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Aragão LHDAE, Santos MJFD, Gurgel ADM, Santos MOSD, Nepomuceno MM, Gurgel IGD. Instruments for assessing the impacts of oil spills: an integrated approach to health, the environment and the socioeconomic profile of exposed areas. CAD SAUDE PUBLICA 2025; 41:e00228723. [PMID: 40172345 PMCID: PMC11960760 DOI: 10.1590/0102-311xen228723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 09/13/2024] [Accepted: 10/17/2024] [Indexed: 04/04/2025] Open
Abstract
Advances in the oil industry have been associated with major disasters involving oil spills in offshore fields, negatively impacting life and the environment. We considered the importance of monitoring and evaluating these events, using various instruments, according to three research axes: health; the environment; and the socioeconomic situation of exposed populations. Thus, the objective was to survey, through a scoping review, scientific evidence involving the application of these instruments to assess the impacts of oil spills. Different databases and languages were used to search for the works. The data were reviewed by a pair of researchers, who carried out the qualitative evaluation. For synthesis of the results, we considered 45 studies distributed among observational studies with no control group, cohort studies with control group, and cross-sectional studies, with a predominance of studies focused on the health axis (n = 39; 86.66%) and with interview method (n = 29; 64.44%). We found 75 records of instruments used, with Likert-type scales, combined scales and free response patterns. In addition, there was a gap in studies on the environmental and socioeconomic axes, especially in an integrated manner. Finally, we considered the importance of new research including essential characteristics of the instruments (consistency, reliability, faithfulness, cross-cultural adaptations) for the possibility of building multidimensional matrices to monitor disasters caused by human action, facilitating decision-making in the formulation of government policies and actions.
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Affiliation(s)
| | | | | | - Mariana Olivia Santana Dos Santos
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil
- Centro Acadêmico do Agreste, Universidade Federal de Pernambuco, Caruaru, Brasil
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Gonçalves JE, Leite ACVM, Lima VMC, de Souza WV, Rego RDCF, dos Santos MOS, Gurgel IGD. Socio-occupational conditions and health of fishers exposed to the oil disaster-crime in Pernambuco, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27:e240050. [PMID: 39417472 PMCID: PMC11481045 DOI: 10.1590/1980-549720240050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/16/2024] [Indexed: 10/19/2024] Open
Abstract
OBJECTIVE To describe the sociodemographic, socio-occupational profile, and effects on the health of artisanal fishers from the state of Pernambuco, Brazil, affected by the oil disaster-crime in Brazil in 2019. METHODS This is a cross-sectional epidemiological study, carried out in 16 municipalities on the coast of Pernambuco, with a sample made up of 1,259 artisanal fishers. A questionnaire containing 14 blocks was used, including socioeconomic issues, exposure to oil, among others. A descriptive analysis was carried out with calculation of simple frequencies and percentages. RESULTS Of those interviewed, 95.1% considered fishing as their main occupation and 97% were carrying out this activity. Among fishers, the most common fishing spot was the mangrove, and wood fire was used in the work process by around 60% of the population. Regarding health issues, 34.4% reported a severe headache or migraine and 28.2% reported burning eyes, within one to three months after the oil spill. CONCLUSION According to the results, working, health, and lifestyle conditions were impacted by the oil disaster-crime. Further research should be carried out to better understand the damage caused by exposure to oil and its effects on the health of fishers. Observing the profile of people who live in artisanal fishing territories in Pernambuco is paramount for public policies and government actions that promote safe and sustainable territories.
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Affiliation(s)
- José Erivaldo Gonçalves
- Fundação Oswaldo Cruz, Aggeu Magalhães Institute, Department of Public Health – Recife (PE), Brazil
| | | | - Verônica Maria Cadena Lima
- Universidade Federal da Bahia, Institute of Mathematics and Statistics, Department of Statistics – Salvador (BA), Brazil
| | - Wayner Vieira de Souza
- Fundação Oswaldo Cruz, Aggeu Magalhães Institute, Department of Public Health – Recife (PE), Brazil
| | | | - Mariana Olívia Santana dos Santos
- Fundação Oswaldo Cruz, Aggeu Magalhães Institute, Department of Public Health – Recife (PE), Brazil
- Universidade Federal do Rio Grande do Norte, Department of Public Health – Natal (RN), Brazil
| | - Idê Gomes Dantas Gurgel
- Fundação Oswaldo Cruz, Aggeu Magalhães Institute, Department of Public Health – Recife (PE), Brazil
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Hwang SH, Lee YJ, Choi YH, Huh DA, Kang MS, Moon KW. Long-term effects of the Hebei Spirit oil spill on the prevalence and incidence of allergic disorders. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:168801. [PMID: 38008335 DOI: 10.1016/j.scitotenv.2023.168801] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
The Hebei Spirit oil spill accident occurred in December 2007, approximately 10 km off the coast of Taean, South Korea, a location notably close to residential areas. Crude oil substances have been detected in various environmental mediums since the accident, yet previous studies have primarily focused on the acute effects of oil exposure due to the short latency period of allergic diseases. Therefore, this study evaluated the long-term effects of oil spill exposure on allergic disorders. Our study included adult residents who had participated in the Health Effects Research on Hebei Spirit Oil Spill (HEROS) study up to five years post-incident, which was a prospective cohort to monitor the health status of Taean residents. We used two indicators to assess oil spill exposure, namely the distance from the initial contaminated coastline to each participant's residence and the number of days participants had engaged in oil clean-up work. Current symptoms such as asthma, allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and multimorbidity were considered allergic disorders. In the baseline survey, the prevalence of asthma, allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and allergic multimorbidity symptoms was associated with both exposure indicators; however, these associations were not observed in the two consecutive surveys. Significant longitudinal associations between oil spill exposure indicators and the four allergic disorders, as well as multimorbidity incidences, were observed during a five-year follow-up period. Our results suggest that oil spill exposure can affect acute and long-term allergic symptoms in residents near the accident site.
