Assessment of health risks of policies

The assessment of health risks of policies is an inevitable, although challenging prerequisite for the inclusion of health considerations in political decision making. The aim of our project was to develop a so far missing methodological guide for the assessment of the complex impact structure of policies. The guide was developed in a consensual way based on experiences gathered during the assessment of specific national policies selected by the partners of an EU project. Methodological considerations were discussed and summarized in workshops and pilot tested on the EU Health Strategy for finalization. The combined tool, which includes a textual guidance and a checklist, follows the top-down approach, that is, it guides the analysis of causal chains from the policy through related health determinants and risk factors to health outcomes. The tool discusses the most important practical issues of assessment by impact level. It emphasises the transparent identification and prioritisation of factors, the consideration of the feasibility of exposure and outcome assessmentwith special focus on quantification. The developed guide provides useful methodological instructions for the comprehensive assessment of health risks of policies that can be effectively used in the health impact assessment of policy proposals.

Non-alcoholic fatty liver disease in a pediatric patient with heterozygous familial hypobetalipoproteinemia due to a novel APOB variant: a case report and systematic literature review

BackgroundFamilial hypobetalipoproteinemia (FHBL) is an autosomal semi-dominant disorder usually caused by variants in the APOB gene that frequently interferes with protein length. Clinical manifestations include malabsorption, non-alcoholic fatty liver disease, low levels of lipid-soluble vitamins, and neurological, endocrine, and hematological dysfunction.MethodsGenomic DNA was isolated from the blood samples of the pediatric patient with hypocholesterolemia and his parents and brother. Next-generation sequencing (NGS) was performed, and an expanded dyslipidemia panel was employed for genetic analysis. In addition, a systematic review of the literature on FHBL heterozygous patients was performed.Case reportGenetic investigation revealed the presence of a heterozygous variant in the APOB (NM_000384.3) gene c.6624dup[=], which changes the open reading frame and leads to early termination of translation into the p.Leu2209IlefsTer5 protein (NP_000375.3). The identified variant was not previously reported. Familial segregation analysis confirmed the variant in the mother of the subject, who also has a low level of low-density lipoprotein and non-alcoholic fatty liver disease. We have introduced therapy that includes limiting fats in the diet and adding lipid-soluble vitamins E, A, K, and D and calcium carbonate. We reported 35 individuals with APOB gene variations linked to FHBL in the systematic review.ConclusionWe have identified a novel pathogenic variant in the APOB gene causing FHBL in pediatric patients with hypocholesterolemia and fatty liver disease. This case illustrates the importance of genetic testing for dyslipidemias in patients with significant decreases in plasma cholesterol as we can avoid damaging neurological and ophthalmological effects by sufficient vitamin supplementation and regular follow-ups

