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Occupational Disease

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									    Occupational Disease

Dr. Ardini Raksanagara, MD., MPH
     Public Health Department
   Faculty of Medicine, UNPAD
 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
 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
 Occupational diseases
  are diseases caused by work or work
 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
  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
Physical       Heat, noise, radiation

Chemical       Solvents, pesticides, heavy metals,
Biological     Tuberculosis, Hep. B, HIV

Ergonomic      Repetitive motion, improper
               designed tools or work areas
Psychosocial   Lack of control over work,
stressor       inadequate personal support
Mechanical     Mainly 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
  – Hepatic dysfunction can be aggravated by
    exposure to certain chlorinated hydrocarbons
  – Bronchial asthma can be aggravated by dust
  – 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 Diseases      Occupational Disease

Occurs largely in the      Occurs mainly among
community                  working population
Multifactorial in origin   Cause spesific

Exposure at workplace      Exposure at workplace is
may be a factor            essential
May be notifiable and      Notifiable and
compensable                compensable
Costs of occupational and work-
       related diseases
    Recognizing Occupational
 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
 Hippocrates
     the standard three questions
      name, age and residence
 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
   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
 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      Is designed to deter or avoid the
Prevention   occurrence of disease or injury
Secondary    Is designed to identify and adequately
Prevention   treat a disease or injury process as
             soon as possible, often before any
             symptoms have developed

Tertiary     Is designed to treat a disorder when it
Prevention   has advanced beyond its early stages,
             to avoid complications & limit
             disability, to address rehabilitative and
             palliative needs
Prevention of Occupational Disease
  Primary Prevention            Secondary Prevention
Control of new hazards         Screening
Control of known hazards
Environmental monitoring
Biological monitoring
Identification of vulnerable   Periodic medical
workers (pre employment        examination
medical examination)
Engineering controls to
minimise exposure
Personal Protective Devices
Prevention of Occupational Disease

 Tertiary prevention aims to minimise the
  consequences in persons who already have
 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
    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
 Repeated mechanical irritation cause
  callosities and thickening of the skin
 Various kinds of radiation
 Tuberculosis and anthrax
 Chemicals can cause irritation or
    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
 Epidemiological studies  has been
  associated with certain exposures

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