Transcript PHILIPPINE RETIREMENT INSTITUTE Committee on Health

Ma. Gia Baquiran- Sison, MD MOH DPCOM
Diplomate, Philippine College of Occupational Medicine
Consultant, World Health Organization, Western Pacific Region
Medical Director, Meralco Corporate Wellness Center
Consultant, Makati Medical Center
Masters in Occupational Health, University of the Philippines Manila
Masters in Occupational Medicine, University of Illinois Chicago
Outline of Presentation
Definition of the practice of Occupational
Medical
 The Role of Emergency Medicine in
Occupational Medicine
 Global trends and Conditions that affect
Occupational Medical Practice
 Local trends in Occupational Medicine in
the Philippines
 Emerging health trends in the workplace
 Conclusion and Recommendations

What is the practice of
Occupational Medicine?

Occupational Medicine is a medical
discipline that emphasizes prevention and
deals clinically and administratively with
the health needs of both individuals and
groups with respect to their working
environment and includes recognition,
evaluation, control, management and
rehabilitation of occupationally-related
diseases and injuries.
Role of ER Medicine in
Occupational Medicine
1985: ACEP established the
Occupational Medicine Committee to
evaluate and develop the role of the ER
physician in Occupational Medicine.
 1986: ACEP defined 6 areas of
Emergency Medicine which is inclusive
of an area in Occupational Medicine

Role of ER Medicine in
Occupational Medicine

ACEP statement: “ The ER physician
with additional qualifications and/or
special competencies may engage in
the provision of initial care and
continuing Occupational Medicine
services including illness and injury
prevention, case management and
patient rehabilitation.
Initial Management of Patients at the ER
presenting with a Work-related Injury or
Illness
Established policy of ACEP last 1998
 Delineates ER physicians’
responsibilities in the following areas:

 Provision of emergency evaluation and




treatment
Determination of medical causation
Establishment of physical limitations
Communication with the employer
Arrangement of appropriate follow-up care
Global Trends and Conditions Affecting
Occupational Medical Practice



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Migration of Industry to developing countries
Migration of workers – OFW’s, seamen
Increase in the Business process outsourcing ( BPO)
business
Demographic changes in nearby countries
Emerging new diseases and conditions
Increased Travel
Top Outsourced Industries in
the Philippines
Manufacturing Industry – microchips, cars,
telecommunication equipment
 Agricultural Industry – pineapple, vegetable oil,
biofuels
 Service Industry – BPO (call centers), medical
transcription and coding, accounting/billing
 Health Services – medical tourism
 Retirement Industry

Local Trends in Occupational
Medicine in the Philippines



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Increase in BPO companies (call centers) – SHIFT WORK
problems
Computer chip industry relocations
Heavy industries (shipbuilding, oil refineries) to Export
processing zones
Outsourcing of health services by companies
Growth of HMO’s and health plans
Enforcement of Occupational Health Laws as mandated
by the Department of Labor and Employment
Philippine Labor Standards in the
Occupational Health Practice
•
•
Based on Rule 1960 of the DOLE-BWC Standards in
Occupational Health and Safety and the Philippine
Labor Code
In all workplaces where there is more than 1 work shift
in a day, the employer shall in addition to the
requirements of the rule, provide the services of a
fulltime first-aider for each work shift.
• Workers 10-50: first aider
• 50-200: full time registered nurse
• 201-300: full time RN, parttime MD, parttime dentist
• 301 above: full time RN, full time MD, full time dentist
General Features
Work as one of the causes.
 Both workers and non-workers are
affected.
 Increase in the NCDs (diabetes,
hypertension, coronary artery disease in
the young)
 Has impact in health cost utilization
 Emphasis must always be towards the
preventive side and fitness to work
should be highly considered.

Top Occupational Health
Issues in the Workplace
Infectious diseases
 Bronchial asthma
 Skin diseases
 Cardiovascular diseases
 Gastrointestinal-related diseases
 Cataract, deafness
 Acute poisoning

Based on the Philippine National OSH Profile, Sept. 2010
Occupational Health Issues in the
Business Process Outsourcing
Increasing number in NCDs (diabetes,
hypertension in the young)
 Shift work related health issues
 Ergonomic-related health issues such as
Repetitive Strain Injuries (RSI)
 Psychosocial factors (job satisfaction,
personality traits, perception of intensified
workload, job control)

Sample Shift Schedules in
the BPO Industry
8 hour shift/ 37.3 hours per week/ 6
days on, 3 days off
 10 hour shift/ 40 hours per week/ 6 days
on, 1 day off
 24 hours shift/ 56 hours on the average
per week/ 7 days on but rotated every 9
days

Re-Emerging Health Issues in
the Workplace
Increase in HIV-AIDS
 Increase in Respiratory diseases, UTI,
Gastrointestinal-related diseases,
Cardiovascular diseases
 Persistence of Obesity as number one in
annual physical examinations
 Resurgence of PTB
 Substance abuse

Demographics: Population
Demographics: Gender
Demographics: Marital Status
Demographics: Age
Demographics: Body Mass
Index (BMI)
Demographics: BMI by
Gender
Demographics: BMI by Age
Smoking History
Smoking History by Age
Drinking History
Drinking History by Gender
Drinking History by Age
Prevalent Illnesses based on
Annual Physical Examination
Medical Conditions by Gender
Medical Conditions by Age
Medical Conditions by
Drinking History
Medical Conditions based on
Smoking History
Top Illnesses based on Doctors’
Diagnosis
Acute Tonsillopharyngitis
 Upper Respiratory Illness
 Gastrointestinal-related Disorders
 Tension Headache/ Migraine
 UTI
 Hypertension
 Conjunctivitis
 Musculoskeletal strain
 Systemic Viral Illness
 OB-related

Top Reasons for ER
Conduction
Gastrointestinal-related disorders
 Cardiovascular-related disorders
 Respiratory-related
 Pregnancy-related
 Asthma
 Accidents
 Anaphylaxis

Top Reasons for Sent Home
Cases
Conjunctivitis
 ATP
 GI-related Disorders
 URTI
 Tension Headache/ Migraine
 Systemic Viral Illness
 Hypertension
 Musculoskeletal disorders
 Dental-related disorders
 UTI

Occupational-related
Contributing Factors
Repetitive activities
 Shiftwork-related
 Forceful exertion
 Awkward/static posture
 Temperature extremes
 Localized mechanical stress
 Lifestyle-related factors such as eating
habits, smoking and drinking

New Trends in Occupational
Health

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To predict individual susceptibility to a
substance/ certain disorders
To estimate internal exposure or early
biological effects by molecular biomarkers or biological monitoring
Monitor exposure especially for
carcinogens like toluene and pesticides
New Trends in Occupational
Health
Introduction of Medical Case Management
 Fitness for Work specialty
 Enforcement of health and wellness
programs in the workplace

References in Occupational
and Environmental Health
Medline via PubMed:
www.ncbi.nlm.nih.gov/entrez/query.fcgi
 TOXLINE and Hazardous Substances
Data Bank:
http://toxnet.nlm.nih.gov/index.html
 IRIS (Integrated Risk Information
System): toxic doses of substances in
the environment
 NIOSHTIC-2: www.2a.cdc.gov/nioshtic-2

CONCLUSION
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Knowledgeable in global trends and their
effects on Occupational Medical Practice
Recent trends and developments in
Occupational and Environmental health
Managed care and its tools to ensure
quality of care and cost-effectiveness
Medical professionals should be
advocates of change in the workplace and
be of GOOD influence to patients/workers