Direct health costs of environmental tobacco smoke exposure and indirect health benefits due to smoking ban introduction

Background: Introducing comprehensive smoke-free policies to public places is expected to reduce health costs. This includes prevented health damages by avoiding environmental tobacco smoke (ETS) exposure as well as indirect health benefits from reduced tobacco consumption. Methods: The aim of this study was to estimate direct health costs of ETS exposure in public places and indirect health benefits from reduced tobacco consumption. We calculated attributable hospital days and years of life lost (YLL), based on the observed passive smoking and disease rates in Switzerland. The exposure-response associations of all relevant health outcomes were derived by meta-analysis from prospective cohort studies in order to calculate the direct health costs. To assess the indirect health benefits, a meta-analysis of smoking ban studies on hospital admissions for acute myocardial infarction was conducted. Results: ETS exposure in public places in Switzerland causes 32 000 preventable hospital days (95% CI: 10 000-61 000), 3000 YLL (95% CI: 1000-5000), corresponding to health costs of 330 Mio CHF. The number of hospital days for ischaemic heart disease attributable to passive smoking is much larger if derived from smoking ban studies (41 000) than from prospective cohort studies (3200), resulting in additional health costs of 89 Mio CHF, which are attributed to the indirect health benefits of a smoking ban introduction. Conclusion: The example of smoking ban studies on ischaemic heart disease hospitalization rates suggests that total health costs that can be prevented with smoking bans are considerably larger than the costs arising from the direct health impact of ETS exposure in public place

Intestinal parasitic infections in schoolchildren in different settings of Côte d'Ivoire : effect of diagnostic approach and implications for control

BACKGROUND: Social-ecological systems govern parasitic infections in humans. Within the frame of assessing the accuracy of a rapid diagnostic test for Schistosoma mansoni in Cote d'Ivoire, three different endemicity settings had to be identified and schoolchildren's intestinal parasitic infection profiles were characterized. METHODS: In September 2010, a rapid screening was conducted in 11 schools in the Azaguie district, south Cote d'Ivoire. In each school, 25 children were examined for S. mansoni and S. haematobium. Based on predefined schistosome endemicity levels, three settings were selected, where schoolchildren aged 8-12 years were asked to provide three stool and three urine samples for an in-depth appraisal of parasitic infections. Triplicate Kato-Katz thick smears were prepared from each stool sample for S. mansoni and soil-transmitted helminth diagnosis, whereas urine samples were subjected to a filtration method for S. haematobium diagnosis. Additionally, a formol-ether concentration method was employed on one stool sample for the diagnosis of helminths and intestinal protozoa. Multivariable logistic regression models were employed to analyse associations between schoolchildren's parasitic infections, age, sex and study setting. RESULTS: The prevalences of S. mansoni and S. haematobium infections in the initial screening ranged from nil to 88% and from nil to 56%, respectively. The rapid screening in the three selected areas revealed prevalences of S. mansoni of 16%, 33% and 78%. Based on a more rigorous diagnostic approach, the respective prevalences increased to 92%, 53% and 33%. S. haematobium prevalences were 0.8%, 4% and 65%. Prevalence and intensity of Schistosoma spp., soil-transmitted helminths and intestinal protozoan infections showed setting-specific patterns. Infections with two or more species concurrently were most common in the rural setting (84%), followed by the peri-urban (28.3%) and urban setting (18.2%). CONCLUSIONS: More sensitive diagnostic tools or rigorous sampling approaches are needed to select endemicity settings with high fidelity. The observed small-scale heterogeneity of helminths and intestinal protozoan infections has important implications for contro

Effects of Radon and UV Exposure on Skin Cancer Mortality in Switzerland.

