职业因素与健康概论20178制概述

IntroductiontoOccupationalEnvironmentandHealth

职业环境与健康（概论）SchoolofPublicHealthSunYat-senUniversityProf.WenChen

1October9,2017Serioussituation---challenge2benzenepoisoningpurpuraX-rayfilmpneumoconiosis

TCEpoisoningskindamageOutlineOverviewOccupationalhazardsHealtheffectsApproachtomakeadiagnosisPreventionandprotectionManagementandimprovement3DefinitionOccupationalHealth: Thescienceandartdevotedtotheanticipation,recognition,evaluationandcontroloffactorsandstresses(arisinginorfromtheworkplaces),whichmaycausesickness,impairedhealthandwellbeingorsignificantfort,andinefficiencyamongworkers.44SchoolofPublicHealth SunYat-senUniversity October10,2012OccupationalMedicine:

Themedicalspecialtydevotedtotreatment,preventionandmanagement

ofoccupationalinjury,illness,anddisability;andpromotionofhealthandproductivityofworkers.55SchoolofPublicHealth SunYat-senUniversity October15,2014

Thegoal

Toreduceindustrialaccidents

Topreventoccupationalhazards/diseases/injuries

Toachievemaximumworkefficiency

Togetapropertreatmentandcompensation6SchoolofPublicHealth SunYat-senUniversity October15,2014ThetasksOccupationalmedicalscreeningandhealthinspection2.Occupationalinvestigation3.Diagnosis,treatmentandrecovery4.Evaluationofworkingcapability5.Regulation6.Prevention7

RecognitionHazardidentification

EvaluationRiskassessment

ControlRiskmanagementThestepstotake88SchoolofPublicHealth SunYat-senUniversity October15,2014Theapproachestostudy9

Invitro

Invivo(animal)

Workersandvolunteer☼Occupationalepidemiology

Cross-section

Case-controlPerspectivecohort☼Occupationaltoxicology

Worldwide(eachyear)

1.9-2.3milliondeathsattributedtooccupationalexposure

1.6milliondeathsattributedtowork-relateddiseases

OvertwomillionnewcasesofoccupationaldiseaseBurdenofoccupationaldisease–WHOdata1010SchoolofPublicHealth SunYat-senUniversity October15,201411Thehiddenepidemic:aglobalpicturePneumoconioses•Millionsofworkerscontinuetobeatriskofpneumoconiosesduetoexposuretosilica,coal,asbestos

•Pneumoconioseshavelonglatencyperiodsandcanoftengoundiagnosedandunreported•Theirassociatedillnesses(chronicobstructivepulmonarydisease,TB,cancers)oftencausedisabilityanddeath12•Traditionalrisks(e.g.,asbestosexposure)continuetotakeaheavytollonworker’shealth

•Technological,socialandorganizationalchangesintheworkplaceduetorapidglobalizationhavebeenpaniedbyemergingrisksandnewchallenges

•Newformsofoccupationaldiseases,suchasmusculoskeletalandmentalhealthdisordersareincreasingwithoutadequatepreventive,protectiveandcontrolmeasuresEmergingrisksandnewchallenges13Work-relatedstress•Psychosocialrisksandwork-relatedstresshaveemergedasmattersofgreatconcern•Stresshasbeenlinkedtomusculoskeletal,cardiovascularanddigestivedisorders

•Workersmayturntounhealthybehaviors(e.g.,alcoholanddrugabuse)inanattempttocopewithwork-relatedstress

•Theeconomiccrisishasledtoanincreaseinstress,anxiety,depressionandothermentaldisorders,evenbringingpeopletotheextremeofsuicide14A

dozen

Foxconn

commitsuicidein2010MonotonousOvertimeworkLackofpsychologicalcounselingStressOccupationaldiseasesinChina

Year

Newlyreported

cases

2005 15,251 2006 11,519 2007 14,296 2008 13,744 2009 18,128 2010 27,240 2011 29,879 2012 27,420 2013 26,393 2014 29,972

