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Use of health information systems in the Russian federation in the assessment of environmental health effects.

The Russian Federation has made an intensive effort to compile and use information on the environment and human health. In 1996-1997, we evaluated the information that was collected and analyzed on the local (raion), regional (oblast), and federal levels with reference to its usefulness in the assessment of environmental health effects. The Russian Federation maintains standardized nationwide institutions that routinely collect health data in polyclinics and hospitals and then report to the national offices. The allocations of the workforce and the broad range of surveyed health outcomes are extensive, but a lack of systematic control of information quality limits the ability to take full advantage of these efforts. On the other hand, the hierarchical system of data collection has advantages over more decentralized or commercial health systems. A major weakness in the current reporting is the aggregation and transformation of data. Although this may not disturb the generation of health statistics, it seriously limits the use of regional and federal level data in the assessment of health effects of environmental exposures. In spite of limitations, some revised approaches to the analysis of existing data may be both feasible and fruitful. Combining information from routine data and newly collected data is likely to be the most effective way to assess the relationship between environmental exposures and diseases. Although there is a strong and justifiable desire to rapidly translate information of environmental health effects into policy alternatives, at present, it seems more useful to emphasize data quality, completeness, and plans for the use of data.

Data Collection↗

Development of local knowledge of environmental contamination in Sydney, Nova Scotia: environmental health practice from an environmental justice perspective.

In Sydney, Nova Scotia, from 1901 through 1988 a coke and steel factory operated with no pollution controls, depositing over a million tons of particulate matter and releasing several thousands of tons of coal tar into the estuary. Previously we documented the presence of lead, arsenic and PAHs, in soil above Canadian guidelines, and in house dust in the communities surrounding the site [Lambert, TW, Lane, S. Lead, arsenic, and polycyclic aromatic hydrocarbons in soil and house dust in the communities surrounding the Sydney, Nova Scotia, tar ponds. Environ Health Perspect 2004; 112:35-41.]. In this paper we further the research by documenting and developing community knowledge with a study of resident's observations and experiences of the industrial contamination. We conducted two surveys, a quantitative door-to-door survey and qualitative dust interview, designed to complement each other and bring together the observations and experiences in the different communities to develop the local knowledge. The combined methodology uses techniques from both social and physical science, and was developed with the cooperation of community members. The research supports the proposition that local knowledge adds contextual meaning that complements the physical measurement of environmental contaminants, in order to understand the complex environment in which people live, and the multiple exposure pathways through which they can be affected. Residents in all three communities provided vivid observations and detailed experiences of the industrial pollution in their community and homes. The local knowledge is consistent with our physical data and review of the historical scientific research in Sydney, and supports the inference that the community was adversely impacted by the coke and steel facility. From a justice perspective, the three communities should be equally considered for remediation as part of the 'tar pond remediation policy' rather than the current policy of including only a few streets and houses.

Air Pollution, Indoor↗

Ecosystem health: challenges for ecotoxicology and environmental health.

Restoring and safeguarding ecosystem health is a major challenge for the 21st century. Man-made substances, particularly persistent bioaccumulative substances have been among the forces that have contributed to weakening the health of ecosystems. However there are other stresses that interact synergistically with chemical stress. These forces, such physical restructuring (habitat change) tend to enhance the impacts of chemical stresses. A dose-response framework that encompasses an array of stresses with synergistic and occasional antagonistic effects is proposed for the assessment of ecosystem health. The flow of ecosystem services is curtailed in damaged systems. These services, such as provision of biodiversity, potable water, foodstuffs, sequestering of contaminants, will determine the suitability of ecosystems for humans. Linking ecotoxicology to ecosystem health provides an avenue for relating a variety of pressures on ecosystems to the conditions essential to sustain life that includes human communities.

Animals↗

Prioritizing environmental issues around the world: opinions from an international Central and Eastern European environmental health conference.

BACKGROUND: As the next generation of scientists enters the field of environmental health, it is imperative that they view their contributions in the context of global environmental stewardship. In this commentary, a group of international graduate students facilitated by three experienced environmental health scientists present their views on what they consider to be the global environmental health concerns of today. This group convened initially in October 2004 at an international health conference in Prague, Czech Republic. OBJECTIVES: In this report we identify perceived environmental health concerns that exist around the world, with a focus on Central and Eastern Europe. Additionally, we address these perceived problems and offers some potential solutions. DISCUSSION: At the meeting, students were invited to participate in two panel discussions. One group of young international scientists identified several significant global environmental health concerns, including air pollution, occupational hazards, and risk factors that may exacerbate current environmental health issues. The second panel determined that communication, education, and regulation were the mechanisms for addressing current environmental challenges. CONCLUSIONS: In this commentary we expand on the views presented at the meeting and represent the concerns of young investigators from nine different countries. We provide ideas about and support the exchange of information between developed and developing countries on how to handle the environmental health challenges that face the world today.

