Evaluation of environmental risks involves several subjective elements, including the individual reaction to the mere presence of such risks. We have carried out a study of students participating in postgraduate courses in environmental and occupational medicine and of medical students. They received a form that contained twelve statements and were asked to indicate whether they agreed or disagreed with these statements. Almost half of the medical students agreed that one must count on developing cancer if one is exposed to a carcinogenic chemical. Responses to other statements were also contrary to the basic principle of the dose-response relationship. A majority in both groups disagreed with the statement that people are unnecessarily concerned about small amounts of pesticides in the environment. Compared to the medical students, the postgraduate students were more sceptical and less concerned regarding environmental risks. These results are in general agreement with a study carried out in the US using the same statements. The results are an indication that we do not necessarily react the same way with regard to information on risks. When communicating such information, the needs and the background of the audience must be appreciated.
Male reproductive health has deteriorated in many countries during the last few decades. In the 1990s, declining semen quality has been reported from Belgium, Denmark, France, and Great Britain. The incidence of testicular cancer has increased during the same time incidences of hypospadias and cryptorchidism also appear to be increasing. Similar reproductive problems occur in many wildlife species. There are marked geographic differences in the prevalence of male reproductive disorders. While the reasons for these differences are currently unknown, both clinical and laboratory research suggest that the adverse changes may be inter-related and have a common origin in fetal life or childhood. Exposure of the male fetus to supranormal levels of estrogens, such as diethlylstilbestrol, can result in the above-mentioned reproductive defects. The growing number of reports demonstrating that common environmental contaminants and natural factors possess estrogenic activity presents the working hypothesis that the adverse trends in male reproductive health may be, at least in part, associated with exposure to estrogenic or other hormonally active (e.g., antiandrogenic) environmental chemicals during fetal and childhood development. An extensive research program is needed to understand the extent of the problem, its underlying etiology, and the development of a strategy for prevention and intervention.
Comment In: Environ Health Perspect. 1997 Feb;105(2):162-39105787
The term scientific dishonesty covers the wide scope from consciously fraudulent actions to gross negligence and refers both to character trait and to actions. Scientific dishonesty may occur in any country, but reactions in Europe have been slow to emerge. On the basis of a thorough review, the Danish Medical Research Council therefore has made recommendations on how to handle and how to prevent scientific dishonesty. Suspected cases must be referred directly to a national committee chaired by a High Court judge. An ad hoc investigatory committee may be appointed in each case. If dishonesty is established, the institution then is asked to implement appropriate sanctions and to report on the actions taken to the national committee. Prevention of scientific dishonesty forms an essential part of good scientific practice and must have an impact on research training, requirements for data storage, guidelines for scientific publication, and criteria for evaluating grant proposals and promotions.
In the Faroe Islands marine food constitutes a considerable part of the diet. In addition to fish, both meat and blubber from pilot whales are included in the diet. Muscle tissue of pilot whales caught in the Faroe Islands contains an average mercury concentration of 3.3 micrograms/g (16 nmol/g), about half of which is methylmercury. In some years an evenly distributed annual catch of pilot whales would make the average dietary intake of mercury close to an excess of the Provisional Temporary Weekly Intake of 0.3 mg recommended by WHO. In one out of eight consecutive births, the mercury concentration in maternal hair exceeded a limit of 10 micrograms/g where a risk of neurobehavioral dysfunction in the child may occur; the maximum was 39.1 micrograms/g. Mercury concentrations in umbilical cord blood showed a similar distribution with a maximum of 351 micrograms/l. The large variation in mercury exposure is associated with differences in the frequency of whale dinners. The average PCB concentration in pilot whale blubber is very high, i.e. about 30 micrograms/g. With an estimated daily consumption of 7 g of blubber, the average daily PCB intake could therefore exceed 200 micrograms, i.e. close to the Acceptable Daily Intake. In Scandinavia, the average daily PCB intake is about 15-20 micrograms. To obtain an improved scientific basis for public health action, two major prospective studies have been initiated. A birth cohort of 1000 children has been examined at approximately 7 years of age for neurobehavioral dysfunctions associated with prenatal exposure to mercury and PCB. Preliminary analyses of the data show that several neurobehavioral tests are associated with mercury exposure parameters. With emphasis on prenatal exposures to PCB, another cohort has been generated during 1994-95, and this cohort will be followed closely during the next years.
Endocrine disrupting industrial chemicals, such as polychlorinated biphenyls (PCBs), are suspected to adversely affect male reproductive functions.
The Faroe Islands community exhibits an unusually wide range of exposures to dietary contaminants, and in this setting we examined the possible association between PCB exposure and semen quality and reproductive hormones in fertile Faroese men.
