AMMONIUM, NITRATE AND NITRITE CONCENTRATIONS IN DRINKING WATER OF THE SOUTH BAČKA DISTRICT OF VOJVODINA

Safe drinking water is one of the basic conditions for life on our planet, necessary for all vital processes in the biosphere. Pollution of water sources, largely from wide-scale agricultural fertilizer use, has resulted in nitrate and nitrite contamination of drinking water. Aim: To determine the concentrations of ammonium, nitrate, and nitrite in drinking water as potential hazards in the settlements of the South Bačka administrative district of Autonomous Province of Vojvodina (northern part of Serbia). A cross-sectional study was conducted during 2019. We analysed 8434 drinking water samples (7319 purified chlorinated, 386 untreated but chlorinated, and 729 untreated). For assessing the concentration of ammonium, nitrate, and nitrite in drinking water, samples were analyzed by a certified laboratory at the Institute of Public Health of Vojvodina using spectrophotometric method. After analyzing samples of purified chlorinated, untreated chlorinated, and untreated water, the exceedance of the prescribed values of ammonium were found in 0.45%, 64.77% and 68.45%, and for nitrites in 0.04%, 5.96% and 0.82% of the samples, respectively. The concentration of nitrate in drinking water concerning the degree of water purification (purified chlorinated and untreated water) exceeded the prescribed value in 0.01% and 5% of the samples, respectively. Determined exceedances of the prescribed limit values for nitrite concentrations recorded in purified chlorinated, untreated chlorinated, and untreated drinking water as well as for nitrate mainly in untreated drinking water, could be considered as potential hazards for human health, especially for the sensitive population group

Cardiovascular diseases and air pollution in Novi Sad, Serbia

Objectives: A large body of evidence has documented that air pollutants have adverse effect on human health as well as on the environment. The aim of this study was to determine whether there was an association between outdoor concentrations of sulfur dioxide (SO2) and nitrogen dioxide (NO2) and a daily number of hospital admissions due to cardiovascular diseases (CVD) in Novi Sad, Serbia among patients aged above 18. Material and Methods: The investigation was carried out during over a 3-year period (from January 1, 2007 to December 31, 2009) in the area of Novi Sad. The number (N = 10 469) of daily CVD (ICD-10: I00-I99) hospital admissions was collected according to patients' addresses. Daily mean levels of NO2 and SO2, measured in the ambient air of Novi Sad via a network of fixed samplers, have been used to put forward outdoor air pollution. Associations between air pollutants and hospital admissions were firstly analyzed by the use of the linear regression in a single polluted model, and then trough a single and multi-polluted adjusted generalized linear Poisson model. Results: The single polluted model (without confounding factors) indicated that there was a linear increase in the number of hospital admissions due to CVD in relation to the linear increase in concentrations of SO2 (p = 0.015; 95% confidence interval (95% CI): 0.144-1.329, R2 = 0.005) and NO2 (p = 0.007; 95% CI: 0.214-1.361, R2 = 0.007). However, the single and multi-polluted adjusted models revealed that only NO2 was associated with the CVD (p = 0.016, relative risk (RR) = 1.049, 95% CI: 1.009-1.091 and p = 0.022, RR = 1.047, 95% CI: 1.007-1.089, respectively). Conclusions: This study shows a significant positive association between hospital admissions due to CVD and outdoor NO2 concentrations in the area of Novi Sad, Serbia

