OCCUPATIONAL MEDICINE

Dr. G.S. JOGDAND, M.D. Ph.D.

DIPLOMA IN OCCUPATIONAL &

ENVIRONMENTAL EPIDEMIOLOGY (U.S.A.)

Professor & Head Dept. Of P.S.M. G.M.C. Akola

OCCUPATIONAL MEDICINE

• Branch of medicine which is devoted for the promotion and protection of workers health.

• Early diagnosis and treatment of diseases of occupational origin, and rehabilitation of disablement of workers.

Historical Background

• Paracelsus, 1493 – 1541.• Bernardino Ramazzini, 1633 – 1714.• Charles Turner Thackrah,1795 –

1833.• Promulgation of Factory Act, 1819.• Appointment of Certifying Factory

Surgeon, 1884.

Occupational Health Hazards

• Physical agents : Heat, Light, Cold, Humidity, Air pressure, Vibrations, Noise, E.M.F., Injurious force, Dusts, Radiant energy.

• Chemical agents : Noxious gasses, Aerosols, Corrosives, Solvents, Metals and Metal fumes, Insecticides and Herbicides.

• Biological agents : Bacteria's, Viruses, Fungi, Molds and other biological agents.

• Mechanical agents : badly maintained machines, Lack of protective devices .

• Social factors : Job security and working conditions, work related tensions and worries, family pressures.

• Heat : Heat cramps, Heat exhaustion, Heat stroke, Heat syncope.

• Cold : Chill blains, Frost bite, Hypothermia.• Humidity : Loss of body fluids,

Dehydration.• Vibrations : Injury and inflammation of

bones, joints and soft tissues.• Abnormal pressure : Pressure bends,

Caissons disease, Air embolism.

HEALTH EFFECTS OF HAZARDS

• Noise : Hearing impairment, hearing loss.• Light : headache, loss of concentration

and miners nystagmus.• E.M.F.: Headache, sleep disturbances,

risk of blood and brain cancer.• Radiant energy :a) Cosmic radiation :-

Cataract, skin cancer. b) U.V. radiation :- Skin and bone cancer.

• Injurious force : injuries and accidents.

• Ionising radiation : a) acute effects :- Radiation burns, acute radiation syndrome.

b) delayed effects :- Genetic mutations, cancers, teratogenesis.

Dusts : organic and inorganic :- Respiratory diseases, Pneumoconioses.

Chemical agents : Burns, Occupational dermatoses and cancers.

Biological agents : Various agent specific diseases.

Social factors : Nature of work and working hours,

Jealousy in promotions, poor housing, less pay, separation from family and lack of job satisfaction.

Occupational Diseases

• Occupational lung diseases : Pneumoconiosis : Coal workers pneumoconiosis, asbestosis, silicosis.

• Airway diseases : Byssinosis, Occupational asthma.

• Malignancies : Lung cancer.

• Musculoskeletal injuries : i) Disorders of back, trunk, arm and leg. ii) Traumatically induced Reynaud’s phenomenon.• Occupational Cancer (other than lung

cancer) : Bladder, Blood, skin, liver, bones, brain and gonads.

• Severe traumatic injuries : Amputation, laceration, fractures, Eye loss, Death.

• Cardiovascular diseases : Hypertension, Coronary heart diseases.

• Disorders of reproduction : Infertility, spontaneous abortions, Birth defects.

• Neurotoxic disorders : Peripheral neuropathy, C.N.S. disorders :- encepphalities, psychosis, personality changes.

• Noise induced hearing loss.• Dermatologic condition :

Dermatoses, Burns (thermal or chemical), Contusions, abrasions.

• Psychological disorders : Alcoholism, substance abuse, Neuroses, personality disorders.

• Infectious diseases: i) Strange & exotic :- Brucellosis, sporotrichosis, anthrax

ii) Lyme disease. iii) Sexually transmitted diseases. iv) HIV infection & AIDS .

Exposure Assessment at Work Place.1. Measurement of the level of hazard in REM (Relevant Exposure Medium).

2. Measurement of Environmental factors I.e. temperature, humidity, & Air movement .

3. Measurement of concentration of air borne contaminants ( Dust, Gases, Vapours & Particles .)

4. Collection of Samples from other exposure media.

Exposure Assessment of Individual Worker

1. Measurement of the concentration of harmful agents and their metabolites in biological samples of exposed worker ( Urine, Blood,

Sputum & exhaled air).

