(BQ) Part 1 book “Current occupational and environmental medicine” has contents: The practice of occupational medicine, international occupational and environmental health, migration and occupational health, the occupational & environmental medical history, electronic health records,…. And other contents.
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Trang 6Contents
AuthorsPreface
Section I Occupational Health
1 The Practice of Occupational MedicineJoseph LaDou, MS, MDRobert J Harrison, MD, MPH2 International Occupational and Environmental HealthJoseph LaDou, MS, MD3 Migration and Occupational HealthMarc B Schenker, MD, MPH4 The Occupational & Environmental Medical HistoryRobert J Harrison, MD, MPHKaren B Mulloy, DO, MSCH
5 Electronic Health Records
Sachin Kapoor, DO, MBA, MPH
6 Workers’ Compensation
Trang 77 Disability Management & Prevention
Jordan Rinker, MD, MPH
Robert Eric Dinenberg, MD, MPHMauro Zappaterra, MD, PhDGlenn Pransky, MD, MOH
Trang 8Peter D Lichty, MD, MOH
15 Ergonomics & the Prevention of Occupational Injuries
David M Rempel, MD, MPHIra L Janowitz, MPS, PT, CPE
Section III Occupational Illnesses16 Medical ToxicologyTimur S Durrani, MD, MPH, MBAKent R Olson, MD17 Clinical ImmunologyJeffrey L Kishiyama, MD18 Occupational HematologyMichael L Fischman, MD, MPHHope S Rugo, MD19 Occupational CancerMichael L Fischman, MD, MPHHope S Rugo, MD20 Occupational InfectionsTimur S Durrani, MD, MPH, MBARobert J Harrison, MD, MPH21 Occupational Skin DisordersKazeem B Salako, MBBS, MRCP
Mahbub M.U Chowdhury, MBChB, FRCP
Trang 10Robert J Harrison, MD, MPH32 SolventsRobert J Harrison, MD, MPHRachel Roisman, MD, MPH33 Gases & Other Airborne ToxicantsWare G Kuschner, MDPaul D Blanc, MD, MSPH34 PesticidesMichael A O’Malley, MD, MPH
Section V Program Management
35 Occupational Mental Health & Workplace Violence
Marisa Huston, MA, MFTRobert C Larsen, MD, MPH
36 Substance Use Disorders
Marisa Huston, MA, MFTStephen Heidel, MD, MBA
37 CBRNE Preparedness
Marek T Greer, MD, MPHRichard Lewis, MD, MPH
38 Occupational Safety
Peter B Rice, CSP, CIH, REHS
39 Industrial (Occupational) Hygiene
Trang 1140 Disease SurveillanceA Scott Laney, PhD, MPHEileen Storey, MD, MPH41 Medical SurveillanceJames Craner, MD, MPH42 Biologic MonitoringRupali Das, MD, MPH
Section VI Environmental Health
Trang 13Authors
Mohana Amirtharajah, MD
Assistant Professor
Hand and Upper Extremity SurgeryDepartment of Orthopedic SurgeryUniversity of California, San Franciscoamirtharajahm@orthosurg.ucsf.edu
Chapter 9
John R Balmes, MD
Professor of Medicine
University of California, San FranciscoProfessor of Environmental Health SciencesSchool of Public Health
Director, Northern California Center for Occupational and EnvironmentalHealthUniversity of California, Berkeleyjohn.balmes@ucsf.eduChapters 23 & 46Neal L Benowitz, MD
Professor of Medicine and Bioengineering and Therapeutic SciencesChief, Division of Clinical Pharmacology
University of California, San Francisconbenowitz@medsfgh.ucsf.edu
Trang 14Paul D Blanc, MD, MPH
Chief, Division of Occupational and Environmental MedicineUniversity of California, San Francisco
paul.blanc@ucsf.edu
Chapter 33
Mahbub M.U Chowdhury, MBChB, FRCP (UK)
Consultant in Occupational DermatologyDepartment of Dermatology
University of Hospital of WalesCardiff, Wales, United Kingdomm.chowdhury1@sky.comChapter 21Diana Coffa, MDHealth Sciences Assistant Clinical ProfessorSchool of MedicineUniversity of California, San Franciscodcoffa@fcm.ucsf.eduChapter 11James Craner, MD, MPH
Assistant Clinical Professor
Division of Occupational and Environmental MedicineUniversity of California, San Francisco
jcraner@drcraner.com
Chapters 6 & 41
Rupali Das, MD, MPH
Assistant Clinical Professor
University of California, San FranciscoExecutive Medical Director
Trang 15Department of Industrial RelationsSacramento, California
rdas@dir.ca.gov
Chapters 42 & 45
Alexis Descatha, MD, PhD
