Environmental Challanges Bisphenol A (BPA) Mold ld th/ill grow ness Lead extent/illness

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1 Environmental Challanges Bisphenol A (BPA) Mold growth/illness Lead extent/illness

2 Ray F. Garman, a MD MPH Department of Preventive Medicine and Environmental Health UK College of Public Health

3 BISPHENOL A In polycarbonate plastics, including some water bottles and baby bottles, & lining of some canned goods FDA:: Safe at typical exposure levels from food and drink FDA Final Report is not out yet; no comment yet about hormone effects specifically

4 BISPHENOL A American Chemistry Council (Plastic Industry Trade Group): If FDA determines that existing margins of safety are insufficient in infant applications, we will promptly p phase out use of BPA in baby bottles and infant formula packaging

5 BISPHENOL A Natural Resources Defense Council: (NRDC): FDA has consistently ignored science and sound policy It s time for the FDA to protect infants and pregnant women.

6 BISPHENOL A FDA: present consensus among regulatory agencies in the United States, Canada, Europe, and Japan is that current levels of exposure to BPA through food packaging do not pose an immediate risk to the general population, including infants and babies

7 BISPHENOL A CANADA (late October): BPA banned in baby bottles FDA: Canadian action taken out of abundance of caution No proof of harm to babies with typical exposure to BPA

8 BISPHENOL A In polycarbonate plastics, including some water bottles and baby bottles, & lining of some canned goods FDA:: Safe at typical exposure levels from food and drink FDA Final Report is not out yet; no comment yet about hormone effects specifically

9 BISPHENOL A WHAT TO TELL PATIENTS: Still a questionable exposure

11 ACOEM HHE with Indoor Molds Important Allergens: 5% with allergic airway symptoms lifetime May produce Mycotoxins Current scientific evidence does not support the proposition that human health has been adversely affected by inhaled mycotoxins in home, school, or office environments.

13 MOLD GROWTH Hydroscopic surfaces support growth, even clay brick and cement tif moisture is sufficiently absorbed >3-4 Molecule depth of water required to allow droplets to run

14 IOM Summary of Findings the Association between Health Outcomes & Exposure to Damp Indoor Environments DAMP INDOOR SPACES National Academies Press Washington, DC 2004

15 Particle Board release of Formaldehyde is increased with increased Relative Humidity PVC backing on carpet tiles increases release of alcohols with increased Relative Humidity

17 Association between Health Outcomes and Damp Indoor Environments Damp Space Associations: Causal Relationship NONE

18 Association between Health Outcomes and Damp indoor Environments Limited or Suggestive Evidence Dyspnea Asthma development Lower Respiratory Illness in otherwise healthy children

19 Association between Health Outcomes and Damp indoor Environments Inadequate or Insufficient of Association Airflow Obstruction in otherwise healthy persons COPD Non Occupational Inhalation Fevers Lower Respiratory illness in otherwise healthy adults

20 Association between Health Outcomes and Damp indoor Environments: Inadequate or Insufficient Association Acute Idiopathic Pulmonary Hemorrhage in Infants Mucous Membrane Irritation Syndrome Skin, GI, Neuropsychiatric, Reproductive symptoms Fatigue Cancer Rheumatologic & other immune diseases

22 Association between Health Outcomes with Mold and other Agents in Damp Indoor Environments Damp Space Associations: Causal Relationship NONE

23 Association between Health Outcomes and Mold or other agents in Damp Environments Sufficient Evidence of Association Nose & Throat Symptoms Wheeze Cough Asthma Sx in sensitized asthmatic persons Hypersensitivity Pneumonitis in susceptibles

24 Association between Health Outcomes and Mold or other agents in Damp Environments Limited or Suggestive Association Lower Respiratory Illness in otherwise healthy children

25 Association between Health Outcomes and Mold or other agents in Damp Environments Inadequate or Insufficient Evidence -Dyspnea -Airflow obstruction in otherwise healthy persons - COPD -Non occupational inhalation fevers - Lower Respiratory Illness in otherwise Healthy adults Acute Idiopathic Pulmonary Hemorrhage in Infants

26 Association between Biological & Chemical Exposures and Exacerbation of Asthma in Sensitive Persons From: Clearing the Air IOM 2000

27 ASTHMA ASSOCIATION/RELATIONSHIP O O S Biological Agents Chemical Agents Sufficient Evidence of Causal Relationship Cat ETS in preschoolers Cockroach House Dust Mite

