indicating an increase in total mortality of previous day NO2 by 0.52% (95% CI: 0.35-0.7%) per 10 µg/m3 change in NO2 concentration.

Time Course of COVID-19 Cases in Austria.

COVID-19 is an infectious disease caused by a novel coronavirus, which first appeared in China in late 2019, and reached pandemic distribution in early 2020. The first major outbreak in Europe occurred in Northern Italy where it spread to neighboring countries, notably to Austria, where skiing resorts served as a main transmission hub. Soon, the Austrian government introduced strict measures to curb the spread of the virus. Using publicly available data, we assessed the efficiency of the governmental measures. We assumed an average incubation period of one week and an average duration of infectivity of 10 days. One week after the introduction of strict measures, the increase in daily new cases was reversed, and the reproduction number dropped. The crude estimates tended to overestimate the reproduction rate in the early phase. Publicly available data provide a first estimate about the effectiveness of public health measures. However, more data are needed for an unbiased assessment.

Indicators of Genotoxicity in Farmers and Laborers of Ecological and Conventional Banana Plantations in Ecuador.

Banana farming represents an important segment of agricultural production in Ecuador. The health of farmworkers might be compromised by the extensive use of pesticides in plantations applied under poorly regulated conditions. Due to an increased awareness of pesticide-related problems for nature, as well as for worker and consumer health, ecological farming has been established in some plantations of Ecuador. We set out to investigate the occupational health of workers in both conventional and ecological farming. Nuclear anomalies in buccal epithelial cells were used as short-term indicators for genotoxicity and a potentially increased cancer risk in the two groups of farmworkers. By application of the Buccal Micronucleus Cytome Assay (BMCA), we found the frequency of micronuclei in conventional pesticide using farmworkers significantly increased by 2.6-fold, and other nuclear anomalies significantly increased by 24% to 80% (except pyknosis with a non-significant increase of 11%) compared to the farmworkers on ecological plantations. These results demonstrate that ecological farming may provide an alternative to extensive pesticide use with significantly reduced indicators of cancer risk. In conventional farming, improvements in education and instruction regarding the safe handling of pesticides and protective equipment, as well as regulatory measures, are urgently needed.

Management of mountainous meadows associated with biodiversity attributes, perceived health benefits and cultural ecosystem services.

Associations between biodiversity, human health and well-being have never been discussed with reference to agriculturally managed, species-rich mountainous meadows. We evaluated these associations between extensively managed (one mowing a year, no fertilization) and abandoned (no mowing since more than 80 years, no fertilization) semi-dry meadows located in the Austrian and Swiss Alps. We quantified the richness and abundance of plants, grasshoppers, true bugs, bumblebees, syrphids and landscape characteristics in the surroundings of the meadows. Associations between these biodiversity attributes and short-term psychological and physiological human health effects were assessed with 22 participants (10 males, 12 females; mean age 27 years). Participants´ pulse rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not affected during visits to managed or abandoned meadows. However, perceived health benefits (e.g., stress reduction, attention restoration) were higher during their stays in managed than in abandoned meadows. Also, the attractiveness of the surrounding landscape and the recreation suitability were rated higher when visiting managed meadows. Perceived naturalness was positively correlated with plant richness and flower cover. A positive correlation was found between SBP and forest cover, but SBP was negatively correlated with the open landscape. A negative association was found between grasshoppers and recreational and landscape perceptions. We suggest to discuss biodiversity attributes not only in connection with agricultural management but also with cultural ecosystem services and health benefits to raise more awareness for multifaceted interrelationships between ecosystems and humans.

Evaluating an 80 Hz tonal noise from a hydropower plant.

A pumped storage power plant produces significant noise such that adjacent areas were deemed uninhabitable for the local population. In recent years, the population in the area has increased, and the noise levels are now causing significant distress to the local population. The company operating the power plant and a citizens' initiative have both commissioned noise measurements. The measurements showed that the continuous pump noise was audible over many kilometers. The A-weighted sound-pressure level of 50 dBA at the next residential area underestimates the perceived noise, given the clear tonal nature in the low frequency range. Interviews of the exposed population, together with detailed "annoyance diaries" by a sample of the residents, proved their high level of annoyance. Their reported observations on distress and sleep disturbances coincide with the time course of the pumping operation. The pumping noise leads to annoyance in a large area, and to considerable nuisance in a smaller one. For the most exposed homes, long-term exposure might be considered a health hazard due to stress and disturbances in sleep quality. Therefore, the operator committed to developing a technical noise control plan. This case shows that a scientific approach within a complex environmental noise problem can foster an agreement about noise protection measures. However, this can only be successful if all involved parties participate in the process. Pilot studies are underway to test the impact of damping material layers on the pipes, the housing of the pipes, and the kind of air vessel solutions between the pumps and the pipes. Int J Occup Med Environ Health. 2019;32(3):401-11.

