Medical management, prevention and mitigation of environmental risks factors in Neurology.

The human environment and exposures arising therefrom are major contributors to neurological disorders ranging from stroke to neurodegenerative diseases. Reduction of exposure to environmental risk factors, with the goal of disease prevention or control, is addressed at the individual as well as the societal level and in recognition of differential subject vulnerability. We examine some practical solutions in high-income countries that may allow a better adaptation to environmental risks and reduce their adverse impact on the nervous system. We consider the citizen's role in reducing unhealthy exposures and explore new approaches to treatment.

Cambio climático y salud / Change climate and health

El cambio climático consiste fundamentalmente en el calentamiento del planeta, que tiene lugar como consecuencia del llamado efecto invernadero. Ese efecto lo ocasionan determinados gases, entre los que destaca el anhídrido carbónico (CO2), producido principalmente durante la combustión de las fuentes de energía fósiles, como el carbón o el petróleo. El calentamiento del planeta supone una grave amenaza para la población del futuro, ya que puede ocasionar una considerable elevación del nivel del mar, una mayor frecuencia e intensidad de fenómenos meteorológicos extremos, e incluso la desaparición de determinadas especies de animales y plantas. En el terreno de la salud es previsible que provoque un gran aumento de la incidencia de enfermedades como los golpes de calor o las infecciones trasmitidas por vectores, tal y como ya se está empezando a observar. Por ello todos los países del mundo deben adoptar las medidas necesarias para reducir drásticamente las emisiones de gases productores del efecto invernadero. Además, los profesionales de la salud debemos adoptar un papel activo, que ayude a concienciar a nuestra sociedad sobre la gravedad del problema, y que haga que los sistemas sanitarios estén suficientemente preparados para afrontar el incremento de enfermedades que es previsible que se produzca. En ese sentido, la Sociedad Española de Medina Interna ha decidido dar un paso al frente, con su incorporación al proyecto plurinacional Lancet Countdown. La Sociedad Española de Medicina Interna es la primera entidad española en sumarse a esa iniciativa

Climate change consists mainly of global warming, a result of the so-called greenhouse effect, which is caused by certain gases, including carbon dioxide (CO2), produced mainly through the combustion of fossil fuels, such as coal and oil. Global warming is a severe threat for future populations because it can cause a considerable rise in sea levels, a greater frequency and intensity of extreme meteorological phenomena and even the extinction of certain animal and plant species. In the field of health, global warming is predicted to cause a considerable increase in the incidence of diseases such as heat stroke and vector-borne infections, the start of which has already been observed. All countries of the world must therefore adopt the necessary measures to drastically reduce the emission of gases that produce a greenhouse effect. Additionally, healthcare practitioners should assume an active role in helping to raise awareness in our society about the severity of the problem and ensuring that healthcare systems are duly prepared to address the increase in disease rates predicted for global warming. The Spanish Society of Internal Medicine (SEMI) has decided to step forward, with its incorporation into the multinational project Lancet Countdown. SEMI is the first Spanish organisation to join this initiative

[Air pollution and health]. / Luchtverontreiniging en gezondheid.

The effects of air pollution on health have been generating attention for years. A large number of pulmonologists have recently expressed concerns about this in an open letter to Dutch Members of Parliament. Air pollution arises mainly in all kinds of combustion processes; in addition, atmospheric chemical reactions play a role in the formation of ozone and particulate matter. Health effects are both acute (increase in daily mortality and morbidity after days with increased concentrations of air pollution) as well as chronic (shortened life span and increased incidence of respiratory and cardiovascular diseases in areas with elevated concentrations of air pollution). These effects already occur at concentrations that are clearly lower than those currently observed in the Netherlands.

Impact of improved cookstoves on women's and child health in low and middle income countries: a systematic review and meta-analysis.

