ITEMS IN AFP WITH MESH TERM:
Work-Related Asthma - Article
ABSTRACT: Work-related asthma accounts for at least 10 percent of all cases of adult asthma. Work-related asthma includes work aggravation of preexisting asthma and new-onset asthma induced by occupational exposure. Occupational exposure to very high concentrations of an irritant substance can produce reactive airway dysfunction syndrome, while exposure to allergenic substances can result in allergic occupational asthma. An important step in the diagnosis of work-related asthma is recognition by the physician of the work relatedness of the illness. A thorough history can elucidate the work relation and etiology. Objective tests, including pulmonary function, nonspecific and specific bronchial hyperresponsiveness, serial peak expiratory flow rates, and skin allergies, should be performed to confirm the diagnosis of asthma and demonstrate a work correlation. Treatment for occupational asthma--use of anti-inflammatory medications such as inhaled steroids and bronchodilators--is the same as that for nonoccupational asthma. Prevention is an integral part of good medical management. In patients with work-aggravated or irritant-induced asthma, reduction of exposure to aggravating factors is essential. In patients with allergic occupational asthma, exposure should be eliminated because exposure to even minute concentrations of the offending agent can trigger a potentially fatal allergic reaction.
Asbestos-Related Lung Disease - Article
ABSTRACT: The inhalation of asbestos fibers may lead to a number of respiratory diseases, including lung cancer, asbestosis, pleural plaques, benign pleural effusion, and malignant mesothelioma. Although exposure is now regulated, patients continue to present with these diseases because of the long latent period between exposure and clinical disease. Presenting signs and symptoms tend to be nonspecific; thus, the occupational history helps guide clinical suspicion. High-risk populations include persons in construction trades, boilermakers, shipyard workers, railroad workers, and U.S. Navy veterans. Every effort should be made to minimize ongoing exposure. Patients with a history of significant asbestos exposure may warrant diagnostic testing and follow-up assessment, although it is unclear whether this improves outcomes. Patients with significant exposure and dyspnea should have chest radiography and spirometry. The prognosis depends on the specific disease entity. Asbestosis generally progresses slowly, whereas malignant mesothelioma has an extremely poor prognosis. The treatment of patients with asbestos exposure and lung cancer is identical to that of any patient with lung cancer. Because exposure to cigarette smoke increases the risk of developing lung cancer in patients with a history of asbestos exposure, smoking cessation is essential. Patients with asbestosis or lung cancer should receive influenza and pneumococcal vaccinations.
Work-Related Eye Injuries and Illnesses - Article
ABSTRACT: More than 65,000 work-related eye injuries and illnesses, causing significant morbidity and disability, are reported in the United States annually. A well-equipped eye tray includes fluorescein dye, materials for irrigation and foreign body removal, a short-acting mydriatic agent, and topical anesthetics and antibiotics. The tray should be prepared in advance in case of an eye injury. Eye patching does not improve cornea reepithelialization or discomfort from corneal abrasions. Blunt trauma to the eye from a heavy object can cause a blow-out fracture. Sudden eye pain after working with a chisel, hammer, grinding wheel, or saw suggests a penetrating globe injury. Chemical eye burns require immediate copious irrigation. Nontraumatic causes of ocular illness are underreported; work-related allergic conjunctivitis increasingly has been recognized among food handlers and agriculture workers who are exposed to common spices, fruits, and vegetables. The patient's history of eye injury guides the diagnosis. Primary prevention and patient counseling on proper eye protection is essential because over 90 percent of injuries can be avoided with the use of eye protection. As laser use increases in industry and medical settings, adequate personal protection is needed to prevent cataracts. Outdoor workers exposed to significant ultraviolet rays need sun protection and safety counseling to prevent age-related macular degeneration. Contact lenses do not provide eye protection, and physicians should be familiar with guidelines for the use of contacts in the workplace.
