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Overview of occupational disease case studies dr. clint ramasir
- 1. Clint Ramasir MBBS: MSc. Occ. Med. Occupational Health Physician
- 2. Hazard – the potential of the chemical, biological, physical agent to cause harm. Risk – the likelihood of harm occurring in actual circumstances of use.
- 4. Physical – Noise, vibration, ergonomic, radiation or lighting, heat cold, manual handling, accidents (cuts, falls, burns) Chemical – Dusts, fumes, gases, aerosols, fibres, liquids, vapors Biological – Bacteria, viruses, fungi and moulds, yeasts, insects Psychosocial – Job stress, job autonomy, job organisation, unsocial hours
- 5. Occupational Mental Health Stress & Adjustment reaction Brain Injury & Learning Difficulties Psychosis Including Schizophrenia Organic Disorders & Neurotoxicity Anxiety & Depression Phobias Personality Disorders Post Traumatic Stress Disorder Dementia Alcohol & Drugs
- 6. 0 500 1000 1500 2000 2500 all illnesses musculoskeletal disorder stress, depression or anxiety Other Illnesses Rate per 100 000 2001/02 2003/04 2004/05 2005/06 2006/07 I 95% confidence interval HSE statistics 2006/07
- 7. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1996 1998 2000 2002 2004 2006 2007 year nervous system injury and poisoning circulatory and respiratory musculoskeletal other mental and behavioural Source:DWP Administrative data
- 8. 0 200 400 600 800 1000 1200 Hearing Problems Breathing or lung problems Stress, depression or anxiety Lower limbs mainly affected Upper limbs or neck mainly affected Back mainly affected Any musculoskeletal disorder Estimated prevalence (thousands) I 95% confidence interval HSE statistics 2006/07
- 9. 0 2 4 6 8 10 12 6. Alzheimer's/Dementia 5. Trachea/Bronchus/Lung Cancer 4. Chronic Obs. Pulmonary Disease 3.Alcohol Use Disorder 2. Ischaemic Heart Disorder 1. Unipolar Depression 3.01 3.07 3.65 4.08 6.76 10.3 Percent of Total DALYs: US & Canada Data courtesy of WHO
- 10. 2004 Disease or Injury As % of total DALYs Rank Lower Respiratory infections 6.2 1 Diarrheol diseases 4.8 2 Unipolar depressive disorders 4.3 3 Ischaemic heart disease 4.1 4 HIV/AIDS 3.8 5 Cerebrovascular disease 3.1 6 Prematurity and low birth weight 2.9 7 Birth asphyxia and birth trauma 2.7 8 Road traffic accidents 2.7 9 Neonatal infections and other 2.7 10 COPD 2.0 13 Refractive errors 1.8 14 Hearing loss, adult onset 1.8 15 Diabetes mellitus 1.3 19 Rank As % of total DALYs 2030 Disease or injury 1 6.2 Unipolar Depressive disorders 2 5.5 Ischaemic heart disease 3 4.9 Road traffic accidents 4 4.3 Cerebrovascular disease 5 3.8 COPD 6 3.2 Lower Respiratory infections 7 2.9 Hearing loss, adult onset 8 2.7 Refractive errors 9 2.5 HIV/AIDS 10 2.3 Diabetes mellitus 11 1.9 Neonatal infections and other 12 1.9 Prematurity and low birth weight 15 1.9 Birth asphyxia and birth trauma 18 1.6 Diarrheol diseases WHO GBD 2004
- 11. 152.8 69.1 44.9 33.3 20.4 15.5 8.2 6.3 5.9 5 4.3 4.2 3.7 2.6 1.5 1.2 0.5 0.3 0.2 Headache Anxiety disorders Sleep disorders Mood disorders Somatoform disorder Addiction Stroke Dementia Child/Adolescent disorders Psychotic disorders Personality disorders Mental Retardation Traumatic Brain Injury Epilepsy Eating disorders Parkinson's disease Multiple Sclerosis Neuromuscular disorders Brain tumor (million) Eur. Neuropsych. (2011) 21, 718-779
- 12. 8.4 15.1 2.4 sickness absence reduced productivity at work staff turnover £billion © The Sainsbury Centre for Mental Health, December 2007 Business costs of mental ill health at work
- 13. Costs Per Average Employee Total Costs to UK Economy % of Total Absenteeism £335 £8.4 billion 32% Presenteeism £605 £15.1 billion 58% Employee Turnover £95 £2.4 billion 9% Total £1,035 £25.9 billion 100% © The Sainsbury Centre for Mental, December 2007
- 14. Common areas of impairment -Impaired concentration and attention -Impaired motor skills -Impaired communication and social skills -Risk to self and others -Effects of abnormal illness behaviour
- 15. Multiple and complex Suggested by other behaviors…… -Sickness absence -Work disputes -Avoidance behavior Work is associated with better mental health Reduced risk of common mental health disorders compared with unemployment or economic inactivity(1) ……. Reasons for association are complex and debatable Reference: (1) “Is work good for your health and well being”, HMSO; Waddel & Burton; 2006
- 16. Definitions of Stress Work Related Stress is… “The adverse reaction people have to excessive pressures or other types of demand placed on them at work”(1) Stress occurs when(2) … An individual perceives … …They are unable to cope .. …With the demands placed upon them, … … Causing a negative outcome for them. (1) Definition (UK Health and Safety Executive,1999 (2) Centre for Organisational Health and Development, University of Nothingham.
