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Cooking- and cookstove-related burns (CSBs) comprise a large proportion of burn injuries globally, but there are limited data on cooking behavior patterns to inform prevention and advocacy. Therefore, we aimed to describe the epidemiology, risk factors, and outcomes of these injuries and highlight the potential of the World Health Organization (WHO) Global Burn Registry (GBR). Patients with cooking-related burns were identified in the WHO GBR. Patient demographics, cooking arrangement, injury characteristics, and outcomes were described and compared. Bivariate regression was performed to identify risk factors associated with CSBs. Analysis demonstrated that 25% of patients in the GBR sustained cooking-related burns (n = 1723). The cooking environment and cooking fuels used varied significantly by country income level ([electricity use: LIC 1.6 vs MIC 5.9 vs HIC 49.6%; P <.001] [kerosene use: LIC 5.7 vs MIC 10.4 vs HIC 0.0%; P <.001]). Of cooking-related burns, 22% were cookstove-related burns (CSBs; 311 burns). Patients with CSBs were more often female (65% vs 53%; P <.001). CSBs were significantly larger in TBSA size (30%, IQR 15–45 vs 15%, IQR 10–25; P <.001), had higher revised Baux scores (70, IQR 46–95 vs 28, IQR 10–25; P <.001) and more often resulted in death (41 vs 11%; P <.001) than other cooking burns. Patients with CSBs were more likely to be burned by fires (OR 4.74; 95% CI 2.99–7.54) and explosions (OR 2.91, 95% CI 2.03–4.18) than other cooking injuries. Kerosene had the highest odds of CSB compared to other cooking fuels (OR 2.37, 95% CI 1.52–3.69). In conclusion, CSBs specifically have different epidemiology than cooking-related burns. CSBs were more likely caused by structural factors (eg, explosion, fire) than behavioral factors (eg, accidental movements) when compared to other cooking burns. These differences suggest prevention interventions for CSBs may require distinctive efforts than typically deployed for cooking-related injuries, and necessarily involve cookstove design and safety regulations to prevent fires and explosions. [ABSTRACT FROM AUTHOR]

Recent public recognition that children are different from adults in their exposures and susceptibilities to environmental contaminants has its roots in work that began >46 years ago, when the American Academy of Pediatrics (APA) established a standing committee to focus on children's radiation exposures. We summarize the history of that important committee, now the AAP Committee on Environmental Health, including its statements and the 1999 publication of the AAP Handbook of Pediatric Environmental Health, and describe the recent emergence of federal and state legislative and executive actions to evaluate explicitly environmental health risks to children. As a result in large part of these efforts, numerous knowledge gaps about children's health and the environment are currently being addressed. Government efforts began in the 1970s to reduce childhood lead poisoning and to monitor birth defects and cancer. In the 1990s, federal efforts accelerated with the Food Quality Protection Act, an executive order on children's environmental health, the Agency for Toxic Substances and Disease Registry/Environmental Protection Agency Pediatric Environmental Health Specialty Units, and National Institute of Environmental Health Sciences/Environmental Protection Agency Centers of Excellence in Research in Children's Environmental Health. In this decade, the Children's Environmental Health Act authorized the National Children's Study, which has the potential to address a number of critical questions about children's exposure and health. The federal government has expanded efforts in control and prevention of childhood asthma and in tracking of asthma, birth defects, and other diseases that are linked to the environment. Efforts continue on familiar problems such as the eradication of lead poisoning, but new issues, such as prevention of childhood exposure to carcinogens and neurotoxins other than lead, and emerging issues, such as. endocrine disruptors and pediatric drug evaluations, are in the forefront. More recently, these issues have been taken up by states and in the international arena. Pediatrics 2004;113:1146-1157; child, child welfare, environmental exposure, environmental health, environmental pollutants, human risk assessment, public policy., Pediatric environmental health, also known as environmental pediatrics, is an area that has gained prominence in recent years. Pediatric environmental health is based on the understanding that children have patterns [...]

