• Journal of Environmental Health Sciences
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• v.49 no.2
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• pp.57-65
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• 2023

Background: The association between exposure to extremely low frequency-magnetic fields (ELF-MF) and childhood leukemia has been controversial. There is a need to clarify this relationship by summarizing key conclusions from systematic review articles. Objectives: The major aim of this study is to summarize key conclusions from systematic review articles on the association between exposure to ELF-MF and childhood leukemia based on childhood exposure to ELF-MF, proximity from childhood household to high voltage cables, and parental occupational exposure to ELF-MF. Methods: This study was conducted through a brief literature review focusing on systematic, meta-analysis, and pooled analysis methods. We conducted a literature search in PubMed using the key words "ELF-MF" and "childhood leukemia" singly or combined. Results: In 2002, the World Health Organization (WHO)'s International Agency for Research on Cancer (IARC) reviewed two manuscripts to conduct pooled analysis and concluded that there is a significant association between exposure to >0.3 μT or 0.4 μT and childhood leukemia. We found a total of four manuscripts for systematic or pool analysis that have been published since the IARC's conclusion. They consistently concluded that there was a significant association between exposure to >0.4 μT and childhood leukemia compared to ELF-MF exposure to below 0.1 μT. The proximity of children's households to high voltage cable lines and occupational exposure by their parents to ELF-MF during certain periods prior to or during pregnancy were inconsistently associated with childhood leukemia. The study found that many EU countries have implemented precautionary policies to prevent potential childhood leukemia due to exposure to ELF-MF. Conclusions: This study recommends implementing a precautionary policy that includes legal exposure limits for ELF-MF to minimize exposure to ELF-MF.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.13
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• pp.5229-5232
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• 2014

Background: While many studies have concluded that local traffic density is positively associated with childhood leukemia, the results are inconsistent. We therefore performed a meta-analysis to assess the relationship between traffic density and the risk of childhood leukemia. Methods: A systematic literature review was carried out using PubMed, EMBASE, and the Cochrane Library from January 1979 to December 2013. We selected and assessed journal articles evaluating the relationship between local traffic density and the risk of leukemia in children. The analysis was carried out using STATA version 12.0. Results: A total of 11 articles, including 12 estimates of effect, were included in our meta-analysis. The summary effect size from the random-effects model, expressed as an odds ratio, was 1.03 (95% CI: 0.98-1.09, p=0.002). No significant association between traffic density and the risk of childhood leukemia was found. Similar conclusions were found on subgroup analysis. Conclusions: The results of our meta-analysis suggested no association between traffic density and the risk of childhood leukemia. This implies that living in close proximity to roads with heavy traffic may not increase the risk of childhood leukemia. However, further high-quality prospective trials are needed to support these results.

• Child Health Nursing Research
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• v.24 no.1
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• pp.68-77
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• 2018

Purpose: The purpose of this study was to develop parent coaching domains for the health management of childhood leukemia survivors. Methods: In this study, we conducted a literature review and in-depth interviews with 6 parents of childhood leukemia survivors who were identified using convenience sampling. We identified areas of parent coaching through the 4 stages of the GROW model, which are: goal setting, realistic grasp, confirmation of realization, and search for alternatives. Results: Nine domains and 27 subcategories emerged from the study. The 9 parent coaching domains for the health management of childhood leukemia survivors were routine life management, education and information provision, emotional support for the surviving children, social support for the surviving children, follow-up management, family support, school life management, symptom management, and improvement of growth and development. Conclusion: This research developed 9 parent coaching domains for the health management of children surviving leukemia. The results of this study are expected to contribute to the efficient health management of childhood leukemia survivors by enabling practitioners to continuously identify new coaching domains as needed for their health management. Researchers should improve the health management of childhood leukemia survivors by developing nursing interventions for these new coaching areas.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.2
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• pp.781-784
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• 2014

Background: Although the cause in most cases of childhood leukemia is not known, the contribution of environmental risk factors in the context of genetic predisposition has been reported with inconsistent results. The aim of this study was to examine association of childhood leukemia with maternal factors especially during pregnancy, to help in avoiding risk factors. Materials and Methods: This case-control study included children younger than 18 years diagnosed with leukemia from 2008 to 2012. Controls were randomly selected and individually matched to cases with respect to age, sex, and residency. All variables were compared between cases and control to determine any significant association with leukemia. Results: Statistically significant associations between risk of childhood leukemia with mother's education (p=0.001), occupation (p=0.0005) and pesticides exposure (p=0.005) during pregnancy were found. However, there were no significant links with maternal age (p=0.090), history of fetal loss (0.85), history of radiography during pregnancy (p=0.400), history of drug intake (p=0.689) and infection (p=0.696) during pregnancy. Conclusions: The results showed increased risk of leukemia in children whose mothers were working in agriculture and were exposed to pesticides during pregnancy. The further study needs to be investigated to know association of various maternal risk factors with leukemia which remained unknown in this study.

