Prevention of heart attacks and other cardiovascular diseases

Prevention of heartattacks and othercardiovascular diseasesA guide for managers, employees andcompany health professionals

Health2013

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OGP Report Number 491

Prevention of heartattacks and othercardiovascular diseasesA guide for managers, employees and

company health professionals

All photographs reproduced courtesy of Shutterstock.com, except pages 8, 26, 27 and 30 which arecourtesy of iStockphoto.com, and page 12 which is courtesy of Bibiphoto/Shutterstock.com.

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PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES

Contents

Executive summary 1

Introduction 3

What is a heart attack? 3

Symptoms of a heart attack 4

The brain and strokes 5

Hypertension (abnormally high blood pressure) 7

What is blood pressure? 7

Normal blood pressure 7

Interpreting the BP readings 8

When to treat hypertension 8

Non-medical treatment 9

Medical treatment 9

Smoking 10

Smoking and cardiovascular disease 10

Smoking and respiratory disease 11

Smoking and cancer 11

Other adverse health effects 11

Smoking in the workplace 11

Metabolic disorders 13

Cholesterol and triglycerides 13

Elevated blood sugar levels 14

What can the oil and gas industry do? 16

Physical inactivity 17

Health impacts of physical inactivity 17

How much physical activity do we need? 18

Risks and benefits of physical activity 18

Obesity 19

Psychosocial origins of the epidemic 19

Obesity and the oil and gas workforce 20


Nutrition and diet 21

Nutrition and cardiovascular disease 21practical behavioural changes


Alcohol 23

Lack of sleep 24

Sleep disorders 24

How sleep affects you heart 24

Practical behavioural changes 24


Stress 26

What is stress? 26

How stress affects the heart 27

Warning signs of stress 27

Employees role in stress reduction 27


The ageing workforce and cardiovascular risk 29

Characteristics of the older workforce 29

What oil and gas companies can do to 30address the risk of cardiovascular disease

Why should companies address the issue? 30

What can companies do? 30

Conclusion 31

References 32

Glossary 36

Appendices

Appendix 1Workplace health promotion 38(or cardiovascular prevention) checklist

Appendix 2H-Factor Programme 40(Sample of an information leaflet on prevention programmes aimed at employees within eni-Saipem)

Appendix 3Healthy workplaces: a model 43for actionFor employers, workers, policy-makers and practitioners (a World Health Organization guide)

Overview

Heart attacks and strokes related tocardiovascular disease (CVD) are the main causesof death among people working in the oil andgas industry today. This reflects a trend in thewider global population: worldwide, 13 millionpeople died of heart attacks and strokes in 2011,and CVD-related deaths per head of populationare increasing.

Although primarily non-occupational, and oftena consequence of lifestyle choices, cardiovasculardiseases represent a significant challenge to thecurrent and future operational and financialperformance of the oil and gas industry.

Designed primarily for company medicalprofessionals and line managers, this documentprovides basic guidance on the main types ofCVDs and their causes and symptoms.

The report also looks at some implications ofcardiovascular diseases for the oil and gasindustry, and offers strategies and improvementsthat can be implemented to help reduce thenumber of CVD-related deaths in future.

A reference section indicates additional sourcesof information relating to CVD. The appendicesinclude three useful tools that can help toreduce the incidence of workforce CVDs byraising awareness of their risks, causes,symptoms and outcomes, and also to promotehealthier lifestyles, both at work and at home.

Raising understanding and awareness ofheart attacks and strokes, and the maincauses of cardiovascular disease.

The main body of this report provides an

introduction to heart attacks and strokes,

including their symptoms and potential industry

responses. It also offers a guide to the most

common causes of cardiovascular disease while

suggesting optionsboth non-medical and

medicalfor reducing the risks.

The main causes of CVD include: hypertension (abnormally high blood

pressure); smoking and the use of smokeless tobacco; metabolic disorders; physical inactivity; obesity; nutrition and diet; alcohol; sleep disorders; stress; and ageing.

Oil and gas industry responses to the riskof cardiovascular disease

Global trends suggest that the oil and gas

industrys future workforce may be more

susceptible to lifestyle choices that can increase

the incidence of CVD. For this reason it is

essential for companies to put in place risk-

based health promotion programmes that are

capable of addressing this lifestyle problem.

Without such efforts, the future repercussions

are likely to have a negative impact on the

industrys business.

This report urges the industry to implement

initiatives to promote workforce well-being and

to sustain them over the long term. It is essential

to understand that the risk of CVD is a global

problem that is likely to worsen both worldwide

and in the oil and gas sector. Data on the issue

should be collected over time and used to

coordinate mitigation efforts and provide

feedback to management.

Specific and general recommendations to

address CVD are contained throughout the

report. It suggests that effective company

leadership has a key role in promoting workforce

well-being and reducing CVD risk factors.

Among actions recommended by the report are

the implementation of health assessments and

screening; awareness, education and training;

promotion of risk factor reduction, such as

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Executive summary

smoking prevention and reduction, healthier

diets, increased physical activity, stress

prevention and reduction, and fatigue

management.

One suggestion in this regard is that the industry

should consider involving the families of its

workers in the reduction of CVD risk through the

provision of initiatives, such as family fitness

days, promoting healthy diets and lifestyles.

Conclusion

Awareness and prevention of cardiovascular

diseases, although a non-occupational problem,

can have a positive impact on business. For this

reason it is imperative that the industry develops

and sustains health management programmes

that address this issue.

The work location is often the first place where

cardiovascular risk factors are identified and

where steps can be implemented to provide

treatment or prevention. However, it must be

clearly understood that the onus of prevention

and treatment rests with individual employees

and not the company or industry.

The oil and gas industry is unique because work

often takes place at remote locations where

medical care may be limited and that are long

distances from specialist treatment centres. For

this reason, regular health assessments can help

identify and reduce risk factors, and define

individual action plans to promote healthy

lifestyles, improve the quality of life and reduce

medical bills. Healthy individuals have a greater

chance of living longer.

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superior vena cava

right coronary artery

left coronary artery

aorta

pulmonary artery

inferior vena cavaleft ventricle

right ventricle

Cardiovascular diseases (CVDs), i.e. heart attacks

and strokes, are the main causes of death within

the oil and gas industry.

Within the general population, it is estimated

that more than 13 million deaths occur

worldwide as a result of ischaemic heart disease,

stroke or other form of cerebrovascular disease;

this is more than 10 times the number of yearly

deaths caused by road vehicle accidents.

Heart attacks and strokes, considered as non-

occupational illnesses, are mainly due to the

coexistence of numerous cardiovascular risk

factors due to lifestyle issues which, along with

ageing, increase the death toll.

The more cardiovascular risk factors one

accumulates over the years, the greater the risk

of having a heart attack or stroke at an early age

with increased potential severity. The major

cardiovascular risk factors include: high blood pressure; tobacco use; high levels of cholesterol in the blood; high levels of sugar in the blood; physical inactivity; overweight or obesity; poor nutrition (an unhealthy diet); and alcohol use;

and to a lesser degree: lack of sleep; and poor stress management.

Other cardiovascular diseases (peripheral arterial

diseasealso known as peripheral vascular

disease; rheumatic heart disease; congenital

heart disease; deep vein thrombosis; and

pulmonary embolism), although potentially

severe, are responsible for far fewer deaths per

year in the world.

The work location is often the first place where

cardiac risk factors are identified and where steps

can be taken to provide treatment or remedy.

However, it must be clearly understood that the

onus of prevention and treatment rests on the

individual and not on the company or industry.

This basic guidance document is designed for

doctors, medical professionals, employees and

line managers, and outlines a number of

strategies and improvements that the oil and gas

industry can implement to reduce the number of

CVD-related deaths in the years to come.

What is a heart attack?

A heart attack (also called a myocardial

infarction, coronary thrombosis or coronary

occlusion) is a condition caused by the complete

blockage of one or more of the coronary arteries

or its branches, i.e. the blood vessels that supply

blood and oxygen to the heart muscle.

This condition commonly occurs in men over 40

years old and to a lesser degree in women over

50 years of age after the menopause. Heart

attacks can also occur in men in their 20s and

30s with a family history of premature coronary

artery disease.

