Public perception of risk concerning celltowers and mobile phones

OBJECTIVE

The controversy about health risks of electromagnetic fields (EMF) has contributed in raising fears concerning emissions from celltowers. The study was to examine whether or not neighbours of celltowers are particularly concerned about adverse health effects of mobile phones and their base stations.

METHODS

Prior to information delivered by medical doctors of the Institute of Environmental Health at public hearings a questionnaire was handed out to participants asking for their personal rating of several environmental health risks including those of mobile telecommunication (n = 123, response rate approx. 48%). Medical students (n = 366) served as a contrast group.

RESULTS

Participants rated health risk for both, mobile phones and celltowers higher as students. A trend for higher ratings was also seen with older subjects and female sex. The risk ratings of both exposures correlated well with each other. The magnitude of the perceived risks, however, resembled that of other ubiquitous exposures like traffic noise and air pollution.

CONCLUSION

Contrary to the claims of the telecommunication industry, opponents of celltowers generally do not express unusual fears concerning electromagnetic field exposure. The outcome of our study indicates that the risk rating is comparable with other perceived common hazards of the civilised world. It is hypothesised that offering information and participation to the concerned population will be efficient in reducing exaggerated fears.

Nicotine and surface of particulates as indicators of exposure to environmental tobacco smoke in public places in Austria

As part of a Europe-wide project the amount of exposure to environmental tobacco smoke (ETS) in public places like schools, restaurants, and public transport facilities was investigated. Three methods were applied: nicotine passive samplers (with a filter treated with sodium bisulphate), the same filters with an active sampling device, and the measurement of fine particles' active surface by unipolar diffusion charging. Settings were selected where either high or low ETS concentrations were expected and where non-smokers would have to stay or at least to pass by. Highest ETS concentrations were found in discos (mean nicotine concentration 154.4 maximum 487.1 microg/m3) and intermediate concentrations in restaurants with no significant difference between smoking (21.3 +/- 6.1 microg/m3) and non-smoking areas (23.3 +/- 15.9 microg/m3) but on average higher values in restaurants with no separation between smoking and non-smoking areas (38.0 +/- 60.6 microg/m3). Concentrations usually below 10 microg/m3 were found in transport facilities (8.9 +/- 8.0 microg/m3, maximum 20.6 in the restaurant section of a railway station's waiting room) and in schools (3.0 +/- 4.6 microg/m3). In hospitals "problem spots" were sought and so concentrations from very low to as high as 45.1 microg/m3 next to a smoking area with no physical barrier or separation and 47.7 microg/m3 inside a smoking room could be documented (21.4 +/- 39.3 microg/m3). The fine particle's surface correlated well with the nicotine concentration (r = 0.8; p < 0.001). Only in one instance (in a pizza restaurant on a busy road with heavy duty diesel traffic and the sampling spot next to the pizza stove) high concentration of fine particles was detected without high nicotine. Tobacco smoke is a key source of indoor fine particles. Health policy must intervene to change the situation found at present in many public places in Austria.

[Suspended particulates and lung health]

