Transcript Presentation-Schoeters 28.09.04

2002-2006
Centre of Environment & Health
 Initiative of Ministries of Health and
Environment
 Goals:
 Scientific support for environmental health
policy
 Follow up of the environmental health status
of the population
 Epidemiology : mortality / morbidity
 Biomonitoring : early warning
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Goals:
 Analyse time trends : efficacity of environmental
measures for public health?
 Analyse spatial trends : healthy and unhealthy
areas?
 Detect yet unknown environmental
threaths:
early warning system for unknown pollution
sources / pollutants
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Biomonitoring network in
humans
air
food
consumables
water
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soil
Goals:
 Analyse time trends : efficacity of environmental
measures for public health?
 Analyse spatial trends : healthy and unhealthy areas?
 Detect yet unknown environmental threaths:
early warning system for unknown pollution sources /
pollutants
 Create an operational unit which can be
mobilised easily in case of environmental
accidents
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Choices to make
 Which areas?
 Which population?
 Which biomarkers ?
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8 study areas
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8 priority regions
Region
Criterium
1. Agglomeration of Antwerp
environmental monitoring area (VMM)
2. Agglomeration of Ghent
environmental monitoring area (VMM)
3. Ports: Antwerp & Ghent
environmental monitoring area (VMM)
4. Rural area
Population density <250 inhabitants/km2 (=P25) +
exclusions:
- Fruit orchards area and adjacent areas
- > 5% industry
- Areas with registrated emission sources +
imission values
- motorway
5. Areas with fruit orchards
Area of apple + pear trees > 10 ha/km2
6. Vicinity of municipal waste
incinerators
Calculated concentration of smoke >= 1.2 µg/m3
7. Non-ferro plant
Calcultated concentration of lead >= 0.9 ng/m3
(minimum Olen)
8. Chemical industry zone
Calculated concentration of fictive pllutant >=
minimum in village of Eindhout
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3 age groups
Exposure to
traffic, life
environment
Growth & development
Growth &
development
Astma & allergy
Adolescents
Astma & allergy
Cancer risk
Adults
Newborns
Exposure at
start of life
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Accumulating
exposures
newborns
adolescents
adults
200 per area
200 per area
200 per area
Maternity/
cord blood
Cd, Pb, PCBs,
dioxin activity
Chlorinated
pesticides
Schools /
urine -blood
Cd, Pb, chlorinated
pesticides,
Tt- muconic acid,
1-OH pyrene
Register
Data from
health records:
Data from health
records +
Data from health
records +
biometry,reflexes,
Hormone levels; comet
assay
Comet assay,
micronucleus,P53,
PSA,CEA
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Cd, Pb,
chlorinated
pesticides
Tt- muconic acid,
1-OH pyrene
difficulties
 Recruitment numbers are too low if
recruitment area is small and spread over
the country eg around incinerators
 Maternities loose their enthousiasm after
a while, how to keep them motivated?
 Highest efficiency by collaborating with
existing organisations eg stem cell banks
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Importance of
communication!
 Among scientists:
 wide participation of all Flemish universities and 2 research
institutes→ broad acceptance
 Field committee meeting / once a month
 Multidisciplinary
 Clear distibution of tasks and responsibilities
 research projects added to the program
 2 prospective studies in newborns :
 Neurological development
 Astma and allergy
 1 study in adolescents: link health effects with air pollution data
 adults : application of new biomarkers ( Univ. Maastricht)
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responsibilities
coördination
VITO
fieldwork
PIH
Communication program
UG
toxicology
UA
dietstudy
KUL
LUC
Health registers
Statistical analysis
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Communication with
public
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Information and communication
June 02

letter from minister to mayor of selected comunities, to hospital (director, head of
the medical advisory commission, to head gynecology )
 Information to maternity , what to expect?
 Visit of field worker to maternity to explain the program
 Short announcements in medical journals
 Information letter to physicians in selected areas
Sept 02
 Announcement in the newspapers and TV
 Information evenings in every province
2004
 In 2 areas active discussionplatfroms to enhance community participation
 Web site and BIOMONITOR ( bi monthly info journal)
2005
 Communication of results to participants , gynecologists, general practitioners,
general public
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Communication with
contractor
 Monthly follow up with administrators and
policy makers
 How to deal with results ?
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No existing legislation
Develop a frame work for decision making
Cost –benefit analysis
Back casting
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Ethical considerations
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Ethical approval for each study separately
Informed consent from children and parents
Children get small reward (filmticket)
Educational package for schools
Inclusion criteria
Freedom to participate and withdraw
Anonimity
Confidentiality
Quality assurance
Communication of results
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Communication of results
Individual
result
Information
channel
values
info
Lead in blood
Y
Participant or
GP
value +
percentile
distribution
Background
info
Cadmium in
blood
Y
Participant or
GP
value +
percentile
distribution
Dioxin activity
/PCBs in
serum
Y
Participant or
GP
value +
percentile
distribution
Fe status
Y
Participant or
GP
Value +
normal range
Genetic
N
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polymorfisms
Participant or
GP
-
Centre for Environment and
health: biomonitoring
Prof. Dr. G. Schoeters
Dr. G. Koppen
E. Brits
Dr. V. Nelen
Website:
http://www.milieu-en-gezondheid.be
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[email protected]
[email protected]
[email protected]
[email protected]
Biomarkers
Newborns: 1600
Markers of
exposure
Cord blood: cadmium,
lead
Cord blood serum:
merker PCBs, pesticides,
dioxine-activitty
Biometry, TSH (heel
prick), Apgar score, time
to pregnancy
Questionnaire: asthma &
allergy
Follow- up of part of
children
Questionnaire: general+
food
Biochemical analyses:
cholesterol, iron status
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cord blood
Adults: 1600
(50-65y)
Blood: cadmium, lead
Serum: marker PCBs,
pesticides
Urine: 1-OH pyrene, ttmuconic acid
Blood: comet test
Serum: hormone balance
Markers of
effect
Confounders
Adolescents: 1600
(14-15y)
Serum: marker PCBs,
pesticides, dioxine-activity
Urine: 1-OH pyrene, ttmuconicacid, cadmium
Blood: comet test, HPRT
Serum: tumour markers
Urine: 8-OH dG
Biometry, sexual
development, hearingtest,
Questionnaire: asthma &
allergy
Questionnaire: asthma &
allergy
Questionnaire: general +
food
Questionnaire: general +
food
Biochemical analyses:
cholesterol, iron status
blood, urinary creatinine
Biochemical analyses:
cholesterol, iron status blood,
urinary creatinine
Confidentiality
 One partner responsible for
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Linking codes and adresses
Coding samples and questionnaires
Ask information from health registers
Questionnaires in sealed envelopes –
transferred to contact person in schools
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Quality assurance
 Biological samples
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Codes
Transport and storage conditions
Quality of measurements
Data base maintainance – statistical
analysis plan
 End of the study, sample destroyed
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