Selected Chapters from occupational medicine

Alena Boriková et al.

Olomouc 2020

Reviewers:

doc. MUDr. Jiří Chaloupka, CSc.

doc. MUDr. Oto Osina, Ph.D.

List of authors:

MUDr. Alena Boriková, Ph.D.

MUDr. Ladislav Štěpánek

doc. MUDr. Marie Nakládalová, Ph.D.

MUDr. Magdaléna Janošíková

MUC. Sammar Ali

Editor: doc. MUDr. Marie Nakládalová, Ph.D.

First Edition

© Alena Boriková et al., 2020

© Palacký University Olomouc, 2020

DOI: 10.5507/lf.20.24457215

ISBN 978-80-244-5721-5

Preface

Motto:

Prevention is better than cure.

Desiderius Erasmus

Dear Students,

Although work is important for the self-realization of man, under certain circumstances it can cause health damage. And this is what these scripts are about.

The main goal of the authors is to always include the possible influence of the working environment in your diagnostic and differential diagnostic considerations when solving your patients' problems and to use the knowledge of the basics of occupational medicine for the benefit of your patients and clients.

We hope you enjoy your studies and future work experience and that you will never experience any damage to health from work.

From the team of authors,

Marie Nakládalová

In Olomouc, October 2019

Contents

Preface

Contents

Introduction

1      Occupational diseases

References

2      Occupational health services

References

3      Risk factors of work

3.1      Adverse microclimatic conditions

3.2      Chemical factors

3.3      Biological agents

3.4      Physical load

3.5      Noise

3.6      Vibration

3.7      Non-ionizing radiation and electromagnetic fields

3.8      Dust

3.9      Mental stress

3.10      Visual load

3.11      Working at elevated air pressure

References

4      Occupational diseases caused by physical agents

4.1      Musculoskeletal disorders

4.1.1      Occupational disorders of the upper extremities due to vibration

4.1.2      Occupational disorders of the upper extremities due to overloading

References

4.2      Professional sensorineural hearing loss

References

4.3      Occupational diseases caused by radiation

4.3.1      Ionizing radiation

4.3.2      Nonionizing radiation

References

4.4      Atmospheric pressure disorders

4.4.1      Decompression sickness (Caisson disease)

4.4.2      Compression sickness

5      Occupational infections

5.1      Occupational infections caused by exposure to infected humans or their tissues

5.1.1      Viral Hepatitis B (VHB)

5.1.2      Viral Hepatitis C (VHC)

5.1.3      Human immunodeficiency virus (HIV)

5.1.4      Tuberculosis (TB)

5.1.5      Scabies

5.2      Travel

5.2.1      Viral Hepatitis A (VHA)

5.2.2      Yellow fever

5.2.3      Typhoid fever

5.2.4      Rabies

5.2.5      Malaria

5.3      Infections transmitted from animals to humans – zoonoses

5.3.1      Brucellosis

6      Occupational skin diseases

6.1      OSDs of physical origin

6.1.1      Mechanical trauma

6.1.2      Temperature

6.1.3      Ionising radiation

6.1.4      Non-ionising radiation

6.2      OSDs of chemical origin

6.2.1      Contact dermatitis

6.2.2      Occupational acne

6.3      OSDs of biological origin

6.3.1      Bacterial infections

6.3.2      Fungal infections (mycoses)

6.3.3      Viral skin diseases

6.3.4      Parasitic and other skin lesions

References

7      Occupational respiratory diseases

7.1      Pneumoconiosis

7.1.1      Silicosis

7.1.2      Asbestos and disease caused by asbestos

7.1.3      Coal worker's pneumoconiosis (CWP)

7.1.4      Lung diseases from welding

7.1.5      Hard metal lung disease

7.2      Allergic respiratory disease

7.2.1      Occupational asthma

7.2.2      Hypersensitivity pneumonitis

7.2.3      Byssinosis

References

8      OCCUPATIONAL TOXICOLOGY

8.1      Metals

8.1.1      Lead

8.1.2      Mercury

8.1.3      Arsenic

8.1.4      Cadmium

8.2      Organic solvents

8.2.1      Aromatic hydrocarbons

8.2.2      Chlorinated hydrocarbons

8.2.3      Refined petroleum solvents

8.2.4      Alcohols

8.2.5      Glycols

8.3      Gas and vapor damage

8.3.1      Substances well soluble in water – chlorine, hydrogen chloride, hydrogen fluoride, ammonia, formaldehyde, sulfur dioxide

