Physician Training Related to Environmental Hazards near Ash Superfund Sites.

Physicians do not receive formal environmental health training in medical schools. The objectives of this study were to provide health care providers with basic environmental medicine training to better advise, treat or refer patients in the community and to observe any differences in the environmental medicine learning gains pre/post- test assessment. To rectify the problem of the lack of physicians' training related to environmental hazards, we conducted an environmental health workshop which targeted physicians living near Health Zone 1, Superfund ash sites. Fifty health care providers from both St. Vincent Family Medicine and Department of Health, Duval County Health Department (DOH-Duval) participated in a pre-test survey before the training and a post-test survey following the training. We used a non-parametric Wilcoxon Signed-Rank test to compare pre- and post- knowledge of training participants. At the 10% level of significance, the number of incorrect answers significantly declined in the post-training survey compared to the pre-training survey for all participants from both facilities combined (p=0.083). Site-specific analysis show, while a significant difference was found for participants from the St. Vincent's site (p=0.084), the difference for participants from the DOH-Duval site was not significant (p = 0.102), although the number of incorrect answers declined. The training resulted in learning gains for the 50 participants and the evaluations were very positive with 100% of physicians recommending this training to other health care providers. Additionally, training participants gave a high mark for the environmental medicine pocket guide. In 2019, the ash sites are 90% remediated and cleanup is expected to be completed in 2022. There is still a need for additional training for physicians due to other active sites (i.e., Kerr-McGee) in the community. This study highlights the importance of providing environmental hazards training to physicians and the approach by which it could be delivered effectively.

Knowledge and Practices to Avoid Heat-Related Illness among Hispanic Farmworkers along the Florida-Georgia Line.

Objectives: Farmworkers who harvest and weed field crops are at increased risk for heat exposure and heat-related illness (HRI). The study objectives were to: (1) train crew leaders to use the Occupational Safety and Health Administration (OSHA) heat safety tool app and evaluate the utility of the app from a crew leader perspective; and (2) characterize heat safety knowledge, preventive practices, and perceptions of HRI risk among Hispanic farmworkers.Methods: Before harvest season, six crew leaders completed a 2-hour OSHA heat illness prevention training, including evaluation of a heat safety mobile app. Between August and October 2018, 101 Hispanic farmworkers participated in cross-sectional surveys about heat safety. Survey participants responded to questions about HRI prevention, HRI knowledge, and sociodemographics.Results: Crew leaders using the heat safety app rated the app very highly on relevance, functionality, value and privacy. Farmworkers did not report being overly concerned about HRI based on their survey responses. Nevertheless, 19% of farmworkers had experienced nonspecific symptoms from working in the heat, such as headache, dizziness, and nausea. In the multivariate linear regression model, farmworkers had lower heat safety knowledge scores if they were H-2A visa holders, female, and only "a little bit concerned," compared to others who were "very concerned" about working in the heat.Conclusion: The results of this study indicate the need for continued heat safety training for both crew leaders and farmworkers to reduce the risk of HRI, especially among less experienced farmworkers.

Community-Based Participatory Research at Jacksonville Florida Superfund Ash Site: Toxicology Training to Improve the Knowledge of the Lay Community.

Until the late 1960's, Jacksonville, Florida incinerated its solid waste with the resultant ash deposited in landfills or used to fill flood-prone areas. These filled areas were later developed into parks, school sites and residential areas. Lead in soil at these sites was the major toxicant of concern and driver of clean-up actions. During the period of assessment of lead-levels in soil, there were no established lines of communication between the City and residents of affected neighborhoods resulting in mistrust in the community. To address communication issues, a community-based, culturally sensitive Community Environmental Toxicology Curriculum (CETC) and a short video were developed for community stakeholders to inform them of risks, health effects, remediation processes and preventive measures. Pre-and post-tests were developed to measure knowledge gained from the toxicology training. Learning gains averaged 47% and 24% for the community leaders and residents respectively. Most participants strongly agreed that the community toxicology curriculum was a useful tool for promoting awareness of environmental risks in their community and addressing the gap in trust between residents and agencies involved in site remediation.

