Skin Exposure to Aliphatic Polyisocyanates in the Auto Body Repair and Refinishing Industry: A Qualitative Assessment

Objectives: Although respiratory exposures have been the primary concern with isocyanates, skin exposure also can occur and may contribute to sensitization and asthma. Methodologies to assess isocyanate skin exposure in the workplace are limited and skin exposure data scarce. The goals of this study...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:The Annals of occupational hygiene 2007-07, Vol.51 (5), p.429-439
Hauptverfasser: LIU, YOUCHENG, BELLO, DHIMITER, SPARER, JUDY A., STOWE, MEREDITH H., GORE, REBECCA J., WOSKIE, SUSAN R., CULLEN, MARK R., REDLICH, CARRIE A.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 439
container_issue 5
container_start_page 429
container_title The Annals of occupational hygiene
container_volume 51
creator LIU, YOUCHENG
BELLO, DHIMITER
SPARER, JUDY A.
STOWE, MEREDITH H.
GORE, REBECCA J.
WOSKIE, SUSAN R.
CULLEN, MARK R.
REDLICH, CARRIE A.
description Objectives: Although respiratory exposures have been the primary concern with isocyanates, skin exposure also can occur and may contribute to sensitization and asthma. Methodologies to assess isocyanate skin exposure in the workplace are limited and skin exposure data scarce. The goals of this study were (i) to evaluate and validate the isocyanate colorimetric indicators against a quantitative assay, (ii) to evaluate the extent of isocyanate surface contamination and skin exposure among auto body shop workers and (iii) to evaluate isocyanate skin exposure determinants. Methods: The colorimetric indicators were compared with a high-performance liquid chromatography (HPLC) quantitative assay based on the National Institute for Occupational Safety and Health Method 5525 using paired laboratory sampling. The colorimetric indicators were then used to assess surface contamination and skin exposure to aliphatic isocyanates in 35 auto body shops and 124 workers as part of an epidemiologic study. The positive sample rate was calculated for various surfaces, body parts and tasks. The color intensity of the colorimetric indicators was rated on a scale 0 (yellow color) to 5 (deep red). Side-by-side comparisons of the qualitative method with the quantitative HPLC assay were also performed in the field using paired samples. Results: Laboratory and field evaluation validated use of the colorimetric indicators. The rate of positive surface samples for isocyanates was 46% (n = 145/313). Thirty-four percent (73/216) of samples were positive for unprotected skin and 20% (n = 22/111) for skin under latex gloves. The highest positive rate observed on skin samples was obtained after paint mixing and spraying tasks. The colorimetric indicators were highly specific for isocyanates, but false negatives occurred when compared with the more sensitive HPLC quantitative assay. The presence of surface contamination and the performance of paint-related tasks were the major determinants of isocyanate skin exposure. Conclusions: This study documents extensive surface contamination and skin exposure, including under gloves, to aliphatic polyisocyanates during painting and paint mixing tasks in auto body shop workers. Contaminated surfaces and aerosol deposition during spray painting may both contribute to skin exposure. The colorimetric indicator is a quick, practical and low-cost, but not highly sensitive, industrial hygiene tool to detect isocyanate surface contamination and skin exposur
doi_str_mv 10.1093/annhyg/mem021
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_20298075</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/annhyg/mem021</oup_id><sourcerecordid>20298075</sourcerecordid><originalsourceid>FETCH-LOGICAL-c462t-9d23c7572587671377e9f3a6c18b0da09b8879c902a7b002559fccff44c2e9033</originalsourceid><addsrcrecordid>eNqF0N1P1TAYBvDGSOSIXnpreiPxZtCPbV29OyB4SEhQ0Ui4aXq6jlPZutm3I-y_t2YLXHrVt8mvz9s8CL2j5IgSyY-197vp7rizHWH0BVrRXBQZpyV7iVaEEJ7llaj20WuA3-mac0lfoX0qSsIYESs0Xt87j88ehx7GYHHs8bp1w05HZ_DXvp0c9GbSXkcLOMG4s3g9JnXS1xP-bgftAta-TmPjvIOd83f4wtcjxDB9wmv8bdStiynuIT0EsACd9fEN2mt0C_btch6gn-dnP0432eXVl4vT9WVm8pLFTNaMG1EIVlSiFJQLYWXDdWlotSW1JnJbVUIaSZgWW0JYUcjGmKbJc8OsJJwfoMM5dwj9n9FCVJ0DY9tWe9uPoBhhsiKiSDCboQk9QLCNGoLrdJgUJepfz2ruWc09J_9-CR63na2f9VJsAh8WoMHotgnaGwfPTpIi53mV3MfZ9ePw353LHx1E-_iEdbhXpeCiUJubWyVPPt_8uha3asP_Aj-vpcU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>20298075</pqid></control><display><type>article</type><title>Skin Exposure to Aliphatic Polyisocyanates in the Auto Body Repair and Refinishing Industry: A Qualitative Assessment</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>LIU, YOUCHENG ; BELLO, DHIMITER ; SPARER, JUDY A. ; STOWE, MEREDITH H. ; GORE, REBECCA J. ; WOSKIE, SUSAN R. ; CULLEN, MARK R. ; REDLICH, CARRIE A.