Risk of adverse birth outcomes in populations living near landfill sites

Evaluation and comparison of spatial cluster detection methods for improved decision making of disease surveillance: a case study of national dengue surveillance in Thailand

BACKGROUND

Dengue is a mosquito-borne disease that causes over 300 million infections worldwide each year with no specific treatment available. Effective surveillance systems are needed for outbreak detection and resource allocation. Spatial cluster detection methods are commonly used, but no general guidance exists on the most appropriate method for dengue surveillance. Therefore, a comprehensive study is needed to assess different methods and provide guidance for dengue surveillance programs.

METHODS

To evaluate the effectiveness of different cluster detection methods for dengue surveillance, we selected and assessed commonly used methods: Getis Ord [Formula: see text], Local Moran, SaTScan, and Bayesian modeling. We conducted a simulation study to compare their performance in detecting clusters, and applied all methods to a case study of dengue surveillance in Thailand in 2019 to further evaluate their practical utility.

RESULTS

In the simulation study, Getis Ord [Formula: see text] and Local Moran had similar performance, with most misdetections occurring at cluster boundaries and isolated hotspots. SaTScan showed better precision but was less effective at detecting inner outliers, although it performed well on large outbreaks. Bayesian convolution modeling had the highest overall precision in the simulation study. In the dengue case study in Thailand, Getis Ord [Formula: see text] and Local Moran missed most disease clusters, while SaTScan was mostly able to detect a large cluster. Bayesian disease mapping seemed to be the most effective, with adaptive detection of irregularly shaped disease anomalies.

CONCLUSIONS

Bayesian modeling showed to be the most effective method, demonstrating the best accuracy in adaptively identifying irregularly shaped disease anomalies. In contrast, SaTScan excelled in detecting large outbreaks and regular forms. This study provides empirical evidence for the selection of appropriate tools for dengue surveillance in Thailand, with potential applicability to other disease control programs in similar settings.

Self-reported symptoms of ocular allergy and its comorbid factors among residents living near a landfill site in Ghana

Residents close to landfill sites may be exposed to long-term emitted toxic compounds that may have effects on their eyes. The aim of this study was to determine the prevalence of symptomatic ocular allergy and its comorbid factors among residents living near a landfill site in Ghana. An exploratory cross-sectional design involving 400 inhabitants living around a landfill site was employed. The prevalence of symptomatic ocular allergy was 59.3%. In a bivariate analysis, comorbid conditions including respiratory disease, coughing, flu, cholera, skin disease, diarrhoea, and hypertension predicted symptomatic ocular allergy. However, only cholera remained a significant predictor of symptomatic ocular allergy in the multivariate analysis. Symptomatic ocular allergy was high among inhabitants around the landfill site in Ghana. While proper design and management of landfills in Ghana is crucial, further longitudinal and clinical studies are required to clinically establish the link between landfill and ocular allergy.

Is residential proximity to polluted sites during pregnancy associated with preterm birth or low birth weight? Results from an integrated exposure database in North Carolina (2003-2015)

BACKGROUND

Preterm birth (PTB) and term low birth weight (LBW) have been associated with pollution and other environmental exposures, but the relationship between these adverse outcomes and specific characteristics of polluted sites is not well studied.

OBJECTIVES

We conducted a retrospective cohort study to examine relationships between residential proximity to polluted sites in North Carolina (NC) and PTB and LBW. We further stratified exposure to polluted sites by route of contaminant emissions and specific contaminants released at each site.

METHODS

We created an integrated exposure geodatabase of polluted sites in NC from 2002 to 2015 including all landfills, Superfund sites, and industrial sites. Using birth certificates, we assembled a cohort of 1,494,651 singleton births in NC from 2003 to 2015. We geocoded the gestational parent residential address on the birth certificate, and defined exposure to polluted sites as residence within one mile of a site. We used log-binomial regression models to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Binomial models were used to estimate adjusted risk differences (aRD) per 10,000 births and 95% CIs for associations between exposure to polluted sites and PTB or LBW.

RESULTS

We observed weak associations between residential proximity to polluted sites and PTB [aRR(95% CI): 1.07(1.06,1.09); aRD(95% CI): 61(48,74)] and LBW [aRR(95% CI): 1.09(1.06,1.12); aRD(95% CI): 24(17,31)]. Secondary analyses showed increased risk of both PTB and LBW among births exposed to sites characterized by water emissions, air emissions, and land impoundment. In analyses of specific contaminants, increased risk of PTB was associated with proximity to sites containing arsenic, benzene, cadmium, lead, mercury, and polycyclic aromatic hydrocarbons. LBW was associated with exposure to arsenic, benzene, cadmium, lead, and mercury.

SIGNIFICANCE

This study provides evidence for potential reproductive health effects of polluted sites, and underscores the importance of accounting for heterogeneity between polluted sites when considering these exposures.

IMPACT STATEMENT

We documented an overall increased risk of both PTB and LBW in births with gestational exposure to polluted sites using a harmonized geodatabase of three site types, and further examined exposures stratified by site characteristics (route of emission, specific contaminants present). We observed increased risk of both PTB and LBW among births exposed to sites with water emissions or air emissions, across site types. Increased risk of PTB was associated with gestational proximity to sites containing arsenic, benzene, cadmium, lead, mercury, and polycyclic aromatic hydrocarbons; increased risk of LBW was associated with exposure to arsenic, benzene, cadmium, lead, and mercury.

Distribution characteristics and potential ecological risk assessment of heavy metals in soils around Shannan landfill site, Tibet

At present, sanitary landfill is mainly used for domestic waste treatment in Shannan City, Tibet. However, there are few studies on heavy metals in the soil around the landfill in Shannan city. Therefore, the surrounding soil of Luqionggang landfill in Shannan City, Tibet Autonomous Region, is taken as the research object. In the study, the geo-accumulation index method, Nemerow comprehensive pollution index method and potential ecological risk index method are mainly used to evaluate the pollution and risk of heavy metals in the soil around the landfill site. The main results are as follows: The average pH value of the soil around the landfill site is 9.37, belonging to the strong alkaline range. The average values of heavy metals Hg and Ni in soil exceeded the background content, and the average contents of other heavy metals Cu, Pb, Zn, Cr, As and Cd did not exceed the background content. The average content of these eight heavy metals did not exceed the screening value of the national soil environmental quality standard. In the horizontal direction, the average content of heavy metal elements Cu, Cr, Cd, Hg and Ni is relatively high in the west. The average content of heavy metals As, Zn and Pb in the north, east and south is slightly higher than that in the west. And the farther away from the landfill, the less the soil is affected by heavy metals. The evaluation results of geo-accumulation index show that heavy metal Hg is the most affected. The average value of the comprehensive pollution index is 2.969, which is between 2 and 3, belonging to the moderate pollution level. And the west side of the landfill (downstream area) is greatly affected. The evaluation results of potential ecological hazard pollution index show that the potential risk index of single pollutants of heavy metals Cu, Pb, Zn, Cr, Ni, As and Cd belongs to low ecological hazard level, and the potential risk index of single pollutants of heavy metal Hg belongs to relatively heavy ecological hazard level. On the whole, the total potential risk coefficient belongs to medium pollution hazard degree. According to the correlation analysis, there is no significant correlation between heavy metal elements As and Hg and the other six heavy metal elements. In addition, the pollution source of heavy metal As may be mainly soil forming factors and the pollution source of Hg may be mainly human factors.

Geospatial analysis of hypospadias and cryptorchidism prevalence rates based on postal code in a Canadian province with stable population

INTRODUCTION

Hypospadias and cryptorchidism are hormone-mediated malformations that occur during male development. Prevalence rates of hypospadias and cryptorchidism are thought to be increasing worldwide. In-utero exposure to endocrine-disrupting chemicals (EDCs) may have a role in the occurrence of these malformations. Our group has reported significant clustering of hypospadias and cryptorchidism at the county level in areas of intense agricultural activity in the Canadian province of Nova Scotia (NS). Finer scale spatial analysis has shown clustering near urban centres.

