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August 7, 1991, Vol 266, No. 5 >
ARTICLE | August 7, 1991

The Recognition and Control of Occupational Disease FREE

Philip J. Landrigan, MD, MSc; Dean B. Baker, MD, MPH
[+] Author Affiliations

Reprint requests to Department of Community Medicine, Box 1057, Mount Sinai Medical Center, One Gustave L Levy Pl, New York, NY 10029 (Dr Landrigan).


JAMA. 1991;266(5):676-680. doi:10.1001/jama.1991.03470050076026
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References

Occupational diseases account each year in the United States for an estimated 50 000 to 70 000 deaths and 350 000 new cases of illness. Often, however, occupational diseases are not correctly diagnosed, because they mimic diseases due to other causes and because most physicians are not well trained in their recognition. Opportunities for prevention and treatment are therefore lost. The occupational history is the most effective means for proper diagnosis of occupational illness. It should routinely be obtained for every patient. A brief but systematic guide for obtaining an occupational history is presented in this report. Also, approaches are summarized for the recognition and diagnosis of such important occupational diseases as occupational cancer, asbestosis and other respiratory disorders, and occupational neuropsychologic disorders. The management and prevention of occupational diseases depend on reduction of hazardous exposures in the workplace and better education of workers, industrial managers, and physicians. This report outlines a program for the control of occupational disease based on (1) preventing exposures in the workplace, (2) premarket toxicity testing of new chemicals and technologies, and (3) astute clinical diagnosis.

(JAMA. 1991;266:676-680)

