Per- and polyfluoroalkyl substances (PFAS) in United States tapwater: Comparison of underserved private-well and public-supply exposures and associated health implications

Drinking-water quality is a rising concern in the United States (US), emphasizing the need to broadly assess exposures and potential health effects at the point-of-use. Drinking-water exposures to per- and poly-fluoroalkyl substances (PFAS) are a national concern, however, there is limited information on PFAS in residential tapwater at the point-of-use, especially from private-wells. We conducted a national reconnaissance to compare human PFAS exposures in unregulated private-well and regulated public-supply tapwater. Tapwater from 716 locations (269 private-wells; 447 public supply) across the US was collected during 2016-2021 including three locations where temporal sampling was conducted. Concentrations of PFAS were assessed by three laboratories and compared with land-use and potential-source metrics to explore drivers of contamination. The number of individual PFAS observed ranged from 1 to 9 (median: 2) with corresponding cumulative concentrations (sum of detected PFAS) ranging from 0.348 to 346 ng/L. Seventeen PFAS were observed at least once with PFBS, PFHxS and PFOA observed most frequently in approximately 15% of the samples. Across the US, PFAS profiles and estimated median cumulative concentrations were similar among private wells and public-supply tapwater. We estimate that at least one PFAS could be detected in about 45% of US drinking-water samples. These detection probabilities varied spatially with limited temporal variation in concentrations/numbers of PFAS detected. Benchmark screening approaches indicated potential human exposure risk was dominated by PFOA and PFOS, when detected. Potential source and land-use information was related to cumulative PFAS concentrations, and the number of PFAS detected; however, corresponding relations with specific PFAS were limited likely due to low detection frequencies and higher detection limits. Information generated supports the need for further assessments of cumulative health risks of PFAS as a class and in combination with other co-occurring contaminants, particularly in unmonitored private-wells where information is limited or not available.

Antibiotic residues of drinking-water and its human exposure risk assessment in rural Eastern China

Trace levels of antibiotics were frequently found in drinking-water, leading a growing concern that drinking-water is an important exposure source to antibiotics in humans. In this study, we investigated antibiotics in tap water and well water in two rural residential areas in Eastern China to assess the related human health exposure risks in drinking-water. Twenty-seven antibiotics were analyzed using ultra performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UPLC-MS/MS). The average daily dose (ADD) and the health risk quotient (HRQ) for exposure to antibiotics in humans were evaluated using 10000 times of Monte Carlo simulations. Ten antibiotics were detected in drinking-water samples, with the maximum concentrations of antibiotic mixture of 8.29 ng/L in tap water and 2.95 ng/L in well water, respectively. Macrolides and sulfonamides were the predominant contaminants and showed the seasonality. Azithromycin had the highest detection frequencies (79.71-100%), followed by roxithromycin (25.71-100%) and erythromycin (21.43-86.96%). The estimated ADD and HRQ for human exposure to antibiotic mixture through drinking-water was less than 0.01 μg/kg/day and 0.01, respectively, which varied over sites, water types, seasons and sex. Ingestion route was more important than dermal contact route (10-6 to 10-4 μg/kg/day magnitude vs. 10-11 to 10-8 μg/kg/day magnitude). Macrolides also contributed mainly to health exposure risks to antibiotics through drinking-water, whose HRQ accounted for 46% to 67% of the total HRQs. Although the individual antibiotic and their combined effects contributed to acceptable health risks for human, the long-term exposure patterns to low-dose antibiotics in drinking-water should not be ignored.

Dietary and drinking water intake of essential trace elements in a typical Kashin-Beck disease endemic area of Tibet, China

BACKGROUND

Essential trace elements (ETEs), such as copper (Cu), iron (Fe), manganese (Mn), molybdenum (Mo), selenium (Se), zinc (Zn), are very important elements for human health.

METHODS

In this study, 89 drinking water samples and 85 highland barleys were collected from 48 villages in 11 townships, and the average daily dose (ADD) of ETEs were calculated, in addition, health effects of ETEs to rural residents in Luolong County, a typical Kashin-Beck disease (KBD) endemic area in Tibet, were assessed.

