Prof Malcolm Sim - Monash University - Risks of chronic diseases in the workplace and interventions to reduce them
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Risks of chronic diseases in the
workplace and interventions to
reduce them
Professor Malcolm Sim
Centre for Occupational & Environmental Health
School of Public Health & Preventive Medicine
Monash University
• What are chronic diseases in the workplace? • Work-related
• Others which may impact on injury risk
• ‘Traditional’ workplace chronic diseases
• The ageing worker
• Proclaimed diseases
• Interventions: “What works?”
• The Cochrane Collaboration
Key points to cover
Non-infectious, degenerative conditions
which can impact on most organ systems
What are chronic diseases?
Non-infectious, degenerative conditions
which can impact on most organ systems
What are chronic diseases?
www.coeh.monash.org
Costs NIHL claims
$9,000 $9,000
$12,360 $13,090 $13,490
$16,230 $17,030 $16,660
$17,880 $17,450
$5,850 $6,125 $5,980 $6,007 $6,123 $5,200
$5,717 $5,500 $5,900 $5,895
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$18,000
$20,000
1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08
Median claim cost
IB cost HA cost
Thorne PR et al. Epidemiology of noise-induced hearing loss in New Zealand.
N Z Med J. 2008 Aug 22;121(1280):33-44.
What about other countries?
Conclusion: “The substantial and
increasing societal costs despite
decades of NIHL control legislation
suggests that current strategies
addressing this problem are not
effective, inadequately implemented,
or both.”
Thorne et al. 2008
“Workers in Mining, Construction, and specific Manufacturing industries appear to
have a much higher prevalence of hearing loss……….”
“Although noise exposure in these industries has been regulated for decades
by OSHA and MSHA, these results suggest that the current regulations and
their enforcement need to be revisited.”
Noise prevention in workplaces
has a very well established
hierarchy of controls
So, why is occupational NIHL not
reducing and, in fact, apparently
increasing in many countries?
Focus groups workers/employers: • an over-reliance on personal hearing
protectors
• infrequent and/or improper use of personal
hearing protectors,
• lack of prominence of noise as a serious work
health and safety issue
• insufficient knowledge of the effects of loud
noise on hearing and quality of life
• belief that noise control costs too much
• belief that hearing loss is inevitable
• prominent in small/medium-sized businesses
Barriers to effective noise control programs
Future mesothelioma trends?
Clements MS, et al. Projected mesothelioma incidence in men in New South Wales. Occup Environ Med 2007;64:747-752.
Predicted years of
peak number in
NSW for the two
models were 2014
and 2021.
Many uncertainties!
www.coeh.monash.org
Pattern of affected workers shows major
increase is in tradespeople, not primary
asbestos workers
• Increased risk of diabetes as we age
• Increased risk of sickness absence for those with
diabetes
• Evidence mixed about impact on risk of work
injury
• BUT for those who are injured, recovery slower
• Some evidence of increased risk of diabetes in
long term claimants who reduce exercise level
and increase weight, so sequelum of work injury
Diabetes and workplace risks
Source is an old ILO list of occupational diseases from the
1950s, despite many updates to the ILO list since that time
Presumptive legislation
Many other examples where scientific
evidence exists for increased chronic
diseases in certain occupations
As well as a better evidence base for
workplace causes of diseases, we need a
better understanding of effective
interventions ie ‘What works?’
Need for better synthesis and application
of scientific evidence to reduce impact of
chronic diseases in workplaces
Recent Cochrane systematic review showed a lack of
good evidence for effectiveness of legislative and
workplace interventions to prevent occupational NIHL
(Verbeek et al, 2009 and 2012)
www.coeh.monash.org
Should surgeons use blunt
needles when operating on
patients to reduce the risk of
needlestick injury?
‘What works?’
www.coeh.monash.org
“Ten trials including 2961 surgeon-operations found a significant
reduction of glove perforations, with a relative risk (RR) of glove
perforation of 0.46 (95% confidence interval (CI) 0.38 to 0.54)”
www.coeh.monash.org
NIOSH eNews
The Monthly Newsletter of the National Institute for Occupational Safety and Health
Volume 10 Number 2 June 2012
Agencies Advocate for Use of Blunt Tip Suture Needles
In an effort to decrease the risk of needlestick injury, NIOSH, the Occupational Safety
and Health Administration (OSHA), and the Food and Drug Administration have issued
a new joint safety communication document that encourages healthcare professionals
to use blunt-tip suture needles as an alternative to standard suture needles when
suturing fascia and muscle. http://www.cdc.gov/niosh/topics/bbp/pdfs/Blunt-
tip_Suture_Needles_Safety.pdf
From the Director’s Desk
John Howard, M.D. Director, NIOSH
Finnish Institute of
Occ Health
Monash University
A satellite of the Cochrane
OSH Review Group in Australia?
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