BACKGROUND: Skin cancer incidence in Switzerland is among the highest in the world. In addition to exposure to ultraviolet (UV) radiation, radon alpha particles attached to aerosols can adhere to the skin and potentially cause carcinogenic effects. OBJECTIVES: We investigated the effects of radon and UV exposure on skin cancer mortality. METHODS: Cox proportional hazard regression was used to study the association between exposures and skin cancer mortality in adults from the Swiss National Cohort. Modeled radon exposure and erythemal-weighted UV dose were assigned to addresses at baseline. Effect estimates were adjusted for sex, civil status, mother tongue, education, job position, neighborhood socioeconomic position, and UV exposure from outdoor occupation. RESULTS: The study included 5.2 million adults (mean age 48 y) and 2,989 skin cancer deaths, with 1,900 indicating malignant melanoma (MM) as the primary cause of death. Adjusted hazard ratios (HR) for MM at age 60 were 1.16 (95% CI: 1.04, 1.29) per 100 Bq/m3 radon and 1.11 (1.01, 1.23) per W/m2 in UV dose. Radon effects decreased with age. Risk of MM death associated with residential UV exposure was higher for individuals engaged in outdoor work with UV exposure (HR 1.94 [1.17, 3.23]), though not statistically significantly different compared to not working outdoors (HR 1.09 [0.99, 1.21], p=0.09). CONCLUSIONS: There is considerable variation in radon and UV exposure across Switzerland. Our study suggests both are relevant risk factors for skin cancer mortality. A better understanding of the role of the UV radiation and radon exposure is of high public health relevance. https://doi.org/10.1289/EHP825

Ionizing and non-ionizing radiation and the risk of childhood cancer-illustrated with domestic radon and radio frequency electromagnetic field exposure

Background Children are exposed to many different environmental factors, including exposure to low-dose ionizing radiation and to non-ionizing radiation. Low-dose ionizing radiation comprises anthropogenic modified radiation and natural ionizing radiation from cosmic rays from the atmosphere, terrestrial gamma radiation from radionuclides in rocks and soils and radiation from radon. Non-ionizing radiation comprises optical radiation and radiation from electromagnetic fields. The latter comprises radiation from extremely low-frequency electromagnetic fields (ELF-EMF; high voltage power lines, electrical installations) and radiofrequency electromagnetic fields (RF-EMF; broadcast transmitters, mobile phone base stations, mobile and cordless phones). Both ionizing and non-ionizing radiation are assumed to be associated with childhood cancer. Aims Within this dissertation, we primarily aimed to assess whether there is an association between domestic radon exposure and childhood cancers. We further investigated whether there is an association between low-dose ionizing gamma radiation and childhood cancers. We finally assessed whether there is an association between RF-EMF exposure from broadcast transmitters and childhood cancers. Methods We performed prospective census-based cohort designs, considering all children, aged less than 16 years and living in Switzerland at the date of census 2000 (December 5th 2000). Time at risk was set to begin at census and lasted until the date of diagnosis, death, emigration, a child’s 16th birthday or until the end of the year 2008. In terms of non-ionizing radiation from far-field RF-EMF sources from broadcast transmitters, we carried out a further prospective cohort analysis, considering all children, aged less than 16 years and living in Switzerland between 1985 and 2008. We assessed exposure at baseline (date of census 2000) for each child’s home address. For the analyses on RF-EMF exposure to broadcast transmitters and childhood cancers where a longer follow-up was considered, we considered exposure at the time of diagnosis. For the analyses on domestic radon exposure and childhood cancers, exposure assessment was based on a nationwide radon prediction model. For the analyses on low-dose ionizing gamma radiation and childhood cancers, exposure assessment was based on modelled and measured dose rates from outdoor gamma radiation. For the analyses on RF-EMF exposure to broadcast transmitters and childhood cancers, exposure assessment was based on modeled field strengths. Results We estimated arithmetic mean radon concentrations to be 85.7 Bq/m³ (range: 6.9-337.2 Bq/m³) for childhood cancer cases and 85.9 Bq/m³ (range: 0.7-490.1 Bq/m³) for the rest of the study population. Despite relative high radon levels in Switzerland, we found no evidence for an association between domestic radon exposure and childhood cancers. We found increased leukaemia risk (including acute lymphoblastic leukaemia) with respect to gamma radiation for children who lived at the same address between 1995 and 2000. Finally, we found no increased leukaemia risk but increased central nervous system (CNS) tumour risks with respect to RF-EMF exposure from broadcast transmitters. Conclusions and Outlook The findings of our analyses, indicating no association between domestic radon exposure and childhood cancers were consistent with past studies that estimated doses of domestic radon concentrations for different body organs (lung, red bone marrow, brain). The results of the analyses on gamma radiation and childhood cancers indicate that low dose ionizing gamma radiation might be relevant in terms of childhood leukaemia. These results were also found to be consistent with dose estimations for different body organs (red bone marrow, brain). They indicated that the same gamma radiation dose to the red bone marrow over a longer time period is probably necessary for gamma radiation to lead to childhood leukaemia. The findings from the analyses on RF-EMF exposure from broadcasting and childhood leukaemia were found to be consistent with results from animal, in-vitro and laboratory studies. On the contrary, the findings indicating increased CNS tumours from RF-EMF exposure to broadcast transmitters contradict results from former studies. Our results are further in contradiction to a previous case-control study on wireless phones. This study could not find an increased risk for CNS tumours from the use of wireless phones that lead to substantially higher exposure to the head. Although no evidence for an association with childhood cancers was found, domestic radon exposure is of public health relevance with regard to lung cancer in adults. The findings from the analyses on gamma radiation and childhood cancers indicate that gamma radiation is of public health relevance as well, especially when children are exposed to the same gamma radiation dose over a longer time period. Statements on possible public health relevance concerning non-ionizing radiation of RF-EMF from broadcasting on the other hand are not yet possible, as the results for CNS tumours need further clarification

