10.5 Occupational Safety & Health Organizations

Occupational Safety & Health Organizations: OSHA

CHOOSE ONE of the following organizations/agencies: OSHA, CAL/OSHA, NIOSH, ILO, WHO, AFL-CIO

Go to their website. Each of these occupational safety and health or labor organizations support a range of occupational health and safety programs. Select a health and safety program sponsored by one of these organizations, read about it.

Provide a short summary on your BLOG and how it might relate to your health and safety.

Employers will find that implementing these recommended practices also brings other benefits. Safety and health programs help businesses:

• Prevent workplace injuries and illnesses
• In the ICU setting, nurses are at high risk for back and joint injuries due to turning, lifting and providing physical care to physically limited patients
• Improve compliance with laws and regulations
• To reduce or prevent the incidences of back/musculoskeletal related injuries due to patient care, hospital employers are required to provide education, training and equipment on safe patient handling and transfering
• Reduce costs, including significant reductions in workers' compensation premiums
• Preventing back/musculoskeletal injuries in nurses during patient care will reduce the rates of disability compensation and sick/medical leave, which in turn will save employers costs
• Engage workers
• Fostering a culture of learning and accepting new practices will engage nurses to comply to safety standards
• Enhance their social responsibility goals
• Increase productivity and enhance overall business operations
• Fewer occupational injuries, will optimize staffing options and increase productivity

Summary on How to Start the Occupational Health Program

1. Prioritize safety and health in workers.
• Create a safe working environment that minimizes unnecessary exposures 
• Invest in decent healthcare insurance programs
2. As management leadership, lead by example.
• Communicate your commitment to a safety and health program
• Define program goals
• Allocate resources
• Expect performance
3. Implement a standardized reporting system.
4. Provide education and training.
• Provide personal protective equipment
5. Implement inspections.
6. Collect hazard controls by assigning workers to recommend solutions.
• Foster a safe work environment for workers to express questions, concerns and ideas
7. Implement hazard controls.
8. Address emergencies.
9. Seek input on work changes.
10. Make improvements.

10.2 MSDS & Toxnet

MSDS & Toxnet: Warfarin (3-(alpha-Acetonyl)-benzyl-4-hydroxycoumarin; 4-Hydroxy-3-(3-oxo-1-phenyl butyl)-2H-1-benzopyran-2-one)

Obtain a Material Safety Data Sheet (MSDS) from your workplace or from the workplace of a family member or friend.   Material Safety Data Sheets are chemical information sheets created by chemical manufacturers that all employers are required to obtain and keep for any potentially hazardous chemicals in the workplace.

Review the MSDS and answer the following questions:

• What are the health risks associated with this chemical?
• Hemorrhage manifested by hemorrhagic skin rashes and lip, nose, and upper airway bleeding
• Upper airway pain, dysarthria, dysphagia and dyspnea (shortness of breath) may occur
• Vomiting, abdominal pain, and bloody stools are common. Back pain may be noted
• Is the chemical a carcinogen?
• Warfarin carcinogen classification is "NA"
• Classified as a teratogen
• What personal protective equipment or special precautions should be taken when working with this chemical?
• Personal protective equipment such as donning gloves to prevent skin absorption during administration of Warfarin to patients
• Donning protective gloves and clothing when applying rodenticides containing Warfarin
• If this is a chemical found in your workplace, what training/education were you given about any risks associated with this chemical?
• Warfarin is a teratogen
• To prevent skin absorption, it is important for individuals administering Warfarin to don gloves, especially if she may be pregnant
• Warfarin must be disposed in a special black hazardous container to prevent toxic waste in the environment

Look up the chemical using the ToxNet databases you mastered while viewing the enviRN-EVIDENCE program. Were there any discrepancies regarding the potential health effects noted in the MSDS? In your BLOG, write about your findings - about the potential dangers associated with the chemical/product you looked up. Was the MSDS an adequate tool for a worker to use to gain an understanding about the potential health risks and how to protect him/herself? (Consider that the general public reads at a reading level at or below 6th grade, and that's if English is their first language.)

Both MSDS and Toxnet consistently described the major adverse health outcome of Warfarin in humans is hemorrhage and teratogenicity. However, Toxnet elaborated more on how Warfarin is used in rodenticides, which increases risk of exposure to the public beyond the medical population. Although there we no discrepancies regarding the potential health effects of Warfarin noted in the MSDS and ToxNet, both tools are difficult to navigate and understand for the general public. Both tools are not appropriate for a worker to use to gain understanding about the potential health risks and how to protect him/herself, because the language used is too scientific and communicated at a reading level beyond the 6th grade level.

M9.4 Heavy Metals

Heavy Metals

"Lead Poisoning"

In addition to describing the adverse health outcomes of lead toxicity/poisoning in humans, especially children, an interesting history of lead and its use in human history was described in this article. Lead poisoning/toxicity is documented to have adverse health effects on the neurological system, gastrointestinal and renal systems. Lead was prevalently used in the wine making and plumbing systems of the Roman Empire and is described as a contributor to its demise. Lead is an ancient chemical known to humanity. The Romans designated it the chemical symbol “Pb” for “plumbum,” because plumbers would use it to line the Roman water pipes, consequently leading to the eventual demise/poisoning of the Roman Empire. The English hat makers of the Victorian Age used lead to line hats, which they would lick in the process of making. Ingesting large amounts of lead caused neurotoxicity that presented with hallucinations, delusions and psychotic behavior – hence the term “mad hatter.” In the U.S.A, lead paint has been banned since the late 1970s, because of evidence that shows severe neurotoxicity resulting from even low levels of lead exposure in children who came into contact with lead based paint in old homes. Yet, why is it still used in other industrial products and hobbies? If the poor health outcomes of lead exposure has been intensively documented throughout history, why does the national government and public health department permit its use in products that are so close to human contact? It seems so unscientific and great disregard for evidence. Throughout human history, human civilizations have has a dangerous affinity to lead.