</creator><creatorcontrib>LIU, YOUCHENG ; BELLO, DHIMITER ; SPARER, JUDY A. ; STOWE, MEREDITH H. ; GORE, REBECCA J. ; WOSKIE, SUSAN R. ; CULLEN, MARK R. ; REDLICH, CARRIE A.</creatorcontrib><description>Objectives: Although respiratory exposures have been the primary concern with isocyanates, skin exposure also can occur and may contribute to sensitization and asthma. Methodologies to assess isocyanate skin exposure in the workplace are limited and skin exposure data scarce. The goals of this study were (i) to evaluate and validate the isocyanate colorimetric indicators against a quantitative assay, (ii) to evaluate the extent of isocyanate surface contamination and skin exposure among auto body shop workers and (iii) to evaluate isocyanate skin exposure determinants. Methods: The colorimetric indicators were compared with a high-performance liquid chromatography (HPLC) quantitative assay based on the National Institute for Occupational Safety and Health Method 5525 using paired laboratory sampling. The colorimetric indicators were then used to assess surface contamination and skin exposure to aliphatic isocyanates in 35 auto body shops and 124 workers as part of an epidemiologic study. The positive sample rate was calculated for various surfaces, body parts and tasks. The color intensity of the colorimetric indicators was rated on a scale 0 (yellow color) to 5 (deep red). Side-by-side comparisons of the qualitative method with the quantitative HPLC assay were also performed in the field using paired samples. Results: Laboratory and field evaluation validated use of the colorimetric indicators. The rate of positive surface samples for isocyanates was 46% (n = 145/313). Thirty-four percent (73/216) of samples were positive for unprotected skin and 20% (n = 22/111) for skin under latex gloves. The highest positive rate observed on skin samples was obtained after paint mixing and spraying tasks. The colorimetric indicators were highly specific for isocyanates, but false negatives occurred when compared with the more sensitive HPLC quantitative assay. The presence of surface contamination and the performance of paint-related tasks were the major determinants of isocyanate skin exposure. Conclusions: This study documents extensive surface contamination and skin exposure, including under gloves, to aliphatic polyisocyanates during painting and paint mixing tasks in auto body shop workers. Contaminated surfaces and aerosol deposition during spray painting may both contribute to skin exposure. The colorimetric indicator is a quick, practical and low-cost, but not highly sensitive, industrial hygiene tool to detect isocyanate surface contamination and skin exposures following the use of isocyanate-containing products.</description><identifier>ISSN: 0003-4878</identifier><identifier>EISSN: 1475-3162</identifier><identifier>DOI: 10.1093/annhyg/mem021</identifier><identifier>PMID: 17602207</identifier><identifier>CODEN: AOHYA3</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Air Pollutants, Occupational - toxicity ; auto body refinishing ; Automobiles ; Biological and medical sciences ; Chemical and industrial products toxicology. Toxic occupational diseases ; Chromatography, High Pressure Liquid - methods ; Colorimetry - methods ; exposure assessment ; Hazardous Substances - toxicity ; hexamethylene diisocyanate (HDI) ; Humans ; isocyanates ; Isocyanates - toxicity ; Medical sciences ; Occupational Exposure - adverse effects ; Paint - toxicity ; Polyurethanes - toxicity ; PPE ; Skin Absorption ; skin exposure ; surface contamination ; Survey of Painters and Repairers of Autobodies by Yale (SPRAY) ; Toxicology ; Various organic compounds</subject><ispartof>The Annals of occupational hygiene, 2007-07, Vol.51 (5), p.429-439</ispartof><rights>The Author 2007. Published by Oxford University Press on behalf of the British Occupational Hygiene Society 2007</rights><rights>2007 INIST-CNRS</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-9d23c7572587671377e9f3a6c18b0da09b8879c902a7b002559fccff44c2e9033</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=19054348$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17602207$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>LIU, YOUCHENG</creatorcontrib><creatorcontrib>BELLO, DHIMITER</creatorcontrib><creatorcontrib>SPARER, JUDY A.