Environmental neurology in the tropics.

We address the impact of the tropical environment on the human nervous system using the multifaceted approach characteristic of environmental neurology. First, environmental factors are examined according to their nature (physical, chemical and biological) and in relation to human activity and behavior. Some factors are specific to the tropics (climate and infections), while others are non-specific (chemicals, human communities and their way of life). Second, we examine the major role of human adaptation to the success of Homo sapiens, with emphasis on the linkage between thermoregulation and sleep-wake regulation. Third, we examine the performance of environmental neurology as a clinical discipline in tropical climates, with focus on the diagnostic and therapeutic challenges posed by human African trypanosomiasis. Finally, the prevention, early detection and monitoring of environmental neurological diseases is examined, as well as links with political and economic factors. In conclusion, practitioners of environmental neurology seek a global, multidisciplinary and holistic approach to understanding, preventing and treating neurological disorders within their purview. Environmental neurology integrates an expanded One Health concept by linking health and wellness to the interaction of plants, animals, humans and the ecosystem. Recent epidemics and the current COVID-19 pandemic exemplify the need for worldwide action to protect human health and biodiversity.

La cultura médico ambiental en el desarrollo local de la comunidad / The environmental medical culture in the local development of the community

Se realizó un estudio con el objetivo de centrar la atención en reflexionar en la importancia de la formación de la cultura ambiental en la carrera de medicina, de relevancia en la comunidad médica y en la sociedad. Se utilizaron métodos como: análisis y síntesis, inductivo-deductivo, modelación, análisis documental, hermenéutico dialéctico. La aplicación de los métodos experimentales permitió la elaboración de un modelo para la formación de la cultura ambiental en los profesionales de la carrera de medicina con un basamento holístico-configuracional al revelar la lógica de la formación de esta cultura contextualizada se proyecta como una solución de impacto a las insuficiencias encontradas con significación, transformación y sistematización, en la práctica médica. La formación de los profesionales de la carrera de medicina en la Facultad de Ciencias Médicas de Bayamo no está acorde a las nuevas exigencias al currículo, que demanda nuestra sociedad debido a las insuficiencias en el proceso de formación de la cultura ambiental en la carrera de medicina(AU)

A study was conducted with the objective of focusing attention on reflecting on the importance of the formation of environmental culture in the medical career, of relevance in the medical community and in society. Methods such as: analysis and synthesis, inductive-deductive, modeling, documentary analysis, dialectical hermeneutics were used. The application of the experimental methods allowed the elaboration of a model for the formation of the environmental culture in the professionals of the medical career with a holistic-configurational base when revealing the logic of the formation of this contextualized culture is projected as a solution of impact on the insufficiencies found with significance, transformation and systematization, in medical practice. The training of medical career professionals at the Faculty of Medical Sciences of Bayamo is not in line with the new requirements of the curriculum, which our society demands due to the inadequacies in the process of formation of environmental culture in the medical career(EU)

The World Federation of Neurology and the challenges in Environment Neurology.

Since its establishment the World Federation of Neurology (WFN) has manifested a keen interest in the environment and its relation to neurological diseases. Thus, in 2007 the WFN renamed the "Neurotoxicological Research Group" to "Environmental Neurology Research Group". In this short article, we review some recent events which illustrate the WFN involvement in Environmental Neurology as well its concerns about global health matters involving environmental issues.

Embracing microbes in exposure science.

Although defined more broadly, exposure science has mainly focused on exposures to environmental chemicals and related stressors, such as airborne particulate matter. There is an opportunity for exposure science to contribute more substantially to improving public health by devoting more attention to microorganisms as key stressors and agents in exposure. The discovery that pathogenic microbes cause disease in humans precipitated a revolution in public health science and disease prevention. With a continued global urgency to address spread of pathogenic microbes, contributions of microorganisms to both infectious and noninfectious processes merit more attention from the exposure science community. Today, discoveries of the importance of the human microbiome as a determinant of health and disease are precipitating a second revolution. Emerging knowledge creates a major opportunity to expand the scope of exposure science to incorporate the human microbiome as a target and modulator of exposure. A study committee of the National Academies of Sciences, Engineering, and Medicine has defined a research strategy to address health risks that pertain to the interaction of environmental chemicals with the human microbiome. Some aspects of this strategy pose important challenges and opportunities for the exposure science community.

Nutritional Ecology and Human Health.

