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Bresnitz EA, Rest KM, Miller N. Clinical industrial toxicology: an approach to information retrieval. Ann Intern Med 1985;103(6 pt 1):967–72.
Coye MJ, Rosenstock L. The occupational health history in a family practice setting. Am Fam Physician 1983;28(5):229-34.
Goldman RH, Peters JM. The occupational and environmental health history. JAMA 1981;246:2831–6.
Levy BS, Wegman DH, editors. Occupational health: recognizing and preventing work-related disease and injury. 6th ed. Philadelphia: Lippincott, Williams and Wilkins, Brown & Company, 2000.
Mayer JL, Balk SJ. A pediatrician's guide to environmental toxins. Contemp Pediatr 1988; pt 1:5(7):22–40, part 2:5(8):63–76.
National Research Council. Environmental tobacco smoke: measuring exposure and assessing health effects. Washington: National Academy Press, 1986.
Rogan WJ. The sources and routes of childhood chemical exposures. J Pediatr 1980;97:861.
Rom WN, editor. Environmental and occupational medicine. 3rd ed. Boston: Lippincott- Raven Publishers, Philadelphia, 1998.
The Western Journal of Medicine. December 1982. Entire issue devoted to occupational and environmental medicine.
US Environmental Protection Agency and US Consumer Product Safety Commission. The inside story: a guide to indoor air quality. Washington: US Environmental Protection Agency, 1995. Report No.: EPA 402-K-93-007. Available from URL: http://www.epa.gov/iaq/pubs/insidest.html.
Zenz C, editor. Occupational medicine. 3rd ed. St. Louis: Mosby, 1994.
Zenz C, editor. Occupational medicine: principles and practical applications. 2nd ed. Chicago: Mosby Year Book Medical Publishers, 1988.
Answers to Pretest Questions
a. The patient's problem list includes recurrent headache and nausea, and unstable angina pectoris.
b. The patient's differential diagnosis of chest pain includes myocardial infarction. The differential diagnosis of headache and nausea includes viral syndrome, tension headaches, migraine, brain tumor, tooth or sinus problems, psychogenic headache, medication reaction (nitroglycerin can cause headaches), and exposure to toxicants.
c. The additional information sought to make a diagnosis would include all aspects of a work and exposure history
More information on taking an exposure history can be obtained from ATSDR, your state and local health departments, and university medical centers. Taking an Exposure History is one topic in the Case Studies in Environmental Medicine series. For other publications in this series, please use the order form on page 46. For clinical inquiries, contact ATSDR, Division of Health Education and Promotion, Office of the Director, at 404-498-0101.
Case Studies in Environmental Medicine:
Taking an Exposure History Evaluation Questionnaire and Posttest, Course Number SS3046 Course Goal: To increase the primary care provider's knowledge of hazardous substances in the environment and to aid in the evaluation of potentially exposed patients.
Objectives Discuss three important reasons for taking an exposure history. List two sources of information on exposure history. Tell Us About Yourself Please carefully read the questions. Provide answers on the answer sheet (page 45). Your credit will be awarded based on the type of credit you select.
1. What type of continuing education credit do you wish to receive? **Nurses should request CNE, not CEU. See note on page 44. E. AAFP (American Academy of Family Physicians) F. ACEP (American College of Emergency Physicians) G AOA (American Osteopathic Association) H. None of the above
2. Are you a... A. Nurse B. Pharmacist C. Physician D. Veterinarian E. None of the above
3. What is your highest level of education? A. High school or equivalent B. Associate, 2-year degree C. Bachelor's degree D. Master's degree E. Doctorate F. Other
4. Which of the following best describes your current occupation? A. Environmental Health Professional B. Epidemiologist C. Health Educator D. Laboratorian E. Physician Assistant F. Industrial Hygienist G Sanitarian H. Toxicologist I. Other patient care provider J. Student K. None of the above
5. Which of the following best describes your current work setting? A. Academic (public and private)
Which of the following best describes the organization in which you work? E. Nongovernmental agency F. Other type of organization
Tell Us About the Course 7. How did you obtain this course? A. Downloaded or printed from Web site B. Shared materials with colleague(s) C. By mail from ATSDR D. Not applicable
8. How did you first learn about this course? A. State publication (or other state-sponsored communication) B. MMWR C. ATSDR Internet site or homepage D. PHTN source (PHTN Web site, e-mail announcement) E. Colleague F. Other
9. What was the most important factor in your decision to obtain this course? A. Content B. Continuing education credit C. Supervisor recommended D. Previous participation in ATSDR, CDC/PHTN training E. Ability to take the course at my convenience F. Other
10. How much time did you spend completing the course, evaluation, and posttest? A. 1 to 1.5 hours B. More than 1.5 hours but less than 2 hours C. 2 to 2.5 hours D. More than 2.5 hours but less than 3 hours E. 3 hours or more
11. Please rate your level of knowledge before completing this course. A. Great deal of knowledge about the content
12. Please estimate your knowledge gain after completing this course. A. Gained a great deal of knowledge about the content Page 3
Remember, you can access the case studies online at www.atsdr.cdc.gov/ HEC/CSEM/ and complete the evaluation questionnaire and posttest online at www.phppo.cdc.gov/phtnonline.
