Occupational Diagnosis

8/15/2019 Occupational Diagnosis

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OCCUPATIONAL DIAGNOSIS

(7 steps of Occupational Diagnosis)Presented by

Dewi Sumaryani Soemarko

Fikry EffendiNuri Purwito Adi

Occupational Medicine DivisionDepartment of Community Medicine !aculty of Medicine

Universitas IndonesiaPrepared by Dewi S Soemarko (Juni 20!)


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"udaya#$egar

a

%omunitas &'ingkungan

(kera)

%eluarga

Pasien • "odi#isik

•*ental

Diagnosis

+olistik

Diagnosis

%omunitas

,-aluasiProgram

*D./s

klim

Diagnosis

ok

upasi


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Prepared by Dewi S Soemarko (Juni20!) contribution 1S and %esa

!

"or#ers$- Personaliy attitude culture

#no%led&e- %or# process- Imunolo&y and nutrition- Illness and disa'ility

Occupational

(ealt) Services

-Manpo%er-(ealt) !acilities-(ealt) facilities

net%or#in&

"*L!A+*$-Income-(uman Development

-*ducation

*nvirontment$- Pysics3 4emicals3

"iology3 ,rgonomic& Psycososial

- *anagement and'eadersip

P+O,L*M IN OCCUPATIONAL (*ALT(

5esources6 *inistry of +ealt (Dit%esa


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*any workers in te world working inunsafety condition ealt problems

'O (200!) 6

- 2 millions died caused by occupationaldiseases and occupational accidents

- !008000 died of 290 million accident

- :0 million work related diseases per year

Data in Indonesia --

Introduction


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9

Dasar +ukum

• ;; 5 no !: taun 200< ttg %eseatan "ab 2 keseatan kera3 pasal :9 ayat

(pengelola) dan ayat ! ( asil *4;)• ;; 53 $o8 2! =aun


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:

Tipe per#em'an&an pelayanan .ese)atan .er/a

("O+S3 2009)

Personel

Jenis industri


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7

Profession in Basic Occupational HealthServices

'O & B+O C 1pril 2009

• Ta)ap I $ Startin& level $nurse3 safety agent (if possible) sort training O+S primary

• Ta)ap II$ ,asic Occupational (ealt) Services0,O(S1pysician3 nurse sort training O+S

• Ta)ap III $ International standard serviceOccupational +ealt Pysician (specialiy trainedeEpert) and team

• Ta)ap I2 $Compre)ensive O(S services 6multidisiplinary team (Occ +ealt Pysician?


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@


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<

Occupational (ealt) ServicesModels

• Primary ealt ser-ices

• n company ser-ices (big company)

• .roup ser-ices (se-eral S*,)• Social security institution ser-ice

pro-ider

• Pri-ate pysician (occ8 +ealtcompetence)

• Out patient clinic (ospital)


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0

$eed to knowFF

• Occupational Diseases

• Bork related Diseases

• Diseases aGected by Occupation


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Penyebab Kematian yang berhubungan dengan

pekerjaan (ILO 1999)

3!

"#!"1!

1#!#!

Kanker 3!

Ke$e%akaan "#!

Peny& Sa%& Perna'aan

Khroni "1!

Peny& Kardioaku%er 1#!

Lain*%ain #!


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2

Diseases amon& t)e Dentist


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!

Cost for Occupational Accidents and

Occupational diseases 0ILO 34441


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• B+O C 1ccess for Occupational +ealtser-ices6

H 9 C 0 I workers in De-eloping countries

H 20 C 90 I workers in ric countries

• Occupational Diseases s data6 part ofce berg (puncak gunung es)

• O+S *onitoring by te *inistry of*anpower still weakness


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9

Diag. PAK

Treatment

Occ.Diseases Diagnosis

Symptom

No treatment

Has been exposed, no symptom

Reporting

No Reporting

"GNNG !S" PAK


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:

Occupational Diseases

(B+O3


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7

4ause Occupational Diseases

(BS"32009)

• dust3 gases3 or fumes

• noise

• toEic substances (poisons)

• -ibration

• radiation

• infectious germs or -iruses

• eEtreme ot or cold temperatures• eEtremely ig or low air pressure


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@

.eneral 4riteria


• +as an association between speciKceEposure to te diseases

• +as a fact3 incidence of te diseasesamong te work community more tante ordinary people

• =e diseases can be pre-ented by tepre-ention acti-ities in te workplace


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<


• ,ased on Kepmenaker No. 333/1989 :

? Knding # diagnosed by

1nnual *edical eck ;p

? by *edical Doctor3 based on6 Pysical ,Eamination3

Bork en-irontment measurement

• Occupational Dia&nosis due 'y MedicalDoctor$ Occupational Diseases


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DeKnisi

•Penya#it a#i'at #er/a 0Occupational Diseases menurut !nternational"a#or Or$ani%ation &!"O' 1998 adala Penyakit yang mempunyaipenyebab yang spesiKk atau asosiasi kuat dengan pekeraan3 yang pada

umumnya terdiri dari satu agen penyebab yang suda diakui8

•Occupational (iseases is a disease or an ailment caused due to excessiveexposure of noxious fumes or substances in a working environment that areinjurious to health.It includes asthma,poisoning due to use of pesticides,blacklung disease among miners, lung cancer due to use of asbestos and other

respiratory problems.Any employee who gets aected by disease or adisability under such condition is liable to receive compensation under thelaws of workmen's compensation or any other related provision. A!"#$%

