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Arsenic is ubiquitous in the environment and human exposure can occur from multiple possible routes including diet. Occupational medicine physicians asked to evaluate workers with elevated urine arsenic levels may be unaware that many sources of arsenic exposure are not work related. In this paper, we address arsenic exposure sources and pathways, adverse health effects of arsenic exposure and those subpopulations at increased risk, and the evaluation and treatment of those exposed to elevated arsenic levels.

OBJECTIVE:--Low-level exposure to some persistent organic pollutants (POPs) has recently become a focus because of their possible link with the risk of diabetes. RESEARCH DESIGN AND METHODS--Cross-sectional associations of the serum concentrations of POPs with diabetes prevalence were investigated in 2,016 adult participants in the National Health and Nutrition Examination Survey 1999-2002. Six POPs (2,2',4,4',5,5'-hexachlorobiphenyl, 1,2,3,4,6,7,8-heptachlorodibenzo-p-dioxin, 1,2,3,4,6,7,8,9-octachlorodibenzo-p-dioxin, oxychlordane, p,p'-dichlorodiphenyltrichloroethane, and trans-nonachlor) were selected, because they were detectable in >=80% of participants. RESULTS:--Compared with subjects with serum concentrations below the limit of detection, after adjustment for age, sex, race and ethnicity, poverty income ratio, BMI, and waist circumference, diabetes prevalence was strongly positively associated with lipid-adjusted serum concentrations of all six POPs. When the participants were classified according to the sum of category numbers of the six POPs, adjusted odds ratios were 1.0, 14.0, 14.7, 38.3, and 37.7 (P for trend < 0.001). The association was consistent in stratified analyses and stronger in younger participants, Mexican Americans, and obese individuals. CONCLUSIONS:--There were striking dose-response relations between serum concentrations of six selected POPs and the prevalence of diabetes. The strong graded association could offer a compelling challenge to future epidemiologic and toxicological research.

This study investigated factors associated with successful return to work for cancer survivors in accordance with the Americans with Disabilities Act. A focus group was held with seven female cancer survivors. Participants discussed return-to-work issues following a cancer diagnosis. Factors such as coworker support and job flexibility improved their experiences, whereas coworker and supervisor ignorance about cancer and lack of support made returning to work more stressful. Participants discussed personal, environmental, and cancer-related factors that influenced their experiences with returning to work following a cancer diagnosis. Knowledge of factors that support employees helps occupational health nurses ease their transition, and may improve quality of life for employees. Physicians and health care provider teams may play a critical role in the employees' positive evaluation of their recovery process. This pilot study serves as a basis for a larger, population-based study.

Objectives The Farm Family Exposure Study was conducted to evaluate real-world pesticide exposure for farmers, spouses, and children. Methods Eligible farm families from Minnesota and South Carolina were randomly selected from a roster of licensed private pesticide applicators. Eligibility required that the family include a farmer, spouse, and at least one child between the ages of 4 and 17 years, that the family live on the farm, that the farmer planned to apply one of the target pesticides [glyphosate, chlorpyrifos, 2,4-dichlorophenoxy acetic acid (2,4-D)] to at least 10 acres (4.1 hectares) of land within 1 mile (1.6 kilometers) of the house. For each family member, geometric means were calculated for 24-hour composite urinary samples, with a 1 ppb (part per billion) limit of detection, the day before, the day of, and for 3 days after the application. Results For the farmers, the peak geometric mean concentrations were 3 ppb for glyphosate, 64 ppb for 2,4-D, and 19 ppb for the primary chlorpyrifos metabolite. For the spouses and children, the percentage with detectable values varied by chemical, although the average values for each chemical did not vary during the study period. The applicators had the highest urine pesticide concentrations, children had much lower values, and spouses had the lowest values. Exposure to family members was largely, though not exclusively, determined by the degree of direct contact with the application process. The exposure profile varied for the three chemicals for each family member. Conclusions The data of this study indicate the importance of chemical-specific considerations when exposure assessments are planned in epidemiologic studies.

Objective: We estimated 2,4-dichlorophenoxyacetic acid (2,4-D) exposure and systemic dose in farm family members following an application of 2,4-D on their farm. Methods: Farm families were recruited from licensed applicators in Minnesota and South Carolina. Eligible family members collected all urine during five 24-hr intervals, 1 day before through 3 days after an application of 2,4-D. Exposure profiles were characterized with 24-hr urine 2,4-D concentrations, which then were related to potential predictors of exposure. Systemic dose was estimated using the urine collections from the application day through the third day after application. Results: Median urine 2,4-D concentrations at baseline and day after application were 2.1 and 73.1 µg/L for applicators, below the limit of detection, and 1.2 µg/L for spouses, and 1.5 and 2.9 µg/L for children. The younger children (4-11 years of age) had higher median post-application concentrations than the older children (≥ 12 years of age) (6.5 vs. 1.9 µg/L). The geometric mean systemic doses (micrograms per kilogram body weight) were 2.46 (applicators), 0.8 (spouses), 0.22 (all children), 0.32 (children 4-11 years of age), and 0.12 (children ≥ 12 years of age). Exposure to the spouses and children was primarily determined by direct contact with the application process and the number of acres treated. Multivariate models identified glove use, repairing equipment, and number of acres treated as predictors of exposure in the applicators. Conclusions: We observed considerable heterogeneity of 2,4-D exposure among farm family members, primarily attributable to level of contact with the application process. Awareness of this variability and the actual magnitude of exposures are important for developing exposure and risk characterizations in 2,4-D-exposed agricultural populations.

CONTEXT: The National Survey of Family Growth (NSFG) classifies pregnancies as intended, mistimed or unwanted. However, these categories could be too broad, as a woman's feelings about a pregnancy, her health behaviors during pregnancy and thus her pregnancy outcomes may vary according to whether her pregnancy is moderately or seriously mistimed. These relationships have not yet been explored. METHODS: Data from the 1995 NSFG were examined to assess associations between pregnancy mistiming and maternal characteristics. Descriptive and multivariate analyses were conducted of the extent of mistiming for each maternal characteristic. Chi-square and F-tests were used to examine the associations between a pregnancy's intendedness-according to a four-category classification-and maternal characteristics, maternal happiness ratings, maternal behaviors and pregnancy outcomes. RESULTS: Fifty-five percent of mistimed pregnancies were mistimed by 24 months or less, 32% were mistimed by 25-60 months and 13% were mistimed by more than 60 months. According to multivariate analyses, pregnancies among younger women, never-married women and black women were mistimed by significantly more months than those among other women. The distribution of moderately mistimed pregnancies differed significantly from those of both seriously mistimed and unwanted pregnancies according to most maternal characteristics; there were few differences between intended and moderately mistimed pregnancies, and between seriously mistimed and unwanted pregnancies. CONCLUSIONS: Mistiming is not a unitary construct. Its extent is associated with maternal characteristics and behaviors. Future research on pregnancy intention should examine the extent of mistiming and consider alternatives to traditional definitions of intendedness.