Population exposure to lead in drinking water in Slovenia

IZHODIŠČE: Različne okoljske raziskave so opozorile, da problematika povišanih koncentracij svinca v pitni vodi obstaja predvsem v starejših objektih, kjer so vgrajeni svinčeni deli omrežja ali drugi materiali, ki vsebujejo svinec. Poleg tega na migracije svinca v pitno vodo vplivajo tudi določene lastnosti pitne vode in stanje vode v ceveh. Otroci so še posebej podvrženi večjemu tveganju za izpostavljenost svincu v okolju, škodljivi učinki svinca pa se pri njih pokažejo že pri manjših koncentracijah v krvi. Namen tega dela je prispevati izhodišča za oblikovanje na dokazih temelječih ukrepov za zmanjševanje vsebnosti svinca v pitni vodi in s tem njegovega vpliva na zdravje ljudi v Sloveniji. METODE: Najprej sem izvedla presečni študiji, kjer sem z vprašalnikom ocenila stanje izbranih javnih vodovodnih omrežij in hišnih vodovodnih omrežij izbranih vrtcev in osnovnih šol. Z eksperimentalno metodo sem v laboratoriju določala koncentracije svinca v pitni vodi izbranih vrtcev in osnovnih šol. Odvzela sem vzorec 250 ml vode, voda je pred odvzemom v ceveh stala od 8 do 18 ur. Ugotavljala sem tudi migracije svinca iz novejših materialov za izgradnjo vodovodnega omrežja. Pri tem je bila uporabljena stara svinčena cev, ki je že bila vgrajena v objektu, in novi materiali (plastične, bakrene, pocinkane in jeklene cevi ter medeninasta pipa, kromirani kotni ventil in plastična gibljiva cev), ki še niso bili uporabljeni. Pri obeh preskušanjih je bila za določitev koncentracij svinca v vodi uporabljena metoda ICP-MS. Sledila je ekološka študija, kjer sem ocenila izpostavljenost svincu pri šestletnih otrocih na podlagi ocen izpostavljenosti preko zraka, vode, hrane in tal. Pri izračunu so bili upoštevani tudi dejavnike absorpcije, predviden je bil najslabši možni scenarij, za izračun sem uporabila model IEUBK. REZULTATI: Analiza vzorcev pitne vode izbranih vrtcev in osnovnih šol je pokazala, da so bile koncentracije svinca nad mejno vrednostjo 10 gl ugotovljene v 22 %, nekaj vzorcev je imelo koncentracije krepko čez mejno vrednostjo. Pozitivna odvisnost med starostjo ustanove in koncentracijo svinca v pitni vodi potrjuje domnevo, da je višja koncentracija svinca posledica starega hišnega vodovodnega omrežja. Migriranje svinca iz cevi se je pojavilo pri pocinkanih ceveh v vseh modelnih raztopinah. Izračun izpostavljenosti svincu za šestletnega otroka je pokazal, da obstaja tveganje za pojav škodljivih učinkov na zdravje. ZAKLJUČEK: Vse koncentracije svinca so bile po točenju vode izmerjene pod vrednostjo 10 gl, kar je dokaz, da je nekaj minutno točenje vode iz vseh pip najučinkovitejši in najhitrejši ukrep za znižanje koncentracij svinca v pitni vodi. Za potrebe državnega monitoringa pitne vode je potrebno uveljaviti nov način odvzema vode za ugotavljanje koncentracij svinca v njej, in sicer vzorčenje vode, ki je v ceveh stala vsaj 8 do 18 ur.BACKGROUND: Various environmental studies have shown that the problem of elevated concentrations of lead in drinking water exists mainly in older buildings, where lead parts are built in the network or the network contains other materials containing lead. Migration of lead into drinking water is also affected by particular characteristics of the drinking water and by stagnation of the water in the pipes. Children are particularly susceptible to increased risk of lead exposure in the environment and adverse effects of lead will manifests at lower concentrations in the blood. The purpose of this work is to contribute starting points for the creation of evidence-based measures to reduce the levels of lead in drinking water, and thus its impact on human health in Slovenia. METHODS: The author conducted a cross-sectional study in order to assess the status of selected public water supply systems and domestic water supply systems in selected kindergartens and elementary schools on the basis of a questionnaire. The concentration of lead in the drinking water of the selected kindergartens and elementary schools was determined by means of an experimental method in a laboratory. Cold drinking water samples of 250ml that stood in the pipes from 8 to 18 hours were used. A method for determining the migration from different materials was applied. An old lead pipe was used, which had already been installed in the facility, as well as new materials (plastic, copper, galvanized pipes and stainless steel pipes and also brass faucet, chrome angle valve and plastic hose) which had not been used yet. To determine the concentration of lead in the water the method ICP-MS was applied. Then the ecological study followed. Lead exposure for a 6-year- old child was calculated on the basis of assessing the uptake of lead from air, water, food and soil. In the calculation, absorption factors were considered and also worst–case scenario was provided. For the assessment, the model IEUBK was used. RESULTS: Sampling showed that more than 22 % of samples had levels of lead higher than 10 gl, some of them highly exceeded that level. Positive correlation between the age of a building and the concentration of lead in drinking water confirms the assumption that the concentration of lead in drinking water is higher in old domestic distribution networks. Implementation of lead migration from various types of pipes demonstrated the migration from galvanized pipes in all simulants. The assessment of lead exposure for a 6-year-old child has shown a risk of adverse health effects. CONCLUSION: All concentrations of lead after flushing the pipes were below the 10 gl, which shows that the most effective and the fastest action to lower the concentrations of lead is flushing the water pipes. For the purposes of the national monitoring of drinking water, it is necessary to apply a better method for determining lead levels in drinking water namely the sampling of water that stood in the pipes at least 8 to 18 hours

