Magazine article Occupational Hazards

Symptoms: The Workplace Dilemma

Magazine article Occupational Hazards

Symptoms: The Workplace Dilemma

Article excerpt

Every day, we all have one or more symptoms. They range from headaches and other aches and pains, to fatigue, sore throat, nausea and cough. If you concentrate while reading this article, I am sure you will be able to identify one or more current symptoms.

Symptoms in and of themselves do not mean disease. Disease can only be diagnosed with a clear history, related physical examination findings and supportive test results. Symptoms may be manifestations of underlying conditions such as allergy, expressions of stress, or just the natural consequence of aging.

Certain symptoms, of course, may herald the onset of disease. Asthma, sinusitis and other disorders are extremely common in the general population. Thus, it is not surprising to find many individuals suffering from symptoms related to these disorders. Billions of dollars a year are spent on over-the-counter or prescription medications to control or hopefully prevent myriad symptoms, whether they be isolated ones such as headache or flareups of common underlying ailments.

Workers who are symptomatic frequently pose a dilemma for occupational health professionals in terms of: Determining workplace associations; proper employee placement; investigation of symptom clusters; and effective medical management.

Workplace Association

"I get these symptoms at work." Probably one of the more difficult determinations is to correlate "something" in the workplace to an individual worker's symptoms or complaints from a group of workers. The mere fact that complaints are perceived to occur at the workplace does not mean that work is causing them. Studies have clearly demonstrated that people who believe there is exposure to a chemical, biological or physical agent have significantly more symptoms than individuals without such beliefs.

One study, for example, found a 50 percent prevalence rate for headaches in the nonexposed population. However, this rate was almost 80 percent for individuals living near a hazardous waste site, but without any hazardous exposure.

While it is very important to investigate all complaints, there must be an objective mechanism in place to assess the potential relationship between work and symptoms. To assure an objective assessment, identification of workplace hazards and appropriate remediation, such as exposure reduction when necessary, specific criteria should be set for:

Temporality - Complaints arise only at work, under the same circumstances and are consistently reproduced;

Clear presence of hazard - Objective demonstration of a hazard which has been documented to produce the symptoms in question;

Adequate dose - The hazard must be present at a level known to cause the symptoms; and Elimination of alternative etiologies Investigation of nonworkplace factors including psychosocial and personal risk factors, e.g., smoking and cough.

High-Profile Symptom Complaints

Multiple Chemical Sensitivity (MCS), Sick Building Syndrome (SBS), Chronic Fatigue Syndrome (CFS), and Cumulative Trauma Disorders (CTDs) all constitute symptom complexes which have been associated with work. Each complex brings its own challenges in terms of causation and aggravation determination and medical management. Clearly, symptoms related to SBS and CTDs can be produced or aggravated by work. However, MCS and CFS should not be considered work-related in any capacity at this time.

Although numerous theories exist, there still is no demonstrated/objective causal association for the wide range of symptoms which have been termed MCS. Presently, CFS is felt to be of viral etiology, although there have been workers' compensation cases attempting to relate workplace chemical exposure to CFS.

Musculoskeletal symptoms associated with CTDs can be due to disorders such as tendonitis or arthritis. More frequently, however, musculoskeletal symptoms including discomfort, fatigue and pain are the result of "psychosocial" factors such as job satisfaction. …

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