Contaminación química, exposoma y salud en la población de las Islas Canarias: una revisión sistemática de los estudios realizados y análisis de la situación
e202304033
Palabras clave:
Exposoma, Estudios de biomonitorización, Salud Pública, Islas Canarias, Contaminantes químicos, Enfermedades metabólicas, Enfermedades cardiovasculares, CáncerResumen
FUNDAMENTOS // El conjunto de exposiciones a sustancias químicas y su papel como causa de enfermedad da lugar al concepto de exposoma, conformado parcialmente por contaminantes químicos a los que un individuo se ve expuesto. Por ello, a diferencia del genoma, es un factor a priori modificable, siendo su estudio crucial en materia de Salud Pública. La población del archipiélago canario ha sido estudiada en cuanto a sus niveles de contaminación química, con numerosos estudios de biomonitorización, lo que hace necesario caracterizar el exposoma de ésta y sus consecuencias en términos de enfermedad, para poder implementar medidas correctoras específicas que minimicen el impacto en su salud.
MÉTODOS // Se realizó una revisión de la literatura científica (MEDLINE y Scopus) de acuerdo con los criterios PRISMA y siguiendo la metodología PICO, para incluir estudios de biomonitorización de contaminantes, o que evaluaran el efecto de éstos en enfermedades prevalentes en el archipiélago.
RESULTADOS // Se seleccionaron veinticinco estudios, tanto de base poblacional como de base hospitalaria. Los resultados demuestran que el exposoma lo conforman, como mínimo, 110 compuestos o elementos, 99 de los cuales parecen estar presentes desde la etapa intrauterina. Destaca la presencia de contaminantes clorados y metales, lo que parece relacionarse con la alta incidencia de enfermedades metabólicas (diabetes), cardiovasculares (hipertensión) y ciertos tipos de neoplasias (cáncer de mama). Aunque tales consecuencias vienen condicionadas por el genoma de la población expuesta, reforzando la enorme importancia de las interacciones genoma-exposoma en el desarrollo de patologías.
CONCLUSIONES // Nuestros resultados indican que es necesario establecer medidas correctoras sobre las fuentes de contaminación que modifiquen el exposoma de esta población.
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OMS. Preventing disease through healthy environments. 2016. Disponible en: https://saludsindanio.org/sites/default/files/documents-files/3871/9789241565196_eng.pdf
Wild CP. 2012. The exposome: from concept to utility. Int J Epidemiol 41: 24-32.
Vrijheid M, Basagaña X, Gonzalez JR, Jaddoe VWV, Jensen G, Keun HC, McEachan RRC, Porcel J, Siroux V, Swertz MA, Thomsen C, Aasvang GM, Andrušaitytė S, Angeli K, Avraam D, Ballester F, Burton P, Bustamante M, Casas M, Chatzi L, Chevrier C, Cingotti N, Conti D, Crépet A, Dadvand P, Duijts L, van Enckevort E, Esplugues A, Fossati S, Garlantezec R, Gómez Roig MD, Grazuleviciene R, Gützkow KB, Guxens M, Haakma S, Hessel EVS, Hoyles L, Hyde E, Klanova J, van Klaveren JD, Kortenkamp A, Le Brusquet L, Leenen I, Lertxundi A, Lertxundi N, Lionis C, Llop S, López-Espinosa MJ, Lyon-Caen S, Maitre L, Mason D, Mathy S, Mazarico E, Nawrot T, Nieuwenhuijsen M, Ortiz R, Pedersen M, Perelló J, Pérez-Cruz M, Philippat C, Piler P, Pizzi C, Quentin J, Richiardi L, Rodríguez A, Roumeliotaki T, Sabin Capote JM, Santiago L, Santos S, Siskos AP, Strandberg-Larsen K, Stratakis N, Sunyer J, Tenenhaus A, Vafeiadi M, Wilson RC, Wright J, Yang T, Slama R. 2021. Advancing tools for human early lifecourse exposome research and translation (ATHLETE): Project overview. Environ Epidemiol 5 (5): e166.
Hohenblum P, Steinbichl P, Raffesberg W, Weiss S, Moche W, Vallant B, Scharf S, Haluza D, Moshammer H, Kundi M, Piegler B, Wallner P, Hutter HP. 2012. Pollution gets personal! A first population-based human biomonitoring study in Austria. Int J Hyg Environ Health 215 (2): 176-179.
