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This paper highlights potential active pharmaceutical ingredients (APIs) generations from improper disposal of medicines and captures the perceptions of key stakeholders – households and pharmaceutical actors in Upper Citarum River Basin (UCRB). Most pharmaceutical waste is disposed of with household waste, suggesting landfills are the most significant APIs contamination sources. We highlight the complex relationship between knowledge, risk perception, and behavioural intentions, stressing the relevance of risk perception as a mediator when studying how knowledge affects behaviour. Age and income are suggested to moderate risk perception and behavioural intention. There is a heavy use of over-the-counter and prescription drugs in UCRB, especially Paracetamol (426.1 tons/year) and Amoxicillin (343.7 tons/year). Measured herbal APIs highlight the cultural significance and dependence on traditional medicine. We suggest examining the influence of affect on perception and behaviour in safe medicine disposal and the environmental and health risk impact of APIs in the water systems. [ABSTRACT FROM AUTHOR]

This article defines analytical performance specifications (APS) for evaluating laboratory proficiency through an external quality assessment scheme. Standard deviations for proficiency assessment were derived from Thompson's characteristic function applied to robust data calculated from participants' submissions in the Occupational and Environmental Laboratory Medicine (OELM) external quality assurance scheme for trace elements in serum, whole blood and urine. Characteristic function was based on two parameters: (1) β – the average coefficient of variation (CV) at high sample concentrations; (2) α – the average standard deviation (SD) at low sample concentrations. APSs were defined as 1.65 standard deviations calculated by Thompson's approach. Comparison between OELM robust data and characteristic function were used to validate the model. Application of the characteristic function allowed calculated APS for 18 elements across three matrices. Some limitations were noted, particularly for elements (1) with no sample concentrations near analytical technique limit of detection; (2) exhibiting high robust CV at high concentration; (3) exhibiting high analytical variability such as whole blood Tl and urine Pb; (4) with an unbalanced number of robust SD above and under the characteristic function such as whole blood Mn and serum Al and Zn. The characteristic function was a useful means of deriving APS for trace elements in biological fluids where biological variation data or outcome studies were not available. However, OELM external quality assurance scheme data suggests that the characteristic functions are not appropriate for all elements. [ABSTRACT FROM AUTHOR]

Lifestyle medicine (LM) utilizes evidence-based therapeutic lifestyle changes to address lifestyle factors that impact health, performance, and injury risk and recovery. By integrating LM principles into clinical care, workplace policies, and programs, along with other evidence-based methods, occupational and environmental medicine clinicians and medical directors can enhance worker health and performance, manage chronic disease, and facilitate faster recovery from injury and illness. This guidance addresses approaches that can be used in the clinic and workplace to address tobacco, substance misuse, nutrition, physical activity, overweight/obesity, sleep, mental well-being, and social connectedness. [ABSTRACT FROM AUTHOR]

The 18th National Postgraduate Symposium on Environmental and Occupational Medicine, co-sponsored by the Editorial Board of Journal of Environmental and Occupational Medicine and the School of Public Health of Sun Yat-sen University, was successfully held on August 22 to 25, 2024 in Guangzhou, Guangdong Province, China. Adhering to the theme of “Research and practice: Healing the schism”, the symposium aims to enliven academic thinking, expand research horizons, encourage innovation, enhance inter-university exchanges, and strengthen talent cultivation, especially to promote the close integration of academic research and public health practice. A total of 105 papers were received from 38 universities. The symposium also gathered about 160 participants, mainly authors postgraduates from universities and experts and professors in the field of environmental and occupational medicine. All the participants discussed the latest research advances and future development trends of environmental and occupational medicine, and endeavor to apply the research results in public health practice.

Abstract Background Identifying and recognizing environmental risk factors for childhood cancer is crucial to prevent it. Medical guild are the first contact to monitor children’s health. Therefore, courses about the contribution of chemical toxins in the environment and health outcomes such as cancer should be included in their professional training. This study aimed to evaluate the perceptions and attitudes of a medical guild and undergraduate students in health sciences about the contribution of the environment to childhood cancer. Methods A pilot study was conducted, an online survey including thirteen questions was shared among medical guild members and undergraduate students in health sciences. Frequencies, percentages, and chi-square homogeneity tests were calculated to compare groups. Results Genetic factors ranked as the first possible cause of childhood cancer (88.2% medical guild and 97.7% undergraduate students). However, 70.6% of medical guild and 64.6% of undergraduate students reported that they have ever suspected that childhood cancer could be related to the environmental conditions in which children live. More than 95% of the participants reported that they would find it useful to have more knowledge about environmental risks and cancer. When data were analyzed by profession (medical guild) and academic year (undergraduate students), no significant differences were observed. Nonetheless, comparisons by academic discipline between undergraduate students, showed that a higher percentage of medicine and environmental sciences and health (over 98%) reported environmental exposure as risk factors associated with childhood cancer compared to 75% from physiotherapy, (p = 0.001). Conclusions In this study, the environmental contribution to childhood cancer is not clear among the medical guild and undergraduate students. They should be trained on the topic of cancer and the environment.