- 17. 0 200 400 600 800 1000 1200 1400 1600 1800 2000 1999 2000 2001 2002 2003 stress musculoskeletal
- 19. STRESSORS INTERACTION OR TRANSACTION OUTCOMES WITHIN DIRECT MANAGEMENT CONTROL •Demands (hours, shifts, job content) •Control (degree of autonomy) •Support (advice, training) •Role (well defined?) •Relationships (colleagues, supervisor) •Change (anticipated, agreed, oppose) OTHER •Home/work Interface •Career ORGANISATION •Sickness absence •Labour relations •High staff turnover INDIVIDUAL •Mental illness •Other illness •Sickness absence INDIVIDUAL
- 20. STRESSORS INTERACTION OR TRANSACTION OUTCOMES WITHIN DIRECT MANAGEMENT CONTROL •Demands •Control •Support •Role •Relationships •Change OTHER •Home/work Interface •Career ORGANISATION •Sickness absence •Labour relations •High staff turnover INDIVIDUAL •Mental illness •Other illness •Sickness absence INDIVIDUAL SECONDARY •Education •Awareness •Support INTERVENTIONS PRIMARY Changing the Environment TERTIARY Dealing with the consequences •Counseling •Occupational Health •Case ManagementPROACTIVE - REACTIVE
- 21. Management Standard Employees indicate that they (are)…. DEMANDS Workload , work patterns and the work environment Able to cope with the demands of their job CONTROL The way employees do their work Able to have a say about the way they do their work SUPPORT Encouragement, sponsorship and resources Receive adequate information and support from their colleagues and superiors RELATIONSHIPS Avoidance of conflict and the management of unacceptable behaviour Not subjected to unacceptable behaviors , eg: bullying at work ROLE Ensuring people understand their roles and the avoidance of conflicting role Understand their roles and responsibilities CHANGE Management of change and how it is communicated The organization engages them frequently when undergoing organisational change
- 22. Gail’s Story Gail is 44 and works as a social worker for a local authority, managing a case load of clients. She has suffered from anxiety and depression in the past. She recently told her manager that she is feeling very anxious and has been suffering from panic attacks. She has been finding it hard to concentrate on writing client reports when she is back in the busy, open-plan office and has difficulty prioritizing her workload. Gail has been to see her GP and is now receiving therapy from the practice’s counselor.
- 23. There is no capacity within the team for Gail’s caseload to be reduced but her manager suggests that they increase her monthly supervision to weekly to discuss client cases and help Gail to prioritize her workload. Gail’s manager also reminds her that she can book a quiet room for a couple of days a week so that she can concentrate on report writing – an option available to all employees. As Gail already has flexitime agreement, her manager agrees for her to come into work later on the day of her therapy. Gail and her manager agree to review these adjustments in a couple of week’s time to see if they are working.
- 24. Mahinder is 35 and as an IT Support Technician for a large company. He has bipolar disorder and has been hospitalized in the past. He has been off work with depression for eight weeks and has kept in contact with his manager over this time. Knowing that Mahinder was considering a return to work his manager referred him to occupational health for advice on what support he may need to return to the workplace. Mahinder attends a back to work meeting with his manager to agree adjustments.
- 25. The Occupational Health physician suggests that Mahinder returns to work on a phased return, gradually building up his hours to full time over 4 weeks. She also suggests that Mahinder introduces his work tasks slowly, concentrating on desk work in the first few weeks and gradually reintroducing customer query facing work which is more demanding. Although Mahinder is feeling a lot better his medication makes him drowsy in the mornings which means that he is unsafe to drive. They agree the adjustments in a live document and agree a provisional date for Mahinder to return to work.