1 15 4 https://www.nal.usda.gov/exhibits/speccoll/files/original/f0823836210e4e506c7d5e6b30024225.pdf f27b8237f2250a67fe96458923a3ecfc PDF Text Text Item D Number °2418 Author Bianco, Vanda Corporate Author ROPOrt/ArtlGto Tttta Typescript: Obstetric Monitoring in Brianza de Seveso From 1975to1981 Journal/Book Title Year 000 ° Month/Day Color ° Number of Images 30 Descrtoton Notes Friday, October 05, 2001 Page 2418 of 2422 �CBSTSTSIC MCNITGE32TG 121 3RIANZA DI 3SVZSG ?20H 1975 TO 13S1 Dr Vanda Bianco (researcil worker, University of Milan) Dr L. Meazza Prof. G. Senotti (Coordinator of C.P.2} (tlie Professor of Obstetric and Gynecolccica] holag^', University of Milan) �REPORT GIT OBSTETRIC MONITORING IN 3RIANZA DI SEVSSO Total monitored pregnancies (up to 16/5/83): 21 532 Methods of investigation The aim of this study since the beginning was to gather pregnancy data on a number as close as possible to 100% of the pregnancies of the women residing in the 11 communes. Since we were to study phenomena like the trend of the spontaneous abortion rate in small population samples, such as zones A and 3, the loss of even a few cases could have appreciably affected the rates. Cur study covers all the pregnancies concluded between January 1st 1975 and December 3-lst 1981. ported was checked The completeness of the cases, re- and missing cases recovered by means of: 1) a list of births in the eleven communes (thoroughly checked by Special office personnel as from the third quarter of 1976 but not for the previous quarters); 2) the reports of spontaneous abortion (sent by law to the provincial medical until autority) June 1973 and available from July i976. The search for reports of spontaneous abortion for the period January "975 June 1976 unfortunatelv Droved fruitless. In fact they were no longer to be found in the competent offices because their preservation after the normal statistical work-over and after the entry into fbrce of law 194 was thought to be pointless; 3) the recovery of clinical data from neighboring hospitals (Carate, Cantu, Garbagnate, Clinica Zucchi of Monza, Saronno) net included in the monitoring plan and from the largest hospitals in the city of Milan, attended by a significant percentage of the pregnant women of the 11 communes; 4) the A/D forms of all the hospitals in Lombardy. These forms are available from May-June 1 975: uo to end1976 they appear incomplete whereas from '77 to '81 the standard is de �available only in March. 1983. Case records for cases probably relevant to our study, have been looked for and mainly found, bi± still missing from this report since it is worked on data elaborated by the computer up to May 16th, 1983. The follO7/i;ig data about each pregnancy are always known: mother's registry office data, date of last menstrual period, date of delivery or abortion and weight of the newborn . The date of conception can be established with good approximation by the date of the last menstrual period. The pregnancy data have been stored in the computer of the Special Office at Desio according to a program agreed in advance with the epidemiology group (figure 1). For the study of spontaneous abortions we have chosen the statistical method that relates the number of spontaneous abortions occurring in a given period to the number of conceptions for that period, in order to exclude any factors that might affect the number of conceptions. In fact the number of conceptions in the populations under study might have been affected in varying degree, contraception having been heavily promulgated at the beginning due to fear of damaging effects of TCDD on the concept embryo . Table 1 gives the total number of pregnancies monitored and the disaggregation by year of conception and by zone of residence of the cravida a**" the ^"me of cc'cclus1' 0*1 of ^~he ^rec^aif '""'•* ^S*T-- •* ~ oregnancies failed to 36 sssicr.ed to rhs zor.es due '"c iv"~c~'2l=~-— •--» ^ c ^ r> £ T- yi -a -^ at— • c •!— ^- r <~* - £ -• .-- s r P ••- 2 �The 1974 conception data are incomplete in that the numbers in the table refer only to the conceptions resulting in delivery or abortion on or after January 1st 1975. Similarly the 1981 data are incomplete because they include only the conceptions resulting in delivery or abortion by 31 December 1981 . 21 532 pregnancies were monitored (all pregnancies ending in voluntary abortion have been deliberately excluded) . This table shows that the total number of conceptions was steadily declining from 1975 to 1980 in line v/ith the national trend. 1975 only was cut of line as throughout the territory and in each individual zone the figures were lower than in 1977, probably due to the heavy contraception program in the area immediately after the accident, through 1977. in scnes A and B, after a low in 1976 the figure rose again in 1977 and 1973, probably by way of compensation. In 1979 and 1980 zones A and B came back into line v/ith the rest of the territory with a progressive fall in the conception rate similar to that for the whole of the Lcnbardy Region. This declining trend justifies the criterion chosen for the determination of the abortion rate. Table 2 gives the number of abortions and of conceptions by area according to tha decree of pollution and by quarter of ccncsptisr from the foxirth quarter cf 1974 to the first quarter of 1981 . Table 3 gives the related percentages. The tone A values are not studied individuallv because the small number of pregnancies to allow a. significant evaluation. From these tablas and from graph 1 there emerges a relativel" �stable trend ir. the nor. ABR zone (index of the reliability of the data), which fluctuates between 1G% and 13% with only two values definitely below the lower limit (9.37% in the 2nd quarter of 1976 and 9.37% in the 2nd quarter cf 1980) and two values above the upper limit (14.47% in the 4th quarter of 1976, the highest value found in the non A3P. zone, and 14.24% in the 4th quarter of 1977) . If we consider the rates for A + B , R and A+3+R exceeding the upper limit found in non A3R (14.47%), -~e note a concentration between the 3rd quarter of 1976 and the 4th quarter of 1978 (table 3A) . The peak - 33.33% - was reached in A-t-3 in the first quarter of 1977. This behavior is indicative of an acute .phenomenon adversely affecting the conceptions in A+3 and R(and A-fB+R) from the 3rd ouarter of 1976 and lasting throughout 1973. • Throughout the period preceding the accident and since the 1st quarter cf 1979 in zone R and in the whole of A+3-i-R there is no single rate exceeding the threshold of 14.47% (maximum value in the control zone). The situation in A+3 is different. Zven thcugh here too the peak concentration of values exceeding 14.47% is found in the period immediately after the accident, "re nonetheless find similar peaks in the preceding period (2nd quarter o£ •j. : IS.42%; 1st quarter of 1976: 22.22%) and after 1973 (1st quarter of 1379: 14.31%; 4th quarter 197?: 19.23%; 1st quarter l?3l: 15.33%) As the population sample is small, these may be thought to be fortuitous events. However, the next table (table 33) may suggest other hypotheses. This table highlights those quarterly rates for zones A+B, �exceeding the peak value of non A3R, exceed the rate for the non A32 zone for the same qtiarter. The follc^/ing points are of great interest: 1) higher rates in R and A+3---R than in non ABU are a practically constant finding right up to end-1373, after v/hich they occur only in the 4th quarter of 1979 and in the 3rd quarter of 1930; 2} in A-i-3 the rates -ere higher than in non A3R in 13 of the 26 quarters studied, 7/1 th a practically uniform distribution. It could be argued that A-r3 has a genetically more abortion-prone "lO^Q population or one chronically exposed to abortigenic factors that are expressed throughout the period under reviet/: in the period July 1976-March 1978 this population experienced an additional factor that.accentuated this predisposition to spontaneous abortion. Cr it may be argued that the factor responsible for the increase in spontaneous abortions in,- 2 (and in A-T-3+?.) in the period from the 3rd quarter of 1976 to the 4th quarter of 1973 w'as' operative in A-r3 previously as veil and that its action in that zone continued into 1979 and 193C. Another line of argument is that II and A-r-3-rZl "5/ere previously exposed to factors capable of increasing the rate of spontaneous abortions and that the sane factors ?/ere at tvcrlc on a greater scale, or nev; factors -rere s-.iperadded '?