Non-specific Indicators Research Articles

Peripartum health and welfare of Holstein-Friesian cows in a confinement-TMR system compared to a pasture-based system

AbstractThe greatest challenge to the welfare of dairy cows occurs in the peripartum period. Given the perception that cow welfare is better in more natural environments, it was hypothesised that cows in a PASTURE-based production system (cubicle housing with grass silage pre-partum and rotational grazing with concentrate supplementation post-partum) would have improved peripartal welfare compared to cows in a HOUSED production system (cubicle housing with a total mixed ration [TMR], pre-partum and post-partum). Blood samples were analysed for acute phase proteins (APP), cortisol, white blood cell (WBC) differential and counts and other biochemical metabolites as non-specific indicators of sub-clinical ill-health and nutritional stress. Daily monitoring of rectal temperature (RT) and rumen fill (RF) scores were used to monitor ill-health and nutritional status. Reproductive health and welfare (calving difficulty, retained placenta, puerperal metritis, endometritis and oestrous cyclicity) was also recorded. No differences were found between treatments for APP, cortisol or WBC. Blood metabolite differences indicated that PASTURE cows were under greater nutritional stress than HOUSED cows. HOUSED cows showed an increase in RF score from day 0 to 10 post-partum and had a higher RF score than PASTURE cows. PASTURE cows had an overall lower RT and lower incidence of reproductive disorders. Results primarily reflect nutritional differences between treatments with PASTURE cows showing greater potential nutritional/metabolic stress in early lactation which has attendant implications for welfare. Nevertheless, this did not result in inferior health and, in accordance with our hypothesis, PASTURE cows’ reproductive health and welfare tended to be better than that of HOUSED cows.

Diffusion tensor imaging detects axonal injury and demyelination in the spinal cord and cranial nerves of a murine model of globoid cell leukodystrophy

Globoid cell leukodystrophy is an inherited neurodegenerative disorder caused by a deficiency of the lysosomal enzyme galactosylceramidase. In both human patients and the authentic murine Twitcher model, pathological findings include demyelination as well as axonal damage in both the central and peripheral nervous system. Diffusion tensor imaging (DTI) has emerged as a powerful noninvasive technique that is sensitive to these white matter disease processes. Increases in radial diffusivity (lambda perpendicular) and decreases in axial diffusivity (lambda parallel) correlate with histopathological evidence of demyelination and axonal damage, respectively. Compared to age-matched, normal littermates, DTI of optic nerve and trigeminal nerve in end-stage Twitcher mice displayed a statistically significant increase in lambda perpendicular and decrease in lambda parallel, consistent with previously characterized demyelination and axonal damage in these regions. In the Twitcher spinal cord, a statistically significant decrease in lambda parallel was identified in both the dorsal and ventrolateral white matter, relative to normal controls. These results were consistent with immunofluorescence evidence of axonal damage in these areas as detected by staining for nonphosphorylated neurofilaments (SMI32). Increase in lambda perpendicular in Twitcher spinal cord white matter relative to normal controls reached statistical significance in the dorsal columns and approached statistical significance in the ventrolateral region. Correlative reduced levels of myelin basic protein were detected by immunofluorescent staining in both these white matter regions in the Twitcher spinal cord. Fractional anisotropy, a nonspecific but sensitive indicator of white matter disease, was significantly reduced in the optic nerve, trigeminal nerve, and throughout the spinal cord white matter of Twitcher mice, relative to normal controls. This first reported application of spinal cord DTI in the setting of GLD holds potential as a noninvasive, quantitative assay of therapeutic efficacy in future treatment studies.

Double contrast-enhanced MRI of viral hepatitis-induced cirrhosis: correlation of gross morphological signs with hepatic fibrosis

