Better Public Policies and Environment Factors Controlling for Children's Health: Advocating for A Better Future

Autor: Chia-Feng Yang, 楊佳鳳
Rok vydání: 2019
Druh dokumentu: 學位論文 ; thesis
Popis: 107
Children’s health is the future of Taiwan. The aims of this study were to set better public health policies and to get better understanding of harmful environmental factors in order to improve the outcomes of specific diseases, including Pompe disease, allergic disorders, asthma and attention deficit hyperactivity disorder (ADHD) among children in Taiwan. Pompe disease is an autosomal recessive lysosomal storage disorder characterized by the deficiency of acid α-glucosidase (GAA). Deficiency of this enzyme leads to the progressive accumulation of glycogen in numerous types of cells and tissues. Early enzyme replacement therapy (ERT) with recombinant human alglucosidase alfa (Myozyme; Sanofi Genzyme, Boston, MA, USA) can prolong survival and improve the long-term outcome of Pompe patients. Newborn screening (NBS) is the only way to initiate the early diagnosis. The first part of this study included those babies that joined Pompe newborn screening from 2008. Annually, approximately two-thirds of the newborn population in Taiwan receive testing for Pompe disease at Taipei Veterans General Hospital (TVGH), and until 2018, more than one million newborns were tested. In 2010, pediatricians at TVGH had established an effective newborn screening program with rapid diagnostic strategies and almost all suspected infant-onset Pompe disease (IOPD) infants could be diagnosed correctly within 2 hours and then received ERT within 4 hours of admission. With such an effective system, the average age of IOPD patients at TVGH started their ERT around 10 days of age, the earliest group all over the world. We compared the prognostic parameters across various studies published after 2008 to evaluate the effectiveness of early screening of IOPD. The results showed that IOPD patients who received very early ERT initiation were associated with better outcomes. Then, we did the survey of allergic diseases for all of them and found 8 of 25 our IOPD patients have symptoms related to allergic diseases and most of them have relatively poorer outcomes of respiratory function, proved by pulmonary function test and polysomnography. The second part of this study therefore focused on allergic diseases, an important health issue in children. We conducted a large-scale cross-sectional, population-based survey to investigate (1) the relationship between allergic diseases, allergic sensitization, and ADHD; (2) the relationship between asthma and the environmental bisphenol A (BPA) exposure. For the study on the relationship between allergic diseases, allergic sensitization, and ADHD, children aged between 3 and 6 years were selected and received skin prick tests (SPTs) for mite, cockroach, dog, milk, egg, and crab allergens. A total of 2772 children from the Childhood Environment and Allergic Diseases Study (CEAS) cohort were found to be eligible for final analysis. Children who had AD and asthma with allergic sensitization were found to be at increased risk for ADHD. The results suggest that AD and asthma with allergic sensitization are associated with ADHD in children. As for the study on the relationship between asthma and the environmental BPA exposure, urine BPA glucuronide (BPAG) level was measured as an indicator of BPA exposure. DNA-methylations were measured by quantitative polymerase chain reaction (PCR). Candidate genes with differential methylation between high and low exposures identified through the screen were further validated by quantitative PCR and investigated in a larger sample of 228 children also from the CEAS cohort. After validation, MAPK1 continued to show difference in methylation and was further investigated in 228 children. In conclusion, the better public policies of NBS for Pompe disease have been proved could contribute the better outcomes and we proved that AD and asthma with allergic sensitization are associated with ADHD in children. Also, we found the pathogenicity of asthma might relate to DNA methylation. Early control of environmental and allergens exposures could help to modify the burden of these diseases. The results might decrease the burden from these diseases and promote the better condition of children’s health in Taiwan.
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