8.3.2      Substances poorly soluble in water – nitrous gases, phosgene, ozone

References

9      Occupational cancers

9.1      Asbestos

9.2      Benzene

9.3      Beryllium

9.4      Cadmium

9.5      Diesel exhaust exposure

9.6      Ethylene oxide

9.7      Formaldehyde

9.8      Hardwood dust

9.9      Nickel

9.10      Polycyclic aromatic hydrocarbons (PAHs)

9.11      Crystalline silica

9.12      Trichloroethylene

9.13      Vinyl chloride

9.14      Welding fumes

9.15      Chrome

9.16      Ionizing radiation

References

Introduction

Occupational medicine

Occupational medicine is an interdisciplinary field that deals with the influence of work, the working environment and working conditions for the health of workers, prevention, diagnosis, treatment and assessment aspects of illnesses caused or worsened by work, and supervision of compliance with acceptable working conditions. It, therefore, examines the health of the employee on the one hand and the working environment with its health risks on the other. It spans almost all areas of medicine, and the field of expertise is constantly expanding as technological advances bring new workflows and previously unknown work risks that can affect various organs of the human body.

Activities of the branch

Occupational medicine:

examines and assesses the working effects that affect workers' health, assesses health risks at work and proposes measures to minimize them

monitors health status, diagnoses work-related diseases and participates in their treatment and prevention

assesses the medical fitness and the suitability of the job

assesses, acknowledges, reports, records and dispenses with occupational diseases and participates in their treatment and prevention, decides on the termination of occupational diseases

evaluates the effectiveness of the activities it carries out

Development trends in the field

Development in occupational medicine is very closely related to the development of the state economy. There is a clear shift of labour from the manufacturing sector to the service sector. The nature of work is changing. Part-time work, temporary contracts, seasonal work, and house work are increasing. Demands on the workforce are increasing – demands on managing new processes and technologies, including information. Increasing profession with high mental stress. These trends are also related to the current spectrum of occupational medical issues. Diseases from physical overload, forced work, repeated one-sided movements, or repeated
long-term stress on small muscle groups and allergic diseases become a significant group of professional injuries. On the contrary, the number of diseases from industrial poisoning, pneumoconiosis and other diseases arising in deep mining is decreasing.

International cooperation

Occupational health professionals collaborate with other organizations and companies:

International Commission of Occupational Health (ICOH)

International Labour Office (ILO)

World Health Organisation (WHO)

European Association of Schools of Occupational Medicine (EASOM)

Collegium Ramazzini, International Programme of Chemical Safety (IPCS)

International Agency for Research on Cancer (IARC)

European Respiratory Society (ERS)

European Association of Poison Centres and Clinical Toxicologists (EAPCC)

Network for development of new techniques for discovering trends in occupational and work-related diseases and tracing new and emerging risks (MODERNET)

1 Occupational diseases

Several definitions of the term “occupational disease” exist. However, for the purpose of the Protocol of 2002 to the Occupational Safety and Health Convention of International Labour Organisation (ILO), the term “occupational disease“ covers any disease contracted as a result of exposure to risk factors arising from work activity. The various definitions, however, have two main mandatory elements in common.

the causal relationship between exposure in a specific working environment or work activity and a specific disease

the fact that the disease occurs among the group of exposed persons with a higher frequency rate than in the rest of the population, or in other worker populations

The causal relationship is established on the basis of clinical and/or pathological data, occupational background and job analysis, identification and evaluation of occupational risk factors and of the role of other risk factors.