28 ASTHMA ASSOCIATION/RELATIONSHIP Biological Chemical Sufficient evidence of an Association Dog Rhinoviruses NOx NO2

29 ASSOCIATION/RELATIONSHIP ASTHMA Biological Chemical Limited Evidence of an Association Domestic Birds ETS is school age, adults Chlamydia trachoma is Formaldehyde Mycoplasma pneumoniae Fragrances RSV

30 Biological Chemical Inadequate or Insufficient Evidence for Association Cow, horse Pesticides Rodents Plasticizers Chlamydia Trachomatis Houseplants Pollen Exposure (in indoor environment) Insects other than Cockroaches

31 Inadequate Evidence of Association Mucous Membrane Irritation ti Syndrome Skin,GI, Neuropsychiatric, Reproductive Sx Fatigue Cancer Rheumatologic & other immune diseases

33 Presence of fungus does not indicate mold damage Indicator Fungi that exceed outdoor concentration ti indicate Mold Colonization

34 ASTHMA ASSOCIATION/RELATIONSHIP Other Impacts not Addressed House Dust Mites Viruses Tobacco Smoke Cockroaches Pesticides NO2 NOx See IOM Report Clearing the Air, 2000 Indoor Allergens, 1993

35 Indicator Fungi: ***Aspergillus fumigatus A. versicolor A penecilloides Actinomyctes Gram Negative Bacteria ***Penecillium ^Stachybotrys chartarum ^Chartomium PLUS: Trichoderma sp. Actinomyctes Urocladum sp. Gram Neg Bacteria

36 Some Mold Toxic Products Fusarium producing DON (deoxynivalenol); called vomitoxin OTA (ochratoxin A); leads to DNA breaks AFB1 (Aflatoxin); leads to expoxide through 450 System P450

37 Hypersensitivity y Pneumonitis Antigens Testing (IgG Antibodies) of limited prognostic Values, rather indicators of exposure. Perhaps better test is Stachylsen (protein hemolysin) as indicator of exposure to Stachybotrys chartarum, [not the same as satratoxin H, a trichothecene]

38 Bacteria Genera Isolates from Building Materials: Acinatobacter Bacillus Nocardia Clavibacter Streptomyces Corybacterium Thermonosporia Flavo Bacterium Mycobacteria

40 Remediation Tasks STOP Water Intrusion Identify Vulnerable Populations Determine Extent & Location of Fungal Contamination (i.e. water and nutrients) Identify Moisture Dynamic Control source of moisture and nutrients after initial remediation

41 DECONTAMINATION OF MOLD-1 (Work site example) Internal Capsule in large room; wiped with fungicide id immediately Air lock at both ends, 4 chambers Haz Mat Suits

42 DECONTAMINATION OF MOLD-2 (Work site example) Office items into Chamber #1 Move, and Fungicide id items in #2 Move, and HEPA vacuum in #3 Move, rewipe in #4 Out of airlock for inspection, possibly repassage

43 DECONTAMINATION OF MOLD-3 (Work site example) DISCARD: Plants, Paper, insulation ceiling tiles, insulation CLEAN: Drip pans, Office Machines, Carpets, Upholstered seats

45 Rye Grass Staggers mold contaminated t feed to herd animals

46 ASTHMA ASSOCIATION/RELATIONSHIP O O S Mucous Membrane Irritation Syndrome (MMI): Rhinorrhea Nasal Congestion Sore Throat (?Inflammatory Cytokine based)

47 Any Moldy Questions? Heavy lead is not always music

48 Lead Poisoning Lead has no known biological function. Lead Pb ++, competes with Ca ++, Fe ++ It is cheap, useful, easy to mine, therefore Lead is ubiquitous- in air, food, water, soil, ceilings etc. There is no consensus for safe lower limit for lead. 48

49 Number of new cases with blood lead levels > 25 g/ g/dl that occurred among 100,000 employed adults years old in Null category states did not report.

