The study of poisons. (See also poisoning.)
Nutritional Profile Energy value (calories per serving): Low Protein: Moderate Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Moderate Sodium: Low Major vitamin contribution: Vitamin A (sour cherries), vitamin C Major mineral contribution: Potassium
About the Nutrients in This Food Cherries have moderate amounts of fiber, insoluble cellulose and lignin in the skin and soluble pectins in the flesh, plus vitamin C. One cup fresh red sweet cherries (two ounces, without pits) has 3.2 g dietary fiber, 64 IU vitamin A (.2 percent of the R DA) and 10.8 mg vitamin C (14 percent of the R DA for a woman, 12 percent of the R DA for a man). One-half cup canned water-packed sour/tart cherries has 0.5 g dietary fiber and 1.5 mg vitamin C, and 377 IU vitamin A (16 percent of the R DA for a woman, 13 percent of the R DA for a man). Like apple seeds and apricot, peach, or plum pits, cherry pits contain amygdalin, a naturally occurring cyanide/sugar compound that breaks down into hydrogen cyanide in the stomach. While accidentally swallow- ing a cherry pit once in a while is not a serious hazard, cases of human poisoning after eating apple seeds have been reported (see apples). NOTE : Some wild cherries are poisonous.
The Most Nutritious Way to Serve This Food Sweet cherries can be eaten raw to protect their vitamin C; sour (“cook- ing”) cherries are more palatable when cooked. * Except for maraschino cherries, which are high in sodium.
Diets That May Restrict or Exclude This Food Low-sodium diet (maraschino cherries)
Buying This Food Look for: Plump, firm, brightly colored cherries with glossy skin whose color may range from pale golden yellow to deep red to almost black, depending on the variety. The stems should be green and fresh, bending easily and snapping back when released. Avoid: Sticky cherries (they’ve been damaged and are leaking), red cherries with very pale skin (they’re not fully ripe), and bruised cherries whose flesh will be discolored under the bruise.
Storing This Food Store cherries in the refrigerator to keep them cold and humid, conserving their nutrient and flavor. Cherries are highly perishable; use them as quickly as possible.
Preparing This Food Handle cherries with care. When you bruise, peel, or slice a cherry you tear its cell walls, releasing polyphenoloxidase—an enzyme that converts phenols in the cherry into brown compounds that darken the fruit. You can slow this reaction (but not stop it completely) by dipping raw sliced or peeled cherries into an acid solution (lemon juice and water or vinegar and water) or by mixing them with citrus fruits in a fruit salad. Polyphenoloxidase also works more slowly in the cold, but storing sliced or peeled cherries in the refrigerator is much less effective than bathing them in an acid solution.
What Happens When You Cook This Food Depending on the variety, cherries get their color from either red anthocyanin pigments or yellow to orange to red carotenoids. The anthocyanins dissolve in water, turn redder in acids and bluish in bases (alkalis). The carotenoids are not affected by heat and do not dissolve in water, which is why cherries do not lose vitamin A when you cook them. Vitamin C, how- ever, is vulnerable to heat.
How Other Kinds of Processing Affect This Food Canning and freezing. Canned and frozen cherries contain less vitamin C and vitamin A than fresh cherries. Sweetened canned or frozen cherries contain more sugar than fresh cherries. Candying. Candied cherries are much higher in calories and sugar than fresh cherries. Maraschino cherries contain about twice as many calories per serving as fresh cherries and are high in sodium.
Medical Uses and/or Benefits Anti-inflammatory effects. In a series of laboratory studies conducted from 1998 through 2001, researchers at the Bioactive Natural Products Laboratory in the Department of Horti- culture and National Food Safety and Toxicology Center at Michigan State University dis- covered that the anthocyanins (red pigments) in tart cherries effectively block the activity of two enzymes, COX-1 and COX-2, essential for the production of prostaglandins, which are natural chemicals involved in the inflammatory response (which includes redness, heat, swelling, and pain). In other words, the anthocyanins appeared to behave like aspirin and other traditional nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen. In 2004, scientists at the USDA Human Nutrition Research Center in Davis, California, released data from a study showing that women who ate 45 bing (sweet) cherries at breakfast each morning had markedly lower blood levels of uric acid, a by-product of protein metabolism linked to pain and inflammation, during an acute episode of gout (a form of arthritis). The women in the study also had lower blood levels of C-reactive protein and nitric acid, two other chemicals linked to inflammation. These effects are yet to be proven in larger studies with a more diverse group of subjects.... cherries
Health has driven much of environmental policy since the work of Edwin Chadwick in the early 1840s. The ?rst British public-health act was introduced in 1848 to improve housing and sanitation with subsequent provision of puri?ed water, clean milk, food hygiene regulations, vaccinations and antibiotics. In the 21st century there are now many additional environmental factors that must be monitored, researched and controlled if risks to human health are to be well managed and the impact on human morbidity and mortality reduced.