RESULTS

The mean concentrations of Cu, Fe, Mn, Mo, Se, Zn in drinking water were 0.278 ± 0.264 μg·kg^-1, 0.766 ± 0.312 μg·kg^-1, 0.411 ± 0.526 μg·kg^-1, 0.119 ± 0.223 μg·kg^-1, 0.155 ± 0.180 μg·kg^-1, and 0.804 ± 1.112 μg·kg^-1, respectively; and mean concentrations of Cu, Fe, Mn, Mo, Se and Zn in highland barley were 3.550 ± 0.680 mg·kg^-1, 81.17 ± 38.14 mg·kg^-1, 14.03 ± 1.42 mg·kg^-1, 0.350 ± 0.200 mg·kg^-1, 0.0028 ± 0.0056 mg·kg^-1, and 23.58 ± 3.10 mg·kg^-1, respectively. The ADD of Cu in the study area was appropriate; the ADD of Fe and Mn in each township were higher than the maximum oral reference dose recommended by the National Health Commission of China, indicating that Fe and Mn had non-carcinogenic health risks; the ADD of Mo and Zn in 36.36% and 54.55% of the townships exceeded the maximum oral reference dose; and 72.73% of the townships had insufficient ADD of Se. The ADD of Mo, Cu and Se in different townships was significantly correlated with the prevalence of KBD.

CONCLUSIONS

Therefore, in order to prevent and control the prevalence of KBD and ensure the health of local residents, it is necessary to reduce the intake of high concentrations of Fe, Mn and Zn in diet, as well as increase the intake of Mo, Cu, especially Se.

The link between microcystin levels in groundwater and surface Nile water, and assessing their potential risk to human health

Although groundwater is an important source for drinking and irrigation water worldwide, particularly in arid countries, they have been paid little attention to their contamination with microcystins (MCs) compared to surface water. Our study is the fourth one reporting existence of MCs in groundwater due to surface-water and groundwater interaction. Dissolved MCs in groundwater were found with higher concentrations in summer (0.1 to 0.84 μg L^-1) than in winter (0-0.06 μg L^-1), in association with MCs detected in nearby surface Nile water. The chronic daily intake (CDI) of MCs for both adults and children (0-0.003 μg kg^-1 body weight d^-1) in groundwater were lower than the chronic reference dose (RfD, 0.003 μg kg^-1 body weight d^-1) during winter, with hazard quotient less than 1. Conversely, CDI values exceeded the reference dose during summer for both adults (0.005-0.024 μg kg^-1 body weight d^-1) and children (0.012-0.05 μg kg^-1 body weight d^-1), with hazard quotient greater than 1. This indicates that MCs concentrations in these groundwater wells might pose adverse health effects to both adults and children during summer, but not during winter. The study provides evidence for the risk of cyanotoxins in groundwater close to cyanobacteria-contaminated surface water. Therefore, regular monitoring for cyanotoxins in groundwater supplies used for drinking-water should be undertaken when cyanobacteria bloom events are noted in nearby surface waters.

Capacity building and training approaches for water safety plans: A comprehensive literature review

The World Health Organization has recommended Water Safety Plans (WSPs), a holistic risk assessment and risk management approach, for drinking-water suppliers across low-, middle- and high-income countries, since publishing its 2004 Guidelines for Drinking-Water Quality. While rapid WSP adoption has occurred, capacity is still catching up to implementation needs. Many countries and regions lack case examples, legal requirements, and training resources for WSPs, corresponding to widespread capacity shortfall in the water supply sector. We undertook a comprehensive review of the literature on capacity building and training for WSPs, with the goal of providing recommendations for multiple stakeholder groups at the scales of individual utilities, national governments, and intermediate units of governance. We propose a WSP training taxonomy and discuss it in relation to the stages of learning (introduction, practice, and reinforcement); describe the importance of customizing training to the target group, local language and circumstances; highlight the relevance of auditing for evaluating change over time; and call for robust methods to monitor WSP capacity development.

