Recent research has shown that women who work night shifts in 50 percent greater chance of getting breast cancer, 1 and that working in shifts the risk of heart disease by 40 percent verhoogt.2 3 here so you can speak of ‘new diseases “, although earlier in this term is thought to RSI, burn-out, acoustic shock and multiple chemical sensitivity.
Occupational diseases are diseases primarily by the work or working conditions have caused. At least that is the legal definition of medical-insurance context is used and applicable to the more classic or more mono causal diseases. One uses the term ‘occupational’ in preventive context, then also the multi-causal diseases to which the tax included in the work the cause. The epidemiological study of conditions, only through a relationship with the work it can be made in concert. This article is based on this broader concept.
Classification
New diseases can be divided into several categories (see the list).
First there are the more or less new syndromes like multiple chemical sensitivity and certain infectious diseases.
Then there is the new category of health risks from recent changes in work and working conditions: RSI, burn-out and acoustic shock. Already more familiar forms of taxation, as in the beginning of this article referred to work in night shift and may lead to the discovery of new health risks.
A whole separate category are the diseases that arise from the parents before or during pregnancy professionally exposed to harmful substances.
Doubt
Regarding the multiple chemical sensitivity, it is questionable whether there really is a new ziektebeeld.4 Can the direct reason for this occupational disease are, in preserving the complaints clearly play different, more personal factors an important role .
Thus in new infectious diseases, there is doubt. They usually get their name from the discovery of a new infectious agent and / or prevention in a new environment. In the legionnaires and Lyme disease, the relationship with exposure and workplaces is clearly present. At that moment the occupational diseases under the strict definition.
Image skirmishes
The rapid developments in information and communication technology and increased (emotional) burden in the education and care and support have led to a frequent incidence of disorders such as RSI and burn-out. One difference with the traditional mono causal diseases that RSI and burnout are multifactorial. RSI should in particular take into account a combination of ergonomic and mental overload. Both the treatment and prevention is a multi-track policy.
The RSI is not really new disease. The complaints have been much longer known in the industry, such as packing or chicken’s butchers. It was not until explicitly interested in RSI when using a VDU the “white boorden’ disease and was with the work-related mental disorders had a significant proportion of disability issues. For all the attention now paid to rapid intervention and reintegration should not the direct cause of the symptoms and the necessity of taking preventive measures to be forgotten.
Computer work and the increasing use of mobile telephony have raised concerns about the risks of exposure to electromagnetic radiation. The results of several epidemiological studies indicate there not enough support. A recent publication about a possible link between mobile phone and sow uveaal melanoma but new twijfel.5
Recently, the media reported the phenomenon of ‘acoustic shock’. On closer examination shows it not to be a new disease, but symptoms that can be explained by the combination of hearing damage from noise and mental overload employees in the rapidly growing industry of call centers.
Look before you leap
Preventive measures may also introduce a new health risk. To prevent the occurrence of chronic toxic encephalopathy in painters and upholsterers for example, is water-based paints and glue. This material contains a preservative that not only the user an allergic reaction (eczema) may exhibit, but also those who just enter treated area.
This is to the pepper crop allergic symptoms occur, has been known for some time. Surprisingly, when workers recently examined an allergy to organic pesticides detected. And what about the increase in latex allergy? This has everything to do with the increased use of gloves for infection.
The motto ‘Look before you leap “applies also to take preventive measures.
Modern Classics
Interstitial lung diseases, including silicosis and lung farmer, belong to the classic appeal lung. In the Netherlands they are virtually not reported. However, inter alia in the construction and maintenance of roads is taking into account relevant quarter exposure.
Among rose growers, a number of cases of extrinsic allergic alveolitis occurred. At this time the cause is still insufficiently clear. Plays the increasing shift to cultivation substrate may play a role?
The composteerderij is a growing industry, but is associated with exposure to various forms of professional lung diseases, including interstitial, may cause.
