toxics: now and forever

Download Toxics: now and forever

Post on 25-Feb-2016

41 views

Category:

Documents

2 download

Embed Size (px)

DESCRIPTION

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 Presentation

TRANSCRIPT

  • Toxics: now and foreverCathey Eisner Falvo, MD, MPHPresident, International Society of Doctors for the Environment representing Physicians for Social ResponsibilityCooper Hospital, April 27, 2011

  • Learning objectivesUnderstand the burden of pediatric disease from environmental pollutionKnow some of the leading environmental pollutants in your areaUnderstand the need for an environmental history as part of the pediatric visitHave 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 sourcesFires Buildings

  • 10 Leading Causes of Death, United States2007, All Races, Both Sexes bases on CDC data

    10 Leading Causes of Death, United States 2007, All Races, Both Sexes

    WISQARSTMProduced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System

    WISQARSTMProduced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System

    WISQARSTMProduced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention 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 Unintentional Injury 965 Unintentional Injury 1,229 Unintentional Injury 6,493 Unintentional Injury 9,404 Congenital Anomalies 546 Malignant Neoplasms 480 Malignant Neoplasms 479 Homicide 2,224 Homicide 3,327 Homicide 398 Congenital Anomalies 196 Homicide 213 Suicide 1,481 Suicide 2,659 Malignant Neoplasms 364 Homicide 133 Suicide 180 Malignant Neoplasms 673 Malignant Neoplasms 980 Heart Disease 173 Heart Disease 110 Congenital Anomalies 178 Heart Disease 346 Heart Disease 738 Influenza & Pneumonia 109 Chronic Low. Respiratory Disease 54 Heart Disease 131 Congenital Anomalies 191 Congenital Anomalies 211 Septicemia 78 Influenza & Pneumonia 48 Chronic Low. Respiratory Disease 64 Cerebro- vascular 71 HIV 127

  • Mechanisms of exposureInutero via the placentaBreast (or bottle) milkAirWaterSoilFood

  • POPS IN BREAST MILKAn example on the efficacy of interventionsSolomon, 2002Dieldrin in breast milk Sweden

    DDT in breast milk SwedenPBDE in breast milk Sweden

  • Toxic body burden Flame Retardants: PBDEs Chemical Specimin CFStudy MaxStudy MinCDC 50th % 95th % DiBDEBDE-15 serum pg/g 158 486 90.5TriBDEBDE-28 serum pg/g 1170 5560 91.1 1100 7900TriBDEBDE-37 serum pg/g u 55. uTetraBDE BDE-47 serum pg/g8680109000 738 19200 157000TetraBDE BDE-51 serum pg/g u 89.4 uTetraBDE BDE-79 serum pg/g 28.1 245 uPentaBDE BDE-99 serum pg/g179024200 595
  • 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-characterized NOAA

  • PESTICIDES

    AldrinDieldrinChlordaneDDTEndrin HeptachlorMirexToxapheneINDUSTRIAL CHEMICALS PCBsHCBUNINTENDED BY-PRODUCTS

    DibenzodioxinsDibenzofuransPERSISTENT 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 ENVIRONMENTAIR

    IndustryWasteTrafficAgricultureWATER LAND DEPOSITIONLong-range transportWATER &SEDIMENTDEPOSITION Air-water Rain Snow ParticlesSOURCESFOOD CHAIN

    Big fishMarine mammals

  • Triclosan

    Soaps and sanitizers ToothpasteA wide variety of commercial antimicrobial useincorporated 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 systemsever damage with coma and deathlearning disabilities-attention deficithearing losstremors

  • Mercury (Hg)

    Three (3) formsHgo - elemental, quicksilverHg+, Hg++- saltsorganic mercury-methyl, ethyl, phenyl

  • Mercury cycle

    Mercury can go from one form to another in the presence of bacteria, sunlight, and other catalystsMercury accumulates in the food chainIt deposits in muscle, not fat, of animals

  • Mercury environmental sources

    In rock, fossil fuel, and water - released into air as vaporIndustrial catalyst and solventPesticides and fungicidesFood = fishVarious electronics-computer monitors

