Focus
Ambiente e salute del bambino: una panoramica
ENVIRONMENT AND CHILD HEALTH: AN OVERVIEW
G. Tamburlini
Dicembre 2009 - pagg. 635 -647
Abstract
The article provides an overview of the relationship between environmental exposure
and health effects relevant to children and adolescents. Main exposures and health effects
are described for the four priority areas identified by the Children’s Environment
and Health Action Plan for Europe (i.e. unsafe environments, unsafe water, polluted air,
chemical and physical agents) as well as for psychosocial exposures. For each area a
synoptic view of the available evidence related to causality, dose-response, burden of
disease and effective interventions is given. Some of the main recent developments in
each exposure group are briefly described. The Author underlines the need that preventive
action, at both individual and community level, is supported by a priority setting
approach based on available evidence about exposure-effects relationship and burden
of disease. The role of exposure to adverse psychosocial environments and to social factors
influencing environmental exposures should not be neglected when dealing with environmental
issues.
Classificazione MeSH
Bibliografia
1. Tamburlini G, Von Ehrenstein O, Bertollini
R (eds). Children’s health and environment: a
review of evidence: a joint report from the European
Environment Agency and the WHO
Regional Office for Europe. Copenhagen, European
Environment Agency, 2002;
www.euro.who.int/ document/e75518.pdf).
2. WHO. Children’s Environment and Health Action Plan for Europe. Fourth Ministerial Conference on Environment and Health, Budapest, Hungary, 23-25 June 2004. Copenhagen: WHO Regional Office for Europe; 2004. Report No.: EUR/04/5046267/7; (http:// www.euro.who.int/document/e83338.pdf, consultato 23 luglio 2009).
3. Tamburlini G. Salute del bambino e tossicità ambientale. Medico e Bambino 2000;19: 592-7.
4. Valent F, Little D, Bertollini R, Nemer LE, Barbone F, Tamburlini G. Burden of disease attributable to selected environmental factors and injury among children and adolescents in Europe. Lancet 2004;363:2032-9.
5. WHO Regional Office for Europe. Mortality from road traffic injuries in children and young people. European Environment and Health information System, 2007.
6. Transport safety performance in the EU: A statistical overview. Brussels, European Transport Safety Council, 2003 (http://www.etsc. be/oldsite/statoverv.pdf, consultato 10 ottobre 2009).
7. Ronfani L, Tamburlini G. Progetto SEI+UNO: valutazione dell’efficacia dell’informazione per la promozione della salute perinatale e infantile. Epicentro, dicembre 2002; www.epicentro.iss.it/archivio/19-12-2002/seipiuunoepicentro2. pdf.
8. www.genitoripiu.it.
9. WHO. Tackling Obesity by Creating Healthy Residential Environments. Copenhagen: WHO Regional Office for Europe; 2007. Report No.: EU/07/5072462; www.euro.who. int/Document/E90593.pdf, consultato 13 ottobre 2009).
10. Laflamme L, et al. Inequalities in environmental exposure. WHO, Regional Office for Europe, 2009.
11. Fewtrell L, Kaufmann R, Kay D, Enanoria W, Haller L, Colford J. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 2004;5:42- 52.
12. www.euro.who.int/childhealthenv/Risks/ (consultato 10 novembre 2009).
13. Galassi C, De Sario M, Forastiere F (a cura di). Studi Italiani sui disturbi respiratori nell’infanzia e l’ambiente. Epidemiol Prev 2005; 29 suppl:1-96.
14. Jedrychowski W, Perera FP, Maugeri U, et al. Early wheezing phenotypes and severity of respiratory illness in very early childhood. Study on intrauterine exposure to fine particle matter. Environ Intern 2009;35:877-84.
15. Gauderman WJ, Vora H, McConnell R, et al. Effect of exposure to traffic on lung development from 10 to 18 years of age: a cohort study. Lancet 2007;369:571-7.
16. Gauderman WJ, Avol E, Gilliland F, et al. The effect of air pollution on lung development from 10 to 18 years of age. N Engl J Med 2004;351:1057-67.
17. Rojas-Martinez R, Perez-Padilla R, Olaiz- Fernandez G, et al. Lung function growth in children with long-term exposure to air pollutants in Mexico City. Am J Respir Crit Care Med 2007;176:377-84.