OBJECTIVES

The objectives of the study were: 1) to perform a granular geospatial analysis of hypospadias and cryptorchidism prevalence, at the postal code level, of all babies born in NS over a 26-year period; and 2) to determine whether there is spatial correlation between these conditions and industries linked to toxic output.

STUDY DESIGN

Cases of hypospadias and cryptorchidism were identified based on ICD-10 codes from the Nova Scotia Atlee Perinatal Database with records of all live births in NS between 1988 and 2013. Data were geocoded and mapped based on the three first digits of the maternal postal code (Forward Sortation Area [FSA]). Regional prevalence of congenital anomalies was calculated for each of the 77 FSAs. To identify statistically significant high and low prevalence clusters for each anomaly, Local Morans I was used on the spatial data. Geospatial point data was created for industries linked to toxic output and correlation between clusters of malformations and proximity to these industries was assessed.

RESULTS

During the study period, there were 1045 cases of hypospadias and 993 cases of cryptorchidism. Both hypospadias and cryptorchidism demonstrated statistically significant areas of high prevalence clusters. There was no significant spatial correlation between the local clustering of the congenital malformations and proximity to toxic industries.

DISCUSSION AND CONCLUSION

Our study shows heterogeneity in the distribution of hypospadias and cryptorchidism, which is consistent with previously published works. In this follow-up, granular geospatial analysis of hypospadias and cryptorchidism prevalence in an area with stable population, we did not confirm the previous findings of high clustering in areas of intense agricultural activity. Furthermore, our analysis did not find high clustering of the congenital malformations in areas near toxic industries to support a clear environmental role in their development. Some of the limitations include underdiagnosis of hypospadias and cryptorchidism (as they both present with a clinical spectrum and are non-life threatening), and limited data currently available on the route of exposure to EDC industries in Nova Scotia.

Association between residential proximity to municipal solid waste incinerator sites and birth outcomes in Shanghai: a retrospective cohort study of births during 2014-2018

We tested the hypothesis of whether maternal residential proximity to municipal solid waste incinerator (MSWI) sites could significantly affect birth outcomes. This retrospective birth cohort study conducted at the International Peace Maternity and Infant Hospital, Shanghai, China, included 59,606 mothers with singleton live births during 2014-2018. Multivariate generalized linear models were used to examine associations between residential proximity to MSWI sites and birth outcomes. Small for gestational age (SGA) was significantly more common among children with maternal residential proximity to MSWI sites (odds ratio [OR]=1.20, 95% confidence interval [CI]: 1.07-1.34). Maternal prepregnancy body mass index (BMI) influenced this association. Infants of underweight mothers (prepregnancy BMI <18.5 kg/m2) with MSWI exposure (OR=2.00, 95% CI: 1.58-2.52) had higher risks of SGA than their counterparts. Our findings underscore the need to prevent adverse environmental effects of MSWI on birth outcomes; improved exposure assessment measures are warranted in future studies.

Overflowing Disparities: Examining the Availability of Litter Bins in New York City

In the 1980s, activists' concerns about the disproportionate placements of landfills in low-income communities ignited the environmental justice movement. Today, similar issues of environmental injustice-the limited availability of litter bins across New York City (NYC) neighborhoods-remain unresolved. This study examines the association between NYC neighborhood income and litter bin availability. The NYC Department of Sanitation 2020 Litter Bin Inventory and archival measures of neighborhood composition and socioeconomic status were aggregated within NYC census tract neighborhoods. Multilevel Bayesian conditional autoregressive Poisson models estimated the prevalence rate ratio for counts of litter bins according to median household income in each census tract, accounting for spatial autocorrelation. Bivariate associations identified that census tracts with higher median household income had a greater prevalence of litter bins than census tracts with lower median household income; however, spatial autocorrelation attenuated the relationship between median household income and availability of litter bins. Further research is necessary to identify the spatially structured condition that accounted for the observed effect. The results warrant further investigation of both perceived and actual disparities in litter bin availability.

E-Waste in Africa: A Serious Threat to the Health of Children

Waste electronic and electrical equipment (e-waste) consists of used and discarded electrical and electronic items ranging from refrigerators to cell phones and printed circuit boards. It is frequently moved from developed countries to developing countries where it is dismantled for valuable metals in informal settings, resulting in significant human exposure to toxic substances. E-waste is a major concern in Africa, with large sites in Ghana and Nigeria where imported e-waste is dismantled under unsafe conditions. However, as in many developing countries, used electronic and electrical devices are imported in large quantities because they are in great demand and are less expensive than new ones. Many of these used products are irreparable and are discarded with other solid waste to local landfills. These items are then often scavenged for the purpose of extracting valuable metals by heating and burning, incubating in acids and other methods. These activities pose significant health risks to workers and residents in communities near recycling sites. E-waste burning and dismantling activities are frequently undertaken at e-waste sites, often in or near homes. As a result, children and people living in the surrounding areas are exposed, even if they are not directly involved in the recycling. While toxic substances are dangerous to individuals at any age, children are more vulnerable as they are going through important developmental processes, and some adverse health impacts may have long-term impacts. We review the e-waste situation in Africa with a focus on threats to children's health.

Regional variation in gastroschisis: a nationwide database review of demographics and outcomes

BACKGROUND

Gastroschisis is an index neonatal malformation with an increasing incidence from earlier decades. The aim of this study was to investigate regional variations in patient demographics, outcomes, and costs in gastroschisis.

MATERIALS AND METHODS

The 2016 kid's inpatient database (KID) obtained from the Healthcare Cost and Utilization Project (HCUP) was used to obtain gastroschisis birth, demographic, and outcome data across four U.S. geographical regions: Northeast, Midwest, South, and West. Categorical variables were analyzed with Pearson's Chi-squared test. Odds ratios (OR) with 95% confidence intervals (CI) were reported for variables with significance (p < 0.05). Appropriate logistic regressions were used for comparing categorical, cardinal, and continuous data.

RESULTS

2043 gastroschisis cases were obtained from the 2016 KID database with a weighted incidence of 5.1 per 10,000 live births. Incidence of gastroschisis across regions was similar when controlling for a number of hospitals reporting to KID. Prematurity was common, with 59% (1204) of neonates with gastroschisis born at less than 37 weeks. 52% (N = 1067) of gastroschisis infants were male. 46% (955) were White, 9% (178) African American, 22% (450) Hispanic, and 8% (155) other. The overall mortality of gastroschisis in this database was 3.6% (75). The average length of stay was 39 days and average cost of treatment was $357,436. Though without significant differences in mortality, there were significant differences in demographics, costs, and lengths of stay between regions.

CONCLUSIONS

There has been a significant increase in gastroschisis incidence over the last three decades. This significant increase appears to be related to an increase in socioeconomic inequality and an alteration in the population demographics in the United States. Further study of regional variations will facilitate the development of best practice guidelines that benefit all.

Investigating correlations between illness and defensive behaviour approach: A case of twin cities of Pakistan

Municipal solid waste (MSW) management has emerged as a major problem for modern societies in recent decades. An optimal waste management system is essential to prevent the pollution burden and associated health related issues. This study carries out an empirical evaluation of the illness caused by inadequate solid waste management in the metropolitan of Rawalpindi-Islamabad. The model is based on utility-maximizing consumer behavior and predicted probability of disease in the household is estimated by employing “seemingly uncorrelated bivariate probit model”. Primary data obtained through multistage random sampling that comprises of 849 respondents. The findings show that irregular waste disposal sites in the vicinity of residences cause illness. The key findings indicate that distance from dumpsites and use of contaminated water adversely affect the health outcomes. Furthermore, the results show that respondents were unable to engage in defensive activities due to a lack of awareness. Oft-times, the waste is dumped in illegal sites that is burnt thus causing excessive air and ground water pollution. The results shed light on the respondents' understanding of the negative consequences of excessive waste disposal and study suggests measures that motivate households to engage in defensive activities through effective campaigns and capacity building programmes that ensure sustainable solid waste management.

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An overview of the household solid waste generation and management practices.

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Construct households' illness function regarding improper waste disposal practices.

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Construct households' defensive behaviour regarding illness function.

