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Occupational health: Promotion & Maintenance of the highest degree of physical, mental & social wellbeing of workers in all occupations (WHO & ILO, 1950 & revised in 1995).
Occupational medicine: A branch of preventive medicine with some therapeutic function (Royal College of Physicians, 1978).
Dr. Dalia El-Shafei
Assist.Prof., Community Medicine Department, Zagazig University
1) To define occupational health, occupational medicine, occupational
disease, and work-related disease.
2) To demonstrate the difference between occupational medicine and
3) To demonstrate occupational health services and the duties of
occupational health professionals.
4) To enumerate and identify occupational hazards.
5) To recognize and diagnose different occupational diseases.
Promotion & Maintenance of the highest degree of physical,
mental & social wellbeing of workers in all occupations
(WHO & ILO, 1950 & revised in 1995).
A branch of preventive medicine with some therapeutic
function (Royal College of Physicians, 1978).
Industrial Medicine Occupational Medicine
workers at any
More than 2,000,000 people die from work-related
accidents or disease every year, equivalent to 1 death
every 15 seconds.
Progress in bringing occupational health to the
industrializing countries is painfully slow. In the poorest
countries, there has been no progress at all.
It is a disease arising out of or during the course of employment and
its cause present in the occupation (e.g. silicosis).
Worker has the right
to receive medical
care at the expense
of the employer.
Worker has the right
for paid sick leave.
If disability occurs,
the worker has the
Why its diagnosis is very critical?
Some diseases are not specially caused by exposures on job, but
they are aggravated by occupational stressors.
so it can be found in the general population (e.g. HPN).
Occupational health is concerned with physical, mental & social
conditions of a worker in relation to his/her work & working
environment as well as his/her adjustment to work & the
adjustment of work to the worker.
Designs & implements
Conducts medical exam.
& biological monitoring
Provides 1st aid &
for disabled workers
Assists the physician in
Assists in supervising the
Educates workers Keeps medical records
the health &
• Prevention &
• Proper expending
of this income.
• Management of
• Making good
social relations at
Periodic medical exam.
• Choose suitable worker.
• Put the suitable worker in the
• Early detection of any health
hazards arises from workplace.
• Early symptoms & signs of
• To combat any infectious
Law specifies the periodicity of the PME for workers in each work or job “48
It is either every 6 Ms or every 2 Ys depending on duration of exposure needed to
develop the occupational disease.
Workers may be temporally or permanently removed from further exposure or may
be advised to continue work.
Mechanization of heavy
work process to lighten
the physical strain.
Enclosure & segregation
of hazardous process.
Good ventilation, lighting
& control of other
physical hazards at
Supplying PPE as
and ear muffs or
are applied &
Provides base line data about
workers' health status
Detection of any deviation from these
data on subsequent PME.
OD can be identified in its early stage to prevent progression of the abnormal
physiologic condition It includes:
of exposure &
early detection of
Early ttt of diagnosed
1st aid ttt of any occupational
Minimize or prevent the
Retraining the disabled
worker for a new job
suitable for his new
physical & mental
disabled workers after
evaluation of the
disability resulted from
occupational disease or
accident & giving him
To diagnose an OD, the nature of the worker's occupation & the cause of
it must present in the occupation.
So, if a worker in a factory of batteries suffered from exposure to lead
toxicity (OD), but he works as driver away from exposure to lead, he will
not be diagnosed as having an OD as John Stone reported in his book on
48 ODs in the Egyptian law.
Excessive sweating & water intake without salt replacement causing
- Prevention by adequate salt intake
- Supplementation with salts “oral or I.V. infusion”.
- Control of hot environment to eliminate or minimize heat hazards.
Severe painful cramps
in muscles of limbs
Severe spasm at
“normal or slightly ↑”.
Excessive sweating, salt & water depletion without replacement causing heamo-
concentration & hypovolemia & circulatory failure.
- Removal of the patient to cool place.
- Water & salt replacement.
- ttt of shock.
↑ body temperature (<40
°C) & excessive
failure (Pallor, Cold
moist skin, HPN, Weak
Disturbance of heat regulating center at brain → heat retention → hyperpyrexia.
- Rapid cooling of body by all possible means.
- Removal of patient from the hot environment.
- Symptomatic “sedatives or stimulants, I.V. saline, O2 inhalation, bed rest”
Abrupt ↑ of body
Flushed hot dry skin.
