William M. Simpson

Medical Education for Agricultural Health and Safety

ABSTRACT Medical education for agricultural health and safety is evolving to intersect primary care, rural community health, and occupational and environmental medicine (OEM). Agricultural hazards are concentrated among the diverse concerns of primary care and community health. Family physicians who respond to this diversity can maintain their rural practices while establishing the credibility necessary for acceptance as partners in programs for agricultural community health. Rural family physicians with expertise in community health and OEM can be the front line of agricultural medicine. Several educational efforts are relevant to producing these physicians: (1) rural medicine, (2) rural public health, (3) family medicine, and (4) OEM (including agricultural medicine). Agromedicine education to prepare physicians to partner with agricultural scientists and cooperative extension agents should also be considered. Each of these efforts requires faculty with special expertise and resources. Few institutions are prepared currently to merge and coordinate these programs into a coherent rural and agricultural medicine program. We recommend that a medical school in each distinctive agricultural region construct a model for developing agricultural medicine physicians and seek partners and resources to operationalize the model. Examples include the Iowa, South Carolina, and Alabama models. A vocal rural and agricultural constituency may be required for success.

The occupational and environmental medicine gap in the family medicine curriculum: needs assessment in South Carolina. Part I.

The occupational and environmental medicine (OEM) gap in US medical education is widely recognized. In 1992, a federal initiative stimulated a primary care approach to improve residency training in South Carolina. This three-part report documents progress in designing and implementing an OEM curriculum, which is family medicine-centered. Each of the states residency training programs participate in an ongoing Environmental Medicine Curriculum Committee effort. Part 1, discusses the needs assessment; Part 2, the five key elements of curriculum; and Part 3 details a clinical guide to the OEM patient.

What's in a name? Revisited: terms used to describe activities related to the health and safety of agricultural-associated populations and consumer

Abstract The fundamental role of an academic journal is to facilitate a dialogue among scholars to advance the knowledge and art of practice related to the journals subject, and consequently, to raise the human condition. As the Journal of Agromedicine begins to chart a course under new management and to enlarge the numbers of contributing scholars and sustaining subscribers, the editor has discovered a variety of concepts, historical developments, and terms used by scholars and practitioners in pursuit of health and safety of agriculture-associated populations and consumers. Each of these concepts, developments, and terms reflect the interests of different scholars and practitioners, who represent a surprisingly broad set of disciplines committed to this large endeavor.

The occupational and Environmental medicine gap in the family medicine curriculum : Five key elements in South Carolina. Part II

Part II of our three-part report examines five of the key elements for occupational and environmental medicine (OEM) training in family medicine residency. These were introduced by the Environmental Medicine Curriculum Committee (EMCC) faculty in South Carolina under a Department of Energy (DOE) grant to the Environmental Hazards Assessment Program (EHAP) of the Medical University of South Carolina, 1992-1997. Each element is being designed, tested, and updated by clinicians in the residency network. A pilot study of 100 third-year medical students conducted in 1996 suggests the difficulty in implementing OEM skills in current family medicine training.

A clinical guide to the occupational and environmental medicine patient in a busy family practice: the two-task, four-prototype approach in the SC/EHAP initiative. Part III.

A four-prototype approach to the occupational and environmental medicine (OEM) patient in a busy primary care setting is described. A 2 x 2 table illustrates the two diagnostic, interrelated tasks during the outpatient, non-urgent visit: (a) sick? yes/no, and (b) exposed? yes/no. One may have the basic skills for task (a) but feel insecure for task (b). With OEM experience, creative use of resources (databases and consultants), and patient cooperation, a better balance between task (a) and task (b) can be achieved. The Environmental Medicine Curriculum Committee (EMCC) initiative described in Part I and Part II of this study has developed this patient-centered model to help the resident in training cope as he or she tries to deal with emerging patient concerns from the workplace and beyond. In November 1996, an expert panel of consultants representing OEM, public health, and family medicine endorsed the prototype OEM patient model for further development.

Pentoxifylline (Trental®)-Induced Visual Hallucinations

and of themselves, represent 100% correlation between the thermometry readings and rectal temperatures. This cannot possibly be randomized data. These 23 data points could only have been produced by fraudulently correlating the rectal temperatures with the thermometry readings. The authors should review the original raw data and will undoubtedly find that this linear row of data points was collected by a single individual. I suggest that those data points be thrown out and the correlation coefficient be recalculated without the obvious linear row that I mentioned. In addition, all of the data reported are in patients within the normal temperature range. It would be of far more use in clinical practice if the same study were done with the instrument in patients who are febrile.

An agromedicine initiative for first-year medical students, 1998-2004: biochemistry seminar proves feasible.

Abstract This report describes a 20 class-hour, 10-session seminar on agromedicine-oriented topics, delivered as part of a basic science course for medical students (biochemistry) at the Medical University of South Carolina. The course was initiated in 1998 and continued through 2004. The preceptors are family medicine and agricultural research professors. Concepts from primary care, epidemiology, entomology, toxicology, and food science appeal strongly to the first-year medical student group (limited to 10 students). The agromedicine/environmental medicine seminar series is one of 16 research seminars available for in-depth study. As part of the course in biochemistry, this seminar has earned positive evaluations from medical students who expect to widen their perspective on global health and the environment. Seminar topics include food safety, farm trauma, nutraceuticals, crop protection, insect-borne disease, occupational health and safety, diet and cancer, birth defects, and bioengineering. Seventy medical students have participated in the interdisciplinary seminar. They perceive environmental science as affecting the health of their patients and as an essential part of their preparation for curative and preventive medicine. Readers may find medical school curriculum committees more receptive to accepting and continuing an agromedicine offering if it can be incorporated in a basic science course such as biochemistry or pharmacology.

The fourteenth annual meeting of the North American Agromedicine Consortium, Charleston, SC, November 4-6, 2001.

The meeting began with research and informational presentations. Randall K. Fahrenholtz of the University of Kansas School of Medicine reported on a telephone survey of one-fourth of the households in a county with large livestock and row crop production. A similar survey was obtained in two non-agricultural counties for comparison. Only preliminary data were available at the time of the presentation. There appears to be no increased risk for cancer in the agricultural population with the exception of a marginally increased risk for prostate cancer. Much more data will be forthcoming from this and other related studies from the University of Kansas. Carol Burns of Dow Chemical discussed the current status of children’s risk in relation to the process for registration of an agrochemical. Joyce A. Smith of Ohio State University presented their experience with skin cancer education of farmers in Minnesota and Ohio. Operation Hat CheckTM, developed by the National Farm Medicine Center, encourages farmers to trade their baseball caps for wide-brimmed hats that provide greater solar protection. More than 1,300 “sun safe” hats were distributed at three farm shows in Minnesota and Ohio. In a mail survey three months after the original intervention (81% response rate) over half had adopted sun safety behavior changes. Twelve percent had purchased additional sun safe hats.

A family outbreak of acute organophosphate poisoning: a diagnostic challenge.

ABSTRACT Acute pesticide poisonings may present with vague symptoms and signs and may require a high index of suspicion for diagnosis. In some instances exposures may be unreported out of ignorance or fear of legal consequences by the patients. Pesticide label information and manufacturers hotline support can be invaluable in providing optimal care for poisoned patients.