Socio-Epidemiological Factors with Negative Impact on Infant Morbidity, Mortality Rates, and the Occurrence of Birth Defects

In the last 30-40 years, developed countries in particular, but also developing ones, have seen an increase in life expectancy and a decrease in infant mortality and morbidity rates. These factors are due to an increase in living standards, a decrease in differences between social classes, the increased accessibility of education to women, and the implementation of some public health measures. When certain basic social and medical measures are implemented on a large scale, their benefits are first reflected in lower infant mortality rates, and only in the second stage are such benefits reflected in decreasing neonatal mortality rates and a smaller number of stillbirths. In this study, we review the literature on these factors. We extrapolate and compare this literature with data recorded in our country in the hopes of finding the reasons why Romania ranks first in the European Union in terms of infant mortality rates. We found that lowering the infant morbidity, mortality, and congenital malformation rates is an absolute priority in Romania, which requires the involvement of decision makers in taking effective measures regarding food supplementation or enhancement using folic acid, adequate counselling of couples, monitoring of all pregnancies, setting antenatal diagnosis, implementing optimal delivery management and therapeutic approaches to problematic pregnancies in other hospitals and by involving the population in health education, avoiding occupational or in-home exposure to toxic factors, avoiding drug use, and implementing disease and infection prevention measures for pregnant women.

Association between prenatal air pollution exposure and risk of hypospadias in offspring: a systematic review and meta-analysis of observational studies

Background: The findings of associations between prenatal air pollution exposure and hypospadias risk in offspring are inconsistent. No systematic review or meta-analysis has yet summarized the present knowledge on the aforementioned topic.

Methods: Relevant manuscripts were identified by searching PubMed and Web of Science databases through January 31, 2020. Summary odds ratios (ORs) with 95% confidence intervals (CIs) in meta-analyses were estimated based on a random effects model. Publication bias was evaluated by funnel plots, Begg’s test, and Egger’s test.

Results: The search identified 3,032 relevant studies. Sixteen studies cumulatively involving 21,701 hypospadias cases and 1,465,364 participants were included. All of these studies were classified as having a low risk of bias. We classified pollutants as nitrogen oxides, particulate matter (PM), ozone, and other exposures. The exposure window to pollutants varied from three months before conception to seven days after delivery. In the meta-analyses, only PM_2.5 exposure in the first trimester was related to increased risk of hypospadias (per 10 μg/m³ OR = 1.34; 95% CI: 1.06–1.68).

Conclusion: We found evidence for an effect of PM_2.5 exposure on hypospadias risk. Improvements in the areas of study design, exposure assessment, and specific exposure window are needed to advance this field.

Methodological issues in descriptive environmental epidemiology. The example of study Sentieri

BACKGROUND

Descriptive epidemiology identifies associations between environmental exposures and health effects that require results from methodologically stronger studies before causation can be considered.

OBJECTIVE

To critically review the methodology and results of Sentieri, a descripitive study on residence in areas with one or more industrial source of pollution.

METHODS

We systematically reviewed the literature quoted by Sentieri for the selection of health effects of nine types of pollution sources of a-priori interest. We also reviewed and meta-analyzed the results of the first report of Sentieri, that analyzed mortality in 44 polluted sites (PS), and 17 causes of deaths during 1995-2002.

RESULTS

Among 159 study results quoted by Sentieri, 23.9 % were supportive of an association between residence near a pollution source and a health effect, 30.2 % were partially supportive, 10.7 % were not supportive, and 35.2 % were not relevant. Among 653 standardized mortality ratios for associations between PS-specific pollution sources and causes of death, 14.4% were significantly above 1.02, and 9.0% were significantly below 0.98. Among 48 meta-analysis, seven were significantly above 1.0, including five on exposure to asbestos.

CONCLUSIONS

Sentieri exemplifies the limitations of descriptive environmental epidemiology studies, in which most hypotheses have limited prior support, most results do not show associations, data on potential confounders and other sources of bias are not available. Such studies tend to replicate well-known associations and occasionally can identify critical situations requiring more investigation, but cannot be used to infer causality either in general or in specific circumstances.

Life cycle assessment of municipal waste management options

To date, landfilling remains the most common waste management practice in Greece in spite of enforced regulations aiming at increasing recycling, pre-selection of waste and energy and material recovery. In this study, selected alternative scenarios aiming at minimizing the unused material fraction to be disposed of in landfills are analyzed, using the life cycle assessment methodology. The methodology was applied in the case of municipal solid waste (MSW) management in Athens and Thessaloniki, with a special focus on energy and material balance, including potential global and local scale airborne emissions. Results are given in the form of indices efficiency, effectiveness, environmental and public health impacts. Material flow accounting, gross energy requirement, emergy intensity, emission and release intensity and morbidity or mortality indicators have been used to support the comparative assessment. However, not all options are equally benign to the local environment and to the health of the local population, since both the former and the latter are still affected by non-negligible local emissions. With regard to public health impacts, adverse effects on respiratory health, congenital malformations, low birth weight and cancer incidence were estimated. A significant and not intuitive result is the fact that life cycle analysis produces different conclusions than a simple environmental impact assessment based only on estimated or measured emissions. Taking into account the overall life cycle of both the waste streams and of the technological systems and facilities envisaged alters the relative attractiveness of the solutions considered.

Trace gas emissions from municipal solid waste landfills: A review

Trace gas emissions from municipal solid waste (MSW) landfills have received increasing attention in recent years. This paper reviews literature published between 1983 and 2019, focusing on (i) the origin and fate of trace gas in MSW landfills, (ii) sampling and analytical techniques, (iii) quantitative emission measurement techniques, (iv) concentration and surface emission rates of common trace compounds at different landfill units and (v) the environmental and health concerns associated with trace gas emissions from MSW landfills. Trace gases can be produced from waste degradation, direct volatilisation of chemicals in waste products or from conversions/reactions between other compounds. Different chemical groups dominate the different waste decomposition stages. In general, organic sulphur compounds and oxygenated compounds are connected with fresh waste, while abundant hydrogen sulphide, aromatics and aliphatic hydrocarbons are usually found during the methane fermentation stage. Selection of different sampling, analytical and emission rate measurement techniques might generate different results when quantifying trace gas emission from landfills, and validation tests are needed to evaluate the reliability of current methods. The concentrations of trace gases and their surface emission rates vary largely from site to site, and fresh waste dumping areas and uncovered waste surfaces are the most important fugitive emission sources. The adverse effects of trace gas emission are not fully understood, and more emission data are required in future studies to assess quantitatively their environmental impacts as well as health risks.

Small-area methods for investigation of environment and health

Small-area studies offer a powerful epidemiological approach to study disease patterns at the population level and assess health risks posed by environmental pollutants. They involve a public health investigation on a geographical scale (e.g. neighbourhood) with overlay of health, environmental, demographic and potential confounder data. Recent methodological advances, including Bayesian approaches, combined with fast-growing computational capabilities, permit more informative analyses than previously possible, including the incorporation of data at different scales, from satellites to individual-level survey information. Better data availability has widened the scope and utility of small-area studies, but has also led to greater complexity, including choice of optimal study area size and extent, duration of study periods, range of covariates and confounders to be considered and dealing with uncertainty. The availability of data from large, well-phenotyped cohorts such as UK Biobank enables the use of mixed-level study designs and the triangulation of evidence on environmental risks from small-area and individual-level studies, therefore improving causal inference, including use of linked biomarker and -omics data. As a result, there are now improved opportunities to investigate the impacts of environmental risk factors on human health, particularly for the surveillance and prevention of non-communicable diseases.