"An environmental health response to a severe outbreak of childhood lead poisoning in NigeriaCasey Bartrem"

Although lead poisoning/toxicity in these Nigerian villages were a result of preventable unsafe mining practices, there is hope to know that remediation is being implemented by UN humanitarian  and non-government organizations and the Nigerian health authorities. Hopefully, these discoveries of lead poisoning/toxicity cases in Nigeria will change policies that implement safer or reduced mining practices. Public education on lead safety is also essential for future prevention. 

M9.3 Green Chemistry

Green Chemistry

BLOG about your thoughts on green chemistry. Have you heard of or seen any examples of green chemistry in your work or in daily life? What are your thoughts on the 12 principles of green chemistry? 

Although there is a revolution for "going green," I have not heard any details about "green chemistry." I have heard of products such as solar panels and hybrid/electric vehicles as components of the green movement. Unfortunately, in my work life in the hospital, I observe so much waste of resources and a lack of staff education and training on proper disposal of biohazardous waste! It appals me that we discard plastic urinals in regular trash. Plastic lasts forever...and it goes into our oceans. When I mention it to management, they say that it is for patient safety, yet they do not understand that disposing plastic urinals in regular trash affects our ecosystem and global health. There must be a better way, but upper managment refuses to take the lead and sometimes I feel helpless, because I am just a staff nurse and my opinions do not matter.

GREEN CHEMISTRY'S 12 PRINCIPLES

These principles demonstrate the breadth of the concept of green chemistry:

1. Prevent waste: Design chemical syntheses to prevent waste. Leave no waste to treat or clean up.

Prevention is the most effective intervention.

1. Maximize atom economy: Design syntheses so that the final product contains the maximum proportion of the starting materials. Waste few or no atoms.

To prevent waste and leave no waste, it is important to educate the public and instill a sense of "thriftiness" or public responsibility to be more conscious about consumerism...only take and use what you need.

1. Design less hazardous chemical syntheses: Design syntheses to use and generate substances with little or no toxicity to either humans or the environment.

Products need to be designed to be more biodegradable or recyclable.

1. Design safer chemicals and products: Design chemical products that are fully effective yet have little or no toxicity.

Eliminate unnecessary chemicals in products, such as flame retardants that are not event shown to be effective in increasing fire safety.

1. Use safer solvents and reaction conditions: Avoid using solvents, separation agents, or other auxiliary chemicals. If you must use these chemicals, use safer ones.
2. Increase energy efficiency: Run chemical reactions at room temperature and pressure whenever possible.

Reform in the powerplant/nuclear plant industry.

1. Use renewable feedstocks: Use starting materials (also known as feedstocks) that are renewable rather than depletable. The source of renewable feedstocks is often agricultural products or the wastes of other processes; the source of depletable feedstocks is often fossil fuels (petroleum, natural gas, or coal) or mining operations.
   

Global investment on research, development and implementation of renewable, sustainable and safer sources/processes of energy.

1. Avoid chemical derivatives: Avoid using blocking or protecting groups or any temporary modifications if possible. Derivatives use additional reagents and generate waste.
2. Use catalysts, not stoichiometric reagents: Minimize waste by using catalytic reactions. Catalysts are effective in small amounts and can carry out a single reaction many times. They are preferable to stoichiometric reagents, which are used in excess and carry out a reaction only once.
3. Design chemicals and products to degrade after use: Design chemical products to break down to innocuous substances after use so that they do not accumulate in the environment.
4. Analyze in real time to prevent pollution: Include in-process, real-time monitoring and control during syntheses to minimize or eliminate the formation of byproducts.
5. Minimize the potential for accidents: Design chemicals and their physical forms (solid, liquid, or gas) to minimize the potential for chemical accidents including explosions, fires, and releases to the environment.

M9.2 Six Chemical Classes

Six Chemical Classes

Highly Fluorinated Chemicals

• Used for oil and water resistant properties on consumer products
• Cookware
• Clothing
• Outdoor appare
• Carpeting 
• Food packaging
• Adverse health outcomes associated with highly fluorinated chemicals in humans:
• Kidney disease
• Cancers (testicular)
• Endocrine disruption (thyroid)
• Total elevated cholesterol and obesity
• Highly fluorinated chemicals are persistent organic chemicals 
• Contaminates water supply through washing of products with highly fluorinated chemicals
• Water purification system isn't designed to filter out these chemicals
• Transmitted from mother to fetus/infant via cord blood or breast feeding

Half of my active wear is "water resistant" and not until now did I ever think about the adverse health effects of the chemicals used to instill these properties of "water resistance" in my personal products. Sadly, it probably has poisoned me. Of all my female relatives, I am the most physically active and health conscious, yet I have the worse reproductive health...it's probably from absorbing the highly fluorinated chemicals in my active wear.