2. Assessment of intensity of biochemical & histological changes dueto exposure.

3. To carry out specialized investigation procedures ( biological Assays for responses to toxins , cytogenetic assays).

Health Hazards of Power plant workers

• 1) Temperature : Workers are exposed to high degree of temperature at boiler rooms, turbine rooms and other work stations closer to boilers.

• 2) Health effects : heat exhaustion due to loss of body fluids due to excessive sweating. Signs and symptoms :- Person feels weakness , Low body temperature, rapid pulse , fainting.

• 3) Heat cramps : Due to loss of electrolytes from the body.

• Signs and symptoms :- Painful cramps of calf muscles and abdominal muscles.

• 4) Heat stroke : Due to exposure to excessive temperature.

• Signs and symptoms :- high body temperature i.e. 108 F – 112F, increased frequency of urination, giddiness and loss of consciousness.

• 5) Prevention and control : Proper ventilation and air conditioning of work place, Use of loose fitting clothes, provision of effervescent salt drinks to affected workers, Physical fitness of workers.

• Exposure to Noise : Exposure at boiler rooms , turbine rooms and other work stations. Type of noise :- a) steady wide band noise from continuously operating motors and machines. b) Impact noise from steam let outs.

• Effects : social deafness :- person is habituated for loud talking could not appreciate whisper, hearing impairment, Occupational hearing loss, lack of concentration, annoyance, mental stress, hyper tension and peptic ulcer.

• Permissible level of noise for humans : 60 to 85 decibels or 185 Hertz .

• Prevention and control : a) pre-placement and periodic medical examination of exposed workers. Use of protective devices such as ear muffs and ear plugs. Enclosing noise producing machines, reduction of noise by fitting mufflers and silencers to noisy machines. Sound proofing of work stations .

Coal and other Dusts

• Exposure at coal handling plant, tippling stations, boiler rooms.

• Respirable dust : dust particles of 0.3 to 5 microns in size.

• Effects of dust inhalation : respiratory disorders like pneumoconiosis and progressive massive fibrosis of lungs.

• Prevention and control : pre- placement and periodic medical examination of exposed workers.

• Proper ventilation of working place.• Good house keeping.• Use of personal protective devices

such as masks and respirators by exposed workers.

• Dust suppression measures like wet mopping of the floor, use of aerosol sprays.

Health effects of Radiation

• Exposure at atomic power plants, near Nuclear Reactor, monitoring panels and other work stations.

• Permissible level of radiation for humans : Five rems /year.

• Effects of radiation : high degree of exposure due to accidental leakage of Nuclear Reactor causing radiation burns, acute radiation syndrome, Cancer of the skin, blood and bones, still births, intrauterine foetal death, abortions, shortening of life span.

• Pre- placement and periodic medical checkup of workers.

• Shielding the source of radiation : the source of X-rays, gamma rays and particulate radiation should be enclosed in radio protective material such as lead and concrete of suitable thickness.

• Distance from the source of radiation : the controls should be located as far as possible or remotely operated.

Prevention and Control

Electromagnetic Field in the Power Plant

• E.M.F. generates magnetic flux density at work place and near over head high tension power transmission lines, electrical sub stations and power generation plants. Which ranges up to 0.05 mT.

• Safety limits : maximum field strength should not exceed 10 Kv /M.

• Recommended continuous exposure limit : 5 gauss with a maximum of 50 gauss for 2 hours.

Effects on Human Health

• Sleep disturbances. • Headache.• Increased susceptibility to

respiratory infections.• Increased risk of blood and brain

cancer.

Prevention and Control

• Insulation and shielding of machines.

• Barrier operation of machines.• Continuous monitoring of E.M.F.

level at work place.• Periodic medical checkup of

exposed workers.

Hazards due to social factors

• Workers are affected by industrial psychoses and neuroses.

• Tensions and worries arising out of social environments in the industry i.e. poor intra and inter- personal relations , poor housing conditions, separation from family, job satisfaction and sickness absenteeism.

• Sickness absenteeism is related to low productivity and low workers morale .

• Level of absenteeism in the country : to the tune of 8 – 10 days / head /year.

Prevention & Control

1. Periodic Medical Examination of Workers.

2. Provision of good housing facility & Recreational activities.

3. Good intra & inter personal relations in the factory.

4. Health Education & Addiction control programmes in the Factory.