預(yù)防醫(yī)學(xué)教學(xué)課件：ch2 Occupational environment

1、Preventive MedicineWhole populationOccupational HealthPreventive HealthEnvironmental HealthNutritional and food HealthOccupational environment and health Chapter 2我國職業(yè)危害現(xiàn)況 危害廣：接觸職業(yè)危害人數(shù)、職業(yè)病患者累計(jì)數(shù)量、 死亡數(shù)量及新發(fā)病人數(shù)量均居世界首位 塵肺為主：塵肺71%、中毒20% 形式嚴(yán)峻：近十年發(fā)病呈反彈傾向 經(jīng)濟(jì)損失嚴(yán)重：每年直接經(jīng)濟(jì)損失1000億元、間接2000億元 監(jiān)督與技術(shù)無保證：人均職業(yè)衛(wèi)生投入不足、 與

2、經(jīng)濟(jì)發(fā)展水平極度不平衡 服務(wù)人員少素質(zhì)低：隊(duì)伍數(shù)量少、人員質(zhì)量低、 文化素質(zhì)低、后備力量不足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-骨質(zhì)溶解氯乙烯-骨質(zhì)溶解氯乙烯-杵狀指AchAchEAchAch乙?；?AchE膽堿乙酸AchE乙酰水解酶有機(jī)磷農(nóng)藥productive dusts (silica, asbestos) pneumoconiosis(1) Chemical factorsproductive toxicantsproductive dustsMiners塵肺病患者灌洗術(shù)后的回收液小煤窯里面：不僅有礦難 還有塵肺病。死于塵肺病

5、的患者是礦難人數(shù)的幾倍之多。(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消除切爾諾貝利后遺癥需要800年1986年4月26日，隨著一聲震天動地的巨響，火光四起，火柱高達(dá)30多米。切爾諾貝利核電站4號核反應(yīng)堆發(fā)生爆炸，廠房屋頂被炸飛、墻壁坍塌。8噸多輻射物質(zhì)混合著炙熱的石墨殘片噴涌而出，釋放出的輻射量相當(dāng)于廣島原子彈爆的200多倍。使周圍環(huán)境的放射劑量為允許指針的2萬倍。1700多噸石墨成了熊熊大火的燃料，火災(zāi)現(xiàn)場溫度

8、高達(dá)2000以上。目前，在切爾諾貝利核事故中參加救援的83.4萬人中，5.5萬人喪生，7萬人殘疾。烏克蘭共有250萬人因核事故而患各種疾病，其中包括47.3萬兒童。在核受害者中最常見的是甲狀腺疾病、造血系統(tǒng)障礙、神經(jīng)系統(tǒng)疾病以及惡性腫瘤等。事故發(fā)生初期，6000平方公里土地?zé)o法使用，400多個(gè)居民點(diǎn)成為無人區(qū)，600多所學(xué)校、 300多個(gè)企業(yè)被關(guān)閉。據(jù)預(yù)計(jì)，核事故造成的直接經(jīng)濟(jì)損失在2350億美元以上。 (3) Biological factors bacteria anthracis bacillus-anthracnose brucella-brucellosis virus forest

9、 encephalitis virus (tick) -forest encephalitis fungus dermatitiseczemaasthma人粒細(xì)胞無形體?。℉uman granulocytic anaplasmosis，HGA）嗜吞噬細(xì)胞無形體（Anaplasma phagocytophilum）侵染人末梢血中性粒細(xì)胞攜帶83種病毒、14種細(xì)菌、17種回歸熱螺旋體、32種原蟲，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):職業(yè)病認(rèn)定跟經(jīng)濟(jì)發(fā)達(dá)程度有關(guān). 我們國家有法定職業(yè)病目錄，但從科學(xué)意義上講，只要是職業(yè)因素引起的都應(yīng)該包括在內(nèi)。所以科學(xué)意義上職業(yè)病概念比法律意義上的要廣。中國法律規(guī)定115種職業(yè)病，是由中國衛(wèi)生行政管理部門決定的。而國外一些國家對于職業(yè)病的診斷與分類一般由醫(yī)學(xué)會或醫(yī)生協(xié)會等專業(yè)組織認(rèn)定，是一種專業(yè)行為。矽肺是職業(yè)病，而矽肺致肺癌不算職

20、業(yè)病。雖是兩種病，但其實(shí)是一回事。有時(shí)只好把矽肺造成的肺癌診斷成矽肺，讓患者可以享受職業(yè)病待遇。在美國，腰背痛、肌肉骨骼損傷、心血管疾病等，經(jīng)過職業(yè)史確診后，可以得到相關(guān)的補(bǔ)償，而我國只注重危害特別大的、受害人數(shù)少的職業(yè)病，像塵肺、噪聲、中毒等。比如. 我國職業(yè)病發(fā)展動向.我國職業(yè)病危害正在由城市工業(yè)區(qū)向農(nóng)村轉(zhuǎn)移，由東部地區(qū)向中西部轉(zhuǎn)移，由大中型企業(yè)向中小型企業(yè)轉(zhuǎn)移，職業(yè)病危害分布越來越廣。 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)職業(yè)病分布越來越廣 新“勞動病”侵害都市白領(lǐng)教師、科研人員長期接觸有毒化學(xué)藥品。解剖老師接觸甲醛，甲

22、醛是肯定的致癌物。牙醫(yī)，血液中汞的濃度比一般人高。寫字樓中的白領(lǐng)，長時(shí)間坐在辦公室的微小氣候里，患有腰背痛、頸椎疾病。在醫(yī)院，醫(yī)生存在著呼吸道病毒感染、肝炎、HIV等血緣性感染。電信行業(yè)、電視臺、報(bào)社激光照排車間的電腦作業(yè)人員，有不同程度頸肩腕綜合征。眼部肌肉高度緊張，長期疲勞，出現(xiàn)視力下降。 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