IJERPH, Vol. 13, Pages 874: Ambient Concentrations of Metabolic Disrupting Chemicals and Children’s Academic Achievement in El Paso, Texas

Concerns about children’s weight have steadily risen alongside the manufacture and use of myriad chemicals in the US. One class of chemicals, known as metabolic disruptors, interfere with human endocrine and metabolic functioning and are of specific concern to children’s health and development. This article examines the effect of residential concentrations of metabolic disrupting chemicals on children’s school performance for the first time. Census tract-level ambient concentrations for known metabolic disruptors come from the US Environmental Protection Agency’s National Air Toxics Assessment. Other measures were drawn from a survey of primary caretakers of 4th and 5th grade children in El Paso Independent School District (El Paso, TX, USA). A mediation model is employed to examine two hypothetical pathways through which the ambient level of metabolic disruptors at a child’s home might affect grade point average. Results indicate that concentrations of metabolic disruptors are statistically significantly associated with lower grade point averages directly and indirectly through body mass index. Findings from this study have practical implications for environmental justice research and chemical policy reform in the US.

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IJERPH, Vol. 13, Pages 873: Leachate from Municipal Waste Landfill and Its Natural Degradation—A Case Study of Zubří, Zlín Region

This work deals with the natural degradation of leachate from an old reclaimed landfill by means of a biological pond. Hamra is a municipal waste landfill with a limited formation of leachate, which has already been reclaimed. Leachate in this location is disposed of using natural biogeochemical method, and it is subsequently discharged into a surface stream. The main issue dealt with here is the long-term effectiveness of natural degradation of leachate and the limits of its use. The solutions of these fundamental questions took advantage of a database of analytical assessments collected during a long-term monitoring of the landfill site. The primary degradation trends and the long-term development have been revealed and described on the basis of these assessments. The main benefit of the biological pond is the dilution of the dominant contaminants, especially of inorganic character. In the case of ammonium ions, they show nitrification caused by their transition from the reduction into oxidizing environment. From a long term point of view, the disadvantage of natural degradation of leachate can be seen in the gradual reduction in efficiency due to the concentration of the substances or an undesired growth of water plants, which can be successfully eliminated, for example, by means of targeted aeration and by maintaining vegetation in the pond and its surroundings. The biological potential of the locality is very favorable and, despite its anthropogenic load, it creates a location with suitable living conditions for many water animals and plants. That is why it can be concluded that the efficiency of the natural biochemical cleaning elements can be considered as sufficient, taking into account the nature of the deposited waste, the quantity and quality of leachate, as well as the climate character of the locality.

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IJERPH, Vol. 13, Pages 870: Assessing Impacts on Unplanned Hospitalisations of Care Quality and Access Using a Structural Equation Method: With a Case Study of Diabetes

Background: Enhanced quality of care and improved access are central to effective primary care management of long term conditions. However, research evidence is inconclusive in establishing a link between quality of primary care, or access, and adverse outcomes, such as unplanned hospitalisation. Methods: This paper proposes a structural equation model for quality and access as latent variables affecting adverse outcomes, such as unplanned hospitalisations. In a case study application, quality of care (QOC) is defined in relation to diabetes, and the aim is to assess impacts of care quality and access on unplanned hospital admissions for diabetes, while allowing also for socio-economic deprivation, diabetes morbidity, and supply effects. The study involves 90 general practitioner (GP) practices in two London Clinical Commissioning Groups, using clinical quality of care indicators, and patient survey data on perceived access. Results: As a single predictor, quality of care has a significant negative impact on emergency admissions, and this significant effect remains when socio-economic deprivation and morbidity are allowed. In a full structural equation model including access, the probability that QOC negatively impacts on unplanned admissions exceeds 0.9. Furthermore, poor access is linked to deprivation, diminished QOC, and larger list sizes. Conclusions: Using a Bayesian inference methodology, the evidence from the analysis is weighted towards negative impacts of higher primary care quality and improved access on unplanned admissions. The methodology of the paper is potentially applicable to other long term conditions, and relevant when care quality and access cannot be measured directly and are better regarded as latent variables.

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IJERPH, Vol. 13, Pages 875: Review of Studies Concerning Electromagnetic Field (EMF) Exposure Assessment in Europe: Low Frequency Fields (50 Hz–100 kHz)

We aimed to review the findings of exposure assessment studies done in European countries on the exposure of the general public to low frequency electric and magnetic fields (EMFs) of various frequencies. The study shows that outdoor average extremely low frequency magnetic fields (ELF-MF) in public areas in urban environments range between 0.05 and 0.2 µT in terms of flux densities, but stronger values (of the order of a few µT) may occur directly beneath high-voltage power lines, at the walls of transformer buildings, and at the boundary fences of substations. In the indoor environment, high values have been measured close to several domestic appliances (up to the mT range), some of which are held close to the body, e.g., hair dryers, electric shavers. Common sources of exposure to intermediate frequencies (IF) include induction cookers, compact fluorescent lamps, inductive charging systems for electric cars and security or anti-theft devices. No systematic measurement surveys or personal exposimetry data for the IF range have been carried out and only a few reports on measurements of EMFs around such devices are mentioned. According to the available European exposure assessment studies, three population exposure categories were classified by the authors regarding the possible future risk analysis. This classification should be considered a crucial advancement for exposure assessment, which is a mandatory step in any future health risk assessment of EMFs exposure.

