Occupational Epidemiology After Modification

OCCUPATIONAL EPIDEMIOLOGY
Under Supervision of
• Prof.Dr.Nawal Fouad.
• Prof.Dr.Nagat Saied.
Prepared By
Hoda Mostafa Mostafa
Neama Mohamed
Intended learning outcomes
At the end of this presentation, each candidate will be able to:
 Discuss Key terms(Epidemiology In The Context Of
Occupational Health).
 Illustrate Objectives of occupational epidemiology
 Explain Nature&Health Effect Of Occupational Factors.
 Differentiate between common categories of occupational
health hazards.
 Analyze relation between work, worker health &disease
 Explain uses of occupational epidemiology.
 Discuss Types of occupational epidemiological studies.
Intended learning outcomes (cont.,)
Illustrate sources of data in epidemiological context.

Evaluate the application of occupational epidemiology.
Discuss levels of application occupational epidemiology.
Explain political and ethical issues in conducting
occupational epidemiology study.
Apply role of epidemiological nurse in occupational
health.
Outlines
Introduction.
Key terms.
Objectives of occupational epidemiology
Nature&Health Effect Of Occupational Factors.
common categories of occupational health
hazards.
Relation between work, worker health &disease
Uses of occupational epidemiology.
Types of occupational epidemiological studies.
Outlines (cont.,)
Sources of data in epidemiological context.
Application of occupational epidemiology.
levels of application of occupational
epidemiology.
Political and ethical issues in conducting
occupational epidemiology study.
Role of epidemiological nurse in occupational
health.
Introduction
• According to the latest International Labour

Organization (ILO) estimates for the year 2015 there
are 2.34 million work-related deaths per year this
mean to over 6000 deaths every day. Worldwide.
• WHO estimates that there are only 10-15% of
workers who have access to a basic standard of
occupational health services.
• Workplace fatalities, injuries and illnesses remain at
unacceptably high levels.
Introduction
• Occupational epidemiology describing the distribution

of deaths, accidents, illnesses in the various sections
of the occupationally active population and of
searching for the determinants of health, injury, and
disease in the occupational environment.
• The science of occurance of diseases in human
population as applied to the field of occupational
health for identification of causes of occupational
diseases,check the effectiveness of preventive
measures.
Epidemiology In The Context Of
Occupational Health
 Definition of epidemiology in occupational health :
• “The study of the frequency and the causes of work-related
diseases and injuries ”
• Occupational epidemiologic studies examine health
outcomes among workers, and their potential association
with conditions in the workplace including noise, chemicals,
heat, or radiation, mechanical ,biological hazards.
Epidemiology In The Context Of
Occupational Health
 Definition of epidemiology in occupational health :
• “The study of the effects of workplace exposures on the
frequency and distribution of diseases and injuries in the
population”
• EXPOSURE:
• “In epidemiology exposure denotes any of a subject’s
Attributes or any agent with which he or she may come into
contact that may be relevant to his or her health”
Objectives of occupational
epidemiology
• The main objective of occupational epidemiology is

prevention through identifying the consequences of
workplace exposures on health.
• This underscores the preventive focus of
occupational epidemiology. Indeed, all research in
the field of occupational health and safety should
serve preventive purposes. Hence, epidemiological
knowledge can and should be readily
implementable.
Objectives of occupational
epidemiology
• second objective of occupational epidemiology is

to use results from specific settings to reduce or to
eliminate hazards in the population at large.
• The results from occupational epidemiology
studies also play a role in the estimation of risk
associated with the same exposures but at the
lower levels generally experienced by the general
population.
Nature&Health Effect Of Occupational
Factors
• Hazard : something that can cause harm if not

controlled.
• Occupational hazard :any source of potential
damage, harm or adverse health effects on
someone under certain conditions at work.
Factors cont,
• Common categories of occupational health

hazards
• 1) physical
• 2)chemical
• 3) Biological
• 4)Mechanical
• 5) Psychosocial
Factors cont,
1) Physical Hazards
Noise Vibration
Extreme temperature Illumination

