Schwartz D A, Wakefield D S, Fieselmann J F, Berger-Wesley M, Zeitler R
Department of Internal Medicine, University of Iowa, College of Medicine, Iowa City 52242.
Am J Med. 1991 Mar;90(3):315-9.
To assess the need for services in occupational medicine, we determined the prevalence of reported occupational exposures in patients seen in the primary care setting. In addition, we evaluated the validity of our survey instrument.
All patients (n = 1,112) seen over a 3-month period of time in the Primary Care Clinic at the Iowa City Veterans Affairs Medical Center were considered eligible for this study. A survey instrument was developed to obtain specific information regarding occupational exposures. The questionnaire was administered to 534 or 48% of all eligible patients. The validity of the survey instrument was evaluated by comparing chest radiographs in subjects with a history of exposure to asbestos, coal dust, or silica to those in patients who were not exposed to any of these agents.
We found that almost 75% of the patients reported prior occupational exposure to at least one potentially toxic agent, and over 30% claimed exposure to at least four potentially toxic agents. The validation study indicated that the reported exposure history for asbestos, coal dust, and silica is significantly associated with anticipated changes on chest radiographs. These findings suggest that this easily administered survey instrument is valid for pneumoconiotic dust exposures and may also be valid for other potentially toxic exposures.
Data from our study indicate that patients seen in the ambulatory care setting may have clinically significant occupational exposures that are relevant to their medical condition.
为评估职业医学服务的需求，我们确定了在初级保健机构就诊患者中报告的职业暴露患病率。此外，我们还评估了我们的调查问卷的有效性。
爱荷华市退伍军人事务医疗中心初级保健诊所3个月内就诊的所有患者（n = 1112）均被认为符合本研究条件。我们开发了一种调查问卷以获取有关职业暴露的具体信息。该问卷被发放给534名符合条件的患者，占符合条件患者总数的48%。通过比较有石棉、煤尘或二氧化硅接触史的受试者与未接触这些物质的患者的胸部X光片，评估调查问卷的有效性。
我们发现，近75%的患者报告曾有职业暴露，接触至少一种潜在有毒物质，超过30%的患者声称接触过至少四种潜在有毒物质。验证研究表明，报告的石棉、煤尘和二氧化硅接触史与胸部X光片上预期的变化显著相关。这些发现表明，这种易于实施的调查问卷对于尘肺病粉尘暴露是有效的，对于其他潜在有毒物质暴露可能也有效。
我们研究的数据表明，在门诊环境中就诊的患者可能有与他们的病情相关的具有临床意义的职业暴露。
