Occupational Health Flashcards
What are the effects of work?
Galen - “Employment is nature’s physician and is essential to human happiness”
‘Good’ work is generally good for health and it is a social determinant of health
What can worklessness need to?
- Poorer physical and mental health (earlier mortality)
- Poorer mental health
- More medical scare
- Poorer social integration
- Loss of self-confidence
- Less monetary resources
- Effect on next gen e.g. child deaths from injury correlating with low employment status and worklessness of parents
What is the main problem at the moment with employment?
There are too few drivers keeping people in work that are sick as employers find it easier to just get them out of work without offering OH support and the states main interventions are focused on the after job-loss period so there are huge delays in assessing benefit claimant’s work capability
What are the stages of sickness from work and claiming benefits?
4 days-28 weeks: sickness absence and statutory sick pay (a lot of ESA claimants still come straight from work w/o a period of support from employer)
39 weeks: claim to employment support allowance (ESA) and work capability assessment
This can result in:
- ESA benefit and support
- Job seekers allowance benefit and support
- Work
- Economically inactive
How does ill-heath affect cost of those in employment?
- State: sickness benefits, healthcare costs and loss of tax
- Employers: sick pay etc.
- Employees: lost earnings
What factors encourage the ‘sick role’?
- Culture, beliefs and attitudes: misconceptions about health and work (e.g. need to be 100% fit) and poor retention in work of those with disabilities or chronic disease
- Inadequate systems: no pathways of rapid intervention to keep you in work or return to it
- Lack of primary care involvement: rehab to work not a performance measure for healthcare and lack of OH advice
What is included in the Improving Lives paper 2017?
- Disability employment gap: support for disabled in and out of work
- Give people with long-term health conditions timely and appropriate health and employment support so their participation in work is not at risk
What does the future of employment look like?
Life expectancy is increasing along with retirement age but not disability free years so we want to prevent early retirement from ill-health and stop the health inequality of low socio-economic status having adverse health effects and high socio-economic status having health benefits
What is occupational health?
A discipline concerned with the effects of work on health and the influence of pre-existent health problems on the capacity to work i.e. work on health and health on work effects
What are the main aims of occupational health?
- Promotion/maintenance of highest degree of physical, mental and social well-being of workers in all occupations
- Prevention of departures from health caused by working conditions
- Placing and maintenance of worker in an occupational environment adapted to his/her physiological and psychological capabilities
How has the nature of work changed?
- Manufacturing -> service industries
- Physical -> sedentary
- Fixed products -> variety of products
- Large firms -> small and medium enterprises
- Strong unions -> reduced membership
- Job for life -> portfolio careers
- Long contracts -> mobile workforce
- Full time -> part-time/flexi-time
- Male workforce -> diverse workforce
- Women at home -> women at work
- Retire at 65yrs -> work beyond 65yrs
What causes work-related ill health?
- Industrial revolution: accidents, poisoning and MSK
- Current: mental health (depression/anxiety) and MSK for example skin (e.g. contact dermatitis), respiratory (e.g. adult onset asthma) and infection
What is a hazard?
Something that might cause harm
What is a risk?
The likelihood of harm actually occurring
What are the steps of a risk assessment?
- Identify hazard i.e. could there be a problem?
- Assess risks to health
- Manage/control the risks e.g. what do I need to do to eliminate/control the problem?
What are the different categories of a hazard?
Physical Chemical Mechanical (ergonomic) Biological Psycho-social/organisational
What can cause hazards for a junior doctor?
Patients
Investigations
Therapeutic agents
Environment
Give actual examples of hazards that junior doctors come face-to-face with.
Biological: infectious agents from inoculation injury
Chemical: aldehydes, anaesthetic agents, antineoplastic drugs and latex
Physical: ionising radiation and manual handling
What are some examples of psychosocial hazards?
Working hours/shift systems Bullying Workload Commuting/parking Home-work interface Stress
What types of self-reported illness are made worst by work?
Stress, depression or anxiety
MSK disorders
Etc.
What is the most common self-reported illness and the reason for most lost working days?
Mental health problems as fit notes are often given by GPs signing people off from work - MSK is next
What types of mental health problems affect people most commonly?
Mental health conditions Poor sleep Worry Fatigue Irritability
What can affect a persons mental health at work?
- Demands: workload vs perceived capacity or domestic/family
- Control: pace and organisation of work
- Support: colleagues, managers, human resources and OH but also outside support e.g. specialist agencies, health professionals, family and friends
What are the key impacts of mental ill health?
Large employment gap High unemployment rate Loss of productivity Health care costs Doubled poverty risk Disability
What are the clinical and psychosocial factors regarding back injury in the work place?
Fear of re-injury High physical demand job Low expectation of return to work Low job satisfaction Low support Lack of adjustments Poor communication
What are examples of work-related neck and upper limb disorders?
