When carrying out reseach and analyses related to occupational health, the first step is to find out the reason for conducting them. The client who wishes the analysis must then have an idea of what kind of information can be obtained through the analysis, and how it can be used for the benefit of the employee and the employer.
Tests and analyses must be in correspondence with the risk analysis of the work environment. Also reseach has to contribute to the assessment of working capacity, or be linked to the prevention and treatment of work-related illnesses. Occupational health care services should not be utilised to carry out tests and analyses that are not directly related to the purpose of the occupational health care service. The employer has already paid social tax for the employees, which is used to finance prevention and treatment of non-work-related illness in both family physician practices and hospitals.
Eye and vision exams
The employer must organise an eye and vision exam once every three years for employees who work with monitors for at least half of his or her working hours. The corresponding examinations must also be carried out at the request of an employee whose vision has deteriorated between check-ups. Eye exams should also be carried out when there are other work environment hazards which may impair vision.
For some professions it is also necessary to check employee’s colour vision or assess scope of vision. In our clinic, eye and vision exams are performed by an optometrist, who consults an ophthalmologist, if necessary. In case of more serious visual impairment or illness, we will refer the employee to an ophthalmologist for additional tests.
In occupational health care, hearing tests are carried out on when an employee has certain hearing requirements as a prerequisite for the job or when risk factors that may impair hearing have been identified in the work environment. For example, rescuers must be able to hear at least 25 dB (0–25dB) at frequencies 500, 1000, 2000 and 3000 Hz without any hearing aids.
Hearing tests are performed in order to prevent illnesses if the work environment risk factors might impair the employees’ hearing. For example, the daily exposure levels of noise for an employee (in the case of a 8-hour working day) must not exceed 85 dB(A), and the peak sound pressure level must not exceed 137 dB. If these limits are exceeded, the employer must take measures to reduce the impact of noise. In this case, the aim of the health examination is to prevent and diagnose noise-induced hearing impairment as early as possible.
The most common assessment of lung function is performed using a stethoscope through auscultation. Spirometry and PEF measurement are used as supplementary studies, if necessary.
Spirometry is used to assess lung volume, elasticity and airway permeability. It can be used in combination with bronchodilators to diagnose asthma and chronic obstructive pulmonary disease (COPD).
Person’s maximum speed of expiration can be measured with PEF measurement . PEF measurement is used in screening of lung diseases and diagnosing occupational asthma.
The employee is sent for the chest X-ray, if necessary. This is used to diagnose diseases that involve damage to the lung tissue. If examinations reveal a suspicion of a more serious health problem, the occupational health physician will refer the employee to a specialist or to a hospital.
In occupational health care, routine performance of laboratory tests is usually linked to a specific regulation which lays down procedures and requirements for health surveillance of a particular profession. Such professions include, for example, rescuers, train drivers and divers. In relatively rare cases, laboratory tests are performed based on work environment risk factors.
According to the classical approach, prevention of general illnesses should not be included in the occupational health care services. Cholesterol, blood sugar and urine analyses of an office worker should be performed by a family physician, who has been provided with financial resourced by the National Health Insurance Fund for that particular purpose.
In occupational health care, the need for tests and analyses should stem from legislation of from the risk assessment of the work environment. Such work environment risk factors include, for example, night work, exposure to chemical, biocides, metals, gaseous substances or organic dust.
The most common laboratory tests related to routine health checks are clinical blood panel, blood glucose analysis, lipid metabolism analysis (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides), liver enzymes, blood typing, and urine analysis for detecting microalbuminuria and glucose.
If the medical examination is related to control of communicable diseases, bacteriological cultures or PCR analysis may be required for detection of pathogens in the faeces.
In occupational health care, cardiovascular examination is mostly related to health check-ups of certain professions. On the other hand, there are work environment risk factors that may contribute to the development of heart disease or hypertension.
Depending on the purpose of the health examination, blood prssure is measures and heart tones are auscultated. In addition, it is possible to take ECG (electrocardiogram) and, if necessary, excercise ECG (excercise stress test). If there is a suspicion of a serious health problem, we will refer the employee to a specialist for a consultation.
In occupational health care, the most common radiological examination is a chest X-ray. Sometimes it is also necessary to examine bones or joints using radiological examination. If necessary, magnetic resonance imaging (MRI) or ultrasound can be used for examining the joints. Radiological examinations are carried out by our partners who have corresponding licences and who follow radiation protection requirements.
The extent of radiological examinations through occupational health care depends on the scope of the contract with the employer. When the contract is more limited, we refer patients who need special examinations to a hospital or a family physician.
Work environment analyses:
We are assessing psychosocial burden of the work environment during preparation of occupational health care plan and, if necessary, when conducting a work environment audit. For that, we conduct health surveys among the employees, evaluate work processes and internal relations, and compliance of resources with the work load. We mainly used evidence-based metrics and guidelines that are recommended by the Finnish Institute of Occupational Health.
The assessment of the psychosocial burden of the work environment may be carried out by our occupational psychologist, who prepares a report of the results. The enterprise’s employees are also involved in the process in order to teach them to notice problems related to psychosocial stress on their own, and to advise them on finding solutions. The results of the report are discussed with the employer’s representative. The employer can also purchase separate seminars and trainings from us on the issues raised by the report. The seminars and training are carried out by our occupational health specialists or cooperation partners.
Evaluation of work environment ergonomics is carried out by occupational physiotherapist. As a result, a report, also known as an audit of the work environment ergonomics is prepared. The enterprise’s employees are also involved in the process in order to improve their ability to independently notice ergonomic problems, and make necessary changes. The results of the report are presented to the employer, and training is offered for the employees, if necessary.
Measurements of the physical parameters of the work environment (noise, vibration, lighting) are performed by our partners who have corresponding certificates from the Estonian Accreditation Centre. We also assist in studing microclimate-related parameters, such as room temperature, humidity, and carbon dioxide levels in the air.
Measurement of biological risk factors (molds, other microorganisms) in the air of the work environment, if it is deemed necessary and if it is technically possible. Our experiences partners carry out reseach on indoor climate and biodamage.
In addition, physical, microbiological, chemical and air quality analyses are carried out by the Health Board as a paid service.