How to advance legal education for future environmental health

Community health workers (CHWs) cover extensive areas observing the environmental conditions in which community members live. However, current CHW training modules do not have modules focusing specifically on environmental health. CHWs appear to lack knowledge of environmental health hazards, and little is known of their attitudes and practices regarding environmental health hazards. The purpose of this study was to determine the knowledge, attitudes, and practices of CHWs in relation to environmental health hazards in the Nelson Mandela Bay (NMB). This study used a quantitative, cross-sectional research design. A sample of 110 respondents completed the questionnaire. The questionnaire was based on the literature, consisting of 36 items in four sections. Data analysis consisted of descriptive and inferential statistics. Reliability and validity were enhanced by utilizing a pre-test study. There were significant differences in attitudes (t = -2.308, df = 91.107, p = 0.023) and practices (t = -2.936, df = 62.491, p = 0.005). Those trained in environmental health had a significantly lower mean attitudes score (m = 3.2365, sd = 1.113) compared to those not trained in environmental health (m = 3.694, sd = 0.894). In addition, those trained in environmental health had a significantly lower mean practice score (practiced more frequently) (m = 1.231, sd = 0.327) compared to those not trained in environmental health (m = 1.4605, sd = 0.4162). Regarding training, 62% (n = 67) of CHWs felt they needed additional training in environmental health. Most of the CHWs had a moderate knowledge of environmental health hazards. Furthermore, most of the CHWs had a very positive or positive attitude towards environmental health hazards. However, there is a need for CHWs to receive very specific training in environmental health. In addition, the scope of work of CHWs, as well as their role in relation to environmental health, needs to be further explored.

The global landscape of professional training in environmental health, encompassing ecological public health or environmental public health, lacks consistent global implementation for training programs for public health practitioners, clinical professionals, and individuals across various disciplines, as well as standardized curricula for undergraduates. This training gap is related to the overall lack of capacity in addressing the population impacts of the triple challenge of pollution, biodiversity loss, and climate change, impeding the worldwide transition to and development of ecological sustainability. This paper reviews existing approaches and their potential to address implementation challenges within the necessarily tight timescale. Spreading of best practice appears feasible even without substantial additional resources, through the reorientation of current practices via comprehensive multi-disciplinary training programs. By adopting international best practices of training in environmental health, the focus in training and education can shift from future decision-makers to enhancing the competencies of current professionals and their institutions.

Public health accomplishments have dramatically improved children's lives. Sanitation programs, vaccines, better nutrition, surveillance and monitoring of disease, and the development of antibiotics have led to extraordinary reductions in infant and child mortality.1 Ambulatory pediatricians have contributed, through research, teaching, and advocacy, and especially through the delivery of improved medical care to this dramatic trend. Despite these advances, children are in trouble:

Scientific advances provide opportunities to improve pediatric environmental health

