Characterization of Risk From Airborne Benzene Exposure in the State of Florida

Environmental airborne benzene is a ubiquitous hazardous air pollutant whose emissions are generated from multiple sources, including industrial emissions, fuel station emissions, and automobile emissions. Chronic occupational exposures to elevated levels of benzene are known to be associated with leukemic cancers, in particular, acute myeloid leukemia (AML), though epidemiological evidence regarding environmental exposures and subsequent AML development is lacking. This investigation uses historical airborne monitoring data from six counties in the State of Florida to characterize the environmental cancer risk from airborne benzene concentrations using current Federal and State regulatory analysis methodology, and a comparative analysis based on occupational epidemiological evidence. Airborne benzene concentrations were collected from 24 air toxics monitoring stations in Broward, Duval, Orange, Miami-Dade, Hillsborough, and Pinellas counties. From the years 2003 - 2006, 3,794 air samples were collected using 8, 12, and 24 hr samples with sub-ambient pressure canister collectors consistent with EPA benzene methodological protocols 101 and 176. Mean benzene concentrations, by site, ranged from 0.18 - 3.58 ppb. Using risk analysis methodology consistent with the EPA and the Florida Department of Environmental Protection (FLDEP) the resulting cancer risk estimates ranged from 4.37 x 10-6 to 8.56 x 10-5, exceeding the FLDEP\u27s acceptable cancer risk level, 1 x 10-6 for all monitoring sites. The cumulative lifetime exposures were calculated in ppm-years by site, ranging from 0.036 - 0.702 ppmyears. A comparative analysis with available epidemiological literature revealed that associations between benzene exposure and cancer outcomes were related to cumulative lifetime exposures in great excess of 1 ppm-years. The results of this investigation indicate that it is not reasonable to expect additional cancer outcomes in Florida residents as a result of airborne benzene exposures consistent with measured concentrations, despite the fact that all regulatory risk calculations exceed acceptable cancer risk levels in the State of Florida

Etiological characterization of acute poisonings in the emergency department

INTRODUCTION: An investigation of emergency department (ED) poisonings was conducted to characterize poisoning demographics and evaluate correlations with select co-morbidities. METHODS: The study population evaluated consisted of 649 poisoning cases admitted between 2004 and 2007 to an inner-city, level 1 emergency department. RESULTS: Ethnicity, age, and gender had a substantial impact on the population distribution as poisoning cases were predominantly African Americans (79.9%) between 36 and 45 years old with a 1:3 male to female ratio. Intentional illicit drug overdose was the most prevalent cause of poisoning, heroin being the most frequent substance found in 35.4% (n = 230) of cases, followed by cocaine overdose at 31.7% (n = 206), concomitant heroin and cocaine overdose at 4.3% (n = 28), multiple drug poisoning at 5.5% (n = 36), and antidepressant/antipsychotic poisoning at 6% (n = 39). Significant correlations were found between heroin poisoning and asthma (F = 20.29, DF = 1, P = 0.0001), cocaine poisoning and hypertension (F = 33.34, DF = 1, P = 0.0001), and cocaine poisoning and cardiovascular disease (F = 35.34, DF = 1, P = 0.0001). A change in the pattern of illicit drug use from injection to inhalation was detected and the resulting increase of inhalation and insufflation of illicit substances may partially explain the correlation found between heroin use and asthma. CONCLUSIONS: These results provide supporting evidence that deliberate poisoning with illicit drugs remains a serious healthcare issue that significantly aggravates co-morbidities and raises treatment costs by increasing both the rate of hospitalization and hospital length of stay

Etiological characterization of acute poisonings in the emergency department

<b>Introduction:</b> An investigation of emergency department (ED) poisonings was conducted to characterize poisoning demographics and evaluate correlations with select co-morbidities. <b>Methods:</b> The study population evaluated consisted of 649 poisoning cases admitted between 2004 and 2007 to an inner-city, level 1 emergency department. <b>Results:</b> Ethnicity, age, and gender had a substantial impact on the population distribution as poisoning cases were predominantly African Americans (79.9&#x0025;) between 36 and 45 years old with a 1:3 male to female ratio. Intentional illicit drug overdose was the most prevalent cause of poisoning, heroin being the most frequent substance found in 35.4&#x0025; ( n = 230) of cases, followed by cocaine overdose at 31.7&#x0025; ( n = 206), concomitant heroin and cocaine overdose at 4.3&#x0025; ( n = 28), multiple drug poisoning at 5.5&#x0025; ( n = 36), and antidepressant/antipsychotic poisoning at 6&#x0025; ( n = 39). Significant correlations were found between heroin poisoning and asthma (F = 20.29, DF = 1, <i>P</i> = 0.0001), cocaine poisoning and hypertension (F = 33.34, DF = 1, <i>P</i> = 0.0001), and cocaine poisoning and cardiovascular disease (F = 35.34, DF = 1, <i>P</i> = 0.0001). A change in the pattern of illicit drug use from injection to inhalation was detected and the resulting increase of inhalation and insufflation of illicit substances may partially explain the correlation found between heroin use and asthma. <b>Conclusions:</b> These results provide supporting evidence that deliberate poisoning with illicit drugs remains a serious healthcare issue that significantly aggravates co-morbidities and raises treatment costs by increasing both the rate of hospitalization and hospital length of stay