-ith a S3~ergic action, causing an even more striking increase in the period July 197-5December 1972 . Interestingly, as from January 1979 the rates for ~. (and A+3+lO "•/ere actually lor/er than in non A32. This datum rules o".t the possibility of a greater gei'.etic predisposition to spontaneous abortion for the inhabitants cf zone li. A rr.cre lilcelv h r '~oth- �:he preventive meas^•lres (removal, killing of animals, prohibition on cultivation, health and hygiene regulations, etc) and reclamation took effect by eliminating the environmental factors (TCDD ? Others ?) that were previously responsable for higher spontaneous abortion rates in this zone than in the control (non ABR) zone. Ail analysis of the population by maternal ace, parity, number of previous abortions elicited no significant differences in the various zones compared, as is appears from table 4. We have calculated the statistical significance of the differences found between the rates in the zones compared. To increase the statistical power of the analysis, we considered zones A, B and R globally and compared periods of four consecutive quarters, taking July "376 as the reference date. This enables us to look at the zones we are comparing for a year before the accident and for four years after (tables 5 and 6). The rates for the first period are identical in the zones compared. In the periods July 1376-June i377 and July 1977-June 1973 the rates for A+3-r3 were higher than in non A3?.. For the statistical comparison we used the Z test according to the formula: ?= ± 2 V od-o) n The differences for ?ercer.tage rate n = number of conceptions the periods July 1976-June 1977 and July 1 377-June 1S73 are statistically significant. The difference for the period July 1 37S-June 1380, in which A+2-i-R presents lower rates than ncn A33, (see diagram), is significant. At the request of the ISC (International Steering Committee^ we conducted a survey of gestaticnal are and birthweights (as possible indicators of to::icity) in the monitored tsrritory. Graph �2 shows exactly superposable gestational age curves for A+3+R and nor. A3H. Graphs 3 and 4 (gestational age by maternal age ar.d gestational age by parity) represent the trend of this phenomenon in the -/hole sample. Since there were no significant differences in respect of these factors in the cones compared, we saw no point in reproducing these graphs with a disaggregation by zone. The birthweicht study was conducted on a percentile basis. Graphs 5-11 give the curves for the 5th, 10th, 25th, 5Cth, 73th, 30th and 95th percentiles, comparing the global sample with A+3+R before and after 10 July 1976 and with non A3R before and after the same date. These graphs do not seem to reveal any important differences between the zones compared. The differences in the first and last weeks probably depend on the smallness of the sample for these weelcs. As these data are very recent, any opinion we can express now is very superficial. CCNCLuSlblTS In the eleven communes there is one area, namsly A+B-Kx, in which the abortion rate is higher than in the rest of the territory, the difference being statisticallv significant for the two years following the ICI-IZoA accident (July 1975-June 1975). In 1979 and 1 9SC the rates in A-r3-rIl "'•ere lower than in non A3?., significantly so in I960. In the period July 1975-June 1976 the rates in the two zones compared were identical. v."e have no direct toxicolocical or biological evidence on which to base an assertion that TCDD was responsible for the difference but the time co~'nci— de'^ce "rovld s~roncplT;t sv.ccest that i.t "*/as. Zone A-r3 considered separately >resen~3 almost consistently higher �spontaneous abortion rates tiian dees non A3?., v/ith a peak cf 33.22% in the 1st quarter of 1977. However, the phenomer.cn may be more apparent than real (apart from the period 1376/72) and related to the small number of cases, 'which results in a distribution of abortion cases in which higher percentage levels (talc en one by one) are likely to be more frequent. The scale of the phenomenon is cf sufficient interest to warrant further investigation, ^/hich is ncv under -;/ay. There are no sizable differences between the populations compared in regard to gestational age, birthweicht or the various pathological conditions of pregnancy other than spontaneous abortion. �Figure 1 PREGNANCY DATA I:T?UT CODE no. : individual number (registry office) maiden name, forename, husband's name place and date of birth. domicile, residence PREGNANCY STARTING DATE ORIGINAL FORM (last menstrual p e r i o d ) CASE SHEET RECOVERED FCRI-i -RE-PREGNANCY HISTORY: 1 ) malformations 2} hereditary diseases - thalassemia 3) hereditary diseases - other 4) hypertension o) nephropathy 6 ) other PREGNANCY CCU2SE : 1 ) E?H toxemia 2} hypertension ( 140-160) 3) hypertension (over 160) 4) nephropathy: cystopyelitis 5) nephropathy: other 6) other 7) RK isoimmunisation . 8) threatened abortion within week 23 9) threatened abortion after week 2Z 10) radiation up to end week 24 11) radiation after week 24 12) exanthematous infections before end week 15 13) exanthematous infections after week 15 • 14) other viral infectious diseases 15.) other infectious diseases 16) other diseases 17) drugs taken: steroid hormones 18) drugs taken: yasosuprina 19) drugs taken: other (excl. Ca and vitamins) * 20) Debendox taken * 21 ) Debendox not taken PREVIOUS PREGNANCIES duration in weeks �CUTCCM3 OF PREGNANCY commune of delivery or abortion date of delivery or abortion spontaneous abortion induced abortion normal delivery non surgical vaginal surgical abdominal b ir t;T!/e i gh t (s) * Datum stored only for gravidas residing in Seregno at the specific request of the USSL 62 operators. For the other gravidas the use of Debendox is included under item 13. �Table 1 Zone A 3 ?. N'or.A3?. Unas sign. 13" A 5 55 39 £l 2 . 149 197 5 11 97 503 2 .83 9 197 5 5 74 45 7 2 .578 2 3 .134 100 = 25 2 . 539 2 24 3.2 Year " 5T - 5 2 .520 3.5 53 ^ 197 3 ----- 11 105 454 2 . 33 1 2 . 308 1979 4 85 453 2 .19 T 4 2 . 73 4 1980 4 77 41Q 2 .14 9 * 2 .553 198 1 0 17 2- 50 - 3 42 521 3.450 17.439 24 21.532 Total Number - 48 of pregnancies observed by zone of residence and by year of conception and totals by zone and by year. �Table 2 3 c IV. 74 A ~ .i - C A C ? quarter 1 -7 14 143 52 73S 1 7 19 15 139 36 577 I 0 1 II C 4 34 19 152 59 709 "7 1 13 130 Ci 736 C i 2 ^ 2 1 22 91 717 I C 1 •7 14 i^ 152 A 124 52 399 II 0 3 3 22 15 131 75 672 III 0 0 C 19 103 35 516 1 i 10 23 4 17 117 100 691 589 T IV . 7 5 IV. 76 T 1 3 7 21 15 126 77 TT 0 1 6 29 20 133 33 645 I I I 22 17 141 79 695 650 1 3 IV. 77 0 0 3 2 28 17 126 94 I r; 1 1- 3 26 20 109 64 396 0 5 2 26 19 109 61 555 III 0 3 4 26 14 124 57 611 1 2 3 27 17 112 72 576 0 3 4 24 12 103 66 490 TT 0 0 3 21 9 107 61 304 III 0 1 4. 14 4 121 77 505 593 IV. 73 I 0 0 3 25 16 122 •j- A 0 0 2 14 7 53 550 II 1 3 2 19 5 105 37 47 475 III 0 0 0 22 15 1 15 62 549 10 1 69 554 IV. 79 IV . 30 0 1 3 22 1 1" Number of conceptions ending on spontaneous abortion (A) and total number of conceptions (C) by quarter and by zone of residence. �Table 3 QUARTER ZONE A— 3 ZONE •3 ZONE ZONE A— 3— x nor. .-. 3 ~. 5. 5 4/7-a 5 . 33 9 79 1/75 2/73 3/73 £/73 5 _ 00 13. 42 3. 59 7- 41 10. 79 1 1 . 73 12. CO 9. 21 10. 06 1 3 • 00 1 1 . 56 3. 94 1 2. 70 a . 73 1 1 . 01 1 2. 59 1/75 2/75 3/76 4/75 22 . 22 1 2 . 00 1 2. 1 G 1 2 . 21 1 3. ^5 i 3 . •; S 1 2. 1 3 1 0 . -1 1 31 1 9- 23 1 4. 53 15. 31 1 5 - 33 1 3- 30 1 4 .£L .1/77 2/77 3/77 i/77 33- 33 20. 00 1 5 .00 7. 14 1 1 . 90 1 5- 04. 12. 06 1 3. 49 i 5 . 33 15. 95 12. 65 12. 3 — 1 3- 07 12. 37 1/73 2/73 3/73 4/73 14. 31 5. 45 13. 79 1 3. 79 13. 35 1 7 . 43 1 1 . 29 1 5 . 13 17. 65 1 5 - 00 1 1 . 76 1-a. 39 10. 7- ' 10. 99 10. 97 1/79 2/79 3/79 i/79 * 4 dt 1 i. 29 5 . £T " 3 • 23 11.! t 3 . /*,- 11. 9. 37 3 • 63 : ~• i ^ 1 3 • il"T '. 2. - .-*T '2. T 1 2 . 35 "/ 0 t ii _ ^ • •* i 1 3. i ! 9. w J 1 1. * — 37 24 1 2. 32 1 i 2; 53 " 2 . ^3 £ " - ' ^ ." 3 5. 0 /' 5 . 90 -/ 0 '• - • 04 a _ ~- v • - .' - T= ~ . •" 5 o •? : . 36 3 . 25 7 _ 2^ ' 2 - 5- ?'- 3 J - -" �TABLE QUARTER 3a ZONE ZONE ZONE •--- 3—?. •3 .- — 3 ... ••---•,-:•:-•: 5 .33 1/75 2/75 3/75 4/75 5 .00 in -53 3 1 1 73 1 2 . 00 m 7 . 41 ~22l 12 .00 — o / -• <- 2/ / O 3/75 4/76 1/77 2/77 3/77 A/ 77 1/73 2/73 3/73 . 4/73 in "23] ' 1 *2 T • -J v B35SS ft? FTo" . QCj 7 .14 |TZ•~aTj 6 .45 13 .73 13 .79 5 .5 1 0 .06 1 3 .00 i : . 56 g . 34 10. 73 TT1] 1/75 • 3 .3 - 2 .70 3 . 73 4/7* 3. /^ •« 1 2. 10 1 2 .33 12. 21 1 FnrT=] "5^1 [T4T 11. 30 ZONE *— . — ^ r^o r. .-\ w .< - 2 .13 FT? . ?'| irf . ** '^ \ 9 .73 .1 1 .01 12 • 53 10 • 35 11 • w ' 1 3 . 30 nil !l£ FT" r\ /t] fTf 7T31 FT?~Q=1 12. 06 13. 49 12 .65 1 2 .34 EH53 EZ, g =j 10 i 6Ell FT . 53 10 .97 12 • 52 i i . 11 11 .35 ^ >* 3 • 37 . 55 ^ " 4, i ^ " i .10 1 2 • 73 n 7 ..4"3l 1 1 . 29 fTT _ r,rj 1 1 .75 13 .07 12 .37 1 1 .37 1 4. 24 ^4 i n .39 \ •™. 1/73 2/79 3/79 4/7? mi OZ 1 4 .29 6 . 57 p 9 7T!1 . 3. 41 •5 31 • * . 1- : - ~ ~J • . 25 . 53 9 . 53 •z . 3~ •' ,^- ' 4 .29 ~ . 57 7 13 £ . 90 3,' 30 4/ 3 0 - C - - ; J . 04 ; J . Ci 3 . 93 "] > . » w •» Q :/30 2/30 .64 • 47 ^ . ^w �TABLE 3b UARTER ZONE ZONE A- 3 ZONE ZONE A-3-?, 9.3 6.39 5 .5 - * 1/75 2/73 3/73 A/75 1/75 2/75 3/76 4/76 ^ _ CO 1 3. 42 10. 79 3. 69 7 • —1 22 . 1 1 1 2. 00 9. 21 10.06 1 3.00 11.56 3 . 94 12 .70 c .73 1 1 .01 1 2 .69 1 2.10 * 1 "* 2 •4 4 I i . T3 1 2 . QQ - 1 2 ^ 21 12.18 1 3 . 43 1.9..._ 2 1 1 4. "6.31 li ii 10 . 3 3 i i ^1 * 13 .30 14 .47 1/77 2/77 3/77 4/77 33.-- -3 3 20. 00 1 6 . 00 7. 14 1 1 . 90 15.33 13.95 12.65 12.34 1 3 .07 12 .37 1 1 • 37 14 .24 1/73 2/73 3/73 4/73 1 a. i l 6. 45 12 17.65 10 .74 10 • 99 10 • 97 12 .'52 1/ 7 9 2/79 2/79 4/79 * / 30 2/30 3/ 3-0 4 •' 3 0 • W ^ ^ B * 1 ^3 5 • 04 12. .PJL 1 3 • 49 13. 17. £1 1 1 ."29 15. i 5 3" n. 1 * 22 3 . -11 .•M^— • i j. C . * -i 1 5.00 11 .76 1 4.. 3? 11 .35 9-37 3-53 67 23 3 . T *r i 3 •^.» '-•"'? 29 5 . 57 7.36 ~ "" 6. 90 1 3 • 91 • " "^ij. 3 . ••3 1 13 .47 12 . 1 0 ; ^ • 73 • "i 2 . 