This article was downloaded by: [University of Florida] On: 17 February 2015, At: 03:14 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Archives of Environmental Health: An International Journal Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vzeh20
Sleep Disturbances and Exposure to Organic Solvents a
a
Birgitta Lindelof , Ove Almkvist & Carl-Johan Göthe
a
a
Department of Occupational Medicine , Huddinge Hospital , Huddinge, Sweden Published online: 03 Aug 2010.
To cite this article: Birgitta Lindelof , Ove Almkvist & Carl-Johan Göthe (1992) Sleep Disturbances and Exposure to Organic Solvents, Archives of Environmental Health: An International Journal, 47:2, 104-106, DOI: 10.1080/00039896.1992.10118762 To link to this article: http://dx.doi.org/10.1080/00039896.1992.10118762
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Sleep Disturbances and Exposure to Organic Solvents
BlRClTTA LINDELOF OVE ALMKVIST CARL-JOHANGOTHE Department of Occupational Medicine Huddinge Hospital Huddinge, Sweden
Downloaded by [University of Florida] at 03:14 17 February 2015
ABSTRACT. An inquiry about sleep habits and sleep disturbances revealed a significantly higher prevalence of insomnia in a solvent-exposed group than in a comparable group that had no occupational exposure to organic solvents. In the solvent-exposed group was also registered an increased consumption of hypnotics, and a significant increase occurred in the number of individuals who had consulted physicians because of sleep disorders. The results indicate that solvent exposure could induce sleep disturbances.
PATIENTS who are exposed to solvents often complain that they have disturbed sleep. Tiredness and increased fatiguability have also been reported by patients with chronic toxic encephalopathy or “psychoorganic syndrome,” which result from professional exposure to organic Various types of sleep disturbances have also been observed in solvent-exposed groups.69 In a study of histology technicians who were exposed to both organic solvents and formaldehyde, sleep disturbances tended to increase as exposure to formaldehyde and organic solvents increased, but the strongest correlation was observed for exposure to formaldeh~de.~ It is, therefore, of interest fo examine the sleep conditions in two groups of workers whose exposures to organic solvents differ.
Materials and methods The solvent-exposed group (n = 112) included all men who were referred to the department of occupational medicine at the Southern Hospital in Stockholm during 1984-1985 because of health disturbances, suspected to be caused by professional exposure to organic solvents. The majority of these patients were house painters, spray finishers, or printers who had experienced occupational long-term exposure to organic solvents. 104
The reference group contained men referred to the same department during the same period because of suspected asbestosis. Asbestos-exposed men with a history of occupational exposure to organic solvents were excluded. In total, the residual group consisted of 99 men. None of the individuals in either group was referred to the department because of problems with sleep. A questionnaire was sent to all persons, and it included questions about sleep habits, quality of sleep at night, tiredness during the day, need to take a nap during the day, and subjective sensation of being thoroughly rested after sleep. Nonrespondence was accepted after two written reminders and at least one attempt to contact by telephone. Twenty-seven solventexposed and 21 asbestos-exposed persons did not respond. There were no significant differences between the groups in this regard. Statistical analysis was performed with a two-sided chi-square test, Student’s t test, Mann-Whitney’s test, and Pearson’s product moment correlation test.
Results In neither the solvent-exposed nor the asbestosexposed group did responders differ significantly from corresponding nonresponders with respect to age distribution, but the solvent-exposed group included Archives of Environmental Health
younger individuals than did the asbestos-exposed group. The mean age in the two groups were 46 y (stan18-65) and 58 y dard deviation [SD] 10.7; range (SD 5.9; range 38-65), respectively. Possible correlations between age and the studied sleep disturbances were controlled. In the asbestos-exposed group, none of these correlations were statistically significant > .47). Also, in the solventexposed group all point-estimated correlation coefficients were low (r < 0.25), but they significantly deviated from zero with respect to subjective evaluation of sleep quality during the 0.05-0.41) and time between going to night (95% CI bed and falling asleep (95% CI 0.02-0.38). Sleep quantity. The times that individuals went to bed in the evening and rose in the morning, and the period of time spent in bed during the night, were similar for both groups. However, the period between going to bed and falling asleep was significantly longer in the solvent-exposed group than in the asbestos-exposed group (medians 30 and 15 min, respectively; p, .0003). The reported frequency of difficulty in falling asleep after going to bed (every night, once a week, less than once a week) was significantly higher in the solvent-exposed group (pa .OOO6). Sleep quality. The number of persons who considered their sleep quality to be bad or very bad was highest in the solvent-exposed group, whereas the number of persons who considered it to be good or very good was highest in the asbestos-exposed group (Table 1). This difference between the groups was significant. There was also a question about sleep quality during the first, middle, and late third of the night. The longest periods of bad sleep quality were observed in the solvent-exposed group, and the difference between the groups was statistically significant (pa .03). Problems with sleepiness during the day were significantly more common in the solvent-exposed group than in the asbestos-exposed group (pa .0003), as was the tendency to feel tired and sleepy after rest during the day (p2 .ooo91. Regular use of hypnotics was significantly more common among solventexposed persons than among asbestos-exposed persons (Table 2). Thirty-nine of 78 solvent-exposed men (50%) and 14 of 76 asbestosexposed men (18%) had consulted physicians because of tiredness or sleeplessness (pa .0002).
