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Background In 2013, a cohort of public health students participated in a ‘flipped’ Environmental and Occupational Health course. Content for the course was delivered through NextGenU.org and active learning activities were carried out during in-class time. This paper reports on the design, implementation, and evaluation of this novel approach. Methods Using mixed-methods, we examined learning experiences and perceptions of the flipped classroom model and assessed changes in students' self-perceived knowledge after participation in the course. We used pre- and post-course surveys to measure changes in self-perceived knowledge. The post-course survey also included items regarding learning experiences and perceptions of the flipped classroom model. We also compared standard course review and examination scores for the 2013 NextGenU/Flipped Classroom students to previous years when the course was taught with a lecture-based model. We conducted a focus group session to gain more in-depth understanding of student learning experiences and perceptions. Results Students reported an increase in knowledge and survey and focus group data revealed positive learning experiences and perceptions of the flipped classroom model. Mean examination scores for the 2013 NextGenU/Flipped classroom students were 88.8% compared to 86.4% for traditional students (2011). On a scale of 1–5 (1 = lowest rank, 5 = highest rank), the mean overall rating for the 2013 NextGenU/Flipped classroom students was 4.7/5 compared to prior years’ overall ratings of 3.7 (2012), 4.3 (2011), 4.1 (2010), and 3.9 (2009). Two key themes emerged from the focus group data: 1) factors influencing positive learning experience (e.g., interactions with students and instructor); and 2) changes in attitudes towards environmental and occupation health (e.g., deepened interest in the field). Conclusion Our results show that integration of the flipped classroom model with online NextGenU courses can be an effective innovation in public health higher education: students achieved similar examination scores, but NextGenU/Flipped classroom students rated their course experience more highly and reported positive learning experiences and an increase in self-perceived knowledge. These results are promising and suggest that this approach warrants further consideration and research.

Background The recent global pandemic posed extraordinary challenges for healthcare systems. Frontline healthcare workers required focused, immediate, practical, evidence-based instruction on optimal patient care modalities as knowledge evolved around disease management. Objective This course was designed to provide knowledge to protect healthcare workers; combat disease spread; and improve patient outcomes. Methods A team of global healthcare workers responded by rapidly creating a competency-based online course. To promote transcultural applicability, the course was developed by an international team of more than 45 educators from over 20 countries. Course delivery included a built-in language translation tool, routine updates, and several innovative course design elements. User feedback was collected to determine efficacy of course content, structure, unique delivery elements, and delivery options. Results An initial population of online learners ( n  = 147) living in 23 different countries and representing 22 languages completed the course and participated in post-course surveys. An additional population of learners ( n  = 505) attended an in-person offering of course materials. Course participants gave positive feedback and several requested additional courses in similar formats. Conclusion Global open access education courses may provide needed resources to empower healthcare professionals during health crises. Responsive course design can accommodate diverse learner resources and transcultural applicability.

Background Most U.S. states have legalized cannabis for medical and/or recreational use. In a 6-month prospective observational study, we examined changes in adult cannabis use patterns and health perceptions following broadened legalization of cannabis use from medical to recreational purposes in California. Methods Respondents were part of Stanford University’s WELL for Life registry, an online adult cohort concentrated in Northern California. Surveys were administered online in the 10 days prior to state legalization of recreational use (1/1/18) and 1-month (2/1/18–2/15/18) and 6-months (7/1/2018–7/15/18) following the change in state policy. Online surveys assessed self-reported past 30-day cannabis use, exposure to others’ cannabis use, and health perceptions of cannabis use. Logistic regression models and generalized estimating equations (GEE) examined associations between participant characteristics and cannabis use pre- to 1-month and 6-months post-legalization. Results The sample ( N  = 429, 51% female, 55% non-Hispanic White, age mean = 56 ± 14.6) voted 58% in favor of state legalization of recreational cannabis use, with 26% opposed, and 16% abstained. Cannabis use in the past 30-days significantly increased from pre-legalization (17%) to 1-month post-legalization (21%; odds ratio (OR) = 1.28, p -value ( p ) = .01) and stayed elevated over pre-legalization levels at 6-months post-legalization (20%; OR = 1.28, p  = .01). Exposure to others’ cannabis use in the past 30 days did not change significantly over time: 41% pre-legalization, 44% 1-month post-legalization (OR = 1.18, p  = .11), and 42% 6-months post-legalization (OR = 1.08, p  = .61). Perceptions of health benefits of cannabis use increased from pre-legalization to 6-months post-legalization (OR = 1.19, p  = .02). Younger adults, those with fewer years of education, and those reporting histories of depression were more likely to report recent cannabis use pre- and post-legalization. Other mental illness was associated with cannabis use at post-legalization only. In a multivariate GEE adjusted for sociodemographic characteristics and diagnoses, favoring legalization and the interaction of time and positive health perceptions were associated with a greater likelihood of using cannabis. Conclusions Legalized recreational cannabis use was associated with greater self-reported past 30-day use post-legalization, and with more-positive health perceptions of cannabis use. Future research is needed to examine longer-term perceptions and behavioral patterns following legalization of recreational cannabis use, especially among those with mental illness.

