Occupational Diseases Work related diseases - PowerPoint Presentation

Slide1

Occupational

Diseases

Work related diseases

HAS 222

Slide2

Presentation Plan

Definition of occupational diseases

Epidemiological data on occupational diseases

Exposure routes for occupational diseases

Classification

of

occupational

diseases

Examples

of

most

frequent

occupational

diseases

and

protection

measures

Pricinciples

of

diagnosis

of

occupational

diseases

Slide3

Occupational

Diseases

- Definition

Occupational disease is disruption of a person’s well-being due to factors which he or she exposed during work.

ILO(International

Labor

Organization

)/WHO (World

Health

Organization

) main

two

elements

of

occupational

disease

:

“

the causal relationship between exposure in a specific working environment or work

activity and a specific disease; and

«

the

fact that the disease occurs among a group of exposed persons with a frequency

above the average morbidity of the rest of the population

»

There

is a

direct

causative

relationship

between

work

and

disease

in

occupational

diseases

.

“

specific

for

the

occupation

”

lead

intoxication

–

battery

manufacturing

silicosis

---

dust

exposure

–

mining

Slide4

Act

for

Occupational

Safety and Health (#6331) A disease that arises after exposure to occupational risks

Legislation

for determination procedures of proportion of loss of ability to work or to earn (October 11, 2008) Temporary or permanent illness, physical or mental disability due to repeated reasons for the nature of the work the insured is working or doing, or due to the conditions of the job execution.

Occupational

Diseases

- Definition

Slide5

Work

Related

Disease

-

Definition The risk factor for

the

disease is outside the work place A pre-existing disease of a

person

may

have

a

much

more

severe

prognosis

during

working

Example

:

stress

related

musculosceletal

diseases

,

coronary

heart

diseases

,

asthma

etc

Slide6

Work

Accidents

and

Occupational DiseasesGlobal workforce: ~2.7 billion Annual fatality caused by work related factors: 2 million (1/30 of all

deaths)*

160 million injuries or disease are diagnosed yearlyEconomic loss: 4% of global GDP ($1.25 trillion) for work related morbidities Work related mortalities: 1 in 1000 *WHO- The World Health Report 2008

Slide7

Frequency

of Occupational

Diseases

in

Turkey (1971-2013) Year

# of

workers x 1000# of ODOD/100 000 worker19954 41197522,1 20005 25480315,320056 919519

7,5

2006

7 819

574

7,3

2007

8 505

120814,220088 8035396,120099 0304294,8201010 0315335,3201111 0316976,3201212 5273953,2201311 9403713,1

Republic of Turkey Social Security Instution, Annual Statistics

Frequency of OD-Expected: 400-1,200 per 100,000-Statistics: 10-35 per 100,000# of OD -Expected 36.000 (0.4%) - 108.000 (1.2%) -Statistics: 300 – 1300 cases

Frequency

(

per

10000)

Slide8

Occupational Diseases

Occupational

diseases

are preventableThey should

be prevented

due to humanistic and economic factors Occupational diseases most frequently occurs in workers having direct exposure to

the

agent

at

workplace

.

Rarely

, relatives of those workers could be diagnosed as well Notification of occupational diseases is mandatory. Workers are paid on a compensation when an occupational disease is diagnosedDiagnosis of an occupational disease could be a chance to prevent other cases

Slide9

If

a disease

:

is not

responding

to standart treatment,is not compatible with typical demographic data,is not predictable in terms of the etiology, it should be suspected that

there

could be an occupational etiology!!

Slide10

Main

three

exposure

routes for harmful agentsInhalationMain entry way for

most agents

Slide11

Main

three

exposure

routes for harmful agentsOral (Gastrointestinal system) Chemicals, mostly accidental

Slide12

Main

three

exposure

routes for harmful agentsSkin contact Mechanical agents Friction, pressureChemicals Allergic

reaction, irritation

Physical agents Hot and cold, sunlightBiological agents Bacteria, fungi, parasites

Slide13

Occupational diseases

Occupational

diseases

could manifest 1. Acutely (within minutes or hours) 2.

