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BACKGROUND: There is little reliable information on human exposure to the metals platinum (Pt), palladium (Pd) and rhodium (Rh), despite their use in enormous quantities in catalytic converters for automobile exhaust systems. OBJECTIVES: To evaluate blood concentrations of Pt (B-Pt), Pd (B-Pd) and Rh (B-Rh) in women from six European and three non-European countries, and to identify potentially influential factors. In addition, molybdenum (Mo) and strontium (Sr) were analysed. METHODS: Blood from 248 women aged 47-61 was analysed by high resolution inductively coupled plasma mass spectrometry under strict quality control. RESULTS: The medians were: B-Pt 0.8 (range

Streptococcus pneumoniae is a leading cause of severe infectious diseases worldwide. This paper presents the results from the first European invasive pneumococcal disease (IPD) enhanced surveillance where additional and valuable data were reported and analysed. Following its authorisation in Europe in 2001 for use in children aged between two months and five years, the heptavalent pneumococcal conjugate vaccine (PCV7) was progressively introduced in the European Union (EU)/European Economic Area (EEA) countries, albeit with different schemes and policies. In mid-2010 European countries started to switch to a higher valency vaccine (PCV10/PCV13), still without a significant impact by the time of this surveillance. Therefore, this surveillance provides an overview of baseline data from the transition period between the introduction of PCV7 and the implementation of PCV10/PCV13. In 2010, 26 EU/EEA countries reported 21 565 cases of IPD to The European Surveillance System (TESSy) applying the EU 2008 case definition. Serotype was determined in 9946/21565 (46.1%) cases. The most common serotypes were 19A, 1, 7F, 3, 14, 22F, 8, 4, 12F and 19F, accounting for 5949/9946 (59.8%) of the serotyped isolates. Data on antimicrobial susceptibility testing (AST) in the form of minimum inhibitory concentrations (MIC) were submitted for penicillin 5384/21565 (25.0%), erythromycin 4031/21565 (18.7%) and cefotaxime 5252/21565 (24.4%). Non-susceptibility to erythromycin was highest at 17.6% followed by penicillin at 8.9%. PCV7 serotype coverage among children

Background The Millennium Development Goals (MDG) provide targets for 2015. MDG 6 includes a target to reduce the tuberculosis (TB) death rate by 50% compared with 1990. We aimed to assess whether this target was reached by the European Union (EU) and European Economic Area countries. Methods We used Eurostat causes of death data to assess whether the target was reached in the EU. We calculated the reduction in reported and adjusted death rates and the annual average percentage decline based on the available data. Results Between 1999 and 2014, the TB death rate decreased by 50%, the adjusted death rate by 56% and the annual average percentage decline was 5.43% (95% confidence interval 4.94–6.74) for the EU. Twenty of 26 countries reporting >5 TB deaths in the first reporting year reached the target of 50% reduction in adjusted death rate. Conclusions The EU reached the MDG target of a 50% reduction of the TB death rate and also the annual average percentage decline was larger than the 2.73% needed to reach the target. The World Health Organization ‘End TB Strategy’ requires a further reduction of the number of TB deaths of 35% by 2020 compared to 2015, which will challenge TB prevention and care services in the EU.

Children's blood-lead concentration (B-Pb) is well studied, but little is known about cadmium (B-Cd) and mercury (B-Hg), in particular for central Europe. Such information is necessary for risk assessment and management. Therefore, we here describe and compare B-Pb, B-Cd and B-Hg in children in six European, and three non-European cities, and identify determinants of these exposures. About 50 school children (7–14 years) from each city were recruited (totally 433) in 2007–2008. Interview and questionnaire data were obtained. A blood sample was analyzed: only two laboratories with strict quality control were used. The European cities showed only minor differences for B-Cd (geometric means 0.11–0.17 μg/L) and B-Pb (14–20 μg/L), but larger for B-Hg (0.12–0.94 μg/L). Corresponding means for the non-European countries were 0.21–0.26, 32–71, and 0.3–3.2 μg/L, respectively. For B-Cd in European samples, traffic intensity close to home was a statistically significant determinant, for B-Hg fish consumption and amalgam fillings, and for B-Pb sex (boys higher). This study shows that European city children's B-Cd and B-Pb vary only little between countries; B-Hg differs considerably, due to varying tooth restoration practices and fish intake. Traffic intensity seemed to be a determinant for B-Cd. The metal concentrations were low from a risk perspective but the chosen non-European cities showed higher concentrations than the cities in Europe. Keywords: Cadmium, Mercury, Lead, Children, Exposure, Biomonitoring

