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Environmental Medicine: Integrating a Missing Element into Medical Education (1995)
Institute of Medicine (IOM)

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. "Case Study 55: Populations at Risk From Particulate Air Pollution - United States, 1992." Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press, 1995.

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Environmental Medicine: Integrating a Missing Element into Medical Education

Reported by: P Vigliarolo, Communications Div; S Rappaport, MPH, K Lieber, MPH, A Gorman, Epidemiology and Statistics Div; R White, MST, National Programs Div, American Lung Association, New York. Air Pollution and Respiratory Health Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC.

Editorial Note: Particulate matter (e.g., dust, dirt, and smoke) is a complex and varying mixture of substances. Sources include motor-vehicle emissions, factory and utility smokestacks, residential wood burning, construction activity, mining, agricultural tilling, open burning, wind-blown dust, and fire. Some particles are formed in the atmosphere through the condensation or transformation of other chemical substances. Particles with diameters <10 µm pose a greater health risk than larger particles because particles of this size are easily inhaled deep into the lungs.

Increased risks for illness and death have been associated with particulate air pollution at levels comparable to those presented in this report (68). Acute effects on the respiratory system are well established and include exacerbations of chronic respiratory disease, restrictions in activity, and increases in emergency department visits and hospitalizations for respiratory illness (8). Persons with asthma are particularly sensitive to the effects of particulate air pollution (8). A national health objective for the year 2000 is to reduce asthma morbidity, measured by a reduction in asthma hospitalizations, from 188 per 100,000 in 1987 to no more than 160 per 100,000 (objective 11.1) (1).

The estimates presented in this report underscore the potential public health importance of particulate air pollution. Although levels of airborne particulate pollution declined substantially from 1988 to 1992 (emissions of PM10 decreased 8% and air concentrations of PM10 decreased 17%) (9), continued efforts are required to reduce health risks associated with particulate air pollution. EPA is reviewing technical and scientific information to determine whether the federal ambient air quality standard for particulate matter, established in 1987, should be revised.

ALA recently issued The Perils of Particulates (10), which includes national and county estimates of populations at potential risk for exposure to particulate air pollution. Copies are available from local offices of the ALA, telephone (800) 586–4872.

References

1. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91–50213.

2. US Environmental Protection Agency. Revisions to the National Ambient Air Quality Standard for particulate matter: final rule. Federal Register 1987;52:24634.

3. Air Resources Board. California ambient air quality standard for particulate matter (PM10). Sacramento, California: State of California, Air Resources Board, Research Division, December 1982.

4. US Environmental Protection Agency. Air quality criteria document for lead. Washington, DC: US Environmental Protection Agency, 1977.

5. NCHS. Current estimates from the National Health Interview Survey, 1991. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1992; DHHS publication no. (PHS)92–1509. (Vital and health statistics; series 10, no. 184).

6. Ostro B. The association of air pollution and mortality: examining the case for inference. Arch Environ Health 1993;48:336–42.

