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December 15, 1999

Although the health of American children has vastly improved over the past 100 years, due largely to vaccinations and to better nutrition, toxic environmental hazards threaten to rival infectious diseases as a scourge of children’s health in the 21st century.

A new Pediatric Environmental Health Specialty Unit (PEHSU) recently formed at Emory University creates a network of physicians and healthcare facilities dedicated to helping protect children from the ill effects of the environment. The new PEHSU at Emory is one of five new centers nationwide funded by the U.S. Agency for Toxic Substances and Disease Registry (ATSDR) and the U.S. Environmental Protection Agency (EPA) through the Association of Occupational and Environmental Clinics (AOEC). The Center at Emory will serve children, families, health care providers and public agencies throughout the Southeast. Other PEHSUs are based in Seattle, Chicago, New York and Boston.

The Emory Center links the Department of Environmental and Occupational Health in the Rollins School of Public Health, the Department of Pediatrics in the School of Medicine, the Georgia Poison Center, Marcus Institute, an affiliate of Kennedy Krieger Institute at Emory University, and a variety of Emory-affiliated clinical facilities, including Children’s Healthcare of Atlanta and the Hughes Spalding Children’s Hospital.

Children are uniquely susceptible to environmental hazards, notes Howard Frumkin, M.D., Dr.P.H., associate professor and chair of environmental and occupational health in Emory’s Rollins School of Public Health and principal investigator for the new PEHSU.

"Children breathe more air and drink more water per pound of body weight than adults, and children play close to the ground where toxic materials can be absorbed," he says. "Because of immature metabolic pathways, children may be relatively less able to detoxify environmental substances, and their developing organs may be especially susceptible to toxic insults. And, because they will live longer than adults, children have a greater opportunity to develop chronic diseases following hazardous exposures."

According to the Centers for Disease Control and Prevention (CDC), the incidence of asthma, childhood cancer, congenital anomalies, neurodevelopmental disorders and endocrine and sexual disorders is increasing, with environmental exposures from modern chemical compounds likely playing an important role. According to the EPA, large portions of the United States experience excessive levels of air pollutants, and housing and schools throughout the country pose exposures to biological contaminants.

The new Specialty Unit will provide information and education to families, communities and health care providers throughout the Southeast regarding environmental hazards and the most effective ways to protect children’s health. It also will refer children for treatment, maintain a database of conditions linked to environmental hazards and consult with government agencies to formulate solutions. The PEHSU will establish an 800 number to welcome calls from throughout the region, and a web site designed to be user-friendly and informative.

"We at Emory are delighted to reach out to the southeastern states with this important service," says Dr. Frumkin. "If you are a parent whose child plays outside during the high ozone days in Atlanta, or if you live near a hazardous waste site, or if you are a parent of a child with a birth defect, and you wonder if workplace exposure could have contributed, you can get information and referral from our center," he explains.

The Emory PEHSU team includes Dr. Frumkin; Robert Geller, M.D., Emory pediatrician and medical director of the Georgia Poison Center; I. Leslie Rubin, M.D., director of the division of developmental pediatrics at Emory and director of academic and medical programs for Marcus Institute; and Gerald Teague, M.D., director of pediatric respiratory medicine at Emory. Janice Nodvin, director of special projects at Marcus Institute, will serve as project administrator.

Numerous programs already are in place at Emory to address environmental health. The Department of Environmental and Occupational Health in the Rollins School of Public Health houses a joint residency program with the School of Medicine linking Emory to a variety of institutions in the Atlanta area, including industries, governmental agencies, and private physician practices of environmental and occupational medicine. Emory faculty and residents conduct research projects on issues such as the health effects of mercury, air pollution and the effects of chemical environmental exposures on reproductive health. Emory’s Consultative Clinic in Environmental and Occupational Medicine is a major referral center for Georgia and the Southeast.

The Emory Department of Pediatrics provides asthma clinical services at five locations around Georgia and conducts extensive clinical research programs in asthma. The Division of Developmental Pediatrics is located within Marcus Institute, an independent institution affiliated with Kennedy Krieger Institute, located near the Emory campus. Marcus Institute provides assessments, treatment and support services for persons with developmental disabilities, some of which can result from environmental exposures. The pediatrics department also is responsible for medical management of the Georgia Poison Center, located at Hughes Spalding Children’s Hospital, part of the Grady Health System. The Poison Center, one of the largest in the U.S., is a state-funded agency that receives approximately 90,000 calls each year relating to toxic exposures. The Hughes Spalding Hospital, principal training site for Emory pediatrics residents, treats many children with acute or chronic intoxications, including lead poisoning, in its Pediatric Toxicology Clinic.