The purpose of this study was to evaluate the diagnostic ability of the expanded gallbladder fossa and right posterior hepatic notch signs for hepatic fibrosis determined by double contrast-enhanced MRI. For patients with chronic viral hepatitis B (n = 96) or hepatitis C (n = 13) who underwent gadopentate dimeglumine-enhanced dynamic MRI followed by ferucarbotran-enhanced gradient-echo imaging, the degree of parenchymal fibrosis was categorised into three groups based on the extent of reticulation and nodularity: (1) pre-cirrhotic or minimal fibrosis; (2) mild to moderate fibrosis; (3) advanced cirrhosis. Each group was evaluated for the presence of a sharp notch in the posterior-medial surface of the right lobe of the liver and expanded gallbladder fossa. The expanded gallbladder fossa sign gradually increased with an increasing degree of fibrosis (Group 1, 50%; Group 2, 61%; Group 3, 78%), and there was no significant difference (p>0.5) between hepatitis B (67%) and C (73%). In the case of the right posterior hepatic notch sign, only 6% of Group 1 and Group 2 patients were positive; 27% of hepatitis B patients and 90% of hepatitis C patients in Group 3 exhibited the sign (p<0.05). Owing to its low prevalence, even in advanced cirrhosis, the right posterior hepatic notch sign is of little value in the diagnosis of cirrhosis due to chronic hepatitis B virus infection, whereas an expanded gallbladder fossa could be used as a non-specific indicator of early fibrosis before the gross appearance of advanced hepatic fibrosis.

Changes in Lake Superior ice cover at Bayfield, Wisconsin

This research documents a 150-year record pertaining to the duration of closed navigation for Bayfield harbor. Data were gathered recording the opening and closing of navigation in Bayfield, Wisconsin from 1857–2007. Data were primarily collected from the Madeline Island Ferry Line and microfilmed copies of the Bayfield County Press. Analysis of the data indicates that the duration of ice cover on Lake Superior at Bayfield, Wisconsin has decreased over the past 150 years at the rate of approximately 3 days/decade or 45 days over the course of the study. During the past 150 years, the date that the last boat is able to navigate in the Bayfield harbor indicates the onset of ice cover. This date has occurred an average of 1.6 days later every decade. Conversely, the date that the first boat is able to navigate in Bayfield harbor marking the break up of ice cover has come to an average of 1.7 days earlier every decade. Although this represents the overall trend for the past century and a half, the most dramatic changes have occurred since 1975. During this period the ice season has begun an average of 11.7 days later and ended 3.0 days earlier every decade. Bayfield's ice season was compared to the lake's annual maximum ice concentration (AMIC) as compiled in a study by [Assel, R.A., Cronk, K., and Norton, D. 2003. Recent trends in Laurentian Great Lakes ice cover, Climatic Change 57: 185–204, 2003.] The fraction of the potential closed navigation season that the Bayfield harbor is ice covered decreased at a rate of 0.77% a year while the AMIC decreased at a rate of 0.39%/year during the period from 1964–2001. In general, the decline in the ice cover at Bayfield mirrors the pattern shown by the AMIC, suggesting that Bayfield's ice season could be used as a nonspecific indicator of overall lake trends.

Initiation of antidepressant therapy: do patients follow the GP's prescription?

The question whether patients actually start drug taking after having received a first antidepressant prescription is often overlooked. To determine the incidence of patients who do not fill or fill only a single antidepressant prescription at the pharmacy, and to identify associated patient characteristics. Retrospective study linking a general practice to a pharmacy dispensing database. General practice in the Netherlands. patients who received a first-time antidepressant prescription from a GP. Three patient groups were identified: patients who did not fill the prescription (non-fillers); patients who filled only a single prescription (single Rx-fillers); and patients who filled at least two consecutive prescriptions. Non-fillers and single Rx-fillers were combined into a group of decliners. Of all 965 patients, 41 (4.2%) did not fill the prescription, and 229 (23.7%) filled only a single prescription. Patients who consulted their GP for a non-specific indication, rather than for depression, anxiety, panic, or obsessive-compulsive disorder, were almost three times more likely (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.8 to 3.9) to decline treatment. Further, the risk of declining was almost fivefold higher (OR = 4.8, 95% CI = 2.1 to 11.3) in non-Western immigrants, and almost twofold higher (OR = 1.8, 95% CI = 1.2 to 2.8) in patients >60 years of age. Over one in four patients who receive a first-time antidepressant prescription decline treatment; they either do not initiate drug taking or do not persist with antidepressant use for longer than 2 weeks.

