Lecture Notes on Occupational Hazards

Arindam Basu

September 21, 2016

Occupational Hazards

Hazard indicates likelihood of harm

Hazards are unique to different industries and occupations

Each Occupation is associated with specific exposure

Summary of this presentation

Chemical Hazards

Physical Hazards

Psychological or Behavioural Hazards

Steps of Control

Chemical Hazards

Hazards due to exposure to specific chemical agents

Sometimes precise chemical agent cannot be identified

Then, structures of similar chemicals are studied

Structureactivity relationships (SARs)

Useful in inferring the toxicity of an unfamiliar chemical

From the known activity of familiar/better-studied structure

Provide the only clues to types of toxicity

SARs can also predict cancers

Pros and Cons

Simple chain structure (alkanes) share property of CNS

depression

Heavy metals are toxic to Kidney

But chemicals with similar structures do not always have

similar properties

Benzene causes leukemia, not phenol (hydroxyl-benzene) and

toluene

Toxins

Biologically mediated chemicals

Plants and Animals produce toxins to defend themselves

Bioactive chemical substances produced naturally by plants

and animals

Beetles can squirt hot cyanide compounds

Figure: Picture of Beetle

Plants load distasteful tannin compounds in newly

regenerated leaves
Figure: Plants that have been partially eaten by herbivores load tannin
compounds in newly regenerated leaves

Fungi secrete chemicals that inhibit bacterial growth,

generating odors that we recognize as spoilage.
Figure: Fungi secrete chemicals that inhibit bacterial growth, generating
odors that we recognize as spoilage.

Aflatoxin B1, which is produced by fungi that contaminate

stored beans, peanuts, and other food items, is reputed to
be the most toxic compound; causes liver cancer in humans
Figure: Aflatoxin B1, which is produced by fungi that contaminate stored
beans, peanuts, and other food items, is reputed to be the most toxic
compound; causes liver cancer in humans

Monarch caterpillars include in them alkaloids from

Milkweed leaves - adult butterflies, toxic and unpalatable

Bees, wasps, spiders, snakes

Health complaints from Chemical Exposure

Workers first report the use of a chemical

As solvent, detergent, or used for etching

Workers may report having been overcome while using a

solvent

In household, we may report some pesticide spray having

made us ill

Quiz: What are the most widespread toxic exposures?

Chronic inhalation of tobacco smoke

Smokers and bystanders (secondary tobacco smoke)

Chronic overconsumption of ethanol (drinking)

Chemical Hazard: Acute versus Chronic

Toxicity can occur due to sudden exposure to large amounts

Toxicity can occur due to slow exposure to small amounts

Benzene is acutely neurotoxic

Benzenes chronic toxicity is to the bone marrow

Chemical Hazards can also be due to different pathways

and organs

Lead is distributed to different organs

In bone, lead is stored in place of calcium

But lead exerts its toxicity to brain and nervous system

Inorganic Mercury Toxicity

Mercury is liquid at room temperature

Hg is volatile, gives off an odorless, colorless, highly toxic

vapour

Vapour is readily inhaled and absorbed into blood stream

Organic methylmercury

picture of fish and water here

Produced in aquatic sediments

Anaerobic bacteria from elemental or inorganic mercury

Biomagnifies in the food chain

Those who consume large amount of fish suffer from organic

Hg poisoning

Single versus Multiple Toxics

Most toxicologic research is conducted with single chemicals

People are exposed to multiple chemicals

This is a challenge for epidemiologists

Compounds are synergistic with each other

Carbon monoxide

The most common chemical asphyxiant

Produced by incomplete combustion

Automobile exhaust

Indoor use of diesel forklifts

Charcoal cooking indoors

Malfunctioning heating systems

Binds 240 times more strongly than oxygen to hemoglobin

Clinical Manifestations

Onset insidious

People become sleepy

Without realizing that they are being poisoned

The standard test for CO exposure is determination of the

COHb concentration in the blood

Proportion of hemoglobin that is bound to CO

Serious medical problems usually do not develop unless levels

exceed 20%

Lead Toxicity

Lead exposure is measured by analysis of lead in whole blood

Lead was used to stabilize vaccines and other biologics

Removed from vaccines for children and infants

Mercury Poisoning

Used in Dental amalgams in the past (silver amalgams)

About 50% mercury

These amalgams release small amounts of mercury vapor

during chewig

Amalgams contribute up to about 1 g of mercury/day

Mercury in Fish

Most predatory fish with high mercury levels are not high in
PUFAs

Salmon, herring, are low in mercury and high in PUFAs

Low in herbivorous fish

High in predatory fish (tuna, swordfish)

Mercury levels have been found as high as 4 ppm in fish being

sold in supermarkets

Minamata disease

Refers to severe methylmercury poisoning

In the mid-1950s

In fishing communities on Minamata Bay (Southern Japan)

Inorganic Hg had been released into Minamata Bay in effluent

from a nearby factory

Transformed into organic mercury

Bioamplified through the food chain

Occupational Exposure to Hg

Among fishmongers

Chefs

Workers who work in Mercury processing plants

Gold panning extraction industry in some developing countries

Manifestations

Mild cases involved numbness, tingling, burning sensations

(mouth and in the fingers)

More serious cases progressed to cognitive impairment

Slurred speech

Unsteady gait

Deafness

Tunnel vision, blindness

Case Study

During a routine medical examination, a 24-year-old man reported

problems with concentration. He frequently lost his train of
thought, forgot what he was saying in midsentence, and had been
told by friends that he seemed to be forgetful.

