Browsing by Subject "Environmental health"

Now showing 1 - 6 of 6
  • Thumbnail Image
    Publication
    Open Access
    Beyond Precision: Ambiomic Survivorship in Childhood and AYA Cancer
    (MDPI, 2026) Ortega García, Juan Antonio; Shakeel, Omar; Wood, Nicole M.; Pérez-Martínez, Antonio; Fuster Soler, José Luis; Miller, Mark D.; Cirugía, Pediatría y Obstetricia y Ginecología; Facultades de la UMU::Facultad de Medicina
    Revisión narrativa que propone un modelo ambiómico de supervivencia en cáncer infantil y del adolescente y adulto joven, desplazando el seguimiento desde la vigilancia postratamiento hacia una atención anticipatoria iniciada en el diagnóstico. El artículo integra marcos internacionales de supervivencia —COG, IGHG, PanCare y NCCN— con evidencia sobre determinantes ambientales, exposoma, toxicogenómica, salud pública e implementación clínica. A partir de la experiencia de la Historia Clínica Ambiental Pediátrica y del programa PLASESCAP-MUR de Murcia, describe la evolución hacia el Ambiomic Health Compass, incorporando evaluación ambiental y social estructurada, Green Page, Green Passport, biomonitorización, datos geoespaciales y alertas dinámicas. El modelo PEHis–AHC se plantea como una referencia escalable para integrar salud ambiental en oncología pediátrica, reducir eventos prevenibles y mortalidad relacionada con el tratamiento, mejorar la equidad y reforzar la continuidad asistencial desde el diagnóstico y a lo largo de la supervivencia.
  • Thumbnail Image
    Publication
    Restricted
    Environment, lifestyle behavior and health-related quality of life in childhood and adolescent cancer survivors of extracranial malignancies
    (Elsevier, 2020-10) Cárceles Álvarez, Alberto; Ortega García, Juan A.; López Hernández, Fernando A.; Fuster Soler, José L.; Sanz Monllor, Ainara; Ramis, Rebeca; Claudio, Luz; Cirugía, Pediatría y Obstetricia y Ginecología
    Background: Childhood cancer is a chronic disease with high survival rates. Childhood cancer survivors (CCS) can still face health effects later in their lives. Health-related quality of life (HRQoL) and the factors that modify it allow CCS and their families to improve care in the long-term follow-up. This study aims to: (1) examine the differences in HRQoL between CCS of extracranial malignancies and a comparison group, and (2) explore the clinical, environmental and lifestyles factors implicated in the HRQoL of CCS. Methods: In this cross-sectional study with a case vs. non-case comparison, the HRQoL of 117 CCS between 8 and 18 years old was compared with healthy non-cases paired by sex and age. The Pediatric Environmental History (PEHis) was applied to obtain information on sociodemographic, clinical, environmental and lifestyle factors. The PedsQL(TM) Generic Core Scales questionnaire was used to evaluate HRQoL. Results: In the multivariate analysis among the CCS, the following variables were significantly associated with HRQoL: Poor outdoor air quality (Total, Psychosocial, Emotional, Social and School domains); household income (Total, Psychosocial and School domains); and the presence of late effects (Total, Physical, Psychosocial, and Social domains); regular contact with nature (Physical domain); and the daily hours of screen-time (Emotional domain). CCS present HRQoL results superior to the non-cases group in the physical domain (86.10 vs. 80.34; p = 0.001), finding no differences in the other domains evaluated. Conclusions: An environmental and community health approach, such as PEHis, in CCS long-term programs promoting the creation of healthier environments and lifestyles contributes to improving their HRQoL and secondarily other chronic diseases.
  • Thumbnail Image
    Publication
    Open Access
    Guardianes de la salud planetaria: una visión integral para transformar el pronóstico del cáncer infantil
    (2025-06) Gómez Chacón, Amparo; Ortega García, Juan Antonio; Martínez Díaz, Francisco; Cirugía, Pediatría y Obstetricia y Ginecología; Facultades de la UMU::Facultad de Medicina
    Introduction: Childhood cancer is the leading cause of disease-related death among individuals aged 1 to 19 years. There is growing interest in understanding the importance of environmental factors and lifestyle in the onset, progression, and outcomes throughout the entire cancer journey, including survival. This study describes the environmental health profile of pediatric cancer patients during active treatment. Methodology: A cross-sectional descriptive study was conducted with 97 patients and their families between March and May 2025, attended at the Virgen de la Arrixaca University Clinical Hospital (Murcia) in the inpatient ward and/or pediatric oncohematology outpatient clinic. A personalized digital survey was conducted face-to-face. It included five spheres: home/family environment; environmental; occupational; lifestyle; participatory. Results: Home: 44.4% female. Mean age 8.84 years (SD 4.61). Pets at home (49.5%). Main water source: 66% plastic bottles; 23.7% osmosis. Swimming pool use: monthly or more (28%). Environmental: Presence of tobacco smokers (38.1%), marijuana smokers (10.3%), pesticide use in home/garden (48.4%); poor air quality in the neighborhood (25%). High-risk chemical hobbies (20.6%). Occupational: 48% of parents work in environments with chemical/biological risk. Lifestyle: ≥2 servings of fresh fruit per day (53.6%). Red meat ≤ once a week (21.7%). Daily outdoor activities (22.6%), ≥2 hours/day screen time (71.7%). Discussion: So far, few modifiable prognostic factors have been reported. The findings reveal an environmental health profile with areas for improvement that could help reduce treatment-related mortality and improve outcomes. Conclusion: Integrating environmental risk assessment during the active treatment phase could help strengthen immune surveillance, reduce treatment-related mortality, and improve long-term outcomes in childhood cancer survivors.