The new environmental network will develop a range of educational materials, conduct teaching sessions throughout the region, provide information and consultation to agencies and health care providers, refer patients needing clinical evaluations, establish a network of committee clinicians and provide clinical services. Concerned parents and health-care providers will soon be able to access the center via a toll-free number staffed by residents specializing in pediatrics or environmental health.

For more information, contact Ms. Janice Nodvin at 404-727-9483.

PEHSU Resources at Emory

The Department of Environmental and Occupational Health

The Department of Environmental and Occupational Health is one of six departments within the Rollins School of Public Health at Emory University. The department has 12 core faculty members and 32 adjunct and joint faculty. It offers the M.P.H. degree in Environmental and Occupational Health and the joint M.S.P.H. in Epidemiology and Environmental and Occupational Health. Emory’s Environmental and Occupational Medicine Residency Program is offered jointly through the Schools of Public Health and Medicine.

The Department of Pediatrics

The Department of Pediatrics in Emory University School of Medicine is the second largest pediatrics department in the country, with a faculty of approximately 120 pediatricians and other health professionals practicing within Emory Children’s Center, the Children’s Heart Center, the pediatric intensive care group and the Grady Health System. The Emory Pediatric Residency Program accepts 18 new residents each year into its three-year program and all Emory medical students rotate through pediatrics for a two-month period. The Department of Pediatrics offers asthma clinical services at five locations around Georgia, and is the largest provider of ambulatory asthma care to the Medicaid population in the state. The department also includes the Division of Developmental Pediatrics, housed within Marcus Institute, which is at three statewide locations. Marcus Institute professionals are clinicians and therapists in developmental pediatrics, genetics, psychiatry, psychology, behavioral psychology, nutrition, speech language pathology, social work and nursing.

The Georgia Poison Center

The Georgia Poison Center is a regional, state-appointed and funded center serving all of Georgia. One of the five largest poison centers in the U.S., the center receives more than 90,000 calls each year from individuals experiencing a toxicologic exposure. Medical toxicologists are constantly available to support the on-site Poison Center staff. Environmental and occupational medicine residents serve as the first back-up physicians for occupational and environmental calls to the Poison Center. Regular conferences include these residents as well as attending Poison Center physicians and pediatrics and emergency medicine residents.

Hughes Spalding Children’s Hospital (HSCH)

The Hughes Spalding Children’s Hospital, an 82-bed children’s hospital, is part of the Grady Health System, the public healthcare system of Fulton and DeKalb counties. HSCH is the principal training site for Emory pediatric residents in both primary care pediatrics and inpatient hospital care. Through its Emergency Care Center and multiple inpatient and outpatient services, including its Pediatric Toxicology Clinic, this hospital cares for a large number of children suffering from acute or chronic intoxications.

Marcus Institute

Marcus Institute, an affiliate of Kennedy Krieger Institute at Emory University, is an independent, nonprofit institution affiliated with the Emory Department of Pediatrics. The institute has emerged as a nationally recognized center of excellence for providing coordinated and comprehensive services for persons with developmental disabilities. In addition to clinical and community services, provided both at the institute and across the state of Georgia, the institute conducts interdisciplinary research and is an active part of Emory’s pediatrics teaching programs. Pediatrics department faculty serve as faculty for Marcus Institute. In addition to treating patients with a wide range of developmental conditions, the institute provides diagnosis and testing, education, counseling and resource referral for patients, families, caregivers and physicians. The institute maintains ongoing affiliations with other Georgia universities, state agencies and professional organizations.

Children’s Healthcare of Atlanta

In 1998 Egleston Children’s Hospital, traditionally one of the major pediatric training sites for Emory School of Medicine, merged with Scottish Rite Hospital to form Children’s Healthcare of Atlanta. Together the two hospitals include 400 beds, a satellite system of 26 clinics and a medical staff of 1,200 representing 43 specialties. Egleston, located on the Emory campus, serves as a tertiary care center for all disciplines of pediatrics. Egleston’s diagnostic capabilities are the most advanced in the region and include extensive radiologic, audiologic, ophthalmologic and laboratory capabilities. The visible presence of Children’s Healthcare of Atlanta within the community provides an effective route for public communication about children’s environmental health.

The Consultative Clinic in Environmental and Occupational Medicine

This consultative clinic, which is part of The Emory Clinic, opened in 1991 and became a member of the Association of Occupational and Environmental Clinics (AOEC). The consultative clinic has emerged as a major referral center for Georgia and the Southeast. Patient referrals to the clinic come from physicians, insurance companies, employers, unions and attorneys. Conditions seen by the six attending physicians at the clinic include environmental and occupational lung diseases, dermatitis, neurological deficits, allergic syndromes and poorly defined syndromes, such as multiple chemical sensitivity. All patients are entered into the AOEC database.




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