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Measurements of total blood Hg (tHg), often used as a proxy for methyl Hg (MeHg) concentrations, are most commonly the focus of population-based studies. Data on Hg species in biomarkers can allow for a more nuanced characterization of environmental exposure sources and risk but their availability is limited, especially for newcomer populations. The purpose of the Metals in Newcomer Women (MNW) study was to address existing data gaps on metal concentrations and exposure sources in newcomer women (19-45 years) and to examine tHg, MeHg and inorganic Hg (iHg) in the blood of East and South Asian women recently arrived to Toronto. Study participants were recruited in 2015 (nâ¯=â¯211). Total Hg concentrations were determined using both ICP-Q-MS and isotope dilution (ID)-SPME-GC-ICP-MS. A sample subset (nâ¯=â¯76) was chosen for the analysis of blood MeHg and iHg concentrations (also using ID-SPME-GC-ICP-MS). Hierarchical regression models were used to assess associations between blood tHg concentrations and environmental exposure factors for MNW participants. For the sample subset, a log-linear model was used to examine associations between blood iHg and MeHg concentrations and fish consumption patterns. The geometric mean (GM) blood tHg concentration was 1.05⯵g/L (95% CI: 0.88-1.25), which was elevated compared to Canadian-born women (GM: 0.57⯵g/L; 95% CI: 0.49-0.66), in a specialized data analysis of the Canadian Health Measures Survey (CHMS). GM concentrations for iHg and MeHg were 0.21⯵g/L (95% CI: 0.16-0.28) and 2.66⯵g/L (95% CI: 2.00-3.55), respectively. Significant distal determinants associated with blood tHg concentrations were: level of educational attainment, having lived in a coastal/fishing community prior to arrival, and global region of origin. Use of iron supplements and consumption of higher mercury fish species were also associated with tHg concentrations in the fully adjusted model. The study results demonstrate that blood Hg concentrations in newcomer women are slightly elevated, with some individuals in exceedance of recommended concentrations for women of reproductive age. The consumption of fish species low in Hg is recommended for newcomer women, especially those who consume fish frequently.
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Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminantes Ambientales/sangre , Mercurio/sangre , Compuestos de Metilmercurio , Mujeres , Animales , Canadá , Monitoreo del Ambiente , Femenino , Humanos , Alimentos MarinosRESUMEN
The prevalence of cardiovascular and metabolic diseases is increased in postmenopausal women, which contributes to the burden of illnesses in this period of life. Yerba mate (Ilex paraguariensis) is a native bush from Southern South America. Its leaves are rich in phenolic components, which may have antioxidant, vasodilating, hypocholesterolemic, and hypoglycemic proprieties. This post hoc analysis of the case-control study nested in the Obesity and Bone Fracture Cohort evaluated the consumption of yerba mate and the prevalence of hypertension, dyslipidemia, and coronary diseases in postmenopausal women. Ninety-five postmenopausal women were included in this analysis. A questionnaire was applied to evaluate the risk factors and diagnosis of cardiovascular diseases and consumption of yerba mate infusion. Student's t-test and chi-square test were used to assess significant differences between groups. The group that consumed more than 1 L/day of mate infusion had significantly fewer diagnoses of coronary disease, dyslipidemia, and hypertension (P<0.049, P<0.048, and P<0.016, respectively). Furthermore, the serum levels of glucose were lower in the group with a higher consumption of yerba mate infusion (P<0.013). The serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides were similar between the groups. This pragmatic study points out the benefits of yerba mate consumption for the cardiovascular and metabolic systems. The ingestion of more than 1 L/day of mate infusion was associated with fewer self-reported cardiovascular diseases and lower serum levels of glucose. Longitudinal studies are needed to evaluate the association between yerba mate infusion and reduction of cardiovascular diseases in postmenopausal women.