Henríquez-Hernández LA, Luzardo OP, Arellano JLP, Carranza C, Sánchez NJ, Almeida-González M, Ruiz-Suárez N, Valerón PF, Camacho M, Zumbado M, Boada LD. 2016a. Different pattern of contamination by legacy POPs in two populations from the same geographical area but with completely different lifestyles: Canary Islands (Spain) vs. Morocco. Sci Total Environ 541: 51-57.
Henríquez-Hernández LA, González-Antuña A, Boada LD, Carranza C, Pérez-Arellano JL, Almeida-González M, Camacho M, Zumbado M, Fernández-Fuertes F, Tapia-Martín M, Luzardo OP. 2018. Pattern of blood concentrations of 47 elements in two populations from the same geographical area but with different geological origin and lifestyles: Canary Islands (Spain) vs. Morocco. Sci Total Environ 636: 709-716.
Wild CP. 2005. Complementing the Genome with an ‘‘Exposome’’: The Outstanding Challenge of Environmental Exposure Measurement in Molecular Epidemiology. Cancer Epidemiol Biomarkers Prev 14 (8): 1847-1850.
Alam MN, Shapla UM, Shen H, Huang Q. 2021. Linking emerging contaminants exposure to adverse health effects: Crosstalk between epigenome and environment. Appl Toxicol 41 (6): 878-897.
Porta M, Puigdomènech E, Ballester F, Selva J, Ribas-Fitó N, Llop S, López T. 2008. Monitoring concentrations of persistent organic pollutants in the general population: The international experience. Environ Int 34: 546-561.
Vorkamp K, Castaño A, Antignac JP, Boada LD, Cequiere E, Covaci A, Esteban-López M, Hauge LS, Kasper-Sonnenberg M, Koch HM, Luzardo OP, Osīteh A, Rambaudi L, Pinorini MT, Sabbioni G, Thomsene C. 2021. Biomarkers, matrices, and analytical methods targeting human exposure to chemicals selected for a European human biomonitoring initiative. Environ Int 146: 106082.
Yusá V, Fernández S, Dualde P, López A, Lacomba I, Coscolla C. 2022. Exposure to non-persistent pesticides in the Spanish population using biomonitoring: A review. Environ Res 205: 112437.
United Nations Environment Programme. Stockholm Convention on Persistent Organic Pollutants (POPs). Disponible en: http://www.pops.int2007 [consultado febrero de 2022].
Consortium to Perform Human Biomonitoring on a European Scale (COPHES). Disponible en: http://www.eu-hbm.info/cophes [consultado junio de 2022].
Human Biomonitoring for European Union. Disponible en: https://www.hbm4eu.eu/ [consultado febrero de 2022].
Boada LD, Sangil M, Alvarez-León EE, Hernández-Rodríguez G, Henríquez-Hernández LA, Camacho M, Zumbado M, Serra-Majem L, Luzardo OP. 2014.Consumption of foods of animal origin as determinant of contamination by organochlorine pesticides and polychlorobiphenyls: results from a population-based study in Spain. Chemosphere 114: 121-128.
Acosta-Dacal A, Hernández-Marrero ME, Rial-Berriel C, Díaz-Díaz R, Bernal-Suárez MM, Zumbado M, Henríquez-Hernández LA, Boada LD, Luzardo OP. 2022. Comparative study of organic contaminants in agricultural soils at the archipelagos of the Macaronesia. Environ Pollut 9: 118979.
Henríquez-Hernández LA, Ortiz-Andrelluchi A, Álvarez-Pérez J, Acosta-Dacal A, Zumbado M, Martínez-González MA, Boada LD, Salas-Salvadó J, Luzardo OP, Serra-Majem L. 2021. Human biomonitoring of persistent organic pollutants in elderly people from the Canary Islands (Spain): A temporal trend analysis from the PREDIMED and PREDIMED-Plus cohorts. Sci Total Environ 758: 143637.
Luzardo OP, Mahtani V, Troyano JM, Alvarez de la Rosa M, Padilla-Pérez AI, Zumbado M, Almeida M, Burillo-Putze G, Boada C, Boada LD. 2009. Determinants of organochlorine levels detectable in the amniotic fluid of women from Tenerife Island (Canary Islands, Spain). Environ Res 109: 607-613.