Temporal Variability of Faecal Contamination from On-Site Sanitation Systems in the Groundwater of Northern Thailand

We investigated the impacts of on-site sanitation systems to local groundwater. In this year-long study, we monitored the response of faecal contamination levels to hydroclimatological factors including rainfall and groundwater table. Concentration of faecal indicators-E. coli (ESC), Enterococcus (ENT), nitrate-in thirteen pairs of shallow and deep wells were determined every 7-14 days. All samples from shallow wells were tested positive for faecal contamination (ESC and ENT > 1 MPN/100 mL) but concentration varies. A maximum of 24,000 MPN/100 mL were recorded in some shallow wells. Water from deep wells showed lower susceptibility to contamination with only 4 and 23% of samples tested positive for ESC and ENT, respectively. Concentrations of ESC and ENT were lower too, with a maximum of 5 MPN/100 mL and 28 MPN/100 mL, respectively. Fluctuation in contamination among the wells was described by four archetypal responses to hydroclimatological forcing: (i) flushing during the onset of wet season, (ii) dilution over the course of the wet season, (iii) concentration during the dry season, and (iv) synoptic response to storms. Previous studies attempting to link the prevalence of faecal/waterborne diseases and temporal factors (e.g., dry vs wet season) have produced differing outcomes. Our study may help explain the relevant hydrological mechanisms leading to these varying observations. Presently, most communities in Thailand have access to 'improved' sanitation systems. However, due to the unsustainable implementation of these systems, the otherwise viable drinking-water resources in the form of the abundant local groundwater has become a genuine health hazard.

Livestock ownership and microbial contamination of drinking-water: Evidence from nationally representative household surveys in Ghana, Nepal and Bangladesh

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Owning livestock can increase the risk of drinking-water contamination.

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Large livestock were associated with water contamination in Ghana and Bangladesh.

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Poultry were associated with drinking-water contamination in Bangladesh.

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Livestock were not significantly correlated with water contamination in Nepal.

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Livestock excreta should be considered for the prevention of water contamination.

Background

Current priorities for diarrhoeal disease prevention include use of sanitation and safe water. There have been few attempts to quantify the importance of animal faeces in drinking-water contamination, despite the presence of potentially water-borne zoonotic pathogens in animal faeces.

Objectives

This study aimed to quantify the relationship between livestock ownership and point-of-consumption drinking-water contamination.

Methods

Data from nationally representative household surveys in Nepal, Bangladesh, and Ghana, each with associated water quality assessments, were used. Multinomial regression adjusting for confounders was applied to assess the relationship between livestock ownership and the level of drinking-water contamination with E. coli.

Results

Ownership of five or more large livestock (e.g. cattle) was significantly associated with drinking-water contamination in Ghana (RRR = 7.9, 95% CI = 1.6 to 38.9 for medium levels of contamination with 1–31cfu/100 ml; RRR = 5.2, 95% CI = 1.1–24.5 for high levels of contamination with >31cfu/100 ml) and Bangladesh (RRR = 2.4, 95% CI = 1.3–4.5 for medium levels of contamination; non-significant for high levels of contamination). Ownership of eight or more poultry (chickens, guinea fowl, ducks or turkeys) was associated with drinking-water contamination in Bangladesh (RRR = 1.5, 95% CI = 1.1–2.0 for medium levels of contamination, non-significant for high levels of contamination).

Conclusions

These results suggest that livestock ownership is a significant risk factor for the contamination of drinking-water at the point of consumption. This indicates that addressing human sanitation without consideration of faecal contamination from livestock sources will not be sufficient to prevent drinking-water contamination.

Exposure of children to metals via tap water ingestion at home: Contamination and exposure data from a nationwide survey in France

