1 ZEUS GmbH, Centre for Applied Psychology, Environmental and Social Research, Sennbrink 46, 58093 Hagen, Germany, schreckenberg@zeusgmbh.de 2 Institute of Hygiene and Environmental Medicine, Justus-Liebig-University Giessen, Friedrichstr. 16, 35392 Giessen, Germany, thomas.eikmann@hygiene.med.uni-giessen.de, caroline.herr@hygiene.med.uni-giessen.de, anja.z.nieden@hygiene.med.uni-giessen.de 3 Sozialwissenschaftliches Umfragezentrum GmbH, Gallenkampstr. 20, 47051 Duisburg, Germany, frank.faulbaum@uni-due.de 4 TU Dresden, Institute and Outpatient Clinics of Occupational and Social Medicine (IPAS), Mommsenstrase 13, 01062 Dresden, Germany; andreas.seidler@mailbox.tu-dresden.de 5 TU Kaiserslautern, Psychology I, Gottlieb-Daimler-Strasse, 67663 Kaiserslautern, Germany, klatte@rhrk.uni-kl.de 6 Horzentrum Oldenburg GmbH, Marie-Curie-Str. 2, 26129 Oldenburg, Germany, m.meis@hoerzentrum-oldenburg.de 7 Mohler & Partner Ingenieure AG, Paul-Heyse-Strase 27, 80336 Munchen, Germany, ulrich.moehler@mopa.de 8 German Aerospace Center, Flight Physiology Department, Linder Hohe, 51147 Cologne, Germany, uwe.mueller@dlr.de 9 University Medical Center Dresden, Blasewitzer Str. 86, 01307 Dresden, Germany, jochen.schmitt@uniklinikum-dresden.de 10 University Magdeburg, Institute for Social Medicine and Health Economics, Leipziger Str. 44, 39120 Magdeburg, Germany, enno.swart@med.ovgu.de 11 Bremen Institute for Prevention Research and Social Medicine (BIPS), Achterstrasse 30, 28359 Bremen, Germany, zeeb@bips.uni-bremen.de 12 Ruhr-University Bochum, Dep.of Psychology, WG Environment & Cognition, 44780 Bochum, Germany, rainer.guski@rub.de

Studies suggest adverse health effects following exposure to bioaerosols in the environment and in particular at workplaces. However, there is still a lack of health-related exposure limits based on toxicological or epidemiological studies from environmental health or from the working environment. The aim of this study was to derive health-based exposure limits for bioaerosols that can protect the general population as group “at risk” via environmental exposure using analysis of peer-reviewed studies related to occupational medicine, indoor air and environmental health. The derivation of exposure limits should be conducted by the members of a bioaerosol expert panel according to established toxicological criteria. A systematic review was performed in Medline (PubMed) including studies containing both data on exposure measurements and observed health outcomes. In addition, literature recommended by the experts was considered. A comprehensive search strategy was generated and resulted in a total of n=1569 studies in combination with the literature recommendations. Subsequently, abstracts were screened using defined exclusion criteria yielding a final number of n=44 studies. A standardized extraction sheet was used to combine data on health effects and exposure to different bioaerosols. After full-text screening and extraction according to the defined exclusion criteria n=20 studies were selected all related to occupational exposures comprising the working areas wood processing, farming, waste processing and others. These studies were analyzed in collaboration with the bioaerosol expert network in terms of suitability for derivation of health-related exposure limits. The bioaerosol expert network concluded that none of the analyzed studies provided suitable dose–response relationships for derivation of exposure limits. The main reasons were: (1) lack of studies with valid dose–response data; (2) diversity of employed measuring methods for microorganisms and bioaerosol-emitting facilities; (3) heterogeneity of health effects; (4) insufficient exposure assessment. However, several indicator parameters and exposure concentrations could be identified for different bioaerosol-emitting facilities. Nevertheless, health-related exposure limits are urgently needed especially in approval procedures of facilities like composting plants or livestock farms emitting bioaerosols in the neighbourhood of residents. In the regulatory toxicology framework, it is common to use animal experimental studies for derivation of general exposure limits if appropriate environmental epidemiological studies on harmful substances are lacking. This might be another possibility to obtain health-related exposure limits for specific bioaerosol parameters. Furthermore, we recommend to use suitable measurable outcome parameters related to bioaerosols; to measure bioaerosols according to a protocol representative for exposure pattern and duration at the particular work place; to develop standardized detection methods for indicator parameters; to combine different detection methods to compensate for the limitations of each method; to apply new analysis methods to identify the real risk potential.

