Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Modernization”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,117 records · Page 62Linked to original sources
PubMed2005

Lipid peroxidation is not increased in heart failure patients on modern pharmacological therapy.

BACKGROUND: Previous studies support a role of oxygen-free radicals in the development of congestive heart failure (CHF). The aim of this study was to investigate whether lipid peroxidation is increased in CHF patients on modern pharmacological therapy and whether there is a positive correlation between plasma levels of markers of lipid peroxidation and severity of heart failure (HF). Plasma malondialdehyde (MDA) and isoprostanes are often used as markers of lipid peroxidation and oxidative stress. We also studied whether long-term treatment with isosorbide-5-mononitrate (IS-5-MN) in combination with standard HF therapy affects P-MDA levels in patients with evidence of left ventricular (LV) dysfunction following acute myocardial infarction (AMI). MATERIALS AND METHODS: Ninety-two patients with clinical or echocardiographic evidence of LV-dysfunction following AMI were randomized to treatment with either IS-5-MN or placebo. In a subgroup of 83 patients with available plasma MDA, echocardiography, right-heart catherization, and plasma natriuretic peptides were evaluated. Control subjects were 80 healthy blood donors. A second study group consisted of 56 patients with CHF, evaluated with respect to LV function, brain natriuretic peptide and markers of oxidative stress (P-MDA and 8-isoprostane). The second control group comprised 50 healthy subjects. RESULTS: Lipid peroxidation measured by P-MDA and 8-isoprostane was not increased in patients with LV dysfunction treated with standard HF therapy. No positive correlation was found to the severity of HF. Long-term IS-5-MN therapy did not influence P-MDA concentrations. CONCLUSIONS: Although results from many experimental and clinical studies suggest that oxidative stress is increased in HF, this may not be true for patients treated with beta blockers and inhibitors of the renin-angiotensin system.

Adolescent↗
PubMed2006

Hazard and control of group II (non-proteolytic) Clostridium botulinum in modern food processing.

Group II (non-proteolytic) Clostridium botulinum poses a safety hazard in modern food processing, which consists of mild pasteurization treatments, anaerobic packaging, extended shelf lives and chilled storage. The high risk is reflected in the relatively large number of botulism cases due to group II C. botulinum in commercially produced foods during the past decades. Because of the high prevalence of group II C. botulinum in the environment, food raw materials may carry spores. Although group II spores are less heat-resistant than group I (proteolytic) spores, they can tolerate the heat treatments employed in the chilled food industry. Some food components may actually provide spores with protection from heat. Spore heat resistance should therefore be investigated for each food in order to determine the efficiency of industrial heat treatments. Group II strains are psychrotrophic and thus they are able to grow at refrigeration temperatures. Anaerobic packages and extended shelf lives provide C. botulinum with favourable conditions for growth and toxin formation. As the use of salt and other preservatives in these foods is limited, microbiological safety relies mainly on refrigerated storage. This sets great challenges on the production of chilled packaged foods. To ensure the safety of these foods, more than one factor should safeguard against botulinal growth and toxin production.

Botulinum Toxins↗
PubMed2006

Women's access to modern methods of fertility regulation.

Preventing unintended pregnancies through access to modern family planning could avert 20-35% of maternal deaths, saving the lives of more than 100,000 women each year. Obstacles to wider access still exist, but they may be overcome by overt policy commitment to reproductive health services, partnership between stakeholders, community involvement and quality programs.

Contraception↗
PubMed2003

Foreign body injury in children in the twentieth century: a modern comparison to the Jackson collection.

OBJECTIVE: To compare two databases of foreign body (FBs) objects causing injury in children (>20 years of age) and record differences in size, shape and material for children at risk over a 70-year period of time. STUDY DESIGN: Retrospective analysis of the Jackson collection (JC) of FBs (1920-1932) and a 12-year modern study (MS) of data taken from 25 children's hospitals in North America over the period 1988-2000. Digital images were obtained of the JC collection. METHODS: Identify age, sex, and type of products, size, shape, and consistency of material from the injury-producing FBs. Statistical Processing for Social Sciences was used for analysis of JC versus MS. RESULTS: 5528 children were evaluated from the MS, and compared with 1238 from the JC. Boys remain at greater risk than young girls (53% versus 47%) over the 70-year period of study. Coins have replaced safety pins (31% versus 15%) as the most common offending FBs. Although 99% of FBs causing injury are less than 1.25 in. in greatest diameter in both the JC and MS, 100% of FBs are eliminated when the test size is greater than 1.75 in. CONCLUSIONS: Boys remain at greater risk of injury over the last 60 years. However, coins have now emerged as the leading cause of injury in children. Children achieve greater protection from risk by modification of the Small Parts Test Fixture (SPTF) from 1.25 to 1.75 in. diameter.