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Affiliation(s)
- Se Hyun Hwang
- Department of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yong-Jin Lee
- Regional Environmental Health Center, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si 31151, Republic of Korea; Department of Occupational & Environmental Medicine, Soonchunhyang University, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si 31151, Republic of Korea
| | - Yun-Hee Choi
- Department of Health and Safety Convergence Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea; BK21 FOUR R & E Center for Learning Health System, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Da-An Huh
- Institute of Health Sciences, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea.
| | - Min-Sung Kang
- Institute of Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si 31151, Republic of Korea
| | - Kyong Whan Moon
- Department of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea; BK21 FOUR R & E Center for Learning Health System, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
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Noh SR, Kim JA, Cheong HK, Ha M, Jee YK, Park MS, Choi KH, Kim H, Cho SI, Choi K, Paek D. Exposure to Crude Oil-Related Volatile Organic Compounds Associated with Lung Function Decline in a Longitudinal Panel of Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15599. [PMID: 36497672 PMCID: PMC9737835 DOI: 10.3390/ijerph192315599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/13/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Children in the affected area were exposed to large amounts of volatile organic compounds (VOCs) from the Hebei Spirit oil spill accident. OBJECTIVES We investigated the lung function loss from the exposure to VOCs in a longitudinal panel of 224 children 1, 3, and 5 years after the VOC exposure event. METHODS Atmospheric estimated concentration of total VOCs (TVOCs), benzene, toluene, ethylbenzene, and xylene for 4 days immediately after the accident were calculated for each village (n = 83) using a modeling technique. Forced expiratory volume in 1 s (FEV1) as an indicator of airway status was measured 1, 3, and 5 years after the exposure in 224 children 4~9 years of age at the exposure to the oil spill. Multiple linear regression and linear mixed models were used to evaluate the associations, with adjustment for smoking and second-hand smoke at home. RESULTS Among the TVOCs (geometric mean: 1319.5 mg/m3·4 d), xylene (9.4), toluene (8.5), ethylbenzene (5.2), and benzene (2.0) were dominant in the order of air concentration level. In 224 children, percent predicted FEV1 (ppFEV1), adjusted for smoking and second-hand smoke at home, was 100.7% after 1 year, 96.2% after 3 years, and 94.6% after 5 years, and the loss over the period was significant (p < 0.0001). After 1 and 3 years, TVOCs, xylene, toluene, and ethylbenzene were significantly associated with ppFEV1. After 5 years, the associations were not significant. Throughout the 5 years' repeated measurements in the panel, TVOCs, xylene, toluene, and ethylbenzene were significantly associated with ppFEV1. CONCLUSIONS Exposure to VOCs from the oil spill resulted in lung function loss among children, which remained significant up to 5 years after the exposure.