Environmental health indicators

Achieving and maintaining good health and prosperity requires a clear and harmonized environment. Studying the environment to protect human health aims to determine the type of pollutants and to monitor their impact on humans. Pollutants include the chemical, physical and microbiological pollutants. It is believed that the best way of studying the interaction between the population and the environment is the method that allows selection of representative, easily measurable and routinely controlled environmental indicators and health status. The World Health Organization recommends "DPSEEA" (Driving Force, Pressure, State, Exposure, Effect and Action) system. "DPSEEA" describes a closed circuit system of interdependent factors of the environment and human health which can be defined as a cause _ effect model. Application of "DPSEEA" system to assess the influence factors of the environment on human health is defined by studying the air quality of the environment, water and sanitation, noise and health, housing, traffic accidents, chemical accidents, and radiation. The use of complex indicators by "DPSEEA" system in our country so far has been used to assess the environmental situation, but not for systematic assessment of the impact factors of the environment on human health. AIM: Aims of the research are based on determining the type of microbiological, physical and chemical hazards in the environment of Novi Sad, exposure of the population and assess the impact of identified hazards to human health, as well as determining the significance of the application of environmental factors as indicators of impacts on human health. METHODOLOGY: Identifying hazards present in the environment of the City of Novi Sad (air quality, drinking water quality, noise) in 2006 were carried out based on the statutory methodology for sampling, microbiological, physical and chemical analysis and preparation of expert opinions on the hazards present in the environment. There were sampled, analyzed and professionally studied 9936 air samples, 6474 samples of drinking water and 648 individual measurements of daily levels of noise. Determination of population-level exposure to environmental noise survey was conducted by applied poll concerning subjective population experience of noise and subjective assessment of noise impact on human health, based on 1079 valid completed questionnaires. Assessment of exposure to microbial, physical and chemical hazards from the environment and determine the impact of identified hazards from the environment on human health is determined in accordance with the "DPSEEA" methodology by using the 15 indicators. To assess the impact of air, water and noise on human health following indicators have been considered: Air_Exl, Air_El, Air_E2, Air_E3, WatSan_S2,WatSan_S3, WatSan_Exl, WatSan_Ex2, WatSan_Ex3, WatSan_Ex4, WatSan_El,WatSan_E2, WatSan_E3, Noise_El and Noise_E2. The questionnaire of the population of the subjective experience of noise and subjective assessment of noise impact on human health was conducted with the help of specially composed questionnaire, based on national surveys conducted.  RESULTS: Out of the 15 indicators of "DPSEEA" system in our research 87 percents is considered accessible, 67 percents quality and 73 percents usable. Monitoring of air quality in the City of Novi Sad in 2006 indicates that average annual concentrations of sulfur dioxide  (0.05). Reducing the average population exposure to suspended particles in 10 µg/m3 in the City of  NoviSad,  reducing the expected total number of deaths from 131 to 115, the expected number of deaths from cardiopulmonary disease (MKB 10:JOO-99 and MKB 1 0:120-25) in people aged above 30 with 42 to 37 and expected number of deaths from respiratory diseases (MKB 1 0:JOO-99) of children under five years from 0.036 to 0.03,  statistically significant Cp>0.05). Increase the total suspended particles (TSP) In air of the City of Novi Sad for 10 µg/m causes the Increase rate of total mortality in 0.047 without statistical significance (p=0.29299) and increased rates of mortality from cardiopulmonary disease (MKB 10:JOO-99 and MKB 10:120-25) of people aged above 30 to 0.016, with no statistical significance . The decrease of total suspended particles (TSP) in air of the City of Novi Sad for 10 µg/m3 induced reduction of total mortality rate of 0.051 with no statistical significance (p=0.26355) and the reduction of mortality from cardiopulmonary disease (MKB 10:JOO-99 and MKB 1 0:120-25) of people aged above 30 years to 0.016 with no statistical significance (p=OA04055).  By monitoring the presence of microbiological and physical-chemical hazards in treated drinking water from the water plant and water system of central water supply infrastructure and sewerage in the City of Novi Sad in 2006 showed the absence of microbiological and physical-chemical hazards in 94.50 percents (p<0.05, 95 percents CI) of controlled samples from a total of 6474 samples of treated drinking water. Identified hazards in 356 (5.50 percents) controlled samples of purified drinking water originating from the water plant and water system of central water supply infrastructure and sewerage in the City of Novi Sad in 2006 were the microbiological in 90 (1.39 percents) (p<0.05, 95 percents CI) and physical-chemical in 266 (4.11  percents) (p<0.05, 95 percents CI) of controlled samples.The results showed that 94.74 percents of No vi Sad population is available of safe drinking water (p<0.05, 95 percents CI) and 88.82 percents of Novi Sad population has resolved the question of removal of liquid waste (p<0.05, 95 percents CI). There are no microbiological, physical and chemical hazards in the drinking water in Novi Sad that contribute to the development of the water transmitted disease. Chance of microbiological, physical and chemical hazards from drinking water may be a contributory factor 4 percents diarrhea (MKB 10: A09, A02, A04, A05, A07, A08) in children aged up to five. Daily monitoring of noise levels in the City of Novi Sad in 2006 indicates that the average annual equivalent daily noise level (LAeq) in the City of  Novi Sad is 68.91dB(A), which is 3.91 dB(A) more than the national and specific standards (65 dB(A)). Determined LAeq of 68.91 dB(A) in the environment of the City of Novi Sad in 2006 was the contributory factor for the incidence of ischemic heart disease (MKB 1 0:120-25) of the adult population in 13.79 percents of cases, respectivly in 1581 cases of the outpatient morbidity and 477 cases of the hospital morbidity. Daily level of noise in the range 65-69 dB(A) in relation to permanent residence in the environment of Novi Sad in exposed population is 38.77 percents, with a contributory factor morbidity from ischemic heart disease (MKB 1 0:120-25) in exposed adult population is 8.26 percents. Estimated exposure to the surveyed population of Novi Sad daily level of noise in the range 70-74 dB (A), in relation to the residence, was 61.23 percents and a contributory factor morbidity from ischemic heart disease (MKBI0:120-25) in exposed adult population amounted to 15.97 percents. Comparing the subjective assessment of the surveyed residents about the most important source of environmental noise, it was found that most respondents (47 percents) considered that the traffic was the most important source of environmental noise, followed by the noise from the neighborhood (23 percents), noise from construction work (21 percents), noise from restaurants (14 percents), noise from the lifts and other electrical wiring (11  percents) and noise originating from industrial facilities (8 percents). Comparing the subjective assessment of the surveyed residents about the traffic as the most significant source of environmental noise, statistically significant differences were found in determining the significance of traffic as a source of noise among all subjects (p=0.0000 11), females (p=0.000016) and age of all subjects (p=0.0066). Noise originating from road traffic makes the need for replacement of housing among the 46 percents of respondents, interfere with television 44 percents of respondents, interferes with reading the newspaper 45 percents of respondents, interferes with conversation 46 percents of  respondents, interferes with daily rest 68 percents of respondents, interferes with mental work 59 percents of respondents, causes significant subjective symptoms during the day 41  percents of respondents and interferes with sleep at night 43 percents of respondents. Conducted survey research finds that daily levels of environmental noise in the city of Novi Sad are disturbing 44 percents of the population and a very disturbing 23 percents of the population.  CONCLUSION: The conducted research indicates that the use of "DPSEEA" system to assess the impact of environmental factors on human health is easy and effective way of presenting the results of the interdependence of health and environmental conditions in the City of Novi Sad. Using "DPSEEA" system in our research has found that the microbiological and physicalchemical hazards in treated drinking water originating from the central city water supply have no impact on the health of people who are connected and use the same water and that the physical and chemical hazards present in the air and environment (noise) affect the human health. It was also found that there is a mutual dependency factor of the environment and the incidence of morbidity and mortality in the population of acute and chronic respiratory diseases, diseases transmitted by water and from cardiovascular disease and that  environmental factors as indicators of impacts on human health are important for prevention and promotion of health among the people