Adolescent↗
PubMed2005

Radiation therapy for Ewing's sarcoma: results from Memorial Sloan-Kettering in the modern era.

PURPOSE: To evaluate the outcomes of patients with Ewing's sarcoma family of tumors (ESFT) treated with modern radiotherapy techniques with MRI along with optimal chemotherapy. METHODS AND MATERIALS: The records of all 60 patients with ESFT who received radiation to the primary site between 1990 and 2004 were reviewed. All patients received chemotherapy, including vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide. Radiation was used as the sole modality for local control in 31 patients and was given either before (n=3) or after surgical resection (n=26) in the remainder. All patients had MRI and CT scan-based treatment planning, and 43% received intensity-modulated radiation therapy. Radiation doses ranged from 30 Gy to 60 Gy (median, 51 Gy), and 35% received hyperfractionated radiotherapy. RESULTS: Median age was 16 years (range, 2-40 years). Because of selection bias for radiotherapy, the majority of primary tumors were centrally located (72%): spine (n=18), pelvis (n=15), extremities (n=12), chest wall (n=5), head and neck (n=5), and other (n=5). Thirty-eight percent of patients presented with metastatic disease, and 52% of primary tumors were >or=8 cm. Actuarial 3-year local control was 77%. The presence of metastases at diagnosis was an adverse prognostic factor for local control (84% vs. 61%, p=0.036). No other predictive factors for local failure were identified. In patients without metastatic disease, 3-year disease-free and overall survival rates were 70% and 86%, respectively, whereas in patients with metastases they were both 21%. Follow-up of surviving patients was 6-178 months (median, 41 months). CONCLUSION: In this unfavorable cohort of ESFT patients, radiation therapy was an effective modality for local control, especially for patients without metastases. The presence of metastases at diagnosis is a predictive factor not only for death but also for local failure.

Adolescent↗
PubMed2006

Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting--the MSKCC experience.

PURPOSE: To perform a retrospective analysis of patients with paranasal sinus (PNS) cancer treated with postoperative radiotherapy (RT) at Memorial Sloan-Kettering Cancer Center. METHODS AND MATERIALS: Between January 1987 and July 2005, 85 patients with PNS and nasal cavity cancer underwent postoperative RT. Most patients had squamous cell carcinoma (49%; n = 42), T4 tumors (52%; n = 36), and the maxillary sinus (53%; n = 45) as the primary disease site. The median radiation dose was 63 Gy. Of the 85 patients, 76 underwent CT simulation and 53 were treated with either three-dimensional conformal RT (27%; n = 23) or intensity-modulated RT (35%; n = 30). Acute and late toxicities were scored according to the Radiation Therapy Oncology Group radiation morbidity scoring criteria. RESULTS: With a median follow-up for surviving patients of 60 months, the 5-year estimates of local progression-free, regional progression-free, distant metastasis-free, disease-free, and overall survival rates were 62%, 87%, 82%, 55%, and 67%, respectively. On multivariate analysis, squamous cell histology and cribriform plate involvement predicted for an increased likelihood of local recurrence, and squamous cell histologic features predicted for worse overall survival. None of the patients who underwent CT simulation and were treated with modern techniques developed a Grade 3-4 late complication of the eye. CONCLUSION: Complete surgical resection followed by adjuvant RT is an effective and safe approach in the treatment of PNS cancer. Emerging tools, such as three-dimensional conformal treatment and, in particular, intensity-modulated RT for PNS tumors, may minimize the occurrence of late complications associated with conventional RT techniques. Local recurrence remains a significant problem.

Adolescent↗
PubMed2004

Major liver resection without clamping: a prospective reappraisal in the era of modern surgical tools.