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Affiliation(s)
- Su Ryeon Noh
- Department of Public Health and Environment, Kosin University, 194 Wachi-ro, Yeongdo-gu, Busan 49104, Republic of Korea
| | - Jung-Ah Kim
- Department of Spatial & Environmental Planning, Chungnam Institute, 73-26 Yeonsuwon-gil, Gongju-si 32589, Republic of Korea
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon-si 16419, Republic of Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, 119 Dandae-ro, Dongnam-gu, Cheonan-si 31116, Republic of Korea
| | - Young-Koo Jee
- Department of Internal Medicine, Dankook University College of Medicine, 119 Dandae-ro, Dongnam-gu, Cheonan-si 31116, Republic of Korea
| | - Myung-Sook Park
- Institute of Environmental Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Kyung-Hwa Choi
- Department of Preventive Medicine, Dankook University College of Medicine, 119 Dandae-ro, Dongnam-gu, Cheonan-si 31116, Republic of Korea
| | - Ho Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
- Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Sung-Il Cho
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
- Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Kyungho Choi
- Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Domyung Paek
- Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
- Division of Cancer Prevention, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si 10408, Republic of Korea
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Rusiecki JA, Denic-Roberts H, Thomas DL, Collen J, Barrett J, Christenbury K, Engel LS. Incidence of chronic respiratory conditions among oil spill responders: Five years of follow-up in the Deepwater Horizon Oil Spill Coast Guard Cohort study. ENVIRONMENTAL RESEARCH 2022; 203:111824. [PMID: 34364859 PMCID: PMC8616774 DOI: 10.1016/j.envres.2021.111824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 05/30/2023]
Abstract
BACKGROUND Over ten years after the Deepwater Horizon (DWH) oil spill, our understanding of long term respiratory health risks associated with oil spill response exposures is limited. We conducted a prospective analysis in a cohort of U.S. Coast Guard personnel with universal military healthcare. METHODS For all active duty cohort members (N = 45,193) in the DWH Oil Spill Coast Guard Cohort Study we obtained medical encounter data from October 01, 2007 to September 30, 2015 (i.e., ~2.5 years pre-spill; ~5.5 years post-spill). We used Cox Proportional Hazards regressions to calculate adjusted hazard ratios (aHR), comparing risks for incident respiratory conditions/symptoms (2010-2015) for: responders vs. non-responders; responders reporting crude oil exposure, any inhalation of crude oil vapors, and being in the vicinity of burning crude oil versus responders without those exposures. We also evaluated self-reported crude oil and oil dispersant exposures, combined. Within-responder comparisons were adjusted for age, sex, and smoking. RESULTS While elevated aHRs for responder/non-responder comparisons were generally weak, within-responder comparisons showed stronger risks with exposure to crude oil. Notably, for responders reporting exposure to crude oil via inhalation, there were elevated risks for allsinusitis (aHR = 1.48; 95%CI, 1.06-2.06), unspecified chronic sinusitis (aHR = 1.55; 95%CI, 1.08-2.22), chronic obstructive pulmonary disease (COPD) and other allied conditions (aHR = 1.43; 95%CI, 1.00-2.06), and dyspnea and respiratory abnormalities (aHR = 1.29; 95%CI, 1.00-1.67); there was a suggestion of elevated risk for diseases classified as asthma and reactive airway diseases (aHR = 1.18; 95%CI, 0.98-1.41), including the specific condition, asthma (aHR = 1.35; 95%CI, 0.80-2.27), the symptom, shortness of breath (aHR = 1.50; 95%CI, 0.89-2.54), and the overall classification of chronic respiratory conditions (aHR = 1.18; 95%CI, 0.98-1.43). Exposure to both crude oil and dispersant was positively associated with elevated risk for shortness of breath (HR = 2.24; 95%CI, 1.09-4.64). CONCLUSIONS Among active duty Coast Guard personnel, oil spill clean-up exposures were associated with moderately increased risk for longer term respiratory conditions.
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Affiliation(s)
- Jennifer A Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Hristina Denic-Roberts
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Oak Ridge Institute for Science and Education, MD, USA
| | - Dana L Thomas
- United States Coast Guard Headquarters, Directorate of Health, Safety, and Work Life, Washington, D.C., USA
| | - Jacob Collen
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - John Barrett
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kate Christenbury
- Social & Scientific Systems, a DLH Corporation Holding Company, Durham, NC, USA
| | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Kim Y, Jeong J, Chatterjee N, Yim UH, Kwon JH, Park MS, Choi J. Activation of the nucleotide excision repair pathway by crude oil exposure: A translational study from model organisms to the Hebei Spirit Oil Spill Cohort. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2019; 254:112997. [PMID: 31454576 DOI: 10.1016/j.envpol.2019.112997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/26/2019] [Accepted: 07/28/2019] [Indexed: 06/10/2023]
Abstract
In order to gain insight into the human health implications of the Hebei Spirit Oil Spill (HSOS), the mechanism of toxicity of the Iranian heavy crude (IHC), the main oil component in the HSOS was investigated in Caenorhabditis elegans and zebrafish. The identified mechanism was translated to humans using blood samples from Taean residents, who experienced HSOS with different levels of exposure to the spill. C. elegans TF RNAi screening with IHC oil revealed the nucleotide excision repair (NER) pathway as being significantly involved by oil exposure. To identify the main toxicity contributors within the chemical mixture of the crude oil, further studies were conducted on C. elegans by exposure to C3-naphthalene, an alkylated polycyclic aromatic hydrocarbon (PAH), which constitutes one of the major components of IHC oil. Increased expression of NER pathway genes was observed following exposure to the IHC oil, C3-naphthalene enriched fraction and C3-naphthalene. As the NER pathway is conserved in fish and humans, the same experiment was conducted in zebrafish, and the data were similar to what was seen in C. elegans. Increased expression of NER pathway genes was observed in human samples from the high exposure group, which suggests the involvement of the NER pathway in IHC oil exposure. Overall, the study suggests that IHC oil may cause bulk damage to DNA and activation of the NER system and Alkylated PAHs are the major contributor to DNA damage. Our study provides an innovative approach for studying translational toxicity testing from model organisms to human health.
