0
September 5, 1986, Vol 256, No. 9 >
ARTICLE | September 5, 1986

Agricultural Herbicide Use and Risk of Lymphoma and Soft-Tissue Sarcoma FREE

Shelia K. Hoar, ScD; Aaron Blair, PhD; Frederick F. Holmes, MD; Cathy D. Boysen; Robert J. Robel, PhD; Robert Hoover, MD; Joseph F. Fraumeni, Jr, MD
[+] Author Affiliations

Reprint requests to Epidemiology and Biostatistics Program, National Cancer Institute, Landow 4C16, Bethesda, MD 20892 (Dr Hoar).


JAMA. 1986;256(9):1141-1147. doi:10.1001/jama.1986.03380090081023
Text Size: A A A
Published online
Article
References

A population-based case-control study of soft-tissue sarcoma (STS), Hodgkin's disease (HD), and non-Hodgkin's lymphoma (NHL) in Kansas found farm herbicide use to be associated with NHL (odds ratio [OR], 1.6; 95% confidence interval [CI], 0.9, 2.6). Relative risk of NHL increased significantly with number of days of herbicide exposure per year and latency. Men exposed to herbicides more than 20 days per year had a sixfold increased risk of NHL (OR, 6.0; 95% CI, 1.9, 19.5) relative to nonfarmers. Frequent users who mixed or applied the herbicides themselves had an OR of 8.0 (95% CI, 2.3, 27.9) for NHL. Excesses were associated with use of phenoxyacetic acid herbicides, specifically 2,4-dichlorophenoxyacetic acid. Neither STS nor HD was associated with pesticide exposure. This study confirms the reports from Sweden and several US states that NHL is associated with farm herbicide use, especially phenoxyacetic acids. It does not confirm the case-control studies or the cohort studies of pesticide manufacturers and Vietnam veterans linking herbicides to STS or HD.

(JAMA 1986;256:1141-1147)

REFERENCES

1 +
Hardell L, Sandstrom A:  Case-control study: Soft-tissue sarcomas and exposure to phenoxyacetic acids or chlorophenols . Br J Cancer 1979;; 39:711-717.
2 +
Eriksson M, Hardell L, Berg NO, et al:  Soft-tissue sarcomas and exposure to chemical substances: A case-referent study . Br J Ind Med 1981;;38:27-33.
3 +
Hardell L, Eriksson M, Lenner P, et al:  Malignant lymphoma and exposure to chemicals especially organic solvents, chlorophenols and phenoxy acids: A case-control study . Br J Cancer 1981;; 43:169-176.
4 +
Honchar PA, Halperin WA:  2,4,5-T,trichlorophenol, and soft-tissue sarcoma . Lancet 1981;; 1:268-269.
5 +
Cook RR:  Dioxin, chloracne, and soft-tissue sarcoma . Lancet 1981;;1:618-619.
6 +
Moses M, Selikoff IJ:  Soft-tissue sarcomas, phenoxy herbicides, and chlorinated phenols . Lancet 1981;;1:1370.
7 +
Johnson FE, Kugler MA, Brown SM:  Soft-tissue sarcomas and chlorinated phenols . Lancet 1981;; 2:40.
8 +
Cantor KP:  Farming and mortality from non-Hodgkin's lymphoma: A case-control study . Int J Cancer 1982;;29:239-247.
9 +
Burmeister LF, Everett GD, Van Lier SF, et al:  Selected cancer mortality and farm practices in Iowa . Am J Epidemiol 1983;;118:72-77.
10 +
Buesching DP, Wollstadt L:  Cancer mortality among farmers . JNCI 1984;;72:503.
11 +
Waldron AC, Park EL: Pesticide Use on Major Crops in the North Central Region... 1978 , research bulletin 1132, Wooster, Ohio, Ohio Agricultural Research and Development Center, 1981;.
12 +
International Classification of Disease for Oncology . Geneva, World Health Organization, 1976;.