Utilizing Genomics through Family Health History with the Theory of Planned Behavior: Prediction of Type 2 Diabetes Risk Factors and Preventive Behavior in an African American Population in Florida.

AIM: African Americans are disproportionately affected by type 2 diabetes. The purpose of this study was to assess to what extent African Americans' knowledge and awareness of family health history and related risk factors for developing type 2 diabetes influence their likelihood of adopting a preventive behavior. METHODS: This study employed an anonymous pencil-and-paper, self-administered survey consisting of two sections. Section 1 was a modified version of the US Surgeon General's Family Health History Initiative and the American Diabetes Association Diabetes Risk Factor Survey. Section 2 of the survey was based on the constructs of the theory of planned behavior. Over 394 African American participants completed the survey. RESULTS: 'Perceived behavioral control' was the strongest predictor of 'likelihood of adopting preventive behavior'. Participants were aware of their family history as a risk factor for type 2 diabetes, but it was not a significant predictor of behavior modifications based on that knowledge. CONCLUSION: The lack of perceived risk in this population shows the importance of not only knowing one's risk factors but translating those risk factors to a more personalized form that fits into the current lifestyle of the individual in a meaningful way.

Florida county health department, environmental health 2006 survey: do rural counties know "what to do' in a chemical or all-hazards event?

The objective of the study described here was to determine basic plans and collaboration with first responder stakeholders and to identify perceived roles and responsibilities in preparing for and responding to a chemical disaster. A survey was developed and provided to environmental health personnel at county health departments (CHDs) in Florida. Most of the counties had good collaborative relationships with first responder stakeholders. A little more than half of the respondents had access to a resource manual with contact information and had developed and maintained a chemical plan. Rural counties were less likely to know "what to do" or their responsibility in a chemical disaster; however, both rural and nonrural counties were equally likely not to have a written plan. Public health agencies at the local CHD must be the communicators of public health messages in coordination with the incident commander and the state communications office in a chemical disaster, so it is important to strengthen collaboration and cooperation with chemical response stakeholders.

Sun safety among farmers and farmworkers: a review.

Farmers and farmworkers face increased risks of skin cancer from exposure to solar ultraviolet radiation (UVR) when working outdoors. The objective of this study was to evaluate the evidence from behavioral and intervention studies from the peer-reviewed studies related to sun safety among farmers and farmworkers and identify any gaps in the literature. A comprehensive review was conducted between 1990 and 2013; 22 studies were identified related to behavior and health interventions of sun safety among these targeted groups. The inconsistency of data collection methods makes it difficult to estimate with accuracy any overall meaningful results of behavior. However, from the studies reviewed, farmers and farmworkers most frequently reported wearing some type of hat (23.6%-100%) as a primary method of protection from the sun when working outdoors. Female farmers were more likely than male farmers to use sunscreen and engage in indoor tanning behavior. All sun safety educational interventions studies reviewed reported positive increases in behavioral change. To a large degree, adequate sun protection is lacking and varies geographically among farmers. Although targeted education is key to making improvements on sun protection behavior, aggressive attempts have to be made. Studies related to farmworkers, sun safety behavior, and skin cancer are scarce and more research is needed in this area.

Residential pesticide use is associated with children's respiratory symptoms.

OBJECTIVE: To characterize the association between residential pesticide application and acute and chronic respiratory symptoms in children, focusing on the location of the pesticide application in and around the home and the type of pesticide applicator (professional vs nonprofessional). METHODS: We used 1999 to 2004 National Health and Nutrition Examination Survey results to investigate this association in children younger than 18 years (N = 14,065). RESULTS: Overall, pesticide use in the home was not associated with wheezing (odds ratio [OR], 1.15; 95% confidence interval [CI], 0.91 to 1.47). Nevertheless, pesticide use in the kitchen or dining rooms was significantly associated with increased odds of wheezing (OR, 1.39; 95% CI, 1.08 to 1.78) and dry cough (OR, 2.38; 95% CI, 1.40 to 4.06) after controlling for covariates. CONCLUSIONS: These findings suggest that residential use of pesticides and the location of pesticide application are associated with increased respiratory complaints in children.

