Description: Background To date, the association of the neurotoxic agent cadmium (Cd) with depression in elderly people has been poorly evaluated. By investigating the relationship between blood cadmium levels and scores on a depression screening test, we aimed to investigate the impact of cadmium exposure on elderly depression. Methods From 2008 to 2010, a total of 395 elderly participants residing in Seoul, Korea, were evaluated 3 times. Demographic data and lifestyle information were obtained via a systemised questionnaire, and blood samples were collected for analysis. Participants underwent the Korean Version of the Short Form Generic Depression Scale test (SGDS-K) for screening depression and associations were estimated using logistic regression models adjusted for potential confounders. Results Blood cadmium levels were associated with depressive symptoms in the first visit data analysis. By analysing the first visit data, the highest quartile blood cadmium group (Q4) showed increased risk for depressive symptoms compared to the lowest quartile group (Q1) (OR 3.50, 95% CI 1.22 to 10.00). However, the data of the second and third visits suggested that blood cadmium may be protective against depressive symptoms (second visit data, Q4 vs Q1, OR 0.78, 95% CI 0.19 to 3.14; third visit data, Q4 vs Q1, OR 0.58, 95% CI 0.04 to 8.77). Conclusions Owing to inconsistent results in analyses between blood cadmium levels and depressive symptoms, we cannot conclude any solid association between blood cadmium levels and depressive symptoms in the elderly population. To clarify the relationship, other prospective studies are needed in the future.

Description: Objectives Casale Monferrato (north west Italy) is an area with an exceptionally high incidence of mesothelioma caused by asbestos contamination at work and in the general environment from the asbestos-cement Eternit plant that was operational until 1986. The purpose of this study was to quantify the association between pleural malignant mesothelioma (PMM) and asbestos cumulative exposure using individual assessment of environmental and domestic exposure, as well as of occupational exposure. Methods This population-based case-control study included cases of PMM diagnosed between January 2001 and June 2006 among residents in the Casale Monferrato Local Health Authority. Population controls were randomly sampled, matched by age and sex to cases. Cumulative exposure was estimated to account for the lifelong exposure history. Analyses were conducted using unconditional logistic regression models adjusting for gender, age at diagnosis and type of interview (direct or proxy respondents). Results 200 PMM cases of 223 eligible cases (89.7%) and 348 (63%) of 552 eligible controls accepted to be interviewed. ORs increased with cumulative exposure index (p〈0.0001) from 4.4 (CI 95% 1.7 to 11.3) (〈1 f/mL-years) to 62.1 (CI 95% 22.2 to 173.2) (≥10 f/mL-years). Among subjects never occupationally exposed, corresponding ORs were 3.8 (CI 95% 1.3 to 11.1) and 23.3 (CI 95% 2.9 to 186.9) (reference: background level of asbestos exposure). ORs of about 2, statistically significant, were observed for domestic exposure and for living in houses near buildings with large asbestos cement parts. Conclusions Risk of PMM increased with cumulative asbestos exposure and also in analyses limited to subjects non-occupationally exposed. Our results also provide indication of risk associated with common sources of environmental exposure and are highly relevant for the evaluation of residual risk after the cessation of asbestos industrial use.

Description: Introduction Italy produced and imported a large amount of raw asbestos, up to the ban in 1992, with a peak in the period between 1976 and 1980 at about 160 000 tons/year. The National Register of Mesotheliomas (ReNaM, "Registro Nazionale dei Mesoteliomi" in Italian), a surveillance system of mesothelioma incidence, has been active since 2002, operating through a regional structure. Methods The Operating Regional Center (COR) actively researches cases and defines asbestos exposure on the basis of national guidelines. Diagnostic, demographic and exposure characteristics of non-occupationally exposed cases are analysed and described with respect to occupationally exposed cases. Results Standardised incidence rates for pleural mesothelioma in 2008 were 3.84 (per 100 000) for men and 1.45 for women, respectively. Among the 15 845 mesothelioma cases registered between 1993 and 2008, exposure to asbestos fibres was investigated for 12 065 individuals (76.1%), identifying 530 (4.4%) with familial exposure (they lived with an occupationally exposed cohabitant), 514 (4.3%) with environmental exposure to asbestos (they lived near sources of asbestos pollution and were never occupationally exposed) and 188 (1.6%) exposed through hobby-related or other leisure activities. Clusters of cases due to environmental exposure are mainly related to the presence of asbestos-cement industry plants (Casale Monferrato, Broni, Bari), to shipbuilding and repair activities (Monfalcone, Trieste, La Spezia, Genova) and soil contamination (Biancavilla in Sicily). Conclusions Asbestos pollution outside the workplace contributes significantly to the burden of asbestos-related diseases, suggesting the need to prevent exposures and to discuss how to deal with compensation rights for malignant mesothelioma cases induced by non-occupational exposure to asbestos.

