Risk Assessment for Children Exposed to Beach Sands Impacted by Oil Spill Chemicals
Due to changes in the drilling industry, oil spills are impacting large expanses of coastlines, thereby increasing the potential for people to come in contact with oil spill chemicals. The objective of this manuscript was to evaluate the health risk to children who potentially contact beach sands im...
Gespeichert in:
Veröffentlicht in: | International journal of environmental research and public health 2016-09, Vol.13 (9), p.1-1 |
---|---|
Hauptverfasser: | , , , , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 1 |
---|---|
container_issue | 9 |
container_start_page | 1 |
container_title | International journal of environmental research and public health |
container_volume | 13 |
creator | Black, Jennifer C Welday, Jennifer N Buckley, Brian Ferguson, Alesia Gurian, Patrick L Mena, Kristina D Yang, Ill McCandlish, Elizabeth Solo-Gabriele, Helena M |
description | Due to changes in the drilling industry, oil spills are impacting large expanses of coastlines, thereby increasing the potential for people to come in contact with oil spill chemicals. The objective of this manuscript was to evaluate the health risk to children who potentially contact beach sands impacted by oil spill chemicals from the Deepwater Horizon disaster. To identify chemicals of concern, the U.S. Environmental Protection Agency's (EPA's) monitoring data collected during and immediately after the spill were evaluated. This dataset was supplemented with measurements from beach sands and tar balls collected five years after the spill. Of interest is that metals in the sediments were observed at similar levels between the two sampling periods; some differences were observed for metals levels in tar balls. Although PAHs were not observed five years later, there is evidence of weathered-oil oxidative by-products. Comparing chemical concentration data to baseline soil risk levels, three metals (As, Ba, and V) and four PAHs (benzo[a]pyrene, benz[a]anthracene, benzo[b]fluoranthene, and dibenz[a,h]anthracene) were found to exceed guideline levels prompting a risk assessment. For acute or sub-chronic exposures, hazard quotients, computed by estimating average expected contact behavior, showed no adverse potential health effects. For cancer, computations using 95% upper confidence limits for contaminant concentrations showed extremely low increased risk in the 10(-6) range for oral and dermal exposure from arsenic in sediments and from dermal exposure from benzo[a]pyrene and benz[a]anthracene in weathered oil. Overall, results suggest that health risks are extremely low, given the limitations of available data. Limitations of this study are associated with the lack of toxicological data for dispersants and oil-spill degradation products. We also recommend studies to collect quantitative information about children's beach play habits, which are necessary to more accurately assess exposure scenarios and health risks. |
doi_str_mv | 10.3390/ijerph13090853 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5036686</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1819432143</sourcerecordid><originalsourceid>FETCH-LOGICAL-c451t-28f943e49358b1480899bb76655093315e8b2b34b81626e5dccaff59b26dd31e3</originalsourceid><addsrcrecordid>eNqNkU1PHDEMhqMKVGDLtccqEpdeFpLJxySXSrBaykpISGw5R0nG0812ZjJNZqvy7xsERcCJky378SvbL0KfKTllTJOzsIU0bigjmijBPqBDKiWZc0no3ov8AB3lvCWEKS71R3RQ1ZIqTfghWt-G_Auf5ww59zBMuI0JLzahaxIMePl3jBkaPEV8AdZv8NoOTcarfrR-KnV3j29Ch9dj6LoyBX3wtsuf0H5bAhw_xRm6u1z-WFzNr2--rxbn13PPBZ3mlWo1Z8A1E8pRrojS2rlaSiGIZowKUK5yjDtFZSVBNN7bthXaVbJpGAU2Q98edced66HxZf1kOzOm0Nt0b6IN5nVnCBvzM_4xgjAplSwCX58EUvy9gzyZPmQPXWcHiLtsqKpqXWlG34PSckxFOSvoyRt0G3dpKJ94oGpRcyVVoU4fKZ9izgna570pMQ_WmtfWloEvL699xv97yf4BpjKezg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1817574868</pqid></control><display><type>article</type><title>Risk Assessment for Children