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PubMed2005

Identifying churches for community-based mammography promotion: lessons from the LAMP study.

There is great potential in public health and faith communities partnering to promote health education and research. This article describes lessons learned from the design and implementation of such a partnership, the Los Angeles Mammography Promotion in Churches Program (LAMP). It is feasible, although challenging, to enumerate and survey churches in a geographically defined urban population, using data compiled from telephone directories, religious sources (e.g., denominational networks), chambers of commerce, and newspapers. Among those sources, telephone directories provided the broadest coverage, whereas religious sources yielded the highest recruitment rate. For collecting survey data from churches, telephone methods are superior to mail methods. For church-based health education programs that seek comprehensive coverage and have adequate resources, it is recommended that telephone directories be combined with religious sources to identify target churches. For programs with limited resources and less emphasis on comprehensive coverage, using religious sources alone is recommended.

Aged↗
PubMedDate not supplied

Is environmental health a determinant or an afterthought in policies ranging from water quality to global warming?

The goal of this discussion is to draw attention to the regrettable fact that health repercussions are not being addressed in policy setting. This absence covers a spectrum from policies as technically focused as that governing water quality, where the health dimensions are well known, to policies as broad as those dealing with global warming, where the health dimensions are still being defined. This situation is likely to worsen unless the environmental health community accepts the responsibility to do more outreach. The presentation also gives examples of how inclusion of environmental health in policy deliberations can increase economically quantifiable benefits and can help justify investments that are otherwise considered too costly. Despite advances in environmental health, many, if not most, important decisions affecting human health are being made without the input of health specialists. At best, considerations of environmental health are afterthoughts in the policies of business, commerce, industry, and many government agencies that are involved--even if inadvertently--with creating most environmental health problems, and by implication, are potentially responsible for their solutions. Examples of situations where the health dimensions are well known, such as with water quality, are provided from some 200 past World Bank projects in water supply, waste disposal, transportation, housing, urban development, and telecommunications, designed mainly by engineers and economists. The absence of health input is not necessarily detrimental if agency policies or environmental reviews can compensate for the absence of direct health input by other means such as environmental assessments, which currently do not systematically include health.

Environmental Health↗
PubMed1996

Seven deadly sins in confronting endemic iodine deficiency, and how to avoid them.

Iodine deficiency is a problem for almost all countries of the world. Goiter is its most obvious consequence, but others do more damage, particularly effects on the developing brain. In 1990, most countries and international agencies pledged the virtual elimination of iodine deficiency by the year 2000. The technology for the assessment and implementation is sufficient to attain this goal, but translating its potential into success requires careful planning. This article reviews seven major errors that frequently occur in iodine supplementation programs and offers suggestions for their avoidance. They are 1) unreliable assessment of iodine deficiency: the best indicators are urinary iodine concentration, thyroid size (preferably by ultrasound), blood spot thyroglobulin levels, and neonatal TSH determinations; the best group for surveys is schoolchildren; 2) poor iodine supplementation plan: iodized salt is the preferred supplement; its effective application frequently requires extensive changes in salt production and marketing, and poor handling of these changes will endanger the iodization program; other measures include iodized oil, iodized water, and iodine drops; all are occasionally useful, but the long range solution should generally be iodized salt; 3) exclusion of relevant stake-holders: the program should include not only health authorities but other arms of the government as well (education, commerce, agriculture, and standards), the salt industry, health professionals, and the iodine-deficient community itself; 4) inadequate education: an understanding of the effects of iodine deficiency and the means for its correction is essential at all levels, from government to affected population; 5) insufficient monitoring: the best instruments are urinary iodine levels, iodized salt use, and thyroid size, measured in representative groups at regular intervals with public reporting of results; 6) inattention to cost: the expense of iodization must be recognized and apportioned fairly; and 7) nonsustainability: for permanent success, an iodization program must be fair to all relevant parties and accompanied by a regular system of appropriate monitoring. Only with careful avoidance of these seven "deadly sins" can the goal of sustainable elimination of iodine deficiency be achieved.

Child↗
PubMed1996

Policy watch: Medicare.

Public policies are often made without much recourse to economic reasoning. Economists are sometimes unaware of what is happening in the world of public affairs. As a result, both the quality of public decision making and the role that economists play in it are less than optimal. This feature contains short articles on topics that are currently on the agendas of policymakers, thus illustrating the role of economic analysis in illuminating current debates. Suggestions for future columns and comments on past ones should be sent to Daniel Weinberg, c/o Journal of Economic Perspectives, HHES Division, Bureau of the Census, Department of Commerce, Washington, D.C. 20233.

