Source: http://www.nwpublichealth.org/docs/wph/occdis.html
Introduction
Occupational exposures contribute to the morbidity and mortality of many diseases. Occupational diseases continue to be under- recognized even though they are responsible for an estimated 860,000 illnesses and 60,300 deaths each year (USA). In Malaysia, even though there are many systems for collecting data through the various agencies like the Ministry of Health (MOH), SOSCO and DOSH, under reporting continue to occur.
At the primary care level (MOH), Doctors and allied health personnel are the first contact. In the industrial setting, the panel doctor would be the first contact. The management perhaps through the Human Resources Manager would monitor the trend of absenteeism amongst the staff. The safety and health personnel can assist in recognizing potential health and safety problems that can arise through the use of chemicals etc in the workplace. In short it is a proactive and multidisciplinary team work.
The general practitioners can play an important role in improving the recognition of occupational disease, preventing progressive illness and disability in their own patients, and contributing to the protection of other workers similarly exposed.
Raising the Level of Suspicion
Occupational disease is surprisingly common. 75 percent of hospitalized and primary care patients report hazardous exposures and 17 percent suspect that their illness is linked to their job. Work-related illness is diagnosed in approximately 10 percent of these patients.
The spectrum of occupational diseases is extremely broad and many conditions commonly encountered in primary care practice may be work related.
| Musculoskeletal Disorders |
- >60% of occupational illness
- Disorders involving arm & neck frequently seek treatment
- Specific diagnoses, such as localized nerve entrapment (e.g., carpal tunnel syndrome), tendinitis (e.g., lateral epicondylitis, de Quervain’s tendinitis), muscle strain and other regional pain syndromes
Respiratory Diseases
- Pneumoconiosis due to inhalation of asbestos, silica or other non-organic dust should be considered in patients who report worsening difficulty in breathing and dry cough
- Airway diseases, including rhino-sinusitis, bronchitis and asthma, have been increasingly recognized as work related
- Occupational asthma related to possible exposure to allergens (e.g., grain dust), respiratory irritants (e.g., sulfur dioxide) or substances acting through other mechanisms (e.g., isocyanates).
Neurologic Disorders
- Toxins, including organic solvents (e.g., toluene and chlorinated hydrocarbons), metals (e.g., lead and manganese) and pesticides (e.g., organophosphates)
- Numbness/pain of extremities (peripheral neuropathy)
- Chronic organic solvent exposure is responsible for a syndrome that includes headaches, fatigue, light-headedness, cognitive difficulties and depression.
Cancer and Heart Disease
- Work exposures also contribute to a notable percentage of cancers and have been increasingly recognized as factors in the development of coronary artery disease.
Stress-Related Illnesses
- Stress has been associated with a range of emotional and physical ailments, including coronary artery disease and heart attacks (myocardial infarction).
- Jobs with high emotional/psychological demands and low potential for control by the worker are more likely to cause stress-related illness.
Source: http://www.wantchinatimes.com/news-subclass-cnt.aspx?id=20110412000134&cid=1103
Work Conditions and Illness
As the focus of business has shifted from manufacturing to service in most industrialized countries, traditional notions of hazardous work have, by necessity, been expanded. Occupational illnesses continue to occur in manufacturing, construction and agricultural sectors, but they are also increasingly being recognized in the service sector.
A significant proportion of occupational illnesses are related to building conditions, such as inadequate fresh-air ventilation, low humidity and the presence of cigarette smoke, volatile organic compounds and fibers, molds or other microbiologic materials.
Typically, workers with symptoms related to indoor air quality report sore throat and eye irritation, frequently accompanied by fatigue and difficulty concentrating. These symptoms generally occur in a group of workers in the same environment. The workers report rapid clearing of the symptoms when they leave the workplace.
Index of Suspicion
An occupational etiology or cause should be considered if an illness fails to respond to standard treatment, does not fit the typical demographic profile (i.e., lung cancer in a 40-year-old nonsmoker) or is of unknown origin.
Much is still unknown about the health effects of most workplace exposures. The introduction of new chemicals and other materials has far outpaced general knowledge of their potential toxicity. Management and doctors continue to play a crucial role in recognizing unsuspected links between exposures and specific illnesses.
Temporal Relationship of Symptoms to Work
The timing of symptoms in relation to work is often crucial in the assessment of a potential occupational illness. A worker with asthma may state that symptoms appear soon after he or she arrives at work and with symptoms disappearing after the shift and on weekends. The timing of symptoms may be more specifically linked to the use of a certain substance, the activation of a specific process or a change of materials or other work conditions. It is important to recognize that as many job-related illnesses progress, the clear relationship of symptoms to work may be obscured by a lack of marked improvement away from work. Patients may still experience the symptoms when they are not at work.
Symptoms Among Co-workers
The probability that work is contributing to a common illness is strengthened if the patient’s co-workers are experiencing similar symptoms. When queried, workers with occupational illness commonly report others who are similarly affected. The history should allow the doctor to evaluate the relative contribution of exposures, both on and off the job, to an illness.
Occupational Health Resources
The need for consultation or referral depends on the doctor’s skill, confidence and time, as well as the specifics of a given case. A telephone consultation or referral to an occupational medicine specialist can provide information on the extent of a patient’s exposure, the likely health effects of the exposure, appropriate diagnostic tests, possible workplace interventions to reduce exposure and recommendations on the patient’s return to work.
Occupational disease by its long latent period between exposure and disease reinforces the notion of ‘all is well’ because ‘no one is sick’.
Management can assist by adherence to the OSHA ‘94 guidelines as far as is practicable in ensuring that the place of work is both ‘healthy’ and safe. In this regard, adoption of a ‘Healthy Workplace’ as recommended by World Health Organization can be implemented.
References
Occupational Safety And Health Act 1994 Malaysia
J Jeyaratnam and David Koh., Text Book Of Occupational Medicine Practice 1996
American Academy Of Family Physicians, Article September 15 1998
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]