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PubMed1984

Workshop on allergic responses and hypersensitivities induced by chemicals; Frankfurt, 12-15 October 1982. World Health Organization/Commission of European Communities.

There is a significant health problem associated with allergy and intolerance to man-made chemicals, both in terms of the severity of the clinical condition and the seriousness of interference with life quality and in terms of the number of exposed people. Recognizing the growing importance of the problem, the World Health Organization Regional Office for Europe and the Commission of European Communities (Health and Safety Directorate) jointly organized a Workshop on Allergic Responses and Hypersensitivities Induced by Chemicals, which was held in Frankfurt/on Main, Federal Republic of Germany, from 12 to 15 October 1982.

Animals↗
PubMed2004

Parental smoking in childhood and adult obstructive lung disease: results from the European Community Respiratory Health Survey.

BACKGROUND: Early exposure to parental smoking appears to influence the development of the airways and predispose to respiratory symptoms. A study was undertaken to determine whether the consequences of parental smoking could be traced in adulthood. METHODS: Information from interviewer-led questionnaires was available for 18 922 subjects aged 20-44 years from random population samples in 37 areas participating in the European Community Respiratory Health Survey. Lung function data were available for 15,901 subjects. RESULTS: In men, father's smoking in childhood was associated with more respiratory symptoms (ORwheeze 1.13 (95% CI 1.00 to 1.28); never smokers: ORwheeze 1.21 (95% CI 0.96 to 1.50)) and there was a dose-dependent association between number of parents smoking and wheeze (one: OR 1.08 (95% CI 0.94 to 1.24); both: OR 1.24 (95% CI 1.05 to 1.47); ptrend = 0.010). A reduced ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) was related to father's smoking (-0.3% (95% CI -0.6 to 0)) and number of parents smoking (ptrend <0.001) among men. In women, mother's smoking was associated with more respiratory symptoms and poorer lung function (ORwheeze 1.15 (95% CI 1.01 to 1.31), never smokers: ORwheeze 1.21 (95% CI 0.98-1.51); FEV1 -24 ml (95% CI -45 to -3); FEV1/FVC ratio -0.6% (95% CI -0.9 to -0.3)). These effects were possibly accounted for by maternal smoking in pregnancy (ORwheeze 1.39 (95% CI 1.17 to 1.65); FEV1 -23 ml (95% CI -52 to 7); FEV1/FVC ratio -0.9% (95% CI -1.3 to -0.4)) as there was no association with paternal smoking among women (interaction by sex, p<0.05). These results were homogeneous across centres. CONCLUSION: Both intrauterine and environmental exposure to parental tobacco smoking was related to more respiratory symptoms and poorer lung function in adulthood in this multicultural study. The age window of particular vulnerability appeared to differ by sex, postnatal exposure being important only in men and a role for prenatal exposure being more evident in women.

Adult↗
PubMed1997

The distribution of total and specific serum IgE in the European Community Respiratory Health Survey.

BACKGROUND: Variations in the prevalence of atopy could provide important clues to the etiology of atopy and asthma. Although estimates of prevalence are available from different studies, a lack of standardization makes comparisons difficult. OBJECTIVE: This study was conducted to estimate the variation of geometric mean levels of serum IgE and the prevalence of specific IgE to common allergens between populations as part of the European Community Respiratory Health Survey (ECRHS), a multicenter survey of asthma and risk factors for asthma. METHODS: Random samples of subjects living in 37 centers in 16 countries who had answered a questionnaire about their respiratory symptoms were invited for further assessment including total serum IgE and the presence of specific IgE against house dust mite (Dermatophagoides pteronyssinus), timothy grass, cat, Cladosporium herbarum, and a local allergen. Sera were tested from 13,883 persons. RESULTS: The estimated prevalence of atopy, defined as the presence of at least one positive specific IgE, ranged from 16% in Albacete (Spain) to 45% in Christchurch (New Zealand). The geometric mean total serum IgE varied from 13 kU/L in Reykjavik (Iceland) to 62 kU/L in Bordeaux (France). There was no relation between the geometric mean total serum IgE in a center and the prevalence of atopy. CONCLUSIONS: There are substantial variations in the prevalence of atopy and the level of serum IgE. These variations are independent of each other and likely to be largely environmental in origin.

Allergens↗
PubMed1994

Trace element reference values in tissues from inhabitants of the European Community. V. Review of trace elements in blood, serum and urine and critical evaluation of reference values for the Danish population.

The availability of accurate trace element reference values in human tissues represents an important indicator to the health status of the general population and occupational groups exposed to trace elements. The EURO TERVIHT project (Trace Element Reference Values In Human Tissues) aims to establish and compare trace element reference values in tissues from inhabitants of the European Community as baseline values for clinical/toxicological assessment studies (Sabbioni et al., 1992, Sci. Total Environ., 120: 39-62). In this context, one of the first steps considered is the critical evaluation (state of the art) of existing literature on trace element reference values in blood, serum and urine in the general population of each EC country. This paper reviews the Danish situation.

Adolescent↗
PubMed1997

Physician-diagnosed asthma and drug utilization in the European Community Respiratory Health Survey.

The aim of this analysis was to estimate the geographical variation in the prevalence of physician-diagnosed asthma and treatment practice for asthma in young adults. The results are based on an ecological analysis of 34 centres in 14 countries, in which a total of 17,029 randomly selected subjects (52% females, age 20-48 yrs) underwent a structured interview and spirometry as part of the European Community Respiratory Health Survey. The sample was enriched with 2,903 symptomatic subjects when investigating treatment in subjects with physician-diagnosed asthma. The prevalence of physician-diagnosed asthma was highest in New Zealand and Australia (11-13%) and lowest in Erfurt, Germany (1.2%) and Spain (1.5-3.0%). The reported use of antiasthma medication in the last 12 months was also highest in New Zealand and Australia (12-16%) and correlated closely with the prevalence of diagnosed asthma (r=0.89, p<0.001). Herbal remedies against breathing problems had been used by 13% of subjects in Hamburg but the reported use of alternative remedies for breathing problems was low in most other centres. The use of inhaled anti-inflammatory drugs in subjects with physician-diagnosed asthma ranged from 49% in the UK to 17% in Italy and correlated with the prevalence of doctors' consultations within the last 12 months (r=0.66, p<0.05). The prevalence of anti-inflammatory treatment was positively related to the prevalence of nocturnal asthma symptoms (p<0.05). We conclude that there is a wide geographical variation in the prevalence of physician-diagnosed asthma and use of antiasthma medication. The geographical variation in the use of anti-inflammatory drugs among individuals with diagnosed asthma may be related to variations in asthma severity, as well as differences in treatment practices between countries.

Adult↗
PubMed1994

Trace element reference values in tissues from inhabitants of the European Community. VII. Review of trace elements in blood, serum and urine of the Belgian population and critical evaluation of their possible use as reference values.

The availability of accurate trace element reference values in human tissues represents an important indicator to the health status of the general population and occupational groups exposed to trace elements. The EURO TERVIHT project (Trace Element Reference Values In Human Tissues) aims to establish and compare trace element reference values in tissues from inhabitants of the European Community as baseline values for clinical/toxicological assessment studies (Sabbioni et al., 1992a,b). In this context one of the first steps considered is the critical evaluation (state of the art) of existing literature on trace element reference values in blood, serum and urine in the general population of each EC country. This paper reviews the Belgian situation.

Adolescent↗
PubMed1990

European Community collaborative study of outcome of pregnancy between 22 and 28 weeks' gestation. Working Group on the Very Low Birthweight Infant.