Participants in this cross-sectional study include 266 proven fertile men residing in the Faroe Islands. PCB levels and hormone profiles were measured in serum samples taken at the clinical examination that included semen quality parameters.
A significant positive association was seen between serum-PCB and the testosterone/estradiol ratio (p=0.04). In the unadjusted analyses, elevated PCB exposure was associated with increased serum concentrations of SHBG (p=0.01) and FSH (p=0.05). We found no association between the serum PCB concentration and the semen quality variables.
In this population of highly exposed fertile men, the current serum-PCB concentration was associated with higher androgen/estrogen ratio. Further studies are needed to establish the findings and further document PCB-associated hormonal effects, any time windows of increased susceptibility, and the role of PCB in sub-fecundity.
People in the Arctic as well as fishermen on the polluted Swedish east coast are highly exposed to persistent organic pollutants (POPs). These compounds have been shown to affect the sperm Y:X chromosome ratio. In present study, the aim was to investigate whether polychlorinated biphenyl (PCB) congeners and 1,1,-dichloro-2,2,-bis(p-chlorophenyl)ethane (p,p'-DDE) influence sperm sex chromosome ratio in Faroese men, and whether these men differ regarding Y:X ratio compared to Greenland Inuit and Swedish fishermen. The study population (n=449) consisted of young men from the general population (n=276) as well as proven fertile men (n=173). The Y:X ratio was assessed by fluorescent in situ hybridization. Serum concentrations of POPs were measured using gas chromatography. Associations between POP concentrations and Y:X ratio were calculated using linear and non-linear regression models as well as trend analysis and pairwise comparison of exposure data categorized into quartiles. The selected POPs were associated with Y:X ratio in fertile Faroese men, but not in the total population; p,p'-DDE (95% CI for B=-0.005 to -0.001, p=0.005) and SPCB (95% CI for B=-0.005 to -0.001, p=0.012). Since p,p'-DDE and SPCB correlated significantly (r=0.927, p
Three approaches have been used to examine how human body burdens of lead depend on different environments: (1) In paleopathologic studies, lead concentrations have been determined in well-preserved human bones or teeth, and pre-pollution samples generally show lead concentrations of about 1% of current levels in industrialized countries. (2) Geographic comparisons of blood-lead concentrations show low levels in, Nepal, Faroe Islands, and Sweden, while high levels occur in Mexico and Malta; average blood-lead levels may vary by a factor of 10 or more. (3) In analytical epidemiology, major exposure sources have been related to lead levels in blood, by either prospective or cross-sectional design. Increased blood-lead concentrations are related to smoking, drinking alcoholic beverages, eating vegetables for dinner, urban residence, and exposure from lead-using industries; average blood-lead values of subgroups within well-defined populations may vary by a factor of 3 or more. The dose-relationships for lead-induced neurotoxicity will depend on the sensitivity of the parameters chosen as indicators of lead exposure and of neurotoxicity. The temporal relationship between lead exposures and the development of deficits must be ascertained. Individual susceptibility and interacting factors must also be taken into account. Differences in addressing these issues impede the comparison between studies. Recently neonatal jaundice has been found to be a risk factor for subsequent neurobehavioral dysfunction in children with a birth weight above 2500 g, but only in children with increased lead exposure. Lead exposure may act in combination with several other factors and result in additive, or synergistic effects.(ABSTRACT TRUNCATED AT 250 WORDS)
The mercury concentration in blood or scalp hair has been widely used as a biomarker for methylmercury exposure. Because of the increased risks associated with exposures during prenatal and early postnatal development, biomarker results must be interpreted with regard to the age-dependent susceptibility. The authors compared regression coefficients for five sets of exposure biomarkers in 917 children from the Faroe Islands examined at birth, 1 year, and 7 years. Outcome variables were the results of neuropsychologic examination carried out in 1993-1994 at age 7 years. After adjustment for covariates, the cord-blood concentration showed the clearest associations with deficits in language, attention, and memory. Fine-motor function deficits were particularly associated with the maternal hair mercury at parturition. Mercury concentrations in the child's blood and hair at age 7 years were significant predictors only of performance on memory for visuospatial information. These findings emphasize the usefulness of the cord-blood mercury concentration as a main risk indicator. They also support the notion that the greatest susceptibility to methylmercury neurotoxicity occurs during late gestation, while early postnatal vulnerability is less, and they suggest that the time-dependent susceptibility may vary for different brain functions.
