1. Occupational Disease Ms.Nirmala BSc.N. Special

2.  1. Introduction to Occupational Diseases in Sri Lanka?  2. Legal aspects –Acts & Regulations  3. Statistics of Occupational Diseases  4. What has been done?  5. Obstacles in early detection, diagnosis notification  6. What we plan to do?  -Role of doctor, employers & employee  7. Conclusion

3.  1. How is the occupational diseases list  system organisedin your country?  2. Which occupational diseases are included in the list?  3. When was the list first established and last updated?  4. Who is responsible for amending lists?

4. How is the list system organised? At the national level the list of occupational diseases is determined by:-  1.Department of Occupational Safety & Health, Ministry of Human Resource – (Notification)  2.Social Security Organisation- (Compensation)  3.Workmen Compensation-(Compensation)  4.Occupational Health Unit.Min. of Health- (Treatment, monitoring & coding according to International Classification Disease (ICD-10)

5.  Which occupational diseases are included in the list?  This is deteminedby the Acts & Regulations that govern:-  1.Notification of occupational diseases  Factories & MacheineryAct 1967  Occupational Safety and Health Act 1994  2.Compensable occupational diseasesEmployees Social Security Act 1969-  3.Workmen’s compensation Act 1952- Foreign worker

6.  1.FACTORIES & MACHINERY ACT  Poisoning or disease arising out of or in connection  with work and is of a class specified in Schedule 3.  DISEASES  -Lead regulations  -Asbestos Process  -Mineral Dust  -Noise Exposure

7.  NOTIFIABLE INDUSTRIAL DISEASES  1. Dust diseases of the lungs  (a) Silicosis –inhalation of (Sio2) silica containing dust  (b) Stannosis-inhalation of tin dusts or fumes  (c) Siderosisor Sidero-silicosis inhalation of dust containing  iron, silica & haematitie

8.  Description of occupational diseases  A.POISONING  1.Poisoning by:  (a)Acrylamidemonomer;  (b)Alcohols, glycols, ketonesor aldehydes  (c)Antimony  (d)Arsenic

9.  Employees Social Security Act Section An employee who is employed in any occupation described If in the 5 th Schedule contracts any contracts disease or injury shown in or the said Schedule to be related that occupation, or if an employee who has been employed in such occupation contacts such a disease or injury within 60 months after ceasing to be employed, the contacting of the disease or injury shall, unless the contrary is proved, to be deemed to be injury bean employment injury arising out of & in the course of an employment.

10. 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

11.  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

12. 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

13. Definition  Occupational diseases are diseases caused by work or work environment  Work-related diseases are diseases initiated, hampered or easy to get by work

14.  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

15.  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

16. 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

17. 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

18. 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.

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

20.  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

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

22. 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

23. Costs of occupational and work- related diseases

24. Recognizing Occupational Disease  The identification of work-related medical problems depend most importantly on the occupational history

25. 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

26. History  Hippocrates the standard three questions recommended  name, age and residence

27. History  1700s : Bernadino Ramazzini - physician, professor of medicine in Modena and Padua, Italy - recommended that physicians enquire about a patient’s occupation.

28.  Evident  that work had relationship to health and disease  The routine questions What is your job ?

29. 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

30. 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

31. 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

32. 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

33.  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

34. 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

35. 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

36. 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

37. 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

38. 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

39. Occupational Dermatoses  The most common occupational diseases  Are almost always preventable by a combination environmental, personaland medical measures

40. 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

41. Type of occupational dermatoses  Acute contact eczema  Chronic contact eczema  Chloracne  Photosensitization  Hypo/hyperpigmentation  Keratoses  Benign tumors and epitheliomas  Ulcerss

42. Occupational cancer  The cause of cancer is still not completely understood  Epidemiological studies  has been associated with certain exposures

43. What we have done?  1.In collaboration with other agencies produced Guidelines on occupational diseases:-  Criteria for the diagnosis of Occupational Lung Disease  Criteria for the diagnosis of the Occupational Skin Disease  Criteria for the diagnosis of occupational Noise Included Hearing Loss  Criteria for the diagnosis of Occupational Pesticide Poisoning and early treatment  2. Compulsory Training of panel doctors in occupational health in collaboration with National Institute of Occupational Safety & Health 24