OBJECTIVES: Improved biomass cookstoves may help reduce the substantial global burden of morbidity and mortality due to household air pollution (HAP) that disproportionately affects women and children in low and middle income countries (LMICs). DESIGN: Systematic review and meta-analysis of (quasi-)experimental studies identified from 13 electronic databases (last update: 6 April 2018), reference and citation searches and via expert consultation. SETTING: LMICs PARTICIPANTS: Women and children INTERVENTIONS: Improved biomass cookstoves MAIN OUTCOME MEASURES: Low birth weight (LBW), preterm birth, perinatal mortality, paediatric acute respiratory infections (ARIs) and COPD among women. RESULTS: We identified 53 eligible studies, including 24 that met prespecified design criteria. Improved cookstoves had no demonstrable impact on paediatric lower ARIs (three studies; 11 560 children; incidence rate ratio (IRR)=1.02 (95% CI 0.84 to 1.24)), severe pneumonia (two studies; 11 061 children; IRR=0.88 (95% CI 0.39 to 2.01)), LBW (one study; 174 babies; OR=0.74 (95% CI 0.33 to 1.66)) or miscarriages, stillbirths and infant mortality (one study; 1176 babies; risk ratio (RR) change=15% (95% CI -13 to 43)). No (quasi-)experimental studies assessed preterm birth or COPD. In observational studies, improved cookstoves were associated with a significant reduction in COPD among women: two studies, 9757 participants; RR=0.74 (95% CI 0.61 to 0.90). Reductions in cough (four studies, 1779 participants; RR=0.72 (95% CI 0.60 to 0.87)), phlegm (four studies, 1779 participants; RR=0.65 (95% CI 0.52 to 0.80)), wheezing/breathing difficulty (four studies; 1779 participants; RR=0.41 (95% CI 0.29 to 0.59)) and conjunctivitis (three studies, 892 participants; RR=0.58 (95% CI 0.43 to 0.78)) were observed among women. CONCLUSION: Improved cookstoves provide respiratory and ocular symptom reduction and may reduce COPD risk among women, but had no demonstrable child health impact. REGISTRATION: PROSPERO: CRD42016033075.

[Health and environment, prevention or precaution?] / Santé et environnement, prévention ou précaution ?

The health status of the populations of developed countries has never been as satisfactory, but will it stay that way? Research on the subject is difficult due to the complex interactions between our environment and our health, with risks inherent to each noxious agent. Preventing the risks proven to be linked to the quality of our living environments is usually the responsibility of authorities, but individuals can also adopt precautionary practices.

[Environmental health education]. / L'éducation à la santé environnementale.

Environmental health education aims to reduce the impact of risk factors for patients. The caregiver's role is to adopt a positive education approach with concrete ways of controlling the living environment. He or she must support people in asserting their choices in terms of health and to make their own contribution to reducing risks.

[Ecological-hygienic evaluation of the environment of territories being adjacent to decultivated uranium mines].

On the territory of Kazakhstan there are uranium deposits, many ofwhich are in mothballed since times of perestroika. Often, the mines are flooded and represent a "time-delay bomb". Inside of mines various there are accumulated gases of both organic and inorganic nature, periodically thrown out and adversely affecting on the health of local populations. The aim of the study was the investigation of the state of the environment of Esilsky district of the Akmola region by common pollutants and chemicals. As the basic variable for the investigation of ambient air there was accepted the maximum one-time concentration of suspended substances, phenol, nitrogen dioxide, sulfur dioxide. The results were evaluated in relation to the MPC for the analyzed substance in the air according to maximal single MPC (MPCms) and daily average MPC (MPCda). The content of metals in the water was determined with the use of spectrophotometer PD-303S. Evaluation of the results was executed in relation of the MPC of substances in water, by means of the comparison with the requirements of Federal standards for drinking water, samples from drinking water sources. There were executed calculations of the overall index of water pollution (IWVgen), the index of water pollution by heavy metals (IWVhm). Chemical analysis of soil was carried out with the use of spectrophotometer PD- 303S (Japan), the photometer expert-003 "Ekoniks". Evaluation of the results was carried out with the respect to the MPC in the soil, the toxicity of all components. Summarizing soil pollution index was evaluated for metals contained in the soil at the level of more than or equal to 1 MAC. The settlement Krasnogorskiy and the village of Kalachi were found to be characterized by a low level of air pollution, increased rigidity of drinking water exceeded the maximum permissible concentrations of copper by 3.45 times and chloride by 1.17 times in the soil cover.

New approaches in human health risk assessment.

Studies on the precise impact of environmental pollutants on human health are difficult to undertake and interpret, because many genetic and environmental factors influence health at the same time and to varying degrees. Our chapter in the AMAP report was based on new approaches to describe risks and future needs. In this paper, we will introduce the issues associated with risk assessment of single chemicals, and present suggestions for future studies as well as a summary of lessons learned during the health-related parts of the European Union-funded FP7 project ArcRisk (Arctic Health Risks: Impacts on health in the Arctic and Europe owing to climate-induced changes in contaminant cycling, 2009-2014; www.arcrisk.eu).

