Depleted uranium and public health.
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Humans↗
Biomedical subjects
M A McDiarmid
Publications and source records attributed to M A McDiarmid.
Urinary uranium concentrations in an enlarged Gulf War veteran cohort.
Depleted uranium was first used on a large scale as a major component of munitions and armaments employed by the U.S. armed forces during the Gulf War in 1991. In response to concern that exposure to depleted uranium may have been a cause of health problems suffered by returning veterans of that war, an already existing surveillance program following depleted uranium "friendly fire" victims was enlarged to assess the wider veteran community's exposure to depleted uranium. Between August 1998 and December 1999, 169 Gulf War veterans submitted 24-h urine samples for determination of urinary uranium concentration and questionnaires describing their potential exposures to depleted uranium while in the Gulf War theatre. Depleted uranium exposure assessment was determined from 30 separate questionnaire items condensed into 19 distinct exposure scenarios. Results of urine uranium analysis were stratified into high and low uranium groups with 0.05 microg uranium/g creatinine being the cut point and approximate upper limit of the normal population distribution. Twelve individuals (7.1%) exhibited urine uranium values in the high range, while the remaining 157 had urine uranium values in the low range. A repeat test of urine for 6 of these 12 produced uranium results in the low range for 3 of these individuals. Exposure scenarios of the high and low uranium groups were similar with the presence of retained shrapnel being the only scenario predictive of a high urine uranium value. Results emphasize the unlikely occurrence of an elevated urine uranium result and consequently any uranium-related health effects in the absence of retained depleted uranium metal fragments in the veterans.
Cohort Studies↗
The "GRAS" status of women's work.
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Adolescent↗
Surveillance of depleted uranium exposed Gulf War veterans: health effects observed in an enlarged "friendly fire" cohort.
To determine clinical health effects in a small group of US Gulf War veterans (n = 50) who were victims of depleted uranium (DU) "friendly fire," we performed periodic medical surveillance examinations. We obtained urine uranium determinations, clinical laboratory values, reproductive health measures, neurocognitive assessments, and genotoxicity measures. DU-exposed Gulf War veterans with retained metal shrapnel fragments were excreting elevated levels of urine uranium 8 years after their first exposure (range, 0.018 to 39.1 micrograms/g creatinine for DU-exposed Gulf War veterans with retained fragments vs 0.002 to 0.231 microgram/g creatinine in DU exposed but without fragments). The persistence of the elevated urine uranium suggests ongoing mobilization from the DU fragments and results in chronic systemic exposure. Clinical laboratory outcomes, including renal functioning, were essentially normal. Neurocognitive measures showing subtle differences between high and low uranium exposure groups, seen previously, have since diminished. Sister chromatid exchange frequency, a measure of mutation in peripheral lymphocytes, was related to urine uranium level (6.35 sister chromatid exchanges/cell in the high uranium exposure group vs 5.52 sister chromatid exchanges/cell in the low uranium exposure group; P = 0.03). Observed health effects were related to subtle but biologically plausible perturbations in central nervous system function and a general measure of mutagen exposure. The findings related to uranium's chemical rather than radiologic toxicity. Observations in this group of veterans prompt speculation about the health effects of DU in other exposure scenarios.
Adult↗
Detection of depleted uranium in biological samples from Gulf War veterans.
During the Persian Gulf War, soldiers may have inhaled, ingested, and/or experienced wound contamination by depleted uranium (DU), which is used in military projectiles and armor. DU is produced by depleting natural uranium of 234U and 235U during the uranium-enrichment process. Although the long-term effects of significant DU exposures require investigation, many veterans express fears about its impact on health. An assay by which DU exposure can be assessed would not only be a useful research tool, but the information could help mitigate the concerns of exposed individuals. In this study, urine samples from individuals enrolled in the Depleted Uranium Follow-Up Program at the Baltimore Veterans Administration Medical Center were examined for uranium content. Isotopic composition of urine uranium was determined by measuring the 235U/238U ratio, using an inductively coupled plasma mass spectrometer. Using this method, natural and depleted uranium could be readily differentiated. By demonstrating the absence of DU in soldiers who suspect exposure by inhalation or ingestion, the assay should reduce psychological stress in these individuals.
