WHC4002 – Learning Goals/Practicals
Case 1 – Can’t you hear I’m getting deaf?............................................................................................... 1
Case 2 – Selective prevention strategies to reduce sickness absence and promote sustainable work 12
Case 3 – Selective prevention strategies to reduce sickness absence and promote sustainable work 26
Case 4 – Early interventions and tertiary prevention: specific focus on psychological interventions .. 34
Case 5 – (Re-)Integration into work I .................................................................................................... 42
Case 6 – (Re-)Integration into work II ................................................................................................... 49
Case 1 – Can’t you hear I’m getting deaf?
1. When is someone considered to be deaf and what are determinants of deafness?
Medical Perspective
hearing loss is defined by the results of a hearing test. There are parameters set out to classify
someone as either deaf or hard of hearing. A complete hearing test examines how loud sounds
across the frequency range have to be in order for you to detect them. It also gauges how well you
can understand speech.
if the average of the frequencies at 500Hz, 1000Hz, and 2000Hz is 90dB or higher, the person
is considered deaf.
Occupational Safety and Health Administration’s (OSHA)
- definition for “material impairment of hearing” (over 25 dB threshold at 1000, 2000, and
3000 Hz)
Causes
- hereditary disorders – some types of hearing loss are hereditary, which means parents pass
on affected genes to their children. In most cases, hereditary hearing loss is caused by
malformations of the inner ear
- genetic disorders – genetic mutations may happen: for example, at the moment of
conception when the father’s sperm joins with the mother’s egg. Some of the many genetic
disorders that can cause hearing loss include osteogenesis imperfecta, Trisomy 13 (Patau
syndrome) and Treacher Collins syndrome
- prenatal exposure to disease – a baby will be born deaf or with hearing problems if they are
exposed to certain diseases in utero, including rubella (German measles), influenza and
mumps. Other factors that are thought to cause congenital deafness include exposure to
methyl mercury and medications such as quinine
- noise – loud noises (such as gun shots, firecrackers, explosions and rock concerts),
particularly prolonged exposure either in the workplace or recreationally, can damage the
delicate mechanisms inside the ear. If you are standing next to someone, yet have to shout
to be heard, you can be sure that the noise is loud enough to be damaging your ears. You can
protect your hearing by reducing your exposure to loud noise or wearing suitable protection
such as ear muffs or ear plugs
, - trauma – such as perforation of the eardrum, fractured skull or changes in air pressure
(barotrauma)
- disease – certain diseases can cause hearing loss, including meningitis, mumps,
cytomegalovirus and chickenpox. Severe cases of jaundice can also cause hearing loss
- other causes – other causes of deafness include Meniere’s disease and exposure to certain
Other list risk factors1:
Aging. Degeneration of inner ear structures occurs over time.
Loud noise. Exposure to loud sounds can damage the cells of your inner ear. Damage can
occur with long-term exposure to loud noises, or from a short blast of noise, such as from a
gunshot.
Heredity. Your genetic makeup may make you more susceptible to ear damage from sound
or deterioration from aging.
Occupational noises. Jobs where loud noise is a regular part of the working environment,
such as farming, construction or factory work, can lead to damage inside your ear.
Recreational noises. Exposure to explosive noises, such as from firearms and jet engines, can
cause immediate, permanent hearing loss. Other recreational activities with dangerously
high noise levels include snowmobiling, motorcycling, carpentry or listening to loud music.
Some medications. Drugs such as the antibiotic gentamicin, sildenafil (Viagra) and certain
chemotherapy drugs, can damage the inner ear. Temporary effects on your hearing —
ringing in the ear (tinnitus) or hearing loss — can occur if you take very high doses of aspirin,
other pain relievers, antimalarial drugs or loop diuretics.
Some illnesses. Diseases or illnesses that result in high fever, such as meningitis, may
damage the cochlea.
Notes:
- Measurement of exposure:
o Pitch tests -> dB
o Biological monitoring
o Environmental monitoring
- Strategies to prevent hearing loss: protective gear
1
https://www.mayoclinic.org/diseases-conditions/hearing-loss/symptoms-causes/syc-20373072
, Figure 1 Sound levels of common noises
2. What are levels of prevention?
Level Medium Example
Macro (inter)national policies Smoking ban, noise limitations
at concerts, Legislation that
ear plugs and ear muffs have
to be available
Meso Organizational strategies Ensuring availability of ear
protection at worksite
Micro Individual strategies Self-monitoring of substance
use, sticking to alert about
volume indication on
smartphone, using ear plugs
and ear muffs
3. What are types/stages of prevention (specifically “universal” and “selective”)?
Type Explanation
Primary aims at reducing the occurrence of disease by eliminating the causal
Prevention factors contributing to disease or reducing workplace exposure to safe
intervening levels.
before health Examples: banning the use of asbestos to prevent asbestosis,
effects occur mesothelioma, and lung cancer, and reduction of noise at its source to
levels that do not cause noise-induced deafness.
