Teaching occupational and environmental medicine in primary care residency training programs: experience using three approaches during 1984-1991.

There is a critical shortage of physicians trained to recognize and treat occupational and environmental health problems. We implemented several required teaching programs for internal medicine and family medicine residents that focus on providing primary care for these problems. Clinical experiences were developed using the university and medical center as an example of a workplace with chemical and physical hazards. On-site experiences were also provided at local industries, but when resident stipend support for this aspect was discontinued, that part of the program was suspended. Didactic programs were associated with a statistically significant improvement in house staff knowledge scores. These occupational and environmental health issues can be introduced during residency, resulting in increased expertise in this discipline.

Persistence of antibody in healthcare workers vaccinated against hepatitis B.

A cross-sectional serological survey was undertaken in 82 randomly selected high-risk healthcare workers previously vaccinated with the hepatitis B vaccine. The study design allowed for the identification and testing for hepatitis B surface antibody in equal numbers of employees in six-month intervals up to five years after vaccination. The results showed a consistent decline in antibody level with time, and an increasing proportion of participants with antibody levels below the commonly accepted protective level of greater than or equal to 10 S/N (sample counts/negative control counts) radioimmunoassay units. The percent of vaccinees whose S/N ratio was greater than 10 fell from 10% at one year, to 25% at two years, to over 50% at four years. Based on these figures, as well as the financial costs of hepatitis B in employees and the predictability of booster immunization, it was possible to assess the cost benefit of a hospital policy for reimmunization. At our institution, a strategy of revaccination at fixed intervals could save up to $200,000 over a ten-year period if revaccination was not offered and vaccine efficacy declined. The information obtained should help determine the need for revaccination and the advantages and disadvantages of alternative revaccination strategies.

Modified extraction procedure for gas-liquid chromatography applied to the identification of anaerobic bacteria.

Chloroform and ether commonly are used as solvents to extract metabolic organic acids for analysis by gas-liquid chromatography in the identification of anaerobic bacteria. Because these solvents are potentially hazardous to personnel, modified extraction procedures involving the use of a safer solvent, methyl tert-butyl ether were developed which remained both simple to perform and effective for organism identification.