Suchergebnisse

Abstract
Amyotrophic lateral sclerosis (ALS) is caused by the gradual degeneration and death of motor neurons, with mostly unknown etiology. Some risk factors have been suggested for this disease including extremely low frequency magnetic fields (ELF-MF) exposure. This meta-analysis assesses the association of residential exposure to ELF-MF with the risk of ALS. Five studies have addressed the risk of ALS in relation to overhead power lines. A pooled relative risk (RR) of 0.71 [95% confidence interval (CI): 0.48, 1.07] for the most exposed population group (either <200 m distance from high voltage power lines or >0.1 μT) was found. Little heterogeneity (I2=0.00%, p=0.67) and indication for publication bias (PBegg's test=0.22; PEgger's test=0.19) was seen. Overall, we found no evidence for an association between residential exposure to ELF-MF and the risk of ALS, although the number of exposed cases is low.

ObjectivesWe assessed the relationship between heat and emergency hospital admissions (EHAs) in Switzerland using clinically relevant metrics.MethodsApplying distributed lag non-linear models, we investigated temperature-admission associations between May and September 1998–2019 for various disease groups, by age class and gender. We estimated the relative risk (RR) for moderate (29°C) and extreme (34°C) daily maximum temperatures relative to disease-specific optimum temperature, and calculated attributable fractions (AFs) for hot days and the following week. We also calculated the total number of heat-related EHAs.ResultsWe attributed 31,387 (95% confidence interval: 21,567–40,408) EHAs to above-optimal temperatures, 1.1% (0.7%–1.4%) of the total. Extreme temperatures increased the EHA risk for mental, infectious and neurological diseases. We observed particularly high AFs due to extreme heat for dehydration (85.9%, 95% CI: 82.4%–88.8%) and acute kidney injury (AKI, 56.1%, 95% CI: 45.3%–64.7%). While EHA risk generally increased with age, we also found high RRs for infectious diseases in children (0–15 years) and AKI in young adults (15–64 years).ConclusionHot weather increases the EHA risk in Switzerland. Therefore a comprehensive clinical and public health response is needed.

Abstract
Exposure to extremely low frequency magnetic fields (ELF-MF) and electric shocks occurs in many workplaces and occupations but it is unclear whether any of these exposures cause Amyotrophic lateral sclerosis (ALS). The aim of this systematic review and meta-analysis is to explore whether occupational exposure to ELF-MF and/or electric shocks are risk factor for ALS. We searched PubMed, Embase, and Web of Science databases up to the end of 2019. Pooled risk estimates were calculated using random-effects meta-analysis including exploration of the sources of heterogeneity between studies and publication bias. Twenty-seven publications fulfilled the inclusion criteria. We found a weak, significant, association between occupational exposure to ELF-MF and the risk of ALS (RRPooled estimate: 1.20; 95%CI: 1.05, 1.38) with moderate to high heterogeneity (I2=66.3%) and indication of publication bias (PEgger's test=0.03). No association was observed between occupational exposure to electric shocks and risk of ALS (RRPooled estimate: 0.97; 95%CI: 0.80, 1.17) with high heterogeneity (I2=80.5%), and little indication for publication bias (PEgger's test=0.24). The findings indicate that occupational exposure to ELF-MF, but not electric shocks, might be a risk factor for ALS. However, given the moderate to high heterogeneity and potential publication bias, the results should be interpreted with caution.

Exposure to electromagnetic fields (EMF) is a cause of concern for many people. The topic will likely remain for the foreseeable future on the scientific and political agenda, since emissions continue to change in characteristics and levels due to new infrastructure deployments, smart environments and novel wireless devices. Until now, systematic and coordinated efforts to monitor EMF exposure are rare. Furthermore, virtually nothing is known about personal exposure levels. This lack of knowledge is detrimental for any evidence-based risk, exposure and health policy, management and communication. The main objective of the paper is to review the current state of EMF exposure monitoring activities in Europe, to comment on the scientific challenges and deficiencies, and to describe appropriate strategies and tools for EMF exposure assessment and monitoring to be used to support epidemiological health research and to help policy makers, administrators, industry and consumer representatives to base their decisions and communication activities on facts and data. ; ISSN:1660-4601 ; ISSN:1661-7827

Exposure to electromagnetic fields (EMF) is a cause of concern for many people. The topic will likely remain for the foreseeable future on the scientific and political agenda, since emissions continue to change in characteristics and levels due to new infrastructure deployments, smart environments and novel wireless devices. Until now, systematic and coordinated efforts to monitor EMF exposure are rare. Furthermore, virtually nothing is known about personal exposure levels. This lack of knowledge is detrimental for any evidence-based risk, exposure and health policy, management and communication. The main objective of the paper is to review the current state of EMF exposure monitoring activities in Europe, to comment on the scientific challenges and deficiencies, and to describe appropriate strategies and tools for EMF exposure assessment and monitoring to be used to support epidemiological health research and to help policy makers, administrators, industry and consumer representatives to base their decisions and communication activities on facts and data.

