Week 8 Flashcards

Question

Occ. disease cancer

Answer 1

Caused by following agents in workplace examples: -asbestos, bis-chloromethyl ether BCME, chromium VI compounds, coal tars, coal tar pitch, beta-naphthylamine, vinyl chloride, benzene, ionising radiations, mineral oil, nickel compounds, wood dust, beryllium and its compounds, cadmium and its compounds

Answer 2

Pneumoconioses- fibrogenic mineral dust, mining, quarrying, sand blasting, grinding of granite Chronic obstructive pulmonary diseases: coal dust, wood dust, paper dust etc Upper airway disorders- sensitising agents or irritants Asthma- sensitising agents (epoxy resins, enzymes, flour dust) or irritants

Answer 3

Allergic contact dermatoses and contact urticaria causes recognised allergy- provoking agents arising from work activities Irritant contact dermatoses caused recognised irritant agents arising from work activities

Answer 4

An occupational history is a chronological list of all patients employment, expanded as necessary to detail any evidence of occupational exposure to potentially hazardous agents and resulting effects on health Most effective instrument: -to determine if there is evidence that work is a likely cause of ill health (diagnosis of disease) -diagnosis will lead to better management or appropriate referral -for assisting return to work after injury or disease if it helps to identify shortfalls in health or fitness against required standards

Answer 5

Systematic questioning of current and previous work and associated history Procedures: -oral questioning about current job -oral questioning about previous jobs -proforma about previous jobs -proforma in own time and oral questioning- probably gives best chance of full and accurate account and is economic with OH practitioner time

Answer 6

Need to first establish the type of disease/disorder and whether the sign, symptoms, clinical features fit with what is known about the health effect Example: baker reports respiratory symptoms

Answer 7

There must be indication of sufficient occupational exposure Exposure information on hazards -type eg chemical substance, noise, radiation -level and duration of exposure -when exposed (specific job tasks) -potential health effects

Answer 8

Evidence of occupational exposure may be obtained from: -occupational history -results of exposure survey at work: personal environmental or biological monitoring data samples -exposure records: workplace risk assessments

Answer 9

Reported signs and symptoms may be supported in some cases by suitable tests eg spirometry, audiometry, vision testing, patch testing Examples: -extent of hearing loss and type -allergic reactions to substances used at work -decrement in lung function

Answer 10

When in relation to exposure do/did the symptoms start -exposure must be prior to start to symptoms

Answer 11

Do the symptoms improve when no longer exposure Peak flow variation between workdays and weekends

Answer 12

Exposure (level must be sufficient to cause the disease) Are the symptoms especially worse when undertaking high exposure tasks or when areas with high exposures

Answer 13

Do other workers suffer similar symptoms associated with the same exposures

Answer 14

Non-occupational conditions that have similar clinical features as the occupational disease: -non occupational exposure -environmental -social (smoking, alcohol) -hobbies, pets -medical history -family history/genetic Need to also consider other employment

Answer 15

Minimum intensity level of exposure required to cause disease Minimum duration of exposure Maximum latency periods- length of time between from cessation of exposure beyond which it unlikely that the disease can be attributed to work Minimum induction period-shortest period form beginning of exposure to beginning of disease below which the exposure would have been unlikely to caused the disease

Answer 16

Temporality Reversibility Exposure- response Strength of association Specificity Consistency Analogy Biological gradient Biological plausibility Principles than be useful in establishing epidemiological evidence of evidence a causal relationship between presumed cause and an observed effect The larger the association between exposure and disease the more likely it is to be causal

Answer 17

Reporting of injuries, diseases and dangerous occurrences regulations 2013 RIDDOR requires employers and other people in control of work premises to report and keep records of RIDDOR- record and report: -work related accidents which cause death; -work related accidents which cause certain serious injuries (reportable injuries) -diagnosed cases of certain industrial diseases -certain dangerous occurrences i.e incidents with potential to cause harm

Answer 18

CTS- work involves regular use of percussive or vibrations tools Severe cramp of hand/forearm- prolonged periods repetitive movements Occupational dermatitis- regular exposure to known skin sensitisers or irritants HAVS- regular use of percussive or vibrating tools or holding of materials which are subject to percussive processes Occupational asthma- significant or regular exposure to a known respiratory sensitisers Tendonitis or tenosynovitis of hand forearm- where the persons work is physically demanding and involves frequent, repetitive movements Any cancer attributed to an occupational exposure to a known human carcinogen or mutagen Any disease attributed to an occupational exposure to a biological agent

Answer 19

Benefit of being in work: -improves general and mental health -reduces psychological distress and minor psychiatric morbidity -minimises the harmful physical, mental and social effects of long term sickness absence -reduces the risk of long term incapacity -improves quality of life and wellbeing

Answer 20

Is to ensure the individual is fit to perform the tasks required for their job effectively and without risk to their own or others health and safety

Answer 21

Patients condition may limit or prevent them form performing job effectively The patients conditions may be made worse by the job and the work environment Patients condition makes certain jobs and work environment unsafe to them personally Patients condition may make it unsafe both for themselves and others Patients condition may pose a risk to the community

Answer 22

Post offer (pre placement) RTW after sickness absence Job change- role or work demands Periodic review relating to specific RTW after injury or illness Possible retirement on grounds of ill health

Answer 23

Self referral Management referral -sickness absence (short and long term) Human Resources

Answer 24

Standard referral form Seen and signed by worker Consultation with OH professional 30-60 mins assessment History, examination (investigations) Report explained to individual Option to see report before its sent Dual responsibility of OH professionals

