Lecture 1.

GENERAL QUESTIONS
PROFESSIONAL PATHOLOGY
The concept of occupational pathology as a clinical discipline.
Occupational diseases are damage to health, caused by exposure to harmful and /
or dangerous factors of labor process. Occupational pathology is a branch of clinical
medicine, which studies the negative impact of factors of the working environment
on the health of working people. As a clinical discipline, occupational pathology is
closely
related to occupational medicine, rehabilitation, the harmonious interaction of which
allows
to carry out in practice effective diagnostics, treatment, prophylaxis, and rehabilitation
of
patients with occupational diseases.

Conditions of occurrence and causes occupational diseases

The level of risk of occupational pathology depends on the hygienic conditions in the
workplace,
tension and the severity of the labor process, the presence of harmful factors,
potential
but hazardous to the health of workers. It can be predicted with taking into account
the class
of working conditions in each specific production.
The following classes of production conditions are distinguished:
• 1st grade. These are safe working conditions that ensure the preservation of health
and high working capacity for workers.
in production. Special measures for labor protection are not required, since the risk of
occupational pathology
practically absent;
• 2nd grade. Complies with safe working conditions. It has
place an insignificant risk of a professional
pathology. If the minimum hygienic requirements are met, first of all, this is a good
rest after a work shift; by the beginning of the next working day, the employee's
functional potential of the body is fully restored;
• 3rd grade. This includes working conditions when the worker
the place, the hygienic standards of various unfavorable production factors that can
lead to an occupational disease are exceeded. In this class, four degrees of exceeding
hygiene standards are distinguished:
1st degree - working conditions with low, moderate risk
occupational disease with predominantly reversible functional disorders. Such conditions
occur if the maximum permissible concentration
(MPC) or permissible level of intensity of harmful
workplace exposures are exceeded by 1.1-3 times;
2nd degree - working conditions with an average, significant
risk of occupational disease, leading to the emergence of persistent functional disorders,
increased
the increase in the duration of periods of temporary disability, contributing to an
increase in general morbidity, the formation of the initial manifestations of an
occupational disease. These conditions are formed if the permissible level of harmful
effects is exceeded in
3.1-5 times;
3rd degree - working conditions with a high risk of an occupational disease occurring
in
mild form. These working conditions are conducive to growth
general somatic morbidity, about which
the duration of the periods increases significantly
temporary disability. They arise if the permissible threshold for the action of
unfavorable production factors is exceeded 5.1-10 times;
4th degree - working conditions with a very high risk of clinically expressed forms of
occupational diseases, a high probability of an increase in
frequency of formation of chronic non-professional diseases occurring with long periods
of temporary disability. Acceptable thresholds
and MPC of harmful factors are exceeded by more than 10 times;
• 4th grade. Suitable for extremely hazardous working conditions
with a high and ultra-high risk of severe
occupational disease, most often acute. Typically, this is the work of rescuers, testers,
industrial emergencies.
Variety of forms of occupational diseases
and their grouping by etiological basis
Distinguish between acute and chronic occupational diseases. Acute occupational disease
arises from a short-term, within no more than three work shifts, exposure to an
unfavorable production factor in the performance of professional duties. Acute
occupational diseases are not
include accidents at work that occur regardless of the professional activity of the
victim.
Chronic occupational disease is formed when long-term, systematic exposure to
damaging factors
production environment.
Chronic occupational diseases include
also the immediate and long-term consequences of acute occupational diseases (for
example: persistent organic changes in the central nervous system after carbon
monoxide poisoning).
The development of occupational diseases is possible after a long period of time after
the termination of work with harmful, hazardous substances and production factors
(for example: late silicoses, beryllium, etc.). Diseases also belong to occupational
the development of which occupational disease is a background or
risk factor (example: lung cancer, which developed on the background of silicosis,
asbestosis, dust bronchitis).

Diseases that one has to meet in professional pathological practice are subdivided
into three main groups:
1. Occupational diseases caused by the action of a certain harmful factor in the
working environment. These diseases have a fairly well-defined, specific
clinical picture. These include pneumoconiosis, acute
and chronic intoxication with lead, mercury, organophosphate pesticides, etc.
2. Diseases resulting from exposure to harmful
factors of the working environment, but in the clinical picture
which there are no specific manifestations, unambiguously
indicating the professional nature of this pathology. It is a chronic bronchitis that
occurs when working industy environment, neurological disorders associated with
exposure to vibration and noise, diseases of the musculoskeletal apparatus for physical
overstrain, etc.
3. Diseases etiologically not associated with adverse factors of working conditions, but
capable of proceeding in a more severe and pronounced form when exposed to such
factors.
So, in individuals with an initial allergic status with exposure to the dust factor of the
working environment is often bronchial asthma occurs.

List of professional diseases, which is used in the establishment of a diagnosis,

examination of the ability to work, consideration of issues related to compensation for
damage to the victim's health.
The list is built according to the etiological principle. He contains
names of diseases in accordance with ICD 10, as well as a description
harmful and dangerous factors of the working environment, labor processes, the impact
of which can lead to the emergence each specific occupational disease.
In this list the following seven groups of occupational diseases are listed:
1. Diseases caused by exposure to chemical factors.
May occur in people working with chemicals with toxic properties (nitric acid, ammonia,
benzene and its derivatives, sulfur, perhydrol, mercury and its compounds, lead and its
inorganic compounds, tetraethyl lead, etc., pesticides used in agriculture.
2. Diseases caused by exposure to industrial aerosols. May be caused by people
working in environments with high levels of dust containing dioxide
silicon in free and bound states, coal particles, graphite, soot, metals, organic and
artificial
mineral fibers, plastics, plant fibers, etc.
3. Diseases caused by exposure to physical factors.
May occur in people working with radioactive substances, sources of ionizing,
electromagnetic
radiation, lasers exposed to intense industrial noise, vibration, etc.
4. Diseases associated with physical overload and overstrain of individual organs and
systems.
May occur when performing work related to intense static-dynamic loads on the
musculoskeletal system, local muscle overloads, staying in a forced posture, requiring
high coordination of movements, stereotyped movements, overstrain of the vocal
apparatus, servicing patients in psychiatric institutions, etc.
5. Diseases caused by exposure to biological factors. May occur when working in
contact with infected sick people and animals, infected biological material, animal and
vegetable products
origin (processing of fur, leather, etc.), antibiotics, fungi-producers of antibiotics,
protein-vitamin
concentrates, feed yeast, compound feed, etc.
6. Allergic diseases. May occur during work involving substances and compounds of an
allergenic effect.
7. Neoplasms. May occur during work related to
distillation products of coal, oil, shale, components of glass fiber lubricants, other
chemical
compounds with carcinogenic properties, sources of ionizing radiation.
Features of the clinical examination and
diagnostics of occupational diseases
If there is an assumption about the occurrence of an occupational disease in a
working person, treatment-and-prophylactic
the institution must draw up the appropriate documents and within a period of not
more than 2 months send him for additional examination in regional or republican center
of occupational pathology.
Acute occupational disease is established by a doctor polyclinic or hospital with
mandatory registration in such cases of emergency notification.
The diagnosis of a chronic occupational disease is established by medical consulting
commissions of the regional and republican centers of occupational pathology. It can
also be established by the of any medical institution, where there is an occupational
pathologist with postgraduate training
on occupational pathology. In such cases, at the meeting of the CWC it is mandatory
a representative of the territorial hygiene center must participate
and epidemiology and a representative of the administration of the enterprise for which
the sick person works.
Occupational skin lesions can be found in
dermatovenous dispensaries, which have specialists trained in professional dermatology.
Methodology of clinical examination of patients and means
diagnostics of occupational pathology have specific features, which is associated with
the need to identify the etiological
the factor that caused the disease and, thus, establish
a causal relationship of this disease with adverse
working conditions at the workplace of the victim.
To confirm the diagnosis of an occupational disease
a thorough analysis of the patient's anamnesis is carried out - drawing up
his professional route. A professional route allows you to establish not only the very
fact of contact with a harmful factor
working environment, but also the duration (experience) of the harmful
impact. A sanitary and hygienic assessment of the working conditions of the sick
person is mandatory. A study of the functional state of various organs and systems in
a patient is carried out. So, for example, to assess the nature of lung damage, to
determine the degree of impairment of the function of external respiration in individuals,
professional
whose disease is associated with working in dusty conditions, X-ray of the lungs,
spirographic examination are performed.
In addition to the classic general clinical examination,
special tests to identify specific signs
some occupational diseases. For example, identifying
lead, mercury in urine with evidence of professionally conditioned intoxication with these
metals.
Required documentation to establish
diagnosis of occupational disease
A diagnosis of acute occupational disease or poisoning can be made in all types of
medical facilities. When a patient is sent to medical institutions that have the right to
establish a diagnosis of a chronic occupational disease,
you need to prepare the following documents:
1. Direction of the medical institution.
2. An extract from the medical record of an outpatient or inpatient patient, which
must indicate:
• all past diseases;
• time from origin;
• results of special instrumental and laboratory
research;
• a list of therapeutic measures and their effectiveness.
3. Information about the results of the preliminary (upon admission to
work) and periodic medical examinations.
4. Sanitary and hygienic characteristics of working conditions.
5. A copy of the employment book.

General principles of treatment

occupational diseases
In the treatment of acute occupational diseases, the well-known principles of
emergency therapy used in general somatic clinical practice are used.
Measures in the treatment of acute occupational intoxication in the workplace include:
• Immediate cessation of contact with toxic substance
by removing the affected toxin from the area of action, cleansing the respiratory tract,
skin, mucous membranes, digestive a path from a toxic substance.
• Activation of intensive excretion of already received
blood and in the depot of a toxic substance.
• Administration of antidotes to neutralize toxins in the body.
• Restoration of the functions of internal organs.
For chronic occupational diseases,
restorative, symptomatic, restorative treatment,
rehabilitation and preventive measures are carried out with
in order to compensate and restore the body functions lost by the patient.
In every case of chronic occupational disease
a specific list of therapeutic measures depends on the type of damaging factor, the
severity of the dysfunctions caused by it organs of the victim. The treatment of many
chronic occupational diseases, for example, occupational bronchial asthma, is carried
out using the same principles that are used to treat similar diseases that are not
etiologically associated with occupational hazards. In other cases, for example, with
chronic lead intoxication, special drugs are used for treatment that can remove lead
from the body — specific antidotes.

The concept of temporary and persistent disability

Occupational diseases can cause temporary, long-term or permanent disability.
Temporary disability is established by medical advisory commissions for no more than 4
months (120
days) without a break or for 5 months with a break. How as a rule, this happens
with severe acute intoxication, with exacerbation of chronic occupational diseases.
Long-term or permanent disability or its significant limitation can only be established by
a medical rehabilitation expert commission with the definition
disability groups. When determining the disability group
use the criteria of the Guidelines for Determining the Cause of Disability.
Five functional classes are distinguished:
• FC-0 - absence of dysfunctions and limitation of life activity.
• FC-1 - slight limitation of life activity in connection with the morning up to 25% of
functions.
• FC-2 - moderate limitation of life activity due to loss of 26 to 50% of functions.
• FC-3 - significant limitation of life activity due to loss of 51 to 75% of functions.
• FC-4 - a pronounced limitation of life activity up to the complete loss of functions
- 76-100%.