• An occupational (isease is a disease or disorder that is caused by the workor working conditions. his means that the disease must have developed dueto exposures in the workplace and that the correlation between theexposures and the disease is well known in medical research. "r put inanother way, it must not be likely, beyond reasonable doubt, that the diseasewas caused by factors other than work.he (ational )oard of IndustrialInjuries, *ankt +jeldslads --, ostboks ///, 0+12-//,!openhagen,0enmark%

Prepared by Dewi S Soemarko (Juni20!) contribution 1S and %esa 20


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• he term 3occupational (isease3 refers to those illnessescaused by exposures at the workplace. hey should be separated,conceptually, from injuries that may also may occur at workplacesdue to a variety of ha4ards. #ncyclopaedia of ublic 5ealth%

• According to rotocol of 2//2 to the "ccupational *afety and5ealth !onvention, -67-, the term 8occupational (isease9covers any disease contracted as a result of an exposure to riskfactors arising from work activity .wo main elements are presentin the de:nition of an occupational disease; the causalrelationship between exposure in a speci:c working environmentor work activity and a speci:c disease< and the fact that thedisease occurs among a group of exposed persons with afre=uency above the average morbidity of the rest of the population.


2

DeKnisi88888


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DeKnisi88888

Penya#it yan& 'er)u'un&an den&an pe#er/aan 0*ork +elate(Disease 1998:

• 1dala Penyakit yang mempunyai beberapa agen penyebab3 dimana faktorpada pekeraan memegang peranan bersama dengan faktor risiko lainnyadalam berkembangnya penyakit yang mempunyai etiologi yang kompleks

Penya#it yan& tim'ul #arena )u'un&an #er/a adala) penyakit yangdisebabkan ole pekeraan atau lingkungan kera8 (%eputusan Presiden $o8 22

=aun

Penya#it yan& men&enai populasi pe#er/a 0Diseases a,ectin$-orkin$ populations

• 1dala Penyakit yang teradi pada populasi pekera tanpa adanya agenpenyebab ditempat kera3 namun dapat diperberat ole kondisi pekeraanyang buruk bagi keseatan8 Penyakit tersebut uga dikenal dengan Penyakityang diperberat ole pekeraan


22


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2!

Diagnosis & dentiKkasi P1%6

• Suda ada penelitian?penelitian yangmembuktikan adanya ubungansebab?akibat

• Diagnosis Okupasi pada pekeradilakukan ole dokter yangkompeten6

– Penyakit 1kibat %era – Penyakit Diperberat ole pekeraan

– Sumber penularan di tempat kera dsb


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2

O"J,4=>,S

O44;P1=O$1' D1.$OSS

• Borker rigts (+ak pekera)• "ased of treatment (Dasar

Penatalaksanaan)

• Disability limitation (*embatasikecacatan)

• Protecting oter workers (*elindungi

pekera lain)


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4ausal of te Occupational Diseases

• Pysical aNards – $oise3 ioning radiation3

eEtreem temperature3-ibration3 yperbaric3

ypobaric3 ekstremtemperature3 ligtning

• 4emical aNards6 – 1ll cemical in dust3

fume3 gases3 smoke3foge3 liuid


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Prepared by Dewi S Soemarko (Juni20!) contribution 1S and %esa 2:

• "iological aNards6 – "acteria3 -irus3 fungi8

• ,rgonomic aNards6• Borkplace Design3 workload

• Psycosocial aNards6 – Bork Stress3 monotoni3etc

n modern country pysical3 cemical3 biologicalaNards a- been controlled C ergonomicsaNards and psycological aNards are temain causal

4ausal of te Occupational DiseasesFFF88


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27


• ILO Convention No6 373 di .ene-a3 December


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2@

'O 4on-ention no 2


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2<

4D 0 ?O+


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!0

,Eample4D 0?O+


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!


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7 steps of Occupational Diagnosis

• =e systematical procedure for making diagnosiste diseases wetere relation to te occupationor te eEposure in te workplace

• tis procedure made by te Perdoki andndonesian Occupational *edicine 4ollege(2007)

• or back up te doctor wose ser-ing teoccupational +ealt#Occupational *edicine standardiNation procedure


!2


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!!

Step 3$

Clinical Diagnosis

Step 7$

*


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Step

Steps !irst

Dia&nosis

Second

Dia&nosis

T)ird

Dia&nosis

36 ClinicalDia&nosis

Dia&nosis 'asedonB anamnesis- p)ysical e


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Step 2

Steps !irstDia&nosis

SecondDia&nosis

T)irdDia&nosis

76 *


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Step !