29 inorganic compounds (Al, As, B, Ba, Be, Bi, Ca, Cd, Ce, Co, Cr, Cu, Fe, Gd, K, Mg, Mn, Mo, Na, Nd, Ni, Pb, Sb, Se, Sr, Tl, U, V and Zn) were measured in the tap water of 484 representative homes of children aged 6months to 6years in metropolitan France in 2008-2009. Parents were asked whether their children consumed tap water. Sampling design and sampling weights were taken into account to estimate element concentrations in tap water supplied to the 3,581,991 homes of 4,923,058 children aged 6months to 6years. Median and 95th percentiles of concentrations in tap water were in μg/L: Al: <10, 48.3, As: 0.2, 2.1; B: <100, 100; Ba: 30.7, 149.4; Ca: 85,000, 121,700; Cd: <0.5, <0.5; Ce: <0.5, <0.5; Co: <0.5, 0.8; Cr: <5, <5; Cu: 70, 720; K: 2210, 6740; Fe: <20, 46; Mn: <5, <5; Mo: <0.5, 1.5; Na: 14,500, 66,800; Ni: <2, 10.2; Mg: 6500, 21,200; Pb: <1, 5.4; Sb: <0.5, <0.5; Se: <1, 6.7; Sr: 256.9, 1004; Tl: <0.5, <0.5; U: <0.5, 2.4; V: <1, 1; Zn: 53, 208. Of the 2,977,123 young children drinking tap water in France, some were drinking water having concentrations above the 2011 World Health Organization drinking-water quality guidelines: respectively 498 (CI 95%: 0-1484) over 700μg/L of Ba; 121,581 (CI 95%: 7091-236,070) over 50mg/L of Na; 2044 (CI 95%: 0-6132) over 70μg/L of Ni, and 78,466 (17,171-139,761) over 10μg/L of Pb. Since it is representative, this tap water contamination data can be used for integrated exposure assessment, in conjunction with diet and environmental (dust and soil) exposure data.

Prevalence of Cryptosporidium and Giardia in the water resources of the Kuang River catchment, Northern Thailand

A catchment-scale investigation of the prevalence of Cryptosporidium and Giardia in the Kuang River Basin was carried out during the dry and rainy seasons. Water samples were collected from the Kuang River and its tributaries as well as a major irrigation canal at the study site. We also investigated the prevalence of gastrointestinal parasitic infection among dairy and beef cattle hosts. Cryptosporidium and/or Giardia were detected in all the rivers considered for this study, reflecting their ubiquity within the Kuang River Basin. The high prevalence of Cryptosporidium/Giardia in the upper Kuang River and Lai River is of a particular concern as both drain into the Mae Kuang Reservoir, a vital source of drinking-water to many local towns and villages at the research area. We did not, however, detected neither Cryptosporidium nor Giardia were in the irrigation canal. The frequency of Cryptosporidium/Giardia detection nearly doubled during the rainy season compared to the dry season, highlighting the importance of water as an agent of transport. In addition to the overland transport of these protozoa from their land sources (e.g. cattle manure, cess pits), Cryptosporidium/Giardia may also be re-suspended from the streambeds (a potentially important repository) into the water column of rivers during storm events. Faecal samples from dairy and beef cattle showed high infection rates from various intestinal parasites - 97% and 94%, respectively. However, Cryptosporidium and Giardia were only detected in beef cattle. The difference in management style between beef (freeranging) and dairy cattle (confined) may account for this disparity. Finally, phylogenetic analyses revealed that the Cryptosporidium/Giardia-positive samples contained C. ryanae (non-zoonotic) as well as Giardia intestinalis assemblages B (zoonotic) and E (non-zoonotic). With only basic water treatment facilities afforded to them, the communities of the rural area relying on these water supplies are highly at risk to Cryptosporidium/Giardia infections.

Relationship between antibiotic- and disinfectant-resistance profiles in bacteria harvested from tap water

Chlorination is commonly used to control levels of bacteria in drinking water; however, viable bacteria may remain due to chlorine resistance. What is concerning is that surviving bacteria, due to co-selection factors, may also have increased resistance to common antibiotics. This would pose a public health risk as it could link resistant bacteria in the natural environment to human population. Here, we investigated the relationship between chlorine- and antibiotic-resistances by harvesting 148 surviving bacteria from chlorinated drinking-water systems and compared their susceptibilities against chlorine disinfectants and antibiotics. Twenty-two genera were isolated, including members of Paenibacillus, Burkholderia, Escherichia, Sphingomonas and Dermacoccus species. Weak (but significant) correlations were found between chlorine-tolerance and minimum inhibitory concentrations against the antibiotics tetracycline, sulfamethoxazole and amoxicillin, but not against ciprofloxacin; this suggest that chlorine-tolerant bacteria are more likely to also be antibiotic resistant. Further, antibiotic-resistant bacteria survived longer than antibiotic-sensitive organisms when exposed to free chlorine in a contact-time assay; however, there were little differences in susceptibility when exposed to monochloramine. Irrespective of antibiotic-resistance, spore-forming bacteria had higher tolerance against disinfection compounds. The presence of chlorine-resistant bacteria surviving in drinking-water systems may carry additional risk of antibiotic resistance.