Education, Medical, Graduate↗
PubMed2000

Increasing the cost-effectiveness of telemedicine by embracing e-health.

In 1999 a national study of telemedicine in Australia led to the promotion of the concept of 'e-health', the health sector's equivalent of 'e-commerce'. A new study explored the view that, with the convergence of technologies and the consequent increase in ability to perform multiple functions with those technologies, it is unwise to promote telemedicine in isolation from other uses of technologies in health-care. The major sources of information for the study were the presentations and discussions at five national workshops held to discuss the findings of the original report on telemedicine. Nineteen case studies were identified. The case studies showed that with the convergence of technologies telehealth is becoming part of e-health. The cost-effectiveness of both telehealth and telemedicine improves considerably when they are part of an integrated use of telecommunications and information technology in the health sector.

Australia↗
PubMed1994

[Health effects of fluorine and its compounds].

Fluoride, the ionic form of fluorine, is a natural component of the biosphere and 13th most abundant element in the crust of the earth. It is, therefore, found in a wide range of concentrations in virtually all inanimate and living things. Many trace elements perform a definite function in human metabolism and the question of the value of fluoride, always found in the body, has been raised. Much evidence suggesting that the inclusion of fluoride in drinking water has beneficial as well as adverse effects on human health was obtained. Either alone or in combination with calcium and/or vitamin D, it is used in high daily doses for the treatment of osteoporosis. Although organic fluorine compounds are used in medicine and commerce, the inorganic fluorine compounds are of greater importance toxicologically because they are more readily available. The major pathway of fluoride elimination from the human body is via the kidney. When renal function deteriorates, the ability to excrete fluoride markedly decreases, possibly resulting in greater retention of fluoride in the body. At this point, more research is needed to evaluate the effects of physiological variables on the fluoride metabolism in humans.

Fluorides↗
PubMed1991

Tritium precipitation in European cities and in Osaka, Japan owing to the Chernobyl nuclear accident.

Tritium precipitations in European cities and in Osaka, Japan were analyzed before and after the Chernobyl nuclear plant accident by the time series analysis code Census IIX11 developed by US Department of Commerce Bureau of the Census. Results of this analysis showed no significant tritium precipitation was produced by the accident although marked amounts of other radioactive nuclides were detected in Europe and Japan immediately after the accident.

Accidents↗
PubMed2000

Chemicals in the environment and developmental toxicity to children: a public health and policy perspective.

There are numerous pesticides and toxic chemicals in the environment that have yet to be evaluated for potential to cause developmental neurotoxicity. Recent legislation and testing initiatives provide an impetus to generating more information about potential hazards to children. In the United States, the 1996 Food Quality Protection Act (FQPA) required the U.S. Environmental Protection Agency (U.S. EPA) to make a finding that a pesticide food use is safe for children. In addition, the law requires U.S. EPA to incorporate an additional 10-fold factor in risk assessments for pesticide residue tolerances to take into account the special sensitivities of infants and children as well as incomplete data with respect to toxicity and exposures. The potential of chemicals in food and drinking water to cause endocrine disruption will also be examined via the Endocrine Disruptor Screening and Testing Program required by the FQPA and the 1996 Safe Drinking Water Act. In addition, a new voluntary chemical information program will provide screening-level information for the some 2,800 high-volume chemicals in commerce in the United States. These initiatives will need to be accompanied by research focused on developmental toxicity for children, including developmental disabilities. Developmental disabilities exact a large toll on children's health in the United States. Three major developmental disabilities--autism, cerebral palsy, and severe mental retardation--each affect substantial numbers of children. We know very little about the etiology of these conditions. A number of priority areas for research are suggested, including a large environmental prospective study of developmental neurotoxicity.

Child↗
PubMed2000

Health effects of asbestos and nonasbestos fibers.

Exposures to asbestos and synthetic fibers remain areas of great concern in the field of occupational lung disease. Despite extensive study, the health effects associated with fibers remains an area of substantial controversy. In particular, effects of fibers at relatively low doses, particularly for mesothelioma, remain a matter of evolving opinion, especially when integrated with the divergence of opinion on relative pathogenicity of different fiber types. Mechanistic studies continue to provide a window into pathogenesis and some hope for understanding dose-response relationships at the lower levels seen in contemporary Western workplaces and the general environment. Changes in clinical assessment based on use of new chest imaging techniques beyond the traditional plain film are also an area of evolution and begin to challenge B-reading as the definitive tool for noninvasive assessment of disease. Public health concerns have to a great extent been transported to the developing world where there is a strong trend toward increased use of asbestos, although it has been virtually eliminated from commerce in most developed countries. For nonasbestos fibers, the major unsettled issues are their relative potencies as carcinogens for the human lung and mesothelium and the need to sort out the relation between physical and chemical properties of these fibers and their pathogenicity. The recent discovery of "flock worker's lung" due to synthetic fibers once again alerts us to emerging diseases associated with new technologies.