18. Collaborative Initiative on Health and the Environment’s Learning and Development Disabilities. Scientific Consensus Statement on Environmental Agents Associated with Neurodevelopmental Disorders 2007:1-35.
19. Grandjean P, Landrigan PJ. Developmental neurotoxicity of industrial chemicals. Lancet 2006;16:2167-78.
20. Chen A, Cai B, Dietrich KN, Radcliffe J, Rogan WJ. Lead exposure, IQ, and behavior in urban 5- to 7-year-olds: does lead affect behavior only by lowering IQ? Pediatrics 2007; 119:e650-8.
21. Windham GC, Zhang L, Gunier R, Croen LA, Grether JK. Autism Spectrum Disorders in Relation to Distribution of Hazardous Air Pollutants in the San Francisco Bay Area. Environ Health Perspect 2006;114:1438-44.
22. Environmental Burden of Disease - European countries (EBoDE) project Quantification, comparison and ranking of environmental stressors within and between participating countries Report of the first project meeting WHO European Centre for Environment and Health Bonn, Germany, 12-13 February 2009.
23. Wilhelma M, Wittsiepe J, Lemm F. The Duisburg birth cohort study: Influence of the prenatal exposure to PCDD/Fs and dioxinlike PCBs on thyroid hormone status in newborns and neurodevelopment of infants until the age of 24 months. Mutation Res 2008;659: 83-92.
24. Sathyanarayana S. Baby Care Products: Possible Sources of Infant Phthalate Exposure. Pediatrics 2008;121:260-8.
25. Baccarelli A, Bollati V. Epigenetics and environmental chemicals. Curr Opinion Pediatr 2009;21:243-51.
26. Lee DH, Lee IK, Song K, et al. A strong dose- response relation between serum concentrations of persistent organic pollutants and diabetes: results from the national health and examination survey 1999-2002. Diabetes Care 2006;29:1638-44.
27. Lee DH, Lee IK, Jin SH, Steffes M, Jacobs DR Jr. Association between serum concentrations of persistent organic pollutants and insulin resistance among nondiabetic adults: results from the national health and nutrition examination survey. Diabetes Care 2007;30: 622-8.
28. Porta M. Persistent organic pollutants and the burden of diabetes. Lancet 2006;368:558-9.
29. McCann D, Barrett A, Cooper A, et al. Food additives and hyperactive behaviour in 3- year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo- controlled trial. Lancet 2007;370:1560-67.
30. Eskenazi B, Rosas LG, Marks AR, et al. Pesticide toxicity and the developing brain. Basic Clin Pharmacol Toxicol 2008;102:228-36.
31. Hertz-Picciotto I, Youn Park H, Dostal M, et al. Prenatal Exposures to Persistent and Non-Persistent Organic Compounds and Effects on Immune System Development. Basic Clin Pharmacol Toxicol 2008;102:146-54.
32. Verhulst SL, Nelen V, Der Hond E, et al. Intrauterine exposure to environmental pollutants and body mass index during the first 3 years of life. Environ Health Perspect 2009; 117:122-6.
33. Hibbeln JR, Davis JM, Steer C, et al. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet 2007;369:578-85.
34. Lederman SA, Jones RL, Caldwell KL, et al. Relation between cord blood mercury levels and early child development in a World Trade Center Cohort. Env Health Perspect 2008;116: 1085-91; doi:10.1289/ehp.10831 (http://dx.doi. org/), online 31 March 2008.
35. Tamburlini G, Barbone F. Maternal fish consumption and children’s development. Lancet 2007;369:1166-7.
36. Knox EG. Roads, railways and childhood cancers. J Epidemiol Community Health 2006; 60:136-41.
37. www.registri-tumori.it.
38. Rehfüss EA, von Ehrenstein OS. Ultraviolet radiation. In: Tamburlini G, Von Ehrenstein OS, Bertollini R (eds). Children’s health and environment: a review of evidence: a joint report from the European Environment Agency and the WHO Regional Office for Europe. Copenhagen, European Environment Agency, 2002.
39. Mjøen G, Saetre DO, Lie RT, et al. Paternal occupational exposure to radiofrequency electromagnetic fields and risk of adverse pregnancy outcome. Europ J Epidemiol 2006; 21:529-35.