Delirium, convulsion Coma & death
Blocking of sweat gland ducts → sweat retention & inflammatory reactions.
- Removal to cooler environment.
- Skin cleanliness to prevent infections.
- Cool showers.
- Mild drying & soothing lotions.
Raised red vesicles
on the affected skin.
Prickling & itchy
exposure to heat.
Noise is any unwanted or undesirable sound.
Auditory field lies between 20-20000 hertz (Hz) or cycles/second. If noise is below
the lower level of normal hearing (<20Hz) it is called infra sound but if the noise
above the upper limit of normal hearing (>20kHz) it is called ultrasound.
Weaving Hammering of
Intensity of the
Type of noise
• HR: ↑ or ↓ “type of noise”.
• RR: often ↑.
• Performance of psycho-motor
tasks “↓or ↑”.
• ↑ community mental illness.
Reduction of noise at
Limit exposure with or
without ear protectors.
Routine monitoring of the
place for noise level &
the population at work for
hearing ability “PME”.
Radiation is the straight line transport of energy through space or matter
Electromagnetic or particulate
radiation capable of producing ions,
directly or indirectly when passing
Electromagnetic radiation with a
wave length not sufficient for
Non ionizing radiation
Mechanism of action:
a) Ionization: is to ripe electrons away from atoms & molecules.
b) Excitation of molecules.
• X- ray
• Gama “γ”ray
• Alpha “α” particles “low power
of penetration & great power of
• Beta “β” particles “greater
power of penetration”.
What happens when
the water molecule is
struck by the gamma
Stopped by a sheet of paper
Stopped by a layer of clothing
or less than an inch of a substance (e.g.
Stopped by inches to feet of concrete
or less than an inch of lead
Stopped by a few feet of concrete::
& atomic energy
Radiologist Scientists using
Whole body irradiation
Exposure to doses > 1Gy →
acute radiation syndrome
“Prodromal symptoms (nausea,
vomiting) & bone marrow
Skin reactions according to the
dose “mild erythema → tissue
necrosis & ulceration”.
cracks & ulceration
Eye cataract: starts at
posterior pole of lens
Working in compressed
air that is too rapidly
Divers who surface too
rapidly from depths >10
Crew or paratroopers in
aircraft who ascend too
rapidly from sea level to
heights >5487 m.
Manifestations of DSI are due to formation of nitrogen bubbles in body
fluids & tissues.
Site in which bubbles are
• Site of symptoms
Size & Rate of growth of
• Severity of symptoms
• Mild or severe limb pain.
• Skin mottling or skin irritation.
• Paralysis or weakness, Tingling or
numbness of the limbs,
• Vertigo, Headache, coma
• Dyspnea, chest pain, Hypotension.
Aseptic necrosis of the bones
Neurological or psychological
according to the
of air by divers
ttt: recompressing the patient & reducing pressure in accordance
with a protocol laid down in set of tables.
Pneumoconiosis or dusty lung = dust collection in the lung &
the lung reaction to its presence.
1- Occupational history.
2- Clinical picture:
-The most important is progressive dyspnea.
-Melanoptysis in CWP.
Cyanosis Clubbing Crepitations
(a) Chest X- ray: shows lung opacities,
ILO classification of lung opacities include:
* Small opacities: < 1cm
Up to 1.5mm
From 1.5 – 3mm
From 3- 10mm
Medium sized opacities
* Large opacities > 1cm
A: area of opacity from 1-5 cm2
B: combined area of opacity < area of Rt. upper lobe.
C: combined area of opacity > area of Rt. upper lobe.
(b) Pulmonary function: restrictive or obstructive or mixed pattern.
(c) Autopsy or biopsy:
- Nature of the dust.
- The pathological reaction in the lung.
Fibrotic lung disease due to inhalation of dust containing crystalline silicon
dioxide (free silica)
Sand blasters Quarry
• Repeated exposure of low level of silica for >20 years.
• Lung: Discrete fibrotic nodules of 2-3mm, mainly in upper lobes with whorled
pattern. These nodules may coalesce together → Progressive massive fibrosis
“PMF” → central ischemic necrosis with cavitation.
• Pleura: thickening, fixed, hard with fibrotic nodules.
Chronic classic silicosis
• As classic but progress more rapidly.