Exposed to Beach Sands Impacted by Oil Spill Chemicals</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central Open Access</source><source>MDPI - Multidisciplinary Digital Publishing Institute</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><creator>Black, Jennifer C ; Welday, Jennifer N ; Buckley, Brian ; Ferguson, Alesia ; Gurian, Patrick L ; Mena, Kristina D ; Yang, Ill ; McCandlish, Elizabeth ; Solo-Gabriele, Helena M</creator><creatorcontrib>Black, Jennifer C ; Welday, Jennifer N ; Buckley, Brian ; Ferguson, Alesia ; Gurian, Patrick L ; Mena, Kristina D ; Yang, Ill ; McCandlish, Elizabeth ; Solo-Gabriele, Helena M</creatorcontrib><description>Due to changes in the drilling industry, oil spills are impacting large expanses of coastlines, thereby increasing the potential for people to come in contact with oil spill chemicals. The objective of this manuscript was to evaluate the health risk to children who potentially contact beach sands impacted by oil spill chemicals from the Deepwater Horizon disaster. To identify chemicals of concern, the U.S. Environmental Protection Agency's (EPA's) monitoring data collected during and immediately after the spill were evaluated. This dataset was supplemented with measurements from beach sands and tar balls collected five years after the spill. Of interest is that metals in the sediments were observed at similar levels between the two sampling periods; some differences were observed for metals levels in tar balls. Although PAHs were not observed five years later, there is evidence of weathered-oil oxidative by-products. Comparing chemical concentration data to baseline soil risk levels, three metals (As, Ba, and V) and four PAHs (benzo[a]pyrene, benz[a]anthracene, benzo[b]fluoranthene, and dibenz[a,h]anthracene) were found to exceed guideline levels prompting a risk assessment. For acute or sub-chronic exposures, hazard quotients, computed by estimating average expected contact behavior, showed no adverse potential health effects. For cancer, computations using 95% upper confidence limits for contaminant concentrations showed extremely low increased risk in the 10(-6) range for oral and dermal exposure from arsenic in sediments and from dermal exposure from benzo[a]pyrene and benz[a]anthracene in weathered oil. Overall, results suggest that health risks are extremely low, given the limitations of available data. Limitations of this study are associated with the lack of toxicological data for dispersants and oil-spill degradation products. We also recommend studies to collect quantitative information about children's beach play habits, which are necessary to more accurately assess exposure scenarios and health risks.</description><identifier>ISSN: 1660-4601</identifier><identifier>ISSN: 1661-7827</identifier><identifier>EISSN: 1660-4601</identifier><identifier>DOI: 10.3390/ijerph13090853</identifier><identifier>PMID: 27618904</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Bathing Beaches ; Beaches ; Chemical spills ; Child ; Coasts ; Colleges & universities ; Conflicts of interest ; Disasters ; Environmental cleanup ; Environmental Exposure - adverse effects ; Environmental Exposure - analysis ; Geologic Sediments - analysis ; Humans ; Hydrocarbons ; Oil spills ; Organic chemicals ; Petroleum Pollution - adverse effects ; Petroleum Pollution - analysis ; Petroleum refineries ; Polycyclic Aromatic Hydrocarbons ; Risk Assessment ; Sediments ; Silicon Dioxide ; Surfactants ; Weather</subject><ispartof>International journal of environmental research and public health, 2016-09, Vol.13 (9), p.1-1</ispartof><rights>Copyright Molecular Diversity Preservation International Sep 2016</rights><rights>2016 by the authors; licensee MDPI, Basel, Switzerland. