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National Pesticide Practice Skills Guidelines for Medical & Nursing Practice

Outlines the knowledge and skills that health professionals need to have about pesticides. This document is part of a national initiative aimed at ensuring that pesticides issues become integral elements of education and practice of primary care providers. English and Spanish


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Organophosphate Pesticides and Child Health

A web-based CME course offers health care providers up-to-date scientific information regarding health risks for children exposed to OP pesticides.


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AOEC Pesticide Training Modules for Training Clinicians


Occupational and Environmental Health Concerns: Reproductive Health Among Florida Farmworkers

Time: 5:00 PM – 6:00 PM EST Description

Health care providers who serve farm communities can positively affect workers’ health through greater understanding of the occupational exposures and risks faced by pregnant women in the agricultural workforce.  A community-based participatory research (CBPR) study was consucted with a partnership between investigators from Emory University, the University of Florida, the Farmworker Association of Florida, and the Farmworker Health and Safety Institute. 

New ACOG Resource Calls for Clinician Responsibility in Preventing Environmental/Occupational Health Risks for Women

The Migrant Clinicians Network (MCN) is pleased to receive support of our mission to be a force for health justice for the mobile poor from the American College of Obstetricians and Gynecologists (ACOG).  A recent ACOG Committee Opinion entitled Exposure to Toxic Environmental Agents - produced in collaboration with the University of California, San Francisco Program on Reproductive Health and the Environment - makes a strong case for the clinician’s role in promoting environmental justice for our female patients.

The statement includes a clear focus on the disproportionate harm from environmental and occupational exposures to toxic chemicals suffered by “vulnerable and underserved populations” with the recognition that “low-wage immigrant populations disproportionately work in occupations associated with a hazardous workplace environment.”

In the opinion, the Committee presents a review of the research linking the impact of toxin exposure to adverse health outcomes for women of all ages and states that the link is “sufficiently robust,” calling on clinicians to take action, especially in the care of pregnant women.  The forms of action recommended in the discussion include:

1) Bolstering healthcare professionals’ knowledge about environmental health risks;

2) Including an exposure history in perinatal care;

3) providing patient education regarding avoiding exposure to toxins; and

4) following reporting requirements for identified exposures. 

Finally, the document urges clinicians to become involved in influencing policy related to exposure of women to environmental toxins through advocacy.

For clinical and patient education resources relevant to the migrant population, please explore the MCN's Environmental and Occupational Health related Tools and Resources as well as the resources linked to the ACOG Committee Opinion

MCN welcomes the support of other organizations in highlighting the important role that clinicians have in promoting the health of women and their babies by helping to prevent exposure to environmental and occupational hazards. 

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Exposure to toxic environmental agents.Committee Opinion No. 575.American College of Obstetricians and Gynecologists.ObstetGynecol 2013; 122:93, 1-5.

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EPA's New Pesticide Resource Includes Expanded Content, Features MCN

Your patient reports stomach pain, nausea and headache. It’s nearing the heart of flu season - these are possible flu symptoms, you think. On examination, the patient doesn’t present with a fever.

“Is anyone at home sick?” you ask.   


“When did the symptoms begin?” 

Hoy (Today).

You notice the patient appears to be dressed for work. “Where were you when the symptoms began?” you ask.

En el trabajo (At work).  

At work, you think. “And what do you do for work?”

Cosecho sandia (I harvest watermelons). 

Watermelons, you think. That’s it. The answer is now becoming clearer.

“Do you or does anyone else use pesticides or other chemicals at work?”

Sí. Ellos usan pesticida y la aplicaron pesticida en la mañana (Yes. They use pesticide and they sprayed it this morning.)

Upon completing the occupational history and consulting with outreach staff, you learn it was likely that your patient was exposed to a Diazinon-based organophosphate insecticide.

Watermelon Toss

So now what do you do to effectively treat the exposed patient?

EPA’s updated comprehensive manual for healthcare providers on pesticide toxicology, diagnosis, and treatment helps to take the guess work out of providing effective care for the pesticide-exposed patient.

The Recognition and Management of Pesticide Poisonings, 6th Edition provides clinicians with the tools to conduct environmental and occupational exposure screenings for patients with suspected pesticide-related illnesses or injuries and to report pesticide exposures to appropriate agencies. It also provides access to the most up-to-date pesticide information and resources to make the diagnosis and follow the proper course of treatment.  

