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					‫بیماری های ناشی از کار‬

    ‫عیذ هحوذ ػلْی ًیب‬
        ‫‪MD, PhD‬‬
           ‫کار و سالمت‬

                ‫ً‬
           ‫• عب کبس: سؽتَ پضؽکی ّ ًغبتب جذیذ‬
‫• اّلیي ببس: تْجَ بَ کبسگشاى هؼبدى ّ کبسخبًَ ُب‬
             ‫عب فٌؼتی‬

              ‫عب کبس‬

             ‫بِذاؽت کبس‬
    ‫بهداشت کار‪Occupational health‬‬

‫• ًَ تٌِب بَ دسهبى بیوبسی ُب هی اًذیؾذ، بلکَ ببػج استمبء‬
             ‫عالهت ّ پیؾگیشی اص بیوبسی ُب هی ؽْد.‬
    ‫بهداشت کار‪Occupational health‬‬

                                             ‫• هدف:‬
‫کویتَ کبسؽٌبعبى عبصهبى یِذاؽت جِبًی: استمبء ّ حفظ‬
 ‫ببالتشیي دسجَ هوکي عالهت جغوی، سّحی سّاًی ّ‬
              ‫اجتوبػی کبسکٌبى هؾبغل‬
   ‫کار و سالمت‬
‫عالهت‬            ‫کبس‬
                 ‫تاریخچه طب کار‬

                                      ‫• 0071 هیالدی‬
‫• بشًبسدیٌْ ساهبصیٌی: پضؽکبى دس هْسد ؽغل بیوبساى عئْال‬
                                               ‫کٌٌذ.‬
                        ‫• بمشاط: اعن، عي، هحل عکًْت‬
                            ‫طب کار‬
          ‫دیابت و ماالریا‬      ‫• بیوبسی ُبی ؽبیغ دس جبهؼَ‬
‫بیماری های عروق کرونر‬           ‫• بیوبسی ُبی هشبْط بَ کبس‬
‫آزبستوز، مسمومیت با سرب‬          ‫• بیوبسی ُبی ًبؽی اص کبس‬
             ‫بیماری های ناشی از کار‬

          ‫• بیوبسی ُبیی ُغتٌذ کَ بَ ػلت هْاجَِ بب ػْاهل‬
   ‫فیضیْلْژیکی، ؽیویبیی، بیْلْژیکی یب عبیکْلْژیکی دس‬
                            ‫هحیظ کبسبَ ّجْد هی آیٌذ.‬
‫• بَ ػلت اؽتغبل بَ یک کبس ّ تحت ؽشایظ هْجْد دس آى بَ‬
                                        ‫ّجْد هی آیٌذ.‬
               ‫بیوبسی‬        ‫ػبهل اتیْلْژیک هْجْد دس هحیظ کبس‬
                                   ‫ػبهل اتیْلْژیک: لببل تؾخیـ‬
                               ‫لببل اًذاصٍ گیشی‬
                                    ‫لببل کٌتشل‬
        ‫بیماری های مربوط به کار‬
       ‫‪Work related disease‬‬
                                   ‫• ‪Multifactorial‬‬
             ‫• بَ عْس ًغبی تحت تبحیش ؽشایظ صیبى آّس‬
‫– افضایؼ فؾبس خْى، بیوبسی ُلی ػشّق کشًّش، بیوبسی ُبی‬
                                         ‫عبیکْتیک‬
                ‫عىامل زیان آور‬

                  ‫ػْاهل فیضیکی : عشّ فذا، استؼبػ‬    ‫•‬
                ‫ػْاهل ؽیویبیی: عشعبى ُب، آلشژی ُب‬   ‫•‬
        ‫ػْاهل اسگًْْهیک: آعیب ُبی کؾؾی، خغتگی‬       ‫•‬
‫ػْاهل خغش هکبًیکی: حْادث ّ آعیب ُبی ًبؽی اص کبس‬     ‫•‬
     ‫ػْاهل سّحی ّ سّاًی: ًبسضبیتی ؽغلی، افغشدگی‬     ‫•‬
                   ‫شغل و بیماری‬

