Timescales of developmental toxicity impacting on research and needs for intervention

Much progress has happened in understanding developmental vulnerability to preventable environmental hazards. Along with the improved insight, the perspective has widened, and developmental toxicity now involves latent effects that can result in delayed adverse effects in adults or at old age and additional effects that can be transgenerationally transferred to future generations. Although epidemiology and toxicology to an increasing degree are exploring the adverse effects from developmental exposures in human beings, the improved documentation has resulted in little progress in protection, and few environmental chemicals are currently regulated to protect against developmental toxicity, whether it be neurotoxicity, endocrine disruption or other adverse outcome. The desire to obtain a high degree of certainty and verification of the evidence used for decision-making must be weighed against the costs and necessary duration of research, as well as the long-term costs to human health because of delayed protection of vulnerable early-life stages of human development and, possibly, future generations. Although two-generation toxicology tests may be useful for initial test purposes, other rapidly emerging tools need to be seriously considered from computational chemistry and metabolomics to CLARITY-BPA-type designs, big data and population record linkage approaches that will allow efficient generation of new insight; epigenetic mechanisms may necessitate a set of additional regulatory tests to reveal such effects. As reflected by the Prenatal Programming and Toxicity (PPTOX) VI conference, the current scientific understanding and the timescales involved require an intensified approach to protect against preventable adverse health effects that can harm the next generation and generations to come. While further research is needed, the main emphasis should be on research translation and timely public health intervention to avoid serious, irreversible and perhaps transgenerational harm.

Spirometry Changes in Cold Climatic Conditions of Antarctica

BACKGROUND

Pulmonary function is one of the important physiological measures that is known to be affected during the changes in the altitude. There is dearth of literature on changes in the pulmonary function variables in the cold climate conditions of Antarctica. We carried out spirometry before, during and after one year stay at Antarctica in members of the Indian expedition.

METHODS

Spirometry was carried out on 23 members of the XXVI Indian Scientific Expedition to Antarctica at baseline, after six months of expedition and at the end of one year, using standard guidelines. The tests were carried out indoor in temperature controlled laboratory.

RESULTS

The pulmonary function test parameters did not vary across the period. Although, both forced vital capacity (FVC) and forced expiratory volume in first second (FEV1) showed a decreasing trend but did not attain any statistical significance. However, peak expiratory flow (PEFR) rate was reduced significantly.

CONCLUSION

Our study did not show consistently significant change in the pulmonary function parameters in the members of the Indian Antarctic expedition.

Commentary on the contributions and future role of occupational exposure science in a vision and strategy for the discipline of exposure science

Exposure science is a holistic concept without prejudice to exposure source. Traditionally, measurements aimed at mitigating environmental exposures have not included exposures in the workplace, instead considering such exposures to be an internal affair between workers and their employers. Similarly, occupational (or industrial) hygiene has not typically accounted for environmental contributions to poor health at work. Many persons spend a significant amount of their lifetime in the workplace, where they maybe exposed to more numerous chemicals at higher levels than elsewhere in their environment. In addition, workplace chemical exposures and other exogenous stressors may increase epigenetic and germline modifications that are passed on to future generations. We provide a brief history of the development of exposure science from its roots in the assessment of workplace exposures, including an appendix where we detail current resources for education and training in exposure science offered through occupational hygiene organizations. We describe existing successful collaborations between occupational and environmental practitioners in the field of exposure science, which may serve as a model for future interactions. Finally, we provide an integrated vision for the field of exposure science, emphasizing interagency collaboration, the need for complete exposure information in epidemiological studies, and the importance of integrating occupational, environmental, and residential assessments. Our goal is to encourage communication and spur additional collaboration between the fields of occupational and environmental exposure assessment. Providing a more comprehensive approach to exposure science is critical to the study of the "exposome", which conceptualizes the totality of exposures throughout a person's life, not only chemical, but also from diet, stress, drugs, infection, and so on, and the individual response.

[Effects of anomalous rise of air temperature on population mortality]

Global climate warming for the last 10 years actualized the problem of mortality rise in some European countries in anomalous summer heat. Russia faced this problem in July-August 2010 when extreme heat entailed a significant elevation of mortality in 31 regions of the country primarily due to coronary heart disease and cerebrovascular diseases. The analysis of foreign researches has shown that old age and living in cities are leading risk factors of deat in anomalous heat. Experience of the European countries and USA evidences that stay in conditioned apartments and early referral for medical assistance are most effective death preventive measures in heat.

