In their work, people can be exposed to dangerous chemicals, hazardous physical agents, emotional stress, and trauma. Any of these occupational exposures can cause disease—sometimes immediately and sometimes after an interval of years or decades.
In addition, tens of millions of people of all ages are exposed to environmental toxins. Some are exposed to high levels in well-publicized disasters, but many more are exposed chronically to lower levels. Air pollution, lead, radon, and pesticides are examples of environmental agents that can cause illness and death.
Occupational and environmental exposures cause a broad range of illnesses, and these diseases can involve virtually every organ system
[...] Occupational and environmental exposures cause a broad range of illnesses, and these diseases can involve virtually every organ system. They include classic, well-described diseases, such as lung cancer and malignant mesothelioma in workers exposed to asbestos, cancer of the bladder in dye workers, pneumoconiosis in coal miners, leukemia and lymphoma in people exposed to benzene, skin cancer in farmers and sailors chronically exposed to the sun, and chronic bronchitis in workers exposed to dust particles. Occupational illnesses also include more recently recognized entities, such as dementia in persons exposed to solvents; sterility in men and women exposed to certain pesticides; asthma and bronchitis in children and adults chronically exposed to particulate air pollution; and carpal tunnel syndrome in workers engaged in repetitive, stressful wrist motion. [...]
[...] Because of the enormous numbers exposed and the wide range of illnesses, the possibility of occupational or environmental exposure to toxins needs to be considered in the evaluation of every patient. Occupational and environmental diseases are underdiagnosed. Many are attributed incorrectly to other causes because frequently these diseases are not distinct in their clinical features and can resemble closely chronic diseases caused by other factors. Examples include lung cancer caused by asbestos or radon, which is attributed to cigarette smoking; severe abdominal pain caused by lead poisoning, which is diagnosed erroneously as acute appendicitis (some cases have resulted in unnecessary laparotomy); dementia caused by organic solvents, which is attributed to "old age" or to ethanol ingestion; renal failure caused by chronic exposure to lead or cadmium, which is ascribed to "idiopathic factors"; hearing loss caused by noise, which is incorrectly attributed to presbycusis; and asthma resulting from an occupational exposure, which is diagnosed incorrectly as intrinsic asthma. [...]
[...] OCCUPATIONAL AND ENVIRONMENTAL HISTORY The history is the most important instrument for obtaining information on the role of occupational and environmental factors in causing disease ( Chapter 5 Information about current and past exposure routinely should be sought in every patient at several logical points when taking a history. At each juncture, a few brief screening questions should be asked systematically. Then if suspicious information is elicited, more detailed follow-up questions are needed. A routine screen for occupational and environmental disease consists of the following items: 1. [...]
[...] Many episodes of these diseases are in essence common-source outbreaks of highly preventable illness. Prompt reporting can lead to identification of additional cases earlier and to prevention by abating a common exposure source. The physician may require access to specialized referral sources in occupational and environmental medicine. Two national organizations that maintain listings of occupational and environmental specialist physicians are the American College of Occupational and Environmental Medicine (Arlington Heights, IL) and the Association of Occupational and Environmental Clinics (Washington, DC). Other valuable resources are the U.S. [...]
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