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-
Downloaded by [University of Florida] at 03:14 17 February 2015
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-
-
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-
Discussion Sleep disorders often occur more frequently as age increases, which is relevant both for difficulties of initiating sleep9,’0 and difficulties of maintaining It is possible that excessive daytime sleepiness does not increase with age during the working period of life,” but that this discomfort is common in older individuals.” Chronic respiratory disease is coupled to increased prevalence of sleep disturbances.”*’* In the study presented here, a group of men who were occupationally exposed to organic solvents reported a higher prevalence of sleep disturbances than a similar group of men occupationally exposed to asbestos (but not to solvents). It is interesting to note that the MarchlAprill992[Vol. 47 (No. 211
I
Slqp quality
Solvents
Asbestos
7 26
20 24 23
Very good
Good Neither g o d nor bad Bad Very bad Total
2*
19.63,df
20 25
- 4,pa - .ooo6
Never Sometimes a year Sometimes a month Sometimes a week Every night Total
-
17.39,df
- 4,pa -
10
7
0
85
77
Table 2.-Use of Hypnotics by Sdvent-Ex& Asbestos-Exposed s u b p a s
$
I
of Sleep Quality during the Night
Table 1.-Evaluation
52
and
63
a a
8 5
12 4 84
0 0
76
.OO2
mean age was lower in the solvent-exposed group and that chronic respiratory disease occurred in the asbestos-exposed group. That the sleep disorders in the solvent-exposed group could be severe is indicated. by an increased use of hypnotics and a significant increase in the number of individuals who had consulted physicians because of tiredness or sleeplessness. Complications resulting from insomnia, e.g., increased fatiguability and a tendency to affect lability, demonstrate some similarities to symptoms observed in chronic toxic encephalopathy induced by occupational exposure to organic solvents. it is open to future research to determine if sleep disturbances might explain or intensify some of the symptoms induced by solvent exposure, and if regular use of hypnotics could affect the clinical course of chronic toxic encephalopathy resulting from solvent exposure.
********** The authors gratefully acknowledge senior lecturer Lennart Custakson at the Department of Statistics, University of Umea, for advice in statistical matters. Submitted for publication July 27, 1990; revised; accepted for publicationApril 16, 1991. Requests for reprints should be sent to Carl-JohanGOthe, Department of Occupational Medicine, Huddinge Hospital, SlOO 64 Huddinge, Sweden. * I * * * * * * * *
105
References
6. Struwe G , Wennberg A. Psychiatric and neurological symptoms in workers occupationally exposed to organic solvents-results of a differential epidemiological study. Acta Psychiatr Scand 1983; 67(suppl 303):68-80. 7. Baker EL, Letz RE, Eisen EA, Pothier LJ, Plantamura DL, Larson M, Wolford R. Neurobehavioral effects of solvents in construction plants. J &cup Med 1988; 30116-123. 8. Monstad P, Nissen T, Sulg IA, Mellgren SI. Sleep apnoea and organic solvent exposure. J Neurol 1987; 234152-54. 9. Kilburn KH, Seidman BC, Warshaw R. Neurobehavioral and respiratory symptoms of formaldehyde and xylene exposure in histology technicians. Arch Environ Health 1985; 0229-33. 10. Bixler EO, Kales A, Soldatos CR, Kales ID, Healey S . Prevalence of sleep disorders in the Los Angeles metropolitan area. Am J Psychiatry 1979; 136:1257-62. 1 1 . Klink M, Quan SF. Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Chest 1987; 91:540-46. 12. Gislason T, Almqvist M. Somatic diseases and sleep complaints. An epidemiological study of 3201 Swedish men. Ada Med Scand 1987; 221 ~475-81.