In contrast to the spectacular advances in the first half of the twentieth century with micronutrient-related diseases, human nutrition science has failed to stem the more recent rise of obesity and associated cardiometabolic disease (OACD). This failure has triggered debate on the problems and limitations of the field and what change is needed to address these. We briefly review the two broad historical phases of human nutrition science and then provide an overview of the main problems that have been implicated in the poor progress of the field with solving OACD. We next introduce the field of nutritional ecology and show how its ecological-evolutionary foundations can enrich human nutrition science by providing the theory to help address its limitations. We end by introducing a modeling approach from nutritional ecology, termed nutritional geometry, and demonstrate how it can help to implement ecological and evolutionary theory in human nutrition to provide new direction and to better understand and manage OACD.

Programa de largo seguimiento de supervivientes de cáncer pediátrico en la Región de Murcia: preferencias y actitudes de los profesionales de Atención Primaria / Long-term follow up of childhood cancer survivors in the Murcia Region: preferences and attitudes of Primary Care professionals

OBJETIVO: Evaluar actitudes, creencias y conocimientos de los profesionales médicos de Atención Primaria acerca del seguimiento de los supervivientes de cáncer pediátrico (SCP) y divulgar el Programa de Largo Seguimiento de Supervivientes de Cáncer Pediátrico en la Región de Murcia (PLASESCAP-MUR). MATERIAL Y MÉTODOS: Estudio transversal descriptivo mediante cuestionario estructurado y autocumplimentado. Se enviaron cuestionarios a todos los profesionales médicos de Atención Primaria del Área de Salud 1 del Servicio Murciano de Salud. RESULTADOS: Tasa de respuesta del 58% (100/172). El 71 y el 22% eran médicos de familia y pediatras, respectivamente. El 49% atendió algún SCP en los últimos 5 años. El 84% refiere que nunca o pocas veces recibió un informe detallado de evaluación global del superviviente. Más del 75% encuentran bastante o muy útiles el acceso a información detallada de largo seguimiento. El 95% prefiere atender a los supervivientes conjuntamente con consulta de largo seguimiento. Un 80% considera que mejorando la calidad ambiental del entorno podría disminuir la morbimortalidad de los supervivientes. Se encontró una relación estadísticamente significativa entre años practicando medicina y percepción de importancia de algunos factores medioambientales. CONCLUSIONES: Para el largo seguimiento de los SCP parece importante aumentar la capacitación de los profesionales sanitarios de Atención Primaria y la información detallada a través de un plan personalizado de largo seguimiento de cada superviviente. PLASESCAP-MUR proporciona un seguimiento integrativo a los supervivientes de cáncer pediátrico en un modelo de atención compartida entre la Unidad de Largo Seguimiento y Atención Primaria

OBJECTIVE: To assess attitudes, beliefs and knowledge of primary medical care professionals as regards the follow-up of Childhood Cancer Survivors (CCS) and the introduction of a Long-Term Follow-Up Program for Childhood Cancer Survivors in the Region of Murcia (PLASESCAP-MUR). MATERIAL AND METHODS: Descriptive cross-sectional study using a structured, self-administered questionnaire. These questionnaires were sent to all primary medical care professionals in Murcia Health District 1. RESULTS: Response rate of 58% (100/172), with 71% and 22% being family physicians and pediatricians, respectively, of whom 49% provided medical care to a CCS in the last 5 years, with 84% reporting that they never or rarely received a detailed report of overall assessment of the survivor. More than 75% found that access to detailed follow-up information was quite or very useful; 95% prefer to consult experts when providing medical care to survivors, and 80% believe that improving the quality of the environment may decrease the morbidity and mortality of the survivors. A statistically significant relationship was found between the length of practicing medicine and the perception of the importance of environmental factors. CONCLUSIONS: It seems to be important to increase the training of primary care professionals for the long-term follow-up of CCS, as well as having the detailed information through a personalized long-term follow-up of each survivor. PLASESCAP-MUR offers an integrated follow-up to CCS in a model of shared care between Long Term Monitoring Units and Primary Care Units

Reducing the global environmental impacts of rapid infrastructure expansion.

Infrastructures, such as roads, mines, and hydroelectric dams, are proliferating explosively. Often, this has serious direct and indirect environmental impacts. We highlight nine issues that should be considered by project proponents to better evaluate and limit the environmental risks of such developments.

Commentary on the contributions and future role of occupational exposure science in a vision and strategy for the discipline of exposure science.

