ABSTRACT
BACKGROUND: Household cleaning products may be a significant source of chemical exposures, including carcinogens and suspected endocrine disruptors. OBJECTIVES: We characterized exposures during routine household cleaning and tested an intervention to reduce exposures to cleaning product chemicals. METHODS: The Lifting Up Communities with Interventions and Research (LUCIR) Study is a youth-led, community-based intervention project. Youth researchers conducted personal air monitoring with 50 Latina women while they cleaned their homes with their regular cleaning products (preintervention visit) and then 1 week later while they used "green" cleaning products provided by the study (postintervention visit). Air samples were analyzed for volatile and semivolatile organic compounds using gas chromatography-mass spectrometry and high-performance liquid chromatography. We compared pre- and postintervention air concentrations of 47 chemicals of concern, selected because they were on California's Proposition 65 list of carcinogens or reproductive/developmental toxicants or were suspected endocrine disruptors. Youth researchers were integrally involved in the study design, data collection, interpretation, and dissemination of findings. RESULTS: We observed statistically significant decreases in air concentrations of 17 chemicals of concern when participants switched to green cleaning products, including decreases in geometric mean concentrations of 1,4-dioxane (-46.4%), chloroform (-86.7%), benzene (-24.8%), naphthalene (-40.3%), toluene (-24.2%), and hexane (-35.5%). We observed significant increases in air concentrations of three fragrance compounds: the plant-derived terpene, beta-myrcene (221.5%), and the synthetic musks celestolide (31.0%) and galaxolide (79.6%). Almost all participants (98%) said the replacement products worked as well as their original products, and 90% said that they would consider buying the replacement products in the future. DISCUSSION: This study demonstrates that choosing cleaning products that are marketed as green may reduce exposure to several carcinogens and endocrine disruptors. Future studies should determine whether use of unscented green products would further reduce exposure to terpenes and musks. https://doi.org/10.1289/EHP8831.
Subject(s)
Endocrine Disruptors , Hazardous Substances , Adolescent , Female , Gas Chromatography-Mass Spectrometry , Hispanic or Latino , Humans , Organic ChemicalsABSTRACT
OBJECTIVES: The timing of treatment is a key prognostic factor in stroke. Our hospital implemented a rapid-action time-to-intervention protocol to optimize reperfusion times. The protocol consisted of direct transfer of stroke-code patients to the scanner or angiosuite and mobilization of the stroke team. Our aim was to assess the impact of the protocol on times to reperfusion. We also sought to evaluate the feasibility and safety of including a stroke-team nurse and assess staff satisfaction with the protocol. MATERIAL AND METHODS: Descriptive study of patients attended by the hospital stroke team between March 2015 and March 2018. Outcomes were compared to those for the previous period (February 2014 to February 2015). RESULTS: Nine hundred three patients were attended under the rapid-action protocol; 502 of them (55.6%) underwent reperfusion. The median (interquartile range) door-to-needle or groin access times were 24 (18-33) minutes for fibrinolysis and 39 (20-75) minutes for thrombectomy. Both times were significantly shorter than in the earlier period (43 [31-66] and 93 [60-150] minutes, respectively; P<.001). Median duration of nurse attendance was 25 (20-32) minutes during the implementation period, and no problems of feasibility or safety appeared during nurse attendance. Twenty staff members (95%) reported that the rapid-action protocol increased their workload but they felt it warranted continued application. CONCLUSION: Direct transfer of stroke patients for scanning or to the angiography suite, with nurse attendance, safely reduced reperfusion times.
OBJETIVO: El tiempo es un factor clave en el tratamiento y pronóstico del ictus. Nuestro centro ha implementado un protocolo de Actuación Rápida Puerta Aguja (ARPA) para optimizar los tiempos de reperfusión. Este protocolo intrahospitalario consiste en tratar a los pacientes derivados por código ictus (CI) directamente en el escáner o en la sala de angiografía movilizando al equipo de ictus. Los objetivos son evaluar el impacto del protocolo ARPA en los tiempos de reperfusión, y valorar la viabilidad y seguridad de incorporar un enfermero de la unidad de ictus (UI) al equipo de ictus para la asistencia a pacientes CI, así como la satisfacción de los profesionales. METODO: Estudio descriptivo de pacientes atendidos en el circuito CI entre marzo 2015 y marzo 2018. Se compararon con el periodo previo entre febrero 2014 y febrero 2015. RESULTADOS: Se atendieron 903 pacientes con el protocolo ARPA y recibieron tratamiento de reperfusión 502 pacientes (55,6%). La mediana de tiempo puerta-aguja para fibrinolisis fue de 24 (18-33) minutos y puerta-punción para trombectomía 39 (20-75) minutos, ambos inferiores (p < 0,001) al periodo anterior, que tuvo unos tiempos de 43 (31-66) y 93 (60-150) minutos, respectivamente. El enfermero atendió los CI durante 25 (20-32) minutos, y no se encontraron problemas graves de seguridad o viabilidad. Veinte profesionales (95%) refirieron que el protocolo ARPA aumentaba su carga de trabajo pero consideraron que se debía seguir aplicando. CONCLUSIONES: El tratamiento de pacientes CI directamente en el escáner o en la sala de angiografía incorporando un enfermero de la UI reduce, de forma segura, los tiempos de reperfusión.