Managing depression in primary care: it's not only what you do it's the way that you do it

Common mental health problems place significant demands on primary care services both in terms of time and resources.1,2 Of the common mental health problems, depression and anxiety make up about 97%.3 Depression is costly to the individual, their family and community, and represents a significant loss of human capital. It poses a considerable burden to the national economy4 and people with depression represent the largest single group receiving incapacity benefits.5,6 Depression is often chronic, has high relapse rates, increases the likelihood of suicide, and is associated with an increased risk of many physical disorders.7 It continues to present a major public health challenge8 despite public education campaigns and evidence-based treatment.9,10 Four papers in this month's BJGP highlight some of the potential problems of treating patients with depression. Patients frequently do not take antidepressant medication as prescribed with as few as 10% of patients completing a course of treatment.11 Van Geffen et al , in this issue of the BJGP , explore the rates of commencing treatment in patients prescribed antidepressants.12 They found that 28% of people newly prescribed an antidepressant by their GP never cashed in their prescriptions or only did so on one occasion. This failure to take the prescribed antidepressants was higher in people given antidepressants for non-specific indications, such as sleep problems, fatigue, relationship problems, and in non-Western immigrants and older people. This compares to drop-out rates for psychological therapies of about 30%7 and poses a particular challenge for healthcare professionals. Antidepressant prescribing has risen in many countries over recent years. Morrison et al , in this issue of the journal, surveyed antidepressant prescribing in Scotland, and found wide prescribing variations.13 These variations showed a positive association with morbidity levels, …

Titres of Specific Antibodies against Toxoplasma gondii in Goats and their Kids

The aim of our study was to perform repeated determination of specific antibody levels in mothers and their kids in order to assess indirectly the possibility of vertical transmission of toxoplasmosis in goats. Twenty-eight goats with their kids were included in the study. The following variables were assessed: number of born kids in relation to antibody titres of goats; levels of specific antibodies in the blood of goats and kids; and concentrations of immunoglobulins (Ig), total protein (TP) and total globulins (G) in order to define the end of colostral immunity and the start of active production of antibodies in kids under 69 days of age. Specific antibodies against Toxoplasma gondii in goats were detected by IFAT in titres ranging from 0 to 1 280. Out of a total of 28 animals, 5 goats were negative (17.9%) and 23 goats were seropositive (82.1%). The goats delivered 42 kids. A total ratio of number of kids to number of mothers was 1.5. Partial evaluation of results in goats without positive titre against T. gondii before parturition and goats with positive titre showed that negative goats tended to have more kids (p &lt; 0.1) (ratio 1.80) compared to positive goats (ratio 1.35). A significant decrease in levels of TP, Ig and G was observed between days 27 and 41. Samples taken on days 55 and 69 proved gradual increase of active production of antibody response, which was supported also by a significant increase (p &lt; 0.01) of monitored non-specific immunity indicators. During this period, we observed increased titres of specific antibodies against toxoplasmosis in 20 kids (5 kids 41 days old, 5 kids 55 days old, and 10 kids 69 days old) and thus we could assume the possibility of vertical transmission of toxoplasmosis.

Fluctuating asymmetry of Betula pendula Roth leaves – an index of environment quality

Fluctuating asymmetry (FA) is a non-specific stress indicator and describe developmental instability in bilateral structure. In plants, FA has been used as a tool for monitoring levels of ecological stress, however, in trees, high value of leaf FA has been assumed to indicate the level of environmental stresses. In this work, I analyzed the FA response to abiotic stress in the Betula pendula Roth leaves in two contrasting sites (polluted vs unpolluted). I also investigated whether another biometrical leaf feature is able to determine FA as an environmental stress indicator. After the cluster analysis and mixed-model ANOVA, I selected one feature, which was leaf apical angle. Results showed significant differences (using chi square test) in apical angle FA in the unpolluted site as compared to the polluted one. Concluding, I suggested that plants living in more stressful sites are more symmetrical and leaf FA for plant species with a wide ecological distribution such as Betula pendula should be used as an index of environmental quality.

Review on natriuretic peptides: where we are, where we are going

Tremendous advances have been made in our understanding of the pathophysiology and treatment of congestive heart failure. However, diagnosis of the disease still remains difficult, even with a comprehensive physical examination. Symptoms such as dyspnea are nonspecific and insensitive indicators for heart failure, which can go largely undetected. Several studies have suggested the need for new diagnostic capabilities, especially with the increasing prevalence of heart failure in the US. The discovery of natriuretic peptides as diagnostic biomarkers has been one of the most critical advances for the management of heart failure. Both B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide have the potential to diagnose heart failure, assess prognostic risk of rehospitalization and mortality, and even help guide treatment. Their relative cost-effectiveness and availability have also facilitated their acceptance into many emergency departments, clinics and in-patient units as standard care when evaluating patients with suspected heart failure. Our understanding of the natriuretic peptide system is still in its infancy, but natriuretic peptides have emerged as important diagnostic and prognostic tools that have generated interest in finding broader applications for their use. The purpose of this review is to discuss the clinical approaches and future applications of natriuretic peptides in diagnosing and managing treatment of congestive heart failure. A comprehensive review of studies to assess the utility of natriuretic peptides for diagnosis and prognosis of heart failure and other conditions. Natriuretic peptides are powerful tools to aid the physician in the diagnosis, prognosis and management of heart failure in both in-patient and out-patient settings. However, natriuretic peptides should be used as an adjunct test as many circumstances can also influence changes in natriuretic peptide levels.

