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Occupational Health
Occupational Health: is the science & art that aim at achieving optimum state of physical,
mental & social wellbeing of workers.
Types of occupational diseases:
- Occupational diseases: during doing the occupational work.
- Work related diseases: by occupational stresses as HTN, CHD.
Prevention of diseases
Occupational health services achieved by Early detection of diseases
Promotion of health
Occupational health team: Physician, Nurse, Hygienist
In building
Mining
Causes: Ovens
Improper ventilated areas
Clinical Picture
C) Heat Pyrexia Exposure to extreme heat damage to the heat regulatory center
Treatment: immersion of the patient into ice cold water.
Pre-employment examination
B) Medical Measurements
Periodic medical examination
Salts & fluids intake
A) Air conduction deafness exposure to noise > 150 decibels rupture of drum e.g. in
military explosions.
Gradual decompression
A) Environmental measures
Inhalation of helium to avoid level of dissolved N2
Pre-employment examination
B) Medical Measurements
Periodic medical examination
Silicosis
A fibrotic lung disease produced by inhalation of dust containing Silicon dioxide.
Etiology It is present in sand, sand stone & granite.
In these occupations: Mines, Porcelain manufacture & Glass industry.
Predisposing factors:
1. Duration of exposure (long period 5 — 10 years).
2. Size: Smaller dust particles are more injurious.
3. Concentration: the higher the conc. of dust the more injurious.
4. The presence of free silica in the dust.
5. Personal susceptibility.
Pathogenesis Silica particles are ingested by alveolar macrophages carry them to lung
tissue macrophages disintegrate stimulate fibroblast function & collagen formation,
- Damaged macrophages attract others that ingest released silica particles
Pathology Silicosis nodular fibrosis, layers of collagen (ONION RING APPEARANCE)
Clinical picture DYSNEA
Complications: Tuberculosis.
Corpulmonale as a result of pulmonary hypertension, chronic bronchitis & emphysema
Diagnosis:
1. History of exposure
2. Radiological examination: Nodular shadow
3. Pulmonary function testing FVC, FEV1 below normal levels.
Prevention:
A) Environmental measures to reduce dust below TLV (Threshold Limit Value).
1. Substitution 2. Segregation. 3. Enclose of machines releasing dust.
4. Ventilation 5. Wetting Water is sprayed to precipitate dust.
6. Cleanliness 7. Protective clothes
B) Medical measures:
1. Pre-emp1oyment examination
2. Periodic medical examination 3. Health education.
Asbestosis
Asbestos is a fibrous material obtained from mines; it has an insulating & fire protecting
characters & can resist chemicals.
Hazards:
Cement Asbestos industry (used in roofs, buildings & pipes manufacture)
During manufacture, fixation, or removal of car breaks.
Pathology Asbestos fibers can be found in the terminal bronchiols or penetrate lung tissue
irritation & injury of lung tissues
- When coated with iron rich protieneanous material Asbestos Bodies (found in sputum)
Predisposing Factors:
1. Duration of exposure after 5-10 years.
2. Dose response relationship.
3. Smoking has synergistic effect in production of lung cancer & mesothelioma.
Clinical picture
Dysnea, cough & expectoration (Chest pain is an indication of involvement of pleura)
On examination Cyanosis, clubbing of fingers
Diagnosis:
1) History
2) X-RAY of the chest
Early stages Frosted glass of cob web appearance.
Late stages opacities appear in lower lobes, pleural fibrosis & calcifications, pleural
effusion (in mesothelioma)
3) Sputum examination: ASBESTOS BODIES, Malignant cells may also be seen.
4) Pulmonary function tests: FVC & FEV1 are reduced
5) Bronchoscopy, Lung & Pleural biopsy: to diagnose lung cancer & mesothelioma of pleura.
Complications:
1. Bronchogenic carcinoma.
2. Mesothelioma of pleura or peritoneum.
3. cor-pulmonale.
Hypertension
The elevation of arterial blood pressure over 140 / 90 in adults
Risk
factors
a) Host factors
1. Genetic
- Heredity interacting with the environmental role not all hypertensive patients have
diseased offspring.
- So children of hypertensive parents should be screened & advised to avoid environmental
factors that aggravate hypertension (e.g. smoking, physical inactivity, and excess sodium)
2. Low birth weight
Low birth weight due to fetal under- nutrition followed by ↑ B.P. later in life
3. The role of sodium salt in essential hypertension
- ↑ sodium intake in diet ↑ B.P…
4. Obesity: HTN is common among obese individuals ↑ risk of ischemic heart disease
5. Physical inactivity: Physical fitness prevent HTN
6. Alcohol intake
7. Smoke: Cigarette smoking ↑ B.P., through nicotine release of nor-epinephrin.
8. Hyperuricemia: Present in 25 - 50 % of individuals with untreated 1ry HTN.
9. Ethnic group: Adult blacks have HTN to higher rises of morbidity and mortality.
10. Sex: Before menopause, HTN is less common in women than in men, but after that HTN
is equally common & dangerous in elderly males & females.
