Aim of the subject I. Topics. Aim of the subject II.

Transcription

1 Aim of the subject I. Environmental risk factors 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?) Topics 1. Introduction to environmental health care 2. Taking an environmental history 3. 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 Mercury 13. Pesticides I. 14. Pesticides II.

2 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 Tompa: A kémiai biztonság alapjai. Medicina, Budapest Nánási: Humánökológia. A természetvédelem, a környezetvédelem és az embervédelem alapjai és módszerei. Medicina, Pre-test Developmental approach to environmental health care 1. 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?

3 Nature vs Nurture? Honeybee - Queen Energy production pollution Nurture (Environment) Africanized bee - Worker Honeybee - Worker Nature (Genes) Outcome of the perfect pregnancy PHYSICAL ENVIRONMENT HUMAN BIOLOGICAL ENVIRONMENT SOCIAL ENVIRONMENT

4 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 Components of Environmental Tobacco Smoke Indoor Measurement Chamber Range Carbon Monoxide, mg/m <1 17 Particulate matter, g/m Nicotine, g/m 3 29 < Acrolein, g/m Benzene, g/m

5 Relative Contributions of Microenvironments RSP Microenvironment Concentration Time Microenvironmental Type g/m 3 Fraction Contribution (%) Indoors at Home Indoors at Work Indoors, Other Vehicle Outdoors Benzo(A)pyrene Metabolism Benzo(a)pyrene glutathione epoxidation transferase Benzo(a)pyrene epoxide Excretion Ultimate carcinogen EXPOSURE ABSORPTION DISTRIBUTIO N METABOLIS M INTERACTION WITH TARGET MOLECULES Toxicokinetic Diagram EXCRETION REPAIR Name at least 3 developmental stages (1 minute) TOXIC EFFECTS

6 DEVELOPMENTAL STAGES Preconceptual Young adult ova, sperm (18 30yr) Fetal Middle aged adult Newborn (30 50 yr) Infant Older adult Toddler (50 70 yr) School aged child Elderly (70 -? Yr) Adolescent Exposure - Newborn Breast milk Active smoking Passive smoking Ethanol Polychlorinated biphenyls Lead Water Maternal Environment Air quality Radiation Absorption - Newborn A two-week old newborn Skin Aniline dye GI tract Well water Respiratory tract ETS

7 Distribution - Newborn 75% Body Weight is Water 25% Fat (14% in Adults) Formation of Blood Brain Barrier Metabolism - Newborn Acetylation Glucuronidation Detoxifying Enzymes Low at Birth Conjugating Enzymes Low at Birth Excretion Metabolism Sulfation Conjugation Age Days Months Glomerular Filtration Tubular Secretion

8 Newborn Interaction with Macromolecules Organs which continue to undergo rapid growth Brain Lung Somatic Growth Tissues with rapid turnover Blood Epithelium Newborn Toxic Effects Smaller Lung Volumes Increased Rate of SIDS Somatic Growth Cognitive Development Motor Development Behavioral Development Synopsis Developmental 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

9 Synopsis Developmental 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 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 Adolescence Self-exposure Occupation Puberty Acute effects Chronic effects Addiction Cancer 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 attention