The Layers of Life

Chapter 6 summarizes the work described in the book. It places Environmental Biodynamics in context of the broader field of general systems theory. It argues that to realize the full potential of Environmental Biodynamics, environmental medicine must refocus the examination of the interaction of environment and health from an emphasis on measuring physiological “moments” (i.e., static measures of environmental factors, infrequent anthropometry, momentary health indicators) to studying dynamic human–environment interfaces, physiological states, and the processes that constrain to those states. To this end, Chapter 6 provides a set of endeavors that must be undertaken to capitalize on and formally test the biodynamic interface paradigm. First, focus scientific inquiry on interfaces that connect biological and environmental systems; second, develop theoretical frameworks that focus on the identification and interpretation of constraints in biological–environmental interfaces; and third, develop laboratory, clinical, and epidemiological methods to relate the complexity characterized at the level of biodynamic interfaces to human health.

The Shape of Change

Chapter 3 introduce the first central principle of Environmental Biodynamics—that complex systems cannot interact directly, nor exist in isolation. It also introduces the corollary principle that although the interface is composed of constant change (i.e., processes) it retains a quantifiable topography—the shape of change—driven by stochastic, deterministic, or chaotic processes. The implication of this, from the perspective of environmental medicine, is that the environment and human physiology are integrated via an interface. An interface emerges wherever the measurement of one system’s state intrinsically includes inputs from another system. And thus, to understand how the environment influences us, and vice versa, environmental medicine must adopt a functional perspective that focuses on the organization of system dynamics and complexity. This is achieved by characterizing the deterministic, stochastic, and chaotic processes that shape environmental homeostasis.

Misdiagnosis in occupational and environmental medicine: a scoping review

Introduction There has been no comprehensive review for misdiagnosis in Occupational and Environmental Medicine (OEM). The possible ramifications of an occupational disease (OD) or an environmental disease (ED) misdiagnosis are not just confined to the individual case but may extend to others exposed to the occupational or environmental hazard. Therefore, a comprehensive scoping review of published literature is imperative for understanding the nature of misdiagnoses in OEM. Methods A medical librarian searched MEDLINE (PubMed), EMBASE, and the Cochrane Library (on 06 November 2020). All collected OEM misdiagnoses were classified based on 2 conceptual frameworks, the typical framework, and the causation model. The distribution of misdiagnosis across each medical specialty, each diagnostic step of the typical framework and the causation model, and false-negative and false-positive were summarized. Results A total of 79 articles were included in the scoping review. For clinical specialty, pulmonology (30 articles) and dermatology or allergy (13 articles) was most frequent and second-most frequent, respectively. For each disease, occupational and environmental interstitial lung diseases, misdiagnosed as sarcoidosis (8 articles), and other lung diseases (8 articles) were most frequent. For the typical framework, the most vulnerable step was the first step, evidence of a disease (38 articles). For the causation model, the first step, knowledge base, was the most vulnerable step (42 articles). For reported articles, the frequency of false-negative (55 articles) outnumbered the frequency of false-positive (15 articles). Discussion In OEM, compared to general medicine, causal misdiagnosis associated with the probability of causation is also important. For making a diagnosis in OEM, a knowledge base about possible ODs and EDs is essential. Because of this reason, the education and training of treating physicians for common ODs and EDs are important. For ODs and EDs, various intentional behaviors of stakeholders should be considered. This scoping review might contribute to the improvement of understanding for misdiagnosis in OEM.

The Growing Relation between Environment and Public Health

Introduction: Environmental health is deteriorating worldwide. Evidence shows that exposure to air, water and soil pollution has caused many deaths worldwide, a trend that is increasing day by day. Health consequences from exposure to environmental pollutants range from cancer, lung disease, heart disease and a series health problems which often lead to death. The majority of pollution related deaths happens mostly in low and middle-income countries. Environmental and pollution health related issues are not getting the attention they deserve in Albania. The main purpose of this article is to identify the relationship between environmental problems and public health consequences, by analysing public policies, case studies and instruments for measuring environmental health indicators. The article also presents suggestions regarding development of Environmental Medicine in Albania, and Public Health Tracking methods. Methods: Qualitative method is thoughtfully used in this article. Specifically, literature review methodology is used to identify environmental indicators that directly affect public health, adequate policies and instruments for the protection of public health, as well as environmental health at the international and national level. Qualitative method is used to reveal and evaluate the topic through multiple facets covering relevant contextual conditions. This method helps identifying the link between public and environment health indicators in a real-life situation, and to understand the relationship between these indicators in the Albanian context. Results and Discussion: Albania lacks a specific measurement system of Environmental Public Health Tracking, as well an established methodology for linking environmental and public health. Potential capacities for measuring environmental and health indicators are limited at the national level, thus, the public health policies do not clearly and fully integrate environmental health indicators for the protection of public health. Vocational training in health and environment is being practiced through various disciplines, but there is a need for specialized environmental medicine health professionals, with adequate competences in the field. Conclusions: The correlation between environment and public health is gaining attention nationally and globally. As in other countries, the need for Environmental Medicine professionals is growing also in Albania. Strong correlations between of environmental pollution indicators (air, water, land pollution) and public health indicators (such as infant and general mortality, morbidity rates, respiratory diseases, etc.) have increased in the last years. Use of instruments (such as EPHT), a fully integrated university curricula and a specific discipline of Environmental Medicine should be made a priority not only nationally, but also globally as environmental problems such as climate change do not recognize national borders. In order to manage the rising cases, states need to be resilient, and build appropriate research based policies and action plans to prevent the occurrence of environmental related public health consequences. Doi: 10.28991/SciMedJ-2021-0302-3 Full Text: PDF

A Re-design Proposal for the ‘Occupational’ & ‘Environmental’ Medicine syllabus under ‘Community Medicine’ subject of the third-year MBBS curriculum in Bangladesh: Suggesting to apply ‘PBLs’, ‘Blended-learning (or, flipped classroom)’ and ‘Guest-lectures’

The reported illnesses and injuries attributed to environmental and occupational factors is a major health challenge being experienced globally over the years.1 In current decade, Bangladesh has experienced a number of environmental and occupational health-related hazards that not only have cost huge government involvement, medically and financially but also caused international bodies to intervene into local affairs (see Table 1). These unprecedented events often question how prepared are young Bangladeshi doctors if they are to receive and manage disaster-victims at real time.2 Globally, ‘Occupational and Environmental Medicine (OEM)’ subject is lectured at third-year of the MBBS course during ‘Population Health’ or ‘Community Medicine’ rotation. Efficient, effective and enjoyable learning on OEM-topics can equip future doctors with important basic knowledge and required practical skills that are necessary to manage cases/victims from pandemic, work-hazards or disasters. Students’ positive engagement with OEM may raise their interest with specialist careers in Community Medicine (Com-Med). Some developed-country studies3-7 reported that students who went through problem-based-learning (PBL) tutored classes made better academic performance on Preventive Medicine, Public Health and Community Health topics than those who had experienced traditionally lecture-tutored curriculum. An Indian study done by Joseph et al.8 documented similar findings. The purpose of this review paper is to appraise current OEM-syllabus under the Com-Med curriculum in Bangladesh and scope, whether the PBLs or case-based-learning (CBLs) model could be appropriate if applied through ‘blended-learning’ or, ‘flipped-classroom (backed by audio-video supports)’ format. This literature-evidenced, student-centred teaching model expectedly would improve students’ practically-oriented learning via their in-class working over real-life cases/problems. Ideally, these cases would be constructed by content-experts and delivered initially by guest-lecturers. Bangladesh Journal of Medical Education Vol.12(1) 2021: 50-67