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Occupational Health Unit

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Occupational Therapy ... Worked as a hospital domestic assistant for 2 years ... Functional capacity (physical/psychological) Job. Demands/requirements ... – PowerPoint PPT presentation

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Title: Occupational Health Unit


1
Basic Concepts in Occupational Medicine
  • Occupational Health Unit
  • Royal Free Hospital

2
Aims Objectives
  • Aim
  • To be able to apply the basic principles of
    occupational medicine to your professional
    practice as doctors
  • Objectives
  • 1. Know what questions to ask in order to take an
    appropriate and relevant occupational history
  • 2. Identify factors or patterns in a patients
    history that may indicate a work related
    contribution to ill health
  • 3. Consider a work related health dilemma and
    reach a conclusion with reasons
  • 4. List 3 causative agents and related work
    activities for occupational asthma, allergic
    contact dermatitis and cancer.
  • 5. Specify what information is necessary to make
    a fully informed assessment of an individuals
    medical fitness for work

3
Occupational Health
  • Work Health
  • (occupational disease/work related ill health)
  • Health Work
  • (medical fitness for work)

4
Occupational Health/Therapy
  • Occupational Medicine/Health
  • a branch of medicine concerned with the
    interaction between health and work (occupation)
  • Occupational Therapy
  • assessment treatment to enable maximum
    independent function in daily living, using
    purposeful activity (occupation)

5
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 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 doesnt 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 managers
    questions?

6
Classification of work hazards
  • Physical
  • Mechanical
  • Chemical
  • Biological
  • Psychosocial

7
Hazard and Risk
  • Hazard potentially harmful
  • Risk probability of harm
  • (quantifiable as risk assessment)

8
Principles of Control of Workplace Hazards
  • Identify
  • Evaluate
  • Control
  • Eliminate
  • Substitute
  • Enclose/separate
  • PPE/vaccinate

9
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?
  •  

10
Presentation of Occupational Disease
  • Pathology
  • Timing of symptoms
  • Possible causes
  • Elicit relevant history

11
The Occupational History
  • What is your job? What do you do for a living?
  • What do you do at work? What do you work with?
    What is a typical working day?
  • How long? What else?
  • Any known hazards? Anyone else with similar
    symptoms?
  • Hobbies? (DIY, pets, gardening, chemicals)

12
Occupational Asthma
  • Occupational Asthma
  • Asthma induced by specific substances encountered
    in the work place. It may occur in individuals
    who would otherwise not have developed asthma
  • Work-related Asthma
  • Asthma which relates to substances in the work
    place (resp irritants) that exacerbate asthma in
    people with pre-existing asthma

13
Causes of Occupational Asthma
  • Isocynates
  • Platinum salts
  • Proteolytic enzymes
  • Wood dusts
  • Glutaraldehyde
  • Soya bean
  • Persulphates or henna
  • Crustaceans or fish products
  • Grain / Flour (barley, oats, wheat, maize)
  • Caster bean dust
  • Laboratory animals
  • Antibiotics
  • Latex
  • Soldering flux (colophony)
  • Ispaghula
  • Tea dust

14
Dose response relationship
KOH 2006
15
UK detergent factory incidence of occupational
asthma vs enzyme use
16
UK detergent factory incidence of occupational
asthma vs enzyme use
17
UK detergent factory incidence and new employees
18
UK detergent factory incidence among new
employees vs enzyme use
19
Investigation of a case of suspected Occupational
Asthma
  • History
  • Symptoms
  • Associated symptoms
  • Duration
  • Work history
  • Is patient aware of exposure to any respiratory
    sensitisers at work?
  • Timing of symptoms (immediate /delayed)
  • Improvement away from work
  • Adult onset
  • Smoking history
  • History of atopy

20
Investigation of a case of suspected Occupational
Asthma
  • Clinical investigations
  • 2hrly PEFR
  • Skin prick test
  • RAST / ELISA
  • Spirometry
  • Bronchial challenge

21
(No Transcript)
22
Management
  • Drug treatment
  • as for non-occupational asthma
  • Non-drug treatment
  • Remove from exposure
  • Review work place
  • Is prevention possible?
  • Are control measures adequate?
  • Compliance with (COSHH) regulations?
  • Health surveillance

23
UK Supermarket bakeries
What happens when a supermarket opens?
No cases of occupational asthma
Increased incidence of occupational asthma
24
Occupational Dermatitis
  • Endogenous (constitutional)
  • Exogenous (contact)
  • Irritant (acute/chronic)
  • Allergic (immediate/delayed)

25
Occupational Dermatitis
  • Allergic
  • Latency
  • Lag period
  • Eye lid swelling
  • Papules and vesicles
  • Exposure to a known sensitiser
  • Irritant
  • usually involves the hands
  • Scaling and redness
  • Papules and vesicles are unusual
  • Exposure to a known irritant

26
Causes of Occupational Dermatitis
  • Irritant
  • Wet work
  • Soap
  • detergents
  • vegetable juices/fruit
  • fish/meat
  • dough
  • Allergic
  • Latex
  • Biocides/preservatives (e.g. formaldehyde)
  • Chrome salts
  • Plant allergens (e.g. onion, garlic, spices)
  • Epoxy resin monomers
  • Hairdressing chemicals

27
History
  • Duration
  • Site
  • Work history
  • Exposure to known allergens/irritants
  • Improvement away from work
  • Treatment

28
Management
  • Avoid exposure
  • Allergen/irritant replacement
  • Skin protection
  • Change job
  • Drug treatment

29
Occupational Cancer
  • Target Organ
  • Lung
  • Nasal sinuses
  • Urothelial tract
  • Liver(angiosarcoma)
  • Carcinogen
  • Asbestos, As, Be, Cd, Cr(VI), Ni, Fe, BCME
  • Ni
  • Rubber, Dyes, Al, Tar/pitch
  • VCM

30
Industrial Injuries Disablement Benefit
  • Prescribed diseases (IIAC)
  • relevant disease
  • relevant occupation
  • Administered by DWP

31
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?

32
Fitness for work
  • Job
  • Relevant medical history
  • Risks (self, colleagues, employer, public)

33
A Model Framework for Assessment of Medical
Fitness for Work
34
Aims Objectives
  • Aim
  • To be able to apply the basic principles of
    occupational medicine to your professional
    practice as doctors
  • Objectives
  • 1. Know what questions to ask in order to take an
    appropriate and relevant occupational history
  • 2. Identify factors or patterns in a patients
    history that may indicate a work related
    contribution to ill health
  • 3. Consider a work related health dilemma and
    reach a conclusion with reasons
  • 4. List 3 causative agents and related work
    activities for occupational asthma, allergic
    contact dermatitis and cancer.
  • 5. Specify what information is necessary to make
    a fully informed assessment of an individuals
    medical fitness for work
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