The Practice of Occupational Medicine Dr. Majid Golabadi Occupational Medicine Specialist

2 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.

3 Occupational Medicine: The 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.

4 Occupational Medicine: Laying the Foundation – Bauer 1556 Georg Bauer publishes De re metallicus, a discussion of the dangers and diseases of miners

5 Occupational Medicine: The Beginning – Ramazzini 1700 Bernardini Ramazzini publishes first edition of Diseases of Workers

6 Occupational Medicine: The 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 among Leading causes of Morbidity & Mortality in … 5 Nearly half of all injuries in some age groups !

Occupational Fatalities Ranking 8

Financial Costs of Occupational Illnesses & Injuries Exceed $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 ? Asth ma

How much of 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 Cases 5-10 % Less than 0.1 % of cancer patient ever receive any settlement from employers !!!

How many Lung Cancer Cases in Men & Women are Work- related? % 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 Services  Curative Services  Rehabilitative Services  Consultative Services  Administrative Services  Research Services  Educational & Training Services  & Others

Levels of Prevention  Primordial Prevention  Primary Prevention  Secondary Prevention  Tertiary Prevention

32 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 Level  Substitution 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 Illness  Screening for Occupational Disease  Screening at-risk Workers who are not Covered by Standard-mandated Examination

Tertiary Prevention of Occupational Illness  Prevent Disability  Prevent Further Progression

Health Examination Programs

1-P reemployment H.E. or P replacement 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 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- Postillness  Motor Vehicle Operator Examination  Locomotive Engineer Examination  Physical Fitness Examination  Flight Personnel Examination  Job Transfer Examination  Disability & Retirement Examination  Foreign Travel Examination (prior to)