Henríquez-Hernández LA, Luzardo OP, Boada LD, González-Antuña A, Domínguez-Bencomo AI, Zumbado M, Burillo-Putze G. 2019. Assessment of 22 inorganic elements in human amniotic fluid: a cross-sectional study conducted in Canary Islands (Spain). Int J Environ Health Res 29 (2): 130-139.
Cabrera-Rodríguez R, Luzardo OP, González-Antuña A, Boada LD, Almeida-González M, Camacho M, Zumbado M, Acosta-Dacal A, Rial-Berriel C, Henríquez-Hernández LA. 2018. Occurrence of 44 elements in human cord blood and their association with growth indicators in newborns. Environ Int 116: 43-51.
Cabrera-Rodríguez R, Luzardo OP, Almeida-González M, Boada LD, Zumbado M, Acosta-Dacal A, Rial-Berriel C, Henríquez-Hernández LA. 2019. Association between prenatal exposure to multiple persistent organic pollutants (POPs) and growth indicators in newborns. Environ Res 171: 285-292.
Agency for Toxic Substances and Disease, USA. Disponible en: https://www.atsdr.cdc.gov/spl/index.html. [Consultado junio de 2022]
Zumbado M, Goethals M, Álvarez-León EE, Luzardo OP, Cabrera F, Serra-Majem L, Boada LD. 2005. Inadvertent exposure to organochlorine pesticides DDT and derivatives in people from the Canary Islands (Spain). Sci Total Environ 339: 49-62.
Luzardo OP, Goethals M, Zumbado M, Álvarez-León EE, Cabrera F, Serra-Majem L, Boada LD. 2006. Increasing serum levels of non-DDT-derivative organochlorine pesticides in the younger population of the Canary Islands (Spain). Sci Total Environ 367: 129-138.
Luzardo OP, Ruiz-Suárez N, Almeida-González M, Henríquez-Hernández LA, Zumbado M, Boada LD. 2013. Multi-residue method for the determination of 57 Persistent Organic Pollutants in human milk and colostrum using a QuEChERS-based extraction procedure. Anal Bioanal Chem 405: 9523-9536.
Vall O, Gómez-Culebras M, Puig C, Rodríguez-Carrasco E, Gómez-Baltazar A, Canchucaja L, Joya X, Garcia-Algar O. 2014. Prenatal and Postnatal Exposure to DDT by Breast Milk Analysis in Canary Islands. PLoS ONE 9 (1): e83831.
Bas P, Luzardo OP, Peña-Quintana L, González JE, Peña JA, Gracia J, Zumbado M, Boada LD. 2012. Determinants of blood lead levels in children: A cross-sectional study in the Canary Islands (Spain). Int J Hyg Env Health 215: 383-388.
Henríquez-Hernández LA, Luzardo OP, Almeida-González M, Álvarez-León EE, Serra-Majem L, Zumbado M, Boada LD. 2011. Background levels of polychlorinatedbiphenyls in the population of the Canary Islands (Spain). Environ Res 11: 10-16.
Henríquez-Hernández LA, Luzardo OP, Zumbado M, Serra-Majem L, Valerón PF, Camacho M, Álvarez-Pérez J, Salas-Salvadó J, Boada LD. 2017a. Determinants of increasing serum POPs in a population at high risk for cardiovascular disease. Results from the PREDIMED-CANARIAS study. Environ Res 156: 477-484.
Henríquez-Hernández LA, Carretón E, Camacho M, Montoya-Alonso JA, Boada LD, Bernal-Martín V, Falcón-Cordón Y, Falcón-Cordón S, Zumbado M, Luzardo OP. 2017b. Potential Role of Pet Cats As a Sentinel Species for Human Exposure to Flame Retardants. Front Vet Sci 31 (4): 79.
Burillo-Putze G, Luzardo OP, Pérez-García C, Zumbado M, Yanes C, Trujillo-Martín MM, Boada-Fernández del Campo C y Boada LD. 2014. Exposición a plaguicidas persistentes y no persistentes en población no expuesta laboralmente de la isla de Tenerife. Gac San 28 (4): 301-304.