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Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus/prevención & control , Dislipidemias/prevención & control , Ilex paraguariensis/química , Preparaciones de Plantas/administración & dosificación , Posmenopausia/efectos de los fármacos , Anciano , Estudios de Casos y Controles , Femenino , HumanosRESUMEN
The prevalence of cardiovascular and metabolic diseases is increased in postmenopausal women, which contributes to the burden of illnesses in this period of life. Yerba mate (Ilex paraguariensis) is a native bush from Southern South America. Its leaves are rich in phenolic components, which may have antioxidant, vasodilating, hypocholesterolemic, and hypoglycemic proprieties. This post hoc analysis of the case-control study nested in the Obesity and Bone Fracture Cohort evaluated the consumption of yerba mate and the prevalence of hypertension, dyslipidemia, and coronary diseases in postmenopausal women. Ninety-five postmenopausal women were included in this analysis. A questionnaire was applied to evaluate the risk factors and diagnosis of cardiovascular diseases and consumption of yerba mate infusion. Student's t-test and chi-square test were used to assess significant differences between groups. The group that consumed more than 1 L/day of mate infusion had significantly fewer diagnoses of coronary disease, dyslipidemia, and hypertension (P<0.049, P<0.048, and P<0.016, respectively). Furthermore, the serum levels of glucose were lower in the group with a higher consumption of yerba mate infusion (P<0.013). The serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides were similar between the groups. This pragmatic study points out the benefits of yerba mate consumption for the cardiovascular and metabolic systems. The ingestion of more than 1 L/day of mate infusion was associated with fewer self-reported cardiovascular diseases and lower serum levels of glucose. Longitudinal studies are needed to evaluate the association between yerba mate infusion and reduction of cardiovascular diseases in postmenopausal women.
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Humanos , Femenino , Anciano , Enfermedades Cardiovasculares/prevención & control , Posmenopausia/efectos de los fármacos , Ilex paraguariensis/química , Preparaciones de Plantas/administración & dosificación , Diabetes Mellitus/prevención & control , Dislipidemias/prevención & control , Estudios de Casos y ControlesRESUMEN
Hirsutism is a common condition, being present in about 5-15% of women. It is characterized by the growth of terminal hair in a pattern typical for men, like as hair growth in upper lip, chin, cheek and lower and upper abdomen. Not infrequently, hirsutism is followed by other signs of hyerandrogenism such as alopecia, acne, and seborrhea. The current study evaluated the association between a self-reported history of hirsutism and oligo-amenorrhea during reproductive age and the presence of several comorbidities in women after menopause. A total of 1057 women were investigated in a cross-sectional study, and information on the age at menarche, menstrual history, complaints about excessive hair growth, and disease development was obtained. Participants from the study were postmenopausal women aged >55 y who attended ac primary care service at least once during the 24-month period. Exclusion criteria included the presence of cognitive impairment and/or communication difficulties. Main outcomes were the presence of comorbidities after menopause. The prevalence of comorbidities was significantly higher in women with a history of hirsutism and/or oligo-amenorrhea [OR = 1.6 (95% CI 1.1-2.4), p = 0.002] or isolated hirsutism [OR 2.0 (95% CI 1.3-3.2), p = 0.004]. The prevalence of stroke, angina or myocardial infarction, cardiac failure, chronic obstructive pulmonary disease, and osteoarthritis were significantly higher in postmenopausal women who had experienced hirsutism and/or oligomenorrhea (p < 0.03). Limitations of the study came from the absence of a clear differentiation between hirsutism and hypertrichosis. According our results, the presence of hirsutism and oligo-amenorrhea during the female reproductive period may indicate susceptibility to important diseases at old age.
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BACKGROUND: Immigrant women are often identified as being particularly vulnerable to environmental exposures and health effects. The availability of biomonitoring data on newcomers is limited, thus, presenting a challenge to public health practitioners in the identification of priorities for intervention. OBJECTIVES: In fulfillment of data needs, the purpose of this study was to characterize blood concentrations of cadmium (Cd) among newcomer women of reproductive age (19-45 years of age) living in the Greater Toronto Area (GTA), Canada and to assess potential sources of environmental exposures. METHODS: A community-based model, engaging peer researchers from the communities of interest, was used for recruitment and follow-up purposes. Blood samples were taken from a total of 211 newcomer women from South and East Asia, representing primary, regional origins of immigrants to the GTA, and environmental exposure sources were assessed via telephone survey. Metal concentrations were measured in blood samples (diluted with 0.5% (v/v) ammonium hydroxide and 0.1% (v/v) octylphenol ethoxylate) using a quadrupole ICP-MS. Survey questions addressed a wide range of environmental exposure sources, including dietary and smoking patterns and use of nutritional supplements, herbal products and cosmetics. RESULTS: A geometric mean (GM) blood Cd concentration of 0.39µg/L (SD:±2.07µg/L) was determined for study participants (min/max: <0.045µg/L (LOD)/2.36µg/L). Several variables including low educational attainment (Relative Ratio (RR) (adjusted)=1.50; 95% CI 1.17-1.91), milk consumption (RR (adjusted)=0.86; 95% CI 0.76-0.97), and use of zinc supplements (RR (adjusted)=0.76; 95% CI 0.64-0.95) were observed to be significantly associated with blood Cd concentrations in the adjusted regression model. The variable domains socioeconomic status (R2adj=0.11) and country of origin (R2adj=0.236) were the strongest predictors of blood Cd. CONCLUSION: Blood Cd concentrations fell below those generally considered to be of human health concern. However, negative health effects cannot be entirely excluded, especially for those that fall in the upper percentile range of the distribution, given the mounting evidence for negative health outcomes at low environmental exposure concentrations.