Health effects associated with proximity to waste collection points in Beitbridge Municipality, Zimbabwe

Population growth, urbanisation and economic development have led to the increasing generation of municipal solid waste while environmentally sustainable management remains a challenge the world over. This study sought to investigate health effects associated with proximity to waste collection points in Beitbridge Municipality, Zimbabwe. A cross-sectional study was undertaken to compare the occurrence of disease among the residents living within different distances from the waste collection points (50 m, 100 m, 150 m, 200 m, 250 m, 300 m and above 300 m). A handheld GPS device was used to collect coordinates of the location for the purposes of mapping. The Fishers Exact test and the Multiple Logistic Regression model conducted (on STATA V 13 SE) to determine the association between different variables and the occurrence of health effects. Questionnaires were administered to 700 stratified randomly selected respondents. Five refuse collection points and spatial distribution of health conditions were mapped at Dulibadzimu high-density suburb. The overall response rate was 98% and females constituted the majority of respondents (58%). Most of these respondents were aged between 26 and 35 years of age and were involved in informal trading (35%). Reported health conditions were diarrhoea, dyspnoea, dry cough, eye irritation and asthma. Distance, waste collection point, level of education, nature of occupation and sex were significant contributors to the prevalence of health effects associated with exposure to waste. Exposure to waste is a serious health concern in Beitbridge. Local authority is encouraged to abolish these waste collection points and invest more on conventional waste management systems in partnership with different stakeholders.

Siting and ranking municipal landfill sites in regional scale using nighttime satellite imagery

In 2016, about 24.9 million tonnes of solid waste were disposed of in Canadian landfills, where landfill technology is a common choice. This study aims to develop a data-driven GIS-based method that considers spatial, environmental, and economic constraints using study regions derived from night time light data for a 40 km buffer around Regina, Saskatchewan, Canada. Unlike other similar studies, this site suitability study assumes no political or administrative boundaries as inputs. Road network stands as the most decisive factor that accounts for 0.239 of entire weight, followed by protective areas with a total weight of 0.220. The regions that ranked the best for siting new landfills were generally located far from predominant water resources and protected areas, but are in the vicinity of major road networks, but are also far from urbanized regions. The sensitivity analysis showed that, overall, road network and protected areas are the most essential layers in this analysis. For the environmental group, protected areas and water resources are major layers. For the economic group, road network and surface temperature are the most important. The method presented in this study can easily accommodate other data sets based on importance in any given area.

The impact of population mobility on estimates of environmental exposure effects in a case-control study

In many studies of environmental risk factors for disease, researchers use the location at diagnosis as a geographic reference for environmental exposures. However, many environmental pollutants change continuously over space and time. The dynamic characteristics of these pollutants coupled with population mobility in the United States suggest that for diseases with long latencies like cancer, historic exposures may be more relevant than exposure at the time of diagnosis. In this article, we evaluated to what extent the commonly used assumption of no population mobility results in increased bias in the estimates of the relationship between environmental exposures and long-latency health outcomes disease in a case-control study. We conducted a simulation study using the residential histories of a random sample from the National Institutes of Health-AARP (formerly American Association of Retired Persons) Diet and Health Study. We simulated case-control status based on subject exposure and true exposure effects that varied temporally. We compared estimates from models using only subject location at diagnosis to estimates where subjects were assumed to be mobile. Ignoring population mobility resulted in underestimates of subject exposure, with largest deviations observed at time points further away from study enrollment. In general, the effect of population mobility on the bias of the estimates of the relationship between the exposure and the outcome was more prominent with exposures that showed substantial spatial and temporal variability. Based on our results, we recommend using residential histories when environmental exposures and disease latencies span a long enough time period that mobility is important.

Maternal, paternal, and neonatal risk factors for neural tube defects: A systematic review and meta-analysis

OBJECTIVE

Neural tube defects [NTDs] are severe congenital anomalies. The etiology of NTDs is not fully known, and studies on the potential risk factors of NTDs present inconsistent results. Thus, we conducted a systematic review and meta-analysis to investigate the maternal, paternal, and neonatal risk factors for NTDs.

STUDY DESIGN

We systematically reviewed relative original studies published through October 6, 2018 available in Pubmed, Embase and the Cochrane Library without restrictions for language. The selected studies measured maternal, paternal, and neonatal risk factors and examined their associations with NTDs. A meta-analysis, including subgroup analysis and sensitivity analysis, was conducted to estimate the pooled effect measures. Two reviewers independently extracted data using a predesigned data collection form.

RESULTS

Forty-five studies were eligible for inclusion in the meta-analysis, and twelve potential risk factors were analyzed. The factors that were associated with NTDs risk included stressful life events [odds ratio [OR],1.61; 95% confidence interval [CI], 1.24-2.08; p < 0.001; I2 = 59.2%], low maternal education level [OR, 1.42; 95% CI, 1.19-1.70; p < 0.001; I2 = 47.7%], pregestational diabetes [OR, 2.24; 95% CI, 1.21-4.12; p < 0.010; I2 = 56.3%], low paternal age [OR, 1.41; 95% CI, 1.10-1.81; p = 0.007; I2 = 0.0%], low birth weight [OR, 5.53; 95% CI, 1.95-15.70; p = 0.001; I2 = 98.5%], and neonatal female gender [OR, 1.54; 95% CI, 1.10-2.14; p = 0.012; I2 = 67.8%].

CONCLUSION

Stressful life events, pregestational diabetes, low birth weight, and neonatal female gender are risk factors associated with NTDs. Low maternal education level and low paternal age are factors that are moderately associated with NTDs. Further cohort studies are required to verify the factors associated with NTDs and control the risk of this severe birth defect.

Effects of sanitation practices on adverse pregnancy outcomes in India: a conducive finding from recent Indian demographic health survey

Background

Several risk factors predisposing women and their live-borns to adverse outcomes during pregnancy have been documented. Little is known about sanitation being a factor contributing to adverse pregnancy outcomes in India. The role of sanitation in adverse pregnancy outcomes remains largely unexplored in the Indian context. This study is an attempt to bring the focus on sanitation as a factor in adverse pregnancy outcome. Along with the sanitation factors, few confounder variables have also been studied in order to understand the adverse pregnancy outcomes.

Methods

The study is based on the fourth round of National Family Health Survey (NFHS-IV) covering 26,972 married women in the age-group 15–49. The study variables include the mother’s age, Body Mass Index (BMI), education, anemia, and Antenatal care (ANC) visits during their last pregnancy. The household level variable includes place of residence, religion, caste, wealth index, access to toilet, type of toilet, availability of water within toilet premises, and facility of hand wash near the toilet. Children study variables include Low Birth Weight (LBW), the order of birth (Parity), and the death of the children of the women in the last 5 years. The target variable Adverse Pregnancy Outcome (APO) was constructed using children born with low birth weight or died during the last pregnancy.

Results

We calculated both adjusted as well as unadjusted odds ratios for a better understanding of the association between sanitation and adverse pregnancy outcomes. Findings from the study showed that women who did not have access to a toilet within the house had a higher risk of adverse pregnancy outcome. In the multivariable model, no association was observed for adverse pregnancy outcome among women who did not have access to toilet and women who used shared toilet. Teenage (15–19 years), uneducated, underweight and anemic mothers were more likely to face APO as compare to other mothers in similar characteristics group.

Conclusions

Our findings contribute to the decidedly less available literature on maternal sanitation behaviour and adverse pregnancy outcomes. Our results support that sanitation is a very significant aspect for women who are about to deliver a baby as there was an association between sanitation and adverse pregnancy outcome. Education on sanitation practices is the need of the hour as much as it needs to follow.

A systematic review of associations between maternal exposures during pregnancy other than smoking and antenatal fetal measurements

BACKGROUND

Reduced birth weight is associated with many maternal environmental exposures during pregnancy, but the gestational age at onset of this association is unknown. We have previously reported associations between maternal smoking and fetal size.

OBJECTIVE

To report on our systematic review of the literature describing associations between antenatal size and growth and maternal exposures during pregnancy.

DATA SOURCES

Electronic databases (OVID and EMBASE) and web sites for cohort studies were searched. Studies were eligible if they examined associations between maternal environmental exposures (including ambient air exposure, diet and alcohol) and antenatal fetal ultrasound measurements. The Navigation Guide was used to assess the strength of evidence.

