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Woolf AD, Jackson JE, Corcoran P, Fritz MK, Kim SS, Maslak TM, Shah M, Hansen L. An Update on Pediatric Environmental Health Specialty Units: Activities and Impacts, 2015-19. Acad Pediatr 2024:S1876-2859(24)00108-6. [PMID: 38494060 DOI: 10.1016/j.acap.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Pediatric Environmental Health Specialty Units (PEHSUs) address health concerns impacting children and their families related to environmental hazards by providing consultation and education to families, communities, and health care professionals. This analysis evaluated the productivity of the national PEHSU program. METHODS PEHSUs reported data on services provided to US communities between October 1, 2014 and September 30, 2019. Descriptive statistics and qualitative analysis are presented. RESULTS During this period, 6102 consultations and 4644 educational outreach activities were recorded. PEHSU faculty and staff published 462 articles, reviews, book chapters, fact sheets, commentaries, short informational pieces, and other materials between 2014 and 2019. These included 190 articles in scientific peer-reviewed journals and 29 textbook chapters to increase professional capacity in pediatric and reproductive environmental health. Lead, other metals, substances of abuse, pesticides, mold, and air pollution were frequently reported as agents of concern and educational topics. Requests for an overview of pediatric environmental health and outdoor pollutants were other frequently reported topics. CONCLUSIONS PEHSUs work to decrease harmful exposures and improve children's health. They serve as expert resources for families, health care professionals, and communities on health effects related to environmental exposures. Data show the breadth and depth of concerns addressed and demonstrate the productivity and impact of this national program.
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Affiliation(s)
- Alan D Woolf
- Division of General Pediatrics (AD Woolf), Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Mass.
| | | | - Peter Corcoran
- Department of Healthy Resilient Children, Youth & Families (P Corcoran), American Academy of Pediatrics, Itasca, Ill
| | - Meredith K Fritz
- Health Economics & Outcomes Research (MK Fritz, SS Kim, and TM Maslak), Battelle, Columbus, Ohio
| | - Stephani S Kim
- Health Economics & Outcomes Research (MK Fritz, SS Kim, and TM Maslak), Battelle, Columbus, Ohio
| | - Tanya M Maslak
- Health Economics & Outcomes Research (MK Fritz, SS Kim, and TM Maslak), Battelle, Columbus, Ohio
| | - Manthan Shah
- US Environmental Protection Agency (M Shah), Office of Children's Health Protection, Environmental Protection Agency, Washington, DC
| | - Linda Hansen
- Office of Capacity Development and Applied Prevention Science (OCDAPS) (L Hansen), Agency for Toxic Substances and Disease Registry (ATSDR), Centers for Disease Control and Prevention (CDC), Atlanta, Ga
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Albouy M, Parthenay M, Nogues M, Leyris A, Degorce L, Barthelemy Z, Rafidison D, Gourgues AS, Migeot V, Pylouster J, Dupuis A. A Clinical Preventive Strategy Based on a Digital Tool to Improve Access to Endocrine Disruptors Exposure Prevention: The MEDPREVED Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11993. [PMID: 36231296 PMCID: PMC9565443 DOI: 10.3390/ijerph191911993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Introduction: The digitalized PREVED (PREgnancy, PreVention, Endocrine Disruptor) questionnaire was used in the clinical practices of health professionals (HP) who adhered to the MEDPREVED strategy. The objectives were to assess the strategy and to determine if it could improve access to endocrine disruptor (ED) exposure prevention. Methods: After having filled in the digital questionnaire in HP waiting rooms, patients were invited to talk about ED exposure during the consultation. HPs were previously trained in ED and had received a prevention kit for their patients. After the seven-month implementation phase, the evaluation phase consisted of five mixed assessments: interviews with: (i) patients who were young children's parents; (ii) patients in the general population; (iii) paediatricians; (iv) midwives; and a quantitative study on GPs. Assessment concerned feasibility, accessibility, and usefulness of the strategy; we then used the Levesque model to evaluate how it could improve access to ED exposure prevention. Results: The study included 69 participants. The strategy appeared feasible for the filling-out step due to digital and environment access. However, it depended on patient and HP profiles. The strategy seemed useful insofar as it facilitated reflexive investment, an intention to healthy behaviour and, rather rarely, talk about ED exposure. The beginning of this discussion depended on time, prioritizing of the topic and HP profile. The strategy has confirmed the Levesque model's limiting factors and levers to access ED prevention. Conclusions: The MEDPREVED strategy is feasible, accessible, and useful in clinical prevention practice. Further study is needed to measure the impact on knowledge, risk perception and behavior of beneficiaries of the MEDPREVED strategy in the medium and long term.