13 +
 Non-Hodgkin's Lymphoma Pathologic Classification Project: NCI sponsored study of classification of non-Hodgkin's lymphomas: Summary and description of a working formulation for clinical usage . Cancer 1982;;49:2112-2135.
14 +
Waksberg J:  Sampling methods for random digit dialing . J Am Stat Assoc 1978;;73:40-46.
15 +
Census of the Population: 1970, vol 1, General Housing Characteristics , pt (18) , Kansas. US Bureau of the Census, 1973;.
16 +
Kansas Crop and Livestock Reporting Service: Pesticides: 1978 Pesticide Usage . Topeka, Kan, US Dept of Agriculture, Economics, Statistics, and Cooperatives Service.
17 +
Gart JJ:  Point and interval estimation of the common odds ratio in the combination of 2×2 tables with fixed marginals . Biometrika 1970;; 57:471-475.
18 +
Mantel N:  χ2 test with 1 degree of freedom, extension of the Mantel-Haenzel procedure . Am Stat Assoc J 1963;;58:690-700.
19 +
Engelman L: Stepwise Logistic Regression in BMDP STATISTICAL SOFTWARE , Dixon WJ (ed). Berkeley, University of California Press, 1983;, pp 330-344.
20 +
Libich S, To JC, Frank R, et al:  Occupational exposure of herbicide applicators to herbicides used along electric power transmission line right-of-way . Am Ind Hyg Assoc J 1984;;45:56-62.
21 +
International Programme on Chemical Safety: Environmental Health Criteria 29: 2,4-Dichlorophenoxyacetic Acid (2,4-D) . Geneva, World Health Organization, 1984;.
22 +
Cochrane WP, Singh J, Miles W, et al:  Determination of chlorinated dibenzo-p-dioxin contaminants in 2,4-D products by gas chromatographymass spectrometric techniques . J Chromatogr 1981;;217:289-299.
23 +
Stubbs HA, Harris J, Spear RC:  A proportionate mortality analysis of California agricultural workers, 1978-1979 . Am J Ind Med 1984;;6:305-320.
24 +
Pearce NE, Smith AH, Fisher DO:  Malignant lymphoma and multiple myeloma linked with agricultural occupations in a New Zealand cancer registry-based study . Am J Epidemiol 1985;; 121:225-237.
25 +
Lynge E:  A follow-up study of cancer incidence among workers in manufacture of phenoxy herbicides in Denmark . Br J Cancer 1985;;52:259-270.
26 +
Zack JA, Suskind RR:  The mortality experience of workers exposed to tetrachlorodibenzodioxin in a trichlorophenol process accident . J Occup Med 1980;;22:11-14.
27 +
Ott MG, Holder BB, Olson RD:  A mortality analysis of employees engaged in the manufacture of 2,4,5-trichlorophenoxyacetic acid . J Occup Med 1980;;22:47-50.
28 +
Cook RR, Townsend JC, Ott MG, et al:  Mortality experience of employees exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) . J Occup Med 1980;;22:530-532.
29 +
Riihimaki V, Asp S, Hernberg S:  Mortality of 2,4-dichlorophenoxyacetic acid and 2,4,5-trichlorophenoxyacetic acid herbicide applicators in Finland: First report of an ongoing prospective cohort study . Scand J Work Environ Health 1982;;8:37-42.
30 +
Project Ranch Hand II: An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides, Baseline Mortality Study Results Brooks Air Force Base, Tex, Epidemiology Division, Data Sciences Division, US Air Force School of Aerospace Medicine, 1983;.
31 +
Bishop CM, Jones AH:  Non-Hodgkin's lymphoma of the scalp in workers exposed to dioxins . Lancet 1981;;2:369.
32 +
Olsson H, Brandt L:  Non-Hodgkin's lymphoma of the skin and occupational exposure to herbicides . Lancet 1981;;2:579.
33 +
Vos JG, Moore JA, Zinkl JG:  Effect of 2,3,7,8-tetrachlorodibenzo-p-dioxin on the immune system of laboratory animals . Environ Health Perspect 1973;;5:149-162.