Antimicrobials

• Prevalently used in consumer personal care products to prevent microbial growth
• Soap
• Deodorant
• Toothpaste
• More beneficial for individuals with gum disease versus children and other individuals who do not have gum disease
• Socks
• Lunch boxes
• Prevalently used antimicrobials in consumer products:
• Triclosan
• Triclocarban
• Adverse health outcomes associated with "unnecessary" or "over use" of antimicrobials:
• Adverse changes in the endocrine, thyroid and reproductive functions
• Contributes to the antimicrobial resistance in strains of bacteria
• Safer alternatives
• Plain soap and water
• Mechanical disinfection

The use of antimicrobials in the U.S.A is over kill. We are addicted to the "magic penicillin" and it is this type of culture that has contributed to the even more detrimental public health issue of antimicrobial resistance.

Flame Retardants

• The original purpose for its use in consumer products was to reduce fire hazards
• Reports show that flame retardants do not increase fire safety
• Used in furniture, building insulation, baby product foam and electronics
• Appalling how it is most accessible by the most vulnerable members of society...babies
• Children have the highest body burdens of flame retardants via oral ingestion
• Adverse health outcomes in humans:
• Endocrine disruption
• Reproductive, neurologic and immune impairment
• Cancer

If reports show that flame retardants do not improve fire safety, why does the government permit manufacturers to continue using it in consumer and building products?

Bisphenols & Phthalates

• Components of consumer products
• Plastics
• Pesticides
• Flame retardants
• Adverse health outcomes in humans:
• Endocrine disruptors (thyroid)
• Disruption in reproductive, metabolic, neurologic and immune functions
• Teratogenic

Plastics are scary, because they are not biodegradeable. So many of our daily living products are made of plastic...we are totally dependent on it. 

Organic Solvents

• Used to dissolve other chemical constituents in consumer products:
• Paint
• Coatings
• Degreasers
• Dry cleaning chemicals
• Non-water based organic solvents are inhaled and absorbed by humans, especially in the construction industry
• Adverse health outcomes in humans:
• Neurotoxicity
• Reproductive toxicity
• Carcinogenic 

Certain Metals

• Lead, cadmium and mercury
• High/toxic levels of metals are associated with adverse health outcomes in humans:
• Decreased mental and central nervous function
• Lower energy
• Damage to blood, lungs, kidneys, liver and other organs 

M8.4 Chemical Policy Reform

Chemical Policy Reform & the Louisville Charter for Safer Chemicals

Consider the elements that your small group identified in class of an ideal chemical policy.

The Louisville Charter is a consensus-built position paper identifying the key elements of a good chemical policy.

In our small group assignment on an ideal chemical policy, we based our fragrance free policy on the 6 principles of the Louisville Charter.  Just like the “2020 national healthy goals,” dates must be set for implementing and re-evaluating these reforms. Governments and corporations impact the progress of healthier economies and societies by implementing the Louisville Charter and committing to practicing innovations for safer chemicals and processes. We must make a major reform of our nation’s chemicals policy.

The Louisville Charter for Safer Chemicals is an extension of the outdated Federal Chemical Policy Reform of the 1970s. The 6 principles of the Louisville Charter include:

1. Require Safer Substitutes and Solutions
• In our group assignment, our fragrance free policy discouraged or prohibited employees from wearing any personal products with fragrance in the work setting
• Our fragrance free policy encourages employees to use personal products that are fragrance free
2. Phase Out Persistent, Bioaccumulative, or Highly Toxic Chemicals
• Encouraging employees to substitute their personal care products with fragrance free products helps to phase out highly toxic chemicals in fragrant personal care products
3. Give the Public and Workers the Full Right-to-Know and Participate
• By providing written information and requesting feedback, workers are engaged
4. Act on Early Warnings
• Implementing a fragrance free policy in the work setting is a response to events of sensitivities and allergies from workers and customers
5. Require Comprehensive Safety Data for All Chemicals
• Collecting pre and post chemical/fragrance free policy implementation will help to evaluate its success
6. Take Immediate Action to Protect Communities and Workers
• Implementing a chemical/fragrance free policy is immediate action to protect workers

References

http://smartpolicyreform.org/the-charter/the-louisville-charter

  

M8.3 Pesticides

Pesticides

Video on "Pesticides"

BLOG: Pesticides are composed of "persistent organic pollutants" and are categorized as herbicides, fungicides and insecticides...all have "cide" as their suffix, which is results in death. Pesticides are potently toxic enough to have adverse even fatal effects on biodiversity, even in humans. Pesticides should be a controlled substance just like antibiotics. Antibiotics are potent enough to kill all bacteria, thus giving rise to other pathogens such as fungi and ameoba...etc. Use of pesticides requires strict monitoring.

Video on "European Food Safety Authority (EFSA)"

BLOG: According to the EFSA scientist in the video, pesticides contain "active substances" that are harmful and widely distributed in the environment. Pesticide residues in treated crop are carried from the field onto the table, or contaminate the water supply or are consumed by animals that humans consume.  Compared to the U.S.A, Europe has stricter policies on the use of pesticides as they are tested before public distribution, then diligently monitored. Compared to the U.S.A, Europe is more experienced and mature when it comes to human rights and the quality of living, so the safety of food for the public is prioritized over profit making in the U.S.A.

Video on " The Pesticide Trap"

BLOG: This is a documentary that poignantly portrays the tragic cycle of destructive pesticide use in farming cotton in India. The pesticides don't only annihilate pests, but they also literally kill the Indian farmers and their families. Compared to the U.S.A the cotton industry in India and its reliance on pesticides and exploitation of its farmers are exponentially worse. It is appalling to know that the Indian government does nothing to regulate the corruption. This documentary shows the importance of public health policies and government in protecting the public. Apparently, the government in India has stooped to the level where it doesn't even protect its farmers.