• Child Health Nursing Research
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• v.25 no.1
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• pp.9-16
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• 2019

Purpose: Childhood leukemia is a serious trauma affecting both adolescents and their parents, who experience painful process. However, adolescents with leukemia and their parents also experience positive changes, which is referred to as posttraumatic growth. We examined posttraumatic growth, core beliefs, impact of event, and event-related rumination in adolescents within 5 years of a diagnosis of childhood leukemia and their parents. Methods: The participants were 68 adolescents with childhood leukemia (aged 13~18 years) and their parents, who were recruited from C university hospital in Korea from May to September 2016. The Posttraumatic Growth Inventory, Core Belief Inventory, Impact of Event Scale-Revised, and Event-related Rumination Inventory were completed by the adolescents and their parents. The mean scores and correlations between variables were investigated for both set of participants. Results: Parents showed significantly higher levels of posttraumatic growth, disruption of core beliefs, impact of event, and invasive rumination than adolescents. Disruption of core beliefs and deliberate rumination were positively correlated with posttraumatic growth in both groups. Conclusion: Nursing intervention programs that involve modifying core beliefs and inducing a positive thought can help adolescents with leukemia and their parents grow after traumatic events.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.11
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• pp.4609-4614
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• 2015

Background: In recent decades, the prognosis for childhood leukemia has improved, especially for acute lymphoblastic leukemia (ALL). In Thailand, though, the survival rate for ALL is unimpressive. In 2006, standard national protocols for childhood leukemia treatment were implemented. We herein report the outcome of the ALL national protocols and explanations behind discrepancies in outcomes between institutions. Materials and Methods: Between March 2006 and February 2008, 486 children with ALL from 12 institutions were enrolled in the Thai national protocols. There were 3 different protocols based on specific criteria: one each for standard risk, high risk and Burkitt's ALL. We classified participating centers into 4 groups of institutions, namely: medical schools in Bangkok, provincial medical schools, hospitals in Bangkok and provincial hospitals. We also evaluated supportive care, laboratory facilities in participating centers, socioeconomics, and patient compliance. Overall and event-free survival were determined for each group using the Kaplan Meier method. Statistical differences were determined using the log-rank test. Previous outcomes of Thai childhood ALL treatment between 2003 and 2005 served as the historic control. Results: Five-year overall survival of ALL treated using the Thai national protocol was 67.2%; an improvement from the 63.7% of the 12-institute historical control (p-value=0.06). There were discrepancies in event-free survival of ALL between centers in Bangkok and up-country provinces (69.9% vs 51.2%, p-value <0.01). Socioeconomics and patient compliance were key elements in determining the outcome (65.5% vs 47.5%, 59.4% vs 42.9%) (p-value < 0.02). Conclusions: Implementation of standard national protocols for childhood leukemia in Thailand did not significantly improve the outcome of ALL. Factors leading to better outcomes included (a) improvement of treatment compliance (b) prevention of treatment abandonment and (c) financial support to the family.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.17
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• pp.7613-7618
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• 2015

Childhood acute lymphoblastic leukemia (ALL) is one of the most common hematologic malignancies which accounts for one fourth of all childhood cancer cases. Exposure to environmental factors around the time of conception or pregnancy can increase the risk of ALL in the offspring. This study aimed to evaluate the influence of prenatal and postnatal exposure to high voltage power lines on the incidence of childhood ALL. It also examines the role of various factors such as environmental factors and alpha-amylase as a marker in the development of leukemia.This cross-sectional case control study was carried out on 22 cases and 100 controls who born and lived in low socioeconomic families in Tehran and were hospitalized for therapeutic purposes in different hospitals ofrom 2013-2014. With regard to the underlying risk factors; familial history and parental factors were detected as risk factors of ALL but in this age, socioeonomic and zonal matched case control study, prenatal and childhood exposure to high voltage power lines was considered as the most important environmental risk factor (p=0.006, OR=3.651, CI 95% 1.692-7.878). As the population study was from low socioeconomic state, use of mobiles, computers and microwaves was negligible. Moreover prenatal and postnatal exposure to all indoor electrically charged objects were not detected as significant environmental factors in the present study. This work defined the risk of environmental especially continuous pre and postnatal exposure to high voltage power lines and living in pollutant regions through the parents or children as well as the previously described risk factors of ALL for the first time in low socioeconomic status Iranian population.