3


Introduction

Above: the heart is a

muscle that pumps

blood to the organs

of the body. Located

in the thorax,

between the two

lungs, the heart

beats approximately

70 times a minute or

more than 100,000

times per day, every

day throughout life!

In one day the heart

will have pumped

more than 30,000

litres of blood. The

heart rate increases

during exercise, fear

and excitement.

Figure 1 The human heart

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With the worldwide increase in female

consumption of tobacco, women are rapidly

catching up with men in terms of heart attack

frequency and age of occurrence.

Ageing and the cardiovascular risk factors can

lead to a narrowing and hardening of the

arteries in the body. This is called arteriosclerosis.

In the coronary arteries, which irrigate the heart,

this results in reduced blood flow to the cardiac

muscle. If a build-up of fatty deposits

(atherosclerosis), a blood clot or spasm totally

clogs or constricts one of the previously

narrowed arteries the result is a heart attack. If

the blood flow is not restored quickly, the heart

muscle becomes damaged from lack of oxygen

and begins to die. This is an emergency.

Symptoms of a heart attack

The typical symptom of a heart attack is chest pain,which: is most often severe, persistent, and described

as tightness, squeezing or a crushing

sensation usually located in the centre of the

chest behind the breastbone or sternum; it

may mimic heartburn in some cases;

spreads to the neck, back, jaw, shoulders or

arms (particularly the left arm and hand); lasts for more than 15 minutes, sometimes

coming and going; occurs at rest or during activity; is often accompanied by palpitations,

fainting, cold sweats, nausea or vomiting,

shortness of breath, and a feeling of fear,

anxiety, imminent death or impending doom;

and may be accompanied by signs of shock or

loss of consciousness.

Figure 2 Causes of a heart attack

Women are less likely to survive heart attacksthan men!

Women are just as vulnerable to heart attacks asmen, and represent nearly half of the heart attackdeaths worldwide. To put this in perspective,women have a much greater chance of dying of aheart attack than of dying from breast cancer.Because the menopause is a cardiovascular riskfactor, women tend to experience heart attacksabout 10 years later than men.

Heart disease has often been mistakenlyconsidered to be a mans disease. And becauseheart attack symptoms in women are often verydifferent to those experienced by men, womenare less likely to realize, or even to believe, thatthey are having a heart attack. It is common forwomen to fail to recognize the symptoms of aheart attack and, as a consequence, women aremore likely to delay emergency treatment.

The most common heart attack symptom forwomen, as in men, is pain or discomfort in thechest. However, more than 40% of women reporthaving no chest pain or discomfort prior to, orduring, their heart attack. This absence of chestpain can result in lost time and incorrect diagnosison the part of the receiving medical professional.

Major symptoms in women during a heart attackoften include one or more of the followingthese may also be responsible for additional losttime and incorrect diagnosis:

unusual fatigue sleep disturbance

sleep disturbance shortness of breath;

indigestion anxiety

cold sweats dizziness

1. Atherosclerosisthe artery is cloggedwith fatty substances, e.g. cholesterol

2. Blood clotprone to developing inarteries affected by atherosclerosis

3. Spasma temporary constrictionin the artery wall

1

23

Above: a heart attack

occurs when the

blood vessels that

supply the heart

become blocked. This

can result from a

narrowing of the

arteries due to fatty

deposits, which in

turn can encourage

the formation of

blood clotsthe

most common cause

of a heat attack. A

less common cause is

a spasm, i.e. a

sudden, temporary

tightening of the

muscles in the walls

of artery.

A suspected heart attack is a medical

emergency requiring urgent attention.

Treatment is most effective when administered

within the first hour (the golden hour) after

the onset of symptoms. The faster a person

having a heart attack is transferred to

emergency facilities where the clogged arteries

can be unclogged, the greater his or her

chances of surviving.

Unfortunately, almost one-third of all heart

attacks are silent and go completely

unrecognized. They do not produce symptoms

of chest pain, and the victim may be treated for

a non-cardiological problem. For example, chest

discomfort may be confused with indigestion or

anxiety. In such cases, patients have a greater

risk of dying than those who experience the

typical severe chest pain of a heart attack.

Any chest pain which lasts for more than 15

minutes must be considered a heart attack, and

the victim should be transported to a medical

facility as a matter of urgency.

The brain and strokes

What is a stroke?

A stroke is the clogging or bleeding of an artery

in the brain provoking the partial or total

destruction of one or more of the specialized

nerve centres. This medical emergency can result

in neurological damage (e.g. partial or total

paralysis of a limb or an entire side of the body

(hemiplegia), speech impairment (aphasia), vision

or memory loss, etc., coma, disability and death.

Irreversible damage appears when the brain tissue

is deprived of oxygen for more than three hours.

Ischaemic strokes, i.e. those caused by a blood

clot which cuts off the flow of blood to the brain

(also called brain attack or acute ischaemic

cerebrovascular syndrome) are responsible for

more than 80% of all strokes observed. Less

5


The brain is a highly

developed computer

made up of billions of

nerve cells or neurons

with various specialized

nerve centres that

coordinate and

regulate everything in

the bodyfrom the

memory, reasoning

and emotions to the

heart beat, breathing

and body temperature

as well as the mobility

and sensitivity of the

body. Blood is carried

to the brain by the

carotid and vertebral

arteries which branch

out into a complex

arterial network within

the brain.

Figure 3 The human brain

common are haemorrhagic strokes which occur

when a weakened blood vessel ruptures, causing

bleeding into the brain.

Strokes affect men more often than women.

Ageing (most strokes appear over 65 years of age

but they can appear at any age) and the same

cardiovascular risk factors that produce a heart

attack are responsible for ischaemic strokes.

Symptoms of a stroke

Early recognition and treatment of a stroke is

essential in order to reduce the severity and

increase the chances of total recuperation.

The US National Stroke Association has identified

the Act FAST rule for rapid recognition of a

stroke:

F for Face: Ask the person to smile. Does oneside of the face droop?

A for Arms: Ask the person to raise both arms.Does one arm drift downward?

S for Speech: Ask the person to repeat a simplephrase. Is their speech slurred or strange?

T for Time: If any of the above signs appearcontact the local emergency service immediately.

Cardiovascular risk factors

The major cardiovascular risk factors are

summarized in the Introduction on page 1.

Whilst steps can be taken to reduce the risk of

CVD from these factors, there are several other

cardiovascular risk factors which cannot be

changed. These include:

Age: the older one gets the greater the risk.More than half of all heart attacks and

ischaemic strokes take place after the age

of 65. Gender: men are more likely to develop

cardiovascular problems than premenopausal

women (however, once past the menopause,

a womans risk is similar to that of a man). Heredity: if there is a history of heart attacks

in a family, particularly under the age of 55,

the likelihood of having a heart attack

increases.

The good news is that it is possible to reduce

the effects of the majority of cardiovascular risk

factors by modifying certain poor lifestyle

habits. However, it is important to realize that

all of the cardiovascular risk factors are

intertwined, for example: smoking increases

blood pressure; stress and smoking increase

levels of bad cholesterol; and lack of sleep

increases obesity and blood pressure.

The following sections review each of the

cardiovascular risk factors and identify what the

individual and company can do to reduce the

risks.

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Figure 4 Causes of a stroke

Smoking, alcohol,

obesity and stress,

among other factors,

are important

contributors to heart

attacks and strokes.

blood clot

cerebral artery

Above: an ischaemic

stroke occurs when a

blood clot lodges in

an artery causing a

blockage, which in

turn cuts off the flow

of blood to the brain.

Less common are

haemorrhagic

strokes (not shown on

the diagram) which

occur when a blood

vessel ruptures,

causing bleeding

into the brain.

Hypertension is a major and highly prevalent

aetiological factor in the development of

cardiovascular disease as well as heart and

renal failure. It is estimated that around 1,000

million people worldwide suffer from

hypertension; this number will continue to rise

over the coming years due to increased life

expectancy and the other cardiovascular risk

factors reviewed in this document.

Hypertension alone is estimated to cause 4.5%

of the disease burden globally, which is more

than that caused by tobacco or alcohol.

What is blood pressure?

