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Health Care Providers Urged to Track Chronic Diseases

      AUSTIN, Texas - Health care providers throughout Texas are being asked to track chronic diseases under a new program aimed at exploring possible links between illness and environmental factors.

      The program seeks to lay the groundwork for a $275 million nationwide disease tracking network to gather data for research and to furnish information on environmental health now lacking in many states, health professionals said over the weekend at a conference on environmental contaminants and children.

      ``When the network is established, it will provide one-stop shopping for environmental health information,'' said Susan West of the Physicians for Social Responsibility, a national nonprofit group working on the project with the Pew Environmental Health Commission at the Johns Hopkins School of Hygiene and Public Health in Maryland.

      The recommendation for the disease-tracking system, made by the Pew Commission, is based on an analysis by Johns Hopkins professor Thomas Burke, chairman of the Director''s Advisory Committee to the National Center for Environmental Health at the Centers for Disease Control and Prevention.

      ``It has to be done,'' said Dr. John Fling, chief of pediatrics at the University of North Texas Health Science Center at Fort Worth, who attended the conference. ``A central registry is the only way to go.''

      Texas, New York and Massachusetts are the first states in which health care workers are being educated and mobilized, West said, noting that state governments are not involved in the initial phase of the program. The hope is that Congress will eventually fund the tracking network, she said.

      Without such an effort to track chronic diseases, public health officials can''t mount effective prevention efforts against asthma, birth defects, developmental disabilities and other diseases such as Alzheimer''s, Parkinson''s and certain cancers, she said.

      The incidence of asthma, the most common chronic disease among children in the nation, has doubled since 1980 and could double again in the next 20 years, conference participants said. It affects about 5 million children younger than 14, causes the most trips by children to emergency rooms and is the most common medical reason for school absence, they said.

      Much of the increase is blamed on air pollution such as diesel exhaust particles, tiny soot particles and ozone, but also on cockroaches, dust mites and other environmental factors.

      ``In some urban areas, as many as 25 percent of children have some asthmatic symptoms,'' said Dr. Stuart Abramson, a pediatric allergist and immunologist at Texas Children''s Hospital in Houston, who addressed the conference. Childhood deaths from asthma are about 900 a year, approaching the level of childhood cancer deaths, roughly 1,100 each year, Abramson said.

      West said that at least 27 states lack tracking and monitoring data for asthma and that only eight states and the District of Columbia adequately track developmental disabilities such as autism and mental retardation, despite an estimated 50 percent rise nationwide in these disabilities in the past decade.

      Although rates for autoimmune diseases such as lupus continue to rise only four states track them, West said. Less than half the nation''s population is covered by a birth defects registry, even though birth defects are the leading cause of infant mortality in the nation and rates for some birth defects are increasing.

      Texas has a good tracking system for birth defects, developed after the state gained national attention about 10 years ago when 33 babies in Cameron County were born with neural tube defects.

      Dr. Martha Linet of the National Cancer Institute said at the conference that the institute is establishing a national childhood cancer registry and tissue bank to identify children immediately after diagnosis and to improve measurements of exposure.

      Scientists have a difficult time gathering data because they must go to every hospital to get permission for children to participate in a study, Linet said. There are a host of ethical and privacy issues that need to be resolved to build registries and tracking networks, she said.

      The registry would be set up at hospitals rather than at universities. Its goal is to identify environmental causes of childhood cancers by 2010, Linet said.

      ``We are on the threshold of doing new causation research,'' she said.

      Children eat, drink and breathe more per body weight than do adults, and with their different metabolism, may be more or less capable of breaking down or excreting toxic substances, said Dr. Lynn Goldman, a Johns Hopkins professor and former assistant administrator for the Environmental Protection Agency''s Office of Prevention, Pesticides and Toxic Substances.

      Because children have longer life expectancies than adults do, environmental exposures to the very young have a bigger chance of showing up later in life, she said.

      ``Children are more susceptible. They are not little adults,'' she said.

      The Texas effort to work with health care providers on environmental issues will be led by the Children''s Environmental Health Institute in Austin, which sponsored the weekend meeting.

      ``We want to train physicians and other medical professionals, in their role as primary care givers, to identify and prevent some of these medical conditions,'' said Janie Fields, the executive director.

      The group may hold town meetings across Texas this year and hopes to present programs at Texas medical schools and child care centers, she said.

      ---

c.2000 Fort Worth Star-Telegram




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