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A questionnaire survey of the 127 US medical schools was undertaken to assess the present status of occupational health teaching as a follow-up to two prior similar studies. The present study revealed that 78 (68%) of the 115 responding schools specifically taught occupational health during the 1991/92 academic year, in comparison with 50% in the 1977/78 and 66% in the 1982/83 academic years. The median required curriculum time was 6 hours in 1991/92, as compared with 4 hours in both previous surveys. Despite the increasing recognition of occupational health and growth of information in this field of medicine, occupational health teaching to medical students has not progressed proportionately.

Research in occupational health and environmental epidemiology can play an important role in furthering our understanding of occupational and environmental health problems. Research guides us in the recognition, management, and prevention of health problems. However, in developing countries, where rates of occupational and environmental illnesses and injuries are higher and where these problems are often more severe than in developed countries, research capabilities are less developed. In mid-1990, a project was undertaken to (a) document ongoing research in occupational health and environmental epidemiology in developing countries, (b) facilitate the exchange of information among researchers in this field, (c) stimulate research, and (d) avoid unnecessary duplication among researchers in this field. A questionnaire was mailed, the purpose of which was to learn the current status of research in developing countries and to develop a directory of such ongoing research. The questionnaire was sent to 1,528 individuals. Of the 500 research projects identified, 77% were investigating chemical hazards; 26%, physical hazards; 10%, biological hazards; and 10%, psychosocial hazards (some projects addressed multiple hazards). The chemical hazards studied most frequently were dusts, pesticides, and lead. The greatest number of research projects were identified in China, India, Brazil, Korea, and Thailand. Most projects were descriptive or cross-sectional epidemiologic studies or industrial hygiene or exposure-assessment studies. The World Health Organization has published a directory of the specific research projects that were identified in this survey.

As the nations of Eastern Europe undergo political and economic transitions, they face considerable occupational and environmental health challenges. Although occupational health services are relatively well developed, environmental health services and policies are not. There are major needs in the areas of education and training, supplies and equipment, and policy development. In addition, privatization poses a variety of new challenges and dangers to occupational and environmental health. This commentary discusses the challenges that face Eastern European nations, and describes opportunities for collaboration among scientists, policymakers, labor, management, and community groups in the United States and Eastern Europe.

Bowel injuries during laparoscopy can result from either electrical damage or direct trauma. When electrocoagulation is used with laparoscopy, it is frequently assumed that any bowel injury is from that source. That assumption might not be accurate. In animal studies we evaluated the histologic characteristics of both electrical and traumatic bowel injuries. A consistent difference in injury pattern, both gross and microscopic, was noted. With a high degree of accuracy, those histologic and gross characteristics can be used to distinguish traumatic from electrical injuries following operative laparoscopy.

Concern about upper respiratory tract irritation and other symptoms among workers at a glass bottle manufacturing plant led to an epidemiologic and an industrial hygiene survey. Questionnaire responses from 35 hot end and 53 cold end workers indicated that the incidence of wheezing, chest pain, dyspnea on exertion, and cough was significantly elevated among hot end workers. Among both smokers and nonsmokers, hot end workers reported higher, but not significantly higher, rates of wheezing and chest pain. Among smokers, hot end workers reported significantly higher rates of dyspnea on exertion and cough than did cold end workers. Data suggest that reported exposure to stannic chloride solution likely caused these symptoms. The industrial hygiene survey, conducted when stannic chloride use had been reduced, cleaning had been done, and ventilation improved, focused on measuring air contaminants that might possibly cause symptoms. Levels of hydrogen chloride, which apparently was formed by the combination of stannic chloride and water in the presence of heat, were elevated. The finding of increased prevalence of respiratory symptoms among hot end workers was consistent with this exposure. Recommendations were made to reduce hazardous exposures at this plant. Individuals responsible for occupational health should be aware that relatively benign substances, such as stannic chloride and water, can combine spontaneously to form hazardous substances.