3 3 ; -, 3 .i . '1.6 - ,5 tt _ 55 Q ~" * . i '^ . " ? . — v' " �TABLE 4a PERCENTAGE DISTRIBUTION OF PREGNANCIES BY RESIDENCE ZONE A) BY MATERNAL AGE GROUP 20- 21-25 25-30 31-35 36-40 A-3-R 14,27 r.cn A3?. 10,50 Unassign. 46 , 15 35,74 35,71 23.07 29,93 31,53 30,75 12,90 14,50 0.00 5,94 5,13 0,00 TOTAL 35,"0 31,21 14,25 5.12 3) 11,23 46-50 50- 1,15 1,35 0,00 0,04 0,09 0, OO 0,00 0,00 0,00 1.31 0,03 0,GO BY NUMBER OF PREVIOUS PREGNANCIES 0 A*a-R . i Unassign . 50 ,31 54 , 55 75 ,92 24 ,8722 ,53 23 ,07 TOTAL 53 ,31 22 ,99 no n A3?. C) 41-45 2 9 ,00 3 3* 0 ,00 3 ,31 2 ,53 0,00 1,99 1 , 56 0,00 a ,53 2 ,32 1,72 a ,56 'BY NUMBER OF PREVIOUS ABORTIONS A-3-R non A3?. Unassign. TOTAL ' ' 92,50 92, 71. 92.30 5,39 5,59 7,59 1,23 1.15 O.CO 0,31 0,42 0,00 92,57 5,73 1,13 0,40 �TABLE 4b DISTRIBUTION OF PREGNANCIES BY RESIDENCE ZONE AND BY AGE GROUP 20- 26-30 31-35 A-8-R 322 305 non ABR 35? 323T Unassign. 5 3 573 2302 4 291 1344 0 134 553 0 25 123 0 1 3 0 0 0 0 2253 3203 1 3 TOTAL 3331 1533 703 151 10 0 11471 1235 21-25 4036 36-40 41-45 46-50 50- TOTAL DISTRIBUTION OF PREGNANCIES BY RESIDENCE ZONE AND BY NUMBER OF PREVIOUS PREGNANCIES 0 1 2 3 A^B-R 1360 non A3R 5350 Unassign. 10 351 2074 3 203 733 0 35 233 0 45 153 0 TOTAL 2533 931 324 193 732O 3^ TOTAL 2255 9203 13 • 11471 DISTRIBUTION OF PREGNANCIES BY RESIDENCE ZONE AND BY NUMBER OF PREVIOUS ABORTIONS 0 A-3-R non ABR Unassign. TOTAL 1 2 2025 3333 12 133 324 1 23 107 0 10531 553 2-7 33 0 2255 3203 13 �TABLE 5 half year -5 —- — -. - - 41 49 I. 77 II. 77 40 I. 73 43 1 1 7^ 10 . 23 1 53 • -2 293 236 313 35 33 II. 75 395 352 42 I -: 12 . 13 3 1 5.02 15 . os IS 5 15 0 12 . 50 17 •: II. 73 ;_ 79 39 220 255 294 23 263 10. 55 II.7S 25 234 I.30 13 29 223 9. 15 7. 39 272 1C. 66 II.30 1". 53 1 ~! 13. 25 •_ 1 7 13 ,1 5 c 13 35 1-= 53 1 7 -• 13 1 . 3** *i 12 .36 13 07 14 . 15 1 2 .97 1234 13 55 12 .77 1 15 1 10 .36 1 1 37 11 594 « ji. Q 11 .1 3 -i .73 13 12 03 1036 11 13 12 .30 1C .62 11 . 77 Number of conceptions ending in abortion (A), total number of conceptions (C) and rate (£) by half year of conception and by residence zone. TABLE 6 nor. A3S period July 75-June 76 July; 76-June 77 July 77-June 78 "4 : 650 1 ii 9C 369 1 3- July 78-June 79 57 537 July 79-June 80 1A 312 .33 310 2724 11. 33 5 .32 1 c 40 34; 2S41 293 75 C6 13. 53 1 1 CO 2 03 266 2131 12. 20 3 . 39 264 2239 11. 79 1 Number of conceptions ending in spontaneous abortion (A), total number of conceptions (C) and rates ($) by one-year period before and after the ICMESA accident in zone A+B+R and in zone non ABR. �CALCULATION OF STATISTICAL SIGNIFICANCE - MODEL Comparison of spontaneous abortion rates in zone A+B+R and in zone non ABR in one-year periods before and after the ICMESA accident according to the Z test. period July 1975-June 1976: A+B+R rate non ABR rate= 11.38 period July 1976-June 1977 13.53 I 2 2541 confidence limits: 12.13 rate for A+B+R = 15.82 15.33 SIGNIFICANT period July 1977-June 1978 :i.S9 I 2 / 16.49 (100- 15.49) confidence limits: 10.41 _ rate for A+B+R = 16.49 13.37 SIGNIFICANT period July 19,78-June 1979 12.20 ± 2 . T12.G3 (130 - 12.03! 2131 confidence limits: rate for A+B+R 10.31 = 12.03 NON SIGNIFICANT period July 1979-June 1980 confidence limits: rate for A+B+R = 8.59 SIGNIFICANT �Graph 1 ABORTION RATES BY QUARTER IN ZONES non A+B+R, A + B + R , A+B, R ,\ • \ A nit-n 111 it \ I'-HJl) c i u; 1 1 ' I i • i • v 11)111 �Graph 2 DISTRIBUTION OF DELIVERIES BY GESTATIONAL AGE AND RESIDENCE ZONE SO 40 RESIDENCE ZONE i >> i i- 0( 0 0 _'ti 1'f) :i(V :)l 32"~3l""34 35 36 ""37 ~'3fl 30 40 42 43 44 45 46 gestational age �Graph 3 DISTRIBUTION OF DELIVERIES BY GESTIONAL AGE AND PARITY -10 PARITY 'J 0 20 Ml :> i on 01 ) 'JO :i ~32~"'Ji3~"~3~"35~ 36 37 38' 39 40 41 42 43 44 45 46 .^esrational age �Graph 4 nrSTHIMUTlON OF DELIVERIES BY GESTIONAL AGE AND MATERNAL AGE GROUP 1U M A T E R N A L AGE GROUP - 20 2 1 L'ii 2fi 30 — — . - 3 1 3t> 3 0 '10 (II g e s t a t i o n a l age ���Graph 7 :JJ.th 4-100 25th PERCENTILE '1000 '.11)00 IHOO ;MOO tola I 2200 — • — • - n o i i A i II[fl 2000 l i J t i II 11)00 lt>00 1200 . born up to 1/7/76 1001 .. born after 1/7/76 nooj4~3 44 45 46 " gestational age ��light Graph 9 1-100 75th PERCENTTLE •1200 'IOOO .mot A :i io :ioo 2-IO A,in - - no,, .<! . born up to 1/7/76 .. born a f t e r 1/7/76 ft 36 37 3fl 30 40 41 '\2 13 14 45 46 yestational age � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 095 Folder The folder containing the original item. 2418 Series The series number of the original item. Series IV Subseries IV Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Bianco, Vanda L. Meazza G. Remotti Title A name given to the resource Typescript: Obstetric Monitoring in Brianza de Seveso From 1975 to 1981 Subject The topic of the resource congenital birth defects https://www.nal.usda.gov/exhibits/speccoll/files/original/2076a32169f5515dfd6eaec1ffc42fd5.pdf 865713cca0d38dc0853ccfd6fd8b22b3 PDF Text Text Item ID Number °0671 Author Corporate Author Report/Article Title Re Port on Survey MDL/2: Prospective Longitudinal Epidemiological Survey of Clean-Up Workers at Work from 1980 in High-Contaminated A Zone Journal/Book Title Ysar °°00 Month/Day Color D Number of Images 112 DOSOriptOn Notes Alvin ^- Young filed this item under the category "Human Exposure to Phenoxy Herbicides and TCDD" Tuesday, February 20, 2001 Page 671 of 680 �SURVEY frDL/2 PROSPECTIVE LONGITUDINAL EPIDBMIOLOGICAL SURVEY OF CLEAN-UP WORKERS AT WORK FROM 1980 IN HIGH-CONTAMINATED A ZONE Research team: I .Gilessi (coordinator} G.Asseimato P.Braaibilla P.Canziateili L.Measza F.Merlo ?.MocarelIi F.Sicarello �SSPOST ON STT2VEY MDL/2 PROSPECTIVE LONGITUDINAL EPIDEMIOLOGICAL SZJ2VBY OF ..CLEAN-UP WORKERS AT WORK FROM 1980 IN HIGH-CONTAMINATED A ZONE. INTRODUCTION In A zone contaminated by high level of TCDD following the ICMESA accident the clean-up operations started in the stammer of 1980. The existence of a real risk for clean-up workers is demonstrated by the experience accumulated in the last years as a result of similar operations at various European industrial plants in Europe. Four years after the contamination episode at the Badische und Soda Fabrik (3A5F) ( two years after the reopening of the plant a new case of poisoning occurred in a worker who had been repairing an autoclave; during the operation he had several tines lifted his protective mask to wipe off the sweat. Four days later1 dermatological manifestations and neurological symptoms appeared; six months later he was admitted to hospital for pancreatitis ind hepatomegaly; nine months later he died; pancreatic necrosis, liver abscesses and chloracne on the trunk were found at necropsy The Clean-up procedures at the Coalite plant in England were inadequate: after the clean-up,79 cases of chloracne occurred in workers not e:eposed at the time of the accident. Numerous cases of chloracne developed among workers engaged 021 t± initial clean-up at the Philips plant in Holland. In the subsequent dismantling of the plant strict personal protection was enforced among the workers, who had to wear ventilated overalls, and * clinical surveill.ar.ce program was set up centered on the ova lutation of biochemical parameters before the event and subsequently. at re-ju �iar intervals. Wo major deviations from normal values were observed in the ten workers who complied consistently with the prevention procedures. In two other workers who had been sent to the contaminated zone to dilute the contents of some tanks with water and who had worn on the overalls correctly one or more liver function parameters were found to be abnormal eleven weeks later; the values slowly normalised in the weeks that followed. In no case were there dermatological manifestations. The Philips researchers concluded that the working methods were effective in preventing exposure to TCDD. Notwithstanding the vast quantity of data on TCDD that has acculated since the Philips episode, a public health surveillance program still has to be based on the observation of biological parameters whose behavior may indirectly reveal exposure to the poison by showing its early effects (early effect indicators). Direct monitoring of the intake of the poison (dose indicator), up to now imply the biopsy of adipose tissue and it is not proposa ble as a continuous nonitoring of groups of active workers in a plan of public health surveillance. 2 - M3TEGDS 2.1 Objectives The general objective of the survey 7;as to gauge the efficiency of tlie safety sieasrares taken during the clean-u? of areas A*-A3. Tlie safety measures rere taken, to prevent any significant exposure to the poison but, going by previous experience, possible e::posure could not be excluded. �2.2 General desicn of the study The design v/as that of a prospective controlled study (almost lilce a trial) comparing clean-up -workers and reference groups. The parameters of interest (essentially clinical signs and symptoms, biochemical parameters) were measured before, during and after the period of potential exposure, in both groups (Fig. 1). 2.3 Population under study The groups under study vere selected at the .