Environmental Health
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Kristine M. Gebbie, DrPH, RN |
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N5290 |
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September 27, 2002 |
Session Goals
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Orientation to basic components of
environmental health |
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Roles of public health agencies in
limiting threats to health from the environment |
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Environmental health activities
typically involving nurses |
Essential public health
services
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Not specific to any population or
program area |
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Developmental over time |
Public Health
Infrastructure
Environmental health
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comprises those aspects of human
health, including quality of life, that are determined by physical, chemical,
biological, social, and psychosocial processes in the environment. It also refers to the theory and practice
of assessing, correcting, controlling, and preventing those factors in the
environment that can potentially affect adversely the health of present and
future generations (WHO, 1993) |
Scenario #1
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Your neighbor calls you to say that her
child broke a thermometer and ate the silvery-grey material inside. |
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You know the silvery-grey material is
mercury, and you have heard that pregnant women and children should limit
consumption of fish because of mercury contamination. Does this mean that eating the material
from the thermometer is a serious problem? |
Food For Thought About
Mercury
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Do you think that the health risks from
mercury in a thermometer might be different from the risks related to mercury
in fish? What could be different? |
More Food For Thought About
Mercury
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With the mercury from the thermometer,
what risks other than swallowing might be a problem? How else might the mercury be absorbed? |
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Do you think there could be a
difference in health effects depending on the route of exposure? |
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Hint: Is there a difference between the
effects of a medication given orally, versus parenterally? Why isn’t insulin given orally? |
Yet More Food For Thought…
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Do you think there could be a
difference in health effects related to the form of mercury in the
thermometer, as opposed to fish? |
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Hint:
Is there a difference between the oral form and parenteral form of the
same medication? If you gave the oral
form parenterally, would it have the same effect? |
One More Thought…
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Do you think there could be a
difference in the effects of mercury on children, as opposed to adults? |
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Are there differences between children
and adults with regard to the effects of medications? |
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Principles and Concepts
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Route of exposure is significant |
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Elemental Mercury |
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eaten by mouth inhaled as vapor |
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GI tract
lungs |
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health effects unlikely
possible health effects |
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(poorly absorbed from gut)
(readily absorbed from lungs) |
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Principles and Concepts
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One form of a substance can have very
different effects from another. |
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Elemental Mercury |
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air |
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Bodies
of Water |
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(bacteria) |
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Methylmercury |
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Methylmercury fish people significant health effects |
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(all routes; neurotoxic) |
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Principles and Concepts
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Effects may vary in different
populations and different individuals |
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To Find Out More About….
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Mercury: |
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www.epa.gov/mercury |
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www.hcwh.org |
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www.nih.gov ®”Mad As A Hatter” |
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Children’s Environmental Health: |
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www.epa.gov/children |
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www.cehn.org |
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Maternal Health: |
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S. Steingraber: Having Faith
(HarperCollins, 2001) |
Scenario #2
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A mother tells you that she arrived
home last Wednesday to discover that the lawn care company had sprayed. There was a strong odor, and liquid could
be seen on the grass and furniture.
After playing outdoors that afternoon, her child developed nausea and
vomiting, with some sweating but no fever.
She also had mild tremors. Her
pediatrician diagnosed her child with “flu” (GI virus). However, she is
asking you if you think the pesticides may have had something to do with her
child’s illness. |
Food For Thought About
Pesticides
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Do you think that pesticide poisoning
(or poisoning by other environmental toxicants) could be misdiagnosed? |
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If the child in this scenario did
develop illness from the pesticides, why didn’t her mother get sick? |
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Principles and Concepts
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Environmental health effects may mimic
other conditions |
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Principles and Concepts
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Children’s behavior may increase
susceptibility to environmental toxicants. |
To Find Out More About…
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Pesticides: |
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www.epa.gov/pesticides |
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www.ace.orst.edu |
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www.psrla.org ( ® “Pesticides
and Human Health”) |
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J.R. Reigart & J.R. Roberts: Recognition
and Management of Pesticide Poisonings (EPA,1999). Available on line at: www.epa.gov/pesticides/safety/healthcare
or by calling 703-305-7666 |
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Scenario #3
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Your aunt has just moved to a new town
that has a chlorinated water supply.
