Pesticide Guidelines for Clinicians

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LAUNCHED 10-Year Pesticides Initiative Creates Standards for

>

> Front-Line Health Care Providers

> X-RCPT-TO:

>

> FOR IMMEDIATE RELEASE

>

> Contact:

> Judy Gelman

> CJW Associates for NEETF

>

> (781) 444-9056

> jlgelman@...

>

> CJW Associates for NEETF

> (508) 842-1410, cynwright@...

>

> MEDICAL & NURSING ENVIRONMENTAL EDUCATION AND PRACTICE GUIDELINES LAUNCHED

> 10-Year Pesticides Initiative Creates Standards for Front-Line Health Care

> Providers

>

> (January 27, 2003—Washington, DC) — In a pioneering step to prepare the

> nation’s primary health care providers to recognize and effectively treat

> pesticide toxicity, The National Environmental Education & Training

> Foundation (NEETF) today released national pesticide competency and practice

> skills guidelines for physicians and nurses—part of NEETF’s 10-year National

> Strategies for Health Care Providers: Pesticides Initiative.

>

>  The companion documents, National Pesticide Competency Guidelines for

Medical

> & Nursing Education and National Pesticide Practice Skills Guidelines for

> Medical & Nursing Practice, were developed specifically for everyday,

> front-line health care professionals. The Initiative has been developed in

> response to a gap in health professional education and the public health

> risks posed by the widespread use of pesticides in the United States.

>

> “Environmental health risks are a leading cause of illness due, in part, to

> the widespread use of pesticides, yet most physicians today receive minimal

> training in environmental health as part of their education and ongoing

> practice,” said Lindell, RN, DNSc, Dean of the College of Nursing,

> University of Cincinnati and one of two project coordinators for the

National

> Guidelines. “These new tools will be the foundation from which front-line

> health care professionals will gain the core knowledge and practice skills

> they need to deal with pesticides-related illness.”

>

> Pesticide toxicity involves issues beyond acute pesticide poisoning

incidents

> in agricultural settings. Pesticides are also a concern because of potential

> chronic health effects from long-term exposures. In addition, pesticide

> exposure can occur in a number of settings outside agriculture, including

> urban environments, homes, and schools. The Educational Competency

guidelines

> are designed for use in basic and advanced components of educational

> institutions; similarly, the Practice Skills guidelines are aimed at primary

> care practitioners.

>

> “The changing worlds of medical and nursing education present unique

> challenges in introducing any environmental health issues into

> already-saturated curricula and competitive professional development

> offerings,” said R. , MD, Assistant Professor of Pediatrics,

> Medical University of South Carolina, and a co-author of the guidelines.

”But

> it is still important to find room for pesticides exposures—both in terms of

> the very real health threats they pose, and as a first step in addressing

the

> growing problem of environmental toxicants,” he said.

>

> The competency guidelines indicate possible ‘points of insertion’ and

> recognize that curricula are highly variable in the form and substance of

> topics. The practice skills guidelines detail opportunities for

incorporating

> pesticide issues into the ongoing practice of health care and within the

> context of individuals’ continued education.

>

> Highlights of the Competency Guidelines include:

> * sample curricular components as “points of insertion,” such as

> environmental or preventive medicine electives, and public sector medicine

> courses;

> * defined levels for individual competencies;

> * role of faculty development in advancing pesticide-related curriculum;

> * “primer” on pesticide regulation, use, exposures, and absorption; and

> * five specific educational competencies.

>

> Highlights of the Practice Skills Guidelines include:

> * “primer” on pesticide regulation, use, exposures, and absorption;

> * literature review;

> * detailed ideas for incorporating pesticide issues into practice areas

> * key principles of adult education; and

> * six recommended practice skill areas, including information content and a

> sampling of relevant resources.

>

> Over the past decade, health professional groups, academic institutions, and

> government and community organizations have called for improved health care

> provider training in environmental health. The American Medical Association,

> for instance, adopted a resolution urging Congress, government agencies, and

> private organizations to support improved strategies for assessing and

> preventing pesticide risks; these strategies include systems for reporting

> pesticide usage and illness, as well as education programs about pesticide

> risks and benefits. Through a number of reports published in the 1990s, the

> Institute of Medicine has recommended integrating environmental health

issues

> throughout the various stages of training and clinical practice for health

> care providers.

> The National Strategies for Health Care Professionals: Pesticides Initiative

> calls for all primary health care providers to acquire a basic knowledge of

> the health effects of pesticides and  the treatments and preventive public

> health strategies to address them. The goal is to change the way primary

care

> providers assess and respond to potential pesticide exposure cases in their

> daily practice.

