HAS 222 Presentation Plan Definition of occupational diseases Epidemiological data on occupational diseases Exposure routes for occupational diseases Classification of occupational diseases ID: 916371
Download Presentation The PPT/PDF document "Occupational Diseases Work related dis..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Occupational
Diseases
Work related diseases
HAS 222
Slide2Presentation 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
Slide3Occupational
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
Slide4Act
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
Slide5Work
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
Slide6Work
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
Slide7Frequency
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)
Slide8Occupational 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
Slide9If
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!!
Slide10Main
three
exposure
routes for harmful agentsInhalationMain entry way for
most agents
Slide11Main
three
exposure
routes for harmful agentsOral (Gastrointestinal system) Chemicals, mostly accidental
Slide12Main
three
exposure
routes for harmful agentsSkin contact Mechanical agents Friction, pressureChemicals Allergic
reaction, irritation
Physical agents Hot and cold, sunlightBiological agents Bacteria, fungi, parasites
Slide13Occupational 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
Slide14Occupational 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
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
Slide16DURATION 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
Slide171.
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
Slide18Top 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
Slide19Occupational diseases caused by chemicals
M
etal
s
Lead
MercuryChromiumCadmiumManganeseNickel
Arsenic
BeriliumAluminum Other heavy metals
Slide20Lead
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»
Slide21Gases
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
Slide22Carbon
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.
Slide23Carbon
monoxide
(CO)
Intoxication- Risky JobsIron-steel manifacturingWorkers of coke ovensFoundry
workers
Traffic policeFiremanWorkers at undergorund garagesWorkers at boiler roomsCar mechanic
Slide24Carbon
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
Slide25Carbon
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
Slide26Solvents
Alyphatic
Aromatic
Alicyclic
Oil
distilatesAlcoholsGlycolPhenolsKetonesEsters
Ethers
GlycolethersGlicide estersAcidsAminesChloride hydrocarbonsChlorofluorocarbonsOthers: turpentine and some monoterpenes, dimethylsulphoxide
Slide27Benzene
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)
Slide28Prof. 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.
Slide29Benzene
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
Slide30Pesticide
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
Slide31Risky
Jobs
for
Pesticide ExposureProductionStorageTransportApplication (agriculture)
preparation
mixing spraying
Slide32Pesticide
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
Slide33Pesticide
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
Slide34Occupational
Skin
Diseases
Group
B-
“skin diseases”B.1. Skin cancerB.2. Other skin diseases
Slide35Occupational
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
Slide36Occupational
skin diseases
-
Risky
JobsHair dresserMachine operatorsCooksBakersGalvanizers
Construction
workersMetal workersHealth providers Tire and plastic producting workersLeather and rubber producersWorkers exposing dye or painters
Slide37Occupational
skin diseases
–
Frequent symptomsBurning sensationPruritusRashUlcersBullous lesions
Nodules
Skin color changeCracks caused by itching
Slide38Occupational
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.
Slide39Occupational
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
Slide40Occupational
musculoskeletal
system
diseasesLower back Carrying by hands Bending the body Whole body vibration
Extreme physical load
Constant working positionRepeated movements
Slide41Occupational
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
Slide42Occupational
Cancers
Bladder
(dye, tire)BrainBoneColorectalEsophagus
Liver
KidneyLarynxLeukemiaLung (asbestos, Environmental Tobacco Smoke)MelanomaMesothelioma (asbestos)Nasal sinusesNasopharynx
Pancreas
Skin
Stomach
Thyroid
Slide43Occupational
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
Slide44Occupational
Cancers
Diagnosis
-
TreatmentSpecific methods for different cancer typesProtection“occupational diseases”
“preventable
” – should be prevented !!!Technical measuresOperational measuresMedical measures
Slide45Occupational
diseases
-
Diagnosis
I- Clinical evaluation II- Laboratory evaluation III- Workplace measurements (I + II) --- clinical diagnosis III ------ occupational etiology (cause
)
Slide46Occupational
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
Slide47Occupational
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.
Slide48Occupational
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.
Slide49Occupational
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.
Slide50MESLEK 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
Slide51Occupational
diseases
–
DiagnosisCessation of exposureSpesific treatment if presentSymptomatic treatmentGeneral supportive
treatment
Slide52Occupational
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
Slide53Take 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