Children and digital dumpsites

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E-waste exposure and child health WEB ANNEX

Literature review on the health

effects of exposure to e-waste

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E-waste exposure and child health WEB ANNEX

Literature review on the health

effects of exposure to e-waste

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Children and digital dumpsites: e-waste exposure and child health. Web Annex. Literature review on the health effects of exposure to e-waste

ISBN 978-92-4-002410-6 (electronic version)

© World Health Organization 2021

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Plastic from e-waste is piled high at Agbogbloshie dump.

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Acknowledgements

This annex was compiled by Julia Gorman (WHO consultant) and Marie-Noël Bruné Drisse (WHO). Final editing by John Dawson, Nairobi, Kenya. This publication was made possible with financial support from the Swedish International Development Cooperation Agency (Sida) and the Federal Ministry for the Environment, Nature Conservation, Building and Nuclear Safety, Germany.

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Table 1. Short-term health effects, stress, injuries

Author Exposure location Exposure setting Exposed population Primary

toxicant Health outcome Decharat S (1) Nakhon Si Thammarat

province, Thailand Informal recycling workers

versus office staff Informal recycling workers (aged 18–57 years).

Exposed (n=54), control (n=25)

Mercury Urinary and airborne mercury levels significantly correlated (r = 0.552, P < 0.001).

The prevalence of insomnia (46.8%), muscle atrophy (36.7%), weakness (24.1%) and headaches were all statistically higher among the exposed group (P < 0.001).

Feldt T et al. (2) Agbogbloshie, Ghana Informal recycling workers vs residents of control urban area

Informal recycling workers.

PAHs PAHs metabolite significantly higher in exposed individuals compared to non- exposed individuals. Urine concentrations: 1-OH-phenanthrene 0.85 vs 0.55 μg/g creatinine (P < 0.001); 2-/9-OH-phenanthrene 0.55 vs 0.37 μg/g creatinine (P = 0.005); 3-OH-phenanthrene 0.99 vs 0.63 μg/g creatinine (P < 0.001);

4-OH-phenanthrene 0.22 vs 0.11 μg/g creatinine (P < 0.001); 1-OH-pyrene 1.33 vs 0.54 μg/g creatinine (P < 0.001). Higher urinary PAH levels found in individuals exposed to e-waste recycling processes.

Yohannessen K et al. (3) Santiago and Temuco, Chile Informal vs formal recycling

workers Informal recycling workers

(n=78), formal recycling workers (n=15)

Not assessed Workers generally reported good health; prevalence of chronic diseases reported was comparable to national levels. Few health differences reported between informal and formal workers.

PAH: polycyclic aromatic hydrocarbon.

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toxicant Health outcome Guo Y et al. (4) Guiyu, China Ecological: exposed town vs

control town Mother–infant pairs.

Lead, chromium,

cadmium, nickel Placental lead: 301.43 vs 165.82 ng/g (P = 0.01); nickel: 7.64 vs 14.30 ng/g (P = 0.00). No differences in cadmium or chromium. No differences in birth weight, birth length or gestational age. Negative correlation between placental nickel and gestational age. Correlation between blood lead and residence in e-waste recycling area.

Guo Y et al. (5) Guiyu, China Ecological: exposed town vs

PAHs Cord blood total PAH: 108.05 vs 79.63 ppb (P = 0.003); chromium: 1.57 vs 1.05 ppb (P = 0.049); BaP: 2.14 vs 1.64 ppb (P = 0.001); DahA: 12.26 vs 11.59 ppb (P = 0.031). Increased BaA, chrysene and BaP in neonates with adverse birth outcomes (P < 0.05). Maternal PAH exposure linked to adverse effects on neonatal health.

Wu K et al. (6) Guiyu, China Ecological: exposed town vs

PBDEs Cord blood total PBDE: 13.84 vs 5.23 ng g^–1 lipid (P < 0.05). No correlation found between PBDEs and neonate length, gestational age or sex.

Wu K et al. (7) Guiyu, China Informal recycling Mother–infant pairs.

PCBs Cord blood PCBs: 338.56 vs 140.16 ng/g, correlated with mothers’ recycling activity.

Higher total PCBs with adverse birth outcomes (t = –2.26, P = 0.03). Negative associations between individual PCB congeners and neonatal height, neonatal weight, Apgar score, gestational age and BMI (all P < 0.05).

Wu K et al. (8) Guiyu, China Informal recycling Pregnant women. Exposed

(n=108), control (n=59) PFOA Serum PFOA: 16.95 vs 8.7 ng/mL (P < 0.001). Negative association between PFOA and spontaneous abortion (t = –3.035, P = 0.003) and preterm birth (t = –2.209, P = 0.029). PFOA associated with 15.99 days reduction in gestational age; 267.3 g reduction in birth weight; 1.91 cm reduction in birth length; 1.37 lg-unit reduction in Apgar score. The same study population as (7).

Li Y et al. (9) Guiyu, China Ecological: exposed town vs

control town Newborn infants. Exposed 2006 (n=100); 2007 (n=100). Control 2006 (n=52); 2007 (n=50)

Chromium Cord blood chromium 2006: 303.38 vs 19.95 mg/L; 2007: 99.9 vs 32.48 mg/L. No association with birth weight or birth length. Evidence suggests that chromium may cause DNA damage in neonates.

Xu X et al. (10) Guiyu, China Informal recycling Newborn infants. Exposed

(n=432), control (n=99) Lead Cord blood lead: 10.87 vs 2.25 mg/dL (P < 0.01), correlated with recycling activity.

Higher rates of adverse birth outcomes: stillbirth (4.72 vs 1.03%); preterm birth (5.68 vs 5.24%); lower birth weight (3168 vs 3258 g); and lower Apgar scores (9.6 vs 9.9, all P < 0.01) linked to prenatal lead exposure.

Table 2. Adverse neonatal outcomes

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toxicant Health outcome

Xu L et al. (11) Guiyu, China Exposed town vs control

town Pregnant women and

newborn infants. Exposed pregnant women (n=99), control (n=86)

Lead, cadmium Cord blood lead: 498.80 vs 27.01; cadmium: 96.19 vs 12.65 ng/g. Cadmium correlated with 205.05 g reduction in neonatal weight and 0.44 cm reduction in body length. No statistical significance found with lead.

