toxics: now and forever
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Toxics: now and forever. Cathey Eisner Falvo, MD, MPH President, International Society of Doctors for the Environment representing Physicians for Social Responsibility Cooper Hospital, April 27, 2011. Learning objectives. - PowerPoint PPT PresentationTRANSCRIPT
Toxics: now and forever
Cathey Eisner Falvo, MD, MPHPresident, International Society of Doctors for the
Environment representing Physicians for Social Responsibility
Cooper Hospital, April 27, 2011
Learning objectives
• Understand the burden of pediatric disease from environmental pollution
• Know some of the leading environmental pollutants in your area
• Understand the need for an environmental history as part of the pediatric visit
• Have some tools for helping your patients avoid environmental toxic exposure
WHO
• 24% disease burden in the world is from environmental exposures*
• “About 3 million children under five die annually from largely preventable environment-related causes”**
Environmental causes of ill-health
• Injury-motor vehicles, sports, • Industry-factories, agriculture, power
sources• Fires • Buildings
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Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System
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Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System
10 Leading Causes of Death, United States2007, All Races, Both Sexes bases on CDC data
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Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System
1-4 5-9 10-14 15-19 20-24 Unintentional
Injury 1,588
UnintentionalInjury 965
UnintentionalInjury 1,229
UnintentionalInjury 6,493
UnintentionalInjury 9,404
CongenitalAnomalies
546
MalignantNeoplasms
480
MalignantNeoplasms
479
Homicide 2,224
Homicide 3,327
Homicide 398
CongenitalAnomalies
196
Homicide 213
Suicide 1,481
Suicide 2,659
MalignantNeoplasms
364
Homicide 133
Suicide 180
MalignantNeoplasms
673
MalignantNeoplasms
980
HeartDisease
173
HeartDisease
110
CongenitalAnomalies
178
HeartDisease
346
HeartDisease
738
Influenza& Pneumonia
109
Chronic Low.Respiratory
Disease 54
HeartDisease
131
CongenitalAnomalies
191
CongenitalAnomalies
211
Septicemia 78
Influenza& Pneumonia
48
Chronic Low.Respiratory
Disease 64
Cerebro-vascular
71
HIV 127
Mechanisms of exposure
• Inutero via the placenta• Breast (or bottle) milk• Air• Water• Soil• Food
POPS IN BREAST MILKAn example on the efficacy of
interventions
Solomon, 2002
Dieldrin in breast milk – Sweden
DDT in breast milk – Sweden
PBDE in breast milk – Sweden
Toxic body burden• Flame Retardants: PBDEs
• Chemical Specimin CF Study Max Study Min CDC 50th % 95th %• DiBDE BDE-15 serum pg/g 158 486 90.5• TriBDE BDE-28 serum pg/g 1170 5560 91.1 1100 7900• TriBDE BDE-37 serum pg/g u 55. u• TetraBDE BDE-47 serum pg/g 8680 109000 738 19200 157000• TetraBDE BDE-51 serum pg/g u 89.4 u• TetraBDE BDE-79 serum pg/g 28.1 245 u• PentaBDE BDE-99 serum pg/g 1790 24200 595 <LOD 42200• HexaBDE BDE-138 serum pg/g 55.4 369 u• HexaBDE BDE-153 serum pg/g 3110 20900 98 4800 65700• HeptaBDE BDE-190 serum pg/g u 151 u• OctaBDE BDE-203 serum pg/g 165 295 67.5• NonaBDE BDE-207 serum pg/g 684 1040 427• DecaBDE BDE-209 serum pg/g u 9040 u
• Bisphenol A BPA Urine ng/mL 7.11 7.11 0.449 2.7 15.9
• Sanitizing Agent: Triclosan • Triclosan Urine ng/mL 60.3 214 U 9.2 459
• Phthalate Metabolites• Mono-ethyl Phthalate (DEP)• m-EtP urine ng/m 200 200 U 181 2720• mono-2-ethylhexyl phthalate (DEHP)• m-EHP urine ng/mL 2.15 101 2.06 4.1 39.5
• Heavy Metals• Lead Pb serum µg/L U 31 U 16 52• Mercury Hg serum µg/L 2.27 2.27 U 0.7 4.6
WHAT ARE "POPs" ? Synthetic organic chemicalsPersistent in environment Long-range transport leads to global pollution Lipophilic Accumulate in food-chainHigh levels in fish and marine mammals
Acute toxicity well-characterizedAcute toxicity well-characterized
NOAA
PESTICIDESAldrin
DieldrinChlordane
DDTEndrin
HeptachlorMirex
Toxaphene
INDUSTRIAL CHEMICALS
PCBsHCB
UNINTENDED BY-PRODUCTS
DibenzodioxinsDibenzofurans
PERSISTENT ORGANIC POLLUTANTS (POPs)
Stockholm Convention: a global treaty ratified by the international community lead by UNEP – calls for the elimination and/or phasing out of 12 POPs www.chem.unep.ch/pops/default.html