International comparison of perinatal mortality rates is subject to various problems in methods of reporting. The main difficulties are differences in the definition of livebirth and the variation in policies on the elective delivery of very preterm fetuses at risk of intrauterine death. This study, based on geographically defined populations within the European Community, set out to compare survival rates in very low birthweight infants (below 1500 g). The first phase of the study in seven populations showed pronounced differences in survival and in the proportion of liveborn infants who weighed less than 1000 g. A further phase studied the outcome of all pregnancies from 22 to 28 weeks' gestation in four populations. There was no significant difference between the four populations in crude survival rates per 1000 livebirths among infants born at 22 to 28 weeks' gestation, but more babies were born alive at the earlier gestations in the United Kingdom. Survival rates were higher in Scotland and England when gestational age at birth was controlled for. Future comparisons of the outcome of perinatal care for extremely immature infants would be more meaningful if data on the outcome of all pregnancies ending after 22 weeks' gestation were routinely collected through the registration system.

Birth Rate↗
PubMed2001

International prevalences of reported food allergies and intolerances. Comparisons arising from the European Community Respiratory Health Survey (ECRHS) 1991-1994.

OBJECTIVE: The aim of this study was to report the prevalence, type and reported symptoms associated with food intolerance. DESIGN: A cross-sectional epidemiological study involving 15 countries using standardized methodology. Participants answered a detailed interviewer-administered questionnaire and took part in blood, lung function and skin prick tests to common aeroallergens. SETTING: Randomly selected adults who took part in the second phase of the European Community Respiratory Health Survey (ECRHS). SUBJECTS: The subjects were 17280 adults aged 20-44 y. RESULTS: Twelve percent of respondents reported food allergy/intolerance (range 4.6% in Spain to 19.1% in Australia). Atopic females who had wheezed in the past 12 months, ever had asthma or were currently taking oral asthma medications were significantly more likely to report food allergy/intolerance. Participants from Scandinavia or Germany were significantly more likely than those from Spain to report food allergy/intolerance. Respondents who reported breathlessness as a food-related symptom were more likely to have wheezed in the past 12 months, to have asthma, use oral asthma medications, be atopic, have bronchial hyperreactivity, be older and reside in Scandinavia. CONCLUSION: Self-reported food allergy/intolerance differed significantly across multiple countries. The reasons for these differences were not explored in this study, but are likely to be largely due to cultural differences.

Adult↗
PubMed1998

Determinants of bronchial responsiveness in the European Community Respiratory Health Survey in Italy: evidence of an independent role of atopy, total serum IgE levels, and asthma symptoms.

The aim of the analysis was to test whether total serum IgE levels, specific serum IgE levels, and asthma symptoms are independent predictors of bronchial hyperresponsiveness (BHR), after controlling for known risk factors or potential confounders. The study was carried out on a sample of 875 young adults, 20-44 years old, who took part in the European Community Respiratory Health Survey in Italy. The subjects underwent a dose-response methacholine challenge test. We also measured airway caliber as the baseline FEV1 in absolute terms and as percentage of forced vital capacity (FVC); skin wheal response to 11 common environmental allergens; and total and specific serum IgE levels to mites, molds, pets, and respiratory symptoms by means of a standardized questionnaire. Atopy (positive skin prick test and/or positive specific IgE assay), total IgE, asthma symptoms, airway caliber, and age appeared to be independent predictors of BHR. When all the other risk factors were taken into account, atopy and total IgE were associated with a threefold increase in BHR risk and thus emerged as the main determinants of BHR. The importance of symptom status as a determinant of BHR decreased remarkably after controlling for atopy and IgE: the odds ratio of current asthmatics to asymptomatic subjects decreased from 15.3 to 8.8. When controlling for symptoms and atopy, a family history of allergic diseases and early respiratory infections was not found to be associated with BHR. Both FEV1 and FEV1/FVC were strongly and inversely associated with BHR. When airway caliber was taken into account, older age was associated with decreased responsiveness, and the level of responsiveness did not differ significantly between males and females and between smokers and nonsmokers. The results from this analysis indicate that at any given age, irrespective of sex and smoking habits, total serum IgE, specific IgE, airway caliber, and asthma symptoms are the main independent factors influencing the occurrence of BHR in a young adult sample.

Adult↗
PubMed2004

Using the European Community Radon Software to estimate the individual health benefits of a domestic radon remediation programme.

