the practice of occupational medicine dr. majid golabadi occupational medicine specialist
TRANSCRIPT
The Practice of Occupational
Medicine
Dr. Majid GolabadiOccupational Medicine
Specialist
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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.
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Occupational Medicine:Occupational Medicine:The Beginnings – Ancient TimesThe Beginnings – Ancient Times
The history of occupational medicine can be traced into antiquity. Observations of increased rates of illnesses and mortality among miners date back to Greek and Roman times.
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Occupational Medicine:Occupational Medicine:Laying the Foundation – BauerLaying the Foundation – Bauer
15561556
Georg Bauer publishes De re metallicus, a discussion of the dangers and diseases of miners
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Occupational Medicine:Occupational Medicine:The Beginning – RamazziniThe Beginning – Ramazzini
17001700
Bernardini Ramazzini publishes first edition
of Diseases of Workers
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Occupational Medicine:Occupational Medicine:The Modern Era – OSH Act of 1970The Modern Era – OSH Act of 1970
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)
• Occupational Safety and Health Review Commission (OSHRC)
Location of Occupational
Illnesses & Injuries amongLeading causes of
Morbidity & Mortality in…
5Nearly half of all injuries in some age groups !
Occupational Fatalities Ranking
8
Financial Costs of
Occupational Illnesses &
InjuriesExceed $250 billion per year
The Human Costs
Staggering!!?
The ILO estimates that : The World’s Work Force suffers More than 1 Billion Accidents Every Year.
Over 2 million People are killed by Their Work Every Year.
More than 6% of National Incomes
Cause Permanent Disabilities &
Economic Losses
The WHO estimates that : There are at least 250 million Cases of Occupational Disease Worldwide!!! with an Unknown additional toll on National Incomes !?
How much of all injury cases result
in Loss of Work ?
One- third
What is the most common
Occupational Respiratory Disease
?
Asthma
How muchof new-onset
Asthma in adults is Work-related ?
20%
How many Chemicals are found in Work Settings?How many Workers are exposed to these Substances?Many Millions
More than Half a Million
Workplace Exposure to Carcinogens
All Cancer Cases5-10 %
Less than 0.1% of cancer patient ever receive any settlement from employers !!!
How many Lung Cancer Cases in Men & Women are Work-related?16-17 %
2%
Occupational Cancers are
Totally Preventable !!!100
%
Work Health
Case 1: The Hazards of Work
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 whether there 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?
Worker
Workplace
O.M O.H
Industrial or Occupational
Hygiene
Anticipation Recognition Evaluation Control Of Health Hazards arising in or
from the Workplace
Occupational Medicine
Practices in Occupational medicine
• Occupational Medicine focuses on the prevention,
evaluation, treatment and resolution of health conditions
caused by the workplace environment.
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 • 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?
Occupational Physician must :Determine that an injury or illness is caused by work,
Diagnose it,Treatment,Assess the extent of impairment, &
Assess the ability of the worker to resume work.
Occupational Medicine Services
Preventive ServicesCurative Services Rehabilitative Services Consultative Services Administrative ServicesResearch ServicesEducational & Training Services
& Others
Levels of Prevention
Primordial PreventionPrimary PreventionSecondary PreventionTertiary Prevention
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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.
Primary Prevention at an Organizational LevelSubstitution of a Less Hazardous
Process for a More Hazardous One
Substitution of a Less Hazardous Substance for a More Hazardous One
Installation of Engineering Controls & Devices
Job Redesign, Work Organization Changes, & Work Practice Alternatives
Primary Prevention at an Individual Level
Education
Personal Protective Equipment
Administrative Measures
Secondary Prevention of
Occupational IllnessScreening for Occupational Disease
Screening at-risk Workers who are not Covered by Standard-mandated Examination
Tertiary Prevention of Occupational
IllnessPrevent DisabilityPrevent Further Progression
Health Examination
Programs
1-Preemployment H.E. or
Preplacement H.E. ?
The Objectives of the Preplacement Health
Exam. (Employment Entrance
Examination)
Case 3: Assessing fitness for work
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?
A Model Framework for Assessment of Medical Fitness for Work
Person•Relevant medical history
•Functional capacity (physical/psychological)
Job•Demands/requirements
•Safety critical work•Hours, travel etc
Risks•Employee•Employer
•Colleagues•3rd parties
(customers/service users/public)
Fitness for
Work
2- Periodic Health Examination
General Specific (Hazard-
related)
The Objectives of Periodic Health
Exam.
3- Other Mandatory Health Examinations
Return-to-Work Examination
a- Postinjury
b- PostillnessMotor Vehicle Operator ExaminationLocomotive Engineer ExaminationPhysical Fitness ExaminationFlight Personnel ExaminationJob Transfer ExaminationDisability & Retirement ExaminationForeign Travel Examination (prior to)