Not often does a new degree program make headline news, but then, in India there is nothing entirely comparable to the new master’s of public health (MPH) program launched 19 January 2010 at Sri Ramachandra University (SRU) in Chennai. With environmental disease constituting roughly half the country’s total disease burden, India has a dire need of the expertise the program will develop with its focus on occupational and environmental health (OEH). “This program is the first MPH [in India] with an exclusive focus on OEH,” says Kalpana Balakrishnan, a professor of biophysics and head of the Department of Environmental Health Engineering at SRU. “These graduates will be trained in recognition, evaluation, and management of OEH risks to serve industry and governmental organizations in addition to assuming roles as teachers of OEH in [this and other] MPH programs.” India faces a double whammy of traditional and modern OEH problems, including indoor air pollution (primarily due to the use of wood, dung, and other solid fuels for cooking); the microbial and chemical contamination of water; chemical, physical, ergonomic, and psychosocial hazards in the workplace; and contamination of food supplies by heavy metals, pesticides, and microbes. Over 37 million people—more than the total population of California—are affected annually by waterborne disease, according to the international nonprofit WaterAid, and the most recent data available—published by James Leigh et al. in the September 1999 issue of Epidemiology—put the number of occupation-related deaths per year at an estimated 121,000. Yet the country, with one-sixth of humanity and a space program, nevertheless has few professionals trained to tackle such problems and inadequate capacity to undertake related research. The 2-year MPH program is the fruit of a collaboration with the University of California, Berkeley, that began in 2002 with support from the International Training and Research Program in Environmental and Occupational Health (ITREOH), an initiative of the Fogarty International Center, National Institutes of Health, in collaboration with the NIEHS and the Centers for Disease Control and Prevention. “A main objective of this collaboration has been to build the capacity of staff at SRU to deliver the MPH program and undertake research,” explains Kirk Smith, a professor of global environmental health at Berkeley and a principal investigator with ITREOH. Fogarty funds have brought 6 SRU faculty to Berkeley to take advanced courses in biostatistics, epidemiology, and other disciplines. Berkeley aims to continue to provide training support over at least the next 2 years. The new MPH program covers topics such as epidemiology, biostatistics, occupational toxicology, industrial hygiene, occupational and environmental safety, exposure assessment and control, health policy and management, behavioral sciences in health, indoor air quality, analysis of airborne chemical contaminants, occupational health clinics, environmental engineering (including the management of hazardous and biomedical waste), and the use of geographic information systems. With initial graduating classes of just 10 students, Balakrishnan says, “The intake will be expanded once a critical mass of teachers is produced from the first few batches.” She believes it could be at least a decade before much of a dent could be made in the subcontinent’s OEH problems and that to truly meet its challenge, India would need dozens more such programs. “It will be difficult in the short term to find students able to pay their own fees to attend until there are jobs available to make it seem worthwhile,” Smith says. “It’s a chicken-and-egg situation, which is one of the main reasons SRU needs to start small and build up slowly to a larger program.” Smith says other Indian universities are now considering offering new courses with OEH content, but one of the major problems they face remains the recruitment of staff capable of teaching in this area. “The production of the first ‘homegrown’ graduates who can specifically fill these positions, who have firsthand experience of India’s OEH problems, and who can begin research to find new ways of quantifying them and dealing with them will be a big step in the right direction,” he says. “Addressing India’s occupational and environmental health concerns is vital in the future of a healthy India,” remarks Sanjay Zodpey, director of the Indian Institute of Public Health and director of public health education for the Public Health Foundation of India, both in New Delhi. “The MPH program in collaboration with Berkeley will not only address the shortfall in trained manpower in occupational and environmental health, but also strengthen indigenous Indian research capacity in these areas.”

BackgroundAdequate knowledge and positive attitude toward menopause are important for women to tackle changes related to menopause. Even though all women experience menopause at some stage in their life, teachers face more difficulties more than other female employees due to the nature of their roles do. In Eritrea, menopause has been given little attention hence gaps exist concerning women’s knowledge, attitude, and the effects of health education on the same subject. This study aimed at assessing the effect of health education on knowledge and attitude of menopause among middle-aged teachers in elementary, junior, and secondary schools of Asmara, Eritrea.MethodA semi-experimental design with pre-intervention, immediate post-intervention, and three-month follow up test was used in this study. The data was collected from 99 middle age teachers using stratified random sampling. The intervention was done using lectures, group discussions, brochures, and handouts. Data on socio-demographics, knowledge, and attitude was collected using a pre-designed questionnaire. The effect of educational training at the three-time points was evaluated by repeated measure ANOVA using SPSS version 22.ResultsThe mean scores of correct knowledge at pre-intervention, immediate post-intervention, and 3-months follow-up were 12.3/22 (SD = 3.06), 17.3/22 (SD = 3.21), and 16.5/22 (SD = 2.52) respectively. A significant difference in scores of knowledge at the three-time points was observed due to the educational intervention with a statistical significance of (p < 0.0001). Post-hoc analysis revealed that knowledge score immediately after intervention was significantly greater than that of pre-intervention (p < 0.0001), and 3-months follow-up (p = 0.004). The mean scores of attitude at the three-time points were 27.9/45 (SD = 5.14), 28.3/45(SD = 5.25), 28.32/45(SD = 5.12). The educational intervention had brought a change in the mean scores of attitude at the three-time point with a statistical significance of (p < 0.0001). Post-hoc analysis revealed that attitude scores at immediate post-intervention were also significant (p = 0.001) with the 3-months follow up at (p < 0.0001) were higher than that of pre-intervention.ConclusionThe structured educational intervention was beneficial to the studied women in intensifying their knowledge and tuning them toward a positive attitude. Hence, proper health education programs regarding menopause are strongly recommended.

