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Woolf AD, Jackson JE, Corcoran P, Fritz MK, Kim SS, Maslak TM, Shah M, Hansen L. An Update on Pediatric Environmental Health Specialty Units: Activities and Impacts, 2015-19. Acad Pediatr 2024:S1876-2859(24)00108-6. [PMID: 38494060 PMCID: PMC11401956 DOI: 10.1016/j.acap.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Pediatric Environmental Health Specialty Units (PEHSUs) address health concerns impacting children and their families related to environmental hazards by providing consultation and education to families, communities, and health care professionals. This analysis evaluated the productivity of the national PEHSU program. METHODS PEHSUs reported data on services provided to US communities between October 1, 2014 and September 30, 2019. Descriptive statistics and qualitative analysis are presented. RESULTS During this period, 6102 consultations and 4644 educational outreach activities were recorded. PEHSU faculty and staff published 462 articles, reviews, book chapters, fact sheets, commentaries, short informational pieces, and other materials between 2014 and 2019. These included 190 articles in scientific peer-reviewed journals and 29 textbook chapters to increase professional capacity in pediatric and reproductive environmental health. Lead, other metals, substances of abuse, pesticides, mold, and air pollution were frequently reported as agents of concern and educational topics. Requests for an overview of pediatric environmental health and outdoor pollutants were other frequently reported topics. CONCLUSIONS PEHSUs work to decrease harmful exposures and improve children's health. They serve as expert resources for families, health care professionals, and communities on health effects related to environmental exposures. Data show the breadth and depth of concerns addressed and demonstrate the productivity and impact of this national program.
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Affiliation(s)
- Alan D Woolf
- Division of General Pediatrics (AD Woolf), Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Mass.
| | | | - Peter Corcoran
- Department of Healthy Resilient Children, Youth & Families (P Corcoran), American Academy of Pediatrics, Itasca, Ill
| | - Meredith K Fritz
- Health Economics & Outcomes Research (MK Fritz, SS Kim, and TM Maslak), Battelle, Columbus, Ohio
| | - Stephani S Kim
- Health Economics & Outcomes Research (MK Fritz, SS Kim, and TM Maslak), Battelle, Columbus, Ohio
| | - Tanya M Maslak
- Health Economics & Outcomes Research (MK Fritz, SS Kim, and TM Maslak), Battelle, Columbus, Ohio
| | - Manthan Shah
- US Environmental Protection Agency (M Shah), Office of Children's Health Protection, Environmental Protection Agency, Washington, DC
| | - Linda Hansen
- Office of Capacity Development and Applied Prevention Science (OCDAPS) (L Hansen), Agency for Toxic Substances and Disease Registry (ATSDR), Centers for Disease Control and Prevention (CDC), Atlanta, Ga
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Sharma A, Smyth L, Jian H, Vargas N, Bowles D, Hunter A. Are we teaching the health impacts of climate change in a clinically relevant way? A systematic narrative review of biomechanism-focused climate change learning outcomes in medical curricula. MEDICAL TEACHER 2024; 46:414-422. [PMID: 37722803 DOI: 10.1080/0142159x.2023.2256963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
PURPOSE Introducing biomedical approaches to the health impacts of climate change can improve medical student engagement with relevant climate-related issues, improve the development of medical schemas, and minimise displacement into crowded medical curricula. This paper aims to systematically review the medical education curricula related to climate change, with a particular focus on systems-based biomechanisms for the health impacts of climate change. We do this to provide a clear agenda for further development of learning outcomes (LOs) in this area to maximize the clinical applicability of this knowledge. MATERIAL AND METHODS A systematic review was undertaken following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Liberati et al. 2009) guidelines for both the published and grey literature. Five databases (PubMed, SCOPUS, ERIC, Open Access Thesis and Dissertation, and Proquest Global Dissertation and Theses) were searched for works published between 2011 and June 2023. Full texts that contained LOs were the main inclusion criteria for the final review. Descriptive and content extraction guided the final narrative synthesis. RESULTS Analysis indicated that biomechanism-related LOs represented about 25% of each published LO set, on average. These outcomes were primarily at the "understand" level of Bloom's taxonomy and were spread across a range of body systems and climate-change aspects. Infectious diseases and extreme heat were strong focuses. Authorship analysis indicated that the majority of these sets of published LOs are from Western contexts and authored by researchers and educators with medical and population health qualifications. CONCLUSIONS Biomechanism-focused teaching about the health impacts of climate change is relatively rare in published curricula. Of the available sets of LOs, the majority are sourced from Western authors and are focused on a fairly circumscribed set of biomedical topics. There is scope to both broaden and deepen curriculum in this area, and we would recommend the field prioritise collaboration with medical educators from the Global South, where the effects of climate change are already the most acutely felt.
