Occupational Health Chapter 13 PDF

School of Public Health Occupational Health Chapter 13 INDIANA UNIVERSITY  Learning Objectives By the end of this chapter the reader will be able to: Describe four events in the history of occupational health Discuss the significance of the occupational environment for health L...

School of Public Health Occupational Health Chapter 13 INDIANA UNIVERSITY  Learning Objectives By the end of this chapter the reader will be able to: Describe four events in the history of occupational health Discuss the significance of the occupational environment for health List physical & psychological effects of occupational hazards State five categories of health impacts of occupational hazards List three methods for the prevention of occupationally related disease INDIANA UNIVERSITY Section 1 Worldwide impact of occupational Occupational Health health Occupational health & occupational Concepts medicine  Occupational Health SECTION 1 File:Carpal-Tunnel.svg Occupational Disease Defined as those health outcomes that are “caused or influenced by exposure to general conditions or specific hazards encountered in the work environment.” E.g., untreated carpal tunnel syndrome Source: Dr. Harry Gouvas, MD, PhD Occupational Medicine Medical specialty focusing on detection & prevention of diseases that arise from the work environment Occupational disease is under- diagnosed & under-registered. WHO estimates that worldwide they are responsible for 2.02 million deaths & 160 million new incidents per year INDIANA UNIVERSITY Section 2 Historical evidences of work- History of related illnesses Bernardino Ramazzini Occupational Health Occupational accidents in the U.S.  Origin of Occupational Health SECTION 2 Work Related Hazards have been recognized since ancient times -Mining 460 BC Hippocrates discussed hazard of metal working & lead 129-200 Galen described hazards to miners 850-923 Rhazes used occupational classifications in medical case descriptions 1567 Paracelsus wrote a book on occupational disease 1700’s – Ramazzini asked people about their jobs INDIANA UNIVERSITY  Bernardino Ramazzini (1633-1714) SECTION 2 ▪ Considered the “father of occupational medicine” ▪ Described manifestations of occupational diseases ▪ His book De Morbis Artificum Diatriba (Diseases of Workers) was published in 1700. – Highlighted risks of hazardous chemicals, dusts, metals used in the workplace – “It is much better to prevent than to cure” INDIANA UNIVERSITY  Occupational Diseases in Historical Literature SECTION 2 Miner’s asthma. Lung disease occurring among coal miners related to dust inhalation over years Potters’ rot. Caused by breathing in crystalline free silica during clay mixing causing inflammation of the lungs Mad hatter’s disease. Chronic exposure to mercury vapors among hat makers. Mercury nitrate was use in the production of felt for hats Phossy jaw. Phosphorous osteonecrosis of the jaw affected those working with phosphorous Phossy jaw Mule spinners’ cancer. Epithelioma of the scrotum caused by deposit of mineral oils on skin of the scrotum Wallace et INDIANA UNIVERSITY al. J Exposure Sciences Environ Epidemiology. 2011  Historically Significant Occupational Accidents : Triangle Shirtwaist Company Fire Image of Triangle Shirtwaist Factory fire on March 25 - 1911.jpg SECTION 2 Occurred on March 25, 1911, New York City 146 women died within 15 minutes Doors were locked & fire escapes were nonfunctional http://upload.wikimedia.org/wikipedia/en/thumb/0/0d/Triangle_Bodies.jpg/300px-Triangle_Bodies.jpg http://upload.wikimedia.org/wikipedia/commons/thumb/3/31/Triangle_Shirtwaist_coffins.jpg/300px-Triangle_Shirtwaist_coffins.jpg INDIANA UNIVERSITY Wallace et al. J Exposure Sciences Environ Epidemiology. 