Factors cont,
NOISE
 Health effect of noise :
• Hypertension, Palpitations .
• Discomfort:(can result from noise that interferes with
daily activities, sleep, or rest).Disturbs relaxation and
sleep.
• Muscle tension, (where the muscles tend to contract in
the presence of loud noises).
• temporary loss of hearing (acuity after exposure to loud
noise ,recovery within 16-48 hrs).
• Permanent ,irreversible loss of hearing.
Factors cont,
NOISE
Early Signs of Hearing Loss
• Difficulty in understanding spoken words in a noisy
environment
• Need to be near or look at the person speaking to help
understand words
• Familiar sounds are muffled
• Complaints that people do not speak clearly
• Ringing noises in the ears (tinnitus)
Factors cont,
Vibration
Physical factor which affects man by transmission of
mechanical energy from oscillating sources
Types
– Segmental vibration
– Whole body vibration
Factors cont,
Segmental Vibration
• Health Effects:
—Hand Arm Vibration Syndrome (HAVS)
(tingling, numbness, blanching of fingers, pain)
Factors cont,
Whole body Vibration
• Health effects:
• Fatigue
• Irritability
• Headache
• Disorders of the spine
Factors cont,
Extreme Temperature
Heat :
• 1) Heatstroke :Cyanosis, muscle twitching,
disorientation, delirium, convulsions because
of prolonged exposure to the sun or heat.
• 2) Heat Exhaustion: Symptoms are headache,
fatigue, muscle weakness, Dizziness, blurring
of vision.
Factors cont,
• 3) Heat syncope ( fainting): Falling unconscious
because of too much exposure to high
temperatures.
• 4) Heat cramps:Cramps in the body, usually
legs.
Factors cont,
Cold Temperature
Frostbite: reddening of skin, localized burning

pain and numbness. Fingers, toes, cheeks,
nose, ears are most susceptible.
Factors cont,
Inadequate Illumination
• Visual Fatigue
• Double Vision
• Headaches
• Painful irritation
• Lacrimation
• Conjunctivitis
Factors cont,
RADIATION
 Ionizing eg :X-rays,Gamma rays
• Effect :Cancer, congenital defects, death.
 Non-ionizing eg:Ultraviolet ,Laser
• Effect: Skin and eye problem ,skin redness,
premature skin ageing, and skin
cancer ,corneal and conjunctival burns,
retinal injury, cataract.
Factors cont,
2)Chemical hazard
• Lead
• Benzene
• Mercury
• Carbon monoxide
• Cadmium
• Epoxy
• Fumes
• Paints
Factors cont,
• Classification of Toxic Effects of chemical
hazards
• Local toxicity- occurs at the site of chemical
contact
• Systemic toxicity- occurs distant from point of
contact, may involve many organ systems
Factors cont,
• Classification of Toxic Effects of chemical
hazards
• Acute toxicity- occurs almost immediately
(hours/days) after an exposure
• Chronic toxicity- represents cumulative damage to
specific organ systems; occurs many months or
years to have recognizable clinical disease
Factors cont,
 Effect of Chemical hazard
• Respiratory Diseases:
• Irritation, inflammation, Pneumoconiosis
• lung Cancer
• Skin Diseases:
• Allergic/contact dermatitis
• Acne
• Skin Cancer
• Liver Disease
Factors cont,
3)Biological Hazards
VIRUSES FUNGI
BACTERIA PARASITES
Factors cont,
Biological Hazards
Factors cont,
Factors cont,
Factors cont,
4)Ergonomics
• - “Fitting the job to the worker”.
• Greek word ‘Ergon’ means ‘Work’,
‘Nomos’ means ‘Law’ .
• It is the ADAPTATION, MODIFICATION,
MANIPULATION of MACHINERY, WORK
ENVIRONMENT, and JOB DEMANDS to suit the
CAPACITY, LIMITATIONS of the workers.
Factors cont,
Ergonomics
• Goal
– to reduce work-related musculoskeletal
disorders (MSDs) developed by workers
• MSDs are injuries and illnesses that affect

