Developing and implementing core competencies in children's environmental health for students, trainees and healthcare providers: a narrative review.

Knowledge of the health impacts of environmental exposures (such as pollution disasters, poor air quality, water contamination, climate change) on children's health has dramatically increased in the past 40 years. The World Health Organization (WHO) estimated that 23% of all deaths worldwide were attributable to the environment, and 26% of deaths in children less than 5 years old could be prevented with removal of environmental risks factors. Yet, little has permeated medical education, leaving pediatric providers ill equipped to address these issues.

Proposed Mitigation and Adaptation Strategies Related to Climate Change: Guidance for OEM Professionals.

Climate change is an urgent challenge amplified by socioeconomic factors that demands thoughtful public health responses from OEM professionals. This guidance statement from the American College of Occupational and Environmental Medicine focuses on the different strategies that these health professionals can implement to protect workers from health impacts associated with climate change hazards, foster workplace resilience in the face of rapidly changing environments, and take the necessary steps to mitigate the effects of global climate change.

A Case Report of Cake Frosting as a Source of Copper Toxicity in a Pediatric Patient.

Introduction: Copper is an uncommon source of metal toxicity in children that requires a high index of suspicion for diagnosis.

Case Report: We describe the unique presentation of a 12-month-old girl who developed acute onset of vomiting and diarrhea after ingestion of a copper-contaminated birthday cake.

Conclusion: This case highlights the presentation, evaluation, and management of the rare pediatric patient who presents with copper poisoning.

Occupational Reproductive Hazards for Female Surgeons in the Operating Room: A Review.

Importance: Higher rates of infertility and pregnancy complications have been found for female surgeons compared with the general population. Several reproductive hazards are present in the operating room and may be associated with these findings. Hazards should be identified and controlled to minimize risks.

Exploring exposure to Agent Orange and increased mortality due to bladder cancer.

Background: During the Vietnam War, many veterans were exposed to Agent Orange (AO), a chemical defoliant containing varying levels of the carcinogen dioxin. The health effects of AO exposure have been widely studied in the VA population. Here we review and interpret data regarding the association between AO exposure and bladder cancer (BC) mortality.

Association of urinary phenolic compounds, inflammatory bowel disease and chronic diarrheal symptoms: Evidence from the National Health and Nutrition Examination Survey.

Endocrine disruptors such as phenolic compounds and parabens may be involved in chronic non-infective disease. While products incorporating these compounds are extensively utilized in consumer and personal products, little is known about their effect on bowel health. Inflammatory bowel disease (IBD) - consisting of the diseases ulcerative colitis and Crohn's disease - and irritable bowel syndrome are common chronic non-infectious diarrheal diseases.

Insect Repellants During Pregnancy in the Era of the Zika Virus.

Health care providers must be equipped to provide appropriate advice to reproductive-aged patients for protection against the potentially devastating consequences of prenatal Zika virus exposure. The goal of this commentary is to summarize what is known about the safety and toxicity of N,N-diethyl-meta-toluamide (DEET) as a topical insect repellant and the pyrethroid permethrin for treatment of fabric, endorsed in the fight against Zika virus. Reviews assessing the safety and toxicity of DEET conducted by the U.

Arsenic and skin cancer in the USA: the current evidence regarding arsenic-contaminated drinking water.

Background: Studies carried out in developing countries, such as Bangladesh and Taiwan, have reported an association between exposure to arsenic in drinking water and increased rates of non-melanoma skin cancer. However, it is unclear whether this correlation can be extended to the populations of developed countries such as the USA, which have lower levels of arsenic exposure and differ in other factors, such as genetics, nutrition, sun exposure, and socioeconomic status.

Objectives: This report examines the current evidence in an attempt to resolve whether populations in the USA have rates of skin cancer that correlate with higher arsenic concentrations.

Occupational handling of nickel nanoparticles: a case report.

A 26-year-old female chemist formulated polymers and coatings usually using silver ink particles. When she later began working with nickel nanoparticle powder weighed out and handled on a lab bench with no protective measures, she developed throat irritation, nasal congestion, "post nasal drip," facial flushing, and new skin reactions to her earrings and belt buckle which were temporally related to working with the nanoparticles. Subsequently she was found to have a positive reaction to nickel on the T.

Taiwan food scandal: the illegal use of phthalates as a clouding agent and their contribution to maternal exposure.