Recent reports of bipolar sterilization failures have questioned the compatibility of bipolar forceps used with different electrogenerators. Four different bipolar forceps were matched and mismatched with five generators and the electrocoagulation effect was studied by two physicians trained in the histologic evaluation of electrical injury. All bipolar systems, matched or mismatched, failed to coagulate the fallopian tube as completely as unipolar control--except for the matched Kleppinger system. Conversely, when mismatched with other generators the coagulation effect of the Kleppinger forceps fell far below that of other bipolar forceps--matched or mismatched. Each bipolar system should be compatible and its electrocoagulation effect studied before it is used for female sterilization.

The recent discovery of over one million asbestos-like fibers per liter of Duluth tap water and the suggestive evidence of a link between certain gastrointestinal (GI) cancers and work exposure to asbestos fibers in the air prompted this study. GI cancer incidence data were gathered for Duluth in the same manner as data previously gathered for comparison cities, Minneapolis and St. Paul. Although some differences in GI cancer incidence occurred among the three cities in 1969-1971, there was no consistent pattern of statistically significant differences observed. The number of GI cancers diagnosed in Duluth residents in 1972 was similar to that in each of the previous three years. This study represents the start of ongoing cancer surveillance in Duluth.

In attempting to make the diagnosis of myocardial infarction, the family physician has available an increasing array of enzyme and nuclear imaging techniques to add to the clinical and electrocardiographic findings. In this review several of the new diagnostic tests are described, and their role is discussed both in supplementing and replacing older diagnostic tests. A general strategy for employing both old and new tests is proposed, with a goal of achieving both increased diagnostic accuracy and reduced charges for laboratory tests.

Strict case definitions were applied to 123 clinically diagnosed cases of infective endocarditis. Cases were categorized as definite (19), probable (44), or possible (41) endocarditis or were rejected (19). Compared to other published studies, our patients had an advanced mean age (57), high incidence of underlying valvular disease (66%), short mean duration of symptoms (27 days), and 15% mortality, the lowest reported for a large series. Most cases were caused by viridans streptococci, Staphylococcus aureus, or enterococci; Enterobacteriacae were absent, and negative cultures infrequent (5%). Subgroups included nosocomial endocarditis (13%), usually with underlying valvular disease and invasive procedures; prosthesis endocarditis (12%); and cases requiring cardiac surgery (18%). Deaths were caused by heart failure, neurologic events, or superinfection. Strict definitions are useful in managing suspect cases, and are essential in comparing clinical studies. Early recognition and treatment should be the focus of efforts to reduce mortality from endocarditis.

This article reviews examples of contamination to the surface or groundwater, the ambient air, and soil resulting from the microelectronics industry. The potential effects on human health arising from such environmental contamination are discussed, as well as aspects of their diagnosis, treatment, and related public health implications. Given the high costs of pollution control, the emphasis must be on prevention, which can be facilitated by a high level of suspicion and by the design of safety and pollution control into manufacturing processes.

Many bipolar sterilization failures have occurred because of incomplete desiccation of the endosalpinx. This study compared the effect upon human fallopian tubes of different waveforms of electrical energy at advancing power settings. When the Valleylab SSE2-L generator was attached to the Kleppinger bipolar forceps, complete desiccation was confirmed with the power set at 25 W in a cutting waveform. Other waveforms (coagulation and blend) failed to complete the task at the same power setting. An inline current meter assures the operator that all the available energy is delivered. This information should help to reduce bipolar sterilization failures.

A survey of 111 of the 127 United States medical schools revealed that 73 (66 per cent) specifically taught occupational health during the 1982-83 academic year, compared to 50 per cent in 1977-78. Occupational health was a required part of the curriculum in 54 per cent of the schools compared to 30 per cent in 1977-78. However, the median required curriculum time for occupational health was four hours during both academic years. Increased attention needs to be given to occupational health in medical school curricula.