Radon can be present in domestic properties at high enough levels to pose a health risk. Such levels can usually be reduced by simple means. Studies on a group of radon-remediated homes in Northamptonshire, a radon affected area, have estimated the health benefits and cost effectiveness from remediation and have shown that remediation can be justified. These assessments have been based on collective population-average risk coefficients. The advent of the European Community Radon Software (ECRS) permits the consideration of individual risk. In particular, it can take into account individual smoking habits, which significantly affect risk, as current scientific opinion is that risks from radon and smoking are multiplicative. This note indicates how the software can be used, and the usefulness of this approach.

Air Pollution, Radioactive↗
PubMed1993

Handling antineoplastic drugs in the European Community countries.

Alkylating antineoplastic drugs (ADs) are carcinogenic to humans and most ADs cause reproductive failures in animal experiments. Studies of occupationally exposed health personnel have shown increased risks for miscarriages (two studies), malformations (two studies) and leukaemia (two studies). During the past decade, work practice guidelines have been issued by authorities in several countries but universal agreement on a set of guidelines which would secure both the work environment and the treatment of patients is yet to come. We reviewed the existing guidelines in the European Community (EC) countries on health personnel's handling of ADs. Five countries had guidelines on the safe handling of ADs. The main principles were to use exhaust cabinets and personal protective equipment. Two sets of guidelines included recommendations for pregnant women. In general, the EC countries' guidelines were less extensive than those issued by the US Occupational Safety and Health Administration. It is argued that the existence of more uniform guidelines in all the member states would be valuable. Specifically, measures should be devised to prevent adverse effects on reproduction.

Antineoplastic Agents↗
PubMed1994

Assessing HIV prevention among injecting drug users in European Community countries: a review.

By September 30th 1991, 19,579 cases of AIDS among injecting drug users had been reported in Europe. HIV seroprevalence rates among drug injectors vary from less than 5% in some cities, to over 50% in others. Since the estimated number of drug injectors in Europe is between 750,000 and 1,000,000, HIV is a considerable threat to drug injectors, their sex partners and their off-spring, affecting large numbers of citizens in the European region. This paper gives an overview of the magnitude of the drugs/AIDS problem in the European region, and the concrete measures that have been taken to prevent HIV infection among drug users. Data from the evaluation of methadone programmes, needle and syringe exchange schemes and data on sexual behaviour change of drug users are critically reviewed. Limitations of the methods used for the evaluation of prevention activities are also discussed. Based on all the material reviewed, the main conclusions are the following: AIDS is a greater threat to public health than problem drug use, more accurate and reliable evaluation methods need to be utilized at European Community level, a combination of prevention measures should be used in order to reduce the further spread of HIV infection among injecting drug users.

AIDS Serodiagnosis↗
PubMed2000

The use of frailty models in genetic studies: application to the relationship between end-stage renal failure and mutation type in Alport syndrome. European Community Alport Syndrome Concerted Action Group (ECASCA).

BACKGROUND: Alport syndrome (AS) is a severe hereditary disease usually transmitted as an X dominant trait and involving a mutation of the COL4A5 gene. It leads to end-stage renal failure (ESRF), but this progression is heterogeneous. Mutations of the COL4A5 gene have been characterised in numerous families using molecular biology. Our objective was to evaluate the interfamilial heterogeneity of the disease and to study relationships between mutation types and progression to ESRF in the European Community Alport Syndrome Concerted Action group (ECASCA) registry database. METHODS: We used the frailty model framework. Frailty models have been developed to analyse censored data with non-independent observations. Random effects are introduced in a Cox proportional regression model to take into account the intracluster correlations. In this study, ESRF is considered a censored event and the intrafamilial correlations are taken into account in the frailty models. RESULTS: These approaches allow us to demonstrate the existence of an interfamilial heterogeneity; the role of the mutation type explains the interfamilial variability. In particular, the results suggest that some mutation types are associated with a higher risk of ESRF for males. CONCLUSIONS: This study shows the importance of characterising the mutation at the molecular level in genetic studies, to understand the relationship between genotype and phenotype. The frailty models constitute an attractive approach in this context, when the phenotype is characterised by a censored end-point.

