Transcript Occupational MedicineN.ppt

H.R.Sarreshtahdar, MD
Occupational Medicine Specialist
Job Human History
Medical History
Lucretius
Ramazzini
Pliny
Paracelsus
Hamilton
Occupational Health
WHO
more than 100,000,000
occupational disorders annually
ILO
more than 50% workers work in
unacceptable workplace
Occupational Health
The promotion and maintenance of the
highest degree of physical, mental and
social well being of workers in all
occupations
Fitness for work
OEM Mission
Occupational and environmental
medicine is
the medical specialty devoted to
prevention and management of
occupational and environmental injury,
illness, and disability; and promotion
of health and productivity of workers,
their families, and communities.
Occupational Health
In 1970, Congress passed the Occupational
Safety and Health Act (OSH Act), creating
the:
 Occupational Safety and Health
Administration (OSHA)
 National Institute for Occupational Safety
and Health (NIOSH)
What Sciences Help
Occupational Medicine ?
Medicine
Statistic & epidemiology
Management
Education & training
Law & legal medicine
Communication
Occupational Health Team
o Occupational physician
o Industrial hygienist
o Occupational nurse
o Ergonomist
o Safety technician
Occupational Health System
Management
Occupational
Medicine
Industrial
Hygiene & Safety
Employees
Occupational Disorders
 INJURIES
 DISEASE
Occupational disease
Work related disease
Work aggravated disease
Occupational Disease
• No treatment
• Preventable
• Chronic
• Impairment & disability
• Co-workers involvement
• High cost
Impact of Health on Productivity
• Absenteeism and Presenteeism
Occupational Disease
• Indistinguishable from
non occupational origin
• Multifactorial
• Latency period
• Dose response relationship
• Susceptibility
‫‪Iceberg Of Occupational‬‬
‫‪Disorders‬‬
‫مرتبط‬
‫با كار‬
‫بررسي پزشكي بدون‬
‫درنظرگرفتن ارتباط شغلي‬
‫وجود عالئم وعوارض بدون مراجعه‬
‫به پزشك‬
‫بدون عالئم باليني‬
Clinical Under
Recognition
• Inadequate knowledge
• Absence specific findings
• Latency
• Multifactorial
• Multiple Susceptibility
Hazards
 Physical
 Chemical
 Biological
 Ergonomic
 Psychosocial
 Other(surfaces, flammables, heights, tips)
Examples Of
Occupational Disorders
o Liver disease (vinyl chloride)
o Bladder cancer (dyes)
o Psychosis (Hg)
o Raynaud’s phenomenon (vibration)
o Rales, wheezes,… (allergens)
Prevention Levels
Primary
Secondary
Tertiary
Primary Prevention
Medical
o Pre-placement and fitness for work
evaluations
o Screening programs (for other workers) and
biologic monitoring
o Advising the employer and employee
regarding the seriousness of the hazards
and availability of preventive measures
Primary Prevention
Non Medical
Anticipation of health hazards
Recognition of health hazards
Evaluation of health hazards
Control of health hazards
Industrial hygiene
Anticipation
Recognition
Evaluation
Control
Secondary prevention
 Designed to detect occupational injuries
or illnesses at an early stage (before the
worker has developed symptoms or any
complications)
Occupational surveillance
Surveillance
• Systematic evaluation of employees to
monitor for the early occurrence of
disease or to detect biomarker of
exposure
• Health surveillance Vs. hazard
surveillance
• Screening is a form of surveillance
designed to detect early signs of workrelated diseases
Screening
 Monitoring
environmental
biologic
 Examination
pre-placement
periodic
Screening
A method for detecting disease or body
dysfunction before an individual would
normally seek medical care.
Screening tests are usually adminstrated to
individual without current symptom, but who
may be at high risk for certain adverse health
outcomes
Principles of screening
Screening test must be selective and
acceptable to the population at risk
Screening test should be valid and reliable
Benefits overweighs the costs
Screening tests should be non-invasive (where
feasible)
Treatment should be available and effective at
the stage when the disease is diagnosed
Steps for Medical
Surveillance
o Risk assessment
o Selection of goals and target population
o Choice of testing modalities
o Collection of data
o Interpretation of data
o Intervention
o Evaluation of program
Risk assessment
 Do
certain workers need special tests?
 For performing this step, the physician
should:
Review work process
• Industrial hygiene survey
• Work-site visit
Review toxicity of materials
• MSDSs
• Databases
Selection of goals and
target population
 Selection of goals (surveillance for what?)
 Selection of population:
For benefit of individual workers
• Screening for disease
• Pre-placement evaluation
• Fitness for work evaluation
For benefit of groups of workers
• Detection of new hazards
• Assessing absence patterns
Choosing Testing Modality
o Questionnaires
ATS questionnaire for pulmonary diseases
OSHA questionnaire for ergonomic exposures
o Physical exam
o Chest X-ray
For silicosis
o PFT
For restrictive lung diseases
o Biologic monitoring
Problems With The
Application Of Tests
 Limitations inherent in the
laboratory itself
 Strategies for obtaining tests
 Interpretation of normal and
abnormal results
Data collection
Occupational disease
asthma
Exposure indicators
blood lead level
Possible physiologic effect
spirometry
Markers of personal risk
allergy to animal proteins
Indications of possible early disease
Β2 microglobulin in urine of Cd workers
Tertiary prevention
 Clinical management of workers who are
injured or ill and appropriate rehabilitation
In order to
Maximize worker’s capacity
Minimize the effects of disease
Improve long-term outcome
Impairment
 An alternation in health
status which is evaluate
by medical means
 A loss, loss of use, or
dearrangement of any body part,
organ system or function
Disability
 Include not only impairment
but how that impairment affects a
person”s ability to meet demands of
life
 Alternation of an individual’s
capacity to meet personal, social, or
occupational demands because of an
impairment
Fitness for Work
Evaluation
o Pre-placement
o Return to work
o Provide reasonable accommodations
o Return to a temporary modified duty
o Place the worker in a permanent
modified position
o Medically terminate the employee