Kentner M, Valentin H
Robert Bosch Corporation, Occupational Medicine Service, Hildesheim.
Zentralbl Hyg Umweltmed. 1993 Mar;193(6):495-512.
In many cases, the increasing knowledge about the causes of occupational diseases has led to improved preventive actions at the working place. This made it possible to achieve a general decrease in the incidence of occupational diseases--except for some illnesses such as asbestos-related and obstructive lung diseases. An opposite trend can be noticed in the field of work-related illnesses, which especially includes cardiovascular, psychiatric and psychovegetative diseases, and musculoskeletal disorders. In contrast to the occupational diseases, in this context work factors are only of less importance and interact with intrapersonal, social and environmental aspects. Since the associations between the working world and the disease are normally too weak due to the multiple causes involved, what is therefore required for researching these multifactorial relationships are most sensitive epidemiological examination methods including large populations and at the same time avoiding or controlling bias and confounding. Most of the recent studies are based on secondary evaluations of already existing data (premature incapacity, inability to work, results from special preventive checks at the working place). Although this leads to large populations, a considerable bias is caused at the same time since these data in most cases are collected for administrative purpose rather than for epidemiological reasons. Moreover, when looking at the different load factors, only the work aspects are mainly taken into consideration, which leads to considerable confounding due to the omitted other concurring causes. Thus, most of the associations discovered so far are not strong enough to allow for a general deduction of special preventive measures at the working place. For further investigation of these relationships, prospective cohort and intervention studies are therefore required.
在许多情况下，对职业病病因的了解不断增加，促使工作场所的预防措施得到改进。这使得职业病的发病率普遍下降——石棉相关疾病和阻塞性肺病等一些疾病除外。在与工作相关的疾病领域，情况则相反，这类疾病特别包括心血管疾病、精神疾病、精神神经机能病和肌肉骨骼疾病。与职业病不同，在这种情况下，工作因素的重要性较低，且与个人、社会和环境因素相互作用。由于涉及多种病因，工作与疾病之间的关联通常较弱，因此研究这些多因素关系需要最敏感的流行病学检查方法，包括对大量人群进行研究，同时避免或控制偏差和混杂因素。最近的大多数研究都是基于对已有数据的二次评估（提前丧失工作能力、无法工作、工作场所特殊预防检查的结果）。虽然这能涵盖大量人群，但同时会造成相当大的偏差，因为这些数据大多是出于行政目的而非流行病学原因收集的。此外，在考虑不同的负荷因素时，主要只考虑了工作方面，由于忽略了其他并存的病因，这会导致相当大的混杂。因此，到目前为止发现的大多数关联都不够强，无法据此普遍推断出工作场所的特殊预防措施。因此，为了进一步研究这些关系，需要进行前瞻性队列研究和干预研究。