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Cadmio/sangre , Exposición a Riesgos Ambientales/análisis , Adulto , Asia Sudoriental , Suplementos Dietéticos , Escolaridad , Emigrantes e Inmigrantes , Femenino , Humanos , Persona de Mediana Edad , Ontario/etnología , Adulto JovenRESUMEN
BACKGROUND: Health care workers (HCWs) are at increased risk for developing occupational skin disease (OSD) such as dermatitis primarily due to exposure to wet work. Identification of risk factors and workplace screening can help early detection of OSD to avoid the condition becoming chronic. AIMS: To determine risk factors and clinical findings for hand dermatitis using a workplace screening tool. METHODS: Employees at a large teaching hospital in Toronto, Canada, were invited to complete a two-part hand dermatitis screening tool. Part 1 inquired about hand hygiene practices and Part 2 comprised a visual assessment of participants' hands by a health professional and classification as (i) normal, (ii) mild dermatitis or (iii) moderate/severe dermatitis. Risk factors were determined using chi-square and Cochran-Armitage analysis on a dichotomous variable, where Yes represented either a mild or moderate/severe disease classification. RESULTS: There were 183 participants out of 643 eligible employees; response rate 28%. Mild or moderate/severe dermatitis was present in 72% of participants. These employees were more likely to work directly with patients, have worked longer in a health care setting, wash hands and change gloves more frequently, wear gloves for more hours per day, have a history of eczema or dermatitis and report a current rash on the hands or rash in the past 12 months. CONCLUSIONS: There was a high percentage of HCWs with dermatitis and risk factors for dermatitis. These findings argue for increased attention to prevention and early identification of hand dermatitis and support further testing of the workplace screening tool.
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Dermatitis Profesional/etiología , Dermatosis de la Mano/etiología , Mano/patología , Personal de Salud , Exposición Profesional/efectos adversos , Agua/efectos adversos , Trabajo , Dermatitis Profesional/diagnóstico , Dermatitis Profesional/epidemiología , Eccema , Exantema/etiología , Guantes Protectores , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/epidemiología , Desinfección de las Manos , Hospitales de Enseñanza , Humanos , Tamizaje Masivo , Ontario/epidemiología , Proyectos Piloto , Factores de Riesgo , Lugar de TrabajoRESUMEN
Chronic lung allograft dysfunction (CLAD) is the leading cause of mortality following lung transplantation. We conducted a retrospective cohort study including 397 bilateral lung recipients transplanted in from 1996 to 2009 to determine the association between ambient air pollution, CLAD and mortality. Pollution exposure was assessed using satellite-based estimates of nitrogen dioxide, distance to major roadway and total length of roadways around a patient's home. Cumulative exposures to ozone and particulate matter were estimated from concentrations measured at fixed-site stations near patients' homes using inverse distance weighted interpolation. Cox proportional hazards models were used to estimate the associations of CLAD with air pollution exposure, adjusting for various individual and neighborhood characteristics. During the follow-up, 185 patients developed CLAD (47%) and 101 patients died (25%). Fifty-four deaths (53%) were due to CLAD. We observed an association between CLAD development and road density within 200 m of a patient's home (HR 1.30 [95% CI 1.07-1.58]). Although based on a subgroup of 14 patients, living within 100 m of a highway was associated with a high risk for developing CLAD (HR 4.91 [95% CI 2.22, 10.87]). These data suggest that exposure to traffic-related air pollution is associated with development of CLAD among lung transplant recipients.