In 2011 the Taiwan Food and Drug Administration reported that plasticizers di(2-ethylhexyl) phthalate (DEHP) and di-iso-nonyl phthalate (DiNP), endocrine disruptors, were illegally added to clouding agents used in foods and beverages. 965 products were found contaminated, of which 206 were exported to 22 countries. This study's purpose was to obtain English names for 28 contaminated products for which DEHP levels were reported, calculate estimated average daily intake (mg/kg/day) for a 50 kg woman consuming one portion, and compare to U.

Wide variation in reference values for aluminum levels in children.

Background: Some parents are requesting aluminum testing in their children with developmental issues. Although aluminum can be measured in plasma, serum, or urine, there is scant scientific information about normal ranges. We sought to determine the basis for laboratory reference ranges and whether these ranges are applicable to children.

Resetting our priorities in environmental health: an example from the South-North partnership in Lake Chapala, Mexico.

Lake Chapala is a major source of water for crop irrigation and subsistence fishing for a population of 300,000 people in central Mexico. Economic activities have created increasing pollution and pressure on the whole watershed resources. Previous reports of mercury concentrations detected in fish caught in Lake Chapala have raised concerns about health risks to local families who rely on fish for both their livelihood and traditional diet.

Low-dose amitriptyline for treatment of persistent arm pain due to repetitive use.

Amitriptyline is sometimes used to treat arm pain related to repetitive use, but rigorous evidence of its benefit is lacking. This randomized controlled trial investigated whether amitriptyline provided greater pain relief or improved arm function than a placebo pill in adults with arm pain associated with repetitive use that had persisted for at least 3 months. Participants (N=118) were randomly assigned to receive 25mg of amitriptyline or a placebo pill for 6 weeks.

The impact of psychological factors on placebo responses in a randomized controlled trial comparing sham device to dummy pill.

Objectives: To explore to what extent psychological factors such as expectation, depression, anxiety and belief in alternative medicine impact placebo response and differential responses to separate placebo interventions.

Methods: We analysed data from a randomized controlled trial designed to compare the clinical response of two distinct placebo treatments (sham acupuncture device and placebo pill) in 119 participants with persistent distal upper arm pain due to repetitive stress injury. We used a multivariable linear regression model to identify potential correlates of self-reported upper extremity pain at the end of treatment in both placebo arms of the study combined.

Using seminar blogs to enhance student participation and learning in public health school classes.

Objectives: We evaluated whether "seminar blogs" enhanced learning in a large graduate-level introductory public health school class.

Methods: Sixty students were divided into 6 online blog groups. Students posted their assignments (case analyses, news commentaries), prompting comments from other students.

Acupuncture for treatment of persistent arm pain due to repetitive use: a randomized controlled clinical trial.

Objective: To compare true and sham acupuncture in their abilities to relieve arm pain and improve arm function in individuals with arm pain due to repetitive use.

Methods: Participants with persistent arm pain (N=123) were randomly assigned to true or sham acupuncture groups and received 8 treatments over 4 weeks. The primary outcome was intensity of pain (10-point scale) and secondary outcomes were arm symptoms, arm function, and grip strength.

Elevated urine arsenic: un-speciated results lead to unnecessary concern and further evaluations.

The consumption of seafood within two to three days of testing can increase total urine arsenic concentrations. Few clinicians are familiar with this fact and often misinterpret elevated results. A retrospective chart review of all cases with arsenic testing seen between 1991 and 2004 at an occupational and environmental medicine referral clinic was performed.

Sham device v inert pill: randomised controlled trial of two placebo treatments.

Objective: To investigate whether a sham device (a validated sham acupuncture needle) has a greater placebo effect than an inert pill in patients with persistent arm pain.

Design: A single blind randomised controlled trial created from the two week placebo run-in periods for two nested trials that compared acupuncture and amitriptyline with their respective placebo controls. Comparison of participants who remained on placebo continued beyond the run-in period to the end of the study.

Mercury exposure: current concepts, controversies, and a clinic's experience.

In the context of controversies surrounding fish consumption, amalgams, and commercial hair testing, we reviewed all cases from an occupational and environmental medicine clinic that had undergone mercury testing. Sixty-nine of 71 (97%) patients had no known mercury exposures other than diet or amalgams. Of these 69, 48 had blood mercury tested and 58 had urine testing.