Internal and external quality control in the toxicological analysis of blood and urine samples in the Federal Republic of Germany

Urinary pentachlorophenol in painters and bricklayers in a four-years time interval after the PCP prohibition ordinance in Germany

Pentachlorophenol (PCP) was widely used as a wood preservative in Germany until 1989, when it was prohibited by law. Within a cross-sectional study we investigated the internal PCP exposure of painters and bricklayers between one year and four years after the ban. PCP was analysed in post-shift urine samples of 189 painters and 148 bricklayers by gas chromatography and electron capture detection (GC-ECD). The median PCP concentration in the urine of painters was 2.4 microg/g creatinine (range: 0.2-52 microg/g creatinine). For the bricklayers a range of 0.1-25 microg/g creatinine (median: 1.8 microg/g creatinine) was determined. The difference between both groups was statistically significant, pointing to a small additional uptake of PCP by the painters probably from an exposure to contaminated wood surfaces or residual PCP containing preservatives. The biomonitoring results for both groups coincided with background values of the general population at that time.

A survey of laboratory and statistical issues related to farmworker exposure studies

Developing internally valid, and perhaps generalizable, farmworker exposure studies is a complex process that involves many statistical and laboratory considerations. Statistics are an integral component of each study beginning with the design stage and continuing to the final data analysis and interpretation. Similarly, data quality plays a significant role in the overall value of the study. Data quality can be derived from several experimental parameters including statistical design of the study and quality of environmental and biological analytical measurements. We discuss statistical and analytic issues that should be addressed in every farmworker study. These issues include study design and sample size determination, analytical methods and quality control and assurance, treatment of missing data or data below the method's limits of detection, and post-hoc analyses of data from multiple studies. Key words: analytical methodology, biomarkers, laboratory, limit of detection, omics, quality control, sample size, statistics.

Exposure assessment in the National Children's Study: introduction

The science of exposure assessment is relatively new and evolving rapidly with the advancement of sophisticated methods for specific measurements at the picogram per gram level or lower in a variety of environmental and biologic matrices. Without this measurement capability, environmental health studies rely on questionnaires or other indirect means as the primary method to assess individual exposures. Although we use indirect methods, they are seldom used as stand-alone tools. Analyses of environmental and biologic samples have allowed us to get more precise data on exposure pathways, from sources to concentrations, to routes, to exposure, to doses. They also often allow a better estimation of the absorbed dose and its relation to potential adverse health outcomes in individuals and in populations. Here, we make note of various environmental agents and how best to assess exposure to them in the National Children's Study--a longitudinal epidemiologic study of children's health. Criteria for the analytical method of choice are discussed with particular emphasis on the need for long-term quality control and quality assurance measures.

Biological monitoring of exposure: trends and key developments

The concept of biological monitoring (BM) has gained the special interest of individual scientists and international organizations. Today, when analytical problems have almost ceased due to new laboratory techniques and quality assurance systems, the methods for interpretation of results have become the most important issue. There are important discrepancies regarding the role of biological monitoring of occupational exposure between Europe and the United States. BM has been an important tool of medical health surveillance in the European countries. In the United States it belongs rather to the field of occupational hygiene. It seems that both the approaches can be accepted. More attention should be paid to the development of the truly health-based biomarkers of exposure based on the dose-effect and dose-response relationships. New areas of application of BM of occupational exposure include determination of DNA and protein adducts, unchanged volatile organic compounds in urine, monitoring of exposure to pesticides, antineoplastic drugs, hard metals, and polycyclic aromatic hydrocarbons. In the general environment BM is the most valuable tool for acquiring knowledge of current levels of internal exposure to xenobiotics, identifying the hot spots and developments in trends of exposure. BM can provide policy makers with more accurate information on the control measures undertaken. At present, the main areas include heavy metals, persistent organic pollutants and pesticides. BM of chemical exposure has become increasingly important in the assessment of the health risk in occupational and environmental medicine. Therefore it would be worthwhile to include BM in the curricula for the training of occupational hygienists.

Urinary 1-hydroxypyrene and mutagenicity in bus drivers and mail carriers exposed to urban air pollution in Denmark

BACKGROUND

Previous studies in Denmark have shown that bus drivers and tramway employees were at an increased risk for developing several types of cancer and that bus drives from central Copenhagen have high levels of biomarkers of DNA damage.

AIMS

The present study evaluates 1-hydroxypyrene concentrations and mutagenic activity in urine as biomarkers of exposure in non-smoking bus drivers in city and rural areas on a work day and a day off and in non-smoking mail carriers working outdoors (in the streets) and indoors (in the office).