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Affiliation(s)
- Youngho Kim
- School of Environmental Engineering, University of Seoul, 163 Siripdaero, Dongdaemun-gu, Seoul 02504, Republic of Korea
| | - Jaeseong Jeong
- School of Environmental Engineering, University of Seoul, 163 Siripdaero, Dongdaemun-gu, Seoul 02504, Republic of Korea
| | - Nivedita Chatterjee
- School of Environmental Engineering, University of Seoul, 163 Siripdaero, Dongdaemun-gu, Seoul 02504, Republic of Korea
| | - Un Hyuk Yim
- Oil & POPs Research Group, Korea Institute of Ocean Science & Technology, Geoje, 53201, Republic of Korea; Ocean Science, Korea University of Science and Technology, Daejeon 34113, Republic of Korea
| | - Jung-Hwan Kwon
- Division of Environmental Science and Ecological Engineering, Korea University, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Myung-Sook Park
- Taean Environmental Health Center, 1952-16 Seohae-ro, Taean-eup, Taean-gun Chungcheongnam-do 32148, Republic of Korea
| | - Jinhee Choi
- School of Environmental Engineering, University of Seoul, 163 Siripdaero, Dongdaemun-gu, Seoul 02504, Republic of Korea.
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Park MS, Choi KH, Lee SH, Hur JI, Noh SR, Jeong WC, Cheong HK, Ha M. Health effect research on Hebei Spirit Oil Spill (HEROS) in Korea: a cohort profile. BMJ Open 2019; 9:e026740. [PMID: 31420384 PMCID: PMC6701659 DOI: 10.1136/bmjopen-2018-026740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The Hebei Spirit Oil Spill occurred on 7 December 2007 and resulted in the spillage of 12 547 kl of crude oil on the coastline near Taean. Historically, this was the largest oil spill in Korean water. The health effect research on Hebei Spirit Oil Spill (HEROS) is a prospective cohort study that aimed to evaluate the long-term health effects of oil spill exposure on residents in the affected community. PARTICIPANTS The Taean Environmental Health Center initially enrolled adults, adolescents and children living in Taean in 2009 and 2010. Follow-up surveys of participating adults and children were conducted every other year. By 2017, a total of 9585 adults and 2216 children and adolescents were enrolled. Of these, 294 adults and 102 children and adolescents were included in all subsequent surveys. FINDINGS TO DATE Children who lived closer to the oil spill site exhibited a lower level of pulmonary function and higher prevalence of allergic rhinitis, than those who lived further away from the oil spill site. Adults who lived in a highly exposed area or participated in clean-up work had higher urine levels of the oxidative stress biomarkers malondialdehyde and 8-hydroxydeoxyguanosine. Changes in haematological parameters during a 3-year period were observed in residents of both sexes in highly exposed areas, in addition to increases in respiratory diseases and mental health problems in female and male participants, respectively. FUTURE PLANS The findings of this study will better enable policy makers to develop environmental health policies intended to prevent adverse health effects in residents of communities affected by oil spills, as well as policies regarding the management of future oil accidents. The HEROS study will continue to follow participants in future and will be updated to enable an investigation of long-term health effects.
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Affiliation(s)
- Myung Sook Park
- Environmental Health Research Team, Taean Environmental Health Center, Taean, Chungnam, Republic of Korea
| | - Kyung-Hwa Choi
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Seung-Hwa Lee
- Environmental Health Research Team, Taean Environmental Health Center, Taean, Chungnam, Republic of Korea
| | - Jong-Il Hur
- Environmental Health Research Team, Taean Environmental Health Center, Taean, Chungnam, Republic of Korea
| | - Su Ryeon Noh
- Department of Public Health and Environment, Kosin University, Busan, Republic of Korea
| | - Woo-Chul Jeong
- Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Gyeonggi, Republic of Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
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Noh SR, Kim JA, Cheong HK, Ha M, Jee YK, Park MS, Choi KH, Kim H, Cho SI, Choi K, Paek D. Hebei Spirit oil spill and its long-term effect on children's asthma symptoms. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2019; 248:286-294. [PMID: 30798030 DOI: 10.1016/j.envpol.2019.02.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
On December 7th, 2007, an estimated 12,547 kL of crude oil was spilled from the collision of Hebei Spirit near residential area. Our previous study demonstrated worsening of children's asthma symptoms one year after the accident. This study investigated long-term effect of the oil spill on children's asthma symptoms up to five years after the accident. All elementary and middle school students in the exposure area were surveyed on one year (n = 655), three years (664), and five years (611) after the accident. Oil spill exposure was estimated using two estimates including distance from the oil spill (A) and modeled estimates of benzene, toluene, ethylbenzene, and xylene (BTEX) compounds (B), and each was dichotomously categorized (A: high-exposure vs low-exposure; B: ≥20 mg/m3 vs < 20 mg/m3). Asthma symptoms were evaluated using a standard questionnaire. Oil spill exposure estimates were associated with asthma symptoms on one year (odds ratio (95% confidence interval) A: 1.9 (1.1-3.1); B: 1.6 (0.9-2.7)), three years (A: 1.9 (1.1-3.2); B: 1.3 (0.8-2.2)), and five years (A: 1.2 (0.7-1.9); B: 1.8 (1.1-2.8)) after the oil spill. Significant longitudinal relationship between oil spill exposure estimates and asthma symptoms was also observed (A: 1.6 (1.2-2.2); B: 1.6 (1.1-2.1)). Overall, the effect of oil spill exposure estimates was more severe on younger children. Oil spill exposure estimates were associated with asthma symptoms in children up to five years after the oil spill.