Background Climate change threatens humanity's health and well-being. While climate change topics have been increasingly incorporated into undergraduate medical education, it is unclear to what extent they have been incorporated into graduate medical education (GME) curricula in the United States. Objective To examine how climate change has been incorporated into GME curricula in the United States. Methods We conducted a scoping review of published literature from January 2013 through November 2023. PubMed and Scopus were searched, with articles assessed by 3 reviewers in a blinded fashion. Resources were included if they described how climate change is incorporated into GME curricula in the United States, and if they discussed topics such as disaster medicine, mass casualty events, environmental medicine, public health, health policy, wilderness medicine, quality improvement, and sustainability. Articles were analyzed using descriptive numerical analysis and qualitative assessment to identify article characteristics and themes. Results The inclusion criteria generated 17 articles that examined climate change incorporation into GME curricula and curriculum interventions covering topics used for inclusion. The most common type of article (5 of 17, 29%) employed surveys of program directors on the inclusion of climate-related topics. Conclusions Published accounts of climate-related topics in US GME program curricula are few. More content is found in topics related to emergency medicine. Curricula frameworks have been proposed for pediatric and internal medicine residency programs, but we know little about their efficacy. Future scholarship should fill these gaps to educate learners to improve health care sustainability and resiliency. [ABSTRACT FROM AUTHOR]

Background Climate change and related pollution and environmental damage are an urgent focus for public health physicians. Curricular content is increasing in medical schools, but to date, only pediatrics has published guidance for residency education. Objective To survey program directors of Accreditation Council for Graduate Medical Education preventive medicine specialties (public health and preventive medicine [PHPM], occupational and environmental medicine [OEM], and aerospace medicine [AM]) for current teaching on climate and health issues. Methods Links to an online 9-question confidential survey were sent to all program directors through Listservs January through March 2024. Questions were developed with guidance from a climate health expert. Responses were analyzed via summary statistics for continuous data, as well as Fisher's Exact, Kruskal-Wallis, and Wilcoxon pairwise comparison tests for nominal data. Results Thirty-five of 71 programs responded (49.3%), including 21 of 42 PHPM, 12 of 23 OEM, and 2 of 6 AM programs. Two (5.9%) reported having a formal curriculum for climate and health issues, and 2 (5.9%) reported not covering any included topics. Programs differed by topic emphasis with OEM and AM more likely to address fire, smoke, wind, and flooding effects. Lectures and local or state health department rotations were the most frequent teaching strategies. Of complete responders, 23 of 34 (67.6%) expressed interest in joining a workgroup to develop shared curricula. Conclusions This survey of preventive medicine residency programs found that most include climate and health topics, but only 2 have a formal curriculum, and 2 reported no topics included in the survey. [ABSTRACT FROM AUTHOR]

The article focuses on the role of occupational and environmental medicine (OEM) clinicians in addressing environmental health concerns. Topics include the impact of environmental factors on health, the importance of OEM training and certification, and emerging environmental health careers and competencies.

Objective: Occupational and environmental medicine (OEM) clinicians require specialized electronic health records (EHRs) to address the privacy, data governance, interoperability, and medical surveillance concerns that are specific to occupational health. Methods: The American College of Occupational and Environmental Medicine (ACOEM) Section of Health Informatics evaluated clinical workflow concerns, assessed health information requirements, and developed informatics recommendations through iterative consultation with ACOEM members. Results: The ACOEM presents 10 recommendations that specialized occupational EHR systems (OEHRs) should meet to serve the information needs and practice requirements of OEM clinicians. Common challenges in OEM practice and potential informatics solutions are used to illustrate each recommendation. Conclusions: The recommendations serve as a framework for occupational health clinicians to consider in their adoption of OEHRs and provide software engineers a set of requirements to facilitate the development and improvement of OEHRs. [ABSTRACT FROM AUTHOR]

Background: Identifying and recognizing environmental risk factors for childhood cancer is crucial to prevent it. Medical guild are the first contact to monitor children's health. Therefore, courses about the contribution of chemical toxins in the environment and health outcomes such as cancer should be included in their professional training. This study aimed to evaluate the perceptions and attitudes of a medical guild and undergraduate students in health sciences about the contribution of the environment to childhood cancer. Methods: A pilot study was conducted, an online survey including thirteen questions was shared among medical guild members and undergraduate students in health sciences. Frequencies, percentages, and chi-square homogeneity tests were calculated to compare groups. Results: Genetic factors ranked as the first possible cause of childhood cancer (88.2% medical guild and 97.7% undergraduate students). However, 70.6% of medical guild and 64.6% of undergraduate students reported that they have ever suspected that childhood cancer could be related to the environmental conditions in which children live. More than 95% of the participants reported that they would find it useful to have more knowledge about environmental risks and cancer. When data were analyzed by profession (medical guild) and academic year (undergraduate students), no significant differences were observed. Nonetheless, comparisons by academic discipline between undergraduate students, showed that a higher percentage of medicine and environmental sciences and health (over 98%) reported environmental exposure as risk factors associated with childhood cancer compared to 75% from physiotherapy, (p = 0.001). Conclusions: In this study, the environmental contribution to childhood cancer is not clear among the medical guild and undergraduate students. They should be trained on the topic of cancer and the environment. [ABSTRACT FROM AUTHOR]

