Occupational Diseases PDF

8.Occupational Diseases Dr. Marve Mohamed MBBS, MSc, PhD Assistant Professor at Ankara Medipol University Learning objectives: Define occupational disease. Summarize occupational diseases and explain the ways of their...

8.Occupational Diseases Dr. Marve Mohamed MBBS, MSc, PhD Assistant Professor at Ankara Medipol University Learning objectives: Define occupational disease. Summarize occupational diseases and explain the ways of their prevention.  Definition of occupational Diseases: Occupational disease refers to a temporary or permanent illness, physical or mental disability, caused by the nature of the work performed or the conditions under which the work is conducted. Work-related diseases are illnesses for which the cause is complex, with the work environment and the nature of the work being significant factors among other causes participated in their occurrence and development. Occupational Disease Work related disease The cause does not need to be in the workplace. Factors in The relationship between exposure to the agent in the the workplace accelerate the occurrence and development working environment and the disease must be causal of these illnesses. It occurs in individuals who are directly exposed to the agent with a frequency above the average morbidity of They are observed in the general population as much as in the rest of the population workers.  Establishing the causal relationship İs carried out on basis of clinical, pathological, and epidemiological data. In epidemiology the causal relationship is established upon the following: 1- Strength of association between the exposure and the disease (Relative Risk RR) 2- Consistency and coherence (different researchs having similar results). 3- Temporality or time sequence (the cause preceeds the disease) 4- Specificity and dose response relationship. 5- Biological plausibility (the mechanism of occurrence) 6- Interventional studies (e.g. Preventive trials) Classification of Occupational Diseases: Two approaches for the cclassifications related to occupational diseases in the relevant legislation : 1- Classification based on the type of agent (physical, chemical, etc.) 2- Classification based on the affected organ or system (skin, respiratory, etc.) Occupational diseases are grouped into five main categories based on the combination of these two approaches. Classification of Occupational Diseases: Group A: Occupational diseases caused by chemical factors (67 diseases in 25 subgroups) Group B: Occupational skin diseases (Skin Cancer and Non-Cancerous Skin Diseases in 2 subgroups) Group C : Pneumoconiosis and other occupational respiratory system diseases (9 diseases in 6 subgroups) Group D : Occupational Infectious Diseases (30 diseases in 4 subgroups) Group E : Occupational diseases caused by physical factors (12 diseases in 7 subgroups)  Diagnosis in Occupational diseases: Diagnostic methods are similar to those used for any illness; clinical examinations and some lab tests are performed. Patient's occupational history should be taken. Another diagnostic method is the evaluation of the workplace environment. Treatment in Occupational diseases: The first step in treatment is to remove the patient from the workplace environment and eliminate exposure to the agent. There are specific treatment options that accelerate the elimination of certain agents from the body or neutralize the agent Appropriate symptomatic and supportive treatment can also be provided. Occupational diseases are preventable: This is one of the most important aspects of these occupational diseases. If workplace factors are controlled using appropriate methods, occupational diseases should not occur at all. Various engineering practices can be implemented, such as ventilation, containment, separation, and using wet working methods. Examples of common occupational diseases: Not all the listed diseases are seen in every country; they can emerge based on specific working environments. In developed countries, sufficient precautions have been taken in industrial work environments. However, as the service sector is more prominent, illnesses arising from working conditions in this sector are more common. In most developing countries, heavy and dangerous jobs are more prevalent. Due to inadequate protective measures, occupational diseases observed are mostly those caused by factors in industrial types of work. Examples of significant occupational diseases in Turkey are provided.  Lead Poisoning: It has been used since the time of early humans due to its softness During industrial use, lead is heated or melted and begins to transform into gas form. In gas form, lead particles enter the body through the respiratory tract, with up to 40% entering the bloodstream Lead binds to red blood cells, getting distributed and stored throughout the body. The largest depot of lead is in the bones. It is also stored in smaller amounts in the liver, kidneys, muscle tissue, brain, etc. Lead Poisoning : Lead is primarily eliminated from the body through urine. Smaller amounts of lead are lost through faeces, hair, nails, skin, and menstruation. Lead is also present in breast milk and can be passed to the baby through breastfeeding. Lead Poisoning: In lead poisoning, various symptoms and signs related to different organs and systems are observed. The most common ones are related to the