Research activities in the Occupational Health Program (OHP) continue to provide opportunities for both productive scholarship as well as prevention practice in the community. A major project, which I lead, involves the on-going surveillance of Gulf War and OIF veterans who were victims of “friendly fire” involving depleted uranium (DU) weapons. These veterans possess multiple fragments of DU in their soft tissues, which are not easily accessed surgically. These retained fragments are oxidizing in-situ and therefore raise the patient’s systemic body burden of uranium. While only weakly radioactive, the uranium toxicity of concern is primarily from the heavy metal chemical hazard it poses. Our clinical investigations focus on the early detection of sentinel effects of this uranium burden on the health of these veterans.
A related project has focused on methods development to allow the assessment of uranium burden and sentinel health effects via mail. As the only center for DU surveillance worldwide, we receive requests for urine uranium testing from veterans nationally and internationally. Refinement and validation of methods has been performed to ensure reliability of results, standardization of processes and translation of the results clinically. Expertise developed from this project has been applied to other biologic monitoring projects we are designing that will allow specimen collection via mail, thus enlarging the reach and participation of interested patients.
Clinical toxicology applications of my work also focus on the surveillance of healthcare workers exposed to chemical hazards in the course of their work. Of special interest is the risk of health harm to workers from preparing and administering anti-cancer chemotherapy. These drugs are well known for their acute and chronic toxicity in treated patients, but they also impose a risk to workers, most notably adverse reproductive outcomes and possibly cancer. We are engaged in a detailed exposure assessment of pharmacists’ and nurses’ drug-handling activity and will link that assessment to measures of internal exposure—actual drug in the urine of workers and biomarkers of genotoxic exposure.
Related to this work have been collaborations with the Centers for Disease Control and Prevention’s Center for Birth Defects and Developmental Disabilities, examining the interface between hazardous work exposures and birth outcomes. I have participated in the CDC’s new initiative on Preconception Care addressing occupational and environmental exposure precautions.
My clinical practice involves the assessment and management of patients who are occupationally or environmentally exposed to toxic substances. We also perform OSHA-mandated surveillance exams for high-risk workers. Ultimately, we promote prevention to our patients, our students and the wider public.
McDiarmid MA, Condon M. Organizational safety culture/climate and worker compliance with hazardous drug guidelines: lessons from the blood-borne pathogen experience. J Occup Environ Med 47:740-749 (2005).
Squibb KS, Leggett RW, McDiarmid MA. Prediction of renal concentrations of depleted uranium and radiation dose in Gulf War veterans with embedded shrapnel. Health Phys 89:267-273 (2005).
Fenton SE, Condon M, Ettinger AS, LaKind JS, Mason A, McDiarmid M, Qian Z, Selevan SG. Collection and use of exposure data from human milk biomonitoring in the United States. J Toxicol Environ Health A 68:1691-1712 (2005).
Lawson CC, Grajewski B, Daston GP, Frazier LM, Lynch D, McDiarmid M, Murono E, Perreault SD, Robbins WA, Ryan MA, Shelby M, Whelan EA. Workgroup report: implementing a national occupational reproductive research agenda—decade one and beyond. Environ Health Perspect 114.3:435-41 (2006)
McDiarmid M.A., K.Gehle. Preconception brief: occupational/environmental exposures, Matern. Child Health J. 10 (2006) S123-S128.
McDiarmid M.A.. Chemical hazards in health care: high hazard, high risk, but low protection, Ann. N. Y. Acad. Sci. 1076 (2006) 601-606.
T.H.Connor, McDiarmid M.A.. Preventing occupational exposures to antineoplastic drugs in health care settings, CA Cancer J. Clin. 56 (2006) 354-365.
M.A.McDevitt, M.Condon, J.Stamberg, J.E.Karp, McDiarmid M.A.. Fluorescent in situ hybridization (FISH) in bone marrow and peripheral blood of leukemia patients: implications for occupational surveillance, Mutat. Res. 629 (2007) 24-31.
McDiarmid M.A., S.M.Engelhardt, M.Oliver, P.Gucer, P.D.Wilson, R.Kane, A.Cernich, B.Kaup, L.Anderson, D.Hoover, L.Brown, R.Albertini, R.Gudi, D.Jacobson-Kram, K.S.Squibb. Health surveillance of Gulf War I veterans exposed to depleted uranium: updating the cohort, Health Phys. 93 (2007) 60-73.
McDiarmid M.A., Squibb K, Engelhardt S, Gucer P, Oliver M. Surveillance of Gulf War I veterans exposed to depleted uranium: 15 years of follow-up, Eur. J. Oncol., 12(4): (2007) 235-242.
McDiarmid M.A., Gardiner P.M, Jack B.W. The clinical content of preconception care: environmental exposures. December 2008. American J. OB&GYN, S357-361.
McDiarmid, M.A., Engelhardt, S.M., Dorsey, C.D., Oliver, M., Gucer, P., Wilson, P.D., Kane, R., Cernich, A., Kaup, B., Anderson, L., Hoover, D., Brown, L. Albertini, R., Gudi, R., and Squibb, K.S. Surveillance Results of Depleted Uranium-Exposed Gulf War I Veterans: Sixteen Years of Follow-Up. J of Tox and Environ Health, Part A, 72(2009) 14-29.
Dorsey C, Squibb K, Engelhardt SM, McDiarmid MA, Biological Monitoring for Depleted Uranium in U.S. Veterans. Env. Health Persp. 2009;1 17:953-956.
Connor, TH, DeBord DG, Pretty, JR, McDiarmid, MA, et.al. Evaluation of antineoplastic drug exposure of health care workers at three university-based US cancer Centers. S Occup Enviro Med. 2010;52:1019-1027.
McDiarmid, MA.,Oliver, MS, Roth, TS, Rogers B, Escalante, C. Chromosome 5 and 7 Abnormalities in Oncology Personnel Handling Anticancer Drugs. JOEM. 20l0;52(10):1028-1034.
McDiarmid, MA, Albertini, RJ, Tucker, ID, Vacek, PM, Carter, EW, Bakhmutsky, MV, Oliver, MS, Engelhardt, SM, Squibb, KS. Measures of genotoxicity in Gulf war I veterans exposed to depleted uranium. Environ Molecular Mut, 2011;52(7):569-581.