</creatorcontrib><creatorcontrib>STOWE, MEREDITH H.</creatorcontrib><creatorcontrib>GORE, REBECCA J.</creatorcontrib><creatorcontrib>WOSKIE, SUSAN R.</creatorcontrib><creatorcontrib>CULLEN, MARK R.</creatorcontrib><creatorcontrib>REDLICH, CARRIE A.</creatorcontrib><title>Skin Exposure to Aliphatic Polyisocyanates in the Auto Body Repair and Refinishing Industry: A Qualitative Assessment</title><title>The Annals of occupational hygiene</title><addtitle>Ann Occup Hyg</addtitle><description>Objectives: Although respiratory exposures have been the primary concern with isocyanates, skin exposure also can occur and may contribute to sensitization and asthma. Methodologies to assess isocyanate skin exposure in the workplace are limited and skin exposure data scarce. The goals of this study were (i) to evaluate and validate the isocyanate colorimetric indicators against a quantitative assay, (ii) to evaluate the extent of isocyanate surface contamination and skin exposure among auto body shop workers and (iii) to evaluate isocyanate skin exposure determinants. Methods: The colorimetric indicators were compared with a high-performance liquid chromatography (HPLC) quantitative assay based on the National Institute for Occupational Safety and Health Method 5525 using paired laboratory sampling. The colorimetric indicators were then used to assess surface contamination and skin exposure to aliphatic isocyanates in 35 auto body shops and 124 workers as part of an epidemiologic study. The positive sample rate was calculated for various surfaces, body parts and tasks. The color intensity of the colorimetric indicators was rated on a scale 0 (yellow color) to 5 (deep red). Side-by-side comparisons of the qualitative method with the quantitative HPLC assay were also performed in the field using paired samples. Results: Laboratory and field evaluation validated use of the colorimetric indicators. The rate of positive surface samples for isocyanates was 46% (n = 145/313). Thirty-four percent (73/216) of samples were positive for unprotected skin and 20% (n = 22/111) for skin under latex gloves. The highest positive rate observed on skin samples was obtained after paint mixing and spraying tasks. The colorimetric indicators were highly specific for isocyanates, but false negatives occurred when compared with the more sensitive HPLC quantitative assay. The presence of surface contamination and the performance of paint-related tasks were the major determinants of isocyanate skin exposure. Conclusions: This study documents extensive surface contamination and skin exposure, including under gloves, to aliphatic polyisocyanates during painting and paint mixing tasks in auto body shop workers. Contaminated surfaces and aerosol deposition during spray painting may both contribute to skin exposure. The colorimetric indicator is a quick, practical and low-cost, but not highly sensitive, industrial hygiene tool to detect isocyanate surface contamination and skin exposures following the use of isocyanate-containing products.</description><subject>Air Pollutants, Occupational - toxicity</subject><subject>auto body refinishing</subject><subject>Automobiles</subject><subject>Biological and medical sciences</subject><subject>Chemical and industrial products toxicology. Toxic occupational diseases</subject><subject>Chromatography, High Pressure Liquid - methods</subject><subject>Colorimetry - methods</subject><subject>exposure assessment</subject><subject>Hazardous Substances - toxicity</subject><subject>hexamethylene diisocyanate (HDI)</subject><subject>Humans</subject><subject>isocyanates</subject><subject>Isocyanates - toxicity</subject><subject>Medical sciences</subject><subject>Occupational Exposure - adverse