Blood pressure in childhood is an important determinant of hypertension risk later in life, and methylmercury exposure is a potential environmental risk factor. A birth cohort of 1,000 children from the Faroe Islands was examined for prenatal exposure to methylmercury, and at age 7 years, blood pressure, heart rate, and heart rate variability were determined. After adjustment for body weight, diastolic and systolic blood pressure increased by 13.9 mmHg [95% confidence limits (CL) = 7.4, 20.4] and 14.6 mmHg (95% CL = 8.3, 20.8), respectively, when cord blood mercury concentrations increased from 1 to 10 microg/liter cord blood. Above this level, which corresponds to a current exposure limit, no further increase was seen. Birth weight acted as a modifier, with the mercury effect being stronger in children with lower birth weights. In boys, heart rate variability decreased with increasing mercury exposures, particularly from 1 to 10 microg/liter cord blood, at which the variability was reduced by 47% (95% CL = 14%, 68%). These findings suggest that prenatal exposure to methylmercury may affect the development of cardiovascular homeostasis.
Breastfeeding seems to confer an advantage to the infant with regard to neurobehavioral development, possibly in part due to essential nutrients in human milk. However, human milk may be contaminated by environmental neurotoxicants, such as methylmercury. At the Faroe Islands where maternal consumption of pilot whale meat and blubber may well cause a considerable transfer of these neurotoxicants into human milk, 583 infants were followed by district health nurses during the first 12 months after birth. Three developmental milestones that are usually reached between between 5 and 12 months of age, i.e., sitting, creeping and standing, were examined. Infants who reached milestone criteria early had significantly higher mercury concentrations in the hair at 12 months of age. This association is contrary to what would be expected from possible neurotoxic effects of mercury. However, early milestone development was clearly associated with breastfeeding which was again related to increased hair-mercury levels. Milestone development was not associated with indicators of prenatal methylmercury exposure, such as the maternal hair-mercury concentration at parturition. The relationship between early milestone development and high hair-mercury levels in the infant therefore seems to be due to confounding caused by the duration of breastfeeding. No other potential confounder played any role in this regard. This study therefore suggests that, if methylmercury exposure from human milk had any adverse effect on milestone development in these infants, the effect was compensated for or overruled by advantages associated with nursing.(ABSTRACT TRUNCATED AT 250 WORDS)
Blood lead concentrations in a Danish reference population were related to information from an extensive questionnaire on work, environment and life style. The mean concentration of lead in blood was 0.167 mumol/L, i.e. significantly lower than in previous studies. This finding is in accordance with the fact that less than 10% of petrol used in Denmark contained lead additives (up to 0.15 g/L). An important finding was that the well-documented predictors for lead in blood at higher concentration levels, such as age, gender, menopausal status, and intake of alcohol, are still valid in a low-level exposure situation. In addition, a strong and negative correlation was found between blood lead concentrations and dietary supplementation with vitamins and minerals. The present data indicate that lead exposure may still constitute a health risk in a small proportion of adult males and postmenopausal women.
OBJECTIVES: Blood lead concentrations in a Danish reference population were related to information from an extensive questionnaire on work, environment, and life-style. METHODS: Data were gathered for 209 persons by means of a questionnaire and blood lead analyses. RESULTS: The mean concentration of lead in blood was 0.167 micromol/l (ie, significantly lower than in previous studies). This finding is in accordance with the fact that less than 10% of the gasoline used in Denmark contains lead additives (up to 0.15 g/l). An important finding was that the well-documented predictors for lead in blood at higher concentration levels, such as age, gender, menopausal status, and intake of alcohol, are still valid in a low-level exposure situation. In addition, a strong and negative correlation was found between blood lead concentrations and dietary supplementation with vitamins and minerals. CONCLUSIONS: The present data indicate that lead exposure may still constitute a health risk in a small proportion of adult men and postmenopausal women.
Possible predictors of the lead burden of children were investigated in a low-exposure area. A total of 1302 school children in the first form within the municipality of Aarhus, Denmark, donated deciduous teeth for determination of the lead concentration in the circumpulpal dentin. The families were interviewed on possible sources of lead. Present and former addresses of residences and day-care institutions were obtained, and the traffic intensity was estimated at each of these addresses. Children with a high lead burden resided significantly more often in heavily-travelled streets than children with a low burden, but only during their first 3 years of life. The increased risk for a high lead burden was related to the traffic intensity in a dose-response manner. Further, children with a high lead burden more often exhibited pica, their mothers smoked more during pregnancy, and their fathers were more likely to work at a garage or shipyard. In a logistic multivariate regression, such parental occupation increased the risk for a high lead burden 1.5-fold (ORadj; P = 0.03), whereas tobacco and traffic each were of borderline significance (ORadj = 1.4, P = 0.08).