Associate Professor, Occupational Health
INSERM, Centre for Research in Epidemiology and Population Healthalexis.descatha@inserm.fr
Chapter 9
Michael J Dibartolomeis, PhD
Chief, Exposure Assessment SectionCalifornia Department of Public HealthRichmond, California
michael.dibartolomeis@cdph.ca.gov
Chapter 50
Robert Eric Dinenberg, MD, MPH
Chief Medical Officer, Viridian Health Management
Executive Director, Viridian Institute for Applied Health Improvementwww.viahi.orgedinenberg@yahoo.comChapter 7Robert Dobie, MDUC Davis Health SystemDepartment of OtolaryngologySacramento, Californiaradobie@ucdavis.eduChapter 13
Timur S Durrani, MD, MPH, MBA
Trang 16University of California, San Franciscodurranit@medsfgh.ucsf.eduChapters 16, 20, & 24Michael L Fischman, MD, MPHClinical ProfessorDivision of Occupational and Environmental MedicineDepartment of MedicineUniversity of California, San Franciscomichael.fischman@fischmanmed.comChapters 18, 19, & 47Allan J Flach, MD, PharmDDepartment of OphthalmologyUniversity of California, San Franciscoflacha2@vision.ucsf.eduChapter 12Marek T Greer, MD, MPH
Associate Medical DirectorBattelle Memorial InstituteColumbus, Ohio
marektgreer@sbcglobal.net
Chapter 37
Robert J Harrison, MD, MPH
Clinical Professor of Medicine
Division of Occupational and Environmental MedicineUniversity of California, San Francisco
robert.harrison@ucsf.edu
Chapters 1, 20, 25, 31, 32, & 49
Stephen Heidel, MD, MBA
Trang 17School of Medicine
University of California, San Diegostephen.heidel@sbcglobal.net
Chapter 36
German T Hernandez, MD, FASN
Assistant Professor of MedicineDepartment of Internal MedicineDivision of NephrologyTexas Tech University Health Sciences CenterEl Paso, Texasgerman.hernandez@ttuhsc.eduChapter 26
Marisa Huston, MA, MFT
Mental Health Coordination ServicesDean of Students Office
University of California, Santa Barbaramarisa.huston@sa.ucsb.edu
Chapters 35 & 36
Ira L Janowitz, MPS, PT, CPE
Senior Ergonomics ConsultantBerkeley Ergonomics Program
University of California, San Franciscojanowitz@comcast.net
Chapter 15
Sarah Janssen, MD, PhD, MPH
Assistant Clinical Professor
University of California, San Franciscosarah.janssen@ucsf.edu
Trang 18Sachin Kapoor, DO, MBA, MPH
Medical Director Employee HealthThe Permanente Medical GroupWalnut Creek, Californiasachin.kapoor@kp.orgChapter 5Jeffrey L Kishiyama, MDAssociate Clinical Professor of MedicineDepartment of ImmunologyUniversity of California, San Franciscojkish@itsa.ucsf.eduChapter 17Michael J Kosnett, MD, MPH
Adjunct Associate ProfessorColorado School of Public HealthUniversity of ColoradoDenver, Coloradomichael.kosnett@ucdenver.eduChapter 30Ware G Kuschner, MD
Associate Professor of Medicine
Division of Pulmonary and Critical Care MedicineStanford University School of Medicine
Stanford, Californiakuschner@stanford.edu
Chapter 33
Joseph LaDou, MS, MD
Clinical Professor Emeritus
Trang 19University of California, San Franciscodrjoeladou@gmail.com
Chapters 1, 2, 4, & 6
Anthony S Laney, PhD, MPH
Epidemiologist
Surveillance Branch, Division of Respiratory Disease StudiesNational Institute for Occupational Safety and Health
Morgantown, West Virginiaalaney@cdc.govChapter 40Robert C Larsen, MD, MPHClinical ProfessorDepartment of PsychiatryUniversity of California, San Franciscorlarsen@occupationalpsych.comChapter 35Richard Lewis, MD, MPHOccupational Medicine and ToxicologyCleveland, Ohiooccdoclewis@aol.comChapters 30 & 37
Peter D Lichty, MD, MOH
Health Services Department
Trang 20University of California, San Franciscoluka@orthosurg.ucsf.eduChapters 8 & 10C Benjamin Ma, MDAssociate ProfessorDepartment of OrthopedicsUniversity of California, San FranciscoChapters 8 & 10Melanie Marty, PhD
Assistant Deputy Director for Scientific AffairsOffice of Environmental Health Hazard AssessmentSacramento, California
melanie.marty@oehha.ca.gov
Chapter 45
Wolf Mehling, MD
Associate Professor of Medicine
University of California, San Franciscomehlingw@ocim.ucsf.edu
