WORK AND HEALTH LECTURE FOR MEDICAL STUDENTS ^WORK ENNOBLES > WORKING HELPS TO FIND THE CREDIT WITHIN THE SOCIETY > UNEMPLOYMENT IS ASSOCIATED WITH: - POVERTY, - DEPRIVATION, PASSIVITY - BARRENNESS X SOCIAL CONSEQUENCES . DISSATISFACTION . PROTESTS, sometimes with VIOLENCE . REVOLUTION ■ WAR - civil, national ^ HEALTH CONSEQUENCES . WORSE LIFESTYLE (MALNUTRITION, SMOKING, ALCOHOL and DRUGS ABUSE, PASIVITY, POOR HYGIENE) . INFECTIOUS DISEASES . PSYCHOSOMATIC DISEASES . PSYCHIATRIC MORBIDITY (depression, suicide) HISTORICAL CHANGES OF ^ WORK_ . EVERYBODY MADE EVERYTHINK = the main contribution to human anatomy and physiology during phylogenesis . HAND-MADE SPECIALIZATIONS . FIRST MACHINES . MECHANIZATION . AUTOMATIZATION . ROBOTIZATION CHANGES IN WORKERS' ^ CONDITIONS . DYNAMIC/ENERGETIC LOAD DECREASED . STATIC LOAD INCREASED . SEDENTARY POSITIONS . MONOTONY WITH NARROW MUSCULOSCELETAL PARTS OVERLOAD Changes - continue - GROWING DEMAND FOR: . SENSES ABILITIES (espec. Vision) . MENTAL ACTIVITY (qualification, attention, responsibility) RISK OF THE LOST OF ^ CONTROL_ . ERGONOMIC APPROACH: . DETAIL KNOWLEDGE ABOUT HUMAN ANATOMY, PHYSIOLOGY, PSYCHOLOGY . ADAPTATION OF WORKING ENVIRONMENT TO HUMAN CAPABILITY ^ EXAMPLES:_ . ERGONOMIC CHAIRS . HANDLE HAFTS . CONTROL EQUIPMENTS . INFORMATIVE EQUIPMENTS . WORKING ENVIRONMENT (microclimate, lighting) . ARRAGEMENT OF WORKPLACE ^ EN VI FORM_ . ERGONOMIC SIMULATIONG SYSTEM = METHOD FOR THE ASSESSMENT OF POOR ERGONOMY: - VIRTUAL WORKING PLACES - ANALYSIS OF WORK PROCESSES - ANALYSIS OF AVAILABILITY, VISIBILITY, BODY LOAD, ENERGY LOST WORK AS A HEALTH RISK OCCUPATIONAL D.: MAINLY AMONG WORKERS CAUSE SPECIFIC OCCUPATIONAL EXPOSURE IS ESSENTIAL WORK-RELATED D. LARGELY IN THE POPULATION MULTIFACTORIAL OCCUPATIONAL EXPOSURE MAY BE A FACTOR ^ THE SOCIAL APPROACH ■ OCCUPATIONAL D.: ■ WORK-RELATED D.: - NOTIFABLE - MAY BE NOTIFABLE - COMPENSABLE - MAYBE COMPENSABLE X OCCUPATIONAL HAZARDS ■ FACTORS: ■ OUTCOMES: - MECHANICAL - ACCIDENTS, INJURIES - HEAVY PHYSICAL - MUSCULOSCELETAL LOAD DISORDERS, INJURIES, LOW BACK PAIN OCCUPATIONAL HAZARDS ERGONOMIC MONOTONY MUSCULOSCELETAL DISORDERS (D. FROM REPEATED OVERLOAD) MENTAL STRESS, LOWERED QUALITY AND PRODUCTIVITY D.FROM REPEATED OVERLOAD X OCCUPATIONAL STRESS . WORK INITIATES STRESSFULL RESPONSE (sympaticus, adrenalin, other hormones) => . ENERGY for STRIFE or RUNNING . IN MODERN SOCIETY THE ENERGY IS CUMULATED WITH KNOWN HEALTH CONSEQUENCES ^ OCCUPATIONAL STRESS . TWO-DIMENSIONAL APPROACH: . 1) TENSE/ LOAD - 2) POSSIBILITY TO COPING = > FOUR CATEGORIES: ^ OCCUPATIONAL STRESS: . 1) HIGH LOAD + HIGH SELF-COPING (physicians, teachers, managers) . 2) HIGH LOAD + LOW SELF-COPING (monotony jobs, time stress . 3) LOW LOAD + HIGH SELF-COPING (artists, scientists) . 