Chapter 13 Occupational Health

Chronic Obstructive Pulmonary Disease (COPD) and Asthma

- About 30% of cases of COPD and asthma can be linked to occupational exposures. - COPD is related to workplace exposure to dusts. - Asthma has become the most frequently diagnosed occupational respiratory disease in the U.S.

Occupationally Associated Diseases and Conditions

- Allergic and irritant dermatitis - Respiratory diseases, e.g., chronic obstructive pulmonary disease and asthma - Fertility and pregnancy abnormalities - Hearing loss caused by noise - Infectious diseases - Musculoskeletal disorders - Traumatic injuries and fatalities - Conditions associated with job stress

Carbon Monoxide (CO)

- An odorless, hazardous, toxic gas - Causes death by depriving the body of oxygen - Persons with conditions such as lung disease, heart disease, and anemia are at increased risk of the effects of CO.

Conditions Associated with Job Stress

- Anxiety, stress, and neurotic disorders - "Going postal" - Critical incident stress - Of six job categories, the classification of technical, sales, and administrative support had the highest percentage of cases of anxiety, stress, and neurotic disorders in 2001

Personal Protective Equipment (PPE)

- Apparatuses designed to protect employees from serious workplace injuries or illnesses resulting from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards

Micorbial Agents

- Are a source of health risks for workers in many occupational categories - For example, health care workers, workers exposed to sewage, and agricultural workers may be exposed to bacteria, viruses, and disease-carrying insects.

Work-related stress

- Chronic stress has been implicated in a range of somatic conditions (e.g., coronary heart disease) and mental disorders including depression. - Term going postal refers to employees who react to stressful conditions of their environment by committing violent acts.

Bernardino Ramazzini (1633-1714)

- Considered the "father of occupational medicine" - Described the 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

Industries with the Largest Numbers of Deaths

- Construction - Transportation and warehousing - Agriculture, forestry, fishing, and hunting

Two Employment Categories Affected Greatly by Noise

- Construction industry—bulldozers, heavy trucks, and loading machines - Healthcare industry—high-speed bone-cutting drills and suctioning devices

Gauley Bridge Disaster

- Covered a time span that began about 1931 - Caused exposure of unprotected workers to high levels of silica dust - Resulted in about 1,500 cases of silicosis and 1,000 deaths

Examples of PPE

- Devices to protect against airborne hazards Ex - Respirators - Devices to protect hearing Ex - Ear muffs and ear plugs - Protective eyewear Ex - Goggles, face shields, safety glasses, and full-face respirators

The Costs of Occupational Injuries, Illnesses and Fatalities

- Direct costs of injuries and illnesses during the 2002 were estimated at $45.8 billion. - Indirect costs were estimated to be $229 billion.

Nonfatal Occupational Injuries and Illnesses (Private Industry)

- During 2002, 4.7 newly reported cases - Since 2002, the number of cases has continued to decline. - During 2008, 3.7 million cases of were reported. - Leading causes of injuries were sprains and strains

Fertility and Pregnancy Abnormalities

- Examples are birth defects, prematurity, low birth weight, spontaneous abortions, and developmental disabilities. - A total of 4 million chemicals in use commercially have not been tested for their reproductive effects.

Exposure Limits

- Guidelines and regulations for limitation of workplace exposures to hazardous agents - The threshold limit value (TLV) "Refers to airborne concentrations of substances and represents conditions under which it is believed that nearly all workers may be unaffected."

Infectious Diseases (Examples of Workers at Risk)

- Healthcare workers - Public utility workers - Agricultural workers - Social service worker & corrections personnel - Clinical laboratory specialists - Mortuary workers - Adult film industry workers

Traumatic Injuries and Fatalities

- In 2007, approximately 15 workers died every day in the United States from traumatic injuries. - The BLS reported a total of 5,214 fatal occupational injuries in 2008.

Hypersensitivity Pneumonitis

- Inflammation of air sacs of lungs; loss of normal breathing function

Respiratory Diseases

- Many of the work-related respiratory diseases are chronic conditions that have long latency periods. - Asbestosis, coal workers' pneumoconiosis, silicosis, byssinosis, mesothelioma, and lung cancer are examples of work-related respiratory diseases.

Hatters' shakes (Mad Hatter's disease)

- Mercury poisoning among millinery workers

Agents of Occupational Disease

- Microbial agents - Lifting heavy weights - Repetitive motion - Workplace accidents - Work-related stress

Occupational Diseases in Historical Literature

- Miners' asthma (Black Lung Disease) - Potters' rot (Silicosis) - Mad hatter's disease (Mercury poisoning) - Phossy jaw - Mule spinners' cancer

Fertility and Pregnancy Abnormalities (Cont'd)

- Most of the 1,000 chemicals used in the work environment that have been demonstrated to cause adverse reproductive effects among animals have not been tested with humans.

