Journal of Exposure Science and Environmental Epidemiology (2007), 1–8r 2007 Nature Publishing Group All rights reserved 1559-0631/07/$30.00
Pesticide loadings of select organophosphate and pyrethroid pesticides inurban public housing
RHONA JULIENa, GARY ADAMKIEWICZa, JONATHAN I. LEVYa, DEBORAH BENNETTa,b,MARCIA NISHIOKAc AND JOHN D. SPENGLERa
aHarvard School of Public Health, Harvard University, Boston, Massachusetts, USAbUniversity of California, Davis, California, USAcBattelle Memorial Institute, Columbus, Ohio, USA
We investigated the magnitude and distribution of pyrethroid and organophosphate pesticide loadings within public housing dwellings in Boston,Massachusetts and compared the results using various sampling methods. We collected dust matrices from living room and kitchen in 42 apartments andanalyzed for eleven pyrethoids (e.g., permethrin and cyfluthrin) and two organophosphates (chlorpyrifos and diazinon) in house dust using GC/MS. Agreement between sampling methods were evaluated using Spearman correlations and Kappa statistics. Permethrin and chlorpyrifos were detected inkitchen floor wipes in all homes, followed in frequency of detects by diazinon (98%), cypermethrin (90%) and cyfluthrin (71%). At least six pesticideswere detected in kitchen floor wipes in the majority of the homes (range 3–8). Positive and statistically significant correlations among dust matrices wereobserved between kitchen floor wipes and living room vacuum dust, including for diazinon (r ¼ 0.62) and cyfluthrin (r ¼ 0.69). Detection of severalpesticides including banned or restricted use products in some public housing units, underscore the need for alternative pest management strategies thatembrace the safe and judicious use of pest control products. Journal of Exposure Science and Environmental Epidemiology advance online publication, 9 May 2007; doi:10.1038/sj.jes.7500576
Keywords: chlorpyrifos, house dust, pesticides, public housing, pyrethoids, urban.
given the fact that pest management may have the objectiveof reducing allergen exposures and related asthma develop-
In the US, people spend approximately 90% of their time
indoors (Gurunathan et al., 1998) and about 74% of
While it is known that non-dietary exposure to pesticides
households use pesticides (US EPA, 2002), indicating that
occurs mostly in the home (Lewis et al., 1994; Whitmore
indoor residential exposures may be a significant exposure
et al., 1994; Simcox et al., 1995), significant data gaps exist
pathway for many individuals. In urban multiunit dwellings,
for residential pesticide exposure in urban households, as
pesticide usage is prevalent due to problems with pest
most studies have focused primarily on agricultural commu-
infestation (Landrigan et al., 1999; Whyatt et al., 2002),
nities and their exposures to organophosphates, including
especially in older, poorly maintained housing stock (Kitch
diazinon and chlorpyrifos (Simcox et al., 1995; Loewenherz
et al., 2000). In these homes, pesticide usage is sometimes
et al., 1997; Gordon et al., 1999; Fenske et al., 2000, 2002).
excessive (Landrigan et al., 1999) and oftentimes includes the
More recently, studies have focused on urban settings and
use of prohibited or restricted-use pesticides (Adgate et al.,
have highlighted the widespread use of pesticides indoors
(Quackenboss et al., 2000; Pang et al. 2002; Whyatt et al.
Adverse health effects associated with pesticide exposure
from residential use include altered fetal growth from
Two classes of pesticides, which have been widely used in
prenatal exposure (Berkowitz et al., 2004; Whyatt et al.,
residential settings, including urban multiunit dwellings, are
2004), childhood cancer (Buckley et al., 2000; Daniels et al.,
organophosphate and pyrethroid pesticides (Landrigan et al.,
2001; Flower et al., 2004) and asthma (Salam et al., 2004).
1999). Based on the potential to cause adverse health effects
The association with asthma may be particularly concerning,
to occupants, especially children, two organophosphates(chlorpyrifos and diazinon) were withdrawn from the indoorresidential market in 2001 and 2002, respectively (US EPA,
1. Address all correspondence to: Dr. R. Julien, 64 Beaumont Street,
2000a, b). Organophosphates exert their toxic effect by
inhibiting the enzymatic degradation of the neurotransmitter
Tel.: þ 1 617 918-1782. Fax: þ 1 617 918-0782.