34 +
Harris MW, Moore JA, Vos JG, et al:  General biological effects of TCDD in laboratory animals . Environ Health Perspect 1973;;5:101-109.
35 +
Hoover R, Fraumeni JF Jr:  Risk of cancer in renal transplant recipients . Lancet 1973;;2:55-57.
36 +
Kinlen LJ, Sheil AGR, Peto J, et al:  Collaborative United Kingdom-Australasian study of cancer in patients treated with immunosuppressive drugs . Br Med J 1979;;1461-1466.
37 +
Filipovich AH, Spector BD, Kersey J:  Immunodeficiency in humans as a risk factor in the development of malignancy . Prev Med 1980;;9:252-259.
38 +
Crow KD:  Soft tissue sarcomas and chlorinated phenols . Lancet 1981;;2:369.
39 +
Kociba RJ, Keyes DG, Beyes JE, et al:  Results of a two-year chronic toxicity and oncogenicity study of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in rats . Toxicol Appl Pharmacol 1978;; 46:279-303.
40 +
Kociba RJ, Keyes DG, Beyer JE, et al:  Long-term toxicologic studies of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in laboratory animals . Ann NY Acad Sci 1979;;320:397-404.
41 +
Van Miller JP, Lalich JJ, Allen JR:  Increased incidence of neoplasms in rats exposed to low levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin . Chemosphere 1977;;10:625-632.
42 +
National Toxicology Program (Report 80-31): Carcinogenesis Bioassay of 2,3,7,8-Tetrachlorodibenzo-p-dioxin (CAS No. 1746-01-6) in Osborne-Mendel rats and B6C3F1 mice (Gavage Study) , technical report series 209, National Institutes of Health publication 82-1765. Research Triangle Park, NC, Dept of Health and Human Services, 1982;.
43 +
National Toxicology Program (Report 80-32): Carcinogenesis Bioassay of 2,3,7,8-Tetrachlorodibenzo-p-dioxin (CAS No. 1746-01-6) in Swiss-Webster Mice (Dermal Study) , technical report series 209, National Institutes of Health publication 82-1757. Research Triangle Park, NC, Dept of Health and Human Services, 1982;.
44 +
Young AL, Calcagni JA, Thalken CE, et al: The Toxicology, Environmental Fate, and Human Risk of Herbicide Orange and Its Associated Dioxin , US Air Force technical report 78-92. Brooks AFB, Tex, US Air Force Occupational and Environmental Health Laboratory, 1978;.
45 +
Blakely BR, Schiefer BH:  The effect of topically applied n-butylester of 2,4-dichlorophenoxyacetic acid on the immune response in mice . J Appl Toxicol , in press.
46 +
Cole P: Direct testimony before the Administrator of the Environmental Protection Agency of the United States of America in re . The Dow Chemical Company, et al. FIFRA Docket No. 415, et al, Washington, DC, (Oct 23) , 1980;.
47 +
Li FP, Fraumeni JF Jr, Mantel N, et al:  Cancer mortality among chemists . JNCI 1969;;43:1159-1164.
48 +
Olin GR:  The hazards of a chemical laboratory environment: A study of the mortality in two cohorts of Swedish chemists . Am Ind Hyg Assoc J 1978;;39:557-562.
49 +
Searle CE:  Epidemiologic study of the mortality of British chemists . Br J Cancer 1978;;38:192-193.
50 +
Monson RR, Fine LJ:  Cancer mortality and morbidity among rubber workers . JNCI 1978;; 61:1047-1053.
51 +
Cantor KP, Fraumeni JF Jr  Distribution of non-Hodgkin's lymphoma in the United States between 1950 and 1975 . Cancer Res 1980;;40:2645-2652.
52 +
Kalant N, Seemayer T:  Malignant lymphoma in spontaneously diabetic rats . N Engl J Med 1979;;300:737.
53 +
Green JA, Dawson AA, Walker W:  Systemic lupus erythematosus and lymphoma . Lancet 1978;; 2:753-756.
54 +
Douglas AP:  Celiac disease and lymphoma of intestines and brain . N Engl J Med 1977;;296:821.