Environmental Health↗

Pediatric environmental health.

The links between environmental agents, environmental conditions, and disease and disability among children are receiving increasing attention. Evidence abounds that children are more susceptible than adults to the damaging effects of environmental agents and conditions. This evidence is illuminated by the much-publicized and expanding research agenda on the prevention, recognition, diagnosis and treatment of environmentally related disease in the pediatric population. Encouragingly, advances in molecular biology and other sciences are providing important tools to aid pediatricians and other healthcare professionals in meeting the environmental health needs of children.

Child↗

Incorporating environmental health into pediatric medical and nursing education.

Pediatric medical and nursing education currently lacks the environmental health content necessary to appropriately prepare pediatric health care professionals to prevent, recognize, manage, and treat environmental-exposure-related disease. Leading health institutions have recognized the need for improvements in health professionals' environmental health education. Parents are seeking answers about the impact of environmental toxicants on their children. Given the biologic, psychological, and social differences between children and adults, there is a need for environmental health education specific to children. The National Environmental Education and Training Foundation, in partnership with the Children's Environmental Health Network, created two working groups, one with expertise in medical education and one with expertise in nursing education. The working groups reviewed the transition from undergraduate student to professional to assess where in those processes pediatric environmental health could be emphasized. The medical education working group recommended increasing education about children's environmental health in the medical school curricula, in residency training, and in continuing medical education. The group also recommended the expansion of fellowship training in children's environmental health. Similarly, the nursing working group recommended increasing children's environmental health content at the undergraduate, graduate, and continuing nursing education levels. Working groups also identified the key medical and nursing organizations that would be important in leveraging these changes. A concerted effort to prioritize pediatric environmental health by governmental organizations and foundations is essential in providing the resources and expertise to set policy and provide the tools for teaching pediatric environmental health to health care providers.

Child↗

Skills and abilities needed by environmental health science and protection professionals in the public sector.

The National Environmental Health Science and Protection Accreditation Council (EHAC) accredits undergraduate academic environmental health science programs in the United States. The guidelines used by EHAC include core and technical courses that students should take in order to graduate with a bachelor of science degree in environmental health science. As part of a review of the accreditation guidelines, the research reported in this paper was undertaken with support from the Centers for Disease Control and Prevention. To identify the skills and abilities needed by entry-level environmental health professionals in the public sector, the research 1) examined existing environmental health priorities in public-health agencies, 2) reviewed entry-level job postings, and 3) surveyed more than 120 public-health professionals across the country. The results suggest that students who graduate from accredited programs must be skilled interpersonal communicators with a broad base of technical knowledge.

Accreditation↗

The politics of risk: a human rights paradigm for children's environmental health research.

A human rights paradigm for environmental health research makes explicit the relationship between poor health and poverty, inequality, and social and political marginalization, and it aims at civic problem solving. In so doing, it incorporates support for community-based, participatory research and takes seriously the social responsibilities of researchers. For these reasons, a human rights approach may be better able than conventional bioethics to address the unique issues that arise in the context of pediatric environmental health research, particularly the place of environmental justice standards in research. At the same time, as illustrated by disagreements over the ethics of research into lead abatement methods, bringing a human rights paradigm to bear in the context of environmental health research requires resolving important tensions at its heart, particularly the inescapable tension between ethical ideals and political realities.

Child↗

Environmental health and hazardous waste issues related to the U.S.-Mexico border.

Environmental health and environmental quality issues along the U.S.-Mexico border have been of concern for several years. The enactment of the North American Free Trade Agreement and the presence of the maquiladoras (foreign-owned industries using imported raw materials) have intensified those concerns recently. Efforts to assess these issues are complicated by the fact that many of the issues affecting the border region are within federal jurisdiction, but the problems are regional and local in nature. Thus, state and local governments become involved with public concerns about real and potential problems. One major problem is that environmental health data from this region are lacking, particularly from Mexico. Some new agencies such as the Border Environment Cooperation Commission, the United States-Mexico Border Health Commission, and the North American Commission on Environmental Cooperation have joined several existing agencies at the federal and state level to address environmental quality and health. Several studies have been initiated to determine air and water quality, but little is being done in the areas of hazardous waste and health assessment. Several problems are anticipated in the generation of such data, such as its format and accessibility. Data gaps and research needs are discussed.

Environmental Health↗

Creating effective messages about environmental health.