                         ‫آیب ؽغل عبب بیوبسی ؽذٍ اعت؟‬       ‫•‬
 ‫آیب بیوبس هی تْاًذ بَ کبس بشگشدد؟ ( آیب اگش بیوبسی ًبؽی‬   ‫•‬
   ‫اص کبس ببؽذ، بشگؾت هٌجش بَ ببصگؾت بیوبسی خْاُذ‬
                                                  ‫ؽذ؟)‬
        ‫آیب بیوبس دیببتی هی تْاًذ کبس ؽیفتی داؽتَ ببؽذ؟‬    ‫•‬
‫آیب بیوبس للبی هی تْاًذ بَ کبسی کَ ًیبص بَ فؼبلیت فیضیکی‬   ‫•‬
                                          ‫داسد بشگشدد؟‬
   ‫آیب بیوبس هبتال بَ فشع هی تْاًذ بَ کبس بشگشدد ّ دس‬      ‫•‬
                              ‫لغوت ًْاس ًمبلَ کبس کٌذ.‬
                        ‫شرح حال شغلی‬
‫ػالٍّ بش ؽغل فؼلی حذالل دس ببسٍ 2 ؽغل لبلی عئْال ؽْد. بؼضی بیوبسی ُب‬          ‫•‬
                                     ‫داسای صهبى ًِفتگی عْالًی ُغتٌذ.‬
                                                      ‫• آصبغتْص‬
                                                      ‫• عیلیکْص‬
                   ‫ػٌبّیي ؽغلی: ّظبیف هحْلَ دس هحیظ کبس سا ؽشح دُذ‬            ‫•‬
   ‫استببط ػالئن بب ؽغل: ػالئوی کَ دس تؼغیالت آخش ُفتَ یب هشخقی ُب بِتش‬        ‫•‬
                                                             ‫هی ؽًْذ.‬
                                                         ‫هؾبغل هتؼذد‬          ‫•‬
                               ‫عبیش هْاسدی کَ دس ؽشح حبل هِن ُغتٌذ:‬           ‫•‬
                                     ‫ؽکبیبت ؽبیغ دس بیي عبیش کبسگشاى‬      ‫•‬
                ‫استببط صهبًی بیي کبس ّ ػالئن بیوبسی: ؽشّع حبد: آعن ؽغلی‬   ‫•‬
                                          ‫اعتفبدٍ اص ّعبیل حفبظت فشدی‬     ‫•‬
                                                         ‫هقشف عیگبس‬       ‫•‬
‫بیماری های ریىی ناشی از کار‬
‫بیماری های ریىی ناشی از کار‬
     ‫• تؾخیـ: ٌُگبم آصهًِْبی ػولکشد سیْی‬
                    ‫• سادیْگشافی لفغَ عیٌَ‬
           ‫• ػالئن ببلیٌی دس هؼبیٌبت دّسٍ ای‬
           ‫بیماری های ریىی ناشی از کار‬
                                                            ‫• ؽشح حبل:‬
                   ‫ؽکبیت افلی بیوبس: عشفَ تٌگی ًفظ، ّیضیٌگ،خلظ‬         ‫–‬
                          ‫ُوْپتیضی ّ دسد لفغَ عیٌَ ػالئن کوتش ؽبیغ‬     ‫–‬
                                                        ‫عببمَ فبهیلی‬   ‫–‬
‫پیؾیٌَ ؽغلی: فشآیٌذ کبس، ّظبیف هحْلَ، پغت ُبی کبسی هجبّس فشد هبتال‬     ‫–‬
                        ‫بشسعی هیضاى توبط ّ آگبُی اص هْاد ّ ػْاهل‬       ‫–‬
 ‫دعتشعی بَ )‪MSDS(Material Safety Data sheet‬ؽٌبعٌبهَ هْادی کَ‬           ‫–‬
                                      ‫فشد دس هؼشك توبط بب آًِبعت‬
                                         ‫کبسبشد ّعبیل حفبظت فشدی‬       ‫–‬
                                                   ‫صهبى ّلْع ػالئن‬     ‫–‬
     ‫بیماری های ریىی ناشی از کار‬
                                          ‫هؼبیٌَ فیضیکی:‬
‫بیوبسی ُبی سیْی ًبؽی اص کبس تظبُشات ببلیٌی اختقبفی ًذاسد.‬
‫بیماری های ریىی ناشی از کار‬
                           ‫گرافی قفطَ ضیٌَ:‬
            ‫رّیت هطتقین بخػی از دضتگاٍ ریْی‬
                Spirometry
• Measurement of air movement in and out of
  the lung during different respiratory
  maneuvers.
• Values measured are:
  – FVC: Forced Vital Capacity
  – FEV1: The forced expiratory volume in one
    second
  – MVV: Maximum Voluntary Ventilation
     ‫بیماری های ریىی ناشی از کار‬
  ‫اضپیرّهتری: در صٌایع جِت بررضی ریَ هِوتریي، در‬
‫دضترش تریي ّ کن ُسیٌَ تریي آزهْى عولکرد ریَ اضت.‬
                                                ‫حجوِای ریْی:‬
                ‫ظرفیت حیاتی: دم عویق ّ پص از آى بازدهی عویق‬
                ‫ُْای جاری: ُْای خارج غذٍ بعذ از بازدم هعوْلی‬
                                         ‫ضرعت جریاى بازدهی:‬
                                        ‫ظرفیت حیاتی پر فػار‬
                                  ‫حجن زهاًِای بازدهی اجباری‬
           ‫‪ ‬الگْ ُای اًطذادی)‪(obstructive pattern‬‬
             ‫‪ ‬الگْ ُای تحذیذی)‪(restrictive pattern‬‬
                 ‫اسپیرومتری‬
  ‫• تؾخیـ هتمبضیبًی کَ دچبس اختالل ػولکشد سیَ ُغتٌذ‬
     ‫بشای ّاگزاسی ؽغل هٌبعب.(هؼبیٌبت لبل اص اعتخذام)‬
‫• تؾخیـ بیوبسی سیْی دس هشاحل اّلیَ (دس هؼبیٌبت دّسٍ‬
                                                 ‫ای)‬
‫پنىمىکىنیىز ها‬
                ‫پنىمىکىنیىز ها‬