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-28f943e49358b1480899bb76655093315e8b2b34b81626e5dccaff59b26dd31e3</citedby><cites>FETCH-LOGICAL-c451t-28f943e49358b1480899bb76655093315e8b2b34b81626e5dccaff59b26dd31e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036686/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036686/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27922,27923,53789,53791</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27618904$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Black, Jennifer C</creatorcontrib><creatorcontrib>Welday, Jennifer N</creatorcontrib><creatorcontrib>Buckley, Brian</creatorcontrib><creatorcontrib>Ferguson, Alesia</creatorcontrib><creatorcontrib>Gurian, Patrick L</creatorcontrib><creatorcontrib>Mena, Kristina D</creatorcontrib><creatorcontrib>Yang, Ill</creatorcontrib><creatorcontrib>McCandlish, Elizabeth</creatorcontrib><creatorcontrib>Solo-Gabriele, Helena M</creatorcontrib><title>Risk Assessment for Children Exposed to Beach Sands Impacted by Oil Spill Chemicals</title><title>International journal of environmental research and public health</title><addtitle>Int J Environ Res Public Health</addtitle><description>Due to changes in the drilling industry, oil spills are impacting large expanses of coastlines, thereby increasing the potential for people to come in contact with oil spill chemicals. The objective of this manuscript was to evaluate the health risk to children who potentially contact beach sands impacted by oil spill chemicals from the Deepwater Horizon disaster. To identify chemicals of concern, the U.S. Environmental Protection Agency's (EPA's) monitoring data collected during and immediately after the spill were evaluated. This dataset was supplemented with measurements from beach sands and tar balls collected five years after the spill. Of interest is that metals in the sediments were observed at similar levels between the two sampling periods; some differences were observed for metals levels in tar balls. Although PAHs were not observed five years later, there is evidence of weathered-oil oxidative by-products. Comparing chemical concentration data to baseline soil risk levels, three metals (As, Ba, and V) and four PAHs (benzo[a]pyrene, benz[a]anthracene, benzo[b]fluoranthene, and dibenz[a,h]anthracene) were found to exceed guideline levels prompting a risk assessment. For acute or sub-chronic exposures, hazard quotients, computed by estimating average expected contact behavior, showed no adverse potential health effects. For cancer, computations using 95% upper confidence limits for contaminant concentrations showed extremely low increased risk in the 10(-6) range for oral and dermal exposure from arsenic in sediments and from dermal exposure from benzo[a]pyrene and benz[a]anthracene in weathered oil. Overall, results suggest that health risks are extremely low, given the limitations of available data. Limitations of this study are associated with the lack of toxicological data for dispersants and oil-spill degradation products. We also recommend studies to collect quantitative information about children's beach play habits, which are necessary to more accurately assess exposure scenarios and health risks.</description><subject>Bathing Beaches</subject><subject>Beaches</subject><subject>Chemical spills</subject><subject>Child</subject><subject>Coasts</subject><subject>Colleges & universities</subject><subject>Conflicts of interest</subject><subject>Disasters</subject><subject>Environmental cleanup</subject><subject>Environmental Exposure - adverse effects</subject><subject>Environmental Exposure - analysis</subject><subject>Geologic Sediments - analysis</subject><subject>Humans</subject><subject>Hydrocarbons</subject><subject>Oil spills</subject><subject>Organic chemicals</subject><subject>Petroleum Pollution - adverse effects</subject><subject>Petroleum Pollution - analysis</subject><subject>Petroleum refineries</subject><subject>Polycyclic Aromatic Hydrocarbons</subject><subject>Risk Assessment</subject><subject>Sediments</subject><subject>Silicon