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Disease Number of Workers PercentageRepeated trauma 276,600 64 Skin disorders 57,900 13 Lung conditions due to toxic exposures 20,300 5 Physical injury 16,600 4 Poisoning 5100 1 Lung disease due to dusts 2900 1 All other illnesses 50,600 12 Total 430,000 100 Data from Levy BS, Wegman DH: Occupational health — an overview. In Levy BS, et al. (eds): Occupational Health. Recognizing and Preventing Work-Related Disease and Injury, fourth ed. Philadelphia, Lippincott Williams & Wilkins, 2000, p. 3; and Bureau of Labor Statistics, U.S. Department of Labor, www.hls.gov. byproducts, and metals are commonly detected at hazardous waste sites ( Table 9-2 ). There are currently 11,300 Superfund-designated waste sites in the United States. The potential human health hazards associated with exposure to chemical mixtures is a major concern.[2] There is considerable difference in the magnitudes of exposure in the occupational and environmental settings. Occupational exposures affect a defined cohort of workers who are exposed to chemicals in the range of parts per million (ppm); by contrast, environmental exposures to these same chemicals in the air, water, or hazardous waste sites may be in the parts per billion (ppb) or parts per trillion (ppt) range. The health effects of such chronic, low-level exposures are unknown. In the United States, four regulatory agencies determine exposure limits for environmental and occupational hazards: the Environmental Protection Agency, the Food and Drug Administration (FDA), the Occupational Safety and Health Administration, and the Consumer Products Safety Commission. The Environmental Protection Agency regulates exposure to pesticides, toxic chemicals, water and air pollutants, and hazardous wastes. The FDA regulates drugs, medical devices, food additives, and cosmetics. The Occupational Safety and Health Administration mandates that employers (including hospitals and physicians) provide safe working conditions for employees. All other products sold for use in homes, schools, or recreation are regulated by the Consumer Products Safety Commission. Physicians should be familiar with current approaches used by regulatory agencies in the United States and be prepared to explain the strengths and limitations of the scientific evidence in nontechnical terms. Health care providers must be prepared to counsel patients about the primary prevention of disease related to occupational and environmental exposures, taking into account potential synergistic effects of mixed exposures and individual genetic susceptibility. Prevention of tobacco smoking would prevent 80% to 90% of lung cancers; however, this objective has been difficult to achieve, especially in teenagers. Strategies for secondary prevention of lung cancer in former or current smokers (e.g., chemoprevention) have been disappointing so far.[3] Prevention of occupationally TABLE 9-2-- Common Chemicals at Hazardous Waste Sites Acetone DDT, DDE, DDD Aldrin/Dieldrin 1,1 and 1,2-Dichloroethane Arsenic Lead Barium Mercury Benzene Methylene chloride 2-Butanone Nickel Cadmium Pentachlorophenol Carbon tetrachloride Polychlorinated biphenyls Chlordane Tri- and Tetrachloroethylene Chloroform Toluene Chromium Vinyl Chloride Cyanide Zinc Data from U.S. Environmental Protection Agency, www.epa.gov/superfund/resources/chemicals.htm. related diseases rests on defining and enforcing safe exposure levels, developing new technologies to reduce industrial exposures, and identifying less toxic substitutes for industrial and chemical agents. These strategies require a basic understanding of biochemical and molecular mechanisms of toxicity. Date: 2016-04-22; view: 927
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