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Tostain JB, Mathieu M, Oude Engberink A, Clary B, Amouyal M, Lognos B, Demoly P, Annesi-Maesano I, Ninot G, Molinari N, Richard A, Badreddine M, Duflos C, Carbonnel F. The Primary Care and Environmental Health e-Learning Course to Integrate Environmental Health in General Practice: Before-and-After Feasibility Study. JMIR Form Res 2024; 8:e56130. [PMID: 38722679 PMCID: PMC11117128 DOI: 10.2196/56130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/13/2024] [Accepted: 03/16/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Environmental and behavioral factors are responsible for 12.6 million deaths annually and contribute to 25% of deaths and chronic diseases worldwide. Through the One Health initiative, the World Health Organization and other international health organizations plan to improve these indicators to create healthier environments by 2030. To meet this challenge, training primary care professionals should be the priority of national policies. General practitioners (GPs) are ready to become involved but need in-depth training to gain and apply environmental health (EH) knowledge to their practice. In response, we designed the Primary Care Environment and Health (PCEH) online course in partnership with the Occitanie Regional Health Agency in France. This course was used to train GP residents from the Montpelier-Nimes Faculty of Medicine in EH knowledge. The course was organized in 2 successive parts: (1) an asynchronous e-learning modular course focusing on EH knowledge and tools and (2) 1 day of face-to-face sessions. OBJECTIVE This study assessed the impact of the e-learning component of the PCEH course on participants' satisfaction, knowledge, and behavior changes toward EH. METHODS This was a pilot before-and-after study. Four modules were available in the 6-hour e-learning course: introduction to EH, population-based approach (mapping tools and resources), clinical cases, and communication tools. From August to September 2021, we recruited first-year GP residents from the University of Montpellier (N=130). Participants' satisfaction, knowledge improvements for 19 EH risks, procedure to report EH risks to health authorities online, and behavior change (to consider the possible effects of the environment on their own and their patients' health) were assessed using self-reported questionnaires on a Likert scale (1-5). Paired Student t tests and the McNemar χ2 test were used to compare quantitative and qualitative variables, respectively, before and after the course. RESULTS A total of 74 GP residents completed the e-learning and answered the pre- and posttest questionnaires. The mean satisfaction score was 4.0 (SD 0.9) out of 5. Knowledge scores of EH risks increased significantly after the e-learning course, with a mean difference of 30% (P<.001) for all items. Behavioral scores improved significantly by 18% for the participant's health and by 26% for patients' health (P<.001). These improvements did not vary significantly according to participant characteristics (eg, sex, children, place of work). CONCLUSIONS The e-learning course improved knowledge and behavior related to EH. Further studies are needed to assess the impact of the PCEH course on clinical practice and potential benefits for patients. This course was designed to serve as a knowledge base that could be reused each year with a view toward sustainability. This course will integrate new modules and will be adapted to the evolution of EH status indicators and target population needs.
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Affiliation(s)
- Jean-Baptiste Tostain
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier, National Institute for Health and Medical Research, Montpellier, France
- Departement of General Practice, University of Montpellier, Montpellier, France
| | - Marina Mathieu
- Clinical Research and Epidemiology Unit, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Agnès Oude Engberink
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier, National Institute for Health and Medical Research, Montpellier, France
- Departement of General Practice, University of Montpellier, Montpellier, France
- Maison de Santé Pluriprofessionnelle Universitaire Avicennne, Cabestany, France
| | - Bernard Clary
- Departement of General Practice, University of Montpellier, Montpellier, France
| | - Michel Amouyal
- Departement of General Practice, University of Montpellier, Montpellier, France
| | - Béatrice Lognos
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier, National Institute for Health and Medical Research, Montpellier, France
- Departement of General Practice, University of Montpellier, Montpellier, France
| | - Pascal Demoly
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier, National Institute for Health and Medical Research, Montpellier, France
| | - Isabella Annesi-Maesano
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier, National Institute for Health and Medical Research, Montpellier, France
- Service de Pneumologie, Allergologie et Oncologie Thoracique, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Grégory Ninot
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier, National Institute for Health and Medical Research, Montpellier, France
| | - Nicolas Molinari
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier, National Institute for Health and Medical Research, Montpellier, France
| | | | - Maha Badreddine
- Department of Pedagogical Engineering and Audiovisual Production, Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Francois Carbonnel
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier, National Institute for Health and Medical Research, Montpellier, France
- Departement of General Practice, University of Montpellier, Montpellier, France
- Maison de Santé Pluriprofessionnelle Universitaire Avicennne, Cabestany, France
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Bloeser K, Kimber JM, Santos SL, Krupka CB, McAndrew LM. Improving care for veterans' environmental exposure concerns: applications of the consolidated framework for implementation research in program evaluation. BMC Health Serv Res 2024; 24:241. [PMID: 38395810 PMCID: PMC10893731 DOI: 10.1186/s12913-024-10614-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/17/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Healthcare systems, like the US Department of Veterans Affairs (VA), need policies and procedures for delivering care to special populations including those with environmental exposure concerns. Despite being common and pervasive, especially among Veterans, environmental exposures are largely overlooked by healthcare providers. To successfully implement care for Veterans with military environmental exposure concerns, an understanding of contextual factors impeding care on the provider (e.g., knowledge and beliefs) and organizational (e.g., leadership's priorities) level is needed. Our goal was to conduct an operational needs assessment of providers to examine provider educational needs regarding Veterans' military environmental exposure concerns. METHODS In 2020, we surveyed 2,775 VA medical and behavioral health providers. Our cross-sectional assessment was informed by the Consolidated Framework for Implementation Research (CFIR) and assessed barriers and facilitators to the uptake and application of knowledge regarding interdisciplinary care for environmental exposure concerns. The web-based survey was emailed to providers across the United States representing a variety of disciplines and practice settings to reflect the interdisciplinary approach to care for environmental exposures. We used bivariate statistics to investigate the intervention setting, inner setting, and individual characteristics of providers regarding care for environmental exposure concerns. RESULTS Approximately one-third of VA medical and behavioral health clinicians report low to no knowledge of environmental exposure concerns. We find 88% of medical and 91% of behavioral health providers report they are ready to learn more about environmental exposures. Half of medical and behavioral health providers report they have access to information on environmental exposures and less than half report care for environmental exposures is a priority where they practice. CONCLUSIONS Our findings suggest interdisciplinary providers' knowledge of and discussion with Veterans about environmental exposures may be influenced by contextual factors at the organizational level. Considering individual-level factors and organizational culture is important to consider when supporting care for environmental exposures. Since this needs assessment, VA established targeted programs to improve care related to military environmental exposures in response to legislation; future exploration of these same variables or contextual factors is warranted.