Occupational Lead Poisoning - Article
ABSTRACT: The continued occurrence of occupational lead overexposure and lead poisoning in the United States remains a serious problem despite awareness of its adverse health effects. Lead exposure is arguably the oldest known occupational health hazard. It is a particularly insidious hazard with the potential for causing irreversible health effects, including hypotension, central nervous system problems, anemia and diminished hearing acuity before it is clinically recognized. Scientific evidence of subclinical lead toxicity continues to accumulate, making further reduction in workplace exposure, regular screening, and earlier diagnosis and treatment of critical importance in the prevention of this occupational hazard. For the most part, the diagnosis of lead poisoning in the adult worker is based on the integration of data obtained from the history, a physical examination, laboratory tests and tests of specific organ function. A blood level of 40 micrograms per dL (1.95 mumol per L) or greater requires medical intervention; a level of 60 micrograms per dL (2.90 mumol per L) or three consecutive measurements averaging 50 micrograms per dL (2.40 mumol per L) or higher indicate the necessity for employee removal. The decision to initiate chelation therapy is not based on specific blood levels but depends on the severity of clinical symptoms.
ABSTRACT: More than one third of high school students work during the school year, and many more are employed during the summer months. Teenage workers face a variety of health and safety hazards. Occupational injury and illness are largely preventable, and family physicians can play a crucial role in this prevention effort by advising adolescents about common workplace dangers. Physicians who sign work permits and provide ongoing health care to teenagers should counsel them and their parents or guardians about the benefits and risks of work and discuss the regulations governing jobs that are prohibited for adolescents, work hours, protective measures and workers' compensation benefits.
ABSTRACT: Peripheral nerve injury of the upper extremity commonly occurs in patients who participate in recreational (e.g., sports) and occupational activities. Nerve injury should be considered when a patient experiences pain, weakness, or paresthesias in the absence of a known bone, soft tissue, or vascular injury. The onset of symptoms may be acute or insidious. Nerve injury may mimic other common musculoskeletal disorders. For example, aching lateral elbow pain may be a symptom of lateral epicondylitis or radial tunnel syndrome; patients who have shoulder pain and weakness with overhead elevation may have a rotator cuff tear or a suprascapular nerve injury; and pain in the forearm that worsens with repetitive pronation activities may be from carpal tunnel syndrome or pronator syndrome. Specific history features are important, such as the type of activity that aggravates symptoms and the temporal relation of symptoms to activity (e.g., is there pain in the shoulder and neck every time the patient is hammering a nail, or just when hammering nails overhead?). Plain radiography and magnetic resonance imaging are usually not necessary for initial evaluation of a suspected nerve injury. When pain or weakness is refractory to conservative therapy, further evaluation (e.g., magnetic resonance imaging, electrodiagnostic testing) or surgical referral should be considered. Recovery of nerve function is more likely with a mild injury and a shorter duration of compression. Recovery is faster if the repetitive activities that exacerbate the injury can be decreased or ceased. Initial treatment for many nerve injuries is nonsurgical.
Red-blue, Umbilicated Nodules On the Fingers - Photo Quiz
Antiretroviral Prophylaxis for Occupational Exposure to HIV - Cochrane for Clinicians
ABSTRACT: Given the burden of occupational illnesses and injuries in the United States, family physicians should understand the role workplace exposures may play in patients' chief concerns. Incorporating employment screening questions into patients' intake questionnaires is an efficient means of identifying potential occupational causes of symptoms. Recommended questions include what kind of job patients have; whether their symptoms are worse at work; whether they are or have been exposed to dust, fumes, chemicals, radiation, or loud noise; and whether they think their health problems may be related to their work. These questions are especially important when the diagnosis or etiology is in doubt. Depending on patients' responses to the screening questions, a more detailed occupational history may be appropriate. It can be useful to ask about routine tasks performed during a typical work shift, as well as anything out of the ordinary (e.g., a change in routine, an injury or accident). The occupational history should include information about alcohol and tobacco use, second or part-time jobs, military service, hobbies, and home environment. Patients with suspected occupational illnesses or injuries may benefit from referral to an occupational medicine specialist for a more detailed assessment and follow-up.