Dioxide</subject><subject>Surfactants</subject><subject>Weather</subject><issn>1660-4601</issn><issn>1661-7827</issn><issn>1660-4601</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNqNkU1PHDEMhqMKVGDLtccqEpdeFpLJxySXSrBaykpISGw5R0nG0812ZjJNZqvy7xsERcCJky378SvbL0KfKTllTJOzsIU0bigjmijBPqBDKiWZc0no3ov8AB3lvCWEKS71R3RQ1ZIqTfghWt-G_Auf5ww59zBMuI0JLzahaxIMePl3jBkaPEV8AdZv8NoOTcarfrR-KnV3j29Ch9dj6LoyBX3wtsuf0H5bAhw_xRm6u1z-WFzNr2--rxbn13PPBZ3mlWo1Z8A1E8pRrojS2rlaSiGIZowKUK5yjDtFZSVBNN7bthXaVbJpGAU2Q98edced66HxZf1kOzOm0Nt0b6IN5nVnCBvzM_4xgjAplSwCX58EUvy9gzyZPmQPXWcHiLtsqKpqXWlG34PSckxFOSvoyRt0G3dpKJ94oGpRcyVVoU4fKZ9izgna570pMQ_WmtfWloEvL699xv97yf4BpjKezg</recordid><startdate>20160901</startdate><enddate>20160901</enddate><creator>Black, Jennifer C</creator><creator>Welday, Jennifer N</creator><creator>Buckley, Brian</creator><creator>Ferguson, Alesia</creator><creator>Gurian, Patrick L</creator><creator>Mena, Kristina D</creator><creator>Yang, Ill</creator><creator>McCandlish, Elizabeth</creator><creator>Solo-Gabriele, Helena M</creator><general>MDPI AG</general><general>MDPI</general><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>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7ST</scope><scope>C1K</scope><scope>SOI</scope><scope>5PM</scope></search><sort><creationdate>20160901</creationdate><title>Risk Assessment for Children Exposed to Beach Sands Impacted by Oil Spill Chemicals</title><author>Black, Jennifer C ; Welday, Jennifer N ; Buckley, Brian ; Ferguson, Alesia ; Gurian, Patrick L ; Mena, Kristina D ; Yang, Ill ; McCandlish, Elizabeth ; Solo-Gabriele, Helena M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-28f943e49358b1480899bb76655093315e8b2b34b81626e5dccaff59b26dd31e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Bathing Beaches</topic><topic>Beaches</topic><topic>Chemical spills</topic><topic>Child</topic><topic>Coasts</topic><topic>Colleges & universities</topic><topic>Conflicts of interest</topic><topic>Disasters</topic><topic>Environmental cleanup</topic><topic>Environmental Exposure - adverse effects</topic><topic>Environmental Exposure - analysis</topic><topic>Geologic Sediments - analysis</topic><topic>Humans</topic><topic>Hydrocarbons</topic><topic>Oil spills</topic><topic>Organic chemicals</topic><topic>Petroleum Pollution - adverse effects</topic><topic>Petroleum Pollution - analysis</topic><topic>Petroleum refineries</topic><topic>Polycyclic Aromatic Hydrocarbons</topic><topic>Risk Assessment</topic><topic>Sediments</topic><topic>Silicon Dioxide</topic><topic>Surfactants</topic><topic>Weather</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Black, Jennifer C</creatorcontrib><creatorcontrib>Welday, Jennifer N</creatorcontrib><creatorcontrib>Buckley, Brian</creatorcontrib><creatorcontrib>Ferguson, Alesia</creatorcontrib><creatorcontrib>Gurian, Patrick L</creatorcontrib><creatorcontrib>Mena, Kristina D</creatorcontrib><creatorcontrib>Yang, Ill</creatorcontrib><creatorcontrib>McCandlish, Elizabeth</creatorcontrib><creatorcontrib>Solo-Gabriele, Helena M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Environment Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Environment Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of environmental research and public health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Black, Jennifer C</au><au>Welday, Jennifer N</au><au>Buckley, Brian</au><au>Ferguson, Alesia</au><au>Gurian, Patrick L</au><au>Mena, Kristina D</au><au>Yang, Ill</au><au>McCandlish, Elizabeth</au><au>Solo-Gabriele, Helena M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Assessment for Children Exposed to Beach Sands Impacted by Oil Spill Chemicals</atitle><jtitle>International journal of environmental research and public health</jtitle><addtitle>Int J Environ Res Public Health</addtitle><date>2016-09-01</date><risdate>2016</risdate><volume>13</volume><issue>9</issue><spage>1</spage><epage>1</epage><pages>1-1</pages><issn>1660-4601</issn><issn>1661-7827</issn><eissn>1660-4601</eissn><abstract>Due