1. Introduction

Celebrovascular dieses is commonly known as stroke or brain attack. It happens when the blood supply to part of brain is cut off. Blood carries essential nutrients and oxygen to our brain so it will work properly. Without blood, our brain cells can be damaged or destroyed and they will not be able to do their job. Because brain controls everything we do, feel, think and remember, a stroke can affect these abilities. A severe stroke can cause physical disablement, mental impairment and in some cases, sudden death. During stroke a person might not be able to ask for help or understand what is happening. The person might become vulnerable and cause a risk to themselves or others; depending on the task and activity they were performing at the time of a stroke. (Stroke Association ND)

2. Types of Stroke

Strokes can happen to anyone and are usually classified in two major categories; ischemic stroke and hemorrhagic stroke.

1. Ischemic strokes represent about 80 per cent of stroke cases and are caused by a blood clot that blocks a blood supply to the brain. This usually happens in one of two ways; •Embolic stroke – a blood clot that has formed somewhere else in the body travels through the bloodstream to the brain, and gets stuck in a small blood vessel, blocking blood flow. •Thrombotic stroke – A clot forms in blood vessels that are clogged by fatty deposits. These deposits usually clog major blood vessels in the neck and reduce blood flow to the brain.
2. Hemorrhagic stroke is caused by a blood vessel in the brain that breaks, leaking blood into the brain. These types of stroke account for about 20 percent of all strokes and usually happen in one of two ways: •Intra-cerebral hemorrhage – In this type of stroke, a blood vessel in the brain bursts and spills blood into thebrain tissue, damaging cells. Brain tissues in the surrounding area also get deprived of blood and are also damaged. •Subarachnoid hemorrhage – In this type of stroke, bleeding starts in a blood vessel on or near the surface of the brain and spills blood into the space between the surface of the brain and the skull.

There is also a related condition known as a Transient ischemic attack (TIA), often known as a mini stroke. This is caused due to a brief delay or decrease in the supply of blood to the brain. Like an ischemic stroke, a TIA occurs when a clot or debris interrupts or blocks blood flow to a certain part of the brain. It often goes unrecognized as the symptoms are slight and last for a short period of time. The cumulative effect of several TIAs can be as disabling as a severe stroke. (IOSH ND)

3. Warning Signs of Stroke

Some common warning signs of stroke or TIA are as under:

• Sudden weakness or numbness of the face, arm, and leg on one side of the body
• Loss of speech, or trouble speaking or understanding speech
• Dimness or loss of vision, particularly in only one eye or half of both eyes
• Sudden onset of blurred or double vision
• Unexplained dizziness
• Sudden onset of unsteadiness, lack of coordination, difficulty walking
• Sudden excruciating headache
• Recent change in personality or mental abilities, including memory loss

(BRASS M 2009)

4. How common Celebrovascular Disease in UK?

Statics shows, after heart disease and cancer stroke is the third largest cause of death, in UK. Every year an estimated 150,000 people have a stroke in UK; in only Yorkshire & Humber about 10,600 people have stroke last year. Stroke can affect anyone, no matter what their age. Stroke is the largest cause of complex disability in adults. There are over a million stroke survivors in the UK, half of whom have been left with disabilities that affect their daily life.

(Stroke Association 2009)

5. Risk factors of the disease

1. Age, our arteries become harder and narrower. However, certain medical conditions and lifestyle factors can speed up the process and increase our risk of having a stroke.
2. Medical problems can increase risk of having a stroke like.

1. High blood pressure

High blood pressure (also called hypertension) can damage our arteries. We may not know if we have high blood pressure, so we should have it checked regularly. The ideal blood pressure for a healthy adult is less than 120/80mmHg.

2. High cholesterol

Cholesterol is a type of fat produced by our liver. It is also found in foods like meat and dairy products. Our body needs small amounts of it, but too much is unhealthy. Extra cholesterol can travel around the arteries in our body, narrowing them and increasing our risk of stroke. We can lower our cholesterol by making sure our diet is healthy and low in saturated fats. Our doctor may advise We to take medication, too. If We are over 40, We should have our cholesterol checked regularly. It should be under 5mmol/L.