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Affiliation(s)
- Atul Sharma
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lillian Smyth
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Holly Jian
- Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia
| | - Nicole Vargas
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Devin Bowles
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Arnagretta Hunter
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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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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Bevan JH, Kumaran K, Walker IV, Wilkinson J. Every medical school should have a planetary health teaching fellow. BMJ 2023; 382:2026. [PMID: 37684037 DOI: 10.1136/bmj.p2026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Affiliation(s)
- James Hj Bevan
- Faculty of Medicine, School of Primary Care, Population Science and Medical Education, University of Southampton, UK
| | - Kalyanaraman Kumaran
- Faculty of Medicine, School of Primary Care, Population Science and Medical Education, University of Southampton, UK
| | - Inna V Walker
- Faculty of Medicine, School of Primary Care, Population Science and Medical Education, University of Southampton, UK
- Health Institute for Health and Care Research Coordinating Centre (NIHRCC), University of Southampton, Southampton, UK
- Health Education England Wessex, NHS England, South East Region, Winchester, UK
| | - Jane Wilkinson
- Faculty of Medicine, School of Primary Care, Population Science and Medical Education, University of Southampton, UK
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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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Woolf AD, Baum CR, Burns M. Poison Centers and Pediatric Environmental Health Specialty Units: Productive Two-Way Partnerships. J Med Toxicol 2023; 19:241-243. [PMID: 36988816 PMCID: PMC10293540 DOI: 10.1007/s13181-023-00942-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
- Alan D Woolf
- Region 1 Pediatric Environmental Health Specialty Unit, Division of General Pediatrics, Boston Children's Hospital, Professor of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA, USA.
| | - Carl R Baum
- Department of Emergency Medicine, Yale New Haven Hospital, Professor of Pediatrics, Yale School of Medicine, 20 York Street, New Haven, CT, USA
| | - Michele Burns
- Massachusetts/Rhode Island Poison Center, Department of Emergency Medicine, Boston Children's Hospital, Assistant Professor of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA, USA
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Bevan J, Blyth R, Russell B, Holtgrewe L, Cheung AHC, Austin I, Shah V, Butler M, Fraser S. Planetary health and sustainability teaching in UK medical education: A review of medical school curricula. MEDICAL TEACHER 2023; 45:623-632. [PMID: 36503358 DOI: 10.1080/0142159x.2022.2152190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND The doctors of the future need to be empowered to deliver healthcare sustainably while protecting their patients' health in the context of a degrading environment. This study aimed to objectively review the extent and nature of the teaching of planetary health and sustainability topics in UK medical education. METHODS A multi-centre national review of the timetabled teaching sessions in medical courses in the UK during the academic year 2020/2021 against the General Medical Council's adopted 'Educating for Sustainable Healthcare - Priority Learning Outcomes'. Medical students were recruited and reviewed the entirety of their own institution's online teaching materials associated with core teaching sessions using a standardised data collection tool. Learning outcome coverage and estimated teaching time were calculated and used to rank participating medical schools. RESULTS 45% of eligible UK medical schools were included in the study. The extent of teaching varied considerably amongst courses. Mean coverage of the 13 learning outcomes was 9.9 (SD:2.5) with a mean estimated teaching time of 140 min (SD:139). Courses with dedicated planetary health and sustainability sessions ranked best. CONCLUSION There is large disparity in the education that medical students receive on these topics. Teaching may not adequately prioritise sustainability or reflect advances in planetary health knowledge.[Box: see text].
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Affiliation(s)
- James Bevan
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rachel Blyth
- NHS Foundation Trust, St. George's University Hospitals, London, UK
| | | | - Lydia Holtgrewe
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Isobel Austin
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Viraj Shah
- Faculty of Medicine, Imperial College, London, UK
| | - Megan Butler
- Medical School, University of Bristol, Bristol, UK
| | - Simon Fraser
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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