”the blue book”, finnish approach to better health surveillance helena taskinen 30 th september...

”The Blue Book”, Finnish approach to better health surveillance

Helena Taskinen

30th September 2003

Tallinn

30th September 2003 ”Blue Book”/ H. Taskinen

Health Examinations

Health risks at work – ”Blue Book”, guidelines for health examinations


The natural progress of diseases

Illness process Symptoms Healing begins start or death

Pre-clinical phase, ident-ifiable by screening

symptomless symptoms


The goal of occupational health services To promote the following through

cooperation between the employer, the employee and the OHS provider: healthy and safe work environment well-functioning work community the prevention of work-related illnesses the maintenance and promotion of the

employees' ability to work

(OHS Act 2001, Finland)


Health Examination (HE) Act (Finland, 2001)

Work entailing specific risk of illness physical, chemical or biological agent new: a risk for reproduction new agents: night work, environmental tobacco

smoke, risk of violence at work


Types of Health examinations (Finland) Pre-employment Periodical New: HE upon termination of

employment especially for carcinogenic exposures advice on further examinations

frequency, contents, possible health care units


Health examination Act (2001, Finland)

When new chemicals/processes are introduced if health effects are expected/ unknown symptoms, unusual diseases etc. animal data as reference

Information on unknown exposure Precaution: careful handling, minimising

exposure


0

2000

4000

6000

8000

10000

90 91 92 93 94 95 96 97 98 99 00 01

0

10

20

30

40

50

Number of cases

Cases/10 000 employed persons

Occupational diseases in 1990 - 2001Cases/10 000 employed personsNumber of cases

Lea AaltoFinnish Register of Occupational Diseases FIOH


Allergic respiratory diseases in 1990-2001

0

100

200

300

400

500

90 91 92 93 94 95 96 97 98 99 00 01

Asthma

Allergic rhinitis

Allergic alveolitis

ODTS

Number of cases



Asbestos-induced diseases in 1990 - 2001

0

300

600

900

1200

1500

90 91 92 93 94 95 96 97 98 99 00 01

Pleural adhesions andcalcificationsAsbestosis

Cancers

Others

Number of cases



Examples of hazards Physical agents:

noise, vibration (hands, whole body), high pressure, ionising radiation, non-ionising radiation

Chemical toxicants: e.g. lead and other metals, organic solvents

and other hydrocarbons, toxic inorganic gases, phenols, pesticides, resins, antibiotics, cytostatics, quartz, asbestos, organic dusts..

Biological agents: bacteria, viruses, mold…


Goals of health examinations To examine and follow-up

workers’ health signs of exposure, early signs of effects late effects (long latency) work ability

To give information of health risks and of safe practices personal protective equipment

Should lead to treatment and rehabilitation, if needed


The Health Examination ProcessThe Health Examination Process

Definitionof needs

Process:- planning- implementation- health education- recommendations

Actions Evaluation


20

Data for HEData for HE

Work & exposure history Symptoms Biological monitoring, biomarkers Specific tests:

questionnaires, audiometry, laboratory tests, lung function, x-ray etc.

Other diseases, medication etc. Life style, exposure from hobbies


Structure of the guideline book General principles and methods

questionnaires, personal protection (EU directive).. proposal for hygienic improvements, follow-up

Specific guidelines for certain (listed in the Act) physical, chemical and biological exposures, and for night work and for work with risk of violence

Guidelines for certain occupations welders, construction workers, painters, food

industry workers, firemen and rescue workers, forest workers, cleaners, hair dressers


Structure of the chapter, 1 Description of the agent (CAS-No of chemicals) Exposure: where, how? Occupational exposure limits, biomonitoring data Adverse effects to health How to estimate the need for HE Health examination

Pre-placement: at the beginning of work periodical upon the termination of employment


Structure of the chapter, 2 Note

restrictions/advice e.g. for pregnant workers Informing the workers and employers Actions: What to do if abnormal findings Bibliography/ web sites for further

information www.inchem.org/pages/cicads.html


Confidentiality Result of health examination is confidential

to employer the necessary information for safety improvements

suitability of the worker to the work entailing specific risk of illness in the form suitable, suitable with restrictions or suitable

Statement of pre-employment examination: worker shall see it first and bring it to employer


Carcinogenic exposure Health examinations do not prevent disease Technical and industrial hygienic measures

to prevent exposure Health examinations in detection of effects

of earlier exposure Information

Note: also reproductive effects possible


Example of a new agent: Environmental tobacco smoke (ETS)

Sidesmoke (from cigarette) 50-90 % Main smoke (exhaled by the smoker) 10-

50% In the tobacco smoke 4000 hazardous

compounds; > 40 carcinogenic


Health effects of ETS Risk of lung cancer 1.3-1.4 fold heart infarction 1.3-1.4 fold brain stroke 1.3-1.4 fold Estimated:

1-3 work related lung cancer in an year in Finland

5-30 heart infarctions and brain strokes obstructive lung diseases, asthma


Laws on tobacco smoking implemented in Finland

1977 1995, work places included 2000, restaurants included

ETS classified as carcinogenic


Significant exposure to ETS 2-4 hours/d at work on 40 work days a year need of health examinations

every 3 years, symptoms, spirometry, X-ray if regarded necessary (suspicion of cancer etc.)

notification in the registry of carcinogenic exposure


Threat of violence (Finland)

In Finland 110 000 employees yearly ”is part of the work” – police, guards etc. ”occasional, unexpected” – hotels, shops,

restaurants, banks, health care etc. 500 compensated as work accidents yearly 2 deaths yearly


Prevention Recognition of the risk, safety planning at

work place, training

Pre-employment HE suitability?, information

Periodical HE follow-up by qustionnaires or HE


PHE and intervention


Laboratory Animal AllergyYear Prevalence, % Incidence

Rate, %1991 18.9 3.3

1992 21.8 10.3

1993 11.9 2.2

1994 12.1 0

1995 14.9 0

Fisher et al. Prevention of laboratory animal allergy. JOEM 1998;40:609-13


Laboratory animal allergy and HE

Medical surveillance: questionnaire, RAST, physical examination yearly

Education, engineering and administrative controls, personal protective equipment

Work practice changes: animal-stock density, wet-shaving

Filter-topped cages, increased and filtered ventilation, dust-free bedding etc.


Health surveillance

Health surveillance in milling, baking and other food industry

3 450 employees 1993 3 asthma, 1 rhinitis 1994 3 -”- 1995 4 -”- 1996 2 asthma, 2 -”- 1997 1 -”- 2 -”-

Smith TA, Patton J. Occup Med, 1999;49:147-153.

”the blue book”, finnish approach to better health surveillance helena taskinen 30 th september...

Documents

health hazards

introducedif health

health examinations

information of health

future negative health

night work

work blue book

safe work environment