1516ByMay2013,datacollectedshowThesumofreportedcasesis834,000Pneumoconiosis750,000Diefromdiseases160,000Poisoning60,000Acutepoisoning31,000ThereportofaccumulatingcasesDistributionofoccupationaldiseases(inChina)1718ClassificationanddistributionofoccupationaldiseaseIncidenceofoccupationalcancers1920IndustryProportionMining36.4%Processing&manufacturing14.7%Electronic10.5%Chemical6.3%Construction5.6%IndustrialdistributionPrivateenterprises66.7%Nationalenterprises21.4%Foreign-investedenterprises8.2%Small50.7%Medium29.1%Large20.3%21Currently,whatarewefacingregardingoccupationaldiseasesinChina?“制造大国，世界工厂”Thereare740millionoflaborforceinChina10millionexistingindustriesthatproduceoccupationalhazards

Newmaterial,newtechnology,newworkingmodeemerging

Insufficientprecautiontotheoccupationalhazards,particularlyinworkersfromruralareas22Abigcountry,makingagreatnumberofproductsintheworld23Mostsevereoccupationaldisease－pneumoconiosisSchoolofPublicHealth SunYat-senUniversity October15,2014Accumulativecasesofreportedoccupationaldiseaseover800,000,RankingNo.1intheworld.

Whilethetraditionaloccupationaldiseasesaspneumoconiosishavenotbeenundercontrol,thenewemergingdiseasesoccurfrequently,duetoexposetoorganicsolvent,workstress,nanoparticle,etc.Rigoroussituationincontrolofoccupationaldiseases三氯乙烯尘肺职业性肿瘤正己烷中毒24NewemergingmaterialsandhealthissueJNanosciNanotechnol

2007,7:3048.:25SchoolofPublicHealth SunYat-senUniversity October15,2014Diagnosis----underestimatedNewcases:10,000-30,000/yHealthinspection:<10%Exposuredetection:lowcoverageLonginductionperiodInadequatetraining/knowledgeofexposuresintheworkplaceLackofrecognitionofthescopeandcostsofoccupationaldiseaseLackofawarenessofthelegalrequirementsforreporting,notificationStrongdisincentivesininsurancesystemstorecognitionofoccupationaldisease？？？2627InsufficientmedicalcareOnlyasmallfractionoccupationaldiseaseiscoveredbymedicalcareAsmallfractionofpeoplesufferingfromoccupationalillnesseseverreceivesworkers’compensationbenefitsSchoolofPublicHealth SunYat-senUniversity October15,2014Achemicalisconsideredhazardousif:Whileproducingorusingthechemical,thereisalikelihoodthatexposuretothechemicalwillcauseaninjury,death,oranadversehealtheffect.Dosedeterminestheeffect!2828SchoolofPublicHealth SunYat-senUniversity October15,2014Locationofhazards2929SchoolofPublicHealth SunYat-senUniversity October15,2014Originsofoccupationalhazards

♠regulation♠workandrest♠ergonomics♠intensionWorkingconditions

ProcessandoperationEnvironmentofworkplaceMaterialsandproducts♠naturalcondition♠layoutanddesign♠Equipments♠Rawmaterials♠By-products♠Products30TypesofhazardouschemicalsSolventsLubricantsFuelsWeldingproductsAcidsandbasesPaintsCleanersReagents31SchoolofPublicHealth SunYat-senUniversity October15,2014

ChemicalAgents

dusts,mists,vapors,gases

PhysicalAgents

ionizingandnonionizingradiation,noise,vibration,andtemperatureextremes

BiologicalAgents

Insects,yeasts,fungi,bacteria,viruses

Others

Monotony,fatigue,repetitivemotionClassificationofhazards32SchoolofPublicHealth SunYat-senUniversity October15,2014RoutesofexposureInhalationbreathingAbsorptionSkincontactEyecontactIngestionswallowing33SchoolofPublicHealth SunYat-senUniversity October15,2014HealtheffectsOccupationaldiseases

