10. RESULTS OF SUBSYSTEM 7: HEALTH EFFECTS AND RISKS RELATED TO OCCUPATIONAL ENVIRONMENT |
10.1 Organization of monitoring activities
This Subsystem includes the follow-up of the health impairment in employees as a consequence of the negative influence of factors in working conditions and the occupational environment. In question is a newly introduced Subsystem which includes nationwide monitoring data on the incidence of occupational diseases as well as that of occupational disease outbreak hazards (the health effects monitoring), exposure monitoring (jobs and workplaces categorization), and the monitoring the negative influence of the selected working conditions and the occupational environment factors on employees’ health. Namely, this is a question of unilateral, long-term and excessive physical burden as well as chemical carcinogens, including the establishment of registries of workplaces and jobs where such substances are present.
Breakdown of Subsystem 7:
The breakdown of the Subsystem facilitates its amplification with new tasks according to current needs and potential.
10.2 Monitoring of health data on occupational diseases and job categorization
10.2.1 Monitoring of health effects
The monitoring of health effects is in the eleventh year of operation and is now fully stabilized. The incidence of occupational diseases and occupational disease outbreak hazard is continuously declining. In 2001, a total of 1677 occupational diseases was been reported in the Czech Republic, of which 1627 were cases of occupational diseases and 50 cases of occupational disease outbreak hazard in a total of 1661 employees (incidence rate per 100 000 insured subjects being 37.1) (Table 10.1). A review of occupational diseases in the past 17 years is presented in Fig. 10.1. The highest number of occupational diseases, as in preceding years, was diagnosed in Northern Moravia (24.3 % of cases) and the Central Bohemian Region (13.7 % of cases). The numbers of occupational diseases by regions in the Czech Republic are presented in Table 10.2 and Fig. 10.2. The majority of them occurred in medical care (268 cases) and in coal mining (266 cases). The most frequent were diseases caused by physical factors, followed by skin diseases, infections and diseases caused by parasites, respiratory tract and lung diseases. Health affections caused by chemicals occurred in 42 cases, and diseases caused by other factors and agents in 2 cases. The share of particular occupational diseases in 2001, according to the list of diseases is presented in Fig. 10.3.
The following were the most frequently reported occupational diseases (according to the Annex to Government Decree No. 178/2001):
Most cases of occupational disease outbreak hazard were reported in Northern Moravia (36 %) and the Region of Olomouc (30 % of cases). The most frequently reported cases were auditory disorders caused by noise (44 % cases).
10.2.2 Monitoring of exposure
• Monitoring of exposure based on job categorization data
In the course of 2001 Part I of the Public Health Service Information System – Health risks of working conditions and their consequences – Monitoring of the exposure on the basis of data on categorization of jobs and workplaces (Phase I) – was tested and finalized. It enables the issuance of a decision by the authorities of public health promotion on the classification of jobs and workplaces into categories on the basis of documentation, presented by the employer. A component of the decision is especially the determination of job classification into the second to fourth categories according to factors of working conditions, the determination of the content and terms of preventive physical examinations, the number of exposed males and females, measures to improve working conditions, etc.
The given categories are set in Public Notice No. 89/2001:
Phase II of the program has been tested, i.e. central data processing of selected information so as to enable exposure monitoring and evaluation of individual factors according to working conditions in each district, region, and up to nationwide summaries (Fig. 10.4a). The reason for such a way of monitoring lies in the recording of the number of people exposed to each factor and their classification into the above-mentioned categories according to the seriousness of exposure while working on a certain job. The current number of people in the categories of jobs under risk 2R and 3 + 4 as of May 31, 2002, according to factors is presented in Fig. 10.4b. Documentation from the “Central Registry” shall be applicable for the processing of regional and nationwide statistics reviews, planning of respective health care activities for professional investigations or estimations of potential global impairment of health. The ratio of each category according to factors can also serve as an indicator of the health care level pursued by employers.
