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Complete Summary WHC4001
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A complete summary of all the cases of course WHC4001 with the most important information of the lectures included as well.
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WHC4001- Determinants of health and labour participationLC1 - Need for sustainable work
1. Major developments in work in recent decades
a. Intensification of work demands
i. High quantitative, mental, and emotional job demands
b. Industrialization and robotization
c. Flexibilization
i. Increase in self-employees and flexible employees
2. Recent/ sudden development and threats
a. Coronavirus
i. Massive job loss, reduced work hours, increased teleworking
3. Demographic changes
a. Age
i. Relatively older individuals
b. Life-expectancy
i. Increasing before the start of COVID-19 pandemic
c. Reduced labour participation at older age
i. Earlier retirement from work
d. Consequences
i. Aging workforce and reduced labour participation form a threat to the
sustainability of pension systems and health care systems
1. Need for extended working careers
2. Need for late retirement
3. Need for increased participation rate
Sustainable work is needed
o A sustainable work force is one where individuals are productively employed in
jobs that sustain psychological and economic well-being and health over time
as well as balance the diverse interests of employers, workers, and families
ICF = internal classification of disability, functioning and health
Levels involved:
- Micro (individual)
- Meso (company, organisation, job title, sector)
- Macro (national, international)
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,LC2: EBOH (CAT) and ICF
LC3: Appraising causality in occupational health
- Association: statistical dependence (correlation) between two or more events,
characteristics, or other variables.
- Cause: an event, condition, or characteristic (or a combination) which plays an
important role in a predictable change in occurrence of the outcome (e.g., smoking and
cancer).
A causal relationship exists when on a population level, the disease incidence would have
been different if the prevalence of the risk factor would have been different. So, a causal risk
factor will influence the incidence of the disease. If the prevalence of the risk factor changes
the disease incidence will also change.
- No sufficient cause: not all smokers, get lung cancer
- Sufficient cause: all workers exposed to high levels of carbon monoxide die
- No necessary cause: not all patients with lung cancer have smoked
- Necessary cause: all workers that die have been exposed to carbon monoxide
Smoking is not sufficient nor a necessary cause: contributing cause (component cause) for
lung cancer.
Ideal study design starting with the best one: intervention approach (intervention and control
group) - Quasi experiment - Analytical approach (observational studies)
Bradford Hill criteria for causality:
- Strength: of the association (RR)
- Consistency: between studies
- Specificity: of exposure and of disease
- Temporality: exposure was there first
- Biologic gradient: dose-response
- Plausibility: all toxicology data
- Coherence: with all other clinical evidence
- Experimental evidence: RR decreases after exposure cessation (so will a chance
finding by the way)
- Analogy: with other similar compounds
Case 1: Occupational exposure to hazardous substances: Asbestos, an exemplary case
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,Learning goals:
1. What is asbestos?
a. Different types
b. How is it produced / made? (Nature?)
c. Where is it used? Which industries?
2. What is the incidence and prevalence of asbestos exposure?
a. Global perspectives over time (historically)
3. How do people get exposed to asbestos?
4. How do you get from asbestos exposure to sickness?
5. What are the possible health effects (asbestosis, lung cancer, mesothelioma) resulting
from asbestos exposure?
a. Other determinants that can contribute to these three health effects (e.g.,
smoking)?
b. What is the incidence, prevalence and morality of health effects resulting from
asbestos exposure?
6. What are occupational exposure limits (OELs)?
a. What does it mean in teams of asbestos?
b. How do you asses OELs?
i. What does 200 fibre years mean?
c. In which environment is it possible to get exposed to asbestos and how can we
asses this?
7. What is the legalisation in respect to exposure to asbestos on national and international
level?
8. What are the criteria for causality (death and asbestos exposure)?
a. Apply these to this case (Mr. Smith)
3
, 1. What is asbestos?
Asbestos is the collective name for a group of fibrous silicates (naturally occurring) with high
durability, tensile strength, and heat resistance.
a. Different types
Asbestos is a generic term for a group of fibrous silicates and can be divided into two groups
that differ in mineralogical and chemical properties: amphiboles and serpentines.
I. Amphiboles include crocidolite, amosite, anthophyllite, tremolite and actinodite.
Crocidolite is recognized to be the most carcinogenic and fibrogenic, but there has
been vigorous debate about the relative potency of chrysotile in carcinogenesis in
the past 30 years.
- Really dangerous, when inhaled fibres make a chemical reaction and get stuck
in the lung alveoli (tissue)
- Carcinogenic (potential to cause cancer)
- Prohibited
II. Chrysotile is the only serpentine and represents 95% of the commercial asbestos
ever used around the world. The consensus currently is that chrysotile can induce
malignant mesothelioma (MM), although it is less potent in this regard than other
types of asbestos
- Really small fibres, body can dispose these fibres, easy to breath out (exhale)
from respiration system
- Also dangerous, but less like to occur
- Controlled use is still aloud
- Softer and more flexible
It is important to consider that there are two different types of asbestos and that these
two types differ from each other in terms of use and their (health-) effects.
b. How is it produced / made? (Nature?)
Asbestos is naturally occurring fibrous silicate mineral and is mostly found rocks. Contributing
to asbestos formation is the faulting and fracturing of these rocks with increased temperatures,
pressures, and the presence of water.
Asbestos originates from Quebec, and it is mainly produced and consumed by Russia and
China. Brazil and Zimbabwe are also large asbestos consumes.
c. Where is it used? Which industries?
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