55 +
Vianna NJ, Polan A:  Lymphomas and occupational benzene exposure . Lancet 1979;;2:1394-1395.
56 +
Paffenbarger RS, Wing AL, Hyde RT:  Characteristics in youth predictive of adult-onset malignant lymphomas, melanomas, and leukemias . JNCI 1978;;60:89-92.
57 +
Krikorian JG, Burke JS, Rosenberg SA, et al:  Occurrence of non-Hodgkin's lymphoma after therapy for Hodgkin's disease . N Engl J Med 1979;;300:452-458.
58 +
Cole P, MacMahon B:  Attributable risk percent in case-control studies . Br J Prev Soc Med 1971;;25:242-244.
59 +
Eichers TR, Andrilenas PA, Anderson TW: Farmers' Use of Pesticides in 1976 , agricultural economic report 418. National Economic Analysis Division, Economics, Statistics, and Cooperatives Service, US Dept of Agriculture, 1978;.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Hardell L, Sandstrom A:  Case-control study: Soft-tissue sarcomas and exposure to phenoxyacetic acids or chlorophenols . Br J Cancer 1979;; 39:711-717.
2 +
Eriksson M, Hardell L, Berg NO, et al:  Soft-tissue sarcomas and exposure to chemical substances: A case-referent study . Br J Ind Med 1981;;38:27-33.
3 +
Hardell L, Eriksson M, Lenner P, et al:  Malignant lymphoma and exposure to chemicals especially organic solvents, chlorophenols and phenoxy acids: A case-control study . Br J Cancer 1981;; 43:169-176.
4 +
Honchar PA, Halperin WA:  2,4,5-T,trichlorophenol, and soft-tissue sarcoma . Lancet 1981;; 1:268-269.
5 +
Cook RR:  Dioxin, chloracne, and soft-tissue sarcoma . Lancet 1981;;1:618-619.
6 +
Moses M, Selikoff IJ:  Soft-tissue sarcomas, phenoxy herbicides, and chlorinated phenols . Lancet 1981;;1:1370.
7 +
Johnson FE, Kugler MA, Brown SM:  Soft-tissue sarcomas and chlorinated phenols . Lancet 1981;; 2:40.
8 +
Cantor KP:  Farming and mortality from non-Hodgkin's lymphoma: A case-control study . Int J Cancer 1982;;29:239-247.
9 +
Burmeister LF, Everett GD, Van Lier SF, et al:  Selected cancer mortality and farm practices in Iowa . Am J Epidemiol 1983;;118:72-77.
10 +
Buesching DP, Wollstadt L:  Cancer mortality among farmers . JNCI 1984;;72:503.
11 +
Waldron AC, Park EL: Pesticide Use on Major Crops in the North Central Region... 1978 , research bulletin 1132, Wooster, Ohio, Ohio Agricultural Research and Development Center, 1981;.
12 +
International Classification of Disease for Oncology . Geneva, World Health Organization, 1976;.
13 +
 Non-Hodgkin's Lymphoma Pathologic Classification Project: NCI sponsored study of classification of non-Hodgkin's lymphomas: Summary and description of a working formulation for clinical usage . Cancer 1982;;49:2112-2135.
14 +
Waksberg J:  Sampling methods for random digit dialing . J Am Stat Assoc 1978;;73:40-46.
15 +
Census of the Population: 1970, vol 1, General Housing Characteristics , pt (18) , Kansas. US Bureau of the Census, 1973;.
16 +
Kansas Crop and Livestock Reporting Service: Pesticides: 1978 Pesticide Usage . Topeka, Kan, US Dept of Agriculture, Economics, Statistics, and Cooperatives Service.
17 +
Gart JJ:  Point and interval estimation of the common odds ratio in the combination of 2×2 tables with fixed marginals . Biometrika 1970;; 57:471-475.
18 +
Mantel N:  χ2 test with 1 degree of freedom, extension of the Mantel-Haenzel procedure . Am Stat Assoc J 1963;;58:690-700.