acetylcholine; at extremely high doses, inhibition of acetyl-
E-mail: julien.rhona@epa.govReceived 4 December 2006; accepted 4 February 2007
choline esterase results in the continued firing of the neuron
and subsequent paralysis or death of the affected organism
participants can be found elsewhere (Clougherty et al.,
With the withdrawal of the organophosphates, pyrethroids
are being used increasingly to control pests indoors (Adgate
et al., 2000). Synthetic pyrethroids have insecticidal proper-
Home visits were scheduled for families who provided written
ties similar to the botanical pesticides known as pyrethrins
consent for their participation in the IPM program. During
(i.e., neurotoxin with rapid paralysis or ‘‘quick knock-down
these visits, environmental measurements as well as health
effect’’ of target pest). However, pyrethroids are more
and quality of life information related to asthma were
persistent in the environment than the naturally occurring
obtained both before and after IPM interventions. During
pyrethrins and are therefore used indoors as well as in
the first visit, vacuum dust and floor wipe samples were
agricultural applications (Todd et al., 2003). The toxic mode
collected to provide baseline information about the pre-
of action for pyrethroids is the disruption of the conductance
valence and surface loadings of target pesticides. Environ-
of neuronal impulses, which results in the generation of
mental measurements were recorded between July 2002 and
multiple action potentials that leads to tremors and
August 2003 from homes in all three developments.
incoordination. These cellular level effects can lead to various
Additional information on household characteristics such
as ethnicity and pesticide use were collected at the time of
In addition to the limited exposure data on pyrethroids,
enrollment. Data discussed in this paper will only focus on
there is not a single standardized or consistent approach for
the measurements taken before the IPM interventions, to
analysis or comparison among pesticide exposure studies
establish baseline pesticide loadings.
(Quandt et al., 2004), as previous studies have focused on
Floor wipes were taken on vinyl floor surfaces in both
various matrices including blood, urine, air and/or vacuum
living room and kitchen from standardized locations.
dust or floor wipes to quantify exposures (Lioy et al., 2002).
Kitchen floor wipes were taken adjacent to the stove and
Therefore, the aim of the current study was to quantify the
living room floor wipes were taken adjacent to the sofa. If
distribution of common pesticides (e.g., select pyrethroids
the latter location was not feasible (e.g., due to clutter), an
and diazinon and chlorpyrifos) within the homes of public
alternate area adjacent to the linen closet in the hallway was
housing residents in Boston and compare pesticide loadings
designated. For the floor wipe samples, we used a sampling
from various collection media. We used house dust as our
protocol that was adapted from the National Human
target medium, since our selected pesticides are semi-volatile
Exposure Assessment Survey in Arizona (NHEXAS-AZ)
(organophosphates) or nonvolatile (pyrethroids), and are
(Gordon et al., 1999), which involved wiping a one-square-
foot area (0.0929 m2) with a three-inch square (58 cm2;
(Berger-preie et al., 1997). Dust samples were collected from
Johnson and Johnsont) sterile gauze wetted with 5 ml 99%
the kitchen, where pesticides are most frequently applied due
isopropanol. Once collected, each wipe sample was placed in
to cockroach infestation (Brenner et al., 2003), and from the
a labeled 60 ml amber glass jar and placed in a cooler.
living room, where families tend to spend significant time
Vacuum dust samples were collected only in the living
while indoors. In addition, we examined the agreement
room due to anticipated low dust loadings on bare kitchen
between floor wipes and vacuum dust sampling methods
floors (Nishioka et al., 1999). Living room samples were
when classifying pesticide exposure within these homes.
collected from all accessible surfaces including sofas andcarpets since these fabric surfaces are primary reservoirs fordust borne pesticides (Lewis et al., 1994) and can serve as asource of continued exposure to occupants (Fenske et al.,
1991; Simcox et al., 1995; Gurunathan et al., 1998;Landrigan et al., 1999). Vacuum dust was obtained using a
The current study is a component of the Healthy Public
sampling protocol that was adapted from the epidemiologic
Housing Initiative (HPHI), a longitudinal intervention study
study conducted in Cape Cod, Massachusetts that looked
targeting apartments of pediatric asthmatics (between 4 and
at the associations between environmental exposures and
17 years of age) living in urban housing. Sixty households
breast cancer (Rudel et al., 2001). The sampling apparatus
were recruited from three public housing developments in
consisted of a 9 A Eureka Mighty-mitet vacuum cleaner,
Boston, Massachusetts. Of the households who were
adjusted to collect dust in a 19 Â 90 mm cellulose extraction
recruited for the intervention study, 43 households partici-
thimble which was placed into an extended arm. This arm
pated in the Integrated Pest Management (IPM) program,
was connected at one end to the vacuum cleaner and capped
which was one of the primary environmental interventions
at the other end with a crevice tool. The samples were
tested. Environmental measurements for the current study
collected by slowly moving the crevice tool using back and
were obtained from 42 of these households. Additional
forth motions over the designated areas for a total sampling
information on HPHI and characteristics of the study
time of five minutes. Once samples were collected, the
Journal of Exposure Science and Environmental Epidemiology (2007), 1–8
cellulose thimbles were removed from the extended arm using
grammed to 2801C. Two diagnostic ions were monitored
gloves and placed into a labeled zip loct bag and stored in a
for identification of each analyte.
