预防医学教学课件：ch2 Occupational environment

1、Preventive MedicineWhole populationOccupational HealthPreventive HealthEnvironmental HealthNutritional and food HealthOccupational environment and health Chapter 2我国职业危害现况 危害广：接触职业危害人数、职业病患者累计数量、 死亡数量及新发病人数量均居世界首位 尘肺为主：尘肺71%、中毒20% 形式严峻：近十年发病呈反弹倾向 经济损失严重：每年直接经济损失1000亿元、间接2000亿元 监督与技术无保证：人均职业卫生投入不足、 与

2、经济发展水平极度不平衡 服务人员少素质低：队伍数量少、人员质量低、 文化素质低、后备力量不足Section I Occupational Hazards and Occupational InjuriesThe factors which exist in theand may be harmful to the workers health, safetyand work capacity.1. Technical procedures2. Working processes 3. Productive environmentsPart 1. Occupational HazardsCate

3、gories: 1. Technical procedures(1) Chemical factors(2) Physical factors(3) Biological factors(1) Chemical factors metals: lead, mercury organic solvents: benzene irritant gases, asphyxiating gases: Cl2 CO HCN H2S aromatic amino and nitro compounds: TNT (trinitrotoluene) pesticides: organophosphate m

4、acromolecular compoundsproductive toxicants poisoning productive toxicantsproductive dusts氯乙烯-骨质溶解氯乙烯-骨质溶解氯乙烯-杵状指AchAchEAchAch乙酰化 AchE胆碱乙酸AchE乙酰水解酶有机磷农药productive dusts (silica, asbestos) pneumoconiosis(1) Chemical factorsproductive toxicantsproductive dustsMiners尘肺病患者灌洗术后的回收液小煤窑里面：不仅有矿难 还有尘肺病。死于尘肺病

5、的患者是矿难人数的几倍之多。(2) Physical factors abnormal meteoric condition abnormal atmospheric pressure noise and vibration ionizing radiation non-ionizing radiation abnormal meteoric conditiontemperature, humidity, air flow, heat radiation abnormal atmospheric pressureHigh pressuredecompression sicknesscaisso

6、n diseaseLow pressure - mountain sicknessCell membraneintracellularextracellularSodium potassium pump noise and vibrationcataract electric ophthalmiaradiation sickness leukemianoise-hearing loss and deafnessvibration-Vibration disease non-ionizing radiation (infrared, ultraviolet, laser, microwave)

7、ionizing radiation (-ray, -ray, -ray)Fukushima nuclear power plantMarch, 2011 Nuclear power plant explosion Soviet Union, 1986消除切尔诺贝利后遗症需要800年1986年4月26日，随着一声震天动地的巨响，火光四起，火柱高达30多米。切尔诺贝利核电站4号核反应堆发生爆炸，厂房屋顶被炸飞、墙壁坍塌。8吨多辐射物质混合着炙热的石墨残片喷涌而出，释放出的辐射量相当于广岛原子弹爆的200多倍。使周围环境的放射剂量为允许指针的2万倍。1700多吨石墨成了熊熊大火的燃料，火灾现场温度

8、高达2000以上。目前，在切尔诺贝利核事故中参加救援的83.4万人中，5.5万人丧生，7万人残疾。乌克兰共有250万人因核事故而患各种疾病，其中包括47.3万儿童。在核受害者中最常见的是甲状腺疾病、造血系统障碍、神经系统疾病以及恶性肿瘤等。事故发生初期，6000平方公里土地无法使用，400多个居民点成为无人区，600多所学校、 300多个企业被关闭。据预计，核事故造成的直接经济损失在2350亿美元以上。 (3) Biological factors bacteria anthracis bacillus-anthracnose brucella-brucellosis virus forest

9、 encephalitis virus (tick) -forest encephalitis fungus dermatitiseczemaasthma人粒细胞无形体病（Human granulocytic anaplasmosis，HGA）嗜吞噬细胞无形体（Anaplasma phagocytophilum）侵染人末梢血中性粒细胞携带83种病毒、14种细菌、17种回归热螺旋体、32种原虫，The factors which exist in the1. Technical procedures2. Working processes 3. Productive environmentsPa

10、rt 1. Occupational Hazardsand may be harmful to the workers health, safetyand work capacity.2. Working processes Bad organization, bad work and rest system Labor intensity psychic and mental stress Uncomfortable position or unhandy tools Stress of single organ or system Stress of single organ or sys

11、temPorterLow back painWatch makerEye diseaseSewerNeck-shoulder-wrist syndromeThe factors which exist in the1. Technical procedures2. Working processes 3. Productive environmentsPart 1. Occupational Hazardsand may be harmful to the workers health, safetyand work capacity.3. Productive environment nat

12、ural environment improper layout of factory improper productive processEtiologic model IndividualOccupationalhazardConditionsoccupational diseasework-related diseaseoccupational trauma Exposure opportunity routedurationconcentrationPart 2. Occupational injuryHeredity:G-6P-D: hemolytic anemia Gender:

13、organic solvent (benzene)Causes of different manifestation between workers in the same workplace Occupational health service Individual susceptibility Behavior and life stylehost risk factorIndividual protection: TNTsmoking Pathway from exposure to disease, showing modifying factors and opportunitie