Koncentracije trihalometanov v bazenski kopalni vodi v Sloveniji

Trihalometani (THM) so rezultat reakcije prostega klora in organskih prekurzorjev. Obiskovalci bazenskih kopališč so zato THM izpostavljeni preko vdihanega zraka, preko zaužite vode, absorbirajo pa se tudi skozi kožo. Pri kratkotrajni izpostavljenosti THM škodljivo delujejo predvsem na centralni živčni sistem, ledvice in jetra ter so lahko vzrok za nastanek astme. Mednarodna agencija za raziskave raka (IARC) uvršča kloroform in bromodiklorometan v 2B skupino (snov je morda rakotvorna za človeka). Vzorčenje, laboratorijske preskuse in ugotovitve o skladnosti bazenske vode naTHM opravljajo akreditirani laboratoriji. Zakonodaja določa mejno vrednost THM v bazenski kopalni vodi in sicer 0,050 mg/l, ki se bo konec leta 2010 znižala na 0,020 mg/l. V letu 2007 je bilo v Sloveniji iz 541 bazenov odvzetih 4768 vzorcev za preskušanje bazenskih voda na THM. V primerjavi z letom 2006 se je število neskladnih vzorcev zaradi THM znižalo iz 51 % na 18 %in sicer zaradi spremembe zakonodaje. V primeru, da se mejna vrednost THM ne bi zvišala, bi imeli v letu 2007 še vedno 47 % neskladnih vzorcev zaradi presežene vrednosti THM. Na znižanje mejne vrednosti THM v letu 2010 se morajo upravljavci bazenov in bazenskih kopališč ustrezno pripraviti. Da bi izboljšali higiensko kakovost bazenske vode je potrebno kontrolirati število kopalcev in uveljaviti osnovna pravila ravnanja obiskovalcev, ki so predpisanaz kopališkim redom.Trihalomethanes (THMs) are the result of reaction between chlorine and organicmaterial. Visitors of swimming pools are therefore exposed to THMs by inhalation, ingestion or by dermal absorption. Short exposure to THMs may produce kidney, liver and central nervous system damage and can be an important cause of allergic asthma. The International Agency for Research on Cancer (IARC) has classified chloroform and bromodichloromethane as possibly carcinogenic to humans (Group 2B). The role of accredited laboratories is to define the THMs concentrations in bathing water. Minimum Contaminant Level (MCL) for THMs in swimming pool water is 0.050 mg/l, which will be lowered in 2010 to 0.020 mg/l. In 2007 there were 541 swimming pools in Slovenia, 4768 samples were taken for THM analysis. Only 18 % of samples were not in compliance with MCL for THMs in comparison with year 2006 when this share was 51 % and this was all because of changed legislation. In case that MCL of THMs had not increased we would have had 47 % of inconsistent samples. Managers of swimming pools will have to be prepared on reduced MCL for THMs inyear 2010. For improving the quality of bathing water it is necessary to control number of bathers and to exercise basic rules for visitors such as showering before going swimming

Skrb za naravne kopalne vode

Izvleček V vročih dneh je vsakdo vesel ohladitve, ki jo ponujajo tudi slovenske reke, jezera in morje. Kopanje pa je varno le na vodnih površinah, ki so temu namenjene, čeprav ob lepem vremenu pritegnejo številne kopalce tudit. i. "divja" kopališča, kot so gramoznice, jezera in reke. Za varno kopanje tam ni poskrbljeno, saj taka mesta nimajo organiziranih služb za reševanje iz vode niti upravljavcev, vprašljiva pa je tudi kakovost vode. Slednja se nadzoruje na 37 naravnih kopalnih vodah, o primernosti za kopanje pa se obveščajo tudi kopalci.During the hot summer, Slovenia\u27s rivers, lakes and part of the Adriatic Sea offer various opportunities for relaxation and cooling. But taking a bath is safe only at places, which are intended for that purpose. Several other placesare also attractive, but swimming there is not safe - there is no competent authority and the quality of bathing water is also doubtful. With the intention of protecting bathers\u27 health, quality of bathing water is checked on 37 bathing waters and the information is actively disseminated and promptly made available during the bathing season

Trihalomethanes in drinking water and bladder cancer burden in the European Union

Abstract Background: Trihalomethanes (THMs) are widespread disinfection by-products (DBPs) in drinking water, and long-term exposure has been consistently associated with increased bladder cancer risk. Objective: We assessed THM levels in drinking water in the European Union as a marker of DBP exposure and estimated the attributable burden of bladder cancer. Methods: We collected recent annual mean THM levels in municipal drinking water in 28 European countries (EU28) from routine monitoring records. We estimated a linear exposure–response function for average residential THM levels and bladder cancer by pooling data from studies included in the largest international pooled analysis published to date in order to estimate odds ratios (ORs) for bladder cancer associated with the mean THM level in each country (relative to no exposure), population-attributable fraction (PAF), and number of attributable bladder cancer cases in different scenarios using incidence rates and population from the Global Burden of Disease study of 2016. Results: We obtained 2005–2018 THM data from EU26, covering 75% of the population. Data coverage and accuracy were heterogeneous among countries. The estimated population-weighted mean THM level was 11.7μg/L [standard deviation (SD) of 11.2]. The estimated bladder cancer PAF was 4.9% [95% confidence interval (CI): 2.5, 7.1] overall (range: 0–23%), accounting for 6,561 (95% CI: 3,389, 9,537) bladder cancer cases per year. Denmark and the Netherlands had the lowest PAF (0.0% each), while Cyprus (23.2%), Malta (17.9%), and Ireland (17.2%) had the highest among EU26. In the scenario where no country would exceed the current EU mean, 2,868 (95% CI: 1,522, 4,060; 43%) annual attributable bladder cancer cases could potentially be avoided. Discussion: Efforts have been made to reduce THM levels in the European Union. However, assuming a causal association, current levels in certain countries still could lead to a considerable burden of bladder cancer that could potentially be avoided by optimizing water treatment, disinfection, and distribution practices, among other possible measures