BACKGROUND: Hemorrhage and transfusions remain the main causes of mortality and morbidity from liver resection. In cases of extended resection, especially performed on diseased liver, ischemia-reperfusion injury related to pedicle clamping may be a significant risk factor of postoperative liver dysfunction. The ideal alternative would be to perform major hepatectomy without clamping and without significant bleeding. STUDY DESIGN: This prospective study aimed to reconsider the risk of major hepatectomy performed without pedicle clamping and under low venous pressure in the light of modern surgical tools. Inclusion criteria were adults requiring a resection of more than three segments on healthy or pathologic livers but not on preoperative documented cirrhosis. RESULTS: Fifty patients, with a mean age of 53 +/- 15 years were included. Twenty-two patients had underlying liver disease. The main indications were colorectal metastases, primary liver tumors, and living donation. Twenty-six right hepatectomies, 17 extended right hepatectomies, and 7 extended left hepatectomies were performed. Unclamping method was successful in 96% of patients on an intention-to-treat basis. Seventy-four percent of patients were not transfused and no patients died. Surgical complication rate was 16% but no complication led to reoperation. Medical complication rate was 20%, including three transient liver dysfunctions. CONCLUSIONS: Major hepatectomy without clamping can be performed safely. The low rate of postoperative liver dysfunction, especially in cases of underlying liver disease, suggests good preservation of the small and diseased remnant liver.

Adult↗
PubMed2006

Modern 5-year survival of resectable esophageal adenocarcinoma: single institution experience with 263 patients.

BACKGROUND: Surgery, as the mainstay of treatment for localized esophageal cancer, is currently being challenged by the assumed high risk of esophagectomy and the poor longterm survival after resection. Epidemiologic and clinical changes over the past decade indicate that these assumptions should be reevaluated. The aim of this study was to assess the modern outcomes of esophagectomy for adenocarcinoma. STUDY DESIGN: We studied 263 consecutive patients (215 men, 48 women), who had esophagectomy for adenocarcinoma from 1992 to 2002. Ninety-seven (37%) were stage I, 63 (24%) were stage II, 93 (35%) were stage III, and 10 (4%) were stage IV. Forty-five percent (119 of 263) had curative en bloc resection, 52% (138 of 263) had node involvement, and 18% (48) received neoadjuvant therapy. RESULTS: Seventeen percent (44 of 263) of the patients were identified in a Barrett's surveillance program. The frequency of T1N0 adenocarcinoma increased over the study period (p=0.024). The overall 5-year survival was 46.5%, and for the last 5 years of the study was 50.4%. The overall 5-year survival for stage I was 81%; for stage II, 51%; for stage III, 14%; and for stage IV, 0%. Complications occurred in 61% and there were 12 perioperative deaths (4.5%). Cox proportional hazard analysis identified tumor stage and type of resection as independent predictors of survival. CONCLUSIONS: Nearly half of patients undergoing esophagectomy for adenocarcinoma survive >or=5 years. Improvements in survival are associated with increased detection of early stage disease, and a liberal use of en bloc resection. Nonsurgical treatments should be compared with these contemporary outcomes measures.

Adenocarcinoma↗
PubMed2005

Pedal symphalangism in modern American and Japanese skeletons.

Pedal symphalangism is a surprisingly common heritable trait of the human foot. In individuals exhibiting the trait, the joint between the intermediate and distal phalanges of one or more lateral toes never develops, resulting in toes with two phalanges rather than three. This study was undertaken to explore variation in the frequency of pedal symphalangism among groups with widely different geographic ancestry, and to consider the applicability of this trait to skeletal biological distance studies. A total of 460 Euro-American, 191 African-American and 99 Japanese skeletons were examined for presence of pedal symphalangism. The American individuals date to the first half of the 20th c, while the Japanese individuals date to the late 19th and early 20th c. Although the country of ancestry is unknown for most of the American individuals, the Euro-Americans appear to be largely northern European, with roots in Germany, Ireland and Scandinavia, while the African-Americans are primarily descendants of slaves with roots in west African countries such as Nigeria, Benin, Togo, Ghana and Sierra Leone. Frequencies of fifth toe pedal symphalangism were calculated and compared among all three samples and found to be significantly higher in modern Japanese (83.7%) than in either Euro-Americans (46.4%) or African-Americans (44.0%). The Euro- and African-American frequencies were statistically indistinguishable for symphalangism of the fifth toe. In the fourth toe, however, the opposite result was found. The African-American frequency (7.9%) was significantly higher than the Euro-American frequency (2.6%), while no difference was found between the African-Americans and Japanese (11.7%). Since fourth toe pedal symphalangism has never been observed in the absence of fifth toe involvement, some of the same genes are clearly involved in producing the trait in both toes. However, differences in the pattern of fourth and fifth toe expression among the three groups identified in this study suggest that additional genetic or developmental factors may play a role in expression of pedal symphalangism in each of the toes.