Online access allows you to receive your certificate as soon as you successfully pass the posttest (score 70% or better).
Continuing Education Coordinator Agency for Toxic Substances and Disease Registry Division of Health Education and Promotion, E-33 1600 Clifton Road, NE Atlanta, GA 30333
Please send me the following Case Studies in Environmental Medicine (limit 3 printed copies per person) Arsenic Dioxins Nitrates/Nitrites Taking an Exposure Asbestos Ethylene/Propylene History Pentachlorophenol Benzene Glycol Polycyclic Aromatic Tetrachloroethylene Gasoline Hydrocarbons (PAH) 1,1,1- Trichloroethane Beryllium 0 Cadmium Ionizing Radiation Polychlorinated Trichloroethylene Biphenyls (PCBs) Jet Fuel N Carbon Tetrachloride Toluene Lead Radon Chlordane Vinyl Chloride Reproductive and Cholinesterase Inhibitors Mercury Developmental Hazards Methanol Chromium Skin Lesions Cyanide Methylene Chloride Stoddard Solvent Page 4
Appendix 2. Regional Poison Control Centers Certified by the American Association of Poison Control Centers
Poison control centers were established in 1953 to help physicians deal with poisonings of adults and children in the United States. In 1983, the American Association of Poison Control Centers was established as the professional organization for poison control centers. The regional poison control centers can act as valuable resources in providing information about the toxicity and health effects of hazardous exposures involved in poisonings. The main emergency number across the country is 1-800-222-1222, although some states have other contact numbers as well as a number for the hearing impaired. For more information, contact the American Association of Poison Control Centers at www.aapcc.org.
Finger Lakes Regional Poison and Drug Info Center, Rochester
Long Island Regional Poison and Drug Information Center, Mineola
Appendix 3. Computerized Information Services The development of electronic databases has revolutionized the retrieval of up-to-date, accurate, and comprehensive information on hazardous exposures. Databases are commonly accessed through (a) the Internet, (b) floppy disk, or (c) CD-ROM (Compact Disk-Read-Only Memory). The advantage of Internet systems is that they provide the greatest versatility and are the most comprehensive in obtaining different kinds of information because several databases can be cross-searched. CD-ROMs may be easier to search and may be cost effective depending on use.
Toxicology Data Network (TOXNET)
TOXNET, developed by the National Library of Medicine (NLM), is a computerized system of files oriented to toxicology and related areas. The user may search them on the Internet at URL: http://toxnet.nlm.nih.gov/. The following files are currently included in TOXNET:
Chemical Carcinogenesis Research Information System (CCRIS)
Developmental and Reproductive Toxicology (DART)
This resource provides scientifically evaluated data from carcinogenicity, mutagenicity, tumor-promotion, and tumor-inhibition tests on 2,100 substances that have been evaluated according to criteria and protocols widely accepted by experts in carcinogenesis. DART is a bibliographic database containing citations to literature published on birth defects and other aspects of reproductive and developmental toxicology since 1989. The file currently contains more than 1,500 records. Plans call for the addition of approximately 3,600 records each year. DART is a continuation of the ETICBACK file. DART is funded by the National Institute of Environmental Health Sciences (NIEHS) and EPA.