Background Health issues caused and/or exacerbated by work are common in patients seeking primary health care. Yet, primary care providers generally receive little or no training in the assessment and management of occupational injuries and illnesses. Aims To conduct a pilot project to develop, implement and evaluate a programme to teach occupational and environmental medicine to primary healthcare providers. Methods We followed the Extensions for Community Healthcare Outcomes (ECHO) model to connect primary healthcare providers with experts in Occupational and Environmental Medicine (OEM). We employed an observational pre–post study design to assess changes in self-efficacy, knowledge, attitudes and beliefs towards OEM. Results From September 2021 to June 2022, we offered two cycles of 12 sessions each. Participants came from medicine, nursing, psychology, occupational and physical therapy, chiropractic, kinesiology, social work, and pharmacy. Sixty-seven participants completed both pre- and post-ECHO questionnaires. Self-efficacy and knowledge ratings significantly increased after attendance at ECHO compared to the pre-ECHO responses. Attitudes and beliefs were unchanged in most of the items assessed. Participants rated their satisfaction with ECHO between 59% and 97%. Conclusions Our pilot study demonstrated the challenges in implementing the first ECHO OEM in Canada. Findings show acceptability and satisfaction, improved self-efficacy, and small increases in knowledge, but not overall attitudes and beliefs. There is a need to understand barriers to participation and to target participants with less knowledge and experience in occupational and environmental medicine. [ABSTRACT FROM AUTHOR]

This article highlights the emerging ethical issues related to reducing the environmental cost of medicines, health technologies and health services, taking as an example the situation of inhalation devices for the relief of various respiratory disorders, i.e., “inhalers”. Inhalers emit greenhouse gases that contribute to climate change. Recently proposed regulatory changes aim to control the use of greenhouse gases, but exceptions are necessary for inhalers due to the lack of less polluting substitutes and their vital importance for certain patients. Healthcare professionals and medical associations are actively campaigning for greater awareness and better education on the subject. On the political front, there are calls for legislation to encourage a rapid transition to cleaner inhalers. Long-term solutions include the use of low-carbon inhalers, such as those that use dry powder, as well as changes in prescribing and use practices. Stakeholders agree on the need to reduce environmental impact while prioritizing patient health, but ethical tensions can arise around possible real or perceived trade-offs between therapeutic efficacy, risk and inhaler durability. Our case study highlights the importance of integrating environmental considerations into health policy and clinical practice while recognising the ethically sensitive issues at this intersection, areas of uncertainty and other challenges to be overcome. [ABSTRACT FROM AUTHOR]

The article focuses on the ongoing shortage of trained occupational and environmental medicine (OEM) physicians, despite a high demand for the specialty. Topics include the funding challenges faced by OEM training programs, the limited visibility of the specialty among medical students and residents, and a historical perspective on the persistent issues affecting OEM residency education over the past decades.

Objective: Respirator medical evaluations are an important component of occupational health practice. Concepts and practices were established 25-50 years ago. Method: We suggest analysis and discussion of three areas warranting update. Results: a) Shift from disease-based decisions to evaluating the following 12 specific domains: cardiopulmonary, sudden change in condition, thermal, work interference, exacerbating existing condition, donning/doffing, dermatologic, proper utilization, fit testing interference, cultural/religious, arms/legs, and subjective responses. Two distinct evaluation processes are advised--"algorithmic" for the frequent straightforward evaluations and "specialist" for the more complex. b) Acknowledging the importance of subjective responses and clarifying the underlying causes--external stimulus, sensation, perception, interpretation, acceptability, and emotional response. c) Optimizing the organizational structures by explicitly defining the scope of evaluations, modifying the sequencing of assessment, and specifying qualifications of clinicians performing assessments. Conclusions: Reassessing respirator medical evaluation methods is needed. [ABSTRACT FROM AUTHOR]

Founded in 1947 as the Institute of Industrial Medicine, the Nelson Institute and Department of Environmental Medicine at New York University (NYU) Grossman School of Medicine (NYUGSOM) was supported by a National Institute of Environmental Health Science (NIEHS) Center Grant for over 56 years. Nelson Institute researchers generated 75 years of impactful research in environmental and occupational health, radiation effects, toxicology, and cancer. Environmental health research is continuing at NYUGSOM in its departments of medicine and population health. The objective of this historical commentary is to highlight the major achievements of the Nelson Institute and the department in the context of its history at facilities in Sterling Forest, Tuxedo, NY and Manhattan, NY. Aspects of our discussion include leadership, physical facilities, and research in many areas, including air pollution, health effects of environmental radiation exposures, inhalation toxicology methodology, carcinogenesis by chemicals, metals, and hormones, cancer chemoprevention, human microbiome, ecotoxicology, epidemiology, biostatistics, and community health concerns. The research of the institute and department benefited from unique facilities, strong leadership focused on team‐based science, and outstanding investigators, students, and staff. A major lasting contribution has been the training of hundreds of graduate students and postdoctoral fellows, many of whom have been and are training the next generation of environmental and occupational health researchers at various institutions. [ABSTRACT FROM AUTHOR]

The increasing demand for accurate 3D coordinate measures in industry, medicine and environmental sciences often comes with multiple constraints regarding the object distance, required accuracy and object signalization. While many systems are specialized in one domain, there are only few systems that operate in close-range applications with extremely high accuracy and are also capable of monitoring deformations at a distance of a few hundred meters. Therefore, a measurement system based on the astro-geodetic observation system QDaedalus is introduced using two combined image-assisted total stations (IATS) Leica NOVA TS60. By combining exact collimation, camera calibration and spatial intersection we show in several close-range experiments that our system is capable of measuring various kind of targets with a 3D point accuracy below 0.01 mm. [ABSTRACT FROM AUTHOR]

