Current Problems in Pediatric and Adolescent Health Care最新文献

英文中文

Providing parenting advice during child health visits: An overview 在儿童健康访问期间提供育儿建议：概述。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-10-01 DOI: 10.1016/j.cppeds.2025.101866

John C. Duby MD, FAAP

引用次数: 0

Foreword-parenting styles Foreword-parenting风格。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-10-01 DOI: 10.1016/j.cppeds.2025.101863

John M. Pascoe MD, MPH (Associate Editor)

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Parenting styles, parenting interventions, and childhood obesity 养育方式，养育干预，和儿童肥胖。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-10-01 DOI: 10.1016/j.cppeds.2025.101865

Rohan Sachdeva BS , Nadia Markie Sneed PhD, APRN, FNP-BC

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Editorial Board Page 编委会页面

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-10-01 DOI: 10.1016/S1538-5442(25)00144-0

引用次数: 0

Parenting styles and interventions for the child health clinician 儿童健康临床医生的父母教养方式和干预措施。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-10-01 DOI: 10.1016/j.cppeds.2025.101864

Ellen L. McMahon , Brian T. Ward , Heath Aston , Seth J. Scholer

Parenting practices significantly influence child development and long-term health outcomes, with extensive evidence linking responsive caregiving to positive cognitive, behavioral, and emotional development, while harsh or inconsistent parenting is associated with adverse effects. This paper reviews the history of parenting research and synthesizes current research on parenting styles, interventions, and their neurobiological mechanisms, emphasizing actionable strategies for children’s healthcare. Key findings highlight the efficacy of tiered, trauma-informed approaches - from universal prevention to targeted interventions - in promoting early relational health. However, disparities persist in access to evidence-based parenting support, particularly among marginalized populations, underscoring the need for culturally adapted programs and equitable implementation.

A child’s clinician is uniquely positioned to deliver parenting support, given their wide reach and preventive focus. The American Academy of Pediatrics (AAP) endorses integrating early relational health frameworks into well-child care, including universal screening for caregiver-child interaction quality, social determinants of health, and caregiver mental health. Effective models combine vertical integration (matching intervention intensity to family needs) and horizontal integration (linking medical homes to community resources). Critical gaps remain, including the need for validated, clinically feasible parenting assessments and expanded clinician training in emotional trauma-informed relational health practices. By embedding parenting support into routine child health care, health systems can foster resilience, advance health equity, and optimize lifelong outcomes for children and families.

养育子女的做法对儿童的发展和长期健康结果有显著影响，大量证据表明，响应性照料与积极的认知、行为和情感发展有关，而严厉或不一致的养育方式与不利影响有关。本文回顾了育儿研究的历史，并综合了目前关于育儿方式、干预措施及其神经生物学机制的研究，强调了儿童保健的可操作策略。主要发现强调了分层的、了解创伤的方法——从普遍预防到有针对性的干预——在促进早期关系健康方面的功效。然而，在获得以证据为基础的育儿支持方面仍然存在差距，特别是在边缘化人群中，这突显了制定适应文化的方案和公平实施的必要性。鉴于儿童临床医生的广泛影响和预防重点，他们在提供育儿支持方面具有独特的地位。美国儿科学会（AAP）支持将早期关系健康框架整合到良好的儿童护理中，包括对照顾者与儿童互动质量、健康的社会决定因素和照顾者心理健康的普遍筛查。有效的模式结合了纵向整合（将干预强度与家庭需求相匹配）和横向整合（将医疗所与社区资源联系起来）。关键的差距仍然存在，包括需要进行有效的、临床可行的育儿评估，以及在了解情感创伤的关系健康实践方面扩大临床医生培训。通过将育儿支持纳入常规儿童卫生保健，卫生系统可以增强韧性，促进卫生公平，并优化儿童和家庭的终身成果。

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引用次数: 0

Impact of infection and microbial exposures on pediatric cancer 感染和微生物暴露对儿童癌症的影响

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-09-01 DOI: 10.1016/j.cppeds.2025.101819

Kensie Soule BS , Nina Nelson BS , Joseph Wiemels PhD , Rachel Gallant MD MS

The etiology of pediatric cancer is likely multifactorial including a combination of genetic alterations and environmental exposures. Infection and antigenic exposures have been identified as contributors to the development of pediatric cancers particularly acute lymphoblastic leukemia (ALL), the most common pediatric malignancy. Viral infections such as Epstein-Barr virus (EBV) and human papilloma virus (HPV) have a well-established association with Hodgkin lymphoma (EBV), Burkitt lymphoma (EBV), and head and neck cancers (HPV). More recent evidence suggests CMV is associated with glioblastoma multiforme and ALL. The incidence of pediatric cancer is much lower than the incidence of these viral infections, indicating that there are likely other factors at play. Aside from these specific viral infections, antigenic exposures in general have been associated with pediatric cancers as well. Early life antigenic exposures are known to impact the gut microbiome which is a crucial component to developing a competent immune system. Higher microbial exposure in early life, such as vaginal delivery (versus cesarean delivery), daycare attendance, and breastfeeding have been associated with lower incidence of pediatric ALL, and this effect is hypothesized to be mediated by the gut microbiome. In this review, we highlight the association between infection, antigenic exposures, and pediatric cancer and potential underlying mechanisms that facilitate this association.

