Environmental Health & Lead Clinic Rotation Materials

The following information, files, and links will be useful to medical students and residents doing a rotation in the Environmental Health and Lead Clinic at Cincinnati Children's Hospital Medical Center. Many of the patients seen in this clinic have either subclinical or overt lead poisoning. We also see children with other exposures such as mold, other heavy metals, carbon monoxide, concerns regarding indoor air quality, and pesticides.

The minimal objectives for this clinic rotation:

  1. See a functioning example of a collaboration between clinical medicine and public health
  2. Learn how to obtain an environmental health history
  3. Learn how to respond appropriately to an elevated blood lead level

Location: The clinic is physically located at 3430 Burnet Ave., 2nd floor in the consult clinics area (near the elevators by the welcome desk)


Schedule: Thursdays 8:30AM-5:00 PM in the CCHMC MOB; there is also clinic on the 1st, 3rd, 5th Tuesday afternoons Cincinnati Children's Liberty Campus. For locations and directions to these satellite locations click here: https://www.cincinnatichildrens.org/patients/visit/directions

Critical files and links for the clinic rotation
Clinic survival guide including information about accessing Epic EHR in our clinic as well as the Environmental Health
History template *** MUST READ***
Download file "Survival Guide.pdf"
These files are the orientation files for the Occupational/Environmental Medicine Residents ***MUST READ for OEM Rotators***
Download file "OEM Rotator Orientation Guide.pdf"
Download file "OEM Rotation Goals and Objectives ACGME.pdf"
Good review article on Pediatric Environmental Health (lead, pesticides, indoor air quality, etc):
Download file "Karr_PIR_2011.pdf"
Pediatric Environmental Health Specialty Units medical management guidelines for lead exposure in children:
Download file "PEHSU Fact Sheet.pdf"
Current Ohio Recommendations on lead screening and management:
Download file "BloodLeadTestingRequirementsandZipCodes.pdf"
Download file "MedicalManagementGuidelines.pdf"

Just in case you thought that lead poisoning was recently discovered, here's a link to Benjamin Franklin's letter on lead poisoning. Believe it or not, some of these same sources of lead exposure are still around today.

The Pediatric Environmental Health Toolkit was created by the Greater Boston Chapter of Physicians for Social Responsibility and is a useful "go-to" guide. There is also a mobile-enabled version here.




Videos on Pediatric Environmental Health
- For those who would rather watch a video instead of reading review articles, here are some links to relevant materials.
UC website with environmental health lectures. This is a quick and easy introduction to Pediatric Environmental Health that I presented at UC: http://eh.uc.edu/cares_retired/learn/physicians/Pediatric_Environmental_Health.htm
- A short video on YouTube from Dr. Bruce Lanphear, former director of the Children's Environmental Health Center at Cincinnati Children's Hospital (now currently at Simon Fraser University in Vancouver, BC)

Toxicant-specific and other resources

Lead
- Straight forward review article on lead poisoning with clinical examples:
http://www.contemporarypediatrics.com/pediatrics/lead-poisoning-whats-new-about-old-problem

- CDC Document "Educational Interventions for Children Affected by Lead - This document describes the evidence behind lead on children's educational function and outlines recommendations for children affected by lead. Although the document is about 50 pages, the Executive Summary (3 pages) is a good starting point
https://www.cdc.gov/nceh/lead/publications/Educational_Interventions_Children_Affected_by_Lead.pdf

Mold
- Institute of Medicine document on damp indoor environments https://www.ncbi.nlm.nih.gov/pubmed/25009878

Indoor Air Quality/Asthma
- The Community Guide (CDC) based review "Asthma: Home-Based Multi-Trigger, Multicomponent Environmental Interventions - Children and Adolescents with Asthma" https://www.thecommunityguide.org/findings/asthma-home-based-multi-trigger-multicomponent-environmental-interventions-children-and

Communication to communities regarding environmental health
- Introduction to message maps and public perception of environmental hazards related to World Trade Center attacks
Galvez MP, Peters R, Graber N, Forman J. Effective risk communication in children's environmental health: lessons learned from 9/11. Pediatr Clin North Am. 2007 Feb;54(1):33-46, viii. PubMed PMID: 17306682. https://www.ncbi.nlm.nih.gov/pubmed/17306682
- Communicating biomarker results to study participants
Haynes EN, Elam S, Burns R, et al. Community Engagement and Data Disclosure in Environmental Health Research. Environmental Health Perspectives. 2016;124(2):A24-A27. doi:10.1289/ehp.1510411.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749085/

Additional useful websites:
Ohio Department of Health Healthy Homes Program
http://www.odh.ohio.gov/odhprograms/cfhs/healthyhomes/healthy1.aspx
City of Cincinnati Lead Poisoning Prevention Program
http://www.cincinnati-oh.gov/health/environmental-health/lead-poisoning-prevention-program/
Cincinnati Children's Hospital Medical Center Environmental Health and Lead Clinic website
http://www.cincinnatichildrens.org/service/e/environmental-health/default/

Information and video about urban gardens in Cincinnati

http://healthnews.uc.edu/news/?/14216/

The long legacy of tetra ethyl lead - Robert Kehoe, MD and Clair Patterson, PhD:

Brief summary from the UC Library Blog regarding Robert Kehoe, MD, one of the earliest lead researchers at the University of Cincinnati:

http://libapps.libraries.uc.edu/liblog/2016/12/but-what-about-robert-kehoe/

Highlights regarding the tireless advocacy of Clair Patterson, PhD to reduce exposure to lead in gasoline

https://publish.illinois.edu/clair-patterson/fighting-for-a-clean-earth/

Home lead test kits are not sensitive enough to detect floor dust lead levels to protect children's health (see Korfmacher and Dixon, Environmental Research, 2007)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2170477/

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