Both prenatal and postnatal passive smoking have been linked with respiratory symptoms and asthma in childhood. Their differential contributions to lung function growth in the general children's population are less clear.To study the relative impact of pre- and postnatal exposure on respiratory functions of primary school children in a wide range of geographic settings, we analyzed flow and volume data of more than 20,000 children (aged 6-12 yr) from nine countries in Europe and North America.Exposure information had been obtained by comparable questionnaires, and spirometry followed a protocol of the American Thoracic Society/European Respiratory Society. Linear and logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results and mean effects were estimated using meta-analytic tools.Smoking during pregnancy was associated with decreases in lung function parameters between -1% (FEV1) and -6% maximal expiratory flow at 25% of vital capacity left (MEF25). A 4% lower maximal midexpiratory flow (MMEF) corresponded to a 40% increase in the risk of poor lung function (MMEF75% of expected). Associations with current passive smoking were weaker though still measurable, with effects ranging from -0.5% (FEV1) to -2% maximal expiratory flow (MEF50).Considering the high number of children exposed to maternal smoking in utero and the even higher number exposed to passive smoking after birth, this risk factor for reduced lung function growth remains a serious pediatric and public health issue.

Epidemiological studies have associated adverse health impacts with ambient concentrations of particulate matter (PM), though these studies have been limited in their characterization of personal exposure to PM. An exposure study of healthy nonsmoking adults and children was conducted in Banska Bystrica, Slovakia, to characterize the range of personal exposures to air pollutants and to determine the influence of occupation, season, residence location, and outdoor and indoor concentrations on personal exposures. Twenty-four-hour personal, at-home indoor, and ambient measurements of PM10, PM2.5, sulfate (SO4(2-)) and nicotine were obtained for 18 office workers, 16 industrial workers, and 15 high school students in winter and summer. Results showed that outdoor levels of pollutants were modest, with clear seasonal differences: outdoor PM10 summer/winter mean = 35/45 microg/m3; PM2.5 summer/winter mean = 22/32 microg/m3. SO4(2-) levels were low (4-7 microg/m3) and relatively uniform across the different sample types (personal, indoor, outdoor), areas, and occupational groups. This suggests that SO4(2-) may be a useful marker for combustion mode particles of ambient origin, although the relationship between personal exposures and ambient SO4(2-) levels was more complex than observed in North American settings. During winter especially, the central city area showed higher concentrations than the suburban location for outdoor, personal, and indoor measures of PM10, PM2.5, and to a lesser extent for SO4(2-), suggesting the importance of local sources. For PM2.5 and PM10, ratios consistent with expectations were found among exposure indices for all three subject groups (personal>indoor>outdoor), and between work type (industrial>students>office workers). The ratio of PM2.5 personal to indoor exposures ranged from 1.0 to 3.9 and of personal to outdoor exposures from 1.6 to 4.2. The ratio of PM10 personal to indoor exposures ranged from 1.1 to 2.9 and the ratio of personal to outdoor exposures from 2.1 to 4.1. For a combined group of office workers and students, personal PM10/PM2.5 levels were predicted by statistically significant multivariate models incorporating indoor (for PM2.5) or outdoor (for PM10) PM levels, and nicotine exposure (for PM10). Small but significant fractions of the overall variability, 15% for PM2.5 and 17% for PM10, were explained by these models. The results indicate that central site monitors underpredict actual human exposures to PM2.5 and PM10. Personal exposure to SO4(2-) was found to be predicted by outdoor or indoor SO4(2-) levels with 23-71% of the overall variability explained by these predictors. We conclude that personal exposure measurements and additional demographic and daily activity data are crucial for accurate evaluation of exposure to particles in this setting.

