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Organisation and networks of indoor environment in North-Rhine-Westphalia

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Organisation and networks of indoor environment in North-Rhine-Westphalia Univ.-Prof. Dr. Wolfgang Dott Institute of Hygiene and Environmental Medicine UKA / RWTH Aachen University Roermond,
Organisation and networks of indoor environment in North-Rhine-Westphalia Univ.-Prof. Dr. Wolfgang Dott Institute of Hygiene and Environmental Medicine UKA / RWTH Aachen University Roermond, Overview of environmental institutions in Germany National institutions: UBA - Umweltbundesamt 1995 & Institut für Wasser-, Bodenund Lufthygiene (WaBoLu)* (*formerly: German health authority (BGA)) 1995 Ø RKI - Robert Koch Institut Ø BgVV - Bundesinstitut für gesundheitlichen Verbraucherschutz und Veterinärmedizin 2002 Ø RKI Ø BfR - Robert Koch Institut - Bundesinstitut für Risikobewertung Ø BVL - Bundesinstitut für Verbraucherschutz und Lebensmittelsicherheit Seite 2 Overview of environmental institutions in Städteregion Aachen Local health authorities (Gesundheitsamt der Städteregion Aachen) Consumer counseling on the local level Local Ordnungsamt Regional Umweltamt der Städteregion Aachen Seite 3 Overview of environmental institutions in NRW scientific institutions Universities Fraunhofer Institute Helmholtz Institute Max Planck Institute universities in NRW with environmental institutions IHU-Aachen IUF-Düsseldorf IUTA-Duisburg/Essen Dept. Hygiene, Social and environm. Medicine-Bochum Faculty of health sciences-bielefeld environmental intitutions with outpatient clinic in NRW IHU-Aachen Seite 4 The development of environmental outpatient clinics in Germany 1970s first environmental committee in the Bundesärztekammer 1986 first constitution of environmental committees on Landesärztekammer -level 1980s constitution of environmental competence centers at german universities 1990 new initiation of committee Health and environment of the Bundesärztekammer since constitution of enironmental medicine counselingservicein 1990 the public health service (Öffentlichen Gesundheitsdienst (ÖGD)) 1992 specialist area hygiene and environmental medicine, additional title environmental medicine since coordination of environmental medicine competence center 1999 activities at german universities by the task group environmental medicine constituion at universities 2003/4 cancelling of th additional title environmental medicine Introduction of curricular further training environmental medicine Seite 5 Institute of Hygiene and Environmental Medicine (IHU) Uniklinik der RWTH Aachen Institut für Hygiene und Umweltmedizin Univ.-Prof. Dr. Wolfgang Dott Epidemiology - studies exposition à disease Analytical chemistry - environmental monitoring Microbiology/mycology - effects of bioaerosols (Eco)Toxicology genotoxicity of chemical products and environmental samples Research centre for electromagnetic environmental safety Outpatient clinic for patients with environmental complaints Seite 6 Seite 6 Methods in environmental medicine epidemiology monitoring toxicology ambient monitoring biological monitoring biol. effect monitoring health disorder and diseases in examined population survay of environmental pollution situation measurement of noxious substances in body liquids, expulsions, organ samples animal testing in-vitro test systems toxico genetics detection of statististical relation evidence of bioavaiability dose-response relation risk assessment determination of limit values Dott, 1995 Seite 7 The environmental outpatient clinic Aachen Umweltmedizinische Ambulanz Aachen (UMA) founded in 1987 (oldest outpatient clinic for environmental concerns in Germany) main catchment area: administrative districts of Cologne and Düsseldorf consultations possible for general practitioner, local health authorities and patients first contact by phone consultation Seite 8 Where to go with environmental health problems in Germany/NRW? general practitioner Ø Hausarzt local authorities? Public health department Ø Gesundheitsamt advisory service environmental outpatient clinics Ø UMA Consumer counseling Ø Verbraucherzentrale advisory service Seite 6 Seite 9 UMA - first contact patient (96%) general partitioner (1%) public health authorities (3%) Ø first call first contact sheet Seite 10 UMA - services consultation by phone (N: /a) extensive anamnesis of possible expositions by questionaire (~50%) personal consultations (~25%) Possibility of interdisciplinary consultations (psychiatric, allergol., ) human biomonitoring housing inspections ( 10%) indoor air analysis (VOC, moisture, mould) Seite 11 UMA - patients from gender and age distribution of patients All patients n: 79 male m: 34 female f: m f Seite 12 UMA - patients 2011 complaints related to indoor conditions Seite 13 UMA - patients 2011 complaints related to indoor conditions patients attribution