A study of possible undue neurobehavioral effects of low-level lead exposure was performed in Danish school children who entered first grade in 1982. Lead absorption was found to relate to impaired psychological test performance and difficulties at school. However, this relationship was confounded by medical risk factors for neurological deficit. Such factors were used as exclusionary criteria before psychological testing and were selected a prior on the basis of a critical evaluation of known etiologies of neurobehavioral dysfunction. Children characterized by a medical risk factor tended to show performance below average and, at the same time, low lead absorption. The medical risks were also associated with delayed motor activity in the first year of life, thus perhaps resulting in diminished lead intake. This confounding effect makes strict exclusion for proven medical risk factors crucial to avoid bias toward the null-hypothesis. In spite of strict exclusion, a residual confounding due to health-related variables still remained. Inconsistent findings in the field of neurobehavioral studies may be partly explained by different means of identification and statistical treatment of medical risk factors.
Eighty-eight percent of all 40-year-old male residents of four suburban municipalities of Copenhagen County were examined for the lead concentration in their blood and interviewed regarding job category and place of work. Of the 504 men, 482 were currently employed, 18 were unemployed, and 4 were pensioners. The total median blood lead level was 13 micrograms/100 ml (0.6 mumol/l). Men employed in construction, industrial production, and transportation had the highest lead levels, while very low concentrations were found among pensioners and farmers. Blue-collar works had higher blood lead results than white-collar workers. Very high levels were found in two men employed at a secondary lead smelter, but otherwise increases in lead concentrations were comparatively small. However, the occupationally related, increased blood lead levels identified in this population contributed significantly to normal "background" levels.
Many studies have found decreased fecundability, that is, the ability to conceive in a menstrual cycle, with increasing female age. To evaluate the effect of maternal age on waiting time to pregnancy, the authors reviewed hospital charts of all pregnant women attending prophylactic antenatal care at Odense University Hospital, Denmark, during 1972-1987. Only the first pregnancy of each woman and only planned pregnancies were included (n = 14,754). The fecundability odds ratio (FR) was calculated as the odds of a conception in a menstrual cycle among the older women divided by the odds among women aged 15-24 years. The FR for women aged 25-29 years was 1.12 (95% confidence interval (CI): 1.04, 1.20), for women aged 30-34 years it was 1.15 (95% CI: 1.01, 1.30), and for women above 34 years the FR was 2.44 (95% CI: 1.84, 3.22) after adjustment for confounders. The increased fecundability with age is contrary to previous studies and may be explained by selection bias, as sterile women were not included. In addition, some very fertile young women who became pregnant by accident before efficient birth control methods were available and therefore were excluded from time to pregnancy studies may now use oral contraceptives until they plan a pregnancy later in life and are included.
Few studies have investigated the association between body mass index and fecundability, that is, the ability to conceive in a menstrual cycle, among fertile women with normal menstrual cycle pattern. We examined the independent and combined effects of duration and regularity of the menstrual cycle, body mass index, and fecundability from records on pregnant women attending antenatal care at Odense University Hospital, Denmark, between 1972 and 1987. We included only the first birth of each woman who had planned pregnancies and no pre-pregnancy disease (N = 10,903). We estimated the fecundability odds ratio (FR) as the odds of conception in a menstrual cycle. After adjusting for confounders, the fecundability for women with a body mass index >25 kg/m2 was lower than for women with a body mass index of 20-25 kg/m2 [FR = 0.77; 95% confidence interval (CI) = 0.70-0.84]. FR was lower for women with long (>35 days) (FR = 0.74; 95% CI = 0.63-0.87) or irregular cycles (FR = 0.78; 95% CI = 0.70-0.87), even when their body mass index was within the normal range (20-25 kg/m2) and/or their cycles were regular.
A random sample of 100 men and 100 women was examined for whole-blood concentrations of mercury, lead, cadmium and selenium, and the serum concentrations of selenium, nickel, fluoride, aluminium, zinc and copper. Major predictors were sex, hormonal factors (pregnancy, menopause, use of oral contraceptives), age, tobacco smoking and alcohol drinking. Among notable associations, increased blood-mercury was related to the presence of more than four amalgam fillings in the teeth. Blood-mercury correlated with blood-selenium, but a relation to fish intake could only be demonstrated for the former parameter. In women, blood-lead appeared to increase with age, with the highest levels seen after the menopause. Serum-nickel was slightly lower in patients with nickel-related contact eczema. Only the selenium concentrations showed a slight increase in individuals taking mineral supplements. Serum-zinc concentrations decreased considerably during the day. Thus, due to the substantial influence of physiological and environmental factors, individual results must be interpreted in the light of the known predictors for the trace element concentration. However, population-based reference intervals for trace elements in blood are useful to explore geographic and temporal variations.