Biomarkers↗
Health effects of depleted uranium on exposed Gulf War veterans.
A small group of Gulf War veterans possess retained fragments of depleted uranium (DU) shrapnel, the long-term health consequences of which are undetermined. We evaluated the clinical health effects of DU exposure in Gulf War veterans compared with nonexposed Gulf War veterans. History and follow-up medical examination were performed on 29 exposed veterans and 38 nonexposed veterans. Outcome measures employed were urinary uranium determinations, clinical laboratory values, and psychiatric and neurocognitive assessment. DU-exposed Gulf War veterans with retained metal shrapnel fragments are excreting elevated levels of urinary uranium 7 years after first exposure (range 0.01-30.7 microg/g creatinine vs 0.01- 0.05 microg/g creatinine in the nonexposed). The persistence of the elevated urine uranium suggests on-going mobilization from a storage depot which results in a chronic systemic exposure. Adverse effects in the kidney, a presumed target organ, are not present at this time, though other effects are observed. Neurocognitive examinations demonstrated a statistical relationship between urine uranium levels and lowered performance on computerized tests assessing performance efficiency. Elevated urinary uranium was statistically related to a high prolactin level (>1.6 ng/ml; P=0.04). More than 7 years after first exposure, DU-exposed Gulf War veterans with retained metal fragments continue to excrete elevated concentrations of urinary uranium. Effects related to this are subtle perturbations in the reproductive and central nervous systems.
Adult↗
The Occupational Safety and Health Administration and the public health model.
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Humans↗
The utility of spot collection for urinary uranium determinations in depleted uranium exposed Gulf War veterans.
The utility of spot urine collections for uranium bioassay determinations was examined in a small cohort of depleted uranium exposed Gulf War veterans. Some members of the group are excreting elevated concentrations of urinary uranium resulting from the metabolism of retained metal fragments, the residua of several friendly fire incidents. Uranium determinations were performed on both 24-h timed collections and spot urine samples using kinetic phosphorescence analyzer (KPA) methodology. Results ranged from non-detectable to 30.7 mcg g(-1) creatinine in a 24-h collection. A creatinine-standardized spot sample and a 24-h uncorrected sample both correlated highly (R2=0.99) with a creatinine corrected 24-h collection, presumed to be the best estimate of the urinary uranium measure. This relationship was upheld when the population was stratified by uranium concentration into a high uranium group (> or = 0.05 mcg U/g creatinine) but for the lower uranium group (< 0.05 mcg U/g creatinine) more variability and a lower correlation was seen. The uncorrected spot sample, unadjusted for volume, concentration or creatinine had the lowest correlation with the 24-h creatinine adjusted result, especially at lower urinary uranium concentrations. This raises questions regarding the representativeness of such a sample in bioassay programs.
Adult↗
Health effects of the 1991 Kuwait oil fires: a survey of US army troops.
The burning of oil wells in Kuwait in 1991 discharged a high volume of potentially toxic pollutants into the air. To determine whether there were health-related complaints associated with having lived and worked there, questionnaires were administered to 1599 soldiers after their return from a 3-month mission in Kuwait. Symptoms occurring before, during, and after the mission were queried. Compared with baseline, symptoms reported more frequently for the Kuwait period were eye and upper respiratory tract irritation, shortness of breath, cough, rashes, and fatigue. Symptoms were associated with reported proximity to oil fires, and their incidence generally decreased after the soldiers left Kuwait. Oil-fire smoke is one of several possible factors that may have contributed to the reporting of symptoms.
Adult↗
Biomonitoring of United States Army soldiers serving in Kuwait in 1991.
