A complementary medicine student-led telehealth clinic: evaluating learning & teaching perceptions.

OBJECTIVES: This study evaluates a multi-centered complementary medicine (CM) student-led telehealth clinic during the COVID-19 pandemic. Likert and qualitative responses explore student and educator learning and teaching perceptions of the implementation of a successful telehealth clinic. RESULTS: 51 students and 17 educators completed the survey. Respondents agreed that support from educators (90%) and orientation (70%) assisted effective performance. Over 90% (93%) of all respondents supported telehealth in student-led clinics, whilst 87% encountered barriers such as technical and infrastructure issues. Respondents agreed that telehealth practice skills improved in case history taking (90%), treatment (90%) and building patient rapport (60%). Respondents (61%) disagreed that physical examination was effectively performed, and 100% of respondents agreed telehealth was a valuable learning experience. This study is the first to explore student and educator perceptions of telehealth in an Australian University multi-centered CM student-led clinic. To be successful in an educational environment, students and educators require digital literacy and adequate telehealth practice infrastructure. Whilst some in-person practice skills are transferable to telehealth, educators need to adapt curriculum to ensure counselling and physical examination skills are specifically taught for virtual consultations. Telehealth in clinical practice requires continued investigation and educational development.

A dialogue between naturopathy and critical medical anthropology: what constitutes holistic health?

Building on a dialogue between three trained naturopaths and a proponent of critical medical anthropology (CMA), this article highlights the relationship between health and society from the viewpoint of two fields that share this focal concern. Both naturopathy and CMA are committed to the notion of holistic health, although their approaches have historically been somewhat different. The responses of the three naturopaths to CMA exhibit both similarities and differences, particularly in terms of insights that CMA may make to naturopathy. This essay also articulates the CMA perspective of naturopathy and posits lessons that naturopathy can teach CMA.

Evaluation of home-based naturopathic telehealth clinic: an innovative COVID-19 pandemic response.

OBJECTIVES: The COVID-19 pandemic in Australia disrupted usual clinical training placements for naturopathic students. An innovative, remote Telehealth clinic was developed and implemented. This pilot study evaluates student and educator learning and teaching experiences in Telehealth. A survey assessed Likert and qualitative written responses to student and staff interaction with the Telehealth clinic. RESULTS: Nine student and 12 educator responses were included in the analysis. All students positively rated Telehealth training resources and the educator support provided. Students rated the Telehealth learning experience as 'very good' (78%) or 'good' (22%) with educator ratings of 'very good' (67%) or 'good' (33%). Thematic analysis of student written responses showed increased client diversity, collaboration, peer learning, increased feedback, and improved digital and technology skills. Virtual physical examination and infrastructure limitations were reported as Telehealth clinical practicum challenges. Naturopathic Telehealth clinic practicum is a valuable alternative to in-person clinical practicums for Australian students. It enhances student collaboration and peer learning. Challenges of technology, infrastructure and incorporating Telehealth in curriculum may be barriers to implementation of Telehealth. However, Telehealth is an important clinical training option to prepare student practitioners for contemporary professional practice if in-person consultation is prohibitive, such as during the COVID-19 pandemic.

Applying toxicological risk assessment principles to constituents of smokeless tobacco products: implications for product regulation.

OBJECTIVE: To determine how information on chemical constituents of different smokeless tobacco products (STPs) may be used in cancer risk assessment for regulatory purposes. METHODS: This study investigated select STP constituents potentially associated with significant cancer risk by applying a known toxicological risk assessment framework. Cancer risk estimates were obtained for selected constituents of STPs and a medicinal nicotine gum formulation with comparable toxicity information and also median concentration data on the GothiaTek analytes. The calculated cancer risk was considered 'unacceptable' if it exceeded the US Environmental Protection Agency's (USEPA's) benchmark of an 'acceptable' cancer risk of 10E-6. RESULTS: The cancer risk estimates derived from daily use of 10 g of STPs meeting the industry-set GothiaTek limits exceed the levels generally considered 'acceptable' by the USEPA at least 8000 times. Except for the medicinal nicotine tested, all the STP types, including the relatively lower tobacco specific nitrosamine (TSNA)-containing snus, were found to carry an 'unacceptable' cancer risk. The calculated cancer risks associated with the snus and the US moist snuff products were, respectively, at least 1000 times and 6000 times greater than the minimum acceptable. TSNA and cadmium are associated with the largest estimated cancer risks for all the STPs evaluated. CONCLUSIONS: This study's findings provide an empirical risk assessment that could guide STP regulation using an existing toxicological assessment framework. The study findings question the scientific rationale of the industry-set standards and highlight the need for regulatory actions to reduce specific toxicants in all STPs.

Secondhand smoke in Israeli bars, pubs and cafes.