>

> Practitioners must be prepared to respond to exposures from a range of

> sources—everything from household and lawn care products to agricultural

> chemicals. Primary providers must be prepared to take an environmental

> history and be prepared to: “problem solve” with patients who may have been

> exposed to pesticides; readily diagnose if appropriate; provide timely

> treatment for pesticide-related health conditions; provide prevention

> education; and consult with local authorities, where appropriate.

>

> The U.S. Environmental Protection Agency estimates there are approximately

> 250-500 physician-diagnosed cases per 100,000 agricultural workers. Data

> collected from Poison Control Centers found that in 1996, more than 40,000

> adults were sufficiently exposed to various types of pesticides to warrant a

> call to their local Poison Control Center. These exposures were

> non-agricultural in nature and are believed to represent less than 30

percent

> of the incident cases of acute pesticide-related illness in the United

> States. Chronic health effects include cancer and asthma, as well as

> reproductive and central nervous effects.

>

> Even when environmental factors are identified as a source of a health

> problem, there is often little knowledge about how to address or prevent the

> problem. A study has shown that among the 76 percent of US medical schools

> requiring environmental medicine content, students spend an average of only

> seven hours of study in environmental medicine over four years’ training in

> medical school.

>

> Guidelines’ authors include experts representing the American Association of

> Colleges of Nursing, American Association of Occupational Health Nurses,

> National Organization of Nurse Practitioner Faculties, and American

> Association of Pesticide Safety Educators. Dr. Lindell and Bernier,

> Jr., MD, Professor and Dean Emeritus, University of Texas Medical Branch

> served as project coordinators.

>

> The National Strategies for Health Care Providers: Pesticides Initiative

is a

> partnership of NEETF and the U.S. Environmental Protection Agency (EPA), in

> collaboration with the U.S. Department of Health and Human Services, the

U.S.

> Department of Agriculture, the U.S. Department of Labor, and a wide range of

> stakeholders.

>

> National Pesticide Competency Guidelines for Medical & Nursing Education and

> National Pesticide Practice Skills Guidelines for Medical & Nursing Practice

> are available online at

> <http://www.neetf.org/health/providers/index.shtm>www.neetf.org/health/pro

> viders/index.shtm. Published copies of the guidelines will be available in

> spring 2003. For more information, contact: The National Environmental

> Education & Training Foundation, National Strategies for Health Care

> Providers: Pesticides Initiative; 1707 H Street, NW, Suite 900, Washington,

> DC, 20006-3915; 202-833-2933, x535; pesticides@....

>

> Chartered by Congress in 1990, The National Environmental Education and

> Training Foundation (NEETF) is a private non-profit organization

dedicated to

> advancing environmental education in its many forms.  Since it was

> established, it has become a leader in the development of new policies,

> grant-making approaches, and direct programming to advance environmental

> literacy in America.  We link environmental education to many of society's

> core goals such as: better health, improved education, environmentally sound

> and profitable business and volunteerism in local communities.

>  

>  

>

> National Strategies for Health Care Providers: Pesticides Initiative Fact

> Sheet

> HEALTH EFFECTS OF PESTICIDES

>

>

> A pesticide is any substance or mixture of substances intended for

> preventing, destroying, repelling, or mitigating any pest. Pests can be

> insects, mice and other animals, unwanted plants (weeds), fungi, or

> microorganisms like bacteria and viruses. Though often misunderstood to

refer

> only to insecticides, the term pesticide also applies to herbicides,

> fungicides, and various other substances used to control pests. Under United

> States law, a pesticide is also any substance or mixture of substances

> intended for use as a plant regulator, defoliant, or desiccant.

>

> Many household products are pesticides, including: cockroach sprays and

> baits; insect repellents for personal use; rat  and other rodent poisons;

> flea and tick sprays, powders, and pet collars; kitchen, laundry, and bath

> disinfectants and sanitizers; products that kill mold and mildew; some lawn

> and garden products, such as weed killers; and some swimming pool

chemicals.

>

> Pesticide exposure can occur in a number of settings outside agriculture,

> including urban and suburban environments, homes, and schools. Exposures can

> lead to acute and/or chronic health effects through indoor and outdoor

> exposures, prenatal and postnatal exposures in children, as well as from

> dietary intake. Chronic health effects represent a range of adult and

> childhood illnesses, such as cancer and asthma, as well as reproductive and

> central nervous system effects.

>

> Agricultural Exposures

>

> * Agriculture accounts for 76 percent of the conventional pesticides used

> each year in the United States.

> * Pesticide handlers and agricultural workers appear to be at greatest risk

> for acute pesticide poisoning. Based on U.S. states with required reporting

> of pesticide-related health concerns, the U.S. Environmental Protection

> Agency (EPA) estimates there are approximately 250-500 physician-diagnosed

> cases of acute pesticide poisoning per 100,000 agricultural workers

> (including pesticide handlers).