REFERENCES

1 +
Rom WN. Environmental and Occupational Medicine . Boston, Mass: Little Brown & Co Inc; 1983;.
2 +
Institute of Medicine. Role of the Primary Care Physician in Occupational and Environmental Medicine . Washington, DC: National Academy Press; 1988;.
3 +
Health and Public Policy Committee, American College of Physicians. The Role of the Internist in Occupational Medicine . Philadelphia, Pa: American College of Physicians; 1984;.
4 +
American College of Physicians.  Occupational and environmental medicine: the internist's role. Ann Intern Med . 1990;;113:974-782.
5 +
Goldman RH, Peters JM.  The occupational and environmental health history. JAMA . 1981;; 246:2831-2836.
6 +
Selikoff IJ, Churg J, Hammond EC.  Asbestos exposure and neoplasia. JAMA . 1965;;188:22-26.
7 +
Rosenstock L, Landrigan PJ.  Occupational health: the intersection between clinical medicine and public health. Annu Rev Public Health . 1986;;7:337-356.
8 +
Levy BS.  The teaching of occupational health in United States medical schools: 5-year follow-up of an initial survey. Am J Public Health . 1985;;75:79-80.
9 +
1989-1990 AAMC Curriculum Directory . Washington, DC: Association of American Medical Colleges; 1989;.
10 +
Committee on Government Operations. Occupational Illness Data Collection: Fragmented, Unreliable and Seventy Years Behind Communicable Disease Surveillance . Washington, DC; 1984;. 60th Report by the Committee on Government Operations. House Report 98-1144.
11 +
President's Report on Occupational Safety and Health . Washington, DC: US Government Printing Office; 1972;.
12 +
Markowitz S, Landrigan PJ.  The magnitude of the occupational disease problem: an investigation in New York State. Toxicol Ind Health . 1989;;5:9-30.
13 +
Landrigan PJ, Markowitz S.  Current magnitude of occupational disease in the United States: estimates from New York State. Ann N Y Acad Sci . 1989;;572:27-45.
14 +
 A proposed national strategy for the prevention of severe occupational traumatic injuries.  In: Proposed National Strategy for the Prevention of Leading Work-Related Diseases and Injuries . Atlanta, Ga: National Institute for Occupational Safety and Health; 1986;.
15 +
Rutstein DD, Berenberg W, Chalmers TC, Child CG, Fishman AP, Perrin EB.  Measuring the quality of medical care: a clinical method. N Engl J Med . 1976;;294:582-588.
16 +
Rutstein DD, Mullan RJ, Frazier TM, Halperin WE, Melius JM, Sestito JP.  Sentinel health events (occupational): a basis for physician recognition and public health surveillance. Am J Public Health . 1983;;73:1054-1062.
17 +
Pott P. Chirurgical Observations Relative to the Cataract, the Polypus of the Nose, the Cancer of the Scrotum, the Different Kinds of Ruptures, and the Mortification of the Toes and Feet . London, England: Hawes Clarke and Collins; 1775;.
18 +
Rehn L.  Blasengeschuewlste bei Fuchsinarbeitern. Arch Klin Chir . 1895;;50:588-600.
19 +
Nicholson WJ, Perkel G, Selikoff IJ.  Occupational exposure to asbestos: population at risk and projected mortality: 1920-2030. Am J Ind Med . 1982;;3:259-312.
20 +
Selikoff IJ, Hammond EC, Seidman H.  Mortality experience of asbestos insulation workers in the United States and Canada, 1943-1976. Ann N Y Acad Sci . 1968;;330:91-96.
21 +
Selikoff IJ, Hammond EC, Churg J.  Asbestos exposure, smoking and neoplasia. JAMA . 1968;;204:100-112.
22 +
Rinsky RA, Smith AB, Hornung R, et al.  Benzene and leukemia: an epidemiologic risk assessment. N Engl J Med . 1987;;316:1044-1050.
23 +
Creech JL Jr, Johnson MN.  Angiosarcoma of the liver in the manufacture of polyvinyl chloride. J Occup Med . 1974;;16:150-151.
24 +
Mabuchi K, Lilienfeld AM, Snell LM.  Lung cancer among pesticide workers exposed to inorganic arsenicals. Arch Environ Health . 1979;; 34:312-318.
25 +
Figueroa WG, Raszowski R, Weiss W.  Lung cancer of chloromethylether workers. N Engl J Med . 1973;;28:1096-1099.
26 +
Wing S, Shy CM, Wood JL, Wolf S, Cragle DL, Frome EL.  Mortality among workers at Oak Ridge National Laboratory: evidence of radiation effects in follow-up through 1984. JAMA . 1991;;265:1397-1402.
27 +
Howe GR.  Risk of cancer mortality in populations living near nuclear facilities. JAMA . 1991;;265:1438-1439.
28 +
Fingerhut M, Halperin WE, Marlow DA, et al.  Cancer mortality in workers exposed to 2,3,7,8-tetra chlorodibenzo-p-dioxin. N Engl J Med . 1991;;324:212-218.
29 +
Bailar JC.  How dangerous is dioxin? N Engl J Med . 1991;;324:260-262.
30 +
Loomis DP, Savitz DA.  Mortality from brain cancer and leukaemia among electrical workers. Br J Ind Med . 1990;;47:633-638.