Blood pressure is the pressure exerted by the

blood on the walls of the arteries. It is described

using two numbers, such as 120/80. The top

number is the systolic pressure, which

corresponds to the pressure in the arteries when

the heart contracts. The bottom number is the

diastolic pressure, which corresponds to the

blood pressure in the arteries when the heart

rests between heartbeats.

A stethoscope and inflatable cuff-like

manometer (sphygmomanometer) placed

around the arm are all that is required to

measure blood pressure. Blood pressure

readings should be taken on both arms and can

be expressed either in millimetres or centimetres

of mercury (Hg).

Having ones blood pressure checked is a simple,

painless medical activity that only takes a few

minutes, but which can save lives by preventing

a heart attack or stroke years later. If high blood

pressure is diagnosed and confirmed, treatment

is required.

Blood pressure should be measured with a

properly calibrated instrument which has an

adequately-sized cuff (i.e. the width of the cuff

should be 40% of the circumference of the limb

testedcuffs that are too small or too large will

produce erroneous results). The test should be

carried out with the patient in a seated or lying

position, after a minimum five-minute rest and

with the arm to be measured resting level with

the heart. It is also advisable for the

measurement to be taken two or three times, for

example at the beginning, during and at the end

of the consultation. It is possible for an

individual to carry out a self-measurement if

properly trained. This may benefit patients by

allowing them to monitor their blood pressure

response to antihypertensive medication,

thereby improving patient adherence to therapy.

Normal blood pressure

The accepted threshold for normal blood

pressure varies constantly over an individuals

lifetime, and even during each 24-hour cycle.

Normal blood pressure for an adult (age 18 and

above) is considered to be 120/80 mm Hg.

Variations of this value can be considered in

respect of an individuals age (e.g. the elderly),

sex and possible coexisting morbidities (e.g.

type 1 diabetes, coronary artery disease, chronic

kidney disease).

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Hypertension (abnormally high blood pressure)

Blood pressure

should be measured

with a properly-sized

and calibrated

instrument, with the

subject in a seated or

lying position, after a

five-minute rest and

with the arm resting

level with the heart.

It is natural for blood pressure to vary during the

day, from one day to the next, and in reaction to

stressful situations, depending on a variety of

factors. Repeated measurements of blood

pressure are therefore recommended before

establishing the diagnosis. One elevated blood

pressure reading does not mean that a person has

high blood pressure; however, such a reading

should be followed by additional measurements

over a period of several weeks. The physician may

wish to monitor an individuals blood pressure at

home via a 24-hour monitoring device. This

process is called ambulatory blood pressure

monitoring (ABPM) and records blood pressure

values during the wide range of situations and

activities that a person experiences throughout

the day, including during sleeping periods. The

averages of the 24-hour values that are used to

diagnose hypertension are a systolic

measurement above 129 mm Hg, or diastolic

measurement above 80 mm Hg.

Interpreting the BP readings

Normal blood pressure is considered to be

The goal of hypertensive therapy is the

reduction of cardiovascular and renal morbidity

and mortality by lowering the blood pressure.

An untreated hypertensive patient is at great

risk, not only of developing a disabling or lethal

CVD (e.g. left ventricular failure, myocardial

infarction, stroke) but also of renal failure and

retinal affections of the eyes. Effective medical

control of hypertension will prevent or forestall

all complications and prolong life in patients

with elevated numbers such as a diastolic blood

pressure greater than 90 mm Hg.

In clinical trials, antihypertensive therapy has

been associated with average reductions of

3540% in stroke incidences; 1525% in

incidences of myocardial infarction; and more

than 50% in incidences of heart failure.

Non-medical treatment

Non-medical treatment mainly addresses

lifestyle modifications and the management of

coexisting conditions (e.g. diabetes, cholesterol).

Lifestyle modifications may contribute to

preventing and reducing hypertension at all

stages of the condition; however, these

modifications are not always enough to

normalize BP even though they may reduce it

by up to 1015 mm Hg.

Lifestyle modifications that can reduce blood

pressure and prevent hypertension include: reducing weight in individuals who are

overweight or obese; implementing dietary measures to reduce salt

intake (to less than 5 g/day), and control

diabetes and blood lipids (fats); increasing physical activity; moderating alcohol consumption; and cessation of smoking.

9


Non-medical

treatment, such as a

healthy diet to help

lose weight, reduce

salt intake and

control diabetes,

may contribute to

reducing blood

pressure by up to

1015 mm Hg.

Medical treatment

When an individual is not able to normalize

blood pressure through lifestyle modifications

alone, certain blood pressure-reducing

medication may be required. This will need to be

prescribed by a physician. The goal of such

medication is to bring the individuals elevated

blood pressure down to acceptable levels.

Antihypertensive medications should be taken

by those people who have: Stage 1 hypertension, or a 24-hour ABPM

average of 130/80 and above, plus any of

the following:

target organ damage;

established cardiovascular disease;

renal disease; or

a 10-year cardiovascular disease risk of 20%

or more. Stage 2 hypertension.

Successful medical treatment of blood pressure

requires regular medical monitoring and

follow-up.

It should be clearly understood that

hypertension is a chronic condition which, in the

majority of cases, requires lifelong treatment.

It is also important to be aware that any

termination of medication will result in a

reappearance of the cardiovascular risk.

The term smoking refers to the use of cigarette,

pipe, cigar and shisha tobacco.

Many people revert to smokeless tobacco, such

as chewing tobacco, spit tobacco, chaw and

snuff, thinking that these are safer because they

dont involve smoking. False! Smokeless tobacco

is highly addictive, delivers twice the nicotine

dose of one cigarette, and causes numerous

health problems.

The US Centers for Disease Control (CDC)

reports that adverse health effects from

tobacco use account for an estimated 443,000

deaths, or nearly one in every five deaths, each

year in the USA.

According to the World Health Organization

(WHO), tobacco kills nearly 6 million people each

year, of whom more than 5 million are users and

ex-users, and more than 600,000 are non-

smokers exposed to second-hand smoke.

More deaths are caused each year by tobacco

use than by all deaths from human

immunodeficiency virus (HIV), illegal drug use,

alcohol use, motor vehicle injuries, suicides and

murders combined. Smoking causes an

estimated 90% of all lung cancer deaths in men,

80% of all lung cancer deaths in women, and is

the cause of an estimated 90% of all deaths from

chronic obstructive lung disease.

Smoking and cardiovascular disease

Smoking is widespread. It increases the risk of

coronary heart disease and can lead to the

development of peripheral vascular disease

resulting in reduced blood circulation.

Cigarette smoking damages the lining of

arteries, leading to a build-up of fatty material

(atheroma) thereby reducing the space for blood

to pass through. The carbon monoxide in

cigarette smoke reduces the amount of oxygen

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Smoking

that the blood can carry to the heart and body.

Nicotine in cigarettes stimulates the body to

produce adrenaline, which increases the heart

rate and raises blood pressure, resulting in the

heart having to work harder. This increases the

tendency for blood to clot.

Smoking decreases exercise tolerance and leads

to a decrease in high density lipoprotein (HDL),

i.e. the good cholesterol. It also increases the

risk of abdominal aortic aneurysm. Studies have

shown that cigarette smoking is an important

risk factor for stroke; inhaling cigarette smoke

produces several effects that can damage the

cerebrovascular system. Women who smoke and

use oral contraceptives are at increased risk of

both coronary heart disease and stroke.

When combined with a family history of heart

disease, cigarette smoking also seems to greatly

increase the risk of cardiovascular disease.

Passive smoking, where non-smokers breathe in

second-hand smoke from people around them,

is also harmful. Research has shown that non-

smokers who live with smokers have a greater

risk of coronary heart disease than those who

do not.

Smoking and respiratory disease

Smoking has been linked to a number of

respiratory diseases, including: chronic obstructive pulmonary (lung) disease

(COPD)a group of diseases including

chronic bronchitis and emphysema; lung cancer and other cancers of the oral

cavity, esophagus and larynx; and asthma.

Smoking and cancer

Smoking is known to cause the following

cancers: bladder cancer; acute myeloid leukaemia; cancer of the cervix; cancer of the oesophagus; kidney cancer; cancer of the larynx (voice box); lung cancer; cancer of the oral cavity (mouth); cancer of the pharynx (throat); stomach cancer; and cancer of the uterus.