Childhood lead poisoning is a preventable illness. In the past 3 decades, removal of key lead sources and prevention of exposure in the United States have led to dramatic decreases in population blood lead concentrations and also in instances of severe lead poisoning requiring treatment. From an international perspective, childhood lead poisoning seems to be of greatest concern in developing countries. The phasing out of lead from gasoline is a critical first step in decreasing worldwide blood lead concentrations. However, many focal sources that can cause lead poisoning remain, such as lead from flour mills, lead-glazed ceramics, mining and smelting, and battery repair and recycling. A large and diverse country, such as India, may have many sources of lead. The challenge will be for developing countries to implement effective national and regional efforts to address their specific sources of lead., ABBREVIATIONS. DHHS, US Department of Health and Human Services; CDC, Centers for Disease Control and Prevention. During the past decade, attention to children's environmental health issues has sharply increased, starting [...]

CHILDHOOD LEAD POISONING is a major preventable environmental health problem in the United States. Since the mid-1970s, there has been major progress in eliminating or reducing lead in gasoline, food […]

To evaluate subclinical health effects of excess vitamin D, a cross-sectional study was conducted of persons consuming milk from a dairy that had overfortified milk for at least 4 years. Milk consumption, sunlight exposure, medical symptoms, serum 25-hydroxyvitamin D (25[OH]D), serum and urinary calcium, and indicators of renal function were measured. Increased milk consumption was associated with increased scrum 25(OH)D and urinary calcium. However, the prevalences of elevated serum 25(OH)D and calcium were no greater than expected, and data indicated normal renal function. It was concluded that most persons exposed to excess vitamin D exhibited no measurable adverse subclinical effects. (Am J Public Health. 1995;85:1418-1422), Consumption of milk containing excess vitamin D does not appear to cause any adverse physiologic effects. Excessive intake of vitamin D can cause calcium absorption disturbances that can lead to urinary tract stones, calcification of soft tissues, and kidney and heart damage. In 1991, a dairy was discovered whose milk contained vitamin D levels 70 to 600 times above recommended levels. Researchers analyzed blood and urine samples from 234 persons who had drunk at least one cup of milk a week from that dairy over at least three months. The amount of milk consumed was associated with higher blood levels of vitamin D and urinary levels of calcium, but blood levels of calcium were normal, as were indicators of kidney function. Persons with high blood vitamin D levels may have compensated for increased calcium absorption by excreting more calcium. Excessive levels could still pose problems to vulnerable populations, such as the elderly.

Objectives. The purpose of the study was to identify cases of hypervitaminosis D caused by the inadvertent overfortification of milk from a home-delivery dairy and to identify risk factors for this illness. Method. Hospital discharge, laboratory, and state health department data were used to define, identify, and describe cases of hypervitaminosis D diagnosed in the exposed communities between January 1, 1985, and June 30, 1991. To identify disease risk factors, community-based sex- and age-matched controls were used in a case-control study. Results. Of the 56 case patients identified, at least 41 were hospitalized; 2 died. The study included 33 case patients and 93 control subjects. Nineteen of the 33 case patients had been customers of the implicated dairy. Risk of illness rose with increasing consumption of the dairy's milk and was also associated with vitamin D supplement use, sunburn susceptibility, and cancer history. Accounting for these factors did not alter the association between drinking the dairy's milk and developing hypervitaminosis D. Conclusions. Overfortification of milk with vitamin D can lead to hypervitaminosis D, manifested by severe illness and death. The episode highlights the need for monitoring the fortification process and enforcing the upper limit for vitamin D addition to milk. (Am J Public Health. 1995;85:656-659), Milk overfortified with Vitamin D can cause hypervitaminosis D, a potentially serious illness. Of 56 patients diagnosed following an outbreak of hypervitaminosis D in Boston, MA, 41 were hospitalized and two died. A local home-delivery dairy, which was found to have a broken measuring instrument, was considered a source of the excess Vitamin D. Milk samples from the dairy were between 70 and 600 times higher than the state limits for fortification. Risk factors for developing the disease included Vitamin D supplements, cancer, sensitivity to sun, and advanced age. Sixty-two percent of the patients were older than 60. Vitamin D is toxic in large amounts, and can cause calcium deposits in the kidneys and heart and changes in the central nervous system. Symptoms include fatigue, weight loss, anorexia, weakness, dehydration, disorientation, constipation and vomiting.

