Occupational Disease

1
Occupational Disease

• Dr. Ardini Raksanagara, MD., MPH
• Public Health Department
• Faculty of Medicine, UNPAD

2
Introduction

• U.S gt 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

3

• In developing countries, occupational injury and
  illness rates are much higher than in the US
• Each day in US an estimated
• 140 workers die from work related diseases
• Occupational injuries and diseases, affecting
  many organ system

4
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

5
Definition

• Occupational diseases
• are diseases caused by work or work environment
• Work-related diseases
• are diseases initiated, hampered or easy to get
  by work

6

• 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

7

• 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 disease
• exp. Lead in the workplace ? essensial for
  lead poisoning
• Silica ? silicosis

8
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

9
Occupational Diseases Factors
Physical 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
10
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.

11

• Work related diseases occur much more frequently
  than occupational disaese.
• They are caused by interaction of several
  extrinsic risk fact

12

• 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

13

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

14
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
15
Costs of occupational and work-related
diseases
16
Recognizing Occupational Disease

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

17
The Occupational History

1. Description of all jobs held
2. Work exposures
3. Timing symptoms
4. Epidemiology of symptoms or illness among other
   workers
5. Non-work exposures and other factors

18
History

• Hippocrates
• the standard three questions recommended
• ? name, age and residence

19
History

• 1700s Bernadino Ramazzini
• - physician, professor of medicine in Modena
  and Padua, Italy
• - recommended that physicians enquire about
  a patients occupation.

20

• Evident ? that work had relationship to health
  and disease
• The routine questions
• What is your job ?

21
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

22
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

23
Screening for Occupational Disease

• Screening Approach
• History questionnaire
• Physical Examination
• Tests
• Chest x-ray
• Pulmonary Function Test
• Biologic monitoring
• Audiometry

24
Preventing Occupational Disease

• Measures Applied to the Process or Workplace
• Substitution of a Non hazardous Substance for
  Hazardous One
• Installation of Engineering Controls and Devices
• Job Redesign,Work Organization Changes and Work
  Practice Alternatives
• Measures Primarily Directed Toward Worker
• Education and Advice
• Personal Protective Equipment
• Organizational Measures

25

• 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

26
The three levels of prevention
Primary 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
27
Prevention of Occupational Disease
Primary Prevention Secondary Prevention
Control of new hazards Screening
Control of known hazards
Environmental monitoring
Biological monitoring
Identification of vulnerable workers (pre employment medical examination) Periodic medical examination
Substitution
Engineering controls to minimise exposure
Personal Protective Devices
28
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

29
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

30
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

31
Occupational Dermatoses

• The most common occupational diseases
• Are almost always preventable by a combination
  environmental, personaland medical measures

32
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

33
Type of occupational dermatoses

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

34
Occupational cancer

• The cause of cancer is still not completely
  understood
• Epidemiological studies ? has been associated
  with certain exposures

35
Thankyou