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Occupational health and occupational medicine :The importance of health of the workforces (a healthy workforce is vital for sustainable social and economic development on a global and national level). The classic approach to ensure health and safety in the workplace, is through two main principles : - Legislation. - Inspection.
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Reasons of non effectiveness of the classic approach in controlling many specific occupational hazards : First- the development of private enterprises. Second- introduction of new agricultural techniques. Third- occupational health problems have gradually increased in type and magnitude and have led to or aggravated disease resulting from exposure to several risk factors (like work environment).* *
Occupational Health and it’s relation with International Organizations:-Alma-Ata (1978).-WHA 40.28 (1987).-EM/RC-38/R.8.(1991)&(1997).-I.L.O.* RAMAZZINI, BERNARDINO (1633-1714) An Italian physician, “Father of Occupational Medicine” he published De Morbis Artificum (On the Diseases of Workers) in1700. Based on observation and anecdote, this was the first systematic account of diseases related to workplace exposures. * *
Introduction Poverty, poor living and working conditions, and lack of education have been repeatedly identified as major impediments to health. Over the years it has become clear that substantial improvements in health cannot be achieved without improvement in social and economic conditions.
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It was explicitly noted that this could be attained only through a fuller and better use of the world’s resources: “health is only possible where resources are available to meet human needs and where the living and working environment is protected from life-threatening and health-threatening pollutants, pathogens and physical hazards" (WHO). * *
•Environmental pollution and degradation have a huge impact on people’s lives. • Every year hundreds of millions of people suffer from respiratory and other diseases associated with indoor and outdoor air pollution. • Hundreds of millions of people are exposed to unnecessary physical and chemical hazards in the work place and living environment. * *
* * Half a million die as a result of road-traffic accidents (RTA). Four millions infants and children die every year from diarrheal diseases, largely as a result of contaminated food or water. Hundreds of millions of people suffer from debilitating intestinal parasites. Two million people die from malaria every year while 267 million are ill with it at any given time.
-Three million people die each year from TB and 20 million are actively ill with it. -Hundreds of millions suffer from poor nutrition. Almost all of these health problems could be prevented (WHO). * As noted in the book Our Planet, Our Health (WHO), the responsibility for protecting and promoting good health extends to all groups in society.
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*No longer is good health the responsibility of only traditional health care professionals, such as doctors, nurses, sanitary engineers, and safety officers, who seek to cure disease, care for the sick, remove pathogens, and reduce injuries. *Now clearly the responsibility of planners, architects, teachers, employers, industrial managers, and all others who influence the physical, mental and social wellbeing of workers in all occupations.
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Economic and Industrial Development and Environmental health
While it is well known that biological agents and naturally occurring chemical and physical hazards have exited throughout human history, there is also along history of environmental pollution from anthropogenic sources (human activities).* *
*Even in ancient times, sites of production and manufacturing were contaminated with pollution. A good example is lead contamination in the area around smelters centuries ago and the horrible odor and water pollution associated with tanneries. *By modern standard, the scale of most of these enterprises was very small, however. The technology was that of individual artisan using traditional work practices that had not substantially changed for centuries.
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*The resulting pollution was usually restricted to the immediate area. Pollution from human waste was considered more of a problem, as it effectively limited the size of cities. *As great a problem as pollution was occupational health and safety, as workers were subjected to intense exposure to variety of hazards at the workplace.
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*The Industrial Revolution marked a dramatic turning point in the interaction between economic activity and the environment. *Industrial pollution was first identified as an obvious and serious issue in the early 1800s, when it became obvious that production on an industrial scale, using the breakthrough technology of the time, resulted in pollution on a scale never before seen.
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*This pollution was largely the result of the energy requirements of a technology based on iron and steel, which led to more widespread air pollution as well as local concentrations of pollution near the factory site.
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Occupational Health: is a multidisciplinary activity, defined by I.L.O. (International Labor Organization), as the promotion and maintenance of highest degree of physical, mental and social wellbeing of workers in all occupations, aiming to protect worker’s health at their work places. * *
Occupational Health Classification: Is classified or divided into three mainCategories;Occupational Medicine. Occupational Safety. Occupational Hygiene.Recently occupational safety and hygiene are integrated.Nowadays occupational health includes(occupational accidents, occupational diseases and work related diseases). * *
Occupational Medicine: Mainly preventive in nature, include different subspecialties or types, which are: Industrial Medicine. Agricultural Medicine. Navigation Medicine. Sport Medicine. Military Medicine. Aviation Medicine.
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Occupational Safety : risk identification at the work place and preventive measures taken to reduce or eliminate the hazards which may lead to accidents. Occupational Hygiene : is the practice of assessment and control of environmental factors and stresses arising in or from the workplace, which may cause injury, sickness, impaired health and wellbeing or significant discomfort and inefficiency among workers or among the citizens of the community .