Xu L et al. (12) Guiyu, China Exposed town vs control

town. Some participants employed in e-waste recycling

Pregnant women and newborn infants. Exposed pregnant women (n=69), control (n=86)

PBDEs Cord blood PBDEs: 32.25 vs 5.13 ng/g. PBDE concentration negatively correlated with head circumference (33.52 vs 34.92 cm, P < 0.05) and neonatal BMI (11.90 vs 12.69 kg/m², P < 0.05), and strongly negatively correlated with Apgar1 score (9.16 vs 10.0, P < 0.001).

Zhang Y et al. (13) Guiyu, China Exposed town vs control town. One participant did work related to e-waste during pregnancy

Pregnant women and newborn infants. Exposed pregnant women (n=237), control (n=212)

Cadmium Maternal urinary cadmium with female neonates: 1.59 vs 0.92; with male neonates: 1.38 vs 0.74 μg/g creatinine (P = 0.00). Maternal urinary cadmium level with female neonates significantly inversely associated with birth weight, length, head circumference, and Apgar 1 and 5 scores (all P < 0.05), and significant association with Apgar 1 score in male neonates (P = 0.004).

Huo X et al. (14) Guiyu, China Exposed town vs control

town Pregnant women. Exposed

(n=155), control (n=102) OH-PAHs Maternal urine OH-PAH: 6.87 vs 3.90 μg/g creatinine (P < 0.001). PAHs linked to decrease of 234.56 g in weight, 1.72 cm in head circumference, 1.06 kg/m² in BMI and 0.42 in Apgar 1 score (all P < 0.05).

Li M et al. (15) Guiyu, China Exposed town vs control

(n=150), control (n=150) PBDEs Cord blood PBDEs: 71.92 vs 15.52 ng/g lipid weight (P < 0.01). Neonatal head circumference, BMI and Apgar 1 score negatively correlated with PBDEs (all P < 0.01).

BaA: benzo[a]anthracene; BaP: benzo[a]pyrene; BMI: body mass index; DahA: dibenz[a,h]anthracene; OH-PAH: hydroxylated polycyclic aromatic hydrocarbon; PAH: polycyclic aromatic hydrocarbon; PBDE: polybrominated diphenyl ether; PCB:

polychlorinated biphenyl; PFOA: perfluorooctanoic acid.

Table 2. Adverse neonatal outcomes continued

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Lin S et al. (16) Guiyu, China Exposed town vs control

town Newborn infants. Exposed

(n=220), control (n=93) Cadmium, lead Cord blood cadmium: 0.0929 vs 0.0239 μg/g (P < 0.01); lead 1.2491 vs 1.3525 μg/g (P > 0.05). Cord blood cadmium negatively correlated with placental telomere length (r = −0.138, P = 0.013), no significant correlation between cord blood lead and telomere length.

Table 3. Short placental telomere

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toxicant Health outcome Huo X et al. (17) Guiyu, China Ecological: exposed town vs

control town Children (< 6 years).

Lead Blood lead: 15.3 vs 9.94 mg/dL (P < 0.01). No differences in haemoglobin levels, height, weight, chest circumference or head circumference.

Xu X et al. (18) Guiyu, China Exposed town vs control

town Children (aged 3–7 years).

PAHs, lead Blood total PAHs: 68.53 vs 26.92 μg/L; blood lead: 13.89 vs 8.55 μg/dL (both P < 0.01). Child height and child chest circumference negatively associated with PAHs (both P < 0.05). Correlation more obvious in boys.

Chromium Blood chromium: 94.3 vs 49.3 μg/L (P < 0.001). Correlation between blood chromium in children and increased body weight and chest circumference.

Zeng X et al. (20) Guiyu, China Exposed town vs control

town Preschool children. Exposed

(n=300), control (n=170) Lead, cadmium, chromium, manganese in PM_2.5

Blood lead: 6.81 vs 4.98 μg/dL; cadmium: 0.66 vs 0.54 μg/L (both P < 0.001); PM_2.5: 57.73 vs 40.53 μg/m³, elevated lead and cadmium in PM_2.5. Blood lead negatively associated with height (r = –0.066, P < 0.05), weight (r = –0.119, P < 0.001), head circumference (r = –0.123, P < 0.01) and chest circumference (r = –0.104, P < 0.05). No association between cadmium, chromium and manganese and childhood development parameters (P > 0.05).

PAH: polycyclic aromatic hydrocarbon; PM_2.5: particulate matter 2.5 microns or less in diameter.

Table 4. Growth

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Cai H et al. (21) Guiyu, China Exposed town vs control

Lead Blood lead: 4.88 vs 3.47 μg/dL (P < 0.001); serum cortisol: 451.96 vs 593.61 ng/

mL (P < 0.001). SPM-HKC scores: touch 19.00 vs 18.00; body awareness 16.00 vs 14.00; balance and motion 18.00 vs 16.00; total sensory systems 90.00 vs 86.00.

Blood lead correlated with decreased serum cortisol and an increase in child sensory integration difficulties.

control town Newborn babies.

Lead Cord blood lead: 113.28 vs 60.43 mg/dL (P < 0.001); meconium lead: 2.5 vs 1.2 mg/g (P < 0.001). NBNA scores: total 38.45 vs 38.92 (P = 0.043); behaviour cluster 10.91 vs 11.29 (P = 0.012). Negative associations between meconium lead and total NBNA activity and behavioural scores.

Liu J et al. (23) Guiyu, China Ecological: exposed town vs

control town Children (aged 3–7 years).

Lead Blood lead: 13.2 vs 8.2 μg/dL (P < 0.01). Temperament scores: mean activity level:

4.53 vs 4.18; adaptability: 4.96 vs 4.67; approach withdrawal: 4.62 vs 4.3 (all P < 0.01). Higher blood lead associated with higher approach–withdrawal scores.

Liu L et al. (24) Guiyu, China Exposed town vs control

town Children (aged 3 years).

Lead Blood lead: 11.30 vs 5.77 μg/dL (P < 0.001). Blood lead negatively correlated with cognitive scale scores (100 vs 120) and language scale scores (99.87 vs 111.39, both P < 0.001).