The role of intracellular glutathione in inorganic mercury-induced toxicity in neuroblastoma cells.

It is well known that antioxidants containing sulfhydryl (-SH) groups are protective against the toxic effects of mercury. The current study was designed to elucidate the mechanism(s) of the cytoprotective effects of glutathione (GSH) and N-acetylcysteine (NAC) against the toxicity of inorganic mercury (HgCl(2)) in neuroblastoma cells (N-2A). The obtained results demonstrated the protective effects of these compounds in a dose dependant manner up to 95 and 74% cell viability, respectively as compared to the control of HgCl(2) of 10%. The administration of buthionine sulfoximine (BSO), an inhibitor of GSH synthesis, increased the toxicity of HgCl(2) in a dose dependent manner. Moreover, BSO treatment attenuated the levels of the cellular free -SH concentrations at low concentrations (1-100 microM) of HgCl(2). The data also show that cellular thiol concentrations were augmented in the presence of GSH and NAC and these compounds were cytoprotective against HgCl(2) and this is due to up regulating of GSH synthesis. A reduction in intracellular levels of GSH was observed with treatment of HgCl(2). In addition, the ratio of GSH/GSSG increased from 16:1 to 50:1 from 1 to 10 microM concentration of HgCl(2.) The ratio of GSH/GSSG then decreased from 4:1 to 0.5:1 with the increase of concentration of HgCl(2) between 100 microM and 1 mM due to the collapse of the N-2A cells. It was of interest to note that the synthesis of GSH was stimulated in cells exposed to low concentration of HgCl(2) when extra GSH is available. These data support the idea that the loss of GSH plays a contributing role to the toxic effects of HgCl(2) and that inorganic mercury adversely affects viability, through altering intracellular -SH concentrations. The data further indicate that the availability of GSH to the cells may not be sufficient to provide protection against mercury toxicity and the de novo synthesis of intracellular GSH is required to prevent the damaging effects of mercury.

Community aerial mosquito control and naled exposure.

In October 2004, the Florida Department of Health (FLDOH) and the Centers for Disease Control and Prevention (CDC) assessed human exposure to ultra-low volume (ULV) aerial application of naled. Teams administered activity questionnaires regarding pesticide exposure and obtained baseline urine samples to quantify prespray naled metabolite levels. Following the spray event, participants were asked to collect postspray urine specimens within 12 h of the spray event and at 8-h intervals for up to 40 h. Upon completion, a postspray activity questionnaire was administered to study participants. Two hundred five (87%) participants completed the study. The urine analysis showed that although 67% of prespray urine samples had detectable levels of a naled metabolite, the majority of postspray samples were below the limit of detection (< LOD). Only at the "postspray 6" time period, which corresponds to a time greater than 5 half-lives (> 40 h) following exposure, the number of samples with detectable levels exceeded 50%. There was a significant decrease in naled metabolites from prespray to postspray (= .02), perhaps associated with a significant reduction (< or = 0.05) in some participants that may have resulted in pesticide exposure by means other than the mosquito control operations. These data suggest that aerial spraying of naled does not result in increased levels of naled in humans, provided the naled is used according to label instructions.

Case report: three farmworkers who gave birth to infants with birth defects closely grouped in time and place-Florida and North Carolina, 2004-2005.