Video on "Integrated Pest Management (IPM)"

BLOG: This video outlines "5 steps of IPM," which educates the public on alternatives to the use of pesticides in farming. This would be helpful to integrate in curriculum for farmers or agriculturists. Even for farmers who do not have a formal education on IPM, it methods could be disseminated by EPA or other environmental organizations. Prior to the development of pesticides and chemicals in agriculture, farming was an art and a science that required agriculturists to utilize the biodiversity to produce bountiful healthy harvests. These methods are ancient, but are just resurfacing with more popularity.

Recall your last night's meal.  Go to this website and enter the foods that comprised your meal: http://www.whatsonmyfood.org/  The information on the site is based on foods that are NOT "organic".

For dinner, I blend and consume a smoothie composed of blueberries, rasberries, blackberries and bananas. 

What did you find out about the pesticide residues that may be in or on your food?    

BLUEBERRIES

52 Pesticide Residues Found by the USDA Pesticide Data Program

BANANAS

11 Pesticide Residues Found by the USDA Pesticide Data Program^1,2,3

My dinner smoothie had 63 known pesticide residue.  The other ingredients of blackberries and rasberries were not listed.                                                                                                                                                                                                                                                                            What do you think about this?                                                                                                              The reality of it is that it is frustrating! I try to eat healthy, yet the "healthy" food I consume is contaminated. It is discouraging.                                                                                                                                                                                                                                                                           What should we be doing about this in terms of public health, not just in terms of our personal choices?                                                                                                                                                 There needs to be strict FDA and government PHDs to regulate chemical/pesticide use in American agriculture. Products from other countries that use hazardous chemicals and pesticides need to be boycott. This will force global change. 

M8.5 Ideal Chemical Policy

Ideal Chemical Policy

The 6 principles of the Louisville Charter are essential for an ideal chemical policy, because they address the issue, recommend solutions and addresses the outcomes from chemical exposure. The 6 principles of the Louisville Charter include:

Require Safer Substitutes and Solutions

By altering production processes and redesigning products and systems to subsitute safer chemcials reduces the use and emissions of hazardous chemicals. Rewarding manufacturers for innovation and incentivizing public and private sectors to invest in research and development of safer sustainable chemicals and products will support safer substitutes and solutions. From a public health perspective, this principle supports the reformation of the manufacturing and production industries to redesign products and systems to substitute safer chemicals. This reformation protects consumers in mass numbers, thus is considered an advancement for public health. 

Phase Out Persistent, Bioaccummulative, or Highly Toxic Chemicals

Implement policies that require companies, manufacturers and other organizations to phase out highly hazardous chemicals that are slow to degrade and cause high burden in living organisms. These policies shouls also ensure that chemicals eliminated in the United States are not exported to other countries. From a public health perspective, this principle acknowledges the public health issues

associated with the ubiquitous use of biotoxic chemicals in our society and offers solutions.  It

supports public accountability and responsibility.

Give the Public and Workers the Full Right-to-Know and Participate

By obligating manufacturers to disclose the chemical and material composition of products to the the workers building them and to the public consumers facilitates the public and workers to be more involve and to practice more informed decision making. Involve public and workers in decisions on chemicals. This principle empowers the public and workers to have better control of environmental exposures and consequently health on a community level.

Act on Early Warnings

Prevent harm from new or existing chemicals when credible evidence of harm exists.

Require Comprehensive Safety Data for All Chemicals
For a chemical to remain on or be placed on the market manufacturers must publicly disclose available safety information about that chemical; its use and hazards from exposure. The previous two principles highlight the goals of public health safety and protection by requiring manufacturers, producers and organizations to produce scientific data that endorses

their products for safe public use.

Take Immediate Action to Protect Communities and Workers

When communities and workers are exposed to levels of hazardous chemicals, immediate action is necessary to eliminate these exposures; this is an intervention that facilitates environmental justice. This principle is the responsibility of government agencies such as the Environmental Protection Agency and Health and Human Services. It addresses the consequences and adverse health outcomes experienced by the public.

            Just like the “Healthy People 2020,” dates must be set for implementing and re-evaluating these reforms. Governments and corporations impact the progress of healthier economies and societies by implementing the Louisville Charter and committing to practicing innovations for safer chemicals and processes. We must make a major reform of our nation’s chemicals policy.

References

http://smartpolicyreform.org/the-charter/the-louisville-charter

M7.8 Topic Interest

TOPIC OF INTEREST

        As a VA nurse and nurse officer in the U.S. Army Reserves, Veterans and military service members hold a very special place in my heart. My topic of interest for my literature review explores the health outcomes and health care implications of Veterans and military service members exposed to burn pits in deployments to Iraq and Afghanistan during Operation Enduring Freedom, Operation Iraqi Freedom and the campaigns in Afghanistan. The prominent agencies that provide information and regulatory oversight on my topic of interest will be the Department of Veterans Affairs, Department of Defense and the United Nations on a lesser degree (since other global troops are involved). It would also be interesting to explore the health outcomes and health care implications of the locals who were exposed to the burn pits associated with military activity. Despite the inhumanities of war and strife, medical/health care advances and innovations have were developed from such experiences. The VA and DOD have introduced some of modern day medical innovations to the civilian sector.

M7.7 Agencies' Role

ROLE OF FEDERAL AGENCIES IN ENVIRONMENTAL HEALTH

https://www.atsdr.cdc.gov/

The Agency for Toxic Substances and Disease Registry (ATSDR), based in Atlanta, Georgia, is a federal public health agency of the U.S. Department of Health and Human Services. ATSDR serves the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and diseases related to toxic substances.