• Child Health Nursing Research
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• v.12 no.3
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• pp.304-313
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• 2006

Purpose: This study was done to describe psychosocial adjustment of adolescents who have survived childhood acute lymphocytic leukemia (ALL). Method: Out of a total of 16 adolescents ($11{\sim}20$ years old) registered at the Pediatric Oncology Clinic at one university affiliated hospital, 13 adolescents agreed to participate in this study. The data were collected through in-depth interviews using a semi-structured questionnaire. The contents of the interviews were analyzed using the inductive content analysis method. Result: Three main categories were identified 'personal characteristics', 'coping patterns', and 'interpersonal relationship'. Personal characteristics included self-praise, self-confidence, altruism, being worrisome, and being difficult. Coping patterns included positive thinking, activeness, and avoidance. Interpersonal relationship included appreciation, intimacy, burdened by over protectiveness, and feelings of regret and equality as peers. Conclusion: The results indicate that adolescents who have survived childhood cancer have both positive and negative experiences. It is suggested that care providers identify and support the strengths of the adolescents in order to help them to adjust more positively after the experience of childhood cancer.

• Clinical and Experimental Pediatrics
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• v.46 no.10
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• pp.972-976
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• 2003

Purpose : For the control of childhood leukemia, of which the mortality is still high, the basic data for the incidence has a great importance. The authors analyzed the data from 133 new patients with childhood leukemia between 1996-2000 in Busan, Korea. Methods : The data were obtained from 133 new cases(87 males and 46 females from 0 to 15 years old) of childhood leukemia who were residents of Busan and who were admitted to the 4 university hospitals and 11 general hospitals from 1996 to 2000. Results : The total number of the new childhood leukemia patients was 133 between 1996-2000; the average annual number of new patients was 26.6. The age-and-sex adjusted annual incidence rate (/100,000) was in the range of 2.37-4.53(male 2.47-5.29, female 0.76-3.36) with an average of 3.29 (male 4.05, female 2.43). Age-specific annual incidence rate(/100,000) was 3.78 in the 0-4 year age group, 3.51 in the 5-9 year age group and 3.08 in the 10-14 year age group. Of the major types of childhood leukemia, the distribution of ALL was average 71.4%, of AML 23.3%, and of CML 4.5%. Of the major types of leukemia by age range, ALL showed highest in the 5-9 year age group, while AML in 0-4 and 10-14 year age groups. Sex-ratio(male to female) of major type of leukemia was 1.97 : 1 and 1.21 : 1, in ALL and AML groups, respectively, while all were male in CML. Conclusion : The average age-and-sex adjusted annual incidence rate(/100,000) of childhood leukemia in Busan from 1996 to 2000 was 3.29. Compared to data in related articles, this data suggests a steady increase in the incidence of childhood leukemia in the Busan area over the last 20 years since 1981.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.6
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• pp.2347-2350
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• 2015

Childhood acute lymphoblastic leukemia (ALL) is one of the most common hematologic malignancies, accounting for one fourth of all childhood cancer cases. Exposure to environmental factors around the time of conception or pregnancy can increase the risk of ALL in the offspring.This study aimed to evaluted the role of prenatal and postnatal exposure to high voltage power lines on the incidence of childhood ALL.This cross-sectional case control study was carried out on 22 cases and 100 controls who were born and lived in low socioeconomic families in Isfahan and hospitalized for therapeutic purposes in different hospitals from 2013-2014.With regard to the underlying risk factors, familial history and parental factors were noted but in this age, socioeonomic and zonal matched case control study, prenatal and childhood exposure to high voltage power lines was considered as the most important environmental risk factors of ALL (p=0.006, OR=3.651, CI 95%, 1.692-7.878). As the population was of low socioeconomic background, use of mobiles, computers and microwave was negligible. Moreover prenatal and postnatal exposure to indoor electrically charged objects was not determined to be a significant environmental factor. Thus, pre and post natal exposure to high voltage power lines and living in pollutant regions as well as familial influence could be described as risk factors of ALL for the first time in a low socioeconomic status Iranian population.