Occupationalinjury

Work-relateddiseasesWithoutcausalrelationshipwithworkbutwhichmaybeaggravatedbyoccupationalhazardstohealth3434SchoolofPublicHealth SunYat-senUniversity October15,2014OccupationaldiseasesHavingaspecificorastrongrelationtooccupationgenerallywithonlyonecausalagentrecognizedCoversanydiseasecontractedasaresultofexposuretoriskfactorsarisingfromtheworkactivityThediseaseoccursamongagroupofexposedpeoplewithafrequencyabovetheaveragemorbidityoftherestofthepopulation.35SchoolofPublicHealth SunYat-senUniversity October15,201436OccupationalinjuryBodilydamageresultingfromworking.Themostusual

organs

involvedarethe

spine,hands,thehead,lungs,eyes,skeleton,and

skin.Commoncauses:poorergonomicsmanualhandlingofheavyloadsmisuseorfailureofequipmentexposuretogeneralhazardsinadequatesafetytrainingandclothing,jewelryorlonghairthatestangledinmachinery.Adynamicequilibriumbetweenthegeneticbackgroundandoccupationalenvironment3738HealtheffectsAcute(short-term)CoughChestpainTroublebreathing;shortnessofbreathIntestinaldisorders–diarrhea,vomitingHeadache,dizzinessIrritability,memorytroublesSkinrash,burns3939SchoolofPublicHealth SunYat-senUniversity October15,2014CommonexamplesofinjuriesDustintheeyes/fluidsintheeyesBurnstoskinfromsoakedclothingEthyleneglycolonlegsHydratedlimeonlegsandfeetGroutinbootsAcidsandalkalisExplodingbatteriesDusts–cement,lime,calciumoxide4040SchoolofPublicHealth SunYat-senUniversity October15,2014ExamplesofacuteillnessMetalfumefever-weldingOverexposuretoCO,formaldehyde,ammoniaExposuretotrona(天然碱)Overexposuretofuels(diesel,gasoline)4141SchoolofPublicHealth SunYat-senUniversity October15,2014HealtheffectsChronic(long-term)WeaknessandfatigueLossofappetiteandweightProlongedcoughNeurologicaldisordersCancerKidneyandliverdisease4242SchoolofPublicHealth SunYat-senUniversity October15,2014Exampleofchronicillness65yearoldmaleMinedpegmatite(花岗岩)from1956to1990(~34years)ExposedtosilicadustroutinelyduringminingprocessIn1991,duringaroutinechestx-ray,silicosisdiagnosedDevelopedshortnessofbreathandchroniccoughin1994SilicosisprogressedDiedin2002(11yearsafterdiagnosis)4343SchoolofPublicHealth SunYat-senUniversity October15,2014Workrelateddiseaseandinjury4444SchoolofPublicHealth SunYat-senUniversity October15,201445Cumulativetraumadisorders(CTD)（累积创伤失调）46WorkrelatedmusculoskeletaldisordersWristrestingsyndrome（鼠标手）Symptomsinclude:swellingpainlossofmotionlossofstrengthTendinitis&TenosynovitisTenleadingoccupationaldiseases(inChina)1.Lungdiseases:

silicosis,coalworkers'pneumoconiosis,asbestosis,byssinosis,occupationalasthma2.Metalpoisonings:

lead,arsenic,mercury,manganese,cadmium,chromium

3.Pesticidepoisoning:

OPs,pyrethroids

4.Organicsolventandaromaticaminepoisonings:

benzene,toluene,carbondisulfide,N-hexane,dichloroethane,TCE,aniline475.Irritantsandasphyxiantspoisonings:

chlorine,ammonia,nitrogenoxide,phosgene(光气),carbonmonoxide,hydrogensulfide6.Dermatitisandchemicalburns