She is concerned about possible health effects of the chlorine. She hasn’t gotten sick from it, but she
really dislikes the taste and she feels concerned. She asks you what you know about this. |
Food For Thought About
Chlorinated Water
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If this person hasn’t gotten acutely
ill from the chlorinated water, is it still possible that there is a negative
health effect occurring? |
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Hint: Are side effects of medications
always manifested in acute symptoms?
Or do medications sometimes cause negative effects over time? |
More Food For Thought About
Chlorinated Water
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Organic chlorine compounds (such as
those formed in chlorinated water, and also in various manufacturing
processes) rarely occur naturally. Are
human-made substances more dangerous than natural substances? Can you think of examples of toxic
natural substances? |
Yet More Food For Thought
About Chlorinated Water
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How can we tell if a substance is
causing chronic effects? If you wanted
to study the long-term health effects of chlorine in water, how would you go
about it? What would some of the
problems be? |
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Principles and Concepts
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Adverse health effects may result from
chronic low-dose exposure. |
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Principles and Concepts
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Compounds that do not exist naturally
(or rarely do) can be especially problematic |
Principles and Concepts
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Assessing risks from chronic exposure
is complicated and difficult |
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Epidemiological studies: assess health
trends and associations |
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Risk assessment: combines toxicological
research (often animal studies) with estimated exposures to determine
estimates of risk |
To Find Out More About…
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Carcinogens (environmental
cancer-causing substances): |
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www.niehs.nih.gov (®National
Toxicology Program ®
Report on Carcinogens) |
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www.epa.gov/children (® childhood
cancer) |
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S. Steingraber: Living Downstream
(Vintage Books, 1998) |
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Effects of chronic exposure to
neurotoxins in children: |
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www.igc.org/psr (®In Harm’s Way) |
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www.epa.gov/children (® developmental
and neurological problems) |
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Federal agencies
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US Environmental Protection Agency and
its state equivalent agencies, clean air, water, etc. |
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Department of Transportation, hazardous
materials transportation |
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Food and Drug Administration and US
Department of Agriculture regulate food safety |
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Agency for Toxic Substances and Disease
Registry (within HHS) environmental health related issues associated with
Superfund sites. |
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Additional agencies
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Housing and Urban Development (HUD);
Healthy Homes |
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Department of Energy (DOE) |
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National Library of Medicine (NLM);
Toxicology and Environmental Health |
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Occupational Safety & Health
Administration (OSHA) and OSHA technical links (SLTC) |
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Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) |
Typical local public health
concerns
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Restaurants |
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Drinking water |
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Public |
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Wells |
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Septic tanks/sewage |
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Solid waste/landfills |
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Lodging places |
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Day care |
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Schools |
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Swimming pools |
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Pests/animals |
Local Environmental
Assessment: where do you fit in?
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Do we have the necessary capacity &
community relationships to undertake a community environmental health
assessment? |
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What do we know about the community
(political, social, economic, and cultural)? |
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Who will participate in the team? How
will the project be governed & who will make decisions? |
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What is the geographic & topical
scope & what are the expected outcomes and decisions? |
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What issues does the public team care
about and why? |
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What are the links among health status,
populations, environmental agent, exposure/health risk and health protection
factors for selected issues? |
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What do we need to know/track? |
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What is the nature and extent of the
problem in our community? |
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What are the biggest/most serious
problems in our community? |
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What are our priorities for action? |
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What can we do about our priorities? |
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Have we been successful? What else do
we need to do? |
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Others involved
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Environmental health professionals in
private industries |
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Occupational health |
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Food safety |
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Industrial hygiene |
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Advocacy groups |
Types of threats
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Threats can be |
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Biological |
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Chemical |
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Radioactive |
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Physical |
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In the |
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Natural environment |
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Built environment |
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Home |
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Workplace |
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Community |
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They can be spread by |
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Air: indoor and out |
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Water: drinking or not |
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Soil: direct or indirect |
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Or a combination |
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And caused by |
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Natural events |
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Seasonal |
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Exceptional |
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Human activity |
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Incidental |
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Deliberate |
Radon: a problem or not?