  • Thumbnail Image
    Publication
    Open Access
    Integrating environmental risk factors into pediatric cancer care: Laying the groundwork for improved outcomes and primary prevention
    (Elsevier, 2025-12-01) Wood, Nicole M .; Shakeel, Omar; Ortega García, Juan Antonio; Miller, Mark D.; Cirugía, Pediatría y Obstetricia y Ginecología; Facultades de la UMU::Facultad de Medicina
    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. 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. 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.
  • Thumbnail Image
    Publication
    Open Access
    Interdisciplinary curriculum reform in toxicology andenvironmental health education : a case study from the University of Alcalá
    (Universidad de Murcia, Servicio de Publicaciones, 2026) Peña-Fernández, Antonio; Sin departamento asociado
    Toxicology plays a critical role in safeguarding public health and the environment, yet its visibility and integration within higher education curricula in Europe have declined over recent decades. At the University of Alcalá (UAH, Spain), a comprehensive strategy has been developed to revitalise toxicology education through curriculum integration, experiential learning, and pedagogical innovation. This review presents a detailed analysis of undergraduate and postgraduate toxicology training at UAH, highlighting its alignment with evolving European Union policies such as the Green Deal and the Chemicals Strategy for Sustainability. Key initiatives include interdisciplinary CBRN (chemical, biological, radiological, and nuclear) preparedness courses, pre-university toxicology rotations, gamified tools like ToxiGame©, and high-fidelity forensic simulations. These interventions aim to address educational gaps in risk assessment, regulatory toxicology, and emergency preparedness, while enhancing student engagement and employability. The UAH model demonstrates how toxicology can be effectively embedded into diverse programmes, including Pharmacy, Environmental Sciences, Criminalistics, and Medicine, in a manner that is scalable, policy-relevant, and responsive to emerging health threats. This work contributes to international efforts to modernise toxicology education and may serve as a blueprint for institutions aiming to strengthen workforce readiness in CBRN safety and environmental health.
  • Thumbnail Image
    Publication
    Open Access
    Secondhand smoke: a new and modifiable prognostic factor in childhood acute lymphoblastic leukemias
    (Elsevier Inc., 2019) Cárceles-Álvarez, Alberto; Ortega-García, Juan A.; López-Hernández, Fernando A.; Fuster-Soler, Jose L.; Ramis, Rebeca; Kloosterman, Nicole; Castillo, Luís; Sánchez-Solís, Manuel; Claudio, Luz; Ferrís-Tortajada, Josep; Cirugía, Pediatría y Obstetricia y Ginecología
    Background The 5-year overall survival (OS) in childhood acute lymphoblastic leukemia (ALL) has reached 90% in high-income countries, levels that can no be longer overcome with strategies based on intensification of treatment. Other approaches in the search for new and modifiable prognostic factors are necessary to continue to improve these rates. The importance of environmental factors in the etiopathogenesis of childhood ALL has been regaining interest but its role in the prognosis and survival of this disease is not well explored. We aim to investigate the association between secondhand smoke (SHS) and survival in children diagnosed with ALL. Methods We analyzed survival rates in 146 patients under the age of 15 years diagnosed with ALL between January 1998 and May 2016 in the Region of Murcia, Spain. Evaluation of parental SHS and other known prognostic factors (sex, age, white blood cell count at diagnosis, cytogenetics, NCI/Rome Criteria, early response to therapy, and relapse) were assessed for impact on OS, event-free survival (EFS), cumulative incidence of relapse (CIR), and treatment-related mortality (CITRM) using Kaplan-Meier analysis, Cox regression, and Fine-Gray model. Results The mean follow-up time was 105.3 months (±66.5). Prenatal exposure to SHS due to parental smoking was highly prevalent. Of the mothers, 44.4% and 55.5% of the fathers smoked at some point during pregnancy. After the child's diagnosis of ALL 39.7% of mothers and 45.9% of fathers reported smoking. The Cox proportional hazards model showed that maternal smoking during pregnancy and after diagnosis (HR = 4.396, 95% CI: 1.173-16.474, p = 0.028); and relapse (HR = 7.919; 95% CI: 2.683-21.868; p < 0.001) are independent prognostic factors in determining survival. The Fine-Gray model showed that maternal smoking during pregnancy and after diagnosis (HR = 14.525, 95% CI: 4.228-49.90, p < 0.001) is an independent prognostic factor in CITRM. Conclusions Persistent SHS worsens OS and TRM in children with ALL. This negative impact contributes to a different prognosis and may possibly provide an exceptional insight into new therapeutic approaches, including environmental aspects such as prevention and smoking cessation to improve survival outcomes.