Chapter 11
Karen B Mulloy, DO, MSCH
Associate Professor
Case Western Reserve University School of MedicineSwetland Center for Environmental Health
karen.mulloy@case.edu
Chapter 4
Kent R Olson, MD
Clinical Professor of Medicine, Pediatrics, and PharmacyUniversity of California, San Francisco
Trang 21Chapter 16
Michael A O’Malley, MD, MPH
Medical Director
Occupational Health ServiceUniversity of California, Davismaomalley@ucdavis.edu
Chapter 34
Glenn Pransky, MD, MOH
Associate Professor
Tufts University School of MedicineDirector, Center for Disability ResearchLiberty MutualHopkinton, Massachusettsglenn.pransky@LibertyMutual.comChapter 7David M Rempel, MD, MPHProfessor of Medicine
Division of Occupational and Environmental MedicineUCSF Ergonomics Program
University of California, San Franciscodavid.rempel@ucsf.edu
Chapters 9 & 15
Peter B Rice, CIH, CSP, REHS
Manager of Safety, Health, and Environmental ProgramsAhtna Netiye’, Inc.
Sacramento, Californiaprice@ahtna.net
Chapter 38 & 39
Trang 22Associate Clinical Professor
Division of Occupational and Environmental MedicineSan Francisco, Californiajrinker@speakeasy.orgChapter 7Rudolph A Rodriguez, MDVA Puget Sound Health Care, Renal Dialysis UnitSeattle, Washingtonrudy.redriguez@va.govChapter 26Rachel Roisman, MD, MPH
Assistant Clinical Professor
Division of Occupational and Environmental MedicineUniversity of California, San Francisco
rachel.roisman@cdph.ca.govrroisman@gmail.com
Chapter 32
Hope S Rugo, MD
Clinical Professor of Medicine
Director, Breast Oncology Clinical Trials ProgramUCSF Comprehensive Cancer Center
University of California, San Franciscohrugo@medicine.ucsf.edu
Chapters 18 & 19
Kazeem B Salako, MBBS, MRCP
Trang 23Chapter 21
Marc B Schenker, MD, MPH
Professor and Director
Center for Occupational and Environmental Health
Co-director, UC Global Health Institute, Center of Expertise on Migrationand Health
Department of Public Health SciencesUniversity of California, Davis
mbschenker@ucdavis.edu
Chapter 3 & Appendix A
Megan R Schwarzman, MD, MPH
Environmental Health Scientist
Center for Occupational and Environmental Health
Associate Director, Berkeley Center for Green ChemistryUniversity of California, Berkeley
mschwarzman@berkeley.edu
Chapter 44
Dennis J Shusterman, MD, MPH
Clinical Professor of Medicine
Division of Occupational and Environmental MedicineUniversity of California, San Francisco
dennis.shusterman@cdph.ca.gov
Chapter 22
Yuen T So, MD, PhD
Professor, Neurology and Neurological SciencesDepartment of Neurology and NeurosciencesStanford University Medical Center
Trang 24Chapter 27
Gina M Solomon, MD, MPH
Deputy Secretary for Science and HealthOffice of the Secretary
California Environmental Protection AgencySacramento, California
gsolomon@calepa.ca.gov
Chapter 43
Craig Steinmaus, MD, MPH
Public Health Medical Officer III
Pesticide and Environmental Toxicology BranchOffice of Environmental Health Hazard AssessmentSacramento, California
craig.steinmaus@oehha.ca.gov
Chapter 48
Eileen Storey, MD, MPH
Chief, Surveillance Branch
Division of Respiratory Disease Studies
National Institute for Occupational Safety and HealthMorgantown, West Virginia
estorey@cdc.gov
Chapter 40
Marilyn C Underwood, PhD
Director of Environmental HealthContra Costa County
Martinez, California
marilyn.underwood@hsd.cccounty.us
Chapter 45
Trang 25Director, Labor Occupational Health ProgramCenter for Occupational and Environmental HealthSchool of Public HealthUniversity of CaliforniaBerkeley, Californiampwilson@berkeley.eduChapter 44Mauro Zappaterra, MD, PhD
Physical Medicine and RehabilitationLos Angeles, California
maurozappaterra@gmail.com
Trang 26Preface
The Fifth Edition of Current Occupational & Environmental Medicine
continues to serve as a concise yet comprehensive resource for health careprofessionals in all specialties who diagnose and treat occupational andenvironmental injuries and illnesses.