Assessment of community healthcare providers ability and willingness to respond to emergencies resulting from bioterrorist attacks

Introduction: Previous findings have demonstrated that preparedness and planning within the public health system are inadequately developed to respond to an act of biological or chemical terrorism. Methods:This investigation used Internet-based surveys to assess the level of preparedness (PL) and willingness to respond (WTR) to a bioterrorism attack, and identify factors that predict PL and WTR among Florida community healthcare providers. Invitations were sent to 22,800 healthcare providers in Florida, which resulted in 2,279 respondents. Results: Respondents included physicians (n=604), nurses (n=1,152), and pharmacists (n=486). The results indicated that only 32&#x0025; of Florida healthcare providers were competent and willing to respond to a bioterrorism attack, 82.7&#x0025; of providers were willing to respond in their local community, and 53.6&#x0025; within the State. Respondents were more competent in administrative skills than clinical knowledge (62.8&#x0025; vs. 45&#x0025;). Areas in which respondents had the highest competency were the initiation of treatment and recognition of their clinical and administrative roles. Areas in which respondents showed the lowest competency were the ability to identify cases and the ability to communicate risk to others. About 55&#x0025; of the subjects had previous bioterrorism training and 31.5&#x0025; had conducted emergency drills. Gender, race, previous training and drills, perceived threats of bioterrorism attack, perceived benefits of training and drills, and feeling prepared were all predictors of overall preparedness. Conclusions: The findings suggest that only one-third of Florida community healthcare providers were prepared for a bioterrorism attack, which is an insufficient response rate to effectively respond to a bioterrorism incident

“Pressured to prescribe” The impact of economic and regulatory factors on South-Eastern ED physicians when managing the drug seeking patient

Objective: The purpose of this study was to elicit the opinions of Emergency Department (ED) physicians, currently practicing in the United States, regarding the impact of economic and regulatory factors on their management of patients exhibiting “drug seeking” behavior. Methods: A descriptive, cross-sectional study, utilizing a convenience sample of ED physicians located in Florida and Georgia was conducted for a period of 2 months. The inclusion criteria specified that any ED physician, currently practicing within the United States, could participate. Results: Of the ED physicians surveyed (n = 141), 71% reported a perceived pressure to prescribe opioid analgesics to avoid administrative and regulatory criticism and 98% related patient satisfaction scores as being too highly emphasized by reimbursement entities as a means of evaluating their patient management. Rising patient volumes and changes in the healthcare climate were cited by ED physicians as impacting their management of patients exhibiting “drug seeking” behavior. Conclusions: The ED physician faces unique challenges in changing healthcare and economic climates. Requirements to address pain as the “fifth vital sign,” patient satisfaction based reimbursement metrics and an economically driven rise in ED patient volume, may have inadvertently created an environment conducive to exploitation by prescription opioid abusers. There is an identified need for the development of continuing medical education and standardized regulatory and legislative protocols to assist ED physicians in the appropriate management of patients exhibiting “drug seeking” behavior

Dermal absorption of a dilute aqueous solution of malathion

Malathion is an organophosphate pesticide commonly used on field crops, fruit trees, livestock, agriculture, and for mosquito and medfly control. Aerial applications can result in solubilized malathion in swimming pools and other recreational waters that may come into contact with human skin. To evaluate the human skin absorption of malathion for the assessment of risk associated with human exposures to aqueous solutions, human volunteers were selected and exposed to aqueous solutions of malathion. Participants submerged their arms and hands in twenty liters of dilute malathion solution in either a stagnant or stirred state. The "disappearance method" was applied by measuring malathion concentrations in the water before and after human exposure for various periods of time. No measurable skin absorption was detected in 42&#x0025; of the participants; the remaining 58&#x0025; of participants measured minimal absorbed doses of malathion. Analyzing these results through the Hazard Index model for recreational swimmer and bather exposure levels typically measured in contaminated swimming pools and surface waters after bait application indicated that these exposures are an order of magnitude less than a minimal dose known to result in a measurable change in acetylcholinesterase activity. It is concluded that exposure to aqueous malathion in recreational waters following aerial bait applications is not appreciably absorbed, does not result in an effective dose, and therefore is not a public health hazard

Dermal absorption of a dilute aqueous solution of malathion

Malathion is an organophosphate pesticide commonly used on field crops, fruit trees, livestock, agriculture, and for mosquito and medfly control. Aerial applications can result in solubilized malathion in swimming pools and other recreational waters that may come into contact with human skin. To evaluate the human skin absorption of malathion for the assessment of risk associated with human exposures to aqueous solutions, human volunteers were selected and exposed to aqueous solutions of malathion. Participants submerged their arms and hands in twenty liters of dilute malathion solution in either a stagnant or stirred state. The “disappearance method” was applied by measuring malathion concentrations in the water before and after human exposure for various periods of time. No measurable skin absorption was detected in 42% of the participants; the remaining 58% of participants measured minimal absorbed doses of malathion. Analyzing these results through the Hazard Index model for recreational swimmer and bather exposure levels typically measured in contaminated swimming pools and surface waters after bait application indicated that these exposures are an order of magnitude less than a minimal dose known to result in a measurable change in acetylcholinesterase activity. It is concluded that exposure to aqueous malathion in recreational waters following aerial bait applications is not appreciably absorbed, does not result in an effective dose, and therefore is not a public health hazard