Occupational diseases PhD Kamil Barański PhD Anna Korczyńska
History of occupational diseases Hippocrates of KOS Bernardino Ramazzini
workplace health and safety (WHS) = occupational safety and health (OSH) = occupational health and safety (OHS) is an area concerned with the safety, health and welfare of people engaged in work or employment
General exposure sources at work Physical exposures (noise, radiation, heat, cold, inadequate lighting, lack of oxygen, ect.) Chemical exposures (solvents, cleaning agents, degreasing agents, etc.) Biological exposures (viruses, bacteria, flour, animal blood, leather, ect.) Psychological exposures (changing working hours, threat of violence, work in isolation etc.) 4
Risk factors at work Posture Repetitive movements Vibration (local vibration-holding a vibrating tool) Work organization (rest periods, breaks) Psychological and social faktors Individual factors Encyclopaedia of Occupational Health and Safety. Geneva 1998 5
Threshold limit value (TLV) Chemical substances Physical agents Risk factors at work The TLV for chemical substances is defined as a concentration in air (for inhalation or skin exposure) for gases (in ppm) for particulates eg. dust, mist, smoke (in mg/m³) TLVs for physical agents include noise exposure, vibration, ionizing and non-ionizing radiation exposure heat and cold stress. 6
Three types of Threshold limit value for chemical substances Threshold limit value - Time weighted average (TLV-TWA): average exposure on the basis of a 8h/day, 40h/week work schedule Threshold limit value - Short-term exposure limit (TLV-STEL): spot exposure for a duration of 15 minutes, that cannot be repeated more than 4 times per day with at least 60 minutes between exposure periods Threshold limit value - Ceiling limit (TLV-C): absolute exposure limit that should not be exceeded at any time 7
Definition an occupational disease is any disease contracted primarily as a result of an exposure to risk factors arising from work activity. Work-related diseases have multiple causes, where factors in the work environment may play a role, together with other risk factors, in the development of such diseases.
Definition of occupational disease in Poland Regulated by labour law An occupational disease is considered as occupational disease when it s listed on the list of occupational diseases.
Four criteria 1. On the list 2. Notification under a specified time (on the list) 3. It is a result of environment at work 4. Unqestionable exposure factors (or high probability)
European definition of occupational disease The case of occupational disease is defined as a case recognized by the national institutions responsible for recognition of occupational diseases. Occupational diseases and other health problems have to be related to work
List of occupational diseases POLAND 1. Acute and chronic intoxications with chemical substances and their sequels 2. Metallic fever 3. Pneumoconioses 1) silicosis 2) coal workers pneumoconiosis 3) pneumoconiosis associated with tuberculosis 4) welders pneumoconiosis 5) asbestosis and other pneumoconioses due to silicates 6) pneumoconiosis due to talc 7) graphite fibrosis 8) pneumoconioses due to metal dusts
4. Diseases of pleura or pericardium induced by asbestos dust 1) diffuse thickening of pleura 2) diffuse plaques of pleura or pericardium 3) pleural exudate 5. Chronic obstructive bronchitis which causes airflow limitation (FEV1 < 60% of predicted value) induced by exposure to dusts and irritant gases, if an excess of TLV was documented within the last 10 years in at least 30% measurements of occupational exposure 6. Bronchial asthma 7. Extrinsic allergic alveolitis: 1) acute or sub-acute form 2) chronic form
8. Acute general allergic reactions 9. Byssinosis 10. Berylliosis 11. Lung diseases induced by hard metals dust 12. Allergic rhinitis 13. Oedematous laryngitis induced by allergy 14. Nasal septum perforation induced by irritant and corrosive agents 15. Chronic voice disorders due to excessive vocal effort lasting at least 15 years: 1) hard vocal nodules 2) secondary hypertrophic changes of vocal folds 3) paresis of internal muscles of larynx with fusiform insufficiency of glottis and persistent hoarseness
16. Diseases caused by ionizing radiation: 1) acute generalised radiation sickness as a consequence of whole body, or greater part of body, irradiation 2) acute radiation sickness of the type of inflammatory or inflammatory-necrotic changes of skin or subcutaneous tissue 3) chronic dermatitis due to radiation 4) chronic lesion of bone marrow 5) cataract due to radiation