Although smokeless tobacco does not produce

respiratory problems or lung cancer because

there is no smoke inhalation, its use had led to

an increased incidence of cancers of the throat,

tongue and mouth. Oral cancer is a particularly

deadly form of cancer, killing 30% to 50% of

newly diagnosed individuals within five years.

Other adverse health effects

Smoking can have adverse affects on

reproduction, pregnancy and small children. It

increases the risk of: infertility; preterm delivery; stillbirth; low birth weight;

sudden infant death syndrome (SIDS); and predisposition of smokers children to

respiratory illnesses (e.g. asthmas, more

frequent colds, etc.).

Dental problems are very common for users of

smokeless tobacco, and include gum and tooth

decay, discoloured teeth, loss of teeth, and bad

breath as well as a decreased sense of taste and

smell. Smokeless tobacco users are also at

higher risk for heart disease and high blood

pressure.

Smoking in the workplace

Employers can improve the health of their

employees by creating a smoke-free workplace

and promoting smoking cessation initiatives.

Smoking in the workplace will commonly target

cigarettes, pipes, cigars and shishas.

Many state and local governments now require

workplaces to be smoke-free and/or designated

areas to be set aside for use as smoking areas.

Benefits of a smoke-free workplace

Benefits for employees include: reduced exposure to cigarette smoke and, as

a consequence, a reduction in the incidence

of smoking-related diseases; saving money; motivation of smokers to stop smoking; and reduced risk of work-related fires.

Benefits for the employer include: promotion of a healthier and safer work

environment; reduced downtime due to smoking breaks; reduced absenteeism; reduce medical expenses; and reduced office maintenance costs (cleaning,

carpets, furniture, etc.).

11


Smoke-free workplace programme

Steps to creating a smoke-free workplace

include: Developing a policy and a plan: company

management and human resources officials

should work to define a no-smoking policy

and the manner in which it will be

implemented across the workplace.

Employees and management should work

together to define a successful smoke-free

work place programme, and identify areas

that can be designated and clearly marked as

smoking areas. The company should create

awareness and information programmes to

inform staff and employees about the

dangers of smoking, and promote cessation

programmes (e.g. patches, consultations, etc.). Creating a supportive environment:

for example, avoiding discrimination against

smokers, and making sure that the emphasis

is on encouraging smokers to engage with

their health rather than penalizing them for

being tobacco users. Initial studies suggest that electronic

cigarettes do not have negative effects on the

cardiovascular system but do affect lung

functions. Further study will be necessary

before firm conclusions can be drawn about

the safety of electronic cigarettes, and this is

an important reason why any policy for

smoking in closed spaces/offices should apply

to electronic cigarettes as well as real

cigarettes.

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13


Metabolic disorders

Cholesterol and triglycerides

Cholesterol and triglycerides are two types of lipid

(or fatty substance) found in all parts of the body,

including the bloodstream. They are essential to

human life but, in excess, can be harmful.

Cholesterol is produced by the liver and is also

consumed in the foods that we eat. It is a

structural component of cell membranes and is

used in the production of hormones, vitamins

and bile acids. The main sources of dietary

cholesterol are meat, poultry, fish, eggs and

dairy products. Certain meats are especially high

in cholesterol content, while foods of plant

origin contain no cholesterol.

Triglycerides are the main form of fat in the

body. Their main purpose is to supply the bodys

energy needs. Consumption of meats, other

fatty foods, and foods that are high in sugars or

starch can increase the levels of triglycerides in

the blood.

Types of cholesterol

Cholesterol and triglycerides are transported

around the body within soluble carriers known

as lipoproteins. There are different types of

lipoproteins, each classified by density; the lower

the density of the lipoprotein the greater the

amount of fats contained within it. This

characteristic is used to identify the different

types of cholesterol in the blood: LDL cholesterol (low density lipoprotein) is

the bad cholesterolelevated levels are

associated with an increased risk of coronary

heart disease, stroke and peripheral arterial

disease. HDL cholesterol (high density lipoprotein) is

the good cholesterolits presence prevents

atherosclerosis by extracting the bad

cholesterol from the artery walls. Total blood cholesterol is the sum of LDL and

HDL cholesterol, and also includes a

percentage of triglycerideselevated levels

of triglycerides are associated with certain

diseases including cardiovascular diseases.

Table 1 The cardiovascular risks associated with different levels of cholesterol and triglycerides in the blood

(internationally accepted normal levels are indicated in bold)

Types of cholesterol / lipid

Levels of cholesterol and triglycerides in the blood

Associated cardiovascular risk

Total cholesterol

Associated cardiovascular risks

Table 1 shows the degree of cardiovascular risk

associated with various concentrations of

cholesterol and triglycerides in the blood. The

internationally accepted norms for cholesterol

and triglyceride levels are indicated in bold text.

Note that increased blood levels of LDL

cholesterol and reduced blood levels of HDL

cholesterol are strongly associated with

cardiovascular disease.

Factors influencing cholesterol andtriglyceride levels

Numerous factors are responsible for increasing

the levels of cholesterol and triglyceride in the

blood, such as diet, obesity, sedentary lifestyle

and smoking.

Several medical conditions, including diabetes,

hypothyroidism (decreased thyroid function),

liver disease, and chronic renal (kidney) failure

can also increase cholesterol levels. Some

medication, especially steroids, can also increase

cholesterol levels.

Diets rich in cholesterol and saturated fats

increase LDL levels. This bad cholesterol is

responsible for the creation of fatty deposits in

blood vessels. Over time these deposits narrow

and obstruct the arteries (atherosclerosissee

image below).

Measures that can be proposed to reduce

elevated cholesterol and triglyceride levels

include: educating the workforce; promoting healthy foods (fruits, vegetables,

fish) and reduced portion size; ensuring that the workforce is aware and

informed of the food sources and risks of

elevated cholesterol and triglyceride levels; providing a visible and appetizing, low-fat

healthy food option, and reducing the

amount of trans fats in workplace menus; educating the workforce concerning the risks

of alcohol and sugar in elevating triglyceride

levels; and encouraging the workforce to identify their

individual risk factors through screening and,

where necessary, to seek medical care for

treatment.

Elevated blood sugar levels

Glucose and its function

Glucose is a sugar that is vital to human health.

When glucose is metabolized in the body it

provides energy to the cells. The muscles and

brain must have a supply of glucose as a source

of energy to function.

Diabetes

Diabetes mellitus, or simply diabetes, is a chronic

metabolic condition where the level of blood

glucose (blood sugar) has become too high. This

occurs when the body does not produce enough

insulin (which helps cells to absorb the glucose

from the blood), or when the body cannot

effectively use the insulin it produces.

Diabetes is characterized by fasting blood sugar

levels of 125 mg/dl (7.0 mmol/l) or higher and,

over time, can lead to serious damage to

several of the bodys organs, especially the

blood vessels and the nerves.

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15


In some people, the level of blood glucose may

be higher than normal but not yet high enough

to indicate diabetesin this case the condition

is known as pre-diabetes.

According to World Health Organization, there

are currently 347 million people living with

diabetes worldwide. The number is estimated to

rise to more than 460 million by 2030.

Types of diabetes

There are two main types of diabetes: Type 1 diabetes: previously known as insulin-

dependent diabetes, this develops when the

bodys immune system mistakenly destroys

the insulin-producing cells in the pancreas. As

a result, the body is unable to produce insulin.

Type 1 diabetes is usually diagnosed in

children and young adults. Type 2 diabetes: previously known as non-

insulin dependent diabetes, this occurs when

the body does not produce enough insulin, or

when the body becomes unable to use the

insulin it produces (insulin resistance). It is the

most common form of diabetes, representing

90% of diabetes cases worldwide, and can

develop at any age. It is often associated with

obesity, lack of physical activities and poor diet.

Diabetes may also occur during pregnancy,

when some women produce higher than normal

levels of glucose in the blood. When diabetes is

diagnosed during pregnancy it is referred to as

gestational diabetes.

