Edward A. Emmett

Community Exposure to Perfluorooctanoate: Relationships Between Serum Concentrations and Exposure Sources

Objective: The objective of this study was to determine serum (perfluorooctanoate [PFOA]) in residents near a fluoropolymer production facility: the contributions from air, water, and occupational exposures, personal and dietary habits, and relationships to age and gender. Methods: The authors conducted questionnaire and serum PFOA measurements in a stratified random sample and volunteers residing in locations with the same residential water supply but with higher and lower potential air PFOA exposure. Results: Serum (PFOA) greatly exceeded general population medians. Occupational exposure from production processes using PFOA and residential water had additive effects; no other occupations contributed. Serum (PFOA) depended on the source of residential drinking water, and not potential air exposure. For public water users, the best-fit model included age, tap water drinks per day, servings of home-grown fruit and vegetables, and carbon filter use. Conclusions: Residential water source was the primary determinant of serum (PFOA).

Community Exposure to Perfluorooctanoate: Relationships Between Serum Levels and Certain Health Parameters

Objective: The objective of this study was to determine whether certain biomarkers of toxicity and/or a past diagnosis of liver or thyroid disease were associated with serum perfluorooctanoate concentrations (PFOA) in a community with longstanding environmental exposure to PFOA. Methods: Serum (PFOA), hematologic and biochemical biomarkers, and a questionnaire were administered to 371 residents selected by stratified random sampling and a lottery among volunteers. Median PFOA was 354 ng/mL (interquartile range, 181–571 ng/mL). Results: No significant positive relationships between serum (PFOA) and liver or renal function tests, cholesterol, thyroid-stimulating hormone, or with red cell indices, white cell, or platelet counts. Mean serum (PFOA) was not increased in those with a history of liver or thyroid disease. Conclusions: No toxicity from PFOA was demonstrated using the measured end points; other end points need to be addressed.

The Relationship Between Birth Weight, Gestational Age and Perfluorooctanoic Acid (PFOA)-Contaminated Public Drinking Water

BACKGROUND Recent studies have examined the associations between perfluorooctanoic acid (PFOA) levels in cord blood and maternal plasma with lowered birth weight and gestational age in humans; however, no study has examined these effects in a population of known high PFOA exposure. Residents drinking PFOA-contaminated water from the Little Hocking Water Association (LHWA) in Washington County, Ohio have serum PFOA levels approximately 80 times those in the general U.S. population. OBJECTIVES To compare birth weights and gestational ages of neonates born to mothers residing in zip codes with water service provided completely, partially or not at all by the LHWA. METHODS Multiple logistic and linear regression analyses were performed on singleton neonatal birth weight data supplied by the Ohio Department of Health to examine the associations between LHWA water service category (used as a surrogate for PFOA exposure) with mean birth weight, mean gestational age, the likelihood of low birth weight (<2500 g), and the likelihood of preterm birth (<37 completed weeks of gestation). All models were adjusted for maternal age, gestational age, sex, race and population-level socioeconomic status. RESULTS The incidence of low birth weight, preterm birth, mean birth weight and mean gestational age of neonates did not significantly differ among water service categories. CONCLUSION Markedly elevated PFOA exposure, as categorized by water service category, is not associated with increased risk of lowered birth weight or gestational age. This study does not confirm earlier findings of an association between PFOA and lowered birth weight observed at normal population levels.

Congenital Anomalies, Labor/Delivery Complications, Maternal Risk Factors and Their Relationship with Perfluorooctanoic Acid (PFOA)-Contaminated Public Drinking Water