Pesticides and other chemical and physical hazards are often associated with nonspecific medical complaints. This can often make it difficult to diagnose pesticide-exposed patients.

“If a patient is thought to have been exposed to a specific pesticide, the clinician can go to the specific chapter,” explains Dr. Jimmy Roberts, who co-authored the updated pesticide manual with Dr. J. Routt Reigart.

And when pesticide poisoning is suspected based on the clinical presentation, but the active ingredient has not been identified, Roberts explains, the index of signs and symptoms found in the Recognition and Management text can help clinicians identify the pesticides that cause the symptoms.

A Need for Pesticide Clinical Resources

Despite an increasing need for frontline clinicians to be prepared to respond to environmental and work related-health concerns – including pesticide exposures – the reality is that in 2013 most primary care providers receive little if any environmental and occupational health education in their training, explains MCN’s Chief Medical Officer, Dr. Ed Zuroweste.

“Publications like this can ‘fill the gap,’” Zuroweste says.  “If we are to provide quality health care to the hardworking individuals who put food on all of our tables, using this text is imperative.”

The updated manual provides signs and symptoms of exposure for both adult and pediatric cases.

Candace Kugel, a certified nurse midwife and MCN’s Women’s Health Specialist, describes the updated Recognition and Management of Pesticide Poisonings as the reference related to pesticide effects for the clinical setting.  Kugel recommends that clinicians become familiar with the tools and organizations outlined in the manual that can provide decision support when treating pesticide-exposed patients.

Amy K. Liebman, MCN’s Director of Environmental and Occupational Health, co-authored the chapter, “Making the Diagnosis,” along with Dr. Geoffrey Calvert. The chapter provides an overview of how to take an exposure history, along with specific information on the type of tests and samples to obtain when evaluating a patient with suspected pesticide poisoning.

Identifying farmworker patients and screening these patients to obtain their occupational and exposure history can help to raise the index of suspicion of a possible pesticide exposure.

"It is vital that we screen farmworkers for possible pesticide exposure, that we provide appropriate treatment, and that we report these exposures to the appropriate agencies in our states"

- Dr. Ed Zuroweste

New to the manual is a chapter on the chronic effects of pesticide exposures.  The “Chronic Effects” chapter gives an overview of possible linkages between pesticide exposure and chronic illnesses, including cancers and behavioral disorders.

According to Dr. Roberts, the chapter is intended to give clinicians more information about pesticide exposures and their relationships to various chronic outcomes.

"It is a matter of providing increased awareness," Roberts said. "The data can serve as a powerful counseling tool, particularly for the prenatal period and for occupational exposures."

Most women working in agriculture are of reproductive age and our knowledge about the effects of pesticides on reproductive health is limited, Kugel explains.

“There is sufficient concern about birth defects, the potential for decreased fertility, and other impacts [on reproductive health] to warrant screening and education of farmworker women related to pesticide exposure,” Kugel says.

Workers and Health Program

MCN's Workers and Health program partners with health centers across the US to incorporate a focus on the recognition and management of environmental and occupational health exposures. Dr. Roberts serves as faculty for this program, training clinicians on pesticide toxicology and the treatment of pesticide exposures.

MCN’s Liebman, who directs the program, works alongside health centers incorporate guidelines and protocols to prepare clinicians to provide effective care for exposed patients. In addition, the program provides clinical and outreach staff with training and resources to help ensure high quality, culturally competent care for migrant and immigrant workers and their families.

Free hard copies of the Recognition and Management of Pesticide Poisonings, 6th Edition are available for order here, along with a complete pdf version available for download.

Visit MCN’s EOH page to learn more about our health center partnership program and other EOH initiatives. On our Pesticides page you can find clinical tools and resources related to the recognition and management of pesticide exposures.

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Webinar Presentation Slides: Workers and Health - How Frontline Providers Make a Difference in the Protection of Migrant Farmworkers and their Families

Part 4 of 7 webinars in the CLINICIAN ORIENTATION TO MIGRATION HEALTH series.

DATE RECORDED: May 15, 2013

PRESENTERS: Amy K. Leibman, MPA, MA, Director of Environmental and Occupational Health, Migrant Clinicians Network

Dr. Mike Rowland, MD, MPH, Vice President, Medical Affairs and Medical Director, Occupational Health, Franklin Memorial Hospital


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