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Affiliation(s)
- Katharine Bloeser
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA.
- The Silberman School of Social Work at Hunter College, The City University of New York, New York, NY, USA.
| | - Justin M Kimber
- Buffalo VA Medical Center, Buffalo, NY, USA
- Russell Sage College, Troy, NY, USA
| | - Susan L Santos
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - Chana B Krupka
- The VA New York Harbor Health Care System, Brooklyn, NY, USA
| | - Lisa M McAndrew
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
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Subiza-Pérez M, Vrotsou K, Esnal H, Kortajarena M, Mujika A, Marinelarena E, Aizpurua P, Arrue M, Mitxelena X, Larrinaga-Torrontegui U, Apalategi U, Campillo I Lopez F, Ibarluzea J. Environmental health knowledge and competences in Basque health workers. A comparison of different professional profiles. ENVIRONMENTAL RESEARCH 2024; 243:117789. [PMID: 38052356 DOI: 10.1016/j.envres.2023.117789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023]
Abstract
Environmental exposures are responsible for a quarter of morbidity and mortality rates globally. Primary care professionals work in a privileged position to detect and intervene on environmental health matters. Nevertheless, due to lack of specific training, international literature shows that primary care health professionals have limited skills to deal with those. The objectives of this study were to assess the levels of environmental health (EH) knowledge and competence of a sample of 446 health professionals and students in the Basque Country and explore the presence that EH has on their daily practice. Only a very small proportion of participants had received training and took environmental clinical history regularly. Participants were confident to deal, and actually dealt, with tobacco, pollen and sun exposures but less able to address topics like biomarkers, pesticides and endocrine disruptors. Finally, and in accordance to previous works, we found moderate levels of EH knowledge and skills in our sample, and observed that nurses and nursing students reported higher EH skills than other professional profiles but scored lower in knowledge. Despite the manifold impacts of environmental exposures on health, interventions to strengthen health professionals' EH competence are required.
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Affiliation(s)
- Mikel Subiza-Pérez
- Department of Clinical and Health Psychology and Research Methods, University of the Basque Country UPV/EHU, Avenida Tolosa 70, 20018, Donostia-San Sebastián, Spain; Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bc 6RJ, Bradford, UK; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, c/ Monforte de Lemos 3-5, Madrid, 280, Spain; Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, Paseo Doctor Begiristain s/n, 20014, Donostia- San Sebastián, Spain.
| | - Kalliopi Vrotsou
- Osakidetza Basque Health Service, Directorate of Health Care, PC-IHOs Research Group of Gipuzkoa, Spain; Biodonostia Health Research Institute, Primary Care Research Group, San Sebastian, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain.
| | - Haritz Esnal
- Department of Preventive Medicine and Public Health, University of the Basque Country UPV/EHU, Paseo Dr Beguiristain, 105, 20014, Donostia-San Sebastian, Spain; Emergency Department, Donostia University Hospital, Paseo Dr Beguiristain, 20014, Donostia-San Sebastian, Spain.
| | - Maider Kortajarena
- Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Paseo Doctor Begiristain 105, 20014, Donostia-San Sebastian, Spain.
| | - Agurtzane Mujika
- Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Paseo Doctor Begiristain 105, 20014, Donostia-San Sebastian, Spain.
| | - Eulalia Marinelarena
- Multiprofessional Teaching Unit of Family and Community Care of Gipuzkoa, Gipuzkoa, Spain.
| | - Pilar Aizpurua
- Health Centre of Ondarreta, ESI Donostialdea, Basque Health Service, Avenida de Zumalakarregi, 24, 2008, Donostia-San Sebastian, Spain.
| | - Miren Arrue
- Department of Obstetrics and Gynecology, Donostia University Hospital, Paseo Doctor Begiristain s/n, 20014, Donostia- San Sebastián, Spain.
| | - Xabier Mitxelena
- Health Centre of Ibarra, ESI Tolosaldea, Osakidetza. Basque Health Service, Euskalherria kalea 14, 20400, Ibarra, Spain.
| | - Unai Larrinaga-Torrontegui
- Preventive Medicine, Mendaro Hospital, Debabarrena Integrated Health Organization, Osakidetza. Mendarozabal z/g, 20850, Mendaro, Gipuzkoa, Spain.
| | - Uxune Apalategi
- Biodonostia Health Research Institute, Primary Care Research Group, San Sebastian, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Osakidetza, Central Services, Multiprofessional Family and Community Care Teaching Unit of Araba, Lakuabizkarra Health Center, 01010, Vitoria-Gasteiz, Spain; Department of Pharmacology, University of the Basque Country UPV/EHU, 20018, Donostia-San Sebastián, Spain.
| | - Ferran Campillo I Lopez
- Pediatric Environmental Health Specialty Unit (PEHSU), Garrotxa Region Pediatric Team, Fundació Hospital d'Olot I Comarcal de la Garrotxa, Avinguda Països Catalans 86, 17800, Olot, Girona, Catalonia, Spain; Vall d'en Bas Primary Healthcare Centre, Garrotxa Region Pediatric Team, Fundació Hospital d'Olot I Comarcal de la Garrotxa, Carrer Doctor Turró, 2, 17176, Sant Esteve d'en Bas, Girona, Girona, Catalonia, Spain; Working Group on Environmental Health, Catalan Society of Pediatrics, Spain; Comitte on Environmental Health, Spanish Association of Pediatrics, Spain.
| | - Jesús Ibarluzea
- Faculty of Psychology, University of the Basque Country UPV/EHU, Avenida Tolosa 70, 20018, Donostia-San Sebastián, Spain; Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, 20013, Donostia-San Sebastián, Spain.
