PEAK food conditions/ Public Health Response

One of the major themes of this semester has been sustainability. The rate at which we are using resources is just simply not sustainable. Humans are straining resources and that's creating issues and challenges. We need to be using resources that are renewable and that are not depleting our earth's natural resources to extinction.

While it may seem like a stretch, Dr. Robert Lawrence, the director of the Center for a Livable Future at the Johns Hopkins Bloomberg School of Public Health, offers some insight into the nature of peak food conditions and the public health implications. He offers big picture items:

 1) Move away from heavy reliance on fertilizer and pesticides

2) Use science to improve food shelf life

3) Reduce refrigeration and freezing 

4) Increase food system energy efficiency and further reliance on renewables

5) Eat less meat, and eat less processed food and reduce long distance fuel transportation

As individuals, Dr.Lawrence recommends the following: eat less meat and dairy; eat more seasonal, low-processed, local, organic food; reduce the number of trips we take to the store; use less packaging and bring our own bags; and waste less food- 40% of food produced gets wasted. While these changes are probably difficult for the average consumer, public health campaigns can do their part to promote behavior change and maintenance of that change. 

We are on a collision course with food insecurity worldwide. As public health professionals, it should be a priority for us to respond to this emerging crisis. Public health implications would include methods to enable the community to make changes and sustain those changes. Public policies should focus on subsidizing healthier foods and making easy for communities to provide organic food options for its pupils. Additionally, federal dollars should be spent to increase public awareness of ways to improve sustainability of food production. 

Finally, the diagram below gives a visual demonstration the potential impact changing diets from animal based to plant based. 

Material Safety Data Sheet (MSDS)

Material Name: Fluorouracil Injection
Trade Name: Fluoroblastin;Fluroblastin;Adrucil
Chemical Family: Mixture
Intended use: Antineoplastic

Health Risks: The health risks associated with this chemotherapy drug include both long term and short term. In the short term, if this drug is absorbed through the skin or if swallowed it can cause systemic effects. In the long term, repeat-dose studies in animals have shown a potential to cause adverse effects on blood and blood forming organs.

Known clinical effects: GI disturbances such as nausea, dyspepsia, and vomiting and gastrointestinal irritation. Effects on blood forming organs are also noted.

Statement of hazard: May impair fertility. May cause harm to the unborn child. May cause heritable genetic damage.

Exposure Control: The material safety data sheet recommends four different kinds of Personal Protective Equipment or PPE. To protect the hands, disposable gloves (double suggested) are recommended if skin contact with drug product is possible and for bulk processing operations. To protect the eyes, safety glasses or goggles are recommended. To protect the skin, the MSDS recommends wearing impervious disposable protective clothing. Finally, if airborne exposures exceed the occupational exposure band range, respirators are recommended.

Training: I have received extensive training on the proper handling of chemotherapy. I have had the opportunity to work in seven different organizations and each time I have gone through orientation, I have received training about proper safety measures when handling chemo drugs. It is well known that chemo drugs are unsafe for pregnant women so nurses who are pregnant or could be pregnant are not given patients receiving chemo just to be extra cautious.

ToxNet Findings: I did not find any discrepancies between what was reported on the MSDS and ToxNet. ToxNet reported some studies that showed less potential for poor outcomes when exposed. However, I did find an interesting section that was not included on the MSDS. ToxNet included a section on signs and symptoms of exposure to fluoroblastin. Toxicity could lead to short term and long term neurotoxicity. Typically, acute neurotoxicity presents itself as an encephalopathy. The good news is that acute toxicity is generally self-limiting and should resolve. Delayed neurotoxicity is immune mediated and typically responds to treatment with corticosteroids. This is important for clinicians to be aware of potential sign/symptoms of toxicity if a patient receiving this drug presents with neurologic problems.

MSDS Tool: I think this is an adequate tool for helping nurses understand proper techniques to reduce their risk of exposure to chemotherapuetic agents. I think a good quality improvement project for local hospitals would be to analyze and update their MSDS tools to include signs and symptoms of toxicity.