Biomarkers of polycyclic aromatic hydrocarbon (PAH) exposure and genetic biomarkers of potential cancer susceptibility were determined in a group of United States Army soldiers who were deployed to Kuwait and Saudi Arabia in 1991 in the aftermath of the Persian Gulf War. Because hundreds of oil well fires were still burning, there was concern that ground troops stationed in Kuwait might be exposed to high levels of PAHs and other toxicants. The United States Army Environmental Hygiene Agency monitored air and soil for ambient PAHs. In addition, a group of 61 soldiers was involved in the biomonitoring study reported here. These soldiers kept diaries of daily activities and provided blood and urine samples in Germany (June) before deployment to Kuwait, after 8 weeks in Kuwait (August), and 1 month after the return to Germany (October). Here we present data for PAH-DNA adducts measured by immunoassay in blood cell DNA samples obtained at all three sampling times from 22 soldiers and bulky aromatic adducts measured by 32P-postlabeling in blood cell DNA samples from 20 of the same soldiers. Urinary 1-hydroxypyrene-glucuronide levels were determined by synchronous fluorescence spectrometry in a matched set of samples from 33 soldiers. Contrary to expectations, environmental monitoring showed low ambient PAH levels in the areas where these soldiers were working in Kuwait. For both DNA adduct assays, levels were the lowest in Kuwait in August and increased significantly after the soldiers returned to Germany (October). Urinary 1-hydroxypyrene-glucuronide levels were also lowest in Kuwait and highest in Germany, but the differences were not statistically significant. The PAH-exposure biomarker levels were not significantly influenced by polymorphic variations of CYP1A1 (MspI) and glutathione S-transferases M1 and T1. Overall, the data suggest that this group of soldiers was not exposed to elevated levels of PAHs while deployed in Kuwait.
DNA Primers↗
Follow-up of biologic monitoring results in cadmium workers removed from exposure.
Biological monitoring and exposure monitoring data for employees at a nickel-cadmium battery production facility were made available to OSHA for review. Sixteen employees were medically removed from occupational exposures to cadmium due to elevated levels of biological parameters (CdB, Cdu, B2U). While the biological monitoring parameters for most workers significantly declined during the 18 months of medical removal, the biological parameters for only one employee's values returned to the normal range. Only one worker had frank renal dysfunction, based on beta-2-microglobulin levels at the time of removal; this dysfunction remained throughout the 17 months of observation after medical removal. Significant policy implications of medical removal protection beyond the current 18-month period provided by the cadmium standards exist and require physician discretion. Mitigating issues which may make it ethically appropriate to return an employee to work despite elevated biologic monitoring parameters are also discussed.
Cadmium↗
OSHA's perspective on occupational exposure to hazardous drugs.
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Drug-Related Side Effects and Adverse Reactions↗
Biological monitoring results for cadmium exposed workers.
As part of a settlement agreement with the Occupational Safety and Health Administration (OSHA) involving exposure to cadmium (Cd), a battery production facility provided medical surveillance data to OSHA for review. Measurements of cadmium in blood, cadmium in urine, and beta 2-microglobulin in urine were obtained for more than 100 workers over an 18-month period. Some airborne Cd exposure data were also made available. Two subpopulations of this cohort were of primary interest in evaluating compliance with the medical surveillance provisions of the Cadmium Standard. These were a group of 16 workers medically removed from cadmium exposure due to elevations in some biological parameter, and a group of platemakers. Platemaking had presented a particularly high exposure opportunity and had recently undergone engineering interventions to minimize exposure. The effect on three biological monitoring parameters of medical removal protection in the first group and engineering controls in platemakers is reported. Results reveal that both medical removal from cadmium exposures and exposure abatement through the use of engineering and work practice controls generally result in declines in biological monitoring parameters of exposed workers. Implications for the success of interventions are discussed.
Air Pollutants, Occupational↗
Respiratory protection guidelines. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, March 1996.