Classifications of occupational diseases have been developed mainly for two purposes.

notification for labour safety inspection and health surveillance

social security (compensation) purpose

Work-related diseases

All illnesses that can be caused, worsened or jointly caused by working conditions. A case of work-related illness does not necessarily refer to recognition by an authority whereas occupational diseases have a specific or a strong relation to the occupation, generally with only one causal agent while work-related diseases have a complex etiology. Among their multiple causal agents, factors arising from the work and/or working environment play a role in the development of such diseases.

List of Occupational Diseases

Occupational diseases are included in international or national occupational disease lists. In most countries, to be recognized as occupational, a disease must be on the list. These lists are usually compensable by national compensation schemes and they are recordable under-reporting systems.

At present, there are two international lists of occupational diseases. Both of them can be the only regarded as recommendation (soft law) that legal regulations should be adopted by relevant bodies in individual member states. Many states have their own lists of occupational diseases based on these recommendations.

International Labour Organisation (ILO) list of occupational diseases (revised 2010)

Commission Recommendation concerning the European schedule of occupational diseases 2003/670/EC

International Labour Organisation (ILO) list of occupational diseases (revised 2010)

Based on the work of two meetings of experts, the ILO Governing Body approved a new list of occupational diseases on 25 March 2010.

The new list includes a range of internationally recognized occupational diseases, from illnesses caused by chemical, physical and biological agents to respiratory and skin diseases, musculoskeletal disorders and occupational cancer. Mental and behavioural disorders have for the first time been specifically included in the ILO list. This list also has open items in all the sections dealing with the afore-mentioned diseases. The open items allow the recognition of the occupational origin of diseases not specified in the list if a link is established between exposure to risk factors arising from work activities and the disorders contracted by the worker.

This new list of occupational diseases reflects the state-of-the-art development in the identification and recognition of occupational diseases in the world of today. It indicates clearly where prevention and protection should take place. This ILO list represents the latest worldwide consensus on diseases that are internationally accepted as caused by work. This list can serve as a model for the establishment, review, and revision of national lists of occupational diseases.

The world’s working population and their families will benefit from this new list.

1. Occupational diseases caused by exposure to agents arising from work activities

Diseases caused by chemical agents | Diseases caused by beryllium or its compounds

Diseases caused by cadmium or its compounds

Diseases caused by phosphorus or its compounds

Diseases caused by chromium or its compounds

Diseases caused by manganese or its compounds

Diseases caused by arsenic or its compounds

Diseases caused by mercury or its compounds

Diseases caused by lead or its compounds

Diseases caused by fl uorine or its compounds

Diseases caused by carbon disulfide

Diseases caused by halogen derivatives of aliphatic or aromatic hydrocarbons

Diseases caused by benzene or its homologues

Diseases caused by nitro- and amino-derivatives of benzene or its homologues

Diseases caused by nitroglycerine or other nitric acid esters

Diseases caused by alcohols, glycols or ketones

Diseases caused by asphyxiants like carbon monoxide, hydrogen sulfi de, hydrogen cyanide or its derivatives

Diseases caused by acrylonitrile

Diseases caused by oxides of nitrogen

Diseases caused by vanadium or its compounds

Diseases caused by antimony or its compounds

Diseases caused by hexane

Diseases caused by mineral acids

Diseases caused by pharmaceutical agents

Diseases caused by nickel or its compounds

Diseases caused by thallium or its compounds

Diseases caused by osmium or its compounds

Diseases caused by selenium or its compounds

Diseases caused by copper or its compounds

Diseases caused by platinum or its compounds

Diseases caused by tin or its compounds

Diseases caused by zinc or its compounds

Diseases caused by fosgene

Diseases caused by corneal irritants like benzoquinone

Diseases caused by amonia

Diseases caused by isocyanates

Diseases caused by pesticides

Diseases caused by sulphur oxides

Diseases caused by organic solvents

Diseases caused by latex or latex-containing products

Diseases caused by chlorine

Diseases caused by other chemical agents at work not mentioned in the preceding čems where a direct link is established scientifi cally, or determined by methods appropriate to national conditions and practice, between the exposure to these chemical agents arising from work activities and the disease(s) contracted by the worker