cooler. Both vacuum dust and floor wipe samples were laterstored in a freezer at À221C until shipment for analysis.
analyzed with each sample set and were used to assess
method performance. For the 78 dust analyses, the QA/QC
To determine pesticide concentrations, each sample was
samples included eight solvent method blanks, three solvent
analyzed for two organophosphates (chlorpyrifos and
method spikes (100 ng/analyte), three reference dust samples,
diazinon) and eleven pyrethroids [allethrin (cis- and trans-
six fortified reference dust samples and five duplicate
isomers) coelute, bifenthrin, isomers of cyfluthrin (three
analyses. Low-level dust fortification was 50 ng/analyte,
chromatographically resolved isomers), cyhalothrin, cyper-
except 62.5 ng/isomer for cyfluthrin and cypermethrin, and
methrin (three resolved isomers), deltamethrin, esfenvalerate,
250 ng/analyte for esfenvalerate and deltamethrin; high-level
permethrin (cis- and trans- isomers), resmethrin, sumithrin
and tetramethrin]. Target pesticides were selected because of
The average solvent spike recovery was 86%, with a range
potential adverse health effects, persistence indoors and/or
of 82712 to 93713% for chlorpyrifos and sumithrin,
respectively. The average low-level spike recovery was 93%,with a range of 5677 to 120710% for resmethrin andcyhalothrin, respectively. The average high-level spike
recovery was 107%, with a range of 84723–132748%
sample, up to 0.50 g, was weighed and fortified with 250 ng
for diazinon and tetramethrin, respectively. There was a
of the compound class-specific surrogate recovery standards
consistent interference to allethrin in the method that
prevented detection and quantification of this analyte in dust
C6-labelled mix of cis/trans-permethrin for pyrethroids.
sample extracts. For the 31 pairs of analytes detected in the
The dust was extracted using ultrasonication in 12 ml of 1:1
duplicate samples, the average relative percent difference for
hexane:acetone. After centrifugation, 10 ml of the extract was
concentration was 25% (0–154%). The SRS recoveries in the
removed, concentrated and solvent exchanged into hexane. A
dust samples showed very good method performance on a
C18 solid phase extraction (SPE) cartridge (1000 mg;
sample-by-sample basis: recovery of 93710% for fenchlor-
dichloromethane (DCM), 15% diethyl ether in hexane and
hexane. The extract was added, the sample was eluted in
The QA/QC samples for the 192 wipe samples included 15
reverse order with these solvents and the resulting eluant was
field matrix blanks and 15 matrix spikes, with the latter
concentrated to a final 1 ml volume. Dibromobiphenyl was
fortified with 150 ng/analyte (with scaling as described above
added as the internal standard for quantification. A nine-
for cyfluthrin, cypermethrin, esfenvalerate, deltamethrin)
point calibration curve, spanning the range of 0–750 ng/ml
before extraction. Average recovery in the spiked wipes was
for analytes and 0–300 ng/ml for SRSs, was analyzed
98%, with a range of 8679 to 112713% for cypermethrin
concurrently with each sample set. Linear regression
isomers and chlorpyrifos, respectively. The SRS recoveries in
analysis was used to establish the calibration curve for each
the wipe samples showed good method performance on a
analyte. Samples with analytes that exceeded the calibration
sample-by-sample basis: recovery of 78715% for fenchlor-
curve range by more than 15% were diluted, respiked with
internal standard and reanalyzed. After quantification,
analyte concentrations were corrected by the recovery of
the matched compound class SRS in that sample.