11. Age: At old age more HTN cases & age related atherosclerosis.
12. Diabetes mellitus:
HTN & diabetes coexist commonly
Environmental factors
Tension, anxiety & continuous exposure to external stress factors ↑ blood pressure in
normo-tensives but high ↑ in hypertensives.
Prevention of
Hypertension
1. Life style modification:
A) Weight reduction: - ↑ exercise - Use ↓ caloric supplement
B) Avoidance of tobacco
C) Dietary Na restriction
B) K supplementation: Patients should ↓ K depletion & ↑ dietary K intake
E) Mg & Ca supplementation: ↓ B.P.
F) Prevent alcohol consumption
G) Physical exercise
H) Relaxation exercises: ↓ stress & anxiety.
2. Anti-hypertensive drug therapy:
Drugs are used if: - life style modification is not followed or ineffective with the patient
- ↑ HTN at the onset
3. Management of etiology of 2ry hypertension.
Bronchial asthma
Asthma cannot be cured, but could be controlled.
CAUSES
1. Indoor allergens (e.g. domestic mites, carpets & furniture, cats)
2. Family history of asthma or allergy. 3. Tobacco smoke.
4. Exposure to chemicals in the workplace.
5. Drugs: aspirin & NSAIDs. 6. Low birth weight & respiratory infection.
Cancer
Descriptive
epidemiology
Cancers arise from undifferentiated stem that are capable of mitotic division &
differentiation.
1. Age: most cancers develop in the 6th, 7th, 8th decades of life.
2. Sex: cancers of non-sexual sites occur in men than women, except in gallbladder & bile
ducts.
3. Race & Geography: Cancers varies among racial groups in the same country.
This variation is due to: - genetic difference among the races
- Cultural patterns - social behavior - economic status.
4. Time Trends:
- The high ↑ in rates of lung cancer is largely due to cigarette smoking.
- Decline in rates of stomach cancer is unknown but may be related to dietary habits,
(consumption of less preserved & more fresher foods)
- Decline in mortality from uterine cancer is probably due to combination of 3 factors:
1. ↓ number of women who still have a uterus
2. ↑ cytological screening 3. Decline in the incidence of new cases
Etiology & 1ry
prevention
Initiators
- Agents cause the genetic damage to the stem or intermediate cells.
- Ionizing radiation, chemicals & certain viruses
3. Industrial exposures
Benzene Leukemia
4. Drugs not an important cause of cancer (account for less than 1% of neoplasms)
5. Ionizing radiation
- Among the atomic bomb survivors in Japan there were
- High ↑ in rates of carcinomas of thyroid & mammary glands & of leukemias
- Lesser ↑ in rates of lymphomas & carcinomas of stomach, esophagus, & bladder
- Risk of leukemia ↑ in early radiologists who took few precautions against radiation
6. Non-ionizing radiation
8. Infectious agents:
EBV nasopharvnea1 carcinomas
HBV Hepatocellular carcinoma (Hepatoma)
HBV viral DNA cervical cancers
Human immunodeficiency virus (HIV) AIDS
An RNA virus Kaposi sarcoma & non Hodgkin’s lymphomas
9. Nutrition
Aflatoxins produced by fungi liver cancers it some parts of the world.
Food additives May be carcinogenic, the evidence is weak
- ↑ artificial sweeteners ↑ risk of bladder cancer
- ↑ fat diet cancers of colon, breast & prostate
Over-nutrition obesity associated with endometrial & postmenopausal breast cancers
It is a basic need of reproductive health, safe motherhood & child health & survival
Aim of family planning services
1. Avoid pregnancy outside the safe childbearing period (20 —34 years).
2. Allow for having the suitable no. of children & avoid unwanted pregnancy
3. For proper pregnancy spacing.
4. For mothers having chronic disease.
Methods for family planning
1. Natural methods: Safe period, lactation, isolation
2. Mechanical: Condom, vaginal diaphragm, cervical cap, IUD
3. Chemicals: Vaginal foam, tablets & vaginal creams
4. Hormonal: Contraceptive pills
Benefits of Proper inter-pregnancy spacing
For the sake of mother:
1. Protection of mothers from risk of multiple pregnancies & labour
2. ↓ maternal mortality ratio.