10.3 Monitoring of the selected exposure and health effects parameters
10.3.1 Monitoring the health effects of selected occupational environment factors
• Monitoring of excessive unilateral burden in relation to damage of the locomotion system
Local muscle burden represents a health problem that can under certain conditions lead to occupational diseases of the extremities due to excessive unilateral burdening. In question are diseases in which organic structures of the upper extremities and the hand are affected. It is well known that several factors participate in the development of this presently most frequent occupational disease. From the point of view of prevention it is necessary to know the significance and proportion of each factor. Therefore, in the resolution of the problem, Subsystem 7 is namely focused on the monitoring of the influence and significance of each work factor which is connected with the local muscle burden. The objective is to reveal their significance in the cause of each type of occupational disease from excessive unilateral burdening, to confirm the justification of applied limits, and to set criteria for the assessment of each occupational disease, as well as to take into consideration the significance of other influence in the development of disease of the locomotion apparatus, such as the individual characteristics of each employee and other non-occupational factors. Results should also serve the assessment of long-term as well as short-term bearability of the job, the elaboration of criteria for assessing fitness for work under risk of unilateral muscular burdening, and for the assessment of the degree of occupational character in individual occupational diseases due to unilateral burdening. It is also necessary to work on the problem of the potential return of workers after therapy of an occupational disease, to jobs under risk of local muscular burdening. Just as important is the focusing on the task of identifying activities and occupations under risk. The most important output should be the elaboration of prevention principles and the intervention potency concerning affections of the musculo-skeletal apparatus at jobs under unilateral excessive work loads.
Monitoring concerned with the influence of work on the health of employees working under conditions of local muscular burdening was focused on three types of jobs in 2001: coil winders in the electronic industry (12 subjects), fire-clay workers (12 subjects), and electric outfitting assembly line workers in the automobile industry (50 subjects). In all three groups the following was carried out:
1. measuring and evaluation of local muscle burdening by the method of integrated
electromyography;
2. public health assessment at the workplace;
3. filling in of a validated and in the preceding year tested questionnaire
on health, by instructed dialogue.
On the basis of results obtained, all the types of working activities under follow-up were evaluated from the point of view of local muscular burdening as under risk, and were classified, within the framework of job categorization according to Public Notice No. 89/2001, as falling into category 3. The classification is in line with the intensity of work and the technological procedure at the time of physiological measurements. Within the framework of the task, in all the subjects in each group a questionnaire survey of health focused on the locomotion apparatus was performed, higher attention being given to subjective complaints of the upper extremities, namely the hand.
From the evaluation of the questionnaires it follows that 74 % of subjects stated subjective complaints regarding the locomotion apparatus, almost 62 % of whom had already had work incapacitation for such complaints – of these, 18 % even repeatedly. Unequivocally the most frequently mentioned area for subjective complaints was the cervical spine (Fig. 10.5), this undoubtedly being in connection with the working position connected with a marked forward bending of the head. This fact is influenced by the eyesight burden by precision demanding work.
A high percentage of respondents refer complaints concerning the upper extremities, namely the hand. Almost 38 % have difficulties in that area. Their intensity is most often described as medium (in 40 % of cases), 12 % complain of great intensity, and 4 % perceive their difficulties as unbearable.
Within the framework of the locomotion apparatus examinations by the company physician, in 8 % of the subjects objectively alterations in the joints have been found, in 4 % edema of the joints, in 4 % painful joints, and in 2 % crepitation and tenderness in the tendons. In the area of the spinal column, 62 % had physiological findings, 28 % kyphosis, and 10 % scoliosis of the spine.
10.3.2 Registry of occupational exposure to chemical carcinogens REGEX
From the point of view of Act No. 101/2000 on the protection of personal data, the relations of the Central Registry at the NIPH with collaborating organizations, were resolved by an agreement on the processing of personal data for the Registry according to section 6 of that Act.
In 2001, the developing (Karviná, Frýdek-Místek) and updating (Ústí n. Labem, Pardubice, České Budějovice) of the data series took place at five regional facilities on the basis of the Governmental Decree No. 178/2001 which newly adjusts the list of carcinogens and working processes with risk of chemical carcinogenicity. There has been updated the list of carcinogens which was adjusted to practical requirements of keeping a database, and handed over to participating facilities. To date, the created database (Ústí n. Labem, České Budějovice, Pardubice, Karviná, Frýdek-Místek) includes a total of 1327 registered employees. Greater demands are being levelled on data of persons exposed to chemical substances, and that corresponds with the range and number of measuring data (combined exposure to several carcinogens), a relatively simpler situation being with exposures, e.g. to cytostatics in health care staff. A critical moment in the keeping of the database seems to be the end of exposure (leaving the plant – change of job, old-age rent or disability pension); an information sheet has been elaborated that is transferred to the physician who takes over consecutive care.
