Taking A Toxic Exposure History

Designed to increase the primary care provider1s knowledge of hazardous substances in the environment and to aid in the evaluation of potentially exposed patients. The primary care clinician can play an important role in detecting, treating, and preventing disease caused by toxic exposure by taking a thorough exposure history. This issue begins with a composite case study that describes a realistic encounter with a patient. This description is followed by a pre-test (answers are provided). It ends with a post-test. Appendix issued in Sep. 1994 on Consultation, Referral and Followup lists: consultation sources; resource centers, and other sources.

Not a day goes by that humans aren’t exposed to toxins in our environment—be it at home, in the car, or workplace. But what about those toxic places and items that aren’t marked? Why are we warned about some toxic spaces' substances and not others? The essays in Inevitably Toxic consider the exposure of bodies in the United States, Canada and Japan to radiation, industrial waste, and pesticides. Research shows that appeals to uncertainty have led to social inaction even when evidence, e.g. the link between carbon emissions and global warming, stares us in the face. In some cases, influential scientists, engineers and doctors have deliberately "manufactured doubt" and uncertainty but as the essays in this collection show, there is often no deliberate deception. We tend to think that if we can’t see contamination and experts deem it safe, then we are okay. Yet, having knowledge about the uncertainty behind expert claims can awaken us from a false sense of security and alert us to decisions and practices that may in fact cause harm.

People are increasingly concerned about potential environmental health hazards and often ask their physicians questions such as: "Is the tap water safe to drink?" "Is it safe to live near power lines?" Unfortunately, physicians often lack the information and training related to environmental health risks needed to answer such questions. This book discusses six competency based learning objectives for all medical school students, discusses the relevance of environmental health to specific courses and clerkships, and demonstrates how to integrate environmental health into the curriculum through published case studies, some of which are included in one of the book's three appendices. Also included is a guide on where to obtain additional information for treatment, referral, and follow-up for diseases with possible environmental and/or occupational origins.

The National Human Monitoring Program (NHMP) identifies concentrations of specific chemicals in human tissues, including toxicologic testing and risk assessment determinations. This volume evaluates the current activities of the NHMP; identifies important scientific, technical, and programmatic issues; and makes recommendations regarding the design of the program and use of its products.

Poisoning is a far more serious health problem in the U.S. than has generally been recognized. It is estimated that more than 4 million poisoning episodes occur annually, with approximately 300,000 cases leading to hospitalization. The field of poison prevention provides some of the most celebrated examples of successful public health interventions, yet surprisingly the current poison control "system" is little more than a loose network of poison control centers, poorly integrated into the larger spheres of public health. To increase their effectiveness, efforts to reduce poisoning need to be linked to a national agenda for public health promotion and injury prevention. Forging a Poison Prevention and Control System recommends a future poison control system with a strong public health infrastructure, a national system of regional poison control centers, federal funding to support core poison control activities, and a national poison information system to track major poisoning epidemics and possible acts of bioterrorism. This framework provides a complete "system" that could offer the best poison prevention and patient care services to meet the needs of the nation in the 21st century.

Diseases of the kidney, bladder, and prostate exact an enormous human and economic toll on the population of the United States. This book examines prevention of these diseases through the development of reliable markers of susceptibility, exposure, and effect and the promise that new technologies in molecular biology and sophisticated understanding of metabolic pathways, along with classical approaches to the study of nephrotoxicants and carcinogens, can be developed and prevention of the diseases achieved. The specific recommendations included in this book complement those made in the previous three volumes on biomarkers, Biologic Markers in Reproductive Toxicology (1989), Biologic Markers in Pulmonary Toxicology (1989), and Biologic Markers in Immunotoxicology (1991).