The broad spectrum of extraosseal functions of vitamin D has recently been investigated. Although majority of recent studies have documented its hypotensive effect, some older studies warrant the risk of development the juvenile hypertension namely after pulse-fortified D vitamin supplementation during infancy. The aim of this study was to compare of the blood pressure in 13 year old groups of adolescents to the mode of D vitamin supplementation during their infancy.Study group represent 1138 thirteen year old adolescents in complex health care of 21 primary care pediatricians (PCPs). This group was divided into three subgroups according their mode of D vitamin supplementation in infancy. 100 children were given the continuous daily supplementation of AD vitamin 200-400 IU /day - " regular subgroup 0", 933 children were given by bolus doses of D vitamin forte 450 000 IU every three months during first year of life - "fortified subgroup 2", and 105 children given by bolus doses of D vitamin during winter, and continuous daily AD drops during summer - " mixed subgroup 1". D vitamin supplementation was done approximately 13 years before blood pressure study.The mean systolic blood pressure was 110 mmHg, and mean diastolic one was 70 mmHg in all subgroups, regardless the mode of vitamin D supplementation. There were no statistic differences among subgroups, between girls/ boys, blood pressure levels were in normal limit. Although calculated daily doses of D2 vitamin during infancy exceeded RDA (200-400 IU) four to ten time, no difference in morbidity was found, concerning various chronic diseases (allergy, cardiovascular, renal, etc.). These results are in full accordance to recent knowledge of higher requirement and safety limit during vitamin D application.The mode of D vitamin prophylaxis during infancy (pulse or daily application) has no influence to blood pressure level in early adolescence. No adverse effects have been found despite that the calculated daily dose was exceeded from three to ten times the recommended daily allowance.

Objective To discuss challenges and opportunities in the introduction of an automated approach for time series analysis (TSA) regarding epidemiological methodology for generation of hypotheses, steps to be performed and interpretation of outputs. Introduction ECDC long term strategies for surveillance include analysis of trends of communicable disease of public health importance for European Union countries to guide public health actions. The European Surveillance System (TESSy) holds data on 49 communicable diseases reported by 30 countries for at least the past five years. To simplify time related analysis using surveillance data, ECDC launched a project to enable descriptive and routine TSA without the need for complex programming. Methods Protocols for TESSy data were developed specifying hypotheses to be tested, types and format of variables needed for TSA for several diseases, including VTEC, and legionellosis. Stata scripts were developed to comply with the basic steps of TSA, including data aggregation, data checking, data description, analysis of trends and seasonality, residual analysis, simple modelling and long-term forecasting. TSA steps were presented as successive tabs in a TSA dialogue box in Stata. Before using the Stata TSA dialogue box, experts were offered a two-day training, and provided with an in-depth manual supporting use and interpretation of TSA outputs using the Stata TSA dialogue box. Results For VTEC, it was possible to identify a small increase in the trend and a seasonal pattern in surveillance data with an estimate of the start of the increased risk for infection in the beginning of the summer season [1]. For legionellosis, an increasing trend in the number of reported cases was observed in 2010 [2]. Feedback from the training showed that using the Stata TSA dialogue box enables a quick exploratory analysis even by non-Stata users who could focus on interpretation of results, rather than the programme writing. However, we emphasise that statistical knowledge of TSA as well as rigorous preparation of the datasets (including data quality checks) and generation of hypotheses, are essential to ensure appropriate analysis and meaningful interpretation of the results. Conclusions Using the Stata TSA dialogue box saves time when performing rapid exploratory TSA of epidemiological data, avoiding the need for complex programming which is still needed for sophisticated TSA. Results of exploratory TSA analysis can trigger new hypothesis, for more advanced and sophisticated TSA. The introduction of a new technology (Stata TSA dialogue box) does not replace multi-disciplinary approach, knowledge and application of a methodological approach to TSA to produce meaningful results that can inform public health decision making. Further testing and training will be performed to enhance simplicity before appropriate dissemination of the Stata TSA dialogue box for a wider use.