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Contaminación del Aire/efectos adversos , Rechazo de Injerto/etiología , Enfermedades Pulmonares/cirugía , Trasplante de Pulmón , Material Particulado/efectos adversos , Complicaciones Posoperatorias , Adulto , Anciano , Aloinjertos , Femenino , Estudios de Seguimiento , Rechazo de Injerto/diagnóstico , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The integration of the veterinary, medical and environmental sciences necessary to predict, prevent or respond to emerging zoonotic diseases requires effective collaboration and exchange of knowledge across these disciplines. There has been no research into how to connect and integrate these professions in the pursuit of a common task. We conducted a literature search looking at the experiences and wisdom resulting from collaborations built in health partnerships, health research knowledge transfer and exchange, business knowledge management and systems design engineering to identify key attributes of successful interdisciplinary (ID) collaboration. This was followed by a workshop with 16 experts experienced in ID collaboration including physicians, veterinarians and biologists from private practice, academia and government agencies. The workshop participants shared their perspectives on the facilitators and barriers to ID collaboration. Our results found that the elements that can support or impede ID collaboration can be categorized as follows: the characteristics of the people, the degree to which the task is a shared goal, the policies, practices and resources of the workplace, how information technology is used and the evaluation of the results. Above all, personal relationships built on trust and respect are needed to best assemble the disciplinary strength of the professions. The challenge of meeting collaborators outside the boundaries of one's discipline or jurisdiction may be met by an independent third party, an ID knowledge broker. The broker would know where the knowledge could be found, would facilitate introductions and would help to build effective ID teams.
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Enfermedades Transmisibles Emergentes , Conducta Cooperativa , Comunicación Interdisciplinaria , Estudios Interdisciplinarios , Zoonosis , Animales , Congresos como Asunto , Investigación sobre Servicios de Salud/organización & administración , Humanos , Relaciones Interprofesionales , Bases del Conocimiento , Médicos , VeterinariosRESUMEN
This article discusses the extent of resource allocation to Occupational Health (OH) to prevent infectious disease exposure and transmission in British Columbia (B.C.). It also characterizes the delineation of roles and responsibilities within OH services in B.C. health care settings and highlights areas where improvements to current OH programs could be made to prevent and control occupational infections. Given the breadth of OH responsibilities, resource allocation in many health care institutions for these services is inadequate and roles and responsibilities may not be clearly delineated.
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Transmisión de Enfermedad Infecciosa/prevención & control , Recursos en Salud/organización & administración , Control de Infecciones/organización & administración , Enfermedades Profesionales/prevención & control , Servicios de Salud del Trabajador , Colombia Británica , Humanos , Asignación de RecursosRESUMEN
Few studies have audited the resources available to infection control (IC) and occupational health (OH) to promote safe work behaviour, whilst comparing audited findings with perceptions by healthcare workers (HCWs). We aimed to determine the IC and OH resources available and compare this with HCWs' perception of resources, following an outbreak of severe acute respiratory syndrome (SARS). A survey of IC and OH resources and a questionnaire completed by HCWs were compared with on-site observational audits. HCWs believed that plans were available to protect against future SARS-like events but audits revealed that these did not exist in many facilities. Both OH and IC were under-resourced post-SARS, with OH professionals particularly lacking in British Columbia. There is a discrepancy between HCWs' perception of what is available and what is actually accessible in facilities. Experts in IC and OH need to focus on communication.
