Occupational Healthby Anna Harrington
The effects of some specific health issues
When considering the impact of any of ill health condition on an individual’s ability to work, it is essential to recognise that although there may be similar symptoms and signs the effect these have on the individual will vary. This is because illnesses will affect individuals to a greater or lesser degree; in addition, coping mechanisms and motivations will vary, as will responses to treatments. The way the individual is treated and managed within the workplace will affect their ability to work effectively and their motivation to attend work. Each person must be assessed as an individual. Below are some common health conditions, with their symptoms, that could affect work or be exacerbated by work.
Both these terms are commonly used in the population, but are also clinical/medical terms. It is important to recognise that there is a continuum between feeling occasionally mildly anxious (either as a natural state or in response to an event – trait anxiety) or having the ‘blues’/feeling down and clinical anxiety and depression.
Again, within the clinical terms anxiety and depression, there are wide variances and a range of more or less debilitating illnesses.
- Disturbed sleeping, overpowering feeling of sadness, inability to focus, irritability, withdrawal, listlessness, pain
- Can affect work through the following areas:
- Impaired concentration
- Impaired motor skills
- Impaired communication, judgement, decision-making and social skills.
Diabetes is a condition that prevents the body from controlling the amount of glucose in the blood stream and cells. This then affects body functions and performance. There are two recognised types of diabetes: type 1 and type 2. Type 1 requires individuals to receive regular injections of insulin; type 2 is generally controlled through oral medication. Both types are also managed through lifestyle factors, such as controlling the amount and type of carbohydrate, sugar and alcohol intake, activity levels and perceived stressful events.
- Increased thirst
- Passing water frequently, especially at night
- Tiredness and fatigue
- Loss of weight
- Genital itching or recurrent thrush
- Blurred vision
- Recurrent skin infections
- Reduced peripheral circulation which can affect sensation (feeling).
More significant, in terms of work, is the need for regular healthy food intake, testing of blood/urine, administration of medicine (oral, injection and inhalation) and increased need for exercise.
The risks from an employment perspective relate to hypoglycaemic attacks, peripheral nerve changes affecting circulation and sensation and possible visual impairments. It is necessary for occupational health professionals to assess each individual, especially in the case of occupations which have a safety critical aspect or require shift work.
Epilepsy is not an illness in itself but a symptom of an underlying problem. The underlying problem may not be known. There are three main groupings of causes:
- Idiopathic – which relates to a genetic predisposition
- Symptomatic – which relates to an underlying illness or disorder, such as meningitis, strokes, brain damage or head injury
- Cryptogenic – where the cause is not known.
Epilepsy is generally divided into partial and generalised seizures.
Symptoms of partial seizures could be a combination of any of the following:
- Experiencing changes in the way things look, smell, feel, taste or sound
- Experiencing an intense feeling of déjà vu (a feeling that these events have happened before)
- Experiencing a tingling sensation (‘pins and needles’) in your arms and legs
- Experiencing a sudden intense emotion, such as fear or joy
- The muscles in the arms, legs and face may become stiff
- Rubbing of the hands
- Making random noises
- Moving the arms around
- Picking at clothes
- Fiddling with objects
- Adopting an unusual posture
- Chewing, or swallowing
- Smacking of the lips.
Each individual case needs to be assessed by occupational health. Concerns would be about shift work (especially night shifts), stress levels and roles with a safety critical component.
Coronary heart disease
Coronary heart disease symptoms include shortness of breath, reduced stamina, pain (angina), palpitations and anxiety.
Each individual case would need to be assessed by occupational health. In particular, concerns would be about the physical nature of the work, safety critical aspects, and psychological aspects of the work, such as the amount of pressure and stress factors.
Cancer symptoms will vary depending on the type and extent of cancer. Generally, symptoms may include tiredness, weight loss, reduced stamina and anxiety/depression.
Each individual case needs to be assessed by occupational health professionals. In particular, concerns would be about the physical nature of the work, safety critical aspects, and psychological aspects of the work, such as the amount of pressure and stress factors.
The following are normal biological processes, so do not treat them as medical problems.