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Trasande L, Sargis RM. Endocrine-disrupting chemicals: Mainstream recognition of health effects and implications for the practicing internist. J Intern Med 2024; 295:259-274. [PMID: 38037246 DOI: 10.1111/joim.13748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Rapidly advancing evidence documents that a broad array of synthetic chemicals found ubiquitously in the environment contribute to disease and disability across the lifespan. Although the early literature focused on early life exposures, endocrine-disrupting chemicals (EDCs) are now understood to contribute substantially to chronic disease in adulthood, especially metabolic, cardiovascular, and reproductive consequences as well as endocrine cancers. The contribution to mortality is substantial, with over 90,000 deaths annually and at least $39 billion/year in lost economic productivity in the United States (US) due to exposure to certain phthalates that are used as plasticizers in food packaging. Importantly, exposures are disproportionately high in low-income and minoritized populations, driving disparities in these conditions. Though non-Hispanic Blacks and Mexican Americans comprise 12.6% and 13.5% of the US population, they bear 16.5% and 14.6% of the disease burden due to EDCs, respectively. Many of these exposures can be modified through safe and simple behavioral changes supported by proactive government action to both limit known hazardous exposures and to proactively screen new industrial chemicals prior to their use. Routine healthcare maintenance should include guidance to reduce EDC exposures, and a recent report by the Institute of Medicine suggests that testing be conducted, particularly in populations heavily exposed to perfluoroalkyl substances-chemicals used in nonstick coatings as well as oil- and water-resistant clothing.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- NYU Wagner Graduate School of Public Service, New York, New York, USA
| | - Robert M Sargis
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, Chicago, Illinois, USA
- Chicago Center for Health and Environment, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA
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Boronow KE, Cohn B, Havas L, Plumb M, Brody JG. The Effect of Individual or Study-Wide Report-Back on Knowledge, Concern, and Exposure-Reducing Behaviors Related to Endocrine-Disrupting Chemicals. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:97005. [PMID: 37682721 PMCID: PMC10489892 DOI: 10.1289/ehp12565] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND To make informed decisions about endocrine-disrupting chemicals (EDCs), people need functional understanding of exposures and health and an ability to act on their knowledge. The return of biomonitoring results is an opportunity to educate people about EDCs and motivate exposure reduction. OBJECTIVES This study investigates environmental health knowledge about EDCs, concerns about health effects, and exposure-reducing behaviors before and after the return of individual-level exposure results or only study-wide results. METHODS Women in the Child Health and Development Studies who were biomonitored for 42 EDCs were randomly assigned to receive a report with personal chemical results or only study-wide findings. We interviewed participants before and after report-back about their knowledge and concerns about EDCs and how frequently they performed exposure-related behaviors. We investigated baseline differences by education and race and examined changes after report-back by race and report type. RESULTS Participants (n = 135 ) demonstrated general understanding of exposure pathways and health impacts of EDCs. For 9 out of 20 knowledge questions, more than 90% of participants (n ≥ 124 ) gave correct responses at baseline, including for questions about chemicals' persistence in the body and effects of early-life exposure. Most participants held two misconceptions-about chemical safety testing in the United States and what doctors can infer from EDC results-although errors decreased after report-back. Initially, concern was higher for legacy pollutants, but report-back increased concern for consumer product chemicals. After report-back, participants took some actions to reduce exposures, particularly to per- and polyfluoroalkyl substances, and total behavior was associated with knowledge and concern but not race, education, or report type. DISCUSSION This study demonstrated that participants had foundational knowledge about EDCs and that report-back further built their environmental health literacy. We conclude that future communications should target misconceptions about chemicals regulation in the United States, because information about regulations is crucial for people to evaluate risks posed by consumer product chemicals and decide whether to engage with public policy. https://doi.org/10.1289/EHP12565.
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Affiliation(s)
| | - Barbara Cohn
- Public Health Institute, Oakland, California, USA
| | - Laurie Havas
- Participant Advisory Council, Child Health and Development Studies, Public Health Institute, Oakland, California, USA
| | - Marj Plumb
- Plumbline Coaching and Consulting, Omaha, Nebraska, USA
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Rosser F, Balmes J. Ozone and childhood respiratory health: A primer for US pediatric providers and a call for a more protective standard. Pediatr Pulmonol 2023; 58:1355-1366. [PMID: 36815617 PMCID: PMC10121852 DOI: 10.1002/ppul.26368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
Ground level ozone is a potent respiratory toxicant with decades of accumulated data demonstrating respiratory harms to children. Despite the ubiquity of ozone in the United States, impacting both urban and rural communities, the associated harms of exposure to this important air pollutant are often infrequently or inadequately covered during medical training including pulmonary specialization. Thus, many providers caring for children's respiratory health may have limited knowledge of the harms which may result in reduced discussion of ozone pollution during clinical encounters. Further, the current US air quality standard for ozone does not adequately protect children. In this nonsystematic review, we present basic background information for healthcare providers caring for children's respiratory health, review the US process for setting air quality standards, discuss the respiratory harms of ozone for healthy children and those with underlying respiratory disease, highlight the urgent need for a more protective ozone standard to adequately protect children's respiratory health, review impacts of climate change on ozone levels, and provide information for discussion in clinical encounters.