The normality of each pesticide distribution was determinedusing the Shapiro–Wilks test. Where the data were skewed,
we used non-parametric tests for analyses. In order to ensure
with 100 ng of fenchlorphos and 13C6-trans-permethrin,
unbiased estimates of the correlations, samples with con-
and extracted using accelerated solvent extraction (ASE)
centrations below the limit of detection (LOD) were assigned
technology (ASE 200; Dionex Corp) in an 11 ml cell using
random values between zero and the LOD according to an
DCM at 2000 psi and 1001C through two cycles. The extract
was concentrated, solvent exchanged, cleaned up and
Because there is no ‘‘gold standard’’ for sampling indoor
analyzed as described above for the dust extracts.
concentrations of dust-borne pesticides, we examined the
Extracts were analyzed using GC/MS in the multiple ion
agreement between two sampling methods conducted in this
detection mode (6890 GC interfaced to a 5973 MSD;
study, vacuum dust and floor wipe sampling. We first
Agilent) using a DB-1701 GC column (30 m; 0.25 mm id;
evaluated the relationships within matrices (kitchen vs. living
0.15 mm film thickness) with the GC temperature pro-
room floor wipes) and between matrices (living room floor
Journal of Exposure Science and Environmental Epidemiology (2007), 1–8
wipes vs. vacuum dust) using Spearman rank correlations.
correlations among specific isomers for each compound. For
For floor wipes, we also tested whether concentrations
kitchen floor wipes, permethrin and chlorpyrifos were
significantly differed between the kitchen and living room,
detected in every home. Diazinon and cypermethrin were
detected at fairly high frequencies (X90%). Cyfluthrin was
We categorized measured concentrations as dichotomous
detected in 71% of homes. For living room floor wipes,
variables and evaluated the agreement between the vacuum
permethrin and chlorpyrifos were also detected at fairly
dust method and the kitchen floor wipe method. As there are
high frequencies, followed by diazinon, which was detected
no well-defined thresholds for health effects for the target
in 80% of the homes. For vacuum dust, similarly high
pesticides, we considered three alternatives: above/below the
detection frequencies were also observed, with cis- and
LOD, the 50th percentile and the 75th percentile. Agreement
trans-permethrin detected in every home. In addition to
was evaluated using the Kappa statistic, which captures the
detection frequency, the data in Table 2i indicate that
level of agreement between these two alternate measurement
most analytes have pesticide loadings that vary across
approaches (where 1 ¼ perfect agreement, 0 ¼ no agreement
several orders of magnitude. This variation in pesticide
above that expected by chance, À1 ¼ perfect disagreement).
distribution is also illustrated in Figure 1, which presents
All statistical analyses were performed using SAS Version 9
the cumulative frequency distribution of the five most
prevalent analytes in kitchen floor wipes. The distributionof cyfluthrin, which is a restricted-use pesticide in certainformulations such as 25% emulsified concentrate (US EPA,2003), is somewhat broader and more skewed than the
distribution for the other pyrethroids. At the upper end ofthe distribution (490th percentile), cyfluthrin loadings were
Table 1 provides study demographics and information on
over 2 orders of magnitude higher than the loadings at the
participants’ choice of pest control methods, including traps
(41%), non-volatile formulations (gels (25%)) and volatile
One way to examine the degree to which analytes occur
formulations (sprays (34%), and smoke bombs (27%)).
simultaneously with one another is to consider the number of
Although 84% of the families reported pesticide use within
analytes detected in each home. All homes had at least two
the past year, 92% indicated an interest in using pest control
pesticides present in vacuum dust, and 17 homes (49%) had
remedies that did not rely on pesticides.
five or more present. Similarly, in examining kitchen floor
Table 2i reports summary statistics for kitchen and living
wipes, all homes had at least three pesticides present and 27
room floor wipes and vacuum dust in the baseline pre-
homes (64%) had six or more present. For the living room
intervention samples. Target analytes with isomers (e.g.,
floor wipes, 17 homes (56%) had five or more pesticides
permethrin, cypermethrin and cyfluthrin) are presented as the
sum for each compound based on high Spearman rank
We also considered the agreement between sampling sites
and between sampling methods (Table 2ii). Spearman rankcorrelations were positive and statistically significant for the
Table 1. Selected household characteristics of IPM participants
majority of prevalent analytes (diazinon, chlorpyrifos,
permethrin and cyfluthrin), ranging from 0.38 to 0.64between living room and kitchen floor wipes, from 0.41 to
0.69 between kitchen floor wipes and living room vacuum
dust samples and from 0.44 to 0.61 between living room floor
Based on the results for the Wilcoxon rank-sum test
(not shown here), with the exception of cypermethrin,
there were no statistically significant differences in pesticide
loadings between living room and kitchen floor wipes
for the prevalent analytes. Thus, given the similarity
between these two matrices for the prevalent analytes, only
the results from the kitchen floor wipes will be represented
To test the agreement between the two forms of
measurements (floor wipes and vacuum dust) from the
Self-report cockroach infestation as severe
perspective of categorization as high/low exposure based on
specific exposure thresholds (Table 3), the magnitude of
Total percentage will exceed 100% because families used multiple pesticide
types at any given time in the home.