muscles, nerves, tendons, ligaments, joints or
spinal discs
Factors cont,
• Risk Factor: ERGONOMICS
• Static posture
• Forceful exertion
• Repetitive movement
• Extreme range of motion
Factors cont,
Common Symptoms of MSDs
• Painful joints
• Pain, tingling, numbness in hands, wrists,
forearms, shoulders, knees and feet
• Shooting or stubbing pains
• Swelling or inflammation
• Fingers or toes turning white
• Back or neck pain
• Stiffness
Factors cont,
• CTS is generally attributed to compression of
the median nerve as it passes through the
carpal tunnel.
Symptoms of CTS
 Weakness, pain, burning, numbness or
tingling in hands and wrists a. often at night or
at rest
 in severe cases pain may spread as far as the
shoulder
Factors cont,
5)Psychosocial hazard
• Stress
• Poor support
• Poor organizatonal managment
• Poor organizatonal justice
• Poor relationships
• Violence
Factors cont,
Stress
• The harmful physical and emotional responses
that occurs when the requirements of the job
do not match the capabilities, resources or
needs of the worker
Factors cont,
Manifestations of Stress
PSYCHOLOGICAL PHYSIOLOGICAL BEHAVIORAL
 Fatigue  Heart rate  Drug use
 Anxiety  Blood pressure  Alcohol intake
 Tension
 Indigestion  Heavy smoking
 Irritability
 Depression
 Impulsive emotional
 Boredom behavior
 Inability to
concentrate
 Low esteem
 Poor work & family
relationship
 Social isolation
 Family
abandonment
Relation BetweenWork,Worker
Health &Disease
• Occupational health: is the promotion and
maintenance of the highest degree of physical,
mental and social well-being of workers in all
occupations . According to WHO & ILO
• Occupational disease: Disease directly caused by a
person’s occupation.
Health &Disease
• Occupational disease occur among workers
exposed to specific hazards
• In some situations may also occur among the
general community as a consequence of
contamination of the environment from the
workplace. e.g lead, pesticides,sement
particles
Health &Disease
• Occupational Disease occur as a result of
exposure to physical, chemical, biological or
psychosocial factors in the workplace.
• These factors in the work environment are
predominant and essential in the causation of
occupational disease exp. Lead in the
workplace may lead poisoning
Health &Disease
• Work condition can aggravate pre existing
disease
• EX:Hepatic dysfunction can be aggravated by
exposure to certain chlorinated hydrocarbons
• Bronchial asthma can be aggravated by dust
exposure
• Renal disease can be aggravated by inorganic
mercury, cadmium and certain solvents
Uses of occupational epidemiology
• Identifying Occupational Hazards to prevent

occupational disease.
• Recognize a disease cluster among workers from
particular occupations or industries.
• Conduct a survey in the industry to determine the
magnitude of the problem.
• Consider other diseases which may occur at
excess.
• Determine exposure to a known hazardous agent
or
to another agent not yet known to be hazardous.
• Start out with a particular exposure and conduct
medical surveillance.
• provide information that can be used in risk
assessment and in the prevention of hazards
in the general population.
Characterizing the workplace
environment(exposure assessment)
• Identify agents likely to be toxic.
• This may be easy (e.g. asbestos exposure) or very
difficult (i.e. mixtures of chemicals).
• Establish the most relevant routes of exposure
for the agents of concern.
• Measure the exposure.
evaluate the effectiveness of workplace
interventions.
Types of occupational epidemiological
studies
Descriptive study
• Descriptive study is one in which information is
collected without changing the environment (i.E.,
Nothing is manipulated). Sometimes these are
referred to as “ correlational ” or “ observational ”
studies.
• To determine etiology of diseases .
• Identify hazards .
• Formulation of principles for the effective
prevention & control of these diseases & hazards.
studies
Cross-sectional Study
•Cross-sectional studies are observational in nature and
are known as descriptive research.
• Researchers record the information that is present in
a population, but they do not manipulate variables.
• Find prevalence of disease in the population.
• The study takes place at a single point in time
• It does not involve manipulating variables
• It allows researchers to look at numerous
characteristics at once (age, income, gender, etc.)
studies
Case series
• Identification and reporting of a disease.
• The cluster might be found among the
work force as a whole or among some segment of
the work force.
• Case series can be very useful to start an
epidemiological investigation, especially when the
disease is extremely rare and the causal factors are
unknown.
studies

