⌛ Orange Corporation Case Study
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Primary prevention of lead exposure has been particularly emphasized in almost all of them. Some call for revised standards for lead in air, house dust, soil and water [ 12 , 61 , 62 , 63 ]. The chief causes of lead exposure are nicely summarized by Levin and colleagues [ 64 ]. Unfortunately, childhood lead poisoning prevention is often deemed to be not important enough to work on, with other pressing medical and public health problems intervening; it is also complicated, complex and involves many stakeholders.
Thus, the clinicians, government officials, and public health officials looking for a quick fix and a one-prescription answer to this medical problem are often disappointed and discouraged. Concern about the neurotoxic effects of lead has been expanded now to include the neurotoxic effects of many more new chemicals out in use by the American public, including children. Some authors have weighed in on the need for more control of the manufacture and use of these toxicants and for more research into adverse health effects [ 31 , 65 , 66 ].
In , a unique group of research scientists, clinicians, government representatives, and health care advocates met to form the Project TENDR Targeting Environmental Neurodevelopmental Risks which focuses on engendering action to prevent exposure of fetuses, infants and children to environmental toxicants [ 67 ]. The group has created a list of five chemical classes of neurotoxins which have adverse effects on brain development. The list includes lead, specific air pollutants, organophosphate pesticides, phthalates, and polybrominated diphenyl ethers PBDEs , which are flame retardants. These were selected based on the degree of evidence for their adverse effects and the ability of this group and other scientists, clinicians, government officials, and advocates to work effectively to prevent exposures to these toxicants.
Later this year, the group will release specific recommendations for prevention of exposure to the five chemical groups. The recent passage of the Frank R. This is a step in right direction for better control of exposures to lead and other toxic chemicals in our environment. How do we remedy the situation in Flint, Michigan, and prevent future episodes similar to the Flint and Navajo Nation disasters? The Flint Water Task Force recommends that the MDHHS establish a Flint Toxic Exposure Registry to follow-up on the children and adults who were residing in Flint from April until the present, and carry out more aggressive clinical and public health follow-up for all children with elevated BLLs in the state [ 29 ].
Hanna-Attisha has established the Flint Child Health and Development Fund which will support children and their families to obtain the optimum health and development outcomes, early childhood education, access to a pediatric medical home, improved nutrition and integrated social services [ 6 ]. This type of close follow-up has been recommended under the Flint Recovery and Remediation section of the Flint Water Task Force, as well as a recommendation to establish a dedicated subsidiary fund in the Michigan Health Endowment Fund for funding health-related services for Flint residents [ 29 ]. Several recent publications support the positive effects that enriched home environments can have on cognition and behavior in both human and animal studies [ 74 , 75 , 76 ].
Secondly, government agencies at the federal, state and local level and municipal authorities will need to improve their performance to ensure environmental justice, rather than contribute toward environmental injustice. This was mandated in an Executive Order by President William Clinton which requires all federal agencies to take action to ensure environmental justice [ 77 ]. Other groups, authors and reports have weighed in on what needs to be fixed and carried out, as indicated earlier in this article. Looking at the Flint case specifically, why was the water supply switched in Flint? The evidence seems to point to financial reasons for this. In Flint, state officials decided to save money without concern for providing environmental protections for a community at well-established increased risk.
This is clear injustice in environmental protection to a low income and minority community. In short, this crisis was the result of failures on every level. We have presented various comments about how environmental racism and injustice played into this situation. Why were the concerns and complaints about water quality from a mostly African-American community not addressed? The facts presented demonstrate that environmental injustice is the major and underlying factor involved in the events in Flint.
Having a state-appointed emergency manager in charge took away the normal communication the City of Flint might have had with its residents and constituents. The Flint Water Task Force has a list of 44 recommendations, mostly directed at the various agencies and offices involved, for improving the situation and preventing further problems [ 29 ]. Perhaps putting the Flint situation under a microscopic analysis may prevent future episodes of such environmental injustice. We must do a better job at moving forward and preventing environmental injustice; our future work is cut out for us. The concept of the paper was developed by all of the authors.