Chronically ( within

days or years) Duration between first contact and manifestations of disease varies between 1 week to 30 years

Slide14

Occupational diseases

1.Local

effects

:

Effects

seen where harmful agents contacted the body

2.Systemic effects

: Effects of harmful agent seen in other organs and systems of bodySKINAcrylicEpoxi resinNickelCoal dustbenzene

LUNG

Asbestos

Silica

Cotton

dust

Cadmium

Diesel exhaustPulp dustBoxide dust GI TRACTAsbestosNitrosaminsWelding fumeLeadLOCAL EFFECTSSYSTEMIC EFFECTSBRAIN AND NERVOUS SYSTEMOrganophosphatesPesticidesLead,MercuryManganeseArsenicCIRCULATIONCarbonmonoxideVinyl chlorideTrichloroethyleneBenzeneToluene LIVERCarbon tetrachlorideVinyl chlorideTrichloroetylene

KIDNEY AND BLADDERBenzidine dyesBetanaftilamineEmissions of coke ovenMercury

BONE

Lead

Slide15

Group

A: Diseases

caused

by

exposure to chemicals (25 group of chemicals like CO, cadmium, chromium, mercury, lead, benzene)Group B: Occupational skin disorders (skin cancers

and skin diseases other

than cancers)Group C: Pneumoconioses and other occupational respiratory diseases (pulmonary diseases caused by exposure to six different types of dust including silica dust) Group D: Occupational infectious diseases (four groups of infectious and parasitic diseases including tuberculosis and viral hepatitis)Group E: Diseases caused by physical agents (radiation

,

pressure

,

noise

,

heat

,

vibration, ergonomics)119 diseases in totalLegislation for determination procedures of proportion of loss of ability to work or to earn

Slide16

DURATION OF EXPOSURE

Required

minimum

duration

between start of harmful effect and symptoms of the disease. Examples: For pneumoconiosis: 3 yearsFor occuaptional hearing

loss: 2 years for

noisy jobs, 30 days for noise level > 85dBDURATION OF RESPONSIBILITYAcceptable maximum duration between end of harmful occupational effect and manifestation of the diseaseExamples: For leukemia caused by benzene exposure: 10 years,For chronical arsenic intoxication: 1 year

Slide17

1.

Diseases

caused

by agentsDiseases caused by chemical agentsDiseases caused by physical agentsDiseases caused by biological agents2. Target organ diseases

Occupational pulmonary

diseasesOccupational skin diseasesOccupational musculoskeletal diseases3. Occupational cancers4. Others

Slide18

Top 10 in

Occupational

Diseases

and

Injuries (NIOSH)Occupational pulmonary diseases (most frequently notified)Musculoskeletal injuriesOccupational cancers (other

than lung cancer

)Amputations, fractures, loss of eye, lacerations, traumatic deathsCirculatory diseases6. Reproductive diseases7. Neurotoxic disorders8. Noise induced hearing loss9. Dermatological problems (most frequently seen)10. Psychological disorders

Slide19

Occupational diseases caused by chemicals

M

etal

s

Lead

MercuryChromiumCadmiumManganeseNickel

Arsenic

BeriliumAluminum Other heavy metals

Slide20

Lead

intoxication

-

Diagnosis

Anamnesis

; symptoms, occupation (eg: battery factory as workplace)Clinical findingsLaboratory: lead

measurement in blood

and urine Workplace measurements: lead measurement Treatment STOP the exposure Supportive treatment (hospitalisation if needed) Specific treatment - «chelation»

Slide21

Gases

Irritant

Gases

with irritant effects on skin and mucosa Acid or alkali; SO2 ,NO2 ,NH3

Bophal-Methyl

isocyanate Simple asphyxiant Gases without chemical reaction in the body CO2 , CH4 (carbon dioxide, methane, nitrogen, helium) replaces oxygen  causes hypoxiaChemical asphyxiant Gases distrupting oxygenation by chemical reactions in

the

body

CO, HCN, H

2

S

(karbon

monoxide, hydrogen cyanide, hydrogen sulfur)“interaction” + , binds to proteinsToxic in extremely low doses - ppm

Slide22

Carbon

Monoxide

Intoxication

If there is no enough oxygen, after fast burning CO2 --- water --- CO

One of the

most toxic gasesColorless – odorless – irritant, Non noticable !!Initial symptoms are nonspecific:Headache, nausea, fatiguePatophysiologyAffinity to hemoglobin is 200-300 times more than oxygenCarboxyhemoglobin ---- COHbIn this form, hemoglobin cannot carry oxygen.

Slide23

Carbon

monoxide

(CO)

Intoxication- Risky JobsIron-steel manifacturingWorkers of coke ovensFoundry

workers

Traffic policeFiremanWorkers at undergorund garagesWorkers at boiler roomsCar mechanic

Slide24

Carbon

Monoxide

Intoxication

Diagnosis

Anamnesis: CO exposure – occupation Clinical findings: nonspecific, “lips are dark

red in color, cherry-red

lips” (!)CO-Hb level measured in exhaled airTreatment COHb half lifeAir 5h. 30 min.Oxygen treatment 1h. 30 min.Hyperbaric oxygen treat. < 30 min.; should be continued until COHb < 10%General supportComa

Aspiration

pneumonia

Cerebral

edema

Slide25

Carbon

monoxide

Intoxication

ProtectionTechnical measuresPrevention of exposureEnclosed systemsAlarm (noise or

light)Ventilation

Personal protector - maskProtection Medical measuresJob entry examinations; Hemoglobin, smoking, heart failure, chronic obstuctive lung diseasePeriodical examinations; CO in exhaled air, COHb measurementEducation; about personal protectors

Slide26

Solvents

Alyphatic

Aromatic

Alicyclic

Oil

distilatesAlcoholsGlycolPhenolsKetonesEsters

Ethers

GlycolethersGlicide estersAcidsAminesChloride hydrocarbonsChlorofluorocarbonsOthers: turpentine and some monoterpenes, dimethylsulphoxide

Slide27

Benzene

Toxicity

C

6

H

6 Aromatic HC prototype * clear, colorless, nice smelling * boiling n: 800C – rapidly evaporate *

very good

solventKaynakları Coke oven, side productOil refineryKullanım GluesPainting, spray painting- “thinner” Synthesis of organic substances – detergents etc.Chemical produciton (closed system)

Slide28

Prof. Muzaffer Aksoy, MD

Prof. Aksoy

noticed

increased

number

of

shoemakers

with

leukemia

. He

published his stuides on producers of sandals and shoes at a scientific journal called “Blood” in 1974. After this studies, US Ministry of Labour sued this aspect and Prof. Aksoy listened as a witness. After this lawsuit, 8-hour exposure limit for benzene decreased from 10 ppm to 1 ppm as an OSH regulation.

Slide29

Benzene

Toxicity

Diagnosis

Anamnesis

,

occupational historyLab: Benzene in exhaled air, phenol in urineTreatmentNo specific

treatment, STOP exposure

General support, coma, treatment of leukemiaProtection Technical; enclosed system, ventilation, maskMedical; job entry examination, blood counts and blood smears for anemia periodical examination, benzene in exhaled air, phenol in urine

Slide30

Pesticide

Exposure

Pesticides

are chemicals used in order to kill unwanted animal, insect, fungi etc.