• ALS Biorepository LaunchedLearn about a new component of the National ALS Registry - the National ALS Biorepository.
• EndosulfanLearn important information about Endosulfan.
• Flint Rash ReportLearn more about the investigation
  (https://www.atsdr.cdc.gov/ntsip/flint_rash_investigation.html)
• Per- and Polyfluoroalkyl Substances (PFAS)Learn important information about PFAS and your health.
  (https://www.atsdr.cdc.gov/pfc/index.html)

Publications

• ATSDR Publications Order Form
• ATSDR Congressional Justification FY 2016[PDF - 955KB]

Emergency Response

• HazMat Emergency Preparedness Training and Tools for Responders
• Managing Hazardous Materials Incidents (MHMIs)

      

BLOG:
        Although the ATSDR is a branch of the U.S. Department of Health and Human Services, it still has an impact on environmental quality. ATSDR has the political and social influence to implement national policies that reduce or eliminate toxic substance production that result in harmful health outcomes for the general public. The agency sets guidelines on the safe management of hazardous materials, thus limiting its presence in the environment. The agency is also responsible for the assessment of waste sites and training health professionals, first responders and health systems in the management of chemical and environmental disasters. ATSDR is a an essential component of the U.S. Department of Health and Human Services and public health in general. Prospects of working with ATSDR as a public health professional would be exciting and rewarding.

M7.4 Local Environmental Services

Daly City Going Green

It brings me great pride and joy to know that Daly City is active in the global movement to reduce the earth's carbon footprint.

http://www.dalycity.org/City_Hall/Departments/city_manager/Daly_City_s_Green_Vision.htm

• Project Green Space and Urban Forestry - The City recently received a $25k grant to support tree planting and rain gardens by local volunteers to regrow our urban forest. New green spaces will boost our resilience to climate change impacts. 
• Blog: This is an efficient environmental health program that knocks out multiple birds with one stone. Not only does it empower community members to have control of their environment by creating, preserving and stewardship, it also provides opportunities for the youth to immerse in stewardship of the earth. This saves the city funds diverted to crime management in the youth.
• 
  
• Bay Area Sunshares - Daly City joined nearly 40 cities and employers across the Bay Area to offer discounts on solar systems and zero-emission vehicles. Learn more about your clean energy options, even if you are a renter. Limited time only. Attend a free workshop at City Hall on September 29th to learn more. Sign up to receive your free, no-obligation quotes by November 4th. 

• Blog: This echoes the federal government incentive of tax deductions for installing solar energy panels. Even my parents were considering in investing int solar energy panels.

• Citywide Composting Program - All residents and businesses now have the opportunity to participate in the new curbside collection of organic waste. Food scraps and food soiled paper products can now be diverted from the landfill and instead turned into nutrient-dense compost. Use your green compost cart and kitchen pails to collect all organic waste.

• Blog: This program is efficient and fosters a sense of civil duty for community members. The fact that the city provides the green bins for compost makes it easier for residents to abide to such civil duty of composting.

• Peninsula Clean Energy - The City Council voted unanimously to join Peninsula Clean Energy (PCE)in January 2016. Now, the County of San Mateo and all 20 cities on the peninsula will be able to use their combined electricity demand to buy and develop renewable, clean power on behalf of all residents and businesses. PCE will help accomplish the greenhouse gas reduction goals of the City's Climate Action Plan and introduce consumer choice to an energy market where none currently exists. 

• Blog: Of all the programs implemented by the city of Daly City, none brings me as much pride as this program on Peninsula Clean Energy, because it shows that the local government truly advocates for the environmental health of its community members by enacting such a prgram that purchases and develops renewable, clean power for its businesses and residents. This program impacts the whole community for generations to come.

• Ordinance

  
  

  Prohibition on Use of Polystyrene-Based Disposable Food Service Ware by Food Vendors, Adopted 2012

  The ordinance will help protect the health and safety of the residents, wildlife and habitat in Daly City, while reducing the amount of waste sent to the landfill. The ordinance includes the following:

  
  

  Prohibits food vendors, including restaurants, delis, cafes, markets, fast-food establishments, vendors at fairs, and food trucks, from dispensing prepared food in polystyrene containers labeled as No. 6

  
  

  Does not prohibit the use of polystyrene for pre-packaged foods (e.g., prepackaged meets or eggs in markets)

  
  

  Does not apply to non-food businesses that use polystyrene for packaging

  
  

  Does not include lids, straws, or utensils

  
  
  

  Blog: Of all the ordinances implemented by the city of Daly City, none brings me as much pride as the ones described above. The ordinance about the prohibition on the use of polystyrene-based disposable food service ware is a direct movement that will definitely send a message to manufacturers. This reduces the potential health effects from the consumption of polystyrene -based disposable food service.  

• Energy Audits for Businesses - In partnership with San Mateo County Energy Watch a citywide campaign to provide free energy audits to local businesses launched spring 2015.

• Blog: It brings me pride to know that Daly City is supportive in doing business with locals by providing free energy audits. 

• Energy Upgrade California® Home Upgrade - Homeowners can improve their home's energy efficiency, increase comfort, and save money by receiving up to $6,500 in incentives and rebates, plus $300 for a home energy assessment.

• Property Assessed Clean Energy (PACE) Financing - PACE makes energy- and water-saving renovations affordable for property owners by providing long-term, competitive financing through an additional property tax assessment. Payments are made through the property tax bill for up to 20 years, and interest is tax-deductible.
• Blog: The two programs described above makes it is easier for the residents to participate in interventions and practices that help to reduce the carbon footprint...they are major incentives.