17. Malignant neoplasms induced by human carcinogens present in work environment: 1) lung cancer, bronchus cancer 2) pleural or peritoneal mesothelioma 3) neoplasms of haematopoietic system 4) skin cancer 5) bladder cancer 6) malignant neoplasms of liver 7) larynx cancer 8) malignant neoplasms of nose and accessory sinuses 9) malignant neoplasms for which the probability of induction by radiation is greater than 10%
18. Skin diseases: 1. allergic contact dermatitis 2. irritant contact dermatitis 3. oil acne, chloroacne, coal tar acne of diffuse nature 4. candida infections: hand intertrigo, nail dystrophy with paronychia due to working conditions 5. dermatophyte infections due to contact with biological material from animals 6. contact urticaria 7. occupational photodermatoses 19. Chronic diseases of locomotor system related to the way the job is performed: 1. tendovaginitis 2. bursitis 3. chronic lesion of meniscus due to the job performed in kneel or squat position 4. periarticular inflammation of shoulder joint 5. epicondylitis of shoulder bone 6. fatigue-induced bone fracture
21. Bilateral permanent noise-induced hearing loss of cochlear or sensoneural type, amounting to at least 45 db in better ear as a pure tone average for 1, 2 and 3 khz audiometric frequencies 22. Vibration syndrome 1) vibratory angioneuropathy 2) osteoarticular form 3) mixed form: angioneuropathy and osteoarticular disorders 23. Diseases induced by work under increased atmospheric pressure 1) decompression sickness 2) barotrauma 3) sequels of compressed air breathing 24. Diseases induced by high or low temperature of environment 1) heat stroke and its sequels 2) heat exhaustion and its sequels 3) frostbites
25. Diseases of visual system induced by physical, chemical or biological agents: 1. allergic conjunctivitis 2. acute conjunctivitis induced by ultraviolet radiation 3. epidemic viral conjunctivitis or keratitis 4. keratopathy induced by irritant agents 5. cataract induced by infrared or long-wave ultraviolet radiation 6. central retinal and choroidal degeneration induced by short-wave infrared radiation or visible radiation of blue spectrum 26. Infectious and parasitic diseases or their sequels
ILO List of Occupational Diseases (revised 2010) Source http://www.ilo.org/wcmsp5/groups/public/@ed_protect/@protrav/@ safework/documents/publication/wcms_125137.pdf
International Labour Organistation 1. Diseases caused by external factors 1.1. Diseases caused by chemical substances 1.2. Diseases caused by physical agents 1.3. Diseases caused biological agents 2. Diseases Systems main bodies 2.1. Occupational diseases respiratory systems 2.2. Occupational Skin Diseases 2.3. Occupational musculo skeletal diseases 2.4 Psychosocial Diseases 3. Occupational Cancer 4. Other Diseases 4.1. Nystagmus Miners 4.2 Other Diseases
PROBLEMS AND CHALLENGES 22
Pneumoconioses Exposure to silica, coal, asbestos and various mineral dust in mining, quarring, construction and other manufacturing processes. Long latency periods Often undiagnosted and unreported Associated illnesses: Chronic obstructive pulmonary disease (COPD) Silicotuberculosis Silica- and asbestos-related cancers 23
Asbestos-related diseases Until the 1970s asbestos was widely used in many industries across different countries to insulate pipes, boilers and ships, make brakes, strengthen cement and many fireproof materials. http://www.bhp.aid.pl/ 24
People who worked with asbestos during that time are now at risk of developing an asbestos-related lung cancer and mesothelioma. It generally takes from 10 to 40 years for ARDs to develop after exposure. France, Germany, Italy, Netherlands, Switzerland,UK 200.000 deaths from Masothelioma 1995 2029 25
Problems and challenges 26
globalization changes in workplace emerging risks new challenges new technologies: nanotechnologies biotechnologies poor ergonomic conditions exposure to electromagnetic radiation psychosocial risks 27
Musculoskeletal disorders Musculoskeletal disorders are among the most important occupational health problems in both developed and developing countries In most cases, it is not possible to point to one casual factor for musculoskeletal diseases (in most cases-several factors) The muscles are the most common site of pain Work-related muscle pain is reported most frequently in the neck and shoulder area, the forearm and the low back 28
LOCAL MUSCLE DISORDERS Muscular rheumatism Fibrosis Myostis Muscle pain Myalgia Fibromyalgia Tenderpoint Triggerpoint REGIONAL SYNDROMES Myofascial pain syndrome Tension neck Rotator cuff syndrome Compartment syndrome GENERAL SYNDROMES Fibrosis syndrome Fibromyalgia syndrom Primary fibromyalgia Polymyalgia Polymyositis Encyclopaedia of Occupational Health and Safety. Geneva 1998 29