To investigate HIV/AIDS related knowledge and attitude among high school students in China, and to preliminarily evaluate the effects of the special HIV/AIDS prevention education programme. A total of 6487 high school students from 24 high schools of Beijing, Zhengzhou and Tangshan were investigated by using questionnaire, among which, 6487 students completed the questionnaire (96.08%). chi(2) test, t test and one way ANOVA were used to test the group differences and logistic regression was employed for further analysis. P < 0.05 was considered as statistically significance. The mean knowledge and attitude scores of the students were separately 14.42 out of 20 and 6.47 out of 10. Students from Tangshan had the significantly (P < 0.001) highest knowledge and attitude level (average score of knowledge = 15.11, average score of attitude = 7.21) followed by Beijing (average score of knowledge = 14.62, average score of attitude = 6.15) and Zhengzhou (average score of knowledge = 13.56, average score of attitude = 6.07). The significant differences were observed in all except the varying attitude between Zhengzhou and Beijing (Knowledge comparison: t(Tangshan vs Beijing) = 0.49, P < 0.001, t(Tangshan vs Zhengzhou) = 1.56, P < 0.001, t(Zhengzhou vs Beijing) = 1.07, P < 0.001; Attitude Comparison: t(Tangshan vs Beijing) = 1.06, P < 0.001, t(Tangshan vs Zhengzhou) = 1.14, P < 0.001, t(Zhengzhou vs Beijing) = 0.08, P = 0.282). Boys had higher knowledge scores (average score of knowledge = 14.61) than those of girls (average score of knowledge = 14.23, t = 4.22, P < 0.001) but no significant difference was found (average knowledge score of boys = 6.47, average knowledge score of girls = 6.48, t = 0.16, P = 0.869). Higher knowledge level (OR = 1.21, P < 0.001) and being a rural student (OR = 1.31, P < 0.001) were significantly associated with higher attitude level, while higher grade (OR = 0.85, P = 0.003) and better academic performance (OR = 0.94, P = 0.003) were negative predictors of attitude. The HIV/AIDS related knowledge among high school students in China was relatively limited and instability positive attitude under the pressure of social desirability. It is necessary to tailor the special education strategies for further education effect improvement.

Guest Editorial: Global Perspective on Environmental Health

Tacit knowledge in environmental health (EH) responds to the strong need to relate environmental conditions with health effects and implement the ideas produced in the educational framework. Training programs on EH have to educate professionals in dealing with problems where environmental degradation threatens health and to answer the currently increasing volume of question society asks on these issues. Therefore, an EH professional should not only be equipped with theoretical knowledge but also with the “know-how” knowledge (or tacit knowledge) that enables in-depth understanding of the mechanisms that links environment with health and facilitates the prevention of incidents and chronic exposure to pollutants. This was the main driver behind the establishment of the Master’s Degree Program “Environment and Health: Capacity building for decision making” at the Medical School of the National and Kapodistrian University of Athens—Greece (UoA). The program builds on the expertise of academic partners on EH issues. The experience of non-academic professionals is an important part of the program, which is aimed at developing innovative methods of knowledge alliance management, introducing the “tacit knowledge” approach, contributing to understanding and managing health-related environmental problems. In order to evaluate the accomplishment of the program’s objectives, a questionnaire was completed by current MSc holders. The program impact regarding its tacit knowledge content was highly regarded (>80.0 %) by the alumni. This adds to the evidence-based strength of tacit knowledge, which is increasingly profiled as a mandatory element of EH academic programs. A SWOT analysis discussion puts the assessment of tacit knowledge in a wider context.