• Earth Day Event 2016 - Residents are invited to City Hall on Sat., Apr 16th from 10am - 2pm for free document shredding, e-waste drop-off, bulky item recycling, compost giveaway and more.
• Household Hazardous Waste Collection Events - San Mateo County residents can safely dispose of household hazardous waste (HHW) free of charge at a special drop-off collection event at City Hall, at 333 90th Street four times per year.
• E-Waste Recycling Event - Electronic equipment is highly toxic to the environment. Residents may safely dispose of it at two events per year.    
• Document Shredding Event - Two times per year, residents may protect themselves by shredding documents at the City's recycling event.
• Blog: The city supported events described above are convenient and resourceful. I have often wondered how to safely discard unused or obsolete electronics and cleaning products. A major incentive is that it is free to participate in these events.
• 
  

M6.7 Obesogens



Seasonal Foods: A New Menu for Public Health

       In the article "Seasonal Foods: A New Menu for Public Health," the concept and practice of "the Global Food Basket" is discussed. The average "food mileage" or distance for food to travel from the farm to the supermarket is "1500 miles." This impacts the global carbon footprint and increases the consumption of natural and human resources to pick, package, preserve, pick up and drop off. In this article, alternatives to the global food basket was referred to as "Seasonal Foods," which are menus based off of locally grown products and produce. This is an arguably healthier alternative, because it offers variety according to the season, boosts local economies, reduces transportation pollution and other human resources. According to http://www.pickyourown.org/CAharvestcalendar.htm#northerncal, the produce that is in season for March 2017 in Northern California is asparagus. Because we are so fortunate for California's Mediterranean climate, there is a diversity of crops, produce and animals as food sources. California is fertile enough to yield grapes, avocados, corn, berries and most other fruits. Seasonal and local foods are opportunities for cost saving, especially for hospital menus, because it reduces time and costs involved in provider negotiations, transportation, packaging and preservation of the food.

Obesogens: An Environmental Link to Obesity

        Prior to this module and reading the article "Obesogens: An Environmental Link to Obesity," I have never heard of "obesogens." In my pathophysiology courses, genetics, lifestyle and diet were always identified as risk factors for obesity and I am aware of medications and chemicals that alter hormone chemistry in the body that have outcomes of weight gain, but it is interesting to learn that chemicals in the our environment influence our genetic makeup and stimulate genes that cause weight gain and obesity. When an entire generation is identified as having gained weight or having a higher propensity for obesity, it truly signals that something is awry in the environment.

       One of the "obesogens" in the article that I researched on toxnet was "tributyltin" or TBT. Blumberg's study on endocrine disruptors shows that TBT causes sex reversals in fish and that it triggers obesity in one generation of mice. This is significant, because we are exposed on a daily basis to TBT from industrial waste in our water systems that contaminates our food and fish supply that we consume. TBT has been identified as a chemical compound that changes animal metabolism.

       As a healthcare professional, it is important to understand that being overweight and obese is largely influenced on only by lifestyle, diet and genetics, but  now we must take into consideration of the effects of toxins in the environment.

TOXNET: Tributyltin

For other data, click on the Table of Contents

Animal Toxicity Studies:

Evidence for Carcinogenicity:
A4; Not classifiable as a human carcinogen. /Tin, organic cmpd, as Sn/
[American Conference of Governmental Industrial Hygienists TLVs and BEIs. Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices. Cincinnati, OH, 2008, p. 57] **QC REVIEWED**

Non-Human Toxicity Excerpts:

Two classes of tributyltin resistant, spontaneous mutants of Escherichia coli K-12 were isolated, using a cytochrome containing (W 1485) and a cytochrome deficient (SASX76) strain. In contrast to the cytochrome sufficient strain, the cytochrome deficient strain was found to be fifty times more sensitive to tributyltin. The class I mutants, isolated from strain W 1485, also showed cross-resistance to triphenyltin. As compared to its wild type parent, the tributyltin-resistant mutants exhibited mucoid colony type, aberrant cell morphology and reduced uptake of tributyltin. Based on these results, it was suggested that the resistance of class I mutants to tributyltin may be associated with above mentioned alteration. The class II tributyltin-resistant mutants were isolated from the cytochrome deficient strain, SASX76. In comparison to class I mutants, these class II mutants were found to have tributyltin-resistant membrane bound adenosine triphosphatase (ATPase) which may account for their resistance to tributyltin.
[Singh AP, Singh K; Z Naturforsch (C) 39 (3-4): 293-99 (1984)] **PEER REVIEWED** PubMed Abstract

Mud snails, Ilyanassa obsoleta, were collected along gradients of tributyltin pollution in the York River-Sarah Creek region of the Chesapeake Bay. Development of imposex (the imposition of male characters on female snails) was assessed. Frequencies of imposex & intensities of penis expression were either zero or very low at 3 sites in the York River where water concn of tributyltin were of the order of 2 ng/1 liter. In the northwest branch of Sarah Creek, with water concns of around 20 ng/1 liter, the frequency of imposex was 100% & the intensity of penis expression was high. Tissue concns of tributyltin were similar in both sexes & ranged from <20 ng/g 1 dry wt at the 3 York River sites to 620-730 ng/g 1 dry wt at a site in the northwest branch of Sarah Creek. An appreciable degree of imposex is induced in Ilyanassa obsoleta at a seawater tributyltin concn of about 10 ng/1 liter & imposex is probably initiated at about 2 ng/1 liter. No evidence was found for the fertilization of Ilyanassa obsoleta by imposex, but the % of females in the samples declined significantly with incr frequency of imposex.
[Bryan GW et al; Mar Pollut Bull 20 (9): 458-62 (1989)] **PEER REVIEWED**

