Occupational Medicine:  Principles and Practice

PubH 6130  (2-3 credits)

Ian A. Greaves, MD and Beth Baker, MD

Spring Semester:  Mondays 1:25 - 4:25 PM

 

 

 

 

 

The course comprises two main components.  Part A (2 credits) deals with the nature of toxic agents and selected physical hazards that are present in the work place, how exposures to these hazards cause disease among workers, and how such disorders may be detected.  Part B (1 credit) deals with the diagnosis and clinical management of common occupational disorders.  Students may elect to take Part A only or Parts A and B.

 

 

Course Objectives and Content

 

 

Part A

 

1.   To develop an understanding of the nature and pathogenesis of diseases caused by exposures to toxic chemicals and physical hazards in the workplace.

 

2.   To become familiar with the metabolism and fate of toxic chemicals relevant to the performance of biological monitoring for ÒexposedÓ individuals.

 

  1. To develop an understanding of some physical hazards that pose health problems for workers.

 

 

Part B

 

4.   To become familiar with the common presentations of occupational diseases caused by toxic agents and physical hazards, the techniques for diagnosing these disorders, and the approaches to medical management involved in treating affected workers.

 

5.   To develop an understanding of the basics of medical care for occupational illness and injuries in the context of workersÕ compensation and regulatory issues.

 

Little emphasis will be given to basic biochemical mechanisms of disease.  This material is as­sumed to have been acquired through an introductory toxicology course listed as a prerequi­site for this course.  Drug toxicity will not be considered.

 

 

Enrollment

 

This course is designed primarily for Environmental Health majors focusing in the areas of occu­pational medicine, occupational health nursing, industrial hygiene, occupational injuries and epidemiology.  Students currently receiving financial support from the NIOSH Training Grant are expected to take this course.  Students enrolling in this course should have completed the equivalent of an introductory course in toxicology.  In addition, some familiarity with workplace exposures, such as obtained in an introductory industrial hygiene course, is highly desirable.

Grading

 

Part A (2 credits): Grading will be based on two written examinations (both multiple choice and short answer questions), each worth 50% of the grade for this section of the course.

 

Part B (1 credit): Grading will be based on a written examination (multiple choice and short answers) worth 50% of the final grade for this section; a project and paper (40%); and participation in class (10%). 

 

No supplementary examination will be offered for additional credit. 

 

Any make-up examination for medical illness or other extenuating circumstance must be discussed with the course instructor.

 

Assignment of ordinal (A/F) grades will be as follows:

 

A         96-100%

A–       91-95

B+       86-90

B         81-85

B–       76-80

C         71-75

F          ² 70. 

 

For the pass/fail (S/N) option, a grade of S is equivalent to at least a C (i.e., S > 70%, N ² 70).

 

Because the course contains considerable medical terminology, non-physicians can be at a disadvantage.  Non-physicians may wish to consider taking this course S/N unless otherwise required to take it for an ordinal grade. 

 

 

Textbooks and Outside Reading

 

No single text adequately covers all the material presented in this course.  The text by McCunney is recommended for the latter half of the course which deals with the practice of occupational medicine.  A list of additional background reading is provided.  InstructorÕs notes and other materials will be placed on the web for many of the classes—selected articles and texts may be placed in the biomedical library to supplement these.

Occupational Medicine:  Principles and Practice

PubH 6101  (2-3 credits)

Spring 2006

 

 

Date

 

Topic

Primary Instructor

Jan. 23

Introduction: Discussion of course outline, evaluations,

reference materials.

Airborne hazards: nature of aerosols, gases and fumes; mechanisms of injury, common symptoms, measurement of health effects (lung function, X-rays)

Lung ÒirritantsÓ

Greaves

Jan. 30

The pneumoconioses: silica, coal dust, asbestos, coal workers pneumoconiosis, beryllium disease

Greaves

Feb. 06

Hypersensitivity lung disorders: asthma, extrinsic allergic

alveolitis, byssinosis

Respiratory asphyxiants

Miscellaneous gases and fumes

Greaves

Feb. 13

Skin irritants and sensitizing agents

Liver disorders caused by toxic agents

Revision of material to date

Greaves

Feb. 20

FIRST EXAMINATION—Part A (one hour)

Kidney disorders caused by toxic agents

Nervous system disorders caused by toxic agents: evaluation of neurologic effects

Greaves

Feb. 27

Organic solvents: chemistry, metabolism, health effects, and

biologic monitoring

Greaves

Mar. 06

Toxic metals: lead, mercury, arsenic, manganese, cadmium; chemistry, metabolism, health effects, biological monitoring

Greaves

Mar. 13

Semester Break: No classes

 

Mar. 20

Pesticides, herbicides and associated human health effects

Reproductive disorders caused by toxic agents

Greaves

Mar. 27

Physical hazards: barometric pressure, gravitational forces

Revision of material since first test

Greaves

Apr. 03

SECOND EXAMINATION—Part A (one hour)

Occupational health surveillance: Case study of asbestos

Greaves

Greaves

Apr. 10

The history and practice of Occupational and Environmental Medicine. Evaluating the worker. Upper extremity injuries.

