Environmental Epidemiology, Volume 2 Use of the Gray Literature and Other Data in Environmental Epidemiology (1997) / Chapter Skim
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4 Researching a Broad Range of Health Outcomes
4 Researching a Broad Range of Health Outcomes
Pages 68-93
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From page 68... ...
Finally, we discuss biologic markers for these end points and considerations of special populations at risk. A comprehensive assessment of the evolving literature on health outcomes that may be associated with environmental exposures is beyond the scope of this study.
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From page 69... ...
Progress over past decades has elucidated the link of an array of respiratory outcomes to air pollution. Adverse effects on the respiratory tract of air pollutants such as ozone or airborne particles are highly nonspecific and not easily detected clinically.
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From page 70... ...
Analyses of data in 8 cities have detected associations of airborne particles with small increases in the risk of mortality (Schwartz, 1991~. In a community study, the closing of a steel mill for a year was associated with more than a 40% decrease in hospital admissions for asthma in children; the next year the mill reopened, and hospitalization rates rose to their previous level (Pope 1989, 1991~.
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From page 71... ...
Subsequent studies that have examined daily time series, rather than episodes, have also associated ambient PM concentrations with short-term variation in peak expiratory flow rate at concentrations below current national ambient-air quality standards (Pope and Dockery, 1992; Pope et al., 1991~. Daily symptom incidence and duration of respiratory illness have been linked to exposure to airborne particles.
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From page 72... ...
Studies have associated airborne particles with increased mortality (Dockery and Pope, 1994; American Thoracic Society., 1996b)
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From page 73... ...
For example, solvent exposure just before testing may interfere with performance tests for chronic neurotoxic effects (Melius and Schulte, 1981~. Thus, the study design should use the proper exposure time range and the proper response time range for the situation being evaluated, e.g., chronic effects in a chronically exposed population.
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From page 74... ...
Environmental exposures have been suggested for such diseases as parkinsonism, amyotrophic lateral sclerosis, Alzheimer's disease, and several peripheral neuropathies (Tanner et al., 1987; Ngim and Devathasan, 1989; Kalfakis et al., 1991; Bos et al., 1991; McLachlan et al., 1991~. Improved means to evaluate more-subtle neurobehavioral and neurophysiologic effects (Valciukas and Lilis, 1980; Xintaras et al., 1979)
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From page 75... ...
In a cohort study, first- and second-grade students who were considered asymptomatic for lead were classified by dentin lead levels and then evaluated with a battery of neuropsychologic tests (Needleman et al., 1979~. Children with high dentin lead scored significantly less well on the Wechsler Intelligence Scale for Children (revised)
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From page 76... ...
Epidemiologic reports have linked paternal occupational exposures to adverse pregnancy outcomes (Davis et al., 1992~. Data from the National Toxicology Program indicate that chemicals affecting the fecundity of male rodents usually affect the fecundity of the female as well.
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PREGNANCY OUTCOMES Adverse pregnancy outcomes include miscarriage and low birthweight, as well as malformations and functional abnormalities. Most of the findings on chemicals causing adverse pregnancy outcomes have been established in animal studies.
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The relation between environmental exposures and birth defects remains important but difficult to study. An innovative study from New York state used existing data to detect some associations between congenital malformations (all types pooled)
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From page 79... ...
More recently, occupational lead exposure has been associated with several kinds of adverse pregnancy outcomes (Schwartz, 1992~. Prospective studies of pregnant women who were not occupationally exposed have associated higher blood or cord lead levels with lower birthweight, small size for gestational age, and shorter duration of gestation.
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From page 80... ...
Renal toxicants may produce glomerular nephritis, tubular necrosis, Fanconi syndrome, interstitial nephritis, hypersensitivity reaction, kidney stones, and cancer. The influence of environmental exposures on the kidney has been widely described in the occupational literature (Littorin et al., 1984; Bernard et al., 1979; Friberg et al., 1985, Druet et al., 1982~.
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Subjects who were extensive debrisoquine metabolizers and who also had occupational exposure to asbestos had an 18-fold increase in the rate of lung cancer. There has been little research on indicators or markers of early or preclinical environmentally induced disease.
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From page 82... ...
Failure to consider these factors can lead to wasteful efforts. Field studies of chemically exposed populations have made little use of immune-system responses to define exposures (NRC, 1989b; Karol, 1987; Grammer et al., 1988; Stejskal et al., 1986; Zeiss et al., 1977~.
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From page 83... ...
Some implications of large coefficients of variation in immunologic markers that may be used to define exposure are that large samples must be used to reduce random variation, comparisons between exposed and nonexposed persons might involve stratification or adjustment for populations whose results significantly deviate from the mean, and construct validity must be established for multiple markers to ensure that confounders are distributed similarly between exposed and nonexposed groups.
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From page 84... ...
Harrison (1988) suggested 4 criteria for determining whether a particular physiologic assay may be useful as a biomarker of aging in an individual organism: the results should change significantly with age, the changes should be repeatable in the same individual, assays of independent physiologic parameters should give similar estimates of age for the same individual, and the degree of aging as determined by the assays should correlate with subsequent longevity.
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From page 85... ...
. The immature enzymatic detoxification systems of embryos, fetuses, and neonates put them at increased risk of the effects of pharmacologic and environmental substances that pass through the placenta, such as heavy metals, PCBs, and immunogens.
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Data gaps also exist on male-mediated adverse pregnancy outcomes. An important research need is the development of measures and tools to identify toxic effects on fecundity.
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REFERENCES American Thoracic Society, Committee of the Environmental and Occupational Health Assembly: R Bascom, P.A.
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1987. Chronic obstructive pulmonary disease symptom effects of long-term cumulative exposure to ambient levels of total suspended particulates and sulfur dioxide in California Seventh-Day Adventist residents.
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1984. Monitoring of hospital emergency room visits as a method for detecting health effects of environmental exposures.
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Third Annual Symposium on Environmental Epidemiology, held April 26-28,1992, in Pittsburgh, PA. Pittsburgh, PA: Center for Environmental Epidemiology, Graduate School of Public Health, University of Pittsburgh.
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From page 91... ...
1979. Deficits in psychologic and classroom performance of children with elevated dentine lead levels.
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1991. Effects of urban air pollution on emergency room admissions for chronic obstructive pulmonary disease.
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1981. The relationship between blood lead concentration, intelligence, and attainment in a school population: a pilot study.
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