40. Hardell L, Carlberg M, Söderqvist F, Mild KH, Morgan LL. Long-term use of cellular phones and brain tumours: increased risk associated with use for more than 10 years. Occup Eviron Med 2007;64:626-32.
41. Niskar AS, Kieszak SM, Holmes AE, et al. Estimated prevalence of noise-induced threshold shift among children 6 to 19 years of age: the third national health and nutrition examination survey, 1988-1994, United States. Pediatrics 2001;108:40-3.
42. Vogel I, Brug J, Hosli EJ, van der Ploeg CP, Raat H. MP3 players and hearing loss: adolescent’s perceptions of loud music and hearing conservation. Pediatrics 2008;152: 400-4.
43. http://www.euro.who.int/childhealthenv/ Risks/InjuriesTop.
44. Parslow RC, Tasker RC, Draper ES, et al. Epidemiology of critically ill children in England and Wales incidence, mortality, deprivation and ethnicity. Arch Dis Child 2009;94: 210-5.
45. http://www.euro.who.int/HFADB.
46. Barlow J, Stewart-Brown S. Child abuse and neglect. Lancet 2005;365:1750-2.
47. Evans GW, Gonnella C, Marcynyszyn L, Gentil L, Salpekar N. The role of Chaos in Poverty and Children’s Socioemotional Adjustment Psychological. Science 2005;16:560-5.
48. Schmidt ME, Pempek TA, Kirkorian HL, Lund AF, Anderson DR. The effects of background television on the toy play behavior of very young children. Child Dev 2008;79:1137- 51.
49. Maikovich AK, Jaffee SR, Odgers CL, Gallop R. Effects of family violence on psychopathology symptoms in children previously exposed to maltreatment. Child Dev 2008;79: 1498-512.
50. Davies PT, Woitach MJ, Winter MA, Cummings EM. Children’s insecure representations of the interparental relationship and their school adjustment: the mediating role of attention difficulties. Child Dev 2008;79:1570-82.
51. Joussemet M, Vitaro F, Barker ED, et al. Controlling parenting and physical aggression during elementary school. Child Dev 2008;79: 411-25.
52. Lugo-Gil J, Tamis-Le Monda CS. Family resources and parenting quality: links to children’s cognitive development across the first 3 years. Child Dev 2009;79:1065-85.
53. Dishion T, Connell A, Weaver C, et al. The family check-up with high risk indigent families: preventing problem behaviour by increasing parents’ positive behaviour support in early childhood Child Dev 2008;79:1395-414.
54. Apollonio MG, Barbiero C, Bascucci S, et al. Supporto precoce ai neogenitori. È necessario? Serve? Medico e Bambino 2005;24:589- 98.
55. Richter L. The importance of caregiverchild interactions for the survival and healthy development of young children. WHO Geneva, 2005.
56. Rahman A, Malik A, Sikander S, et al. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan. A cluster randomized controlled trial. Lancet 2008;372:902-9. 57.Walker SP, Chang SM, Powell CA, Grantham-McGregor SM. Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: prospective cohort study. Lancet 2005;366: 1804-7.
58. Irwin L, Siddiqi R, Hertzman C. Early Child Development: A Powerful Equalizer Final Report for the World Health Organization’s Commission on the Social Determinants of Health. June 2007.
59. Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S; on behalf of the Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008;372:1661-9.
60. Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report. Geneva: World Health Organization, 2008; http://whqlibdoc. who.int/publications/2008/9789241563703_ eng.pdf, accessed 13 July 2009.
61. Romieu I, Ramírez-Aguilar M, Moreno-Macias H, et al. Infant mortality and air pollution: modifying effect by social class. J Occup Environ Med 2004;46:1210-6.
62. Bolte G, Kohlhuber M, Weiland SK, Zuurbier M, Stansfeld S, Heinrich J. Socioeconomic factors in EU-funded studies of children’s environmental health. Eur J Epidemiol 2005; 20:289-91.
63. Bellinger DC. Lead neurotoxicity and socioeconomic status: conceptual and analytical issues. Neurotoxicology 2008;29:828-32.
64. WHO expert meeting on “Environment and health risks: the influence and effects of social inequalities” in September 2009.
65. Bolte G, Tamburlini G, Kohlhuber M. Environmental inequalities among children in Europe: evaluation of scientific evidence and policy implications. Eur J Public Health 2009 (in press).
