Varicose Veins


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Incidence of varicose veins in relation to occupation and working hours - A study conducted in tertiary care hospitals of South India.

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Varicose Veins

  1. 1. The Incidence of Varicose Veins in Relation to Occupation and Working Hours <br />Presented By:<br />Mohammad Amir<br />Final Year MBBS<br />JJM Medical College<br />Davangere<br />
  2. 2. What are varicose veins?<br />A disease of dilated tortuous veins of lower limbs.<br />The penalty man is paying for his erect<br />posture.<br />2<br />
  3. 3. How serious is the problem?<br />The varicose veins affect 5% of the population and 1% have or have had the venous ulceration.<br />At any one time up to 200,00 people in UK have active venous ulceration.<br />In Europe, in the year 1952, the disability from varicose vein was more than that from auto mobile accidents.<br />Severe chronic venous insufficiency is found in nearly 20% of working men and women.<br />The actual magnitude of problem is suspected to be more since it is a slowly progressing disease and sometimes symptom free in earlier stages.<br />3<br />
  4. 4. What are the factors responsible?<br />The following factors can either cause or precipitate the disease.<br /><ul><li>Primary valvular weakness.
  5. 5. Occupations of prolonged standing
  6. 6. Age
  7. 7. Parity
  8. 8. Immobilization following a surgery
  9. 9. Low fiber diet</li></ul>4<br />
  10. 10. How to identify the disease?<br />Aching in veins which<br /> increases towards the end <br /> of the day.<br />Ankle swelling<br />Itching<br />Bleeding<br />Superficial thrombophlebitis<br />Eczema<br />Lipodermatosclerosis<br />Ulceration<br />5<br />Lipodermatosclerosis in a cotton mill worker who participated in the study<br />A typical venous ulcer<br />
  11. 11. Study Design & Setting<br /><ul><li> Retrospective cohort study, on 58 patients who were diagnosed with varicose veins and admitted in Bapuji Hospital and CG Hospital Davangere during January 2009 to April 2010.
  12. 12. Exclusion criteria: Patients with insufficient data and non-specific occupational history were excluded.</li></ul>6<br />
  13. 13. Results<br />7<br />Table- 1<br />Table-2<br />
  14. 14. Occupation and the disease<br />70.69% cases involved in mainly standing occupations while only 29.31% patients belonged to mainly sitting occupations.<br />8<br />
  15. 15. Sex and the disease<br />The male: female ratio among the varicose vein patients was found to be 4:1<br />9<br />
  16. 16. The duration of work and age incidence<br />On an average, the patients who got the disease had worked standing or walking for 9.33 hours/day.<br />The maximum incidence was seen in the age group of 30-39 years with as many as 17 cases out of 58 cases studied. <br />10<br />
  17. 17. Discussion<br />The average working time in present study was found to be 9.33 hours/day which led to the development or precipitation of inherent tendency to varicose veins.<br />Dr. Rajmohan Nambiar in Singapore also noted that 67% of varicose veins patients had involved in professions of prolonged standing.<br />In the year 1998, Shida Tsutomu from Japan observed that over 85% patients had engaged in prolonged standing occupations with average working time of 10.4 hours/day.<br />11<br />
  18. 18. Men or women? Who are affected more?<br />The male versus female incidence in present study was found to be 4:1 which is, though contradictory to general belief but expected considering the following facts –<br /><ul><li>Low awareness
  19. 19. Under reporting
  20. 20. Little concern about the disease till it is symptom free
  21. 21. Females being less active in standing occupation.</li></ul>12<br />
  22. 22. Conclusions<br />There is a definite co relation between varicose veins and standing occupations, and taking care of the factors responsible for the disease will go a long way in increasing the productivity and efficiency of workers.<br />People who work more than 9.33 hours per day standing or walking are more likely to develop the disease. <br />The maximum patients belonged to the age group of 30-39 years, which is the most active and productive period of life. <br />13<br />
  23. 23. Recommendations<br />Job rotation<br />Pre placement examination<br />Health education<br />Elastic stockings<br />Periodic health check-ups<br />14<br />
  24. 24. Acknowledgement<br /><ul><li> Thank are due to Dr. H.R Chandrashekhar The Principal, JJMMC, Dr. Prakash M.G. Professor of Surgery, Dr. Vijay Kumar B. Professor of Community Medicine, Dr. P.S. Balu Associate Professor of Community Medicine, and Dr. Ajay K.T. Assistant Professor of Physiology, JJM medical college Davangere, for providing me this opportunity, encouragement and critical review of the manuscript.
  25. 25. To my friends Manish, Shakkir and Ravishu for their help and support throughout the project.</li></ul>15<br />
  26. 26. References<br />Bauer G. A plea for the chronic ulcer patient AngiologyVol. 1 No.2.1950:229<br />Curwen I.H.M., Scott B.O. Ann. phys. Med. 1952; 1: 17<br />Kewine Burnand.Beiley& Love’s short practice of surgery.25th edition.UK.Hodder Arnold.2008:925<br />Niren Angle & John J. Berger. Varicose veins:Chronic venous insufficiency. Vascular surgery:a comprehensive review. 6th edition WB Saunders. US.1996:826<br />American college of phlebology. Phlebology: The Treatment of Leg Veins. (accessed on 07/06/2010)<br />Greenfield.Lazor J.Venous and lymphatic disorders. Schwartz principles of surgery. US. Mc Graw HillInc. 1994:1003-1007<br />Nambiar.Rajmohan. The Incidence of Varicose veins in Singapore. Singapore medical journal. Vol.9 No.3:167-169(1968)<br />16<br />
  27. 27. 17<br />Questions?<br />