3. Malnutrition including teeth decay & osteomalacia.
4. ↓ health hazards of pregnancy & labour: e.g. toxemia & puerperal sepsis.
5. ↓ hazards related to urogenital system e.g. fistulae, uterine prolapse.
6. ↓ hazards of illegal abortion to get rid of unwanted child.
For the sake of foetus
Community Oct. Med. 14 2008
0105068372
↓ Infant mortality rate & ↓ congenital Abnormalities & pregnancy wastage, lethal sublethal.
- Mother give better care nutritional, psychological, education & medical care for smaller
number of children.
For the sake of husband
1) Better psychological & emotional states.
2) Better working for the non loaded father.
For the community
1. Better educational level. 2. Better housing.
3. Increased percapita share. 4. Improvement of health services.
5. The public resources is allotted to industrial & national promotion program.
Outcome of Pregnancy:
1. Favorable: delivery of a healthy live born.
2. Unfavorable i.e. dead baby (called pregnancy wastage),
It is of two types:
• Lethal i.e. abortion, miscarriage, stillbirth, neonatal death & postneonatal deaths
• Sublethal: e.g. congenital anomalies, mental retardation, cerebral palsy, Also prematurity.
Maternal mortality
Maternal mortality: a biostatistical index which monitors the safety of the reproductive
process through which mothers in the reproductive age might pass through.
The interaction between the maternal fitness & environmental factors would determine
the process of maternity and its outcome part of which is the maternal survival
- Maternal mortality is death of women during performing their maternity function at
pregnancy, delivery or puerperium.
Maternal Mortality is one of the main indicators of the health status & welfare of a
community.
Ecology of maternal mortality
Agent
- Failure of adaptation to pregnancy, delivery or puerperium.
- Occurs when the stress of the maternity process exceeds the vital reserve of the mother.
Host
- Mothers who are intolerant to maternity stress might be due to:
1. Limited vital reserve due to constitutional factors
2. Incomplete recovery of their vital reserve due to previous maternity or other stressing
factor (recovery needs 2 years at least).
3. Morbid condition whether limiting her vital reserve to the maternity process.
• Endocrine Balance: Pregnancy & delivery are the stresses to which mothers are exposed.
- MCH centers are responsible for care of under 5 years children (from birth to school age),
& include infants & preschool children.
Objectives of the child health care program
1. Monitoring of growth & development of children.
2. Implementation of the program of compulsory (obligatory) vaccination to prevent diseases.
3. Treatment of common diseases & early detection of critical cases to be referred to
specialized clinics.
4. Control of infectious diseases.
5. Minimization of under 5 years mortality.
6. Prevention of diarrhoeal diseases as well as respiratory tract infection.
7. Health education.
8. Rehabilitation.
Health problems among
children
(1) Morbidity (2) Mortality
I. Infectious
diseases
- Infection is a health problem in developing countries.
- It may be congenital or acquired.
(a) Congenital infection
It is in utero infection (vertical infection)
- Transmitted from the mother to her
- embryo (during the 1st trimester) before formation of placenta
- fetus (trans-placental infection)
N.B. Congenital infection lead to unfavorable outcome of pregnancy which is lethal
(abortion, still birth) or sublethal (congenital anomalies or congenital diseases e.g. Syphilis,
Rubella syndrome, , AIDS)
Forms of congenital infection: Syphilis, rubella, cytomegallo inclusi5n virus, hepatitis B virus
infection, AIDS, Toxoplasma gondii.
IV-
Accidents
Below-five-year children are exposed to Varity of injuries starting from birth injuries, home
& road injuries.
V- Social
disorders
Contributing factors
1) Big family size & low percapita income.
2) Poor housing & high crowdness index
3) Low socioeconomic standards
4) Separation of parents (loss of love & security)
5) Mother’s Employment (lack of close with mother)
VI- Handicapping
(Disability)
Definition: Any physical, mental, social or psychological morbidity that interferes with
leading normal life & activities.
Prevention:
Congenital disability could be prevented through premarital, preconceptional & pre- natal
care.
1. Premarital care
a. Premarital counseling & examination for diagnosis & treatment of sexually transmitted
diseases, genetic counseling to avoid hereditary diseases.
b. Vaccination in non immune couples; females are vaccinated at least 3 months before
pregnancy.
c. Health education for healthy life & avoid any harmful practices that may affect
pregnancy.
2. Prenatal care: to ensure healthy safe intrauterine growth & development & to avoid
adverse intrauterine.