The purpose of this study was to investigate the effect of digital education by using the Theory of Planned Behavior on the improvement of occupational health and ergonomic conditions of dentists. This Quasi-experimental study, which consisted of two descriptive and quasi-experimental parts, was conducted on 63 dentists in Bojnourd city (Iran) in 2017. The dentists were included in the study through the census method. After identifying the determinants of ergonomic conditions in the descriptive study, the Quasi-Experimental study was undertaken to determine the effect of digital intervention. Data collecting methods were demographics information questionnaire, Nordic questionnaire, a self-administered questionnaire designed in compliance with theoretical constructs and the RULA tool, which were completed before and after the intervention by dentists. More than 97% of the dentists were at high risk of developing skeletal problems. The constructs of subjective norm, perceived control, attitude and behavioral intentions were significant predictors of their ergonomic behaviors (p < 0.001). Results show that there was no significant difference in the mean attitude and knowledge scores between the experimental and control groups before the educational intervention (p = 0.164). But after the intervention, the mean attitude and knowledge scores in the experimental group were significantly different from before the intervention (p < .05). Training based on the (TBP) using digital media was effective in the knowledge and attitude of ergonomic conditions of the dentists. However, it was not effective for behavioral intention.

A New Day for Global Environmental Health

In 1988, New York City’s West Harlem community had a problem. The recently opened North River Sewage Treatment Plant, which stretches eight blocks along the Hudson River, was doing a poor job of processing about 170 million gallons of raw sewage daily. Residents were concerned about the foul smells coming from the plant, and parents complained that their children were suffering from respiratory problems. The community knew it needed help, but it also needed something else: information on the exposures it was facing, on the health effects of those exposures, and on the courses of action open to the people. When the community mobilized months later to form West Harlem Environmental Action Inc. (WE ACT), it had taken the first step toward cultivating just that sort of environmental literacy.

Education in environmental health of health care professionals: What needs to be done?

Aim: This research aimed to assess the understanding, attitudes, and clinical practices of orthodontists and orthodontic residents in managing impacted maxillary canine teeth. Methods: Conducted in 2023, this cross-sectional study surveyed orthodontists and residents from nine provinces in Iran. A custom-designed questionnaire evaluated their knowledge, attitudes, and practices regarding the treatment of impacted upper canines. Data analysis involved multiple backward linear regression and Pearson's correlation tests. Results: A total of 96 participants—72 orthodontists and 24 residents—completed the questionnaire. The average knowledge score was 6.41 ± 1.94, and the mean attitude score was 15.9 ± 2.7. A significant positive correlation existed between knowledge and attitude scores (P = 0.001). Participants who saw more patients weekly had higher knowledge scores (P = 0.002), while those with more clinical experience had lower knowledge scores (P = 0.002). Attendance in additional periodontology or oral surgery courses significantly influenced attitudes (P = 0.001). Faculty members preferred apically positioned flaps for labially impacted canines, whereas other participants favored closed exposure techniques (P = 0.025). Clinicians with a higher patient load (P = 0.02) and more experience (P = 0.00) were more inclined to extract the lateral incisor and replace it with the impacted canine. Conclusion: Iranian orthodontists and residents demonstrated above-average knowledge and positive attitudes toward managing impacted maxillary canines. Certain clinical preferences were significantly associated with their knowledge levels.

Posits that in the last decade or so, there has been a very great increase of training courses in occupational and environmental health, not only in developing countries but in developed ones as well. However, training for occupational health nurses and education in general environmental and occupational health for schoolteachers and school students, and students in engineering and business management, still leave much to be desired.