Diseases caused by physical agents | Hearing impairment caused by noise

Diseases caused by vibration (disorders of muscles, tendons, bones, joints, peripheral blood vessels or peripheral nerves)

Diseases caused by compressed or decompressed air

Diseases caused by ionizing radiations

Diseases caused by optical (ultraviolet, visible light, infrared) radiations including laser

Diseases caused by exposure to extreme temperatures

Diseases caused by other physical agents at work not mentioned in the preceding items where a direct link is established scientifi cally, or determined by methods appropriate to national conditions and practice, between the exposure to these physical agents arising from work activities and the disease(s) contracted by the worker

Biological agents and infectious or parasitic diseases | Brucellosis

Hepatitis viruses

Human immunodefi ciency virus (HIV)

Tetanus

Tuberculosis

Toxic or infl ammatory syndromes associated with bacterial or fungal contaminants

Anthrax

Leptospirosis

Diseases caused by other biological agents at work not mentioned in the preceding čems where a direct link is established scientifi cally, or determined by methods appropriate to national conditions and practice, between the exposure to these biological agents arising from work activities and the disease(s) contracted by the worker

2. Occupational diseases by target organ systems
Respiratory diseases | Pneumoconioses caused by fi brogenic mineral dust (silicosis, anthraco-silicosis, asbestosis)
Silicotuberculosis
Pneumoconioses caused by non-fi brogenic mineral dust
Siderosis
Bronchopulmonary diseases caused by hard-metal dust
Bronchopulmonary diseases caused by dust of cotton (byssinosis), fl ax, hemp, sisal or sugar cane (bagassosis)
Asthma caused by recognized sensitizing agents or irritants inherent to the work process
Extrinsic allergic alveolitis caused by the inhalation of organic dusts or microbially contaminated aerosols, arising from work activities
Chronic obstructive pulmonary diseases caused by inhalation of coal dust, dust from stone quarries, wood dust, dust from cereals and agricultural work, dust in animal stables, dust from textiles, and paper dust, arising from work activities
Diseases of the lung caused by aluminium
Upper airways disorders caused by recognized sensitizing agents or irritants inherent to the work process
Other respiratory diseases not mentioned in the preceding items where a direct link is established scientifi cally, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising from work activities and the disease(s) contracted by the worker
Skin diseases | Allergic contact dermatoses and contact urticaria caused by other recognized allergyprovoking agents arising from work activities not included in other items
Irritant contact dermatoses caused by other recognized irritant agents arising from work activities not included in other items
Vitiligo caused by other recognized agents arising from work activities not included in other items

Other skin diseases caused by physical, chemical or biological agents at work not included under other items where a direct link is established scientifi cally, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising from work activities and the skin disease(s) contracted by the worker

Musculoskeletal disorders | Radial styloid tenosynovitis due to repetitive movements, forceful exertions and extréme postures of the wrist

Chronic tenosynovitis of hand and wrist due to repetitive movements, forceful exertions andextreme postures of the wrist

Olecranon bursitis due to prolonged pressure of the elbow region

Prepatellar bursitis due to prolonged stay in kneeling position

Epicondylitis due to repetitive forceful work

Meniscus lesions following extended periods of work in a kneeling or squatting position

Carpal tunnel syndrome due to extended periods of repetitive forceful work, work involving vibration, extreme postures of the wrist, or a combination of the three

Other musculoskeletal disorders not mentioned in the preceding items where a direct link is established scientifi cally, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising from work activities and the musculoskeletal disorder(s) contracted by the worker