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IJERPH, Vol. 13, Pages 876: Can We Further Improve the Quality of Nephro-Urological Care in Children with Myelomeningocele?

Myelomeningocele (MMC) results from a failure of normal neural tube fusion in early fetal development. Retrospective, observational study of medical data of 54 children treated in Pediatric Nephrology and Urology Clinics for five years was performed. The following data were analyzed: serum creatinine, eGFR, urine analysis, renal scintigraphy (RS), renal ultrasound, and urodynamics. Mean age of studied population: 12.3 years, median of eGFR at the beginning and at the end of survey was 110.25 and 116.5 mL/min/1.73 m2 accordingly. Median of frequency of urinary tract infections (fUTI): 1.2 episodes/year. In 24 children: low-pressure, in 30 children: high-pressure bladder was noted. Vesicouretral reflux (VUR) was noted in 23 children (42.6%). fUTI were more common in high-grade VUR group. High-grade VURs were more common in group of patients with severe renal damage. At the end of the survey 11.1% children were qualified to higher stages of chronic kidney disease. Renal parenchyma damage progression in RS was noted in 22.2% children. Positive VUR history, febrile recurrent UTIs, bladder wall trabeculation, and older age of the patients constitute risk factors of abnormal renal scans. More than 2.0 febrile, symptomatic UTIs annually increase by 5.6-fold the risk of severe renal parenchyma damage after five years.

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IJERPH, Vol. 13, Pages 871: Comparison of Three Real-Time Measurement Methods for Airborne Ultrafine Particles in the Silicon Alloy Industry

The aim of this study was to compare the applicability and the correlation between three commercially available instruments capable of detection, quantification, and characterization of ultrafine airborne particulate matter in the industrial setting of a tapping area in a silicon alloy production plant. The number concentration of ultrafine particles was evaluated using an Electric Low Pressure Impactor (ELPITM), a Fast Mobility Particle Sizer (FMPSTM), and a Condensation Particle Counter (CPC). The results are discussed in terms of particle size distribution and temporal variations linked to process operations. The instruments show excellent temporal covariation and the correlation between the FMPS and ELPI is good. The advantage of the FMPS is the excellent time- and size resolution of the results. The main advantage of the ELPI is the possibility to collect size-fractionated samples of the dust for subsequent analysis by, for example, electron microscopy. The CPC does not provide information about the particle size distribution and its correlation to the other two instruments is somewhat poor. Nonetheless, the CPC gives basic, real-time information about the ultrafine particle concentration and can therefore be used for source identification.

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IJERPH, Vol. 13, Pages 877: Assessment of Dietary Mercury Intake and Blood Mercury Levels in the Korean Population: Results from the Korean National Environmental Health Survey 2012–2014

From a public health perspective, there is growing concern about dietary mercury intake as the most important source of mercury exposure. This study was performed to estimate dietary mercury exposure and to analyze the association between mercury intake and blood mercury levels in Koreans. The study subjects were 553 adults, comprising a 10% representative subsample of the Korean National Environmental Health Survey (KoNEHS) 2012–2014, who completed a health examination, a face-to-face interview, and a three-day food record. Dietary mercury and methylmercury intakes were assessed from the three-day food record, and blood mercury concentration was measured using a mercury analyzer. The association between dietary mercury intake and blood mercury levels was analyzed by comparing the odds ratios for the blood mercury levels above the Human BioMonitoring (HBM) I value (5 μg/L) among the three groups with different mercury intakes. The average total mercury intake was 4.74 and 3.07 μg/day in males and females, respectively. The food group that contributed most to mercury intake was fish and shellfish, accounting for 77.8% of total intake. The geometric mean of the blood mercury concentration significantly and linearly increased with the mercury and methylmercury intakes (p < 0.001). The odds ratios for blood mercury levels above the HBM I value in the highest mercury and methyl mercury intake group were 3.27 (95% Confidence Interval (CI) 1.79–5.95) and 3.20 (95% CI 1.77–5.79) times higher than that of the lowest intake group, respectively. Our results provide compelling evidence that blood mercury level has a strong positive association with dietary intake, and that fish and shellfish contribute most to the dietary mercury exposure.

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