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Environmental and Occupational Health

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Assessment of Maternal Occupational Pesticide Exposures during Pregnancy and Three Children with Birth Defects: North Carolina, 2004

Introduction

In August of 2005, the North Carolina Division of Public Health, Occupational and Environmental Epidemiology Branch (OEEB) was notified that three women who had worked on farms in North Carolina owned by Ag-Mart had delivered infants with birth defects.  All three births took place in Florida where the women also worked on Ag-Mart farms and lived near each other.  This report summarizes the OEEB’s investigation and assessment of the pesticide exposures likely experienced by these women while in North Carolina. 

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Fall-Spring Internship Opportunities - Salisbury, MD

MCN’s Salisbury, MD office has an opportunity for an intern to assist in special projects and research related to the Environmental and Occupational Health (EOH) program. The EOH program works to assist frontline providers to integrate EOH practices into primary care to meet the unique healthcare needs of migrant patients. MCN’s EOH efforts involve the development and distribution of clinical and patient education resources, training of clinicians and stakeholders, advocating for environmental justice for migrant and seasonal farmworkers.

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Farmworker Clinical Care Resource for Occupational Health

http://www.farmworkercliniciansmanual.com

This comprehensive manual was developed by the New York Center for Agricultural Medicine and Health and the Migrant Clinicians Network for the diagnosis and treatment of occupational injuries in migrant and seasonal farmworkers. The information in the manual does focus on agricultural occupations in the Northeast.

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Providing Medical Services to Low-Wage Workers with Job Injuries: Model Tools and Instructions for CHCs in California

This booklet is intended to help Community Health Centers put in place an effective and efficient workers' compensation program.

Webinar: The Nuts & Bolts of Cholinesterase Monitoring

Webinar Resources

Presenters

Matthew C. Keifer, MD, MPH, Dean Emanuel Endowed Chair/ Director, National Farm Medicine Center
Carolyn Sheridan, RN, BSN, Clinical Director, AgriSafe Network

CommuniCare

Their Story: 

CommuniCare Health Centers (CommuniCare) is a private, non‐profit community health organization providing health care services to the culturally diverse, low‐income, uninsured, and under‐insured populations of Yolo County and parts of Solano County in California.CommuniCare has worked with MCN to design an environmental and occupational health invention in their extensive perinatal program. CommuniCare first incorporated exposure screening questions into their initial intake encounter. This encounter lasts one hour and is conducted by health educators. The information is compiled for the attending Certified Nurse Midwives (CNM) who use the information to determine risk status and plan the patient’s prenatal care. After piloting a series of questions and assessing the wording and effectiveness, CommuniCare incorporated the following three screening questions into their intake process:

  • What kind of work do you do?
  • What kind of work do members of your household do?
  • Are you now, or have you previously been exposed to pesticides, solvents, or other chemicals, dusts, fumes, radiation, or loud noise?

If the patient presented with a specific problem the following questions were asked:

  • Do you think your health problems are related to your home or other location?
  • Do you think your health problems are related to your work?
  • Are your symptoms better or worse while you are at home or at work?

CommuniCare also altered the format of their charts to allow for space to document responses to the screening questions. If the screening noted possible risks, the charts were flagged and the CNM conducted a more thorough environmental and occupational history. CommuniCare also implemented a system to facilitate reporting and consulting with or referring patients to an Occupational-Environmental Health Specialist. In addition, CommuniCare made resources such as the California Birth Defects Monitoring System and the Pregnancy Risk Information Line more readily available to clinicians. In addition to these clinical systems changes, CommuniCare also incorporated patient education into the initial prenatal visit and the post partum visit. MCN facilitated a specific training for the health educators to help them with the integration of the pesticide screening questions into their intake process and understand ways to promote pesticide safety education with their patients. CommuniCare health educators received MCN’s comic book, Lo Que Bien Empieza… Bien Acaba, to use during the initial visit. Designed for women of reproductive age, the comic book discusses the problem of pesticide exposure, health effects of exposure, and ways to prevent it. To use in the post partum visit, MCN gave CommuniCare, Aunque Cerca… Sano, a comic book to help farmworker families minimize the risk of pesticide exposure. Focusing on children, this comic book explains the problem of pesticide exposure, the health effects associated, and methods for prevention.

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MCN's Lead Exposure Screening Form for Pregnant Migrant Women

Bilingual form to screen pregnant women for lead exposure.  Developed by MCN.

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MCN's Lead Clinical Guidelines for Migrant Pregnant Women

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Rapid Clinical Assessment Tool for Adolescent Farmworker Injury and Exposure

Use the link below to access MCN's Rapid Assessment Tool to help adolescent farmworkers identify agricultural tasks they perform in agriculture and facilitate clinician understanding about the health risks associated with it.  Youth worker images are adapted and reproduced with permission from the National Children Center for Rural and Agricultural Health and Safety. Images copyrighted through Marshfield Clinic, Marshfield, Wisconsin.

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MCN Pesticide Exposure Clinical Guidelines and Assessment Form

MCN's Pesticide Clinical Guidelines and Pesticide Exposure Assessment Form assist in the recognition and management of acute pesticide exposures in primary care settings.

The pesticide guidelines were adapted from guidelines developed by Dr. Dennis H. Penzell, a former medical director of a Community and Migrant Health Center with experience in large-scale pesticide exposure incidents.

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