Steps !irst

Dia&nosis

Second

Dia&nosis

T)ird

Dia&nosis

3& +e%ation between e,poure in theworkp%a$e and the -%ini$a% Diagnoi(.iden$e /aed)

*vidence 'ased from /ournal te


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Step Steps !irst

Dia&nosisSecond

Dia&nosisT)ird

Dia&nosis

=6 *


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Step 9

Steps !irstDia&nosis

SecondDia&nosis

T)irdDia&nosis

>6 Individual !actors Can cause t)e diseases in step 3

Is t)ere anindividual factorcan cause t)ediseases in step 3

Please %rite do%n


!@


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Step :

Steps !irstDia&nosis SecondDia&nosis T)irdDia&nosis

?6 Ot)er e


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Step 7Steps !irst

Dia&nosisSecond

Dia&nosisT)ird

Dia&nosis

6 Conclusion of Occupational Dia&nosis

OccupationalDia&nosis

Is t)e Occupational

Dia&nosis$- Occupational

Diseases- Diseases &ettin&

%orse 'yoccupation

- No Occupational

diseases- Need more data

,u#an penya#ita#i'at #er/a0diper'erat ole)pe#er/aan atau


0


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7 steps of Occupational Diagnosis


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'anutan 7 langka Diagnosis Okupasi


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Prepared by DS3

kontribusi6 1S dan !

,Eample case no

1 man3 mr8 1 come to te Occupational*edicine clinic wit main complain 6dyspnoe since 9 days a go 888888

1fter te pysical eEamination and take te

spirometry test 3 e as been told 6 1stma

Bat is te occupational Diagnosis

8 4linical Diagnosis•. 1namnesis

•. Pysical ,Eamination

BD# 1sma bronkial


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Prepared by DS3

kontribusi6 1S dan

case FF

28 ,Eposure in te workplace *ake potensial aNards table

• Occupational istory Borking nowadayspabrik tepung1packing%

• Bat arete aNards ; >our, ?.!;?.);?.#;?.sy;?.%

!8 5elation between eEposure in te workplace

and te 4linical Diagnosis(e-idence based#referencies#eEperience)

•. lour astma


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Prepared by DS3

kontribusi6 1S dan 9

case FF

8 ,noug eEposure in te workplace

• n Packing Department6 Qour dust moretan ='>

• $ot using te masker

98 ndi-idual factor can cause te 4linicalDiagnosis in step

•. s e a-e te allergic anoter atopy

•. s e te only one get 1stma in te workplace

•. s tere anyone get astma 3 too


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Prepared by DS3

kontribusi6 1S dan :

case FF

6. Other exposure like in the workplace s exposure

• s tere any eEposure like Qour inoutside te workplace

(no)

78 =e conclusion of Occupational

Diagnosisastma caused by Qour dust duringwork in te Packing department


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Prepared by DS3


,Eample case no 2

Boman3 *iss = s coming to te clinic witsymptomps6 eadace3 ypestaesia in te botands since ! monts a go8

1fter te pysical eEamination and take te neurologytest 3 se as been told as polyneuropty

Bat is te occupational Diagnosis

8 4linical Diagnosis

•. 1namnesis and self assessmnet uestionaireSR:

•. Pysical ,Eamination. BD# susp8 Polyneuropaty perifer e8c . DD# neurotoEic 3 deKciency -it "2


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Prepared by DS3

kontribusi6 1S dan @

case 2F

28 ,Eposure in te workplace

*ake potensial aNards table

• Occupational istory Borking nowadays *hoes

factory1bottom sole%

• Bat arete aNards

; ..., ?.!; methyl #thyl +etone *olvent%< );?.#;?.sy;?.%

!8 5elation between eEposure in te workplace andte 4linical Diagnosis(e-idence based#referencies#eEperience)

•. *,% 4ronic $eurologic


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Prepared by DS3

kontribusi6 1S dan <

case 2FF

8 ,noug eEposure in te workplace

• n "ottom sole Department

• ,Eposure @ ours per day3 *,%concentration (personal) more tan 200 ppm

98 ndi-idual factor can cause te 4linicalDiagnosis in step

•. s tere a genetic factor can cause te4linical diagnosis in step (no)

•. s tere only *iss = get te diseases $o3tere are ! more friends of er


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Prepared by DS3


case 2F88

:8 Other exposure like in the workplace s exposure

• s tere any eEposure like *,% inoutside te workplace

(no)

78 =e conclusion of OccupationalDiagnosis6

$eurotoEic cronic caused by *ekeEposure in te workplace(occupational Diseases)

D ft P t k


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Daftar Pustaka

• Sulistomo 18 Diagnosis Okupasi3 Sub dep %edokteranOkupasi Dept lmu %edokteran %omunitas %;3 Jakarta20098

• 'O ,nsiklopedia3 rt edition3• Departemen %eseatan 58 ;ndang?;ndang no 2! taun

Documents

Occupational Diagnosis