] www.SlideShare.net/AhmedRefat - 1- Dr. Ahmed-Refat AG Refat Occupational Diseases List History of Occupational Diseases (O.D) Listing Definition of O.D and Work-Related Diseases (WRD) Criteria for identification of O.D International List of O.D Prescribed Occupational Diseases
] www.SlideShare.net/AhmedRefat - 2- I- History of O.D ListingIn 1919, the year of its creation, the "ILO" declared that anthrax was an occupational disease.In 1925, the first ILO List of Occupational Diseases was established by the Workmen’s Compensation i.e., Occupational Diseases Convention (No. 18).The Current O.D List is … "ILOs list of O.D- 2010"
] www.SlideShare.net/AhmedRefat - 3- Definition of OD & WRD Occupational Disease = “…a disease contracted as a result of exposure ( over a period of time ) to risk factors arising from work activities ”OR:".. a disease that is caused or made worse by occupation".
] www.SlideShare.net/AhmedRefat - 4-In the third edition of the ILO’s Encyclopaedia ofOccupational Health and Safety, a distinction wasmade among the pathological conditions that couldaffect workers in which diseases due to occupation(occupational diseases) and diseases aggravatedby work or having a higher incidence owing toconditions of work (work-related diseases) wereseparated from conditions having no connectionwith work. However, in some countries work-relateddiseases are treated the same as work-causeddiseases, which are in fact occupational diseases. The concepts of work-related diseases and occupational diseases have always been a matter of discussion.
] www.SlideShare.net/AhmedRefat - 5-Occupational Diseases, having a specific or astrong relation to occupation, generally with onlyone causal agent.Work-Related Diseases, with multiple causal agents,where factors in the work environment may play arole, together with other risk factors, in thedevelopment of such diseases, which have acomplex etiology..
] www.SlideShare.net/AhmedRefat - 6- "Legal" Definition of Occupational Disease “Occupational diseases are those that are included in international or nationalO.Ds lists, and are usually compensable by national workers’ compensation schemes and are recordable under reporting systems.
] www.SlideShare.net/AhmedRefat - 7- For occupational diseases,work is considered the main cause of the disease. Work-related diseases are those where work is one of several components contributing to the disease. Such diseases arecompensated only in very few cases and in very few countries.” (ILO, 2005).
] www.SlideShare.net/AhmedRefat - 8-General criteria foridentification and recognition of occupational diseases
] www.SlideShare.net/AhmedRefat - 9-The causal relationship is established on the basis of : Clinical and pathological data, Occupational history and job analysis, Identification of occupational risk factors The role of other risk factors.
] www.SlideShare.net/AhmedRefat - 10 -Epidemiological and toxicological dataare useful for determining the causal relationship between a specific occupational disease and itscorresponding exposure in a specificworking environment or work activity.
] www.SlideShare.net/AhmedRefat - 11 -As a general rule, the symptoms are not sufficientlycharacteristic to enable an occupational disease tobe diagnosed as such without the knowledge of the pathological changes caused by the physical,chemical, biological or other factors encountered in the exercise of an occupation.
] www.SlideShare.net/AhmedRefat - 12 - It is therefore normal that, as a result of improvements in knowledge regarding themechanisms of action of the factors in question, the steady increase in the number of substancesemployed, and the quality and variety of suspectedagents, it becomes more and more feasible to makean accurate diagnosis, while the range of diseasesrecognized as occupational in origin is broadening.
] www.SlideShare.net/AhmedRefat - 13 -The recognition of a disease as being occupational is a specific example of clinical decision-making / applied clinical epidemiology. Deciding on the cause of a disease is not an “exact science” but rather a question of judgmentbased on a critical review of all the available evidence, which should include a consideration ofEpidemiologic Criteria for Causality !! as follows:
] www.SlideShare.net/AhmedRefat - 14 - Epidemiologic Criteria for Causality1- Strength of association. The greater the impact ofan exposure on the occurrence or development of adisease, the stronger the likelihood of a causalrelationship.2-Consistency. Different research reports havegenerally similar results and conclusions.
] www.SlideShare.net/AhmedRefat - 15 - Epidemiologic Criteria for Causality –cont..3-Specificity. Exposure to a specific risk factor resultsin a clearly defined pattern of disease or diseases.4-Temporality or time sequence. The exposure ofinterest preceded the disease by a period of timeconsistent with any proposed biological mechanism.5-Biological gradient. The greater the level andduration of exposure, the greater the severity ofdiseases or their incidence.