BACKGROUND: Secondhand smoke poses a serious health hazard. In Israel the recent passage of a law designed to protect people from secondhand smoke in public places was greeted with controversy. The debate is taking place without data on actual levels of pollution for secondhand smoke in public places. OBJECTIVES: To estimate levels of small respirable suspended particles, atmospheric markers of secondhand smoke, in Israeli bars, pubs and cafes, to compare them with levels in other countries, and to analyze RSP determinants. METHODS: This study was conducted in bars, pubs and cafes in Jerusalem and Tel Aviv prior to passage of the enforcement bill. Venues were randomly sampled from lists available in the local mass media. RESULTS: The average level of RSPs across all venues, 283 microg/m3, was nearly identical to levels in countries without enforced smoking bans. Bars and pubs had higher values than cafes (P = 0.0101). The effect of smoker concentration was borderline significant (P = 0.0540), with RSP levels increasing as smoker concentration increased. The effect of venue height was also borderline significant (P = 0.0642), with RSP levels decreasing as venue height increased. CONCLUSIONS: Levels of indoor air pollution from secondhand smoke in Israeli bars, pubs and cafes prior to the recent passage of the enforcement bill were similar to levels in countries without enforced smoking bans, and roughly 10 times as high as countries with enforced smoking bans. Whether the new law will successfully promote clean air in Israeli bars, pubs, cafes, and other indoor places is yet to be seen.

Revising the machine smoking regime for cigarette emissions: implications for tobacco control policy.

BACKGROUND: The WHO Framework Convention on Tobacco Control includes provisions for testing and regulating cigarette emissions. However, the current international standard for generating cigarette emissions--the ISO machine smoking regime--is widely acknowledged to be inappropriate for purposes of setting regulatory restrictions. OBJECTIVE: To review alternatives to the ISO machine smoking regime and the extent to which they: 1) Represent human smoking behaviour, 2) Reduce the potential for industry exploitation, particularly in the area of risk communication, and 3) Serve as suitable measures for product regulation. METHODS: Emissions data from 238 Canadian cigarette brands tested under the ISO and "Canadian Intense" machine smoking regimes. RESULTS: None of the alternative smoking regimes, including the Canadian Intense method, are more "representative" of human smoking behaviour and none provide better predictors of human exposure. CONCLUSIONS: Given that alternatives such as the Canadian Intense regime are subject to the same fundamental limitations as the ISO regime, key questions need to be addressed before any smoking regime should be used to set regulatory limits on smoke emissions. In the meantime, regulators should remove quantitative emission values from cigarette packages and more work should be done on alternative machine smoking methods.

Providing a Science Base for the Evaluation of Tobacco Products.

OBJECTIVE: Evidence-based tobacco regulation requires a comprehensive scientific framework to guide the evaluation of new tobacco products and health-related claims made by product manufacturers. METHODS: The Tobacco Product Assessment Consortium (TobPRAC) employed an iterative process involving consortia investigators, consultants, a workshop of independent scientists and public health experts, and written reviews in order to develop a conceptual framework for evaluating tobacco products. RESULTS: The consortium developed a four-phased framework for the scientific evaluation of tobacco products. The four phases addressed by the framework are: (1) pre-market evaluation, (2) pre-claims evaluation, (3) post-market activities, and (4) monitoring and re-evaluation. For each phase, the framework proposes the use of validated testing procedures that will evaluate potential harms at both the individual and population level. CONCLUSIONS: While the validation of methods for evaluating tobacco products is an ongoing and necessary process, the proposed framework need not wait for fully validated methods to be used in guiding tobacco product regulation today.

Do health policy advisors know what the public wants? An empirical comparison of how health policy advisors assess public preferences regarding smoke-free air, and what the public actually prefers.

BACKGROUND: Health policy-making, a complex, multi-factorial process, requires balancing conflicting values. A salient issue is public support for policies; however, one reason for limited impact of public opinion may be misperceptions of policy makers regarding public opinion. For example, empirical research is scarce on perceptions of policy makers regarding public opinion on smoke-free public spaces. METHODS: Public desire for smoke-free air was compared with health policy advisor (HPA) perception of these desires. Two representative studies were conducted: one with the public (N = 505), and the other with a representative sample of members of Israel's health-targeting initiative, Healthy Israel 2020 (N = 34), in December 2010. Corresponding questions regarding desire for smoke-free areas were asked. Possible smoke-free areas included: 100% smoke-free bars and pubs; entrances to health facilities; railway platforms; cars with children; college campuses; outdoor areas (e.g., pools and beaches); and common areas of multi-dweller apartment buildings. A 1-7 Likert scale was used for each measure, and responses were averaged into a single primary outcome, DESIRE. Our primary endpoint was the comparison between public preferences and HPA assessment of those preferences. In a secondary analysis, we compared personal preferences of the public with personal preferences of the HPAs for smoke-free air. RESULTS: HPAs underestimated public desire for smoke-free air (Public: Mean: 5.06, 95% CI:[4.94, 5.17]; HPA: Mean: 4.06, 95% CI:[3.61, 4.52]: p < .0001). Differences at the p = .05 level were found between HPA assessment and public preference for the following areas: 100% smoke-free bars and pubs; entrances to healthcare facilities; train platforms; cars carrying children; and common areas of multi-dweller apartment buildings. In our secondary comparison, HPAs more strongly preferred smoke-free areas than did the public (p < .0001). CONCLUSIONS: Health policy advisors underestimate public desire for smoke-free air. Better grasp of public opinion by policy makers may lead to stronger legislation. Monitoring policy-maker assessment of public opinion may shed light on incongruities between policy making and public opinion. Further, awareness of policy-maker misperceptions may encourage policy-makers to demand more accurate information before making policy.