UVOD U PATOLOGIJU RADA

PROFESIONALNE BOLESTI

BOLESTI U SVEZI S RADOM

LISTA PROFESIONALNIH BOLESTI

MEDICINA RADA

= medicinska struka koja se bavi SPRJEČAVANJEM I LIJEČENJEM bolesti koje nastaju kao posljedica djelovanja profesionalnih štetnosti

ŠTETNOSTI MOGU BITI:

FIZIKALNE KEMIJSKE BIOLOŠKE VEZANE UZ ERGONOMSKE UVJETE VEZANE UZ PSIHIČKE NAPORE 

PROFESIONALNA BOLEST

PROFESIONALNA BOLEST profesionalna štetnost je morbogeni faktor

BOLEST U SVEZI S RADOM

profesionalna štetnost je rizični čimbenik (pospješuje ili pojačava postojeću

nasljednu sklonost bolesti i/ili postojeću neprofesionalno stečenu bolest)

GLOBALNI RAZMJER PROBLEMA

2000.g. 56 501 000 nesmrtonosnih prof. bolesti i povreda

5,344 smrtnih ishoda 75% hospitaliziranih i ambulantno

liječenih bolesnika anamnestički navode izloženost štetnostima na radnom mjestu

U novije vrijeme predmet ne samo stručnog, nego i medijskog interesa

FINANCIJSKI ASPEKT PROBLEM

1992. Procjena referentnih troškova je u SAD bila 171 bilijun $

1994. Gubitak u USA-nacionalnom dohotku vezan uz apsentizam: direktni troškovi 1,1 bilijun $, daljnjih 49,4 bilijuna nadomješteno “income protection” programima

PODACI ZA HRVATSKU

Prema podacima HZJZ : 2000. Zabilježene 22 054 ozljede na radu,

40 sa smrtnih ishodom Iste godine prijavljena 81 profesionalna

bolest (od toga 36% pneumokonioza, 23% izazvano vibracijama, 16% zaraznih bolesti, 7,4% oštećenja sluha izazvana bukom, 6,1% kožnih bolesti)

U istoj godini:

ZMIO podneseno 25 405 zahtjeva za ocjenu radne sposobnosti i invalidnosti

Od toga u punu invalidsku mirovinu otišlo 2322 osiguranika (9,3%), a 3770 (15%) ocijenjeno nesposobnim za daljnje obavljanje svoga posla i prekvalificirano ili poslano na profesionalnu rehabilitaciju

RAZLIKOVATI

PROFESIONALNA BOLEST = kronično stanje uzročno povezano s radom

NESREĆA NA RADU= akutni incidentni događaj koji se zbije unutar 24 sata, a uzročno je povezan sa radnim procesom

ZNAČAJKE PROFESIONALNE BOLESTI

An illness that fails to respond to standard treatment, does not fit the typical demographic profile or is of unknown cause should raise suspicion of an occupational etiology.

Respiratory system, lungs Shipping &

Receiving Air freight Ground transportation

Supply distribution system Headquarters Chemical processing Wastewater treatment New products development Prevention of catastrophic events Steady production

Can act as the target organ Can be a pathway to systemic effects

Gases, vapors - effects depend on solubility Upper resp. - irritation Lower resp. - pulmonary edema

Particulates - depends on size, density Diseases called – “pneumoconioses” Defense mechanisms

Upper resp. - mucociliary escalator Lower resp. – macrophages

Asbestos silica

Gastro-intestinal; Skin Shipping &

Receiving Air freight

Ground transport

Supply distribution system Headquarters Chemical processing Wastewater treatment New products development Prevention of catastrophic

events Steady production

Solids, liquids taken internally on the skin

Blood Shipping & Receiving

Air freight Ground transport

Supply distribution system

Headquarters

Chemical processing Wastewater treatment

New products development Prevention of catastrophic

events Steady production

“hematopoetic” toxins Acute:

CO, Methylene Chloride! – chemical asphyxiation

Chronic: benzene - leukemia

Brain & nerve system Shipping & Receiving

Air freight Ground transport

Supply distribution system

Headquarters Chemical processing Wastewater treatment New products development Prevention of catastrophic

events Steady production

“neurotoxins” Heavy metals

Lead Mercury Manganese

Solvents Toluene Carbon disulfide (CS2)

liver Shipping & Receiving

Air freight Ground transport

Supply distribution system Headquarters

Chemical processing

Wastewater treatment New products development Prevention of catastrophic

events Steady production

“hepatotoxins” Vinyl chloride - angiosarcoma

Kidney & bladder Shipping & Receiving

Air freight Ground transport

Supply distribution system Headquarters Chemical processing

Wastewater treatment

New products development Prevention of catastrophic

events Steady production

“nephrotoxins” Amines, dyes - cancer Ethylene glycol - oxalic crystals

Reproduction Shipping & Receiving

Air freight Ground transport

Supply distribution system Headquarters Chemical processing Wastewater treatment

New products development

Prevention of catastrophic events

Steady production

“teratogens”, “mutagens” DBCP – sterility (testicular atrophy) Cellosolves – sperm mobility Lead – learning disorders Nitrous oxide - miscarriages

Cancer Shipping & Receiving

Air freight Ground transport

Supply distribution system Headquarters Chemical processing Wastewater treatment New products development

Prevention of catastrophic events

Steady production

“Carcinogens” Vinyl chloride, carbon tetrachloride Asbestos, silica Chromium, beryllium, cadmium Wood dust

Homeostasis Shipping & Receiving

Air freight Ground transport

Supply distribution system Headquarters Chemical processing Wastewater treatment New products development Prevention of catastrophic

events

Steady production

Condition of maintaining good health Be aware of threshold concept of exposure Be aware of special considerations

Sensitization (allergic response)

Summary Bottom line

Occupational disease usually develops slowly Long latency No immediate warnings

Therefore, as part of management, you need to “plan ahead” be proactive, not reactive be aware of

health & safety regulations exposure guidelines need for monitoring need for personal protective equipment (PPE) need for training and education

BOLESTI POVEZANE S RADOM

PROBLEM: U većini slučajeva profesionalna etiopatogenetska komponenta bude zanemarena

(obično su to nepovoljni ergonomski uvjeti) i bolest bude tretirana samo klinički, što povratkom na rad dovodi do egzacerbacija

NAJČEŠĆE:

1. Sindrom bolnih leđa i bolnog ramena

2. Kronična nespecifična bolest pluća

Skupina respiratornih bolesti kronični bronhitis, emfizem pluća i bronhalna astma

3. Arterijska hipertenzija

3. Zdravstveni učinci rada na

videoterminalima (VDU)

4. Psihosomatske bolesti

INTERVENTNE MJERE:

1. prepoznati značaj bolesti povezanih s radom  2. novčana naknada tijekom apsentizma zbog

ovih razloga 3. ergonomska i organizacijska rješenja koja će

smanjiti incidenciju bolesti povezanih s radom  4. stvoriti Listu bolesti povezanih s radom kao

što je učinjeno za profesionalne bolesti