Current Problems in Pediatric and Adolescent Health Care最新文献

{"title":"Integrating environmental risk factors into pediatric cancer care: Laying the groundwork for improved outcomes and primary prevention","authors":"Nicole M. Wood ,&nbsp;Omar Shakeel ,&nbsp;Juan A. Ortega-Garcia ,&nbsp;Mark D. Miller","doi":"10.1016/j.cppeds.2025.101821","DOIUrl":"10.1016/j.cppeds.2025.101821","url":null,"abstract":"<div><div>Childhood cancer incidence has steadily risen both in the United States and worldwide, yet its environmental contributors remain underrecognized in clinical care. Children and cancer survivors are particularly susceptible to environmental exposures due to their unique physiology and the long-term health vulnerabilities that follow cancer treatment. Although exposures to substances such as pesticides, air pollution, and household chemicals are linked to increased cancer risk, limited clinical frameworks and clinician training leave oncologists underprepared to address growing environmental health concerns from families.</div><div>A holistic pediatric oncology environmental health program in Murcia, Spain offers a scalable vision for embedding the environment into longitudinal cancer care. In the United States, survey data from two large academic pediatric cancer centers revealed strong clinician interest in addressing environmental health in pediatric oncology, leading to the development of a consultative model. Workshops and a standardized environmental health history tool, adapted for clinical use and integration into the medical record, have laid the groundwork for implementation of an environmental consult service across 3 care settings: cancer predisposition clinics, survivorship programs, and as requested. These efforts aim to reduce family anxiety, offer actionable risk-reduction strategies, and empower primary teams with the knowledge to engage in meaningful conversations.</div><div>The patient-centered tools, interdisciplinary training, and structured integration into clinical workflows are designed to strengthen environmental health knowledge and practice of pediatric oncologists in the United States.</div></div>","PeriodicalId":49086,"journal":{"name":"Current Problems in Pediatric and Adolescent Health Care","volume":"55 9","pages":"Article 101821"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of residential proximity to upstream oil and gas development and childhood, adolescent and young adult cancer risk","authors":"Eric C. Stewart ,&nbsp;Nicholaus P. Johnson ,&nbsp;Cassandra J. Clark ,&nbsp;Catherine Metayer ,&nbsp;Nicole C. Deziel","doi":"10.1016/j.cppeds.2025.101838","DOIUrl":"10.1016/j.cppeds.2025.101838","url":null,"abstract":"<div><h3>Objective</h3><div>Upstream oil and gas development (OGD) can release carcinogenic and radioactive agents into air and water. This review summarizes evidence on the relationship between residential proximity to upstream OGD and cancer risk among children, adolescents, and young adults (CAYA).</div></div><div><h3>Methods</h3><div>We systematically searched PubMed and Embase through April 25, 2025, for original, peer-reviewed epidemiologic investigations of residential proximity to upstream OGD and cancer in CAYA (≤25 years). We excluded studies of downstream activity, those lacking CAYA-specific results, and non-English publications. Two reviewers independently screened records, extracted data, and assessed risk of bias with a World Health Organization tool.</div></div><div><h3>Results</h3><div>From 3274 screened articles, 10 met inclusion criteria. Four case-control studies, all United States-based (Pennsylvania <em>n =</em> 3, Colorado <em>n =</em> 1), used individual-level proximity metrics during defined temporal windows and controlled for confounders. Six ecological studies (Ecuador <em>n =</em> 4, Croatia <em>n =</em> 1, Pennsylvania <em>n =</em> 1) used area-based density or binary exposure metrics with limited confounder adjustment. All studies assessed hematopoietic malignancies. All case-control studies observed positive associations between OGD proximity and cancer with three reporting elevated leukemia risk. Two studies from different states reported highly similar leukemia risk in the closest OGD buffer zones (Colorado: 3 km OR 2.07, 95 % CI 1.08-3.74; Pennsylvania: 2 km OR 1.98, 95 % CI 1.06-3.69). Ecologic study findings were mixed, including elevated risks for hematologic and central nervous system cancers. Limitations include few studies, imprecise exposure metrics, and potential residual confounding.</div></div><div><h3>Discussion</h3><div>Despite limited evidence, the majority of studies reported positive, statistically significant associations between OGD and childhood cancer, most consistently for leukemia, supporting efforts to reduce OGD proximity to children.