Investigation of Occupational and Investigation of Occupational and - - PowerPoint PPT Presentation

Investigation of Occupational and Investigation of Occupational and Environmental Diseases Environmental Diseases

Dr.

• Dr. Somkiat

Somkiat Siriruttanapruk Siriruttanapruk 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 disease and injury disease and injury-

• a highly challenging and

a highly challenging and difficult area requiring not only great difficult area requiring not only great

• perational and technical skills but in many
• perational and technical skills but in many

ways ways, , a different mindset for the field a different mindset for the field epidemiologist epidemiologist. .” ” William E William E. . Halperin Halperin

Work Work

Health Health

Occupational Diseases Occupational Diseases

“… “…are diseases arising out of, are diseases arising out of,

• r in the course of, work or
• r in the course of, work or

employment employment – – resulting from resulting from the exposure of health hazards the exposure of health hazards at work. at work.” ”

Work Work-

• Related Diseases

Related Diseases

“… “… 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 need not be a risk factor in each a risk factor in each case. case.” ”

Differences between Occupational and Differences between Occupational and Work Work-

• Related Diseases

Related Diseases

Occupational diseases Occupational diseases

• Occurs mainly among

Occurs mainly among working population working population

• Cause

Cause-

• specific

specific

• Exposure at workplace

Exposure at workplace is essential is essential

• Notifiable

Notifiable and and compensable compensable Work Work-

• related diseases

related diseases

• Occurs largely in the

Occurs largely in the community community

• Multifactorial

Multifactorial in origin in origin

• Exposure at workplace

Exposure at workplace may be a factor may be a factor

• May be

May be notifiable notifiable and and 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
• 2. To identify causative or other risk factors related to work

related to work 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.

• 1. Clinical Investigation

Clinical Investigation 2.

• 2. Investigation of the Workplace

Investigation of the Workplace 3.

• 3. Epidemiological Investigation

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 Other relevant information for for 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
• peration 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 1.1 Directly to company’ ’s doctor s doctor 1.2 Factory manager 1.2 Factory manager 1.3 Workers 1.3 Workers’ ’ representatives or trade representatives or trade 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 Walk-

• through survey

through survey

“ “ … …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.” ”

The information needed from the The information needed from the walk walk-

• through survey

through survey

• General information of the enterprise

General information of the enterprise

• Work process

Work process

• Health hazards

Health hazards

• Other high risk factors

Other high risk factors

• Clues for appropriate preventive and control

Clues for appropriate preventive and control measures measures

Other important information needed Other important information needed

• Material Safety Data Sheet

Material Safety Data Sheet

• Information of the provision of occupational

Information of the provision of occupational health service: health service:

• 1. Data on environmental measurements
• 1. Data on environmental measurements
• 2. Data on health surveillance of workers
• 2. Data on health surveillance of workers
• Information of workers with occupational

Information of workers with occupational diseases and injuries diseases and injuries

• Information of chemical incidents and other

Information of chemical incidents and other accidents accidents

Material Safety Data Sheets (MSDS) Material Safety Data Sheets (MSDS)

“… “…are produced by the chemical manufacturers in are produced by the chemical manufacturers in a wide variety of formats and data quality, and a wide variety of formats and data quality, and aimed primarily at employers of people handling aimed primarily at employers of people handling chemicals. chemicals.” ”

MSDS MSDS’ ’s s online

• nline
• http

http:// ://msds msds. .pdc pdc. .cornell cornell. .edu edu/ /

• http

http:// ://hazard hazard. .com com/ /msds msds/ /index index. .php php

• http

http:// ://www www. .ilpi ilpi. .com com/ /msds msds/ /index index. .html html

Practical points for walk Practical points for walk-

• through survey

through survey

• The survey should start from the entry of raw materials,

The survey should start from the entry of raw materials, follows by an order of each step until the finishing of follows by an order of each step until the finishing of the final product including maintenance section. the final product including maintenance section.

• The survey should be made in the company of someone

The survey should be made in the company of someone who understands the workplace and the process. who understands the workplace and the process.

• Observing what workers actually do their work,

Observing what workers actually do their work, including how to protect themselves from health including how to protect themselves from health hazards. hazards.

• Paying attention to the particular job in question,

Paying attention to the particular job in question, especially the conditions that may cause the illness of especially the conditions that may cause the illness of patient. patient.

The Check The Check-

• list

list

… …is an useful tool to collect the information is an useful tool to collect the information during the survey. It also assists to achieve during the survey. It also assists to achieve the objectives of the survey. the objectives of the survey.

Components of the check Components of the check-

• list

list

• General information

General information of enterprise

• f enterprise
• Basic information of workers

Basic information of workers

• The provision of occupational health service

The provision of occupational health service

• Work process and diagram

Work process and diagram

• Health hazards and their risk

Health hazards and their risk

• Recommendations for preventive and control

Recommendations for preventive and control measures measures

• Making next appointment for further assessment

Making next appointment for further assessment

• Signature of surveyor and date of the survey

Signature of surveyor and date of the survey

Methods for collecting data and Methods for collecting data and information information

• Observation

Observation

• Asking and interviewing

Asking and interviewing

• 1. Representative who were accompanied
• 1. Representative who were accompanied

with during the survey with during the survey

• 2. Occupational health personnel in
• 2. Occupational health personnel in

enterprise enterprise

• 3. Workers
• 3. Workers
• Direct measurement

Direct measurement

Activities after the visit Activities after the visit

• Searching for more information and

Searching for more information and knowledge knowledge

• Consulting the experts

Consulting the experts

• Preparation for further

Preparation for further measurements and measurements and investigation investigation

• Data analysis

Data analysis

• Preparation of report

Preparation of report

• Communication with the workplace and

Communication with the workplace and

• ther relevant organizations
• ther relevant organizations

Epidemiological investigation Epidemiological investigation

Aims Aims

• To identify the magnitude of the problem

To identify the magnitude of the problem

• To describe the outbreak in terms of time, place,

To describe the outbreak in terms of time, place, persons persons

• To identify or confirm the cause of the disease

To identify or confirm the cause of the disease

• To identify other high risk factors

To identify other high risk factors

Steps of investigation Steps of investigation

1. 1.