Pre-diabetic state

Pre-diabetic individuals are those people with a

fasting blood glucose level between 100 mg/dl

(5.55 mmol/l) and 125 mg/dl (6.94 mmol/L) and

are at significant risk of developing type 2

diabetes within the next 10 years.

The following text deals exclusively with type 2

diabetes, the most common form encountered

globally and within the oil and gas industry, and

which is mainly lifestyle dependent.

Signs and symptoms of diabetes

A large number of people with elevated blood

sugar levels have no symptoms. When symptoms

occur, the following are common: increased thirst; frequent urination; excessive hunger; weight change; increased fatigue; changes in vision; tingling or numbness in the hands or feet; and recurring skin or other infections.

Managing elevated blood glucose levels

Type 2 diabetics can initially be managed with

a combination of diet and increased physical

activity, followed by medication if necessary

(oral medication or insulin injection). Careful medical management through weight

loss and lifestyle improvement may not only

reduce the need for medication but, in some

cases, may also retard the progression of the

disease and normalize blood sugar levels. The same factors can prevent a pre-diabetic

condition from evolving to full blown diabetes. The management of metabolic syndrome may

be necessary; this occurs when a range of

metabolic risk factors occur together in an

individual causing increased risk of heart

disease, stroke and diabetes. The set of risk

factors for metabolic syndrome includes:

Left: a diabetic

patient measuring

glucose levels in the

blood using a blood

glucose meter

HDL (good) cholesterol of less than

40 mg/dl (1.04 mmol/l) in men or less than

50 mg/dl (1.30 mmol/l) in women;

a triglyceride level of 150 mg/dl

(1.69 mmol/l) or greater;

high blood sugar levels with fasting blood

glucose of 100 mg/dl (5.55 mmol/l) or greater;

insulin resistance or glucose intolerance

due to improper functioning of insulin; and

abdominal obesity (i.e. excess body fat

around the waist).

Complications of diabetes

Long-term complications may include: cardiovascular disease (heart attack, heart

failure, stroke, etc.); chronic kidney failure; eye damage leading to blindness (e.g.

cataract, retinopathy, glaucoma); nerve damage; vascular disease of the limbs (i.e. leading to

gangrene and amputation); erectile dysfunction in men; and increased rate of infections.

What can the oil and gas industry do?

The following approaches are recommended to

provide awareness of the risks from metabolic

disorders and to help individuals avoid them: Create and sponsor company wellness and

healthy lifestyle programmes. Increase risk-based health promotion and

health education. Encourage health awareness, e.g. via a

diabetes awareness day or reduce obesity day. Promote healthy eating in company-

controlled catering facilities, e.g. through the

provision of free dietary consultations. Promote physical activity by setting up on-

site exercise facilities (in locations with large

numbers of employees) or subsidizing gym

membership, encouraging walking, jogging

and cycling. Provide free periodic medical checks for all

employees and their spouses.

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Near right: diabetes

can lead to a range

of complications in

addition to

cardiovascular

disease, including

for example eye

damge due to

cataracts,

retinopathy and

glaucoma.

Far right: providing

access to gym

facilities is just one

of a number of ways

in which the

industry can help its

employees reduce

the risks from

metabolic disorders.

17


Physical inactivity

Individuals who do not undertake the minimum

recommended amount of daily physical exercise

required to maintain good health are said to be

physically inactive.

General day-to-day physical activity includes

walking, climbing stairs or cycling, occupational

(i.e. at work) and household activities, and

games. Physical activity may also include

scheduled sports or aerobic activity and/or

muscle-strengthening exercises that are usually

designed specifically to improve and/or maintain

physical fitness.

Health impacts of physical inactivity

Studies have demonstrated that physical

inactivity, also referred to as a sedentary lifestyle,

is associated with a number of illnesses including

cardiovascular diseases. The WHO indicates that

physical inactivity has been identified as the

fourth leading risk factor for global mortality,

and may account for an estimated 3.2 million

deaths globally. Physical inactivity is also

estimated to be the main cause of approximately

30% of heart attacks worldwide.

The health benefits of regular physical activity are

strongly supported by epidemiological studies:

regular physical activity is highly beneficial in

preventing CVDs (and in reducing the severity of

symptoms with individuals already suffering from

a CVD), whether people maintain an active daily

lifestyle and/or participate in scheduled physical

activity. Research shows that as much as half of

the functional decline between the ages of 30

and 70 is due not to ageing itself but to an

inactive way of life.

The direct and/or indirect benefits of regular

physical activity in reducing CVD risk factors are

summarized below: Improved blood flow to the heart muscle. Reduced blood pressure: regular exercising

mainly aerobic activitycan help to reduce

systolic (and, to a lesser extent, diastolic)

blood pressure by up 10 to 15 mm Hg. This is

achievable over a period of several months. Reduced blood fat levels: regular exercising

can decrease triglycerides and increase HDL

(good) cholesterol. A decrease in total and

LDL (bad) cholesterol is reported only when

weight loss and/or a reduction in dietary fats

are associated with regular physical activity. Improved body mass index (BMI), and healthy

changes in body composition towards more

lean muscle and less fat: regular physical

activityespecially when combined with a

lower calory dietcan contribute to losing

weight and reducing body fat. Improved blood sugar levels and decreased

insulin requirements. Reduced inflammatory biomarkers: regular

physical activity has a chronic anti-

inflammatory effect, triggering a reduction in

C-reactive protein (CRP) and other

inflammatory markers.

In addition to reducing CVD risk factors, the

practice of a regular physical activity has a number

of other positive effects such as reducing the risk of

breast and colon cancer, improving control ofor

even preventingnon-insulin dependent diabetes

mellitus. It also contributes to maintaining a

healthier musculoskeletal system, including

prevention of osteoporosis. Last but not least,

exercising reduces stress, and improves energy

levels, sleep and well-being, lowering the risk of

developing anxiety or depression.

Studies have shown

that individuals who

do not remain

physically active,

either through daily

activities or

scheduled exercising,

are at greater risk of

cardiovascular

disease.

How much physical activity do weneed?

Health agencies are actively promoting aphysically active lifestyle and have set a minimumrecommended amount of physical activity: A baseline average of 20 to 30 min of physical

activity every day in addition to the physicalactivity performed as part of the job functionand/or routine duties at home (for examplecooking or doing the laundry, walking to thecar park, or shopping).

Walking is probably the safest and easiestactivity that can be performed by everyone,and this could be optimized by simplepractices such as parking the car away fromthe office and/or taking the stairs instead ofthe elevators. Also consider the following tips: If you elect to engage in physical activities,

choose a practice you enjoy and set goals.This could involve playing golf, orswimming, etc.

Get into a routinego to the pool or gym,join a fitness class, or plan a regular run:this will ensure that you get somescheduled exercise.

Keep movingwhenever you can, walk,cycle or run instead of taking the car.

Limit the time you spend watching TV orsitting in front of a computer during leisuretime.

Spread your sessions of moderate tovigorous aerobic activity throughout theweek. Do at least 10 minutes of physicalactivity at a time.

Join a team or exercise with anotherpersontake part in sports and recreationactivities in groups.

A greater amount of physical activity beyondthe above baseline recommendations willprovide even greater health benefits.

Employers have a leading role to play in

promoting an active lifestyle. Creating a gym

within the office facilities or subsidizing

membership in health clubs, sponsoring walking

and/or cycling events, and/or providing

pedometers are good examples of simple but

very effective initiatives. Leaders have a role in

supporting workplace activity, demonstrating

healthy behaviour and encouraging others to

make time for physical activity.

Risks and benefits of physical activity

Epidemiological studies clearly demonstrate the

benefits of sustained physical activity over time.

It is recommended that all individuals planning

to embark on any form of exercise programme

consult with a health-care professional before

doing so.

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19


Obesity

Obesity is a global epidemic that presents

significant health risks to virtually all age groups

in both developed and developing countries. It

also poses particular challenges for the health-

care community when assessing the suitability

of workers for different occupational roles.

Epidemiological evidence suggests that levels of

obesity will continue to increase worldwide

unless a concerted global effort is undertaken to

address this ongoing problem.