Mental and behavioural disorders | Post-traumatic stress disorder

Other mental or behavioural disorders not mentioned in the preceding item where a direkt link is established scientifi cally, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising from work activities and the mental and behavioural disorder(s) contracted by the worker

3. Occupational cancer

Cancer caused by the following agents | Asbestos

Benzidine and its salts

Bis-chloromethyl ether (BCME)

Chromium VI compounds

Coal tars, coal tar pitches or soots

Beta-naphthylamine

Vinyl chloride

Benzene

Toxic nitro- and amino-derivatives of benzene or its homologues

Ionizing radiations

Tar, pitch, bitumen, mineral oil, anthracene, or the compounds, products or residues of these substances

Coke oven emissions

Nickel compounds

Wood dust

Arsenic and its compounds

Beryllium and its compounds

Cadmium and its compounds

Erionite

Ethylene oxide

Hepatitis B virus (HBV) and hepatitis C virus (HCV)

Cancers caused by other agents at work not mentioned in the preceding items where a direct link is established scientifi cally, or determined by methods appropriate to national conditions and practice, between the exposure to these agents arising from work activities and the cancer(s) contracted by the worker

4. Other diseases

| Miners’ nystagmus

Other specifi c diseases caused by occupations or processes not mentioned in this list where a direct link is established scientifi cally, or determined by methods appropriate to national conditions and practice, between the exposure arising from work activities and the disease(s) contracted by the worker

Table 1: ILO list of occupational diseases (revised 2010)

Commission Recommendation concerning the European schedule of occupational diseases 2003/670/EC

The European list of occupational diseases has existed since 1990 and was last updated in 2003. It is a list developed by the European Commission and serves as a recommendation for the Member States of the European Union. The European list of occupational diseases is divided into two parts. The first part – Annex I contains diseases that have been scientifically proven to influence the work on the disease. The second part – Annex II includes diseases where a causal link between work and disease is assumed.

The European Commission has recommended Member States to include as soon as possible the national diseases listed in Annex 1 (Annex I) and further to consider the inclusion of other work-related diseases in national legislation. This concerns diseases for which professional origin can be established, in particular, those listed in Annex 2 (Annex II), which should be registered and eventually included in Annex I.

In the Czech Republic, the list of occupational diseases contains six chapters (diseases caused by chemical agents, diseases caused by physical agents, occupational diseases related to the respiratory tract, lung, pleura and peritoneum, occupational skin diseases, occupational infectious and parasitic diseases, occupational diseases caused by other factors and agents).

For information, the chart shows the number of occupational diseases in the Czech Republic in 2018.

Figure 1: Occupational diseases in the Czech Republic in 2018

Priorities for prevention of occupational diseases at the European level

psychosocial factors: the integration of psychosocial aspects in general health and safety policies, and tools related to issues like stress and mental health

the revision of the Carcinogens Directive including the potential improvement brought by the inclusion of the reprotoxic agents in the Directive

proposal for a new directive on musculoskeletal disorders

The issue of asbestos reached a European Parliament resolution

References

EUROPEAN AGENCY FOR SAFETY AND HEALTH AT WORK, ‘Occupational diseases’, Outlook 1 – New and emerging risks in occupational safety and health, Belgium, 2009. [on-line]. Available at: https://osha.europa.eu/en/emerging-risks [cit. 2019-08-14]

EUROPEAN COMMISSION, INFORMATION NOTICES ON OCCUPATIONAL DISEASES: a guide to diagnosis. Office for Official Publications of the European Communities. [on-line]. Luxembourg, 2009. Available at: https://publications.europa.eu/en/publication-detail/-/publication/5d549879-7f75-4e89-b737-e19f530d1236/language-en [cit. 2019-08-14]

EUROPEAN COMMISSION, OCCUPATIONAL DISEASES IN THE EU - The system(s) and their role / Way forward, Belgium, 2014. [on-line]. Available at: htps://ec.europa.eu/social/main.jsp?langId=en&catId=88&eventsId=940&furtherEvents=yes [cit. 2019-08-14]