Abstract. Extreme temperatures have reached unprecedented levels in many regions of the globe due to climate change, and a further increase is expected. Besides other consequences, high temperatures increase the mortality risk and severely affect the labour productivity of workers. We perform a high-resolution spatial analysis to assess the impacts of heat on mortality and labour productivity in Switzerland and project their development under different Representative Concentration Pathway (RCP) scenarios, considering that no socio-economic changes take place. The model is based on the risk framework of the Intergovernmental Panel on Climate Change (IPCC), which combines the three risk components: hazard, exposure, and vulnerability. We model the two impact categories in the same spatially explicit framework, and we integrate uncertainties into the analysis by a Monte Carlo simulation. We model first that about 658 deaths are associated with heat exposure currently each year in Switzerland. Second, the economic costs caused by losses in labour productivity amount to around CHF 665 million (approx. USD 700 million) per year. Should we remain on an RCP8.5 emissions pathway, these values may double (for mortality) or even triple (for labour productivity) by the end of the century. Under an RCP2.6 scenario impacts are expected to slightly increase and peak around mid-century, when climate is assumed to stop warming. Even though uncertainties in the model are large, the underlying trend in impacts is unequivocal. The results of the study are valuable information for political discussions and allow for a better understanding of the cost of inaction.

Extreme temperatures have reached unprecedented levels in many regions of the globe due to climate change anda further increase is expected. Besides other consequences, high temperatures increase the mortality risk and severely affectthe labour productivity of workers. We perform a high-resolution spatial analysis to assess the impacts of heat on mortality and labour productivity in Switzerland and project their development under different Representative Concentration Pathway (RCP) scenarios, considering that no socio-economic changes takes place. The model is based on the risk framework of the Intergovernmental Panel on Climate Change (IPCC), which combines the three risk components: Hazard , Exposure , and Vulnerability . We model the two impact categories in the same spatially explicit framework and we integrate uncertainties into the analysis through a Monte Carlo simulation. We model, that first, about 670 people die today per year because of heat in Switzerland. Second, the economic costs caused by losses in labour productivity amount to around CHF 413 million (approx. $ 465 million) per year. Should we remain on an RCP8.5 emissions pathway, these values may double (for mortality) or even triple (for labour productivity) by the end of the century. Under an RCP2.6 scenario impacts are expected to slightly increaseand peak around mid-century, when climate is assumed to stop warming. Even though uncertainties in the model are large, theunderlying trend in impacts is unequivocal. The results of the study are valuable information for political discussions and allowfor a better understanding of the cost of inaction.

In diesem Kapitel befassen wir uns mit der materiellen Umwelt der Menschen und den Auswirkungen, die sie auf die menschliche Gesundheit haben kann. Vor allem in den letzten beiden Jahrhunderten hat sich unsere Umwelt durch Bevölkerungswachstum, Industrialisierung und Urbanisierung stark verändert, und sie verändert sich laufend weiter. Im ersten Abschnitt widmen wir uns dem sich ändernden Klima und seinen ökologischen und gesundheitlichen Folgen. Dazu diskutieren wir die politischen Aspekte, die in diesem Zusammenhang von großer Bedeutung sind, einschließlich der Maßnahmen zur Reduktion von Treibhausgasemissionen. Im zweiten Abschnitt gehen wir auf die Trinkwasserversorgung und Abwasserentsorgung ein, die von zentraler Bedeutung für die Gesundheit der Bevölkerung sind. Der nächste Abschnitt widmet sich der Verschmutzung des Bodens, der Grundlage des Lebens auf dem Festland und wesentliche Basis der Nahrungsmittelproduktion und des Wasserhaushaltes. Danach beschäftigen wir uns mit der Luftverschmutzung. Wir betrachten die wichtigsten Schadstoffquellen, die gesundheitlichen Auswirkungen der Luftverschmutzung und mögliche präventiven Maßnahmen. In einem weiteren Abschnitt erörtern wir die Begriffe und Maßeinheiten rund um ionisierende und nicht ionisierende Strahlung, die häufigsten Strahlungsquellen, gesundheitlichen Auswirkungen und präventive Maßnahmen. Abschließend definieren wir Schall und Lärm, schauen uns die wichtigsten Lärmquellen an und gehen auf die Bedeutung der durch Lärm ausgelösten Erkrankungen und ihre Prävention ein.