Environmental Mutagen Information Center (EMIC)
EMIC is a bibliographic database on chemical, biologic, and physical agents that have been tested for genotoxic activity. It contains citations from literature after 1988. The database is produced by the Oak Ridge National Laboratory in Oak Ridge, Tennessee, and is funded by the federal government
Environmental Mutagen Information Center Backfile (EMICBACK)
This is the backfile for the Environmental Mutagen Information Center
Environmental Teratology Information Center Backfile (ETICBACK)
ETICBACK is a bibliographic database containing more than 49,000 citations to publications concerning teratology and developmental toxicology. It contains publications dating from before 1950 through 1988. This database was produced by Oak Ridge National Laboratory in Oak Ridge, Tennessee. ETICBACK is continued in the Developmental and Reproductive Toxicology (DART) database.
Hazardous Substances Data Bank (HSDB)
This toxicology database was developed by NLM and ATSDR. It is a information derived from the Poisindex database. This database is partially funded by ATSDR.
Integrated Risk Information System (IRIS)
IRIS is an EPA database that contains chemical-specific information on more than 370 chemicals. It contains information on reference doses, carcinogenicity, drinking water health advisories, risk management, and supplementary data.
Toxic Chemical Release Inventory Facts (TRIFACTS)
TRIFACTS supplements the environmental release data on chemicals in TRI with information related to the health and ecologic effects and safety and handling of these chemicals. The data may be especially useful to workers, employers, community residents, and health professionals.
Toxics Release Inventory (TRI)
TRI was created by NLM and EPA. It is a record of estimated releases to the environment, reported by industries, of more than 300 toxic chemicals based on information collected by EPA.
Toxicology Information On-Line (TOXLINE/TOXLIT)
TOXLINE/TOXLIT is designed specifically to offer comprehensive
Hazardline provides emergency response, safety, regulatory, and health information on more than 4,000 chemicals. Produced by Occupational Health Services, Occupational Health Services, 400 Plaza Drive, Secaucus, NJ 07094. Hazardline contains an extensive companion file on MSDSs.
MEDLINE is the database used by most health care practitioners. It is the a concentration on biomedicine. MEDLINE indexes more than 4,300 journals published in the United States and abroad. It can be accessed easily through the NLM Gateway at URL: http://gateway.nlm.nih.gov/.
Online Library System (OLS) is the online library system for the library network of EPA. It consists of several related databases that can be used to Page 5
locate materials on a variety of topics. OLS is available through the Internet at URL: www.epa.gov/natlibra/ols.htm.
Reproductive Toxicology (REPROTOX) includes information on reproductive toxicology. It provides current assessments on the potentially harmful effects of environmental exposure to chemicals and physical agents on human pregnancy, reproduction, and development. REPROTOX is available through the Internet at URL: reprotox.org.
National Pesticide Information Retrieval System (NPIRS) is a collection of pesticide-related databases available on the Internet through subscription at URL: www.ceris.purdue.edu/npirs.
National Institute for Occupational Safety and Health (NIOSH) Technical Information Center (NIOSHTIC-2) is a compilation in abstract form of information about toxicology, epidemiology, industrial hygiene, and other areas of occupational safety and health. It is produced by NIOSH. NIOSHTIC is available on the Internet at URL: www.cdc.gov/ niosh/nioshtic.html.
Registry of Toxic Effects of Chemical Substances (RTECS) is a database that provides information on more than 100,000 potentially toxic chemicals and includes toxicity data, chemical identifiers, National Toxicology Program test status, and exposure standards. RTECS is built and maintained by NIOSH, and is available on the Internet at URL: www.nisc.com/factsheets/rtecs.htm.
Compact Disk-Read-Only Memory Systems The CD-ROM systems use a compact disk reader and a computer software package to read the information on a compact disk. Because the CD-ROM databases are generally updated on a quarterly basis, the information is not as current as that obtained from online searches. Two of the better known CD-ROM producers are Micromedex and SilverPlatter. Micromedex products include Poisindex and TOMES. SilverPlatter products include CHEM-BANK, OSH-ROM, and PEST-BANK. (For a complete listing of environmental health databases and vendors see Environment On-line ... The Greening of Databases, On-Line, Inc.; Wilton, CT; ISBN 0-910965-05-6.)