Downloaded by [University of Florida] at 03:14 17 February 2015
1 . Antti-Poika M. Prognosis of symptoms in patients with diagnosed chronic organic solvent intoxication. Int Arch Occup Environ Health 1982; 51 :81-89. 2. Axelson 0, Hane M, Hogstedt C. Case reports on chronic psycho-organic syndrome in house painters. Lakartidningen (Swedish, abstract in English) 1976; 73:319-21. 3. Lundberg 1. Medical examination of paint industry workers with long-term exposure to a mixture of organic solvents. Arbete och Halsa (Sthlm) (Swedish, abstract in English) 1981; 2:l-54. 4. Orbaeck P, Risberg J, Rosen I, Haeger-Aronsen 6, Hagstadius S, Hjortsberg U, Regnell G , Rehnstrom S, Svensson K, Welinder H. Effects of long-term exposure to solvents in the paint industry. A cross-sectional epidemiologic study with clinical and laboratory methods. Scand J Work Environ Health 1985; ll(supp1 2):l-28. 5. Rasmussen K, Bjerre A, Petersen R, Sabroe S. Health complaints caused by working with chlorinated solvents in the electronic industry. Ugeskr Laeger (Danish, abstract in English) 1985; 147:1053-57.
?h U W
WORKSHOP
STATISTICS & COMPUTING IN DISEASE CLUSTERING 23-24 July 1992,
Stony Brook, New York
Applied Biomathematics, with funding from EPRI and NCI, is conducting a workshop on disease clustering. Our aim is the active involvement of participants in discussion of the following areas:
Scient$c Merit Cluster Allegations CZuster Patterns Methods G1S
Resources
How should clustering methods be selected? How should we deal with post-hoc data analyses? How can space-time clusters be characterized? What is the power of clustering techniques under various conditions? Can GIS and geostatistics help identify links between environment and health? What data bases and software are available for cluster investigations?
Contributed papers are solicited on these or related topics. The program committee consists of Dr. Geoffrey Jacquez, Applied Biomathematics, (chair) Dr. Roger Crimson, Department of Preventive Medicine, SUNY at Stony Brook, Dr. Leeka Kheifets, Electric Power Research Institute (EPRI), Dr. Daniel Wartenberg, Robert Woods Johnson Medical School. Workshop information may be obtained from
106
Dr. Jeffrey A. Millstein, Applied Biomathematics 100 North Country Road, Setauket, NY 11733 (516) 751-4350, Fax: (516) 751-3435
Archives of Environmental Health
Archives of Environmental Health: An International Journal Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vzeh20
Sleep Disturbances and Exposure to Organic Solvents a
a
Birgitta Lindelof , Ove Almkvist & Carl-Johan Göthe
a
a
Department of Occupational Medicine , Huddinge Hospital , Huddinge, Sweden Published online: 03 Aug 2010.
To cite this article: Birgitta Lindelof , Ove Almkvist & Carl-Johan Göthe (1992) Sleep Disturbances and Exposure to Organic Solvents, Archives of Environmental Health: An International Journal, 47:2, 104-106, DOI: 10.1080/00039896.1992.10118762 To link to this article: http://dx.doi.org/10.1080/00039896.1992.10118762
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Sleep Disturbances and Exposure to Organic Solvents
BlRClTTA LINDELOF OVE ALMKVIST CARL-JOHANGOTHE Department of Occupational Medicine Huddinge Hospital Huddinge, Sweden
Downloaded by [University of Florida] at 03:14 17 February 2015
ABSTRACT. An inquiry about sleep habits and sleep disturbances revealed a significantly higher prevalence of insomnia in a solvent-exposed group than in a comparable group that had no occupational exposure to organic solvents. In the solvent-exposed group was also registered an increased consumption of hypnotics, and a significant increase occurred in the number of individuals who had consulted physicians because of sleep disorders. The results indicate that solvent exposure could induce sleep disturbances.
PATIENTS who are exposed to solvents often complain that they have disturbed sleep. Tiredness and increased fatiguability have also been reported by patients with chronic toxic encephalopathy or “psychoorganic syndrome,” which result from professional exposure to organic Various types of sleep disturbances have also been observed in solvent-exposed groups.69 In a study of histology technicians who were exposed to both organic solvents and formaldehyde, sleep disturbances tended to increase as exposure to formaldehyde and organic solvents increased, but the strongest correlation was observed for exposure to formaldeh~de.~ It is, therefore, of interest fo examine the sleep conditions in two groups of workers whose exposures to organic solvents differ.