The Centers for Disease Control and Prevention supported research coordinated by the Association of Environmental Health Academic Programs (AEHAP) for the purpose of developing effective messages about environmental health. The purpose of these messages would be to increase the visibility of the environmental health profession and improve the public's awareness and understanding of the role played by the profession in protecting the public's health. To accomplish this task, AEHAP first collaborated with a marketing team to develop initial test messages. The core message revolved around five major themes: effects of pollution, susceptible populations, economics and prevention, homeland security, and specific environmental health issues. The draft messages were tested in three focus group settings: 1) policy makers, 2) environmental health professionals, and 3) the general public. This paper reports a finding that there is a perceptual gap among environmental health professionals, policy makers, and the public. This gap is part of why there is a compelling need for the environmental health community to develop and disseminate more effective messages about the profession.

Administrative Personnel↗

Information management. Computer resources for the occupational and environmental health nurse.

Occupational and environmental health nurses are responsible for the management of large amounts of very complex information, ranging from individual employee health records to reports that insure corporate compliance. There are four primary tools available to the occupational health nurse to facilitate efficient management and use of health information--occupational health information systems, office support programs, communication systems, and the Internet and intranets. Selection and implementation of an integrated health information system requires the involvement of any organization that uses data processed by the system. A project management approach to implementation and maintenance of a system insures adherence to time lines and attention to details. The internet provides access to a vast amount of information useful to both the occupational health professional and the employee. Intranets are internal systems that may facilitate distribution of health information to employees, maintenance of current health related policies, and more efficient reporting procedures.

Algorithms↗

Environmental health response clinics. A survey of program options.

Environmental Health Response Clinics are established in response to concerns about community exposures to hazardous situations (chemical, biological, radiological). They are developed in response to a demand for "clinical services" and operate outside the usual health care financing and delivery mechanisms. Prompted by their experience in California, the authors formed a focus group to identify possible goals and services. A mail survey of occupational-environmental health professionals was then conducted to evaluate the feasibility and priority of representative goals. The analysis suggests that services should focus on the specific hazard of concern and that communication and education are essential components. The tendency to "do a general physical examination" should be eschewed. Ratings for priority and feasibility were disparate for several possible goals. In some instances, a "hands-on examination" may not be the best use of resources. Environmental health professionals may serve by direct clinical service or by advising community-based practitioners. Providing routine clinical services alone cannot meet the expectations for an environmental health response clinic.

California↗

Environmental health: a survey of Texas primary care physicians.

Although the role of environmental health hazards in cancer and other diseases is increasingly appreciated, most physicians have had little or no training in environmental health or in integrating exposure histories into their clinical practice. As part of the Texas Medical Association Physician Oncology Education Program, we mailed a questionnaire to 350 Texas primary care physicians (PCPs) to evaluate their attitudes, practice, training, and preferred sources for information regarding environmental health issues. Of the respondents, 86.1% reported that they had never received specific training in environmental health history-taking and 91.7% indicated a desire to learn more about environmental health hazards. The data also revealed that patients regularly raise questions about environmental topics that PCPs do not routinely discuss. Our findings identify a need for more environmental health education for Texas PCPs, and we suggest several possible mechanisms by which this might be accomplished.

Attitude of Health Personnel↗

The role of environmental health personnel in hazardous materials emergency response.

Environmental Health staff, as representatives of the local Health Officer, have a significant role in responding to hazardous materials emergency incidents in California. This paper describes the development of a county hazardous materials emergency response plan which led to the implementation of a hazardous materials emergency response team staffed by Environmental Health professionals. Each emergency incident has its own unique characteristics so Environmental Health staff must be well prepared to be flexible and adapt the responses and recommendations to what is found at the scene. Responsibilities, procedures, equipment and clean-up strategies at the scene are discussed. Planning, preparation, training and coordination are the key elements to respond to these emergencies effectively.

California↗

Training of environmental health officers in Anglophone west Africa: how adequate for environmental monitoring?

There is concern that the curriculum for training Environmental Health Officers (EHO) in Anglophone English speaking West Africa grossly lags behind the skills needed by sanitarians in the sub-region to cope with the challenge of environmental monitoring/control. This paper examines in detail the existing curriculum for the training of EHOs at the diploma and degree levels in the sub-region and observes that both curricula lack sufficient credit weight to impart the desired skills to perform the highly scientific task of environmental monitoring. Suggestions are made on ways and means of enhancing the professional education of EHOs in the sub-region. The paper contends that the situation places sanitarians in the sub-region at a serious academic handicap as many universities are reluctant to accept them for further studies in related fields.

Africa, Western↗