Hintergrund: Umweltmedizinische Studien belegen, dass es im Einflussbereich von bioaerosolemittierenden Anlagen zu gesundheitlichen Wirkungen wie Allergien oder Infektionen kommen kann. Dennoch sind für Bioaerosole im Außenluftbereich weder Dosis-Wirkungs-Beziehungen bekannt noch existieren Grenzwerte. Zielsetzung: Im Projekt GABi (Gesundheitsbasierte Ableitungswerte Bioaerosole) sollten deshalb aus den Ergebnissen von wissenschaftlichen Studien zusammen mit einem Expertennetzwerk gesundheitsbezogene Beurteilungswerte für Bioaerosole abgeleitet werden. Mangels genügend geeigneter umweltepidemiologischer Studien sollte wie in der Toxikologie üblich auch auf Arbeitsplatz- und Innenraumstudien zurückgegriffen werden. Methoden: Eine systematische Literatursuche in Medline (PubMed) wurde durchgeführt und Studien einbezogen, die Zusammenhänge zwischen Exposition (Luftmessungen) und Wirkung (Gesundheitseffekte) untersuchten. Zusätzlich wurden Literaturempfehlungen der Experten berücksichtigt. Die Ableitung sollte nach toxikologischen, infektiologischen und allergologischen Kriterien durch die Experten erfolgen. Ergebnisse: Die Literatursuche erbrachte zusammen mit den Literaturempfehlungen n = 1565 Studien. Das anschließende Abstract-Screening mit definierten Ausschlusskriterien führte zu einer Eingrenzung auf n = 44 Studien. Ein standardisiertes Extraktionssheet wurde erstellt, mit dessen Hilfe eine Zusammenstellung und Zuordnung der gesundheitlichen Wirkungen zu den Expositionsdaten verschiedener Bioaerosole erfolgte. Nach dem Volltextscreening und der Extraktion gemäß der definierten Ausschlusskriterien wurden n = 20 Studien ausgewählt, die fast ausschließlich aus der Arbeitsmedizin stammten und vor allem die Bereiche Landwirtschaft, Abfallwirtschaft und Holzverarbeitung umfassten. In Expertentreffen wurden die Studien hinsichtlich ihrer Datenqualität und Eignung als Schlüsselstudie geprüft. Vor allem das Fehlen geeigneter Umweltstudien und belastbarer Expositionsdaten wurden kritisiert. Als Fazit der Expertentreffen wurde festgestellt, dass keine der bisher veröffentlichten Humanstudien die Kriterien für eine Ableitung gesundheitsbezogener Beurteilungswerte erfüllt und geeignete Dosis-Wirkungs-Beziehungen enthält. Allerdings konnten potentielle Leitparameter und Expositionskonzentrationen für die verschiedenen Arbeitsbereiche identifiziert werden. Schlussfolgerungen: Weitere Forschungsarbeiten zur Etablierung gesundheitsbezogener Beurteilungswerte sind erforderlich. In einem Folgeprojekt ist die Analyse von tierexperimentellen Studien zur Ableitung von allgemeinen Grenzwerten geplant. LGL-ÖGD

It is well known from occupational and environmental medicine that adverse health effects may occur as a result of exposure to bioaerosols. However, there is still a lack of health-related measure values based on the knowledge gained from toxicological, environmental-medical, or epidemiological studies. The project GABi (Gesundheitsbasierte Ableitungswerte Bioaerosole) is aimed on the development of health-related guideline levels for bioaerosols by the analysis of research studies, investigations, and reports related to occupational medicine, indoor air and environmental health in collaboration with the Bioaerosol-Expert-Network. To this, a systematic review of the literature is conducted in Medline (Pub Med) including both studies containing data to the exposure (aerosol measurements) and health effects in the same paper. In addition, literature recommended by the experts is considered. The development of measure values is conducted by the experts according to toxicological and allergological criteria. A comprehensive search strategy was generated and resulted in n = 1.537 studies in Medline and in combination with the literature recommendations in n = 1.565 after removal of duplicates. Subsequently, an abstract screening was conducted using defined exclusion criteria leading to a final number of n = 99 studies. Moreover, endotoxin and beta-glucan studies (n = 45), but also children's studies (n = 10) were excluded. Furthermore, a standardized extraction sheet for collection and correlation of health effects to exposure data of different bioaerosols was generated. The results of the literature review constitute the basis for the identification of key studies and the determination of dose-related health effects for relevant classes of microorganisms. The actual state of the study regarding evaluation is presented.

