OCCUPATIONAL HEALTH BERNARDINO RAMAZZINI Father of Occupational Health. • Occupational health refers to the total health of the worker and hence is broader in scope. Ecological approach – it seeks to ensure a dynamic equilibrium between the industrial worker and his occupational environment. • Occupational disease – Disease directly caused by a person‟s occupation. • Knowledge of work related diseases Helps in patient management providing the physician with useful clues to diagnosis. Definition: 4Ps. • Aims at the promotion and maintenance of the highest degree of physical, mental and social well being of workers in all occupation; • the prevention of ill-health among workers caused by their working conditions; • the protection of workers in their employment from risk resulting from factors that adversely affect health; • the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological ability. To summarize, the adaptation of work to man and of each man to his job. – Defn. by joint ILO/WHO committee on Occ. health, 1950. Ergonomics - “Fitting the job to the worker”. Integral part of occupational health services. Greek word „Ergon’ means „Work’, „Nomos’ means „Law’ . It is the ADAPTATION, MODIFICATION, MANIPULATION of MACHINERY, WORK ENVIRONMENT, WORK & REST SCHEDULE and JOB DEMANDS to suit the CAPACITY, LIMITATIONS & EXPECTATIONS of the workers. Occupational Environment • Sum of external conditions and influences prevailing at the place of work which have a bearing on the health of the working population. Three types of interactions in the work place: Man and physical, chemical, & biological agents. Man and machine. Man and man.Psychosocial factors: Interpersonal relationships, service conditions, Job satisfaction, job security, leadership style, communication system, pay system, incentives… OCCUPATIONAL HAZARDS 1. Physical hazards. 2. Chemical - Acids, Alkalis, pesticides. Solvents [ benzene, trichloroethylene, ] 3. Biological – Micro organisms, Animal products – hair, hide, wool, agriculture products. 4. Mechanical 5. Psychosocial - Failure to adapt to the psychosocial environment. a. Psychological and behavioral changes. b. Psychosomatic ill-health OCCUPATIONAL HAZARDS 1. Physical hazards.Heat – Direct & indirect effect of high temperature, radiant heat, heat stagnation. Comfort zone – 20 -27 degree C. Cold: General & local cold injury Light- Acute & chronic effect of bright & dim light & glare. Radiation – ultra violet, ionizing: x-rays, radio isotopescobalt 60, phosphorus 32. Permissible level of radiological exposure – 6 rem / year. Noise – Auditory & non auditory effect. Vibration- hazardous in the frequency range of 10- 500Hz CHEMICAL HAZARDS A. Local action: - irritants, sensitizers, B. Inhalation:– Dusts – organic , Inorganic Gases – Simple asphyxiants : Methane, Nitrogen, Carbon dioxide. Chemical asphyxiants : CO, Hydrogen sulphide, HCN Irritant gases: Ammonia, SO2, Anesthetic gases: Chloroform, Ether, Trichloroethylene. Metallic compounds: C. Ingestion : Metallic compounds : Arsenic, Antimony, Beryllium, Chromium, Cadmium, Cobalt, Lead, Mercury, Manganese, Zinc. Classification occupational diseases. Diseases due to: 1. physical agents. 2. Chemical agents. 3. Biological agents. 4. Occupational cancers.- Cancer of skin, lungs, bladder. 5. Occupational dermatoses 6. Diseases of psychological origine. [Hypertension, Peptic ulcer, Industrial neurosis.] 