effects</subject><subject>Paint - toxicity</subject><subject>Polyurethanes - toxicity</subject><subject>PPE</subject><subject>Skin Absorption</subject><subject>skin exposure</subject><subject>surface contamination</subject><subject>Survey of Painters and Repairers of Autobodies by Yale (SPRAY)</subject><subject>Toxicology</subject><subject>Various organic compounds</subject><issn>0003-4878</issn><issn>1475-3162</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0N1P1TAYBvDGSOSIXnpreiPxZtCPbV29OyB4SEhQ0Ui4aXq6jlPZutm3I-y_t2YLXHrVt8mvz9s8CL2j5IgSyY-197vp7rizHWH0BVrRXBQZpyV7iVaEEJ7llaj20WuA3-mac0lfoX0qSsIYESs0Xt87j88ehx7GYHHs8bp1w05HZ_DXvp0c9GbSXkcLOMG4s3g9JnXS1xP-bgftAta-TmPjvIOd83f4wtcjxDB9wmv8bdStiynuIT0EsACd9fEN2mt0C_btch6gn-dnP0432eXVl4vT9WVm8pLFTNaMG1EIVlSiFJQLYWXDdWlotSW1JnJbVUIaSZgWW0JYUcjGmKbJc8OsJJwfoMM5dwj9n9FCVJ0DY9tWe9uPoBhhsiKiSDCboQk9QLCNGoLrdJgUJepfz2ruWc09J_9-CR63na2f9VJsAh8WoMHotgnaGwfPTpIi53mV3MfZ9ePw353LHx1E-_iEdbhXpeCiUJubWyVPPt_8uha3asP_Aj-vpcU</recordid><startdate>20070701</startdate><enddate>20070701</enddate><creator>LIU, YOUCHENG</creator><creator>BELLO, DHIMITER</creator><creator>SPARER, JUDY A.</creator><creator>STOWE, MEREDITH H.</creator><creator>GORE, REBECCA J.</creator><creator>WOSKIE, SUSAN R.</creator><creator>CULLEN, MARK R.</creator><creator>REDLICH, CARRIE A.</creator><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7U2</scope><scope>7U7</scope><scope>C1K</scope></search><sort><creationdate>20070701</creationdate><title>Skin Exposure to Aliphatic Polyisocyanates in the Auto Body Repair and Refinishing Industry: A Qualitative Assessment</title><author>LIU, YOUCHENG ; BELLO, DHIMITER ; SPARER, JUDY A. ; STOWE, MEREDITH H. ; GORE, REBECCA J. ; WOSKIE, SUSAN R. ; CULLEN, MARK R. ; REDLICH, CARRIE A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-9d23c7572587671377e9f3a6c18b0da09b8879c902a7b002559fccff44c2e9033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Air Pollutants, Occupational - toxicity</topic><topic>auto body refinishing</topic><topic>Automobiles</topic><topic>Biological and medical sciences</topic><topic>Chemical and industrial products toxicology. Toxic occupational diseases</topic><topic>Chromatography, High Pressure Liquid - methods</topic><topic>Colorimetry - methods</topic><topic>exposure assessment</topic><topic>Hazardous Substances - toxicity</topic><topic>hexamethylene diisocyanate (HDI)</topic><topic>Humans</topic><topic>isocyanates</topic><topic>Isocyanates - toxicity</topic><topic>Medical sciences</topic><topic>Occupational Exposure - adverse effects</topic><topic>Paint - toxicity</topic><topic>Polyurethanes - toxicity</topic><topic>PPE</topic><topic>Skin Absorption</topic><topic>skin exposure</topic><topic>surface contamination</topic><topic>Survey of Painters and Repairers of Autobodies by Yale (SPRAY)</topic><topic>Toxicology</topic><topic>Various organic compounds</topic><toplevel>online_resources</toplevel><creatorcontrib>LIU, YOUCHENG</creatorcontrib><creatorcontrib>BELLO, DHIMITER</creatorcontrib><creatorcontrib>SPARER, JUDY A.</creatorcontrib><creatorcontrib>STOWE, MEREDITH H.</creatorcontrib><creatorcontrib>GORE, REBECCA J.</creatorcontrib><creatorcontrib>WOSKIE, SUSAN R.</creatorcontrib><creatorcontrib>CULLEN, MARK R.</creatorcontrib><creatorcontrib>REDLICH, CARRIE A.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Safety Science and Risk</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>The Annals of occupational hygiene</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>LIU, YOUCHENG</au><au>BELLO, DHIMITER</au><au>SPARER, JUDY A.</au><au>STOWE, MEREDITH H.</au><au>GORE, REBECCA J.</au><au>WOSKIE, SUSAN R.</au><au>CULLEN, MARK R.