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Affiliation(s)
- Su Ryeon Noh
- Department of Public Health and Environment, Kosin University, Pusan, Republic of Korea
| | - Jung-Ah Kim
- Department of Environment and Ecology Research, ChungNam Institute, Gongju, Republic of Korea
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea.
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Young-Koo Jee
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | | | - Kyung-Hwa Choi
- Taean Environmental Health Center, Taean, Republic of Korea
| | - Ho Kim
- Department of Public Health, Seoul National University Graduate School of Public Health, Seoul, Republic of Korea
| | - Sung-Il Cho
- Department of Public Health, Seoul National University Graduate School of Public Health, Seoul, Republic of Korea
| | - Kyungho Choi
- Department of Environmental Health, Seoul National University Graduate School of Public Health, Seoul, Republic of Korea
| | - Domyung Paek
- Department of Environmental Health, Seoul National University Graduate School of Public Health, Seoul, Republic of Korea
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Post-Deepwater Horizon Oil Spill Exposure Patterns Among Children in Mobile County, Alabama. J Occup Environ Med 2018; 59:993-999. [PMID: 28857935 DOI: 10.1097/jom.0000000000001112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to characterize environmental exposure from Deepwater Horizon oil spill among pre-K to fourth-grade children from six schools in Mobile County, Alabama. METHODS A mail-in survey administered 11 months post-oil spill to children's parents/caregivers elicited information on exposure-related activities. Descriptive and multivariable analyses were performed. RESULTS Overall, 180 children (coastal schools, 90; inland schools, 90) completed the survey. During the post-oil spill period, children in coastal schools were less likely to reduce their exposure-related activities, including fishing; eating and selling caught fish; visiting beaches; and parental participation in cleanup activities, than children in inland schools. Particularly, fishing and eating caught fish were significantly associated with the coastal group (odds ratio = 2.28; 95% confidence interval = 1.54 to 3.36). CONCLUSION Proximity to the shoreline may serve as an indicator for potential exposure in oil spills among vulnerable populations including children.
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D'Andrea MA, Reddy GK. The Development of Long-Term Adverse Health Effects in Oil Spill Cleanup Workers of the Deepwater Horizon Offshore Drilling Rig Disaster. Front Public Health 2018; 6:117. [PMID: 29755965 PMCID: PMC5932154 DOI: 10.3389/fpubh.2018.00117] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/05/2018] [Indexed: 12/16/2022] Open
Abstract
Background The purpose of this study was to assess the long-term adverse health effects of the 2010 Deepwater Horizon Gulf oil spill exposure in workers who participated in its cleanup work. Methods Medical charts of both the oil spill exposed and unexposed subjects were reviewed. The changes in the white blood cells, platelets, hemoglobin, hematocrit, blood urea nitrogen, creatinine, alkaline phosphatase (ALP), aspartate amino transferase (AST), alanine amino transferase (ALT) levels, as well as their pulmonary and cardiac functions were evaluated. Results Medical records from 88 subjects (oil spill cleanup workers, n = 44 and unexposed, n = 44) were reviewed during initial and 7 years follow up visits after the disaster occurred. Compared with the unexposed subjects, oil spill exposed subjects had significantly reduced platelet counts (×103/µL) at their initial (254.1 ± 46.7 versus 289.7 ± 63.7, P = 0.000) and follow-up (242.9 ± 55.6 versus 278.4 ± 67.6, P = 0.000) visits compared with the unexposed subjects (254.6 ± 51.9 versus 289.7 ± 63.7, P = 0.008). The hemoglobin and hematocrit levels were increased significantly both at their initial and follow-up visits in the oil spill exposed subjects compared to the unexposed subjects. Similarly, the oil spill exposed subjects had significantly increased ALP, AST, and ALT levels at their initial and follow-up visits compared with those of the unexposed subjects. Illness symptoms that were reported during their initial visit still persisted at their 7-year follow-up visit. Notably, at their 7-year follow-up visit, most of the oil spill exposed subjects had also developed chronic rhinosinusitis and reactive airway dysfunction syndrome as new symptoms that were not reported during their initial visit. Additionally, more abnormalities in pulmonary and cardiac functions were also seen in the oil spill exposed subjects. Conclusion This long-term follow-up study demonstrates that those people involved in the oil spill cleanup operations experiences persistent alterations or worsening of their hematological, hepatic, pulmonary, and cardiac functions. In addition, these subjects experienced prolonged or worsening illness symptoms even 7 years after their exposure to the oil spill.