EUROPAEM EMF Guideline 2016 for the prevention, diagnosis and treatment of EMF-related health problems and illnesses.

Chronic diseases and illnesses associated with non-specific symptoms are on the rise. In addition to chronic stress in social and work environments, physical and chemical exposures at home, at work, and during leisure activities are causal or contributing environmental stressors that deserve attention by the general practitioner as well as by all other members of the health care community. It seems necessary now to take "new exposures" like electromagnetic fields (EMF) into account. Physicians are increasingly confronted with health problems from unidentified causes. Studies, empirical observations, and patient reports clearly indicate interactions between EMF exposure and health problems. Individual susceptibility and environmental factors are frequently neglected. New wireless technologies and applications have been introduced without any certainty about their health effects, raising new challenges for medicine and society. For instance, the issue of so-called non-thermal effects and potential long-term effects of low-dose exposure were scarcely investigated prior to the introduction of these technologies. Common electromagnetic field or EMF sources: Radio-frequency radiation (RF) (3 MHz to 300 GHz) is emitted from radio and TV broadcast antennas, Wi-Fi access points, routers, and clients (e.g. smartphones, tablets), cordless and mobile phones including their base stations, and Bluetooth devices. Extremely low frequency electric (ELF EF) and magnetic fields (ELF MF) (3 Hz to 3 kHz) are emitted from electrical wiring, lamps, and appliances. Very low frequency electric (VLF EF) and magnetic fields (VLF MF) (3 kHz to 3 MHz) are emitted, due to harmonic voltage and current distortions, from electrical wiring, lamps (e.g. compact fluorescent lamps), and electronic devices. On the one hand, there is strong evidence that long-term exposure to certain EMFs is a risk factor for diseases such as certain cancers, Alzheimer's disease, and male infertility. On the other hand, the emerging electromagnetic hypersensitivity (EHS) is more and more recognized by health authorities, disability administrators and case workers, politicians, as well as courts of law. We recommend treating EHS clinically as part of the group of chronic multisystem illnesses (CMI), but still recognizing that the underlying cause remains the environment. In the beginning, EHS symptoms occur only occasionally, but over time they may increase in frequency and severity. Common EHS symptoms include headaches, concentration difficulties, sleep problems, depression, a lack of energy, fatigue, and flu-like symptoms. A comprehensive medical history, which should include all symptoms and their occurrences in spatial and temporal terms and in the context of EMF exposures, is the key to making the diagnosis. The EMF exposure is usually assessed by EMF measurements at home and at work. Certain types of EMF exposure can be assessed by asking about common EMF sources. It is very important to take the individual susceptibility into account. The primary method of treatment should mainly focus on the prevention or reduction of EMF exposure, that is, reducing or eliminating all sources of high EMF exposure at home and at the workplace. The reduction of EMF exposure should also be extended to public spaces such as schools, hospitals, public transport, and libraries to enable persons with EHS an unhindered use (accessibility measure). If a detrimental EMF exposure is reduced sufficiently, the body has a chance to recover and EHS symptoms will be reduced or even disappear. Many examples have shown that such measures can prove effective. To increase the effectiveness of the treatment, the broad range of other environmental factors that contribute to the total body burden should also be addressed. Anything that supports homeostasis will increase a person's resilience against disease and thus against the adverse effects of EMF exposure. There is increasing evidence that EMF exposure has a major impact on the oxidative and nitrosative regulation capacity in affected individuals. This concept also may explain why the level of susceptibility to EMF can change and why the range of symptoms reported in the context of EMF exposures is so large. Based on our current understanding, a treatment approach that minimizes the adverse effects of peroxynitrite - as has been increasingly used in the treatment of multisystem illnesses - works best. This EMF Guideline gives an overview of the current knowledge regarding EMF-related health risks and provides recommendations for the diagnosis, treatment and accessibility measures of EHS to improve and restore individual health outcomes as well as for the development of strategies for prevention.

[The evaluation of economic damage due to premature mortality of population of the Republic of Sakha (Yakutia)].