1. Diseases due to physical agents: Heat – Heat stroke, Heat hyperpyrexia, Heat syncope, Heat Exhaustion, Heat rash. Light – Occupational cataract, Miners nystagmus. Cold – Hypothermia, Frost bite, Trench foot. Pressure – Air embolism, Blast injuries. Vibration – Osteoarthritis, Reynauds disease [white fingers] Noise – Occupational deafness. Radiation- Cancer, genetic changes, Aplastic anaemia. Mechanical factors – Injuries and Accidents. Radiation hazards 1. Sources of radiation hazard: Natural & man made. 2.Types of radiation :Ionising: Electromagnetic - x rays, gamma rays Corpuscular – alpha, beta particles Non ionising: UV, Infra-red, day light, microwave, 3. Units of radiation: Gray . it is the unit of absorbed dose. [1 rad = 0.01 Gy] . Sievert: Dose equivalent. It indicates the degree of potential radiation danger to man [100 rem = 1 Sv] Dose equivalent = Absorbed dose [ D] x quality factor [Q] Q = 1 for x-ray , gamma ray & 20 for alpha particles 4. Occupations with increased radiation hazards. Contd…… 5. Biological effects of radiation: a. Somatic effect: [ Effects are during the life span of the irradiated person.] i. Immediate – Acute radiation sickness ii. Delayed – Leukaemia, Malignant tumours, - lung cancer in uranium miners Foetal developmental anomalies, Decreased life span. b. Genetic effect: [ will be seen in off-spring ] i. Chromosomal mutation – sterility. ii.Point mutation – Huntington‟s Chorea. Downs syndrome, Phenyleketonurea etc. Prevention of radiation hazards. Radiation protection is the youngest branch of hygiene – Radiation Hygiene. Primary Prevention: 1. Inhalation, swallowing, direct contact with skin to be avoided. 2. Use of protective clothing & Adequate ventilation in work place. 3. Periodic check up of workers in every 2 months. 4. Shielding and protection in case of x -rays. 5. Safety of x-ray machine. 6. Proper disposal of Radioactive waste. Secondary Prevention: 1. Early detection. 2. Treatment 2. Diseases due to CHEMICAL agents. Gases – gas poisoning. Inorganic dusts: Coal dust - Anthracosis Silica - Silicosis. Asbestos - Asbestosis. Iron - Siderosis Organic dusts : Cane fiber - Bagassosis. Cotton dust –Byssinosis. Hay or grain dust – Farmer‟s lung. Chemicals – Burns, dermatitis, cancer, respiratory illness • Metals – lead, mercury, arsenic, chromium cause poisoning • • • • LEAD POISONING Lead arsenate, carbonate and oxides are more toxic forms. Lead sulfide is least toxic. 1.Workers susceptible to lead poisoning: 2. Mode of absorption: a. Inhalation b. Ingestion. c. Skin [ organic – tetraethyl lead] 3. Clinical features: a. Toxic effect of inorganic lead: Anemia, Loss of appetite, Abdominal colic, constipation, blue line on the gums, wrist drop, foot drop, stippling of red cells. b. Toxic effect of organic lead: Mostly on CNS – headache, insomnia, mental confusion, delirium. CONTD….. DIAGNOSIS: 1. History. 2. Clinical features. 3. Lab. Tests: • Lead in urine - > 0.8 mg / litre [ indicates exposure and absorption.] • Coproporphyrin in urine [CPU] > 150 microgms / litre. • Amino levulinic acid in urine [ALAU] >5 mg / litre • Blood level of 70 micrograms / 100ml is associated with clinical symptoms. • Basophilic stippling of RBCs. MANAGEMENT OF LEAD POISONING: 1. Early diagnosis: To prevent further absorption. 2. Treatment: Removal of lead from soft tissues. – Saline purge removes unabsorbed lead from the gut. Use of d- penicillamine is effective as a chelating agent and promotes excretion of lead in the urine. 3. Prevention of recurrence. Contd…. PREVENTION: 1. Substitution. 2. Isolation. 3. Local exhaust ventilation. Lead conc. should be below 2 mg per 10 cu. metres of air in the working atmosphere. 4. Personal protection. 5. Good house keeping. 6. Periodic examination of workers. 7. Personal hygiene. 8. Health education. 