Occupational lead poisoning has been greatly reduced as a problem in Finland during the 1970s. Case-finding efforts and increased awareness of plant physicians first caused an increase of the incidence with a peak of 89 reported cases in 1974. A sharp decline followed, and, although about 30 mild cases are still reported annually, classical clinical poisoning hardly exists anymore. An extensive regular monitoring program covering 8,000--10,000 blood lead (PbB) analyses a year also shows that exposure levels have been reduced. In 1977 only 70 PbB values, or 1%, were in excess of 70 micrograms/100 ml, and 243 values (4%) exceeded 60 micrograms/100 ml. All such values came from workers employed by less than 30 workplaces, and several of them belonged to workers monitored more than once a year. It is proposed that the general development of occupational health in Finland is to a great extent reflected in this favorable development; however, since special research, educational and informative efforts have been devoted to the lead problem, it may well be that these measures have also influenced the outcome. The results show that, on a nationwide scale, the lead problem can be coped with much more effectively than one has been apt to think. Hence the nonfeasibility of lowering maximum permissible exposure levels has been put in serious doubt. There is no reason to allow unnecessarily high exposure in the vast majority of workplaces only because a small minority has technical difficulties.
Nonrecognition and mismanagement of work-related diseases is often linked to inadequate medical training. However, undergraduate training in occupational medicine faces many challenges, including lack of student interest and limited curriculum time. The purpose of this article is to present an undergraduate training program developed in one medical school to ensure that all medical students acquire the basic knowledge to recognize work-related health conditions and understand the fundamental principles of workers' comprehensive care. The program involves various learning methods including case studies, small-group learning, interactive large-group teaching, field activities, and e-learning. It has resulted in improving students' attitudes and competencies in occupational medicine and requires little curriculum time.
To obtain baseline information with respect to occupational medicine practice in Canada, a questionnaire survey of members of the Occupational and Environmental Medical Association of Canada was carried out by mail in 1993. One hundred eighty-six responses were received (56% of the membership). The average age of the respondents was 49.5, 12% were female, and 55% worked full-time in occupational medicine. Practice types included corporate settings (58%), clinics (23%), government agencies (14%), worker's compensation boards (7%) and academic settings (5%). Sixty percent had some formal training in occupational medicine, and 46% had occupational medicine certification by either the Royal College of Physicians and Surgeons of Canada, the Canadian Board of Occupational Medicine, or the American Board of Preventive Medicine. Younger physicians were more likely to be female and have gone directly into occupational medicine. Women were more likely to be working full-time in occupational medicine but worked fewer hours per week. Those physicians with specialty qualifications were older and more likely to be working full-time in occupational medicine and be active in professional activities. The Association intends to continue surveying its members on a triennial basis, identifying trends in the practice profiles and continuing education needs.
A method of providing experience for readers in the classification of radiographs for pneumoconiosis is described. It is based on an exchange of films by mail, with provision for ongoing feedback of results. The effects of this feedback on reading levels is described. The method is suitable for readers who are unable to attend major centers for formal instruction, and has the additional advantage of continual monitoring of reading levels.
BACKGROUND: Objective was to describe variations in how social insurance officers conceive the cooperation with the health care in their daily work with sick leave. METHODS: Fifteen social insurance officers (SIOs) working with administration of sickness benefits were interviewed. They were purposefully recruited to represent different parts of the social insurance office organization, different ages, gender, education, and work experience. The interviews were audio-recorded, transcribed verbatim and analyzed using phenomenographic approach. RESULTS: 11 women and 4 men, aged 25-65, with a work experience ranging from 1-40 years were interviewed. Three descriptive categories embracing eleven subcategories emerged: 1) Communication channels included three subcategories; to obtain medical opinions, to hold meetings with actors involved, to experience support functions; 2) Organizational conditions included five subcategories; to experience lack of time, to experience problems of availability, to experience lack of continuity, to experience unclear responsibility, to experience ongoing change; 3) Attitudes included three subcategories; to conceive the attitudes of the physicians, to conceive the attitudes of the patients, to conceive the attitudes of the SIOs. CONCLUSION: Personal communication was described as crucial to ensure a more efficient working process. The personal contact was obstructed mainly by issues related to work load, lack of continuity, and reorganisations. By enhancing and enabling personal contact between SIOs and health care professionals, the waiting times for the sick-listed might be shortened, resulting in shorter periods of sick-leave. Issues around collaboration and communication between gatekeepers need to be recognized in the ongoing work with new guidelines and education in insurance medicine.
Creation of new or considerably improved legal organizational and methodic base for State Sanitary and Epidemiologic Supervision activities necessitates higher qualification of doctors in industrial medicine and human ecology. Contemporary postgraduate medical training should include three important spheres: 1) evaluation of health state of occupational and population groups; 2) hygienic criteria to reveal correlation between health and life conditions (occupational, environmental and other factors); 3) hygienic aspects of occupational and everyday safety. Medical and biologic model of health evaluation appeared to be the most adequate to reveal influence of work conditions and ecologic factors on workers and population, methodic basis of this evaluation is search of quantitative dependencies and proof of the findings specificity. Hygienic aspects of occupational and everyday safety include two principal directions: problem of major chemical jeopardy and hygienic certification of production.