4 groups

Insecticide:fly, mosquito Malathione, Parathione, ... Halogenated HC; DDT, Hexachlorobenzene, ...Fungicide: fungiHerbicide: plants; grass 2,4 dichloro phenoxyacetic acid (2, 4 D)Rodenticide: mouse, rat anticoagulant, dicoumarol

Slide31

Risky

Jobs

for

Pesticide ExposureProductionStorageTransportApplication (agriculture)

preparation

mixing spraying

Slide32

Pesticide

Exposure

1500

different

formulations Mostly used (70%) organic phosphorus compounds (organophosphates

)

ToxicityInhibits cholinesterase enzyme(ChE)Parasympatic activity; increase in body secretions, myosis, abdominal pain, blurred vision, muscle cramps, diarrhea, nausea and vomiting, mental status change, confusion, coma ---- deathAsymptomatic until ChE activity decreases to 50%

<10% -

symptoms

of severe

intoxication

Slide33

Pesticide

Exposure

Treatment

Supportive

treatmentEnzyme activity returns approxiamtely 1.5% daily.Atropine, chemical antagonist (parasympatholytic)

ChE re-activator

ProtectionProtection of skin during applicationDirection of wind during applicationMaskPeriodical measurement of ChE activity in blood

Slide34

Occupational

Skin

Diseases

Group

B-

“skin diseases”B.1. Skin cancerB.2. Other skin diseases

Slide35

Occupational

skin diseases

Nearly 30% of occupational diseases

90%:

contact

dermatitis (80% of which is irritant contact dermatitis)Duration of responsibility: 5 years for skin cancer, 2 months for other

skin diseasesAgents;

• Physical (hot, cold, sun light, friction, radiation, pressure, etc.) • Biological (bacteria, fungi, virus, ricketsiae, etc.) • Chemical (Cr, Ni, gases, solvents, glue, glove, shoe, etc.)Deformations are most frequently seen in hands

Slide36

Occupational

skin diseases

-

Risky

JobsHair dresserMachine operatorsCooksBakersGalvanizers

Construction

workersMetal workersHealth providers Tire and plastic producting workersLeather and rubber producersWorkers exposing dye or painters

Slide37

Occupational

skin diseases

–

Frequent symptomsBurning sensationPruritusRashUlcersBullous lesions

Nodules

Skin color changeCracks caused by itching

Slide38

Occupational

musculoskeletal

system

diseasesCaused by repeated physical movements that can harm tendons, nerves, muscles, and other soft tissues Divided into 2 groups: Upper extremity (neck, shoulder, elbow, wrist, hand)

Lower back

Physical and psyhcosocial factors are responsibleMain symptom is pain.

Slide39

Occupational

musculoskeletal

system

diseasesResponsible factorsInappropriate posture and movementsLoad on muscles during workRate, duration, and number of repeatsMovements requiring extreme muscle forceVibration

Heat

Devices with ergonomical insufficienciesPsychosocial problems

Slide40

Occupational

musculoskeletal

system

diseasesLower back Carrying by hands Bending the body Whole body vibration

Extreme physical load

Constant working positionRepeated movements

Slide41

Occupational

Cancers

4-5% of

all

cancers; 1% (GI tract) 15% (Lung)Chimney sweepers’ scrotal cancer (skin cancer of

scrotal skin) –

Percival Pott, MD (1775) Risky jobsMining – radon, uranium,...Chemical productionTire productionAsbestos industry

Slide42

Occupational

Cancers

Bladder

(dye, tire)BrainBoneColorectalEsophagus

Liver

KidneyLarynxLeukemiaLung (asbestos, Environmental Tobacco Smoke)MelanomaMesothelioma (asbestos)Nasal sinusesNasopharynx

Pancreas

Skin

Stomach

Thyroid

Slide43

Occupational

Cancers

Grup 1 –

Carcinogens

Tar skinAsbestos lung, mesothelioma,...Benzene

leukemia, ...