2011  Historically Significant Occupational Accidents: Gauley Bridge Disaster (Continued...) Covered a time span that began about 1931. a three-mile tunnel construction through Gauley Mountain, West Virginia Caused exposure of unprotected workers to high levels of silica dust Resulted in about 1,500 cases of silicosis & 1,000 deaths INDIANA UNIVERSITY Section 3 Occupational Safety & Health Regulation of Act NIOH & OSHA Occupation Safety Epidemiology of occupational health  Occupational Safety and Health Act, 1970 SECTION 3 Industrial revolution of 1800’s 1833 – First appointment of “industrial surgeons” Reversal during depression of 1920’s 1930’s first occupational medicine associations 1970 – Occupational Safety & Health Act created both 1. the National Institute for Occupational Safety & Health (NIOSH) as part of the CDC, is the federal agency responsible for conducting research & making recommendations for the prevention of work-related injury & illness The Occupational Health and Safety Administration (OSHA), which is in U.S. Department of Labor & is responsible for developing & enforcing workplace safety & health regulations INDIANA UNIVERSITY  NIOSH and OSHA SECTION 3 Health assessment Advisory services -Pre-employment, return to work, job -Prevention of occupational disease change -Legislation & codes of practice -Examination of exposed workers -Medical aspects of new processes -Study of sick absence -Physical therapy & rehabilitation -Reduction & prevention of non-occupational -Emergency treatment diseases -First-aid training -Immunological services -Retirement advice -Contingency planning for major disasters INDIANA UNIVERSITY Significance of the Occupational Environment for Health SECTION 3 NIOSH reported that on a typical day: -11,000 employees enduring disabling injuries Every year, ~ 5.2 million nonfatal work related & injuries that required time off from work; 93.6% were injuries & 6.4% were Illnesses There are ~5,542 work related deaths/year (15 deaths/day) -The number of newly reported nonfatal injuries exceeded 4.7 million in the private industry -The direct cost of these injuries were estimated at $45.8 billion - Additionally, $229 billion for Indirect costs INDIANA UNIVERSITY  SECTION 3 Significance of the Occupational Environment for Health (continued) Serious nonfatal occupational injuries are those that require recovery away from work & extend in duration beyond the day of occurrence. In US, nonfatal occupational injuries have been reported in the magnitude 1.2-1.6 million/year INDIANA UNIVERSITY  Leading Causes of Disabling Conditions Sprains & strains Cuts, lacerations, & punctures Bruises & contusions In 2008, a total of 71.2% of injuries took place in the service-providing sector. Significance of the Occupational Environment for Health SECTION 3 INDIANA UNIVERSITY Section 4 Agents of occupational Occupational Diseases health Systems of the human body affected by occupational threats Occupationally Associated Diseases and Conditions SECTION 4 Allergic & irritant dermatitis Respiratory diseases, e.g., chronic obstructive pulmonary disease & asthma Fertility & pregnancy abnormalities Hearing loss caused by noise Infectious diseases Musculoskeletal disorders Traumatic injuries & fatalities Conditions associated with job stress INDIANA UNIVERSITY  Agents of Occupational Disease SECTION 4 Large number of agents & diversity of unhealthful workplace settings are associated with occupational disease Three main kinds of hazards: Physical Noise, vibration, light, temperature, radiation,. Chemical Liquids: vapors, mists, fogs Solids: dusts Gases (Co, & other combustion gases) Biological Bacteria, viruses, fungus INDIANA UNIVERSITY  Physical Agents SECTION 4 -VIBRATION: Segmental Whole-body -NOISE: Hearing loss Whole-body Vibration Segmental Vibration Other effects -RADIATION: Ionizing Non-ionizing INDIANA UNIVERSITY  Physical Agents: Sound SECTION 4 Produce by vibrating bodies Form of mechanical energy Carried in the air as longitudinal waves Impinges upon auditory system & produce physiological response INDIANA UNIVERSITY  Physical Agents: Noise SECTION 4 A type of sound that is unwanted Can be made up of pure tones, a narrow band of frequencies,& sound impulses Can be annoying, can disrupt performance & produce adverse health effects INDIANA UNIVERSITY  Physical Agents: Noise ( Continued ) SECTION 4 Ototoxic is agent