Microrobotic platforms hold significant potential to advance a variety of fields, from medicine to environmental sensing. Herein, minimally functional robotic entities modeled on readily achievable state‐of‐the‐art features in a modern lab or cleanroom are computationally simulated. Inspired by Dou and Bishop (Phys Rev Res. 2019;1(3):1–5), it is shown that the simple combination of unidirectional steering connected to a single environmental (chemical) sensor along with constant propulsion gives rise to highly complex functions of significant utility. Such systems can trace the contours orthogonal to arbitrary chemical gradients in the environment. Also, pairs of such robots that are additionally capable of emitting the same chemical signal are shown to exhibit coupled relative motion. When the pair has unidirectional steering in opposite directions within the 2D plane (i.e., counter‐rotating), they move in parallel trajectories to each other. Alternatively, when steering is in the same direction (corotation), the two move in the same epicyclical trajectory. In this way, the chirality of the unidirectional steering produces two distinct emergent phenomena. The behavior is understood as a ratchet mechanism that exploits the differential in the radii of curvature corresponding to different spatial locations. Applications to environmental detection, remediation, and monitoring are discussed. [ABSTRACT FROM AUTHOR]

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This review paper highlights the current toxicological aspects of magnetic nanomaterials in the field of medicine and the environment, conducted through a comprehensive literature review. The main goal was to investigate and analyze the key challenges identified in the literature that enhance the effective utilization of these systems, particularly focusing on magnetic iron oxide (Fe3O4) nanoparticles. We aimed to investigate the factors that influence their intended applications. We sought to understand how the characteristics of the produced NPs could be enhanced to improve their biocompatibility compared to existing samples in the literature. Moreover, we investigated morphological aspects intricately connected to physicochemical characteristics and their prospective applications in biomedicine. Additionally, we assessed the regulatory implications of nanostructured materials. Therefore, the initial aspect of this review delved into the historical evolution of nanoparticles, investigating significant milestones that have influenced the exploration of this technology. We examined the main discoveries, factors influencing the choice of synthesis methods, and the most prevalent approaches for surface functionalization employed by scientists for materials possessing superparamagnetic characteristics, such as iron oxide. The second aspect of the review focused on a survey-based exploration of the global regulation progress concerning superparamagnetic nanoparticles throughout the years. Additionally, we identified the main challenges encountered in establishing safety criteria for the diverse applications under investigation. This encompassed an assessment of the potential impacts of these materials on both human health and the environment. [ABSTRACT FROM AUTHOR]

The skew distribution has the characteristic of appropriately modeling asymmetric unimodal data. However, in practice, there are several cases in which the data present more than one mode. In the literature, it is possible to find a large number of authors who have studied extensions based on the skew distribution to model this type of data. In this article, a new family is introduced, consisting of a multimodal modification to the family of skew distributions. Using the methodology of the weighted version of a function, we perform the product of the density function of a family of skew distributions with a polynomial of degree 4, thus obtaining a more flexible model that allows modeling data sets, whose distribution contains at most three modes. The density function, some properties, moments, skewness coefficients, and kurtosis of this new family are presented. This study focuses on the particular cases of skew-normal and Laplace distributions, although it can be applied to any other distribution. A simulation study was carried out, to study the behavior of the model parameter estimates. Illustrations with real data, referring to medicine and environmental data, show the practical performance of the proposed model in the two particular cases presented. [ABSTRACT FROM AUTHOR]

Historically musculoskeletal injury has substantially affected United States (US) service members. Lumbosacral spine injuries are among the most common sites of injury for service members across all US military branches and usually presents with pain in the lower back and extremities. The aim of this study is to identify and describe the 50 most-cited articles relevant to military medicine on the subject of the spine. In April 2020 Web of Science was used to search the key words: spinal cord injury, spine, thoracic spine, lumbar spine, cervical spine, sacrum, sacral, cervical fusion, lumbar fusion, sacral fracture, combat, back pain, neck pain, and military. Articles published from 1900 to 2020 were evaluated for relevance to military spine orthopaedics and ranked based on citation number. The 50 most-cited articles were characterized based on country of origin, journal of publication, affiliated institution, topic, military branch, and conflict. 1900 articles met search criteria. The 50 most-cited articles were cited 24 to 119 times and published between 1993 and 2017. 30 articles (60%) originated in the United States. Aviation, Space, and Environmental Medicine accounted for the most frequent (n = 10) destination journal followed by Spine (n = 8). 37 institutions contributed to the top 50 most-cited articles. The most common article type was clinically focused retrospective analysis 36% (n = 18), clinically focused cohort study 10% (n = 5), and clinically focused cohort questionnaire, cross-sectional analysis, and randomized study 8% each (n = 4). 90% of articles were non-surgical (n = 45). The US Army had the greatest number of associated articles. Operation Iraqi Freedom and Operation Enduring Freedom were the most-cited conflicts. The 50 most-cited articles relevant to military spine orthopaedics are predominantly clinically focused, arising from the US, and published in Aviation, Space, and Environmental Medicine , Spine , and The Spine Journal. [ABSTRACT FROM AUTHOR]

