Occupational health. Recognizing and preventing work-related disease, third edition. Levy BS, Wegman DH, eds. Boston, MA: Little Brown & Co, 1995 Jan; :57-82
Recognition of occupational diseases was discussed focusing on the diagnosis of symptomatic workers, screening for occupational disease, and occupational surveillance for disease control. Three levels of prevention were summarized. Primary prevention involved taking measures to promote good health or protect against disease; secondary prevention was based on promptly treating a disease as soon as it is recognized; tertiary prevention involved corrective therapy intended to prevent sequelae and limit disability once a disease has developed or to address rehabilitation needs if the disease is too advanced. Diagnosing occupational diseases is based on constructing an occupational history which should include descriptions of all jobs held, work exposures, timing of symptoms, and information about other workers involved in similar jobs that may have the same symptoms or illnesses and nonwork exposures. Situations in which a physician should suspect an occupational disease and take as detailed an occupational history as possible were described. These included the presence of respiratory symptoms, skin disorders, hearing impairment, back and joint problems, cancer, exacerbation of coronary artery disease, liver disease, neuropsychiatric problems, and illnesses of unknown origin. Screening was regarded as a secondary preventive measure. To be effective, screening programs must be selective and be able to detect a disease in its latent stage, as opposed to identifying it when symptoms first appear. A screening program must provide adequate followup, and tests used in a screening program must have good reliability and validity, while the screening program must be cost effective. Screening approaches used for nonmalignant respiratory diseases, hearing impairment, toxic effects resulting from chemical exposures, cancer, and back problems were described. Surveillance can be used to monitor disease occurrence, the presence of hazardous exposures, or worker exposures to hazardous agents. Surveillance programs can be based on or utilize a variety of techniques including programs based on death certificate analysis, employer records, workers' compensation records, cancer registries, physician reports, worker surveys, union records, employee records, and disability records.