The evaluation of economic damage was implemented in relation to premature mortality of population of the Republic of Sakha (Yakutia), the region with particular social economic and natural climatic conditions specific to territories of the North. The calculation of economic damage is based on methodology proposed by number of ministries of the Russian Federation and Rosstat in 2012. The presented evaluations and analysis of materials give an idea about total amount of economic damage because of mortality of population of the Republic of Sakha (Yakutia) which is necessary to consider during development of regional programs of decreasing of population mortality.

[Technogenic environmental pollution and the public health: analysis and prognosis].

Technogenic risk factors are very aggressive for a human health. Due to the progressive increase in environmental pollution the problem of the adverse impact of these factors on the health of both the human population as a whole, and individual groups every year is becoming increasingly important. At that the influence of anthropogenic pollution on the various manifestations of infectious pathology in the scientific literature is presented very modestly. In this paper there is presented a review of research devoted to the problem of the interrelationship of man-made pollution of the environment and public health.

[Features of physical development of girls residing in the altai territory with the different level of the environmental load].

There was performed the determination of the characteristics of the physical development of 660 girls aged of from 6 years 6 months to 17years 5 months 29 days, residing in the Blagoveshchenskiy and the Ust-Pristanskiy regions of the Altai Krai. The Blagoveshchenskiy region is characterized by a high level of ambient air pollution (potential of the atmospheric pollution accounts for 2.7-3.0). Sodium sulfate, sulfur dioxide, hydrogen sulfide, carbonic oxide, nitrogen dioxide, vanadium pentoxide, ammonia, manganese and its compounds, hexavalent chromium make the greatest contribution to the atmospheric pollution. The Ust-Pristanskiy region is referred to the least polluted territories of the Altai Krai. Living conditions in the Blagoveshchenskiy region of the Altai Krai were found to influence on the girls ' physical and sexual development. The girls living in the Blagoveshchenskiy region show the pubertal growth spurt one year later, which is lasting longer. As a result, by the age of 17, measurements of the body and leg length are almost 6 cm higher in girls of the Blagoveshchenskiy region. 97% of the Blagoveshchenskiy region residents have pathological (trochanter index ≤ 1.85) and disevolutive (trochanter index = 1.86 - 1.91) types of age evolution which testifies to the thyroid and reproductive hormones deficiency. Among the residents of the Ust-Pristanskiy region, 80% have either normal values of the trochanter index (1.95 - 2.0) or slightly deviated from the norm (hypoevolutive, normoevolutive, and hyperevolutive types of age evolution). The level of the endocrine system diseases prevalence, nutrition and metabolic disorders among the teenagers of the Blagoveshchenskiy region are 2.5 times higher than in the rural area of the Altai Krai. The relative risk of the endocrine system diseases occurrence, nutrition disturbances and metabolic disorders in the teenagers of the Blagoveshchenskiy region equals to OR=1.87 (x=272.7, p<0.001).

[Hygienic assessment of living conditions and morbidity of the population in the port cities of the Sakhalin region].

The aim of this study was to perform a comprehensive hygienic assessment of environmental conditions in the port cities of the Sakhalin region to identify priority risk factors affecting on population health and management decisions for the optimization of living conditions. As a result of the assessment of risk and damages for public health from the effects of air pollution on the dose-response, effects were found to excess of impact on the target organs by 10 times. The main ecotoxicant was determined to be manganese oxide, which is associated with a priority manganese content in soil samples ofport cities. The positive dynamics of the gain in the accumulation of soil heavy metals according to the total index indicates to the existence of problems for soil contamination. Analysis of demographic variables shows that the population of the Sakhalin region in general and the port cities in particular relates to a regressive type. The main causes of the population decline are mortality and migration outflow of able-bodied population in other regions of Russia. However, in the port cities there is an increase in the number of work places, contributing to an increase in the labor force. The primary and general morbidity of the population ofport cities is characterized by higher levels compared with the average for the Sakhalin Region and the Far Eastern Federal District. Among all the classes of diseases as priority ones there are marked "neoplasm", "diseases of the nervous system", "respiratory diseases", "diseases of the skin and subcutaneous tissue". Port cities occupy the top ranking places on the incidence of malignant tumors among the cities of the Sakhalin region.

[State of kidneys of the population of the industrial city].