7.Noise-inducedhearingloss8.Vibrationdisease9.Arc-welder'seye-flash10.Occupationalcancers:

lungcancer,mesothelioma,bladdertumor,leukemia,skinandlivercancersTenleadingoccupationaldiseasesinChina(con’t)48Howtomakeadiagnosis?49Fourcriticalelementsfordiagnosisofoccupationaldisease(HCFL)Historyofoccupationalexposureagents,duration,location,protection,etc.Clinicalfeatures

personalhealthhistory,symptoms,signs

Fieldinvestigationandsurveillancesystem

assessmentofexposurelevel,monitoring,environmentalinspection,process,personalprotectiveequipmentutilized,etc.Laboratoryorphysicalexaminations

biochemicalmarkers,enzyme,protein,IHC,neurologicalfunctions,CT,x-ray,etc.5050SchoolofPublicHealth SunYat-senUniversity October15,2014YOUareatthe1stlineofdefense!Whodoyoucallon/interactwith?

Physician/Occupationalphysician

Safetyprofessional

Industrialhygienist5151SchoolofPublicHealth SunYat-senUniversity October15,2014Thequicksurvey

Whatkindofworkdoyoudo?

Areyounoworhaveyoupreviouslybeenexposedtodusts,chemicals,radiation,orloudnoise?

Areyoursymptomsbetterorworsewhenyouareatwork?52SchoolofPublicHealth SunYat-senUniversity October15,201453MajortypesofexposureCorrosivesubstances(acid,alkalis)DustsFibers(asbestos,fiberglass)GasesHeavymetalsPesticides,insecticides,herbicidesPlastics(di-isocyanates,phthalates,acrylonitrile)PetrochemicalsPhysicalagents(noise,heat,vibration,repetitiveliftingorothermotions)Radiation(electromagnetic,X-ray,ultraviolet)SchoolofPublicHealth SunYat-senUniversity October15,201454DetailquestioningbasedoninitialsuspicionSelf-administeredquestionnaireforallpatients:ChronologyofjobsCurrentjob:descriptionofatypicaldayReviewofjobchronologyandassociatedexposureExaminationofthelinkbetweenworkandthechiefsymptom:ClinicalcluesExplorationofthetemporallinkindetail“Doothersatworkhavesimilarproblems?”SchoolofPublicHealth SunYat-senUniversity October15,2014Step1-Medical&exposurerecords

Priormedicalrecords

IndustrialHygienedata

Labels,ChemicalInventoryLists5555SchoolofPublicHealth SunYat-senUniversity October15,2014Step2-Exposurehistory

Symptoms&exposurehistory

Completehistory&physicalexamination

Specificjobduties,hazardexposures

Exposuremonitoring

Frequencyofintoxicationepisodes

Duration,location,protection5656SchoolofPublicHealth SunYat-senUniversity October15,2014Step3-Medicalhistory

Symptoms

Historyofbloodexamination

Hearingloss

HistoryofpsychologicalproblemsPriortoexposureAfterexposure5757SchoolofPublicHealth SunYat-senUniversity October15,2014Step4-PhysicalexaminationFocuson:

Skin

Eyes

Gastro-intestinal

Neurologicsystem

MentalStatus5858SchoolofPublicHealth SunYat-senUniversity October15,2014Step5-Laboratorytests

Screening

BiologicalIndices

PathologicIndices5959SchoolofPublicHealth SunYat-senUniversity October15,2014Step6-Othertesting

Nerveconductionstudies

Colorvision

HearingFunctionaltest(blinkreflex–facialandtrigeminalnerveevaluation)6060SchoolofPublicHealth SunYat-senUniversity October15,2014Step7-SiteVisit

“WalkThrough”ofpatient’sworkplace

AssessworkplaceandpotentialexposuresPersonalorareaIndustrialhygieneSamplingVentilationofworksitePotentialskinexposure

Obtainpriorenvironmentaltestresults,ifavailable6161SchoolofPublicHealth SunYat-senUniversity October15,2014Step8–Relationship?

Decidewhetherthethepatient’sdiagnosisismorelikelythannotwork-related.

Isthelatencyperiodadequate?