CONTEXT: There is little evidence linking adverse reproductive effects to exposure to specific pesticides during pregnancy. CASE PRESENTATION: In February 2005, three infants with congenital anomalies were identified in Collier County, Florida, who were born within 8 weeks of one another and whose mothers worked for the same tomato grower. The mothers worked on the grower's Florida farms in 2004 before transferring to its North Carolina farms. All three worked during the period of organogenesis in fields recently treated with several pesticides. The Florida and North Carolina farms were inspected by regulatory agencies, and in each state a large number of violations were identified and record fines were levied. DISCUSSION: Despite the suggestive evidence, a causal link could not be established between pesticide exposures and the birth defects in the three infants. Nonetheless, the prenatal pesticide exposures experienced by the mothers of the three infants is cause for concern. Farmworkers need greater protections against pesticides. These include increased efforts to publicize and comply with both the U.S. Environmental Protections Agency's Worker Protection Standard and pesticide label requirements, enhanced procedures to ensure pesticide applicator competency, and recommendations to growers to adopt work practices to reduce pesticide exposures. RELEVANCE TO PROFESSIONAL PRACTICE: The findings from this report reinforce the need to reduce pesticide exposures among farmworkers. In addition, they support the need for epidemiologic studies to examine the role of pesticide exposure in the etiology of congenital anomalies.

Acute pesticide poisoning in the U.S. retail industry, 1998-2004.

OBJECTIVE: This study was conducted to describe the national magnitude and characteristics of acute pesticide poisoning among workers and customers in retail establishments. METHODS: Analyses included retail employees 15-64 years of age and customers with acute pesticide poisoning identified from the Sentinel Event Notification System for Occupational Risks-Pesticides (SENSOR-Pesticides) and California Department of Pesticide Regulation from 1998 to 2004. Pesticide poisoning incidence rates and incidence rate ratios (IRR) were calculated. RESULTS: A total of 325 cases of acute pesticide poisoning were identified. Of these cases, 287 (88%) were retail employees and 38 (12%) were customers. Overall, retail employees had a significantly lower acute pesticide poisoning incidence rate compared with non-agricultural, non-retail employees (IRR=0.53; 95% confidence interval 0.47, 0.59). However, significantly elevated pesticide poisoning incidence rates were observed for four retail occupations (janitors, stock handlers/baggers, bakery/deli clerks, and shipping/receiving handlers). In addition, workers employed in two retail industry sectors (farm supply stores and hardware stores) had significantly elevated acute pesticide poisoning incidence rates. Incidence rates among the retail employees demonstrated a quadratic trend, monotonically decreasing from 1998 to 2000 and monotonically increasing from 2000 to 2003. The rates appear to have leveled off in 2003 and 2004. CONCLUSIONS: Preventive measures to decrease acute pesticide poisoning incidence in the retail sector include adoption of unbreakable and tear-resistant container requirements, increased utilization of integrated pest management strategies, and advisement to store managers, employees, and customers about poisoning prevention.

Acute pesticide-related illness among emergency responders, 1993-2002.

BACKGROUND: Emergency responders are among the first to arrive at a pesticide-related release event. Magnitude, severity, and risk factor information on acute pesticide poisoning among those workers is needed. METHODS: Survey data collected from the SENSOR-Pesticides, CDPR and HSEES programs between 1993 and 2002 from 21 states were reviewed. Acute occupational pesticide-related illness incidence rates for each category of emergency responder were calculated, as were incidence rate ratios (IRR) among emergency responders compared to all other workers employed in non-agricultural industries. RESULTS: A total of 291 cases were identified. Firefighters accounted for 111 cases (38%), law enforcement officers for 104 cases (36%), emergency medical technicians for 34 cases (12%), and 42 cases (14%) were unspecified emergency responders. Among the 200 cases with information on activity responsible for exposure, most were exposed while performing activities related to a pesticide release event (84%) and not involving patient care, while the remainder involved exposure to pesticide-contaminated patients. A majority of cases were exposed to insecticides (51%). Most had low severity illnesses (90%). The incidence rate was highest for firefighters (39.1/million) and law enforcement officers (26.6/million). The IRRs were also elevated for these professions (firefighters, IRR = 2.67; law enforcement officers, IRR = 1.69). CONCLUSIONS: The findings suggest the need for greater efforts to prevent acute occupational pesticide-related illness among emergency responders.

Acute illnesses associated with pesticide exposure at schools.

CONTEXT: Pesticides continue to be used on school property, and some schools are at risk of pesticide drift exposure from neighboring farms, which leads to pesticide exposure among students and school employees. However, information on the magnitude of illnesses and risk factors associated with these pesticide exposures is not available. OBJECTIVE: To estimate the magnitude of and associated risk factors for pesticide-related illnesses at schools. DESIGN, SETTING, AND PARTICIPANTS: Analysis of surveillance data from 1998 to 2002 of 2593 persons with acute pesticide-related illnesses associated with exposure at schools. Nationwide information on pesticide-related illnesses is routinely collected by 3 national pesticide surveillance systems: the National Institute for Occupational Safety and Health's Sentinel Event Notification System for Occupational Risks pesticides program, the California Department of Pesticide Regulation, and the Toxic Exposure Surveillance System. MAIN OUTCOME MEASURES: Incidence rates and severity of acute pesticide-related illnesses. RESULTS: Incidence rates for 1998-2002 were 7.4 cases per million children and 27.3 cases per million school employee full-time equivalents. The incidence rates among children increased significantly from 1998 to 2002. Illness of high severity was found in 3 cases (0.1%), moderate severity in 275 cases (11%), and low severity in 2315 cases (89%). Most illnesses were associated with insecticides (n = 895, 35%), disinfectants (n = 830, 32%), repellents (n = 335, 13%), or herbicides (n = 279, 11%). Among 406 cases with detailed information on the source of pesticide exposure, 281 (69%) were associated with pesticides used at schools and 125 (31%) were associated with pesticide drift exposure from farmland. CONCLUSIONS: Pesticide exposure at schools produces acute illnesses among school employees and students. To prevent pesticide-related illnesses at schools, implementation of integrated pest management programs in schools, practices to reduce pesticide drift, and adoption of pesticide spray buffer zones around schools are recommended.

Inflammation and inducible nitric oxide synthase have no effect on monoamine oxidase activity in glioma cells.

Heightened monoamine oxidase (MAO) and inducible nitric oxide synthase (iNOS) activity can contribute to oxidative stress, the formation of active neurotoxins, and associated neurodegenerative diseases of the brain. Although these enzymes co-exist within astrocytes, there has been little research examining the correlation between the two during inflammation. In this study, C6 glioma cells were stimulated with lipopolysaccharide (LPS):Escherichia coli 0111:B4 (6 micro g/mL):rat interferon-gamma (IFN-gamma) (100U/mL). In LPS/IFN-gamma-treated cells, the MAO substrates dopamine (DA) and tyramine caused a concentration-dependent attenuation of NO(2)(-) and NO(3)(-). In contrast, treatment with an MAO-A inhibitor (clorgyline) or an MAO-B inhibitor ((-)-deprenyl) did not reverse these effects. MAO activity was inhibited effectively by clorgyline and deprenyl; however, neither MAO inhibitor had an effect on NO(2)(-) in stimulated cells. Inversely, increasing concentrations of LPS/IFN-gamma resulted in heightened iNOS protein expression and NO(2)(-); however, these events did not correlate with any distinctive change in MAO enzyme activity. Moreover, a selective iNOS inhibitor, N(6)-(1-iminoethyl)-L-lysine, in LPS/IFN-gamma-stimulated cells caused a concentration-dependent attenuation of NO(2)(-) with no effects on MAO activity or iNOS protein expression. The attenuating effects of DA on iNOS were blocked completely by ICI 118-551 [(+/-)-1-[2,3-(dihydro-7-methyl-1H-inden-4-yl)oxy]-3-[(1-methylethyl)amino]-2-butanol hydrochloride], indicating a role for the beta(2)-adrenergic receptor. In conclusion, these data indicate that activity or expression of iNOS does not influence MAO activity in activated rat glioma cells. Moreover, DA exerts an inhibitory effect on glial iNOS through a receptor-mediated cascade.