Description: Objectives To examine vascular endothelial growth factor (VEGF) and PGE2 levels in urine from the copper smelting workers exposed to arsenic and analyse the relationships between urinary VEGF or PGE2 level and arsenical metabolites. Methods The study was conducted in a group of 106 copper-smelting male workers. Information about each subject was obtained by questionnaire, inorganic As (iAs), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), VEGF and prostaglandin E2 (PGE2) in urine were determined. Standing height, body weight, and blood pressure were measured. Results According to the urine arsenic levels, participants were separated into three groups: Group 1: urine total arsenic 〈35 mg/L, Group 2: 35–100 mg/L, and Group 3: 〉100 mg/L. The median levels of urinary VEGF and PGE2 in Groups 1, 2 and 3 were 10.57 and 1032.0 pg/mL, 24.39 and 1060.9 pg/mL, and 49.0 and 1330.4 pg/mL, respectively. Urinary VEGF levels were positive associated with arsenical metabolites (iAs, MMA, DMA and TAs). Additionally, urinary VEGF and PGE2 levels were all correlated positively with the urinary MMA% (r=0.221, p=0.026 and r=0.206, p=0.037). While urinary VEGF was negatively with DMA% and secondary methylation index (r=–0.242, p=0.014 and r=–0.214, p=0.030, respectively). Conclusions Urinary VEGF and PGE2 levels increased in arsenic exposure copper smelting workers, and urinary VEGF levels are well associated with the urinary arsenicals. This finding may provide useful information for developing measurement, prevention and treatment of damage induced by arsenic in the future.

Description: Objectives To examine mortality patterns and cancer incidence in a pooled cohort of 29 993 US career firefighters employed since 1950 and followed through 2009. Methods Mortality and cancer incidence were evaluated by life table methods with the US population referent. Standardised mortality (SMR) and incidence (SIR) ratios were determined for 92 causes of death and 41 cancer incidence groupings. Analyses focused on 15 outcomes of a priori interest. Sensitivity analyses were conducted to examine the potential for significant bias. Results Person-years at risk totalled 858 938 and 403 152 for mortality and incidence analyses, respectively. All-cause mortality was at expectation (SMR=0.99, 95% CI 0.97 to 1.01, n=12 028). There was excess cancer mortality (SMR=1.14, 95% CI 1.10 to 1.18, n=3285) and incidence (SIR=1.09, 95% CI 1.06 to 1.12, n=4461) comprised mainly of digestive (SMR=1.26, 95% CI 1.18 to 1.34, n=928; SIR=1.17, 95% CI 1.10 to 1.25, n=930) and respiratory (SMR=1.10, 95% CI 1.04 to 1.17, n=1096; SIR=1.16, 95% CI 1.08 to 1.24, n=813) cancers. Consistent with previous reports, modest elevations were observed in several solid cancers; however, evidence of excess lymphatic or haematopoietic cancers was lacking. This study is the first to report excess malignant mesothelioma (SMR=2.00, 95% CI 1.03 to 3.49, n=12; SIR=2.29, 95% CI 1.60 to 3.19, n=35) among US firefighters. Results appeared robust under differing assumptions and analytic techniques. Conclusions Our results provide evidence of a relation between firefighting and cancer. The new finding of excess malignant mesothelioma is noteworthy, given that asbestos exposure is a known hazard of firefighting.

Description: Background There is inconsistency regarding the effects of cadmium exposure on liver function between the positive results found in animal studies and the negative results highlighted in epidemiological studies. We investigated whether environmental cadmium exposure is associated with an elevation in serum liver enzyme activity in Korean adults. Methods This cross-sectional study evaluated adult participants without liver disease from the Korean National Health and Nutrition Examination Survey for 2008–2009. Multiple linear regression was conducted to investigate the association between blood cadmium concentration and the serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) adjusting for age, sex, body mass index and the amount of alcohol consumption. Subjects were stratified into quartiles by their cumulative cadmium exposure rank. We estimated the multivariate-adjusted ORs for liver enzyme elevation using logistic regression models with the first quartile as the reference group. Results Total number of the subjects in the analysis was 3914. The blood cadmium concentrations were significantly associated with liver enzyme levels (AST, β=2.677, p value 〈0.0001; ALT, β=3.696, p value 〈0.0001; ALP, β=11.730, p value 〈0.0001). As the cadmium levels approached higher quartiles, the ORs for an elevated AST, ALT and ALP was increased significantly. Conclusions Environmental cadmium exposures are associated with an elevation in serum liver enzyme levels in Korean adults.