The earlier IOM committee concluded that (1) the care of individuals with occupationally and environmentally-related exposures and/or conditions requires mastery of a special body of knowledge, skills, and attitudes by the primary care or other first contact physician, and (2) all levels of medical education -- undergraduate, graduate, and continuing education -- are currently deficient in OEM training. Only 66 percent of U.S. medical schools specifically teach occupational medicine as part of the required curriculum; among schools that require such teaching (about half), the mean required curriculum time over 4 years is 4 hours.18 A 1987 Association of American Medical Colleges (AAMC) survey of medical school graduates found that occupational medicine was taken as an elective by only 1.4 percent, the least frequently selected elective reported.19 An AAMC survey in 1988 found that only one of 127 medical schools reported having a required course in environmental health, although 100 schools reported that environmental health concepts were taught in other courses.20A survey of 89 departments of internal medicine with divisions of general internal medicine found that only 20 programs (22 percent) offered clinical occupational medicine experience to medicine residents, elective in almost all cases.21
The deficiency in numbers of academic faculty in occupational and environmental medicine is well-documented. In one survey of 102 medical schools, only 59 percent reported having even a single faculty member with special interests in occupational medicine.22 In another survey of 127 medical schools, only 37 faculty were identified as specializing in occupational medicine.16
Specialty training in occupational medicine at the graduate level is largely confined to the 29 occupational medicine residency training programs approved by the Accreditation Council for Graduate Medical Education (ACGME). Most residency programs are based in either schools of public health or medicine, although some are jointly sponsored by schools of public health and medicine. In some instances trainees have dual status as occupational medicine residents and department of medicine fellows. The ACGME does not accredit any occupational and environmental medicine training as a clinical medical subspecialty. It is estimated that about 70 resident physicians are produced each year who are deemed eligible to sit for the certification examination in occupational medicine by the only extant certifying body, the American Board of Preventive Medicine.
Biological monitoring of chemical exposure in the workplace has become increasingly important in the assessment of health risk as an integral part of the overall occupational health and safety strategy. In environmental medicine biological monitoring plays also an important role in the assessment of excessive, acute or chronic exposure to chemical agents. To guarantee that the results obtained in biological monitoring are comparable with threshold limit values and results from other laboratories, the analysis must be carried out with tested and reliable analytical methods and accompanied by a quality assurance scheme. Confounding influences and interferences during the pre-analytical phase can be minimised by recommendations from experienced laboratories. For internal quality control commercially available control samples with an assigned concentration are used. External quality control programs for biological monitoring are offered by several institutions. The external quality control program of the German Society of Occupational and Environmental Medicine has been organised since 1982. In the meantime the 27th program has been carried out offering 96 analytes in urine, blood and plasma for 47 substances. This program covers most of the parameters relevant to occupational and environmental medicine. About 350 laboratories take part in these intercomparison programs. At present, ten German and 14 international laboratories are commissioned to determine the assigned values. The data evaluated from the results of the intercomparison programs give a good overview of the current quality of the determination of analytes assessed in occupational and environmental toxicological laboratories. For the analysis of inorganic substances in blood and urine the tolerable variation ranges from 7.5 to 43.5%. For organic substances in urine the tolerable variation ranges from 12 to 48%. The highest variations (36-60%) were found for the analysis of organochlorine compounds in plasma. The tolerable variations for the determination of solvents in blood by head space gas chromatography range from 26 to 57%. If the recommendations for the pre-analytical phase, the selection of reliable analytical methods by the laboratory and the carrying out of adequate quality control are observed, the pre-requisites for reliable findings during biological monitoring are fulfilled
A thorough, concise, up-to-date guide to the diagnosis and treatment of common occupational and environmental injuries and diseasesCoverage includes:Chapters on how to conduct an occupational and environmental medical history, examine the patient, evaluate exposures, and prevent further injury and illnessNew methods of disability management and the important role that physicians can play in preventing disabilityPractical information on the toxic properties and clinical manifestation of common industrial materialsTechniques to prevent acute and cumulative workplace-related injuriesDetailed discussion of international occupational and environmental health, and issues of worker migrationAn appendix that concisely introduces the important topics of biostatistics and epidemiologyLANGEThe definitive overview of common occupational and environmental illnessesNEW CHAPTERS on electronic health records, the management of chronic pain, violence in the workplace, terrorism preparedness, disease surveillance, and chemical policyValuable to practicing physicians as well as students and residents
Environmental medicine is a multidisciplinary field involving medicine, environmental science, chemistry and others, overlapping with environmental pathology. It can be viewed as the medical branch of the broader field of environmental health. The scope of this field involves studying the interactions between environment and human health, and the role of the environment in causing or mediating disease. This specialist field of study developed after the realisation that health is more widely and dramatically affected by environmental factors than previously recognized.
In the United States, the American College of Occupational and Environmental Medicine (OCOEM) oversees board certification of physicians in environmental (and occupational) medicine. This board certification isn't recognized by the American Board of Medical Specialties.
Environmental medicine is concerned primarily with prevention. Food-borne infections or infections that are water-borne (e.g. cholera and gastroenteritis caused by norovirus or campylobacteria) are typical concerns of environmental medicine, but some opinions in the fields of microbiology hold that the viruses, bacteria and fungi that they study are not within the scope of environmental medicine if the spread of infection is directly from human to human. Much of epidemiology, which studies patterns of disease and injury, is not within the scope of environmental medicine, but e.g. air pollution epidemiology is a highly active branch of environmental health and environmental medicine. Any disease with a large genetic component usually falls outside the scope of environmental medicine, but in diseases like asthma or allergies both environmental and genetic approaches are needed.
The U.S. Army has, since at least 1961, used the term \"environmental medicine\" in a sense different from the above. Its U.S. Army Research Institute of Environmental Medicine, at Natick, Massachusetts, conducts basic and applied research to determine how exposure to extreme heat, severe cold, high terrestrial altitude, military occupational tasks, physical training, deployment operations, and nutritional factors affect the health and performance of military personnel. Research on the effect of environmental pollutants on military personnel is not part of USARIEM's mission, but is within the purview of the U.S. Army Center for Environmental Health Research at Fort Detrick, Maryland.
Experts in occupational medicine can help prevent workers from becoming sick or injured on the job. They can also help workers achieve the best possible recovery if they are sick or injured on the job. Trained staff can also assist both the worker and their family with the stress caused by being sick or injured on the job.
Experts in occupational medicine can help prevent your employees from becoming sick or injured on the job. They can also help your employees who are sick or injured on the job achieve the best possible recovery, and can assist in ensuring that your workers return to work safety by identifying alternative, \"light-duty\" and work restriction programs. Specialty services include: occupational illness and injury prevention education, medical surveillance examinations, respirator fit testing and clearance examination, fit for duty examinations and a variety of wellness safety programs.
The clinics are a resource for health care providers treating patients with potential work-related illnesses and injuries. The OHCN is available for consultation or referral of patients with occupational diseases or injuries. They have diverse treatment teams of physicians, nurses, industrial hygienists and social workers that assist providers in assessing and managing their patients' work-related conditions and, if necessary, provide worksite and social work interventions. The OHCN's board certified occupational medicine physicians and staff are also experts in dealing with the Workers' Compensation system a