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Occupational Medicine Prof. Francesco S. Violante

Occupational Medicine Prof. Francesco S. Violante. General Concepts Evolution of Working Conditions Health and Labour Occupational Injuries and Diseases. What is Occupational Medicine.

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Occupational Medicine Prof. Francesco S. Violante

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  1. Occupational MedicineProf. Francesco S. Violante General Concepts Evolution of Working Conditions Health and Labour Occupational Injuries and Diseases

  2. What is Occupational Medicine • It is considered to have been founded in 1700 by Prof. Bernardino Ramazzini's treatise “De Morbis Artificum Diatriba” (b. Carpi – d. Padova)‏ • It was for a long time identified as the medical specialty concerned with the diagnosis, treatment and prevention of occupational diseases • It has developed in Europe since the first half of the XIX century • At the beginning of the XX century, the first “Work Clinic” is established in Milan, and the International Commission on Occupational Health is founded in 1906

  3. What is Occupational Medicine • It is the medical specialty concerned with the protection and promotion of the working population's health • It is not an “anatomical” specialty • It is a qualification required by law for exercising some professional activities (Competent Physician and Authorized Physician)‏ • It has developed and uses peculiar techniques, which have in their turn become operative specialties

  4. Occupational Medicine Specialties • Occupational Hygiene • Occupational Toxicology • Occupational Epidemiology • Ergonomics • Medical Radioprotection (Authorized Physician)‏ • Corporate Medicine (Most specialized physicians are employed in this sector)‏

  5. Evolution of Working Conditions • As with many aspects of human life, working conditions remained almost unchanged for centuries • Structured work, as we know it today, is a product of the “Industrial Revolution” (XVIII century)‏ • We are currently living in what is called a “post-industrial society”

  6. Life and Working Conditions before the Industrial Revolution • In past centuries, life was dominated by undernutrition, bad hygienic conditions and lack of effective medical care • In the Middle Ages, life expectancy (today in Italy: 77-83) was about 50 for those who reached adulthood • Food availability and big epidemics have affected the world population rate: • 1000: 300.000.000 • 1500: 500.000.000 • 1800: 1.000.000.000 • 1930: 2.000.000.000 • 1975: 4.000.000.000 • 2000: 6.000.000.000

  7. World Population Development

  8. Population Developmentin different continent Popolazione in milioni (scala logaritmica) Anno

  9. Working Conditions before the Industrial Revolution • Most of the population was employed in agriculture and zootechnics; few worked as craftsmen and even less in the service industry • The working life began as soon as children were strong enough • All the work was done by strength of arm, animals and simple machines (levers, block-and-tackles)‏ • The working day lasted from sunrise to sunset • Healthcare (mostly ineffective or dangerous) had to be paid for or was provided by charities (religious organizations)‏

  10. Health and Labour before the Middle Ages • Hyppocrates (460-377 B.C.): miners, metal craftsmen, dyers, farmers • Lucretius (100-55 B.C.): De Rerum Natura, miners • Plinius the Elder (23-79): miners • Galenus (129-200): miners, gladiators • Al-Razi (850-923): cotton spinning

  11. From the Middle Ages to the Industrial Revolution • 1242: Roger Bacon publishes the formula for black powder, which would lead, in the ensuing centuries, to a change in military technology (and in excavation techniques)‏ • 1492: the Discovery of America • Ellenbog (1440-1499): metal workers • Paracelsus (1493-1541): miners and glazers • 1455: Johann Gutenberg puts on sale the first printed book, a Bible • George Bauer, called Agricola (1494-1555): De Re Metallica, gold and silver metallurgy • 1677: van Leeuwenhoek develops the microscope

  12. The Industrial Revolution • It takes place in England between 1760 and 1830, after the Agricultural Revolution • 1712: Newcomen's Steam Engine • GA Scopoli (1723-1788) is appointed as physician of the mercury mines in Idrjia, where he works for 16 years. He is author of the De Hydroargyro Idriensi Tentamina, a treatise on mercury poisoning in miners • 1768: Arkwright patents the mechanical spinning frame

  13. The Industrial Revolution • 1786: John Fitch's Steamboat • 1810: Krupp improves the steel production process (originally developed in 1740 by Huntsmann, in Sheffield), eventually improved by Bessemer (1854) and Martin, by the Siemens in 1866 and by Thomas (1875)‏ • 1825: The Locomotion 1 by Robert Stephenson drags the first commercial train in the world from Stockton-on-Tees to Darlington • 1840: Samuel Cunard launches a transatlantic service between Great Britain and the United States