Air Pollutants, Occupational↗
PubMed1998

Human exposure assessment and the National Toxicology Program.

The National Institute of Environmental Health Sciences/National Toxicology Program (NIEHS/NTP) is developing a new interagency initiative in exposure assessment. This initiative involves the NIEHS, the Centers for Disease Control and Prevention through its National Center for Environmental Health, the National Institute for Occupational Safety and Health, the EPA, and other participating institutes and agencies of the NTP. This initiative will benefit public health and priority setting in a number of ways. First, as discussed above, it will strengthen the scientific foundation for risk assessments by the development of more credible exposure/response relationships in people by improving cross-species extrapolation, the development of biologically based dose-response models, and the identification of sensitive subpopulations and for "margin of exposure" based estimates of risk. Second, it will provide the kind of information necessary for deciding which chemicals should be studied with the limited resources available for toxicological testing. For example, there are 85,000 chemicals in commerce today, and the NTP can only provide toxicological evaluations on 10-20 per year. Third, we would use the information obtained from the exposure initiative to focus our research on mixtures that are actually present in people's bodies. Fourth, we would obtain information on the kinds and amount of chemicals in children and other potentially sensitive subpopulations. Determinations of whether additional safety factors need to be applied to children must rest, in part, upon comparative exposure analyses between children and adults. Fifth, this initiative, taken together with the environmental genome initiative, will provide the science base essential for meaningful studies on gene/environment interactions, particularly for strengthening the evaluation of epidemiology studies. Sixth, efficacy of public health policies aimed at reducing human exposure to chemical agents could be evaluated in a more meaningful way if body burden data were available over time, including remediation around Superfund sites and efforts to achieve environmental justice. The exposure assessment initiative is needed to address public health needs. It is feasible because of recent advances in analytical technology and molecular biology, and it is an example of how different agencies can work together to better fulfill their respective missions.

Environmental Exposure↗
PubMed2006

Safe harbor: protecting ports with shipboard fuel cells.

With five of the largest harbors in the United States, California is beginning to take steps to manage the large amounts of pollution generated by these bustling centers of transport and commerce. One option for reducing diesel emissions is the use of fuel cells, which run cleaner than diesel and other internal combustion engines. Other technologies being explored by harbor officials are diesel-electric hybrid and gas turbine locomotives for moving freight within port complexes.

Air Pollution↗
PubMed2003

An occupational reproductive research agenda for the third millennium.

There is a significant public health concern about the potential effects of occupational exposure to toxic substances on reproductive outcomes. Several toxicants with reported reproductive and developmental effects are still in regular commercial or therapeutic use and thus present potential exposure to workers. Examples of these include heavy metals, organic solvents, pesticides and herbicides, and sterilants, anesthetic gases, and anticancer drugs used in health care. Many other substances are suspected of producing reproductive or developmental toxicity but lack sufficient data. Progress has been limited in identifying hazards and quantifying their potencies and in separating the contribution of these hazards from other etiologic factors. Identifying the causative agents, mechanisms by which they act, and any potential target populations, present the opportunity to intervene and protect the reproductive health of workers. The pace of laboratory studies to identify hazards and to underpin the biologic plausibility of effects in humans has not matched the pace at which new chemicals are introduced into commerce. Though many research challenges exist today, recent technologic and methodologic advances have been made that allow researchers to overcome some of these obstacles. The objective of this article is to recommend future directions in occupational reproductive health research. By bridging interdisciplinary gaps, the scientific community can work together to improve health and reduce adverse outcomes.

Communication↗
PubMed1976

Naturally occurring insecticides.

Naturally occurring insecticides are abundant and varied in their effects, though but a few are articles of commerce. Even for these, pyrethrum, nicotine, rotenone, hellebore, ryania, and sabadilla, there is a paucity of information on mammalian toxicology and environmental effects. In general, these materials are characterized favorably by low acute toxicity and ready dissipation in nature. Unfavorable aspects of natural insecticides are the contained mixture of active and inactive components and the low active ingredient content on a crop yield basis pointing to a high unit cost. Natural insecticides can serve additionally as leads to unnatural mimics, of which the commercially successful synthetic pyrethroids are prime examples. The chemical nature, relationship of insecticidal activity to chemical structure, occurrence, production, and utilization, registered uses, metabolism, and insect and mammalian toxicity are reviewed.