               ‫• بیوبسی ُبی سیْی حبفل اص گشد ّ غببس‬
‫• )2391(‪ : ILO‬ػببست اعت اص تجوغ گشد ّ غببس دس سیَ ّ‬
                       ‫ّاکٌؼ ببفتی ًغبت بَ حضْس آى‬
‫پنىمىکىنیىز ها‬

                      ‫• خْػ خین‬
           ‫• کالژًْط یب فیبشّتیک‬
‫پنىمىکىنیىز ها‬
                     ‫• خْػ خین:‬
                   ‫– عیذسّصیظ‬
          ‫• کالژًْط یب فیبشّتیک :‬
                  ‫– آصبغتْصیظ‬
                  ‫– عیلیکْصیظ‬
            ‫پنىمىکىنیىز های خىش خیم‬

 ‫• گشد ّ غببس ُبی هؼذًی عبب تخشیب عبختبس آلْئْلی سیَ‬
                           ‫ّ فیبشّص کالژًی ًوی ؽًْذ‬
                                             ‫– ػْاسك ًذاسد‬
                    ‫– ػالئن تٌفغی ّ ػولکشد سیَ ایجبد ًوی کٌذ‬
‫– ؽبیؼتشیي= عیذسّصیظ: دس احش توبط بب فیْم ُبی اکغیذ آُي دس‬
   ‫کبسگشاًی کَ دس جْؽکبسی فْالد،هؼبدى عٌگ آُي ّ سیختَ‬
                                         ‫گشی کبس هی کٌٌذ.‬
  ‫– کؾف اتفبلی دس هؼبیٌبت دّسٍ ای ّ دس گشافی ُب، ًذّل ُبیی‬
   ‫ؽبیَ عیلیکْصیظ دیذٍ هی ؽْد ّلی فیبشّص سیَ ػبسضَ ایي‬
                                               ‫بیوبسی ًیغت‬
‫پنىمىکىنیىز ها‬
                     ‫• خْػ خین:‬
                   ‫– عیذسّصیظ‬
          ‫• کالژًْط یب فیبشّتیک :‬
                  ‫– آصبغتْصیظ‬
                  ‫– عیلیکْصیظ‬
‫آزبستىزیس‬
    ‫• آصبغت= پٌبَ ًغْص یب آهیبًت‬
                     ‫آزبست‬

• A group of naturally occurring minerals whose
  characteristic feature is that they occur as
  fibres
• Masses of tiny fibres form dust if disturbed
Most common types of asbestos used

• Serpentine
    • Chrysotile (white asbestos)
• Amphibole
  • Amosite (brown asbestos)
  • Crocidolite (blue asbestos)
            Why was it used?