RESULTS

There were 451 abstracts identified and 36 papers were included of which maternal diet was the exposure of interest in 15, maternal ambient air exposure in 10, maternal alcohol in 3 and other exposures in 8. The first paper was published in 2006. Associations were present between exposures and fetal measurements in 18% of comparisons with second trimester measurements and in 46% of comparisons with third trimester measurements. In the third trimester, when an association was present, reduced head size was most commonly (58%) associated with current or previous maternal exposure, with reduced length being least commonly (32%) associated and reduced weight being intermediate (52%). In the third trimester, increased maternal nitrogen dioxide exposure was associated with reduced head size was associated with in all seven studies identified and reduced fetal weight in five out of six studies.

CONCLUSION

There is sufficient evidence of toxicity in the context of maternal exposure to nitrogen dioxide and reduced third trimester fetal head size. There is currently insufficient evidence of toxicity with regard to maternal exposures to dietary factors, alcohol and environmental chemicals and reduced fetal size.

Introduction to environmental engineering

Nowadays we can easily say that environmental engineering is truly an interdisciplinary science. Combining biology, ecology, geology, geography, mathematics, chemistry, agronomy, medicine, economy, etc. environmental engineering strives to use environmental understanding and advancements in technology to serve mankind by decreasing production of environmental hazards and the effects of those hazards already present in the soil, water, and air. Major activities of environmental engineer involve water supply, waste water and solid management, air and noise pollution control, environmental sustainability, environmental impact assessment, climate changes, etc. And all this with only one main goal – to prevent or reduce undesirable impacts of human activities on the environment. To ensure we all have tomorrow.

Hazardous waste and health impact: a systematic review of the scientific literature

Waste is part of the agenda of the European Environment and Health Process and included among the topics of the Sixth Ministerial Conference on Environment and Health. Disposal and management of hazardous waste are worldwide challenges. We performed a systematic review to evaluate the evidence of the health impact of hazardous waste exposure, applying transparent and a priori defined methods. The following five steps, based on pre-defined systematic criteria, were applied. 1. Specify the research question, in terms of "Population-Exposure-Comparators-Outcomes" (PECO).

POPULATION

people living near hazardous waste sites; Exposure: exposure to hazardous waste; Comparators: all comparators; Outcomes: all diseases/health disorders. 2. Carry out the literature search, in Medline and EMBASE. 3. Select studies for inclusion: original epidemiological studies, published between 1999 and 2015, on populations residentially exposed to hazardous waste. 4. Assess the quality of selected studies, taking into account study design, exposure and outcome assessment, confounding control. 5. Rate the confidence in the body of evidence for each outcome taking into account the reliability of each study, the strength of the association and concordance of results.Fifty-seven papers of epidemiological investigations on the health status of populations living near hazardous waste sites were selected for the evidence evaluation. The association between 95 health outcomes (diseases and disorders) and residential exposure to hazardous waste sites was evaluated. Health effects of residential hazardous waste exposure, previously partially unrecognized, were highlighted. Sufficient evidence was found of association between exposure to oil industry waste that releases high concentrations of hydrogen sulphide and acute symptoms. The evidence of causal relationship with hazardous waste was defined as limited for: liver, bladder, breast and testis cancers, non-Hodgkin lymphoma, asthma, congenital anomalies overall and anomalies of the neural tube, urogenital, connective and musculoskeletal systems, low birth weight and pre-term birth; evidence was defined as inadequate for the other health outcomes. The results, although not conclusive, provide indications that more effective public health policies on hazardous waste management are urgently needed. International, national and local authorities should oppose and eliminate poor, outdated and illegal practices of waste disposal, including illegal transboundary trade, and increase support regulation and its enforcement.

Assessing the impact of hazardous waste on children's health: The exposome paradigm

Assessment of the health impacts related to hazardous waste is a major scientific challenge with multiple societal implications. Most studies related to associations between hazardous waste and public health do not provide established of mechanistic links between environmental exposure and disease burden, resulting in ineffective waste management options. The exposome concept comes to overhaul the nature vs. nurture paradigm and embraces a world of dynamic interactions between environmental exposures, endogenous exposures and genetic expression in humans. In this context, the exposome paradigm provides a novel tool for holistic hazardous waste management. Waste streams and the related contamination of environmental media are not viewed in isolation, but rather as components of the expotype, the vector of exposures an individual is exposed to over time. Thus, a multi-route and multi-pathway exposure estimation can be performed setting a realistic basis for integrated health risk assessment. Waste management practices are thus assessed not only regarding their technological edge and efficacy but also their effects on human health at the individual and community level, considering intra-subject variability in the affected population. The effectiveness of the exposome approach is demonstrated in the case of Athens, the capital of Greece, where the health effects associated to long term and short term exposure to two major waste management facilities (landfill and plastic recycling) are presented. Using the exposome analysis tools, we confirmed that proximity to a landfill is critical for children neurodevelopment. However, this effect is significantly modified by parameters such as parental education level, socioeconomic status and nutrition. Proximity to a plastics recycling plant does not pose significant threats under normal operating conditions; yet, in the case of an accidental fire, release of persistent carcinogenic compounds (dioxins and furans) even for a short period results in increased lifelong risk, especially for breast feeding neonates.

Ecological risk assessment of an open dumping site at Mehmood Booti Lahore, Pakistan

A robust risk assessment of Mehmood Booting Open Dumping (MBOD) site has been carried out by developing holistic risk assessment framework. Framework mainly comprises on baseline study, hazard identification, and risk quantification and evaluation. Physico-chemical analysis of groundwater and leachate, health risk assessment, and estimation of gas emissions from the site were carried out for risk evaluation. LandGEM 3.02 modelling software was used to measure the gas emissions. Analysis of leachate showed that all parameters were exceeding the WHO standard limit. Water samples were found polluted with heavy metals and total coliform contamination. Health survey inferred that problems which were faced by the majority of respondents were respiratory problems (80%). LandGEM model estimated that total landfill gas (TLG) emitted from the site for the year 2014 was 1.760E+05 Mg/year, CH₄ emission was 5.445E+06 Mg/year, CO₂ emission was 1.290E+05 Mg/year and for non-methane organic compound emission was 2.021E+03 Mg/year. It can be concluded that in the near future, almost all the water locations are possibly threatened with leachate contamination due to the continued accumulation of solid waste at MBOD site. The study recommends that new sanitary landfill sites should be designed to minimize the adverse effects associated with solid waste disposal and to preclude further pollution to surface water, groundwater, soil, and air.

Systematic literature review of reproductive outcome associated with residential proximity to polluted sites

This study aims to assess the evidence on adverse pregnancy outcome associated with living close to polluted industrial sites, and identify the strengths and weaknesses of published epidemiological studies. A systematic literature search has been performed on all epidemiological studies published in developed countries since 1990, on the association between residential proximity to industrial sites (hazardous waste sites, industrial facilities and landfill sites) and adverse pregnancy outcome (low birth weight, preterm birth, small for gestational age, intrauterine growth retardation, infant mortality, congenital malformation). Based on 41 papers, our review reveals an excess risk of reproductive morbidity. However, no studies show significant excess risk of mortality including fetal death, neonatal or infant mortality and stillbirth. All published studies tend to show an increased risk of congenital abnormalities, yet not all are statistically significant. All but two of these studies revealed an excess risk of low birth weight. Results for preterm birth, small for gestational age and intrauterine growth retardation show the same pattern. There is suggestive evidence from the post-1990 literature that residential proximity to polluted sites (including landfills, hazardous waste sites and industrial facilities) might contribute to adverse reproductive outcomes, especially congenital malformations and low birth weight-though not mortality. This body of evidence has limitations that impede the formulation of firm conclusions, and new, well-focused studies are called for. The review findings suggest that continued strengthening of rules governing industrial emissions as well as industrial waste management and improved land use planning are needed.

The influence of the built environment on adverse birth outcomes

Adverse birth outcomes are associated with neonatal morbidity and mortality, and higher risk for coronary heart disease, non-insulin-dependent diabetes and hypertension in adulthood. Although there has been considerable research investigating the association between maternal and environmental factors on adverse birth outcomes, one risk factor, not fully understood, is the influence of the built environment. A search of MEDLINE, Scopus, and Cochrane was conducted to find articles assessing the influence of the built environment on preterm birth (PTB), low birth weight (LBW), and small-for-gestational-age (SGA). In total, 41 studies met our inclusion criteria, and were organized into nine categories: Roadways, Greenness, Power Plants, Gas Stations/Wells, Waste Management, Power Lines, Neighborhood Conditions, Food Environment, and Industry. The most common built environmental variable was roads/traffic, encompassing 17/41 (41%) of the articles reviewed, of which 12/17 (71%) found a significant small to moderate association between high traffic exposure and adverse birth outcomes.