Background Medulloblastoma is associated with rare hereditary cancer predisposition syndromes; however, consensus medulloblastoma predisposition genes have not been defined and screening guidelines for genetic counselling and testing for paediatric patients are not available. We aimed to assess and define these genes to provide evidence for future screening guidelines. Methods In this international, multicentre study, we analysed patients with medulloblastoma from retrospective cohorts (International Cancer Genome Consortium [ICGC] PedBrain, Medulloblastoma Advanced Genomics International Consortium [MAGIC], and the CEFALO series) and from prospective cohorts from four clinical studies (SJMB03, SJMB12, SJYC07, and I-HIT-MED). Whole-genome sequences and exome sequences from blood and tumour samples were analysed for rare damaging germline mutations in cancer predisposition genes. DNA methylation profiling was done to determine consensus molecular subgroups: WNT (MBWNT), SHH (MBSHH), group 3 (MBGroup3), and group 4 (MBGroup4). Medulloblastoma predisposition genes were predicted on the basis of rare variant burden tests against controls without a cancer diagnosis from the Exome Aggregation Consortium (ExAC). Previously defined somatic mutational signatures were used to further classify medulloblastoma genomes into two groups, a clock-like group (signatures 1 and 5) and a homologous recombination repair deficiency-like group (signatures 3 and 8), and chromothripsis was investigated using previously established criteria. Progression-free survival and overall survival were modelled for patients with a genetic predisposition to medulloblastoma. Findings We included a total of 1022 patients with medulloblastoma from the retrospective cohorts (n=673) and the four prospective studies (n=349), from whom blood samples (n=1022) and tumour samples (n=800) were analysed for germline mutations in 110 cancer predisposition genes. In our rare variant burden analysis, we compared these against 53 105 sequenced controls from ExAC and identified APC, BRCA2, PALB2, PTCH1, SUFU, and TP53 as consensus medulloblastoma predisposition genes according to our rare variant burden analysis and estimated that germline mutations accounted for 6% of medulloblastoma diagnoses in the retrospective cohort. The prevalence of genetic predispositions differed between molecular subgroups in the retrospective cohort and was highest for patients in the MBSHH subgroup (20% in the retrospective cohort). These estimates were replicated in the prospective clinical cohort (germline mutations accounted for 5% of medulloblastoma diagnoses, with the highest prevalence [14%] in the MBSHH subgroup). Patients with germline APC mutations developed MBWNT and accounted for most (five [71%] of seven) cases of MBWNT that had no somatic CTNNB1 exon 3 mutations. Patients with germline mutations in SUFU and PTCH1 mostly developed infant MBSHH. Germline TP53 mutations presented only in childhood patients in the MBSHH subgroup and explained more than half (eight [57%] of 14) of all chromothripsis events in this subgroup. Germline mutations in PALB2 and BRCA2 were observed across the MBSHH, MBGroup3, and MBGroup4 molecular subgroups and were associated with mutational signatures typical of homologous recombination repair deficiency. In patients with a genetic predisposition to medulloblastoma, 5-year progression-free survival was 52% (95% CI 40–69) and 5-year overall survival was 65% (95% CI 52–81); these survival estimates differed significantly across patients with germline mutations in different medulloblastoma predisposition genes. Interpretation Genetic counselling and testing should be used as a standard-of-care procedure in patients with MBWNT and MBSHH because these patients have the highest prevalence of damaging germline mutations in known cancer predisposition genes. We propose criteria for routine genetic screening for patients with medulloblastoma based on clinical and molecular tumour characteristics. Funding German Cancer Aid; German Federal Ministry of Education and Research; German Childhood Cancer Foundation (Deutsche Kinderkrebsstiftung); European Research Council; National Institutes of Health; Canadian Institutes for Health Research; German Cancer Research Center; St Jude Comprehensive Cancer Center; American Lebanese Syrian Associated Charities; Swiss National Science Foundation; European Molecular Biology Organization; Cancer Research UK; Hertie Foundation; Alexander and Margaret Stewart Trust; V Foundation for Cancer Research; Sontag Foundation; Musicians Against Childhood Cancer; BC Cancer Foundation; Swedish Council for Health, Working Life and Welfare; Swedish Research Council; Swedish Cancer Society; the Swedish Radiation Protection Authority; Danish Strategic Research Council; Swiss Federal Office of Public Health; Swiss Research Foundation on Mobile Communication; Masaryk University; Ministry of Health of the Czech Republic; Research Council of Norway; Genome Canada; Genome BC; Terry Fox Research Institute; Ontario Institute for Cancer Research; Pediatric Oncology Group of Ontario; The Family of Kathleen Lorette and the Clark H Smith Brain Tumour Centre; Montreal Children's Hospital Foundation; The Hospital for Sick Children: Sonia and Arthur Labatt Brain Tumour Research Centre, Chief of Research Fund, Cancer Genetics Program, Garron Family Cancer Centre, MDT's Garron Family Endowment; BC Childhood Cancer Parents Association; Cure Search Foundation; Pediatric Brain Tumor Foundation; Brainchild; and the Government of Ontario.