to specific sources Seite 14 UMA - patients 2011 reported symptoms connected with indoor related problems Seite 15 UMA - professional verification of indoor related problems 27 patients Problems concerning indoor environment confirmed by the medical staff (N = 11) No problem of the indoor environment could be confirmed (N = 16) Search for alternative reasons of the symptoms Environmental monitoring not necessary (N = 2) Environmental monitoring necessary or done (N = 4) Local Inspection of the patients housing conditions (N = 2) Local inspection & environmental monitoring (N = 3) Seite 16 AURA (= Arbeitskreis Umweltmedizin in der Region Aachen) working commitee for environmental medicine in the region round Aachen Founded in 1999 to coordinate the activities of the local health authorities, the university and the general partitioners Aim: education of general partitioners in environmental questions, coordination Re-founded in 2013 with the emphasis on cooperation between the local health authorities in the administrative region Cologne and district Neuss and the institute of hygiene and environmental health Seite 17 UMA - Interdisciplinary environmental medical center at University Hospital Aachen (UKA) Patient with environmental disease Inst. of Hygiene and environmental Medicine Ø epidemiology Ø biomonitoring Dermatology / Allergology Ø clinical immunology Ø molecular epidemiology Psychiatry Ø Psychopathology Ø Neuropsycology Environmental outpatient clinic Consultation of other clinical departments (f.i. Pediatrics, Neurology, Internal medicine, ENT) Public health department Aachen and Kreis Aachen Interdisciplinary diagnostical algorithm Seite 18 Best practice example of national cooperation in the MUT project (IHU/UKA) scientific network of medical, environmental and technology between IHU Aachen airumwelt GmbH Aachen IUF Düsseldorf IUTA Düsburg/Essen Jena indoor climatology Leipzig environmental epidemiology and LMU/TU Munich allergotoxicology and epidemiology Seite 19 Research network Medizin, Umwelt und Technik medicine Allergology/Dermatology, Ophthalmology, Neurology, Psychiatry, Pediatrics, Internal medicine Human genetics, Endocrinology/reproduction, Nuclear medicine environment Human toxicological meaning Pollution of air, water and soil, noise, electromagnetic fields public health MUT technology Process engineering Pollution control of air, water and soil Medical engineering Effects on humans Development of specific diagnosis methods for environmental use Aachen city, Aachen county, Heinsberg county, Düren county, german speaking community of belgium, Westelijke Mijnstreek, Midden-Limburg, Heerlen Environmental epidemiological examinations, health report, development and realization of preventative medical conceptions Seite 20 Best practice example of international cooperation in the MRSA project Euregional cooperation in the Euregio Maas-Rhein in several projects Interreg I and II Environmental outdoor conditions and the relation to respiratory complaints in schoolchildren Interreg IV/ EuPrevent MRSA Improving patient safety and patient mobility by harmonizing infection control standards in the Euregio and building network structures Seite 21 bottlenecks Financing of environmental outpatient clinics Aachen Berlin Freiburg Gießen Jena Munich New buildings / building restoration quality of construction material scant attention to health annoyance check up (RWTH project) Seite 22 Sources of air pollution in dwelling places Source noxious substance Construction materials brick, natural stone radon Flake board formaldehyde Derived timber products pentachlorphenole, fungicide Insulation material formaldehyde, glass fibre Fire protection asbestos and other fibres adhesives volatile organic connections (VOC) Paintig Hg, VOC, BTEX Room setup Heating and cooking CO, SO 2, NO, NO 2 Fire places dust particles, CO, PAK furniture formaldehyde, VOC, smell Domestic gas radon Dweller and activities metabolism CO 2, NH 3, VOC, smell Tobacco smoke CO 2, NO 2, HCN, VOC, PAK, Cd, Nicotin, Nitrosamines Aerosol spray fluorcarbonates, vinylchlorides, N 2 O Houseware KW, NH 3, VOC, smell Seite 23 conclusion 1. housing conditions and indoor pollution have a great influence on human health 2. indoor environment-related complains and negativ health effects are common 3. biomonitoring is seldom necessary to solve indoor related problems 4. environmental monitoring is useful only after inspection of the local setting and extensive medical history 5. education and empowerment of the public regarding environmental hygiene at home is most important! Seite 24 UMA - impact cascade perception (irritation, smell) conditioning / attribution / stress sensitivity disorder harassment reaction stress functional disorder Seite 25 UMA - moisture and mould- health evaluation relative air humidity [%] OPTIMUM indoor temperature C Seite 26
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