• Asbestos was commonly used 1940-1980s for
       • Durability
       • Fire resistance
       • Excellent insulating properties
‫?‪Why was it used‬‬

     ‫– ضاختواى برای عایق کاری‬
        ‫– ضاخت لباش ُای ایوٌی‬
             ‫– ضیواى ّ آجر کف‬
     ‫– پتْ ُای خاهْظ کٌٌذٍ آتع‬
                   ‫– لٌت ترهس‬
   Asbestos Exposure Pathways
• Most common exposure pathway:
  – Inhalation of fibers

• Minor pathways:
  – Ingestion
  – Dermal contact
    What are the health effects of
    exposure to asbestos?
•Asbestos becomes a health hazard when fibers
become airborne and are inhaled.
• Effects depend on length, diameter and
composition of fiber
• Disease is usually associated with long-term
exposure in occupational or para-occupational
setting (immediate family or live near asbestos mine
or factory)
•Risk depends on how much and how long
  Asbestos related diseases
All forms of asbestos can potentially cause:
Non cancer
   pleural plaques
   asbestosis
Cancer
   lung cancer
   Malignant Mesothelioma
                     Asbestosis

• A chronic and progressive lung disease caused by
inhaling asbestos fibres over a long period of time.
• 5- 20 years to develop
• inflammation from fibres causes scarring (fibrosis) and
stiffening of the lung. This causes less oxygen exchange
            Asbestosis: Symptoms
• Dyspnea
    – Becomes progressively worse
•   Cough/sputum
•   Chest pain/tightness
•   Restrictive lung impairment
•   Clubbing of fingers (advanced stages)
•   Asbestos bodies found in lung tissue and sputum
    – In general, asbestos fibers remain in the body once
      inhaled.
                                  Gaseous exchange in the lung




Development of scar tissue that
prevents gaseous exchange
    Severity of Asbestos-Related Diseases
•   Fiber concentration
•   Duration of exposure
•   Frequency of exposure
•   Smoking (Risk
    increases)
            Lung cancer

•usually takes 10 to 20 years to develop after asbestos
exposure.
• asbestos in non-smokers: 5x background rate
•asbestos in smokers: 50x background rate
• Symptoms: persistent cough, weight loss, cough up
blood
Lung Cancer
       Malignant Mesothelioma

•a cancer of the lining of the lung and chest cavity
(pleural mesothelioma)
•or the lining of abdominal cavity (peritoneal
mesothelioma)
• can take 30 to 50 years to develop
• particularly associated with crocidolite
• Australia has world’s highest incidence
          Malignant Mesothelioma

•Rapidly fatal : 75% dead 1 year after diagnosis
•Smoking has no apparent effect on risk
• Symptoms: short of breath, chest pain, weight loss
•Has occurred in people without direct occupational
exposure but exposed to large quantities of dust
                        Conclusion

•   The major route of exposure to asbestos is inhalation
• There is no known “safe” level of exposure
•Asbestos becomes a health hazard when fibers become
airborne
• Exposure should be minimized by sensible precautions
    Silicosis
•
   Silicosis


The Invisible killer!
                  ‫‪Silicosis‬‬
‫• عیلیظ یب دی اکغیذ عیلیکْى فشاّاى تشیي هبدٍ هؼذًی دس‬
                                    ‫پْعتَ صهیي اعت‬
                    Silica
• The cutting, breaking, crushing, drilling,
  grinding, or abrasive blasting of stones may
  produce fine silica dust.
                ‫‪Silicosis‬‬
‫• عیلیکْصیظ بَ بیوبسی پبساًؾین سیَ حبفل اص اعتٌؾبق‬
‫رسات لببل تٌفظ عیلیظ هتبلْس گفتَ هی ؽْد ّ اص ًظش‬
 ‫ببلیٌی ؽبهل اًْاع هختلف عیلیکْص هضهي یب کالعیک،‬
‫تغشیغ ؽذٍ یب تحت حبد، ّ حبد هی ببؽذ. ایي حبالت بش‬
‫اعبط ػالئن ببلیٌی ّ ؽذت ّ هذت هْاجَِ بب عیلیظ اص‬
                           ‫یکذیگش هتوبیض هی ؽْتذ.‬
                      Silicosis
• Silicosis (also known as Grinder's disease and
  Potter's rot) is a form of occupational lung disease
  caused by inhalation of crystalline silica dust, and is
  marked by inflammation and scarring in forms of
  nodular lesions in the upper lobes of the lungs.
             Silicosis – history
• This respiratory disease was first recognized in
  1705 by Ramazzini who noticed sand-like
  substances in the lungs of stonecutters
 Diseases Associated with Exposure to
              Silica Dust
• Silicosis
  – Chronic silicosis
  – Accelerated silicosis
  – Acute silicosis
  – Progressive massive fibrosis
• Chronic Obstructive Pulmonary Disease
  – Emphysema
  – Chronic bronchitis
  – Mineral dust-induced small airway disease
         Silicosis-Epidemiology
• The prevalence of silicosis is difficult to estimate
• the reported cases have been estimated to represent
  only one third of the total cases of silicosis
• In calculating an individual's risk for silicosis,
  duration and intensity of exposure are of primary
  interest but peak exposure also may be important.
        Silicosis-Epidemiology
• In the United States, it has been estimated that
  at least 1.7 million workers are exposed to
  silica, of whom between 1500 and 2360 will
  develop silicosis each year
                Prevalence