</au><au>REDLICH, CARRIE A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Skin Exposure to Aliphatic Polyisocyanates in the Auto Body Repair and Refinishing Industry: A Qualitative Assessment</atitle><jtitle>The Annals of occupational hygiene</jtitle><addtitle>Ann Occup Hyg</addtitle><date>2007-07-01</date><risdate>2007</risdate><volume>51</volume><issue>5</issue><spage>429</spage><epage>439</epage><pages>429-439</pages><issn>0003-4878</issn><eissn>1475-3162</eissn><coden>AOHYA3</coden><abstract>Objectives: Although respiratory exposures have been the primary concern with isocyanates, skin exposure also can occur and may contribute to sensitization and asthma. Methodologies to assess isocyanate skin exposure in the workplace are limited and skin exposure data scarce. The goals of this study were (i) to evaluate and validate the isocyanate colorimetric indicators against a quantitative assay, (ii) to evaluate the extent of isocyanate surface contamination and skin exposure among auto body shop workers and (iii) to evaluate isocyanate skin exposure determinants. Methods: The colorimetric indicators were compared with a high-performance liquid chromatography (HPLC) quantitative assay based on the National Institute for Occupational Safety and Health Method 5525 using paired laboratory sampling. The colorimetric indicators were then used to assess surface contamination and skin exposure to aliphatic isocyanates in 35 auto body shops and 124 workers as part of an epidemiologic study. The positive sample rate was calculated for various surfaces, body parts and tasks. The color intensity of the colorimetric indicators was rated on a scale 0 (yellow color) to 5 (deep red). Side-by-side comparisons of the qualitative method with the quantitative HPLC assay were also performed in the field using paired samples. Results: Laboratory and field evaluation validated use of the colorimetric indicators. The rate of positive surface samples for isocyanates was 46% (n = 145/313). Thirty-four percent (73/216) of samples were positive for unprotected skin and 20% (n = 22/111) for skin under latex gloves. The highest positive rate observed on skin samples was obtained after paint mixing and spraying tasks. The colorimetric indicators were highly specific for isocyanates, but false negatives occurred when compared with the more sensitive HPLC quantitative assay. The presence of surface contamination and the performance of paint-related tasks were the major determinants of isocyanate skin exposure. Conclusions: This study documents extensive surface contamination and skin exposure, including under gloves, to aliphatic polyisocyanates during painting and paint mixing tasks in auto body shop workers. Contaminated surfaces and aerosol deposition during spray painting may both contribute to skin exposure. The colorimetric indicator is a quick, practical and low-cost, but not highly sensitive, industrial hygiene tool to detect isocyanate surface contamination and skin exposures following the use of isocyanate-containing products.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>17602207</pmid><doi>10.1093/annhyg/mem021</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0003-4878
ispartof The Annals of occupational hygiene, 2007-07, Vol.51 (5), p.429-439
issn 0003-4878
1475-3162
language eng
recordid cdi_proquest_miscellaneous_20298075
source MEDLINE; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection
subjects Air Pollutants, Occupational - toxicity
auto body refinishing
Automobiles
Biological and medical sciences
Chemical and industrial products toxicology. Toxic occupational diseases
Chromatography, High Pressure Liquid - methods
Colorimetry - methods
exposure assessment
Hazardous Substances - toxicity
hexamethylene diisocyanate (HDI)
Humans
isocyanates
Isocyanates - toxicity
Medical sciences
Occupational Exposure - adverse effects
Paint - toxicity
Polyurethanes - toxicity
PPE
Skin Absorption
skin exposure
surface contamination
Survey of Painters and Repairers of Autobodies by Yale (SPRAY)
Toxicology
Various organic compounds
title Skin Exposure to Aliphatic Polyisocyanates in the Auto Body Repair and Refinishing Industry: A Qualitative Assessment
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-26T13%3A35%3A06IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Skin%20Exposure%20to%20Aliphatic%20Polyisocyanates%20in%20the%20Auto%20Body%20Repair%20and%20Refinishing%20Industry:%20A%20Qualitative%20Assessment&rft.jtitle=The%20Annals%20of%20occupational%20hygiene&rft.au=LIU,%20YOUCHENG&rft.date=2007-07-01&rft.volume=51&rft.issue=5&rft.spage=429&rft.epage=439&rft.pages=429-439&rft.issn=0003-4878&rft.eissn=1475-3162&rft.coden=AOHYA3&rft_id=info:doi/10.1093/annhyg/mem021&rft_dat=%3Cproquest_cross%3E20298075%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=20298075&rft_id=info:pmid/17602207&rft_oup_id=10.1093/annhyg/mem021&rfr_iscdi=true