Occupational DiseaseOccupational Disease

Public Health DepartmentFaculty of Medicine, UNPAD

Introduction U.S : > 2 m permanent/temporary disability from

various causes The number of people with disabilities from

occupational illness is not known because the difficulty of diagnosis

Estimation for each year :– 400.000 new cases disabling occupational illness– 100.000 death from occupational disease– 10 m occupational disease cases occur each year

worldwide

In developing countries, occupational injury and illness rates are much higher than in the US

Each day in US : an estimated140 workers die from work related diseases

Occupational injuries and diseases, affecting many organ system

Major categories of occupational illness by organ system

Musculoskeletal disorders Respiratory disorders Neurologic and psychiatric disorders Skin disorders Reproductive and development disorders Cardiovascular disorders Hematologic disorders Hepatic disorders Renal and urinary disorders

Definition

Occupational diseasesare diseases caused by work or work environment

Work-related diseasesare diseases initiated, hampered or easy to get by work

Occupational disease occur among workers exposed to specific hazards

In some situations may also occur among the general community as a consequence of contamination of the environment from the workplace.e.g lead, pesticides

Occupational Disease occur as a result of exposure to physical, chemical, biological or psychosocial factors in the workplace.

These factors in the work environment are predominant and essential in the causation of occupational diseaseexp. Lead in the workplace essensial for

lead poisoning Silica silicosis

Occupational Diseases Factors

Occupational diseases are adverse health conditions in the human being, the occurrence or severity of which is realted to exposure to factors on the job in the work environment

Occupational Diseases FactorsPhysical Heat, noise, radiation

Chemical Solvents, pesticides, heavy metals, dust

Biological Tuberculosis, Hep. B, HIV

Ergonomic Repetitive motion, improper designed tools or work areas

Psychosocial stressor

Lack of control over work, inadequate personal support

Mechanical Mainly cause accident and injuries

Work Related Disease

WHO categories work related diseases as “ multifactorial” in origin

There are diseases in which workplace factors may be associated in their occurrence but need not be a risk factor in each case.

Work related diseases occur much more frequently than occupational disaese.

They are caused by interaction of several extrinsic risk fact

Work condition can aggravate pre existing disease– Hepatic dysfunction can be aggravated by

exposure to certain chlorinated hydrocarbons– Bronchial asthma can be aggravated by dust

exposure– Renal disease can be aggravated by inorganic

mercury, cadmium and certain solvents

frequently seen in the general community.- hypertension- ischaemic heart disease- psychosomatic illness- musculoskeletal disorders- chronic non specific respiratory

disease/chronic bronchitis

Differences between Occupational Disease and Work Related Diseases

Work Related Diseases Occupational Disease

Occurs largely in the community

Occurs mainly among working population

Multifactorial in origin Cause spesific

Exposure at workplace may be a factor

Exposure at workplace is essential

May be notifiable and compensable

Notifiable and compensable

Costs of occupational and work-related diseases

Recognizing Occupational Disease

The identification of work-related medical problems depend most importantly on the occupational history

The Occupational History

1. Description of all jobs held2. Work exposures3. Timing symptoms4. Epidemiology of symptoms or illness

among other workers5. Non-work exposures and other factors

History

Hippocratesthe standard three questions

recommended name, age and residence

History

1700s : Bernadino Ramazzini- physician, professor of medicine in

Modena and Padua, Italy- recommended that physicians

enquire about a patient’s occupation.

Evident that work had relationship to health and disease

The routine questionsWhat is your job ?

The component of an occupational history

Job description/nature of job Hours of work/shift work Types of hazards Past occupation Other jobs Domestic exposures Hobbies Do other workers have a similar illness ? Relationship of illness to period away from work

Additional information in occupational history

Smoking/ alcohol intake/drugs Similar complaints among other workers Time relationship between work and

symptoms Degree of exposure Use of protective device Methods of materials handling

Screening for Occupational Disease

Screening Approach :1. History : questionnaire2. Physical Examination3. Tests :

1. Chest x-ray2. Pulmonary Function Test3. Biologic monitoring4. Audiometry

Preventing Occupational Disease1. Measures Applied to the Process or Workplace

a. Substitution of a Non hazardous Substance for Hazardous One

b. Installation of Engineering Controls and Devicesc. Job Redesign,Work Organization Changes and

Work Practice Alternatives

2. Measures Primarily Directed Toward Workera. Education and Adviceb. Personal Protective Equipmentc. Organizational Measures

To prevent occupational disease effectively, health professionals must know how to anticipate and recognize conditions in those who present with symptoms and those who are presymptomatic

The three levels of preventionPrimary Prevention

Is designed to deter or avoid the occurrence of disease or injury

Secondary Prevention

Is designed to identify and adequately treat a disease or injury process as soon as possible, often before any symptoms have developed

Tertiary Prevention

Is designed to treat a disorder when it has advanced beyond its early stages, to avoid complications & limit disability, to address rehabilitative and palliative needs

Prevention of Occupational DiseasePrimary Prevention Secondary Prevention

Control of new hazards ScreeningControl of known hazardsEnvironmental monitoringBiological monitoringIdentification of vulnerable workers (pre employment medical examination)

Periodic medical examination

SubstitutionEngineering controls to minimise exposure

Personal Protective Devices

Prevention of Occupational Disease

Tertiary prevention aims to minimise the consequences in persons who already have disease

The goal is to limit symptoms or discomfort, minimize injury to the body and maximize functional capacity

Occupational Disease TARGET ORGAN : An organ that is damaged by xenobiotic or

its metabolite

System : Respiratory• Musculoskeletal, - Nervous System• Skin - Reproductive• Eye - Cardiovascular• Hematologic - Hepatic• Renal and Urinary Tract

Source : – Physical – Biological– Chemical

Occupational Disease in Developing Countries

Asbestos is the major cause of disability and ill health

Pesticide :– The majority of workers in developing

countries are in agriculture– Pesticide are often applied by hand, or without

proper protection of workers who use spray equipment

Occupational Dermatoses

The most common occupational diseases Are almost always preventable by a

combination environmental, personaland medical measures

The skin can be affected by many factors

Repeated mechanical irritation cause callosities and thickening of the skin

Various kinds of radiation Tuberculosis and anthrax Chemicals can cause irritation or

sensitization

Type of occupational dermatoses

Acute contact eczema Chronic contact eczema Chloracne Photosensitization Hypo/hyperpigmentation Keratoses Benign tumors and epitheliomas Ulcerss

Occupational cancer

The cause of cancer is still not completely understood

Epidemiological studies has been associated with certain exposures