Animals↗
PubMed1994

Children and toxic substances: confronting a major public health challenge.

Despite early warnings of lead toxicity, until recently this metal was added to a variety of consumer and industrial products. Today, thousands of children in the United States, and probably tens of thousands more worldwide, are suffering the consequences of exposure to lead. The lead story looms as major public policy failure that will eventually cost billions of dollars to remedy. Little is known about the toxicological properties of the more than 70,000 chemicals in commerce. Consequently, it seems likely that other "leads" are finding their way into our food, water, and air. Inadequate testing of chemicals to which the public is exposed presents a serious public health risk, particularly to children whose nervous systems are still developing. The Federal government should expand toxicological testing programs for existing and new chemicals, requiring increased developmental toxicological, particularly neurotoxicological, testing of chemicals to which the public is significantly exposed. In keeping with the concept of full-cost pricing, the costs of these tests should be incurred by the manufacturer, not the government, and should be considered a routine cost of product development.

Child↗
PubMed1995

Defining the role of pollutants in the disruption of reproduction in wildlife.

Although chemical exposure has been associated with reduced reproduction in certain North American fish, reptiles, and mammals, definitive cause-and-effect data are lacking in many instances. Because the increasing use and global transport of industrial chemicals pose significant risk to successful reproduction, methods should be developed that can define the geographic extent and magnitude of injury and risk to wildlife. Because industrial chemicals are articles of commerce, information about injury to wildlife has been contentious and too often ineffective in changing societal behavior. The following strategies are advocated for inferring causal relationships. First, a balanced and comprehensive assessment of the data is necessary to determine the geographic extent of exposure and reproductive effects associated with environmental pollution. Initial efforts to document reproductive injury should focus on specific ecosystems in which detrimental effects have been observed, but lack sufficient causal data. Model systems (including experimental mesocosms or field ecosystems) should be identified or designed that can adequately test multigenerational reproductive effects. Mechanistic data from supportive laboratory studies on reproductive toxicity, quantitative structure-activity relationships, and bioaccumulation can be used to predict effects of related pollutants and to determine risk. Such information is essential to prevent future injury to wildlife and to prioritize the numerous remediation decisions facing our society.

Animals↗
PubMed1998

20 years of toxicology.

With over 80,000 chemicals being used in commerce worldwide, it is important to identify the human health effects of these chemicals and the levels of exposure at which they are harmful to humans. In order to address this need, the National Toxicology Program (NTP) was established in 1978; since then, the NTP has become the world's leader in designing, conducting, and interpreting various types of toxicity assays.

Animals↗
PubMed1999

Emergency planning and the acute toxic potency of inhaled ammonia.

Ammonia is present in agriculture and commerce in many if not most communities. This report evaluates the toxic potency of ammonia, based on three types of data: anecdotal data, in some cases predating World War 1, reconstructions of contemporary industrial accidents, and animal bioassays. Standards and guidelines for human exposure have been driven largely by the anecdotal data, suggesting that ammonia at 5,000-10,000 parts per million, volume/volume (ppm-v), might be lethal within 5-10 min. However, contemporary accident reconstructions suggest that ammonia lethality requires higher concentrations. For example, 33,737 ppm-v was a 5-min zero-mortality value in a major ammonia release in 1973 in South Africa. Comparisons of secondary reports of ammonia lethality with original sources revealed discrepancies in contemporary sources, apparently resulting from failure to examine old documents or accurately translate foreign documents. The present investigation revealed that contemporary accident reconstructions yield ammonia lethality levels comparable to those in dozens of reports of animal bioassays, after adjustment of concentrations to human equivalent concentrations via U.S. Environmental Protection Agency (EPA) procedures. Ammonia levels potentially causing irreversible injury or impairing the ability of exposed people to escape from further exposure or from coincident perils similarly have been biased downwardly in contemporary sources. The EPA has identified ammonia as one of 366 extremely hazardous substances subject to community right-to-know provisions of the Superfund Act and emergency planning provisions of the Clean Air Act. The Clean Air Act defines emergency planning zones (EPZs) around industrial facilities exceeding a threshold quantity of ammonia on-site. This study suggests that EPZ areas around ammonia facilities can be reduced, thereby also reducing emergency planning costs, which will vary roughly with the EPZ radius squared.

Air Pollution↗