19 +
Engelman L: Stepwise Logistic Regression in BMDP STATISTICAL SOFTWARE , Dixon WJ (ed). Berkeley, University of California Press, 1983;, pp 330-344.
20 +
Libich S, To JC, Frank R, et al:  Occupational exposure of herbicide applicators to herbicides used along electric power transmission line right-of-way . Am Ind Hyg Assoc J 1984;;45:56-62.
21 +
International Programme on Chemical Safety: Environmental Health Criteria 29: 2,4-Dichlorophenoxyacetic Acid (2,4-D) . Geneva, World Health Organization, 1984;.
22 +
Cochrane WP, Singh J, Miles W, et al:  Determination of chlorinated dibenzo-p-dioxin contaminants in 2,4-D products by gas chromatographymass spectrometric techniques . J Chromatogr 1981;;217:289-299.
23 +
Stubbs HA, Harris J, Spear RC:  A proportionate mortality analysis of California agricultural workers, 1978-1979 . Am J Ind Med 1984;;6:305-320.
24 +
Pearce NE, Smith AH, Fisher DO:  Malignant lymphoma and multiple myeloma linked with agricultural occupations in a New Zealand cancer registry-based study . Am J Epidemiol 1985;; 121:225-237.
25 +
Lynge E:  A follow-up study of cancer incidence among workers in manufacture of phenoxy herbicides in Denmark . Br J Cancer 1985;;52:259-270.
26 +
Zack JA, Suskind RR:  The mortality experience of workers exposed to tetrachlorodibenzodioxin in a trichlorophenol process accident . J Occup Med 1980;;22:11-14.
27 +
Ott MG, Holder BB, Olson RD:  A mortality analysis of employees engaged in the manufacture of 2,4,5-trichlorophenoxyacetic acid . J Occup Med 1980;;22:47-50.
28 +
Cook RR, Townsend JC, Ott MG, et al:  Mortality experience of employees exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) . J Occup Med 1980;;22:530-532.
29 +
Riihimaki V, Asp S, Hernberg S:  Mortality of 2,4-dichlorophenoxyacetic acid and 2,4,5-trichlorophenoxyacetic acid herbicide applicators in Finland: First report of an ongoing prospective cohort study . Scand J Work Environ Health 1982;;8:37-42.
30 +
Project Ranch Hand II: An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides, Baseline Mortality Study Results Brooks Air Force Base, Tex, Epidemiology Division, Data Sciences Division, US Air Force School of Aerospace Medicine, 1983;.
31 +
Bishop CM, Jones AH:  Non-Hodgkin's lymphoma of the scalp in workers exposed to dioxins . Lancet 1981;;2:369.
32 +
Olsson H, Brandt L:  Non-Hodgkin's lymphoma of the skin and occupational exposure to herbicides . Lancet 1981;;2:579.
33 +
Vos JG, Moore JA, Zinkl JG:  Effect of 2,3,7,8-tetrachlorodibenzo-p-dioxin on the immune system of laboratory animals . Environ Health Perspect 1973;;5:149-162.
34 +
Harris MW, Moore JA, Vos JG, et al:  General biological effects of TCDD in laboratory animals . Environ Health Perspect 1973;;5:101-109.
35 +
Hoover R, Fraumeni JF Jr:  Risk of cancer in renal transplant recipients . Lancet 1973;;2:55-57.
36 +
Kinlen LJ, Sheil AGR, Peto J, et al:  Collaborative United Kingdom-Australasian study of cancer in patients treated with immunosuppressive drugs . Br Med J 1979;;1461-1466.
37 +
Filipovich AH, Spector BD, Kersey J:  Immunodeficiency in humans as a risk factor in the development of malignancy . Prev Med 1980;;9:252-259.
38 +
Crow KD:  Soft tissue sarcomas and chlorinated phenols . Lancet 1981;;2:369.
39 +
Kociba RJ, Keyes DG, Beyes JE, et al:  Results of a two-year chronic toxicity and oncogenicity study of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in rats . Toxicol Appl Pharmacol 1978;; 46:279-303.
