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BMC Public Health. 2010 Jul 9;10:405. doi: 10.1186/1471-2458-10-405.
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Occupational history: A neglected component of history taking.职业史:病史采集过程中被忽视的部分。
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本文引用的文献

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The law and incomplete database information as confounders in epidemiologic research on occupational injuries and illnesses.法律和不完整的数据库信息是职业伤害和疾病的流行病学研究中的混杂因素。
Am J Ind Med. 2010 Jan;53(1):23-36. doi: 10.1002/ajim.20763.
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Asbestos exposure and benign asbestos diseases in 772 formerly exposed workers: dose-response relationships.772 名曾接触石棉工人中的石棉暴露和良性石棉病:剂量-反应关系。
Am J Ind Med. 2009 Aug;52(8):596-602. doi: 10.1002/ajim.20713.
3
Diagnosis-specific sick leave as a risk marker for disability pension in a Swedish population.特定诊断的病假作为瑞典人群中残疾抚恤金的风险标志物。
J Epidemiol Community Health. 2007 Oct;61(10):915-20. doi: 10.1136/jech.2006.055426.
4
Managing injured workers: family physicians' experiences.管理受伤工人:家庭医生的经验
Can Fam Physician. 2005 Jan;51(1):78-9.
5
Services provided by family physicians for patients with occupational injuries and illnesses.家庭医生为职业伤病患者提供的服务。
Ann Fam Med. 2006 Mar-Apr;4(2):138-47. doi: 10.1370/afm.515.
6
What are the questionnaire items most useful in identifying subjects with occupational asthma?在识别职业性哮喘患者时,哪些问卷项目最有用?
Eur Respir J. 2005 Dec;26(6):1056-63. doi: 10.1183/09031936.05.00024705.
7
Work-related disease in general practice: a systematic review.全科医疗中的职业相关疾病:一项系统综述。
Fam Pract. 2005 Apr;22(2):197-204. doi: 10.1093/fampra/cmh727. Epub 2005 Feb 14.
8
Screening to identify patients at risk: profiles of psychological risk factors for early intervention.筛查以识别有风险的患者:早期干预的心理风险因素概况。
Clin J Pain. 2005 Jan-Feb;21(1):38-43; discussion 69-72. doi: 10.1097/00002508-200501000-00005.
9
Occupational medical history taking: how are today's physicians doing? A cross-sectional investigation of the frequency of occupational history taking by physicians in a major US teaching center.职业病史采集:当今医生做得如何?对美国一家主要教学中心医生进行职业病史采集频率的横断面调查。
J Occup Environ Med. 2004 Jun;46(6):550-5. doi: 10.1097/01.jom.0000128153.79025.e4.
10
Haz-Map: information on hazardous chemicals and occupational diseases.危害地图:关于危险化学品和职业病的信息。
Med Ref Serv Q. 2004 Summer;23(2):49-56. doi: 10.1300/J115v23n04_05.

基层医疗从业者与职业病诊断

The Primary Care Practitioner and the diagnosis of occupational diseases.

机构信息

Department of Environmental Medicine and Public Health, Padua University, Padua, Italy.

出版信息

BMC Public Health. 2010 Jul 9;10:405. doi: 10.1186/1471-2458-10-405.

DOI:10.1186/1471-2458-10-405
PMID:20618928
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2914077/
Abstract

BACKGROUND

Rather than a clinical diagnosis, in occupational medicine the critical point is the etiological diagnosis. The first is useful for the therapy, the latter for preventive, epidemiological, regulatory, and insurance measures.

DISCUSSION

As with causality criteria which are employed in population studies, the answering of four easy questions allows a Primary Care Practitioner to establish a causal link between the work activities and a potential disease that a specific patient may present.After determining the clinical diagnosis and the actual pathology of an occupational disease, the identity, duration, and intensity of the exposure have to be detected for establishing a close-causal effect. The judgment on the occupational origin of the disease requires an integrated approach using multiple sources of information, and goes beyond the clinical diagnosis. This may require consultation with a specialist in occupational medicine.

SUMMARY

It is important that the Primary Care Practitioner takes an accurate medical history since this may be the only chance a patient has to have their occupational disease recognised and properly detected/identified. Proper identification of the causative nature of such diseases is important for establishing preventive measures in eliminating and controlling future cases against exposure, epidemiological reporting and studies (particularly in identifying the rates of disease), regulatory reporting requirements and insurance compensation.

摘要

背景

在职业医学中,关键的是病因诊断,而不是临床诊断。前者对治疗有用,后者对预防、流行病学、监管和保险措施有用。

讨论

与在人群研究中使用的因果关系标准一样,回答四个简单的问题可以让初级保健医生在特定患者可能出现的潜在疾病与工作活动之间建立因果关系。在确定职业病的临床诊断和实际病理后,必须检测接触的身份、持续时间和强度,以确定密切的因果关系。对疾病职业来源的判断需要使用多种信息来源的综合方法,并且超出了临床诊断。这可能需要咨询职业医学专家。

总结

初级保健医生准确地询问病史非常重要,因为这可能是患者唯一有机会让其职业病得到认可并得到妥善发现/识别的机会。正确识别此类疾病的致病性质对于制定预防措施以消除和控制未来的暴露病例、流行病学报告和研究(特别是在确定疾病率方面)、监管报告要求和保险赔偿非常重要。