Contamination of the Firth of Forth (Scotland) by tributyltin cmpds leached from antifouling paints has been identified using the degree of penis development (imposex) in the common dogwhelk Nucella lapillus. In 1987, a high degree of imposex was observed in the vicinity of pleasure craft activity, fishing harbors & a boat yard, reflecting localized inputs of tributyltin from these sources. Dogwhelks collected in 1975 from sites comparable to those surveyed in 1987 showed lower degrees of imposex & also a lower incidence of penis development in females.
[Bailey SK, Davies IM; Sci Total Environ 76 (2-3): 185-92 (1988)] **PEER REVIEWED** PubMed Abstract

The behavioral toxicity of an organic tin cmpd under consideration for use in marine antifouling paint was assessed using a Sidman avoidance paradigm. The assessed cmpd, an organometallic polymer (tributyltin(methacrylic-CO- methylmethacrylate) ester), is from a group of alkyltin cmpds of which triethyl & tributyltin are known to be toxic. Rats were tested under a free- operant avoidance procedure for 6 months while ingesting the polymer in their drinking water. At the beginning of the 5th month significant behavioral changes became evident, reflected in incr in shock rate, decr responding, & a shifting of the interresponse time distribution. Performance improved upon withdrawal of the contaminant suggesting that limited exposure to the polymer may not result in permanent behavioral dysfunction.
[Walsh JM et al; Neurobehav Toxicol Teratol 4 (2): 241-6 (1982)] **PEER REVIEWED** PubMed Abstract

Repeated chronic toxicity experiments were conducted with the Chesapeake Bay zooplankton Acartia tonsa to evaluate its sensitivity to tributyltin. Experiments were initiated with Acartia tonsa nauplii <48 hr old. All tests were conducted with continious flow conditions & measured tributyltin concn. Results from a 9 day range finding experiment & two 6 day chronic experiments are presented. Tributyltin test concns were maintained with minimal fluctuations over time & toxicity results were similar in the repeated chronic experiments. The range-finding experiment demonstrated severe reductions in survival of Acartia tonsa at the lowest measured concn (0.29 ug tributyltin/l) In the 6 day experiments, 0.023 & 0.024 ug tributyltin/l were the lowest measured tributyltin concn to significantly reduce survival relative to the controls (ie, lowest observed effect concn (LOEC)). No observed effect concn (NOEC) measured at 0.012 & 0.010 ug tributyltin/l were used to calculate chronic values of 0.016 & 0.017 ug tributyltin/l for these two experiments. Acartia tonsa nauplii are very sensitive to tributyltin relative to other estuarine organisms. These toxicity data are environmentaly relevant since tributyltin concn exceeding the chronic value for Acartia tonsa have been reported from numerous locations in Chesapeake Bay.
[Bushong SJ et al; Environ Toxicol Chem 9 (3): 359-66 (1990)] **PEER REVIEWED**

The teratogenicity of tri-n-butyltin chloride was examined in Wistar rats. The pregnant rats were admin orally 25, 15, 9, 5 & 0 (Control) mg of tri-n-butyltin chloride/kg bw/day from day 7 to 15 of pregnancy. Maternal toxicity, as evidenced by both of decr body weight gain & food consumption was observed at 25, 15 & 9 mg/kg/day dose group. However, only in the 25 mg/kg/day dose group some clinical signs of toxicity (sedation, diarrhea & salivation) were observed & 70% of the dams were dead. In the 25 mg/kg/day dose group, all fetuses were dead. Statistically significant reductions in the female fetal body weight were observed in 9 & 5 mg/kg/day dose groups. In all groups treated with tri-n-butyltin chloride except the 25 mg/kg/day dose group, no significant differences in the numbers of live fetuses & intrauterine death (dead fetuses & resorptions) or sex ratios of fetuses were found between the tri-n-butyltin chloride treated & control groups. Fetal external, skeletal & internal malformations were not observed at any of the dose levels. However, several types of skeletal & internal variations including delayed ossifications were observed in some groups treated with tri-n-butyltin chloride, but the incidences were not significantly different from controls. Also two fetuses with dilatation of the renal pelvis were found in 9 & 5 mg/kg/day dose group. Statistically significant incr of placental weight in all tri-n-butyltin chloride treated groups were observed when compared to that of control group. In conclusion, tri-n-butyltin chloride admin orally to Wistar rats during days 7-15 of pregnancy produced related signs of fetal toxicity but no evidence of teratogenicity & induced a marked incr in placental weight. /Tri-n-butyltin chloride/
[Itami T et al; Drug Chem Toxicol 13 (4): 283-95 (1990)] **PEER REVIEWED** PubMed Abstract