Most people can check to see whether their

weight is healthy by using a measure known as

the body mass index (BMI). A persons BMI is

calculated by dividing their weight (in kilograms)

by their height (in metres) squared. For example,

an adult who weighs 70 kg and is 1.75 m tall will

have a BMI of: 70 (1.75 x 1.75) = 22.9 kg/m2

Obesity is generally indicated by a BMI above 30 (a

BMI of 25 indicates overweight). Current estimates

by the WHO indicate that almost one in 10 of the

worlds adult population is obese. In the oil and

gas industry, a conservative estimate is that more

than one-third of the workforce is overweight or

obese, and this is considered to be increasing.

There are several indicators for obesity, including

BMI and the measurement of the waist

circumference. The latter is the thought to be the

best indicator of cardiovascular risk, because BMI

is subject to variations in interpretation in

different populations and in varying individual

circumstances. For example, scientific evidence

shows that Asians tend to develop CVDs and

diabetes at lower BMIs than European people,

and bodybuilders and pregnant women have a

clear justification for the additional weight

relative to their height.

Although obesity can pose certain health and

safety risks it is imperative that such individuals

are not discriminated against in the work

environment. It is essential that oil and gas

companies put in place weight loss programmes

to address this issue, and where possible, work

categories should be tailored to accommodate

those who are overweight or obese.

Psychosocial origins of the epidemic

Below are some examples of changes which,

over the years, have driven a cultural shift

towards obesity: The development of modern transportation

and urbanization. Mass marketing and the availability of cheap,

abundant, high-calorie foods (i.e. fast food). The non-sustenance role of food. An increase in sedentary lifestyle and the

24-hour availability of food.

Overweight or obese people have a greater

frequency of suffering: high blood pressure; heart attacks; strokes; diabetes; sleep apnoea; osteoarthrosis of the hips and knees; and greater predisposition to some diseases (e.g.

certain cancers).

Obesity has become

an issue of epidemic

proportions around

the globe, and

presents a

considerable health

and safety risk.

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In addition, overweight and obese individuals

are often considered to be predisposed to: increased absenteeism; increased medical expenditures; and decreased life expectancy.

Obesity and the oil and gas workforce

Challenges specific to the oil and gas workforce

include the following: Many oil and gas operations take place in

remote locations (e.g. on offshore platforms)

which may be situated at a considerable

distance from the nearest specialist treatment

centre; the provision of medical assistance to

address problems related to obesity (as well

as other health problems) may therefore be

particularly challenging. Obesity can be considered a safety risk and

may influence fitness for duty in certain

circumstances (e.g. offshore vessels, confined

or narrow stairs, fire brigade rescue

operations, evacuation by lifeboat and

helicopter, etc.).


Where possible, companies should: identify overweight and obese employees; raise awareness about the effects of overweight/

obesity, and the less well-known waist-to-

height ratio as well as BMI as a measure of risk. inform about, and promote, a healthy diet; require catering staff to provide healthy foods

that are identified as such (i.e. low in calories,

fat, sugar, salt, etc.), and encourage healthy

food habits (e.g. reducing calories, using well

prepared and tasty vegetables and desserts)

and a reduction in portion size; require catering companies to remove

artificial trans fats; encourage company walks, and distribute

pedometers; encourage the use of gyms, fitness clubs and

safe areas at work locations; reassign severely obese employees when

safety issues have been identified with regard

to their weight; and provide leadership to demonstrate support

for healthy eating and fitness.

Figure 5 Estimated obesity (BMI 30 kg/m2) prevalence (%), in males aged 15 and over (2010 data)

Source: adapted from Ono, T.,Guthold, R., Strong, K. WHO GlobalComparable Estimates, 2005. Theboundaries and names shown and thedesignations used on this map do notimply the expression of any opinionwhatsoever on the part of the WorldHealth Organization concerning thelegal status of any country, territory,city or area or of its authorities, orconcerning the delimitation of itsfrontiers or boundaries. Dotted lineson maps represent approximateborder lines for which there may notyet be full agreement. WHO 2012.All rights reserved.

21


Nutrition and diet

Fuelled by urbanization and the growth of the

global economy, many developed and

developing nations are foregoing their

traditional patterns of eating in favour of a

Western diet typically high in animal products

and refined carbohydrates, and low in whole

grains, fruits and vegetables.

An unhealthy diet can have a direct impact on

many conditions that increase the risk of CVD,

including blood cholesterol levels, body weight,

blood pressure and blood glucose levels.

Adopting a healthy diet together with a healthy

lifestyle can reduce the risk of heart disease,

heart attacks and strokes, and can help to avoid

conditions that may eventually lead to heart

disease.

Nutrition and cardiovasculardiseasepractical behaviouralchanges

The following guidelines for healthy food and

nutrition can help to reduce or even eliminate

some cardiovascular risk factors.

Reduce salt intake

The amount of dietary salt consumed by an

individual has a direct impact on blood pressure

and cardiovascular risk. The WHO recommends a

salt intake of less than five grams (about one

teaspoon) per person per day. Adding salt to

food and eating foods containing high salt

levels, particularly processed foods, frequently

contribute to exceeding the recommended

intake of salt.

Reduce consumption of fats

It is important to limit saturated fats and trans

fats such as beef, pork, lamb, bacon, high-fat

dairy products, butter and most processed foods.

Preference should be given to monounsaturated

and polyunsaturated fats found in olive oil,

canola (rapeseed) oil, nuts, olives and avocados.

Tips to help reduce dietary cholesterol include: reduce the number of eggs consumed to two

per week ; remove skin from poultry before eating; remove fat from red meat before eating; choose non-fat or low-fat cheeses; limit total cheese intake to three meals

weekly; choose broth in preference to cream-based

soups; limit high-fat dairy foods; choose non-fat or

low-fat varieties; and favour grilling, boiling, steaming or

microwave cooking over frying and roasting.

Increase intake of dietary fibre

This can be achieved by: increasing consumption of fresh fruits and

vegetables; and consuming cereals, and whole grain breads,

crackers, pasta and brown rice.

Reduce intake of sugars and sweeteners

Tips to reduce intake of dietary sugars include: avoid sugar-sweetened beverages like sodas

or soft drinks, energy drinks, fruit drinks,

sweetened milk or milk alternatives; reduce the amount of sugar added during

meal preparation or baking; avoid foods with added sugars or sweeteners

(check labels for added sweeteners, e.g. cane

juice, glucose, maltose, fructose, high fructose

corn syrup and molasses); limit or eliminate candy, sweets and baked

products; favour foods such as fruits, vegetables, lean

proteins and whole grains in meals and snacks; reduce or eliminate processed foods, which

are often high in added sugar as well as fats

and sodium (salt).

Increase consumption of fruits, vegetables,legumes and nuts

Adequate consumption of fruit, vegetables and

legumes (beans, lentils, peas, etc.) reduces the risk

of cardiovascular disease, some cancers and other

chronic diseases, such as obesity and type 2

diabetes. Nuts are high in monounsaturated fat,

and can help to reduce the bad cholesterol and

prevent heart disease. Tips include: eat plenty of fruit and vegetables; aim for 1/2 cup of legumes at least four times

weekly; and

choose fresh or dry roasted, unsalted nuts

and natural peanut butter for maximum heart

protection. Avoid sugared, salted or oil

roasted varieties.

Substitute plant protein for animal protein

Replacing animal protein with plant protein and

fish can provide a range of health benefits and

reduce the risk of CVD. Tips include: choose legumes, dark leafy green vegetables

or quinoa as good sources of plant protein; reduce intake of animal proteins; and eat more non-fried fish.

Further advice

General advice for encouraging a healthy eating

plan includes the following: Skipping meals is not recommended Divide calories into 46 smaller meals. Avoid heavy meals before going to sleep. Practice portion control an awareness of

the recommended portion sizes for certain

types of foods can help maintain a good

eating plan.


Oil and gas companies can have a positive

impact on the nutrition environment by

providing a worksite that is physically designed

to encourage good health. Examples include: Increasing the visibility and availability of

healthy food options where food is provided

in the workplace (e.g. in vending machines,

cafeterias, snack bars, common areas, and at

meetings and company-sponsored events. Utilizing marketing techniques at the point of

sale in company cafeterias to promote healthy

diet and food choices. Social marketing

techniques can be helpful in this respect. Providing adequate resources for refrigeration

and heating of foods so that employees can

bring healthy meals to work from home.

