Introduction to the Mid-America Pediatric Environmental Health Unit (MAPEHSU) Jennifer Lowry, MD Co-Director, MAPEHSU University of Kansas Medical Center Kansas City, KS

WHAT IS A PEHSU? PEHSU program established in 1998 A PEHSU site is comprised of collaboration between an AOEC Occupational & Environmental Medicine Clinic and supporting institution’s pediatric department PEHSU staff include a project director, OEM physician, pediatrician, project coordinator and other specialists. Goal is to increase awareness and knowledge of pediatric environmental health

PEHSU Locations Region 1: Boston, MA Region 2: New York, NY Region 3: Washington, D.C. Region 4: Atlanta, GA Region 5: Chicago, IL Region 6: Tyler, TX Region 7: Kansas City, KS Region 8: Denver, CO Region 9: Irvine & San Francisco, CA Region 10: Seattle, WA Alberta, Canada Morelos, Mexico

Insert PEHSU Map It is on a separate PPT file

5 Pediatric Environmental Health Specialty Units (PEHSU) The objective of the PEHSU Program is to increase the knowledge base of pediatric environmental medicine by providing a forum for environmental specialists and pediatricians to combine knowledge for the purpose of providing : l Education l Consultation l Referral

PEHSU BEGINNING 1996 ATSDR Child Health Initiative 1996 to 1998 PEHSU Program Catalyst –Methyl Parathion Exposure in 400+ children –Mercury Exposure 1998 first 2 PEHSU sites formed in Seattle, WA and Boston, MA.

PEHSU Purpose The overall purpose of the PEHSU program is to bring together the environmental and pediatric specialties to include not only pediatricians, but also primary care providers such as family medicine physicians, nurse practitioners and nurses

PEHSU Structure The structure of PEHSU sites is built around an arrangement between an Occupational and Environmental Medicine Clinic (an AOEC member clinic) and a supporting institution’s pediatric department. Generally, a PEHSU is located within an academic institution.

PEHSU SERVICES l Consultation – Provides clinical/medical consultation to practicing clinicians and health officials l Education/Outreach – Provides pediatric environmental health education to practicing clinicians/health professionals, clinical trainees and the general public l Referral – Provides referral to public health agencies and clinical sub-specialists with interest in pediatric environmental health

Funding and Program Management of PEHSU Program Agency for Toxic Substances Disease Registry (ATSDR) U.S. Environmental Protection Agency (EPA) Association of Occupational & Environmental Clinic (AOEC) provides program management

What is the MAPEHSU? Serve EPA Region 7 (Iowa, Kansas, Nebraska and Missouri) Serve health care professionals and general public Consultation –To physicians and health care providers Referral –To health agencies with an interest in pediatric environmental health Education Outreach Partnership with regional Poison Control Centers

Activities to Date School bus particulate matter and health effects on school children grant, April 2005 Pediatric Environmental Health Conference, December 2005, Kansas City, MO Web-based CME program, anticipated availability December 2005 Educational presentations and exhibits at professional conferences Sponsor of EPA Region 7 Indoor Air Quality Conference, October 2005 Consultation with ATSDR, EPA and health departments

Poison Control Center Data (2003 ) Leading Toxic Exposures in children –Cosmetics/personal care products –Analgesics –Cleaning substances (household) –Cold and cough preparations –Topical preparations –Pesticides –Antidepressants –Foreign bodies/toys/miscellaneous –Plants –Antimicrobials

Cleaning Substances (Household) Leading toxic substances –Hypochlorite bleach –Isopropanol glass cleaner –Carpet/upholstery cleaner –Alkali wall/floor/tile cleaner –Granular dishwasher detergent –Granular laundry detergent –Liquid/gel dishwasher detergent –Anionic/nonionic miscellaneous cleaner –Alkali miscellaneous cleaner –Unknown miscellaneous cleaner

Plants Leading plant exposures –Oxalates –Dermatitis –Gastrointestinal irritant –Amygdalin/cyanogenic glycoside –Solanine –Cardiac Glycosides –Hallucinogenic –Other toxic –Non-toxic –Unknown toxic or if toxic

Pesticides Leading Toxic Exposures –Anticoagulant: superwarfarin –Insect repellant with DEET –Borate/boric acid –Pyrethroid –Organophosphate –Carbamate –Insect repellant without DEET –Naphthalene –Chlorophenoxy –Other insecticide

Foreign body/toys/miscellaneous Leading Exposures –Dessicants –Small toys –Glow products –Mercury thermometers –Feces/urine –Bubble blowing solution –Soil –Coins –Other

Our Team –Jennifer Lowry, MD (Toxicologist) –Kathryn Veal, MD, MPH (Pediatrician) –H. William Barkman, MD, MSPH (Occupational Medicine) –Mary Walker, Project Coordinator (800) toll free in EPA Region 7 website: www2.kumc.edu/mapehsu address: