10. OCCUPATIONAL HEALTH RISKS AND THEIR CONSEQUENCES |
10.1 Organization of monitoring activities
This Subsystem includes the follow-up of the impairment of health 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 threats (monitoring of health effects), exposure monitoring (categorization of jobs and workplaces), 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 load as well as chemical carcinogens exposure, 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 register of occupational diseases and occupational disease threat
In the year 2002 there have been reported in the Czech Republic 1,600 profession-linked affections (977 in males and 623 in females) in 1,567 employees, of those 1,531 being occupational diseases and 69 occupational disease threats. In comparison with the years 1996 through 2001 there continued the decreasing trend in incidence as well as of the overall number of reported profession-linked affections (Tab. 10.1 and Fig. 10.1). The incidence of profession-linked affections (35.7 per 100,000 employees) dropped by 1.7 cases as against the year 2001. The drop was foremost in occupational diseases, the number of reported cases being by 5.9 % (by 96 cases) lesser than in the year 2001. On the other hand, the number of occupational disease threats increased by 38.0 % (by 19 cases) in 2002.
Once again, in 2002, the greatest numbers of reported profession-linked affections have come from the Moravian-Silesian Region (362, i.e. 22.6 % of cases) and from the Central Bohemian Region (213, i.e. 13.3 % of cases) (Fig. 10.2). In the Moravian-Silesian Region the majority of affections appeared in consequence of physical factors (215 cases). In question were foremost diseases due to long-term excessive unilateral burdening of the extremities and diseases due to vibrations. In the Central Bohemian Region the greatest number of diseases reported were affections within the framework of respiratory tract diseases in the list of occupational diseases (115 cases). In question were foremost diseases caused by particulate matter containing free crystalline silicium oxide, diseases caused by asbestos dust, and lung cancer caused by radioactive substances (Tab. 10.2, Fig. 10.2).
As against preceding years, in the year 2002 most profession-linked affections came from the healthcare sphere of economic activities (OKEČ N85 – 261, i.e. 16.3 % of cases). The coal mining branch (OKEČ C10) with 13.8 % of the cases reported, was in second place only. The greatest increase in profession-linked affections (by 105 cases, i.e. by 118.0 %) in 2002 has been registered in the production branch of metal constructions and metal produce (OKEČ D28), wherein there mainly increased the numbers of cases down with occupational dermatitis, cases due to vibrations, and diseases connected with the overburdening of the extremities.
A total of 601 profession-linked affections were caused by physical factors in the year 2002. In decreasing order there followed dermal affections (346 cases), respiratory tract and lung diseases (310 cases), infectious and parasitic diseases (301 cases), diseases caused by chemical substances (42 cases) (Fig. 10.3).
The most frequent diagnoses among occupational diseases were peripheral nerve affections due to overburdening of the extremities (177 cases) and due to vibrations (174 cases). In occupational disease threats there have been diagnosed most frequently impaired hearing due to noise (19 cases, i.e. 27.5 %) and arthrosis in joints of the upper extremities due to vibrations (15 cases, i.e. 21.7 %).
10.2.2 Monitoring of exposure
Monitoring of exposure to individual factors in working conditions on the basis of data on the categorization of jobs and workplaces
In the course of 2001 there has been tested and finalized 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 (the so-called Phase I), which enables on the basis of documentation, presented by the employer, containing a proposal for categorizing jobs and work sites, to issue a decision by the authorities of public health promotion on the classification of jobs and workplaces into categories. There has simultaneously been kicked off and tested Phase II of the program, i.e. the central data processing of selected information, so that there can be followed up and assessed the exposure levels to individual factors according to working conditions in each district and region, leading to nationwide summaries. The current numbers of exposed employees placed in categories 2R, 3, and 4 by regions are presented in Tab. 10.3 and in Fig. 10.4a. The greatest numbers of exposed employees are registered in the Ústí n/L Region – 25,044, followed by the Central Bohemian Region and Prague.
From the analyses drawn up in the Categorization Information System it follows that up to May 22, 2003, 842,953 subjects have been included in categories 2, 2R, 3, and 4, i.e. 18 % of all employees, that representing 21,189 per 100,000 of the population. At jobs under risk there have been registered 188,467 subjects representing 6,079 per 100,000 of the population. In category 4, that being high-risk workplaces, there have been included 7,014 subjects (226 per 100,000 of the population) of whom 1,220 are females.
The greatest numbers of exposed employees (2, 2R, 3, 4) are registered under the factor Psychical load – 338,168, Physical load – 311,531 subjects, and Noise – 249,204 subjects. On the other hand, at work under risk (i.e. 2R, 3, 4) the greatest numbers are registered under the risk factor Noise – 95,757 subjects, Biological agents – 42,204 subjects, Particulate matter – 23,484 subjects, and Physical load – 23,300 (Fig. 10.4b). Surprisingly low is the number of subjects exposed to Chemical substances – 60,158 subjects, and only 17,372 at work under risk (i.e. 2R, 3, 4).