</div></div>","PeriodicalId":49086,"journal":{"name":"Current Problems in Pediatric and Adolescent Health Care","volume":"55 9","pages":"Article 101838"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship of dietary folate, folic acid, and childhood cancer","authors":"Yijin Xiang ,&nbsp;Joseph L. Wiemels ,&nbsp;Eric M. Nickels","doi":"10.1016/j.cppeds.2025.101820","DOIUrl":"10.1016/j.cppeds.2025.101820","url":null,"abstract":"<div><div>Folate (vitamin B9) is an essential micronutrient and plays a critical role in one-carbon metabolism, DNA synthesis, and epigenetic regulation, particularly during early embryonic development. While the preventive role of maternal periconceptional folate intake against neural tube defects as well as other birth defects is well established, growing evidence suggests that folate status may also influence childhood cancer risk. In this review, we examine the biological mechanisms linking folate to childhood cancer, with a focus on acute lymphoblastic leukemia (ALL). We synthesize findings from population-wide natural experiments, observational studies, and meta-analyses, with particular attention to timing, dosage, and source of folate intake. Meta-analyses consistently report protective associations between maternal folic acid supplementation and childhood ALL, while evidence for natural dietary folate is more limited and less consistent. Genetic variants in folate metabolism pathways, particularly in the <em>MTHFR</em> gene, may modify these associations, and gene–environment interactions are increasingly recognized as important. Maternal folate status during the periconceptional period has also been linked to changes in offspring DNA methylation and potentially to long-term health outcomes, including at specific epigenetic loci such as <em>IGF2</em> and <em>ZFP57</em>, as well as across the epigenome. The overall evidence supports the continued promotion of adequate maternal folate intake. Future research should prioritize causal inference methods, epigenome-wide analyses, and greater inclusion of underrepresented populations to clarify the role of folate in childhood cancer etiology.</div></div>","PeriodicalId":49086,"journal":{"name":"Current Problems in Pediatric and Adolescent Health Care","volume":"55 9","pages":"Article 101820"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board Page","authors":"","doi":"10.1016/S1538-5442(25)00121-X","DOIUrl":"10.1016/S1538-5442(25)00121-X","url":null,"abstract":"","PeriodicalId":49086,"journal":{"name":"Current Problems in Pediatric and Adolescent Health Care","volume":"55 8","pages":"Article 101847"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foreword: Issue 2 the primary care providers role: From vascular tumors/malformations to cancer, both survivorship and end of life care","authors":"","doi":"10.1016/j.cppeds.2025.101825","DOIUrl":"10.1016/j.cppeds.2025.101825","url":null,"abstract":"","PeriodicalId":49086,"journal":{"name":"Current Problems in Pediatric and Adolescent Health Care","volume":"55 8","pages":"Article 101825"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The primary care providers role in high-risk pediatric cancer care","authors":"Wilson File M.D., MMEdL,&nbsp;Melissa Mark M.D.,&nbsp;Linda Pegram M.D.","doi":"10.1016/j.cppeds.2025.101824","DOIUrl":"10.1016/j.cppeds.2025.101824","url":null,"abstract":"<div><div>Pediatric oncology has seen significant advancements in survival rates over the past decade, yet cancer remains the leading cause of disease-related mortality in children in the United States. In 2024, an estimated 15,000 new pediatric cancer cases were expected, with approximately 10% resulting in death. High-risk cancers, including high-grade gliomas and metastatic solid tumors, present ongoing challenges in treatment and care. This article emphasizes the critical role of primary care providers (PCPs) in the pediatric cancer continuum, particularly in supporting families through initial diagnosis, treatment, and bereavement.</div><div>PCPs often serve as the first point of contact for families, making their role in disclosing a cancer diagnosis pivotal. Effective communication strategies are essential to help families navigate the emotional landscape of a cancer diagnosis and to outline subsequent steps in care. The impact of childhood cancer extends beyond the patient, significantly affecting siblings who may experience emotional distress and unmet informational needs.</div><div>A pediatric cancer diagnosis has significant psychosocial implications for families and PCPs play a key role by providing a supportive environment for open discussions about cancer and its effects on family dynamics. If curative treatment is no longer possible and there is a shift toward palliative care, it can be helpful for PCPs to maintain continuity of care and support during end-of-life scenarios.