Embed Size (px)
Citation preview
Environmental risk factorsEnvironmental risk factors
Aim of the subject I.
• teach the basic concepts in connection with the environment (exposition epidemic, toxicology, and other factors)
• understand the environmental risk factors’effects reaching especially children and their development
Aim of the subject I.
• teach the basic concepts in connection with the environment (exposition epidemic, toxicology, and other factors)
• understand the environmental risk factors’effects reaching especially children and their development
Aim of the subject II.
• recognize the possible environmental risk factors (place of living, school, workplace, leasure institutes)
• students should be able to recognise the signs and symptoms caused by chemicals of the general environment
• students should have knowledge on such diagnoses and treatment (what’s next?)
Aim of the subject II.
• recognize the possible environmental risk factors (place of living, school, workplace, leasure institutes)
• students should be able to recognise the signs and symptoms caused by chemicals of the general environment
• students should have knowledge on such diagnoses and treatment (what’s next?)
Topics1. Introduction to environmental health care2. Taking an environmental history3. Environmental potpourri I.4. Environmental potpourri II.5. Environmental potpourri III.6. Environmental epidemiology I.7. Environmental epidemiology II.8. Human reproduction and the environment I.9. Human reproduction and the environment I.10. Metals – Lead I.11. Metals – Lead II.12. Metals – Mercury13. Pesticides I.14. Pesticides II.
Topics1. Introduction to environmental health care2. Taking an environmental history3. Environmental potpourri I.4. Environmental potpourri II.5. Environmental potpourri III.6. Environmental epidemiology I.7. Environmental epidemiology II.8. Human reproduction and the environment I.9. Human reproduction and the environment I.10. Metals – Lead I.11. Metals – Lead II.12. Metals – Mercury13. Pesticides I.14. Pesticides II.
Study expectations– course attendance
Evaluation– written exam
Study material– course notes
Study expectations– course attendance
Evaluation– written exam
Study material– course notes
Literature:• Pediatric Environmental Health 2nd edition
Committee on Environmental Health
American Academy of Pediatrics
Ruth A. Etzel, MD, PhD, Editor
Sophie J. Balk, MD, Associate Editor
• Ember István: Környezet egészségtan 2006.
• Tompa: A kémiai biztonság alapjai. Medicina, Budapest 2004.
• Nánási: Humánökológia. A természetvédelem, a környezetvédelem és az embervédelem alapjai és módszerei. Medicina, 2005.
Literature:• Pediatric Environmental Health 2nd edition
Committee on Environmental Health
American Academy of Pediatrics
Ruth A. Etzel, MD, PhD, Editor
Sophie J. Balk, MD, Associate Editor
• Ember István: Környezet egészségtan 2006.
• Tompa: A kémiai biztonság alapjai. Medicina, Budapest 2004.
• Nánási: Humánökológia. A természetvédelem, a környezetvédelem és az embervédelem alapjai és módszerei. Medicina, 2005.
Developmental approach to environmental health careDevelopmental approach to environmental health care
Pre-test1. A 1 month old baby will be exposed to the same
chemicals as a 15 year old child
Yes or No?
2. A newborn may absorb chemicals through the skin
Yes or No?
3. Parts of the toxicokinetic diagram include exposure, absorption and metabolism.
Yes or No?
4. Strategies to reduce impact of chemical exposure may differ based on the developmental stage of the exposed person.
Yes or No?
Pre-test1. A 1 month old baby will be exposed to the same
chemicals as a 15 year old child
Yes or No?
2. A newborn may absorb chemicals through the skin
Yes or No?
3. Parts of the toxicokinetic diagram include exposure, absorption and metabolism.
Yes or No?
4. Strategies to reduce impact of chemical exposure may differ based on the developmental stage of the exposed person.
Yes or No?
Nature vs Nurture?
Honeybee - Worker
Honeybee - Queen
Africanized bee - Worker
Nurture(Environment)
Nature(Genes)
Nature vs Nurture?
Honeybee - Worker
Honeybee - Queen
Africanized bee - Worker
Nurture(Environment)
Nature(Genes)
Energy production – pollutionEnergy production – pollution
PHYSICAL ENVIRONMENT
BIOLOGICALENVIRONMENT
HUMAN
SOCIALENVIRONMENT
PHYSICAL ENVIRONMENT
BIOLOGICALENVIRONMENT
HUMAN
SOCIALENVIRONMENT
Outcome of the perfect pregnancy
Outcome of the perfect pregnancy
CHILDREN ARE NOT
LITTLE ADULTS
• Different physical environments
• Different biological
environments
• Different social environments
CHILDREN ARE NOT
LITTLE ADULTS
• Different physical environments
• Different biological
environments
• Different social environments
Learning Objectives
• Be able to list six developmental stages.