Severe respiratory tract irritation occurred in at least 74 of 100 boilermakers who were exposed to high levels of vanadium pentoxide fume during oil-to-coal conversion of a utility company power plant in a rural area of western Massachusetts. Many were welders working in confined areas with inadequate ventilation. Most frequent symptoms were productive cough, sore throat, dyspnea on exertion, and chest pain or discomfort. The illness was severe enough to cause 70 workers to consult physicians and most of them to lose time from work (median, five days). Wheezing (in 39%) was the most frequent finding on physical examination. Mild hypoxemia was noted in several workers; most (72%) had normal chest x-ray films. Expiratory flow rate over the middle 50% of the forced vital capacity was the pulmonary function test most remarkably affected (median, 57% of predicted for 24 workers tested). The Occupational Safety and Health Administration documented levels of vanadium pentoxide fume at or above the permissible exposure limit in all eight air samples taken from inside the boiler; it cited the company for inadequate mechanical ventilation and an inadequate respiratory protection program for workers. The report of this outbreak may help prevent future problems by drawing attention of physicians, workers, and managers to the potential pulmonary hazards in power plant conversion.

After a sharp increase in viral hepatitis cases, mostly type B, among the 2000 employees of a general hospital during three years, we conducted an investigation which consisted of obtaining data on employee cases and surveying many current employees. Of the 38 cases, 22 occurred in non-physician, ward employees. Of 189 current ward employees, 8% had antibody to hepatitis B surface antigen (anti-HBS) and 1% had hepatitis B surface antigen (HBSAg). Hepatitis B virus (HBV) seropositivity was highest for employees who worked closely with hemodialysis and renal transplant patients and for those who claimed that their ward was understaffed. Nine of the 38 cases occurred in clinical lab workers. Of 70 current lab employees, 17% were positive for anti-HBS and none for HBSAg. HBV seropositivity was highest for those working in the chemistry section (highest there among those performing blood-gas determinations and those working with the multi-channel autoanalyzers) and those who routinely got blood on their skin and clothes at work. All seropositive employees worked routinely with blood. These data support the hypotheses that many hospital employees contract hepatitis B from exposure to HBSAg-positive patients and many clinical laboratory employees contract it from exposure to HBV-contaminated blood.

In Minneapolis, 107 cases of hepatitis A were identified and traced primarily to consumption of cold sandwiches served for lunch in a department store's popular basement restaurant. A sandwich-maker in the restaurant was the index patient. The date of onset of her illness and the dates of food consumption and onset of illness of infrequent restaurant patrons were consistent with accepted periods of infectivity and incubation for hepatitis A. Because the sandwich-maker frequently touched her hands to her mouth when she worked, and because we could not find evidence for fecal, airborne, or other modes of transmission, we believe that she may have contaminated food with infectious oropharyngeal secretions. The secondary attack rate was much lower among household contacts who received immune serum globulin than among those who had not.

We report on a second phase of a physician-based project on occupational disease surveillance based on both sentinel health events and sentinel physicians. We included participating physicians in seven specialties and incorporated a component to assess the feasibility of using physician reporting to target work site evaluations. We identified 36 patients whose illnesses were probably or possibly work-related. We found that both patients and physicians were reluctant to request workplace evaluations.

A questionnaire survey of the 112 U.S. medical schools was conducted to determine the content and format of occupational health teaching during the 1977--78 academic year. In only 46 (50 percent) of the 92 responding institutions was occupational health specifically taught; and only 28 (30 percent) required it in their curricula, usually in the preclinical years. Among these 28, the median required curriculum time was four hours. Thirty-five (38 percent) of the responding schools offered a variety of elective courses or clerkships, mainly in the clinical years and taken by few students. Given the extent of work-related medical problems in the United States and the frequency with which almost all physicians see patients with work-related problems, much more of the core curriculum of medical schools should be devoted to occupational health.

To assess the current extent of programs and policies to facilitate smoking cessation among employees, we queried 128 large employers in Massachusetts in mid-1978. Eighty-four (66 per cent) responded. Fifty-four (64 per cent) of the respondents had designated jobs or work areas in which smoking was prohibited usually because of potential danger to products or equipment. Seven (8 per cent) of the employers provided counseling, and 10 (12 percent) provided smoking cessation programs for those employees who desired to quit smoking. There is a clear need for the development and evaluation of workplace policies and programs aimed at reducing smoking.