7. Schwartz J. Air pollution and daily mortality: a review and meta analysis. Environ Res 1994;64:36–52.

8. Dockery DW, Pope CA. Acute respiratory effects of particulate air pollution. Annu Rev Public Health 1994;15:107–32.

Page
906
Front Matter (R1-R12)
Executive Summary (1-4)
1 Introduction (5-13)
2 Curriculum Content (14-21)
3 Implementation Strategies (22-43)
4 Changing Medical Education (44-51)
5 Concluding Remarks (52-53)
References (54-58)
Appendixes (59-60)
A: Taking an Exposure History (61-96)
B: Medical School Courses and Clerkships: Access Points for Integrating Environmental Medicine (97-120)
C: Case Studies in Environmental Medicine (121-138)
Case Study 1: Arsenic Toxicity (139-163)
Case Study 2: Seasonal Arsenic Exposure from Burning Chromium-Copper-Arsenate-Treated Wood (164-167)
Case Study 3: Asbestos Toxicity (168-188)
Case Study 4: Benzene Toxicity (189-207)
Case Study 5: Beryllium Toxicity (208-223)
Case Study 6: Cadmium Toxicity (224-243)
Case Study 7: Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning (244-248)
Case Study 8: Carbon Tetrachloride Toxicity (249-266)
Case Study 9: Chlordane Toxicity (267-288)
Case Study 10: Chronic Reactive Airway Disease Following Acute Chlorine Gas Exposure in an Asymptomatic Atopic Patient (289-290)
Case Study 11: Chromium Toxicity (291-311)
Case Study 12: Cyanide Toxicity (312-331)
Case Study 13: Dioxin Toxicity (332-348)
Case Study 14: Ethylene/Propylene Glycol Toxicity (349-371)
Case Study 15: Formalin Asthma in Hospital Staff (372-373)
Case Study 16: Gasoline Toxicity (374-394)
Case Study 17: Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease (395-401)
Case Study 18: Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis (402-409)
Case Study 19: Lead Toxicity (410-435)
Case Study 20: Legionaires' Disease: Description of an Epidemic of Pneumonia (436-444)
Case Study 21: Mercury in House Paint as a Cause of Acrodynia: Effect of Therapy with N-Acetyl-D, L-Penixillamine (445-449)
Case Study 22: Mercury Toxicity (450-472)
Case Study 23: Methanol Toxicity (473-492)
Case Study 24: Methylene Chloride Toxicity (493-511)
Case Study 25: Paint Remover Hazard (512-515)
Case Study 26: Fatal Outcome of Methemoglobinemia in an Infant (516-517)
Case Study 27: Nitrate/Nitrite Toxicity (518-537)
Case Study 28: An Outbreak of Nitrogen Dioxide-Induced Respiratory Illness Among Ice Hockey Players (538-541)
Case Study 29: Pentachlorophenol Toxicity (542-557)
Case Study 30: Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy (558-561)
Case Study 31: Cholinesterase-Inhibiting Pesticide Toxicity (562-584)
Case Study 32: Infertility in Male Pesticide Workers (585-587)
Case Study 33: Pesticide Food Poisoning from Contaminated Watermelons in California, 1985 (588-595)
Case Study 34: Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticides (596-604)
Case Study 35: Polynuclear Aromatic Hydrocarbon (PAH) Toxicity (605-621)
Case Study 36: Polychlorinated Biphenyl (PCB) Toxicity (622-638)
Case Study 37: Ionizing Radiation (639-673)
Case Study 38: Radon Toxicity (674-694)
Case Study 39: Residential Radon Exposure and Lung Cancer in Sweden (695-700)
Case Study 40: Community Oubreaks of Asthma Associated with Inhalation of Soybean Dust (701-706)
Case Study 41: Tetrachloroethylene Toxicity (707-726)
Case Study 42: Toluene Toxicity (727-743)
Case Study 43: Occupational Asthma Due to Toluene Diisocyanate Among Velcro-like Tape Manufacturers (744-749)
Case Study 44: 1,1,1-Trichloroethane (750-766)
Case Study 45: Trimethyltin Encephalopathy (767-771)
Case Study 46: Trichloroethylene Toxicity (772-792)
Case Study 47: Vinyl Chloride Toxicity (793-811)
Case Study 48: Work-Related Disorders of the Neck and Upper Extremity (812-813)
Case Study 49: Contact Dermatitis in Surgeons from Methylmethacrylate Bone Cement (814-816)
Case Study 50: Skin Lesions and Environmental Exposures: Rash Decisions (817-861)
Case Study 51: Acoustic Trauma Caused by the Telephone: A Report of Two Cases (862-867)
Case Study 52: Behavioral and Audiologic Manifestations of Noise-Induced Hearing Loss (868-871)
Case Study 53: Reproductive and Developmental Hazards (872-892)
Case Study 54: Childhood Asthma and Indoor Enviromental Risk Factors (893-903)
Case Study 55: Populations at Risk From Particulate Air Pollution - United States, 1992 (904-908)
D: Resources: Agencies, Organizations, Services, REferences, and Tables of Environmental Health Hazards (909-970)
E: Committee and Staff Biographies (971-975)