that can produce hearing loss (very loud sound & drug or chemicals used in the workplace) Noise induce hearing loss in cumulative way. Thus, long time exposure to noise is associated with hearing loss Noise also induce other hearing disorder: – Temporary shifts – Difficulty to understand words – Signal detection INDIANA UNIVERSITY  Noise: Sound Measurement SECTION 4 INDIANA UNIVERSITY Noise: Human Frequency Range and Limits SECTION 4 INDIANA UNIVERSITY  Effects of Noise < Than 85 Db SECTION 4 dB Effect 80 Difficult conversation 75 Difficult phone conversation 70 Normal conversation if high voice (Not adequate for office work) 65 Upper limit to a comfortable noisy environment 60 Acceptable 55 Upper limit to a comfortable calmed environment 50 Difficult to sleep 40 Acceptable for concentration & sleeping 50% of human tumors INDIANA UNIVERSITY  Asbestos SECTION 5 Asbestos is a group of six fibrous ▪ silicate minerals: – Amosite – Chrysolite (banned in 4/2022) – Tremolite – Actinolite – Anthrophyllite – Crocidolite Asbestos minerals which have been used commercially from the top: chrysotile, amosite and crocidolite INDIANA UNIVERSITY  Asbestos and Industry SECTION 5 Building materials – Brake linings – Textiles, insulation – Paints, Plastic – Caulking compounds – Floor tiles, cement – Roofing paper, Where Do I Look for Asbestos in My House ? – Board covers, filters gas mask, conveyor belts, etc. INDIANA UNIVERSITY  Asbestos and Cancer SECTION 5 Alveolar macrophages adhere to a larger asbestos body (close to a large multinucleated giant cell). Its presence induce chronic inflammation, which after many yeas ends as cancer INDIANA UNIVERSITY  Asbestos related Disease: Lung Cancer SECTION 5 Cause by low exposure to asbestos dust (20-25% asbestos workers) Uncontrolled growth of abnormal cells in the lungs, which form lumps of cancer cells that disrupt the lungs & their function Types: Small Cell Lung Cancer, grows fast (smoking & asbestosis) & Non- small Cell Lung Cancer INDIANA UNIVERSITY  Epithelial cells Mesothelioma SECTION 5 Epithelial cells are especially sensitive to damage by asbestos Lug mesothelioma, cancer of the pleural lining of the lung, Which is essentially incurable, & commonly leads to a great deal of pain Mesothelioma: Ca of lung or stomach. It is “marker disease” Gastrointestinal Ca colon, rectum, esophagus, & stomach (drink water contains  asbestos) INDIANA UNIVERSITY Section 6 Occupational Asthma Seasonal farm workers Other Occupational Issues Stress at the workplace Microbial agents  Organic Dust: Asthma SECTION 6 ▪ Byssinosis – cotton dust Chronic disorder of the airways Airways in lungs become inflamed & constricted Disease causes wheezing, breathlessness, chest tightness, ▪ Bagassosis – sugar cane & nighttime or early morning coughing INDIANA UNIVERSITY  Seasonal Farmworkers Health SECTION 6 ~1.1-3 million migrant & seasonal farmworkers labor on U.S. farms planting, cultivating, & harvesting food vital to the economy They are at risk of occupational injuries caused by pesticides, fertilizers, chemicals, harsh environmental conditions (dust, heat, cold, dehydration) & other exposures (pathogenic microorganisms, farm machinery & transportation accidents) INDIANA UNIVERSITY  Seasonal Farmworkers Health (continued…) SECTION 6 Farm work also involves frequent lifting & carrying of heavy , unbalanced loads; prolonged kneeling, bending, stooping, twisting, repetitive hand tasks, & other physical stressors These exposures can increase farmworker risk for musculoskeletal sprain & strain injures resulting in significant physical pain & disability. INDIANA UNIVERSITY ▪ This is the first study worldwide exploring association between chronic exposure to traffic air pollution & atherosclerosis among young (25-33 years of age) traffic police officer ▪ Crowded cities worldwide use traffic control officer to facilitate motor vehicle traffic ▪ Traffic control officers are heavily expose to toxic mixtures of motor vehicle exhaust CIMT assessed by Ultrasound  Work-Related Stress SECTION 6 Job stress. Defined as the Chronic