40 +
Kociba RJ, Keyes DG, Beyer JE, et al:  Long-term toxicologic studies of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in laboratory animals . Ann NY Acad Sci 1979;;320:397-404.
41 +
Van Miller JP, Lalich JJ, Allen JR:  Increased incidence of neoplasms in rats exposed to low levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin . Chemosphere 1977;;10:625-632.
42 +
National Toxicology Program (Report 80-31): Carcinogenesis Bioassay of 2,3,7,8-Tetrachlorodibenzo-p-dioxin (CAS No. 1746-01-6) in Osborne-Mendel rats and B6C3F1 mice (Gavage Study) , technical report series 209, National Institutes of Health publication 82-1765. Research Triangle Park, NC, Dept of Health and Human Services, 1982;.
43 +
National Toxicology Program (Report 80-32): Carcinogenesis Bioassay of 2,3,7,8-Tetrachlorodibenzo-p-dioxin (CAS No. 1746-01-6) in Swiss-Webster Mice (Dermal Study) , technical report series 209, National Institutes of Health publication 82-1757. Research Triangle Park, NC, Dept of Health and Human Services, 1982;.
44 +
Young AL, Calcagni JA, Thalken CE, et al: The Toxicology, Environmental Fate, and Human Risk of Herbicide Orange and Its Associated Dioxin , US Air Force technical report 78-92. Brooks AFB, Tex, US Air Force Occupational and Environmental Health Laboratory, 1978;.
45 +
Blakely BR, Schiefer BH:  The effect of topically applied n-butylester of 2,4-dichlorophenoxyacetic acid on the immune response in mice . J Appl Toxicol , in press.
46 +
Cole P: Direct testimony before the Administrator of the Environmental Protection Agency of the United States of America in re . The Dow Chemical Company, et al. FIFRA Docket No. 415, et al, Washington, DC, (Oct 23) , 1980;.
47 +
Li FP, Fraumeni JF Jr, Mantel N, et al:  Cancer mortality among chemists . JNCI 1969;;43:1159-1164.
48 +
Olin GR:  The hazards of a chemical laboratory environment: A study of the mortality in two cohorts of Swedish chemists . Am Ind Hyg Assoc J 1978;;39:557-562.
49 +
Searle CE:  Epidemiologic study of the mortality of British chemists . Br J Cancer 1978;;38:192-193.
50 +
Monson RR, Fine LJ:  Cancer mortality and morbidity among rubber workers . JNCI 1978;; 61:1047-1053.
51 +
Cantor KP, Fraumeni JF Jr  Distribution of non-Hodgkin's lymphoma in the United States between 1950 and 1975 . Cancer Res 1980;;40:2645-2652.
52 +
Kalant N, Seemayer T:  Malignant lymphoma in spontaneously diabetic rats . N Engl J Med 1979;;300:737.
53 +
Green JA, Dawson AA, Walker W:  Systemic lupus erythematosus and lymphoma . Lancet 1978;; 2:753-756.
54 +
Douglas AP:  Celiac disease and lymphoma of intestines and brain . N Engl J Med 1977;;296:821.
55 +
Vianna NJ, Polan A:  Lymphomas and occupational benzene exposure . Lancet 1979;;2:1394-1395.
56 +
Paffenbarger RS, Wing AL, Hyde RT:  Characteristics in youth predictive of adult-onset malignant lymphomas, melanomas, and leukemias . JNCI 1978;;60:89-92.
57 +
Krikorian JG, Burke JS, Rosenberg SA, et al:  Occurrence of non-Hodgkin's lymphoma after therapy for Hodgkin's disease . N Engl J Med 1979;;300:452-458.
58 +
Cole P, MacMahon B:  Attributable risk percent in case-control studies . Br J Prev Soc Med 1971;;25:242-244.
59 +
Eichers TR, Andrilenas PA, Anderson TW: Farmers' Use of Pesticides in 1976 , agricultural economic report 418. National Economic Analysis Division, Economics, Statistics, and Cooperatives Service, US Dept of Agriculture, 1978;.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems