ACOEM OEM Core Competencies: 2021.

Competency is defined as possession of sufficient physical, intellectual, and behavioral qualifications to perform a task or serve in a role which adequately accomplishes a desired outcome. Recognizing the need for defining competencies essential to occupational and environmental medicine (OEM) physicians, the American College of Occupational and Environmental Medicine developed its first set of OEM Competencies in 1998. Later updated in 2008, and again in 2014, the increasing globalization and modernization of the workplace, along with published research on OEM practice, required an update to ensure OEM physicians stay current with the field and practice of OEM. Delineation of core competencies for the profession provides employers, government agencies, health care organizations, and other health practitioners a solid context of the role and expertise of OEM physicians.

Arsenic Exposure, Assessment, Toxicity, Diagnosis, and Management: Guidance for Occupational and Environmental Physicians.

: Arsenic is ubiquitous in the environment and human exposure can occur from multiple possible routes including diet. Occupational medicine physicians asked to evaluate workers with elevated urine arsenic levels may be unaware that many sources of arsenic exposure are not work related. In this paper, we address arsenic exposure sources and pathways, adverse health effects of arsenic exposure and those subpopulations at increased risk, and the evaluation and treatment of those exposed to elevated arsenic levels.

Correlation between physical activity, fitness, and musculoskeletal injuries in police officers.

In order to explore the correlation between physical activity, fitness, and injury among police officers, a cross section of active-duty members of the Minneapolis Police Department were surveyed about their level of fitness, physical activity, and prevalence of injury and chronic pain within the past year. In the study, officers with the highest self-reported fitness levels were less likely to experience sprains (OR 0.27, 95% CI 0.08-0.88), back pain (OR 0.48, 95% CI 0.09-0.88), and chronic pain (OR 0.21, 95% CI 0.06-0.73) than those who considered themselves less fit. Officers who were the most physically active were about a third as likely to report back pain (OR 0.37, 95% CI 0.10-0.73) and less than half as likely to report chronic pain (OR 0.42, 95% CI 0.19-0.91) as those who engaged in less activity. And officers with a BMI greater than 35 were 3 times more likely to report back pain (OR 3.36, 95% CI 1.17-9.66) than those whose BMI fell in the normal range (18-25). Thus, officers who engage in higher levels of physical activity and are more physically fit have a lower prevalence of musculoskeletal injuries and chronic pain.

Workplace hazards to women's reproductive health.

Women make up nearly half of Minnesota's workforce. Thus, many women, including those of reproductive age, are exposed to workplace hazards. These hazards may be chemical-toxicants such as heavy metals, pesticides, and endocrine disruptors; physical--the result of activities or proximity to something in the environment; or biological-infectious agents. And they are of growing concern among scientists and the public. Although data on the effect of these hazards on the reproductive health of women is limited, there is evidence indicating they ought to be of concern to women and the physicians who treat them. Clinicians are encouraged to assess women for exposure to workplace hazards and to communicate with them about whether such exposure might increase their risk for problems such as infertility, miscarriage, and preterm birth. This article highlights selected job-related hazards and offers suggestions for caring for working women of reproductive age.

Successful return to work for cancer survivors.

This study investigated factors associated with successful return to work for cancer survivors in accordance with the Americans with Disabilities Act. A focus group was held with seven female cancer survivors. Participants discussed return-to-work issues following a cancer diagnosis. Factors such as coworker support and job flexibility improved their experiences, whereas coworker and supervisor ignorance about cancer and lack of support made returning to work more stressful. Participants discussed personal, environmental, and cancer-related factors that influenced their experiences with returning to work following a cancer diagnosis. Knowledge of factors that support employees helps occupational health nurses ease their transition, and may improve quality of life for employees. Physicians and health care provider teams may play a critical role in the employees' positive evaluation of their recovery process. This pilot study serves as a basis for a larger, population-based study.

Biomonitoring of 2,4-dichlorophenoxyacetic acid exposure and dose in farm families.

OBJECTIVE: We estimated 2,4-dichlorophenoxyacetic acid (2,4-D) exposure and systemic dose in farm family members following an application of 2,4-D on their farm. METHODS: Farm families were recruited from licensed applicators in Minnesota and South Carolina. Eligible family members collected all urine during five 24-hr intervals, 1 day before through 3 days after an application of 2,4-D. Exposure profiles were characterized with 24-hr urine 2,4-D concentrations, which then were related to potential predictors of exposure. Systemic dose was estimated using the urine collections from the application day through the third day after application. RESULTS: Median urine 2,4-D concentrations at baseline and day after application were 2.1 and 73.1 microg/L for applicators, below the limit of detection, and 1.2 microg/L for spouses, and 1.5 and 2.9 microg/L for children. The younger children (4-11 years of age) had higher median post-application concentrations than the older children (> or = 12 years of age) (6.5 vs. 1.9 microg/L). The geometric mean systemic doses (micrograms per kilogram body weight) were 2.46 (applicators), 0.8 (spouses), 0.22 (all children), 0.32 (children 4-11 years of age), and 0.12 (children > or = 12 years of age). Exposure to the spouses and children was primarily determined by direct contact with the application process and the number of acres treated. Multivariate models identified glove use, repairing equipment, and number of acres treated as predictors of exposure in the applicators. CONCLUSIONS: We observed considerable heterogeneity of 2,4-D exposure among farm family members, primarily attributable to level of contact with the application process. Awareness of this variability and the actual magnitude of exposures are important for developing exposure and risk characterizations in 2,4-D-exposed agricultural populations.

Occupational medicine physicians in the United States: demographics and core competencies.

OBJECTIVE: We assessed the demographic profile and opinions of current occupational medicine (OM) physicians on the importance of specific core competencies. METHODS: A random sample of 1500 OM physicians listed in the membership directory of the American College of Occupational and Environmental Medicine (ACOEM) were asked to complete a voluntary survey. RESULTS: Six hundred and ten OM physicians completed the survey. Fifty two percent worked in clinical settings, and 16% worked in corporate or industrial settings. Eighty percent were satisfied with their choice of careers. CONCLUSIONS: OM physicians appeared to be highly trained, with 60% certified in OM and 68% board certified in other specialties. The OM physicians valued staying current in the field, understanding the relationship between occupational exposure and health, and communicating with stakeholders most highly. Occupational physicians are an important source of knowledge regarding what competencies and core knowledge areas are important for OM practice.

Occupational medicine residency graduate survey: assessment of training programs and core competencies.

OBJECTIVE: This study provides insight into Occupational Medicine (OM) residency graduates and how residency programs are meeting their education goals. METHODS: A survey of graduates from nine OM residency program was performed to evaluate the effectiveness of OM residency training in the United States and Canada. RESULTS: Eighty percent of the OM residency graduates were currently practicing OM. Three-quarters worked in clinical practice for a mean of 20 hr/wk. Other activities varied and included management, teaching and consulting. Ninety-five percent were satisfied with their OM residency training. The competencies acquired were mostly ranked highly as practice requisites, although preparation in clinical OM might be better emphasized in training. Recent OM residency graduates were more likely to be board-certified in OM than other American College of Occupational and Environmental Medicine physician members (73% vs 41%). CONCLUSIONS: OM residency graduates over the past 10 years were highly satisfied with OM residency training, with the training generally meeting practice needs.

A strong dose-response relation between serum concentrations of persistent organic pollutants and diabetes: results from the National Health and Examination Survey 1999-2002.

OBJECTIVE: Low-level exposure to some persistent organic pollutants (POPs) has recently become a focus because of their possible link with the risk of diabetes. RESEARCH DESIGN AND METHODS: Cross-sectional associations of the serum concentrations of POPs with diabetes prevalence were investigated in 2,016 adult participants in the National Health and Nutrition Examination Survey 1999-2002. Six POPs (2,2',4,4',5,5'-hexachlorobiphenyl, 1,2,3,4,6,7,8-heptachlorodibenzo-p-dioxin, 1,2,3,4,6,7,8,9-octachlorodibenzo-p-dioxin, oxychlordane, p,p'-dichlorodiphenyltrichloroethane, and trans-nonachlor) were selected, because they were detectable in >or=80% of participants. RESULTS: Compared with subjects with serum concentrations below the limit of detection, after adjustment for age, sex, race and ethnicity, poverty income ratio, BMI, and waist circumference, diabetes prevalence was strongly positively associated with lipid-adjusted serum concentrations of all six POPs. When the participants were classified according to the sum of category numbers of the six POPs, adjusted odds ratios were 1.0, 14.0, 14.7, 38.3, and 37.7 (P for trend < 0.001). The association was consistent in stratified analyses and stronger in younger participants, Mexican Americans, and obese individuals. CONCLUSIONS: There were striking dose-response relations between serum concentrations of six selected POPs and the prevalence of diabetes. The strong graded association could offer a compelling challenge to future epidemiologic and toxicological research.