COVERAGE & APPROACH TO THE SUBJECT
The book provides a complete guide to common occupational andenvironmental injuries and illnesses, their diagnosis and treatment, andpreventive measures in the workplace and community Our aim is to helphealth care professionals understand the complexities of occupational andenvironmental health issues and provide useful clinical information oncommon illnesses and injuries The book contains many new chapters,expanding the coverage of occupational and environmental medicine wellbeyond that of the earlier editions To enhance the book’s usefulness as aclinical resource, it is published in the Lange® Current series The seriesconsists of practical, concise, and timely books in core specialties and keysubspecialties that focus on essential diagnostic and treatment information.
SPECIAL AREAS OF EMPHASIS
• Detailed coverage on the diagnosis and treatment of a broad spectrum ofoccupational and environmental injuries and illnesses.
• Chapters on how to conduct an occupational and environmental history,perform a physical examination, and prevent further injury.
Trang 27• Practical information on the toxic properties and clinical manifestations ofcommon industrial materials.
• Techniques to prevent workplace-related injuries and illnesses through theapplication of ergonomic principle.
ORGANIZATION & HIGHLIGHTS OF EACHSECTION
Section I (Chapters 1 through 7) define the practice of occupational andenvironmental medicine and introduce the health care provider to thediagnosis of occupational injuries and illnesses These chapters offerguidance for identifying workplace and community exposures to toxicmaterials—putting this information to immediate clinical use and applying ittoward better health and safety practices in the workplace This sectionpresents a comprehensive discussion of disability prevention andmanagement, and considers the important issues in the international practiceof occupational and environmental medicine.
Section II (Chapters 8 through 15) concisely discusses commonoccupational injuries and their treatments Noise-induced hearing loss and theimpact of other physical hazards, such as heat, cold, and radiation areexamined This section also discusses how ergonomic principles can beinstituted in the workplace to prevent further work loss associated with injuryand illness The chapter on management of chronic pain is an important newaddition to the book.
Section III (Chapters 16 through 29) is a comprehensive discussion ofclinical toxicology arranged by organ system, with special emphasis on theenvironmental as well as workplace origins of toxic exposure It thoroughlyreviews commonly recognized environmental and occupational illnesses andhighlights many clinical problems not often thought to be work related.
Trang 28Section V (Chapters 35 through 42) presents the roles and responsibilitiesof the industrial hygienist and the safety professional Chapters onoccupational mental health and workplace violence, and substance usedisorders present programs for controlling and treating these problems.
Section VI (Chapters 43 through 50) provides a comprehensive discussionof environmental medicine and some of the complex societal issues thataccompany industrialization and technologic advances throughout the world.Emphasis is placed on recognizing that some common “occupational”exposures are found also in homes and public locations and require the samehigh index of suspicion that is assumed when encountered in the workplace.
The Appendix concisely introduces biostatistics and epidemiology These
Trang 29ACKNOWLEDGMENTS
This book brings together UCSF faculty with a combined experience of 40years of teaching occupational and environmental medicine, and manygraduates of the program now working in public health agencies and othercampuses I also welcome the new co-editor, Robert J Harrison, MD, MPH,whose considerable contributions to the former editions of the book uniquelyqualify him to take on this role.
Trang 311The Practice of Occupational Medicine
Joseph LaDou, MS, MDRobert J Harrison, MD, MPH
The Occupational Safety and Health Act of 1970 (OSHAct) ensures “everyworking man and woman in the United States safe and healthful workingconditions.” This act created the Occupational Safety and HealthAdministration (OSHA) and the National Institute for Occupational Safetyand Health (NIOSH) At the time the OSHAct was passed, occupationalmedicine was one of the country’s smallest medical specialties, with only afew residency-trained specialists in academic positions, consulting practices,or employed by major corporations Private practitioners provided care foroccupational injuries, sometimes in industrial settings, but mostly as a part ofother services provided in a private office or hospital setting.