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Affiliation(s)
- Marion Albouy
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
- Ecology and Biology of Interaction, CNRS UMR 7267, CEDEX, 86073 Poitiers, France
- INSERM-CIC1402, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
- BioSPharm Pole, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Maud Parthenay
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Maeva Nogues
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Agathe Leyris
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Léa Degorce
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Zacharie Barthelemy
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Diana Rafidison
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Anne-Sophie Gourgues
- BioSPharm Pole, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Virginie Migeot
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
- Ecology and Biology of Interaction, CNRS UMR 7267, CEDEX, 86073 Poitiers, France
- INSERM-CIC1402, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
- BioSPharm Pole, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Jean Pylouster
- Research Centre on Cognition and Learning, MSHS, 5 Rue T. Lefebvre, CEDEX, 86073 Poitiers, France
| | - Antoine Dupuis
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
- Ecology and Biology of Interaction, CNRS UMR 7267, CEDEX, 86073 Poitiers, France
- INSERM-CIC1402, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
- BioSPharm Pole, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
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Woolf AD, Sibrizzi C, Kirkland K. Pediatric Environmental Health Specialty Units: An Analysis of Operations. Acad Pediatr 2016; 16:25-33. [PMID: 26233834 DOI: 10.1016/j.acap.2015.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In 1998 the Agency for Toxic Substances and Disease Registry (ATSDR) secured the first federal funding to develop an innovative network of public health-oriented entities: Pediatric Environmental Health Specialty Units (PEHSUs). PEHSU goals were to provide pediatric and environmental health education to health care providers and health profession students, to offer consultation to health care professionals, parents, and others regarding environmental health exposures, and to provide referrals to specialized medical resources when necessary. This report analyzes the productivity of US PEHSUs from 1999 to 2014. METHODS This was a retrospective analysis of federally mandated quarterly reports filed by each PEHSU. These reports document specific goal-related deliverables outlined under cooperative agreements awarded to the Association of Occupational and Environmental Clinics (AOEC) with funding from the Environmental Protection Agency (EPA) and ATSDR. Costs were obtained from grant budget information available from the administrator of the grants, AOEC. RESULTS Total EPA/ATSDR funding for PEHSUs paid to AOEC during 1999-2014 was $23,847,452. The average cost to the EPA/ATSDR of running each PEHSU in 2014 was $169,256. Through over 8000 consultations and educational activities, PEHSUs reached 702,506 people: 298,936 health professionals, 61,947 health professional trainees, 323,817 members of the public, and 17,806 public health officials and others. CONCLUSIONS PEHSUs have grown into an established, productive network of clinical and educational centers whose expertise and activities have benefited both the public and health care professionals alike. The federal contributions to the cost of operating these centers have been more than offset by the benefits PEHSUs have conferred on the communities they serve.
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Affiliation(s)
- Alan D Woolf
- Pediatric Environmental Health Center, Division of General Pediatrics, Boston Children's Hospital, Region 1 New England Pediatric Environmental Health Specialty Unit (PEHSU), and Harvard Medical School, Boston, Mass.