Sauna as a valuable clinical tool for cardiovascular, autoimmune, toxicant- induced and other chronic health problems

Sauna therapy has been used for hundreds of years in the Scandinavian region as a standard health activity. Studies document the effectiveness of sauna therapy for persons with hypertension, congestive heart failure, and for post-myocardial infarction care. Some individuals with chronic obstructive pulmonary disease (COPD), chronic fatigue, chronic pain, or addictions also find benefit. Existing evidence supports the use of saunas as a component of depuration (purification or cleansing) protocols for environmentally-induced illness. While far-infrared saunas have been used in many cardiovascular studies, all studies applying sauna for depuration have utilized saunas with radiant heating units. Overall, regular sauna therapy (either radiant heat or far-infrared units) appears to be safe and offers multiple health benefits to regular users. One potential area of concern is sauna use in early pregnancy because of evidence suggesting that hyperthermia might be teratogenic.

Biomarkers of immunotoxicity for environmental and public health research

The immune response plays an important role in the pathophysiology of numerous diseases including asthma, autoimmunity and cancer. Application of biomarkers of immunotoxicity in epidemiology studies and human clinical trials can improve our understanding of the mechanisms that underlie the associations between environmental exposures and development of these immune-mediated diseases. Immunological biomarkers currently used in environmental health studies include detection of key components of innate and adaptive immunity (e.g., complement, immunoglobulin and cell subsets) as well as functional responses and activation of key immune cells. The use of high-throughput assays, including flow cytometry, Luminex, and Multi-spot cytokine detection methods can further provide quantitative analysis of immune effects. Due to the complexity and redundancy of the immune response, an integrated assessment of several components of the immune responses is needed. The rapidly expanding field of immunoinformatics will also aid in the synthesis of the vast amount of data being generated. This review discusses and provides examples of how the identification and development of immunological biomarkers for use in studies of environmental exposures and immune-mediated disorders can be achieved.

[Results of study concerning possible influence of rocket space activities on public health]

Using special medical examination results and specified criteria of objective evaluation, the authors summarized results of studies concerning health state of population dwelling in area possibly influenced by rocket space activities factors.

Health risk assessment of electromagnetic fields: a conflict between the precautionary principle and environmental medicine methodology

The purpose of the precautionary principle is that legal requirements are to be made to safeguard against the possible health risks that have not yet been scientifically established. That a risk is not established cannot, therefore, be used as an excuse for not applying the principle. Yet, that rationale is exactly what is happening in the case of the possible health risks from exposure to electromagnetic fields (EMF). The scientists, representing both the World Health Organization and the European Commission, do not have at all the precautionary principle in mind when they report on health risks. Their starting point is instead to determine whether new research findings have been scientifically established and thus cannot be the basis for an amendment to the existing exposure limits. Uncertain indications of risk are ignored or played down. This approach is in conflict with European Union (EU) law, which requires that the degree of scientific uncertainty should be presented correctly. A thorough examination of the state of research shows many serious indications of possible health risks from exposure very far below existing limits for EMF. Case law, for other types of exposure, also shows that the precautionary principle can be applied on the basis of weaker evidence than that. Our investigation shows that the precautionary principle is not being used for its intended purpose in relation to exposure to EMF. The reason for this position is that decision-makers are being misled by inaccurate risk assessments.

Weight-of-evidence evaluation in environmental assessment: review of qualitative and quantitative approaches

Assessments of human health and ecological risk draw upon multiple types and sources of information, requiring the integration of multiple lines of evidence before conclusions may be reached. Risk assessors often make use of weight-of-evidence (WOE) approaches to perform the integration, whether integrating evidence concerning potential carcinogenicity, toxicity, and exposure from chemicals at a contaminated site, or evaluating processes concerned with habitat loss or modification when managing a natural resource. Historically, assessors have relied upon qualitative WOE approaches, such as professional judgment, or limited quantitative methods, such as direct scoring, to develop conclusions from multiple lines of evidence. Current practice often lacks transparency resulting in risk estimates lacking quantified uncertainty. This paper reviews recent applications of weight of evidence used in human health and ecological risk assessment. Applications are sorted based on whether the approach relies on qualitative and quantitative methods in order to reveal trends in the use of the term weight of evidence, especially as a means to facilitate structured and transparent development of risk conclusions from multiple lines of evidence.