Kappa coefficients was considered for the following exposure
Journal of Exposure Science and Environmental Epidemiology (2007), 1–8
Table 2i. Summary statistics for pesticide prevalence (% above limit of detection) and pesticide loadings in kitchen and living room floor wipesamples (mg/m2) and vacuum dust (mg/g)
Kitchen floor wipes (N ¼ 42)Chlorpyrifos
thresholds, LOD, the median percentile and the 75th
percentile. Kappa coefficients were positive and strong(significantly 40) for cyfluthrin at all three thresholds
The findings of the high prevalence of pesticides, for example,
(0.33, 0.47 and 0.30), permethrin (0.59 and 0.51) and
permethrin and chlorpyrifos, in these urban housing units
diazinon (0.53 and 0.51) at the median and 75th percentile,
are consistent with other studies that obtained information
respectively, and for chlorpyrifos (0.35), at the median
on pesticide prevalence via surveys and questionnaires
percentile. We were unable to compute Kappa coefficients for
(Landrigan et al., 1999; Adgate et al., 2000; Kinney et al.,
the two most ubiquitous target pesticides (permethrin and
chlorpyrifos) due to 100% detection in at least one medium
While sampling occurred after diazinon and chlorpyrifos
(Sim and Wright 2005) and in general, the high detection
were removed from the residential market, the measured
rates for the analytes in question limit the statistical power of
concentrations in house dust can most likely be attributed
to the persistence of these pesticides indoors. However, the
Journal of Exposure Science and Environmental Epidemiology (2007), 1–8
Table 3. Test of equivalence between kitchen floor wipe and vacuum
dust methods (N ¼ 34), considering multiple exposed/unexposedthresholds
Values represent Kappa statistics and standard errors.
concentrations above the 90th percentile exceeded the median
concentrations by several orders of magnitude, which may
indicate that a subset of residents is applying the productincorrectly.
Since few studies have measured concentrations of these
analytes in house dust in urban settings, there are limited data
to make a determination of whether residents in these public
Figure 1. Cumulative frequencies of five target pesticides detected in
housing developments are disproportionately exposed to
pesticides and may be at risk of adverse health effects. Astudy which looked at exposures to several pesticides
Table 2ii. Spearman correlations between sampling matrices and
including chlorpyrifos, diazinon and cis- and trans-perme-
betwen sampling locations for the most prevalent pesticides (LR ¼
thrin in predominantly single-family homes measured geo-
metric mean concentrations of approximately 113 ng/g forchlorpyrifos, 25 ng/g for diazinon, 337 ng/g for cis-perme-
thrin and 517 ng/g for trans-permethrin (Colt et al., 2004).
These measurements were similar to our median concentra-
tions in vacuum dust, although it should be noted that
the limit of detection in that particular study was an order
of magnitude higher than the limit of detection in our
measurements were also observed in the floor dust of a daycare setting with preschoolers, with observed median
*Statistically significant at the 0.05 level.
chlorpyrifos concentrations of 135 ng/g (Morgan et al.,
**Statistically significant at the 0.01 level.
2005). However, these measurements were taken before thephase-out of organophosphates. We are also unaware of
presence of cyfluthrin was a cause for concern for several
other studies, which measured levels of numerous analytes,
reasons. It is the active ingredient found primarily in a
especially pyrethroids, in low-income multiunit dwellings,
product known as Tempo. Based on information obtained
which underscores the importance and uniqueness of our
from the Material Safety Data Sheet (MSDS) prepared by
findings. And given the known neurological pathways
the manufacturer, Bayer (e.g., MSDS #R000023651 and
affected by pyrethroids, the levels we have observed in this
MSDS #29752), this compound is available in a variety of
study suggest that the current substitution of organophos-
formulations (e.g., wettable powders and suspension con-
phates with these chemicals may incur their own health risks
centrate) and in certain formulations is licensed for pest
management professionals and/or commercial use only.