3. Type 2 diabetes

Diabetes is a condition where there is too much sugar in our blood. This can cause fatty deposits to build up in our arteries, which can lead to them becoming blocked. This then increases our risk of having a stroke, particularly if we have had diabetes for a long time and We have not been controlling it very well.

4. Arterial fibrillation (a type of irregular heartbeat)

When the heart beats irregularly, blood clots can form and travel to the brain. They can block an artery and cause a stroke. If we have arterial fibrillation, our risk of having a stroke is increased up to five times. We are more likely to develop this condition if we are over 65.

5. Heart disease

Other problems like heart valve disease and heart attacks can increase our risk of a stroke. Having treatment for our condition and regular check-ups will help to keep our risk as low as possible.

3. Lifestyle factors, are, also affect our risk. Taking steps to change as many of the risk factors as we can, will help us to reduce our risk of having a stroke

1. Smoking

Smoking causes our arteries to fur up (atherosclerosis) and makes our blood more likely to clot. If We smoke, We are twice as likely to have a stroke, and this risk will increase the more We smoke. Stopping smoking will reduce our risk of a stroke (and other health conditions) – no matter how old we are or how long we have smoked.

2. Drinking

Drinking too much alcohol raises our blood pressure. Binge drinking – drinking more than eight units (for men) or six units (for women) in a single session – is particularly dangerous as it can cause our blood pressure to rise very quickly.

3. Drugs

Some types of drugs can increase our risk of stroke by damaging our blood vessels and raising our blood pressure. They include stimulant drugs like cocaine and amphetamines, and drugs that improve sports performance.

4. Eating Habit of Junk food, high fat protein, salty dishes and fats is also play a significant role in increasing risk factor of strokes. As such it is recommended to use vegetables, low fat protein, plenty of fibres to avoid risk of stroke aptly.

IV. Overweight

Being overweight puts us at risk of high blood pressure, heart disease and type 2 diabetes, all of which increase our risk of a stroke. To find out if we are a healthy weight for our height, visit our GP. A healthy diet and regular exercise will help we to lose or control our weight.

V. Stress and depression

Many things in life – like work issues, redundancy, family problems and bereavement – can lead to stress and depression. These not only take a physical toll on our body, but if they are not treated, they can lead to long-term health problems. It‘s important that We get any help We need from our doctor and other healthcare professionals.

VI. Genetic Risk factor

Study provides evidence that common genetic variation has a role in the pathogenesis of ischemic stroke.

VII. Work

Adverse working conditions that may lead to blood pressure increases may also be unhelpful in avoiding repetition to their type of illness. (St.Georges)

6. What are the main legal implications?

The law places duties on the employer to assess risks posed to their workers and, where necessary, to take action to safeguard health and safety, including health surveillance if appropriate. This could be achieved by carrying out a comprehensive risk assessment.

Not complying the regulations the employer may have to face prosecution in Employment Tribunals and Court of Law for not providing reasonable adjustments to the workplace.

Following are the main laws we must follow in this case.

The Health and Safety at Work etc Act 1974 requires employers to secure the health, safety and welfare of employees at work. This includes providing a safe place of work, safe systems of work, information and training.

The Workplace (Health, Safety and Welfare) Regulations 1992 require employers to provide adequate welfare facilities for their employees.

The Management of Health and Safety at Work Regulations 1999 (as amended) require suitable and sufficient assessments of health and safety risks at work to be carried out and every employer shall ensure that his employees are provided with such health surveillance as is appropriate having regard to the risks to their health and safety which are identified by the assessment. Further, every employer shall appoint one or more competent persons to assist him in undertaking the measures he needs to take to comply with the requirements and prohibitions imposed upon him, If employee is mobility impaired he may need a personal evacuation plan putting in to place to comply with the Regulatory Fire Reform Safety Order 2005.

