Although exposure to high levels of microbial bioaerosols can be linked to the deterioration of the human respiratory system, precise exposure levels responsible for such effects are still unknown. A previous systematic review concluded that there was not enough information in the studies in humans to derive an exposure-response relationship. Thus, the aim of this systematic review was to derive exposure limits for microbial bioaerosols based on health effects in experimental animal studies. A systematic search was done in MEDLINE (PubMed) for long-term in vivo exposure of the respiratory system via inhalation of a quantified microbial bioaerosol. A total of n = 301 studies were retrieved. Abstract screening using predefined inclusion and exclusion criteria was followed by full-text screening and standardized data extraction of study characteristics and measured outcomes. As a result, four suitable studies were identified where mice or guinea pigs were exposed for 4-12 weeks to a previously described mixture of fungal spores or conidia via inhalation. The number of macrophages, neutrophils, eosinophils and lymphocytes following subchronic exposure has been reported by all included papers and suggested a dose- and time-dependent relationship. Significant inflammation was observed following subacute exposure to Aspergillus fumigatus. However, the outcomes of the studies could not be directly compared due to the large degree of variation and poor description of the exposure conditions. It is our conclusion that more experimental research needs to be done with the specific aim of establishing a No-ObservedAdverse-Effect Level (NOAEL) and a Lowest-Observed-Adverse-Effect Level (LOAEL) for exposure to microbial bioaerosols in ambient air. Expertise of both exposure and outcome assessment should be brought together to enable standardization of experimental animal studies with properly generated aerosols aiming to derive health-based exposure limits.

Introduction: Based on the concept that noise may trigger repeatedly unavoidable autonomous physiological reactions, which each can cause an increase of blood pressure, the study examined the effects of chronic aircraft noise on self-measured blood pressure (SBPM). Methods: Study region includes areas near a large airport within the 40 dB(A) equivalent continuous sound level contours of aircraft noise for day and night-time, targeting on voluntary adults residing in the defined region. Noise exposure (equivalent continuous sound level LpAeq,18-06h) of the 12 months ahead of measurements was assigned to respective addresses of participants. Telemedical blood pressure devices handed to study participants were issued for SBPM. After being trained, participants performed 2 daily measurements for a 21-day period. Ahead of coaching, a questionnaire with reference to current health, medications, lifestyle, individual factors, as well as noise sensitivity was completed. Multiple linear regression model was calculated to investigate the association between the LpA,eq,18-06h and main outcome systolic BP including age, gender, social status, pack years, and physical activity. Results: Data analyses included n=844 (58.4% w; 41.6% m). BP values (mean of morning readings [mmHg]) were systolic/diastolic 118.1/72.3 in women and 125.4/78.8 in men. Multiple linear regressions result [mmHg×dB-1] b=0.11; 95%CI [-0.01;0.23] for systolic and b=0.06; 95%CI [-0.04; 0.16] for diastolic values. Conclusions: The results of our study － small positive effect estimators without statistical significance － are overall comparable to previously conducted scientific research concerning air traffic noise and continuous BP values. However, no statistically significant correlations between air traffic noise and hypertension as in the HYENA study were found. A direct quantitative comparison with the results of this study may be allowed only to a limited extent, due to methodical differences.

Introduction: Studies suggest adverse health effects following exposure to bioaerosols in the environment and at the workplace. However, there is still a lack of health-related exposure limits. Objectives: The aim of the project was to derive health-related exposure limits for bioaerosols by analysis of (a) human studies and (b) animal studies regarding inhalation experiments in separate reviews in collaboration with a bioaerosol expert network. Methods: Two systematic reviews of studies including data on exposure and health effects in the same manuscript were carried out in Medline (Pubmed). Exposure limits should be derived by the experts according established approaches in regulatory toxicology. Results: Different search strategies were developed and resulted in n=1,565 human studies, n=138 animal studies following fungal exposure and n=163 animal studies following bacterial exposure. Subsequently, abstracts were screened using defined exclusion criteria. After full-text screening n=20 human studies were selected all related to occupational exposures. The screening of experimental animal studies resulted in four fungal studies and one bacterial study. Data on health effects and exposure was extracted using standardized extraction sheets. The studies were evaluated in collaboration with the experts. None of the human studies provided suitable dose-response relationships for derivation of exposure limits. The main reasons were: lack of studies with valid dose-response data; diversity of employed measuring methods for microorganisms and bioaerosol-emitting facilities; heterogeneity of health effects; insufficient exposure assessment. The experimental animal studies are currently under evaluation. Conclusions: Our results revealed that despite the documented health effects derivation of exposure limits for bioaerosols based on to date available human studies remain a matter of rough estimation. The analysis of experimental animal studies is in progress.