As a result of passage of the OSHAct and formation of OSHA andNIOSH, occupational medicine became the center of considerable attentionby medical schools, hospitals, clinics, and physicians from many differentspecialties The opportunities for public health practice, union-based clinicalcare, and independent consulting created new career opportunities formedical students Medical schools received financial support for trainingfrom NIOSH, and OSHA gave occupational physicians a voice in theincreasingly regulated industrial setting.
OPPORTUNITIES IN OCCUPATIONALMEDICINE
Trang 32Moreover, the IOM reports a severe shortage of frontline primary carephysicians who are willing and able to care for patients with occupational andenvironmental illnesses The IOM concludes that data from the Bureau ofLabor Statistics (BLS) are significant underestimates of occupationaldiseases, which emphasizes the need for more and better diagnoses ofoccupational diseases by primary care practitioners The IOM recommendsthat “all primary care physicians be able to identify possible occupationallyor environmentally induced conditions and make appropriate referrals forfollow-up.”
Since passage of the OSHAct, US employment has more than doubled,from 56 million workers at 3.5 million work sites to 130 million workers atnearly 8 million work sites Most of the labor force expansion during thisperiod was in service sector companies with fewer than 500 employees.Although these companies are not likely to employ occupational physicians,they do add to the demand for injury and illness care as well as for health andsafety consulting Employers expect to hire almost 500 occupationalphysicians over the next 5 years and are looking for residency-trainedspecialists Skills in evidence-based clinical evaluation and treatment,determining fitness for work, and worker and management communicationsare the most important technical skills needed by employers The estimatednumber of occupational physicians that employers expect to hire over thenext 5 years is substantially higher than the number estimated to be producedfrom current training programs Opportunities in occupational medicine, andin the increasingly important specialty of environmental medicine, vary byregion There are many industrial areas with an established medicalcommunity serving their needs, yet in other areas there are growing industrialcorridors very much in need of occupational physicians.
Occupational Medical Practice
Trang 33ranking the workplace as the eighth leading cause of death Since the early1970s, more than 113,000 worker deaths have been attributed topneumoconioses This number represents only a small portion of the totaldeaths attributable to occupational lung disease The number of deaths fromasbestos-related mesothelioma has been increasing steadily in the same timeperiod, as are deaths with hypersensitivity pneumonitis as an underlying orcontributing cause Asthma is now the most common occupationalrespiratory disease Population-based estimates suggest that approximately15% of new-onset asthma in adults is work-related.
The human costs associated with occupational injuries and illnesses arestaggering Financial costs of occupational injuries and illnesses exceed $250billion per year The medical and indirect costs of occupational injuries andillnesses are at least as large as the cost of cancer.
Workers’ compensation law places the occupational physician in acritically important role The physician must determine that an injury orillness is caused by work, diagnose the condition, prescribe care, and assessthe extent of impairment and the ability of the worker to resume work Insome instances, determinations that injuries or illnesses are the result of workmay be contentious and require the physician to determine causation andprovide an opinion in the legal setting.
Occupational physicians play an important role in prevention, recognition,and treatment of injuries and illnesses In some regions, occupationalphysicians customarily are employed by corporations More recently, it hasbecome the practice of corporations to contract with occupational physiciansto act as their consultants These consultants increasingly become involved inissues of environmental as well as occupational health Most workplaceinjuries and illnesses, however, are attended by private practitioners in clinicand hospital settings This is a function of the framework of the workers’compensation systems within each state.
Trang 34practice in this highly specialized area of workers’ compensation.
Recognition of Occupational Injury & Illness
It is a disconcerting fact that workers’ compensation fails to compensate mostoccupational injuries and illnesses, including fatalities Only a small fractionof occupational diseases is covered by workers’ compensation, and only asmall fraction of people suffering from occupational illnesses ever receivesworkers’ compensation benefits Either by law or by practice, compensationin many states is particularly limited for occupational diseases A recent studysuggests that workers’ compensation insurance absorbs only 21% of the truecosts of occupational injuries and illnesses.
