The relevance of occupational medicine to primary care in the 21st century.

The relatively infrequent incidence of dramatic outbreaks of occupational disease, as occurred in the past, along with economic downturns, have lowered the medical altitude of the workplace as a risk factor for or determinant of disease and disability. However, in 2007 alone, there were more than 4 million nonfatal occupational illnesses in the United States. Equally relevant is the explosion in 2010 at a coal mine in West Virginia that left 29 workers dead. Not to be overlooked are the ongoing challenges to medical practitioners of managing workers' compensation cases. At the same time, the convergence of demographic changes, changes in the workplace structure, and emerging technologies are reinforcing the views of occupational medicine clinicians and other practitioners that occupational health must be integrated into primary care systems and that total separation of work-caused and nonwork-caused care is counterproductive and arbitrary. Therefore, basic principles, concepts, and procedures of occupational medicine must be integrated into the substrate of information and experience upon which students must depend on entering a medical career.

Medical education in the 21st century.

This commentary is a reaction of medical educators and health practitioners to the Josiah Macy Jr. Foundation's recently released report, Revisiting the Medical School Mission at a Time of Expansion. The report is a fresh assessment of what more medical schools must do to prepare students for 21st century challenges and opportunities to improve the health status of the population including underserved groups.

Environmental influences on cardiovascular health.

A growing body of evidence indicates that the respiratory system is not the only target organ that may be injured by the inhalation of airborne particulate matter. Increased attention is now focused on research showing a link between particulate matter air pollution and cardiovascular morbidity and mortality, raising complex questions about the mechanism by which dirty air affects the heart. At the same time, the population at risk of cardiovascular continues to grow, including the obese, overweight, hypertensive and senior citizens. This pervasive and growing public health and medical care issue elevates into sharp relief the need for physicians and other healthcare practitioners to understand the clinical consequences exposure to particulate air pollution. This review is designed to further that understanding.

The need for diversity in the environmental health workforce.

Epidemiologic evidence makes clear that the likelihood of exposure to environmental contaminants increases in most poor and underserved communities. Despite progress in reducing a number of environmental risk factors for disease, serious environmental problems persist, and those remaining problems are highly complex. Their solution requires meaningful community engagement as well as a diverse environmental health workforce. Demographic data, and related social and economic developments, strongly indicate that such a workforce must include underrepresented minorities. While the problem has not been solved, select programs have made impressive contributions to meeting this need, an example of which is described in this paper.

Katrina perspectives.

This commentary draws attention to a number of factors that may have converged, and in the process, exacerbated the effects of hurricane Katrina on the health and wellbeing of the people of New Orleans.

Nanotechnology and nanomedicine: a primer.

Nanosciences and nanotechnology are transforming a wide array of products and services that have the potential to enhance the practice of medicine and improve public health. But there are a number of health, safety and environmental issues to be addressed. This review summarizes some basic facts about nanotechnology and cites examples of its application to medicine and public health.

Workshop on global health trends for health professional education.

Global finance, trade, communication, media, politics, and the cultivation of overseas relationships to advance U.S. interests are among the forces that have engendered what we now know as globalization, a historical development towards worldwide interconnectedness. While manifest in diverse realms, globalization powerfully influences human health and health services and poses challenges for physicians and other health care professionals. To review these challenges and their ramifications, a workshop was convened at Howard University to consider the implications of global health trends for medical education. Highlights of the discussion are summarized here.

Pediatric environmental health.

The links between environmental agents, environmental conditions, and disease and disability among children are receiving increasing attention. Evidence abounds that children are more susceptible than adults to the damaging effects of environmental agents and conditions. This evidence is illuminated by the much-publicized and expanding research agenda on the prevention, recognition, diagnosis and treatment of environmentally related disease in the pediatric population. Encouragingly, advances in molecular biology and other sciences are providing important tools to aid pediatricians and other healthcare professionals in meeting the environmental health needs of children.

The microbiome: a contributor to health and disease.

As the 21st century unfolds there is substantial evidence that biological research is experiencing extraordinary scientific and technological advances. Prominent among these advances are the completion of the Human Genome Project, which laid the foundation for the second advance, the Human Microbiome Project. Emerging from these advances are two overarching conclusions: a) genomics is no longer the sole domain of the geneticist, and b) we each are hosts to trillions of microorganisms. Genomics and other technologies have enhanced efforts to characterize the structure, composition, and functions of the microbiome. This characterization has fueled progress in understanding the role of the microbiome in health and disease. In this review, we highlight developments that have helped illuminate the microbiome-health connection. This information can improve an understanding of connections and relationships among multiple factors (or determinants) of health.

Environmental factors influencing public health and medicine: policy implications.

Environmental health threats are increasing throughout the United States, particularly in low-income populations and in communities of color. Environmental science researchers are investigating plausible associations between the environment and human health. As a result, the role and responsibility of the primary care physicians and other health care providers are changing. This paper highlights selected lines of evidence suggesting that clinicians should now consider interactions between humans and their environment as central to providing effective primary care. Subject areas include: exposure to environmental agents, reproductive toxicity, pulmonary disease, neurobehavioral toxicity, endocrine disruptors, mechanisms of environmental disease, and cultural competence. Concerns about these and other environmentally related issues influence the manner in which primary care is practiced now, and will be practiced in the future. Biomedical technology and community awareness demand that physicians pay more attention to advances in environmental medicine. Ironically, one of the least taught subjects in medical school is environmental medicine. To effectively respond to growing concerns about the role of the environment in human health, clinicians, researchers, educators, public policy officials, and the general public must join together to reduce the risk of environmental health threats and improve quality of life.

Environmental factors associated with asthma.

Asthma, a disease of attacks and remission, continues to account for substantial morbidity and direct economic costs. Numerous studies--epidemiologic, toxicologic and clinical--present evidence for a broad spectrum of environmental risk factors associated with asthma. This review summarizes current thinking on a subset of these factors. Knowledge of potential environmental determinants of asthma is important to both the patient and healthcare professional in the application of multiple modalities of medical and environmental intervention for management of the development, and exacerbation of this chronic inflammatory disorder of the airways.

The changing landscape for the elimination of racial/ethnic health status disparities.

The elimination of racial/ethnic health status disparities is a compelling national health objective. It was etched in sharp relief by the 1985 report of the U.S. Department of Health and Human Services Secretary's Task Force on Black and Minority Health and considerable attention has been devoted to the problem since that report. But the problem persists, disparities are not fully explained and effective policies to reduce them have been elusive, a situation presenting both opportunities and challenges. Important advances towards reducing racial/ethnic health disparities may be made by better understanding the complex bidirectional relationship between and among the multiple factors, biological and non-biological, influencing morbidity and mortality. The landscape in which these influences are felt is anything but static. In this paper selected components of the landscape that are critical to the elimination of racial/ethnic health status disparities are reviewed. These factors underscore the importance of adopting and maintaining a perspective on health disparities that encompasses a broad array of health determinants.