Adult↗
PubMed2005

The radiological impact from airborne routine discharges of a modern coal-fired power plant.

In this paper the radiological impact from the airborne routine discharges of a modern coal-fired power plant at Langerlo (Belgium) is evaluated. Therefore, the natural radioactivity contents of the coal and the fly-ash discharged were measured. With a bi-Gaussian plume model the maximum annual values of the 226Ra concentration in the air (4.5 nBq/m3) and of the total deposition (1.5 mBq/m2) were calculated. The transfer of the radionuclides from air and soil to the biospheric media, exposing man, were modelled and the annual, individual, effective dose to the critical group, after an assumed life span of the power plant of 70 years, was evaluated at 0.05 microSv/y. This is several orders of magnitude lower than the annual doses for most power plants reported in the literature. The flue gas purification system, extended with a denitrification unit and a desulphurisation unit, was found to be the basis for this low impact.

Air Pollutants, Radioactive↗
PubMed2005

Variation in modern human enamel formation times.

Most of what we know about the timing of human enamel formation comes from radiographic studies on children of known age. Here, we present new longitudinal data derived from a histological analysis of tooth enamel. Two samples, one from southern Africa and one from northern Europe, contained all anterior and molar tooth types. Two further samples contained only one tooth type: canines from a medieval Danish sample and third molars from a modern North American sample. Data were collected on 326 molars and 352 anterior teeth. Each tooth was sectioned and prepared for polarized light microscopy. We used daily enamel cross striations to determine cuspal enamel formation time, recorded the periodicity of long-period striae in the lateral enamel, and used this value to calculate enamel formation times for each decile of crown length. We present data that reveal some of the processes whereby differences in enamel formation times arise between our samples. Mean cuspal enamel formation times were similar in southern African and northern European anterior teeth, but differed in certain molar cusps. All the southern African anterior teeth completed enamel formation earlier. The greatest difference in mean chronological age at enamel completion was 5.2 vs. 6.2 years of age in lower canines. However, enamel completion times in the molar teeth showed few differences between the samples, with mean times for the longest forming cusps all falling between 3.0 years and 3.45 years. Our data suggest fewer differences between samples and smaller ranges of variation than in many radiographic studies and present a more realistic picture of worldwide variation in enamel formation times.

Amelogenesis↗
PubMed2005

Neonatal screening for cystic fibrosis is beneficial even in the context of modern treatment.

OBJECTIVES: To determine whether early identification of babies with cystic fibrosis (CF) improves outcome in the current environment of new improved treatments, considering the criticism that there may be only marginal benefit gained by CF newborn screening (NBS). STUDY DESIGN: We tested whether CF NBS in the setting of modern CF center care still afforded benefit using the UK CF Database (UKCFD; ) to compare clinical outcomes in infants who underwent NBS and control subjects who were clinically diagnosed (CD). With Mann-Whitney rank tests, 184 patients who underwent NBS aged 1 to 9 years in 2002 (excluding meconium ileus) were compared with matched patients who were CD in 3-year age groups (950 control subjects). RESULTS: Patients as old as 6 years who underwent NBS had significantly greater median height z-scores, less severe Northern chest radiography scores, better Shwachman-Kulczycki scores, and lower rates of chronic Pseudomonas aeruginosa infection. No difference was found for weight z-score or % predicted forced expiratory value in 1 second or forced volume capacity. Nutritional benefit was demonstrated in patients who underwent NBS and were homozygous for the DeltaF508 mutation. CONCLUSIONS: NBS segregates with better outcomes in patients as old as 6 years compared with age- and gene-matched control subjects who are CD. This cross-sectional study shows that infants who undergo screening derive nutritional benefit in improved median height and reduced morbidity.

Age Factors↗
PubMedDate not supplied

Radiographic analysis of polyethylene glenoid components using modern cementing techniques.