^replacement examination. The subjects vere sent by the firm handling :.hs clean-up to Desio Hospital. None had previously been engaged en clean-up operations. The preplacement examination took place in trsro stages: first 35 clean-up workers vere selected and then a month later another 37 subjects ^rere chosen, 36" as controls and 1 as a clean-up worker. 2.4 Preplacement examination. Data collection. For every subject the preplacement examination included: 2.4.1 In t ervi ev-cuest ionary 2.4.2 History and physical 2.4.3 examination Laboratory tests 2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram (ECG) 2.4.7 Chest X-ray 2.4.1 Intervi e^-quest.ionary The main purpose was to obtain informations for the comparision of the clean-up workers with the controls. �The interviesz-questionary was administered, by two trained interviewers at the time o£ the medical examination. The questions included:universal variables(like years of schooling, marital status, telephone, working history), habit (drinking, smoking-), drugs intake, family history and personal history with special reference to liver disease and skin diseases. A copy of the questionary form is attached in Appendix A. 2.4.2 The history was taken and the physical examination done by occupational health specialists of the Occupational Health Service of Desio Hospital. A copy of the case record form used is attached in Appen<Sc B 2.4.3 Laboratory tests The following tests were done: 1 - Glutamic oxalacetic transaminase (SGOT or AST) 2 - Glutamic pyruvic transaminase (SGFT'or ALT) 3 - Alkaline phosphatase-(AP) 4 - Gamma glutamyl transpeptidase (GGT) 5 - Bilirubin £ _ Cholesterol 7 _ Triglycerides o „ Surface antigen of hepatitis B Virus (HBsA.g) 9 - Electrophoresis of serum proteins 10 _ Blood cells count plus platelets and differential 11 - Total urinary porphyrins 12 - Urinary dejta-aninolevulinic acid (ALA-U) Most of the parameters were chosen because TCDD is hepa totoxic and affects the lipid metabolism. An increase in SGOT-SGPT is to be regarded., as an indicator of cytolysis-, an increase in GGT as an indicator of enzyme in �duction and an increase in AP as an indicator of biliary stasis. The urinary porphyrins vere determined because TCDD is known to exert a porphyrogenic effect. 2.4.4 Lung function test 2.4.5. Neurological examination, nerve conduction velocity, EMG 2.4.5 Slectrocardiographic examination 2.4.7 Cliest X-ray examination 2.5 Selection of groups of clean-up workers and controls The criterium of eligibility was the fitness of the following parameters: 1 Males between 18 and 55 years old 2 JTo clinical signs of acute or chronic diseases such as viral hepatitis, diabetes, chronic liver disease, skin dis ease, etc., 3 Results within the normal range for the following laboratory tests: SGOT,SGPT,GGT,AP,Serum bilirubin,RBC,hematocrit f her--i globin,WBC and differential counts,platelets,urinary porphjyr 4 Ho clinical or instrumental signs of peripheral hervous~sys 5 Normal ventilatory function test. Out of 112 candidates only 72 were found eligible for the clean-up work and entered the study. Grounds for exclusion <jrere medical problems (Irver disease( a normal values in laboratory tests), problems relating to the nature of the u'ork (abnormalities of ventilatory function -/it! reduced tolerance to the wearing of a mask). 2.5 periodic examinations According to the protocol, svery subject had to be examined every 6 months. Moreover, b~ regional lav the clean-up vor^e had to be examined every 3C working days un~il the end cf the �job. The periodic examinations included physical examination and laboratory test as required for the preplacement examination. ' 2.7 Final tests The final tests were done 6 and 12 months after completion of the clean-up job. 2.8 Data analysis Given the sample size the power of the tests used was estimated and proved to be adequate for the design of the study. The frequency distribution for the demographic and other variables (Table 1) was reported. For comparing this distribution the chi-squared test for independent samples was used. For the comparison of the continuous variates (Figs. 3-26) oneand two-way variance analysis was used, by group (clean-up and reference workers) and by, test (tests done at successive examinations), using the SPSS program. All tests were rated significant if the probability depending on chance was less than 0.05* (with two tails). Discriminant analysis was done with a program developed by Davies. The logic of the discrimisnt approach lies in the fact tjiat significant differences could be identified for the entire battery of -rests used, where for a single test no significant difference emerges. HS3ULTS The results of the ^replacement examination and of the firs- 4 periodic examinations are reported here. The results will also be shOwT. for the subset of incividvials wich underwent all the periodic tests. �The data are also presented according to the number of hours worked. The time trend of six selected parameters for each worker is also indicated. 3.1 Response The outline of the study design and follow-up response are sho\..i in Fig. 1 . During the follow-up two of the exposed workers died in a road accident. One missed out after the first follow-up and yet anotherone after the second Another four failed to attend for the fourth follow-up. _ In the reference group the response rate was low: five failed to attend for the first follow-up, seven for the second and third and another six for the last (response rate « 65%). Among the clean-up workers the response rate was 100% of those present on the job, who needed to comply with periodical control and to be passed fit to continue working;. The fail in the response" rate at the last follow-up was due to ex clean-up workers (those who had for various r-s* sons given up working- in the zone) . In tha reference croup the low response rate was due to distance from tha place cf residence or to emigration to other areas. One control subje after the first follow-up was included among the clean-up "/or! ers and from that date ha was s:ccludec from the data analysis 2.2 Base data 3.2.1 Int erview-cues t ior.ary One of the clean-up workers and four -of the controls were not interviewed, tnter-croup comparability in respec" cf certain characteristics is indicated in Table 1 . Age, sc ucation, marital status, smoking, drinking, previous exposure to heparotcxic substances and liistorv of skin cis- �ease presented fairly similar distributions in the two groups. Significant differences were found in respect of history of liver disease and possession of a telephone at home, which proved to be more frequent in the reference group. 3.2.2 Laboratory data Of the laboratory tests done those most relevant for statistical analysis are the ones that, according to the scientific literature, seem to be correlated with exposxire to TCDD, viz.'urinary porphyrins, liver enzymes, serum cholesterol and triglycerides. The results of the WBC, platelet, serum protein, albumin and gamma globulin tests are also presented. At the preplacernent examination no significant difference was found in the variables studied, except for alkaline phosphatase, the mean value of which was higher in the reference group. 3.3 Follow-up results kDuring the follow-up period nine workers left the job for reasons unrelated to health. Five workers were rated no longer fit and r/ere dismissed. The grounds for unfitness were: 1 - in siibject 12 abnormal SCOT (42 mU/ml) and SCOT (75 aU/ial} values in t^/o tests, in October and December 193*!: tiiese values returned to normal in subsequent tests. 2 - in subject 13 severe hypertension (135-125 rnmKc). 3 - in subject 14 a slight increase in GGT. 4 - in subject 15 persistent presence of H3sAg. 5 - in subject 27 use cf antiepiieptic drugs. These subjects continued to attend for follor-up examinations according -c the program for ex clean-up workers. Another subject cave up tl:e job a fev; days after starting because he cculc �not stand the mask and was lost to follow-up. 3.3.2 Clinical evaluation No case of skin or neurological disease occurred. Clinical examination revealed nothing noteworthy. The percentage of subjects with hepatomegaly did not differ significantl in the two groups; the higher percentage among the cleanup workers might be due to the fact that the doctors were not "blind" (Fig. 2). Mo significant difference emerged in respect of weight variations. 3..3.3 Laboratory data The analysis was dene separately for all the cases in the follow-up period and for a subset of subjects whose data were available for all the periodic examinations (except the last). Dispersion charts for 10 out of 14 laboratory tests in th; first four examinations are shown in Figs. 3-26 together with the means and standard deviations. 3.3.3.1 Urinary porphyrins (Figs. 3 and 4) ITo significant difference was found between the t groups at successive tests but a significant c:-/f ence was found for both croxips between tests dens successive times. But the values were within r:.or limits, well below threshold values. The same re suits appeared for the subset of subjects air/ays present. 1 1 o 3 * J . J • £. <;r'i",r^ CPS*** f ~ - CS i Urvj A. — a«jr"i \ V-t~s . *.3 ,£. f *? f O , ' O / o^ Mo significant difference was found, except fcr 3 at third follow-up, when the mean value cf t«s *:••: posed (17.75 iBC/ml) was higher than in the r.cr. e:-:; posed (14.28): this difference ~-as also sicr.ifica within the subgroup of ever-present subjects. �10 3.3.3.3 Alkaline phosphatase (Figs. 9-10) The significant difference observed in the baseline test disappeared in subsequent tests. 3.3.3.4 Gamma GT (Figs. 11-12) 3.3.3.5 3.3.3.5 3.3.3.7 3.3.3.8 No significant difference was found between the two groups in the successive tests but a significant difference did emerge for both groups between successive tests. Bilirubin (Figs. 13-14) Serum total bilirubin behaved in the same way as GGT. ALA-U (Figs. 15-16) The same applies to ALA-U. Cholesterol and triglycerides (Figs.17-18-19-20) Ho difference was observed. Other laboratory tests * ! A significantly lower vTBC count was found in the clean-up workers at first follow-up (Figs. 21 and 22) and the same applies to platelets (Fig. 23). -The serum total protein value was higher than in the controls (Fig. 24) and a lower mean serum albumin (Fig. 25^ in the .clean-up workers in the.preplacemeat examination only in the subgroup of the ever-present. A significantly higher gamma globulin value (Fie.26) was found in the clean-up workers at second followup. 3.3.3.9 Analysis of the biliary data In order to identify deviations from the normal values, some variables were converted into binary data, above or below the threshold used at tl:e ^replacement examination. The frequency of ovitside range values was too low'for statistical analysis: r.o r.orercrt.v<$•' 6 •• �11 3.3.3.10 Discriminant analysis The dispersion chart of the scores obtained by discriminant analysis of the values of eleven laboratory tests is show, in Fig. 37. Mo significant discriminant function was identified. 3.4 On-job hours and laboratory tests The clean-up workers were divided into three subgroups by the number of hours worked in zone A at the time of the second follow-up. Seven had worked less than 200 h, nine from 201 *o 400 h and twenty more than 400 h. JTo significant difference iin the mean values of the lab tests was found at the first and second follow-up (Table 2N-. 3.5 Individual assessment of the clean-up workers It must be stressed that, while the program of tests for the reference group envisaged an examination every six months, the clean-up workers und'ertrent medical checks every 30 days as lor they continued on the job. The number of examinations of th:« •group was between 2 and 20 (mean 12.41). In the foregoing *'•'-, * analysis we have considered only the five for which the contro data are also available. Figs. 38 to 73 show the time trer;-*-. of six selected parameters (porphyrins, 5GCT, A?, GGT, cholesterol and triglycerid.es) for each worker. The analysis of the test shows that in ten cases (nos. 4,10,16 20,22,23,27,37,32 and 35) 210 variables increased by more than 100% of the baseline value curing the follow-up period; in thi teen cases (nos. 1,2,3,3,6,14,15,13,19,25,29,30 ar.d 33) f:ere was an increase of more than iCCf. in at least one parameter bvi always within the normal rar.ee. In another thir-eer. cases ''-i 3,3,11,1 2,: 3,17, 21,24, 26, 2S, 34,36) there was an increase of .,-,c than 1 CC'= in at laast ons sarsnister wi~h values bevond the ?.c~* �12 range: in six cases the increase was in the triglycerides, in three in alkaline phosphatase, in one the urinary porpliyrins and triglycerides, in one case transaminase and triglycerides and in one case GGT. CONCLUSIONS The program of surveillance for the clean-up workers in area AlA5 of Seveso was undertaken to check the efficiency of the safety measures taken during the clean-up operation started in May 1930. The principal conclusions are: 1. During the follow-up period no case of clear clinical disease that, could be attributed to TCDD (chloracne, peripheral neuropathy, liver disease, etc.) occurred. 2. Of the five workers rated unfit after the commencement of the job one had abnormal liver enzyme values in two tests, which subsequently normalised. There was no known cause of the increase and so a transient effect of TCDD exposure cannot be excluded, 'although the contemporaneous weight gain (more than 15 kg) may suggest nutritional causes. 3. Mo definite difference between clean-up workers and controls was found in respect of the laboratory tests. The .same conclusion was reached when the data were treated as binary data and discriminant analysis was applied to i3 lab test variables. 4. The analysis of the time trends of six variables in the cleanup workers shows that some variations occurred in the triglycerides: these are, however, :r.ore likely to be due to biological variability or to insufficient precision in analysis. In sum, the survey failed to show biologically significant features �13 such as to suggest that the workers engaged on the clean-up operations in the highly contaminated zones can have absorbed TCDJ5. The safety measures adopted seeni to have provided effective protection for the v/orkers. Desio, 30 July 1983. �TABLE 1. Distribution of Detaographic and Other Variables in Clean-up and Reference Groups Characteristics Mean Age Education (Tears completed) 0-5 6-9 10+ Clean-up Workers Reference Workers 31.2 C-.74 3. 7 2. 13 15 7 < Ch£ s ? j ' 9 ^|5 19 10 3 Marital Status Never Married Married Separated, Divorced Widowed * - 19 10 0 . 1315 2 Chi sq.-j3.54 £u£ Smoking Habit (Cigarettes/day) Non-smoker Ex-smoker Less than 20 20 or more 1 1 2. 11 11 3 5 7 12 Chi sq.-2.56 Alcohol Consumption (cc./day) 0 Less than 40 40 or more 7 9 19 Chi sq.-l.13 6 12 14 Previous Exposure to Hepatotoxic Substances Yes No 3 32 Chi sqf-|.33 7 25 �•i TA3LZ 1. Distribution of Desographic and Other Variables , ' (Continued) in Clean-up and Reference Groups Characteristics Clean-up Workers Reference Workers Telephone at Horns Yes No ' 13 22 . 21 11 History of Dermatitis Yes No 6 29 Chi . 9 23 4'29 Chi sq,-$.25~ 12 23" History of Liver Enlargement Yes No Past ?hysician*s Warning on Liver Disease Yes No 4 32 Chi s '^Significant at ? less than .05 4 28 �f 1 !-..i? »esulls of various laboratory tests (mean and afrwJW (tt\»latio») at the ^re-employment examination, after 3 and !) monllts in uorkorSt^lvidetl according to the number oMiours spent in AT, A2 zones" Number of hours Total urinary porphyrlne (^icj/cj.crcat.) SCOT (U/l.) SGPI (U/l) Alkaline |»hosfaUse(U/L) Uaiiima-GI (U/l.) Total D i l l nib ln(Mj/dl) I'M (sue) llciuoijlouin (y/dl) HIC (xl0 3 /«»u 3 ) less than 200 fp m 201 to 400 l 1 pre-uN|>l.ex. 3" mnrith ex. 9 " month ex. |re-eiM|il.ex, 3rd month ex. 9 ln month ex. 09.20 (47, 26) 60.43 (IG.67) 93.57 (S4.&&) 75.09 (3f.$*j 01.00 (2T.O&) 96.44 (44.20) 70.55 (38.01) C6.9f> 20.71 (LSI) 10.03 (6.06) 10.29 (4. |»fl) 15.66 (2, 70) 14.67 (2.J2) 12.67 (3.24) 15.20 (3.02) 14.75 (*.,'.«) 13.60 (3.D. 23.71 III. 32 ) 23.06 (&.03) 20.33 (3.67) 34.03 19.14 16.70 (&.V3) 34.67 (IJ.2B) 14.09 (3. 10) 37.11 (6.4&) 12.00 (2.00) 33.56 (7.04) 17.70 (4.07) 27.20 (fi. 71) 19.35 (ii.Oi.) 32.15 (7.61) 16.110 (fi. ?2) 27,71 (5.02; 30.00 (10.07) 31.67 ' (J2.14) 26.29 (fO.97) 10,70 (12,36) 23.11 (12.00) 20.56 ( 7.62) 17.95 (0.0 J ) 20.115 (7.2J); in. us (x./ .62 (,J7) 26.29 .69 (.16) 29.59 (2.57) 16.51 (.9.1) .66 (.13) 25.55 (2.33) 15.64 (.73) .65 (.12) 26. GU (2.00) 15.65 (.7G) .67 (.7; 20.77 (/lu.16 ( . 1* 6.09 (1. 10) 193.25 (34. GO) 6.'J/ (J.lrt) 206.20 f<i7.3&) 6.ir> ('•' .73 (.13) 27.25 (2.43) 15.1)0 (.ifl).» I'laltilcts (xlO3/™3) AllHMln(g/dl) 4.00 (.220 f HHI/jll ) 9 ' HKHitl 71.17 (24. 19) 6.46 (1.60) 216.14 (47.34) (i.iiiiua-GlobuUne (<|/dl) Cholesterol Scrum level (my/Mllt I t lij]y«:«!r idc^ more than 400 (iru-cutpl.ex. 3 Mionlh ex. 1.02 1.12) 242.43 (60.30) 1-U5.43 , ..... (a. la) .50 (.16) 27, 511 (3.22) . 15.93 j (.34) 7.15 / .67 .66 (,ie) (.IB) 27.06 29.67 (3.2?) 16.31 f.fiff) p5.4fi) 230.17 (43.06) 6.06 (I.flfi) 222.00 (40. 0fi) 4.97 (.45) .96 ((. ?D 16.06 (.00) 4.9U (.3C J .94 (.12) . 223.50 ft 7. 60 j 155.17 6.73 (1.30) 200. U9 (42. If) (2.2r; 16.01 (.02) 6.ni 6.67 (3.2SJ 209.56 (44. U) 200.71) (36.77) 4.96 (.«) 1.17 4.29 (.16) 1.15 (.22) (.12) (I. 72) 4.62 (.33) 1.22 (.17) ID4.7U (33.2fc) i?2.G6 (.11) 215.71 (63.&0) 131.1)0 j J J92.70 (30. 00) 109.66 192.09 (20.55) rUC.Sfc" 4.70 (.33) 1.21 (.20J 174.11 ( 25.22) 101.37 /.1/J.H.SI /40.&£<; •; * ±..42* ( 42.3fi) .4.70 (•36) I.H) (.20) 179.60 ^23. 61) 'b.y Ulii.Zll) (2/. (a. ; 2U.70 (/. I'Jfi.ifO (3« 5.05 (-1 1.16 <"-J ID3. no ( 2' 134.30 (•'•• �'IG. 1 OUTLINE OF TEE STUDY DESIGN AND r'OLLOW-Oi' CLEAN-U? AND REFERENCE GROUPS List o Workers Eligible (n-72) Non-Eligible (n*41) Preplacsmenr Examination Clean-up Workers (n«36) lesDoncents Non-ResVxondents Controls (n*36) Pvescondents Non-Respondents 1s u Follow-un •* 2 _ ,i Fbllow-un 3rd FoUow-UD 4 Follow-ID �FIG.2 PROPORTION OF LIVER ENLARGEMENT AMONG CLEAN-UP AND CONTROLS. CLEAN-UP YORKERS CONTROLS X Llvor F.nlnrrjniiiQntG cm. orO. 5 1 JAM 1- 1 1 1 1 JAM JAN �F i g. 3 • URINARY PORPHYRINS VALUES In cloan-up and refGrQnco groups (mcg/1) C 11 U R R ii 10 ,,. ** *• "• -i- tt +-H- if, J *Mi Tf ii o0 * i i I .,1 *•• -r •i- ^ EXAM i �; . - '•• 1 , ' j r i F i g./4 .URI NARY PORPHYRINS (mean'sd) in cloan-up and reference groups qmx* i cloan-up \zzz\ GKflMP 2 rufarancQ KXX) EXAH | EXAH 2 !ii|Mii If leant betwucii-bxautt mena d EXAH 3 , HXAH 4 EXAH 'J �Fig. 5 S GU VCllUQS in clean-up and reference groups 1.U./B.1 'C* -f K R R R .,.