Therapeutics and toxicology.
Wright RO, Fields N. Therapeutics and toxicology. Current Opinion in Pediatrics 2008;20(2):171.
The once nascent field of pediatric environmental health is now maturing into a new life stage of discovery and disease prevention. Many notable achievements in research, biomonitoring and clinical practice have shaped our understanding of how environmental factors impact children's growth and development. The once nascent field of pediatric environmental health is now maturing into a new life stage of discovery and disease prevention. Many notable achievements in research, biomonitoring and clinical practice have shaped our understanding of how environmental factors impact children's growth and development. This issue of the journal contains a series of summaries on the recent findings in child neurotoxicology. The growing complexity and sophistication of the studies, the research questions and the analytical methods presented in this issue reflect the continuing maturation of the field of pediatric environmental health. Over the past decade, several programs have helped develop research expertise in children's environmental health while recruiting new investigators and pediatricians into the field. For instance, there is now a network of healthcare providers with pediatric environmental health expertise regionally distributed across North America, including Canada and Mexico. With funding support from the US Environmental Protection Agency (EPA) and the Agency for Toxic Substances and Disease Registry (ATSDR), pediatric environmental health subspecialty units (www.atsdr.cdc.gov/HEC/natorg/pehsu.html) serve the pediatric environmental clinical needs, while sharing case examples and lessons learned across the network, and give healthcare providers guidance on the care of patients with complaints related to the environment. In 1998, the US National Institute of Environmental Health Science and the EPA jointly funded a program to create Children's Environmental Health Centers (https://www.epa.gov/ncer/childrenscenters/). Research findings from these centers have contributed to improvements in US environmental policy. Research by investigators in children's centers supported the EPA's decision to remove chlorpyrifos and diazinon from the retail shelves. The centers at University of California, Berkeley and University of Washington have conducted extensive work on the reduction of agricultural pesticide exposure in both migrant and nonmigrant farmworker communities. Meanwhile, researchers at Columbia University and Mt Sinai School of Medicine have conducted parallel work on the impact of pesticide and urban toxicant exposures. The Columbia Center has also found links between polycyclic aromatic hydrocarbons and developmental and respiratory effects in children. Neurotoxicology is not the only field relevant to pediatric environmental health and environmental exposures can contribute to respiratory, cardiac, psychiatric and oncologic diseases as well. The work conducted by the Children's centers has been extraordinarily diverse in both the outcomes studied and the techniques employed. Workers in centers at the University of California-Davis and University of Medicine and Dentistry of New Jersey research the oft-neglected role of the environment as a risk factor for autism, whereas centers at Johns Hopkins University, University of Southern California, University of Iowa, and University of Michigan address the role of multiple environmental factors (urban and rural) in the onset of asthma. The Duke University Center, the newest center, is studying the role of the environment in prematurity and reproductive outcomes using advanced geospatial statistical modeling. The centers have also addressed research on unique populations, such as work at the University of Illinois on contaminants in fish and their impact on the health of Hmong refugees in the Wisconsin Fox River Valley, and research at the Harvard School of Public Health on the effect of metal mining waste on child development in Oklahoma. The translational impact of this work may not be realized for several years, but the potential clinical applications are exciting, such as the University of Cincinnati Center's work on meconium as an integrated biomarker of prenatal chemical exposure. Work on Pediatric Environmental Health is continuing internationally, as the World Health Organization recently released its first ever report highlighting children's special susceptibility to harmful chemical exposures (http://whqlibdoc.who.int/publications/2006/924157237X_eng.