Materials and methods The solvent-exposed group (n = 112) included all men who were referred to the department of occupational medicine at the Southern Hospital in Stockholm during 1984-1985 because of health disturbances, suspected to be caused by professional exposure to organic solvents. The majority of these patients were house painters, spray finishers, or printers who had experienced occupational long-term exposure to organic solvents. 104
The reference group contained men referred to the same department during the same period because of suspected asbestosis. Asbestos-exposed men with a history of occupational exposure to organic solvents were excluded. In total, the residual group consisted of 99 men. None of the individuals in either group was referred to the department because of problems with sleep. A questionnaire was sent to all persons, and it included questions about sleep habits, quality of sleep at night, tiredness during the day, need to take a nap during the day, and subjective sensation of being thoroughly rested after sleep. Nonrespondence was accepted after two written reminders and at least one attempt to contact by telephone. Twenty-seven solventexposed and 21 asbestos-exposed persons did not respond. There were no significant differences between the groups in this regard. Statistical analysis was performed with a two-sided chi-square test, Student’s t test, Mann-Whitney’s test, and Pearson’s product moment correlation test.
Results In neither the solvent-exposed nor the asbestosexposed group did responders differ significantly from corresponding nonresponders with respect to age distribution, but the solvent-exposed group included Archives of Environmental Health
younger individuals than did the asbestos-exposed group. The mean age in the two groups were 46 y (stan18-65) and 58 y dard deviation [SD] 10.7; range (SD 5.9; range 38-65), respectively. Possible correlations between age and the studied sleep disturbances were controlled. In the asbestos-exposed group, none of these correlations were statistically significant > .47). Also, in the solventexposed group all point-estimated correlation coefficients were low (r < 0.25), but they significantly deviated from zero with respect to subjective evaluation of sleep quality during the 0.05-0.41) and time between going to night (95% CI bed and falling asleep (95% CI 0.02-0.38). Sleep quantity. The times that individuals went to bed in the evening and rose in the morning, and the period of time spent in bed during the night, were similar for both groups. However, the period between going to bed and falling asleep was significantly longer in the solvent-exposed group than in the asbestos-exposed group (medians 30 and 15 min, respectively; p, .0003). The reported frequency of difficulty in falling asleep after going to bed (every night, once a week, less than once a week) was significantly higher in the solvent-exposed group (pa .OOO6). Sleep quality. The number of persons who considered their sleep quality to be bad or very bad was highest in the solvent-exposed group, whereas the number of persons who considered it to be good or very good was highest in the asbestos-exposed group (Table 1). This difference between the groups was significant. There was also a question about sleep quality during the first, middle, and late third of the night. The longest periods of bad sleep quality were observed in the solvent-exposed group, and the difference between the groups was statistically significant (pa .03). Problems with sleepiness during the day were significantly more common in the solvent-exposed group than in the asbestos-exposed group (pa .0003), as was the tendency to feel tired and sleepy after rest during the day (p2 .ooo91. Regular use of hypnotics was significantly more common among solventexposed persons than among asbestos-exposed persons (Table 2). Thirty-nine of 78 solvent-exposed men (50%) and 14 of 76 asbestosexposed men (18%) had consulted physicians because of tiredness or sleeplessness (pa .0002).
--
-
-
-
-
-
Downloaded by [University of Florida] at 03:14 17 February 2015
-
-
-
-
-
-
Discussion Sleep disorders often occur more frequently as age increases, which is relevant both for difficulties of initiating sleep9,’0 and difficulties of maintaining It is possible that excessive daytime sleepiness does not increase with age during the working period of life,” but that this discomfort is common in older individuals.” Chronic respiratory disease is coupled to increased prevalence of sleep disturbances.”*’* In the study presented here, a group of men who were occupationally exposed to organic solvents reported a higher prevalence of sleep disturbances than a similar group of men occupationally exposed to asbestos (but not to solvents). It is interesting to note that the MarchlAprill992[Vol. 47 (No. 211
I
Slqp quality
Solvents
Asbestos
7 26
20 24 23
Very good
Good Neither g o d nor bad Bad Very bad Total
2*
19.63,df
20 25
- 4,pa - .ooo6
Never Sometimes a year Sometimes a month Sometimes a week Every night Total
-
17.39,df
- 4,pa -
10
7
0
85
77
Table 2.-Use of Hypnotics by Sdvent-Ex& Asbestos-Exposed s u b p a s
$
I
of Sleep Quality during the Night
Table 1.-Evaluation
52
and
63
a a
8 5
12 4 84
0 0
76
.OO2
mean age was lower in the solvent-exposed group and that chronic respiratory disease occurred in the asbestos-exposed group. That the sleep disorders in the solvent-exposed group could be severe is indicated. by an increased use of hypnotics and a significant increase in the number of individuals who had consulted physicians because of tiredness or sleeplessness. Complications resulting from insomnia, e.g., increased fatiguability and a tendency to affect lability, demonstrate some similarities to symptoms observed in chronic toxic encephalopathy induced by occupational exposure to organic solvents. it is open to future research to determine if sleep disturbances might explain or intensify some of the symptoms induced by solvent exposure, and if regular use of hypnotics could affect the clinical course of chronic toxic encephalopathy resulting from solvent exposure.