Fluoride: A naturally-occurring health hazard in drinking-water resources of Northern Thailand

In Northern Thailand, incidences of fluorosis resulting from the consumption of high-fluoride drinking-water have been documented. In this study, we mapped the high-fluoride endemic areas and described the relevant transport processes of fluoride in enriched waters in the provinces of Chiang Mai and Lamphun. Over one thousand surface and sub-surface water samples including a total of 995 collected from shallow (depth: ≤ 30 m) and deep (> 30 m) wells were analysed from two unconnected high-fluoride endemic areas. At the Chiang Mai site, 31% of the shallow wells contained hazardous levels (≥ 1.5 mg/L) of fluoride, compared with the 18% observed in the deep wells. However, at the Lamphun site, more deep wells (35%) contained water with at least 1.5mg/L fluoride compared with the shallow wells (7%). At the Chiang Mai site, the high-fluoride waters originate from a nearby geothermal field. Fluoride-rich geothermal waters are distributed across the area following natural hydrological pathways of surface and sub-surface water flow. At the Lamphun site, a well-defined, curvilinear high-fluoride anomalous zone, resembling that of the nearby conspicuous Mae Tha Fault, was identified. This similarity provides evidence of the existence of an unmapped, blind fault as well as its likely association to a geogenic source (biotite-granite) of fluoride related to the faulted zone. Excessive abstraction of ground water resources may also have affected the distribution and concentration of fluoride at both sites. The distribution of these high-fluoride waters is influenced by a myriad of complex natural and anthropogenic processes which thus created a challenge for the management of water resources for safe consumption in affected areas. The notion of clean and safe drinking water can be found in deeper aquifers is not necessarily true. Groundwater at any depth should always be tested before the construction of wells.

Occurrence and variability of iodinated trihalomethanes concentrations within two drinking-water distribution networks

Non-iodo-containing trihalomethanes (TTHM) are frequently detected in chlorinated tap water and currently regulated against their carcinogenic potential. Iodinated THM (ITHM) may also form in disinfected with chlorine waters that are high in iodine content, but little is known about their magnitude and variability within the drinking-water pipe distribution network of urban areas. The main objective of this study was to determine the magnitude and variability of ITHM and TTHM levels and their corresponding daily intake estimates within the drinking water distribution systems of Limassol and Nicosia cities of Cyprus, using tap samples collected from individual households (n=37). In Limassol, mean household tap water ITHM and TTHM levels was 0.58 and 38 μg L(-1), respectively. Dichloroiodomethane (DCIM) was the dominant species of the two measured ITHM compounds accounting for 77% of total ITHM and in the range of 0.032 and 1.65 μg L(-1). The range of DCIM concentrations in Nicosia tap water samples was narrower (0.032 - 0.848 μg L(-1)). Mean total iodine concentration in tap water samples from the seaside city of Limassol was 15 μg L(-1) and approximately twice to those observed in samples from the mainland Nicosia city. However, iodine concentrations did not correlate with the ITHM levels. The calculated chronic daily intake rates of ITHM were low when compared with those of TTHM, but because of their widespread occurrence in tap water and their enhanced mammalian cell toxicity, additional research is warranted to assess the magnitude and variability of human ITHM exposures.