Cohort study
• “Cohort” is defined as a group of people who share a common
characteristic or experience within a defined time period.
• Eg. workers who are exposed to a particular occupational hazard
compared to a control group that was not exposed to the occupational

hazards being investigated ,Follow2 groups over time,At the end,
analyse disease outcome occurrence in both groups and compare.
• For obtaining additional evidence to refuse or support the existence
of an association between suspected cause or disease.
Source of Exposure Data for Occupational
Epidemiology Studies
The three main sources of data routinely collected for other
purposes are: (1) official statistics and records kept by
corporate bodies;
(2) records of employment and other data in workplaces;
and
(3) records kept by occupational health services. As these
three sources of data are not collected

1. Official statistics and records kept by corporate bodies
A wide variety of mortality and morbidity data is obtainable
from government statistics and from records kept by
corporate bodies.
National mortality data Several countries provide mortality
rates for the trades and professions in which large numbers
are employed. There are direct and indirect methods:

(cont.,)
In the direct method, age- specific death rates from the

study population are applied to corresponding age groups
in the standard population to give the number of deaths
expected to occur if the standard population had
experienced the same death rates as the study population.
The expected deaths in each age group are totaled and
compared with the observed deaths in the standard
population.
(cont.,)
The comparative mortality figure (CMF) and the direct

standardized death rate (SDR) are calculated as follows:
total expected deaths in standard population.
CMF = total observed deaths in standard population x 100
Direct SDR = CMF x crude death rate in standard
population
(cont.,)
In the indirect method of standardization, age- specific

death rates from the standard population (the total male or
female population of England or Wales) are applied to
corresponding age groups in the study population, which is
an occupational group such as agricultural workers or
cotton textile workers.
(cont.,)
The expected deaths in each age group are totaled to show how
many deaths would have occurred in the study population if it
had experienced the death rates of the standard population.
The total is then compared with the observed deaths in the
study population and the standardized mortality rate (SMR) is
calculated as follows: -
SMR = Total observed deaths in study population x 100 Total
expected deaths in study population
2. Records of employment and other data held at workplaces
Records of employment Dates of employment are essential

in the historically prospective type of cohort study in which
the population under study entered employment many
years ago. Employment records are unlikely to include data
and cause of death, particularly concerning workers who
have changed jobs or have retired.
2. Records of employment and other data held at workplaces
(cont.,)
Other work records These records include reasons for

leaving employment, which are generally unreliable and of
little value in epidemiological enquiries into health risks,
although the labor records of lateness and absence from
work may be used as indices of working conditions, of
morale, and of work satisfaction.
3. Records kept by occupational health services
Occupational health services usually keep details of

medical examinations, consultations, environmental
monitoring, treatments at work, and sickness absences.
Such records are essential for the management and
treatment of patients and for environmental investigations,
as well as for the investigation of compensation claims.
3. Records kept by occupational health services (cont.,)
Medical examinations and environmental monitoring: The

replacement examination is primarily used to place new employees in
suitable occupations. It makes it possible to identify persons who are
likely to be vulnerable to certain exposures.
Treatment records: Attendances for treatment for work injuries are
required to be kept by workplaces in many countries. They enable
employers to fulfil their duty with respect to notification of work
accidents.
3. Records kept by occupational health services (cont.,)
Sickness absence at the workplace :Sickness absences are recorded