Exposure science is a holistic concept without prejudice to exposure source. Traditionally, measurements aimed at mitigating environmental exposures have not included exposures in the workplace, instead considering such exposures to be an internal affair between workers and their employers. Similarly, occupational (or industrial) hygiene has not typically accounted for environmental contributions to poor health at work. Many persons spend a significant amount of their lifetime in the workplace, where they maybe exposed to more numerous chemicals at higher levels than elsewhere in their environment. In addition, workplace chemical exposures and other exogenous stressors may increase epigenetic and germline modifications that are passed on to future generations. We provide a brief history of the development of exposure science from its roots in the assessment of workplace exposures, including an appendix where we detail current resources for education and training in exposure science offered through occupational hygiene organizations. We describe existing successful collaborations between occupational and environmental practitioners in the field of exposure science, which may serve as a model for future interactions. Finally, we provide an integrated vision for the field of exposure science, emphasizing interagency collaboration, the need for complete exposure information in epidemiological studies, and the importance of integrating occupational, environmental, and residential assessments. Our goal is to encourage communication and spur additional collaboration between the fields of occupational and environmental exposure assessment. Providing a more comprehensive approach to exposure science is critical to the study of the "exposome", which conceptualizes the totality of exposures throughout a person's life, not only chemical, but also from diet, stress, drugs, infection, and so on, and the individual response.

The environment-pathogen-host axis in communicable and non-communicable diseases: recent advances in experimental and clinical research.

Allergies and autoimmune diseases are spreading worldwide. Control of infections, on the other hand, remains an issue, even in the post-antibiotic era. Chronic or poorly controlled infections occur in immune compromised individuals such as HIV patients, hospitalized patients exposed to multi-resistant bacteria, or patients on immunosuppressive treatment. They may become an even more emerging issue in an ageing population. At the same time, profound environmental changes such as global warming, urbanization, increasing environmental pollution and novel food engineering technologies may alter the abundance or aggressiveness of allergens/allergen carriers in our environment. Likewise, changes in dietary habits - and possibly also use of antibiotics - have an impact on the composition of our natural microbial flora in the gut, airways and skin, which may alter susceptibility for common diseases, among them allergies, asthma and atopic eczema. At the recently founded Institute of Environmental Medicine of the Technische Universität Munich, located in Augsburg at the UNIKA-T, experimental, clinical and translational research is focused on the complex interactions of environment, pathogen and host in expression or control of communicable and non-communicable diseases. We present our research concept and recent findings in environment - host interactions.

From worker health to citizen health: moving upstream.

New rapid growth economies, urbanization, health systems crises, and "big data" are causing fundamental changes in social structures and systems, including health. These forces for change have significant consequences for occupational and environmental medicine and will challenge the specialty to think beyond workers and workplaces as the principal locus of innovation for health and performance. These trends are placing great emphasis on upstream strategies for addressing the complex systems dynamics of the social determinants of health. The need to engage systems in communities for healthier workforces is a shift in orientation from worker and workplace centric to citizen and community centric. This change for occupational and environmental medicine requires extending systems approaches in the workplace to communities that are systems of systems and that require different skills, data, tools, and partnerships.

Do we need a specialization in Environmental Medicine?

Promoting Environmental Medicine and Environmental Neurology needs in the first place a building up knowledge and research. Education for young students and training during the entire curriculum are a second step. These common goals are necessary to emphasize the main effects of Environment in diseases and so to lead to better care.

A niche for infectious disease in environmental health: rethinking the toxicological paradigm.

OBJECTIVE: In this review we highlight the need to expand the scope of environmental health research, which now focuses largely on the study of toxicants, to incorporate infectious agents. We provide evidence that environmental health research would be strengthened through finding common ground with the tools and approaches of infectious disease research. DATA SOURCES AND EXTRACTION: We conducted a literature review for examples of interactions between toxic agents and infectious diseases, as well as the role of these interactions as risk factors in classic "environmental" diseases. We investigated existing funding sources and research mandates in the United States from the National Science Foundation and the National Institutes of Health, particularly the National Institute of Environmental Health Sciences. DATA SYNTHESIS: We adapted the toxicological paradigm to guide reintegration of infectious disease into environmental health research and to identify common ground between these two fields as well as opportunities for improving public health through interdisciplinary research. CONCLUSIONS: Environmental health encompasses complex disease processes, many of which involve interactions among multiple risk factors, including toxicant exposures, pathogens, and susceptibility. Funding and program mandates for environmental health studies should be expanded to include pathogens in order to capture the true scope of these overlapping risks, thus creating more effective research investments with greater relevance to the complexity of real-world exposures and multifactorial health outcomes. We propose a new model that integrates the toxicology and infectious disease paradigms to facilitate improved collaboration and communication by providing a framework for interdisciplinary research. Pathogens should be part of environmental health research planning and funding allocation, as well as applications such as surveillance and policy development.