UCSF PEHSU: Articles

Children’s Cancer and Environmental Exposures: Professional Attitudes and Practices

By Western States PEHSU staff and collaborators Zachek, C. M., Miller, M. D., Hsu, C., Schiffman, J. D., Sallan, S., Metayer, C. and Dahl, G. V., Journal of Pediatric Hematology and Oncology, 2015. 37(7): p. 491-7.  Epidemiologic studies worldwide have provided substantial evidence of the contributions of environmental exposures to the development of childhood cancer, yet this knowledge has not been integrated into the routine practice of clinicians who care for children with this disease. To identify the basis of this deficit, we sought to assess the environmental history-taking behavior and perceptions of environmental health among pediatric hematologists and oncologists.  A web-based survey was sent from June to October 2012 to 427 pediatric oncologists, fellows, and nurse practitioners from 20 US institutions, with an overall response rate of 45%. RESULTS: Survey responses indicated that environmental exposures are of concern to clinicians. The vast majority of respondents (88%) reported receiving questions from families about the relationship between certain environmental exposures and the cancers they regularly treat. However, a lack of comfort with these topics seems to have limited their discussions with families about the role of environmental exposures in childhood cancer pathogenesis. Although 77% of respondents suspected that some of the cases they saw had an environmental origin, their methods of taking environmental histories varied widely. Over 90% of respondents believed that more knowledge of the associations between environmental exposures and childhood cancer would be helpful in addressing these issues with patients. CONCLUSIONS: Although limited in size and representativeness of participating institutions, the results of this survey indicate a need for increased training for hematology/oncology clinicians about environmental health exposures related to cancer and prompt translation of emerging research findings in biomedical journals that clinicians read.

Impact of Environmental Chemicals on Lung Development
by Western States PEHSU’s Dr. Mark D. Miller and Melanie A. Marty, MA
Environmental Health Perspectives 118:1155-1164 (2010). This paper reviews evidence on the impact of environmental chemicals on lung development and key signaling events in lung morphogenesis, and the relevance of potential outcomes to public health and regulatory science. Using peer-reviewed literature on developmental lung biology and toxicology, mechanistic studies, and supporting epidemiology the authors evaluated potential mechanisms for xenobiotics to affect lung development and potentially result in altered function as an adult.

A Network of Pediatric Environmnetal Health Speciality Units (PEHSUs): Filling a Critical Gap in the Health Care System (pdf)
This paper was published in Medycyna Środowiskowa.
Environmental Medicine 2012 15 (3), a journal of the Institute of Occupational Medicine and Environmental Health in Sosnowiec, Poland and the Polish Society of Environmental Medicine (www.medycynasrodowiskowa.pl). It is posted here with the permission of the journal and its editor Z. Rudkowski.

Practical Guidelines for Evaluating Lead Exposure in Children with Mental Health Conditions: Molecular Effects and Clinical Implications (pdf)
by PEHSU staff Drs. Burke and Miller
Postgraduate Medicine, Volume 123, Issue 1, January 2011 (with permission of the publishers) In this article, we review some of the clinical and scientific challenges that relate to the assessment and treatment of children presenting for mental health care who may have potential lead exposure

Thyroid-Disrupting Chemicals: Interpreting Upstream Biomarkers of Adverse Outcomes (pdf)
Miller MD, Crofton KM, Rice DC, Zoeller RT Environmental Health Perspectives 117:1033*1041 (2009).
Background: There is increasing evidence in humans and in experimental animals for a relationship between exposure to specific environmental chemicals and perturbations in levels of critically important thyroid hormones (THs). Identification and proper interpretation of these relationships are required for accurate assessment of risk to public health.

We review the role of TH in nervous system development and specific outcomes in adults, the impact of xenobiotics on thyroid signaling, the relationship between adverse outcomes of thyroid disruption and upstream causal biomarkers, and the societal implications of perturbations in thyroid signaling by xenobiotic chemicals. Data sources: We drew on an extensive body of epidemiologic, toxicologic, and mechanistic studies.

Outcomes of the California Ban on Pharmaceutical Lindane: Clinical and Ecologic Impacts (pdf)
By UCSF PEHSU staff and collaborators Humphreys EH, Janssen S, Heil A, Hiatt P, Solomon G, Miller MD. in Environmental Health Perspectives, 2008 Mar;116(3):297-302.
Conclusions: The California experience suggests that elimination of pharmaceutical lindane produced environmental benefits, was associated with a reduction in reported unintentional exposures, and did not adversely affect head lice and scabies treatment. This ban serves as a model for governing bodies considering limits on the use of lindane or other pharmaceuticals.

Environmental Risk Communication for the Clinician (pdf)
By UCSF PEHSU staff Drs. Miller and Solomon in Pediatrics Vol. 112 No. 1 July 2003;112:211*217
Although they are accustomed to discussing risks in the medical arena through the process of informed consent, primary care clinicians may have difficulty communicating with their patients and communities about environmental health risks. Clinicians are generally trusted and can play important roles as educators, alert practitioners, or even advocates talking about environmental health risks with individuals and groups. Communication of risk requires an understanding of how scientists and clinicians assess risk the process of quantitative or qualitative risk assessment. Risk is never a purely scientific issue; risk is perceived differently depending on some well-understood characteristics of the hazard, the individual perceiving the risk, and the social context. Many low-income communities of color have faced and continue to face disproportionate environmental exposures and disease burdens. The issue of environmental justice can significantly affect the context of a discussion about a specific environmental risk. The essence of risk communication has been well described and requires careful evaluation of the science and the social context, honesty, listening to and partnering with the community, and a clear, compassionate team approach.

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