Emission characteristics of polycyclic aromatic hydrocarbons from combustion of different residential coals in North China

Emission properties of polycyclic aromatic hydrocarbons (PAHs) from combustion of six residential coals in North China were investigated. The results indicated that, the total emission factors (EFs) for 15 PAH species in gaseous and particulate phases ranged from 52.8 to 1434.8 mg/kg with a decreasing sequence of local bituminous coals and anthracite coals, and honeycomb briquettes were largely dependent on the raw coals used to produce them. Particulate phase, dominated by median or high molecular weight components, made a major contribution (68.8%-76.5%) to the total EFs for bituminous coals, while gaseous phase with principal low molecular weight species accounted for most (86.3%-97.9%) of the total EFs for anthracite coals. The phase partitioning of PAH emission for honeycomb briquettes was similarly dependent on the crude coals. The total EFs, phase partitioning and component profiles of emitted PAHs were mainly influenced by the inner components of the studied coals. Burning mode and flue number on household coal-stoves also affected the emission characteristics by means of the oxygen supply. A sum of seven carcinogenic PAHs, benzo(a)pyrene(BaP)-equivalent carcinogenic power and total toxicity potency expressed in 2,3,7,8-tetrachlorodibenzo-dioxin(TCDD) toxic equivalence exhibited that bituminous coals and produced honeycomb briquettes had remarkably elevated values. Fluoranthene, benzo(b)fluoranthene, benzo(k)fluoranthene, chrysene and indeno(1,2,3-cd)pyrene from anthracite coals showed higher levels of BaP-based toxic equivalent factor, though the other toxicity indices were rather low for this type of coal.

A critical appraisal of 2007 American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines for Interventional Pain Management: an independent review utilizing AGREE, AMA, IOM, and other criteria

BACKGROUND

Today, with the growing interest of the medical community and others in practice guidelines, there is greater emphasis on formal procedures and methods for arriving at a widely scrutinized and endorsed consensus than ever before. Conflicts in terminology and technique are notable for the confusion that guidelines create and for what they reflect about differences in values, experiences, and interests among different parties. While public and private development activities continue to multiply, the means for coordinating these efforts to resolve inconsistencies, fill in gaps, track applications and results, and assess the soundness of particular guidelines continue to be limited. In this era of widespread guideline development by private organizations, the American College of Occupational and Environment Medicine (ACOEM) has developed guidelines that evaluate areas of clinical practice well beyond the scope of occupational medicine and yet fail to properly involve physicians expert in these, especially those in the field of interventional pain management. As the field of guidelines suffers from imperfect and incomplete scientific knowledge as well as imperfect and uneven means of applying that knowledge without a single or correct way to develop guidelines, ACOEM guidelines have been alleged to hinder patient care, reduce access to interventional pain management procedures, and transfer patients into a system of disability, Medicare, and Medicaid.

OBJECTIVE

To critically appraise occupational medicine practice guidelines for interventional pain management by an independent review utilizing the Appraisal of Guidelines for Research and Evaluation (AGREE), American Medical Association (AMA), Institute of Medicine (IOM), and other commonly utilized criteria.

METHODS

Revised chapters of ACOEM guidelines, low back pain and chronic pain, developed in 2007 and 2008 are evaluated, utilizing AGREE, AMA, IOM instruments, and Shaneyfelt et al's criteria, were independently reviewed by 4 appraisers.

RESULTS

Critical appraisal utilizing the AGREE instrument found that both chapters scored less than 10% in 3 of the 6 domains, less than 20% in one domain, over 30% in one domain, and over 70% in one domain. Global assessment also scored below 30% with a recommendation from AGREE, "not recommended or suitable for use in practice." Based on AMA key attributes, both chapters of ACOEM guidelines met only one of the 6 key attributes, only 3 of the 8 attributes were met by IOM criteria, and based on the criteria described by Shaneyfelt et al, overall only 28% of criteria were met.

CONCLUSION

Both the low back pain and chronic pain chapters of the ACOEM guidelines may not be ideal for clinical use based on the assessment by the AGREE instrument, AMA attributes, and criteria established by Shaneyfelt et al. They also scored low on IOM criteria (37.5%). These guidelines may not be applicable for clinical use.