4) LOW LOAD + LOW SELF-COPING (unemployed, portress) PREVALENCE OF STRESS-^ RELATED DISEASES . LOWEST IN THE 3rd GROUP . LOW IN THE 1st GROUP . HIGH IN THE 4th GROUP . HIGHEST IN THE 2nd GROUP PHYSICAL HAZARDS ■ NOISE ■ VIBRATION ■ RADIATION ■ EXTREME MICROCLIMATE ■ HEARING LOSS ■ PSYCHOSOMATIC D. ■ TR. VASONEUROSIS ■ CANCER, RADIAT.D. ■ CATARACT ■ CVD, H YPERTH ERM. ■ CHILBLAINS CHEMICAL HAZARDS DUSTS ■ PNEUMOCONIOSIS ■ SILICOSIS ■ ASBESTOSIS ■ BERRYLIOSIS ■ SIDEROSIS X RESPIRABLE DUST . DIAMETER 1 - 5 um; 2.5 um . DUST 10+ um : MUCOCILLIAL ESCALATOR . DUST less than 1 um - IN EXPIRATED AIR CHEMICAL HAZARDS WIDE SPECTRUM ■ INJURIES, OF HUNDREDS IRRITATION COMPOUNDS . TOXICANTS . CARCINOGENS . ALERGENS ■ TERRATOGENS BIOLOGIC HAZARDS ■ ANIMALS ■ INJURIES, ■ ANTROPOZOONOS, ■ MICROBIAL AND ■ INFECTIONS VIRAL FACTORS . ALLERGIES - PLANT ALLERGENS . ALLERGIES PSYCHOLOGICAL STRAIN ■ DIFFERENT STRESS ■ NEUROSIS FACTORS . DEPRESSION DISSATISFACTION CONFLICTS PSYCHOSOMATIC D X CATEGORIES OF WORK ■ 1) WITHOUT THE . 3) HIGH RISK(s) RISK ■ 4) VERY HIGH ■ 2) WITH RISK(s) ACCEPTABLE RISK(s) WORK FACTORS AND WORK-^ RELATED D. ■ BEHAVIORAL AND ■ WORK OVERLOAD PSYCHOSOMATIC D. . W0RK UNDERLOAD - HYPERTENSION . SHIFT WORK ■ CAREER DEVELOP. ■ MIGRATION ■ INTERPERSONAL CONFLICTS ■ RESPONSIBILITY OCCUPATIONAL HAZARDS ^ FOR HEALTH PROFESSIONALS . INFECTIOUS AGENS . X-RAY . INJURY . POSTURAL STRESS . NOISE, VIBRATION 1 OCCUPATIONAL HAZARDS . CHEMICALS: . ORGANIC SOLVENTS . CHEMICAL CARCINOGENS AND TERRATOGENS (CHEMOTHERAPY, ANESTESIOLOGY) . ANORGANIC MERCURY X OCCUPATIONAL HAZARDS . ALLERGENS: . PROCAIN, MESOCAIN . IODINE, FAMOSEPT, FORMALDEHYDE . SULFONAMIDES . ANTIBIOTICS . ACRYLATES, LATEX/RUBBER OCCUPATIONAL STRESS sy. WAITING-ROOM'S OVERFILL LACK OF DRUGS, DIAGNOSTIC METHODS ECONOMY ADMINISTRATIVE OVERLOAD PATIENT'S MOOD PATIENT'S RELATIVES INTERPERSONAL RELATIONSHIPS SHIFT-WORK ^ OUTCOMES OF STRESS - „BURN our sy. . PSYCHOSOMATIC DISEASES . ALCOHOLISM, SMOKING, DRUGS . PSYCHIATRIC DISORDERS - SUICIDES RR 2,0 (Finland, UK) - 4,0 (USA) NANO-PARTICLES - NEW ^ HAZARDS?_ . COMPOUNDS OF DIFFERENT CHEMICALS . AT LEAST ONE DIAMETER IS UP TO 100 nm . DIFFERENT PHYSICAL and CHEMICAL PROPERTIES ^ WHAT WE KNOW? . HIGH ABILITY TO MAKE CLUSTERS WITH DIAMETERS OF RESPIRABLE DUST (1-5 um) . INCREASED TRENDS TO WIDE USING, INCLUDING MEDICINE ^ NANOMEDICINE > OPTIC NANO-SENSORIC SYSTEMS (intracellular observation - apoptosis) > NANOHEMOSTATIC APPROACH -hemostatis within 15 sec.) ■ NANOROBOTS: target transport of drugs, angioplastic, immunology, surgery, monitoring of diabetic patients) ^ IN DENTIST PRACTICE > NANO-CLEARING of TEETH: dentifrice, oral water => growth of hydroxyapatite in tooth enamel lesions, metabolisms of organic chemicals, destroy of plaques and dental calculus X WHAT WE DO NOT KNOW? . TO MEASURE THE LEVEL OF EXPOSURE . THE INFLUENCE OF NANOPARTICLES ON HUMAN HEALTH . EVEN THE EXPERIMENTAL STUDIES GIVE INADEQUATE INFORMATIONS: mesothelioma, pneumonitis, oxidative stress, cross the hematoencephalic and placental barriers WORLD CENTERS OF ^ RESEARCH_ . USA ■ South Korea . EU > SYSTEM OF PRELIMINARY CAUTION ^ PROFESSIOGRAM 1 . TRY TO DEVELOPE THE WORKPLACE CHECKLIST FOR THE PATIENT WITH Isch.Heart Dis - MAN, 50 YEARS OLD > WHICH RISK FACTORS WILL BE IMPORTANT FOR HIM? X PROFESSIOGRAM 1 . 