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Affiliation(s)
- Franziska Rosser
- Department of Pediatrics, Division of Pulmonary Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - John Balmes
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- School of Public Health, University of California, Berkeley, CA
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Newman NC, Knapke JM, Kiniyalocts R, Belt J, Haynes E. Evaluation of academic detailing to educate clinicians regarding childhood lead poisoning prevention: a pilot study. J Osteopath Med 2023; 123:159-165. [PMID: 36628491 DOI: 10.1515/jom-2022-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/11/2022] [Indexed: 01/12/2023]
Abstract
CONTEXT Environmental exposures are associated with approximately 19% of disease globally, and exposure to neurotoxic chemicals is estimated to cost the United States $50 billion per year. Despite calls from the Institute of Medicine to increase training for clinicians regarding environmental health since the 1990s, there is still little instruction in environmental health for clinicians. This leaves gaps in knowledge that need to be bridged through outreach and education to practicing clinicians. Academic detailing (AD) is an educational intervention associated with improved prescribing practices in healthcare professionals but has not been applied to preventive or environmental health. Childhood lead exposure is a common condition associated with lifetime increased risk of cognitive and behavioral problems. Ohio has more than 2 million homes built before 1978, making exposure to lead-based paint a significant public health problem; however, only 50% of high-risk children are tested for lead. Few receive health promotion information regarding lead poisoning prevention, in part because this is not a part of training for healthcare providers (HCPs). OBJECTIVES The objectives of this study were twofold: (1) implement a pilot of AD sessions on the topic of childhood lead poisoning prevention with frontline HCPs and their staff in different practice settings; and (2) evaluate the acceptability of these training sessions utilizing quantitative and qualitative methods. METHODS Physicians, nurses, social workers, community health workers, and clinical office staff were recruited from clinics who care for children at high risk for lead exposure. Trainings consisting of small group AD style sessions were presented at these sites. Learning objectives included increasing knowledge regarding lead testing requirements, enabling identification of lead's impact on child development and equipping participants to provide anticipatory guidance for parents regarding lead poisoning prevention. Participants provided feedback through an anonymous questionnaire and qualitative feedback. RESULTS There were 46 participants (12 physicians in practice/in training, 21 nursing or office staff, and 13 community health or social workers); more than 90% of the participants reported that the training achieved its learning objectives. Small-group presentations were preferred (91%); approximately 39% of participants requested an online format. Participants preferred that the presenters be either a public health or lead clinical expert, and they suggested that future activities include clinical vignettes. CONCLUSIONS Academic-detailing style training shows promise in promoting childhood lead poisoning prevention for frontline HCPs.
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Affiliation(s)
- Nicholas C Newman
- Department of Pediatrics and Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Attending Physician, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jacqueline M Knapke
- Department of Family and Community Medicine at the University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rachael Kiniyalocts
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John Belt
- Bureau of Environmental Health and Radiation Protection, Field Services Division, Ohio Department of Health, Columbus, OH, USA
| | - Erin Haynes
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA
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Trasande L, Kassotis CD. The Pediatrician's Role in Protecting Children from Environmental Hazards. Pediatr Clin North Am 2023; 70:137-150. [PMID: 36402464 PMCID: PMC10591514 DOI: 10.1016/j.pcl.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Children suffer disproportionately from disease and disability due to environmental hazards, for reasons rooted in their biology. The contribution is substantial and increasingly recognized, particularly due to ever-increasing awareness of endocrine disruption. Regulatory actions can be traced directly to reductions in toxic exposures, with tangible benefits to society. Deep flaws remain in the policy framework in industrialized countries, failing to offer sufficient protection, but are even more limited in industrializing nations where the majority of chemical production and use will occur by 2030. Evidence-based steps for reducing chemical exposures associated with adverse health outcomes exist and should be incorporated into anticipatory guidance.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Grossman School of Medicine, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU School of Global Public Health, New York, NY, USA.
| | - Christopher D Kassotis
- Institute of Environmental Health Sciences and Department of Pharmacology, Wayne State University, Detroit, MI, USA
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Sousa LAD, Zaitune MPDA. Uma revisão de escopo de revisões sistemáticas sobre exposição humana ao mercúrio. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2022. [DOI: 10.1590/2317-6369/38120pt2022v47e18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Resumo: Introdução: a promulgação da Convenção de Minamata no Brasil em 2018 incentivou o cumprimento dos seus objetivos em reduzir o uso e a poluição por mercúrio. Objetivo: caracterizar a produção científica sobre exposição humana ao mercúrio e identificar lacunas de conhecimento a fim de subsidiar a tomada de decisão em saúde. Métodos: revisão de escopo de revisões sistemáticas e metanálises, sem restrição de idioma ou data de publicação, utilizando as bases PubMed, BVS e Cochrane Library. Resultados: 71 estudos atenderam aos critérios de elegibilidade, com 40 revisões sistemáticas, 30 metanálises e 1 overview. Amálgama dentário e contaminação alimentar e ambiental por atividades que utilizam mercúrio foram as fontes de exposição mais mencionadas. Os temas mais estudados contaram com transtornos mentais e comportamentais, assim como uso de biomarcadores e testes neurocomportamentais relacionados à exposição ao mercúrio. Discussão: lacunas como a exposição ocupacional ao mercúrio, uso em práticas tradicionais e em cosméticos apontam para a necessidade de mais estudos. As revisões identificadas podem oferecer subsídios para sínteses de evidências e protocolos de atenção à saúde de populações expostas, assim como para a elaboração de políticas públicas que visem o controle do uso e da exposição ao mercúrio.