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Affiliation(s)
- Mark A D'Andrea
- University Cancer and Diagnostic Centers, Houston, TX, United States
| | - G Kesava Reddy
- University Cancer and Diagnostic Centers, Houston, TX, United States
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Ramirez MI, Arevalo AP, Sotomayor S, Bailon-Moscoso N. Contamination by oil crude extraction - Refinement and their effects on human health. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2017; 231:415-425. [PMID: 28826075 DOI: 10.1016/j.envpol.2017.08.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 08/01/2017] [Accepted: 08/02/2017] [Indexed: 06/07/2023]
Abstract
The harmful effects of oil on various species of flora and fauna have been studied extensively; however, few studies have studied the effects of oil exposure on human health. The objective of this research was to collect information on the acute health effects and serious psychological symptoms of the possible consequences of such exposure to crude oil. Some studies focused on the composition of different chemicals used in the extraction process, and wastes generated proved to be highly harmful to human health. Thus, studies have shown that individuals who live near oil fields or wells - or who take part in activities of cleaning oil spills - have presented health conditions, such as irritation to the skin, eyes, mucous membranes, kidney damage, liver, reproductive, among others. In Ecuador, this reality is not different from other countries, and some studies have shown increased diseases related with oil crude and oil spills, like skin irritation, throat, liver, lung, infertility, and abortions, and it has been linked to childhood leukemia. Other studies suggest a direct relationship between DNA damage because of oil resulting in a genetic instability of the main enzymes of cellular metabolism as well as a relationship with some cancers, such as leukemia.
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Affiliation(s)
- Maria Isabel Ramirez
- Departamento de Ciencias de La Salud, Universidad Técnica Particular de Loja, San Cayetano Alto, Loja, 11-01-608, Ecuador.
| | - Ana Paulina Arevalo
- Departamento de Ciencias de La Salud, Universidad Técnica Particular de Loja, San Cayetano Alto, Loja, 11-01-608, Ecuador.
| | - Santiago Sotomayor
- Departamento de Ciencias de La Salud, Universidad Técnica Particular de Loja, San Cayetano Alto, Loja, 11-01-608, Ecuador.
| | - Natalia Bailon-Moscoso
- Departamento de Ciencias de La Salud, Universidad Técnica Particular de Loja, San Cayetano Alto, Loja, 11-01-608, Ecuador.
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Jung D, Kim JA, Park MS, Yim UH, Choi K. Human health and ecological assessment programs for Hebei Spirit oil spill accident of 2007: Status, lessons, and future challenges. CHEMOSPHERE 2017; 173:180-189. [PMID: 28110007 DOI: 10.1016/j.chemosphere.2016.12.153] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/31/2016] [Accepted: 12/31/2016] [Indexed: 05/06/2023]
Abstract
Hebei Spirit oil spill (HSOS) of December 2007 is one of the worst oil spill accidents that occurred in Yellow Sea. The affected coastline along the west coast of Korean Peninsula hosts one of the largest tidal flats worldwide, and is home to tens of thousands of human residents. Based on nation-wide concerns on ecosystem damages and adverse human health effects, two separate surveillance programs on ecosystem and human health were initiated: a 10-year follow-up program by Ministry of Oceans and Fisheries to assess ecological impacts of the oil spill, and an exposure and health effect assessment program by Ministry of Environment for the residents of Taean and its vicinity. For the past eight years, extensive monitoring and surveillance data on ecosystem and humans have been accumulated through these programs. But these studies have been conducted mostly independently, and collaborations were seldom made between two programs. The lack of communication resulted in gaps and overlaps between the programs which led to loss of critical information and efficiency. As oil spill can affect both humans and ecosystem through various pathways, collaboration and communication between human and ecosystem health surveillance programs are necessary, and will synergize the success of both programs. Such concerted efforts will provide better platform for understanding the status of impact, and for developing approaches to address human and ecosystem health challenges that may be faced following environmental disasters like HSOS.
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Affiliation(s)
- Dawoon Jung
- School of Public Health, Seoul National University, Seoul 08826, Republic of Korea; Institute of Health and Environment, School of Public Health, Seoul National University, Seoul 08826, Republic of Korea; Korea Environment Institute, Sejong 30147, Republic of Korea
| | - Jung-Ah Kim
- School of Public Health, Seoul National University, Seoul 08826, Republic of Korea; Taean Environmental Health Center, Taean 32148, Republic of Korea
| | - Myung-Sook Park
- Taean Environmental Health Center, Taean 32148, Republic of Korea
| | - Un Hyuk Yim
- Oil and POPs Research Group, Korea Institute of Ocean Science and Technology, Geoje 53201, Republic of Korea
| | - Kyungho Choi
- School of Public Health, Seoul National University, Seoul 08826, Republic of Korea; Institute of Health and Environment, School of Public Health, Seoul National University, Seoul 08826, Republic of Korea.