New technology could lead to exposure (ever decreasing) fibrils associated with granulomatous longaandoeningen.6 7 Especially if it is not a cluster-wise action arises in this rare type of chronic disease relationships with occupational exposure not directly. Distrust in setting an appropriate example of the diagnosis “sarcoidosis” is also on his plaats.7 The systematic inclusion of an occupational history may play an important role in finding the cause.
Technological changes have also led to the introduction of new allergens that can cause occupational asthma. The use of enzymes in various production processes is one example.
Technological marvels almost forgotten diseases can also create new urgency. One example is the problem of caisson disease in working on the Westerscheldetunnel.8
New insights
Through epidemiological studies, new links between already more familiar forms of employment taxes and certain conditions laid. These links must then be made, however, biologically plausible.
Working in such night suppresses nocturnal melatonin production. This increases the protective effect of melatonin on tumor development from which the increased incidence of breast cancer in women working night shifts, a possible explanation.
Working in shifts and work under stressful conditions (high pressure, low autonomy and reduced social support) found heart rate variability verminderen.3 The probability of the occurrence of arrhythmia is thus increased. There is thus a factor introduced alongside the more known risk a separate contribution.
The health risks from breathing fine dust are increasingly of interest. Studies that focus on exposure of the general population, there appears to exist a relationship not only with the occurrence of respiratory diseases. Also the link to an increased incidence of heart disease is a consistent finding and is explained from an inflammatory reaction in the longen.9 This is a multifactorial disease genesis. The factor ‘work’ is one of the determinants. In the individual case is difficult to indicate whether and, if so, to what extent this causal factor was. However, many diseases are referred to and a large population is exposed to particulate matter. Public health is certainly involved here.
This welding lasdampkoorts cause, has long been known. Recent reports by the Dutch Center for Occupational Diseases (Diseases) point out, however, a detrimental effect of welding fumes, namely longinfecten. In a few years ago published mortality study here already gewezen.10 The researchers assumed that the components of welding fumes by local immunosuppression pave the way to infection.
Offspring
The Barker hypothesis states that the occurrence of chronic diseases in adulthood may have its origin in the fact that the parents have been exposed to hazardous substances. As for occupational exposure research are hardly over. Kersemaekers imposes a relationship between exposure to hair stylists and processing fluids in a poorer neuropsychological development of their kinderen.11 Examination in the general population has a similar relationship was found when exposed to organochlorine compounds.
Here again it is multifactorial disorders in individual cases where no decision will be possible, but on the basis of epidemiological data probably.
Amenities
‘New’ diseases are often more familiar illnesses caused by recent changes in employment or the conditions which recently have shown that they already know more onerous working conditions could be linked. A ‘taster attitude’ to physicians in general, but occupational physicians in particular, address the identification of new relationships between work and illness, is a prerequisite for the development of new hypotheses.
The final setting of an occupational disease requires then some very specific etiologic diagnosis. The lack of a good infrastructure for clinical occupational medicine that provides funding associated with more problems in the Netherlands than in other European countries. Know a risque professionel, making it related to the right and the amount of a benefit is a necessary causal connection with work to establish.
The issue of the new but the old occupational justifies continued attention through (epidemiological) research. This should provide insight into the prevalence and the determinants of (new) diseases and the effectiveness of intervention strategies.
Correspondence Address: TMPal, Dutch Center for Occupational Diseases, Coronel Institute / AMC, PO Box 22660, 1100 DD Amsterdam. E-mail: t.m.pal @ amc.uva.nl
New occupational classification
new disease multiple chemical sensitivity, legionellosis, Lyme disease
conditions change by RSI, burn-out, acoustic shock, allergy to preservatives
in work and working conditions (paint, glue, oil), allergy to organic pesticides
pepper crop), latex allergy, rose breeders lung, lung-composteerders, nylonvlokwerkerslong, enzyme allergy (food, pharmaceuticals)
new risks in known breast cancer by night, cardiovascular disease and furrow-service burden, and cardiovascular disease by fine dust, welding fumes by longinfecten
effects on offspring impaired neuropsychological development
exposure to harmful
materials of the parents