TheEquality Act 2010 imposes a duty on employers to make reasonable adjustments and provide legal defense against discrimination on the grounds of disability, including disability relating to stroke.

Besides, internationally all signatory countries of the United Nations Convention on the Rights of People with Disabilities – 2006 are bonded to take appropriate measures to avoid discriminatory act with disable persons/ employees.

(UNCHR 2006)

7. Rehabilitation

Although track record of the employee concerned is not good with respect to attendance and he has previously been warned for his intolerant attitude to ill health matters and absence from ill health. But, everything should be done to make sure the employee feels welcome when they return to work, and that other employees are treating the employee well to avoid any chance of discrimination.

As the individual has suffered a stroke and he is resuming duty after five month, we need to rehabilitate him phase wise. First of all line manager need to revise the Risk Assessment of workplace with respect to disabilities of employee concerned to take reasonable and sufficient controls for safety of employee and other co-workers by considering the following factors.

• Mobility

• Manual Dexterity
• Physical co-ordination
• Continence
• Ability to lift, carry or otherwise move everyday objects
• Speech, hearing or eye sight
• Memory or ability to understand, concentrate or learn
• Perception of risk of physical danger
• Amended duties or times of attendance.

Keeping in view the above factors and handling of hazardous/ toxic chemicals are being stored in nail salon industry like Acetone (nail polish remover), Acetonitrile (fingernail glue remover), Butyl acetate (nail polish, nail polish remover), Dibutyl phthalate (DBP), (nail polish), Ethyl acetate (nail polish, nail polish remover, fingernail glue), Ethyl methacrylate (EMA), (artificial nail liquid), Formaldehyde (nail polish, nail hardener) , Toluene, formaldehyde, dibutyl phthalate and risky equipments. You should consider reasonable adjustments of the employee concerned as per appended list and offer him time off for (physiotherapy or occupational therapy) so that a he might be able to return to work after five months successfully.

Working arrangements

• Encourage employees to stay in touch with work

• Offer them a phased return to build up their strength, gradually increasing their hours of work

• Change their working hours so they don’t have to travel at busy times, or offer them flexible working to

Support their work–life balance

• Provide them with help travelling to and from work, or let them park nearer workplace entrances

• Allow them to work from home if possible

• Give them time off work for medical treatment and assessments

Working environment

• Move their workstation so that it’s more accessible, or closer to washing and toilet facilities if appropriate

• Alter the work premises, for example install ramps or improve lighting

Work adjustments

• Give them specialist equipment or modify existing equipment

• Modify their workstation or furniture

• Change or simplify their work pattern, such as no shift or night work

• Give them extra or refresher training

• Modify instruction manuals and standards to suit their abilities

• Modify their work tasks, such as reducing the need for face-to-face meetings or travel

If they suffer from work anxiety

• Modify management systems to give them more control in line with agreed modifications

• Reduce their pace of work – give them less difficult targets or deadlines, longer breaks

• Modify procedures for testing and assessing competence or ability to do a job

• Give them a ‘companion’, mentor or more supervision

• Give some of their tasks to other employees, give them different work, or re-deploy them

• Give them training and information, for example on back care.

(IOSH 2012)

8. Conclusions and recommendations

In UK, celebrovascular disease is very common. Workers should be encouraged to avoid this disease by adopting healthy life style and diet. The individual suffering from this condition may be out of office for long period and need more than physical and moral support to recover from the aftereffects of the stroke. It is not only our moral obligation but also legally the organization is responsible for supporting him adequately without any discrimination and provide him equal opportunities for his healthy return at work; This is because people with adverse medical conditions can lose their skills and confidence. Long periods of inactivity and isolation can have a negative impact on their physical, psychological and social health, as well as their general wellbeing. It has been reported that people out of work for more than a year have, on average, eight times more psychological ill health than those in work.