66. www.nationalchildrensstudy.gov.
67. http://ec.europa.eu/environment/che-micals/ reach/reach_intro.htm (consultato 10 ottobre 2009).
68. http://ec.europa.eu/legislation_ summaries.
69. Tamburlini G, Barbone F. Maternal fish consumption and children’s development. Lancet 2007;369:1166-7.
70. Akachi Y, Goodman D, Parker D. Global climate change and child health: a review of pathways, impacts and measures to improve the evidence base. UNICEF Innocenti Discussion paper 2009; http://www.unicefirc. org/publications/pdf/idp_2009_03.pdf.
2. WHO. Children’s Environment and Health Action Plan for Europe. Fourth Ministerial Conference on Environment and Health, Budapest, Hungary, 23-25 June 2004. Copenhagen: WHO Regional Office for Europe; 2004. Report No.: EUR/04/5046267/7; (http:// www.euro.who.int/document/e83338.pdf, consultato 23 luglio 2009).
3. Tamburlini G. Salute del bambino e tossicità ambientale. Medico e Bambino 2000;19: 592-7.
4. Valent F, Little D, Bertollini R, Nemer LE, Barbone F, Tamburlini G. Burden of disease attributable to selected environmental factors and injury among children and adolescents in Europe. Lancet 2004;363:2032-9.
5. WHO Regional Office for Europe. Mortality from road traffic injuries in children and young people. European Environment and Health information System, 2007.
6. Transport safety performance in the EU: A statistical overview. Brussels, European Transport Safety Council, 2003 (http://www.etsc. be/oldsite/statoverv.pdf, consultato 10 ottobre 2009).
7. Ronfani L, Tamburlini G. Progetto SEI+UNO: valutazione dell’efficacia dell’informazione per la promozione della salute perinatale e infantile. Epicentro, dicembre 2002; www.epicentro.iss.it/archivio/19-12-2002/seipiuunoepicentro2. pdf.
8. www.genitoripiu.it.
9. WHO. Tackling Obesity by Creating Healthy Residential Environments. Copenhagen: WHO Regional Office for Europe; 2007. Report No.: EU/07/5072462; www.euro.who. int/Document/E90593.pdf, consultato 13 ottobre 2009).
10. Laflamme L, et al. Inequalities in environmental exposure. WHO, Regional Office for Europe, 2009.
11. Fewtrell L, Kaufmann R, Kay D, Enanoria W, Haller L, Colford J. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 2004;5:42- 52.
12. www.euro.who.int/childhealthenv/Risks/ (consultato 10 novembre 2009).
13. Galassi C, De Sario M, Forastiere F (a cura di). Studi Italiani sui disturbi respiratori nell’infanzia e l’ambiente. Epidemiol Prev 2005; 29 suppl:1-96.
14. Jedrychowski W, Perera FP, Maugeri U, et al. Early wheezing phenotypes and severity of respiratory illness in very early childhood. Study on intrauterine exposure to fine particle matter. Environ Intern 2009;35:877-84.
15. Gauderman WJ, Vora H, McConnell R, et al. Effect of exposure to traffic on lung development from 10 to 18 years of age: a cohort study. Lancet 2007;369:571-7.
16. Gauderman WJ, Avol E, Gilliland F, et al. The effect of air pollution on lung development from 10 to 18 years of age. N Engl J Med 2004;351:1057-67.
17. Rojas-Martinez R, Perez-Padilla R, Olaiz- Fernandez G, et al. Lung function growth in children with long-term exposure to air pollutants in Mexico City. Am J Respir Crit Care Med 2007;176:377-84.
18. Collaborative Initiative on Health and the Environment’s Learning and Development Disabilities. Scientific Consensus Statement on Environmental Agents Associated with Neurodevelopmental Disorders 2007:1-35.
19. Grandjean P, Landrigan PJ. Developmental neurotoxicity of industrial chemicals. Lancet 2006;16:2167-78.
20. Chen A, Cai B, Dietrich KN, Radcliffe J, Rogan WJ. Lead exposure, IQ, and behavior in urban 5- to 7-year-olds: does lead affect behavior only by lowering IQ? Pediatrics 2007; 119:e650-8.