儿童癌症的病因可能是多因素的，包括遗传改变和环境暴露的组合。感染和抗原暴露已被确定为儿童癌症发展的贡献者，特别是急性淋巴细胞白血病（ALL），最常见的儿科恶性肿瘤。病毒感染，如爱泼斯坦-巴尔病毒（EBV）和人乳头瘤病毒（HPV），与霍奇金淋巴瘤（EBV）、伯基特淋巴瘤（EBV）和头颈癌（HPV）有明确的联系。最近的证据表明，巨细胞病毒与多形性胶质母细胞瘤和ALL有关。儿童癌症的发病率远低于这些病毒感染的发病率，这表明可能还有其他因素在起作用。除了这些特定的病毒感染外，抗原暴露通常也与儿童癌症有关。众所周知，生命早期的抗原暴露会影响肠道微生物群，而肠道微生物群是发育免疫系统的关键组成部分。生命早期较高的微生物暴露，如阴道分娩（相对于剖宫产）、日托和母乳喂养与儿科ALL发病率较低有关，这种影响被假设是由肠道微生物组介导的。在这篇综述中，我们强调了感染、抗原暴露和儿童癌症之间的联系以及促进这种联系的潜在机制。

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Integrating extreme weather and air pollution risk reduction into pediatric cancer care 将减少极端天气和空气污染风险纳入儿童癌症护理

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-09-01 DOI: 10.1016/j.cppeds.2025.101807

Hannah M. Thompson MD MPH , Omar Shakeel MD , Mark Miller MD MPH , Perry Sheffield MD MPH

The health impacts of extreme weather and air pollution are expected to worsen into the future. There is growing evidence that vulnerable populations, including pediatric patients with cancer, may be at increased risk. There is limited progress, however, on translating these growing risks into clinical prevention strategies. We describe the utilization of a simple risk communication framework and list resources to help pediatric oncology providers engage in discussion of extreme weather and air pollution with patients to reduce their risk.

极端天气和空气污染对健康的影响预计将在未来加剧。越来越多的证据表明，弱势群体，包括患有癌症的儿科患者，可能面临更高的风险。然而，在将这些日益增长的风险转化为临床预防策略方面进展有限。我们描述了一个简单的风险沟通框架的使用，并列出了资源，以帮助儿科肿瘤学提供者与患者讨论极端天气和空气污染，以降低他们的风险。

引用次数: 0

Impact of the environment on childhood cancer clinical outcomes 环境对儿童癌症临床结果的影响

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-09-01 DOI: 10.1016/j.cppeds.2025.101801

Catherine Metayer

Incidence rates of several childhood cancers have increased in the past decades in high- and middle-income countries, and epidemiologic studies worldwide have documented the important role of several environmental factors contributing to these trends, such as sources of air pollution and pesticides. What is less known is whether these chemicals also affect clinical outcomes in childhood cancer patients and survivors, via biological pathways involving DNA damage, epigenetic changes, oxidative stress, pro-inflammatory and immune responses which may operate across the cancer continuum from etiology, response to treatment, survival and survivorship. Despite overall improvement in cancer cure rates, children of color and underserved backgrounds still experience poorer prognosis than their white and affluent counterparts. While social determinants largely explain these observations, the independent effect of chemical exposures is not well-characterized. Drawing from adult studies, we present emerging evidence from epidemiologic childhood cancer studies on the impact of pre- and post-natal exposures to ubiquitous chemicals such as tobacco smoke, traffic-and industry-related air pollution, and pesticides on the health of childhood cancer patients and survivors. Data presented in this review provide the foundation to consider integrating environmental health into the treatment plan for childhood cancer patients and survivors, alongside other known therapeutic and modifiable prognostic factors.

