OCCUPATIONAL DISEASES OCCUPATIONAL DISEASES ОДЕСЬКИЙ ДЕРЖАВНИЙ МЕДИЧНИЙ УНІВЕРСИТЕТ THE ODESSA STATE MEDICAL UNIVERSITY Áiáëiîòåêà ñòóäåíòà-ìåäèêà Medical Student’s Library Започатковано 1999 р. на честь 100-річчя Одеського державного медичного університету (1900–2000 рр.) Initiated in 1999 to mark the Centenary of the Odessa State Medical University (1900–2000) 1 OCCUPATIONAL DISEASES Recommended by the Central Methodical Committee for Higher Medical Education of the Ministry of Health of Ukraine as a manual for students of higher medical educational establishments of the IV level of accreditation using English Odessa The Odessa State Medical University 2009 BBC 54.1,7я73 UDC 616-057(075.8) Authors: O. M. Ignatyev, N. A. Matsegora, T. O. Yermolenko, T. P. Oparina, K. A. Yarmula, Yu. M. Vorokhta Reviewers: Professor G. A. Bondarenko, the head of the Department of Occupational Diseases and Radiation Medicine of the Donetzk Medical University named after M. Gorky, MD Professor I. F. Kostyuk, the head of the Department of Internal and Occupational Diseases of the Kharkiv State Medical University, MD This manual contains information about etiology, epidemiology, patho- genesis of occupational diseases, classifications, new methods of exami- nation, clinical forms and presentation, differential diagnosis, complica- tions and treatment. It includes the questions of prophylaxis, modern trends in treatment according to WHO adopted instructions, working capacity expert exam. The represented material is composed according to occupational dis- eases study programme and it is recommended for the students of higher medical educational establishments of the IV accreditation standard and doctors of various specialities. Рекомендовано Центральним методичним кабінетом з вищої медичної освіти МОЗ України як навчальний посібник для студентів вищих медичних навчальних закладів IV рівня акредитації, які опановують навчальну дисципліну англiйською мовою (Протокол № 4 від 24.12.2007 р. засідання Комісії з медицини науково-методичної ради Міністерства освіти і науки України) © О. М. Ігнатьєв, Н. А. Мацегора, Т. О. Єрмоленко, Т. П. Опаріна, К. А. Ярмула, Ю. М. Ворохта, 2009 ISBN 978-966-7733-47-6 (серія)© Одеський державний медичний ISBN 978-966-443-016-3 університет, 2009 4 PREFACE According to the best available estimates 100 million workers are in- jured and 200,000 die each year in occupational accidents and 68– 157 million new cases of occupational disease are attributed to hazardous exposures or workloads. Such high numbers of severe health outcomes contribute to one of the most important impacts on the health of the world’s population. Occupational injuries and diseases play an even more impor- tant role in developing countries where 70% of the working population of the world lives. By affecting the health of the working population, oc- cupational injuries and diseases have profound effects on work produc- tivity and on the economic and social well-being of workers, their fami- lies and dependents. According to recent estimates, the cost of work-related health loss and associated productivity loss may amount to several per cent of the total gross national product of the countries of the world. The formal workforce constitutes on average 50–60% of a country’s total population. If informal work and work at home are also taken into account, the major part of the population is involved in work. This work products all economic and material values all other societal activities thus ensuring the socioeconomic development of countries. The Constitution of the WHO, the WHO Global Strategy on Health for All, plus the JLO Conventions on Occupational Safety and Health and on Occupational Health Services stipulate among other issues the fun- damental right of each worker to the highest attainable standard of health. To access to occupational health services should be ensured for all work- ers of the world irrespective of age, sex, nationality, occupation, type of employment, or size or location of the workplace. Although effective occupational health and safety programmes and many structural changes have improved the conditions of work in some sectors, several hazardous agents and factors such as physical, chemical, 5 biological as well as psychosocial stress in addition to occupational acci- dents still threaten the health of workers in all countries continuing to cause occupational and work-related diseases and injuries throughout the world. In some economic sectors and in some countries occupational health indicators show even worse trends than in the past. Although the transfer of healthy and safe technologies has had a posi- tive impact on development, the transfer of hazardous technologies, sub- stances and materials to developing countries, which have insufficient capacity to deal with such problems, constitute a threat both to the health of workers and the environment. New developments in work, the work environment and work organi- zation, the introduction of new technologies, new chemical substances and materials in all countries, and the growing mechanization and in- dustrialization in developing countries can lead to new epidemics of oc- cupational and work-related diseases and injuries. In addition, demographic changes in working populations call for new strategies and programmes for occupational health throughout the world. The level of occupational health and safety, the socioeconomic devel- opment of the country and the quality of life and well-being of working people are closely linked with each other. This suggests that intellectual and economic inputs in occupational health are not a burden but have a positive and productive impact on the company and national economy. Some industries and countries have demonstrated that it is technically fea- sible and economically productive to prevent and minimize hazards at work. Thus occupational health is an important factor for sustainable so- cioeconomic development that enables workers to enjoy a healthy and productive life both throughout their active working years and beyond Way to a new healthy working life. Governments should ensure the development of necessary infra-struc- tures for effective implementation of occupational health programmes, including occupational health services, research programmes, training and education, information services and data banks. Networking of such in- frastructures within and among the countries would substantially facili- tate their efforts to implement national programmes. It is a realistic long-term objective to organize well functioning and com- petent occupational health services for all workers to ensure healthy and safe workplaces as well as the required services for each individual work- er. In order to be comprehensive such an occupational health service should include first of all a multidisciplinaly preventive element, including sur- veillance of the work environment and health of workers and, where ap- propriate, relevant curative and health promotion elements. 6 The focal point for practical occupational health activities is the work- place. Employers are responsible for planning and designing a safe and healthy work, workplace, work environment and work organization, as well as for maintaining and constantly improving health and safety at work. Workers in many countries are trained in occupational safety and health. They have the right to know the potential hazards and risks in their work and workplace, and they should, through appropriate mechanisms, par- ticipate in planning and decision-making concerning occupational health and other aspects of their own work, safety and health. 7 Introduction TO OCCUPATIONAL DISEASES THE PLACE OF OCCUPATIONAL DISEASES IN THE TRAINING OF GENERAL PHYSICIANS In the modern world a human being comes across with the greatest majority of harmful factors which can unfavourably influence on his health. The diseases caused by the influence on the human’s body unfa- vourable factors of the industrial sphera are called occupational. A doc- tor should be aquainted with this group of diseases because they have special course and their social meaning is great as well. This group of diseases is learnt in a special unit of inner medicine, a so called occupatio- nal pathology. Occupational pathology is a clinical discipline which studies the prob- lems of etiology, pathogenesis, clinical course, diagnosis, treatment and prophylaxis of occupational diseases. Occupational pathology is a part of general clinical subjects and its meaning is closely connected with know- ledge in other fields of medicine. Occupational pathology is closely connected with hygienic subjects and especially with labour hygiene, toxicology, pathological physiology and other medical subjects. It goes without saying that the occupational pathology is connected with social points, labour protection and safety protection. The persons of different medical professions often come across with the consequences of a harmful influence of industrial factors on the human being’s organism. That is why they should have some knowledge in the field of occupational pathology. It refers to the general physicians as well as they should give medical aid on the enterprises and together with the doctor of sanitary and epide- miological stations to fulfil sanitary supervision, prevent harmful influ- ence of industrial factors, treatment, reduction of general and occupational morbidity. Labor is one of the human being’s activity which has a favorable influ- ence on his health