Perioperative D-Dimer Levels in Patients with Musculoskeletal Tumors

Background:D-dimer (DD) levels have been reported as a sensitive but non-specific indicator for deep vein thrombosis (DVT) and pulmonary embolism (PE). Few reports have examined perioperative DD levels in musculoskeletal tumor.Materials/Methods:Subjects comprised 77 patients who had undergone oncological resection of musculoskeletal tumor. DD levels were assessed preoperatively and on postoperative days 1 and 7. Multidetector-row computed tomography (MD-CT) was performed to detect DVT/PE for cases with DD level >10.0 µg/ml.Results:Mean preoperative DD level was 0.84 µg/ml. Significant elevation of postoperative DD levels was confirmed. DD levels were significantly changed by various clinical conditions, such as malignancy, age and prosthetic reconstruction. In 4 of 5 cases with postoperative DD levels >10.0 µg/ml, DVT/PE was detected. Conclusion:Activation of the coagulation system by surgery and heterogeneity of DD levels under various clinical conditions in musculoskeletal tumor patients were suggested.

Shade and Herbivory Induce Fluctuating Asymmetry in a Mediterranean Oak

Fluctuating asymmetry (FA), random nondirectional deviations from perfect symmetry, has been proposed as a useful indicator of environmental stress. Nevertheless, FA acts as a nonspecific indicator of stress; thus, factorial designs are needed to disentangle which of the factors may induce FA. We used an experimental approach in which seedlings of Quercus pyrenaica were exposed to two levels of light, water, and simulated herbivory. To determine whether FA may operate as a stress indicator, leaf width and number of lobes were measured. Our predictions were (1) different levels of light, water, and herbivory can bring different levels of FA and (2) fluctuating asymmetry can act as an early stress indicator. As predicted, FA was higher in shade than in sun, both for leaf width and number of leaf lobes. By contrast, pruning affected FA only for number of lobes. FA was higher in pruned seedlings in the sun but lower in pruned seedlings in the shade. The two FA indices used ( \documentclass{aastex} \usepackage...

Prospective Study of High-Sensitivity C-Reactive Protein as a Determinant of Mortality: Results from the MONICA/KORA Augsburg Cohort Study, 1984–1998

C-reactive protein (CRP), an exquisitely sensitive systemic marker of inflammation, has emerged as an independent predictor of cardiovascular diseases (CVD). Because other chronic diseases are also associated with an inflammatory response, we sought to assess the association of high-sensitivity CRP (hsCRP) with total and cause-specific mortality in a large cohort of middle-aged men. We measured hsCRP at baseline in 3620 middle-aged men, randomly drawn from 3 samples of the general population in the Augsburg area (Southern 0Germany) in 1984-85, 1989-90, and 1994-95. Outcome was defined as all deaths, fatal CVD, fatal coronary heart disease (CHD) including sudden cardiac deaths, and cancer deaths. During an average follow-up of 7.1 years, 408 deaths occurred (CVD 196, CHD 129, cancer 127). In multivariable Cox regression analysis, subjects with hsCRP >3 mg/L at baseline showed an almost 2-fold increased risk to die vs those with hsCRP <1 mg/L [hazard ratio (HR) 1.88, 95% CI 1.41-2.52]. HRs were 2.15 (95% CI 1.39-3.34) for fatal CVD, 1.74 (1.04-2.92) for fatal CHD, and 1.65 (1.01-2.68) for cancer mortality. In contrast, neither total nor HDL cholesterol significantly predicted all-cause or cancer mortality, and cholesterol had only modest effects on CVD mortality. Our results suggest that increased circulating hsCRP concentrations are associated with an increased risk of death from several widespread chronic diseases. Persistently increased hsCRP is a sensitive and valuable nonspecific indicator of an ongoing disease process that deserves serious and careful medical attention.