Diagnostic relevance of the determination of lymphocyte subpopulations in environmental medicine

Earlier hopes that determination of lymphocyte subpopulations might become a strong diagnostic tool in environmental medicine have not been fulfilled in recent years. Analysis of the scientific literature rather shows that there are only few examples for environmental exposures causing reproducible shifts of lymphocyte subpopulations. Moreover, current knowledge suggests that "environmental diseases" are not associated with characteristic changes of subpopulation patterns. If lymphocyte subpopulations are analyzed, each diagnostic step, including indication, sample handling, analytic procedure and data-interpretation, should adhere to good quality criteria. Taking all together, the determination of lymphocyte subpopulations in the context of environmental medicine comes under category IV of the criteria of the Commission for Methods and Quality Assurance in Environmental Medicine of the German federal health authority (Robert Koch-Institute; RKI): "A procedure cannot be recommended because there is not sufficient information to justify it" (here: no solid trends in epidemiological examinations), "and because theoretical considerations speak against an application" (here: high physiological variability and missing exposure or substance specificity).

[Introduction of proteomic approach to environmental medicine]

Recent progress in life science technology and the availability of much information on genes obtained by genome analysis has enabled us to analyze the changes of proteins on a large scale. Sets of proteins are called proteomes, and proteomics is the scientific field of proteome analysis including differential, post translational modification and interaction analyses. Various proteomic techniques, particularly two-dimensional gel electrophoresis (2-DE), mass spectrometry, protein chip methods, and surface plasmon resonance (SPR), are very useful for acquiring proteomes in cells, tissues and body fluid, and for analyzing interactions between a protein and other biofactors including proteins. A proteomic approach is also useful for determining biomarkers of diseases and key proteins involved in various stages of metabolism such as differentiation, cell cycle and apoptosis. Environmental pollutants including endocrine disruptors inhibit activities of various organs in wild animals and humans. Proteomic approaches could be very useful tools for elucidating the mechanisms of damage caused by environmental pollutants. In this review, we describe the application of a proteomic approach to the field of environmental medicine.

Neo-Lamarckian medicine

Darwinian medicine is the treatment of disease based on evolution. The underlying assumption of Darwinian medicine is that traits are coded by genes, which are often assumed to be sequences of DNA nucleotides. The quantitative genetic ramification of this perspective is that traits, including disease susceptibility, are either caused by genes or by the environment, with genotype-by-environment interactions usually considered statistical artefacts. I emphasize also examining those epigenetic signals that can be altered by environmental perturbations and then transmitted to subsequent generations. Although seldom studied, environmentally-alterable meiotically-heritable epigenetic signals exist and provide a mechanism underlying genotype-by-environment interactions. Environment of a parent can affect its descendants by heritably altering epigenetic signals. Neo-Lamarckian medicine is the application of these evolutionary epigenetic notions to diseases and could have enormous public health and environmental policy implications. If industrial contaminants adversely affect organisms by meiotically-heritably altering their epigenetic signals, then cleaning up these contaminants will not remedy the problem. Once contaminants have adversely altered an individual's epigenetic signals, this harm will be transmitted to future generations even if they are not exposed to the contaminant. Exposure to environmental shocks such as free radicals or other carcinogens can alter cytosine methylation patterns on regulatory genes. This can cause cancer by up-regulating genes for cell division or by down-regulating tumour suppressor genes. Environmentally-alterable meiotically-heritable epigenetic signals could also underlie other diseases, such as diabetes, Prader-Willi syndrome, and many complex diseases. If environmentally-altered meiotically-heritable epigenetic effects are widespread - which is an important open empirical question - they have the potential to alter paradigmatic views of evolutionary medicine and the putative dichotomy of nature versus nurture. Neo-Lamarckian medicine would thereby shift emphasis from cure to prevention of diseases.

