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Using an occupational history

Using an occupational history. Grant McMillan Hon Senior Clinical Lecturer. Institute of Occupational and Environmental Health University of Birmingham Number 5 of a series of lectures and tutorials for medical undergraduates.

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Using an occupational history

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  1. Using an occupational history Grant McMillan Hon Senior Clinical Lecturer Institute of Occupational and Environmental Health University of Birmingham Number 5 of a series of lectures and tutorials for medical undergraduates

  2. This is a self-help tutorial designed to provide you with an introduction to using an occupational history to help you determine if your patient has an occupational disease.

  3. Categories of work-related diseases I Work the cause II Work a causal factor in diseases of common occurrence III Work provoking or aggravating an established disease IV Work offering ready access to potential dangers

  4. Criteria for diagnosing an occupational/work-related disease • Effect • Exposure • Time sequence • Competing causes • Biological plausibility Each of these is now considered in turn

  5. Effect • Describe the effect ie presence of symptoms and signs. • Does this fit the case definition of an accepted work-related disease? • Have you found other cases?

  6. Exposure Exposure must be sufficient to cause the disease From the history, occupational hygiene records or by monitoring determine: • What? Nature of hazard • How much? Dose received • Is this sufficient to cause harm?

  7. Exposure Now, compare measured or recorded dose against published exposure limits to determine if exposure could be expected to cause effects. Remember that some people are unusually sensitive to some hazardous agents.

  8. Time sequence • Exposure must be prior to onset of illness. • Immediate effects eg hydrogen cyanide • Hours delay of effects eg phosgene, oxides of nitrogen, arc eye. • Weeks or months delay of effects – dermatitis, asthma • For cancers - appropriate latency period

  9. Consider non-occupational causes • What is differential diagnosis? • Non-occupational causes • Environmental • Social (smoking, alcohol, hobbies, pets) • Family history/genetic • Other employment

  10. Consider the biological plausibility of your diagnosis. Does it fit in with what you know about the causation and nature of diseases?

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