Serum perfluoroalkyl substances in residents following long-term drinking water contamination from firefighting foam in Ronneby, Sweden.

BACKGROUND: In December 2013, it was discovered that drinking water supplied to one third of the households in Ronneby, southern Sweden, was highly contaminated by PFAS (sum level >10,000 ng/L) originated from firefighting foams used at a nearby military airport. OBJECTIVES: To report serum PFAS levels of Ronneby residents participating in a biomonitoring program, and to describe the variation by age, sex and calendar period for residential exposure. In addition, a reference group living in a neighboring municipality without PFAS contaminated drinking water was examined. METHODS: Blood samples and demographic data were collected for 3297 Ronneby residents and 226 individuals from the reference group. Yearly residence addresses were available for 3086 Ronneby residents from the national population registry. Serum concentrations of PFHxS, PFOS and PFOA were determined in all participants, with additional PFHpA, PFNA and PFDA in subsets of the participants. RESULTS: The population geometric means for serum PFHxS, PFOS and PFOA were 114, 135 and 6.8 ng/mL for all Ronneby residents, i.e.135, 35 and 4.5 times higher than for the reference group. Ronneby residents who resided in the area with contaminated water supply during 2005-2013 showed much higher PFAS levels in 2014 than those exposed only before 2005. Ronneby residents who never resided in the area with contaminated water supply also had higher serum PFAS levels than the reference group. All three PFAS were highly correlated (rs > 0.9 for each pair). Serum PFAS levels were lowest in teenage years and then increased with age. Adult females had lower PFAS levels on average than males under the age of 60 but higher above 60. DISCUSSION: The results reveal high serum PFAS levels dominated by PFHxS and PFOS in the Ronneby residents highly exposed to PFAS originated from firefighting foams. The PFAS exposure in Ronneby permits studies of associations to a range of health parameters, as well as studies of the toxicokinetics of PFAS exposure

Climate and Health - A summary of knowledge

In summary, we believe that climate change is a major threat to our health. The greatest direct threats are: 1. Lack of food and clean water 2. Heatwaves 3. Changing spectrum of disease Secondary effects may be at least as serious, and include increased risk of conflicts due to lack of food, water and arable land, as well as increased migration. The effects on people’s mental health are also likely to be significant; primarily among those who are directly affected by extreme weather events, for example, but also in the form of greater worry and anxiety about the consequences of a changing climate. Globally, the effects are very unevenly distributed, and rising temperatures will hit poor countries hardest of all, while in the Nordic region the effects are likely to be less serious from the global perspective. Nevertheless, we are already seeing the effects of a warmer climate in the shape of increased risk of heatwaves and forest fires. We still have a lot to gain in this part of the world from limiting climate impact as much as possible