Chlorpyrifos exposure in farm families: results from the farm family exposure study.

We used urinary biological monitoring to characterize chlorpyrifos (O,O-diethyl-O-(3,5,6-trichloro-2-pyridinyl) phosphororthioate) exposure to farm family members from Minnesota and South Carolina who participated in the Farm Family Exposure Study. Five consecutive 24-h urine samples were obtained from 34 families of licensed pesticide applicators 1 day before through 3 days after a chlorpyrifos application. Daily 3,5,6-trichloro-2-pyridinol (TCP) urinary concentrations characterized exposure profiles of the applicator, the spouse, and children aged 4-17 years. Self-reported and observed determinants of exposure were compared to the maximum postapplication TCP concentration. All participants had detectable (> or = 1 microg/l) urinary TCP concentrations at baseline. Applicators' peak TCP levels occurred the day after the application (geometric mean (GM) = 19.0 microg/l). Postapplication TCP change from baseline in the spouses and children was negligible, and the only reliable predictor of exposure was assisting with the application for children aged 12 years and older. The applicators' exposure was primarily influenced by the chemical formulation (GM = 11.3 microg/l for granular and 30.9 microg/l for liquid), and the number of loads applied. Repairing equipment, observed skin contact, and eating during the application were moderately associated TCP levels for those who applied liquid formulations. Estimated absorbed doses (microg chlorpyrifos/kg bodyweight) were calculated based on TCP excretion summed over the 4 postapplication days and corrected for pharmacokinetic recovery. The GM doses were 2.1, 0.7, and 1.0 microg/kg bodyweight for applicators, spouses, and children, respectively. Chlorpyrifos exposure to farm family members from the observed application was largely determined by the extent of contact with the mixing, loading, and application process.

Biomonitoring for farm families in the farm family exposure study.

OBJECTIVES: The Farm Family Exposure Study was conducted to evaluate real-world pesticide exposure for farmers, spouses, and children. METHODS: Eligible farm families from Minnesota and South Carolina were randomly selected from a roster of licensed private pesticide applicators. Eligibility required that the family include a farmer, spouse, and at least one child between the ages of 4 and 17 years, that the family live on the farm, that the farmer planned to apply one of the target pesticides [glyphosate, chlorpyrifos, 2,4-dichlorophenoxy acetic acid (2,4-D)] to at least 10 acres (4.1 hectares) of land within 1 mile (1.6 kilometers) of the house. For each family member, geometric means were calculated for 24-hour composite urinary samples, with a 1 ppb (part per billion) limit of detection, the day before, the day of, and for 3 days after the application. RESULTS: For the farmers, the peak geometric mean concentrations were 3 ppb for glyphosate, 64 ppb for 2,4-D, and 19 ppb for the primary chlorpyrifos metabolite. For the spouses and children, the percentage with detectable values varied by chemical, although the average values for each chemical did not vary during the study period. The applicators had the highest urine pesticide concentrations, children had much lower values, and spouses had the lowest values. Exposure to family members was largely, though not exclusively, determined by the degree of direct contact with the application process. The exposure profile varied for the three chemicals for each family member. CONCLUSIONS: The data of this study indicate the importance of chemical-specific considerations when exposure assessments are planned in epidemiologic studies.

Farm Family Exposure Study: methods and recruitment practices for a biomonitoring study of pesticide exposure.