Promoting healthy

food in company-

controlled catering

facilities can help to

encourage good

health in the

workplace.

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23


Alcohol

Alcohol contains nothing of nutritional value

no vitamins, no minerals and no proteins. But

with seven calories per gram, it does contain a lot

of calories. One standard-size glass of wine,

whisky or beer contains 12 grams of alcoholthe

equivalent of 84 calories. This explains why heavy

drinkers gain weight and develop a beer belly.

Chronic or excessive consumption of alcohol

causes digestive problems (gastritis, gastric

ulcers, and pancreatitis), increases the risk of

digestive cancers (mouth, tongue, throat,

esophagus, pancreas, colon and rectum) and

damages the liver, leading to cirrhosis.

Even moderate drinking affects cognitive

functioning; binge drinking and excessive

repeated consumption can cause brain damage

such as memory loss. Alcohol reduces libido and

sexual performance and, along with smoking, is a

major cause of impotency. Exposure of fetuses to

alcohol during pregnancy is the primary cause of

birth defects, especially for cognitive development.

Alcohol is a drug that can lead to dependency

and cause withdrawal symptoms. Dependence

on alcohol, i.e. alcoholism, is a progressive

disease that can be fatal.

Drinking alcohol also increases the likelihood of

having a driving accident because of decreased

awareness, visual perception, reflexes and overall

performance. Brain activity is slowed while

reaction time is increased, which explains the

high number of alcohol-related traffic fatalities.

A glass of wine or beer every now and then is fine

for many people. It can reduce tension and stress

and help people to relax. Certain studies indicate

that moderate drinking may have cardiovascular

benefits. However, it should also be remembered

that alcohol consumption can lead to increased

blood pressureone of the most important risk

factors for cardiovascular disease.

Alcohol contains nothing of value as far as

nutrition is concerned. Despite the fact that

some studies indicate that moderate drinking

may have cardiovascular benefits, alcohol is a

drug; even moderate drinking affects cognitive

functioning, whilst drinking in excess increases

cardiovascular risk.

Lack of sleep is a worldwide problem which

began with the invention of the electric light

bulb and has become increasingly prevalent

with the advent of modern screen-based

technology (e.g. televisions, computers,

smartphones, tablets, etc.).

Sleep disorders

There are many types of sleep disorders,

including insomnia, sleep apnoea, restless leg

syndrome, narcolepsy and circadian rhythm

disorders. Two of the most common are: Insomnia: the inability to fall asleep or remain

asleep. This results in the sufferer not getting

the amount of sleep needed to wake up

feeling rested. This is the most common

sleep-related complaint. Sleep apnoea: the most common type of

sleep apnoea is obstructive sleep apnoea

(OSA). OSA is responsible for pauses in

breathing accompanied by snoring, fatigue

the following day, decreased alertness and

heart attacks. The problem is often noticed by

the individuals partner and can be confirmed

by sleep studies.

How sleep affects your heart

The average sleep requirement for adults is

considered to be around 7 to 8 hours, although

what is considered normal sleep varies from one

person to another. The actual amount of sleep a

person needs will depend on various factors,

including age and genetics.

Insufficient sleep can contribute to: heart disease; high blood pressure; heart rate modifications; insulin resistance (which can lead to type 2

diabetes and obesity); compromised immune response; and hormonal imbalance.

Practical behavioural changes

While some sleep disorders require a visit to a

sleep specialist, individuals with minor sleep

disturbances can improve some problems on

their own. Recommendations to help overcome

sleep disturbances include the following: Keep a sleep diary to track your symptoms

and sleep patterns. This can create a starting

place for dialogue with your physician or a

specialist. Improve your sleep hygiene and daytime

habits:

Develop a bedtime routinethis will teach

your body to wind down before sleeping.

Keep a regular sleep schedule, including

during weekends.

Use a timer to record TV programmes that

are broadcast after scheduled bedtime, and

turn off gadgets before going to sleep.

Use the bedroom only for sleeping and sex.

Set aside enough time for sleep. Most

people need at least 7 to 8 hours to enable

them to wake up feeling refreshed.

If problems and stress are contributing to

lost sleep, develop a relaxation plan, e.g.

exercising regularly early in the day can

improve sleep at night by reducing stress.

Dont go to bed hungry; but be cautious of

overeating, since indigestion may disrupt

sleep.

Drink caffeinated beverages in moderation

and avoid alcohol at bedtime. The effects of

caffeine can take up to eight hours to

subside and alcohol can act as a stimulant.

Shift workers may need to explain to

friends and family the importance of

getting sufficient sleep, and the

consequences of tiredness on health and

safety.

Before bed, avoid the use of alcohol and

medicines, such as sleeping pills.

Eat sensibly, exercise, and maintain a

healthy body weight.

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Lack of sleep

25



Disrupted sleep and fatigue have had a

significant impact on employee health and safety

at the worksite as well as on worker productivity.

A Fatigue Risk Management System (FRMS) can

identify sleep issues among employees and

reduce accident and injury rates significantly.

FRMSs need to be incorporated into corporate

policies and standards.

Sleep management is an integral part of an

FRMS which includes: workload-staffing balance; shift or duty rest scheduling; employee fatigue training; sleep disorder management; workplace environment design; and alertness monitoring and links to fitness for

duty.

Ideally, an FMRS will also include: appropriate staffing levels and hours of work

limits; fatigue identification, sleep management and

alertness training; accountability and regular review structures; continuous improvement processes; and metrics.

Senior leadership should acknowledge the

importance of the issue and actively provide

their support in addressing it. Senior leaders

should ensure that the workforce is provided

with education and awareness about managing

fatigue-related risks associated with shift-work.

Additionally, leaders should support the

environmental changes needed to reduce the

risks to safety.

Identification of the environmental issues, and

elimination of associated risks, are critical when

addressing fatigue. For example, important

questions may include: Do production platform sleeping quarters

provide an optimal place for sleeping; is the

temperature optimum; is it too noisy; and is

there a TV located in the room? If sleep schedules are specified for shift

workers, are they successful in optimizing

sleeping patterns or do they hinder them?

Fatigue can have

a significant

impact on

employee health

and safety at the

worksite as well

as on worker

productivity.

Stress is a normal part of life and is fundamental

to successful human performance. Stress can

give us a push to do our best in challenging

situations and to increase and maximize

performance and productivity. However,

unalleviated stress can affect our bodies, minds

and behaviour.

Unmanaged stress can lead to an increase in the

risk of heart disease. Learning how to recognize

the signs of stress and taking action to reduce its

harmful effects are important steps to

maintaining a healthy cardiovascular system.

What is stress?

Stress is the bodys reaction to any change that

requires an adjustment or response. The body

reacts to these changes with physical, mental

and emotional responses. There are two main

types of stresspositive and negative.

Positive stress typically results in an increase in

performance, focus and efficiency, while

negative stress is either an ongoing cycle that

becomes a way of life or a singular heightened

response to a situation where the stress

response is not called for (i.e. heightened stress

to being stuck in trafficas if our lives were in

danger when no danger exists).

Stress is affected by emotional and external

factors. Emotional factors involve a persons

evaluation of stressors, real or imagined. Examples

are hostility, anger, depression and anxiety.

External factors are stressors in ones environment,

such as natural disasters, work, change and

uncertainty, disease, marital and financial

problems, responsibility for others, everyday

annoyances and frustrations that accumulate and

overwhelm.

Stress can affect a person both instantly (acute

stress) and over a period of time (chronic stress),

as described below: Acute stress: this occurs when a person is

faced with an immediate threat or a need to

adapt, for example in the event of a personal

attack or a sudden noise. The threat may be

an actual danger or just something that is

perceived as threatening. The acute stress

response is commonly referred to as the fight

or flight response, and is inherited from our

distant ancestors who would frequently have

had to either fight or flee to protect

themselves from attack by marauding

invaders or wild animals. Chronic stress: this is ongoing and often

results from stressors encountered in modern

day living, such as financial concerns, job

pressures or relationship problems. This type

of stress suppresses the fight or flight

response, resulting in prolonged responses in

the body that prevent recovery and repair.