Background/Aim: Improper drug disposal methods are a threat to the nature and its ecosystem by accumulation of active compounds included in these pharmaceuticals. Aim of this study was to assess the knowledge, attitude and practice (KAP) on the rationale consumption and appropriate disposal methods of unused and expired medications among common public in Kanchipuram district, Tamilnadu, India. Method: KAP questionnaire was prepared to get responses from all participants who had volunteered for the study. Questionnaire had queries pertaining to the personal information about the respondent and respondent’s knowledge, practice and attitude concerning drug usage, the disposal methods of unused and expired medicines and their awareness and knowledge towards drug take back programme. Results: In this study 37.91 % out of the 807 participants had excellent knowledge on the rationale consumption and appropriate disposal of unused/ expired medications, 48.94 % had average knowledge, but only 6.56 % of the total participants had more positive attitude and 66.66 % had positive attitude. Only around 45.84 % of the participants were following the good practices. Conclusion: Guidelines, policies and strict vigilant actions need to be initiated by government of India for safe utilisation of pharmaceutical products and disposal of unused/expired medications to safeguard our ecosystem from some of the major treats like antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background: Occupational physicians (OPs) can lead to substantial economic costs due to work-related injuries and diseases, including early retirement, skill loss, and increased medical and insurance expenses. These have led the American College of Occupational and Environmental Medicine (ACOEM) established competencies for OPs. Objective: To investigate the occupational medicine practices among physicians in Thailand according to residency training in preventive medicine, or occupational medicine, course in various settings including medical residency training institute, tertiary hospital, and company or factory. Materials and Methods: The present study was a qualitative design research by structural in-depth interviews. The study sample consisted of 15 OPs, selected through criterion sampling. The research tools included a structured interview form with two parts, 1) personal information, 2) competency of OPs in practice according to the World Federation of Medical Education (WFME) Standard. Results: Twelve out of 15 OPs (80%) participated in the present study. The findings revealed that the predominant workplace was in tertiary hospitals at 58.33%. These physicians mainly conducted fitness for work and return to work assessments for 75%, which requires compliance with legal mandates. Medical emergencies in workplaces were less often addressed, with 66.67% of physicians reporting infrequent handling. They attributed this to the limited regulations. Notably, adherence to the Occupational Safety and Health Administration (OSHA) medical surveillance standards was low, showing a preference for the Thai over global regulations. Fit for work assessments were common, averaging 48 cases per month, while disease investigation was minimal, at less than one case per month. Confidence levels mode was five points across most of the competencies, with lower confidence in conducting occupational disease investigations due to low volume of cases. Conclusion: Fitness for work assessment was the most proficient and frequently used practice among Thai OPs. The practice of OPs should adhere to the clear laws and guidelines to ensure the expertise of OPs in performing their duty effectively. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medicinae et Sociologica (AMS) is the property of University of Debrecen and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Previous studies have suggested that firefighters, police officers and civil servants in the education sector, particularly in Western countries, are vulnerable to mental stress and disorders; however, evidence for this association in South Korea is lacking. Aims This study aimed to identify whether firefighters, police officers and teachers are at a higher risk for occupational mental health disorders. Methods We used workers' compensation claims from civil servants (2009–18). Our target population comprised 46 209 civil servants (9009 civil servants in administrative and technical positions, 23 107 police officers, 4417 firefighters and 8676 civil servants in the educational sector). Occupational and environmental medicine physicians and medical doctors defined and confirmed mental disorders. We conducted Cox proportional hazards regression analyses to evaluate civil servants' risk of occupational mental health disorders. Results Compared with the civil servants in administrative and technical positions, civil servants in the education sector (hazard ratio [HR] = 2.16; 95% confidence interval [CI]:1.65–2.84) showed a statistically significant increased risk of mental disorders; conversely, firefighters did not (HR = 0.80; 95% CI 0.51–1.27). Police officers had a significantly decreased mental disorder risk compared with civil servants in administrative and technical positions (HR = 0.17; 95% CI 0.11–0.25). Conclusions The risk of occupational mental health disorders was higher in civil servants in the education sector but lower in police officers and firefighters than civil servants in administrative and technical positions. Further studies on civil servants' mental health awareness are required to confirm our results. [ABSTRACT FROM AUTHOR]