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Roberts JR, Karr CJ, de Ybarrondo L, McCurdy LE, Freeland KD, Hulsey TC, Forman J. Improving pediatrician knowledge about environmental triggers of asthma. Clin Pediatr (Phila) 2013; 52:527-33. [PMID: 23539690 PMCID: PMC5816678 DOI: 10.1177/0009922813482752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Control of environmental triggers (ETs) greatly improves asthma outcomes in children. Disseminating these findings to general pediatricians has not been well established. METHODS After delivering a structured and standardized presentation on ET identification and control to pediatricians, we surveyed them about knowledge and practices of ET assessment and management. We analyzed matched responses for pre/post and 3- to 6-month follow-up using McNemar's χ(2) test. RESULTS Matched data were available for 367 participants, and 3- to 6-month follow-up data were available for 83. There was a significant posttraining increase in intention to ask about ETs and recommend ET management. After 3 to 6 months, all responses remained significantly higher than baseline, except "likely to refer to an asthma specialist." CONCLUSION Pediatricians reported a significant improvement in knowledge about ETs of asthma and a willingness to incorporate exposure history questions and remediation recommendations in their routine practice.
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Affiliation(s)
| | | | | | - Leyla E. McCurdy
- National Environmental Education Foundation, Washington, DC, USA
| | | | | | - Joel Forman
- Mt Sinai School of Medicine, New York, NY, USA
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Abstract
Pesticides are a collective term for a wide array of chemicals intended to kill unwanted insects, plants, molds, and rodents. Food, water, and treatment in the home, yard, and school are all potential sources of children's exposure. Exposures to pesticides may be overt or subacute, and effects range from acute to chronic toxicity. In 2008, pesticides were the ninth most common substance reported to poison control centers, and approximately 45% of all reports of pesticide poisoning were for children. Organophosphate and carbamate poisoning are perhaps the most widely known acute poisoning syndromes, can be diagnosed by depressed red blood cell cholinesterase levels, and have available antidotal therapy. However, numerous other pesticides that may cause acute toxicity, such as pyrethroid and neonicotinoid insecticides, herbicides, fungicides, and rodenticides, also have specific toxic effects; recognition of these effects may help identify acute exposures. Evidence is increasingly emerging about chronic health implications from both acute and chronic exposure. A growing body of epidemiological evidence demonstrates associations between parental use of pesticides, particularly insecticides, with acute lymphocytic leukemia and brain tumors. Prenatal, household, and occupational exposures (maternal and paternal) appear to be the largest risks. Prospective cohort studies link early-life exposure to organophosphates and organochlorine pesticides (primarily DDT) with adverse effects on neurodevelopment and behavior. Among the findings associated with increased pesticide levels are poorer mental development by using the Bayley index and increased scores on measures assessing pervasive developmental disorder, inattention, and attention-deficit/hyperactivity disorder. Related animal toxicology studies provide supportive biological plausibility for these findings. Additional data suggest that there may also be an association between parental pesticide use and adverse birth outcomes including physical birth defects, low birth weight, and fetal death, although the data are less robust than for cancer and neurodevelopmental effects. Children's exposures to pesticides should be limited as much as possible.
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Abstract
This statement presents the position of the American Academy of Pediatrics on pesticides. Pesticides are a collective term for chemicals intended to kill unwanted insects, plants, molds, and rodents. Children encounter pesticides daily and have unique susceptibilities to their potential toxicity. Acute poisoning risks are clear, and understanding of chronic health implications from both acute and chronic exposure are emerging. Epidemiologic evidence demonstrates associations between early life exposure to pesticides and pediatric cancers, decreased cognitive function, and behavioral problems. Related animal toxicology studies provide supportive biological plausibility for these findings. Recognizing and reducing problematic exposures will require attention to current inadequacies in medical training, public health tracking, and regulatory action on pesticides. Ongoing research describing toxicologic vulnerabilities and exposure factors across the life span are needed to inform regulatory needs and appropriate interventions. Policies that promote integrated pest management, comprehensive pesticide labeling, and marketing practices that incorporate child health considerations will enhance safe use.
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