[75th anniversary of the journal, Occupational Medicine -- Occupational Medicine and Industrial Ecology].
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Fridolin Schuler (1832-1903), physician in Glarus, laid the foundations of the Swiss legislation for the protection of the working population. The law for illness and accident insurance followed in 1911, it was complemented with regulations concerning the protection from occupational diseases. Of great practical importance were coordinated efforts of physicians, technologists, hygienists and safety engineers, who founded in 1956 the "Studiengruppe für Gesundheitsschutz in Industrie und Gewerbe". In 1973 they joined with the "Groupement romand" in the "Swiss Society for occupational medicine, occupational hygiene and occupational safety" (AAA). In 1964 the Association of Swiss occupational physicians has been founded. In order to strengthen the promotion of occupational health in Switzerland a special commission on occupational medicine was constituted in 1980 within the AAA. Several subcommissions are presently working on a steadily increasing number of problems in the field of occupational health.
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Occupational hygiene of the railway transport is a well defined sphere of knowledge. It is closely connected with the general occupational medicine and yet occupies a significant place in the railway medicine. Occupational medicine of the railway transport is based on results of sciences connected with each other and at the same time it serves for the favourable research is included sciences, such as occupational physiology and hygiene pathology, sanitary technics, chemistry, acoustics et al.
Occupational and environmental medical literature that confronts a physician is difficult to grasp. The development of the microcomputer makes it easier for the occupational medicine physician to perform computer literature searches. Occupational medical residents and physicians both familiar and unfamiliar with computers submitted identical searches to identify strengths and weaknesses of combinations of computer databases and assisting software. The combination of DIALOG databases and In-Search software were judged to be the most useful for the occupational medicine physician.
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.
Occupational medicine has been a specialty of the American Board of Preventive Medicine since 1955. There are a number of current clinical and administrative topics that are discussed, including employment drug testing, American College of Occupational and Environmental Medicine (ACOEM) guidelines, 24-hour coverage, ergonomics, fiscal accountability, and treating job injuries and workers' compensation claims.
Occupational medicine presents ethical dilemmas between worker health and corporate goals, for both physicians and managers. Physicians in occupational practice recognize conflict between 'moralist' and 'utilitarian' ethical positions. This paper analyzes the relation of professional roles to ethical interpretations by occupational physicians, based on their own and medical ethicists' formulations of dilemmas. Physicians' conflicting responsibilities to workers as patients and to corporate practices and policy are reviewed in the context of occupational risk and the critical anthropology of health.
Occupational and environmental medicine traditionally dealt with elements, particularly with heavy metals. The interest was justified by the wide exposure in the workplace and in the general environment and by the evidence of their specific biological and toxicological effects. During the last 2 decades of 20th century the availability of indicators of exposure or of internal dose has substantially increased thanks to improvement in AAS-ETAAS techniques and to the entrance of ICP-MS into the field of biological monitoring. There are now more and more demands for controlling pre-analytical and analytical factors, for analysing biological matrices in addition to blood and urine and for setting up methods for elements not yet extensively studied in respect to their possible biological or toxicological role. Finally, deeper knowledge has to be reached in order to evaluate the significance of elements and, possibly, of their species in biological fluids at current doses and in order to face their effects, especially those in the first portion of the dose-response curve, which is going to be the main field of interest of occupational and environmental toxicology for the next few years.
The Department of Occupational Hygiene, State School of Hygiene at the National Institute of Hygiene was established in 1926/27. Prof. Brunon Nowakowski was its founder and the first Director. Teaching and providing of highly qualified personnel for occupational medicine institutions was the main area of the Department's activity. The Department also carried out scientific research focusing on organisation of labour hygiene in Poland, and occupational diseases, lead poisoning in particular. The results of studies carried out by the Department provided the basis for the elaboration of numerous legal regulations in the area of occupational medicine.
Occupational health data suggested there would be many injuries and one fatality for every kilometre of the 12.9-km bridge that by next year will link Prince Edward Island to the rest of Canada. However, Dr. Scott Cameron reports that the project's safety record has far exceeded expectations. The family physician from Summerside, PEI, is delighted to be medical adviser for the history-making project.
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Increasing emphasis is being placed on preventive medicine, which has been neglected in the past, compared to curative medicine. Occupational medicine is destined to play a major role in this advance of preventive medicine. One area which requires more involvement is the performance of screening examinations for risk factors (RFs) at the workplace--not only related to effects of potentially hazardous materials or working conditions, but also to the employee's general health state, directly associated with long-term work performance. Cardiovascular diseases, especially arteriosclerotic coronary artery disease (CAD), is responsible for considerable morbidity and the majority of deaths in industrialized countries. Screening programs in occupational medicine involving RFs in this area should be improved in the future. Screening procedures for the major RFs: hypertension, diabetes and nicotine abuse, are generally better understood and implemented than those for hyperlipoproteinemia, although the latter is probably highest on the list of major RFs of CAD. To clarify this issue we studied 350 persons, using an oral fat tolerance test applied after fasting. Results showed that fasting and postprandial serum total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) concentrations remain essentially unchanged after a fat-rich meal, while triglyceride (TG) levels vary considerably, from no change to great increases, different and characteristic for each individual. The practical significance for screening programs in occupational medicine is that lipid screening tests needs to concentrate only on TC, LDL-C and HDL-C, need not include TG, and do not require employees to be in a fasting state, but can be carried out at any time.
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