Basic Concepts in

Occupational Medicine

Lecture by: M.K. Sastry

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

• The modern definition of Occupational Health

(ILO and WHO) is:

“The promotion and maintenance of the highest

degree of physical, mental and social well-being of
workers in all occupations –
total health of all at work”
 Occupational Health / Therapy
Occupational Occupational Therapy
Medicine / Health • Assessment & treatment
• A branch of medicine to enable maximum
concerned with the independent function in
interaction between
daily living, using
health and work
purposeful activity
(“occupation”)
(“occupation”)
Presentation of Occupational Disease

• Pathology
• Timing of symptoms
• Possible causes
• Elicit relevant history
 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)
 Investigation Of A Case Of Suspected
Occupational Disease
History
• Symptoms
• Associated symptoms
• Duration
• Work history
• Is patient aware of exposure to any respiratory
sensitisers at work?
 Investigation Of A Case Of Suspected
Occupational Disease
History
• Timing of symptoms (immediate /delayed)
• Improvement away from work
• Adult onset
• Smoking history
• History of atopy
 Outline

• Review history of occupational disease over

time
– Prevention
– Diagnosis and management
– Compensation
• Reflection
 Definitions – ILO 1993
• Occupational diseases
– Having a specific or a strong relation to occupation
generally with only one causal agent and recognized as
such
• Work-related diseases
– With multiple causal agents, where factors in the work
environment may play a role, together with other risk
factors, in the development of such diseases, which
have a complex etiology
 Definitions – ILO 1993
• Diseases affecting working populations
– Without causal relationship with work
but which may be aggravated by
occupational
 ILO List of Occupational Diseases
• Diseases caused by agents
– Chemical, physical, biological
• e.g. Beryllium
• Diseases by target organ system
– Respiratory, skin, musculoskeletal
• e.g. Pneumoconioses
• Occupational cancer
– Cancer caused by the following agents
• e.g. Asbestos
 Ancient times

• Egypt, Greece and Rome

– Mining one of the oldest industries
– miners – slaves, criminals
– work = punishment
– manual trades – inferior
– miners used bags, sacks, animal bladders
as masks to decrease dust exposure
 Middle Ages
• Central Europe – mining a feudal enterprise
– Serf labour – unskilled
• Growth of trade - increased need for money and
capital – mines of Central Europe
– Need for skilled labour
– Mines deeper, conditions worsened
 16th & 17th centuries
• Mining, metal work and other trades
flourished
• Some improvement in ventilation
• Shift from feudalism to capitalism
• Guilds – artisans – sickness benefits, funeral
benefits
 16th & 17th centuries
• Awareness of health hazards
– Agricola
• Town physician in Bohemia
• 1556 – De Re Metallica – hazards of metal
mining
 16th & 17th centuries
– Paracelsus
• Town physician in Austria
• 1567 – occ diseases of mine & smelter
workers
– 1572 – lead
– 1575 – carbon monoxide
– 1630 - arsenic
 18th century
• Bernardino Ramazzini
– Physician, professor of medicine in Modena and
Padua
– “Diseases of Workers” – 1700
• Systematic study of trade diseases
– Father of Occupational Medicine
– “what is you occupation?”
 19th century
 Statutory medical service for factory workers
 Factory Inspectors
 Medical certification for children
 Certifying Surgeons
 Workers with exposure to lead, white
phosphorus, explosives, rubber – periodic
exams
 Notification of industrial disease – lead,
phosphorus, arsenic, anthrax
 1898 – Thomas Legge – Medical Inspector
of Factories
 20th century
• Workers‟compensation
– Quickly moved from wage loss to clinical
ratings, “meat chart”
– Many enquiries
– Continual modifications, additional benefits &
coverage
– Occupational disease
• 1913 – industrial disease – 6 listed in Schedule 3
• 1926 – silicosis, pneumoconiosis
• 1932 – cancer
• 1944 – exposure length removed
• WCB could add to Schedule 3
 Mid 20th century
• Occupational Health and Safety legislation
• EU directive
– General duty
– Evaluation of risk
– Program of prevention
– Establishment of preventive services
– Worker rights
• Knowledge
• Participation
• Refuse unsafe work and freedom from reprisals
 RSF Schilling

• Wide variation in occupational health standards & practice

– Humanity of a society
– Wealth of society
– Social status of worker
– Political organization of workers and their
representation in government
– Pioneers advocating improvements by revealing facts
about loss of life and sickness caused by workplace
– Improvements in the future will depend on medical and
technological skills being generally available rather than
on the expertise of the few
 Occupational hazard

 ``Source or situation with a potential for harm in terms of

injury or ill health, damage to property, damage to the
workplace environment, or a combination of these``
SAFETY AND HEALTH LEGISLATIONS :
THE FACTORIES ACT,1948
SCHEDULES

 First schedule - List of Factories

involving Hazardous processes (29)

 Second schedule - Permissible levels of certain

chemical substances in work environment.