Disability is determined when violations occur

professional ability to work based on the following
criteria:
• 1 group of disability is established with complete disability, when the patient, due to
the presence of pronounced
functional disorders, needs constant outside help, care or supervision. Corresponds to
the functional class FK-4.
• 2 group of disability is established for patients with FC-3, which:
labor is unavailable due to severe functional limitations caused by the disease;
labor is contraindicated due to the aggravation of the condition
sick as a result of any professional labor activities;
labor is not contraindicated, but is available in specially created conditions.
• 3 group of disability is established for patients with FC-2 in accordance with the
following criteria:
in case of a forced transition for health reasons to a job of a lower qualification (a
decrease in qualifications by 4 categories or more, a decrease in the category, level
management for managers);
with a decrease for health reasons, the volume production, reduction for the same
reasons, the duration of the working day.

Preliminary when applying for a job and periodic medical examinations.

Preliminary upon admission to work and periodic pursue the following goals:
• Determination of the suitability of workers and employees assigned to them
work, ensuring occupational safety and
the spread of infectious and parasitic diseases.
• Identification of persons with occupational diseases or suspected to have such a
disease.
• Recognition of common (non-professional) diseases, when
the presence of which further work in hazardous and hazardous labor conditions can
worsen their course and prognosis for health and working capacity.
• Appointment of individual medical and health-improving measures to employees with
identified diseases or with suspicion of an occupational disease: dispensary observation,
examination in a clinic, outpatient and inpatient treatment, health improvement in a
dispensary, sanatorium, homes
recreation, rational employment.
• Assessment of working conditions and development of sanitary and hygienic measures
in order to eliminate factors that cause occupational disease.
• Ensuring continuity in the provision of medical and preventive care to workers in
production by organization of engineering and medical teams.
Medical preliminary upon admission to work examinations allow the selection of persons
who, due to their physical development and state of health, are not contraindicated to
work with
this or that production factor. Preliminary examinations are carried out only in the
direction of the employer, which indicates the name of the profession and occupational
hazards for
in this particular production, general and additional contraindications to employment. In
the absence of these data, the medical
inspection is not carried out and a certificate of validity is not issued.
The results of the preliminary medical examination are documented in the form of a
social and clinical conclusion. On
Based on the materials of this conclusion, the person being examined is given a
certificate indicating "good" or "not good" for implementation
of this work without detailing the results of the inspection.
Periodic medical examinations provide:
• dynamic monitoring of the health status of workers
under the influence of occupational hazards;
• identification and prevention of the initial signs of occupational diseases;
• identification of common diseases in which further work
in conditions of exposure to occupational hazards can worsen their clinical course;
• assessment of working conditions with the subsequent development of sanitary and
hygienic measures to improve them;
• preventing the spread of infectious and parasitic diseases.
The following are subject to periodic medical examinations categories of persons:
• working with hazardous substances;
• those working under the influence of unfavorable and industrial factors (noise,
vibration, physical stress, dust, toxins, etc.);
• employees of catering and food industry;
• students of secondary and higher educational institutions;
• employees of educational, preschool, health-improving institutions;
• workers of housing and communal services;
• medical workers who have previously passed the preliminary
medical checkup.
Periodic examination data is entered into the medical outpatient card. Moreover, each
doctor involved
in examination, gives his individual opinion on the professional the suitability of the
employee. On a separate sheet of the outpatient card the data of the professional
route of the worker is entered:
enterprise, workshop, site, profession, harmful and unfavorable working conditions.
After the inspection, a final act is drawn up in 4 copies, in which one hectare of the
following resolutions is recorded, taking into account age of the patient, work
experience and course of the disease:
• Practically healthy. Can continue to work under conditions of probable exposure to
occupational hazards.
• Revealed a general, non-professional disease with an indication
diagnosis and made one of the following conclusions:
- the employee can continue to work professionally,
- the employee is subject to treatment,
- the employee is subject to dispensary supervision;
- further work in contact with professional
harmfulness, is contraindicated (recommendations for transfer to another job are given
by the VKK).
• Suspected occupational disease. Employee subject to:
about additional examination,
on the dynamic observation of the shop and district doctor.
The final act is drawn up in 4 copies, one of which remains in the medical institution
that performed the medical inspection, and three others are sent without fail:
• To the tenant.
• To the territorial center of hygiene and epidemiology.
• district doctor.