Primary prevention with regard to chemicals requires either: (1)
elimination of toxic materials and their replacement by less hazardous
substitutes or (2) use of safe systems of work, and controls such as
complete enclosure or local exhaust ventilation at the source of aerosol
generation.
, Secondary aims to detect over-exposure, or early reversible effects of disease in
Prevention order to take corrective action.
screening to Example: regular monitoring of blood lead levels among exposed
identify diseases workers could indicate a potential for lead poisoning, or regular
in the earliest audiograms among noise-exposed workers may show temporary
threshold shift (TTS). Removal of workers with TTS from further noise
exposure, and subsequent containment of the source of the noise can
allow recovery of hearing, and a return to regular work duties.
Successful secondary prevention depends on the ability to identify
work-related illness early and effectively through screening workers at
high risk for occupational disease.
Tertiary aims to minimize the consequences in people who already have
Prevention established disease.
managing disease is primarily a curative and rehabilitative function and depends on
post diagnosis to availability of appropriate treatment. However, even for acute
slow or stop. poisonings, there are very few specific effective antidotes available.
Hence, the focus should be on primary or secondary prevention.
Examples: cardiac or stroke rehabilitation programs, chronic disease
management programs (e.g. for diabetes, arthritis, depression, etc.) or
support groups that allow members to share strategies for living well.
Universal Prevention
Universal interventions target the general population and are not directed at a specific risk
group. Universal prevention measures address an entire population (national, local,
community, school, or neighbourhood) with messages and programs aimed at preventing or
delaying the use of alcohol, tobacco, and other drugs. The mission of universal prevention is
to deter the onset of substance abuse by providing all individuals with the information and
skills necessary to prevent the problem. The entire population is considered at risk and able to
benefit from prevention programs.
Example:
The mission of universal prevention is to deter the onset of drug abuse by providing all
individuals in a population with the information and skills necessary to prevent the problem.
All members of the population share the same general risk for drug abuse, although the risk
may vary greatly among individuals.
Noise limitations at concerts
Selective Prevention
Selective interventions target those at higher-than-average risk for substance abuse;
individuals are identified by the magnitude and nature of risk factors for substance abuse to
which they are exposed. Selective prevention measures target subsets of the total population
that are considered at risk for substance abuse by virtue of their membership in a particular
segment of the population. Selective prevention targets the entire subgroup, regardless of the
degree of risk of any individual within the group.
Prevention aimed at musicians
Indicated Prevention
Indicated interventions target those already using or engaged in other high-risk behaviors to
prevent heavy or chronic use. Indicated prevention measures are designed to prevent the
Case 1 – Can’t you hear I’m getting deaf?............................................................................................... 1
Case 2 – Selective prevention strategies to reduce sickness absence and promote sustainable work 12
Case 3 – Selective prevention strategies to reduce sickness absence and promote sustainable work 26
Case 4 – Early interventions and tertiary prevention: specific focus on psychological interventions .. 34
Case 5 – (Re-)Integration into work I .................................................................................................... 42
Case 6 – (Re-)Integration into work II ................................................................................................... 49
Case 1 – Can’t you hear I’m getting deaf?
1. When is someone considered to be deaf and what are determinants of deafness?
Medical Perspective
hearing loss is defined by the results of a hearing test. There are parameters set out to classify
someone as either deaf or hard of hearing. A complete hearing test examines how loud sounds
across the frequency range have to be in order for you to detect them. It also gauges how well you
can understand speech.
if the average of the frequencies at 500Hz, 1000Hz, and 2000Hz is 90dB or higher, the person
is considered deaf.
Occupational Safety and Health Administration’s (OSHA)
- definition for “material impairment of hearing” (over 25 dB threshold at 1000, 2000, and
3000 Hz)
Causes
- hereditary disorders – some types of hearing loss are hereditary, which means parents pass
on affected genes to their children. In most cases, hereditary hearing loss is caused by
malformations of the inner ear
- genetic disorders – genetic mutations may happen: for example, at the moment of
conception when the father’s sperm joins with the mother’s egg. Some of the many genetic
disorders that can cause hearing loss include osteogenesis imperfecta, Trisomy 13 (Patau
syndrome) and Treacher Collins syndrome
- prenatal exposure to disease – a baby will be born deaf or with hearing problems if they are
exposed to certain diseases in utero, including rubella (German measles), influenza and
mumps. Other factors that are thought to cause congenital deafness include exposure to
methyl mercury and medications such as quinine
- noise – loud noises (such as gun shots, firecrackers, explosions and rock concerts),
particularly prolonged exposure either in the workplace or recreationally, can damage the
delicate mechanisms inside the ear. If you are standing next to someone, yet have to shout
to be heard, you can be sure that the noise is loud enough to be damaging your ears. You can
protect your hearing by reducing your exposure to loud noise or wearing suitable protection
such as ear muffs or ear plugs
, - trauma – such as perforation of the eardrum, fractured skull or changes in air pressure
(barotrauma)
- disease – certain diseases can cause hearing loss, including meningitis, mumps,
cytomegalovirus and chickenpox. Severe cases of jaundice can also cause hearing loss
- other causes – other causes of deafness include Meniere’s disease and exposure to certain
Other list risk factors1:
Aging. Degeneration of inner ear structures occurs over time.