Medina-Estévez F, Zumbado M, Luzardo OP, Rodríguez-Hernández A, Boada LD, Fernández-Fuertes F, Santandreu-Jiménez ME, Henríquez-Hernández LA. 2020. Association between Heavy Metals and Rare Earth Elements with Acute Ischemic Stroke: A Case-Control Study Conducted in the Canary Islands (Spain). Toxics 8: 66.
Rodríguez-Díaz R, Alcaide-Ruggiero L, Rodríguez-Fiestas S, Hess-Medler S, González-Pérez J, Gutiérrez AJ, Hardisson A, Rubio C, Paz S, González-Weller D, Blanes-Zamora R. 2021. Associations of Semen Quality with Seminal Non-essential Heavy Metals in Males from the Canary Islands. Biol Trace Elem Res 99: 4525-4534.
Valerón PF, Pestano J, Luzardo OP, Zumbado M, Almeida M, Boada LD. 2009. Differential effects exerted on human mammary epithelial cells by environmentally relevant organochlorine pesticides either individually or in combination. Chem Biol Interactions 180: 485-491.
Rivero J, Luzardo OP Henríquez-Hernández LA, Machín R, Pestano J, Zumbado M, Boada LD, Camacho M, Valerón PF. 2015. In vitro evaluation of oestrogenic/androgenic activity of the serum organochlorine pesticide mixtures previously described in a breast cancer case–control study. Sci Total Environ 537: 197-202.
Heindel J, Blumberg B, Cavec M, Machtingerd R, Mantovanie A, Mendez MA, Nadal A, Palanza P, Panzicai G, Sargis R, Vandenbergk L, vom Saal F. 2017. Metabolism disrupting chemicals and metabolic disorders. Reprod Toxicol 68: 3-33.
Lobstein T and Brownell K. 2021. Endocrine-disrupting chemicals and obesity risk: A review of recommendations for obesity prevention policies. Obes Rev 22: e13332.
Vrijheid M, Fossati S, Maitre L, Márquez S, Roumeliotaki T, Agier L, Andrusaityte S, Cadiou S, Casas M, deCastro M, Dedele A, Donaire-Gonzalez D, Grazuleviciene R, Haug L, McEachan R, Meltzer H, Papadopouplou E, Robinson O, Sakhi A, Siroux V, Sunyer J, Schwarze E, Ibon Tamayo-Uria I, Urquiza J, Vafeiadi M, Valentin A, Warembourg Ch, Wright J, Nieuwenhuijsen M, Thomsen C, Basagaña X, Slama R, Chatzi L. 2020. Early-Life Environmental Exposures and Childhood Obesity: An Exposome-Wide Approach. Environ Health Perspect 128 (6): 067009-4.
Domínguez Coello S, Cabrera de León A, Rodríguez Pérez MC, Borges Álamo C, Carrillo Fernández L, Almeida González D, García Yanes J, González Hernández A, Brito Díaz B, Aguirre-Jaime A. 2010. Association between glycemic index, glycemic load, and fructose with insulin resistance: the CDC of the Canary Islands study. Eur J Nutr 49 (8): 505-512.
Stratakis N, Rock S, La Merrill MA, Sáez M, Robinson O, Fecht D, Vrijheid M, Valvi D, Conti DV, McConnell R, Chatzi VL. 2022. Prenatal exposure to persistent organic pollutants and childhood obesity: A systematic review and meta-analysis of human studies. Obes Rev 3 (S1): e13383.
Famiyeh L, Chen K, Xu J, Sun Y, Guo Q, Wang C, Lv J, Tang YT, Yu H, Snape C, He J. 2021. A review on analysis methods, source identification, and cancer risk evaluation of atmospheric polycyclic aromatic hydrocarbons. Sci Total Environ 789: 147741.
Young J, Caib L, States JC. 2018. Impact of Prenatal Arsenic Exposure on Chronic Adult Diseases. Syst Biol Reprod Med 64 (6): 469-483.
Henríquez-Hernández LA Luzardo OP, Boada LD, Carranza C, Pérez-Arellano JL, González-Antuña A, Almeida-González M, Barry-Rodríguez C, Zumbado M, Camacho M. 2017c. Study of the influencing factors of the blood levels of toxic elements in Africans from 16 countries. Environ Pollut 230: 817-828.
