Association of Occupational and Environmental Clinics.

Occupational and environmental medicine practitioners must know general medicine, but they also have to be aware of the clinical aspects of toxicology, risk assessment and identification of exposures, epidemiology, molecular biology, pharmacology, and public health. Occupational and environmental physicians are often the first health providers to discover links between environmental exposures and human health effects.

The Association of Occupational and Environmental Clinics (AOEC), a Washington, D.C.-based nonprofit network of more than 60 clinics and 250 individuals, was founded in 1987 with the mission of advancing the practice of occupational and environmental medicine. The AOEC supports collaborative research that develops data on environmental and workplace health hazards and the health effects stemming from exposure to such hazards. The association also facilitates the exchange of information on topics such as the diagnosis and treatment of occupational and environmental diseases among health care professionals and the general public. To promote these efforts and provide an Internet base for their activities, the AOEC has developed a website located at http://www.aoec.org/.

Member clinics are located in 29 states, the District of Columbia, and 4 Canadian provinces. The AOEC Clinics page lets visitors search for clinics by state or by university or program name. Clicking on a link opens a page with clinic contact information, lists of the most common diagnoses seen at the clinic, and general services provided. These may include medical surveillance, screenings, and industrial hygiene consulting, and more specialized services such as pulmonary function assessment, skin allergy testing, assessments of indoor mold, and acute and chronic toxicity assessments.

The AOEC Educational Resources page features downloadable PowerPoint presentations on such topics as lead, occupational asthma, and impacts of criteria air pollutants on the respiratory health of children. Workbooks, training manuals, videotapes, and fact sheets are among other resources available from the AOEC library that can be downloaded or requested online.

The Educational Resources page provides information on university curricula and a link to EnviroDX, a multimedia "virtual clinic" developed by Eddy Bresnitz of the Robert Wood Johnson Medical School. Users are presented with four "patients" (whose symptoms may or may not be caused by environmental factors) and information on their exposure history as well as resources for researching the possible effects of suspected toxicants. Users select diagnostic tests, make a final diagnosis, prepare a treatment plan, outline preventive measures, then quiz themselves to check their answers.

Through cooperative agreements with the Agency for Toxic Substances and Disease Registry and the U.S. Environmental Protection Agency, the AOEC has created 12 Pediatric Environmental Health Speciality Units (PEHSUs) throughout North America. These units are collaborations between AOEC university clinics and pediatric clinics at the same institution. They serve as an educational resource for primary care providers and parents. The Pediatric Environmental Health Units page provides portals to each PEHSU's webpage, phone numbers, and links to the sites of other organizations that are of special interest to parents.

The AOEC is working to build an online record of actual occupational and environmental cases with profiles of anonymous patients. The AOEC expects these cases to be used as markers to help select participants for future research trials and to provide interesting cases of unrecognized health effects related to environmental exposures. The AOEC is also working on a database of all possible environmental toxicants that can cause health effects.