Many workers’ compensation laws now prevent or discourage therecognition of occupational diseases The efforts of many industries and theirinsurers to deny claims lead to the failure to compensate workers who haveoccupational diseases Another important contributing cause is the limitedinformation available to physicians Of the tens of thousands of chemicals incommon commercial use in the United States each year (3000 of them inquantities of > 1 million pounds per year), only 7% have been screened fortoxicity, and fewer than half of those have been studied thoroughly Althoughinterest in occupational medicine is increasing across the country, the failureto diagnose occupational diseases and the lack of proper compensation ofworkers continue to be major social policy failures.
More than half a million chemicals are found in work settings, and manymillions of workers are exposed to these substances Yet only 10,000workers’ compensation claims for illnesses caused by chemical exposure arefiled each year Workplace exposure to carcinogens accounts for about 5–10% of all cancer cases, yet fewer than 0.1% of cancer patients ever receiveany settlement from employers For example, NIOSH estimates that 16–17%of lung cancer cases in men and 2% of cases in women are work-related.
Trang 35Teaching Occupational Medicine
The majority of physicians who practice occupational medicine in the privatepractice setting do so with the knowledge gained by self-study, attendance atshort courses, and practice experience A lack of training in occupationalmedicine may account for some of the failure to diagnose occupationaldiseases and eventually to compensate workers Traditional public healthapproaches are infrequent in many such practices Moreover, the long latencyperiods of many occupational diseases present a causation dilemma both forphysicians and for insurers Time constraints and knowledge may hamper theability to recognize common work-related conditions such as work-relatedasthma, and concerns regarding the effect of the diagnosis on the patient’s joband income may discourage reporting.
Occupational medicine in recent years is receiving an increasing emphasisin medical schools Faculty that had limited opportunity for research andteaching in occupational medicine at most medical schools now find anumber of new positions through the avenue of environmental health Thisdynamic advancement is largely the result of academic achievements in theUnited States where fundamental research in both fields appears to beexpanding In a survey of European medical schools, on the other hand, amean number of 25.5 hours was given to formal instruction in occupationalmedicine to medical undergraduates Occupational diseases and principles ofprevention are covered in most schools, while disability and return to workare very poorly represented among the topics that were taught to students.The teaching of occupational medicine to undergraduates in the UnitedKingdom has declined, with fewer schools now providing lectures, projectwork, or ward-based tuition in this subject However, the success of addingenvironmental medicine to occupational is now beginning to be recognizedthroughout the world in both teaching and research venues.
Residency and Other Training
Trang 36training programs with specialized training in disciplines that includeoccupational medicine, occupational health nursing, industrial hygiene,occupational safety, and other closely related occupational safety and healthfields of study.
Most training programs in occupational medicine are associated withuniversities that have schools of public health, but some programs are foundwithin specific departments (eg, preventive medicine, community medicine,internal medicine, or family practice) within a medical school There are 25approved residency programs in the United States The annual number ofgraduates from each residency program averages only slightly greater thantwo This small number does not answer the requirement for academicallytrained occupational physicians, nor does it fill the vacancies in public healthdepartments in many areas of the country.
Board Certification
Board-certified physicians generally have more diverse practice activities andskills, with greater involvement in management, public health–orientedactivities, and toxicology The American Board of Preventive Medicine(ABPM) began board certification of specialists in occupational medicine in1955 ABPM has certified a total of 4047 occupational physicians through2013 Fewer than half of these board-certified occupational physicians arecurrently in practice Although occupational medicine is the most popular ofthe ABPM certifications, it remains one of medicine’s smallest specialties.Applicants for board certification peaked at 331 in 1996 Fewer than half thatnumber applied for board certification in 2013 The number of occupationalphysicians certified by ABPM is not replacing the losses to retirement orretreats from the field In 2012, 86 of 119 physicians (a pass rate of 72%)passed the board certification examination This small supply of new board-certified specialists is far below that which would be required merely toreplace the loss by retirement of older board-certified physicians.
Trang 37ABPM certification after 1998.
For details on certification, contact
American Board of Preventive Medicine111 West Jackson Boulevard, Suite 1110Chicago IL 60604(312) 939-2276abpm@theabpm.orgREFERENCESAmerican College of Occupational and Environmental Medicine.http://www.acoem.org/distancelearning.aspx.
Gehanno JF: Undergraduate teaching of occupational medicine in Europeanschools of medicine Int Arch Occup Environ Health 2013 Apr 19 [Epubahead of print] [PMID: 23604622].