Arsenic skin, lungChromium airwaysCadmium prostateNickel nasal sinuses lungVinyl chloride liver, angiosarcomaAromatic amine bladderIonizing rad. leukemiaU.V. skin

Slide44

Occupational

Cancers

Diagnosis

-

TreatmentSpecific methods for different cancer typesProtection“occupational diseases”

“preventable

” – should be prevented !!!Technical measuresOperational measuresMedical measures

Slide45

Occupational

diseases

-

Diagnosis

I- Clinical evaluation II- Laboratory evaluation III- Workplace measurements (I + II) --- clinical diagnosis III ------ occupational etiology (cause

)

Slide46

Occupational

diseases

-

Diagnosis

I. Clinical evaluationAnamnesis Symptoms ----- occupationPhysical examination FindingsPhysiological evaluations

audiogram,

pulmonary function tests, EMG, ...Endoscopic examinations bronchoscopy, ...Ref: Bilir N, Yıldız AN, İş Sağlığı ve Güvenliği, Hacettepe Üniversitesi Yayını, Ankara, Aralık 2004

Slide47

Occupational

diseases

–

Diagnosis – Key Questions1. Do you work, what is your job? 2. Do you think

that your

medical problem is related to your job? 3. Do your symptoms vary at work and at home?4. Do you have exposure to dust, chemical, metal, radiation, noise?5. Do you have a history of exposure to dust, chemical, metal, radiation, noise? 6. Do your collagues have similar complaints or symptoms

?

One

or

more

”

Yes” answer leads to detailedl occupational history. Ref: LAX MB, GRANT AD, MANETTI AD, KLEIN R, Recognizing Occupational Disease- Taking an Effective Occupational History, American Family Physician, September, 1998.

Slide48

Occupational

diseases

–

Diagnosis – Detailed occupational historyDefining all jobs (previous

and current)

Workplace exposuresTiming of symptomsSimilar symptoms in other collaguesExposures outside workplace, hobbiesRef: Levy BS, Wegman DH, Halperin WE, Recognizing Occupational Disease and Injury , Ed: Levy BS, Wegman DH, Occupational Health. Fourth Edition, Lippincott Williams-Wilkins, USA, 2000, p: 99-120.

Slide49

Occupational

diseases

–

DiagnosisII. Laboratory evaluation:Radiology X-ray, ultrasound, CT, ...Biochemistry a. Etiological agent

: blood and

urine measurements (Pb, Pb, Hg, Cd), benzene in exhaled airb. Metabolite: phenol in urine (benzene) c. Biochemical disorder: ALA-D, Hemoglobin, cholinesterase (ChE) activity, ...Pathology: biopsy, skin, lung, liver, …Ref: Bilir N, Yıldız AN, İş Sağlığı ve Güvenliği, Hacettepe Üniversitesi Yayını, Ankara, Aralık 2004.

Slide50

MESLEK HASTALIKLARI

TANISI

III.Workplace

measurements

(studies of work hygiene)Noise - dBTemperature, wind-air current, humidity

, ...Pb

, Hg in air (mg/m3)Dust type and amountRadiation – type – amount, dose

Slide51

Occupational

diseases

–

DiagnosisCessation of exposureSpesific treatment if presentSymptomatic treatmentGeneral supportive

treatment

Slide52

Occupational

diseases

–

Diagnosis Insured worker applies to Social Security Instution Offices with

suspicion of OD

Public University Hospitals Ministry of Health Education and Research HospitalsOccupational Disease Hospitals

General

Health

Insurance

Office,

Department

of

Disability and Health CouncilsSocial Security Instution Council of Occupational Diseases High Health Council of Social SecurityIn case of objection

Slide53

Take Home Messages

Occupational diseases are specific to occupation

Occupational

diseases

are preventable and should be prevented Occupational diseases are diagnosed in the

presence of suspicion and

investigation If an occupational diseases is suspected, detailed occupational history should be takenBlood, urine, and workplace measurements are performed for diagnosis of occupational diseaseTechnical, operational, and medical measures should be applied to prevent occupational diseases