NORAH (Noise Related Annoyance, Cognition and Health) is a monitoring program on transportation noise in the vicinity of Frankfurt Airport. It includes three work packages on noise annoyance, health related quality of life (HQoL), cardio-vascular health diseases of adults, and cognition and HQoL in children. Cross-sectional, case-control and longitudinal sub-studies with a wide range of methods for the assessment of the transportation noise effects in adults and children are applied: Interviews, psychological tests, physiological measurements, and secondary data analysis combined with a case-control study. The monitoring program for blood pressure (BPM) is designed as a longitudinal study (phase one in 12/13, follow-up 13/14) aiming to analyze, whether blood pressure (averaged over measurements within 14 consecutive days out of 21-day-period) as well as the risk of cardio-vascular diseases in total is associated with aircraft noise exposure, road traffic and railway noise and whether the changes in the flight operations due to the airport expansion correspond with changes in the average blood pressure over time. Participants (n=2000) are trained to assess their blood pressure in the morning and evening on 21 days. In addition, they fill in a questionnaire on cardio-vascular risk factors at the beginning of the measurements. The same participants are asked to repeat this measurement in the follow-up one year later. The devices used for measuring blood pressure are fitted with an integrated Bluetooth module, which wirelessly sends the measured values to a cell phone, that in turn forwards the received values (real time) to a secure online database, using a protected internet connection (SSL encryption). Medical staff is monitoring the values to ensure frequency of the measurements and giving feedback to participants. The NORAH Study will be carried out from 2011 to 2014 by commission of the Envi- ronment & Community Center / Forum Airport & Region, Kelsterbach, Germany.

Zusammenfassung Im Beitrag1) wird das Konzept und die Methodik einer unter der Bezeichnung NORAH (Noise-Related Annoyance, Cognition, and Health) laufenden umfangreichen Studie zur Wirkung von Verkehrslarm (Flug-, Schienen- und Strasenverkehrslarm) vorgestellt. Die NORAH-Studie wurde anlasslich der Diskussionen um den Ausbau des Frankfurter Flug hafens von der Gemeinnutzigen Umwelthaus GmbH, Kelsterbach, einer 100%igen Tochter des Landes Hessen, nach europaweiter Ausschreibung im April 2011 an ein interdisziplinares Forschungskonsortium, koordiniert von der Ruhr-Universitat Bochum und der ZEUS GmbH, Hagen, vergeben. Die Untersuchung wird vornehmlich in der Rhein-Main-Region sowie daruber hinaus an den Flughafen Berlin-Brandenburg, Koln-Bonn und Stuttgart durchgefuhrt. Die Studie umfasst Langs- und Querschnittsuntersuchungen und eine epidemiologische Fall-Kontroll-Studie, in denen ein Methodenmix, bestehend aus akustischen Berechnungen und Messungen der Verkehrslarmexposition, Befragungen, physiologischen Messungen, psychologischen Testverfahren sowie Sekundardatenanalysen von Krankenkassendaten zum Einsatz kommt.