Letter to the Editor In their seminal paper, An overview of health workforce education and accreditation in Africa: implications for scaling-up capacity and quality (Hum Resour Health 20, 37, 2022), the authors call for comprehensive action across the continent to strengthen the standards for professional education. The all-volunteer effort is slower than we believe it should be. [...]we welcome collaborators at https://nursesinternational.org/ who are committed to open education, such as NextGenU.org [3]. Chio K. Effective practice in providing online, in-service training in health professionals in low-resource settings.

If we as a society fail to publish all competent research, we have committed irreparable world-scale malpractice.1 The moral imperative of \"publish or perish\" is now broad and urgent with the advent of easy and prompt publication. If we fail to publish data, the data perish; with data's demise, people (whose clinicians should have had the advantage of knowledge in the literature) suffer and perish, along with the public investment we have made as taxpayers, donors to, participants in and fundraisers for research. Currently configured journals will perish as well, because we will have failed as guarantors of public access to the knowledge the public has earned with their tax dollars and charitable donations.

To identify factors in favor of or against establishing and working in private practice, to determine the quality of life and work-related behavior and experience patterns of German physicians working in private practice, and to analyze the correlation of those factors. A representative sample of physicians in private practice in Schleswig-Holstein, Germany, was surveyed according to a 2-year longitudinal design (T1 - 2008, N = 549 and T2 - 2010, N = 414). The study included 22 items regarding the attractiveness of establishing and working in private practice, and the questionnaires: the Short Form-12 Health Survey (SF-12), and Work-related Behavior and Experience Pattern (Arbeitsbezogenes Verhaltens- und Erlebensmuster - AVEM). Job satisfaction among those private practitioners decreased over time but their willingness to choose the profession once again remained unchanged. Patient care and the continuity of physician-patient relationship encouraged establishing and working in private practice; state regulation, financial risk, and administrative effort weighed against it. At both T1 and T2, physicians scored significantly lower for mental health than general population. About 20% of physicians showed a healthy behavior and experience pattern but 40% of them showed the pattern of reduced working motivation. About 20% of participants were at elevated risk for overexertion and for burnout. Physical and mental health as well as the total distribution of patterns did not change significantly during the 2-year observation period. Physicians at higher burnout risk rated tasks related to patient care considerably less positively than those with healthy pattern. In order to improve job satisfaction and quality of life, and to make private practice more attractive, those German physicians require a) improved legislation, b) educational programs that promote the attractiveness of private practice, and c) highly accessible counseling services for the prevention and treatment of stress, overexertion, and burnout. Int J Occup Med Environ Health 2017;30(3):485-498.

Background Physician-delivered preventive counseling is important for the prevention and management of chronic diseases. Data from the U.S. indicates that medical students with healthy personal habits have a better attitude towards preventive counseling. However, this association and its correlates have not been addressed in rapidly urbanized settings where chronic disease prevention strategies constitute a top public health priority. This study examines the association between personal health practices and attitudes toward preventive counseling among first and fifth-year students from 8 medical schools in Bogotá, Colombia. Methods During 2006, a total of 661 first- and fifth-year medical students completed a culturally adapted Spanish version of the \"Healthy Doctor = Healthy Patient\" survey (response rate = 78%). Logistic regression analyses were used to assess the association between overall personal practices on physical activity, nutrition, weight control, smoking, alcohol use (main exposure variable) and student attitudes toward preventive counseling on these issues (main outcome variable), stratified by year of training and adjusting by gender and medical training-related factors (basic knowledge, perceived adequacy of training and perception of the school's promotion on each healthy habit). Results The median age and percentage of females for the first- and fifth-year students were 21 years and 59.5% and 25 years and 65%, respectively. After controlling for gender and medical training-related factors, consumption of ≥ 5 daily servings of fruits and/or vegetables, not being a smoker or binge drinker were associated with a positive attitude toward counseling on nutrition ( OR = 4.71; CI = 1.6–14.1; p = 0.006 smoking ( OR = 2.62; CI = 1.1–5.9; p = 0.022), and alcohol consumption ( OR = 2.61; CI = 1.3–5.4; p = 0.009), respectively. Conclusion As for U.S. physician and medical students, a positive association was found between the personal health habits of Colombian medical students and their corresponding attitudes toward preventive counseling, independent of gender and medial training-related factors. Our findings, the first relating to this association in medical students in developing regions, also suggest that within the medical school context, interventions focused on promoting healthy student lifestyles can potentially improve future physician's attitudes toward preventive counseling.