METHODS

Twenty-four hour urine samples were collected on a working day and a day off from 60 non-smoking bus drivers in city and rural areas and from 88 non-smoking mail carriers working outdoors (in the streets) and indoors (in the office). The concentration of 1-hydroxypyrene was measured by means of HPLC and the mutagenic activity was assessed by the Ames assay with Salmonella tester strain YG1021 and S9 mix. The N-acetyltransferase (NAT2) phenotype was used as a biomarker for susceptibility to mutagenic/carcinogenic compounds.

RESULTS

Bus drivers excreted more 1-hydroxypyrene in urine than did mail carriers. The differences were slightly smaller when NAT2 phenotype, cooking at home, exposure to vehicle exhaust, and performing physical exercise after work were included. The NAT2 slow acetylators had 29% (1.29 [CI: 1.15-1.98]) higher 1-hydroxypyrene concentrations in urine than the fast acetylators. Male bus drivers had 0.92 revertants/mol creatinine [CI: 0.37-1.47] and female bus drivers 1.90 revertants/mol creatinine [CI: 1.01-2.79] higher mutagenic activity in urine than mail carriers.

CONCLUSION

The present study indicates that bus drivers are more exposed to polycyclic aromatic hydrocarbons (PAH) and mutagens than mail carriers. Mail carriers who worked outdoors had higher urinary concentration of 1-hydroxypyrene, a marker of exposure to PAH, than those working indoors. The individual levels of urinary mutagenic activity were not correlated to excretion of 1-hydroxypyrene. This might be due to the fact that the most potent mutagenic compounds in diesel exhaust are not PAH but dinitro-pyrenes. Among bus drivers, fast NAT2 acetylators had higher mutagenic activity in urine than slow NAT2 acetylators and female bus drivers had higher mutagenic activity than male bus drivers.

Analytical methods for biological monitoring of exposure to pesticides: a review

Synthetic pesticides have been used since in the early to mid twentieth century. In the US alone, over 800 pesticide active ingredients are formulated in about 21,000 different commercial products. Although many public health benefits have been realized by the use of pesticides, their potential impact on the environment and public health is substantial. For risk assessment studies, exposure assessment is an integral component, which has unfortunately, often been weak or missing. In the past several decades, researchers have proposed to fill these missing data gaps using biological monitoring of specific markers related to exposures. In this paper, we present a review of existing analytical methodology for the biological monitoring of exposure to pesticides. We also present a critical assessment of the existing methodology and explore areas in which more research is needed.

Finnish quality assurance programme for biological monitoring of organic solvents

The FIOH quality assurance programme for organic solvents and their metabolites consists of analyses for 2,5-hexadione, phenol, mandelic acid, methylenedianiline, methylhippuric acid, trans,trans-muconic acid and trichloroacetic acid in urine, and creatinine and relative density for standardisation. Four times a year two levels of spiked urine or urine specimens collected from occupationally exposed workers are distributed to the participants in 22 countries. RSD and recovery were studied during 1997-2000. Average RSDs of all participants varied between 23 and 56% and were clearly dependent on the analytical method used and the concentration level of the samples. Since 1997 the target values have been determined in reference laboratories for five of the analytes. Lower RSDs (9-21%) and good recoveries were obtained for all analytes in these laboratories, indicating that good performance can be achieved even in the complex analyses performed in biological monitoring of exposure to industrial chemicals.

Quality assurance of biological monitoring in occupational and environmental medicine

Biological monitoring of chemical exposure in the workplace has become increasingly important in the assessment of health risk as an integral part of the overall occupational health and safety strategy. In environmental medicine biological monitoring plays also an important role in the assessment of excessive, acute or chronic exposure to chemical agents. To guarantee that the results obtained in biological monitoring are comparable with threshold limit values and results from other laboratories, the analysis must be carried out with tested and reliable analytical methods and accompanied by a quality assurance scheme. Confounding influences and interferences during the pre-analytical phase can be minimised by recommendations from experienced laboratories. For internal quality control commercially available control samples with an assigned concentration are used. External quality control programs for biological monitoring are offered by several institutions. The external quality control program of the German Society of Occupational and Environmental Medicine has been organised since 1982. In the meantime the 27th program has been carried out offering 96 analytes in urine, blood and plasma for 47 substances. This program covers most of the parameters relevant to occupational and environmental medicine. About 350 laboratories take part in these intercomparison programs. At present, ten German and 14 international laboratories are commissioned to determine the assigned values. The data evaluated from the results of the intercomparison programs give a good overview of the current quality of the determination of analytes assessed in occupational and environmental toxicological laboratories. For the analysis of inorganic substances in blood and urine the tolerable variation ranges from 7.5 to 43.5%. For organic substances in urine the tolerable variation ranges from 12 to 48%. The highest variations (36-60%) were found for the analysis of organochlorine compounds in plasma. The tolerable variations for the determination of solvents in blood by head space gas chromatography range from 26 to 57%. If the recommendations for the pre-analytical phase, the selection of reliable analytical methods by the laboratory and the carrying out of adequate quality control are observed, the pre-requisites for reliable findings during biological monitoring are fulfilled