Loud noise. Exposure to loud sounds can damage the cells of your inner ear. Damage can
occur with long-term exposure to loud noises, or from a short blast of noise, such as from a
gunshot.
Heredity. Your genetic makeup may make you more susceptible to ear damage from sound
or deterioration from aging.
Occupational noises. Jobs where loud noise is a regular part of the working environment,
such as farming, construction or factory work, can lead to damage inside your ear.
Recreational noises. Exposure to explosive noises, such as from firearms and jet engines, can
cause immediate, permanent hearing loss. Other recreational activities with dangerously
high noise levels include snowmobiling, motorcycling, carpentry or listening to loud music.
Some medications. Drugs such as the antibiotic gentamicin, sildenafil (Viagra) and certain
chemotherapy drugs, can damage the inner ear. Temporary effects on your hearing —
ringing in the ear (tinnitus) or hearing loss — can occur if you take very high doses of aspirin,
other pain relievers, antimalarial drugs or loop diuretics.
Some illnesses. Diseases or illnesses that result in high fever, such as meningitis, may
damage the cochlea.
Notes:
- Measurement of exposure:
o Pitch tests -> dB
o Biological monitoring
o Environmental monitoring
- Strategies to prevent hearing loss: protective gear
1
https://www.mayoclinic.org/diseases-conditions/hearing-loss/symptoms-causes/syc-20373072
, Figure 1 Sound levels of common noises
2. What are levels of prevention?
Level Medium Example
Macro (inter)national policies Smoking ban, noise limitations
at concerts, Legislation that
ear plugs and ear muffs have
to be available
Meso Organizational strategies Ensuring availability of ear
protection at worksite
Micro Individual strategies Self-monitoring of substance
use, sticking to alert about
volume indication on
smartphone, using ear plugs
and ear muffs
3. What are types/stages of prevention (specifically “universal” and “selective”)?
Type Explanation
Primary aims at reducing the occurrence of disease by eliminating the causal
Prevention factors contributing to disease or reducing workplace exposure to safe
intervening levels.
before health Examples: banning the use of asbestos to prevent asbestosis,
effects occur mesothelioma, and lung cancer, and reduction of noise at its source to
levels that do not cause noise-induced deafness.
Primary prevention with regard to chemicals requires either: (1)
elimination of toxic materials and their replacement by less hazardous
substitutes or (2) use of safe systems of work, and controls such as
complete enclosure or local exhaust ventilation at the source of aerosol
generation.
, Secondary aims to detect over-exposure, or early reversible effects of disease in
Prevention order to take corrective action.
screening to Example: regular monitoring of blood lead levels among exposed
identify diseases workers could indicate a potential for lead poisoning, or regular
in the earliest audiograms among noise-exposed workers may show temporary
threshold shift (TTS). Removal of workers with TTS from further noise
exposure, and subsequent containment of the source of the noise can
allow recovery of hearing, and a return to regular work duties.
Successful secondary prevention depends on the ability to identify
work-related illness early and effectively through screening workers at
high risk for occupational disease.
Tertiary aims to minimize the consequences in people who already have
Prevention established disease.
managing disease is primarily a curative and rehabilitative function and depends on
post diagnosis to availability of appropriate treatment. However, even for acute
slow or stop. poisonings, there are very few specific effective antidotes available.
Hence, the focus should be on primary or secondary prevention.
Examples: cardiac or stroke rehabilitation programs, chronic disease
management programs (e.g. for diabetes, arthritis, depression, etc.) or
support groups that allow members to share strategies for living well.
Universal Prevention
Universal interventions target the general population and are not directed at a specific risk
group. Universal prevention measures address an entire population (national, local,
community, school, or neighbourhood) with messages and programs aimed at preventing or
delaying the use of alcohol, tobacco, and other drugs. The mission of universal prevention is
to deter the onset of substance abuse by providing all individuals with the information and
skills necessary to prevent the problem. The entire population is considered at risk and able to
benefit from prevention programs.
Example:
The mission of universal prevention is to deter the onset of drug abuse by providing all
individuals in a population with the information and skills necessary to prevent the problem.
All members of the population share the same general risk for drug abuse, although the risk
may vary greatly among individuals.
Noise limitations at concerts
Selective Prevention
Selective interventions target those at higher-than-average risk for substance abuse;
individuals are identified by the magnitude and nature of risk factors for substance abuse to
which they are exposed. Selective prevention measures target subsets of the total population
that are considered at risk for substance abuse by virtue of their membership in a particular
segment of the population. Selective prevention targets the entire subgroup, regardless of the
degree of risk of any individual within the group.
Prevention aimed at musicians
Indicated Prevention
Indicated interventions target those already using or engaged in other high-risk behaviors to
prevent heavy or chronic use. Indicated prevention measures are designed to prevent the
