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Case Studies in Environmental Medicine
A mother brings her 2½-year-old son to you for consultation. She explains that her family moved to your community about 7 months ago when her husband changed jobs. Over the past month and a half, the boy has developed progressive loss of appetite and weight loss. He has also suffered from an increasingly severe and itchy rash. Although usually very active and pleasant, he has become ill-tempered and, for the past couple of days, he refuses to walk around, preferring to lie in bed or be carried. He rubs his knees and cries periodically throughout the day. Neither the parents nor the child’s grandmother, who lives with them, has been ill. The boy’s medical history has been unremarkable. His height and weight have been consistently in the 25th percentile for his age. He is on a regular toddler diet, and all developmental milestones have been appropriately met. He is not taking any medications. The mother denies any family use of dietary supplements or herbal medicines. The family history is negative for blood transfusions and use of illicit drugs, human immunodeficiency (HIV) infection, and metabolic or genetic diseases. A review of systems and a brief assessment of how the family functions are negative. No one in the family has been traveling in a foreign country. During the day, the child stays at home with his mother or grandmother. The mother works part-time as a bookkeeper-clerk in a local dry-cleaning facility. The father works as a production manager in a thermometer factory. The mother states that both parents are concerned about environmental contaminants, specifically those that might be associated with their workplaces, and whether or not hese contaminants can put their family at risk. The parents have heard neighbors’ and co-workers’ comments about ailments associated with mercury exposures. The parents also mention reports of teenagers in the community taking mercury from the local high school chemistry lab over the past several months. These incidents resulted in an ongoing investigation by the environmental division of the state health department. One of the teenagers who reportedly took mercury from the lab helped with odd jobs around the parents’ house, including indoor housecleaning. Questions To Consider1. What additional information should you gather by interview? 2. What would you include in this patient’s problem list? 3. What is the differential diagnosis for this patient? For the answers to these
questions and the complete Case Studies in Environmental Medicine:
Pediatric Environmental Health, visit the case studies home page
(www.atsdr.cdc.gov/HEC/CSEM).
School LocationsCharacteristics of Schools Sited On or Near Hazardous Waste Sites in Brownfields Communities
In an initial analysis using
1999 school data, we found that 438 schools were built on or within
1 mile of 61 NPL sites in 16 brownfields showcase communities
designated by EPA. One hundred thirty-eight of these schools (with a
total enrollment of more than 92,000 students) had been built directly
on an NPL site. Seventy-six percent of these on-site schools were built
above contaminated groundwater plumes. Because of remediation efforts,
none of the schools above the plumes are currently exposed to contaminated
groundwater.
This initial analysis suggests
that, across the country, a substantial number of students attend schools
near or built on top of an NPL site. However, proximity is not equivalent
to exposure. A school-specific exposure assessment must be done to determine
whether any chemical hazards from nearby NPL sites have affected the
school population (see pilot exposure assessment section). Pilot Exposure Assessment of Schools Sited On or Near Hazardous Waste Sites in Brownfields CommunitiesBecause it is possible that site conditions or the availability of information on exposures might have changed since the date of release of a public health assessment (PHA) on a National Priorities List (NPL) site, ATSDR initiated a pilot field project in summer/fall 2001 to evaluate whether specific exposure pathways exist for school populations near these sites. ATSDR selected a subset of NPL sites in the United States for follow-up examination through this pilot project. For the pilot study, we used 16 brownfields showcase communities and 61 NPL sites in those communities. From these 61 NPL sites, we chose a subset of 13 that
The sites selected were in Florida, Oregon, Texas, Utah, and Washington. More than 50 schools are located on or within 1 mile of these 13 sites.
[Table of Contents] The Impact of ADHD May Be UnderestimatedThe public health impact of attention deficit-hyperactivity disorder (ADHD) may be greatly underestimated by school and public health officials, say scientists at the National Institute of Environmental Health Sciences (NIEHS). In a recently published study, the NIEHS scientists and their colleagues at the University of North Carolina School of Medicine in Chapel Hill reported that when they queried parents in a “typical” county of rural and suburban homes (Johnston County, North Carolina), the parents reported more than 15% of boys in grades one through five had been diagnosed with ADHD and about 10% (or two-thirds of those diagnosed) were taking medication for the condition. Asking the parents was a key to the higher figures, the researchers thought, because school nurses might not be aware of children who were receiving medication treatment entirely at home. “Treatment rates are usually viewed as abnormally high if they exceed the 3% to 5% prevalence estimate for ADHD cited in an American Psychiatric Association manual in 1994,” the authors said. “Therefore, the national public health impact of ADHD may be greatly underestimated by both educators and public health officials.” The study used
parental and teacher reports of 6,099 children in 17 public elementary
schools in the semirural county. Because Johnston County has a racial/ethnic
and educational profile similar to North Carolina as a whole, the authors
of the study said they thought that medication treatment rates are probably
similar in many other counties in North Carolina and elsewhere. The
researchers said similar data need to be collected nationally to better
understand ADHD medication treatment patterns. The research
appears online in the February issue of the American Journal of Public
Health, a publication of the American Public Health Association.
The journal is accessible at www.apha.org.