Routes of exposure
And repair
But the problem isn’t
everywhere
Responsible actions
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Know the ‘zone’ you are in |
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Exercise healthy questioning when a new
threat is announced |
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Be wary of ‘quick fix’ advertisements |
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Use good risk communication with the
public |
Food and threats
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USDA:Meat, poultry, eggs |
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In order for the USDA to investigate a
problem with meat, poultry or egg products, you must have: |
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The original container or packaging |
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Any foreign object that you might have
discovered in the product |
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Any uneaten portion of the food
(refrigerate or freeze it) |
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FDA: labeling and standards |
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Cooperative programs for milk and
shellfish |
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States |
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Pesticides |
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Markets |
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Restaurants: premises and food handlers |
Nurses encounter
environmental issues
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In home visits |
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Construction |
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Safety |
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Food and water |
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Waste products |
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In the workplace |
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In vulnerable settings |
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Hospitals |
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Day care |
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In the community at large |
Child environmental history
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Screening Questions for Environmental
Exposures (should be asked in most cases): |
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Do you think the child’s health
problems are related to the home, daycare, school, or other location? |
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Has there been any exposure to
pesticides, solvents or other chemicals, dusts, fumes, radiation, or loud
noise? |
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What kind of work do the parents or
other household members engage in? |
Detailed History (when
environmental etiology is suspected):
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Do you live next to/near an industrial
plant, commercial business, dump site, or nonresidential property? |
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Which of the following do you have in
your home? Air conditioner; air purifier;
central heating (gas or oil);
Gas stove; electric stove; fireplace; Wood stove; humidifier |
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Have you recently acquired new
furniture or carpet, refinished furniture or remodeled your home? |
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Have you weatherized your home
recently? |
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Approximately what year was your home
built? |
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Are pesticides or herbicides (bug or
week killers, flea and tick sprays, collars, powders, or shampoos) used in
your home or garden or on pets? |
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Do you (or any household member) have a
hobby or a craft? |
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Do you work on your car? |
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Have you ever changed your residence
because of a health problem? |
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Does your drinking water come from a
private will, city water supply, or grocery store? |
West Nile Virus
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Classic zoonotic disease |
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Agent: a virus |
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Host: birds |
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Vector: mosquito |
Nurses and West Nile virus
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Case finding: alert to unusual symptoms
or severity |
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Prevention: |
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Individual behavior |
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Household management |
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Community management |
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From the DOHMH
City Health Alert to
Professionals
Additional information
Slide 48
Nurses should know
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Basic Knowledge and Concepts |
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basic mechanisms and pathways of
exposure to environmental health hazards, basic prevention and control
strategies, the interdisciplinary nature of effective interventions, and the
role of research. |
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Assessment and Referral |
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environmental health history, potential
environmental hazards and sentinel illnesses, appropriate referrals; access
and provide information to patients
and communities, and to locate referral sources. |
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Advocacy, ethics, and risk communication |
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role of advocacy (case and class),
ethics, and risk communication in patient care and community |
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Legislation and Regulation |
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Legislation/regulations related to
environmental health. |
Some key terms
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Risk |
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Risk assessment |
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Hazard identification |
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Dose response |
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Exposure assessment |
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Risk characterization |
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Risk management |
Precautionary principal
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where there are threats of serious or
irreversible damage, lack of scientific certainty shall not be used as a
reason for postponing cost-effective measures to prevent environmental
degradation or protect human health. |
Pharmacology and toxicology
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Origin, nature, use of drugs |
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One-time, short term, long term |
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Oral, IM, IV, dermal, topical |
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Adverse effects of chemicals on health |
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Single event, short term, lifetime |
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Ingestion, inhalation, dermal
absorption |
Dose-Response Curve
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Pharmacology: |
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Dose-response curve |
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graphically represents |
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the relationship |
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between the dose |
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of a drug and the response elicited |
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Dose-Response Curve
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Toxicology: |
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Dose-response curve |
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describes the |
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relationship of the |