Facts about the patient

I

He felt excessively tired after waking in the morning and at

the end of his workday

At work, he often felt drunk or dizzy

He misunderstood simple instructions from his supervisor

He developed insidiously during the previous 2 years

He thought that other employees in his area of the plant had

complained of similar symptoms

He relief during a week-long fishing vacation Highlighted

21/09/2016

He drank alcohol occasionally Highlighted 21/09/2016

He worked for approximately3 years as a car painter in a repair

garage for the railway

Organic solvent Poisoning

Frequently used in oil refining and petrochemical production

Plastics manufacturing, painting, and building maintenance.

Often several different solvents are present in one product

Benzene Poisoning

Colourless pleasant smelling liquid

Widely used as solvent

Benzene Toluence Ethylbenzene Xylene

Commonly used as an industrial and commercial solvent

Health Effects of Benzene Exposure

High exposures suppress the bone marrow

Anaemia or pancytopenia

Causes cancer

Leukaemia, other haematopoeitic malignancy

Measuring benzene in blood is not useful

Urinary phenol has been used as a nonspecific biomarker of

benzene exposure

Occupations with regular use of solvents

Chemical production

Laboratory research

Production and application of paints, dyes, and coatings

Printing

Who are more likely to suffer from Benzene toxicity?

Pathologists

Petrol Pump attendants

Printing Press Workers

Endocrine disrupting compounds

Chemicals may mimic some of the actions of hormones

Xenobiotics that mimic estrogen

For men, exposure to endocrine disrupting agents lead to

feminization

Maternal occupational exposure associated with children with

hypospadias

Thyroid problems

Quiz: Which was the first endocrine disruptor?

What about DDT?

Interfered with reproduction in birds

Birds laid thinshelled eggs that broke during incubation

DDT and its metabolites are bioaccumulative compounds

Biomagnified in the food chain

Detectable even in pristine environments

Due to atmospheric transport and deposition

Case study: woman with severe rash

Figure: (An image of a

woman with rash here)

A 38-year-old woman presented to the

emergency department of a rural
hospital complaining of a severe rash.
First appeared on her forearms several
weeks before, and during the previous 2
weeks, had become more severe and
spread to her face and neck. She
worked at a greenhouse.

Case Study: Answer

Figure: (An image of a

woman with rash here)

Although she did not herself apply

pesticides or fungicides, but she was
exposed to them when the greenhouses
were sprayed before she arrived at work
each day and when she handled flowers.

How do Organochlorine or Organophosphate Pesticides

work

What can be done about Occupational Hazards?

Substituion

Engineering Control

Personal Practice

Personal Protective Equipments

Precautionary Principles (1998)

When an activity raises threats of harm to human health or the

environment, precautionary measures should be taken even if some
cause and effect relationships are not fully established scientifically

Components of Precautionary principle

Take preventive action in the face of uncertainty

Shift the burden of proof to the proponents of an activity

Explore a wide range of alternatives to possibly harmful

actions

Increase public participation in decision making

Group Discussion

Divide yourselves into three groups

Read the study provided (10 minutes)

Each member in the group will need to focus on one section

(ideally)

Then discuss:

What is the main problem?

How was it studied?

What are the key lessons?

Barry S Levy, David H Wegman, Sherry L Baron, and

Rosemary K Sokas.
Occupational and Environmental Health.
Recognizing and Preventing Disease and Injury. Oxford
University Press, January 2011.
ESH Bindu and M Reddy.
Occupational Hazards among Cooks in Commercial Kitchens.
International Journal of Science and Research (IJSR),
5(6):970974, June 2013.
Eero Pukkala, Rafael Aspholm, Anssi Auvinen, Harald Eliasch,
Maryanne Gundestrup, Tor Haldorsen, Niklas Hammar, Jon
Hrafnkelsson, Pentti Kyyr
onen, Anette Linnersjo, Vilhjalmur
Rafnsson, Hans Storm, and Ulf Tveten.
Incidence of cancer among Nordic airline pilots over five
decades: occupational cohort study.
BMJ, 325(7364):567, September 2002.
B B Kelman.
Occupational hazards in female ballet dancers.

Workplace Health & Safety, 2000.