Validity of reported indicators of pesticide exposure and relevance for cytotoxic and genotoxic effects on buccal cells.

Higher rates of nuclear anomalies in buccal cells of coffee workers exposed to pesticides in comparison to their unexposed peers were detected in our field study. Here, we extend our findings by examining other exposure indicators in this sample. Occupational exposure of 38 exposed and 33 non-exposed farmworkers was assessed as exposure days in the last month (0-25 days) and as years of exposure (0-47 years). Genotoxic and cytotoxic markers in buccal cells were analysed following standard procedures for buccal micronucleus cytome assay. Both exposure markers were associated with a higher frequency of nuclear anomalies with odds ratios more than 1. After restricting the analysis to the exposed workers only, this association remained only with the marker of recent exposure. In a secondary analysis also environmental exposure defined as proximity of the home to the nearest sprayed field (distance <1000 m) was assessed. Proximity led to increased rates (with odds ratios more than 3) of genotoxic but not cytotoxic nuclear anomalies. Reported recent frequency and intensity of pesticide use and application are a valid exposure marker relevant for cytological pathologies in the buccal mucosa. The exposure metric for environmental exposure was rather crude and confounding by some unmeasured factor cannot be fully excluded. Nevertheless, simple exposure indicators that can even be obtained under rather difficult field conditions do provide health-relevant and valid information.

Health-Related Effects of Short Stays at Mountain Meadows, a River and an Urban Site-Results from a Field Experiment.

The study compared psychological and physiological health effects of short-term stays at managed and abandoned meadows, a mountain river, and an urban site of a dependent sample of 22 adult participants (mean age 27) during an 11-day field trip. The study found that pulse rates decreased during the stays at all the meadows and the urban site while no decrease was observed at the river. Blood pressure increased at all sites during the stay, with no study-site differences for systolic, but for diastolic, blood pressure. Participants reported more positive psychological health effects as a result of their stays at the most remote meadow and the river on attention restoration, stress reduction and wellbeing compared to the urban site, while no differences in health perceptions were observed between managed and unmanaged meadows. This study suggests that perceived and measured health benefits were independent of the degree of naturalness of meadows. While differences measured on the physiological level between urban built and natural sites were marginal, psychological measures showed higher health benefits of the natural environments compared to the built one.

Alien Species and Human Health: Austrian Stakeholder Perspective on Challenges and Solutions.

No saturation in the introduction, acceleration of spread and the increasing impacts of alien species are a characteristic feature of the Anthropocene. Concomitantly, alien species affecting human health are supposed to increase, mainly due to increasing global trade and climate change. In this study, we assess challenges and solutions posed by such species to the public health sector in Austria over the next few decades. We did so using an online questionnaire circulated to 131 experts and stakeholders working on human health and biological invasions, supplemented by in-depth interviews with eleven selected experts. Results from the online survey and in-depth interviews largely support and complement each other. Experts and stakeholders suggest that (i) the allergenic Ambrosia artemisiifolia (common ragweed), the photodermatoxic Heracleum mantegazzianum (giant hogweed), and vectors of diseases such as Aedes albopictus (Asian tiger mosquito) are considered the alien species posing the most severe challenges; (ii) challenges are expected to increase in the next few decades and awareness in the public health sector is not sufficient; (iii) effective and efficient solutions are mainly related to prevention. Specific solutions include pathway management of introduction and spread by monitoring and controlling established populations of ragweed, hogweed and mosquitos.

Subjective Symptoms of Male Workers Linked to Occupational Pesticide Exposure on Coffee Plantations in the Jarabacoa Region, Dominican Republic.

Acute and sub-acute effects of pesticide use in coffee farmers have rarely been investigated. In the present field study, self-reported health symptoms from 38 male pesticide users were compared to those of 33 organic farmers. Results of cytological findings have been reported in an accompanying paper in this issue. The present second part of the study comprises a questionnaire based survey for various, potentially pesticide related symptoms among the coffee farmers. Symptom rates were generally higher in exposed workers, reaching significance in nine out of 19 assessed symptoms. Significantly increased symptom frequencies were related to neurotoxicity, parasympathic effects and acetylcholine esterase inhibition, with the highest differences found for excessive salivation, dizziness and stomach ache. We revealed a lack of precautionary measures in the majority of farmers. Better education, regulations, and safety equipment are urgently needed.

Cytotoxic and Genotoxic Effects of Pesticide Exposure in Male Coffee Farmworkers of the Jarabacoa Region, Dominican Republic.