********** The authors gratefully acknowledge senior lecturer Lennart Custakson at the Department of Statistics, University of Umea, for advice in statistical matters. Submitted for publication July 27, 1990; revised; accepted for publicationApril 16, 1991. Requests for reprints should be sent to Carl-JohanGOthe, Department of Occupational Medicine, Huddinge Hospital, SlOO 64 Huddinge, Sweden. * I * * * * * * * *
105
References
6. Struwe G , Wennberg A. Psychiatric and neurological symptoms in workers occupationally exposed to organic solvents-results of a differential epidemiological study. Acta Psychiatr Scand 1983; 67(suppl 303):68-80. 7. Baker EL, Letz RE, Eisen EA, Pothier LJ, Plantamura DL, Larson M, Wolford R. Neurobehavioral effects of solvents in construction plants. J &cup Med 1988; 30116-123. 8. Monstad P, Nissen T, Sulg IA, Mellgren SI. Sleep apnoea and organic solvent exposure. J Neurol 1987; 234152-54. 9. Kilburn KH, Seidman BC, Warshaw R. Neurobehavioral and respiratory symptoms of formaldehyde and xylene exposure in histology technicians. Arch Environ Health 1985; 0229-33. 10. Bixler EO, Kales A, Soldatos CR, Kales ID, Healey S . Prevalence of sleep disorders in the Los Angeles metropolitan area. Am J Psychiatry 1979; 136:1257-62. 1 1 . Klink M, Quan SF. Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Chest 1987; 91:540-46. 12. Gislason T, Almqvist M. Somatic diseases and sleep complaints. An epidemiological study of 3201 Swedish men. Ada Med Scand 1987; 221 ~475-81.
Downloaded by [University of Florida] at 03:14 17 February 2015
1 . Antti-Poika M. Prognosis of symptoms in patients with diagnosed chronic organic solvent intoxication. Int Arch Occup Environ Health 1982; 51 :81-89. 2. Axelson 0, Hane M, Hogstedt C. Case reports on chronic psycho-organic syndrome in house painters. Lakartidningen (Swedish, abstract in English) 1976; 73:319-21. 3. Lundberg 1. Medical examination of paint industry workers with long-term exposure to a mixture of organic solvents. Arbete och Halsa (Sthlm) (Swedish, abstract in English) 1981; 2:l-54. 4. Orbaeck P, Risberg J, Rosen I, Haeger-Aronsen 6, Hagstadius S, Hjortsberg U, Regnell G , Rehnstrom S, Svensson K, Welinder H. Effects of long-term exposure to solvents in the paint industry. A cross-sectional epidemiologic study with clinical and laboratory methods. Scand J Work Environ Health 1985; ll(supp1 2):l-28. 5. Rasmussen K, Bjerre A, Petersen R, Sabroe S. Health complaints caused by working with chlorinated solvents in the electronic industry. Ugeskr Laeger (Danish, abstract in English) 1985; 147:1053-57.
?h U W
WORKSHOP
STATISTICS & COMPUTING IN DISEASE CLUSTERING 23-24 July 1992,
Stony Brook, New York
Applied Biomathematics, with funding from EPRI and NCI, is conducting a workshop on disease clustering. Our aim is the active involvement of participants in discussion of the following areas:
Scient$c Merit Cluster Allegations CZuster Patterns Methods G1S
Resources
How should clustering methods be selected? How should we deal with post-hoc data analyses? How can space-time clusters be characterized? What is the power of clustering techniques under various conditions? Can GIS and geostatistics help identify links between environment and health? What data bases and software are available for cluster investigations?
Contributed papers are solicited on these or related topics. The program committee consists of Dr. Geoffrey Jacquez, Applied Biomathematics, (chair) Dr. Roger Crimson, Department of Preventive Medicine, SUNY at Stony Brook, Dr. Leeka Kheifets, Electric Power Research Institute (EPRI), Dr. Daniel Wartenberg, Robert Woods Johnson Medical School. Workshop information may be obtained from
106
Dr. Jeffrey A. Millstein, Applied Biomathematics 100 North Country Road, Setauket, NY 11733 (516) 751-4350, Fax: (516) 751-3435
Archives of Environmental Health