The prevalence of autism has been increasing at an alarming rate. Even accounting for the expansion of autism spectrum disorder diagnostic (ASD) criteria throughout the 1990's, there has been an over 300% increase in ASD prevalence since the year 2000. The often debilitating personal, familial, and societal sequelae of autism are generally believed to be lifelong. However, there have been several encouraging case reports demonstrating the reversal of autism diagnoses, with a therapeutic focus on addressing the environmental and modifiable lifestyle factors believed to be largely underlying the condition. This case report describes the reversal of autism symptoms among dizygotic, female twin toddlers and provides a review of related literature describing associations between modifiable lifestyle factors, environmental exposures, and various clinical approaches to treating autism. The twins were diagnosed with Level 3 severity ASD "requiring very substantial support" at approximately 20 months of age following concerns of limited verbal and non-verbal communication, repetitive behaviors, rigidity around transitions, and extensive gastrointestinal symptoms, among other common symptoms. A parent-driven, multidisciplinary, therapeutic intervention involving a variety of licensed clinicians focusing primarily on addressing environmental and modifiable lifestyle factors was personalized to each of the twin's symptoms, labs, and other outcome measures. Dramatic improvements were noted within several months in most domains of the twins' symptoms, which manifested in reductions of Autism Treatment Evaluation Checklist (ATEC) scores from 76 to 32 in one of the twins and from 43 to 4 in the other twin. The improvement in symptoms and ATEC scores has remained relatively stable for six months at last assessment. While prospective studies are required, this case offers further encouraging evidence of ASD reversal through a personalized, multidisciplinary approach focusing predominantly on addressing modifiable environmental and lifestyle risk factors. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to highlight the utility of a new certificate program in Total Worker Health® (TWH) designed for health professionals in other community health settings (OCHS). Methods: Stakeholder needs assessment, priority setting, and comparison with existing core competencies in TWH approaches were performed to identify learning objectives and curricular threads in alignment with adult learning principles. Faculty-student pairings were conducted for content and assessment development. Results: A free six-module training course that prepares OCHS professionals to collaborate with occupational safety and health (OSH) professionals. Conclusions: TWH can be advanced through collaboration between OSH and OCHS professionals. In service of shared ground, OCHS professionals should articulate the influence of work on health, TWH principles, and OSH vocabulary and concepts. Such training is a necessary step toward facilitating groups for the benefit of all work and workers. [ABSTRACT FROM AUTHOR]

This scoping review aims to outline key discoveries, gaps in knowledge, and potential future directions in the field of forest therapy research in Europe. Clinical studies investigating the effects of forest therapy sessions in Europe were systematically screened through PubMed, Embase, Cochrane Library, the Directory of Open Access Journals (DOAJ), and Google Scholar (search date: January 2024). This review encompasses 26 selected studies, collectively engaging 2775 participants across various European countries, including Italy, Poland, Spain, Germany, Finland, Hungary, Sweden, Iceland, and Switzerland. These studies predominantly measured psychological outcomes such as mood states, affect, attention levels, subjective wellbeing, and quality of life. Additionally, physiological assessments were conducted, covering vital signs, salivary cortisol, body composition, and blood count. Notably, most of the investigation sites were covered by evergreen forests. Forest therapy practices in Europe demonstrated significant benefits in psychological aspects, including relaxation, mood enhancement, and improved wellbeing, accompanied by physiological improvements, particularly in asthma patients. While a fair-to-good methodological quality was identified in randomized controlled trials, the acknowledged weaknesses point towards a need for more rigorous and standardized research approaches. In conclusion, this comprehensive scoping review provides valuable insights into the current landscape of forest therapy research in Europe, highlighting its potential to positively impact both physical and mental wellbeing. The findings underscore the need for further research addressing methodological limitations and exploring gaps in understanding, thereby contributing to the continued advancement of forest therapy as a holistic wellbeing intervention within the European context. [ABSTRACT FROM AUTHOR]

Environmental factors contribute to more than 25% of all global disease but as medical student, we consider that environmental health is insufficiently taught. We are not armed for facing patient's questions, prevent diseases linked to environmental exposure and adapt care in susceptible population. We conducted a national French survey, using a web-based questionnaire from October to November 2021. All medical students were interrogated to assess their knowledge on environmental health and their desire to obtain a specific curriculum on this topic. Two hundred and thirty-two students responded to the survey and most (62.7%) had never had any teaching on environmental health during their medical studies. The majority claimed to have no knowledge on environmental health (63.6%), and most had never been read or seen media content about it (59.2%). Those who had knowledge on environmental health, had been informed through social media, questioning the reliability of this content. Most (87.3%) were ready to take a specific course on environmental health issues during their medical studies in order to better inform their patients with evidence-based medicine and identify at risk population. Through a survey, we identified the need and the emergency of implanting a curriculum on environmental medicine in our medical education. [ABSTRACT FROM AUTHOR]

The article highlights periodical's accomplishments in 2023, acknowledging and thanking the 295 reviewers and editorial board for their vital contributions; and also mentions periodical editors including Olorunfemi Adetona, Andrea Aegerter, and Miriam H. Alexander.

Persistent symptoms are common after acute COVID-19, often referred to as long COVID. LongCOVIDmay affect the ability to performactivities of daily living, including work. Long COVID occurs more frequently in those with severe acute COVID-19. This guidance statement reviews the pathophysiology of severe acute COVID-19 and long COVID and provides pragmatic approaches to long COVID symptoms, syndromes, and conditions in the occupational setting. Disability laws and workers' compensation are also addressed. [ABSTRACT FROM AUTHOR]

Introduction: The discharge of hospital wastewater leads to the establishment of microorganisms from human biota in aquatic ecosystems. This is risky, as there is the possibility of horizontal gene transfer of antibiotic resistance genes from bacteria to other bacterial strains in the aquatic ecosystem and the environment in general, contributing to the expansion of bacterial resistance to antibiotics and the therapeutic ineffectiveness of these medicines. Objective: To demonstrate the environmental risk due to discharge of wastewater from a hospital into an urban river in Santa Clara, Cuba. Materials and Methods: Bacteria were isolated from sediment and soil from the banks of the Bélico river and their resistance to parenteral antibiotics for intra-hospital use employed between 2015 and 2019 was determined. If positive, the environmental risk of these medicines in terrestrial surface waters was estimated, and the resistance of in-hospital strains was assessed. Results and Discussion: All isolated bacterial strains were resistant to at least one of the parenteral antibiotics for intra-hospital use employed in the period under study. All antibiotics were environmentally risky in terrestrial surface waters. There was a high antibiotic resistance of the strains isolated from hospitalized patients. Conclusions: The discharge of untreated wastewater into the Bélico river led to the establishment of bacterial strains which can have a negative impact on the environment, including human health. [ABSTRACT FROM AUTHOR]