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Actitud del Personal de Salud , Infección Hospitalaria/prevención & control , Adhesión a Directriz/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Investigación sobre Servicios de Salud , Control de Infecciones/métodos , Salud Laboral , Colombia Británica/epidemiología , Brotes de Enfermedades/prevención & control , Humanos , Control de Infecciones/estadística & datos numéricos , Ontario/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/prevención & control , Encuestas y CuestionariosRESUMEN
AIMS: To assess the impact of newly introduced point-of-sale glass bottle recycling on indoor air quality and employee health. METHODS: Airborne exposures and both chronic and acute respiratory and somatic symptoms were surveyed among 226 employees at 36 randomly selected liquor stores with bottle recycling and in-house glass breaking. Each store was visited twice; between visits glass breaking was discontinued for one month in half the stores (selected at random), although bottles were still collected and stored on site. Rates of chronic symptoms were compared to an external, unexposed control population. RESULTS: Geometric mean exposure levels were 0.18 mg/m3 for inhalable particulate matter and 3.6 EU/m3 for endotoxin (270 personal samples); 1064 CFU/m3 for viable fungi (648 area samples). Fungal levels were associated with visibly mouldy bottles being broken, outdoor fungal counts, and uncovered glass bins. Exposures were not altered by the intervention of shutting down glass breaking machinery. Compared to controls, employees reported more work related chronic chest tightness and chronic nasal symptoms. Acute chest symptoms were associated with breaking visibly mouldy bottles, but not with measured fungal counts. Inhalable particulate matter levels >0.2 mg/m3 were associated with acute upper airway irritation. Somatic symptoms were associated with measures of psychosocial job strain. CONCLUSION: Results suggest that this type of recycling programme may generate fungal exposures sufficient to elicit upper airway and chest symptoms.
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Contaminantes Ocupacionales del Aire/efectos adversos , Contaminación del Aire Interior/efectos adversos , Conservación de los Recursos Naturales , Vidrio , Exposición Profesional/efectos adversos , Enfermedad Aguda , Adulto , Microbiología del Aire , Enfermedad Crónica , Recuento de Colonia Microbiana , Comercio , Monitoreo del Ambiente/métodos , Femenino , Hongos/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/etiología , Vigilancia de la Población/métodos , Enfermedades Respiratorias/etiologíaAsunto(s)
Exposición a Riesgos Ambientales/efectos adversos , Vacunas contra Hepatitis B/efectos adversos , Mercurio/efectos adversos , Enfermedades del Sistema Nervioso/inducido químicamente , Conservadores Farmacéuticos/efectos adversos , Timerosal/efectos adversos , Trastorno Autístico/inducido químicamente , Humanos , Conservadores Farmacéuticos/química , Factores de Riesgo , Timerosal/químicaRESUMEN
The risk of microbial disease associated with drinking water is presently a priority concern among North American water jurisdictions. Numerous past outbreaks, together with recent studies suggesting that drinking water may be a substantial contributor to endemic (non-outbreak related) gastroenteritis, demonstrate the vulnerability of many North American cities to waterborne diseases and have fuelled ongoing debates in Canada and the United States concerning the need for stricter water quality guidelines, changes in watershed management policies, and the need for additional water treatment. The Greater Vancouver Regional District (GVRD) water supply system serves approximately two million consumers from a system consisting of three unfiltered surface water supplies (Figure 1). Although GVRD policies reduce the potential for fecal contamination of the source water supplies by humans and domestic animals, the GVRD watersheds support many wildlife species that can potentially shed organisms pathogenic to humans. Because GVRD's water treatment strategy relies principally on watershed protection and chlorination*, and these two strategies together do not eliminate all risk of waterborne disease transmission, it is possible that some disease-causing organisms reach the consumer.
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Gastroenteritis/epidemiología , Gastroenteritis/microbiología , Contaminantes del Agua/efectos adversos , Abastecimiento de Agua/normas , Adolescente , Adulto , Distribución por Edad , Anciano , Colombia Británica/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Encuestas Epidemiológicas , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo , Distribución por Sexo , Población Urbana , Microbiología del AguaRESUMEN
Trail, Canada, has been the site of an active lead/zinc smelter for nearly a century. Since 1991, the Trail Community Lead Task Force has carried out blood lead screening, case management, education programs targeted at early childhood groups and the general community, community dust abatement, exposure pathways studies, and remedial trials. From 1989 through 1996, average blood lead levels of children tested for the first time declined at an average rate of 0.6 microg/dl/year, while blood lead levels in Canadian children not living near point sources appeared to be leveling off following the phase-out of leaded gasoline. Since there was no concurrent improvement in local environmental conditions during this time, it is possible that the continuing decline in Trail blood lead levels has been at least partly due to community-wide intervention programs. One year follow-up of children whose families received in-home educational visits, as well as assistance with home-based dust control measures, found that these specific interventions produced average blood lead changes of +0.5- -4.0 microg/dl, with statistically significant declines in 3 years out of 5. Education and dust control, particularly actions targeted toward higher risk children, appear to have served as effective and appropriate interim remedial measures while major source control measures have been implemented at the smelter site.