Klimat och hälsa - En kunskapssammanställning

Sammanfattningsvis anser vi att klimatförändringarna är ett stort hot mot vår hälsa. De största direkta hoten utgörs av brist på mat och rent vatten, värmeböljor och ändrat sjukdomspanorama. De sekundära effekterna kan bli minst lika allvarliga som en ökad risk för konflikter pga brist på mat, vatten och odlingsbar jord, och ökad migration. Effekterna på människors psykiska hälsa kan också bli betydande; främst förstås de som direkt drabbas vid t ex extrema väderhändelser, men också i form av ökad oro och ångest över vad ett ändrat klimat kan medföra. Effekterna globalt är mycket ojämnt fördelade, och temperaturökningen kommer drabba fattiga länder hårdast, sannolikt kommer effekterna i Norden vara mer begränsade i ett globalt perspektiv. Icke desto mindre ser vi redan nu effekter av ett varmare klimat, med ökad risk för värmeböljor och skogsbränder. Även vi har mycket att vinna på att begränsa klimatpåverkan så långt som möjligt! Hösten 2019 gav vetenskapsakademiernas gemensamma organ i Europa, EASAC ut en sammanställning av det vetenskapliga underlaget över vilka hälsoeffekter av klimatförändringar vi kan förvänta oss med fokus på Europa. Bilden är alarmerande. Vid 2° C temperaturhöjning kan vi t ex förvänta oss en överdödlighet på drygt 130 000 personer per år i Europa enbart beroende på värmeböljor år 2100. Men EASAC konkluderar också att snabba och avgörande åtgärder för att minska växthusgasutsläppen för att hålla temperaturökningen under 2° C över förindustriell nivå, skulle reducera riskerna för de värsta hälsoeffekterna. Den goda nyheten är att viktiga åtgärder mot klimatförändringarna dessutom har positiva effekter på hälsan: utfasning av fossila bränslen är en första viktig åtgärd. De bidrar idag till den största andelen av utsläppen av växthusgaser, och 22 påverkar också vår hälsa. Exponering från fossila bränslen har globalt beräknats ge upphov till 3.6 miljoner förtida dödsfall om året [15]. Enligt den senaste rapporten från UNEP krävs en minskning av utsläppen av växthusgaser med 7.6 % per år mellan 2020 och 2030 globalt om man skall kunna uppnå 1.5 ° C målet [67]. Även ändrade matvanor med minskat köttintag och ökad konsumtion av frukt och grönsaker minskar utsläppen av växthusgaser och har starka positiva effekter på vår hälsa. I ett globalt perspektiv är produktionen av mat också en av de stora utsläppskällorna av växthusgaser. Dessutom är den mat som produceras, processas och marknadsförs en viktig orsak till ohälsa genom att vara för fet, söt och salt och leda till för högt kaloriintag, överkonsumtion av rött kött och charkuteriprodukter [68]. En optimal klimatsmart kost skulle kunna reducera antalet förtidiga dödfall med cirka 20 % per år [22]. Lösningar finns alltså inom räckhåll och mycket kan göras baserat på befintlig kunskap. Som även EASAC påpekar, har vetenskapssamhället en viktig roll att spela för att sprida information om klimatförändringarnas hälsoeffekter, men också det stora behovet av förändring och åtgärder för att minimera temperaturökningen. För att på politisk nivå kunna genomföra nödvändiga åtgärder krävs ett starkt mandat för dessa åtgärder. Därför är ökade kunskaper om effekterna av ett förändrat klimatet ett viktigt steg. Vi har i modern tid inte tidigare mött ett större hot mot folkhälsan. Därför har vi inom sjukvården en speciellt viktig roll som kunskapsspridare, för att förebygga de värsta effekterna. Vi borde också föregå som goda exempel, t ex genom att minska resursslöseriet i vården, och bidra till en minskning av vårt klimatavtryck. Vi lever i en tid av ökad global välfärd. Aldrig tidigare har så många människor haft så goda förutsättningar för en bra hälsa. Lyckas vi inte lösa klimatfrågan kommer vi inte kunna uppnå god och jämlik hälsa för alla. För en god hälsa är vi helt beroende av tillgång på mat, rent vatten, utbildning, ekosystemtjänster, rättvisa och fred. Allt detta riskeras om vi inte anpassar oss till, och vidtar åtgärder, mot klimatförändringar

Perfluoroalkyl substances (PFAS) in drinking water and risk for polycystic ovarian syndrome, uterine leiomyoma, and endometriosis : A Swedish cohort study