  14. Working Conditions during the Industrial Revolution • Safety and Hygiene standards are very poor • The population's hygienic and nutritive conditions are also precarious (though improving)‏ • There is no general healthcare • The first laws on child labour ban and limit its use (between 12 and 8 hours depending on age)‏

  15. Labour in History:the Spinning Mill (1815)‏

  16. Labour in History: 1800 Working in the Spinning Mill: silkworms Fonte: http://www.provincia.venezia.it/medea/est/frulli/filanda/filande.htm

  17. Labour in History: 1800 Working in the Spinning Mill: silkworms Fonte: http://spazioinwind.libero.it/filandeonline/images/7%20Bachi.jpg

  18. Labour in History: 1800 Women and Children in the Spinning Mill Fonte: http://www.bibliolab.it/donne_web/pic/galleria1/1800_Donne%20e%20bambini%20in%20filanda.jpg

  19. Labour in History: ~1900 Factory Workers of the Rasica Spinning Mill in Osio Sotto Source: http://www.lomb.cgil.it/sedi/bg/cdl/2006/8marzo/sommario_foto.htm

  20. Labour in History: ~1900 Argentiera miners (Sassari) at the end of the XIX century Source: http://www.cgil.it/sardegna/foto345.html

  21. Industrial Development in Italy • On the eve of the First World War, Italy is still an agricultural country with few factories • The first stage of industrial growth dates back to the period between the two World Wars • After the Second World War, Italy emerges first as an industrial economy and later as a post-industrial one (after 1980)‏

  22. Labour in History: ~1940 Legler Mechanical Looms in the forties Source: http://www.lomb.cgil.it/sedi/bg/cdl/2006/8marzo/sommario_foto.htm

  23. Labour in History: 1950 Weber Factory: Drilling Machine Operator Source: Regione Emilia Romagna http://www.form-azione.it/pariopportunita/donnedellaltrosecolo.htm

  24. Labour in History: 1950 Factory worker making sweet boxes by hand Source: Regione Emilia Romagna http://www.form-azione.it/pariopportunita/donnedellaltrosecolo.htm

  25. Labour in History: 1950 Ducati Factory Worker Source: Regione Emilia Romagna http://www.form-azione.it/pariopportunita/donnedellaltrosecolo_06.htm

  26. Labour in History: 1960 Miners working in the Prestavel mine (fluorite veins)‏ Sourcehttp://www.stava1985.it/intranet/stava1985_it/www/wo_albums/Index/20050718_152739/20050718_162011/PhotoFolder?display=medium

  27. Labour in History: 1965 Miner working with jack-leg – Mine in Valle Vedra Source: http://www.wwmm.org/storie/storia.asp?id_storia=252&pagina=9&project=0

  28. 1886 Ban on child labour under 9 and ban on night labour under 12 1902 Minimum age for working 12 years 1904 Minimum age for working 14 years 1899-1913 General prevention regulations and regulations for some specific sectors 1898-1934 Mandatory insurance against occupational injuries and (later) diseases The first Italian laws on work safety

  29. Year Agriculture Industry Service 1881 65,4% 20,2% 14,4% 1936 52,0% 25,6% 22,4% 1951 43,0% 29,9% 27,1% 1981 11,1% 41,5% 47,4% 2000 5,3% 32,1% 62,6% Workforce composition in Italy between 1881 and 2000 (INAIL data)‏

  30. Males Females Total Industry 5.316.779 1.712.202 7.028.981 Trade 2.298.682 1.687.856 3.986.538 Credit and Insurances, services to companies 1.168.507 884.174 2.052.681 Agriculture 739.903 413.775 1.153.678 Transportations and Communications 780.240 198.789 979.029 Other Activities 2.537.860 3.254.965 5.792.825 Total 12.841.971 8.151.761 20.993.732 Active Population per Sector in Italy (Istat Data, 2001)‏

  31. Relationship between Health and Labour • Work can affect health both negatively and positively • Negative consequences: occupational injuries and diseases, reduction of life expectancy • However, “healthy” work is an important factor in health promotion

  32. Occupational Injuries and Diseases • Occupational Injury: damage to an individual's psychophysical integrity due to a violent causal factor which is concentrated in time during the working activity • Occupational Disease: damage to an individual's psychophysical integrity due to a causal factor which is diluted in time during the working activity • Occupational Injuries and Diseases are, by definition, predictable events