It can be stated that of the overall number of employees, 4,591,137 are registered as falling into categories 2, 2R, 3, and 4 – 18 % of subjects, at work under risk, i.e. 2R, 3, and 4–4.7 % of subjects. The numbers presented should be considered to be preliminary in as job registration has not been finished yet, and in the immediate future there shall have to be a check-up on and correction of incorrectly entered data.
10.3 Monitoring of selected parameters of exposure and health effects
10.3.1 Monitoring the health effects of selected occupational factors
Monitoring of excessive unilateral burden in relation to damage of the locomotion system
In the year 2002 there has continued the task of assessing the causal relations between working conditions and the appearance of musculo-skeletal diseases, namely diseases due to unilateral excessive overburdening.
In the year 2002 there have been examined 150 subjects of various professions at six different kinds of workplaces. Such professions were chosen in which there had repeatedly been reported and investigated occupational diseases from the point of view of local muscular load: female assembly-line workers, female assemblers of electric appliances, female sewers, upholsterers, glass cutters, and various professions in piano production (female string outfitters, polishing, keyboard assembling, keyboard balancing, music instrument mechanic, piano tuner, etc.). On this task, in the year 2002, there have participated expert members of three Regional Public Health Centers – those of Hradec Králové, Ústí n/L, and Plzeň. Data are processed on an on-going basis in the computer program EPI-INFO.
At all the selected workplaces there has been carried out the assessing of local muscular load of the forearm flexors and extensors by integrated electromyography. With all the employees at the selected workplaces, through structured interview, there has been filled in a questionnaire focused on subjective health complaints concerning the locomotion system to enable an assessment of the mutual relationship between their occurrence and working conditions. A partial objective was i.a. to find whether it is possible to utilize the increased occurrence of subjective complaints in workers as an auxiliary indicator of increased risk at work, under what conditions, and how the type of work load influences their occurrence and characteristics.
Part and parcel of the project was also the examination of the locomotion apparatus as it is performed at the office of the enterprise physician. Another partial objective is to utilize thus obtained information also for the determination of the frequency and content of preventive physical examinations at workplaces that are at risk, from the point of view of local muscle load. Investigated was the influence on time factors (shift work, over-time hours, 12-hour shifts) on the appearance of subjective health complaints, objective findings, and eventual manifestations of disease. The final results will be available after finishing the whole project.
The jobs are characterized by unilateral excessive burdening of certain motor structures. In question are jobs in a forced working position with marked motor monotony, often carried out at a high work tempo (repetitive motion) and under time stress (female assembly workers), and on the other hand, jobs at which there is exerted great supra-limit muscular strength (upholsterers, female string outfitters), as well as professions in which there takes place unilateral excessive overloading during frequent and repeated manipulation with burdens. From Fig. 10.6a it is apparent that most complaints concerning the motor apparatus are localized in the neck region of the spine, forearm and hand, and in the lumbar section of the spine. Likewise, the elbow and knee joints are strained parts of the body. Complaints are manifested by pain (Fig. 10.6b), however, tingling sensations are not to be overlooked. When comparing the occurrence of complaints at work with manipulation with heavy burdens and without it (Fig. 10.6c and 10.6d), there dwindles away the category “without complaints”, increases the frequency of reported complaints, beside in the forearm and hand, also in the lumbar spine, knees and coxae.
10.3.2 The registry of occupational exposure to chemical carcinogens, REGEX
In the year 2002 there continued within the framework of the Monitoring Program – Subsystem VII – Project 2.1.5.2: “Register of profession-linked exposures to carcinogens” (REGEX) at the Regional PHS Centers Ústí n/L, Plzeň, České Budějovice, Central Bohemian Region, Karlovy Vary, Hradec Králové, Jihlava, Zlín, Olomouc, and the District PHS Centers Karviná and Frýdek Místek. An Up-date from the Pardubice Region was provided by the NIPH Division of Industrial Hygiene and Occupational Diseases. The volume of data introduced into the register depended on the capacity of each of the PHS workplaces, not on the scale of exposure to carcinogens in the regions.
The number of exposed subjects in the central register at the NIPH as of December 31, 2002, was 3,360. The register contains 3,861 entries about exposed subjects. The difference between exposed numbers and entries in registry represents number of people – 501 – entered repeatedly in the years under follow-up.
The objective for the year 2003:
It should be stressed that the system REGEX shall be fully functioning for utilization in health prevention and for analysis of the objective risk in profession-linked exposure to carcinogens upon the covering of all the regions in the Czech Republic.