14、s for interventionModifying FactorsDoseAdverse Health EffectSubclinical DiseaseHealthyWorkerAdditive or Synergistic Co-exposureGenetic SusceptibilityRepairExposure ConcentrationExposure DurationExposure FrequencyOccupational health standardsPersonal protective equipmentEngineering and administrative

15、 controlsProgressionAge, Gender, Nutrition, BehaviorScreening Wellness programsBiomonitoringSurveillance primary prevention secondary prevention tertiary preventionPart 3. Prevention & Control of Occupational injury1. Primary principle(1) Legislation:(2) Management: (3) Technology: (4) Health care:

16、Part 3. Prevention & Control of Occupational injury2. Preventive measuresPreventive health surveillancePeriodic health surveillanceAccident health surveillanceOccupational health surveillanceIndividual protectionOccupational health surveillance Pre-employment examination: occupational contraindicati

17、on Periodic examination high risk group, early changesPart 3. Prevention & Control of Occupational injury Health records Occupational history and medical record Category and concentration of occupational hazard Family medical record Basic health data Occupational monitoring data Others: behavior, li

18、fe styleSection II Occupational diseaseIndividualOccupationalhazardConditionsoccupational diseasework-related diseaseoccupational trauma Exposure opportunity routedurationconcentration Occupational diseases are disease caused by exposure to harmful occupational hazards at the workplace, leading to a

19、bnormal function or structure damage with clinical manifestation, and resulting in labor ability decline. Part 1. Conception (WHO):职业病认定跟经济发达程度有关. 我们国家有法定职业病目录，但从科学意义上讲，只要是职业因素引起的都应该包括在内。所以科学意义上职业病概念比法律意义上的要广。中国法律规定115种职业病，是由中国卫生行政管理部门决定的。而国外一些国家对于职业病的诊断与分类一般由医学会或医生协会等专业组织认定，是一种专业行为。矽肺是职业病，而矽肺致肺癌不算职

20、业病。虽是两种病，但其实是一回事。有时只好把矽肺造成的肺癌诊断成矽肺，让患者可以享受职业病待遇。在美国，腰背痛、肌肉骨骼损伤、心血管疾病等，经过职业史确诊后，可以得到相关的补偿，而我国只注重危害特别大的、受害人数少的职业病，像尘肺、噪声、中毒等。比如. 我国职业病发展动向.我国职业病危害正在由城市工业区向农村转移，由东部地区向中西部转移，由大中型企业向中小型企业转移，职业病危害分布越来越广。 Pneumoconiosis Ionizing radiation induced occupational illness Occupational poisoning Physical agents

21、induced occupational diseases Biological agents induced occupational diseases Occupational dermatoses Occupational eye diseases Occupational ear, nose and throat diseases Occupational cancers Other occupational diseasesPart 2. Category (2002) 10(115)职业病分布越来越广 新“劳动病”侵害都市白领教师、科研人员长期接触有毒化学药品。解剖老师接触甲醛，甲

22、醛是肯定的致癌物。牙医，血液中汞的浓度比一般人高。写字楼中的白领，长时间坐在办公室的微小气候里，患有腰背痛、颈椎疾病。在医院，医生存在着呼吸道病毒感染、肝炎、HIV等血缘性感染。电信行业、电视台、报社激光照排车间的电脑作业人员，有不同程度颈肩腕综合征。眼部肌肉高度紧张，长期疲劳，出现视力下降。 Definite causes occupational hazards. Definite exposure dose and effect (response) relationships between causes and diseases. People exposed to the same

23、 occupational hazard often suffer from the same illness. Early detection and treatment lead to good prognosis. No effective treatments in most cases for the moment, prevention is important.Part 3. CharacteristicsdoseeffectdoseresponsePart 4. Health effects (system injuries)nerve system: neurosis-lik

24、e syndrome; mental disorder; peripheral neuropathy; poisonous encephalopathy; conscious disturbance respiratory system: chemical pneumonia; chemical pneumonedema; acute respiratory distress syndrome; bronchitis; chronic obstructive lung diseases; fibrosis; asthma; allergic alveolitisdigestive system

25、: liver swelling; hepatitis; gastroenteritis; abdomen painshaematopoietic system: aplastic anemia; hemolytic anemia; methemoglobin; hemorrhage; decrease of leucocyte and platelet; leukemia urinary system: acute and chronic nephritis; cancerscardiovascular system: heart diseases; coronary heart disea

26、ses; abnormal heart rate; abnormal blood pressure; atrioventricular block; myocarditis reproductive system: miscarriage or stillbirth; infertility of sterility; impotenceskin: dermatitis; occupational acne; melanosis; dermal ulcer; cancersPart 5. Diagnosis Occupational history Productive environment

27、 investigation Medical recordsCase historyClinical manifestationLaboratory examinationIndividualOccupationalhazardConditionsoccupational diseasework-related diseaseoccupational trauma Exposure opportunity routedurationconcentrationEtiologic model IndividualOccupationalhazardConditionsoccupational diseasework-related diseaseoccupational trauma Exposure opportunity routedurationconcentration Occupational hazard is one of the c