stress has been harmful physical & emotional implicated in a range of somatic responses (anxiety, stress, & conditions (e.g., coronary heart neurotic disorders) occurring disease) & mental disorders when requirements of job do not including depression match the capabilities, resources, or needs of the worker Term going postal refers to employees who react to stressful Job stress can lead to poor health conditions of their environment & even injury by committing violent acts INDIANA UNIVERSITY  SECTION 6 Stress and Associated Conditions Sources of job stress include: – Work overload (long hours, high pressure deadline) – Job dissatisfaction – Job insecurity (fear of layoff, changes in nature of job) – Worker’s lack of control over their environment & conditions of employment – Assembly line work that involves repetitive task – Dealing with members of the public who may be abusive – Inadequate compensation & lack of benefits INDIANA UNIVERSITY Occupational Diseases; Stress and Associated Conditions SECTION 6 INDIANA UNIVERSITY  Microbial Agents SECTION 6 Are a source of health risks for workers in many occupational categories For example, health care workers, workers exposed to sewage, & agricultural workers may be exposed to bacteria, viruses, & disease- carrying insects INDIANA UNIVERSITY Section 7 Primary interventions Surveillance of conditions at Safe Workplace the workplace Role of federal offices keeping a safe work environment  Prevention of Occupational Disease SECTION 7 Primary prevention is the best method of occupational hazards: 1. Engineering control are physical modifications of the work environment to reduce hazard: quite machinery, installation of protective guards, improvement ventilation 2. Modification of work practices: safety education & training programs 3. Administrative controls: organization of work shifts & rotation of employees to minimize exposure to hazards INDIANA UNIVERSITY  Prevention of Occupational Disease (Continued..) SECTION 7 Personal protective equipment. Are devices to protect against air borne hazards: contaminant removers filters (chemical, gases & airborne particles) & clean air suppliers ‒ Devices to protect hearing: ear plugs & earmuffs ‒ Device to protect eyes: goggles, face shields, safety glasses, & respirators that cover the full face Public health surveillance: collection of data about occupational injuries, illnesses & maintenance of database on exposure to occupational hazards such as noise, industrial chemicals, & ionizing radiation INDIANA UNIVERSITY  Exposure Limits SECTION 6 Exposure limits. Workplace exposure to hazardous agents are higher than the exposure of the general population. In order to protect workers from higher exposures, government agencies have established guidelines & regulations for limitation of exposure Threshold limit value (TLV): refers to airborne concentrations of substances & presents conditions under which it is believed that nearly all workers may be unaffected Guidelines for TLV are published annually by the American Conference of Governmental Industrial Hygienists (AGGIH) for use by industrial hygienists to guide them in making decisions about safe levels of exposure to chemicals & other agents found in the occupational environment INDIANA UNIVERSITY  SECTION 7 Public Health Surveillance Surveillance systems include the collection of information about occupational injuries & illnesses & maintenance of databases on exposures to occupational hazards. INDIANA UNIVERSITY  U.S. Agencies that Conduct Surveillance SECTION 7 National Institute for Occupational Surveillance Programs NIOSH Safety & Health (NIOSH) National Surveillance System of National Center for Health Statistics Pneumoconiosis Mortality (NCHS) (NSSPM) Bureau of Labor Statistics (BLS) National Traumatic Occupational Fatalities (NTOF) Surveillance Occupational Safety & Health System Administration (OSHA) State-based Sentinel Event Mine Safety & Health Notification System for Administration (MSHA) Occupational Risks (SENSOR) INDIANA UNIVERSITY Questions? Next class, quiz # 5