Environmental medical relevance of molds in living environment Fungi, their spores and/or other fungal components are inhaled and can induce irritating symptoms of the mucous membranes (mucous membrane irritation (MMI), sometimes called as mucous membrane irritation syndrome (MM IS)) and/or allergic reactions. In addition, unspecific complaints like head-ache and fatigue are often attributed to mold exposures by affected persons. Symptoms of allergic disorders are mainly similar to hay fever or asthma bronchiale with dyspnea and cough. Severe toxic effects (organic dust toxic syndrome (ODTS)) can be observed in case of very high mold concentrations usually not occurring indoors except for certain workplaces. Rarely, fungi can induce infections in certain risk groups like strongly immunosuppressed persons. Indoor air mold exposure is critical from a hygienic preventative point of view despite the fact that is currently impossible to identify in individual cases a definitively causal relationship between indoor mold exposure and specific health disorders.

1 ZEUS GmbH, Centre for Applied Psychology, Environmental and Social Research, Sennbrink 46, 58093 Hagen, Germany, schreckenberg@zeusgmbh.de 2 Institute of Hygiene and Environmental Medicine, Justus-Liebig-University Giessen, Friedrichstr. 16, 35392 Giessen, Germany, thomas.eikmann@hygiene.med.uni-giessen.de, caroline.herr@hygiene.med.uni-giessen.de, anja.z.nieden@hygiene.med.uni-giessen.de 3 Sozialwissenschaftliches Umfragezentrum GmbH, Gallenkampstr. 20, 47051 Duisburg, Germany, frank.faulbaum@uni-due.de 4 TU Dresden, Institute and Outpatient Clinics of Occupational and Social Medicine (IPAS), Mommsenstraße 13, 01062 Dresden, Germany; andreas.seidler@mailbox.tu-dresden.de 5 TU Kaiserslautern, Psychology I, Gottlieb-Daimler-Strasse, 67663 Kaiserslautern, Germany, klatte@rhrk.uni-kl.de 6 Hörzentrum Oldenburg GmbH, Marie-Curie-Str. 2, 26129 Oldenburg, Germany, m.meis@hoerzentrum-oldenburg.de 7 Möhler & Partner Ingenieure AG, Paul-Heyse-Straße 27, 80336 München, Germany, ulrich.moehler@mopa.de 8 German Aerospace Center, Flight Physiology Department, Linder Höhe, 51147 Cologne, Germany, uwe.mueller@dlr.de 9 University Medical Center Dresden, Blasewitzer Str. 86, 01307 Dresden, Germany, jochen.schmitt@uniklinikum-dresden.de 10 University Magdeburg, Institute for Social Medicine and Health Economics, Leipziger Str. 44, 39120 Magdeburg, Germany, enno.swart@med.ovgu.de 11 Bremen Institute for Prevention Research and Social Medicine (BIPS), Achterstrasse 30, 28359 Bremen, Germany, zeeb@bips.uni-bremen.de 12 Ruhr-University Bochum, Dep.of Psychology, WG Environment & Cognition, 44780 Bochum, Germany, rainer.guski@rub.de

Einleitung: Zahlreiche Studien wurden publiziert zu möglichen Auswirkungen einer Fluglärmbelastung auf die Gesundheit der Anwohner. Die Studien unterscheiden sich erheblich in der Zahl der Probanden, der Untersuchungsmethoden, der Kontrolle nach weiteren Einflussfaktoren sowie der Expositionsermittlung. Nachfolgend wird über die Auswertung der Fragen zur Gesundheit im Rahmen der Belästigungsstudie im Umfeld des Frankfurter Flughafens berichtet.

In 1997, a cross sectional study aimed to relate self-reported health to measurable, malodorous bioaerosol pollution in the residential outdoor air. This first cross-sectional survey was the baseline for a five-year follow-up investigation. The analysis investigated associations of reported complaints and bioaerosol pollution with regard to gender-specific differences in the course of the follow-up. The study group consisted of 214 participants of a bioaerosol exposed residential area and 142 unexposed controls. The questionnaires were assessed in 1997 (baseline), 1999, and 2002, whereas the source of the bioaerosol pollution (a large-scale composting site) was closed shortly after the baseline investigation. Participants filled in a set of questionnaires including the screening for somatoform complaints (SOMS), health-related quality of life (SF-36), as well as questions to assess odor annoyance. As expected, complaints were reported more frequently in the exposed study group than in the control group. The rate of complaints by women decreased stronger than the rate of complaints by men with the closing of the large-scale composting site. The results demonstrated gender-related differences in the assessment of reported health in an environmental health study.