Long term absence is not just costly for employees – employers and society pay a high price too. In the UK, around 36 million working days are lost as a result of work-related illness and injury each year. The Health and Safety Executive (HSE) estimates that this represents an annual loss to UK society of up to £31 billion, as such it is highly recommended to rehabilitate by adopting the above said suggestions in the best interest of the company and country, please.

9. References

1. What is Celebrovascular Disease?

Stroke Association (n.d.) [online] London Stroke Association. Available at:

http://www.stroke.org.uk/about/what-is-a-stroke Accessed on 15 Feb. ‘14

2. IOSH (n.d) [online] The Grange, Highfield Drive, Wigston, Leicestershire IOSH Available at:

http://www.iosh.co.uk/en/Books-and-resources/Our-OH-toolkit/Non-work-related-conditions/Stroke.aspx Accessed on 14 March ‘14

3. Introduction to stroke by LAWRENCE M. BRASS, M.D available at http://doc.med.yale.edu/heartbk/18.pdf Accessed on 9 April 2014

4. Statistics resource sheet on strokes from The Stroke Association

Stroke Association (2009) [online] London Stroke Association Available at:

http://www.stroke.org.uk/sites/default/files/files/AOS%20Statistics.pdf

Accessed on 20 Feb. ‘14

5. How to prevent a Stroke? Stroke Association, Leaflet 3, and version 1.

Stroke Association (December 2012) [online] London Stroke Association Available at:

http://www.stroke.org.uk/sites/default/files/How%20to%20prevent%20a%20stroke_0.pdf Accessed on 20 Feb.’14

6. Genetic risk factors for ischaemic stroke and its subtypes the METASTROKE Collaboration): a meta-analysis of genome-wide association studies. St George’s University of London, (October 5, 2012) [Online] Stroke genetics Available at:

http://www.strokegenetics.com/isgc-publications/metastroke-paper.pdf Accessed on 27 Feb. ‘14

7. A Healthy Return, good practicing guide for rehabilitating people at work by IOSH

IOSH (2012) [online] The Grange, Highfield Drive, Wigston, Leicestershire IOSH Available at:

http://www.iosh.co.uk/~/media/Documents/Books%20and%20resources/Guidance%20and%20tools/A-healthy-return.ashx

Accessed on 07 March ‘14

8. Ensure your own actions reduce risk to health & safety (NVQ2 Hairdressing)

http://htmob.mobi/sites/default/files/download/document100.pdf

Accessed on 10 March ‘14

9. The United Nations Convention on the Rights of People with Disabilities – 2006

United Nations Convention (2006) [Online] UK United Nations Convention Available at:

http://www.un.org/disabilities/documents/convention/convention_accessible_pdf.pdf Accessed on 06 March ‘14

10. OSHA Health hazardous in Nail salons

OSHA (2010) [Online] Washington OSHA U.S. Department of LaborAvailable at:

https://www.osha.gov/SLTC/nailsalons/chemicalhazards.html

Accessed on 06 March ‘14

11. The Health and Safety at Work etc Act 1974

Legislation.gov.uk (2001) [Online] UK Legislation.gov.uk Available at:

http://www.legislation.gov.uk/uksi/2001/2127/contents/made

Accessed on 15 Feb ‘14

12. The Workplace (Health, Safety and Welfare) Regulations 1992

Legislation.gov.uk (1992) [Online] Legislation.gov.uk Available at:

http://www.legislation.gov.uk/uksi/1992/3004/contents/made

Accessed on 19 Feb. ‘14

13. The Management of Health and Safety at Work Regulations 1999

Legislation.gov.uk (1999) [Online] Legislation.gov.uk Available at:

http://www.legislation.gov.uk/uksi/1999/3242/contents/made

Accessed on 03 March ‘14

14. TheEquality Act 2010

The Stationery Office Limited (8/April/2010) [online] UK Available at: http://www.legislation.gov.uk/ukpga/2010/15/pdfs/ukpga_20100015en.pdf Accessed on 22 March ‘14

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