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Humans↗
Increased frequencies of sister chromatid exchange in soldiers deployed to Kuwait.
Frequencies of sister chromatid exchange (SCE), a measure of genotoxic exposure, were assessed in military troops deployed to Kuwait in 1991. Soldiers completed health questionnaires and had blood collected prior to, during and following deployment to Kuwait. Frequency of spontaneous SCE was determined on blood samples as a measure of mutagenic exposure. Compared to pre-deployment baseline SCE frequency means, levels obtained 2 months into the Kuwaiti deployment were significantly increased (P < 0.001) and persisted for at least 1 month after return to Germany. Outcome was unaffected by known personal SCE effect modifiers including smoking, age and diet. Potential sources of the apparent mutagenic exposure are discussed.
Air Pollutants↗
ELF magnetic field exposures in an office environment.
Potential exposures to extremely low frequency (ELF) magnetic fields were investigated in response to worker concerns about an apparent increased spontaneous abortion risk in a payroll office environment. Concern in this office centered on the use of video display terminals (VDTs), which have been investigated as a potential cause of adverse reproductive outcomes among women. In this investigation, magnetic field sources were evaluated using a hand-held survey meter. Emdex datalogging dosimeters were also used to determine full shift personal exposures for 15 women working in the payroll area. On average, the exposures of workers to ELF magnetic fields in the payroll office area ranged from 1.0 to 6.5 mG with a mean of 3.2 +/- 1.5 mG. The results of this study indicate that many sources of ELF magnetic fields, including printers, photocopiers, and the electrical distribution system, can contribute to a worker's exposure in an office environment.
Computer Terminals↗
Investigation of a spontaneous abortion cluster: lessons learned.
An investigation of a reported spontaneous abortion excess in an office environment was undertaken employing a multidisciplinary approach, including (1) an epidemiologic/validation step; (2) an industrial hygiene survey, including electromagnetic field measurements and indoor air quality determinations; and (3) a risk perception/risk communication component. This approach was needed because there are numerous chemical and physical agents and psychosocial stressors that may potentially impact the reproductive status of female office workers. Although video display terminals (VDTs) are typically the focus of spontaneous abortion (SAB) investigations, one cannot ignore other stressors in the environment. Magnetic field exposures within a payroll area were determined using a hand-held survey meter and data logging dosimeter. On average, the full shift time-weighted average exposures of workers to extremely low frequency (ELF) magnetic fields in the payroll office area ranged from 1.0 to 5.6 mG. Influencing the investigation's protocol design were the Centers for Disease Control's (CDC's) recent Guidelines for Investigating Clusters of Health Events. Although these guidelines grew primarily out of cancer cluster investigations, we applied them in this instance and found them to be generalizable to reproductive hazards investigations. A spontaneous abortion excess was validated over a 2-year period among 26 women with 32 reproductive events, with rates 1.5-2.5 times the expected, depending on comparison figures used. Lessons learned in the investigation, including the applicability of the CDC's Cluster Investigation Protocol and the enormous importance of risk perception and risk communication, are described.
Abortion, Spontaneous↗
Investigation of a spontaneous abortion cluster: development of a risk communication plan.
A risk communication plan was developed for a group of payroll office workers who were investigated for a possible cluster of spontaneous abortions (SABs). Survey and focus group methods were used to assess the workers' attitudes, beliefs, and information preferences. We found that four features of the workforce needed to be considered in developing an effective plan: 1) subgroups of workers varied on their levels of concern, awareness, involvement, and definitions of the problem; 2) workers did not have the necessary knowledge concerning SABs or the scientific method to participate in a two-way communication; 3) workers were highly stressed; and 4) workers were distrustful that they would be told the truth about the SABs. A multicomponent risk communication strategy was developed to overcome these barriers. Specifically, we recommended that background information on SABs and the scientific method be presented before the report of the study results and that follow-up sessions should be conducted on job stress and the emotional aspects of miscarriages.
Abortion, Spontaneous↗