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
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