WORKING AND HEALTH LECTURE FOR MEDICAL STUDENTS WORK IS ENNOBLIG n TO BE EMPLOYED HELPS TO FIND THE CREDIT WITHIN THE SOCIETY n UNEMPLOYMENT IS ASSOCIATED WITH: - POVERTY, - DEPRIVATION - BARRENNESS HEALTH CONSEQUENCES n WORSE LIFESTYLE (MALNUTRITION, ALCOHOLISM, SMOKING, DRUGS ABUSE, POOR HYGIENE) n PSYCHOSOMATIC DISEASES n PSYCHIATRIC MORBIDITY WORK AS A HEALTH RISK n OCCUPATIONAL D.: - MAINLY AMONG WORKERS - CAUSE SPECIFIC - OCCUPATIONAL EXPOSURE IS ESSENTIAL n WORK-RELATED D.: - LARGELY IN THE POPULATION - MULTIFACTORIAL - OCCUPATIONAL EXPOSURE MAY BE A FACTOR THE SOCIAL APPROACH n OCCUPATIONAL D.: - NOTIFABLE - COMPENSABLE n WORK-RELATED D.: - MAY BE NOTIFABLE - MAY BE COMPENSABLE OCCUPATIONAL HAZARDS n FACTORS: - MECHANICAL - HEAVY PHYSICAL LOAD n OUTCOMES: - ACCIDENTS, INJURIES - MUSCULOSCELETAL DISORDERS, INJURIES, LOW BACK PAIN OCCUPATIONAL HAZARDS n ERGONOMIC n MONOTONY n MUCSULOSCELETAL DISORDERS (D. FROM REPEATED OVERLOAD) n MENTAL STRESS, LOWERED QUALITY AND PRODUCTIVITY n D.FROM REPEATED OVERLOAD PHYSICAL HAZARDS n NOISE n VIBRATION n RADIATION n EXTREME MICROCLIMATE n HEARING LOSS n PSYCHOSOMATIC D. n TR.VASONEUROSIS n CANCER, RADIAT.D. n CATARACT n CVD,HYPERTHERM. n CHILBLAINS CHEMICAL HAZARDS n DUSTS n PNEUMOCONIOSIS n SILICOSIS n ASBESTOSIS n BERRYLIOSIS n SIDEROSIS CHEMICAL HAZARDS n WIDE SPECTRUM OF HUNDREDS COMPOUNDS n INJURIES, IRRITATION n TOXICANTS n CARCINOGENS n ALERGENS n TERRATOGENS BIOLOGIC HAZARDS n ANIMALS n MICROBIAL AND VIRAL FACTORS n PLANT ALLERGENS n INJURIES, n ANTROPOZOONOS. n INFECTIONS n ALLERGIES n ALLERGIES PSYCHOLOGICAL STRAIN n DIFFERENT STRESS FACTORS n NEUROSIS n DEPRESSION n DISSATISFACTION n CONFLICTS n PSYCHOSOMATIC D. WORK FACTORS AND WORK-RELATED D. n BEHAVIORAL AND PSYCHOSOMATIC D. n HYPERTENSION n WORK OVERLOAD n WORK UNDERLOAD n SHIFT WORK n CAREER DEVELOP. n MIGRATION n INTERPERSONAL CONFLICTS n RESPONSIBILITY OCCUPATIONAL HAZARDS IN HEALTH PROFESSIONALS PRACTICE n WHICH OF THEM CAN YOU FIND? OCCUPATIONAL HAZARDS n INFECTIOUS AGENS n X-RAY n INJURY n POSTURAL STRESS n NOISE, VIBRATION OCCUPATIONAL HAZARDS n CHEMICALS: n ORGANIC SOLVENTS n CHEMICAL CARCINOGENS AND TERRATOGENS (CHEMOTHERAPY, ANESTESIOLOGY) n ANORGANIC MERCURY OCCUPATIONAL HAZARDS n ALLERGENS: n PROCAIN, MESOCAIN n IODINE, FAMOSEPT, FORMALDEHADE n SULFONAMIDES n ANTIBIOTICS n ACRYLATES, LATEX/RUBBER OCCUPATIONAL STRESS n sy. OF OVERFILL WAITING-ROOM n LACK OF DRUGS n LACK OF DIAGNOSTIC METHODS n ADMINISTRATIVE OVERLOAD n PATIENT´S MOOD n PATIENT´S RELATIVES n INTERPERSONAL RELATIONSHIPS n SHIFT-WORK OUTCOMES OF STRESS n „BURN OUT“ sy. n PSYCHOSOMATIC DISEASES n ALCOHOLISM, SMOKING, DRUGS n PSYCHIATRIC DISORDERS – SUICIDES RR 2,0 (Finland, UK) – 4,0 (USA) PROFESSIOGRAM 1 n TRY TO DEVELOPE THE WORKPLACE CHECKLIST FOR THE PATIENT WITH ICHS – MAN, 50 YEARS OLD n WHICH RISK FACTORS WILL BE IMPORTANT FOR HIM? PROFESSIOGRAM 1 n INCREASED HEART RATE, BLOOD PRESSURE, NEEDS