Impact of climate conditions on hospital admissions for subcategories of cardiovascular diseases

Background: The aim of this study has been to examine the association between climate conditions (CC) and hospital admissions for the subcategories of cardiovascular diseases (CVD), according to patients’ age. Material and Methods: From January 2010 through December 2011, the daily number of hospital admissions for angina pectoris (AP), essential hypertension (EH), acute myocardial infarction (AMI) and ischemic heart diseases (IHD) for adults (19–64 years old) and the elderly (≥ 65 years old), as well as for the CC (N = 728 days) was collected for multivariate Poisson regression analysis, confounding with season and weekends. The results were expressed by using the relative risk with the corresponding 95% confidence interval. Results: The risk for the AMI among the adults and the elderly is significantly higher for 41.8% and 38.9%, respectively on the days with lower ambient temperature and lesser for 32.7% and 29.8%, respectively on the days with lower air pressure values. The risk for the IHD among the elderly is significantly higher on the days with lower ambient temperature and lower relative humidity for 50.6% and 37.4%, respectively. Conclusions: Our findings explain how the CC and subcategories of CVD are associated, which could be used for adequate public awareness of the risk for hospitalization due to climate conditions. Med Pr 2017;68(2):189–19

Cardiovascular diseases and air pollution in Novi Sad, Serbia

Objectives: A large body of evidence has documented that air pollutants have adverse effect on human health as well as on the environment. The aim of this study was to determine whether there was an association between outdoor concentrations of sulfur dioxide (SO2) and nitrogen dioxide (NO2) and a daily number of hospital admissions due to cardiovascular diseases (CVD) in Novi Sad, Serbia among patients aged above 18. Material and Methods: The investigation was carried out during over a 3-year period (from January 1, 2007 to December 31, 2009) in the area of Novi Sad. The number (N = 10 469) of daily CVD (ICD-10: I00-I99) hospital admissions was collected according to patients' addresses. Daily mean levels of NO2 and SO2, measured in the ambient air of Novi Sad via a network of fixed samplers, have been used to put forward outdoor air pollution. Associations between air pollutants and hospital admissions were firstly analyzed by the use of the linear regression in a single polluted model, and then trough a single and multi-polluted adjusted generalized linear Poisson model. Results: The single polluted model (without confounding factors) indicated that there was a linear increase in the number of hospital admissions due to CVD in relation to the linear increase in concentrations of SO2 (p = 0.015; 95% confidence interval (95% CI): 0.144-1.329, R2 = 0.005) and NO2 (p = 0.007; 95% CI: 0.214-1.361, R2 = 0.007). However, the single and multi-polluted adjusted models revealed that only NO2 was associated with the CVD (p = 0.016, relative risk (RR) = 1.049, 95% CI: 1.009-1.091 and p = 0.022, RR = 1.047, 95% CI: 1.007-1.089, respectively). Conclusions: This study shows a significant positive association between hospital admissions due to CVD and outdoor NO2 concentrations in the area of Novi Sad, Serbia

What Are the Effects of Meteorological Factors on Exacerbations of Chronic Obstructive Pulmonary Disease?