Shoulder pain Epicondylitis Tenosynovitis Non-specific diffuse forearm pain CTS
What are risk factors for carpal tunnel syndrome (CTS) development?
- Prolonged and extreme wrist flexion
- Forceful and repetitive wrist movement
- Direct pressure on the carpal tunnel
- Use of hand-held vibrating tools
What must you do for patients who come in with work-related neck and upper limb disorders?
- Establish anatomical diagnosis
- Consider work-related risk factors by asking the patient what they do at work in functional terms
- Exclude recreational risk factor
How can the risk of upper limb disorders at work be decreased?
- Improved ergonomics of tool design, equipment and work layout to improve posture, reduce forces and repetition
- Job rotation to reduce time at a repetitive task
- New employee to work at a slower rate initially
- Forced rest breaks to allow recovery time
- Redeployment if the above measures aren’t effective
- Rehab of affected workers e.g. reduce hrs, work-rate etc.
What types of occupations increase the risk of occupational asthma?
- Carpenters due to wood dust
- Electronic soldering due to rosin
- Bakers due to flour and enzymes
- Paint sprayers, polyurethane foam and glues/laminates due to isocyanates
What is the key characteristic feature of occupational asthma when taking a history?
Symptoms improve on days away from work
How can you recognise a work-related health problem?
History
Exams
Investigations
What is an occupational history?
The most effective instrument for the proper diagnosis of occupational disease
What questions do you ask in a occupational history?
- What is your job?
- What do you do in your job? I.E. What tasks do you do? What do you work with? E.G. chemicals, vapours, gases, dusts, fumes, tools etc.
- How long have you been doing this job?
- Do you have any other jobs?
- Have you done any different kinds of work in the past?
- Have you been told anything you use at work may make you ill?
- Has anyone at work had the same symptoms?
- Domestic exposures to work agents?
- Do you have any hobbies e.g. DIY or gardening that bring you into contact with chemicals?
What do you ask in a occupational history for long latency conditions?
- Have you done any different kinds of work in the past?
2. What were you exposed to?
What are examples of long latency conditions?
Asbestos exposure induced problems e.g. asbestosis and mesothelioma (usually due to gas exposure in gas mask production)
How do you assess for work and promote return to work?
- Medical certification
2. Sickness absence and rehabilitation
Who’s responsibility is it to assess fitness for work?
A GP is rarely involved with determining fitness to start work it is normally the EMPLOYER’S responsibility (with advice from their Occupational Health Adviser)
What is the key clinical outcome that indicates treatment success when assessing a patient’s health?
Return to work - needs to be integral part of management plan because after 6 weeks sickness absence 1/5 people leave paid employment
Why types of illness certificates exist?
Sick absence self-certification for up to 7 days
Medical certificate or ‘fit note’ (med 3) beyond 7 days but can come back to work before that if fit to do so
What is a fit note and what is its role?
Medical certificate that provides certification for statutory sick pay advising patients about period of sickness absence and employers about suitable adjustments - facilitates return to work through communication with doctors, patients and employers
When must you complete the comments box of a fit note?
When you have ticked “may be fit for work” - MAY be useful even if you have ticked “not fit for work”
What must be put in the comments box of a fit note?
Ticked “may be fit for work”:
- What can they do?
- Amended duties (activities to be avoided too)
- Altered hours (changes to times/duration of work or rest breaks)
- A phased return to work i.e. gradual increase in work duties or hours
- Workplace adaptations
- Redeployment
What part of the fit note is mandatory and why?
The assessment of fitness again at the end of fit note because it gives patient an indication as to whether they can expect to be fit for work and when the fit note expires, helping them and their employer to plan for future
Who does The Equality Act 2019 Disability Discrimination affect?
People with a physical or mental impairment that has a substantial and long-term adverse effect on ability to carry out normal day-day activities such as getting dressed, preparing a meal, walking, using transport, reading and understanding material
How are people assessed for a disability?
Without medication, prosthesis or other aid as without them he/she would be substantially impaired or disabled
What should workplaces do for disabled employees?
Make reasonable adjustments to avoid putting them at a disadvantage compared to non-disabled people in the workplace including hours and equipment
Are occupational health services a part of the NHS?
No
Is there a legal obligation for employers to provide an occupational health service?
No
What are the roles of the occupational health team?
- Provide independent and impartial advice to employer and employee
- Investigate and diagnose those who are sick or injured due to their work
- Assist return of sick and injured to work ASAP
- Matching people with jobs appropriate to health, fitness and susceptibility status
What is the role of the Health and Safety Executive?
- Shaping and reviewing regulations
- Producing research and statistics
- Enforcing law
What scheme comes into affect when a person is returning to work? What type of help do they provide?
Department of Work and Pensions Access to Work scheme which is free and individualized providing:
- Special aids/equipment
- Adaptations to equipment
- Travel to and in work
- Mental Health Support Service