Background: Perfluorinated substances (PFAS) are chemicals with endocrine disruptive properties that may interfere with the female reproductive system. However, few studies have explored the association between benign gynecological diseases and high PFAS exposure. Objectives: The aim of this study was to investigate the possible associations between PFAS exposure and subsequent diagnosis of polycystic ovarian syndrome (PCOS), uterine leiomyoma (fibroids), and endometriosis in a cohort exposed to PFAS through drinking water. Material and methods: In 2013, high levels (with sum of PFAS above 10,000 ng/L), dominated by perfluorooctanesulfonic acid (PFOS) and perfluorohexane sulfonic acid (PFHxS), were found in the drinking water from one of the two waterworks in Ronneby, Sweden. The contamination came from firefighting foams used at a nearby airfield. Females of all ages (n = 29,106) who had ever resided in the municipality between 1985 and 2013 formed a cohort. Individual exposure was assessed based on municipality waterworks distribution data linked to annual residential address data; 27% of the females had ever lived at an address with PFAS-contaminated water. Gynecological health outcomes were retrieved from the Swedish National Patient Register. The Cox proportional hazards model was used to estimate the association between exposure and each diagnosis. Results: There were in all 161 cases of PCOS, 1,122 cases of uterine leiomyoma, and 373 cases of endometriosis. In women aged 20-50 years (n = 18,503), those with the highest estimated PFAS exposure had increased hazard ratios (HR) for PCOS (HR = 2.18; 95% confidence interval (CI) 1.43, 3.34) and uterine leiomyoma (HR = 1.28; 95% CI 0.95, 1.74). No increased HR for endometriosis was found (HR = 0.74; 95% CI 0.42, 1.29). Conclusions: Exposure to high levels of PFAS in drinking water was associated with increased risk of PCOS and possibly uterine leiomyoma, but not endometriosis. The findings for PCOS are consistent with prior studies reporting positive associations between PCOS and PFAS exposure at background levels

Cancer incidence in a Swedish cohort with high exposure to perfluoroalkyl substances in drinking water

Background: The use of firefighting foams at a military airport resulted in high levels of perfluorinated substances (PFAS) in the drinking water distributed to one-third of households in the Swedish municipality of Ronneby between the mid-1980s and the end of 2013. Method: The Ronneby Register Cohort, a large cohort comprising all individuals (N = 60,507) who ever lived in the Ronneby municipality during the period of drinking water contamination, was linked to the Swedish Cancer Register 1985–2016. Individual exposure was classified based on comprehensive data on yearly residential address and water distribution. External analysis explored standardized cancer incidence ratios (SIR) for residents never, or ever, residing in the contaminated water district, compared with those residing in other towns in the same county as reference population. Cox models provided hazard ratios (HR) for different exposure groups within the cohort. Results: 5,702 individuals with cancer were identified. SIR for overall cancer was 1.04 for men (95%CI 0.96–1.12) and 0.89 for women (95%CI 0.82–0.96) who ever lived in the contaminated drinking water area. Kidney cancer, which was reported with increased risk in C8 study, showed somewhat elevated HR in this study (HR 1.27; 95%CI 0.85–1.89). The HR was modestly elevated for bladder cancer (HR 1.32; 95%CI 1.01–1.72), and reduced for prostate cancer (HR 0.83; 95%CI 0.71–0.98). In subjects who ever lived in the contaminated water area during 2005–2013, when exposure was estimated to be highest, higher risks for kidney cancer (HR 1.84; 95%CI 1.00–3.37) but lower for prostate cancer (HR 0.76; 95%CI 0.59–0.98) were observed. Conclusion: Analysis of this large cohort exposed to high levels of PFAS, dominated by PFHxS and PFOS, revealed no evidence for an overall increased risk of cancer. A moderately increased risk of kidney cancer was observed, in accordance with previous findings after PFAS exposure dominated by PFOA

Placing children and adolescents at the centre of the Sustainable Development Goals will deliver for current and future generations

Child health is taking the back seat in development strategies. In summarising a newly released collaborative report, this paper calls for a novel conceptual model where child health takes centre stage in relation to the 2030 Agenda and the Sustainable Development Goals. It lays out five principles by which renewed effort and focus would yield the most benefit for children and adolescents. These include: re-defining global child health in the post-2015 era by placing children and adolescents at the centre of the Sustainable Development Goals; striving for equity; realising the rights of the child to thrive throughout the life-course; facilitating evidence informed policy-making and implementation; and capitalising on interlinkages within the SDGs to galvanise multisectoral action. These five principles offer models that together have the potential of improving design, return and quality of global child health programs while re-energising the 2030 Agenda and the Sustainable Development Goals