From September 20 to 23, 2023, the 17th National Postgraduates Symposium on Environmental and Occupational Medicine was successfully held in Baotou, Inner Mongolia. This symposium was co-sponsored by the Editorial Board of Journal of Environmental and Occupational Medicine and School of Public Health, Baotou Medical College, Inner Mongolia University of Science and Technology. Themed "Research and practice: Healing the schism", the symposium aimed to activate academic thinking, expand research perspectives, encourage innovation awareness, enhance school-to-school exchanges, and cultivate young talents, especially to promote the close integration of academic research and public health practice. Participants from more than 30 universities and research institutions submitted a total of 82 articles. The symposium also gathered about 200 authors and postgraduates from all over the country to discuss the latest progress and future development in the field of environment and occupational medicine and strive to apply the research results to public health practice.

The article discusses a study by Austin Bradford Hill on disease and the environment which is widely cited in the addiction and public health fields as an authoritative source to draw causal inferences from evidence of associations provided by observational studies. Hill outlined factors that he thought should be considered in making decision on the interpretation of causation. Also noted are strengths and limitations of his approach to causal inference and attempts to improve on his approach.

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. [ABSTRACT FROM AUTHOR]

Primary amebic meningoencephalitis (PAM) is a necrotizing and hemorrhagic inflammation of the brain and meninges caused by Naegleria fowleri, a free-living thermophilic ameba of freshwater systems. PAM remains a neglected disease that disproportionately affects children in tropical and subtropical climates, with an estimated mortality rate of 95–98%. Due to anthropogenic climate change, the average temperature in the USA has increased by 0.72 to 1.06 °C in the last century, promoting the poleward spread of N. fowleri. PAM is often misdiagnosed as bacterial meningitis or viral encephalitis, which shortens the window for potentially life-saving treatment. Diagnosis relies on the patient’s history of freshwater exposure and the physician’s high index of suspicion, supported by cerebrospinal fluid studies. While no experimental trials have been conducted to assess the relative efficacy of treatment regimens, anti-amebic therapy with adjunctive neuroprotection is standard treatment in the USA. We performed a literature review and identified five patients from North America between 1962 and 2022 who survived PAM with various degrees of sequelae. [ABSTRACT FROM AUTHOR]

Climate change is an urgent challenge amplified by socioeconomic factors that demands thoughtful public health responses from OEM professionals. This guidance statement from the American College of Occupational and Environmental Medicine focuses on the different strategies that these health professionals can implement to protect workers from health impacts associated with climate change hazards, foster workplace resilience in the face of rapidly changing environments, and take the necessary steps to mitigate the effects of global climate change.

The article "Eureka" published in the Journal of Social Work in End-of-Life & Palliative Care by Zhaohui Su reflects on the importance of caring for one's body and mind. It emphasizes the significance of maintaining and managing one's physical and mental well-being, regardless of external circumstances. The author prompts readers to consider the value of their own body and mind, highlighting the necessity of mindfulness, daily care, and emergency resilience for a future-proof self. [Extracted from the article]

Abstract Aim Hypothermia is associated with poor prognosis in patients with sepsis. However, no studies have explored the correlation between the severity of hypothermia and prognosis. Methods Using data from the Japanese accidental hypothermia network registry (J‐Point registry), we examined adult patients aged ≥18 years with infectious diseases whose initial body temperature was ≤35°C from April 1, 2011 to March 31, 2016, in 12 centers. Patients were divided into three groups according to their body temperature: Tertile 1 (T1) (32.0–35.0°C), Tertile 2 (T2) (28.0–31.9°C), and Tertile 3 (T3) (

Objective: The need to confront the obesity epidemic and its impact on employers requires a serious look at how we address the treatment of obesity. This article focuses on the core components of obesity care and the need for employers to offer a comprehensive obesity benefit (COB) as part of employee insurance coverage. Methods: In May 2022, the American College of Occupational and Environmental Medicine convened a roundtable meeting, which brought together five corporate medical directors and representatives from aerospace/defense and energy industries to learn about the disease of obesity and provide clinical insights regarding health and safety in their respective industries. The goals of the program were to provide awareness of benefits for the treatment of obesity and identify the feasibility for employers of implementing a COB for their employees. Participants learned how a comprehensive approach to covering obesity treatments is necessary, and what benefits should be offered to employees. Results: Participants were invited to review the insurance benefits they currently offer to employees and compare them to the COB. Outcomes were limited by a lack of participation by the employers invited to participate. Participants identified actions that need to be addressed for employers to develop a more comprehensive approach to obesity care. Conclusion: Implementing a COB can help employers increase access and utilization of comprehensive obesity care by employees. [ABSTRACT FROM AUTHOR]