] www.SlideShare.net/AhmedRefat - 16 - Epidemiologic Criteria for Causality-cont..6-Biological plausibility. From what is known oftoxicology, chemistry, physical properties or otherattributes of the studied risk or hazard, it makes biologicalsense to suggest that exposure leads to the disease.7- Coherence. A general synthesis of all the evidence(e.g. human epidemiology and animal studies) leads tothe conclusion that there is a cause–effect relationshipin a broad sense and in terms of general commonsense.
] www.SlideShare.net/AhmedRefat - 17 - Epidemiologic Criteria for Causality-cont..8-Interventional studies. Sometimes, a primarypreventative trial may verify whether removing a specifichazard or reducing a specific risk from the workingenvironment or work activity eliminates the developmentof a specific disease or reduces its incidence.
] www.SlideShare.net/AhmedRefat - 18 -To incorporate a specific disease in the O.D -List, the following criteria must be considered :(i) there is a causal relationship with a specific agent, exposure or work process;(ii) they occur in connection with the work environment and/or in specific occupations;(iii) they occur among the groups of persons concerned with a frequency which exceeds the average incidence within the rest of the population; and(iv) there is scientific evidence of a clearly defined pattern of disease following exposure and plausibility of cause .
] www.SlideShare.net/AhmedRefat - 20 - Endless / comprehensive List or.. Evidence-Based List !!!???According to the WHO, at the workplace,workers are exposed to:- Chemical risk factors: 100,000 (Carcinogens: 400)- Biological agents: 200- Physical factors: 50- Adverse ergonomic conditions: 20- Allergens: 3000
] www.SlideShare.net/AhmedRefat - 21 -Occupational Disease ListsA number of types of lists of occupational diseases exist.A list of diseases that is agreed at national level forcompensation purposes is called: Prescribe Diseases ListIn Europe, there are the two extremes :Sweden, which has an open list,and France, which specifies the symptoms, the type ofwork and the time limit;Other countries fall between these two extremes.In most countries, to be recognised as occupational, adisease must be on the list.
] www.SlideShare.net/AhmedRefat - 22 - Prescribed OD List & OD List Lists of diseases devised for compensation/benefitpurposes are generally shorter than lists compiled for prevention purposes; the latter will necessarilyinclude diseases that may or may not yet be formallyrecognised officially as diseases, and may include new and emerging diseases.
] www.SlideShare.net/AhmedRefat - 23 -The classification of ‘occupational’ relates to the cause and not the nature of the disease, and mostcountries have drawn up a list of ‘prescribed diseases’, for which compensation or benefits are payable.In most countries, there is an agreed list of diseases, for which compensation or benefit is payable through the social insurance system, and these are referred to as ‘prescribed diseases’. The diseases on this list are agreed at national level and are normally restricted (within the list) to an association with an occupation or work activity.
] www.SlideShare.net/AhmedRefat - 24 - A disease is considered ‘prescribed’ if the risk to workers in a certain occupation issubstantially greater than the risk to the general population, and the link between the disease and the occupation can beestablished in each individual case or presumed with reasonable certainty.
] www.SlideShare.net/AhmedRefat - 25 -Classifications of occupational diseases have been developed mainly for two purposes:(1) notification for labour safetyinspection and health surveillance and(2) social security (compensation)purposes.
] www.SlideShare.net/AhmedRefat - 26 - An occupational disease is not characterised merely by the disease itself, but by a combination of adisease and an exposure, as well as an association between these two.
] www.SlideShare.net/AhmedRefat - 27 -The hierarchy of classification systems1. Diseases caused by agents 1.1 Diseases caused by chemical agents 1.2 Diseases caused by physical agents 1.3 Diseases caused by biological agents2. Diseases by target organ 2.1 Occupational respiratory diseases 2.2 Occupational skin diseases 2.3 Occupational musculoskeletal diseases3. Occupational cancer4. OthersNB:The classifications contain both categories defined by the causative agent and categoriesdefined by the medical diagnosis. Cases of a given disease may therefore fall into severalcategories
] www.SlideShare.net/AhmedRefat - 28 -ILO List of Occupational Diseases -2010
] www.SlideShare.net/AhmedRefat - 29 -1. Occupational diseases caused by exposure to agents arisingfrom work activities1.1. Diseases caused by chemical agents1.1.1. Diseases caused by beryllium or its compounds1.1.2. Diseases caused by cadmium or its compounds1.1.3. Diseases caused by phosphorus or its compounds1.1.4. Diseases caused by chromium or its compounds1.1.5. Diseases caused by manganese or its compounds1.1.6. Diseases caused by arsenic or its compounds1.1.7. Diseases caused by mercury or its compounds1.1.8. Diseases caused by lead or its compounds1.1.9. Diseases caused by fluorine or its compounds1.1.10. Diseases caused by carbon disulfide1.1.11. Diseases caused by halogen derivatives of aliphatic or aromatic hydrocarbons1.1.12. Diseases caused by benzene or its homologues1.1.13. Diseases caused by nitro- and amino-derivatives of benzene or its homologues1.1.14. Diseases caused by nitroglycerine or other nitric acid esters1.1.15. Diseases caused by alcohols, glycols or ketones1.1.16. Diseases caused by asphyxiants like carbon monoxide, hydrogen sulfi de, hydrogencyanide or its derivatives