Based on several severe air pollution episodes, a temporal correlation between high concentrations of particulate matter (PM) and SO2 pollution and acute increases in respiratory and cardiopulmonary mortality had been established in Vienna for the 1970's. After air pollution had decreased in Austria in the 1980's--as documented by data on SO2, and total suspended particles (TSP)--no such associations between day-to-day changes of SO2 and TSP and mortality have been documented any more, however, traffic related pollutants like fine particles and NO2 remained a problem. Therefore, short term effects of PM on lung function, morbidity and mortality were investigated in Vienna, Linz, Graz and a rural control area. Long-term exposure and chronic disease--even more important for public health--were studied in repeated cross-sectional, a mixed longitudinal and a birth cohort study on school children in the city of Linz. Lung function growth was found impaired from long-term exposure to air pollutants and improved in districts where ambient air pollution had decreased. Where only TSP and SO2 had decreased, no continuous improvement of small airway function was found and end-expiratory flow rates stayed impaired where NO2-reduction from technical improvements of cars and industry was counterbalanced by increase of motorized (diesel) traffic. Remaining acute effects of ambient air pollution in 2001 from PM, NO2 and co-pollutants found in a time series study also show that continuing efforts are necessary. Active surface of particles inhaled several hours to days before spirometry was found related to short-term reductions in forced vital capacity-FVC (p<0.01), forced expiratory volume in one second-FEV1 (p<0.01) and maximal expiratory flow rate at 50% of vital capacity-MEF50 (p<0.05). In pupils with asthma or previous airway obstruction 4-week-diaries proved that the following symptoms increased with acute exposure to higher active surface of particles: wheezing (p<0.01), dyspnea, cough when going to sleep, cough at night (p<0.05). Efforts to reduce exposure to fine particles from motor traffic and passive smoking have to be increased if we want to achieve full recovery of children from air pollution effects and best respiratory performance in adulthood. Surveillance seems to be necessary not only for particle mass but also for particle number and surface. Little is known on the mechanisms of irreversible long-term effects of PM such as myocardial infarction and cancer. In a prospective cohort study on 1630 dust-exposed and 1630 non dust-exposed workers matched for smoking we found an increase of lung cancer related to nonfibrous insoluble PM. Other studies were able to relate lung cancer to specific particles like those from diesel engines, and a large prospective study of the American Cancer Society was able to link lung cancer in the general population with long-term exposure to fine particles from combustion processes. All these recent epidemiological findings will have consequences for occupational and ambient air PM standards.

Moulds in housing: visual inspection and spore counts comparison--implications for future strategies in the public health setting

OBJECTIVES

Among the problems of health related to living conditions presented to a public consulting centre for environmental medicine in Vienna, the main point at issue was damp housing and mould growth. On answering this demand indoor exposure to fungal spores was identified by visual semi-quantitative assessment of fungal growth on the one hand and quantitative measurement of viable spores on the other hand. The validity and practicability of this approach was investigated.

METHOD

We applied these two simple methods in a standardised form and compared the results in a field study, which has been conducted between 1995 and 1999. In 197 rooms in Viennese flats (183 of which were claimed to be "mouldy") fungal spore concentrations were measured by RCS-impactor and Rose-Bengal-agar. Outdoor measurements were taken simultaneously outside the buildings and were used for reference.

RESULTS

Independent classification of visible growth of mould in flats correlated significantly (r = 0.635; p < 0.0001) with the ratio of indoor/ outdoor concentration of fungal spores.

CONCLUSIONS

It is usually possible to classify the severity of the problem just by local inspection. Visible plaques should always be an indication for sanitary measures. However, spore counting is indicated for quantifying health relevant exposures, for scientific comparisons and in documentation and follow up such as for litigation purposes. Quantitative data bear more credibility and so help to prove the need of sanitation.

[Toxicologically determined indoor air guidelines values]

At the Austrian Ministry for Environment (now: Federal Ministry for agriculture and forestry, environment and water management) a working group was established to propose indoor air guideline values. This consists of representatives of different disciplines, such as physicians, toxicologists, engineers and lawyers. Already in the constituent meeting it was decided to employ a set pattern for establishing toxicologically sound guideline values. It was then agreed to use the pattern proposed by the German ad-hoc-working team. The interdisciplinary discussions, however, demonstrated the need for additional clarification, since representatives of different disciplines obviously interpret the various terms and principles differently. In particular, there is a need for discussing in detail the relation between the guideline values for indoor air to other air quality standards (outdoor air and workplace) and to specify their scope and application, especially the need to describe in greater detail what should be done in case either guideline value I or II was exceeded.

[Determinants of patient satisfaction with services of the Vienna environmental medicine counseling center]

Client satisfaction is a relevant aspect for assessing the efficiency of a Medical Advisory Board. The study presented here aimed at determining the factors that guarantee satisfaction. These findings are essential for the further development of the service of the Advisory Board of the City of Vienna for Environmental Medicine ("UMB"). To this end a brief anonymous questionnaire was sent to 245 clients. This comprised elements evaluating the degree of satisfaction with the consultant service of the Advisory Board, fulfillment rate of expectations, solutions offered for various problems, and whether--if necessary--the "UMB" Advisory Board would be consulted again. A satisfactory response rate of 43% was obtained. The results show a high degree of satisfaction among the clients with the consultations (= 78%) despite unresolved or only partly resolved problems (71%) and questions that remained open for discussion (38%). Approximately 90% of the clients would again consult "UMB" for advice. The reasons for consultation did not show any significant influence on the client satisfaction. However, satisfaction of clients depended on whether or not a solution was found in respect of their problem and on the action taken by "UMB" to solve it. Summarising the findings, the analyses show that apart from on-the-spot assessment and detailed inspection, comprehensive case histories and interviews are an important basis for further clarification of problems caused by environmental factors.

