Tee L. Guidotti

Elevated lead in drinking water in Washington, DC, 2003-2004: the public health response.

Background In 2003, residents of the District of Columbia (DC) experienced an abrupt rise in lead levels in drinking water, which followed a change in water-disinfection treatment in 2001 and which was attributed to consequent changes in water chemistry and corrosivity. Objectives To evaluate the public health implications of the exceedance, the DC Department of Health expanded the scope of its monitoring programs for blood lead levels in children. Methods From 3 February 2004 to 31 July 2004, 6,834 DC residents were screened to determine their blood lead levels. Results Children from 6 months to 6 years of age constituted 2,342 of those tested; 65 had blood lead levels > 10 μg/dL (the “level of concern” defined by the Centers for Disease Control and Prevention), the highest with a level of 68 μg/dL. Investigation of their homes identified environmental sources of lead exposure other than tap water as the source, when the source was identified. Most of the children with elevated blood lead levels (n = 46; 70.8%) lived in homes without lead drinking-water service lines, which is the principal source of lead in drinking water in older cities. Although residents of houses with lead service lines had higher blood lead levels on average than those in houses that did not, this relationship is confounded. Older houses that retain lead service lines usually have not been rehabilitated and are more likely to be associated with other sources of exposure, particularly lead paint. None of 96 pregnant women tested showed blood lead levels > 10 μg/dL, but two nursing mothers had blood lead levels > 10 μg/dL. Among two data sets of 107 and 71 children for whom paired blood and water lead levels could be obtained, there was no correlation (r2 = –0.03142 for the 107). Conclusions The expanded screening program developed in response to increased lead levels in water uncovered the true dimensions of a continuing problem with sources of lead in homes, specifically lead paint. This study cannot be used to correlate lead in drinking water with blood lead levels directly because it is based on an ecologic rather than individualized exposure assessment; the protocol for measuring lead was based on regulatory requirements rather than estimating individual intake; numerous interventions were introduced to mitigate the effect; exposure from drinking water is confounded with other sources of lead in older houses; and the period of potential exposure was limited and variable.

The Fort McMurray Demonstration Project in Social Marketing: theory, design, and evaluation

CONTEXTnThe Fort McMurray Demonstration Project in Social Marketing is a multifaceted program that applies the techniques of social marketing to health and safety. This paper describes the origins of the project and the principles on which it was based. VENUE: Fort McMurray, in the province of Alberta, Canada, was selected because the community had several community initiatives already underway and the project had the opportunity to demonstrate value added.nnnCONCEPTnThe project is distinguished from others by a model that attempts to achieve mutually reinforcing effects from social marketing in the community as a whole and from workplace safety promotion in particular.nnnDESIGNnSpecific interventions sponsored by the project include a media campaign on cable television, public activities in local schools, a community safety audit, and media appearance by a mascot that provides visual identity to the project, a dinosaur named Safetysaurus. The project integrated its activities with other community initiatives.nnnMAIN OUTCOME MEASURESnThe evaluation component emphasizes outcome measures. A final evaluation based on injury rates and attitudinal surveys is underway.nnnRESULTSnBaseline data from the first round of surveys have been compiled and published. In 1995, Fort McMurray became the first city in North America to be given membership in the World Health Organizations Safe Community Network.

Ethics and skeptics: what lies behind ethical codes in occupational health.

Objectives: Ethical codes, or systems, are conditioned and their enforcement is permitted by social processes and attitudes. In occupational health, our efforts to adhere to our own ethical frameworks often are undermined by forces and interests outside the field. Failure to acknowledge the profoundly social nature of ethical codes impedes our ability to anticipate consequences, to legitimate decisions based on utility and benefit, and to find social structures that support, rather than invalidate, our view of ethical behavior. We examine three sets of social philosophies. Methods: Jane Jacobs, the visionary urban planner, has written Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics, which is a restatement in modern terms of a critical passage in Plato’s most important dialogue, the Republic. She (and Plato) postulate two major ethical systems, renamed here the “guardian system,” which is characterized by loyalty, cohesiveness, and confidentiality, and the “marketplace system,” which is characterized by trade, decentralization, and shared information. Occupational health, in this formulation, often runs afoul of the guardian mentality and also may be subject to inappropriate negotiation and compromise in the marketplace system. George Lakoff, a semiotician, has written Moral Politics: What Conservatives Know That Liberals Don’t, which argues that there are two fundamental social paradigms based on concepts of the family. One, which he calls the Strict Father, emphasizes discipline, the positive aspects of taking risks, and the need to individuals to be self-sufficient. The other, which he calls the Nurturing Parent, emphasizes empowerment, the positive aspects of security, and the need for community and relationships. Occupational health practice violates aspects of both and therefore is supported by neither. Classical Chinese thought involved many schools of thought, including Confucianism and Legalism. It has been suggested that Confucianism provides little support for government regulation or occupational health, however this is questioned. Conclusions: Occupational health may improve its standing as a social priority by recognizing and maneuvering within social frameworks that accomodate it, rejecting social frameworks that invalidate it, and reinforcing positive cultural trends within society that support it.

What is the Finnish model of work ability

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.

Occupational medicine in a developing society: a case study of Venezuela.

Recent activities of the World Health Organization and other international agencies have placed new emphasis on occupational health in developing nations. Venezuela is a nation in transition from a developing society dominated economically by petroleum and agriculture to an economically- diversified industrialized urban society. It provides a case study which illuminates the problems of extending occupational health services in developing economies and questions of public policy regarding utilization of medicalresources and the priority that occupational health should hold in such a society. Occupational health has become a serious problem in the developing world as new industries and accelerating economic development occur without adequate resources for worker protection. The study of cases such as that of Venezuela may provide guidance for anticipating and preventing problems in other nations. This paper should be considered a pilot study to explore a social aspect of occupational health that has not received adequate attention.

What key performance indicators can be used in occupational health

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.

Unjustified Employee Concern Aroused by a Direct-Service Toxicologic Testing Laboratory

A rising concern for personal health and fitness on the part of employees is a positive development with great potential for personal well-being. When misdirected into fads and exploitive practices, however, this concern can be a source of unnecessary anxiety and confusion. This brief report describes a problem that may become more common in our increasingly health-conscious society.

What is the role of emergency management in occupational medicine

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.