The purpose of this study was to examine the initial radiographic appearance and changes occurring over time in patients who have undergone total shoulder arthroplasty by modern methods of bone preparation and current cement techniques. Sixty-five patients underwent seventy total shoulder arthroplasties by use of a cemented all-polyethylene, keeled glenoid component. The surface radius was equal to the radius of a one-piece humeral component. The mean clinical follow-up was 4.18 years (range, 2-8.6 years); radiographic follow-up averaged 3.9 years (range, 2-8.6 years). Three observers evaluated radiographs 1 to 2 months postoperatively and at final follow-up. The glenoid component was considered at risk for clinical problems if there was a complete lucent line surrounding the component and some part of the line was 1.5 mm or greater in width or two of three or all three observers identified a shift in component position. Similarly, a humeral component was judged to be at risk if three or more zones had lucent lines 2 mm or greater in width or a shift in component position had occurred. On the early radiographs, 10 glenoid components had incomplete lucencies behind the keel. On the most recent radiographs, 59 glenoid components had incomplete lucent lines and 3 had complete lucent lines. Eight components were judged to have shifted in position. When data for lucent lines and shifting were combined, 10 (14%) of the glenoid components were at risk. At follow-up, no cemented humeral components were at risk whereas 3 (6%) of the 54 tissue ingrowth components were at risk for clinical loosening. Given the number of shoulders in this study, there were no associations between radiographic changes and clinical results. Improvements have occurred in glenoid component fixation. However, additional advances are possible and may occur from improved surgical technique, decreased particle-related osteolysis, enhanced joint kinematics, or novel fixation methods.

Adult↗
PubMed2004

Development of biologic coronary artery bypass grafting in a rabbit model: revival of a classic concept with modern biotechnology.

OBJECTIVE: We have developed a technique for biologic coronary artery bypass grafting, which is a revival of a classic concept with modern biotechnology. METHODS: Acute myocardial infarction was created by ligating the major branch of the circumflex artery in rabbits. Animals were divided into four groups: a nontreated group (group N), a group in which omentum was used to wrap the infarcted area (group G), a group in which a gelatin hydrogel sheet incorporating 100 microg basic fibroblast growth factor was placed over the infarcted area (group F), and a group in which the infarcted area was similarly treated with basic fibroblast growth factor followed by omental wrapping (group FG). Cardiac function was subsequently assessed by echocardiography. Postmortem angiography through the gastroepiploic artery was done in groups G and FG. Infarct size and arteriolar density were evaluated. RESULTS: Group FG showed a better fractional area change than did the other groups (group N P <.001, group G P =.002, group F P <.001). Angiography revealed that communication from the gastroepiploic artery to the coronary artery was created through a rich bed of neovascularization in all 7 animals of group FG, whereas poor collaterals were recognized in only 2 of 7 animals in group G. Infarct size was reduced to a greater extent in group FG than in groups F, G, and N (10% +/- 3%, 16% +/- 5%, 19% +/- 7%, 23% +/- 2%, respectively, group F P =.04, groups G and N P <.01). The number of arterioles 20 to 100 microm in diameter was increased to a greater extent in group FG than in groups F, G, and N (23 +/- 5 arterioles/mm(2), 14 +/- 3 arterioles/mm(2), 10 +/- 1 arterioles/mm(2), 4 +/- 2 arterioles/mm(2), respectively), with the differences being significant. CONCLUSIONS: These results show that bypass from the gastroepiploic artery to coronary arteries can be achieved without surgical anastomosis through slow release of basic fibroblast growth factor in this rabbit acute myocardial infarction model. This new revascularization concept, biologic coronary artery bypass grafting, could be applicable for revascularizing many tiny coronary vessels in patients who are difficult to treat with conventional surgery or catheter intervention.

Analysis of Variance↗
PubMed2007

Hyperoxaluria in kidney stone formers treated with modern bariatric surgery.

PURPOSE: Nephrolithiasis and renal failure secondary to severe hyperoxaluria were complications of jejunoileal bypass for obesity, leading to the discontinuation of this procedure in the United States in 1980. Bariatric procedures currently in use have not been adequately evaluated for this complication. MATERIALS AND METHODS: We compared 24-hour urine chemistry studies of 132 patients with nephrolithiasis who had undergone bariatric surgery with the urine chemistry studies of patients who had undergone jejunoileal bypass, those with routine kidney stones and normal subjects. The primary aim was to determine if hyperoxaluria developed in patients who underwent bariatric surgery and had kidney stones as had been seen with jejunoileal bypass. RESULTS: Patients who have undergone modern bariatric surgery had an adjusted mean urine oxalate excretion of 83 mg per day compared to 39 mg per day for routine kidney stone formers and 34 mg per day for normal subjects (p <0.001 for both comparisons), but not quite as high as that found in patients treated with jejunoileal bypass (102 mg per day, p <0.001). Urine supersaturation of calcium oxalate, the main driving force for calcium oxalate stone formation, was higher in patients treated with bariatric surgery compared to routine kidney stone formers and normal subjects (p <0.001 for both comparisons). CONCLUSIONS: Hyperoxaluria is the most significant abnormality of urine chemistry studies in patients with kidney stones who have undergone bariatric surgery. Many of these patients have a degree of hyperoxaluria that could lead to kidney failure. Further studies are required to determine the prevalence of this problem in patients who have undergone bariatric surgery.

