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An index case of occupational disease or injury is defined as the first ill or injured individual from a given workplace to receive medical care and thereby to draw attention to the existence of a workplace hazard and an additional workplace population at risk.

A further purpose of case identification may be to assure that the affected individual receives appropriate clinical follow-up, an important consideration in view of the scarcity of clinical occupational medicine specialists (Markowitz et al. Finally, occupational health surveillance is an important means of discovering new associations between occupational agents and accompanying diseases, since the potential toxicity of most chemicals used in the workplace is not known.

Workers may have a limited ability to provide an accurate report of their toxic exposures.

Despite some improvement in countries such as the United States in the 1980s, many workers are not informed of the hazardous nature of the materials with which they work.

Second, the collection of incidence and prevalence data allows analysis of trends of occupational disease and injury among different groups, at different places and during different time periods.

Detecting such trends is useful for determining control and research priorities and strategies, and for evaluating the effectiveness of any interventions undertaken (Baker, Melius and Millar 1988).

First, recognition of the underlying cause or causes of any illness is the sine qua non for recording and reporting occupational diseases.

However, in a traditional medical model that emphasizes symptomatic and curative care, identifying and eliminating the underlying cause of illness may not be a priority.

It is only through an epidemiological assessment of the dimensions of occupational disease that its importance relative to other public health problems, its claim for resources and the urgency of legal standard setting can be reasonably evaluated.

Furthermore, health care providers are often not adequately trained to suspect work as a cause of disease (Rosenstock 1981) and do not routinely obtain histories of occupational exposure from their patients (Institute of Medicine 1988).

This should not be surprising, given that in the United States, the average medical student receives only six hours of training in occupational medicine during the four years of medical school (Burstein and Levy 1994).

A second broad function of occupational health surveillance is to identify individual cases of occupational disease and injury in order to find and evaluate other individuals from the same workplaces who may be at risk for similar disease and injury.

Also, this process permits the initiation of control activities to ameliorate the hazardous conditions associated with causation of the index case (Baker, Melius and Millar 1988; Baker, Honchar and Fine 1989).

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