Investigation of Occupational and Investigation of Occupational and Environmental Diseases Environmental Diseases Dr. Somkiat Somkiat Siriruttanapruk Siriruttanapruk Dr. Bureau of Occupational and Bureau of Occupational and Environmental Diseases Environmental Diseases Department of Disease Control Department of Disease Control
“Welcome to the world of occupational Welcome to the world of occupational “ - a highly challenging and disease and injury - a highly challenging and disease and injury difficult area requiring not only great difficult area requiring not only great operational and technical skills but in many operational and technical skills but in many , a different mindset for the field ways , a different mindset for the field ways epidemiologist . . ” ” epidemiologist . Halperin William E . Halperin William E
Work Work Health Health
Occupational Diseases Occupational Diseases “…are diseases arising out of, are diseases arising out of, “… or in the course of, work or or in the course of, work or employment – – resulting from resulting from employment the exposure of health hazards the exposure of health hazards at work.” ” at work.
Work- -Related Diseases Related Diseases Work “… are categorized as are categorized as multifactorial multifactorial “… in origin. These are diseases in in origin. These are diseases in which workplace factors may be which workplace factors may be associated in their occurrence but associated in their occurrence but need not be a risk factor in each a risk factor in each need not be case.” ” case.
Differences between Occupational and Differences between Occupational and Work- -Related Diseases Related Diseases Work Occupational diseases Work- -related diseases related diseases Occupational diseases Work � Occurs mainly among Occurs mainly among � Occurs largely in the Occurs largely in the � � working population community working population community � Cause Cause- -specific specific � Multifactorial Multifactorial in origin in origin � � � Exposure at workplace Exposure at workplace � Exposure at workplace Exposure at workplace � � is essential may be a factor is essential may be a factor � Notifiable Notifiable and and � May be May be notifiable notifiable and and � � compensable compensable compensable compensable
Occupational health hazards Occupational health hazards � Physical factors Physical factors � � Chemical factors Chemical factors � � Biological factors Biological factors � � Ergonomic factors and other unsafe Ergonomic factors and other unsafe � conditions conditions � Psycho Psycho- -social aspects of work social aspects of work �
The objectives of occupational disease The objectives of occupational disease investigation investigation 1. To confirm the diagnosis of occupational diseases in 1. To confirm the diagnosis of occupational diseases in patients patients 2. To identify causative or other risk factors related to work related to work 2. To identify causative or other risk factors for further prevention and control of occupational diseases in for further prevention and control of occupational diseases in both patients and other workers both patients and other workers
Types of investigation Types of investigation 1. Clinical Investigation Clinical Investigation 1. 2. Investigation of the Workplace 2. Investigation of the Workplace 3. Epidemiological Investigation 3. Epidemiological Investigation
Clinical Investigation Clinical Investigation
Aims Aims � To establish the pathological and functional To establish the pathological and functional � diagnosis diagnosis � To identify the cause of the disease To identify the cause of the disease �
Components of the investigation Components of the investigation 1. History taking 1. History taking 2. Physical examination 2. Physical examination 3. Laboratory tests 3. Laboratory tests
Components of an occupational history Components of an occupational history � Job description/nature of job Job description/nature of job � � Duration of work Duration of work � � Types of hazards Types of hazards � � Past occupations Past occupations � � Other jobs including hobbies Other jobs including hobbies � � Preventive measures provided in workplace Preventive measures provided in workplace � � Results of health check Results of health check- -up and workplace up and workplace � measurements measurements � Past history of occupational illnesses Past history of occupational illnesses � � Domestic exposures Domestic exposures �
Other relevant information for for Other relevant information confirmation of the diagnosis confirmation of the diagnosis � Similar complaints among other workers Similar complaints among other workers � (Clustering of illness) (Clustering of illness) � Time relationship between work and Time relationship between work and � symptoms (Time sequence) symptoms (Time sequence) � Degree of exposure Degree of exposure � � Relationship of illness to periods away Relationship of illness to periods away � from work from work � Personal history (Smoking/alcohol Personal history (Smoking/alcohol � intake/drugs) intake/drugs)
Problems in history taking Problems in history taking � End occupations End occupations � � Job titles Job titles � � Multiple jobs Multiple jobs �
Important points for consideration in Important points for consideration in clinical investigation clinical investigation � Contact and communication with Contact and communication with � responsible physicians responsible physicians � Confidentiality of patient Confidentiality of patient’ ’s information s information � � Collection of the information Collection of the information as much as as much as � you can you can � Co Co- -operation with other relevant agencies operation with other relevant agencies �
Investigation of the workplace Investigation of the workplace
Aims Aims � To identify To identify a cause of the patient a cause of the patient’ ’s illness s illness � � To find out whether other workers are To find out whether other workers are � affected affected � To find out whether the cause can be To find out whether the cause can be � eliminated eliminated
Obstacles for conducting workplace Obstacles for conducting workplace investigation investigation � Ethical problems Ethical problems � � Unfamiliarity with the approach to Unfamiliarity with the approach to � management management � Industrial relationship problems Industrial relationship problems � � Lack of time Lack of time � � Ignorance of how to go about it Ignorance of how to go about it �
Steps of workplace investigation Steps of workplace investigation � Before entering the workplace Before entering the workplace � � The visit The visit � � After the visit After the visit �
Preparations before entering the Preparations before entering the workplace workplace � Setting up the objectives Setting up the objectives � � Setting up the team Setting up the team � � Preparation of tools and equipment Preparation of tools and equipment � � Preparation of information and knowledge Preparation of information and knowledge � � Making contact with workplace Making contact with workplace � � Ethical consideration Ethical consideration �
How to make contact with the workplace How to make contact with the workplace � Seeking the advice of expert in the field Seeking the advice of expert in the field � � Contacting relevant agencies Contacting relevant agencies � � The approach to management The approach to management � 1.1 Directly to company’ ’s doctor s doctor 1.1 Directly to company 1.2 Factory manager 1.2 Factory manager 1.3 Workers’ ’ representatives or trade representatives or trade 1.3 Workers unionists unionists � Reasons for requesting a visit Reasons for requesting a visit �
Activities of the visit Activities of the visit � Meeting with managers or other Meeting with managers or other � representatives representatives � Asking for initial information Asking for initial information � � Walk Walk- -through survey through survey � � Analysis of initial situation Analysis of initial situation � � Initial report or communication Initial report or communication � � Recommendations and making further Recommendations and making further � appointment appointment
Walk- -through survey through survey Walk “ … …is the most important and easiest is the most important and easiest “ activity in occupational health practice activity in occupational health practice for which all occupational health for which all occupational health personnel have to do in order to know personnel have to do in order to know and to get information about what and and to get information about what and how workers perform their work.” ” how workers perform their work.
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