Occupational Disease Public Health Department Faculty 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 : – new cases disabling occupational illness – 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 estimated 140 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 diseases are diseases caused by work or work environment  Work-related diseases are 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 disease exp. 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 Factors PhysicalHeat, noise, radiation ChemicalSolvents, pesticides, heavy metals, dust BiologicalTuberculosis, Hep. B, HIV ErgonomicRepetitive motion, improper designed tools or work areas Psychosocial stressor Lack of control over work, inadequate personal support MechanicalMainly 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 DiseasesOccupational Disease Occurs largely in the community Occurs mainly among working population Multifactorial in originCause 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 held 2.Work exposures 3.Timing symptoms 4.Epidemiology of symptoms or illness among other workers 5.Non-work exposures and other factors

History  Hippocrates the 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 questions What 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 : questionnaire 2.Physical Examination 3.Tests : 1. Chest x-ray 2. Pulmonary Function Test 3. Biologic monitoring 4. Audiometry

Preventing Occupational Disease 1.Measures Applied to the Process or Workplace a. Substitution of a Non hazardous Substance for Hazardous One b. Installation of Engineering Controls and Devices c. Job Redesign,Work Organization Changes and Work Practice Alternatives 2.Measures Primarily Directed Toward Worker a. Education and Advice b. Personal Protective Equipment c. 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 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

Prevention of Occupational Disease Primary PreventionSecondary Prevention Control of new hazardsScreening 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

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