Carla Campbell performed the lead writing. Rachael Greenberg, Deepa Mankikar and Ronald Ross contributed references, edited the paper, and contributed to the revisions. All authors reviewed the article and approved the final content. National Center for Biotechnology Information , U. Published online Sep Ross 4. Ronald D. Paul B. Tchounwou, Academic Editor. Author information Article notes Copyright and License information Disclaimer.
Received Jul 5; Accepted Sep This article has been cited by other articles in PMC. Keywords: environmental justice, lead poisoning, water contamination, Flint water crisis. Description of the Flint Water Crisis At this point, most Americans have heard of the avoidable and abject failure of government on the local, state and federal level; environmental authorities; and water company officials to prevent the mass poisoning of hundreds of children and adults in Flint, Michigan from April to December [ 1 , 2 , 3 ].
Elevated Blood Lead Levels in US Children and the Adverse Health Impacts and Costs of Exposure Lead exposure in young children can lead to decrements in intelligence, development, behavior, attention, and other neurological functions. Conclusions In short, this crisis was the result of failures on every level. Author Contributions The concept of the paper was developed by all of the authors. Conflicts of Interest The authors declare no conflict of interest. References 1. Dixon J. How the crisis unfolded. Detroit Free Press. Jan 24, Ganim S. Environmental Protection Agency. Edwards M. Elevated blood lead in young children due to lead-contaminated drinking water: Washington, DC, — Renner R. Out of plumb: When water treatment causes lead contamination. Health Perspect.
Nakamura D. Water in D. Hanna-Attisha M. Elevated blood lead levels in children associated with the Flint drinking water crisis: A spatial analysis of risk and public health response. Public Health. Landrigan P. American Academy of Pediatrics Policy statement—Prevention of childhood lead toxicity. Lanphear B. The impact of toxins on the developing brain.
Campbell C. Public health and law collaboration: The Philadelphia lead court study. Bellinger D. A strategy for comparing the contributions of environmental chemicals and other risk factors to neurodevelopment of children. In October , the third patient, a year-old female, was diagnosed with hyperthyroidism after presenting with tachycardia, mood swings and fatigue. The patient is under steady surveillance for early detection of other features of the autoimmune polyendocrine syndrome. The autoantibody titres are not always helpful. A review by Saravanan and Dayan 3 summarising the immunobiology, assay methodology and prevalence in thyroid diseases of each of the major thyroid autoantibodies provided estimates of the prevalence of such antibodies see Table 1.
The classic sonographic finding of autoimmune thyroiditis is a hypoechoic echo texture of the thyroid. In Hashimoto thyroditis with a normal clinical course, the chronic inflammation leads mostly to atrophy of the thyroid with an indolent thyroid reduced in size, displaying a non-homogeneous hypoechoic texture see Figure 4. If Hashimoto thyroiditis is diagnosed at an early stage, the thyroid is a normal size and hypoechoic areas occur in a diffuse pattern.
Elevated thyroglobin values may be helpful as an indication of the destruction of the thyroid follicles. However, this investigation is usually not necessary. Data on the possible incidence of hashitoxicosis are rare and such observations are often published as case reports. Nabhan et al. Of 69 patient with autoimmune thyroiditis, eight were diagnosed with hashitoxicosis The duration of hyperthyroidism ranged from 31 to days.
Only one of the eight patients had been treated with methimazole; the others were treated with a beta-blocker or not at all. The authors tried to identify factors predisposing to the development of hashitoxicosis, such as sex, age, family history, thyroid hormone levels, anti-thyroid antibody titres, J thyroid scan results and presenting features. Increase share of wallet. Decrease time to market. Uncover breakthrough insights. Discover unmet needs. Drive action across the organization. Run world-class research. Find experience gaps. Take action on insights. Integrations with the world's leading business software, and pre-built, expert-designed programs designed to turbocharge your XM program. World-class advisory, implementation, and support services from industry experts and the XM Institute.
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