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Contaminación Ambiental/prevención & control , Intoxicación por Plomo/prevención & control , Plomo/sangre , Metalurgia , Colombia Británica , Manejo de Caso , Niño , Preescolar , Polvo/prevención & control , Monitoreo del Ambiente , Educación en Salud , Humanos , Lactante , Plomo/análisis , Tamizaje Masivo , Modelos Biológicos , Contaminantes del Suelo/análisis , Espectrofotometría Atómica , Factores de TiempoRESUMEN
As part of a soil lead regulation process, this review was conducted to determine the association between lead in soil and established human health effects of lead or validated biomarkers of lead exposure. We reviewed only studies where soil exposure could be distinguished from other sources of lead and whose design could reasonably be used to infer a causal relationship between soil lead and either biomarkers or health effects. No such studies of health effects were found. Studies describing a quantitative relationship between soil lead and blood lead did meet our criteria: 22 cross-sectional studies in areas with polluted soil; and three prospective studies of soil lead pollution abatement trials. The cross-sectional studies indicated that, compared to children exposed to soil lead levels of 100 ppm, those exposed to levels of 1000 ppm had mean blood lead concentrations 1.10-1.86 times higher and those exposed to soil lead levels of 2000 ppm had blood lead concentrations 1.13-2.25 times higher. The prospective studies showed effects within the ranges predicted by the cross-sectional studies. Differences in results between studies were surprisingly modest and likely explainable by random sampling error, different explanatory variables included in data analyses and differences in methods of measuring lead in environmental specimens.
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Contaminación Ambiental , Plomo/efectos adversos , Salud Pública , Contaminantes del Suelo , Adolescente , Adulto , Anciano , Niño , Preescolar , Exposición a Riesgos Ambientales , Monitoreo del Ambiente , Estudios Epidemiológicos , Femenino , Humanos , Lactante , Recién Nacido , Plomo/análisis , Plomo/normas , Masculino , Persona de Mediana Edad , Valores de ReferenciaRESUMEN
High costs and the potential risk to public health of drug-related workplace accidents are major concerns. Studies conducted to evaluate this problem are restricted by concerns for individual rights and fears of jeopardizing labor relations. However, in collaboration with the Medical Examiner's office. Alberta Occupational Health and Safety examined a unique set of data on 459 deaths occurring at work. The only illicit drug found was cannabis for which 10 workers tested positive. Forty workers tested positive for alcohol, 28 for prescription, and 22 for nonprescription drugs. Evidence of alcohol use was found in a higher percentage of fatalities due to motor vehicle accidents, falls, and being caught in or under equipment than in other types of workplace fatalities.
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Accidentes de Trabajo/mortalidad , Intoxicación Alcohólica/epidemiología , Accidentes por Caídas/mortalidad , Accidentes de Tránsito/mortalidad , Adulto , Alberta/epidemiología , Distribución de Chi-Cuadrado , Humanos , Masculino , Abuso de Marihuana/epidemiología , Detección de Abuso de SustanciasAsunto(s)
Agotamiento por Calor/etiología , Enfermedades Profesionales/etiología , Aclimatación , Adulto , Humanos , Masculino , PronósticoRESUMEN
Questionnaire, radiographic, and lung function information for 983 Quebec chrysotile workers at work in 1966 was used to develop five clinical response scales (i.e., parenchymal and pleural fibrosis, airflow limitation, chronic bronchitis, and airway reactivity). The relationship of the scales to variables describing temporal patterns of exposure was studied, taking into account cumulative exposure, age, and smoking. All response scales related to variables containing only time information, and in all cases temporal patterns of exposure influenced exposure response relationships. For pulmonary fibrosis, the strongest relationships were to cumulative exposure; for pleural fibrosis to exposure peaks and residence time of dust in the lung; for airway reactivity to early and recent exposure; and for airflow limitation and chronic bronchitis to smoking and to dust level and load over time. These results add to the gathering evidence that exposures to environments containing airborne asbestos may result in airway abnormalities.