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The Awareness of Pulmonologists and Patients with Respiratory Diseases about the Impact of Air Pollution on Health in Poland. J Clin Med 2021; 10:jcm10122606. [PMID: 34204758 PMCID: PMC8231647 DOI: 10.3390/jcm10122606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 01/19/2023] Open
Abstract
Within the European Union, air pollution is highest in Poland. The aim of this study was to compare the awareness of Polish pulmonologists and that of patients with respiratory diseases about the impact of air pollution on health. It was a crossover study with voluntary and anonymous participation. The study included 309 pulmonologists and 262 patients with respiratory diseases. The majority of the patients declared good knowledge about the impact of air pollution on health, and only 16% of the pulmonologists declared sufficient knowledge on this topic. The main sources of information on air pollution were radio and television for patients and the medical press for doctors. Doctors rarely informed patients about the impact of air pollution on their disease. Patients followed information on the quality of air in their areas more often than doctors. Polish patients’ knowledge about the main sources of air pollution in their areas was higher than the knowledge of pulmonologists. Patients declared knowledge of air pollution standards twice as often as doctors. Patients with respiratory diseases are interested in the effects of air pollution on their health. Polish patients’ knowledge about air pollution and its health effects is higher than that of the specialists treating them. Professional education of Polish pulmonologists in this field is needed.
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Zielonka TM. Awareness of Polish physicians regarding the impact of air pollution on health. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2021; 77:478-485. [PMID: 34096478 DOI: 10.1080/19338244.2021.1935677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The air quality in Poland is the worst in Europe. The aim of the study was to assess the awareness of Polish physicians about the impact of air pollution on health, the sources of their knowledge and how this knowledge is used in clinical practice. The study was based on a voluntary and anonymous questionnaire and included 94% of doctors from a hospital in Warsaw. Only 25% of physicians think that their knowledge of the impact of air pollution on health is sufficient. The main sources of this knowledge were the internet and TV. Only 5% of physicians know what air pollution concentrations are acceptable, 17% follow the levels of air pollution in their region and 3% inform their patients when air pollution exceeds permissible limits. The older and noninterventional physicians inform patients more often about these dangers. The knowledge of physicians on air pollution is not sufficient and they need professional education in this area.
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Kligler B, Pinto Zipp G, Rocchetti C, Secic M, Ihde ES. The impact of integrating environmental health into medical school curricula: a survey-based study. BMC MEDICAL EDUCATION 2021; 21:40. [PMID: 33419439 PMCID: PMC7796639 DOI: 10.1186/s12909-020-02458-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/16/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Inclusion of environmental health (EH) in medical education serves as a catalyst for preparing future physicians to address issues as complex as climate change and health, water pollution and lead contamination. However, previous research has found EH education to be largely lacking in U.S. medical education, putting future physicians at risk of not having the expertise to address patients' environmental illnesses, nor speak to prevention. METHODS Environmental health (EH) knowledge and skills were incorporated into the first-year medical school curriculum at Hackensack Meridian School of Medicine (Nutley, New Jersey), via a two-hour interactive large group learning module with follow up activities. Students completed the Environmental Health in Med School (EHMS) survey before and after the year 1 EH module. This survey evaluates medical students' attitudes, awareness and professionalism regarding environmental health. In year 2, students completed the Environmental Health Survey II, which measured students' perceptions of preparedness to discuss EH with future patients. The research team created both surveys based upon learning objectives that broadly aligned with the Institute of Medicine six competency-based environmental health learning objectives. RESULTS 36 year 1 students completed both the pre and post EHMS surveys. McNemar's test was used for paired comparisons. Results identified no statistically significant changes from pre to post surveys, identifying a dramatic ceiling. When comparing year 2, EHS II pre-survey (n = 84) and post-survey (n = 79) responses, a statistically significant positive change in students' self-reported sense of preparedness to discuss environmental health with their patients following the curriculum intervention was noted. CONCLUSIONS Our conclusion for the EHMS in Year 1 was that the current generation of medical students at this school is already extremely aware of and concerned about the impact of environmental issues on health. Through the EHS II in Year 2, we found that the six-week environmental health module combining didactic and experiential elements significantly increased medical students' self-reported sense of preparedness to discuss environmental health issues, including climate change, with their patients.
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Affiliation(s)
- Benjamin Kligler
- The Deirdre Imus Environmental Health Center®, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Genevieve Pinto Zipp
- Department of Interprofessional Health Sciences & Health Administration, School of Health and Medical Sciences, Seton Hall University, Nutley, NJ, USA
| | | | | | - Erin Speiser Ihde
- The Deirdre Imus Environmental Health Center®, Hackensack University Medical Center, Hackensack, NJ, USA.
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Wong KH, Allen A, Durrani TS. Evaluating Effectiveness of Online Learning Modules in Pediatric Environmental Health Education. J Med Toxicol 2020; 16:269-275. [PMID: 31873854 PMCID: PMC7320078 DOI: 10.1007/s13181-019-00746-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/16/2019] [Accepted: 10/24/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Content and training about pediatric environmental health are lacking in healthcare professionals' education. In an initiative to improve pediatric environmental health education, the Pediatric Environmental Health Specialty Unit (PEHSU) program offers free, interactive, web-based ("eLearning") modules on environmental health topics. The aim of this study is to determine the effectiveness of PEHSU eLearning modules in increasing knowledge about pediatric and reproductive environmental health. METHODS This is a retrospective analysis of 994 users who had completed at least one of the 12 PEHSU eLearning modules and its associated pre-test and post-test scores between March 2016 and November 2018. Users who completed modules between March 2016 and April 2018 received a 6-month follow-up survey to assess the impact of the knowledge gained on their clinical practice. RESULTS A wide range of clinical professionals and nonclinical professionals utilized and completed the PEHSU eLearning modules. For all users, post-test scores were significantly higher than pre-test scores, with an increase of 30.55% ± 22.37 (paired t-test, p < 0.0001), after completion of eLearning modules. CONCLUSION PEHSU eLearning modules are effective at increasing environmental health knowledge of clinical and nonclinical professionals. Further studies are needed to determine long-term knowledge retention and clinical impact.