Zumbado M, Luzardo OP, Lara PC, Álvarez-León EE, Losada A, Apolinario R, Serra-Majem L, Boada LD. 2010. Insulin-like growth factor-I (IGF-I) serum concentrations in healthy children and adolescents: Relationship to level of contamination by DDT-derivative pesticides. GH&IGF Res 20: 63-7.
Cohen P. 2006. Overview of the IGF-I system. Horm Res 65 (S1): 3-8.
Luzardo OP, Almeida-González M, Henríquez-Hernández LA, Zumbado M, Álvarez-León EE, Boada LD. 2012. Polychlorobiphenyls and organochlorine pesticides in conventional and organic brands of milk: Occurrence and dietary intake in the population of the Canary Islands (Spain). Chemosphere 88: 307-315.
Almeida-González M, Luzardo OP, Zumbado M, Rodríguez-Hernández A, Ruiz-Suárez N, Sangil M, Camacho M, Henríquez-Hernández LA, Boada LD. 2012. Levels of organochlorine contaminants in organic and conventional cheeses and their impact on the health of consumers: An independent study in the Canary Islands (Spain). Food Chem Toxicol 50: 4325-4332.
Rodríguez-Hernández A, Camacho M, Boada LD, Ruiz-Suarez N, Almeida-González M, Henríquez-Hernández LA, Zumbado M, Luzardo OP. 2015. Daily intake of anthropogenic pollutants through yogurt consumption in the Spanish population. J Appl Animal Res 43 (4): 373-383.
Estévez E, Cabrera MC, Molina-Díaz, A, Robles-Molina J, Palacios-Díaz, P. 2012. Screening of emerging contaminants and priority substances (2008/105/EC) in reclaimed water for irrigation and groundwater in a volcanic aquifer (Gran Canaria, Canary Islands, Spain). Sci Total Environ 433: 538546.
Luzardo OP, Ruiz-Suárez N, Henríquez-Hernández LA, Valerón PF, Camacho M, Zumbado M, Boada LD. 2014. Assessment of the exposure to organochlorine pesticides, PCBs and PAHs in six species of predatory birds of the Canary Islands, Spain. Sci Total Environ 472: 146-153.
Henríquez-Hernández LA, Carretón C, Camacho M, Montoya-Alonso JA, Boada LD, Valerón PF, Falcón-Cordón Y, Almeida-González M, Zumbado M, Luzardo OP. 2016b. Influence of parasitism in dogs on their serum levels of persistent organochlorine compounds and polycyclic aromatic hydrocarbons. Sci Total Environ 562: 128-135.
Laraque D, Trasande L. 2005. Lead Poisoning: Successes and 21st Century Challenges. Pediatr Rev 26: 429-437.
Surkan PJ, Zhang A, Trachtenberg F, Daniel DB, McKinlay S, Bellinger D. 2007. Neuropsychological function in children with blood lead levels <10µg/dL. Neurotoxicology 28: 1170-1177.
Rubio C, González-Iglesias T, Revert C, Reguera JI, Gutiérrez A, Hardisson A. 2005. Lead Dietary Intake in a Spanish Population (Canary Islands). J Agric Food Chem 53: 6543-6549.
Rodríguez-Hernández A, Camacho M, Henríquez-Hernández LA, Boada LD, Valerón PF, Zaccaroni A, Zumbado M, Almeida-González M, Rial-Berriel C, Luzardo OP. 2017. Comparative study of the intake of toxic persistent and semi persistent pollutants through the consumption of fish and seafood from two modes of production (wild-caught and farmed). Sci Total Environ 575: 919-931.
Boada LD, Lara PC, Álvarez-León EE, Losada A, Zumbado M, Limiñana-Cañal JM, Apolinario R, Serra-Majem L, Luzardo OP. 2007. Serum levels of insulin-like growth factor-I in relation to organochlorine pesticides exposure. GH &IGF Res 17: 506-511.
Luzardo OP, Henríquez-Hernández LA, Valerón PF, Lara PC, Almeida-González M, Losada A, Zumbado M, Serra-Majem L, Álvarez-León EE, Boada LD. 2012b. The relationship between dioxin-like polychlorobiphenyls and IGF-I serum levels in healthy adults: evidence from a cross-sectional study. PLoS One 7 (5): e38213.