Each individual responds to lifes problems,

difficulties and everyday annoyances in their

own personal ways. For example, given the same

situations, some individuals will respond with

frustration and anger while others remain

relaxed and even-tempered. Evidence suggests

that it is the individuals reaction to situations,

crises and everyday eventsrather than the

stress itselfthat is the real problem.

IPIECA OGP

26

Stress

Chronic stress,

resulting from the

pressures of

modern-day living,

can have a

prolonged

detrimental effect

on the body if not

addressed.

27


How stress affects the heart

Stress alone does not provoke heart attacks. It is

the individuals poor response to stress over time

that can lead to heart disease.

Stress is also known to worsen other risk factors

such as high levels of cholesterol and high

blood pressure. Stress changes the way blood

clots develop and can increase the risk of a

heart attack if it continues without relief.

Frequently, many factors cluster together to

increase disease risk. For example, when people

are under stress their blood pressure goes up,

they may overeat and exercise less, and they

may be more likely to smoke.

Poor responses to stress often include increased

smoking, excessive eating, increased caffeine

intake, lack of sleep, increased alcohol and drug

abuse including excessive use of tranquilizers

and sleeping pills.

Good responses to stress include healthy eating,

physical activity and relaxation periods, and

sufficient sleep.

Warning signs of stress

Common signs and symptoms of stress include: physical signs: dizziness, general aches and

pains, grinding teeth, clenched jaws,

headaches, indigestion, muscle tension,

difficulty sleeping, racing heart, ringing in the

ears, stooped posture, sweaty palms,

tiredness, exhaustion, trembling, weight gain

or loss, upset stomach; mental signs: constant worry, difficulty

making decisions, forgetfulness, inability to

concentrate, lack of creativity, loss of sense of

humour, poor memory; emotional signs: anger, anxiety, crying,

depression, feeling powerless, frequent mood

swings, irritability, loneliness, negative

thinking, nervousness, sadness; and

behavioural signs: bossiness, compulsiveeating, critical attitude towards others,

explosive actions, frequent job changes,

impulsive actions, increased use of alcohol or

drugs, withdrawal from relationships or social

situations.

Employees role in stress reduction

There are a number of ways in which the

employee can manage his or her response to

stress. Some useful recommendations include: healthy eating; drinking in moderation; regular activity and/or exercise; avoiding excessive caffeine intake and the

consumption of energizing drinks; smoking cessation; and ensuring adequate sleep and rest.

Additional recommendations include: knowing and accepting ones limits; recognizing and admitting to ones mistakes; asserting oneself and assuming responsibility; managing time effectively; setting priorities; thinking positively and setting realistic

personal goals and expectations; and taking advantage of support groups,

including family, friends, colleagues, etc.

Stress can manifest

itself in a variety of

physical, mental,

emotional and

behavioural ways,

and in severe cases

can lead to more

frequent use of

alcohol and drugs,

thereby increasing

cardiovascular risk.


Workplace leaders and managers are architects

of the work environment and need to attend to

those elements in the workplace that can

contribute unnecessarily to unalleviated stress.

Below are some specific areas that workplace

leaders need to pay attention to: Control over work: How much do employees

or workers actually understand about their

work? How engaged are they in the goals of

the work? How much control do they have

over how the work gets done? Are employees

working hours monitored with the aim of

avoiding excessive time spent working? Roles and responsibilities: Do workers

understand their roles and how their

responsibilities fit with the roles of their

co-workers? Communications: Does the workplace have a

commitment to clear and regular

communications about changes in the work

or organization? Is management available for

regular communications with employees?

Diversity: Is the workplace free fromprejudice, bullying and harassment? Are

workers open to, and respectful of, each

others differences? Recognition of positive performance: Is the

workplace an environment where the

achievements of work teams and individual

workers are celebrated and recognized? Conflict management: When differences

arise between workers, is there a clear avenue

for the reconciliation of these differences? Work/life balance: Is the company cognizant

of work/life boundaries? Do employees

perceive that managers and leaders

appreciate and honour the fact that they have

personal responsibilities and commitments?

These workplace variables are key to the

development of an environment where

unnecessary stress is reduced.

Good relationships

with management

and colleagues, and

a recognition of

employees

commitments and

responsibilities are

important aspects

of managing

workplace stress.

IPIECA OGP

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29


The ageing workforce and cardiovascular risk

It is not easy to define an older worker. The WHO

defines 45 years and over as the dividing line

between younger and older workers.

Ageing is not a disease but a biological process

that starts at birth. Although exercise, a proper

diet and good lifestyle choices have been shown

to slow down the ageing process, they cannot

reverse it.

In general, individuals may not have the same

strength or physical abilities at age 50 or 60 that

they had at 25 or 30.

However, age should not determine fitness to

work. There can be a significant difference

between the employees chronological age and

their physiological age. For example, a 60-year-

old individual may be fitter than a 40-year-old.

Characteristics of the olderworkforce

The consensus is that knowledge, skills and

experience are advantages for retaining older

workers. Older employees also have the

potential to provide training as well as to act as

role models for the younger generation of

employees.

Older workers are potentially as adaptable and

flexible in learning new technologies and coping

with change and stress as the younger

workforce.

However, duration of absenteeism and recovery

may be more significant and costly following

injury or illness in employees over 45 years of age.

The ageing process will result in increased

arteriosclerosis (hardening of the arteries),

hypertension and increased frequency of

cardiovascular illnesses (heart attacks and

strokes) as well as an increased frequency of

other chronic diseases (e.g. diabetes,

musculoskeletal disorders, cancer, kidney

diseases). These medical issues can be

responsible for work limitations or restrictions.

Emphasis should be placed on the

implementation of employee wellness

programmes that can contribute to allowing the

ageing workforce to work and be productive for

a prolonged period of time.

Health assessments and fitness-for-task

examinations should place adequate emphasis

on the following in the ageing population: blood pressure and the cardiac function; musculoskeletal strength; coordination and physical flexibility; visual acuity; hearing; and potential side-effects of medication taken for

chronic illness.

The oil and gas industry will be faced with an

ageing workforce in the coming years as the

number of older workers continues to increase

relative to the number of younger employees.

Age should not

determine fitness to

work: a 60-year-old

individual can be

just as physically fit

as a 40-year-old,

and knowledge,

skills and experience

are good reasons for

retaining older staff.

Why should companies address theissue?

The global trend among young people today is

towards getting fatter, eating more junk food,

drinking more soft drinks, increasing screen time

and reducing physical activity. The generation of

new employees coming into the oil and gas

industry reflects this worldwide trend.

It is essential for companies to put in place risk-

based health promotion programmes that are

capable of addressing this lifestyle problem.

Without such efforts, the repercussions in years

to come are likely to have a negative impact on

the industrys business.

What can companies do?

Specific recommendations appear continuously

throughout this document. General examples of

how companies can promote well-being and

reduce cardiovascular risk factors include: effective company leadership and

commitment; health assessments and screening; awareness, education and training; promotion of risk factor reduction,

addressing:

smokingsmoking cessation programmes;

no-smoking environments;

foodcontracting catering companies that

are capable of implementing healthy

eating programmes (e.g. using less salt, less

fat, less sugar, more vegetables, more fruit,

tasty and attractive foods, etc.);

beveragesdiscourage soft drinks and

provide a plentiful supply of fresh water;

alcoholprovide education on the risks

and effects;

inactivityencourage fitness days; promote

the use of gyms and fitness clubs; promote

walking, including the use of stairs;

stressfocus on prevention and managing

the root causes of work-related stress at the

organizational level; provide training and

awareness at the employee level, and

access to counselling where possible; and

fatigueoperate an effective fatigue

management system. involving families where possiblee.g.

inviting families to fitness days; encouraging

spouses and families to favour healthy food

options when shopping, cooking and eating.

Initiatives to promote well-being need to be

sustained over the long term. It is essential to

understand that the risk of cardiovascular disease

is a global problem and is likely to worsen in the

oil and gas industry over the coming years. Data

on the issue should be collected over time and

used to coordinate ongoing efforts and provide

feedback to management.

IPIECA OGP

30

What oil and gas companie

Prevention of heart attacks and other cardiovascular diseases

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