PURPOSE: The Farm Family Exposure Study was initiated to characterize pesticide exposure to farm family members around the time of one pesticide application in a manner that will facilitate exposure assessment in epidemiologic studies of pesticides. METHODS: A sample of farm families with children was recruited by randomly selecting farmers from lists of licensed pesticide applicators in Minnesota and South Carolina. Eligible families were selected from among those who planned to apply one of three chemicals, glyphosate, 2,4-D, or chlorpyrifos, as part of their normal operations. The applicator, spouse, and all children in the family ages 4-17 years were included in the study. The applicator and spouse completed self-administered questionnaires addressing demographics, farming practices and potential exposures to them and their children. Field observers documented the application, recorded application practices, equipment, potential exposures, and the presence of children or spouses in the immediate vicinity of pesticide activities. All study participants were asked to collect each urine void for 5 days, 1 day before through 3 days after the application. Pesticides were measured in 24-h composite urine samples with a one part per billion limit of detection. RESULTS: Of 11,164 applicators screened, 994 families met the inclusion criteria. Of these, 95 families were enrolled. Enrollees were similar in most characteristics to their peers who were not participants in the study. In total, there were 106 applications, 10 of which involved more than one chemical. This resulted in urinary data for 48 farmers and spouses and their 79 children for glyphosate, 34 farmers and spouses and their 50 children for chlorpyrifos, and 34 farmers and spouses and their 53 children for 2,4-D. Compliance with the 24-h urine collection was particularly good for the adult participants. There were more missing samples for children than for adults, but overall compliance was high. CONCLUSION: The Farm Family Exposure Study should provide insights about pesticide exposure under real world conditions and thereby facilitate improved exposure assessment in epidemiologic studies of agricultural populations.

Persistent neuropathy and hyperkeratosis from distant arsenic exposure.

The purpose of this case series is to assess long-term sequelae of arsenic exposure in a cohort acutely exposed to arsenic in drinking water from a well dug into a landfill containing arsenical pesticides. Ten of the 13 individuals (or next of kin) in the initial study agreed to participate in the follow-up study. Next of kin provided questionnaire data and released medical information on the three individuals who had died. The remaining seven cohort members were assessed by an interview, questionnaire, detailed physical examination and sensory nerve testing. Available medical records were obtained and reviewed. Sensory testing was performed using an automated electrodiagnostic sensory Nerve Conduction Threshold (sNCT) evaluation. Sensory complaints and electrodiagnostic findings consistent with polyneuropathy were found in a minority (3/7) of subjects 28 years after an acute toxic arsenic exposure. Two of the seven patients examined (1 of 3 with neuropathic findings) also had hyperkeratotic lesions consistent with arsenic toxicity and one of the patients had hyperpigmentation on their lower extremities possibly consistent with arsenic toxicity.

Second births among teenage mothers: program results and statistical methods.

This paper uses survival analysis to examine three large-scale, multi-site, randomized, controlled programs that attempted to prevent or delay second births to teenagers. Statistically significant differences in the hypothesized direction were found between the intervention and the control groups in the Elmira and Memphis Home Visitation sites. No statistically significant differences in the hypothesized direction were found in the Teen Parent Welfare Demonstration overall or in any of its three sites or in all New Chance sites combined. Delaying second pregnancies among teenagers requires intensive efforts. Survival analysis is a more accurate and useful way of presenting program results than simple analysis of the proportion of women with a second birth.

The extent of pregnancy mistiming and its association with maternal characteristics and behaviors and pregnancy outcomes.

CONTEXT: The National Survey of Family Growth (NSFG) classifies pregnancies as intended, mistimed or unwanted. However, these categories could be too broad, as a woman's feelings about a pregnancy, her health behaviors during pregnancy and thus her pregnancy outcomes may vary according to whether her pregnancy is moderately or seriously mistimed. These relationships have not yet been explored. METHODS: Data from the 1995 NSFG were examined to assess associations between pregnancy mistiming and maternal characteristics. Descriptive and multivariate analyses were conducted of the extent of mistiming for each maternal characteristic. Chi-square and F-tests were used to examine the associations between a pregnancy's intendedness--according to a four-category classification--and maternal characteristics, maternal happiness ratings, maternal behaviors and pregnancy outcomes. RESULTS: Fifty-five percent of mistimed pregnancies were mistimed by 24 months or less, 32% were mistimed by 25-60 months and 13% were mistimed by more than 60 months. According to multivariate analyses, pregnancies among younger women, never-married women and black women were mistimed by significantly more months than those among other women. The distribution of moderately mistimed pregnancies differed significantly from those of both seriously mistimed and unwanted pregnancies according to most maternal characteristics; there were few differences between intended and moderately mistimed pregnancies, and between seriously mistimed and unwanted pregnancies. CONCLUSIONS: Mistiming is not a unitary construct. Its extent is associated with maternal characteristics and behaviors. Future research on pregnancy intention should examine the extent of mistiming and consider alternatives to traditional definitions of intendedness.