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Who Unep 8 9 10 11 World Health Organization International Programme on Chemical Safety (Ipcs) Environmental Health Criteria Document On

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Who Unep 8 9 10 11 World Health Organization International Programme on Chemical Safety (Ipcs) Environmental Health Criteria Document On 1 WORLD HEALTH ORGANIZATION IPCS 2 INTERNATIONAL LABOUR ORGANIZATION Unedited draft 3 UNITED NATIONS ENVIRONMENT PROGRAMME Restricted 4 5 6 7 WHO UNEP 8 9 10 11 WORLD HEALTH ORGANIZATION INTERNATIONAL PROGRAMME ON CHEMICAL SAFETY (IPCS) ENVIRONMENTAL HEALTH CRITERIA DOCUMENT ON 12 PRINCIPLES FOR EVALUATING HEALTH RISKS IN CHILDREN 13 ASSOCIATED WITH EXPOSURE TO CHEMICALS 14 15 16 17 Draft Prepared by: Dr Germaine BUCK-LOUIS, Division of Epidemiology, Statistics and Preventive Research, NIH, National Institute of Child Health Development, USA; Dr Terri DAMSTRA, World Health Organization, International Programme on Chemical Safety, Interregional Research Unit, USA; Dr Fernando DIAZ-BARRIGA, Universidad Autonoma de San Luis Potosi, Facultad de Medicina, Mexico; Dr Elaine FAUSTMAN, Institute for Risk Analysis and Risk Communication, University of Washington, USA; Dr Ulla HASS, Danish Danish Institute of Food & Veterinary Research (FDIR), Department of Toxicology & Risk Assessment, Denmark; Dr Robert KAVLOCK, US Environmental Protection Agency, Reproduction Toxicology Facility, USA; Dr Carole KIMMEL, US Environmental Protection Agency, National Center for Environmental Assessment, USA; Dr Gary KIMMEL, Silver Spring, Maryland, USA; Dr Kannan KRISHNAN, University of Montreal, Canada; Dr Ulrike LUDERER, Center for Occupational and Environmental Health, University of California at Irvine, USA; Dr Linda SHELDON, US Environmental Protection Agency, Human Exposure and Atmospheric Sciences Division, USA. 1 1 2 TABLE OF CONTENTS 3 4 5 CHAPTER 1 – Executive Summary, Conclusions, and Recommendations 6 1.1 Introduction 7 1.2 Conclusions 8 9 CHAPTER 2 – Introduction and Background 10 2.1 Introduction 11 2.2 Purpose and Scope of Document 12 2.3 Global Burden of Disease in Children 13 2.4 Major Environmental Threats to Children 14 2.4.1 Economic and nutritional factors 15 2.4.2 Social, cultural, demographic, and lifestyle factors 16 2.4.3 Chemical hazards 17 2.5 Intrinsic Factors 18 2.6 The Significance of a Developmental Stage Approach 19 20 CHAPTER 3 – Unique Biological Characteristics of Children 21 3.1 Growth and Development 22 3.1.1 Body weight and height 23 3.1.2 Organ weights/volumes 24 3.1.3 Skin 25 3.2 Anatomical and Functional Characteristics 26 3.3 Physiological Characteristics 27 3.3.1 Breathing rate 28 3.3.2 Cardiac output 29 3.3.3 Blood flow to organs 30 3.3.4 Body composition 31 3.3.5 Tissue composition 32 3.3.6 Bone growth and composition 33 3.4 Metabolic Characteristics 34 3.5 Toxicokinetics 35 3.5.1 Absorption, distribution, metabolism and elimination 36 3.5.2 Physiological changes in mother and their influences on 37 toxicokinetics 38 3.5.3 Dose to target 39 3.6 Normal Development 40 3.6.1 Basic principles of normal development 41 3.6.2 Nervous system 42 3.6.3 Reproductive system 43 3.6.4 Endocrine system 44 3.6.5 Cardiovascular system 45 3.6.6 Immune system 2 1 3.6.7 Respiratory system 2 3.6.8 Kidney 3 3.7 Conclusions 4 5 CHAPTER 4 – Developmental Stage Specific Susceptibilities and Outcomes in Children 6 4.1 Introduction 7 4.2 Mortality, Growth Restriction, and Birth Defects 8 4.2.1 Mortality 9 4.2.2 Growth restriction 10 4.2.3 Birth defects (structural malformations) 11 4.2.3.1 Etiology 12 4.2.3.2 Functional developmental toxicity 13 4.3 Specific Organ Systems 14 4.3.1 Nervous system 15 4.3.1.1 Periods of vulnerability and consequences of exposure 16 4.3.1.2 Specific Examples 17 4.3.2 Reproductive system 18 4.3.2.1 Periods of vulnerability 19 4.3.2.2 Consequences of exposure to chemicals 20 4.3.3 Endocrine and metabolic disorders 21 4.3.3.1 Periods of vulnerability 22 4.3.3.2 Consequences of exposures 23 4.3.4 Cardiovascular system 24 4.3.5 Immune system 25 4.3.5.1 Periods of vulnerability 26 4.3.5.2 Consequences of early exposure 27 4.3.6 Normal development respiratory system 28 4.3.6.1 Periods of vulnerability 29 4.3.6.2 Consequences of exposures 30 4.3.7 Kidney 31 4.3.7.1 Periods of vulnerability 32 4.3.7.2 Consequences of exposure 33 4.4 Cancer 34 4.4.1 Childhood cancers that may have environmental causes 35 4.4.2 Adult cancers related to childhood exposures 36 4.4.3 Chemical exposures of special concern 37 4.5 Conclusions 38 39 CHAPTER 5 – Exposure Assessment of Children 40 5.1 Introduction 41 5.2 General Principles of Exposure Assessments 42 5.3 Methods for Conducting