• Inhaled high level of recently fractured quartz → immediate damage of the
alveoli → acute alveolitis → fibrosis.
• It needs 20 years to develop:
• Early stages asymptomatic discovered accidentally by chest X-ray.
• Progressive dyspnea.
• Cough & sputum due to bronchitis.
Chronic or Classic silicosis
• As chronic silicosis but progress within shorter period.
• It is fatal. It develops in few weeks & progress in 1-3 years only.
• Progressive dyspnea.
• Massive proteinuria with renal failure.
• Respiratory failure & death.
X- ray is the clue diagnostic tool.
Pulmonary function tests: (restrictive pattern).
• Small rounded opacities in the upper lung zones.
• In massive fibrosis: bilateral opacities “cavitation if TB infection occurred”.
• Egg shell calcification: Hilar & mediastinal LNs are enlarged & calcified.
• Bilateral pleural thickening adjacent to pulmonary fibrotic nodules.
• As chronic silicosis but progress more rapidly.
• Ground glass appearance.
Respiratory failure Emphysema Bronchitis
• PEME & PME.
•Substitution of silica by
•Enclosure of dusty
•Proper ventilation of the
• Work place monitoring
for keeping dust level ˂
threshold limit value
• Use of respiratory
• Avoid smoking.
Asbestos ore Asbestos fibers
Flexible Good insulation
- Chrysotile - “White asbestos”
- Amosite - “Brown asbestos”
- Crocidolite - “Blue asbestos”
Greatly ↑ during & after World War II in ship insulation.
Use has greatly declined since the late 1970’s
Pipe insulation Surfacing
Fireproofing Acoustic &
fibrosis which is usually
accompanied by pleural
fibrosis & thickening.
Symptoms: progressive Dyspnea.
1- History of exposure.
2- Clinical picture.
Limitation of the
movement of the
lower chest wall
Chronic exposure to CO
NYC bridge & tunnel officers
Acute toxicity: depends on concentration of COHb in blood.
<10% No symptoms
At 10% Headache
10-20% Headache, tinnitus, dyspnea
20-30% As above + nausea, vomiting
30-45% As above + confusion, coma
> 50% Respiratory center depression & death
headache, memory loss.
Prevention & control
O2 “100% or
TLV: CO in respirable air is 50 ppm & COHb in blood is 5g/100g Hb.
1- Fumigant (rodenticide, insecticide).
2- Extraction of silver & gold.
Mechanism of action:
- HCN absorbed through the lung.
- Excreted in urine & feces as thiocyanates.
- It inhibits cytochrome oxidase enzymes.
Removal from exposure
Amyle or Na nitrite
Na thiosulfate IV infusion
Di cobalt EDTA (600 mg IV)
& Na thiosulfate
- Manufacture pipes, sheet metals and foil.
- In paints, enamels and glazes.
Inlet to the body:
Through inhalation of dust & fumes. Also, ingestion & absorption
through the skin (by organic compounds) may occur.
A- Distribution in the body:
- Bound to RBCs, membranes.
- Precipitate in bone, teeth.
- Exist in the plasma.
- Almost via the kidney.
- Small amount excreted through bile.
- Sweat & milk.
What are the Normal levels of lead??
<20 micrograms/dL of lead in the blood
<5 micrograms/dL of lead in the blood
Mania, loss of weight.
Anemia is due to:
-Direct effect on RBCs.
-↓ life span of RBCs.
Treatment of lead poisoning:
Identification of source
of lead poisoning.
Removal from exposure Chelation therapy
• Symptomatic patient with
BLL >100 µg/dl.
• Ca EDTA and/ or oral
The term "ergonomics" is derived from 2 Greek words: "ergo
= work" & "nomi = natural laws”.
Ergonomists study human capabilities in relationship to work
It is the application of knowledge as regards human abilities &
limitations to the design of tools, machines, tasks etc.
All work activities should
permit the worker to adopt
several different, but
equally healthy & safe
Where muscular force has
to be exerted it should be
done by the largest
appropriate muscle groups
Work activities should be
performed with the joints
at about mid-point of their
range of movement. This
applies particularly to the
head, trunk, & upper
Lack of balance
between rest &
The following symptoms may be found:
• These symptoms may not appear immediately because they develop over weeks,
months, or years. By then, the damage may be serious.
Tingling Joint swelling ↓ ability to
↓ grip strength Pain from