Quality control in toxicological analysis

The validity and effectiveness of quality control procedures are reviewed here in light of the principles of analytical toxicology, and of the professional responsibility involved in awareness of the profound influence which analytical results have in the fields of health and social security. Regardless of the methods used, laboratory work should aim essentially at achieving a very high degree of reliability. Factors contributing to the 'quality' of analytical results and methods used to check their reliability are discussed here. The technical background and organization of internal and external quality control procedures are presented, with particular reference to educational aspects, and to the ways in which computer and internet technologies may be exploited for further improvement of the effectiveness of these procedures.

Lead concentrations in blood among the general population of Korea

The purpose of this survey was to obtain information on the overall blood lead concentrations of the Korean population due to environmental exposure. Five hundred and twenty-five Korean adults from four provinces who had no previous occupational exposure to lead were chosen by random sampling to represent the general (normal) population. Blood lead determinations were performed by atomic absorption spectrometry with a graphite furnace. Interlaboratory quality control for analysis of blood lead was carried out in seven laboratories in Korea and Europe. The geometric mean were 6.36 micrograms/dl for males and 5.09 micrograms/dl for females. There was no correlation between blood lead concentration and age. The mean concentration of blood lead in smokers was higher than that in nonsmokers (P < 0.0005). The mean blood lead concentration in male nonsmokers was higher than that in female nonsmokers (P < 0.0005). Differences in mean blood lead values according to residential area were observed, and this result showed good agreement with the results of ambient monitoring.

Quality assurance in biomarker measurement

Quality assurance (QA) concerns the validity of all the analytical processes (from collection of the samples to interpretation of the results). It is not an abstract concept but must be adapted to the different situations such as the different exposure levels, the different analytical methods, and the context of use (risk assessment procedures, research, routine determinations). The main requirements in QA programmes regard the control of all the known sources of preanalytical and analytical variations, while the instruments with which adequate QA can be implemented are the certified materials and the quality control programmes (quality manual, internal and external quality controls). Another important concept in QA is that measurements must be placed a different metrological levels: at the highest there are the methods (definitive, reference) to be used for assessing accuracy of routine methods. QA programmes should enable a grading of biomarkers (from experimental only to full evaluated) and of the laboratories in order to identify the significance of the test and to assess the level at which a laboratory could operate.

Current status of the external quality assurance programmes of the German Society for Occupational and Environmental Medicine

Due to a technical rule issued by the Ministry of Labour, in Germany toxicological analysis in blood and urine for biological monitoring must be carried out under quality assurance. Since 1982 the German Society for Occupational and Environmental Medicine has offered 13 intercomparison programmes. The 1994 round robin considered 7 metals and 5 solvents in blood, 12 organochlorine compounds in plasma and 14 inorganic, as well as 11 organic, compounds in urine in the occupational and in the environmental exposure range. Reference values and tolerance ranges are established by reference laboratories. Successful participation was certified if the results for 2 concentration adjustments were in tolerance range (assigned value +/- 3 S.D.). In 1994 in 119 laboratories the percentage rate of accurate results was 59%. This mean success rate is in agreement with the last 12 round robins.

Danish external quality assessment scheme: an interlaboratory comparison study on lead, cadmium and chromium in lyophilized human blood concentrate

A Danish External Quality Assessment Scheme (EQAS) was carried out by the Danish National Institute of Occupational Health during the period 1988-1992. The scheme was implemented for 29 international laboratories from 15 countries assaying lead, cadmium, and chromium in human blood to ascertain the systematic error and uncertainty of the analytical methods. In the survey the quality control material AMI B701-B705, based on lyophilized human whole-blood concentrate, were used. As an estimate of the true values the reference values used in this evaluation were (a) the computed values, i.e., sum of the basal and spiked trace element concentration, and (b) the consensus values normally used in the Danish EQAS. This international evaluation of lead, cadmium, and chromium in human blood demonstrated that the use of lyophilized human blood concentrate quality control materials combined with this scheme is valuable in estimating the systematic error and the uncertainty of the analytical methods. For evaluating analytical performance, the computed values were preferable to the consensus values for lead and cadmium in human blood. Due to analytical difficulties suitable reference values were not established for chromium in blood. The study revealed analytical difficulties for cadmium and chromium in human blood. The assessment of laboratories according to established performance indexes indicates that few laboratories can maintain these performance indexes.