Harber P: Career paths in occupational medicine J Occup Environ Med2012;54:1324 [PMID: 23047658].
Harber P: Occupational medicine practice: activities and skills of a nationalsample J Occup Environ Med 2010;52:1147 [PMID: 21124250].
Harber P: Value of occupational medicine board certification J OccupEnviron Med 2013;55:532 [PMID: 23618887].
Leigh JP: Economic burden of occupational injury and illness in the UnitedStates Milbank Q 2011;89:728 [PMID: 22188353].
Leigh JP: Workers’ compensation benefits and shifting costs foroccupational injury and illness J Occup Environ Med 2012;54:445[PMID: 22446573].
National Assessment of the Occupational Safety and Health Workforce,2011.
http://www.cdc.gov/niosh/oshworkforce/pdfs/NASHW_Final_Report.pdf.Parhar A: Barriers to the recognition and reporting of occupational asthma
Trang 38SELF-ASSESSMENT QUESTIONS
Select the one correct answer to each question.Question 1: Occupational injuries and illnessesa are defined by workers’ compensation law
b require an occupational physician to provide medical care
c are among the five leading causes of morbidity and mortality in theUnited States and in most other countries
d are declining in number as insurance settles claimsQuestion 2: Occupational physicians
a are primarily employed by public health agencies
b play an important role in prevention, recognition, and treatment ofinjuries and illnesses
c are prevented by law for acting as consultants to employers
d should endeavor not to become involved in issues of environmentaland occupational health
Question 3: Independent medical examiners
a are required when a compensation case results in litigationb are hired by workers to resolve disputes
c often provide the highest level of evaluation the worker willencounter
d are in most jurisdictions hired by plaintiff’s attorneysQuestion 4: Board-certified physicians
a generally have more diverse practice activities and skills, withgreater involvement in management, public health-orientedactivities, and toxicology
b make up the large majority of occupational physicians in privatepractice
Trang 392International Occupational &Environmental Health
Joseph LaDou, MS, MD
GLOBAL WORKING CONDITIONS
The world’s workforce sustains more than 250 million injuries every year.Included in this number are 2 million people killed by their work each year.Occupational illnesses attributed to hazardous exposures or workloads maybe as numerous as occupational injuries The lack of adequate surveillance ofoccupational disease prevents accurate assessment of the problem The globalepidemic of occupational injury and disease is not new It is inherent in thenature of industrial development that poorer countries adopt hazardousproduction The resultant epidemic of injuries and illnesses is compoundedby the rapid transfer by developed countries of hazardous industries no longercompatible with host country government regulation While internationalstandards attempt to obligate employers to pay for occupational injury anddisease, inadequate prevention, detection, and compensation make a mockeryof these standards.
Trang 40illness can tip an entire family into poverty.
Developing countries seldom have enforceable occupational andenvironmental regulations Occupational health should have high priority onthe international agenda, but occupational safety and health (OSH) lawscover only about 10% of workers in developing countries These laws omitmany major hazardous industries and occupations Progress in bringingoccupational health to the industrializing countries is painfully slow In thepoorest countries, there has been no progress at all.
Many other health issues compete with occupational and environmentalhealth for scarce funding Developing countries are concerned withoverwhelming problems of unemployment, malnutrition, and infectiousdiseases About 450 million people live in extreme poverty and malnutrition,while another 880 million live in what can only be described as absolutepoverty Nearly every fifth worker in the world has to survive on less than $1a day for each family member Sixteen million people die each year fromeasily preventable diseases, and occupational diseases are not included in thatdefinition.
Working conditions in much of Latin America, Africa, Central andEastern Europe, China, India, and Southeast Asia are unacceptable The laborforce in developing countries totals around 1.8 billion, but it will rise to morethan 3.1 billion in 2025—implying a need for 38–40 million new jobs everyyear This being the case, demands by workers and governments forimproved occupational safety and health are not likely to be heeded.
Developing countries are far behind industrialized countries in thedevelopment of workers’ compensation programs In many countries of Asia,Latin America, and Africa, only a small fraction of the workforce is coveredby workers’ compensation programs In countries as large as Egypt, India,Pakistan, and Bangladesh, fewer than 10% of workers are covered byworkers’ compensation In China, fewer than 15% of workers are covered,and in Venezuela and Colombia, fewer than 20% In many developingcountries, workers’ compensation is little more than a paper program wherethe government works in concert with industry to minimize the provision andthe costs of benefits.