Occupational Illness

Sep 16, 2019 admin DA LIỄU, GIẢI PHẪU BỆNH, HÔ HẤP, Y HỌC DỰ PHÒNG 0

Occupational Illness

Aka: Occupational Illness, Occupational Disease, Occupational Disorder, Occupational Injury, Work-Related Illness, Work-Related Injury, Workplace Injury, Injured Worker

II. History: Occupational

  1. Job History
    1. Employers (include part-time work)
    2. Job titles and responsibilities
      1. Construction workers, nursing aids and custodians are highest risk
    3. Accidents and injuries at each location
      1. Most common fatal injuries are due to MVA, strikes by equipment, falls, Violence, and harmful substance exposures
      2. Personal history of symptoms and injuries at each work site
    4. Military service
  2. Exposures
    1. Specific exposures (with frequency and quantity of exposure and safety data sheets)
      1. Biological exposures (communicable disease, animals)
      2. Chemical exposures (solvents, fumes, dust)
      3. Physical exposures (noise, radiation, vibration and repetitive motion, heavy lifting)
      4. Stressors (work relationships, workload and overtime)
    2. Personal Protective Equipment
    3. Assistive Devices
    4. Monitoring data (e.g. lead, radiation badge)
  3. Symptoms attributed to workplace exposure
    1. Similar symptoms in coworkers
    2. Symptom onset after new job or work responsibilities, new work process or materials
    3. Symptoms worse during or immediately after work
    4. Symptoms improve when on vacation from work
  4. Pscyhosocial factors
    1. Stress at work
    2. Job satisfaction
    3. Job variation versus monotony
    4. Relationship with coworkers or supervisors
    5. Fear avoidance behavior (limited activities imposed by patient due to fear of injury)

III. History: Non-occupational

  1. Habits
    1. Tobacco use
    2. Alcohol use
    3. Illicit substance use (e.g. Marijuana)
  2. Household contact history
    1. Others in same household with similar illnesses or symptoms
    2. Others in same household who work with hazardous materials (e.g heavy metals, lead)
  3. Home environment
    1. Heating and cooling (central air, wood stove, Carbon Monoxide detectors)
    2. Age of home and renovation history
    3. Pets in home
    4. Nearby industrial plant or toxic waste site
    5. Drinking water source
    6. Home projects (yard work, home remodeling)
    7. Hobbies (hunting, carpentry, painting)
  4. Psychosocial factors
    1. Excessive stress
    2. Family members or friends on Disability insurance
  5. Exercise
    1. Flexibility
    2. Weight lifting (e.g. dumbbell or kettlebell)

IV. Associated Conditions: Common Workplace Attributed Illnesses and Injuries

  1. Noise-induced Sensorineural Hearing Loss
  2. Acute Injuries
    1. Eye Injury in the Workplace
    2. Lacerations
    3. Falls
    4. Burn Injury
  3. Repetitive motion injury
    1. Low Back Pain
    2. Rotator Cuff Injury or Shoulder Impingement
    3. Carpal Tunnel Syndrome
    4. Lateral Epicondylitis
    5. Knee Injury
  4. Respiratory
    1. Occupational Asthma
    2. Allergic Occupational Asthma
  5. Cancer
    1. See Carcinogens in the Workplace
  6. Skin Conditions
    1. See Work-Related Skin Disease
  7. Ischemic Heart Disease
    1. See Cardiovascular Risk Factors (with attention to associated work related chemical exposures)

V. Precautions

  1. Early return to work is preferred with the best longterm outcomes
    1. Apply restrictions to prevent further injury or worsening
    2. Patient should expect some level of discomfort with return but the workday effects should significantly exacerbate the condition
    3. Of those off work due to restriction for >3 months, only 50% return to regular employment
  2. Avoid early Opioid use if possible
    1. Encourage the use of Non-Opioid Analgesics (e.g. NSAIDs) and non-pharmacologic therapy (e.g. physical therapy, massage)
    2. Low Back Pain treated early with Opioids is associated with prolonged use of Opioids, longer recovery period and higher surgery rate
    3. Webster (2007) Spine 32(19): 2127-32 [PubMed]

VI. Management

  1. Medical Documentation: Four Ws (from ACOEM)
    1. Where
      1. Work site where the injury occurred
    2. When
      1. Time and date of injury
    3. Who
      1. Who witnessed the injury?
      2. Who else was injured?
    4. What
      1. Mechanism of injury (and circumstances)
      2. List possible injuries and pain sources
  2. Specific evaluations
    1. Independent medical examination (frequently requested by employer)
    2. Functional Capacity Evaluation
    3. Impairment Rating
    4. Neuropsychological Exam

VII. Management: Return to Work (Workability Letter)

  1. Capabilities
    1. What activities can a patient safely perform
  2. Restrictions
    1. What activities is a patient unable to perform (without risk to self or others)
  3. Limitations
    1. What activities is a patient physically incapable or performing
  4. Schedule changes
    1. Recommendations for modified work schedule
  5. Duration
    1. Length of time for which restrictions are in place

VIII. Resources

  1. Agency for Toxic Substances and Disease Registry (ATSDR)
    1. http://www.atsdr.cdc.gov/
  2. National Institute for Occupational Safety and Health (NIOSH)
    1. http://www.cdc.gov/niosh/
  3. Occupational Safety and Health Administration (OSHA)
    1. http://www.osha.gov/

IX. References

  1. Boden (2008) Ann Epidemiol 18(6): 500-6 [PubMed]
  2. Goldman (1986) J Occup Med 28(10): 967-74 [PubMed]
  3. Schwartz (1991) Am J Med 90(3): 315-9 [PubMed]
  4. Taiwo (2010) Am Fam Physician 82(2): 169-74 [PubMed]
  5. Vanichkachorn (2014) Am Fam Physician 89(1): 17-24 [PubMed]

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