Although much has been written about the potential power of the association between physicians' personal health practices and those of their patients, objective studies of this relationship are lacking. We investigated this association using objectively measured health care indicators. We assessed 8 indicators of quality of health care (screening and vaccination practices) for primary care physicians (n = 1488) and their adult patients (n = 1 886 791) in Israel's largest health maintenance organization; the physicians were also patients in this health care system. For all 8 indicators, patients whose physicians were compliant with the preventive practices were more likely (p < 0.05) to also have undergone these preventive measures than patients with noncompliant physicians. We also found that more similar preventive practices showed somewhat stronger relations. For example, among patients whose physician had received the influenza vaccine, 49.1% of eligible patients received flu vaccines compared with 43.2% of patients whose physicians did not receive the vaccine (5.9% absolute difference, 13.7% relative difference). This is twice the relative difference (7.2%) shown for pneumococcal vaccine–eligible patients of influenza-vaccinated versus nonvaccinated physicians (60.9% v. 56.8%). When we examined the rates of unrelated practices, we found that, for example, mammography rates were identical for patients whose physicians did and did not receive the influenza vaccine. We found a consistent, positive relation between physicians' and patients' preventive health practices. Objectively establishing this healthy doctor–healthy patient relation should encourage prevention-oriented health care systems to better support and evaluate the effects on patients of improving the physical health of medical students and physicians.

Objective: To understand predictors of Canadian physicians' prevention counseling practices. Methods: A national mailed survey of a random sample of Canadian physicians conducted November 2007-May 2008. Results: Primary care physicians (n=3,213) responded to the survey (41% response rate); those with better personal health habits, female physicians, and physicians aged 45-64 years old were more likely to report \"usually/always\" counseling patients than did others, but there were no significant differences by province, origin of one's MD degree, or practice location. There was a clear and consistent relationship between personal and clinical prevention practices: non-smokers were significantly more likely to report counseling patients on smoking cessation; those who drank alcohol less frequently, drank lower quantities or binged less often were more likely to counsel on alcohol; those exercising more to counsel patients more about exercise; those eating more fruits and vegetables to counsel patients more often about nutrition; and those with lower weight were more likely to counsel about nutrition, weight or exercise. Physicians who strongly agreed or agreed that \"they will perform better counseling if they have healthy habits\" averaged higher rates of counseling (p<0.001). Conclusions: Personal characteristics of Canadian physicians help predict prevention counseling. These data suggest that by encouraging physicians to be healthy, we can improve healthy habits among their patients -an innovative, beneficent, evidence-based approach to encouraging physicians to counsel patients about prevention. Objectifs : Connaître les prédicteurs du counseling en prévention offert par les médecins canadiens. Méthode : Sondage postal national mené entre novembre 2007 et mai 2008 auprès d'un échantillon aléatoire de médecins canadiens de premier recours. Résultats : Quarante-et-un p. cent des médecins contactés (n=3213) ont répondu au questionnaire. Les répondants ayant de meilleures habitudes de santé, les femmes et les répondants de 45 à 64 ans avaient plus tendance à conseiller leurs patients « habituellement/toujours », mais il n'y avait pas de différences significatives selon la province, l'origine du diplôme de médecine ou le lieu d'exercice. Le lien entre les habitudes personnelles et les pratiques de prévention clinique était clair et systématique : les non-fumeurs avaient significativement plus tendance à conseiller l'arrêt du tabac à leurs patients; les répondants dont la consommation d'alcool était plus faible, moins fréquente ou moins sujette aux excès occasionnels étaient plus susceptibles d'offrir des conseils sur l'alcool; ceux qui faisaient davantage d'exercice physique avaient plus tendance à donner des conseils sur l'exercice physique; ceux qui mangeaient davantage de fruits et légumes avaient plus tendance à donner des conseils de nutrition; et ceux qui n'étaient pas en surpoids avaient plus tendance à donner des conseils sur la nutrition, le poids ou l'exercice physique. Les médecins qui étaient d'accord ou tout à fait d'accord avec l'énoncé « leurs conseils seront meilleurs s'ils ont euxmêmes de saines habitudes » affichaient en moyenne de taux de counseling supérieurs (p<0,001). Conclusion : Les caractéristiques personnelles des médecins canadiens sont des prédicteurs du counseling en prévention. En incitant les médecins à être en bonne santé, il serait possible d'améliorer les habitudes de santé de leurs patients. C'est une approche novatrice, bénéfique et éprouvée pour encourager les médecins à donner des conseils de prévention aux patients.