 Third schedule - List of notifiable

diseases. (29 categories)
 OCCUPATIONAL HEALTH HAZARDS

TYPES OF OCCUPATIONAL HEALTH HAZARDS

A. Physical
B. Chemical
C. Biological
D. Mechanical
E. Psychosocial
 PHYSICAL HAZARDS
• Temperature -Heat / Cold
• Illumination
• Noise
• Vibration
• Radiation
• Atmospheric pressure
DISEASES DUE TO PHYSICALAGENTS
 Heat - Heat hyperpyrexia, Heat Exhaustion Heat Syncope,
Heat Cramps, burns, Prickly heat
 Cold - Frost bite,
 Light – Occupational Cataract,
 Atmospheric-pressure-Caisson disease, air embolism,
explosion.
 Noise - Occupational deafness,
 Radiation -Cancer,Leukemia,aplastic anemia,
Pancytopenia
 Electricity - Burns, Shocks,
 Human Heat Balance Equation
• M+R+-C+-CV-E=+-S
• Basic equation can be used for any adjustment in
relation to existing Environmental condition to keep
body in thermo neutral in that particular environment
• HEAT= Evaporative cooling will be more
• COLD= Process of conserving heat from conductive,
radiative & convective heat will be more so th the body
will remain in thermo-neutral
e.g. it will neither gain or loss heat irrespective of
environment heat or cold change.
 Heat Illness
 Predisposing Factors
 Physical activity
 Extremes of age, poor physical condition, fatigue
 Excessive clothing
 Dehydration
 Cardiovascular disease
 Skin disorders
 Obesity
 Drugs
 Phenothiazines, anticholinergics, B and Ca
channel blockers, diuretics, amphetamines, LSD,
cocaine, MAOIs
 Heat Stroke
SYMPTOMS PREVENTION
 True emergency  Awareness
 Altered LOC  Adaptation of behavioral and
physical activity
 Any neurological finding
 Clothing
 And elevated
temperature  May still be sweating initially
 Activity
 Syncope
 Appropriate hydration
 History is critical
 Education
 Frost Bite
SYMPTOMS
 Caused by freezing conditions which cut off circulation,
usually in extremities (hands, feet, ears, nose), which
may be permanently affected. Frost-bitten areas are
cold, pale or marbled-looking, solid to the touch, and
painless (until circulation is restored).
TREATMENT
 Giving warm drinks, and covering with blankets. Warm
the injured part with body heat only-put a hand under
an armpit,
for example. Do not rub the skin or apply direct heat to
the injured area.
CHEMICAL HAZARDS
 Routes of entry - Inhalation, Ingestion, skin absorption.
(inhalation is the main route of entry)
 Chemical agents can be classified into-
 Metals - Lead, TEL, As, Hg, Cd, Ni , Co etc. 2) Aromatic
Hydrocarbons - Benzene, Toluene,phenol etc.
 Aliphatic Hydrocarbons - Methyl alcohol
 Gases - *Simple asphyxiants : N2, CH4, CO2
 Chemical asphyxiants : CO, H2S, HCN
 Irritant gases : Ammonia, SO2, Cl2,
 Systemic poison : CS2
 DUSTS (Pneumoconiosis)

Inorganic Dust
 Coal Dust --Anthracosis
 Silica --Silicosis
 Asbestos --Asbestosis

Organic Dusts
 Cane Fiber - Bagassosis (Bronchi gets affected)
 Cotton dust - Byssinosis (In Textile industries)
 Tobacco - Tobaccosis,Lung Cancer
 Grain Dust - Farmer’s Lungs
 Biological Hazards

• Bacteria-Tetanus,Tuberculosis, Anthrax, Brucellosis

(Milkmen),Gonorrhea(Sex-workers-Genital organs get
affected).
• Virus - Hepatitis, AIDS
Protozoal&Parasitic-Malaria,Hydatid(Dog
• handlers),Hookworms, tapeworms (Agri-workers),
• etc.
• Fungi-(Agri-workers)-Tinea-infections,
• Coccidiomycosis, Psittacoses, ornithosis, etc.
 MECHANICAL HAZARDS
 Injuries- Falls,cuts,abrasions,concussions,contusions,etc.
 Ergonomic Disorders- Musculo-skeletal disorders (MSDs),
Cumulative-trauma- Disorders (CTDs) etc.