Assignment of class projects

Baker

Apr. 17

Evaluating work-related illness. Workers compensation. Low back pain and disability.

Baker

Apr. 24

Evaluating work-related disability I: AMA and other guidelines; assessing level of disability. Skin disorders. Reproductive hazards

Baker

May 01

Evaluating work-related disability II: Noise and hearing; Indoor air quality. Revision of materials for final exam.

Baker/Greaves

May 08

Presentation of class projects

FINAL EXAMINATION—Part B (one hour)

Greaves/Baker

BIBLIOGRAPHY FOR PubH 6130:

PRINCIPLES  AND  PRACTICE  OF  OCCUPATIONAL  MEDICINE.

 

 

Recommended

 

1.      McCunney, R.J. (editor).  A Practical Approach to Occupational and Environmental Medicine.  Third edition, Little Brown, 2003.

         An expanded edition of a very practical guide for practising physicians.  The format falls between that of Rom and of Levy & Wegman, and provides a solid basis for under­standing the breadth and scope of occupational and environmental medicine.

 

Useful Background Reading

 

The following references are considered background material for the course.  Two of the back­ground references are listed with specific chapters for some of the sessions.  This is designed to help non-physicians and others who have little medicine, histology or toxicology to keep abreast of the material.

 

1.      Cassarett and DoullsÕ Toxicology: The Basic Sciences of Poisons.  Edited by Klaasen, Amb­dur and Doull.  Macmillan.

 

2.      Levy, B.S. and Wegman, D.H. (editors). Occupational Health: Recognizing and Preventing Work-Related Disease. Little Brown.

         An introduction to occupational medicine that provides a public health perspective on occupa­tional disease.  Inexpensive.

 

3.      Rom, W.N. (editor).  Environmental and Occupational Medicine.  Little Brown.

         A classic in occupational medicine.  Useful background material offered in a conventional, medical textbook format.  Expensive.

 

Additional References

 

The following are a brief bibliography of general and specialized reference books that may be use­ful for various parts of the PubH 5130 course.  Many of these should be available in the Biomedi­cal Library.  They will not be placed on reserve during the course, but if you have problems obtain­ing access to a copy, see Dr. Greaves.

 

Bernstein, I.L., Chan-Yeung, M., Malo, J-L. and Bernstein, D.I. (eds) Asthma in the Workplace.  Marcel Dekker: New York, 1999.  A comprehensive discussion of occupational asthma—causes, pathogenesis, diagnosis, treatment, and prevention.

 

Friberg, L., Norberg G.F. and Vouk, V.B. (editors).  Handbook on the Toxicology of Metals.  Elsevier, 1979.  Still a classic reference despite its age.

 

Johnson, B.L. (editor).  Advances in Neurobehavioral Toxicology: Applications in Envi­ronmental and Occupational Health.  Lewis, 1990.  State-of-the-art review of neurotoxicology that is relevant to environmental and oc­cupational hazards.  Includes an international and public health perspective that is useful.

 

Lauwerys, R.R. Industrial Chemical Exposure: Guidelines for Biological Monitoring.  Biomedical Publications, second edition, 1993.  Excellent synthesis of toxicology and surveillance methods for biological monitoring.

 

Morgan, K. and Seaton, A.  Occupational Lung Diseases.  Third edition, Saunders, 1995.  An alternative to Parkes. Deals with occupational lung problems from a more North American view than does Parkes.

 

Mottet, N.K.  Environmental Pathology.  Oxford, 1985.  A pathologistÕs attempt to describe occupational diseases.  Very conservative and traditional in its approach and succeeds in making an interesting subject boring!  Uses an organ system approach which is not helpful to the environmental/occupational practitioner, but contains useful information on specific agents if you like chasing through indices.  The only book to address this topic so far.

 

Occupational Diseases: A Guide to Their Recognition.  USDHEW (NIOSH) No. 77-181, 1977.  An old but useful encyclopedic reference for toxic chemicals and their respective health ef­fects.  Available from the Government Printing Office.

 

Parkes, D.W.  Occupational Lung Disorders.  Third edition, Butterworth, 1994.  The definitive text on occupational lung problems.  An excellent ref­erence text.  Prohibitively expensive.

 

Sullivan, J. and Krieger, G.  Clinical Environmental Health and Toxic Exposures.  Second edition, 1999.  A useful reference for diseases caused by toxic chemicals.