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* Activities of Occupational Medicine : Medical exam. Of the workers; a. pre employment exam. b. periodic exam. 2. First –aid facilities. 3. Health education. 4. Rehabilitation. 5. Epidemiological studies and medical records. 6. Environmental and biological monitoring. * *
* Types of occupational hazards : Physical hazards (noise, vibration, temperature, electricity, radiation, light and pressure ). Chemical hazards (dust, mists, fumes, gases, fibers, vapors and liquids). Biological hazards (insects, mites, moulds, yeasts, fungi, bacteria, viruses and parasites) . Ergonomic : fitness of the work process and work place to the workers (posture, movement, repetitive motion and light) . Psychological hazards (tension, stress, and phobia) . Accidents and mechanical hazards .
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* General control measures of occupational hazards : Elimination by substitution. Isolation of the process . Total enclosure of the process. Suppression of the emission . Shielding of the source or worker.
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Locally applied exhausted ventilation. General ventilation . Reduce time of exposure . Personal protective equipment with personal hygiene Health education to the workers (information, training and instruction) . General cleanliness . Personal hygiene . Maintaining control : a. pre employment exam . b. periodic medical exam . c. monitoring procedures .
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*Occupational diseases: Are adverse health conditions in the human being, the occurrence or severity of which is related to exposure to factors in the job or in the work environment, such factors can be; physical, chemical, biological, ergonomic, psychological or mechanical .
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Characteristic of occupational diseases : The occupational cause of occupational disease is often overlooked by health care providers . This is due to several special characteristics of occupational diseases that may obscure it’s occupational origin : * *
Characteristic of occupational diseases :The clinical and pathological presentation of most occupational diseases is identical with that of non-occupational, e.g.: asthma due to airborne exposure to toluene diisocyanate is clinically indistinguishable from asthma due to other causes. Occupational disease may occur after the termination of exposure, e.g.: asbestos – related mesothelioma ( cancer of the lung and abdomen) which can occur 30-40 years later . The clinical manifestation of occup. dis. are related to the dose and timing of exposure, e.g.: different doses and time of exposure to mercury.Occupational factors can act in combination with non –occupational factors to produce disease, e.g.: exposure to asbestos alone increase the risk of lung cancer 5 folds, also the long term smoking of cigarettes increase risk of lung cancer about 50-70 folds . * *
*Occupational Health Services : Is defined by I.L.O as (the services which are mainly concerned with preventive function and responsible for advising the employer, the workers and their representative on the requirement for establishing and maintaining a safe and healthy working environment which will facilitate optimal physical and mental health in relation to work and the adaptation of work to the capabilities of workers in the light of their state of physical & mental health).
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Occupational health services is a team work and not merely a single person work, the leader of the team should be a physician because of his knowledge and experience, others like occupational engineering, technician and environmental workers have a contributory function .
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*Functions of occup. health services : Preliminary orientation to the enterprise (for new occup. Health services staff ). Surveillance of the working environment, (surveillance means continuous systemic collection, analysis, interpretation of health data that are important for planning, implementation and evaluation of the health program ) . Informing employer, enterprise management and workers about occup. health hazards . Assessment of health risks (to compare worker’s exposure with TLV – Threshold Limit Value –or if the substance used known to be carcinogenic ) . Surveillance of worker’s health . * *
First –aids services and emergency preparedness Occup. health care, general preventive and curative health services . Rehabilitation . Adaptation of work to workers (Ergonomics ) . Protection of vulnerable groups . Information, education and training . Health promotion activities . Data collection and record keeping . Researches . Internal collaboration . External collaboration . * *
*Basic functions of occup. health physician and occup. health worker at work place : Fitting the person in right place of work . Provide treatment services . Controlling the recognized hazards at work place through maintenance of TLV of the dangerous substances . Identification and recognition of hazards . Avoiding the potential risk by planning with help of hygienic economist . Screening for early evidence of occup. and non occup. diseases .
