1. Workplace Health Monitoring in Romania Adriana Todea Teodor Haratau Romania

2. ROMANIA Is located in the East- centre of the European continent, having the 12th position in Europe according to the surface and the border ’ s length of 3190,3 km.

3. General situation of Work –related Health Monitoring Includes the medical actions for prevention of illness and for wellbeing at workplace

4. Objectives of Work –related Health Monitoring Prevention of any prejudice due to risks related to workplace conditions Promoting and maintaining the work ability of everyone taking part in working life Developing the conditions for being able to cope at work and participating in working life.

5. Organisations responsible for Work –related Health Monitoring Public Health Ministry District Public Health Authorities (42) Public Health Institutes (4) Public Health Center

6. Medical Units Enterprises medical dispensaries: The number : 246 in 2005 Other structures: Medical private OH Centers Individual private OH dispensaries

7. Enterprises medical dispensaries In Romania there exists an even more complex situation as General Practitioners can work and at the same time perform as enterprise physicians.

8. Main Tasks (1) Acknowledge risk at work Pre -Employment medical check Periodical medical check Medical training

9. Main Tasks (2) Performing employees’ health surveillance through employment medical checks, periodical medical checks and so on in county (42 districts) occupational health centers, to ensure an accurate correlation between the anatomical, physiological and health features of the employees and specific working conditions.

10. Is work related Health Monitoring carried-out regularly and what are the periods of time in question? Quarterly reports to the OHS Committee Periodical visits at workplaces Annual report of enterprise physician to the Public Health Authority

11. Aspects and elements taking into account in work- related health monitoring Risk assessment regarding to exposure to phisical, chemical, byological agents at workplaces Muskuloskeletal overuse due to physical work Mental activities

12. The Diagnosis of OD Definition: occupational diseases, in the sense of the Law of Labor Protection, are those diseases induced by performing a job or an occupation, caused by harmful physical, chemical, biological or psychosocial conditions characteristic to the workplace, and also by the strain of different organs and systems of the organism, during performing work duties, disregarding the employment contract between the employer and employee. Are also considered OD those occurring in the conditions stated above in students, apprentices, during practical training. needs to be in the acknowledged final list of occupational diseases and work-related injuries.

13. List of Occupational Diseases (1) according to ICD-10 list Romanian legislation:General Labor Protection Norms/2002 Annex no 2 contains a detailed Table of occupational diseases that must be reported *

14. List of Occupational Diseases (2) Reactive syndrome caused by: Exceptional stress Diseases of the nervous system Diseases of the circulatory system Raynaud’s syndrome Vibration in upper limbs Varicose veins in lower limbs Prolonged standing posture Thrombophlebitis due to physical exertion of upper limbs

15. Work-related Diseases Definition: are diseases with multiple causes, one of the compounding factors being of occupational nature. List of work-related diseases (GNLP/2002) High blood pressure Causes: Noise, vibrations, high temperature or caloric radiation, stress Myocardial Ischaemia Causes: Physical and psychological strains Neurosis and other mental diseases Causes: Noise, vibrations, stress.

16. Work-related diseases Working conditions has a great impact on cardio-vascular diseases and mental diseases The impact of working conditions must be quantified by means of aetiological fraction

17. Aetiological fraction Show that working conditions play a considerable role in cardiovascular or mental diseases An occupational risk factor is any factor in the work environmental that is causally related to cardiovascular or mental diseases Any factor that direct or through one of the conventional risk factor ( such as blood pressure ) increases the risk of getting a cardiovascular or mental disease.

18. Information needed In order to quantify the influence of the work environmental on premature cardiovascular diseases two kind of information are needed: the risk associated with each risk factor the prevalence of each risk factor.

19. Other Criteria control with time dimension control with the confounding variables control with selection process quality of measurements of exposures and diseases quality of design and statistical analysis.

20. Cardiovascular risk workplace factors Chemical Non-chemical

21. Chemical Risk Factors Very definite: Carbon disulphide, nitroglycerin nitroglycol Quite definite: lead, passive smoking Quite possible: cobalt, arsenic, combustion products Possible: organophosphates, dinitrotoluene, antimony, beryllium, carbon monoxide

22. Non-chemical Risk Factors Very definite: physical inactivity at work Quite definite: work strain (high demands and low influence), shift work, noise Possible: heat, irradiation, power frequency magnetic fields, low frequency noise.

23. Studies regarding to work-related diseases Studies: Risk assessment regarding to mental exposure at workplace Health problems and unemployment Cardiovascular diseases at control air traffic workers

24. General data related to sick absence at work  muskuloskeletal diseases 17,27%.  diseases of the respiratory system 15,9%;  cardiovascular diseases 7,51%  neurosis and other neurological-mental diseases 7,03%.

25. Main work-related health problems facing in Romania Insufficient number of occupational physicians Lack of collaboration between multidisciplinary team members Necessity of more preventive actions addressed to the employees.

26. Thank you! Adriana Todea Institute of Public Health Bucharest, 1-3 Dr. Leonte Street adrianat@ispb.ro