Risk communication and the Precautionary Principle

The perception of risks for environment and health deriving from globalization processes and an uncontrolled use of modern technologies is growing everywhere. The greater the capacity of controlling living conditions, the larger is the possibility of misusing this power. In environmental and occupational health research we tend to reduce the complexity of the observed phenomena in order to facilitate conclusions. In social and political sciences complexity is an essential element of the context, which needs to be continuously considered. The Precautionary Principle is a tool for facing complexity and uncertainty in health risk management. This paper is aimed at demonstrating that this is not only a problem of technical risk assessment. Great attention should also be paid to improve risk communication. Communication between the stakeholders (experts, decision makers, political and social leaders, media, groups of interest and people involved) is possibly the best condition to be successful in health risk management. Nevertheless, this process usually runs up against severe obstacles. These are not only caused by existing conflicts of interest. Differences in values, languages, perceptions, resources to have access to information, and to express one's own point of view are other key aspects.

[Efficiency of sanitary measures in oil-producing areas]

The paper presents the results of an analysis of the efficiency of sanitary and environment-protective measures relating the ambient atmosphere in the oil-producing areas of the Republic of Tatarstan. It characterizes the environment-protective activity of the PJSC "Tatneft", gives a sanitary evaluation of the quality of the ambient air in the oil-producing areas. It has been ascertained that the improvement of manufacturing technology and the construction of gas and dust catching units on the oil-producing facilities reduce atmospheric pollutant emissions. The levels of hydrocarbons, nitric oxide, and hydrogen sulfide have been substantially decreased. At present, the influence of oil-producing facilities on the quality of the ambient air is 17-19%; the main source of atmospheric pollution is motor transport (its influence on atmospheric pollution is 40-56%). At present versus 1989-1995, the degree of pollution and the mutagenic potential of the ambient air are reduced, which suggests the efficiency of sanitary and environment-protective measures implemented by the PJSC "Tatneft".

[Methodology in occupational and environmental epidemiology]

The close links between environment and health have long been known. The methodological bases for this study were especially developed in the occupational settings, and notably so in the study of occupational carcinogens. Many pollutants recently spread from the confined work places to the general environment (e.g., lead, benzene, PAHs, asbestos, noise) either as effluents of industrial sites or as exhausts of diverse environmental combustion sources (e.g., traffic, heating). The methodologies developed in the occupational settings proved extremely useful in addressing these new environmental problems. Main experiences in Italy include the study of a large residential population exposed to dioxin; the study of benzene and PHA's exposure in the city environment; the effect of point industrial pollution sources on the surrounding territory; the short and long term effect on respiratory and cardiovascular health outcomes and functions after exposure to PM10 and 2.5 in large cities.

[Molecular biological approaches for environmental medicine]

A revolution in biology and medicine is taking place as a direct consequence of rapid developments in the field of molecular biology. The tremendous advances in our knowledge of basic molecular genetics and cell biology have opened the door for new methods of diagnosis, assessment of individual susceptibility to disease, and elucidation of the pathogenesis of disease. These advances will have a profound impact on the practice of occupational and environmental medicine. In this review, we intend to summarize the approaches we have applied in order to deal with the environmental problems we have faced.

[From industrial hygiene and toxicology to environmental hygiene and toxicology: problems and prospects]

BACKGROUND

Low-dose exposures to mixtures of substances have received increasing interest and they involve many different occupational and environmental situations. The presence in the population (working and general) of groups of susceptible individuals is an important public health issue that poses new challenges to science and society.

OBJECTIVES

To discuss the evolution from traditional occupational hygiene and toxicology to the new environmental (general and occupational) hygiene and toxicology.

RESULTS

Environmental hygiene and toxicology have remarkably improved analytical tools available to solve most of the analytical issues posed by the present exposure scenario. Biomarkers of low-dose exposure, early effects and individual susceptibility are being intensively investigated.

CONCLUSIONS

The challenge in this field for the coming years appears to be not the analytical but the medical and ethical implications.

Toxicology: past, present, and future

Toxicology is the study of poisons and poisoning and has an ancient and venerable history. Although there have been numerous notorious poisonings throughout the ages and rather astute descriptions of toxic agents, the scientific study of toxicology did not commence until the 19th century. There was rapid development of analytical methods in the late 19th century and then an acceleration of both method and scientific development in the latter half of the 20th century. Toxicology today can be subdivided into clinical toxicology, forensic toxicology, industrial or occupational toxicology, environmental toxicology, pharmaceutical toxicology, experimental toxicology, and workplace drug testing. The historical development of these overlapping areas of toxicology will be discussed, culminating in a prediction as to what the future may bring.