Intensive agrochemical use in coffee production in the Global South has been documented. The aim of this study was to investigate cytotoxic and genotoxic effects of pesticide exposure in male farmworkers in the Dominican Republic comparing conventional farming using pesticides to organic farming. Furthermore, feasibility of the buccal micronucleus cytome assay (BMCA) for field studies under difficult local conditions was tested. In a cross-sectional field study, pesticide exposed (sprayers) and non-exposed male workers on coffee plantations were interviewed about exposure history, and pesticide application practices. Buccal cells were sampled, and BMCA was applied to assess potential effects on cell integrity. In total, 38 pesticide-exposed and 33 non-exposed workers participated. Eighty-four and 87%, respectively, of the pesticide-exposed respondents did not use masks or gloves at all. All biomarkers from the BMCA were significantly more frequent among exposed workers-odds ratio for micronucleated cells: 3.1 (95% confidence interval: 1.3⁻7.4) or karyolysis: 1.3 (1.1⁻1.5). Buccal cells as sensitive markers of toxic oral or respiratory exposures proved feasible for challenging field studies. Our findings indicate that the impact of pesticide use is not restricted to acute effects on health and wellbeing, but also points to long-term health risks. Therefore, occupational safety measures including training and protective clothing are needed, as well as encouragement towards minimal application of pesticides and more widespread use of organic farming.

Reloading Pupils' Batteries: Impact of Green Spaces on Cognition and Wellbeing.

Cognitive functioning and academic performance of pupils depend on regular breaks from classroom work. However, it is unclear which settings during such breaks provide the best environment to restore cognitive performance and promote wellbeing of adolescent pupils. Therefore, we investigated the effects of staying in different urban green spaces during breaks. Sixty-four pupils (16⁻18 years old) participated in a cross-over experiment. They were placed into one of three settings (small park, larger park, forest) for one hour during a lunch break. Wellbeing was assessed four times (Nitsch scale), and a cognitive test (d2-R Test of Attention) was applied in the classrooms before and after the break. Wellbeing was almost always highest after the stay in the green spaces. However, a sustained effect was only found for the forest. Concentration performance values of the d2-R test were significantly higher after the pupils’ stay in green spaces for all sites. The highest increase of performance was found for the larger park type. In conclusion, this pilot study showed that study breaks in green spaces improved wellbeing and cognitive performance of adolescents. It also found that larger green spaces, either parks or forests, have stronger positive impacts on wellbeing and cognitive performance than small parks.

Vulnerability to heatwaves and implications for public health interventions - A scoping review.

BACKGROUND: Heatwaves form a serious public health threat, especially for vulnerable groups. Interventions such as active outreach programs, exposure reduction measures and monitoring and mapping of at-risk groups are increasingly implemented across the world but little is known about their effect. OBJECTIVES: To assess how vulnerable groups are identified and reached in heat health interventions, to understand the effectiveness and efficiency of those interventions, and to identify research gaps in existing literature. METHODS: We performed a literature search in relevant scientific literature databases and searched with a four element search model for articles published from 1995 onward. We extracted data on intervention measures, target group and evaluation of effectiveness and efficiency. RESULTS: We identified 23 eligible studies. Patterns exist in type of interventions 1) to detect and 2) to influence extrinsic and intrinsic risk and protective factors. Results showed several intervention barriers related to the variety and intersection of these factors, as well as the self-perception of vulnerable groups, and misconceptions and unfavorable attitudes towards intervention benefits. While modest indications for the evidence on the effectiveness of interventions were found, efficiency remains unclear. DISCUSSION: Interventions entailed logical combinations of measures, subsumed as packages. Evidence for effective and efficient intervention is limited by the difficulty to determine effects and because single measures are mutually dependent. Interventions prioritized promoting behavioral change and were based on behavioral assumptions that remain untested and mechanisms not worked out explicitly. CONCLUSIONS: Multifaceted efforts are needed to tailor interventions, compiled in heat health warning systems and action plans for exposure reduction and protection of vulnerable populations, to fit the social, economic and geographical context. Besides adequately addressing relevant risk and protective factors, the challenge is to integrate perspectives of vulnerable groups. Future research should focus on intervention barriers and improving the methods of effectiveness and efficiency evaluation.

Red meat, diseases, and healthy alternatives: A critical review.

Meat is an important food for human nutrition, by especially providing high-quality protein and also some essential micronutrients, in front iron, zinc, and vitamin B12. However, a high intake of red and processed meat is associated with an increased risk for diseases, especially type 2 diabetes and colorectal cancer, as several epidemiological studies and meta-analyses have shown. This review summarizes meta-analyses of publications studying the association between red and processed meat intake and type 2 diabetes, cardiovascular diseases, colorectal and other cancers, and all-cause mortality. Various potential mechanisms involved in the increased disease risk are discussed. Furthermore, the beneficial effects of healthy alternatives for meat, like fish, nuts, vegetables and fruits, pulses and legumes, whole grains, and dairy products are reviewed by including selected papers and recent meta-analyses.

