The Role of Physician Advocacy in Supporting Policy Change That Reduces Leaded Aviation Gasoline Emissions.

BACKGROUND: Leaded aviation gasoline (AvGas) accounts for 70%, or 935,082 pounds, of total lead emissions in the United States and has been repeatedly linked to elevated blood lead levels (BLLs) in those living in the vicinity of airports using AvGas. The well-established link between lead exposure and adverse health outcomes provided a platform ripe for environmental health advocates and pediatric health experts to assist a local environmental health organization in addressing lead waste from a local airport, Montgomery-Gibbs Executive Airport (MYF). METHOD: We detail the steps we took, as a physician clean-air advocacy group. We provide a qualitative analysis of our efforts in addressing leaded air pollution through targeted and creative environmental health advocacy through three main avenues: government, public awareness, and academia. OBJECTIVES: Our actions were taken to ensure the City of San Diego installed an unleaded fuel tank at MYF to reduce leaded aviation gasoline usage and subsequently lead air pollution in the surrounding area. DISCUSSION: Ultimately, the identified objective of an unleaded fuel tank was added to the San Diego City budget and scheduled for construction. We hope our actions can serve as a framework to provide concrete steps for clinicians and other advocates to enact change in their communities.

Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providers.

The field of endoscopy has revolutionized the diagnosis and treatment of gastrointestinal (GI) diseases in recent years. Besides the 'traditional' endoscopic procedures (esophagogastroduodenoscopy, colonoscopy, flexible sigmoidoscopy, and endoscopic retrograde cholangiopancreatography), advances in imaging technology (endoscopic ultrasonography, wireless capsule endoscopy, and double balloon enteroscopy) have allowed GI specialists to detect and manage disorders throughout the digestive system. This article reviews various endoscopic procedures and provides up-to-date endoscopic indications based on the recommendations of American Society for Gastrointestinal Endoscopy and American Cancer Society for primary care providers in order to achieve high-quality and cost-effective care.

Transitioning of children with GH deficiency to adult dosing: changes in body composition.

As more evidence gathers regarding the beneficial effect of growth hormone replacement therapy (GHRT) on body composition and other parameters in adults with childhood-onset growth hormone deficiency (GHD), questions emerge regarding whether or not GHRT should be discontinued following cessation of statural growth, and the effect of GHRT during the transition period on body composition and related parameters. This review discusses the effect of discontinuation of GHRT following attainment of adult stature, and the treatment and dose effect when GHRT is reinstated. We also review data regarding who should receive GHRT, the criteria for diagnosing persistent GHD, dosing of GHRT and the possibility of a GH 'holiday'.