PP-30-066 Background/Aims: General population is exposed to phthalates like DEHP through nutrition, consumer products, and medical devices. Oral intake is assumed to be the main pathway of this exposure. Aim of the presented analysis was to identify associations of phthalate metabolites and nutrition in a group of volunteers. Methods: Male patients of an andrological clinic, students, and a music class of an adult education centre were asked to complete a questionnaire concerning type and frequency of food consumption. Spot urine samples were collected to determine phthalate exposure. We analyzed primary and secondary metabolites of DEHP: MEHP, 5OH-MEHP, 5oxo-MEHP, 5cxMEHP in each sample. Crosstabs (χ2 testing) and regression models adjusted for age and BMI were employed to identify associations between the sum (cΣDEHP4) of the metabolites classified in quartiles and the dichotomized frequency of food consumption. Results: For cΣDEHP4 median (μg/L) in the study group (n = 399; age: median = 34 years; 5.5% women; BMI = 25.5) was 37.95. Crosstabs showed significant higher rates of frequent consumption (>once a week) of “black tea (day before probe)” (P = 0.047), “meat” (P = 0.024), and “smoked and processed meats” (0.004) related to cΣDEHP4 ≥75th percent (67.51 μg/L), while “salad and vegetables” (P = 0.002) and “fresh fruits” (0.003) to cΣDEHP4 ≤25th percent (18.68 μg/L). None of the other parameters (snacks, milk/milk-products, drinks, etc) were related to high cΣDEHP4. Regression analysis found associations for “meat” and high cΣDEHP4, while high BMI-values were associated inversely. Conclusion: The association between high cΣDEHP4 and frequent consumption of meat/processed meat could be attributed to production and packaging processes, where DEHP's lipophilic character might be important. This is confirmed by the results for salad/vegetable/fruit. The inverse effect of BMI on MEHP described elsewhere could also be confirmed for the sum (cΣDEHP4). However, due to the structure of study group (94.5% male) the results should be considered as preliminary and further systematic investigation, eg, with nutrition protocols in a survey are needed.

In a survey of 2,312 residents living near Frankfurt Airport aircraft noise annoyance and disturbances as well as environmental (EQoL) and health-related quality of life (HQoL) were assessed and compared with data on exposure due to aircraft, road traffic, and railway noise. Results indicate higher noise annoyance than predicted from general exposure-response curves. Beside aircraft sound levels source-related attitudes were associated with reactions to aircraft noise. Furthermore, aircraft noise affected EQoL in general, although to a much smaller extent. HQoL was associated with aircraft noise annoyance, noise sensitivity and partly with aircraft noise exposure, in particular in the subgroup of multimorbid residents. The results suggest a recursive relationship between noise and health, yet this cannot be tested in cross-sectional studies. Longitudinal studies would be recommendable to get more insight in the causal paths underlying the noise-health relationship.

In October 2002 German physicians appealed to persons in the field of health care, politicians and the public with "great concern" ("Freiburger Appell", "Appeal of Freiburg") claiming "soaring incidences of symptoms and diseases in the general population" to be causally related to the "commence of radio (wave) burden", i.e. due to mobile radio technology. This first example was followed by several further appeals published nationally and Europe-wide up until today. The aim of the present paper is an evaluation of the scientific literature and databases to check incidence and prevalence of symptoms and diseases stated in the appeals to have "dramatically increased" or to have appeared in "greater frequency" in adults. If the allegations were true a clear time-trend should show up since the start of widely-used mobile communication technology. The following health conditions were considered: Alzheimer's disease, dementia, sleep disturbances, tinnitus, cerebrovascular disease, ischemic heart-diseases, headache, migraine. Data on the incidence of these conditions were assessed from 1993 through at least 2005. For this, a systematic search by keywords was performed in the online-database of the National Library of Medicine (pubmed) and other national and international (European and US) databases. For none of the considered symptoms or diseases a "dramatic increase" was found to have occurred since 1993. Because of the different diagnoses and terms used in the studies, direct comparability is somewhat difficult. Indeed, with the data available no time related increases and surely no "dramatic increase" can be identified, even if the limited comparability is considered. This analysis strongly suggests that the allegations of the quoted appeals are not supported by public health data.