Carpal tunnel syndrome 59% of all recognized diseases (European Occupational Diseases Statistic, 2005) 10% of all years lost to disability (WHO raport, 2009) 30
Mental disorders Work-related stress and its health consequences have emerged as a matter of great concern Enterprises are increasingly confronted with psychological harassment, mobbing, bullying, sexual harassment other forms of violence Problems with stress (unhealthy behaviours-abuse of alcohol or drugs) 31
Prevention 32
Prevention - organization International labour organization Occupational Safety & Health Administration (OSHA) European Agency for Safety & Health at Work (EU OSHA) NAPO
Prevention Qualification tests for work Periodic tests for work 34
Prevention at work General protection Personal protective equipment (PPE) PPE is equipment that will protect the user against health or safety risks at work. Protected: the lungs (eg from breathing in contaminated air) the head and feet (eg from falling materials) the eyes (eg from flying particles or splashes of corrosive liquids) the skin (eg from contact with corrosive materials) the body (eg from extremes of heat or cold) 35
Allergic occupational diseases in health services workers Allergic rhinitis Allergic angioedema of the larynx Bronchial asthma Allergic contact dermatitis Contact urticaria
Allergic diseases of the skin (dermatitis) and respiratory diseases The most common allergens in professional medical staff: metals (nickel, cobalt, chromium, mercury) gum nurses, doctors specialty treatment, orderlies (release of chromium and nickel from cleaning fluids and disinfectants, contact with metal tools, surgical thread) the most common additions or such vulcanization accelerators (thiram ) - basic contact allergen latex gloves
natural rubber latex, acrylates dentists aids, dental technicians and orthodontists. medicines the most common cause allergy : neomycin and other antibiotics aminoglycosides, PNC and its synthetic products, benzocaine, sedative drugs, cytostatics. disinfectants flavoring
MBT (mercaptobenzothiazole) natural rubber latex, Acrylates dentists aids, dental technicians and orthodontists. Drugs the most common cause allergy : neomycin and other antibiotics aminoglycosides, PNC and its synthetic products, benzocaine, sedative drugs, cytostatics. Disinfectants
Epidemiology of occupational diseases in Poland
1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 Number of cases Incidence rate on 100 000 hired Number of reported occupational diseases and incidence rate on 100 000 hired in Poland 1981-2013 14000 140 12000 10000 8000 6000 4000 2000 0 120 100 80 60 40 20 0 Lata Source: Based on data from IOM in Łódź
1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Incidnace rate on 100000 (hired) 180 Incidence rate on 100 000 (hired) of women and men 160 140 120 100 80 60 40 20 0 Source: Based on data from IOM in Łódź
Europe - findings Frequency of fatigue or painful and long sitting positions SOURCE: https://osha.europa.eu/pl/surveys -and-statistics-osh/esener/2014
Reported moving or lifting heavy objects SOURCE: https://osha.europa.eu/pl/surveys -and-statistics-osh/esener/2014
Reported noise SOURCE: https://osha.europa.eu/pl/surveys -and-statistics-osh/esener/2014
Workplace health and safety.
workplace health and safety (WHS) = occupational safety and health (OSH) = occupational health and safety (OHS) is an area concerned with the safety, health and welfare of poeple engaged in work or employment 47
Risk factors at work Posture Repetitive movements Vibration (local vibration-holding a vibrating tool) Work organization (rest periods, breaks) Psychological and social faktors Individual factors Encyclopaedia of Occupational Health and Safety. Geneva 1998 48
Ergonomics 49
Definition Ergonomics is the systematic study of people at work with the objective of improving the work situation, the working conditions and the tasks performed. The aim of ergonomics is to ensure that the working situation is in harmony with the activities of the worker. Encyclopaedia of Occupational Health and Safety. Geneva 1998 50
www.iea.cc 2000 - The International Ergonomics Association defines ergonomics: Ergonomics (or human factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance. www.isoes.info 51
Workstation ergonomics 52
Poor ergonomic conditions Muscular and psychological disturbances Visual fatigue Eye strain, sore eyes Headaches Fatigue Muscle sorenes Cumulative trauma disorders Back disorders Psychological tension Anxiety and depression 53