Landin-Wilhemsen K, Wilhemsen L, Lappas, G, Rosén, T, Lindstedt, G, Lunberg, PA, Bengtsson, BA. 1994. Serum Insulin-like growth factor I in a random population sample of men and women: relation to age, sex, smoking habits, coffee consumption and physical activity, blood pressure and concentrations of plasma lipids, fibrinogen, parathyroid hormone and osteocalcin. Clin Endocrinol 41: 351-357.
Evangelou E, Ntritsos G, Chondrogiorgi M, Kavvoura FK, Hernández AF, Ntzani EE, Tzoulaki I. 2016. Exposure to pesticides and diabetes: A systematic review and meta-analysis. Environ Int 91: 60-68.
Boada LD, Zumbado M, Henríquez-Hernández LA, Almeida-González M, Álvarez-León EE, Serra-Majem L, Luzardo OP. 2012. Complex organochlorine pesticide mixtures as determinant factor for breast cancer risk: a population-based case-control study in the Canary Islands (Spain). Environ Health 11: 28.
Rivero J, Henríquez-Hernández LA, Luzardo OP, Pestano J, Zumbado M, Boada LD, Valerón PF. 2016. Differential gene expression pattern in human mammary epithelial cells induced by realistic organochlorine mixtures described in healthy women and in women diagnosed with breast cancer. Toxicol Lett 246: 42-48.
Boada LD, Henríquez-Hernández LA, Zumbado M, Almeida-González M, Álvarez-León EE, Navarro P, Luzardo OP. 2016. Organochlorine Pesticides Exposure and Bladder Cancer: Evaluation from a Gene-Environment Perspective in a Hospital-Based Case-Control Study in the Canary Islands (Spain). J Agromedicine 21 (1): 34-42.
Boada LD, Henríquez-Hernández LA, Navarro P, Zumbado M, Almeida-González M, Camacho M, Álvarez-León EE, Valencia-Santana JA, Luzardo OP. 2015. Exposure to polycyclic aromatic hydrocarbons (PAHs) and bladder cancer: evaluation from a gene-environment perspective in a hospital-based case-control study in the Canary Islands (Spain). Int J Occup Env Health 21 (1): 23-30.
Roberts JR, Karr CJ, Paulson, JA, Brock-Utne AC, Brumberg HL, Campbell CC, Lanphear BP, Osterhoudt KC, Sandel, MT, Trasande L, Wright RO. 2012. Pesticide exposure in children. Pediatrics 130e: 1765-1788.
Suwannakul B, Sapbamrer R, Wiwattanadittakul N, Hongsibsong S. 2021. Prenatal organophosphate exposure can cause adverse birth outcomes to humans. Environ Sci Pollut Res 28: 45064-45074.
Hong D, Min J-Y, Min K-B 2021. Association between pyrethroids and prostate endpoints; stratified according to renal function. Environ Int 153: 106489.
Pérez-Rodrigo C, Hervás BG, Gianzo-Citores M, Aranceta-Bartrina J. 2021. Prevalence of obesity and associated cardiovascular risk factors in the Spanish population: the ENPE study. Rev Esp Cardiol 24: S1885-5857(21)00072-4.
Henríquez-Hernández LA, Luzardo OP, Valerón PF, Zumbado M, Serra-Majem L, Camacho M, González-Antuña A, Boada LD. 2017d. Persistent organic pollutants and risk of diabetes and obesity on healthy adults: Results from a cross-sectional study in Spain. Sci Total Environ 607-608: 1096-1102.
Henríquez-Hernández LA, Luzardo OP, Zumbado M, Camacho M, Serra-Majem L, Álvarez-León EE, Boada LD. 2014. Blood pressure in relation to contamination by polychlorobiphenyls and organochlorine pesticides: Results from a population-based study in the Canary Islands (Spain). Environ Res 135: 48-54.
Louro H, Heinälä M, Bessems J, Buekers J, Vermeire T, Woutersen M, van Engelen J, Borges T, Rousselle C, Ougier E, Alvito P, Martins C, Assunção R, Silva MJ, Pronk A, Schaddelee-Scholten B, Gonzalez MC, de Alba M, Castaño A, Viegas S, Humar-Juric T, Kononenko L, Lampen A, Vinggaard AM, Schoeters G, Kolossa-Gehring M, Santonen T. 2019. Human biomonitoring in health risk assessment in Europe: Current practices and recommendations for the future. Int J Hyg Environ Health 222 (5):727-737.
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