Analyse von Verkehrsströmen an ausgewählten intermodalen Knotenpunkten in der Schweiz

In diesem Bericht wird die Bedeutung von intermodalen Knotenpunkten im Personenverkehr untersucht, wobei ein besonderes Augenmerk auf die Fahrgastfrequenzen, die Verkehrsmittel- wahl sowie die mittlere Distanz zwischen zwei Verkehrsträgern geworfen wird

Beschreibung einer Datenbank zu den Schweizer Gemeinden

In diesem Arbeitsbericht ist eine Datenbank für die fast 3'000 Schweizer Gemeinden mit einer Vielzahl von Informationen, wie Daten zur ansässigen Bevölkerung, zu Arbeitsstätten und Beschäftigten in Tourismus- und Freizeitbetrieben beziehungsweise im Einzelhandel, zur Flächennutzung, zur Kultur-, Freizeit- und Sportinfrastruktur, zu Freizeitgrossanlagen sowie zum Tourismus, beschrieben

Public health risk assessment associated with heavy metal and arsenic exposure near an abandoned mine (Kirki, Greece)

The 'Agios Philippos' lead-zinc mine in the Kirki region (NE Greece) is now closed, but its legacy of heavy metal contamination remains at the site. At present, management of the contaminated land is of major concern. The area is in a reclamation process and requires immediate remediation action, whereas human risks need to be carefully evaluated. In order to assess these risks, samples from around the mine were collected and analyzed and a scenario involving the oral, dermal, and inhaled doses of arsenic and heavy metals was formulated. A Monte Carlo approach was undertaken, in order to model the average daily dose and quantify the corresponding hazard index and cancer risk. A toxicological risk was associated with samples collected in the vicinity of the mine (floatation, mine tailings) and a pronounced carcinogenic risk for arsenic was evident at the broader occupational/environmental setting. These findings urge for immediate rehabilitation actions that will mitigate population exposures and promote long-term environmental safety in the area

Effects of Radon and UV Exposure on Skin Cancer Mortality in Switzerland

BACKGROUND: Skin cancer incidence in Switzerland is among the highest in the world. In addition to exposure to ultraviolet (UV) radiation, radon alpha particles attached to aerosols can adhere to the skin and potentially cause carcinogenic effects. OBJECTIVES: We investigated the effects of radon and UV exposure on skin cancer mortality. METHODS: Cox proportional hazard regression was used to study the association between exposures and skin cancer mortality in adults from the Swiss National Cohort. Modeled radon exposure and erythemal-weighted UV dose were assigned to addresses at baseline. Effect estimates were adjusted for sex, civil status, mother tongue, education, job position, neighborhood socioeconomic position, and UV exposure from outdoor occupation. RESULTS: The study included 5.2 million adults (mean age 48 y) and 2,989 skin cancer deaths, with 1,900 indicating malignant melanoma (MM) as the primary cause of death. Adjusted hazard ratios (HR) for MM at age 60 were 1.16 (95% CI: 1.04, 1.29) per radon and 1.11 (1.01, 1.23) per in UV dose. Radon effects decreased with age. Risk of MM death associated with residential UV exposure was higher for individuals engaged in outdoor work with UV exposure (HR 1.94 [1.17, 3.23]), though not statistically significantly different compared to not working outdoors (HR 1.09 [0.99, 1.21], ). CONCLUSIONS: There is considerable variation in radon and UV exposure across Switzerland. Our study suggests both are relevant risk factors for skin cancer mortality. A better understanding of the role of the UV radiation and radon exposure is of high public health relevance. https://doi.org/10.1289/EHP825