by occupational health services because they are helpful in the
management of individual health problems.
In sickness absence studies, two rates are commonly used. They are
as follows:
Application of occupational epidemiology
• By contributing to reduction in exposure,

occupational epidemiology helps reduce health
risks among workers. Using occupational
epidemiological methods can also have benefits
for society at large. For example,
recommendations for exposure limits to benzene
developed by the
Expert Panel on Air Quality Standards were based
on occupational epidemiology.
Application of occupational epidemiology
(cont.,)
• Using meta-analysis, many occupational epidemiology
studies can be synthesized in order to help set
occupational exposure limits and make other kinds of
policy decisions. This can also can be applied in health
risk assessments, which is a method of predicting
health risk based on hypothetical exposure conditions.
Levels of application of occupational
epidemiology
• Surveillance to describe the occurrence of illness in
different categories of workers and so provide early
warning signals of unrecognized occupational hazards.
• Generation and testing of an hypothesis that a given
exposure may be harmful, and the quantification of an
effect.
• Evaluation of an intervention (for example, a
preventive action such as reduction in exposure levels)
by measuring changes in the health status of a
population over time.
Ethical issues in epidemiology and public
health practice
This includes reporting research results and maintaining
and promoting health in communities. In carrying out these
professional roles, epidemiologists often encounter a
number of ethical issues and concerns that require careful
consideration. Many of these issues have been addressed in
the literature on ethics in epidemiology and public health
practice including ethics guidelines.
Moral reasoning in public health (cont.,)
Deontological theories (sometimes referred to as Kantian

theories) hold that people should not be treated as means
to an end and that some actions are right or wrong
regardless of the consequences. Deontological theories
provide strong support for protecting research participants
and whole communities of people.
Moral reasoning in public health (cont.,)
Utilitarian theories, on the other hand, strive to maximize

beneficial consequences. The principle of utility requires
aggregate or collective benefits to be maximized. From a
utilitarian perspective, the principle of utility is the ultimate
ethical principle from which all other principles are derived.
Role of epidemiological nurse in occupational health
 A nurse epidemiologist investigates trends in

groups or aggregates and studies the occurrence
of diseases and injuries. The information is
gathered from census data, vital statistics, and
reportable disease records.
Role of epidemiological nurse in occupational health (cont.,)
 Nurse epidemiologists identify people or

populations at high risk; monitor the progress of
diseases; specify areas of health care need;
determine priorities, size, and scope of programs;
and evaluate their impact.
Role of epidemiological nurse in occupational health (cont.,)
They generally do not provide direct patient care, but serve as

a resource and plan educational programs. They also publish
results of studies and statistical analysis of morbidity and
mortality. Examples of practice settings are the Centers for
Disease Control and Prevention in Atlanta, Georgia; public
health departments; and governmental agencies.
Role of nurse in epidemiology
1. Promotive role
2. Preventive role
3. Curative role
4. Rehabilitative role
1. Role in Promotion of Health
• Using knowledge of epidemiology, the community

health nurses can set priorities for health programs
according to the immediate health needs.
1. Role in Promotion of Health (cont.,)
• Using knowledge of epidemiology, they establish

the health resources more effectively, by giving
more emphasis to urgent health problems needing
attention.
1. Role in Promotion of Health (cont.,)
• Plan the strategies to meet the new health needs. Nurses

in the community as a member to health team
participate in surveillance at all levels, which will depend
on the existing situation, their preparation, and the level
at which they work.
2. Role in Prevention
•Epidemiology is one of the basic sciences applicable

to nursing. The nurses working in a community deal
with people in various settings and help them solve
their health problems. They make the nursing
process.
2. Role in Prevention (cont.,)
•They identify and investigate the problem, formulate

and test the hypothesis regarding the causal factors,
formulate alternative interventions and implement to
prevent and control the problem and evaluate
effectiveness of intervention.
•They have an active role in the prevention and control of

communicable diseases which include:
- Identify sources of infection and methods of spread of
infection.
- Health education of people in general.
- Having an important role in the prevention and control of