21. Windham GC, Zhang L, Gunier R, Croen LA, Grether JK. Autism Spectrum Disorders in Relation to Distribution of Hazardous Air Pollutants in the San Francisco Bay Area. Environ Health Perspect 2006;114:1438-44.
22. Environmental Burden of Disease - European countries (EBoDE) project Quantification, comparison and ranking of environmental stressors within and between participating countries Report of the first project meeting WHO European Centre for Environment and Health Bonn, Germany, 12-13 February 2009.
23. Wilhelma M, Wittsiepe J, Lemm F. The Duisburg birth cohort study: Influence of the prenatal exposure to PCDD/Fs and dioxinlike PCBs on thyroid hormone status in newborns and neurodevelopment of infants until the age of 24 months. Mutation Res 2008;659: 83-92.
24. Sathyanarayana S. Baby Care Products: Possible Sources of Infant Phthalate Exposure. Pediatrics 2008;121:260-8.
25. Baccarelli A, Bollati V. Epigenetics and environmental chemicals. Curr Opinion Pediatr 2009;21:243-51.
26. Lee DH, Lee IK, Song K, et al. A strong dose- response relation between serum concentrations of persistent organic pollutants and diabetes: results from the national health and examination survey 1999-2002. Diabetes Care 2006;29:1638-44.
27. Lee DH, Lee IK, Jin SH, Steffes M, Jacobs DR Jr. Association between serum concentrations of persistent organic pollutants and insulin resistance among nondiabetic adults: results from the national health and nutrition examination survey. Diabetes Care 2007;30: 622-8.
28. Porta M. Persistent organic pollutants and the burden of diabetes. Lancet 2006;368:558-9.
29. McCann D, Barrett A, Cooper A, et al. Food additives and hyperactive behaviour in 3- year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo- controlled trial. Lancet 2007;370:1560-67.
30. Eskenazi B, Rosas LG, Marks AR, et al. Pesticide toxicity and the developing brain. Basic Clin Pharmacol Toxicol 2008;102:228-36.
31. Hertz-Picciotto I, Youn Park H, Dostal M, et al. Prenatal Exposures to Persistent and Non-Persistent Organic Compounds and Effects on Immune System Development. Basic Clin Pharmacol Toxicol 2008;102:146-54.
32. Verhulst SL, Nelen V, Der Hond E, et al. Intrauterine exposure to environmental pollutants and body mass index during the first 3 years of life. Environ Health Perspect 2009; 117:122-6.
33. Hibbeln JR, Davis JM, Steer C, et al. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet 2007;369:578-85.
34. Lederman SA, Jones RL, Caldwell KL, et al. Relation between cord blood mercury levels and early child development in a World Trade Center Cohort. Env Health Perspect 2008;116: 1085-91; doi:10.1289/ehp.10831 (http://dx.doi. org/), online 31 March 2008.
35. Tamburlini G, Barbone F. Maternal fish consumption and children’s development. Lancet 2007;369:1166-7.
36. Knox EG. Roads, railways and childhood cancers. J Epidemiol Community Health 2006; 60:136-41.
37. www.registri-tumori.it.
38. Rehfüss EA, von Ehrenstein OS. Ultraviolet radiation. In: Tamburlini G, Von Ehrenstein OS, Bertollini R (eds). Children’s health and environment: a review of evidence: a joint report from the European Environment Agency and the WHO Regional Office for Europe. Copenhagen, European Environment Agency, 2002.
39. Mjøen G, Saetre DO, Lie RT, et al. Paternal occupational exposure to radiofrequency electromagnetic fields and risk of adverse pregnancy outcome. Europ J Epidemiol 2006; 21:529-35.
40. Hardell L, Carlberg M, Söderqvist F, Mild KH, Morgan LL. Long-term use of cellular phones and brain tumours: increased risk associated with use for more than 10 years. Occup Eviron Med 2007;64:626-32.
41. Niskar AS, Kieszak SM, Holmes AE, et al. Estimated prevalence of noise-induced threshold shift among children 6 to 19 years of age: the third national health and nutrition examination survey, 1988-1994, United States. Pediatrics 2001;108:40-3.
42. Vogel I, Brug J, Hosli EJ, van der Ploeg CP, Raat H. MP3 players and hearing loss: adolescent’s perceptions of loud music and hearing conservation. Pediatrics 2008;152: 400-4.