Alleles↗
PubMed2003

Pet-keeping in childhood and adult asthma and hay fever: European community respiratory health survey.

BACKGROUND: Whether pet-keeping early in life protects against or promotes allergy remains unclear. OBJECTIVE: Our aim was to examine the effects of childhood pet-keeping on adult allergic disease in a large international population-based study, including information on sensitization, adult pet-keeping, and pet prevalence in the populations. METHODS: We used information from structured interviews (n = 18,530) and specific IgE to common aeroallergens in blood samples (n = 13,932) from participants in the European Community Respiratory Health Survey (ECRHS) to analyze the associations between keeping pets and adult asthma and hay fever. RESULTS: Keeping cats in childhood was associated with asthma only among atopic subjects, an association that varied between centers (P =.002) and was stronger where cats where less common (< 40% cats: odds ratio(wheeze) [OR(wheeze)] = 1.84, 95% CI = 1.31-2.57; 40%-60% cats: OR(wheeze) = 1.33, 95% CI = 1.10-1.61; > or =60% cats: OR(wheeze) = 0.98, 95% CI = 0.73-1.33). Dogs owned in childhood or adulthood were associated with asthma among nonatopic subjects (childhood: OR(wheeze) = 1.28, 95% CI = 1.13-1.46; adulthood: OR(wheeze) = 1.31, 95% CI = 1.14-1.51; both: OR(wheeze) = 1.69, 95% CI = 1.40-2.04). In atopic subjects, those who had owned dogs in childhood had less hay fever (OR = 0.85; 95% CI = 0.73-0.98) and no increased risk of asthma (OR(wheeze) = 1.01, 95% CI = 0.87-1.17). Respiratory symptoms were more common in subjects who had owned birds during childhood (OR(wheeze) = 1.12; 95% CI = 1.02-1.23) independent of sensitization. CONCLUSIONS: The effects of pet-keeping in childhood varied according to the type of pet, the allergic sensitization of the individual, and the wider environmental exposure to allergen. Cats owned in childhood were associated with more asthma in sensitized adults who grew up in areas with a low community prevalence of cats. Dogs owned in childhood seemed to protect against adult allergic disease but promote nonallergic asthma.

Adolescent↗
PubMed1999

Perennial rhinitis: An independent risk factor for asthma in nonatopic subjects: results from the European Community Respiratory Health Survey.

BACKGROUND: Although clinical and experimental studies suggest that upper respiratory tract dysfunction may affect the lower airways, rhinitis is usually not studied as a potential risk factor for asthma. This is because both diseases share key elements of pathogenesis and are usually considered as different manifestations of the same underlying "atopic" state. OBJECTIVE: We sought to assess whether asthma is associated with rhinitis in the absence of immunologic disorders in a population study. METHODS: Data from 34 centers participating in the European Community Respiratory Health Survey were analyzed. Random samples of 20- to 44-year-old subjects were invited to complete a detailed questionnaire and undergo total and specific IgE measurements, skin prick tests to 9 allergens, and bronchoprovocation challenges with methacholine. RESULTS: Subjects with perennial rhinitis (n = 1412) were more likely than control subjects (n = 5198) to have current asthma. After adjustment for sex, age, smoking habit, family history of asthma, geographic area, and season at the time of examination, asthma was strongly associated with rhinitis among atopic subjects (odds ratio [OR] = 8.1; 95% confidence interval [CI] = 5.4-12.1) but also among nonatopic subjects (OR = 11.6; 95% CI = 6.2-21.9). Moreover, the association remained very strong when the analysis was restricted to nonatopic subjects with IgE levels of 80 kIU/L or less (OR = 13.3; 95% CI = 6. 7-26.5). In nonasthmatic subjects bronchial hyperresponsiveness was also more frequent in subjects with rhinitis than in those without rhinitis (OR = 1.7; 95%CI = 1.2-2.6 in nonatopic subjects with IgE levels of </=80 kIU/L). CONCLUSION: The strong association between perennial rhinitis and asthma in nonatopic subjects with normal IgE levels is consistent with the hypothesis that rhinitis is an independent risk factor for asthma.