Bariatric Surgery↗
PubMed2005

The incorporation of iodine in thyroid hormone may stem from its role as a prehistoric signal of ecologic opportunity: an evolutionary perspective and implications for modern diseases.

To optimize fitness under conditions of varying Darwinian opportunity, organisms demonstrate tremendous plasticity in their life-history strategies based on their perception of available resources. Higher-energy environments generally promote more aggressive life-history strategies, such as faster growth, larger adult size, greater genetic variation, shorter lifespan, larger brood sizes, and offspring ratio skewed towards the larger-sized gender. While numerous mechanisms regulate life-history plasticity including genetic imprinting, methylation, and growth factors, evidence suggests that thyroid hormone plays a central role. Given the pivotal adaptive role of thyroid hormone, the teleology of its dependence on dietary iodine for production remains unexplained. We hypothesize that iodine may have emerged as a substrate for production of thyroid hormone in prehistoric ecosystems because the former represented a reliable proxy for ecologic potential that enabled the latter to modulate growth, reproduction, metabolic rate, and lifespan. Such a scenario may have existed in early marine ecosystems where ocean-surface vegetation, which concentrates iodine for its antimicrobial and antioxidant properties, formed the basis of the food chain. Teleologic parallels can be drawn to the food-chain accumulation of antimicrobials that also exhibit antioxidant properties and promote adult size, brood size, and offspring quality by modulating central hormonal axes. As each higher species in the food chain tunes its life-history strategy based on iodine intake, the coupling of this functional role of iodine with its value as a resource signal to the next member of the food-chain may promote runaway evolution. Whereas predators in prehistoric ecosystems successfully tuned their life-history strategy using iodine as a major input, the strategy may prove maladaptive in modern humans for whom the pattern of iodine intake is decoupled from resource availability. Iodine acquired through sodium iodide supplementation may independently contribute to some biologic dysfunctions currently attributed to sodium.

Animals↗
PubMed2006

From Nutty Professor to Buddy Love--Personality types in modern science.

People often suggest that scientists should have a specific personality type, usually conscientious and self-critical. But this is a mistake. Science as a social system needs to be conscientious and self-critical, but scientists as people do not necessarily have to conform to that stereotype. Since science works by a process of selection, it makes sense to have a wide range of personalities in science. It takes all types. However, the selection pressures within science have changed over recent decades. In the past, a successful scientist often resembled the white-coated, bespectacled and introverted Nutty Professor in Jerry Lewis's movie of that name. But the modern science superstar is more like the Nutty Professor's alter ego, nightclub singer 'Buddy Love': a sharp-suited, good-looking and charismatic charmer. While Nutty was dull but impartial, Buddy is compelling but self-seeking. Our attitude towards public scientific pronouncements should be adjusted accordingly.

Culture↗
PubMed2003

Environmental hazards to children's health in the modern world.

Patterns of illness in children have changed dramatically in the last century, and will continue to change in this century. The major diseases confronting children are now chronic and disabling conditions termed the "new pediatric morbidity"-asthma, leukemia and brain cancer, neurodevelopmental dysfunction and neurobehavioral abnormality, reproductive and systemic developmental problems. Chemical toxicants in the environment, poverty, and little or no access to health care are all factors contributing to life-threatening pediatric diseases; children are uniquely vulnerable to chemical toxicants because of their disproportionately heavy exposures and their inherent biological growth and development. Genetic susceptibility and environmental exposures during vulnerable periods of development are also important contributors to the etiologies of many diseases of childhood. It is vital that we develop a better understanding of the mechanisms and interactions between nutrition, infectious disease, environmental exposures, and genetic predisposition in order to develop better prevention methods. This paper briefly examines modern contributors to children's environmental health problems, efforts to date on both the regional and international level to address these challenges, and reflects upon major research needs that must be addressed in order to close the gaps that exist in our understanding of the relationship between environmental exposures and children's health.

Child↗