3. Disease due to BIOLOGICAL agents. • Anthrax : Raw meat handlers, Tanners, Wool factory workers. Veterinarians, • Brucellosis : Livestock workers, Veterinarians. • Leptospirosis: Sewer workers, slaughter house workers, veterinarians, • Tuberculosis: Hospital workers, medical & nursing students, zoo workers. • Tetanus: Farmers, Ranchers. • Hookworm infestation: Farmers, ditch diggers, sewer workers. • STD & AIDS: Drivers, CSWs, Sales persons. • Hepatitis B: Doctors, Dentists, lab. Workers, med./ nursing students. OCCUPATIONAL HAZARDS OF AGRICULTURAL WORKERS. 1. 2. PHYSICAL HAZARDS. ZOONOTIC DISEASES. BRUCELLOSIS, LEPTOSPIROSIS, ANTHRAX, BOVINE TUBERCULOSIS, TETANUS. 3. RESPIRATORY DISEASES. FARMER’S LUNG, BYSSINOSIS, FARMER’S LUNG, BAGASSOSIS, ASTHMA, 4. TOXIC HAZARDS: FERTILIZERS, INSECTISIDES, PESTICIDES. 5. ACCIDENTS. Accidents in industry CAUSES: a. Human factor: contributes to 85% accidents in industry. 1. Physical: 2. Physiological - Age, sex, time , experience. 3. Psychological b. Environmental factor: PREVENTION: 1. 2. 3. 4. 5. Pre-placement examination. Adequate job training. Continuing education. Ensuring safe working environment. Periodic surveys to find out hazards. HEALTH PROBLEMS DUE TO INDUSTRIALISATION. 1. ENVIRONMENTAL SANITATION PROBLEMS. i. ii. iii. iv. HOUSING. SEWAGE DISPOSAL WATER POLLUTION. AIR POLLUTION. 2. FOOD SANITATION PROBLEMS 3. COMMUNICABLE DISEASES. TB, Malaria, STDs, Water 4. 5. 6. 7. & food borne diseases MENTAL PROBLEMS.Behavior disorders, Psychoneuroses. SOCIAL PROBLEMS. Drug addiction, alcoholism, prostitution, gambling, Increased crime rate ACCIDENTS. MORBIDITY & MORTALITY. SICKNESS ABSENTEEISM Useful index in industry to assess the health of the workers. CAUSES: 1. Economic causes. 2. Social causes. 3. Non- occupational causes. 4. Medical causes. PREVENTION: 1. Good factory management practices. 2. Good human relationship. 3. Application of ergonomics. PREVENTION OF OCCUPATIONAL DISEASES PREVENTION OF OCCUPATIONAL DISEASES MEASURES FOR HEALTH PROTECTION OF WORKERS. 1. Nutrition. 2. Communicable disease control. 3. Environmental sanitation. • • • • • • • • • Water supply Food. Toilet. Proper garbage & waste disposal. General plant cleanliness. Sufficient space. Lighting. Ventilation. Protection against hazards. MEASURES FOR HEALTH PROTECTION OF WORKERS. Contd…. 4. Mental health: GOALS: • • • • To promote health and happiness of workers. To detect signs of stress and strain and take necessary measures. Treatment of employees suffering from mental illnesses. Rehabilitation of those who become ill. 5. Measures for women and children. 6. Family planning services 7. Health education. PREVENTION OF OCCUPATIONAL DISEASES MEDICAL MEASURES: 1. 2. 3. 4. • • • • • • Pre –placement examination. Periodical health check up. Medical and health care facilities. Supervision of work environment. Water supply , food, general plant cleanliness Toilet. Proper garbage & waste disposal. Sufficient space. Lighting. Ventilation. Protection against hazards. 5. Notification 6. Maintenance and analysis of records. 7. Health education and counseling. Engineering Measures 1. 2. 3. 4. 5. 6. 7. 8. Design of building. Good house keeping. General ventilation. Dust & fume control. Local exhaust ventilation. Enclosures. Isolation. Mechanization. Substitution. Protective devices. Environmental monitoring & research. Legislative Measures. A. Formulation and implementation of Factory Act to regulate: 1. Health, safety and welfare of workers. 2. Employment of young persons. 3. Hours of work. 4. Leave with wages. 5. Occupational diseases. 6. Employment in hazardous processes Legislative Measures. contd…. B. Insurance facilities for workers: 1. Medical benefit. 2. Sickness benefit. 3. Maternity benefit. 4. Disablement benefit. 5. Dependent‟s benefit. 6. Funeral expenses. 7. Rehabilitation allowance.
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