Ma. Gia Baquiran- Sison, MD MOH DPCOM

Diplomate, Philippine College of Occupational Medicine

Consultant, World Health Organization, Western Pacific Region

Medical Director, Meralco Corporate Wellness Center

Consultant, Makati Medical Center

Masters in Occupational Health, University of the Philippines Manila

Masters in Occupational Medicine, University of Illinois Chicago

Outline of Presentation Definition of the practice of Occupational

Medical The Role of Emergency Medicine in

Occupational Medicine Global trends and Conditions that affect

Occupational Medical Practice Local trends in Occupational Medicine in the

Philippines Emerging health trends in the workplace Conclusion and Recommendations

What is the practice of Occupational Medicine? Occupational Medicine is a medical

discipline that emphasizes prevention and deals clinically and administratively with the health needs of both individuals and groups with respect to their working environment and includes recognition, evaluation, control, management and rehabilitation of occupationally-related diseases and injuries.

Role of ER Medicine in Occupational Medicine

1985: ACEP established the Occupational Medicine Committee to evaluate and develop the role of the ER physician in Occupational Medicine.

1986: ACEP defined 6 areas of Emergency Medicine which is inclusive of an area in Occupational Medicine

Role of ER Medicine in Occupational Medicine ACEP statement: “ The ER physician

with additional qualifications and/or special competencies may engage in the provision of initial care and continuing Occupational Medicine services including illness and injury prevention, case management and patient rehabilitation.

Initial Management of Patients at the ER presenting with a Work-related Injury or Illness

Established policy of ACEP last 1998 Delineates ER physicians’

responsibilities in the following areas:Provision of emergency evaluation and

treatmentDetermination of medical causationEstablishment of physical limitationsCommunication with the employerArrangement of appropriate follow-up care

Global Trends and Conditions Affecting Occupational Medical Practice Migration of Industry to developing countries Migration of workers – OFW’s, seamen Increase in the Business process outsourcing ( BPO)

business Demographic changes in nearby countries Emerging new diseases and conditions Increased Travel

Top Outsourced Industries in the Philippines Manufacturing Industry – microchips, cars,

telecommunication equipment Agricultural Industry – pineapple, vegetable oil,

biofuels Service Industry – BPO (call centers), medical

transcription and coding, accounting/billing Health Services – medical tourism Retirement Industry

Local Trends in Occupational Medicine in the Philippines

Increase in BPO companies (call centers) – SHIFT WORK problems

Computer chip industry relocations Heavy industries (shipbuilding, oil refineries) to Export

processing zones Outsourcing of health services by companies Growth of HMO’s and health plans Enforcement of Occupational Health Laws as mandated

by the Department of Labor and Employment

Philippine Labor Standards in the Occupational Health Practice• Based on Rule 1960 of the DOLE-BWC Standards in

Occupational Health and Safety and the Philippine Labor Code

• In all workplaces where there is more than 1 work shift in a day, the employer shall in addition to the requirements of the rule, provide the services of a fulltime first-aider for each work shift.• Workers 10-50: first aider• 50-200: full time registered nurse • 201-300: full time RN, parttime MD, parttime dentist• 301 above: full time RN, full time MD, full time dentist

General Features Work as one of the causes. Both workers and non-workers are affected. Increase in the NCDs (diabetes,

hypertension, coronary artery disease in the young)

Has impact in health cost utilization Emphasis must always be towards the

preventive side and fitness to work should be highly considered.

Top Occupational Health Issues in the Workplace Infectious diseases Bronchial asthma Skin diseases Cardiovascular diseases Gastrointestinal-related diseases Cataract, deafness Acute poisoning

Based on the Philippine National OSH Profile, Sept. 2010

Occupational Health Issues in the Business Process Outsourcing Increasing number in NCDs (diabetes, hypertension in the

young) Shift work related health issues Ergonomic-related health issues such as Repetitive Strain

Injuries (RSI) Psychosocial factors (job satisfaction, personality traits,

perception of intensified workload, job control)

Sample Shift Schedules in the BPO Industry

8 hour shift/ 37.3 hours per week/ 6 days on, 3 days off

10 hour shift/ 40 hours per week/ 6 days on, 1 day off

24 hours shift/ 56 hours on the average per week/ 7 days on but rotated every 9 days

Re-Emerging Health Issues in the Workplace Increase in HIV-AIDS Increase in Respiratory diseases, UTI,

Gastrointestinal-related diseases, Cardiovascular diseases

Persistence of Obesity as number one in annual physical examinations

Resurgence of PTB Substance abuse

Demographics: Population

Demographics: Gender

Demographics: Marital Status

Demographics: Age

Demographics: Body Mass Index (BMI)

Demographics: BMI by Gender

Demographics: BMI by Age

Smoking History

Smoking History by Age

Drinking History

Drinking History by Gender

Drinking History by Age

Prevalent Illnesses based on Annual Physical Examination

Medical Conditions by Gender

Medical Conditions by Age

Medical Conditions by Drinking History

Medical Conditions based on Smoking History

Top Illnesses based on Doctors’ Diagnosis Acute Tonsillopharyngitis Upper Respiratory Illness Gastrointestinal-related Disorders Tension Headache/ Migraine UTI Hypertension Conjunctivitis Musculoskeletal strain Systemic Viral Illness OB-related

Top Reasons for ER Conduction

Gastrointestinal-related disorders Cardiovascular-related disorders Respiratory-related Pregnancy-related Asthma Accidents Anaphylaxis

Top Reasons for Sent Home Cases Conjunctivitis ATP GI-related Disorders URTI Tension Headache/ Migraine Systemic Viral Illness Hypertension Musculoskeletal disorders Dental-related disorders UTI

Occupational-related Contributing Factors Repetitive activities Shiftwork-related Forceful exertion Awkward/static posture Temperature extremes Localized mechanical stress Lifestyle-related factors such as eating

habits, smoking and drinking

New Trends in Occupational Health To predict individual susceptibility to a

substance/ certain disorders To estimate internal exposure or early

biological effects by molecular bio- markers or biological monitoring

Monitor exposure especially for carcinogens like toluene and pesticides

New Trends in Occupational Health Introduction of Medical Case Management Fitness for Work specialty Enforcement of health and wellness

programs in the workplace

References in Occupational and Environmental Health Medline via PubMed:

www.ncbi.nlm.nih.gov/entrez/query.fcgi TOXLINE and Hazardous Substances

Data Bank: http://toxnet.nlm.nih.gov/index.html

IRIS (Integrated Risk Information System): toxic doses of substances in the environment

NIOSHTIC-2: www.2a.cdc.gov/nioshtic-2

CONCLUSION

Knowledgeable in global trends and their effects on Occupational Medical Practice

Recent trends and developments in Occupational and Environmental health

Managed care and its tools to ensure quality of care and cost-effectiveness

Medical professionals should be advocates of change in the workplace and be of GOOD influence to patients/workers