(09) (51) 0 \ 10 i i t i in i tt o EXAM • i • • �: i Fig, 6 S, G, 0, L GnQan+sd) in clean-up and referenca groups CROUP I ctiCHT-yn IZZZ3 GROUP 2 reference [XXX] EXAM I i: Hcnut EXAM 2 EXAM 3 EXAH 4 EXAH 5 a inetm m �V'* . •'*: Fig.7 S G P T values in clean-up and reference groups ,' — ,'/••, l.U./ml /. ( a 0 (64) 0 V )0 fc t r| |- I Hl * 1 1 t* V v trf 10 • -1- :t o0 EXAM • i • » �:?&•• Fig.S ALKAL PHOSPHATASE valuQ in clean-Up and reference groups o R K 1.U./1 R C •h,(53) I I- 11+ I- ft; iO I: + 1 » tt + n 4 , t tr tiI-K *4 ** + 10 0 EXAM I > >tf' ,. *: «• +H i 0 H �L .i I j u ..i S. G. P, T, ir» clean~up and refer once groups CROW* i cJuorruv) ^ 67eWF 2 rafanmcQ 1XXX) W 0 EXAM 1 EXAM EXAH3 EXAM 4 L'XAH 5 �F i g:10ALKAL, PHOSPHATASE (mean+sa; in cjQan-up and reference groups l.tk/1 .WJP I aon-Mp ZZJ2 foroncQ ''10 0 EXAM 1.- EXAM 2 EXAM 3 Hi|;nt.fleant l>etuceu~^&-o|i|ia |iiona*difference. -..-•** «•- EXAH 4 EXAH 5 �•pi Fig.tl G G T P vciluQs in clQcnvup and rQfQrQncQ groups 1 * c LU./I R c ' n -1 1 (55) H +(51) 1 . 1 -|- -f -I- •l- C ft +(b7)-l-(b1) -II- -1•1-.•.,. •1- ** ;: "1** h II. t 1. *l* i1! 1 1fo J 1 i .,. 'K 1 '., ., f +f ^r 1 -II 4- i .'I | •|* .1. " -1- 1 •* f *•* -1^ If ' r" 't •!• -ftt.- I* *+ „ t ^ \ 11 4- w A .,. ,. -I- \ If +1 *]> tit i T*H- t V + T •1- + + • H- -|-|. 'I, •11 n *'" T •1- •!• "1* -Hfl- R +(52) -1+ 1- .•-,. 'C ' t 4 + •I- . i 1 i EXAM • • I • �Fig. 12 G,G.T,P. (rnean+sd) in claan-up and rcfGrenco groups I.U./l cJucuruo CROUP 2 rafaranoB fXXX) 40 0 EXAM S ,n if Scant EXAM 2 EXAM 3 EXAM 4 EXAH �vu i in cloan-up and rGforence groups R R R MCJ .4 1.2 1.0 l III II •H-f III- l-l- .0 •il-l •I-H- .0 •I- h II- tH- •i-i- •H-l- •nI f+ 11 •i- •in- •n- ^-^ ni•n-i- h I •n-i- i •i-i-i•in- ii i n> .2 ii h 0.0 EXAM . S//7V/.*&, • V-Vt �J t *.— J H. ti Fig.14BILlRUBIN (moan+sd) in clean-up and PQfaronce groups I cJorrt/) t//) Z) KXX1 o L-XAH 1 EXAM 2 inn 3 f leant l>ctwcun-exjuii«0 EXAM 3 (Ufterejice. EXAH EXAM 5 �Fig. 15 U - ALA values in clQan-up and rQfQrQncQ groups 11 R •g/1 (t •It G I * t ll-l- f| *•* I I f 1 4 t\ -I- 4 t ++ 't f* -II- ft t 0 EXAM • i » i �-). i: i Fig. 16 U - A L A dnean^sd) in clQarrup and rcfenQncQ groups cjaorrwi IZZZ1 2 rafaranca IXXX1 o EXAM I 8 i I'M i. if leant EXAM 2 EXAH 3 mean EXAH 4 EXAM 5 I J :*- 3 - �Fig.,17 CHOLESTEROL values in clean-up and reference groups t »• t t *+* T t* ** » A n EXAM K + • �i = ! t- J F i g, 16 CHOLESTEROL L.:. j u i «- 1 L. I' i. 1 l. (inean-«-sd) in clQQn~up and raferonco groups 300 ng IZZ CROUP 2 IXXX1 200 100 0 \ CXAH I EXAM 2 CXAH 3 EXAM CXAH 5 �F i g.19 TRIGLYCERIDES values in clQan-up and refQrQncQ groups it U K R ^.(6/0) «. •I" I ^.( 329) 4. (300) -f- +* ... •I- ' * 1 1 ... '1= ** «.. 1 + 1.i. •i.1 i ! *? tit -J-. :j: J -j'H' :' |+ : 'M ,;|; *t ^':| 1, *+ + + 1 t * tTil "•"<" 4 t H + f *, - -f . I] '|| .:-- | | | .;. ^ * * ** tl +*+ t a. iL'l* - . . 4.r-(- 1 + * J'l l */ . . ; * *• ! « 0 1 t ''^ *i * * t / ft ' EXAM * I * fc I * * 4:|- -t+tr '; '» • '<t aL « + ' i 1 t* * • i I1_ �Fig;2QTRIGt¥GERIDES (niQan+sd) in clQarrup and reference groups GliOUP I cluarvp 300 I7-771 GROUP 2 referancti KXX] wo - 0 HXAM 1 EXAM 3 EXAM 4 EXAM S �> Fig.21 LEUKOCYTES values in clean-up and reference groups / MtttQ \\ K H R •I* •ii + \ •i t * . i V +1- ti H:|: :: *h ' • it * oo EXAM *. t 4* ;. �i £~:.; « -. j ; F ig.22 LEUKOCYTES (mean'sd) in c)Qan~up and. reference groups /«rao CROUP I zz IXXX1 o EXAM f EXAH ^ Hi I'.ni ficnuL iiel:wccii-Biioui>B EXAM 3 EXAM 4 EXAH 5 �F i g.23 PLATELETS (meon+ed) in cloan-up and roferonce groups CTrtJW* I cJanrrt/p 400 /•mo 17771 2 rtiforoncQ Ixxxi 200 0 EXAM i EXAM 2 EXAM 3 " SI I mi If tcnnt liQ|.wiicn~exaroa menu difference, EXAM 4 EXAMS �, . 1.. .. . ; - ' - • t""J .-- .; L. , . Fig..24 SERUM PROTEINS (mean+sd) in clean-up and rofo^QncQ groups CROUP 2 roller onca fXXXI o EXAM 1 F-XAH ^ EXAM 3 EXAM 4 EXAM 5 �Fig.25 ALBUMIN (mean+sd> in clecm-up and reference groups GROUP i 100 c hum-up EZZJ GROUP 2 rnfnronca 00 20 0 EXAM 1 EXAH2 EXAM 3 EXAM 4 EXAM S �1. i F i g. 26 ^-GLOBULINS (mean-'-sd) in cloan-up and pQferencu grou|i9 GROUP 2 rnfttrflnco V77777A i l-XAH i EXAM 2 EXAH 9 .'«ii>nifleant j>ct:wecn-ftroupa nieiuf (Difference. l-XAH 4 EXAM 5 �Fig,27 PORPIIYRIN PATTERN IN CLEANUP AND CONTROLS, DY EXAM (CUT-OFF=250) CUE/UNI' HOUHAI. 50 NllMHiR «: SUBJECTS ci r.AN-in» AIJNOKMAI. NURHAI. IZZZJ 30 ADMOHMM 20 10 0 EXAM I EXAM 2 EXAM 3 EXAM 4 �I "3 f I. I fiq.28 SCOT PATTERN IN CLEAN-UP AND CONTROLS, BY EXAM (CUT-OFFMO) CMIAN-lf* NMIMAL 50 NUMUBl OF SUUI£CTr> AN II' MOfvHAL KXXX sxxx 30 CONIROLS M1HOHHM. 20 10 CXAM I EXAM 2 EXAM 3 I-XAM 4 I �fig.29.SGPT PATTERN IN CLEAN-UP AND CONTROLS, BY EXAM (CUT-OFFM2) mmin* [IZ II l 50 CLEAN UP ADMOIIMM. 40 CONIHOLS NURHAL \ZZZ\ NUMBER (H: 30 CQMIROL8 ADIJOHMM. 10 0lEXAH 1 EXAM 2 EXAM 3 EXAM 4 �J . 1 . I v'~1 Fig.30 A.P. PATTERN IN CLEANUP AND CONTROLS, BY EXAM(CUT-QFF=50) Cf£AN-U> 50 mm OF NORMAL IZZZI CLFAN Ul» AI1NOUMAI. CONIKOI.S NURHAI. \ZZ73 IXXXXl • [7 30 COHntOLS ADIIOHHAI. 20 10 0 IIXAM 1 EXAM 2 EXAM 3 EXAM 4 �Fig:3t GGTP-PATTERN IN CLEANUP AND COMTROLSrOY EXAM(CUT-OFF-50) QJ JFJUHJP NHW. 50 NUHOtlt OF SUBJECT?} CI.KANUI' ADNOUMAL JXXXX CONIROIS NORMAL IZZZJ IXXXX 30 Cl)WIU)L!> AONOiiMAI. 10 / 0 EXAM 1 EXAM 2 EXAM 3 l-XAH 4 �Fig.3.2 BILIRUBIN IN CLEAN-UP AND CONTROLS, BY EXAM <CUT-QFF=M) (LEAN-UP NORMAL I | 50 NUHOER OF SUBJECT^ CLEAN-UP ADNOHHAL COMllfflLS NORMAL izzzi CONVBOLS ADNQKHAL 20 10 0 EXAM I EXAH 2 EXAH3 EXAH 4 �Fig.33 WBC PATTERN IN CLEAN-UP AND CONTROLS, OY EXAM (CUTOFFS. 5) 50 NUHIER OF SUOJECTp C1.EAN-UI1 AHNOUMAI. xxxx COMTROLS MDRHM, IZZZ] 30 CONIHOLS ADHOIJHAL 20 10 0 EXAM 1 EXAM 2 TiXAM 3 EXAM 4 �i J • \ f\g.34 U - A14 PATTERN IN CLEAN-UP AND • CONTROLS, OY EXAM (CUT-OFF=6) MUHI)L:II (M: SUDJECTS NORMAL Cl I AN W ADNOHMAL com iaiis NORMAL IZZZJ CONTROLS AONOIiMAI. sxxx; 30 10 CXAH I I : XAH2 EXAM 3 UXAM 4 �FigJ35 CHOLESTEROL IN CLEANUP AND CONTROLS. OY EXAM(CUTOFF=270) EAfH»> 50 NUMfO OF SUBJECT? CIITJ CII:AN IH» ADHOIJHAl. tin CONIHOL HORMM. IZZZI 30 CONTHOI. S ABtiOHMM. 20 10 0 EXAM 1 F.XAH 2 EXAM 3 EXAM 4 �Fig.36 TRIGLYC. IN CLEAN-UP AND CONTROLS, BY'EXAM <CUT-OFF=1GO) OF 50 NORMAL Cl.nAN-UP AIMUIHAI. CONIUUl.S NORMAL 30 CONTKOLS AOHOKHAL 20 10 0 I:XAM EXAM 2 EXAM 3 EXAM 4 �OH 13 1J\IK)HATOUY TESTS IN CI.EAN-UI* AND REFERENCE GROWS. BY EXAM. CLEAN-UP VOKKERS REFERENCE tt u 1 I +1 t • t t. 0 ••• jn Jl* *r* 0 •I-I- <* •i- •', 0 Iftt 2. 3 EXAM • • • » �iq.38TIME TRENDS OF 6 PARAMETERS I N CLEAN~UP-WORKER // 1: S.P.,25 yrs I Variation 200 " uu 0.0. T. linu- 20 100 « JMHSP. 33 \ 4 0 C.T.I*. i l l . H P 10 CIKM, 100 (UCI.YC. (thiur-112 •200 JAM JAN �Fi«,.39TIME TRENDS UK b J CLEAN-UP WORKER // 2: G.G..32 y 200 0.0. T. ollim-IO 100 X -XV / U'llOW. 0 1 .C.T.I . m i ^NN -\A-^ V 1 •* -» ^^ CIKM, -100 -200 JAN/ \ \—- i I--.*- *— *- ^^*.?. \ JAN JAN Mlow-vp pariait <3~IW 12-Q2) * • • • • ^y¥*» • • • « • • • •* �Fin. 40 TIME TRENDS OF 6 PARAMETERS J CLEAN-UP WORKER #3i V. F., 39 yrs 200 IYIIINO ,O.T. 100 . 0 i. T. I'. »_ -^- • •* '\\ yVi *^V"'\ ;/r ' lt**-*'^^~*TfX V-7 • ' . N I KM.. -100 IOLYC. i \\i\(r-101) -200 JAM -i—i—t—t. (3-00/12-02) IN �Fit,:41:TIME TRENDS OF 6 l! . CLEAN-UP WORKER /M: P. V.. 34 yro Vur/ot/on IYIHNS O.T. fncr-H) mow. .T.I1. I i ii««20 )K)I.. KH.YC. lino'-M JAN JAN Follow-up porlod (3-00 / 12-02) �« . i i "J I LT.-J L... J I ! i ;l . j| L .J Fin.42, TIME TRENDS OF 6 PARAMETERS IN J CLEAN-UP WORKER ffSi I.S,,41yra Variation WINS O.T. \ MBSI*. T.I1. ML .•• . i«/•. ..••*.• / * * ••«•• IQ.YC. ^-n—.» »^i»,i M~nn/i?~n?} L. J L l t �® Rn.43.TIME TRENDS OF 6 IN CLEAN-UP WORKER //6: V. C., 27 yrQ V Variation iur-09 luv-M HSP. f.P. )L no.-100 Jl.YC. no-Ill) JAN JAN (3-W/I2-02) �E,:|.44TTME TRENDS OF 6£ARAME%RS J WINS m-lll O.T. incHV 'IIOW. .T.I1. 101.. lino-DO CLEAN-UP WORKER //7s G.N.,26yrQ IN �FU1.45TIME TRENDS OF 6 PARAMETERS IN . '• yxt i1^ * A • t tf^ ft ft/*\r"\i y f~* f*x fff/"\ f\ t~\ * /-\. CLEAN-UP WORKER //8: S. R.. 49 yra ^Variation .T. .1*. I.. JAN , JAN Follow-up pnricul (3-00/1^-02) �r. IN ft, .46 TIME TRENDS OF 6 PARAMETERS J CLEAN-UP WORKER //9s C. 2. ,?.d ypo. X Variation 300 IWIIYIUNS I u io« 11 no-120 I). 0.0.1. AUUMWfl* IJ.G.T.P. CUM., haool TIUCI.YC. -100 Eoll,0!«-i)n oarlail (3-00/12-02) / �Fin,47 TIME TRENDS OF 6 PARAMETERS J CLEAN-UP WORKER fflOiF.L.39 IN yra. X Variation .HHIN3 . i). T. llroHD 100 Uiw27 [J.T.I1. 0 tlliur-ltH UGI.YC. )llno«H7 -inn JAN _l—I—I. I—I—I—I,. I i—k—i—i—i—i—i—i—u _l—I—I—I—I—1—I—»- JAN . JAN Follow-up pnrlofl (3~0n/l2-02) �i 1 I 1 Fin48 TIME TRENDS OF 6 PARAMETERS IN CLEAN-UP WORKER //11«L. A., 30 yra. X Variation 200 IIYHINS • I'llOSI*. G.T.I*. CIKH.. UICI.YC. -inn «__! uirind O-flO/»2-U2) 1 1 1 1 1 1 t j i . .! �w, • ,3.43 TI ME TRENDS Uh b P AK AFlh I hi<b CLEAN-UP WORKER //12sM.R.,24 yra. X Variation 1J.O.T. THOU 1HH.YC. JAN JAN FoUow~ii(» (Kirlocl (3-00/J2-02) IN �io.50 TIME TRENDS OF 6 PARAMETERS IN CLEAN-UP WORKER //13? A.F., 46 yr s. X Variation IIYRINS .0. r. li/uHO I'IKJtJP. 5.P.T. 1101. llnu-HH ICt.YC. llim"100 �Hn.51 (I TIME TRENDS OF 6 PARAMETERS IN CLEAN-UP WORKER //M:G.C.,<I4 yrs. 1IYIUN5 f G.O.T. .illnnn22 (I.T.P. CIIOL IUGI.YC. JAN , • JAN Fol 1 ow-up por I (id (3-00/12-02) �•&.I i i C~j i.... i L.T'3 ) f '. J fin.52 TIME TRENDS OF 6 PARAMETERS IN J CLEAN-UP WORKER //15, S, G.. 24 yrs. TOtlNS 0.0. T. 0. T. |». UKK. UIW.YC. �Fia 53 1 1 ME TRENDS OF 6 IN CLEAN-UP WORKER //16«E.P,,30 yre. X Vori<itlon 200 MUM O.T. 11»«" 17 100 MK18I1. 