Routinely collected English birth data sets: comparisons and recommendations for reproductive epidemiology

BACKGROUND

In England there are four national routinely collected data sets on births: Office for National Statistics (ONS) births based on birth registrations; Hospital Episode Statistics (HES) deliveries (mothers' information); HES births (babies' information); and NHS Numbers for Babies (NN4B) based on ONS births plus gestational age and ethnicity information. This study describes and compares these data, with the aim of recommending the most appropriate data set(s) for use in epidemiological research and surveillance.

METHODS

We assessed the completeness and quality of the data sets in relation to use in epidemiological research and surveillance and produced detailed descriptive statistics on common reproductive outcomes for each data set including temporal and spatial trends.

RESULTS

ONS births is a high quality complete data set but lacks interpretive and clinical information. HES deliveries showed good agreement with ONS births but HES births showed larger amounts of missing or unavailable data. Both HES data sets had improved quality from 2003 onwards, but showed some local spatial variability. NN4B showed excellent agreement with ONS and HES deliveries for the years available (2006-2010). Annual number of births increased by 17.6% comparing 2002 with 2010 (ONS births). Approximately 6% of births were of low birth weight (2.6% term low birth weight) and 0.5% were stillbirths.

CONCLUSIONS

Routinely collected data on births provide a valuable resource for researchers. ONS and NN4B offer the most complete and accurate record of births. Where more detailed clinical information is required, HES deliveries offers a high quality data set that captures the majority of English births.

A systematic critical review of epidemiological studies on public health concerns of municipal solid waste handling

AIMS

The ultimate aim of this review was to summarise the epidemiological evidence on the association between municipal solid waste management operations and health risks to populations residing near landfills and incinerators, waste workers and recyclers. To accomplish this, the sub-aims of this review article were to (1) examine the health risks posed by municipal solid waste management activities, (2) determine the strengths and gaps of available literature on health risks from municipal waste management operations and (3) suggest possible research needs for future studies.

METHODS

The article reviewed epidemiological literature on public health concerns of municipal solid waste handling published in the period 1995-2014. The PubMed and MEDLINE computerised literature searches were employed to identify the relevant papers using the keywords solid waste, waste management, health risks, recycling, landfills and incinerators. Additionally, all references of potential papers were examined to determine more articles that met the inclusion criteria.

RESULTS

A total of 379 papers were identified, but after intensive screening only 72 met the inclusion criteria and were reviewed. Of these studies, 33 were on adverse health effects in communities living near waste dumpsites or incinerators, 24 on municipal solid waste workers and 15 on informal waste recyclers. Reviewed studies were unable to demonstrate a causal or non-causal relationship due to various limitations.

CONCLUSION

In light of the above findings, our review concludes that overall epidemiological evidence in reviewed articles is inadequate mainly due to methodological limitations and future research needs to develop tools capable of demonstrating causal or non-causal relationships between specific waste management operations and adverse health endpoints.

Respiratory Health in Waste Collection and Disposal Workers

Waste management, namely, collection, transport, sorting and processing, and disposal, is an issue of social concern owing to its environmental impact and effects on public health. In fact, waste management activities are carried out according to procedures that can have various negative effects on the environment and, potentially, on human health. The aim of our study was to assess the potential effects on respiratory health of this exposure in workers in the waste management and disposal field, as compared with a group of workers with no occupational exposure to outdoor pollutants. The sample consisted of a total of 124 subjects, 63 waste collectors, and 61 office clerks. Informed consent was obtained from all subjects before inclusion in the study. The entire study population underwent pulmonary function assessments with spirometry and completed two validated questionnaires for the diagnosis of rhinitis and chronic bronchitis. Statistical analyses were performed using STATA 13. Spirometry showed a statistically significant reduction in the mean Tiffenau Index values in the exposed workers, as compared with the controls, after adjusting for the confounding factors of age, BMI, and smoking habit. Similarly, the mean FEV1 values were lower in the exposed workers than in the controls, this difference being again statistically significant. The FVC differences measured in the two groups were not found to be statistically significant. We ran a cross-sectional study to investigate the respiratory health of a group of workers in the solid waste collection and disposal field as compared with a group of office workers. In agreement with most of the data in the literature, our findings support the existence of a prevalence of respiratory deficits in waste disposal workers. Our data suggest the importance of adopting preventive measures, such as wearing specific individual protection devices, to protect this particular category of workers from adverse effects on respiratory health.

The evidence of toxic wastes dumping in Campania, Italy

The region of Campania (particularly Naples and Caserta) were subjected to extensive illegal dumping operations of toxic and radioactive wastes since the 1980s. The highly toxic wastes (HTW) dumping operations that have taken place both along the coast and the hinterland, have extremely adverse effects on health, livelihoods and the future prospect of sustainable development of the local population. The toxic wastes dumping in Campania is real and it has compromised (irreversibly) the human health, natural environment, food security and the long-term development prospects of the affected population. To reverse this tragic trend, it is necessery the identification, isolation and reclamation of the polluted sites and full assessment of the nature and the scale of the polluting chemicals and other hazardous wastes. The purpose of this review is to contribute significantly to the available evidence of the long-running toxic waste dumping in Campania and its negative impact on the health of population.

Respiratory hospital admission risk near large composting facilities

BACKGROUND

Large-scale composting can release bioaerosols in elevated quantities, but there are few studies of health effects on nearby communities.

METHODS

A cross-sectional ecological small area design was used to examine risk of respiratory hospital admissions within 2500m of all 148 English large-scale composting facilities in 2008-10. Statistical analyses used a random intercept Poisson regression model at Census Output Area (COA) level (mean population 310). Models were adjusted for age, sex, deprivation and tobacco sales.

RESULTS

Analysing 34,963 respiratory hospital admissions in 4656 COAs within 250-2500m of a site, there were no significant trends using pre-defined distance bands of >250-750m, >750-1500m and >1500-2500m. Using a continuous measure of distance, there was a small non-statistically significant (p=0.054) association with total respiratory admissions corresponding to a 1.5% (95% CI: 0.0-2.9%) decrease in risk if moving from 251m to 501m. There were no significant associations for subgroups of respiratory infections, asthma or chronic obstructive pulmonary disease.

CONCLUSION

This national study does not provide evidence for increased risks of respiratory hospital admissions in those living beyond 250m of an outdoor composting area perimeter. Further work using better measures of exposure and exploring associations with symptoms and disease prevalence, especially in vulnerable groups, is recommended to support regulatory approaches.

The Genetic and Environmental Factors Underlying Hypospadias

Hypospadias results from a failure of urethral closure in the male phallus and affects 1 in 200-300 boys. It is thought to be due to a combination of genetic and environmental factors. The development of the penis progresses in 2 stages: an initial hormone-independent phase and a secondary hormone-dependent phase. Here, we review the molecular pathways that contribute to each of these stages, drawing on studies from both human and mouse models. Hypospadias can occur when normal development of the phallus is disrupted, and we provide evidence that mutations in genes underlying this developmental process are causative. Finally, we discuss the environmental factors that may contribute to hypospadias and their potential immediate and transgenerational epigenetic impacts.

Using Geographic Information Science to Explore Associations between Air Pollution, Environmental Amenities, and Preterm Births

The study uses geographic information science (GIS) and statistics to find out if there are statistical differences between full term and preterm births to non-Hispanic white, non-Hispanic Black, and Hispanic mothers in their exposure to air pollution and access to environmental amenities (green space and vendors of healthy food) in the second largest city in New England, Worcester, Massachusetts. Proximity to a Toxic Release Inventory site has a statistically significant effect on preterm birth regardless of race. The air-pollution hazard score from the Risk Screening Environmental Indicators Model is also a statistically significant factor when preterm births are categorized into three groups based on the degree of prematurity. Proximity to green space and to a healthy food vendor did not have an effect on preterm births. The study also used cluster analysis and found statistically significant spatial clusters of high preterm birth volume for non-Hispanic white, non-Hispanic Black, and Hispanic mothers.