10.4 Partial conclusions
Monitoring of the occupational environment effects on health, i.e. the Central Registry of Occupational Diseases and the Central Registry of Occupational Disease Hazard, reveals a further decline in the occurrence of occupational diseases by 4.2 % which represents a total of 1677 cases. Incidence fell from 38.3 to 37.1 cases per 100 000 insured subjects. Thus, there is a continuing falling trend in the overall number and incidence of reported occupational diseases.
The highest incidence of diseases due to physical factors has been confirmed; for the first time in the whole period of statistical monitoring, most occupational diseases have been reported in the healthcare sector, a little less in coal mining.
Concrete results can be found in the task of exposure monitoring on the basis of job categorization data. There is already proceeded, besides fundamental registration, also the analytical stage (Phase II) giving summary data by regions, factors of working conditions, and the number of exposed persons by job category and factors, and by gender.
The monitoring of excessive burdening in relation to impairment of the locomotion system has been enlarged by further collaborating Public Health Centers, preliminary pieces of knowledge have been obtained in selected employees by direct examination as well as through questionnaires.
The monitoring of occupational exposures to chemical carcinogens has been extended practically to every region; material for the list of carcinogens and supplementation of the REGEX system has been processed.
Table 10.1 Notified occupational diseases and threat of occupational disease
|
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
Occupational diseases total |
2 543 |
2 376 |
2 111 |
1 885 |
1 751 |
1 677 |
– occupational diseases |
2 519 |
2 350 |
2 054 |
1 844 |
1 691 |
1 627 |
– threat of occupational disease |
24 |
26 |
57 |
41 |
60 |
50 |
Occupational diseases – males |
1 565 |
1 551 |
1 261 |
1 192 |
1 104 |
1 034 |
Occupational diseases – females |
978 |
825 |
850 |
693 |
647 |
643 |
Incidence rate |
55.2 |
51.6 |
45.8 |
40.9 |
38.3 |
37.1 |
Table 10.2 Notified occupational diseases in regions
Region |
Occupational diseases* |
Total |
|||||
1 |
2 |
3 |
4 |
5 |
6 |
||
Jihomoravský |
3 |
15 |
29 |
18 |
20 |
0 |
85 |
Jihočeský |
1 |
40 |
4 |
26 |
41 |
0 |
112 |
Vysočina |
1 |
13 |
6 |
16 |
41 |
1 |
78 |
Karlovarský |
0 |
5 |
2 |
8 |
30 |
0 |
45 |
Královéhradecký |
5 |
19 |
14 |
40 |
9 |
0 |
87 |
Liberecký |
1 |
15 |
5 |
10 |
13 |
1 |
45 |
Olomoucký |
1 |
58 |
16 |
33 |
13 |
0 |
121 |
Moravskoslezský |
2 |
242 |
75 |
58 |
31 |
0 |
408 |
Pardubický |
12 |
14 |
14 |
49 |
15 |
0 |
104 |
Plzeňský |
1 |
45 |
16 |
43 |
18 |
0 |
123 |
Prague |
1 |
26 |
6 |
34 |
18 |
0 |
85 |
Středočeský |
13 |
54 |
115 |
35 |
13 |
0 |
230 |
Ústecký |
1 |
33 |
4 |
20 |
42 |
0 |
100 |
Zlínský |
0 |
30 |
5 |
10 |
9 |
0 |
54 |
Total |
42 |
609 |
311 |
400 |
313 |
2 |
1 677 |
* 1 – O. diseases caused by chemicals
2 – O. diseases caused by physical factors
3 – O. diseases of lung, pleura and peritoneum
4 – O. diseases of skin
5 – O. diseases infectious and parasitic
6 – O. diseases caused by other factors