Answer 25

A GP is rarely involved with determining fitness to start work Normally the employers responsibility (with advice from their OH advisor)

Answer 26

A GP is often involved in assessing fitness to return to work RTW Fundamental questions: -does the patient want to RTW -does patient need to be symptom free before RTW - is some work feasible

Answer 27

Many people with health conditions can work as they recover from their condition Work can aid recovery and benefit the employer by reducing sickness absence Need to focus on what individual can do rather than incapacity Introduced in 2010 doctor to advise if an employee may be fit to work with some support Tick Boxes for doctors to use to suggest common ways to help a return to work Note: -certification for statutory sick pay (and other benefits) -advisory (to the patient), not an instruction

Answer 28

The patients occupation is not always recorded The patient is not asked about their work GPs don’t feel trained to use to fit note and rarely advise someone might be fit GPs often don’t understand occupational health

Answer 29

Effects of health on work Effects of work on health Workplace adjustments/adaptations etc required for employee to work safely Communicate outcome and recommendations Equality Act 2010

Answer 30

A functional assessment of the individuals capacities will be of most use when as much is known about the job as about the individual assessed

Answer 31

Patient details Reason for referral Sickness absence record Current job- job tasks/ environment/hours/shifts/night worker Occupational history Presenting complaint, diagnosis may or may not be available History of presenting complaint- medication Past medical, social and family history Functioning and leisure activities Physical examination as required Additional assessment Questionnaires Spirometry, audiometry, vision, workplace assessment

Answer 32

Advise the individual on the impact of their medical condition for safe driving Advise individual on their legal requirements to notify the DVLA of any relevant conditions Notify the DVLA when fitness to drive requires notification but individual cannot or will not notify the DVLA themselves The driver is legally responsible for informing the DVLA

Answer 33

Unlawful for employer to discriminate against workers including job applicants on grounds of medical disability it requires that all reasonable steps be taken to accommodate their health problems

Answer 34

Definition of disability: physical or mental impairment and the impairment has a substantial and long term adverse effect on their ability to carry out normal day to day activities

Answer 35

Fit Unfit (physically, mentally incapable of performing task) Fit with restrictions/adjustments Cannot make assessment with further information

Answer 36

When is the likely date of RTW Will there be any residual disability upon RTW Will it be permanent or temporary Will the employee be able to render regular service If the answer to 2 is yes what duties would you recommend that your patient does not do and for how long Will your patient require continued treatment or medication upon RTW

Answer 37

Written recommendations to manager/HR Discuss content of report with employee Offer to show report to employee before it is sent (written consent) Copy to employee Copy to GP Arrange follow up assessment

Answer 38

Management commitment Employee involvement Education Team approach (long term absence) -HR, management, OH, clinicians, OT Monitor/identify on going risks Effective use of rehabilitation and health facilities

Answer 39

Encourage patient to keep in touch with work Reduced hours: half days/phased return Change pattern of work/shifts Change tasks or work content Adapt the workplace: alter layout Reduce pace of work: frequent or longer breaks Adapt equipment Provide training Provide for mobility and transport Redeployment- temporary or permanent Access to work

Answer 40

Identify hazards Decide who might be harmed and how Evaluate the risks and decide on precautions Record your findings and implement them Review your assessment and update if necessary

Answer 41

Job title alone may be insufficient need to understand job tasks, work environment and work organisation Example job titles in a foundry : -“ forge worker” -‘stamper’ -‘laddle person’ -foundry operative -die caster

Answer 42

Observation of work practices and the work environment Supplier data sheets Records on site Published literature

Answer 43

Type of hazards (classification) Where present Hazard characteristics Who is exposed and number exposed Exposure circumstances- how and when Measures used to minimise risks to health

Answer 44

Physical Chemical Biological Psychosocial Ergonomic Mechanical Safety

Answer 45

Machine operators Supervisors Maintenance staff Other workers in area Cleaners-waste disposal Visitors

Answer 46

Hazard routes of exposure Concentration of substance Potential health effects- acute and chronic Potential effects of combined exposures Areas of body exposed (dermal) Target organs

Answer 47

Environmental (ambient): -personal: inhalation (breathing zone), dermal,noise, vibration, radiation -fixed point sampling (static): thermal, light Biological: -blood, urine, exhaled breath Compare measured personal exposure levels with occupational exposure limits OELs OELs are set by the HSE for different hazards types and used by employer to demonstrate compliance. OEL are either based on a threshold or non-threshold concept

Answer 48

What control measure are used to minimise the risk How effective are the control measures Hierarchy of control: -elimination -substitution -engineering controls -administrative controls -PPE

Answer 49

What is HS: putting in place systematic, regular and appropriate procedure to detect early signs of work related ill health among employees exposed to certain health risks; and acting upon the results Purpose of HS: -early identification of effects of exposure to hazards at work -assess effectiveness of control measures in the workplace -identify individuals who may be more susceptible -make decisions on fitness for work

Answer 50

Identifiable disease or effect related to exposure Reasonable likelihood that disease will occur under conditions of exposure Valid technique for detecting indication of disease or effect

Answer 51

Who is at risk Risk of what -acute and chronic health effects Likelihood of work related Ill health Action plan to minimise risk further

Answer 52

Any changes which effect the level of risk to employees examples changes in the following: -substances/tool used -methods of work -production methods -finding from HS

Answer 53

Substitute hazards for less toxic Change methods of work Improve control measures or their effectiveness Increase the level of health surveillance Additional training for those exposed