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

”The Blue Book”, Finnish approach
to better health surveillance
Helena Taskinen
30th September 2003
Tallinn
Health Examinations
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Health risks at work – ”Blue Book”,
guidelines for health examinations
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”Blue Book”/ H. Taskinen
The natural progress of diseases
symptomless
Illness process
begins
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symptoms
Pre-clinical
phase, identifiable by
screening
Symptoms
start
”Blue Book”/ H. Taskinen
Healing
or death
The goal of occupational health services
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To promote the following through
cooperation between the employer, the
employee and the OHS provider:
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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)
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Health Examination (HE) Act (Finland,
2001)
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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
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Types of Health examinations
(Finland)
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Pre-employment
Periodical
New: HE upon termination of
employment
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especially for carcinogenic exposures
advice on further examinations
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frequency, contents, possible health care units
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Health examination Act (2001, Finland)
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When new chemicals/processes are
introduced
if health effects are expected/ unknown
 symptoms, unusual diseases etc.
 animal data as reference
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Information on unknown exposure
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Precaution: careful handling, minimising
exposure
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Occupational diseases in 1990 - 2001
Cases/10 000
employed persons
Number of cases
10000
50
8000
40
6000
30
4000
20
2000
10
Number of cases
Cases/10 000 employed persons
0
0
90 91 92 93 94 95 96 97 98 99 00 01
Finnish Register of Occupational Diseases
Lea Aalto
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FIOH
Allergic respiratory diseases in 1990-2001
Number of cases
500
400
300
Asthma
200
Allergic rhinitis
100
Allergic alveolitis
ODTS
0
90
91
92
93
94
95
96
97
98
99
00
01
Finnish Register of Occupational Diseases
Lea Aalto
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”Blue Book”/ H. Taskinen
FIOH
Asbestos-induced diseases in 1990 - 2001
Number of cases
1500
1200
900
Pleural adhesions and
calcifications
Asbestosis
600
Cancers
300
Others
0
90 91 92 93 94 95 96 97 98 99 00 01
Finnish Register of Occupational Diseases
Lea Aalto
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FIOH
Examples of hazards
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Physical agents:
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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…
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Goals of health examinations
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To examine and follow-up
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To give information of health risks and of safe
practices
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workers’ health
signs of exposure, early signs of effects
late effects (long latency)
work ability
personal protective equipment
Should lead to treatment and rehabilitation, if
needed
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The Health Examination Process
Definition
of needs
Process:
- planning
Actions
- implementation
- health education
- recommendations
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Evaluation
Data for HE
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Work & exposure history
Symptoms
Biological monitoring, biomarkers
Specific tests:
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questionnaires, audiometry, laboratory tests,
lung function, x-ray etc.
Other diseases, medication etc.
Life style, exposure from hobbies
20
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Structure of the guideline book
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General principles and methods
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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
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welders, construction workers, painters, food
industry workers, firemen and rescue workers, forest
workers, cleaners, hair dressers
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Structure of the chapter, 1
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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
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Pre-placement: at the beginning of work
periodical
upon the termination of employment
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Structure of the chapter, 2
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Note
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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
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www.inchem.org/pages/cicads.html
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Confidentiality
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Result of health examination is confidential
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to employer the necessary information for
safety improvements
suitability of the worker to the work entailing
specific risk of illness in the form
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suitable, suitable with restrictions or suitable
Statement of pre-employment examination:
worker shall see it first and bring it to
employer
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Carcinogenic exposure
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Health examinations do not prevent disease
Technical and industrial hygienic measures
to prevent exposure
Health examinations in detection of effects
of earlier exposure
Information
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Note: also reproductive effects possible
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Example of a new agent: Environmental
tobacco smoke (ETS)
Sidesmoke (from cigarette) 50-90 %
 Main smoke (exhaled by the smoker) 1050%
 In the tobacco smoke 4000 hazardous
compounds; > 40 carcinogenic
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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:
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1-3 work related lung cancer in an year in
Finland
 5-30 heart infarctions and brain strokes
 obstructive lung diseases, asthma
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Laws on tobacco smoking
implemented in Finland
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1977
1995, work places included
2000, restaurants included
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ETS classified as carcinogenic
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Significant exposure to ETS
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2-4 hours/d at work on 40 work days a year
need of health examinations
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every 3 years, symptoms, spirometry, X-ray if
regarded necessary (suspicion of cancer etc.)
notification in the registry of carcinogenic
exposure
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Threat of violence (Finland)
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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
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Prevention
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Recognition of the risk, safety planning at
work place, training
Pre-employment HE
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suitability?, information
Periodical HE
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follow-up by qustionnaires or HE
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PHE and intervention
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Laboratory Animal Allergy
Year
1991
Prevalence, % Incidence
Rate, %
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
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Laboratory animal allergy and HE
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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.
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Health surveillance
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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.
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