A survey of 12 issues of bodybuilding and popular health magazines showed 89 brands of 311 products, most for muscle growth. Increased testosterone levels and nutritional supplementation were the next most frequent advertised effects. Researchers found unusual or unidentifiable ingredients in a list of 235 unique ingredients. Only 77.8% of the products listed ingredients, most frequently amino acids. Over half the products contained specified or unspecified amino acids. Other frequently listed ingredients were herbs and vitamins, and many products used 'miscellaneous' ingredients. Steroid type ingredients advertised in 9% of all products were of plant or insect origin. Prescription medication was listed as an ingredient as well as glandular concentrates without stating the origin. Some advertisers may have attempted to evade Food and Drug Administration regulations on product claims. Products are promoted as being organic or natural when they are most often from manufactured or chemically derived sources. Patients with chronic diseases may be particularly susceptible to claims as may adolescents.

Of 418 patients of a South Carolina psychiatrist who used L-tryptophan in 1989, 47 were diagnosed with eosinophilia-myalgia syndrome according to the Centers for Disease Control (CDC) case definition. An additional 68 who had fewer symptoms were diagnosed as possible cases. Of the 47 confirmed cases, 45 had used the same brand of L-tryptophan, which was traced to the Japanese manufacturer Showa Denko KK. Thirty-six of the possible cases had also used this brand. Of the 157 people who used this brand, 45 were diagnosed with the syndrome and 36 were considered possible cases. The higher the dose taken, the greater the risk of getting the disease. Since many patients using L-tryptophan did not meet the CDC criteria for the disease but nevertheless had several of the symptoms, relying on the CDC criteria may cause physicians to miss many cases.

Abstract This commentary addresses the article by Berman, et al. on reproductive health trends in Israel potentially related to endocrine disrupting chemicals (EDCs) and on associated health policy decisions in Israel to prevent long-term effects from exposure to EDCs. There are intensive, ongoing research efforts in the US that will provide additional guidance on this issue in the future. The commentary also notes and commends the growing capacity and resources for environmental health work in government and academia in Israel.

Eosinophilia-myalgia syndrome (EMS) was first recognized in October 1989. Since that time, 1,531 individuals are known to have suffered from the disorder, and 27 have died. The condition was rapidly observed to be associated with the use of L-tryptophan as a dietary supplement, and the removal of such products from the market resulted in a dramatic reduction in new cases. A study of the distribution and characteristics of EMS patients revealed that individuals in western states were more affected, and there was a predominance of non-Hispanic white females among the patients. These features may be accounted for by the distribution in the use of dietary supplements. Dietary supplements are more popular in the western states than elsewhere in the US. Furthermore, non-Hispanic white women account for 80 percent of the use of dietary supplements, which include vitamins, minerals, amino acids, and other nutrients. L-tryptophan has been recommended for insomnia, depression, and premenstrual syndrome. While men are obviously unlikely to take supplements for premenstrual syndrome, it is also true that men are one third less likely to take dietary supplements for insomnia and depression than women. It cannot be ruled out, however, that these women may also have some constitutional predisposition to EMS. Curiously, the features of eosinophilia-myalgia syndrome are similar to those of the toxic oil syndrome, which occurred in Spain in 1981 and affected 20,000 people and caused 330 deaths. The use of L-tryptophan as a dietary supplement preceded the outbreak of EMS by several years, and, indeed, many EMS patients had used tryptophan for years. Consequently, it seems likely that contaminants in commercial tryptophan products, rather than tryptophan itself, are the culprit. The substance responsible for eosinophilia-myalgia syndrome has not been conclusively identified. (Consumer Summary produced by Reliance Medical Information, Inc.)