3. Health education: It is a continuous process to preparation of girls to be the future
mothers. It is continued till child birth.
- Quality of technical care consists of: application of medical science & technology in a
manner that maximizes its benefits to health without increasing its risks.
- Degree of quality is, the extent to which the care provided is expected to achieve the
most favorable balance of risks & benefits.
- Quality of health care is a process of change or fully meeting requirements of lowest cost
or more specifically full meeting the needs of consumers
Quality:-
- Doing the right thing Appropriate.
- Doing the right thing right Effective.
- Doing the right thing for 1st time & every time Efficient.
How change?
1. Cooperation 2. Involvement 3. Education 4. Management 5.
Resources
- The costumer: Expectation & rights & satisfaction,
• Measuring Quality?
- Structure
- Process
- Outcome
Total Quality Management (TQM)
Definitions: • Definitely customer focused.
• Philosophy, concepts, tools & techniques focused.
• Emphasis in employee involvement.
• Continuous improvement and TQM a never ending journey.
• Organization wide-all departments function and level.
• Everyone responsible for quality.
• Involves process and culture change.
TQM
• Total Quality management is about improvement.
• Improvement requires change
• The change process requires consensus between all concerned.
• Education & training may assist the process of change but it is not sufficient by itself
changes in the organization’s policies, structures & technical systems are also likely to be
necessary.
Practical approach of TOM
Family Medicine
Principles of Family Medicine
1. Continuity of care 2. Comprehensive care
3. Coordinated care 4. Care of patient in the family context
5. Health care in the community context.
1. Continuity of care
Family practice is defined as the medical specialty that provides continuity and
comprehensive health care for the individual & the family.
2. Comprehensive care
Family practitioners can provide independent care for 85 90% of problems
encountered in daily practice.
- Comprehensive care may be synonymous with personal medicine.
- Personal medicine is a process of providing broad-based health care which both physician &
patient recognize that the relationship extends beyond that of provider and client.
- When providing personal medicine, the physician may act as advisor, advocate, confidant or
healer.
- The concept of the “five-star doctor” is an ideal profile of a doctor possessing a mix of
aptitudes to carry out the range of services that health settings must deliver to meet the
requirements, quality, cost-effectiveness & equity in health.
- The five sets of attributes of the “five-star doctor” are summarized as follows:
Vaccination Schedule
• Sabin (poliomyelitis).
- 3 drops on tongue
• Hepatitis B vaccine.
2nd month - 0.5 ml IM
• Quadruple vaccine
- 0.5 ml IM or deep subcutaneous.
(OPT + polio salk)
• DPT.
18 to 24th • MMR (measles, mumps, - 0.5 ml IM. 0.5 ml subcutaneous.
month Rubella) - 3 drops on tongue.
• Sabin (polio).
Reproductive health
A state of complete physical, mental, & social wellbeing & not merely the absence of disease
or infirmity ()عجز, in all matters related to the reproductive system & to its function &
processes.
Components of Reproductive Health
I. Health promotion of females, from birth, childhood, adolescence & childbearing period.
II. Safe motherhood.
III. Family planning service.
IV. Prevention & management of:
• Complicated abortion.
Health record
It is a file initiated at birth of any child & follows him (her) to school & through the whole
life, for registration of all concerning health & morbidity.
Contents of health record
1. Birth data (date, weight, length, head circumference and any detected abnormality.
2. Results of health appraisal at the periodic visits to the MCH center as.
a- General health status & body built.
b- Growth monitoring by anthropometric measurements plotted on growth chart for early
detection of any deviation from normal to be managed.
c- Criteria of developmental milestones according to age.
3. Vaccinations given, by date & age.
4. Curative services provided on morbidity & referral if any value of health record.
Value of health record
1. Follow-up and growth monitoring.
2. a data for statistical analysis for comparison between countries, current & past states.
Infant mortality rate IMR: The infant is the baby in his first year
Morbidity Statistics
Incidence Rate =
Prevalence Rate =
Measures of fertility
FEV1: Forced Expiratory Volume in the first second. The volume of air that can be forced
out in one second after taking a deep breath, an important measure of pulmonary function.
Fibroblasts cells of connective tissue play a critical role in wound healing.
Mumps: an acute contagious disease, usually affecting children, that causes a fever with swelling of
the salivary glands and sometimes also affects the pancreas and ovaries or testes. It is caused by a
virus and can be prevented through vaccination. It may cause sterility if contracted by a man.
Rubella: a highly contagious viral disease, especially affecting children, that causes swelling of the
lymph glands and a reddish pink rash on the skin. It can be harmful to the unborn baby of a
pregnant woman who contracts it.