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Affiliation(s)
- Katelyn H Wong
- School of Medicine, University of Connecticut, 263 Farmington Ave, Farmington, CT, 06032, USA
| | - Amanda Allen
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Timur S Durrani
- School of Medicine, University of California San Francisco, 1600 Divisadero St, San Francisco, CA, 94115, USA.
- Division of OEM, ZSFG, Western States Pediatric Environmental Health Specialty Unit, Box 0843, San Francisco, CA, 94143-0843, USA.
- California Poison Control System - San Francisco Division, Box 1369, San Francisco, CA, 94143-1369, USA.
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Völker M, Hunchangsith P. Drivers of Physicians' Engagement in Addressing Eco-health Problems. ECOHEALTH 2018; 15:853-863. [PMID: 30250980 DOI: 10.1007/s10393-018-1372-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 06/08/2023]
Abstract
Physicians are in a unique position to be first-hand observers of the effects of environmental factors on population health. As a source of information which is highly trusted, they are also well-suited to raise awareness about the linkages between ecosystem and population health. Yet, current clinical practice in many parts of the world rarely includes environmental health assessments and patient education. The empirical evidence on the reasons for this lack of engagement is limited by the small number of studies published, its narrow geographical scope and the dearth of multivariate statistical analysis. This study used a mixed-methods approach to investigate the determinants of whether physicians at selected hospitals in Thailand assess the environmental history of their patients and provide environmental health advice. Using an ordered logistic regression model, it was found that physicians' engagement was associated with their knowledge, personal motivation, perception of being supported by senior staff and ability to discuss with colleagues. According to key informants, possible remedies for the observed lack of physicians' engagement include revisions of the medical school curriculum, clear strategies for addressing eco-health linkages in the clinical context at the national and hospital level, and better cooperation between relevant government institutions in Thailand.
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Affiliation(s)
- Marc Völker
- Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand.
| | - Pojjana Hunchangsith
- Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
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Miller MD, Valenti M, Schettler T, Tencza B. A Multimedia E-Book-A Story of Health: Filling a Gap in Environmental Health Literacy for Health Professionals. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:A133-A136. [PMID: 27479986 PMCID: PMC4975592 DOI: 10.1289/ehp222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Narrative approaches and storytelling are emerging as powerful health promotion tools that can spark interest, increase understanding of determinants of health, and translate complex science. A Story of Health, a multimedia e-book with continuing education credits was designed to harness the power of storytelling to increase environmental health literacy. Health professionals are a key audience. They recognize that patients may be suffering from preventable illnesses of environmental origin but often feel ill-equipped to educate individuals and families about risks associated with common exposures. A Story of Health seeks to fill this gap and help readers develop the competencies they need in order to help patients make informed choices, reduce health risks, improve quality of life, and protect the environment. Americans rate nurses and medical doctors as having the highest honesty and ethical standards of all professions. These medical professionals can play a key role in changing patterns of patient behavior and influencing public policies. The e-book provides an easily accessible method of developing environmental health competency. The multimedia format with graphical interpretations allows for quick reviews of topics or for more in-depth analysis via links to additional resources. The CE evaluations have been overwhelmingly positive.
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Affiliation(s)
- Mark D. Miller
- Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco, California, USA
- California Environmental Protection Agency, Oakland, California, USA
| | - Maria Valenti
- Collaborative on Health and the Environment, Bolinas, California, USA
| | - Ted Schettler
- Science and Environmental Health Network, Ames, Iowa, USA
| | - Brian Tencza
- Environmental Medicine Branch, Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, USA.
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Environmental Health: Children׳s Health, a Clinician׳s Dilemma. Curr Probl Pediatr Adolesc Health Care 2016; 46:184-9. [PMID: 26846483 DOI: 10.1016/j.cppeds.2015.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/04/2015] [Indexed: 11/20/2022]
Abstract
Few pediatricians receive training in environmental health, yet accumulating research shows that a disproportionate burden of exposure from environmental toxicants (man-made contaminants) is borne by children, adolescents, and the developing fetus. This is explained in part because of children׳s vulnerability to environmental-toxicants based on socioeconomic status, body surface area, metabolism, and potential transfers via placenta and breast milk. Public concern about toxicants affecting children in air, land, water, food, and beverages places pediatricians in the challenging position of being expected to knowledgably answer questions about environmental exposures while lacking sufficient training in the field. Surveys show pediatricians have high interest in environmental topics, yet feel a low sense of self-efficacy regarding patient education and lack evidence-based treatment guidelines and other effective educational tools. The goal of this article is to provide an overview of selected toxicants relevant to pediatric health, review practical suggestions to reduce or eliminate children's exposures, and introduce resources for taking an environmental health history to better prepare pediatricians and other clinicians caring for children to decrease harmful exposures in infants, children, and adolescents.
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Massaquoi LD, Edwards NC. A Scoping Review of Maternal and Child Health Clinicians Attitudes, Beliefs, Practice, Training and Perceived Self-Competence in Environmental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15769-81. [PMID: 26690461 PMCID: PMC4690954 DOI: 10.3390/ijerph121215018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 10/25/2015] [Accepted: 11/27/2015] [Indexed: 11/16/2022]
Abstract
Clinicians regularly assess, diagnose and manage illnesses which are directly or indirectly linked to environmental exposures. Yet, various studies have identified gaps in environmental assessment in routine clinical practice. This review assessed clinicians' environmental health practices, attitudes and beliefs, and competencies and training. Relevant articles were sought using a systematic search strategy using five databases, grey literature and a hand search. Search strategies and protocols were developed using tailored mesh terms and keywords. 43 out of 11,291 articles were eligible for inclusion. Clinicians' attitudes and beliefs towards environmental health and routine clinical practice were generally positive, with most clinicians believing that environmental hazards affect human health. However, with the exception of tobacco smoke exposure, environmental health assessment was infrequently part of routine clinical practice. Clinicians' self-competence in environmental assessment was reported to be inadequate. Major challenges were the time required to complete an assessment, inadequate training and concerns about negative patients' responses. Clinicians have strong positive attitudes and beliefs about the importance of environmental health assessments. However, more concerted and robust strategies will be needed to support clinicians in assuming their assessment and counselling roles related to a wider range of environmental hazards.