U.S. Agencies That Conduct Surveillance

- National Institute for Occupational Safety and Health (NIOSH) - National Center for Health Statistics (NCHS) - Bureau of Labor Statistics (BLS) - Occupational Safety & Health Administration (OSHA) - Mine Safety and Health Administration (MSHA)

Surveillance Programs Operated by NIOSH

- National Surveillance System of Pneumoconiosis Mortality (NSSPM) - National Traumatic Occupational Fatalities (NTOF) Surveillance System - State-based Sentinel Event Notification System for Occupational Risks (SENSOR)

Agents of Occupational Disease (Cont'd)

- Noise - Dusts - Toxic heavy metals and their fumes - Carbon monoxide - Chemicals - Ionizing radiation

Triangle Shirtwaist Company Fire

- Occurred on March 25, 1911, in New York City - 146 women died within 15 minutes - Doors were locked and fire escapes were nonfunctional

Phossy jaw

- Phosphorus necrosis of jaw

Musculoskeletal Disorder (MSD)

- Refers to "an injury or disorder of the muscles, nerves, tendons, joints, cartilage, or spinal disks."

Noteworthy Figures in History

- Rhazes (ca. 850-923) used occupational classifications in medical case descriptions. - Paracelsus (1493-1541) wrote a book on occupational diseases. - Bernardino Ramazzini

Nature of Sound and Hearing

- Sound is produced by oscillating waves of various frequencies. - The term Hertz (Hz) denotes the number of cycles per second associated with the oscillation of a given sound wave.

Leading Causes of Disabling Conditions

- Sprains and strains - Cuts, lacerations, and punctures - Bruises and contusions - In 2008, a total of 71.2% of injuries took place in the service-providing sector.

Common MSD in the Workplace*

- Sprains, strains, tears - Soreness, pain, hurt, except the back - Back pain, hurt back - Hernia - Carpal tunnel syndrome - Tendonitis - Musculoskeletal system and connective tissue diseases and disorders, except tendoniti

Public Health Surveillance

- Surveillance systems include the collection of information about occupational injuries and illnesses and maintenance of databases on exposures to occupational hazards.

Permissible Noise Levels in the Workplace

- The NIOSH recommended exposure limit (REL) for noise exposure in the workplace during an 8-hour shift is 85 dBA. - dBA refers to A-weighting, meaning that exposure is an 8-hour time-weighted average.

Hearing Loss Caused by Noise

- The second most-commonly self-reported occupational injury or illness - As many as 10 million workers in U.S. suffer from noise-induced hearing loss. - Prolonged exposure to noise may result in psychological reactions that adversely impact the immune system and physical well-being.

Allergic and Irritant Dermatitis

- The skin is one of the most common sites of contact with chemicals in the workplace. - Manufacturing, construction, food production, and activities such as metal plating and engine service put workers at highest risk for skin diseases.

Sound Pressure Level (SPL) and Decibels (dBs)

- The sound pressure level (SPL) is a measure of the intensity of sound. - The SPL is reported on a logarithmic scale that uses decibels (dBs). - An increase of 10dB represents a 10-fold increase in sound intensity.

Noise

- The term ototoxic refers to agents that can produce hearing loss. - Ototoxic agents include very loud sounds and several classes of drugs and chemicals used in the work environment.

Primary Prevention Versus Use of PPE

- The three methods of primary prevention are preferred over other methods for protecting workers such as the use of PPE.

Toxic Heavy Metals and Their Fumes

- Toxic heavy metals (arsenic, lead, mercury, cadmium, chromium and nickel) are potential hazards to human health. - Processing and milling of heavy metals put workers at risk of breathing fumes and dusts that contain toxic levels of these metals.

Historically Significant Occupational Accidents

- Triangle Shirtwaist Company fire - Gauley Bridge disaster

Painters' colic

- abdominal pain associated w/ anemia caused by exposure to white lead in paint

Caisson disease (decompression sickness)

- caused by decompression when workers emerged from caissons (used to construct bridges) - workers were exposed to high pressures for long time

Asbestos

- causes progressive scarring of lung tissue

Miner's asthma (Black Lung Disease

- common name for pneumoconiosis among miners exposed to dusts such as coal dust - pneumoconosis - accumulation of dust in lungs and the tissue reactions to its presence

Sound Pressure Level (SPL) and Decibels (dBs) (Cont'd)

- dBs are advantageous for characterizing the large variability in the range of sounds that the human ear can perceive.

Mule spinners' cancer

- mule is textile spinning machine; - usually refereed to scrotal cancer that occured among males who were exposed to mineral oils during working on the mule

Byssinosis

- obstruction of small airways; impaired lung function

Filecutters' paralysis

- paralysis of hands caused by lead exposure

Potters' rot/miner's phthisis

- silocosis, respiratory disease from inhalation of silica dust - causes scar tissue in lungs

Bakers' itch

- skin reaction (eczema) caused by contact w/ components of baked goods

Job stress

- the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker.

Brass-founders' ague

- type of metal fume fever caused by inhalation of fumes from welding brass; assoicated w/ fever and other symptoms that resolve after 24 hrs

Malignant mesothelioma

- uncommon cancer of chest lining

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."

Occupational Medicine

Medical specialty focusing on detection and prevention of diseases that arise from the work environment

Preventing Occupational Disease

Primary Prevention - Engineering controls --Quieter machinery, improved building ventilation - Modification of work practices --Safety education and training programs - Administrative controls --Organization of work shifts and rotation of employees

Orign of Occupational Health

Recognition of occupational risks from mining occurred during Greek and Roman times.