How to be paid for what you do: know the process.

Current Procedural Terminology and ICD-9-CM codes are tools used in clinical medicine to define work done and diagnoses or conditions for which the work was performed. It is important that all physicians become knowledgeable about these schemes to describe services provided correctly and accurately.

Azoospermia and oligospermia among a large cohort of DBCP applicators in 12 countries.

Azoospermia and oligospermia have been well demonstrated among workers exposed to 1,2-dibromo-3-chloropropane (DBCP) in manufacturing and formulation of this pesticide. After DBCP was banned in the United States in the late 1970s, two American companies continued to export it to many less developed countries. In the early to mid-1990s, attorneys assembled a cohort of approximately 26,400 male plaintiffs who, as workers on banana and pineapple plantations in 12 of these countries, had been exposed to DBCP, primarily during its application. These attorneys, for the purpose of a lawsuit against the two American companies, developed from interrogatories a database on these men that included information about stated periods of occupational DBCP exposure. Seminal fluid analysis results were also entered into the database. Analyzing information in this database, the authors found that, after a median exposure to DBCP of three years, 64.3% of these men overall, and 90.1% of men studied from the Philippines, had azoospermia or oligospermia. The mean number of children reported by the men was 2.5 overall. The percentage of men with no children was 28.5% overall. This report represents the largest cohort of DBCP-exposed workers in which adverse reproductive health effects have been described, and the first report of the adverse effects on the reproductive health of workers exposed to DBCP primarily through its application in a cohort of this size. This serious and extensive occurrence of adverse reproductive health effects due to the export of a hazardous pesticide before and after its ban in the United States illustrates a number of needs for monitoring, research, education, and policy development.

The future of environment and health: a global perspective.

The future of occupational and environmental health will depend largely on involving all groups in society, thinking globally and acting locally, and developing the popular and political will to support it. It is necessary for professionals in the field to better understand important economic, technologic, sociocultural, and other trends, and to focus their energies on listening to those being served and assessing their needs, as well as educating, advocating, and building partnerships to address these needs. Values, visions, and leadership can have an extraordinary impact on the future of the environment and health.

Accidental nuclear war--a post-cold war assessment.

BACKGROUND: In the 1980s, many medical organizations identified the prevention of nuclear war as one of the medical profession's most important goals. An assessment of the current danger is warranted given the radically changed context of the post-Cold War era. METHODS: We reviewed the recent literature on the status of nuclear arsenals and the risk of nuclear war. We then estimated the likely medical effects of a scenario identified by leading experts as posing a serious danger: an accidental launch of nuclear weapons. We assessed possible measures to reduce the risk of such an event. RESULTS: U.S. and Russian nuclear-weapons systems remain on a high-level alert status. This fact, combined with the aging of Russian technical systems, has recently increased the risk of an accidental nuclear attack. As a conservative estimate, an accidental intermediate-sized launch of weapons from a single Russian submarine would result in the deaths of 6,838,000 persons from firestorms in eight U.S. cities. Millions of other people would probably be exposed to potentially lethal radiation from fallout. An agreement to remove all nuclear missiles from high-level alert status and eliminate the capability of a rapid launch would put an end to this threat. CONCLUSIONS: The risk of an accidental nuclear attack has increased in recent years, threatening a public health disaster of unprecedented scale. Physicians and medical organizations should work actively to help build support for the policy changes that would prevent such a disaster.

Laparoscopic-assisted vaginal hysterectomy: American Association of Gynecologic Laparoscopists' 1995 membership survey.

A questionnaire was mailed to all members of the AAGL to determine the current performance of laparoscopic-assisted vaginal hysterectomy (LAVH), and to assess the relative frequencies of techniques and complications. Answers of the 1092 members who responded were entered into a database computer program and analyzed. The analysis revealed 14,911 LAVHs performed by 767 members. Complication rates appeared to be in the same range as those reported for vaginal hysterectomy and total abdominal hysterectomy. Inferior epigastric injury was the most common complication. Physicians showed a shift in their practices away from abdominal hysterectomy after they learned LAVH.

Global occupational health issues: Working in partnership to prevent illness and injury.

1. Occupational health problems in developing countries are more widespread and serious because they occur against a background of endemic risk factors for ill health. 2. In general, developing countries have less adequately developed occupational health personnel and programs and less adequately developed and enforced laws and regulations than developed countries. 3. Awareness of the importance of occupational health among workers, management, government officials, and the public is increasing with developing countries. 4. Occupational health professionals in developed countries can contribute in many ways to improving occupational health in developing countries.