] www.SlideShare.net/AhmedRefat - 30 -1.1.17. Diseases caused by acrylonitrile1.1.18. Diseases caused by oxides of nitrogen1.1.19. Diseases caused by vanadium or its compounds1.1.20. Diseases caused by antimony or its compounds1.1.21. Diseases caused by hexane1.1.22. Diseases caused by mineral acids1.1.23. Diseases caused by pharmaceutical agents1.1.24. Diseases caused by nickel or its compounds1.1.25. Diseases caused by thallium or its compounds1.1.26. Diseases caused by osmium or its compounds1.1.27. Diseases caused by selenium or its compounds1.1.28. Diseases caused by copper or its compounds1.1.29. Diseases caused by platinum or its compounds1.1.30. Diseases caused by tin or its compounds1.1.31. Diseases caused by zinc or its compounds1.1.32. Diseases caused by phosgene1.1.33. Diseases caused by corneal irritants like benzoquinone1.1.34. Diseases caused by ammonia1.1.35. Diseases caused by isocyanates1.1.36. Diseases caused by pesticides1.1.37. Diseases caused by sulphur oxides1.1.38. Diseases caused by organic solvents
] www.SlideShare.net/AhmedRefat - 31 -1.1.39. Diseases caused by latex or latex-containing products1.1.40. Diseases caused by chlorine1.1.41. Diseases caused by other chemical agents at work not mentioned in the preceding itemswhere a direct link is established scientifi cally, or determined by methods appropriate to nationalconditions and practice, between the exposure to these chemical agents arising from workactivities and the disease(s) contracted by the worker1.2. Diseases caused by physical agents1.2.1. Hearing impairment caused by noise1.2.2. Diseases caused by vibration (disorders of muscles, tendons, bones, joints, peripheralblood vessels or peripheral nerves)1.2.3. Diseases caused by compressed or decompressed air1.2.4. Diseases caused by ionizing radiations1.2.5. Diseases caused by optical (ultraviolet, visible light, infrared) radiations including laser1.2.6. Diseases caused by exposure to extreme temperatures1.2.7. Diseases caused by other physical agents at work not mentioned in the preceding itemswhere a direct link is established scientifi cally, or determined by methods appropriate tonational conditions and practice, between the exposure to these physical agents arising fromwork activities and the disease(s) contracted by the worker
] www.SlideShare.net/AhmedRefat - 32 -1.3. Biological agents and infectious or parasitic diseases1.3.1. Brucellosis1.3.2. Hepatitis viruses1.3.3. Human immunodefi ciency virus (HIV)1.3.4. Tetanus1.3.5. Tuberculosis1.3.6. Toxic or infl ammatory syndromes associated with bacterial or fungal contaminants1.3.7. Anthrax1.3.8. Leptospirosis1.3.9. Diseases caused by other biological agents at work not mentioned in the preceding itemswhere a direct link is established scientifi cally, or determined by methods appropriate tonational conditions and practice, between the exposure to these biological agents arising fromwork activities and the disease(s) contracted by the worker
] www.SlideShare.net/AhmedRefat - 33 -2. Occupational diseases by target organ systems2.1. Respiratory diseases2.1.1. Pneumoconioses caused by fi brogenic mineral dust (silicosis, anthraco-silicosis,asbestosis)2.1.2. Silicotuberculosis2.1.3. Pneumoconioses caused by non-fi brogenic mineral dust2.1.4. Siderosis2.1.5. Bronchopulmonary diseases caused by hard-metal dust2.1.6. Bronchopulmonary diseases caused by dust of cotton (byssinosis), fl ax, hemp, sisal orsugar cane (bagassosis)2.1.7. Asthma caused by recognized sensitizing agents or irritants inherent to the work process2.1.8. Extrinsic allergic alveolitis caused by the inhalation of organic dusts or microbiallycontaminated aerosols, arising from work activities2.1.9. Chronic obstructive pulmonary diseases caused by inhalation of coal dust, dust from stonequarries, wood dust, dust from cereals and agricultural work, dust in animal stables, dust fromtextiles, and paper dust, arising from work activities2.1.10. Diseases of the lung caused by aluminium
] www.SlideShare.net/AhmedRefat - 34 -2.1.11. Upper airways disorders caused by recognized sensitizing agents or irritants inherent tothe work process2.1.12. Other respiratory diseases not mentioned in the preceding items where a direct link isestablished scientifi cally, or determined by methods appropriate to nati onal conditions andpractice, between the exposure to risk factors arising from work activities and the disease(s)contracted by the worker2.2. Skin diseases2.2.1. Allergic contact dermatoses and contact urticaria caused by other recognized allergyprovoking agents arising from work activities not included in other items2.2.2. Irritant contact dermatoses caused by other recognized irritant agents arising from workactivities not included in other items2.2.3. Vitiligo caused by other recognized agents arising from work activities not included in otheritems2.2.4. Other skin diseases caused by physical, chemical or biological agents at work not includedunder other items where a direct link is established scientifi cally, or determined by methodsappropriate to national conditions and practice, between the exposure to risk factors arisingfrom work activities and the skin disease(s) contracted by the worker .