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Supervising of vulnerable groups of people or workers (e.g. : young, pregnant, asthmatic, diabetic and hypertensive patients) . Counseling . Surveillance of working environment . Health education and training for first aids. Advice to management and worker’s representative .Environmental control outside work place . Periodic review of statistics concerning the health conditions and data keeping . Medical and health researches . * *
SICKNESS ABSENCE: One of the most important tools for evaluation of occup. health is the study of sickness absence, which is the absence from the work accepted as attributable to sick or injury, although could be due to psychological or social problems, (usually the absence due to pregnancy not be included in the study of sickness absence). • There are three main factors affecting the persons to have sickness absence (which depend or based on three principles of workers, work itself and work place or environment); * *
SICKNESS ABSENCE: (contin.)1.Personal factors (worker’s factors), e.g.: age, sex, family responsibility, (the number of spills coming down as the age of the worker coming up, the females take more spills than males). 2.Organization factors (work or job factors), e.g.: type and size of the factory, management attitude, supervisory quality, sickness pay, working conditions and medical services. 3.Regional factors( work place or environment), e.g.: geography, season and epidemiologic distribution. ( Sickness Absence cause problems to the community and cost money). * *
Control of sickness absence: (occupational physician’s duty), is by the following:1.Identify the problem which can be medical, social or behavioral.2.Prevent the occurrence of illness in order to decrease disease incidence.3.Reduce duration of absence.4.Apply effective resettlement. * *
NOTIFIABLE DISEASES: Are group of diseases when occur in a factory are compulsory notifiable by the doctor and employer to the chief inspector of that factory, which include; 1.Aniline poisoning, 2.Anthrax, 3.Arsenic poisoning, 4.Beryllium poisoning, 5.Cadmium poisoning, 6.Carbon disulphide Poisoning, 7.Chrome poisoning,
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(contin.) NOTIFIABLE DISEASES 8.Chronic Benzene Poisoning, 9.Decompression sickness, 10.Epithliomatous dis. 11.Lead Poisoning, 12.Manganes Poisoning, 13.Mercurial Poisoning, 14.Phosphorus poisoning, 15.Toxic Anemia, 16.Toxic Jaundice.
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PRESCRIBED DISEASES: Are those diseases which (compensation are payable) under the act, provided the condition arise as a result of specified employment. They include all notifiable diseases and others. NOTE: all occupational diseases are preventable if we know Where, When, How and What to look for.
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*Staff of occup. health services center: Depend on; * nature of the industry. * size of industry &number of workforces. * availability of specialist. * financial resources.
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Staff of occup. health services center:
The staff is acting as a team work, which include; occupational physician, occup. health worker, safety engineer, mental health specialist, work physiologist, ergonomist, physiotherapist, toxicologist, epidemiologist, and health educator. (Generally in Europe one physician and two nurses serve 2000-7000 workers).
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Size of the problem: there are about 5 million chemicals, in different work places we only know 120.000 of them, and according to the document, there are 250 million accidents happen in the work among which 330.000 are fatal, there are 160 million new cases of occup. diseases. International Labor Organization (I.L.O) at 1999, had published that : there are 1.1 million deaths in work place, 34% of them were due to accident. Accident occupy third rank in the scale of ten leading cause of death, economically accidents cost 14% of the National Gross Product (NGP).
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The major hazards and challenges facing occup. health services : Chemical safety. Radiation protection. Working of children and young persons. Diseases pattern in children. Occupational Injuries. Behavioral disorders. Relation between occupational health and productivity.
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Assessment of exposure: 1.Environmental assessment: work place and surrounding . 2.Biological assessment: blood, urine and enzymes. 3.Medical examination; - pre-employment exam. -periodic exam. -and screening tests.* *
WORK-RELATED DISEASES:- This category has certain characteristics which were identified and stated by the WHO Expert Committee as follows: Multifactorial diseases which may frequently be work- related, also occur among the general population, working conditions and exposures need not be risk factors in each case of any one disease.
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WORK-RELATED DISEASES: (contin.)
However, when such diseases affect the workers, they may be partially caused by adverse working conditions, they may be aggravated, accelerated or exacerbated by work place exposures, and they may impair working capacity. It is important to remember that personal characteristics, other environmental and socio-cultural factors usually play a role as risk factors for these diseases.* *
Multifactorial work-related diseases are often more common than occupational diseases and therefore deserve adequate attention by the health services infrastructure, which incorporates the occup. health services. The work-related diseases which deserve particular attention are; 1.Behavioural and psychosomatic disorders. 2.Hypertention. 3.Coronary heart diseases. 4.Peptic ulcers. 5.Chronic nonspecific respiratory diseases. 6.Locomotor disorders.
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Prevention of occupational diseases: Primary prevention; by reducing the risk of diseases which is most commonly done by- reducing the magnitude of exposure to hazardous substances, through change in production process, e.g.: substitution of hazardous substance with a safer one or enclosure or special ventilation or using of personal protective equipments, which are known as engineering controlling measures.
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Secondary prevention; by identifying health problems before they become clinically apparent and intervening to limit the adverse effects (also known as occupational disease surveillance), e.g.: blood lead level measurement in exposed workers.
* * Prevention of occupational diseases: (contin.)
Tertiary prevention; by minimizing the adverse clinical effects on health of a disease or exposure, e.g.: changing the type of job, giving aids like hearing aids to workers suffering from sensory- neural hearing loss (SNHL), which may result from chronic exposure to noisy sound.
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