The second question of the occupational history: what is the riskiest part of your job?

Metals and disease: a global primary health care perspective

Metals are an important and essential part of our daily lives. Their ubiquitous presence and use has not been without significant consequences. Both industrial and nonindustrial exposures to metals are characterized by a variety of acute and chronic ailments. Underreporting of illnesses related to occupational and environmental exposures to chemicals including metals is of concern and presents a serious challenge. Many primary care workers rarely consider occupational and environmental exposures to chemicals in their clinical evaluation. Their knowledge and training in the evaluation of health problems related to such exposures is inadequate. This paper presents documented research findings from various studies that have examined the relationship between metal exposures and their adverse health effects both in developing and developed countries. Further, it provides some guidance on essential elements of a basic occupational and environmental evaluation to health care workers in primary care situations.

[Identification and selection of diseases of possible occupational origin managed through the National Health System]

OBJECTIVE

To identify and select common diseases of possible occupational origin, managed through the Spanish National Health System.

DESIGN

Cross-sectional study.

SETTING

Catalonia (Spain).

PARTICIPANTS

Data were collected on people over 15 years of age who were seen for the first time in a primary care clinic or were admitted to a hospital or had an episode of non-occupational sickness absence in catalonia in 2008 or died in this region in 2007.

MAIN MEASUREMENTS

A total of 407 diagnostic codes for possible occupationally-related diseases were selected from a modified version of the european union ICD-10 list of diagnostic codes, from which 34 were selected and assessed by an expert panel.

RESULTS

The initial 34 diagnoses represented 6.7% of all new outpatient visits, 13.8% of the sickness absence episodes, 13.6% of acute admissions and 15.8% of all annual deaths. Asthma appeared prominently in all four databases. The list was pared down to a final list of 26 four-digit icd-10 codes, that accounted for 3.3% of the first visits, 8.9% of lost work time episodes and 2.7% of acute admissions.

CONCLUSIONS

The implementation of a "red flag" into the electronic medical record each time one of these 26 diagnostic codes is entered, could help to improve the reporting of occupational diseases.