Environmental Medicine: Integrating a Missing Element into Medical Education

Saint Louis University School of Medicine

University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School

Cornell University Medical Center

University of Rochester School of Medicine

State University of New York at Brooklyn College of Medicine

State University of New York at Syracuse College of Medicine

Bowman Gray School of Medicine

Duke University School of Medicine

East Carolina University School of Medicine

University of North Carolina at Chapel Hill School of Medicine

Medical University of South Carolina College of Medicine

University of South Carolina School of Medicine

University of Texas Medical Center at San Antonio

University of Vermont College of Medicine

West Virginia University School of Medicine

NIOSH Educational Resource Centers

The National Institute for Occupational Safety and Health (NIOSH) funds Educational Resource Centers (ERCs) which conduct research and administer graduate training programs in occupational medicine, occupational health nursing, and industrial hygiene and safety. They also provide continuing education programs for safety and health professionals and outreach programs for the community.

ALABAMA

Deep South Center for Occupational Health and Safety

University of Alabama at Birmingham

Elizabeth Murray

Continuing Education

(205) 934–7178

CALIFORNIA

Northern California ERC

Center for Occupational and Environmental Health

University of California at Berkeley

Barbara Plog, Continuing Education

(510) 231–5647

Southern California ERC

University of Southern California

Ramona Cayuela, Continuing Education

(213) 740–3995

ILLINOIS

Illinois ERC

Occupational Health and Safety Center

University of Illinois, Chicago

Leslie Nickels, School of Public Health

(312) 996–7473

MARYLAND

Johns Hopkins ERC

Johns Hopkins University

Department of Environmental Health Sciences

Dr. Jacqueline Corn,

Continuing Education

(410) 955–2609

MASSACHUSETTS

Harvard ERC

Harvard Educational Resource Center

Daryl Bichel, Continuing Education

(617) 432–3314

Table of Contents

Front Matter R1-R12

Executive Summary 1-4

1 Introduction 5-13

2 Curriculum Content 14-21

3 Implementation Strategies 22-43

4 Changing Medical Education 44-51

5 Concluding Remarks 52-53

References 54-58

Appendixes 59-60

A: Taking an Exposure History 61-96

B: Medical School Courses and Clerkships: Access Points for Integrating Environmental Medicine 97-120

C: Case Studies in Environmental Medicine 121-138

Case Study 1: Arsenic Toxicity 139-163

Case Study 2: Seasonal Arsenic Exposure from Burning Chromium-Copper-Arsenate-Treated Wood 164-167

Case Study 3: Asbestos Toxicity 168-188

Case Study 4: Benzene Toxicity 189-207

Case Study 5: Beryllium Toxicity 208-223

Case Study 6: Cadmium Toxicity 224-243

Case Study 7: Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning 244-248

Case Study 8: Carbon Tetrachloride Toxicity 249-266

Case Study 9: Chlordane Toxicity 267-288

Case Study 10: Chronic Reactive Airway Disease Following Acute Chlorine Gas Exposure in an Asymptomatic Atopic Patient 289-290

Case Study 11: Chromium Toxicity 291-311

Case Study 12: Cyanide Toxicity 312-331

Case Study 13: Dioxin Toxicity 332-348

Case Study 14: Ethylene/Propylene Glycol Toxicity 349-371

Case Study 15: Formalin Asthma in Hospital Staff 372-373

Case Study 16: Gasoline Toxicity 374-394

Case Study 17: Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease 395-401

Case Study 18: Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis 402-409

Case Study 19: Lead Toxicity 410-435

Case Study 20: Legionaires' Disease: Description of an Epidemic of Pneumonia 436-444

Case Study 21: Mercury in House Paint as a Cause of Acrodynia: Effect of Therapy with N-Acetyl-D, L-Penixillamine 445-449

Case Study 22: Mercury Toxicity 450-472

Case Study 23: Methanol Toxicity 473-492

Case Study 24: Methylene Chloride Toxicity 493-511

Case Study 25: Paint Remover Hazard 512-515

Case Study 26: Fatal Outcome of Methemoglobinemia in an Infant 516-517

Case Study 27: Nitrate/Nitrite Toxicity 518-537

Case Study 28: An Outbreak of Nitrogen Dioxide-Induced Respiratory Illness Among Ice Hockey Players 538-541

Case Study 29: Pentachlorophenol Toxicity 542-557

Case Study 30: Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy 558-561

Case Study 31: Cholinesterase-Inhibiting Pesticide Toxicity 562-584

Case Study 32: Infertility in Male Pesticide Workers 585-587

Case Study 33: Pesticide Food Poisoning from Contaminated Watermelons in California, 1985 588-595

Case Study 34: Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticides 596-604

Case Study 35: Polynuclear Aromatic Hydrocarbon (PAH) Toxicity 605-621

Case Study 36: Polychlorinated Biphenyl (PCB) Toxicity 622-638

Case Study 37: Ionizing Radiation 639-673

Case Study 38: Radon Toxicity 674-694

Case Study 39: Residential Radon Exposure and Lung Cancer in Sweden 695-700

Case Study 40: Community Oubreaks of Asthma Associated with Inhalation of Soybean Dust 701-706

Case Study 41: Tetrachloroethylene Toxicity 707-726

Case Study 42: Toluene Toxicity 727-743

Case Study 43: Occupational Asthma Due to Toluene Diisocyanate Among Velcro-like Tape Manufacturers 744-749

Case Study 44: 1,1,1-Trichloroethane 750-766

Case Study 45: Trimethyltin Encephalopathy 767-771

Case Study 46: Trichloroethylene Toxicity 772-792

Case Study 47: Vinyl Chloride Toxicity 793-811

Case Study 48: Work-Related Disorders of the Neck and Upper Extremity 812-813

Case Study 49: Contact Dermatitis in Surgeons from Methylmethacrylate Bone Cement 814-816

Case Study 50: Skin Lesions and Environmental Exposures: Rash Decisions 817-861

Case Study 51: Acoustic Trauma Caused by the Telephone: A Report of Two Cases 862-867

Case Study 52: Behavioral and Audiologic Manifestations of Noise-Induced Hearing Loss 868-871

Case Study 53: Reproductive and Developmental Hazards 872-892

Case Study 54: Childhood Asthma and Indoor Enviromental Risk Factors 893-903

Case Study 55: Populations at Risk From Particulate Air Pollution - United States, 1992 904-908

D: Resources: Agencies, Organizations, Services, REferences, and Tables of Environmental Health Hazards 909-970

E: Committee and Staff Biographies 971-975

NIOSH Educational Resource Centers