OCCUPATIONAL MEDICINE

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OCCUPATIONAL MEDICINE
H.R.Sarreshtahdar, MD Occupational Medicine
Specialist
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Job Human History
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Medical History
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Occupational Health

• WHO more than 100,000,000 occupational
  disorders annually
• ILO more than 50 workers work in
  unacceptable workplace

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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

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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.
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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)

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What Sciences Help Occupational Medicine ?

• Medicine
• Statistic epidemiology
• Management
• Education training
• Law legal medicine
• Communication

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Occupational Health Team

• Occupational physician
• Industrial hygienist
• Occupational nurse
• Ergonomist
• Safety technician

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Occupational Health System
Management
Occupational Medicine
Industrial Hygiene Safety
Employees
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Occupational Disorders

• INJURIES
• DISEASE
• Occupational disease
• Work related disease
• Work aggravated disease

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Occupational Disease

• No treatment
• Preventable
• Chronic
• Impairment disability
• Co-workers involvement
• High cost

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Impact of Health on Productivity
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Occupational Disease

• Indistinguishable from non
  occupational origin
• Multifactorial
• Latency period
• Dose response relationship
• Susceptibility

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Iceberg Of Occupational Disorders
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Clinical Under Recognition

• Inadequate knowledge
• Absence specific findings
• Latency
• Multifactorial
• Multiple Susceptibility

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Hazards

• Physical
• Chemical
• Biological
• Ergonomic
• Psychosocial
• Other(surfaces, flammables, heights, tips)

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Examples Of Occupational Disorders

• Liver disease (vinyl chloride)
• Bladder cancer (dyes)
• Psychosis (Hg)
• Raynauds phenomenon (vibration)
• Rales, wheezes, (allergens)

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Prevention Levels
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Primary Prevention

• Medical
• Pre-placement and fitness for work evaluations
• Screening programs (for other workers) and
  biologic monitoring
• Advising the employer and employee regarding the
  seriousness of the hazards and availability of
  preventive measures

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Primary Prevention

• Non Medical
• Anticipation of health hazards
• Recognition of health hazards
• Evaluation of health hazards
• Control of health hazards

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Industrial hygiene
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Secondary prevention

• Designed to detect occupational injuries or
  illnesses at an early stage (before the worker
  has developed symptoms or any complications)
• Occupational surveillance

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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 work-related diseases

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Screening

• Monitoring environmental
  biologic
• Examination
• pre-placement periodic

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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

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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

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Steps for Medical Surveillance

• Risk assessment
• Selection of goals and target population
• Choice of testing modalities
• Collection of data
• Interpretation of data
• Intervention
• Evaluation of program

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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

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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

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Choosing Testing Modality

• Questionnaires
• ATS questionnaire for pulmonary diseases
• OSHA questionnaire for ergonomic exposures
• Physical exam
• Chest X-ray
• For silicosis
• PFT
• For restrictive lung diseases
• Biologic monitoring

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Problems With The Application Of Tests

• Limitations inherent in the laboratory itself
• Strategies for obtaining tests
• Interpretation of normal and abnormal results

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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
• ?2 microglobulin in urine of Cd workers

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Tertiary prevention

• Clinical management of workers who are injured or
  ill and appropriate rehabilitation
• In order to
• Maximize workers capacity
• Minimize the effects of disease
• Improve long-term outcome

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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

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Disability

• Include not only impairment
  but how that impairment affects a persons
  ability to meet demands of life
• Alternation of an individuals capacity to meet
  personal, social, or occupational demands because
  of an impairment

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Fitness for Work Evaluation

• Pre-placement
• Return to work
• Provide reasonable accommodations
• Return to a temporary modified duty
• Place the worker in a permanent modified position
• Medically terminate the employee

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Any question?
Thanks For Attenrtion