Exposuredataconsistent?6262SchoolofPublicHealth SunYat-senUniversity October15,2014Step9-Makethediagnosis

Wasthedoseoftheexposureadequate,inyouropinion,tocausetheproblem?(e.g.,isthereahistoryofacuteintoxicationepisodes?)

ORIspatientparticularlysensitivetotheeffectsofhazards(e.g.increasedindividualsusceptibilityoracquiredintolerance)?6363SchoolofPublicHealth SunYat-senUniversity October15,2014Step9-DiagnosisRuleoutotherdiseaseswithsimilares:e.g.,AlcoholicHepatitis/HepatitisBDecideifapre-existingconditionexiststhathasbeenexacerbated.6464SchoolofPublicHealth SunYat-senUniversity October15,2014Step9-Diagnosis(con’t)

Mustbereviewedbyatleast3professionalsdestinedfordiagnosisofoccupationaldiseaseaccordingtothe(inChina)

Mustbereviewedandapprovedbystatecouncil6565SchoolofPublicHealth SunYat-senUniversity October15,2014PreventionofoccupationaldiseasePrimaryPreventionEliminateorreducehazardousexposuresSecondaryPreventionEffectivelyidentifyandtreatwork-relatedillnessthroughsymptoms/screeningproceduresTertiaryPreventionReducecomplicationsanddisabilitycausedbyexistingdisease6666SchoolofPublicHealth SunYat-senUniversity October15,2014Controlofhazardsoragents

ControlsinthisorderofpreferenceEngineeringControlsEngineeringchangesindesign,equipment,processesSubstitutinganon-hazardousmaterialAdministrativeControlsReducethehumanexposurebychangesinprocedures,work-areaaccessrestrictions,workerrotation,Biologicalmarkers:toassessexposure–blood-leadlevelsPersonalProtectiveEquipment/ClothingEarplugs/muffs,safetyglasses/goggles,respirators,gloves,clothing,hard-hats6767SchoolofPublicHealth SunYat-senUniversity October15,2014Whattobeawareof?

RiskmanagementHazardassessmentRiskcommunication

StandardsofpracticeGovernmental–Scientificguidelines-6868SchoolofPublicHealth SunYat-senUniversity October15,2014Minimumelementsofhealthmanagement

Recognitionofhealthhazards

Evaluationofhealthhazards

Controlofhealthhazards

Recordkeeping

Employeetraining

Periodicprogramreview6969SchoolofPublicHealth SunYat-senUniversity October15,2014CodeofOccupationalDiseasePreventionofPRC

中国职业病防治法

EnforcementfromDec31,2011

RevisionSep1,2016

70SchoolofPublicHealth SunYat-senUniversity October15,20141.Pneumoconiosisandotherrespiratorydiseases2.Occupationaldermatitis3.Occupationaleyediseases4.Ear,nose,throat,oraldiseases5.Occupationalpoisoning6.Physicalagents7.Radiation8.BiologicalAgents9.Occupationalcancer10.OthersCategories71SchoolofPublicHealth SunYat-senUniversity October15,2014职业病目录

我国1957年—14种1987年—9大类100多种

2002年10大类115种，2013年12月23日10大类130种（一）尘肺病1.矽肺2.煤工尘肺3.石墨尘肺4.碳黑尘肺5.石棉肺6.滑石尘肺7.水泥尘肺8.云母尘肺9.陶工尘肺10.铝尘肺11.电焊工尘肺12.铸工尘肺13.根据诊断标准可以诊断的其他尘肺72一、职业性尘肺病及其他呼吸系统疾病（二）其他呼吸系统疾病1.过敏性肺炎2.棉尘病3.哮喘4.金属及其化合物粉尘肺沉着病

（锡、铁、锑、钡及其化合物等）5.刺激性化学物所致慢性阻塞性肺疾病6.硬金属肺病

二、职业性皮肤病1.接触性皮炎

2.光接触性皮炎

3.电光性皮炎

4.黑变病

5.痤疮

6.溃疡7.化学性皮肤灼伤

8.白斑

9.