INTRODUCTION:Phthalates are suspected to act as endocrine modulators in humans and exert reproductive toxicity. The general population is exposed to phthalates through nutrition, consumer products, medications and medical devices. The aim of the present study is to explore whether internal phthalate exposure represented by metabolites of di(2-ethylhexyl) phthalate (DEHP) can be related to human markers of reproductive function (i.e. semen concentration, motility and morphology). METHODS:We recruited 349 men who were part of subfertile couples and were referred for fertility work-up between April 2004 and November 2005. Semen analysis was performed according to recommendations of the World Health Organization (WHO). Parameters were dichotomized based on 1999 WHO reference values for sperm concentration (<20million/ml) and motility (<50% sperm with progressive motility), as well as Tygerberg strict criteria for morphology (<4% normal forms). We analyzed internal DEHP exposure in single spot urine samples by determining its secondary metabolites mono(2-ethyl-5-oxo-hexyl)phthalate (5oxo-MEHP), mono(2-ethyl-5-hydroxyhexyl)phthalate (5OH-MEHP) and 5carboxy-mono(2-ethylhexyl)phthalate (5cx-MEPP) next to the monoester metabolite mono(2-ethylhexyl)phthalate (MEHP). Logistic regression was performed for the three semen parameters (concentration, motility, and normal morphology) to estimate their dependence on the sum of the four DEHP metabolites (DEHP-4) under consideration. Adjustment was performed for age, duration of abstinence, and smoking status. RESULTS:DEHP metabolites of n=349 men (age: median=34ys) were analysed. Median concentrations [microg/l] were MEHP (n=337) 4.35, 5OH-MEHP (n=341) 12.66, 5oxo-MEHP (n=341) 9.02, and 5cx- MEPP (n=292) 14.53. Semen parameters of n=349 men were analysed by logistic regression. Semen concentration (<20mio/ml: 35%) or sperm motility (WHO A+B <50%=20%) were not found to be associated statistically significantly with the sum the DEHP metabolites (DEHP-4). DISCUSSION:Metabolites of DEHP and other phthalates analyzed in urine are very specific for determining recent internal phthalate exposure. According to our evaluation human reproductive parameters from semen analyses do not show significant associations with concentrations of DEHP metabolites determined in spot urine sampled at the day of andrological examination.

In-hospital surveillance of surgical site infections (SSI) was conducted on 599 patients in a German university hospital. On a subgroup of 342 patients, SSI was assessed after discharge from hospital based on data of a questionnaire and telephone interviews. Postdischarge surveillance revealed substantially higher infection rates than in-hospital surveillance. From assessment of single questionnaire items, a model of a 3-item questionnaire for surveillance of SSI is proposed.

This chapter contains sections titled: Clinical Environmental Medicine Assessment of Health Complaints Environmental Attribution Case History Exposure Assessment and Evaluation Biomonitoring Effect and Susceptibility Monitoring On-site Inspection Ambient Monitoring Interdisciplinary Clinical Diagnostics Evaluation of Clinical Cases Conclusions

The aim of this article was to re-evaluate and possibly modify the standardized Environmental Worry Scale (EWS) by Hodapp et al. [1996. Evaluation eines Fragebogens zur Erfassung von Umweltbesorgnis. Z. Gesundheitspsychologie IV(1), 22–36] with regard to its content and structure. In order to do this, 161 participants were chosen as a reference group to take part in a survey. The data were analyzed and a factor analysis yielded two instead of one component of worry, namely “personal” and “general” environmental worry, leading to a new evaluation method. This revised evaluation method was then applied to patients (n=227) with or without self-reported multiple chemical sensitivity (MCS) and thus used in the context of reported health complaints. The outlined results indicate that the assessment of worry as proposed by Hodapp et al. [1996. Evaluation eines Fragebogens zur Erfassung von Umweltbesorgnis. Z. Gesundheitspsychologie IV(1), 22–36] should be elaborated by the newly developed evaluation method with which a ratio determined by “personal” and “general” worry can be calculated. In addition to analyzing the absolute quantity of worry, the calculated ratio allows to draw conclusions on the structure of worry. It will be discussed to what extent the results present new insights into the role of worry among patients suffering from environmental diseases.