Re-evaluation of a 2014 multi-country European outbreak of Salmonella Enteritidis phage type 14b using recent epidemiological and molecular data.

A European multi-country outbreak of Salmonella Enteritidis phage type (PT) 14b occurred from March to November 2014 associated with the consumption of eggs. The outbreak involved more than 400 human cases from France, Luxembourg, Austria and the United Kingdom. In 2016-2017, it has been re-evaluated combining recent epidemiological results with latest molecular data. The outbreak was traced back to one large Bavarian egg producer with four distinct premises, three located in Bavaria, one in the Czech Republic. The outbreak isolates of S. Enteritidis PT 14b were grouped into three closely related clades by whole genome sequencing. Two of these clades could be referred to two Bavarian premises of the egg producer on the basis of epidemiological and molecular data, while epidemiological data presumably linked the third clade to another premises of the egg producer. Interestingly and in contrast to the situation in other European countries where several outbreaks were documented, all notified 91 laboratory-confirmed cases of S. Enteritidis PT 14b from Bavaria were sporadic, singular cases not belonging to any epidemiological outbreaks. In conclusion, as demonstrated here, the resolution of food-related outbreaks with such a high discriminatory power is rare in outbreak investigation.

Mortality Among Hardmetal Production Workers: A Retrospective Cohort Study in the Austrian Hardmetal Industry.

OBJECTIVE: This study retrospectively investigates causes of death among workers of a hardmetal plant in Austria. METHODS: A retrospective cohort was formed of 1965 workers still employed in or after 1970. Follow-up was until end of 2014 based on national databases. Cobalt exposure was assessed through industrial hygiene data and urine analyses. Cox proportional hazards models were calculated for selected causes of death. RESULTS: During 45,598 years of observation in total 177 deaths were observed. Forty-nine workers died from any cancer, 10 from lung cancer, and three from chronic obstructive pulmonary disease. Only the latter showed a significant association with cumulative exposure. CONCLUSIONS: Although this is a young study population with little power to detect subtle effects, at least it does not indicate a pronounced cancer risk among tungsten carbide workers due to cobalt.

SUV driving "masculinizes" risk behavior in females: a public health challenge.

Involvement of sport utility vehicles (SUV) in accidents especially with children is of increasing importance. Studies have indicated a more risky behavior in SUV drivers. We conducted an observational study focusing on traffic violations, car type, and the gender of the driver in Vienna. The study was conducted on five weekdays at the beginning of school term. Three busy intersections were selected.Drivers of 43,168 normal cars and 5653 SUVs were counted at the intersections during the observation period. In total 13.8% drivers were unbelted, 3.1% were using a handheld mobile phone, and 2.5% violated traffic lights. These frequencies were significantly higher in SUV drivers than in normal passenger car drivers. This "SUV effect" also occurred in women for all violations, although male drivers violated traffic laws more often than female drivers. However, for driving unbelted the difference between males and females was smaller in SUV drivers.

Health and Wellbeing of Occupants in Highly Energy Efficient Buildings: A Field Study.

Passive houses and other highly energy-efficient buildings need mechanical ventilation. However, ventilation systems in such houses are regarded with a certain degree of skepticism by parts of the public due to alleged negative health effects. Within a quasi-experimental field study, we investigated if occupants of two types of buildings (mechanical vs. natural ventilation) experience different health, wellbeing and housing satisfaction outcomes and if associations with indoor air quality exist. We investigated 123 modern homes (test group: with mechanical ventilation; control group: naturally ventilated) built in the years 2010 to 2012 in the same geographic area and price range. Interviews of occupants based on standardized questionnaires and measurements of indoor air quality parameters were conducted twice (three months after moving in and one year later). In total, 575 interviews were performed (respondents' mean age 37.9 ± 9 years in the test group, 37.7 ± 9 years in the control group). Occupants of the test group rated their overall health status and that of their children not significantly higher than occupants of the control group at both time points. Adult occupants of the test group reported dry eyes statistically significantly more frequently compared to the control group (19.4% vs. 12.5%). Inhabitants of energy-efficient, mechanically ventilated homes rated the quality of indoor air and climate significantly higher. Self-reported health improved more frequently in the mechanically ventilated new homes (p = 0.005). Almost no other significant differences between housing types and measuring time points were observed concerning health and wellbeing or housing satisfaction. Associations between vegetative symptoms (dizziness, nausea, headaches) and formaldehyde concentrations as well as between CO2 levels and perceived stale air were observed. However, both associations were independent of the type of ventilation. In summary, occupants of the mechanically ventilated homes rated their health status slightly higher and their health improved significantly more frequently than in occupants of the control group. As humidity in homes with mechanical ventilation was lower, it seems plausible that the inhabitants reported dry eyes more frequently.