10.4 Partial conclusions
In the year 2002 there continued the declining trend of incidence and also of the overall number of reported profession-linked affections. The incidence of profession-linked diseases (35.7 per 100,000 employees) has fallen as against the year 2001 by 1.7 cases. The decline related foremost to occupational diseases. On the other hand, there has increased the number of occupational disease threats in the year 2002. The greatest numbers of profession-linked affections in 2002 have again been reported from the Moravian-Silesian Region (362, i.e. 22.6 % of cases) and from the Central Bohemian Region (213, i.e. 13.3 % of cases). As against previous years, in the year 2002, there appeared more profession-linked diseases in the branch category of economic activities (OKEČ) of healthcare (OKEČ N85 – 261, i.e. 16.3 % of cases). The coal mining sector (OKEČ C10) with 13.8 % of reported cases was in second place only. The greatest increase in profession-linked affections (by 105, i.e. by 118.0 % cases) was, in the year 2002, registered in the branch of metal construction and metal produce production (OKEČ D28). The most frequent diagnosis in occupational diseases were peripheral nerve affections due to overburdening of the extremities (177 cases) and due to vibrations (174 cases). In occupational disease threat the most frequently diagnosed was impaired hearing (19 cases, i.e. 27.5 %) and arthrosis of joints in the upper extremities due to vibrations (15 cases, i.e. 21.7 %).
At jobs under risk there have been registered 188,467 subjects, that representing 6,079 per 100,000 of the population. In category 4, i.e. workplaces under high risk, there are included in the Czech Republic 7,014 subjects (226 per 100,000 of the population) of whom 1,220 are females. The greatest numbers of exposed employees included in categories 2R, 3, and 4 have been registered in the Ústí n/L Region – 25,044, as well as in the Central Bohemian Region and Prague.
The number of persons exposed to carcinogens within the framework of the register REGEX was 3,360 as of December 31, 2002.
Table 10.1 Notified professional diseases
Calendar Year |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
Professional diseases total |
2 543 |
2 376 |
2 111 |
1 885 |
1 751 |
1 677 |
1 600 |
– occupational diseases |
2 519 |
2 350 |
2 054 |
1 844 |
1 691 |
1 627 |
1 531 |
– threat of occupational disease |
24 |
26 |
57 |
41 |
60 |
50 |
69 |
Professional diseases – males |
1 565 |
1 551 |
1 261 |
1 192 |
1 104 |
1 034 |
977 |
Professional diseases – females |
978 |
825 |
850 |
693 |
647 |
643 |
623 |
Incidence rate |
55.2 |
51.6 |
45.8 |
40.9 |
38.3 |
37.1 |
35.7 |
Table 10.2 Notified professional diseases in regions
Region |
Professional diseases* |
Total |
||||
1 |
2 |
3 |
4 |
5 |
||
Jihomoravský |
3 |
13 |
31 |
24 |
42 |
113 |
Jihočeský |
4 |
43 |
8 |
31 |
28 |
114 |
Vysočina |
3 |
38 |
9 |
12 |
19 |
81 |
Karlovarský |
1 |
3 |
0 |
7 |
18 |
29 |
Královéhradecký |
0 |
23 |
14 |
23 |
26 |
86 |
Liberecký |
0 |
13 |
2 |
14 |
18 |
47 |
Olomoucký |
0 |
67 |
12 |
34 |
4 |
117 |
Moravskoslezský |
3 |
215 |
69 |
38 |
37 |
362 |
Pardubický |
13 |
7 |
16 |
27 |
32 |
95 |
Plzeňský |
6 |
45 |
19 |
37 |
12 |
119 |
Prague |
1 |
18 |
4 |
22 |
32 |
77 |
Středočeský |
5 |
49 |
115 |
32 |
12 |
213 |
Ústecký |
1 |
29 |
6 |
31 |
12 |
79 |
Zlínský |
2 |
38 |
5 |
14 |
9 |
68 |
Total |
42 |
601 |
310 |
346 |
301 |
1 600 |
* 1 – Professional diseases caused by chemicals
2 – Professional diseases caused by physical factors
3 – Professional diseases of lung, pleura and peritoneum
4 – Professional diseases of skin
5 – Professional diseases infectious and parasitic
Table 10.3 Number of employees exposed to hazardous agents (category 2R + 3 + 4) in regions, up to 22. 5. 2003
Region |
Females |
Males |
Total |
Karlovarský |
2.019 |
4.479 |
6.498 |
Zlínský |
2.481 |
4.829 |
7.310 |
Olomoucký |
2.696 |
4.819 |
7.515 |
Vysočina |
1.796 |
6.096 |
7.892 |
Moravskoslezský |
2.537 |
5.525 |
8.062 |
Plzeňský |
2.814 |
7.835 |
10.649 |
Jihomoravský |
4.87 |
6.62 |
11.49 |
Liberecký |
5.436 |
7.658 |
13.094 |
Královéhradecký |
6.168 |
7.493 |
13.661 |
Pardubický |
4.62 |
9.952 |
14.572 |
Jihočeský |
5.642 |
14.541 |
20.183 |
Prague |
10.331 |
10.702 |
21.033 |
Středočeský |
6.529 |
14.935 |
21.464 |
Ústecký |
7.633 |
17.411 |
25.044 |
Categories: 2R – potential hazardous work, 3 and 4 – hazardous work.
Data stem from works and workplaces categorization.