Needs, education and accreditation in occupational medicine in Italy

In Europe, continuing medical education is one of the main instruments for improving physicians performance and ensuring adequate health care for citizens. Recent regulations have made such continuing education compulsory in Italy. Considering the particular features of occupational medicine, the Italian Society of Industrial Medicine and Industrial Hygiene (S.I.M.L.I.I.) recently set up a specific education and accreditation programme for occupational physicians, called the Excellence Accreditation Scheme. The programme is based on the findings of a survey among occupational physicians, carried out in collaboration with the National Institute of Occupational Safety and Prevention (I.S.P.E.S.L.), which enquired into their training and continuing education needs. The programme started in 2003, and its first edition—presented here—involved more than 400 physicians specialising in occupational health.     

Integrating occupational health and safety into the health education classroom.

Given the startling number of job-related illnesses and injuries which occur every year, occupational health and safety, a hitherto neglected topic, deserves significant attention in the school health education curriculum. Youngsters need to be exposed to this field before they become indifferent or callous toward diseases and accidents in the workplace and while the opportunity still exists to weight health and safety considerations in selecting a career. In addition, when students take up regular employment, they cannot rely on industry, government, or organized labor to protect them fully from occupational illnesses and accidents; they must possess the skills and attitudes necessary to safeguard themselves. Occupational health and safety education in the schools can focus on general awareness, skill development, and job-specific information. The field can be easily and appropriately integrated with a number of current health education topics. Examples of integration are provided for eleven typical areas of a school health education curriculum.     

Time accounting in community medicine education

This paper describes the approach used by the Department of Community Medicine of the Mount Sinai School of Medicine in the formulation of personnel time requirements for undergraduate medical education. The results presented reveal that the two required undergraduate courses utilize a total of 5627 hours of faculty and support staff time. Implications of this method are discussed for program budgeting in medical education and the use of various course methods (e.g., lecture, seminar, tutorial).     

Vinyl chloride: its impact on occupational medicine practice in Iran

Upon the establishment of a positive relationship between occupational exposure to VCM and angiosarcoma of the liver, strict precautionary measures for the protection of VCM exposed employees in the Abadan Petrochemical Company have been instituted. All such workers have been required to have pre-employment and annual medical examinations with emphasis on liver functions. Among 43 such employees who have undergone regular medical evaluation in the past three years, no instance of liver dysfunction of angiosarcoma has been discovered. The Iranian Standards Institute reviewing occupational health data and local conditions provisionally set in 1976 a TLV of VCM of 25 ppm TWA for 8 hours with revision foreseen for 1977. It is believed that such precautionary measures should be revised and improved according to available data and knowledge and that variations in other environmental and local factors which may well play an important role in the potential pathogenicity of the exposure should be carefully considered in determining the extent of the precautionary measures and standards in each locality.     

Persistence, planning, patience, and prevention: aspects of sex education in medicine.

This paper emphasizes the rapid response of American medical schools to the absence of sex education in their curricula, which has led to diversity of design, strategy, and evaluation of human sexuality courses. It further points out that most such courses are inadequate to teach physicians knowledge and skills that will be required when they leave medical school. Major areas of resistance to full implementation of comprehensive sex education programs are cited, with one method outlined to overcome institutional resistance. The authors cite case examples of the variety of sexual conflicts that become accessible in students and faculty as a result of such instruction. They suggest that groups of persons who are sexually knowledgeable and possess counseling skills in sex therapy could greatly improve sex education in the medical institution.     

Future impact of genetic screening in occupational and environmental medicine

New genetic technologies open up the possibility of predictive screening, both for individual genetic risk factors for susceptibility to workplace hazards and for late onset (both single gene and multifactorial) hereditary disease. Although the initiative for testing may lie with employers and employees there are many potential stakeholders--from family members and workplace colleagues to insurers and society in general. The role of the occupational health professional will not only involve the contextual interpretation of genetic test results but also the myriad of associated ethical and moral questions. This paper considers a range of ethical issues with which the occupational health professional may be confronted as genetic technology advances.