digestive system (dull abdominal pain, constipation, metallic taste in the mouth, and Burton's line formed by lead sulphide on the gums). Anemia is the most well-known sign of lead poisoning. Lead poisoning causes anemia by decreasing hemoglobin synthesis (Hb around 8-10 grams) Lead Poisoning: Lead crosses the blood-brain barrier, causing nervous system symptoms Symptoms include headaches, nausea, severe vomiting at advanced stages, and altered consciousness (lead encephalopathy). It also causes motor paralysis in peripheral nerves. Less commonly, cardiovascular and kidney symptoms occur in lead poisoning cases, with proteinuria being the most frequent. If glucosuria and hyper phosphaturia are also present, this condition is called Fanconi syndrome. Lead Poisoning: Treatment: the patient should be removed from the workplace and EDTA should be used to accelerate the elimination of lead from the body. Protective measures in the workplace should be reviewed, and other workers should be evaluated in this regard. As a preventive approach, entry examinations and periodic control examinations should be conducted. Silicosis: A classic occupational disease seen among miners The disease occurs due to the deposition of silica dust in the lungs and the resulting fibrotic reaction around it (pneumoconiosis) Not all dusts cause fibrotic reactions. Therefore, some dusts may accumulate in the lungs without causing pneumoconiosis. Among various dusts, silica dust has the highest fibrogenic potential, followed by asbestos and coal dust. Asbestos, particularly one type, is known to cause lung cancer and mesothelioma. Silicosis: Individuals exposed to silica dust need to have worked for many years to develop silicosis. According to the relevant regulations, the shortest duration for the occurrence of silicosis is specified as 3 years. In most cases, it is observed after 10 years or more. Silicosis: Symptoms: Shortness of breath, cough, and sputum production, followed by the development of obstructive lung disease. Even if exposure to dust ceases, symptoms of the disease are progressive due to the ongoing fibrotic reaction. There is no treatment to remove the dust from the lungs or stop the fibrotic reaction. Symptomatic approaches are used to try to alleviate the patient's discomfort. Silicosis: Prevention: Effective dust control measures in the workplace and the use of dust masks or respirators when necessary can provide effective protection. Pre-employment examinations should evaluate respiratory system problems in advance, and early diagnosis efforts can be conducted using periodic lung function tests and chest X-rays. Pesticide Poisoning: Substances used to destroy plants and animals that are harmful to humans are called pesticides. Pesticides are divided into groups such as insecticides, herbicides, fungicides, and rodenticides. Among these groups, the most commonly used are insecticides. Insecticides can come in various chemical formulations. The most widely used among them are organophosphorus compounds. Phosphorus insecticides primarily enter the body through the respiratory system. However, absorption through the skin is also important Pesticide Poisoning: Phosphorus compounds inhibit the enzyme acetylcholinesterase, resulting in continuous parasympathetic activity. Clinical signs and symptoms appear depending on the level of enzyme inhibition. Initially, there is restlessness and abdominal pain; as the condition progresses, abdominal cramps and diarrhea are added to the symptoms. In more advanced cases, severe constriction of the pupils is a very typical finding. All types of body secretions increase, leading to pulmonary oedema. In cases of excessive exposure, the condition can result in death.  Pesticide Poisoning: Atropine is used as a specific treatment in patients. In the early stages of poisoning, using PAM (Pridin Aldoxim) an antidote for phosphorus compounds, is very effective. However, it is not very beneficial after the initial stage. To prevent poisoning, necessary precautions should be taken during dilution to avoid contact with the body. Gloves, protective clothing, and a mask, if needed, should be used. If there is wind, spraying should be done with the applicator standing downwind. Noise-Induced Hearing Loss: One of the common problems Noise can be an issue in all jobs, such as the metal industry, woodworking, textile factories, etc. Noise disturbs people, makes communication difficult, and may lead to hypertension. When the noise level exceeds a certain threshold, it causes irreversible hearing loss by damaging the sound-sensitive cells in the inner ear.  Noise-Induced Hearing Loss: Hearing loss occurs when the sound intensity in the environment is 85 decibels or more Noise-induced hearing loss does not occur suddenly. It requires being in a noisy environment for a prolonged period, at least 2 years However, it is accepted that hearing loss can develop within 30 days in an environment where the noise level is consistently 85 decibels or higher. Noise-Induced Hearing Loss: Necessary technical measures should be taken to control the noise at its source. In addition to these measures, ear defenders should be used if necessary. Early diagnosis is very important in this matter. It is possible to detect it in the early stages with audiological evaluation. conclusion: Let’s sum up Feedback (comments, opinions...) Thank you