> * Migrant and seasonal farmworkers are especially at high risk since they

> often work and live in areas where pesticide exposures can be significant.

>  

>

> Non-Agricultural Exposures

>

> *Control of a growing number of exotic and public health pests has increased

> the potential for pesticide exposure to the public. In recent years,

spraying

> of insecticides over residential neighborhoods, for example, involved

> millions of people, in New York City for control of West Nile Virus-carrying

> mosquitoes and in several Florida counties for control of the Mediterranean

> fruit fly (Medfly).

> An estimated 84 percent of American households use pesticides, according

to a

> 1990 EPA survey. Homeowners annually use 5-10 pounds of pesticide per

acre on

> their lawns and gardens, many times the amount applied by farmers to corn

and

> soybean fields. They also use pesticides in the form of disinfectants,

> including pine oil cleaners, bathroom cleaning products, and cleaning

> materials for swimming pools. In addition, structural pest control operators

> and workers in nurseries, greenhouses, and landscaping are also at risk for

> work-related exposures.

>

> * Data collected from Poison Control Centers found that in 1996, more than

> 40,000 adults were sufficiently exposed to various types of pesticides to

> warrant a call to their local Poison Control Center. It is estimated that as

> many as 60 percent of these individuals developed symptoms of pesticide

> poisoning.  These figures are thought to represent less than 30 percent of

> the incident cases of      acute pesticide-related illness in the United

> States.

>

>  Children’s Pesticides Exposure

>

> * Children may be more susceptible than adults to environmental health risks

> because of their physiology and behavior.  They eat and drink more and

> breathe more air in proportion to their body weight than adults. They also

> play close to the ground and put objects in their mouths. Their bodily

> systems are still developing, and they may be less able than adults to

> metabolize and excrete pollutants.

> * In the agricultural setting, children may be exposed to pesticides in a

> number of ways: through prenatal exposure, from being in the fields where

> their parents work, contact with pesticide residues on parents’ clothing,

> living next to areas being treated, and working in the fields themselves.

> * In non-agricultural settings, children may be exposed to pesticides in

> their houses, yards, day cares and schools. In 1996, Poison Control Centers

> were notified about approximately 80,000 children (age 0-19)  who were

> exposed to common household pesticides in the United States,  an estimated

> one-quarter of whom developed symptoms of pesticide poisoning.  In 1992-98,

> there were an estimated 24,000 emergency department visits annually

resulting

> from pesticide exposure, of which 61 percent of the cases involved children

> younger than age 5.

>

>  Chronic Health Effects of Pesticides Exposures

>

> * Cancer: Over 60 active ingredients for pesticides have been classified as

> probable human carcinogens by EPA or the International Agency for

Research on

> Cancer. Although most of these pesticides are no longer on the market or

have

> had their uses severely restricted, persons previously exposed may be at

> increased risk. A review by the National Cancer Institute (NCI) lists 15

> pesticides for which there is evidence of cancer in human epidemiologic

> studies.

> * Central nervous system effects: Many insecticides and fumigants are

> designed specifically to target the nervous system of the pest they are

> intended to control. There is increasing human evidence in the form of case

> reports and epidemiologic studies that suggests that humans may experience

> chronic neurologic or neurobehavioral effects following high levels of

> exposure to certain types of pesticides. Several reports have also found

> chronic neurological sequelae (reduced neurobehavioral function) after acute

> organophosphate poisoning.

> * Reproductive effects:  Many pesticides have been identified as

> developmental or reproductive toxicants based on animal studies. An

> epidemiologic study published in Occupational Medicine: State of the Art

> Reviews in 1997 concluded, “there is increasing evidence for reproductive

and

> developmental effects of both maternal and paternal pesticide exposures.

> Areas of particular concern include infertility and time to pregnancy,

> spontaneous abortion, neural tube defects, and limb reduction defects.”

> * Asthma: An Institute of Medicine report concluded that although there is

> evidence suggesting that high level exposures to some pesticides may elicit

> persistent asthma, there is not enough evidence to say whether an

association

> exists between pesticide exposures at the levels typically encountered in

> nonoccupational or residential settings and the development or exacerbation

> of asthma.

>

> Chartered by Congress in 1990, the National Environmental Education and

> Training Foundation (NEETF) is a private non-profit organization

dedicated to

> advancing environmental education in its many forms.  Since it was

> established, it has become a leader in the development of new policies,

> grant-making approaches, and direct programming to advance environmental

> literacy in America.  We link environmental education to many of society's

> core goals such as: better health, improved education, environmentally sound

> and profitable business and volunteerism in local communities.

>  

>  

>

> The National Environmental Education & Training Foundation, Inc.

> 1707 H Street, NW, Suite 900, Washington, DC 20006 Tel 202_833_2933 Fax

> 202_261_6464

>  

>  

>

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