Occupational diagnosis

BEIs apply to 8 hr exposures, five days a week. However, BEIs for altered working schedules can be extrapolated on pharmacokinetic and pharmacodynamic bases. BEIs should not be applied, either directly or through a conversion factor, to the determination of safe levels for non-occupational exposure to air and water pollutants, or food contaminants. The BEIs are not intended for use as a measure of adverse effects or for diagnosis of occupational illness. 

Although ADHD is considered a childhood disorder, signs and symptoms persist into adolescence and adulthood in approximately 40% to 80% and 60% of cases, repectively.1,9 Adult ADHD is difficult to assess, and diagnosis is always suspect in patients failing to display clear symptoms prior to 7 years of age.4 Adults with ADHD have higher rates of psychopathology, substance abuse, social dysfunction, and occupational underachievement. 

Somashekaraiah BV, Venkaiah B, Prasad ARK. 1990. Biochemical diagnosis of occupational exposure to lead toxicity. Bull Environ Contamin Toxicol 44 268-275. 

The decision whether to start L-dopa as soon as the diagnosis is made or only when symptoms compromise social, occupational, or psychological well-being has generated controversy. 

The diagnosis of COPD is based in part on the patient s symptoms and a history of exposure to risk factors such as tobacco smoke and occupational exposures. 

Recordable nonfatal cases without lost workdays Cases of occupational injury or illness that do not involve fatalities or lost workdays but do result in (1) transfer to another job or termination of employment or (2) medical treatment other than first aid or (3) diagnosis of occupational illness or (4) loss of consciousness or (5) restriction of work or motion. 

The recent Burden of Skin Disease study, a joint project of the American Academy of Dermatology Association and the Society of Investigative Dermatology, found that the third most common skin ailment was contact dermatitis. According to this study, 72 million Americans had contact dermatitis in 2004 which resulted in 1.4 billion in direct costs and almost 500 million in indirect costs due to lost productivity.83 A review of 1993 BLS data showed that of 60,200 cases of occupational skin diseases, 12,613 (21%) resulted in one or more days away from work.70 The mean time away from work was 3 days, but 17% lost workday cases had over 11 days away from work. Of those with days away from work, 70% had a diagnosis of dermatitis. In 2001, of the 38,900 skin disease cases, 6,051 (16%) resulted in days away from work, with a median of 3 days lost.68 Of these, 78% had dermatitis. A study of 235 Canadian workers with oc-... 

Spiewak, R. and Dutkiewicz, J., A farmer s occupational airborne contact dermatitis masqueraded by coexisting rosacea delayed diagnosis and legal acknowledgement, Ann. Agric. Environ. Med, 11, 329, 2004. 

Moscato, G. et al., Occupational asthma a longitudinal study on the clinical and socioeconomic outcome after diagnosis, Chest, 115, 249, 1999. 

Cannon, J., Cullinan, P. and Newman-Taylor, A.J., Consequences of a diagnosis of occupational asthma A controlled study. Thorax, 49, 390P, 1994. 

Shortness of breath, cough, and wheeze are common symptoms of respiratory diseases (Table 3.2). These shared symptoms make misdiagnosis by physicians common if the diagnosis is based solely on reported symptoms. Medical tests help to distinguish the respiratory diseases from each other (Table 3.3). Other pitfalls in medical diagnosis include diagnosing common diseases (such as asthma, emphysema, and chronic bronchitis) instead of the actual rarer diseases (such as BO) and not considering occupational exposures as the cause. 

Other workers with flavoring-related BO were not appropriately diagnosed, even after reports of flavoring-related BO were published in the scientific literature (Kreiss et ah, 2002a Lockey et ah, 2002 Parmet and von Essen, 2002), public health commimications (CDC, 2002), and the press. Frequent misdiagnoses by physicians included asthma, bronchitis, and emphysema due to a presumptive diagnosis, an incomplete medical evaluation, and/or failure to make a coimection with occupational exposures. 

Alternative hypotheses to fibrous materials exposure for induction might well be entertained in view of the possibilities of idiopathic etiology of childhood mesothelioma, the latency of onset, difficulty of accurate diagnosis, and uncommon occurrence of mesotheliomas in occupational situations, much less in the general population except in the dusty areas of Turkey. 

Chen Y, Chen C, Jin S, et al The diagnosis and treatment of acute acrylonitrile poisoning a clinical study of 144 cases. J Occup Health 41(3) 172-176, 1999... 

Burge P, O Brien I, Harries M Peak flow rate record in the diagnosis of occupational asthma due to isocyanates. Thorax 34 317, 1979... 

Schizophreniform disorder in DSM-FV is somewhat different from schizotypal disorder in ICD-10. The diagnosis of schizophreniform disorder requires the identical criteria of schizophrenia (criterion A), except for two differences the total duration of the illness is at least 1 month, but less than 6 months (criterion B), and impaired social or occupational functioning during some part of the illness is not required. The delusional disorder in DSM-IV corresponds more or less to the category persistent delusional disorder of ICD-10, and brief psychotic disorder (DSM-IV) is similar to the ICD-10 category acute and transient psychotic disorder, whereas the shared psychotic disorder of DSM-IV corresponds to induced delusional disorder of ICD-10. 

In the context of tests of cognitive function, most or all of these behavioral characteristics are likely to interfere with optimal performance. However, poor performance on tests of cognitive function are neither necessary nor sufficient for a diagnosis of ADHD the DSM-IV stipulates that clinically significant impairment in social, academic or occupational functioning (due to the above symptoms) must be notable in two or more settings for a diagnosis of ADHD to be made. 

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