Objectives: The aim of the study was to make an international comparison of blood levels of cadmium (B-Cd), lead (BPb) and mercury (B-Hg) of women in seven European, and three non-European cities, and to identify determinants. Materials and Methods: About 50 women (age: 46–62) from each city were recruited (totally 480) in 2006–2009. Interview and questionnaire data were obtained. Blood samples were analysed in one laboratory to avoid interlaboratory variation. Results: Between the European cities, the B-Pb and B-Cd results vary little (range of geometric means: 13.5–27.0 μg/l and 0.25–0.65 μg/l, respectively); the variation of B-Hg was larger (0.40–1.38 μg/l). Between the non-European cities the results for B-Pb, B-Cd and B-Hg were 19.2–68.0, 0.39–0.99 and 1.01–2.73 μg/l, respectively. Smoking was a statistically signifi cant determinant for B-Cd, while fi sh and shellfi sh intakes contributed to B-Hg and B-Pb, amalgam fi llings also contributed to B-Hg. Conclusions: The present results confi rm the previous results from children; the exposure to lead and cadmium varies only little between different European cities suggesting that other factors than the living area are more important. The study also confi rms the previous fi ndings of higher cadmium and lead levels in some non-European cities. The geographical variation for mercury is signifi cant.

The objective of the study was to determine some Cardiovascular Disease (CVD) risk factors in 174 Roma children and adolescents (88 males and 86 females) aged 7-18 in 3 Central Slovakian cities (44 from Zilina, 39 from Bansk, Bystrica and 91 from Rimavska Sobota). Venous blood samples were drawn in the morning, after a 12 hour overnight fast for biochemical analysis. Total cholesterol (TC) and triglycerides (TG) were determined enzymatically. HDL-cholesterol (HDL-C) after selective precipitation lipoproteins containing apolipoprotein B and LDL-cholesterol (LDL-C) was calculated by the Friedewald Formula. Serum levels of apolipoproteins (apo A, apo B) were analyzed immunochemically. Concentration of lipoprotein a [Lp(a)] was analyzed by immunonephelometric method (Beckman-Coulter System). Anthropometric measurements, including weight, height, waist and hip circumference were used to calculate the sum of the body mass index (BMI) and waist to hip ratio (WHR). Measured blood pressure (BP) was used to classify for hypertension. Significant differences were determined in serum levels of LDL-C (p < 0.05; by Tukey HSD test multiple comparison more significant difference was determined between Zilina and Rimavska Sobota p < 0.046), TG (p = 0.008), apo A (p < 0.001), Lp(a) (p = 0.042), WHR (p < 0.001), BMI (p < 0.001), sBP (p < 0.001) and dBP (p = 0.012) in Roma individuals of all locality groups. The Roma population from Rimavsk, Sobota had (in comparison to the examined populations) statistically higher values of TC, TG, LDL-C, lower HDL-C. The population showed significant relation of TG and stress at home (p = 0.03) and at school (p = 0.01), HDL-C and cigarette smoking (p = 0.004), apo A and cigarette smoking (p = 0.02) and socioeconomic status (p = 0.006), WHR and cigarette smoking (p = 0.02). Risk values of WHR, apo B and Lp(a) were mostly determined in Zilina's population (WHR significantly connected with family history CVD p = 0.03, cigarette smoking p = 0.02 and leisure time physical activity p < 0.001) and BMI, apo A and BP in Banska Bystrica. WHR was positively correlated to BP and negatively to HDL-C and TG only in Roma participants from Rimavska Sobota. BMI was positively correlated to systolic BP in populations from Banska Bystrica and Rimavska Sobota. The results of the study should improve the paediatric health treatment and prevention of CVD risk predictors for Roma from different cities.