One hundred and twenty-five of 173 people who ate at a picnic and/or a smorgasbord prepared by a bar-restaurant in a Midwestern town in September 1973 developed diarrhea, abdominal cramps, and other symptoms 23 hours (median time) later. Eleven were hospitalized. Stool cultures from 18 ill individuals grew Salmonella infantis, Salmonella agona, and Salmonella schwarzengrund. Stool cultures from 5 of 8 restaurant employees grew S. infantis or S. agona. Cultures of remaining foods and food-contact surfaces were negative. Food-specific attack rates, based on interviews with 121 eaters, implicated potato salad and chicken dressing as vehicles of transmission, both likely contaminated when prepared in pans that shortly before contained uncooked, chicken pieces suspected to have harbored salmonellae. Chickens were eventually traced to 3 farms where feed samples were found to contain Salmonella typhimurium and Salmonella cubana, raising the possibility that other feed samples may have contained the serotypes responsible for the outbreak. The main control measure was temporarily closing the food service, which was to have catered a large church picnic the next day. The outbreak had an economic impact estimated at $28,733.

Because of the inadequacies of surveillance data for occupational disease in the United States, this study was undertaken to determine the feasibility of using physicians' and hospital records for occupational disease surveillance. The study was based on Rutstein's sentinel health event (occupational) classification and the use of sentinel physicians. Data were gathered on nonmalignant dermatologic and respiratory diagnoses prospectively at five sites and retrospectively at four of these sites. The combined approaches identified 49 patients whose illnesses were probably work-related. Because the prospective approach took less than 10% of the time for each case identified compared with the time required for the retrospective approach, and prospective data are more timely and easier to access, the prospective approach appears to be better.

Although frequently unrecognized, Reye's syndrome is a significant cause of serious illness and death in children. Erroneous diagnoses include gastroenteritis, meningoencephalitis, metabolic encephalopathy, drug overdose and primary psychiatric disease. No specific cure is known but early diagnosis and vigorous empirical treatment may increase chances of survival. Although the EEG may be a useful tool in prognosis, it cannot be relied upon in deciding when to initiate or abandon aggressive therapy.

After receiving reports of lead poisoning in two workers at a secondary lead smelter, we evaluated the health status of 38 current smelter workers and 87 of their household contacts by questionnaires, physical examinations, and laboratory tests. Fatigue, cough, and diarrhea were the most frequent symptoms in plant employees; each occurred in at least a third. The most frequent physical finding, hand tremor, occurred in 10 of 33 plant employees. Twelve employees had blood lead concentrations at or above 80 microgram/100 ml, and 17 others had blood lead concentrations at or above 60 microgram/100 ml. All physical signs possibly due to excess lead absorption were manifested by employees with blood lead levels of 60 microgram/100 ml or greater, with one exception. Household contacts of employees had few symptoms suggestive of excess lead absorption.

Glioblastomas developed within two years of each other in an otherwise unrelated married couple in their fifties. There was a daughter who died of Hodgkin's disease but no other unusual incidence of cancer in either siblings, parents or other children. No clear etiology of risk factors for brain tumor were identified. The development of such conjugal tumors, although apparently rare, raises important etiologic questions.

After a large foodborne outbreak of hepatitis A in April 1974, the Minnesota Department of Health attempted to improve ongoing hepatitis surveillance with a system based on 1) a large centralized blood bank, which reports results of tests for hepatitis B surface antigen (HBsAg) on suspected hepatitis patients; 2) private physicians, who are encouraged to report cases; and 3) an epidemiology aide, who contacts all detected patients and their physicians. During the first year of this system, we detected 932 cases (24.5 per 100,000), a threefold increase over previous years, and obtained detailed epidemiologic data on each case. Although physicians diagnosed 61% of these cases as hepatitis A (or non-B) and 39% as hepatitis B, they tested only 53% of all patients for HBsAg. Sixty-seven per cent of the tested patients were HBsAg-positive, but only 17% of the untested patients had illnesses diagnosed by physicians as hepatitis B. This suggests that many patients with clinically-diagnosed viral hepatitis who are not tested for HBsAg may be erroneously diagnosed by physicians as having non-B hepatitis. Thirty-three per cent of HBsAg-positive patients with known occupations, not including housewives and students, worked in meidcally-related occupations. For 51% of the HBsAg-positive patients, we could not identify recent parenteral exposure to hepatitis B.