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Sandifer PA, Knapp LC, Collier TK, Jones AL, Juster R, Kelble CR, Kwok RK, Miglarese JV, Palinkas LA, Porter DE, Scott GI, Smith LM, Sullivan WC, Sutton‐Grier AE. A Conceptual Model to Assess Stress-Associated Health Effects of Multiple Ecosystem Services Degraded by Disaster Events in the Gulf of Mexico and Elsewhere. GEOHEALTH 2017; 1:17-36. [PMID: 30596189 PMCID: PMC6309401 DOI: 10.1002/2016gh000038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 05/28/2023]
Abstract
Few conceptual frameworks attempt to connect disaster-associated environmental injuries to impacts on ecosystem services (the benefits humans derive from nature) and thence to both psychological and physiological human health effects. To our knowledge, this study is one of the first, if not the first, to develop a detailed conceptual model of how degraded ecosystem services affect cumulative stress impacts on the health of individual humans and communities. Our comprehensive Disaster-Pressure State-Ecosystem Services-Response-Health (DPSERH) model demonstrates that oil spills, hurricanes, and other disasters can change key ecosystem components resulting in reductions in individual and multiple ecosystem services that support people's livelihoods, health, and way of life. Further, the model elucidates how damage to ecosystem services produces acute, chronic, and cumulative stress in humans which increases risk of adverse psychological and physiological health outcomes. While developed and initially applied within the context of the Gulf of Mexico, it should work equally well in other geographies and for many disasters that cause impairment of ecosystem services. Use of this new tool will improve planning for responses to future disasters and help society more fully account for the costs and benefits of potential management responses. The model also can be used to help direct investments in improving response capabilities of the public health community, biomedical researchers, and environmental scientists. Finally, the model illustrates why the broad range of potential human health effects of disasters should receive equal attention to that accorded environmental damages in assessing restoration and recovery costs and time frames.
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Affiliation(s)
- Paul A. Sandifer
- School of Sciences and MathematicsCollege of CharlestonCharlestonSouth CarolinaUSA
| | - Landon C. Knapp
- Master's in Environmental StudiesCollege of CharlestonCharlestonSouth CarolinaUSA
| | | | - Amanda L. Jones
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | | | | | - Richard K. Kwok
- Epidemiology BranchNational Institute of Environmental Health ScienceResearch Triangle ParkNorth CarolinaUSA
| | - John V. Miglarese
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Lawrence A. Palinkas
- Department of Children, Youth and FamiliesUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Dwayne E. Porter
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Geoffrey I. Scott
- Department of Environmental Health SciencesUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Lisa M. Smith
- Office of Research and DevelopmentU.S. Environmental Protection AgencyGulf BreezeFloridaUSA
| | - William C. Sullivan
- Department of Landscape ArchitectureUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
| | - Ariana E. Sutton‐Grier
- Earth System Science Interdisciplinary CenterUniversity of Maryland and National Oceanic and Atmospheric AdministrationSilver SpringMarylandUSA
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Smith CR, Rowles TK, Hart LB, Townsend FI, Wells RS, Zolman ES, Balmer BC, Quigley B, Ivancˇic΄ M, McKercher W, Tumlin MC, Mullin KD, Adams JD, Wu Q, McFee W, Collier TK, Schwacke LH. Slow recovery of Barataria Bay dolphin health following the Deepwater Horizon oil spill (2013-2014), with evidence of persistent lung disease and impaired stress response. ENDANGER SPECIES RES 2017. [DOI: 10.3354/esr00778] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Laffon B, Pásaro E, Valdiglesias V. Effects of exposure to oil spills on human health: Updated review. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2016; 19:105-28. [PMID: 27221976 DOI: 10.1080/10937404.2016.1168730] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Oil spills may involve health risks for people participating in the cleanup operations and coastal inhabitants, given the toxicological properties of the oil components. In spite of this, only after a few major oil spills (crude oil or fuel oil no. 6) have studies on effects of exposure to diverse aspects of human health been performed. Previously, Aguilera et al. (2010) examined all documents published to that date dealing with any type of human health outcome in populations exposed to oil spills. The aim of the present review was to compile all new information available and determine whether evidence reported supports the existence of an association between exposure and adverse human health risks. Studies were classified in three groups according to type of health outcome addressed: (i) effects on mental health, (ii) physical/physiological effects, and (iii) genotoxic, immunotoxic, and endocrine toxicity. New studies published on oil-spill-exposed populations-coastal residents in the vicinity of the spills or participants in cleanup operations-provide additional support to previous evidence on adverse health effects related to exposure regarding different parameters in all three categories considered. Some of the observed effects even indicated that several symptoms may persist for some years after exposure. Hence, (1) health protection in these individuals should be a matter of concern; and (2) health risk assessment needs to be carried out not only at the time of exposure but also for prolong periods following exposure, to enable early detection of any potential exposure-related harmful effects.