• Silicosis is the most common occupational
  lung disease worldwide, it occurs everywhere
  but is especially common in developing
  countries
Silicosis is a long, slow debilitating killer

• Sometimes symptoms don’t show up till
  retirement age.
• Progressive shortness of breath often leads to
  the use of portable oxygen cylinders
• The strain caused by respiratory problems often
  causes or provides opportunities for other
  disease such as TB or heart disease
            Clinical features (1)
• The main symptom is breathlessness, first noted
  during exertion and later at rest as the large working
  reserve of the lung is diminished. In chronic silicosis,
  in the absence of other respiratory disease, even this
  symptom may be absent
• a patient with chronic silicosis may present without
  symptoms for assessment of an abnormal chest
  radiograph
          Clinical features(2)
• The appearance of breathlessness may mark
  the development of a complication such as
  progressive massive fibrosis or tuberculosis, or
  may reflect associated airway disease
• Cough and sputum production are common
  symptoms and usually relate to chronic
  bronchitis, but may reflect the development of
  tuberculosis or lung cancer
          Clinical features(3)
• Chest pain is not a feature of silicosis, nor are
  systemic symptoms such as fever and weight
  loss, which should be attributed to tuberculosis
  or lung cancer until proven otherwise.
• Clubbing is also not a feature of silicosis
          Clinical features(4)
• In accelerated and acute silicosis, the time
  scale of symptom evolution is in years or
  months rather than decades. In acute silicosis,
  breathlessness may become disabling within
  months, followed by impaired gas exchange
  Cyanosis
  Cor pulmonale
  Respiratory insufficiency
          Clinical features(5)
• Patients with silicosis are particularly
  susceptible to tuberculosis (TB) infection -
  known as silico-tuberculosis. The reason for
  the increased risk 10-30 fold increased
  incidence - is not well understood. It is thought
  that silica damages pulmonary macrophages,
  inhibiting their ability to kill mycobacteria
            Types of Silicosis
(1) Chronic silicosis
Occurs after 15-20 years of exposure to
  moderate to low levels of silica dust. Chronic
  silicosis itself is further subdivided into:
             simple
             complicated silicosis
            Chronic silicosis
• This is the most common type of silicosis.
  Patients with this type of silicosis may not
  have obvious symptoms, so a chest X-ray is
  necessary to determine if there is lung damage.
            Types of Silicosis
(2) Asymptomatic silicosis
Early cases of the disease do not present any
  symptoms
            Types of Silicosis
(3) Accelerated silicosis
  Silicosis that develops 5-10 years after high
  exposure to silica dust. Symptoms include
  severe shortness of breath, weakness, and
  weight loss
            Types of Silicosis
(4) Acute silicosis
     Silicosis that develops a few months to 2
  years after exposure to very high
  concentrations of silica dust.
           Diagnosis of Silicosis
• Abnormal chest X-ray (or chest CT scan) consistent
  with silicosis
• History of significant exposure to silica dust
• Medical evaluation to exclude other possible causes of
  abnormal chest x-ray
• Pulmonary function tests are helpful to gauge severity
  of impairment, but NOT for diagnosis.
• Lung biopsy rarely indicated (since no effective
  treatment, biopsy is done only when other diagnoses are
  being considered)
              Lung function
• The lung function profile is determined by the
  extent of silicosis as well as associated or
  concomitant airway and vascular changes
• In chronic silicosis, spirometric tests (FEV1,
  FEV1/FVC, and maximal mid-expiratory
  flow) usually reflect airflow limitation.
              Lung function
• In the accelerated and acute forms, functional
  changes are more marked and progression is
  more rapid. In acute silicosis, lung function
  shows a restrictive defect and impairment of
  gas exchange, which leads to respiratory
  failure and eventually to death from intractable
  hypoxemia
                Radiography