  • Mercury-environ. source 2

    Light switchesCosmeticsPharmaceuticals and folk remediesBatteriesLamps and light bulbs

  • A word about climate changeBurning fossil fuel is a major source of green house gasesBurning fossil fuel is a major cause of acute and chronic respiratory diseaseBurning fossil fuel is a major source mercuryBurning 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 historyParents/patients occupational & hobby historyNeighborhood, including multifamily dwelling exposureReduce, reuse, recycle, compostRead labels-plastics with #1, 2, 4 and 5 are saferOnly use microwave safe labeled containers in the microwave ovenLock up chemicals (in original container)No smoking/other fires in homeKeep car idling to a minimum and never in a closed space (garage)Have smoke and carbon monoxide detectors in the home

  • Action 2Wash hands after bathroom and before eatingFishing? Check state advisory for contaminationEat 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 future of nations.

    They need cleaner, safer and healthier environments free of POPs and other pollutants.

    Clean environments and education will enable children to reach their full potential as individuals, as contributing members of society and as pillars for sustainable development WHO

  • Thank youQuestions ?

  • Pediatric environmental health specialty units (PEHSU)REGION 2 Service area: New Jersey, New York, Puerto Rico, Virgin Islands Mount Sinai Pediatric Environmental Health Specialty Unit Academic Affiliation Mount Sinai School of Medicine: Department of Pediatrics. Department of Community and Preventive Medicine Hospital Affiliation: Mount Sinai Medical Center Location: New York, New York www.mssm.edu/cpm/pehsu/ (212) 241-5756 Toll Free (866) 265-6201 E-mail pehsu@mountsinai.org>REGION 3 Service area: Delaware, Maryland, Pennsylvania, Virginia, Washington DC, West Virginia Mid-Atlantic Center for Childrens Health & the Environment Pediatric Environmental Health Specialty Unit Academic Affiliation: George Washington University Hospital Affiliation: Childrens National Medical Center Location: Washington, DC www.childrensnational.org/MACCHE (202) 471-4829 Toll Free (866) 622-2431 E-mail: MACCHE@cnmc.org

  • References and sites of usehttp://ehp03.niehs.nih.gov/home.actionhttp://www.cdc.gov/asthma/healthcare.htmhttp://www.cdc.gov/exposurereport/http://www.cdc.gov/Environmental/l

    ****Talk by Dr. Maria Neira, Director for Public Health and Environment at the UN World Health Organizations (WHO) , Geneva at Third Paris Appeal International Congress: Childrens health and the environment, 12-13 April, 2011, UNESCO, Paris, France further. The cancers related to the environment, which comprise roughly 19 per cent of all cancers and cause 1.3 million deaths each year, are often the result of situations where people have limited control over the quality of air they breathe, the water they drink, and the level of chemical contamination in indoor and outdoor environments and at places of work. **WHO 2009, Global Health Risks, available http://www.who.int/healthinfo/global_burden_disese/global_health_risks/en/index.html *Asthma deaths are declining but childhood illness with asthma is increasing (CDC)Childhood leukemia incidence is going up slowly, all cancers are going up slowly, brain cancers are going up but not statistically significantly. (NIH)*http://webappa.cdc.gov/cgi-bin/broker.exe?_service=v8prod&_server=app-v-ehip-wisq.cdc.gov&_port=5082&_sessionid=j7lcS8w5M52&_program=wisqars.leadcaus10.sas&_service=&log=1&rept=&State=00&year1=2007&year2=2007&Race=0&Ethnicty=0&Sex=0&ranking=10&PRTFMT=FRIENDLY&lcdfmt=lcd2age&category=ALL&c_age1=0&c_age2=0&_debug=0* Aris A et al., Maternal and fetal exposure to pesticides associated to genetically modified foods in Eastern Townships of Quebec, Canada, Reprod Toxicol (2011)

    Pesticides associated to genetically modified foods (PAGMF), are engineered to tolerate herbicides such as glyphosate (GLYP) and gluphosinate (GLUF) or insecticides such as the bacte