 

     

Aeroallergens, allergic rhinitis, and sedating antihistamines: risk factors for traumatic occupational injury and economic impact

BACKGROUND: The U.S. workplace injury burden is significant. Our objective was to assess the particular impact of aeroallergen, allergic rhinitis, and antihistamine exposures and side effects on the risk of traumatic work-related injuries, and the associated economic impact. METHODS: This is an observational case-control study with 1,223 acute traumatic injury cases that are compared to 1,202 chronic back injury controls. Structured telephone interviews were conducted in 1998 and 1999 on Workers' Compensation applicants injured in 1997. Antihistamine use and pollen levels were measured 2 weeks prior to the injury date. RESULTS: Sedating antihistamine exposures elevated acute injury risk (main effect OR: 2.93). A significant increase in traumatic injury risk was observed for combined sedating antihistamine and high pollen exposures among subjects with physician and self-diagnosed allergic rhinitis (OR: 2.41). Direct medical costs associated with this increased risk were estimated at $143 million in 2001. CONCLUSIONS: Workers with physician-diagnosed allergic rhinitis have as high a reliance on sedating antihistamines as do self-diagnosed and self-medicating nasal allergy sufferers. High pollen exposures along with sedating antihistamine use may confer significant additional injury risks among allergic rhinitis sufferers. Medical management "best practices" of diagnosed allergic rhinitis should include avoidance of sedating antihistamines to minimize acute, traumatic injury risks.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Learning objectives for training and continuing education in occupational medicine.

Occupational medicine (OM) training programs apparently vary more in content and practice skills than other medical special training programs. This variation appears to exist both within programs, in that individual trainees in some programs may engage in very different experiences, and between programs. Some variation is not necessarily undesirable, considering the multiplicity of professional roles, the eclectic backgrounds of many residents, and the diversity of points of view in each of the specialties. However, excessive variation in medical content and practice skills in the training experience may result in uneven training and, in fact, undermines the integrity of the specialty. A consensus on core content and skills for specialty training might help. A consensus would help physicians to judge their own level of preparation in order to decide to participate in further training and continuing education programs. I prepared a model set of objectives for occupational medicine under the auspices and with the endorsement of the American College of Preventive Medicine. Further evaluation can refine the objectives, implement use of the objectives in formal training programs, and assess the utility of the format for other preventive medicine specialties.     

The community in the classroom: designing a distance education community health course for nurses in Solomon Islands

In 1994 in order to improve educational opportunities for nurses in the Solomon Islands and to try the distance learning model as an educational method, the Distance Education Programme of the Ministry of Health implemented five post basic nursing certificate courses for health workers. This paper focuses on issues and experiences in the development of the Community Health course which in some ways as the most difficult of the courses to prepare. As in many Pacific Island countries, the geographic context of Solomon Islands creates isolated working situations for rural health practitioners, with difficult and limited communications. Each module in the course consists of a study guide with glossary and in-text questions, hand-outs, and an assignment. Videos are available to accompany several units and practical teaching aides are also given. Audiotapes for teaching sessions are currently being developed. The benefits of the distance education model offered in this course are discussed in detail and attention is drawn to some of the difficulties encountered. Overall, the outcome of the trial of this method has been highly successful.     

Alaska's model program for surveillance and prevention of occupational injury deaths

The National Institute for Occupational Safety and Health (NIOSH) established its Alaska Field Station in Anchorage in 1991 after identifying Alaska as the highest-risk state for traumatic worker fatalities. Since then, the Field Station, working in collaboration with other agencies, organizations, and individuals, has established a program for occupational injury surveillance in Alaska and formed interagency working groups to address the risk factors leading to occupational death and injury in the state. Collaborative efforts have contributed to reducing crash rates and mortality in Alaska's rapidly expanding helicopter logging industry and have played an important supportive role in the substantial progress made in reducing the mortality rate in Alaska's commercial fishing industry (historically Alaska's and America's most dangerous industry). Alaska experienced a 46% overall decline in work-related acute traumatic injury deaths from 1991 to 1998, a 64% decline in commercial fishing deaths, and a very sharp decline in helicopter logging-related deaths. Extending this regional approach to other parts of the country and applying these strategies to the entire spectrum of occupational injury and disease hazards could have a broad effect on reducing occupational injuries.