• Silicotic nodules are usually, although not
  invariably, symmetrically distributed and tend
  to occur first in the upper zones .later, although
  not invariably, other zones are involved.
  Occasionally the nodules are calcified,
  resembling micro-lithiasis
               Radiography
• Enlargement of the hilar nodes may precede
  the development of the parenchymal lesions.
  "Eggshell" calcification, when present, is
  strongly suggestive although not
  pathognomonic, of silicosis
• Pleural plaques may occur but are not a
  common feature.
                 Treatment
• Silicosis is an irreversible condition with no
  cure. Treatment options currently focus on
  alleviating the symptoms and preventing
  complications
• The disease will generally progress even
  without further exposure, but the rate of
  deterioration is probably reduced
                Prevention
• The most important aspect of the management
  of silicosis relates to its prevention
• a sustained effort must be made to increase
  awareness of silicosis.
• Recent deaths from silicosis in younger
  individuals in the United States have occurred
  after exposure in the construction and
  manufacturing sectors, with none from mining
                Prevention
• The best way to prevent silicosis is to identify
  work-place activities that produce crystalline
  silica dust and then to eliminate or control the
  dust. Water spray is often used where dust
  emanates. Dust can also be controlled through
  dry air filtering
Occupational asthma
           Occupational asthma

Disease characterized by variable airflow
obstruction and/or airway hyper-responsiveness
due to causes and conditions attributable to a
particular working environment and not to stimuli
encountered outside the workplace
         ‫‪Occupational asthma‬‬
‫• آعن ؽغلی ػببست اعت اًغذاد بشگؾت پزیش هجبسی ُْایی‬
   ‫ّ یب ّاکٌؼ بیؼ اص حذ دسخت تشاکئْبشًّؾیبل بَ ػلت‬
 ‫اعتٌؾبق ػْاهل هْجْد دس هحیظ کبس . ایي ػْاهل هوکي‬
‫اعت اص عشیك هکبًیغن ایوٌی یب غیش ایوٌی عبب آعن ؽغلی‬
                                               ‫ؽًْذ.‬
      Recognise and establish work-
               relatedness
• Occupational history
• Medical history suggesting work-relatedness
  – Symptoms started after employment
  – Improvement of symptoms during weekends and
    holidays
  – Worsening of symptoms on returning to work
• Objective testing
    Primary prevention of OA

• Reduce exposure
• Pre-employment screening
  – Atopy
  – Genetic factors
• Education
• Screen for potential respiratory sensitizers
                 Summary
• Awareness of occupational exposure as a cause
  of disease is important
• Occupational history is mandatory
• To establish a work relationship, objective
  evidence of exposure and occurrence of
  symptoms or changes in lung function is
  necessary
• Reduction of exposure is the key to prevention
‫بیسینىزیس‬
                  ‫بیسینىزیس‬
‫• ساهبصیٌی یک ؽکل خبؿ اص آعن سا دس هیبى کبسگشاًی کَ‬
   ‫بب غببس پٌبَ، کٌف، ّ کتبى عشّ کبس داؽتٌذ سا تْفیف‬
                                              ‫ًوْد.‬
‫بیسینىزیس‬
     ‫• دس کبسگشاى فٌبیغ ًغبجی‬
             ‫بیسینىزیس- عالئم‬
                   ‫• ؽکبیبت تٌفغی خبؿ هشتبظ بب کبس‬
                                     ‫• ػالئن دّؽٌبَ‬
‫• کبسگش بؼذ اص چٌذ عبل کبس دس فٌبیغ ًغبجی اص فؾشدگی‬
 ‫عیٌَ دس بؼذ اص ظِش اّلیي سّص کبسی ُفتَ ّ تٌگی ًفظ‬
                                       ‫ؽکبیت داسد‬
        Occupational screening
• Lung disease associated with occupation
   – Lung cancer
   – Occupational asthma
   – Asbestosis
   – Mesothelioma
   – Byssinosis
   – Coal workers’ pneumoconiosis
   – Silicosis
   – Hypersensitivity pneumonitis
Work Related Musculoskeletal
         Disorders
Have you ever had pain at work?
Have you ever had pain that was
     aggravated by work?
  Etiologic Risk Factors for WMSD
• Broad range of physical, psychological and
  work organization factors epidemiologically
  established and plausibly explained as
  etiological risk factors for WMSD.
      Work related musculoskeletal
          disorders (WMSD)
• RSI (repeated strain injury), CTD (cumulative trauma
  disorder), Over use syndrome, MSD, WMSD are believed to
  wear out the body tissues such as nerve, tendons, muscles,
  tendon sheath, cartilages

• Due to repeated straining body tissue and not allowing enough
  time to heal are believed to cause progressive discomfort, pain,
  and ultimately disability to continue regular work.