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Are healthcare providers asking about environmental exposures? A community-based mixed methods study. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2015; 2015:189526. [PMID: 26557853 PMCID: PMC4617875 DOI: 10.1155/2015/189526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/17/2015] [Indexed: 11/18/2022]
Abstract
People living near environmental hazards may develop symptoms and health conditions that require specialized monitoring and treatment by healthcare providers. One emerging environmental hazard is coal ash. Coal ash is comprised of small particles containing heavy metals, polycyclic aromatic hydrocarbons, and radioactive elements. The overall purpose of this study was to explore whether healthcare providers ask patients if they live near an environmental hazard like coal ash storage sites and to assess what health conditions prompt a provider inquiry.
Focus groups were conducted in 2012 and a cross-sectional survey was administered in 2013. Overall, 61% of survey respondents reported that their healthcare providers never asked if they lived near an environmental hazard. One focus group member stated “No, they don't ask that. They just always blame stuff on you….” Respondents with asthma and other lung conditions were significantly more likely to be asked by a healthcare provider if they lived near an environmental hazard. Due to the unique exposures from environmental hazards and the low prevalence of patients being asked about environmental hazards, we recommend that healthcare providers take environmental health histories in order to understand patients' exposures, to monitor symptoms of exposure, and to assist with education about reducing exposure.
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Zachek CM, Miller MD, Hsu C, Schiffman JD, Sallan S, Metayer C, Dahl GV. Children's Cancer and Environmental Exposures: Professional Attitudes and Practices. J Pediatr Hematol Oncol 2015; 37:491-7. [PMID: 26334434 PMCID: PMC4571458 DOI: 10.1097/mph.0000000000000416] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 07/23/2015] [Indexed: 12/03/2022]
Abstract
BACKGROUND Epidemiologic studies worldwide have provided substantial evidence of the contributions of environmental exposures to the development of childhood cancer, yet this knowledge has not been integrated into the routine practice of clinicians who care for children with this disease. To identify the basis of this deficit, we sought to assess the environmental history-taking behavior and perceptions of environmental health among pediatric hematologists and oncologists. PROCEDURE A web-based survey was sent from June to October 2012 to 427 pediatric oncologists, fellows, and nurse practitioners from 20 US institutions, with an overall response rate of 45%. RESULTS Survey responses indicated that environmental exposures are of concern to clinicians. The vast majority of respondents (88%) reported receiving questions from families about the relationship between certain environmental exposures and the cancers they regularly treat. However, a lack of comfort with these topics seems to have limited their discussions with families about the role of environmental exposures in childhood cancer pathogenesis. Although 77% of respondents suspected that some of the cases they saw had an environmental origin, their methods of taking environmental histories varied widely. Over 90% of respondents believed that more knowledge of the associations between environmental exposures and childhood cancer would be helpful in addressing these issues with patients. CONCLUSIONS Although limited in size and representativeness of participating institutions, the results of this survey indicate a need for increased training for hematology/oncology clinicians about environmental health exposures related to cancer and prompt translation of emerging research findings in biomedical journals that clinicians read.
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Affiliation(s)
- Christine M. Zachek
- Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco
| | - Mark D. Miller
- Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California Berkeley, Berkeley
| | | | - Joshua D. Schiffman
- Department of Pediatrics, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Catherine Metayer
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California Berkeley, Berkeley
| | - Gary V. Dahl
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California Berkeley, Berkeley
- Stanford University School of Medicine, Stanford, CA
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Trasande L, Niu J, Li J, Liu X, Zhang B, Li Z, Ding G, Sun Y, Chen M, Hu X, Chen LC, Mendelsohn A, Chen Y, Qu Q. The Environment and Children's Health Care in Northwest China. BMC Pediatr 2014; 14:82. [PMID: 24670157 PMCID: PMC3986873 DOI: 10.1186/1471-2431-14-82] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 03/21/2014] [Indexed: 11/11/2022] Open
Abstract
Background Industrialization in the northwest provinces of the People’s Republic of China is accelerating rapid increases in early life environmental exposures, yet no publications have assessed health care provider capacity to manage common hazards. Methods To assess provider attitudes and beliefs regarding the environment in children’s health, determine self-efficacy in managing concerns, and identify common approaches to managing patients with significant exposures or environmentally-mediated conditions, a two-page survey was administered to pediatricians, child care specialists, and nurses in five provinces (Gansu, Shaanxi, Xinjiang, Qinghai, and Ningxia). Descriptive and multivariable analyses assessed predictors of strong self-efficacy, beliefs or attitudes. Results 960 surveys were completed with <5% refusal; 695 (72.3%) were valid for statistical analyses. The role of environment in health was rated highly (mean 4.35 on a 1-5 scale). Self-efficacy reported with managing lead, pesticide, air pollution, mercury, mold and polychlorinated biphenyl exposures were generally modest (2.22-2.52 mean). 95.4% reported patients affected with 11.9% reporting seeing >20 affected patients. Only 12.0% reported specific training in environmental history taking, and 12.0% reported owning a text on children’s environmental health. Geographic disparities were most prominent in multivariable analyses, with stronger beliefs in environmental causation yet lower self-efficacy in managing exposures in the northwestern-most province. Conclusions Health care providers in Northwest China have strong beliefs regarding the role of environment in children’s health, and frequently identify affected children. Few are trained in environmental history taking or rate self-efficacy highly in managing common hazards. Enhancing provider capacity has promise for improving children’s health in the region.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, 227 East 30th Street Rm 109, New York, NY 10016, USA.