SUMMARY Background: Social inequalities have been shown to contribute to the risk of lung cancer in industrialized countries, but it is unclear whether they also play a role in former socialist countries of Europe. Methods: A case-control study involving 3,403 cases and 3,670 controls was conducted in Central European countries (Czech Republic, Hungary, Poland, Romania, Slovakia), Russia, and in the UK. Indicators of socioeconomic status, including education and white/blue collar occupation based on lifetime occupations were analysed as indicators of risk factors for lung cancer development, after adjustment for tobacco smoking and exposure to occupational carcinogens. Results: Both indicators of socioeconomic status: low education and blue collar occupations were found as significant risk factors for lung cancer in men. The odds ratio of lung cancer for blue collar occupations compared to white collar occupations was 1.37 (95% confidence interval 1.15–1.62), that for low education compared to high education (analysis restricted to Central European countries) was 1.35 (95% confidence interval 1.03–1.77). No such effects were observed in women. Conclusions: The confirmation of the significant inverse association between the indicators of socioeconomic status and lung cancer risk in men may serve as a strong incentive for adoption of occupational and public health measures in lung cancer prevention.

Objectives: Adverse effects have been reported of prenatal and/or postnatal passive exposure to smoking on children’s health. Uncertainties remain about the relative importance of smoking at different periods in the child’s life. We investigate this in a pooled analysis, on 53 879 children from 12 cross-sectional studies—components of the PATY study (Pollution And The Young). Methods: Effects were estimated, within each study, of three exposures: mother smoked during pregnancy, parental smoking in the first two years, current parental smoking. Outcomes were: wheeze, asthma, “woken by wheeze”, bronchitis, nocturnal cough, morning cough, “sensitivity to inhaled allergens” and hay fever. Logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results, and mean effects (allowing for heterogeneity) were estimated using meta-analytical tools. Results: There was strong evidence linking parental smoking to wheeze, asthma, bronchitis and nocturnal cough, with mean odds ratios all around 1.15, with independent effects of prenatal and postnatal exposures for most associations. Conclusions: Adverse effects of both pre- and postnatal parental smoking on children’s respiratory health were confirmed. Asthma was most strongly associated with maternal smoking during pregnancy, but postnatal exposure showed independent associations with a range of other respiratory symptoms. All tobacco smoke exposure has serious consequences for children’s respiratory health and needs to be reduced urgently.

Methodological approaches to the analysis of hierarchical studies of air pollution and respiratory health — examples from the CESAR study

The effects of long-term exposure to air pollution on respiratory symptoms and respiratory hospitalization (for asthma, bronchitis or pneumonia) were assessed in a cross-sectional study of children (ages 7--11 years, N=667) living in a moderately industrialized city in Central Slovakia. Individual health, residence and family history data obtained through the CESAR study were coupled, using Geographic Information System (GIS) technologies, with total suspended particulate (TSP) exposure estimates derived from dispersion modeling of almost all local stationary sources. These data were used to assess, at the intra-city level and child-specific level, the potential for TSP as a risk factor for respiratory disease in children. TSP, PM10, and PM2.5 monitored ambient concentrations are highly correlated in the study location. Modeled TSP concentrations resulting from local source emissions are dominated by a large wood processing facility, suggesting variation in exposures among children. The prevalence of respiratory non-asthmatic symptoms and hospitalizations was associated with increased TSP. No association between long-term exposure to TSP and asthma diagnosis or wheeze symptoms was found. Logistic regression modeling indicated a significant increase in hospital admissions for asthma, bronchitis or pneumonia associated with increasing air pollution (OR 2.16, CI, 1.01--4.60), doctor-diagnosed bronchitis (OR 1.53, CI, 1.02-2.30), and parent-reported chronic phlegm (OR 3.43, CI, 1.64--7.16), expressed as odds for a 15 microg/m3 increase in estimated TSP exposure, and these increases are not due to differences in socio-economic, health care or other identified factors.