In this multicentre Study on Multiple chemical sensitivity (MCS) 291 Consecutive environmental medicine (FM) outpatients were examined in several environmental medicine outpatient centres/units throughout Germany in 2000/2003. Of the EM outpatients, 89 Were Male (30.6%) and 202 were female (69.4(%), aged 22-80 (mean 48 years, S.D. = 12 years). The sample was representative for university-based environmental outpatient departments and represented a cross-sectional study design with in integrated clinical-based case-control comparison (MCS vs. non-MCS). Three classifications of MCS were used: self-reported MCS (sMCS), clinically diagnosed MCS (cMCS), and formalised computer-assisted MCS with two variants (f1MCS, f2MCS). Data were collected by means of an environmental medicine questionnaire, psychosocial questionnaires, the German version of the Composite International Diagnostic Interview (CIDI). and a medical baseline documentation. as well as special examinations in partial projects on olfaction and genetic Susceptibility markers.The hypothesis guided evaluation of the project showed that the patients heterogenic health complaints did not indicate a characteristic set of symptoms For MCS. No systematic Connection Could be observed between complaints and the triggers Implicated, nor was there any evidence for a genetic predisposition or obvious disturbances of the olfactory system. The standardised psychiatric diagnostics applying CIDI demonstrated that the EM patients in general and the subgroup With MCS ill particular suffered more often from mental disorders compared to an age and gender matched sample of the general population and that in Most patients these disorders commenced many years before environment-related health complaints.Our results do not support file assumption of a toxicogenic-somatic basis of the MCS phenomenon. In contrast, numerous indicators for the relevance of behavioural accentuations, psychic alterations or psychosomatic impairments were found in the group of EM-outpatients With Subjective "environmental illness". (C) 2008 Elsevier GmbH. All rights reserved.

In patients attributing their health complaints to environmental factors (EnvPat) evidence based medical diagnostics usually do not confirm environmental and somatic causes of symptoms. Many symptoms remain unexplained. Aim of the study was the systematic assessment of medically unexplained physical symptoms (MUPS) in EnvPat and comparison to symptom rates reported by subjects of an environmental study exposed to environmental odors (EnvExp). This specific exposure was chosen, as odors are associated by an unclear mechanism with physical symptoms. By this we aimed to enlighten the open question as to likeliness that MUPS of EnvPat are caused by hitherto unrevealed environmental exposures or result from somatization. MUPS were measured with SOMS-2 in EnvPat n=92, patients presenting in a university environmental outpatients clinic, and different study groups exposed to environmental odors (EnvExp). These were: (1) subjects exposed to annoying odors and medically relevant concentrations of bioaerosols, such as airborne microorganisms (EnvExp-1, n=74), and (2) subjects exposed to odors alone (EnvExp-2, n=282) as well as unexposed controls (Controls, n=235). Logistic regression and analysis of variance were applied to analyze rates of single complaints and the sum index of complaints (SOMS-CoIx). In EnvPat rates of MUPS were highest – significant (p<0.05) adjusted OR in 23 of 25 MUPS compared to controls – and highest SOMS-CoIx (mean 15.3 (S.D. ±9.3). Rates of MUPS were lower in environmentally exposed subjects with difference in the two strata: while EnvExp-1 differed in several complaints, i.e., nausea and SOMS-CoIx (mean 7.2, S.D. ±6.9) from controls (p<0.05), EnvExp-2 (SOMS-CoIx mean 4.8, S.D. ±5.2) showed relevant differences only in two single complaints and not in the SOMS-CoIx from controls, SOMS-CoIx mean 3.9, S.D. ±5.0. This remained when adjusting for age, gender, and school education. Rates of MUPS in environmental patients were clearly higher than in subjects with actual environmental exposure, making it unlikely that their symptoms are due to undetected environmental factors. MUPS of EnvPat show similarities to psychosomatic patients. In the environmental survey symptom assessment by SOMS-2 was sensitive to different environmental scenarios, i.e., higher rates of physical complaints were only found in subjects with hazardous residential bioaerosols pollution as well as an annoying odor exposure and interestingly not in subjects exposed to annoying odors alone. This underlines that questionnaire data of somatic complaints need to be interpreted on the basis of exposure assessment in order to unjustly attribute health complaints to annoyance.