POPs IN THE ENVIRONMENT
AIR
IndustryWasteTraffic
Agriculture
WATER
LAND DEPOSITI
ON
Long-range transport
WATER &SEDIMENTDEPOSITION
• Air-water • Rain• Snow• Particles
SOURCES
FOOD CHAINFOOD CHAIN
Big fishBig fishMarine Marine mammalsmammals
Triclosan
• Soaps and sanitizers • Toothpaste• A wide variety of commercial antimicrobial use
– incorporated in conveyor belts, fire hoses, dye bath vats, or ice-making equipment
– commercial HVAC coils, adhesives, fabrics, vinyl, plastics (toys, toothbrushes), polyethylene, polyurethane, polypropylene, floor wax emulsions, textiles (footwear, clothing), caulking compounds, sealants, rubber, carpeting
• An endocrince disrupter
Health effects –Hg
• Central nervous system– sever damage with coma and death– learning disabilities-attention deficit– hearing loss– tremors
Mercury (Hg)
• Three (3) forms– Hgo - elemental, quicksilver– Hg+, Hg++- salts– organic mercury-methyl, ethyl, phenyl
Mercury cycle
• Mercury can go from one form to another in the presence of bacteria, sunlight, and other catalysts
• Mercury accumulates in the food chain• It deposits in muscle, not fat, of animals
Mercury environmental sources
• In rock, fossil fuel, and water - released into air as vapor
• Industrial catalyst and solvent• Pesticides and fungicides• Food = fish• Various electronics-computer monitors
Mercury-environ. source 2
• Light switches• Cosmetics• Pharmaceuticals and folk remedies• Batteries• Lamps and light bulbs
A word about climate change
• Burning fossil fuel is a major source of green house gases
• Burning fossil fuel is a major cause of acute and chronic respiratory disease
• Burning fossil fuel is a major source mercury
• Burning trash is a major source of mercury, dioxin, arsenic, furans, etc (depending on what is burned)
What can you and your patients do?
• Ask as part of the patients history– Parents/patients occupational & hobby history– Neighborhood, including multifamily dwelling exposure
• Reduce, reuse, recycle, compost• Read labels-plastics with #1, 2, 4 and 5 are safer• Only use “microwave safe” labeled containers in the
microwave oven• Lock up chemicals (in original container)• No smoking/other fires in home• Keep car idling to a minimum and never in a closed
space (garage)• Have smoke and carbon monoxide detectors in the
home
Action 2• Wash hands after bathroom and before eating• Fishing? Check state advisory for contamination
• Eat a variety of foods
• TAKE ACTION in your community, and at the state and federal level
Some contaminants are beyond you and your patients’ ability to control
Children represent the Children represent the future of nations.future of nations.
They need cleaner, safer and They need cleaner, safer and healthier environments – healthier environments – free free of POPs and other pollutants.of POPs and other pollutants.
Clean environments and Clean environments and education will enable children education will enable children to reach their full potential as to reach their full potential as individuals, individuals, as contributing members of as contributing members of society and as pillars for society and as pillars for sustainable development sustainable development
WHO
Thank you
Questions ?
Pediatric environmental health specialty units (PEHSU)
• REGION 2Service area: New Jersey, New York, Puerto Rico, Virgin IslandsMount Sinai Pediatric EnvironmentalHealth Specialty UnitAcademic Affiliation Mount Sinai School of Medicine: Department of Pediatrics. Department of Community and Preventive MedicineHospital Affiliation: Mount Sinai Medical CenterLocation: New York, New Yorkwww.mssm.edu/cpm/pehsu/(212) 241-5756Toll Free (866) 265-6201E-mail [email protected]>
• REGION 3Service area: Delaware, Maryland, Pennsylvania, Virginia, Washington DC, West VirginiaMid-Atlantic Center for Children’s Health & the Environment Pediatric Environmental Health Specialty UnitAcademic Affiliation: George Washington University Hospital Affiliation: Children’s National Medical Center Location: Washington, DCwww.childrensnational.org/MACCHE(202) 471-4829 Toll Free (866) 622-2431E-mail: [email protected]
References and sites of use
• http://ehp03.niehs.nih.gov/home.action• http://www.cdc.gov/asthma/healthcare.htm• http://www.cdc.gov/exposurereport/• http://www.cdc.gov/Environmental/l