] www.SlideShare.net/AhmedRefat - 35 -2.3. Musculoskeletal disorders2.3.1. Radial styloid tenosynovitis due to repetitive movements, forceful exertions and extremepostures of the wrist2.3.8. Other musculoskeletal disorders not mentioned in the preceding items where a direct linkis established scientifi cally, or determined by methods appropriate to national conditions andpractice, between the exposure to risk factors arising from work activities and the musculoskeletaldisorder(s) contracted by the worker2.4. Mental and behavioural disorders2.4.1. Post-traumatic stress disorder2.4.2. Other mental or behavioural disorders not mentioned in the preceding item where a directlink is established scientifi cally, or determined by methods appropriate to national conditionsand practice, between the exposure to risk factors arising from work activities and the mentaland behavioural disorder(s) contracted by the worker .
] www.SlideShare.net/AhmedRefat - 36 -3. Occupational cancer3.1. Cancer caused by the following agents3.1.1. Asbestos3.1.2. Benzidine and its salts3.1.3. Bis-chloromethyl ether (BCME)3.1.4. Chromium VI compounds3.1.5. Coal tars, coal tar pitches or soots3.1.6. Beta-naphthylamine3.1.7. Vinyl chloride3.1.8. Benzene (1. Synonyms: Benzol, benzole, coal naphtha, cyclohexatriene, phene, phenyl hydride,pyrobenzol. (Benzin, petroleum benzin and Benzine do not contain benzene).2. Formula: C(6)H(6) (CAS Registry Number: 71-43-2)3.1.9. Toxic nitro- and amino-derivatives of benzene or its homologues3.1.10. Ionizing radiations3.1.11. Tar, pitch, bitumen, mineral oil, anthracene, or the compounds, products or residues ofthese substances3.1.12. Coke oven emissions
] www.SlideShare.net/AhmedRefat - 37 -3.1.13. Nickel compounds3.1.14. Wood dust3.1.15. Arsenic and its compounds3.1.16. Beryllium and its compounds3.1.17. Cadmium and its compounds3.1.18. Erionite3.1.19. Ethylene oxide3.1.20. Hepatitis B virus (HBV) and hepatitis C virus (HCV)3.1.21. Cancers caused by other agents at work not mentioned in the preceding items where adirect link is established scientifically, or determined by methods appropriate to nationalconditions and practice, between the exposure to these agents arising from work activitiesand the cancer(s) contracted by the worker4. Other diseases :4.1. Miners’ nystagmus4.2. Other specific diseases caused by occupations or processes not mentioned in this list where adirect link is established scientifically, or determined by methods appropriate to national conditions and practice,between the exposure arising from work activities and the disease(s) contracted by the worker .
] www.SlideShare.net/AhmedRefat - 39 -Notification of occupational diseasesIn addition to the diagnosis of occupationaldisease, additional information should beincluded in the notification.ILO has defined the minimum information to beincluded :(a) enterprise, establishment and employer(b) person affected by the occupational disease(c) occupational disease
] www.SlideShare.net/AhmedRefat - 40 - A- Enterprise, establishment and employer(i) name and address of the employer(ii) name and address of the enterprise(iii) name and address of the establishment(iv) economic activity of the establishment(v) number of workers (size of the establishment)
] www.SlideShare.net/AhmedRefat - 41 - B- Person affected by the occupational disease(i) name, address, sex and date of birth(ii) employment status(iii) occupation at the time when the diseasewas diagnosed(iv) length of service with the present employer
] www.SlideShare.net/AhmedRefat - 42 - C- Occupational disease(i) name and nature of the occupational disease(ii) harmful agents, processes or exposure towhich the O.D is attributable(iii) description of work which gave rise to thecondition(iv) length of exposure to harmful agents andprocesses(v) date of diagnosis of the occupational disease