Background: Control of leishmaniasis in the Mediterranean Basin relies on the active contributions from researchers in the fields of animal, human and environmental health. The application of knowledge, perceptions and practices (KPP) questionnaires to health students and professionals in Europe could be fundamental to identify and explore gaps in KPP, highlighting the diversity of conceptions related to this disease between students and professionals active in (One) Health. The objective of this study was to characterize and compare the current knowledge, perceptions and practices regarding leishmaniasis among subgroups of students and health professionals in Portugal through the application of an online questionnaire. Methods: A cross-sectional study targeted the population of health students and professionals in Portugal, including students in medicine, veterinary medicine and environmental health, physicians, veterinarians and environmental health technicians. Potential participants were approached by email via universities and professional societies and organizations and provided with the link to access the online questionnaire. Answers to the self-administered sociodemographic and KPP questionnaire were collected between July and December 2022. Individual KPP scores were calculated by summing grades defined for each question. Logistic regression models were used to search for potential associations, and the results were expressed at estimated crude and adjusted odds ratios with 95% confidence intervals. Results: In total, 486 participants were included in this study: 254 students and 232 professionals. Overall, 75% of the participants reported having heard of both human and animal leishmaniasis, and > 80% reported hearing about the disease during their course work (although this was significantly lower among those in the field of environmental health). Around 90% of participants identified the pathogenic agent as a parasite, and an arthropod bite was identified as the main route of transmission by > 95%. Animal leishmaniasis was considered to be diagnosed in Portugal by 87% of participants and human leishmaniasis by only 69%. The main barriers pointed out by professionals to the control of leishmaniasis were: lack of knowledge in the general population, failures in the early diagnosis and treatment of diseased animals, absence/inefficacy of vector control programs and lack of knowledge in human health professionals. Median knowledge and perception scores were higher among professionals in the animal health field and higher in professionals than in students. Median practice scores were not significantly different between groups and subgroups. The multivariate analysis revealed that a longer period of study (for students) and having seen cases of leishmaniasis (for physicians) were associated with above-mentioned median knowledge score. Conclusions: Most health students and professionals are knowledgeable about the cause and transmission route of leishmaniasis. However, recognition of the disease as autochthonous in humans is less common, highlighting the importance of promoting an approach to this infection through a One-Health lens. A national structured plan to control leishmaniasis could overcome some of the barriers pointed out by professionals, namely by implementing systematic phlebotomine surveillance and integrated reporting of animal and human cases of disease. [ABSTRACT FROM AUTHOR]

On the background of antibiotic‐free livestock husbandry, animal nutritionists are trying to find alternatives to antibiotics. Many herbs have been developed for animal diets to replace antibiotics. Humulus Scandens (HS) is also known as Humulus japonicus and Japanese hop in English, lü Cao (葎草) in Mandarin Chinese and kanamugura (カナムグラ) in Japanese. It is a traditional Chinese medicine with good environmental adaptability. It can grow rapidly and cover any area. Its high yield, strong vitality and medical value allow its potential to be used as an exogenous additive for animal diets to replace antibiotics. However, the knowledge about this herb is limited at present. This manuscript reviewed the processing method of HS and its application in livestock husbandry in order to provide references for its application. [ABSTRACT FROM AUTHOR]

The article focuses on the American Board of Preventive Medicine's (ABPM) update of the content outline for the Occupational Medicine (OM) initial certification examination and the longitudinal assessment program, reflecting the evolution of practice to include environmental medicine. Topics include the name change of the specialty from OM to OEM, the practice analysis process, and the shift towards recognizing the broader scope of Occupational and Environmental Medicine (OEM).

The article discusses research which assessed the changes in perceived knowledge, attitudes and awareness of study participants on air pollution after receiving their personal air monitoring results. Cited are the demographic characteristics of participants, the domains and questions included on the questionnaire, and the strengths and limitations of the study.

The accuracy of a classification is fundamental to its interpretation, use and ultimately decision making. Unfortunately, the apparent accuracy assessed can differ greatly from the true accuracy. Mis-estimation of classification accuracy metrics and associated mis-interpretations are often due to variations in prevalence and the use of an imperfect reference standard. The fundamental issues underlying the problems associated with variations in prevalence and reference standard quality are revisited here for binary classifications with particular attention focused on the use of the Matthews correlation coefficient (MCC). A key attribute claimed of the MCC is that a high value can only be attained when the classification performed well on both classes in a binary classification. However, it is shown here that the apparent magnitude of a set of popular accuracy metrics used in fields such as computer science medicine and environmental science (Recall, Precision, Specificity, Negative Predictive Value, J, F1, likelihood ratios and MCC) and one key attribute (prevalence) were all influenced greatly by variations in prevalence and use of an imperfect reference standard. Simulations using realistic values for data quality in applications such as remote sensing showed each metric varied over the range of possible prevalence and at differing levels of reference standard quality. The direction and magnitude of accuracy metric mis-estimation were a function of prevalence and the size and nature of the imperfections in the reference standard. It was evident that the apparent MCC could be substantially under- or over-estimated. Additionally, a high apparent MCC arose from an unquestionably poor classification. As with some other metrics of accuracy, the utility of the MCC may be overstated and apparent values need to be interpreted with caution. Apparent accuracy and prevalence values can be mis-leading and calls for the issues to be recognised and addressed should be heeded. [ABSTRACT FROM AUTHOR]