INTERNATIONAL LABOUR ORGANIZATION, List of Occupational Diseases. Identification and recognition of occupational diseases: Criteria for incorporating diseases in the ILO list of occupational diseases, 2010. [on-line]. Geneva, Switzerland. Available at: https://www.ilo.org/safework/info/publications/WCMS_125137/lang--en/index.htm [cit. 2019-08-14]

INTERNATIONAL LABOUR ORGANIZATION, National System for Recording and Notification of Occupational Diseases Practical Guide, 2013. 2002 [on-line]. Geneva, Switzerland. Available at: https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---safework/documents/publication/wcms_210950.pdf [cit. 2019-08-14]

INTERNATIONAL LABOUR ORGANIZATION, P155 – Protocol of 2002 to the Occupational Safety and Health Convention, 1981, 2002 [on-line]. Geneva, Switzerland. Available at: https://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:12100:0::NO::P12100_ILO_CODE:P155 [cit. 2019-08-14]

OSHWIKI CONTRIBUTORS. NETWORKING KNOWLEDGE. Introduction to occupational diseases. 2016 [on-line]. Available at: https://oshwiki.eu/wiki/Introduction_to_occupational_diseases. [cit. 2019-08-14]

TUČEK M. [Koncepce oboru pracovního lékařství]. 2002 [on-line]. Available at: https:/ https://www.google.cz/url?url=https://www.pracovni-lekarstvi.cz/files/koncepce.doc [cit. 2019-08-14]

2 Occupational health services

Occupational health is a specialty concerned with the interrelationship between health and work. The Joint International Labour Organization and World Health Organization (ILO/WHO) Committee on Occupational Health defined occupational health as “the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations” (1950, revised in 1995). The ILO is a tripartite United Nations agency founded in 1919. It brings together governments, employers and workers of 187 member states to set labour standards, develop policies and devise programs promoting decent work for all women and men.

The ILO Constitution states that workers must be protected against sickness, disease and injury arising out of their employment. Yet for millions of them, the reality is very different. According to the most recent ILO global estimates, 2.78 million work-related deaths are recorded every year. In addition to suffering caused for workers and their families, the associated economic costs are colossal. The losses in terms of compensation, lost work days, interrupted production, training and reconversion, as well as health-care expenditure, represent around 3.94% of the world’s annual gross domestic product. At the same time, economic assessments indicate that rational protection of workers from such harm may be achieved at a fraction of these costs.

The role of occupational health is more preventive than therapeutic. The provision of occupational health should involve employers, employees, public authorities and, last but not least, special services referred to as occupational health/medical services. These are guided by ILO Conventions. The Occupational Safety and Health Convention, 1981 (No. 155) is the ILO’s basic legal document. The aim is to prevent work-related health damage, that is, occupational injuries and diseases, by minimizing the possible causes of hazards inherent in the working environment where reasonably practicable. It means that, when considering the type and extent of measures, their costs or social impact on employment should also be taken into account. According to the Convention, all measures taken to ensure occupational health and safety are the responsibility of the employer. Since these measures often require professional qualification, the Convention states that employers and workers are provided with guidance and services in this area.

These issues are addressed by the Occupational Health Services Convention, 1985 (No. 161). It provides for the establishment of enterprise-level occupational health services (OHS) which are responsible for maintaining a safe and healthy working environment. OHS shall have such of the following functions as are adequate to the occupational risks:

identification and assessment of the risks from health hazards in the workplace

surveillance of the factors in the working environment and working practices which may affect workers’ health, including sanitary installations, canteens and housing where these facilities are provided by the employer

advice on planning and organisation of work, including the design of workplaces, on the choice, maintenance and condition of machinery and other equipment and on substances used in work

Vážení čtenáři, právě jste dočetli ukázku z knihy Selected chapters from occupational medicine.
Pokud se Vám ukázka líbila, na našem webu si můžete zakoupit celou knihu.