Current approaches to cyanotoxin risk assessment and risk management around the globe

Toxic cyanobacteria became more widely recognized as a potential health hazard in the 1990s, and in 1998 the World Health Organization (WHO) first published a provisional Guideline Value of 1 μg L-1 for microcystin-LR in drinking-water. In this publication we compare risk assessment and risk management of toxic cyanobacteria in 17 countries across all five continents. We focus on the three main (oral) exposure vehicles to cyanotoxins: drinking-water, water related recreational and freshwater seafood. Most countries have implemented the provisional WHO Guideline Value, some as legally binding standard, to ensure the distribution of safe drinking-water with respect to microcystins. Regulation, however, also needs to address the possible presence of a wide range of other cyanotoxins and bioactive compounds, for which no guideline values can be derived due to insufficient toxicological data. The presence of microcystins (commonly expressed as microcystin-LR equivalents) may be used as proxy for overall guidance on risk management, but this simplification may miss certain risks, for instance from dissolved fractions of cylindrospermopsin and cyanobacterial neurotoxins. An alternative approach, often taken for risk assessment and management in recreational waters, is to regulate cyanobacterial presence - as cell numbers or biomass - rather than individual toxins. Here, many countries have implemented a two or three tier alert level system with incremental severity. These systems define the levels where responses are switched from Surveillance to Alert and finally to Action Mode and they specify the short-term actions that follow. Surface bloom formation is commonly judged to be a significant risk because of the elevated concentration of microcystins in a scum. Countries have based their derivations of legally binding standards, guideline values, maximally allowed concentrations (or limits named otherwise) on very similar scientific methodology, but underlying assumptions such as bloom duration, average body size and the amount of water consumed while swimming vary according to local circumstances. Furthermore, for toxins with incomplete toxicological data elements of expert judgment become more relevant and this also leads to a larger degree of variation between countries' thresholds triggering certain actions. Cyanobacterial blooms and their cyanotoxin content are a highly variable phenomenon, largely depending on local conditions, and likely concentrations can be assessed and managed best if the specific conditions of the locality are known and their impact on bloom occurrence are understood. Risk Management Frameworks, such as for example the Water Safety Plan concept of the WHO and the 'bathing water profile' of the European Union are suggested to be effective approaches for preventing human exposure by managing toxic cyanobacteria from catchment to consumer for drinking water and at recreational sites.

Uranium in drinking-water: a unique case of guideline value increases and discrepancies between chemical and radiochemical guidelines

BACKGROUND

Uranium represents a unique case for an element naturally present in the environment, as its chemical guideline value in drinking water significantly increased from 2 μg/L in 1998 up to 15 μg/L in 2004 and then to 30 μg/L in 2011, to date corresponding to a multiplication factor of 15 within a period of just 13 years.

OBJECTIVES

In this commentary we summarize the evolution of uranium guideline values in drinking-water based on both radiological and chemical aspects, emphasizing the benefit of human studies and their contribution to recent recommendations. We also propose a simpler and better consistency between radiological and chemical values.

DISCUSSION

The current chemical guideline value of 30 μg/L is still designated as provisional because of scientific uncertainties regarding uranium toxicity. During the same period, the radiological guideline for (238)U increased from 4 Bq/L to 10 Bq/L while that for (234)U decreased from 4 Bq/L to 1 Bq/L. These discrepancies are discussed here, and a value of 1 Bq/L for all uranium isotopes is proposed to be more consistent with the current chemical value of 30 μg/L.

CONCLUSION

Continuous progress in the domains of toxicology and speciation should enable a better interpretation of the biological effects of uranium in correlation with epidemiological human studies. This will certainly aid future proposals for uranium guideline values.

Trihalomethanes in public drinking water and stillbirth and low birth weight rates: an intervention study

During 2003-2004, United Utilities water company in North West England introduced enhanced coagulation (EC) to four treatment works to mitigate disinfection by-product (DBP) formation. This enabled examination of the relation between DBPs and birth outcomes whilst reducing socioeconomic confounding. We compared stillbirth, and low and very low birth weight rates three years before (2000-2002) with three years after (2005-2007) the intervention, and in relation to categories of THM change. We created exposure metrics for EC and trihalomethane (THM) concentration change (n=258 water zones). We linked 429,599 live births and 2279 stillbirths from national birth registers to the water zone at birth. We used Poisson regression to model the differences in birth outcome rates with an interaction between before/after the intervention and EC or THM change. EC treatment reduced chloroform concentrations more than non-treatment (mean -29.7 µg/l vs. -14.5 µg/l), but not brominated THM concentrations. Only 6% of EC water zones received 100% EC water, creating exposure misclassification concerns. EC intervention was not associated with a statistically significant reduction in birth outcome rates. Areas with the highest chloroform decrease (30 - 65 μg/l) had the greatest percentage decrease in low -9 % (-12, -5) and very low birth weight -16% (-24, -8) rates. The interaction between before/after intervention and chloroform change was statistically significant only for very low birth weight, p=0.02. There were no significant decreases in stillbirth rates. In a novel approach for studying DBPs and adverse reproductive outcomes, the EC intervention to reduce DBPs did not affect birth outcome rates. However, a measured large decrease in chloroform concentrations was associated with statistically significant reductions in very low birth weight rates.