Micromedex developed the Poisindex CD-ROM system used in poison control centers. Poisindex contains toxicology information on drugs and consumer products.
The TOMES-Plus system (Toxicology, Occupational Medicine and Environmental Series Information System) provides toxicology information about acute and chronic exposure to occupational and environmental chemicals. The TOMES-Plus system includes
(1) MEDITEXT: detailed information on the evaluation and treatment of persons exposed to industrial chemicals. OSHA permissible exposure limits (PELs) information is also supplied.
(2) HAZARDTEXT: information on spills, leaks, and fires that may occur in hazardous materials incidents; protocols for first accident/injury/illness response.
(3) NAERG (North American Emergency Response Guidebooks, formerly the Department of Transportation Emergency Response Guides); HSDB; the U.S. Coast Guard's Chemical Hazard Response Information System (CHRIS); the Oil and Hazardous Materials/Technical Assistance Data System (OHM/TADS); RTECS; the New Jersey Department of Health's fact sheets; EPA'S IRIS: and REPROTOX.
SilverPlatter has various CD-ROM disks of toxicology information, including the following: CHEM-BANK, which includes RTECS, OHM/ TADS, CHRIS, and HSDB.
OSH-ROM includes the NIOSHTIC database, the HSELINE database of the Health and Safety Executive Information Services (United Kingdom), and CISDOC from the International Labour Organization. The Major Hazard Incident Data Service (MHIDAS) provides information on more than 3,000 major accidents involving chemicals.
PEST-BANK contains information on the U.S.-registered pesticides used in agriculture, industry, and general commerce. The information comes from NPIRS. It contains information on synonyms, registration dates and registering companies, composition and formulation, sites, and pests affected by the pesticide.
TOXLINE contains toxicologic information from NLM that includes references to published materials on topics such as drugs, food, chemicals, occupational hazards, pesticides, and toxicologic analysis.
MEDLINE contains bibliographic citations and abstracts of biomedical literature.
National Institute for Occupational Safety and Health (NIOSH) (CDC) exposures) 1-800-35-NIOSH (1-800-356-4674) http://www.cdc.gov/niosh/homepage.html
OSHA (Occupational Safety and Health Administration) DO NOT SEND E-MAIL—Please contact the toll-free number: 1-800-321-OSHA (6742) immediately. Office of Public Affairs: 202-693-1999 http://www.osha.gov/
EPA Office of Pesticide Programs Public Regulatory Docket 703-305-5805 http://www.epa.gov/pesticides/docket/
National Pesticide Telecommunications Network 1-800-858-7378 http://ace.orst.edu/info/nptn/
National Pesticide Information Retrieval System (NPIRS) insecticides, fungicides, state and federally registered chemicals: 765-494-5249 http://ceris.purdue.edu/npirs/index.html
National Radon Information Hotline 1-800-SOS-RADON (1-800-767-7236) http://www.epa.gov/iedweb00/iaqinfo.html#Radon hotline
Toxicology Information Response Center (Oak Ridge)
Agency for Toxic Substances and Disease Registry (ATSDR) Technical Information Service. ]) 1-888-42-ATSDR (1-888-422-8737) http://www.atsdr.cdc.gov/
Toxic Substances Control Act (TSCA) Hotline/Public Information Office (EPA) (Answers questions and gives general technical assistance on TSCA; guidance on TSCA regulations) 202-554-1404
Toxics Release Inventory System (EPA) by companies) 1-800-424-9346 http://www.epa.gov/tri/
EPA Office of Water (Groundwater and Drinking Water) 1-800-426-4791 (Safe Drinking Water Hotline) http://www.epa.gov/OGWDW/ Page 6
Minnesota Department of Health PO Box 64882 St. Paul, MN 55164-0882 (651) 296-8401
New Mexico Department of Health Puerto Rico Department of Health PO Box 26110 PO Box 70184 Santa Fe, NM 87502-6110 San Juan, PR 00936 (505) 827-2613 (787) 274-7602
Montana Department of Public Health and Human Services PO Box 4210 Helena, MT 59604-4210 (406) 444-5622 Page 7 |
Which of the following best describes a nonprofit organization?
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