Environmental impacts on health include:
noise
air pollution
water pollution
dust •odours
contaminated ground
loss of amenities
vermin
vibration
animal diseases
Environmental risk factors Many of the major determinants of health, disease and death are environmental risk factors. Some are natural hazards; others are generated by human activities. They may be directly harmful, as in the examples of exposure to toxic chemicals at work, pesticides, or air pollution from road transport, or to radon gas penetrating domestic properties. Environmental factors may also alter people’s susceptibility to disease: for example, the availability of su?cient food. In addition, they may operate by making unhealthy choices more likely, such as the availability and a?ord-ability of junk foods, alcohol, illegal drugs or tobacco.
Populations at risk Children are among the populations most sensitive to environmental health hazards. Their routine exposure to toxic chemicals in homes and communities can put their health at risk. Central to the ability to protect communities and families is the right of people to know about toxic substances. For many, the only source of environmental information is media reporting, which often leaves the public confused and frustrated. To bene?t from public access to information, increasingly via the Internet, people need basic environmental and health information, resources for interpreting, understanding and evaluating health risks, and familiarity with strategies for prevention or reduction of risk.
Risk assessment Environmental health experts rely on the principles of environmental toxicology and risk assessment to evaluate the environment and the potential effects on individual and community health. Key actions include:
identifying sources and routes of environmental exposure and recommending methods of reducing environmental health risks, such as exposure to heavy metals, solvents, pesticides, dioxins, etc.
assessing the risks of exposure-related health hazards.
alerting health professionals, the public, and the media to the levels of risk for particular potential hazards and the reasons for interventions.
ensuring that doctors and scientists explain the results of environmental monitoring studies – for example, the results of water ?uoridation in the UK to improve dental health.
National policies In the United Kingdom in 1996, an important step in linking environment and health was taken by a government-initiated joint consultation by the Departments of Health and Environment about adding ‘environment’ as a key area within the Health of the Nation strategy. The ?rst UK Minister of State for Public Health was appointed in 1997 with responsibilities for health promotion and public-health issues, both generally and within the NHS. These responsibilities include the implementation of the Health of the Nation strategy and its successor, Our Healthy Nation. The aim is to raise the priority given to human health throughout government departments, and to make health and environmental impact assessment a routine part of the making, implementing and assessing the impact of policies.
Global environmental risks The scope of many environmental threats to human health are international and cannot be regulated e?ectively on a local, regional or even national basis. One example is the Chernobyl nuclear reactor accident, which led to a major release of radiation, the effects of which were felt in many countries. Some international action has already been taken to tackle global environmental problems, but governments should routinely measure the overall impacts of development on people and their environments and link with industry to reduce damage to the environment. For instance, the effects of global warming and pollution on health should be assessed within an ecological framework if communities are to respond e?ectively to potential new global threats to the environment.... environment and health
The concept of the dose-response is important for understanding the risk of exposure to a particular substance. This is embodied in a statement by Paracelsus (c.1493–1541): ‘All substances are poisons; there is none which is not a poison. The right dose di?erentiates a poison and a remedy.’
Poisoning may occur in a variety of ways: deliberate – SUICIDE, substance abuse or murder; accidental – including accidental overdose of medicines; occupational; and environmental
– including exposure during ?re.
Ingestion is the most common route of exposure, but poisoning may also occur through inhalation, absorption through the skin, by injection and through bites and stings of venomous animals. Poisoning may be described as acute, where a single exposure produces clinical effects with a relatively rapid onset; or chronic, where prolonged or repeated exposures may produce clinical effects which may be insidious in onset, cumulative and in some cases permanent.