Impact of removing iodised salt on children's goitre status in areas with excessive iodine in drinking-water

The impact of removing iodised salt on children's goitre status in a high-iodine area (HIA) remains unclear. The aim of the present study was to explore the changes in the prevalence of goitre in children after removing iodised salt from their diet. For this purpose, three towns with the median water iodine content of 150-300 μg/l were selected randomly in Hengshui City, Hebei Province, China. A total of 452 and 459 children were randomly selected from the three towns in order to measure thyroid volume by ultrasound before and after removing iodised salt, respectively. Their goitre status was judged using the criteria of age-specific thyroid volume recommended by the WHO. After removing iodised salt, the overall median urinary iodine content (MUIC) of children decreased from 518 (interquartile range (IQR) 347-735) to 416 (IQR 274-609) μg/l. The MUIC of children across sex and age group decreased significantly except for the age group of 9 years. The overall prevalence of goitre in the three towns significantly decreased from 24·56% (n 111/452) to 5·88% (n 27/459) (P< 0·001). Goitre prevalence in children aged 8-10 years decreased from 33·70% (n 31/92), 23·32% (n 45/193) and 20·96% (n 35/167) to 6·10% (n 10/164), 5·52% (n 9/163) and 6·06% (n 8/132), respectively. Goitre prevalence in boys and girls decreased from 27·05% (n 66/244) and 21·63% (n 45/208) to 6·66% (n 15/226) and 5·15% (n 12/233), respectively. The decreases in the prevalence of goitre in children across sex and age group were all statistically significant. The present study revealed that goitre prevalence in children decreased significantly after removing iodised salt from their diet for about 1·5 years in the HIA in Hebei Province.

Dopamine-β-Hydroxylase Activity and Levels of Its Cofactors and Other Biochemical Parameters in the Serum of Arsenicosis Patients of Bangladesh

Dopamine-β-hydroxylase (DBH) is a neurotransmitter (catecholamine)-mediating enzyme, which catalyzes the formation of norepinephrine from dopamine. The levels of DBH activity, its coenzyme (ascorbic acid) and cofactor (Cu(++)) and other biochemical parameters were measured in the serum of 32 arsenicosis patients of Bangladesh at three different age groups, namely, group 1 (10-18 years, 9 patients), group 2 (19-40 years, 14 patients) and group 3 (41-70 years, 9 patients) of the locality of Stadium Para of Meherpur district of Bangladesh. The values were compared with the same number of age-matched normal healthy individuals of the respective group. DBH activity was markedly decreased in the patients of group 1 as compared to that of the normal healthy people. The activities of DBH were decreased to lesser extents for the other two age groups. The total protein contents in the serum of arsenicosis patients were also significantly low as compared to that in the age-matched control groups. The levels of ascorbic acid and copper were found to be decreased in the serum of arsenicosis patients. The serum glucose levels were elevated in arsenicosis patients, as compared to that of the respective healthy controls. Other parameters, such as zinc and vitamin A levels were also decreased in the serum of arsenicosis patients. It was evident from the results of drinking of the arsenic contaminated water of shallow tube wells that the levels of DBH activity decreased significantly as compared to the control healthy persons. The levels of proteins, ascorbic acid, copper, zinc and vitamin A were decreased in the serum of people drinking the arsenic contaminated tube wells water as compared to that in the control healthy people with the exception that the levels of glucose were elevated in the serum of these patients. The pathophysiological significance of the results could be correlated with the decreased in proteins and that in DBH activities as DBH deficiency is characterized by lack of sympathetic noradrenergic function.The general physiologic findings of autonomic function indicate that complete DBH deficiency include minimal or absent plasma norepinephrine and epinephrine.