Ergonomics: ``Adjustment of Man & Machine``/

Application of human biological sciences with engineering science to
achieve optimum mutual adjustment of man & his work, the benefit being
measured in terms of human efficiency and well being
Tool / machine design to fit to work. Ergo tools/ ergofriendly tools : Tools
which reduce the stresses or problems resulting in CTD’s / MSD’s.)
Principles of Control of Workplace Hazards
 Identify
 Evaluate
 Control
 Eliminate
 Substitute
 Enclose/separate
 PPE/vaccinate
Manual Handling - Back Injuries
• All forces which come down the spine
compresses discs and as a result of
• Continuous squeezing they can rupture
and bulge causing severe pain.
• Most back injuries are built over along
period of time by repetitive pounding on
discs caused by improper methods. After
sometime some minor lift can produce
such rupture
• ``Straight back rule``
• „Thinking before lifting‟
Manual Handling - Back Injuries
 Control any risk by reducing
necessity for manual handling by
using alternative means of
handling
 Consider the load; size, awkward
shape, etc
 Consider need for mechanical or
manual assistance
 Position legs apart - one foot level
with the load
 Keep back straight, look up
 Manual Handling - Back Injuries
 Bend from the hips, avoid „twisting‟ the body
 Tighten the stomach muscles, but don‟t hold
breath
 Bend the knees
 Keep the load close to the body
 Lift with the legs, not the back
 Keep carrying distance short
 Avoid changing grip or „jerking‟ the load
 Deposit the load by bending the knees and
 Keeping the back straight
 VDT USER`S-ERGONOMIC GUIDELINES

SEATING POSITION

 Seat height to be adjusted so that thighs

are horizontal & feet are resting flat on the
floor
 Thigh-torso angle is not less than 90
degrees, with 100 degrees as preferable
 Chair should have ``Backrest``with
support for curvature in lumbar area

Natural S-curvature
of the spine
 VDT USER`S-ERGONOMIC GUIDELINES

WORKING POSTURE

 Wrist and forearm-held in straight line to

reduce tendon & nerve stress
 Upper & lower arm-at 90 degree angle
 Elbows to be kept close to the sides
 Head-Screen distance=25-48 inches(min
12 ``) from the VDT users eye
 Optimal viewing angle is 20 degrees
below the horizontal line from the eyes
 VDT USER`S-ERGONOMIC GUIDELINES

VISION & LIGHTING

 NO GLAIR
 VDT to be placed 90 degrees to the light source, adjust
screen angle
 Use screen filters to reduce glare
 Screen intensity needs to be adjusted
 Frequent breaks from the screen to reduce stress on eyes
 Optical illusion
 VDT USER`S-ERGONOMIC GUIDELINES

GENERAL GUIDELINES

 Change positions, Stretch or walk around if feeling

tiredness
 ``LIGHT TOUCH`` on Keyboard to reduce hand stress or
developing CTD`s
 Look at ``Optical Illusion`` for 1-2 minutes after every 20
minutes of work with vdt to reduce eye stress
 Rotate eye ball and also concentrate on a distant object &
near object alternatively to reduce eye stress
 Keep the vdt screen and eyeglasses clean
VDT USER`S-ERGONOMIC GUIDELINES

OPTICAL ILLUSIONS
 PSYCHOSOCIAL HAZARDS
 Lack of job satisfaction, insecurity, poor interpersonal
relations, work pressure, ambiguity, etc.
 Psychological & behavioral changes – hostility,
aggressiveness, anxiety, depression, alcoholism, drug
addiction, sickness absenteeism.
 Psychosomatic disorders- Hypertension, headache, body-
ache, peptic ulcers, asthma, diabetes, heart disorders,
etc.
 TYPE OF CONTROL MEASURES

 Medical (required to monitor

effectiveness of Engg. Controls)

 Engineering (Best Engg. Control is to

reduce exposure)

 Administrative / Legal. (Emphasis given to reduce

the exposure
 ENGINEERING CONTROLS
A. Designing-building, Work station.
B. Good Housekeeping.
C. Ventilation
D. Mechanization
E. Substitution.
F. Enclosure
G. Isolation
H. Local Exhaust Ventilation.
I. Personal Protective Devices.
J. Work Environment Monitoring
K. Statistical Monitoring.
 Carbon-Dioxide
• Has no odor.
• Heavier than air.
• TLV exposure limit is 5,000 ppm.
• IDLH 50,000 ppm
• Can cause death by asphyxiation
 Ammonia

 Odor detection limit 1-5 ppm

 Irritating 50 ppm (eyes), 100
 ppm (respiratory tract)
 TLV 25 ppm
 IDLH 500 ppm
 Lethal 10,000 ppm
 Irritant in nature
Thank You