0 liu-lOB arc. llinr-03 -ion <—' JAH JAM : ; JAM Follow-up porlod (3-00/1R-02) �i i • i L:.J L i L Fin.54 TIME TRENDS OF 6 PARAMETERS IN J CLEAN-UP WORKER #17iG.R.,35 yrs. Variation •no 10 II*. 3 217 c. r»U7 JAM JAN OAT 1 ml O-OU/12~D?.> L. J �Fiq.55. TIME TRENDS OF 6 PAKAMtlhKb IN w f^i r~ i ii t ir\ t.ir\r\i/r~r\ 111 f\ i r* *\ M CLEAN-UP WORKER //lOsA.C.,34 X Variation WIHS O.T. lna«!0 1WSI1. lnn«29 . P. T. IIn<H2 IWL HOC. JAN JAN Pol 1 ow-up pop I od O-tW \ 2-02) �J 4 i > I ( Fiq.56 TIME TRENDS OF 6 PARAMETERS IN CLEAN-UP WORKER //19: $. C., 23 yrs. 1WHIN8 B.O.T. .PI WIJI». 0. P. T. CIHM.. UW.YC. �in-57 TIME TRENDS Uh ti rAKAMtiuv CLEAN-UP WORKER //20: W. R.. 43 yrs. X Ytu'iatlon 200 1HN3 O.T. 100 'IIO'JP. lno«20 A . i». T. \ Ifll(V'H) n IH)L. llno-vOI) N. HJl.YC. inn JAN JAH JAN FoUow-up'parlcul (3-00/12-02) �,.96 TIME TRENDS OF 6 PARAMETERS IN CLEAN-UP WORKER //2h G, I.. 45 yro. K Variation 200 mim O.T. ton llnn-17 0 IMH.. IW.YC. iUiur-01 •100 !—«-*—•--•-* JAH JAK FO]|OW~U|> pcirloci C-J-IO/12-02) �•><• -.' -M fin. 59 11 ML TKbUb Uh u r'AK ' l I tK CLEAN-UP WORKER //22i E. 0., 35 yro. 200 IIYIUMIJ I.O.T. I i IMP 13 100 PI Mil*. U.T.P. 0 n n rt r* •* -- • —i. HW.YC. ulliuv : Ul •100 JAM JAN ' JAH Fol low-up'pnrlotl p-OO/ia-02) I I �Fin.60 TIME TRENDS OE 6 PARAMETERS '' . CLEAN-UP WORKER #23i F, C.. 40 yro. % Vcir lotion 1IYHIH3 C. P. T. HW.YC. JAM l-'nl inw-tin nnrintl O~iO/\?.' IN �Ro.61 11 ML J Wi CLEAN-UP WORKER. 024: M. V. , 34 yro. X Variation •OR T. IM. Inn»I73 ICI.YC. -100 JAM JAM JAM r | ollow-up jinrlod (3-00/12-Q2) •M i �'-•"'. « ... J i . J Rq.62 TIME TRENDS OF 6 PARAMETERS L i TM 111 CLEAN-UP WORKER #25; A.S.,51 yro X Variation il Intytf'J UH) G.O.T. BOO ./... 200 v100 CM'.. 0 i: ' •100 •-•*-'j— •- -••- -*-- *~• JAM ,.i—I....J. t_ i— i—i...»—i_.t...i JAM nnriml <3--fln / i . -' -< �a Ba.63 TIME TRENDS OF 6 PARAMETERS IN CLEAN-UP WORKER #2Gt A, G., 24 y ra Variation .JIJIJ 1 lYiwis • i i U. T. • i •! lilfl~ll • Illl: 1 / * •i*««i 'fill i.l ill / F . T. I . 1 llM"'i // '• /v /.j M 1 (1 /\ /\ » • % * * \ ' / -"* — t w*7 • J AN 1 1 1 f \l \ .t- t ... . 1 . .t . t l l l l l III i ••** •*-t^5^— — .•- ..V.-... .1. —— -.-T-t ^-O^ v-y "•~-N/VI^--\'K*-. X',*-^ ' \' » ^/\x* >» 1 'I I f f a .....A^^A^VV '""^ V-'i .. i nn lull • / \ . • A \ •"• ' A\._A../A ./ • •/ \ ,' ••' ••' i/ '•• ;•',) / if / o W.YC. I iiuHI7 A /I i x '~/\~ \~lr~ \~I"J\~ 7 \V \\ •/ '•• . *'• • • ; / ' \: i '•• --"\\\ i' '^ \\ \ 11)1.. lMG=177 f A / \ j __. .1. .. - 1 l..|. ; 1 1 A / « / -/ A \/\AH-\^ \ /ty«'-\ \ If in Mill A it i\ 1 1 II 1 f * t 1 1 f 1 —- ^* »» _ ^ . *^ _jf ^ •^^_ x ^ * \ ^^ v ^ * ^"•• : * •. „- ^^^ ^-,.•N* •^~* M\ J AN " .. J M low-up /)nr/oi/ (jhfld / l • i* * tt it it �Ra.64 TIME TRENDS OF 6 PARAMETERS IN J , CLEAN-UP WORKER //27? H- S.. 30 yra Variation 200 .0.1. ;. r. i». 1 llno-KO IGLYC. -100 JAM nnrintl (3- �R R .65 TIME TRENDS OF 6 PARAMtlhUb IN CLEAN-UP WORKER //28s J. S., 36 yrs X Variation mm im-OO O.T. itlQ"10 WJI*. inuQ15 , T. P. a.. lno-100 GLYC. -1UO . JAM parlod (3-00 / \2-Q2) �J Fin. 66 TIME TRENDS OF 6 PARAMETERS IN CLEAN-UP WORKER //295 G. F. , 43 yrs X Variation 200 IWRINS ilnu=39 5.O.T. tllniHO \ 100 .HK1SP. jl lnc=22 C.T.I*. jllno=3l i 0 DHL MGLYC. -100 JAM : I �-io.67 TIME TRENDS OF 6 PAKAMtltio UN CLEAN-UP WORKER //30: R. R., 23 yrs X Variation • 300 mm A O.T. lne«17 200 WJI*. 100 llne=5 IK)L ltnc=141 IULYC. '-100 MJAM i / -4 1 1 ( I....J....I. JAN period tf-QQ / �L::J L...J .. . J Fin. 68 TIME TRENDS OF 6 PARAMETERS IN CLEAN-UP WORKER //31i N.F.,37 yra X Variation lne«70 .O.T. 100 ;. T. i1. \ 0 i xx.. Iliwl72 IGI.YC. -100 JAN nn / �Fiq.69 TIME TRENUb ui- u i/m,,,.,, CLEAN-UP WORKER //32« F. D.. 27 yrs X Variation m =53 T. JSP. f.P. ncHO • • • . • • / K/ \fJ i OL Inn-I00 ;GLYC. llne«00 -100 JAN JAN • .. ' JAN Followvp period (3-00 / 12-02) �j - ' I. . *.. .J L 1 [ - L ; i , L j ,:....; L.J i....j. i.;j L.... Fiq.70 TIME TRENDS OF 6 PARAMETERS IN J CLEAN-UP WORKER #33? RT S.,43 yrs X Vnriotion lllHQ-00 0.0.T. allne-U (.HWSK , G.T.I', to I lna-20 CIK)L. dlihQ-202 iHIGLYC. QQllllQ B 75 -100 JAN JAK .i~.l /Q-nn / i i. j ,. J �Fig.71 TIME TRENDS OF b P CLEAN-UP WORKER //34: A.Z..31 yrs Variation 200 tins iQ=04 .T. '•(•\* I I I / / I 100 I * /I /» n—// l V \— i /•r// \/\ \ / /\ \/l IOSP. T.P. tne=9 0 (X.. liu-lOG CLYC. ilna**70 -100 JAM JAN JAN period (3-00 / Ai / ;\ ' �i > ; Fin.72'TIME TRENDS OF 6 PARAMETERS CLEAN-UP WORKER //35a T. C., 33 yrs X Variation 200 O.O.T. J.G.T.I*. CIIOI, oollnQ=107 1IUGLYC. iuullim :> 225 -100 JAN JAN Fntlow-un narinct (3-QQ / 12~02) IN �R.q.75 TIME TRENDS Uh b lJAKAMtihKb J CLEAN-UP WORKER //36i A. S., 23 yrs * Variation mm J.T. lim-41 T. I1. IOL CI.YC. llmHM -100 JAM i.i.i—i_J—i—i—i 1.1,1 i—i—i—<—i JAH , JAN FoJJoir-tyj period (3-BO / 12-1)2) �APPENDIX A FACSIMILE OF INTERVIEW QUESTIONARY �Study en the surveillance of the cLean-up workers in the TCDD /decontamination/ Seveso, Italy. Date of the interview Starting time Interviewer's number Interview number A - Personal Data Al - "What is- your full name?" A2 -"When were you born?" (Specify day, month and year) A3 - "Where were you born?" (Specify Town and Province) A4 -"What is your address?" (Specify street., number. Town,, nrov. ,•< postal code) AS- "Do you have a telephone?" Yes . . . .. /___/ No /__/ I don11 Know / / JTo answers / / If YES, go to A6 else, go to A7 A6- "What is your telephone number?" I den 1 1 knew / / �A7 - "Vfhat is your present civil status?" Single ............... . /__/ Married ..... .......... /_ / Separated ............. /_ / Divorced .............. / / Widow/er ........ . ..... /_/ Other (specify) answers ........... ............ /_ / A8 - "What is the highest educational record you have got?" University degree ............. . . / _ / High School ..................... /_ / m- Secondary School Primary School .......... ^ ..... / _ / ............. ..... / _ / Other ( specify). ..... ............. No records ..... ^ ................ /_ / /_ / I don ' t know ...... ......... .'„... / _ / No answers ....... ............... /_ / A9 - "Did you do the military service?" NO .. .......... . ---- /__/ I DON'T KNOW ....... '/ _ / NO ANSWEHS ......... /_ / OTHER (Specify) ---- / _ / If NO, go to A10 else, go to A12 A10 -"Why did you net do the military service?" Health reasons / / Family reasons / / Other (Soecifv) / / �All - "In the last month, have you been smoking cigarettes?" YES /__/ I. CANNOT REMEMBER / NO ANSWERS / / OTHER / / / If YES, go to A12 else, go to A17 A12 - "How many a day?" A13 - "At what age did you start smoking? I cannot remember . . . / / . No answers.........../_ / A14 - "How long have you been smoking?" YEARS ............... /__/_/ 1 CANNOT REMEMBER . / . /_ / A15. - "Over the last five years, the number of cigarettes you smoke- a day hast INCREASED -................/_ / DECREASED.............../_ / THE SAMS.............../_ / I DON ' T KNOW . . ........./_ / .. OTHER (Specify) ....... . ....... In case of increase or decrease, go to A16, ej. Se, co to A17. �A16 - "Why?" (Specify) Go to A21 A17 - "Have you ever smoked in the past?" If yes, go to 1£ else, go to A21 A18 - "How old were you when you smoked the first cigarette?" AGE /__/ I CANNOT REMEMBER / / AlSbis - "Have you smoked more than 5 packets of cigarettes in your life?" If yes, go to Al9 „, fc YES NO else, go to Dl A19 - "For how many years have' you been smoking?" / .,, . . / I. .. / ' / — / / / A20 - "Kow many cigarettes a day were you smoking in that period?" NUMBER OF CIGARETTES . . ..... / _ /^ I CANNOT REMEMBER .......... / _ /" ALCOHOL 31 - "Have you ever drunk alcoholic drinks like wine, licuors, beer? YES.................../_ . NO .................... /__ I DON ' T KNOW........../ _ OTHER (Specify) ........ NO ANSWERS If YES, go to 32 else, ao co Cl ............ / �32 - "At what age did you start drinking aLcohcLic beverages?" YEARS ...... ............. I DON ' T. KNOW ............ NO ANSWERS .............. / OTHER (Specify) .......... . S3 - "At present, are you drinking alcoholic beverages? YES .................... /__, NO ..................... I DON ' T KNOW ........... NO ANSWERS ............. YES, go to B6 else, go to 34 34 - "At what age did you. give:, up drinking alcoholic beverages: YEARS I DON'T KNOW NO ANSWERS BS - "Why did, you give- up drinking alcoholic / / v . . /__ \ beverages?" I DON' T KNOW NO ANSWERS •"*- Note for the interviewer: read DRINKS if yes at D2, else read DRINKEO /m -'' — / 26 - "Could you specify what kind of alcoholic beverages you usual " WINE.................../ BEER.................../ OTHER (Specify) �REGULARLY DURING MEALS REGULARLY DURING AMD BETWEEN1 MEALS . . .* REGULARLY BETWEEN MEALS /_ I DON <T KNO:; /~ NO ANSWERS /_ 20 - "On these occasions, how much do you drink?" /_ /_ i • WINE /__/ 1-2 glasses a day Two fflaases to half a liter a day Half a liter to one liter a day More than one liter a day I don' t know No answers BEER / / / / / / /__/ 1-2 glasses a day Two classes to half Half a liter to one More than one liter I don' t know No answers / / / / / / a liter a day liter a day a day ..