Confirm the outbreak Confirm the outbreak

2. 2.

Verify the diagnosis Verify the diagnosis

3. 3.

Define the case and identify magnitude of the Define the case and identify magnitude of the problem problem

4. 4.

Describe the outbreak in terms of time, place, Describe the outbreak in terms of time, place, and person and person

5. 5.

Identify high risk group Identify high risk group

6. 6.

Set up the hypothesis and design the study Set up the hypothesis and design the study

7. 7.

Conduct the study Conduct the study

8. 8.

Collect and analyze the data Collect and analyze the data

9. 9.

Summarize and write the report Summarize and write the report

10.

• 10. Implement preventive and control measures

Implement preventive and control measures

Kinds of studies or investigation Kinds of studies or investigation

• Investigation of cases of known

Investigation of cases of known

• ccupational etiology
• ccupational etiology
• Investigation of cases of unknown etiology

Investigation of cases of unknown etiology

• Determination of whether exposure is

Determination of whether exposure is associated with an adverse health outcome associated with an adverse health outcome

• Evaluation of the effectiveness of an

Evaluation of the effectiveness of an intervention intervention

Issues of concern for investigations Issues of concern for investigations

• The request for assistance

The request for assistance

• The right of entry

The right of entry

• Trade secrets and workers

Trade secrets and workers’ ’ confidentiality confidentiality

• Participation of company, union, government

Participation of company, union, government agencies, and media agencies, and media

• Notification of results

Notification of results

• Preparation for the consequences of the

Preparation for the consequences of the investigation investigation

Other considerations in conducting Other considerations in conducting

• ccupational investigations
• ccupational investigations
• An epidemic in workplace may or may not

An epidemic in workplace may or may not be of occupational etiology. be of occupational etiology.

• Consider overall adverse health outcome

Consider overall adverse health outcome rather than one specific disease rather than one specific disease

• Beware of

Beware of “ “Healthy worker effect Healthy worker effect” ”

Investigation of Investigation of environmental diseases environmental diseases

Characteristics of environmental diseases Characteristics of environmental diseases comparing to occupational diseases comparing to occupational diseases

• Affected on every aged group in community

Affected on every aged group in community but children and elderly people are but children and elderly people are vulnerable vulnerable

• Level of exposure usually lower, however

Level of exposure usually lower, however duration of exposure may be longer duration of exposure may be longer

• To define exposed population is more

To define exposed population is more difficult difficult

• Causative agents are always a mixture of

Causative agents are always a mixture of chemicals chemicals

Nature of environmental disease Nature of environmental disease development development

• Sources

Sources

• Exposure

Exposure

• Health effect

Health effect

Important sources of environmental health Important sources of environmental health pollutions pollutions

• Air pollution

Air pollution

• Water pollution

Water pollution

• Food contamination

Food contamination

• Soil contamination

Soil contamination

• Radiation

Radiation

Characteristics of exposure Characteristics of exposure

• Geographical variation

Geographical variation

• Temporal variations

Temporal variations

• Route of exposure

Route of exposure

• Pollutant combinations

Pollutant combinations

Classification of spatial exposure Classification of spatial exposure

• Localized point source

Localized point source

• Line source

Line source

• Area

Area-

• base source

base source

• Diffuse sources

Diffuse sources

Adverse health effect Adverse health effect

• Acute Vs Chronic

Acute Vs Chronic

• Specific Vs Non

Specific Vs Non-

• specific

specific

Data sources of adverse health effect Data sources of adverse health effect

• Existing data sources

Existing data sources

• Special or active disease surveillance

Special or active disease surveillance

• Survey

Survey

Methods for analysis of hazard exposure Methods for analysis of hazard exposure and adverse health effect linkage and adverse health effect linkage

• Ecological analysis

Ecological analysis

• Time series analysis

Time series analysis

• Risk analysis

Risk analysis

Kinds of environmental investigation Kinds of environmental investigation

• The investigation of cases for known

The investigation of cases for known point source of industrial pollution point source of industrial pollution

• The investigation of cases from reports

The investigation of cases from reports

• f disease excess (clusters) in specific
• f disease excess (clusters) in specific

localities without a putative source localities without a putative source

• The investigation of cases after

The investigation of cases after chemical incident or disaster chemical incident or disaster

• Ecological

Ecological-

• correlation studies

correlation studies

Conclusions Conclusions

• The investigations of occupational and

The investigations of occupational and environmental diseases share a reliance on basic environmental diseases share a reliance on basic methods of epidemiology. methods of epidemiology.

• The investigators need well co

The investigators need well co-

• operation or
• peration or

support of other experts in this field. support of other experts in this field.

• The social and economic complexities and other

The social and economic complexities and other related issues need to be concerned or aware of. related issues need to be concerned or aware of.

• The prevention and control of diseases is the

The prevention and control of diseases is the ultimate goal of the investigation. ultimate goal of the investigation.

Recommendations for new investigators Recommendations for new investigators

• Try to keep on practicing the investigation

Try to keep on practicing the investigation to gain more experience to gain more experience

• Work together with the others as a teamwork

Work together with the others as a teamwork

• Join a network with experts in this field

Join a network with experts in this field

• Study hard

Study hard

• Disseminate your study to public

Disseminate your study to public