31 +
National Occupational Hazard Survey 1972-1974 . Cincinnati, Ohio: National Institute for Occupational Safety and Health; 1978;. Dept of Health, Education, and Welfare publication 78-114.
32 +
Parkes WR. Occupational Lung Disorders . 2nd ed. London, England: Butterworths; 1982;.
33 +
National Heart, Lung, and Blood Institute. Prevention and Control of Respiratory Diseases: Report of a Task Force . Bethesda, Md: National Institute of Health. In press.
34 +
Department of Health and Social Security. Pneumoconioses and Allied Chest Diseases: Diagnosis and Procedure for Claiming Industrial Injuries Benefits . London, England: Her Majesty's Stationery Office; 1975;.
35 +
Silica and Some Silicates . Lyons, France: International Agency for Research on Cancer; 1987;;42. Monographs on the Evaluation of Carcinogenic Risks to Humans.
36 +
Chan-Yeung M.  Occupational asthma. Chest . 1990;;98( (suppl) ):148S-161S.
37 +
Pepys J, Hutchcroft BJ.  Bronchial provocation tests in etiologic diagnosis and analysis of asthma. Am Rev Respir Dis . 1975;;112:829-859.
38 +
Landrigan PJ.  Toxic exposures and psychiatric disease: lessons from the epidemiology of cancer. Acta Psychiatr Scand Suppl . 1983;;67:6-15.
39 +
Spencer PS, Schaumburg HH. Experimental and Clinical Neurotoxicology . Baltimore, Md: Williams & Wilkins; 1980;.
40 +
National Research Council. Toxicity Testing: Strategies to Determine Needs and Priorities . Washington, DC: National Academy Press; 1984;.
41 +
Cullen MR, Cherniack MG, Rosenstock L.  Occupational medicine. N Engl J Med . 1990;;322:594-601, 675-683.
42 +
Baker EL, Melius JM, Millar JD.  Surveillance of occupational illness and injury in the United States: current perspectives and future directions. J Public Health . 1988;;9:198-221.
43 +
Rempel D, ed.  Occupational medicine: medical surveillance in the workplace. State Art Rev . 1990;;5:435-652.
44 +
Freund E, Seligman PJ, Chorba TL, Stafford SK, Drachman JG, Hull HF.  Mandatory reporting of occupational diseases by clinicians. JAMA . 1989;;262:3041-3044.
45 +
Whorton D, Milby THE, Krauss RM, Stubbs HA.  Testicular function in DBCP exposed pesticide workers. J Occup Med . 1979;;21:161-166.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Rom WN. Environmental and Occupational Medicine . Boston, Mass: Little Brown & Co Inc; 1983;.
2 +
Institute of Medicine. Role of the Primary Care Physician in Occupational and Environmental Medicine . Washington, DC: National Academy Press; 1988;.
3 +
Health and Public Policy Committee, American College of Physicians. The Role of the Internist in Occupational Medicine . Philadelphia, Pa: American College of Physicians; 1984;.
4 +
American College of Physicians.  Occupational and environmental medicine: the internist's role. Ann Intern Med . 1990;;113:974-782.
5 +
Goldman RH, Peters JM.  The occupational and environmental health history. JAMA . 1981;; 246:2831-2836.
6 +
Selikoff IJ, Churg J, Hammond EC.  Asbestos exposure and neoplasia. JAMA . 1965;;188:22-26.
7 +
Rosenstock L, Landrigan PJ.  Occupational health: the intersection between clinical medicine and public health. Annu Rev Public Health . 1986;;7:337-356.
8 +
Levy BS.  The teaching of occupational health in United States medical schools: 5-year follow-up of an initial survey. Am J Public Health . 1985;;75:79-80.
9 +
1989-1990 AAMC Curriculum Directory . Washington, DC: Association of American Medical Colleges; 1989;.
10 +
Committee on Government Operations. Occupational Illness Data Collection: Fragmented, Unreliable and Seventy Years Behind Communicable Disease Surveillance . Washington, DC; 1984;. 60th Report by the Committee on Government Operations. House Report 98-1144.
11 +
President's Report on Occupational Safety and Health . Washington, DC: US Government Printing Office; 1972;.
12 +
Markowitz S, Landrigan PJ.  The magnitude of the occupational disease problem: an investigation in New York State. Toxicol Ind Health . 1989;;5:9-30.
13 +
Landrigan PJ, Markowitz S.  Current magnitude of occupational disease in the United States: estimates from New York State. Ann N Y Acad Sci . 1989;;572:27-45.
14 +
 A proposed national strategy for the prevention of severe occupational traumatic injuries.  In: Proposed National Strategy for the Prevention of Leading Work-Related Diseases and Injuries . Atlanta, Ga: National Institute for Occupational Safety and Health; 1986;.
15 +
Rutstein DD, Berenberg W, Chalmers TC, Child CG, Fishman AP, Perrin EB.  Measuring the quality of medical care: a clinical method. N Engl J Med . 1976;;294:582-588.