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body’s response to |
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different amounts of |
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an agent |
Interactions
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Pharmacology: |
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Drug interactions define the effect one
drug has on another. |
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Toxicology: |
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Toxicological interactions define the
effect one chemical has on another. |
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Interactions, continued
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3 types of effects: |
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Additive: the sum = the whole |
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Synergistic or potentiated: one
enhances the other’s effect |
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Antagonistic: one reduces the effect of the other |
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Potency
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Pharmacology: |
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Potency refers to the relative amount
of drug required to produce the desired response. |
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Toxicology: |
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The potency of a toxic chemical refers
to the relative amount it takes to elicit a toxic effect compared with other
chemicals. |
The Regulatory Process
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The regulatory process for approval to
sell a medication includes several stages of testing on animals and humans. |
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The regulatory process for hazardous
chemicals that are not food, drug, cosmetic, or pesticide in nature does not
require any original testing for human health risks. |
Access to information
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Clean air act |
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Clean water act |
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Safe drinking water act |
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Superfund amendments |
% persons living in areas
that do not meet air quality standards
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One or more pollutants: 45% |
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Ozone: 41% |
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Particulate matter (PM –2.5): 11% |
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Carbon monoxide: 13% |
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Nitrogen dioxide: 0% |
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Sulfur dioxide: 1% |
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Lead: 0% |
Zip Code: 10034 Inwood
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SULFURIC ACID |
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29,679 pounds |
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LEAD |
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37 pounds |
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POLYCYCLIC AROMATIC COMPOUNDS |
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4 pounds |
7 Cardinal Rules for Risk
Communication:
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Accept and involve public as a
legitimate partner |
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Plan carefully and evaluate your
efforts |
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Listen to your audience |
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Be honest, frank, and open |
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Coordinate and collaborate with other
credible sources |
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Meet the needs of the press |
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Speak clearly and with compassion |
Perception of risk
Airline water, September
20, 2004
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Drinking water onboard 87.4% of 158
randomly selected passenger airplanes met EPA standards. |
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12.6 % of domestic and international
passenger aircraft tested carried water that did not meet standards. |
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20 aircraft had positive results for
total coliform bacteria; two of these aircraft (1.3 percent) also tested
positive for E.coli |
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Passengers with compromised immune
systems or others concerned may want to request canned or bottled beverages. |
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What will you say?
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How do you think this risk will be
perceived? |
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Average traveller? |
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Transplant recipient with suppressed
immune system? |
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How will you shape the message? |
Vulnerable populations:
children
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toxicants may disrupt and cause
permanent damage to the developing nervous, immune, and respiratory systems
of young children. |
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skin, respiratory, & GI absorption
of toxic materials is greater than that of adults. |
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normal exploratory behavior increases
opportunities to ingest toxicants such as lead-based paint. |
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diets differ in their exposure to
residues on foods such as fruits. |
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Children accumulate exposure throughout
a lifetime. |
Bicycle helmet use in
Oregon
Active protection
If instructed to boil
water, you should boil it for:
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30 seconds |
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1 minute |
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3 minutes |
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5 minutes |
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1 hour |
How many Americans will
develop skin cancer in a lifetime?
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One in five |
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One in ten |
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One in a hundred |
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One in a thousand |
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The Great Lakes contain
what % of the nation's and world's freshwater supply?
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25; 5 |
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50; 10 |
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90; 20 |
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100 of both - that's why they're GREAT |
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If your skin burns in ten
minutes, what SPF sunblock should you use if you plan to be outside for 5
hours?
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SPF 4 |
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SPF 15 |
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SPF 30 |
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Just stay inside |
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How did old New York City
subway cars land in the Atlantic Ocean?
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The "F" line ends on Coney
Island |
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To create calamity movie scene |
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Put there to create artificial reefs |
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Free car wash |
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If you drive 20,000
miles/year + gas is $2.25/gal., how much will you save if you drive a hybrid
instead of a large SUV?
Which creates more
pollution, the average car or the average home?
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average car |
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average home |
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about the same |
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