BACKGROUND We have previously examined the associations between perfluorooctanoic acid (PFOA) exposure, birth weight and gestational age in individuals exposed to PFOA-contaminated residential drinking water from the Little Hocking Water Association (LHWA). In this investigation, we expand the scope of our analysis to examine the associations between PFOA, congenital anomalies, labor and delivery complications and maternal risk factors. OBJECTIVES To compare the likelihood of congenital anomalies, labor and delivery complications and maternal risk factors in neonates and their mothers residing in zip codes with public water service provided completely, partially or not at all by the LHWA. METHODS Logistic regression analyses were performed on singleton neonatal birth outcome data supplied by the Ohio Department of Health to examine the associations between LHWA water service category and the outcomes of interest. When possible, models were adjusted for maternal age, preterm birth, neonatal sex, race, maternal education, alcohol use, tobacco use and diabetic status. RESULTS Increased PFOA exposure, as assessed by water service category, was not associated with an overall increase in the likelihood of congenital anomalies or any specific diagnosis (adjusted OR: 1.4, 95% CI: 0.34-3.3). The overall likelihood of labor and delivery complications was significantly lower among mothers with water service provided by the LHWA, as compared to mothers not serviced by the LHWA (adjusted OR: 0.65, 95% CI: 0.46-0.92). A significant increase in the likelihood of anemia (crude OR: 11, 95% CI: 1.8-64) and dysfunctional labor (crude OR: 5.3, 95% CI: 1.2-24) was noted for mothers residing within zip codes serviced by the LHWA, but the number of reported cases was very small. CONCLUSION At the levels measured in the LHWA, we conclude that PFOA is not associated with increased risk of congenital anomalies, most labor and delivery complications and maternal risk factors. Additional research is required to assess the observed associations between PFOA, anemia and dysfunctional labor.

multivariate Analysis of the Effect of Selected Factors on the Elicitation of Patch Test Response to 28 Common Environmental Contactants in North America

Standardized patch tests were performed on 3,974 patients between August 1, 1985 and July 31, 1989. Significant determinants of positive responses based on previously reported bivariate analysis of response were entered into a logistic regression model; the contribution of each factor to response to each of 27 test substances with which the patients were tested was evaluated. For 14 test substances, age increased the odds of response; nickel was striking in that increasing age decreased the odds of a positive response. Specific contactants were found to be associated with gender and topographical location of the eczematous dermatitis leading to the application of the patch tests. Atopic dermatitis was associated with a lower odds of response toP-phenylenediamine, but in no instance was associated with increased odds of a positive response.

Chemosensory loss: functional consequences of the world trade center disaster.

Background Individuals involved in rescue, recovery, demolition, and cleanup at the World Trade Center (WTC) site were exposed to a complex mixture of airborne smoke, dust, combustion gases, acid mists, and metal fumes. Such exposures have the potential to impair nasal chemosensory (olfactory and trigeminal) function. Objective The goal of this study was to evaluate the prevalence of chemosensory dysfunction and nasal inflammation among these individuals. Methods We studied 102 individuals who worked or volunteered at the WTC site in the days and weeks during and after 11 September 2001 (9/11) and a comparison group with no WTC exposure matched to each participant on age, sex, and job title. Participants were comprehensively evaluated for chemosensory function and nasal inflammation in a single session. Individual exposure history was obtained from self-reported questionnaires. Results The prevalence of olfactory and trigeminal nerve sensitivity loss was significantly greater in the WTC-exposed group relative to the comparison group [prevalence ratios (95% confidence intervals) = 1.96 (1.2–3.3) and 3.28 (2.7–3.9) for odor and irritation thresholds, respectively]. Among the WTC responders, however, individuals caught in the dust cloud from the collapse on 9/11 exhibited the most profound trigeminal loss. Analysis of the nasal lavage samples supported the clinical findings of chronic nasal inflammation among the WTC-exposed cohort. Conclusions The prevalence of significant chemosensory impairment in the WTC-exposed group more than 2 years after their exposure raises concerns for these individuals when the ability to detect airborne odors or irritants is a critical safety factor. Relevance to clinical practice This outcome highlights the need for chemosensory evaluations among individuals with exposure to acute high or chronic levels of airborne pollutants.

Field Survey of Health Perception and Complaints of Pennsylvania Residents in the Marcellus Shale Region

Pennsylvania Marcellus Shale region residents have reported medical symptoms they believe are related to nearby Unconventional Natural Gas Development (UNGD). Associations between medical symptoms and UNGD have been minimally explored. The objective of this descriptive study is to explore whether shale region Pennsylvania residents perceive UNGD as a health concern and whether they attribute health symptoms to UNGD exposures. A questionnaire was administered to adult volunteers with medical complaints in a primary-care medical office in a county where UNGD was present. Participants were asked whether they were concerned about health effects from UNGD, and whether they attributed current symptoms to UNGD or to some other environmental exposure. There were 72 respondents; 22% perceived UNGD as a health concern and 13% attributed medical symptoms to UNGD exposures. Overall, 42% attributed one or more of their medical symptoms to environmental causes, of which UNGD was the most frequent. A medical record review conducted on six participants who attributed their medical symptoms to UNGD revealed that only one of these records documented both the symptoms in question and the attribution to UNGD. The results of this pilot study suggest that there is substantial concern about adverse health effects of UNGD among Pennsylvania Marcellus Shale residents, and that these concerns may not be adequately represented in medical records. Further efforts to determine the relationship between UNGD and health are recommended in order to address community concerns.

Characteristics and Outcomes of an Innovative Train-in-Place Residency Program

BACKGROUND Physicians who make a midcareer specialty change may find their options for formal training are limited. Here, we describe a train-in-place program, with measureable outcomes, created to train midcareer physicians who desire formal training in occupational medicine. OBJECTIVE We evaluated educational outcomes from a novel residency program for midcareer physicians seeking formal training and board certification in occupational medicine. METHODS Physicians train in place at selected clinical training sites where they practice, and participate in 18 visits to the primary training site over a 2-year period. Program components include competency-based training structured around rotations, mentored projects, and periodic auditing visits to train-in-site locations by program faculty. Main outcome measures are achievement of Accreditation Council for Graduate Medical Education Occupational Medicine Milestones, American College of Occupational and Environmental Medicine competencies, performance on the American College of Preventive Medicine examinations, diversity in selection, placement of graduates, and the number of graduates who remain in the field. RESULTS Since inception of this program in 1997, there have been 109 graduates who comprise 7.2% of new American Board of Preventive Medicine diplomates over the past decade. Graduates scored competitively on the certifying examination, achieved all milestones, expressed satisfaction with training, and are geographically dispersed, representing every US region. Most practice outside the 25 largest standard metropolitan statistical areas. More than 95% have remained in the field. CONCLUSIONS Training in place is an effective approach to provide midcareer physicians seeking comprehensive skills and board certification in occupational medicine formal training, and may be adaptable to other specialties.

Realities of environmental toxicity and their ramifications for community engagement

Research on community responses to environmental toxicity has richly described the struggles of citizens to identify unrecognized toxins, collect their own environmental health facts, and use them to lobby authorities for recognition and remediation. Much of this literature is based on an empiricist premise: it is concerned with exploring differences in how laypeople and experts perceive what is presumed to be a singular toxic reality that preexists these varying perspectives. Here, we seek to reexamine this topic by shifting the focus from facts to facticity-that is, by exploring the many types of knowledge that communities develop about toxicity and how these knowledges articulate with the ideas of scientific and governmental authorities about what kinds of information are valid bases for policymaking. In making this shift, we are influenced by work in semiotic anthropology and science and technology studies (STS), which emphasizes that lived experience generates distinct realities rather than different perceptions of the same underlying state. Using this framework, we present an analysis of oral history interviews conducted in 2013-14 in the small American town of Ambler, Pennsylvania. Part of Amblers legacy as a nineteenth- and twentieth-century center of asbestos manufacture is that it is home to two massive asbestos-containing waste sites, one of which was being remediated by the Environmental Protection Agency (EPA) at the time of this study. Our interviews demonstrate that even asbestos, a toxin with a well-established public narrative, is a fundamentally different object for different members of the Ambler community. For many of these individuals, the epistemology and practices of the EPA are incongruent with or tangential to their toxicity-related experiences and their consequent concerns for the future. As such, our findings suggest caution in framing the community engagement efforts of environmental health agencies primarily as facilitations of citizen science; this approach does not acknowledge the multiplicity of toxic realities.