过去几十年来，在高收入和中等收入国家，几种儿童癌症的发病率有所增加，世界各地的流行病学研究证明，空气污染源和杀虫剂等若干环境因素对这些趋势起着重要作用。不太清楚的是，这些化学物质是否也会影响儿童癌症患者和幸存者的临床结果，通过涉及DNA损伤、表观遗传变化、氧化应激、促炎和免疫反应的生物学途径，这些途径可能在癌症的病因、治疗反应、生存和幸存者中起作用。尽管癌症治愈率总体上有所提高，但有色人种和缺乏服务背景的儿童的预后仍然比白人和富裕的同龄人差。虽然社会决定因素在很大程度上解释了这些观察结果，但化学品暴露的独立影响尚未得到很好的描述。从成人研究中，我们提出了来自儿童癌症流行病学研究的新证据，这些证据表明，产前和产后暴露于无处不在的化学物质，如烟草烟雾、交通和工业相关的空气污染以及杀虫剂，对儿童癌症患者和幸存者的健康产生了影响。本综述提供的数据为考虑将环境健康纳入儿童癌症患者和幸存者的治疗计划以及其他已知的治疗性和可改变的预后因素提供了基础。

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Editorial Board Page 编委会页面

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-09-01 DOI: 10.1016/S1538-5442(25)00132-4

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Investigating the causes of childhood acute lymphoblastic leukemia through mutational epidemiology 通过突变流行病学研究儿童急性淋巴细胞白血病的病因

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-09-01 DOI: 10.1016/j.cppeds.2025.101818

Adam J. de Smith, Naying Zhou, Yunqi Li, Tanxin Liu, Nathan Patrus, Joseph L. Wiemels

Acute lymphoblastic leukemia (ALL) is the most common cancer in children, and prevention of this disease would significantly reduce childhood mortality and morbidity. While the role of germline genetic variation in the etiology of ALL is well established, the contribution of modifiable risk factors is less well known. Epidemiologic studies have identified several environmental and infectious or immune-related factors associated with childhood ALL, although studies often relied on questionnaire data, which can be prone to recall bias, and/or provided limited information on the potential leukemogenic role of these exogenous exposures.

Environmental exposures that have carcinogenic properties (e.g., tobacco smoke, ultraviolet radiation) can leave behind molecular footprints in tumor samples that have specific patterns of mutations, and these mutational signatures can be leveraged to study cancer etiology. Mutational epidemiology has thus emerged as a novel approach to investigate the potential carcinogenic role of exogenous exposures in cancer development, by leveraging the availability of sequencing data in large numbers of patients and combining epidemiological methods with analysis of mutational signatures, which may reveal a personalized history of causative exposures. Such studies have already yielded discoveries in adult solid tumors, identifying novel risk factors and providing insights into environmental factors that may underlie global variation in cancer incidence. However, this approach has yet to be applied to childhood cancer epidemiology.

Sequencing studies of childhood ALL have revealed specific patterns of somatic alterations, including mutational signatures related to APOBEC enzymes, reactive oxygen species, and ultraviolet radiation, as well as deletions mediated by illegitimate V(D)J recombination. In this review, we discuss current knowledge on the modifiable and non-modifiable risk factors for childhood ALL, the patterns of somatic genomic alterations that have been identified in ALL patient samples, and how mutational epidemiology could help to pinpoint the leukemogenic role of environmental exposures which will be critical for future prevention strategies.

急性淋巴细胞白血病（ALL）是儿童中最常见的癌症，预防这种疾病将显著降低儿童死亡率和发病率。虽然种系遗传变异在ALL病因学中的作用已经得到了很好的证实，但可改变的危险因素的作用却鲜为人知。流行病学研究已经确定了一些与儿童ALL相关的环境和感染或免疫相关因素，尽管研究通常依赖于问卷调查数据，这可能容易产生回忆偏差，并且/或提供了这些外源性暴露的潜在白血病发生作用的有限信息。具有致癌特性的环境暴露（例如，烟草烟雾、紫外线辐射）可以在具有特定突变模式的肿瘤样本中留下分子足迹，这些突变特征可以用于研究癌症病因。突变流行病学因此成为一种研究外源性暴露在癌症发展中的潜在致癌作用的新方法，通过利用大量患者测序数据的可用性，并将流行病学方法与突变特征分析相结合，这可能揭示致病暴露的个性化历史。这些研究已经在成人实体瘤中取得了发现，确定了新的风险因素，并提供了对可能导致全球癌症发病率变化的环境因素的见解。然而，这种方法尚未应用于儿童癌症流行病学。儿童ALL的测序研究揭示了体细胞改变的特定模式，包括与APOBEC酶、活性氧和紫外线辐射相关的突变特征，以及由非法V(D)J重组介导的缺失。在这篇综述中，我们讨论了目前关于儿童ALL可改变和不可改变的危险因素的知识，在ALL患者样本中已经确定的体细胞基因组改变模式，以及突变流行病学如何帮助确定环境暴露的白血病发生作用，这将对未来的预防策略至关重要。

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Current Problems in Pediatric and Adolescent Health Care

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