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Affiliation(s)
- Blanca Laffon
- a DICOMOSA Group, Department of Psychology, Area of Psychobiology , Universidade da Coruña , Coruña , Spain
| | - Eduardo Pásaro
- a DICOMOSA Group, Department of Psychology, Area of Psychobiology , Universidade da Coruña , Coruña , Spain
| | - Vanessa Valdiglesias
- a DICOMOSA Group, Department of Psychology, Area of Psychobiology , Universidade da Coruña , Coruña , Spain
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Meo SA, Alrashed AH, Almana AA, Altheiban YI, Aldosari MS, Almudarra NF, Alwabel SA. Lung function and fractional exhaled nitric oxide among petroleum refinery workers. J Occup Med Toxicol 2015; 10:37. [PMID: 26435731 PMCID: PMC4591067 DOI: 10.1186/s12995-015-0080-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/21/2015] [Indexed: 12/03/2022] Open
Abstract
Background Occupational and environmental exposure to petroleum refinery products poses a great threat to human health. This study aimed to assess the lung function and Fractional Exhaled Nitric Oxide (FeNO) among petroleum refinery workers. Methods In this cross-sectional study, 112 participants (56 petroleum refinery workers with mean age 35.20 ± 1.62 years, and 56 age, weight, height, ethnicity and socioeconomically matched control subjects with mean age 30.02 ± 1.76 years) were recruited. A comprehensive clinical history and examination was conducted to decide whether to include in the study or not. Ventilatory lung function test parameters were recorded by using a Spirometer and Fractional Exhaled Nitric Oxide (FeNO) was measured by Niox Mino. Results A significant decline in lung function parameters FEV1 (p = 0.0001), FEV1/FVC Ratio (p = 0.01), PEF (p = 0.0001), FEF 25 % (p = 0.0001), FEF-50 % (p = 0.012) was observed among oil refinery workers compared to their matched controls. However, there was no difference in the mean values of FeNO between the groups. Conclusion Subjects working in the petroleum refinery have significantly impaired lung functions. However, there was no change in the values of FENO between the groups. The lung function impairment pattern provide evidence in the favor of an obstructive lung disease.
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Affiliation(s)
- Sultan Ayoub Meo
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia ; Clinical Physiology, Department of Physiology (29), College of Medicine, King Khalid University Hospital, King Saud University, P.O. Box 2925, Riyadh, 11461 Saudi Arabia
| | | | | | - Yazeed Ibrahim Altheiban
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Saud Aldosari
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nawaf Faleh Almudarra
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sulaiman Ali Alwabel
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Jaligama S, Chen Z, Saravia J, Yadav N, Lomnicki SM, Dugas TR, Cormier SA. Exposure to Deepwater Horizon Crude Oil Burnoff Particulate Matter Induces Pulmonary Inflammation and Alters Adaptive Immune Response. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2015; 49:8769-8776. [PMID: 26115348 PMCID: PMC4526136 DOI: 10.1021/acs.est.5b01439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The ″in situ burning" of trapped crude oil on the surface of Gulf waters during the 2010 Deepwater Horizon (DWH) oil spill released numerous pollutants, including combustion-generated particulate matter (PM). Limited information is available on the respiratory impact of inhaled in situ burned oil sail particulate matter (OSPM). Here we utilized PM collected from in situ burn plumes of the DWH oil spill to study the acute effects of exposure to OSPM on pulmonary health. OSPM caused dose-and time-dependent cytotoxicity and generated reactive oxygen species and superoxide radicals in vitro. Additionally, mice exposed to OSPM exhibited significant decreases in body weight gain, systemic oxidative stress in the form of increased serum 8-isoprostane (8-IP) levels, and airway inflammation in the form of increased macrophages and eosinophils in bronchoalveolar lavage fluid. Further, in a mouse model of allergic asthma, OSPM caused increased T helper 2 cells (Th2), peribronchiolar inflammation, and increased airway mucus production. These findings demonstrate that acute exposure to OSPM results in pulmonary inflammation and alteration of innate/adaptive immune responses in mice and highlight potential respiratory effects associated with cleaning up an oil spill.
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Affiliation(s)
- Sridhar Jaligama
- Department of Pediatrics, University of Tennessee Health Science Center, 50 North Dunlap Street, Memphis, Tennessee 38103, United States
- Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee 38103, United States
| | - Zaili Chen
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, United States
| | - Jordy Saravia
- Department of Pediatrics, University of Tennessee Health Science Center, 50 North Dunlap Street, Memphis, Tennessee 38103, United States
- Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee 38103, United States
| | - Nikki Yadav
- Department of Pediatrics, University of Tennessee Health Science Center, 50 North Dunlap Street, Memphis, Tennessee 38103, United States
- Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee 38103, United States
| | - Slawomir M. Lomnicki
- Department of Environmental Sciences, Louisiana State University, Baton Rouge, Louisiana 70803, United States
| | - Tammy R. Dugas
- Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana 70803
| | - Stephania A. Cormier
- Department of Pediatrics, University of Tennessee Health Science Center, 50 North Dunlap Street, Memphis, Tennessee 38103, United States
- Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee 38103, United States
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D'Andrea MA, Reddy GK. The reply. Am J Med 2014; 127:e27. [PMID: 25205270 DOI: 10.1016/j.amjmed.2014.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 11/19/2022]
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