50 Uses and Sources of Lead Paint (until 1970) Household dust (via settlement of air pollution, paint removal) Ceiling dust Occupational Solder Ceramic glazes Mines, smelters 50

51 More Uses and Sources of Lead TV's, Computer monitors Batteries, Bullets Sinkers Aviation X-ray shields Crystal-ware (high levels in decanters) Explosives Non-stick linings i of pots (in the past) Plastic colouring (wire, blinds) Pewter 51

52 Home Lead Testing

53 Reduction of Lead hazards in the home 53

54 Absorption of Lead 54

55 Absorption of Lead Lead goes down iron or calcium absorption pathway in GIT. Children absorb lead well orally (~50%) cf adults poorly (~10%). Children also have more hand to mouth activity. it Lead absorption is enhanced if diet is poor in iron or calcium. Pica is one of the worst risk factors. Lead can be inhaled. [Tetraethyl lead can be absorbed via skin]. S:\Leadgpc\BB Lead Poisoning.ppt 55

56 Contribution of Sources 56

57 Distribution of Lead 95% long bones. Binds into matrix. Released during osteolysis. 4% brain,liver, kidneys. 1% blood. Crosses placenta, foetal BBB is open 57

58 Release of lead during osteolysis Pregnancy increases mobilization of lead from maternal skeleton Gulson BL, Jameson CW, Mahaffey KR, Mizon KJ, Korsch MJ, Vimpani G.. J Lab Clin Med 1997a;130:51-62 Mobilization of lead from the skeleton during the post- natal period is larger than during pregnancy. Gulson BL, Mahaffey KR, Jameson CW, Mizon KJ, Korsch MJ, Cameron MA, Eisman JA. J Lab Clin Med 1998a;131:324-9 Lead is released in menopausal bone loss Lead levels have second peak in middle age- more in men than women (NHANES 3). Lead follows calcium into and out of bone. 58

59 Lead movement In childhood, blood lead levels reflect the environmental lead level ie exogenous lead. Protection requires placing barriers between the child and the lead. In adults, lead levels reflect the release of endogenous lead from bone, as well as the intake of exogenous lead. Protection requires prevention of 59 exposure plus preservation of bone

60 Data from the US NHANES 3 study showing the second peak of lead levels in adulthood. Higher adult male levels l reflect occupation and hobby. High risk occupations would be even higher. Women get a post-menopausal peak. 60

61 Lead and Race. Data from the UIS NHANES 3 study showing differences with race probably reflecting differences in accommodation and occupation 61

62 U.S. Lead Situation Lead banned from paint 's- Levels higher than Australia 3. Late 1980's Removal of lead from gasoline 's Universal questionnaire i screening Universal blood testing 's Public housing program 's Private housing program 's Massive EPA environmental program 62

63 Health Effects of Lead Concentration related IQ/ delinquency related to total dosage in childhood 63

64 Symptoms from lead are rare! 64

65 Lead and Neurodevelopment Each 0.48 µmol/l(10µg/dl) µg in children. = 4 to 7 IQ points (US Acad. Pediatrics). Industry/ Australian government consensus of 3-5 IQ points. Effects on behaviour are FAR WORSE. Delinquency rates are 8 times higher in the top 30% of bone lead. Needleman Needleman, Herbert L. et al, "Bone Lead Levels and Delinquent Behavior," JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Vol. 275, No. 5 (February 7, 1996), pgs Measurable adverse behaviour changes in 2 year olds Mendelsohn Alan L. Mendelsohn, Benard P. Dreyer, Arthur H. Fierman, Carolyn M. Rosen, Lori A. Legano, Hillary A. Kruger, Sylvia W. Lim, and Cheryl D. Courtlandt "Low-Level Level Lead Exposure and Behavior in Early Childhood Pediatrics 1998; 101: e10 65

66 Lead and IQ 66

67 Lead and the Elderly Risk of dementia increases with lead burden Risk of accidental lead ingestion 67

68 Unresolved Questions How much does lead contribute to cognitive decline and Alzheimer s disease? Do bone preserving therapies or calcium supplements reduce cognitive decline? Is lead a modifiable risk factor for dementia? 68

69 Does your child. Childhood Risk Factor Questionnaire Have a brother or sister, housemate or No playmate with an elevated blood lead level? Yes Sometimes eat non-food items such as soil or paint? Have any of the following conditions sometimes associated with lead poisoning, eg iron deficiency anaemia, behaviour problem, learning problem or developmental delay? No Yes No Yes

Environmental Challanges

Environmental Challanges Bisphenol A (BPA) Mold growth/illness Lead extent/illness Ray F. Garman, MD MPH Department of Preventive Medicine and Environmental Health UK College of Public Health 1 BISPHENOL