*».., ~ / / / / / / / / /• / * / / 32 - "Have you been drinking these drinks in the last week?: vrh i skyt Br andy, Bitt er s, et c. ? " / / /_/ YES NO I DON'T.IOTO:: HO ANSWERS / / .. / / . If YES, go to 310 else go to Cl BIO - "What kind of hard liquors have you ALCOHOLIC APERITIFS BITTERS-DIGESTIVES KAU-DS-VI2. . COGNAC WIIISKY /_ / " / " / " / COFFFT: WITH LIQUEUR / OTHER.' " �7) •311 - "You usually drink these drinks: OGCASIOKALLY REGULARLY BEFORE . OR AFTER MEALS RSGULARLY BETWEEN MEALS REGULARLY DOTH ON AND BETWEEN MEALS / / / / / / / / I ?-12 - "On these occasions, how Tiuch do you drink?" ONE TO TWO LIQUEUR GLASSES A DAY THREE TO FuUIl LIQUEUR GLASSES A DAY MORE THAiT FOUR LIQUEUR GLASSES A -DAY / / /__/ /_/ Cl - "In the last two months from today, have you been taking medi pills, suppositories, syrups., etc. YES . , . . ,.. NO /__/ NO ANSWERS / / I DON'T Ktfow t / / If YES, go to C2 else/ go to Dl .\ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ • ^ ^ • • ^ • ^ I M B ^ B M ^ M M ^ ^ ™ * ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ • ^ ^ • ^ ^ • • ^ • ^ ^ I M ^ B ^ ^ I ™ ™ ^ \ \ 12 - "Would you please tell the names of the medicines you have 1) 2) ; . 3) 4) . Eor. each medicine at C2, go to the cuestions C3,C4,C5 C3 - "Have you been taking I) ,.2), 3), 41 YES NO I DON' T KNOW .\T0 ANSWERS 1} /__/ /___/ /__/ / / 2 /__/ /__/ / / / / for more than one week?" 3 /_/ /__/ / / / / ^ /" / / / �8) C4 - "What troubles caused you to take 1), 2), 3), 4)?" Note: Specify the type of trouble for each medicine 1} 2) 3) i A] ' CS - "Did the physician prescribe the mpriicine 1), 2), 3), 1)?" 2) /__/ 1) /_/ YES / / / / 2) /__/ / / I DON'T KNOW 1TO ANSWERS .. CS - "For how long have you been taking the medicine i), 2), 3), 4)?' 1) 2) 3)- YEARS / / / /_/_/ /_/__/ MONTHS / / / /— /—/ /__/__/ Dl - MEDICAL HISTORY "Have you ever suffered frotn any diseases?" of the following trou'-.las or YES Acne Soils Viral hepatitis Chronic hepatitis Hepatic cirrhosis Epilepsy Gail-bladder and/or biliary ducts stones Diabetes NO I DON'T REM. I DON'T KHO'.: VTAll OF 3 /__/ /__/ /__/ /__/ / / /___/ /__/ /__/ / / / / / / /__/ /__/ /_/ / / / / / / /__/ /_/ /_/ / /• /__/ / / /_/ /__/ /_/ / / / / / / /___/ / / / / /__/ /___/ / / /__/ / / /'___/ / / /__/ For each YZ3 at Dl, ask for D2 and fill in the above cclu~n, else c:o to D3 �D2 - "When dirt it start ...... (read the disease)?", D3 - "Have you ever been hospital -zed?" YES NO .......................... ............ ............... i DON ' T KNO;; ................. NO ANSWERS ................... /__/ /_/ /_ / /__/ If YES go to D4, else go to D9 D4 - "liow -nany ti-aes have you been l-ospitaLized?" Number of ti-ru?s / / D5 - D6 - For each time, write th<? disease, tlie year, t'.ie Hospi tal name and the town where it is. "For what disease have you been hospitalized t'-te (1st, 2nd, 3rd) time? "When did it happen?" (year) D7 - ' "What is the na-.e of the Hospital?" D8 - "Where Disease_ ~ is the Hospital?" (town) Number of Year of cIoapita^izationa-.HoapitaJLization nosrital £Ta-*r " D9 - "Please/ tell us the name and the address of your physician1 DlO - "Have your physician ever told you that your liver is i conditions?" YES NO /_/ /__/ i DON'T :-:sow / / I DC17' T XEMEM2E?. / / �10) Dll - "In th •» last two years, have you ever lost Tiore* than 5 : 'ilos 1 without being on a special diet?" /__/ /__/ /_/ / / YES . : NO I DOT' T KNOW I DON'T REMEMBER If YES go to 012, else go to D13 D13 - "Why did you lose weight? D13 - "In the last t\ o years have you rvrr been under treatment again anaemia?" *. /__/ /__/ / / / / / / YES NO I DON'T KKO»: I DON-T REMEMBER NO ANSWERS If YES specify* tee treatment D14 - "Have you ever suffered from skin troubles because of exposure sunbeams?" /__/ /__/ / /• / / YES NO I DON * T KNOW NO AN5:vEi1S If YES go to D15 else go to El D15 - "Please describe these troubles" Dlo - "Do these troubles reappear after each exposure to sun1"cans " YES .... NO .... I DON • T KNOW .................. ................... ............. /__/ /___/ / / �ENDING TI::E OF T"nr QUESTIONNAIRE / / / / / El - " la the interviewed hard of hearing?" /__/ YES /__/ NO I DON ' T KNOW / / E2T - "Can the interviewed speak and understand Italian correctly?" /__/ /__/ ./ / VES NO I DON'T . K2JOW E3 - "In which day of the week was the interview made?" * Monday Tuesday Wednecday Thursday Friday / / / / / / / / / / _ �APPENDIX 3 CASE SHEET USED F02 MEDICAL EXAMINATION" �DE3IO HOSPITAL OCCUPATIONAL HEALTH SS2VICS Chief Physician: Prof. I.Gaessi CLINICO-SPIDEMIOLOGICAL SURVEY MDL - 1 MDL - 2 ICM3SA CLSAN-U? "C25C Desio Hospital Surname and name place of birth Registered residence Usual date tel. address Marital status married unmarried nridower Occupation Exposed Treating physician Examining physician rAi'iiijI *-~ O'^ .~_o_ f iW^T V Father Mother CT 7 -' v> (»<; control separated divorced �PHYSIOLOGICAL HISTORY Birth Delivery Development Schooling1 at tern normal normal compulsory premature dystocic precocious high school Military service: yes force no health reasons : yes no • Marriage: no yes Present occupation Previous " 'for risks see cuesticnarv^ • «» ' at . . years . no. children no. abortions twin late university �smoking (see questionary) drinking (see cv.estionary) drugs (see questionary } only C ) • Diet poor • Digestion: normal normal yes no why Bowel movements: normal Urine output: normal Sex life: reported normal reported abnormal plentiful constipated yes no since which year why loose �PAST HISTORY: (supplemented by cuestionary) Diseases: Hospital admissions Accidents Allergies * PSBSEHT HIS.TOKY: (past year) Visual apparatus disturbances diseases Auditory apparatus disturbances diseases Respiratory system disturbances diseases Heart disturbances diseases Digestive tract disturbances diseases �Urinary system disturbances diseases Limbs disturbances diseases Masculosksletal system disturbances diseases Skin disturbances diseases Nervous 33/31 em disturbances diseases �PHYSICAL EXAMINATION Height Constitution: longilineal thin 3P max Weight normal medium min kg brevilineal fat Heart rate Slcin: normal abnormal specialist examination Subcutaneo\is tissue. Abnormal findings no • yes wh Lymph nodes. Abnormal findings no yes specify i-tisculature. Abnormal findings no ves specify Skeletal system. Abnormal findings no yes specify Usual veight athletic obese �Head: mobility eyes ears: nose: mouth: ache yes no abnormal findings abnormal findings oropharynx abnormal findings no yes teeth Neck: no yes no yes abnormal findings abnormal findings no yes Respiratory System: abnormal findings no yes if yes: chest deformity "F.V.T. (fremitus - vocal - tactile) percussion : auscultation Mammary Glands: abnormal findings no yes Heart: abnormal findins no es no yes �Abdomen: abnormal findings no yes Liver: normal findings yes no : in any case: - upper limit on the right midclavicular line: intercostal space or rib - lower limit (cm from tlie costal arch on right midclavicular line): . at end of normal inspiration palpation percussion . in max forced inspiration palpation percussion - margin and surface - consistency - tenderness Spleen: normal findings yes no Other Findings Abdominal Organs Genitourinary Sidneys: Bladder: System abnormal findings abnormal findincs 3xterr.al gsnitalia: no no abnormal findings yes •res r.o -es �Limbs: abnormal findings no 753 upper• lower varices no yes peripheral pulses (radial, posterior tibial, dorsal artery of foot) abnormal findings no yes if yes: Nervous System And Psyche abnormal findings Remarks: no yes � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 034 Folder The folder containing the original item. 0671 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Ghezzi, I G. Assennato P. Brambilla P. Cannatelli L. Meazza F. Merlo P. Mocarelli F. Sicurello Title A name given to the resource Report on Survey MDL/2: Prospective Longitudinal Epidemiological Survey of Clean-Up Workers at Work from 1980 in High-Contaminated A Zone Subject The topic of the resource dioxin decontamination safety ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 029 Folder The folder containing the original item. 0490 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Bianco, Vanda L. Meazza G. Remotti Description An account of the resource <strong>Corporate Author: </strong>University of Milan Date A point or period of time associated with an event in the lifecycle of the resource May 16 1983 Title A name given to the resource Obstetric Monitoring in Brianza Di Seveso from 1975 to 1981 Subject The topic of the resource Italy human exposure dioxin industrial spills ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 029 Folder The folder containing the original item. 0469 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Basso, P. L. Abate A. Belloni L. Bisanti C. Borgna P. Bruzzi G. Dorigotti L. Falliva A. Fanuzzi M. Formigaro G. Maggiore E. Marni L. Meazza F. Merlo R. Puntoni A. Rosa E. Stagnaro M. Vericelli Date A point or period of time associated with an event in the lifecycle of the resource 1982 Title A name given to the resource Mortality and Birth Defects From 1976 to 1979 in the Population Living in the TCDD Polluted Area of Seveso Subject The topic of the resource dioxin human exposure heath effects Italy ao_seriesIII