The substance user at risk of harm to self or others: assessment and treatment issues.

This article is divided into two main sections, one discussing suicide and substance use, and the other describing substance use and various forms of violent behavior toward others, including sexual assault and domestic violence. In each section, issues regarding prevalence of harm to self and others in substance users, clinical assessment and treatment, etiologic factors, definitional problems, and research needs are discussed. Substance use appears to be associated strongly with both violence toward self and violence toward others, but the exact nature of these relationships is somewhat unclear.

Environmental medicine content in medical school curricula.

BACKGROUND: The Institute of Medicine has recommended basic clinical competence in environmental medicine (EM) for all physicians. However, the amount and content of instruction in EM currently offered in U.S. medical schools is unknown. METHOD: This cross-sectional study was based on responses to a questionnaire regarding the EM curriculum content of U.S. medical schools, mailed in June 1994 with the Association of American Medical Colleges curriculum survey. RESULTS: Of the 126 schools, 119 (94%) responded. Of these, 29 (24%) reported no required EM content in the curriculum. Schools with EM content averaged seven hours of instruction. Eighty-one schools (68%) had faculty with environmental and occupational medicine expertise, primarily within the departments of medicine, preventive medicine, and family medicine. CONCLUSION: There is a need for increased instruction in EM in medical school curricula for students to acquire the knowledge and skills to prevent, diagnose, and treat health problems with an environmental exposure component. For those schools without EM content in the curriculum, the necessary expertise to develop EM curriculum may be available in current faculty.