1. Dr. SULTAN BURAENA, MSc, SpOk
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2. INTERACTION OF HUMAN AND
UNCONTROLED ENVIRONMENT
ENVIRONTMENT
DISEASE DIAGNOSIS
(Unhealthy)
TREATMENT
AND CURE
HEALTHY
PERSON
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3. ENVIRONTMENT
DISEASE DIAGNOSIS
(Unhealthy)
RECOGNITION AND
EVALUATION OF PROBLEMS
TREATMENT
AND CURE
PREVENTIVE
CONTROL MEASURES
ENVIRONTMENT HEALTHY
(Healthy) PERSON
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4.  The discipline of occupational medicine  a
relatively recent development in history of
modern medicine.
 Modern medicine  evolution of medicine
from Hippocratic times 2500 years ago.
 Occupational medicine  become a
recognized discipline from the time of
Ramazini in the 18th century.
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5.  Occupational Health  not only concerned
with disease but also promoting health and
preventing disease  besides emphasizing
health rather than disease, also implies a
multidisciplinary responsibility as well as a
mechanism for the provision of health
services for working population.
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6.  Define occupational health  as the
promotion and maintenance of the highest
degree of physical, mental and social well-
being of workers in all occupations.
 OH  IS THE TOTAL HEALTH OF ALL
WORK.
 OH services  seen as mechanism to achieve
its objective
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7.  OH  the recognition of two-way
relationship between work and health
WORK  HEALTH
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8. • Work  not only have an adverse impact on
health, but may also be beneficial to health and
well-being.
• Health status  will have an impact on work
• Healthy worker  more productive than an
unhealthy worker
• Worker with impaired health  not only less
productive but can also be a danger to
themselves as well as other workers and the
community.
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9.  A worker may suffer from the full spectrum of
diseases:
 The diseases prevalent in the community
 Work related diseases
 Occupational diseases
 Occup Health Physician  must recognized
the relationship between work and disease
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10.  For instance  Malaria and diabetes :
 Disease prevalent in the community
 Has an impact on the worker’s
performance an equally
 Work may have a deleterious effect on
his disease
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11.  OD  Occur as a result of exposure to
physical, chemical, biological or
psychological factors in work place 
predominant and essensial in the causation
of OD
 For example 
 Exposure to lead  essential for lead poisoning
 Exposure to silica  silicosis
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12.  Must be recognized  other factors such as
individual susceptibility may play a varying
role in the development of disease among
exposed workers.
 OD  occur exclusively among workers
exposed to specific hazards  in some
situations these OD may also occur among
the general community  as consequence of
contamination of the environment from the
work place  e. g. lead, pesticides
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13.  OCCUPATIONAL DISEASE
 ARE CAUSE-SPECIFIC
 e.g. ASBESTOS CAUSES ASBESTOSIS
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14.  WHO  catagorises WRD as
“multifactorial” in origin  workplace
factors may be associated in their
occurrence but need not be a risk factor
in each case.
 WHO  frequently seen in the general
community
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15.  Hypertension
 Ischaemic heart disease
 Psychosomatic illness
 Musculoskeletal disorders
 Chronic non-specific respiratory disease/
Chronic bronchitis
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16. Work-Related Occupational
Disease Disease
Occurs largely in the Occurs mainly among
community working population
Multifactorial in origin Cause specific
Exposure at workplace Exposure at workplace
may be a factor is Essential
May be notifiable and Notifiable and
compensable compensable
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17.  Keppres RI no 22/1993
 Penyakit yang timbul karena hubungan kerja :
▪ Penyakit yang timbul karena hubungan kerja adalah
penyakit yang disebabkan oleh pekerjaan atau
lingkungan kerja
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18.  ILO (1983):
 Occupational Disease & Work Related Disease still not be
separated
 Gagasan WHO & ILO (1987)- adopsi (1989):
 Work related disease can be used as occupational disease
that already known which work places and work process
are one of the significant reason
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19.  Clinical approach (Personal):
 Obtain diagnose of occupational disease:
1. Clinical diagnose
2. Occupational exposure be obtained
3. Relationship between exposure and disease/symptoms
4. High degree of exposure
5. The role of individual factor
6. Other factor of non working
7. Occupational disease diagnose or not
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20.  1700s  Bernadino Ramazzini, physician and
professor of medicine in Madena & Padua
Italy  reommended that physician enquire
about a patient’s occupation.
 Previous, the standard three quistions
recommeded by Hipopocrates  the enquire
of patient,s name, age, and residence.
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21. The information obtained in the routine
question asked of patients: “WHAT IS
YOUR JOB“
 is often inadequately used and
furthermore usually incomplete
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22.  To assess the extent to which the illness has
been caused or in some way related to the
patient’s job . E.g. The patient’ anaemia 
exposure to lead.
 Pertaining to returning to his job
 Gives indicationof the patient’s educational
and socio-economic status  considerable
value in providing appropriate and under
standable advice to the patient
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23.  What are the long term effect of disease?
 What is the nature of the job the patient is
returning to?
 Is the rerturn to work likelyto cause a recurrence
of disease or to aggravate the disease?
 Is returning tolikely to cause damage or ill health
to other work colleagues or the general
community.
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24.  Patient condition was clearly the result of
occupational exposure e.g.  anaemia (lead),
asthma, dermatitis, musculoskeletal (poor
ergonomic  returning to the same w0rk
situations will only result in recurrence same
condition
 May aggravate their illness 
 diabetic patient’s regular meal time and medication 
adversely affected if return to shift work.
 After myocardial infarction  may not be able return to
work requiring physical exertion and stressful jobs
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25.  End occupations
 Job Titles
 Multiple jobs
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26.  Patient’s job  usually given the current
occupation.
 It might be  the patient has retired or
changed job
 Health problems may associated with a
previous job  important as far as
possible to ask a patient their entire a
previous job.
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27.  When ask their job  patient usually provide
a job title  may not be of much value 
unless the physician is familiar with the
workplace and potensial hazard
 Obviously necessary to pursue with the
question  the nature of the job hazards  a
job discription that may seem relatively safe
 relevance to the causation of the illness
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28.  Patient may be holding more than one
job.
 Patients may choose only main
occupation not inform other jobs .
 Often appropriate  the patient be aske
to whether it is the only job held or hold
other jobs as well.
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29.  job description / nature of job
 Hours of work / shift Work
 Types of hazards
 Past occupation
 Other Jobs
 Domestic exposure
 hobbies
 Do other workers have a similar illness ?
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30.  Smoking/ alcohol intake/ drugs
 Similar complaints among other
workers
 Time relationship betwen work and
symtoms
 Degree of exposure
 Use of protective devices
 Methods of materials handling
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31.  History of smoking  absorption of lead
appears to be higher among smokers
 Relationship between onset of symptoms
and exposure  such as pesticide poisoning
and occupational asthma.
 Degree of exposure  workplace very dusty
or very hot
 The use of protective devices  use
inappropriately or incorrectly.
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