• Relationship between physical exposures in occupations and
   WMSD has been noted by an overwhelming number of
   previous studies.
   Factors believed to be associated
              with MSD
• Repetition/duration/rest – short cycle time
  (<30 sec)
• Static work
• Joint deviations – awkward postures
• Acceleration- speed of movement
• Internal forces on joints
• Vibration
• Coldness
• Non occupational factors – fitness level,
  mental stress, smoker, hobby.
    Upper Extremity Disorders
   Carpel tunnel syndrome
   Cubital tunnel syndrome
   Thoracic outlet syndrome
   Raynaud’s syndrome (white finger)
   Rotator cuff syndrome
   Tendinitis
   Tenosynovitis
   Trigger finger
   Ganglion cyst
      Neurovascular Disorders

• Carpal Tunnel Syndrome
  – Impingement of the median nerve caused by irritation and
    swelling of the tendons in the carpal tunnel



• Cubital Tunnel Syndrome
  – Pressure on the ulnar nerve when the elbows are exposed to
    hard surfaces
      Neurovascular Disorders

• Thoracic Outlet Syndrome
  – Compression of the blood vessels between the neck and
    shoulder caused by reaching above shoulder level or
    carrying heavy objects


• Raynaud’s Syndrome
  – Also known as Vibration White Finger ; Blood vessels of
    the hand are damaged (narrowed) from repeated exposure
    to vibration for long periods of time
            Tendon Disorders
• Rotator Cuff Syndrome
• DeQuervain’s Disease
   – Combination of tendinitis and tenosynovitis
• Tendinitis
   – Irritation of the tendon
• Tenosynovitis
   – Irritation of the synovial sheath
• Ganglion Cyst
   – Accumulation of fluid within the tendon sheaths
    Common Occupational CTDs
      of the Upper Extremities

Carpal Tunnel Syndrome occurs from chronic swelling
of the flexor tendons in the wrist.

The median nerve, which feeds the first three fingers and
the thumb, can become impaired from pressure in the carpal
tunnel in the wrist.

Symptoms include:
  pain in the first three fingers and the thumb

  numbness in these areas

  tingling in these areas
      Carpal Tunnel Syndrome

• Etiology: Repetitive motions, wear & tear,
  Fracture of wrist

• Symptoms: Pain, paresthesia, difficulty in
  grasping
Carpal Tunnel Syndrome
    Common Occupational CTDs
      of the Upper Extremities
Raynaud’s Syndrome is when blood vessels
of the hand are damaged (narrowed) from
repeated exposure to vibration for long
periods of time

This is connected with use of vibrating tools,
such as hair clippers and jack hammers.
  Common Occupational Injuries
         of the Back

Strains and sprains are damage to the tendons and
ligaments caused by one time exertions such as
lifting or carrying heavy objects.

These can lead to very noticeable back pain, but the
pain usually begins to subside within a few days
     Common Occupational CTDs
           of the Back
 Disk erosion occurs from prolonged pressure on the
spinal disks, which causes them to become
permanently compressed.

The space between the vertebrae becomes smaller,
which can lead to impingement of the nerve roots
leading out from the spine.

Sitting puts more pressure on the spinal disks than
standing, and sitting with the back unsupported can
lead to high levels of disk pressure.
    Common Occupational CTDs
          of the Back
Sciatic nerve impingement, also called sciatica, is
common for people who sit for prolonged periods of
time.

The sciatic nerve runs from your lower back down the
back of your leg and into to your feet.

Swelling in certain muscles in the buttocks can put
pressure on the sciatic nerve, causing pain down the
leg.
  Common Occupational CTDs
        of the Back
Herniated discs occur when the inner portion of the
disc protrudes, putting pressure on the nerve roots
leading from the spine.

Pain or numbness in the legs is a common
symptom of herniated discs in the lower back.
Herniated/Bulging Disc
Noise at Work
             What Is Noise?

• Noise is any unwanted sound
• By-product of many industrial processes, e.g.
  operating machinery
• Exposure to high levels of noise may lead to
  hearing loss and other harmful health effects
              Scope of the Problem
• In the UK there are over
  170,000 people with significant
  work-related hearing damage
• 14,200 are serious enough
  affected to receive disablement
  benefit
             Did You Know?