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Newman N, Lowry J, Mall J, Berger M. An ongoing lack of knowledge about lead poisoning. Am J Public Health 2013; 103:e9-e10. [PMID: 23947313 DOI: 10.2105/ajph.2013.301499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nicholas Newman
- Nicholas Newman is with the Pediatric Environmental Health and Lead Clinic and the Pediatric Environmental Health Specialty Unit (PEHSU) Region 5 Satellite, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Jennifer Lowry is with the Mid-America PEHSU and the Section of Clinical Toxicology, Children's Mercy Hospitals and Clinics, Kansas City, MO. Jennifer Mall is with the Association of Schools of Public Health, Washington, DC. Martha Berger is with the Office of Children's Health Protection, US Environmental Protection Agency, Washington, DC
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Toxic environmental chemicals: the role of reproductive health professionals in preventing harmful exposures. Am J Obstet Gynecol 2012; 207:164-73. [PMID: 22405527 DOI: 10.1016/j.ajog.2012.01.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 01/24/2012] [Accepted: 01/24/2012] [Indexed: 11/24/2022]
Abstract
Every pregnant woman in the United States is exposed to many and varied environmental chemicals. Rapidly accumulating scientific evidence documents that widespread exposure to environmental chemicals at levels that are encountered in daily life can impact reproductive and developmental health adversely. Preconception and prenatal exposure to environmental chemicals are of particular importance because they may have a profound and lasting impact on health across the life course. Thus, prevention of developmental exposures to environmental chemicals would benefit greatly from the active participation of reproductive health professionals in clinical and policy arenas.
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Exposure to second-hand smoke at home and its associated factors: findings from the Global Adult Tobacco Use survey in Vietnam, 2010. Cancer Causes Control 2012; 23 Suppl 1:99-107. [DOI: 10.1007/s10552-012-9907-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 01/27/2012] [Indexed: 11/26/2022]
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Haynes EN, Beidler C, Wittberg R, Meloncon L, Parin M, Kopras EJ, Succop P, Dietrich KN. Developing a bidirectional academic-community partnership with an Appalachian-American community for environmental health research and risk communication. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:1364-72. [PMID: 21680278 PMCID: PMC3230433 DOI: 10.1289/ehp.1003164] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 06/16/2011] [Indexed: 05/20/2023]
Abstract
BACKGROUND Marietta, Ohio, is an Appalachian-American community whose residents have long struggled with understanding their exposure to airborne manganese (Mn). Although community engagement in research is strongly endorsed by the National Institutes of Health and the National Institute of Environmental Health Sciences in particular, little has been documented demonstrating how an academic-community partnership that implements the community-based participatory research (CBPR) principles can be created and mobilized for research. OBJECTIVES We created a bidirectional, academic-community partnership with an Appalachian-American community to a) identify the community's thoughts and perceptions about local air quality, its effect on health, and the perception of risk communication sources and b) jointly develop and conduct environmental health research. METHODS We formed a community advisory board (CAB), jointly conducted pilot research studies, and used the results to develop a community-driven research agenda. RESULTS Persons in the community were "very concerned" to "concerned" about local air quality (91%) and perceived the air quality to have a direct impact on their health and on their children's health (93% and 94%, respectively). The CAB identified the primary research question: "Does Mn affect the cognition and behavior of children?" Although the community members perceived research scientists as the most trusted and knowledgeable regarding risks from industrial emissions, they received very little risk information from research scientists. CONCLUSIONS Engaging a community in environmental health research from its onset enhanced the quality and relevance of the research investigation. The CBPR principles were a useful framework in building a strong academic-community partnership. Because of the current disconnect between communities and research scientists, academic researchers should consider working collaboratively with community-based risk communication sources.
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Affiliation(s)
- Erin N Haynes
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
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Gehle KS, Crawford JL, Hatcher MT. Integrating environmental health into medical education. Am J Prev Med 2011; 41:S296-301. [PMID: 21961679 DOI: 10.1016/j.amepre.2011.06.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 05/20/2011] [Accepted: 06/05/2011] [Indexed: 10/17/2022]
Abstract
Although environmental factors contribute to more than 25% of all global disease, and toxic agents ranked fifth in underlying causes of U.S. deaths in 2000, environmental medicine education is largely omitted in the continuum of U.S. medical education. The paucity of specialists trained in environmental medicine (i.e., occupational medicine and other preventive medicine specialties and subspecialties), coupled with the lack of adequate general medical education on how to prevent, diagnose, refer, or treat patients exposed to hazardous substances in the environment, contributes to lost opportunities for primary prevention or early intervention to mitigate or minimize environmentally related disease burden. Survey findings of graduating medical students over the past few years have identified environmental health as a medical school topic area that can be improved. This article reflects a panel presentation on the challenge of including environmental health in general medical education. It was given at the 2010 "Patients and Populations: Public Health in Medical Education" conference cosponsored by the CDC and the American Association of Medical Colleges. A variety of educational strategies, models, and educational resources are presented that illustrate how recommended competency-based environmental health content can be integrated into medical education to better prepare medical students and physicians without specialized expertise in environmental medicine to provide or facilitate environmental preventive or curative patient care.
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Affiliation(s)
- Kimberly S Gehle
- Division of Toxicology and Environmental Medicine, Environmental Medicine and Education Services Branch, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, USA.
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Woodruff TJ, Sutton P. An evidence-based medicine methodology to bridge the gap between clinical and environmental health sciences. Health Aff (Millwood) 2011; 30:931-7. [PMID: 21555477 PMCID: PMC6663095 DOI: 10.1377/hlthaff.2010.1219] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Physicians and other clinicians could help educate patients about hazardous environmental exposures, especially to substances that could affect their reproductive health. But the relevant scientific evidence is voluminous, of variable quality, and largely unfamiliar to health professionals caring for people of childbearing age. To bridge this gap between clinical and environmental health, we created a methodology to help evaluate the quality of evidence and to support evidence-based decision making by clinicians and patients. The methodology can also support professional societies, health care organizations, government agencies, and others in developing prevention-oriented guidelines for use in clinical and policy settings.
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