Imposex, the manifestation of male morphological sex characters in females of functionally dioecious neogastropod taxa, is an abnormal response to tri-n-butyltin contamination introduced to the marine environment in antifouling paints. Since the phenomenon has been thoroughly described only in Atlantic species, a comparative survey of field populations from British Columbia was undertaken, & field studies were carried out to assess the relative value as bionindicators of species in the genus Nucella from the Pacific coast. The majority of neogastropods to date have demonstrable signs of imposex, although this leads to sterilization of females in only a few species, depending on differences in the development in females of pallial vas deferens. Within the Nucella species complex, Nucella lamelloa, Nucella canaliculata, & Nucella emarginata show promise as tri-n-butyltin bioindicators. Only the response of Nucella emarginata, however, was related to tri-n-butyltin bioaccumulation, based on measurements of a limited number of samples. This is attributed to the apparent irreversibility of imposex, the temporal variability of both environmental levels & tissue burdens of tri-n-butyltin, & the considerably shorter life-span of nucella emarginata relative to that of Nucella lamellosa & Nucella canaliculata. The geographic distribution of imposex in Nucella species suggests that water-borne concns of tri-n-butyltin sufficiently high to induce imposex occur over large areas within British Columbia where exchange with oceanic water is limited.
[Bright DA, Ellis DV; Can J Zool 68 (9): 1815-24 (1990)] **PEER REVIEWED**

The ability of organotin cmpds to inhibit gamma-aminobutyric-acid uptake was studied in male Swiss-Webster mice. The cmpds tested were trimethyltin; its tetramethyl, dimethyl, & monomethyl analogs; inorganic tin; triethyltin; tripropyltin; tributyltin; & triphenyltin. To study gamma-aminobutyric-acid uptake, mice forebrains were homogenated, & gamma-aminobutyric-acid or one of the organotin cmpds was added. Ouabain binding was also examined in mice forebrain homogenates. Activity of adenosine-triphosphatase was determined. All organotins containing three carbotin bonds were potent inhibitors of gamma-aminobutyric-acid uptake. Various thiol & sulfur cmpds, particularly sodium-sulfide, were capable of antagonizing the inhibitory effect of triphenyltin, & also the other organotins to a minor degree. All triorganotins also inhibited adenosine-triphosphatase activity. Although a correlation between inhibition of ouabain binding & gamma-aminobutyric-acid uptake by organotins could be found, inhibition of gamma-aminobutyric-acid uptake by the specific inhibitors ouabain & strophantidin was qualitatively & quantitatively different from that by organotins. /It was/ concluded that all triorganotins are capable of inhibiting synaptosomal gamma-aminobutyric-acid uptake by a mechanism involving, but not limited to, inhibition of adenosine-triphosphatase.
[Costa LG; Toxicol Appl Pharmacol 79 (3): 471-9 (1985)] **PEER REVIEWED** PubMed Abstract

Exposure of Nucella lima (gmelin) to seawater or Mytilus trossulus (Gould) fresh containing tributyltin for 4 months resulted in the development of imposex, the superimposition of male reproductive tract characteristerics in female snails, in a time-dependent manner. Specific imposex characteristics measured in female snails included growth of a penis & vas deferens, & an incr in the magnitude of 2 imposex indices, relative penis size & the vas deferens sequence index. Imposex characteristics developed to a similar degree in snails fed tributyltin contaminated mussels (0.362 ug tributyltin/g wet weight) or exposed to 0.064 ug tributyltin/l in seawater by the 2nd month of exposure. After exposure to tributyltin for 4 months, intensification of imposex characteristics continued during a subsequent 10 month recovery period when snails were held in tributyltin free laboratory seawater & fed tributyltin free mussels. No significant differences in mortality & feeding rates occurred between control snails & those exposed to 0.064 ug tributyltin/l seawater or those exposed to tributyltin laden mussels; significant mortality & a decr feeding rate occurred in snails exposed to 0.914 ug tributyltin/l seawater, indicating that this concn is close to the long-term LC50. Tributyltin was bioaccumulated from both food & seawater in direct relationship to concn & length of exposure. Dibutylization of tributyltin occurred at a slow rate in all experimental groups, but a higher proportion of tributyltin was metabolized to dibutyltin & monobutyltin in snails exposed to 0.914 ug tributyltin/1 seawater. For Nucella lima, tributyltin bioaccumulation from food & resulting imposex responses are euivalent to low level exposures to tributyltin in seawater.
[Stickle WB et al; J Exp Mar Biol Ecol 143 (3): 165-80 (1990)] **PEER REVIEWED**

Between April & November, 1985, a study of the levels of organotins in adult & seed Crassostrea gigas grown in the southwest & southeast of England was carried out. This work corresponds with a similar study of organotin water levels (reported separately). The analytical procedure used was directly coupled high performance liquid chromatography-flame atomic absorption spectrometry. Individual adult oysters & groups of 20-40 seed oysters were taken for analysis on a monthly basis. The profiles of tributyltin, dibutyltin & monobutyltin are discussed in relation to each other & levels found in the waters. In general, levels of all three organotin species were found to be higher in the seed oysters. Mean levels of tributyltin reached 3.1 ug g/l in seed oysters from Exe, Devon, in October, whereas mean levels of dibutyltin & monobutyltin reached 16.1 & 16.7 ug g/l in Teign, Devon, seed oysters in October. Bioconcn factors of approx 1000 were found, but seem to be greater when lower levels of tributyltin were present in the water, perhaps indicating a more 'efficient' removal from the water. The degree of shell thickening was calculated for all oysters submitted for analysis. The highest % of adult oysters with severely thickened shells was found at Tollesbury Fleet, where 61% of oysters showed shell thickness index values of six or less. Generally, two peaks in tributyltin levels in the oysters were observed, in the late spring & early summer: these seem to correlate with peak levels of tributyltin in the waters immediately proceeding these times. A large proportion of dibutyltin & monobutyltin found in the oysters seems to come from the metabolism of the tributyltin ingested. It is suggested that high sediment loadings may contribute to the severe deformation of oysters grown at Tollesbury Fleet, but only in the presence of tributyltin.