In terms of our methodological conclusions, there were
Moreover, field staff were informed that Tempo was being
some positive and statistically significant correlations between
applied by residents in its concentrated form and was not
the vacuum dust and floor wipe samples. However, based on
mixed with water as required per labeling instructions. This
our findings of a modest agreement between these two
misuse of Tempo would result in substantially higher
matrices for some analytes, we are unable to conclude that
exposures than intended and should be investigated in further
floor wipe samples can serve as a universal proxy for vacuum
detail. In homes where cyfluthrin was detected, the
dust samples. In instances where there was a strong
Journal of Exposure Science and Environmental Epidemiology (2007), 1–8
agreement between the analytes, for example, permethrin and
To the best of our knowledge, this study is the first to
diazinon, this may be due in part to the liquid formulation of
report on concentrations of 10 pyrethroids and two
these pesticides (e.g., smoke bombs and aerosol sprays) used
organophosphates in an urban setting, and more specifically,
in the home. Applications such as smoke bombs intentionally
in a multiunit residential setting. Our results show a wide
distribute the pesticide throughout the home. The aerosol
range of pesticide levels with certain pyrethroids (permethrin)
spray is a more targeted application; however, there is
and organophosphates (chlorpyrifos) detected in every home,
potential for considerable overspray. Due to relatively high
and restricted-use pesticides (cyfluthrin) detected in a
vapor pressures as well as movement of dust, many pesticides
majority of homes. In addition, the significant correlation
migrate from treated areas to non-target surfaces (Guru-
between vacuum and floor wipe sampling methods for certain
nathan et al., 1998; Lioy et al., 2002; Bennett and Furtaw
ubiquitous analytes indicates that kitchen floor wipe samples
2004). The frequency of pesticide use and the close proximity
could potentially serve as a less expensive and non-intrusive
of rooms in our study homes, which is quite typical in inner-
proxy, which can be especially helpful in a challenging
city public housing, will undoubtedly facilitate this process.
On the other hand, if Tempo (with cyfluthrin as its active
imply that interventions may be warranted in these develop-
ingredient) is applied in powdered form in the kitchen,
ments, with efficient and practical methods needed to
barring any mechanical means of resuspension such as
preferentially select homes for possible interventions, given
the substantial variability in concentrations across units.
that significant deposition onto non-target surfaces will
Equally important are the policy implications of our findings,
occur. For cypermethrin, we do not have information on
which suggest that efforts should be made to promote and
whether the product formulation that was used in these
institutionalize viable and safer pest control alternatives in
homes came in liquid formulation (emulsifiable concentrates)
or dry formulation (e.g., wettable powder and dust granules),making it difficult to determine the precise reason for non-agreement.
There are some potential limitations that influence the
interpretation of our findings. In exposure studies where
Funding was provided by US Department of Housing and
dermal exposure is the potential pathway under considera-
Urban Development (grant# MALHH0077-00), W.K.
tion, dislodgeable pesticides (i.e., pesticide residue on a
Kellogg Foundation, Boston Foundation and Jessie B.
surface that is removed by the skin) are regarded as the most
Cox Charitable Trust Melvin W. First Scholarship and
appropriate measurement for human exposure (Fenske et al.,
Akira Yamaguchi Endowment. Special thanks to the families
1991). Our choice of isopropanol as the wetting agent to
who participated in the study, as well as the community
collect floor wipe samples likely improved our collection
partners for their cooperation and commitment to the success
efficiency, but may also result in removal of these residues
from both the surface and sub-surface, impairing compar-ability with other exposure measures.
We did not obtain information about the approximate
time of the most recent pesticide application in the home,
Adgate J.L., Kukowski A., Stroebel C., Shubat P.J., Morrell S., and Quackenboss
a factor, that would clearly influence the concentration
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this assumption would not introduce much error since
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October 31, 2012 1. 2. 3. 4. 5. Old Guard Stays At Tomb Of Unknowns Amid Storm. 6. High Rate Of Female Veterans Receiving Mammograms. 7. Start-Up: Women Veterans. 8. New Hope For Veterans With Traumatic Brain Injuries. 9. Group Contracted To Study DoD-VA iEHR Migration At Pacific JITC. 10. New National Cemetery Opens In Zachary. 11. OIG Sees Problems In Data
Facilitation of the Development of Healthcare in Uganda Health is a complex issue and there is no simple solution to taking care of the health needs of any nation. Uganda has a population approaching 30,000,000, with over 50% of people below the age of fifteen. The prevalent diseases are not the degenerative diseases, which mainly affect developed countries, but infectious diseases and diseas