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In response to the rapidly changing occupational health environment, Bangkok DusitMedical Services (BDMS) has recognized a need to increase the quality and availabilityof occupational health services. This manuscript describes the evolution of aninternational health alliance, based on the “twinning” framework, to achieve acollaborative goal of developing an Occupational Health Center of Excellence(COE-OH) in Thailand. Through this alliance, the COE-OH has supported thedevelopment of programs in the areas of health promotion, training and research. Thetwinning framework was applied as the alliance moved through initiation, implementation,monitoring and evaluation. Project evaluation was viewed as an iterative process thatinformed next steps in the process as the collaboration developed. Initial products ofthis alliance include adaptation of the “Let’s Get Healthy!” health promotion and datacollection tool for use as part of the Thai employee check-up; development andimplementation of occupational health trainings for various levels of clinical staff;student exchange opportunities; and the creation of the infrastructure to supportstanding up of a fully human subjects compliant data repository for research. Threeyears into this alliance, the COE-OH has reached a point where feasibility has beenestablished and the immense opportunities of future joint work have become apparent.

Society is currently on the threshold of a new revolution in understanding the interaction of genes and the environment. This research has profound implications for understanding occupational disease and will present ethical challenges to occupational health practice. The public must be educated about the potential promise, as well as the threats, posed by emerging genetic technologies.

Background Workers' Compensation is a no-fault, administrative system designed to provide injured workers with medical care and wage replacement benefits without the delay, expense, and uncertainty of civil litigation. The system evolved from common law at the beginning of the twentieth century and was designed as a compromise between workers and employers in which each group surrendered certain legal rights and privileges in exchange for a speedier and more certain outcome. Compensation for occupational diseases like occupational asthma, rhinitis, or dermatitis is often complicated by the difficulty of proving that the condition "arose out of and in the course of employment." Physicians play an important role in these determinations through their expert opinion. Results Physicians must develop a consistent model to address these issues, and then present their findings and conclusions in a clear, well-reasoned, and compelling manner. In the end, the causation analysis should not solely depend on unsupported "opinion" or proceed from the conscious or unconscious biases of the physician. Conclusion Biased, illogical, scientifically unsupported, or even incompletely explained conclusions damage the credibility of physicians in the community and undermine the purposes of the workers' compensation system itself.

Society is currently on the threshold of a new revolution in understanding the interaction of genes and the environment. This research has profound implications for understanding occupational disease and will present ethical challenges to occupational health practice. The public must be educated about the potential promise, as well as the threats, posed by emerging genetic technologies.

Background: During the 1991 Gulf War, some Allied troops were potentially exposed to chemical warfare agents as the result of the detonation of Iraqi munitions at Khamisiyah. Methods: In 1999, we conducted a computer-assisted telephone survey of 2918 Gulf War veterans from Oregon, Washington, California, North Carolina, and Georgia to evaluate the prevalence of self-reported medical diagnoses and hospitalizations among this potentially exposed population and among comparison groups of veterans deployed and nondeployed to the Southwest Asia theater of operations. Results: Troops reported to be within 50 kilometers of the Khamisiyah site did not differ from other deployed troops on reports of any medical conditions or hospitalizations in the 9 years following the Gulf War. Hospitalization rates among deployed and nondeployed troops did not differ. Deployed troops were significantly more likely to report diagnoses of high blood pressure (odds ratio [OR]=1.7); heart disease (OR=2.5); slipped disk or pinched nerve (OR=1.5); post-traumatic stress disorder (OR=14.9); hospitalization for depression (OR=5.1); and periodontal disease (OR=1.8) when compared to nondeployed troops. There was a trend for deployed veterans to report more diagnoses of any cancer (OR=3.0). Conclusions: These findings do not provide evidence of any long-term health effect associated with exposure to the detonation of chemical warfare agents, but support findings from other investigations of increased morbidity among deployed troops. The prevalence of cancer among this population of deployed troops merits ongoing attention.

Prescriptions for controlled-release oxycodone, a narcotic analgesic, recently contributed to a dramatic increase in pharmacy costs for a large private insurance company. To determine whether this agent offered clinical benefits over other available drugs that would justify its significantly greater cost, a systematic review of 16 clinical trials was undertaken. The review suggested that immediate-release and controlled-release preparations of oxycodone have similar efficacy and comparable side effect profiles. Controlled-release oxycodone has the advantage of less frequent dosing than immediate-release oxycodone; however, other agents may be dosed infrequently at much lower costs. For patients requiring a controlled-release opioid treatment, controlled-release morphine and methadone should be considered because they appear to be as effective as oxycodone and cost considerably less. Controlled-release oxycodone may be appropriate for some patients, particularly if they cannot tolerate other controlled-release or long-acting opioid analgesics.