Chronic obstructive pulmonary disease (COPD) is one of the greatest global public health challenges. Acute exacerbations of COPD lead to the accelerated deterioration of lung function, reduced quality of life, a higher number of hospitalizations, and increased mortality. The factor causing the exacerbation is usually an infectious agent, but the impact of environmental factors is being studied more thoroughly. Among them, meteorological factors are the least examined. Multiple studies have shown that lower temperatures during the cold season, as well as sudden temperature changes regardless of the season, have the most significant negative effect on patients with COPD. However, higher temperatures, especially during summer heatwaves, can also cause COPD exacerbation and it is expected that this will be an even more important health problem in the future considering climate changes. The effects of other meteorological factors on acute exacerbation of COPD, such as atmospheric pressure, solar radiation, rainfall, wind speed, and humidity are far less investigated and opposing results have been obtained in different studies. Thus, there is a need for further research in this area that would result in clinical recommendations and public health interventions that could decrease the global burden of COPD

Salt content in ready-to-eat food and bottled spring and mineral water retailed in Novi Sad

Introduction. Salt intake above 5 g/person/day is a strong independent risk factor for hypertension, stroke and cardiovascular diseases. Published studies indicate that the main source of salt in human diet is processed ready-to-eat food, contributing with 65-85% to daily salt intake. Objective. The aim of this paper was to present data on salt content of ready-to-eat food retailed in Novi Sad, Serbia, and contribution of the salt contained in 100 g of food to the recommended daily intake of salt for healthy and persons with cardiovascular disease (CVD) risk. Methods. In 1,069 samples of ready-to-eat food, salt (sodium chloride) content was calculated based on chloride ion determined by titrimetric method, while in 54 samples of bottled water sodium content was determined using flame-photometry. Food items in each food group were categorized as low, medium or high salt. Average salt content of each food group was expressed as a percentage of recommended daily intake for healthy and for persons with CVD risk. Results. Average salt content (g/100 g) ranged from 0.36±0.48 (breakfast cereals) to 2.32±1.02 (grilled meat). The vast majority of the samples of sandwiches (91.7%), pizza (80.7%), salami (73.9%), sausages (72.9%), grilled meat (70.0%) and hard cheese (69.6%) had a high salt profile. Average amount of salt contained in 100 g of food participated with levels ranging from 7.2% (breakfast cereals) to 46.4% (grilled meat) and from 9.6% to 61.8% in the recommended daily intake for healthy adult and person with CVD risk, respectively. Average sodium content in 100 ml of bottled spring and mineral water was 0.33±0.30 mg and 33±44 mg, respectively. Conclusion. Ready-to-eat food retailed in Novi Sad has high hidden salt content, which could be considered as an important contributor to relatively high salt consumption of its inhabitants

Biomonitoring Study of Toxic Metal(loid)s: Levels in Lung Adenocarcinoma Patients

Lung cancer is a leading cause of cancer deaths worldwide. The aim of this study was to investigate heavy metal(loid)s (Cd, Pb, Hg, Cr, Mn, Mo, Ni, and As) in lung cancer patients in order to elucidate their role as lung cancer environmental risk factors. Sixty-three patients of both sexes with adenocarcinoma stage IIIB or IV were enrolled in this research. The heavy metal(loid) urine concentrations were measured using ICP-MS. Arsenic was quantified above 10 μg/L in 44.44% of the samples. Nickel urinary concentrations above the ToxGuide reference levels were found in 50.79% of the samples, while lead was quantified in 9.52% of the urine samples. The urinary chromium levels were above the mean ToxGuide levels in 41.27% of the patients and were significantly higher in men in comparison with women (p = 0.035). The chromium urinary concentrations were positively associated with the CRP serum levels (p = 0.037). Cadmium was quantified in 61.90% of the samples with levels significantly higher in females than in males (p = 0.023), which was associated with smoking habits. Mercury was measured above the limit of quantification in 63.49% of the samples and was not associated with amalgam dental fillings. However, the Hg urinary concentrations were correlated positively with the ALT (p = 0.02), AST (p p < 0.001) serum levels. In 46.03% of the samples, the Mo concentrations were above 32 μg/L, the mean value for healthy adults according to the ToxGuide, and 9.52% of the patients had Mn levels higher than 8 μg/L, the reference value for healthy adults based on ToxGuide data. The obtained results are preliminary, and further studies are needed to have a deeper insight into metal(loid) exposure’s association with lung cancer development, progression, and survival prediction