to changes in the drilling industry, oil spills are impacting large expanses of coastlines, thereby increasing the potential for people to come in contact with oil spill chemicals. The objective of this manuscript was to evaluate the health risk to children who potentially contact beach sands impacted by oil spill chemicals from the Deepwater Horizon disaster. To identify chemicals of concern, the U.S. Environmental Protection Agency's (EPA's) monitoring data collected during and immediately after the spill were evaluated. This dataset was supplemented with measurements from beach sands and tar balls collected five years after the spill. Of interest is that metals in the sediments were observed at similar levels between the two sampling periods; some differences were observed for metals levels in tar balls. Although PAHs were not observed five years later, there is evidence of weathered-oil oxidative by-products. Comparing chemical concentration data to baseline soil risk levels, three metals (As, Ba, and V) and four PAHs (benzo[a]pyrene, benz[a]anthracene, benzo[b]fluoranthene, and dibenz[a,h]anthracene) were found to exceed guideline levels prompting a risk assessment. For acute or sub-chronic exposures, hazard quotients, computed by estimating average expected contact behavior, showed no adverse potential health effects. For cancer, computations using 95% upper confidence limits for contaminant concentrations showed extremely low increased risk in the 10(-6) range for oral and dermal exposure from arsenic in sediments and from dermal exposure from benzo[a]pyrene and benz[a]anthracene in weathered oil. Overall, results suggest that health risks are extremely low, given the limitations of available data. Limitations of this study are associated with the lack of toxicological data for dispersants and oil-spill degradation products. We also recommend studies to collect quantitative information about children's beach play habits, which are necessary to more accurately assess exposure scenarios and health risks.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>27618904</pmid><doi>10.3390/ijerph13090853</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1660-4601 |
ispartof | International journal of environmental research and public health, 2016-09, Vol.13 (9), p.1-1 |
issn | 1660-4601 1661-7827 1660-4601 |
language | eng |
recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5036686 |
source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central Open Access; MDPI - Multidisciplinary Digital Publishing Institute; PubMed Central; Free Full-Text Journals in Chemistry |
subjects | Bathing Beaches Beaches Chemical spills Child Coasts Colleges & universities Conflicts of interest Disasters Environmental cleanup Environmental Exposure - adverse effects Environmental Exposure - analysis Geologic Sediments - analysis Humans Hydrocarbons Oil spills Organic chemicals Petroleum Pollution - adverse effects Petroleum Pollution - analysis Petroleum refineries Polycyclic Aromatic Hydrocarbons Risk Assessment Sediments Silicon Dioxide Surfactants Weather |
title | Risk Assessment for Children Exposed to Beach Sands Impacted by Oil Spill Chemicals |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-09T17%3A42%3A21IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Risk%20Assessment%20for%20Children%20Exposed%20to%20Beach%20Sands%20Impacted%20by%20Oil%20Spill%20Chemicals&rft.jtitle=International%20journal%20of%20environmental%20research%20and%20public%20health&rft.au=Black,%20Jennifer%20C&rft.date=2016-09-01&rft.volume=13&rft.issue=9&rft.spage=1&rft.epage=1&rft.pages=1-1&rft.issn=1660-4601&rft.eissn=1660-4601&rft_id=info:doi/10.3390/ijerph13090853&rft_dat=%3Cproquest_pubme%3E1819432143%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1817574868&rft_id=info:pmid/27618904&rfr_iscdi=true |