Environmental and socio-economic determinants of infant mortality in Poland: an ecological study

BACKGROUND

Health status of infants is related to the general state of health of women of child-bearing age; however, women's occupational environment and socio-economic conditions also seem to play an important role. The aim of the present ecological study was to assess the relationship between occupational environment, industrial pollution, socio-economic status and infant mortality in Poland.

METHODS

Data on infant mortality and environmental and socio-economic characteristics for the 66 sub-regions of Poland for the years 2005-2011 were used in the analysis. Factor analysis was used to extract the most important factors explaining total variance among the 23 studied exposures. Generalized Estimating Equations model was used to evaluate the link between infant mortality and the studied extracted factors.

RESULTS

Marked variation for infant mortality and the characteristics of industrialization was observed among the 66 sub-regions of Poland. Four extracted factors: "poor working environment", "urbanization and employment in the service sector", "industrial pollution", "economic wealth" accounted for 77.3% of cumulative variance between the studied exposures. In the multivariate regression analysis, an increase in factor "poor working environment" of 1 SD was related to an increase in infant mortality of 40 (95% CI: 28-53) per 100,000 live births. Additionally, an increase in factor "industrial pollution" of 1 SD was associated with an increase in infant mortality of 16 (95% CI: 2-30) per 100,000 live births. The factors "urbanization and employment in the service sector" and "economic wealth" were not significantly related to infant mortality.

CONCLUSION

The study findings suggested that, at the population level, infant mortality was associated with an industrial environment. Strategies to improve working conditions and reduce industrial pollution might contribute to a reduction in infant mortality in Poland.

Health impacts from living near a major industrial park in Oman

Background

Oman is heading towards heavy industrialisation with rapid establishment of new industrial parks. One of these, the Sohar Industrial Zone (SIZ) started to operate in 2006 and includes many industries that potentially affect local air quality and the health status of its surrounding residents. The study aim was to assess the health effects in a population of ≥20 years old, living in the residential area around the SIZ.

Methods

Area-specific health care visits data for acute respiratory diseases (ARD), asthma, conjunctivitis and dermatitis were obtained for the period between January 1, 2006, and December 31, 2010. Exposure was defined as distance from the SIZ to determine high, intermediate, and control exposure zones (≤5, >5–10, and ≥20 km from the SIZ respectively). Generalized additive models were used to model age and gender adjusted monthly health events for the selected diseases, adjusted for age and gender-specific population smoking prevalence. The high and intermediate exposure zones were later combined in the models because of their similarity of effects. Exposure effect modification by age, gender and socio-economic status (SES) were examined.

Results

Living within the high and intermediate exposure zones was associated with a greater risk ratio for ARD (RR: 2.02; 95 % CI: 1.88–2.17), asthma (RR: 3.61; 95 % CI: 2.96–4.41), conjunctivitis (RR: 2.83; 95 % CI: 2.47–3.24), and dermatitis (RR: 2.11; 95 % CI: 1.86–2.39), compared to the control exposure zone. Greater exposure effects were observed amongst ages ≥50 years and lower SES groups.

Conclusion

This is the first study carried out in Oman to assess the link between environmental exposure and health. These findings hope to contribute to building up evidence for environmental health and sustainable development policy in the country.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1866-3) contains supplementary material, which is available to authorized users.

Long-term trends and seasonality of omphalocele during 1996-2010 in China: a retrospective analysis based on the hospital-based birth defects surveillance system

BACKGROUND

Little is known about secular trends and seasonal variation in the birth prevalence of omphalocele in China. This study aimed to explore the long-term trends and seasonality of this birth defect, to provide insight into the etiology and prevention of omphalocele.

METHODS

A retrospective analysis of all births with omphalocele (1322 cases in 8.8 million births) registered in the hospital-based Chinese Birth Defects Monitoring Network between January 1996 and September 2010. Negative binomial cyclical regression models were used to analyze the long-term trends and seasonal fluctuations of omphalocele occurrence in the southern and northern regions and urban and rural areas of China.

RESULTS

The total prevalence of omphalocele was 1.50 cases (95% confidence interval (CI): 1.42-1.58) per 10,000 births. There was no significant secular trend of omphalocele occurrence in China between 1996 and 2010. The observed prevalence of omphalocele in rural areas was 2.03-2.54 cases per 10,000 births between May and August, which was higher than that observed in other months. The highest prevalence of births with omphalocele in rural areas occurred at the end of June; on average, the prevalence of omphalocele at that time point increased by 20% (95% CI: 6-35%) compared with other months.

CONCLUSIONS

There were no long-term trends found for occurrence of omphalocele in China between 1996 and 2010; however, seasonality was observed for omphalocele in women living in rural areas. These results may help generate hypotheses for further study of environmental factors that vary by season.

Environmental, parental and gestational factors that influence the occurrence of hypospadias in male patients

OBJECTIVE

Hypospadias is a congenital defect, which affects normal development of the male urogenital external tract. In this malformation, the urethral orifice of the penis is positioned ventrally, thus interfering with normal urination and creating, in some adults, problems during sexual intercourse. Heritability of hypospadias has been shown in some reports, and the abnormality has been associated with the presence of mutations in one of the genes involved in urogenital development. However, even for patients who were born in families with a higher incidence rate of this defect, no evident genetic alteration could be identified in known genes, indicating that the list of loci involved is still incomplete. To further complicate matters, recent reports also underline that epigenetic changes, without any identifiable gene sequence mutation, may be involved in gene function impairment. Therefore, the inheritance of most hypospadias cases is not evident, suggesting that the genetic background is not the only cause of this malformation; indeed, the majority of hypospadias cases are classified as sporadic and idiopathic.

MATERIALS AND METHODS

Evidence has accumulated highlighting the role of the environment and of its relationships with the genome in the etiology of this abnormality. In particular, the interaction between some chemicals, which are able to mimic endogenous molecules such as sexual hormones--for this reason called endocrine disrupting compounds (EDC)--and specific receptors has been extensively investigated during the pregnancy. Additionally, several articles have shown that parental and gestational factors play a significant role too. Indeed, physiological alterations, such as body weight of the mother and/or of the newborn, mother's diabetes, impaired father fertility, and exposure of one parent to job-related pollutants, show in many cases a direct correlation with hypospadias incidence. The overall prevalence of this condition has been studied in many countries, suggesting that at least in some periods and/or in specific populations there are detectable fluctuations, probably mirroring the different natural environments. However, many articles present data that do not agree with these findings and, consequently, most causes of hypospadias are still highly debated.

RESULTS

In this review, we summarize the developmental steps involved in urogenital tract formation, with a particular emphasis on the genes that most frequently are associated with this condition, or that are subject to environmental stress, or that may be the targets of hormone-like, exogenous molecules. Then, we make an overview of the identified factors able to impair the function of important genes, even in the absence of their mutations, including those for which contradictory reports have been published. Finally, we propose an explanation of sporadic cases of hypospadias that reconciles these contradictions and suggest some steps for moving forward in the research focused on this condition.

CONCLUSION

We hypothesize that most patients develop hypospadias because of gene-environment interactions acting on polymorphic genes that, in the absence of environmental stimuli, would otherwise cause no developmental anomaly during urogenital development.

Environmental pollution from illegal waste disposal and health effects: a review on the "triangle of death"

The term “triangle of death” was used for the first time by Senior and Mazza in the journal The Lancet Oncology referring to the eastern area of the Campania Region (Southern Italy) which has one of the worst records of illegal waste dumping practices. In the past decades, many studies have focused on the potential of illegal waste disposal to cause adverse effects on human health in this area. The great heterogeneity in the findings, and the bias in media communication has generated great healthcare doubts, anxieties and alarm. This paper addresses a review of the up-to-date literature on the “triangle of death”, bringing together the available information on the occurrence and severity of health effects related to illegal waste disposal. The Scopus database was searched using the search terms “waste”, “Campania”, “Naples”, “triangle of death” and “human biomonitoring”. Despite the methodological and sampling heterogeneity between the studies, this review examines the evidence from published data concerning cancer incidence, childhood mortality and birth defects, so that the current situation, knowledge gaps and research priorities can be established. The review aims to provide a contribution to the scientific community, and to respond to the concerns of the general population.

