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Occupational DiseaseOccupational Disease
Ms.Nirmala
BSc .N. Special
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
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?
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)
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
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
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
Description of occupational diseases A.POISONING 1.Poisoning by: (a)Acrylamidemonomer; (b)Alcohols, glycols, ketonesor aldehydes (c)Antimony (d)Arsenic
Employees Social Security Act Section
An employee who is employed in any occupation described If in the 5th 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.
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
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
Definition
Occupational diseases
are diseases caused by work or work environment
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 workplace.
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 diseaseexp. 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 FactorsPhysical Heat, noise, radiation
Chemical Solvents, pesticides, heavy metals, dust
Biological Tuberculosis, Hep. B, HIV
Ergonomic Repetitive motion, improper designed tools or work areas
Psychosocial stressor
Lack of control over work, 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 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
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 community
Occurs mainly among working population
Multifactorial in origin Cause spesific
Exposure at workplace may be a factor
Exposure at workplace is essential
May be notifiable and compensable
Notifiable and compensable
Costs of occupational and work-related diseases
Recognizing Occupational Disease
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
History
Hippocrates
the standard three questions recommended
name, age and residence
History
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 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
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
Screening for Occupational Disease
Screening Approach :1. History : questionnaire2. Physical Examination3. Tests :
1. Chest x-ray2. Pulmonary Function Test3. Biologic monitoring4. Audiometry
Preventing Occupational Disease1. 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 Workera. 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 preventionPrimary 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
Prevention of Occupational DiseasePrimary Prevention Secondary Prevention
Control of new hazards Screening
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
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
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 equipment
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 factors
Repeated mechanical irritation cause callosities and thickening of the skin
Various kinds of radiation Tuberculosis and anthrax Chemicals can cause irritation or
sensitization
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 understood
Epidemiological studies has been associated with certain exposures
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 treatment2. Compulsory Training of panel doctors in occupational health in collaboration with National Institute of Occupational Safety & Health 24