- Nausea, fatigue, joint laxity, heat intolerance
Workplace considerations relate to
- Exposure to hazards
- Risk control
- Susceptibility to occupational stressors
- Risk of falls from height due to changes in centre of gravity
- Use of personal protective equipment (ppe)
- Confined working spaces
- Intolerance to strong smells
- Need to urinate more frequently.
Around 45 per cent of women cope with these symptoms well:
- Hot flushes
- Night sweats
- Emotional disturbance
- Sleep disturbances
- Low mood
- Dryness of skin and hair.
The chief substances likely to be misused are
- Prescription drugs
- Non-prescription legal drugs/solvents such as painkillers
- Non-prescription illegal drugs.
- Stimulants, such as cocaine, make people feel full of energy
- Depressants/sedatives, such as heroin, make people feel relaxed
- Hallucinogens, such as LSD, make people see, feel or hear things that are not real.
Effects on work
The whole workforce is affected if an individual is abusing drugs or alcohol. They may be anxious for the individual and/or worried about the quality and safety of the work being performed; they may become protective towards the individual, hiding it from the employer for fear of the individual losing their job.
The work performance of the individual will suffer and may affect safety and quality. Relationships internally and externally could also be affected.
Signs of substance use
- Drinking during working hours
- Drinking during breaks or before coming on shift
- Regular heavy drinking outside working hours
- Getting drunk outside working hours
- Periods of sickness absence
- Becoming confused
- Possible dishonesty/theft
- Not meeting deadlines
- Reduction in productivity
- More frequent accident records
- Disciplinary problems – mood swings, erratic behaviour
- Deteriorating relationships with co-workers and others
- Unkempt appearance
- Smell of alcohol (no smell with drugs)
- Drug paraphernalia/empty bottles (rare).
This may help you to find out if alcohol or other substance abuse is harming your business.
It is necessary to consider the effects of drug and alcohol abuse in the risk assessment process.
Drugs and alcohol testing
Before embarking on drugs and alcohol testing, it would be prudent for the employer to reflect on the reasons why abuse of these substances may be occurring and to put in remedial action to reduce, for example, stress or long and irregular hours.
False positives are common, so any positive result will need to go on for further testing, which is costly.
Drug screening or testing is a sensitive issue because of the many employment implications involved. Securing the agreement of the workforce to the principle of screening is essential, partly because of the practical and legal issues involved.
Before it is implemented, the company will need to consider
- Whether it will include both drugs and alcohol and how much a screening system will cost
- What type of testing is needed
- Random – currently there is a debate over the legality of random drug testing
- Who will conduct the sampling?
- How can confidentiality be assured?
- How will test samples be collected?
- How will test samples be kept secure to ensure they cannot be tampered with?
- What action will be taken if a positive result is given?
There may be a case for considering the introduction of screening, particularly in certain critical jobs (where staff, such as drivers, pilots and some machinery operators, have responsibility for making safety-critical decisions, for example) in which impairment due to drugs could have disastrous effects for the individual, colleagues, members of the public and the environment.
For more, see Drugs and Alcohol, Screening.
As their manager, it may fall to you to facilitate the care, treatment and support for an individual who is suspected of being under the influence at work.
- Remember that they have the same right to be treated with respect, honesty and to expect confidentiality not to be broken as anyone suffering with a physical or mental health problem.
- Explain to the individual the facts of why you suspect they may be under the influence of drugs or alcohol.
- Explain that you will treat the problem as a health issue and you will offer support to assist the person to remain sober at work.
- Cease any safety-critical or quality-critical activities.
- It may be necessary to provide transport to take the individual home.
- Review the risk assessment relating to the hazards of the job the individual undertakes.
- Following the review of risk assessment, adjust their work role to ensure safety of self and others.
- If an admission is made, you should then offer support through signposting to an agency, such as drugs and alcohol concern.
- Recognise that it may be a one-off occurrence, especially in the younger workforce, and respond appropriately.
- Discuss with individual their possible referral to Occupational Health and provide assurance over confidentiality and support.
- Ring Occupational Health for your own support and guidance.
See the topic on Drugs and Alcohol.