Liu L et al. (25) Guiyu, China Exposed town vs control

Lead, cadmium Blood lead: 11.30 vs 5.77 μg/dL; cadmium: 1.22 vs 0.72 μg/L (both P < 0.001);

FT4: 16.65 vs 16.06 pmol/L (P = 0.007); TSH: 2.79 vs 2.21 mIU/L (P = 0.001). Lead negatively correlated with cognitive score (100 vs 120) and language score (99.87 vs 111.39, both P < 0.001). No significant relationship found between lead and FT4 and TSH levels and cognitive development. No correlation between cadmium and cognitive development. The same study population as (24).

Liu W et al. (26) Guiyu, China Exposed town Children (aged 3–7 years).

Exposed (n=240) Lead, cadmium,

manganese Blood lead: 7.33 μg/dL; cadmium: 0.69 μg/dL; manganese: 17.98 μg/dL; serum S100β: 0.12 μg/L. ADHD symptoms prevalence: 18.6%. Serum S100β levels positively correlated with blood lead levels. Child blood levels of lead, cadmium and manganese correlated with some behavioural abnormalities.

Wang X et al. (27) Zhejiang province, China Exposed town vs tinfoil manufacturing area vs control town

Children (aged 11–12 years). Exposed (n= 108), tinfoil manufacturing town (n=151), control (n=70)

Lead Blood lead: 8.11 vs 6.97 vs 2.78 μg/dL (P < 0.001). No significant differences of IQ observed between study populations.

Zhang R et al. (28) Guiyu, China Exposed town Children (aged 3–7 years).

(n=243) Lead, cadmium Blood lead: 7.9 μg/dL; cadmium: 0.95 μg/L. ADHD symptoms prevalence: 12.8%.

Children with high blood lead level had 2.4 times higher risk of ADHD than those with low blood lead levels. No correlation between cadmium and ADHD behaviours.

ADHD: attention deficit/hyperactivity disorder; FT4: free thyroxine; IQ: intelligence quotient; NBNA: neonatal behavioural neurological assessment; S100β: S100 calcium-binding protein B; SPM-HKC: sensory processing measure-Hong Kong Chinese version; TSH: thyroid-stimulating hormone.

Table 5. Neurodevelopment, learning and behavioural outcomes

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Cao J et al. (29) Guiyu, China Exposed town vs control

(n=62), control (n=56) Lead Blood lead: 5.06 vs 3.60 μg/dL (P = 0.00); CD4⁺ central memory T cells: 25.79 vs 21.43; CD8⁺ central memory T cells: 0.89 vs 0.62 (both P < 0.001). Blood lead level positively correlated with percentage of peripheral CD4⁺ and marginal changes to CD8⁺ central memory T cells.

Dai Y et al. (30) Guiyu, China Exposed town vs control

town Preschool children (aged

2–6 years). Exposed (n=332), control (n=152)

Lead Blood lead: 6.5 vs 4.5 μg/dL; erythrocyte lead: 17.0 vs 11.9 μg/dL; erythrocyte CR1 expression: 6257.515 vs 8162.840 (all P < 0.01). High blood lead (> 7.00) and high erythrocyte lead (> 18.6) levels associated with lower erythrocyte CR1 expression.

Huo X et al. (31) Guiyu, China Exposed town vs control

Lead Blood lead: 6.51 vs 4.41 μg/dL; erythrocyte lead: 16.60 vs 11.77 μg/dL (both P < 0.001); CD44: 68.08 vs 76.15%; CD58: 40.77 vs 46.32% (both P < 0.01). High erythrocyte lead concentrations significantly related to lower erythrocyte CD44 and CD58 expression.

Li R et al. (32) Northern China Exposed town vs control

town Population. Exposed

(n=23), control (n=28) Lead, PCBs, PBDEs, PBBs, DP, HCB, βHCH, p,p’DDE

Blood lead: 77.1 vs 66.7 μg L–1; plasma PCBs: 60.4 vs 28.4 ng g–1; DP: 9.0 vs 2.8 ng g–1; PBB-153: 0.55 vs 0.25 ng g–1; PBDEs: 29.3 vs 23.0 ng g–1 (all P < 0.01);

reactive oxygen species in immune cells: 8.3 vs 28.4 (P < 0.001). Plasma PCBs total 2 times higher than control group. Suggested link between plasma PCB levels and increased reactive oxygen species levels.

Lin X et al. (33) Guiyu, China Exposed town vs control

Lead, arsenic, mercury, chromium, cadmium, manganese, nickel, copper, zinc, selenium

Blood lead: 9.43 vs 6.79 μg/dL (P < 0.001); arsenic: 5.53 vs 6.56 μg/L (P = 0.002);

mercury: 1.92 vs 2.25 μg/L (P = 0.051); cadmium: 0.12 vs 0.27 μg/L (P = 0.005);

chromium: 14.38 vs 10.64 μg/L (P = 0.005); manganese: 16.31 vs 15.08 μg/L (P = 0.030); nickel: 4.41 vs 3.44 μg/L (P = 0.059); copper: 919.10 vs 842.45 μg/L (P < 0.001); zinc: 4746.39 vs 4313.0 μg/L (P = 0.039); selenium: 135.77 vs 149.06 μg/L (P = 0.027). Significant association between elevated lead, copper and zinc and decreased antibody titres after vaccination.

Lin Y et al. (34) Guiyu, China Exposed town vs control

Lead Blood lead: 5.61 vs 3.57 μg/dL (P < 0.001). Antibody titres against measles: 669.64 vs 1046.79 mIU/mL; mumps: 272.24 vs 491.78 U/mL; rubella: 37.08 vs 66.50 IU/

mL. Lead associated with reduction in anti-mumps and anti-rubella antibody titres after vaccination.

Table 6. Immune function

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toxicant Health outcome Xu P et al. (35) Zhejiang province, China Exposed town vs control

town Population (aged 15–65

years). Exposed (n=40), control (n=15)

PCBs, PBDEs PCBs: 964.39 vs 67.98 ng g^–1(P < 0.0001); PBDEs: 139.32 vs 75.74 ng g^–1 (P > 0.05); FT3: 4.72 vs 5.64 pmol L^–1; FT4: 14.98 vs 18.67 pmol L^–1 (both P < 0.001); TSH: 2.51 vs 1.80 µIU mL^–1 (P > 0.05); white blood cells: 6.43 vs 6.24 L^–1 (P = 0.7); haemoglobin: 152.4 vs 135.33 g L^–1(P < 0.01); platelets: 244.15 vs 201.4 *10⁹ L^− 1(P < 0.05). PCBs negatively correlated with FT3 and FT4. PBDEs positively correlated with levels of white blood cells, haemoglobin and platelets. No correlation between PBDEs and thyroid hormones (P > 0.05).

Lead Blood lead: 6.76 vs 6.05 μg/dL (P < 0.05); HBsAb titre: 1.04 vs 4.06 s/co (P < 0.001). Lead associated with reduced HBsAb response.

Zhang Y et al. (37) Guiyu, China Exposed town vs control

town Children. Exposed (n=285),

control (n=126) Lead Blood lead: 6.00 vs 3.92 mg/dL (P < 0.01). Lead correlated with levels of platelets (Rs = 0.112), neutrophils (Rs = 0.139), monocytes (R_s= 0.120) (all P < 0.05). IL-1β (Rs = 0.162) levels positively and IL-27 (Rs = −0.306) levels negatively associated with lead (both P < 0.05).

Zhang Y et al. (38) Guiyu, China Exposed town vs control

Lead, cadmium Blood lead: 10.34 vs 8.30 μg/dL (P < 0.05); cadmium: 2.39 vs 1.79 μg/L (P < 0.05).

Lead linked to increase in count of monocytes (β = 0.083), eosinophils (β = 0.078), basophils (β = 0.013), monocyte percentage (β = 0.766) and decline in neutrophils percentage (β = −4.153). Cadmium linked to increase in neutrophils percentage (β = 3.919) and count (β = 0.665) (all P < 0.05).

β-HCH: β-hexachlorocyclohexane; DP: dechlorane plus; FT3: free triiodothyronine; FT4: free thyroxine; HBsAb: hepatitis B surface antibody; HCB: hexachlorobenzene; IL-1β: interleukin-1β; IL-27: interleukin-27; PBB: polybrominated biphenyl; PBDE:

polybrominated diphenyl ether; PCB: polychlorinated biphenyl; p,p’DDE: p,p’dichlorodiphenyldichloroethylene; TSH: thyroid-stimulating hormone.

Table 6. Immune function continued

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toxicant Health outcome Eguchi A et al. (39) Hung Yen province, Viet

Nam Exposed town vs control

town Informal workers. Exposed

(n=77), control (n=34) PCBs, OH-PCBs, PBDEs, MeO- PBDEs, OH-PBDEs, BPhs

Serum PCBs: 420 vs 290 pg g^–1; OH-PCBs: 160 vs 82 pg g^–1; PBDEs: 290 vs 230 pg g^–1; BPhs: 300 vs 200 pg g^–1 (all P < 0.05). FT3: 3.3 vs 3.5 pg g^–1; TT3: 1.2 vs 1.3 pg g^–1; TT4: 78 vs 85 pg g^–1 (all P < 0.05); FT4: 1.3 vs 1.2 pg g^–1; TSH: 1.4 vs 1.5 pg g^–1 (both P > 0.05). Positive correlation found in females between PCBs and OH-PCB and levels of FT4, FT3, TT3, TT4 (P < 0.05), but negative correlation with TSH concentrations.

Eguchi A et al. (40) Northern Viet Nam Exposed town vs control

(n=83), control (n=48) Perchlorate,

thiocyanate Serum perchlorate: 0.116 vs 0.086 ng mL^–1 (P < 0.05); TT3: 1.2 vs 1.3 ng mL^–1; FT3: 3.3 vs 3.4 pg mL^–1 (P < 0.05). No significant difference in thiocyanate. No correlation between thyroid hormone and perchlorate or thiocyanate (P > 0.05).

Han G et al. (41) Luqiao, China Ecological: exposed town vs

control town Population. Exposed

(n=195), control (n=174) PCBs, PBDEs,

dioxin Serum PCBs: 484 vs 255.38 ng g^–1; PBDE: 664.28 vs 375.81 ng g^–1; dioxin: 26 vs 39.64 ng g^–1; TSH: 1.88 vs 3.31 ng g^–1. No P value reported. Suggests that TSH levels in children are affected by POPs.

Ju Y et al. (42) China Ecological: exposed town vs

control town Mothers and newborn

babies. Exposed (n=48), control (n=45)

Not assessed Maternal TSH: 2.63 vs 2.10 mIU/L; FT4: 16.47 vs 160.76 pmol/L (both P < 0.05).

Cord blood TSH: 6.35 vs 5.47 mIU/L; FT4: 8.45 vs 9.52 pmol/L (both P < 0.05).

mRNA levels statistically significant compared to control group.

Lv QX et al. (43) Wenling, China Exposed town vs control

for over 5 years (n=64), exposed for under 2 years and not employed in e-waste recycling (n=10)

PCBs, PBDEs Serum PCBs: 26.2 vs 14.0 ng g^–1lipid weight (P < 0.05); PBDEs: 9.77 vs 4.80 ng g^–1 lipid weight (P < 0.001). Increased body burden of PCBs and specific PDBE congeners. PCBs negatively correlated with TSH levels during pregnancy (P < 0.001).

Yuan J et al. (44) China Formal recycling Formal and informal

workers vs not exposed.

PBDEs Serum PBDEs: 382 vs 158 ng/g lipid weight (P = 0.045); serum TSH: 1.79 vs 1.15 microIU/mL (P < 0.01). No association between PBDEs and oxidative DNA damage.

Wang H et al. (45) Taizhou, China Ecological: workers in exposed town vs those in control town

Population. Exposed

(n=236), control (n=89) PBDEs Serum TSH: 1.26 vs 1.57 μIU/mL; T3: 1632.4 vs 1817.2 pmol/L; FT3: 4188.8 vs 4404.4 pmol/L (all P < 0.001). No difference in serum T4. PBDEs may contribute to changes in TSH and T4 levels.

Table 7. Thyroid and endocrine system function

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(n=40), control (n=15) PCBs Serum PCBs: 964.39 vs 67.98 ng g^–1 (P < 0.0001); PBDEs: 139.32 vs 75.74 ng g^–1 (P > 0.05); TSH: 2.51 vs 2.78 μIU mL^− 1(P = 0.609); FT3: 4.72 vs 5.64 pmol L⁻¹ (P < 0.001); FT4: 14.98 vs 18.67 pmol L^− 1 (P < 0.001). PCBs negatively correlated with levels of FT3, FT4, monocytes and lymphocytes. PCBs positively correlated with levels of neutrophils, haemoglobin, serum creatinine and β₂-MG. PBDEs positively correlated with levels of white blood cells, haemoglobin and platelets (all P < 0.05). This study is also quoted in Table 6.

Xu P et al. (46) Zhejiang province, China Exposed town vs control

PCBs, PBDEs,

PCDD/Fs Serum PCBs: 40.56 vs 20.69 ng g^− 1 lipid (P < 0.01); PBDEs: 32.09 vs 8.43 ng g^− 1 lipid (P < 0.01). No difference in TSH between groups. Serum PCDD/Fs not significant. PBDEs positively correlated with ACTH level (r = 0.61, P < 0.05).

Zhang J et al. (47) China Ecological: exposed town vs

control town Pregnant women. Exposed

(n=25), control (n=25) PCCD/Fs, PCBs,

PDBEs Cord blood PCDD/Fs: 0.041 vs 0.014 pg; PCBs 0.022 vs 0.0041 pg; PBDEs 23.4 vs 16.15 pg/g (all P < 0.05). Serum TSH: 1.15 vs 2.65 nmol/L; FT4: 112.5 vs 139.0 nmol/L (both P = 0.015). Negative correlation between PCDD/Fs and PCBs and levels of TT4. No correlation with PBDEs.

ACTH: adrenocorticotropic hormone; β₂-MG: beta-2 microglobulin; BPh: bromophenol; FT3: free triiodothyronine; FT4: free thyroxine; MeO-PBDE: methoxylated polybrominated diphenyl ether; mRNA: messenger ribonucleic acid; OH-PBDE:

hydroxylated polybrominated diphenyl ether; OH-PCB: hydroxylated polychlorinated biphenyl; PBDE: polybrominated diphenyl ether; PCB: polychlorinated biphenyl; PCDD/F: polychlorinated dibenzodioxin/dibenzofuran; POP: persistent organic pollutant; T3: triiodothyronine; T4: thyroxine; TSH: thyroid-stimulating hormone; TT3: total triiodothyronine; TT4: total thyroxine.

Table 7. Thyroid and endocrine system function continued

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toxicant Health outcome Zheng G et al. (48) Guiyu, China Ecological: exposed town vs

control town School children (aged 8–13 years). Exposed (n=71), control (n=73)

Chromium, manganese and nickel

Blood manganese: 374.92 nmol/L vs 271.18 nmol/L; nickel: 5.3 vs 3.0 mg/L (both P < 0.01). FVC in boys aged 8–9 years: 1859 vs 2121 mL (P = 0.03). Decrease in FVC with increased chromium level (11-year-olds: β = –14.02, P = 0.018; 13-year-olds:

β = –43.23, P = 0.027); decreased FVC with increased nickel level (10-year-olds:

β = –18.47, P = 0.035).

towns School children (aged 5–7

Lead Blood lead: 5.53 vs 3.57 μg/dL (P < 0.05). FVC: 1.23 vs 1.33 L (P = 0.004); FEV₁: 1.16 vs 1.24 L (P = 0.005). Birth weight: 3.07 vs 3.25 kg; height: 111.03 vs 112.56 cm; chest circumference: 52.63 vs 53.42 cm (all P < 0.05). Lung function associated with birth weight and chest circumference. Same study group as (50).

towns School children (aged 5–7

Lead, cadmium Blood lead: 5.53 vs 3.57 μg/dL (P < 0.001); cadmium: 0.58 vs 0.57 μg/L (P > 0.05).

Lower haemoglobin and haematocrit levels, but higher platelet and thrombocytosis levels in exposed group (all P < 0.05). FVC: 1.23 vs 1.33; FEV₁: 1.16 vs 1.24 (both P < 0.01); FVC/FEV₁: 0.95 vs 0.96% (P = 0.20). No association between blood lead and cadmium with platelet level, FVC or FEV₁ (P > 0.05). 1 g/L haemoglobin decline associated with 5 mL and 4 mL decrease in FVC and FEV₁ respectively (P < 0.05).

The same study population as (49).

Lead, cadmium, chromium, manganese in PM_2.5 and in blood

Blood lead: 6.24 vs 4.75 µg/dL; cadmium: 0.576 vs 0.500 µg/L; lead in PM_2.5: 152.96 vs 80.28 ng/m³; cadmium in PM_2.5: 5.58 vs 3.48 ng/m³ (all P < 0.05); no difference in blood chromium or manganese (both P < 0.05). Increased cough, dyspnoea, phlegm, wheeze in exposed group (P < 0.05). Blood chromium associated with cough (AOR = 1.91); blood manganese associated with wheeze (AOR = 2.91);

elevated blood lead (> 5 µg/dL) associated with asthma (AOR = 9.50) (all P < 0.05).

AOR: adjusted odds ratio; FEV₁: forced expiratory volume; FVC: forced vital capacity; PM_2.5: particulate matter 2.5 microns or less in diameter.

Table 8. Lung function, respiratory function and asthma

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Author Exposure location Exposure setting Exposed population Primary toxicant Health outcome Zhang S et al. (52) Guiyu, China Exposed town vs control town Children (aged 2–7 years). Exposed

(n=110), control (n=112) PM_2.5 PM_2.5: 39.06 vs 26.6 μg/m³; PM_2.5CDI: 1.40 vs 0.88 ng kg^–1 day^–1 (P < 0.001).

Saliva: SAG: 5.05 vs 8.68 ng/mL (P = 0.027). Higher white blood cell count, neutrophils, monocytes, IL-8 and TNF-α in exposed group (all P < 0·001) associated with CDI. CDI negatively correlated with SAG level. Higher monocyte count associated with lower SAG level (P < 0.05).

CDI: chronic daily intake; IL-8: interleukin-8; PM_2.5: particulate matter 2.5 microns or less in diameter; SAG: salivary agglutinin; TNF-α: tumour necrosis factor alpha.

Table 9. Airway antimicrobial activity

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Lu X et al. (53) Guiyu, China Exposed town vs control

Lead Blood lead: 7.14 vs 3.91 μg/dL (P < 0.001). Elevated blood lead associated with higher Lp-PLA2, IL-6, TG and lower HDL and PP (all P < 0.05). Lp-PLA2 negatively associated with PP and HDL.

Zheng X et al. (54) Guiyu, China Exposed town vs control

Lead, PAHs Blood lead: 7.232 vs 3.912 μg/dL (P < 0.001) and elevated PAHs in exposed group (both P < 0.05). Elevated blood lead linked to higher counts of IL-6, IL-12p70, IP-10, CD4+ T cell percentage, neutrophil and monocyte counts (all P < 0.05).

Cong X et al. (55) Guiyu, China Exposed town vs control

(n=228), children native to reference area (n=104), non-native children living in reference area for > 1 year (n=91)

PM_2.5, PM₁₀, SO₂,

NO₂, CO Higher concentrations of PM_2.5, PM₁₀, SO₂, NO₂, CO among exposed group (data not given, all P < 0.001). Median heart rate: 106 vs 102 vs 100 bpm; plasma norepinephrine: 4.425 vs 3.885 vs 3.444 nmol/L (both P < 0.01). Positive association between concentrations of PM_2.5, PM₁₀, SO₂, NO₂and plasma norepinephrine; PM_2.5, PM₁₀, SO₂, NO₂ and CO levels linked to increase in heart rate (P < 0.05).

CO: carbon monoxide; HDL: high-density lipoprotein; IL-6: interleukin-6; IL-12p70: interleukin-12p70; IP-10: gamma interferon-inducible protein 10; Lp-PLA2: lipoprotein-associated phospholipase A2; NO₂: nitrogen dioxide; PAH: polycyclic aromatic hydrocarbon; PM_2.5: particulate matter 2.5 microns or less in diameter; PM₁₀: particulate matter 10 microns or less in diameter; PP: pulse pressure; SO₂: sulfur dioxide; TG: triglyceride.

Table 10. Cardiovascular risk factors

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Liu Y et al. (56) Guiyu, China Exposed town vs control

Lead, cadmium Blood lead: 4.94 vs 3.85 μg/dL (P < 0.001); urinary cadmium: 2.49 vs 1.80 μg/g cre (P = 0.134). Hearing loss: 28.8 vs 13.6% (P < 0.001). Hearing loss for lead exposure: AOR = 1.24. Lead may be an important factor for hearing loss.

AOR: adjusted odds ratio.

Table 11. Hearing loss

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toxicant Health outcome Zhang B et al. (57) Guiyu, China Exposed town vs control

Lead Blood lead: 9.40 vs 5.04 mg/dL; serum BDNF: 35.91 vs 28.10 ng/mL (both P < 0.001). Serum BDNF positively correlated with blood lead. Lower item and source olfactory memory scores (at 15 minutes, 5 and 24 hours) among exposed group (P < 0.01). Olfactory memory scores negatively correlated with blood lead and serum BDNF (both P < 0.05).

BDNF: brain-derived neurotrophic factor.

Table 12. Olfactory memory

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toxicant Health outcome Chen Y at al. (58) Guiyu, China Exposed town vs control

town Hospitalized adults.

Lead, cadmium Blood lead: 8.7 vs 5.1 µg/dL (P < 0.001); cadmium: 2.1 vs 2.6 µg/L (P > 0.05). Red blood cell count: 4.5 vs 4.2 x103/µL; haemoglobin: 137.0 vs 123.0 g/dL; platelets:

234.0 vs 231.0 µL (all P > 0.05). Blood lead positively correlated with blood cadmium. Positive correlation between blood lead and red blood cell count and haemoglobin.

Table 13. Liver function

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toxicant Health outcome Zeng Z et al. (59) Guiyu, China Exposed town vs control

town Children. Exposed (n=331),

control (n=135) Lead Blood lead: 5.64 vs 3.68 μg/dL (P < 0.01). Higher PLT, PCT, MPV and P-LCR levels among exposed group (P < 0.01). Positive correlation between blood lead and levels of PLT, PCT, MPV, P-LCR.

MPV: mean platelet volume; PCT: plateletcrit; P-LCR: platelet–large cell ratio; PLT: platelet count.

Table 14. Impaired blood coagulation

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toxicant Health outcome Song S et al. (60) Qingyuan, China Exposed towns vs control

town Population; adults (aged

Bisphenols BPA in serum: 3.2 vs 2.8 ng/mL (P < 0.05); BPF: 0.062 vs 0.092 ng/mL; BPAP:

0.011 vs 0.022 ng/mL; BPAF: 0.0074 vs 0.0061 ng/mL; BPS: 0.0061 vs 0.0071 ng/

mL (no P level recorded). Abnormal fasting blood glucose: 45 vs 31% (P < 0.05).

Abnormal fasting blood glucose associated with BPA. BPAF linked to low fasting blood glucose.

BPA: bisphenol A; BPAF: bisphenol AF; BPAP: bisphenol AP; BPF: bisphenol F; BPS: bisphenol S.

Table 15. Fasting blood glucose levels

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urban area Hospital outpatients.

Exposed (n=473 938), control (n=668 764)

Not assessed Male genital disease morbidity (2004–2009) 0.753 per 1000 vs 0.355 per 1000 (P < 0.05). Higher morbidity of male genital disease in exposed group.

Yu YJ et al. (62) Guiyu, China Exposed towns vs control

town Males aged 18–50 years.

PBDEs PBDE levels in semen: BDE-28: 5.02 vs 1.62 pg g^–1; BDE-47: 6.75 vs 1.32 pg g^–1; BDE- 153: 7.36 vs 3.62 pg g^–1 (all P < 0.05). Lower sperm count and sperm progressive motility among exposed group. Negative correlation between BDE-47 levels and sperm concentration and sperm progressive motility. Positive correlation between BDE-28, BDE-47 and BDE-153 and paired semen samples.

BDE: brominated diphenyl ether; PBDE: polybrominated diphenyl ether.

Table 16. Male reproductive disorders, genital diseases and sperm quality

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town Population (aged 15–65

PCBs, PBDEs PCBs: 964.39 vs 67.98 ng g^–1 (P < 0.0001); PBDEs: 139.32 vs 75.74 ng g^–1 (P > 0.05); serum creatinine: 87.05 vs 74.49 µmol L^–1; β₂-MG: 0.25 vs 0.18 µmol L^–1 (both P < 0.001). PCBs positively correlated with serum creatinine and β₂-MG. This study also quoted in Tables 6 and 7.

β₂-MG; beta-2 microglobulin; PBDE: polybrominated diphenyl ether; PCB: polychlorinated biphenyl.

Table 17. Kidney injury markers

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Chen L et al. (63) China Ecological: exposed town vs

control town Population. Exposed

(n=58), control (n=80) Not assessed Micronuclei in binucleated cells: median 4.0 vs 1.0% (P < 0.01). No statistical evidence between genotypes and frequencies of micronuclei in population.

Yuan J et al. (44) China Recycling activity Recycle workers (n=23) vs

farmers (n=26) PBDEs Micronuclei in binucleated cells: 5.0 vs 0.0% (P < 0.01). No association between PBDE exposure and oxidative DNA damage. This study is also quoted in Table 7.

Wang Q et al. (64) China Recycling activity Recycle workers (n=48) vs

not exposed (n=56) Lead, copper,

cadmium Blood lead: 11.44 vs 9.104 μg/dL (P < 0.001); micronuclei in binucleated cells: 4.0 vs 1.0% (P < 0.01). Positive correlation between blood lead and micronuclei in binucleated cells. No associations with copper or chromium.

Liu Q et al. (65) Jinghai, China Recycling activity Recycle workers (n=171) vs

not exposed (n=30) Not assessed Micronuclei in binucleated cells: 16.99 vs 3.47%; chromosomal aberration: 5.5 vs 1.7% (both P = 0.00). Significant difference in DNA damage between exposed and control groups (P = 0.00). Women more affected than men (P < 0.05).

control town Newborn infants. Exposed (2006: n=100; 2007:

n=100), control (2006: n=

52; 2007: n=50)

Chromium Cord blood chromium 2006: 303.38 vs 93.89 μg/L; 2007: 99.90 vs 70.60 μg/L (both P < 0.01). Correlation between DNA damage and cord blood chromium levels in neonates (P < 0.05). This study also quoted in Table 2.

Ni W et al. (66) Guiyu, China Maternal or paternal

recycling activity vs control town

Pregnant women, newborn infant pairs. Exposed (n=126), control (n=75)

Lead, cadmium,

chromium, nickel Cord blood lead: 110.45 vs 57.31 ng/mL; cadmium: 2.50 vs 0.33 ng/mL (both P < 0.001); no difference in either chromium or nickel between groups (P > 0.05).

Cord blood 8-OHdG: 162.09 vs 153.69 ng/mL (P > 0.05). 8-0HdG positively associated with cadmium, chromium and nickel (all P < 0.05).

He X et al. (67) China Exposed town vs control

(n=23), control (n=25) PCBs, BDEs, DP,

HCB, HCH, DDE Periphery blood PCBs: 149.01 vs 35.39 ng/g lipid; DPs: 8.14 vs 1.96 ng/g lipid; BDE congeners: 16.33 vs 14.28 ng/g lipid (all P < 0.05). Higher reactive oxygen species activity and micronucleus rate in exposed group (both P < 0.05). No correlation between PBDEs, DP or PCBs and micronucleus rate (P < 0.05). Expression of NEIL1/3 and RPA3 downregulated, but RNF8 upregulated in exposed group. Expression of CDC25A upregulated in males, but downregulated in females in the exposed group (all P < 0.05).

Xu X et al. (68) Guiyu, China Exposed town Children (aged 3–6 years).

(n=118) Lead, cadmium,

mercury Blood lead: 7.43 µg/dL; blood cadmium: 0.72 µg/L; blood mercury: 11.13 µg/L;

median 8-OHdG: 407.79 ng/g creatinine. Children with elevated blood lead levels had higher 8-OHdG levels than children with low blood lead levels. Children with elevated blood mercury associated with higher 8-OHdG (P < 0.05). No correlation between blood cadmium and 8-OHdG levels (P > 0.05).

8-OHdG: 8-hydroxy-2’-deoxyguanosine; BDE: brominated diphenyl ether; DDE: dichlorodiphenyldichloroethylene; DNA: deoxyribonucleic acid; DP: dechlorane plus; HCB: hexachlorobenzene; HCH: hexachlorocyclohexane; PBDE: polybrominated diphenyl ether; PCB: polychlorinated biphenyl.

Table 18. DNA damage

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Li Y et al. (69) China Ecological: exposed town vs

control town Men (n value not given) Not assessed miRNA expression profiles in spermatozoa: differential regulation (109 downregulated, 72 upregulated).

control town Mothers and neonates.

Cadmium Cord blood cadmium: 3.61 vs 1.25 µg/L (P < 0.01). Metallothionein expression in placenta: 67.0 vs 3.7% (P < 0.01). Placental cadmium concentration correlated with increased placental metallothionein expression.

Zhang Q et al. (71) Guiyu, China Ecological: exposed town vs

control town Pregnant women. Exposed

(n=55), control (n=50) Cadmium, lead Placental cadmium: 83.99 vs 51.59 ng/g (P < 0.001); placental lead: 521.01 vs 273.24 ng/g (P = 0.299). Placental cadmium negatively correlated with S100P protein and positively correlated with metallothionein expression. No correlation with placental lead.

Li K et al. (72) Jinghai, China Exposed town vs control

town Adults employed primarily

in non-e-waste sectors.

Living within 5 km of e-waste facilities (n=30) and 40 km from e-waste facilities (n=28)

Calcium, copper, iron, lead, magnesium, selenium, zinc, malondialdehyde, PCBs, PBDEs, DP, BB-153

Blood lead: 90.39 vs 68.40 µg/L; copper: 17.34 vs 15.20 μM; malondialdehyde: 1.29 vs 0.25 nmol/mL; PCBs: 42.59 vs 10.14 ng/g; PBDEs: 23.05 vs 14.60 ng/g; calcium:

1.71 vs 1.82 nM; zinc: 100.66 vs 127.42 µM (all P < 0.05). Micronucleus rate: 18.27 vs 7.32% (P < 0.05). Men more affected than women.