16 +
Rutstein DD, Mullan RJ, Frazier TM, Halperin WE, Melius JM, Sestito JP.  Sentinel health events (occupational): a basis for physician recognition and public health surveillance. Am J Public Health . 1983;;73:1054-1062.
17 +
Pott P. Chirurgical Observations Relative to the Cataract, the Polypus of the Nose, the Cancer of the Scrotum, the Different Kinds of Ruptures, and the Mortification of the Toes and Feet . London, England: Hawes Clarke and Collins; 1775;.
18 +
Rehn L.  Blasengeschuewlste bei Fuchsinarbeitern. Arch Klin Chir . 1895;;50:588-600.
19 +
Nicholson WJ, Perkel G, Selikoff IJ.  Occupational exposure to asbestos: population at risk and projected mortality: 1920-2030. Am J Ind Med . 1982;;3:259-312.
20 +
Selikoff IJ, Hammond EC, Seidman H.  Mortality experience of asbestos insulation workers in the United States and Canada, 1943-1976. Ann N Y Acad Sci . 1968;;330:91-96.
21 +
Selikoff IJ, Hammond EC, Churg J.  Asbestos exposure, smoking and neoplasia. JAMA . 1968;;204:100-112.
22 +
Rinsky RA, Smith AB, Hornung R, et al.  Benzene and leukemia: an epidemiologic risk assessment. N Engl J Med . 1987;;316:1044-1050.
23 +
Creech JL Jr, Johnson MN.  Angiosarcoma of the liver in the manufacture of polyvinyl chloride. J Occup Med . 1974;;16:150-151.
24 +
Mabuchi K, Lilienfeld AM, Snell LM.  Lung cancer among pesticide workers exposed to inorganic arsenicals. Arch Environ Health . 1979;; 34:312-318.
25 +
Figueroa WG, Raszowski R, Weiss W.  Lung cancer of chloromethylether workers. N Engl J Med . 1973;;28:1096-1099.
26 +
Wing S, Shy CM, Wood JL, Wolf S, Cragle DL, Frome EL.  Mortality among workers at Oak Ridge National Laboratory: evidence of radiation effects in follow-up through 1984. JAMA . 1991;;265:1397-1402.
27 +
Howe GR.  Risk of cancer mortality in populations living near nuclear facilities. JAMA . 1991;;265:1438-1439.
28 +
Fingerhut M, Halperin WE, Marlow DA, et al.  Cancer mortality in workers exposed to 2,3,7,8-tetra chlorodibenzo-p-dioxin. N Engl J Med . 1991;;324:212-218.
29 +
Bailar JC.  How dangerous is dioxin? N Engl J Med . 1991;;324:260-262.
30 +
Loomis DP, Savitz DA.  Mortality from brain cancer and leukaemia among electrical workers. Br J Ind Med . 1990;;47:633-638.
31 +
National Occupational Hazard Survey 1972-1974 . Cincinnati, Ohio: National Institute for Occupational Safety and Health; 1978;. Dept of Health, Education, and Welfare publication 78-114.
32 +
Parkes WR. Occupational Lung Disorders . 2nd ed. London, England: Butterworths; 1982;.
33 +
National Heart, Lung, and Blood Institute. Prevention and Control of Respiratory Diseases: Report of a Task Force . Bethesda, Md: National Institute of Health. In press.
34 +
Department of Health and Social Security. Pneumoconioses and Allied Chest Diseases: Diagnosis and Procedure for Claiming Industrial Injuries Benefits . London, England: Her Majesty's Stationery Office; 1975;.
35 +
Silica and Some Silicates . Lyons, France: International Agency for Research on Cancer; 1987;;42. Monographs on the Evaluation of Carcinogenic Risks to Humans.
36 +
Chan-Yeung M.  Occupational asthma. Chest . 1990;;98( (suppl) ):148S-161S.
37 +
Pepys J, Hutchcroft BJ.  Bronchial provocation tests in etiologic diagnosis and analysis of asthma. Am Rev Respir Dis . 1975;;112:829-859.
38 +
Landrigan PJ.  Toxic exposures and psychiatric disease: lessons from the epidemiology of cancer. Acta Psychiatr Scand Suppl . 1983;;67:6-15.
39 +
Spencer PS, Schaumburg HH. Experimental and Clinical Neurotoxicology . Baltimore, Md: Williams & Wilkins; 1980;.
40 +
National Research Council. Toxicity Testing: Strategies to Determine Needs and Priorities . Washington, DC: National Academy Press; 1984;.
41 +
Cullen MR, Cherniack MG, Rosenstock L.  Occupational medicine. N Engl J Med . 1990;;322:594-601, 675-683.
42 +
Baker EL, Melius JM, Millar JD.  Surveillance of occupational illness and injury in the United States: current perspectives and future directions. J Public Health . 1988;;9:198-221.
43 +
Rempel D, ed.  Occupational medicine: medical surveillance in the workplace. State Art Rev . 1990;;5:435-652.
44 +
Freund E, Seligman PJ, Chorba TL, Stafford SK, Drachman JG, Hull HF.  Mandatory reporting of occupational diseases by clinicians. JAMA . 1989;;262:3041-3044.
45 +
Whorton D, Milby THE, Krauss RM, Stubbs HA.  Testicular function in DBCP exposed pesticide workers. J Occup Med . 1979;;21:161-166.

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