  33. Working is good for our Health • It is not yet clear which occupational factors are associated with an improved health status • Income, Social Relations, Identity • Physical Activity • Abstention from Smoke (in some sectors)‏ • Regular Medical Checks (maybe)‏ • Healthy Worker Effect: phenomenon described in Epidemiology whereby workers usually have better health than unemployed people

  34. Working Condition Relative Risk Steadily employed 1,00 Intermittently employed 1,52 Unemployed (previously employed)‏ 2,29 Steadily unemployed 2,61 Steadily out of labour force 4,81 Mortality and Labour (Turin 1991-96)‏

  35. Cleaning and waste collection operators 34,4 Armed Forces 37,9 Postmen 34,8 Physicians, dentists, psychologists, pharmacists 37,6 Porters 34,9 Lawyers, magistrates, chartered accountants, notaries 37,5 Food Industry workers 35,0 Teachers 37,4 Carpenters 35,2 Technical professions 37,2 Life expectancy according to occupation at 35 (Turin, males, occupation in 1991)‏

  36. Lawyers, magistrates, chartered accountants, notaries 36,3 Physicians, dentists, psychologists, pharmacists 38,9 Waitresses, cooks and barmaids 37,5 Technical professions 38,5 Machine tool operators, mechanics 37,8 Teachers 38,5 Entertainment industry workers and journalists 38,0 Transport Vehicle drivers 38,4 Nurses and health technicians 38,0 Cleaning and garbage collection operators 38,4 Life expectancy according to occupation at 35 (Turin, females, occupation in 1991)‏

  37. Italian Population divided by age and sex (1-1-2008)

  38. Age Classes (years)‏ Males Females Total Below 1 1.320 1.017 2.337 1-14 720 469 1.189 15-29 4.257 1.345 5.602 30-44 8.579 4.148 12.727 45-59 24.445 13.591 38.036 60-69 45.516 24.432 69.948 70-79 88.331 64.105 152.436 80-89 79.272 105.664 184.936 90 and over 26.856 66.323 93.179 Total 279.296 281.094 560.390 Deaths by age and sex class - Italy, 2002

  39. Cause Males Females Total Circulatory system diseases 105.726 131.472 237.198 Tumours 93.398 69.672 163.070 Respiratory apparatus diseases 20.617 15.324 35.941 Traumatisms and poisonings 16.026 10.667 26.693 Digestive apparatus diseases 12.485 12.234 24.719 Psychic diseases, diseases of the nervous system and sense organs 9.552 14.765 24.317 Infectious and parasitic diseases 2.145 2.147 4.292 Other morbid conditions … … … Total 279.296 281.094 560.390 Deaths by group of causes - Italy, 2002

  40. Deaths by group of causes Mortalità per causa - Per 100.000 abitanti

  41. Deaths due to external causes of traumatisms and poisonings– Italy, 2002

  42. Site Males Females Total Trachea, bronchus and lung 25.765 6.528 32.293 Colon, rectus and anus 9.164 8.072 17.236 Breast (in women)‏ ― 11.309 11.309 Stomach 6.266 4.686 10.952 Liver and intrahepatic bile ducts 6.661 3.604 10.265 Linfatic and emopoietic tissues 3.887 3.724 7.611 Prostate 7.132 ― 7.132 Leukemias 3.022 2.533 5.555 Major Malignant Tumours causing death, by sex – Italy, 2002

  43. Death from cancer – Italy, 2002

  44. Occupational Injuries

  45. All Lethal Agriculture (in-itinere injuries)‏ 53.355 (1.259) ‏ 121 (18) Industry and Service (in-itinere injuries)‏ 790.278 (88.236) )‏ 911 (249) ‏ Public employees (in-itinere injuries)‏ 31.457 (5.008 ‏ 88 (9) ‏ Total (in-itinere injuries)‏ 875.090 (97.201) 1120 (276)‏ Occupational Injuries reported to INAIL (2008)‏

  46. Economic activity All Lethal Manufacturing industry 3.505 837 Building sector 6.069 1.236 Trade 2.184 372 Transportations 3.696 701 Agriculture 4.560 4.153 Hotels and restaurants 2.943 61 Electricity, gas, water 1.830 53 Occupational Injuries in the EU (2005)

  47. Occupational Injuries Industry and Service- type of lesion(INAIL 2008)

  48. Occupational Injuries - Agriculture- type of lesion (INAIL 2008)

  49. Occupational Injuries Industry and Service- site of lesion(INAIL 2008)

  50. Occupational Injuries - Agriculture- site of lesion (INAIL 2008)

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