Investigating health at Kerma: Sacrificial versus nonsacrificial individuals

This analysis examines heterogeneity in risks by assessing the health status of individuals in two distinct burial contexts from the Nubian site of Kerma: sacrificial (n = 100) and nonsacrificial (n = 190) burial areas dated to the classic Kerma period ( approximately 1750-1500 BC). Indicators of physiological stress that were examined include cribra orbitalia, dental enamel hypoplasia, tibial osteoperiostitis, and femur length. The analysis presented here shows that the people interred in the sacrificial and nonsacrificial burial contexts at Kerma in Upper Nubia had similar health profiles that were comparable with other contemporaneous samples from the region. If sacrificial individuals did not experience the same risk of death as nonsacrificial individuals, it was not evident in the frequencies of nonspecific stress indicators. However, this differential risk of death may be blurred by our inability to examine nonadults for childhood disease. This research demonstrates the complexities involved in understanding the multiple factors that result in heterogeneity in skeletal samples.

Nonspecific indicators of immune protection overvoltage in athletes

Nonspecific indicators of immune protection overvoltage in athletes

Effects of stocking density on growth and non-specific immune responses in juvenile soft-shelled turtle, Pelodiscus sinensis

To investigate the influence of stocking density on the growth and non-specific immune responses of juvenile soft-shelled turtle, Pelodiscus sinensis, three groups of turtles (initial body weight 74.2±12.2 g) were reared in 80 cm (L) × 40 cm (W) × 30 cm (H) tanks for 35 days at three stocking densities (StD), which were 1 individuals (ind.) tank−1 (3.13 ind m−2) for D1, 4 ind. tank−1 (12.5 ind m−2) for D2 and 6 ind. tank−1 (18.75 ind m−2) for D3 respectively. D1 was the control group. Turtles were weighted individually at the beginning and at the end of the trial. At the end of the rearing trial, non-specific immune parameters were determined. The results showed that the heterophil:lymphocyte ratio (HLR) increased and the total plasma protein decreased with increasing StD, suggesting a stress response. Specific growth rate (SGR) significantly decreased with increasing StD. Non-specific immune indicators such as blood cell phagocytic activity, serum haemolytic activity and serum bacteriolytic activity increased clearly at a higher StD, indicating a pattern of immunoenhancement. The results indicated that at StDs of 4 and 6 ind. tank−1, non-specific immune responses were not suppressed compared with the control, but were inversely enhanced at the cost of growth reduction. A possible energy-based trade-off between growth and constitutive immunity may exist in soft-shelled turtles.

Gross enamel hypoplasia in molars from subadults in a 16th–18th century London graveyard

Dental Enamel Hypoplasia has long been used as a common nonspecific stress indicator in teeth from archaeological samples. Most researchers report relatively minor linear and pitted hypoplastic defects on tooth crown surfaces. In this work we report a high prevalence and early age of onset of extensive enamel defects in deciduous and permanent molars in the subadults from the post-medieval cemetery of Broadgate, east central London. Analysis of the dentition of all 45 subadults from the cemetery, using both macroscopic and microscopic methods, reveals disturbed cusp patterns and pitted, abnormal and arrested enamel formation. Forty-one individuals from this group (93.2%) showed some evidence of enamel hypoplasia, 28 of them showing moderate or extensive lesions of molars, deciduous or permanent (63.6% of the sample). Scanning Electron Microscope images reveal many molars with grossly deformed cuspal architecture, multiple extra cusps and large areas of exposed Tomes' process pits, where the ameloblasts have abruptly ceased matrix production, well before normal completion. This indented, rough and poorly mineralized surface facilitates both bacterial adhesion and tooth wear, and when such teeth erupt fully into the mouth they are likely to wear and decay rapidly. We suggest that this complex combination of pitted and plane-form lesions, combined with disruption of cusp pattern and the formation of multiple small cusps, should henceforth be identified as "Cuspal Enamel Hypoplasia."

Is bioarchaeology a handmaiden to history? Developing a historical bioarchaeology

Bioarchaeologists researching historic period populations recognize that textual sources provide abundant information on ancient political, social, and economic contexts of the individuals they are investigating. These researchers however often treat these documents and inscriptions as truthful, legitimate historical narratives simply used for comparison with biological data. This case study from the Classical Near East demonstrates the utility of critically assessing textual data used in bioarchaeological research in addition to the applicability of bioarchaeology for answering research questions in Near Eastern archaeology. Multivariate assessment of non-specific indicators of stress and evidence of skeletal trauma identified homogeneous health and disease profiles among indigenous communities in provinces of Arabia and Palaestina Tertia in addition to higher trauma levels among pastoral nomadic samples. These results contrast with some forms of textual data from the region emphasizing the barbaric nature of local populations, perceptions that apparently did not influence their treatment by imperial administrators. Addressing why textual and biological data differ and including the physical, ideological, political, and cultural context of ancient writers, papyri, inscriptions, and graffiti in this case increased bioarchaeology’s interpretive ability for understanding life under Roman and Byzantine rule in the Near East.