Association between hospital discharge rate for female breast cancer and residence in a zip code containing hazardous waste sites

BACKGROUND

Exposure to chemicals plays a role in risk of breast cancer. However, possible associations between risk of breast cancer and residential proximity to hazardous waste sites (HWSs) have not been reported.

METHODS

We determined rates of hospital discharge with a diagnosis of female breast cancer in relation to residence in a zip code containing HWSs in New York State (NYS) after adjustment for ethnicity, age, income and urbanicity. Waste exposure was assessed by both the number of waste sites and the type of contaminants. Negative binomial regression was used to test the associations.

RESULTS

After controlling for confounders, the hospital discharge rate of breast cancer for women living in zip codes having four or more HWSs or in zip codes having one HWS increased significantly (at the 0.05 level) by 9.1% and 6.4%, as compared to those living in a zip code with no HWS. The association for women living in zip codes having two or three HWSs was not significant. This indicates that the extent of exposure cannot be assessed solely by the number of waste sites. The discharge rate for women living in zip codes containing at least one volatile organic compound (VOC) waste site was significantly increased 5.6% as compared to those living in a zip code without any HWS, while the increases were not significant for women living in zip codes containing waste sites with persistent organic pollutants (POPs) or other contaminants. The significant associations were stronger for African American than Caucasian women and stronger in more urbanized than in rural areas.

CONCLUSIONS

Residence within a geographic area (defined by zip codes) that includes a hazardous waste site with VOCs is significantly associated with an increased rate of hospitalization for breast cancer, and the association is stronger for African American than Caucasian women and stronger in more urbanized than in rural areas after adjustment for the confounders.

Similar causes of various reproductive disorders in early life

During the past few decades, scientific evidence has been accumulated concerning the possible adverse effects of the exposure to environmental chemicals on the well-being of wildlife and human populations. One large and growing group of such compounds of anthropogenic or natural origin is referred to as endocrine-disrupting chemicals (EDCs), due to their deleterious action on the endocrine system. This concern was first focused on the control of reproductive function particularly in males, but has later been expanded to include all possible endocrine functions. The present review describes the underlying physiology behind the cascade of developmental events that occur during sexual differentiation of males and the specific role of androgen in the masculinization process and proper organogenesis of the external male genitalia. The impact of the genetic background, environmental exposures and lifestyle factors in the etiology of hypospadias, cryptorchidism and testicular cancer are reviewed and the possible role of EDCs in the development of these reproductive disorders is discussed critically. Finally, the possible direct and programming effects of exposures in utero to widely use therapeutic compounds, environmental estrogens and other chemicals on the incidence of reproductive abnormalities and poor semen quality in humans are also highlighted.

Bowel disorders and its spatial trend in Manitoba, Canada

BACKGROUND

Bowel disorders have destructive impacts on the patients social and mental aspects of life and can cause emotional distress. The risk of developing bowel incontinence also increases with age. The rate of incidence of inflammatory bowel disease in Manitoba, Canada, has been unusually raised. Therefore, it is important to identify trends in the incidence of bowel disorders that may suggest further epidemiological studies to identify risk factors and identify any changes in important factors.

METHODS

An important part of spatial epidemiology is cluster detection as it has the potential to identify possible risk factors associated with disease, which in turn may lead to further investigations into the nature of diseases. To test for potential disease clusters many methods have been proposed. The focused detection methods including the circular spatial scan statistic (CSS), flexible spatial scan statistic (FSS), and Bayesian disease mapping (BYM) are among the most popular disease detection procedures. A frequentist approach based on maximum likelihood estimation (MLE) has been recently used to identify potential focused clusters as well. The aforementioned approaches are studied by analyzing a dataset of bowel disorders in the province of Manitoba, Canada, from 2001 to 2010.

RESULTS

The CSS method identified less regions than the FSS method in the south part of the province as potential clusters. The same regions were identified by the BYM and MLE methods as being potential clusters of bowel disorders with a slightly different order of significance. Most of these regions were also detected by the CSS or FSS methods.

CONCLUSIONS

Overall, we recommend using the methods BYM and MLE for cluster detection with the similar population and structure of regions as in Manitoba. The potential clusters of bowel disorders are generally located in the southern part of the province including the eastern part of the city of Winnipeg. These results may represent real increases in bowel disorders or they may be an indication of other covariates that were not adjusted for in the model used here. Further investigation is needed to examine these findings, and also to explore the cause of these increases.

Health effects associated with the disposal of solid waste in landfills and incinerators in populations living in surrounding areas: a systematic review

OBJECTIVES

Potential health hazards for the environment and people living nearby landfills and incinerators are claimed to be related to several methods of waste management. Independent systematic review of the scientific literature is a key procedure to support the lay public and policy makers to achieve informed decisions.

METHODS

The study design and potential biases of papers retrieved in this comprehensive literature search were analyzed.

RESULTS

The most consistent result is that the risks of congenital anomalies and hospitalization due to respiratory disease are likely to be real nearby special waste landfills. From the very little information on exclusively urban waste depots it is reasonable to say that correct management of landfill does not increase the risk of these health effects. It is confirmed that historically incinerators are an important source of pollution and harm for the health of populations living nearby; however, changes in technology are producing more reassuring results.

CONCLUSIONS

A moderate level of confidence is possible in limited areas of knowledge, implying the need to overcome the limitations of current studies about exposure assessment and to control confounders at the individual level.

Adverse birth outcomes in the vicinity of industrial installations in Spain 2004-2008

Industrial activity is one of the main sources of ambient pollution in developed countries. However, research analyzing its effect on birth outcomes is inconclusive. We analyzed the association between proximity of mother's municipality of residence to industries from 24 different activity groups and risk of very (VPTB) and moderate (MPTB) preterm birth, very (VLBW) and moderate (MLBW) low birth weight, and small for gestational age (SGA) in Spain, 2004-2008. An ecological study was defined, and a "near vs. far" analysis (3.5 km threshold) was carried out using Hierarchical Bayesian models implemented via Integrated Nested Laplace Approximation. VPTB risk was higher for mothers living near pharmaceutical companies. Proximity to galvanization and hazardous waste management industries increased the risk of MPTB. Risk of VLBW was higher for mothers residing near pharmaceutical and non-hazardous or animal waste management industries. For MLBW many associations were found, being notable the proximity to mining, biocides and animal waste management plants. The strongest association for SGA was found with proximity to management animal waste plants. These results highlight the importance of further research on the relationship between proximity to industrial sites and the occurrence of adverse birth outcomes especially for the case of pharmaceutical and animal waste management activities.

Contaminated sites in Europe: review of the current situation based on data collected through a European network

Under the European Union (EU) Thematic Strategy for Soil Protection, the European Commission has identified soil contamination as a priority for the collection of policy-relevant soil data at European scale. In order to support EU soil management policies, soil-related indicators need to be developed which requires appropriate data collection and establishment of harmonized datasets for the EU Member States. In 2011-12, the European Soil Data Centre of the European Commission conducted a project to collect data on contaminated sites from national institutions in Europe using the European Environment Information and Observation Network for soil (EIONET-SOIL). This paper presents the results obtained from analysing the soil contaminated sites data submitted by participating countries. According to the received data, the number of estimated potential contaminated sites is more than 2.5 million and the identified contaminated sites around 342 thousand. Municipal and industrial wastes contribute most to soil contamination (38%), followed by the industrial/commercial sector (34%). Mineral oil and heavy metals are the main contaminants contributing around 60% to soil contamination. In terms of budget, the management of contaminated sites is estimated to cost around 6 billion Euros (€) annually.