Basic Concepts in Occupational Medicine What is occupational
Basic Concepts in Occupational Medicine
What is occupational medicine ? Occupational Medicine is the branch of clinical medicine most active in the field of Occupational Health. Its principal role is the provision of health advice to organizations and individuals to ensure that the highest standards of Health and Safety at Work can be achieved and maintained Occupational health
History Ramazini Father of occupational medicine What is your occupation ?
ILO , WHO Promotion and maintenance of the highest degree of physical, mental and social well being of workers in all occupations; Protection of workers in their employment from risks resulting from factors adverse to health Placing and maintenance of a worker in an occupational environment adapted to his physiological and psychological equipment and, Summary , the adaption of work to people and of each person to their job.
Occupational Health Work Health (occupational disease/work related ill health) Health Work (medical fitness for work)
Types of Prevention Primary – Target: those with potential for exposure; no disease yet. Goal: change exposure conditions Secondary – Target: those with early stage of disease, no symptoms yet Goal: reverse disease, delay symptom onset Tertiary – Target: those with clinical disease Goal: cure or control of disease. 10
Opportunities for Prevention Primary Secondary. Tertiary Prevention time Healthy Worker Asymptomatic Symptomatic Disease 11
ﻧکﺎﺕ ﻣﻬﻢ ﺩﺭ ﺷﺮﺡ ﺣﺎﻝ گیﺮی کﺎﺭگﺮ ﻗﺒﻠی ﻣﺸﺎﻏﻞ ﺷﻐﻠی ﻋﻨﺎﻭیﻦ ﻣﺘﻌﺪﺩ ﻣﺸﺎﻏﻞ Change in symptoms during the work day Change in symptoms over the work week Change in symptoms on weekends and vacations Onset of symptoms away from work. Other experiences with work-related events.
Classification of work hazards Chemical - liquids, fumes, mists, vapours, gases, dusts Physical - radiation, noise, vibrations, temperature, humidity Ergonomic - body position, repetitive actions, work pressure Biological - bacteria, viruses, fungi Psychosocial • Safety hazard - shift work, stress - inadequate machine guards, unsafe workplace conditions, unsafe work practices
Routs of exposure Inhalation Skin absorption Ingestion Transfer across placenta Intravenous Intramuscular subcutaneous
Target organs Nervous system Blood circulation lungs Liver Kidney Skin Muscle & Bone
Common chemical groups Dusts, fumes and gases Solvents Metals Acids and bases Pesticides
Preventive measure Elimination Substitution Engineering control Administrating control Personal protective equipment Monitoring Training
MONITORING EXPOSURE HEALTH SURVEILLANCE monitoring exposure ◦ where serious risks if controls fail ◦ to confirm exposure limits are not exceeded ◦ to confirm that controls are working properly ◦ keep records health surveillance ◦ where exposure is linked to a disease which could occur and can be detected ◦ where employees are working in a process listed in schedule 5 and exposure could be significant
Monitoring Exposure Anticipation, recognition, evaluation, control Measurement of exposure , comparison to existing standard , & recommendation of control
Evaluation of health hazards Air quality monitoring Air- borne particulate sampling Ambient noise measurement Lighting evaluation Thermal stress evaluation
Occupational health surveillance Systemic monitoring of health events and exposures in working populations in order to prevent and control occupational hazards and their associated diseases and injuries
Biologic Monitiring The measurement of a chemical , its metabolite , or a nonadverse biochemical effect in a biologic specimen for the purpose of assessing exposure.
Thanks for your attention Any Question?
Case 2: Is it work-related? A 58 -year-old hospital porter has been off sick for almost a year, with low back pain. He says he injured his back at work. His back pain has not improved with physiotherapy and analgesia. He has difficulty walking up and down stairs and is breathless on exertion. His occupational history is as follows: · Left school at 15 · Had numerous labouring jobs in the construction industry for 20 years or so · Worked on a tunnelling project for 18 months · Worked as a lorry driver for a brewery for 8 years · Worked as a hospital domestic assistant for 2 years · Has been employed as a hospital porter for 11 years 1. What occupational hazards might account for his breathlessness? 2. How would you assess whether his symptoms are work related or not? 3. What are the possible causes of his back pain? 4. What advice would you give him? 5. Is he likely to be return to work? 6. What work might he be able to do?
Fitness for work Job Relevant Risks medical history (self, colleagues, employer, public)
A Model Framework for Assessment of Medical Fitness for Work Person • Relevant medical history • Functional capacity (physical/psychological) Risks Fitness for Work • Employee • Employer • Colleagues • 3 rd parties (customers/service users/public) Job • Demands/requirements • Safety critical work • Hours, travel etc
Case 3: Assessing fitness for work Y You are an occupational physician. A 29 -year old HIV positive doctor has been offered a post on an anaesthesia rotation. 1. Is it relevant to know how HIV was acquired? 2. How will you assess whether s/he is medically fit for the job? 3. What information will you need, to make a fully informed assessment?
Case 1: The Hazards of Work You are an occupational physician. A 31 -year-old laboratory technician is referred to your clinic by her manager, because of alleged lateness and poor performance at work. You are asked to assess whethere is an underlying medical cause for this. She tells you that she has not been sleeping well lately, possibly due to nocturnal coughing. She says the lab is cold and drafty, and that by the end of the working day her right arm is aching. She says that when she told her manager, he was unsympathetic; telling her she should leave if she doesn’t like the job. 1. What are the presenting medical problems? 2. What are the possible work-related causes of her symptoms? 3. What are the potential hazards in her workplace and how might you classify them? 4. How will you respond to the manager’s questions?
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