Broiler chicken health, welfare and fluctuating asymmetry in organic versus conventional production systems

The aim of this study was to test three predictions: (1) that a combination of animal-based parameters indicates better health and welfare in broilers from organic versus conventional farms, (2) that broilers from organic farms show less fluctuating asymmetry (FA) than broilers from conventional farms, and (3) that, at the level of the individual bird, the relationship between FA and welfare is negative and strongest in conventional broilers. On 140 slaughter-age birds randomly selected from seven organic and seven conventional flocks in Belgium we measured standardised FA and five conventional animal-based welfare indicators (tonic immobility duration, latency-to-lie, and condition of the foot pad, hock, and breast). The caeca from the birds from four organic and four conventional flocks were removed for assessing the presence of two bacterial pathogens ( Salmonella and Campylobacter) and the concentration of the health-promoting lactic acid bacteria. Finally, the blood serum concentration of the acute phase protein alpha-1-acid glycoprotein (AGP), a non-specific indicator of immunological stress, was determined. Salmonella was found in the caeca content of two (2.5%) birds only (both from the same conventional farm), whereas 44 (55.7%) birds were infected with Campylobacter. The prevalence of Campylobacter, the concentration of lactic acid bacteria, the duration of tonic immobility, and the condition of the breast and foot pad did not differ between both production systems. Apart from a higher concentration of AGP, organic birds had better scores for hock condition and a longer latency-to-lie indicating better leg health. In addition, organic birds scored better on the aggregated welfare index (i.e. the average of the five standardised welfare indicators). As both production systems differed in many aspects (e.g. slower-growing genotypes, slaughter age, feed, stocking density, group size) it is impossible to assign differences in welfare/health indicators to a single factor. Whatever the causes may be our findings suggest that, despite the potentially elevated risk of immunological challenge, broiler chicken welfare is generally superior in organic farms as compared with conventional farms in Belgium. Regarding the validity of FA as welfare indicator, the prediction of lower FA in the population with highest aggregated welfare score was confirmed but, at the level of the individual, no associations between FA and the aggregated welfare index were found irrespective of whether data from organic and conventional broilers were analysed separately or combined.

Nonspecific indicators of immune response under stress in athletes

Nonspecific indicators of immune response under stress in athletes

Impact of the Specificity of the Exposure Metric on Exposure???Response Relationships

Exposure misclassification may occur when nonspecific exposure indicators are used. Developing estimates of more specific measures may be difficult due to sampling limitations or a paucity of historical measurements and, thus, often requires substantial effort. We examine the impact on exposure-response relationships of moving from 2 measures of exposure mixtures (dust, chlorophenols) to more specific exposure indicators (wood dust, pentachlorophenol, tetrachlorophenol) in a retrospective cohort. The study population consisted of 26,847 male sawmill workers (> or =1 year employment between 1950 and 1995) with linkage to national cancer registries. A subcohort (n = 11,273 employed more than 1 day between 1985 and 1995) was linked to hospital discharge records. We evaluated the shape (log-linear vs log-log models), goodness of fit, precision, and expected versus observed attenuation of the exposure-response relationships. The correlation between the cumulative exposure indices was moderately high (dust/wood dust, r = 0.68; total chlorophenol/pentachlorophenol, r = 0.88; total chlorophenol/tetrachlorophenol, r = 0.78). An increase in chronic obstructive pulmonary disease hospitalizations was found with wood dust but not with total dust. Stronger associations for non-Hodgkin lymphoma and kidney cancer incidence were observed with pentachlorophenol than with total chlorophenol; no association was observed with tetrachlorophenol. We observed greater attenuation than expected using total dust, but less than expected using total chlorophenol. The relationships between health outcomes were substantially attenuated when nonspecific exposure indicators were used. This study demonstrates the importance of developing exposure metrics as specific to the disease-causing agent as possible, particularly when the composition of mixed exposures varies by work areas.