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 . DECREASED SOURCE OF OXYGEN: - ENVIRONMENTAL TOBACCO SMOKE (nicotine, carbon monoxide, hydrocyanide) - CARBON MONOXIDE - CARBON DISULPHIDE - NITRATES ( Monday morning death) ^ PROFESSIOGRAM 1 ■ COBALT (Quebec Beer-drinker's Cardiomyopathy)- Co + alcohol (?) . HALOGENATED HYDROCARBONS (trichlorethylene, fluorocarbons) -ventricular fibrillation - SILICOSIS, INFECTIONS, INJURY - pericarditis ^ PROFESSIOGRAM 1 . LEAD . CADMIUM . NOISE = > HYPERTENSION ^ PROFESIOGRAM 2 . TRY TO DEVELOPE THE WORKPLACE CHECKLIST FOR PREGNANT WOMAN > WHICH RISK FACTORS WILL BE IMPORTANT FOR HER AND FOR FETUS? ^ PROFESSIOGRAM 2 . INCREASED NEEDS FOR OXYGEN FROM THE 2nd TRIMESTER - STRESS - ERGONOMY ^ PROFESSIOGRAM 2 . DECREASED SOURCE OF OXYGEN: - POSTURAL STRESS - ENVIRONMENTAL TOBACCO SMOKE - CARBON MONOXIDE - CARBON DISULPHIDE X PROFESSIOGRAM 2 . EXPOSURE TO TERRATOGENS: - SMOKING + ENVIRONMENTAL TOBACCO SMOKE - NICOTINE - ALCOHOL - THALIDOMID - ORGANIC MERCURY X PROFESSIOGRAM 2 . TERRATOGENS: - VIRAL/MICROBIAL INFECTIONS - X-RAYs - CADMIUM, LEAD - ORGANIC SOLVENTS - COCAIN, HEROIN, MARIHUANA WL PROFESSIOGRAM 2 . NOISE, VIBRATION . LIPOSOLUBLE VITAMINES . SOME DRUGS . EL.MAG. WAVES . POLYCYCLIC CHLORINATED HYDROCARBONS (PCBs, PCDDs, PCDFs) ^ PRIMARY PREVENTION . CONTROL OF NEW HAZARDS . CONTROL OF KNOWN HAZARDS . SUBSTITUTION OF RISK FACTORS . TECHNICAL CONTROLS TO MINIMASE EXPOSURE . ADMINISTRATIVE CONTROLS ^ PRIMARY PREVENTION . ENVIRONMENTAL MONITORING . BIOLOGICAL MONITORING OF EXPOSURE . IDENTIFICATION OF VULNERABLE PERSONS (pre-employed examination) . PERSONAL PROTECTIVE DEVICES ^ PRIMARY PREVENTION . SMOKING REDUCTION/CESSATION . ALCOHOL - APPROPRIATE AMOUNT, ONLY IN THE PRIVACY . EXERCISE AND FITNESS . NUTRITION IN WORKPLACE CANTEENS, IN VENDING MACHINES ^ SECONDARY PREVENTION . SCREENING = EARLY DETECTION OF DELETERIOUS EFFECTS . PERIODIC MEDICAL EXAMINATIONS - TESTS OF CHEMICAL EXPOSURE: -measurement of chemical/metabolite -measurement of conjugates -measurement of body reactions RESPONSIBILITY IN ^ PREVENTION . EMPLOYERS: - INFORMATION ABOUT RISKS - CONTROL FOR REDUCTION OF EXPOSURE - CONTRACT WITH PHYSICIANS - PROTECTIVE DEVICES RESPONSIBILITY IN ^ PREVENTION ■ 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 . WORKERS: - ACCEPT THE INFORMATION AND ADVICES FOR SAFETY WORK - USE THE PROTECTIVE DEVICES - ABSOLVE PREVENTIVE MEDICAL EXAMINATIONS ^ RULES IN CZECH REPUBLIC . HAZARDOUS WORKPLACES ARE STATUTED BY REGIONAL HYGIENIST . LIMITS/NORMS ARE STATUTED BY GENERAL HYGIENIST - OCCUPATIONAL DISEASES ARE DIAGNOSED BY SPECIALISTS IN REGIONAL OFFICES ^ HEALTHY WORKPLACE . SUPPORT of FRIENDLY ENVIRONMENT . SUPPORT of HEALTHY LIFE-STYLE (nutrition, smoking cessation, activity during breaks) . SUPPORT of WORKING MOTHERS WITH SMALL CHILDREN . „FLIGH~T WORKING TIME ^ HEALTHY WORKPLACE ■ SUPPORT of INDIVIDUAL WORKERS' INITIATIVE and PARTICIPATION on PRODUCTION, MANAGEMENT . ACTIVITIES FOR LEISURE TIME ^ WORKING_ ■ IS THE ESSENTIAL PART OF HUMAN LIFE . IT CAN BE THE SOURCE OF SELF-SATISFACTION - But ALSO OF HEALTH DAMAGES