43. http://www.euro.who.int/childhealthenv/ Risks/InjuriesTop.
44. Parslow RC, Tasker RC, Draper ES, et al. Epidemiology of critically ill children in England and Wales incidence, mortality, deprivation and ethnicity. Arch Dis Child 2009;94: 210-5.
45. http://www.euro.who.int/HFADB.
46. Barlow J, Stewart-Brown S. Child abuse and neglect. Lancet 2005;365:1750-2.
47. Evans GW, Gonnella C, Marcynyszyn L, Gentil L, Salpekar N. The role of Chaos in Poverty and Children’s Socioemotional Adjustment Psychological. Science 2005;16:560-5.
48. Schmidt ME, Pempek TA, Kirkorian HL, Lund AF, Anderson DR. The effects of background television on the toy play behavior of very young children. Child Dev 2008;79:1137- 51.
49. Maikovich AK, Jaffee SR, Odgers CL, Gallop R. Effects of family violence on psychopathology symptoms in children previously exposed to maltreatment. Child Dev 2008;79: 1498-512.
50. Davies PT, Woitach MJ, Winter MA, Cummings EM. Children’s insecure representations of the interparental relationship and their school adjustment: the mediating role of attention difficulties. Child Dev 2008;79:1570-82.
51. Joussemet M, Vitaro F, Barker ED, et al. Controlling parenting and physical aggression during elementary school. Child Dev 2008;79: 411-25.
52. Lugo-Gil J, Tamis-Le Monda CS. Family resources and parenting quality: links to children’s cognitive development across the first 3 years. Child Dev 2009;79:1065-85.
53. Dishion T, Connell A, Weaver C, et al. The family check-up with high risk indigent families: preventing problem behaviour by increasing parents’ positive behaviour support in early childhood Child Dev 2008;79:1395-414.
54. Apollonio MG, Barbiero C, Bascucci S, et al. Supporto precoce ai neogenitori. È necessario? Serve? Medico e Bambino 2005;24:589- 98.
55. Richter L. The importance of caregiverchild interactions for the survival and healthy development of young children. WHO Geneva, 2005.
56. Rahman A, Malik A, Sikander S, et al. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan. A cluster randomized controlled trial. Lancet 2008;372:902-9. 57.Walker SP, Chang SM, Powell CA, Grantham-McGregor SM. Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: prospective cohort study. Lancet 2005;366: 1804-7.
58. Irwin L, Siddiqi R, Hertzman C. Early Child Development: A Powerful Equalizer Final Report for the World Health Organization’s Commission on the Social Determinants of Health. June 2007.
59. Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S; on behalf of the Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008;372:1661-9.
60. Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report. Geneva: World Health Organization, 2008; http://whqlibdoc. who.int/publications/2008/9789241563703_ eng.pdf, accessed 13 July 2009.
61. Romieu I, Ramírez-Aguilar M, Moreno-Macias H, et al. Infant mortality and air pollution: modifying effect by social class. J Occup Environ Med 2004;46:1210-6.
62. Bolte G, Kohlhuber M, Weiland SK, Zuurbier M, Stansfeld S, Heinrich J. Socioeconomic factors in EU-funded studies of children’s environmental health. Eur J Epidemiol 2005; 20:289-91.
63. Bellinger DC. Lead neurotoxicity and socioeconomic status: conceptual and analytical issues. Neurotoxicology 2008;29:828-32.
64. WHO expert meeting on “Environment and health risks: the influence and effects of social inequalities” in September 2009.
65. Bolte G, Tamburlini G, Kohlhuber M. Environmental inequalities among children in Europe: evaluation of scientific evidence and policy implications. Eur J Public Health 2009 (in press).
66. www.nationalchildrensstudy.gov.
67. http://ec.europa.eu/environment/che-micals/ reach/reach_intro.htm (consultato 10 ottobre 2009).
68. http://ec.europa.eu/legislation_ summaries.
69. Tamburlini G, Barbone F. Maternal fish consumption and children’s development. Lancet 2007;369:1166-7.
70. Akachi Y, Goodman D, Parker D. Global climate change and child health: a review of pathways, impacts and measures to improve the evidence base. UNICEF Innocenti Discussion paper 2009; http://www.unicefirc. org/publications/pdf/idp_2009_03.pdf.
Corrispondenza: tamburli@burlo.trieste.it