Adult↗
PubMed1992

Early diagnosis of the multiple endocrine neoplasia type 2 syndrome: consensus statement. European Community Concerted Action: Medullary Thyroid Carcinoma.

The diagnosis of medullary thyroid carcinoma by biochemical and genetic testing is possible in families with multiple endocrine neoplasia type 2. At an early stage total thyroidectomy usually cures the patient. As the clinical penetrance of the autosomal dominant, transmitted, multiple endocrine neoplasia type 2 gene is not complete, family screening is indicated for every new patient who presents with apparently sporadic medullary thyroid carcinoma. Problems related to a screening programme and early diagnosis have led the members of the European Community Concerted Action: Medullary Thyroid Carcinoma group to formulate a consensus on biochemical and genetic screening. For biochemical screening, measurement of basal and pentagastrin and/or calcium stimulated serum levels of calcitonin by radioimmunoassay are essential starting at the age of three and continuing annually until 35 years of age. Furthermore, annual screening for pheochromocytoma by measuring the urinary excretion of catecholamines and for hyperparathyroidism by serum calcium determination is indicated. Genetic screening using linked markers can be done with a 95% accuracy in informative families when DNA is available from at least two family members proven to be affected. Biochemical screening can thus be reserved for gene carriers, while those at low risk can be reassured. Combined biochemical and genetic screening for multiple endocrine neoplasia type 2 is important and effective for the cure of medullary thyroid carcinoma.

Adrenal Gland Neoplasms↗
PubMed1996

Regulatory requirements for veterinary vaccine stability in the European Community.

The regulatory criteria of quality, safety and efficacy for any medicinal product must apply throughout its shelf-life to ensure it remains fit for its intended use. The methods and evaluation criteria for determining the stability characteristics and shelf-life of immunological medicinal products may differ from those of pharmaceuticals as a result of their heat-sensitive nature and complexity. The range of species and diseases for which veterinary immunological medicinal products may be used has resulted in differences between the regulatory requirements for human and veterinary products. The European Community requirements for the stability data needed to support an application to place a product on the market differ from those of the United States Department of Agriculture. The value of accelerated stability testing is discussed in relation to applications for Marketing Authorizations and variations thereof. The need for harmonization is increasing as pharmaceutical companies move to expand into the world market. Regulators are faced with many issues on which opinions differ, or have yet to be formed. Advances in understanding stability parameters will be essential if agreement between regulatory authorities on testing requirements is to occur. Even if the researcher, pharmaceutical company and regulator ensure the product has an appropriate shelf-life, the storage conditions employed by the user may negate the efforts made.

Animals↗
PubMed1998

Mortality from non-Hodgkin lymphoma and UV exposure in the European Community.

There has been a large, unexplained rise in the incidence of non-Hodgkin's lymphoma (NHL) in many countries. It has been hypothesised that increased exposure to solar ultraviolet (UV) radiation may have been a factor in this increase. The hypothesis that exposure to ultraviolet radiation is a factor in NHL can be tested by examining whether geographical variations in UV and in the incidence of the disease are positively correlated. Previous studies have given mixed results but some of these have failed to take into account confounding by socio-economic factors and the multilevel structure of data derived from several different countries. It was therefore decided to carry out a study using data on NHL mortality for the period 1971-80 for level II administrative units in 9 countries in the European Community. Estimated levels of solar UV and per capita GDP were also derived. Poisson regression models of the relationship between NHL mortality, UV and per capita GDP, taking into account the multilevel structure of the data, were fitted using the MLn package. Simple models that did not adjust for the effects of variations in per capita GDP or account adequately for the structure of the data produced apparent negative or quadratic associations between NHL and UV. However, further models show that there is a highly significant positive association between NHL and per capita GDP. Once this is included in the fixed and random parts of the multilevel model the association between NHL and UV becomes positive although non-significant (p = 0.081) at the conventional 0.05 level. These results underline the need to control for socio-economic factors and to take into account the multilevel structure of the data. Studies using international data that do not do this run the risk of producing misleading results.

Cause of Death↗