BB-153: 2,2’,4,4’,5,5’-hexabromobiphenyl; DP: dechlorane plus; miRNA: micro-ribonucleic acid; PBDE: polybrominated diphenyl ether; PCB: polychlorinated biphenyl.

Table 19. Gene expression

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toxicant Health outcome Zhang T et al. (73) Qingyuan, China Exposed town vs control

urban and rural areas Population (aged 0.4–87 years). Exposed (n=116), control urban (n=22), control rural (n=20)

Bisphenols Urinary BPA: 2.99 vs 0.589 vs 0.952 ng/mL (P < 0.01); BPS: 0.361 vs 0.388 vs 0.652 ng/mL (P > 0.05); BPF: 0.349 vs 0.0886 vs 0.556 ng/mL (P < 0.01). Urinary 8-OHdG:

8.00 vs 6.84 vs 7.31 ng/mL (P value not given). 8-OHdG significantly positively correlated with BPA and BPS in exposed group (both P < 0.001), but no correlation with BPF (P > 0.05).

Lu SY et al. (74) Qingyuan, China Exposed town vs control

urban and rural areas Population (aged 0.4–87 years). Exposed (n=175), control urban (n=17), control rural (n=29)

Organophosphate flame retardants and plasticizers

Urinary BCEP: 0.81 vs 0.43 vs 0.50 ng/mL (P < 0.05); BCIPP: 0.11 vs 0.028 vs 0.069 ng/mL (P < 0.01); DBP: 0.38 vs 0.10 vs 0.10 ng/mL (P < 0.05); DPHP: 0.57 vs 0.67 vs 0.37 ng/mL (P < 0.01). Urinary concentrations of BCEP, BCIPP, DBP and DPHP significantly correlated with increase in 8-OHdG.

Lu SY et al. (75) Qingyuan, China Exposed towns vs control

urban area Population (aged 0.4–87

years). Exposed (n=130), control urban (n=22), control rural (n=24)

PAHs Urinary OH-PAHs: 25.4 vs 10.9 vs 11.7 μg/g creatinine; 8-0HdG: 16.2 vs 12.3 vs 11.6 ng/mL; MDA: 47.9 vs 36.1 vs 31.3 μg/g creatinine (all P < 0.05). OH-PAHs significantly associated with elevated 8-OHdG.

Zhou X et al. (76) Guiyu, China E-waste recycling workers and residents of areas with e-waste recycling vs control town

Pregnant women and neonates. Exposed pregnant women (n=46), control (n=44)

Not assessed Median maternal serum estradiol: 2137.52 vs 1549.74 pg/mL; umbilical cord estradiol: 2757.91 vs 2211.29 pg/mL; maternal serum progesterone: 100.10 vs 61.61 ng/mL; umbilical cord progesterone: 156.52 vs 145.87 ng/mL (all P < 0.05).

Levels of estradiol and progesterone significantly elevated in exposed group.

Significant increase in mRNA levels of estrogen receptors and decrease in mRNA levels of progesterone receptors in exposed group (all P < 0.05).

Li R et al. (32) China Exposed town vs control

town Adults. Exposed (n=23),

control (n=28) PCBs, PBDEs,

PBBs, DP, HCB, β-HCH, p,p’-DDE, lead

Plasma PCBs: 60.4 vs 28.4 ng g^–1; DP: 9.0 vs 2.8 ng g^–1; PBB-153: 0.55 vs 0.25 ng g^–1(all P < 0.01). No difference in PBDEs, HCB, β-HCH, p,p’-DDE or lead. Increased levels of white blood cells, lymphocytes and neutrocytes in exposed group (20.9%, 18.6%, 24% respectively). Lower reactive oxygen species in respiratory burst of neutrophil granulocytes among exposed group (data not shown, P < 0.001).

Positive correlation between PCBs in plasma and reactive oxygen species levels in white blood cells and neutrophil granulocytes (both P < 0.05). This study also quoted in Table 6.

8-OHdG: 8-hydroxy-2’-deoxyguanosine; β-HCH: β-hexachlorocyclohexane; BCEP: bis(2-chloroethyl) phosphate; BCIPP: bis(2-chloro-isopropyl) phosphate; BPA: bisphenol A; BPF: bisphenol F; BPS: bisphenol S; DBP: dibutyl phosphate; DP: dechlorane plus; DPHP: diphenyl phosphate; HCB: hexachlorobenzene; MDA: malondialdehyde; mRNA: messenger ribonucleic acid; OH-PAH: hydroxylated polycyclic aromatic hydrocarbon; PAH: polycyclic aromatic hydrocarbon; PBB: polybrominated biphenyl;

PBDE: polybrominated diphenyl ether; PCB: polychlorinated biphenyl; p,p’-DDE: p,p’-dichlorodiphenyldichloroethylene.

Table 20. Oxidative stress

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Children and digital dumpsites

E-waste exposure and child health WEB ANNEX

Literature review on the health

effects of exposure to e-waste

E-waste exposure and child health WEB ANNEX

Literature review on the health

effects of exposure to e-waste

Contents

Acknowledgements

Table 1. Short-term health effects, stress, injuries

Table 2. Adverse neonatal outcomes

Table 2. Adverse neonatal outcomes continued

Table 3. Short placental telomere

Table 4. Growth

Table 5. Neurodevelopment, learning and behavioural outcomes

Table 6. Immune function

Table 6. Immune function continued

Table 7. Thyroid and endocrine system function

Table 7. Thyroid and endocrine system function continued

Table 8. Lung function, respiratory function and asthma

Table 9. Airway antimicrobial activity

Table 10. Cardiovascular risk factors

Table 11. Hearing loss

Table 12. Olfactory memory

Table 13. Liver function

Table 14. Impaired blood coagulation

Table 15. Fasting blood glucose levels

Table 16. Male reproductive disorders, genital diseases and sperm quality

Table 17. Kidney injury markers

Table 18. DNA damage

Table 19. Gene expression

Table 20. Oxidative stress

References