Continuing progressive deterioration of the environment in the Aral Sea Region: disastrous effects on mother and child health

Scientists, non-governmental experts (NGOs) and governmental officials from the Central Asian Republics and an international group of invited scientists and NGO representatives participated in a workshop on the disastrous health problems in the Aral Sea Region. Various serious problems were reported in more than 20 presentations. Particular emphasis was put on the way in which adverse environmental factors such as contaminated water and food have contributed to the deterioration of human health, particularly that of mothers and children.

CONCLUSION

There is an urgent request that the international community assists local scientists to develop programmes to improve the health of the population in the Aral Sea Region.

Wrap-around arterialized venous flap for salvage of an avulsed finger

The case of an avulsed finger with extensive soft-tissue trauma is presented. The digit was salvaged using an arterialized wrap-around flow-through venous flap from the forearm.

[Iatrogenic necrosis of the large toe after tourniquet placement--clinical course and reconstruction]

We present a necrosis of the big toe in a 20-year-old woman with an ingrowing toenail after wedge-shaped excision in the big toe. The reason for the necrosis was a tourniquet that was left in place after the operation. The ischemia, which lasted for 2 days, resulted in subtotal necrosis of the big toe. Six weeks after the operation the patient underwent microsurgical reconstruction. This is a report on the treatment of this complication from the beginning. Early surgical intervention is advocated.

[The lower trapezius muscle island flap. Anatomic principles and clinical relevance]

Up to now, there is no uniform anatomic description neither of the branches of the subclavian artery nor of the pedicle of the lower myocutaneous trapezius flap. A dissection study was carried out on 140 necks in 70 cadavers. Variations of the subclavian artery and its branches, vessel diameter at different levels, the course of the pedicle under the levator scapulae muscle, the arc of rotation of the island flap, and the variations of the segmental intercostal branches to the lower part of the trapezius muscle were examined. Results of this study enable us to suggest a new nomenclature for the branches of the subclavian artery, a proper pedicle definition, and a technique for safe flap elevation. The lower trapezius island flap is a thin and pliable myocutaneous flap with a constant pedicle which ensures safe flap elevation. This flap has the potential for a wider acceptance due to minor donor site morbidity, large arc of rotation, and an ample range of clinical applications in the head and neck area as an island flap as well as a free flap.

[The posterior interosseous flap--review and personal experience]

The posterior interosseous flap was first introduced by Zancolli and Angrigiani (1985) and short time later by Penteado and Masquelet (1986). The flap is used for soft tissue reconstruction in the hand but has not gained wide acceptance due to tedious pedicle dissection and venous problems. In 1993, Angrigiani et al. published a simplified modification in the elevation of the flap. They included a constant fasciocutaneous perforating vessel in the flap to enhance the viability. We applied the modified elevation technique in twelve patients. Our experience, indications, and complications will be discussed. In contrast to Angrigiani's statement, our flaps still show a temporary mild to moderate venous congestion similar to the flaps raised in the original technique.

Venous thrombosis in a replanted finger with underlying factor V Leiden mutation

Resistance to activated protein C (APC resistance) was described recently as a cause for thrombophilia. APC inactivates coagulation co-factors Va and VIIIa. A single base-pair mutation changing Arg506 to Gln at the APC cleavage site of the factor V gene leads to a factor V Leiden variant, which is the most frequent cause of APC resistance. Recently, its role in peripheral venous thrombosis during pregnancy was described. We here report a case with thrombosis of the venous anastomoses after finger replantation with resistance to activated protein C associated with factor V Leiden mutation.