Literature published between 2000 to 2004 concerning electromagnetic fields (EMF) of mobile communication and electromagnetic hypersensitivity (EHS) or unspecific symptoms of ill health, respectively, is reviewed. Basically, literature from established databases was systematically searched for. For each study, the design and quality were evaluated by means of a criteria list in order to judge evidence for causality of exposures on effects. Finally, 13 studies of sufficient quality were considered for this review. In only one provocation study, individuals with self-reported electromagnetic hypersensitivity were exposed to EMF. Their perception of field status was no better than would have been expected by chance. Results of five randomised cross-over studies on impaired well-being due to mobile phone exposure were contradictory. Even though these studies would allow more reliable exposure assessment, they are limited due to short exposure period and the small study size. No firm conclusion could be drawn from a few observational epidemiological studies finding a positive association between exposure and unspecific symptoms of ill health due to methodological limitations. Causality of exposure and effect was not derivable from these cross-sectional studies as field status and health complaints were assessed at the same time. In addition, exposure assessment has not been validated. In conclusion, based on the limited studies available, there is no valid evidence for an association between impaired well-being and exposure to mobile phone radiation presently. However, the limited quantity and quality of research in this area do not allow to exclude long-term health effects definitely.

ISEE-172 Introduction: Evaluating public health relevance of an industrial source is complicated if the source in question leads to annoyance due to environmental odours. As worry is expected to arise with perception of environmental odours, higher rates of reported health complaints are expected in those exposed. Aim: In the process of evaluating an industrial source it would be favourable to consider effects of annoyance due to environmental factors, as well as environmental worry on reported health, separately from those attributed to actual organic impairment. Methods: Reported bodily complaints (47 single bodily complaints for which the subject’s house physicians had found no explanation, SOMS 2 questionnaire acc. to Rief et al. 1997) and environmental worry (scale acc. to Hodapp et al. 1996) were assessed in questionnaire based interviews in residents living near large scale composting sites. These sites were causing considerable odour annoyance. Microbiological measurements were performed in residential air, assuring that health relevant bioaerosol pollution (determination of viable microorganisms in residential air) did not occur in the neighborhood. With logistic regression (SPSS version 11.5) adjusted (age, gender, education) odds ratios (OR) were calculated for single bodily complaints, sum of bodily complaints (complaints index) being >4 in a basic model for residents near composting sites in association to their reported odour annoyance. In a second step, environmental worry was included in the model. Results: 130 subjects were included in the study, 67% reported being annoyed by residential odour. In odur annoyed residents, odds ratios were elevated for reporting single complaints: nausea [OR 4.07, 95% Confidence interval (CI) 1.11, 14.97], headache [OR 3.21, 95% CI 1.25, 8.25], intolerance of food [4.10, 95% CI 0.87, 19.34], dryness of mouth [OR 8.62, 95% CI 0.98, 75.92], hot or cold sweating [4.32, 95% CI 0.82, 22.86] as well as complaints index of >4: [OR 2.56, 95% CI 1,07, 6.12] in the basic model. When further adjustment was performed for individual environmental worry, OR for complaints associated with odour annoyance decreased and were considerably weaker for general unspecific complaints: headache [OR 2.38, 95% CI 0.89, 6.38], dryness of mouth [OR 5.77, 95% CI 0.61, 54.69], sweating [OR 4.32, 95% CI 0.82, 22.86] as well as complaint index being >4 [OR 2.18, 95% CI 0.87, 5.43], while OR for nausea increased, OR [4.39, 95% CI 1.10, 17.59]. Conclusion: This study was able to discriminate between environmental odour annoyance and worry, in association with reported health status in residents near an odorous industrial source. Association between individual odour annoyance and complaint rates decreased clearly once individual worry was considered. Possible health effects of microbial pollution from the composting sites did not need to be considered, on the basis of prior measurements showing no relevant bioaerosols pollution. From this it can be deduced that in situations where environmental annoyance (e.g. due to an industrial source) is inevitable, risk communication and public information leading to a decrease in environmental worry may improve individual perception (and reports) of health status in affected subjects. This in turn may lead to better acceptance of the environmental source in question.