Diagnosis of poisoning is usually by circumstantial evidence or elimination of other causes of the clinical condition of the patient. Some substances (e.g. opioids) produce a characteristic clinical picture in overdose that can help with diagnosis. In some patients laboratory analysis of body ?uids or the substance taken may be useful to determine or con?rm the o?ending agent. Routine assays are not necessary. For a very small number of poisons, such as paracetamol, aspirin, iron and lead, the management of the patient may depend on measuring the amount of poison in the bloodstream.
Accurate statistics on the incidence of poisoning in the UK are lacking. Mortality ?gures are more reliable than morbidity statistics; annually, well over 100,000 cases of poisoning are admitted to hospital. The annual number of deaths from poisoning is relatively small – about 300 – and in most cases patients die before reaching hospital. Currently, CARBON MONOXIDE (CO) is by far the most common cause of death due to poisoning. The most common agents involved in intentional or accidental poisoning are drugs, particularly ANALGESICS, ANTIDEPRESSANT DRUGS and SEDATIVES. Alcohol is also commonly taken by adults, usually in combination with drugs. Children frequently swallow household cleaners, white spirit, plant material – such as belladonna (deadly nightshade) and certain mushrooms; for example, death cap and ?y agaric – aftershave and perfume as well as drugs. If possible, the suspect container, drug or plant should be taken with the victim to the hospital or doctor. The use of child-resistant containers has reduced the number of admissions of children to hospital for treatment. Bixtrex® is an intensely bitter-tasting agent which is often added to products to discourage ingestion; however, not everybody is able to taste it, nor has any bene?cial e?ect been proven.
Treatment of poisoning usually begins with decontamination procedures. For ingested substances this may involve making the patient sick or washing the stomach out (GASTRIC LAVAGE): this is usually only worthwhile if performed soon after ingestion. It should be emphasised that salt (sodium chloride) water must never be given to induce vomiting, since this procedure is dangerous and has caused death. For substances spilt on the skin, the affected area should immediately be thoroughly washed and all contaminated clothing removed. Following eye exposure, the affected eye/s should be thoroughly irrigated with saline or water.
Treatment thereafter is generally symptomatic and supportive, with maintenance of the victim’s respiratory, neurological and cardiovascular systems and, where appropriate, monitoring of their ?uid and electrolyte balance and hepatic and renal function. There are speci?c antidotes for a few substances: the most important of these are PARACETAMOL, iron, cyanide (see CYANIDE POISONING), opioids (see OPIOID), DIGOXIN, insecticides and some heavy metals. Heavy-metal poisoning is treated with CHELATING AGENTS – chemical compounds that form complexes by binding metal ions: desferrioxamine and pencillinamine are two such agents. The number of people presenting with paracetamol overdose – a common drug used for attempted suicide – has fallen sharply since restrictions were placed on its over-thecounter sales.
When a patient presents with an illness thought to be caused by exposure to substances at work, further exposure should be limited or prevented and investigations undertaken to determine the source and extent of the problem. Acutely poisoned workers will usually go to hospital, but those suffering from chronic exposure may attend their GP with non-speci?c symptoms (see OCCUPATIONAL HEALTH, MEDICINE AND DISEASES).
In recent years, legislation has been enacted in the UK to improve safety in the workplace and to ensure that data on the hazardous constituents and effects of chemicals are more readily available. These o?cial controls include the Control of Substances Hazardous to Health (COSHH) and the Chemicals (Hazard Information and Packaging) Regulations (CHIP) and are UK legislation in response to European Union directives.
The National Poisons Information Service is a 24-hour emergency telephone service available to the medical profession and provides information on the likely effects of numerous agents and advice on the management of the poisoned patient. The telephone numbers are available in the medical literature. In the UK this is not a public-access service. People who believe they, or their relatives, have been poisoned should seek medical advice from their GPs or attend their local hospital.
Toxbase The National Poisons Information Service provides a primary clinical toxicology database on the Internet: www.spib.axl.co.uk. This website provides information about routine diagnosis, treatment and management of people exposed to drugs, household products and industrial and agricultural products.
(See also APPENDIX 1: BASIC FIRST AID.)... poisons
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