Internet Resources SeminarLast year the Mid-Atlantic Center for Children’s Health and the Environment (MACCHE), in conjunction with ATSDR Region 3, the U.S. Environmental Protection Agency (EPA) Region 3, and the National Library of Medicine, held a 1-day seminar on The Use of the Internet for Children’s Environmental Health. MACCHE is the Region 3 Pediatric Environmental Health Specialty Unit (PEHSU) and is located at George Washington University in Washington, D.C. The seminar educated professionals about available Internet resources on children’s health and introduced them to the new PEHSU. The seminar will be repeated at several locations throughout the region in the coming year. Persons from Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia who might be interested in having this course presented to their organization should contact MACCHE at 202-994-1166 or toll-free at 1-866-MACCHE1 (1-866-622-2431).—Lora S. Werner, MPH BAM! Answers to Your QuestionsVisit the Centers for Disease
Control and Prevention’s BAM! (Body and Mind), an e-zine for kids, at
www.bam.gov. Children's
Environmental Health Case Study
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Calendar |
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October
12, 2002
In Harm’s Way: Toxic Threats to Child Development, Minneapolis, Minnesota.
Hosted by the University of Minnesota School of Public Health. Contact
Kathleen Schuler, Institute for Agriculture and Trade Policy, by e-mail:
kschuler@iatp.org or telephone: 612-870-3468.
October 18–20, 2002
International Symposium on Children’s Health and the Environment, Istanbul,
Turkey. Hosted by the Association of Physicians for the Environment
of Turkey. Contact Gunay Can by e-mail: alpincan@yahoo.fr
or telephone: ++90-212-586-1549.
October 28–29, 2002
3rd European Conference on Pediatric Asthma, London. Contact Castle
House Medical Conferences by telephone: +44 (0)1892-539606; e-mail:
asthma@castlehouse.co.uk;
or Web site: www.castlehouse.co.uk.
November
4–5, 2002
Research, Technologies, and Applications in Biodefense, McLean, Virginia.
Contact Mary Addonizio by telephone: 617-630-1373 or e-mail: addonizio@healthtech.com.
November 6–9, 2002
American Evaluation Association Annual Conference, Arlington, Virginia.
Contact Susan Kistler by telephone: 1-888-232-2275 or e-mail: aea@eval.org.
November 7–8, 2002
Advisory Council for the Elimination of Tuberculosis, Atlanta. Contact
Paulette Ford-Knights by telephone: 404-639-8008 or e-mail: pbf7@cdc.gov.
November 7–9, 2002
9th Annual Minority Health Conference: Healthy Texans 2010, Irving,
Texas. Contact Linda Freeman by telephone: 972-721-3629; e-mail:
healthtx@ci.irving.tx.us;
or Web site: www.ci.irving.tx.us/healthtx.
November 8–9, 2002
Society for Public Health Education (SOPHE) 53rd Annual Meeting, Philadelphia:
Declaring Our Interdependence: United for Health Education. Contact:
Society for Public Health Education, 750 First Street NE, Suite 910,
Washington, DC 20002-4242; telephone: 202-408-9804; e-mail: info@sophe.org;
or Web site: www.sophe.org.
November 9–12, 2002
Association of Schools of Public Health 62nd Annual Meeting, Philadelphia.
Contact: Mary Stickley by e-mail: mes@asph.org.
November 9–13, 2002
American Public Health Association 130th Annual Meeting, Philadelphia:
Putting the Public Back into Public Health. Contact: APHA Meeting
Coordinator Edward Shipley by telephone: 202-777-2478; fax: 202-777-2530;
e-mail: edward.shipley@apha.org;
or Web site: www.apha.org/meetings.
November 13–15, 2002
Brownfields 2002: Investing in the Future, Charlotte, North Carolina.
Contact: Brownfields 2002,
c/o Engineers’ Society of Western Pennsylvania, 337 Fourth Avenue, Pittsburgh,
PA 15222; telephone: 412-261-0710, ext. 32; e-mail: brownfields@eswp.com;
or Web site: www.brownfields2002.org.
November 16–20, 2002
2001 Society for Environmental Toxicology and Chemistry (SETAC) Conference.
Contact: SETAC North America Office, 1010 North 12th Avenue, Pensacola,
FL 32501-3367; telephone: 850-469-1500; fax: 850-469-9778; e-mail setac@setac.org;
or Web site: www.setac.org.
November 18–21, 2002
20th International Neurotoxicology Conference, Little Rock, Arkansas.
Hosted by the University of Arkansas for Medical Sciences. Contact Dr.
Joan Cranmer by telephone: 501-320-2986 or e-mail: CranmerJoan@uams.edu.
November 19–21, 2002
2002 Conference on Tobacco or Health, San Francisco. For more information,
contact the National Conference on Tobacco or Health by telephone: 301-294-5664;
e-mail: registrar@feddata.com;
or Web site: www.tobaccocontrolconference.org.
December
1–3, 2002
Hope 2002—Second International Conference on HIV and Substance Abuse,
Mumbai, India. Contact Dr. Yusuf Merchant by telephone: 009122-3453253;
e-mail: info@hopeconference.org;
or Web site: www.hopeconference.org.
December 6–8, 2002
Primary Care Research Methods and Statistics Conference, San Antonio.
Hosted by the University of Texas Health Science Center at San Antonio.
Contact Susan Duncan, Director of CME, by telephone: 210-567-4446 or
e-mail: duncan@uthscsa.edu.
December 11–13, 2002
The 8th Annual Maternal and Child Health Epidemiology Conference, Clearwater,
Florida. Jointly sponsored by the University of South Florida Colleges
of Medicine and Public Health, Centers for Disease Control and Prevention,
and the Lawton and Rhea Chiles Center for Healthy Mothers and Babies.
Contact Erica Thomas by telephone: 813-974-6695 or e-mail: contend@hsc.usf.edu.
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Contact Name: Wilma López/ WLópez@cdc.gov
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Case
Studies in Environmental Medicine: Pediatric Environmental Health is
ATSDR’s newest case study. It has been accredited and will soon be online
on the case study home page (