Occupational and environmental medicine: meeting the growing need for clinical services
Article Abstract:
The need for physicians trained in occupational and environmental medicine is addressed in this article, and strategies for recruiting such specialists are explored. Diseases caused or adversely affected by factors in the environment and workplace are expensive because of the direct and indirect costs, yet, in general, the issues of occupational and environmental disease are not sufficiently recognized. Traditionally in the US, occupational medicine has been the province of graduates of schools of public health; only recently has a clinical specialty in this area been established. Environmental medicine has barely come that far. Practitioners in these areas need to understand how to obtain information concerning occupational exposure and how to diagnose diseases that could result from such exposures. A partial list of these diseases, each associated with certain types of work, includes lung cancer, leukemia, asthma, chronic bronchitis, disorders of the nervous system, kidney failure, and high blood pressure. Specialists need to have broad training in several areas, such as toxicology, industrial hygiene, biostatistics, and epidemiology. As many as 5,500 physicians are needed in occupational and environmental medicine and recruiting them should be of highest priority. The basic approaches to recruitment should include increasing interest in the field; establishing centers where physicians can receive excellent training; integrating environmental medicine with occupational medicine; increasing funding for academic programs and faculty support; financing graduate training; and establishing methods of certification and accreditation of specialists in occupational and environmental medicine. Each of these goals is discussed in detail, with suggestions on how to accomplish them. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1991
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Occupational medicine
Article Abstract:
The areas of occupational medicine most relevant to clinical practice are reviewed, with a focus on conditions not typically covered in a nonspecialized medical journal. The field of occupational medicine is so new that little information is available on the prevalence of many occupational diseases, although silicosis, the most prevalent occupational disease in the world, remains common in the United States. Considerable progress has been made in understanding immunologically caused respiratory problems such as occupational asthma, which is now known to be associated with a long list of causal agents. New evidence suggests that asthma of this sort does not simply disappear when exposure to the agent ends but may instead continue and even progress. Allergic alveolitis ('farmer's lung'), byssinosis (a lung disease of cotton and hemp workers), and beryllium disease, are also discussed. Occupationally caused diseases of the kidney result from exposure to toxins, which are filtered by the kidney, and it is likely that lead and organic solvents can cause renal disease even when present at levels below those recognized as dangerous. A summary of data from several studies indicates a 2.8- to 8.9-fold increased risk for glomerulonephritis in workers exposed to solvents. The effect on formed blood cells by certain agents such as nitrites is well documented, but newer evidence implicates benzene in causing changes in the bone marrow machinery that makes blood cells, leading to myeloproliferative disorders such as leukemia. Benzene substitutes are now suspected of causing some of the same blood disorders they have been developed to prevent. An extensive bibliography is provided. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1990
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Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease
Article Abstract:
Supplemental beta carotene and retinol (vitamin A) may have either no effect or possibly a negative impact on heart disease or lung cancer among heavy smokers and workers exposed to asbestos. Beta carotene is a dietary source of vitamin A thought to lower the risk of cancer. Researchers compared lung cancer rates, heart disease, and overall mortality among 9,420 adults who took supplements and 8,894 adults who took a placebo (the control group). Daily supplements consisted of 30 milligrams of beta carotene and 25,000 IU of retinol in the form of retinyl palmitate. Both groups were at high risk for heart disease and lung cancer due to a history of smoking or work with asbestos. After an average of four years, lung cancer was 28% higher and overall mortality rate was 17% higher in the vitamin group than in the control group. Death from heart complications was 26% higher in the vitamin group, prompting an early discontinuation of the study. The supplemental use of beta carotene raises safety issues, failing to justify public enthusiasm.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1996
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