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Pages 24-41

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From page 24...
... . • Understanding environmental exposures is a missing piece in adopting pre cision medicine.
From page 25...
... Health equity is achieved when every person can "attain his or her full health potential," and no one is "disadvantaged from achieving this potential because of social position or other socially determined circum stances," described Juarez. Public health aims to achieve health equity by eliminating health disparities and achieving optimal health for all Americans.
From page 26...
... Finally, Juarez called for a human "exposome" project, like the Human Genome Project, that allows investigators from different fields to come together and standardize these types of measures. BIOMARKERS OF PRENATAL EXPOSURE TO AIR POLLUTION AND CHILDREN'S HEALTH AND DEVELOPMENT3 Over 80 percent of toxic air pollutants and CO2, a greenhouse gas, are emitted by the combustion of fossil fuels.
From page 27...
... . Air toxics are associated with infant mortality, preterm birth, low birth weight, new and exacerbated cases of asthma, decreased lung function, immune disorders, neuro­ developmental effects (intelligence loss, autism spectrum disorder, and attention deficit and hyperactivity disorder)
From page 28...
... Biological markers in samples of blood, placental tissue, and ­others can measure or estimate internal dose, biologically effective dose, pre­clinical effect, and susceptibility. The concept underlying ­molecular FIGURE 3-1  Timing of maturational events in human brain development.
From page 29...
... . • PAH-DNA adducts, a marker of potential DNA damage from PAH exposure, have been associated with adverse developmental out comes, such as decreased birth weight, length, and head circum­ ference, reduced IQ scores, attention problems, delayed maturation FIGURE 3-2  Simplified scheme of molecular epidemiology and biomarkers.
From page 30...
... The observed effects of prenatal exposure to PAHs (measured by personal air samples or PAH-DNA adducts) include behavioral problems, anxiety and depression symptoms, ADHD, decreased emotional regulation, autistic traits, reduced birth weight, and reduced head circumference and IQ.
From page 31...
... Echoing comments by Landrigan, Burke, Woodruff, and others, Perera commented that environmental health professionals need more research that shows the benefits of regulation and other public health interventions and is more focused on pregnant women and children in environmental justice communities. TESTICULAR CANCER AS A LATE SYMPTOM OF TESTICULAR DYSGENESIS SYNDROME6 Industrialized countries have had birth rates below sustainability l­evels for several decades and are now facing declining populations, said Skakkebæk.
From page 32...
... During and after puberty, the germ cells differentiate into spermatocytes, spermatids, and sperms. According to the current model for the pathogenesis of testicular germ cell tumors, an arrest of cell differentiation at the fetal gonocyte stage due to poor Leydig or Sertoli cell functions will lead to the proliferation of gonocytes into germ cell neoplasia in-situ (see Figure 3-3)
From page 33...
... Testicular germ cell cancer may be just one symptom of testicular dysgenesis syndrome due to dysfunction of fetal Sertoli and Leydig cells, said Skakkebækk. The dysgenesis of the Sertoli and Leydig cells and impaired germ cell differentiation may also lead to reduced semen quality and androgen insufficiency (see Figure 3-4)
From page 34...
... . Skakkebækk concluded that the testicular germ cell cancer rate, which is linked to the maldevelopment of fetal gonads and male infertility, is a FIGURE 3-5  Global trends in testicular cancer diagnosis.
From page 35...
... Birth outcomes associated with later life disease include preterm birth and low birth weight, which both capture heterogeneous disease etiologies. Environmental toxicities are typically very specific, which dilutes the association with these heterogeneous outcomes.
From page 36...
... were pooled for analysis (n = 6,043 cases and n = 538 preterm births) (Welch et al., 2022)
From page 37...
... Exposure to replacement chemicals will also be important, as exposure patterns change over time, such as for pesticides, flame retardants, and PFAS; new recruitment into cohorts is needed to understand the consequences of these new exposures. PRENATAL EXPOSURES AND BIOMARKERS AS MARKERS FOR AUTISM RISK8 "What role does the environment play in precision medicine?
From page 38...
... Teeth and hair can be used to reconstruct prenatal exposures because both matrices have incremental markings that mark time. Using baby teeth, which have rings like a tree to mark different developmental periods, weekly measures of lead exposure can be estimated going all the way back to the prenatal period (Arora et al., 2021)
From page 39...
... In one of his s­ tudies, Skakkebæk found that the best predictor of male semen quality was ­testosterone levels at 3 months. Arora said that an important goal over the next 25 years would be to make progress on climate change.
From page 41...
... , cumulative risk assessment (led by Linda Birnbaum, National Institute of Environmental Health Sciences, retired) , and biomarkers (led by Marie Fortin, Jazz Pharmaceuticals)


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