Environmental Neurotoxicology (1992) / Chapter Skim
Currently Skimming:
5. Surveillance to Prevent Neurotoxicity in Humans
5. Surveillance to Prevent Neurotoxicity in Humans
Pages 95-110
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 95... ...
The methods of postmarketing secondary prevention of environmental neurotoxic disease include environmental monitoring and surveillance of the human population to detect neurotoxic disorders as early as possible, which are combined with efforts to keep potentially toxic exposures to a minimum. Epidemiologic studies and clinical screening are complementary facets of maintaining alertness so that neurotoxic illness will not go unnoticed.
|
From page 96... ...
Although toxicologic information derived from future in vitro and in viva investigations might be expected to form an ever-increasing proportion of the neurotoxicity data base, responsibility to conduct epidemiologic surveillance, to monitor toxic exposures, and to study incidents of human exposure to neurotoxicants when they occur will remain. Surveillance and monitoring play oversight or exploratory roles.
|
From page 97... ...
Much knowledge about neurotoxicants and neurotoxic disease has, however, come from observation of humans— from case reports to large-scale epidemiologic studies. Most reports of outbreaks of necrologic diseases have come from medical clinics, state health departments, industrial medical groups, or consultative programs, such as the Health Hazard Evaluation Program of the National Institute for Occupational Safety and Health (NIOSH)
|
From page 98... ...
98 Is c .= in ,o ~ 0 ~ ~ ~ ~ · - O ~ I; ~ E - E, ~ c, Em .~ A ~ a .< ,, 3 ~ it, ~ O ~ O O c, ~ O Z E E e E, p 0 0 ° it, ° ° c E ca ce of o o can o 4_ so can o o u, o cat o .Q .e ce m ~ o ._ ~ U
|
From page 99... ...
99 · o ~ cd ~ c ~ At c ~ ~ am ~ 9' 9 ~ ~ E D ~ 9 ~ ' 9 ' F A s ~ ° $-4 o o o o o ~ o o ~ ~ ~ ~ o o ~ o ~ ~ ~s, ~ c sit c o 0 E V)
|
From page 100... ...
100 TABLE 5-2 Components of Clinical Neurologic Examination ENVIRONMENTAL NEUROTOXICOLOGY General appearance Tremor—arms outstretched and at rest Ability to sit still Speech—clear, slurred Gums, nails, color of skin Vital signs Cranial nerves I Sense of smell tested II Funduscopic examination, disk margins, visual acuity, visual fields III Pupil size and reactivity to light; extraccular movements—nystagmus IV Extraecular movements V Pin and touch over face, corneal reflex VI Extraocular movements VII Symmetry of facial movement VIII Hearing acuity, vestibular function IX-X Presence of gag reflex, ability to swallow XI Symmetry of shoulder built and movement XII Tongue: midline presence of atrophy or abnormal movements Motor examination Presence of atronhv. fasciculations.
|
From page 101... ...
Specific monitoring or screening devices (e.g., the Optacon and the Vibratron II for assessment of vibratory sensitivity and NTE II to detect losses in temperature sensitivity) have successfully identified neuropathy at the preclinical stage (Arezzo and Schaumburg, 1980, 1989~.
|
From page 102... ...
memory Sternberg Memory Test Paired associates Short-term memory Long~term memory C World Health Organization Neurobehavioral Core Test Battery (NCTB)
|
From page 103... ...
The field needs to develop a comprehensive rationale for the development of a neurotoxicity screening battery. Ideally, it would be based on the functions of the nenous system and the range of potential neurotoxic effects, and that is not yet possible.
|
From page 104... ...
Although those test batteries appear to be best suited to assessments of neurotoxic exposures in humans, their usefulness needs constant examination in light of new types of neurotoxicity, possible changes in the most frequently reported health effects (as chemical use shifts) , and new cognitive or neurobiologic theories of nervous system function.
|
From page 105... ...
When the objective is to assess broad trends in population exposure to neurotoxicants and to gather information on groups potentially at risk, selection of an appropriate surveillance strategy will depend on the expected degree of toxicity of the chemicals under study, the size of the exposed population, and the intensity of exposures. In essence, hazard or exposure surveillance consists of obtaining information on the distribution and use of chemicals, on the distribution of exposures, and on the size and distribution of the exposed population.
|
From page 106... ...
on every death in the country through the National Death Index The basic data on death certificates are fairly uniform across states, and demographic ENVIRONMENTAL NEUROTOXICOLOGY cause-of-death information and some occupational data are almost always available. Occupational data are of uneven quality, which usually depends on whether anyone uses them for research purposes.
|
From page 107... ...
It requires careful comparison between observed physical and temporal patterns of exposures to possible toxicants and the occurrence of the cases. 107 The NIOSH Health Hazard Evaluation Program and similar activities of academic or government groups provide mechanisms for rapid evaluation of reported outbreaks and can therefore confirm initial reports of a possible neurotoxic problem.
|
From page 108... ...
codes to derive mortality rates for as small an area as a county, which would be a step toward identifying geographic areas with increased incidences of sentinel diseases. The industrial or occupational information routinely entered on death certificates is encoded on higher-level, more easily retrievable records in only a few states, however, and that dim~n~shes the usefulness of the SHE(O)
|
From page 109... ...
, OSHA compliance monitoring, health-hazard evaluations, and similar programs can be reviewed to identify occupational and industrial groups with the potential for substantial exposure. Another group of persons for potential followup consists of patients (probably of HMOs)
|
From page 110... ...
PET scanning has been used in diagnosis of neurotoxicity in people exposed to MPTP (Caine et al., 1985~. At present, however, PET and MRI are not routine screening tools.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.