• Be able to outline a toxicokinetic diagram for each developmental stage.
• Be able to identify different environmental influences and their relative importance to each stage of development
• Be able to think of different interventions that would alter children s interaction with the environment to improve their health
Learning Objectives
• Be able to list six developmental stages.
• Be able to outline a toxicokinetic diagram for each developmental stage.
• Be able to identify different environmental influences and their relative importance to each stage of development
• Be able to think of different interventions that would alter children s interaction with the environment to improve their health
Components of Environmental
Tobacco Smoke
Indoor
Measurement Chamber Range
Carbon Monoxide, mg/m3 248 <1–17
Particulate matter, g/m3 349 10-1900
Nicotine, g/m3 29 <1-1010
Acrolein, g/m3 19 20-120
Benzene, g/m3 37 20-317
Components of Environmental
Tobacco Smoke
Indoor
Measurement Chamber Range
Carbon Monoxide, mg/m3 248 <1–17
Particulate matter, g/m3 349 10-1900
Nicotine, g/m3 29 <1-1010
Acrolein, g/m3 19 20-120
Benzene, g/m3 37 20-317
Relative Contributions of
Microenvironments
RSP
Microenvironment Concentration Time Microenvironmental
Type g/m3 Fraction Contribution (%)
Indoors at Home 15 0.75 47
Indoors at Work 50 0.15 31
Indoors, Other 25 0.04 4
Vehicle 90 0.04 15
Outdoors 40 0.02 3
Relative Contributions of
Microenvironments
RSP
Microenvironment Concentration Time Microenvironmental
Type g/m3 Fraction Contribution (%)
Indoors at Home 15 0.75 47
Indoors at Work 50 0.15 31
Indoors, Other 25 0.04 4
Vehicle 90 0.04 15
Outdoors 40 0.02 3
Benzo(A)pyrene Metabolism
Benzo(a)pyrene
Benzo(a)pyrene epoxide
Ultimate carcinogen
Excretionepoxidation
glutathione transferase
Benzo(A)pyrene Metabolism
Benzo(a)pyrene
Benzo(a)pyrene epoxide
Ultimate carcinogen
Excretionepoxidation
glutathione transferase
EXPOSURE
ABSORPTION
DISTRIBUTION
METABOLISM
EXCRETION
INTERACTION WITH TARGET MOLECULES
TOXIC EFFECTS
REPAIR
ToxicokineticDiagramEXPOSURE
ABSORPTION
DISTRIBUTIONN
METABOLISMM
EXCRETION
INTERACTION WITH TARGET MOLECULES
TOXIC EFFECTSEFFECTS
REPAIR
ToxicokineticDiagram
Name at least 3 developmental stages (1 minute)
Name at least 3 developmental stages (1 minute)
DEVELOPMENTAL STAGES
• Preconceptual –ova, sperm
• Fetal
• Newborn
• Infant
• Toddler
• School aged child
• Adolescent
• Young adult
(18 – 30yr)
• Middle aged adult
(30 – 50 yr)
• Older adult
(50 – 70 yr)
• Elderly (70 - ? Yr)
DEVELOPMENTAL STAGES
• Preconceptual –ova, sperm
• Fetal
• Newborn
• Infant
• Toddler
• School aged child
• Adolescent
• Young adult
(18 – 30yr)
• Middle aged adult
(30 – 50 yr)
• Older adult
(50 – 70 yr)
• Elderly (70 - ? Yr)
Exposure - Newborn
• Breast milk
• Active smoking
• Passive smoking
• Ethanol
• Polychlorinated biphenyls
• Lead
• Water
• Maternal Environment
• Air quality
• Radiation
Exposure - Newborn
• Breast milk
• Active smoking
• Passive smoking
• Ethanol
• Polychlorinated biphenyls
• Lead
• Water
• Maternal Environment
• Air quality
• Radiation
www.babaszoba.hu
A two-week old newborn
www.babaszoba.hu
A two-week old newborn
Absorption - Newborn
• Skin
• Aniline dye
• GI tract
• Well water
• Respiratory tract
• ETS
Absorption - Newborn
• Skin
• Aniline dye
• GI tract
• Well water
• Respiratory tract
• ETS
Distribution - Newborn
• 75% Body Weight is Water
• 25% Fat (14% in Adults)
• Formation of Blood Brain Barrier
Distribution - Newborn
• 75% Body Weight is Water
• 25% Fat (14% in Adults)
• Formation of Blood Brain Barrier
Metabolism - Newborn
• Detoxifying Enzymes
• Low at Birth
• Conjugating Enzymes
• Low at Birth
Metabolism - Newborn
• Detoxifying Enzymes
• Low at Birth
• Conjugating Enzymes
• Low at Birth
0 10 20 30 2 3 4 5
Age Days MonthsExcr
etion
M
etab
olism
Sulfation
Acetylation Glucuronidation
Conjugation
GlomerularFiltration
TubularSecretion
0 10 20 30 2 3 4 5
Age Days MonthsExcr
etion
M
etab
olism
Sulfation
Acetylation Glucuronidation
Conjugation
GlomerularFiltration
TubularSecretion
Newborn – Interaction with
Macromolecules• Organs which continue to undergo
rapid growth
– Brain
– Lung
– Somatic Growth
• Tissues with rapid turnover
– Blood
– Epithelium
Newborn – Interaction with
Macromolecules• Organs which continue to undergo
rapid growth
– Brain
– Lung
– Somatic Growth
• Tissues with rapid turnover
– Blood
– Epithelium
http://www.shenanigansonthird.com/special-care-premature-babies.htmhttp://www.shenanigansonthird.com/special-care-premature-babies.htm
Newborn – Toxic Effects
• Smaller Lung Volumes
• Increased Rate of SIDS
• Somatic Growth
• Cognitive Development
• Motor Development
• Behavioral Development
Newborn – Toxic Effects
• Smaller Lung Volumes
• Increased Rate of SIDS
• Somatic Growth
• Cognitive Development
• Motor Development
• Behavioral Development
SynopsisDevelopmental Exposure Absorption Metabolism Interaction Toxic
Stage Effects
__________________________________________________________________
Fetus Maternal Placental Very Low Most tissues Abortion
Non-Placental SIDS
Growth
Retardation
Death
Cancer
Newborn Maternal Skin Very Low CNS Lung
Breast milk GI tract Lung Development
Water Respiratory Tract Somatic
Growth
SynopsisDevelopmental Exposure Absorption Metabolism Interaction Toxic
Stage Effects
____________________________________________________ __________________
Fetus Maternal Placental Very Low Most tissues Abortion
Non-Placental SIDS
Growth
Retardation
Death
Cancer
Newborn Maternal Skin Very Low CNS Lung
Breast milk GI tract Lung Development
Water Respiratory Tract Somatic
Growth
SynopsisDevelopmental Exposure Absorption Metabolism Interaction Toxic
Stage Effects
_____________________________________________________________________
Infant Home Diet Complex Changes Acute effects
Floor Respiratory Chronic effects
Air Rate
Exploratory Metabolic
behavior Rate
Yard
Diet
School Age Neighborhood Acute effects
School Chronic effects
Day Care Dose effects
Adolescence Self-exposure Puberty Acute effects
Occupation Chronic effects
Addiction
Cancer
SynopsisDevelopmental Exposure Absorption Metabolism Interaction Toxic
Stage Effects
____________________________________________________ _____________________
Infant Home Diet Complex Changes Acute effects
Floor Respiratory Chronic effects
Air Rate
Exploratory Metabolic
behavior Rate
Yard
Diet
School Age Neighborhood Acute effects
School Chronic effects
Day Care Dose effects
Adolescence Self-exposure Puberty Acute effects
Occupation Chronic effects
Addiction
Cancer
Intervention is Dependent on
Development• Newborns spend most of their time at home
• They absorb ETS through breathing and via breast milk
• Their brains and lungs are most vulnerable
• Strategy to reduce exposure is to– Have parents stop smoking
– Have occupants of home stop smoking
– Have child caretakers stop smoking
Intervention is Dependent on
Development• Newborns spend most of their time at home
• They absorb ETS through breathing and via breast milk
• Their brains and lungs are most vulnerable
• Strategy to reduce exposure is to– Have parents stop smoking
– Have occupants of home stop smoking
– Have child caretakers stop smoking
Last Breakout Session
• Break into groups
• For your chemical and developmental
stage, list 3 strategies to reduce toxic
effects
• 2 minutes
• Regroup
• Each group report back
Last Breakout Session
• Break into groups
• For your chemical and developmental
stage, list 3 strategies to reduce toxic
effects
• 2 minutes
• Regroup
• Each group report back
Thank you for your attentionThank you for your attention