• About 30 million workers are exposed to
  hazardous noise on the job
• Noise-induced hearing loss is the most
  common occupational hazard for American
  workers
• Hearing loss from noise is slow and painless;
  you can have a disability before you notice it
• It is 100% preventable
                       Hearing Loss
  •Temporary Hearing Loss
       - results from short term
       exposure to noise
       - hearing returns when away
       from the noise

  •Permanent Hearing Loss
- results from exposure to a moderate
  or high level of noise over a long
            period of time
              -hearing loss is
           PERMANENT
         Signs of developing hearing loss

• Inability to hear soft or high
  pitched sounds
• Trouble understanding
  conversation at a distance or in a
  crowd
• Ringing in the ears
• Others can hear something you
  can’t
         Signs of Hearing Loss


• Do you ask people to speak louder so that you
  can hear?
• Do you have to turn the TV or
  Radio so loud that others
  complain?
            Can You Imagine?
• Not being able to
  – Hear what the other person is saying?
  – Listen to the sound of music?
  – Listen to the sound of nature?



• Being afflicted with
  – Uncomfortable ringing in your ears?
  – Abnormal sounds that interfere with your sleep?
              Types of Hearing Loss
• Conductive
  – Sound is not conducted from outer ear to inner ear
  – Reduction in sound level
  – Condition results from fluid in middle ear, foreign bodies, infection in ear
    canal, impacted ear wax, malformation of ear
• Sensorineural
  – Results from damage to the inner ear or nerve pathways from ear to brain
  – Corrected through surgery
  – Caused by birth injury, diseases, noise exposure, head trauma, aging
• Mixed
  – Hearing loss resulting from both conductive and sensorineural
    Effects of Noise on Hearing
Note: How quickly hearing loss takes place
 depends on the intensity of the noise, its
 duration, and how often the exposure occurs.
There is no cure for hearing
          damage!

           • Normal hearing can never
             be restored
           • Hearing aids do not restore
             noise-damaged hearing
           • At best, they help the person
             a little
      Measurement of Noise
  Loudness is measured in decibels
170 dB      Jet airliner
120 dB      Riveting hammer
110 dB      Shouting loudly
 70 dB      Street sounds
 38 dB      Quiet bedroom
This is a logarithmic scale – an increase of 1dB
    means about 30% more noise
       If your average daily exposure is
                 over 80dB(A)
• The employer must:
   – Inform you of the risks to
     your hearing from noise and
     how you can reduce those
     risks
   – Make hearing protective
     equipment available
If your average daily exposure is
          over 85dB(A)
        Your employer must:
          – Try to reduce noise at source
          – Provide hearing protection &
             insist on its use
          – Identify & sign ear protection
             zones
          – Conduct noise assessments &
             keep records of them
          – Provide hearing checks if
             requested
If your average daily exposure is
          over 87dB(A)
             • This is a maximum & must
               not be exceeded
             • Noise to the ear must be
               reduced
                – Preferably at source
                – Otherwise by hearing
                  protection
Hearing protection
    • The effectiveness of hearing
      protection varies according to
      type, manufacture and correct
      wearing.
    • Most will reduce noise at the
      ear by about 15 - 20dBA
Hearing protection
      Ear Plugs
      • Must be kept clean (many
        are single use)
      • Must be put in properly
        (there is a special technique)
      • Generally comfortable to
        wear especially in hot
        weather
           Hearing protection
Canal Caps
• Like in-ear ear plugs on a headband
• Pleasant to wear
• Often do not completely seal in the ear
• Generally not a good idea for >85dB for prolonged
  periods
Hearing protection

              Ear Muffs

         Advantages                   Disadvantages

 • More protection at higher   • Higher cost
   frequencies than earplugs   • Eye glasses can interfere
 • Durable, long lasting         with ear muff seal
 • Can be fitted on hard hat   • May be uncomfortable in
                                 hot environments
 • Reusable
Hearing protection


       • Try to limit your time
         in noisy areas
          – Remember the effect
            is cumulative
          Audiometric Testing

• Monitors employee’s hearing over time
• Baseline audiogram must be performed within first 6
  months of work exposure ( 8 hour TWA ≥ 85 dBA)
• Annual audiograms are required each year after
  baseline audiogram
• Employer must pay for the cost of each required
  audiogram
  Why Do Audiometric Testing?

• Obtain a Baseline Audiogram for future
  comparison
• Identify occupational hearing loss
• Identify Standard Threshold Shifts (STS)

				
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