The assessment of renal functions of the adult population of Atyrau (West Kazakhstan) exposed to Atyrau oil refinery and other industrial objects (enterprises in the city), as well as employees of this refinery has been performed by virtue of the identification ofpathological changes in the urine with the use ofphotometric screening, determination of serum levels of creatinine, urea, uric acid and the calculation of glomerular filtration rate. There were obtained evident data testifying to the development of statistically significant exertion of renal function in residents of this city as compared with those of control area residents. There was revealed a statistically significant decrease in the relative density of urine in in 42% of the population, leucocyturia - in 20%, erythrocyturia - in 25%. Decreased glomerularfiltration rate was noted in these people. A statistically significant elevation of the level of uric acid in the blood in combination with an acidic reaction and sharply acidic urine reaction indicates to the possibility of the development of urate urolithiasis which is confirmed by cases of discharge of stones in the urine in 20% of the population according to data of previously executed questionnaire survey. The above mentioned changes in the functional renal reserve and hyperuricemia are equally often found among the residents of the city - Atyrau refinery workers, and the rest of the city people as well. The results of the study allow to recommend the screening ofurine with quantitative registration ofpathological changes as a mean of the most optimal objective methods for early detection of renal dysfunction in population exposed to nephrotoxic impact of environmental techno-genic pollutants.

[Ecological-hygienic aspects of the prevalence of respiratory diseases in adolescents and children of the Primorsky Krai].

There was executed the ecologic-hygienic assessment of the distribution of respiratory diseases prevalence in bioclimatic zones of the Primorsky Krai. The aim of the study was a systematic assessment of the impact of ecological-hygienic factors of environment on the distribution of respiratory diseases in adolescents and children of the Primorsky region. As an information database there were used indices of the prevalence of diseases of the respiratory system of the ICD-10 class of the official statistical report forms for the period of2000-2013 and the parameters of the environment offactor modules (6 - socio-sanitary, 5 - environmental). The numerical values of modules offactors were determined according to a specially developed scoring scale. The study of the prevalence was carried out with the use of a classical method of data analysis - descriptive statistics, Chi-square criteria. By means of the method of regression analysis from the SPSS package software there was established the relationship of environmental factors and the level of the prevalence of diseases, and were calculated values of the factor loadings influencing on the morbidity rate of children and adolescents. The study revealed that in the structure of morbidity diseases of the respiratory system account of 39% in adolescents, 61% - in children. Constructed predictive models describe the trend of the increasing in the prevalence in adolescents and children. Over the past 15 years, the level of respiratory diseases morbidity rate increased by 46.1%. It is established that the prevalence of respiratory diseases in children and adolescents from various districts of the Primorsky territory depends on the features of the bioclimatic zones and the degree of sanitary-hygienic situation, as well as combinations of parameters that form these zones; the highest cumulative level of the prevalence is observed in the bioclimatic zone of the coast, that is caused by the various degree of the impact of biotropic factors of environment; The prevalence of diseases of respiratory system is mainly affected by bioclimatic factors: residence in an area of high humidity, temperature swings, movements of air masses in combination with air pollution.

[Individual risks to adolescent health, caused by contaminating the air, and their relationship with the levels of specific autoantibodies].

The high levels of the air pollution create prerequisites for the development of the pathology of target organs exposed to chemical agents. Big enterprises of oil refining and chemical industry of the Irkutsk region are located in the cities of Angarsk and Sayansk. The average level of the air pollution for several years in these cities is assessed as high and moderate, respectively. The use of the personalized approach may allow to more correctly evaluate the risk for the damage to health and the body's response to external impacts. The purpose of this study was to assess the risk offormation ofpathological processes in the body of adolescents in the conditions of inhalation exposure to chemicals, taking into account the individual load and study of the level of specific autoantibodies. The study included 373 adolescents from the city with high levels of air pollution and 188 schoolchildren from the city with a moderate level pollution. There was made an evaluation of the individual chemical hazard load on adolescents ' body due to the air pollution, physiologicalfeatures and the organization of educational process and leisure. There were studied the levels of specific autoantibodies, reflecting the state of the organs - targets for the impact ofpollutants. The calculation of the individual chemical load allows to calculate indices of the hazard for the health problems of each individual and to identify individuals at increased risk of developing diseases of organs and systems, which are targets for exposure to pollutants. The increase in the hazard index of developing respiratory diseases was found to be accompanied by an increase of the relative content of autoantibodies against membrane antigens of the lung tissue. There was revealed the elevation in autoantibodies levels to the proteins of vascular endothelial with increasing hazard index of disturbances in the cardiovascular system in adolescents living in city with high levels of air pollution.