OF OXYGEN: - STRESS (working time/shift, timing monotony work, noise, mental stress – responsibility) - ERGONOMY (outdoor/indoor workplace microclima, postural stress, physical overload PROFESSIOGRAM 1 n DECREASED SOURCE OF OXYGEN: - ENVIRONMENTAL TOBACCO SMOKE (nicotine, carbon monoxide, hydrocyanide) - CARBON MONOXIDE - CARBON DISULPHIDE - NITRATES ( Monday morning death) PROFESSIOGRAM 1 n COBALT (Quebec Beer-drinker´s Cardiomyopathy)- Co + alcohol (?) n HALOGENATED HYDROCARBONS (trichlorethylene, fluorocarbons) – ventricular fibrillation n SILICOSIS, INFECTIONs, INJURY - pericarditis PROFESSIOGRAM 1 n LEAD n CADMIUM n NOISE => HYPERTENSION PROFESIOGRAM 2 n TRY TO DEVELOPE THE WORKPLACE CHECKLIST FOR PREGNANT WOMAN n WHICH RISK FACTORS WILL BE IMPORTANT FOR HER AND FOR FETUS? PROFESSIOGRAM 2 n INCREASED NEEDS FOR OXYGEN FROM THE 2nd TRIMESTER - STRESS - ERGONOMY PROFESSIOGRAM 2 n DECREASED SOURCE OF OXYGEN: - POSTURAL STRESS - ENVIRONMENTAL TOBACCO SMOKE - CARBON MONOXIDE - CARBON DISULPHIDE PROFESSIOGRAM 2 n EXPOSURE TO TERRATOGENS: - SMOKING + ENVIRONMENTAL TOBACCO SMOKE - ALCOHOL - THALIDOMID - ORGANIC MERCURY PROFESSIOGRAM 2 n TERRATOGENS: - VIRAL/MICROBIAL INFECTIONS - X-RAYs - CADMIUM, LEAD - ORGANIC SOLVENTS - COCAIN, HEROIN, MARIHUANA PROFESSIOGRAM 2 n NOISE, VIBRATION n LIPOSOLUBLE VITAMINES n SOME DRUGS n EL.MAG. WAVES n POLYCYCLIC CHLORINATED HYDROCARBONS (PCBs, PCDDs, PCDFs) PRIMARY PREVENTION n CONTROL OF NEW HAZARDS n CONTROL OF KNOWN HAZARDS n SUBSTITUTION OF RISK FACTORS n TECHNICAL CONTROLS TO MINIMASE EXPOSURE n ADMINISTRATIVE CONTROLS PRIMARY PREVENTION n ENVIRONMENTAL MONITORING n BIOLOGICAL MONITORING OF EXPOSURE n IDENTIFICATION OF VULNERABLE PERSONS (pre-employed examination) n PERSONAL PROTECTIVE DEVICES PRIMARY PREVENTION n SMOKING REDUCTION/CESSATION n ALCOHOL – APPROPRIATTE AMOUNT, ONLY IN THE PRIVACY n EXERCISE AND FITNESS n NUTRITION IN WORKPLACE CANTEENS, IN VENDING MACHINES SECONDARY PREVENTION n SCREENING = EARLY DETECTION OF DELETERIOUS EFFECTS n PERIODIC MEDICAL EXAMINATIONS n TESTs OF CHEMICAL EXPOSURE: -measurement of chemical/metabolite -measurement of conjugates -measurement of body reactions RESPONSIBILITY IN PREVENTION n EMPLOYERs: - INFORMATION ABOUT RISKS - CONTROL FOR REDUCTION OF EXPOSURE - CONTRACT WITH PHYSICIANS - PROTECTIVE DEVICES RESPONSIBILITY IN PREVENTION n PHYSICIANS: - INFORMATION ABOUT HEALTH RISKS OF OCCUPATIONAL HAZARDS - EXCLUDING THE VULNERABLE PERSONS - PERIODIC MEDICAL EXAMINATIONS + COLLABORATION WITH SPECIALISTS - PROPOSALS FOR WORKERS PROTECTION RESPONSIBILITY IN PREVENTION n WORKERS: - ACCEPT THE INFORMATION AND ADVICES FOR SAFETY WORK - USE THE PROTECTIVE DEVICES - ABSOLVE PREVENTIVE MEDICAL EXAMINATIONS RULES IN CZECH REPUBLIC n HAZARDOUS WORKPLACES ARE STATUTED BY REGIONAL HYGIENIST n LIMITS/NORMS ARE STATUTED BY GENERAL HYGIENIST n OCCUPATIONAL DISEASES ARE DIAGNOSED BY SPECIALISTS IN REGIONAL OFFICES