Exposure Assessments 43 5.3.1 Direct methods 44 5.3.2 Biomarkers of exposure 45 5.3.3 Modeling 46 5.4 Unique Characteristics of Children that Affect Exposure 3 1 5.5 Exposure as It Relates to Children Around the World 2 5.5.1 Sources/geographical location 3 5.5.2 Pathways of exposure 4 5.5.2.1 Ambient air exposure pathway 5 5.5.2.2 Indoor exposure pathways 6 5.5.2.3 Water exposure pathway 7 5.5.2.4 Soil exposure pathway 8 5.5.2.5 Food-chain exposure pathway 9 5.5.2.6 Human exposure pathways 10 5.5.3 Settings/microenvironments 11 5.5.3.1 Residential 12 5.5.3.2 School 13 5.5.3.3 Child care centers 14 5.5.3.4 Recreational 15 5.5.3.5 Special settings 16 5.5.4 Environmental equity factors (vulnerable communities) 17 5.6 Special Considerations for Children’s Exposure: Case Studies 18 5.6.1 Influence of activities 19 5.6.2 Environmental equity 20 5.6.3 Aggregate exposure 21 5.6.4 Cumulative exposure 22 5.7 Conclusions 23 24 CHAPTER 6 – Methodologies to Assess Health Outcomes in Children 25 6.1 Introduction 26 6.1.1 Methodologic approaches for children’s health 27 6.1.2 Methodologic approaches for animal studies 28 6.2 Growth and Development 29 6.2.1 Human studies 30 6.2.2 Animal studies 31 6.3 Reproductive Development and Function 32 6.3.1 Human studies 33 6.3.2 Animal studies 34 6.4 Neurological and Behavioral Effects 35 6.4.1 Human studies 36 6.4.2 Animal studies 37 6.5 Cancer 38 6.5.1 Human studies 39 6.5.2 Animal studies 40 6.6 Immune 41 6.6.1 Human studies 42 6.6.2 Animal studies 43 6.7 Respiratory 44 6.7.1 Human studies 45 6.7.2 Animal studies 46 6.8 Hemopoeitic/Cardiovascular, Hepatic/Renal, Skin/Musculoskeletal, 4 1 Metabolic/Endocrine 2 6.8.1 Human studies 3 6.8.2 Animal studies 4 6.9 Conclusions 5 6 CHAPTER 7 – Implications and Strategies for Risk Assessment for Children 7 7.1 Introduction 8 7.2 Problem Formulation 9 7.3 Hazard Identification 10 7.3.1 Endpoints and critical periods of exposure 11 7.3.2 Human studies 12 7.3.3 Relevance of animal studies for assessing potential hazards to children 13 7.3.4 Reversibility and latency 14 7.3.5 Characterization of the health related data base 15 7.4 Dose Response Assessment 16 7.4.1 Application of health outcome data 17 7.4.2 Quantitative evaluation 18 7.4.2.1 Tolerable daily intake (TDI) and reference dose 19 (RfD/reference concentration (RfC) approaches 20 7.4.2.2 Benchmark dose (BMD) – benchmark concentration 21 (BMC) approach 22 7.4.2.3 Biologically-based dose-response models 23 7.4.2.4 Duration adjustment 24 7.4.2.5 Toxicokinetics 25 7.5 Exposure assessment 26 7.5.1 Age-specific exposures 27 7.5.2 Assessment methods 28 7.6 Risk Characterization 29 7.7 Conclusions 30 5 1 2 3 CHAPTER 1 - EXECUTIVE SUMMARY, CONCLUSIONS AND 4 RECOMMENDATIONS 5 6 7 1.1 Introduction 8 9 Environmental factors play a major role in determining the health and well-being of children.* 10 Accumulating evidence indicates that children (who comprise over one-third of the world’s 11 population) are among the most vulnerable and that environmental factors can affect children’s 12 health quite differently than adults. Poor, neglected, and malnourished children suffer the most. 13 These children often live in unhealthy housing, lack clean water and sanitation services, and have 14 limited access to health care and education. One in five children in the poorest parts of the world 15 will not live to their fifth birthday, mainly because of environment-related diseases. The World 16 Health Organization (WHO) estimates that over 30% of the global burden of disease in children 17 can be attributed to environmental factors. 18 19 Health is determined by a variety of factors. In addition to the physical environment, genetics, 20 and biology, social, economic, and cultural factors play a major role. It is critical to understand 21 the various driving forces during childhood that shape health and behaviour throughout life. The 22 purpose of this document is to evaluate the scientific principles to be considered in assessing 23 health risks in children from exposures to environmental agents during distinct developmental 24 stages and provide information that can be used to protect children at the individual, family and 25 community levels. The central focus of this document is on the developmental stage rather than 26 on a specific environmental chemical or a specific disease or outcome. Developmental stage- 27 specific periods of susceptibility have been referred to as “critical windows for exposure” or 28 “critical windows of development.” These distinct life stages are defined by relevant dynamic 29 processes occurring at the molecular, cellular, organ system, and organism level.
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