chronic and noninfectious problems, such as cardiovascular
conditions, accident, cancer, etc.
- Notification of certain diseases like measles, diphtheria,
tetanus, etc. to health authority.
They can also teach and supervise other workers in
surveillance activities.
3. Curative Role
• They may deal with the problem independently, especially

when these are the nursing problems, minor ailments or
simply health conditions and they are only the health
workers in a healthcare setting.
• They may participate as them members, especially when it
is large scale investigation, e.g. occurrence of any epidemic.
3. Curative Role (cont.,)
• They may participate in data collection, data analysis,

planning, implementation and evaluation.
• They may early diagnosis and treatment.
• They traces the contacts and keep them under
surveillance.
• They identify sources of infection and methods of spread of
infection.
4. Role in Rehabilitation
• They evaluate the effectiveness of measures used to

control specific disease or disorder.
• They can help people in the restoration of family and social
life.
• They can also play a role in psychological rehabilitation by
helping in restoring personal dignity and confidence of a
person.
References
• Karvonen,M. &Mikhee,M,I.Epidemiology of occupational health,
WHO Regional Publications, (1986) pp 1-17 ,119-180
• Advancing social justice, promoting decent work, International
Labour Organization ,World Statistic https
://www.ilo.org/moscow/areas-of-work/occupational-safety-and-hea
lth/WCMS_249278/lang--
en/index.htm
References (cont.,)
• Agius, Raymond. "Occupational Epidemiology". Retrieved 2017-07-30.
• Halperin, William; Howard, John (2011-10-07).

"Occupational Epidemiology and the National Institute for Occupation
al Safety and Health"
. Morbidity and Mortality Weekly Report. U.S.
Centers for Disease Control and Prevention. 60 (4): 97–103. PMID
21976172
• Karvonen, M., and Mikheev, M,I.,. Epidemiology of occupational
health. WHO Regional Publications, European Series No. 20 ,World

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OCCUPATIONAL EPIDEMIOLOGY

Illustrate sources of data in epidemiological context.

• According to the latest International Labour

• Occupational epidemiology describing the distribution

• The main objective of occupational epidemiology is

• second objective of occupational epidemiology is

• Hazard : something that can cause harm if not

• Common categories of occupational health

Extreme temperature Illumination

Frostbite: reddening of skin, localized burning

• MSDs are injuries and illnesses that affect

• Identifying Occupational Hazards to prevent

compared to a control group that was not exposed to the occupational

The three main sources of data routinely collected for other

purposes are: (1) official statistics and records kept by

(2) records of employment and other data in workplaces;

(3) records kept by occupational health services. As these

three sources of data are not collected

A wide variety of mortality and morbidity data is obtainable

from government statistics and from records kept by

National mortality data Several countries provide mortality

rates for the trades and professions in which large numbers

are employed. There are direct and indirect methods:

In the direct method, age- specific death rates from the

The comparative mortality figure (CMF) and the direct

In the indirect method of standardization, age- specific

Records of employment Dates of employment are essential

Other work records These records include reasons for

Occupational health services usually keep details of

Medical examinations and environmental monitoring: The

Sickness absence at the workplace :Sickness absences are recorded

• By contributing to reduction in exposure,

Deontological theories (sometimes referred to as Kantian

Utilitarian theories, on the other hand, strive to maximize

 A nurse epidemiologist investigates trends in

 Nurse epidemiologists identify people or

They generally do not provide direct patient care, but serve as

• Using knowledge of epidemiology, the community

• Using knowledge of epidemiology, they establish

• Plan the strategies to meet the new health needs. Nurses

•Epidemiology is one of the basic sciences applicable

•They identify and investigate the problem, formulate

•They have an active role in the prevention and control of

- Having an important role in the prevention and control of

• They may deal with the problem independently, especially

• They may participate in data collection, data analysis,

• They evaluate the effectiveness of measures used to

• Halperin, William; Howard, John (2011-10-07).

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