</div><div>By fostering strong therapeutic relationships and remaining engaged throughout the cancer journey, PCPs can play a vital role in enhancing the overall well-being of pediatric cancer patients and their families, ultimately bridging the gap between specialized oncology care and the medical home.</div></div>","PeriodicalId":49086,"journal":{"name":"Current Problems in Pediatric and Adolescent Health Care","volume":"55 8","pages":"Article 101824"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"That spot is not a hemangioma: Identifying other vascular anomalies for the primary care provider","authors":"Katherine D Watson ,&nbsp;Melisa Ruiz Gutierrez ,&nbsp;Sally J Cohen-Cutler","doi":"10.1016/j.cppeds.2025.101822","DOIUrl":"10.1016/j.cppeds.2025.101822","url":null,"abstract":"<div><div>Vascular anomalies are a broad spectrum of disorders that can be challenging to recognize, risking misdiagnosis. Primary care providers are often the first to evaluate these lesions and must distinguish between more common hemangiomas and rarer vascular malformations that require different management. With the growing availability of treatment approaches including medical therapies, timely referral and ongoing care with a specialty multidisciplinary vascular anomalies clinic is crucial for optimizing outcomes. This primer provides an overview of key diagnostic features, classification, and initial management strategies for primary care teams suspecting a new vascular anomaly diagnosis.</div></div>","PeriodicalId":49086,"journal":{"name":"Current Problems in Pediatric and Adolescent Health Care","volume":"55 8","pages":"Article 101822"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer survivorship for the PCP","authors":"Sharon L. Conner MSN, APRN, FNP-C ,&nbsp;Wilson File MD, MMEdL","doi":"10.1016/j.cppeds.2025.101823","DOIUrl":"10.1016/j.cppeds.2025.101823","url":null,"abstract":"<div><div>The number of childhood cancer survivors (CCS) in the United States exceeds 500,000 and continues to rise<span><span>¹</span></span>. While recurrence risk diminishes over time, the prevalence of late effects from cancer treatment increases with age and affects over 60% of survivors<span><span>2</span></span>, <span><span>3</span></span>. Primary care providers (PCPs) are ideally positioned to manage the long-term health needs of CCS, yet many feel ill-equipped due to a lack of concise guidelines<span><span>4</span></span>, <span><span>5</span></span>. This article provides a comprehensive overview for PCPs on managing late effects in CCS. Key areas of focus include general health maintenance, psychological and neurocognitive care, immune function and vaccinations, as well as monitoring for endocrine, cardiovascular, pulmonary, and secondary malignancies. Emphasis is placed on regular screenings and lifestyle modifications. We advocate for proactive PCP involvement in the surveillance and management of late effects associated with childhood cancer treatment.</div></div>","PeriodicalId":49086,"journal":{"name":"Current Problems in Pediatric and Adolescent Health Care","volume":"55 8","pages":"Article 101823"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Quality Improvement and Pediatric Primary Care 2025","authors":"William T. Gerson M.D","doi":"10.1016/j.cppeds.2025.101843","DOIUrl":"10.1016/j.cppeds.2025.101843","url":null,"abstract":"","PeriodicalId":49086,"journal":{"name":"Current Problems in Pediatric and Adolescent Health Care","volume":"55 7","pages":"Article 101843"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selecting the correct control chart: A practical example from adolescent care","authors":"Beth Williams ,&nbsp;Lisa Ziemnik","doi":"10.1016/j.cppeds.2025.101805","DOIUrl":"10.1016/j.cppeds.2025.101805","url":null,"abstract":"<div><div>Oftentimes physicians or clinic leaders are asked to embark on strategic or quality improvement initiatives to improve selected preventive and well child metrics. The first step in selecting the correct control chart for this work is understanding the type of data being measured. Once the type of data is determined, a standardized flowchart is used to select the correct control chart. Each type of data requires the correct control chart to display and monitor quality improvement efforts effectively. Understanding types of data and using a flowchart to select the appropriate control chart helps remove the mystery behind selection and ensures control charts can be used and interpreted correctly.</div></div>","PeriodicalId":49086,"journal":{"name":"Current Problems in Pediatric and Adolescent Health Care","volume":"55 7","pages":"Article 101805"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}